Hot and Cold Baths: “A useful treatment for insanity”
On Thursday 2nd June 1796 a patient, known only as L.I., was admitted to the Liverpool Asylum in a state of “furious insanity” believed to have brought on by excessive alcohol consumption. His treatment was managed by the physician James Currie, who wrote about his medical work in useful detail.
Currie was born in 1756 in Dumfries, Scotland, the son of of a church minister. At the age of sixteen he went to Virginia in hopes of making a commercial fortune in what was then part of the British colonies of America. Not being a very healthy individual, and not having much business success, his prospects were totally dashed by the revolution and independence movement during which he sided with the British, was at some stage captured and then obliged to buy his freedom. These vicissitudes altered his plans for his life and he returned to England, studied medicine in Edinburgh before settling in Liverpool in 1780 where he ran the Infirmary. Soon after, married and with a family, he was comfortably situated. Not only was he a medical man, but Currie was also a writer and man of letters, an admirer of poet Robert Burns whom he greatly admired and, indeed, once met. After Burns’ death Currie published an anthology of Burns’ poetry. Frequently in poor health himself, Currie died at the age of 49.
Treatment of the mentally deranged was not Currie’s primary concern, although he devoted considerable energy to it. He might be considered to have taken an enlightened approach to the care and treatment of the insane, insisting that they be accommodated separately from the physically ill and securing financial support for the building of an asylum for the special care of lunatics separated from the infirmary. This was all some years before asylums became established elsewhere and his work as a pioneer in this respect attracted some favourable attention in the years that followed.
One of Currie’s key preoccupations was research into the benefits of water as treatment for a range of conditions. His interested had initially been aroused by his own academic studies wherein he sought to move away from patients’ subjective accounts of their temperature and replace them with objective measures taken by means of a thermometer. In 1786 he learned of the value of cold water treatment for fever which had been documented by another medical professional, Dr William Wright, on a journey back from the West indies. Currie was stimulated to make a careful study of the use of water at different temperatures, externally and internally applied, across a wide range of conditions. His careful methods of work and findings doubtless distinguished him and contributed to the development of medical science.
After L.I.’s admission to the asylum a range of treatments for his extreme mania were attempted. These included a salt purgative to clear his bowels, given forcibly, followed by laudanum to promote sleep. This was followed by opium for better sleep, and the prescription of milk alone as his food. This caused vomiting and was discontinued, to be replaced with wine, gruel and other solid food for around two weeks. His strength was improved but his insanity was “as violent as ever”. He then commenced daily baths heated to 95 degrees and digitalis via an infusion. This made little difference and so was discontinued. By mid July he was being prescribed peruvian bark (used as a malaria treatment).
Over these weeks L.I. was carefully monitored, temperature and pulse measured, and the lack of any real success in his treatment noted. In late July, therefore, Currie decided to make use of a cold bath. This appeared to have some positive benefits, but the furious mania returned soon after. Consequently it was ordered that when his manic fury was at its height L.I. would be thrown into the cold bath. As soon as he climbed out he would be thrown back in again, and this was done five times until he was no longer able to climb out. But, he was calm. And he remained calm thereafter, being given baths every other day as well as some oxide of zinc. Currie reported that his patient “never relapsed, and was discharged some time afterwards, in perfect health of body and mind”.
The logic of using such a treatment was probably connected to a view of insanity as being a state of inflammation of the brain. Given that observations of patients with fevers seemed to confirm that they might be treated positively with the cooling effects of tepid or cold water either applied externally as an affusion i.e. tipped over the patient, or internally — i.e. being drunk, it followed that dousing or bathing with cold water might impact the brain. Mania might readily be seen as an overheated or inflamed cerebrum.
In any event, baths for the treatment of insanity became a well-established option and used with enthusiasm for many years within the County asylums. A range of methods and approaches to the use of the treatment were adopted. By 1874 John Bucknill and Daniel Hack Tuke were writing authoritatively about insanity and describing baths as one of the most effective “secondary remedies”. By this point they had modified or excluded a number of the earlier preferred water treatments because, among treatment choices there were “few that have been more abused”.
No doubt Bucknill and Tuke were referring to such approaches as the surprise bath. This involved the patient being shown into a darkened room. The floor opened onto a large bath filled with cold water. As the patient stepped forward they would fall into the bath. The surprise, together with the cold water, were — for a time at least — considered to be positive therapy for insanity. Another development was the use of a planking system over the bath so that the patient could be forcibly restricted. The head of the patient would be “trapped” above the planking and the only visible part of the body. The water in the bath would be warm or hot, and the attendants would then douse the head of the patient with buckets of cold water at regular intervals in order the promote the cure.
Bucknill and Tuke acknowledged that cold showers on a cold winters day had resulted, on occasion, in heart failure for the patient. Hence they recommend careful monitoring of the temperature of the water and baths or showers that were shorter in duration than had generally been practiced — i.e. a few minutes rather than a few hours. Often the approach to be used was a warm (body temperature) bath for a period of time with cold wet towels being applied to the head at regular intervals.
A number of variations of the treatment were explored over time, with sophistications being tailored to the diagnosis of the patient. In the latter half of the nineteenth century another treatment deployed was that of Turkish steam baths. Asylums such as those in Devon and in Lancaster had such baths installed, although they came to be regarded as a waste of time and money. It is most probable that the best effect from the bathing was to ensure that the patient was clean.
It is difficult to comprehend, from today’s standpoint, that so much belief was placed in the use of hydrotherapy for people in mental distress. But it is nonetheless worth acknowledging that this and many other recommended treatments predate the development of sophisticated statistical methods to evaluate the effectiveness of any prescribed regimen. Clinical observation of individual cases was the principal means of determining good outcomes from treatments. Hence observational bias — ignoring treatment failures from consideration, and commendation of an approach which looked to have been successful, combined with enthusiastic promotion, might readily convince others desperately seeking treatment solutions.
In the attention given to hydrotherapy for psychiatric patients over more than a hundred years lies another lesson. When a new treatment is embraced with enthusiasm by its developers and promoters the positive benefits it appears to have may not be down to the treatment at all but to the interest and enthusiasm which its developers convey. When subsequently adopted routinely across large numbers of facilities and routinely applied there is less enthusiasm. So those patients who are subjected to it are no longer the special scientific subjects of interest. They have merely to endure another treatment fad while waiting to be subjected to the next new idea.
