retained in current classification systems.100 The distinction between organic and functional disorders, as emphasised by both Hallaran and Kraepelin, is also retained in diagnostic and clinical practices some two centuries after Hallaran’s text first appeared.
Unsurprisingly, Hallaran was, like virtually all of his peers, deeply concerned with ‘the extraordinary increase of insanity in Ireland’, which he, characteristically, attributed to both ‘corporeal’ (i.e. bodily) and ‘mental excitement’,101 and which he also related to the effects of social unrest,102 ‘terror from religious enthusiasm’,103 and ‘the unrestrained use and abuse of ardent spirits’,104 among other factors. Unlike many of his peers, however, Hallaran brought a great deal of systematic and critical thought to the treatment of mental disorders, expressing scepticism about many of the established remedies of the times and notable enthusiasm for others.
Treatments in the Late 1700s and
Early 1800s: Spin Doctors
In his 1810 textbook, Hallaran provided a careful consideration of many traditional physical treatments for mental disorder (e.g. bloodletting); a detailed exploration of novel treatments (e.g. Dr Cox’s Circulating Swing, which is explored shortly); and a re-evaluation of traditional medicinal remedies (e.g. opium) and various other approaches (e.g. shower baths, diet and exercise).105
These treatments, and Hallaran’s relatively scientific approach to them, represented a shift from older, more traditional practices which, according to Lady Jane Wilde (1821–1896), included placing the mentally ill person in a pit in the ground (three feet wide and six feet deep), with only the head uncovered, and leaving him or her alone for three days and three nights, without food or contact with anyone.106 A harrow-pin (from a harrow, an agricultural instrument) was placed over the person, owing to the alleged mystical properties of harrow-pins. If the unfortunate person survived this dreadful ordeal, it was reported that a cure might be effected, although Lady Wilde conceded that the majority of those who survived emerged from the pit cold, hungry and mentally worse than ever.
Lady Wilde also recounted folk beliefs that madness was both hereditary and caused by demonic possession, and could be cured by drinking honey, milk and salt in a seashell before sunrise.107 Other treatments included exorcism by witch doctor, which involved the local witch doctor drinking whiskey, speaking unintelligibly at some length, throwing holy water over the patient and room, hitting the patient repeatedly with a blackthorn stick (while the patient was held down), and then swirling the blackthorn stick wildly around the room hitting any people or objects it encountered.108 Particular attention was paid to hitting the door through which the demon would allegedly escape. The exorcist was comprehensively fortified with whiskey throughout this elaborate, alarming, brutal process.
It is not entirely clear when this ritual dates from, how long it persisted, or whether it occurred at all, but Lady Wilde goes on to describe a specific example which, she says, took place ‘lately’ (her book appeared in 1890).109 If Lady Wilde’s sources are to be regarded as reliable, this is a most disturbing case. It concerns a man in Roscommon who apparently became mentally ill and was bound hand and foot, foaming at the mouth. He was described as ‘elf-stricken’ as it was believed he had been replaced by a fairy demon. The witch doctor was summoned and concluded that the unfortunate man had been replaced by a horse which needed to be fed oats in order to keep the horse alive and, thus, keep the real man (now in Fairyland) alive too.
At this, the patient was forcibly fed a sheaf of oats while the exorcist and the general company sent for five kegs of poitín (poteen, a strong, distilled, alcoholic Irish beverage) to fortify themselves for the exorcism ahead. A bucket of cold water was thrown on the patient’s head and the exorcism began. In the midst of the ritual, however, the patient was untied and immediately made as if to attack the witch doctor, with the result that the witch doctor and all the others fled the house, pursued by the extremely irate patient. The patient was, however, soon overpowered and again tied up, after which a magistrate ordered that he be brought to Roscommon Lunatic Asylum, where he is said to have died.
By way of contrast with these disturbing, dramatic tales, Hallaran’s treatment techniques in Cork in the early 1800s were significantly less punitive, although they were not entirely without drama either. Turning to traditional physical treatments first, Hallaran expressed particularly little faith in venesection (bloodletting) which was a common treatment for a range of conditions, including mental illness, for many centuries.110 While acknowledging the usefulness of venesection in certain circumstances, Hallaran generally felt that ‘bleeding to any great extent does not often seem to be desirable, and except in recent cases, does not even appear to be admissible’.111 This was consistent with the views of Dr William Battie (1703–1776), influential author of Treatise on Madness, who had written in 1758 that bloodletting was positively harmful if the patient was feeble or suffering from convulsions.112
The administration of emetics, to make the patient vomit, was another common treatment for a range of disorders,113 but while Hallaran acknowledged ‘the use of emetics in all febrile affections’ (i.e. infections producing high body temperature),114 he was cautious about their use in mental disorder: ‘I have been a witness to very disagreeable consequences arising from the want of necessary precaution on this head, which have deterred me from directing full emetics in any case’. Battie was similarly circumspect about vomiting.115
Notwithstanding these views, emetics and purgatives were commonly used for a range of physical and mental disorders in Ireland and elsewhere: in 1810, the same year that Hallaran published his textbook, Dr Martin Tuomy, Fellow of the Royal College of Physicians of Ireland, produced his Treatise on the Principal Diseases of Dublin116 in which he explicitly endorsed the use of purgatives and emetics, which might be administered daily for up to 21 days. As was the case with bloodletting, these treatments were aimed at evacuating noxious ‘humours’ from the body in order to produce clinical improvement. There was, however, growing disenchantment with the indiscriminate use of emetics and purgatives throughout the nineteenth century, and prescriptions for more violent emetic and purgative agents declined as the century progressed.117
Hallaran noted that patients occasionally exhibited ‘excessive obstinacy’118 and, in such circumstances, he recommended the use of the ‘circulating swing’ which had been recently developed by Dr Joseph Mason Cox (1763–1818), a Bristol-born mind doctor.119 Building on the work of Dr Erasmus Darwin (1731–1802) who described a ‘rotative couch’ aimed at inducing sleep,120 Cox suggested suspending a chair from the ceiling by means of ropes; seating a patient securely in the chair; and instructing an asylum attendant to rotate the chair at a given speed, thus spinning the patient around a vertical axis for a given period of time.121 This technique was employed at many asylums throughout nineteenth-century Europe, especially in German-speaking countries.122 It was, according to Cox, ‘both a moral and a medical mean in the treatment of maniacs’.123
In Ireland, Hallaran ‘was not slow in taking advantage of Dr Cox’s observations’124 and assembled an apparatus that was ‘so contrived, that four persons can if necessary, be secured in it at once’.125 Hallaran used this ‘Herculean remedy’ for patients ‘who have been recently attacked with maniacal symptoms, and who, previous to its employment, had been sufficiently evacuated by purgative medicines’.126
In the ‘obstinate and furious’ the swing reportedly generated ‘a sufficiency of alarm to insure obedience’, while in the ‘melancholic’ it generated ‘a natural interest in the affairs of life’.127 Hallaran warned against indiscriminate use of the apparatus, advising particular caution with tall patients and noting that certain patterns of rotation could produce ‘sudden action of the bowels, stomach and urinary passages, in quick succession’.128 Despite these drawbacks, the swing was also a source of entertainment for certain patients who ‘used it sometimes when permitted, as a mode of amusement, without any inconvenience or effect whatever’.129
Despite Hallaran’s awareness of the adverse effects of the swing,
