Turkish baths in asylums

Sussex District Lunatic Asylum

As with the introduction of the Turkish bath into the British Isles, the opening of a bath at the Cork asylum was soon followed in England. The new asylum at Hayward’s Heath had been opened in 1859 and its Medical Superintendent, Charles Lockhart Robertson was a firm believer in reform, totally opposed to the use on patients of any form of physical restraint, and well-disposed towards hydropathy.

He was one of a number of medical practitioners who been introduced to the Turkish bath in George Witt’s private bath at his home in London’s Knightsbridge. Robertson, like Power, was a member of the Medico-Psychological Association, and would have known about the Cork bath at a very early stage. He decided to install one at Hayward’s Heath.

We know more about this bath than the earlier one because, soon after it was built, Robertson included a full description of it, together with a plan, in his 1861 Journal of Mental Science review of Erasmus Wilson’s The Eastern or Turkish bath.

He was proud of the fact that it cost less than £50, even including the piping in of water for the showers, and that it was probably ‘the cheapest bath which has yet been built’. This was achieved, in part, by constructing it as a lean-to against a new wash-house, so that an existing chimney-flue and stoke-hole could be used, and only two exterior walls had to be built.

The main part of the bath was 10 ft x 30 ft, divided into three rooms, each lit by a window. The hot room (calidarium), with tiled floor, was 12 ft wide. The washing-room (lavatorium) was 9 ft wide, as was the dressing-room (frigidarium) through which bathers entered the bath from the wash-house yard.

The rooms were 12 ft high at the wash-house end, sloping down to 9 ft where they met the exterior wall. This was hollow and, like the space over the ceiling, filled with sawdust as insulation.

The much smaller furnace room—part of the new wash-house—was divided into two, with a door leading from the area housing the shared furnace into the hot room. A curtain placed across the upper part of the room and over the furnace effectively provided a hotter area (laconicum), as David Urquhart had done in the bath at his Riverside home.

A Sherringham ventilator allowed fresh air into the hot room, directing it over the furnace. The heated air then travelled round the room through a flue which, with a board on top, acted as a seat. The room could be heated to 200°F in four hours.

Although the washroom, sensibly built a step lower than the other two rooms, had several types of shower, a pail of water, wrote Robertson, 'when an attendant is at hand, is more convenient, and to many insane patients less alarming, than the douche-pipe.'

The bath was not yet in regular use at the time of writing so Robertson was unable to give any significant clinical information. Although he quoted from an advance copy of Power’s first report, his own rather more cautious belief was that the use of the bath in an asylum would have a general therapeutic value rather than result in specific cures.

David Urquhart's advice and interest

In February 1863, Robertson received a letter from Urquhart asking for information about the use of the asylum bath. Robertson’s reply shows that in the intervening period there had been some constructional changes to the bath, and also to the manner in which it was used.

First, he had replaced the flues underneath the seating by heat-radiating iron pipes from the furnace. Second, he had increased the temperature in the hot room from around 145-150°F to 170°F and, third, he had increased the once or twice weekly time spent in the bath from twenty minutes to an hour. ‘I fully realize,’ he modestly wrote, ‘how much I have to learn yet of the therapeutic uses of the bath; how little I know of its operations.

Robertson found the results of his alterations encouraging. After such a short period, he wisely refrained from assigning cures for specific conditions, although the following year, with rather more experience, he wrote an article for the British Medical Journal about the specific case of a man with suicidal tendencies being successfully treated by the bath.

For now, he contented himself with telling Urquhart that the bath had been helpful in cases of melancholia, with patients who had been refusing food and, with young women, in restoring regular menstruation.

Not least important was the general improvement in health gained from the cleansing effects of the bath, which was ‘a remedial agent grateful to the feelings of the insane, and which they do not, like other means of washing, associate with the idea of punishment.’

Robertson does not need to spell out to Urquhart that a patient’s mental association of washing with punishment was not, in the mid-nineteenth century, a form of persecution complex.

It is true that asylums at that time could not be compared with those of a century earlier when patients were chained to the wall in order to restrain them.

Yet even in the early 1850s, the treatment books of the York Retreat (established in 1796 by the Quaker reformer William Tuke for 'the humane care of the mentally ill’) showed that the prolonged use of showers was frequently resorted to as a means of quieting patients prior to the later, and widespread, prescription of bromides as sedatives.

Such 'showers' were usually hosepipe douches, the temperature and water pressure being determined by whichever attendant was administering it.

When Urquhart went to visit the bath that November he had been expecting to find, he wrote to Sir John Fife, a ‘low temperature, repulsive filth, and unventilated cellars. I found these chambers light and airy, and a temperature of 180°!’

He remarked that Robertson, as physician and manager, had been typically cautious with his initial temperatures and his use of brick flues. But having changed to radiating pipes, the cost of fuel was halved and he found the higher temperature obtained to be ‘more bearable and more agreeable to the patients and to himself’. He even seemed prepared to try Urquhart’s suggested temperatures of 200° or 220°.

As with so many Turkish baths which open with a fanfare, it is difficult to determine how long this one survived. But it seems to have still been in operation in 1899 when plans were drawn up to build a new one.

This page slightly modified 11 October 2019