EMS.
No German spa is better known to the English than Ems, lying in a narrow valley of the Lahn river, only six miles from Coblentz, in the Duchy of Nassau. The town is built on the right bank of the little river, and the slate hills rise almost perpendicularly behind it. The sun’s beams are collected into a focus there, during a great part of the day, and the air is hot and sultry. These hills, on both sides, are covered with vines, trees, or cultivation. The walks about Ems are not so well shaded as at Wisbaden and some other watering-places in Nassau; but there are plenty of donkeys and guides to take the invalids up to the higher grounds for pure air. The environs are very pretty, especially the road to Nassau, about five miles from Ems.[49]
These waters did not escape the notice of the Romans, whose coins and other vestiges have been found there. The waters issue from the foot of the eastern slate mountain (Mont de Bains) and their sources are hidden from human eye and investigations.[50] They are clear and transparent as crystal, when first drawn in a clean glass. The chief fountains are the Kesselbrunnen and the Krachenchen—the first has a temperature of 115° of Fahrenheit—the latter, only 83°. These are the drinking springs. There are several others, varying in temperature from 80° to 124°, and used as baths. Some of them are about the temperature of the blood, and fit for general bathing, without increase or reduction. They have the taste of chicken-broth, with a slight smack of iron. They preserve their physical qualities (excepting temperature) for forty-eight hours, uncorked—when corked and sealed, they are said to keep good for several months. They are light and easy of digestion.
The Ems waters are eminently alkaline. A pint (of the Kesselbrunnen) contains 20 grains of bicarbonate of soda—two of carbonate of the same—two of carbonate of magnesia—one of sulphate of soda—one of common salt (muriate of soda)—and a very minute trace of iron. All the springs contain nearly the same ingredients—but the Krachenchen shews much more carbonic acid gas than the Kesselbrunnen, on account of its lower temperature.
Thilenius (the elder and younger) the Nestors of Ems, make the following observations on the waters.
“They operate on the human constitution mildly but efficiently, with little disturbance to the functions of the body. On this account they agree well with delicate persons, whose nerves are morbidly sensitive,—the sad effects of mental emotions, civilized life, and other debilitating causes. They are, therefore, peculiarly suited to the female constitution.—They may be employed, too, in advanced stages of disease, where other mineral waters of more exciting qualities, would be inadmissible. Their alkaline properties enable them to resolve obstructions, and free the functions of the kidneys, skin, liver, and various other secreting organs—especially the uterine vessels. They correct tenacious and morbid bile, as well as acidities—and thus prove aperient in a mild degree. Their intimate connexion with carbonic and sulphuretted hydrogen gas enables them to give activity to the secreting vessels, and evacuate unhealthy humours, while they give vigour to the whole organism, oppressed by chronic diseases. They have, at the same time, a soothing and tranquillizing effect on the nervous system. No waters, with the exception of Schlangenbad, produce such a pleasing and salutary operation on the skin, which they cleanse, soften, and leave in a sattiny state, thus improving the complexion, and clearing the pores. They are potent in discussing glandular swellings, and promoting absorption of abnormal deposits.”
The foregoing exposition of the general effects of the Ems waters is more rational, modest, and just, than we shall usually find in the eloges of most other spa doctors. We shall now give a catalogue of the particular maladies for which these waters are specially recommended—marking, as usual, the probable, the doubtful, and the dangerous, with the numbers 1, 2, and 3.
[1. Probable. 2. Doubtful. 3. Dangerous.]
They are represented as prompt and efficacious in all complaints dependent on acidities (1)—Glairy accumulations in the bowels (1)—Foul humours in the blood (1)—Spasms of the stomach (2)—Colics and vomitings (2)—Indigestion (1)—Irregularity of bowels (1)—Flatulence (2)—Loss of appetite (1)—Sense of distention and malaise after food (1)—Embarrassments of the chest (2)—Neglected catarrhs (1)—Inveterate coughs (1)—Asthma (2)—Hæmorrhage from the lungs (2)—Hooping-cough (1)—Loss of voice (1)—Obstinate jaundice (1)—Gall-stones (1)—Gravel (1)—Hypochondriasis (1)—Rheumatism and gout (1)—Spleen (2)—Hysteria (2)—Chorea (2)—Epilepsy (2)—Chlorosis or green sickness (1)—Uterine obstructions and irregularities (1)—Painful periods (1)—Leucorrhœa (1)—Swellings of the limbs (1)—Induration and enlargement of glands (1)—Sterility (2)—Paralysis (1)—Nervous and intermittent fevers of long standing (2)—Lameness (1)—Commotions of the brain or spinal marrow (2)—(the baths in such cases might be dangerous)—Neglected syphilitic affections (1)—Morbid effects of mercury injudiciously administered (1)—Ascites otherwise incurable (2)—Diseases of the skin (1)—Fistulæ (2)—Goitre (1)—Dropsy (2)—Inveterate inflammation of the Eyes (2)—Rickets of children (2)—Curvature of spine (2)—Scald-head (1).
From this ample carte des maladies (and I have omitted several which will not bear publication in this country) the valetudinarian will be able to select the dish that suits his taste—or rather the evil which he wishes to discharge. I have endeavoured to estimate the value of the remedy. Thilenius, indeed, expresses an apprehension that readers may be sceptical as to the power of one remedy curing so many and such different diseases. But he says—“let the sceptic come and see.” Who can combat the following argument?—“The result of our most profound researches is the firm persuasion that mineral waters are the gifts of Divine mercy to suffering humanity.” The same might be said of every medicine; but medicines often do harm, and so do mineral waters, unless administered with prudence. It will be seen that the stigma of No. 3 (dangerous) has been affixed in no instance to the Ems waters; but this applies to drinking them and not to bathing. I cannot too often repeat my conviction that there is far more mischief produced by spa-bathing than by spa-bibbing—especially in the case of the Ems waters, which are by no means of such an exciting nature as those of Wisbaden and several other warm springs. In every case where there is either local inflammation or constitutional excitement, these and other thermal waters are dangerous as baths. Thilenius himself remarks as follows:
“The condition of the body, when these waters are used, may be compared to that in which a kind of fever exists. It includes a period of four or six weeks, or even longer, in inveterate maladies. In this period, the waters exert their influence for the removal of the disease. This influence is felt, sooner or later. It is more or less distinctly perceptible, according to the nature of the complaint. It manifests itself, generally, by a kind of languor, in which the patient expresses himself as being ‘affected by the waters.’”
The waters of Ems have had greater reputation in affections of the chest than most other mineral springs, in consequence of the strong recommendation of Hufeland, who observes:—“We know how few mineral springs there are that can be used with safety in diseases of the lungs. Patients with such affections are commonly prohibited from visiting a mineral spring. Here the reverse is the case; and, in my opinion, Ems stands alone, with Selters, in this respect.”
It is quite evident, however, that it is in the more incipient cases of pulmonary diseases only, that Ems could be of any service—namely, where the tubercles are few in number, and in an unexcited condition—where the cough is slight, and the expectoration merely mucous, without fever or emaciation. In affections of the trachea, however, dependent on chronic inflammation of the mucous membrane, the waters and locality of Ems have been found highly beneficial, as the crowds of people from all parts of Germany can testify. It really would be well worth trying Ems, in such cases, before undertaking a long journey to Pisa or Rome.
Since the above was written, and while staying at Ems, in July, 1840, I met with a recent work by Dr. Doring, bath physician at Ems, from which I think it proper to make some extracts.
“Among all the maladies which are alleviated or cured by the waters of Ems, the affections of the chest are of the first consideration.
1. Pulmonary Complaints having their origin in other parts of the body.—Where these result from congestion or engorgement of the viscera of the abdomen, connected with gout.
2. Loss of voice, hoarseness, &c.
3. Chronic inflammation of the mucous membrane of the larynx, trachea, and bronchia.—When this affection has attained the name and nature of pituitary phthisis, the waters of Ems work wonders, especially where this state depends on latent gout, rheumatism, or repelled cutaneous complaints. The Kesselbrunnen is very efficacious in such conditions of the mucous membrane. If the malady has not advanced beyond the limits of curability, the warm baths prove auxiliary to the internal use of the water.
4. Chronic inflammation of the substance of the lungs themselves.
5. Debility of the chest.—However vague and inexact this term, there is a disposition to pulmonary disease to which it may be applied, and which it is of great importance to recognize. One of the chief symptoms is a susceptibility to colds, or irritability of the mucous membrane of the chest, accompanied by oppression, weight, and hacking cough. If this be neglected, it may lead to serious disease. A protracted course of the Kesselbrunnen, repeated for several seasons, has been found very efficacious in such states of the respiratory apparatus.
6. Tubercles of the lungs; or pulmonary consumption.—This dreadful malady, which cuts off such prodigious numbers of the human race, is more frequently arrested in its progress by the Kesselbrunnen, than by any other remedy. At the same time it is proper to remark that neither this nor any other remedy will prove efficacious, if the disease be confirmed. It is where the tubercles are in a nascent or latent state, that the Ems waters tend to purify the blood, and prevent further deposition of tuberculous matter in the air-cells. Perhaps, too, they may cause absorption of those already deposited. It need hardly be urged that the earlier the waters are used the better.
7. In obstinate and neglected catarrhs of the mucous membrane of the trachea and larynx, the Kesselbrunnen has produced the most beneficial effects.
8. Spitting of blood.—If this proceeds from irritability of the lungs themselves—from active congestion—or general plethora, the Ems waters will be absolutely injurious. But if the hæmorrhage be symptomatic of disordered conditions of the liver and other abdominal organs, then, the Ems waters taken internally, but not as baths, may prove serviceable. The same reasoning will apply to asthma.
9. Scrofula.—Daily experience has proved the efficacy of the alkaline waters of Ems in scrofulous affections generally.
10. Nervous disorders.—The waters of this spa have a singularly soothing and tranquillizing effect on the nervous system, as great numbers of patients can annually testify. Hence they are much used in hypochondriasis, neuralgia, tic douloureux, periodical head-aches, chorea, &c.
11. Congestions of the liver and abdominal organs generally—hæmorrhoids—jaundice—engorgements and indurations of the uterus, ovaries, &c.—colics, cramps, and epigastric pains—heart-burns—vomitings, &c. These are all ameliorated or cured by the waters of Ems.
12. Gout.—The action of the Ems waters on the constitution is to throw out the morbid matter from the blood—the cause of this painful malady in all the normal and irregular forms. At the same time, if the malady be of long standing, and the individual of weakly constitution, the waters of Wisbaden or Carlsbad will be more efficacious than those of Ems.
13. Rheumatism.—The same observations will apply to this as to gout.
14. Chronic eruptions and ulcerations of the skin are greatly benefitted by this spa.
15. Disorders of the urinary organs.—In no class of disorders have the Ems waters gained more reputation than in this, including catarrh of the bladder, gravel, stone, diabetes, &c.
16. Catamenial irregularities.—Females from all parts of Europe resort to the waters of Ems for the cure of these troublesome complaints, including sterility, chlorosis, &c.”[51]
I have introduced this quotation from one of the most recent writers on the waters of Ems, and himself a practitioner there, of considerable repute; but do not, and cannot vouch for the strict accuracy of all the observations contained in it. As in most of the writings of spa doctors, it must be taken “cum grano salis.”
COUNTERINDICATIONS.
According to Dr. Doring, these are as follow:—
1. The Ems waters are hurtful in all acute or subacute inflammations of any organ or structure whatever.
2. In people of florid complexions or plethoric constitutions, especially if there be any disposition to hæmorrhages, or determination to the head.
3. In dropsical effusions of chest, abdomen, or cellular membrane.
4. In organic diseases of heart or great vessels.
5. In confirmed consumption, and in marasmus from whatever cause.
POINT OF SATURATION, OR CRISIS.
The Crises produced by the waters of Ems are not so distinct and frequent as those resulting from some of the more potent spas. They act more gently and more slowly than the generality of mineral waters. Nevertheless, the following observations of Dr. Doring are to be carefully attended to.
“There are certain cases, constitutions, and forms of disease, in which it would be unsafe to continue the Ems waters up to the point of saturation. Thus if, after two or three weeks’ course, there occur little indispositions or discomforts—feelings of debility—a sense of prostration—a change of usual temper—an increase of sensibility; or even an irritability or moroseness—an unusual propensity to sleep, with agitating dreams—a loss of appetite—or, on the contrary, a thirsty white tongue, bitter taste in the mouth, oppression and distention of stomach, derangement of bowels and kidneys, and acceleration of pulse—it is then time to lessen the quantity of the waters, or entirely to stop them for some days. The foregoing are indications of over-drinking, or over-bathing, to which the term ueberbaden is given, and should never be neglected.”
As at Wisbaden, there is occasionally an eruption on the skin, after a few baths, and this is considered to be critical.
Thilenius, contrary to the custom of most of the spa doctors, admits that, although the waters alone cure many disorders, yet, in a great many cases, appropriate medicines are absolutely necessary. He contends, however, and I believe with justice, that many diseases give way to the combination of the waters and medicine, which resist the latter, if unaided by the former.
The preparation for the waters of Ems, as of all other mineral springs, is of the greatest importance, and is but too little attended to. Many patients repair to these sources, either exhausted by long-continued illness and the fatigues of the journey, or in a state of excitability from tonics and other medicines. In the one case some restorative remedies are to be exhibited, and in the other, quietude and saline aperients are necessary before the waters are used, internally or externally. Temperance is indispensible both before and during the use of the waters.
GENERAL RULES FOR TAKING THE WATERS AND BATHS.
The best season is between the beginning of May and the end of September. The waters are taken early in the morning. Weakly persons should begin with small portions, till they are accustomed to the springs. The morning is also considered the best time for bathing. The patient should immerse himself slowly—first to the knees—and afterwards the whole body, having first sponged the face and neck. Those who are subject to determinations of blood to the head should keep a handkerchief moistened with cold water to the head during the bath. A bladder of cold water is still better. The individual should not lie quiet in the bath, and much less should he go to sleep. He should keep constantly rubbing or sponging the body or limbs—and if not able to do this, a servant should do it for him. He should not remain more than ten minutes in the water, at first—and he should gradually increase the time to half an hour or more. Those whose skins are very sensitive ought to bathe in a flannel dress. The temperature should be from 94° to 98° of Fahrenheit. On leaving the bath, the individual ought to wrap himself up in a warm sheet, and when dry to dress himself. It is recommended then to retire to his bed-room and remain lying on the bed for a quarter or half an hour, but without sleeping. Those who are aged, weakly, or nervous, may take a glass of milk or a cup of coffee, after the bath. Most people can take a glass of milk and Ems waters mixed. The latest time for bathing is two hours before dinner. One bath in the day is quite sufficient.[52]
The waters are drunk, sometimes before, sometimes after bathing. They should be sipped warm at the source, otherwise some of their volatile qualities are lost. The quantity taken, like that of food, must be regulated by the power of digestion. Too much water, like too much food, will produce the same distention and discomfort of stomach. The same temperance and frugality is necessary in both cases. From two to three wine-glassfuls of the waters taken twice, thrice, or four times, at intervals of a quarter of an hour, will in general be sufficient. Some cow’s or goat’s milk may be mixed with the waters. Gentle exercise, between the doses of water, is essentially necessary. In some cases it may be proper to take a few glasses of the waters two or three hours after dinner—not sooner.
Asthmatic people, and those labouring under serious maladies of vital organs, are recommended to take a few glasses of the waters in their beds, early in the morning—but never to exceed a pint in this way.
A light breakfast may be allowed in half an hour or an hour after the last tumbler of water at the springs. It is fortunate that near this, as near most alterative waters, there is a chalybeate—viz. Schwalbach—where the patient may be very conveniently sent, when no farther progress is likely to be made at Ems; or where a tonic is necessary after the debilitating effects of the latter have taken place. Those who cannot visit Ems may take the bottled waters at a distance, with very little loss of virtue. They will keep for several months. They are used with considerable benefit en lavement. Of the douches or local application of the waters to the ailing region, I need not speak.
The regimen, while taking these and other waters, is of some consequence. Coffee or chocolate half an hour after the last glass, with bread but no butter, is the rule of the day at Ems. Tea is prohibited, as too much favouring perspiration—a rather unnecessary precaution I imagine. A liquid preparation of rice (called content) with some spice, is recommended to those of very nervous temperaments for breakfast. Between breakfast and dinner, some light avocation, conversation, or reading—after which a promenade. Temperance is essentially necessary at these waters, as they generally excite the appetite. The dinner hour of one o’clock at the table-d’hôtes is a great bore to all who are not downright ill—and these had better dine at home. The siesta is condemned in strong terms by Thilenius, if there be any fulness about the head, or if the individual be plethoric; but to the weakly this indulgence is allowed. The early dinner draws after it, as a necessary consequence, some supper—so that, upon the whole, the four o’clock dinner, without supper, will be found the most convenient and salutary.
Of the gambling-tables I shall take another opportunity to speak: mean time the following remark of Thilenius will not be inappropriate here.
“He who cannot gamble without losing his temper, should avoid the hazard-tables.” This is easy morality! The physical effects of passion and all the horrible emotions of mind at roulette, are merely considered as hurtful to the body of the bather; but no idea appears to be entertained that these are detrimental to the soul as well as to the body. The fact is, however, that none but gamblers by profession, and not all of them, can win or lose money without passion, although they may contrive not to shew it strongly in their countenances. In every point of view, therefore, moral and physical, these hells on earth ought to be shunned as eagerly as those of the nether regions.
I may now make a few cautionary remarks on the dangers of bathing and drinking the waters of Ems, and indeed of mineral waters (thermal) in general—a subject little touched upon by writers at the spas themselves. I cannot too often or too strongly warn every one against warm baths, who has the slightest degree of local chronic inflammation going on in any of the organs of the body, as evinced by white tongue, dryness of skin, accelerated pulse, evening thirst, or scanty action of the kidneys. The exciting mineral waters, taken internally or externally, will be almost certain to raise the chronic into a subacute, or even acute, inflammation, with a corresponding grade of constitutional irritation. Of this I have seen many instances, both at home and abroad. The existence of such conditions should be carefully ascertained before the spa is introduced: and proper means taken to remove all traces of inflammation. But even where there is no proof of any inflammatory action, the state of plethora or general fulness of the vessels renders warm bathing hazardous. In all, or almost all organic diseases of internal parts, especially of the heart, brain, or lungs, the warm bath is to be eschewed. The tide of the circulation carried to the surface by the hot bath, must have a subsequent recoil, and then the weakened organ may suffer. Besides, the warm and, still more, the hot bath excites the heart and great vessels into increased activity for the time, and the blood is carried with greater force towards the brain, endangering congestion there. But what are the admonitory symptoms or phenomena by which the patient may judge, when danger is approaching? The spa doctor is not always at hand, in these emergencies. He is often too much employed at such times. When giddiness, sleepiness, chilliness, confusion of thought, weariness, head-ache, pains in the limbs, unusual sounds in the ears, sparks before the eyes, loss of appetite, oppression after food, feverishness, thirst, languor, depression of spirits, inability to sleep at the usual hour, malaise or, in fact, any uncomfortable feeling, not previously felt, occurs soon after drinking the waters, and especially after bathing, and if these, or any of these recur after the second or third day, let the waters be suspended till advice is taken. I am well aware that the spa-doctors will say—“oh these are critical, or even favourable symptoms, demonstrating the efficiency of the spring.” All I say is—Beware! you are standing on a precipice!
We must now take leave of Ems. It is a very hot place in warm weather, and I must say that the exterior and interior of the houses are not in the most perfect accordance. The fogs are frequent in the mornings, and the heat oppressive in the middle of the day. Few people can sleep without some of the windows being kept open, and the danger of catching colds is not inconsiderable. The reputation of the waters is very extended. The Empress of Russia and her daughter were swallowing them freely while we were there (1840), and seemed to require them or some other restoratives, as they exhibited any thing but hyperborean complexions. Several physicians have recommended a residence at this spa during the Winter; and I am inclined to think that it would not be a bad sejour for people with tracheal affections, or irritable conditions of the mucous membrane of the lungs.