How the Therapeutic Value 
of our Mineral Springs may 
be increased. 
V 
CLAKENCE C. KICE, M. D., 
INSTRUCTOR IN DISEASES OF THU NOSE AND THROAT IN 
THE NEW YORK POST-GRADUATE MEDICAL SCHOOL 
AND HOSPITAL. 
REPRINTED PROM 
5Tl)e Neto ¥ortt .fRetical .journal 
for October 16, 1886. Reprinted from the New YorJc Medical Journal 
for October 16, 1886. 
IIOW THE THERAPEUTIC VALUE 
OF OUR MINERAL SPRINGS 
MAY BE INCREASED.* 
By CLARENCE C. RICE, M. D., 
INSTRUCTOR IN DISEASES OF THE NOSE AND THROAT IN THE NEW YORK 
POST-GRADUATE MEDICAL SCHOOL AND HOSPITAL. 
More attention lias been paid to the mineral springs of 
the United States and their medicinal virtues during the 
last few years than ever before; and this is not that we 
have largely developed new resources, but because there is 
a demand on the part of the public for this line of thera- 
peutics. Our patients have been educated abroad, and 
have discovered the benefit of treatment to be derived from 
mineral waters before the physician himself has become 
aware of it. The physician meets people constantly who 
have spent a season at Carlsbad or Ems. In these days of 
rapid traveling the distance to Europe is not considered a 
serious obstacle to one who is willing to he at any trouble 
to regain his health; and as for expense, it may easily cost 
as much to remain at home. Just why so many thousand 
Americans go to European spas for their health, when na- 
* Read before the American Climatological Association at its third 
annual meeting. 2 
HOW THE THERAPEUTIC VALUE OF OUR 
ture has been so lavish with the same resources here at 
home, would seem at first thought difficult to explain, but 
a little inquiry will show that the physician rather than the 
patient has been at fault, and has been the cause of this 
vast emigration of our invalids to Europe. The owners of 
mineral springs and the proprietors of watering-place hotels 
have also been somewhat to blame, because they have not 
up to this time furnished the public with the apparatus for 
using mineral waters which can be found at European spas. 
There are many Americans who have been under medical 
care at Wiesbaden and Homburg who, perhaps, are not ac- 
quainted with a single American mineral spring, and imag- 
ine that people visit Richfield and Saratoga solely because 
these places are fashionable summer resorts, and not at all 
on account of the waters to be found there. A number of 
times I have heard visitors express surprise when they 
learned, for the first time, that many of the hotel guests 
were at these places for the sole purpose of taking the 
baths. I speak of this only to show that Americans are 
to-day less acquainted with their own than with European 
mineral springs. Saratoga means to them a place of gayety, 
where the water may be drank or let alone, according to 
one’s fancy. I have talked with many people who are in 
the habit of spending their summers at our watering-places, 
and they seemed to consider the matter of drinking the 
mineral waters mostly in the light of a joke. They took 
them for no special purpose; they had little idea of their 
effect, but drank the waters mainly because their neighbors 
did, or because it was fashionable. Using the waters in 
this aimless, careless manner, is it any wonder that harm is 
done, and that the efficacy of the waters oftentimes falls into 
bad repute ? Europeans at their spas drink the waters and 
take the baths as carefully, punctually, and religiously as 
they say their prayers, and even Americans seem wholly MINERAL SPRINGS MAY BE INCREASED. 
3 
changed when at foreign watering-places, and they would 
as soon think of selecting any spring, without regard to 
their ailment, as of drinking the waters which had been 
selected for them without first consulting the physician of 
the place as to the proper quantity of water to be taken, and 
the correct time for drinking it. Tf Europeans were as much 
in the habit of visiting our springs as we are of going to 
theirs, I dare say they would treat our waters with the same 
marked respect. 
It is possible, too, that the value of European mineral 
waters, like that of some other things, is enhanced in the 
minds of Americans because, if not always English, they are 
foreign. One reason for the difference in the behavior of the 
American at home and abroad is that he does not appreci- 
ate home waters because they can be so easily obtained. 
Feeble appreciation means little faith, and lack of faith 
in any remedy is almost always accompanied with little or 
no benefit, partly from mental causes, and partly because 
the remedy is not given a fair trial. A voyage across the 
Atlantic puts an American in condition to be benefited by 
European waters by improving his general health. I have 
no idea that Ems or Wiesbaden would have so many Ameri- 
can admirers if these springs were situated in Virginia in- 
stead of in Germany. 
It does not seem worth while to enter deeply into the 
analyses of the various American mineral waters, nor to de- 
termine in what points they are different from those most 
celebrated in Europe, for I do not believe that this is, at 
present, the most important part of the subject for Ameri- 
can physicians to consider. It is vastly more to the purpose 
that, whatever mineral spring is used, it should be employed 
intelligently and on scientific principles, and that the par- 
ticular spring should be selected by the physician with 
some regard to the ailment of the patient. The patient 4 
HOW THE THERAPEUTIC VALUE OF OUR 
should be under strict detailed orders from his physician; 
and these instructions should cover not only the manner of 
using the waters, but the matter of food, exercise, social 
life, mode of living, etc. It is in regard to these points 
that physicians at the European spas are most particular, 
and*we can learn from them in this respect. Their 
patients are under good discipline, and understand thor- 
oughly what the treatment is intended to do for them. 
Carlsbad has not a greater reputation for curing people so 
much because its waters are better medicinally than the 
Congress or Ilathorn of Saratoga, as because patients at 
Carlsbad are under better therapeutic conditions; and the 
same may be said in comparing the waters of Aix-la-Cha- 
pelle and of Aix in Savoy with the sulphur waters of Rich- 
field. Trousseau says, in speaking of the waters of Carls- 
bad and Vichy: “ I know of no medication more perilous 
than that of these waters administered without reserve, 
without discernment, and without regard to individual con- 
ditions of health, etc.” 
Let us for a moment look for the factors which have 
tended to make European watering-places so celebrated. 
Are the “cures” to be credited to the medicinal properties 
of the waters alone? Ilow much have habits of living at 
European watering-places to do with the benefit the patients 
derive, and what part of the physical improvement is due 
to a sea voyage, changes in climate and scene, and rest 
from business? These are pertinent questions in searching 
for the secret of the success of the celebrated German and 
French mineral springs. 
First, I believe that the mental effect 'produced upon a 
patient by the rigorous course of treatment which is custom- 
ary at German springs is very salutary, and is a factor 
which hitherto has not been sufficiently appreciated at our 
mineral sanitaria. The physician who loses sight of the Mineral springs may be increased. 
5 
value of mental medicine in any kind of practice is working 
at serious disadvantage, and especially in treating patients 
who visit mineral springs, for they are, as a rule, a peculiar 
class. They have traveled much, and have seen every- 
thing. They have been treated for their complaints by 
many physicians in many different ways, and they have 
long since lost all faith in medicines. They talk over 
their ills with each other, and are proud to relate how 
many different “cures” they have tried, and how little 
benefit they have received. Such a patient can not be 
cured unless his mental condition can be placed upon a 
healthy basis. He must be made to feel that his visit at 
the springs is not mere pastime, but that he has a disease 
which is understood by his physician, and that the waters 
are suited to that disease. If they are not, he should be 
sent to the proper springs. These patients, then, must be 
taken hold of in a strong manner, for there is no class of 
patients so unimpressionable as the one to be found at the 
hotel of a watering-place. They must be made to work for 
themselves, and in this way they will soon become interested 
in their recovery, and their thoughts will be upon their cure 
rather than upon their disease. The whole mode of life at 
the European spas is one calculated to impress the invalid 
with the idea that not only is a great deal being done for 
him, but that he also is doing much for himself to regain 
his health. There is something in this mental tonic which 
is very healthful. 
During a visit at the French and German springs last 
summer, I had the pleasure of meeting many of the physi- 
cians who practiced there. I was very much impressed with 
the enthusiasm exhibited by these medical men in regard 
to their mineral waters. They seemed never tired of talk- 
ing of them, and they had great faith in their curative 
properties. A patient quickly sees and feels this quality in 6 
HOW THE THERAPEUTIC VALUE OF OUR 
a physician, and his own confidence is increased. Among 
American physicians I have noticed the half-hearted manner 
in which they advised the use of mineral springs when it 
seemed that the highest praise they could pay the water 
was that if it was used carefully it would do no harm — 
“damning it with faint praise.” 
Another point of difference between European and 
American spas is in the social life. Life at Richfield and 
Saratoga is almost a repetition of gay New York during the 
season. Only a small proportion of the visitors imitate their 
European cousins in rising early and going to the springs for 
the waters, but they breakfast at the usual city hour—from 
eight to ten. Frequently their servants carry the water to 
their rooms and the invalids drink it in bed. In Europe a 
person is rarely so feeble that he can not be wrapped up 
and carried by two atten hints in a Sedan chair to the spring 
and bath, and this is done rain or shine. I was at Aix-les- 
Bains one day when the rain was falling in torrents, but this 
did not diminish the number of people at the bath-house. 
The feeble patients were wrapped up head and foot in rub- 
ber blankets and carried from their hotels to the spring. 
One sees little of this in America. It certainly would not 
become popular at our leading mineral spas unless it was 
fashionable, and it would not readily become fashionable un- 
less the better classes of people had the sole monopoly. The 
ladies who, as they themselves express it, are “ literally worn 
out ” by the season’s work, and who have come to the sani- 
tarium to regain their health and to rest, do not in the 
slightest degree relax their interest in society matters and 
dress. And the lines separating the various “ sets ” are as 
rigidly drawn in the country as in town. It is unfortunate 
that this should be the grade of life at our mineral springs, 
and that our mineral waters should be expected to cure not 
only gout and bronchitis, but the vices of living which occa- MINERAL SPRINGS MAY BE INCREASKD. 
7 
sion these diseases. The same change is needed as in a 
patient whom Trousseau and Pidoux thus describe: “Living 
in the midst of luxury, not getting up till midday, confining 
herself most of the afternoon to a perfumed room which the 
light scarcely penetrates, taking a drive in a close carriage 
when the weather is fine enough, living on made dishes 
which are made the more piquant as her appetite grows 
more fantastic. Next she is influenced by her passions, good 
or bad, sad or gay, her social and family duties—the rou- 
tine of every-day little annoyances, and finally by ennui, 
that pest of idleness and of riches. Her appetite fails, her 
digestion is languid, her nervous system is exalted. She 
gives an endless deal of trouble to her doctor, who can do 
little for her and who in despair sends her to some spa. 
There her habits are changed in every way. She has to get 
up early in the morning for her water or her bath. She 
leads a comparatively simple life in the open air—and, with- 
out going into further details as to her changed mode of 
life, can you wonder if she returns to Paris cured ? ” 
I was impressed with the simplicity of life and habit at 
Carlsbad. Among the hundreds of people who were wait- 
ing in line to reach the famous Sprudel, almost every nation- 
ality under the sun was represented, as could be seen by 
their different styles of dress. People, too, in every station 
of life were there, from the nobleman to the poor Pole. 
Side by side they drank the waters with apparently but 
one desire—to regain their health. They were enthusiasts. 
They observed to the minutest detail the instructions of 
their physician both as to the temperature and the amount 
of water they drank. Many of them were out of bed at 
four o’clock in the morning, in order to get the water before 
the great rush began ; and, from conversation, I learned that 
some of these people retired as early as eight in the evening 
to get sufficient sleep before the early start. It was a little 8 
HOW THE THERAPEUTIC VALUE OF OUR 
ridiculous to hear patients exalt the virtues of the spring 
they were assigned to, and speak disparagingly of the oth- 
ers, when it is remembered that the waters of Carlsbad dif- 
fer from one another but slightly except as to the temperature. 
The greatest man in Carlsbad is the veteran of many seasons 
who can drink without discomfort large quantities of the 
waters. He is envied by all the men and women who are 
limited by their physicians to a single glassful. It was very 
evident that these people had come to Carlsbad from all 
parts of the world for the waters and for nothing else. Pa- 
tients there breakfast simply on coffee and rolls, and each 
patient goes to a bakery, buys his bread, and carries it to a 
coffee-house, where he eats it. I speak of these simple de- 
tails because they present such a striking contrast to the 
mode of life at our watering-places. At Saratoga I heard a 
woman sa}', when she was asked if she did not fear that the 
bountiful breakfast she was eating would counteract the de- 
sired effects of the mineral waters she had taken an hour 
before, that “ it was hard enough to get out of bed at seven 
in the morning and drink the waters, and she did not pro- 
pose to starve herself.” She was a stout woman and had 
been sent by her physician to drink the waters for rheuma- 
tism and gout. Under such circumstances, is it a matter of 
much importance whether the waters contain a little more 
or a little less lithium, or whether the cathartic principle is 
Epsom or Glauber’s salts ? Physicians and hotel-keepers at 
mineral springs, who lay great stress upon the presence of a 
fraction of a grain of some valuable medicinal salt in their 
pet mineral water, are not looking at the question in all its 
different phases. We all know that there is a great deal of 
truth in the statement of Dr. Beale, an English writer. He 
says : “ If patients could be induced to retire to a pleasant 
part of the country, where they would take moderate exer- 
cise and be free from mental anxiety, meet with agreeable MINERAL SPRINGS MAY BE INCREASED. 
9 
society, live regularly, take small doses of alkalies, and bathe 
themselves for an hour or two a day in warm water in which 
some carbonate of sodium has been dissolved, they would re- 
ceive as great benefit as by traveling hundreds of miles away 
and at much less trouble and expense.” But, after all, such a 
happy combination of circumstances and conditions can not 
be readily found in our country, and certainly not nearer to 
New York than our watering-places, where all the desirable 
factors recommended by Dr. Beale can be at the disposal of 
patients, if their physicians in town and in the country will 
not content themselves with simply telling them how to use 
the water, but will also give careful instructions about eat- 
ing, exercise, and habits of life generally. The amount of 
benefit the patient obtains and the reputation of the spring 
will largely depend upon these commonplace matters of liv- 
ing. While I found that almost all of the physicians I met 
at the different watering-places throughout Belgium, Switz- 
erland, Germany, and France were fully convinced that their 
own spring was competent to cure every patient whose ail- 
ment came in their particular line, I also noted that these 
physicians did not have faith enough to believe that their 
waters could cure a gouty man who continued to drink 
wine at late dinners or reduce the weight of a woman who 
sat in her hotel-room all day. They order their patients to 
walk a great deal, and, as many of the European spas are 
situated at the foot of mountains, the walks are up and 
down steep inclines. The physicians did not lay much 
stress upon these outside matters of eating and exercise, and 
were disposed to give to the waters the entire credit of the 
cure. But they were giving their mineral waters a fair 
trial by placing their patients in the best hygienic condi- 
tions. Patients, too, were educated to believe that the 
waters were the sheet-anchor upon which they were to de- 
pend. They walked many miles to digest the waters and 10 
HOW THE THERAPEUTIC VALUE OF OUR 
make room for more. They ate only the simplest varieties 
of food, because all luxuries were incompatible with the 
chemical action of the salts, which were to revolutionize 
their disordered bodies, and they went to bed early only 
for the sake of being able to drink the waters at the most 
appropriate time—at day-break. Is it any wonder that the 
majority of patients who visit these springs and who have 
led the sedentary lives common to the inhabitants of cities 
improve on such a regimen and return to the same water- 
ing-place whenever they are out of health, believing that it 
is the only spot on earth for them ? We were almost going 
to say that their improvement under these conditions would 
be as pronounced if there was nothing but Croton water to 
drink and bathe in, but this would not be true, for many of 
the European waters are wonderful. 
The social life I have spoken of, which is common to 
our watering-places, shuts out the real invalid, who must be 
away from noise and gay, active life; and many of these 
people go to Europe. 
While I believe that the majority of visitors at European 
spas are to some extent invalids, Dr. George E. Walton 
says, in his excellent book on “The Mineral Springs of the 
United States,” that “ many, and in this country perhaps 
the majority, of visitors at springs journey thither not be- 
cause of any specific malady with which they are afflicted, 
but to obtain relief and rest from the harassing care of 
business.” It has come to be believed that, while our 
springs are good for healthy people, they have not sufficient 
virtue to cope with organic diseases. This feeling has come 
about, not from a lack of waters in the United States whose 
analyses show them to be equal to those abroad, but because 
of the inefficient manner in which they have been employed. 
It will readily be seen that the comparison between our 
waters and those of the Old World can never be a fair one MINERAL SPRINGS MAY BE INCREASED. 
11 
to us until we follow the example of our profession across 
the water and place our patients under all the conditions 
most favorable to health. 
Another feature, which up to this time has been want- 
ing, and which our mineral springs sorely need to give them 
reputation and efficiency, is the indorsement of the medi- 
cal profession. And I do not mean subscribing to the ad- 
vertisement of any company who are bottling the waters of 
some spring, but physicians, individually or in committees 
appointed for the purpose, should have careful analyses 
made, and they should ascertain by clinical investigation 
the therapeutical value of our mineral waters, and, if they are 
found to be valuable medicinal agents, they should be given 
a place as such in our materia medicas. This is another 
advantage that the European springs have had. Mineral- 
water treatment forms quite a large portion of the thera- 
peutics recommended by von Niemeyer* in his “Text-book 
of Medicine,” and he speaks in no doubtful manner, as, for 
example: “In our present state of knowledge, a course of 
water at Carlsbad is the measure which should deserve the 
chief reliance as a remedy for diabetes mellitus.” In the 
treatment of renal calculus Sir Henry Thompson f says : “ Of 
all medicinal remedies, perhaps none are so valuable as min- 
eral waters,” and Trousseau and Murchison speak in the 
same emphatic terms in respect to the treatment of other 
diseases. 
Not only have the medical profession of Europe made 
the therapeutics of mineral waters popular by their indorse- 
ment, but the German and French governments have largely 
supported their springs. In Germany a majority of the 
springs belong to the Government, which appoints general 
* Yon Niemeyer, “ Text-book of Medicine,” vol. ii, p. 781. 
f Thompson, “On the Urinary Organs,” 1869, p. 202. 12 
HOW TIIE THERAPEUTIC VALUE OF OUR 
and local inspectors, whose duty it is to regulate all matters 
connected with them. The pride for the use of the water 
and baths is fixed by the Minister of Commerce. In some 
instances the bath physicians hold official positions under 
the Government. It is usual to arrange the tariff in three 
classes, in order to bring the price within the reach of the 
poor and rich alike. Austria supports baths for the use of 
her invalid soldiers. By means of this governmental sup- 
port large luxurious bath-houses, furnished with all neces- 
sary and sometimes most elaborate apparatus, are kept open 
for the public. In America the improvement of mineral 
springs, erection of bath-houses, purchase of apparatus, etc., 
have been effected entirely by private capital; and the want 
of money has frequently been the main obstacle in develop- 
ing our mineral resources. 
At Aix-les-Bains, in Savoy, there are four large swim- 
ming baths with douches of various kinds and about fifty 
rooms, each having two attendants, who administer what is 
there called the “ grande douche.” The patient sits on a 
low wooden stool with his feet in warm mineral water; 
one attendant, standing behind, deluges the back with the 
water, which pours out of a large hose, while the second 
attendant washes and rubs the front of the body. Dr. 
Grainger Stewart, of Edinburgh, who took a course of 
baths at Aix-les-Bains, says: “It is astonishing with what 
skill, patience, tenderness, and firmness the shampooing and 
passive movements are performed.” Dr. Brachet, of Aix- 
les-Bains, told me that the large increase in the number of 
bathers—from eleven thousand in 1872 to twenty-four thou- 
sand in 1882—was, in his opinion, due as much to the skill 
of the two hundred employees as to the therapeutic repu- 
tation of the wTaters. These attendants bring their patients 
in Sedan chairs from their hotels, and, after the bath and 
massage, they carry them back and put them to bed, rub- MINERAL SPRINGS MAY BE INCREASED. 
13 
bing them until the normal temperature is restored. I 
might speak of the many varieties of douches at Eras, some 
of which are to be found in our Russian bath-houses—of 
the inhaling-rooms, filled with finely pulverized mineral 
waters; of the departments devoted to the spraying of the 
waters for the relief of nasal and bronchial catarrh; of the 
carbonic-acid-gas baths ; of the various appliances for di- 
recting mineralized steam upon a single rheumatic or gouty 
joint; of the mud and peat baths to be found at Carlsbad, 
and the amphitheatre at Royat in France, where numerous 
patients sit about a large opening which looks like the fun- 
nel of an ocean steamship, and inhale the mineralized steam 
which pours out of it. The interesting method of douch- 
ing at Royat deserves a word. The attendant in charge 
stands on a raised platform about six feet from the patient. 
Within easy reach there are a number of faucets which 
regulate the temperature of the water and the force and 
size of the stream. With a hose and nozzle the attendant 
can direct any kind of a stream upon the patient, from fine 
needles to a large douche, and at any temperature. This is 
used so skillfully that a patient’s temperature can be nicely 
regulated after he has taken his bath and before he goes 
home. There are many more styles of treatment, but you 
are all familiar with them. It is not my purpose to de- 
scribe any methods of medication, nor to endeavor to ascer- 
tain the amount of benefit that patients derive from them. 
That great benefit is obtained is not to be doubted, and it 
is equally true that the reputation of the leading European 
mineral waters is increasing every year. I have been in- 
terested in searching for the causes that have contributed 
to this success, because I believe that if they can be ascer- 
tained they can be employed with advantage by us at home. 
We have the waters, and, if this subject of mineral-water 
therapeutics is an important one, then what has been said 14 
IIOW TI1E THERAPEUTIC VALUE OF OUR 
in this paper is not inappropriate for the consideration of 
this association. 
Last year, at New York, your president, Dr. A. L. 
Loomis, spoke of the necessity of making further inves- 
tigation and obtaining greater knowledge of mineral-water 
therapeutics, and more attention is being paid to this sub- 
ject by the medical profession. At Richfield Springs, I 
learn that between two and three hundred mineral baths 
are given daily during the season, that new springs have 
been developed during the last six months, and that they 
have sufficient water now to give one thousand baths daily. 
Two years ago a department for the atomization of sulphur 
water for the treatment of catarrh of the upper air-passages 
was also arranged at Richfield, a room where the water was 
sprayed by steam, and stalls where it was atomized by com- 
pressed air. There is a similar department connected with 
the sulphur baths at Sharon. 
Before closing, I wish to express my obligation to Dr. 
Brachet, of Aix-les-Bains, Dr. Brand, of Royat, Dr. Schnee, 
of Carlsbad, and Dr. Reuter, of Ems, for courtesies and 
valuable information extended to me. Allow me to repeat 
the suggestions offered in this paper, which, if followed, I 
believe will increase the therapeutical value of our mineral 
springs: 
1. Physicians, individually or in committee, should make 
careful analyses of our mineral waters. 
2. The medicinal value of the waters should be tested by 
clinical investigation, and the conclusions arrived at given 
to the profession. 
3. If the waters are found to possess marked medicinal 
merit, physicians should interest themselves in the develop- 
ment of the springs and the improvement of bath-houses 
and apparatus. 
4. Physicians, in sending patients to a mineral spring, MINERAL SPRINGS MAY BE INCREASED. 
15 
should be most careful to select the proper water, and should 
send with the patient his .history and the diagnosis of his 
disease for the benefit of the physician at the bath. 
5. Patients at our mineral spas should be placed under 
more rigid medical discipline, and more attention should be 
paid to their habits of living. 
6. The social life at our watering-places should be 
placed on a more wholesome basis. REASONS WHY 
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