CHANGES IN DIET AND MEDICINE.

SOME competent person—and to be competent he must possess in some directions an encyclopaedic knowledge— should write a monograph on this subject. An example of the

curious and interesting facts with which it abounds may be found in some statistics with which Dr. C. J. Hare has illustrated a recent lecture on "Good Remedies out of Date."* These statis- tics are drawn from the books of some of the chief Metropolitan hospitals, and illustrate very significantly the changes which have taken place in medical practice and in what this practice more or less consciously reflects,—national habits of life. They deal with an article of diet, milk ; with alcoholic liquors, which, whatever their value, a fiercely controverted point, are used as a substitute for, or auxiliary of, diet; and with a therapeutic agent, once well known to our middle-aged readers, but with which the younger generation is quite unfamiliar,—the leech.

With regard to milk, the changes of practice, though not uniform, and, indeed, exhibiting some curious fluctuations, has been in the direction of an increase which may be almost called enormous. The figures refer to the first years of five successive decades, beginning with 1832, and, as the accommodation of the hospitals has varied, may be best exhibited under the form of the average cost per bed. The minimum figure in the table belongs to Guy's Hospital under the year 1842, when the cost per bed was a little under seven shillings for the year. Ten years before it had been about as much under twelve, and it rose to nearly the same figure ten years after. It was eighteen shillings in 1862, thirty shillings in 1872, and exceeded three pounds when another decade had been completed. At St. George's, the minimum seems never to have been so small. But here, too, we find a curious fluctuation, the cost having fallen from five- and-twenty shillings in 1832 to sixteen in 1852. University College Hospital was not founded in 1832, but at the next decade it presents the highest figure of the four to which Dr. C. J. Hare's statistics refer,—thirty-four shillings. The next decade shows the decrease, common, it will have been observed, to the four institutions, and indicating—if we may generalise from so limited a number of instances—a change in medical opinion. The figures in the four last decades are 14s., £2 6s., £2 8s., and £3 8s. respectively. The figures supplied by Westminster Hospital do not differ materially, but are specially interesting as showing the maximum expenditure hitherto reached,—the very large sum of four pounds ten shillings. The effect of this diet upon hospital patients must, we should think, be strongly marked. There is no article in respect of which the food of the poor differs more from that of the well- to-do middle and upper class ; and even among these the annual expenditure of a family without young children would hardly amoUnt to three pounds per head.

In the matter of alcoholic drinks, we find, as we might have expected, a much greater discrepancy of facts; but the general result has been decrease. Guy's begins with a large expendi- ture in beer,—as much as £2 12s. in 1832,—and exhibits a uniform decrease, decade after decade, till in 1882 it reaches the minimum of fourteen shillings. It has furnished no statistics about wine and spirits before 1862, when it shows an expenditure not far short of two pounds. This diminishes to eighteen shil- lings in the course of the next -twenty years. It is needless to go in detail through the figures presented by the other hospitals. The maximum is found in the Westminster, under the year 1862, when the aggregate expenditure for beer, wine, and spirits amounted to four pounds ten shillings per bed. The same hos- pital also supplies, twenty years later, the minimum, having reduced its outlay under this head to a sum little exceeding one pound. It is a curious fact, though a wholesome fear of our medical friends forbids us to theorise upon it, that one hospital presents the maximum and minimum in the use of one article, and the maximum in another. It may also be noted that the year 1862 seems to mark a period when alcoholic liquors were largely used in medical practice. The average expenditure of the four hospitals in that year was £3 15s. In 1882 it had sunk to £2 3s. Many of our readers will remember the name of Dr. Todd, and the influence which his example in largely pre- ecribing alcohol in certain kinds of disease had upon the medical practice of the day. If our statistics were more complete, it might be possible to fix the year at which this in- fluence had reached its height. It must not be forgotten that we still find, in 1882, a divergence of practice in this respect which probably represents a similar divergence of general opinion. In 1862, the highest expenditure was 24 10s., and the lowest 23 7s, In 1882, the figures were respectively £3 (about) and. £1 4s. This is, indeed, one of the most interesting • The lecture itself we have not been able to procure, and are so prevented from making • fuller acknowledgment to its author.

topics of the day. At some workhouse infirmaries, where theory is probably stimulated by economic considerations, alcoholic liquors are almost entirely disused ; and there is at least one minor hospital where the same practice is followed. Here, then, is a large field for the collector of facts, who will, we hope, precede by a long distance the constructor of theories.

And now to come to the leech. Here, unfortunately, Dr. C. J. Hare's figures refer to two hospitals only; but their character is so marked in both instances that the deficiency is less to be regretted. We exhibit the figures in a table :—

ST. BARTHOLOMEW'S.

Year. Number of Leeches used. Beds.

1832 97,300 300 1842 48,100 550 1852 27,300 600 1862 6,200 650 1872 1,000 670 1882 1,700 670

ST. GEORGE'S.

1832 21,800 200 1842 19,600 317 1852 4,050 325 1862 1,360 350 1872 500 353 1882 754

351 These figures may be thus exhibited in their diminishing order of number of leeches used per bed :-

St. Bartholomew's 195, 187, 45, 9, if, 2f

St, George's 109, 61, 10,4, 11r, 2i- (nearly).

The older hospital seems to have been more conservative of the usage. It is a curious economical fact that the leeches seem to have cost more in 1882 than in 1832, though the consumption had been reduced to about a fiftieth part. Leech- gathering must have been in times past a distinct occupation followed by an appreciable part of the population. It must now have dwindled away, with the effect of diminishing the supply even beyond the diminution of the demand. Or has fifty years of draining made the leeches actually fewer ? The present writer must, however, own his ignorance as to the sources of the past and present supply.

Statistics of the quantities used of the chief drugs, such as quinine and calomel (does anyone, we wonder, now take the odious senua which was one of the terrors of our childhood P), of anms- thetics, and of other things without number, would be extremely interesting. Professor Rogers has given us "Six Centuries of Work and Wages ;" why should not he or another give us "Six Centuries of Food," and an expert in the art, "Six Centuries of Medicine "?