The Role of Medical Practitioners

8/12/2019 The Role of Medical Practitioners

1/24

63

THE ROLE OF MEDICAL PRACTITIONERS

From the seventeenth century, medical writers had explored the medical value

o bathing in cold water and seawater and their combined wisdom seems to havebeen that the sea could cure almost every condition. Doctors led the way in pro-moting bathing practices and providing medical texts or others to ollow andthey helped to promote the virtues o one resort over another. Dr Robert Wittie

published a detailed study o Scarboroughs spa waters in 1660 in which he cau-tioned against taking seawater internally, but in the second edition published in1667 he admitted using it successully to treat an attack o gout.1Te use o sea-

water and salt water was soon taken up by other doctors and scientists. In 1696Sir John Colbatch employed saline water and steam bathing in a bathhouse thathe built near the salt deposits in Cheshire, treating patients in a primitive ormo sauna.2A ew years later in the early eighteenth century Sir John Floyer recog-nized that: Since we live in an Island, and have the Sea about us, we cannot wantan excellent Cold Bath, which will both preserve our Healths, and cure manyDiseases, as our Fountains do.3In this simple statement he made the explicit,logical link between cold bathing and sea bathing, ushering in the new, national

vogue or using the sea.By the time o Floyers death in 1734 local doctors were beginning to promote

sea bathing, as well as their own medical practices and their local resort to attractclients to their town. In 1735 Peter Shaw wrote about Scarborough as a destina-tion or bathing, while the writings o Dr Richard Russell and Dr John Awsiterhelped to make Brighton popular in the 1750s and 1760s.4Dr Russell has beensingled out by many historians or his leading role in the promotion o the use oseawater or health, but more recent research has suggested that he was building

on a medical tradition that stretched back into the seventeenth century.5

In termso the development o bathhouses in the town it was another doctor who tookthe lead. By 1768 Dr Awsitter was advocating that bathhouses could be used byinvalids all year round and he included a blueprint or a bathhouse.6

At the end o the eighteenth century John Anderson discussed sea bathingbecause o his connection to the new Royal Sea Bathing Hospital at Margate.His book offers a detailed scientic examination o the conditions that could


2/24

64 ravel and ourism in Britain, 17001914: Volume 3

be treated by seawater bathing and how this should be conducted.7Like othereighteenth-century writers he believed that a huge range o conditions couldbe susceptible to this treatment. He included in this list rheumatism, scurvy,leprosy, diabetes, rickets, nervous complaints, poor circulation and various com-mon inections. Patients at the hospital had to be recommended, then examinedin London beore being sent to Margate.8Te treatment at Margate was initially

primitive. Patients were taken to the sea and ully immersed using the hospitalsbathing machine, but this treatment was unsuitable or most o the year and inthe mid-nineteenth century an indoor pool was built.

Doctors, such as Tomas Reid rom the Isle o Tanet, recommended thatbathing should take place beore the sun had a deleterious effect on the sea andDr Crane warned against a great depression o the spirits i bathing took placelater in the day.9 Tese explanations might be medical but another potentialexplanation or getting bathing out o the way was to leave the rest o the dayree to enjoy the entertainment that resorts had to offer.10

Te consensus o Georgian medical writers was that people should bathe incold water, but Dr Awsiter at Brighton suggested that a warm bath might moreeffectively open the pores and allow salt water to penetrate.11His idea, whichundoubtedly helped the promotion o the bathhouse he was soon to open,ound support rom Dr Reid in Kent. He observed that a warm bath heated tobetween 90 and 100 degrees Fahrenheit could benet those weakened by disease

with the warm water acting as a sedative.12

Unsurprisingly, the collective wisdom o medical writers was that qualiedproessional staff should administer sea bathing to patients. Doctors wanted toretain control o a lucrative activity taking place in their resorts, though theydressed this up with medical reasons.13Tomas Hinderwell writing at the end othe eighteenth century eared that:

by continuing too long in the water or Bathing improperly very serious consequencesmay ollow, as catarrh, ever, epilepsy, apoplexy, and even death. Hence the necessityo caution in Bathing in the Sea or Cold Bath; or I have known healthy persons bathethemselves into ill-health.14

As well as qualied doctors, another group o people were involved with thetreatment o patients. o help bathers using bathing machines in saety, guides,

ofen reerred to as dippers, could be hired. At Scarborough in the 1780s eachlady bather was attended by two guides and gentlemen by one guide, i required,while a lad tended the horse that pulled the vehicles into and out o the sea.15Most, though by no means all, dippers or bathing guides were women whoencouraged timid bathers into Britains cold waters and they also served as asaety measure or people who could not swim, probably the majority o Geor-gian bathers. Tese women acquired a certain admiration and even celebrity in


3/24

Te Role of Medical Practitioners 65

their lives, with Te imesdescribing them as mermaids: Bathing has been somuch the mode, that the emale guides have been converted into mermaids;they are become a sort o amphibious animal in pickle, rom blushing June todark November.16Some bathing guides seem to have developed a reputation ortheir medical knowledge; Dr Anderson in 1795 cited the opinions o a numbero guides who had witnessed the positive effects on the health o their invalidcharges.17Te most amous was probably Martha Gunn who is buried in Bright-ons churchyard; she died on 2 May 1815 aged 88 afer serving as a bather ornearly seventy years.18Te duties o dippers were not restricted to in the sea,but at times enorced the separation o the sexes on the beach. A 1770 guide-book tells o a man who accidentally turned up to bathe in the area reserved or

women at the end o the Steine and was driven off by a dipper.19

Notes1. R. Wittie, Scarborough Spaw (York: Richard Lambert, 1660), pp. 4650; R. Wittie,

Scarbrough-Spaw: or a Description of the Natures and Virtues of the Spaw at ScarbroughYorkshire (York: Richard Lambert, 1667), p. 172.

2. J. Colbatch, A Physico Medical Essay, Concerning Alkaly and Acid (London: DanBrowne, 1696), pp. 13841.

3. J. Floyer, Te Ancient [Psykhrolysia] Revived: or, an Essay to Prove Cold Bath-ing both Safe and Useful(London: S. Smith and B. Walord, 1702), p. 191.

4. P. Shaw, A Dissertation on the Contents, Virtues and Uses, of Cold and Hot MineralSprings; Particularly Of Scarborough: In A Letter to Robert Robinson, Esq; Recorder ofthat Corporation(London: [n.p.], 1735; London, 1752): J. Awsiter, Toughts on Bright-

elmston. Concerning Sea-Bathing, and Drinking Sea-Water. With Some Directions fortheir Use (London: J. Wilkie, 1768).

5. A. Brodie and G. Winter,Englands Seaside Resorts(Swindon: English Heritage, 2007),pp. 810; A. Brodie, Liverpool and the Origins o the Seaside Resort, Georgian GroupJournal,20 (2012), pp. 6376.

6. Awsitter, Toughts On Brighthemlston, pp. 1718.7. J. Anderson,A Practical Essay on the Good and Bad Effects of Sea-Water and Sea-Bathing

(London: C. Dilly, etc., 1795), p. 9.8. F. G. St Clair Strange, Te History of the Royal Sea Bathing Hospital, Margate 17911991

(Rainham: Meresborough Books, 1991), p. 29.9. . Reid, Directions for Warm and Cold Sea-Bathing; with Observations on their Appli-

cation and Effects in Different Diseases(London: [n.p.], 1795), p. 8; J. Crane, CursoryObservations on Sea-Bathing; the Use of Sea-Water Internally, and the Advantages of a

Maritime Situation, as Conducing to Health and Longevity to Which is Added, a Concise

History of Weymouth(Weymouth: Printed or the author, 1795). p. 87.10. J. Cole, Te History and Antiquities of Filey in the County of York (Scarborough: John

Cole, 1828), p. 109.11. Awsiter, Toughts on Brightelmston, p. 15.12. Reid,Directions for Warm and Cold Sea-Bathing, pp. 1517.13. Russell, A Dissertation on the Use of Sea-Water in the Diseases Of Te Glands, p. 131;

Anderson,A Practical Essay on the Good and Bad Effects of Sea-Water and Sea-Bathing,p. 63.


4/24


14. . Hinderwell, History and Antiquities of Scarborough (York: Tomas Wilson, 1798),p. 197.

15. J. Schoeld,An Historical and Descriptive Guide to Scarborough and its Environs(York:W. Blanchard, 1787), p. 20.

16. Te imes, 26 September 1805, p. 3.17. Anderson,A Practical Essay on the Good and Bad Effects of Sea-Water and Sea-Bathing,

pp. 29, 56, 57.18. K. Ferry,Beach Huts and Bathing Machines (Oxord: Shire, 2009), p. 10.19. Te New Brighthelmstone Directory(London: . Durham, 1770), pp. 223.


5/24

67

J. AWSITER, HOUGHS ON BRIGHELMSON.CONCERNING SEABAHING, AND DRINKING

SEAWAER1768

J. Awsiter, Toughts on Brightelmston. Concerning Sea-Bathing, and Drinking Sea-Water(London: J. Wilkie, 1768), pp. 413, 1420.

Dr. John Awsiter was one o the doctors in Brighton who sought to attract visitorsto the resort who were in search o improved health. Te most amous physician wasDr Richard Russell (16871759), who had a practice in Lewes and later Brighton.1

When Russell died, most o his practice at Brighton passed to Dr Anthony Rel-han. By the 1760s a number o London doctors also came to Brighton to cater orthe growing numbers o visitors.2Tereore, alongside Relhan there was Dr Poolerom Lewes, who had bought a house in the resort, Dr Schomberg and Dr Lucas

Pepys, as well as Awsiter. Awsiters book would have helped to promote Brighton,but it would also have promoted his practice in particular.

Like other contemporary medical writers, Awsiters book argues that sea-water could cure a wide range o conditions. He examines bathing in the sea,drinking seawater and using salt to cure conditions. He includes some recipesto make the consumption o seawater more palatable, though his ideas or usingsalt to cure the bites o a rabid dog required mixing it with urine. Awsiters bookrecommended that bathing machines should have skreens at the rear to protectbathers rom view and rom waves in the sea.

Awsiter also examines some o the history o sea bathing, looking at traditionso cold water bathing, as well as practices in warmer countries and during the erao the Roman Empire. Although much o Awsiters work reects ideas espousedby other writers, he is unusual in advocating the use o warm water bathing. Some

writers suggested warm water or rail patients, but Awsiter recommended that allpatients would benet rom it, using the evidence o Bath where people were suc-cessully treated in its warm and hot water baths.3He also contradicts the widelyheld opinion that sea bathing should only take place during the morning, hisexperience suggesting that the effects were the same at any time o the day.


6/24


Te reason or Awsiters advocacy o the use o warm water bathing andbathing at any time o the day is because in the ollowing year he would open abathhouse. In this extract he included a blueprint or a small, warm water bath-house, covering thirty square eet and standing twelve eet high. It would containour rooms, each with a bath, behind which would be a copper or heating the

water. In 1769 his rst bathhouse was erected in the area known as the Pool,at the southern end o the Steine, close to the established sea-bathing sectiono beach.By 1803 the building was rectangular in plan and had a neo-classicalaade that included a pediment and dentils. It contained two cold baths, ourhot baths and a shower bath.4

Notes1. His scientic observations on the virtues o sea bathing were published inDe tabe glan-

dulari, sive, De usu aqu marin in morbis glandularum dissertatio (1750), with anEnglish edition entitledA Dissertation Concerning the Use of Sea Water in the Diseases ofthe Glandsbeing published in 1752.

2. S. Berry, Georgian Brighton(Chichester: Phillimore & Co, 2005), pp. 245.3. See Volume 2, p. 215.4. A. Brodie and G. Winter,Englands Seaside Resorts(Swindon: English Heritage, 2007),

pp. 99100.


7/24

69

J. Awsiter, Thoughts on Brightelmston. ConcerningSea-Bathing, and Drinking Sea-Water(1768)

ON BAHING.

Bathing in the sea or pleasure, arises rom two motives, the love o cleanliness, andthe rereshment that cold bathing affords the body, by bracing and cooling it. othis a bold sandy shore contributes, where the water is clear, and ree rom the mix-ture o muddy resh waters, which always deposite a quantity o lth; where thedescent o the shore is gradual, not rocky; and where the tides do not suddenly rise,to make bathing dangerous: Such a shore or sea-bathing is to be preerred, and the

perection o such a shore Brightelmston1can boast. But with all these advantages,there are inconveniencies which attend sea-bathing here; yet none but what maybe easily remedied, by a proper attention o the inhabitants.

Te coast o Brightelmston being open to the main sea, there is no shelter tothe Bathers rom the wind, which sets in to this shore almost constantly; and,i the weather is not very serene, the great agitation o the water occasionedthereby, makes the bathing ofentimes disagreeable, not to say dangerous, moreespecially to the ladies. Tis inconvenience may be remedied by a different posi-tion o the bathing machines while in use.

I would recommend that one hal the number o machines,2at least, be pro-vided with skreens, to extend projectingly rom the top o the door to the water,somewhat afer the manner o those at Margate; these would keep off the wind,and make the machines more private. o this may be objected, the orce o the

waves, and strength o the wind, which might / overset the machines so pro-

vided; but this inconvenience is easily remedied.When the sea is much troubled, the machines should be turned, and pushedbackwards a suffi cient depth into the sea, that the person bathing may go into the

water with his ace to the shore, and rom this position o the machine will arisetwo advantages: Te waves will be prevented rom breaking against the door othe machine, and wetting the party while undressingor dressing, and the machineby being placed between the person bathing and the sea, will break off the orce


8/24


o the waves, and be a shelter rom the wind; and when several are placed near toeach other, afer this manner, the shelter o them will be very considerable, andconsequently the bathing rendered much more comortable. I think the shoreon the East o the town is allotted to the use o the ladies, without any mixtureo gentlemen, and I think a urther rule should take place: Tat no man servantor inhabitant, be permitted to bathe on that side o the town during the season.

It has been a notion generally received, though very erroneously, that bathingis most wholesome in cold weather, the blood and humours3not being so liableto agitations as in Summer heats: Te utmost orce o which mode o reasoningcentres thus; by bathing in cold weather only, the person who bathes has it notso much in his power to hurt himsel by imprudence.

Te pores o the skin are more closed, and perspiration carried on more spar-ingly in cold weather, and when very cold the pores will be braced sometimes toa degree o rigidity, whereby the humours necessary to be breathed off, by theskin, are interrupted, and ofen occasion xed pains in the limbs; in these casescold bathing will not open the pores properly, and we must have recourse to thetemperate bath and riction. Te / Germans, in such cases, relieve themselvesby warm medicated baths; and though it is a custom among the Russians to usecold bathing, to inure them to the extremes o their climate, we are inormedthat they go into the warm bath rst; and, at any rate, water in a uid state intheir country, during the colder months, must be warmer than their atmosphere.

We nd that bathing was never much practiced in Northern countries; but

i we turn our eyes to the Eastern and warmer climes, we can trace it back agreat way into antiquity. Bathing was a custom prevalent with the gyptians,or Pharaohs daughter would not have ound Moses among the bulrushes; prob-ably it was a part o their law, a religious institution to prevent the ravages othe Plague, which so continually swept off numbers o their people. From thesemotives also bathing became a part o the Jewish religion, the Mosaic law being

partly ounded on those o the g yptians; it is thus used among the urks andMahometans, and o the pleasure-baths o these people, Lady Mary WortleyMontague4has lately given us some account.

Te propriety o bathing in hot countries is obvious, or when the pores othe body are relaxed, the spirits wasted, and the skin also ouled by great dis-charges o sweat, arising rom intense heat, what can so soon cleanse the skin,

recruit the spirits, and restore the body, under these circumstances, as bathing.It is to be observed, that bathing, as originally used, was in natural baths,

and mostly in rivers, which by the agitation o their waters, and their suracesbeing constantly exposed to the sun, were in a state o warmth, though muchcolder than the atmosphere, and very different rom the cold o articial baths,the waters o which are in a state o rest, and shielded rom the sun, on whichaccount these require greater caution when brought into use. /


9/24

Awsiter, Toughts on Brighthelmston 71

Bathing being much used in the East, it is but natural to suppose the inhabit-ants o towns which bordered on the sea, rom a scarcity o resh water, were putofentimes to the necessity o bathing in sea-water; learning hence that seawaterdid not harm them, but contrarywise was serviceable in many respects, it becamea physical concern; in early ages the priests were the physicians, through whom

probably Hippocrates5was enabled to write a whole book on water.Te Greeks, copying the Eastern people, made great use o baths, and the

Romans afer them, who used them to such excess that they became a specieso luxury; every street o Rome had baths, the emperors erected stately edices,

with baths or public use, and there was not a Roman o note who had not,within his house, a sweating room, hot, a temperate, and a cold bath. Pliny,6in aletter to Gallus, describing his villa, gives some idea o these by an account o hisown; and the degree o elegance to which they carried these articles o luxury wasamazing.* Te use the Romans made o their baths was to y to them as a mate-rial remedy in disease; in these cases they used the temperate bath, hot bath, andsometimes the sweating room, to open the obstructed pores, and breathe off theoffending humours by sweat; and the people o our own country, as their poresare so requently liable to be shut up, by sudden changes o weather, might deriveadvantages, in point o health, by more requently bathing, than is at presentcustomary among us.

When I was at Bath, the Duke o Kingston was erecting a most elegant seto baths and sweating rooms8(or which spirited action he deserves the thanks

o the public) when the / workmen ound, by digging, the remains o a Romanstove, which proves that these people, while in possession o our country, had aset o baths in that place, and those o great extent, their ues having been tracedto different sides o the abbey church-yard; the many remains o Roman antiqui-ties discovered at Bath by Dr. Guidot9who analysed and wrote on the waters,and others since him, I think suffi ciently prove these ues to be Roman.

Having recourse to their baths when diseased, were not the only advantagesthe Romans derived rom them: Tey used them daily or pleasure, and pre-

vention o disease, they bathed constantly beore dinner, afer hunting or otherathletic exercise; and though their country was in a warmer latitude than ours,no harm arose to them rom this practice, but in these cases, when the blood andhumours were in agitation, they used the precaution to go rst into the warm or

temperate bath, to prepare them or the cold; Tus, rom atigue, their bodieswere rereshed; they were clean and cool, and remained in that state till dinnertime, afer which they requently indulged themselves with sleep.

* * Montaucon vol. III. p. 2. o his History o Antiquities,7gives a particular account othese baths.


10/24


I have brought this Roman mode o bathing into a point o view, that wemay learn rom them, to what extent we may use baths without injury. We ndthat no inconveniencies arose rom their methods, they bathed afer exercise,and atigue, to recruit their spirits and strength; and considering the serenity otheir skies, and warmth o their atmosphere, there was little danger likely to ariserom bathing; but in a climate so variable as ours, it requires a greater degree ocaution, or in our greatest summer heats the pores o our bodies are ofen sud-denly closed by a prevailing chilliness o the atmosphere. /

When we use the cold bath or pleasure, to prevent any injury rom it, weshould bathe when our stomachs are empty and our spirits calm; to those whouse exercise no preparatory physic is required, agreeably to Hippocratess opin-ion, but the indolent and sedentary should previously empty themselves by art,that no uture injuries may arise rom a Plethora.10

Tough it is not prudent in our climate to use cold bathing, afer the body hasbeen heated by exercise, as practiced in hotter climates, we should use exercise aferbathing, and those who cannot, should have their limbs well rubbed, and theirbodies warmly, but not hotly cloathed, to renew a proper degree o perspiration.

Swimming is a noble exercise o the limbs, and cold bathing, simply considered,braces the body and adapts it or exercise, provided we do not use bathing to excess.Te sea, rom the clearness and temperature o the water, (being warmer than riveror spring water) is a desirable bath, and with these advantages, by the action o thesalts contained in it, we are not so liable to cold aferwards; and rom the stimulus

o the salts, the skin is excited to a discharge o whatever matter secretly obstructsthe pores; thus pimples appear, ofentimes, on the skin afer sea bathing, which areeasily remedied by a continuation o that bathing. Te only inconvenience attend-ing sea bathing, as a pleasure bath, proceeds rom a glutenous adhesive property inthe water, arising rom the salts and bitumen contained in it, that leaves a clammi-ness on the skin, which river and spring water do not.

Bathing in the sea or use, as an invalid, is very different, in some respects,rom bathing in the sea or pleasure, and should not be entered upon but withcaution; we know by / experience, that sea-water used externally and internally;is an excellent remedy or many complaints, and so much so, as to succeed, with

proper helps, when every other means used by the skilul physician has ailed;but rom a remissness in the application, or by too great hurry or imprudence in

the use o this remedy, ofentimes the patient is disappointed in his hopes o aspeedy cure, and what Dr. Russel,11on this topic, has complained o very justly.I am sensible, says he, many o my patients, rom the inconvenience o beinglong absent rom business, or pursuit o their pleasures, will be apt to hurry intoa course o bathing beore the body is altered, and suffi ciently prepared by drink-ing sea water, or by a previous course o other remedies; which hurry is alwaysdetrimental to the patient, by protracting his cure.


11/24


Sea-water is a noble remedy or all diseases o the skin, old ulcers, and diseaseso the glands, even hereditary complaints have yielded to it. Tough Dr. Russelis willing to suppose that no diseases are hereditary, but in this particular I mustdiffer rom him, and that in glandular complaints, which he particularly writesupon. For instance, when a childing woman is diseased with an old scorbutic, 12schrophulous,13or leprous14humour; during the time o uterine gestation, she is,to appearance, in a manner ree rom the complaint; but when not pregnant, herdisorder returns to the same state as beore; this is an observation I have maderequently, and particularly in leprous cases. Without entering into a nice discus-sion o the subject, it is obvious rom hence, that the humours are attracted by,and become a portion o the circulating humours in the embryo; and when thishappens, a prognostic may be made, that the disorder o the parent is incurable,however remediable it may be in her offspring, though, / by proper care, thedisorder may be checked which, without such helps, must become troublesomeat a critical period o lie, i not sooner.

But to the matter in hand; the body o the person who bathes should be emp-tied previously, and i there are any external tumors or swellings or internal andcontaining matter, bathing is detrimental until the matter is discharged. Where thelips o a wound also are callous, or the induration15o a tumor very great, cold bath-ingmust be ommitted till it begins to abate, which is known by the eel, when theextremities o it become sof, and the whole detached and loose; then cold bath-ing is serviceable towards compleating the cure. Dipping an invalid in the sea, and

taking him out again instantaneously, makes sea-bathing o little more use than abracer, and the effect scarce more than is common rom every cold bath.Bathing in the sea constantly has this effect; every sore, imperectly healed,

it will open aresh; and when this happens, Dr. Russel observes that the partaffected being ofen bathed with sea water, and rubbed with a slimy sea plantcalled the Quercus Marina16has a better effect than general bathing: Te reasonis obvious, the part being requently wetted with the water, and salt slime othe plant, was kept moist; by this means the active principle o the water (thesalt) had time to insinuate itsel; or sea-salt has these particular properties, itnot only corrects the corrosive and malign humours, that attend obstinate andold ulcers, but possesses at the same time, a drying quality which contributes toheal them. I can give a amiliar instance o this, which, or the benet o society,

ought not to be concealed.Sea-salt, properly applied, is apresent cureor the bite of a mad dog. /ake sea-salt, or common kitchen-salt, disolve it in resh warm human urine,

load the urine with as much salt as it can dissolve, with this liquor cleanse thewound and limb, o whatever Saliva may stick to it, ll the wound with salt, weta double rag in the prepared liquor; and bind it on the part, as it dries, wet it

with resh liquor; in six hours open and wash the wound with the prepared liq-


12/24


uor, ll it with resh salt, apply the wetted rag, and proceed as beore, in twelvehours the virus o the bite will be subdued: Afer this, keep the wound clean by

washing it night and morning with a cloth dipt in the prepared salt liquor, till itis healed; let the party take as much sea-water, or three mornings successively,as will purge, and afer each purging, at bedtime, an opiate o Mithridate 17dis-solved in pennyroyal water.18Te use o the sea-water is to empty the body, andthe use o the opiate to calm the spirits, which are generally, much agitated, anddepressed on these occasions. Let the patient bit be kept quiet, let him not livelow, but moderately indulge himsel with wine. Tis regimen need only be pur-sued till the wound is healed, but i the wound is large, or when there are morethan one, the party may take a draught o sea water daily, or a short time.

Te ratio o the cure consists in the action o the salt upon the malign viruso the wound, beore it can make any progress to inect the circulation. Te salt,by being dissolved in urine, becomes more active, and is particularly assimu-lated to penetrate into any part o the body to which it is applied. Te successo the application depends much, on the immediate time, the omission o it ortwenty-our hours, might render this remedy precarious, and, perhaps, o noeffect. As the poison at rst is local, this application to the part affected, imme-diately destroys all danger. Te purging / thereore, with sea water, the opiate atnight, and the regimen prescribed, are only cautionary aids, co-operating withthe topical application. [...]

Beore I quit the subject o cold bathing, it is necessary to observe, that the

only time o bathing, at Brightelmstone, is early in the morning, but to bathein the middle o the day, or in the evening, is equally benecial; nay, in somerespects, is to be preerred to the morning, or when the cold winds o Autumn(or in act, o any other time o the year) prevail, exposing the body to them, isdangerous, beore the / genial inuence o the Sun has warmed them. And sea-bathing, as a remedy, will ofen ail, nay sometimes do harm, unless regulatedby the physician, and proper medicines used at the same time, to the success o

which, sea-water is a material agent in compleating a cure, by co-operating withthem, but cannot perorm the great things some expect rom it o itsel.

We shall now treat a little on warm bathing. Cold bathing, simply con-sidered, is a bracer, but we recommend sea-bathing or something more, or thebenets derivable rom the Salt and Bitumen19contained in this water, which

makes it a desirable agent in removing some particular obstinate disorders, mosto which have been pointed out already. Where a disorder is very obstinate, andhas been o long standing, bathing in the sea (cold bathing being a bracer) in thebeginning o a cure is ofentimes improper, which Dr. Russel also observed, andhe was obliged, in such cases to have recourse to the medicated warm bath.

As the active principle o sea-water is the salt contained in it, by the use oa temperate and hot bath o sea-water, many great advantages may be derived;


13/24


instead o bracing and closing the pores o the skin, which is the consequenceattending cold bathing, the hot bath would open them, and by the activity othe salt contained in the water, penetrate through every obstruction with whichit comes into contact. I in this sense we derive benet rom cold bathing, howmuch greater must be the benet received rom hot bathing?

From the good effects o the hot bath used in Epileptic and maniacal cases(see Dr. Shaws20observations on hot bathing), it is natural to suppose that themadness and Hydrophobia21caused by the bite o a mad dog, being neglected, iscurable by a hot bath o salt-water. /

Convulsions are produced by a stimulus on the nerves, which causes themto contract themselves. Opium may abate the convulsions and uror o caninemadness or a time, by the stupor it produces on the nervous system; as such it isa desirable medecine: But as salt is destructive o this poison, it being insinuatedby the pores into the body, by means o heat and moisture, it will relax the habit,mix with the uids, and probably will destroy the virus; and as sweating is theconsequence o hot bathing, so it may send off by the skin what is offensive tonature, and is the cure on which there is most dependence; though I would notrecommend the use o opium to be wholly laid aside, or reasons just given, butto use discretionally both remedies, as assistants to each other.

Dr. Russel rightly observes, that in scrophulous diseases the glands o themysentery22 are always affected; Dr. Andree, in his Orthopia23 observes thesame o the mesentery o rickety children, and Heister the same, but contra-

dicts himsel to oppose Cheselden.24

As the glands o the belly, in these cases,are primarily affected, nothing can remove these rugose25and knotty swellings,and lay the proper oundatian o a cure so readily, and effectually, as a temper-ate or hot sea bath, by which we make an application, immediately to the part,o a penetrating and resolving discutient. We nd, even in hot countries, thatthey have their hot baths as well as cold, which they use to open the pores o thebody when obstructed, and breathe off by them whatever is offensive to nature.Indeed the preerence o the hot bath over the cold, in the cure o some diseases,is a subject that would admit o much discussion, and in deence o which, manyauthorities might be quoted, were it not so obvious that it needs none.

o make thereore bathing in sea-water more effectual, I would recommendthe use o hot baths made o sea-water, to / different degrees o heat, as the

nature o the disease may require. Te provision o a bathing-tub, copper, andthe inconvenience o carrying daily water to a house distant rom the sea, in asuffi cient quantity to make a bath, has so much trouble and expence attending it,that a patient will not have recourse to it, though necessary; nor can the physi-cian well recommend it under such disadvantages.

Te town o Brightelmstone has been much avoured by the countenance omany noble and genteel amilies, who resort to it every season; in return, every


14/24


means should be, and I believe is put in practice to accommodate them, moreespecially those who are so unhappy as to be invalids. For this purpose I wishto see a set o baths erected.

Te building to contain these baths must be near the sea, on account o thewater, I would recommend the bathing rooms to be nished in a plain but neattaste, and the baths themselves, respecting shape and size, to be nearly similar tothose erected by the Duke o Kingston at Bath.

A building whose area is thirty eet, and twelve eet high, will admit o ourrooms, with a bath in each, a loby or servants to wait in, with a space behind themthe whole length o the building, or the copper, the uel, and cold bath, whichmust be kept supplied with resh sea-water pumped out o the sea at hal tide.One end o this room may be made also a sweating room, by a proper serpentinedisposal o the copper ue; there must be a communication, by pipes, rom thecopper to the baths, and a like communication rom the reservoir, that the baths,by this means, may be attemperated to any degree o heat required; and here it isnecessary to observe, unless ordered otherwise by the physician, that a hot bathshould never exceed the natural heat o the body, and any medium between 50and 80 degrees o Farenheits thermometer will be / a good standard; or i atblood heat it may overcome and weaken the party too powerully, but while inthe bath the heat must be kept up by the addition o hot water.

Tere should be chairs26provided also, as at Bath, to take the patient rom,and back again to the bed side, or the advantage aferwards o sweating or taking

rest, as the nature o the illness may require.Te utility o these baths is obvious; they may be used either or hot or coldbathing; there are some invalids to whom cold bathing would be serviceable,could they be able to bear the atigue o being dipt into the sea, and (what ismore material) to be exposed to the cold air. I the weather happens to be stormy,and the sea so rough as not to admit o bathing in it, recourse may be had to thebaths; by this means bathing would become more universal, be unattended withterror, no cure protracted, and the stay o the company prolonged. MoreoverInvalids would have the advantage o this bathing remedy all the year round,

whereas, on account o the variableness o our climate, it is denied them at pre-sent, except in the Summer months, and then only in calm weather.

We come next to the Drinking o Sea-water.

o drink sea-water is certainly o great use in many cases, it cleanses theglands, and excites them to a discharge o whatever obstructs them, &c. but thereare inconveniences that arise rom the constant use o it, which ought to be pro-

vided against. Tere are many constitutions too delicate, and stomachs too weakto bear the nausea and sickness it produces, and even where this inconvenienceis overcome by struggles, it makes the party very thirsty the remainder o the day.Tese are material objections to the constant use o it, and unless used constantly

we cannot expect to derive much benet rom it. /


15/24


When it is taken two or three times, in quality o a purge, the sickness itproduces is not detrimental, but on the contrary, ofen serviceable, and a goodpreparative to a course o bathing, where pleasure mostly is concerned; but whenit is meant to be continued, as an alterative diluent, it will not do. For example,in a glandular consumption, where constantly purging the body is not desired,and weakens the patient.

o remedy these inconveniencies, I would recommend the sea-water to bedrank every morning in small quantities, not to exceed a quarter o a pint atone time, and that mixed with an equal quantity o new milk, by this means thesickness and thirst will be prevented, and thus united, become a noble medicine,they are correctors to each other, and neither the milk or sea-water, so combined,

will disagree with the stomach, that could not bear either o them seperately.When sea-water is required as a gentle purge, and the stomach not able to

bear it, I recommend the ollowing ake o sea-water and milk each our ounces; put them over the re; and

when they begin to boil, add a suffi ciency o Cremor artar27to turn into whey,strain it rom the curd, and when cool drink it.

Sea-water thus managed is a great cleanser, a purier o the blood, and acooler; whereas, sea-water taken alone is heating to many constitutions. Somemay imagine, by the addition o Cremor artar to the sea-water, the effi cacy oit, as a medicine, is abated, on the contrary, it has all the advantages sea-water can

possess as an aperient or purge, without any o the disadvantages attending the

use o it when alone; except in some very particular cases.Beore I quit the subject, it is necessary to give one caution about drinkingsea-water. /

As the complaints or which it is constantly drank are generally very obsti-nate, some one mercurial preparation may be recommended to be taken atthe same time; but I would recommend to the patient careully to avoid every

preparation o mercury (unless particularly ordered by the physician): For bythe action o sea salt on mercury, it is converted into a violent poison, not unlikecorrosive sublimate, and may prove very injurious to the constitution, moreespecially to the nervous system.

Having nished these cursory hints on bathing or pleasure, or use as aninvalid, on the advantages derivable rom hot salt baths, and made some obser-

vations on drinking sea-water, I shall conclude with wishing to see every planwhich may contribute to the cure o obstinate diseases, carried into execution.

Brightelmston, Yours, &c,Sept.8, 1768.

FINIS.


16/24


17/24


18/24


Dr Reid recommended morning bathing, beore the sun had a negative effecton the sea; in the same year Dr Crane at Weymouth similarly warned against agreat depression o the spirits i it took place later in the day.1o support thisDr Reid provides temperature inormation about the sea and the air. He alsosuggests the requently recommended practice o drinking seawater, includingusing warm milk to make the taste more bearable!

Notes1. J. Crane, Cursory Observations on Sea-Bathing; the Use of Sea-Water Internally, and the

Advantages of a Maritime Situation, as Conducing to Health and Longevity to Which isAdded, a Concise History of Weymouth (Weymouth: Printed or the author, 1795), p. 87.

See the next headnote in this volume, on p. 85.


19/24

81

T. Reid,Directions for Warm and Cold Seabathing;with Observations on their Application and Effects inDifferent Diseases (1795)

SECION I.

GENERAL DIRECIONS FOR COLD BAHING.

W a remedy is used indiscriminately, it must o necessity, very re-quently be used improperly. Tis observation can in no instance be so justlyapplied, as to sea-bathing. In this age, o which dissipation and luxury, are prom-inent eatures, it is become so much, and so generally the ashion, or all rankso people, to make excursions in the summer to the sea side, that every place is/ crouded during the season. Unortunately or many, a general idea has taken

possession o the public mind, that i bathing does no good it cannot do harm.Tis is certainly not a act; cold bathing produces a powerul impression on thesurace o the body, and rom thence on the internal parts; and although in manydiseases, a very effi cacious remedy, yet when applied without proper precaution,or preparation, requently occasions dangerous, and sometimes, atal conse-quences. Since it has become the custom or people in general to read medicalbooks, written expressly or the purpose; every one thinks they are qualied, notonly to prescribe or themselves, but or all their acquaintance; and they will bemuch offended i not attended to, in preerence to any other, however regular.I am very ready to allow, that in the hands o many, such books may be o use,in directing simple medicines, till proper advice can be procured; but I must atthe same time be allowed to declare my opinion, that such studies have been /the source o innite harm to the community at large: It is putting active agentsinto the hands o those who are not competent to their application. Tat this isno hasty, or inconsiderate assertion, I appeal to every medical mans experience.

Tis being the case, we are not to be surprised, i people go into the sea, with-out advice, without preparation. How ofen have I seen young persons in highhealth, afer a ew times bathing, become pale, lose their strength and appetite,


20/24


21/24

Reid, Directions for Warm and Cold Seabathing 83

rom a load, more or less oppressing the vis vit, is enabled to produce the re-action, and thereby ensure the benet expected rom bathing.

I the person is not very weak, nor greatly reduced in strength, and the distancerom the water not great, they had better walk than use a carriage; as there shouldalways be beore immersion, rather an increase o warmth, and the circulation some-

what quickened, by which the re-action o the system becomes more certain. /Te head should always be rst wetted, and afer one dip, come out o the

water as quick as possible. It is not necessary to be very solicitous in drying theskin afer bathing, as being wet with salt-water, does not occasion indisposition,as resh water generally does, probably rom the different actions on the extreme

vessels; even the dew that usually alls very heavy in the evening, is not attendedwith any bad consequence to those who have been exposed to it. I have notobserved any inconveniency arising rom using varnished silk caps, but whereit can be avoided, it is better in every respect. Afer bathing, moderate exerciseshould be taken, careully avoiding whatever may atigue the body, or exhaustthe spirits, as that would deeat the intention.

Te general custom o bathing early in the morning is certainly right, andshould not be given up without suffi cient reason; but I observe that the deli-cate and weakly, especially ladies who have been accustomed to lie late in bed, /are soon atigued upon getting up so much beore their usual time: And this isincreased by waiting more or less or the machine, as every one, without distinc-tion, bathes in the order their names are put down, and or which deputies are

not allowed. Such persons will do well in taking a light breakast, and two hoursafer, they may go into the sea, with ease and saety.*Te usual manner o bathing is, to be dipped three times, and to go in two

mornings and miss one, both which I think improper. It is the sudden shock

* As this may be done by 10 oclock, the water will not have acquired an increase o heatrom the sun, even in the warmest part o our summer. Indeed, it is very rare in thisclimate, that the water o the sea is at all affected by his rays. From a long course oexperiments in August, September, and October, 1788, I ound the temperature o theSea-Water, at the depth o our or ve eet, taken between seven and nine in the morn-ing, to be very near the temperature o the air in the shade; differing about two degreeseither way; but uniormly colder when the wind was easterly. On the 30th o August thethermometer, in the shade, stood at 58, in the sea at 60, wind west. Te same day, at 11

in the Downs, at the depth o 30 eet, the thermometer was only at 60. In A, Te o the , was

In the shade, 58 to 66. Med. 62. In the sea, 60 to 64. Med. 62.

In S, In the shade, 56 to 67. Med. 61 . In the sea, 54 to 65. Med. 59 .

In O, In the shade, 52 to 62. Med. 57. In the sea, 52 to 58. Med. 55. /


22/24


on the body that rouses the energy o the system; a repetition cannot increase,and is very likely to weaken the effect o the rst impression. In proportion asany action on the body is repeated, in proportion it becomes amiliar, and theeffects gradually diminish, it being a principle inherent in our nature, to becomeamiliar with any place or circumstance, usus requens omnium magistrorum

precepta superat.4 In like manner bathing two days in three, i it does notimmediately disagree, will diminish the inuence o the water upon the system,thereby depriving them o that ull success, they would enjoy i used more mod-erately. I think bathing once in two days, and plunging in only once, is as ofen asis commonly attended with benet.

When I said it was right to go into the sea with some degree o quickenedcirculation / and increased warmth, I must not be understood to mean, thatthose who are heated by previous atigue or intemperance should bath; in suchit would be very hazardous, and by no means to be attempted.

People o all ages, and in every condition o health, are accustomed whenat the sea side to drink salt water in the morning, under the idea o its being asweetener o the blood, and an antiscorbutic.5 In my opinion salt water takeninternally, possesses no quality superior to any other purgative, taken in suchquantity as to produce similar operation. It is a nauseous, disagreeable potion,ofen very rough in its passage, and when it does not operate, always heating anddisordering the body; especially in children, who I daily see tormented in this

way rom the very best motive; and I much wish, that I could use any argument

to prevent the sufferings o my little riends. I it must be swallowed, any thing tothe contrary notwithstanding, / the addition o an equal quantity o warm milksofens the taste, and requently prevents its disagreeing with the bowels. Onthe days o bathing, neither salt water nor any other purgative should be taken;because purging universally weakens the powers o the system, which cold bath-ing is intended to strengthen. As an antiscorbutic, or a sweetener o the blood, Ican only say, I have never seen any good produced by taking salt water with this

view. How ar the circulating uids can be affected by, or be the cause producingdisease, I shall not consider here, having given my sentiments in a ormer work.*

Te air on the sea is purer, and more ree rom noxious effl uvia7or exhala-tions, than on land. Tis is proved beyond a possibility o doubt, by seaaring

people, with proper precaution, suffering less rom disease, and by a late cele-

brated and lamented Circumnavigator, having lost ewer men, ...

* Essay on Phthisis Pulmonalis, 2d Edition.6


23/24

Notes to pages 5973 519

15. pellucid rheum: transparent or translucent, watery, mucous secretion.16. Dr. Darwin: Erasmus Darwin (17311802) was a physician and natural philosopher.

He was author oZoonomia, the rst volume o which appeared in 1794. His ideas onevolution undoubtedly inuenced his grandson, Charles Darwin.

17. torpor: lethargy; apathy, listlessness, indifference and lack o activity.18. catarrh: a discharge rom nose and eyes that generally accompanies a cold.19. apoplexy: A sudden attack that causes a loss o the powers o sense and motion which is

preceded by giddiness and a partial loss o muscular power.20. Palsy: a paralyis o all or part o the body.21. St. Vituss Dance: St Vituss Dance, a dancing mania, which was diagnosed in the seven-

teenth century as Sydenham chorea, is a disease o the nervous system with symptomsresembling dancing.

22. Cutaneous Disorders: skin diseases.23. Gout: a disease causing a painul inammation o small joints, especially the big toe,caused by the deposition o sodium urate in the orm o chalk-stones.

24. Scropbula: presumably scroula which is a disease causing chronic enlargement anddegeneration o the lymphatic glands.

25. Scurvy: A disease caused by a lack o vitamin C. Its symptoms include a general debility,extreme tenderness o the gums, oul breath, eruptions o the skin and pains in the limbs.

Awsiter, Toughts on Brightelmston (1768)

1. Brightelmston: Brighthelmston is an old name or Brighton.2. machines: bathing machines.3. humours: the uids o the body.4. Lady Mary Wortley Montague: Lady Mary Wortley Montagu (bap. 1689, d. 1762) was

married to the British ambassador in Constantinople between 1716 and 1718, hence herknowledge o urkish culture.

5. Hippocrates: Hippocrates o Cos (c. 460 c. 370 ) was an ancient Greek physician,who laid the oundations o medicine and medical ethics.

6. Pliny: Pliny the Elder, Gaius Plinius Secundus ( 2379) was a Roman writer and natu-ral philosopher, as well as naval and army commander o the early Roman Empire.

7. Montaucon vol. III. p. 2. o his History o Antiquities: Bernard de Montaucon (16551741) was the author o Te Antiquities o Italy Being the ravels o B. de Montaucon , which was published in London in 1725.

8. When I was at Bath, the Duke o Kingston was erecting a most elegant set o baths andsweating rooms: Tese baths were built in 17636 by Tomas Jelly, but were demolishedwhen the Pump Room beside the Roman Baths was extended. Tey were paid or byEvelyn Pierrepont, second Duke o Kingston upon Hull (171273).

9. Dr. Guidot: Tomas Guidott (c. 16381706) was a physician and writer who settled in

Bath in 1667.10. Plethora: An overabundance o one or more humours, especially blood.11. Dr. Russel: Dr Richard Russell (16871759). See n. 2 on p. 517, above.12. scorbutic: suffering rom scurvy.13. schrophulous: suffering rom scroula, a chronic enlargement and degeneration o the

lymphatic glands.14. leprous: suffering rom leprosy.15. induration: hardening.


24/24

520 Notes to pages 7388

16. Quercus Marina: a seaweed.17. Mithridate: various medicinal preparations containing many ingredients that were

believed to be a universal antidote to a poison or a panacea.18. pennyroyal water: herb-inused water.19. Bitumen: pitch, asphalt.20. Dr. Shaws: Peter Shaw (16941763), physician and author o a number o works on

medicine, includingInquiry into the Contents, Virtues, and Uses o the Scarborough Spaw-Waters (London, 1734). See Volume 2, p. 67.

21. Hydrophobia: a symptom o rabies involving a ear o water.22. mysentery: Te mesentery is a membrane in the abdomen.23. Dr. Andree, in his Orthopia: the physician John Andree (1697/81785).24. Cheselden: the surgeon and anatomist William Cheselden (16881752).

25. rugose: wrinkled.26. chairs: sedan chairs.27. Cremor artar: Cream o artar.

Reid,Directions or Warm and Cold Seabathing (1795)

1. : the healing power o nature (Latin).2. Cullens: William Cullen (171090), chemist and physician.3. cathartic: A cathartic is something that cleanses and purges the bowels.4. usus fequens omnium magistrorum precepta superat: effectively practice makes perect

(Latin).5. antiscorbutic: or treating scurvy.6. Essay on Phthisis Pulmonalis, 2d Edition: Tomas Reid,An Essay on the Nature and Cure

o the Phthisis Pulmonalis. Te Second Edition Enlarged. o Which is Added an Appendix

on the Use and Effects o Frequent Vomits (London: [n.p.], 1785).7. effl uvia: an outow o particles.

Crane, Cursory Observations on Sea-Bathing (1795)

1. Dean Berkeley: George Berkeley (16851753), Church o Ireland Bishop o Cloyne, andphilosopher.

2. ar-Water: In 1744 Berkeleys book Siriswas published, which advocated the use o tarwater, a native American preventative distilled rom pine resins.

3. Monsieur Goulards Preparation o Lead: Goulards Extract, named afer the French sur-geon Tomas Goulard (16971784), is a solution o lead acetate and lead oxide used asan astringent to draw together or contract sof organic tissues.

4. Dr. Clephanes Remark on the Duke o Portlands heretoore celebrated Powder or the Cureo the Gout: John Clephane (1701/258) was a Scottish physician who was linked to the

promotion o a gout powder.5. Huxham: the physician John Huxham (c. 16921768). Te quote is rom Observationes

de aere et morbis epidemicisin 1739 in which meteorological records, made at Plymouthbetween 1728 and 1737, were collated with the diseases observed there.

6. Viscera: the internal organs o the body.7. strumous: indicative o being likely to suffer rom scroula.8. Opthalmias: swelling o the eyes, conjunctivitis.9. cutaneous: cutaneous means pertaining to the skin.

The Role of Medical Practitioners

Documents

Transcript of The Role of Medical Practitioners