Emergency coffee

This story of misadventure and an unusual resuscitation method seems particularly appropriate for what Twitter tells me is International Coffee Day. It was published in the Pacific Medical Journal in 1866; the author, Dr Cachot, was an eminent physician from San Francisco.

The daughter of Mr. D–, aged 22 months, swallowed from a vial a portion of tinct. aconite, with chloroform and camphor, which had been prepared for external use.

Aconite, prepared from a beautiful purple flower known as wolf’s-bane or monkshood, has long been used in herbal medicine, but it is also extremely toxic. Chloroform and camphor are also dangerous if taken orally by a small child. This preparation (a tincture) was evidently intended for external use only.

The mother immediately gave syrup of ipecacuanha, and then mustard and water.

Ipecacuanha, prepared from another plant root, was used for various purposes, but in combination with mustard was administered in the hope of making the child vomit.

Being sent for, I arrived about twenty-five minutes after the poison had been taken. The child had vomited slightly, but there was no indication of the presence of the poison in the ejecta. Applied the stomach pump and removed some fluid highly impregnated with the odor of chloroform and camphor.

The stomach pump was a fairly recent invention, first demonstrated in the 1820s.

On my arrival I had found the child almost pulseless, the body and extremities covered with an extremely cold sweat, complete muscular relaxation, with occasional spasms, respiration scarcely perceptible, involuntary fecal discharges, dilated pupils. These symptoms appeared to be increasing, though I was confident the greater portion of the poison had been removed.

These symptoms must have been terrifying for the poor mother, and no doubt would worry a clinician even today. It is also quite possible that the doctor had saved the child’s life by evacuating the remainder of the poison before it could be metabolised.

Aromatic spirit of ammonia and brandy were administered freely, but the child soon fell into a complete stupor with stertorous breathing, and the entire surface of the body and limbs remained perfectly cold, in spite of mustard and warm applications.

‘Stertorous’ breathing is noisy and laboured. The situation was grave indeed; and then the doctor had a brainwave.

The case seemed to be nearly hopeless, when observing some very strong, black coffee at hand, I injected a large quantity into the rectum, and retained it there by forcible pressure.

Not an unprecedented intervention, but at this comparatively late date an unusual one. The stimulant properties of coffee had been known (and sometimes employed medicinally) since its introduction to fashionable European society in the seventeenth century. It was less frequently used as a resuscitative measure, however.

The effects soon began to show themselves in the restoration of vital action, and in an hour from the enema the child was, to all appearance, out of danger. No unpleasant consequences occurred, except irritability of stomach, which was allayed by lime water and milk. The effect of the coffee enema was so prompt and decided that I cannot but attribute the recovery of the child to that remedy.

It seems more likely to me that the child recovered simply because the poison had been metabolised. However, solutions do pass very quickly through the mucous membranes of the rectum and into the bloodstream, so perhaps a large dose of caffeine had an effect as well? As ever, if you are better qualified than me to offer an opinion (as many of my readers are), please feel free to leave a comment below. It should, I hope, go without saying that under no circumstances should one even contemplate trying it at home.