HYDROTHERAPY HT SARATOGA I RWI N nMolMl intljeCtlpoflmgork COLLEGE OF PHYSICIANS AND SURGEONS LIBRARY Xx'] HYDROTHERAPY AT SARATOGA Sacred Fonts ! flow on forever, Health on mankind still bestow ; If a virgin woo thee, give her Rosy cheeks and beauty's glow ; If an old man — make him stronger, Suffering mortals soothe and save, Happier send them home, and younger. All who quaff thy fervid wave. — LoBKowiTZ : trans. Johnston. HYDROTHERAPY AT SARATOGA A TREA TISE ON NA TURAL MINERAL WA TERS BY J. A. IRWIN M.A., Catnbridge, Eng.; M. A ., M. D., Dublin University; L. M., Coll. of Physicians, Ire.; Member of Royal Coll. of Surgeons, Eng.; Member of the British Medical Association; Fellow of the London Obstetrical Society., and the New York Academy of Medicine., etc. FORMERLY House-Surgeon Royal Free Hospital, London; Medical Officer Shrop. shire and Montgomeryshire Counties Lunatic Asylum: and Physician to the Manchester Southern Hos- pital for Women and Children CASSELL PUBLISHING COMPANY NEW YORK ^1 Copyright, 1892, by J. A. IRWIN. Aii rights reserved. THE MERSHOar COMPAKY PSBSS, BAHWAY, N. J. ^- PREFACE. The United States, in so many re- spects exceptionally gifted, possesses already more than 8000 known mineral springs, of which about 800 have been analyzed, and not a few found equal, if not superior, to those of highest repute in the Old World. Nevertheless, the scientific use of mineral waters is strangely ill-defined, and, since the days of Priessnitz — the father of the so-called hydropaths, who accepted water as the only remedy for all diseases — a certain atmosphere of quackery has permeated the subject, resulting in its neglect by reputable physicians. VI PREFACE. Visitors at the watering places are glutted with circulars and pamphlets is- sued for purposes of advertisement, by persons fiancially interested, and each putting forward in almost identical clap-trap the same absurdly pretentious claims. Saratoga is especially so plagued ; owing, in a measure, to the large and in- creasing number of the springs, and the occasionally hostile rivalry of the pro- prietors. As a consequence, the waters are used without proper guidance or discrimination, and often improperly, with disastrous result ; and in the public estimation there remains scarce any middle ground between an unques- tioning cure-all faith and an equally un- reasonable condemnation. The purport of this work is to PREFACE. Vll establish among educated readers a correct and unprejudiced valuation of mineral waters generally, and those of Saratoga in particular. Mineral springs have been known and appreciated from the earliest times, both for drinking and bathing purposes. They have been written upon by Hip- pocrates himself, and since the days of Herodotus and Pliny. It is easily con- ceded, then, that a treatise upon this subject can in few respects lay claim to originality ; and, as will be noticed in the text, the author acknowledges a wide obligation to others, and in some instances holds them duly responsible for opinions not coincident with his own, or confirmed by direct experience. It has, at least, the merit of being absolutely non-partisan — from the pen Vlll PREFACE. of one who, while highly esteeming mineral hydrotherapy in its by no means unlimited sphere, regards it as nothing more than an important, al- though much neglected branch of gen- eral medicine. In teaching its uses it is impossible at times to avoid entering somewhat fully into the clinical aspects of disease, and the associated applic- ability of other methods of practice. It should not be understood, however, that this work is intended as a guide to self-treatment, even within the confines of hydro-therapeutics ; nor can it super- sede for sick persons the necessity of professional advice, which must always vary in accordance with the circum- stances of each individual case. But, as an intelligent patient, capable of un- derstanding and co-operating with the PREFACE. IX aims of his physician, is more likely to derive benefit from treatment, so it is desirable that persons visiting Saratoga, and making use of its waters, should have some general knowledge of their characteristics and mode of action. It is also hoped that in the following pages the professional reader may find information, not without interest and practical value ; and, although some points are left untouched, or still in doubt, which may be more fully dis- cussed in the future, it should be re- membered that, as in all other branches of knowledge, ** not directly, but by successive approximations do mankind reach correct conclusions."^ Grand Union Hotels No. 14 West iqth St., Saratoga. New York. CONTENTS. CHAPTER I.. SARATOGA. PAGE Necessity of periodic change — Saratoga — Advantages as a health resort — Accessibility — Discovery of springs — Early history . . . . . . i CHAPTER n. THE ORIGIN OF MINERAL WATERS. Mineral waters — Source of water — Method of mineraliza- tion — Acquisition of gases — Peculiarities determining emergence . . . . . . -9 CHAPTER HI. GEOLOGICAL CONDITIONS AT SARATOGA, Geological conditions at Saratoga — Water-shed — Local characteristics . . . . . • ^9 CHAPTER IV. CLASSIFICATION AND ANALYSIS. General classifications of mineral waters — Chemical — Therapeutical analyses of Saratoga waters — Difficalties concerning — Tables of analyses — Skeleton analysis . 29 XIV CONTENTS. CHAPTER V. COMPONENT PARTS OF THE SARATOGA WATERS. PAGE Component parts of the Saratoga waters, considered sepa- rately — Carbonic acid gas — Salines — Alkaline bicarbon- ates — Iron — Water . . . . '39 CHAPTER VI, METABOLISM, AND ALTERATIVE EFFECTS. Definition — Excuse for physiological details — General effects of waters — Special sphere of usefulness , . 73 CHAPTER VII. BALNEOLOGY, OR THE SCIENCE OF BATHING. Balneology — General division — Physiology — Hygienic cold bath — Use not confined to robust persons — Hot and warm baths — Thermal mineral baths — Bath fever — The douche — The wet pack — Mud and sand baths — Turkish and Russian baths . . . . . .85 CHAPTER VIII. THERAPEUTIC APPLICABILITY AND DIETETICS. General applicability of hydro-mineral treatment — Dietary — No special prohibitions — Life at Saratoga facilitates temperance ....... 135 CHAPTER IX. A PRACTICAL DIVISION OF SARATOGA WATERS. Practical division of Saratoga springs . . . 153 CONTENTS. XV CHAPTER X. GENERAL PRECEPTS. PAGE General precepts governing their use — Best time to drink — Quantity — Question of suspending ordinary treatment . 159 CHAPTER XI. NOSOLOGY. Nosology — Scrofula — Characteristics of the diathesis — Manifestations— Hydro-mineral treatment in. Phthisis — Method of attack — Applicability of mineral waters — Bal- neological treatment — Saratoga as residence. Gout — Eti- ology — Acute, and vicarious attacks — Chemical action of waters — Disposal of urates. Rheumatism — En*atic char- acteristics — Alkaline remedies — Atony of the skin — Stim- ulant bathing — Lumbago, sciatica and torticollis. Di- gestive Diseases — Various types — Gastric ulcer — Use of waters by syphon. Liver — Cirrhosis — Tumors — Jaun- dice — Ascites — Metallic poisoning. Pancreas. Constipa- tion. Abdominal stasis. Obesity — baths in. Catarrh — general and local use of waters. Renal and Bladder Diseases — Diabetes. Diseases of the Heart and Blood vessels. Diseases of Bone. Skin Diseases. Diseases of Women. Nervous Diseases. Retarded Convalescence . 173 CHAPTER Xn. Bottled, recharged, and artificial mineral waters . . 255 Hydrotherapy at Saratoga CHAPTER I. SARATOGA. A FEW weeks' sojourn at the sea- side, or some inland health resort, has become to Americans a national neces- sity. The average city man of to-day can scarcely be considered entirely healthy. If seldom absolutely sick, he is quite often "a little under the weather." He will tell you that noth- ing ails him ; but follow closely his daily life and you will find that he is constantly taking medicines — as his forefathers never did. Now it is a 2 H YDRO THERA PY AT SARATOGA. quinine pill to brace up on, or combat a latent malaria ; now some antipyrine or phfenacetine for a cold or head- ache ; now some pepsine or a cathartic for his stomach or bowels, and so on. Why is this so ? Because of his own imprudences : his hurrying, rest- less, nerve-straining life, constant high pressure, too many bracers, irregular meals, eating too much and chewing too little ; but always ready to sacri^fice the requirements of nature on the insatiable altars of business or pleas- ure. Such a one walks upon the edge of a precipice from which he cannot be induced to tear himself away ; but he is often willing to postpone the inevit- able crash, which, even he knows, is bound to come sooner or later, in the form of cirrhosis, Bright's disease, or SARATOGA. some miserable neurosis, by giving his system a complete renovation at least once a year. For this purpose a visit to some bright summer resort is just what he needs ; and none on this hemisphere offers as wide advantages as Saratoga. Not only are the waters pleasant to drink, and available in some form to the majority of visitors — the pleasure seeker following in the route of fashion, as well as the invalid, the ex-- hausted brain-worker, and the fagged- out beauty striving to regain her lost complexion — but all the attendant cir- cumstances are usually conducive to the restoration of perfect health. The rapid succession of new events enlivens the mind and leads away from worri- ment. The pure country air, the mod- 4 HYDROTHERAP Y AT SARA TOGA. erate altitude, the usually pleasant temperature and cool nights, the ^altered diet, the increased bodily exer- cise, the easy relinquishment of injur- ious habits, the facilities for active recreation of all kinds and luxurious bathing, combined with a delicious rest, which is not idleness but merely change of thought — each plays its part in accomplishing a physical and psychical recuperation. ^ To one who, during ten months out of the twelve, is obliged to live in, and breathe, the dirt-carrying, moisture- laden atmosphere of the sea-board cities, the air itself has a conspicuous cleanliness brimming with health. He notices that stray articles he happens to touch no longer soil his hands, even that his linen takes many hours longer SARATOGA. to show the accustomed evidence of wear. In fact, Saratoga offers all that the country can give, without the intoler- able dullness, which at some health resorts renders life a perfect blank. A good general description of Sara- toga — its pleasant location, delightfully shaded streets, natural beauties, and interesting history ; its parks, lakes, magnificent hotels, and never-ending attractions — is to be found in the guide books, and needs but the briefest outline here. The village is situated toward the eastern border of the State of New York, at the termination of the Adirondack range, and about the center of the valley extending from Balston to Quaker Springs. It is distant from New York City 183 miles. 6 HYDRO THERAP Y AT SARA TOGA. from Philadelphia 274 miles, from Bos- ton 205 miles, from Washington 412 miles, and from Chicago 841 miles, and is readily accessible from all these places. The altitude is about 300 feet. The population varies from about 11,000 in the winter to 35,000 during the season, which lasts from the mid- dle of June to the middle of Septem- ber. The accommodation for visitors of all classes is ample and excellent, and the general sanitary arrangements are good. The name, like most others in this vicinity, is derived from the Iroquois Indian. The discovery of the springs is rela- tively modern, with the exception of the High Rock, which, according to tradition, not long since* confirmed *i865— Walton. SARATOGA. by interesting remains found at the base of the rock, was known to, and utiHzed by, the Indians back in the fourteenth century. The earliest knowledge by white men of the valua- ble qualities of the waters seems to date from the advent of Sir William Johnson in 1767. That illustrious Scotch-Irishman, who in colonial days served this country scarce less than did subsequently George Washington, is mainly known to the popular history of to-day by the incident that, when he ailed unto death, the Indians, whom he had befriended and controlled by kind- ness and integrity, carried him for re- lief to the " Medicine spring of the Great Spirit," at Saratoga. The first white man's habitation was erected in 8" H YDRO THERA PY AT SARATOGA, During the subsequent thirty years various sturdy pioneers kept simple taverns for the entertainment of such visitors as were, even then, attracted by the growing reputation of the springs ; but the starting point of the Saratoga of to-day may be reckoned from the building, by Gideon Putnam, in 1802, of Union Hall; upon the site of which now stands the magnificent Grand Union Hotel. Since then over forty new springs have been discovered, any one of which might make the reputation of a health resort ; superb hotels have been erected on all sides ; and America has become possessed of a vSpa which, in every re- spect, rivals the oldest and most es- teemed in Europe. CHAPTER II. THE ORIGIN OF MINERAL WATERS. « Much interest still attaches to the origin of mineral springs, but belongs rather to the fascinating science of geology than to the mainly therapeutic scope of this treatise. From remote antiquity, through the superstitious ages, when good spirits were believed to guard medicinal springs, all manner of fantastic the- ories hav^e had ardent advocates ; and the subject has been abundantly dis- cussed by wise men and by fools. The rational points of inquiry are : (i) Whence comes the endless supply of water ? (2) How does it obtain its lo HYDRO THERAP Y AT SARA TOGA. mineralization and gaseous saturation ? (3) What local peculiarities determine its emergence ? The answers are fairly within our knowledge : (i) The water itself is neither newly created beneath the earth, nor is it the out-pouring of a subterranean sea, but is merely a part of the great aqueous circulation of nature ; and hence does not end. If we trace this circulation through^ its course, taking rain as a starting point, we find that as water descends from the clouds a portion goes directly into the lakes and rivers, or to renew thei great salty reservoirs ; while the remainder, falling upon the land, is collected on the surface to form mighty rivers, or else sinks deep into the ground ; but not to remain there permanently. It ORIGIN OF MINERAL WA TERS. 1 1 finds its way through soil and rock, through fissures and joints, until finally, by continuous descent, it reaches an outlet at some lower level ; or else by hydrostatic pressure is forced back to the surface in the form of springs. Then, having fulfilled its assigned pur- pose, whatever that may have been on earth, all which came from the skies passes away again by evaporation, to be recondensed in the atmosphere above, and fall once more as rain. Thus is completed a single round of one of the stupendous revolutionary systems which govern the entire course of nature, and know no pause or stay. How long this circuit may occupy for any particular water, such as that which issues from the springs, it would be idle to speculate; but ultimately, **that 12 H YDRO THERA PY AT SARA TOGA . which the fountain sends forth returns again to the fountain." It has been proven by experiment* that the quan- tity of celestial water which falls as rain, snow, and dew is more than suffi- cient to supply that which flows from the rivers and springs all over the world. (2) Now as to its mineralization and acquisition of gases : Water is unequaled as a solvent. No known substance can entirely resist solution by water ; f and as a consequence absolutely pure water scarcely exists in nature. As the rain descends from the skies, even before it reaches the earth's surface, it has already absorbed impurities from the atmosphere ; and from then * Mariotte and Halley. — Walton. t A. Getkie, " Text Book of Geology." ORIGIN OF MINERAL WATERS. 13 until it again passes off by evapo- ration, when — like man at his exit — it must leave all behind, it is — like man during his stay — constantly picking up something from each media with which it comes in contact. Already armed with minute quanti- ties of carbonic acid and other ingre- dients from the air, it proceeds to take up the organic acids which are plentiful in the surface soil, and, thus early equipped with considerable chemical activity, sets out upon its geological career. It permeates, to unknown depths, the rocks and minerals which form the crust of the earth, and all of which are more or less porous to water, and, as it percolates through them, dissolves and carries with it certain of their constituents. These meeting 14 HYDRO THERA PY AT SARA TOGA. Others of possibly chemical antithesis, countless compounds are formed ; new gases are generated, which are also ab- sorbed by the water, and utilized to augment its further solvency, until ultimately, after an eventful history, there is forced to the surface the extra- ordinary, indefinitely varied compound known as mineral water. This the analysts handle with skill. Th'Cy separate and weigh accurately, up to a five-thousandth part of a grain,* the basic ingredients, which are found, in almost every instance, to correspond with the composition of the rocks from whence they came ; but the science of man has not yet ascertained the exact character of the chemical compounds resulting from this intricate tour of * Breneman, Nat. Bot, Gaz, ORIGIN OF MINERAL IVA TERS. 15 Nature's laboratory ; any more than it can invariably explain the physiological chemistry following their ingestion. (3) The emergence of mineral springs at certain localities is dependent upon the nature and integrity of the geo- logical strata beneath. However may be solved the great cosmical problem of the manner in which the earth, from being a semi- liquid, nebulous mass, whirling through space, became the beautiful world we now inhabit, it is certain that the for- mation of its crust, whether by the hardening of fluid, or the deposit of sedimentary substances, took place at different periods, and in layers of vari- ous thickness and composition, super- imposed one upon another. It is also certain that, while this heterogeneous l6 HYDROTHERAP Y AT SARA TOGA. crust was in course of formation and still malleable to internal force, seis- mitic disturbances shaped hills and val- leys ; but long afterwards — perhaps many centuries — when the surface crust had become too hard to bend, similar volcanic outbursts resulted in huge cracks or fissures, penetrating to the very bowels of the earth, and often attended by dislocations of strata, which deranged the original levels, so ^that when the broken surfaces came to- gether again, rocks of different quality were in apposition to each other. In some instances, however, the part- ings thus made were permanent ; and when fierce earthquakes had quelled, mighty chasms, even miles in width, remained forever. As ages rolled on, the relatively ORIGIN OF MINERAL WATERS. 1 7 smaller interspaces became filled with deposits of various character, usually more permeable than the original rocks, while many of the larger breaks still endure, and may be seen interspersed among the loveliest scenery of the world — as straits, like that of Magel- lan, or Smythe's Sound, or as narrow valleys and mountain gorges, bounded in between corresponding surfaces of perpendicular cliff. In comparison with these stupendous natural convulsions of the past, how small appear the volcanic activities of to-day : the phenomena of our Yellow Stone Park ; or even the wonders of Ojigoku, the Great Hell of Japan, where one day the ground is solid and the next a bubbling, boiling spring. CHAPTER III. GEOLOGICAL CONDITIONS AT SARATOGA. Cracks and disturbance of strata are termed by geologists "faults." They vary from immense rents and spacious caverns to tiny crevices, running in all directions through colossal layers of rock. It is easily understood how water imprisoned — often under high pressure, between the less pervious strata — should find at these points a means of escape, and thus make its way upward. As a matter of fact it is the presence of geological faults of some degree which determine, in most parts of the world, the emergence of mineral springs. «9 20 HYDRO THERAP Y AT SARA TOGA. At Saratoga there is a geological *' fault " of extensive proportions — the result of some terrific upheaval long ago. Originally a huge irregular fissure of incalculable depth, and extending through the valley many miles to the northeast and southwest of where the village of Saratoga now stands, it is probable that both sides of the chasm were depressed many thousand feet below their pristine horizontal ; but^the eastern edge sunk considerably lower than the western, so that when, during subsequent centuries, the interspace became filled with calcareous deposits, the long-parted strata no longer occu- pied corresponding levels ; but those to the eastward lay not less than fifty feet below their counterparts upon the other side. GEOLOGICAL CONDITIONS. 21 The accompanying cut, modified from one by Professor Chandler, fairly illus- trates the situation. t(r ^vlg-U^oJ^ (ctArxC Captain Butler, in his essay on this subject,* notes two particularly inter- esting local circumstances : (i) That all the springs which have appeared or been discovered, at or near Saratoga, are to the eastward of the fault ; while * Saratoga, i« 2 2 HYDRO THERAP Y AT SARA TOGA . Upon the western side, although every effort has been made and the drill sunk through the rock at various points to a depth of one thousand feet, no mineral water has been found. (2) Also, that although the same water may frequently be reached, but at a depth increasing proportionally to the distance, by boring in a direct line to the eastward ; if the opening be made to the north or south of this line, a spring may be reached, but it will usually be of different char- acter, and unconnected with the first. According to the same authority, the drill, in passing downward through five or six hundred feet of rock, is liable to tap, at different depths, several inde- pendent streams of mineral water of diverse quality, of which the owner may select and utilize that which he pre- GEOLOGICAL CONDITIONS. 23 fers. This occurred in the boring of the Royal Spring in 1887. From these data, supported by the ascertained dip of geological strata toward the fault, he deduces the theory that the watershed which feeds the Saratoga springs extends from the mountain ranges thirty odd miles to the eastward ; from whence the water percolates downward toward the west, dividing itself, by the way, into dis- tinct streams at various depths, until ultimately — unless tapped by artificial boring — it reaches the almost perpen- dicular wall of later deposit, which fills the fault, and there finds more pervious material, or else convenient crevices, favoring its ascent toward the surface. As, however, there are also mountains upon the western side, and as the strata, 24 HYDRO THERAP Y AT SARA TOGA . on that side also, incline toward the fault, and slightly toward the south, and there is no positive proof of the non- existence of mineral water, while ordi- nary water has been reached at consider- able depth, it seems probable that the western rainfall may also contribute to supply the springs. There is no subterranean connection between the Saratoga springs and the ocean ; nor, as a rule, is there evidence of inter-communication between neigh- boring springs ; which, although some- times rising but a few feet apart, main- tain their special characteristics. Un- questionably, however, some collateral intercourse through the ramifying crev- ices in the rocks is possible between the Congress, Hathorn, Favorite, Pat- terson, Putnam, and Imperial Springs; for although, in their normal condition. GEOLOGICAL CONDITIONS. 25 each has very distinct individuaHty, on each occasion when one has been de- pressed, by excavation or pumping, it has unfavorably influenced, some or all, of the others.* The flow from the springs is con- stant from year to year, and at all sea- sons, and seems scarcely to suffer by the repeated borings in search of new water, which here, unfortunately, there is no law to control. Intermission or spouting occurs in fountains such as the Champion and Geyser, obtained by deep artesian boring ; and is explained on the sup- position that the drill opens the water cavity at a point below its highest part ; thus leaving a kind of pocket above the level of the aperture, in * A similar circumstance has been observed at Aix- la-Chapelle, and other foreign Spas. 26 HYDROTHERAPY AT SARATOGA. which free gas collects ; until at inter- vals the tension becomes so great that forcible expansion takes place : the ac- cumulated gas, so to speak, blows ^i[ '/ itself off, resulting in periodically in- creased upward pressure in the tube. At the Champion the column of water is said to have been driven at GEOLOGICAL CONDITIONS. 27 times upward of ninety feet into the air.* Similar, although milder pheno- mena, observed at other places,f where the paucity of gas would preclude this theory, are attributed to syphon action emptying a natural cistern, and tem- porarily ceasing during the intervals while it refills (?). Professor Tyndall has demonstrated that the magnificent spouting Geysers of Iceland owe their recurrent accelera- tions to periodic explosions of con- densed steam, generated at a higher temperature^ — relatively equal, owing to increased pressure — deep in the earth's bosom. There are already more than forty * Butler. t Such as Colmars ; or Pliniana on the shores of Como, described by Pliny. — Walto7i. 28 H YDRO THERAP Y AT SARA TOGA . mineral springs in the village and im- mediate vicinity of Saratoga ; and without doubt others may be dis- covered whenever sought for. As far as can be ascertained, twenty-eight have been analyzed at various periods ; and all are so abundantly mineralized that there can be no question as to the propriety of styling them " mineral waters " ; although the term, as gener- ally applied, is ambiguous, and not a few springs in other localities, which have acquired reputation for medical properties, are found on analysis to differ little from some ordinary potable waters. Any one of Saratoga's waters possesses more chemical quality and therapeutic merit than many European Spas, which have earned world-wide celebrity. CHAPTER IV. CLASSIFICATION AND ANALYSES. For a clear understanding of the general subject, and for comparison of our own with foreign waters, a scien- tific classification of all mineral springs would be desirable ; and has been attempted at various times with, un- fortunately, but indifferent success. There is a French, a German, and an American classification. Waters have been classified according to their chemical characteristics as alka- li7ie, saline, chalybeated, stilp hated, magnesian, lit hie, calcic, salicious, iodized, arsenical, and acidtdoits ; according to their gaseous qualities, as carbonated, 29 so HYDRO THERAP Y AT SARA TOGA. sulphuretted, carburetted, and nitro- genized ox azotized ; according to their temperature, as cold, warm and hot, or thermal and non-thermal ; and finally, according to their therapeutic effects, as laxative, aperient, cathartic, diu- retic , alterative, anti-lithic, tonic, and strengthening. But all of these divi- sions are unsatisfactory, and in practice misleading. In chemical enumeration it is only possible to indicate the more promi- nent constitutents, ignoring minor ones, which not infrequently are im- portant factors in determining the special characteristic and remedial potency of the water ; and further, most well-known springs — notably those under consideration — contain not one, but many distinct and important CLA SSIFICA TION AND ANAL YSES. 3 ^ mineral ingredients ; and might there- fore claim recognition under almost any of these headings. Dr. A. C. Peale, in his recent valuable reports to the United States Geological Survey * describes the Saratoga waters as car- bonaiedy sodzc-murzated, alkaline ^ saline ; to which he might have truthfully sub- jointed the additional qualities oichaly- beated and calcic. From the therapeutical standpoint a classification is quite as hopeless. It may be frankly admitted that we have not as yet a sufficiently accurate clini- cal knowledge of the effects of mineral water drinking, alone, and unaided by auxiliary circumstances, in scientifi- cally diagnosed disease, to form a reli- able estimate of the relative value of * Bulletin, 32. 3 2 HYDRO THERAP Y AT SARA TOGA . Springs of various quality ; or the exact place to which mineral hydro- therapy generally is entitled among other measures of sound practice. Moreover in attempting to classify a water by its effects, it should be re- membered that these are largely governed by the method of imbiba- tion : the hour of the day, the quantity taken, and the physical condition of the individual. For example, a given quantity of any of the saline waters' taken fasting in the morning, may act as a brisk aperient — by passing rapidly through the alimentary canal, thus exciting secretion and increased peris- taltic action ; wljereas, the same quan- tity of the same water, taken in divided draughts throughout the day, is easily absorbed into the blood, and conse- CLA SSI PICA TION A ND ANAL YSES. 3 3 quently may produce excellent alterative and diuretic effects, but without per- ceptible influence upon the bowels. As already stated, mineral water analysis can only be absolutely reliable in the estimation of basic salts and acids. The combination of these, as supposed to exist in nature, is merely surmise upon the part of the analyst ; although based upon a general knowl- edge of chemical affinities, and no doubt in most instances approximately correct. Unfortunately the present study of the Saratoga springs is hampered by yet another, and more serious source of error, which it is hoped may be early eliminated from future investigation. Of the analyses now available, not a few were made many years ago, long 34 HYDRO THERAP Y AT SARA TOGA. before the use of the spectroscope, and other advances in the science of water analysis, had rendered possible an accurate report. It is therefore emi- nently desirable, independent of possi- ble changes in the waters themselves, that these springs should be re-ex- amined by some chemist whose name could be accepted as a guarantee. Owners neglecting this hint will lay themselves open to grave suspicion ; more especially, as it has been observeS, both here and abroad,* that the effects of mineral waters are not always what might be expected from the analyses ; but that certain springs produce more powerful influence, and of a nature fairly attributable to their contents, than do others stated to contain the * Madden, " Spas of Germany." CLASSIFICA TION AND ANAL YSES. 35 same ingredients in very much larger quantities. Nevertheless, in the absence of trust- worthy clinical evidence, a careful scrutiny and comparison of the com- ponent parts shown by analysis will always be our best guide in the thera- peutic employment of mineral waters. Analyses, as commonly presented, are startling masses of figures, calcul- ated to puzzle even an expert arith- metician, and conveying little informa- tion to the casual investioator. The quantities of quite crude substances are stated in fractions so minute as to be absolutely ridiculous. For instance, of waters such as those under considera- tion, many of which contain as much as five or six hundred grains of common salt to the gallon, it seems only de- 36 H YDRO THERA PY AT SARA TOGA . signed to perplex, that the exact quantity of this useful ingredient should be particularized down to three decimals of a grain per gallon — or about the one two-thousandth part, to a full gallon of water, of what one would ordinarily consume on a boiled egg, without being conscious of any medication whatever ! The following tables are constructed so as to show at a glance the quantities and proportions of all tangible ingredi- ents — a one-hundred part of a grain to the gallon being deemed as amply ac- curate for even the most scanty and potent constituent with which we have to deal ; and the water being over- credited with any more minute frac- tion stated in the analysis quoted. "Traces" of commonplace commodities, CLA SSIFICA TION A ND ANAL YSES. 3 7 such as borax and strontia, supposed to exist in quantities so infinitesimal as cannot be expressed even in thousandth parts of a grain to the gallon, and, which could not be suspected of thera- peutic influence by the most ultra- homeopath, are omitted altogether. The skeleton table is especially de- signed for an easy comparison of the different springs. u z V o z 00 t3 • C D z L. o ID :: I oo U t^MD O 01 <-t 6- t^ f^ t^ 1-^ o o> U z en O Id O O D VO in m ro vo in ,i2 00 vo O " (^ in 2, in >- " t^ M l> oo u l-l vo 00 J* o in ^ t^ CO 00 N 00 M-VO M ro rt mo3 N in a- vo o o^ « O M -^ m « OO o N in 00 o3 n t^ 00 in « moo M O 4-. rt i> c o : oJ • -a ij C -o o ^5 ."2 j: o ue 2 6-2 O 3 in •- rt T3 ^ o o COP^ H 3.:: ci 3 ^3--: rtt3 ^ O ™ 1— I ■— ™ 7^ « : (U c Ji ^ — : c •< o _ J3 d c " o 'H 1 -ax) c/3 u:i Ph CO •< S rt _;^ Ifl • o^ -o " cr Oi-H •c < o t. o^ c/. 'C =5 oO a ^ _ rt"* H o 1 o « 'A c ■<«■ -<»■ On O OO t^ IH in o ro OO s§ o o t^ T t ^ 1/-J 00 PI m PI t^ o M pi CO 4 LO 00 rn pi d ro ^ h " x; CO CO 00 NO in m NO <; M ro ro ^ CJ u. i* ^ N m »«-> ro f) N On r^ m M N m m ro PI 0^ • 111 tn 1" M "^ 03 T -t- M 6 00 PI fO lO PI lo d in M PI q q PI PJ q •-; NO ON pi CT « PI CO IT) IH f^ J " PI t m *_ ■<^ < ■ H D i2 M n \0 O ►-' t^ CO > 00 o-oo in r<- M m m O .S H O^ cr, PI 00 -^ M On M CO q n r> ro iH r~ M o 0> V 0^ CO fc: CO (In 6 (N 0) PJ On On PO M M M SnO NO C3N w ' >-i ' pi ' NO in O ■o Ph * 1-1 ►4 < > O !- Tj- rONO r^ NO moo irioo NO PI 00 PI NO NO 1-i pi ■*CO ON NO " q ro M 00 q ' ■ ro " ' PI CO OO 8 o NO ^ (N PI PI m m « CJ 1 (/J 3^" c O H (_, CO NO in O vo lO c eg 6 q q ■"J- q i>- lAiCo' NO d in in in o pi ci ro OO q pJ o in a« VO PI vo PI rt NO ■* 4 < « CO M ■* t^ PI PI •§^ PI NO 00 in ro m ON 00 °g O ^ O- ON CO t^ ^ PI ro 00 On d pi PI rn PI H M NO 'to M M 00 q M '^ rt VO H 00 M PI CO m M J2 (N PI PI in ^ Oh u J . D ^ O ■«t- o- •ro 8 t o VO ^ m OO IJ t^ ti r^ pi lA •4- in ro d vd ON On ON PI ON ro lO NO y5 *■ ro 1, «0 O vo 8 1/1 q q ro •* M ^ O m 8 o o o c NO ro PJ g O t-~ o 00 lo ri2 d t^ t^ lo t^ pi ■>}• rn ■<5- d in X r? t^ t^ M c^ ro PI H in W'"' < ro rn " m p) * u 1-1 C! CO o -^ m NO 00 On •^^ r^ ro -* vo t^ ^ ^ ^ 6 00 On CO t~. ON ■4 M -^ lO ■. n in d NO lO q oo' -^ ro N On 4 M PI ON ro ro o O in > < m'O « ■^ in ^ m IH NO <^ •<1- ■,•!). •.^ a oi J^ . in in S 1) ' cS x) o 4j c c o o "(5 : V '. a ■ . -. (/) O <-> 0) U t^ a. (I. O O 4J .;« (u c <" ■|5 OS o 1- 1-. P5CC : •1 i- • ; 3 3 « oi C •^•- rt O H o o o.-zi- wojO-ic^^ "o 3 M S fl) *-» . — ^ 0! i; c O i| o o 3.2 C.2 3 o H 15 < ■ - d •^ O tjj ja3 C o s Only the analyses marked * are deemed absolu tely reliable at the present time. 1 The Hathorn Spring has a new analysis in course of preparation at time of | going to press, c Contains Ammonia Bicarb., 6.59 grains, a. Includes Sul- phates of Soda, M agnesium and Calcium, p^. Contains Nitrates, 1.08 grain, i Manganese Eicarb., 1.38 grain, p. Contains A mmonia Bicarb., 2 grains, and Manganese, 0.49 grain, r. Given as Oxide of Iron, t Contains Chlorid -of Ammonia, .80 grain. % Contains Chloride oi Magnesia, 10.83 grains. < H >-( III 2 m rf- t^ 00 moo H N ro t^OO m m CO a> t^ IB 00 m *C q q !>• N M q CO P) q q &03 t^ vd vd in " 06 vd CO ^ '^ w 3 Q •^ r^ M 00 ro CO w ro n ^ ^VO rovD w -*• ■* in 00 S 2 vnoo -^ c«-) N -vf Ov ? H P4 vq ^ "p. ro^ d in M m' d> PJ CO in s 00 Ov H ^ M m in Pi ^ •< Ul . rr, CO CO Ov in in -<)- H is 00 c> 06 t> VO M VO ■* P) M dvcd >-> CO in d M CO ■«- CO in d m a C4 0> N Pi CO CLi u u« K (L> a 'J- ■^ ro t^ -+ ■* M T^ T^vo t^oo Pi o> N 4 H in ■*00 ro & & 6 m d t-«. VO in in CO ' ' ' a ' q p3 q m • >-} CJ m ro e) CO -* VO pi w w M CO CO * O- Pi 00 fO w t^ VO VO 00 w 00 X 00 -+ 00 00 in m t^vo « in M M PI q M t^ -^ CO q CO m u M "^ CC PI M ■>!- 00 0^ -<*■ P) VO 00 > H M PI CO CO •^ * u -i- M M M H ro in -* M ■>*- M t^oo VO r~ CO CO &i in ^a lO VO 10 m ro M ro in CO moo M o- < m X 00 00 "^ "^ 00 r^ t^ 1 10 00' 06 t^ IN vd pi . . . . t^ "S m (-• M ^ H m -* M M -^ 00 CO - U3 ^ H( H CO •<«■" 00 m t>. pj 00 in H CO in ■<*- ov ■n M CO M ' M H d M (/) t^ M " ^ rr M m t^ ■* t^ in >o ^^ g CO CO < N N VO Pi m m 00 ■*-*■* 00 8 u, vo n CO 00 r^ ro CO "^ q VO w in N CO a CO :r; vd vd 06 M di Ov CO 4 Pi ■ * 00 d^ V. VO VO • u re • -a • -v If. • • • «^ d'H ft fXH a. 8 S-o.::" IS •-5 5 ."H .s «■ .-H si V ti. U < re 1 C in u H 6 i'S 1 E 3.H C.2 :: ^ re ^§ 5re c T3 OV3 3 3 t£ C5 •a 13 ■"•- o.~ ci: c < "c cr C ■§c3 «•- u 3 u a g SKELETON ANALYSIS OF ONE U. S. GALLON. Name of Spring. tn a o Ui o a s U i Total Alkaline BiCARBONATES. z 0: II2I 715 400 .70 "95 742 446 .65 408 267 130 5.58 894 577 306 •74 680 510 163 .80 258 166 79 3.00 514 377 124 3.22 719 454 258 •47 991 586 400 .98 460 297 154 5-39 821 512 305 .86 628 399 221 1.48 270 127 140 .10 351 152 193 i^56 1290 818 463 •76 518 a8i 233 1.22 687 ' 467 210 2.58 419 201 212 1.03 416 213 197 1.08 255 90 159 2.10 518 274 236 1.23 657 56s 85 1.72 302 135 160 1.71 337 145 186 2.51 696 462 228 .27 331 150 176 350 182 158 3^8i 367 142 222 1 .06 < -5 6 ^ Carlsbad Champion Columbian. . . . Congress Empire Eureka Excelsior , Favorite Geyser Hamilton Hathorn High Rock Imperial .... . Kissengen . . . , Lafayette Patterson Pavilion , Peerless Putnam Red Spring. . . Royal Saratoga A. , . Seltzer Star Union United States Washington . . Vichy. ..... 6.70 6.25 S-33 2.09 5.32 9.01 7^30 3.24 5-13 8.05 2.32 9.49 1.29 1.97 •94 2.24 .90 2.04 2.00 4.85 ^•77 713 465 272 537 644 239 250 963 454 316 491 409 287 361 810 417 332 502 405 500 212 324 407 384 245 363 383 CHAPTER V. COMPONENT PARTS OF THE SARATOGA WATERS. It will be noticed that identical elements are present In almost all the Saratoga waters; a feature which would still pertain if the analyses of the other famous springs of the world ♦ were grouped with these in a single table. Even when compared with the popular Bohemian group — Carlsbad, Marlenbad, and Franzensbad, so much sought after by Americans, and gravely stated to be ''quite different from anything In this country " — it will be found that the Saratoga waters, 39 40 HYDRO THERAP Y AT SARA TOGA. while superior in many respects, are composed of practically the same chemical ingredients ; with but a single exception, scarcely to be regretted, the lack of sulphate of soda, or glauber salts : a commodity so crude and unimportant, that it is passed over in a recent text-book of materia medica* with the single comment that it has ''long since ceased to be used." But although the same constituents exist in the various Saratoga springs,* they are so diversely proportioned, that what are the prominent and potential elements of one, have relatively small importance in another ; and thus the aggregate characteristics differ so widely, that we find among them quite dissimilar compound remedies ; and fair *Bartholow, " Materia Medica." COMPONENT PARTS OF WATERS. 4I representatives of almost every type of serviceable mineral water. And, strange as it may seem, the particular effect of the most prominent compo- nent appears to be invariably empha- sized by the associated influence of the accompanying substances. On the other hand, not a few of the most esteemed waters are so similar throughout ; or the gradations are so finely shaded off, that a choice between them must rest upon convenience or empirical repute. All are abundantly supplied with carbonic acid gas, the most impor- tant component of a mineral water ; since, independent of its own special qualities, it brings into solution sub- stances which would otherwise be in- ert,, and renders the water attractive, 42 HYDRO THERAP Y AT SARA TOGA. palatable, and easily digested. The quantity in the Saratoga waters varies from 25 to 65 cubic inches to the pint ; or about doubly as much as contained in most of their celebrated European rivals. It is especially valuable in the chalybeate waters, to which — as well as the milder alkaline and saline waters, such as the Patterson, Peerless, Royal, Kissengen, and Vichy — it imparts an exceedingly pleasant taste and grate- ful influence upon the stomach. All contain chlorides of sodium and potassium — the chloride of sodium ranging, as grains per pint, from 88 in the Champion, 84 in the Carlsbad, 70 in the Geyser, 68 in the Congress, and 59 in the Hathorn, down to about 11 in the Red Spring, and 9 in the mis- named Magnetic. COMPONENT PARTS OF WATERS. 43 All contain bicarbonate of sodium, the most active of the alkaline group, but the Vichy and Kissengen in greater quantities, both absolutely and in proportion to other ingredients. All contain magnesium and calcium, but in very diverse proportions. All contain lithium ^'^ — the Pavilion, Geyser, and Hathorn in greater quantity than any of "■ the lithia waters " so widely advertised — at least four times as much as most of them. All contain iron, but in some it is the merest trace, scarce noticeable even as a tannate when mixed with wines and spirits, while the Columbian, Hamilton, Washington, and Pavilion are power- ful chalybeate waters. Almost all contain the iodide and bro- * The older analysts probably failed to recognize it. 44 HYDRO THERAP Y AT SARA TOGA. mide of sodium — the latter salt being especially noticeable in the Congress — but usually in quantities so minute that one might question the possibility of therapeutic effect, had it not been proven by clinical experience ; and did we not know that foreign waters, by which distinct symptoms of iodism have been induced, possess no more than these.* The Carlsbad and Pat- terson contain bicarbonate of ammonia ; and the Putnam and Patterson bicar- bonate of manganese. Almost all contain sulphate of po- tassium, alumina, silica, and barium ; scarcely enough, however, to warrant the expectation of specific result, but * Wildegg, to i6 oz., 0.218 of a grain. — Madden, op. cit. Kreuznach, Elise Spring, 0.035; Hall, o.ioo; Krankenheil and Diirkheim, o.oio. — Braun, op. cit. COMPONENT PARTS OF WATERS. 45 worth remembering when making choice between otherwise similar wa- ters. As in ordinary prescribing the secret of success — our ultra-scientific (?) Ger- man confreres notwithstanding — lies not so much in the selection of the single drug chiefly indicated in the disease, as in skillful combination with it of other remedial agents, which, without ham- pering its activity in the directions looked for, diminish the undesired con- sequences frequently unavoidable in the adequate exhibition of efficacious medicaments. So, in mineral waters nature presents us with endless com- binations already prepared ; but to their proficient utilization a somewhat converse talent must be applied. The value of a particular substance 46 HYDRO THE RAP Y AT SARA TOGA . must be estimated, not only by the ab- solute quantities contained in a given measure of water, but also in conjunc- tion with the other component parts of the same water, which are indivisibly associated with it. For example, one might gladly prescribe the grain of bi- carbonate of lithium contained in about a pint of Geyser water, without desir- ing to administer the seventy grains of common salt, which must accompany it. Whereas, in another case this pre- cise dose of carbonated saline water might be exactly what was indicated, while the presence or absence of lithium would be practically immaterial. It is, however, also well before select- ing a particular spring and determining the dose for a given case, to disassociate, and consider separately, the amount COMPONENT PARTS OF WATERS. 47 and therapeutic significance of its prin- cipal components. Salines. — Chloride of sodium, or common salt, is the most universal in- gredient of all mineral waters ; being often most prominent even in those named after some other characteristic component. The considerable quantity shown in the analyses of the Saratoga springs might startle, and even repel, one unaware of its manifold usefulness in the workings of the economy. The quest of salt, as a daily condi- ment, is one of the earliest and in- grained of human instincts ; and more than any other has marked the advance from nomadic to civilized life. Its use is amply indorsed by recent physiologi- cal experiment. It is found to be by far the most constant and plentiful 48 HYDROTHERAP Y AT SARA TOGA. mineral compound of the healthy body ; and is absolutely essential to its proper nutrition and general well-being. Om- nipresent in the tissues, bones, and juices, it is largely concerned in the metabolism — both constructive and eliminative — which constitutes the ac- tive mechanism of life. Salt is a neces- sary constituent of the blood ; main- taining the solution of albumen and fibrine, while preserving the integrity of the blood corpuscles. It promotes osmosis, and wherever fluid transuda- tion takes place, chloride of sodium is certainly present. It favors absorption, secretion, and elimination of all kinds — more especially, the excretion of urea. It increases the flow of gastric juice and bile ; contributing to the formation of the hydrochloric acid req- COMPONENT PARTS OF WATERS. 49 uisite to the former. It is also an im- portant (actor of the saliva and pan- creatic juice, thus assisting in the di- gestion of starchy foods. It prevents fermentation in the stomach and bow- els ; and maintains the solubility of the chyme, especially as regards albumen- ous and amylacious substances. In short, it appears to exercise a kind of antiseptic, and most beneficial, guard- ianship over the entire organism. No wonder, then, that it should be eaten upon almost every article of food, and rank high among the '' necessities of life." The normal human body con- tains about one-quarter of a pound of common salt,* and the average con- sumption by each person is supposed to range from forty to four hundred grains * Lankester ; Dalton, " Human Physiology." 50 HYDROTHERAP Y AT SARA TOGA. per day ; while in Russia, where, prob- ably owing to the dirty habits of the people, there seems to be a still greater necessity for salt, and two ounces a day is not deemed excessive for those who can afford it, the divinely assigned paternity of the Czar has emphasized itself by laws monopolizing the produc- tion of that article. Considered independently of other ingredients, and without reference to alteration of accustomed diet, from sixty to three hundred grains in the daily quantity of mineral water may be regarded as a dose. The minimum will usually suffice for general purposes, while any excess above the maximum figure would probably be followed by irritation of the stomach and bowels, and acute disturbance of digestion. COMPONENT PARTS OF WA TERS. 5 1 The chloride of potassium, present in much smaller quantity, seems to pos- sess somewhat analogous properties, but is of relatively little importance. It is supposed by some recent physiolo- gists to be mainly engaged in* retro- gressive changes. Alkaline Bicarbonates. — Next in order, both as to quantity and remedial importance, comes the alkaline group : the bicarbonates of sodium, magnesium, calcium, and lithium. Physiologists fail to assign them any well-defined place in the workings of the healthy organism. Bicarbonate of sodium is believed to maintain the normal alkalinity of the blood, saliva, bile, milk, and mucous secretions ; and to assist the chloride of sodium in the solution of fibrin and * Wroninch in " Schmidt's Jahrb." — Braun, op, cit. 5 2 HYDRO THERAP Y AT SA RA TOGA. albumen; lime is concerned in the formation and renewal of bone ; and traces of each are found in muscles and other parts of the body. It is, however, in the many abnormal conditions, dependent upon excess of acid in the system, that the bicarbon- ates exercise their highly corrective potency. In the state of perfect solu- tion in which they exist in these mineral waters, they not only neutralize hyper- acidity of the stomach and digestive tract, but they are rapidly absorbed into the blood and there rectify the morbid prominence of acids, which give rise to gout, rheumatism, many catarrhs, calculus, gravel, and the host of painful conditions. Each of the bicarbonates co-operates with the others in attaining this result. Even the bicarbonate of COMPONENT PARTS OF WATERS. 53 lime, which has been regarde^by some as a useless salt, has recently been proven on high authority * to exercise a particularly beneficial influence by its exceptionally high power of amalgam- ating with acids, and by interchanges with the alkaline phosphates of the blood, becoming itself a phosphate. It also improves the flavor of the water. Bicarbonate of magnesia Is perhaps the most perfect stomachic antacid ; beside possessing a mild purgative tendency, wiiich readily re-enforces the similar , influence of chloride salts. The exact position of bicarbonate of llthia is still difficult to define. Since ^ Moriz Wagner, " Untersuchungen iiber die Re- sorption der calciumsalze " ; Pfeiffer ; Fiirst, Deutsche Med. Zeitu7ig, i8gi. 54 H YDRO THE RAP Y AT SARATOGA, the discovery, not so many years ago, of its easy affinity for uric acid, it has steadily grown in popular favor ; and possibly its merits have been exagger- ated. Nevertheless, it has been shown to unite with uric acid more readily than the other alkalies, and to form a compound more soluble and readily disposed of by the kidneys ; and, even by those who declare it overrated, it is credited with the peculiar faculty of promoting the combining power of the other bicarbonates.^ Clearly its pres- ence cannot be overlooked, even in waters otherwise so favored as those of Saratoga. The alkaline bicarbonates must be looked upon as purely remedial — in- valuable in various abnormal conditions, * Fiirst, Ebstein. COMPONENT PARTS OF WATERS. 55 but in no sense contrlbutinpf to the nu- trition of the healthy body, as does the chloride of sodium. They promote re- trogressive change of tissue mainly ; and consequently, if it were not for the corrective influence of the chloride of sodium, would tend, when long continued, to weaken digestion, ema- ciate the body, and diminish the amount of fibrin in the blood. But in the Saratoga waters the happy com- bination with carbonic acid, and gen- erally with iron, as well as the chloride of sodium, counteracts their otherwise depressing effect ; while the latter salt performs yet another important func- tion in favoring the safe elimination of the various alkaline urates formed by the union of the bicarbonates with uric acid in the blood ; which might other- 5 6 HYDRO THERA PY AT SARA TOGA . wise prove as undesirable as the uric acid itself. The therapeutic uses of the promi- nently alkaline waters being mainly with the acid dyscrasise of gout and rheumatism, and in certain forms of dyspepsia and renal diseases, may ap- propriately be discussed more fully when considering those conditions in a future chapter. The value of both chlorides, alka- lies and gas, in external application, is considered in the chapter upon Baths. Iron. — The chalybeate springs of Saratoga are in every respect among the finest in the world. They contain about five and one-half grains of bicar- bonate of iron to the gallon, which is an unusually large amount ; but, as with other distinctly characteristic COMPONENT PARTS OF WATERS. 57 waters, the utility of the leading com- ponent is not so much to be deter- mined by the quantity^ present, as by its combination with other ingredients, and consequent digestibility. The copious impregnation with carbonic acid gas, already alluded to, contributes largely to the excellence of these waters ; for, not only does it increase the solubility of the iron itself — thus making it infinitely more potent than proportionate doses of any pharmaceu- tic preparation — but it facilitates its amalgamation with the alkaline and saline components, conceals the inky ferruginous flavor common to chaly- beate waters, and renders these spark- ling, piquapt, and easily assimilated. Indeed so palatable are these waters that a word of warning is necessary to 5 8 HYDRO THERAP Y AT SARA TOGA . those who, unaware of their medical potency, might be tempted to use them too freely. Iron is not, as most medicines, a substance foreign to the normal organ- ism. Like the chloride of sodium, it exists in many parts of the healthy body, and no doubt performs an important office. It is a material ele- ment of the haematin, which cannot be formed without it ; and also of the red corpuscles, which represent the life supporting function of the blood, and have been proven to diminish rapidly in numbers when in need of iron.''* In health, the ordinary mixed diet provides enough for all purposes ; but during and after exhausting illness, severe hemorrhage, or similar depress- * Bartholow, op. cit. COMPONENT PARTS OF WATERS. 59 Ine influences, the want of iron is plainly manifest ; and is usually accom- panied with such loss of vigor in the digestive and assimilative functions, that it cannot be supplied in the usual form of nutriment. Administered by the preparations of the pharmacopoeia, the stomach is often intolerant of its presence, or it passes away unabsorbed in the stools. By these chalybeate waters, on the other hand, the iron, owing to its abso- lute solution, is not only readily absorbed — -thus contributing directly to the formation of red blood — but when judiciously used promotes digestion, increases the disposition to consume blood-producing foods, and the ability to utilize them. To which ends it is seconded by the accompanying salines, 6o H YDR O THERA PY AT SARATOGA. which — not like the sulphate salts — show for it a marked affinity ; and further, by their laxative tendency, avoid in most instances the necessity of purgatives, so common during an ordinary course of iron. From these considerations, may be inferred how invaluable is a perfect chalybeate water in the long list of infirmities in which iron would be indi- cated in everyday practice ; that is, in all conditions in which anaemia is a prominent characteristic : in chlorosis, protracted convalescence from severe illness, or surgical operations ; in all forms of hemorrhage, bad confine- ments, and over-prolonged lactation ; in almost all derangements of the men- strual function — amenorrhcea, of the anaemic type, as well as menorrhagia ; COMPONENT PARTS OF WATERS. 6i in exhausting catarrhs of the uterus and mucus membranes ; in the scrof- ulous, malarial, and specific cach- exias ; and in the host of other mala- dies in which imperfect performance of function, general want of tone, and debility, indicate poverty of blood. It is interesting to note that the more recent and direct is the cause of anaemia, the more readily is the iron taken up, and utilized by the system. Valuable as are these waters, it is es- sential that all who partake of them, or counsel their use by others, should fully realize that they are not alone a pleas- ant beverage, but more particularly a powerful medicament ; which, indis- creetly used, is just as potent for evil, as, under suitable circumstances, it might be for good. 62 H YDRO THERA PY AT SARATOGA. Chalybeate waters are contra-indi- cated in a very considerable portion of cases : in all forms of plethora, espe- cially in short-necked, full-blooded per- sons, with a proneness to rush of blood to the head, and in the hyper-sanguin- eous temperament in general; in chronic stagnate conditions of the brain or cord, nervous hypersemia, accompanied with vaso-motor irritability, and a ten- dency to hemorrhage or local conges- tions ; and in all cases where there is reason to suspect the integrity of the blood vessels. In all such conditions the chalybeate waters might prove ac- tively dangerous ; and even Saratoga — absolutely safe as one might be led to consider the waters, from the reckless use of them which is constantly going on, without much apparent harm — is not COMPONENT PARTS OF WATERS. ^Z without its traditions of serious mishap. Even in suitable cases, or in perfect health, the excessive use of the stronger chalybeate waters is apt to produce unpleasant symptoms : excited cardiac action, cerebral congestion, mental con- fusion, pain in the head and dizziness ; and there are some persons who show marked repugnance to iron in any tan- gible form. Under no circumstance can anything be gained by large doses ; for, it is an established fact that the blood cannot be forced to take up more iron than its normal amount — about forty-five grains — and the deficiency, no matter how caused, can seldom exceed ten to twenty grains.* Any attempt * Halliburton, "Chemical Physiology"; Dalton,<7/, cit.; one part of iron to 230 of red globules, Gorup- Basanez. — Bartholow. 64 H YDR THERA PY AT SARATOGA. to introduce more than this quantity, merely impedes that, which in smaller doses, would have been absorbed and utilized. One grain of iron contained in about a pint and a half of the Col- umbian or Hamilton springs, taken in at least three parts throughout the day, may be regarded as amply sufficient for any indication ; and about one-third of that amount as suitable for the average case. Water. — In a detailed estimate of the component parts of a mineral water, one is apt to overlook that which is not only essential to the utilization of all the others, but,' by its own merits, frequently contributes most to the beneficial results of an hydriatic course —the water itself. Few persons, even among those con- COMPOXENT PARTS OF WATERS. 65 spicuous in discussing medical topics, realize the diatetic value of water, or give thought to the elementary truism, that two-thirds of the human body are composed of that commodity.* It is abundant in the blood, and in all the secretions, contributing from eighty to ninety-nine per cent, of the entire vol- ume of the latter ; while not less than fifteen or sixteen pounds of water cir- culate in the blood of the average sized person. f It constitutes about sev- enty per cent, of muscle, and propor- tionately of all other animal structures. Not only is water thus preponderant in quantity, but it is the most indispen- sable element in all the complex phe- nomena of life. It maintains the fluid- * Dalton, op. cit.^ et al, 70 per cent.; Halliburton, op. ctt., 58.5 of the adult, and 66.4 of the infant, t Weber and Lehmann, " Physiological Chemistry." 66 H YDRO THERA PY AT SARATOGA. ity of the blood and juices, requisite for the solution of their component ma- terial, and the healthy performance of function. It is the vehicle by which nutrient matter is carried into the cir- culation, and thence applied to the sus- tenance of the body; but,~even while nutrition is occurring, . destructive changes are taking place simultan- eously, and hence, water is again neces- sary for the solution and discharge of used-up material. In fact, water is es- sential and subservient to every vital process of the organism : to chemical union and decomposition, to digestion, absorption, transudation, nutrition, se- cretion, and elimination ; and, conse- quently, needs continual replenishment, in order that its multitudinous duties may be efficiently performed. COMPONENT PARTS OF WATERS. 67 Physiologists * calculate that about two quarts of water per day, taken into the system either as fluid or a compon- ent of solid food, is requisite for the ordinary adult. Which amount — or, strange to say, even a little more, sup- posed to result from the union of its chemical elements within the body — having formed an integral part of all the animal tissues, and become laden with the effete products of retrogressive change, is daily discharged by the kid- neys, skin, lungs, and bowels. There are times, however, by no means infrequent, owing to injudicious diet, lack of exercise, or other causes inherent to our civilization, when this ordinary circulation of water seems in- sufficient for the purposes of the econ- * Barral, Dalton. 68 H YDRO THERA PY AT SARA TOGA . omy ; when morbid materials have accu- mulated in the blood and tissues, which, unless eliminated, are sure to manifest their presence in some form of ill-health. Under such circumstances, the copious imbibation of even ordinary water, without any medicinal ingredient, will, if tolerated by the stomach, usually answer the indication to a marvelous degree ; for not only does the unaccus- tomed supply of water directly stimu- late the excretory organs, but the in- creased fluidity facilitates a semi-me- chanical flushing-out of the entire sys- tem. It has been demonstrated experi- mentally* that water introduced into the stomach, especially when of moder- ate temperature, is rapidly absorbed into the blood, and almost immediately * Becquerel, Genth, Mosler, Braun. COMPONENT PARTS OF WATERS. 69 followed by increased secretion of all kinds — of saliva, gastric and pancreatic juices, bile, perspiration, exhalation, and urine; and . not only is the volume of fluid augmented, but also, very largely, the quantity of normal solids. For in- stance, of the urine, it has been proven that unaccustomed plentiful water- drinking, although actually diminish- ing the amount of uric acid, will in- crease, not only the quantity of water, but also the aggregate of other solids — mainly urea, by twenty to twenty-four per cent, in twenty-four hours. From these considerations, it will be seen how important is the regular con- sumption of fluid. The habit, espe- cially common among young ladies, of deluging the stomach with iced water, is unquestionably injurious — producing 70 HYDRO THERAP Y AT SARA TOGA. chronic congestion, gastric catarrh, and dyspepsia, and thus seriously im- paring general nutrition ; while, on the contrary, the moderate use of fluids — of water, when it can be obtained free from the organic impurities so danger- ous in the surface-collected waters of cities, or of light wine at meal times, especially as an adjunct to animal food — promotes digestion and sustains health. For those unable to exercise freely, a liberal supply of water is par- ticularly desirable ; and, it should be remembered, that on account of its gentle stimulating quality, the stomach will bear without distress, a much larger quantity of gaseous than of plain water. In the present treatise, however, we are concerned less with the dietetic uses COMPONENT PARTS OF WA TERS. 7 i of water, than with Its special influence as the main factor in an occasional course of mineral hydrotherapy ; and the agent by which important medic- inal substances are conveyed into the system. Anyone who has had the patience to study the previous pages, has at least acquired this rudimental principle in the scientific utilization of the Saratoga, or any other mineral waters : that even when considered separately, the main tendency of the water itself, as well as of its principle ingredients, is to promote tissue change, or metabolism ; and that when taken conjointly, in the form of a natural mineral water, they so mu- tually re-enforce each other, that a powerful influence is exercised in this direction. CHAPTER VI. METABOLISM, AND ALTERATIVE EFFECTS. For the benefit of the non-medical reader, it may be well, at this point, to interpose a word of explanation of the term just used, which, although by no means generally understood, has already, more than once, crept into this work, and will be frequently and un- avoidably used hereafter. The vital process, or combination of processes, variously described as, change of tis- sue, tissue metamorphosis, or metabol- ism, includes almost all the mechanico- chemical operations inherent to animal life : respiration, circulation, alimenta- tion, nutrition, and excretion ; the 73 74 H YDRO THERA PY AT SARATOGA. mysterious association of function, by which substances of certain quality are taken into the body as food, digested by the ferments of the alimentary canal, assimilated and absorbed into the blood, given off again to support the structures of the body, and ulti- mately converted into heat, force, vi-' tality, and life. In every living organ- ism there simultaneously progress a building up, and a tearing down of tis- sue : a constant interchange of used- up, for utilizable material. A certain energy is expended in the process of excreting and getting rid of the effete products of combustion, which, having fulfilled their parts in nutrition, are no longer of use in the system — this pro- cess is retrogressive metabolism. The loss so caused is compensated for by ME T ABOLISH AND ALTERA TIVES. 75 the in-take and assimilation of new substances, which are as constantly devoted to the recuperation of the economy — this process is progressive, or constructive metabolism. Any slug- gishness or impairment of either or both of these great functions — whether the result of defect in some particular organ, or a general dyscrasia, such as malaria, scrofula, rheumatism, gout, or specific infection — soon manifests itself in some form of ill-health. And here, may be appropriately de- fined yet another term inevitable to our subject, but, which seldom conveys any definite meaning to the non-profes- sional mind : an alterative is a medica- ment, or an influence, which without purgation, diuresis, or other noticeable excess of secretion, or antecedent 76 HYDRO THERAP Y AT SARA TOGA. phenomena of any kind, restores to its normal condition the disordered pro- cess of metabolism. It is mainly be- cause of their alterative quality, that the Saratoga waters are so superlatively valuable in almost every form of chronic disease — in all of an indolent character. It is equally, because of their stimulating influence upon metab- olism, that they are usually contra- indicated in malignant, wasting, or inflammatory ailments ; or where in- creased constitutional activity might be injurious. If excuse be needed for the possibly tedious physiological details of the previous pages, and the frequent refer- ence to metabolism in those to come, let it be plainly stated, that without at least as much knowledge of these ME TABOLISM A ND A L TERA TI VES. 77 matters as here conveyed, the scien- tific, or even rational, use of miner- al waters would be absolutely impos- sible ; and one might as well, at the outset, take council with the hall-boy, or the advertising circular of almost any spring. All are sure to name the complaint of immediate inter- est ; since all lay claim to curative powers in well-nigh every disease in the nosology. Take but a single ex- ample. There is scarcely a mineral spring anywhere upon the face of the globe, which does not pre- tend to cure rheumatism — and yet what widely different conditions are included under that single term. Who can suppose that the remedy, which would benefit an ancient and dried-up valetudinarian, suffering from 78 HYDRO THERAP Y AT SARA TOGA . a chronically stiff hip-joint, could be at all suitable, or otherwise than deleteri- ous, to a young person with high fever, and acute inflammation of the heart and pericardium ; ye^ both may be suffering from rheMTnatism. Under ordinary circumstances the Saratoga waters, taken in sufficient ^ quantity, produce purgation, diuresis, diaphoresis, and other soon manifest effects upon excretion ; which are usually highly advantageous, especially , when commencing a course — but any or all of which might, in most instances, be as well attained by a suitable pre- scription dispensed according to the pharmacopoeia. It is not, therefore, upon such results alone — however use- ful under certain conditions — that the deservedly high reputation of these. ME TABOLISM AND AL TERA TIVES. 79 waters depend. It is rather upon their secondary, or alterative effects, in the innumerable chronic conditions of ill health — none the less serious because ill-defined — consequent upon vitiated blood, or some morbific constitutional tendency, defective digestion, imper- fect nutrition, or partial failure of any of the vital functions included under the general term metabol- ism. Here is the sphere in which mineral hydrotherapy stands absolutely with- out a rival ; where a properly directed course of Saratoga waters — whether taken internally or used as baths, or both at the same time, or alternately as circumstances dictate — will often suc- ceed in restoring health, even when the ordinary methods of sound practice 8o H YDRO THERA PY AT SARA TOGA. have proved ineffectual. But to obtain these happy results, with the approxi- mate regularity of ordinary scientific treatment, we must adopt the same careful system of prescribing : we must abandon the happy-go-lucky empiricism of sending patients to springs, of whose constituents and mode of action we know little, simply because others are said to have been cured of like- named ailments — but of what type- or special characteristics we know noth- ing; and finally, we must fully recog- nize this fundamental principle of rational hydro-therapeutics : that, in their most precious capacity, mineral waters seldom act directly as specifics for disease, but rather as correctives of the constitutional conditions, which give rise to and maintain it ; and, con- ME TABOLISM AND ALTERA TIVES, 8 1 sequently, although the good effects may not be immediately evident, they are reliable ; and will be found more permanent than those obtainable by other means. Indeed, in many cases, the benefit experienced from a course of mineral water is more marked after, than dur- ing, the treatment, although none the less attributable to it. And this is why many of the same persons year after year visit Saratoga, not so much at- tracted by its gaieties and pleasant life, or even the prospect of immediate re- lief, as to obtain a fresh supply of health, sufficient to last them over another year. It naturally follows, that just In pro- portion as we recognize the remedial value of these waters, we must regard 82 HYDRO THERAP Y AT SARA TOGA . them as medicaments, not to be indulged in as an ordinary beverage, or without considering their therapeutic effects, and the requirements of the individual con- stitution. There can be no doubt that reckless or ill-advised potation of the stronger waters has led to unpleasant consequences ; and subsequently, to un- just condemnation of the springs, by persons who should rather have blamed their own stupidity. Ev^n the delicious milder waters, although scarcely capable of serious harm, under ordinary conditions, are so well equipped with gas and minerals, that they should not be partaken of without reference to the state of diges- tion, and other circumstances. The hospitable friend, who at the cost of five cents, would insist upon treating ME TABOLISM A ND AL TERA Tl VES. 83 you to a glass of Vichy, is asking you to consume close upon fifteen grains of alkaline bicarbonates ; which may be precisely what you need to correct the hyper-agidity of your stomach ; but, if the circumstances are otherwise, he might, with at least equal propriety, in- vite you to a quinine pill at the drug store, or to name your choice refresh- ment elsewhere. The special conditions of ill-health to which the Saratoga waters are scientifically applicable in accordance with the analyses, or, in which the happy experience of thousands has ac- corded to them a well merited reputa- tion, will be more fully discussed in a subsequent chapter ; where, will also be found some instruction in the best method of using them, and the auxiliary 84 HYDRO THERAP Y AT SARA TOGA . conditions most favorable to a success- ful Issue. Meantime, It Is desirable that the reader should understand something of the physiology and therapeutic Influ- ence of mineral baths, which In many ailments are scarcely less Important than the drinking of mineral water, and for the use of which there are ex- cellent opportunities at Saratoga. CHAPTER VII. BALNEOLOGY, OR THE SCIENCE OF BATHING. The use of mineral baths forms an important, although much neglected, branch of hydrotherapy. In no other part of our subject does so much uncer- tainty and contradiction prevail ; or, Is it so often difficult, even for those thor- oughly well-informed, to reconcile the clinical results empirically obtained, with any rational theory of physiology or animal chemistry. In all ages baths have been esteemed as valuable in promoting health and combating disease ; but, until compara- tively recently, there has been scarce an 85 86 HYDRO THERAP Y AT SARA TOGA. effort on the part of physiologists to explain their beneficial effects, or dem- onstrate the method of their action ; and, even among physicians, there still obtains a wide ignorance of the tech- nique of scientific bathing. First, a word upon the conditions common to bathing generally, whether with ordinary or mineral water. Aside from the special advantages of cleanli- ness — which, naturally are of the first moment, since the skin is one of the most important, and probably the most diversely functioned of human organs, and a healthy skin is impossible with- out cleanliness — baths may for practical purposes be divided now, as they were by Hippocrates, into two classes: (i) Tonic or Sttmulattng Balks — consisting of cold water, or warm water quickly THE SCIENCF OF BATHING. 87 followed by cold, and taken either as the full bath, plunge, douche, shower, sponge, or needle bath ; and (2) Seda- tive Baths — of lukewarm, tepid, or hot water, vapor, or air ; and taken in the ordinary bath tub, or sitz bath, or as Russian or Turkish baths, or as sprays, jets, the wet pack, or hot compress. The conclusions of recent investiga- tors* may be somewhat tersely sum- marized as follows : The primary ef- fects of a cold bath, no matter how administered — or, indeed, of cold in any form applied to the surface of the body — are to induce contraction of the external blood vessels, to accelerate the *Liebermeister of Basel, Rohrig, Zuntz, Colasanti, Finkler, Voit, Rembold, Winternitz, Delmas Saint- Hilaire, Jiirgensen, Bartels, Pfluger, Thompson, Braun, and others. 88 H YDRO THERAP Y AT SARATOGA. pulse and rate of respiration, to in- crease the secretion of urine, the excre- tion of carbonic acid, the consumption of oxygen, accompanied by augmented tissue metamorphosis — the decomposi- tion of non-nitrogenous matter, and the conversion of fats ; and, lastly, to heighten the external expenditure and internal production of heat. The increased elimination of carbonic acid is very large, sometimes as much as four or fiv^ hundred per cent. ; * and, although the loss of heat usually ex- ceeds its increased production, so that the mean result is a lowering of bodily temperature, an exception may occur when the cold applied is very intense — thus stimulating actively the heat-pro- ducing function — but of such momen- * Braun. THE SCIENCE OP BATHING. 89 tary duration, that little pre-existing heat is abstracted. Under ordinary circumstances, the measure of these effects is in direct pro- portion to the degree of refrigeration — which may be regarded as the index of peripheral irritation — but inversely to its duration. In most cases, however, reaction soon takes place, a new set of phenomena of precisely opposite char- acter are manifested, and before long the opposing conditions have equalized one another, and systemic equilibrium is restored. But, if the cold is so in- tense that the initial stimulus merges at once into depressing shock, or so prolonged that the aggregate temper- ature of the bather is considerably re- duced, then the effects are precisely contrary to those just described, and in 90 HYDRO THERAP Y AT SARA TOGA. addition, there occurs increased decom- position of azotized substances, and ex- cretion of urea. Experiments in the physiology of tepid and warm baths give less notable results. In the warm bath, of ordinary temperatures, the primary changes are not so marked as in cold bathing, and are naturally of opposite character. When, however, the bath — whether of air, vapor, or water— is extremely hot, or so long continued that the internal tem- perature of the body is materially raised, the phenomena presented re- semble in many respects those noted in the early stage of moderate cold bath- ing ; but, instead of rapidly reacting, these increase in proportion to the du- ration and intensity of the bath. This curious similarity of the primary THE SCIENCE OF BATHING. 9 1 changes in the temperate cold bath, to the secondary ones of the extreme hot bath — the difference lying in the sub- sequent appearance or non-appearance of reaction — renders the physiology of balneo-therapeutics somewhat compli- cated ; but readily emphasizes the fact that considerable intelligence must be exercised in the choice and direction of baths, in order to obtain, in every case, the desired result. Under suitable conditions, and prop- erly applied, the constitutional effect of a cold bath is exhilarating, and unques- tionably beneficial. There is a pecu- liar and delicious sense of invigoration, and Increased muscular force ; which latter Is especially Interesting, as it has been shown that the reflex tissue changes take place very largely in the 92 H YDRO THERAP Y AT SARA TOGA . muscles.* The mind Is also refreshed. There is a feeling of buoyancy, and readiness to undertake exertion, psy- chical as well as physical ; and although, as has been said, the aggregate temper- ature of the body is usually lowered,f in consequence of the loss of heat dur- ing the bath exceeding its increased production, yet, there is experienced a pleasant sensation of expansive warmth — the manifestation of physi- ological reaction from the stimulus of cold. Except in the treatment of fever — a discussion of which would lead beyond the scope of this work % — when it may be desired to reduce perma- * Bell, Jour. Bal. and Diet. t Braun, tran. Herman Weber. X Currie, Brand, Ziemssen, Winternitz, J. C. Wilson, and others. THE SCIENCE OF BATHING. 93 nently an abnormal pyrexia, the sub- stantial benefit of the cold bath lies, not so much, in the immediate physi- ological effects, which are exceedingly transient in character, as in the vigor and persistency of the reaction. This, when practiced regularly, affords to the blood vessels, and the great sys- tem of sympathetic nerves which con- trol them, a kind of calisthenic exercise, eminently salutary ; and prophylactic against dangerous congestions of mu- cous membranes or internal organs. It stimulates and strengthens the heart,* lungs, nerve-centers, and musular sys- tem. It improves the appetite, aug- ments the functions of the skin, kidneys, and liver; and by the elimination of carbonic acid, and the effete products * Winternitz. 94 HYDRO THERAP Y AT SARA TOGA. of tissue combustion, improves the quality of the blood. But like all remedies potent for good, the cold bath is not without danger when unwisely handled. When from any cause, whether general debility or disease of internal viscera, the system is incapable of rapid and effective re- sponse, cold in any form is hazardous. Cold baths are contra-indicated in al- most every form of advanced organic disease, especially of the blood vessels, heart, kidneys, liver, or spleen ; except, perhaps, when many years of favorable experience may justify their contin- uance, but even then, it should be in modified form, and with great caution. Those unaccustomed to cold baths, and old persons in whom the arteries are THE SCIENCE OF BATHING. 95 liable to be weakened, should never commence their use without competent advice. As a matter of fact, cerebral apo- plexy, congestion of the lungs, and sim- ilar dangers, so dreaded by those un- familiar with the subject, are rarely observed ; but, occasionally, reaction is exceedingly difficult to establish — most frequently when the bath has been over- prolonged — ^and, imprudent bathers may remain for hours in a state of alarming depression, the result of primary shock, or too protracted cooling. The colds of everyday life are more likely to arise from a passing draught of air, ac- cidentally wet feet, or some like appar- ently trivial cause, than from the most extreme hydriatic procedures : a cir- cumstance explained by Braun, ''be- 96 HYDRO THERAP Y AT SARA TOGA. cause, most colds arise from cold locally applied, and the more locally limited is the refrigeration of the skin, the less is the general production of heat and re- action." Indeed, it may be stated, that regular cold bathing, by educating the peripheral nerves and vaso-motor sys- tem to withstand temperature changes, is the very best preventative against the ordinary catarrhs of our trying climate. To advocate a therapeutic measure, and then so limit its applicability as to exclude almost every condition of dis- ease, may appear paradoxical; but such would be the fate of any other remedy, no matter how valuable, if considered in- dividually, in reference to an equally wide range of maladies. It should be easily understood, from the foregoing synopsis of the physiology of the cold THE SCIENCE OF BATHING. 97 bath, that, as its modus operandi in strengthening and curing is to stimu- late and intensify vital functions, a cer- tain textural integrity of the organs, responsible for those functions, is essen- tial to a satisfactory result. It follows, and experience amply demonstrates, that in the chronic diatheses, such as gout, rheumatism, or scrofula, in the earlier manifestations of tubercle, and other conditions dependent largely upon disordered function and defects of nutrition, cold baths are capable of immeasurable good. Mineral Baths. — The previous re- marks, and those to follow upon the techfiique of balneology, apply, almost equally, to bathing with ordinary as with mineral water. Now, to determine the reason of the 98 H YDRO THERA FY AT SA RA TOGA . unquestionably greater curative efficacy of the latter. Theoretically it rests upon credence in the capability of the cutaneous sur- face to absorb salts and eases — a doc- trine unreservedly accepted in the past, and abundantly proven of salts, when applied as unguents or liniments. It gives a comprehensible explanation of the best results observed, and, there- fore, has been loudly advocated by those financially interested in mineral springs. Nevertheless, experiment, al- though proving the absorption of gases,"^ throws grave doubt upon the possibility of any tangible amount of mineral matter beine taken into the system in this way.f On the other * Martigny, Lebkiichner, Krause, Gerlach, Braun, etc. . t KleUinski, Lehmann, Herbert, THE SCIENCE OF BATHING. 99 hand, we have the accumulated evi- dence of all times, that baths of certain mineral impregnation have a curative potency, distinct from and beyond, the effects of simple water ; and not explain- able as cutaneous stimulation alone — although, no doubt, an important factor.* Braun remarks: ''The ques- tion of absorption remains an open one, and the one fact ajone seems to be satisfactorily proved, that absorption, If it does take place In the bath, can only be small In amount." It Is worthy of consideration, however, that no matter how minute may be the quantity of saline matter absorbed by the skin, such as it is, It passes directly and un- changed. Into the circulation ; and thus may induce therapeutic results entirely * Rohrig, Zuntz. lOO HYDRO THERAP Y AT SARA TOGA. out of proportion to the same, or many times a greater, quantity taken by the stomach. Unquestionably, too, the bi- carbonate of soda, and other alka- lies, produce a salutary, softening in- fluence upon the skin, probably by chemical solution of its secretions and the scales of the epidermis ; thus, augmenting in a high degree the healthful function^ of that important organ. The ocean itself is a great reservoir of mineral water, and, except in lack- ing gaseous impregnation, is by no means dissimilar to the stronger saline waters of Saratoga, or the world-famed sool baths of Europe ; yet, who will combat the universal belief that sea- bathing possesses virtues unequaled by fresh water, or the time-honored THE SCIENCE OF BATHING. loi tradition that ''a wetting by sea water does not give cold." The Hygienic Cold Bath. — A morn- ing plunge in the ordinary bath-tub, or the shower, or English sponge bath, are the best methods of regular hy- gienic bathing. A rational tempera- ture ranges from 75° or 80° F., down to 45° F. ; but a bath of about 60° F. will usually give the most salutary re- sult to the averaore constitution. Ex- ceptionally robust individuals, com- monly those accustomed to active country life, may habituate themselves, without detriment — so long as they re- main organically sound — to very much lower temperatures.'^ There can be * Recently a medical writer described his personal experience of twelve years with cold river baths in winter. The bath was taken between six and seven o'clock in the morning, and even when the thermom- 102 HYDROTHERAPY AT SARATOGA. no doubt, however, that the unaccus- tomed, and ill-advised, use of exces- sively cold water is capable of serious injury ; and has done much to mar the popularity of cold bathing, and foster deep-rooted prejudice against its rea- sonable employment. The most assured results will be obtained by moderation ; and, there being no certain guide, beyond ex- perience, to the reactive capacity of ap individual, it is wise to commence with milder hydriatic methods, such as a eter was as low as io° F. On windy days he was able to dispense with a towel, and dry himself by walking up and down in the breeze. This apparently suicidal procedure produced in him an agreeable effect. — Ny, Medicinische Monatschriff, July, 1891. But doctors differ : not long since a physician of Iowa remarked at a scientific meeting, " that the people of his State bathe but once a year, and yet they have a minimum death rate!" — The Post Graduate N.-Y, Medical Record, March 5i 1892. THE SCIENCE OF BATHING. 103 shower or sponge bath at a tempera- ture not lower than 80° F., and then proceed gradually — sometimes after an interval of several days — to the more severe. Mineral water, on account of its ex- tra stimulating qualities, may be used colder than plain water ; and the shower, rain, or sitz bath, than when the entire body is immersed. The period of immersion should sel- dom exceed two minutes ; and usually the fullest benefit may be derived in less than one-half that time. It is a good method for those in average health to stand up in the bath after the the first fifteen or twenty seconds' im- mersion — rub the body briskly, soap being used if desired, ai^d the nature of the water permits it — and then take i 04 H YDRO THERA PY AT SARATOGA. another plunge, with continued active rubbing under water. Thus is obtained the benefit of a second reaction, to- gether with thorough cleansing of the skin. It is important that all forms of cold bath should be taken in a moderately warm and well-ventilated room ; and immediately followed by brisk friction with a rough towel or flesh brush. The skin and nails should show a reddish tint : any bluish or mottled appearance indicates that the reactive powers have been overtaxed, and consequently the bath injurious. The custom of returning to a warm bed after a cold bath, recommended at some German Spas,* seems justified *Teplitz, Ragatz,Wildbad, W^armbrunn, Wiesbaden, and others. THE SCIENCE OF BATHING. 1 05 by no sound reason. For the healthy fresh air, exercise, and a good breakfast would be more salutary ; and, when the object Is to promote perspiration, this can be better attained by a hot vapor bath or wet pack. A cold bath should never be taken after a heavy meal, but a cup of coffee or other light refreshment before the morning bath is, for delicate persons, by no means undesirable. A cold bath is also contra-indicated in excessive fatigue, or when the body is perspiring, or is chilled, or exhausted from any cause. After violent exercise it is prudent to rest for half an hour, or first take a warm bath, which produces much the same effect, before shocking the system with cold. When only one bath is taken each Io6 HYDRO THERAP Y AT SARA TOGA . day — and this is usually sufficient, ex- cept under special advice, as treatment for definite disease — the morning, im- mediately after rising, is decidedly the best time : not only, because it is usually the most convenient, and the system is rested and ready for reactionary gym- nastics, but also, because it is the time of the twenty-four hours (between 7 A. M. and noon) when the natural heat of the body is approaching its maxi- mum point. If a second cold bath is indicated, it should be taken from one to two hours before dinner, so as to al- low at least half an hour for absolute repose. If taken late at night the re- action may interfere with sleep, al- though, as will be seen later, the tran- qullizing effect of the lukewarm bath or wet pack tend to promote it. THE SCIENCE OF BATHING. 107 It is a common error to suppose that only persons of active habits and ro- bust constitution may advantageously use the cold bath. On the contrary, those who are by nature feeble, or per- sons obliged to lead an enervating, sed- entary life, derive even greater benefit from its judicious employment. To such, it is the very best general tonic, substitute for exercise, conservator of health, and prophylactic against the diseases to which they are especially liable ; but naturally, in these cases, extra care must be exercised in matters of technique ; and it should be borne in mind, that, as in all applications of heat and cold, absolutely contradic- tory results are apt to follow ap- parently similar procedures ; the effect not desired may ensue from neglect io8 HYDROTHERAPY AT SARATOGA. of some seemingly unimportant de- tail. The Hot Bath. — Little need be said of the positively hot bath ; by which is meant submersion, for an ap- preciable time, in water at a tempera- ture of from 105° to 120° F. Unless extreme in heat, and conse- quently injurious, the physiological effects of such a bath, are of slight consequence to those in health ; and only in some forms of rheumatism, and rare emergencies — such as the passage of a calculus, irreducible her- nia, retention of urine, or when it is urgently desired to draw blood to the surface, in order to relieve sudden con- gestion of internal organs — are they of remedial importance in disease. Besides the extremely hot bath is famil- iar, and already too popular, in many THE SCIENCE OF BATHING. 109 households ; and even when used by the heahhy, for purposes of cleanHness, claims rather a word of caution than of advocacy. While cold bathing is, as a general experience, more appreciated by men than by women, the habitual use of very hot baths is frequent among ladies ; and, unless followed by a cool douche or shower, which is seldom the case, is decidedly injurious — debilitating to the nervous system, relaxing to the muscles, and subversive of graceful con- tour. On the contrary, the warm bath (from 95° to 102° F.), in every form, has a wide range of therapeutic usefulness ; and, paradoxical as it may seem, is often applicable to the same class of cases for which cold bathing has already been recommended. The fundamental purport of both no H YDRO THERAP Y AT SARA TOGA. cold and warm bathing is the same — i. e., to promote function. Cold accom- pHshes this end by stimulating latent force into activity ; warmth, by physi- cally facilitating the defective perform- ance of organic life, Cold contracts peripheral blood vessels, increasing ar- terial tension, but, as a secondary effect, expands them ; warmth relaxes at once. Baruch^ remarks, that, "by means of hydrotherapy we may exercise perfect control of the pressure and distribu- tion of the blood." True, in a great measure : but, at times, it is no simple task to elect the method most likely to give the result desired. As, in localized inflammations, one may hesitate be- tween the ice-bag and the more con- servative system of hot fomentations * " Syst. Pract. Therapeutics." — Hare, THE SCIENCE OF BATHING.. m and poultices ; so, under some circum- stances, it needs an educated judgment to determine whether a given constitu- tion possesses sufficient reserve vitality to profit by a refrigeration, demanding strong reaction, or, whether it is wiser to rest content with making easier the imperfect efforts of nature, by the im- mediate application of warmth. The salutary administration of cold presupposes sufficient structural integ- rity of viscerae to insure benefit from rapid changes of vascularity, and suffi- cient capacity for internal heat-produc- tion to compensate for the pre-existing heat abstracted in the batR. Warmth, on the other hand, makes no such de- mand. It takes nothing from the or- ganic force inherent to the individual, and, at the same time, although in a 112 H YDRO THERAP Y AT SARA TOGA . lesser degree, serves the same thera- peutic purpose. For this reason, it is suitable to the majority of persons who seek professional advice, and to whom cold bathing would be contra-indicated by some of the conditions already stated. Warm Mineral Baths. — No thermal springs have yet been discovered in this section of the country — the high- est natural temperature in New York State being 75° F., at Lebanon.* They abound, however, in the Western States and other parts of the world ; notably on the continent of Europe, where they -are much esfeemed in the treatment of chronic gout, rheumatism, scrofula, skin diseases, and a variety of other com- plaints ; but, the technique usually * Peale, United States Geographical Survey. THE SCIENCE OF BATHING. 1 13 occupies more time than even the average health-seeking American would be willing to expend ; and, in many places, leads to social institutions not likely to become fashionable here. For instance, at Leukerbad, '' gentle- men and ladies bathe together in reser- voirs adapted for about twenty persons, beguiling the time with conversation, reading, taking luncheon, and playing dominoes on floating boards. The bathers, attired in woolen mantles and capes, in this manner avoid the ennui otherwise unavoidable."* The Saratoga waters are naturally cold (from 40° to 52° F.) ; but may be heated to any point desired with practi- cally no change in mineralization, and a loss of gas so insignificant that, even * Braun. 1 14 HYDROTHERAP Y AT SARA TOGA. after the heating process, these waters still contain about double as much as the most celebrated thermal baths of Europe. The Schwartz system of bath-tub, extensively used at foreign resorts with the view of lessening the escape of gas during the heating of naturally cool water, is therefore unnecessary here ; and, as the notion of '' a telluric, or electro-volcanic " heat, with specific properties dissimilar from those of ordinary heat, exists only in the imagination and parlance of the spa charletan, it is ridiculous to assert, that the heating of these waters, being artificial, detracts in any respect from their remedial potency, as com- pared with naturally hot baths. Indeed, the Saratoga waters are so highly saturated with gas, that, under THE SCIENCE OF BATHING. 115 some circumstances, its excess may become an element of daneer. Car- bonic acid, when taken in the stomach, or absorbed through the skin, is usually an exceedingly valuable stimulant, but when respired by the lungs it is always injurious — causing difficulty of breath- ing, dizziness, cardiac oppression, and ultimately asphyxia. The heating of the bath favors its escape, as also do the movements of the submereed body ; and refreshing as it may seem to agitate the sparkling water, and watch the brioht bubbles risine to the surface, it must be remembered that when they pass off into the atmos- phere, and are inhaled by the lungs, the injurious results will go far to counterbalance the beneficial stimula- tion of the cutaneous surface. It 1 1 6 H YDRO THERAP Y AT SARA TOGA. is, therefore, desirable that the bath should be well stirred up, or allowed to stand for a period before use, so as to permit a moderate loss of gas ; or, better still, that the bather should remain quiet during immersion, in order that the carbonic acid may be absorbed, and act freely upon the peri- pheral nerve filaments, without largely vitiating the respired air. Baths of carbonic acid gas are given at Rehme, Franzensbad, Marienbad, Kissengen, and other places. The body is in- closed in a reservoir filled with gas, the head only being excluded. Such baths could just as easily be administered at Saratoga, but are of no special value. In point of mineralization, the waters of Saratoga are very similar in constitu- ents, and usually quite equal in strength, 'THE SCIENCE OF BATHING. I17 to many of the most celebrated natural sool baths of Europe.* They contain over one per cent, of chloride salts, which is double as much as many of high repute abroad, and amply sufficient for most general purposes. But if, as in certain cases of unusually torpid skin, scrofulous or rheumatic exudations, or similar conditions, a stronger solution is desired, there is no reason why the bath should not be artificially strength- ened at Saratoga, as is customary at Baden-Baden, Kreuznach, Rehme, El- men, Arnstadt, Wittekind, Pyrmon, Cannstadt, and other famous watering places abroad. This may be done, up to three or four per cent, with common salt, or the combination of salts natural ♦Kreuznach, Aix-la-Chapelle, Spa, Baden-Baden, Wiesbaden, Soden, Kissengen, Hall, Homburg, etc. . 1 1 8 HYDRO THERAP Y AT SARA TOGA . to the waters obtained by evaporation, or, what is known at European Spas as "Mother-lye" (Mutter lauge), that is, a highly concentrated solution of the chloride salts, from which much of the chloride of sodium has been removed for commercial purposes. Warm baths of the natural Saratoga waters are beneficial in a wide range of chronic diseases. Almost equally with cold baths they stimulate all the func- tions — increasing the appetite, improv- ing digestion, and facilitating the elim- ination of effete or morbid material through the lungs, skin, and kidneys. But, as has already been stated, it is impossible to do more than generalize in matters of technique, which may be indefinitely modified, and adapted to the powers and requirements of the THE SCIENCE OF BATHING. » 119 individual constitution. The tempera- ture, strength, duration, and frequency of the baths, and the length of time it is wise to continue a course without in- terruption, are all points which must be determined separately for each particu- lar case ; and will largely depend, not only upon the nature of the disease, and constitutional condition of the sick person, but also upon the effects first produced, which should be carefully ob- served from day to day. From 90° to 98° F. is usually warm enough ; as on account of the stimulat- ing qualities of the gas and minerals, which are appreciated by the skin as a kind of textural unctuosity, these waters can be borne with comfort at a much lower temperature and for a longer time than ordinary water. i20 • HybROTHERAP Y AT SARA TOGA. The duration of the bath cannot in every instance be prescribed before- hand, but may range according to the circumstances, and the sensations of the bather, from ten minutes to half an hour or more. At Aix-les-Bains, Wildbad, Gastien, Rehme, and other European bath resorts, an hour is the usual time ; and using a mild water, such as the Red Spring, would not be too long. There is no limit to the duration of a bath of ordinary warm water, so long as the temperature is maintained ; but it should be remembered, that long con- tinued mineral baths might become in- jurious, not only by too powerful •cuta- neous stimulation, but also through the amount of carbonic acid unavoidably inspired. It is well to commence a course of mineral bathing somewhat THE SCIENCE OF BATHING. l2i cautiously, until the effects have been noted, especially in cases where too stimulating an influence is not desired : say, a bath at 98° F., of ten or fifteen minutes, every alternate day, until three or four have been taken ; and sub- sequently, every day for some weeks, the temperature being gradually low- ered and the duration increased ; or, if circumstances permit, and continuous betterment is experienced, every second day throughout the entire season. As a rule, the sensations in the bath are ex- ceedingly pleasant, and independent of benefit to any special ailment, the skin becomes soft and white, and the general health is improved. To drink the waters and bathe upon alternate days is popular at some foreign resorts, and to frail constitutions is often a judicious 1 2 2 HYDRO THE RAP Y AT SARA TOGA . distribution of the influences of treat- ment. Occasionally, excessive bathing, espe- cially at very high temperatures, and when accompanied by immoderate internal use of the waters, gives rise to a condition of general constitutional disturbance, with considerable fever, cardiac irritability, and a pustular eruption on the skin. This is known as bad-strum at the German spas, and la poussde at the French ; and at some of the quack hydropathic establish- ments is termed '' the crisis" — and pre- tended to be a necessary part of the cure. In reality, it is evidence of excessive and injudicious use of the waters, and consequent hyper-satura- tion, and is comparable to the ''physio- logical," or semi-toxic, effects of drugs. THE SCIENCE OF BATHING. 123 when administered too largely or too lono-. It seldom does much, harm, and when the waters are entirely sus- pended passes off in a few«days. At Saratoga these unpleasant symptoms appear much less frequently, and with less violence, than is common at foreign resorts. As moderate exercise is beneficial after the cold bath, so a period of complete repose is generally desirable after the warm. The Douche. — Of the many special forms of bath those most worthy of consideration, irrespective of the na- ture of the water, are the douche, or movable jet bath, and the wet pack. The Douche may be of any tempera- ture, and is usually applied with con- siderable force — sometimes equal to that of water fallinor from 60 to 100 124 H YDRO THERAP Y AT SARA TOGA . feet. By it, whether with hot or cold water, there is obtained, in addition to the ordinary effects of other baths, de- pendent mainly upon the nature and temperature of the water, a special mechanical quality in the impingement of the water against the skin, acting as a kind of hydro dynamic massage; and, thus stimulating in a favorable manner the peripheral nerves, blood vessels, and subjacent -muscles. It is valuable in many conditions of con- stitutional debility, functional impo- tence, and chronic disease ; more particularly, in abnormal states of the nervous system. In these cases, how- ever, it is open to the objection that it can only be properly applied by a skilled attendant, and might prove dangerous in inexperienced hands. It THE SCIENCE OF BATHING. 125 may be used colder than other forms of bath, owing to the force with which the water strikes the skin, but should always be of short duration. In France, where it is preferred to any other method of balneotherapy, and is extensively prescribed by Charcot, Dujardin-Beaumetz, and other noted authorities, it is usually administered by a physician under their direction. At the establishment of Keller, the patient of either sex stands before the operator, receiving the column of water alternately, or as circumstances dictate, upon the spine, and anterior surface of the body — a procedure somewhat startling to the Anglo-American sense of propriety, and scarcely in accord with our notions of professional dignity. What is termed the Scotch, or mixed 126 H YDRO THERAP Y AT SARATOGA, douche — consisting of very hot and very cold jets, repeatedly alternated — is an excellent remedy for stiff joints, strumous or rheumatic exudations, and other local maladies. The Wet Pack. — From a strictly therapeutic standpoint the wet pack is more widely applicable, and in some respects more valuable, than any other form of bath. Its administration needs no special skill, and with a little care is entirely free from danger. It can be taken in one's own apartment, and when mineralized water is used a quart bottle will suffice for a bath. The .method of applying it is as fol- lows : A couple of stout blankets are spread upon the bed, then an ordinary linen sheet or tablecloth, which has been wrung out of water at a moderate tem- THE SCIENCE OF BATHING. 127 perature — say 60^ F. — is smoothly spread over them. The patient now lies in the center. The sheet is rapidly wrapped around him, one side being carried under the arms and well be- tween the legs, while the other is brought outside the arms, and tucked closely about the neck, thus enclosing the entire body, except the head and feet, and so, that evei*ywhere the wet sheet is in contact with the skin. The blankets are then rolled snugly about the body, and if desired, more covering may be heaped on top. A hot water bag to the feet, which are best excluded from the wet sheet, and, if found pleas- ant, a cool compress around the head complete the equipment. The first sensation is of chill, but this, almost invariably, passes off in a very few 128 HYDRO THERAP Y AT SARA TOGA. seconds — otherwise the pack must be discontinued — then the sheet feels com- fortably warm, the skin perspires freely, and there is experienced a singularly tranquilizing, calmative effect — easily leading to sleep. Thus is obtained the benefit of a slight tonic reaction — so slight, as to make no appreciable demand upon the vitality — with superadded, a quieting, soothing effect, quite equal to that of the ordinary warm bath. The patient may remain in the pack from twenty minutes to two hours, or even longer, dependent upon the result desired, and the degree of comfort induced ; and if disposed to sleep, he may be allowed to do so without detri- ment. The procedure is terminated by a rapid sponge over with tepid or THE SCIENCE OF BATHING. 129 cold water, in order to counteract undue relaxation of the cutaneous structures ; or, if the patient is weary, a simple drying with a soft towel will suffice ; when he will soon fall into calm and refreshing sleep. The merits of the wet pack deserve a wider recognition in the medical pro- fession than accorded them, at present ; and it is much to be desired that the prejudice against such procedures — the popular hydrophobia which so hampers their employment in ordi- nary practice — should be thoroughly uprooted from the public mind. Thus, might be avoided many a dose of harmful medicine — thus, many a fevered skin ^cooled, many an irritable spirit calmed, and many a restless night spared, 13° HYDROTHERAP Y AT SARA TOGA. From what has been said of its ef- fects, it would seem unnecessary to specify the host of various maladies in which the wet pack, or some of its modifications, are valuable. From the earlier stages of pneumonia, simple pyrexia, and the exanthemata, to chronic rheumatism, phthisis, pelvic inflammations, dysmenorrhea, and in- somnia, it is almost everywhere suit- able, can scarcely do harm, and is capable of immeasurable good. What is termed '' the hot wet pack " is an entirely different form of treat- ment, with a much narrower applica- bility. In it is used, instead of a sheet wet with cold water, a blanket wrung out of very hot water ; otherwise, the procedure is the same, although the effect is comparable rather to a hot THE SCIENCE OF BATHING. 131 than a warm bath. It may be applied locally or to the entire body, In which latter case, It acts as a kind of universal stupe or poultice. The ''dripping sheet," and "sheet bath" differ slightly In technique, and have each warm advocates among scien- tific hydrlatlsts ; but neither has ap- peared attractive to the writer. Mud baths, except for dirt-lovers, and sand baths, except for hydropho- bics, possess no merits not fully equaled by clean water. Turkish and Russian Baths. — An adequate consideration of the vapor and hot air, or Russian and Turkish baths, would demand a chapter to Itself ; but Is clearly beyond the scope of this work. Suffice It to say, that both forms of bath are luxurious to the high- 132 HYDROTHERAPY AT SARATOGA. est degree; and to constitutions which they suit, and when properly carried out, are often beneficial and refreshing. In a general way they follow the prin- ciples governing other forms of bath ; and are curative in much the same range of chronic disease. In the Turk- ish or dry air bath, a temperature up to 240° F. is easily borne for some min- utes ; while, in the Russian or vapor bath, 120° F. is barely endurable. Although closely resembling each other in man}^ respects, one fundamen- tal difference must be remembered, that, while the Turkish bath favors per- spiration more fully than any other hydriatic method, the Russian bath ac- tually impedes it. Both increase to a very marked degree the excretion of urea, an effect, which, according to THE SCIENCE OF BATHING. I33 German observers, continues for days after the bath. Like other applications of extreme heat, they put considerable strain upon the vital functions, and are at times disturbing to nervous equilibrium. Cardiac action Is not unfrequently even doubled in rapidity during the first ten or fifteen minutes, and the bodily tem- perature raised two or more degrees In the same time — conditions usually ex- pressive of some morbid process. Aside from their superlative cleanli- ness, the greatest merit of both forms of bath lies in the fact that the extreme heat prepares so perfectly for the deli- cious cold douching to follow ; and hence, the subsequent feeling of invlg- oration. Nevertheless, they have but a limited applicability, either as a hy- 134 H YDRO THERAP Y AT SARA TOGA . gienic measure, or in the treatment of disease. They should not be indulged in by the old, or when there is any sus- picion of organic disease, or indeed, un- der any circumstances without compe- tent advice. There are three, bathing establish- ments at Saratoga : T/ie Saratoga Baths, just opened and luxuriously appointed ; The Red Spring, and the misnamed Magnetic. There is also -a bath house at The White Sulphur Spring, south of Saratoga Lake. All are well conducted. CHAPTER VIII. THERAPEUTIC APPLICABILITY, AND DIETETICS. The omni-curative pretension, which so often characterizes the Hterature of mineral waters, is apt to suggest a doubt of their remedial potency, even within the domain where their value has been demonstrated beyond ques- tion. And, unfortunately, this ten- dency to exaggeration is not confined to the advertising circulars, but some- times may be noticed in the writings of those from whom better things might be expected. To cite an example, not too near home, a Carlsbad physician — of homeo- 135 136 HYDROTHERAPY AT SARATOGA. pathic persuasion — works his way through the nosological alphabet, enumerating as curable by that spa almost every conceivable malady : no less than eight distinct diseases of the spleen; ''most of which," comments Dr. Madden, with delicious cynicism, '* we are utterly ignorant of in this country, but have the satisfaction of learning that they may all be cured by sending the patient to Carlsbad." Strange as it may seem, such stupid hyperbole is not always intentionally dishonest, but often the result of the common error, which is responsible for much of the confusion and contra- diction pertaining to the subject ; and which, it has been one of the first ob- jects of this work to correct. Mineral waters are in no sense specifics. Judi- THERAPEUTIC APPLICABILITY. 137 ciously selected, and carefully adminis- tered, tJicy a7'e, zuitJiottt exception, the safest and most efficient correctives of the morbid constittitional conditions common to most for7ns of chrofiic dis- ease ; and hence, may be justly credited with the widest ranee of iiidi- 7'ect curative power ; but, even in condi- tions, such as the uric acid diathesis, in which their action is most chemically direct, it is based upon the same scien- tific principles which govern the use of other remedies ; and, should be guarded by the same discrimination and watch- fulness, that we are accustomed to exer- cise in other methods of practice. The dogmatic assertion that one spring will cure rheumatism, another gout, another kidney diseases, and another dyspepsia — without any regard 138 HYDRO THERAP Y AT SARA TOGA . to the type of the disease or the condi- tion of the patient — is as unjust to the water, as it is cruelly misleading to the sufferer; and too often results in disap- pointment to the one, and unmerited loss of reputation by the other. It even happens -that the same ' water, which is most capable of combating a morbid predisposition, or actually en- gaged in erradicating a dyscrasia, may, if unwisely pressed, absolutely aggra- vate the active manifestations. Thus, for instance, it has been noticed, and unfairly cited in disparagement of min- eral hydratics, that the alkaline waters most warmly commended for the relief of constitutional gout, will, in some cases, positively determine an acute at- tack. Such misfortunes, however, are readily intelligible to anyone who will THERAPEUTIC APPLICABILITY. I39 take the trouble of understanding the rationale of mineral-water drinking, in conjunction with the pathology of this, or any other disease ; and, are as easily avoided as the untoward consequences, following the misuse of any other remedy. No less easily understood is the appar- ently paradoxical experience, that dis- eases of quite different kind are cured or alleviated at the same spa, whereas cases of the same nature are cured or alleviated by very different spas ; merely showing, that any well di- rected course of mineral waters, inde- pendent of its immediate effects, has, by its influence upon metabolism, a health-restoring quality in almost every perverted condition of the system. When we remember, the variety and 1 40 H YDRO THERA PY AT SARATOGA. therapeutic powers of the Saratoga waters ; the absence of all guidance or restriction in their use ; the diverse con- ditions in which they are prescribed, often entirely at haphazard, without reference to the quality of their ingred- ients, the method of their action, or the fitness of any particular spring to the special need of the individual pa- tient ; and finally, with entire neglect of the general hygienic precautions whicji usually surround any other medicinal course — it is indeed remarkable how regularly they produce beneficial ef- fects, and how seldom we hear of an authenticated failure, after even the sem- blance of a fair trial. When disap- pointment does result, it is unhesitat- ingly attributed to the worthlessness, or uncertain action, of the waters, and not, DIETARY, 141 as it usually should be, to the unwise selection of a spring, or, perhaps, the ill-advised administration of an entirely inappropriate remedy. Diet. — A properly regulated dietary is the most important auxiliary of an hydriatic course. Indeed, it is abso- lutely essential to a satisfactory result ; but here, too, it is necessary to clear the decks of absurd exaggeration, and traditional prejudice, as preliminary to a reasonable mastery of the situation. A large proportion of all disease is attributable directly or remotely to an habitually injudicious diet. This is especially true of gout, rheumatism, dyspepsia, hepatic and renal com- plaints, and a variety of other ailments most susceptible of relief at Saratoga, and niost likely to seek treatment 142 HYDRO THERAP Y AT SARA TOGA. there. It is the fundamental principle of rational medicine to remove, or miti- gate, the cause of disease before essay- ing its cure. In the ordinary routine of practice, we are accustomed to ad- vise such patients as to their habits of life, and specify for them an approxi- mate scale of diet — the adoption of which we regard as no less significant than the medicine prescribed for the disease. Dietetic reformation, to pre- cisely the same extent, neither more or less, is necessary during a hydro-min- eral course as during any other course of regular medication ; bearing in mind, of course, the special chemical charac- teristics of the water, and the conditions incidental to the bulk of fluid con- sumed. Persons suffering from complaints di- DIETARY. 143 rectly the result of over-eating, or other excess, who unfortunately lack the requisite self-control to abstain from continued intemperance, may, /redzs/>osih'on to phthisis, but, in which no structural alteration of the lung is yet discoverable ; and those in which there already exists tubercu- lar deposit, cavity, or tendency to hemoptysis. In the former class, care- ful internal use of the waters, and well regulated cold baths, are capable of zm- measurable benefit ; whereas, in the latter, imbibation is practically forbid- den, and either extremes of tempera- ture in the bath would be immediately dangerous ; and, although frequent bathing is still desirable, to calm the excited nerve centers, control pyrexia, ^nd maintain cutaneous activity, it PHTHISIS. 193 should be restricted to the tepid full bath, or wet pack. Winternitz, a high authority, favors a local wet pack, or cold compress applied to the chest alone. Although applying rather to the winter resorts than to Saratoga — which is, in all respects, a desirable summer residence during any stage of pulmon- ary phthisis — the writer cannot leave this subject without recording a word of protest against the scandalous expedient of inducing a dying consumptive to leave the luxuries of a comfortable home, by the deceptive promise of ben- efit elsewhere. A physician's duty does not end with the possibility of re- covery. However painful to his own feelings, and humiliating to his science, he is still bound to promote the com- 194 HYDROTHERAP Y A T SARA TOGA. fort of his patient's last days — and then euthanasia. Gout and Rheumatism. — Aside from hereditary predisposition, these mala- dies start with a common pathogenesis: primarily, defective digestion and faulty assimilation, with consequent disorder of the nutrient process ; and, subse- quently, an excess of acid material in the blood. Hence, their earliest thera- • peutic indication is also in common — to provide alkaline carbonates in order to neutralize abnormal acidity ; but, from this point their courses so diverge, ther- apeutically, as well as pathologically, that it has even been proposed to con- firm a posteriori, a distinctive diagno- sis of the more prominent influence in the hybrid condition termed rheumatic- gout, by testing separately the remedial GOUT, 195 power of their individual specifics — col- chicum and salicin. The more chronic forms of eout and rheumatism, however, aeain resemble each other in many re- spects, notably in the benefit they de- rive from the use of the alkaline-saline waters ; but the details of procedure differ in so many important particulars as to require a separate, although brief consideration. Gout. — As the outcome of heredity, or injudicious diet, or both, an excess of uric acid appears in the blood ; which, according to the best, but still obscure researches of biological chem- istry, is, under certain conditions, lia- ble to crystalize in the tissues ; and thus give rise to severe inflammation, pyrexia, swelling of joints, and intense pain — the simplest expressions of acute 196 H YDRO THERAP Y AT SARA TOGA . gout. The treatment consists of local sedation, warmth, colchicum, and anti- phlogistics. Mineral waters, to the ex- tent of effective medication, have at this stage no definite utility ; and if unwisely administered, would probably aggravate the symptoms, by their gen- erally stimulating influence. In the intervals between those attacks, on the other hand, when it is intended to improve the constitutional condition, and correct the abnormal state of the blood which is liable at any moment to renew acute mischief, we have, in the alkaline-saline waters, a remedy of direct and invaluable potency. The successful accomplishment of the requisite chemical changes in the blood, and the safe disposal of the re- GOUT. 197 suiting products, are, however, by no means simple matters. When alkalies are brought into contact with uric acid, alkaline urates — of soda, lime, or llthia, as the case may be — are the result ; and these, if perfectly dissolved, and sufficiently diluted, and not in ex- cess of the eliminative capacity of the excretory organs, are thrown off with- out trouble ; and the desired end is thus safely attained. When, however, a large quantity of alkaline salts are in- troduced into a system hypercharged with uric acid, and full provision for the solution and removal of the result- ing urates is not at the same time assured, or when, by too rapid solution of deposits of uric acid — previously in- active in the tissues — an unwonted quantity is set free in the circulation, 1 98 HYDRO THERAP Y AT SARA TOGA. an acute attack of gout is not unlikely to be the consequence. This is the explanation * of those unfortunate crises, which occasionally occur during an apparently well directed course of alkaline waters ; and which are responsible for the impres- sion, not uncommon among podagric wise-acres that, "• it is better to leave the gout severely alone." So it is, until one has learned to handle the remedy! But such attacks may be avoided, and yet, the constitutional con- dition corrected, by proceeding care- fully with the earlier treatment, with- out unduly hastening the chemical changes ; and further, by selecting waters, such as exist at Saratoga, * Pfeiffer, Die Gicht und ihre erfolgreiche Behand' lung ; Yxavsi, Deutsche med.Zeitung, 1891. GOUT. 199 which, by a suitable combination of alkaHes and salines, not only accom- plish the first indication of neutralizing excessive uric acid, but, in the same degree, provide for the dilution and elimination of the resulting urate com- pounds. The bicarbonates — especially that of soda — as ordinarily administered, are particularly liable to deter- mine these adventitious seizures. When long continued, they tend to disturb digestion, thus promoting an increased formation of the mor- bid material they were Intended to eradicate ; and, moreover, their use necessitates, in many cases, the constant employment of purga- tives. It has also been demonstrated ex- 200 H YDRO THERAP Y AT SARA TOGA . perimentally * that, although under the influence of bicarbonate of soda, as usually prescribed, the uric acid in the urine diminishes at first, until it has almost entirely disappeared, yet, it soon returns again in spite of the continued administration of the medicine. On the other hand, not only does a much smaller quantity of the bicarbonate produce the same result, when con- tained, in combination, in a natural mineral water ; but the effect continues as long as the water is taken, and often outlasts the treatment by a considera- ble period. An insuperable obstacle to summar- izing a treatment of gout, lies in the * Munch, Archiv fiir hez'lkunde; Braun, op. ci't.; Frickhinger, Ober die harnsdure losende Eigen- schaft des Fachinger Wassers ; Fiirst, op. cit* GOtJT. 20 i frequency and variety of associated ail- ments : some causative, others conse- quential. Dyspepsia, enlargement of the liver, spleen or pancreas, inactivity of the kidneys, torpidity of the intes- tines, general organic stasis, or the condi- tion described as abdominal plethora — are all, prominent contributing factors in the Induction of gout. Fortunately, the same waters indicated for uncom- plicated, or ** regular gout," are usually of a nature to be directly serviceable to each of these contributory conditions. Their presence and prominence will, however, materially Influence the selec- tion of a spring — favoring, as a rule, an Increased proportion of saline ingre- dients. On the other hand, there are a number of minor ailments, such as skin diseases, catarrhs, and the like, 202 HYDRO THERA PY AT SARA TOGA. which are directly the products of con- stitutional gout ; and, bearing upon them the stamp of the dyscrasia, are thus, independent of special character- istics, brought within the scope of min- eral hydriatics. It must not be understood that bene- ficial results attending a well directed course of the Saratoga, or similar waters, in the gouty diathesis, is to be exclusively attributed to the nature of the ingredients, and consequent chem- ical reaction taking place within the body. On the contrary, at least as much credit should be accorded to their influence in promoting metabolism, es- pecially the oxidation of the carbo^ hydrates, and formation of urea ; and to the hydro-static lixiviation of the tis- sues and juices ; and to the augmented GOUT. 203 activity of the excretive organs, and consequent solution and washing out of effete matters in general — including, no doubt, the mater ies morbi of gout. The prognosis in these cases should usually be guarded. The confirmed gouty constitution is under all circum- stances unsatisfactory to manage. Re- covery is necessarily a slow process; and in many of the old established cases it can scarcely be hoped to do more than improve the general constitution, ward off acute attacks, limit the deposit of urates, and, perhaps, after considerable perseverance, diminish exudations, or partially dissolve articular deposits. Charcot * questions the latter possi- bility of hydro-mineral treatment, but it may be noted that this distinguished * Sur Ies maladies des Vieillards. 204 H YDRO THERAP Y AT SARA TOGA . authority has had no experience with Saratoga waters. In gout, more even than in other diseases, the details of hydriatic treat- ment must be modified in accordance with the requirements of the indivi-dual case. Generally speaking, the pro- longed internal use of the waters is of more value than bathing ; although moderately warm (95° to 105° F.) full baths, and wet packs, mitigate consti- tutional irritability, improve the condi- tion of the skin, and in recent cases may even promote absorption. Local packing is usually soothing, but in the suppressed form may determine a more acute inflammation. Showers, sprays, and douches are contra-indicated ; ex- cept as prophylaxis in robust persons of hereditary predisposition, but In GOUT. 205 whom the disease is as yet undefined. Not uncommonly heart lesions, or other organic defects, will be found to exist in the more serious forms of gout, which of themselves would absolutely preclude the cold water treatment. The choice of springs should be guided by the nature of the local mani- festations, and the preponderance of constitutional plethora or anaemia. For the uncomplicated dyscrasia, notably alkaline waters, with comparatively slight saline admixture — such as the Kissengen and Vichy — may answer well. With abdominal torpidity, a greater proportion of chloride of so- dium is Indicated, and then the Pat- terson, Hathorn, Congress, or Excelsior may be recommended ; or, if plethoric engorgement is still more conspicuous. 2 o6 HYDRO THERA PY AT SA RA TOGA . the powerfully saline Carlsbad, Cham- pion, or Geyser. In atonic cases, with well marked debility, often resulting from repeated attacks, or too prolonged depressing treatment, the saline-chaly- beates may prove most beneficial. In this disease all waters are better taken warm, the slight loss of gas en- tailed thereby, being, if anything, an advantage. The bowels should be kept freely open; and for this, or any other purpose, we must not hesitate, when necessary, to combine pharmaceutical remedies with hydriatic procedures. Rheumatism, — In this disease hydro- mineral treatment is accorded uni- versal commendation. Indeed, it is astonishing that there are so few disappointments, when it is remem- RHEUMATISM 207 bered how recklessly are put forward the rival claims of mineral springs all the world over ; how many, and how varied are the morbid expres- sions included under the almost generic term, rhetunatism ; and how innumer- able are the sufferers, who, without direction of any kind, or the least knowledge of their chemical quality or method of action, partake of mineral waters — often totally unsuited for their particular cases. But rheumatism is as erratic in its manifestations and retrocessions, as it is obscure in its causation and path- ology ; and hence, it being impossible to establish its treatment upon a strictly rational basis, w^e are in a large meas- ure forced to accept the guidance of experience. 2o8 H YDRO THERA PY AT SARA TOGA . For convenience, it has been here as- sociated with gout, but although resem- bHng each other in so many particulars, it would be difficult to maintain a scien- tific connection between gout and rheumatism; and even the primary- postulate of an acid dyscrasia, might be doubted in some unquestionably rheu- matic affections, were it not for the regularity with which good results fol- low the appropriate use of alkaline remedies. As may be imagined, a full discussion of the hydro-therapeutics of rheumatism might fill a volume ; and yet there remains but little to be said of really practical importance, which is not indirectly embodied in the abstract principles already enunciated. As in gout, the applicability of hydriatic methods is directly proportion- RHEUMATISM. 209 ate to the chronic character of the symptoms ; and would usually be nega- tived in the acute disorder. Possible exceptions to this rule, are the administration of cold baths during the extreme temperatures of rheu- matic fever ; and, the limited use of the milder alkaline waters — from which most of the gas has been permitted to escape — as a febrifuge, in the same condition. The sub-acute varieties of muscular and articular rheumatism are exceed- ingly liable to engraft themselves upon the other cachetic states, such as the malarial, scrofulous, or lithaemic ; and, are not uncommonly associated with specific or catarrhal taints. These cir- cumstances distinctly favor the hydro- mineral treatment ; but, occasionally 2 lO HYDRO THEKAP Y AT SARA TOGA. suggest the combined administration of the pharmacopoeial iodides, or simi- lar medicaments — which are in no sense incompatible with it. Neither is there reason, why in suitable cases, elec- tricity should entirely resign its impor- tant function. Mineral waters, however, possess no electrical or magnetic prop- erties ; and, therefore, it is to be re- gretted that baths well conducted, and otherwise to be highly recommended, should, in this respect, sail under false colors. For internal use, the waters of Sara- toga are unequaled in the treatment of rheumatism. The choice of springs is governed by the same principles ap- plied to gout, and other diseases. In uncomplicated cases, the prominence of the alkaline bicarbonates, especially RHE UMA TISM. 2 1 1 those of lithia and soda, is the primary consideration. The relative import- ance of the salines and iron will de- pend upon constitutional characteris- tics already explained in other connec- tions ; while for corpulent persons, otherwise healthy, an active course of the stronger purgative waters may pro- duce excellent results. In about the same proportion as the inte^mal use of mineral waters is of most importance in the treatment of gout, so is the external application for the cure of rheumatism. This seems largely due to their effect upon the skin. There is a peculiar torpidity of that organ, described as atony of the skin^^ which seems to be both causitive, and adjunctive, of sub-acute * Braun — Herman Weber. 212 H YDRO THERAP Y AT SARA TOGA . rheumarthritis ; and which is most favorably influenced by all forms of stimulant bathing. With few exceptions, the treatment of rheumatism may be advantageously conducted upon more vigorous lines than would be admissible, under simi- lar circumstanced, in the management of gout. In the absence of cardiac, or other organic sequelae of the acute stages — the presence of which can usually be ascertained without diffi- culty — there is no reason why energetic balneological procedures should not be early invoked with immediate ad- vantage. The choice between heat and cold is subject to the considerations fully discussed in the chapter upon baths. Cold water treatment, when admissible. RHE UMA TISM. 2 1 3 is in every respect to be preferred ; for by it, we not only cure the rheumatism ; but Hkewise restore vigorous health, and not unfrequently metamorphose a limping valetudinarian into an example of robust physical well- being. On the other hand, distinctly hot (105° F.) mineral baths — continued from twenty minutes to half an hour, and repeated once a day, or oftener, whether followed by a cool shower or not — have given most gratifying results, under cir- cumstances precluding the application of cold. It is a general belief, that upon their high temperature and long duration, rather than upon the miner- alization of the water, depends the world-wide reputation for curing rheu- matism, enjoyed by many of the "' in- 214 H YDRO THERAP Y AT SARA TOGA . different " thermal baths, at European spas.* Almost any modification of balneo- logical procedure may be indicated in the treatment of this disease. Douches, or the douche-massage, at any tem- perature, are especially applicable when the larger articulations, such as knees, hips, or shoulders are prominently af- fected ; and for long standing peri-ar- ticular exudations — the prognosis of which, it may be said, is decidedly more hopeful than in similar conditions of gouty origin. In recent sub-acute rheu- matism of the muscles or joints, wet packs are particularly valuable ; and the early use of the hot air, or vapor bath, has successfully aborted an attack. * Teplitz, Wiesbaden, Wildbad, and others. DYSPEPSIA. 215 Of the vicarious local affections known as hunbago^ torticollis, and sciatica — intercostal, cervico-brachialy ma7Jivzillary, and lumbo-abdomi7ial neu- ralgias, it may be premised, that just in the proportion as their causa- tion is rheumatic or otherwise cachec- tic, and 7iot neurotic, will they derive benefit from mineral baths, local douches, and the internal use of the Saratoga waters. It should be remembered that, in the cure or palliation of any form of rheumatism, a restricted diet, and well- regulated hygiene, constitute essen- tial factors. Diseases of the Digestive Organs. — Hydro-mineral treatment, of some variety, is so constantly applicable to ailments of this class, that to consider 2 1 6 HYDRO THERAP Y AT SARA TOGA. them separately, would involve a con- tinued repetition. Saratoga is famous for the cure of dyspeptics. Its waters contain ele- ments suitable for almost every type of gastric derangement ; and yet, to pre- scribe them with a reasonable certainty of success, necessitates the same accu- racy of diagnosis, as would be indis- pensable in using the remedies of the pharmacopoeia. For the atonic conditions marked by peristaltic inertia, and deficient gastric secretion, which, in ordinary practice, would suggest the exhibition of nux vomica, capsicum, armoracia, acids, or pepsine, the waters rich in chloride of sodium and carbonic acid are especially indicated; and should, as a rule, be taken before meals, and cold — so as to DYSPEPSIA. 21 'J retard stomachic absorption, and em- phasise the locally stimulating effect. When, on the other hand, the symp- toms are those of sub-acute gastritis, evidenced by hypersecretion, hypera- cidity, local tenderness, sense of full- ness, and flatulent irructations, the milder alkaline waters, in which soda, magnesia, and lime predominate, will give the best results. In these cases they may be taken during, or soon af- ter meals, and are usually most effect- ive when used warm, in small quanti- ties and frequently. Magnesia is espe- cially valuable as a stomachic antacid, and lime, when there is tendency to flatulence or diarrhea — lithia and soda in almost all circumstances. In many ordinary forms of gastric in- digestion, evincing generally defective 2 1 8 HYDRO THERAP Y AT SARA TOGA. function, and often partaking of the distinctive characteristics of both the aforenamed classes, the combination of chlorides and bicarbonates, found in the milder alkaline-saline waters, may prove singularly effective. When catarrhal hyper-secretion is coincident with gas- tric dilatation, the waters may be used advantageously to wash out the stomach with the syphon tube ; after which operation, at least twenty minutes should elapse before food. Hydro-mineral treatment may be re- garded as prophylactic against gastric ulcer, which, no doubt, often results from long-continued hyper-acidity ; but when the existence of ulcer has been positively recognized, it is wise to inter- dict the stronger saline and gaseous waters, as being too irritating to the DYSPEPSIA. 219 diseased surface, and possibly tending toward haematemesis. The mild alka- line waters, however, heated and par- tially deprived of gas, may still be beneficial. It should be remembered that, be- sides their immediate chemical action upon hyper-acid secretion, and the hydro-dynamic cleansing of unhealthy gastric membranes, these bicarbonate- saline waters render a further service by increasing the anti-catarrhal influ- ence of alkalies in the circulation, and improving the general health. In pro- moting the latter intent, with special reference to the betterment of diges- tion, the favorable influence of cold baths, showers, douches, and all forms of mineral bathing is indubitable. Liver. — ** Is life worth living? "in- 2 20 H YDRO THERAP Y AT SARA TOGA . quires the title of Mallock's interesting book. ** It all depends upon the liver," i-s the well-known response of the witty sybarite. Then Saratoga, be- yond a doubt, contributes to a more unqualified affirmative, for who can question its facilitating influence upon "the current affairs " of both the liver, and the one who lives. Crudely expressed, mineral waters absorbed by the stomach pass rapidly into the portal circulation; and a con- siderable proportion thus permeates the liver — physiologically stimulating, and semi-mechanically flushing out, that important digestive and excretive or- gan. Hence, their effect is cholagogue, anti-catarrhal of the much-accused hepatic duct, both chemically correc- tive and hydro-dynamically expulsive LIVER. 22 1 of gall stones^ — and, moreover, the best remedy for the constitutional habit which predisposes to their formation. It would be impossible even to outline, within the scope of this work, a moiety of the hepatic derangements to which hydro-mineral treatment is applicable in some degree ; suffice it to say, that, except in some rare structural degenera- tions, or, the still more infrequent con- ditions of pressure upon the portal circulation by aneurismal, cancerous, hydatid, or other tumors — in which cases, it might be desired to limit the quantity of fluid ingested — the intelH- gent use of the Saratoga waters is in- variably helpful. In cirrhosis, and its accompaniments, these waters are exceptionally useful ; also, in general torpidity or biliousness ; 2 2 2 H YDRO THERA PY AT SARA TOGA . in the chronic hyperaemia following residence in tropical climates, or asso- ciated with the malarial, gouty, or spe- cific cachexias ; and, in all forms of re- sultant jaundice — more especially, in that attributable to obstructive catarrh of the biliary duct, without prominent symptoms of inflammation. Their happy influence is manifest, not only in aug- menting functional activity, and in- creasing the excretion and fluidity of the bile ; thus, relieving the nerve cen- ters, and the kidneys — often sorely tested — from the toxical presence of bile in the blood ; but also, by remov- ing cutaneous pigmentation, correcting icteric itch, and improving the general health. Ascites demands a passing word, more especially, as the dropsies of car- LIVER. 223 diac and renal origin come less dis- tinctly within the hydriatic sphere. Except in cases of malignant origin, these waters are an exceptionally use- ful adjunct to other curative measures ; tending to amend the causative condi- tion, and to promote absorption — by stimulating the kidneys, skin, and intes- tines. The alkaline waters are always ser- viceable — the proportion of saline ad- mixture, ot the advisability of iron, be- ing determined, as in other diseases, by the relative prominence of plethora or anaemia. As a general rule in liver derangements, the milder waters are most suitable, and are best taken warm ; but cold, and highly gaseous, water will sometimes control the obstinate vomit- ing common in these cases. Warm 2 24 // YDRO THERAP Y AT SARA TOGA . mineral baths are invariably useful ; and the application of local douching is extensively practiced abroad. Ex- tremes of temperature should never be used. Metallic Poisoning. — In connection with diseases of the Hver, may be men- tioned chronic metallic poisoning by mercury, arsenic, lead, or copper. However absorbed into the system, these metals show a distinct affinity for the liver ; and, are deposited in its sub- stance in greater proportion than in any other tissue. The alkaline-saline waters, freely imbibed, possess an un- equaled power in promoting their elimination ; and the chalybeates in subsequently restoring constitutional tone. Pancreas, — So rarely are organic PANCREAS. 225 changes of this important digestive gland, or the presence of concretions in its substance, diagnosticated during life, in contra-distinction from the usu- ally co-existing diseases of the liver, and other adjacent organs, that the writer can find no record of the results of treatment ; and admits, without diffi- dence, an entire lack of personal ex- perience. If, however, such a case were to present itself, he would not hesitate to treat it, cautiously, upon the well recognized principles applicable to the more familiar conditions of the liver. Constipation. — This distressing con- dition is dependent upon the unassimil- able character of food ; defects of the digestive secretions which should chem- ically alter its quality, and facilitate its 2 26 H YDRO THERAP Y AT SARA TOGA . absorption, or passage through the ali- mentary canal ; and muscular atony, or lack of peristaltic power in the stomach or intestines. In ordinary practice, it is deemed important to distinguish the relative prominence of these causative factors, before undertaking treatment ; and, no form of empiricism is more worthy of condemnation than the ** shot gun " prescription, or its prototype, the advertised cathartic pill, containing a little of everything : of which it is hoped that some one ingredient may hit the right spot, and so afford relief — prob- ably of short duration — while it is pretty certain, that the remaining items will only disturb previously normal function, and so aggravate the original difficulty. The Saratoga and similar waters are, however, an exception to this condem- ABDOMINAL STASIS. 227 nation of an universally applicable pur- gative compound; for although, they un- questionably stimulate peristalsis, pro- mote the secretion of the digestive fer- ments, and hydro-dynamically assist the evacuant function of the intjpstines ; and hence, might be regarded as a typical volley at almost every form of consti- pation, they produce all of these effects without unduly localized irritation ; and experience proves that their judicious use is entirely free from subsequent ill effect. Nevertheless, the fact should be emphasized that no inine7^al waters — not even the bitter waters of Pulna, Friedrichshall, Hunyadi, or the Rubi- nats — alone, and unaided by the pro- ducts of pharmacy, are suitable remedies with which to force efficient catharsis in the obstinately costive state, much less. 228 HYDROTHERAP Y AT SARA TOGA. in ill-defined intestinal obstructions ; nor, can the continued use of any saline aperient be regarded as a proper treat- ment for chronic constipation. In most persons, any of the markedly gaseous and saline waters will, when taken cold, during the morning hours, and followed by moderate exercise, induce easy and satisfactory alvine movements — in pro- moting which purpose, the carbonic acid gas is an important item. To this primary effect, may no doubt be at- tributed much of their generally salu- brious influence, which in turn, contrib- utes to the permanent cure of con- stipation, as of similar ailments often largely dependent on perverted consti- tutional habit. Abdovtinal Stasis. — No class of in- valids derive more benefit from a well ABDOMINAL STASIS. 229 directed hydriatic course than those suffering from that, somewhat vaguely expressed, condition of congestive debil- ity, known as abdominal plethora, or the hemorrhoidal habit. This state is char- acterized by general torpidity of the di- gestive apparatus, sluggishness of the abdominal circulation, and venous stasis of pelvic organs. It is usually, although not necessarily, associated with con- stipation and corpulence ; and, not un- frequently with fatty heart, or functional cardiac insufficiency. It is sometimes dependent upon the cachexiae — espe- cially the 77talartal, with accompanying enlargement of the liver and spleen — and commonly evinces itself by rectal and prostatic engorgement, and the ap- pearance of piles. In women it is a frequent cause of subacute ovaritis 230 HYDRO THERAP Y AT SARA TOGA. and uterine disorders. It produces, in many instances, extreme nervous depression, and may be regarded as the physical condition, of which hypo- chondriasis is the mental expression. Such cases usually demand as vigorous treatment, as co-existing organic de- rangements, will permit. The alkaline- saline waters internally — or, if marked constitutional anaemia, without symp- toms of cerebral congestion, the s^line- chalybeates ; together with, some form of energetic bathing. The douche- massage, and ascending douche, are especially useful. Obesity. — The photographer has dis- tanced the physician in reducing lovely woman to the graceful contour which her fancy prescribes, while her indolent habits, and vigorous appetite, just as OBESITY. 231 energetically deny. In men, over-eat- ing, alcoholic indulgence, and want of exercise are the usual causes of obesity ; but some persons of abstemious habits are abnormally disposed, to fat; and, to both sexes, about the middle period of life, there not uncommonly comes an unwonted tendency in this direction. No medical treatment directly influ- ences the accumulation of fat, without serious, and often permanent, impair- ment of general health. The only ra- tional methods of controlling its de- posit are the adoption of a modified and restricted dietary — excludino-, as far as possible, sugar, the carbo-hydrates, and other notably fat-forming foods; together with systematically increased exercise, and, such other measures as favor the physiological conversion of fats, and 232 H YDRO THERAP Y AT SARA TOGA. promote eliminative metabolism. The internal use of the alkaline-saline waters furthers these ends — not only by augmenting tissue-change, but also, by stimulating the emunctories, and so facil- itating the removal of used-up material. But to obtain marked results, they must be taken freely, although, never pressed to the extent of inducing painful cathar- sis or diarrhea. Baths, however, and those of the dis- tinctly energetic character, which, as explained in the chapter on balneology, promote metabolism, are decidedly the most reliable means, yet known to science, of reducing superfluous adipos- ity. But, if success would be attained, the rationale of their action must be thoroughly understood. Free perspir- ation in the Turkish bath will cause an OBESITY. 233 immediate reduction of weight, and so may delude one, struggling against cor- pulence, into the gratifying belief that he has already been made thinner ; but unfortunately this loss is almost entirely of water, which is soon replaced in the or- dinary course of even moderate alimen- tation, whereas, scarcely any real effect has been produced upon fatty tissue, by the easily graded, although often in- tense, temperatures commonly applied in these baths. On the other hand, either extremes of heat or cold, or more efficatious still, the sudden alter- nation of markedly contrasting temper- atures — especially from heat, as in the vapor bath, to cold, by the plunge or douche — have been proven to exercise a pronounced influence, in promoting the physiological combustion and removal 234 HYDRO THE RAP Y AT SARA TOGA, of fat. The ordinary cold bath — and mineral water, when easily obtainable, is to be preferred, for reasons already stated — tends in this direction ; but, as it is the thermic shock, rather than any special quality of the water, which pro- duces this special effect, the method of obtaining It to the fullest degree, is to emphasize the impression of cold, by the preparatory application of heat. It need not be added, that bathing of this character might, under some circum- stances, be hazardous, and should only be undertaken by those who are organ- ically sound, and under careful direc- tion. Catarrh. — Wherever in the human body there exists a mucous surface, local irritation, or perverted constitu- tional habit are apt to occasion the ob- RENAL DISEASES. 235 stinate subacute Inflammation, with con- sequent morbid secretion, known as catarrh. This unhealthy influence may affect the nasal, faucial, pharangeal, bronchial, pulmonary, gastric, hepatic, cystic, intestinal, rectal, vesical, ure- thral, uterine, or vaccinal mucous mem- branes ; but. wherever it appears, or whatever type it assumes, there is al- ways one point in common : all ca- tarrhs are benefited by alkaline rem- edies ; and, never more constantly, than when administered as alkaline, or al- kaline-saline mineral waters. Not only is their influence, by increas- ing the alkalinity of the blood and secre- tions, essentially anti-catarrhal, and, is hydro-mineral treatment generally, al- most specific in the constitutional dys- crasiae, so often associated with, and 236 HYDROTHERAPY AT SARATOGA. causative of, the catarrhal state ; but, even when appHed locally, these waters possess merits difficult to equal from the products of pharmacopoeia. For the post-nasal space and throat, as a wash or spray ; for the stomach, rec- tum, and vagina, as a douche or irriga- tion ; for the cystic duct and bladder as a pack ; and for the catarrhal ten- dency generally, in almost any phase of balneological technique, the Saratoga waters offer a potent remedy — both curative and prophylactic. Renal Diseases. — Diuresis is such a constant eiTect of the Saratoga waters, that, all who drink them must notice how considerably and invariably is aug- mented the excretion of urine ; and so, can scarcely doubt their influence, for good or evil, in abnormal conditions RENAL DISEASES. 237 of the kidneys. The general washing out of the system, which constitutes the most prominent primary result of unaccustomed imbibation, is mainly completed through increased renal ac- tivity. In some proportion to the quantity consumed, an unusual amount of water is absorbed into the circula- tion, a general lixiviation of the tissues ensues, and the kidneys are required, more than all other excretory organs together, to carry off, not only the superabundant fluid so acquired, but with it, a largely increased proportion of the ordinary ingredients of normal urine. From such an obvious influence, in- dependent of clinical experience, may be readily inferred the therapeutic ap- plicability of these and similar waters. 23^ HYDRO THERAP Y AT SA RA TOGA. So long as the exquisitely delicate ana- tomical bodies which compose the work- ing substance of the kidney, are struc- turally intact, they evince a readiness — which might well shock a modern trade's union — for whatever extra work unusual circumstances may necessitate. However remiss the liver, skin, and other co-scavengers of the human or- ganism, these indefatigable little work- ers are ever prepared to perform extra duty ; and hence, are our most reliable auxiliaries in correctingr morbid condi- tions of constitutional torpidity. Min- eral waters stimulate renal function; and, as in the other excretory processes, by increasing fluidity, facilitate its per- formance. They dilute irritant urine, dissolve and expel concretions formed in the substance or pelves of the kid- DIABETES. 239 neys, or bladder, or retained in the ureters ; and so, are especially indicated in the treatment of gravel or calculus, and in catarrhs of bladder and urethral membranes. In these conditions the milder alkaline waters are absolutely unequaled. When, on the other hand, as in all forms of Bright's disease, organic degen- eration is already in progress, and these once perfect physiological struc- tures — formerly ready to undertake all manner of supplementary excretion^ — are no longer equal to the normal per- formance of their legitimate function, it would be manifestly ill-advised to force upon them extra work, which might possibly be transferred elsewhere. Hence, although the other influences of these waters should still be consid- 240 HYDRO THERAP Y AT SARA TOGA. ered, which, by coincidently stimu- lating the liver and skin, may even relieve renal inadequacy, hydro-mineral treatment is applicable only, in the mildest forms, and under skillful super- vision. Diabetes. — This frequent and formid- able disease is still homeless in noso- logical classification. Whether, it is primarily of cerebral, cerebro-spinal, hepatic, or pancreatic origin ; or, should be regarded as a general neurosis ; or, precisely how important, from an etio- logical standpoint, should be estimated the hereditary, mental, gouty and other extraneous influences with which it is commonly associated — are points which have not yet been scientifically deter- mined. Certain it is, that least of all does it belong to distinctly renal dis- •DIABETES. 241 eases, among which it is usually placed by the non-medical public. It may be frankly confessed that knowing so little of its causation, and scarce more of its subsequent organic chemistry, we are guided in treatment almost entirely by observation and experience. It is not therefore, as in diseases previously con- sidered, so much by rational deduction, as upon the faith of a practically unan- imous authority, backed in some meas- ure by personal observation, that a carefully regulated hydro-mineral treat- ment is here recommended. Persons suffering from the more chronic forms of diabetes, are unques- tionably among the most regular fre- quenters of the principle foreign spas — and without regard as to the distinc- tive characteristics of the particular 242 HYDROTHERAP Y AT SARA TOGA . waters — yet, no class of invalids lay claim to more constant benefit. Sara- toga has an equally happy, if less ex- tensive, record in similar cases. When uncomplicated by hepatic, gouty, malarial, or markedly anaemic tendencies, which, as in other diseases, must be carefully considered, the milder alkaline-saline, and notably alkaline waters, are the best ; and may be taken, with apparently equal advantage, either warmed or at the natural temperature. Warm baths of all kinds are unques- tionably serviceable in diabetes. Those of Saratoga water, have the additional advantage of a more directly stimulat- ing influence upon the skin — an im- measurable service in this disease. The cold-water system is seldom admissible. The essential importance of a special HEART DISEASES. 243 diet needs no comment in this connec- tion. Diseases of the Vascular System. — In serious organic diseases of the heart — particularly those of the valves, and in atheromatous or calcareous degenera- tion of the blood vessels, the more ener- getic methods of hydriatic treatment are positively interdicted, for general use. A special caution is necessary in cases of aneurism. When directed, however, by those conversant with the manage- ment of cardiac diseases, and familiar with the effects of mineral waters, their favorable influence upon general nutri- tion may still be exercised without danger ; and even with marked benefit, in conditions of organic insufficiency. Only baths of medium temperatures are admissible in these cases. 2 44 H YDRO THERAP Y AT SARATOGA. In the functional cardiac neuroses, which not uncommonly result from the abuse of tea or tobacco, or indulgences involving nervous hyper-excitement, al- though the stronger springs are to be avoided, the mild alkaline-saline waters are serviceable ; and excellent results may be obtained from baths — both soothing and exhilarating. Diseases of Bone. — The rachitis of early life, the decalcification of later years known as osteo-malacia, and simple caries or necrosis occurring at any period of life, are all so nearly connected with the dyscrasiae — the ma- larial or specific taint — that, the pretty constant benefit derived from hydro- mineral treatment is probably attribut- able to improvement of general health, rather than to the presence of lime, or SklN DISEASES. 24^ »gr.r I ■ --.i» — - -^ ■■ , — — — ■ ■- — -. any other special ingredient of the water. Skin Diseases figure prominently in the category of maladies curable by almost every mineral spring. These affections, in most instances, are but an expression of some morbid constitu- tional condition ; and so, will be in- directly benefited by any treatment tending to promote nutrition. And so manifest is the influence of these waters upon the function of the healthy skin, that it is impossible to doubt their alterative p(5tency in the abnormal con- ditions of that important organ. It is difficult, however, to believe that the im- mediate application of a fluid, so essen- tially stimulating as saline mineral water, can be advantageous to a surface al- ready characterized by hyper-irritability. 246 HYDRO THERAP Y AT SARA TOGA. Some cutaneous affections of the mark- edly atonic type are no doubt cured, as in ordinary practice, by the local use of remedies primarily irritant. Water itself is essentially beneficial in the wide- est range of skin diseases, and so, it might be unwise to expose a fallacy, which has brought the unwashed to water — and so verily effected the cure ; but, one accustomed to the treatment of the chronic exanthemata, and eczema- tous conditions generally, may well suspect that these happy results, from immersion in saline water, have been at- tained not because, but in spite, of the ingredients. The alkaline waters, and those containing in marked proportion the salts of lime, are most soothing to cutaneous surface. Diseases of Women are usually as- DISEASES OF WOMEN, 247 sociated with, and often caused by, the co-existence of pelvic congestion, with constitutional ancemia. This is equally true of the many functional disturb- ances of menstruation, as of chronic ovaritis, salpingitis, abnormal growths, displacements, lacerations, hyperplasia, and leucorrhoea ; and, is the essential point upon which hinge most success- ful systems of treatment. It also hap- pens, not unfrequently, that these ail- ments — notably those of the obsti- nately catarrhal type — are closely con- nected with the cachexise, especially the gouty ; and, it is by no means an un- common experience for chronic endom- etritis or leucorrhoea, which had re- sisted every other treatment, to yield be- fore a well directed anti-lithaemic course. Hence, from every standpoint, some use 24^ H YDRO THERAP Y AT SARA TOGA. of the Saratoga waters is indicated in these cases ; and if not directly cura- tive, they will be found a powerful aux- iliary to other measures. For marked venous congestion of the pelvic organs, the alkaline-saline waters may be used internally ; together with a carefully selected system of bathing, of which local irrigation may form an important part. For more distinctly anaemic ^pa- tients — the saline-chalybeate waters, or such combination as circumstances sug- gest ; and when admissible, the cold- water system. I n chlorosis, or pernicious anaemia, of which amenorrhoea is a pretty constant symptom, the hydro- mineral treatment offers more hope than all other remedies. Nervous Diseases. — In combating these merciless and enigmatical ail- NER VO US DISEA SES. 249 ments, which are everywhere a growing scourge to civiHzed humanity, and no- where more keenly felt than in this community, we have a powerful, but, as yet, scarcely recognized ally in scientific balneology. That the external use of water ranks with electricity, in the treat- ment of these diseases, is a general opinion among those who have studied the subject most carefully.^ But in these diseases, more than any other, it is important that the technique of bathing should be skillfully prescribed ; and sometimes, it is essential that the pa- tient should submit to a regular, and somewhat complicated C4)urse, under competent direction. In the infinitely varied conditions of functional charac- ter, often resulting from overwork or * Charcot, Dujardin-Beaumetz, Dana, and others. 250 HYDRO THERAP Y AT SARA TOGA. prolonged anxiety, in which, without tangible pathological change, the nerv- ous system demands invigoration, ex- traordinary benefit is derived from all forms of cold bathing. In some in- stances the alternate application of hot and cold water, by the rain bath or douche, gives even better results. On the other hand, for the more irritable types of neurasthenia, we have, in the prolonged tepid bath and wet pack, an unequaled means of soothing nervous excitement ; and often inducing quiet and refreshing sleep, which could not otherwise be obtained. By these means are l^nefited the innumerable vaso-motor derangements, and func- tional impotences, for the treatment of which, we have relied heretofore upon the administration of nervine CON VA LESCENCE. 251 stimulants, electricity, and massage. Wherever these remedies were indi- cated, hydrotherapy can accomplish the same end, with the added merit of more direct improvement of general health ; and a constant compatibility with other methods of treatment. For most of these cases the saline mineral waters possess exceptional utility. The internal use of the waters may be sug- gested by the circumstances. Retarded Convalescence. — During progressive recovery from serious illness there sometimes occurs a period, when in spite of the best directed efforts, and without any expressly assignable cause, exhausted nature declines to make further progress toward accustomed health. It has been observed follow- ing the infectious exanthemata, typhoid 252 H YDRO THERAP Y AT SARA TOGA . fever, pneumonia, diphtheria, severe abdominal inflammations, serious sur- gical operations, and hemorrhage oc- curring at child-birth, or from other causes. The recent influenza epidem- ics, afforded not a few examples of persons apparently recovered, but still, dating from the attack, a debility before unknown ; which unfortunately, culmi- nated, in many instances, in fatal pneu- monia or pulmonary phthisis. The anaemia so established is of a markedly irritative character ; seemingly depend- ent upon exhaustion or perversion of nerve energy, rather than absolute pov- erty of blood, or inherently defective vascularity. It manifests a deter- mined resistance to all forms of ordinary treatment. For this condition a visit to Saratoga, and well directed CONVALESCENCE. 253 hydro-mineral course, gives promise of the best result ; and in a few weeks, may recall more of the familiar self, than months of the most skillful treat- ment at home. Mineral springs are everywhere celebrated for the cure of old wounds. CHAPTER XII. BOTTLED AND RE-CHARGED MINERAL WATERS. It is always best, when possible, to visit the springs and drink of, and bathe in, the waters fresh from the fountain head ; for, not only does the invalid thus reap the benefits of gen- eral change, healthful country air, easier compliance with sanitary pre- cepts, and other auxiliary circumstances ; but it should be remembered, that nat- ural mineral waters are difficult to preserve, and exceedingly liable to de- teriorate in transit, or under the ordi- nary conditions of careless storage. At some of the most valuable springs 2SS 256 HYDROTHERAP Y AT SARA TOGA. the method of bottling is still lament- ably defective. The water, instead of being tapped low down in the tubing, is allowed to flow from the surface, and only reaches the bottles after much of the gas has already escaped ; the corks are often imperfect ; even the glass is sometimes of a quality to chemically contaminate the water ;* and worst of all, it not uncommonly reaches the con- sumer after having stood for months in some drug store, regardless of tem- perature, the position of bottles, or other precaution for its preservation. As a consequence, much of the natur- ally abundant carbonic acid gas is lost ; the alkaline carbonates, held by it in solution, as bicarbonates, are largely precipitated ; the iron rapidly oxidizes, * Breneman, BOTTLED MINERAL WATERS. 257 and falls as the familiar brown sediment of hydrous peroxide ; and, the water itself becomes turbid and dirty looking — its bright, sparkling character and de- licious tingling taste being replaced by qualities flat, insipid, and disgusting. In consequence is pronounced many an unjust verdict upon the Saratoga waters, by those who have never drank them fresh at their source, but, judge only by the mawkish stuff supplied from the drug store. Nor is the retailer entirely to blame. The fault usually begins at the spring ; and further, so many new waters, the majority possessing no special merit, have been forced upon the market, yet comparatively seldom called for, that it would be impossible for the ordinary drug store to carry a fresh stock of each. 258 H YDRO THERAP Y AT SARA TOGA . If the proprietors of the various springs could be induced to set aside their traditional jealousies, to the extent of maintaining in each of the large cities a joint emporium, where the waters could at all times be obtained fresh and in good condition, it would surely be to their individual gain, and largely to the advantage of the public. The date of bottling should be stamped on each label ; and further, it may *be hinted, that as all the springs, in season and out of season, are wasting enormous quantities of water — some as much as two gallons per minute — the price might be lowered, with still increased profit resulting from a larger sale. The adoption of these suggestions would soon render it difficult for the foreign waters, now so popular through- BOTTLED MINERAL WATERS. 259 out this country, to retain their suprem- acy. It Is impossible to leave this part of the subject without reference to the suicidal recriminations of some of the spring proprietors a few years ago ; which, at the time, did much to dis- credit Saratoga. Without enterinof upon the nauseous evidence of this quarrel, the writer does not hesitate to assert, that, however dishonest the pur- pose. It would be Impossible, In face of the volume of water, and the Immense force with which It Is driven upward from most of the springs, to tamper with the waters extensively until after they had left the source. Indeed, so copiously mineralized, and naturally saturated with gas, are the principle Saratoga waters, that. It would be diffi- 26o HYDRO THkRAP V AT ^ARA T6GA. cult to introduce more than nature has already furnished. The Kissengen, Patterson, Royal, Peerless, Hathorn, Congress, Excelsior, and probably other waters, are supplied in bottles, exactly as they come from the source. That at any spring it should be deemed nec- essary to re-enforce the water with sup- plementary gas as is sometimes done at the time of bottling, is scarcely to be understood, except it be to repair negli- gence, or unskillful handling. At several of the springs, the quan- tity of gas is phenomenally large — capable of driving the water a con- siderable distance upward. The pecu- liar odor of carbonic acid is very perceptible near those which are closed in ; and sometimes, the air becomes suf- ficiently impregnated with it, to be BO TTLED miner a L WA TERS. 2 6 1 dangerous to breathe, and even extin- guish a light. At the Lafayette Spring, a short dis- tance south of the Champion, a curious industry has recently been established. The water ascends with enormous force. It is liberally mineralized, and by no means unpleasant to taste; nevertheless, it is not used either for drinking or bath- ing purposes, but exclusively for the com- mercial value of the natural carbonic acid gas obtained from it. As the water issues from the tubing, it is guided into powerful machinery, where the gas is separated, liquified at enormous pressure, and forced into strong steel cylinders, ready for sale. The refuse water passes off flat and brackish. At the Johannis Spring, at Zollhaus, 262 H YDRO THERA PY AT SARA TOGA. Nassau, which resembles in many re- spects the alkaline springs of Saratoga, the water is treated in a somewhat sim- ilar manner, although for a different purpose. Like the Saratoga waters, it contains a trace of iron, and the object of the artificial process is to get rid of that mineral, in order to render the water miscible without discoloration with wines and spirits, and thus more suitable for table use. The carbonic acid is collected, as the water emerges from the spring, and forced into a gasholder. Then, the water is freely exposed to the atmosphere in open tanks, so as to allow the oxidation of the proto-carbonate of iron, which is thus converted into, and precipitated as, a basis hydroxide ; and lastly, by means of powerful pumps, the same BOTTLED MINERAL WATERS. 263 gas is re-charged into the water; which is then ready for bottling, and is by no means unpleasant to drink. It is, how- ever, distinctly dishonest to advertise such a product, as '' a natural mineral water " ; since the original asso- ciation of gases and mineral salts, upon which undoubtedly depends the therapeutic value of natural waters, has been decomposed by the withdrawal of the gas, and cannot be exactly restored by artificial means. In fact, water so treated, differs in no respect from the chemical imitation manufactured in the ordinary way, except inasmuch, as there is still some guarantee of the purity of the gas and minerals, and freedom from dangerous organic impregnation. It is claimed that a water aerated under pressure with its own natural gas, 264 HYDRO THERAP Y AT SARA TOGA, •gives out that gas at a slower rate, when the pressure is withdrawn, than a water similarly aerated with artificial gas. However this may be, it seems proven that gas naturally incorporated with mineralized water is retained longer than similar gas artificially introduced into water similarly mineralized. No matter what the primary qualities of the natural waters, once the gases are dis- charged, and the water evaporated, the remaining salts are chemically identical with those produced in the ordinary way. They have entirely lost what special virtues they possessed in the original natural combination, and when re-dissolved in water, must be taken in many times a larger dose to produce effects resembling those of the original water. INDEX. Abdominal plethora, 229 Alkalies, 38, 51, 199, 208 Alteratives, 75 Alumina, 38, 44 Amenorrhoea, 60, 247 Ammonia, 44 Analysis, 33 '' tables, 38 Aneurism, 243 Arsenic, poisoning by, 224 Artificial waters, 264 Barium, 38, 44 Bathing establishments, 134 Bath fever, 92 Baths — carbonic acid, 116 " division of, 86 " douche, 123 " duration, 103, 120 " hygienic cold, loi " hot, 108 " in gout, 204 ** mineral, 97, 117 " mud, 131 265 266 /J\^DEX. Baths- -in nervous diseases, 124, 249 « obesity, 232 <( physiology, 87 ef seq. (( in phthisis, 189 (( rheumatism, 213 (I Russian, 131 a sand, 131 (( in scrofula, 181 <( time for, 106 « Turkish, 131 <( warm, 109, 119 (( wet pack, 126 Bone, c liseases of, 244 Bottled waters, 255 Bright': s disease, 239 Calcium, 38,43, 51 Carbonic acid gas, 38, 41, 57, 115, 260, 262 Catarrh, 96, 236 Chalybeate waters, 38, 42, 56, 156 Children, scrofulous, 180 Chlorosis, 60, 248 Cirrhosis of liver, 221 Classification, chemical, 29 " therapeutical, 31 Constipation, 225 Consumption, 184^/ j(?^. Convalescence, 60, 251 Copper, poisoning by, 224 Cutaneous diseases, 245 Diabetes, 240 Dietary, 141 et seq, ; wine and alcohol, 149 INDEX. 267 Douche, 123 Dripping sheet, 131 Dyspepsia, 56, 70, 215 ei seq. Gastric ulcer, 218 Geological faults, 19 Gout, 56, 97, 138 Hematemesis, 219 Hemoptysis, 191 Hepatic diseases, 219 ei seq. Heart diseases, 243 Hydropathy, v Hygienic cold bath, loi Influenza epidemics, 252 Iron, 38, 42, 56 JOHANNIS SPRING, 26 1 Johnson, Sir W., 7 Lactation, 60 Lead, poisoning by, 224 Leucorrhoea, 61, 247 Leuk, baths at, 113 Lithia, 38, 43, 46, 51, 53 Liver, diseases of, 219 et seq. Lumbago, 215 Magnesium, 38, 43. 5i» 53> 217 Manganese, 380, 44 Massage douche, 124 Menstrual derangement, 60, 247 268 INDEX. Mercury, poisoning by, 224 Metabolism, 73, 176 Metallic poisoning, 224 Mineral waters : " alterative effects, 76 " as baths, 97 et seq. " classification, 29 ** emergence of, 15 " mineralization of, 12 " origin of, 9 et seq. " precepts in use of, 159 Mud baths, 131 Nervous diseases, 248 Neuralgias, 215 Nosology, 173 et seq. Obesity, 230