su Columbia tHtriwnttp mtljeCttptfitoiork College of pfegteiang anb burgeons; Hifcrarp Digitized by the Internet Archive in 2010 with funding from Columbia University Libraries http://www.archive.org/details/practicalobservaOOmyrt THE HARROGATE MINERAL WATERS AND CHRONIC DISEASES, WITH CASES. PRACTICAL OBSERVATIONS ON THE HARROGATE MINERAL WATERS. AND CHRONIC DISEASES, WITH CASES. BY ANDREW SCOTT MYRTLE, M.D., L.R.C.S.E., J. P., LATE HON. CONSULTING PHYSICIAN, HARROGATE BATH HOSPITAL ; MEMBER CLINICAL SOCIETY, LONDON; MEM. OF THE MED.-CHIR. AND OBST. SOCS., EDINBURGH ; CORRESPONDING MEM. OF THE MEDICO-CHIRURGICAL SOCIETY OF GLASGOW, ETC. AND JAMES AITKEN MYRTLE, M.D., CM., J.P., MEMBER OF THE BRITISH MEDICAL ASSOCIATION ; MEMBER OF THE LEEDS MEDICO-CHIRURGICAL SOCIETY FOURTH EDITION, WITH ADDITIONS. ^arrogate : ROBERT ACKRILL, MONTPELLIER STREET. 1893, ^^.5'Haf '»= % _: - Two years have elapsed since the first edition of this treatise was published. Since then, I have felt more and more the necessity of such a work as the present, as the knowledge of the resources of Harrogate is only beginning to spread among members of the medical profession, upon whose minds the fact is slowly, but surely, dawning, that patients requiring special treatment by hydro-therapeutic measures need not be sent to foreign spas for that purpose but can enjoy all the advantages of very different and opposite mineral springs at one place, saving thereby time, and to those who are not over rich, what always ought to be considered — money. In the most recent work " On the Baths and Wells of Europe," by Dr. Macpherson, of London, we find it written — " Harrogate, with the most important drinking waters in England, and therefore mentioned here at somewhat disproportionate length, has kept up its reputation ever since it was discovered ;" and in speaking of the cases suitable for treatment there : " Who can fail to observe that these are exactly the same class of cases that benefit so much at Homburg and Kissengen ? " Also, in speaking of the small amount of iron in most chalybeate springs, the same author says: "It might be possible to give more iron by using such wells as the Arapatak and the strong Harrogate," meaning the chloride of iron spring. I know there are many of my professional brethren who laugh at mineral waters as means of cure ; but I also know that no one remedy has had such a long uninterrupted run of patronage, both as regards the general public and the most enlightened physicians, in all ages, and in all countries ; and, therefore, I feel assured that the high reputation which Harrogate and many other spas have held since they were discovered, will be maintained to the end. Harrogate, April 17th, 1869. PREFACE TO THE THIRD EDITION. Suddenly called upon to republish this little volume, I find my time so thoroughly taken up, I can only offer a reprint. I regret this very much, as the experience of the last five years has caused me to alter my views in several important matters bearing on the treatment especially of skin affections by means of our waters and baths. I would also have liked to have gone into the chemical analyses of all the different springs afresh, both those used for drinking and bathing, as we know that their active ingredients have, in several instances, undergone very great changes within a brief period. Harrogate, July, 1874. PREFACE TO THE FOURTH EDITION. At the request of Mr. Ackrill, the publisher of this treatise, I have re-written a considerable portion of it ; given the most recent analyses of our waters ; and, in conjunction with my son, as co-editor, have drawn particular attention to those forms of chronic disease which, in our practice, have proved most suitable for the successful employment of the various Springs and Baths, alone, or in combination with other resources ; especially massage and the Swedish movement system. At present, the special baths — Needle, Douche, Spray, Vapour, Medicated, and what is known as the Aix-Douche — are administered to perfection by skilled attendants ; and, when the new suite of baths about to be erected is completed, Harrogate will be, as far as its baths are concerned, unsurpassed, just as it is now unequalled as regards the number, variety, and strength of its springs. Mr. Ackrill has asked permission to insert some advertisements at the end of this edition. I can see no reason why the Tradespeople of Harrogate should not have this privilege, especially as the book is intended for the guidance of our visitors more than anything else, and is brought out by the publisher, at his own risk, and not at that of the editors. Harrogate, April 17th, 1893. CONTENTS. CHAP. PAGE. i. Introductory Remarks i II. Physical Characteristics of Harrogate . . . . 13 in. General Character of the Waters 21 iv. Classification, Analytical Tables, The Strong Sulphurous 29 v. The Mild Sulphurous 39 VI. The Saline Chalybeates 47 vii. The Pure Chalybeates .. 55 viii. General Remarks on Skin Diseases' .. .. 59 ix. Eczema and Psoriasis 63 x. Urticaria, or Nettle Rash . . 75 xi. Acne 77 xii. Specific Eruptions 78 Cases of Skin Diseases . . . . 82 xiii. Indigestion from Functional Causes .. .. 98 xi v. Indigestion from Structural Changes 113 xv. Liver Affections ,. n6 xvi. Jaundice 126 xvii. Gout 144 xviii. Rheumatism 153 xix. Chest Affections 163 xx. Boils. Carbuncles „ . . 170 xxi. Neuralgia 174 xxii. Anaemia 180 xxui. Neurasthenia 185 xxiv. Jaded Brains 205 xxv. Signs of Jaded Brains .. .. 216 xxvi. Massage 230 OPINIONS OF THE PRESS. "It is a frequent source of complaint, and one which is not ill-founded, that metropolitan physicians are apt to overlook the value and efficacy of the British mineral springs, in favour of the foreign sources. Bath, Buxton, Cheltenham, and Har- rogate especially, possess springs of which the remedial influence is potent and incontrovertible. Dr. Myrtle does justice to the value of Harrogate waters in the treatment of dyspepsia, biliary or renal derangement, gout, &c. ; and brochures such as this serve usefully to remind practising physicians of the hydro-therapeutic resources of our own country." — British Medical Journal, September 21, 1867. " We find in this little volume an agreeably-written account of the uses of the mineral waters which have rendered Har- rogate so famous. Originality is scarcely to be looked for in a small and unpretending book of this kind, but Dr. Myrtle's remarks on "Jaded Brains" are well worth reading by any practitioners who are consulted by people living and working year after year in our large cities. Mineral waters are, perhaps, in England, in danger of being too much neglected. Conti- nental physicians place much greater reliance than we do upon them as remedial agents, and we think they might be resorted to with advantage in many obstinate cases which are suffered to linger on without trying them. " Many people fancy there are no really potent springs in England. It cannot be too often repeated that no spa of its kind is superior to Harrogate, and that, where sulphurous waters are indicated, it is a work of supererogation to leave England in search of them. We are glad to find that Dr. Myrtle is not extravagant in his estimate of the virtues of Harrogate waters, but speaks with that calmness and prudence which all rational physicians should cultivate." — Medical Press and Circular, December n, 1867. "It is much to be regretted that so little science is brought to bear upon the question of the use of mineral waters in the treatment of disease. It would be difficult to name a subject which is less understood by the mass of practitioners in our country ; yet the virtues of mineral waters, used judiciously in their natural state, are daily becoming more apparent, and the profession consequently cannot but be indebted to those who point out the indications for their use, and honestly seek to afford reliable information by carefully analysing the details of their experience, and committing the result to print. We have very much reason to think that England can supply all that the famous continental watering-places are supposed exclusively to possess in the matter of mineral springs. This is a very important consideration indeed in an economic sense for patient and physician, and it shows the necessity of giving every possible publicity to written opinions on the subject. Dr. Myrtle has penned a good book on the Harrogate waters. He describes the physical characters of Harrogate ; the general characters of the waters ; gives analytical tables of them ; details their effects, and the cases best suited for their use ; points out the best time of year for sending patients to Harrogate, and other matters of interest. His remarks on Jaded Brains, "the disease of the age." are suggestive, and worthy of perusal. "The practitioner will find in Dr. Myrtle's book every information that he needs to possess on the subject of Harrogate and its waters, and we commend it to the notice of medical practitioners, as placing them in the possession of knowledge which too often receives more attention from the sick than from the profession — a state of things that conduces to the great success of quackery." — Lancet, July PRACTICAL OBSERVATIONS ON THE HARROGATE MINERAL WATERS. CHAPTER I. % INTRODUCTORY REMARKS. HE gist of the following pages constituted the subject matter of two papers which were read by me before scientific societies composed of members of my own profession; at first I never contemplated that they should put on another garb, and in the form of a treatise be offered to the public. It is at the repeated and urgent request of many of my friends and patients that I now venture to address the general reader. 2 PRACTICAL OBSERVATIONS ON Some may deem the observations I have to make upon the waters of Harrogate uncalled for, believing that their merits have been sufficiently brought forward by previous writers, and point to the books extant in support of their faith. To such I would simply say that my remarks are not intended to subvert those of my predecessors, but to supple- ment them ; and I think this is all the more necessary because I find that Dr. Althaus, in the " Spas of Europe," whilst he devotes pages to the description of springs infinitely of less importance than our mild sulphur water, when treating of Harrogate only gives Dr. Hoffman's analysis of the Old Sulphur and the Montpellier strong sulphur waters — he seems to be ignorant of the existence of its other, and no less valuable, springs ; he then sums up — I shall give his own words — here is all he says : " These waters are distinguished by the large amount of sulphuret and chloride of sodium they contain, and are suitable for all cases in which other muriated and sulphurous springs are employed." We must remember Dr. Althaus is a German ; and as a set off to his partial notice, I shall now state the opinion of the greatest medical writer of this age, upon the importance he attaches to our mineral waters ; and this opinion was formed after he had visited and personally inspected the different springs. Dr. Copland, in his work on THE HARROGATE MINERAL WATERS. 6 consumption and bronchitis, whilst speaking of the efficacy of sulphurous waters in certain stages of these diseases, says : " I consider Harrogate to be, as respects air, soil, climate, and mineral springs, by far the most important watering place in this country, and unequalled by any on the Continent of Europe, for the diversity and curative influence of its waters in a large number of diseases. So diversified are these springs, and yet, individually, so constant in their composition, so entirely free from any contingent change or artificial admixture — so entirely the products of deeply-seated sources — that it becomes necessary, but by no means difficult, to arrange them so as to employ them appropriately to the constitution and temperament of individuals, and to the peculiarities and stages of a wide range of diseases." It is impossible to fix the time when Harrogate was first resorted to on account of its wells, but we can safely state that for the past two hundred years many sick people have come to it in search of health ; year by year the number has increased, and to such an extent that last year, during the height of the season, it was no easy matter to supply the demands made at the different pump- rooms and Baths ; at the latter many had to wait for hours till their turn came, . and at the former, unless you went early, you had to dawdle about 4 PRACTICAL OBSERVATIONS ON a bit before you could procure your morning's draught. The question very naturally arises, how is it that whilst other watering-places in England, once famous, have suffered from the rage for foreign Spas, Harrogate has not only maintained its place, but has grown rapidly from a small insignificant village into one of the most important health resorts in this or any country ? How is it that thousands of people flock to drink waters which, as a rule, are anything but palatable, and when compared to many of the justly celebrated continental waters, simply atrocious ? The reason is not far to seek. Harrogate, in the first place, possesses, and that within a vety limited geographical area, a greater variety of springs, as regards their chemical composition and physiological action, than any place I have yet heard of; and in the second, its climate and environs offer to the invalid conditions which few places afford. Many visit it for these alone, finding that the air is so pure and invigorating they require simply to breathe it for a time in order to regain that natural or healthy equilibrium which somehow had been disconcerted. From the unparalleled diversity of these mineral springs as regards their number, composition, and strength, few cases of chronic functional health derangements are beyond their reach, and many THE HARROGATE MINERAL WATERS. cases of structural changes in most important organs, especially those connected with the pro- cesses of digestion, assimilation, and elimination, are greatly benefited by their judicious use, for a time, at least, the progresss of diseased action is retarded, and the patient enjoys a respite. I grant in such cases the good may be only temporary, but even here " half a loaf is better than no bread," and is gratefully accepted by the sufferer. It may be supposed, and very justly, that I look on everything connected with Harrogate with a strong necessity, 'tis " Hobson's choice " in my case. I admit it, 'tis quite true I have a decided bias in that direction, and avow it ; but am I singular in this ? In the avowal I may be, but in the leaning to a certain sheet-anchor I am not. Have not all medical men their favourite weapons, which from practice they use more skil- fully, and therefore more successfully than others ? Do we not find some one agent entering into every or almost every prescription of the most unprejudiced physician ? It may be Tr. Aurant Co. — Spir. Chloroformi — Sod. Bicarb — or Bismuth, to say nothing of more potent remedies. And as to diet, has not each his favourite dish ? mutton- chops, white meats, milk, fish ; one allows nothing but claret, another dry sherry ; this one may go the length of champagne, and that one permits 6 PRACTICAL OBSERVATIONS ON nothing but whisky and water ; all are good, but whilst the Harrogate doctors may prescribe the same regime as regards food and drink, they are constrained to limit their treatment to administra- tion of the natural materia medica at their command, for the best of all reasons, under the circumstances it is the best thing they can do, and the very thing for which their patients have been sent for ; ordinary treatment in the majority of instances has been pretty fairly tried, they now desire and expect that we shall employ that, to them extraordinary, to us usual plan of dealing with their symptoms, in order that health may be restored. Medical men, as well as their patients, frequently write describing their cases and asking if, from the description, we doctors in Harrogate advise a trial of its waters, and it is partly with a view to point out those cases which are almost certain to derive benefit by such a course, that I venture to pen the following remarks — remarks, I may add, founded o \ thirty-three years' ex- perience, and a growing conviction that the role which Harrogate has played, and will play, in dealing successfully with a wide range of chronic diseases, is far greater than even its most sanguine advocates now claim for it. One word here on cases that cannot receive good, and frequently are greatly weakened if not injured THE HARROGATE MINERAL WATERS. 7 by being sent to Harrogate. I allude to all cases of advanced organic disease, of whatever nature. I have had many, too many, cases of old standing, often complicated — disease of the heart, liver, lungs, kidneys, brain — consigned to me, cases which no plan of treatment, above all no kind of mineral water, could possibly reach ; when they ought to have been allowed to bide their time at home, surrounded by its comforts, and among their own people. The difficulty and danger attending the removal of such is so great, that, even should the patient desire to make the effort, his friends should try and persuade him to abandon it. Still I often find that the love of life, the longing for ease, the yearning for change, impels many to seek and obtain permission from the doctor himself to try what Harrogate can do for them, and this is what happens : — After a weary journey, the poor invalid arrives worn out and exhausted ; he has to put up with the first lodgings he can find, or submit to the noisy bustling life of a hotel. Then he sends for a doctor, and tells him he has come full of hope that he will get well, asks at once what waters he is to drink, and when he may have a bath. The doctor finds him suffering from various organic lesions ; he may be dropsical or his blood degenerated, and so weak he cannot wash his hands and face without being overdone, requiring 8 PRACTICAL OBSERVATIONS ON to sit down and rest before he has strength to dry himself; and in this state he expects to be told to drink and bathe ''like the rest of them." And when told no water can be administered to him with benefit, no bath with safety, he cannot understand it ; likely enough he thinks he has got hold of the wrong man, and determines to see what a couple of glasses of the old sulphur will do for him, and possibly they nearly do for him. Not- withstanding he may persevere for a morning or two, when, disappointed in his new doctor, in the waters, and everything about the place, he leaves Harrogate for somewhere else ; forgetting or ignoring that wherever he goes, or under whom- soever he places himself, he must carry the burden imposed upon him ; it has become a part of himself as much as his right hand. Other cases there are who, owing to idiosyncrasy, find Harrogate anything but a comfortable place to live at ; and just as some get feverish and bilious and drowsy at the sea-side, so others become rest- less and sleepless here. The air is too strong for them, takes away the appetite they had, and induces a feeling of malaise that, is anything but desirable. These cases are by no means common ; however, and generally speaking, with a little careful treatment the symptoms readily pass away. It may be proper to state here that this essay is THE HARROGATE MINERAL WATERS. V not intended for the edification of the public alone, but also that, in a measure, it may serve as a guide to my professional brethren ; its tone, therefore, of necessity must be medical ; at the same time, I trust not so deeply medical as to prevent anyone getting at my meaning. To the professional reader, I may state that I well remember how thoroughly ignorant I was regarding the nature and thera- peutic uses of mineral waters before circumstances compelled me to make them my special study. Since then I have learned that my ignorance was, and is, shared by the great majority of our profession, who, notwithstanding the number of books which have been written upon the various spas of this and other countries, 'have shown little desire to become acquainted with their merits, and as a rule allow the patient or the patient's friends to take the initiative in recommending their trial. Under these circumstances, and considering that the nature and properties of our own mineral spas are less known than many of their continental sisters, in every respect inferior to them as curative agents, I trust the remarks I am about to make may at least serve to elucidate the qualities of the springs with which I am best acquainted. More- over, from the fact that previous to my settling in Harrogate I was engaged in practice for fifteen years, when I employed the ordinary materia 10 PRACTICAL OBSERVATIONS. ON medica at my command in the treatment of disease, I am enabled to make a comparison, in many cases, regarding the merits of the respective systems. And surely, after thirty-three years experience in the management of a very large number, and as great a variety, of cases by any special plan, it cannot be uninteresting or unprofit- able to inquire into the results, and ask the questions : Is this system followed by a greater or less amount of good than the ordinary method ? Is the trouble, inconvenience, and expense, attending the removal of my patient to a watering place for the relief of such and such symptoms, to be compensated by benefits, present or prospective, sufficient to warrant my sending him thither ? And it is to assist you in answering these questions, as far as Harrogate is concerned that I now proceed to make the following practical observations on its mineral waters. En passant, let me ask you to bear in mind that no case of acute form of disease, no matter whether of the skin, fibrous tissues, or internal organs, should be sent to Harrogate or any watering place. These favoured spots are for the relief of chronic ailments, and the more chronic the better — cases like that of the soi-disant clergy- man, who, after curing his own throat or stomach, at once, for the consideration of thirteen stamps, proceeds to cure thousands of sufferers whose throats THE HARROGATE MINERAL WATERS. 11 and lives have been despaired of for the space of 24 years, and who by his aid are at once made to feel the inestimable blessings of health. Joking apart, it is a fact that mineral waters frequently exhibit their happiest action in the most unpromising cases as regards chronicity — especially when there is an absence of serious organic lesion, or the presence of a dyscrasy (meaning ill-humour or blood distemper) ; for instance, cases complicated with gout, rheumatism, malaria, lead poisoning, or syphilis. To the non-professional reader, let me say a few words. Having come so far, do not suppose you have only come to drink and be whole. Harrogate is no Pool of Siloam ; it possesses no miraculous properties ; and its waters require to be adminis- tered not only with a thorough knowledge of their nature and power, but with an equal knowledge of the fitness of the patient for their exhibition ; and few patients, even when doctors are the patients, know what is best for them. If your own medical man has been unable to advise you as to the water most suitable to your case (I haven't met with one who could), do not experiment upon yourself, or drink this or that, because Tom, Dick, or Harry are drinking it, but consult one of the medical men of the place. I recommend this step in all honesty, and without fear that in doing so I shall be misunderstood. By adopting that course 12 PRACTICAL OBSERVATIONS i you will receive the greatest good in the shortest time. Such is my experience, and the reverse has been the experience of hundreds of visitors who have taken the waters at their own hands. It is no unfrequent occurrence to find that, even under the best advice and strictest care, patients get wrong whilst drinking all mineral waters ; sometimes they seem to develop the evil that may happen to be lurking in the system, so that a bilious, or gouty, or rheumatic subject becomes, for a time, more bilious, gouty, and rheumatic with each dose of water ; and it requires prompt and judicious steps to be taken, so as to bring, as it were, good out of evil. The same remarks hold true regarding the outward application of mineral waters : and many a patient has cause to repent his having had recourse to the warm sulphur bath, when, for reasons which he could not comprehend, but which would have been readily recognised by a medical man acquainted with its properties, he ought not to have resorted to it at the time he did. CHAPTER II. PHYSICAL CHARACTERISTICS OF HARROGATE. <^g^OR a general description of the town and neigh- bourhood, I must refer you to Thorpe's guide C> book. I may observe, however, that the air and climate from the beginning of May till the end of October is all that the invalid can wish; from the fact that Low Harrogate is situated in a basin eighty feet below High, and is surrounded on all sides, so as to afford protection from prevailing winds, it is much milder than High, which standing on an open plain 400 feet above the sea's level, affords a constant breeze, even in the hottest of the dog days. The air of both, like that of Nice,* some- times proves to a few highly susceptible individuals too stimulating, inducing sleeplessness, loss of appetite, and general nervous irritability, with marked febrile symptoms. Fortunately, its purity * Many of my patients state that the climate of Cannes resembles Harrogate more than any other health resort in the south of France 14 PRACTICAL OBSERVATIONS ON has a very different effect upon most people, enabling them to do more with less fatigue, and giving them a feeling of buoyancy and elas- ticity to which they had long been strangers. One of the greatest advantages Harrogate possesses as regards climate is attributable to its being so far inland; equidistant from the sea, on the east and west coasts, it is more genial than the former and less relaxing than the latter, and offers to all invalids who do not agree with sea air, climatic conditions of the utmost importance, and such as few other health resorts in England possess. Besides being favourably situated geographically, its atmosphere is not polluted by the smoke of public works or neighbouring towns ; the beneficial effect of this is shown in the feeling of relief from a sense of languor and oppression experienced by many, who return to it after business hours, from towns like Newcastle, Leeds, or Bradford. And not only so : the health of such is so greatly and permanently improved by spending half their time in this pure air, that it is now a favourite residence with them ; and many of them assure me that their families now enjoy a freedom from sick- ness which they never knew before. In a great measure this experience has made Harrogate a centre for education. Thirty years ago we had only one boys' school and one young THE HARROGATE MINERAL WATERS. 15 ladies' of any size, now I cannot tell the number of schools we boast of; but collectively they con- tain a very large number of children at an age most liable to disease. I have made inquiries at most of these schools, and I find that many of the children were sent on account of their deli- cate health ; that one boys' school, established for above thirty years, with an average of seventy pupils between eight and eighteen years of age, has never had a case of any infectious disease in it except measles, and never had a single death. That a lady's school established for even a longer period, with an average of thirty pupils of the same age, has a similar report to offer, with one imported case of scarlet fever and recovery ; that another lady's school in existence for eighteen years, with an average of eighteen pupils, reports health of children interrupted once by a mild form of measles. In one lady's school which I have attended for thirty years I have watched the pro- gress of a large number of delicate girls, and can speak with confidence on one point ; they improve in health as soon as they come to Harrogate, and during their holiday visits they very often lose colour and tone, regaining both on a resumption of school life. The children in Harrogate are remarkably free from scrofulous disease, the distinguishing feature 16 PRACTICAL OBSERVATIONS ON of which I hold to be a tendency to form pus or matter, whenever the child's health is disturbed, or should it receive any trifling local injury. This tendency in all probability depends on some imper- fection in the performance of those organic changes connected with the functions of assimilation in- volving not only ingestion and egestion, but the final yet important changes wrought in the system through the influence which pure air and sunshine exert on the red corpuscles of the blood, for which they have the strongest affinity. Destroy this affinity, let a child breathe foul air, live in dark- ness, add damp to its surroundings, and feed it as you will, let it originally be of the healthiest class, yet in a few weeks it will show signs of struma; its glands and joints will become enlarged, inflame and suppurate, in a little longer time tubercle will be found depositing itself in some of the most important organs of its body. My ex- perience of Harrogate as a place of residence for children who show symptoms of the strumous diathesis leads me to recommend it strongly to the parents of such children. As a rule they require no more than the ordinary treatment which school affords, they neither stand in need of waters nor physic, they have simply to live in its pure atmosphere in order that their health may be brought to as high a standard as it is capable THE HARROGATE MINERAL WATERS. 17 of attaining. I have little doubt in a very few- years Harrogate will be one of the most popular educational towns in England, when the above fact becomes sufficiently recognised. Harrogate is very favourably dealt with in respect to its construction ; it is really a village ; its buildings are detached, and even its streets are exposed to the most perfect system of ventilation ; hence, I believe, arises its immunity in a great measure from diseases of an endemic and epidemic character, such as t3^phus, typhoid and gastric fevers, malignant cholera, and diptheria. It is to this peculiarity we must also attribute the fact that children coming from infected districts, and during their convalescence from scarlet fever, small-pox, or whooping-cough, rarely (if they do bring the seeds of these diseases with them) are the means of infecting others. Another remarkable fact, speaking clearly as to the healthiness of Harrogate, was found in its exemption from the rinderpest. When cattle were dying in dozens, of the plague, within two miles or less of the plateau upon which Harrogate now stands, not a single case of the disease occurred in it ; and this was all the more remarkable, as before the stringent orders of the Privy Council were issued preventing the transport of cattle, 1 have seen herds crossing the Stray on their way to Knares- c 18 PRACTICAL OBSERVATIONS ON borough, having animals so affected with the plague, that they died before they reached their destination. Harrogate has yet two advantages ; the one being good drainage, the other pure water. The former has been carried out at great cost, and is now perfect ; the other has been supplied to the town for some years, and for purity and agree- ableness equals the Ilkley and Malvern springs. Every house in the town commands a supply of what is known as the town's water, in distinction to pump water ; not that the latter is unfit for all ordinary purposes, but because it is very commonly slightly chalybeate, and thereby apt to cause unpleasant systems whenever there is irritability of the mucous membrane, or intolerance of iron from peculiarity of idiosyncrasy. For some years after settling in Harrogate I met with several cases of illness which were clearly traced to the regular use, for domestic purposes, of pump water impreg- nated with oxide of iron. Our domestic supply is brought from springs in Haverah Park, and is stored in well-constructed reservoirs, the hydraulic pressure from which is so great, as to insure a full and free flow to the top of the highest house in the district supplied by the company's pipes. During the uninterrupted and continual droughts of 1867 and 1868, Harrogate was well supplied THE HARROGATE MINERAL WATERS. 19 with water for all purposes, private and public. When most other towns were put on an allowance and all waste of water strictly prohibited, Harro- gate* experienced no lacK of this prime necessary of life and comfort. r ; i • . i ' .■■„■ .;..■:,. . ■ ■ ' ii'i-i: ■■'i'.; l .i.iii!iiiii.iii|ii .■ . ,:■ v.. .,, „ . ,■ . ,.; I n ! 1 1 1 ITTTiTTTT :m llllllllillllli:illlllllllllllllllllllllllllllllllllllllllllH!. : III .^lllllllllllllllllllllllllllllllllllllllllllinilllllllllllllllllllllMiillillll'llllllllll tc&P CHAPTER III. GENERAL CHARACTER OF THE WATERS. ^jTT would be a mere waste of time were I to give ^j] a detailed account of all the different springs in use, or present the reader with even -analytical tables of them ; accordingly, I shall select as speci- mens six of the most characteristic of the various groups ; and in treating of the therapeutic action of any water, I shall speak of it as a whole, and not attempt to apportion to each salt its curative value. Some writers have done so, attempting to show that the different salts in mineral waters meet with as different salts in the blood and tissues of the patient, and this leads to a series of chemical changes alike scientific and satisfactory. Chloride of calcium in a water is represented as meeting with the phosphate and carbonate of soda in the blood ; double decomposition is supposed to take place ; and you have chloride of sodium on the one hand, phosphate and carbonate of lime on THE HARROGATE MINERAL WATERS. 21 the other — the earthy constituents of bone ; ergo, such a water must be be valuable in rickets. My knowledge of the action of remedies cannot carry me so far as this ; and I am of opinion that the views regarding the chemical changes described, may be as erroneous as is that pathology which attributes the rickety diathesis to a want of eartrry matter in the bones, or supposes it could be remedied by supplying any amount of such from without. Again, it is held by some that this salt, as found in our Harrogate waters, rivals the preparations of Iodine in its powers over enlarged Glandular swellings, and all strumous affections, as well as Dyspeptic conditions, cleansing the tongue, sweeten- ing the breath, removing enlarged Tonsils, capri- cious appetite, and giving sleep to the restless child. Then, as to the Barium Salts, what wonderful influences these are supposed to exert, Glandular swellings are made to disappear, Ulcerations heal, Inflammation of the eyes yield, and what is still more wonderful, the muscular coat of the Arterial system is peculiarly fond of Barium Chloride, and consequently, the enfeebled heart and degenerate vessels are directly invigorated ; result, decided increase of intra-arterial pressure, the pulse becoming more resistant as verified and estimated 22 PRACTICAL OBSERVATIONS ON by the sphygmometer. What a role ; I fear I can- not subscribe to it, but then, I have never yet required to use a sphygmometer,* or even a weigh- ing machine. I have no doubt in my own mind that it is impossible to estimate the relative value of the different active ingredients of such a compound medicine as the sulphurous or saline chalybeate waters. These seem to be so combined in their natural state as to produce in their action a uniformity of adaption to the requirements of cer- tain diseased conditions which cannot be affected by the artificial combination of their chemical elemexits. I have heard medical men say, " We have all the constituents of your mineral waters in ordinary medicines, and can administer them in such proportions and combinations as we think advisable." All very true. You may make an artificial mineral water to look, taste, and smell like the real, but you cannot get it to act like it. *I consider this instrument, when used in the ordinary run of cases, nothing better than a scientific toy, it certainly serves to astonish the patient to see his pulse being weighed ? But it can give no information to the Physician which cannot be readily obtained by the old fashion of placing his finger over the artery, when he will at once ascertain whether the pulse is hard or soft, quick or slow, regular or irregular The delicate and highly sensitive tip of an educated finger is a much more reliable instrument than any mechanical jiggering piece of steel ever invented. THE HARROGATE MINERAL WATERS. 23 I have tried the experiment, and there is as much difference between the two in therapeutic value as there is between the relative value of any real article and its imitation ; and this is shown daily in the improvement brought about by the action of mineral waters, when medicines, having chemically the same peculiarities, have failed in the end for which they were prescribed. Besides, I would call your attention to a remarkable fact, that the dried salts obtained by the most careful evapora- tion of a mineral water when re-dissolved have neither the appearance nor power of the water itself, and it has been found that you require three times the amount of the dried salts to pro- duce the same results as are obtained from the comparatively small quantity present in a dose of natural water. Why it should be so I do not pretend to be able to explain ; but that in no way militates against the simple fact that it is so. Here, as elsewhere, in watching the effect of remedies, we are unable to explain the mode of action ; but we are not there- by prevented coming to a correct conclusion as to the results of that action. Here I would remark that some imagine that 'tis the water, and not what are called the active ingredients, that washes the blood, and, ergo, drink as much water at home — the result will be the 24 PRACTICAL .OBSERVATIONS ON same ! Such is the opinion avowed by Sir William Roberts in his Croonian Lectures on " The Chemistry and Therapeutics of Uric Acid, Gravel, and Gout," delivered this year before the College of Physicians, London. If so, I would ask him to explain the statement he makes: — "Not infre- quently the first effect of these waters on a gouty patient is either to provoke a downright attack of gout or to aggravate the symptoms under which he is suffering," and " that this event is now recognised by the physicians practising at the Spas as a thing to be looked for." All that I have got to say is that Sir William spoke in ignorance, both as to the therapeutics of our mineral waters and the experiences of those who prescribe them. My argument, founded on Sir William's own assertions, is that it must be the active ingredients, not their solvent, which exert such baneful influences when these are injudiciously or ignorantly administered ; and if, when so given, they possess such a power, when administered with judgment and a due knowledge of what is required of them, they are as potent for good, and more so, than the ordinary remedies afforded by the chemist. Why are patients sent to Spas by their medical attendants ? Why do they come of their own accord, and advise others to do likewise ? Simply because the usual remedies, even hot and cold THE HARROGATE MINERAL WATERS. 25 water, have failed to benefit them. The traditions, which have been handed down for centuries, regarding the power and inestimable value of certain natural springs, drive them there in search of health, and I firmly believe that were we practitioners at such resorts to publish the result of our treatment as frequently as others publish the result of their treatment by means of drugs — above all, in the very class of cases dealt with in the Croonian Lectures, already mentioned — the balance, as regards immediate relief and greater immunity from recurrent attacks of gravel and gout, by their special hydrotherapeutic treatment, would stand a long way above that of any other mode. All the waters of Harrogate have certain features in common. They are essentially cold springs, exhibit little variation of temperature, show more or less alkaline reaction, and, like other mineral springs, have undergone slight changes, both as regards the quantity of their chemical ingredients, and, in more than one instance, the very nature of some of them. Mr. Davis, chemist, Harrogate, who has devoted much time to the analysis of these waters, remarks that — " Since 1854, when Dr. Hofmann analysed them, the sulphur waters must have undergone remarkable changes, inasmuch as the sulphate of lime has disappeared from them, 26 PRACTICAL OBSERVATIONS ON and there are now present salts of baryta, strontia, and lithia. From the universal presence of the last-named salt in all the waters of the district, we may reasonably infer that it has always been there, but was not detected till the spectroscope (a recent invention) proved its existence." * The Kissengen or Montpellier Spring seems to have undergone similar changes ; but by far the most remarkable alteration has taken place in the chloride of iron spring, or, what has justly been called, Dr. Muspratt's Chalybeate. Here, besides the appearance of the salts above-named, we have large quantities of the protochloride and proto- carbonate of iron, as discovered by Dr. Sheridan Muspratt, College of Chemistry, Liverpool ; and chloride of barium, discovered by Dr. Miller, King's College, London, in 1865 ; salts which were not found in water taken from the same source, although examined in 1854 ^Y -Dr. Hofmann. Here I cannot help remarking that several of the changes above described are for the better. Some of them may be more imaginary than real — that is to say, * Mr. Davis, by regular analytical monthly experiments, has discovered that the Kissengen Spring varies as regards the amount of its respective ingredients to a very great extent, according to the rapidity of its consumption. The more rapidly this water is drawn from the well the less are its solid or chemical constituents, and, consequently, the less its therapeutic power. THE HARROGATE MINERAL WATERS. '1 1 the salts might have been found in the water by former analysts had they been looked for. To Dr. Muspratt, however, is due the sole merit of establishing the nature and value of the chloride of iron spring ; and his discovery was so unexpected, and so thoroughly at variance with established beliefs, that at first it was looked upon with doubt. That doubt was properly acted upon by subjecting the water to the analysis of Dr. Miller, on the part of the proprietors of the spring, and Dr. Herapath, on the part of Dr. Muspratt ; and it must prove a satisfaction to every one to know that these three eminently scientific chemists came independently to the same conclusion — a conclusion which exhibits Harrogate in a new light, and shows that it can boast of possessing the richest, the rarest chalybeate water which has ever been subjected to the test of chemistry. From the fact that the most important of the sulphurous and saline chalybeate waters show the same temperature (ranging from 40 to 48 summer and winter, flow at the same rate whether there has been a very wet or dry season), and hold an uniform amount of salts in solution, we conclude that they must have their origin in collections of water at a considerable depth. The pure chalybeate waters spring from sources less deep, and are influenced by the rain-fall to a perceptible degree. 28 PRACTICAL OBSERVATIONS In the very long droughts of 1864 and 1865, one spring was every now and again dry, showing that it depended to a very considerable extent on meteoric supplies for its existence. ~ xfu cr \5ffiffiffl®>^ £ffi)SQ3':^>5]p^ CHAPTER IV. CLASSIFICATION OF THE HARROGATE WATERS. OCTOR HOFMANN, after careful analysis, divided them into four classes — The Strong Sulphurous. ,, Mild Sulphurous. ,, Saline Chalybeate. ,, Pure Chalybeate. The following tables give the most recent analyses of the principal springs, and represent the amount of saline constituents in a gallon of water : — The classification of Dr. Hofmann, although made 50 years ago, when chemical analysis was very imperfect compared to what it is now, is most thoroughly characteristic of the different springs ; showing close affinities to each other in their component parts and therapeutic properties. TABLE OF THE ANALYSES OF THE SULPHUR GROUP. Saline Constituents in Grains per Gallon. Old Sulphur Well. Eoyal Pump Eoom. (Thorpe). Strong Sulphur. M ontpellier. (Attfield). New or Mild Sulphur. Eoyal Pump Eoom (W. A. Miller). Mild Sulphur. Montpi llier. (Attfleld). Ct +3 as ft . Sodium Sulphydrate... Sodium Sulphide Barium Chloride Strontium Chloride ... Calcium Chloride Magnesium Chloride... Potassium Chloride ... Lithium Chloride Ammonium Chloride... Sodium Chloride Magnesium Bromide... Magnesium Iodide ... Calcium Carbonate ... Magnesium Carbonate Potassium Carbonate Sodium Carbonate ... Barium Sulphate Strontium Sulphate ... Calcium Sulphate Sodium Nitrate Silica 5.215 6.89 1.36 trace trace trace 116.44 trace trace 10.01 3.51 .65 14.47 1.88 3.27 14.500 8.777 .707 1.222 trace 6.566 trace 43.635 48.281 9.592 .753 1.031 893.670 2.283 .113 29.768 5.953 trace 2.816 79.936 57.989 4.811 trace .996 827.371 .619 31.296 27 "»89 5.691 16.70 2.39 11.34 trace 1.792 27.913 trace trace 215.896 trace trace 18.476 12.799 .656 388.800 582.95 8.750 16.711 .418 .529 .913 .900 3.570 .370 3.836 .701 2.40 1.608 1047.561 1002.586 654.87 485.258 280.413 151 .59 GASES IN CUBIC INCHES. Sulphuretted Hydrogn. Carbon Dioxide Carburetted Hydrogen Nitrogen 10.16 40.10 4 18 11.50 60.00 2.30 3.70 13.22 54.00 .80 3.20 2.01 50.26 66.00 19.41 58.00 TABLE OF ANALYSES OF THE SALINE CHALYBEATE AND IRON GROUP. Saline Constituents in eJ a ^2 c =3 ® o \S j- - . n-i 8 ■? S ■ '- -7 ■=■ % £ 1 3 a cj o a "S si. (J rains per Gallon. m 5 ;cgc ~ 2 - 3 Q <5~ o8 9 1 2 c •-a O a Ferrous Chloride _ 13.213 _ _ _ Ferrous Carbonate 9.590 11.050 5.800 6.042 1.364 1.358 1.271 — Ferrous Sulphate 69.33 Ferric Sulphate 78.76 Aluminium Sulphate ... 89.47 Calcium Sulphate — — 9.097 7.625 .749 .697 .307 56.91 Magnesium Sulphate ... 57.3S Potassium Sulphate 3 14 Ammonium Sulphate ... — — — — — — — 2.19 Barium Sulphate .509 .222 Potassium Chloride 21.425 3.205 1.130 .150 — 1.323 — — Sodium Chloride 074.598 277.561 176.370 11.650 1.625 .280 1.543 33.96 Ammonium Chloride ... .439 .406 trace — trace trace trace — Barium Chloride — 5.204 — — — — — — Strontium Chloride .887 .6-24 Calcium Chloride 87.337 94.015 — 2.311 — — — — Manganese Chloride ... — .971 trace — trace trace — — Magnesium Chloride ... 65.391 57.315 4.735 13.148 — — — — Lithium. Iodides, Brom- ides. Fluorides traces traces traces — traces traces — — Barium Carbonate 2.136 — — — -. — — — Calcium Carbonate 8.858 — 13.762 .341 1.532 1.435 2.264 — Magnesium Carbonate ... — — 5.785 — 1.952 2.667 3.039 — Potassium Carbon nfp ... — — — .262 1.057 .991 — Sodium Carbonate — — 1.103 — 1.338 Silica 3.570 1.414 .675 .204 .502 1.041 trace 3.27 Organic Matter — — 1.450 .750 : .663 trace 874.740 465.200 218.804 41.471 1 9.839J10.521 10.753 394.41 GASES IN CUBIC INCHES. Carbon Dioxide Carburetted Hydrogen.. Oxygen Nitrogen 21.3 1.5 5.2 53.55 17.04 .31 1 8.98 1 13.74 8 00 11.85 .40 5.53 14.95 .15 .67 6.35 28.0 28.33 22.56 17.78 22.12 32 PRACTICAL OBSERVATIONS ON Of the Strong Sulphurous. — I shall take, as an example of this class, the Old Sulphur Well — the Harrogate water par excellence. On looking at the table of its constituents, one is struck with the large amount of chlorides it holds in solution, and with its general resemblance to sea water ; con- sequently its physiological action in some respects resembles that of its great prototype, for when taken in small doses, it creates thirst ; in larger, it excites nausea, vomiting, and purging, just as sea water does ; by reason of its containing less chloride of sodium and no sulphate of magnesia, it is less of an irritant ; and from its being impregnated with the chloride of calcium and sulphide of sodium, it possesses physiological and therapeutic properties which sea water does not, and which enable it to act in a special manner upon the lymphatic, glandular, and nervous systems, thereby promoting certain metamorphological changes in those tissues of the body which have become the seat of abnormal deposits. The physiological action of this water is therefore stimulant, aperient, deobstruent, alterative, and specific. As a stimulant, it acts first on the nerves of the stomach, and through them on the capillaries, increasing the secretion of the mucous follicles ; in like manner it acts throughout the whole alimentary THE HARROGATE MINERAL WATERS. 33 canal. It also exerts the same influence on the bronchial membrane and the skin ; but the organ it stimulates with the most certainty is the liver, for not only does it excite it to throw off more bile as an ordinary cholagogue, but it seems to promote a healthier activity of its other functions, which are necessary to the perfection of the processes of digestion and assimilation. As an aperient, it acts effectually and agreeably, producing copious evacuations without nausea, griping, or exhaustion. This action is not confined to one portion of the bowel, but seems to cause a general emptying of both small and large intestines ; hence its great value in all cases where there is constipation, with obstruction to the circulation of the portal system. As a deobstruent or resolvent, it promotes absorption ; in proof of which I may instance the rapid consumption of the fatty tissues of the body in those who, like Banting, have a decided tendency to obesity, and in the softening and gradual reduction of glandular indurations and gouty and rheumatic swellings during its use. I must also add that I have in several instances observed chronic hypertrophy, as well as simple congestion of the uterus, slowly subside under its influence ; and doubtless it is to that fact that it owes its D 34 PRACTICAL OBSERVATIONS ON reputation for removing sterility as well as for facilitating the function of menstruation. As an alterative, it acts principally on the mucous surfaces and skin, promoting a healthier condition of both by modifying and regulating their secretions, as is well shown in the rapid improvement which it effects in cases of chronic catarrh of the stomach and bowels, and in those forms of dyspepsia which are caused by an irregular supply or vitiated condition of the gastric juice. As a specific — I speak of its specific action,, because I am satisfied that I have observed effects produced by it which I have never seen follow,, with such uniformity, the administration of any other remedial measures, and because I am con- vinced that in certain cases it cures upon a principle, as special and peculiar to it, as is that principle which gives to quinine its anti-periodic character, and entitles that alkaloid to rank as a specific against diseases observing in their course marked periods of exacerbation and remission ; this specific action is manifested in the control it exer- cises over various cutaneous diseases, in certain forms of dyspepsia, but principally in the power it has over old-standing hepatic disorders, where we can scarcely say whether the case is one of functional or organic mischief. THE HARROGATE MINERAL WATERS. 35 The general action of this water is decidedly lowering, and a common complaint among those who have taken it either too long, or in too great a quantity, is a feeling of being pulled down, or good for nothingness ; at the same time I have never found it act so strongly in this way as the ordinary saline aperients generally resorted to, such as the sulphates, citrates, and tartrates of magnesia, potash, and soda, a common form of which you have in the Seidlitz powder. This may be easily accounted for in the conservative action of the chlorides, compared with the searching action of the sulphates, &c. I am satisfied of this, because many patients, who tell me they cannot stand anything of the nature of saline medicines, take the sulphur waters in medium doses, not only with comfort, but benefit, for weeks together. Some- times cases, which at first sight one might readily suppose would be powerfully acted upon by moderate doses of the strong sulphur, resist its aperient action altogether, and, strange to say, respond to the mildest sulphur with the greatest readiness ; and herein Harrogate possesses peculiar advan- tages over most Spas, in the extraordinary variety of its waters. If one well proves unsuit- able, there is another next door, or next again, that will meet your wants. In ordinary cases, I seldom continue its regular use for more than from eight days to three 36 PRACTICAL OBSERVATIONS ON weeks ; but in extraordinary cases — cases requiring its specific action — I have observed not only the greatest tolerance of it, but an expressed liking for it, after it has been daily taken in full doses for weeks and even months, all the while the patient showing no signs of debility or exhaustion from its action, but the contrary. If taken injudiciously, however, it frequently creates serious constitutional disturbances, charac- terised by loss of appetite, thirst, giddiness, drowsiness, intense headache, biliary derangement, and fever — symptoms which have led to more than temporary inconvenience in subjects predisposed to disease, or affected with organic lesions. Scarcely a year passes without some one paying a heavy penalty in this respect, and, considering the fool-hardy way in which some folk indulge in big drinks of the strongest waters, it is astonishing that more accidents do not happen. I shall give one as a warning. In 1866, a gentleman, above seventy, took large draughts of the old well before breakfast for several mornings ; each morning he felt worse and worse. He then, without asking advice, took the Kissengen ; after which he suffered intense headache. In the middle of the night he was heard to open his bedroom door, and between six and seven I found him lying on the floor, dead. Rupture of a blood-vessel had taken place ; THE HARROGATE MINERAL WATERS. 67 and I have no doubt the weak coats of this vessel gave way from the heart having been unduly- excited by the stimulating effects of the waters ; and I have as little doubt that the accident might have been prevented, had ordinary caution been resorted to, even the night before it occured. Administration. — Before commencing a course of this water, it is advisable to ascertain the habit and present state of the bowels, as, if there is any irregularity or approach to constipation, it is necessary, in the first instance, to remove such by suitable treatment. If this is not attended to, the chances are either that the water is speedily rejected, or, if retained, it only causes discomfort and disgust. It is also wise, if time permits, not to begin with the water immediately after a long and fatiguing journey, when the stomach has been put out by improper or irregular meals. When the patient is feeble and unequal to much exertion, he has the water brought fresh from the well to his room, where, after drinking it, he takes what exercise he can. If the digestion is weak, I invariably prescibe the water warm, as when taken cold it lies heavy on the stomach, and does not pass off so readily by the bowels, thereby causing nausea, with flatulent distension and headache. A pint to a pint and a half, taken in half-pint doses, at intervals 38 PRACTICAL OBSERVATIONS of fifteen or twenty minutes, beginning an hour or an hour and a half before breakfast, is generally sufficient to produce its aperient action. To secure its alterative or other physiological action, from two to eight ounces are taken cold three or four times a day ; these doses seldom affect the patient visibly. One thing I must insist upon : a patient cannot take these or any mineral waters with benefit and continue at work ; for the happy action of a mineral water there must be leisure, and as little mental anxiety as possible. Hence it is, I believe, that waters fail in producing the same effect when taken at home as they do when drunk at the source. Nay, more : I would ask how often, and to what extent, is the restorative action of all remedial means thwarted by this attempt to get well and continue in harness at the same time. I I I I I I 1 I I I 1 I I I I I I I I I I I I I I I I I I I I \ } f | f ,' \ ■ ,> , ; i | T % CHAPTER V. MILD SULPHUR WATERS. HESE hold a very important place in the medical history of Harrogate. Few may be aware of the fact that whilst they are called mild here, and relatively are mild, they would become strong if contrasted with many of the thermal and cold sulphur springs of the Continent. They hold a larger amount of saline constituents in solution, and as much sulphur in the form of sulphide of sodium, as do the springs of Aix-la-Chapelle, of Borcette, and Baden. They also contain an equal quantity of gas with the waters of the two last-named spas. They are twenty times stronger, as regards salines, when compared with the waters of Bareges, Bagneres de Luchon, St. Sauveur, and Eaux Bonnes in the 40 PRACTICAL OBSERVATIONS ON Pyrenees, or even the now highly fashionable resort Aix-le-Bains, all of which derive their power from their high temperature rather than their chemical ingredients. On looking at the analytical table of the mild sulphur waters, you find that they present, in a minor degree, the chemical characters of the strong ; and consequently we may expect them to show similar physiological properties. Except in such cases as I have already mentioned, they are by no means equal to the strong as aperients ; and for this very reason they become much more certain to act as diuretics and diaphoretics. They also have the same kind of specific power over certain diseases which I attributed to the strong, but in a lesser degree. They prove of the greatest value in cases where, from peculiarity of constitution or irritability of mucous membrane the strong cannot be borne, and are then given in the same way and doses with similar results. They are, however, much more frequently given in conjunction with the stronger waters, these being taken as an aperi- ent before breakfast ; the others as a corrective, alterative, or diuretic, at intervals during the day, in doses varying from four to twelve ounces. The mild sulphur water of the Royal Pump Room is a little more than half as strong as the old sulphur, and the same holds good with regard THE HARROGATE MINERAL WATERS. 41 to the mild and strong sulphur springs at the Montpellier Gardens; and the mildest sulphur waters are much more alkaline than those I have been speaking about. There are three springs showing this to a great extent, the strongest by far is the Magnesia Well,* then follow those at Harlow Carr, and Starbeck, all have been recently analysed by Mr. Davis, and are extensively pre- scribed, especially in the form of baths : but none of the waters of Harrogate hold anything approach- ing the quantity of alkali, which forms the princi- pal feature in the springs at Vichy, Fachingen, Geilnau, or Neuenhr, containing as these do from 45 to 7 grains of the carbonates of soda, lime, and potash in the pint. These are truly acidulous (by reason of excess of carbonic acid) alkaline waters, and are thereby useful in cases where that class of remedies is indicated. By reason of this very alkalinity, however, I think they require to be given with more circumspection than waters which are less so ; for, be it remem- bered, that in a healthy state all our secretions are acid ; and it is only when, by reason of imper- fect and faulty digestion, the blood becomes charged, not only with a greater amount of acidity than it ought to contain, but a different form of acid, that alkalies are urgently demanded so as to * This water is not used for Baths. 42 PRACTICAL OBSERVATIONS ON combine with this new or excessive acid, forming a soluble salt, which can be easily thrown out of the system by its various excretories. This*j[is very readily done, and, in my opinion, the danger is that may be overdone; and it is to this that I attri- bute the fact that many patients who have under- gone repeated courses of the alkaline springs above-named, have derived more real benefit from a course of our mild sulphur waters than they did from the use of the strongly alkaline waters of the Continent. In all cases of dyspepsia, giving rise to those symptoms to which the name of lithic acid diathesis has been given, in certain forms of rheu- matism, gout, neuralgia, in catarrhal affections of the alimentary and bronchial mucous membranes, and especially in chronic catarrh of gall bladder, and duct, the mild sulphur waters exert a most beneficial influence, and show results equal to those obtained by a course of other mineral waters, justly celebrated for their success in the treatment of these affections. The Hospital mild sulphur or magnesia water is, perhaps, of all the wells in Harrogate, the most popular ; partly because it is by no means an unpleasant beverage, and can be taken at all times, and in any quantity, but mainly because it acts with great regularity as. a diuretic, and has the property of eliminating THE HARROGATE MINERAL WATERS. 43 from the system uric acid and its salts. I have known many cases of gout and rheumatism which had resisted a prolonged course of hydropathy, as well as a fair trial of the mineral waters of Bux- ton, entirely cured by its means. External Uses of the Sulphur Waters. — All of these are used externally in the form of lotions and baths. Their external use, however, is chiefly confined to cases of skin disease, hepatic, gouty, and rheumatic affections. For the first-named, the milder waters are most frequently resorted to, not only on account of their being less impregnated with the chlorides, but because they are more alkaline, and thereby possess a softening and soothing effect upon the skin. The stronger waters are to be preferred in the other cases, as the) 7 act more powerfully as stimulants and deriva- tives. For bathing purposes, however, waters of the same strength as those which are drank are never employed, as they would prove too stimula- ting, and would soon engender cutaneous mischief, especially in cases where there was a tendency thereto. As it is, this not infrequently happens, by immersion being continued for a greater length of time or at a higher temperature than is proper. Doubtless, in certain highly chronic cases, this power may be turned to advantage ; and the old indolent disease may be converted into an acute 44 PRACTICAL OBSERVATIONS ON active one, and so lead to a radical change in the condition of the parts affected, which will often terminate in healthy action. This plan is very often adopted on the Continent, where patients are kept under water at a rather high temperature for six, eight, and ten hours daily. This is especially the case at Leuk, in Switzerland, where the chief salt in the water is sulphate of lime, and the temperature as it issues from its source is as high as 125 . Hence the favourite plan is to establish a crisis. The patient is so treated that between the fifth and twelfth day he is made to feel very shaky, the skin becomes covered with an eruption resembling erysipelas, accompanied by the sensation of burning and itching, with symptoms of consti- tutional disturbance of a feverish nature ; and this artificial disease often lasts for a long time. The same train of symptoms can be induced by very free bathing in any of our sulphur waters at a high temperature, but they are by no means to be desired. I can conceive a case where such a course of treatment might be thought warrantable, but I have not yet met with one. I am, moreover, convinced that anything like those symptoms, to which the name of crisis has been given, ought, if possible, to be avoided, as all the good which can be got from the use of a mineral water may be had without it ; and I believe THE HARROGATE MINERAL WATERS. 45 this opinion is becoming more and more general among medical men. If mischief follows excessive bathing at too high a temperature, it is no less apt to follow moderate bathing at the proper temperature, provided it has been resorted to at the wrong time. I do not mean time of day, but period as regards the disease. I have frequently met with people who were highly dissatisfied with the results of their course of baths, when they ought to have been dissatisfied with their own stupidity or imprudence. There are stages, especially of skin diseases, that require much humouring in the matter of baths ; and if this is not attended to, they resent the treatment in a manner most unmistakable. Moreover, unless the inside of the patient is brought into fair working order, you need not expect the outside to benefit greatly by anything you may apply to it in the way of baths and lotions. The great object, before resorting to these, is to ascertain the condition of the digestive organs and system generally ; for if these are in a sluggish or unhealthy state, or if you have disease of the heart, lungs, blood-vessels, or brain, baths must not be indulged in at all, or under certain restrictions. Once in proper condition to commence bathing, it is astonishing to the patient, and no less gratifying to his attendant, to observe the real, and often 46 PRACTICAL OBSERVATIONS rapid improvement effected by a few baths ; the skin then seems capable of responding kindly to the treatment, and in a short time is found performing its important function in a satisfactory manner. Good effects not always immediate. — The good effect of these waters is frequently not so much seen or felt during as after their administration. I have often been told by patients visiting Harrogate regularly that they feel better in health, and con- tinue to improve long after they had given up drinking the waters ; and it is this which induces hundreds to return year after year to undergo a regular systematic course of them. I consider this the strongest proof of their true value, for certainly it cannot be for the pleasure of drinking them, or their immediate effects, that these visitors annually pay their respects to the wells. We also frequently find that patients who cannot afford time for a full course of the waters, and are ^consequently sent away before the curative process has been far advanced, report that their progress towards recovery goes on satisfactorily, and that they now respond to treatment which before had little influence over them. This has been especially noticed with regard to iron, arsenic, and cod-liver oil, in the treatment of skin diseases. % '. ym. — f % CHAPTER VI. OF THE SALINE CHALYBEATE WATERS. HE presence of these springs within a few yards of springs so opposite in constitution and properties as those we have just been considering is a most remarkable natural fact. It is more than that ; it is one of the highest value and import. By reason thereof we can treat to the end cases which, having been corrected and purified by a course of sulphur water, require to be set up and strengthened by a course of steel. Moreover, by their means we are enabled to deal with a large and daily increasing class of patients who could receive no benefit from our sulphurous waters. This cannot be too strongly insisted upon, as hundreds are annually sent to drink the waters of Homburg, Pyrmont, and Spa, who might 48 PRACTICAL OBSERVATIONS ON receive as much benefit from the saline and pure chalybeates we have here. Like the sulphur waters, these are not so rich in gases as to entitle them to rank as sparkling ; still, they hold enough to make them agreeable when drank fresh, and insipid when taken after having been allowed to stand even for an hour or two, so that the gas has escaped. Whilst wanting in gaseous properties, they are rich in far more important matters. Of this class I have furnished the analysis of two examples — the Kissengen (so called from its resemblance to the Ragozzi Spring) and the Chloride of Iron Spring. The former holds the same salts in solution as the Old Sulphur Well, and in nearly the same proportions, differing from it in the substitution of the carbonate of iron for the sulphide of sodium. Its physiological action is, therefore, in a great measure akin to the sulphur, modified by the presence of iron ; it is accordingly more of a tonic, less of a depurant ; conservative, rather than eliminative ; and possesses none of those properties peculiar to the sulphur water, which I spoke of under its alterative and specific action. This is a most valuable spring ; holding a medium place between the sulphur and the chloride of iron, it gives to Harrogate great advantages in the treatment of many complicated and troublesome cases, and comes in with the THE HARROGATE MINERAL WATERS. 49 best effect as a tonic aperient after the patient has been corrected, as regards his secretions, by a course of the sulphur. It proves of the greatest use in all cases of constipation or atony of the muscular coat, and co-operates with the more tonic chalybeate waters, where these have a tendency to lock up the bowels. In many cases of nervous dyspepsia hypochondriasis, anomalous or atonic gout, certain stages and forms of eczema, and in chlorosis, this water is exhibited with the best possible results. Its immediate effect is stimulating and agree- able ; according to the quantity taken, it acts as an aperient or tonic ; sometimes it proves more potent as an aperient than sulphur — when it is taken in full doses, and where it does not act upon the bowels, it passes off readily by the kidneys. Occasionally it sits heavy on the stomach, es- pecially if it has been taken cold, and the doses drank in too rapid succession.* Administration. — Two or three glasses, of eight ten, or twelve ounces, taken before breakfast, at intervals of fifteen or twenty minutes, are generally sufficient to produce its aperient action. As a * This water can be obtained at the Well, or in bottle, highly charged with carbonic acid, which makes it lighter of digestion for delicate stomachs. E 50 PRACTICAL OBSERVATIONS ON tonic, three, four, or six ounces, three or four times a day, are usually prescribed an hour before meals. In these quantities if proves a most valu- able alterative tonic in strumous affections. Where iron is not so well borne, the chlorides come in with power, promoting a better digestion of all food ; so that, with a richer chyme and chyle, you soon have evidences of a healthier blood. Chloride of Iron Spring. — This water contains eight times more iron than the Kissengen, and one-third less saline matter ; it is, therefore, more of an analeptic, less of an evacuant. Its real nature was only brought to light in 1865, by the careful analysis of the late Dr. Sheridan Muspratt, who discovered that the water held in solution 16 grains of proto-chloride, and 12 grains of the proto-carbonate of iron in the imperial gallon — an amount possessed by no known spring in this or any other country.* Dr. Mus- pratt's analysis was fully confirmed by Dr. Miller, of King's College, London, as also by the late Dr. Herapath, of Bristol. The fact that this spring holds the ferrous chloride in solution, in so large a quantity, renders it unique, and places it at the * Mr. Davis, in 1873, found this spring contained a much larger amount of the chloride than it did when examined by Muspratt and Miller ; the former gave 16 grains in 1866, the latter 14^. Davis, in January and February, found 30^ The amount of carbonate, however, remains the same. THE HARROGATE MINERAL WATERS. 51 very top of the long list of British and Continental chalybeates. Nor is it too much to add that it is without an equal. This water, when drank at the source (and it can only be taken with most advan- tage there) is cold, clear, and very slightly sparkling, has an agreeable strong saline taste, not unlike the water from a fresh oyster. After swallowing it, the strong styptic or metallic taste is evident, and remains in the mouth for a time. Its immediate effect is stimulating, many people remarking that they feel as if they had taken a glass of generous wine instead of mineral water. Some speak of its causing a glowing sensation in the stomach, followed by a feeling of comfort and support, whilst all describe the after effects as invigorating and strengthening in a marked degree. The cura- tive value of this spring cannot be over-estimated, as its power for good in all chronic cases where iron is indicated is very manifest. The various forms of scrofula, whether of the system at large or of special organs, may, by its means, be combated successfully. Chronic glandular swellings yield to its influence. It is especially serviceable in many forms of dyspepsia ; in all functional derangements of the nerves, as tic, neuralgia, chorea, and most hysterical affections ; also in many cases of poor gout. Above all it has proved most service- able in cases of rheumatoid avthvites, even of long 52 PRACTICAL OBSERVATIONS ON standing. This condition is invariably attended with great debility — blood starvation—and requires very different treatment to that of ordinary chronic rheumatic affections, which are so greatly benefited by the sulphur waters. I may add that I have never seen this water prove beneficial in diabetes mellitus, or fatty disease of the heart, although I have found it useful in cases of Bright's disease of the kidneys, provided the structural changes in these organs had not gone too far. It is given in doses of from two to six ounces, three or four times a day. No water in Harrogate requires to be given with more circumspection than this, as it frequently proves not only most difficult of digestion, but is apt to cause several of the most painful physiological effects common to the ordinary pharmaceutical preparations of iron. This water ought always to be drunk at the pump, as it is so readily decomposed that the least motion or con- tact with the atmosphere renders it totally unfit for use. Like the Kissengen, this has also of late been charged with carbonic acid, and many patients find they can take it with greater freedom on that ground. As a proof of the sustaining effect of this water, I have observed that many patients cannot take their usual quantity of stimulants whilst drinking it regularly ; and that on giving it up they feel a THE HARROGATE MINERAL WATERS. 53 decided want, and have to exercise a certain amount of resolution in order to overcome the desire for a stimulant which the loss of the water has created. A little food, such as a biscuit, is the best thing to meet this want. In cases where wine is actually needed, then it ought to be allowed ; but in no case where it can be dispensed with ought the mere feeling of desire for it prove a sufficient reason for its employment. I have used this water in a great number and variety of cases of debility arising from the most opposite causes, and I have had every reason to be satisfied with its effects. So visible are they, that it is no uncommon thing for one patient to remark upon the improved look of another, adding, " I never saw anything like it." Why so? Because the chloride of iron is found to be more readily assimilated than any other compound of the metal ; and hence its power, hence its great value as a means of cure. Every now and again we meet with individuals who cannot take it without entailing upon themselves painful symptoms, just as we meet with people who cannot take opium without an attack of nettlerash, or quinine without a headache. The proper course to adopt, under these conditions, is to abandon the remedy ; per- severance only leads to disappointment and disaster. 54 PRACTICAL OBSERVATIONS The Alexandra Spa. — In March, 1870, this spring was discovered in the Bogs Fields, whence it is now conveyed in glass tubes to the Royal Pump Room. In my opinion this is one of the most perfect saline chalybeate waters we possess. Occupying chemically a place between the Kissengen and the chloride, it can be used therapeutically with the greatest benefit in a large class of cases where, from one reason or another, these springs are contra-indicated. Since its discovery I have used it regularly, and I have every cause to feel satisfied with the result. fc & x+x ! x}x' H>W4 xtx t=t=l X|X ^ to CHAPTER VII. THE PURE CHALYBEATES. % HERE are many springs of this class in Harrogate, the principal being the Tewit, St. John's, and the Hospital Chalybeate, all of which are very much resorted to by visitors requiring ferruginous tonics ; they possess similar qualities and properties to those of Tunbridge Wells, and, except in the small amount of carbonic acid they contain, are almost identical with the waters of Schwalbach in Nassau, the Altwasser in Silesia and St. Moritz in the Upper Engadine. They are peculiarly efficacious in the treatment of delicate girls suffering from functional derangement of health, and want of good red blood. These seem better able to appropriate the small quantity of iron in its subtle state ol division in this class of chalybeate waters, than in any other ; and to this fact I assign the cause of improvement 56 PRACTICAL OBSERVATIONS ON upon such small quantities of iron as are found in these springs, when that mineral has failed to benefit to any extent when given in the cruder forms of our chemical preparations. I may mention that, although iron exists in such small quantity in these springs, I have had several patients who could not continue to take them, because they experienced the same un- pleasant symptoms which they invariably had felt when iron had been prescribed for them. These waters are very pleasant to drink, and, therefore, peculiarly suitable for children. They are frequently used externally as lotions and collyria ; but I question very much if they can be of more use when applied externally than pure spring water. An important point in the use of all chalybeate waters must not be forgotten ; they ought never to be prescribed when the system is in a loaded condition ; they can do nothing but harm if given to anyone whose liver or digestive system is in (to use a homely expression) a foul state. Some- times patients are sent to drink the Kissengen or chloride of iron, with tongues, breaths, and com- plexions indicative of impurity ; the consequence is, as sure as they drink, so certainly do they suffer from an increase of all their signs of ill-health — just as they would suffer if they had been put upon the ordinary tonics and full diet at home. THE HARROGATE MINERAL WATERS. 57 These waters are equally unsuitable in all cases where there is congestion or irritability of the mucous membrane of the alimentary canal. If given here, they occasion sickness, severe griping, and diarrhoea ; a glazed tongue, or a raw tongue, will become more glazed and more raw the longer iron waters are drank. Weakness alone does not warrant the use (abuse) of tonic waters, any more than it permits underdone beeksteaks and XXX to be taken thrice a day. Before dealing with the different classes of patients most suitable for treatment by these waters and baths, I may remark, that when a patient is sent by a medical man, or comes of his own accord, to Harrogate, I consider that he is sent or comes, for the special purpose of having its waters tried; in order, if possible, they may bring about that which ordinary treatment had failed in accomplishing. I, therefore, whenever practicable, avoid the use of all medicines, and trust entirely to the natural means at my disposal. In doirg so, I must not be supposed to despise drugs and maintain that the waters, and nothing but the waters, are useful in the treatment of such and such disease. I use them as a specialist, because it would be a piece of gross presumption on my part to suppose that I could succeed in treating cases by the usual means adopted by all well- 58 PRACTICAL OBSERVATIONS educated and honest practitioners, when they had failed in hands equally or better skilled with their use than mine. I am led to make these remarks because several medical men, who heard me read these observations in their original form, seemed to be dissatisfied because I did not give my patients physic ; and because they had never used mineral waters, and knew nothing about them, they did not hesitate to pronounce them a myth ; one more learned than the rest, suggesting that, as an experimentum crucis, I should have so many dozens of the ordinary water used for culinary purposes in the town where he lived, sent to Harrogate; and that I should treat so many of my patients with that water, and an equal number suffering in a similar fashion with Harrogate water ; com- pare the results and report. That was the most profound, the most astounding advice ever given to mortal. One can scarcely credit it, but it was offered in all seriousness, and by a teacher, a lecturer on materia medica. In some few instances it may be necessary to prepare the patient by the exhibition of a smart aperient, without, or in combination with, mercury ; but even these might be made fewer by having the dose administered before leaving home, and thus time would be saved. CHRONIC DISEASES AT THE HARROGATE SPA rJi^ I vMi i / ^3- % CHAPTER VIII. GENERAL REMARKS ON SKIN DISEASES. HESE are much more general than one would credit. Among medical men even, it is only those who, from their having made dermatology their speciality, know how very common they are ; numbers of people are met daily and known intimately, who suffer from very decided and extensive cutaneous affections, and nothing is even suspected to be wrong with them. The parts affected are hid from view, and those exposed look and are, fortu- nately, perfectly normal. It seems rather singular that no one is willing to admit that anything is wrong with the outer covering of his body ; and should this be so it occasions an amount of vexa- tion which hardly any other disease inflicts. The usual expression with patients suffering from skin 60 . PRACTICAL OBSERVATIONS ON disease is, "I would not mind if it were any- thing else, but to have this nasty eruption is horrid ; no one in our family ever had a spot on the skin, and my skin used to be so pure." I have seen some get quite angry or ashamed, be- cause they had to confess to having some paltry rash, whilst they would almost be de- lighted to inform you that they were martyrs to neuralgia, or victims of heart disease. In short, you may sympathise safely with the subject of a consumptive cough, diseased liver, or worn-out stomach ; but should your neighbour show a spot on his nose, keep off it — look as if you saw it not — if you wish to steer clear of offence. Should you desire to wound his feelings and raise a blush, you have only to say, " What is the matter with your face ? " and you have gained your end, and, may be, made an enemy for life. The reticence of patients, who are actually in the consulting-room of their medical man, is some- thing remarkable, as if one had reason to feel ashamed of skin diseases more than other ailments. It is not unreasonable, I think, to suppose that much of this may be traced to the hard laws and severe penalties that were enforced against him who had "In the skin of his flesh a rising, a scab, or bright spot " {vide Leviticus xiii). The appearance of any one of these subjected THE HARROGATE MINERAL WATERS. 61 the unfortunate Israelite to being immediately carried before the priest, and by him incarcerated for seven days, however innocuous the spot might have been ; if at the lapse of that time it was pronounced a leprosy, he was shut up again ; and in the event of recovery was subjected to hard and oppressive enactments, for, besides having his clothes destroyed, he had to become the purchaser of various expensive offerings, and, what to many would be far worse, he had to shave off all his hair even to his eyebrows, and appear before the congregation with head and face as smooth as a billiard ball. Under these circumstances I have little doubt even the most devout Jew would try and conceal any blemish in his skin as long as he could, hoping that the unclean thing might depart as it came, and thereby save him from the awful treatment which must follow its discovery. Although we stand in dread of no such prison discipline, should our skins be ever so spotty, as did the Jew, still I believe that the moral effect of the Levitical law acts on the mind of the Christian, and makes him slow to admit that his skin is in any way unhealthy ; for, whilst every one is ready and anxious to proclaim that he is suffering from bronchitis, consumption, gout, and rheumatics, so bad, I have never yet met the man, woman, or child even who pled guilty of the itch, one of the simplest and most curable things going. 62 PRACTICAL OBSERVATIONS When we consider that the skin is one of the most complex organs in our bodies, both in relation to its structure and functions ; that during the whole period of our lives it is undergoing perpetual changes of growth and decay ; that it is subjected to all sorts of vicissitudes as regards its physical, mechanical, and chemical conditions, we need not marvel that it should exhibit many and important aberrations from its normal state, and that it is so very difficult to restore to health when it has be- come the seat of disease. Apart from those forms arising from poverty and the neglect of personal cleanliness, I question if social position has any influence in determining the relative frequency or severity of skin affections. By far the majority of the sick who visit Harrogate on account of its waters, suffer from one or other form of cutaneous bother, and every season, even the rarest forms are to be met with in private practice, or seen in the Bath Hospital. With these I need not take up time, because, however interesting on account of their rarity, they can be treated more successfully by medicines than by waters. The same remark applies to all acute attacks of skin disorder ; and as to the chronic, whose name is legion, I shall confine my remarks to those which have come most frequently under my observation, and in the order of their frequency. CHAPTER IX. ON ECZEMA AND PSORIASIS. (/Jf' HESE, by far, are the most common I i i cutaneous diseases met with in this country. I therefore propose briefly to point out certain facts regarding them. Every form of eczema can be produced artificially in any indi- vidual, no matter whether that person may have a predisposition to it or not. When so caused (by irritants) it often proves as troublesome to the patient, and as difficult to cure, as when it occurs spontaneously. But you cannot produce psoriasis by the same means. No matter what device you adopt, a single patch cannot be made to appear, even in one who is prone to it, and this peculiarity shows, I think, that they are pathologically as widely separated from each other as small-pox is 64 PRACTICAL OBSERVATIONS ON from scarlet fever, and that psoriasis is not, as the late Erasmus Wilson maintained, nothing but chronic eczema. On thinking over the favourite sites of each, whilst eczema shows an affinity for the flexures of joints and portions of skin in close contiguity with each other, parts which are frequently in a state of relaxation and moisture, psoriasis shows a preference for the outside of joints, the elbows, knees, and knuckles, parts where the skin is as frequently in a state of tension and dryness. Again, eczema is very much under the influence of climatic conditions, heat and cold, exposure to the air, and above all, functional derangement of the digestive organs, especially the liver ; psoriasis remains unaffected by these, and presents the self- same characters in the temperate, torrid, and arctic regions. Both, sometimes, are found to disappear entirely on the accession of an acute attack of fever, rheumatism, gout, or asthma, to reappear as soon as these have run their course, just as all signs of phthisis occasionally subside in a consump- tive female during pregnancy. Both are capable of being cured by local treatment without the aid of a single dose of medicine ; both have the habit of revisiting anyone who has once suffered from them ; and both are equally hereditary. In my own practice I have twice or thrice met with THE HARROGATE MINERAL WATERS. 65 cases of eczema in five generations of the same family, and one instance where psoriasis appeared in one member, and that the strongest male member of each family in five consecutive genera- tions. Cases where I have seen both eczema ana psoriasis in three or four generations have been of frequent occurrence. Such being the case, I hold that we have as much reason to speak of a dartrous diathesis as a gouty ; and were men and women who are liable on each side to eczema and psoriasis to intermarry, the dartrous constitu- tion would become so developed as to compel us to recognise its place and importance in clinical medicine, and would no longer be spoken of as a term employed in order to cloak our ignorance. The treatment locally I have found most successful in eczema, has proved utterly useless in psoriasis, and that which is most powerful for good in the latter has again and again proved most injurious in the former. Be it understood, 1 am speaking of the ordinary applications which are at the command of us all, not of such special means as mineral waters and baths ; as these, when judiciously administered, possess a marvellous power for good, and equally so in both. For the last four or five years I have remarked that most of the patients who have consulted me on account of these eruptions, have got it into their 66 PRACTICAL OBSERVATIONS ON heads that they are martyrs to gout in the skin, and it has become quite the fashion among medical men to pronounce in favour of this theory. I confess I am no believer in it, all my experience is against it. Every year I am more and more convinced that what is called the uric acid diathesis has nothing to do with the production of these eruptions, or any form of eruption whatever. I am quite alive to the fact that some of our highest authorities have advocated this doctrine most honestly, and hold that in order to deal with eczema and psoriasis successfully you must treat them according to the well-known therapeutic indications so universally observed in dealing with gout. Dr. Burney Yeo, in his address on " The Therapeutics of the Uric Acid Diathesis," delivered in Dublin, in 1887, under the head of " Principal Morbid Conditions dependent on or associated with the Uric Acid Diathesis," placed eczema, psoriasis, pruritus — anal and vulvar, and acne. I trust it may not be thought impertinent on my part, or disrespectful to my distinguished friend, when I state that for one of these affections he has seen, I have seen and watched hundreds, that I have sought for evidence in the urine and exudation of many, and have failed to discover the slightest proof of any excess of uric acid in the great majority of my patients ; and, oddly enough, where THE HARROGATE MINERAL WATERS. 67 I have found uric acid in great abundance, and of constant occurrence, appearing as cayenne pepper crystals visible to the eye, as well as in forms, only made known by the microscope, I have seldom met with any symptom of skin trouble ; in fact I have often wondered at the enormous amount of uric acid given off by the kidneys in certain forms of neurotic dyspepsia, for years together, and the total absence not only of skin disease, but of any manifestation of gout or rheumatism, the accepted forms of evil which are now universally believed to have their origin in the presence of an excess of uric and lactic acids in the blood, and the arrestment of the former as the insoluble biurate of sodium in the tissues. When do we find this condition most commonly declare itself ? After middle life is past, after years of hard work, anxiety, and over indulgence in strong meat and stronger drink. When is eczema found to make its appear- ance ? Very frequently in infancy and childhood, although it confines itself to no period of life, still the most acute forms are generally met with long before the uratic habit has been formed ; this I hold is a strong argument against the dogma that that there is any relationship between them. In a paper I published in the Lancet, in 1888, in support of this view, I brought forward a still stronger, in the following words : — " Wherever any tissue has b<5 PRACTICAL OBSERVATIONS ON been the frequent seat of gout, and if to periodic we add protracted, structural changes invariably follow — degenerations, in fact — and the part so affected never regains its normal condition. What happens here ? I can produce cases that have been subject to attacks of both eczema and psoriasis for thirty — ay fifty — years, who will tell you that every portion of their skins has been, not once, but scores of times, the seat of these eruptions, and if you examine any part where they no longer exist, you will find it perfectly healthy in appearance, and as capable of performing its functions as if these had never been interfered with. Would such be the case were gout the cause ? " Another argument against the gouty proposition as regards eczema and psoriasis is that these eruptions were familiar to the profession, and recog- nised by the laity as wet and dry scurvy in Scotland, as wet and dry tetter in England, as flechten in Germany, ages before gout was ever heard of. You will find good descriptions of them not only in medical works, but in books on domestic medicine, written centuries ago, before gout had made its appearance. It is a historical fact that whilst these eruptions were common enough, no case of gout had been met with in Scotland previous to 1767, for had there been we must have had it recorded in the lectures and THE HARROGATE MINERAL WATERS. 69 writings of such careful observers as men like Cullen, Gregory, Black, and Hunter. The last point I shall refer to is, that as far as my ex- perience goes, the well-known remedies against the uric acid diathesis are in the great majority of cases ineffectual for the cure of eczema, and utterly worthless in psoriasis. The most frequent complication in eczema, especially in early life, is asthma ; a neurotic condition occasioned by the act of some irritant coming in contact with the mucous membrane of the bronchi, much in the same way as eczema can be induced by irritation of the skin. I find that they are hereditary in about the same proportion, 40 per cent., and that when they appear in the same patient the eczema is most obstinate, and the itching most aggravating, so much so that I have heard many patients say they prefer the difficulty of breathing as the choice of two evils. Between asthma and eczema there is a strong affinity ; they are often brought on or greatly increased by irritation from within as well as without, and are found to make frequent inter- changes. At one time I thought the strumous diathesis was closely connected with eczema, but after long and careful observation I have come to the conclusion that it has nothing to do with it, and that tuberculous patients are less liable to cutaneous disorders than any other class. 70 PRACTICAL OBSERVATIONS ON Psoriasis has nothing in common with scrofula, it generally affects the strongest and healthiest in a family predisposed to it, and if left to itself never involves any greater evil than what its ugli- ness entails. I have seen several cases of consump- tion supervene on the long continued abuse of mercury, iodine , and arsenic for the cure of this disease, especially in highly sensitive subjects whose minds were constantly brooding on the pain- ful fact that they were lepers ; but that was in my early days, of late I have seen no such results, and I attribute this to the discontinuance of such large and uninterrupted doses of these poisonous drugs, and the better knowledge we have of the power which local treatment has in controlling the excessive cell formation, which is the main feature in this case. As far as varieties go, I may at once say I recognise only eczema and psoriasis ; the forms they take are practically of no importance, how- ever imposing they look on paper. Everybody will admit that both are becoming more and more com- mon ; as a proof of this I need only point to the rapid growth of dermatologists. In 1845, in Eng- land, we had only one of any note, Erasmus Wil- son ; Scotland was entirely without ; and Ireland was little better off. Now we have them flourish- ing in every city, and attached to every general THE HARROGATE MINERAL WATERS. 71 hospital in the kingdom. The etiology of both affections is still to be discovered, notwithstanding the great advances made in every department of pathology and therapeutics. As .yet, no bacillus has been found, and, what is more, I prophesy that none ever will be ; for wherever that most fashionable, highly cultivated micro-organism takes possession, death and destruction follow. Look at splenic fever, chicken cholera, and tubercle. Now, the affections under our consideration are in reality scarcely to be classed as diseases, for, correctly speaking, they are mere divergences or exaggera- tions of that cell life continually going on in health, and, however extensive, vexatious, and protracted, they never lead to any structural changes or per- manent functional derangements, and never destroy life. Whilst our knowledge as to their proximate cause has made no progress, I am pleased to add that the same cannot be said as to their treat- ment, for here we have made immense strides ; still, it is emphatically experimental, quite as empirical to-day as it was when I commenced practice. We have no royal road to cure — no specific ; the best methods of treatment, the most usually successful, every now and again, even in the same individual, prove worse than useless. Often have I fancied I had made a great dis- covery, thought of the Patent Office and enormous 72 PRACTICAL OBSERVATIONS ON wealth, but, like Sir Edward Clark and cocaine in summer catarrh, my hopes have been rudely shaken. Patients and friends continually ask, " Can you cure this? " "Will it ever return ? " I answer both questions, "Yes." Some also ask, "Would it not be dangerous to drive this in?" And even medical men, I suppose by way of comforting the patient, say, "It is better out." My great aim is to cure, and as quickly as possible, with one solitary exception — eczema capitis in teething infants. I hold that both are non-contagious, and I differ entirely with Dr. Jonathan Hutchinson in his recently expressed views that the spread of eczema and psoriasis to contiguous portions of skin is due to "an infective process," and that this must serve as " the keynote of a large part of the therapeutics of the skin." By an infective process I mean, and I suppose Dr. J. Hutchinson means, the trans- mission of a noxious principle or material from one individual to another, or from one portion of the same individual to another portion. If eczema and psoriasis are spread by infection, surely we might look for their being frequently given to the friends and attendants constantly employed in dressing and waiting on those suffering from the very worst forms of both ; in all my experience have never met with such a result. If they spread by an infective process, why not chilblains, which, THE HARROGATE MINERAL WATERS. 73 according to the same authority, arise from " inherited peculiarity of tissue as regards suscepti- bility to cold" — in fact, vasomotor disturbance? This infective process is a new doctrine, and we are entitled to ask what is the contagium, and how does it happen that a single patch of eczema lasts a lifetime without spreading ? Common-sense and long experience tell me that the common cause of the spread of eczema is scratching, and wherever this is resorted to self-aggravation is the law, but that aggravation is not brought about by infection either in the part or through the blood, but by the nails; in fact, I go so far as to say — if you prevent itching, you do away with scratching, and the eczema is cured. The constitutional disturbance created by successful vaccination undoubtedly has proved in many well authenticated cases the exciting cause of acute eczema, both vesicular and pustular. I am strongly in favour of conforming to the rule of the Vacci- nation Act, which compels parents and guardians to have infants under their charge vaccinated at the end of the third month, but I think the question of early vaccination in an infant who has already shown signs of skin disease, or who is of known eczematous parents, is one requiring grave con- sideration. Some medical men think vaccination has nothing to do with the appearance of the rash ; others advocate its adoption for its cure. For my 74 PRACTICAL OBSERVATIONS part I feel disposed in all such cases to recommend the postponement of the operation till after teething has been completed, or at least its necessity is made absolute from the prevalence of small-pox in the district. Much of the opposition to this most benign and invaluable preventive measure has arisen from real or imputed diseases of the skin breaking out before the maturation of the cow pock or shortly after. I therefore see good reason why great discrimination should be exercised, and that we are perfectly justified at the request of the parent or on our own responsibility to grant a certificate deferring vaccination so long as we think it expedient. In conclusion, whilst with the late Dr. Tilbury Fox and others I admit that eczema may be in- fluenced by certain diathetic conditions, I hold that it is not the outcome of these, and as far as my observations go psoriasis is not under their influence at all. I am at one with the great German dermatologist, and agree with Hebra that we must look for the proximate cause of these eruptions to faulty enervation ; it may be between the vaso-motors and capillaries of the parts affected, it may be in the great sympathetic nerve centres, the harmony of whose action has been destroyed by long continued physical and exhaustive efforts, or by what is equally trying, anxiety of mind, pecuniary losses, or grief. m HHg It. ,K'l .* ,llll.,dlll. Jill,. ..1 ..,■■■■.■■»:. ":..-" .I'll- 4.1l,..,llll...Hlll. ..Hi,. .,|l|,, ID I', ,* 1 :• .'I, fl, ,.1: ..», ,|||„ „ ♦♦ .»>«.«« A — 9 • t 4 * " vjy •jT m CHAPTER XVII. GOUT. ANY who pay a visit to our Spa are thoroughly conversant with the cause, C? s} 7 mptoms, and natural course of an honest attack of gout, as it appears in its favourite resorts. Certain impurities, principally uric acid, get arrested in their passage through the small vessels, a block is established, and the result local inflam- mation of a specific character ; with this there is, more or less, functional disturbance of the digestive, circulatory, and nervous systems; but if left to itself the disease runs a pretty uniform course, the patient's sufferings not being so much in keeping with the severity of the local s} 7 mptoms as his idiosyncrasy. By and by pain, heat, redness and swelling disappear, and the person is not only as THE HARROGATE MINERAL WATERS. 145 well as ever, but, as Dr. Cullen wrote ages ago, — "enjoying greater ease and alacrity in the functions of mind and body than he had done for a long time previously." In dealing with all such cases of acute gout, I maintain that any attempt to mitigate the symptoms, or cut short the fit by any kind of treatment whatever, is a mistake; the patient should be asked to grin and bear, and told simply to rest the part and wrap it up in cotton wool. If the appetite is normal I do not make the slightest change in diet, in fact. I act on the principle of fanning the flame so that the fire shall burn itself out in a legitimate manner and place. By adopting this course I find patients make good and rapid recoveries, and enjoy better health, and a longer interval between their attacks than by any other. Treat such cases with purgatives, alkalies, colchicum, and I grant that the symptoms may be quickly ameliorated, cut short, or arrested. But what follows ? The patient, generally, does not make such good, or rapid, recovery, and is more liable to a relapse ; or the disease returns at an earlv date, it may be in a less violent, but also in a less healthy fashion. The treatment has scotched, not killed the snake. I have been speaking of acute gout, as it affects the joints of the hands and feet ; we must bear in mind that it does not always confine itself to these parts, but, not infrequently, seizes on seme L 146 PRACTICAL OBSERVATIONS ON internal and important organ. The stomach, bowels, kidneys, bladder, heart and brain may suddenly become its seat ; the symptoms, when such happens, are most alarming, and require prompt and powerful measures to be immediately resorted to for their subjugation ; unfortunately they are not so readily recognised, and thus may be allowed to run a fatal course. One of the most constant features of internal gout is the very marked depression of the ganglionic centres, the patient looks as if he had been the subject of shock, such as we witness in severe accidents. What is called flying gout I have generally found associated with a loaded condition of portal system, with decided hepatic derangement, and speedily removed by treatment directed to remedy this condition. I need say nothing as to the strong hereditary nature of gout, or to the fact that it frequently appears for the first time in individuals. The causes which favour its development are good living, excessive use of stimulants (especially those of a saccharine sort), and indolence; to the foregoing I would add bad air ; these are allowed to be the common factors of the gouty diathesis, but they are by no means the only ones. I have met with lots of cases where we have neither had hereditary tendency, gross living, or intemperate habits, with slothfulness, to account for it ; men and THE HARROGATE MINERAL WATERS. 147 women have become martyrs to it because they have been subjected to bitter trials, sorrow, anxiety, and worry, with physical exhaustion ; any- thing which depresses the vital powers may prove the exciting cause of gout, whether one is predis- posed to it or not. Dr. Clifford Allbutt, in an address to the Medical Chirurgical Society of the West Riding, spoke to the fact that gout was frequently found to exist as a neurosis. Some years ago I met with a case which exemplified this in a remarkable way. During the Indian Mutiny, in 1857, a powerful, smart young officer was chosen to perform a most difficult, dangerous, and arduous duty. He was given important despatches, and had to carry them 70 miles, through a district infested by rebels ; he had to accomplish his journey in one day and return with the answer the next. This he did, but on his reaching head quarters, he was so prostrate he had to be lifted from his horse and carried to his bed ; next morning lie was removed to the hospital, and shortly after was attacked with acute gout in both great toes, ankles, and thumbs. No member of his family was ever known to have suffered from any form of gout, and he has never been very long free from it since. I have several times seen children, weakened by acute illnesses, show all the signs of acute, gout during the early 148 PRACTICAL OBSERVATIONS ON days of their convalescence, without their parents ever having exhibited the slightest trace of being of gouty constitution. I shall mention one more case, showing that nerve shock or strain led to an acute fit of gout. A lady, at 60, was for 45 minutes placed in a state of extreme mental anxiety, whilst her hus- band, who was an old man, had to undergo a most serious and highly dangerous operation under chloroform ; she was not present at the operation, and her state of dread was something terrible. Immediately after all was over she was seized with an acute attack of gout and nettle rash, and ever since, 11 years ago, both have revisited her for longer or shorter periods. I would ask the question is gout more frequently met with now in proportion to the increase of the population, than in our own recollection ? Like myself, some of my readers may be able to carry their minds back 20, 30, or even 40 years. Let me tell them my professional experience. From 1839 till 1844 I was daily in the habit of seeing patients, as an apprentice and student, in private and hospital practice in Edinburgh, — during that time I don't remember seeing one case of acute gout. I never heard one word regarding it from my master or teachers, and in my text books I found it once spoken of as having some con- nection with stone in the bladder. THE HARROGATE MINERAL WATERS. 149 From 1844 till 1859, when I was in practice in Scotland, I met with one case of acute primary gout. Since 1859 I have been in practice in Harrogate, where chronic gouty patients are sent in hundreds, but these I shall leave out of my calculation, and confine myself to my resident practice, and here I find I have seen on an average about 17 fresh cases per annum, among a class in every way similar to my patients in Scotland, where in 15 years I saw one case. Among the visitors, I find that Scotland and Ireland furnish more gout) 7 cases than England. I mention this because, about the year 1760, Dr. Gregory, the most celebrated plrysician of his day, and Profes- sor of Practice of Physic in Edinburgh University, whilst on a visit to London, assured his medical friends that during his life he had only seen two cases of gout. All this time it was very common in London. The fact that Dr. G. only saw two cases shows that the disease must have been almost unknown in the North a hundred years ago, and now every Scotch village surgeon is as familiar with it as I am. Has gout increased in like ratio in England ? I am fully persuaded it has, and is rapidly on the increase. What can we attribute this increase to ? 1 st. I would observe that English and Scotch have been for centuries given to strong drink, 150 PRACTICAL OBSERVATIONS ON and, whenever they could get it, fond of good living. Too much value has been attached to Abernethy's remedy against gout — " Live on six- pence a day, and earn it." We must fall back on other factors of gout than alcoholic drinks and generous diet, and ask ourselves — Are there at pre- sent any conditions of life in operation which did not exist during our grandfathers' time, and can those conditions in any way account for the in- crease of certain diseases, among which gout holds a prominent place ? I . think the answer is not far to seek ; our whole conditions of life and mode of transacting both public and private business have changed. Our ancestors led com- paratively sleepy lives ; they had none of that constant mental excitement and physical hurry- scurry which must be kept up in these days if any one desires to be in the race ; consequently they felt nothing of the strain put on mind and body, and the exhaustion induced in both, which we commonly meet with ; and to this exhaustion of nerve force, I think, we may reasonably attribute a portion of the victims of gout. I would point to another possible cause, one which, in my own mind, I have little doubt about, and that is excessive tea-drinking. Let me call your attention to the following facts in regard to the increase of gout and the consumption of this article. Tea, many of you may know, was THE HARROGATE MINERAL WATERS. 151 introduced into this country about 200 years ago. For long it was only to be met with as a curiosity, and was not found in any but the houses of the rich as a common beverage. Earlv in this century, in fact, until the monopoly which the East India Company held regarding its importation was abolished, in 1833, tea-drinking was not to be seen in every dwelling, and it is at least remarkable that since 1833 gout has increased •■normously. I must confess that I think Richard Cobden was not far wrong when he expressed his opinion that tea was a slow poison which would lead to the rapid degeneracy of the race, and I have long felt convinced that I have seen as much mischief result from intemperance in tea-drinking as I have from dram-drinking. In conclusion, let me say a few words on a new tap opened for the sole benefit of the thirsty public. I shall be curious to watch what may happen during the next ten years, after we have got our systems fairly saturated with those marvellous drinks which Limited Liability introduces to us ; those beautiful, sparkling, refreshing and invigorating beverages at 5s. 6d. per dozen, more agreeable than champagne, and, in my opinion, a hundredfold more injurious. In those trashy compounds, I believe, we shall find a new source of dyspeptic torments and an additional factor to gout. I once was bullied into tasting some stuff with a fine sounding 152 PRACTICAL OBSERVATIONS name and gorgeous get up ; from the little sip I took I can honestly advise every one, who has any respect for his inside to avoid all drinks whose names, whatever their beginnings, end with the letters ade, one, ine, and stand by the good old- fashioned beverages of our youth. If stimulants are to be taken, and, I believe, to a certain extent they are necessary, you will find sound beer, good wine, and old spirit more wholesome, more suitable to climatic conditions under which we live, than any other, and not one whit more gouty. Many patients suffer from anomalous gouty symptoms, flying pains in feet and head, sudden sharp attacks of pain in stomach or bowels, cramp in legs, short hacking cough in the morning, irregular action of the heart, and various other symptoms, for which they take aperients, with alkalies and tonics, with more or less benefit. Still the symptoms insist on re-appearing, and, when this happens, I have witnessed many cures effected by sulphur waters, sometimes by their enabling the patients to get up a real attack and so clear the atmosphere ; at other times by gradually removing the gouty poison from the tissues where it had been resting. In either case the result is the same, the removal of those trifling, but worrying, discomforts which so frequently interefere with the night's rest of those subject to them, thereby rendering them, to some extent, unequal for the day's work. M.LLLXXXTlwIJ aaBHaaaaaaaa^Ha CHAPTER XVIII. « RHEUMATISM. E know as little about the pathological cause of rheumatism as our predecessors did fifty years ago, the researches of the most eminent specialists and scientists having up to the present produced no definite result. Some iavour the lactic acid theory, others the lithic acid theory, others the uric acid (although that acid has not been found), whilst the most recent is the bacteriological one. This latter, as regards acute rheumatism, has some points in its favour, as we have always present the high temperature associated with most of the diseases caused by micro-organisms, also there is a more or less tendency towards what we might call a crisis, and we have clinically the know- ledge that acute rheumatism frequently appears in scarlet, typhoid, measles, and various fevers con- tracted usually at an earl)- period of life, and each 154 PRACTICAL OBSERVATIONS ON having its special bacillus. From the amount of lithates passed by the kidneys during and after an attack, I myself favour the lithic acid theory, more perhaps because I cannot bring myself to look upon everything from a bacteriological point of view, and cannot hold the uric acid theory owing to the clinical differences — so well known — between acute gout and acute rheumatism ; for in the latter we have the great, often the very great, increase of temperature, the tendency to implicate many joints at once, the dangers of pericarditis and other serious complications in serous mem- branes, a thing unknown in gout, the distinctive cause (usualjy a chill), and lastly the comparative immunity in people of mature age. I shall say a few words on rheumatism under three heads : — Acute rheumatism, including rheu- matic fever, which I will not touch upon, as being a disease which certainly never will be treated by mineral waters and baths ; chronic or recurrent rheumatism in muscles ; chronic rheumatism of joints and rheumatoid arthritis. The muscular form is characterised by great pain, usually worst when the patient gets warm in bed, by the suddenness of its onset, by a slight rise in the temperature, and by its recurrence in the muscles previously affected. Perhaps the commonest forms we meet are in children, THE HARROGATE MINERAL WATERS. 155 when it appears in the form of stiff neck, and in older people what is popularly known as lumbago, and that extremely painful variety, pleuro-dynia; more rarely we find it in the muscles of the limbs and abdomen. The chief causes are injury to the part, exposure to cold, and over-exertion. It does not damage the muscles in any way, and answers readily to treatment, especially a course of mineral waters and baths. Chronic articular rheumatism is caused in the same manner as chronic gout, viz., by repeated attacks of acute rheumatism, with this difference, there is no deposit of urates, lithates, or other salts, and the deformation of the joint is due to a simple inflammatory process, tightening the liga- ments, producing fixation (more or less) with the consequent atrophy of the muscles working the joint. The predisposing causes of this form are exposure to cold and damp, hard labour, poverty, and mental depression. It is characterised by more or less pain and stiffness, with swelling of the joint, the latter symptom being hard and firm as if it were a solid enlargement of a normal joint, and one of its remarkable features is the peculiar liability patients suffer from exacerbations due to the climatic changes, rendering them, in their own words, excellent barometers; a good description, for I have seen some who could foretell rain or fine weather by 156 PRACTICAL OBSERVATIONS ON twenty-four hours, from the long experience and knowledge afforded them by their afflicted joints ; this is certainly, I believe, one of the best clinical diagnostics between it and chronic gout. Frequently we find that the heart is affected. The patients are usually of mature age — although it is seen in young people as the result of a severe attack of acute rheumatic fever — are fairly well nourished, and, except for their local trouble, healthy, with the exception of those cases where the heart is seriously diseased, when we find the usual complaints produced by complications interfering with the action of that important organ. There can be no doubt that the peculiar alterations caused in joints by the chronic forms of gout and rhuematism have, until recently, hidden the more terrible disease, rheumatoid arthritis, from the majority of our profession, and it is due to the careful researches of Sir A. Garrod and other eminent authorities on gout that we are now able to differentiate this joint affection. I look upon rheumatoid arthritis as a nervous disease due to debilitating causes affecting the various articular structures. It occurs at any age, but is perhaps most common between the ages of 20 and 35 ; attacks the smaller joints first ; is ve^ frequently symmetrical ; and, though insidious, often slow in its onset and progression, produces such changes in the joints attacked that THE HARROGATE MINERAL WATERS. 157 we find the articular cartilages, more or less, completely ulcerated ; the ends of the bones enlarged and thickened by internal deposit. It is characterised by much the same symptoms as chronic gout or rheumatism of a joint, swelling, heat, and pain, but these symptoms do not answer to the treatment which we find so successful in cases due to those causes. I must here call attention to the points where rheumatoid arthritis differs from the two previous diseases. Anaemia, more or less marked, is always present, even in the early stages ; also many neurotic symptoms, such as night sweating, numbness of parts affected, headache, and other constitutional disturbances. Sir A. Garrod, in his Croonian Lecture of 1891, showed that it differs from gout for the following reasons : — 1. There is no excess of uric acid in the blood. 2. The affected joints never show a deposit of the biurate of sodium. 3. There is ulceration of the cartilages from the beginning of the disease. 4. It is manifested in the joints alone, and there is no evidence of any morbid state of blood. 5. There is no known relation between the condition of the kidneys, skin, or digestive organs and this disease. It differs from chronic rheumatism in various ways, the principal being that in many cases we 158 PRACTICAL OBSERVATIONS ON have no history of previous rheumatic attacks ; the constitutional and neurotic symptoms are always present ; the swelling of the joints is boggy fusiform, with an appearance more of effusion than inflammation ; and we rarely, if ever, find any heart complications. The atrophy of the muscles is always marked, and progresses pari passu with the disease ; seemingly not being due merely to want of use as in rheumatism or gout, but to some change in the nerve supply to the muscles of the affected joint. That the treatment of gout in past years has been antacid is well shewn by the recourse gouty patients and their medical advisers have to the various alkaline mineral waters and baths, and interesting though Sir W. Roberts' experiments are, with their extraordinary results, viz : — that the salts of soda, potash, &c, increase the production or deposit of biurate of sodium, I, from a clinical point of view, can only admire and disagree with his theories. Having watched many cases of gout carefully during a thorough course of our waters and baths, and having periodically examined the urine of those patients microscopically, I find the crystals of uric acid, which are usually large and well formed before the treatment is commenced, slowly and gradually diminish in size and perfection of shape as the patient proceeds with bis cure ; at the same THE HARROGATE MINERAL WATERS. 159 time the general health improves day by day, the gouty pains disappear, and we are enabled by the judicious use of our natural mineral waters and baths to restore man}- a sufferer to complete health. Each case must be judged on its own merits, with due regard to the age and strength of the patient ; but, on the whole, I find the sulphur class of waters eliminates and diminishes the uric acid crystals more effectually than the Kissengen or chalybeates. The course must never be pushed too far, and the majority of cases, if time permits, do well with a tonic after- course. Rheumatic cases are particularly benefited by a full course of the milder sulphur waters. Especially is this the case where there has been during the acute attack any complications in a serous mem- brane ; the absorbent action of the sulphurous group on inflammatory products being most marked. Even cases of peri and endo-carditis, due to rheu- matism, improve on a mild and prolonged course of one or other of this class of waters. As regards local treatment, we have at our command all the ordinary and special baths in use at the present day ; but I hold it to be necessary for the full benefit to be derived that the action of the skin should be stimulated, and, as far as possible, made normal before any special bathing is ordered. 160 PRACTICAL OBSERVATIONS ON Rheumatoid arthritic patients do well here, the bracing climate, the pure air and brightness of Harrogate tend to improve the character of their general health ; in addition, we have such a variety of pure chalybeate waters and others of the same class, highly charged with various salts in com- bination with iron, that one or other is sure to be of benefit, by enriching the blood, lessening the anaemia, and thereby arresting the wasting process taking place in the articular cartilages of the affected joints, and counteracting the debilitating causes which are acting on the central nervous system. Case xxviii. — Mr. P., set. 62, came to Harrogate in April, 1861 ; had been confined, for six months previous, to his bed or sofa from gout in both feet. During this time he was under medical treatment. General health good ; has always been a temperate liver; tongue coated; circulation feeble; pulse weak; appetite impaired; sleeps little. To take the old sulphur water, warm, in aperient doses, before breakfast, and the same in alterative doses at 12 and 4 p.m. The water was drunk at his lodgings, as he could not bear the least motion. At the end of eight days, so much better he could bear a slipper, and had his first bath of strong sulphur water. In three weeks he could walk a little, and the Kissengen water was prescribed instead of THE HARROGATE MINERAL WATERS. 161 the sulphur. He continued to improve rapidly and steadily, and left at the end of May, well. He remained free from gout during the rest of 1861, and all 1862. In March, 1863, he felt he was in ior another attack, and, at once determined to visit Harrogate. I found him in much the same state as in 1 861, and put him on the same treatment, and with similar results; as on April 15th he left Harrogate in good condition. In April, 1864, he returned, and had a three-weeks' course of the waters, as a. preventitive measure ; and he had no gout that year, nor during 1865. In the beginning of 1866 he was again laid on his back with it, and under treatment for a month before he could bear to travel, when he again repaired to Harrogate, and with the same benefit as formerly. So convinced is this patient uf the good he receives from Harrogate treatment that, although he comes from the North of Scotland, and hates travelling, he has determined to visit Harrogate annually. Mr. P. was again under my care some years afterwards, and he told me he never had a return of gout since he left Harrogate, and that his general health had been most satisfactory. Case xxix. — Mr. S., set. 47, consulted me in November, 1867, on account of gout affecting the knees, ankles, elbows and wrists. Has had frequent attacks of gout during the last twenty years, for M 162 PRACTICAL OBSERVATIONS which he took quantities of Blair's pills ; latterly has been very much reduced in strength, partly from anxiety in business and bad digestion, but principally from recurring attacks of painful swellings in the neighbourhood of the large joints ; for these has been treated with alkalie i and hot baths ; bowels very easily acted upon ; skin given to perspiration ; kidneys, as might be expected from the freeness of the former secretions, are not so active, and the secretion is loaded with lithates ; no organic disease of any kind. To drink the old sulphur thrice a day,, and to have a strong sulphur bath every night before going to bed. To live on plain, generous food, chiefly animal, and to drink nothing but gin and water ; to give up smoking entirely, and to take as much exercise as possible. This treatment was pursued for five weeks, at the end of which time Mr. S. left, having recovered his health sufficiently to enable him to resume work. He wrote me in a month to say that he continued to improve and gain strength. .A " — Ik. CHAPTER XIX. CHEST AFFECTIONS. fROM June till the end of October few places offer greater advantages to those suffering from chronic bronchitis and certain stages of consumption than Harrogate ; its pure, dry, bracing air is the very best that can be inhaled, and by its influence alone the work of the lungs is made easier, more perfect, aud many of the secondary troubles which commonly complicate affections of the chest are greatly lessened. I allude to the more perfect oxydation of the blood, the restoration of defective digestion, and through these the removal of the restlessness and sleepless- ness which so often tax the strength of this class of invalids. 164 PRACTICAL OBSERVATIONS ON The night air of Harrogate during the summer months is even more suitable for these cases than the day; and must be breathed to know the feeling of having one's lungs inflated with air in every way perfect for the purposes of respiration. I always advise every one to sleep with open windows, but out of all draughts ; then you awake with a feeling of freshness and buoyancy that is simply delightful. I have observed that this simple plan has prevented night-sweats entirely, and allowed the patient to sleep through the night and awake free from headache, and with a fair relish for breakfast, when a closed window gave rise to headache, and distaste for all food. When chest affections are accompanied by functional disorder of the liver, stomach, or bowels, as they very often are, then the waters are given with the most satisfactory results ; and it is in cases of this kind that sulphur waters have acquired such a reputation abroad for the cure of bronchial, laryngeal, and pulmonary complaints. There is one form of bronchitis, which is by no means uncommon with people of middle life, which proves rather obstinate under the usual remedies, and, which I have seen, repeatedly, entirely removed by a three-weeks course of sulphur water and baths, without the addition of any other thing in the way of treatment, and that is gouty bronchitis; the THE HARROGATE MINERAL WATERS. 165 peculiar feature of which is that — until you recognise the gouty constitution, in your treatment of the bronchial disease, you can make no impression on it. Here, the cough and dyspnoea, are most distressing in the morning, and generally accompanied by irregular action of the heart, and various dyspeptic symptoms ; you have, also, frequently a past history of painful joints, lumbago, sciatica ; or, other members of the family have shown gout, and these facts guide you in recognising the nature of the case, and treatment required. Cases of chronic bronchitis, with profuse expec- toration, complicated with emphysema, improve rapidly. The bronchial membrane calms down, as it were, after breathing the pure, non-irritating air, its secretion becomes less in quantity, and pus soon disappears from it altogether ; the breathing becomes easier, and the patient, who, on arrival, could scarcely walk from his cab to his sitting-room without gasping for breath, in a few days can walk with ease, on the flat, and, in a few more, is found ascending a steep incline at a slow, but easy pace. Many patients of this class find that their digestion is greatly invigorated by small doses of the sulphur waters ; however, baths ought seldom to be indulged in, especially during the early part of their stay. Where the heart is also diseased, the relief afforded to it by the diminution of the bronchial irritation is very great. 166 PRACTICAL OBSERVATIONS ON Those liable to spasmodic asthma are often very curiously dealt with. Arriving quite well, no sooner do they inhale the fresh air than, suddenly, their breathing becomes thick and laboured ; this rapidly increases until, all the worst symptoms of their old complaint return, and their whole strength is engaged in trying to force air into their already over-distended Jungs. I have sometimes observed that by removing patients so affected from High to Low Harrogate, or vice versa, relief speedily follows, and the air-cells regain their normal condition, as the following examples show : — A boy, about nine years of age, suffering from extensive eczema, was brought to lodgings in High Harrogate, in the middle of summer ; two hours after his arrival he was gasping for breath, compelled to sit up in bed, with every muscle in his frame employed in vain attempts to overcome the spasm of the muscular fibres of his bronchial tubes ; his face was pale, cold, and anxious, his lips, blue, and the wheezing of his chest was heard in all parts of the room ; he spent the night in this painful condition, the remedies prescribed having proved of no use whatever. Next morning I had him removed to lodgings near the Old Well, and, almost immediately, the severity of his symptoms relaxed, and in a few hours he was breathing quietly, and asleep. He remained, THE HARROGATE MINERAL WATERS. 167 for many weeks, on account of his skin affection, and, during his stay, never experienced another attack. A young lady, liable to spasmodic asthma, had to sleep in the parish of St. Mary's for a certain number of nights before she could be married there ; each night she tried to sleep in her lodgings in Royal Parade she was attacked with spasmodic asthma ; I advised her to change places with a sister who was living about eighty feet above her, near the Prospect Hotel, and, on doing so, the asthma ceased to trouble her, and no treatment was required. Many invalids whose chests are simply delicate, after spending the winter and spring months in the south of England or Europe, and to whom life in any of our large towns is hurtful, would find the climate of Harrogate most suitable for them during the summer months. The subsoil does not retain water, so that after the heaviest rainfall the paths and roads dry up quickly, and permit one to take walking exercise without the chance of wet feet. In fact, there are few days, even during the wettest season, that the most delicate need be confined to the house the entire day. The prevailing wind during summer is westerly, and the air is so dry that at ii p.m. I have often failed to detect the presence of moisture on iron railings and garden 168 PRACTICAL OBSERVATIONS ON seats ; I attribute this in a great measure to the absence of trees on the common. Many mourn over our want of shade — for my part, I look on the bareness of our Stray as one of the most distinguishing and beneficent features in the place, and I am pleased to see that trees refuse to grow on it ; if they did, they might add to its beauty, but not to its salubrity. Case xxx. — Mr. F., aet. 56, clergyman, came to me in February, 1868. He was suffering from difficulty of breathing, with cough and expectora- tion ; could not walk up the least ascent, or go upstairs for want of breath ; and in the middle of the night had to sit up in bed and gasp for breath ; had long suffered from dyspepsia, with liver complaint ; and had been under medical treatment for years, more or less. Nothing seemed to do him permanent good, and he had been recommended to try Harrogate. Pulse quick and feeble ; face congested ; tongue loaded ; general chronic bronchitis in both lungs ; heart's action very weak, but normal. I thought this a very fair case to test the effects of Harrogate during a cold, trying month, where there was chest affection as well as general derangement of the whole digestive system. He took full doses of the Old Well, warm, each morning before breakfast; these acted freely. During the day he took small THE HARROGATE MINERAL WATERS. 169 doses of the same. Shortly all his symptoms began to abate ; his breathing became freer ; expectoration easier ; he was able to walk out daily, and at the end of six weeks he considered himself as well as he could ever hope to be. I have frequently observed the good effect of the old sulphur water in promoting the solution or thinning of tough phlegm in cases of chronic bronchorrhoea. The air of Harrogate also acts as a tonic to the relaxed and congested mucous membrane, thereby lessening the secretion from its surface, much in the same way as the air of Cannes does. Many of my patients have drawn my attention to the similarity of the two places as regards climatic conditions and the corresponding results attending them. I! *-$«& &$«* fa IS* 7°\ i_AjLi_A _i-A_t_ JL+ -t-AAAA.t-t-t-t-t-t__t-t.-t CHAPTER XX. BOILS, CARBUNCLES. ¥ATIENTS labouring under this form of disease are frequently sent to Harrogate, and the influence its waters and baths have in correcting this local inflammation is very great. Boils, very generally, come in crops ; no sooner does one burst and heal than a successor takes its place, and this goes on for months. They appear to occur under two conditions : — Poverty of blood from debility, after acute illness ; or impurity of blood from absorption, or retention, of poisonous, or effete matter. In the former case, the saline chalybeate and pure chalybeate waters are clearly indicated ; in the latter the sulphurous ; the liver THE HARROGATE MINERAL WATERS. 171 is frequently found to be inclined to torpidity in these cases, and the whole of the digestion at fault. Pure atmosphere is an important element in the treatment of this class of patients, and immunity from worry and work is no less so. After carbuncles have passed through their acute stages, and the sloughs got away, they often leave the patient in a very prostrate condition, and the process of healing is interrupted when this happens. A change to Harrogate is very speedily followed, in the majority of cases, by rapid amendment, under the exhibition of the Kissengen, and especially the chloride of iron spring. I have seen more visible changes for good in patients weakened by carbuncles than in any other class, and the amount of the chloride of iron they can stand is proportion- ately great, When this water is so freely borne, it is well to disallow all stimulants, and occasionally to interrupt its exhibition, for a day or two, and administer an aperient at the same time. Case xxxi. — Miss C, aet. 50, sent to Harrogate on account of succession of carbuncles and boils, which have been her constant tormentors for more than two years, has at this time many boils on the body and two small carbuncles on upper and outer right thigh. Before the appearance of a carbuncle, is prostrated with sickness-; is much emaciated, and greatly depressed 172 PRACTICAL OBSERVATIONS ON in spirits. Kissengen water prescribed in aperient doses before breakfast, and chloride of iron spring during the day ; in a fortnight treatment had to be discontinued on account of an attack of influenza, which was followed by fresh furuncular mischief; these left Miss C. in a very feeble state. In the beginning of April she commenced the chloride of iron alone, taking it in full doses before breakfast, at midday, and afternoon. This was continued for one month with the best possible results, both as regards the general health and local symptoms. Here I may state that the above water gave tone to the bowels, which acted regularly under its influence, a condition altogether exceptional, as she had for years been compelled to take purgatives. This is no uncommon, yet a most important and beneficial action of this spring; and I must also add that I have given it in a large number of cases similar to the one I have now related, with the invariable result of removing the predisposition to that most unsatisfactory con- dition of the body, which has for its object the raising of a perpetual crop of boils or smalJ carbuncles. I might easily relate the history of many in- teresting cases, but this I think sufficient for my purpose. I admit they are exceptional cases, as I have selected them in order to show what THE HARROGATE MINERAL WATERS. 173 Harrogate waters, unaided, in most instances, can accomplish in the way of cure. Some there are who will tell you that sulphur, magnesia, cream of tartar, or any cooling medicine, would have done as well, forgetting that these simples, backed by the most heroic remedies, had been tried, and persevered in for months, with questionable results. Others will attribute the good to the pure air, pleasant society, and absence of business cares; but the cases I have detailed could not be in- fluenced by these conditions, as they all came from districts remarkable for their purity of atmo- sphere. They were without society, being for the most part immured in lodgings, lacking many of the comforts of home ; and they were constantly worrying themselves on account of being separated from their friends, and because they found Harro- so dull. In speaking thus favourably of Harrogate as a health resort, do not for a moment suppose that I have the slightest wish to disparage other watering places, or, above all, general therapeutics. Such is very far from my thoughts, as I have not only the greatest respect for legitimate medicine, but an honest faith in its applicability, as being not only a means, but the best means, for effecting the cure or relief ut most diseases. .♦♦♦♦♦♦♦♦♦♦♦^♦♦-^♦♦♦♦♦♦♦♦♦♦♦♦-t^* ♦♦♦♦> ++♦♦** + *-»*♦->♦♦•-. ♦*♦♦*♦♦♦♦♦♦♦+♦♦♦♦+♦♦♦+♦♦+■♦■♦♦♦♦♦♦♦♦♦♦♦♦*. ++*+♦ ♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦+♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦+♦♦♦ ^♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦•♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦^ CHAPTER XXI. NEURALGIA. CJjTF there is one state of unhealth more difficult ^J| to understand — more difficult to combat suc- cessfully than another — it is that singular form of pain affecting the nerve tissue proper, which we call neuralgia. This pain confines itself to no particular nerves or parts, but attacks all alike : now it is superficial ; now deep-seated ; here its seat is the stomach ; there the lungs or uterus ; the great nerve centres themselves do not escape ; and the brain and spinal column sometimes experience it in its worst forms. Often it flits about in the most puzzling fashion, from the fore- head to the knee ; from the throat to the bowels. To-day you may have it simulating bronchitis or croup, to-morrow inflammation of the deep-seated THE HARROGATE MINERAL WATERS. 175 structures of the eye, or coats of the stomach. More frequently it is very much localised, and when it is so it may be found to depend on some local cause — pressure on the nerve trunk, for example. When facial it is often supposed to be connected with caries of the teeth, and many a one has had all, or almost all, the teeth pulled out, in order to remove the source of pain, in vain. It has been remarked by various writers, that when the pain is of a scalding or burning character it is most difficult of removal. I have seen several cases where this kind of pain has been predominant, and never found permanent relief from any plan of treatment ; for a week or two all seemed to go well, when back it came worse than ever. The cases of neuralgia which derive most benefit by a visit to Harrogate, are those which can be clearly traced to debility, especially when that is accom- panied by anaemia. I have never seen much good effected in cases of severe local neuralgia ; but in most of the erratic forms the result has been satisfactory, but by no means so satisfactory as I could desire, and until we know something more regarding the nature of this abnormal state of health, I fear our treatment of it will be followed by like success. The late Dr. Anstie, in his work on this subject, has thrown a great deal of light upon it. Before its publication, many looked on 176 PRACTICAL OBSERVATIONS ON all neuralgias as of a gouty or rheumatic nature. This he refutes, and maintains that every true neuralgia is caused by atrophy of the posterior root of the spinal nerve of the part affected. He also holds that it is essentially a disease of debility, and brings a certain amount of evidence to show that it is a hereditary neurosis. Moreover, in a lecture I once heard him deliver at one of Sir J. Crichton Browne's conversaziones in Wakefield Asylum, he maintained that this and all neurotic affections could be clearly traced to the abuse of alcohol by the individual sufferer or his pro- genitors. Whether right or wrong in these views, we are greatly indebted to that scientific physician for the labour and research he brought to bear on this disease. For my own part, my experience leads me, empirically I admit, to arrive at a different conclusion as to the etiology of neuralgia, as well as to its connection with intemperance — self-acquired or inherited. Debility of some form or another I have generally found the usual con- dition of most neuralgic patients, and their attacks were very frequently traceable to exhaustion fol- lowing excitement or overtaxation of strength. I have not met with many cases that showed any family history of painful affection of the nerves; and the cases which have come under my observa- tion could not be accounted for by atrophy of the THE HARROGATE MINERAL WATERS. 177 posterior root of one or other of the spinal nerves. Atrophy — non-inflammatory atrophy — means struc- tural disease and permanent incapacity — a condition of nerve which no system of treatment could possibly benefit. Patients suffering from most forms of neuralgia, although they may resist treat- ment for long, get well in the end ; and many of them remain so. Would this be the case if there was actual wasting of so important a part as a posterior root ? Then as to intemperance acting as an exciting cause. Most of the worst cases I have seen have been fragile women, who never had been given to the regular use — let alone the abuse — of alcohol ; and I have little doubt that, were hospital physicians to go into the history of their neuralgic patients, they would find the greatest number furnished by the under-fed, over-worked needle- women, who, as far as my experience goes, are the most suffering and the most temperate, as well as the most over-taxed section of our community. Grief and disappointment I have frequently found acting as factors of neuralgia, especially among the higher classes of society. Under these circum- stances it attacks the thoracic and abdominal nerves more frequently than those of the face or extremities, giving rise to palpitation, apncea, vomiting, diarrhoea ; renal, uterine, and vesical N 178 PRACTICAL OBSERVATIONS ON symptoms of the most painful and perplexing nature. We often find it associated with hysteria, and when it is so, I think that it is even more amenable to treatment than when it is not. This may be more apparent than real, as hysterical subjects are more impatient of suffering than those who are not. Case xxxii.— May 16th, 1861. Mrs. M., set. 37, recommended by her medical man to try Harro- gate ; has suffered for many years from severe neuralgia, which attacks different parts of the body. At first the disease made its appearance whilst living in Australia, and subsequent to an attack of rheumatic fever. Also suffers from bilious attacks, with pain in left side, and severe headache for days together ; otherwise, general health in good condition. To drink the old sulphur as an aperient, and the mild thrice a day in alterative doses. To have a mild sulphur bath every second day. June 4th, much better ; no return of neuralgia, although the weather has been cold and wet. To substitute the Kissengen for the Old Well, and the chloride of iron for the mild sulphur. 14th. — Has continued as above since the 4th ; looks much better ; has gained flesh ; states that for the last two or three days has felt giddy after taking the tonic water. To discontinue it, and take the Kissengen in small doses instead. THE HARROGATE MINERAL WATERS. 179 23rd. — Has gone on progressing; feels stronger, and has no neuralgic symptoms. Considers herself so well, will return home to-morrow. The following spring I learned that Mrs. M. had passed a much better winter than she had ever done since she first became affected with neuralgia, and that she never had a bad attack since her visit to Harrogate. I have in many instances observed great good follow the use of the mild sulphur water of the Montpellier Gardens in chronic neuralgia, where the pain is of a dull aching character and localized. When the pain is more acute and erratic, the chloride of iron proves more^ valuable than the sulphur. A, ill,. ...ih. .illi . jll',. JIK..JHI,, IIIIHM II llllll lllllllllllll II I 111 IIEli IIIIMI !i I II IDS lllll lllill Mill! Illlli llllllil »♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦ cK^^ SflflE ♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦ Hf-» rfjk ♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦ vvt^ I 1IIII! llllllllliaillllllllillllKI III II llllliiiliiiiiilllicmillliiiiiiiiiiiiiiiiiiiii "fH' if '"i" i' 1 ' "ir""'ii' n 1 ""i ic 'mi' in' ''mii 1 ''iii' 'i|,ii-n ( f ri||i. 'i,n i,i> 'lip, | |i< "H||i, mi' ■ in" ■,!;"' mi : ii' ',i.,i"„||i I,, mhi— iik, ■ CHAPTER XXII. Anemia. Sjff ASES of poverty of blood, where the relative IE i proportion of the red and serous con- stituents has been disturbed, the former being greatly diminished, are easily recognised by their pallid faces, clear pearly conjunctivae and bloodless lips and gums ; they suffer from breath- lessness on the least exertion, with palpitation ; loss of appetite ; their lower eyelids after a night's sleep are puffy, so is the face sometimes, and at night the feet and ankles more frequently be- come cedematous. If you press the fingers on any part firmly, in a few hours you will find that part black and blue ; the body may be round and plump, and keep so on the smallest amount of food of the simplest kind. This state THE HARROGATE MINERAL WATERS. 181 may be the result of various causes — direct loss of blood ; waste induced by acute disease ; from mental depression ; disappointed affection ; or it may come on without any assignable cause what- ever. It is much more commonly met with among young females than any other class, and is most difficult of cure. Arsenic, iron, and fresh air, with suitable nutriments are the best means for remedying this deficiency of red blood ; and of all the pre- parations of iron, I know none so easily assimilated, none which enter into and become incorporated with the blood so quickly as that which is found in mineral waters, and of those highly charged with carbonic acid, the sparkling chalybeate springs of Schwallach, Pyrmont, Spa, and St. Moritz are by far the best. After them come the iron springs which hold certain salts in solution, such as the Harrogate Kissengen, Alexandra, and chloride of iron springs. Here the various chlorides act in the same way as the carbonic acid, but not so pleasantly ; they render the iron easier of digestion, and besides that, they assist in promoting a better solution of food ; they are much more likely to do good than the pure chalybeates, which contain a very small amount of carbonate of iron held in solution by an equally small amount of carbonic acid. Some- times we find the blood greatly altered in certain 182 PRACTICAL OBSERVATIONS ON chronic diseases where nutrition has been inter- fered with, especially in diseases of the liver ; the blood becomes very dark ; it escapes from the vessels underneath the skin, forming purple points or blotches which last weeks or months. There is often haemorrhage from the mucous membrane, and brushing the teeth or mastication is generally accompanied with bleeding from the gums. The symptoms resemble those of scurvy produced by long-continued use of salted provisions, minus fresh vegetables, but unlike scurvy they refuse to yield to antiscorbutic remedies such as fresh vegetables and lime juice ; in short, often the blood continues in this broken-down condition in defiance of treatment. Whilst several cases pre- senting these features were undergoing a course of sulphur waters on account of liver complaints, I have had my attention frequently directed by the patients themselves to the remarkable changes produced on these blood stains, and to the almost sudden cessation of the bleeding at the nose and gums ; in many, these perhaps because the most objective were the first improvements observed. The explanation is very simple ; the water corrects the faulty action of the liver, and improves the processes of digestion ; chylification is made more perfect, the blood has richer new material added to it, and whilst this is going on it is also having THE HARROGATE MINERAL WATERS. 183 the fusty matter, which has been poisoning it ever since it got into it, removed by increased activity on the part of the various channels of excretion. Case xxxiii. — L. B., aet, 24, has been for years in delicate health, and more or less under medical treatment on account of chlorosis. In June last, was sent by her medical man to Harrogate, in order to try the effects of the chloride of iron spring. When I first saw her she presented most of the characteristic symptoms of anaemia ; she was nearly bloodless, her digestive organs were greatly deranged, appetite capricious and depraved, the circulating and nervous systems were equally at fault, she could scarcely move from one room to another for want of breath and palpita- tion. Her mind was in as miserable a plight as her body, she was gloomy and depressed when awake ; when asleep, she was tortured with fearful dreams and awoke in a terrible fright, generally bathed in perspiration. Latterly her stomach had revolted against everything in the shape of medicine, the very thought of which brought on retching, which nothing but ice could allay. After two days rest, her diet being strictly confined to strong beef-tea with port wine, and corn flour with brandy, I ordered her to take two 8-ounce glasses of the Kissengen water, warm, an hour before breakfast, with twenty minutes between 184 PRACTICAL OBSERVATIONS each; this acted as a mild but effectual aperient. Half an hour after meals, thrice a day, she drank very slowly 3-oz. of chloride of iron. Both waters agreed with her from the first. For the first fortnight she was wheeled in a bath chair to the wells ; after that, she was able to walk once a day to them, a distance of 300 yards ; at the end of a month she was much better ; dis- continued the Kissengen water, and substituted 6-oz. of the chloride of iron for it before break- fast. She continued this treatment till the end of August, improving steadily day by day ; and in the beginning of September she returned home sufficiently restored in health as to be able to assume, with comfort to herself, the duties of a moderately active life. L. B. has had a second and a third course of the chloride of iron, and is now (April, 1869) in good health, and no longer anaemic. -*rr+- V&-- ■+TT- CHAPTER XXIII. T \ !▼ Take your p^^^p" 1/1 Ol Lvl>vJli>VJ and Recipes to thi LOWEST ons PRICE! Recipes to the above Pharmacy. It is certain I am much loved of all ladies." — Much ado about nothing. THE CELEBRATED HARROGATE BOUQUET. The Floral World ransacked for its Sweets, Unique Odour, Lasting Fragrance, Refreshing Perfume. PATRONISED BY ROYALTY. "And it I will have, or I will have none." — Taming of the Shrew. JOHN KNOWLES, (a WINE MERCHANT, 29, Parliament Street, -Be- flawogate. THE OLDEST ESTABLISHMENT. SPECIALTIES (APPROVED BY THE MEDICAL PROFESSION) REQUIRED BY INVALIDS ARE FULLY DESCRIBED IN OUR PRICE LIST, WHICH WILL BE POSTED ON APPLICATION. Cm a CJC o f—: £— O Cm O Q --? Ci3 ed Em -o <=> C3 Cs- «i a — T -*s S~ c/2 •< «T <_> <=> a «j Cm <=> td a? CO — a? orf -= Cm •QD <_t> =C •CUD 05 _o J=3 "3 C-H cd Cm -Q a £-m A. ATKINSON (Late COUPLAND), PHARMACEUTICAL AND DISPENSING -f^- e CHEMIST, 16, REGENT PARADE, HIGH HARROGATE. Telephone No. 17. Nearest Chemist to the Queen, Granby, Empress, and County Hotels. THE WESTERN COLLEGE, QUEEN'S ROAD, HARROGATE. This is a Select private Boar&ittQ an& 3>a\> Scbool for the Sons of Merchants, Professional Men, Sec, and aims at imparting a sound Education of a modern and practical type. Young and backward Boys are thoroughly grounded, and therefore soon make rapid progress to higher studies. Each Pupil receives, besides instruction in class, much individual care and special teaching ; a course which has resulted in very marked success, as is evidenced by the Reports of the College of Preceptors, of the Cambridge University Syndicate, of the London and Victoria Universities, &c., concerning Pupils who have been educated at this School. The health and physical training of the Boys are matters of the first importance. A good table is kept ; and they have plenty of play and exercise. The School Premises are situated in the best and healthiest part of the town, have a south and a west aspect, and have been specially designed and adapted for educational purposes. Drainage, ventilation, lighting, and heating receive careful attention. There has been no epidemic in this school since its foundation. The Fees are Inclusive, there being no Extras, except for Instrumental Music. References anti full particulars marj he obtai'netJ from A. H. ALLAN, M.A., Head Master. "THE POPULAR" MILLINER Y, MANTL E, DRESSMAKING, AND GENERAL DRAPERY ESTABLISHMENT. WELBORN'S, i 1— t A . ^liiiiiimiiiii t GORDON HOUSE, BEULAH STREET, HARROGATE. ^Ke 5)»d CORNWALL ROAD, A *** HARROGATE. ' hydropathic * Overlooking the new Public Park adjoining the Bogs Field. QstaUiskment, (In close proximity to the Mineral Water Baths, Pump Room, Concert Hall, Theatre, and Pleasure Grounds. Within FIVE MINUTES' walk of the New GOLF LINKS.) THIS Establishment combines all home comforts, with the necessary Baths for Hydropathic treatment, and is replete with accommodation to suit the most fastidious. The great aim of the Management is cleanliness in all departments. There is a Billiard Room and Lawn Tennis Grounds. All the Bedrooms are furnished equal to the best hotels, and Visitors requiring a quiet and well-appointed establishment will find it at the Spa Hydro. It is in the very best situation, close to the Harlow Carr Moors, and the new Golf Links, and having from every window a wide view of the adjoining picturesque country. Table d'Hote at 6-30 p.m., to allow visitors to make ex- cursions during the dav and return for dinner. All Visitors ate allowed to choose their own Medical Attendant. WINES AND SPIRITS ALLOWED. THE TERMS ARE MODERATE. Further information can be obtained by applying to the Manageress, Miss S. A. BROWN. FRESHFIELD REYNOLDS (Late Manag'ng Partner of the firm of Harvey, Reynolds & Co., Leeds), $ Ijatmacmttcal ^ AND jfamilg Cfjsmtst, (Optician, &t 4 STATION BRIDGE, HARROGATE (Immediately overlooking the Southern End of the Railway Station,). SPECIALITY— SURGICAL APPLIANCES. JFrrsfjftrHj Hcnnoltis Uebotw special &ttmttnn to tfjts Brand), And his Stock embraces an extensive assortment of articles often required by Invalids, viz. : — Elastic Stockings, Bandages, Belts, Trusses, Spinal Supports, Chest Expanders, Railway Conveniences, Air and Water Cushions and Beds, Hot Water Bottles, Enemas, Douches, &c, &c. THE "CONNAUGHT" PRIVATE HOTEL ♦- AND -+ BOARDING HOUSE, ' COLD BATH ROAD. The house is detached, and offers special advantages through its central and convenient situation, being close to the Springs, Baths, Concert Rooms, and Gardens. A few minutes' walk from Railwav Station. HOME COMFORTS. MODERATE CHARGES. MRS. COONEY, Proprietress. Cambriftp Cmcmt, ^arrogatt PARKER'S LIBRARY. SU\3SCR\P\"\0U OR BN TWEMOYAiWE... PARKER'S Selection of Leather Goods is unsurpassed for Choice, Elegance, and Durability. Stationery, Plain and Fancy, in great variety and qualities. Every Visitor should purchase PARKER'S SHILLING BOOK WS before returning home ; it contains 48 Views of Harrogate and neighbourhood, and has no equal ; sold at Parker's Library only. COFFEE in PERFECTION. ORIENTAL CAFE, STATION SQUARE, HARROGATE. Proprietor .—EDWARD STANDING. 6-lb. Parcels of Coffee or Tea delivered Free by Parcel Post. CHAS. WALKER, Compete House FuhNisheh. Specialities in Bedroom, Dining Room, and Drawing Room Suites. CARPETS, Cabinet Makers, Upholsterers, and LINOLEUMS, Carpet Makers on the Premises. OILCLOTHS, == RUGS, &C. ORDERS EXECUTED IN TOWN OR COUNTRY. Note the Address : — Parliament Street, Harrogate. \ ( I l\ H is tlie nearest to anc ^ directly This FIRST-CLASS )HOTEL le nearest to and dir opposite the Station. EASTERN "" .r,"V HAS hKN T, rr' Five Minutes' Walk from the Pump Room, Baths, and all Places of Amusement. HOTEL. * -r i < -^ ♦ > ▼- ■ Telegraphic Address — "CLAYTON, HARROGATE." Proprietor : T. F. CLAYTON A NAT URAL BLOOD MIX TURE. THE 6 — -vj5- — » f^ U 1 C\ D T T^ U Prescribed for I, l\ Lwl\J \j ]Lj Nervous Debility, Dyspepsia, Scrofula, OF IRON Hysterical Affections, &c. This Unrivalled Natural Tonic is now CDDIMP bottled Aerated, and can be sent by Parcel /S Y JV J i\ V 7 P ° St ° r Rail t0 a11 Parts - in an y quantity. THE attention of leading medical men, not in England only, but throughout Europe, is being drawn to this unrivalled ferruginous spring, which, as Dr. Myrtle has declared, "exhibits Harrogate in a new light, and shows that it can boast of possessing the richest and rarest chalybeate which has been subjected to the test of chemistry." Prices (including Bottles and Packing) : — 3 oz. 4 oz. 6 oz. 8 oz. Onk Dozen .. .. ..4/- 4/6 6'- 8- Two Dozen .. .. .. 7/- 8/- 9/- 15- Three Dozen .. .. .. .. 9/- 10/6 15- 21/- Larger quantities at a proportionate reduction. Apply at THE SPA, HARROGATE. Lessee— CHAS. F. DAWSON. BY SPECIAL APPOINTMENT. : 2^s — » HAIR DRESSER TO H.R.H. THE DUKE OF CON NAUGHT. J. S. SMITH, HAIR DRESSER, 5, ROYAL PARADE, LOW HARROGATE. CHIROPODIST: HOURS, 9 to 6; or Visitors attended at their apartments by special arrangement. MACKAY AND FOWLER, LATE C. WRIGHT AND SON'S CARRIAGE MANUFACTORY, HARROGATE, YORKSHIRE. Established above 80 Years. DRAWINGS AND ESTIMATES SENT ON APPLICATION. MEDAL AWARDED FOR GREAT SUPERIORITY OF WORKMANSHIP AND MATERIAL. Inspection invited to their large and varied stock of CARRIAGES, especially their Fitted with Patent Automatic Head. Having during the last quarter of a century made a very large number of Landaus with Patent Head, they are able to supply this kind of Carriage in the greatest perfection. REPAIRS DONE OX MODERATE TERMS. PUIiLAH'S . . HARROGATE KISSINGEN, OR SALINE CHALYBEATE SALTS. Prepared with the greatest possible care, and possessing the Medicinal Properties so beneficial in those maladies for which the Harrogate " Kissingen Water" is renowned. It is an Aperient, Alterative, and Tonic, and eminently useful in the derangement of the alimentary organs, bilious obstructions, nervous and general debility, scurvy, scrofula, and all cutaneous diseases. Directions. — As an Aperient, &c, one or two teaspoonfuls, to be taken early in the morning, in a tumbler of tepid water ; as a Chalybeate, a saltspoonful, to be taken twice a day, in half a tumbler of cold water, at n o'clock a.m. and 4 p.m. Keep the bottle tightly corked, and use a dry spoon. Sold in Bottles at 2s. 9d. and 4s. 6d. each. Prepared by J. H- PUliliflfl, Dispensing Chemist, A, ROYAL PARADE, HARROGATE. BARBER'S GE ORGE HOT EL VISITORS TO HARROGATE will find many advantages in making their temporary residence at this Hotel, it being situated within Three Minutes' Walk of the Sulphur and Cheltenham Springs, Seven Minutes' Walk from the Railway Station, and in the immediate vicinity of the Public Baths, Concert Rooms, &c. The Sheltered Situation makes it admirably adapted for Visitors in the Spring and Autumn. Terms per Day : Board and Lodgings in Public Rooms, 8s. per day, inclusive. Ditto Private, 9s. Private Sitting Rooms from 3s. to 5s. each. Beds charged extra if for less than four nights. Horses' Hay, 10s. 6d. per week. Ostler Extra. BILLIARD ROOM. STABLING FOR HUNTERS & CARRIAGE HORSES. The Baths and Waters are accessible all the year round. The Royal Pump Room, LOW HARROGATE. Under the Management of the Corporation. The Old Sulphur Well. Magnesia Water. Strong and Mild Sulphur Water. Alexandra Chalybeate Water. Pure Chalybeate Water. The Montpellier Pump Room, PLEASURE GARDENS, AND CONCERT ROOM. Under the Management of the Corporation. In these Grounds are the celebrated Strong and Mild Sulphur Springs, also the NOTED KISSINGEN SPRING (the only one in Great Britain). Pump Room Open Daily, 7 a.m. to 6 p.m. Sundays, 7 to 9-30, and 12 to 1-30. A Band plays in these Gardens Every Morning during the Season from 7-30 to 9 o'clock. The Waters, both at the Royal and Montpellier Pump Rooms, are Carefully Bottled (the Kissingen Waters being Aerated by the most Approved Process). Kissingen Water . . . . . . . . 24 oz. . 8s. 6d. per dozen Ditto 12 oz. . . 6s. od. .. Ditto Aerated 8 oz. . . 5s. od. ,, Strong Sulphur .. .. .. .. 24 oz. . 6s. od. „ Ditto 12 oz. . 4s. 6d. ,, Mild Sulphur Water . . . . 24 oz. 6s. od. ,, Ditto Ditto .. .. .. .. 12 oz. 4s. 6d. „ Bottles and Hampers included. Applications and inquiries to be made to the Genera / Superintendent. The Magnesia Well, LESSEE The Magnesia Water. BOGS FIELD. ■ MR. JAMES WILFORD. I The No. 36 Well (Sulphur Water). LESSEE The Tewit Well, MR. JOHN TOAS. The Tewit Chalybeate Water. The Kissingen Water in Bottles (Aerated 1. The John 's Well, HIGH HARROGATE. LESSEE - MISS BILTON. The John's Well Water — Chalybeate. The Kissingen Water in Bottles (Aerated). All the above Pump Rooms and Wells are the property of the Harrogate Corporation. & i if) *£ CO o & x> o O THE VICTORIA PUBLIC BATHS. (The Property of the Harrogate Corporation.) The Special Baths in this establishment, viz. : Needle, Aix-Douche, Douche, Sitz. Vapour, &c, have been entirely re-constructed and enlarged for the Season 1891. FIRST-CLASS BATHS. Turkish Bath (Montpellier only) for Gentlemen Aix-Douche (by experienced Masseurs) Thermal Sulphur Bath Do. with Plain Water, Needle or Shower Strong or Mild Sulphur, Length, Deep, or Hip Bath {26s. a dozen ; 14s. half dozen.) Do. if before 9 a.m. or after 5 p.m. Do. with Plain Water, Needle or Shower Sulphur, Douche, Needle, or Shower Bath Douche or Needle Bath, Plain Water Electric Steam Douche Running or Still Sitz Bath Ascending Douche Bath Vapour Bath, with Needle or Shower Liver Pack, or Hot Pack with Needle or Shower Plain Water Bath Shower Bath Dry Massage, first quarter of an hour Do. each succeeding quarter s. d. 2 6 3 6 3 3 6 2 6 2 3 2 I 6 3s. 6d. and •s I 6 I 3 2 I 6 I e 2 I SECOND-CLASS BATHS (Victoria Baths only). Strong or Mild Sulphur Bath . . . . ■ . . . . . . 2 Do. if before 9 a.m. or after 5 p.m. .. .. .. .. 1 Plain Water Bath . . . . . . . . . . . . 1 Baths open Daily from 7 a.m. to 8 p.m. Sundays from 8 a.m. to 1 p.m. English and Foreign Masseurs engaged. Special Masseur engaged from Aix le Bains. MONTPELLIER PUBLIC BATHS. " (The Property of the Harrogate Corporation.) STRONG OR MILD SULPHUR. These Baths are supplied from the Springs in the Grounds, of which there are 13. SULPHUR VAPOUR BATHS. FRESH WATER BATH, AIX-DOUCHE, and MASSAGE. NEEDLE, SHOWER, and DOUCHE BATHS (Ascending or Descending), with Fresh or Sulphur Water. INVALID SITZ BATHS. Prices same as at the Victoria Baths. TURKISH BATHS, the only Turkish Bath in the Kingdom where the Needle, Shower, and Douche can be had with Strong or Mild Sulphur Water. Baths open Daily from 7 a.m. to 8 p.m. Sundays from 8 a.m. to 1 p.m. Office : Victoria Baths. Applications and inquiries to be addressed to Mr. T. R. COLLINS, General Superintendent. NOW READY ! MAY BE HAD OF ALL BOOKSELLERS. The Best Guide to Harrogate Published &* Every Visitor should have one. THORPE'S- EW ILLUSTRATED GUIDE TO Harrogate & District. ♦ Printed and Published by Robert Ackrill, Harrogate, to which is added Walks & footpaths around Harrogate, With 12 Maps, and GEOLOGY OF HARROGATE. U Full Page Plates. 30 Full Page Views. 67 Illustrations. Price i/-, Bound in Cloth 2/-. THE T HEATRE HARROGATE. Lessee - - - W. H. BREARE. r JY DMIRABLY Ventilated, always cool in summer, 11 every seat commands uninterrupted view of the stage. Comfortable, replete with new scenery, elegant stage appointments, abundance of exits, adequate protection from fire, and altogether the most complete establishment of its size in the kingdom. The most Eminent Lecturers Entertainers, and First-Class Operatic and Dramatic Companies visit the Town Hall Theatre. Booking Office : Parker's Library, Cambridge Crescent. For Terms of Rental apply to W. H. BREARE, "HERALD" OFFICE, HARROGATE. Robert Ackrill, LiLl 1 1 UllrllEiOO colour Printer. - LITHOGRAPHIC ART PRINTING A D D T M T V D SPECIALITY JT A 1 1 1 1 J_J 1U "Herald Printing Works, HARROGATE, Close to the Montpellier Gardens. PRESS JOURNAL CRITICISjVIS. From The Printing World," April, 1892. We have just received from Mr. Robert Ackrill, of Harrogate, a parcel of specimens of work recently done in his office. We can only speak of them with the most unqualified praise. The display and artistic arrangement are of the very highest order, and quite equal to any we have ever seen. The cultured taste in design, and exceeding choice harmony in the colours of inks used, without one exception, stamp the work as being of the most tasteful and high-finished character, and places brother Ackrill in the forefront of artistic typographers in this country. From The Printers' Register." October 6th, 1892. For many years Mr. Robert Ackrill, of Harrogate, has been one of the leading artistic printers in the North, and the specimens recently received from him sliow that freshness of style and first-class execution are still his characteristics. A circular of an illustrated guide is beautifully designed, and shows careful regard for accurate register, the marginal ornamentation being a spray of leaves and flowers, with plumed birds. The designs of his own office stationery are excellent testimonies of the care, skill, and taste, which he bestows on his work. From Paper and Printing Trades Journal," June, 1892. A parcel of work has been received from Mr. Robert Ackrill, Harrogate, and from the general high excellence of the collection we should say he has a well-stocked office, replete with the newest designs in types, with abundance of labour-saving materials. Some of the specimens are really of a high artistic order, and will compare favourably with the productions of the best printers in this country. They are chaste and beautiful in design, and correct and tasteful in colour harmony. A circular announcing a concert, printed in several colours, has a beautiful embossed ground. It is a particularly fine example of the best kind of typography. The delicacy of the colouring, and the exquisite precision of the register, stamp it as the production of a master of his art. The entire collection is delightful, indeed, in every technical attribute, and shows consummate skill on the part of the producer. Jjl 'arrogate ^fiotols. c c ■5- o o 30 O o r ■ - i ; 3: 5 L - . • c TRINITY Head Master : MR. J. P. HUGHES, COLLEGE, Asssisted by a Numerous and Efficient Staff of Resident and Visiting Masters. HARROGATE. THE College was specially built for Scholastic Purposes, and stands in its own grounds of eight acres. The Boys are carefully taught, and are very successful in various exams., such as the London University Matric, Cambridge Local, Pre- liminary Law, &c. For Physical Training they have the advantages of a large Swimming Bath, a large and well-fitted up Covered Gymnasium, Covered Playground; Cricket and Football Fields, Lawn Tennis Grounds. Parents and Boys will testify to the Home Comforts enjoyed: THE ROYAL Yorkshire Ginger Ale, FROM PURE JAMAICA GINGER ROOT. Unrivalled as a Wholesome Non-Intoxicant. Sec Analyses of ABSOLUTELY PURE. Drs. A. H. HASSAL, M.l). and • ElOttoZHEHNER, F.C.S. of XOH K>^ |o Carriage Paid on Orders of Six Dozen and Upwards. Seltzer, Potass, Lithia, Soda Water, Lemonade, FOR HOME AND EXPORT. HOME-BREWED GINGER BEER IN THE OLD STONE BOTTLES. HARSTON AND CO., Royal Spring Mineral Water Works, HTAREOG-ATE, 34, BOND STREET, and 9 & 11, BOWMAN LANE, LEEDS. N.B.— The only First-Class Mineral Water Works in Harrogate using Spring Water. BRUNT'S PRINCE OF WALES' MILD SULPHUR BATHS, STARBECK, NEAR HARROGATE. The Sulphur Waters at these Baths rank amongst the first of English and Continental Sulphur Springs, notably in the richness of the alkalies in which these springs do especially excel. The absence of the constipating and indigestible sul- phates especially commends it to notice for internal use. Again, we find that the combination of the sulphides and chlorides, with its richness of the alkalies, gives to these Sulphur Springs such practical and therapeutical advantages, which, with the valuable and curative properties at its command, have a very remarkable curative range for the special treatment of cases which resort to it, which embrace amongst the following : — Derangements of the digestive organs, especially in cases of gouty, scrofulous, and impoverishment of the blood ; the tissue exhaustion of retarded convalescence and chronic ailments, as worry, overtaxed application to business, constipation and disorders of the liver and ladneys ; rheumatism, rheumatic gout, eczema, scurvy, and all cutaneous affections of the skin (for which these waters have a far-famed notoriety). From the practical exposition here given, it will be seen at a glance that these Sulphur Springs possess, for both internal and external use, one of the most valuable of nature's own remedies, and especially commends itself to notice for both drinking and bathing purposes to the invalid. (SEE ANALYSIS.) Note : — The estimated supply is upwards of 3 million gallons per annum of pure water, and the largest supply known to exist in the neighbourhood, and has been scientifically conserved (so as to retain its fullest virtues) under the diiection of the Public Analyst for Harrogate, thus ensuring a pure Mild-Sulphur Bath. CD bJD o S-H — o CX> PQ bJD S3 S-, 3S 33 I CO c5 CD S3 oo 25 CD DC I h | < | m | D i I I 5 - ' ° DC < x. —. ?- t* £ .~ 3 pec E d £ 2 o CO C u. — - - - - - O " Pi 3J 3£ \* PI c • nd Sib 3=2 3 "" a - - _> P >j= •- o *2» 3C H <£ ■■ pq > 1 ■a >, §1 < m ico 13 5° E 3 E f o S « z „ ^ O u ■g co .= £ co a — ^ 5 _ a 2 22 _i rt <5 O o -Vi C -1 rt • Ji ^ >-X. "-I |B 3k. CO U) LI I >, c — o '5 § a -a a 2. aj to & o <-3 r - _• D _^ .c . -O pj _ >, en o Sinjinsaoo "ptre '0.7 '3aipiH-qvov{ ptre spasq joj asAiuay ot[qu- o •3- "* - *J T^- _: -; o mo ucuajofuojo^-u frt,'5cc:oooout>.• £ -I < P < t x c r o &£,_: c -S 3 s 3 « ^ o — - UJ Z QJ O ^1 - ^ - 5 -a -S ri o- o o . x -O a) £V O O X o o — J- - 8-88* "S T-, « < - X "3 :£ UK ~ X 08 C c ^-' en's „-"rt o . Id o m y; S g ffl o « D-3 b c b O U U U- U ^T r- — 'J « « o « «««. c Cti -r^ TI T^ Ct S — -^ ^ £.C~ C U w d-'jMffl O 73 •< Sen st ^ 1 O g bn 2J Cr '0 "<% ~~i 00 ^ - " T«» -i< CO to ■$\ 53 STRATHMORE HOUSE, RIPON ROAD, * * HARROGATE. J. J. RIGG, M.A. Careful and Individual General Education ; also Special Preparation for the Public Schools, the Professions, or the Universities. REPORT FOR THE LAST 20 YEARS. GREENWOOD, ™ G. WESTON, A.P.S. MEDICAL. HALL, 2 5) PARLIAMENT STREET, HARROGATE FOR HIGH-GLASS DISPENSING, PURE DRUGS, AND REASONABLE PRICES. HIGH-CLASS SCHOOL FOR GIRLS. HIGHFIELD, EAST PARADE, HARROGATE. PRINCIPALS THE MISSES WILSON. Assisted by Resident English and Foreign Governesses. Piano and Violin Piano Piano Singing Painting Dancing Drilling . . Herr Max Blume, (Lcipsic Conservatorium) F.S.Sc. Lond., Gold Medallist, Pupil of Moscheles and Plaidy, Author of " Theory with relation to the Practice of Technical Studies" &c, &c. Miss Wilson. ..Miss Kate Wilson. . . Herr Max Blume. Miss Pollard, Leeds. The Misses Jackson, Leeds. Sergt. Parke, Leeds. Swedish Drill Daily. Miss Wilson has had great experience in educational matters, has studied Music and Languages in Dresden and Paris, and is thoroughly conversant with the German system of education. Miss Kate Wilson holds a Senior R.A.M. Certificate, was awarded the diploma of Silver Medallist by the London Academy of Music, 1889, and obtained 1st Class Honours, Advanced Grade, National Society of Professional Musicians, 1890. HIGHFIELD, which is one of the healthiest situations in Harrogate, has recently been greatly enlarged by the addition of the next house ; the class-rooms and sitting-rooms are now of very large size, and extremely pleasant and airy. There is a good Garden and Tennis Lawn. FOR TERMS APPLY TO PRINCIPALS. WRITE FOR PRICE LIST. JVlaXiaell Grayson & Co. WINE MERCHANTS, HARROGATE. EVERY DESCRIPTION MpDITATPD OF ES • SUPPLIED. CHARLES T. MEYER, SILK MERCER AND ESTABLISHED COSTUMIER, 38, James Street. EXCLUSIVE DESIGNS IN PARIS MODEL COSTUMES, MANTLES. AND JACKETS. SPECIALITY. — Dress-making and Mantle-making by fully qualified cutters, of West End experience, under the management of Mrs. C. G. Meyer. ASHV1LLE COLLEGE, HARROGATE. Head Mastet : JOHN BOWICK, LL.D. Assistant Masters : Mr. A. W. Priestley. B. A. Mr. F. W. Jordan. Mr. 1VJ. Allaun. Mr. W. C. Pritchard, B.A. Mr. J. A. Benson. Mr- E. A. Haddock. Mr. R. Parke. THIS College is beautifully situated in an exceptionally healthful and picturesque locality. There are EXTENSIVE RECREATION GROUNDS, A LARGE GYMNASIUM, And every convenience far all the usual Out-door Games. The internal arrangements are most complete, the Dormitories are light and airy, and the Diet is wholesome and liberal. The Course of Study is verv extensive, and much attention is given to the Teaching of SCIENCE and COMMERCIAL SUBJECTS. Information may be obtained on application to the Head Master, or to REV. R. CHEW, Hanover House, Sheffield, Hon. Secretary. prospect gotsl, larrogatt W. BA.RTRAM, Proprietor. £J"T"*HIS First-Class Hotel is situated in a central and elevated position, within two minutes' walk of the Railway Station ; jL it is in immediate proximity to the Wells, Baths, and Concert Rooms, and commands most extensive and picturesque views of the surrounding country. The Suites of Private Apartments are elegant, spacious, lofty, and replete with every family comfort. An Elegant Drawing Room for the use of Visitors staying in the Hotel. A Reading Room, well supplied with Newspapers and Periodicals, and all important Telegrams leceived during the day. Public and Private Billiard Rooms, fitted with Burroughes and Watts' First-Class Tables. Hot, Cold, Shower, and Rain Baths always ready. Lawn Tennis. American Elevator. The Extensive Stabling is of modern construction, and consists of well-ventilated Loose Boxes, good Stalls, and Coach Houses. Open and Close Carriages. TERMS ON APPLICATION. \)itt gatt Itotd, ^arrogate. f p-^HIS Hotel is most pleasantly and conveniently situated for Families and Gentlemen, who will find it replete with every J_ comfort at moderate charges. It is within one minute's walk of the Sulphur and Chalybeate Springs, the Baths, and the Concert Rooms. The Rooms are large and airy ; Spacious Drawing, Dining, and Reading Rooms, and well-ventilated Smoking and Billiard Rooms, with Tables by Burroughes and Watts, of London. Cabs and Omnibuses to and from every train. Excellent Stabling, Coach Houses, Carriages, and Post Horses. W. BARTRAM, Proprietor. TERMS ON APPLICATION ROYAL OAK HOTEL, BETTWS-Y-COED, 1TORTH WALES. THIS Celebrated Hotel has an unrivalled situation, and is very suitable as a Centre from which the most beautiful Scenery in North Wales may be visited. It is near the Station, to which it has a Private Road. Coaches start Daily from the Hotel for Llanberis, Bedgellert, Bangor, Port Madoc, Snowden, Pass of Aberglaslyn, Lakes Ogwen & Idwal, &c, &c. POSTING IN ALL ITS BRANCHES. E. PULLAN, Proprietor. (Ten Years Proprietor of the Crown Hotel, Harrogate.) THE Harlow Manor HYDROPATHIC ESTABLISHMENT. OZPIEHSTIEID JTJT-TT . 1893. Over ioo Beds. Complete System of Bat lis, Including TurkisJi, Plunge, Etc. Harlow Manor was originally one of the most palatial houses in Harrogate, erected regardless of cost, and surrounded by extensive grounds, laid out with the highest art of the land- scape gardener. The property having been acquired by the Company, a new building was erected, in harmony with the style of the original manor, with the result that the estab- lishment is generally recognised as a triumph of architectural skill. The interior arrangements of the building are not only unique, but in perfect keeping with the artistic elevation of the structure. It is situated in a bracing, but sheltered position, where the health-giving breezes of the moors, and the warmth of the south, have unimpeded access to the establishment. The Harlow Manor Hydro' is within a few minutes' walk of the Wells, Baths, Stray, Railway Station, Harlow Moor, and places of amusement, and is surrounded by the most interesting; walks of Harrogate. Communications should be addressed to "THE manager;' Harlow Manor Hydropathic Establishment. WEST END STORES ESTABLISHED 1823. so, west zp^:r,:k: The Largest Home Curing HAM and BACON FACTOR in the Town. FAMILY GROCER, BAKER, AND CONFECTIONER. V Proprietor, WILKINSON ESTABLISHED 1864. THE HARROGATE HOUSE AGENCY. JOHN DAY & SON, Parliament Terrace, Harrogate. HOUSES, SHOPS, and other Properties to be LET or SOLD. FURNISHED HOUSES & APARTMENTS in large numbers. PROMPT ATTENTION TO APPLICATIONS BY LETTER. THE aranjate Hgirrnpatljir COMPANY, LD. (JT^HIS Establishment stands in about five acres of beautiful Pleasure Grounds, and is most favourably situated alike For Invalids and Visitors 5 its position, whilst elevated and command- ing, is still, from its southern aspect and sheltered situation, Well Suited for all Classes of Invalids Both in Winter and Summer. SPACIOUS PUBLIC ROOMS. ELECTRIC LIGHT THROUGHOUT. AMERICAN ELEVATOR. The Baths are handsome and commodious, and every care has been taken in the construction of the Turkish Bath to ensure perfect ventilation, and the correction of those inconveniences which deter many from its use. For TERMS, &c. } Apply to The MANAGER.. BEECHWOOD . PRIVATE . . HOTEL . AND BOARDING EST A BLISHMENT QUEEN'S ROAD & COLD BATH ROAD, HARROGATE. Unsurpassed lor Position and Home Comforts, and within 10 minutes' walk of Wells and Baths. LAWN TENNIS. CARRIAGES FOR HIRE. :o: Pic-nic Parties arranged for at Moderate Charges. The Caira Hydropathic Establishment, iRoiDPOisr ir,o^:d, habbog-ats. Situated in the Finest Position in Harrogate. \1Q GAiESAS. vauosomp. pupaac rooms smoyai p.oom PP>OVI\PmP)\NG OOPPAPjOPS. SP\-P_UO\0 PPGP0LM\On HNVA., W\TH SPPAUG YY.OOP FvUQ PROPPP\_N kp?Q\mt'Q STKGP p.UA"p_p\"i\\uvi\p.n-\s EMERN P\1PU\HG. Baths comprise : Russian, Turkish, Needle, Plunge, &c. Billiards. Tennis (both grass and asphalt). Nearly 4 Acres of Grounds. For Terms, &c, apply to ARTHUR ERNEST WYNN, Manager. W. HALE & Co., (LATE HODGSON) WHOLESALE AND RETAIL Wxvit & spirit Mbtzb, OPPOSITE THE SULPHUR WELL, LOW HARROGATE, WITH ORDER AND BOTTLE DEPARTMENT AND LARGE WINE AND SPIRIT BAR ' ATTACHED. ESTABLISHED 1839. FIRST-CLASS LOCAL NEWSPAPERS. Important to Advertisers ! ! ROBERT ACKRILL. "HERALD" PRINTING WORKS, MONTPELLIER STREET, SOLE PROPRIETOR AND PUBLISHER OF "&\}t garrogatr Serato," And Weekly List of Visitors, published every Wednesday. Circulates. largely in Harrogate and District, and sent away in large numbers to all parts of the Kingdom. Price id. "Cijr Etpon GaKttr," Published eve;y Thursday and Saturday. Circulates most extensively in the city of Ripon. and a large district surrounding. Price id. Advertisements inserted in both editions at one charge. "SHje Snarrsborougi} $tost." Has a large circulation in Knaresborough. Boroughbridge. Harrogate, and the adjoining districts Every Friday evening. Price id. "3Kje Urtalr anti Nortfjallerton Hftmeg," Circulates extensively in Bedale, Northallerton, Askrigg, Leyburn, Middleham, Hawes, Richmond, Masham, and throughout the North Riding. Every Friday. Price id. "Cijr gateleg Brttigr arOi Nftfoerfcak Serato," Circulates throughout Nidderdale. Pateley Bridge. Harrogate, Ripon, Riplev. &c Every Friday. Price id. Orders. Communications, and Advertisements should be sent to R. Ackrill. Harrogate. PRIX l\lTlVr ° F EVERY DESCRIPTION * ' ■*• A I * vJ Accurately, neatly, & expeditously executed at the Printing Works, Montpellier Street, Low Harrogate. Advertisements and Orders Received for Cijr fiarrogate atjbrrttsrr antj ILtst of Ufettors," Every Saturday Morning. Price id. Ma urice Stephens, 46, JAMES STREET, <~*^z£ HARROGATE. (Two doors fvon the Post Office) FOR high-class * Photography -¥ OF EVERY DESCRIPTION. —5*<~ Enlargements Made to Life size from photographs, however faded, on Paper, Porcelain, &c, and highl}? finished in OIL, WATER COLOURS, AND BLACK & WHITE CRAYONS. PRICE LIST ON APPLICATION. COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special arrange- ment with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE C28(l14l)M100 M99 RA849.5H24 1893 pSSlefil observations on the Har-