Cornell University Library RA 864.A3B79 Aix-les-Bains in Savoy; tlie medical treat 3 1924 012 504 134 Cornell University Library The original of tliis book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31 92401 25041 34 AIX-LES-BAINS (SAVOY). WOEKS BY TEE SAME AUTHOR. Observation d'Hydrocephale. (Chambeiy, 1864.) Du role du Parasite dans I'etiologie dea maladies cutanees Parasitaires. (Montpellier, 1864.) De la contagion dela Phthisie Tuberouleuse. (Nice, 1866.) Observation de Tetanos traumatique et rhumatismal, traite aux eaux d'Aix. {Union Mklicale, 26 Ootobre, 1869.) Myome Uterin deloge par le travail de raccouchement et op^re aveo succes. (Paris, 1870.) Traitement des blesses aux Eaux d'Aix. (Paris, 1872.) Angiome de I'Uterus. (Observation presentee a la Sooiete de Chirurgie, 1872.) Aperiju clinique sur les Eaux d'Aix et de Marlioz, 1874. Du Ehumatisme uterin. (Traduction de Oed, 1879.) Ouverture de I'institut Anatomique de Pome. [Progres Medical, 1881.) Observation de Coxalgie guerie par les aimants. {Progres Medical, 1881.) Observation de Xanthome en tumeur. (Bhachet et MONNAED.) (Annales de Dermatologie et de Syphiligraphie, 1881.) Phumatisme. (Traduction de Maclagan, 1883.) Epuisement Nerveux et Hysterie, leur traitement. (Tra- duction de PLATrAiE, 1883.) Comptes rendu de nion service a I'Asile AngIo-Pran9aic. durant les 10 dernieres ann^s. Observations de Myxojdenie Cretinoide. (Lecture faite av Congres des Soci6t& Savautes le 25 Fevrier, 18S2.) AIX-LES-BAINS {IN SAVOY), THE MEDICAL TREATMENT AND GENERAL INDICATIONS. BT DOCTOR BEACHET, Physician to the Bathing Establishment of Aix-les- Bains and Marlioz \ Physician of the TJiermal Hospital ; Senior Physician of the Anglo-French Asylum; Physician to the P. L. M. Paikvay Company; to the Society of Artists and Inventors of Pai^ ; Member of the Hydrological Society of Paris ; Member of the Medical Academy of Rome ; Member of the Academy of Savoy ; and Member of the Medical Societies of Geneva, Montpelli^, t]x. cjc. HENRY RENSHAW, 356, STRAND, LOiN'DON. 1884. [_All rights reserved. ^ BALLANTYNE AND HANSON, EDINBURGH CHANDOS STREET, LONDON 2)ist(ngttfsbe5 /iDembers of ms profession IN GREAT BRITAIN AND IRELAND, FROM WHOM I HAVE RECEIVED VALUABLE INFORMATION, WITH MANY PROOFS OF CONSIDERATION AND KINDLY FEELING, THIS LITTLE WORK IS INSCRIBED AS A SINCERE THOUGH INADEQUATE MARK OF RESPECT AND ESTEEM BY THE AUTHOR. PREFACE. Since the publication of my clinical study of the mineral waters of Aix-les-Bains and Marlioz, the increased importance of these spas, and my own wider experience, enable me to furnish more copious notes. Situated on the borders of Lake Boui-get, at the foot of the AIjds between France, Italy, and Switzerland, Aix is easy of access by the railway from Paris to Rome. The English visitors, appreciating natu- ral beauties, have almost transformed it PREFACE. into an English colony, especially during the spring and autumn months. I do not pretend to enter into details of physiological or clinical research, but simply to indicate certain practical re- sults of my daily observation during the last twenty years, which I trust may be favourably received by my colleagues who have hitherto failed to appreciate the value and influence of the medical treat- ment of Aix-les-Bains and Marlioz. Some pages are added for the benefit of tourists, who resort in large numbers to Aix, fortunately without requiring the treatment. Many detailed Guides exist, and it is not in medical competence to PREFACE. write a book of that nature. I simply indicate to patients an agreeable mode of occupying their leisure moments, and to all lovers of natural beauties the points "where they can best be enjoyed. L. Beachet. Aix-les-Bains, Savoie, France, is« March, 1884. CONTENTS. PAGE Peeface vii Statistics of Visitors during the last Hundred Years i Historical Eetrospect 3 Climate 7 GEOLOGt 9 Thermal Establishment 11 Chemical Analysis of the Waters of Aix-les- Bains 15 Mode of Using the Waters at Aix .... 18 Internal Use — Douclies — Steam Baths (bouil- lons — BerthoUet) — Baths — Swimming Baths (Pi seines)— Inhalations — Spray. General and Therapeutic Action of the Waters 25 Thermal Fever (Fousse'e). Duration of the Treatment 27 Best Season foe the Course . 29 Diet during the Course 30 CONTENTS. DISEASES SUCCESSFULLY TEBATED AT AIX-LBS-BAINS. page: Eheumatic Diseases 31 Eheumatoid Arthritis 39 Eheumatic Gout — Chronic Eheumatic Ar- thritis — Nodosity of the Joints — Nodosity of Heberden — Arthritis Deformans. Gout 51 Neuralgia — Sciatica — Case of Gouty Sciatica 54 Diseases of the Organs of Eespiration ... 59 Ehinitis — OzKna — Pharyngitis — Catarrh of the Pharynx — Sore Throat — Granular Pharyngitis — Clergyman's Sore Throat — Herpes of the Pharynx — Eheumatic and Gouty Sore Throat — Chronic Laryngitis — Chronic Bronchitis — Hay Fever — Asthma — Catarrhus Senilis — Winter Cough — Phthisis. Syphilitic Diseases ^2 Scrofula ^5 Skin Diseases ^g Psoriasis — Prurigo — Eczema — Herpes — Acne. Women's Diseases Simple and Follicular Vaginitis — Hsematocele — Uterine Diseases : Amenorrhoea — Dys- menorrhoea — Metritis — Ulceration — Leucorrhoea — Uterine Tumour — Disturb- ances at the Change of Life. r CONTENTS. PAGE Hysteria 93 Anemia and Chlorosis : Cases 95 Cretinoid Mtx(EDEMA(CACHExiE Pachvdermique OF Charcot) 100 Paralysis 108 Local Paralysis — Hysterical Paralysis — Mer- curial and Lead Palsy — Syphilitic Paraly- sis — Hemiplegia — Paraplegia. Sdrgical Cases 115 Illnesses foe which the Waters of Aix are unadvisable 118 Torpid Phthisis — Cancerous Diseases — Some Cases of Heart Disease — Nervous Irrita- bility — Congestion or Softening of the Brain ADJUNCTS TO THE TKEATMENT OP AIX. Springs of Marlioz 121 Challes Waters 124 St. Simon Waters 126 Whey Cure 128 Electricity combined with the Treatment of Aix-les-Bains 129 CONTENTS. PAKT II. GENERAL INDICATIONS. PAGE EOUTE BETWEEN PaRIS .\ND AiX-LES-BaINS . . 133- General Coup-d'ceil of the Country .... 135 The ToYiiJ of Aix-les-Bains 139 Hotels — Boarding-houses — Lodging-houses . 140 Carriages — Omniuuses — Eiding Horses — Donkeys 141 Steamers and Boats 142 Tariffs 142 Divine Service 143 Eoman Catholic Church — English Protestant and Presbyterian Churches. Hospitals 144 Thermal Hospital — Anglo-French Protestant Asylum. Antiquities of Aix 145 Arch of Campanus — Eoman Baths — Temple of Diana — Sun-dial. Museum and Library 143 CONTENTS. PA&E Amusements 148 Casino — Villa des Fleurs — Pigeon-shooting — Eaces. Walks 151 Eoche'du Eoi — Boulevard des Cotes — Park of ]\Iarlioz — St. Simon — Pont Pierre — Chateau de Syllan — Maison du Diable — Bois Lamartine — The Grand Port — The Petit Port — Hill of Tresserves — Mouxy — Trevignin — Clarafond. Drives 155 Waterfall, Tower of Gresy — Moulin des Primes — Grotto of Banges — Tour du Lac — Castle of La Serraz — Castle of LaMotte — Le Bourget — La Eoute de la Dent du Chat — Castle of Bourdeau — Castle of Chatillon — Drive to the Ehone by the Canal of Saviere — Val de Pier — Valley of the Beauges — Castle of Miolan — The Grande Chartreuse — Lake of Aiguebe- lette. Mountain Ascents 163 Dent du Chat — The Eevard — The Dent du Nivolet — Samnoz — Alps — Tower of Cessans. Steamer ok Boat Excursions 166 Bourget — Bourdeau — Chatillon — Canal to the Ehone — Hautecombe. Excursions to Chambery— to Gorges de Fier — to Anneoy. EEEATA. Page 6, for " King "Victor Amedee III.," read " King Victor Amedde III." 9, for " Dr. Lambard," read " Dr. Lombard." lo, for " frequently," read " constantly." 92, for " Irrigation," read " Irrigations." 1 10, for " success," read " medication." 1 17, for " beneficent," read " beneficial." 124, for "Dr Cagalis," read "Dr. Oazalis." 165, for " A four hours drive," read " At four bours drive." AIX-LES-BAINS (SAVOY). THE MEDICAL TREATMENT AND GENERAL INDICATIONS. STATISTICS OF VISITORS DURING THE LAST HUNDRED YEARS. The best recommendation of our Medical Springs is the regularly increasing number of bathers (as indicated by the official Table annexed), of whom many return year after year to confirm and renew the beneficial and invigorating effect. Number of Eeeeipts of the Years. Bathers. Establishment. 1783 588 2,467 o 1815 1,750 6,221 o 1816 1,150 11,279 o 1828 2,162 26,965 o B AIX-LES-BAINS. Yeara. 1829 Number of Bathers. Eeoeipts of the Establishment. ?i,?8o 1841 2,4i;o 39,066 1842 2,600 41,638 iSm 3,460 52,869 iSi^q 4,069 62,360 1866 ... 10,051 112,256 95 1867 q,7^7 117,337 1868 0.870 115,461 25 1869 10,016 113,718 1870 8,382 o8.?oQ I87I Q, ^44 120,056 1872 11,221 146,367 1873 12,005 150,504 1874 I2,8q2 146,622 25 1876 I A. 1 64. 1^:^.000 1879 , i7,i^q8 156,000 1880 i8,6qi; .... 178,000 I88I .... ...... 20,625 186,701 1882 24.,! 12 . ... 106, ^c; I 1883 ... a 201,078 I venture to assert that this annual in- crease of bathers is due not only to the thera- peutical success of the waters, but also to the zeal and skill of the 200 employes of the establishment. Our doucheurs and doucheuses enjoy a European reputation for the care and attention bestowed indis- criminately on poor and rich. HISTORICAL RETROSPECT. HISTORICAL EETROSPBCT. The strategical position of Savoy, at the foot of the Alps, has from time immemorial given so great an importance to this country, that nothing could occur in Europe without its being concerned. Hence the interest attached to its history, which, apart from all patriotic enthusiasm, must be regarded as one of the most admirable and attrac- tive. The savant may pursue his pre-historic studies, from the summit of the mountain glaciers to the bottom of the lakes. The historian discovers that in remote ages this small spot, so favoured by Nature, was successively occupied by the Allobrogi* and the Komans, the masters of the world, whose bathing propensities are well known. They constructed at Aix an immense establishment, replete with luxury * Many customs, still existing in Savoy, trace their origin to the occupation of the Allobrogi. B 2 AIX-LES-BAINS. and comfort. Abundant proofs of the Eoman occupation have been found at Aix, sufficient to reproduce the plan of the Boman baths, which closely resembled those of Titus, Agrippa, Antonine, and Diocletian, at Rome. I have found in the Baths of Cara- calla, at Eome, and in the grounds at Aix, some piecesof brick and amphorae completely identical. These Baths were destroyed on the first invasion of the barbarians. Some historians assert that the Emperor Gratian restored them, for which reason Aix was called aquae Gratianoe. I can discover no mention of the subject in the Latin writers. Christianity had no share in the re- estabHshment of the Baths. For a period of six centuries Aix, in common with other bathing places, disappeared from the pages of history. At the end of the fourth cen- tury it fell under the yoke of the barbarian ; next passed under the dominion of the Merovingian and Carlovingian kings ; then under that of the Dukes of Burgundy. Ultimately, in 1032, it became the property HISTORICAL RETROSPECT. of the counts, dukes, and kings of Savoy, ■whence those heroes (improperly termed by Thiers the wolves of Savoy) extended little by little their possessions, and founded a chivalric dynasty which reigned without interruption for nine centuries, the last illustrious representative placing on his brow the iron crown and ascending to the Quirinal. The old castles and abbeys surrounding the lake demonstrate the high estimation in which Aix and its valley have been held since the thirteenth cen- tury ;* but it was only since the sixteenth century that attention was again directed to the Baths, and Aix was constituted a mar- quisate. Henry IV., King of France, came * We strongly recommend visitors to attempt the ascent of the moTontains, a task now lendered easy, as the study of their geological characters, with those •of our grottoes and valleys, is extremely interest- ing : also occasionally to fish for palafites (antiquities), in the lake of Bourget. This small lake contains four stations, or " Villages Lacnstres," built on piles, at a long distance from the shore; probably used originally as store-houses, protected alike from thieves and wild beasts. Beautiful specimens of bronzes and flints of different periods, found in the lake, may be seen in the Museums of Aix and Chambery. AIX-LES-BAINS. to bathe there : for many years the appel- lation of Royal was given to the Swimming Bath, over which now passes a street bear- ing the monarch's name. In 1739 Aix was destroyed by fire. King Victor Amedee III. created a suitable bathing establishment in 1776. During the twenty years of the first French occu- pation the Baths of Aix were neglected. Many plans and projects were contemplated, but political disasters impeded their execu- tion. The return of the House of Savoy, in 181 5, inaugurated an era of progress for Aix-les-Bains, which continued under the direction of the Drs. Despine till i860, when Savoy passed for the second time into the hands of France. Since that epoch Aix has greatly increased, not suddenly, but in a gradual manner, due to the supe- riority of its spas and to the expenditure which the Government has unhesitatingly incurred. The proverb says — Woe to a people with too much history ! The Savoyard feels no regret on that score ; in the midst of these CLIMATE OF A IX. successive cha,nges he has remained faithful to the flag of Savoy ; always passionately attached to his mountains and his lakes ; but fighting with equal bravery — and re- specting equally all national institutions — during the alternate occupation of France and Italy. CLIMATE OF AIX. The town of Aix, situated in a valley, protected from winds by the surrounding mountains, enjoys a mild and equable chmate. This topographic position also accounts for the elevated temperature occa- sionally prevalent. As the majority of cases treated here result from the pernicious in- fluence of sudden atmospheric changes, it is evident that the climate of Aix is espe- cially adapted to rheumatic and gouty patients. The rich and splendid vegetation — far superior to that of the adjacent countries — proves these excellent atmospheric con- ditions. Patients unaccustomed to this AIX-LES-BAINS. warm moist air are at first almost overcome by its effect, and feel incapable of the sliglitest exertion. Thus nervous patients, exhausted by years of insomnia, experience sudden relief from neuralgic sufferings with the soothing benefit of sleep. The millions of litres of water used in the Baths flow through the streets in badly closed canals, at a temperature of 1 1 8" Fahr., and decomposing in the open air, absorb a portion of its oxygen. But as they only mark five sulphurdrometric degrees the air cannot thereby be vitiated. HoweA-er, the municipality, recognizing the consideration due to strangers who object to the sulphureous odours, has made every effort to close the canalization as far as the lake where the waters discharge themselves ; and in the course of a very few days cold water only, in great quanti- ties, will flow through the streets, and emanations of sulphuretted hydrogen will no longer exist outside the establishment. Persons affected by phthisis and chronic bronchitis breathe easily at Aix. GEOLOGY OF A IX. A few minutes' walk or drive soon leads to the cool and bracing atmosphere of the hills, when the effects of over-heat are experienced. The ordinary temperature is fifty degrees. GEOLOGY OP AIX AND ITS ENVIRONS. The quantity and variety of mineral springs in Savoy have at all times inter- ested geologists ; in the narrow space of a few miles are found the alkaline waters of St. Simon ; the sulphureous waters of Challes and Marlioz ; those of AUevard, Brides, and Uriage — in a word, all those waters now occupying our attention, in addition to innumerable sources abounding on all sides. M. Mausson and Dr. Lambard, from Geneva, recognize that the surrounding mountains form the prolongation of the Jura Chain, and that they are formed of the same strata : Calcareous, Neocomian, Oxfordian, Coralian, and Salitic, found near AIX-LES-BAINS. tlie great Jurassic Chain, one of the out- posts of the Alps. The valley of Aix pre- sents numerous gaps : and the rises and falls are very frequent. In the Bauges you see how the Calcareous strata have been frequently raised. Probably the mineral springs pierce the soil after these disturb- ances. Considering the temperature of the waters of Aix, they must spring from a depth of about a thousand metres. They do not rise direct from the centre of the earth, but follow the intervals of the Cal- careous strata of the Bauges. Thus in remote ages the inhabitants of this valley sank wells in their mountains, hoping to reach the hot sources. M. Mausson recognises a point of com- parison between the extreuie north and south of the Jura. In fact, in the north are found the hot springs of Baden, the sulphuric waters of Schinznach, and the saline waters of Bermamdorf, Wildegg, llllillingen, &c. &c. ; and in the south, the innumerable springs of Savoy. THERMAL ESTABLISHMENT. THERMAL ESTABLISHMENT. We will not enter into a detailed descrip- tion of the establishment of which our colleague, Dr. Blanc, published a long, technical account a few months since.* I. The alum and sulphur sources, though differing but slightly, do not pene- trate the soU at the same spot. The alum spring rises a little above the town, which it reaches by m"eans of a gallery two metres in length and two in height, extending pver ninety-two metres ; at the extremity is the vast Serpent Grotto — so named from some harmless serpents found there — presenting magnificent stalactite efiects. In 1857 some workmen employed in enlarging the canal accidentally broke the inner surface of the grotto, and all the water contained rushed down into the town. Beyond the grotto is the reservoir of the spring ; here the water appears to be covered by a layer * "The Mineral Waters of Aix and Marlioz," By Dr. Blanc. J. & A. Churchill. London, 1883. AIX-LES-BAINS. of grey and unctuous baregine, soft to the touch ; huge gas bubbles occasionally appear on the surface. Beneath this layer the water is clear and limpid. Strangers must not fail to visit this grotto in order to • be convinced of the enormous bulk of water of high temperature at the service of the baths, which can be used pro- fusely, unhke Bareges and other places, where the limited supply renders great thrift necessary. 3. The sulphur source rises in the Estab- lishment ; on raising the stone which covers it, numerous small bubbles of sulphuretted gas are visible on the surface. The Establishment is composed of a ground floor {souhassement) and a first and second floor. Patients who walk with diffi- culty reach the first floor by means of an easy incline without ascending the stair- case. Above a large wide staircase is the Buvette (Trinkhalle), a splendid hall, light and well-proportioned, separating the baths and piscines of the ladies from those of the gentlemen. THERMAL ESTABLISHMENT. 13 Those who cannot ascend to the Buvette find in the town several public fountains with taps of the mineral waters. The maximum pressure of the douches obtain- able on the ground floor is 15 J metres, but the doucheurs have at their disposal a manometer, which enables them, by means of the different apparatus, to regulate the pressure of the douche according to the medical prescriptions. The Establishment comprises : — 1. Two immense swimming baths with cold douches. 2. Two old swimming baths. 3. Two commodious family swimming baths with douches. 4. Forty-one single baths. 5. Twenty-five large douches with two doucheurs or doucheuses. 6. Twenty douches with a single doucheur or doucheuse. 7. Two douches en cercle. 8. Three douches a colonne. H AIX-LES-BAINS. 9. Six vapour baths (Berth oUet). 10. Two inhaling rooms. 1 1 . Three rooms for administering spray. 12. Five vaporarium. 1 3. Six bouillons (steam baths). 14. Four ascending douches. 15. Four foot baths. The maximum of the various forms of treatment varies from 2,000 to 2,300 daily. Recent additions and improvements re- lieve patients from the necessity of incon- veniently early hours, formerly entailed by the [inadequate accommodation for their baths and douches. Government has decided to let the bathing establishment to a company, on whom will devolve all administrative details. TARIFF OF THE BATH, rixed by the Minister of Commerce, on April 26, 1882. Francs Douolies du soubassement et Annexe- Sud 2 50 Bouillon senl i cq Douclies de I'Annexe aveo bain 3 o Denotes des Princes vieux, neufs ; donche neuve... i 50 Douche a colonne 2 o ANALYSIS OF THE WATERS. i; Francs. Douches moyennes : centre, enfer, vertioale, vapo- rarium I o Douclies BerthoUet \ ^P^^^ ^ ^ '^'^ "^^^^"^ '50 ( avant 6 b. ,, i o Douches en cercle, en lame, locales, pharyngiennes, humage i o Inhalation i o Douches ascendantes o 50 Bains de pieds 050 Bains refrig^rfis en baignoires ( apres 6 h. du matin 3 o avec ou sans la douche < pulverises ( avant 6 h. „ ... i 50 _ . .,. . 5 apres 6 h. du matin i Co Bams ordmaires I , ^ , C avant on. „ i o Piscines, grandes | hommes i 50 et petites ( femmes i 25 Piscines ovale et carree des Albertins o 50 Piscine de famille. — L'heure 10 o jours ordinaires , 060 ( jours d'iUuminations I o Portage simple o 6 double I o Visite de Grottos ] ?° (.10 THE CHEMICAL ANALYSIS OP THE "WATERS OF AIX-LES -BAINS. These mineral waters have been classed amongst sulphur-soda springs, and are distinguished from those of the Pyrenees by the proportion of carbonic acid gas and calcium bases which they contain. We have said that two sources supply i6 AIX-LES-BAINS. the establishment of Aix, the one of sul- phur and the other of alum ; both have a temperature varying between 114° and 117° Fahr. The alum source (double sulphate of alumina and potash) was so called in former times when sulphate of alumina was designated as alum. The alum spring, called the gracieuse by Daquin, is most employed for internal use, as it is easy of digestion. I give this explanation for the guidance of the nume- rous patients who fear to take the alum spring on account of its supposed consti- pating effects. These two thermal springs yield the enormous quantity of four million litres in twenty-four hours : to reduce their temperature natural cold water is added. We use at least seven millions of litres daily for the medical treatment. Occasion- ally, after a severe storm, a slight reduction of temperature takes place, caused by temporary filtration of rain water through the earth, but never sufficiently to inter- rupt the course of baths or diminish the medical efficacy of the treatment. ANALYSIS OF THE WATERS. 17 ANALYSIS OF TEE MINERAL WATEB OF AIX. By M. WiLK. Sulphur. Alum. Free sulpliuretted hy- ) 1 > 3'37to4T3mm. 374 mm. drogen ^ j j' t j -j 't 'Siilphurunder the form ) „ . 7■^ IT.-. 5- 304 mm. 3'oomm. 01 liyposmphite ... ) ' ^ -^ -Carbonic aoid gas 47'i5 oc. 44-58 oc. (by weight) o'o932 gramme 00882 jSTitrogen i3'03co. I2'5 cc. 0-1982 •Calcic carbouate o'i894 0-1623 Magnesic „ ..., 0-0105 0-0196 Ferric „ o'ooio o-ooo8 .Sihca 0-0175 Total deposit from boihng... 0-2009 0-1983 Silica 0-0479 o'o^^S ■Calcic sulphate 0-0928 0-0810 Magnesic „ 0-0735 0-0493 Sodio „ 0-0327 0-0545 Aluminic „ o-oo8i 0-0003 Sodic chloride 0-0300 0-0274 'Calcic phosphate 0-0076 traces. Total constituents ) ^ .,.^, , ,. > 0-2916 0-2461 remainmgm solution ) Total fixed consti- ) tuents determined i °492S 4433 Svlfliur Spring. Alum Spring. Organic matter very changeable. Lithium ■^ traces \ Potassium ( 0-0050 doubtful ( q.qqq,. Strontium C doubtful ( >, Iodine -' traces > Q l8 AIX-LES-BAINS. Organic Matter of the Water of Aix, or Barcginc. The baregine of Aix, dried at ioo°, leaves 50 per cent. of ashes, consisting, in 100 parts, of — SiKca 37'4i Alumina 4"86 Ferric oxide 1000 (about) _, , , I Hydrochloric acid ' bubstances un- ) c._!^i„i .-. I determined Magnesia small quantity — none. ( Hydrochloric acid ^ ■< Snlphimc „ > 1176 I Carbonic ,, ) 100 MODE OF USING THE WATEE, AT AIX-LES-BAINS. Internal Use. — These waters are easy of digestion, producing neither sickness nor irritation, only at first a feeling of aversion which soon passes away. They promote and increase urinary secretions and eliminate urea and uric acid. I pre- scribe them when there is no evidence of gastric or bilious symptoms. Occasionally, the treatment diminishes the action of the bowels, but it must not be suspended on that account ; a gentle aperient, the tea of Aix, or a mineral purgative water, alone Inleneur d'une douche MODE OF USING THE WATER. 19 becoming necessary. The exact quantity of sulphur water to be taken cannot be fixed, as it varies according to the indivi- duality of the patient. Excess of the internal use of mineral waters, prevalent in many spas, is no longer tolerated ; taken too freely they over-stimulate perspiration and the urinary functions ; their digestion is impeded and absorption is thus neutra- lized. Certain diseases requiring a large absorption of sulphur may be advan- tageously treated by internal use of the Marlioz and Challes waters, both con- taining a great quantity of iodine, bromide, and sulphide of sodium. Three to four tumblers of Aix water daily generally suffice ; but two glasses of ChaUes water are rarely exceeded. Douche— Maillot— Vapour Bath— Pis- cines. — Every kind of douche can be obtained at Aix, local or general, ascending or descending, hot or reduced to any temperature, weak or strong, in light and spacious rooms. The patient sits down on a wooden chair, with his feet in hot c 2 AIX-LES-DAINS. water, and one or two doucheurs or dou- cheuses propel jets of water all over the body, hottest of all on the feet and legs. Simultaneously, for several minutes, the doucheurs shampoo, rub, and knead every part of the body, thus stimulating the capillary and general circulation : the tem- perature, strength, and duration of the douches and shampooing are previously indicated by the doctor. An article by Dr. Grainger Stewart of Edinburgh, who followed the course last season, describes so thoroughly the process, whUst proving his appreciation of the ad- ministration and results, that a brief extract is appended : — "It is astonishing with what skiU, what patience, tenderness, and firmness the sham- pooing and passive movements are per- formed. When every joint has been moved to the utmost extent possible, the patient is made to stand, while from a distance a powerful stream of water is propelled uj)on the different limbs, especially about the articulations chiefly affected. According MODE OF USING THE WATERS. 21 to circumstances, he may have warm water to the last, or he may have a cool or even, a cold douche or perhaps a good cold shower- bath, which in Aix is known, whether in compliment to our climate or for some better reason, as the Douche Ecossaise. When the bath is over, the patient is rapidly dried, wrapped in flannel sheets and blankets, and is carried back to his hotel in the curious sedan-chair. Having reached his apartment, he is lifted into bed, still swathed like a mummy, is covered up with additional blankets and a quilt, and left to perspire for a longer or shorter period. After twenty minutes or half an hour, he is carefully rubbed down by an attendant, who had accompanied him to the bath. If the case be less severe or the patient feeble, he may not be subjected to this post-balneal bed perspiration. "As an occasional variety, instead of having the douche, the patient is sent to have a steam bath — the BerthoUet, as it is termed in Aix. He enters an apartment which contains a curious wooden box, with AIX-LES-BAINS. a round hole in its movable lid. After undressing, he steps into the wooden box, and finds that he is shut in all except the head, the round hole being occupied by his neck. Immediately a valve on the level of the floor is opened, the hot vapour rises about him, and he soon begins to perspire freely. The perspiration running from his brow, trickles down his face. Presentl}'- he feels the streams flowing down his sides and his legs, and very speedily a feeling of oppression and debility comes on, and after ten or twenty minutes the bath is opened up, the patient is carefully dried and re- moved to his hotel. " Sometimes on the same day as a douche, and sometimes as the sole treatment, the patient gets a local vapour bath. By ingenious contrivances the bathman is en- abled to steam one arm or one leg. Speedily the limb begins to perspire, and the parts be- come soft and comparatively flexible. Per- spiration occurs all over the body, especially in those who have been undergoing other MODE OF USING THE WATERS. 23 forms of treatment, and so great care xequires to be taken to prevent a chill. But the patients often sit and read while ■one arm or leg is exposed to the vapour. When the parts have been thoroughly .softened, manipulation, shampooing, and passive movements of joints are carefully carried out, just as after the douche, but only confined to the one limb. " On, certain days the patient is sent to the spacious and comfortable swimming baths, and there he is allowed to disport himself for a longer or shorter time, practis- ing amid the somewhat warm water active movements of his limbs. As his joints relax, he may find that he can cross the bath in ten strokes instead of the fifteen that were originally necessary, and that he can continue the exercise much longer than he could at first. When his swim is ended — and swimming in warm water is rather enervating — he may have a cold douche or not according to the directions of the doctor. He is rapidly dried, and if well 24 AIX-LES-BAINS. enough, is directed to walk about smartly in the gardens, which are close to the establishment." Baths. — Few establishments can prO' vide so many baths at different degrees of temperature and mineralization, thanks- to the large quantity of water at our dis- posal. Natural water is added to the bath to diminish the temperature and mineral; strength. By the addition of some litres of Challes water, baths extremely rich in sulphureous principle are obtained ; if tepid, they preserve the stimulating pro- perty of their mineral constituents. Inhalations. — 'Two large inhaling rooms,- one possessing a perfect system of humage,- have been fitted up. Here the patient inhales the sulphureous vapour in various ways, according to the mode prescribed ^ The inhaling apparatus delivers the steam without necessitating an inspiratory effort. Spray. — Thermal water, atomized in> spray, may be directed on every part of the body; and in this form is especially employed in throat and nose diseases, iix ACTION OF THE WATER. affections of the eyes and face, and where there is relaxation of the mucous mem- brane. Water thus pulverized loses no portion of its medical activity, and pene- trates most readily into every fold of the- skin and miicous. GENERAL AND THERAPEUTIC ACTION OF THE WATER: THERMAL FEVER (POUSSEE). The action of these waters affects essen- tially the excretions of the skin and of the kidneys, and influences the respiration and circulation. Hence all physiological phe- nomena are increased ; the appetite is- strengthened, the muscular tone developed,, and the menstrual functions are regulated. The douche and vapour baths are especially exciting, for the surrounding air,, at a variable temperature rising up to 105 or no degrees — charged with watery and hydro-sulphureoas vapour sensibly dimin- ishing the oxygen — increases the rapidity 26 AIX-LES-BAINS. of the respiration, and consequently of the circulation. Many years ago, a distinguished phy- sician of Lyons made numerous physio- logical observations on the results of his treatment at Aix, and these are confirmed, by personal experience among my hospital patients. The heat of the body rises during the douches two or three degrees, and that of the arterial pulsations from 70 to 100. Some sort of artificial fever is produced, which naturally finds vent in abundant perspiration ; at the same time the organic matters contained in the urine are excreted in large quantities ; the shock from two or three volumes of hot water for several minutes, accompanied by shampooing, adds to the general excitement. The ensuing disturbance of the • system necessitates great precaution ; any imprudence or ex- aggeration may develop pathological phe- nomena ; but by prudently and steadily pursuing the stimulating treatment for three or four weeks, the happiest results are attained. DURATION OF TREATMENT. 27 Further on I will point out the counter- indications of the course. The thermal fever or slight fever, sometimes complicated by gastric symptoms, yields in most cases to rest and diet. When the tissues of the skin are very delicate, a slight irritation occurs ; but never in my long practice have I observed the poussee (so called) in a severe form, or complicated vrith fever. In addition to their stimulating properties, sulphureous thermal waters produce a special effect commonly ascribed to electricity, but which in point of fact is neither understood nor defined, and which never exists in sulphur waters artificially compounded. DURATION OF THE TREATMENT. The length of the course cannot be arbitrarily defined; it varies according to the age, sex, and constitution of the patient, and the nature and date of the illness. Evidently nervous women, children, old men, and those long invalided, are unable 28 AIX-LES-BAINS. to support so long or severe a treatment as adults seeking relief from rheumatism, sciatica, or laryngitis. Before starting, the habitual medical adviser should be consulted ; afterwards, the dii-ections of the local doctor who watches the progress and powers of en- durance of each individual must be scru- pulously observed. It is often found ad- visable temporarily to suspend the treat- ment. When taken in satisfactory con- ditions, the ordinary course lasts about twenty-five days, with brief intervals of rest. An after cure of a week's fresh air in some adjacent mountain retreat before returning to the daily routine of life — a system more in vogue in Germany than in France — contributes greatly to the success- of the treatment. I often send my patients to the village of St. Gervais, where the H6tel Mont Blanc, at an altitude of 2400 feet, is es- pecially recommended. Nervous excite- ment, and temporary lassitude resulting BEST SEASON FOR THE COURSE. 29 from the course of Aix, yield rapidly to the tonic and calming effects of this en- chanting spot ; to which the innumerable Tvalks around the base of the Giant of the Alps lend additional charm. The best route is by train to Annecy, thence carriage drive of about seven hours through a glorious country to St. Gervais. Monnetiers, on the shores of the Lake of Geneva, is one . of the most delightful of Swiss Alpine stations, with excellent ac- comodation for visitors. BEST SEASON FOE, THE COTJRSE. The moderation and regularity of the climate enable the treatment to be followed during six months of the year ; however, I do not advise patients to arrive before the 25th of April or after the 15th of October. The most opportune season dates from the 1st of May to the middle of October; for the action on the skin opens the pores and renders the patient unusually susceptible to changes of temperature. As the seasons 2,Q AIX-LES-BAINS. vary from year to year, it is prudent before fixing date of departure to write to the local doctor. The months of July and August are very hot, but English visitors by avoiding the close rooms of the Casinos during the afternoon, and seeking fresh air and oxygen on the neighbouring heights, will find them quite endurable. In support of this view I may quote the opinion of Dr. Prosser James, a regular visitor to Aix, and author of an excellent work on the mineral waters of Europe : — " It is often said that English people should avoid Aix in August, but personally I have not found it too hot in that month ; and in those severe rheumatic cases which are sensitive to cold, there are several reasons for choosing that time for a course of baths." DIET DURING THE COURSE. Though frequently consulted on this point, I cannot lay down general laws ; the diet of each patient is regulated according to his special malady, constitution, and RHEUMATIC DISEASES. 31 ordinary habits, and in the first place by the advice of his own doctor. In the hotels food is simple, but of excellent quality, and thoroughly adapted to the course ; no kind of venison or of pork is provided. It is best to eat sparingly of brown meats, and soft- water fish in preference to sea fish ; to vary the diet as much as possible ; and to make no change in the customary bever- ages ; where wine is not drunk, the local doctor occasionally prescribes some form of tonic. Constipation must be combated, particularly in gouty and rheumatic cases. Constant exercise in the open air is essen- tial. The damp atmosphere of the spring and autumn evenings, late hours, and every kind of excess, are prejudicial. RHEUMATIC DISEASES. Of aU known diseases, rheumatism has been most used and abused for estab- lishing the merits of difierent spas, but to our waters we unhesitatingly ascribe the specific quality of healing rheumatism. 32 AIX-LES-BAINS. through the process of external and internal absorption of sulphuretted hydrogen, which eliminates the generating poison through the uiine and the pores of the skin, as proved by the experience of centuries and confirmed by recent scientific observations. Dr. Hermann Weber expresses himself on this subject with a certain amount of scepti- cism easy to understand and almost to adopt. " There is no bath which would not be recommended as a remedy for rheumatism, and this disease, moreover, belongs to those which possess hundreds of popular cures, and to which the artificial and natural remedies of the enthusiast and impostor are applied with especial predilection. Many a champion of quackery has become rich through rheumatic chains and anti-rheu- matic balsams ; and among the cases re- commended for Hoff's malt extract and Lampe's cure with simples, rheumatism stands at the head. The word rheumatism, although so familiar to the physician and to the ignorant, does not designate an idea forming a scientific or even practical cate- RHEUMATIC DISEASES. 33 gory for individual cases and groups of cases. Of all that we call rheumatic, nothing but acute rheumatism of the joints presents an actual and exact idea of disease ; and everything else bearing this name forms a chaos of different and partially undefined conditions."* In fact, every pain, from the slightest twinge to the most excruciating form of neuralgia, Is termed indiscriminately rheu- matism. We treat with certain success — 1. Torpid rheumatism of a lymphatic or scrofulous nature in varied constitutions — by douches, shampooing, and swathing. 2. Rheumatism complicated by neuralgia vdth neuropathic constitutions and visceral metastasis — by simple baths or swimming baths, slight douches of about the tempera- ture of the body, or even lower (atony, anaemia). 3. Rheumatism complicated by skin- troubles — by the more highly mineralized waters of Marlioz and Challes. * "Curative BfEeets of Baths and Waters." By H. "Weber. 1875. D 34 AIX-LES-BAINS. In the two latter cases the patient, by gentle exercise, stimulates the reaction due to the exciting draught of mineral water. Later on, the beneficial effect of the treat- ment in joint diseases based on rheumatism will be pointed out. Some years ago I presented to the College of Surgeons in Paris some notes on a case of traumatic and rheumatic tetanus which had been cured by our course ; unfortunately they are too voluminous for the limits of these pages. To me, tetanus represents an exaggeration of those phenomena which constitute rheumatism. Cases derive relief at Aix when the pain manifests itself in the envelopes of the nerves, sheaths of the muscles, tendons, fibrous textures of the joints, or in the periosteum. This treatment is also efiica- cious in lumbago, pleurodynia, and gouor- rhoeal rheumatism. " The most frequent cause of this affection is the previous existence of gonorrhoea, but sometimes a history only of leucorrhcea can be traced ; hence the propriety of the term RHE UMA TIC DISEA SES. 3 5 ' Genital Rheumatism.' In sub-acute and clironic rheumatic synovitis the knee-joint is generally affected, and the form of the swelling corresponding to the synovial sac is diagnostic ; fluctuation is distinct ; there is some increase of heat and a little pain, but no redness of the skin, and no dis- position to suppuration or ulceration."* In the last few years I have observed many cases of complete cure of this form. ■" Gonorrhosal rheumatism occurs in con- nection with gonorrhoea. It is not accom- panied by the same amount of febrile dis- turbance as acute or even sub-acute rheu- matism ; it affects fewer joints, has a special preference for the knee, and does not show the same tendency to shift about. Acid perspirations do not occur, and it does not tend to affect the heart, "t Dr. Maclagan's lucid summary proves that this form of rheumatism admits of a stringent course * "Leltsomian Lectures." By William Adams, F.R.C.S., 1869. f " On Eteumatism." By Dr. Maolagan. Pickering, 1881. P. 6. D 2 20 AIX-LES-BAINS. without incurring risk of metastasis or cardiac repercussion. Dr. Maclagan, who first applied salicine to the cure of rheumatism, approves also of sulphureous water in rheumatic cases. " The treatment of some of the sulphureous baths of France and Germany holds out the best prospect of relief."'^' Experience proves that our waters not only cure rheumatic manifestations, but combat hereditary rheumatic diathesis ; iind after several courses impart to the constitution the power of resisting the encroaches of rheumatic poison. Our treatment, when pursued vigorously, is slightly debilitating. Thus Dr. Garrod, a great authority in this matter (quoted by Besnier, p. 709, " Dictionnaire des Sciences Medicales"), declares that according to his recent observations of the effects of mineral waters, the results of hydro-thermal treat- ment are frequently unsatisfactory, either because they are not adapted to the indi- vidual case, or because they have been in- * Maclagan, p. 223. RHEUM A TIC DISEASES. 37 judiciously and very vigorously applied. The waters of Vichy, Carlsbad, and Wies- baden are hurtful when not administered with great caution ; those of Aix in Savoy, of Marlioz and of Challes, have furnished more satisfactory results, and it has always proved beneficial to supplement this course with a tonic treatment at Schwalbach Spa,, or St. Moritz. Professor Stewart's note will be read with interest:* — " The treatment of Aix is of extra- ordinary value in various rheumatic con- ditions. Fird, it is of great service in the way of removing the thickness and stiffness which so often remain after attacks of acute rheumatism — a stiffness due partly to changes within the joint, but mainly to thickening of the fibrous tissues around the articulation. Second, in cases of chronic rheumatism, where a slow inflammatory action is going on in and around the joints, it suffices both to remove inflammatory products and to diminish the tendency to * Edinburgh Clinical Journal, Oct. 29, 1883. 38 AIX-LES-BAINS. rheumatic inflammation. Third, in rheu- matic affections of the muscles, fasciae, and nerve sheaths, it affords in many cases the most decided and speedy rehef Fourth, in the wasting of muscles, which so often occurs in connection with rheumatic pro- cesses, the manipulation and shampooing, along with the electrical stimulation which the doctors superadd, generally prove dis- tinctly serviceable ; and fifth^ on the occurrence of slight rheumatic threatenings it appears that the use of the BerthoUet, or vapour bath, often suffices to prevent the further development of the disease. " The proper temperature of baths and douches, and the density of vapour, depend on the state and susceptibility of the individual. Some patients cannot support simple baths, and are greatly benefited by douches and vapour baths; others can be treated only by simple baths. Thus our course necessitates continued medical supervision, based especially on frequent analysis of the urine. The length of the shampooing and sweating processes, and RHEUMATOID ARTHRITIS. 39 tlie duration of the entire course, vary according to the torpid or inflammatory symptoms of the case. RHEUMATOID ARTHRITIS. Rheumatic Gout, Chronic Rheumatic Artliritis, Nodosity of the Joints, Nodosity of Heberden, Arthritis Deformans — is not a blend of gout and rheumatism, as commonly sup- posed.'* Garrod quotes Fuller to this effect : — " The disease should not be re- garded as of a hybrid character, or, in other words, made up in part of rheu- matism, in part of gout." E,heumatic or gouty persons may develop rheumatic gout ; but even here the arthritis cannot be re- garded as causally related to either. Garrod writes : " It appears to result from a peculiar form of mal-nutrition of the tissues of the joints, being an inflamma- tion accompanied with defective powers ; but there is no evidence, upon which any reliance can be placed, to show that it de- * " Gout in its Protean Aspects." By J. M. Fother- gill, M.D. Page 242. Lewis. 1883. 40 AIX-LES-BAINS. pends either upon the presence of any morbid principle, or upon a weakened con- dition of the vessels or structures of the affected parts."* It is a disease of debility — that may be affirmed — free from any tendency to affect the heart, or to induce any kidney change. PJieumatic gout, then^ is a disease sui generis, in which there is general atony and a depraved nutrition of the ends of bones, of the epiphyses indeed, to speak broadly, and dyspepsia occurs incidentally. FuUer, who gives great attention to it, says : " Its earliest attacks are usually seen in girls whose uterine functions are suspended or ill-performed :" while " it invades the stiffening articulations of the woman who has arrived at that time of life which is marked by the cessation of the monthly periods ; it shows itself during the state of debility which follows a miscarriage, or a difficult and protracted labour, more espe- cially when the labour has been accompanied by flooding." * Garrod, " On Gout." RHEUMATOID ARTHRITIS. 41 Many years ago I translated a very inter- esting pamphlet by Dr. Ord, on " Hysterical Rheumatism of Women at a Critical Period, or in connection with certain Uterine Derangements ; " since then many such cases have come under my notice, which I, in common with the physician of St. Thomas's Hospital, denominate "Hysterical Ptheumatism." The diagnosis of this affec- tion becomes easy after a certain experience, therefore it would be superfluous to dwell on the modes of diagnosis of Fuller, Hay garth, Garrod, and other eminent specialists. When the disease is advanced, no certain improvement can be obtained in the bones (epiphyses) ; but progress of the malady may be delayed, the peri-articular swelling dimi- nished, and a certain elasticity restored to the articulations ; thus I always warn the patient that we can only hope to stem the progress of the disease. Local sulphureous vapours are peculiarly successful if taken twice daily with two glasses of Challes water tinged with iodide of potassium, or of lithia, according to the 42 AIX-LES-BAINS. case. A new stimulus is imparted to the system, the organic functions receive an impulse not obtainable in any other way ; and remedies which have proved unavail- ing at home shortly become active agents for good. Fuller thus explains the action of the water and of our treatment. This purely essential affection is due to a specific poison on which our waters act by an elimi- nating process through the two organs of secretion. We occasionally observe in women of a certain age arthritis of the finger-joints or inflammation of the hip and shoulder. Case of Rheumatic Arthritis cured at Aix. — Miss H , eighteen years old, lymphatic temperament, menstruation regular, no hereditary ailments. After violent fatigue in 1 8 70, experienced acute pain in the left knee, necessitating immobility of the joint, to which a bandage was applied. A course of iron and quinine was prescribed to act on the nervous and neuropathic condition. Electricity produced a certain amelioration, but was not long endured. Her doctor then recommended a visit to Aix, in spite RHEUMATOID ARTHRITIS. 43 of the fatigue of the journey. On her arrival neither inflammation nor swellina: was observable. The extreme sensitiveness of the ai'ticulation and surrounding nerves indicated a rheumatic state, combined w^ith a neuro-hysterical condition, vpith atrophy of the thigh and calf of the leg. After fifteen short baths, appetite returned and the nervous state diminished daily. I then prescribed mild douches, with gentle sham- pooing of the muscles of the thigh and leg. But, in spite of every precaution, the dread of the operation was so great that the course was necessarily suspended after ten douches; pain became less acute, but the joint had not recovered movement. I then applied, during twelve days, con- tinuous currents of electricity, which the patient bore very well, and which facilitated slight movement \ and ultimately prescribed local douches to the affected limb for two consecutive days, alternated on the third day with the electric currents. Rapid im- provement ensued, and after a month of this course, crutches and the rolling-chair 44 AIX-LES-BAINS. wure discarded. Miss H left at the end of September completely cured. In spite of a violent attack of typhus, which confined her to her bed, the joint retained the acquired suppleness and strength; and walks of ten miles were undertaken without fatigue. I quote this case from among many others, because it proves that chronic arthritis affects all ages, even when not preceded by acute arthritis ; in this in- stance a neuropathic condition was domi- nant, and muscular atrophy was at the same time successfully treated. Arthritis was limited because it encountered only a lymphatic rheumatic state, and the internal tonic treatment wisely prescribed from the onset, had the best effect on the anaemic iind cachectic condition. Here is also de- monstrated the impossibility of deciding the limits of the course. Durinof the four months passed by the patient at Aix she underwent sixty bathing operations. Just as this little work is going to press, my colleague, Dr. Demeaux, sends me a RHEUMATOID ARTHRITIS. 45 highly interesting note on the different deviations of the great toes in cases of rheumatic gout and gout, and as his study throws a new light on the diagnosis of these affections, I gladly avail myself of permission to publish it : — "In chronic rheumatism our attention is frequently called to the deformity of the great toe, consisting of a deviation when the soles of the two feet touch each other. This is produced by a proliferant osteitis on a level with the internal surface of the metatarso-phalangeal joint of each toe. Sometimes the skin is the seat of chronic inflammation, and of pain, especially under the pressure of the boot. " Chronic forms generally first present themselves in bony articular or pre- articular lesions ; cases in which the alter- ations are limited to the flabby parts of the joints appear scarce, especially in France. " Eheumatism producing deformity com- mences in the small joints. The nodosities of Heberden are regarded as the expression 46 AIX-LES-BAINS. of the most precocious and attenuated form of the diathesis. The outward deviation of the great toes precedes. I have never encountered these nodosities where their malformation is not very evident. The fact of the great toe being generally the seat of the diathesis is accounted for, not only by the pressure of the boot, but be- cause the whole weight of the body is thrown on those joints. " Dr. Besnier, in his article on ' Rheu- matism' in the Medical Dictionary, attri- butes to functional abuse a powerful agency in these local articular rheumatic affec- tions. " Professor Verneuil, in one of his clinical lectures in 1883 {Semaine JJSdicale), indi- cates this deviation as 'a certain sign of arthritic diathesis.' I have met with this malformation of the great toes in children five or six years old, and in young girls, showing no other rheumatic symptoms. The pressure of the boot being sometimes considered the sole or chief cause, I naturally inquire : How then account for RHEUMATOID ARTHRITIS. 47 these affections in children ? Certain cases of neuralgia, myalgia, and even of arthritis, which have come under my notice, without offering this first impression of the rheu- matic diathesis, have been attributed, after more or less careful observation, to albu- minuria, glycosuria, lead poisoning, syphilis, or scrofula. " This malformation of the great toe is not uniform, one toe being almost always more crooked than the other ; thus proving the predominance of the affection on one side of the body. This peculiarity gives to the malady an hemiplegic appearance, in respect to its origin. The predominance of rheumatism occui-s sometimes to the right, sometimes to the left of the body ; but apparently more often to the left. The hemiplegic appearance of deforming rheu- matism is not limited to articular lesions ; it is applicable also to circumarticular manifestations. " In the frequent cases of complications in the bronchial regions, the wheezings of the base appear more common on the side 4'! AIX-LES-BAINS. most affected by rheumatism. In one of the last seances of the Berlin Medical Society, Professor Yirchow observed, ' Care must be taken not to confound deforming- arthritis with uratic arthritis : these two forms rarely co-exist in the same subject. I have only met with one case in which I have proved the presence of uratic deposits out of nodosities.' The morbid process of the gout and that of deforming rheu- matism being dissimilar, the alteration in the form of the great toes must not be considered identical in the two cases. " This difference in the material changes of the regions might prove in doubtful cases a valuable sign of the different diagnosis. The uratic infiltration which characterizes gout, and the proliferant osteitis which characterizes deforming rheumatism, cannot leave the same im- pression on the parts aftected. I have seen a great many rheumatic cases, but have less experience in gouty cases. It appears to me that in gouty cases the great toes touched, or were but slightly separated RHEUMATOID ARTHRITIS. 49 from, each other. I have clearly observed this in a gentleman who in three years had had four acute attacks, of which two were very severe. In deforming rheumatism, the exostosis (Virchow) which occupies the internal surface of the metatarso -pha- langeal joint of the first toes bends the great toes outside. The- accumulation of matter occurs in the entire joint, and in- creases its size ; in rheumatism the osteitis is produced inside, and is partial and essentially deforming. " I arrive at the following conclusions : — " I . In the bony forms of chronic rheuma- tism a special deformity of the great toes exists, the deviation occurring outside, which is a more evident sign of the diathesis than any other articular localization. "2. Any other peri-articular manifesta- tion, with a gouty appearance, not coincid- ing with this deformity, must be looked on as doubtful, and the cause will probably be traced to some other existing malady or some other diathesis. "3. This deformity is not uniform; the E 50 AIX-LES-BAINS. preponderance on one side extends to the corresponding half of the body. It also imparts to I'heumatism a hemiplegic aspect as to the local seat. " 4. The change of form differs from that produced by gout, the two morbid pro- cesses being essentially dissimilar. "5. Might the pathological distortion of the great toes furnish the element of a comparative diagnosis between deforming rheumatism and gout ?" Dr. Demeaux proceeds to the applica- tion of Aix waters in this pathologic variety. I regret that restricted space compels me to curtail this clinical study, which indi- cates the modifications in our thermal course, and especially the importance of analysing the urine wlien directing the mode of treatment. Our colleague adopts as a general system for rheumatism — I. General sudation; 2. Local sudation and tepid douches. For gout, on the con- trary, he recommends the inverse course — I. Tepid douches ; 2 . Local vapour baths on the parts affected, of short duration, and GOUT. 5r carefully watched ; 3. Sudation progressively increasing in the exceptional cases where there is a complete integrity of the systfem with sufficient power of endurance. The late Dr. F. Bertier preferred tepid douches in cases of gout and rheumatic gout. Personally I never lay down general indications for our course. Participating to a certain extent in the views of Dr. De- meaux, I often prescribe local vapour baths with an immediate subsequent application of a bandage round the limb, or that portion of the limb submitted to the steam bath. GOUT. The etiology of this disease is well known, thanks to the researches of Tennant, Forbes, Murray, WoUaston, Hood, Fuller, and especially of Garrod and Charcot. The origin is traced to the presence of uric acid in the blood, frequently affecting the joints and muscles. For many years a prejudice still extant precluded the use of sulphureous waters in these cases. This is easily accounted E 2 AIX-LES-BAINS. for by the dread of our course enter- tained by certain doctors in the beginning- of the present century, when all patients, irrespective of age and constitution, under- went the entire treatment — the hot bath, steam bath, and swathing — whilst now a third of our patients only take the baths and douches at a temperature of 96° Fahr., and are carried back to their beds without the enforced perspirations — too exciting in certain cases. Gout, better understood than rheuma- tism, is subject to acute crises, frequently excited by the former mode of treat- ment. Even at present gouty as well as rheumatic and sciatic crises may be evoked by our course, but these crises are generally advantageous, and the course is only sus- pended until acute pain subsides. It re- quired all the influence of a renowned physician such as Garrod to restore to Aix its reputation as a remedy in cases of gout ; which, judging from the benefit derived by the numerous patients to whom he had prescribed our waters, he was fully in a GOUT. 53 position to appreciate. In page 437 of his last edition (1876), Pr. Garrod expresses a positive opinion in favour of our course, when gout manifests itself as cutaneous eruptions such as psoriasis and eczema, or as swelling and fulness of the joints, or as forms of gout not connected with portal congestion, where the influence of ordinary thermal waters is equally eflB.cacious. There would be nothing to add to the emphatic assertion of this great authority, were I not in a position to prove by long personal experience among English pa.tients the eliminating efiects of our course, whence the frequency and intensity of gouty crises are diminished, although at the beginning of the treatment a slight manifestation may be produced. Strict diet is invariably prescribed, and careful medical superintend- ence must be exercised, especially in respect to the urine. In addition to the thera- peutic course there is the mechanical treat- ment I exercise by means of continuous currents in cases of gouty joint diseases and muscular atrophy. 54 AIX-LES-BAINS. Short and frequent vapour baths, followed by gentle shampooing, exercise a specific action on those articular deformities which gradually lead to ankyloses ; absorp- tion of the effusion in the bursse is thus effected, and stiffness gradually disappears. I have even seen cases where the move- ments of the joints were facilitated by the precipitation of chalk-stones. We have equal success in atrophy of the muscles proceeding from gout, which is the more serious because the arthritis is far more severe, as Sir James Paget asserts in his " Lessons on Clinical Surgery." This muscular atrophy, which does not resemble the muscular atrophy in the arthritis described by Charcot, results exclusively from gouty and rheumatic lesions. Baths, douches and shampooing, supplemented by electric currents, are highly beneficial. NEURALGIA. The forms most frequently treated with success at Aix are brachialgia, pleurodynia, and sciatica. Patients sufferino- in the NEURALGIA. 55 hip, the leg, or even, from lumbago, indis- criminately designate their complaint as sciatica, though in damp countries arti- cular and peri-articular pains often result from an actual arthritis of the hip, closely resembling sciatica. I insist on this point, because the treat- ment differs according to the malad}^ ; whilst real sciatica derives great benefit from a vigorous course, its counterfeits are intensified under a similar treatment. Great care must be taken to ascertain whether the pain arises from rheumatism, gout, syphilis, exposure to cold and wet, or simply from over-fatigue. When due to syphilis, sciatica can only be cured by the specific treatment, but such cases are rare. Professor Fournier observes that neuralgia rarely affects the entire nerve, and never descends below the knee. I have observed three cases of partial sciatica, proved to be of syphihtic origin. When there is evidence of the specific element the waters of Aix produce the double effect of combating the local mani- 56 AIX-LES-BAINS. festation and facilitating the endurance of the required form of treatment. If pain is acute, I consider the simple bath preferable to the vapour bath, as it acts sufficiently on the skin -without over-exciting the nervous system ; but where neuralgia is torpid and atonic, the large douche be- comes requisite. When the patients are in a veiy debilitated state, plain swimming baths succeed very well. Every year numerous cases of recovery from sciatica ensue from a course of sulphur baths, in which the mineral element excites and regulates the functions of the skin. Pain long existent, where atrophy has produced immobility of the limb, necessitates a prolonged treatment ^ first the element of pain, and then the ravages caused by the malady, must be dealt with. Douches and shampooing constitute the final cure. In neuralgia, as well as rheumatism and other similar affections, an increase of pain frequently occurs during the first days of the treatment, and may last for some time. Almost as many cases of neuralgia alone NEURALGIA. 57 are cured at Aix as of the entire category of other forms of rheumatism. Nine-tenths of cases thus treated, if not completely cured, experience considerable relief during the first season, and success is certain after a second or third season. Case of Gouty Sciatica — Complete Cure. —Ten years since I copied this observa- tion of my master, Professor Quissac : — " Mr. , nearly thirty years of age, of a bilious, sanguine temperament, of robust constitution, subject to flying gout, wearied by suffering for many days from a sharp pain in the region of the right instep, applied upon this part a nearly cold lin- seed-meal poultice. Some hours later, the pain in the foot had vanished, but was succeeded by acute pain in the posterior region of the thigh, in the course of the sciatic nerve. In vain it was tried to bring back the inflammation to its primitive seat — all means failed. Leeches were applied in the track of the nerve, then flymg blisters, and lastly, the actual cautery. No progress was made. The invalid walked 58 AIX-LES-BAINS. with much pain, supported by crutches. The pains did not cease in the track of the nerve ; they were specially very sharp on movement of the limb. The saline waters of ... . were recommended. The patient went to the place, drank the waters, took the baths and the douches. No benefit accrued after a month's residence. The state of matters remained the same until the commencement of the summer of the following year. He then went to the sul- phureous spa of Aix, in Savoy, a cripple, walking by the aid of crutches. He there made use of the waters internally, and externally by baths and douches. A speedy amelioration showed itself, he made rapid progress, and after five weeks' treatment, threw away his crutches, and recovered the complete use of his limb. Twelve years have since elapsed, and the sciatica has not returned. Mr. is not altosfether cured of the gouty diathesis, for now and again he suffers from intestinal colic, cramps of the stomach, sometimes from palpitations of the heart, with uneasiness in the region THE ORGANS OF RESPIRA TION. 59 of this organ, sometimes from pains in the joints, or in the lumbar region ; but these various symptoms, although very incon- venient, do not continue for many days, as they succumb speedily to weU-directed remedies. The health, with the exception of these attacks, is very good." DISEASES OF THE ORGAlSrS OF RESPIRATION. RHINITIS— OZiENA. The waters of Marhoz and Challes are highly efficacious in cases of chronic inflammation of the nostrils. We frequently meet with gouty subjects, especially strumous children with swollen pituitary membrane, emitting a foetid odour from muco-purulent discharge, and caries or necroses of spongy bones in severe syphilitic and scrofulous cases. The nasal douches of Marlioz, the inhalation of natural sulphureous steam, spray ad- ministered locally, swimming baths, with the internal use of Challes waters, closely resembling in effect cod-liver oil, produce a general invigorating influence. 6o AIX-LES-BAINS. PHARYNGITIS. {Catarrh of the Pharynx — Sore Tliroat.) Granular Pharyngitis {Clergyman's Sore Throat). Herpes of the Pharynx (Rheumatic and Gouty Sore Throat). We never treat acute pharyngitis, but often meet with patients in whom acute inflammation has left great weakness of the mucous membrane, with the predisposi- tion to fall back to the previous state under the sHghtest atmospheric influences. This simple inflammation of the pharynx is liable to degenerate into granular pharyngitis, especially when there is a gouty or rheumatic tendency. The stru- mous, gouty, and rheumatic diatheses pre- dispose to the disease. Chronic varieties* ensue according to the constitution of the patient; thus Dr. Morell Mackenzie recog- nizes threfe forms of congestion of the pharynx (herpes of the pharynx, rheumatic and gouty sore throat), and devotes a * Morell Mackenzie, "Diseases of the Throat and ]S[ose." LARYNGITIS. 6i separate chapter to each of these forms. Gueneau de Mussy, Chomel, and Pidoux atti'ibiite forty out of forty-five affections of the pharynx and larynx to herpes. Without recapitulating the previous obser- vations on the effect of our waters in the three constitutional affections, I may add that our pulverized vsraters, sulphurous in- halations and steam, with the internal use of Challes water, afford the surest means of attacking the malady. CHRONIC LARYNGITIS. {Chronic Catarrh of the Larynx). This affection, erroneously identified by many authors with phthisis of tlie larynx, consists* in chronic inflammation of the lining membrane of the larynx, charac- terized by hoarseness or loss of voice, and generally by cough, more or less violent. Occasionally the malady causes thickening of the affected membranes, capable of de- generating into ulceration. Singers, lawyers, preachers, all who over- fatigue the voice, are especially liable to * Morell Mackeuzie, p. 284. 62 AIX-LES-BAINS. this affection, as are also inveterate smokers and imbibers of alcoholic beverages. The jnfluence of chmate is likewise remarkable. In Lyons, where the situation between two rivers causes very sudden changes of tem- perature, these maladies are extremely prevalent. Herpes is in this case, as in pharyngitis, the general predisposing cause. I ordinarily prescribe with excellent results general vapour baths and douches, which by their action on the skin relieve the congestion of the larynx. For local treatment we find at Aix and at Marlioz Siegle's spray-producers very weU organized ; the atomization of the fluid is ef- fected by steam. The following observations from Morell Mackenzie's work have more weight than any personal views of my own. " Several patients whom I have sent to the Pyrenean springs have derived un- doubted benefit from the use of those waters ; but, on the whole, I have seen more benefit from the waters of Aix-les- Bains and Marlioz. The climate of the Pyrenees is , sub-tropical, and generally very LARYNGITIS. 63 •enervating in its effects on English patients. I can particularly recommend the hot sulphur waters of Savoy when the voice j remains weak and the mucosa is relaxed rather than congested." Further on, alluding to the treatment of chronic glandular laryngitis, Dr. Morell Mackenzie adds : " The sulphur waters of Aix-les-Bains are especially valuable." Apart from the testimony of this eminent London specialist, Drs. Lennox Browne, Prosser James, Smyly of Dublin, Fauvel of Paris, and others too numerous to mention, prove their confidence in the waters of Aix by sending patients thus affected, who are in most cases successfully treated. Most valuable is the annexed opinion of Dr. Lennox Browne, who has personally inspected and studied the principal spas of Europe, and whose successive visits to Aix enable him to appreciate the value of the course. "The only way by which pulverized liquids can be taken into the larynx and lungs, without doing more harm than good, is that in which the waters of Marlioz 64 AIX-LES-BAINS. ' (Aix-en-Savoie), &c., are administered ; large rooms {salles d'inlialations) being charged with clouds of very finely atomized medicated waters." Later on, the same author writes : — " Within the last few years, however, great advance has been made in this branch of treatment, and it is proved, beyond doubt, that the action of natural mineral waters does not depend solely, or even to any great extent, on the amount, often very small, of active ingredients which they contain, but is the result of their natural chemical combination, and of their thermal properties. It is this last principle of natural high temperature that is to be found in almost every water of any value for bath treatment, especially of those suited to diseases of the larynx." Amongst the baths mentioned by the author, Aix-les Bains occupies the first rank for external use, and Challes for internal use.* Dr. Lennox Brown writes : " For the cure * "Diseases of the Throat," Lennox Browne, pp. 59 and 86. Bailliere, 1878. CHRONIC BRONCHITIS. of a chronic cold and the eradication or diminution of the tendency to take cold, much may be done by hygienic measures, and especially by a ' cure' at Aix."* It must be borne in mind that this course is only beneficial when the origin of the evil is suppressed ; thus singers must allow their voice complete rest, and on smokers must be imposed total abstention, whilst (a far greater sacrifice in certain cases) those saloons where heated atmosphere, effluvium of gas, and, above all, moral emotions, increase the congestion of that delicate organ the larynx, must be com- pletely abandoned. CHRONIC BRONCHITIS. Whether this affection manifests itself by abundant expectoration or in the form ot emphysema, our course exercises a calming effect on the crisis. It is impossible, arbi- trarily, to define when and where the warm * " Voice, Song and Speech," by Lennox Browne and Emil Behnke. 2nd edition, page 285. Sampson Low, Marston & Co. 1884. E 66 AIX-LES-BAINS. inlialations of Aix or those of lower tem- perature of Marlioz prove most beneficial. In cases of chronic shortness of breath combined with sHght cough and expectora- tion, the simple sulphureous vapour inhala- tion of Aix is generally efficacious. Pa- tients breathe more freely on entering the rooms charged with heated vapour. Bron- chitis attended by expectoration is also benefited by this warm inhalation, espe- cially in cases of elderly people. At first, inflammation slightly increases and expec- toration is more copious ; but these symp- toms rapidly diminish ; and at the end of the course patients, if not completely cured, find themselves far less liable to the pernicious influence of cold and atmo- spheric changes, and to the recurrence of the winter cough from which many chronic illnesses originate. The internal use of tepid sulphur water at night, by exercising a gentle stimulating action on the skin, calms the dyspnoea, and soothes the cough and expectoration. Of aU the remedies employed in chronic catarrh of the bronchial tubes^ " steam inhalations PHTHISIS. 67 are probably more useful than any other class of local remedies that can be employed by the patient himself They are of the greatest service in all acute inflammatory affections of the throat, and also in most chronic affections of that organ."* Spray of pulverized water must never be employed where dyspnoea in gouty, rheu- matic, or herpetic bronchitis exists with secondary symptoms. The inhalations of Marlioz prove frequently more efficacious than those of Aix on account of the mineral elements — iodine, sulphide and chloride of sodium, with which they are so highly ch^irged. Hay fever, so prevalent among Americans, is treated successfully by vapour inhalations combined with nasal douches. PHTHISIS. Clinical observations, especially pathologic anatomy, prove that this affection may be frequently cured. The tubercles are neu- tralized, either through elimination or by mineral transformation, t EHmination of * Morell Mackenzie, p. 271. t Gueueau de Mussy, tome i. p. 459. P 2 68 AIX-LES-BAINS. the tubercle leaves cavities in the lung^ which finally adhere by a tissue of the cicatrization ; when communicating with the bronchi they are easily recognized by the experienced ear of the practitioner. Mineralization is a modification of the tu- bercle which becomes calcareous and creta- ceous, remaining in the parenchyma as a foreign element, with all power of evolu- tion suspended. M. Gu^neau de Mussy be- lieves that this cretaceous transformation occurs frequently in arthritic constitutions — which would explain those observations in which the tuberculous diathesis is linked with rheumatic and gouty manifestations. During certain periods of suspension, or at least of delay, of phthisis, recourse should be had to our waters, especially when the patient is infirm or debilitated. Better results may be anticipated when consumptive patients are of a languid, torpid, reduced constitution, than when of an inflammatory, nervous, and irritable constitution. It is important to remain within due limits, which, if exceeded, excite febrile exacerbations, congestion, ha3mop- PHTHISIS. 69 tysis, directly affecting the pulmonary .system. Not only tubercles, but all the accompanying symptoms hastening its de- velopment, are treated by our course. Baths taken rather lower than the tem- perature of the body, of short duration, at first occasion a slight oppression and quick- ening of the breath, but gradually the cough is soothed, expectoration facilitated, the pulse beats regularly, and the temperature is lowered/'' After the bath the patient breathes freely, appetite increases, the pulse is lowered by twelve, twenty — sometimes twenty-eight — pulsations ; the temperature falls about two per cent., perspiration dim- inishes or even subsides, and sleep returns. To resume, baths facilitate respiration by stimulating the action of the skin, and of the supplementary breathing functions. They also fortify the skin, render it impervious to cold, and produce on the general system a feeling of hien-etre, due to the bracing effect. Douches render great services in the therapeutics of consumption by their retro- grade action on diathesic affections, and * Duvand-Fardel, " Eaux MitK^rales de la France.'' ^o AIX-LES-BAINS. the equilibrium imparted to the cutaneous functions. Local douches applied to the lower limbs, seconded by shampooing and friction, obviate the vicious distribution of caloric. A fluxion is produced by the increased cutaneous calorification, and im- proved circulation, vs^hich frequently averts local congestion, ensues. In women, the uterus is the starting- point of congestion, and, unfortunately, many consumptive women thus lose men- struation, which may be facilitated by hip baths, injections, and local douches on the lower limbs. Should it then recur punc- tually twice or thrice, there is every prospect of a regular continuation, by which the congestive movements of the lungs are subdued. Inhalations especially facilitate expec- toration, and diminish the fatiafuine couo-h of consumptive patients. The sulphur absorbed in the mucous membrane diminishes those abundant and exhausting secretions ; all the affected parts thus coming in contact with the mineralized element. PHTHISIS. 71 Sulphur waters liave been often accused of promoting hoemoptysis. Might not this complication be ascribed to the fatigue of the journey, and the change of atmospheric pressure ? I entirely differ from some of my colleagues in the Pyrenees, who calmly survey the advent of haemoptysis as a natural and even beneficial result of the commencement of the course. When called on to attend such cases, after two or, three days of our treatment I invariably prescribe great moderation and caution. However, when, in spite of all precautions, these symptoms continue with perspiration and febrile indications, the course must be abandoned. Frequently, patients unable to remain in certain spots renowned for their good effects in pulmonary affections, derive great benefit at ,,Aix and Marlioz. The elevation of these two stations not being high, whilst the air is exceptionally pure, consumptive patients are favoured with the most im- portant curative elements to meet their case. 72 AIX-LES-BAINS. SYPHILITIC DISEASES. Our waters are renowned in the treat- ment of syphilis. All doctors in describing them have pubhshed observations on this class of disease. But their chemical and eliminative action on the specific poison cannot be precisely indicated, nor can any observations be relied on unless confirmed by many years of careful superintendence, as the symptoms sometimes recur at a subsequent period. I have seen, in my own practice, a gentle- man in whom, after an interval of eleven yeai-s, the old syphilitic manifestations re- turned after a severe course of baths and douches. Sulphur waters do not act as a specific against syphilitic virus. Mercury alone has power to eradicate that poison. The eliminating action of Aix Avaters on the excretory system, in combination with the internal use of Marlioz and Challes water, becomes a powerful depurative, espe- cially in i)iveterate and obstinate cases. For more than a centuiy sulphur waters S YPHILITIC DISEA SES. 73 have enjoyed the reputation of revealing latent syphiHs. In 1857, the Hydrologic Society of Paris took this question in hand, and named a commission, which concluded that : Sulphur waters often reveal latent syphilis, and are useful as tests of the presence ■of syphilis in the system. Since then, in all thermal stations this law has been confirmed by careful observa- tions. Many medical men of Aix (Savoy), Carlsbad, Aix-la-Chapelle, Bagneres de Luchon, Schinznach, &c., have published interesting illustrations of this fact. Dr. Hermann, of Schinznach, terms the sulphureous water the reactive against syphilis, and although not infallible, this view to a certain extent is confirmed by my experience. While admitting the legitimate use of mineral sulphureous water in this important point of diagnosis, 1 believe that rare exceptions occur, especially when a very long treatment has not been undergone. The duration of the cure cannot be limited to the fashionable course of one- and-twenty days, a long graduated and interrupted treatment is essential in order 74 AIX-LES-BAINS. to obtain the double result of excitation and manifestation. The latent state exists especially in lymphatic and strumous na- tures deficient in reactive energy. Nowhere better than at Aix can be found the means of graduating the temperature and sulphuration of the douches and vapour baths, so as to stimulate cachectic and feeble constitutions. We must pay special attention to the thermality, which is the sole bond of union between the water containing chloride of sodium used in Germany against syphilis, and the sulphureous springs employed with the same beneficial results in France and Spain. The Spanish hydrologists assert that the springs of Murcia, Carratraca, &c., are by themselves specific against syphilis. ■ After the internal use of Challes water, so rich in mineral elements^ secondary symptoms frequently disappear. The treatment at Aix acts energetically against mercurialism, vs^hich often com- plicates the syphilitic cachexy. The water retards the salivation produced by mercury and all other mercurial phenomena. SYPHILITIC DISEASES. 75 The elimination of mercury by sulphur has been long recognized. Dr. Blanc pub- lished many years ago a pamphlet on the elimination of mercury by the skin result- ing from the use of the sulphureous medi- cation. I have often observed the presence of mercury in a metallic state in the urine of patients after some days of treatment. Hermann had already detected mercury in the stools of his patients affected by mercurialism. Durand-Fardel offers the following ex- planation of the action produced by sulphureous water : — " It can be obtained from nearly every mineral water at high temperature, whether the mineralization be weak or strong, but it especially belongs to thermal sulphureous water." If some specific symptom appears, we prescribe a severe internal or external specific medication, to be followed at in- tervals during some years, as urged by Professor Fournier, until the patient is con- vinced that a permanent cure is effected. 76 AIX-LES-BAINS. SCROFULA. Cases of scrofula are most frequently met with among the young people resorting to our baths. The sulphureous waters, seconded by the internal use of Challes water, exercise a stimulating, invigorating, and restorative influence. During many years the bene- ficial action of the Challes springs was ascribed to the slight quantity of iodine contained in them ; further researches have demonstrated that it is due to the elements of sulphide of sodium, which has the ■double effect of increasing the power of nutrition and diminishing the glandular exudations, thus permitting a better cir- culation of lymph. We do not believe in the alterative anti- scrofulous properties attributed to certain 'German baths. We know the effect of chlorine on blood as a chemical experiment ; but the general action of mineral water on the entire system is not that of a chemical agent. The modus operandi generally ■depends on the association of different SCROFULA. 77 chemical principles and on the application of the hydro -mineral system of treatment. The vitality of the skin is thus increased, the nerves and muscles are strengthened, all the functions are stimulated, especially those of the lymphatic system. We succeed chiefly in the torpid forms of scrofula. Amongst the numerous cases of scrofula cured by our waters, I will only mention two cases of erythematous lupus of the face, and three cases of lupus rodens, com- pletely cured after two months of baths and spray of Challes water. The greatest proportion of scrofulous affections at Aix are manifested by dia- thesis of the bones and articulations ; in the latter case the injury probably com- mences in the synovial membranes or in the epiphyses. The surrounding parts are tumefied and fungous, and every sort of affection, from simple abscess to clusters of fistula, from stiffness of articulation to subluxation, may be encountered. Femoral affection is unfortunately the most frequent. We wiU not repeat our general observa- 78 AIX-LES-BAINS. tions on articular diseases, but only add that constitutional scrofula aggravates them to an alarming extent. Hence arise caries, necrosis, or simply osteitis and periostitis, with abscesses and fistulse in the articula- tions. Douches, especially vapour baths, stimulate the granulation of ths ulcers, of the bony and fibro-muscular tissues, dis- tending and eliminating the degenerated pieces of bone. Frequently, this elimina- tion occurs long after the cure which pro- duced it. M. Petrequin has demonstrated the efficacy of our course in cases of scrofulous ophthalmia. The alterative and tonic action may be manifested, but not completed, in the short space of twenty-one days in deeply rooted affections, such as scrofula. Long and care- ful treatment under medical guidance can alone eradicate the disease. SKIN DISEASES. The bath as a local effect is a simple pansement of the dermatosis ; as a general effect it acts on the nervous system, and if SKIN DISEASES. 79 the cutaneous affection arises from constitu- tional disturbance, such modifications may ensue as to ensure thorough recovery. Tlie greater the absorption of the sulphureous element, the more hopeful are the prospects of a cure. This absorption, slight when the skin is dry and scaly, is very great in moist affections where the mucous parts are exposed to the air. Skin diseases may be of rheumatic or gouty nature. Sulphur waters only act in chronic cases ; in the first place, of those resulting from rheumatism, such as eczema, herpetic erythema, acne, hchen ; and from gout, psoriaris, eczema, prurigo, acne, &c. The inveterate form of psoriasis is the commonest at Aix, and results equally from gout and rheumatism. Our waters unaided do not effect the cure ; but under their influence the patches become fainter, the scales fall from the skin, and the absorp- tion and action of internal medicines are facilitated. I never continue the course in those cases where acute symptoms reappear, but I remember three recent cases of torpid So AIX-LES-BAINS. psoriasis, which being of rheumatic origia were completely cured at Aix. Prurigo results from want of vitality in the skin. The mineralization of our baths suffices to arouse the torpid functions with- out irritating the skin : I have treated suc-^ cessfully, by means of simple tepid baths, patients covered with pimples which caused unbearable itching. Sczema. — Sulphur has long been con- sidered the specific cure of the malady, but I am inclined to modify this view, and not to employ in excess sulphur waters (Aix, Challes, or Marlioz), where their action stops too rapidly the progress of eczema. I once saw a child nearly killed by three days' long application of Challes water, which suddenly stopped an attack of impetigo capitis of the scalp. The first effect of sulphur baths on eczema is to exaggerate the symptoms ; but if the treatment is followed at leisure, the manifestations gradually disappear ; our hospital patients derive the greatest benefit in these cases, because they do not DISEASES OF WOMEN. require to hurry the course, and their tonic treatment is thus unaccompanied by fatigue. Herpes. — We do not observe any amelio- ration in cases of shingles, of herpes prepu- tialis. Acne. — Here the tonic and stimulating swimming baths are most efficacious, with local spray directed on the part affected. The suppuration and cicatrization of the small pustules are hastened without leaving hard red tumours. Thus it is evident that the category of dermatosis influenced by our waters is limited, but in those referred to their local effects and tonic action are very remarkable. DISEASES OF WOMEN. Simple and Follicular Vaginitis. — The irritation so troublesome in this dis- ease, when connected with eczema, or having rheumatic tendency, is greatly alleviated by the use of sulphur baths. Frequently the sebaceous follicles of the mucous membrane of the vagina are G AIX-LES-BAINS. inflamed, and produce disturbances of the general health, with discharges, pains in the back and thighs, constriction of the sphincter, and great sensibility in walking, the uterus remaining in its normal state. I have invariably treated these cases by a course of plunge baths of Aix water, of hip baths of Marhoz water, and injections of ChaUes water, especially avoid- ing cold vaginal injections. The mode of administering injections requires skilful attention. Two years ago I performed on one of my patients affected by vaginal leucorrhoea the excision of a series of granulations so hard and vokiminous that I feared for one moment they were of a nature of epithelial cancer. Afterwards I was enabled successfully to introduce a canula and a bath speculum. This treat- ment lasted forty days. I saw her six months afterwards, leucorrhoea and mental depression previously evident had com- pletely disappeared. Haematocele. — A remarkable instance of a lady afflicted with hsematocele (retro- DISEASES OF WOMEN. 83 uterine) was sent to me by one of the leading physicians of Paris. Mrs. M , aged forty-four, periods regular, feeble constitution and circulation ; one child ; complains, after walking, of vio- lent pain in abdomen ; is sometimes sick, frequently requires to empty bladder, had itching of the rectum, small tumom- in the pelvis appreciable through the vagina in the posterior walls. This was her state when first I saw her on the 2nd of August, 1880. I immediately prescribed a course of simple sulphureous baths at 96° to be taken every morning, with hip baths and slight vaginal injections of Challes watsr during twenty minutes at night, and two tumblers of Challes water to be drunk daily. After thirty-four baths Mrs. M left Aix com- pletely cured. I often see her in Paris ; the periods are regular, the micturition is quite normal, and she has not experienced any return of the symptoms. This cure was due to the alterative properties of Challes water, and to the general stimulating effects of sulphur baths. G 2 84 AIX-LES-BAINS. Uterine Diseases. — We will only allude to Amenorrhma and Dysmenorrhoea. When these diseases are not produced by natural deformity requiring surgical intervention, they result from general conditions to which the stimulating action of our waters affords certain reUef. To women of a certain age I prescribe douches and sham- poomg. Young girls should resort to the swimming bath, as that invigorating exer- cise adds to the stimulating effect of the waters. Metritis— Ulceration— LeucorrhoBa.— The study of uterine affections proves that the greatest number result from chronic metritis, which, with occasional traumatic exceptions, start from some kind of diathesis. If, according to eminent pathologists, the greatest proportion of cases of laryngo-pharyngitis may be traced to dermatosis, that result is also frequently met with in affections of the uterine mu- cous membrane, such as follicular catarrhal metritis and consecutive leucorrhoea. Dis- placements and all their neuro-pathogenic DISEASES OF WOMEN. 85 concomitants, such as anaemia, nervousness, dyspepsia, insomnia, weakness, and weight in the abdomen, are under the influence of uterine disorder. It is most interesting to follow the evolutions of this diathesic state, sometimes localized in the vaginal or uterine mucous membrane, sometimes producing bronchitis or acute a.ngina, which in turn give place to eruptions of the capillary or other portions of the cutaneous covering. Another cause of uterine congestion, and, in sympathy, of all disorders resulting from the lesion of so delicate an organ, is rheumatic diathesis. The baths and douches of Marlioz are adapted to the purely herpetic state ; those of Aix to rheumatic complication. Our medication, whilst determining a revulsion on the entire cutaneous surface, re-esta- blishes the functions of the skin. "By intense sudations it reduces morbid ten- dency, and substitutes perspiration by the pores for the leucorrhceic discharge.* Experience has proved the pernicious * Courty, " Maladies Uterines.'' 86 AIX-LES-BAINS. influence of cold water on these delicate organs. I remember, amongst others, the case of a lady suffering from chronic uterine catarrh, who, after taking three cold hip baths, and three cold local injections, was attacked by a very serious metro-ovaritis. The conclusive arguments of Virchow^' demonstrate that the contraction of the arterial system due to cold leads to con- gestion of the internal organs, and espe- cially to that of a uterus already enlarged. We are by no means surprised when consulted by women who return from sea baths and hydropathic stations, with an exaggeration of those symptoms which ac- company metritis — such as a sensation of heaviness and weight in the hypogastric, uterine colics, dysmenorrhoea, throbbmg with tenderness about the groins and perineum, hypersesthesia, and itching of the vulva. The abuse of strong repeated injectioiis is also pernicious ; since there are cases in * Virobow, " Physiologisohe Besoliwerungen iiber das Seebaden," page 89. DISEASES OF WOMEN. 87 which injections increase the natural irrita- bility. Therefore we substitute the use of speculums of gutta percha or metal in the ' bath, as they can be easily introduced and kept in place by the patient ; and the organ thus profits by the bath without the irritation of a sudden shock, or of a different temperature produced by the injection. We have especially noted the advantage of this bath of the womb in ordinary cases of tumefaction of the glandulse and follicles of the cervix ; the patient feels how far she can introduce the instrument without tear- ing the sensitive granulations. "The thermal treatment of chronic metritis, consisting of prolonged baths, and swimming baths is particularly efficacious. Vaginal irrigations modify catarrhal surfaces, but vaginal douches should be almost entirely abolished, as they excite congestion, and uterine and peri-uterine neuralgia. "* M. Denos, physician of the H6pital la Piti^jf advises powerful application of thera- * Durand-Fardel, " Lemons a I'Bcole Pratique,'' p. 212. 1874. f " Annales de Gyndoologie.'' 1876. 88 AIX-LES-BAINS. peutic agencies in cases of torpid metritis, and metritis complicated by rheumatic or gouty diatliesis. We have frequently observed as an equally important result of a course of baths, the power of stimulating the effects of local treatment previously abortive, especially in cases of torpid metritis com- plicated by scrofula. When the reaction is thus effected, astringent, emollient, or caustic remedies may be applied according to the case. Displacements, and prolapsus generally produced by metritis, disappear when the origin is eradicated. Tonic sulphureous treatment acts also most efficaciously on relaxation of the ligaments. First Case of Ulceration of Labia Uteri cured at Aix. — Madame C , twenty-five years old, arrived at Aix, June, 1874; of good constitution but lymphatic tempera- ment ; she commenced menstruation at the age of fifteen without pain; married at eighteen, she had a child fifteen months afterwards, and subsequently suffered acute agony in the hypogastric regions, DISEASES OF WOMEN. with white discharge after the monthly epochs ; pelvic and sacral pain increas- ing in intensity whUst walking and driv- ing ; and great mental depression. There was an evident congestion of the cervix ; and I observed through the speculum an indolent bleeding ulcer of no great depth. Madame C had been cauterized eight times without result ; as there ap- peared to be no displacement of the organ I recommended simple swimming baths. After the fifth, the patient complained of a discharge of muco-pus, and consented to my proposal of a general cauterization of the ulcerated parts. Three days after- wards I prescribed one tepid hip-bath and injection, to be followed by the ordinary large baths, with an internal bath by means of the speculum. By degrees Madame C was enabled to walk in comfort, the monthly epochs occurred in their usual course without suffering ; and after thirty baths she was completely cured. I advised her to take walking exercise and frequent tonics, and invariably to rest after experiencing the 90 AIX-LES-BAINS. slightest fatigue. She has been very well ever since. Second Case : Chronic Metritis proceeding from Rheumatism. — Madame V , twenty- three years old, married two years, of weak constitution and lymphatic temperament; had inhabited ever since her marriage a new damp house ; had no family. Three months after her marriage, whilst suffer- ing from dysmenorrhoea, she was seized with acute pelvic pains and violent back- ache, which she attributed to a drive in an open carriage on a damp cold day. Treated by a midwife, whose diagnosis she could not produce, she had taken baths and injections, with applications of bhsters and leeches on the hypogastric region, and thus passed eighteen months without experienc- ing the slightest relief She arrived at A.ix in the beginning of the summer of 1874 with general health greatly impaired and difficult digestion ; all chronic pains increased whilst walking or sitting upright ; irritability of the bladder, fulness and heat about pelvis ; the cervix pushed forward in a state of DISEASES OF WOMEN. 91 prolapsus, hard and sensitive. The uterine catheter entered easily to a distance of about six centimetres. In this evident case of uterine and peri-uterine inflammation, I prescribed iodide of iron before meals, a tumbler of Marlioz water at night, and daily tepid Aix baths with the speculum bath ; the case being of too inflammatory a nature to support more stimulating injec- tions. After seven baths, as the patient complained of pains in the shoulder and wrist, I deemed it prudent to dis- continue the treatment, and the pains ceased. I then recommended hip baths, accompanied by douches to the back and shampooing of the limbs ; the patient then to be swathed until gentle perspiration ensued. After eight douches the monthly epochs returned more abundant and satis- factory in colour, necessitating five' days Potash. 0-0057 „ Ammonia 0-0022 „ Lime 0-0856 „ Slagnesia o-O02i „ Alumina 0-00022 ,, Iron 0-00039 .. Manganese distinct traces- Cobalt slight „ Copper abundant „ Lead id. Antimony traces. Arsenic 0-000007 gr. Dialized organic matter abundant. Xon-dialized „ abundant enough. Total I -023887 gra. The temperature is S3° Fahr. Challes water is twenty times richer in sulphide of sodium than any other spring most favoured in this particular. ST. SIMON WATERS. This spa, neglected during many years, has recently resumed an important position in the therapeutics of Aix. ST. SIMON WATERS. 127 The water, unctuous to the touch, ■without smell, of an agreeable flavour, has a natural temperature of 6';^'^ Fahr. The spring yields about 200,000 litres daily ; and contains, according to M. Kramer's analysis, bicarbonate of jime, magnesia, potash, iron, sulphate of magnesia, alum, organic matters, &c. In prescribing this water for irritabihty of the mucous of the stomach, the sedative effects have always proved satisfactory. Dr. Petrequin of Lyons has remarked its exciting influence on saliva, and I often observe its special efiect on urine, and in cases of cystitis, when hot water douches over-stimulate the bladder, the waters of St. Simon rapidly calm the pain and inflammation. They are also eflicacious in cases of rheumatism with visceral metastasis subject to gastric disturbances ; and are very digestive as a diimer beve- rage, four to six glasses daily assist the digestion. 128 AIX-LES-BAINS. WHE? CURE. The combination of whey cure with sul- j^hureous treatment originated in Germany, and is chiefly met with in Alpine and Carpathian stations, more than twenty-five being exchisively adapted to consumption and chronic affections of the respiratory organs ; in the Pyrenees also the happiest effects are produced. In the parks of Aix and Marhoz, dairies exist Adhere the patient drinks cows' or goats' whey according to the prescription, Avhilst taking exercise after baths and douches. Acting as a mild aperient, whey succeeds in cases of catarrh of the stomach when not resulting from dyspepsia, and is in- valuable in digestive atony and constipa- tion, frequently occurring at the commence- ment of the course. As an alterative, it succeeds in herpetic affections ; also in nervous erethism and irri- ELECTRICITY. 129 tability, produced by the early stage of the treatment. As a means of nutrition, whey is a great resource to -those enfeebled constitutions which incapable of digesting the fatty and caseine elements of milk are benefited by the remaining component parts. ELECTRICITY. After witnessing the excellent results obtained by Drs. Onimus in Paris and De Watteville in London, I ventured to employ at Aix the electric current ; it is a useful adjunct to the course, owing to its stimulating and modifying efiects on ner- vous, muscular and articular diseases ; and is also a diagnostic agent in paralytic affections of doubtful nature. At first I encountered adverse criticism ; but the value of continuous currents, which pro- voke neither spasms, organic disturbances, nor depression, is now recognized. Induced currents, on the contrary, owing to their K 130 AIX-LES-BAINS. irritating and exciting influences, are often counterindicated. Continuous currents are successfully employed in cases of chronic rheumatism, muscular atrophy, arthritis, stiffiiess of the joints, and different forms of paralysis. PART II. GENERAL INDICATIONS. K CO CO — ; C/} V < ;^ X —^ fz :lj <^ UJ —J ffl _i 1 LU C^ PJ r- •< 1— 1 c s: 1 'Hj CO X ;' -^ < <^ D_ UJ en -d oi LU u_ LU C2 OO y; >. ^. EOTJTE BETWEEN PARIS AND AIX-LBS-BAINS. Fares: — First Class, fr. 71 c. 65 ; Second Class, fr. 53 c. 70 The Rapid Train leaves Paris at 7 p.m. and arrives at Aix at 5.33 a.m., taking only ten hours and a half. Another rapid train leaves Paris at 8.55 A.M., arriving at Aix at 8.26 P.M.; both convenient, without change of car- riage. There are many other trains in the day. GENERAL COTJP D'CEIL OF THE COUNTRY. How can I better describe the varied beauties of Aix than by quoting a portion of " A Pastoral in Green ?"* "The green mountains gird in Aix-les- Bains — the Alps of Grenoble and of Italy, possessing not only sympathetic outlines, but melodious colouring : symphonies in grey rock ; chorales in green grove and bosky dingle, in gurgling stream, and in rushing river ; dirges in dusky ravine and sombre forest, where nightingales chant. The purple tints too, so charming among hills, cling to these Savoyard Alps will- ingly ; purple shadows that gather as the afternoon sun lowers, the green tints showing through like shot-silk. " The Lake of Bourget, shut out from the friendly little town of Aix by a long- * All the Year Bound, August 31, 1878. 136 AIX-LES-BAINS. shaped, envious, bowery hill, has much to do with the purple tints. Pui-plo moun- tain-tints show up readily from soa, lake, or big bi'oad river ; a friendly understanding, as it were, between sky and water, rcllected on mountain-sides. Those jturple shadows are very dear to me, with that underlying richness of untrodden emerald lawn and rough woodland. " Eound the Lake of Bourget, and cling- ing about Aix, are belts and groves of sycamore and Jir, walnut and ash, limes fragrant with blossoms, and lofty poplars shaking in the breeze; each mouiitain- tree forming a brick as it were in green walls, out of which the liouses, and the little chCdets, the Etablisscment des Bains, the cathedral, the hotels, grow up like mushrooms in a water-meadow." It is not in my ])rovinGe to eulogize the attractions of my country. Let me rathc^r transcribe some of the graceful words of a well-known and most poetic writer :* — * Right Hon. Lord Lamington ; " Aix-loa-Bains and Annecy." — Ninalcculh Century, August, 1883, COUP D'CEIL OF THE COUNTRY. 137 " For those who wish to combine the pursuit of health with a pleasant life and beautiful scenery, there are few places that offei*so many advantages as Aix-les-Bains. It is only one day's journey from Paris. Those visitors who arrive in the early part ■of the season, before every favoured spot is thronged with bathers and tourists, will be able to combine all the good to be de- rived from the healing waters and soft soothing air with a life full of varied interest. Lamartine resided some time at Aix : it was here he wrote ' Raphael,' which may serve as an excellent guide-book for the •district. He makes Raphael select Aix as a residence because it combines the charm •of the beautiful valley and fertile plain Avith the majesty of Alpine scenery, The •district between Chamb^ry and Annecy ■does not exceed sixty miles, but these sixty miles are full of objects of interest ; and the two lakes of Bourget and Annecy are not inferior in beauty to Maggiore and ■Como. How deeply Lamartine was im- pressed with this scenery may be perceived 138 AIX-LES-BAINS. in every page of ' Baphael.' If Lamartine has identified himself with the lake of Bourget, Rousseau, in his 'Confessions,'' has achieved the same result at Chamb^ry ; while his early and later life passed at Annecy has added to the charm of that picturesque town ; while his description of the lake invited so much attention to its beauty that many followed his example and built residences on its shores. Like Byron, Scott, and Burns, Lamartine and Eousseau have added to the charm of scenery which is exceptionally lovely ; in ' Raphael,' Lamartine observes that Nature, however grand and absorbing in interest,, gains by its association with genius. ' How much,' he adds, ' does not Vaucluse owe to Petrarch ; Sorrento to Tasso ; Yenice to Byron ; Annecy and Chambdry to- Rousseau and Madame de Warens !' and we may now add, Aix-les-Bains to La- martine." Unfortunately, the limits of my little work do not admit of quotations from many other authors who have helped to immor- THE TOWN OF AIX-LES-BAINS. 139 talize tlie beauties and charms of our be- loved valley ; but I must particularize the graphic and graceful pictures of H.E,.H. Princess Beatrice, which appeared in the last January number of Good Words. THE TOWN OF AIX-LES-BAINS Is situated at an altitude of 823 feet above the level of the sea, and 90 feet above Lake Bourget. Containing nearly 5,000 inhabitants, it is built on the decline of the Bevard chain of mountains about one mile from the lake. This cluster of hotels and houses rising one above the other presents a picturesque aspect from all points of view. The wide, well-planned streets abut on all sides on grand shady avenues, affording delightful shelter during the sultry season. Almost aU the hotels and many of the private houses are surrounded by gardens, which contribute greatly to the general salubrity. The Park, purchased with the Castle from the Marquis d'Aix in 1869, I40 AIX-LES-BAINS. was laid out as a public walk. The Castle now serves as the Post Office and Town HaU. HOTELS— BOARDING-HOUSES — LODGING- HOUSES. The visitor finds superior accommodation at hotels, boarding-houses and furnished lodgings, at fixed rates, varying from 9 to 18 francs per day for board and lodging. Considering that wine is included, this price is reasonable. Most adapted for perfect quiet are the furnished houses, about one hundred in number — generally with kitchens at the disposal of the lodgers, who have also the facility of taking their meals at any of the forty hotels, or eighteen boarding-houses, at fixed charges per day or meal. Many hotels and villas have been recently con- structed on the heights overlooking the town and lake, offering a choice to those Avho prefer repose with glorious scenery to CARRIAGES. 141 the advantages of the immediate proximity of the Baths and Casinos, with their nu- merous attractions. Large famihes requir- ing special accommodation are advised to write beforehand, as Aix is crowded during the season, particularly from June till the end of September. CARRIAGES. Excellent landaus, victorias, and pony carriages can be hired by the month, day, or hour, or at special rates for excursions. Carriages, with one or two horses, having^ tariff affixed, are always found at the railway station and in the streets. Om- nibuses of the hotels meet all the trains at the terminus. To avoid difficulties with the coachmen, it is essential to fix before- hand the fares for excursions. Since last year, chars-a-banc and breaks start at stated hours for the most attrac- tive spots in the neighbourhood, at a very- moderate tariff per head. Donkeys and riding horses are always available. 14^ AIX-LES-BAINS. STEAMERS AND BOATS. Steamers leave the Grand Port daily at one o'clockj and conduct passengers round the lake, stopping at all the points of interest. Three times a week very large and comfortable steamers proceed from the same point to Lyons, retiu:ning the next day. A steamer can be secured for private parties by giving a few hours' previous notice. Sailing and rowing boats are hired by the day or hour for excursions or fishing. TARIFFS. Omnibuses. F. c. To Marlioz, and return o 60 To St. Simon, single ticket 040 „ and return o 60 — To Gresy Waterfall, single o 60 „ „ and return 080 Oarkiages. Course in the town, one or two persons i o three or four persons 3 o Drive out of the town (by the hour, without reference to the number of persons) — Carriage with one horse 3 o „ with two horses 4 o DIVINE SERVICE. 14^ TAKIPr ACCOKDING TO DISTANCES. From Aix to St. Innocent, Brison, and return — ]?. 0. Carriage witli one horse 9 o „ „ two horses ., 12 o Drive by the borders of the lake past [Tresserves, Bon Port, and TerrenuRj^ or Bon Port, Viviers, and Marhoz — Carriage with one horse 8 o „ „ two horses 11 o Drive to and from Bonrget — A carriage with one horse 11 o „ „ two horses 15 o To and from the Moulin de Primes — Carriage with one horse 9 o „ „ two horses 12 o Boats. Two boatmen accompany boats containing six passengers — To Haute Combe 9 " Bourdeau 5 ° Bourget 8 o BonPort 4 o Chatillon 14 o Donkeys. By hour (each hour) i o Half-day 4 o Day 7 o DIVINE SERVICE. The Koman Catholic Church, rendered interesting by an ancient chapel within its precincts, is quite insufficient in size, and 144 AIX-LES-BAINS. will shortly be replaced by one worthy in dimensions of the numerous visitors. Partly destroyed by fire in the conflagration of Aix in the fifteentli century, the edifice presents a variety of architectural epochs, from pure Gothic to the worst period of the Renaissance. English Protestant service is regularly performed twice on Sundays in a charming little church recently enlarged to meet the requirements of the yearly increasing num- bers of visitors. Presbyterian and French Protestant ser- vice take place also twice on Sundays in the large church annexed to the Anglo- French Hospital. HOSPITALS. To King Victor Amedeus of Savoy was due the inauguration of gratuitous baths with cheap board and lodging for indi- gent patients. Subsequently the Empress Josephine built and endowed a hospital in memory of the Baroness de Broc, who met HOSPITALS. 145 with a tragic end in the cataract of Gresy. This hospital, at first insufficient in size, has been generously subsidized by native and foreign gratuities, among which the largest were contributed by Mr. Haldimand, Mr. Boyd, and my father, Mr. Brachet, many years Mayor of Aix, &c. &c. One hundred and twenty beds exist, and are generally occupied in summer. During the last two years the annual number of patients amounted to 877. An Anglo-French Protestant Asylum, established ten years ago is supported entirely by voluntary contributions. M. Fournier, the French Protestant minister, and Mrs. MacYiccar, an Irish lady, have collected large subscriptions in Great Britain and on the Continent, and visitors occasionally leave substantial additions to the funds. Patients treated in both hospi- tals are entitled to the gratuitous service of the Baths. When patients can lay no claim to private charity they are admitted to both hospitals at a daily charge of two francs, 146 AIX-LES-BAINS. on producing the necessary certificates of poverty signed by the Mayors of their communes. THE ANTIQUITIES OF AIX. The Arch of Campanus almost entirely preserved appears to have been the entrance to the Thermes, though long erroneously regarded as a sepulchral arch of which purpose the inscriptions offer no sort of indication. The principal inscrip- tion — " L. Pompeius Campanus vius fecit" — may be supposed to designate the name of the author, and the other inscriptions the members of his family or his colleagues ; or possibly the names of the administrators of the Thermes. This arch is constructed, as well as the Temple, of huge blocks of stone supported without cement by their own weight. The western aspect presents eight niches, once probably occupied by the effigies of the persons whose names are inscribed at the base. THE ANTIQUITIES OF AIX. 147 The Roman Bath of octagon form is one of the lasb specimens of Roman architecture. The bricks employed in its construction bear the mark of Clarianus, a manufacturer residing in Vienne (Dauphine), and are similar to those found in the Roman ruins at Lyons, thus proving that the Roman constructions at Aix and Lyons date from the same epoch — either the reign of Augustus or of Tiberius. This Roman bath is situated in the cellars of the Pension Chabert, and in the same house is a Roman sun-dial originally found in the Roman bath. Fragments of ancient marble statues were discovered in the excavations around the bath, as also amphor;e, and many coins dating from the two first Chris- tian centuries. The Temple of Diana. — This edifice, hedged in by modern buildings, denotes by its elegant simplicity the taste of Grecian architecture improved by Roman progress. Unfortunately, one fa9ade opposite the Baths is destroyed ; the other fa9ades are composed of huge blocks of stone, piled up L 2 148 AIX-LES-BAINS. over each other. Archseologists attribute this construction to the reign of Tiberius, some believing that it was dedicated to the worship of Venus, others to that of Diana, according to local traditions. Museum. — A staircase of the sixteenth century of the purest Renaissance style leads to the interior of the Temple of Diana with a Museum on the first-floor, contain- ing many objects of local interest and great- antiquity, the gift of Count L. Lepic. The price of admission is one franc. In the same edifice is a Library, where all the works and maps referring to the history of the country are collected. AMUSEMENTS. We have two large casinos — the Casino Ancien Cercle ; a club for ladies and gentle- men personally introduced was built by subscriptions thirty years ago. The shares entirely taken up in Savoy receive no interest, the profits being applied to the -a re) ~1 =3 > < -a o c CO AMUSEMENTS. 149 _ __^ « improvement of the club. Thus, two years since an elegant and commodious theatre, .and a spacious hall decorated with Salviati's mosaics, were constructed. Twice a day, in addition to other amuse- ments, a band plays in the gardens. In the evening there are alternate performances of opera and concerts executed by Colonne's .celebrated orchestra from the Chatelet in Paris ; once a week fireworks and a ball, .and occasionally special performances of plays by the first Parisian artists. The Reading-room is provided with the leading newspapers of all countries, and an excel- lent restaurant is attached. Casino. For the season — F. c. One person 4° o Hasband and wife 65 o Father or mother with one child, under twelve years old 65 o Father and mother, with one unmarried child 85 o Family, composed of father, mother, and several unmarried children 100 o Children under twelve years old 5 o Single entry by day 3 o I50 AIX-LES-BAINS. The Villa des Pleurs offers the same amusements and is also much frequented, the spacious gardens proving very attrac- tive. The directors of both these estab- hshments are most courteous and attentive to foreigners. Villa des Fleurs. For the season — F. c. One person 40 o Two persons 7° o Eaoli extra person 20 o Subscription for a fortnight at the rate of two francs per day — ■ Single entry by day 3 o Pigeon Shooting. — Two years since, shooting matches, in which the chief champions of Europe have taken part, were successfully inaugurated at St. Simon, about two miles from Aix. Races. — A local company has under- taken the establishment of annual races at Marlioz, a picturesque adjacent spot. The opening race on this fine course is fixed for Jul}' next. W A Lies. 151 "WALKS. To commence, I indicate short walks suffic- ing to produce without fatigue the required reaction after the douches, and place at the head the Roche du Roi — an ancient stone quarry, commanding the finest view of the town and lake. Ascending by the splendid hotel, and returning by the avenue of Marlioz, this walk occupies about half an hour ; morning is the best time for witnes- sing the effects of light and shade. Boulevard des Cotes. — Turning to the left of the Etablissement, follow this new boulevard by a gentle ascent, with an un- interrupted view of the town, and of the furthest extremities of the lake and moun- tains. On both sides of the road numerous villas are built, and others are projected. If not too fatiguing, it is advisable to pro- ceed as far as Notre Dame des Eaux, a most commanding situation; otherwise, a few minutes' walk leads direct to the Park and town. 1 5 2 AIX-LES-BAINS. Park of Marlioz. — Those who are not strong enough to ascend the heights, enjoy a walk of about twenty minutes' duration to Marhoz, through one of those splendid avenues of trees for which Aix is justly celebrated. St. Sixaon, Font Pierre^ Chateau de Syllan. — Passing the cemetery by the Geneva road, a short walk leads to St. Simon, renowned for its mineral alkaline spring, and for a large plantation of roses, oifering a varied choice to the intending purchaser. If not tired, proceed till you reach a stone bridge (Pont Pierre), turn to the left, and a gentle ascent through a vineyard abuts on the wood of Touvieres and the Castle of Syllan. You will be amply rewarded by the grand panorama of the Alpes Dauphinoises, the mountain of the Grande Chartreuse, the general view of the town and lake, and, above all, of the plain, the seat of a great battle between the Romans and the Allobroges, where 120,000 men fell victims.* Return by St. * Cabiaa, 1668. WALKS. 153 Innocent, the abode of the Angora rabbits, and the Grand Port. This walk, occupying about two hours, may be performed on foot, or on donkeys. Maison du Diable. — Close to the road of the Petit Port is the north end of the Hill of Tresserves, on which stands the Maison du Diable — so named after a popular legend — the property of the Hon. Lady W , who for many years exercised with her late husband profuse hospitality towards t,he inhabitants and visitors of Aix. Bois Iiamartine,, situated on the decline of the Hill of Tresserves, was illustrated by the most sympathetic of our poets, to whom we owe the glorious poem of the " Lake." The Grand Port. — A splendid avenue to the left of the Gigot leads in about twenty minutes to the Grand Port, the starting-point of the steamers, with a general view of the lake and its sur- roundings. The Petit Port. — Still nearer to Aix is the Petit Port, whence the lake is viewed 154 A IX-LES-BA INS. i'rom another aspect. The distance on foot is about a quarter of an hour from Aix. A new canal is projected to bring the waters of the Lake into the centre of the town, thus enabling visitors to start in boats direct from the hotel. Hill of Tresservesj at the south of Aix, commands on one side the Bois Lamartine and the town, with its mountain background ; and on the other, through richly wooded slopes, an enchanting view of the lake and surrounding hills. Some of the villas are occupied by English residents. Returning by the borders of the lake, an hour and a half is agreeably occupied. Monxy, Trevignin, Clarafond. — Leav- ing the town, and passing behind the Etab- lissement, the visitor arrives by an easy ascent at the village of Mouxy, thence to the left at the village of Trevignin, and to the right at that of Clarafond. All these roads are beautifully wooded, and the atmosphere becomes more bracing as we ascend. DRIVES. 155 DRIVES. Waterfall of Gresy. — The most fre- quented excursion by carriage or train is to the Cascade of Gresy, about twenty minutes' drive from Aix, where the meeting: of two rivers produces a glorious effect. At the distance of two minutes' walk from the highroad, a little steam tender is in waiting to take the visitor through a narrow and highly picturesque gorge, a mile in length, presenting no danger. Tower of Gresy. — I advise the visitor to ascend to this Tower, an ancient building, dating from the end of the eleventh century, whence \h£ view is magnificent. Accord- ing to some historians, this was the site of the Cemetery during the Roman occupation, of Aix, and of the Christian Cemetery in the sixth century. The Donjon Tower was built in the twelfth centmy. Great interest is derived from a careful study of the ancient inscriptions at its base. 156 AIX-LES-BAINS. Moulin de Prime. — Continuing this ■drive, a shady and charming road, most enjoyable during the hot season, leads to the Moiilin de Prime, about five miles distant from Aix. Grotte de Bange. — Farther on is the Grotte de Bange, well vs^orth a visit — a torrent (Le Cherant) follovping the entire length of the road refreshes the atmosphere ; gold-dust is found in the bed of the river. The so-called Grotto, an immense cavern, about fifteen minutes from the high road, vs^ith a lake at its extremity, is difiicult of .access. The drive occupies from four to five hours. Tour du Lao. — To obtain a general idea •of the country, the best plan is to follow the right border of the lake, and return by Tresserves or Viviers. This drive occupies an hour and a half Chateau de la Serraz.- — Turning to the right of Terrenue, at the head of the lake, DRIVES. 157 a delightful drive through groves of pines and chestnuts, leads to La Serraz Castle, whence the scenery is lovely. Chateau de la Motte. — The straight road from Terrenue conducts to the Chateau de la Motte. The splendid park resembles in many respects the far-famed English parks, seldom met with in our country. These two expeditions occupy three or four hours. Le Bourget et le Col du Chat. — The village of Bourget, about fifty minutes from Aix, is situated on the opposite side of the lake. The well-preserved ruins of an old castle built in the thirteenth century by the Counts of Savoy ; the village church contiguous to the dilapidated remains of another ancient castle, are the chief objects of interest. A little farther on, a winding carriage-road leads by an easy ascent, in less than an hour, to the Col du Chat. By this road Hannibal achieved his re- !S8 AIX-LES-BAINS. nowned passage across the Alps, two hundred and fifteen years before the Chris- tian era. Tliis excursion cannot fail to charm and interest the visitor. Castle of Bourdeau. — The straight road from Bourget conducts to the Castle of Bourdeau — a hunting-box of the old Counts of Savoy constructed in the eleventh century. Frequent repairs at different epochs give to this castle an air of origin- ality singularly picturesque when viewed from the lake. The commanding aspect of the terrace, at an altitude of 900, feet deserves special comment. The grand salon contains some old Italian pictures of a certain merit. Castle of Chatillon — A gay and smihng road — a miniature Corniche, winding at the base of the mountain by the borders of the lake, leads in an hour and a half from St. Innocent to Chatillon, enabling the visitor to survey the stupendous railway DRIVES. 159 "Works constructed by an English Company twenty-five years ago. The castle stand- ing on a platform at the sunnnit of a hill commands the view of the entire lake. The last Baroness of Chatillon who inhabits the castle graciously accords permission to visit the terrace and the ancient tower ; whence not only the lake, but the Rhone Valley are plainly distinguished. In this castle, Pope Celestin IV. was born, at the end of the eighth century. In hot weather, it is best to proceed by train to Chindrieux station ; the little Corniche road is exposed to the sun, and affords no shelter. Drive to the Rhone by the Canal of Saviere. — This bright and attractive route, highly recommended to people too nervous for boat excursions, follows the canal through which the w^aters of the lake flow into the Rhone by a bridge recently con- structed over the canal of Saviferes. Carriages arrive direct by a steep but practicable route, at Haute Combe — a great i6o AIX-LES-BAINS. advantage for timorous peo2:)le not ventur- ing in boats. Val de Pier. — This road about nine miles in length was constructed twenty years ago through mountain gorges hitherto deemed impassable, and follows the course of a deep river (the Fier), through which the Avaters of Lake Annecy flow into the Rhone. There is ample time for this excursion between luncheon and dinner. Take the train from Aix to Rumilly (an ancient and interesting town), drive to Seyssel by the Val de Fier, and return by train from Seyssel to Aix. Valley of the Beauges. — A continua- tion of the road past Gresy, the Moulin de Prime, and the Grotto of the Banges, leads to a fertile Alpine valley, rich in vegetation and abounding in glorious points of view. The excursion occupies an entire day, and by way of economy, a large party should be arranged to share the expenses. Although food may be obtained DRIVES. i6i at the inns, it is more prudent to take a hamper of provisions. Starting in carriages or breaks at seven in the morning, the best halting-place for breakfast is the Ch^telard, a chai-ming little village at the base of a steep rock. Drive on through a picturesque road penetrating the very heart of the Alps to St. Pierre d'Albigny, whence the train occupies an hour and a half in returning to Aix. Or Aix may be reached through the Deserts, or by the Chartreuse des Aillons ; each road offering so many attractions, that it is impossible to indicate the best mode of surveying the glorious Alpine effects. Castle of Miolan. — If the return by way of St. Pierre dAlbigny is selected, the Castle of Miolan — an ancient State prison — is well worth visiting. When going direct by railway from Aix, carriages must be previously ordered from the hotel -keeper of St. Pierre d'Albigny. The Grande Chartreuse. — This excur- sion is frequently made in one day ; but when two days can be spared proves far M i62 AIX-LES-BAINS. more agreeable. By starting after the bath or douche at ten or eleven in the morning, the return to Aix in time for the bath the next afternoon is easily effected, as the Etablissement remains open until five. It is advisable to engage a landau for four persons \ the gentlemen of the party sleep at the monastery, and may attend the morning service ; whilst the ladies find every comfort at an adjacent inn, and may rest or witness the splendid effect of the rising sun. The combination of the ideal and the mystic with the beauties of Nature endows this excursion with special attrac- tions, intensely appreciated by all visitors. Iiake of Aiguebelette— Spas of Ija Bauche. — At the south extremity of the Mont du Chat behind the mountain of L'Epine, a little lake, nearly three miles long and a mUe and a half broad, glis- tens like an opal in the midst of pme groves. A train from Chambery depo- sits the tourist at the station of Aigue- belette, close to the lake, whence it is easy MOUNTAIN ASCENTS. 163 to visit the iron spas of La Bauche. Half a day suffices for the whole expedition. MOUNTAIN ASCENTS. Dent du Chat. — The summit of the Dent du Chat is the most frequented mountain ascent in tlie environs of Aix. Delicate people and invalids must not attempt to climb to the most elevated peak, five thousand feet high. Carriages drive to the inn, vyhence — as all along the road — a magnificent view is obtained. In thirty minutes a steep accessible route enables the tourist to enjoy the full view over the Alps, Mont Blanc, the Rhone Valley ; the ex- pedition occupies four or five hours. To shorten the distance the lake is occa- sionally crossed in boats. From a medical point this mode cannot be recommended ; fatigue and exhaustion predispose to chills, with all their dangerous results ; whilst in a carriage sufficient wraps avert all risk. The Revard. — The excursion lo this mountain is inexpressibly attractive — a mule M 2 1 64 AIX-LES-BAINS. and donkey-patti passing through splendid forests of pines abuts on the highest point of the Revard (5,070 feet). The magnifi- cent view extending over the chain of Alps, including Mont Blanc, baffles description. A projected hotel will afford the best oppor- tunity for recruiting debilitated constitu- tions, and render the Grand Revard one of the most frequented stations as an after- cure, combining aU the requirements of bracing air, pure water, and unrivalled position. The summit is reached in three hours and a half. These two mountain excursions, easy and by no means fatiguing, are almost indispensable. Attention must now be called to more distant, though very in- teresting, ascents. The Dent du Nivolet. — The best way to the Nivolet is by train or road to Chamb^ry ; thence two hours' drive to the vUlage of the Deserts and a walk of two hours lead to the summit (5,070 feet). The view of the Chambery valley is un- equalled. DRIVES. 165 Semnoz Alps^ otherwise called Righi of Savoy. — A four hours' drive from Aix is the foot of Mont Semnoz. The ascent occupies two hours on foot or donkey. By sleeping at the excellent hotel-chalet — at an altitude of 5,600 feet — enjoying the entire panorama of the mountains and lakes of Savoy and Switzerland, the varied effects of sunrise and sunset may be witnessed. The projected railway will remove all existing obstacles, and render the ascent of the Semnoz practicable to the most delicate persons. Tower of Cessens. — To reach this very ancient tower the Geneva road is followed as far as Albens, whence an ascent by a good carriage drive in aspect resembling Scotch scenery leads to the summit of the mountain : an excellent view of the valley of the Rhone and the lake may be here enjoyed ; return by Albens, St. Girod, the Castle de Loches, and Gresy. This excursion is easily performed between lun- cheon and dinner. i66 AIX'LES-BAINS. STEAMER OR BOAT EXCURSIONS. A GENERAL description has already been given of many interesting points daily visited in boats, but equally accessible by carriages — such, as Bourdeau, Le Bourget, Chatillon, the canal to the Rhone, &c. ; it only remains to describe the Abbey of Hautecombej the ancient burial-place of the House of Savoy and almost the only spot there still belonging to that E,oyal race dates from the twelfth century, when Amadeus the Third bestowed the site on the Abbot of Clairvaux. The Abbey was doomed to destruction in 1796, and trans- formed into a pottery manufactory ; but was completely restored and re-decorated in 1824 by King Charles Felix, and is now occupied by some Bernardine monks. In the church are more than three hun- dred statues, many old pictures, mauso- leums, and simple tombstones. The monu- ments of King Charles Felix, buried in 1 83 1 , 3 (t3 -Q CHAMBER Y. 167 and of his Queen, Mary Christine, buried in 1849, are the most interesting. No admission is granted to the cloister. The private apartments of the Kings of Savoy may be visited. In the hottest weatlier there is a re- freshing breeze on the lake. Invalids and all who walk with difficulty enjoy the entrancing views around without leaving the boat, which as a change is recommended to all as a delightful mode of transit. CHAMBERY. The former capital of the Dukedom of Savoy has preserved, amidst innumerable varieties of architecture denoting changes of dynasty, its ancient type. As seat of the Prefecture of the Department of Savoy, greater animation prevails than in ordinary towns occupied by twenty thousand inhabitants. The new streets, wide and clean, contain excellent shops ; the Palace of Justice and the Town Hall are singularly fine edifices. The majority of the hospitals and asylums are due to the 1 68 AIX-LES-BAINS. benevolence of the Comte de Boigne, a native of the town, who returned from the East Indies with a colossal fortune ; in recognition of his services, the municipality erected in his honour a monument of doubtful taste sux'rounded by effigies of elephants, which occupies a prominent position in the town. The old Castle, a most interesting monument built in 1232, has been so often partially burnt and re- stored that it now presents every variety of architecture. Formerly occupied by the Governors of Savoy, it now serves as the Prefecture. From the summit of the tower a general coup-d'oeil of the enchanting surroundings amply repays the fatigue of the ascent. In the Sainte Chapelle, the porch in Renaissance style, and some ancient frescoes and stained-glass windows, are remarkable. The little Gothic chapel is also interesting. The Museum contains a complete collection of antiquities dis- covered in the lake ; of old coins ; and of the costumes formerly worn in different parts of Savoy. CHAMBERY. Les Charmettes. — The remembrance of Jean Jaques Rousseau and Madame de Warens enhances the interest of this pic- turesque cottage, half an hour's drive from Chambery, commanding some fine points of view. Challes. — The EtabHssement, the Ca- sino, and the waters more highly impregnated with sulphur than any others in the world, render Challes very interesting ; the hotel of the old Castle is also curious ; and on the terrace, where dinners are served, may be enjoyed an admirable view of the setting sun, as it sinks behind the range of the Alps. The Bout du Monde. — This charming waterfall, issuing from the Doria Gorge at the foot of the rock of Mount Nivolet, works an important paper mill ; and is little out of the direct road from Chambery to Challes. All the drives round Chambery are dis- tinguished by the richness and variety of the vegetation, and the magnificent points of view. 170 AIX-LES-BAINS. Gorges du Fier. — Leaving the Annecy train at Lovagny — an hour and a quarter from Aix — the Gorges du Fier are at a short distance; invalid chairs are available. The gallery, 260 metres in length, is protected from all risk hy a balustrade a metre in height ; a mild and soothing temperature pervades. The torrent, pur- suing its headlong course amidst rocky crags beneath the gallery, presents an aspect of striking grandeur. The Chateau of Montretiers — close to the Gorges — dating from the fourteenth cen- tury, resembles, in miniature, the splendid Castle of Pierrefonds. Once a baronial residence, Montretiers has been recently purchased by a gentleman from Lyons. ANNECY. The railway transit from Aix to Annecy occupies one hour and twenty minutes. Population, i:?,ooo inhabitants. Situated at the foot of Mount Semnoz, and at the extremity of the lake bearing its name, Annecy possesses two excellent hotels, and fe 'm,^ 3^* **«Wr^. Xi'fiii !.*.*« ^^lil ANNECY. i/r carriages and boats of all descriptions are available. For further details I again gladly refer to Lord Lamington's vivid and graceful description :* — "After a long experience of travel, seldom have I seen any place combine so much to charm and interest as Annecy. The lake not only flows up to the town, but through canals which are crossed by narrow bridges ; and on either side are quaint old houses, such as Prout loved to sketch : which, although many of them of wood, have re- mained unchanged for centuries. Those who love symmetry must not penetrate into streets and lanes of Annecy ; but the artist may find subjects for his brush to occupy many a day : every turn presents a fresh object of delight to the student in pencil or pen. It is strangely diversified in appearance. There are stately houses in the old Venetian style, with balconies of highly-finished ironwork, and decorated * " Aix-les-Bains and Annecy." Lord Lamington, in Nineteenth Century, August, 1883. 172 AIX-LES-BAINS. architraves, where old families stUl reside in dignified retirement. Commanding the town is the quaint old castle of the Dukes of Genevois-Nemours, dating from the four- teenth century — with its towers and massive keep, its i-am parts and battlements, which so frequently and successfully defied the power of France, and averted that conquest which now has been achieved by purchase. Annecy is a Bishopric and Prefecture ; and as troops are always garrisoned there, there is enough animation to add to its mediaeval interest. The dignity of a Prefecture has. led to the formation of delightful gardens on the shores of the lake, which is about twelve miles long by three wide, and is sur- rounded on three sides by Alpine snow- covered mountains. Thus Annecy adds to the loveliness of Como the grandeur of Lake Leman. " Many illustrious men have found their rest in retirement on its shores. Eugene Sue, Gustine, and Rousseau passed the latter years of their lives there. ' The Maison- nette de Chavoires, now called the 'Maison o X t- -tu C ANNECY. 173 de Rousseau.'where lie dwelt so many years, still exists, although falling into ruins. " The Acaddmie Florimontaine held its sittings in the ancient episcopal palace, where Francois de Sales lived. No name was so honoured and loved as this Apostle of the Alps. He died in 1 622, and was buried in the beautiful cathedral. In such estima- tion was his memory held by the people, that when the city was taken by the French in 1630, one of the six articles of capitulation was that the body of Frangois de Sales should never be moved from the city. " Even those who take little interest in spots associated with genius such as Rous- seau's, or in noble lives such as Saint Frangois de Sales' (he was canonized in 1658), or who only visit Annecy for change of air or love of beautiful scenery, will be grateful to be invited there. There are few spots where the love of retirement can be more pleasantly indulged, and there is sufficient movement to prevent the painful sense of solitude. It is very charming to 174 AIX-LES-BAINS. sit in the beautiful park and watch, the lights and shadows on the rich wooded hill-sides, while far beyond are seen the mountains of the Val d'Isere ; and stiU further distant the snowy summits of the Dauphind Alps. Another advantage is that Annecy, although less than two hours distant from Aix-les-Bains, is comparatively little known to tourists. It is fervently to be hoped that no sulphurous spring may be discovered, and that it may remain a little city to flee to from the lalnea strepitumque of Aix. After a few days spent there the invalid will return with increased enei-gy to complete his treatment." THE END. rfilNTED BY EALLANTYNB, HANSON AND CO. LONDON AND EDINBUROiC Visitors will find at ANTOINE BOLLIET'S LIBRARY, 54, PLACE CENTRALE, All Standard and Eecent English and French Books for Hire or Purchase. FRENCH AND ENGLISH NEWSPAPERS Are found at the Bookstall of the Railway Station.