Senin, 18 Maret 2013

The human centrifuge

"His countenance attached to saturnine blackness, the eyes, suffused with bile, were immovably fixed on the ground, the limbs seemed deprived of their locomotive powers, the action of the lungs, and the circulation retarded, the tongue parched and silent, and the whole man resembled an automaton." In Dr Cox's opinion, his patient was in the grip of a "melancholy stupor". As the director of one of the largest private asylums in Georgian England, Joseph Mason Cox was mad-doctor to the better off and bad just the thing to rouse this poor soul from the depths of his depression. Cox, one of the first qualified doctors in England to specialise in mental disorders, had invented a new sort of treatment: a human centrifuge. A spin in Cox's "circulating swing" was said to shock the madness from a man.

GOOD wine, a relaxing massage and soothing music: for Asclepiades, a Greek doctor practising in 1st century Rome, these were the best remedies for insanity. Kind and gentle treatment was far better than chains and beatings. And the best therapy of all was sleep -- preferably natural, wholesome slumber rather than that induced by poppy juice or other mind-altering preparations. To encourage a better sort of sleep, Asclepiades invented one of the most enlightened pieces of medical technology: a swinging bed.

If gentle swinging was effective, then, how much more might be achieved by rapid rotation? At the start of the 19th century, a radical variation on the swinging bed began to appear in asylums across Europe. However, patients treated in Joseph Cox's circulating chair found the experience anything but relaxing. Tied down and spun round at speed, they turned pale, threw up and passed out. It was a far cry from Asclepiades's soothing swing, but it got results. Even the most disturbed patients became calm and easy to control. Cox believed any fear or discomfort was all to the good, helping to distract a patient's mind from mad thoughts. Best of all, it encouraged deep and therapeutic sleep.

Down the centuries ideas about how to deal with the insane veered from one extreme to another: some advocated kindness, others believed that physical restraint and intimidation were more effective. Most asylums had been little more than places to lock up the mad, but by the late 18th century attitudes were changing. Cox was one of a new breed of mad-doctor. He was not a jailer or a manager of maniacs, but a medical professional who had studied mental disorders and was prepared to devote his life to investigating better ways to treat them.

The concept of swinging as therapy had gone in and out of fashion ever since Asclepiades. Towards the end of the 18th century, James Carmichael Smith, a Commissioner for Madhouses and physician to Britain's most illustrious madman --King George III -- revived the notion. He suggested swinging could be used to subdue "the nervous influence" and "the principle of irritability" in many sorts of madness.

The idea of the human centrifuge sprang from the fertile mind of Erasmus Darwin, physician, poet and inventor, Darwin was interested in the nature of disease and how to cure bodies rather than minds. He was a great believer in the healing power of sleep. But how best to induce it? Darwin's friend James Brindley provided inspiration, Although famous as a canal engineer, Brindley started out as a millwright: he'd heard that if a man lay on a millstone as it turned, he soon fell asleep. "The centrifugal motion of the head and feet must accumulate the blood in both those extremities of the body, and thus compress the brain," Darwin reasoned.

The same effect, he suggested, could be achieved more comfortably in a bed suspended "so as to whirl the patient round with his head most distant from the centre of rotation". Darwin enlisted another friend, steam pioneer lames Watt, to draw up designs for a "rotative couch", a bed attached to an arm that revolved around a vertical shaft fixed to the floor and ceiling. Darwin never built his revolving bed. It was more suited to a hospital than the parlour of a man in private practice, he said. When Cox took over his family's asylum in 1788, he was ideally placed to test it.

Cox was soon singing the praises of rapid rotation. By the time he published his Practical Observations on Insanity in 1804 he had considerable experience of it. Whirling his patients round at speed worked wonders, he wrote. Like Darwin, Cox believed in the restorative powers of sleep. He also believed that if you provoked some sort of physical crisis in the body, it would shock the mind back to normality, at least temporarily. Spinning certainly had a drastic effect on the body. At first the motion made patients feel nauseous; up the speed and they vomited then lost control of bladder and bowels. Some bled from the nose and ears; some had convulsions. Many passed out.

It was a sizeable shock to the system and invariably had a calming effect. According to Cox, even the most demented, violent patients would be left quiet and easy to control without resort to drugs. "The slumbers thus procured differ as much from those induced by opiates as the rest of the hardy sons of labour from that of the pampered, intemperate debauchee."

The simplest version of Cox's device consisted of a Windsor chair suspended from a hook in the ceiling and rotated with the help of ropes around the chair legs. The patient, Cox advised, should be secured in a straitjacket and "prevented from falling out of the chair by a broad leather strap, passed round the waist and buckled to the spars, while another strap to each leg may fasten it to the front ones of the chair." A more sophisticated version was a bed or chair attached to an arm that revolved around a vertical shaft, much like Darwin's concept. "The necessary motion may be given by the hand of an attendant pushing or pulling the extremity of the projecting arm, with greater or lesser force, each time it circulates, but by a little simple additional machinery any degree of velocity might be given, and the motion communicated with the utmost facility."

By 1813 Cox was promoting spinning as a safe and effective treatment for most kinds of madness. "No remedy is capable of effecting so much with so little hazard. In almost every case it will produce perfect quiescence, allay all irritation, silence the most vociferous and loquacious." It was, he confessed, harder to make a madman giddy than a sane one, "but there are very few of them who can resist the action of a continued whirling with increased velocity, especially if suddenly stopped. The shock this gives to the system and the alarm it excites is not easily conceived by those who have never witnessed it."

Cox's chair became hugely popular in asylums in both the UK and elsewhere. In Ireland, William Hallaran, who ran the Cork Lunatic Asylum, was a great enthusiast, so much so he built a version that could take four patients at a time and spun at 100 revolutions a minute. The effect was much as Cox described: patients felt sick, threw up and later fell into a deep sleep, from which, Hallaran maintained, they awoke with their mad ideas "totally altered". The device, he wrote, rendered his asylum "remarkable for its tranquillity…regularity and order".

After a few decades Cox's chairs began to fall out of favour. Some doctors suspected they did little more than exhaust patients into submission. The treatment was dangerous -- some patients died. By the end of the century the chairs had been consigned to museums. in the meantime the human centrifuge emerged in a new guise. When Austrian physiologist Robert Bárány carried out his ground breaking research into the role of the inner ear in our sense of balance, he used a piece of equipment that differed from Cox's spinning chair in just one respect: it was called the Bárány chair. In 1914, his research won him a Nobel prize.

Further reading: "Cox's chair: 'a moral and a medical mean in the treatment of maniacs'" by Nicholas Wade and others, History of Psychiatry, vol 16, p 73

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