THE USE OF STIMULANTS IN THE TREATMENT OF THE SICK
POOR.
AN interesting and a very instructive Report has lately been presented to the Board of Guardians of St. George's Union, London, by the medical officer of the Infirmary, Dr. Webster. It is curious to remark that notwithstanding the hard life and the great wear-and-tear of those who ultimately fill our workhouses, and live what must be a very joyless existence, length of years falls to a large proportion. Out of the 313 deaths in the year, 105 of the deceased were over 70 years of age, and 63 of the remainder were between 60 and 70. Whatever may be the other effects of a pauper state therefore, it does not seem materially to shorten life. We have lately had from Sir Henry Thompson an article in the Nineteenth Century on "Food," and its influence on health and longevity, and the conclusion to which it chiefly points is singularly borne out by these Union statistics. It is obvious that Sir Henry, basing his opinions on great physiological knowledge and medical experience, believes disease is more constantly due to excess of food and drink than to bad quality or a deficiency. He is also of opinion that all the elements necessary to the full nutrition of the body and muscular and nervous power may be sup- plied by a variety of vegetable food, with very little aid from the animal kingdom, beyond a small addition of milk, eggs, or butter, and without any help from alcohol. Now, as regards the food of the inmates of our work- houses, it must be chiefly vegetable and farinaceous, with some small admixture of milk and meat, and never in excess. And assuredly the average health and mortality of this class of the population will bear favourable comparison with those next above them,—that is, the working-classes, who can generally command greater variety and quantity of food, not unmixed with malt and alcoholic compounds. The average expenditure for a workhouse inmate, it appears, is estimated at 5s. 3N. per head per week, which no doubt suffices to provide food in sufficient quantity, if not of great variety or superior quality.
There are many other facts brought out in this Report, touching the general treatment and sanitary conditions of the inmates both of the Infirmary and the Workhouse. But perhaps the most important and suggestive of these relate to the alcoholic question, and the use of stimulants in the treatment of disease among the patients admitted into the Infirmary during the year. The total number treated being 2,496, there was a fair field of inquiry and study. It would appear that the subject has been for some years under the consideration of the Guardians of St. George's Union, which had the repute of being the greatest consumer of malt and other liquors among the parishes. But public opinion has worked great changes in Poor-law administration, in this, as in other respects. The Report of the Select Committee of the House of Lords on Intemperance, we are told, was handed to Dr. Webster on his appointment, a little more than a year ago; and he was desired, after careful consideration, to inform the Guardians whether it WAS possible to limit the consumption of stimulants in the Infirmary ? The opening of a large and new Infirmary afforded a favourable opportunity for giving a fair trial to any new system ; and Dr. Webster having, from long observation in Poor-law hospitals, strong convictions of his own as to the advantages of a non-alcoholic method of treatment in the majority of cases, he determined to attempt to put it in practice, though at first only in a tentative manner. The patients were gradually educated in the principle that spirit was a medicine, rather than a food; and no startling result following the absence of such food, even when the Infirmary contained 670 people, living from day to day without beer or brandy as an article of diet, and without any deterioration of health due to its deprivation, established the system on a firm basis. Some very striking results of this experiment are given, in a tabulated form, which, if not
conclusive on the use of stimulants in medical treatment, are at least worthy of the most careful consideration, both of the profession, the guardians, and the public generally. In the Poplar and Stepney sick asylum, with an average number of 450 patients, the cost of ale, wine, and spirits being 2625, the death- rate was 19 per cent. In the Chelsea Infirmary, 240 patients, and the cost of stimulants being £349, the death-rate was 121 per cent. In the St. George's Union Infirmary, 559 patients, and an
expenditure of 3s. 6td. on stimulants, the death-rate was 121 per cent., comparing favourably with the mortality in the Union where the consumption of alcoholic fluids was the largest. We are the more inclined to accept Dr. Webster's inference from these data, as there is evidence that alcohol has not been rigidly excluded in his treatment of the sick. No hard-and-fast line has been drawn. He tells the Board that, "Given a patient dying of consumption, who can take or retain but little food, and expressing a strong desire for wine, this would certainly be prescribed." And again :—" It has been found necessary also to use brandy in certain cases, immediately after admission. In those seriously ill, the fatigue of removal often causes almost fatal exhaustion. The brandy here obviously performs the most useful function,—that of a palatable medicine."
We will not follow Dr. Webster into the farther details by which he shows satisfactorily that by abolishing the use of beer in his treatment of a large class of those who find their way to the infirmary, either as malingerers or with trifling aches and pains, they become ready for discharge much earlier than they otherwise would have been. So with the large number suffer- ing merely from catarrh or colds. If these were supplied daily with ale, he found it was long before they felt strong enough to return to work. A still more remarkable effect was noticed in the year's experience, in the restoration of more than thirty old women to active life. Prior to their removal to St. George's Infirmary, they had been bedridden for various spaces of time, ranging from one to seventeen years. They had all been supplied daily with brandy or beer, or both. "The whole of them," we are told, "are now able to leave their beds. Many are able to walk about, some to work. Appetites have been developed for solid material, and an interest is once more taken in the surroundings." And Dr. Webster observes, in reference to this marvellous resuscitation of these thirty old women : — "I am compelled to ascribe this amelioration of condition to the altered moral state, greater physical energy, and improved food- assimilation, brought about by the withdrawal of alcohol." And in corroboration of this view, and as an evidence of better diges- tion on the general question, it is recorded that on the male side ,a demand arose for extra bread ! Finally, as an additional evidence of the moral and physical improvement of the inmates under this rggim,e, we learn that "out of fifty-nine nurses and female officers, no less than forty-eight now commute their allowance of ale for an equivalent in coin, and this quite voluntarily." And of course, the presumption is that they find other and better uses for their money than the purchase of alcoholic drinks.
We must, in conclusion, say that we have seldom seen a Report of a Poor-law official, lay or medical, of a more satisfactory char- acter than this of Dr. Webster's, or one that reflects greater credit both on the official and his employers the Guardians; and we cannot help expressing a hope that this imperfect summary may induce the Guardians of other Unions to refer to the Report itself, and apply its lesson to their own advantage. It is not a mere question of economy or saving to the ratepayers, nor is it that principally, although a saving of £500 or £600 sterling per annum is by no means unimportant ; but the fact that as a principle of curative treatment, the sick poor are themselves greatly benefited by its application, and a regimen from which alcohol and malt are nearly altogether banished. This is the practical result of paramount importance, to which we would call attention, more especially as matter for congratula- tion and approval.
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