A personal therapeutic journey

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Abstract
Brompton cocktails In March 1948 I began working as a volunteer nurse once or twice a week in one of the early homes for “terminal care.” St Luke's Hospital had 48 beds for patients with advanced cancer. Here I met the regular administration of a modified “Brompton cocktail” every four hours. The St Luke's version omitted the cannabis and, I think, the cocaine. They adjusted the morphine dose to the patient's need; if more than 60 mg was required the route was changed to injection. Hyoscine was used with morphine for terminal restlessness. From 1951 to 1957 I was a medical student, yet again at St Thomas's. During that time there was a revolution in the drugs available for control of symptoms. The first phenothiazines, the antidepressants, the benzodiazepines, the synthetic steroids, and the non-steroidal anti-inflammatory drugs had all come into use by the time I arrived at St Joseph's Hospice in October 1958. A clinical research fellowship from the Department of Pharmacology at St Mary's Hospital Medical School under Professor Harold Stewart enabled me to begin work there to investigate terminal pain and its relief. St Joseph's Irish Sisters of Charity had welcomed the local chest physician with the new antituberculosis drugs in the early 1950s and were ready for further innovations. The two visiting general practitioners were pleased to have help. They had already begun using chlorpromazine but they were not giving morphine orally or regularly, relying on injections as required and pethidine by mouth. Oral morphine together with alcohol and cocaine was introduced with cyclizine as the main antiemetic. The doses were nearly all as low as I had seen in St Luke's. The therapeutic advances and having the time to sit and listen to a patient's story, transformed the wards. Gradually, we began to tackle the other symptoms. I tried to set up a trial of nepenthe (an oral opioid) with or without aspirin but found the almost solo clinical care of patients in 45 beds made completion impossible. Instead, I was able to report to the Royal Society of Medicine in November 1962 on analysed records of 900 patients showing that “tolerance and addiction are not problems to us, even with those who stay longest.”1

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