Turkish baths in asylums

The Second Middlesex County Asylum, Colney Hatch

The foundation stone of England's largest 'lunatic asylum' was laid on 8 May 1849. By 1852, when it had been open for a year, it was costing 8/2d per week to keep each of its patients, of whom there were, by 1856, nearly 1,500. Even as late as 1914, when the establishment was run by the London County Council, the cost was still only 10/- per week per patient.

Dr Edgar Sheppard became Medical Superintendent of the Male Department in 1862  and had, by the time he left in 1881, been both reviled for reaction and praised for innovation.

When the asylum was opened, Henry Pownall, chairman of the Middlesex magistrates, had proudly stated that 'No hand or foot would be bound here'. But in the mid '60s, Sheppard had felt the need to reintroduce the use of physical restraints for some of his patients. For this he was widely criticised, especially as reversion to the old practice was interpreted as an indication that the newer—more humane—methods had failed. However, a visiting German neuro-psychiatrist, on a tour of British asylums, suggested that the practice was almost inevitable with such an establishment.

An asylum with more than 2,000 patients and only two directing physicians…each with only one assistant…and…one attendant for twelve patients, is indeed an impossibility…with or without restraint…It is not an argument against the non-restraint system, but only against asylums of the enormous size of Colney Hatch.

On the other hand,  Sheppard organised leisure activities with concerts and dramatic performances, brought in outside groups to entertain, formed an asylum band and held fortnightly balls.

Planning the bath

Sheppard had long been a hydropathist and, since its reintroduction into the British Isles in 1856, an advocate of the Turkish bath. Its first recorded use in the treatment of mental illness was  in 1861. Articles describe its tentative introduction under Dr Power, resident doctor at the  Cork District Lunatic Asylum, and under Dr Lockhart Robertson at the Sussex County Lunatic Asylum at Haywards Heath.

Sheppard visited Dr Power's Turkish bath at the Cork Asylum in 1863, and this strengthened his resolve to have one installed at Colney Hatch.

There is also a strong, though as yet unconfirmed, possibility that some time between Sheppard’s appointment and the building of a bath at Colney Hatch, some patients were allowed to visit Richard Metcalfe’s Graffenberg House Hydropathic Establishment, two railway stations down the line, at New Barnet. Writing in 1906, Metcalfe claims that he,

had a licence to receive cases of mental alienation, and the Lunacy Commissioners did me the honour to approve of my methods of treatment; that is by hydrotherapeutics, but especially by the Turkish or hot-air bath.

On Monday 16 May 1864, he invited David Urquhart and Major Robert Poore, directors of the London & Provincial Turkish Bath Company, to visit the asylum and 'discuss the possibility of building a Turkish bath for the inmates'.

Urquhart seems to have given the impression that a Turkish bath could be constructed for around £300, but when he wrote to Sheppard the following Monday he suggested a much grander affair which was estimated to cost an extra £200. On the intervening Saturday, the asylum's Clerk of Works, Mr Wood, had visited Urquhart and come back with technical data and dimensions so that a plan could be drawn for submission to the Board on 24 May.

This plan was for a building of 1,500 square feet which, Urquhart wrote,  'will become the model for the asylums, hospitals, unions, and barracks of the three kingdoms...'

Urquhart realised that the Board would be concerned that money spent on what was at that time still a relatively new type of facility should allow of its use by as many patients as possible.  He continued,

As you dispose of the patients' time, and can arrange relays from six in the morning till eight at night (and herein lies your facility), you can pass 700 patients through the operation of the bath daily. For mere washing you can pass them through it at the rate of 250 an hour.

The charge for fuel will not exceed 1s.6d. per diem. I will not speak of soap or linen, as those charges you bear already.

In Mid-October, Sheppard and Wood were invited to Urquhart's London Hammam by its manager, John Johnson, to see the new experimental room heated to a temperature of 205º F solely by radiation. Thanking Urquhart for suggesting the visit, Sheppard wrote that a temperature of 180º F would seem most appropriate for the proposed bath at Colney Hatch, the plans and specification of which were,

now in the hands of the contractors for the purposes of an estimate, which I may hope to obtain in a few days. We shall then commence operations without delay.

In this, Sheppard proved to be somewhat over-optimistic.

Perhaps the most innovative aspect of Urquhart's  original plan was the proposal that,

The whole will be arranged panoptically, so that a superintendent, himself unseen, can, with the exception of one apartment, watch every patient.

Here, Urquhart was following a plan proposed by his family friend and childhood mentor, Jeremy Bentham who, in 1791, had designed the Panopticon as the basis for a new type of prison which allowed the maximum supervision of prisoners by the minimum number of warders.

Like Bentham's prison, however, this Turkish bath was never built. The Asylum Board, rejected the plan on account of its cost, and Sheppard noted in his  report for 1865 that Mr Wood was 'now engaged upon plans of a less elaborate description' for submission to the next meeting of the Visiting Justices.

The Turkish bath approved later that year was, at approximately 700 sq ft, less than half the size of that originally proposed, and of a much simpler construction.

The building work cost £180; equipping, fitting, and furnishing it, a further £120. The total cost of £300 was the equivalent of half of Dr Sheppard's annual salary, or feeding just over 600 patients for one week. The rooms were heated by radiation and even though the doorway was only covered with a blanket, the temperature reached a steady 190º F.

The bath in use

John Johnson was invited to the opening on 26 July 1865 and described how Sheppard  brought in a patient to try the new baths.

It was a case of malancholia—a young intelligent man he seemed, had lost a child, and could not be brought to believe in its death, but fancied it had been stolen. Dr Sheppard said it was a very bad case, as he could not get any sleep. Had not had more than three hours' sleep in four days and nights. Was in the bath nearly an hour, sweated very well, epidermis peeled off in the most extraordinary manner. He was very comfortable all through the bath, and afterwards while cooling, and, despite the conversation going on between four or five persons present as to the bath itself, fell off into a sound sleep. Dr Sheppard woke him, and he said he felt very comfortable. He went to bed at eight and slept soundly till six next morning, when he took exercise—a new man. Dr Sheppard says it was a bad case, but now he will be right in about ten days.

The asylum's annual report for the following year, 1866, had numerous mentions of the Turkish bath and its success.  The Secretary's report noted that 'several of the Patients themselves, when coming before the Committee for their discharge, have attributed their cure in some measure to its influence'.

But although there were always more female than male patients at Colney Hatch, he also noted that,

Up to the present time it has not been used for Female Patients in consequence of the Nurses being ignorant of the duties required, but the Committee have authorised the Medical Superintendent of the Female Department to send a certain number of Nurses to London for instruction, should he think fit to do so.

Unsurprisingly, Sheppard, in his Medical Superintendent of the Male Department's Report, dwelt on his pet project at some length pointing out that Visiting Justices and Medical Superintendents of several other asylums who were considering whether the bath should be added to their own institutions came to Colney Hatch to see it for themselves. He assured those committee members who had previously 'had a not unnatural mistrust of a power so susceptible of misapplication, and so shrouded in prejudices by the community at large' that the Turkish bath at Colney Hatch had been an unqualified success.

It is no wonder that Sheppard should have achieved good results with the Turkish bath, and that it should have gained the approval of his patients. At that time the provision of toilets was inadequate and the normal bathing facilities were considered unacceptable by the Commissioners in Lunacy. Hunter and Macalpine quote a number of their reports criticising the inadequate supply of hot water in the ordinary  baths such that 'about 3 Men and from 3 to 6 Women are bathed in the same water', and that, 'It was not until 1883 that every patient was bathed in fresh water.'

Sheppard was no less up-beat in his report the following year.

The success of the Turkish bath, established in 1865, is abundantly confirmed by the experience of 1866. Upwards of 80 male patients, besides attendants and servants, can testify as to its usefulness.

The bath was now being used by the female patients, with equal success. Mr W G Marshall, the Superintendent of the Female Department, referred in his report to a patient with Dementia after Puerperal Mania who attributed her recovery to the bath.

Previous to her having the baths she suffered from small abscesses of a furuncular character, which she prevented from healing by constantly picking, and she would sit listlessly about the ward, not taking any interest in objects around her. After the third bath her habits became much improved, her health re-established, and she began to employ herself in needlework and general household work, and was a most useful Patient during the remainder of the time when she resided in the Asylum.

In 1867 the Turkish bath had been used 497 times by nearly 100 patients, and the following year, the number of baths had reached 600, the number of Patients themselves being 104, of whom 47 have been discharged as recovered.

But such numbers, of course, represented a very small percentage of the patients, a point noted by the Commissioners themselves who, effectively confirming Urquhart’s initial view, wrote,

The Turkish bath is in active and beneficial operation. We witnessed its application, and from the reports made to us upon the subject, it is we think to be regretted that from its small extent, its use is necessarily much limited and infrequent.

And Sheppard was clearly pleased to hear that the Visiting Justices had heard from the mouths of many Patients, on discharge, how much they attributed their speedy cure to 'the agency of that eastern blessing which is now becoming an institution also of the western world'.

Although Sheppard asked for the bath to be extended, this does not appear to have happened. By now, however, the success of the Turkish bath in helping some of the patients to a speedier recovery was being taken for granted. It warranted no more than passing mentions in the reports of the years which followed, and it is not known how long it remained in operation.

But it continued in use during the reign of the next superintendent and was still in use between 1882 and 1888 when Robert Jones, later Sir Robert Armstrong-Jones, was Superintendent. He was so impressed by it that he took the idea with him to his next post at Claybury Asylum in Woodford, setting up a Turkish bath there in 1893 which, excepting the duration of World War I, remained open until 1939.