«MEDICAL CARE IN THE WORKHOUSES IN BIRMINGHAM AND WOLVERHAMPTON, 1834-1914 by ALISTAIR EDWARD SUTHERLAND RITCH A thesis submitted to the University of ...»
bloodletting by means of locally applied leeches.35 The practice of removing blood from the body declined substantially after the ‘blood-letting controversy’ in Edinburgh in 1857, in which John Bennett, professor of the institutes of medicine, challenged the principles behind the bleeding of patients.36 However, its value as treatment continued to be accepted theoretically. For instance, all methods were reduced from 35% of patients in Massachusetts General Hospital in the 1830s to only 1% in the 1880s.37 The most common method of general bloodletting was by venesection, the opening of a vein using a lancet. It produced a reduction in pulse rate, a decrease in body temperature and a feeling of relaxation, considered necessary in sthenic conditions. If local extraction of blood was required, for instance from an inflamed joint or around the eyes in ophthalmia, leeches were used. Leeches had been in use in medical practice in ancient Greece and the species preferred for this purpose was named Hirudo medicinalis by Linnaeus in 1758.38 It took from 30 to 60 minutes for the worm to extract sufficient blood to drop off the skin, but bleeding can continue from the site for up to one hour, as the leech produces an anticoagulant transmitted to the host via its mouth.39 Leech therapy gained great popularity in the early nineteenth century, as Broussais promoted it as his preferred method of bloodletting.
J. H. Warner, ‘Therapeutic Explanation and the Edinburgh Bloodletting Controversy: Two Perspectives on the Medical Meaning of Science in the Mid-nineteenth Century’, 24 (1980), pp.241-42, 254.
Warner, Therapeutic Perspective, p.117.
R. G. W. Kirk and N. Pemberton, Leech, London, 2013, pp.49, 62.
Ibid., pp.51, 160-63.
Ibid., pp.55, 59; Acknerknecht, p.70.
induce a partial vacuum, and by blistering or applying plasters containing irritative substances to the skin. There is no record of venesection being used in either Birmingham or Wolverhampton workhouse, but Birmingham guardians spent between £11 and £24 per quarter on the purchase of leeches between 1847 and
1849.41 At that time, Mary Hill was employed in the workhouse as the ‘Leech Woman in Surgery’ and earlier in the decade, two male inmates were paid 1s each per week as ‘leech bleeder[s]’.42 The guardians agreed that leeches could be supplied from the infirmary to treat the sick poor at home on the instruction of the district surgeons.43 In 1868, Edmund Robinson, WMO in Birmingham, requested leave to have treatment for ‘inflammation’ of his eyes by the production of blisters.44 The other common physical therapy was carried out using static electricity. The greater understanding of the principles of electricity in the early eighteenth century led to its promotion as a medical treatment. Within two decades, it had become ‘the fashionable wonder of mid-Georgian England’.45 Machines generating static electricity, such as the Leyden jar, were developed and used to deliver both a generalised electrical stimulation to the body and localised ‘shocks’ to specific areas.46 Around 5% of patients in the Royal Infirmary of Edinburgh in the late eighteenth century received electrical therapy, mainly for paralysis and rheumatism.47 An electrical machine was one of the first pieces of medical equipment purchased at BCL, Birmingham Board of Guardians (hereafter BBG), GP/B/2/1/5, 4 January, 25 May 1848;
GP/B/2/1/6, 24 April, 22 May 1849.
BCL, BBG, GP/B/2/1/5, 13 March 1846; BCL, HC, GP/B/2/3/1/1, 9 August 1842; see Table 6.6.
BCL, BBG, GP/B/2/1/4, 1 December 1841.
BCL, VGPC, GP/B/2/8/1/5, 24 July 1868.
P. Elliot, ‘“More Subtle than the Electric Aura”: Georgian Medical Electricity, the Spirit of Animation and the Development of Erasmus Darwin’s Psychophysiology’, Medical History, 52 (2008), p.198.
Risse, Hospital Life, p.216.
Ibid. pp.203, 217.
became more widely used from the 1830s, reached its height of popularity in the 1890s, but fell into relative disuse from the 1910s.49 Local application of an electric current through a particular part of the body was preferred, avoiding the occurrence of an electric shock or the production of pain.50 Electrical therapy was used to treat a variety of chronic diseases, but more specifically neurological conditions such as paralysis and chorea.51 Because it was thought also to be able to influence internal
electric current applied to the patient could be generated by an induction coil (faradic electricity) or by a battery (galvanic electricity).53 An ‘Electro Galvanic Battery’ was purchased by Birmingham guardians in 1850 for use by the WMO, John Humphrey.
In his successful request for the purchase of an additional battery for the machine, he praised the ‘beneficial effect’ it had on patients.54 Nutrition Diet was considered to be an important item in the therapeutic regimen because of its ability to provide a stimulus to the human system.55 As a result, different types of diet were prescribed for specific indications and medical institutions incorporated them Reinarz, The Birth of a Provincial Hospital, p.28.
Elliott, p.219; L. Rosner, ‘The Professional Context of Electrotherapeutics’, Journal of the History of Medicine and Allied Sciences, 43 (1988), pp.67, 78; I. R. Morus, Shocking Bodies, Stroud, 2011, pp.81Rosner, pp.64, 70; Morus, p.126.
Morus, pp.84, 126.
BCL, BBG, GP/B/2/1/7, 19 June 1850; GP/B/2/1/8, 30 October 1850; the term galvanic derived from Luigi Galvani, an Italian physician, who carried out experiments in which he stimulated frogs’ legs with electricity.
Risse, Hospital Life, p.221.
into their official regulations. The aim was to manage a patient’s diet in order to allow the healing process to proceed unhindered. In the 1860s, German chemist Justus von Liebig, who had a seminal influence on nineteenth-century chemistry by applying it to the functioning of living organisms, put forward his principles of nutritional physiology.56 He divided food into those components, such as protein, that were converted into organised tissue and those, such as carbohydrate and fat, which were oxidised to assist respiration and provide heat.57 He postulated that a ‘vital force’ caused the decomposition of food and its assimilation into the tissues of the body and also provided resistance to destructive influences.58 He explained the cause of disease as an inability of the ‘vital force’ to neutralise all disturbing factors.
Oxygen was the principal instrument causing disease, because of its ability to destroy living tissue, but certain foods could minimise tissue breakdown.59 Doctors in institutions organised a series of dietaries for different conditions: regular, full, low, fever, ordinary sick. A low debilitating diet was an essential ingredient for the antiphlogistic or sedative regimen. It was lacking in animal food products other than milk, given in small quantities and prescribed for all inflammatory conditions.60 As the century progressed and the theories of disease altered, so the therapeutic manipulation of the diet led to the increasing use of stimulant regimens, similar to those proposed by John Brown almost a century before. John Warner has shown that the low diet declined in use, from 16% of patients at Massachusetts General Hospital in the 1830s to 2% in the 1870s. Prescription of a high diet underwent the reverse W. H. Brock, ‘Liebigiana: Old and New Perspectives’, History of Science, xix (1981), p.201; T. O.
Lipman, ‘Vitalism and Reductionism in Liebig’s Thought’, Isis, 58 (1967), p.185.
Warner, ‘Physiological Theory and Therapeutic Explanation in the 1860s: The British Debate on the Medical Use of Alcohol’, Bulletin of the History of Medicine, 54 (1980), pp.241-42.
Risse, pp.220-24; Warner, Therapeutic Perspective, pp.145-46.
process, from nil in the earlier period to 20% in the later one.61 The main ingredients in the strengthening diet were beef, mutton or chicken as meat was considered a powerful stimulant.62 Dr Edward Smith, MO of the PLB, reported on ‘Dietaries for the Inmates of Workhouses’ in 1866, with recommended dietaries for different classes of inmate.
However, these did not include guidance for sick inmates as their diet was under the control of the medical officers, who adapted them to the individual needs of each patient. He did note the variability in the ordering of medical extras, from a wide
dietaries for the sick, which could be adjusted as necessary, were advised for the convenience of food preparation; and he gave examples of such diets in use in 68 workhouses he had surveyed.63 The main constituents of the ‘Full Diet’ for sick inmates were bread, butter and tea for breakfast and supper; meat, potatoes, and bread at dinner. Named dietaries included low, extra, milk, special, liquid, convalescent, while some unions only labelled them by numbers. The majority of unions provided three or four sick diets, although each diet was also available with a lower quantity of food for women.64 Fifteen unions had no set dietaries, leaving the medical officer to order individual diet, and of those unions that did have them, 74% provided specific fever diets.65 The sick dietaries in Cardiff Workhouse in the 1880s similarly relied mainly on bread, cooked meat, potatoes and soup. The fever diet, consisting of eight ounces of bread and two and one-eighth pints of milk with beef tea when required, Warner, Therapeutic Perspective, p.117.
Risse, Hospital Life, p.222.
British Parliamentary Papers (hereafter BPP), 1866 , pp. 20, 54-55.
was prescribed to all acute cases as well as to patients with fever.66 The ‘Full Sick’ dietary in Birmingham workhouse in the early years after the NPL contained bread, milk pottage, cooked meat, potatoes, soup, cheese and suet puddings. For those who could not manage the quantity involved in the full diet, there was the ‘Half Sick’ diet, which was smaller in quantity, with similar ingredients except for the meat, which was unsalted.67 Birmingham guardians sought permission from the Local Government Board (hereafter LGB) in 1886 as their medical officers wished to make a fish diet available for patients. This was made up of 10 ounces of bread daily, with a half pint of milk for breakfast, 8 ounces of boiled fish and half a pound of potatoes for dinner, and one pint of gruel for supper. Presumably, the intention was to use it to treat certain conditions, as Dr Suckling was of the opinion that there were about 25 patients under his care in the infirmary who would benefit from it. The LGB pointed out that ‘dietaries’ for sick inmates were at the sole discretion of MOs and did not require the Board’s approval.68 When it issued new regulations for dietaries for different classes of inmate at the beginning of the twentieth century, infirm men and women were included, with reduced amounts for those whom the MO considered could not take the full ration.69 The nutritional content of these diets must be questioned, however, as an outbreak of scurvy occurred in the mental wards of Wolverhampton workhouse in January 1908.70 However, no recommendation was made for inmates with an acute illness. Consequently, minutes of the guardians in Wolverhampton and Birmingham contain little information on the diets prescribed for sick inmates.
Sheen, The Workhouse and its Medical Officer, Bristol, 1890, pp.17-18, 61.
BCL, BBG, GP/B/2/1/4, 17 October, 9 December 1838; HC, GP/B/2/3/1/1, 14 November 1844.
The National Archives (hereafter TNA), MH12/13353, 17 May 1886.
BCL, Workhouse Management Committee (hereafter WMC), GP/B/2/3/2/3, 7 December 1900;
WALS, HC, PU/WOL/E/1, 25 January 1901.
WALS, House Committee (hereafter HC), PU/WOL/E/3, 9 January 1908; scurvy results from a dietary deficiency of vitamin C.
Medicinal Use of Alcohol Alcohol, especially in the form of wine, was an important therapeutic agent in the treatment of the sick, used externally as an antiseptic on wounds and burns, internally before and after surgery as an analgesic and sedative and medically as an appetite stimulant and diuretic.71 The prescription of wine reached its greatest medical popularity during a period from the seventeenth to nineteenth centuries, but its use declined in the late nineteenth century following doubts about its efficacy and the appearance of new pharmacological agents.72 The initial stimulus in the later eighteenth century for the more widespread use of alcohol, providing it with a rational basis for its prescription, was the system of medicine proposed by John Brown in the previous century. According to W. F. Bynum, alcoholic beverages along with opium were Brown’s favoured remedies for asthenic conditions.73 Alcohol was a popular remedy among Brown’s colleagues and his esteemed mentor, William Cullen, prescribed beer liberally in fever cases.74 The increasing cost of the consumption of alcoholic-containing drinks in the 1790s forced the Royal Infirmary of Edinburgh to tighten its procedures for their prescription, by requiring the physicians to record them each day.75 By the middle of the nineteenth century, ‘alcoholic therapeutics’ had gained a prominent position in British medical practice, replacing the use of bloodletting and S. P. Lucia, A History of Wine as Therapy, Philadelphia, 1963, pp.110, 114,150; H. W. Paul, Bacchic Medicine: wine and alcohol therapies from Napoleon to the French Paradox, Amsterdam, 2001, pp.i, 60.
Lucia, pp.8, 155-56; Paul, p.iii.
Risse, ‘Therapeutics’, pp.50, 61.
Risse, Hospital Life, p.225.