Thursday, 14 July 2016

Just what the Doctor ordered?

A new blog today on medicinal alcohol, courtesy of our Summer Intern (and York history student) Gaby Davies.

Whilst looking through the York Medical Society records, it was interesting to find the York County Hospital ‘Wines and Spirits book’ 1861-1865.  The pages contain lists of names of doctors, rooms and incidents, and the corresponding number of servings of port, sherry, brandy or gin that was needed.  Doctors seem to be doling out spirits and wines on a daily basis to their patients, and giving more for particularly bad events; September 29th 1861 required 20 servings of brandy due to the ‘Lendal Bridge accident yesterday’, and on 9th January 1861 8 servings of port were needed due to a ‘railway accident’.  This seems to make it clear that this is medicinal alcohol, rather than that beverages ordered by patients (and not doctors getting through a particularly difficult shift).

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This reliance on alcohol seems startling from a contemporary viewpoint, but in the early- to mid-19th century, Victorian doctors relied on alcohol heavily for quite general medical purposes, although towards the late 19th century medical opinion did start to turn against alcohol as a catch-all solution to ailments, and it started to be seen harmful and addictive.  Before this point, however, alcohol was prescribed liberally both as a stimulant and a sedative.  Brandy was used to ‘stimulate circulation’, to resuscitate the unconscious much like smelling salts, and in emergencies, especially outdoor pursuits such as hiking and skiing.  In hospitals it was often given intravenously or even (wince) rectally.  Even in 1920, physician William Hale White espoused its virtues, primarily as ‘A pleasant depressant, peculiarly efficacious in inhibiting peripheral impulses, such as pain here, and discomfort there, that it diminishes those trivial worries which bother the sick.  In larger doses it has the advantage of inducing sleep.’  This rather unscientific viewpoint may have been the reason the alcohol in this book seems to have been given to patients so regularly; for lack of other drugs it was a quick solution to mild pain or lack of sleep, and was an easy way to improve a patient’s comfort.  It was even used for children when teething or colicky, and many ‘tonics’ sold by unlicensed practitioners for babies could be up to 50% alcohol.  The fact that it was ‘opium free’ was often enough to convince mothers that the tonic was safe.

Victorian doctors also used alcohol enthusiastically as a painkiller for the dying, along with ether and opium.  Combinations of ether, brandy and port wine were often used as a stimulant for a weak heart and to promote circulation, and brandy was additionally favoured for its aid to the digestive process. Doctor William Munk recommended that for those with a terminal illness, small quantities of alcohol should be given frequently, favouring port and sherry over champagne as the latter tended to wear off quickly.  

Choosing the right alcohol for the right patients.
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It was not just in England that this culture of medicinal alcohol was prevalent; in America during Prohibition, doctors could prescribe spirits to their patients and there was even a medical beer campaign, which congress had shut down by 1921 for fear that, as the New York Times put it, ‘druggists become bartenders and the drug store a saloon.’

Looking through The Retreat documents we find similar evidence of this general use of alcohol by doctors.  One 1860s circular advertising ‘cheap light wines’ has two full pages of doctors’ recommendations, published in the Medical Times, of how wine can be used as an aid to breastfeeding (unless you are working class, in which case beer will do), a cure for acidity which would ‘add ten years to your patient’s life’, a drink to ‘fill the veins with pure healthy blood’ and as a healthier substitute to tea.  

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Pure clean claret for nursing mothers?
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Several articles also recommend that wines are ‘admirably adapted for children’, and that for children ‘puncheons of cod-liver oil might be spared at the age of 16-20, if, at the age of 7-10…the physician had said, ‘give her some kind of light, clean tasting, sub-acid wine…so that it might tempt her to relish her mutton’.  The document is an advertisement so these articles have clearly been cherry-picked, but the fact that they were published at all despite medical opinion beginning to turn at this point is an insight into the respect given to various quasi-scientific opinions of individual doctors, and the resulting effect that this had on patients.

‘Medical alcohol’ would clearly have worked, to a certain extent, in dulling pain and making patients fall asleep. It can only have been a relief for mothers when, after hours of crying, their teething babies would finally drift off thanks to some ‘medicinal’ tonic which was basically the equivalent of giving them a shot of vodka.  However, developments in the mid-to-late-19th century led to medicinal alcohol slowly declining as a cure.  A better understanding of the pharmacology of alcohol came about, improved alternative treatments were developed, anaesthetics such as chloroform and nitrous oxide became more widespread, alcoholism and its dangers to the human body became better understood and the temperance movement became more prominent.  Brandy was still occasionally recommended even in the 1930s as a general sedative, a food for those finding it hard to take in physical nutrition and up until the 1940s there were still debates as to whether it could help in cases of pneumonia.  This ‘wine and spirits’ book is a fascinating relic of a time where the virtues of alcohol were widely accepted and recommended by doctors, and can give us an insight into the lack of alternative, effective medicines at this time.  

And on a purely curious note, it leaves us wondering why the laundry maid regularly checked out 3 servings of port!


Port for the laundry maid?
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The Retreat Archive is currently being digitised.  More details are available at the Wellcome Library website.

Bibliography

Beverly Gage, 'Just What the Doctor Ordered' in Smithsonian Magazine (http://www.smithsonianmag.com/history/just-what-the-doctor-ordered-80480921/?page=2&no-ist)

Henry Guly, 'Medicinal Brandy' in Resuscitation (July, 2011).

Patricia Jalland, Death in the Victorian Family (Oxford, 1996).

R. H. Kinsey, 'An Address on Alcohol and on Drainage' in The British Medical Journal (1883).

The Rose Melnick Medical Museum, 'Medicinal alcohol and Prohibition' (https://melnickmedicalmuseum.com/2010/04/07/medicinal-alcohol-and-prohibition/)

William Hale White, 'Discussion on the value of alcohol as a therapeutic agent,' Proc R Soc Med. 1920.