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This week I taught a few classes at Bellahouston Academy in south Glasgow on the four humors (blood, black bile, yellow bile, and phlegm). As I've previously posted, humoral medicine was central to how physicians treated mental illness for nearly 2500 years. One of my assignments for the 12- and 13-year-olds was to think up some cures for patients whose humors were out of whack or not in balance. One of their patients was a manic, overly aggressive person who was suffering from an excess of yellow bile, which had the quality of being hot and dry. A very clever student suggested that all the patients needed was a cold shower. How right she was. For centuries, water has been used to treat people with mental health problems. But not always in the same way.
When mental illness was seen in primarily supernatural terms, water was seen as a spiritual purifier. This makes sense when you think of the baptism and holy water of Christianity and the cleansing rituals of other religions. Certainly, water was used by the Ancient Greeks to cure many maladies. During the Middle Ages, manic people were often ducked into holy wells to the point of exhaustion. This spiritual approach to therapy dovetailed neatly with the humoral approach of using cold water to reduce the heat and dryness associated with yellow bile. One example of such a well and the combination of spiritual and humoral therapy can be found in this case study from Cornwall:
"The water running from St. Nunes well fell into the square and closed wall plot, which may be filled in which depth they listed. Upon this well was the frantic person set to stand, his back towards the pool, and from thence with a sudden blow in the breast tumbled headlong into the pond; where a strong fellow … took him up and down, alongst and athwart the water, until the patient, by foregoing his strength, had somewhat forgot his fury. Then he was conveyed to the church, and certain masses sung over him; upon which handling, if his right wits returned, St Nunne had the thanks, but if there appeared small amendment, he was bowssened again and again, while there remained in him any hope of life, for recovery."
During the Renaissance, the Flemish physician and chemist Jean Baptiste Van Helmont (1580-1644) reintroduced water therapy in his Ortus Medicinae (1648). Van Helmont recommended that patients be fully immersed in cold water to the point of near-death in the hopes of "killing the mad idea" which caused mental derangement. Slightly less severe variations of water treatment or "water cure" were taken up during the eighteenth century – killing patients was not good for business.
By mid-century, this hydrotherapy was the most common treatment used by physicians and in asylums. There were two main methods: of hydrotherapy: douche (shower), a constant torrent of water could either cool the heat of madness or rouse the melancholic; and balneum (bath), which were meant to calm nerves. Hydrotherapy often conducted in public in ponds, fountains, or the sea, which invited public viewing.
With the spread of asylums during the nineteenth century, such therapies moved indoors and elaborate devices were built, including cold shower rooms, bath boxes, dunking devices, ladder and bucket, and "the tranquilizer" of Benjamin Rush (1746-1813), the "Father of American Psychiatry" and signer of the Declaration of Independence.
As Rush described:
"I have contrived a chair and introduced it to our [Pennsylvania] Hospital to assist in curing madness. It binds and confines every part of the body. By keeping the trunk erect, it lessens the impetus of blood toward the brain. By preventing the muscles from acting, it reduces the force and frequency of the pulse, and by the position of the head and feet favors the easy application of cold water or ice to the former and warm water to the latter. Its effects have been truly delightful to me. It acts as a sedative to the tongue and temper as well as to the blood vessels. In 24, 12, six, and in some cases in four hours, the most refractory patients have been composed. I have called it a Tranquillizer."
Often it was the surprise of being pushed into a pool of frigid water that was thought to help "shock" the patient into sanity. As Jean-Etienne Esquirol (1772-1840) described: "The sufferer came down the corridors to the ground floor, and arrived in a square vaulted room in which a pool had been constructed. He was pushed over backwards into the water."
Although this may seem to be a harsh treatment, it was thought to be an improvement on the practice of restraining patients using straps or straitjackets. Of course, this could be abused. Patrick Blair (c. 18th C) used hydrotherapy to treat women who would not sleep with their husbands. He stripped them, blindfolded them, and tied them to a chair, showering them with copious amounts of water (15 tonnes in one case) for up to 90 minutes. Hydrotherapy was also often not therapeutic at all, but punitive used to punish "silly behaviour and laughing" to violence and attempted escapes.
By the middle of the nineteenth century, the healing waters of spas, such as the Grefsen Water Therapy Institute in Norway, were used to treat neurotic patients. Rather than being coerced into the bath or shower - or pushed into it - these patients paid a great deal of money for the privilege.
Hydrotherapy continued to be used during the twentieth century, including at London Asylum in Ontario, which used a wide range of warm and cold baths. Guy Hinsdale's Hydrotherapy (1910) provided some details:
"Case 1, Daniel, aged 30, white, acute mania: On admission, this patient was garrulous, vituperative, restless, noisy, and hostile in manner. He was placed in the continuous bath Oct. 16, 1907. The temperature of the water was 100°F. Little or no improvement was noted at the end of the first day. On the second day, the temperature was raised to 105°F. The patient began to show improvement, which gradually continued, and at the end of the fifth-day motor restlessness ceased and the patient was no long garrulous and noisy. In this case, a permanent benefit was observed and the patient was discharged a few weeks later, restored."
In many ways, hydrotherapy was replaced by other shock therapies, namely, insulin shock treatment, electroshock therapy, and finally, lobotomy. I'll talk about these in future blogs. But before you dismiss hydrotherapy all together, think about the last, nice, hot bath you took - did it make you feel better? What about the last swim you took in a clear, pristine lake or in the ocean? Water continues to be a healer, perhaps one we should consider more carefully.
