at the wells sipping water is associated with early rising, considerable exercise and a very carefully regulated diet. It is, indeed, the care with which the diet of patients is regulated and the difficulty that patients find in obtaining forbidden foods at hotels and restaurants, that make Carlsbad better for the liver than any other watering-place. Amongst other places having a similar action are Marienbad, Franzensbad and Tarasp. The waters just mentioned contain free alkali as well as sulphates, and are employed more especially in cases of hepatic disorder, such as congestion of the liver, jaundice, gall-stone and diabetes. A number of other waters containing sulphides and chlorides are powerfully purgative, and are more often drunk at home than at the springs. Amongst these are the Hungarian waters, Aesculap, Apenta, Franz Josef and Hunyadi Janos; and the Rubinat and Condal waters of Spain. Waters which have a similar composition are drunk at the springs of Leamington and Cheltenham in England, Brides Salins and St Gervais in France, for chronic constipation, dyspepsia, gout and hepatic disorders of a milder character than those usually treated at Carlsbad. The waters in which chlorides form the purgative principle are those of Homburg, Kissingen, Wiesbaden and Baden Baden in Germany, and Bridge of Allan in Scotland. Similar waters, but much weaker, are found at Innerleithen and Pitkeithly. Sulphur waters are chiefly used for painful and stiff joints, chronic skin disease, and chronic catarrhal affections. The most important are Aix-les-Bains, and a number of springs in the Pyrenees in France, Aachen in Germany, Harrogate in England, Strathpeffer and Moffat in Scotland. Iron waters are used in anaemia and the affections which are frequently associated with it. The most important are Spa in Belgium, Schwalbach in Germany, St Moritz and Tarasp in Switzerland. Iron waters are, however, common, and are generally found at all those places which have sulphur waters. Simple alkaline waters containing carbonates, chiefly of sodium along with some magnesium and calcium, are drunk for their utility in gastric and intestinal disorders as well as in rheumatism and gout. They are also employed locally as sprays and douches to the nose, throat, vagina and rectum, for catarrhal conditions of the mucous membranes. The most important are Vichy and Vals in France and Neuenahr in Germany. Alkaline waters containing a little common salt are perhaps even more important than the pure alkaline, as the salt lessens the depressing effect of the alkali. They are therefore used largely in chronic gout, rheumatism and in calculous affections of the kidney. Amongst the most important are Ems and Wildungen in Germany, Contrexeville and Royat in France.
Simple thermal waters are those which contain only a very small quantity of solids, and owe their efficacy chiefly to their temperature. They are used partly for drinking, but even more so for baths. Bath, Buxton and Matlock in England; Mallow in Ireland; Wildbad, Schlangenbad and Badenweiler in Germany; Gastein and Teplitz in Austria; Ragatz in Switzerland; Plombieres and Dax in France; and Bormio in Italy are amongst the best known. When water is dashed against the body with more or less violence, its effects are more powerfulBaths. than when the body is simply immersed in it. Thus the stimulating effect of sea-bathing is more marked than simple salt-water baths, for in addition to the effect upon the skin produced by the salt and by the temperature of the water, we have the quicker removal of heat by the continual renewal of the water as the waves dash over the body, and mechanical stimulus from its weight and impetus. Somewhat similar effects are produced by so-called wave-baths, and at Nauheim, although the fresh movement of the water against the surface of the body is much less than in the sea, yet its stimulating effect is greatly increased by the presence of carbonic acid in it. Douches have a still more powerful action than waves. They are generally given in the air, but at Plombieres very simple douches are given under water. These form a more powerful wave-bath, and in combination with intestinal irrigation, are used very successfully for the treatment of abdominal disorders. Douches to the spine are much employed for nervous debility, and good effects are also obtained in such cases from the so-called needle-bath, where small streams of water at high pressure are driven against the whole surface of the body. In the treatment of stiffened joints, massage under water is very serviceable, and in the so-called Aix douche a nozzle from which water continuously streams is fastened to the wrist of the masseur, so that a current of water is constantly playing upon the joint which he is rubbing. While water containing much saline matter, and more especially water containing free carbonic acid, has a very stimulating action upon the skin, mud has a sedative effect, so that in a mud-bath one feels a pleasant soothing sensation as if bathing in cream. These mud-baths are chiefly employed at Marienbad, Franzensbad and Homburg. Sulphur-baths and sulphur waters are chiefly used in combination for rheumatism and gout, and massage, especially under water, is frequently combined most advantageously with baths and drinking water to effect a cure.
Exercises, passive and active, are also used in diseases of the joints, as well as massage and baths, but exercises and training are even more important in cases of cardiac disease. In very bad cases of heart disease, where the patient is unable to Exercise.go about, the best plan of treatment usually is to make him stay absolutely quiet in bed and have massage, which aids the circulation, tends to remove waste, and increases the appetite. To this is added gentle exercise, beginning with the fingers at first. At Meran walks have been arranged according to Oertel’s system, and at Llangammarch in Wales both Oertel’s and Schott’s systems are employed, and baths according to the Nauheim system are also to be found in London, Sidmouth, Leamington, Buxton, Strathpeffer, &c. Many people who have sedentary employments are unable to get as much exercise as they require because they have not either the time or the opportunity. Such persons may sometimes get a good deal of exercise in a short time by the use of dumb-bells, of elastic cords, or of cords running over pulleys and weighted at one end. The whole system of methodical exercises was started by Ling in Sweden, but it has been developed to a large extent for the purpose of increasing muscular strength by the professional athlete Sandow. A punching ball or rowing machine is even better as being less monotonous. Fencing, boxing or wrestling may also be resorted to. Walking on the flat is of comparatively little use as a mode of exercise, and has become supplanted to a considerable extent by bicycling. Ascending mountains, however, is very different, because in walking up a steep ascent all the muscles of the body are thrown into action, and not only those of the legs. In addition the purer and rarefied air of the Swiss mountains seems to produce a sense of exhilaration which is not felt nearer the sea-level. For those who suffer from nervous depression, exercise in the Swiss mountains is useful, and even living at a height of about 6000 ft. above the sea-level seems to have an exhilarating influence. The nature of this is not very easy to analyse, but as mental depression is closely associated with irritation of the vagus nerve and weakening of the circulation, it seems not at all unlikely that mountain air acts by accelerating the pulse and quickening the circulation, and thus creating a sense of well-being. Indeed, many patients liken its effect to that of drinking champagne. In some persons rarefied air is too stimulating, so that they find difficulty in sleeping, and for those who suffer from insomnia a warm moist air nearer the sea-level is preferable.
It sometimes happens, however, that people cannot sleep at the seaside itself, although they do so perfectly well a mile or two inland. Where the nervous system is exhausted, such warm and moist climates as Malaga, Madeira, Tenerife and Grand Canary are suitable. In these places not only is the air moist, but the temperature is particularly equable, and they are therefore suitable places also for persons suffering from kidney disease.Health resorts. Many such persons also do well in dry, warm places, such as the higher reaches of the Nile, Egypt, Mentone, St Raphael and other sheltered places on the Riviera. The places mentioned are all suitable for persons suffering from chronic bronchitis, who should avoid any irritation
