VALETUDINARIUM.
It is often more easy to ascertain the internal condition of the body through the medium of external phenomena, than that of the mind through the physiognomy of the countenance. To the experienced observer, the complexion, the expression, the eye, the gait, the tone of voice, the figure, the proportion of the different parts of the body, and many other indications incapable of description, convey very authentic information respecting the condition of organs and structures that are far removed from sight. It is in a great sanitarium like this, where invalids are gathered from all quarters of the world, that a young physician, under the guidance of an old one, might beneficially study the physiognomy of diseases. For, although the greater number of spas have much that is common, both as respects the waters and the maladies for which they are taken, yet each spa, or at least, each class of spas, exhibits some characteristic features among the mass of visitors, indicative of the maladies which led them to the Hygeian fountains of the place. Thus it is impossible to stand long at the Fontaine Elisée of Aix-la-Chapelle, without discerning a large sprinkling of cutaneous complaints, however carefully they may be concealed by the wearers of them. It is in vain that—
“Wrapp’d in his robe white Lepra hides his stains,”
the features of the leper disclose the worm that torments him by day and by night. The French and Germans are universally imbued with the doctrine that the repression of a certain malady, which has got the musical soubriquet of “Scotch-fiddle,” is the cause of half the evils to which flesh is heir. On this account, the continental folks have a great longing, or rather a violent itching for sulphureous waters. The slightest odour of sulphuretted hydrogen gas in a newly-discovered spring, is a real treasure—and in the old ones, it is sure to preserve reputation to endless ages!
The neighbouring mineral source—Spa—together with Schwalbach, Brockenau, Bocklet, and other chalybeate springs, attract a different class of votaries—namely, the pallid, the debilitated, the leucophlegmatic—those, in fact, who have been sucked, and left bloodless by vampyre diseases.
The emblem of Wisbaden might be a swelled and gouty foot—that of Wildbad a crutch, or a hobbling paralytic invalid—Kissengen, the tumid liver and green fat—Marienbad, the paunch of Falstaff, and the jaundiced eye.
But Carlsbad presents a greater medley than any of the other spas that I have visited. When we contemplate, even for a single morning, the crowds that surround the Sprudel alone, presenting specimens of almost every human infirmity, not in solitary cases, but often in trains of twenties or thirties in succession—when we consider that, in these various specimens, there are many that are of a diametrically opposite nature to each other—yet all cured or relieved by an upheaving fountain that never varies in temperature, taste, or composition—doubts may well arise whether there is not some truth in the sarcastic remark of an eminent philosopher,—that “there are more false facts than false theories in physic.”—But there is something to be said per contra. 1st. Many complaints which are thought and believed to be cured by mineral waters, are only relieved pro tempore—and the contradiction seldom or never appears. 2d. Many different diseases are produced by the same causes acting on different constitutions. Thus luxurious living and idleness will, in one person, induce gout—in a second, hæmorrhoids—in a third, liver complaint—in a fourth, rupture of a bloodvessel in the lungs—in a fifth, congestion in the brain—in a sixth, paralysis—in a seventh, stone in the kidney or bladder,—and the list might be far extended. Now, if the same cause or class of causes produce such a number of different maladies; there is nothing unreasonable in the supposition that the same remedy, or class of remedies, may be useful in abating or even removing those varied disorders.
3d. With the exception of a few specific remedies, such as mercury, sulphur, colchicum, and ergot, with the real nature of whose physiological operation on the human frame little is known, almost all the other medicinal agents act through the medium of the digestive organs, the liver, the kidneys, and the skin. Now, the mineral waters of such spas as Wisbaden, Kissengen, Marienbad, Carlsbad, &c. act through these organs also, and contain the elements of many of our most efficient remedies. They have, besides, great advantages over ordinary medicines at home, in consequence of the exercise of travelling, the change of air, and the alteration of habits that precede the course of the waters.
4. Through what channels do the noxious physical agents enter the constitution and produce disease? Through the digestive organs and skin, without doubt,—to which may be added the lungs, which may imbibe the principles of disorder with the oxygen from the air we breathe.
5. But there is a great class of moral causes of diseases, acting on the body through the medium of the mind—a class so extensive that Plato considered it to be the origin of all corporeal maladies!
6. Against these moral agents the great spas possess powerful auxiliary counter-agents, as preventives, in the form of amusements on the spot and abstraction from cares. They also present the means of removing (if removeable) the effects which these moral causes have already inflicted on the bodily frame.
7. The far greater number of physical remedies act by altering and improving disordered functions and secretions—by evacuation—and by imparting tone to debilitated organs or the whole constitution.
8. It must be allowed that mineral waters contain, to a very considerable extent, the requisite ingredients for fulfilling one or all of the foregoing indications.
9. It is often found to be beneficial to combine tonics, alteratives, and aperients in the same formula or prescription, in order that the three indications alluded to, may be simultaneously accomplished.[77] It is undeniable that some of the spas contain within themselves this combination of chalybeates, aperients, and alteratives, either of which ingredients can be increased at pleasure on the spot.
10. The medicinal agents in the mineral waters, though in much smaller quantities than when given in prescriptions, have a much better chance of success, in consequence of their being so largely diluted by the hand of Nature, and the temperature of the diluent being so very high, in most of the springs.
11. The early hours, and the exercise taken while drinking mineral waters, have powerful influence in promoting their salutary operation. How many invalids, in England, would start from their beds at five o’clock in the morning, to drink salt and water till seven or eight o’clock, using their limbs all the time in locomotion? very few!
12. The warm bathing, which generally precedes or accompanies the drinking of the waters, has also great effect in augmenting the medicinal agency of the waters taken internally. The circulation is drawn to the surface—the insensible perspiration augmented—and various internal organs sympathise with the skin and are relieved from habitual congestion.
13. The habit of early rising, which is unavoidable at the great spas, leads to many other good habits. Early meals and early bed-going follow of course, and of consequence. The excursions in the middle of the day, undertaken while devoid of care, and free from business, contribute not a little to the efficacy of the spas, and to soundness of repose at night.
14. When I observed that many of the German spas combined tonic, with aperient, and alterative qualities, I by no means averred that these qualities were always well proportioned for all complaints and various constitutions. On the contrary, they are often very deficient in one or other of these qualities—and it is by overlooking this defect, and trusting solely to the remedial agency of the waters, that continental physicians commit a grand mistake—especially in the treatment of British patients.
15. The digestive organs of our continental neighbours are habitually in a far more tender and excitable condition than those of our countrymen, in consequence of their greasy and sloppy food, and the poverty and acidity of their wines and other drink. They cannot, therefore, bear medicines of any strength, without great suffering. Relying on identity of constitution, the mineral waters are often administered ineffectually by foreign physicians to the people of these islands. These last are washed and drenched, from day to day, and from week to week, while the glandular organs (the liver in particular) not directly affected by the waters, become torpid in function, and vitiated in their secretions. Hence it is that, after a week or a fortnight, much derangement takes place in the digestive organs—febrile irritation is set up—the nervous system is impaired—and then, when the patient declares that the waters are disagreeing with him, the spa doctor consoles him with the information that the spa-fever or crisis has come, and, if he lives through it, he will be much better than before it commenced! All this, in nine cases out of ten, might be prevented by taking a small dose of blue pill—a couple of grains, for instance—over night. In this case, a much smaller quantity of the waters would be sufficient in the morning, and the liver and other glands would be roused to simultaneous action with the bowels. The physicians of Cheltenham and Leamington act on this plan, and render the course of waters far more beneficial than they otherwise would be. The crisis or spa-fever appears to me an act of salutary rebellion, on the part of Nature, against the injudicious employment of the waters, and an effort to restore the equilibrium of function among the great organs, which equilibrium has been disturbed by the waters themselves.
16. It is a well-known fact that soldiers, sailors, and even civilians, will recover from illness much sooner in a public hospital than in their own homes—although attended by the same physician or surgeon. The same applies to infirmities of mind as well as of body. The individual who becomes insane, has infinitely less chance of recovery at home amongst his friends, than among strangers in an asylum. A great valetudinarium, like the spas, comes under the same rule. How is this to be accounted for? I have heard the aphorism of Rochefaucault quoted in explanation, viz. “that we derive pleasure from the sight of misery and suffering in others, even when they are our dearest friends.” From long acquaintance with human nature, I venture to say that, in this celebrated aphorism—or rather sophism—the author of it only stated half a fact, and drew from that half fact a false inference. The emotion which we involuntarily experience at the sight or the intelligence of misfortune or affliction in others, whether strangers or friends, is not unmixed—but a compound of commiseration for the afflicted, and a feeling of secret satisfaction (magnified by Rochefaucault into pleasure) at our own immunity from the evil. Two sailors are on the lee yard-arm furling the mainsail in a tempest. The ship lurches—the yard-arm is swept by a wave—and one of the sailors is torn from his hold, and plunged into the deep. Will the French philosopher persuade us that the seaman, who clings to the yard and escapes death, feels pleasure, unmixed with sorrow, at the sight of his drowning mess-mate? The poet, who saw and described a catastrophe identical with the above, but on a larger scale, was far from entertaining the sentiment of the philosopher.
“Bereft of power to help, their comrades see
Their late companions die beneath their lee,
With fruitless sorrow their lost state bemoan.”
17. But there are other and adequate causes assignable for the more rapid recovery of health in public places of resort for invalids, than in private life. Man is the creature of habit; and habit results chiefly from imitation. In a great watering-place, we acquire, or at least comply with, habits which we would not attempt at home. How many delicate and fashionable invalids would start from their couches at sun-rise every morning, in London, and drink repeated draughts of nauseous compounds before breakfast? How many would dine at one, instead of seven o’clock? How many would retire to bed at nine o’clock, instead of midnight or later? How many gourmands and Bacchanalians, in England, would comply with the rigid rules of abstemiousness enjoined by the spa doctors, and which they dare not infringe, lest the disobedience might render the waters useless, or even injurious?
The revolution in social, but insalutary habits alone, would cure half the disorders for which the aristocratic valetudinarian flies to the spas. If the maxim of Rochefaucault, too, have any foundation in truth, what a prodigious source of pleasure must the spa-goer find in the different watering-places, where he daily contemplates almost the whole of the moving mass of mortals around him labouring under more or less of bodily suffering! But, admitting the less humiliating explanation which I have attempted of the philosophical maxim, the result will not be materially different. Every one affected by disorders at all curable, will see many around him who are evidently afflicted by diseases beyond the reach of remedy. While commiserating the fate of their neighbours, they have a pleasing consciousness and assurance that they themselves are not in such a hopeless condition. As for the victims doomed to an early grave, they never despair. They see daily recoveries going on around them—and hope, “that comes to all,” does not withhold its balmy influence even from them! The resounding Sprudel is pouring forth its healing waters for the incurable as well as for the curable, whilst the veil of mystery that hangs over its origin and source, exaggerates, on the well-known principle, “omne ignotum pro magnifico,” the virtues of its miraculous qualities! The season of the year in which the journey is made and the waters taken, is not a little favourable to the recovery of health, and, combined with the sanguine expectations of recruited vigour and emancipation from sufferings, gives wonderful efficacy to the spa.