The Bath waters : their uses and effects in the cure and relief of various chronic diseases.

Preface

In presenting a Second Edition of this work to the notice of the profession and the public, I have to assure them that it has undergone considerable correction, and that I have brought to bear upon its improvement the knowledge gained by many years experience in the treatment of patients sent to this city for the benefit of the thermal waters.

I have to thank the reviewers of my first edition for their very flattering and favourable notices ; and to express my acknowledgments to various writers on Mineral Springs, both British and Foreign, for the kind manner in which they have done me the honor to speak of my researches.

Bath, 35, Brock Street; Dec. 29th, 1859.

CONCLUSION .... 153

Appendix

QUANTITATIVE AND MIOROSCOPICAL ANALYSES OF THE THERMAL

WATERS _ 130

THE BATH MINERAL WATER HOSPITAL . 162

BELLOTT'S HOSPITAL . .... Ig5

THE BATHS AND PUMP ROOMS . igg

TUNSTALL on the BATH WATERS.

Second Edition.

STATISTICAL TABLE.

Shewing ffu proportion of' cases per Cent; cured ami relieved h the Bath ffltfers; the cross lines represettf the numbers cured, and Ifa faint lines these <wfw derive great benefit.

THE

BATH WATERS:

THEIE USES AND EFFECTS.

Chapter I. Of The General Properties Of The Bath Waters

The virtues of the Bath Thermal Waters have occupied the pens of many distinguished physicians, more' particularly those of the last century, during which period the city itself, extending from its ancient boundaries, stretched its magnificent streets and noble crescents far up the adjacent hills, and, from being one of the smallest and most inconvenient cities in the empire, took its place as the first in beauty and splendour. Its hot springs, which attracted the Romans to make choice of the valley of the Avon as a place of relaxation from the toils of a predatory warfare, and to bestow upon their settlement the name of " The City of Waters of the Sun," still preserve their uninterrupted

B flow, and that mysterious healing power which no chemistry can explain and no mere artificial formation produce. Eliminated in Nature's laboratory, they flow towards the surface of the earth, adding to the bounteous gifts of Providence for the good of suffering humanity.

If we refer to the various chemical analyses of the Bath Waters, and observe the minuteness of the quantity of the medicinal substances which are dissolved in them, we are naturally at a loss to explain their beneficial effects and mode of action — we see results without being able to discern causes. Chemistry, indeed, in its reduction to their ultimate elements of the substances contained in the Bath Waters, performs an essential service to the medical investigator, but fails altogether in its attempts to discover the mode by which ingredients are held in solution in a stream (constant and unvarying), which, in the hottest day and coldest night, preserves a uniform temperature of 115 degrees of Fahrenheit's thermometer.

This temperature is derived from the source of the spring itself, and has been denominated Thermal Heat, and these and other allied waters, in various parts of the globe, have thence been denominated Thermal Waters.

I am persuaded that much of the benefit derivable from the Bath waters is due to this thermal property, which enables them to produce their exhilarating effects by the introduction, directly into the system, of free carbonic acid, united with saline materials, and a chalybeate in an extremely minute state of subdivi sion, in a warm and grateful fluid. Thus, by their internal administration, they stimulate the capillary vessels of the stomach, increase the nervous energy, and the volume and frequency of the pidse; promote the secretions, more particularly of the skin, liver, and kidneys, and by this means restore to their natural condition impaired and disordered functions — in fact, producing a tonic and stimulant effect more rapidly than any other form in which iron can be administered. And if we regard these waters merely as an article of the Materia Medica, an experience of many generations has proved them to be the best form of administering this valuable mineral.

In their external administration, they brace the extreme vessels of the skin, enabling it to secrete healthy perspiration in those forms of disease in which this function is depraved or unhealthy ; and in general terms they may be said to improve the quality and vigour of the circulating fluid, by producing a direct tonic effect upon the heart and arteries.

I shall hereafter proceed to show how the effects of the Bath waters are beneficial in cases where their use is undertaken judicib 2 ously; and prejudicial, where due caution is not observed.

Much discredit has been thrown upon their use by those who have never seen the peculiar effects produced by them. Many say, a common warm bath, or an artificial medicated one, answers quite as well. I can only say, that my own experience justifies neither the one opinion nor the other.

While studying diseases of the skin in Paris, in the year 1834, 1 carefully observed the effects of medicated baths, and their great efficacy in Lepra and other allied diseases ; but in no one instance did I observe the cure or relief so speedy or so permanently beneficial as I have seen produced by the Bath waters. And the same remark holds good in reference to hot and cold sea baths, which, generally speaking, produce too much irritation upon the already susceptible skin of the patient.

I have never seen a case of true Lepra Vulgaris which has not derived benefit from the Bath waters, either alone or in combination with other remedies.

With regard to common water heated to the same temperature, no person could immerse himself in a water bath of 105 or 110 degrees, without severe suffering; whereas the former is the ordinary temperature employed at the Bath Hospital, the patients describing it as warm and pleasant. And I have seen a person take a bath at 114 degrees, without any inconvenience, but this was only done as an experiment, to determine the heat that could be borne. As a contrast, it may be stated that a hot water bath varies from 98 to 100, which is the temperature of a warm thermal bath. Moreover the effects of the hot water bath are relaxing and sedative, those of the hot thermal bath bracing and tonic ; there is no disposition whatever to sleep after it, on the contrary the brain is more active, and the spirits more buoyant. The one produces loss of appetite and depression, the other an increase of appetite and exhilaration.

The general principles which should guide us in the employment of the Bath waters are, those which influence us in the use of all tonic remedies — that is to say, an absence of inflammatory action or disposition, a weak pulse, pallid look, with general loss of muscular power and energy. The more particular symptoms of disease, or condition of the circulating system, which forbid their use, will engage our attention when we come to speak of the specific states of diseased or morbid action in which their use is generally beneficial. It may be sufficient here merely to refer to the great discredit brought upon every remedial agent by its indiscriminate employment. I have no b 3

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desire to extol the Bath waters as an invariable specific in every stage of the diseases hereafter to be dwelt on, but as a valuable remedy, the use of which is founded upon strictly physiological principles, and which has been the means, for centuries past, of affording relief in the diseases in which its use is clearly indicated, when other means have entirely failed ; in this I am but following in the wake of a multitude of distinguished medical authors, and adding to what is already known, the results of my own experience and observation, having had more than ordinary opportunities for forming a correct judgment, in that I have watched several thousand cases during their employment of the Waters, both when resident medical officer at the Mineral Water Hospital, and subsequently in private practice.

It is extremely curious that modern analyses both of the blood and of the Bath waters, shew that many of the saline and mineral ingredients of the one are found in the other; and in this respect we may, perhaps, find a reason why these waters are so beneficial in diseases in which the circulating fluid is altered in character, and deteriorated in quality ; it being borne in mind that in the blood the saline and mineral ingredients are suspended in a Vital fluid of a high temperature, and in the Bath waters in a Thermal fluid, the source of whose heat is entirely a matter of scientific hypothesis. It may be affirmed that no purely natural fluid so much resembles, in many of its constituent elements, the composition of healthy blood, as the Bath waters, it being remembered that the salts contained in the former are united together by vital heat, with certain animal principles ; while the salts contained in the latter are held in solution by thermal heat, and are separated by cooling into solid and fluid portions, as the various parts of the blood are into coagulum and serum by the application of cold.

If, then, we seek for a reason why these waters are so grateful to the system of a person debilitated by the action of acute disease, we can, I think, supply an answer. By long continued debility and suffering, want of exercise, and confinement to a room not exposed to the full influence of atmospheric air, the body, more particularly in certain cases of rheumatism, has become charged with blood which wants many of the elements of that fluid in a healthy state. The perspiration is offensive to the nose, and acid in its reaction upon test paper ; the blood, if drawn in a full stream, is black, and separates into two distinct portions — a coagulum, with a coating of buff, more or less thick, and a large proportion of watery, or serous matter ; and if, as I have in many instances found, that the same individual, after undergoing a course of bathing until it has produced another active attack of inflammation in the joints previouslydisordered, has lost blood, this blood has been altered in character and consistence, no longer separating in two portions, but presenting one Uniform appearance of a bright red color; and if, as I constantly witness, this last attack is followed by perfect recovery, I feel bound to say that the red color of the circulating fluid, and the immunity from succeeding attacks, is due to the effect of the Bath waters upon the blood. But this will form a portion of our enquiry when we come to treat of the effects of the Bath waters in chronic rheumatism, liable to occasional active attacks.

CHAPTEE II.

OF THE DISEASED CONDITIONS IN WHICH THE BATH WATERS AKE BENEFICIAL.

Of all the diseased conditions for the relief of which the Bath Waters are recommended, unquestionably the greatest amount of relief is experienced in those disorders of the nervous functions which do not involve the cerebro-spinal system. Among these Chorea stands first, then Sciatica, and Neuralgia.

The next class comprehends those paralytic affections which are produced by loss of power in the extreme motor nerves of the extremities, caused, most frequently, by the absorption of lead and other minerals into the system, although numerous instances of this diseased condition are met with from various causes, which will form the subject of another Chapter. These affections are classed together in the Bath Mineral Water Hospital under the name of Dropped Hands and Feet, and are palsied conditions of the nerves of the extremities which do not involve the nervous centres.

The next contains those diseases of the skin which, unaccompanied by sores of any kind, discharge a solid matter, varying in size from a branny roughness to a large scale, and in quantity from a few grains to many ounces daily, in which the disease does not materially affect the general health of the patient, as Lepra, Psoriasis, Eczema, Impetigo, Pityriasis, Porrigo, Tinea Capitis, and their various subdivisions and complications.

The next will comprehend Chlorosis, and other functional diseases of the uterine system, Anemia, and the loss of general health and strength produced by continued illness, mental anxiety, studious labour, or bodily fatigue; diseased conditions, having their origin in diminished circulating power, and which, for our present purpose, may be classed together under the head of General Debility.

I now come to those which far outnumber all the others, viz., Gout, and Chronic Rheumatism. In the first of these the Bath waters have been used with most signal and almost universal success; we can, indeed, scarcely open the memoirs and biographies of celebrated persons of the last century, without finding constant references to their good effects. They deserve, indeed, to have accorded to them the reputation of a specific action upon this disease, as far as relief is concerned, and were constantly recommended by the most celebrated practitioners of the Metropolis, from the reign of Queen Anne to that of George the Third.

In Chronic Rheumatism they are equally efhcacious; but as this disease comprehends all painful affections, from the temporary heat and swelling of one or more joints to the complete or partial loss of power over several, the statistical or numerical account fails to shew the great benefit derived.

In chronic stiffness of the limbs after fractures, dislocations, and contusions, requiring long confinement in one posture for the cure of the original injury, their use has been attended with great advantage. The same may be said of chronic injuries to the spinal column, where all symptoms of inflammation have subsided.

In the hip joint disease, as soon as the active symptoms have subsided, I have seen the general health, in many cases, completely restored, the tendency to hectic fever removed, and considerable power given to the affected limb.

I shall have, hereafter, to speak of paralysis dependant upon organic lesion of the brain — Hemiplegia, loss of power of the extremities of one side — an incurable disease, one, in which the use of stimulating remedies requires great caution, and where only partial benefit can be hoped for from any plan of treatment adopted, and this only when the apopletic symptoms are relieved. I shall consider, also, what claims these waters possess as a remedy in Paraplegia, loss of power of the lower limbs, dependant upon inflammation of the spinal marrow. It must be admitted that the classing together under one name, two diseases so opposite in their origin and termination, as apoplectic and mineral palsies, has caused much difference of opinion as to the value of the Bath waters in paralytic cases. I set a high value upon their use in the latter variety, because experience convinces me that at least 92 per cent, are cured, while relief is all that can be expected or hoped for in the former. The same may be said in reference to Paraplegia. I have seen complete loss of power of the lower limbs, produced by fever and the metallic poisons, in which the disease has slowly proceeded from the feet upwards, completely cured; while in those cases in which the spine was first affected, but little relief has been obtained.

All the diseases cured and relieved by the Bath waters are chronic, so that it is necessary that I should proceed to shew the various circumstances which forbid their use, in order that the medical attendant may be guided as to the class of cases which, failing the ordinary remedies, are likely to derive benefit from their employment.

There are eight circumstances which, in general terms, render the use of the Bath Waters improper.

1st. Epilepsy. — In no case where well marked epileptic fits have occurred should they be employed, because their use will cause the disease to return.

2nd. Recent Apoplexy. — 'This is an evidence of determination of blood to the brain, and forbids their employment.

3rd. Phthisis and Scrofula. — Because their use would produce active symptoms : the same might perhaps be said of the chronic diseases of the bronchial membrane ; but I have never seen any mischief produced, in debilitated constitutions, by their cautious employment for the relief of the diseases mentioned above, even when accompanied with chronic bronchitis.

4th. Disease of the Heart. — This refers more particularly to cases of rheumatism. In all forms of that disease, where the acute stage has involved the heart, and disturbed cardiac action continues in the chronic, the use of the Bath waters is attended with great danger. In cerebral palsy, the fact of the circulation being affected, is condemnatory of their employment in any form.

5th. Acute Diseases are not benefitted, but rather increased in intensity, by their use, however long they may have contimied.

6th. Chronic Abscess or Ulceration. — This circumstance applies more particularly to diseases of the joints, and to certain states of cutaneous disease, involving large abrasions or ulcerations.

7th. Paralysis of the Sphyncter Muscles. — I c

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have never seen a case in which this distressing symptom was present, derive the slightest advantage from the use of the Bath waters.

8th. Haemorrhages, whether active or passive, forbid the employment of the Bath waters.

I have now briefly detailed those disqualifications which, not being attended to prior to sending patients to Bath, have brought discredit, not only upon medical skill, but also upon the springs themselves. It is very easy to say, "Go to Bath;" but when the suffering invalid arrives, and finds his case neither suitable for cure nor relief, he is put to great inconvenience, and may suffer a serious relapse ; or he may continue their use for a period of time unadvisedly, so that he aggravates his malady by the means employed for its relief, and departs worse than he came.

It .wjll be seen that the existence of any diseased condition which has a tendency to accelerate the circulation of the blood in a person labouring under active disease of the internal organs, or cerebro-spinal system, contra-indicates the employment of the Bath waters for the relief of the special diseases which are suitable in themselves for their employment, supposing the patient to be in perfect general health.

Of their employment in conjunction with blood letting, low diet, and antiphlogistics, I shall speak more particularly when I come to describe the various states of disease enumerated above, and, under each, shall point out the remedies which are the most likely to assist these waters in their action upon the constitution. I shall, therefore, assume that the patient comes for the express purpose of making a trial of the waters, and it ought to be presumed, by his medical attendant in this city, that the more usual remedies have been already ineffectually employed ; it will then be seen how far general or specific treatment is likely to be useful as an adjuvant to the means of treatment which the Thermal springs supply.

It would occupy too much space to enter into descriptions of the various diseases mentioned above ; nor is it necessary to detail cases in a work of this kind, written after so large an experience. The former may be easily referred to in systematic treatises ; the latter would encumber the text, without adding to the value of the observations. The plan I propose is, to take each class of disease separately; to point out the efficacy of the Bath waters as a remedy in each ; and then to review the effects of remedies employed conjointly with them.

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Chapter III

OF THE DIET AND REGIMEN TO BE OBSERVED DURING A COURSE OF THE BATH WATERS.

Experience in every age has shewn that the physician does but little, who, confining himself to the prescribing of medicines, neglects to attend to the various auxiliary means which aid him in the treatment of disease. In reference to our present enquiry, these comprise diet, clothing, air, exercise, and amusement.

The first requisite to the invalid in the employment of any remedy is confidence, imparted by the hope of receiving benefit; and, as a class of remedies, mineral waters demand this confidence more than any others : far better not to resort to them at all, than to do so without a reliance on their efficacy. Another essential is complete tranquillity of mind, and absence of all mental anxiety. The patient who goes to a Spa should leave all his troubles at home, or remain there until he can do so. It is presumed that he visits the springs to restore his impaired health, and this object should be his exclusive study during his stay. Thus, then, confidence and tranquillity are the first essentials to restoration to health.

Attention to diet is necessary in all states of disease benefitted by the waters of Bath. Many of them, indeed, absolutely require it ; and when so many diseases, relieved by them, owe their origin to irregularities of diet and indigestion — as gout, from luxurious living; rheumatism, in certain cases, from hard beer and cider ; and many diseases of the skin, from the constant use of pork and salted meats — it will be manifest that a strict rule in reference to this subject cannot be too forcibly impressed upon the invalid.

The patient should rise early, and take moderate exercise before breakfast ; and avoid taking this meal in his bedroom, or, if obliged to do so, let him have his windows open for a short time, to admit the fresh purifying air. It is a great mistake to suppose that the admission of fresh air is prejudicial to the invalid ; it only is so when the patient is exposed to a thorough draught. It is the close bedroom air which produces so much mischief in that stage of rheumatism in which the acute disease is subsiding into the chronic stage, and which renders the patient, on first leaving his bed, liable to suffer from the slightest breath of air.

For breakfast and tea, he may take as much stale bread and butter, or toast, as he can manage, with not more than two cups of black tea, or coffee, and one egg ; but no meat or fish of any description.

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He should take a moderate luncheon of biscuit, with one glass of good white wine, should he require it.

His dinner should consist of mutton, lamb, or beef, roast or boiled; boiled or roast fowl; he should eat sparingly of animal food, and avoid altogether all highly-seasoned dishes, green vegetables, and fish; and this meal should be taken in the middle of the day, in order that digestion may be fairly completed before retiring to rest.

Stimulants are to be avoided, more particularly the stronger kinds of malt liquor ; the best beverage, if the digestive system be impaired, either by the long continuance of the disease, or the previous administration of powerful medicines, is very weak Cognac brandy and water.

The supper must be of the lightest description, consisting entirely of farinaceous materials, and should, in every case, be taken at least one hour and a half before retiring to rest.

The bed should be comfortably warm, and not too luxurious or enervating ; for, if so, it is likely to interfere with the salutary effect of the Bath water treatment, by causing too great a determination to the skin.

The clothing should be sufficiently thick to protect the patient from atmospheric changes, but not too warm. Thus, an underclothing of merino is better than flannel, and good cotton stockings far better than worsted. All unnecessary wraps are to be thrown away; for, however useful they may have been when the disease first appeared, they now only render the parts to which they are applied, more susceptible to cold and local inflammation; and the same remark applies to bandages of every description, which interfere or restrict the free motion of the joints to which they are applied. Upon this subject I speak not from mere observation, but from personal experience ; having had twice to resort to Bath for protracted courses of the waters, I am enabled to say, that I have enjoyed a greater freedom from rheumatic attacks, since I adopted this plan of clothing, than I ever did under the warmer treatment which I before thought necessary.

Fortunately for those who resort to Bath for their health, the houses on the Parades and streets adjacent were erected exclusively for the accommodation of the invalid. The pavement is on a level with the street doors, so that, by means of the wheel chairs — which take their name from this city — -even the cripple may enjoy the fresh air without fatigue, and partake, in some degree, in the amusements, so necessary to his forlorn condition.

To all who can walk, I recommend free exercise in the open air. Bath is surrounded, at easy distances, by romantic walks and pleasing villages. With a view to interest the valetudinarian, I, while residing at the Bath Hospital, employed the leisure time spared me from more arduous labours, in the preparation of a volume, entitled, " Rambles about Bath and its Neighbourhood," in order that he might know how to employ his time in healthful recreation. Such little excursions, chosen as they may be in Bath, even in the severest weather, so as to avoid the chilling breeze, will add variety to his amusements, and, by the occupation of his mind, forbid the contemplation of the supposed hopelessness of his case, and aid the efforts that may be made for the restoration of his health,

Bath, indeed, still preserves its Saxon reputation as the " City of the Sick Man." Its Pump-Room was erected that it might form a promenade in wet weather; and there is not a day, however cold, in which a warm and sheltered walk may not be chosen.

It must here be remarked that Bath is, from position, the warmest inland town in the empire during the winter season; that its prevalent winds are westerly, so that those who come from a more bracing air, require out-of-door exercise, otherwise their health fails, and the full benefit expected from the waters is neutralized by the warmth of the atmosphere. But if the invalid will bear in mind that he comes to Bath, not to frequent its fashionable resorts, but for the benefit of his health, he will require no other inducement to take his out-of-town walk or drive.

When longer excursions are inadmissible, the Victoria Park will afford variety enough. It is situated to the westward, and is sheltered from the north and north-easterly winds, so prejudicial to the poor rheumatic invalid.

Above all things, let the invalid avoid any inducement to violate the rules laid down for his guidance in reference to diet ; let him shun all temptations which will interfere with his main object, and steadily devote himself to an observance of the simple rules which are to guide him during his residence at the springs.

There is one point which, although incidentally noticed by writers upon this subject, has not received that attention which its importance demands, and that is, that these waters are the best remedy that can be used to wean the habitual indulger in strong potations of his propensity to drink. The stomach, in these unhappy cases, experiences a craving, which is relieved by a glass of the Bath waters; the dyspepsia is relieved, not at the expense of fresh fuel added to the already burning heat, but with a grateful fluid which moderates its rage. The glow of health is substituted for that of a feverish excitement ; and a steady course of the waters will speedily cure the vicious propensity ; in some instances, by producing a smart attack of gout, heretofore latent in the system and, in others, by supplying energy to the injured organs, which enables them to resist and subdue the morbid propensity by the restoration of their healthy functions. I have had many instances under my notice in which these results have occurred : in this condition the healthy stimulus afforded by the waters is so grateful, that the patient, at last, prefers it to that which, a few weeks before, he thought essential to his very existence.

I have never seen any ill result, in those accustomed to live well, who have adopted the temperance system during their treatment by the Bath waters ; on the contrary, the very best results have marked all cases in which this plan has been adopted.

Chapter IV. Op The Modes Of Employing The Bath Waters

Taken altogether, there are nowhere more systematic arrangements for the comfort of the in- "v alid, than those which are presented by the suite of Baths and Pump Rooms in the immediate neighbourhood of the thermal springs, the property in which having been, since the reign of Queen Elizabeth, vested in the Mayor and Corporation, everything that science could suggest and suffering require, has been brought to bear upon their completion.

I need not here enter into the enumeration of the number of gallons eliminated from the springs in a given time, or any of the details which find their proper places in the Guide books of the city; — I have alone to deal with the Bath waters in their therapeutic or medicinal character.

To those who come to Bath for its amusements, the season commences in November, and terminates in April ; but for those who resort hither for the restoration of their health, various periods of the year seem to me to be appropriate for different disorders.

The winter is certainly best for those who drink the waters for the diseases induced bydebility and exhaustion ; and in all cases where a mild air is recommended for the invalid, this season is to be preferred, great care being taken to avoid all exposure to cold.