# Essay on the mineral waters of Carlsbad/Complaints which Carlsbad can cure or relieve, and those which it aggravates

COMPLAINTS WHICH CARLSBAD CAN CURE OR RELIEVE, AND THOSE WHICH IT AGGRAVATES.
It would be quite impossible to describe all the complicated diseases which we treat at Carlsbad, and upon which we are called to give our opinion. What has been said in the preceeding chapter, will however sufficiently point out the cases in which our waters can be recommanded. Chronic affections offering in general an immense field, we cannot say with precision where their efficacy begins and where it ends. Practical tact and a thorough investigation of the symptoms must help practitioners in their judgement; but few mistakes will occur, if they pay due attention to the following classification, given above sixty years ago by David Becher, which, in spite of all the vicissitudes of medical doctrines and nosological nomenclatures, remains still the most rational. I shall ​add to it, some miscellaneous observations, without systematic order, upon various essential points of our practice.
The virtues of the Carlsbad waters, says Becher, can be reduced to five principal effects:
* They correct the weakness of the primae viae, free them from matters collected and accumulated there, even when inveterate.
* They resolve and dissipate obstructions, particularly those of the abdomen.
* They correct, change, evacuate the acrimony of the blood, or drive it towards the lower exor the surface of the body.
* They expell from the urinary passages sand, gravel and calculi.
* They have often proved very beneficial in many serious disorders, produced by occult causes, difficult to point out.
The last paragraph shows particularly the great utility of providing patients sent to Carlsbad with a good history of their complaints, which are in general complicated, obstinate, and arise from a variety of causes, climate, mode of life, etc. Such invalids, careless about the past, lay often the highest importance upon insignificant circumstances, and say nothing about those which would throw light upon their case. As to instructions, about the mode of drinking, bathing, douching, and steaming, as well as about regimen and diet, which of course should be entirely ​regulated by the medical adviser, to whom they apply at Carlsbad; such instructions, written or printed, which many physicians think proper to give to their patients, are absolutely useless, and often attended with disagreable consequences, if there happens to be diversity of opinions between those instructions and the precepts of the local physician. The worst part of our functions is to be consulted for diseases which Carlsbad can only aggravate, and to find ourselves in the painful necessity of declaring to such patients, that they would have done better to stay at home. Such mistakes, caused by an imperfect knowledge of the effects of our waters, are but too frequent. Supported by hope, the journey to the wells was at least tolerable; but, deprived of all further illusions, the way home is dreadful. More than one arrives here every year to be buried, without having been able to drink a single drop of the water from which he expected recovery, or at least great relief.
They never agree with an inflammatory state, general or partial, nor with symptoms of orgasmus, congestions and vertigo, which must be removed by appropriated means, before the water is administered. Should such accidents take place during the cure, it must be interrupted.
They are decidedly hurtful in every degree of pulmonary phthisis; to individuals disposed to hemorrhagies, and still more during hemorrhagies; they accelerate and increase the pulsations and dilatations, and consequently the rupture, of anevrisms; they ​aggravate all syphilitic complaints, but they can be tried, as touch-stone, in doubtful cases of that morbid principle, which they generally awaken, if dormant. I have seen them however stop chronic and indolent blenorrheas, after the inflammatory and painful period had ceased, when the gleet does not proceed from strictures of the urethra, indurations of the prostate and other organic disorders of the urinary passages.
They aggravate scorbutic affections, and accelerate often the disorganization of abdominal scirrhous parts, when too far advanced. They are in general dangerous in dropsy, though we have seen them succeed in a few cases of anasarca, without visceral indurations of too long standing. If a physician thinks himself justified to try them in dropsical cases, the utmost circumspection and very small doses are necessary. The most delicate part of our practice is to draw a line of demarcation, and to determine, in abdominal diseases, whether the affected part is already in a state of disorganization; and, where consumptive and hectical symptoms have began, whether the waters can be tried, or whether we must refuse them to such individuals. I shall relate a most remarkable case, where I tried them rather unwillingly, following the axiom: Potiùs remedium anceps quam nullum:
An English lady, four and twenty years of age, the last of a family swept off by consumption, had enjoyed good health, till she married, in her seven​teenth year. After her first confinement with puerperal fever, in 1821, she lingered fifteen months. The existence of gall-stones being suspected, she was sent to Cheltenham, whose saline waters brought on a miscarriage (at Carlsbad we never allow pregnant women to drink), followed by an excessive weakness, which yielded to proper regimen and the sea-side. In 1823, she was happily delivered of a third child, which she lost, ten months old, whilst again pregnant of another, still alive and healthy. Her husband having been suddenly called to sea, she lived in continual anxiety, and was seized with a fever, that alarmed her physician, because the delivery was approaching, which however was easy and regular, but followed by an inflammation of the bowels and liver. She was twice bled, twelve ounces each time, and leeches were applied to the temples, on account of violent head-ach. Some milk is said to have been seen swimming in the blood drawn from her, and since that time she always lingered. A second inflammation of the liver was also subdued by copious blood-letting. She tried again successfully the seaside. Pains in the liver and the head, with a violent fever, returned, in 1826; and, after a convalescence of two months, she had an inflammation of the lungs, for which, in less than twenty-four hours, she was twice bled ad deliquium animi, to the enormous quantity of twenty-two and of eighteen ounces, beside innumerable leeches, blisters, etc. In October 1825, her husband returned from the West-Indies to Eng​land. They went to Pisa, Leghorn and Rome, where she became daily worse, affected with pulmonary symptoms, night-sweats, fever, excessive weakness, etc., so that her life was despaired of. A gentleman, coming from Carlsbad, whose waters he had drunk under my direction, for various ailments subsequent to the yellow fever he had undergone at Antigua, advised that lady, though no medical man, to make haste for Carlsbad, quoting his own case, quite different from hers. On her arrival (27th of June 1827), finding in her almost every symptom of hectic fever, cough, excessive weakness, absolute impossibility of standing on her legs, still less of walking, I could not allow her to try the waters, her last hope. I begged of her to wait a fortnight, to allow me to observe her daily, and I advised her goat-milk. The pulmonary symptoms were so much relieved, that, after the stipulated time, I allowed her to try the waters, beginning with two beakers, which I increased, without any inconvenience, to eight daily. The improvement was gradual, and indeed wonderful. She lost her cough, got some embonpoint, and recovered strength enough to take long walks, an airing in a carriage or on a donkey; her good humour returned; in one word, her recovery, from the moment she experienced the desobtruent effects of the waters, became an object of general astonishment and admiration. For the consolidation of her cure, or rather, as she said, out of gratitude, she came again, in 1828 and 1829; she closed even, against my advice, an ​issue, which had been applied three years before on the region of the liver, without any bad consequence; and, in 1831, she was brought to bed of an healthy child.
In this case, therefore, the liver was evidently the principal seat of that lady’s complaints, and the pectoral symptoms, the hectic fever, and complete loss of strength, only secondary and aggravated by immoderate bleeding. Had the pulmonary affections been the primary disease, our waters would have undoubtedly accelerated her death, which seemed approaching, when she arrived at Carlsbad.