SOME REMARKS* y on MEDICINAL MINERAL WATERS, NATURAL AND ARTIFICIAL: THEIR EFFICACY IN THE TREATMENT OF CHRONIC DISEASES, ikies isx ijreir fawflammt, Efcl'I-X'IALLY THOSE OF CARLSBAD.EMS.KISSINGEN.MARIENBAD.PYRMONT PULLNA SEIDSCHUTZ A\D HEiLBRUNN. ' rviAj"A' H BY a HANBURY SMITH, M. D. HAMILTON, OHIO. D. W. HALSEY, PRINTER. 1855. i SOME REMARKS OH MEDICINAL MINERAL WATERS, NATURAL AND ARTIFICIAL; THEIR EFFICACY IN THE TREATMENT OF CHRONIC DISEASES, AND JUIes for t\tlx impfopeni, ESPECIALLY THOSE OF CARLSBAD, EMS, KISSINGEN,MARIENBAD, PYRMONT, PULLNA, SEIDSCHUTZ AND HEILBRUNN. BY S. IIANBURY SMITH, M. D. ,wGw- IIAMILlPON, OHIO. D. W. HALS KY, PRINTER 1855. PREFACE. It is difficult to conceive why an art so useful to humanity as the re-construction in the chemist's laboratory of such well known valuable medicinal agents as the more celebrated min- eral 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 correctly stated in Prof. H. Rose's masterly account of his life and labors, de- livered before the Academy of Sciences of Berlin, established the first manufactory of such waters at Stockholm, a manu- factory still carried on by his pupil and successor, Prof. Mos- ander. Soon afterwards Struve took up the same subject, and more than thirty years ago, commenced those successful la- bors, which have conferred so much lustre on his name. By the efforts of later chemists, especially Soubeiran, Anglada, Barruel, Savaresse, and Stevenaux, it has been developed with a most satisfactory rapidity and success. With regard to the perfection which they may be imitated, Dr. Granville ob- serves, "Dr. Struve's imitations of them (Puilna, Saidschutz, and Seidlitz) may be taken with the fullest confidence, as iden- tical 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 effi- cacious, and the quantity drunk both at Brighton and in Lon- don, I have been informed by M. Schweitzer, has been prodi- gious."-—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 in praise of any particular spa, without finding in it absurd declamations about the more intimate alliance of the chemical elements with each other and with their comiiiuii solvent water, in medicinal IV PREFACE. springs, than it is possible to bring about in the laboratory; and that, therefore, these natural productions cannot be suc- cessfully imitated. But every tyro in chemistry knows that the chemical components of a mineral water are united with each other in certain definite proportions, and no other, ac- cording to immutable laws now well understood. Chemical analysis is capable of detecting the minutest portion of an in- gredient in gallons of its solution; and therefore the quantity of each element being given, the proportions in which bodies combine known, and due regard had to the influence of tem- perature, pressure, quantity, and order of solution, it is evi- dently as practicable to reproduce exactly the compound solu- tion 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 every day accomplished on the largest manu- facturing scale—although the processes required are delicate and difficult, and require greater accuracy and care than per- haps any known in the whole range of the chemical arts. There are some again who entertain the superstitious notion that mineral waters possess some mysterious attribute, 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 contain but a small proportionate amount of salts in solution. Such views are entirely visionary, and, together with the sneers of interested persons, and all other objections 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 distinguished from the na- tural. They have the same smell, taste, color, and "temper- ature; by analysis yield the same results; and thirty years' experience, in countries where the art of healing and the suc- cessful cultivation of the medical sciences are unsurpassed, if equaled, has proved beyond all further cavil that the artificial perfectly resemble the natural waters, both in the direct re- PREFACE. V suits their use produces, and also in their after effects; and that they cure the same diseasas as quickly, as perfectly, and as lastingly as their prototypes. These waters are drunk directly out of the apparatus in which they are made, each at the proper temperature, pressure of gas, &c., and those cold waters whose composition will admit 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 notori- ous. But by taking certain precautions, it is in many in- stances 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 physician and chemist, in my ac- count of the capital of Saxony, which he inhabits, I sta- ted, 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 realization of those anticipations has been most complete; and nothing could be more satisfactory than the investigation of the value and importance of that establishment, which took place before the Privy Council in November, 1836; when Lord Lyndhurst and Lord Brougham, who had examined the writer of these pages at great length, respecting the novelty as well —*The Spas of Germany. By A. B. Granville, M. D., F. R. S., Knight of the Order of the Crown of Wurteinber^; and of the Royal Ordei of St. Mi- clia"i of P.avarh; member of the principal literary mid scientific societies in Europe; author of '-St. Peteishuroii,"' W. W. vi PREFACE. as utility of Struve's process, decided, on his evidence, that the institution 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 artificial min- eral waters, (which is due to the sagacity, penetration, and chemical skill of Struve,) it is not my purpose to enter at present. I alluded to his process in a former work, and shall probably have occasion, at some future opportunity, to give a fuller account and description of it. Neither is it my inten- tion to say a word in praise of the establishment of Brighton; although, as a 'German Spa,' I might very fairly have press- ed 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 degree, 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 intensity of union. To produce all the effects of the real or natural mineral water, of which they are the closest imitation 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 celebrated physicians in Germany,—at the head of which I may place Kreysig, Clarus, Ammon, and many more,—strongly corrobo- rates 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." Laboratories are now in active operation all over Europe, at Paris, Berlin, Dresden, Konigsburg, Leipzig, Doberan, Mos- cow, St. Petersburg, Warsaw, Stockholm, Gottenburg, Copen- PREFACE. vii hagen, Brighton, &c, and especially at the more celebrated springs and baths. It may be important to bathe in the thermal*waters of Weisbaden or Toeplitz for example, while drinking the waters of some spring a thousand miles off. The laboratory supplies the want. But 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 de- terred by the expense and bustle from visiting the more fashionable Spas to regain lost health, the necessary outlay is reduced by the new art, to a sum within reach of almost every one. The writer, well known to the profession in the United States, long the pupil and friend of Berzelius, and for ten years physician to and director of a similar institution in Stockholm, Sweden, has been induced to superintend an es- tablishment for the manufacture of the medicinal mineral waters gotten up by some public-spirited individuals of this place. The most important waters—those applicable to the cure of the largest range of diseases, will be first supplied. Any others found desirable will afterwards be added to the list, whether European or American; as Saratoga, Harrodsburg, or any that have been submitted to a reliable analysis, or whose popularity may make it advisable to undertake such analysis with a view to re-composition. The establishment will always be open to the inspection of respectable physicians, and every information afforded. Such waters as admit of bottling, as Kissingen, Marienbad, Pullna, Seydschutz, Pyrmont, Selters &c, will be prepared and put up for sale in the usual manner, as soon as practicable; and due notice of the fact be given to the profession. All laudatory remarks in the following pages are from au- thorities of the highest character on this subject, for reasons which will be understood and appreciated by all honorable and high-minded physicians. Hamilton, Butler County, Ohio, April, 1855. CHAPTER I. GENERAL REMARKS ON MINERAL WATERS* "Whatever may be the difference of opinion among conti- nental practitioners on other points of medical practice, almost all agree in acknowledging that natural mineral waters, "God's own compositions," as Paracelsus termed them, are the reme- dies 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 aliusion to them in ancient writings, 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 operation on the human body has been ascribed by many to occult and mysterious properties, somewhat approaching to the miraculous, an idea which is still entertained by some individuals, notwithstanding the pro- gress of science has demonstrated that their action is refera- ble to the ordinary principles of therapeutics, though it must be confessed that our knowedge of the mode of action of medical agents still remains enveloped in great obscurity. —*The Baths of Germany, considered with reference to their remedial effica- cy in chronic diseases: with an appendix, on the cold water cure. By Edwin Lee, Esq. Fellow of the R >yal Medico-Chirurgical Society; corresponding and honorary member of the principal continental medical and chirurgical so- cieties; author of the mineral springs of England; the Jacksonian Prize Essay on the operations for stone; a treaties on some nervous disorders, &c. 9 GENERAL REMARKS. "Some persons, however, ascribe the benefit from a visit to a mineral spring, entirely to the journey, the mentel relaxation and freedom from the cares of avocation, the exercise in the open air, &c. That many invalids would derive great advan- tage from the mere change of air, scene, and mode of life, is unquestionable; and it is equally true, that without these impor- tant auxiliaries 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 medicinal operation of the water, which, though slow, and often not pro- ductive of immediate and active effects, is, on that very ac- count, more suited to the class of chronic complaints, in which mineral waters are usually employed. 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 influence, and the benefit obtained is clearly to be as- cribed to the waters alone. Many persons are unable to take exercise, care little about the beauties of scener}T, take no in- terest in public amusements, soon become tired, and experi- ence discomfort at being separated from their homes and friends, and are induced to subject themselves to the inconven- iences of a long journey to a mineral spring, by the expecta- tion of the benefit which they know they are likely to derive from it. How many persons have I known crippled and al- most confined to their room, suffering from pain, without so- ciety or resources for amusement, whose spirits have been greatly depressed on account of their condition, and the incon- venience of a residence in a crowded hotel or bath-house, and notwithstanding, a short time after using the baths have expe- rienced a sensible amelioration, and have ultimately recovered though they had previously tried other means of relief with- out success. These are the cases by which the powers of mineral water may be satisfactorily tested. Many persons again, engaged in business, soon experience at a bath the in- fluence of ennui, are disinclined to form new acquaintances and are anxious respecting the course of their affairs, and yet are induced to prolong their stay from the evident improve- GENERAL remarks. 3 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 re- quired, will often derive as much benefit from drinking an arti- ficial 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 discovered from the circumstances of diseased animals instinctively re- sorting to them, and recovering their health by bathing in, or drinking the water. Alibert says, "It is a known fact, that 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 distances more or less considerable, the rumina- ting 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 the peo- ple 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 reliever. Some invalids derive no benefit from one mineral spring, yet are greatly advantaged on using another more suited to the nature of their disease; though the mode of life be the same in both placet;. Notwithstanding the inferiority of exported waters to those at the springs, they are often eminently ser- viceable, although the invalids, instead of breathing the pure air of the country, and rising early in the morning 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; in short, make no change in their usual mode of living. The power of mineral springs is fur- ther proved by their prejudicial effects when used in cases to 4 GENERAL REMARKS. which they are not adapted, and also when incautiously em- ployed by persons in health. "Other examples might be adduced, if it were necessary, to show that mineral waters are powerful means in the removal and mitigation of chronic disease, which require 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 pre- parations, inasmuch as in these cases, active medication fre- quently does harm, and the good effects of the treatment are generally more durable, in proportion as they are gradually produced. "The evidence of antiquity," says a standard au- thor, "with regard to the efficacy of mineral waters, the expe- rience of centuries which confirms this efficacy, the universal favour in which they are held among all civilized people, not- withstanding the difference of medical theories, sufficiently demonstrate that they are of all remedies, those of which the reputation is 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; she has tempered the virtues of the waters, and their energy, and she has adapted them to different temperaments. We obtain many medicaments from plants and minerals, but they almost all require certain pharmaceutical preparations, whereas min- eral waters are remedies which are always at our disposal; they contain sulphur, carbonic acid, and neutral salts, which are fre- quently employed 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 apothecary? Most mineral waters are not harmless; one cannot use them with impunity in cases where they are counter-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 en- ergy, by mixing them with milk, or some other emollient GENERAL REMARKS. 5 fluid."* Others, however, far from regarding mineral waters as substances possessing but little remedial efficacy, are apt to entertain wrong notions of their powers, and frequently use them in cases 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- moting their efficacy. Under such circumstances, it is not surprising that disappointment should ensue, and that these persons should frequently leave watering-places in a worse state of health than on their arrival. "The very free use which the English and Americans are in habit of making of active medicines, which stimulate particu- lar organs, renders many people unable to comprehend that the modus operandi of mineral waters differs from that of phar- maceutical preparations; the action of the former should be general and alterative, and their sensible effects are often subordinate, and frequently not apparent till a person has been using the water for some time. 'We should, however, be greatly in the wrong,' says Dr. Kreysig,j 'if we were to con- sider in all cases the increase of the intestinal, urinary, or cu- taneous secretions as critical, and as the sole or chief effects of the waters, for this is often a circumstance of very subor- dinate importance, and only constitutes the most superficial effect, although the quickest and the most apparent. The Carlsbad waters frequently cure the most obstinate obstruc- tions and enlargements, without occasioning any notable evac- uations.' But in most pharmaceutical preparations, the ac- tion is of a local nature, affecting principally a particular part or parts, and is speedily 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 alteration in their state at the expiration of a few days, or a fortnight, not unfrequently abruptly break off, either to re- __*palissier et Boutron-Charlard, Manuel des Eaux Minerales. Paris 2nd edition. f])e'l'usage des Eaux Minerales de Leipsic, 1829. 6 GENERAL REMARKS. turn homewards, or to go to some other place, and report that they used such or such waters, without finding themselves a bit the better; others, though they may have regularly used the waters for a longer period, yet acting upon their own re- sponsibility, or without being attended by a properly qualified professional adviser to superintend their course, and make such alterations as circumstances may require, frequently adopt improper methods of employing it, and are disappointed in the results when it may be that the blame rests entirely with themselves. "'In general,' says a French author, 'mineral waters are not suited to acute diseases; the rapid course of these affec- tions requires prompt and active measures. The case is dif- ferent with respect to chronic diseases, the treatment of which succeeds so much the better in proportion as the medication is milder and more gradual. Mineral waters employed at the source are unquestionably the best of all the remedial means for producing this medication. They act in some cases by modifying the state of the humours, as the Vichy waters, in other instances, by imparting to chronic diseases a slightly acute state, which rouses the torpid organs, increases the se- cretions, and promotes salutary crises. When this excitation is slow and moderate, it relieves and cures obstinate diseases; but when too energetic, it exasperates them, re-kindles latent inflammations, and hastens the course of organic alterations. It is, then, in the maintaining this excitation within proper bounds, in graduating, in regulating the dose, so to speak, ac- cording to the nature and the degree of the morbid lesion and the temperament of the patient, that the talent of the bath- physician consists.'* "Other persons, though employing the waters in a proper manner, are yet so much under the influence of habit, that they do not make the requisite alteration in their diet and mode of living, but pursue the same system, which perhaps tend to produce and to keep up their disorder. A German writer on mineral waters has said, 'Whosoever comes to a *Munuel des Eaux Mineralea. GENERAL REMARKS. bath and desires to be cured must will it in earnest;' and it behoves every invalid who wishes to give a mineral spring a fair chance, to bear constantly in mind the object which has brought him to it, without being led to act improperly from the influence of habit and example, or from a misplaced econo- my. "'Many chronic complaints, especially when not of long standing, would be better treated by medicines than by min- eral waters, which I by no means wish to be considered as remedies -of universal application, and which, in many in- stances, 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 di- rected 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 chances of advantage from mineral waters is much diminished. Patisser observes on this point, "The patients who go to min- eral 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 sulphates, muriates, and car- bonates. Some metals, as iron and manganese, and silex, are those most frequently met with. The volatile principles are for the most part carbonic acid, sulphuretted hydrogen, and azote. The quantity and forms ot combination of these sub- stances vary exceedingly, and the therapeutical action of a mineral spring, is frequently not of the kind which an investi- gation of its chemical composition would lead one to suppose. It is well known by those who have paid any attention to the subject, that in a chalybeate spring, for instance, possessing 8 GENERAL REMARKS. strongly-marked tonic properties, and where the presence of iron is evident to the taste and sight, the chemical analysis exhibits in most instances, no more than half or three quar- ters of a grain of this metal to the pint of water. An author whom I have already quoted, says on this point: 'It is evi- dent to us that the medicinal action of natural mineral wa- ters is not always in relation with what we know of their con- stitutional principles; it is not a few grains more or less of mineralizing salts which determine the salutary effect of min- eral waters; chemistry teaches us to characterise, to class the waters; shows us the analogies which exist between them, ena- bles us to anticipate some of their properties, by showing us the predominating mineralizing substances; but it belongs to clinical observation, to the authority of multiplied facts, to de- termine their therapeutical action.'* Dr. Gairdner likewise says on this part of the subject: 'In judging of the effects of a mineral 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 circumstance of dilu- tion will certainly facilitate the operation of matters which might otherwise pass, little changed through the alimentary canal; and from the extremely minute state of division in which the active particles are presented to the sentient mouths of the capillary absorbents, it is more than probable that they are directly absorbed 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 carbonate of iron to the gallon of water; the real quantity of this tonic received at a single dose into the stomach, or contained in a pint of water, must therefore be extremely small, and nevertheless it will exert a more salutary influence upon the system than twenty times the dose of the artificial carbonate in our ordinary pre- scriptions.'! * Patisser Manuel des Eaux Minerals, 2nd edition. butgh^32 Hist0ry'&c' of ^neral and Thermal Springs. Edin- GENERAL REMARKS. 9 "Much of the efficacy of mineral springs depends upon the state of intimate combination of the saline, metallic and gas- eous substances with the water. Daily experience in the practice of medicine demonstrates that the properties of rem- edial agents are frequently enhanced by pharmaceutical com- bination, and the difficulty of combining these substances as closely as they are found to be in a state of nature, is one rea- son of the superiority of mineral waters. The state of dilu- tion (which I have already alluded to) in which the various particles are held in mineral waters, must also materially influ- ence their operation, 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 Reau- mur's scale renders them adapted to various and opposite in- dications, according as a more relaxing and solvent, or as a tonic and bracing, action is required. "Mineral waters are then to be considered as strictly altera- tive remedies, and though their primary operation is mostly evidenced by increased activity of the secretory 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 inde- pendently of any increase of secretion. Such are chalybeate and some alkaline waters. During the employment of some others, various unpleasant symptoms, or what is called the Bath-fever, are not unfrequently induced. "'Again, other patients experience no alteration in th?ir 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 prepared for the next season; when, on re- suming the use of #je same waters, they are observed to pro- duce a speedy effect," and cure as if by enchantment' Min- 10 GENERAL REMARKS. eral waters," says Dr. Von Ammon, 'can only produce their beneficial effects in a slow and gradual manner: a hurried per- turbatory employment 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 effected. "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 induced 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 (Nach- wirkung) of mineral water is not a fallacy, but a truth proved by repeated experience. Many diseases are too ancient and deeply-rooted for a cure to be effected by a month or six weeks' course; and though an aggravation rather than an amelioration of the complaint, is occasionally experienced at the time, yet the patient frequently feels himself benefited 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 ca- ses, however, a shorter, as from two to three weeks, is recom- mended. In other instances a much longer course is required, or even two courses during the season, two or three weeks in- tervening between them. During this period, patients for the most part drink the water daily; the quantity being gradually increased according to circumstances, towards the termination of the course gradually decreased. The water should always be drunk early in the morning at the spring, when possible, gentle walking exercise being taken at the time. In some in- stances, it is diluted with milk, or some other simple fluid. It is also advisable in many cases to drink a little of the water in the afternoon. As other medicines mostly interfere with the operation of mineral waters, they should be abstained from, unless recommended by the physician. *Brunnen Diatetik. 4th edition. GENERAL REMARKS. 11 "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 Weis- baden or Ems, are often sent to Schwalbach, or Schlangenbad, to use those waters; and after a course at Carlsbad, to Marien- bad, Franzensbad,-or Tceplitz. Much judgment on the part of the physician is required, in order to determine justly when an after-cure should be recommended, as the inconveniences sometimes complained of after the employment of an active springs, are often of very temporary duration, and are th? prelude to the occurrence of critical appearances, and of a favourable change, which might be prevented by the exhibition of a wa- ter of a totally different character; and even those cases when a chalybeate, 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 per- sons the suspension of the course, and change of air for a few days, suffices to remove the oppression which is sometimes induced at an early period, and before the system has become sufficiently saturated with the water. It is likewise essential after a course of mineral waters, that invalids should not con- sider 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." CHAPTER II. In the following remarks on the special indications for the use of certain mineral waters, I shall continue to extract or translate from authors of repute, all of them so far as is known or so far as a judgment can be formed, wholly disin- terested, and of acknowledged professional standing. With regard to the first in order and importance, Carlsbad in Bohemia, not less than one hundred and ninety-eight works have been published on the place and its springs up to 1836 iuclusive; but not one of these in English. I shall commence with an extract from the work of Dr. Granville already men- tioned. "The maladies for the cure of which Carlsbad has been long celebrated, are many. Hufeland, one of the most illustrious practitioneis in Germany, who died a few }'ears ago at Berlin, full of years and reputation, being asked by me, during my first visit to that capital, for the reason of this un- diminished celebrity of Carlsbad, answered, 'C'est qu'il guerit des maux rebelles a tout autre moyen curatif.f There is not a single medical man of eminence in Germany who does not entertain the like opinion. "It would be out of place in a work like the present, which I purposely design for the general reader, (although even the physician of this country will find more information in it than he can obtain from any other English work on the subject at present extant,) were I to enter into a detailed statement of the disorders for which the waters of Carlsbad have been suc- cessful recommended. It will be sufficient for my purpose to state generally, that those waters exert their principal san- ative action, 1st, on all chronic affections which depend on de- bility of the digestive organs, accompanied by the accumuln- flt is because it cures maladies resisting all other curative means. USE OF MINERAL WATERS. 13 tion of improper secretions; 2dly, on all obstructions, par- ticularly of the abdomen, which, as Becher, the oracle of Carlsbad, observes, they resolve and disperse; 3, &c, and occasionally even apoplexy has followed. There are, however, exceptional custS 40 REGIMEN. where a short slumber may be permitted, but this must be decided by the "Spa doctor." The remainder of the day should be devoted to agreeable occupation, music, games, exercise, society; in a word, one should ever bear in mind that health is the object in view, and as that has 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 fulfilment of which, the most powerful and properly prescribed medicine may fail of effect. That the summer months are the proper season for drink- ing mineral waters will appear very evident on reflecting that exercise in the open air, then so agreeable, is a powerful ad- juvant to the physical action of the waters, while the external worlel, 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 wa- ters makes the body unusually sensitive, and more susceptible to the impression of cold; in the second, the open, perspirable state of skin produced by warmth of external air, prevents 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 kidneys 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. FIHIS.