^ ' --■' lo Imu) Patients Abroad. R A ,L?9 %' }h\ Thoi?=*ao- I. .inn. LIBRARY OF CONGRESS, fA-n-r— Cfcap. .„„;... lopijriglji fu + - Shelf Xu7Jf UNITED STATES OF AMERICA. ERE 10 SEP PAT MINERAL AND OTHER WATER CORES CLIMATIC TREATMENT. DR. THOMAS LINN, Doctor of Medicine \ Faculty of Paris ; Doctor of Medicine and Surgery , University of New York; Me?nber of the British Medical Associ- ation; Member of the Continental Anglo- American Medi- cal Society ; Membre de la Societe de Medecine Pra- tique de Paris ; Me??ibre de la Societe" de Mddecine et Climatologie de Nice ; Physician to the Bath- ing Establishments at Aix-les-Bains and Marlioz (in Summer) ; in Winter at No, 16, Quai Massena, Nice, France. 1894. GEORGE S. DAVIS, DETROIT, MICH. n^/^-TL, V- H' Copyrighted by GEORGE S. DAVIS. 1894. TABLE OF CONTENTS. CHAPTER I. PAGE Introduction 1-3 CHAPTER II. Mineral Waters — Hydropathic Stations — Sand and Mud Baths — Milk, Whey, and Grape Cures — Massage and Electricity 4-13 CHAPTER III. Climatic Resorts : Winter, Summer, Sea-Sides, and Mountains — Air Cures — " Terrain-Kur " or Ex- ercise Treatment 14-26 CHAPTER IV. Alphabetical Index of Maladies, with Names of the Best Places to Send Patients to in Europe. ..27-76 INTRODUCTION. The question may be asked, why we should send patients away to health resorts in Europe when we have at home springs and climates that are as useful for their treatment. We can admit at once that the home establish- ments are well appointed and have competent physi- cians, while everything that nature and medical art can give is to be obtained there. Then, again, why send patients elsewhere ? First of all, it may be out of our power to do otherwise, the family having already decided upon a tour in Europe for pleasure, instruction, or for business reasons of one of its members; and the treatment of the patient while absent is the only question we are called upon to decide. Next, a complete change may be most necessary— a new land away from all the old associations or the chance of returning to them quickly by train, strange faces, change of habits and customs, different food and language, the soil even of another character, so that the body as well as the mind benefits by the novel surroundings. Then we-must say that the large experience that has been gained in European resorts, where for so many years the records of treatment of certain dis- eases have been kept, has a resulting effect upon therapeutics that is quite apart from the chemical composition of any mineral-water or the temperature of a climate. These years of accumulated evidence, and the thousands of scientific medical experiments, added to the really magnificent curative establishments, have brought treatment in them to a point of perfection which accounts for the preference given to health resorts abroad. The European watering-places are very numer- ous, and it is quite impossible for many of our medi- cal brethren to have a correct idea of the treatment given at all of them. It is known in a general way that Vichy is good for stomach complaints, that Carlsbad is a purgative water useful in liver troubles, and that Nice in the south of France has a good, tonic, mild climate in winter; but there are not many of the home physicians who have had the time and oppor- tunity of frequenting the health resorts of Europe and making a study of their methods of cure, so that they are not always in a position to indicate the different stations for each disease to make a cure at. The author will endeavor to supply this informa- tion in a concise form for ready reference by physi- cians. He wishes to mention that he has made it a special point, during a number of years' practice abroad, to visit the health stations and study their methods of treatment, besides having sent patients to — 3 — them and observed the results. He also practices himself at a well known European mineral-water station in summer, and at a popular climatic resort in winter, and has had access to the fullest scientific details concerning balneo-therapy and climato-therapy in Europe, so that he trusts the indications given will be accepted as being the nearest possible to the cor- rect ones, given without partiality, and the best places to send patients to for treatment when abroad. I give only the names of the places recom- mended for the different maladies, and must refer the reader to guide-books for routes to the stations and the fullest details of each place; most of them publish monographs of the stations in different languages. MINERAL WATERS— HYDROPATHIC ESTABLISH- MENTS—SAND AND MUD BATHS— MILK, WHEY AND GRAPE CURES— MAS- SAGE AND ELECTRICITY. Hydro-mineral medication has changed consid- erably in late years. Formerly it was thought that the small quantity of the salts of lithium, arsenic, iodine, or bromides with sulphur found in the waters, had an immense influence over disease; but now that it is known that the mineral elements are often infinitesi- mal in quantity, and that very few of the mineral waters have an extraordinary action per se on the organism, this influence is no longer considered the preponderating one in the cures made, and the former absolute faith in the mineral constitution of the waters is now much weakened, for it is clear that the other elements of the cures are very important. What really acts at many of the springs is the water itself, hydro-therapy, life in the open air, hygiene, change of scene and habits, exercise, rest from business, as well as the mineral elements them- selves, for I do not mean that no advantage is to be gained from the mineral salts found in the waters — far from it; but they are not the only agencies to look to for curative action at the resorts. It is often the method of application of the waters rather than the kind of water. Priessnitz, the great founder of water cure, used nothing but the common water of a mountain stream, and made won- derful cures. It is the same with the more modern Father Kneipp. I cannot in this little volume say as much as I would like to about the mineral waters, but must refer to the larger works on the subject. I may mention, however, that they are usually divided into five classes: Sulphurous, Saline, Purgative, Alkaline, and Ferruginous. The Sulphur springs act best in chronic lym- phatic patients. The Salt ones are much used for strumous troubles. The Purgative waters have a wide scope, and the Alkaline springs are of great import- ance in internal medication. The Iron-water springs are not so much used as they deserve to be, for excellent results are obtained at them. A number of the Sul- phur-waters contain iodides and bromides. The Alka- line ones often contain arsenic, some of them have it in considerable quantities. Copper, mineral tar, and many other important elements are found in some of the waters; others again act almost alone by the natu- ral temperature of the water. ADVICE DURING A MINERAL-WATER CURE. The moment a patient arrives at the springs he should place himself under the absolute direction of the doctor there to whom he has been sent. To undertake to swallow more water than is or- dered, through the false impression that because it is good for one he cannot take too much of it, is to expose oneself to a grave error that under certain circumstances may become a serious danger. The old Romans were great bathers and also drinkers of mineral water. Pliny says: " A considerable number of patients boast of resting hours in the baths, which is bad for them, and I have seen them drink so much of the spring water that their skin was so stretched that it covered over their rings." We don't feel sure that Pliny was not doing here as some other historians do, that is, stretching his facts; but in any case, no more mineral water should be drunk than is ordered by a doctor of the place who knows by experience the useful quantity. BEST SEASON FOR THE COURSE, AND ITS DURATION. The bathing establishments are, many of them, open all the year round, but the doctors do not advise patients to go to them before May nor to remain after October. English visitors rather prefer cold weather, and they often arrive for the baths in May, and return again in September. Americans come during the whole season, but prefer the summer. The most fashionable and crowded time is during July and August. This is true of all the mineral springs of Europe, and the question may be asked if the world in general is right in flocking in thousands to the baths during the hot months ? Certainly severe rheumatic cases, old people, and those sensitive to cold, must find it best for them to come at this time, or they would not do so in such great numbers. The months of May, June and September have certain advantages; the baths are not so crowded, the air is more bracing, and reasonable rates prevail. As to the duration of the treatment: it has been rather arbitrarily fixed by custom at three weeks, or twenty-one days, and many take about sixteen douches or baths in this time, with one or two days' rest between, but this should all depend upon the case. Almost every patient demands a careful study by a competent bath physician, who alone can fix the proper duration and number of douches. — 8 — It may be said, though, in a general way, that many people get sufficient treatment in three weeks. Some cases require two seasons to cure a chronic malady, but all get improvement in a single one. It is important that the baths and douches be not taken continuously; brief intervals of rest are essential to success in the treatment. .This is the experience of the best physicians who have practiced for many years abroad. An " after cure" of some little time in a cool mountain-resort is always advisable. The therapeutical action of hot mineral-waters and douches, with massage, we may explain as follows: There is produced an energetic stimulation of the cutaneous surface, which results as it were in a purgation of the skin, making it eliminate whatever excrementitious matters may have been retained in the organism. It also relieves at the same time any congestion of the deeper parts or organs, while giving a stimulus to the circulation in general. To this must be added the effects of the mineral elements in the waters taken into the system and blood, both by drinking them and by inhalation during the bath or douche. We must add a word of warning to patients who are disposed to take powerful massage douches with- out advice, as harm can result from an injudicious use of them. Some people insist on the masseicrs giving them a vigorous treatment when they have no proper power of reaction, so that they simply exhaust — 9 — themselves and produce a state of feverish debility and weakness, whilst under proper medical direction the same persons could derive great benefit from mineral waters scientifically used. Just here I would like to mention a specialty at Aix-les-Bains; this is the carrying home of the patient after baths or douches. The custom is to walk to the bath house (although one may be Bath Chairs. carried to it if desired) ; the hotel servant carries a blanket' and linen to the establishment, which is furnished without extra charge by the hotels. The bather, having disrobed in the dressing-room at- tached to the douche, enters the bath, and his usual clothing is returned to the hotel by the servant. After the douche and rubbing down, the patient is carefully wrapped in the blanket, which has been warmed in a gas oven in the meantime, and, the bath chair having been brought into the dressing-room, 10 the patient is put into it and carried to the hotel, up to his room, where he is deposited in bed and left to perspire a certain time, when he is again rubbed down by the attendant, or by himself, and resumes his usual attire in time for breakfast. This I consider an important part of the Aix treatment. How much harm is done and how many colds are caught elsewhere by the usual method of taking baths and then dressing quickly in hot dress- ing-rooms, and walking home with the pores of the skin open, while the weather may be cold or wet! It is all very well to advise that patients dress quickly and go for a walk, or hurry home and go to bed or stay in warm rooms covered. But nothing seems to protect rheumatic and sensitive people from catching cold after baths as does the above system used at Aix. THE DOUCHE-MASSAGE IN RHEUMATISM. One of the most important applications of the Aix waters is the massage or shampooing of the pa- tient while under the hot sulphur-water. This is done here with a perfection not to be found elsewhere in the world. The men and women who perform it have had their art handed down to them for many years, as their fathers and mothers have been "mas- seurs" or "masseuses" before them. The Aix waters have an unctuous quality that makes them particularly adapted to rubbing and kneading the muscular struc- tures—a property not found in other waters. The Douche-Massage is given as follows: The Douche-Massage. t\ D 12 The patient is placed on a wooden stool, and the attendants pour the water over the body from a hose, while at the same time they shampoo, knead, and rub according to the directions given by the physician, who accompanies the patient to the douche the first time, to give instructions as to temperature, force, duration, and pressure on particular parts. This specialty of massage under water has noth- ing in common with the dry massage or that practiced with ointments elsewhere. Hydropathic Stations. — Besides the mineral-waters proper, there are a number of excellent water-cures, where the scientific application of pure water is prac- ticed under medical direction, and with sufficient pressure to accomplish good results in the treatment of a large number of diseases. The large cities have also good establishments of this kind; some of these will be mentioned under the diseases for which they are appropriate. (See Hydropathic Establishments^) Sand and Mud Baths. — Putting the patient into a pit dug on the sea-shore and covering portions of the body with sand, is a form of treatment which is still in use in certain parts of Europe, such as Arcachon and other sea-beaches. The Mud Bath is a variety of this. The mud of rivers and some springs is put into a bath-tub and heated with steam. The patient gets into this, or else it is applied locally to joints like a plaster, while hot. This is done at Dax, St. Amand, and Marien- — 13 — bad. Mud is now sent to Paris from Dax and ap- plied there in the same manner as at the Springs, at private bathing establishments. Milk, Whey, and Grape Cures. — These methods of cure are used now at nearly all the stations: Mont- reux, Meran, and Pugny are grape cures. Massage and Electricity . — These are given at most of the stations, the last at all the hydropathic estab- lishments. Massage under water is the specialty at Aix-les-Bains. Dry massage or massage with various pomades, lanolin, etc., is now practiced almost every- where in Europe. The health resorts and large cities all have these shampooers, or masseurs and masseuses, men and women who are practiced in this art of rubbing. Their addresses can be had from the physicians in each place. CLIMATIC RESORTS: WINTER, SUMMER, SEA- SIDE, AND MOUNTAIN— AIR CURES— "TERRAIN KUR" OR THE EXER- CISE TREATMENT. Winter Stations. — The Mediterranean coast-line is thickly set with renowned health resorts that are certainly the best wintering places in Europe for many reasons. We have for years sought "what does not exist" that is, a perfect climate — one where it would be neither too cold nor too hot, without rain, wind, snow, or frost. Two years in Egypt proved to me that it could rain and hail even there, and that the cold was felt all the more as the houses are devoid of fire-places. Besides this discomfort, one has to read there his London paper six days old as the latest news, which makes him feel that the real world is afar off. . In many other winter resorts I had the same difficulty of finding perfect weather with comfort, and I must confess that even in the favored region of the south of France (where the change from northern lands is so wonderful, and where flowers are blooming and birds singing in midwinter), even there the snow can now and then be seen on the tops of the far-distant Alps, which prevent its falling into this sunny strip of land, and disagreeable winds will sometimes arise, while the exhilarating sunshine may prove treacher- — i5 — ous if proper precautions are not taken; but after all these little troubles, there is no place in the world where so many climatic and other advantages can be had as in the French Riviera. One of the greatest points is that it is only eighteen hours from Paris, and twenty- five from London and the great centres of Europe. There are few of us in these modern days of civiliza- tion that can bear to go to outlandish places, away from reach of the best advice and scientific aid, par- ticularly when we are ill and far from home and friends. We feel then that we ought to have every possible accommodation at hand, even with our de- sire for a fine climate in winter. This can be had in Nice, and on the Riviera, where every comfort is ob- tainable: the telegraphic news is laid on the break- fast table every morning in the Paris and London papers, while in the larger towns everything that modern taste demands is provided. As to climate, it is admitted that u the country which allows us to spend the most time in the open air is the best one for invalids in winter." This is the rule for perfection in winter resorts, and it is as nearly ap- proached as possible in Nice and the south of France, where it Is rare that a day comes when one cannot go out during at least some portion of it. It must first of all be observed that there is no such thing as a tropi- cal climate in continental Europe, or even a very warm one, in winter. The best that can be found is a fairly mild one with a sunny atmosphere, slight rainfall, no — i6 — fogs or snow, and a tonic dry air. In Nice, between October and May, there are over two hundred clear sunny days, while in the same time in London there are not more than a dozen. The main characteristics of the Rivieran climate are much the same in all the resorts on the Mediter- ranean, but each has its secondary qualities— certain spots or portions of each town are more protected than others. For instance, at Nice, which is on a broad mountain torrent called the "Paillon" where it comes down from the northern range of mountains, it leaves a way open to the north winds, and some of the hotels and public places are within this tract; but this does not prevent Nice from having certain quar- ters as well protected as any along the coast. There are places in its Vallon des Fleurs, Brancolar and Carabacel quarters which have full protection and are sheltered from all winds, while they have several de- grees of temperature more than the other districts. Among the resorts in the south, some accidental pro- tection by a hill or a clump of trees makes all the dif- ference — the rest is the same at all the stations. This accounts for the important advice to patients not to locate themselves in any of the towns in the south of France without consulting a local physician first. Everything also depends on the sun here, so invalids must be warned not to accept any rooms but those that look south, or what is called " au midi" so that they will have the full benefit of the sun's rays. DO NOT TRAVEL SOUTH TOO QUICKLY. One of the disadvantages of the splendid new express trains deluxe is that they make people take too sudden a change of climate. All strangers need to be acclimatized here as elsewhere, according to their personal peculiarities and constitution. Some suffer by these sudden changes in loss of sleep and appetite; others get too great an impulse in their digestion from the tonic air giving them an unaccustomed zest for food, and they over-eat. Again, others get a con- siderable increase in their catarrhal troubles for a time, or some disorder of the nervous system. So that a slower trip south is advisable for invalids. This precaution is not so important perhaps as the others, as care in eating and a few days' quiet rest in the hotel will obviate the inconveniences of a rapid change when the latter cannot be avoided. Hippocrates advised physicians who had settled to practice in a place, first of all to consider its medical topography, seasons, winds, water, climate, etc.; and as a large number of competent men have already studied these subjects for more than half a century past in regard to Nice and the Riviera, I have only to add my personal experience, to give my readers the actual facts in the case, which are not based on speculation or theory, but on sound investigation and honest research, which should be the foundation of all science. 2 TTT THE REGIMEN MUST BE CHANGED IN THE SOUTH. The food and drink of the North are not suitable here. Nothing, perhaps, does more harm than the con- servatism of the English and Americans, and for that matter those of other nations, who will insist on taking their home habits with them wherever they go. Eng- lish ale and the heavy meat foods of the North are not suitable in the South. It is a safe rule to confor?7i i?i most things to the habits of the people in the place you live in. There is no use fighting against a change of climate; it is just as hopeless as planting flowers in a soil that does not suit them. The matter of regimen alters, however, with each separate case, and cannot be fully dealt with here; the suggestion is thrown out that if you want to feel well, then suit your habits to the climate. It dates back to the highest antiquity that after long and patient observation physicians recommended delicate patients to pass their winters on the Mediter- ranean, and modern science can only confirm the efficacy of this good advice. It may be that the microbian theory of the cause t of pneumonia and kindred complaints is correct, but certainly the part taken by exposure to extreme cold and damp is the most important factor in all these troubles. This we know to a certainty by clinical facts, and this knowl- edge is of more value than a thousand theories. — i 9 — Even if the microbes be the seed of disease, they will not develop on healthy soil, so to speak; and the ground must be prepared to receive them. The mechanism of this preparation is only too well known: we get overheated in a damp, cold climate, and we "catch" the disease. The mere mechanical effect of cold, contracting the little blood-vessels which run just beneath the surface of the skin, drives away the blood from these parts and must create a congestion -somewhere else — most likely in one of the vital organs, or wherever we have our weak spot, the so- called "locus minor is resistentice" (and few of us can boast of being free from an imperfection of some kind); this part is of course least apt to recover promptly from the temporary congestion produced, and disease follows. The old saying, " Warmth is life, cold is death" is true. How cold checks perspiration, thus preventing the carrying off of injurious worn-out materials from the body, is well known. Thus the work of purification is thrown on the internal organs, — lungs, kidneys, etc.; and they have to try to perform the work the skin can no longer accomplish. When they are not in good order, congestion again results. It is wonderful how quietly we all take dangers that come upon us in a familiar form. If an epidemic arises, and kills off a thousand people in a few weeks, the world is alarmed and almost a panic is produced; but severe cold last winter in London destroyed one thousand in four weeks, and yet nothing was said. 20 The death-rate before the frosty weather was 20.4, but it rose then to 29.7. The year before, during the influenza, it fluctuated about 21. Little heed is taken of this warning and lesson, or of the fact that it is perfectly true that the great majority of people who live in cold, damp climates "perish by the lungs." The direct influence of cold itself per se cannot be denied. It may be that it places individuals in a state of bacil- lary receptivity, but the part taken by it is the most important one, and it must be admitted that all per- sons subject to diseases of the respiratory tract give themselves the best chance of escaping dangerous illness by wintering in the South. Drugs in such cases are often but palliative. The failure of all the modern cures proves that the best one for all chronic bronchial troubles with profuse secretions is a pro- longed residence in a mild, dry climate. Sufferers from dry bronchitis do better in damp places like Algiers and Pau. It must be remembered that only the patients who suffer from the passive variety of phthisis do well in the South. The good effects of such an atmosphere as that of Nice on chronic inflam- mations of the larynx, nares, etc., are certain and sure. But the advantages of wintering South are not confined to chest complaints. Next in importance to derive benefit from a residence on the Riviera, are all feeble subjects, whether from age or faulty constitution. The large class of weak subjects do 21 well here because their temperature is kept up and a reaction is created by the dry, stimulating, tonic air. This also acts on the digestive organs, and dyspeptics get an appetite and are able to assimilate food much better here than in the North. The action of the light and dry air on hypo- chondriacal, melancholic, and anaemic patients is well known. Diabetes, skin diseases, as well as calculous affections, are also relieved, because, the functions of the skin being better performed in the South in winter, the work of the other organs is eased. Women's complaints are very much relieved here (dysmenorrhoea, etc.). Paralysis, rheumatism, sciatica, and gout are ameliorated constantly. In one word, all chronic maladies are benefited by the climate of Nice and the Riviera. The only exceptions known are certain nervous complaints. (Under the heading "Alphabetical Index of the Various Diseases" will also be found the proper indi- cations for them, not only as to climatic places, but also the mineral and other water cures.) The winter resorts in Europe may be divided into three classes: First Class. — The mild, dry, sunny, tonic climatic places in the French Riviera: Hyeres, St. Raphael, Cannes, Nice, Monaco, Monte Carlo, with Mentone 22 and their suburbs. Next the Italian resorts: Berdi- ghera, Ospedaletti, San Remo, Alassio, with Corsica and Algiers. Second Class. — The fairly good winter climates of the Eastern Riviera, below Genoa, which are damper and colder, but still sunny: Nervi, Spezzia, Naples. While next to them may be ranked Montreux, Meran, Arco, and Gardone-Riviera. Third Class. — The very cold, sunny, high-moun- tain winter resorts, such as Davos-Platz, Pontresina, and St. Moritz. In these high valleys the sun shines so strongly that in mid-winter it is often possible to go skating in light clothing; while the thermometer in the shade is below freezing-point the»sun heat may be considerable. I shall not enter into the great discussion as to whether mild, sunny, sea-side winter resorts are better than the very cold, high, mountainous ones. I think that the personal equation is the best rule to go by. If a patient likes cold and has a good reaction, the mountains may be best for him; but if he prefers the mild climates of the South, they should be allowed. The essential is plenty of sunshine, and outdoor life and air, combined with the other elements of cure. Summer Stations. — Nearly all the mineral-water springs are summer watering-places, being situated in the mountains, and they are often climatic air cures, so that not much need be said here except to mention that almost all of Switzerland is an excellent summer — 23 — watering-place for mountain air. The elevation of the country is from 700 to 15,000 feet, and in general it is a cool and often wet country, even in summer time. In some of the more narrow valleys, it is true, the heat is at times oppressive, but in most of the higher regions it is cold up to July and August, and in some years even during these months. Switzerland is mostly a country to visit for pleasure, however, outside of its excellent mineral- water stations and milk cures. Some of the special air cures of Europe are Gor- bersdorf and Falkenstein, in Germany; Vernet, and Pugny-les-Corbieres at Aix-les-Bains, in France. (See Phthisis, in Alphabetical Index of Maladies, etc.) Sea- Sides. — The resorts on the Atlantic coast are very numerous, comprising all the well known sea- side places on the English Channel, together with the French and Belgian ones. The Mediterranean sta- tions differ from the Atlantic by having no breakers and being in a mild climate, so that baths can be taken even in winter. The whole Mediterranean coast has a large number of these resorts, from the Italian frontier at Ventimiglia to San Remo, Bordi- ghera, Alassio, Nervi, Spezzia, Leghorn, and on down to Naples, where we find the islands of Ischia and Capri. The Adriatic side is not frequented by stran- gers. Cannes, Nice, and Mentone, while they possess bathing apparatus, are used mostly by the natives in summer time, although there is no question that — 2 4 — the famous inland sea has more salt in it than the Atlantic, so that the baths should be of great value. But fashion has decreed otherwise, and the world blindly follows it and goes to the Atlantic sea-side resorts. The temperature is never excessive on the great tideless sea, even in summer. Still it must be admitted that it is colder at the sea-side in the North, and there are no breakers in the southern sea, as I have already said. The French sea-coast is a very long one, stretching as it does all the way from Dun- kerque and Calais on the English Channel to the Atlantic by Arcachon and Biarritz, on again to the Mediterranean, and along its coast from Marseilles to Mentone. The most frequented places are Dieppe, Boulogne-sur-Mer, Etretat, Trouville, St. Malo, Houl- gate, Dinard, Dinan, Concarneau, Royan, Arcachon, Biarritz, and St. Jean de Luz — these all on the Atlan- tic side; Biarritz on the Bay of Biscay has no less than three large amphitheatre-shaped beaches, with splendid breakers constantly rolling in from the ocean, so that it can be recommended as affording the finest and most bracing sea-bathing in France. Under this heading I should, perhaps, have mentioned the sea-side resorts in Great Britain first, as it is usually the country American travelers first reach. The beaches here are very good, as a rule, with smooth sands and excellent breakers. If a bracing place is wanted, the east and southeast coast should be chosen; if a milder locality, then the west. — 2 5 — Queenstown, Aberistwith, Scarborough, Covves, Folk- stone, Dover, Brighton, Ramsgate, and Margate are the best known resorts. Therapeutics of Sea-Baths. — Sea-baths are indi- cated in muscular debility and exhaustion, tuberculo- sis in joints, white swellings, etc. They help those who need repose, and convalescents. Sea-bathing is adapted for delicate women and girls, and also for children and over-worked men. It improves the general health and braces the system against catching cold, and is a tonic to the cerebro- spinal system. We must make special mention of its effects on scrofulous children. The contra-indications are eye diseases, and some of the skin diseases, as well as chorea and convulsive troubles of any kind. Sufferers from diseases of the heart and lungs, gout, with any tendency to cerebral congestion, as well as highly irritable and nervous people, had better not use sea-baths. Mountain air would be best for such cases. We might here make a few suggestions for pa- tients going to sea-side places: first, to bathe at the warmest time of the day — say n to 12; next, never soon after a full meal or when very tired. It is well to go in while warm from exercise, and not follow the old plan of getting cool before entering the water. One should not stand about half-dressed after- wards, but walk or return to warm rooms. — 26 — The "Terrain Kur" is Professor Oertel's method of treating weak muscular hearts by ascending walks. It is useful also in obesity, neurasthenia, and in cases of defective pulmonary expansion. Meran, Arco and many of the German places are known for this treat- ment, while Pugny-les-Corbieres at Aix-les-Bains has now introduced it in France. These walks seriously carried out on this system are now quite popular, and many of the European stations have regulated gentle ascents marked out with the height at each few hundred yards, and benches to repose upon. ALPHABETICAL INDEX OF MALADIES, WITH NAMES OF RESORTS IN EUROPE TO SEND THEM TO. I give the leading indications of the important places (many more could be added), mentioning them in the order of merit or success in the treatment of the diseases, given as nearly as possible. It is understood, of course, that all the health stations are good for certain complaints; for instance, anaemia and debility may be improved at any of them, while rheumatic complaints are treated with more or less success at all hot springs. The exact indications for each mineral spring are much controverted, every writer finding different ones, but I mention the station best suited to each malady according to the experience of the largest number of authorities. Space does not permit of my giving more than the name of each resort, and the larger works on the places must be consulted for particulars in regard to any special one selected. The usual European Guides will give the routes and practical directions. Concerning many of the larger European sta- tions, large volumes have been written in different languages; application may be made for these to local physicians or to the director of the bathing establishment or springs. — 28 — Addison's disease may possibly be improved at the stronger arsenical waters, such as La Bourboule, Levico, etc. Hot douches upon the lumbar region for the pain in this disease are considered useful, and can be had at all the water-cure stations. Milk-diet treat- ment, so well given with "sterilized milk" in Switzer- land, is also a useful aid in supporting these patients. Certainly, assiduous or even forced feeding of a com- plete aliment seems to check the progress of the dis- ease for a time at least. Ague, — La Bourboule, arsenical waters. Royat, Vichy, in France. Bath, in England. Carlsbad, in Austria. Marienbad, Tarasp, Homburg, Ems. It is probable that the action of the arsenical mineral-waters is most useful in malarial anaemia, and they are certainly of great service as a prophy- lactic to persons who have to live in malarial districts. Anglo-Indians and Colonists resort largely to these waters, finding themselves protected from fever, by their use during one season, for several years afterwards. A sea- voyage and a stay at a northern sea-side, after residence in malarial countries, is also useful; while mountain air after residence in lowlands is cer- tainly so. In fact, in all such cases the well known rule is to make a complete change from the place the disease was contracted in. This is perhaps the most important rule in malarial treatment. Hydropathy is important; see Cold-Water Cures, — 2 9 — Albuminuria [chronic Bright* s disease). — For the diuretic effect, any of the alkaline waters, such as Vichy, Vals, Royat, Bilin, Evian, Plombieres, Buxton, Contrexeville, Vittel, Ems, Harrogate, Homburg, salt waters, Neuenahr, Wildungen, Kissingen. Nearly all the mineral waters contain iron, but if there is much anaemia some of the stronger ferruginous ones may be tried, such as Spa and Schwalbach. In winter the bright climate of the south of France — in particular Nice, owing to its being a gay, lively place — is useful for these depressed patients. Madeira, Canaries, Nas- sau; also milk cures. All the milder carbonated waters may be used and drunk in considerable quantities; Carlsbad in small quantities and with caution. Protracted warm baths at the same time as the use of the water internally. When the cases are far advanced, those waters that contain iron are best. In the cirrhotic form of Bright's disease, constant purgation with the saline waters, Hunyadi Janos, Friedrichshalle, etc., may be tried at home or at the springs. When ursemic symptoms appear, the hot wet- pack has done good. Alcoholism (see Intemperance also). — Vichy, Carls- bad, and the alkaline springs in general are useful to help the stomach. The mild restraint of the inebriate, or hydropathic — 3° — asylums, can be strongly advised for as long a period as possible. The milk and grape cures at Meran, Montreux, and other stations can also be recommended. Pougres and Royat both help the chronic gastritis in these cases, while Chattel Guyon is a station in France whose laxative alkaline waters are quite cele- brated for this condition when there is sluggishness of the bowels. Carlsbad, in Austria, when there is some liver dif- ficulty and when the abdominal viscera need rousing. Alopecia. — All the hot sulphur baths for baldness: Aix-les-Bains, Luchon, Harrogate, etc. Amaurosis. — Several springs claim to help vision, such as Brides in France, Carlsbad, Marienbad, Kis- singen; and Voslau, near Vienna, in Austria, also, for the grape cure. Amenorrhoza. — St. Sauveur, Neris, and Aix-les- Bains, in France; Schwalbach, Franzensbad, Hom- faurg, Kreuznach, and Pyrmont, in Germany; Bath and Bushey, in England; while all the warm winter resorts — Nice, Cannes, Mentone — are celebrated for the facility with which women's functions are per- formed in winter time. Massage of the abdominal walls alone, or even uterine massage in conjunction with mineral and other ~water cures, is clearly indicated in these cases. — 3i — Electricity is also useful and can be had at most of the foreign resorts. The warmer waters are best when there is neu- ralgic suffering, when local applications are used with great benefit. Ancemia. — Here, as mentioned elsewhere, the list is a long one, so many places helping the condi- tion, but I give only a few of them. First, the iron waters at Spa, Bath, Tunbridge-Wells, Pyrmont, Schwalbach, Homburg, Franzensbad, The Hydro- pathic Establishments, Forges, Bussang, Royat, La Bourboule, Chatel Guyon, St. Moritz, Levico, Marien- l)ad. Then the sea-side places, St. Malo, Biarritz, Arcachon, Trouville, Ostend. The climatic stations all over Switzerland. Meran, Glion, Pugny-les-Cor- bieres at Aix-les-Bains. Winter climates of a tonic, sunny nature, Nice, Cannes, etc. Life in the open air and free exposure to the vivifying influence of sunlight are among the best blood-restoratives, but must be under genial cli- matic conditions, for such patients fear cold and bad weather. Massage also may be added to the hydrotherapy. The traveling and change of scene and climate are useful adjuncts in the cures recommended abroad. Inhalations of oxygen, and baths of compressed air, are used for anaemia and chlorosis at some of the European stations. — 32 — The high-air cures, Davos and St. Moritz, may be added for those who enjoy cold, bracing air. Anasarca. — See Dropsy. Ankylosis. — In fixed joints the very hot applica- tions of mud and sulphur- waters are best. Dax, St. Amand, Aix, Bath, Malvern, Teplitz, Loeche; Baden in Switzerland; Acqui in Italy; Wildbad in Germany. There is no question that such waters often pro- duce effects which in ordinary surgery would be con- sidered surprising; where there is a complication with scrofula or tuberculosis the salt waters are import- ant aids. Salins-Moutiers, near Brides-les-Bains, in France, and Droitwich in England, are types of this class of waters. Electrical applications to the muscles are often added to the treatment. Anthrax. — See Carbuncle. Aphonia. — See Throat Diseases. Aphthce. — Vichy and alkaline waters. Apoplexy. — See Cerebral System. Arteriosclerosis. — Marienbad, Carlsbad, Brides, Tarasp, for the corpulent; Vichy, Neuenahr, Baden- Baden, Royat, Kissingen, for thin patients. It is, of course, understood that I do not give — 33 — the drug treatment of diseases, but only the climatic or water-cure indications as far as possible. Some waters contain a certain portion of salts such as sodium iodide, etc., but not in sufficient quantity to be looked upon as regular drug or medicinal treat- ment, which we agree that nothing can replace. Drugs themselves can be had anywhere, but one can- not get everywhere the rules of hygiene carried out as can be done with ease at mineral-water stations. Here the patients will conform to early rising and the judicious regimen sanctioned by experience, so that the dormant energy of the system held down by dis- ease awakens, not only because of the waters, but because the lungs have been filled with pure air, and the great arteries which go to the lungs and to the sys- tem generally become enlarged so that they distribute a larger, ampler current that assists greatly in cure, and makes the chances of its being complete better than by the usual drug treatment carried out at home. Ascites. — Mineral waters are contra-indicated, but the warm winter residences will be useful. Asthma. — It is truly said that these patients can find places where they are better off than at others; for instance: some of them do well on heights, the oxy- gen of the air seeming to help them; others do well in plains or at the sea-side; so that the indications vary greatly. Mont Dore, Cauterets, Eaux Bonnes, 3 TTT — 34 — Meran, St. Moritz, Scarborough, Malvern, La Bour- boule, Schinznach, Allevard, Royat, St. Honors, En- ghien, Brighton, Bournemouth, Ems, Montreux, Nice- Cimiez, San Remo, Pau, Grasse, Glion, Biarritz, Arcachon, Lugano, Hastings, Weybridge, Pine Woods. To make a choice among these places I should say that the arsenical waters of Mont Dore and La Bourboule in the centre of France suit a large number of cases, who breathe better in such high places. To patients who prefer the air of the plains, and who are besides arthritic, Vichy is useful. The lymphatic cases do best in the hot sulphur-water stations. Cauterets, in the French Pyrenees, for a high mountain place of this kind with hot springs; and Enghien, close to Paris, for a cold sulphur-water treatment in the plains. It is very strange and to be remarked that certain asthmatics can live in perfect health in the close air of large cities, whilst a journey to the mountains or sea-shore brings on their attacks. The converse is true, and they must search for the place where they can enjoy immunity from attacks, be it plain, sea-side, or mountain. Atrophy. — Dax, Aix, Baden-Baden, Bath, Lama- Ion, Salies de Beam, Loueche, Schwalbach, hydrop- athy. In the rare cases where the first cause of muscu- lar atrophy can be found out, of course the appropri- ate medical treatment should be used. For instance, — 35 — if syphilis is suspected, the mixed medication, and so on. In many cases of atrophy a spinal origin is diagnosticated, and electricity (with galvanic current) is applied directly to the spinal column. When, however, the atrophy is of a myopathic or neurotic order, the induced current is applied, either by faradization of the muscles, or what is called general faradization. Electric baths are also recommended. The treatment in all cases is a very long one, and massage, douches, and all the different forms of hydrotherapeutic treatment, can be well combined with the electricity — which is given, as before stated, in almost all the bathing establishments abroad. Bladder {Diseases of). — Catarrh: Contrexeville, Vittel, Evian, Amphion, Thonon, Pougues, Vichy, Royat, Brides, Tarasp, hydropathic cures. Cystitis: The above and Neuenahr, Bath; hot baths of all kinds. Incontinence of Urine: Neris, St. Sauveur, Plom- bieres. Warm climates in winter are useful for bladder troubles. Stone: Vichy, Royat, Pougues, and a few other stations have made small stones pass. It has been advised to change climate in all cases of calculi; most writers believe that such change has a very powerful influence over the formation of concre- tions in the bladder. But so many difficulties arise in - 36 - judging this matter, in reference to change of water, diet, etc., that we can hardly form a just estimate of the value of change in preventing the occurrence of these disorders. It cannot be doubted, however, that the tendency to the formation of calculi will be less likely to arise in a climate where the patient enjoys com- parative health, and where the tone of his diges- tive and assimilative powers is fairly maintained. The mineral waters of Vichy, Carlsbad, Royat, Pou- gues, and others have always been reputed efficacious in the reduction of these formations. I cannot say they have the power to dissolve them, but I have constantly seen patients pass stones after a few weeks' treatment at these stations, and every physician who has practiced for a certain time at these watering- places has a collection of calculi. Boils and Carbuncles (disposition to). — A urine- examination should be made first in such cases. Uriage, Aix, La Bourboule, Schinznach, Carlsbad ? Mont Dore, and many of the sulphur waters. It is the duty of all physicians to search the med- ical history well of all patients who are subject to boils or carbuncles. It is probable that they will often find albuminuria, diabetes, or some of the or- ganic degenerations. The salt and also the sulphur- ous waters have long been used with success in these troubles, but of course the causal or actual disease must be met by treatment appropriate to it. — 37 — The arsenical springs at La Bourboule, when there is any sugar in the urine, are most useful in cases of boils. Bright 's disease. — See Albu?ntnuria. Bronchitis [chronic). — Ems, Cauterets, Challes, Marlioz, La Bourboule, Eaux Bonnes, Luchon, St. Honore, Allevard, Royat, Mont Dore, Soden, Pyr- mont, Schinznach, Ischl, Plombieres. Climatic Treatment: When there is much mucous discharge, try the dry tonic climates, such as Nice, Mentone, Cannes, St. Remo; when of the dry, hack- ing form without discharge, the more moist mild climates, such as Pau, Algiers, Tangiers, Madeira, Meran, Montreux, Torquay, Hastings, Isle of Wight, Arcachon, etc. In giving the above list of mineral waters and climates as the most recommended ones in bronchial troubles, I need hardly say that all bronchial and laryngeal affections are amongst those that derive the most benefit from change of climate. It is also, of course, understood that it is only in their chronic forms that these remedial agents can be brought to bear upon them. All chronic bronchial cases whose malady recurs every winter, should break this ten- dency by starting south by the end of September. The English climatic resorts, such as the Under- cliff, Clifton, Brighton, Worthing, Torquay, Queens- -38- town, are only suitable for those patients of a nervous temperament who have a dry, sensitive condition of the air-passages, with very little or no expectoration. The moment there is a catarrhal or mucous dis- charge, it is only the dry tonic and exciting-air cli- mates that are of use. Egypt should be added to the above for those who can afford the long journey there and consequent expenses. A summer tour to the watering-places is indi- cated after the winter climatic treatment, when a careful course of mineral waters can be taken to great advantage. The long list of invalids who suffer from an un- usually sensitive mucous membrane of the larynx and bronchi, especially elderly persons, is immense in the south of France every winter. The mild air here permits of their gradually becoming accustomed to the out-door air, and the younger ones of this class get a new lease of life and probably prevent worse troubles by leaving the raw air of their homes. Many people look upon the Mediterranean coast as their El Dorado; and why some of them prefer one place and some another is difficult to find out, when the climate in all the stations is so very much alike. Clear from Pau to Pisa there are some thousand health resorts, and each one of them counts a solid constituency of suf- ferers from bronchial troubles who swear by a certain place, and utterly abhor the others, quite near by. It is probable that some slight protection and local agree- — 39 — able surroundings, rather than any difference in the condition of the different patients' bronchial tubes, make this preference. All those who suffer from diseases of the larynx had better spend the winter on the Riviera than any- where else. Common sense teaches us that an organ so delicate and so directly accessible to the outer air as the larynx, is more easily irritated and injured by a cold climate than by a mild one. Burns. — Vichy and the hot alkaline waters. Any prolonged baths for old burns. Calculi [biliary). — Vichy, Pougues, Royat, Mari- enbad, Carlsbad, Vittel, Contrex£ville, Ems, Evian, La Porretta, Franzensbad. (See under Bladder). In addition to the treatment so often successful at Vichy, Carlsbad, and similar stations as indicated above, great importance is given to milk treatments abroad, as well as life in the open air, with a great deal of exercise or massage. Cancers. — Of course not much can be done in such cases, but a certain amount of relief from pain can be got at hot alkaline springs, such as the "grande grille " at Vichy. The sulphur waters are harmful in cancer, being too exciting. Carbuncle. — See Boils. — 40 — Catarrhs. — Chronic intestinal: Brides, Carlsbad, Bath, Cheltenham, Homburg, Marienbad. Nasal: See Rhinitis. Pulmonary: See Phthisis. Eaux Bonnes, Cau- terets, Marlioz, Aix-les-Bains, Ems, Royat, La Bour- boule, Meran, Mentone, San Remo, Beaulieu, and all the winter climates. Urethral: The alkaline waters, Vichy, Pougues, Ems, Kreuznach. Uterine: See Uterus. Catarrhs are the most common disorders of all the mucous membranes, and when in a chronic stage are most difficult to cure promptly and surely. There is perhaps nothing so efficacious as change of climate during convalescence from influenza. This catarrhus epidemicus leaves so many obscure debilitating disorders after it that frequently the only remedy left to quell the long-lingering effects is to send the victim abroad, where a complete change prevents these complaints going into some of the chronic forms of disease that may be ac- companied by complications of a dangerous nature. If influenza takes the intestinal form, or if there is any catarrh of the intestines, Brides les-Bains in France offers a good form of treatment, also Carlsbad or Marienbad in Austria, and Cheltenham in England. The urethral catarrhs are treated at the hot alkaline waters best, such as Vichy, For bronchial catarrhs, Cauterets and Eaux Bonnes, in the Pyrenean Moun- — 41 — tains on the Spanish border of France, are celebrated, while Ems is perhaps the best place in Germany. The waters in France mentioned are of the sulphur- ous class, while Ems is an alkaline water like Royat in France. Cerebral System. — Some resorts treat brain and spinal troubles: Lamalou and Balaruc, in France, claim good results, and Carlsbad, Gastein, Ragatz, Wildbad and Plombieres treat such cases. They are not suitable to most of the mineral springs, but are well managed at the hydropathic establishments — Divonne, Champel, etc. These cases should not be sent to the tonic exciting climates of the south of France, such as Nice, Cannes, and the whole Riviera. They might suit at Pau and the more damp, sedative resorts, like Madeira. (See Locomotor Ataxy?) Chlorosis (see Anozmia also). — Spa, Pyrmont, Schwalbach, Royat, Plombieres, Meran, St. Moritz, Clifton, . Malvern, Homburg. All the water cures. Forges, Neris, Greoulx, St. Sauveur, Pougues, Bour- bon, La Bourboule. Anaemia, chlorosis, and general cachexia are closely allied; they are characterized by a vitiated state of the blood, arising in many ways and differing in each state as to the lesions of the blood-globules, but they may be appropriately spoken of here, for in all of them change of air, outdoor moderate exercise, — 42 — well ventilated rooms, cheerful scenery, sunlight, amusement, are indicated. Of course, when they arise from insufficient or improper food, bad ventilation, want of exercise, abuse of alcoholic liquors or even drugs, syphilis, ex- hausting forms of business, debilitating' discharges, imperfect menstruation, each of these causes must be met with a judicious exhibition of alterative and tonic treatment; but gentle traveling, mineral-water treat- ment at an iron spring, with residence in bright, sunny, dry climates in winter, such as Nice and the whole French and Italian Riviera, may be recom- mended with the greatest confidence. All the hydropathic establishments in Europe treat chlorosis, but it is best to try an iron-water as well. Spa in Belgium, and Schwalbach in Germany, usually head the list, while Plombieres and Royat in France combine an iron-water of a much weaker character with a combination of arsenic. Then. La Bourboule in France presents quite a strong arsenical water that has valuable indications in chlorosis. Meran gives a grape cure, but has no mineral waters. Its climate is bracing. Chorea. — La Bourboule, Levico, Plombieres, Aix- les-Bains, Baden-Baden. La Bourboule, in the Auvergne Mountains in the centre of France, is the strongest arsenical spring. Levico and Rousegno are in Upper Austria, and have — 43 — extremely strong arsenical waters which contain cop- per and other salts. Gymnastics, massage, and static electricity are favorite modes of treatment for chorea added to most of the watering-places abroad. Some of the estab- lishments try absolute isolation. Colic (hepatic). — Carlsbad, Vichy, Brides-les- Bains, Cheltenham, Harrogate, Marienbad, Chatel Guyon. (See Liver Diseases as well.) Capvern and Vittel, in France, should be added to the French stations treating hepatic colic, as well as Contrexeville. These waters, like Evian, also in France, act on the kidneys and the liver, but do not purge, while Carlsbad in Austria, Chatel Guyon and Brides-les-Bains in France, and Cheltenham in Eng- land, add a purgative action as well. Confinement (when difficult). — Any of the warm baths, and life in warm climates. Nice and the south- of-France places are excellent during labor, and tend to make it much easier. Constipation. — Carlsbad, Chatel Guyon, Brides, Montmirail, Cheltenham, Homburg, Leamington, Kissingen, Capvern, Aulus, Harrogate. The bottled waters, such as Hunyadi Janos, Pullna, Rubinat, Vil- acabras, Friedrichshall. For those who can travel as far as Budapest, in — 44 — Hungary, the excellent Hunyadi-Janos waters can be taken on the spot. This water is popular all over the world, but, like all waters, can be best taken on the spot. It is true that the purgative waters do not need to be as fresh as the other mineral waters con- taining gases. None of the waters in France are purgative, and but a few are laxative. Montmirail and Chatel Guyon are the strongest, and they require almost a quart to produce a purgatiive action in most people. Brides-les-Bains is also laxative, and Voriage slightly so. In late years, Rubinat, Villacabras, and Carva- bana w r aters from Spain have been introduced into France. They give a purgative action with quite a small dose, but do not seem as yet to displace the Hunyadi-Janos Hungarian water. Pullna and Fried- richshall are not so reliable, often require large doses, and their sate has much diminished in France and England. Contractions of Muscles and Tendons. — At hot sul- phur springs such as Aix-les-Bains, Dax, Marienbad. Massage given with the waters, as at Aix-les-Bains, is the best treatment. See description of the douche-massage, page n. Cough. — See Bi-onchitis. Convalescence. — All mountain and sea-side places. See Ancemia for mineral springs and climates. — 45 — Cystitis. — See Bladder Diseases. Debility. — Gastein and the cold-water cures have a reputation for nervous forms. See also Convalescence. Diabetes. — La Bourboule, Vichy, Brides-les-Bains, Teplitz, Carlsbad, Neuenahr, Clifton, Pougues, Vittel,. Droitwich, Contrexeville, Capvern. In the lighter forms, as well as the medium cases, the life in the open air, gentle exercise, walks, and freedom from intellectual work, combined with a cure at Vichy every year or one of the above mineral- water springs, can be recommended. French physicians make this distinction in pre- scribing waters: they say arthritic, gouty, or gravel cases that become diabetic in middle life, and that are robust still, do best at the alkaline waters, like Vichy, which often causes all the sugar to disappear from the urine; while those who are older and have begun to get thin, and are fatigued by their disease, will do better at Royat or at the stronger arsenical waters of La Bourboule. A moderately warm, sunny, dry climate, by in- creasing the activity of the skin and lungs, is sure to exercise a beneficial effect in such cases when aided by diet and a judicious regimen. The German doctors regard Carlsbad as a good cure, but only for the slighter forms of the disease. It is said to increase and maintain the tolerance of - 4 6 - the starchy foods by some special action on the hepatic cells. Carlsbad water does act on the liver probably, and this may be the cause of its good influ- ence in light cases of diabetes. Neuenahr in Germany also claims cures from its salt waters. Contrexeville in Northern France is advised for gouty diabetics. A well regulated diet treatment is also rigorously attended to much better when at mineral springs, where one has time to give the fullest attention to this important part of diabetic regimen. Dropsy. — Carlsbad, Cheltenham, Brides, Harro- gate, La Bourboule, Baden-Baden, Bagneres de Bigorre, Cauterets, the " Terrain Kurs." As dropsy is only a sign or symptom of many different diseased conditions, the cause of the ac- cumulation of serous fluid must be first sought for. See Bright 's Disease, Heart Affections, Ascites. Dysentery. — Carlsbad claims to treat this disease; and La Bourboule, with other arsenical waters, like Levico, may be useful if it comes from residence in malarial districts. Spa, the iron springs in Belgium, also has it on its list of cures. As many of these cases of chronic dysentery are found in patients coming from a life in hot^climates, — 47 — it is probable that the change of climate alone has much to do with the cure. In fact, it may be stated as an indispensable condition of cure that these patients must leave the place where they contracted the disease. Kissingen water in very small doses is claimed to be a cure, exerting a constipating action and favoring .gastric digestion. It is probable that all very hot waters are useful by an intestinal antiseptic or rather simply purifying action. Dyspepsia. — Acid form: Vichy, Vals, Royat, Neuenahr, Alet. Atonic form; Pougues, Homburg, St. Moritz, .Spa, Brides-les-Bains, Orezza water used at home. Painful: Plombieres, Evian, Amphion, Pougues. Flatulent forms: St. Sauveur, Niederbronn, Hom- burg. Catarrhal forms (with constipation): Carlsbad, Marienbad, Brides, Chatel Guyon, Tarasp, Kissingen, Harrogate, Leamington. Dyspepsia is one of the disorders, in the allevia- tion of which change of climate is preeminently suc- cessful. When arising from too close application to study or business, or indulgence in any depressing passion, or almost from any cause whatever when un- accompanied by organic lesions, it may without fail be improved, if not entirely cured, by judicious change -of air, regimen, and a proper course of waters. It - - 4 8 - will be essential, first of all, to secure an accurate acquaintance with each particular feature of the case, both of those that are apparent and others of a masked kind. Not infrequently these patients will lead a practitioner off the scent by insisting that they have heart disease, or else bronchial or pulmonary complaints of an obscure nature, whereas the symp- toms felt in the throat and chest may be, and often are, simply dependent on a disordered condition of the digestive apparatus. If the dominating symptoms are of an inflamma- tory type, a sedative climate should be recommended, such as Pau in France, or the resorts on the south coast of England. The dry tonic climates of the south of France are contra-indicated; but if the case belong to the atonic variety, then the dry stimulating climate of Nice will do wonders, and a winter spent in such a suitable climate, with the subsequent sum- mer at one of the mineral springs, will go far towards a permanent cure. Many persons, even physicians, suppose that courses at mineral springs such as Brides-les-Bains, Tarasp, and Carlsbad, are lowering; but, on the con- trary, they are tonic and health-restoring, producing results in dyspepsia with constipation that no so-called restorative drugs can. They wash out the intestines and remove all toxic accumulations, promote ab- dominal circulation, and stimulate the liver and the peptic glands. When the tendency is acid and more — 49 — to diarrhoea than constipation, then the more alkaline springs, such as Vichy and Royat, are more applicable. Dysuria. — In painful urination, Contrex6ville, Vittel, Evian, are advised in France, Ems in Ger- many; Homburg also would be useful. Here, again, before coming to a decision, we must search for the cause of the pain in urination, and treat it. Ear Troubles. — Brides-les-Bains has these on its list. It is possible that the action of hot baths may have some slight influence for good. Eczema. — See Skin Diseases. E?nphysema. — The dry mountain climates help distention of the tissues with gas. Meran, Madeira, San Remo, in Italy, and Cimiez at Nice, are advised. The mineral waters also give excellent results. Eaux Bonnes, Cauterets, Allevard, La Bourboule, and Mont Dore, in France. At Reichenhall, in Germany, inhalation of saline spray is combined with the pneu- matic-chamber treatment. It is probable that all the springs do good, not so much through the mineral water, but owing to the fact that they are situated in tonic air climates in the mountains, where, the ozone or oxygen being in- creased in the lung tissue, and the unused and com- pressed air-cells relieved, benefit is derived. 4 TTT - 50 — Erysipelas. — Some of the chronic cases, and those subject to the disease, do well at hot sulphur-water springs, Aix, etc. Erythema. — The skin inflammations are much soothed at hot alkaline springs, Vichy, etc. Exophthalmic Goitre. — Hydropathic establish- ments are recommended for these complicated thyroid cases, where cold-water treatment can be combined with electricity. Eye Diseases. — These are very little if any aided by mineral waters. Fractures. — All old fractures do well at hot mud sulphur-baths. Dax, Bareges, Baden, Aix, Acqui, Salins, and hot salt springs. The treatment of old fractures at the hot sulphur- water stations has been recognized for many years in France as being of great value. In the time of Na- poleon I., large hospitals were built over the baths at Bareges, Vichy, Aix-les-Bains, and many other springs in this country, which are still kept up by the French Government, which yearly sends large num- bers of soldiers to be treated for fractures, stiff joints, etc. Gall- Stone. — See Colic {hepatic). Gastralgia. — See Dyspepsia {painful). — 5i — Gastric Catarrh and Ulctr. — See Stomach {Diseases of). Genu Valgum. — Aix, and the hot sulphur-waters where massage is given. Gleet. — Contrexeville, Vittel, Pougues. These waters act on the kidney, but it is doubtful if they would cure the local lesion. Gout. — Royat, Vichy, Dax, Teplitz, Marienbad, Eath, Aix-les-Bains, Homburg, Uriage, Brides, Carls- bad, Malvern, Harrogate, Baden-Baden, Cheltenham, Strathpeffer, Vittel, Nauheim, Kissingen, Evian (hy- dropathic establishments), Buxton, Ems, Leaming- ton, Pougues, Contrexeville. It must not be expected that any bath will resolve tophi. To the above mineral-water springs may be added Wiesbaden in Germany, as well as Aix-la-Chapelle, as they are fre- quently resorted to by persons of gouty disposition. Removal to a mild and dry climate in winter is usually followed by abatement in the frequency of the attacks in this disorder, if not by its removal alto- gether, when change of climate is resorted to at an early stage in the disease and when adherence to a proper regimen is rigidly observed. Of course, it is not during a paroxysm, nor even when an attack is imminent, that the change can be made, but when the patient is free from acute symptoms. In removing to a warmer climate, care must be — 52 — taken to regulate the diet in accordance with the habits of the country. The southeast coast of France, called " The Riviera," is usually considered to be the type of climate most useful and serviceable in these cases. Nice is perhaps the best place, unless the patient is also subject to chest complaints, when Beaulieu, or even Mentone, being more sheltered, would be advisable. The alkaline mineral-waters probably exert their beneficial effects through their action on the liver and alimentary canal. The gout cures at Carlsbad and all the stations embrace much more than drinking the waters, for they include exercise, bathing, diet, and many other things carefully attended to. Apollinaris water, which is sometimes recom- mended by English writers for gout, has no value. It is a simple drinking-water that is charged with gas by artificial means, and no one goes to its springs. It will be noticed that all kinds of mineral waters are recommended for gout. The hot ones are best in chronic rheumatic conditions, while Kissingen and Homburg salines are useful in chronic dyspepsia, Contrexeville and Vittel when the kidneys need work- ing, while the sulphur springs are best in the gouty constitution when it is accompanied by cutaneous eruptions. Drinking plenty of any hot water that has reached over boiling-point is a valuable remedy in gout, as it acts as a diluent and solvent of renal and other ex- — 53 ~ crementitious matters. This combined with hot baths keeps the skin in active order. These truths show that all the hot mineral-springs are useful in gout, as they hasten the complete metabolism of nutritive waste. It is considered highly beneficial to drink the hot sulphur-waters of Aix. English medical writers, speaking of the use of mineral waters, say that springs of the class of Aix have the advantage of being thermal, or hot, and act on the system by diluting the blood temporarily, and lowering the percentage of urates and sodium salts. This tends to retard uratic precipitation, and gives the kidneys time to overtake their arrears in the task of eliminating uric acid. Hcematemesis. — See Stomach (Diseases of). Hoztnatitria. — Contrexeville, Carlsbad, Spa. Hemoptysis. — See Phthisis. Hemorrhoids. — Carlsbad, Franzensbad, Brides, Vittel, Homburg, Kissingen, Moffat, Strathpeffer, Chatel Guyon. These are laxative waters that act in the usual way to relieve piles, but in the last few years what is called the perineal douche is given at Aix-les- Bains and other hot-water stations, to great advan- tage. This is combined with injections into the lower rectum of very hot water. This has a powerful effect for good, not only on piles, but on all the congestions — 54 — and hypertrophies of the lower bowel, with the ad- jacent parts. Prostatic troubles are wonderfully benefited by this form of treatment. Hay Fever. — The mountain stations: Cauterets, Luchon, Switzerland. Heart Diseases. — Nauheim, Aix-les-Bains, Bath, Baden-Baden, Pugny-les-Corbieres at Aix-les-Bains, are stations where the Oertel " terrain kur," or ascend- ing walks, are given, as well as Meran, Arco, and a number of the German health resorts. Nice and the Riviera in winter, and warm climates in general, are recommended in heart cases. Certain hydropathic operations would be harmful, but Aix-les-Bains claims with a few other stations that only good can come of a mild tonic form of mineral-water bathing treatment in many forms of heart disease. Hepatic Diseases. — See Liver {Diseases of). Herpes. — See Skin {Diseases of). Hydropathic Establishments. — In England: Mat- lock, Smedley's; Dr. Fergusson's at Malvern; Wyche- side at Malvern; The Mansion, Richmond Hill, Sur- rey; Tyndale, Hexham, Northumberland; The Hall, Bushey; The Somerville, St. Aubin's, Jersey; The Imperial, Harrogate. In Scotland: Deeside, Heath- cot, near Aberdeen; Bridge of Allan, near Stirling; — 55 — Philps, Dunblane, Perthshire; The Waverley, Mel- rose; The Edinburgh (Jas. Bell, manager). Champel in Geneva; Divonne, also near there. Gerardmer, in the vosges of France, is a good water-cure. Worisho- fen, in Bavaria, is Father Kneipp's home, while Jor- danbad, in Wiirtemberg, is on this system. In Paris, Dr. Beni-Barde, Rue Boileau 12, Dr. Duval, Rue Jacob 20, Dr. Descourtis, Faubourg St. Honore 108. and Dr. Keller, same street, 127, with Dr. Chevan- drier de la Drome, 47 Rue Pigalle, have excellent hydrotherapeutic establishments. There are many more of these water cures, but the above are a fair sample of them. It must also be remembered that all the mineral-water cures and stations, even the hot springs, have also a hydropathic system installed. They are all in mountainous countries, where they can get plenty of pure cold water in addition to the water coming from the springs; so it is made use of in cold douches and all the usual cold-water cures. Hypochondriasis. — Gastein, St. Sauveur, Matlock, Champel, Divonne. Hydropathic cold-water cures. The sunny winter places: Nice, Nervi, San Remo, etc. Hysteria. — Aix-les-Bains, Carlsbad, Franzensbad, Gastein, Spa, Bagneres de Bigorre, St. Sauveur, Mat- lock, Champel, Divonne. (See Hydros.) The bright winter climatic stations: Nice, Cannes, Monte Carlo. Hysteria and hypochondriasis are of those dis- - 56 - orders that traveling from place to place amongst bright sunny cities, like those on the Riviera, with cheerful society, improves constantly. The mineral- water indications are those of nervous forms of dys- pepsia: the dry, exciting, tonic atmosphere of Nice, with all its gaiety, moderate diet, gentle exercise, and careful attention to the healthy performance of the secretory and excretory functions, combined with bathing and massage. Italy in the spring, May and June (after the bad weather has been passed) at Nice or Cannes, for instance, is to be recommended, for the bright Italian cities are only a few hours apart, and there is so much to see in each of them to interest this class of patients that this trip should form part of every European tour. Impotence. — Aix-les-Bains, Chatel Guyon, Fran- zensbad, sea-sides, warm climate in winter, Nice, etc. Gastein, in Austria, claims to treat this trouble with great success. Indeed, most of the German watering-places place impotence on their list of cures. Inso?nnia. — Aix-les-Bains, Bagneres de Bigorre, mountain climates in general, Gastein, Wildbad, Mari- enbad, Franzensbad. The valley of Aix is very seda- tive, and sleeplessness is cured easily there. There is a marked difference between Aix and the Riviera as regards sleeping. Owing to the excellent atmospheric conditions, people rest well at Aix, while in the South — 57 — the exciting air tends to produce insomnia in nervous patients. Intemperance. — Alcholism is well treated in Eng- land in special water-cure establishments. I men- tion Tower House, Westgate-on-Sea, Kent; Dalrym- ple Home, Rickmansworth, Herts; High Shot House, St. Margaret's, Twickenham, Middlesex; Kingswoods Park, Gloucestershire, near Bristol; The Peak at Buxton. This question of the abuse of alcoholic drinks is not well discussed in medical works, and yet it is of the greatest importance. It has been forced upon the English by the intemperance of the citizens; living as they do on a damp island, they found they could take with impunity, indeed with benefit for a certain time, a quantity of alcohol. This, however, had a limit, and it was soon found to end in disease. Vichy and the hot alkaline springs abroad, of course, do good in these cases, which are often com- plicated by liver disorders. (See Liver.) Intermittent Fever (after attacks of, and those subject to). — La Bourboule, Levico, Homburg, Carls- bad. Sea voyage. The arsenical waters, as above, are the best of the mineral waters for this condition. Intestines (Atony of).-— Carlsbad, Chatel Guyon, Marienbad. -58- Intesti?ial Obstruction. — The same. Jaundice. — See Liver {Diseases of). Joints (Diseases of). — Aix-les-Bains, Dax, Teplitz. (See Rheu7?iatis?n.) Kidneys (Diseases of). — Milk and whey cures, and grape cures, which are given at nearly all the stations. (See Albuminuria?) In chronic nephritis after all inflammation is over,, send to Contrexeville, Vittel, Vichy, Royat, Pougues, Evian, Matlock, Tarasp, Amphion, Thonon. Change of climate may be successfully employed in several forms of renal disease which threaten to go on badly as a consequence of too close application to business so common in America, a deficiency of out- door life and exercise, a too stimulating diet, and the very common over-free indulgence in alcoholic. and other stimulating drinks. A warm and fairly dry climate, by increasing the activity of the skin and lungs, would exercise a bene- ficial effect in all such cases, especially when aided by a well regulated diet and judicious regimen. Evian is a very favorite water for such cases. It is nicely sit- uated on the French side of the Geneva lake (Lake Leman). Larynx. — See Throat (Diseases of). — 59 — Lead Poisoning. — Ofen or Budapest, Aix, Cau- terets, Brides. The elimination of lead can be hoped for by hot sulphur-waters, particularly when com- bined with massage under the water, as done at Aix- les-Bains, Bath, etc. Leucorrhoea. — Baden, near Vienna. Bagneres de Bigorre, Spa, Franzensbad, Plombieres, Aix-les-Bains, Ischl. Daily vaginal injections are arranged for in many of the baths in Europe. With this local treatment can be combined the effects of alkaline waters — iron springs or the sulphur ones, as may be needed. The hot alkaline baths, such as Vichy, with the internal use of one of its iron springs like " The Madame" for drink- ing, is often successful in cases taken early. The sulphur-waters, such as Baden-bei-Wien, Bagneres, Aix, as well as Franzensbad and Ischl, are more used for old or chronic cases to get the stimulative effects of the sulphur- water on the mucous membranes. Spa and Schlanganbad are more used for the medicinal effects of iron-waters on the anaemia or chlorosis that may be present with the " whites." The salt waters said to contain iodine — Hom- burg, Soden, Salins-Moutiers — are given when scrof- ula is suspected. Liver {Diseases of). — Carlsbad, Ems, Vichy, Brides, Montecatini, Pougues, Clifton, Panticosa, — 6o — Royat, Malvern, Leamington, Cransac, Harrogate, Cheltenham, Marienbad, La Bourboule, Bourbonne. Carlsbad and Vichy are the most popular springs for cases of liver complaint, but the mere word " liver" does not define accurately what the disease may be the patient has. When there are any symp- toms of hepatic colic, for instance, the waters like Evian, Vittel, or Contrexeville are more often used than Carlsbad or Vichy. Congested liver, with or without enlargement, is certainly treated advantageously by such waters as Carlsbad, Marienbad, and Tarasp, while almost simi- lar effects can be got at Kissingen and Brides, in France; Harrogate, Cheltenham, and Leamington, in England, have a certain purgative action that is use- ful; and a number of cases are benefited by ordinary sulphur-waters, but, as a rule, waters containing purga- tive salts are used. Cirrhosis in early stages, before the organism breaks up, is often treated with benefit at the salt wells which contain iodine. For waxy, amyloid livers, and fatty liver in the strong, Vichy may be tried, or even Carlsbad; but the moment these patients become weak and anaemic, then chalybeates should be intro- duced: the waters of Brides, Royat, and La Bour- boule in France, Spa in Belgium, and Ems in Ger- many, may be tried then to advantage. Locomotor Ataxy. — Lamalou, in France, and Ba- — 61 — laruc claim cures. Uriage, Aix-la-Chapelle, Aix-les- Bains, Gastein, Wildbad, Ragatz, Nauheim, Neris. Bushey and Bath treat such cases. In winter they are sent to warm climates — Nice, Cannes, Nervi, San Remo, etc. As tabes is nine times out of ten of syphilitic origin, it is logical to give anti-syphilitic treatment, and one of the best means of having it tolerated is to give it in hot sulphur-water douches, like those of Aix-les-Bains in France, and Aix-la-Chapelle in Ger- many. Besides this action, Lamalou and Balaruc, in France, are stations near Marseilles that claim won- derful effects of a specific nature. Some of the French professors send their patients to these places every year. Neris, in France, is also a watering-place that is said to possess special virtue in nervous cases. Lumbago. — Bath, Aix, Baden-Baden, Marienbad, and all the hot springs. Beyond question, massage under hot water will cure chronic cases of lumbago. Malaria. — La Bourboule, Levico, Brides, Bath, Aix, sea-side and hydropathic establishments. The arsenical waters like La Bourboule and Levico have the double advantage of being medicinal and being in a high mountain country. The first is in the famous Auvergne Mountains, in the centre of — 62 — France, and the second is a very strong arsenical water in the Austrian Tyrol. Naturally, change is of great value in malaria. The hydropathic establish- ments giving cold-water cures help the condition with all their hygienic treatment and the healthy sur- roundings which are generally to be found there. Metritis. — See Uterus. Myalgia. — Aix, and all the hot springs where massage is used. Neuralgia and Neuritis. — Aix-les-Bains,* and the hot sulphur baths when from rheumatism. The cold ones when arising from nervous disturbance. The triumph of massage under hot water is seen in neuralgias at Aix, and at Bath in England, while the excellent cold-water cures can do great good in neu- roses. Neurasthenia, Nervous Debility, Neurosis (see Hydropathic Establishments). — Gastein, Alvaneu, cold- water cures, Neris, Lucca, Levico, Pyrmont, Mal- vern, Spa, Teplitz, Aigle, Plombieres, St. Sauveur, Ems, Droitwich, Baden, St. Moritz, Marienbad, Rip- poldsau, Salins, Divonne, Champel. Dr. R. Vigoureaux, of Paris ; has lately studied this condition, and he claims that it is an outcome of arthritism. In a word, the neurasthenics are rheu- - 63 - matics, and he proposes that they should be treated in water cures by warm baths of long duration (one to three hours), to combat the general erethism and insomnia; with this massage, and, above all, static elec- tricity. He adds bicarbonate of soda in large doses to ^overcome the acid condition of the blood found in arthritic subjects, and excludes all other medication. He thinks the alimentation should only be sufficient for the actual needs of the system, and does not ap- prove of over-feeding. If it be so that the neuras- thenics are rheumatics, then the well known results at Aix-les-Bains of massage under the hot sulphur- water can be tried, and the after-cure at an alkaline station like Vichy would be useful. For nervous diseases the climate of the Mediter- ranean Coast has, according to different writers, as many disadvantages as virtues. Some physicians have taken the course of simply forbidding the Riviera for all their patients who have disordered nerves; but such a sweeping condemnation is by no means de- served. . Experience has taught us that epileptics should not go to Nice, and the morbid condition of such -patients, as their stay is prolonged there, gets worse and worse. Hysteria often seems incompatible with our pres- ent view of it as a mental disease, and all cerebral forms should be excluded but hypochondria. Neural -asthenia of spinal origin, locomotor ataxy without - 6 4 - insomnia, all the neurotic disorders of the stomach and intestines, neuralgia of peripheric origin, espe- cially in elderly persons, have so frequently shown decided improvement that attention must be called to the fact. I have been often struck with the good results in neurotic uterine and ovarian troubles and in many troublesome neuralgias. The rapid transition, by the express trains now in use, from the North, makes it only natural that some functional disturbance of the nervous system should occur in many people on first coming to the exciting air of the South, but only a short time in it will show the beneficial influence of the tonic climate. Nose {Diseases of). — See Rhinitis. Obesity. — Brides-les-Bains, Marienbad, Carlsbad, Aix-les-Bains, Pugny-les-Corbieres at Aix for ascend- ing walks. Kissingen, Arco, Meran, Bath. The regular recommendation of massage and muscular exercise, with a certain regimen, is what is always prescribed in obesity, and to this can be added a mineral-water treatment. In the strong, the purga- tives of Carlsbad and Marienbad in Austria. In the weaker, the laxatives of Brides-les-Bains in France, or Chatel Guyon. Certain acute cases do well under an alkaline treatment, like Vichy in France. All of these places have good walks for exercise. Aix-les-Bains has the massage underwater, which is a - 65 - ten-mile walk in each bath, and has the advantage of exercising muscles that cannot be moved by ordinary walking up or down hill, or even by gymnastic exer- cises. All the stations have milk cure, and fencing, lawn- tennis, and other exercises. Paralysis. — Agitans: Massage at Aix-les-Bains useful. The cold-water cures. Cerebral form: Lamaiou, Balaruc, Gastein, Nied- erbronn, Malvern, Acqui. Spinal form: Wiesbaden, Schinznach, Gastein, Mont Uore, Neris, Plombieres. Rheumatic forms: Aix-les-Bains, Neris, Acqui, Bath, Valdieri, Harrogate, Baden-Baden. Lead forms: Cauterets, Luchon, Aix-la-Chapelle, Uriage, Ofen, Dax, Bath. Senile forms: Balaruc, Lamaiou. Hysteric: Ems, Plombieres, Aix. Syphilitic: Aix-la-Chapelle, Aix-les-Bains. Climatic Treatment: Nice, Cannes, Mentone, etc. It would require a large book to write up the different forms of paralysis and their treatment at the European Spas. The above is a fair selection of the places treating the various forms, and in a general way they all do well at hot baths where a systematic massage of the paralyzed muscles or nerves can be carried out. Even hemiplegia is claimed to be cura- ble at Lamaiou, in France, while the cold-water estab- — 66 — lishments certainly do good in nervous forms. Lead forms are best sent to the hot sulphur baths. They all do well in the warm climates in winter. Phthisis. — The question of treatment of these cases is a very complicated one. The best general rule is as stated under " Winter Resorts : " " That the cli- mate that affords the greatest facilities for passing the greater portion of the time in the open air is the best one for such patients." An ocean journey is good in mild weather, and a few places are recommended in England, when the patient cannot go farther, such as Penzance, Hastings, Torquay, and Ventnor. Glen- gariff and Rostrevor may be considered in Ireland, and Rothesay in Scotland. The dry climates have constantly proved of the greatest benefit to consump- tives, such as Mentone, Tangiers, Morocco, Egypt, The Cape, Australia, Malaga, Madeira, San Remo, Reaulieu, near Nice, Ajaccio in Corsica, Alassio, Amelie-les-Bains. Arcachon, or Pau, would do in autumn, but not later. Next the high altitudes, cold sunny places, Davos-Platz, St. Moritz, Pontresina, Arco, Meran, Gardone-Riviera. The Denver, Colo- rado, sanataria are excellent also. A word must be added for the air cures, Gorbersdorf, Falkenstein, and Vernet, with Pugny in France. As to mineral-water treatment in summer: Eaux Bonnes, Ems, Mont Dore, Cauterets, Ischl, La Bourboule, Royat, Marlioz, St. Honore, Allevard. -67 — It is difficult to explain the exact situation of each health resort in Europe in regard to the indica- tions for consumptives. The principles I have laid down are contained in the newer phthisis-therapy, so successfully used in Germany. I mean the air cure. Life in the open air, day and night, can be well carried out even outside of the great institutions, and perhaps much better where there is not an accumulation of fellow-sufferers. This may be done in small hotels and boarding-houses, the "Pensions" of Southern France, where all the system may be practiced under careful medical direction. I have often seen active consumption reduced to a stationary condition in the South, in the presence of favorable circumstances, with proper hygienic and dietetic treatment. The consumptive who has been ill for years drifts slowly into aerophobia in spite of all treatment and strengthening diet. He stays in the house more, oxidizes his blood less, and gets into bad ways; and just here an anatomical factor belonging to nature's healing forces comes in to reinforce the enemy. The beneficent efforts of nature to hem in the seat of the disease with protective walls in such a way as to" isolate it, causes the formation of stringy scars in the diseased lung, of flat and filamentous adhesions in the pleura, and by thus cutting off portions of the breath- ing surface it diminishes it. From these, nature's healing operations, more imperfect oxidation takes place, with some obstruction of the circulation. Such patients revive in the South, where the warm sun and air tempt them out of doors. The cold mountain cli- mates are beyond their power of assimilation. Of course the residence in Southern France is not to be a permanent one; and as it is only provisional, the object of renewed adaptation to the conditions of the home life must be kept in view by patient and physician, and all efforts be made to have the patient get well enough to take up the healthy mode of life at home. Pleurisy (chronic). — Eaux Bonnes, St. Honore, Mont Dore; the warm climates in winter. Pleurodynia. — Aix-les-Bains, and hot waters in general. Pneumonia. — After-treatment: The warm cli- mates in winter, and the sulphur springs the next summer. Potfs disease. — Salins, Meran, sea-sides. Psoriasis and Prurigo. — See Skin Diseases. Rheumatism. — Simple chronic forms: Aix-les- Bains, Bath, Dax, Buxton, Acqui, Woodhull-Spa, Nauheim, Salins, Droitwich, Baden, Teplitz, Luchon, Cauterets, Malvern, Plombieres. Mud, pine and sand baths, Marienbad, and most of the hot springs — best — 6 9 — where the " massage-douche" is given, as at Aix- les-Bains. Rheumatism with nervous diseases: Neris, St. Sauveur, Bath, Plombieres, Tarasp, Matlock. With gout: Royat, La Bourboule, Pougues. With gravel: Vichy, Vittel, Carlsbad, Wiesbaden. With bronchial catarrh: Mont Dore, La Bour- boule. With skin disease and syphilis: Aix-la-Chapelle, Aix-les-Bains, La Bourboule. With deformed and fixed joints: Dax, St. Amand, Marienbad, mud baths. The climatic treatment is, of course, mild cli- mates, such as Nice, Cannes, Mentone, San Remo. Egypt sometimes, but in this case they must not stay in Alexandria or near the damp coast. Cairo is best, or up the Nile. There is no question but what persons afflicted with rheumatism should seek warm climates in win- ter, never the mountains. The residues of acute rheumatism of the joints are most rapidly cured in the south of France. The results are less certain in chronic rheumatism, but the comfort obtained is valuable to the sufferers. The chronic forms of rheu- matism assume so many disguises that we often have to call it a nervous debility more than real rheuma- tism. We constantly see cases of arthritis deformans that remain stationary in the South, and yet it will be — 7 o — admitted that this disease is a notoriously progressive one in the North. Rhinitis {Chronic Nasal Catarrh). — When in pas- sive, depressed patients, the sulphur-waters: Cau- terets, Luchon, St. Honore, Marlioz, Challes, Alle- vard. In nervous patients, the alkaline springs: LaBour- boule, Mont Dore, Royat. Ems. Climatic treatment is effective; I know of nothing better than the dry-air places of the south of France, where we have con- stant success in post-nasal catarrh. Nice, Mentone, etc., but more than one season's residence is necessary. Sciatica. — Aix-les-Bains, • Bath, Buxton, Teplitz, St. Sauveur, Woodhull-Spa. Dry mild winter climates in winter. Nice, Cannes. One author claims Monte Carlo to be particularly good for such cases, winter and summer. Skin Diseases. — Acne: Luchon, Aix, Ems, Schlan- genba.d, Tarasp, Schinznach, La Bourboule, Harro- gate, Ardales. Eczema: Uriage, Kreuznach, Salins, Aix, Levico, Royat, Acqui, Cauterets, Kissingen, Bath, Lisdon- varna. Lupus: Ofen, Budapest, Eaux Bonnes, Levico. Psoriasis: Nauheim, Bath, Levico, Harrogate. Prurigo: N£ris, Luxeuil, Aix. — 7i — Tinea sycosis: Sea baths, Salins. Urticaria: Kissingen, Franzensbad, Moffatt, Vichy, Aix, Neris. The skin diseases are mostly sent to sulphur baths as above; but taking eczema alone, it will be seen that the sulphur-waters of Aix, Uriage, and Cau- terets, in France, are recommended, and then the arsenical alkalines, like Royat and La Bourboule, meet other cases, while the salt springs, like Salins in France, are also given. To say just why and when, is extremely difficult. I have seen Luchon tried in one case and do no good, although a strong sulphur- water, and Aix, a weak spring, accomplish a cure in connection with massage. It may be stated that the sulphur-waters are best in the scaly cases without much pain, and the alkaline when pain is consider- able. Lupus is treated at Eaux Bonnes, and Buda- pest in Hungary claims results. The very strong copper and arsenical waters at Rousegno and Levico, in upper Austria, are also claimed to be curative in this disease. Acne is treated at Aix; also Urticaria, though this last does best at Vichy when from a stomach cause. Here again, in all these complex cases, we come back to the question, What is the cause ? in all the dis- eases, and particularly so in skin complaints, admit- ting, for instance, the so-called three-fold etiology of urticaria or nettle-rash. If it be from a nervous cause, then Neris, in France, or Kissingen, is the best — 72 — cure. If from the digestion, then Vichy and the places mentioned under Dyspepsia. If from some female irregularity, then the hot sulphur-waters with massage, as at Aix, Savoy in France, or Fran- zensbad in Austria. Spermatorrhoea. — Gastein, Cauterets, Allevard, Marlioz, Neris, Balaruc. Sprain. — Aix-les-Bains, and hot sulphur-waters, with massage. Sterility. — A number of the hot springs claim (doubtfully) to cure this condition. The massage- douche may be useful. Aix-les-Bains, Franzensbad, Ems, Pougues, Marienbad, Schwalbach, Spa, and iron-waters. Stomach {Diseases of). — Vichy, Homburg, and the gaseous alkalines, grape cures, Voslau, Kissingen. Gastralgia: Plombieres, Roy at, Evian, Homburg, Pougues. Dilatation: Carlsbad, Chatel Guyon, Aix. Catarrh: Carlsbad, Chatel Guyon. Ulcer: Vichy, Ems. Under Dyspepsia I have given some of the indi- cations for these stomach complaints in a general way. Hyperacidity and hypersecretion of the gastric juice are, of course, the two most common forms of de- — 73 — rangement of the gastric organ, while mere neurotic atony does not produce a loss of function and must be treated differently. A great distinction must be made between Vichy and Homburg, as the first is an alkaline water and the second a saline. It is probable that by drinking large quantities of alkaline water, or, indeed, any warm water, the bile will flow more readily and in greater attenuation, but the old dogma of some specific action of alkalines on the secretion of bile is no longer believed. The mild salines like Homburg seem to have an excellent action in many stomach cases, owing to their power of quickening gastric digestion. This subject is too vast to be entered into here. The hint is thrown out to wash out the stomach, and use the new chemical tests before making a diagnosis and giving advice. Strumous Affections. — First period (children 2 to 10) : Sea-sides, Arcachon, Biarritz, Cannes, Nice, Berck. Then the salt springs: Salins, Uriage, Nauheim, Ischl. Second period (10 to 20, adolescents) : Salies de Beam, Salins, Ischl, Nauheim, Valdieri, La Porretta, Soden. Third period (adults): Then the hot sulphur-springs: Luchon, Cauterets, Aix, Baden, Eaux Bonnes, St. Honore, Enghien, Acqui, Kreuznach, Marienbad, St. Moritz, Woodhull-Spa, Harrogate, Ischl. See Tuber- culosis. — 74 — Syphilis. — Aix-la-Chapelle, Aix-les-Bains, Uriage, Archena, Saxon, Harrogate, and sulphur-waters in general, but the constitutional treatment must not be dispensed with. Aachen, as Aix-la-Chapelle is called in Germany, has a well deserved reputation in syphilis. The Ger- mans believe in rubbing in mercury just before the baths, and have men trained for the purpose. It is not easy to get patients themselves to rub the lanolin ointments, or the regular blue one. The lanolin makes them very black, and they have difficulty in getting it off, so that when it can be ordered to be rubbed in by the bathmen it is probable that a better treatment can be carried out in a systematic way in such resorts as Aachen. On the other hand, it has got to be so well known now as a bath for the treat- ment of what a witty writer there calls "suppressed rheumatism" that Aix-la-Chapelle is feared by the knowing ones. In the French Aix-les-Bains, syphilis is also treated, but not so much by the use of mercurial in- unctions. The French and foreign doctors at the French resort follow Professor Fournier, of Paris, and give the proto-iodide internally, and rely on the baths with douche-massage to eliminate the surplus or at least keep the skin in good order. Throat {Diseases of). Tonsillitis: Marlioz, Challes, Cauterets, Allevard, Uriage, Ems, Homburg. — 75 — Pharyngitis: St. Honore, Pierrefonds, Ems, Eaux Bonnes, Schinznach, Soden. Ulcerated throat: Aix-les-Bains, Aix-la-Chapelle, Baden, Uriage. The mild winter climates, Nice, Cannes, Mentone, etc. All the remarks under Bronchitis can be referred to for these cases. Tuberculosis. See Strumous Affections. — In treat- ing young children who are strumous, the sea baths of the Mediterranean have a certain advantage over those of the Atlantic, being more salt, without break- ers, and in a warm climate, so that baths can be taken all the year round. Cannes has a better beach than Nice, but there are good spots all along the coast. See under Phthisis and note that all the sulphur baths are useful in these states, while the so-called inland mountain salt springs are often more useful than the sea itself. Nauheim in Germany, Salins- Moutiers in France, Droitwich in England, are ex- amples. Uterus {Diseases of). — Women's diseases and all the pelvic affections are treated at many of the springs with great success: Franzensbad, Baden, St. Sauveur, Marlioz, Aix, Luchon, Brides, Kissingen, Kreuznach, Marienbad, Bath, Royat, Schwalbach, Spa, Woodhull- Spa, Pyrmont, Gastein, Wiesbaden, Bourbon l'Arch- ambault. The mild winter climates, as already said, - 76 - are indicated in all diseases of women, whose special functions are performed there better than in the North in winter. Varicose Veins. — Alkaline waters, Vichy, etc., are better than the hot sulphur-waters, but care must be taken in all cases not to bring on phlebitis by exces- sive massage and the use of baths. Venereal Excess. — Gastein. See Hydropathic Es- tablishments, page 54. Wounds. — Old gun-shot wounds are treated at the hot sulphur-springs, such as Bareges, Luchon, Aix, Teplitz, also at La Bourboule, while the mud baths of Dax, and Marienbad are given with success. Soluble Elastig Capsules ^m- ► •» «4 -*»► By delicate and fastidious patients, nauseous drugs, being repugnant both to the palate and to the stomach, are refused and thus their use in such cases practically prohibited. 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