SPA MEDICINE Patients, Practitioners and Treatments in Stuart and Georgian Bath An anthology compiled by Trevor Fawcett Prescription written by Dr William Oliver for George Tyndale, 12 May 1756 (Bath Central Library, William Oliver prescriptions, A.L. 732, 737-44) 1 INTRODUCTION THE HOT WATERS What most recommended Bath as a place of healing was of course the promise of the mysterious, subterranean hot waters that gushed out copiously at several springs on the site and fed the three principal baths. Bathing in ordinary water of a comfortable temperature would have soothed certain physical conditions anyway, but common belief endowed the Bath waters with quite unusual extra healing qualities, making them a natural medicine for a huge range of complaints from paralysis, chronic rheumatism, skeletal deformities and gout to digestive disorders, skin disease and infertility. Categorised as hot and ‘dry’ (i.e. inducing thirst), they suited cool, moist, ‘phlegmatic’ illnesses best, and by the same token were inappropriate for conditions such as lung complaints and fevers. Theories of disease were currently in flux, as the long-held belief that chronic illness resulted from imbalances in the four cardinal humours (blood, phlegm, yellow and black bile) contended with newer doctrines about the chemical and mechanical nature of human physiology. Medical opinion agreed, nevertheless, that illness resulted when the free movement of bodily fluids became impeded by blockages in the ducts, vessels and internal organs that carried them and by impurities in the fluids themselves. The great aim of hot water treatments was therefore to help remove these blockages and expel impurities through sweating, urine, and evacuations – frequently with the additional aid of drugs taken before or during the water cure. It ideally required an extended course of treatment of many weeks or months. Actual immersion in the baths (or the alternative of dry pumping, when a particular part of the body was doused in hot water) was not the sole form of hydrotherapy. The waters might equally well be taken internally by drinking them straight from the pump or, if that proved impractical, in bottled form away from the springs. Therapeutic drinking was little practised at Bath until after the Restoration of 1660, the start of our period. During the Elizabethan and early Stuart promotion of the spa, people mainly came to bathe. Only when new drinking pumps finally ensured a safe supply, uncontaminated by water from the baths, did water drinking take off at Bath, as it long had at Tunbridge Wells, Epsom and Harrogate, and abroad at Spa and Bourbon. By 1673 Bath was already sending bottled water to London and other places. Yet the impoverished Corporation remained slow to improve drinking facilities. It took the royal visits of 1702-3 to stir the city into action by erecting the first Pump Room, opened in 1706. At that stage drinking was being prescribed more commonly than bathing, and sometimes in quite large doses of six pints or more a day. Later on barely half that amount would be thought sufficient. Bathing proper may have declined for a time before returning to favour. One visiting doctor, John Quinton, noted in 1734 that he had ‘liv’d to see the ancient Custom of Bathing reviv’d, and more than double the Number of Persons who have Bath’d in this, than any preceding years…’. None of the baths was really convenient, however, and all of them were unroofed and open to the elements – less than ideal when the main visiting season, formerly confined to the summer, evolved into autumn and spring seasons instead and eventually embraced the winter months as well. Moreover, the King’s and adjoining Queen’s Baths were all too public, overlooked by private lodging houses and from 1706 by the Pump Room itself. The Cross Bath served for some decades as the preferred bathing place for gentry, but like the nearby Hot Bath was quite small and short on amenities. From 1742 the Hot Bath had a further role as the resort of patients undergoing treatment at the Bath General Hospital. Both these baths were much rebuilt in the later eighteenth century, but various tinkering at the King’s and Queen’s Baths throughout the period brought only modest 2 improvement to the bathing arrangements. In due course two private baths increased the choice – the Kingston Baths from 1766 and the New Private Baths in 1789. The Corporation owned all the other bathing establishments and appointed the varied staff of sergeants (i.e. the two supervisors), bath guides and cloth women, as well as deriving considerable revenue from leasing out the mineral waters to a long succession of ‘pumpers’. The Pump Room itself – slightly improved in 1733, extended in 1751, and then magnificently rebuilt in the early 1790s – was a further civic responsibility. That the waters were medically beneficial remained an article of faith to practitioners and patients alike, though exactly how they operated was guesswork, and what, besides heat, were their vital constituents aroused anxious debate. Sulphur was assumed to be a key ingredient from an early date thanks to its association with subterranean fire, its prestige in alchemy, its undoubted presence at certain other spas, and the apparent yellow-staining effect on items immersed in the baths. This notion was supposedly ‘exploded’ in 1674 when Dr John Mayow found no trace of sulphur, yet sulphur soon returned to favour alongside the idea that bitumen, nitre, or a ‘salino-suphureous’ ingredient also played an active part, together with a volatile gas that escaped as the waters cooled. Writing in 1704 the elder Dr William Oliver spoke of ‘a Chaos of Salts’ plus ‘an exalted Vitriolick Steel’ that gave the waters their chalybeate quality. The influential Dr George Cheyne pictured the waters washing into the bloodstream where the contained sulphur and steel acted like a detergent, cleansing even the minutest vessels and bracing the bodily fibres. Imbibing the hot mineral waters at the fountainhead before they had gone flat was, for some observers, essential to their effectiveness, drinking them at a distance being ‘a splendid fallacy’ – a view naturally rejected by all those trading, either by civic authority or clandestinely, in bottled spa water, including the proprietors of several cold water medicinal springs near Bath, at Lyncombe, Rode and Middlehill. The sulphur theory came under renewed attack in the 1750s when Charles Lucas, an Irish medic, analysed the waters afresh and detected no such component. His analysis again threw into question the very nature of the magic fluid on which Bath’s whole spa economy ultimately depended, not to speak of the reputation of the local medical establishment. A campaign to nullify Lucas’s finding was needed at once, and it took the form of a semantic sleight of hand. Dr Rice Charleton provided the main counter claim in 1754. The term ‘sulphur’, he wrote, should not be taken to mean the yellowish element known also as ‘brimstone’ that burned with a blue flame, but rather ‘in a much more extensive Sense, so as to comprehend all unctuous Bodies in general.’ Since Bath waters contained unctuous substances they merited being called sulphureous. And so the issue was glossed over, though henceforth there would be a greater tendency to see dissolved iron or ‘steel’ (i.e. a ‘chalybeate impregnation’) as the most active healing principle. This was Dr George Smith Gibbes’s contention still in 1803 for example. Alternatively one could point to Dr William Falconer’s claimed discovery that the waters contained carbon dioxide and that this was significant. The important thing was to maintain their mystique against the argument that the benefits of drinking were relatively minor compared with the effects of all the herbal and chemical medicines that were urged on patients, or indeed of the healthier lifestyle many of them adopted while at the spa, lighter diet, gentle exercise, and early nights, besides the change of scene. On the other hand the advantages of bathing in the waters, in contrast to drinking them, could more easily be shown – as in the statistics of full and partial cures achieved at the General Hospital - especially in cases of palsy, joint and muscular problems, and skin disease. More arguable was whether the simple heat of the baths produced the improvement or the much-contested extra ingredients? MEDICAL INSTITUTIONS If the first sites of organised medical practice were the hot baths, they were joined over the years by a variety of more specific institutions, starting with the Bath General Hospital (opened 1742) or, in a 3 lesser way, much earlier still (c.1609) with Bellot’s Hospital, a short-stay house with medical supervision for twelve poor patients at a time. Like Bellot’s, the Hospital admitted only officially nominated applicants from outside Bath. It was in effect an institutional means of controlling the numbers of the sick and lame poor who might otherwise resort to the spa claiming their natural right to the bounty of the hot springs, because any unauthorised arrivals could now be categorised as vagrants and summarily removed. Partly on these grounds the Corporation sanctioned the Hospital through an Act of Parliament in 1739 but took no civic role in its building, financing and administration which came instead under an independent charitable body of trustees. Dependent on public philanthropy, the institution stressed its rigorous standards, financial integrity, and medical usefulness from the very start. It was headed by an elitist panel of governors, advertised its presence nationally, issued annual reports, carried out weekly inspections, and appointed a team of honorary physicians and surgeons who, limited solely by the current state of Hospital finances, ruled on admissions, courses of treatment, and discharge of patients.