others, although of apparently similar composition; it is found to be more soothing to the stomach. The only noticeable difference in this spring is that it deposits around its basin a considerable amount of a greenish organic substance termed barègine, so named from its presence having been noted long ago in the waters of Barège.

There is nothing in the chemical analysis of the water of Schlangenbad (of the same class as our own spa, Buxton) to account for the peculiarly luxurious effect of this bath, which the author of Bubbles from the Brunnen of Nassau describes justly as the most harmless and delicious luxury of the sort' he had ever enjoyed, and he quotes the opinion of a Frenchman that dans ces bains on devient absolument amoureux de soi-même!' Describing elsewhere my own impressions of this bath, I have said, ' Reclining in one of those luxurious baths, the water with its delicious softness and pleasant temperature seems to envelop the whole body with a sort of diffused caress; while, from some peculiar property in the water, it gives a singular lustrous beauty to the skin, which seems to be suddenly endowed with a remarkable softness and brilliancy.'

Then, again, some special modes and processes of employing a mineral water doubtless have more influence in determining the range of its usefulness than its mere chemical composition. The peculiar vapour chambers and other modes of applying the waters practised at Mont Dore have much to do with their efficacy in the relief of cases of asthma and other forms of chest affections. The production of very profuse perspiration is often the consequence of the application of these processes, and seems to be not very remotely connected with the beneficial results obtained.2

At Aix-les-Bains the combination of the douche with shampooing and massage has been carried to great perfection, and may be credited with much of the benefit derived from treatment there. The physicians at Kreuznach believe that much of the success attending their treatment of scrofulous and other tumours depends greatly on the system and processes they adopt in the application of their fortified salt springs.

So also the very strict régime enforced at some of the Continental spas, where the tables d'hôte are under the direct control of the physicians-as, for instance, at Carlsbad-contributes greatly to the attainment of the results aimed at.

It has been said, and with much truth, that there is a fashion in waters, and that various spas come into and go out of fashion like many other things.

Au temps de François Ier (says M. Taine ), les Eaux Bonnes guérissaient les blessures: elles s'appelaient eaux d'arquebusades; on y envoya les soldats blessés à Pavie. Aujourd'hui elles guérissent les maladies de gorge et de poitrine. Dans

2 Etude sur les Sueurs qui se produisent sous l'influence du Traitement Thermal au Mont Doré. By Dr. Cazalis. Voyage aux Pyrénées.

cent ans, elles guériront peut-être autre chose: chaque siècle, la médecine fait un progrès. Un médecin célèbre disait un jour à ses élèves: 'Employez vite ce remède pendant qu'il guérit encore.' Les médicaments ont des modes comme les chapeaux.

A few years ago a fierce controversy arose between some of the physicians of the Pyrenean spas and some of those practising at Mont Dore, as to the relative value, in certain cases, of sulphur and arsenic. Arsenic was coming into fashion, and it was seen that sulphur, for a time, was in danger of going out of fashion. The managers of numerous spas, then, began to magnify the amount of arsenic contained in their sources, while the curious in these matters might have noted that in many others, as at Vichy for example, where they had other potent ingredients to trust to, they took little account of the arsenic in their springs, although it existed in them in greater quantity than in some that boasted largely of its presence. Arsenic still holds its ground, and is long likely to do so, especially in such a spa, for instance, as that of La Bourboule in Auvergne, five or six miles from its more ancient neighbour Mont Dore. This water, containing as it does a very notable quantity of arsenic, is, for that and other reasons, perhaps one of the most valuable additions that have been made of late years to our available mineral springs.

But far and away the most fashionable constituent in mineral waters at the present time is lithium, and the authorities in various foreign spas appear to be competing with one another in the discovery of this popular ingredient. Who shall produce an analysis with the greatest quantity of lithium in it? That seems to be the burning question at this moment with bath managers all over Europe.

A striking testimony to this fashion is afforded by the recently circulated analysis of the springs at St. Moritz. Formerly the presence of a notable quantity of iron in these springs was regarded as the point of paramount importance, now the list of constituents is headed by Lithium Chloride'!

Why this exalted estimation of lithium? Because lithium is a remedy for gout, and the desire to acquire the esteem of the many sufferers from this ubiquitous malady is foremost in the wishes of spa physicians. A cure for the various kinds of goutiness is, in the language of commerce, an 'article greatly in demand,' hence the eagerness to possess one, or rather to possess the reputation of possessing one.

It was Royat who led the way and started this vogue for lithium. The Royat springs are hot, weak alkaline springs, all containing lithium in certain proportions, and it used, on account of the similarity in the composition of its springs, to be called the French Ems. The Royat springs also contain a minute quantity of arsenic.

The success which has attended the efforts to establish Royat as a resort for certain forms of goutiness has led to considerable competition on the part of other spas for a like reputation, and as the

prosperity of Royat is considered to be based on the possession of lithium in its waters, no effort has been spared to discover lithium in other springs.

Remarkable claims have recently been advanced in favour of the Contrexéville waters in the treatment of atonic forms cf gout, and it is not difficult to foresee that this spa also is about to enter on a period of popularity. Its waters are very feebly mineralised, and some of the benefit they produce might possibly with justice be assigned to the amount of pure water that is consumed in drinking them. But not only do they cure gout and diabetes at Contrexéville, but they claim to have turned diabetes into gout; they do not, however, appear to have as yet turned gout back again into diabetes-the patient would probably object!

In speaking of the spa treatment of these supposed related disorders, gout and diabetes, it would be most unwise to forget or overlook the claims of Neuenahr and the brilliant success which has attended the treatment of diabetes there. Dr. R. Schmitz has published an analysis of 310 cases of diabetes treated at Neuenahr, from which it appears that 135 got rid of all symptoms of the disease, 134 were greatly benefited, and only in 41 was the result of the course unsatisfactory, and for very obvious reasons. Exceedingly good results have also been obtained at Neuenahr in the treatment of chronic articular gout.

5

When we find a number of Continental spas, which possess waters of very various composition, publishing evidences of their efficacy in the cure of the same chronic maladies, we are naturally induced to ask, Is there any common agency operative in all of them? There is this common to nearly all of them, that they require the daily introduction into the body of a considerable quantity of an important solvent agent-water! and this brings me to the consideration of a subject with which I must conclude this article, viz. the use of 'hot water as a remedy,' a subject, I venture to think, by no means remotely connected with the spa treatment of certain maladies, especially of gout and corpulence.

A very eminent confrère once asked me to define gout. I had often thought over this difficulty, and I was, therefore, prepared with an answer; so I defined gout as disturbed retrograde metamorphosis! This seems a very pedantic phrase, but it is capable of explanation, and when examined it will, I think, be found to be nearly, if not altogether, coextensive with the meaning of gout. For the perfection of healthy life it is requisite that certain changes (metamorphoses), constructive and destructive (retrograde), should

On the Common Origin of Diabetes and the Uric Acid Diathesis. By Dr. Debont d'Estrées, of Contrexéville. Lancet, May 22, 1886.

Results of Medical Treatment of 310 Diabetic Patients. By R. Schmitz, M.D., Neuenahr.

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take place in the body with perfect regularity and uniformity. Constructive metamorphosis (after growth is completed) is concerned in maintaining the fabric of the animal frame in its due integrity; destructive (retrograde) metamorphosis is concerned in carrying away, completely and quietly, the results of the incessant use and wear of the fabric. This is what is meant by the words ' tissue change' of so frequent occurrence in every attempted explanation of the action. of baths and waters. If there is a disturbance in the constructive changes, the perfection of the fabric suffers, and loss of strength must follow; if there is disturbance in the destructive changes, the injury to the health of the body may not be so immediately apparent, but they will be felt, sooner or later, and in proportion to the gravity of the disturbance. Mere excess of food may be the cause of some of these disturbances, or an improper method of feeding. Thus it is easy to understand how corpulence arises. Something is regularly taken into the system which is not needed for construction or maintenance; if in the 'retrograde metamorphosis' this excess were got rid of in a regular and normal manner nothing remarkable would arise. But in some organisations there is a tendency not to turn this excess into substances which can readily be discharged from the body, but to throw it on one side, as it were, within the body in the form of fat, probably a provision of nature for storing up excess of food in a readily convertible form in anticipation of a season when food may be difficult to procure, for fat disappears rapidly enough when persons are deprived of food, and those who profess that they get fat on nothing' would soon be undeceived if they were seriously to try this painful experiment.

But a tendency to disturbance of 'retrograde metamorphosis' may be independent of excess or error in the matter of feeding, and depend on an inherited peculiarity, although aggravated undoubtedly and called into activity frequently by excesses and errors of diet. The tendency both to gout and corpulency are very commonly inherited and often coexist in the same person.

Now it is to get rid of the results of these disturbances and to prevent their recurrence that most mineral water cures are undertaken. One reason why certain substances resulting from these abnormal changes are so injurious, and linger so long in the system, is because of their very slight solubility, and it has recently been maintained that the regular consumption of such an active solvent as pure hot water would serve the purpose of getting rid of these troubles as efficaciously as a course of mineral waters. I do not doubt there is much truth in this, but I do not doubt also that the presence of certain constituents in many mineral springs increases considerably the solvent action of the water in certain cases and in certain persons.

• Exception might be taken to the word 'destructive,' and 'retrograde' is more strictly accurate.

VOL. XX.-No. 114

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Those who believe they can get all they require by the consumption daily of a certain quantity of hot water have only themselves to blame if they do not carry into effect such an easy, cheap, and harmless mode of treatment.

I do not propose to pursue this discussion further, at present; the whole question of the role played by water in the processes of nutrition and its influence on corpulence has been largely debated recently in France, Germany, and America, and experimental investigations are still being pursued for the purpose of throwing light on this important practical subject.7

To treat this question fully and satisfactorily would require an article to itself, and it seems wiser to postpone such an undertaking until the investigations which are now in progress shall have attained greater completeness.

I should like, in conclusion, to quote some remarks I published fifteen years ago on this head, when considering the action of mineral waters: It is not unimportant to consider what the effect may be of drinking daily a large quantity of water, apart from the mineral substances which it holds in solution, especially in the cases of persons unaccustomed to the use of pure water as an ordinary beverage. This is a part of the inquiry very commonly omitted, yet it cannot be doubted for a moment that the admission of from one to two pints of an influential physical agent like water into the alimentary canal, every day, in opposition to ordinary habit, must have a very decided influence on the health of the body.'8

J. BURNEY YEO.

An excellent account of these investigations so far as they have at present gone is to be found in the Archives d'Hydrologie for March, April, and May 1886.

Notes of a Season at St. Moritz and a Visit to the Baths of Tarasp.