# Essay on the mineral waters of Carlsbad/Miscellaneous practical observations

MISCELLANEOUS PRACTICAL OBSERVATIONS.
HABITUAL COSTIVENESS.
A great number of patients, in consequence of a sedentary life, of studious habits, daily abuse of opening medecines, come to Carlsbad without other complaints than habitual costiveness. Our waters remove in general that torpidity of the digestive tube, restore the regularity of its functions and appetite; but such patients, if they wish their cure to be permanent, must absolutely give up those auxiliary means, and join to the use of the waters a regular regimen. We see often individuals affected with a variety of abdominal disorders, and their direct and indirect consequences upon digestion, upon the nervous and cutaneous systems, without being able to discover the least induration or increased sensibility by the touch; but their yellow complexion and their ​hypocondriacal and melancholy feelings evince the abdominal nature of their case, and the necessity of drinking desobstruent waters. Though English visitors have not been hitherto so numerous as patients from all other parts of the world, that slavery to purgative medecines, that fondness for mercurial preparations (calomel or blue pills), that apprehension of danger, if four and twenty hours pass without having their bowels cleaned, have been particularly observed among them. Many physicians of eminence, such as Dr. James Clarke, of London, and Dr. John Abercrombie, of Edinburgh, have of late strongly blamed that national predilection. I shall not repeat here their arguments, founded upon extensive experience; but I have attended many English invalids, who, after a regular course of our waters, felt no more the want of mercurial or other drastic and irritating purgatives, as well as I have seen immoderate eaters, great drinkers, and lovers of refined cookery, contract here salutary habits of frugality and temperance.
BILIARY AND URINARY CALCULI.
The renown of Carlsbad for the expulsion of calculi seems to be old standing, and, according to the Journal kept in 1571 by George Handsch of Limusa, ​Philippine Velser laboured under such concretions. We see every year a great number of patients, in whom their existence is manifest, or at least very probable; others bring with them, as proofs, the specimens they have collected. I remember, amongst others, a patient, with an indurated liver and jaundice, who, after having drunk only three days, evacuated innumerable gall-stones, about the size of small and large peas, with which he filled several boxes. A most remarkable patient of mine, an Italian nobleman, voided daily, during two months without interruption, a good tea-spoonful of gravel, and numberless gallstones, of very different size. I counted once 270, passed in four and twenty hours, of the usual yellow (ginger-bread) colour, but some of them sky-blue. He never felt any pain nor any derangement of health from those double concretions, except an excessive moral anxiety about their prodigious abundance, attended besides with continual borborygms, attributed by some to a collection of gas, by others, to a collection of water, in the bowels themselves, or between them and the peritoneum. This patient, after having drunk during two months, tried the Franzensbad waters, which are chalybeate and acidulous. They stopt both evacuations; he came back to Carlsbad, where, as soon as he began again to drink, both excretions (sand and gall-stones) took place, as copiously as before. I observed, during two seasons, this singular case, but the patient returned to Italy, and gave no further account of himself. The sky-blue ​concretions, which he jocosely called his turquoises, are an excessively rare phenomenon. A year after, I saw again a few blue gall-stones, evacuated by a Russian field-officer, who, during the campaign in Persia, caught a most obstinate intermittent fever, in consequence of which he was sent to Carlsbad. Those blue concretions drew the attention of many eminent physicians; unluckily no analysis took place, but all sorts of conjectures were hazarded on the origin of that colour, amongst others an ingenious one, proposed by a learned Saxon gentleman, founded upon the presence of copper, which analytical researches have proved to exist in several articles of our daily vegetable and animal food. (Almanach for 1833, ch. V.). The celebrated J. G. Walter, of Berlin, collected innumerable gall-stones, described, after his death, by his son Frederick-Augustus, in the Anatomisches Musaeum, I. Th. Berlin. 1796. Some blue ones are to be seen. Plate II et IV.
The most extraordinary case of biliary concretions expelled by the action of our waters, has been published by Dr. Leo († 1729), with the analysis of those concretions by Dr. Pleischl, professor of chemistry at Prague, under the title of Merkwürdige Krankengeschichte einer Gallenstein-Kranken, nebst der chemischen Analyse und Abbildung dieser Gallensteine und des krystallisirten Cholestrins. Prag, 1826. Every one of the four biliary calculi, evacuated at Carlsbad by Leo’s patient, a Saxon lady, sixty-five years of age, are, according to the very correct ​picture annexed to his Memoir, as big as middle-sized walnuts. Though the similarity of their composition with other gall-stones was proved by the analysis, it was questioned whether they had been formed in the gall-bladder or in the intestinal tube. Their dimension appeared indeed so much out of proportion with the usual diameter of biliary ducts, that the belief of their formation in the gall-bladder must partly rest upon the well-known and astonishing power of dilatation and contraction possessed by certain organs, whilst the explanation of their formation in the alimentary canal offers still greater pathologic difficulties. The excruciating pains which attended the evacuation of those enormous concretions and the cholestrin found in them, are sufficient proofs of their formation in the gall-bladder. Such is at least the opinion of the learned professor, Dr. Pleischl.
In a great number of cases, the violent pains in the vicinity of the biliary organs, the sudden cessation of those pains, a visible change in the complexion, and even the total disappearance of the jaundice, leave no doubts about the existence of gall-stones; but, if their passage through the alimentary tube is probable, they cannot always be detected. Most patients are careless about ascertaining the fact; many feel reluctant to trouble their physician with this loathsome investigation; in short, various circumstances render it more or less difficult, and, in order to be conclusive, the examination should take place every day. I attended last year a lady, whose ​frequent pains about the pit of the stomach, were so violent, and the variations of her yellow complexion so sudden, that neither of the two physicians who had attended her for two years, nor myself, could doubt of the existence of gall-stones. The above-mentioned investigation took place, but perhaps not often enough, and without result. Her excruciating pains brought on frequent cataleptic fits, during which she stretched her arms, and joined her hands in the attitude of prayer; she remained then, with staring eyes and absence of mind, above a quarter of an hour, in that state, till the fit subsided and was followed by the three stages of an ague: shivering, heat and perspiration, which lasted a few hours. The storm over, she only felt fatigued, but was soon well enough to go out, to walk and to attend to all her social duties. The waters operated copiously, her urin was turbid and yellow, and she had at Carlsbad only one cataleptic fit, of which I was eye-witness. Having experienced moral affections of a grievous nature, she had two or three slight ague-fits, but no cataleptic symptoms.
In cases of sand and gravel, our waters are particularly efficacious. George Handsh tells us, in the Journal he kept in 1574, that archduke Ferdinand was freed at Carlsbad from three urinary calculi, one of which was as big as an almond; and P. G. Schacher wrote, in 1711, an interesting paper: De thermarum Carolinarum usu in renum et vesicae calculo. I have attended a great number of patients, ​afflicted by such diseases. The effect of our waters is powerful, when those concretions do not overpass the diameter of the urinary passages, but little is to be expected from their lithontriptic action upon bigger stones. Their solidity and composition being very different, the effect of the water cannot be the same upon all, and we have not the means of ascertaining their nature in the human body. The best authors, particularly Becher, pretend, and many cases have confirmed to me the truth of their observation, that our springs correct and destroy the tendency to a formation of stones (lithiasis), and of late French lithotomists and lithotritists, among them Dr. Civiale himself, have sent to Carlsbad patients successfully operated, to prevent the reproduction of calculi.
ARTHRITIC AND HEMORROIDAL DISORDERS; CHLOROTIC AND OTHER FEMALE MALADIES; METALLIC INFLUENCES, etc.
Arthritic and gouty disorders, every where so frequent and so cruel, find here essential relief, and sometimes their complete removal. Becher, after thirty years practice, affirmed that one third of the patients he had treated at Carlsbad, suffered more or less from that morbid principle. A physician, ​his predecessor, P. G. Schacher, wrote a good Essay on this subject: Dissertatio de thermarum Carolinarum usu in arthritide. Lips. 1709.
The Carlsbad water, acting with so much energy upon secretions and excretions, and strengthning secondarily our digestive organs, must prove useful in various forms of arthritis, so frequently combined with abdominal disorders. Experience and observation confirm every year that principle; but we can scarcely expect to entirely remove by the waters those calcareous hard concretions, which, in their advanced state, tumefy the joints. They are particularly efficacious in the wandering gout (arthritis vaga), provided patients adopt, not only during the cure, but after it, a proper regimen, and give up luxurious and epicurean habits, so apt to produce and to increase gouty disorders. We see often such dormant evils, roused by the use of the waters, which also cause pains and inflammation of the joints; they frequently bring forward herpetic and other eruptions, which relieve these pains; they even sometimes excite spontaneous blisters and vesicles of various sorts; they very often produce oedematous swellings in women’s feet, which disappear as soon as they give up drinking the waters; and all these external effects prove salutary. That oedematous swelling is mentioned by ancient authors. Gouty complaints are in general more successfully removed by abundant urine, than by copious alvine evacuations.
​The best confirmation of the efficacy of our waters in gouty disorders, and the best description of a complete crisis I can give, is certainly my own case: I was born in 1770, counting, on the fatherly side, four gouty generations. When thirty-five years old, I began to feel this inheritance, by a severe fit of podagra, which lasted a fortnight, after which my foot remained a long time weak and tender, but without any other ailment. A few weeks, sometimes many months, elapsed, without any attack. In 1822, the podagra disappeared suddenly on the third day, and produced the most alarming symptoms: cough, dyspnaea, sleeplessness, intolerable tickling of the throat; copious, puriform and acid expectoration, rapid decay, cadaverous complexion, in short, all the fore-runners of a tracheal consumption. Leeches, guaiac, Plummer’s powders, and particularly, goat’s-milk, restored me, but I never lost a painful sensation of stricture in the trachea, so that the air I breathed seemed to pass over an ulcerated surface, and my voice, like a good hygrometer, following the atmospheric variations, was extinct in damp weather, and returned when dry. A little before my departure from Vienna, in April 1826, the same symptoms returned, but with less general weakness and emaciation than formerly. In spite of the alarming state of my lungs and trachea, which counter-indicated the use of the waters, and attending merely to the arthritic principle, I began to drink, on the 17th of May. On the fourth day, I ​felt a vertigo, lost my appetite, was unable to stand upon my legs, my eyes were sparkling, my cheeks burning, and I had almost apoplectic feelings. These violent symptoms lasted only two days, after which I continued, during six weeks, to drink seven beakers of Neubrunn, beyond which I could never go. I was very little purged, but the excretion of a fetid and oily urine lasted as long as the use of the water. Gradually all my complaints disappeared, and I was fortunate enough to get completely rid of a large herpetic eruption on the neck, which had annoyed me beyond expression during six years, and had resisted a variety of remedies, and even sulfureous fumigations. My health has been since and is still (1835) perfect.
Such a complete and radical cure, operated in so short a time, is not a daily occurrence, and inveterate gouty cases require in general the repetition of the treatment.
Piles, fluent or blind, being oftener a concomitant symptom than a primary disease, it is nearly impossible to give fixed precepts about the use of our waters in hemorrhoïdal cases, which must be examined and weighed in their totality, before we can decide how far Carlsbad may be useful or hurtful. I have seen a few patients where the great abundance of flux obliged me to send them to other mineral waters, acting with less energy on the vascular system. On the other side, I have observed a still greater number of cases of blind piles, where the bursting ​of the hemorrhoïdal vessels and a new flux have relieved painful symptoms of head-ach and general plethora.
In chlorotic disorders and menstrual derangements, the good effects of the Carlsbad waters are less to be expected from the very small quantity of iron-oxyd which they contain, than from their desobstruent quality and their manifest power of accelerating circulation and vivifying the complexion. The same is to be said of leucorrhea, in the treatment of which we must care fully distinguish whether it proceeds from obstruction of the abdominal organs, or from mere debility. The first class can be essentially improved at Carlsbad; the second requires in general other more chalybeate and gaseous waters, such as Franzensbrunn and the Ferdinand’s wells at Marienbad.—During pregnancy and during menstruation, drinking must be interrupted; but there may be cases of very scanty monthly period, during which it may be recommended with success.
We see every year, amongst the indigent patients admitted in the St. Bernard’s Hospital, a few individuals, who, after having worked in the different looking-glasses manufactures of Bohemia, Nuremberg, etc., are unable to continue their profession, on account of a shaking of the whole frame or of some limbs, brought on by the influence of quick-silver or lead. The physician attending that hospital, has assured me repeatedly that the greatest number of them are cured or relieved by the internal use of ​the waters and by bathing. Though such diseases occur rarely in other classes of people, I remember to have treated with success the proprietor of leadmanufactures, and a celebrated painter, affected with numbness of the hand, produced by metallic influences. David Becher quotes some cases, where disorders occasioned by arsenic were cured or relieved at Carlsbad.
I have attended successfully many patients, who had laboured under the yellow fever, dysentery, cholera, intermittent fevers, acute and chronic disorders of the liver and spleen at Antigua, Batavia, the Mauritius, Rio de Janeiro, Calcutta, etc. The symptoms which brought them to Carlsbad were abdominal indurations, morbid complexion, herpetic eruptions, dyspepsy, hypocondriasis, etc., which, in spite of their various geographical origin, did in no respect differ collectively from those of the patients we see every year, coming from all parts of Europe.