Some Observations on the Cure of Mad Persons by the Fall of Water, Patrick Blair, 1725 AD

Some Observations on the Cure of Mad Persons by the Fall of Water
Patrick Blair
(MD Aberdeen, FR S, physician and botanist of Boston, Lincolnshire)
1725 AD
British Museum Natural History Section
Collection of J. &. T. Martyn, Banksian MSS. (No. 103)

(letter to the Secretary of the Royal Society James Jurin, 1684-1750, MD Cantab., Fellow and President of the College of Physicians, were read to the Society in December 1725 but not published. Blair's manuscript however was preserved by his friend John Martyn, 1699-1768)

See also: History of Psychiatry homepage

The case of "Waterfall"

The case of "Subterranean"

Introduction:

In 1725 AD, Patrick Blair, Doctor, perfected a system of torture that cured the insane that he learned of from Franciscus Helmont in 1694. Whereas Helmont lowered a bound mad man, head first into a large tank of water, Blair dropping large volumes of water on the head of a mad man seated and bound in a chair. Most important is that both Helmont and Blair viewed the cause of insanity to be spiritual choices of men rather than bodily diseases. For this reason, water torture was an effective way of convincing the mad man to stop his insane behaviour. Blair and Helmont boast that this method indeed cured the insane! Blair would blind fold people before the procedure as a way of further inducing terror of death. Whereas Helmont reported many downed from his cure, Blair never lost a patient! His final device included a large pump that elevated 18,000 gallons of water 35 feet in the air above the person strapped to a chair below. Additionally, he even sprayed water up into the face for a more complete effect. He used this final version to cure a woman who was, "mad, neglected every thing, ... kept her room, would converse with nobody but kept spitting continually" and refused to have sex with her husband. For 7 weeks before water treatment, she had "frequent bleedings, violent Emeticks, strong purgatives and potent Sudorificks and Narcoticks were not wanting". This brought about a partial cure: "gave all signs of recovery except that of the dislike to her husband". She he strapped her naked into the chair which, "put her in an unexpressable terrour especially when the water was let down. I kept her under the fall 30 minutes, stopping the pipe now and then and enquiring whether she would take to her husband but she still obstinately deny'd till at last being much fatigu'd with the pressure of the water she promised she would do what I desired". But the next day she refused. So he water tortured her in this way two more times. But when she recovered, again she refused. So Blair, "I threatned her with the fourth Tryal, took her out of bed, had her stript, blindfolded and ready to be put in the Chair, when being terrify'd with what she was to undergo she kneeld submissively that I would spare her and she would become a Loving obedient and dutifull Wife for ever thereafter. I granted her request provided she would go to bed with her husband that night, which she did with great chearfullness ... About 1 month afterwards I went to pay her a visit, saw every thing in good order". Blair proclaimed her cured! Whether you view this as a genuinely insane woman or a stubborn angry wife putting on the act of a mad man, either way it corrected the bad behavior! Blair claimed his water treatment by the "fall of water" was, "the safest method of curing mad people ... and sink the patients spirits even to a deliquium [melted] without the least hazard of their Lives." (Cure of Mad Persons by the Fall of Water, Patrick Blair, 1725 AD)

300 years of Psychiatry
Richard Hunter, 1963, p 325

These observations contained in a letter to the Secretary of the Royal Society James Jurin (1684-1750), MD Cantab., Fellow and President of the College of Physicians, were read to the Society in December 1725 but not published. Blair's manuscript however was preserved by his friend John Martyn (1699-1768), professor of botany, University of Cambridge, who himself took a special interest in mental diseases, attended patients at Duffield's madhouse in Little Chelsea [see FIG. 68], and introduced valerian which became the standard sedative for the 'neurotic' out-patient in the nineteenth and well into the twentieth centuries.

Blair put forward his `Cataractick way of cold Bathing' as an improvement on Helmont's (1694) hazardous ducking treatment since by it he could 'sink the patients Spirits even to a deliquum without the least hazard of their lives'. It had the following other advantages:

The Surprize upon being blindfolded . . . is a great means to the recovery of Reason.
Tho' at a second operation there is no more a surprize yet the Terror of the former creates such a dread & horrour of it [as] much contributes to produce the desir'd effect . . .
The difference in the pressure is very considerable betwixt the high & low fall . . .
The pondus of the water that fell is easily calculated.

In other words the amount and force of water discharged on patients' heads was measurable and so could be regulated which gave it a scientific flavour. The dose was determined according to the tenacity with which the mad person clung to his or her delusional feelings and beliefs, or, as the second case amusingly shows, refused to be normalised. The horror of such procedures aside, their wider psychiatric significance was that they made superfluous, in fact nugatory, study of the patient's mind. Not only did they provide no incentive for psychological investigation but they shifted interest almost systematically away from it to preoccupation with refinements and variations of physical agents and techniques — then water height and pressure. The patient's mind entered into this, as into all physical treatments of mental illness, only for an ad hoc assessment of symptoms before, during and after treatment.

Many variations on the theme of applying cold water to the madman's head were ingeniously invented on the analogy that 'that which will make a drunken Man sober in a minute, will certainly go a great way towards the Cure of a Madman in a month'. William Cullen (1784) for instance noted 'the benefit which has been received in some maniacal cases from the application of ice . .. to the naked head, and . . . the noted Clay Cap'. G. G. Brown, MD St Andrews, FRCP Edin. of Bath knew that 'application of cold water to the head . . . is an old species of practice, and also that it has often proved unsuccessful' but attributed failures 'in a great measure to the manner of using it, and likewise to the want of perseverance in it'. He introduced the method of 'winding an handkerchief round the head, and keeping it continually wet with a spunge dipped in cold water, until it produced a shivering-fit' and continued this for as long as fifteen days, even extending 'the application . . . along the course of the carotid . . . arteries . . . until sobbing and sighing came on . . . the criterion of the incipient return to rational ideas' (Annals of Medicine, for the year 1799. Edinburgh, 1800). In 1813 great stir was made by two London practitioners Messrs Delahoyde and Lucett as they were known, who claimed to have discovered a new 'secret process' against insanity for which they secured considerable financial support including the patronage of the Royal Dukes (The first report of the Committee who have undertaken to make enquiry into, and ascertain the extent of the process practised by Messrs. Delahoyde and Lucett for the relief of persons afflicted with insanity, and to provide the means of paying the expense of such enquiry, 1813). However their treatment was soon revealed as none other than douching the head with cold water sufficient 'to produce a slight concussion upon the shaven vertex' with the patient lying in a warm bath. In the mid- nineteenth century 'the cold shower' or 'douche' [see FIG. 117] was still 'ordered for one of its three effects . . . "the shock", the "reaction", and the direct refrigerant or depressing effect produced by a continuance of the shower, or its frequent repetitions' (Harrington Tuke On warm and cold baths in the treatment of insanity, 1858. Journal of Mental Science, vol. 4) and was recommended by Boismont (1859) as a specific for hallucinations.

It is noteworthy that Blair's original double shock of surprise plus measured quantities of cold water poured from measured heights on patients' heads so impressed Benjamin Rush that in 1796 'in a wing of the [Pennsylvania] hospital, particularly appropriated to the reception of insane patients, a space, about three feet square, was left in the flooring of the galleries communicating with the cells on each story. This space was occupied by a strong wooden lattice, or grating, divided into spaces of about one inch square. As these lattices were placed in an exactly perpendicular direction, one over the other, it was easy for the medical attendant to subject the patient to any degree of impression required, by directing the water to be thrown from the height of one, two, or three stories' (J. E. Stock Medical collections on the effects of cold, as a remedy in certain diseases, 1805).

(300 years of Psychiatry, Richard Hunter, 1963, p 325)

Patterns of Madness in the Eighteenth Century, A Reader
Allan Ingram, 1998 AD, p 73

"Some Observations on the Cure of Mad Persons by the Fall of Water (1725).

Blair qualified in medicine at Aberdeen, and practised for much of his life in Boston, Lincolnshire. His Observations were never in fact published, but were read to the Royal Society in 1725. The eighteenth century saw many forms and applications of shock therapy in the treatment of the insane, but Blair's must be one of the most fearsomely spectacular. Shock therapy is based on the belief that an artificially induced crisis of the body can restore the mind. At the same time, there is also in this form of therapy an implicit moral judgement taking place on the individual who obstinately chooses to maintain his or her delusions in the face of common sense and public expectation. This is particularly clear in the extract below, where Blair's activities are quite explicitly undertaken in order to return his patient to a norm of social and linguistic behaviour. Only when she has made the promise he requires in a form of language he recognises is she spared the treatment her lunacy demands. Moreover, it is pointedly apparent with shock therapy that any distinctiveness or individuality in the patient is of no account. Interest in the mind is subordinated by a preoccupation with the body and with ways of reducing it to submission. Equally, only through the body, its docility and acquiescence, can the mind be judged as being restored to normality. What is distinctive in Blair's account is the way the whole procedure, including the refinements adopted in treating this particular case, exposes a therapy as a species of rape performed on behalf of an estranged husband by a male medical practitioner on a female patient." (Patterns of Madness in the Eighteenth Century, A Reader, Allan Ingram, 1998 AD, p 73)

"But the Irish physician Patrick Blair was equally clear that a wife's refusing to love her husband was a sign of madness, and that her saying, after the most horrendous treatment, that she would do so after all and would go to his bed that night was therefore a sure sign of her cure." (Patterns of Madness in the Eighteenth Century, A Reader, Allan Ingram, 1998 AD, p 120)

Some Observations on the Cure of Mad Persons by the Fall of Water
Patrick Blair
1725 AD
British Museum Natural History Section
Collection of J. &. T. Martyn, Banksian MSS. (No. 103)

CATARACTICK TREATMENT

It was at first a fiery zeal for Religion or rather a mistaken notion of it too much encourag'd by a certain set of people that disordered his senses and at last made him furiously mad . . . He had a few glimpses of Reason when I came first to him, suffered himself to be bleed and took what was prescrib'd to him but was so outrageous that 4 men could scarce keep him in bed . . . his fury increased and his strength augmented so much that double the number of men could not keep hold of him but they were forc'd to make use of ropes and fetter his hands and feet with Iron. Next day I attempted the Cold Bath and ordered him to be plung'd thus bound into an hogshead of water all of a sudden, and throwing 8 or 10 palefulls of water by the force of so many people upon his head all at once, but this had scarce any effect because I neglected to blindfold him, but though he was somewhat calm'd a little after. Upon this I ordered him to be kept dark in fetters and ropes untill next day that I contriv'd a byspout from a Current of water (for a Cornmill) which had 20 foot fall. I plac'd him directly below this in a Cart by whose wheels mov'd it to and from under the water as occasion requir'd. Thus I kept him under this vast pressure of water for 15 minutes untill his spirits were fully dissipated and his strength quite exhausted, and it is to be observ'd that he who being blind-folded and led by 2 persons came whistling singing dancing and merrily leaping along about 1/2 mile to the fall of the mill was fain to be carried home in a Litter I had provided on purpose. Being laid in his bed the fetters put on and the room darkened he fell asleep immediately and slept 19 hours and awoke as sound in his judgement as ever . . . Ever since he has continued so well that they put him shortly after to be an apprentice to a brewer where he has led a very sober life.

This unexpected and surprising success encouraged me to make further Improvements on the Practice by the fall of water and since coming to Boston my Endeavours have not been in vain. I was sometime in this place before I understood there was an Engine so fit for my purpose as it has since prov'd to be. It is built at about 1 1/2 mile from hence in order to raise and convey water to serve the Town. There is a wind Engine like that which raises the New River water at London. At some distance is built a Square Tower 35 foot high. The water being forc'd to it by the Engine ascends perpendicularly in a large pipe at one corner and is discharg'd into a cistern on the top of the Tower which will contain about 80 Tun of water [17,920 gallons]. At the opposite corner the water descends directly by another pipe from whence its convey'd to the Town. There are 3 habitable rooms in the bottome of the Tower, the middle of which has a Chimney. I have got a lateral pipe fixed to the descending one by which I make the water to fall in any part of the middle room I think proper. I have a bathing Tub 6 foot long, I place a Chair in it in which the patient sits. The chair is so fix'd in the Tub and the patient so ty'd to the chair that none of them can move. The Lateral pipe has a cock by which I can stop or let down as much or as little water as I think proper. When the patients have got sufficiently of the fall I have a bed in readiness in the next room where they are laid and suitable care is taken of them as will appear by the following observations...

A married Woman . . . became mad, neglected every thing, would not own her husband nor any of the Family, kept her room, would converse with nobody but kept spitting continually, turning from any that turn'd from her and chiding any who put their hand in their sides, telling them she was not a whore . . .

These Symptomes requir'd great preparation of the vitiated humors before she could undergo such an operation; frequent bleedings, violent Emeticks, strong purgatives and potent Sudorificks and Narcoticks were not wanting, nor did I fail to let her have sutable and specifick Alteratives, but none of them answered the design nor workt for a wish'd for advantage. In this course I continued her for 1 month, now it was time to come to a salivation which I usually have recourse in such cases . . . she became insensibly to have the use of her Reason and after 5 weeks under this second course of physick she began to enquire more seriously into the state of domestic affairs at the servants who came to see her, spoke more kindly to them, shew'd a desire to be at home, quitted much of her former gestures speeches and behaviour, was obedient when reprov'd because of them and gave all signs of recovery except that of the dislike to her husband and yet she would sometimes allow her self to be called by his name which she could not endure before.
Observing these alterations I train'd her into the Engine house putting her in hopes of getting home from thence that night but when she went into the Room in which she was to Lay I ordered her to be blindfolded. Her nurse and other women stript her. She was lifted up by force, plac'd in and fixt to the Chair in the bathing Tub. All this put her in an unexpressable terrour especially when the water was let down. I kept her under the fall 30 minutes, stopping the pipe now and then and enquiring whether she would take to her husband but she still obstinately deny'd till at last being much fatigu'd with the pressure of the water she promised she would do what I desired on which I desisted, let her go to bed, gave her a Sudorifick as usual. She slept well that night but was still obstinate.
I repeated the bleeding and other preparatory doses.
A week after I gave her another Tryal by adding a smaller pipe so that when the one let the water fall on top of her head the other squirted it in her face or any other part of her head neck or breast I thought proper. Being still very strong I gave her 60 minutes at this time when she still keept so obstinate that she would not promise to take to her husband till her spirits being allmost dissipated she promised to Love him as before. Upon this she was laid a bed as formerly but next day she was still obstinate.
Evacuations being endeavoured for 2 or 3 dayes more I gave her the 3rd Tryal of the fall and continued her 90 minutes under it, promised obedience as before but she was as sullen and obstinate as ever the next day.
Being upon resentment why I should treat her so, after or 3 dayes I threatned her with the fourth Tryal, took her out of bed, had her stript, blindfolded and ready to be put in the Chair, when being terrify'd with what she was to undergo she kneeld submissively that I would spare her and she would become a Loving obedient and dutifull Wife for ever thereafter. I granted her request provided she would go to bed with her husband that night, which she did with great chearfullness . . .
About 1 month afterwards I went to pay her a visit, saw every thing in good order . . .

Being thus successful I was willing to know the pounds of water and the pressure of her strength was able to undergo . . By . . . Calculation it appear'd that in 90 minutes there was 15 Ton of water let fall upon her .. .

In a word I have made such an Improvement of this Cataractick way of cold Bathing that as its the most effectual so its the safest method of curing mad people for I can calculate or measure the water as it falls to the weight of 1 oz. and sink the patients spirits even to a deliquium without the least hazard of their Lives which dare not be ventured by plunging or immersion which they have hitherto made use of in such cases.