had the Romans, who recognized various degrees of consanguinity, within which there was no connubium. At Sparta, proceedings were taken against those who married too late in life, with a view to prevent children being born of feeble and unhealthy constitution. How much of this kind of debility do we recognise in the puny and peccant offspring of the day? We can hardly stretch our imaginations so far as to fancy what appearence the squalid progeny of our time would make in coats of mail. Undoubtedly, such a state of things must sooner or later bring defeat upon us. The blood unions of the Saxon have certainly held out wonderfully. Here a few drops may go a great way; but our blindness and ignorance will not save us from the fate of those who have preceded us in folly. Do not let us overlook the position of Spain in the present day. She has laughed at consanguinity till her nobles and her aristocracy are nil. The Romans called their slaves hybride; what would they call the Spanish nobiliity now? We need not ask why she is a third-rate nation, with these facts before us. We call ourselves a great nation, and we probably desire to continue to take the lead. Spain was once a great nation; but she brought her sons and daughters too near in marriage, and where is she now? Let Albion's sons take warning from them, and, at any cost, pass laws to prevent their too near approach to the remainder of their flesh." On Warm and Cold Baths in the Treatment of Insanity BY HARRINGTON TUKE, M.D. The employment of warm and cold bathing in the treatment of the insane is of the highest antiquity. Three thousand years ago, long before Pindar had sung his famous aporov μev vowo, or that Hippocrates, and after him Celsus, Aretous, and Galen, had given their testimony to the value of its application in head affections, and in nervous disorders; Melampus the Pylian, the first "alienist," and indeed the first physician of whom we have any record, is said to have cured mania and melancholia by the administration of hellebore and the use of the warm bath. It may be my thical, that by the last prescription he restored the health of a princess, and gained a wife; but it is not the less true that his practice, as recorded or alluded to by Homer, Herodotus, and Ovid, was rational and successful; and that the first specialist appears to have well understood the efficacy of purgation, and the beneficial effects of bathing, in the treatment of mental disease. The continental physicians, almost universally, and the greater number of the English practitioners, consider the bath to be perhaps the most valuable of their remedial agents in the treatment of insanity. But, while agreeing in the principle of its employment, there is a decided difference in their method of administering the bath, and a marked discrepancy in their opinions as to its mode of action; the French theory and system not only differing from the English, but the English physicians themselves being considerably at variance with each other. This difference may on examination prove to be rather verbal than real, but there can be no doubt of its existence. I therefore propose in this essay, to discuss the various modes of applying the bath in the public and private practice of lunacy; to trace the special adaptation of each to the several forms of insanity; to try to lay down some general rules for their application; and to reconcile, if possible, the apparently conflicting views now held upon the subject. I shall not dwell upon those modes of forced bathing, now, I trust, almost obsolete, some of which, till within the last quarter of a century, were considered so valuable as a means of calming the excitement, or repressing the violence of mania. The best known form of these old baths was the "bath of surprise," a reservoir of water into which the patient was suddenly precipitated, while standing on its moveable and treacherous cover. In an elaborate work on insanity, published by Guislain in 1827, he speaks of a plan where the patient was "dropped into water, and caught in a net." This he considers "dangerous." and therefore, as an improvement, figures with great care a bridge that he had caused to be constructed over a deep and running water, in the centre of which was an edifice of iron, formed like a "Chinese temple." This, on touching a spring in the bank, became a gigantic cage, and fell with the patient into the water. There seems to be no idea in his mind of any cruelty in this proceeding. Another less scientific and costly, but more hazardous plan, was that of tying ropes to a patient, and dragging him VOL. IV. NO. 26. n through a river, a practice that must either have been borrowed from, or have originated the system pursued by the buccaneers, one of whose modes of punishment was to drag their prisoner, under the ship's bottom, from one yard arm to the other. An ingenious "bath of surprise was sometimes made, by thrusting the patient into a perfectly dark chamber, one half of which formed an enormous cistern of water, into which he would most inevitably fall suddenly, while searching for a means of egress. The essence of all these plans appears to have been to, as nearly as possible, kill the patient, without exactly doing so; and the absurdity of such schemes would render them unworthy of notice, if it were not that the extreme to which the continental practitioners have recently carried the douche bath is almost as preposterous, and that a lately published report on the "prolonged shower-bath" must lead to the supposition, that there are still some who consider the use of painful and dangerous remedies justifiable in the case of patients who have lost their reason, and are therefore, to some extent, helpless in the hands of rashness and empiricism. The Greek and Roman physicians prescribed the bath in almost every disease, the very derivation of the word Balneum, from Badλav aiviav opem ferre, if it be anything more than the ingenius hypothesis of some enthusiastic hydropathist, marks their estimation of its curative effect. The popular appreciation of the hygienic importance of bathing is attested by the many stately buildings raised for that purpose in almost every city, by municipal regulations as to the frequent use of the bath by strangers and travellers, and by the fact that a magnificent bath-room was considered an essential part of the establishment of every wealthy Roman. Pliny censures the ladies of his time for paving their bathing rooms with silver, and having even the pipes of the hypocaustum of the same metal. A great part of the life of a Roman citizen, in the latter days of the empire, was spent in the warm bath, and it is not impossible that a habit so enervating, and carried to so great an excess as to provoke several edicts against it from the Emperors, might have had some share in the gradual decadence of the Roman valour, fortitude, and supremacy. It might have been expected that the special advantage of the warm bath in the treatment of the insane, should be familiar to the ancients; it is surprising that its value should ever have been overlooked; it is only to be accounted for on the supposition that the modes of bathing I have described, in all which cold water was employed, were in consonance with the theory of the inflammatory nature of all brain diseases, which was once so generally and erroneously entertained. Considered simply as a means of promoting cleanliness, there can be no question of the advantages of the warm bath, if the employment of a bath is is be compulsory. Its application is far pleasanter than the cold bath, and in the class of patients generally found in the public asylums, the warm bath is a positive luxury. In most of the county asylums, and in many of the large private establishments, every patient, on admission, is carried into the bathing room and immersed in a warm bath, and stringent rules are laid down for bathing at regular intervals. The bath on admission then becomes the commencement of the medical treatment, and it is easy to understand, that in many cases its value as a tranquillizer of the excited brain is very important, and even the feeling of comfort induced by its use is in itself salutary to the exhausted nervous system. The same plan is usual at all large hospitals, barracks, and prisons; in these its value is obvious, but it is not for these advantages only that Dr. Conolly lays so much stress upon its employment on the admission of the lunatic into a large asylum. In private asylums, as in private practice, rules are not so easily enforced, nor indeed are they so necessary; it is however, the more important that the medical attendant should make himself acquainted with the habits of his patients in this respect, or it will occasionally happen that from idleness, apathy, or delusion, proper ablution will be entirely neglected. I had very recently placed under my care, a lady who had been for years insane, and in a private asylum; there was an eruption on her skin, which was besides painfully excoriated in several places, from her systematic avoidance of even partial cleanliness, under the idea that washing was injurious to her. This lady was so apparently conscious of all the ordinary proprieties of life, that this state of affairs had not been suspected; and she has not yet forgiven my having delicately insisted on the use of the bath, although I thus cured her painful and disagreeable skin affection. The particular odour of the cutaneous secretion which is almost always present, and is sometimes so observable in patients afflicted with mental disease, is much diminished n2 by habits of cleanliness; and the well-known physician who some years ago coarsely said, that he "could smell a madman," would find himself baffled in the present wards of Hanwell, or in any well-regulated asylum. The hard and dry skin, and crisp hair, so often found conjoined with brain disease, are other indications of the necessity for frequent ablution. In cases of dementia or paralysis, where the patients are dependant upon the attention of their servants, it is the duty of the medical attendant to see that cleanliness is observed, and its good effect will be obvious, not only in the skin being restored to its healthy function, and equalised temperature, but also in an improved mental vigour and tranquillity. The question of the comparative value of the warm and cold baths, will come under review in speaking of the respective advantages of each. I am not at all inclined to agree with Dr. Willis, who, in answer to a question from a Committee of the House of Commons, said, "I think warm baths may be very useful, but it can seldom happen that a cold bath will be required." My own opinion is, that the one and the other are equally valuable, when judiciously employed; but in the cases I have just referred to, the use of the warm bath is alone admissible, and its temperature should be suited to the season of the year, and the constitution of the patient. In the report of the Commissioners of Lunacy, presented to the Lord Chancellor in 1847, will be found a description of the practice of fifty-three of the leading medical men engaged in the treatment of the insane, with an able analysis of their views. In my examination of these returns, I have found the following tables to indicate statistically, in some degree, the opinions of those gentlemen who have replied to the questions of the Commissioners, with regard to the relative importance of the various forms of baths in the two principal phases of the malady they are considering. 1. Summary of answers as to forms of baths employed by fifty-three medical men in the treatment of mania. Warm and cold baths ordered by ... ... ... 24 11 Cold only Tepid ... 9 ... ... 0 Hot bath, 100° ... Baths not mentioned in the report of |