MEDICINAL MINERAL WATERS, NATURAL AND ARTIFICIAL; THEIR EFFICACY IN THE TREATMENT OF CHRONIC DISEASES AND littles far tjjm Ctitplatpitf, ESPECIALLY THOSE OF CARLSBAD, EMS, VICHY, KISSINGEN, MARIENBAD, PYR- MONT, EGRA, PULLNA, SEIDSHUTZ aWd HEILBRUNN. / BY S. HANBURY SMITH, M. D. t n u " If we bring diseases on ourselves by our folly, or they assail u/ as derivatives from the circumstances surrounded by which we live, or we suffer through the errors of our parents, nature is kind mother enough sometimes to help us to the remedy." HAMILTON, OHIO, D. W. HALSEY, PRINTER. 1856. DEDICATION. 4 TO Cjje UMal ^rattutt OF THE UNITED STATES, This earnest and exponent of the effort in which he is now engaged to bring to our doors, and familiarize the practitioner with their employment, a series of therapeutic agents of acknowledged value, yet heretofore, inmost cases, only attainable by the invalid at the cost of long and expensive journeys, 18 MOST RESPECTFULLY DEDICATED BY A Faithful" Con/rater," S. HANBURY SMITH. % PREFACE. I had intended to have urged the importance of these much neglected portions of our Materia Medica on the attention of the profession in the United States, several years ago, but was mainly prevented so doing by the an- nouncement of Prof. Bell in his "Baths and the Watery Regimen," published in 1850, that he expected shortly to publish a similar comprehensive work on Mineral Wa- ters. During the past year, Prof. Bell has put forth a small but valuable ittanual on the Mineral and Thermal Springs of the United States and Canada; to "be re- garded," as he says in his preface, "as an earnest of the intention of the author, and an instalment of his accu- mulated stores." At the same time, he gives such an account of the range of his larger work, still in progress, as to raise expectations and stimulate a curiosity I have no doubt will be fully realized and gratified, only hoping that the enjoyment will not be too long deferred. That there is a large series of chronic diseases and anomalous disordered conditions, best cared by the use of mineral waters, and a smaller series, often incurable by any other known means, is a postulate which will undoubt- edly be granted by every practitioner of reputation, throughout the whole continent of Europe. That, more- over, in another series of cases, mineral ivaters efficiently aid ordinary therapeutic measures, and that in a fourth, the effects produced by their employment afford a valuable IV PREFACE. source of diagnosis, will be as readily granted. The well established facts, the long catalogue of observations re- corded by competent observers, leave no room for dis- pute or cavil about the truth of these propositions. Af- ter all, there is nothing more wonderful in the curative powers of the compound medicine called a "mineral water," in those cases in which it is specially indicated, than there is in the admitted virtues of the time-tested compounds of the Pharmacopoeia, when similarly admin- istered. Carlsbad -water is as much the best medicine in some cases, as sulphate of quinine is in others; when all our ordinary chalybeates fail, the administration of the same, or even a much smaller dose of iron, in some such combination as is afforded by P}'rmont, or the Ferdinands-quelle of Marienbad, shall gladden us with its happy effects. In fact, in mineral waters, na- ture has presented us with an extensive range of "Proe- paraia et Composita," containing the same ingredients that we are daily prescribing, only compounded accord- ing to formulae of her own. They have been successful- ly employed in curing disease in all times and countries ; imposing structures—temples of Esculapius and Hygeia —were reared hard by them; Pliny, writing before the commencement of the Christian era, lavishes his praises on the still prized waters of Spa; the English dame "of high degree," while quaffing health in the "pump-room" at Bath, little dreams that Caesar's legions had taken the liberty to resort to the same spring for the same pur- pose, and given it the very name which (Anglicized) it now bears; and the hot springs of Baden-Baden still cleanse the Teutons, as of old they did the soldiers of Aurelian. In the lapse of ages, the revolutions of em- pires, the jar of civil wars, springs of rare virtues have been lost for centuries, then re-discovered, and again be- PREFACE. V come famous. As an example of this last occurrence, may be mentioned the quelle of Heilbrunn, in Bavaria. This spring, after having long enjoyed a great reputa- tion, was, together with the monastery hard by, de- stroyed by the Huns, in 985; a century after was re- discovered; subsequently rose into renown or fell into neglect many times, until again and quite recently the waters have attained a reputation as remarkable and as well deserved, for the cure of scrofulous and cutaneous diseases, as those of Carlsbad in calculous affections, whether urinary or biliary. That the remedies here in question have been compar- atively so little examined or employed systematically by the Anglo-Saxon race on both sides of the Atlantic, ad- mits, I think, of an easy though not short explana- tion, and as it would consume too much time and occu- py too much space to discuss the matter in full, suffice it to mention a few suggestive "headings," such as, na- tional love of a hasty cure—no time to doctor—thorough purgation—perturbating remedies—a good dose and have i done with it—something we can understand—beef and porter require calomel and black draughts—coffee and dyspepsia, blue mass and salts—almost general igno- rance of subject—consequent skepticism and credulity —extremes meet—health sacrificed to fashion at Amer- ican watering places—ruinous expense of a season at Saratoga—manage these things differently in Bohemia, etc., etc., etc. In the little work of Dr. Bell's already named, no mention is made of that greatest of the many favors conferred by Chemistry on Therapeutics, namely the t Synthesis of Mineral Waters. It is difficult to con- ceive why an art so useful to humanity as the re-con- struction in the chemist's laboratory of such well known VI PREFACE. valuable mediciaal agents as the more celebrated mineral waters, should not as yet have been even commenced in the United States. It is the more remarkable, as it is an art first taught practically by Berzelius, who, as cor- rectly stated in Prof. H. Rose's masterly account of his life and labors, delivered before the Academy of Scien- ces of Berlin, established the first manufactory of such waters at Stockholm, a manufactory still carried on by his pupil and successor, Prof. Mosander. Prof. Struve of Dresden, took up the same subject, and more than thirty years ago, commenced those successful labors, which have conferred so much lustre on his name. By the efforts of later chemists, especially Soubeiran, An- glada, Barruel, Savaresse, and Stevenaux, it has been developed with a most satisfactory rapidity and success. With regard to the perfection which they may be imita- ted, Dr. Granville observes, "Dr. Struve's imitations of them (Pullna, Saidschutz, and Seidlitz,) may be taken with the fullest confidence, as identical in their effects with the natural waters.'* *** "Struve's imitation of it (Kissingen), which is to be obtained from the German Spa at Brighton, is found to be equally good and effica- cious, and the quantity drunk both at Brighton and in London, I have been informed by M. Sehweitzer, has been prodigious."—Dr. Granville s Spas of Germany, 2d edition, 1839, pp. 321 and 385. It were easy to offer a large amount of evidence of the same character, given by the most distinguished physicians in Europe. One can hardly take up a pamphlet written rn praise of any particular spa, without finding in it absurd decla- rations about the more intimate alliance of the chemi- cal elements with each other and with their common sol- vent water, in medicinal springs, than it is possible to bring about in the laboratory; and that, therefore, these PREFACB. Vil natural productions cannot be successfully imitated. But every tyro in chemistry knows that the chemical compo- nents of a mineral water are united with each other in certain definite proportions, and no other, according to immutable laws now well understood. Chemical analysis is capable of detecting the minutest portion of an ingre- dient in gallons of its solution; and therefore the quant- ity of each element being giyen, the proportions in which bodies combine known, and due regard had to the influence of temperature, pressure, quantity, and order of solution, it is evidently as practicable to reproduce exactly the compound solution called a mineral water, as it is to reproduce exactly Glauber's or Epsom salt, or sal-ammoniac, by a mixture of their ingredients in due proportion and in a proper manner—a thing which is ev- ery day accomplished on the largest manufacturing scale —although, in the former case, the processes required are delicate and difficult, and require greater accuracy and care than perhaps any known in the whole range of chemical arts. x There are some again who entertain the superstitious notion that mineral waters possess some mysterious attri- bute, agency, spirit, or ingredient, not to be detected by chemical analysis, even the most searching and exact; and to this something they attribute the truly wonderful healing powers of some waters, especially such as con- tain but a small proportionate amount of salts in solu- tion. Such views are entirely visionary, and, together with the sneers of interested persons, and all other ob- jections whatsoever which have been or may be brought against properly prepared artificial mineral waters, are met by the now well established fact, that neither in physical nor in medicinal properties can they be distin- guished from the natural. They have the same smell, Vlll PREFACE. taste, color, and temperature; by analysis yields the same results; and thirty years' experience, in countries where the art of healing and the successful cultivation of the medical sciences are unsurpassed if equalled, has proved beyond all further cavil that the artificial perfect- ly resemble the natural waters, both in the direct results their use produces, and also in their after effects; and that they cure the same diseases as quickly, as perfect- ly, and as lastingly as their prototypes. These remarks, however, are only applicable to such waters as have been analyzed on the spot, by fully com- petent chemists, and to such imitations of them as a long and extended experience has proved to be identical in therapeutic results. It is not pretended that all pub- lished analyses of mineral springs are correct; on the contrary, it is well known that many are not made by competent chemists, and are, therefore, not reliable, and some were made at a date so early, that subsequent im- provements in knowledge and method have made it desi- rable that a new examination should be undertaken. But a large number—including all the more valuable ones— are not in this predicament. They have been analyzed again and again, and the products of the laboratory, compared with the originals, both medically and chem- ically, so often, and for such a long series of years, as to leave no doubt of their identity in composition. Every day bears witness to their value as curative a- gents; and of even the less perfect imitations it may be truthfully said, that they have proved to be new medi- cines, capable of being successfully employed in most chronic diseases, especially such as prove rebellious to ordinary treatment. These waters are drank directly out of the apparatus, each at its proper temperature, pressure of gas, &c, and PREFACE. IX those cold waters whose composition will Tidinit of it, are also sold in bottles. Not all will admit of bottling; the different taste and effects of many of the waters of the natural springs, after being a short time in bottle, are notorious. But by taking certain precautions, it is in many instances possible to produce an artificial water that shall bear bottling and transportation far better than the natural. This is a matter of common experience in Europe with regard to several, and especially to Selters water, of which one million two hundred thousand flasks are annually sold by the Duke of Nassau direct from the springs. Probably a much larger quantity is sold direct from the laboratory; for few persons would prefer the genuine—half-rotten or flat—to the artificial, fresh and sparkling. Says Dr. Granville:* "The introduction of artificial mineral waters into the practice of medicine, as prepared by Struve, has now received the sanction of several years' experience. In speaking of that scientific physi- cian and chemist, in my account of the capital of Saxo- ny, which he inhabits, I stated, in 1828, that much was to be expected from the result of his labors,—the benefit of which was about to be extended to England, by the formation of an establishment at Brighton, which has since received the name of 'The German Spa.' The re- alization of those anticipations has been most complete: and nothing could be more satisfactory than the investi- gation of the value and importance of that establish- ment, which took place before the Privy Council in No- vember, 1836; when Lord Lyndhurst and Lord Brough- am, who had examined the writer of these pages at great —*The Spas of Germany. By A. B. Granville, M. D., F. R. S., Kn-'ght of the Order of the Crown of Wurtemberg and of the Roynl Order of St. Michael of Bavaria ; member of the principal literary and scientific societies in Europe; author of "St. Petersburgh," &c, &c. X PREFACE. length, respecting the novelty as well as utility of Struve's process, decided, on his evidence, that the in- stitution was deserving of the enlargement of the time of the patent, to the full extent of the original grant. "Into the merits of the mode of preparing the artifi- cial mineral waters, (which is due to the sagacity, pene- tration, and chemical skill of Struve,) it is not my pur- pose to enter at present. I alluded to his process in a former work, and shall have occasion, at some future op- portunity, to give a fuller account and description of it. Neither is it my intention to say a word in praise of the establishment of Brighton; although, as a 'German Spa, I might very fairly have pressed it into my service. That establishment is prosperous, and from four to five hundred patients of note find yearly at it a pleasant and easy mode of recovering their health. I have myself used and prescribed largely, and with great success, the several waters prepared at that establishment; and the time will come when some of those mineral waters will take the place of the perpetual drugging so injuriously prevalent in London. "The artificial waters in question are found to contain all the qualities and properties, in the most minute de- gree, of their corresponding mineral springs, as well in regard to the effect which they produce on the human body, as in their chemical composition, taste, and inten- sity of union. To produce all the effects of the real or natural mineral water, of which they are the closest imi- tation possible, they only need the auxiliaries to which I have so often referred in the present volume, and which are so eminently calculated to facilitate and hasten the recovery of patients. The testimony of the most cele- brated physicians in Germany,—at the head of which I may place Kreysig, Clarus, Ammon, and many more,— PREFACE. xi strongly corroborates my opinion of those waters; and I was happy to find, during my last visit to Germany, that that opinion has been and is gaining ground all over that country." I may add the following testimony of Dr. Copland, an author of authority undisputed and scarcely rivalled. At the close of the article on "irritation" in his Diction- ary of Practical Medicine, he says: "In many diseases of irritation, the factitious mineral waters prepared at Brighton have proved of great benefit, even in the range of my own experience, having frequently prescribed them since 1824." Copland also makes reference to their value in several parts of his great work, as in the arti- cles on Headache, Hypochondriasis, Jaundice, Indiges- tion, &c. Laboratories are now in active operation all over Europe, at Paris, Berlin, Dresden, Konigsburg, Leip- zig, Doberan, Moscow, St. Petersburgh, Warsaw, Stock- holm, Brighton, &c, and especially at the more celebra- ted springs and baths. It may be important to bathe in the thermal waters of Weisbaden or Tceplitz- for ex- ample, while drinking the waters of some spring a thous- and miles off; the laboratory supplies the want. Thus on the simple score of cost, the benefits derived from the practical application of chemical science are as great in a healing point of view, as they are in the economical arts of every day life. While very large numbers of people are deterred by the expense and bustle from vis- iting the more fashionable Spas to regain lost health, the necessary outlay is reduced by the new art, to a sum within the reach of almost every one. As the "Carlsbad Spa" or establishment for the chem- ical re-construction of the medicinal mineral waters, as affording active, efficacious, and in this country novel Xll PREFACE. means of curing chronic diseases, is now in full opera- tion in Cincinnati, and its value already tested by ample experience, the author and compiler has found it advisa- ble to make considerable alterations in this edition of his pamphlet, as well as to make such additions to it, as to render it a condensed but almost complete essay on the subject of which it treats. i CHAPTER I. GENERAL REMARKS ON MINERAL WATERS.* "Whatever may be the difference of opinion among continental practitioners on other points of medical prac- tice, almost all agree in acknowledging that natural min- eral waters, "God's own compositions," as Paracelsus termed them, are the remedies best calculated for the cure and relief of a great number of chronic diseases, and as such they have been employed from the earliest periods. The frequent allusion to them in ancient writ- ings, the remains of magnificent structures found at sev- eral thermal springs, and the traditional accounts which have been transmitted down to the present time, afford evidence of the high estimation in which they were held. By the pagans they were considered to be direct gifts from the gods for the benefit of mankind, and their op- eration on the human body has been ascribed by many to occult and mysterious properties, somewhat approach- ing to the miraculous, an idea which is still entertained by some individuals, notwithstanding the progress of —*This chapter is compiled from a work honored with the approbation of the medical critics of England and Germany, viz: "The Baths of Germany, considered with reference to their remedial efficacy in chron- ic diseases: with an appendix, on the cold water cure. By Edwiw Lee, Esq. Fellow of the Royal Medico-Chirurgical Society; corres- ponding and honorary member of the principal continental medical and chirurgical societies; author of the Mineral Springs of England- th« Jacksonian Prize Essay on .he Operations for Stone; a Treatise on eorne Nervous Disorders, &c.,» and from a review of the Report of the French Academy of Medicine in the British and Foreign Medico- Chirurgica) Review, on the Mineral Springs of France. general remarks, etc. 15 science has demonstrated that their action is referable to the ordinary principles of therapeutics, though it must be confessed that our knowledge of the mode of action of medical agents still remains enveloped in great ob- scurity. "Some persons, however, ascribe the benefit from a visit to a mineral spring, entirely to the journey, the mental relaxation and freedom from the cares of avoca- tion, the exercise in the open air, &c. That many in- valids would derive great advantage from the mere change of air, scene, and mode of life, is unquestionable; and it is equally true, that without these important auxilia- ries the beneficial effects would not be produced in many instances; yet there is no doubt that, in the majority of cases, the benefit is mainly to be attributed to the me- dicinal operation of the water, which, though slow, and often not productive of immediate and active effects, is, on that very account, more suited to the class of chron- ie complaints, in which mineral waters are usually em- ployed. It must also be borne in mind, that in several of the worst cases, in those who resort to mineral springs for relief, these auxiliary circumstances can have no in- fluence, and the benefit obtained is clearly to be ascribed to the waters alone. Many persons are unable to take exercise, care little about the beauties of scenery, take no interest in public amusements, soon become tired, and experience discomfort at being separated from their homes and friends, and are induced to subject themselves to the inconveniences of a long journey to a mineral spring, by the expectation of a benefit which they know they are likely to derive from it. How many persons have I known crippled and almost confined to their room, suffering from pain, without society or resources for amusement, whose spirits have been greatly de- 16 GENERAL REMARKS, ETC. pressed on account of their condition, and the inconve- nience of a residence in a crowded hotel or bath-house, and notwithstanding, a short time after using the baths have experienced a sensible amelioration, and have ulti- mately recovered, though they had previously tried oth- er means of relief without success. These are the cases by which the powers of mineral water may be satisfacto- rily tested. Many persons, again, engaged in business, soon experience at a bath the influence of ennui, are disinclined to form new acquaintances, and are anxious respecting the course of their affairs, and yet are in- duced to prolong their stay from, the evident improve- ment in their health during the course, though perhaps little or no alteration is made in their ordinary time of rising, or in their diet. Such persons, where a course of bathing is not required, will often derive as much benefit from drinking an artificial mineral water, which may also be recommended as an efficient substitute, when a person cannot undertake a long journey, or if he reside near an establishment of mineral waters, and is desirous not to absent himself from his family and his avocations. "Several highly efficacious springs have been discov- ered from the circumstances of diseased animals instinc- tively resorting to them, and recovering their health by bathing in, or drinking the water. Alibert says, "It is a known fact, that at Vichy, in the month of April, at the period when the snow melts upon the mountains, when the wind has passed over the springs from the direction of Puy de Dome, and has carried the vapour to distan- ces more or less considerable, the ruminating animals on the left bank of the Allier, swim across the river to come and drink with avidity at the salutary springs of the establishment; the waters are then fit for use, and GENERAL REMARKS, ETC. 17 the people of the country are in the habit of saying, the season has commenced, the beasts have come across, les betes ont passe. The peasantry in the neighborhood of mineral springs have been for centuries in the habit of using them, in those cases which experience had taught them were likely to be relieved. Some invalids derive no benefit from one mineral spring, yet are greatly ad- vantaged on using another more suited to the nature of their disease; though the mode of life be the same in both places. Notwithstanding the inferiority of exported waters to those at the springs, they are often eminently serviceable, although the invalids, instead of breathing the pure air of the country, and rising early in the morn- ing to take exercise, continue to breathe the vitiated air of a metropolis, lie in bed during the great part of the morning, and take no exercise except in a carriage l in short, make no change in their usual mode of living. The power of mineral springs is further proved by their prejudicial effects when used in cases to which they are not adapted, and also when incautiously employed by persons in health. "Other examples might be adduced, if it were neces- sary, to show that mineral waters are powerful means in the removal and mitigation of chronic disease, which re- quire great caution in their administration, and should be employed not as a last resource, and when a disease has become inveterate, as is too often the case; but as therapeutical agents better suited to the treatment of many chronic diseases than pharmaceutical preparations, inasmuch as in these cases, active medication frequently does harm, and the good effects of the treatment are generally more durable, in proportion as they are gradu- ally produced. "The evidence of antiquity," says a standard author, "with regard to the efficacy of mineral 18 GENERAL REMARKS, ETC. water?, the experience of centuries vrhich confirms this efficacy, the universal favor in which they are held among all civilized people, notwithstanding the differ- ence of medical theories, sufficiently demonstrate that thev are of ail remedies, those of which the reputation js the most justly established. Nature bestows these remedies liberally upon us, in order to invite us to have recourse to them more frequently in our diseases. She has consulted as much as possible our delicacy, our taste; f.lio has tempered the virtues of the waters, and their energy, and she has adapted them to different tempera- ments. We obtain many medicaments from plants and minerals, but they almost all require certain pharmaceutic- al preparations, whereas mineral waters are remedies which are always at our disposal; they contain sulphur, car- bolic acid, and neutral salts, which are frequently em- ployed in the practice of medicine. Why, when found in Nature's laboratory, should these substances not have an equal power as when taken from that of the apothe- cary ? Most mineral waters are not harmless; one can- not use them with impunity in cases where thev are coun- ter-indicated, and every year persons become the victims of their imprudence in this respect. So far from being inert, mineral waters are at times so active, that We are obliged to moderate their energy, by mixing them with milk, or some other emollient fluid."* Others, however far from 'regarding mineral waters as substances possess- ing but little remedial efficacy, are apt to entertain wrong notions of their powers, and frequently use them in ca- ses to which they are ill adapted; or, trusting entirely to them, neglect to make the necessary alteration in their habits and regimen, and to adopt other means of pro- —*Patissier et Boutron-Charlard, Manuel des Eaux Minerales. Paris 2d edition. GENERAL REMARKS, ETC. 19 moting their efficacy. Under such circumstances, it is not surprising that disappointment should ensue, and that these persons should frequently leave watering pla- ces in a worse state of health than on their arrival. "Tho very free use which the English and Americans are in the habit of making of active medicines, which stim- ulate particular organs, renders many people unable to comprehend that the modus operandi of mineral waters differs from that of pharmaceutical preparations; the ac- tion of the former should be general and alterative, and their sensible effects are often subordinate, and frequent- ly not apparent till a person has been using the water for some time. 'We should, however, be greatly in the wrong,' says Dr. Kreysigrf 'if we were to consider in all cases the increase of the intestinal, urinary, or cutaneous secretions as critical, and as the sole or chief effects of the waters, for this is often a circumstance of very sub- ordinate importance, and only constitutes the most su- perficial effect, although the quickest and the most ap- parent. The Carlsbad waters frequently cure the most obstinate obstructions and enlargements, without occa- sioning any notable evacuations.' But in most pharma- ceutical preparations, the action is of a local nature, af- fecting principally a particular part or parts, and is speed- ily followed by sensible effects: hence, many of those who have been accustomed to this mode of medication, are with difficulty induced to go through a regular course, or cure, as the Germans call it; and finding no material al- teration in their state at the expiration of a few days, or a fortnight, not unfrequently abruptly break off, either to return homewards, or to go to some other place, and to report that they used such or such waters, without find- ing themselves a bit the better; others, though they —f De 1' usage des Eaux Minerales de Lcipsic, 1829. 20 GENERAL REMARKS, ETC. may have regularly used the waters for a longer period, yet acting upon their own responsibility, or without be- ing attended by a properly qualified professional adviser to superintend their course, and make such alterations as circumstances may require, frequently adopt improp- er methods of employing it, and are disappointed in the results when it may be the blame rests entirely with themselves. " 'In general,' says a French author, mineral waters are riot suited to acute diseases; the rapid Course of these affections requires prompt and active measures. The Case is different with respect to chronic diseases, the treatment of which succeeds so much the better in pro- portion as the medication is milder and more gradual. Mineral waters employed at the source are unquestiona- bly the best of all the remedial means for producing this medication. They act in some cases by modifying the state of the humors, as the Vichy waters, in other in- stances, by imparting to chronic diseases a slightly acute state, which rouses the torpid organs, increases the se- cretions, and promotes salutary crises. When this ex- citation is slow and moderate, it relieves and cures ob- stinate diseases; but when too energetic, it exasperates them, re-kindles latent inflammations, and hastens the coarse of organic alterations. It is, then, in the main- taining this excitation within proper bounds, in gradua- ting, in regulating the dose, so to speak, according to the nature and the degree of the morbid lesion and the temperament of the patient, that the talent of the bath- physician consists.'J "Other persons, though employing the waters in a proper manner, arc yet so much under the influence of habit that they do not make the requisite alteration in —^Manuel des Eaux Minerales. GENERAL REMARKS, ETC. 21 their diet and mode of living, but pursue the same sys- tem, which perhaps tends to produce and keep up their disorder. A German writer on mineral waters has said, 'Whosoever comes to a bath and desires to be cured, must will it in earnest;' and it behooves every invalid who wishes to give a mineral spring a fair chance, to bear constantly in mind the abject which has brought him to it, without being led to act improperly from the influence of habit and example, or from a misplaced economy. "'Many chronic complaints, especially when not of long standing, would be better treated by medicines than by mineral waters, which I by no means wish to be consid- ered as remedies of universal application, and which, in many instances, would be altogether inapplicable; but? on the other hand, there are many diseases of a long duration, in which medicine has been but of little avail, and which a properly directed course of mineral waters would often remove when other means would not succeed. This resource is, however, too frequently delayed till the last, the patient having gone through a whole range of pharmaceutical preparations and the chance of advant- age from mineral waters is much diminished. Patissier observes on this point, "The patients who go to mineral springs, have often exhausted all the resources of phar- macy, their stomach is weakened by the drugs with which it has been oppressed and the cessation from this medication is not perhaps the least of the advantages which they derive from a visit to the springs.' "The mineralizing substances contained in medical springs, consist of the fixed or solid, and the volatile or gaseous. Among the fixed substances, are alkaline and earthy bases, in combination with acids, forming sul- phates, muriates and carbonates. Some metals, as ^ron, and manganese, and silex, are those most frequently met 22 GENERAL REMARKS, ETC. with. The volatile principles are for the most part car- bonic acid, sulphuretted hydrogen, and azote. The quan- tity and forms of combination of these substances vary exceedingly, and the therapeutical action of a mineral spring, is frequently not of the kind which an inversti- gation of its chemical composition would lead one to sup- pose. It is well known by those who have paid any at- tention to tho subject, that in a chalybeate spring, for instance, possessing strongly marked tonic properties, and where the presence of iron is evident to the taste and sight, the chemical analysis exhibits in most instan- ces, no more than half or three quarters of a grain of this metal to the pint of water. An author whom I have already quoted, says on this point: 'It is evident to us that the medicinal action of natural mineral waters is not always in relation with what we know of their constitu- tional principles; it is not a few grains more or less of mineralizing salts which determine the salutary effect of mineral waters; chemistry teaches us to characterise, to class the waters; shows us the analogies which exist be- tween them, enables us to anticipate some of their prop- erties, by showing us the predominating mineralizing sub- stances ; but it belongs to clinical observation, to the authority of multiplied facts, to determine their thera- peutical action.'* Dr. Gairdner likewise says on this part of the subject: 'In judging of the effects of a min- eral water, it is important to discriminate what portion of these are to be ascribed to the mere water itself, what to its elevated temperature in the case of thermal waters, and what to its foreign ingredients. The simple circum- stance of dilution will certainly facilitate the operation of matters which might otherwise pass, little changed through the alimentary canal; and from the extremely —*Pattissier, Manuel dcs Eaux Minerales, 2nd edition. GENERAL REMARKS, ETC. 23 minute state of division in which the active particles are presented to the sentient mouths of the capillary absorb- ents, it is more than probable that they are directly ab- sorbed into the circulating mass. Indeed, in no other way can we account for the powerful effects which result from the use of many chalybeate springs. The strongest does not contain more than five grains of the carbonate of iron to the gallon of water; the real quantity of this tonic received at a single dose into the stomach, or con- tained in a pint of water, must therefore be extremely small, and nevertheless it will exert a more salutary in- fluence upon the system than twenty times the dose of the artificial carbonate in our ordinary prescriptions.'! "Much of the efficacy of mineral springs depends up- on the state of intimate combination of the saline, metal \ lie and gaseous substances with the water. Daily expe- rience in the practice of medicine demonstrates that the properties of remedial agents are frequently enhanced by pharmaceutical combination, and the difficulty of combin- ng these substances as closely as they are found to be in a state of nature, is one reason of the superiority of min- eral waters. The state of dilution (which I have already alluded to) in which the various particles are held in min- eral waters, must also materially influence their opera- tion, and produce effects different from those which would be obtained by the same substances, if exhibited in a more concentrated form. The great variety in the tem- perature of mineral waters, from 8° or 10° to 60° of Reaumur's scale renders them adapted to various and op- posite indications, according as a more relaxing and sol- vent, or as a tonic and bracing, action is required. "Mineral waters are then to be considered as strictly —fOn the Natural History, &c, of Mineral and Thermal Springs. Edinburgh, 1832. 24 GENERAL REMARKS, ETC alterative remedies, and though their primary operation is mostly evidenced by increased activity of the secreto- ry functions, yet in many instances no immediate effects are perceptible by the patients, and in these cases more benefit sometimes results from their use than in others where their operation is more sensibly felt at the time. Some produce their effects independently of any increase of secretion. Such are chalybeate and some alkaline waters. During the employment of some others, vari- ous unpleasant symptoms, or what is called the Bath-fe- ver, are not unfrequently induced. "'Again, other patients experience no alteration in their symptoms, neither during nor immediately after the treatment. The waters appear to have been without any action on them. Such persons should be subjected, during the winter, to a treatment by medicines which have an analogous operation to the waters. The cure is frequently obtained in this manner, or, at least, it is pre- pared for the next season; when, on resuming the use of the same waters, they are observed to produce a speedy effect, and cure as if by enchantment.' Mineral waters," says Dr. Von Amnion, 'can only produce their beneficial effects in a slow and gradual manner: a hurried pertur- batoryvemployment of them not only prevents the cure, but almost always causes an aggravation of the disease; they are drank in order to become mixed with the blood, by means of the digestive powers, and in this manner the curative changes in the body are affected. "Cold waters are digested slower, and their operation on the vascular system is less penetrating than warm ones. Hence critical signs are much more frequently in- duced by the use of the latter than the former. "The beneficial effects of a course of mineral waters is not always evident at the time. But the after-operation GENERAL REMARKS, ETC. 25 (Nachwirkung) of mineral water is not a fallacy, but a truth proved by repeated experience. Many diseases are too ancient and deep-rooted for a cure to be effected by a month or six weeks' course; and though an aggrava- tion rather than an amelioration of the complaint, is oc- casionally experienced at the time, yet the patient fre- quently feels himself benefitted by the after operation.* "A course of mineral waters, or cure, as it is termed in Germany, generally lasts from four to six weeks; in many cases, however, a shorter, as from two to three weeks, is recommended. In other instances a much longer course is required, or even two courses during the season, two or three weeks intervening between them. During this period, patients for the most part drink the water daily; the quantity being gradually increased ac- cording to circumstances, towards the termination of the course gradually decreased. The water should always be drunk early in the morning at the spring, when pos- sible, gentle walking exereise being taken at the time. In some instances it is diluted with milk, or some other simple fluid. It is also advisible in many cases to drink a little of the water in the afternoon. As other medi- cines mostly interfere with the operation of mineral wa- ters, they should be abstained from, unless recommend- ed by the physician. "It likewise not unfrequently happens, that what is called an after cure, by a different kind of mineral water or of other means is required. Thus, to relieve the state of relaxation and oppression which these other springs sometimes occasion, the subsequent employment of a cold saline or chalybeate is advisable. Patients, after having undergone a course of Wiesbaden or Ems, are often sent to Schwalbach, or Schlangenbad, to use those —*Brunnen Diatetik. 4th edition. 26 GENERAL REMARKS, ETC. waters; and after a course at Carlsbad, to Marienbad, Franzenbad, or Toepiiiz. Much judgment on the part of the physician is required, in order to determine justly when an after-cure should be recommended, as the in- conveniences sometimes complained of after the em] loy- ment of an active spring, sire often of very temporary duration, and are the prelude to the occurrence of critical appearances, and of a favorable change, which might be prevented by the exhibition of a water of a totally different character; and even those cases when a chalbyeate, for instance, is indicated after a course of hot saline or alkaline waters, a period of ten days or a fortnight should intervene before the change be made. In many persons the suspension of the course, and change of air for a few days, suffices to remove the op- pression which is sometimes induced at an early period, and beforo the system has become sufficiently saturated with the water. It is likewise essential after a course of mineral waters, th:it invalids should not consider that caution is no longer requisite; many have prevented the good effects of the course, by returning too soon to the worry of affairs, or to an improper regimen, or by hurried traveling homewards." The "Administration cles Mines" of France furnishes to the government of that country a list of all the known mineral springs therein, and although the num- ber reaches the very high figure of 864, it is considered below the truth. At 140 of these are one or m<>re phy- sician-inspectors, appointed by Government, who t.re re- quired to send in annual reports, which are then trans- mitted to the Academic de Medicine to examine. The documents are referred to an expert, who examines them in detail, and makes a critical repori on them to the GENERAL REMARKS, ETC 27 Academy, and in due time this last is printed and thus given to the world. M. Pa Ussier, in his review of the reports for 1851-2, thus sums up; and his scientific position and high char- acter lend great force to his positions: "1. Mnerul Waters cons chrt'd m Prophylactic Agents. —M. Patissier believes that the hygienic value of these as compared with their m.dicinal, has been undeirated by the profession. They offer a most valuable resource for the town valetudinarian, who, neither ill nor well, only gets worse under ph irmaceutical treatment, whether of atonic or depressing kind. Under their employment and that of the attendant hygienic circumstances, old pains disappear, nervous irritability is allayed, nutrition is rendered more aoiive, and with the increase of strength courage and hope return. In the melancholic and hypo- chondriacal the benefit derived is sometimes remarkable; as is the case also, in young persons whose constitution has become enfeebled and their nervous system over- stimulated, by excess of study. In "lymphatism"—a diathesis which, though sometimes hereditary, is oftener the product of vitiated air, sedentary habits and bad food—the advantage of the sea-side, sulphurous, ferru- ginous, and saline waters, is undoubted. This condition of the organism, without being actual disease, is not health, and is betrayed by a swollen, pale countenance, false embonpoint, a feeling of general lassitude, slow pulse, and general indolence of functions. By render- ing the imperfect nutrition and languishing vitality more active, and imparting more tone to the tissues— the employment of mineral waters may prevent the es- tablishment of scrofula and phthisis. "2. Mneral Waters as Curative Agents.—Taken at their source, mineral waters constitute the best agents 28 GENERAL RUM AUKS, ETC. for the treatment of chronic disease, when prescribed with due attention to the stage of its progress and the temperament of the patient. Complex in their opera- tion, they are at once stimulant in various degrees and alterative. Their stimulant power is often pre-eminently useful, rendering the chronic disease for an instant acute, and by rousing the organic movements from their inertia, facilitating the disgorgement of the vessels that are the seat of passive congestion—mineral waters acting in such cases very much as irritating collyria do in chronic opthalmia. This stimulant action is also exhibited in the increase of the secretions, and in the appearance of various forms of eruption at the surface. The alterative action, though less appreciable to the sense, is no less real, the humors evidently undergoing modification by means of the sulphur, iodine, arsenic, iron and alkalies contained in the waters. Owing to these active princi- ples existing in such weak proportions, this modifying influence has been, denied to them; but alterative medi- cines seem to be more effectually absorbed in the diges- tive passages, in proportion as they are given in divided doses dissolved in liquid. Thus a much greater effect is produced in chlorosis and.anoemia by ferruginous mineral waters, than by pharmaceutical preparations of steel in large doses. . . M. Patissier protests against the too indiscriminate employment of these agents, without duo consideration of the special adaptation of certain classes of them to different pathological conditions. As a result of his ex- amination of the reports, he finds persons suffering from the diathesis affections (as rheumatism, gout, dartres scrofula, and syphilis,) resort, as it were instinctively to mineral waters. The morbid conditions known as diathe- ses, are evidently the product of a special change in the GENERAL REMARKS, ETC. 29 fluids: and upon them the active principles of mineral waters exert great modifying influence. These princi- ples are so well combined with adjuvants, and so com- pletely dissolved, that they readily penetrate into the circulation, impressing upon the entire organism a far more salutary influence than results from the use of most pharmaceutical substances. The amendment takes place slowly, with appreciable crises, and may not become complete until some time after the employment of the waters has ceased. M. Patissier believes that the doctrine of metastasis has undeservedly fallen into discredit, and he finds the reports full of instances of the production of functional disturbances by the metastasis of gouty, rheumatic or syphilitic principles. These affections often, indeed, as- sume the mask of neuroses, visceral neuralgia, &c, and the diagnosis may be difficult to establish—the maxim, naturam morborum ostcndit cur alio, often finding its ap- plication. Many pathological distinctions, to all appear- ance very serious, and which have resisted the most ra- tional treatment, are dissipated by provoking to the surface the rheumatic, gouty, or syphilitic principles, or reproducing a dartrous eruption inconsiderately repressed. In diseases of the skin much good or harm may result according as the mineral waters are selected, with due regard to the cause of the affection and amount of irrita- tion, and the perseverance with which they are employed. In scrofula, their use is rarely continued long enough to exert a curative influence on lesions springing from so deep-seated an infection of the economy. It is by no means rare to find syphilis, that had long remained lat- ent, becoming unmasked and amenable to treatment un- der the influence of mineral waters. They are not in themselves anti-syphilitic; but they are useful adjuvants 30 CARLSBAD. to specific treatment. It is i\m.rkable that during their employment salivation is rarely produced, even when larg.: doses of mercury are given. Chronic diseases, as met with at the thermal establish- ments, are f,.r from presenting tin mselves in the same pimple m inner as thry are described in the books. Few individuals off r but a single lesion, sevi ral usually co-existing or cng..ndtring each other, so that both the c/.r itive indications are sometimes contradictor}', and re- quire tact for their seizure." CHAPTER II. Indications for the use of particular Waters. Thermal Waters: Carlsbad, Ems and Vicut. CARLSBAD. I shall commence with an extract from the work of Dr. Granville already mentioned. "The maladies for the cure of which Carlsbad has been long celebrated, are many. Ilufeland, one of the most illustrious practi- tioners in Germany, who died a few years ago at Berlin, full of years and reputation, being asked by me, during my first visit to that capinil, for the reason of this undi- minished celebrity of Carlsbad, answered, 'Cost qu'il guerst des maux rebelles a tout autre moyen curatif.'t There is not a sing'e medical man of eminence in Ger- many who does not entertain the like opinion. * * * —fit is because it cures maladies resisting all other curative means. CARLSBAD. 31 "My own experience warrants me in commending the Carlsbad waters in all obstinate cases of induration, tume- faclion, tenderness, and sluggish action of the liver; in imperfect or suppressed gout; in par.dysis dependent on the stomach and not fullness of blood in the head; in cases of tic, and nervous disorders; finally, in obstruc- tions of the glands of the mesentery, and in those en- gorgements of the spleen, and distended state of the splenetic vessels, which are much more common (as I have proved in another publication) in females, especi- ally of the better classes, than medical men appear to be aware of. Physicians in this country, now-a dajrs, seem to have forgotten that such an organ as the spleen exists. They have directed the whule force of their bat- teries against a larger and more important organ, the liv- er; every sin and iniquity being laid at its door. This view may, to a certain extent, be juyt with regard to m.ile patients, who,—from a greater and more frequent exposure to all the morbid causes that can affect the liv.r—such as vicissitudes of climate, excessive gluttony and high living, immoderate potation of strong liquors, violent exercise of the body, intense thought, and violent mental excitement (as was the case with that illustrious victim of diplomacy, whose name will never perish)— present too often the most afflicting piclure of hepatic disorder. But ic is not less true, also, that in female patients the spleen is oftener affected than the liver with obstruction and enlargement, for reasons that nre equal- ly peculiar to the cansti'.u'ion and the habits of their sex. This distinction is of the utmost importance, and in the course of iw?n'y years' practice in this metropolis during which period some thousands of cases of female complaints have come under my notice, that distinction forced itself, as it were, on my attention, and I have 32 CARLSBAD. reason to be thankful that I never after lost sight of it. "Well, then, these very obstructions of the spleen are essentially benefitted at Carlsbad; sometimes by the warmer, at other times by the less warm springs ; accord- ing to the degree, intensity, and peculiar cause of the indisposition. Being aware of this fact, I never hesita- ted sending those of my patients who could afford it, to Carlsbad, where they have all found that relief which drugging had never given to them in London. In saying this, however, I do not mean to insinuate that no other warm mineral springs than those of Carlsbad will be found equally useful in the same class of complaints. The contrary is the case, as may and will be seen in other parts of this work. "The power of the Sprudel, in dissipating adhesions, has been mentioned with confidence by some physicians. The testimony given me of this fact by one of the pa- tients on the spot, would seem to corroborate the state- ment. "It is the despondent, dejected, misanthropic, fidgety, pusillanimous, irritable, outrageous, morose, sulky, weak- minded, whimsical, and often despairing hypochondriac,— for he is all of these, and each in turn,-—made so by con- tinued indigestion, by obstinate and unremitting gout, by affections of the nerves of sympathy and of the gas- tric region, and by other equally active causes,—that Carlsbad seems pre-eminently to favor. "Closely allied to this class of disorders is the forma- tion of biliary concretions. Innumerable cases of this sort have been recorded as cured at Carlsbad; and I am acquainted with an eminent foreign physician, whose case I alluded to in my work on St. Petersburg, who owes to Carlsbad the complete recovery from one of the most in- veterate affections of this sort that man can suffer under CARLSBAD. 33 and live. With respect to gravelly and calculous depo- sitions, the single case of Dr. Bigel of Warsaw forms the strongest evidence of the great efficacy of the Carls- bad waters in such complaints. That gentleman, after having submitted at Berlin to the new operation of lithotripsy, on account of a large calculus in the blad- der, of which he was suffering, at the age of sixty four, was obliged to have recourse to the waters of Carls- bad, which smoothed, diminished, and lastly expelled from time to time, all the remaining fragments of the stone until he quite recovered. I have already alluded to another case of recovery from gravel in the person of an equally eminent physician, Joseph Frank. * * "Copious secretions of the kidneys, and perspira- tion, are much more frequent effects of drinking the Carlsbad water than purgation; and it is curious that the salts of that water are detected in both those excretions. Some drops of the perspiration produced after drinking the tSprudel, when examined by the microscope, exhib- ited crystals of those salts. "One of the inconveniences more or less common to all mineral waters when taken internally—borborigmas, or rumbling in the intestines, particularly if the patient has foolishly eaten of vegetables—is not so frequent with the Carlsbad water. My appetite was sharpened after the several goblets I had swallowed, without any consequent distention. On one or two occasions I fancied I felt the beating of the vessels of the head more loud- ly ; and the action of the heart was certainly disturbed "Altogether, the immediate effects of the Carlsbad waters show its potency, and v.Trn patients from at- tempting to use it, either under the advice of physicians personally unacquainted with its nature, or without any advice at all." 34 CARLSBAD. I shall next extract a few lines from Lee's "Mineral Springs of the continent of Europe:" "From the powerful effects on the mucous membranes, absorbent system, and parenchymatous viscera, the wa- ters of Carlsbad are highly efficacious in the removal or mitigation of abdominal engorgements; induration of the liver or spleen following acute disease; hypochondriasis with constipation; piles menorrhagia, and other derange- ments of the uterine secretion not of an inflammatory nature; enlargement of the lymphatic and salivary glands; chronic gout, when accompanied by much stom- ach and liver disorder; long standing disease of the kid- neys, with tendency to the formation of stone; some cutaneous affections, especially when of syphilitic or mer- curial origin; enlargement and Chronic disease of joints. They are contra indicated in persons of a full habit of body, and those liable to cerebral congestion, unless these states have been in some measure removed, pre- viously, by preparatory treatment; in cases of structural disorganization, as consumption, acute gout with calca- reous deposits; hemorrhage, epilepsy, and other convul- sive diseases." Taking up next in order in the work of Dr. James Johnson,t we find in the preface the following: "As far as the Spas are concerned, Dr. Granville's. work is full of information on this subject. The profes- sion and the public, indeed, are deeply indebted to Dr. Granville and Mr. Edwin Lee for opening out wider, and clearer views of the continental mineral waters; but the subject itself, so far from being exhausted, is only m its infancy of investigation. Whether we regard the con- —fPilgrimages to the Spas in pursuit of health and recreation- with an inquiry into the comparative merits of different mineral waters- the maladies to which they are applicable, and those in which they are in- jurious. By James Johnson, M. D., Physician extr. to the late King CARLSBAD. 35 stituent elements of the waters themselves, their physi- ological operation, or their remedial efficacy, there is ample room for many future inquirers." In the work itself Dr. Johnson makes the following quotation: "The operation of the Carlsbad waters, in fact, is what is called 'alterative or 'deobstruent;' and as such they are applicable to a long list of maladies arising from congestion or obstruction in the abdominal organs, particularly the liver, spleen, mesentery, and other gland- ular viscera, attended by debility of the stomach, heart- burn, acidity, distention, eructations, constipation, jaun- dice, biliary concretions, hypochondriasis, haemorrhoids, head-aches, giddiness, gouty feelings, cutaneous erup- tions, scrofula, and urinary obstructions."* This is an encouraging picture, but I have no rea- son to consider it as overcharged. "In chlorotic amenorrhoeal disorders, Carlsbad waters are beneficial; not so much from the minute quantity of iron they contain, as from their stimulant and deobstru- ent qualities. Females ought not to use these waters at all times. "A painful complaint which often presents itself at Carlsbad is biliary calculi. Dr. De C. thinks that the waters are almost specific in such cases. He lately at- tended an invalid who had come from a great distance to Carlsbad.J On the third day of using the waters a pro- digious number of gall-stones, of all sizes, were expelled. He has often found gravel to be expelled from the kid- neys and bladder during the use of these waters; but he does hot vouch for their lithontriptic powers—that is their power of dissolving urinary calculi, although this quality has been attributed to them by some physicians." —*Carlsbad; ses Eaux Minerales. Par de Carro. —{A brother-in-law of mine and sent by me to Carlsbad. S. H. S. 36 CARLS3AD. Before quitting those celebrated waters, I must take1 a short notice of a little work just published by a rising young physician of Carlsbad, whose acquaintance I had the pleasure of making there. {From the Medico-■Chirurgical Journal) Geschichte von Karlsbad. Von Dr. Hlawaczek.—His- tory of Carlsbad. The learned author gives a most elaborate account of almost every work that has been published on these fa- mous waters, since their discovery by the Emperor Charles IV. in the sixteenth century. His book is, in short, a catalogue rdeonnee of the writings of his prede- cessors. The few practical observations contained in it may be thus stated: The medicinal powers of the Carlsbad waters are the following: "1. They invigorate the primoe vise, and dislodge from them all impurities and accumulations. Hence in various forms of dyspepsia, arising from sedentary life, from tor- por of the bowels, &c, they are especially useful; also in chronic jaundice, obstinate head-aches accompanied with constipation, &c. "With such patients the use of the Carlsbad waters often acts as an emetic for the first day or two.—Corpu- lent indolent persons, who feed too much and take little exercise, are always benefited. "In all obstructed and infarcted states of the abdom- inal viscera, the use of the Carlsbad waters may be rec- ommended. Hence, in many cases of hypochondriasis and haemorrhoids, they are beneficial; also in enlarge- ments of the liver, spleen, and mesenteric glands. "In addition to these maladies, we may enumerate many cases of amenorrhoea and dysmenorrhoea—diseases which are so often dependent upon accumulations in the CARLSBAD. 37 bowels and general torpor and plethora of the system. "2. The Carlsbad waters have the effect of freeing the blood of acrimonious particles, either by neutralizing and discharging them out of the body, or by causing a metastasis and derivation of them to the joints or to the skin. Hence in various forms of internal gout and rheumatism, they are singularly useful; the disease being often drawn from the internal viscus which may happen to be effected to some outward part. "3. The Carlsbad waters cleanse the urinary passages of calculous deposits. "And lastly, they often effect a cure in a number of anomalous diseases, whose causes are not known, and to Which indeed a name cannot be given; as, for example, loss of power and feeling in the limbs, a tendency to syncope followed by cramps, some cases of epilepsy and asthma; also in certain disturbances of the mental func- tions. In these cases, the Carlsbad waters seem to act as an alterative. "The venerable Hufeland published in 1815, a treatise on the chief medicinal springs in Germany. He recom- mends the use of the Carlsbad waters in cases of con^ stipation, tympanites, incipient disorganization of the stomach and bowels and other abdominal viscera, mora especially of the liver, of chronic jaundice, of congestion of the mesenteric and portal veins; also in nervous ail- ments, as amaurosis, hypochondriasis, and in various forms of calculous disease. He also strongly recommends them in most of the forms of gout. The Carlsbad wa- ters, in addition to their purgative qualities, are pos-* sessed of remarkable alterative powers, so that often they effect quite a change in the state of the blood and other fluids of the body, depriving them of all acri- monious and hurtful particles* and restoring them to a 38 CARLSBAD. condition of health. Hence their striking utility in numerous cases of cachexia, wdiich are irremediable by ordinary medical treatment."—Hlawaczek. It may be as well to introduce here some further re- marks by Dr. Johnson on the modus operandi of miner- al waters: "Many different diseases are produced by the same causes acting on different constitutions. Thus luxurious living and idleness will, in one person, induce gout—in a second, haemorrhoids—in a third, liver complaint—in a fourth, rupture of a blood-vessel in the lungs—in a fifth, congestion of the brain—in a sixth, paralysis—in a seventh, stone in the kidney or bladder,—and the list might be far extended. Now, if the same cause or class of causes produce such a nuihber of different maladies, there is nothing unreasonable in the supposition that the same remedy, or class of remedies, may be useful in abating or even removing those varied disorders. "With the exception of a few specific remedies, such as mercury, sulphur, colchicum, and ergot, with the real nature of whose physiological operation on the hu- man frame little is known, almost all the other medicinal agents act through the medium of the digestive organs, the liver, the kidneys and the skin. Now, the mineral waters of such spas as Wiesbaden, Kissingen, Marien- bad, Carlsbad, &c., act through these organs also, and contain the elements of many of our most efficient rem- dies. They have, besides, great advantages over ordin- ary medicines at home, in consequence of the exercise of traveling, the change of air, and the alteration of habits tliat precede the course of the waters. "The far greater number of physical remedies act by altering and improving disordered functions and secre- tions—by evacuation—by imparting tone to debilitated CARLSBAD. 39 organs or the whole constitution. It must be allowed that mineral waters contain, to a very considerable ex- tent, the requisite ingredients for fulfilling one or all of the foregoing indications. "It is often found to be beneficial to combine tonics, alteratives, and aperients in the same formula or pre- scription, in order that the three indications alluded to, may be simultaneously accomplished. It is undeniable that some, of the spas contain within themselves this combination of chalybeates, aperients, and alteratives, either of which ingredients can be increased at pleasure on the spot. "The medicinal agents in the mineral waters, though in much smaller quantities than when given in pre- scriptions, have a much better chance of success, in con- sequence of their being so largely diluted by the hand of Nature, and the temperature of the diluent being, so very high inmost of the springs." Lee, in his "Baths of Germany," observes : "As fur- ther proofs of the solvent powers of the Carlsbad waters, it is stated that during their use encysted tumors have disappeared, nasal polypi have spontaneously fallen off, that bony prominences diminish, and that fractured bones become softened at the point of the fracture. Some similar effects have also been observed from tlje use of the artificial Carlsbad waters in Struve's estab- lishment." Finally, Dr. A. Vetter, well known in Europe as an author on these subjects in bis Allgemeines Brunnen and Badebucb, Berlin, 1840, observes, "If further proof is desired that the powerful effects of the Carlsbad wa- ters depend on the mode in which their elements are combined, we cite the perfectly analogous effects pro- duced by the factitious waters of Struve." 40 CARLSBAD. The physical effects produced by the use of the Carls- bad water, vary more remarkably than is the case with any other known spa, depending always on the constitu- tion of the patient, and the character of his disease. Thus, when this latter is of less importance or gravity, its immediate effects are mild and gentle, and only ob- served in an increase cf functional activity' of the skin, kidneys, and bowels; and although producing perhaps several loose motions from the latter daily, its aperient operation is much milder than that of ordinary laxation, is painless, and so far from weakening, that appetite and power of digestion increases, and the invalid feela lighter, gayer, stronger and in every respect better. But when employed in serious and deep-rooted ail- ments, as, for example, gout, rheumatism, abdominal plethora, liver or sp/een disease, &o, it often induces very marked disturbance in the system. At first its use is followed by costiveness, even in those whose bowels have previously been regular; then follows a diarrhoea, lasting a few days, to be again followed by costiveness. At the same time a mini or of troublesome symptoms appear, such as pains in the limbs, weakness, restless- ness, despondency, loss of appetite, weak digestion, nausea, flatulence, loss of sleep, full and frequent pulse local congestions, sense of weight, pressure or giddiness in the head, a general feeling of sickness, alternate chills and heats, and in some instances real paroxysms of fever. Occasionally pain and sense of weight across the loins are followed by attacks of piles in different forms; or the patient is troubled with bleeding or a mucous dis- charge from the nose, a very disagreeable sweat, erup- tions on the skin, especially around the mouth, tooth- ache, sense of pressure in the back of the head or over the eyes, motes or muscoe volitantes, and, in cases of CARLSBAD. 41 liver disease, jaundice. These symptoms, which make their appearance from five or six days to a fortnight after the commencement of the treatment, increase by de- grees until they become so severe and apparently serious, that any one, physician or patient, not thoroughly ac- quainted with the effects of mineral waters, would be alarmed, and cease or counsel the cessation of their em- ployment. No greater mistake could be made. It is just in proportion to the necessity for their use that— as a rule—these symptoms appear; they are merely a proof and a consequence of the arousing of the previous- ly dormant energies of the system to shake off disease, and cease spontaneously on the occurrence of critical evacuations. Thus after they have continued from three or four days up to even a month, the time elapsing be- ing mainly determined by the obstinacy and previous du- ration of the disease, a new set of symptoms occur: as profuse, perhaps very offensive sweat, painful micturi- tion with the discharge of a large quantity of light yel- low, dark red, or smoke colored urine, and a sense of ' burning in the rectum, followed by the passage of an enormous quantity of green, black, or yellow, tough, slimy, or tarry focal matier, with occasionally membra- nous shreds or even casts of portions of intestine. Af- ter the occurrence of one or more of these critical dis- charges, the patient rapidly improves, appetite returns, the strength increases, all the functions are performed with a healthy vigor, and to his infinite joy and satis- faction, he finds himself free from all his former ail. ments. It must be borne in mind, however, that in very old and serious cases, the effects of a course of Carlsbad Water continue for a long time after its conclu- sion, and the symptoms just described first make their appearance even some weeks afterwards. In such cases 42 EMS. it is by no means uncommon to hear the cure attributed to some innocent and indifferent medicine which has been taken in the mean time. On the other hand there are cases not to be cured by a single course, when it be- comes necessary to repeat it a following summer, or even to drink a third season. Invaluable a curative agent as Carlsbad water is, in the cure of a large series of chronic disorders, just so dan- gerous and destructive is it if used without a proper at- tention to diet and regimen, or in cases to which it is not adapted. These are all kinds of malignant disorders, —in which it accelerates the developement of the dis- ease—all kinds of internal disorganizations, certain de- graded conditions of blood, great debility, tendency to hemorrhages, especially of the lungs, tuberculosis, or- ganic diseases of the heart or larger arteries, and in cer- tain "nervous" conditions. EMS. Of the waters of Ems, says Dr. Lee in his Baths of Germany: "The resident practitioners also speak highly of the effects of these waters in cases of disordered di- gestive functions, with torpor of the liver; and there is no doubt, that in several of these cases, attended with heartburn, acidity, and other symptoms of a vitiated EMS. 43 state of the secretions, they are calculated to be of considerable benefit,—they are also well adapted to some deranged states of the health, occurring in women and children, without any particular organ appearing to be the seat of the disease. Dr. Diel, who was bath physi- cian at Ems, for upwards of thirty years, strongly re- commended the waters in congested states of the ab- dominal circulation, with its consequences hemorrhoidal affections, etc., and also in dysmenorrhoea, and some other diseases peculiar to females. "The Ems waters would be likely to be of great ser- vice in irritation of the urinary passages, with deposit of lithic acid, or other gravel; especially where there exists a gouty or calculous diathesis, or when combined with a deranged state of stomach. "But it is in diseases of the respiratory organs that Ems has acquired the highest reputation; patients with these diseases forming annually a large proportion of its visitors, some of them in such an advanced state of dis- ease as to be little likely to derive much advantage from any remedial measures. Hufeland, in alluding to the ef- fects of the Ems waters, in this class of diseases, says, 'We know how few mineral springs there are, that can be used with safety in diseases of the lungs; patients with such affections are commonly prohibited from visit- ing a mineral spring; here the reverse is the case, and, in my opinion, Ems stands alone with Setters in this re- spect.'* Diel also adds his testimony to their efficacy in these cases, and in certain kinds of asthma. "Dr. Doring recommends the Ems springs in scrofu- lous diseases; and in many of these affections I should say, they are likely to produce a great amelioration; es- _*Practische Uebersicht der vorzuglichsten Heilquellen Deutschlands. 44 EMS. pecially in delicate children with enlarged mesenteric glands, the water being drank alone, or with milk, and combined or not with bathing, according to circumstan- ces. In several patients with enlarged glands of the neck, and other local affections, from the same cOnstitu-* tional cause, a course of Ems water would be highly ser- viceable as a preliminary to the employment of a more tonic medication; tonics being very often indicated iri these patients, who, however, are frequently not able to bear them, without the previous use of remedies of a solvent nature. "In nervous affections of an hysterical nature, Ems is calculated to be of considerable benefit, particularly if there co-exists disorders of the digestive functions, or of the periodical secretion, with irregular distribution of blood, as marked by frequent flushings, cold feet, etc." From Dr. Granville's work I take the following ex- tracts : "Dr. Kreysig, who is a great authority in regard to the Ems waters, states that they have affected re^ markable cures; first, in cases of pulmonary Complaints; secondly, in general or partial debility of the nerves; thirdly, in certain complaints peculiar to the other sex. I may add, fourthly, that of late years they have been considered as valuable remedial agents in the treatment of indigestion. "When used in complaints of the chest, it is usual to mix with a third or fourth part of fresh milk. The treat- ment generally lasts six weeks, and the season of the year in which the waters appear to be most effectual, are the months of July and August. "It would require another volume, were I to enter at all into the consideration of the many disorders—such as gout, rheumatism, scrofula, glandular obstructiou, in- digestion, sexual disturbances, sterility, &c.—for which EMS. 45 the Ems waters have been recommended; or were I even to limit myself to the citation of a few of the many ca- ses that have been treated by those waters under my di* rections. I will, however, state it as my general opin- ion ot the Ems waters—an opinion founded upon consid- erable experience, and I might appeal at once to many who will probably read this passage, and who will admit the truth of what I am about to say, and have said to them when they were proceeding to that Spa—that, taken internally* they are what I call 'disturbing wa- ters ;' not in the way of purgatives, but in the way of alteratives, to a degree which is scarcibly producible by means of ordinary medicine, and which, although very beneficial to some, is injurious to many, and requires* under any circumstances, great circumspection in the lengthened use of them. So great is the disturbance produced in the system while the waters are drunk, that I am acquainted with very few patients who have got well of their complaints during the treatment, or before they came away from Ems. Of the rest who recovered long after they left the Spa* the major part had judi- ciously enough been prevailed upon to go and finish their" cure at some other place—generally a cold Spa." The next is from Dr. James Johnson: "Thilenius (the elder and younger) the Nestor of Ems, makes the fob* lowing observations on the waters: "They operate on the human constitution mildly but efficiently, with little disturbance to the functions of the body. On this account they agree well with delicate persons, whose nerves are morbidly sensitive,—the sad effects of mental emotions, civilized life, and other de* bilitating causes. They are, therefore, peculiarly suited to the female constitution. They may be employed, too, in advanced stages of disease, where other mineral wa- 46 EMS. ters of more exciting qualities, would be inadmissible. Their alkaline properties enable them to resolve obstruc- tions, and free the functions of the kidneys, skin, liver, and various other secreting organs—especially the uter- ine vessels. They correct tenacious and morbid bile, as well as acidities—and thus prove aperient in a mild de- gree. Their intimate connexion with carbonic and sul- phurretted hydrogen gas enables them to give activity to the secreting vessels, and evacuate unhealthy hu- mours, while they give vigour to the whole organism, oppressed by chronic diseases. They have, at the same time, a soothing and trancfuilizing effect on the nervous system. No waters, with the exception of Schlangen- bad, produce such a pleasing and salutary operation on the skin, which they cleanse, soften, and leave in a satiny state, thus improving the complexion, and clearing the pores. They are potent in discussing glandular swel- lings, and promoting absorption of abnormal deposits.' "The foregoing exposition of the general effects of the Ems water is more rational, modest, and just, than we shall usually find in the eloges of most other spa doctors. "Thilenius, contrary to the custom of most of the spa doctors, admits that although the waters alone cure many disorders, yet, in a great many cases, appropriate medicines are absolutely necessary. He contends, how- ever, and I believe with justice, that many diseases give way to the combination of the waters and medicine, which resist the latter, if unaided by the former." The waters of Ems have a peculiar, very mild, and al- most tranquilizing effect, and are therefore suited to very feeble and irritable subjects, especially such as do not well bear other mineral waters. None the less—and al- though it almost never operates as an aperient—in its Remarkable powers as a resolvent and deobstruent, and EMS. 47 as a means of. improving the condition of the fluids, and of accelerating and perfecting nutrition and metamorpho- sis, it may almost be considered a rival of Carlsbad.— Like Carlsbad, too, in consequence of its awakening to new life all the vital processes of the organism, it some- times occasions a feeling of weakness, restlessness, op- pression, &c; but to nothing like the same extent that the stronger water does. Morover, such effects, when following the use of Ems water, disappear much sooner, without the occurence of those marked critical evacua- ations noticed when discussing the effects of Carlsbad, and leave the patient feeling every way relieved. To sum up: Ems is particularly useful in the chronic disea- ses of the respiratory, nervous and uterine systems; and in all those disorders for which Carlsbad has been recom- mended, but where the patient is very young, feeble, or irritable, as also wherever there is danger of exciting in- flammatory action, or there is a tendency to local conges- tions, hemorrhages or fluxes, suspicion of tuberculosis, purulent discharges, as well as in all less important com- plaints not requiring a more powerfully deobstruent and laxative treatment. As the patient often becomes constipated while drink- ing Ems water, he should either take a tumbler of Carls- bad allowed to cool considerably, or one of Kissmgen the'first thing, to be followed by the allotted portion of Ems or else some mild aperient medicine the previous evening as rhubarb and magnesia, cream of tartar and magnesia, electuary of senna, or a little manna. 48 VICHY. VICHY. The waters of Vichy are decidedly and strongly alca- line, a property due to the large quantity of carbonate of soda which they contain. At the same time the action of the alcali must be much modified by the other saline ingredients, although these exist in but compara- tively minute quantities, for not only is the use of the same amount of the simple carbonate not borne easily, but it will by no means produce the same effects; and pven the abuse of these wraters has not been known to be followed by that deterioration of constitutional power observed to result from the excessive use of alcalies, showing itself in pallor of countenance, ©edematous gwel- Jings and passive haemorrhages. The use of Vichy wrater is more particularly indicated in the lithic acid diathesis, but it is also much used in cau- ses of abdominal plethora or obstruction, in long standing dyspepsia with acidity, in soine hemorrhoidal affections, and derangements of the genito-urinary apparatus. In scrofula an improved modification of the constitu- tion takes place, patients acquire vigor, and ulcerations and inflammations are healed, or brought into a favorable condition for healing. Engorgement or even hypertrophy of structure "wheth- er implicating only mucous membrane, as in some forms of dyspepsia, or the parenchymatous tissue of organs, as in cases of chronic disease of the liver, spleen, womb or ovary, seems especially amenable to their (the Vichy waters') employment; reductions of size of these en- larged organs being even sometimes effected at a far re- moter period than could be hoped for5 and generally oc- curring when the waters are resorted to early, and per- severingly continued." MARIENBAD. 49 In gout and chronic rheumatism these waters are un- surpassed as curative agents, destroying the disposition to relapse. Chalybeate, Alterative and Resolvent Waters : Marienbad, Kissingen, Egra. MARIENBAD. Of the properties of the Kreutzbrunnen at this place, Dr. Granville observes: "The medical virtue of the Kreutzbrunnen appears particularly conspicuous, in all the varieties of disorders by which the digestive func- tions are affected, no matter how severe in degree. The testimony of medical men, and of many of the patients themselves, who are, after all, the best witnessess, sup- port the opinion of Dr. Heidler in this point. It is, says he, by the removal of faulty and offensive secretions previously lodging in the intestines, that the Kreutzbrun- nen not only corrects, but improves, and, lastly restores permanently, the tone of the stomach and the appetite. "The diuretic power of the Kreutzbrunnen is very stri- king, and from the very first to the last day of using it; nor is the solvent and purgative faculty it possesses less remarkable. Three or four beakers of the water suffice; 50 MARIENBAD. -though in general, double that number is drunk to pro- duce absolute purgation. But I feel convinced that its solvent power would be increased, by being drunk mixed with an equal quantity of hot mineral water. When so taken, I hold the Kreutzbrunnen to be an invaluable rem- edy in all bilious complaints, without requiring the least assistance from mercury. " On the action of the heart and the pulse this water exerts considerable influence. At first it seems to dis- turb both; but as soon as its effect on the intestines is established, that disturbance ceases, and a well-being en- sues, which is not readily obtained from the daily use of ordinary drugs. This property of the Kreutzbrunnen renders it susceptible of application in cases where either the constitution or the age of the patient admits of no remedy productive of irritation; and, therefore, persons subject to apoplexy even, or such as are threatened with consumption of the lungs, may take the Kreutzbrunnen, mixed either with hot mineral water or milk, for the re- moval of those disorders." According to Heidler quoted by Lee, and praised by both Johnson and Granville, "the use of the Kreutzbrun- nen is most applicable in those cases, where there is a de- rang ^d state of the mucous membrane of the alimentary canal, with collection of mucosities, in cases of obesity, abdominal engorgement and congestion of various or- gans, from repletion and fulness of the veins; in the ner- vous affections of both sexes, when connected with a full habit, and in persons accustomed to free living who lead a sedentary life. In such persons, some degree of accel- eration of pulse, feverishness, and determination of blood towards the head, are sometimes occasioned; which ef- fects may often be prevented by allowing the water to be exposed for some time to the air before drinking, or MARIENBAD. 51 by warming it, which allows the escape of the gas; though by these means the tonic properties are impaired, and the operation is rendered more laxative. " This water is also well adapted to procure the evacu- ation of gall-stones, and to prevent their formation, as well as that of gravel or stone in the bladder, which so frequently depends upon the above-mentioned causes; here also the diuretic property of the water has a bene* ficial effect in causing the expulsion of these concretions when formed; though, when a diuretic effect is more es- pecially sought for, the Ferdinands-brunnen is to be pre- ferred." Dr. Johnson also quotes from the work of Herzig, a physician resident at Harienbad, whom he recommends to his countrymen visiting the place: "The water of the Marienbad springs has a soothing effect on the nervous system, and checks vomiting and pain in the stomach and bowels, in consequence partly of the carbonic acid contained in the water, and partly of its property of in- creasing all the secretions. " In the plethoric persons it often proves stimulating, and causes headache, redness of face, and feelings of cer- ebral congestion—owing, probably, to the carbonic acid and the iron contained in it "Its most marked effect is to increase all the secre- tions, especially those of the bowels, kidneys and skin- large quantities of mucus are discharged with the stools. The mucous secretions of the bladder, and also of the vagina, are usually much increased at first, but subse- quently greatly diminished, when these organs are in a state of weakness. Various forms of cutaneous erup- tion often make their appearance and rheumatic and gouty pains are usually increased at first, but subsequent- ly disappear during the use of the waters. 52 MARIENBAD. "The digestive and nutritive functions are quickened and invigorated, and the patients acquire strength and liveliness, in consequence of the improved state of the intestinal secretions. The Kreutzbrunn waters at Marien- bad produce similar effects to those of the Carlsbad and the Kissingen waters; but the former are more purging and evacuant, and act less upon the vascular system, and more upon the digestive functions than they do. " The diseases in which the Marienbad waters are most useful, are— "1. All congested states of the portal system of veins, indicated by torpid bowels, loss of appetite, hse- morrhoids, and gouty complaints; and the various di- seases connected with inactivity of the abdominal circu- lation, such as hypochondriasis, dyspepsia, morbid sensi- bility, headache, &c. Numerous cases of chronic rheu- matism and gout, which are so frequently associated with congestion of the vena portae, are relieved by the use of the Marienbad waters. "2. Diseased states of the mucous membranes, such as some obstinate catarrhs, affections of the mucous coat of the bladder, uterus, &q. "3. Plethora, sanguineous congestions, crampy pains of the limbs, absent or difficult menstruation, and the numerous morbid symptoms dependent upon this state. " 4. Torpor of the bowels and its host of attendant evils. " By means of its property of increasing all the se- cretions and excretions of the body, and of bringing out cutaneous eruptions and gouty affections to the limbs, the Kreutzbrunn waters of Marienbad are an excellent remedy in numerous diseases which depend either upon a plethoric state of the abdominal circulation, or upon the accumulation of impurities in the bowels, or upon an MARIENBAD. 53 unhealthy condition of the mucous membranes. At the same time, they subdue the morbid irritability of the whole system, or of individual parts; they remove con- gestions, plethora, and various evils dependent upon these. They are especially useful in all eases where nature her- self seems to be striving to induce either an increase of the secretions, or a flow of blood from certain parts, as the nose, anus, &c. "When the Marienbad waters do not prove sufficient- ly aperient, a small portion of Glauber or Epsom salts may be added to it. In some cases, the water will agree better, if previously heated; and in others, they are use- filly combined with a little warm milk, or with a small portion of wine." b. FERDINANDS-QUELLE. Ferdinands-queile differs mainly from Kreutzbrunnen, in that it contains about twice as much iron, and less sul- phate of soda. Hence it excites the nervous and circu- latory systems far more than the latter does. Not un- frequently it causes an overflow of good spirits amount- ing to an intoxication, making the pulse fuller and more frequent, exciting the free action of skin and kidneys, but not operating on the bowels, on the contrary, proving astringent. Its use invigorates the digestive organs, and thereby the nutrition of the body generally is improved; as seen in the increase of flesh, of firmness of fibre, of capacity for bearing fatigue. At the same time it is by no means deficient in those alterative and deobstruent powers so eminently characterizing its brother spring. It is specially indicated in those disorders whose primary objective symptom is weakness, weakness caused by pre- vious acute disease, over-exertion of body or mind, or great loss of blood or other fluids, or degradation of the vital fluid itself. Thus its effects are best seen in the 54 MARIENBAD. cure of chlorosis, amenorrhoea, lencorrhoea, metrorrhagia, tendency to repeated abortion, sterility, impotence de- pending on local or general debility and irritability, and in such cachectic conditions as are depending on debility as immediate cause. Also in numerous cases called dys- peptic, especially when accompanied with pyrosis, gastra- lgia, flatulence, colic, &c. In the scrophulous and rachitic diathesis it is also of marked service, as well as in some cases of metallic poisoning, in scurvy, and in commencing dropsy, after ague. In nervous disorders accompanied, but not apparently caused by disorder of the general health, with great ir- ritability, it is of great use, and is often the only water that can be borne, But it is in that form of hypochondria where the purer chalybeates cannot be used in consequence of existing portal plethora and other material disorders of the ab- dominal viscera, that the Ferdinands-quelle is almost specific. In a gentle and mild way, its use excites func- tional activity in the organs above mentioned, soon fol- lowed by an agreeable sense of lightness, vigor, and well- being. It is a good preparative to the stronger, pure chaly- beate waters of Pyrmont or Spa, and is excellent after a long-continued course of the more powerful resolvent wa- ters has removed the disease, but left the patient in a de- bilitated condition. KISSINGEN. 55 KISSINGEN. From Lee's work is taken this extract: "The combina- tion of stimulating, solvent, and tonic powers of the Ra- gozi, renders it most suited to relieve those states of disease connected with, or dependent on, abdominal plethora, liver congestion, and obstruction of the circula- tion of the vena portse, which chiefly occurs in persons of middle age. A deranged state of stomach and bow* els with difficult digestion, or feeling of unusual disten- sion after eating; constipation: piles; a disordered state of the skin with eruptions, especially about the face? painful and irregular menstruation; hypochondriasis; gout, when recent and not occurring in old people; and scrofulous affections of the glands, are among the com- plaints most likely to be cured or relieved by a course of the Ragozi water, combined with baths of the Pandur. The same means would be very efficacious in many cases of dyspepsia, arising from excess in the pleasures of the table, or the abuse of ardent spirits, and attended with heartburn, acrid eructations or pyrosis." The following is from Granville: "According to the testimony of the best authorities—those, I mean, on whose skill, candor, and veracity, one may safely rely— and I will mention at once, besides Siebold, the patriarch Dr. Kreysig, with whom I have conversed at great length on this subject, as well as Dr. Mass and Dr. Balling—the Ragozi is, par excellence, the remedy against chronic dis- eases. In acute or febrile disorders its virtues are null. 56 KISSINGEN. It is not easy to imagine a more happy combination than is found in the Ragozi, of gently purgative, depurative, and alterative salts. Judging, prima facie, from such a circumstance alone, I should expeet the very best effects from the use of the Ragozi, in every possible modifica- tion of complaints of the stomach,—from the mere want of appetite, and oppression after eating, to the most com- plicated derangement of the various abdominal processes which constitute digestion. I will only instanee, as an example, the nausea and retching (first indications of forthcoming disease) which salute the overnight tippler when he first wakes in the morning. Half a glass of the Ragozi, taken immediately on waking, will arrest those symptoms. "When impurities have collected in the intestines or principal passages, the Ragozi removes them with aston- ishing quickness,—stimulating at the same time, by its proportions of gas, and moderate quantity of steel, the nervous and muscular energies of the stomach and its dependencies. Dr. Mass asserts that this water is a safer and more certain remedy for obslipatio intestinorum than almost any other. The intestinal functions are rendered regular by its use, and their regularity continues after the patient has ceased to drink the water. "In local fullness of blood in the principal viscera of the abdomen,—the liver, for instance, the spleen, the mesenteric veins, and in cases of incorrect distribution of that fluid to those organs which characterize the fe- male constitution,—the Ragozi has acquired great repu- tation. The last-mentioned circumstance has led practi- tioners of Celebrity to apply it in cases where anomalies exist in that one particular function which is the source of so much suffering to females; and, by a natural induc- tion, in cases also of sterility. KISSINGEN. 57 "It becomes me not, as the writer of a work avowed- ly intended for general readers, to enter into further par- ticulars on a subject which has lately engaged the atten- tion of several practitioners on the continent, and my own. But to have passed wholly unnoticed the circum- stance which, perhaps, more than any other, renders this Spa so truly valuable, would have argued either igno- rance or neglect. The causes of sterility are various. The larger number of them, which have been well studied by those who have inquired into this question, and into the powers of this mineral spring, are as certainly removed by it as any other obstruction; and, so far, the problem would be one of easy solution. But there are also causes of that singular state of the female Constitu- tion which are likely to be aggravated by the Ragozi; and, therefore, the question is one that requires deliber- ation. Dr. Maas and Dr. Kreysig have put me in pos- session of cases of disordered female constitutions, which, even in a purely medical book, I should forbear quoting, but which, with some similar cases that have fallen 'under my own knowledge, go to confirm whatever has been said before by Siebold, respecting the virtues of the Ragozi. " There is another class of invalids who derive un- doubted benefit from Kissingen waters; and these are your 'hard livers;'—I mean such as have a hard (liver, from having lived hard. Instances were Quoted to me, of persons bearing about with them considerable swellings of that organ, which could be felt through the skin, as hard as a stone, but which were softened, diminished, and at last wholly removed, by the dissolvent powers of the Ragozi. 'As long,' says Dr. Maas, 'as the reproductive forces are not too far sunk, and no considerable emacia- tion or insidious fever has shown itself, we have still great hopes of saving the patient by the use of the Ragozi.'' 58 EGER OR EGRA. EGER OR EGRA, The waters of Franzensbrunn at Egra, most nearly r'ef- semble those of the Ferdinandsquelle of Marienbad,- but contain less iron and carbonates of alkalies and earths* and more sulphate of soda. They differ therefore in effects in being less tonic but more laxative. As they can be employed in the same class of diseases, it is only neces- sary to say of them, that they are more suitable in a se- ries of cases where the debility is less striking than the physical derangement. The waters of the Franzensbrunn require less strict. ness of diet and regimen than almost all others. They are peculiarly adapted therefore for the disorders of ar- tists, literary men, jurists, public officers and men of bus- iness, all of whom are liable to injure health by want of exercise and sleep, and by excessive application. Women of delicate and weakly constitutions also bear the use of these waters very well. The same disagreeable symptoms are often induced by the use of even those mild waters, which have been al- ready described, but they are commonly neither severe nor of long duration. pyrmont. 59 Pure Chalybeate Waters PYRMONT. TRINJtfJTJELLli:. " Pyrmont possesses three kinds of mineral springs— chalybeate, saline, and acidulous; but is chiefly frequent- ed on account of the chalybeate ones, especially the Trinkquelle, of which upwards of a hundred thousand flasks are exported annually. The water is exceedingly rich in iron and carbonic acid gas, is limpid, very spark- ling, of an agreeably acid and somewhat astringent taste, and, on standing, deposits a brownish sediment composed of oxide of iron and maganese; its temperature is 10 ° R. A few glasses taken in quick succession occasion a sort of temporary intoxication, with a feeling of satis- faction and hilarity. When a certain quantity is drunk it has an aperient effect, and promotes the excretion of urine. It is better supported than most waters of this class; and when it can be procured, merits a decided preference over others, especially in cases of general debility remaining after loss of blood, copious discharges, parturition, or severe illness; in chlorosis, hypochondria- sis, hysterical and other nervous affections; diseases of the digestive and urinary apparatus, depending on gen- eral or local debility; passive uterine and hemorrhoidal hemorrhage; suppressed or difficult menstruation; leu- corrhea, and sterility from weakness, especially where the generative organs had not acquired their full develope- ment previous to marriage." 60 HEILBRUNN. Iodated Alterative, Resolvent and Deobstruent Waters. HEILBRUNN. "That the Iodated mineral waters of Germany have effected numerous and important cures in a variety of diseases, must be admitted on the testimony of those who have prescribed the remedy, watched its progressj and communicated the result. "The Adelheid's Quelle has deservedly ranked highest in this class of springs, and has obtained the notice of some of the most reputed members of the faculty in Ger- many. The testimony of some of them, in regard to the diseases in which it has been found efficacious, I shall transcribe from the work of my friend Dr. Wetzler. "According to Geiger the Adelheid's Quelle may be prescribed with advantage in the following diseases: "1st. Loss of Appetite and Indigestion. "2d. Chronic, affections of the Liver and Spleen. "3d. In Ague and Jaundice. "4th. In disease of the Kidneys from Calculous de- posits. "5th. In Chlorosis, Affections of the Womb and Ster- ility. "6th. In Hypochondriasis and Melancholy. "7th. In chronic Erysipelas, cutaneous diseases, as Psora, Porrigo, etc. "8th. In gouty affections, stiff and enlarged joints, Palsy, etc. "Karl in his work states that the water may be em- HEILBRUNN. 61 ployed with the greatest success in all cutaneous disea- ses, as Psora, Tetter, Lichen, etc.; in contractions of Limbs from Gout, Rheumatism, or Palsy, in morbid af fections of the Bowels, and some particular organs, as the Liver, Spleen, and Mesentery; and in the diseases consequent upon such affections as Jaundice, Ague, in- cipient Dropsy, White Swelling etc.—in calculous affec- tions of the Kidneys, and in certain affections of the Uterus, particularly amenorrhoea, and sterility. "The Adelheid's Quelle has also been much employed at Munich, especially in the general Hospital, and that with great success in induration of the glands, Disease of the generative organs in females, ovarian Dropsy, etc. "Dr. Dietrich has for many years been in the habit of prescribing the Adejheid's Quelle with the greatest suc- cess in the following diseases, viz. Scrofula, Atonic Gout, Chronic Catarrhal affections, in the latter stages of Gon- norrhcea, in secondary symptoms, in schirrous affections- in exudation and hardening of the Cuticle etc. "The late Dr. Xav. Martin, who was well acquainted with the practical application of the Adelheid's Quelle, states that it is decidedly efficacious in all scrofulous dis- eases ; in Tubercular Phthisis, in induration and schir- rous affections of the bowels and ovarii, in frequent abor- tion, and in almost all the diseases already mentioned. "I come now to Dr. Wetzler's classification of the dis- eases in which the Adelheid's Quelle proves sanative. "1st. In all affections of the mucous membranes, the lymphatic and glandular systems, inactivity in the pro- cess of assimilation, Congestion in the vena portarum, in Urethral affections, and diseases of the urinary and gen- erative organs. "2nd. In accumulation of mucus in the air passages, protracted Catarrh, etc. 02 PULLNA AND SAIDSCHUTZ. "3d. In cases where a scrofulous or strumous habit is indicated. "4th. In congestion of the bowels, fiver, spleen, and pancreas. "5th. In sexual maladies, especially in the female, "6th. In chronic affections of the Bladder with disposi? tion to calculous or gravelly deposits. "7 th. In affections of the nervous system dependent on, or arising from, chronic dyspepsia. "8th. In tendency to acidity in the system, as in Gout, Rheumatism etc. "All these varieties of diseases Dr. Wetzler illustrates by cases, which will come to be noticed in a subsequent chapter. "The above classification along with those that pre^ cede it, though condensed, has been extracted from the works of the various authors whose names are given. "On a review of this classification it will at once appear that there is little discrepancy in the enumeration of disT eases; all are agreed in regard to the efficacy of the wa- ter in Scrofula, Glandular affections, cutaneous diseases, whether simple or complicated; in short, in all maladies in which Iodine is Indicated."* —*The Iodated waters of Heilbrunn, by Sir Alexander Mackenzie Downie, M. D., &c, &c. Saline Aperient Waters. PULLNA AND SAIDSCHUTZ. "A glass of the former would produce some action on the bowels in most people, two or three are generally taken in the morning by those who go through a course; its use could not, however, be long continued without PULLNA AND SAIDSCHUTZ. 63 Weakening the alimentary canal and the constitution.— Taken regularly for a short period, it is a very useful means of overcoming habitual constipation; when the desired effect is not produced by a moderate quantity, it would be better to warm the water, and use some of it in an enema instead of increasing the dose. It generally acts without griping, or inconvenience, and may be em- ployed with advantage in some inflammatory and febrile diseases, in which a cooling purgative is required, as also in chronic disorder of the digestive organs induced by too full liting and attended with a plethoric condition of the systeril, a tendency to local congestions, as of the brain, thoracic and abdominal viscera, and hemorrhoidal Vessels. In the tendency to gout and to the formation of calculous concretions, painful and difficult menstrua- tion in persons of a full habit, and who frequently re- quire aperient medicine, it may be exhibited with ad- Vantage, and likewise to children with a full and tumid abdomen; mixed with a little syrup of warm whey. "The Pullna water is not unfrequently employed pre- paratory to a course of the saline tonic springs, as Mar- ienbad, Franzensbad, etc. "According to Dr. Reuss, the Saidschutz water in small doses improves the digestion and appetite, and ex- cites the absorbents of the alimentary canal, the iron and soda preventing its action from causifag debility. In lar- ger doses it proves purgative, and increases the flow of bile, without too touch irritation of the mucous mem- brane; hence it is highly useful in torpid states of the abdominal circulation and absorption, as a revulsive means, and in diminishing an abnormal plasticity of the blood."t t Das Saidschutzer Wasser, chemische untersucht von J. Berzelius, mit Bemerkungen ueber seine Heilkraft., von Dr. Reuss. Prag, 1840. 64 , PULLNA AND SAIDSCHUTZ. "By its excessive or too prolonged use, the stomach becomes debilitated, loss of appetite ensues, and diar- rhoea, sometimes with an inflammatory condition of the bowels, supervenes. It is applicable to the same kind of eases as the Pullna water, and is often advantageously combined with a course of bathing at one of the thermal springs, especially in cutaneous eruptions, acne, etc., combined with disordered digestion in young and middle- aged persons." DIET AND REGIMEN. 65 CHAPTER III. On the Viet and Regimen of Mineral Water Drinkers. The medicinal mineral waters are specially indicated in cases of chronic disease, as well as in those often name- less departures from health or disordered conditions, sooner or later ending in confirmed chronic disease. Such are commonly the result of a mode of life at vari- ance with Nature's intentions. Intemperance of every description—in quantity of food or drink, whether dilu- ted alcohol, tea or coffee; in tobacco or other narcotic; want of occupation or excessive labor, either of body or mind; violent of depressing emotions; want of sleep; living: under circumstances of defective ventilation; the effects of certain poisons, as the malarial, mercury, arse- nic, lead, copper, phosphorus ; faulty or insufficient cloth- ing ; these are the notorious causes of a host of mala- dies, most commonly afflicting the wealthy and refined, the members of the learned professions, artists, mer- chants, statesmen and politicians. But no class can es- cape entirely; and, in addition to some of those enu- merated, the gentler sex is exposed to many other sour- ces of chronic ailment peculiar to it. The first thing then, when using mineral waters, is to abandon all im- proper habits and to live with the utmost regularity. The best time of the day for drinking the waters is, as a rule, very early in the morning; the last glass should have been taken by eight o'clock. In the morning the body is rested, refreshed and re-invigorated; and the mind is tranquil, the stomach is empty, and the quanti- 66 DIET AND REGIMEN. ty of fluid in the system "being diminished, the mineral water is more easily tolerated, digested and absorbed. Not only at this early period of the day, but throughout the whole time devoted to the cure, the dress of the pa- tient demands the closest attention. The customs of fashionable so-called "watering places" are often suffi- cient to nullify all the good effects which might reason- ably be expected from the use of the waters; for, what can surpass the absurdity of coming to the spring in the morning, almost in ball-costume, not to mention the dis- sipations, the late hours, the match-making, the heart- burning, the excessive crowding, the unwholesome diet which make such watering places anything but temples of Hygiea. During the whole day the dress should be so warm that no risk of taking cold may be run; but the mornings and evenings require particular care in this respect. This rule should especially apply to the cloth- ing of the lower extremities, and neither open-worked hose nor paper-soled slippers can be worn by those seri- ously in search of improved health. The quantity of mineral water to be drank will be de- termined by the character of the water, the nature of the disease, and the strength of the constitution. The rule is to begin with a smaller quantity and gradually to increase it during a period of four or five days, up to the largest quantity prescribed or tolerated. The maximum is commonly from six to eight beakers of the warm, and from eight to fourteen or even sixteen of the cold waters- Trie beaker holds about six ounces. It should not be emptied in one hasty draught, but be slowly swallowed like other drinks, especially when using the cold waters; and if heated by exercise these latter should never be taken until the excitement of the circulation is allayed by rest. The first glass should be taken not later than DIET AND REGIMEN. 67 six o'clock in the morning, and the subsequent ones at intervals of about fifteen or twenty minutes, or as often as the stomach is in a condition to dispose of more wa- ter. Between each glass gentle exercise in the open air is of considerable importance, in order to cause a more rapid and complete absorption; but nothing is more hurt- ful than violent exertion, which causes indigestion of the water, sense of weight and giddiness in the head, great perspiration, and, in consequence, often severe colds, gen- eral weakness and feeling of fatigue during the rest of the day, as well as the indefinite prolongation of the cure. There are, however, some persons so exceedingly ner- vous and debilitated, often in consequence of too luxu- rious and indolent habits, that they can scarcely bear the pure and refreshing air of the morning, and can by no means digest any considerable quantity of mineral water; but if they attempt it, suffer from dyspepsia, nausea, loss of appetite, pains in the stomach and bowels, constipa- tion or diarrhoea, headache, vertigo, and a general sense of not being well. Such subjects are often unable to continue even the gentlest exercise without frequently stopping to rest. They should immediately on rising take a small cup of coffee without cream, or of weak tea, especially of some herb, as sage, balm, mint or the like, and should first an hour afterwards drink a half beaker or less of the mineral water every eight or ten minutes. As such persons also do not generally bear the cold wa- ters so well as the warm, if the former, from their compo- sition, are more decidedly indicated, a small portion of some appropriate warm water may bo added, as Ems or Carlsbad to Marienbad. By so doing also a portion of the carbonic acid is dissipated, a very desirable thing for those of weak nerves, subject to vertigo or congestion of the brain. Where there is great weakness and irritabili- 68 DIET AND REGIMEN. ty—either general or especially in the digestive or re- spiratory system, or in the case of children, a table- spoonful or two of hot milk may be substituted for the hot mineral water. Finally, if even in this manner the waters can not be taken in the usual and proper quanti- ty, then, what in the language of the Spas is called the "little cure," or course, may be tried, often with as re- markable success as is met with in any of the "great cures." This milder course consists in taking only one or at most two beakers every morning for many months or a year, a course which has often succeeded in curing obstinate diseases acknowledged incurable by any other known means. Having swallowed the last glass, gentle exercise must again be taken for at least one hour, after which may follow a light breakfast of coffee, chocolate, cocoa, broma, tea or meat broth, with cold light bread, clry toast, or crackers, but no butter. It is best to pass the rest of the forenoon in agreeable society, taking a ride in a carriage or on saddle, a good walk or any other not too violent exercise, reading aloud and indulging in good-humored mirth. The forenoon to the Spa guest the most important part of the day; it is the time during which the water drank in the morning is coursing through the blood-vessels, and when the medicinal agents con- tained in it are brought into the most intimate relation with every portion of the economy. It is therefore emi- nently wrong to engnge in any violent exercise or to suf- fer any emotion to affect one during that time ; to return to one's accustomed avocations, to strain any particu- lar organs, as the eyes, the lungs or the muscies, as such conduct not only prevents the waters working for good, but often causes them to produce very unpleasant effects. It is of just as much importance to keep mental as cor- poreal diet during the use of mineral waters; for the pa- DIET AND REGIMEN. 69 tient borne down by sorrows, cares and anxieties, in'ever present dread of real or imaginary evils, suffering the torments of ungratified passion or the stings of con- science,—if unable to still the troubled waters of the soul, seeks health in vain in those of the Spa. The best time for dinner is about one o'clock, and a slowly masticated and carefully regulated choice of food is the more important as apparantiy very trifling errois often damage the chances of cure quite materially, and an indigestion may be followed by most serious conse- quences. Such errors are apt to produce abdominal ple- thora with considerable corpulent enlargement, remaining long after the conclusion of the course; and next to mod- eration as to quantity in everything, it is of importance to partake only of food, both suitable for the individual in health, and not incompatible with the medicine he is taking. With regard to the first, not more should be consumed, even of the most innocent article of diet, than can be digested without any sort of inconvenience; and as to the second, it is but to avoid everything which ever disagrees with the patient, as well as all things allowed by common consent to be "heavy," "strong," "flatulent," likely to make people "bilious," or to turn "sour on the stomach." It may suffice to name as specimens of "for- bidden fruit," cheese, pastry, heavy puddings, warm bread of all descriptions, all sorts of pan or griddle cakes, green fruit, salad, pickles, pork, fresh and salt, salted or smoked meats or fish, highly spiced dishes or sauces, cakes, can- dy, ice-cream and vinegar. Most persons using mineral waters become very sleepy after dinner, and should therefore endeavor to keep awake by gentle exercise in the open air or sufficiently exciting society and conversation, for indulgence in a nap is com- monly paid for in frightful dreams, oppression on the 70 DIET AND REGIMEN. chest, headache, heaviness of the limbs, low spirits, ver- tigo, &c., and occasionally even appolexy has followed. There are, however, exceptional cases where a short slum- ber may jbe permitted, but this must be decided by the "Spa doctor." The remainder of the day should be devoted to agre- able occupation, music, games, exercise, society; in a word, one should ever bear in mind that health is the ob- ject in view, and this having been lost by a too artificial mode of life, a return to something nearer what may be called a natural mode, is a condition, without the fulfill- ment of which, the most powerful and properly prescrib- ed medicine may fail of effect. That the summer months are the proper season for drinking mineral waters will appear very evident on re- flecting that exercise in the open air, then so agreeable, is a powerful adjuvant to the physical action of die wa- ters, while the external world, then clothed in its most joyous hues, produces its share of healthful and health- giving influence on the body through the mind. Warmth also actually increases the power of the remedy. For in the first place, the drinking of mineral waters makes the body unusually sensitive, and more susceptible to the im- pression of cold; in the second, the open, perspirable state of skin produced by warmth of external air, pre- vents many injurious effects of mineral waters, such as congestion of blood in the head and chest; and in the third, such free action of skin prevents the too violent or exclusive direction of the force of the waters to the kid- neys or bowels. These remarks, however, only apply to the so-called "great cure" or course; the smaller ones may be commenced and continued at any period of the year. *