The Brompton Cocktail

Brompton’s Cocktail, sometimes called Brompton mixture[1] was an elixir meant for use as a pain suppressant dosed for prophylaxis. Made from morphine or diacetylmorphine (heroin), cocaine, highly pure ethyl alcohol (some recipes specify gin), and sometimes with chlorpromazine (Largactil) to counteract nausea, it was given to terminally ill individuals (especially cancer patients) to relieve pain and promote comfort near death.

In popular culture it also came to be associated with medical euthanasia. According to legend (and perhaps in fact) doctors would provide a large dose to terminally ill patients who wished to die. At St A’s this medication was supposed to be administered by a trained nurse. There were a number of occasions when, as a student nurse, I was instructed to give this medication to patients who were terminally ill. Not all were in pain, and one I recall had been “Cheyne-Stoking”[2],but had made a partial respiratory recovery (although was clearly close to death).

The decision to prescribe Bromptons was always in the hands of the medical staff, but I was never privy to the decision-making process, and I’m pretty sure the patients weren’t. Nor am I convinced that due consideration was given to the decision to prescribe which appeared to be based on the estimated longevity of the patient’s final decline. I’m not suggesting that was given consciously to bring forward the end – to put the patient out of his/her suffering – but it seemed to me that the value and consideration put on an elderly chronic patient’s life was marginally less than of other elderly infirm. Perhaps I was wrong. Brompton's cocktail was given most in the mid-twentieth century. It is now considered obsolete.

Note 1: The Brompton cocktail is named after the Royal Brompton Hospital in London, England, where the formulation of this mixture was standardized in the late 1920s for patients with cancer.

Note 2: Cheyne–Stokes respiration is an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnoea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes. It is generally accepted that this occurs when the end of life is imminent.