Whisky (?) and Chloroform in Congestive Chills?
By A. C. Hewett, Ll. B., M. D., Chicago
C. B. Dean, M. D., commends spiritus frumenti, drs. iv, chloroform (chlorine formyl), dr. ss, mixed, and given at a single dose in order to obtain prompt reaction when the chill is on.
His casual remark on page 384, "If brandy is not available, I use water with which to combine the chloroform," "mixes his babies" a little.
Spiritus frumenti is whisky, whether classified adjectively by proof-per-cent alcohol, or by links of surveyor's chain and vernacular "Forty Rod." (Dunglinson's Medical Dictionary and U. S. P.)
Brandy is a generic name given to distillates from different substances by the aid of heat; as that from French wine: Spiritus Vini Gallici: (U. S. P., P. Br.), apple brandy and peach brandy.
There are whiskies and whiskies, as there are brandies, varying greatly in stimulating and medicinal effects. It is to be regretted that Dr. Dean did not more accurately name what he used: especially, as he claimed, truthfully, without doubt, successes after "doing some thinking," and using said formula, to abort chills.
Pioneers blazing paths through wildernesses should "chip" deeply and broadly. The above is written in no spirit of technical criticism. Far from it. Dr. Dean is the pioneer, so far as I can learn, in this use of chloroform and the publishing of the same to abort congestive chills, thus lessening "shock." He is to be commended for possessing the courage of his convictions, and giving his treatment to the profession.
Dr. Finley Ellingwood in his "Eclectic Treatment of Disease," under the heading of "Pernicious Intermittent Fever," gives as first synonym for that disease, congestive chill; and defining it says:
"A sudden, profound, general congestion exhibiting the phenomena of surgical shock. (Vide Vol. I, p. 46, under caption "Pernicious Fever.")
So far as I can recall, he is the first writer of prominence to note that important fact. Are not all chills consequential upon, or shadowed by congestion?
Dr. Ellingwood says of chloroform (what I have never seen elsewhere): "As a prompt solvent it is a valuable menstruum under important circumstances." Also, "Taken internally, being insoluble, and easily diffusible, it produces intense local effects rapidly." ("Ellingwood's Materia Medica and Therapeutics," p. 133.)
I trust I may add without offense to Dr. Ellingwood that so taken it produces marked general effects as a diffusible stimulant and neuropurpuric.
A case illustrative: More than fifty years ago, late in the first year of my medical practice (?), I was called to see a patient who (as per messenger) "had awful histrikes." Arrived, I found an Irish woman about 20 years old, weighing about 160 pounds. I diagnosed "Acute hystero-psychosis." When not kicking off the bed-clothing, and tearing out her hair, she seemed spasmodically suffering, but not unconsciously so. I was in the country, and had no bromides with me, or other appropriate sedatives for uterine neuriatria, but I had chloroform, of which I put 20 drops on sugar, dissolved in a tablespoonful of warm water. Asking her to take the dose, she snapped her teeth together viciously, and with closed lips refused all coaxing, and buried her head back into the pillow, presenting two distended bell-shaped nostrils temptingly. Upon impulse I said: "Mouths were not made for medicine—noses are better." Watching for the end of an inhalation, I tipped the contents of the spoon into one of the nasal funnels. Of course, there were sputterings and coughings, and immediate change from the prone to a sitting posture. After a catch of good breath, she turned a pair of "buttermilk blue" eyes upon me with glints like sun gleams on steel, and with a hibernio-celtic trill of r's said, "Doctor-r-r G——," turned her face to the wall and curled herself down. I noted that it was not a spasm that coiled her down, and left her.
The dose, or method, or both, acted as a prompt cure: perhaps a prophylactic; for during four years following she had no return of hysteria.
The chloroform and the questionable method caused notoriety that I did not seek, and the alliterative title, "Dare-devil Doctor," was the term applied to the prescriber.
Very soon thereafter, a hurry call took me to a severe case of pernicious fever. A farmer's wife, about 30, well built, well moulded; mother of four children. Two experienced, able doctors present. Congestive chills in that region were endemic. These doctors had lost cases. Patient shaking, surface and extremities cold, face of a grey pallor; retching, purging and cramps. The doctors said: "Cholera morbus;" I, "Congestive chill; Get hot water and mustard." The doctors: "No! Morphine and calomel." I, to husband: "First chill?" Husband: "No; second time." Husband to doctors: "Give the young man his way; you have lost several cases." To me, "Take care of her." The doctors left, and I, a boy, remained in charge. I took of chloroform 30 drops, and 20 drops of strong spirit of camphor, on sugar. Dissolved the sugar in one-half tumbler of hot water, and gave it. I ordered hot water and mustard. Prepared a second dose, with chloroform 15 drops. Retching and shivering ceased. Fifteen minutes gone (with hot water to the feet and mustard to the back of neck.) I feared to give a second dose, and watched the color come to the cheeks and lips. In twenty minutes the patient opened her eyes, looked at her husband, and poor me, smiled wearily and dropped off into a quiet sleep.
I prepared of quinine 30 grs., leptandrin 9 grs., Capsicum 6 grs., divided into three powders, to be given, one powder every four hours, till her ears began to ring.
The recovery was rapid and uneventful. Before frost came, which seemed to end the endemic, I had over twenty cases to treat with no deaths to my record. This was favored, no doubt, by the lateness of my calls to battle with the already dying-out scourge. Since that "long ago," I have continued mentally and practically in the study and use of chloroform. I have not kept a record of the internal doses given, but they were many, and not one regretted.
As a general analgesic and anesthetic I have administered it more than twenty thousand times with not a death, or collapse consequent. I say this not boastfully, but reverently, grateful to a Benign Providence seemingly attendant and helpful. I chose the method of administration since advised by Dr. Ellingwood in his inspired choice of terms directing its administration, and in his cautions, precedent and following. He knew nothing of my theories or methods. Quoting: "A few breaths of dilute chloroform vapor taken . . . will often produce great relief in confinement with no apparent effect upon the consciousness of the patient" (Ellingwood's Materia Medica and Therapeutics, 6th ed., p. 137). When thus given, method, method, method, in congestive chills in aid of the internal medicines a second dose internally is seldom, if ever, required. Thus given, it is always safe, and as an aid invaluable.
Apropos of the present prevalence of pneumonia, and of the fact that when ushered in, or attended by a chill, not followed by diaphoresis, the disease runs a much longer course, if death does not early occur; should there not be much more attention paid to the chill and to its speedy abortment than there is under the prevalent treatment?
Should there not be a special care that blood dyscrasia always consequent upon congestion and shock be abated, countervailed. What better, first, last and all the time, as a general dysthetica, than specific echafolta, no matter what other medicines and methods are called for. (Vide Ellingwood's treatises, in his Materia Medica and Therapeutics, page 444, et seq., and idem. 705.)
I cannot conscientiously close this article without urging my readers not only to carefully study the book referred to, but to possess it themselves and absorb the entire work.
Its lore and methods have prolonged my life beyond the "three score years and ten" limit, and in obedience to ordinary courtesy and every-day gratitude, I can say no less.