STOKER. 
TREATMENT 
OF 
STRUMOUS DISEASE. [ WITH THE AUTHOR’S COMPLIMENTS. 
UPON THE 
TREATMENT OF STRUMOUS DISEASE 
BY WHAT MAY BE CALLED 
THE SOLFATARA METHOD. 
BY 
HORATIO R. STORER, M. D., 
NEWPORT, R. 1., 
PRESIDENT OF THE GYNAECOLOGICAL, SOCIETY OP BOSTON. 
[Reprinted from The Boston Medical and Surgical Journal, June 27, 1878.] 
CAMBRIDGE : 
snntcfc at tfyc Hibccjn&c 
1878. UPON THE TREATMENT OF STRUMOUS DISEASE BY WHAT 
MAY BE CALLED THE SOLFATARA METHOD.1 
In former years I have repeatedly drawn the attention of the society 
to purely gynsecological points connected with the aatiology, symptom- 
atology, and treatment of phthisis. A means of treatment will now, 
with a few additional words of introduction, be presented which during 
last fall was in London thought of sufficient importance for me to bring 
before the British profession.2 The question is one that bears not upon 
the relief merely, but the possible cure of consumption and other forms 
of stifimous disease ; a result that, as proved by dissection, has hitherto 
occasionally occurred by accident, but by our art has ordinarily not been 
effected. I shall merely present portions of the paper to which I have 
referred, and trust that sufficient interest may be excited by them to 
bring the new method into trial and perhaps practical use in this country. 
For the four years 1872-76, and in part at the request of the Amer- 
ican Medical Association, I was continuously engaged in investigating 
the relative claims of certain of the health resorts of Central and South- 
ern Europe. The inquiry was made more particularly with reference 
to the needs of American invalids, who go abroad in so great numbers, 
but, differing in national type of constitution, ways of living, etc., from 
the sick Russians, English, French, and Germans who form the bu]k of 
their traveling companions, by no means always reach the localities 
best adapted for their respective disorders. Of these American invalids 
a very large proportion are consumptives. 
The winter of 1872 was spent upon the Riviera, chiefly at Mentone ; 
those of 1878, 1874, 1875, and two of the summers were passed in 
Southern Italy, and the winter of 1876 and summer of 1877 on the 
English south coast, including the Isle of Wight, and in London. 
One of the objections most frequently made to Southern Italy as a 
residence for invalids by European writers upon climate has been the 
fact that, save in specially sheltered and usually very limited localities, 
its winter climate is changeable, and therefore, while borne by some 
classes of patients, it is particularly unfitted for chest affections, Naples 
is the only central point of resort upon the main-land south of Rome. 
1 Eead before the Gynaecological Society of Boston, February 7, 1878. 
2 Upon the Arsenical Atmosphere and Arsenical Hot Spring of the Solfataraat Pozzuoli, 
near Naples, in the Treatment of Strumous Disease. Lancet, September 29, 1877, page 
456. 4 
Strumous Disease 
The greater portion of the city and most of the towns and villages out- 
side of it that are resorted to by English and Americans for winter 
residence are directly exposed to the harsh easterly winds, chilled by 
the snows of the Apennines ; as, for instance, the favorite Strada Santa 
Lucia in Naples, and the whole of Castellamare. Delightful and safe 
though the latter place may be towards the end of spring and through 
summer, it is hardly to be recommended during winter for any class of in- 
valids.1 As regards consumptives, the same is nearly as true of Sorrento. 
Till within a couple of years the only places in Naples and its neighbor- 
hood that have been at all fit for delicate chests during winter have been, 
in Naples, the Riviera di Chiaia, or plain along the sea in the modern por- 
tion of the city, and the westerly extremity of the new Corso Vittorio Em- 
manuele above it, the respective merits of which, so far as concerns the 
chance of enteric and malarial fever, I have elsewhere discussed; and 
outside of Naples, Amalfi, Pozzuoli, and the islands of Ischia and Ca- 
pri, to which latter invalids who go during winter often do so with fear 
and trembling, over a stormy sea, while Pozzuoli, lying a few miles to 
the westward of Naples, upon the northern shore of the entrance to the 
gulf, has been till within the last year wholly unprovided for their re- 
ception. Amalfi, on the Gulf of Salerno, is nearly four hours away 
from Naples, by rail and carriage. The two hours’ drive from the near- 
est station, Vietri, is upon a cliff road far above the sea, and very at- 
ti’active, fully as much so as the best part of that from Castellamare to 
Sorrento, or the Corniche road on the Genoese Riviera; the town 
seems at first sight well sheltered, and there is so much of beauty and 
novelty about one that the visitor is always charmed. Directly down 
through Amalfi, however, there comes from the mountains a little 
river, and its course serves as the channel for fierce winds at times, 
while the town itself is filthy and ill kept. Pozzuoli, on the other hand, 
is better protected, lies equally to the south, and is very much more ac- 
cessible from Naples. Hitherto the question has been decided, so far as 
their equal sun and warmth are concerned, by the fact that there were 
two quite comfortable hotels at Amalfi, and nothing whatever in a 
suitable part of the town that was available for invalids at Pozzuoli. 
In a series of letters published at Paris in 1874, and subsequently 
reprinted at Naples,2 after speaking of the climatic and hygienic rela- 
tions of the latter city, I discussed in similar terms to the present, but 
at greater length, the respective merits of its neighboring and subordi- 
nate curative resorts, dismissing several of these with the brief remark 
1 If I correctly remember the opinion expressed a year or two ago concerning Castellamare 
in one of the English medical journals, by Dr. Maclean, of Netley, I am compelled to differ 
from that gentleman, who would probably have modified his favorable views as to this place, 
perhaps even his unfavorable ones as to Naples, had he but prolonged his visit. 
2 Southern Italy as a Health Station for Invalids. Naples. R. Marghieri. 1875. Pp. 
70. Treated hy the Solfatara Method, 
5 
that they were “ hardly fitted for the residence of invalids for the reason 
that as yet they are not provided with sufficiently comfortable hotels.” 
Among them was Pozzuoli. It became generally known in Naples dur- 
ing 1875 and 1876 that my attention had become forcibly drawn to cer- 
tain medical peculiarities of Pozzuoli shortly to be described, and it may 
have been partly in consequence that a comfortable hotel-pension, under 
English management and especially for invalids, has since been opened, 
the proprietress, Mrs. Dawes, having been very favorably known to me 
through her house for convalescents at Yico Equense, on the other side 
of the Bay of Naples, midway between Castellamare and Sorrento, one 
of the best-managed places of the kind that I found anywhere in Europe. 
I may mention also, in passing, that Dr. Cerio, of Capri, long an Italian 
army surgeon, English speaking, and with strong Anglo-Saxon affinities 
(through his English wife), has now removed to Pozzuoli for the pur- 
pose of thoroughly investigating the subject of the present paper; and 
from what I have seen of the gentleman and of his practice at Capri I 
have reason to believe that erelong we shall be put in possession of 
very important evidence corroborative of the conclusions that may be 
drawn from the statements I am about to make. 
Now as to Pozzuoli and its peculiar merits in the treatment of stru- 
mous disease. Assertions very adverse to Pozzuoli will be found in 
English works upon climate that must, however, have been made as 
much without personal knowledge of the place as in ignorance of what 
has lately been discovered at it. For.instance, there is mention in the 
latest edition of Tanner’s Manual, by Dr. Broadbent, of London, of 
“ the fatality of phthisis at Pozzuoli.” 1 Plainly, patients already mori- 
bund may be carried to a place to breathe their last, as is yearly done 
at Mentone, without jlustly causing its condemnation ; while for a na- 
tive Italian, once down with pulmonary disease; —in that country con- 
sidered contagious, and to which their damp houses render them pecul- 
iarly prone, —to hope to recover under purely Italian nursing and 
hygiene is something ordinarily out of the question. That Pozzuoli 
lies on the road, though on the Naples side, to “ the undrained swamps 
in the neighborhood of Baias ” is nearly as much to the point as to 
speak of Hampstead in the same breath as the discharge outlets of the 
London sewage, or of Beacon Hill and the worst pest holes of Lynn.2 
An invalid may drive to the one, as he may to the other, if he chooses 
to do so, but it is not necessary in either case. 
During 1873 and 1874 my attention was chiefly given to the ordinary 
considerations of local climate and a study of the Neapolitan chain of 
LAn Index of Diseases and their Treatment. London. 1876. Page 442. 
2 Yide Report upon the Sanitary Condition of the City of Lynn, rendered to the Massa- 
chusetts State Board of Health, by Prof. J. G. Pinkham, an active member of the Gynaeco- 
logical Society of Boston; and an editorial in The Boston Medical and Surgical Journal, 
February 7, 1878. 6 
Strumous Disease 
mineral springs, extending from Meta, adjoining Sorrento, through the 
whole circuit of the gulf, and ranging in temperature from 15° C., or 
thereabouts, at Meta, Vico Equense, and Castellamare, through from 
17° C. to 21° C. in the springs of the city of Naples, to from 80° C. to 
95° C. at Pozzuoli, Baiae, and the adjacent island of Ischia. I then 
became aware, from chance statements of my friends Dr. J. A. Men- 
zies, of Naples, and Signor Saggese, a skillful chemist, that several of 
the more noted Neapolitan physicians were commencing to claim for 
Pozzuoli an exceptional excellence of a wholly different character, as- 
serting that a portion of it had an atmosphere of its own, perceptibly 
charged not with sulphur merely, but with arsenic, from the semi-extinct 
volcanic crater known as the Solfatara, which, from but slightly rising 
above the level of the adjoining country, is easily accessible on foot, by 
donkey, or by sedan-chair to the most feeble invalid. The breathing of 
this sulpho-arsenical atmosphere, it was stated, not only theoretically 
promised to be of benefit in cases of threatened or actual pulmonary 
tuberculosis, after repeated visits to the crater, extending over a longer 
or shorter period, but had in fact been proved so by actual experiment. 
Such assertions, in such a country, were to be received with great 
caution, but occasion offered for me to make a practical test of the 
matter during the winter of 1874-75. A lad of eighteen, my own 
son, extremely tall for his age, feeble, and ill-nourished, had passed 
the preceding two winters at Mentone under the supervision of Dr. 
Henry Bennet, and at Sorrento, going steadily from bad to worse, so 
that his medical friends had become exti’emely solicitous as to the re- 
sult. The patient was now confided to Dr. Menzies, by whose direc- 
tions, after the late portion of the autumn of 1874 had been spent in 
the westerly extremity of the Corso Vittorio Emmanuele at Naples 
(the very sunniest and most sheltered portion of the whole city), he 
was removed, still failing, to Amalfi. He passed some wTeeks at this 
place without noticeable benefit. It was therefore determined to make 
trial of Pozzuoli, despite the difficulty of obtaining a passably comfort- 
able lodging. An apartment, such as it was, was hired, furnished, and 
a cook was taken out from Naples. The patient was unable to walk 
even the short distance from the house to the Solfatara, and was there- 
fore carried into it by a couple of porters, breathing its direct exhalations 
for a gradually increasing period. Almost immediately he commenced 
to improve. In addition to the prolonged respiration of this special 
atmosphere he took also, in minute quantities, the water of a spring 
arising from within the crater, and very unlike the prevailing mineral 
sources of the neighborhood, which are alkaline, while this is sharply 
charged with sulphuric acid, and in use requires large dilution. The 
spring, and also the atmosphere in the vicinity of the greater vent of 
the crater, contain by analysis very appreciable quantities of arsenic. Treated hy the Solfatara Method. 
7 
Other and ordinary measures, demanded by the alarming exhaustion of 
the patient, were meanwhile as hitherto pursued, and a certain amount 
of the improvement which then set in and became continuous was pos- 
sibly attributable to them. There could, however, be no question that 
this improvement began with and was rendered uninterrupted by the 
special influences of the Solfatara. In the case now reported marked 
physical signs had been wanting. All the rational symptoms, how- 
ever, profuse night sweats and a host of others, had long been 
those of progressing pulmonary or at any rate strumous disease. 
Though now greatly interested in the subject, I could as yet —in 
view of a possible relapse in the instance referred to,1 the impropriety 
of forming a conclusion from so limited an experience, and the total 
unfitness of Pozzuoli for the residence of invalids who had been accus- 
tomed to average American and English comforts -r- only say the fol- 
lowing in my report to the American Medical Association, made in the 
spring of 1875 : “ Regarding the Solfatara at Pozzuoli, which has been 
recommended as a residence for certain classes of invalids, the Neapol- 
itan physicians are of opinion, and the question is one worth consider- 
ing, that the arsenical and other emanations given out-by the still-smok- 
ing crater sensibly and beneficially modify the neighboring atmosphere 
in a medicinal way.” 
In proceeding to investigate the matter still further, I found that per- 
haps the first attempt to utilize the local atmosphere of the Solfatara was 
made by Dr. Abele Franza in 1871, as recorded in 1874 by Prof. Sebas- 
tiano de Luca, of the University of Naples.2 Franza’s patient, a Russian, 
was attended in consultation with Professors Manfr£ and Lauro, and 
the diagnosis was advanced tubercular disease. He had been treated 
in Naples for four months without benefit, and the case had been pro- 
nounced a hopeless one. He was removed to-Pozzuoli, and remained 
there for six; weeks, being merely from time to time carried into the 
Solfatara, and respiring its vapors. The improvement is declared to 
have been immediate and to have remained permanent. A similar case, 
of even more interest, was reported at the same time by Dr. Annec- 
chini.3 The patient was seen in consultation with Prof. A. de Mar- 
1 No relapse, however, occurred. The patient was able to pass the winter of 1875-76 
continuously in Naples, living upon the Yomero, above the Corso Vittorio Emmanuele. He 
returned to America in October, 1876, convalescent, and went through that winter safely in 
the harsh climate of Boston. He is now a student in the Massachusetts Institute of Tech- 
nology. 
For the sake of other invalids, it may be well to state that the house occupied in Naples, 
“ Gastello Monjoujou,” but recently built for the private residence of Prince Palagonia, and 
still owned by him, is altogether the most desirable in the entire city for a consumptive 
stranger, alike for sheltered and sunny situation, cheerful outlook, dry and spacious gardens, 
and internal comfort. 
2 Ricerche Sperimentali sulla Solfatara di Pozzuoli. Naples. 1874. Page 13. 
8 Ibid, page 43. 8 
Strumous Disease 
tini, of Naples, and considered clearly one of acute tuberculosis (tisi 
galoppante'). A year after, the disease having in the mean time greatly 
progressed, this lady commenced to inhale the air of the Solfatara, and 
“ solely in consequence ” (per virtii esdusiva della potenza medicatrice 
delV aria della Solfatara} she was pronounced “to have been radically 
cured ” (essa era in uno stato di salute il piii soddisfaeente, come se 
nulla avesse sofferto'). 
The admirable work upon the medical geography of Italy by Prof. 
Luigi Marieni, of Milan, which, so far as the mineral springs of that 
country are concerned, must long remain a chief authority, was pub- 
lished in 1870,1 a year before these facts occurred. In 1868 and 1869 
Professor de Luca had presented three papers to the Academy of Sci- 
ences of the Royal Society of Naples upon the Composition of the Ther- 
mo-Mineral Water of the Solfatara, and the Temperature of the Greater 
Throat (ffumarola) of its Crater, whence the arsenical exhalations es- 
cape, and within a limited though constant radius of which they are 
appreciable by Marsh’s test. Other papers, chemical and therapeutical, 
upon the same subject, to the number of twelve or more, have followed 
from this gentleman, and are to be found in the Oomptes Rendus of the 
Naples Academy; still others have been communicated by him to the 
Academy of Science at Paris, and he has also published the brochure 
already quoted, entitled Experimental Researches upon the Solfatara of 
Pozzuoli. The effect has been widely to attract professional attention 
in Southern Italy, and indeed throughout Europe, guaranteed as Pro- 
fessor de Luca’s statements have been by the testimony of many of the 
physicians and surgeons to the great hospital Degl’ Incurabili at Naples, 
some of whom are also attached to the University. 
Whether the hopes of these gentlemen are well grounded can be 
proved only by continued experiment. They are now, however, even 
more sanguine than at first, and at the present moment, after, it is said, 
“ the complete and radical cure ” of quite a number of additional cases 
of advanced phthisis, who had been made to reside continuously for 
several weeks at the Solfatara, a branch of the Incurabili hospital 
has been established within the crater for the special treatment of pul- 
monary disease. To make the collateral test upon English-speaking 
patients has, as already stated, now for the first time been rendered 
possible at Pozzuoli. It is not unlikely that in the future the crater of 
the Solfatara may become as famous for its effect upon the prolongation 
of life as the neighboring Grotto del Cane has been for imperiling it. 
It will be very interesting to test for arsenic the atmosphere of the 
various stufe, or volcanic vent holes of steam and dry air, existing 
upon the neighboring island of Ischia (a famous place of resort for in- 
valids, in the Bay of Naples), which does not yet seem to have been 
1 Geografia Medica dell’ Italia. Milan. 1870. Pp. 665. Treated by the Solfatara Method. 
9 
thought of, though they were studied with care by the late Dr. Chevalley 
de Rivaz, of Casamicciola ;1 and it would be also well that the same should 
be done with those at Calistoga and the Geysers, already noted in the 
treatment of disease, in the vicinity of San Francisco, California, and 
the similar fumaroles of the Yellowstone. 
Whether equal advantage to that mentioned above can be gained by 
a partial return to the old way of treating phthisis by artificial prepara- 
tions of arsenic, this time with sulphur or sulphuric acid, a combina- 
tion that seems never yet to have been used in medicine,2 and em- 
ploying them by inhalation, in atomized solutions, either cold or con- 
joined with steam, is as yet a point to be determined. My own im- 
pressions are in their favor. 
It may be argued that the as it were camping-out life at the Solfa- 
tara has something to do with the effect produced. The freest and most 
open air is never too pure for consumptives anywhere, but in Italy the 
ordinary life is an out-of-doors one, and these Solfatara cases had been 
subjected to it before being carried to Pozzuoli, and yet had rapidly de- 
clined. 
It may also be said that by the Solfatara method we are not treating 
a local disease by constitutional measures, but a constitutional one with 
a local tendency by means that are wholly localized. Though seem- 
ingly true in cases of pulmonary disease, the remark cannot be applied 
to other forms of struma, which appear to derive similar benefit. It 
would seem probable that the arsenic produces its effect, granting the 
premises that in Naples are now assumed, in a manifold way: (1) by 
direct action, in diseases of the respiratory passages; (2} by increasing 
nutrition or suspending waste, or both, for which it has long been noted; 
(3) as a general alterative; and (4) as a general tonic.3 
In the case observed by me, the arsenical water of the Solfatara was 
1 Description des Eaux minero-thermales et des lltuves de File dTschia. Naples. 1859. 
2 In answer to an inquiry that I addressed him, Mr. Theodore Metcalf, of Boston, has 
kindly given me the following resume of our present knowledge upon the subject: “ The 
only arsenical preparations used in medicine are the liq. potassse arsenitis, liq. sodse arseni- 
tis, liq. arsenici chloridi, and a solution of chloro-phosphide of arsenic, recommended by 
Dr. Hammond, of New York. The arseniates of ammonia, potassa, and soda are in use ; 
also Donovan’s solution, iodide of arsenic, and arseniates of antimony, copper, iron, quinia, 
and strychnia. Pastes of arsenic I have never had any occasion to make, nor any fumiga- 
tions, except in one instance, when I had an order to saturate cigars with liq. potass, arsen. 
The arsenious acid in pills is also considerably used, and arsenic combined with quinia, iron, 
etc. Orpiment, a tersulphuret of arsenic, consisting of one equivalent of arsenic and three 
of sulphur, is used only as a pigment and a depilatory. Eealgar, a bisulphuret, one 
equivalent of arsenic and two of sulphur, is used only as a pigment. Neither of the sul- 
phides, that is sulphurets, of arsenic are supposed to be so poisonous as the arsenic itself, 
but so far as I know they are never prescribed. The most recent medical literature that I 
have at hand gives nothing new in arsenical remedies.” 
3 See Aveling, Decongestive Action of Arsenic upon Mucous Membranes, British Med- 
ical Journal, January, 1872, page 10; Journal of the Gynecological Society of Boston, 
September, 1872, page 221. 10 
Strumous Disease Treated hy the Solfatara Method. 
used in conjunction with the respiration of its atmosphere, and may 
have increased the action of the latter, while its own, like that also of 
the atmosphere, may have been enhanced by the sulphuric acid that it 
contains. In many of the successful Italian cases, however, the inhala- 
tion of the arsenical atmosphere has alone been employed, thus narrow- 
ing the question to its ultimate merits. In either case, however, the 
treatment would chiefly have been constitutional, in accordance with Dr. 
Henry Bonnet’s well-expressed formula : “ The most advanced minds in 
the profession more and more recognize the fact that the local manifes- 
tations of chronic chest diseases, tubercular or inflammatory, are mere 
epiphenomena. They require treatment, of course, but their treatment is 
of secondary importance when compared with the treatment of the con- 
stitutional state of the patient, which is at the root of the mischief.” 1 
Remarks upon the effect of the Solfatara in purely gynaecological 
cases, functional and organic, I must reserve for a future occasion. 
Meanwhile the whole question will be still further investigated, from an 
English stand-point, by Dr. Cerio. 
1 Dobell’s Reports on the Progress of Practical and Scientific Medicine in Different Parts 
of the World. London. 1870. P. 418.