In chlorotic and amenorrhœal disorders, Carlsbad waters are beneficial; not so much from the minute quantity of iron they contain, as from their stimulant and deobstruent qualities. Females ought not to use these waters at all times.
A painful complaint which often presents itself at Carlsbad is biliary calculi. Dr. De C. thinks that the waters are almost specific in such cases. He lately attended an invalid who had come from a great distance to Carlsbad. On the third day of using the waters a prodigious number of gall-stones, of all sizes, were expelled. He has often found gravel to be expelled from the kidneys and bladder during the use of these waters; but he does not vouch for their lithontriptic powers—that is, their power of dissolving urinary calculi, although this quality has been attributed to them by some physicians.
It is in chronic gout, especially of the wandering and misplaced kind, that the Carlsbad waters have acquired considerable renown, disputing the palm with Wisbaden itself. It is in general necessary to take some chalybeate waters, in such cases, after the course at Carlsbad is completed. It is acknowledged by Sir John De Carro, that more than one visitation to Carlsbad will be necessary in gouty affections of any standing.
In the nervous tremors occasioned by quicksilver, these waters have been found very beneficial, both internally and externally.
THE CARLSBAD STURM, OR CRISIS.
From the age of 35 years, Dr. De Carro was subject to severe attacks of gout, each attack generally lasting ten or fifteen days, followed by much debility, with great tenderness of the feet. The intervals were of various duration—sometimes months—sometimes years. The complaint is hereditary in his family for four generations. About fifteen years ago (1825) one of the paroxysms ceased suddenly on the third day, followed by alarming symptoms—difficulty of breathing—irritation about the throat—total loss of sleep—copious muco-purulent expectoration, of an acrid and acid taste—rapid emaciation—cadaverous expression of countenance—and all the symptoms of approaching laryngeal phthisis. From these, however, he gradually emerged; but a sense of constriction in the trachea remained, occasioning loss of voice and many uncomfortable feelings. In April 1826, many of the symptoms above-mentioned returned, with considerable violence, and the Dr. removed from Vienna to Carlsbad. The waters of this spa are not beneficial in pulmonic complaints generally, but Dr. De C. considered his own malady as misplaced gout, and he commenced the waters on the 17th of May, at the Neubrunn. “During the first three days he felt no effect whatever. He had been unable to get higher than seven goblets daily; but, on the fourth day, he felt as if he were drunk—lost his appetite—staggered on his legs—had indistinct vision—burning cheeks—excited and agitated circulation—overwhelming drowsiness, and total inability to read or write. These violent symptoms continued for three days, and were much mitigated by copious evacuations, (tres soulagé par des evacuations copieuses) and, the storm having subsided, he continued the course of waters for six weeks, without further inconvenience. The bowels became regular, and there was a copious but fætid secretion from the kidneys during the whole time. All the symptoms of misplaced gout disappeared.”[75]
Dr. De C. observes that, had he not been a physician, he would have looked upon the above symptoms as forerunners of apoplexy. I am quite confident that they were so, and that the apoplexy was warded off by the “copious evacuations” that were procured, whether by nature or art. I have seen several instances of this “bad-sturm,” and have no doubt of their being owing to some inflammatory action going on in some part of the body (as was clearly the case in the present instance), or to the neglect of aperient medicine taken in conjunction with the waters. The misplaced gout, such as Dr. De C. presented, is readily relieved by saline aperients, with small doses of colchicum and counter-irritation, without the risk of the “bad-sturm,” which is a violent conflict between the constitution and the remedy. It is when the complaint is quiescent, and all inflammatory symptoms removed, that the Carlsbad and other mineral waters are beneficial.
Dr. De Carro has a short chapter on the East and West Indian invalids who resort to Carlsbad annually, for the relief of broken-down constitutions, and especially for affections of the liver, the spleen, and for the consequences of intermittent and remittent fevers contracted within the tropics. The worthy doctor, who has the usual dread of mercury, so widely infecting the Continental faculty, seems to hint pretty broadly that many of the Anglo-Oriental and Occidental diseases, are as much owing to the remedies as to the climate. Be this as it may, he gives the pagoda-complexioned gentry great hopes of benefit from the waters of the Sprudel.
The regime laid down by Dr. De Carro, is rather more liberal than by some of his confreres at the German Spas. Breakfast should not be taken till an hour after finishing the last goblet. Besides the exercise which is taken while drinking the waters, he recommends half an hour’s promenade after leaving the spring, if the patient be not too fatigued. The breakfast itself may be coffee, tea, or chocolate, according to the habits or inclinations of the invalid. Coffee is rather hazardous where there is any tendency to inflammatory action in the constitution. The bread and the cream are excellent at Carlsbad. Dejeuners a la fourçhette are inadmissible here. The dinners at Carlsbad are very abstemious, as the Traiteurs are obliged to regulate them by the orders of the faculty. They present no temptation to commit excesses. A very temperate use of plain and well-boiled vegetables is permitted. Salads, cheese, herrings, anchovies, and all raw fruit are strictly forbidden. The supper should be a little soup—and the time of going to bed is ten o’clock at the latest. Gambling is forbidden. The beer of the place, and light wines are permitted. The Bohemian, Hungarian, and Austrian wines are wholesome; but those of the Rhine, the Rhone, and Moselle may be used. It is recommended to keep the mind tranquil and contented! Alas! the prescription is easily written, but what pharmacy can supply the drug?
The season at Carlsbad extends from the first of May till the 30th of September. It is divided into three epochs. From the 1st of May till the 15th June, those who love quietude, economy, and health, will go to the spa. From the latter period till the middle of August, when the air is nearly as hot as the waters, Carlsbad swarms, like a bee-hive, with legions of invalids and their friends, who lead, as Dr. De Carro says, “une vie bruyante,” and pay handsomely for their accommodations. The last six weeks, like the first, are more quiet, cool, and reasonable in expense. Those, too, who are anxious to have long interviews with their doctors, and pour out all their complaints into his attentive ear, will avoid the hot and fashionable season, and prefer the beginning or end.