|LOST HOSPITALS OF LONDON|
A brief history of healthcare provision in London
HOMES FOR INEBRIATESWhile drunkenness had traditionally been an accepted part of life in England, by the beginning of the 19th century, as the country industrialised, the need for a reliable, punctual workforce prompted a change of attitude. Social reformers, appalled by the drunkenness they witnessed in the streets of large cities and towns, began to campaign for greater restrictions on the sale of alcohol.
As problems brought about by rapid urbanisation - urban crime, poverty and a high infant mortality rate - came to be blamed on alcohol, groups began to promote temperance (the moderate use of alcohol) and even the total abolition of its production and distribution, so that any consumption of alcohol would be unacceptable (teetotalism).
The first national temperance organisation was founded in 1828 and the teetotal movement in 1832, which encouraged adults and children to 'sign the pledge' - a promise that they would not drink alcohol of any kind. Neither organisation showed interest in those already chronically addicted, who were regarded as 'inebriates', doomed to follow a path of drunkenness, alcoholism and death. (Much of the beer sold to the working classes was adulterated with nux vomica (strychnine) - to impart bitterness (and thus save on the cost of hops) - and with cocculus indicus - to produce a more intoxicating effect.)
The first to suggest that chronic drunkenness had the characteristics of a disease had been the Scottish physician Thomas Trotter in 1788, although Benjamin Rush had described "an uncontrollable, overwhelming and irresistible desire to consume alcohol" in 1784. Delirium tremens (the 'DTs'), brought about by the withdrawal of alcohol, was first described in 1813.
A campaign began, led mostly by medical practitioners, to institute treatments for inebriates. One of these, Dr Donald Dalrymple, M.P. for Bath, felt that, in order for them to be treated successfully, inebriates would have to be removed from the source of their addiction, that is, a compulsory abstinence. He attempted to introduce a Bill in Parliament in 1870, which was aimed at forcibly confining habitual drunkards in reformatories, where moral and spiritual influences could be brought to bear as well as medical care.
The Bill was defeated. Habitual drunkards were regarded as a minor social problem, compared to child labour and education, while a strong lobby of brewers and those in the drink trade made the passing of such legislation extremely difficult.
In 1872, nonetheless, a House of Commons Select Committee on Habitual Drunkenness was established, with Dr Dalrymple as its Chairman. The Committee attributed the increase in drunkenness to shorter working hours and higher wages, while magistrates were regarded as too lenient, giving only small fines or short prison sentences of several weeks or months to convicted drunkards. It recommended that a Drunkards Register be kept and that two classes of sanitaria be established - one for those who could pay (who would be admitted voluntarily) and one for those who could not (to be financed by the local authorities) for the compulsory treatment of convicted drunkards.
In 1872 there were already at least three homes for inebriates in Britain - the Christian Home for Inebriates in Bakewell (Derbyshire) and in Sheerness (Kent) and the Queensbury Lodge Inebriate Institution for Females in Edinburgh - all of which were vastly oversubscribed. Treatment at first was medical (mustard plasters were applied to 'draw out the poisons'), then spiritual (by homilies and sermons). Patients stayed on average for three months. However, despite drunkenness being no respecter of class, age or sex, none of these homes catered for the working classes.
Dr Dalrymple died prematurely in 1873, but his campaign continued under the auspices of the British Medical Association (B.M.A.). The government resisted any intervention but, as the number of arrests for drunkenness rose dramatically in London, it began to be seen as a serious social problem.
An Act was finally passed, with difficulty, through Parliament in 1879. The Act to facilitate the control and care of habitual drunkards described a habitual drunkard as someone who "cannot be certified as a lunatic, but who due to habitual intemperate drinking is dangerous to him or herself or incapable of managing their affairs". Such a person could apply to two magistrates to voluntarily sign away his freedom and be sent to a Licensed Retreat for up to one year, so long as he or his family could afford the charges.
The Act was disappointing to those campaigners who wished to impose compulsory detention for all habitual drunkards, not just those who could pay. The lack of compulsion, unless criminal acts had occurred or the drunkard had been declared insane, meant that non-criminal inebriates were free to continue to drink themselves and their families to ruin. Another concern to the campaigners was that the craving for alcohol was a vice which could be passed down to the next generation ('degenerationism').
Although the Act was due to expire after ten years, it was made permanent in 1888, with the term 'Habitual Drunkard' changed to 'Inebriate'.
The later Inebriates Act, 1898, allowed non-criminal inebriates to be admitted to reformatories for up to three years if they had been convicted of drunkenness four times in one year (and also criminal inebriates if they had been convicted of an imprisonable crime). However, local authorities, charged with funding the reformatories, which were to be more like medically run prisons than the voluntary retreats, resisted the financial implications for their rate payers.
The term 'inebriate' originally described a person intoxicated with alcohol, but came to include those intoxicated with drugs, especially narcotics. Inebriety was classified by the intoxicating agent - alcohol, opium, chloral, ether, chlorodyne, etc., but the provisions of the Act only covered drug-taking if the substance was ingested in liquid form, for example, laudanum, not by injection.
By 1899, in the United Kingdom, fifteen homes were licensed under the Acts, although not all admitted drug addicts.
In 1905 the Committee of the Homes for Inebriates Association called for further legislation and, in 1908, a Departmental Committee agreed that all drug-taking should be included under the Act.
However, interest in legislation dealing with inebriates was waning, while the popularity of inebriate institutions peaked in the years before the outbreak of WW1 in 1914.
After WW1 prosecutions for drunkenness fell, mainly due to restrictions on the opening hours of public houses and the reduction in the strength of alcoholic beverages. Adulteration of whisky with cheaper ingredients, such as methyl alcohol, by certain dealers became more frequent practice after the war, producing toxic symptoms in those who drank such spirits.
In 1930, in a study of 1,645 patients consecutively discharged from Dalrymple House, spirits were the most common alcohol consumed, followed by beer (44 patients, then wine (40). Only 47 took drugs alone but, of the rest, 200 took drugs in some form or other (morphine and opium being the commonest; cocaine was much rare). Those most at risk of addiction were 'gentlemen' of no occupation (380). Of the employed, the list was headed by merchants (178) followed by (in order of frequency) medical practitioners (130), military officers, clerks, manufacturers, farmers (including market gardeners), solicitors, engineers, distillers (including brewers) (33), clerks in holy orders and civil servants (equal position), schoolmasters (including tutors), barristers-at-law, stockbrokers, artists and members of the theatrical profession (22) and journalists (9). Fifty percent gave a family history of inebriety and 11% of insanity, with or without inebriety. The age period of greatest addiction was 30-40 years (636 patients), then 40-50 years (524). One patient was aged under 20, and four between 70-80 years.
The power to compulsorily detain non-criminal inebriates, so long demanded by the medical profession, was never granted by Parliament.
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29th November 2013)
Alford SS 1880 The Habitual Drunkards Act of 1879. London, H.K. Lewis.
(Author unstated) 1924 The rescue of drug addicts. Lancet 204 (5265), 180-181.
(Author unstated) 1925 The treatment of chronic drunkards. Lancet 205 (5308), 1091.
(Author unstated) 1930 A statistical study of alcoholism. British Medical Journal 2 (3631), 221-222.
Berridge V 2004 Punishment or treatment? Inebriety, drink and drugs, 1860-2004. Lancet 364 (Suppl. 1), 4-5.
Lord E (undated) Newsletter 62. Dalrymple House, Rickmansworth, and the Treatment of Inebriates. Rickmansworth Historical Society.
Mann K, Hermann D, Heinz A 2000 One hundred years of alcoholism: the twentieth century. Alcohol and Alcoholism 35, 10-15.
Parrish J 1886 Inebriety, and Homes for Inebriates in England. Quarterly Journal of Inebriety 8, 1-22.
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