Circulating Swing belonged to an era prior to the development of more humane treatments for the mentally ill and prior to clear enunciation of their rights.131 From today’s perspective, Hallaran’s use of the swing appears misguided: some two hundred years later, it is to be hoped that increased emphasis on the rights of the mentally ill will ensure sustained emphasis on the dignity of patients during treatment and enhance the provision of evidence based therapies that are humane, safe, effective and acceptable to patients and their families.132
Hallaran’s 1810 textbook concluded with detailed evaluations of a range of therapeutic approaches to mental disorder, including traditional medicinal remedies (digitalis, opium, camphor and mercury) and physical treatments for insanity (shower baths, diet and exercise). Digitalis,133 which appeared to act by ‘restraining the inordinate action of the heart and arteries’,134 had, according to Hallaran, substantial ‘merits as an anti-maniacal remedy, on as high a scale as can well belong to any one subject of materia medica’.135 The current understanding of the action of digitalis (chiefly on a sodium pump enzyme) suggests that digitalis may indeed have had an effect on the brain,136 but it was not until the work of Dr William Withering (1741–1799) that the issues of standardised preparation and dose-response characteristics were identified as critical for the safe and effective use of the drug.137
Hallaran believed that opium138 had ‘deservedly obtained a principal character amongst anti-maniacal remedies’139 but that camphor, another common treatment,140 ‘frequently failed altogether’ in the treatment of mania.141 He had similar doubts about mercury142 except, perhaps, ‘as a preparative for the commencement of the digitalis’.143
Hallaran was notably enthusiastic about water treatments,144 maintaining that the shower-bath worked ‘by immediately tranquilising the high degree of febrile action’145 and ‘answers an extremely good purpose in enforcing cleanliness at all seasons’ (a real consideration in large, unhygienic asylums).146 Other water treatments of the day primarily aimed at inducing shock and terror, and included the ‘bath of surprise’ whereby the mentally ill person was thrown from a bridge into running water and caught with a net; being dragged through a river; or being forced into a dark room, one half of which comprised a cistern of water into which the person would inevitably fall while seeking to escape.147
In 1756, Charles Lucas (1713–1771), a radical Irish physician, apothecary and politician, had published an enthusiastic, influential Essay on Waters dealing with ‘simple waters’, ‘cold medicated waters’ and ‘natural baths’:
It will appear strange to every attentive reader, that the most useful and necessary part of the creation, whether economically, physically, or medicinally considered, has been so far, and so long neglected, as to make it, at this day, necessary to compile so large a volume as this, to rectify men’s notions in so interesting a point!
[…] Warm bathing, for the like reasons, had long been an established and approved remedy amongst the ancients, in all kinds of mania or madness; though in this, as well as other respects, it has become so much neglected by the moderns.148
In 1772, a year after Lucas’s death, a similarly themed volume was published in Dublin, titled The Theory and Uses of Baths, Being an Extract from the Essay on Waters by the Late Charles Lucas, Esq., MD, with Marginal Notes by Dr Achmet, Illustrated by Some Annexed Cases.149 The distinctly enterprising ‘Dr Achmet’ (also known as Patrick Kearns and Patrick Joyce) ran the Royal Patent Baths at Bachelors Walk in Dublin, offering a range of water therapies, including hot and cold baths flavoured with putrefying horse manure.150 In the 1772 volume, ‘Dr Achmet’, perhaps unsurprisingly, recounted excellent testimonials from his clients, including the following fulsome account of one water cure:
My case when I began the use of the vapor baths was as follows; the disorder in my head had arose to such a degree, that I was in almost a constant state of delirium, and my mind so full of inquietude and uneasiness, that I could not stand or sit any length of time in one place, and at certain times, my bowels seemed full of pains and inflammations, and an almost constant burning painfulness in my fundament, with a callous lump below my groin; in short, my situation was such, that rest, either day or night, I was a stranger to.
I have now been one month under the doctor’s care [‘Dr Achmet’], in which time he has treated me with the utmost tenderness, attention and care; and since the first week of my residence with him, I have daily continued recovering the use of my senses, and faculties, and my disease seems, in every place that it affected me, to have submitted to the salutary effects of his medicines and vapor baths; in such a manner am I now, that I hope, through the blessing of God, of being as well as ever I was in my life. I must here observe, that when I first went into the vapor, or steaming bath, my time was limited every other day to about an hour, and that in the last week of my being there, I generally spent every day from three to four hours in the said bath …
… I have continued to recover my strength, and am light, supple, and full of spirits at this time …151
Back in Cork, Hallaran, in addition to promoting water treatments, also recognised the importance of diet and described the asylum’s ‘farinaceous diet’ (i.e. consisting of meal or flour)152 in some detail. ‘Animal food’ was carefully restricted to ‘certain seasons of the year’ owing to its tendency to produce a ‘disposition to riot’ and ‘aggravation of insanity’.153 This was an intriguing objection to meat, given the centrality of alcohol (wine, beer, porter, etc.) in asylum diets – for both patients and attendants – throughout much of the 1800s.154 (The cost of wine and spirits could be included in the budget for ‘medicines’, which was helpful).155
Regulation of diet was a key element in programmes of ‘moral management’ which were employed in most Irish asylums throughout the nineteenth century.156 Other elements included regular exercise and gainful occupation.157 This therapeutic approach, along with the principle of the ‘panopticon’ (having a point from which an unseen governor could see all), had a critical influence on the design of many Irish asylums constructed during the great ‘asylum-building era’ of the nineteenth century,158 The ‘moral management’ paradigm actively informed the ‘Kirkbride Plan’, advocated by Thomas Story Kirkbride (1809–1883), a Philadelphia mind doctor.159
Hallaran also paid considerable attention to exercise and gainful activity. He suggested ‘removing the convalescent, and incurable insane, to convenient distances from large cities and towns, to well enclosed farms, properly adapted to the purposes of employing them with effect, in the different branches of husbandry and horticulture’.160 Over the following two hundred years, various developments in the practice of psychiatry (including the introduction of neuroleptic medication) were to tilt the balance away from this broad based, multi-modal approach to treatment recommended by Hallaran. The late twentieth century, however, saw the re-emergence of reenergised models of biopsychosocial psychiatry which emphasised the role of occupational therapies in the process of recovery,161 consistent with the approach outlined by Hallaran almost two centuries earlier.
Developments in England,
France and the United States
As these developments and innovations in treatment were unfolding in late eighteenth- and early nineteenth-century Ireland, especially in Hallaran’s establishments in Cork, they coincided, to greater or lesser extents, with significant shifts in practice elsewhere. In England, the asylums that emerged during the 1700s were mostly highly custodial places and, although there were inevitably pockets of enlightened practice, there were also clear, systematic problems across the emergent system. At Bedlam in London, there were continual reports of abuse and poor conditions, albeit accompanied by contrasting reports of good treatment at times, with the result that Bedlam was subject of interminable speculation among journalists, politicians and the public, to whom it provided endless cause for concern and morbid fascination.162
More broadly, the asylums of eighteenth-century England
