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Cornell University Library
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THE SPAS

OF

AIX-LES-BAINS AND MARLIOZ,

SAVOY
RA
POY
AZBS¢

By the same Author

DES EAUX MINERALES DE LA SAVOIE
Paris, 1873
“(ygnog ay7 mots) XTV

 
 

AIX-LES-BAINS ABLIOZ,

SAVOY : : f -

THEIR PHYSIOLOGICAL ACTION, MODES OF APPLICATION,
‘CLINICAL EFFECTS, AND ANALYSIS;

TOGETHER WITH

PRACTICAL INSTRUCTIONS.

BY

FRANCIS BERTIER, M.D. Panis;

PHYSICIAN TO THE BATHING ESTABLISHMENTS OF AIX-LES-BAINAa AND MARLIO£Z; MEMBER
OF THE MEDICAL BOCIETIES OF CHAMBERY AND GENEVA; MEMBER OF THE
SQCIETE PROTECTRICE DE L'ENFANCE, MARSEILLES} MEMBER
OF THE MEDICAL SOCIETY OF HYDROLOGY, PARIS,

 

LONDON:
J. & A. CHURCHILL, NEW BURLINGTON STREET.
[All rights reserved. ]

5
 

fo

 

ah UNIVER,
The 7h |

   
 

President White /
PREFACE

I rrusr that this little work will prove useful to
the physician, as demonstrating the curative pro-
perties of the waters of Aix, and be somewhat of a
guide to intending visitors to the thermal springs of
Aix-les-Bains and Marlioz.

I have to acknowledge valuable aid from the
experience and suggestions of my father, Dr L.
Bertier, Physician and Assistant-Inspector to the
Bathing Establishment for the last thirty-five years.

I also avail myself of this opportunity to thank
the Physicians and Surgeons of the Hospitals of
London and Dublin for their kindness and courtesy
to me during my sojourn amongst them, and for
the great benefit derived from their lectures and
clinics. _

Lastly, my sincere acknowledgments are due
to my confrére, “ Quatorze,” for the faithful trans-
lation of this work.

FRANCIS BERTIER.

Arx-LEs-Batns; July, 1877.
CONTENTS

PREFACE
ContTENTS

INTRODUCTION

CHAPTER I
PHYSIOLOGICAL ACTION

Description and Analysis of the Waters of Aix-les-
Bains :

CHAPTER II
MODES OF APPLICATION

Character of the Thermal System. Thermal, Vapour,
and Douche Baths. Stimulating Effects

PAGE

vil

xii
Vill CONTENTS

CHAPTER IIT

SEDATIVE, OR SOOTHING AND TONIC MODE OF

TREATMENT

PAGE
Piscines (Swimming Baths). Salles d’Inhalation.

Quieting Effects . ‘ ; . 2i

CHAPTER IV
INTERNAL ACTION OF THE SULPHUR

A Course of Water-drinking. The Thermal Fever.
Diet. Poussée. The most appropriate Season
for taking the Baths at Aix. ‘ a 29)

CHAPTER V
THERAPEUTICS

Rheumatism, Acute and Subacute. Arthritis. Rheu-
matoid Arthritis or Osteo-arthritis. Hydrar-
throsis. Strumous and Rheumatismal Affections
of Joints. Muscular Rheumatism. Sciatica . 37

CHAPTER VI

GOUT. GOUTY SCIATICA . . 71
CONTENTS ix

CHAPTER VII

AFFECTIONS OF THE STOMACH AND THE GENITO-

URINARY APPARATUS
PAGE
Dyspepsia. Blennorrhagia. Leucorrhea. Ovaritis.

Chronic Uterine Catarrh. Chronic Metritis.
Fungoid Growths. Dysmenorrhea. Sterility . 80

CHAPTER VIII
GENERAL AFFECTIONS. DIATHESIS

Chlorosis. Anzmia. Debility. Scrofula. Syphilis.
Cutaneous Diseases . ‘ é . 88

CHAPTER IX
AFFECTIONS OF THE NERVOUS SYSTEM

Paralysis. Hemiplegia. Spinal Paralysis. Diph-
theritic Paralysis. Typhoid Paralysis. Loco-
motor Ataxy. Paralysis from Pressure. Hys-
terical Paralysis. Anewmic or Chlorotic Paralysis.
Mercurial Paralysis. Facial Paralysis. Para-
lysis Agitans. Chorea. Glosso-pharyngo-laryn-

geal Paralysis 97

CHAPTER X
AFFECTIONS OF THE RESPIRATORY APPARATUS

Chronic Catarrh—Bronchitic, Laryngeal, and Nasal.
Follicular Pharyngitis. Pulmonary Phthisis.
Asthma . r i z . 104
x CONTENTS

CHAPTER XI

SURGICAL AFFECTIONS
PAGE
Fractures. Stiffness of Tendons, Sprains. Caries.

Pseudo-ankylosis. Wounds by Fire-arms. Dis-
eases of the Hye is : ‘ . 119

APPENDIX

NATURAL ADJUVANTS TO THE WATERS OF AIX

I. Marlioz  . : : : . 123
If. Challes  . : 3 . 127
III. St. Simon . ‘ : ‘ . 130
IV. Chalybeate Spring . 3 ; . lel

PRACTICAL INSTRUCTIONS

Journey to Aix—Trains, &c. . . . 132
History of the Baths - . 2 - . 1382
Description of Aix - i ‘ . 134
Climate ; ‘ ! ; . 185
Salubrity of Aix 5 ‘ : . 185
Curiosities and Antiquities ; é . 186
The Assembly Rooms . A ‘ . 137
Thermal Grottos ‘i i ‘3 . 189
Excursions :
On Foot . : : . . 140
On Foot, or on Donkey . § . 143
In Carriages ‘ ‘ ‘ . 146
By Steamer or Small Boats . : . 11

By Railway f . i - 152
CONTENTS

Booksellers, Stationers, Libraries, &c.
Bankers

GENERAL TARIFF

Subscription to the Assembly Rooms
Hire of Public Carriages

» Donkeys 7

» Boats . 5 3
Tariff of the Bathing Establishment

xi

PAGE
. 155
~ 155

157
157
158
158
159
INTRODUCTION

Somz years ago I sketched in a short pamphlet
the medical history of the principal mineral springs
of Savoy (‘Des Eaux Minérales de la Savoie,’ Paris),
but this brochure, scarcely sufficing for some of our
watering places of secondary importance, was especi-
ally inadequate as regards Aix, of which it only gave
the medical aspect. Since that date five years have
elapsed, during which time I have been enabled to
collect many facts and to group together numerous
observations. These form the basis of this new
work. I regret having to omit many particulars
which have their importance, but the limits to which
I wish to confine myself do not admit of extended
details. I do.not aspire to write a complete disser-
tation, but a practical work, which may aid the
physician as a summary and handbook in the study
of the therapeutic indications of our Sulphur Springs.
To give more weight, and, if I may venture to express
XIV INTRODUCTION,

myself so, more ingenuousness to the clinical part of
my work, I have quoted the names of, and when
necessary, the letters of introduction from the
physicians who have sent me patients, regarding
whom [ have published observations.

In the first place, I purpose studying the physio-
logy of the waters of Aix and of Marlioz, then
enlarging upon their curative virtues, and, lastly,
concluding with some general, practical, non-medical
remarks, intended for bathers who come for the
first time to Aix-les-Bains. But before discussing’
these questions, with the details which form my plan,
I will give an abridged summary of the hydropathic
wealth of Savoy in a rapid enumeration of its prin-
cipal mineral springs. ;

First, by reason of their vicinity, we have the
Eau de Challes, the most mineralised of the sulphur
springs. They contain twenty times more sulphur
than the richest Haux des Pyrénées, and a consi-
derable proportion of iodine. (See analysis.)

Next, there are the Eaux de Montiers, the only
strongly chlorinated and thermal waters of France ;
and then the purgative and tonic waters of Brides,
distant scarcely two miles the one from the other,
Nature appears to have placed them by design in
this proximity, to present, by their union, the
INTRODUCTION XV

elements of a complete medication. Professor
Gubler thus expresses himself respecting the waters
of Montiers in his first course of lectures, when he
passes in review the different waters, strongly or
highly chlorinated, sodic, and thermal. “There is
yet another mineral water almost unknown to the
physicians of Paris, and notwithstanding, well
worthy of attention, namely, the waters of Montiers
(Savoy), which contain 17°16 grammes of salts in
1000 grammes; that is to say, the mineralization of
the principal spring of Nauheim, the Kurbrunnen,
with a temperature much higher, 38° C. (100°4°
Fahr.), and such an abundance of water that one
can bathe in the running stream.” Let us add,
that the position of Montiers, situate at an altitude
somewhat considerable, though in the region of
the vine, offers exceptionably favorable conditions to
the ordinary patrons of chlorinated sodic waters.
There are again the Haux de St Gervais, rightly
preferred in the treatment of the diathese dartreuse
(ringworm, &c.), by two well-known physicians,
Alibert and Dr Hardy: the Eaux de la Caille,
running beneath the celebrated bridge of that name,
on which is a well regulated establishment: the
ferruginous waters of Bauche, and the springs of
Evian, picturesquely situate upon the shores of
XV1 INTRODUCTION

Lake Léman, and so beneficial in many complicated
affections.

From this rapid enumeration, it must be allowed
that the mineral hydrology of Savoy is one of
the most complete and most interesting that can be
discussed.

I should be justified by the occasion which offers
itself so naturally to my pen, to dedicate some lines
to this country, the cradle of the House of Savoy ;
to celebrate its enchanting lakes, which inspired
Lamartine; to describe its rugged or coquettish
mountains; to dilate on the mildness of its climate,
the infinite variety of its landscapes, and the
excursions so prized by the tourist. I must not,
however, enter into all these particulars, but proceed
without further preamble to the medical study of the
waters of Aix.
THE SPAS

OF

AIX-LES-BAINS AND MARLIOZ

CHAPTER I
PHYSIOLOGICAL ACTION .

Description and Analysis of the Waters of Aiz-les-
Bains

Or all the Sulphurous Spas of the Continent, Aix
is unquestionably the most important. The world-
wide reputation of its thermal establishment is
easily accounted for: in the first place, by the
abundance of the natural hot water,—the supply
amounting to a million gallons daily, at a tempera-
ture of 112° to 114° Fahr.; secondly, by the well-
known attention and skilfulness of the shampooers ;
thirdly, by its proximity to Marlioz and Challes,

1
2 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

which, as containing the two strongest sulphur
springs on the Continent, are most useful aux-
iliaries in the mineral water-cure. These three
springs act together in complete medical harmony,
and, notwithstanding their different properties, pre-
sent many conditions admitting the happiest com-
binations in medical treatment, and answering all
the requirements and indications of sulphurous
therapeutics.

“The climate of Aix,” says Dr Garrod, in his
‘Treatise on Gout and Rheumatic Gout’ (3rd edi-
tion, London, 1876), ‘‘is Italian, and for English
patients the best time for undergoing the course is
during the months of May and June, or the month
of September. The douche forms a very important
speciality in the treatment at Aix, and this is
combined with the influence of the hot vapour from
the waters, together with ordinary bathing in, and
drinking of the Aix water. When a large amount
of sulphur is desirable in the form of the sulphide of.
sodium the water of Marlioz, situate about a mile
from Aix, or the Challes water, from near Chambéry,
which contains, not only a very large amount of
sulphur, but also iodides and bromides, is employed
internally in the treatment.”

Two sources supply the thermal establishment at
PHYSIOLOGICAL ACTION 3

Aix, the one called the Eau d’Alun, the other de-
nominated the Eau de Soufre. These waters differ
only as regards their points of egress; they are
nearly identical under the double relation of mine-
ralisation and temperature, the latter at the two
fountains being from 45° to 46° C. (113° to 114° F.).
As to the mineralisation or chemical composition of
the waters of Aix, we quote the result of the experi-
ments of M. Joseph Bonjean, a pharmaceutist of
Chambéry, who devoted much time and labour to
their analysis.

Analysis of the Sulphur Spring at Aix-les-Bains
TEMPERATURE 113° Faur.

In 1000 grains of water there are contained :

Nitrogen . . . - 0°03204 gr.
Free carbonic acid P 5 . 0°02578 ,,
Free sulphuretted hydrogen. - 004140 ,,
Silex . * . - 0°00500 ,,
Phosphate of alumina .
a of lime ‘i < - 7000249 ,,
Fluoride of calcium s ‘
Carbonate of lime : : . 0°14850 ,,
55 of magnesia . 3 . 0°02587 ,,
“ of iron « * . 0°00886 ,,
.of strontia . . . traces
Sulphate of soda ‘ : - 0°09602 ,,

» of lime i a: + 0:01600 ,,
4 PHE SPAS OF AIX-LES-BAINS AND MARLIOZ

Sulphate of magnesia . . . 0°03527 gr.

» ofalumina . ‘ - 005480 ,,

» of iron 3 2 . traces
Chloride of sodium i ‘ - 000792 ,,

» of magnesium 7 - 001721 ,,
Alkaline iodides ; a . traces
Glairine . . . indeterminate quantity
Loss. : - - 0:01200 gr.

Total in 1000 grains . . 0°43000 gr.

The analysis of the waters of Alun is practically
identical ; it is therefore not given,

Subsequently MM. Ossian, Henry fils, and Bon-
jean, made some experiments together upon these
waters at the Chemical Laboratory of the Faculty of
Paris, and found in ten litres of the water:

Iodine 0:000486 gr.
Bromine 0:000218 ,,
Iodine 0°003782 ,,
Bromine traces.

Source de Soufre {

Source d’Alun |

This analysis is very old, and accordingly, must be
received with caution on account of the very incom-
plete means of investigation then employed. It
might be as well if the Government would direct a
new analysis to be made as soon as possible.

The springs of Aix are specially remarkable for
the large proportion of sulphuretted hydrogen which
PHYSIOLOGICAL ACTION 5

they emit. Despite this abundance of sulphur gas
they only indicate four degrees by the sulphydro-
meter. M. Durand-Fardel says, ‘“ Fontan remarks
that the waters of Aix are slightly sulphuretted. It
would be, perhaps, more correct to say that they
very quickly lose their sulphur principle. They
also deposit much sulphur and a quantity of sul-
phuric acid, which proceeds to organise itself in
forming sulphates upon the walls, the iron-work,
the timber it encounters, reddening the materials ”
(‘ Traité Thérapeutique des eaux Minérales de France
et de l’Etranger,’ par Durand-Fardel, 1857).
The limit of this work does not allow me to give
a detailed description of the different balneo-thera-
peutic means employed at the establishment at Aix.
The abundance of the water admits of an almost
endless variety. I would, however, mention the
following :
25 spacious rooms for the douche.
32 private bath-rooms.
4 large swimming baths called “ piscines.”
2 old swimming baths.
2 rooms for the “douche en cercle” and “de
siége.”
3 rooms for inhalation and spray douche.
8 docal douches.
6 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

6 rooms for general and local vapour baths.
2 douches called “ enfer,” &c. &c.

The out-pour of these two springs, as before
mentioned, is a million gallons a day, and that of
the night being stored up in large reservoirs,—
arranged so as to maintain the original heat of the
water, 46° C, (114°8° Fahr.),—supply each day, and
almost exclusively in the morning, more than 1200
baths, 2000 douches, and 200 inhalations, say in all
38400 major applications, without naming accessory
ones.
CHAPTER II
MODES OF APPLICATION

Character of the Thermal System.—Thermal, Vapour,
and Douche Baths.—Stimulating Effects

Ir is easy to reduce the various medications,
stimulating, revulsive, alterative, tonic, and sedative,
of which the numerous medical writings treat
concerning the waters of Aix, to two general types.
They are:

1. The stimulant or exciting medication ; and

2. The sedative, or soothing and tonic medication.

I shall consequently study in the waters of Aix
the two effects which answer to this double medica-
tion.

Let me say, at once, that the first demands much
prudence and judgment in itsemployment. Dr Ber-
tier, my father, thus expressed himself on this point, in
a pamphlet published in 1853, ‘ Whence comes this
danger? It is the result of the misuse, too often
8 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

made, of the douche, in indulging in it imprudently,
and without submitting to the instruction of a
physician, a proceeding always necessary. In
acting in this manner the bather exposes himself to
the consequent ill-effects, for the douche and the
vapour bath give an enormous force and activity to
the waters. In this form of application is centred
the exceptional merit of the waters of Aix; it is
to it that they owe their ancient reputation. The
douche and the bains de vapeur every year effect
many marvellous cures ” (‘ Remarques sur l’Action
des eaux d’Aix dans la Phthisie Pulmonaire’).

I would state here, so as not to revert to it, that
the results of stimulation are not due to the
intrinsic action of the waters of Aix, since their
mineralisation consists especially in a hyposthenic
gas—sulphuretted hydrogen. In fact, this is the
opinion put forth on the subject by M. Durand-
Fardel in his ‘ Traité de Thérapeutique des eaux
Minérales de France et de VHtranger’ (p. 99).
“This thermal station (Aix) is of great importance,
less perhaps for the intrinsic quality of its waters as
for their great abundance, their temperature, from
which excellent advantage can be derived, and the
extreme perfection of their management and their
methods of administration. Such, indeed, is the
MODES OF APPLICATION 9

attention given to that part of the treatment, which
includes the douches, the vapour bath, the sham-
poing, &c., that the chemical or medicamentous
qualities of the mineral water seem to vanish in great
part before means of action of quite a different
order.”

Three causes concur to produce stimulating effects
in a mineral water. They are:

1. Dynamization, apparent or latent, which
includes heat and electricity.

2. Mechanical action.

8. Chemical combination.

1. The investigations of M. Scoutteten, of Metz,
prove, in an unobjectionable manner, that electricity
plays an important rédle in mineral waters. But
though recognising the existence of this action, we
cannot, seeing the actual state of our knowledge,
assign to it, in a positive manner, the part which it
takes in the production of physiological phenomena
yet unexplained. But it matters little whether it be
to electricity or to other causes, which have hitherto
escaped all means of investigation, that they owe
part of their peculiar properties; the unquestion-
able fact still remains, that waters artificially heated
never bring about the same physiological and
therapeutic result as springs with natural colorifica-
10 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

tion. Thermality is the true cause of the stimula-
tion, or, at least, the most efficacious cause. It
suffices even to explain the success of indifferent
waters, such as Chaudes, Aigues, Néris, and Plom-
biéres.

Hydrotherapeia, that is to say, the application of
cold, can produce some of the effects of stimulation
corresponding with those obtained by thermality,
but it can only be exceptionally employed by a
person affected with rheumatism in whom reactions
are generally difficult.

I honour myself in sharing here again the
opinion of Professor Gubler, when he affirms that
those waters are not the most mineralised which
best exhibit this stimulating action, but those which
are at the same time the most thermal, the most
abundant, and the best administered. According
to him, although Baréges and Luchon are in this
category, they are much inferior to Aix, where one
has a vaporium of 40° to 45° C. (104° to 112° Fahr.),
and so large a quantity of water that the different
bathing operations can be varied to any extent. I
conclude my observations on thermality by quoting
here the remarks of MM. Trousseau and Reveil.
“The thermality of the waters plays a réle impor-
tant as therapeutic, whether its action be considered
MODES OF APPLICATION 11

as isolated, or as combined with the other elements
of mineralization. It plays also a rdle in the com-
position of the medicament which the waters con-
stitute. Though it might be easier for us to arti-
ficially impart to a mineral water the degrees of
temperature it has lost, than to imitate its chemical
composition, this artificial thermality would not
correspond to the natural thermality. Not that
these would be different, the one from the other—
such an idea would be contrary to the most ele-
mentary notions of physics—but because, in becoming
cold, waters, naturally warm, alter themselves in
some way. By this fact alone, a portion of the
chemical elements, held in solution by reason of a
certain degree of temperature, precipitates itself,
the chemical combinations are modified, and in
re-heating them we could not restore them to their
primitive state.” (‘Traité de Art de Formuler,’
Paris, 1859).

2. Under the section of mechanical action, it is
necessary to understand the different processes
which are employed with so much success at Aix,
such as the shampooing, la percussion de l’eau; in
a word, the douche with all its varieties. Sir
Dominic Corrigan has thus described them in some
notes respecting Aix, written after a residence there,
12 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

from which he derived the happiest results. “ At
eight o’clock (I rose at seven o’clock) there was at
the door of my bedroom one of those sedan-chairs
already described. A double blanket provided by
the hotel, and white as snow, was spread upon the
seat and upon the foot-board, which was so con-
structed as to be lengthened or shortened, according
as required for the feet. In this I was folded up
half dressed, the curtains drawn, and the journey
commenced. It did not occupy more than six or
eight minutes to reach the establishment. A door,
half-glass, was then opened, and I found myself in
the douche-room, about six or eight feet square and
twelve high, with an arched brick roof, large and
airy, with a floor in which there was kept constantly
a depth of three or four inches of hot water, circling
about from two pipes of about one inch and a half
diameter, the superfluous water running off through
a discharge opening. In this douche two able--
bodied attendants—and indeed they required to be
so from their unceasing labours—took me by the
hands, and placed me sitting on a wooden stool, with
a smaller and lower stool for my feet. They imme-
diately commenced operations. One stood in front
of me, the other behind me; and while each directed
a tube, in full force, of hot water upon back, shoul-
MODES OF APPLICATION 13

ders, arms, and legs, each attendant laboured stre-
nuously in shampooing back, shoulders, arms and
legs. This process lasted about fifteen minutes,
the two tubes discharging their contents with the
force of a fire-engine; and as each discharging tube
obtained its supply from two united tubes—one
with very hot water, the other with cold—the tem-
perature was raised instantaneously, to please the
' bather’s feelings, by a tap on each stop regulating
the supply, the guide to temperature being a ques-
tion from either of the shampooers if it was “bon!”
This process being at length completed, I stood up,
and was assisted, if necessary, by one of the attend-
ants, to a round iron bar secured in the wall at each
end (but separated from it by a small space), on
which I rested my hands, with my face to the wall,
much in the same position in which I might suppose
a garotter to be placed for his flogging. While
this was being done the second attendant fitted,
on the open end of one of the discharge tubes, a
‘rose,’ like that of a garden watering-pot. He then
laid on a stronger and hotter force of water, and
made it play over back of neck to heels, now here,
now there, now everywhere, until one felt as if this
needle-bath were flaying one, and yet the sensation
was not of pain, but of pleasure verging on pain.
14 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

This did not continue more than two minutes, I
think, but the time seemed much longer, when a
bell rang, one blow, and then the ‘maillot,’ or
swaddling clothes, arrived.

‘The glass door into the bath-room was opened,
and there appeared in the doorway the sedan, or
‘chaise & porteurs,’ with its curtains drawn back,
its foot slide drawn out, and a doubled white sheet
spread out to sit on, and reaching as high as my
shoulders, with ample folds to envelope the feet.
While one of the doucheurs still continued the
necessary discharge of hot water on the legs, the
other applied a hot napkin over the neck and chest,
and then, having hastily dried me, and tied over my
head and knotted under the jaws another napkin,
folded crosswise, in the style of one of our country-
women carrying a basket of eggs to a country fair,
I sat down in the sedan and was quickly enveloped
in a hot sheet, over which a thick warm blanket
was folded; the curtains being drawn close the
bearers set out, and in a very short space of time
deposited me at the bedside in my hotel. Here,
without disturbing any of the wrappings, the two
carriers—‘ porteurs’—lifted me by the legs and
shoulders, and quickly dropped me into bed, and
drew the bedclothes over me. The hot packing
MODES OF APPLICATION 15

was delicious, and for twenty minutes I enjoyed a
most refreshing sleep, or composure of brain. At
the end of that time my ‘ gargon,’ who had accom-
panied me with the blankets from the hotel, entered,
bearing on his arm a pannier. This is an open
basketwork, like a child’s go-cart of wickerwork ;
it is about four feet high, of equal diameter through-
out, and divided across the centre by an open
‘wickerwork partition. In the upper portion were
some napkins and my nightdress, which rested on
the sides and open work partition, while in the
lower portion hung, suspended by a cord from the
screen above, an iron brazier containing red-hot
wood ashes. This arrangement heats napkins and
nightdress to a most comfortable temperature, and
at the same time protects them from being scorched,
or burnt by the live ashes. The ‘gargon’ pro-
ceeded quickly to divest me of the ‘mailiot,’ or
swaddling clothes, to put on my hot nightdress,
to lay over my chest in front and on my shoulders,
on each respectively, a very hot napkin, and over
these the ordinary bedclothes, and he then left me,
telling me that I was thus placed ‘ pour calmer,’ and
that I might so sleep, or lie as long as I liked. The
process, as far as any interference from without was
concerned, was now completed, and, thus left, I fell
16 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

into a refreshing sleep of half an hour. Some
persons sleep much longer. Such was the douche.”

“Ta douche Hcossaix,” the name given to it at
Aix, subjects the patient to a quick transition from
heat to cold alternately. It produces the same effect
as the hydrotherapeic treatment, over which it
nevertheless has the advantage of being able to
expedite reaction by means of the warm water with
which the body is bathed at the finish, without
naming besides some principles and virtues of the
mineral water which are not met with in the treat-
ment by ordinary cold water.

The vapour bath consists in placing the whole,
or a part of the body in a special apparatus, whither
is conducted vapour, natural and condensed, just
evolved from the thermal water circulating in reser-
voirs beneath.

8. By chemical combination is understood the
manner in which the elements of mineralization are
united. The manner of union is not known to
analysts. These combinations produce stimulating
effects upon the skin only in proportion to their
presence in the mineral water—such as the powerful
Chlorinated Sodic and Sulphuric.

The waters of Aix rest their reputation of being
stimulant principally upon the causes of excitation
MODES OF APPLICATION 17

already mentioned—namely, electricity, thermality,
and the stimulating mechanical processes employed.

Through this stimulation three kinds of effects
are obtained—a, Immediate; (3, Consecutive; and
y, Ulterior.

a. The Immediate Effects.—There is a peripheral
redness of the whole body ; the circulation is accele-
‘rated; the temperature of the blood rises from
about 1° to 2° C. (1° to 4° Fahr.), since any cooling
through the lungs, or evaporation by perspiration,
is prevented in an atmosphere so thoroughly satu-
rated with vapour; the pulse becomes fuller, and
the respiration is quickened. There is a sense of
uneasiness, and sometimes precordial spasm accom-
panied with giddiness. But, happily for the patient,
perspiration sets in—it is the safety valve—a pro-
fuse perspiration, which increases in proportion to
the phenomena we proceed to point out, of which it
corrects the inconveniences, and prevents the dangers
arising therefrom.

B. The Consecutive Effects are not slow in showing
themselves. There ushers in a singular relief, a re-
markable suppleness both of muscles and joints,
walking is easier; lastly, the bather experiences
general comfort.

2
18 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

y. If this stimulation be submitted to several
times, the ulterior effects are obtained. By means
of the perspiration, a serous exudation is produced,
having its “‘contre-coup ” in the lymphatics and
capillaries, which undergo a very opportune degree of
distension in plethoric constitutions. All the func-
tions are carried on more easily. One can say, with
Professor Gubler, that the whole system experiences,
as it were, a real “ appel de vivre.” Nevertheless,
at times, there intervenes some prejudicial pheno-
mena, such as constipation, a slight sense of fulness
of the head, and even moderate fever; but these
symptoms quickly pass away under a temperate
regimen, aided by any mild alkaline water taken at
meals, such as St Simon (near Aix), St Condillac,
or St Galmier, together with a slight purgative.

Before leaving this subject, and without entering
into the numerous therapeutic applications of the
sulphurous waters of Aix, which will form the theme
of a special chapter, I will refer in a few words to
some affections this stimulating method applies to
more particularly. It invigorates the vital actions
collaterally only, it accelerates the circulation, it
absorbs the tissues in course of proliferation, and
incites to activity latent forces. The organism
\

MODES OF APPLICATION 19

‘sustains, on the whole, a real loss, but by stimula-
tion it reaches a much greater functional activity,
‘permitting it to repair in part this loss.

What I have said justifies the employment of this
method of treatment in troublesome skin affections,
which must be conducted to an acute stage to
effect a cure—the cases in which Professor Hardy
employs with success copaiba, such as in certain
forms of lichen, and psoriasis inveterata.

The stimulating method becomes also a touch-
stone in syphilis. The lively excitation produced
upon the skin sometimes brings out, externally, the
specific eruptions which denote the presence of this
diathesis in the economy. When these manifesta-
tions appear, they are valuable signs, removing all
hesitation as regards prognosis and treatment.

Chronic affections of the joints, hydarthrosis,
sciatica, stiffness in tendons or joints,’ and certain
constitutional, and chronic affections alike derive
benefit from this stimulant action. It succeeds also
in certain cases of asthenia, and languor—so often
very troublesome complications.

Lymphatic subjects, overburdened with embon-
point, lose a portion of their grossness by this
treatment. Indeed, powerful stimulating medica-
tion makes the liquids disappear first, then imper-
20 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

ceptibly the adipose tissue itself is absorbed. If,
on the contrary, a moderate and temperate medica-
tion is employed, functional activity is developed,
and the subjects, to whom it is applied, are better
nourished and their systems better repaired—the
results to be avoided.

It is also a means for emptying the lymphatics
and capillaries of persons of soft and scrofulous
tissues. When this result is obtained, a more
temperate and tonic treatment is followed.
CHAPTER ITI

SEDATIVE, OR SOOTHING AND TONIC MODE OF
TREATMENT

Piscines (swimming baths).—Salles d’ Inhalation —
Quieting effects

I wave shown that the stimulating method of the
Aix treatment consisted of the employment of
vapour baths, douche Hcossaise, douche chaude to a
temperature of 36° to 44°C. (97° to 112° Fahr.),
with an appropriate shampooing, according to the
effects desired. I would now say a few words about
the sedative, or quieting medication. Let me state
at the onset, it demands much pleasanter proceed-
ings than the stimulatimg method; that is to say,
lukewarm baths, inhalation of the sulphurous gas,
aud douches, at a temperature varying between 34°
and 36° Fahr. In thése cases the .bather is not
wrapped up in the “maillot,’ swaddling clothes,
and is rarely conveyed to the hotel in the sedan, or
22 THE SPAS OF AIX-LES-BAINS AND MARL10Z

“chaise & porteurs.” If the weather be inclement,
and the patient very subject to colds, the sedan
would be necessary. The bather, after the douche,
contents himself with a walk, which favours the
moderate reaction one wishes to result.

The quieting effects obtained by the waters of Aix,
administered otherwise than in douches and étuves,
had already in 1853 attracted the attention of my
father, who wrote at this date: “‘ We must not forget
that side by side with this means, much too ener-
getic in certain cases, and for certain temperaments,
there exists other ways less active, yet nevertheless
very efficacious for taking the waters of Aix. These
are—besides the drinking of the waters—the sul-
phurous bath, the swimming bath, the inhalation
room. The waters of Aix are not then too strong:
they only become so to those who employ them
without judgment, and in the absence of judicious
directions. One must be persuaded that there is
no temperament so feeble, no constitution so debi-
litated as not to profit by them. I have made several
experiments, conclusive by their success, on very
young infants, and on the most delicate and nervous
women, (‘Remarques sur l’Action des eaux d’Aix
dans la Phthisie Pulmonaire.’ Par le Dr Ber-
tier, 1853).
SEDATIVE AND TONIC TREATMENT 23

Since the date at which my father so published
the result of his experience, there has been erected,
the Etablissement de Marlioz with its cold sul-
phurous inhalations. Some very large swimming-
baths have also been constructed at the Htablisse-
ment d’Aix, and the physicians of this place have
brought together all the most varied and complete
agents of the soothing mode of treatment.

Many conditions are necessary in order that a
natural medical water may produce quieting
effect.

In the first place, it ought to evolve a hyposthenic
gas; namely, sulphuretted hydrogen. MM. Trous-
seau and Pidoux thus express themselves on this
point in their ‘Traité de Thérapeutique’:—“ It is
certain that the nervous system and the blood are
particularly influenced by this gas, which has a very
manifest stupefying power. Accordingly one can
understand, up to a certain point, how it diminishes
the inflammatory stimulation of the lungs in chronic
catarrhs, and in commencing phthisis, and how the
mineral sulphur waters give the most unlooked-for
results in the diseases of which we are now
speaking.”

It is necessary, then, that this water be not too
charged with active principles, and that it be taken
24: THE SPAS OF AIX-LES-BAINS AND MARLIOZ

lukewarm, or cold. Lastly, it is essential to have a
complete instalment of baths and douches at a
maximum temperature of 35° C. (95° Fahr.).

The waters of Aix and those of Marlioz, which so
happily perfect each other, combine all these con-
ditions. “The bains and the piscines,” says Sir
Dominic Corrigan, ‘‘may be dismissed in a few
words. The bain is simply a plain warm bath, in
no respect differing from an ordinary warm bath at
home. The piscine is in every respect a most
comfortable bath, and very superior, in my opinion,
to the bain. It is a very fine swimming bath, warm
as the ordinary warm bath. It is open nearly the
whole day, and capable of accommodating about
thirty or forty bathers without crowding, permitting
swimming and diving. It is provided at one end
with a cold douche, in which many of the bathers
take great delight, alternating warm bath and cold
douche. When about to leave the bath, the Oriental
custom of clapping the hands two or three times is
the signal, and an attendant receives you on
emerging with a hot sheet, dries your limbs with
hot napkins, and then assists you, if necessary, in
dressing. The temperature of the piscine was
usually about 35° Cent. or 95° Fahr. I tried the
warm bath in a private room and the piscine, but
SEDATIVE AND TONIC TREATMENT 25

after one trial of éach I invariably gave the prefer-
ence afterwards to the piscine.”

Mathias Mascard carried out in 1801 some experi- .
ments upon the lukewarm baths; these have been
verified many times since. They agree in all points
with those I have been able to make myself at Aix.
I cannot do better than give a résumé of them:

“1, Every bath of a heat below 35°5° C. (96°
Fahr.) lessens the frequency of the pulse whenever
particular causes do not oppose this effect.

“2, The more frequent the pulse is, the more it
deviates from the natural state, the more the bath
lowers it.

«3. The temperature of the bath, which appears
to have the greatest power in lessening the pulse, is
that which I designate under the name of warm, or
lukewarm, from 35° to 29° C. (96° and 85° Fahr.).

“4, The more prolonged the baths, the more the
‘frequency of the pulse is diminished ; I have noticed
that, as regards myself, a bath of an hour and a half
has lessened the pulsations from 63 to 54” (‘ De la
Nature et de Usage des Bains,’ par Mathias Mas-
card, 1801, pp. 79, 80). 4

“ Whilst the warm bath lessens the loss of heat,”
says Dr Braun, “it moderates the normal compen-
sating reaction; and whilst it surrounds the skin
26 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

with an equable temperate medium, it frees the loss
of heat from all variations of time and place, and
produces a quieting effect” (‘On the Curative Effects
of Baths and Waters,’ by Julius Braun. Translated
by Hermann Weber).

The large piscines of Aix, the temperature of
which does not exceed 35° C. (95° Fahr.), and where
one can swim at one’s ease, are also in themselves
veritable “ salles-d’inhalation,” whence the sulphu-
retted hydrogen evolves itself mixed with the vapour
of the lukewarm water. They are doubly sedative.

Of the three means employed to obtain the
sedative action, namely, the inhalation of the sul-
phurous gas, the drinking of the water, and the
lukewarm bath and douche, the first is much the
most efficacious.

Sulphuretted hydrogen, breathed in small quantity,
combines with the globules of the blood, prevents
oxygen reaching them, retards their destruction, and
lessens also the phenomena of respiratory combus-
tion. A portion of this gas, moreover, seizes upon
the oxygen of the air, and contributes also to
depress the temperature of the body. These com-
plex phenomena produce a very marked sedation in
the different systems. One notices a diminution of
the beats of the heart, a lessening of the circulation,
SEDATIVE AND TONIC TREATMENT 27

the blood reaches the different organs in less quantity
and force, and, as a result, there is much less
tendency to hyperemia. The patients also, who
come to Marlioz to respire the gas, experience an
invariable relief, their cough is quieted, the oppres-
sion disappears, and the movements of the heart
become less frequent.

M. Niepce has made some experiments at Allevard,
which would appear as if conducted at Mavrlioz, if
one did not know that these two stations had a great
analogy to each other. He says, ‘ Hemoptysis
diminishes in frequency, and in quantity, and is
rapidly checked by the influence of the not too
prolonged inhalation of this gas (sulphuretted hy-
drogen). The sedation upon the movements of
the heart, and upon the circulation, manifests itself
equally as well even when this organ is not affected,
and one can understand, in consequence, the relief
which pertains to the lungs from this lessening of
the circulation” (‘Sur lAction Thérapeutique de
VEau Sulfureuse d’Allevard, &c. Par le Dr Niepce,
Inspecteur de ces Haux, 1855, p. 47).

This sedative medication, of which I have briefly
sketched the effects, produces excellent results in
cases of simple bronchitis: in tuberculosis with
irritation of the respiratory passages ; that is to say,
28 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

accompanied with spasms, distress, uneasiness, and
tickling.

It succeeds again very well in rheumatic persons
enfeebled by age, or excesses of different kinds; and
lastly, at all times when it is desired to renew the
vital forces of a debilitated constitution.

It is beneficial too for women who suffer from
nervousness and irritability, and for that numerous
class of asthmatics for whom a too rarefied atmo-
sphere, and an elevated situation are altogether
contra-indicated. On entering the salles d’in-
halations, they experience an agreeable coolness,
respiration is easier, and the pulse diminishes in
frequency. They realise all the phenomena of which
we have before spoken.

Professor Gubler says, ‘The Eaux Sulphurées
Calciques also attain to a worthy position, and
render good service in certain forms of tuberculosis
of the respiratory organs, characterised by a con-
tinued irritability of the affected surfaces, which
demands the topical sedative action of sulphuretted
hydrogen, as well as the metamorphic action of the
sulphurous principle introduced into the circulation
through the stomach.”
CHAPTER IV
INTERNAL ACTION OF THE SULPHUR

A Course of Water-drinking.—The Thermal Fever.
—Diet.—Poussée.—The most appropriate season
for taking the baths at Aix

Arrer having briefly pointed out the effects of
the external treatment, I will now say a few words
about the internal cure, which it is often necessary
to employ, concurrently with the first named, in
utilising the warm waters of Aix, or the springs of
Marlioz or Challes, which are cold, but much more
sulphurous.

The physiological action of Sulphur, taken inter-
nally, is described in the following manner by
Professor Gubler :—‘‘ Once having reached the
blood, sulphur acts as a diffusible stimulant, it acce-
lerates the circulation, raises the temperature, in-
flames the viscera, almost determines hemorrhages,
causes headache, sometimes giddiness, increases
cutaneous transpiration, and produces,—when the
30 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

dose is large and long continued,—an appreciable
febrile movement. This fever is accompanied by
an eruption,—erythematous, miliary, or vesico-pus-
tulous,—which can assume also other forms in ac-
cordance with the intensity of the cause, and the
constitution of the subject. This exanthema is
known in thermal stations under the name of
poussée.

* After a time, sulphur seems to be able to pro-
foundly modify nutrition, the anatomical state of
the tissues, and, in consequence, their appropriate
function. This alterative action may be attributed
to the integration of a very great number of mole-
cules of the metalloid into the organic plasma, and
the histological elements which have been poly-
sulphurized.

“The stimulant, or irritant action exercised by
sulphur upon the skin, and the respiratory mucous
membrane, is explained by the passage of this
principle through the secretory apparatus of these
teguments. Sulphur, in fact, is metamorphosed in
the circulation: one part into sulphuric acid, then
into sulphates, which pass in the urine, thus its
diuretic action ; and the other part into sulphuretted
hydrogen, which, like other volatile substances,
escapes by the lungs and the sudoriparous glands.
INTERNAL ACTION OF THE SULPHUR 31

As for the remainder, it is possible that the sulphur
reaches the cutaneous emunctory under another
form, that, for example, of a sulphuretted essence.
Invalids always exhale a manifestly sulphurous
odour, and their emanations also materially effect
the brilliancy of metallic silver’? (‘ Commentoires
Thérapeutiques de Codex Medicamentarius, par
A. Gubler, Professor de Thérapeutique a la Faculté
de Médecine de Paris, &c. &c.).

The sulphurous waters of Challes possess the
property of making the urine, and excreta alkaline.

“. In drinking,” says M. Bonjean, “‘in a day, a
litre of Hau de Challes, by glassfuls every second
hour, the urine, voided five or six hours after the
ingestion of the first glassful, loses its acidity ; it is
then completely neutral, and soon acquires a very
appreciable alkaline reaction. During the continu-
ance of the treatment, the urine preserves its alkaline
state, but it resumes its ordinary acidity when the
use of the mineral water ceases. The alkalinity
does not restrict itself to the urine, it extends to

the perspiration, and the other secretions.
“2. The urine is deprived of all its colouring

principle ; it is rendered as limpid as water, and
does not deposit any mucus.
“3. In becoming alkaline, the urine absorbs,
32 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

moreover, some iodine and bromine, of which the
water of Challes contains considerable proportions.
Without concentrating the urine, it is easy to ascer-
tain, by nitric acid, the presence of iodine, of which
it contains evident traces for six or seven days. I
‘have equally been able to recognise iodine in my
saliva for five or six days ” (‘Recherches Chimiques,
Physiologiques et Médicales sur les Eaux de Challes,’
par M. J. Bonjean).

The Eau de Marlioz, taken an hour before a meal,
notably increases the digestive functions and stimu-
lates the appetite. It is also diuretic, but in a less
degree than that of Challes.

This alkalinity of urine, and diuresis, produced by
the water of Challes taken as a beverage, explain the
good effects derived from the water in chronic gout.
Without doubt, the stimulation produced upon the
kidney provokes the excretion of a greater quantity
of uric acid (which, according to the researches of
Dr Garrod, is secreted in insufficient quantity in
the urine of chronic gouty patients), and prevents
its accumulation in the blood. “ From these, and
other less complete examinations, I am inclined to
think that in individuals who suffer frequently from
gout, even though no visible deformity, or deposits
have resulted therefrom, the kidneys lose, to some
INTERNAL ACTION OF THE SULPHUR 33

extent, their power of excreting uric acid, and that
the blood is often kept impure from its presence ”
(‘ Treatise on Gout,’ Dr Garrod).

Before concluding the physiological study of the
waters of Aix, I must not omit to mention the two
phenomena formerly considered as critical, namely,
the thermal fever, and the poussée.

Without denying the existence of the thermal
fever, I dare to affirm, nevertheless, that it is exces-
sively rare, and that it is not met with in patients
who follow the instructions of their physicians, and
who do not exceed the limits assigned to the
continuance of the treatment, and the length of
each bathing operation.

It is certain that a treatment irrational, or pro-
longed beyond propriety, can, and should bring
about a state of over-stimulation and fever. But
we must guard ourselves against calling all gastric
derangements, though febrile,—thermal fever: de-
rangements which are due to causes already enume-
rated, and to others more accessory, such as the
fatigue of the first douches, the dog-day heats of
summer, or, better still, the too sumptuous mode of
living, perhaps, at the large hotels. The following
are the judicious terms in which Sir Dominic
Corrigan describes this last danger :—“ There are

3
34 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

some impediments, which the waters of Aix have to
contend against, with which we ought to be ac-
quainted, as they interfere to our prejudice as well.
The first of these is the dietary. It is too good for
visitors from our country; the French breakfast, or
déjeiner at. half-past 10 or 11 o’clock in the morn-
ing is too heavy—fish, butcher’s meat, fowl, fruits,
mushrooms, wine, &c., eaten generally in a very
high temperature, followed by a dinner, excessive in
proportion and kind; while in the middle of the
day, and without exercise to work off these
effects, the merits of ‘Cognac,’ ‘Chartreuse,’
* Kirsch Wasser,’ and ‘ Elixir of Spa,’ are discussed
by gentlemen, sous les arbres, who naturally refer to
ladies for their opinions, and mixed in these collo-
quies, now and then, the puff of a mild cigarette, but
not from Irish lips. We had better recommend
ourselves and our friends, in visits to Aix, to avoid
these impediments, and to content themselves with
our own plain breakfast, without wine, and to
refrain from ‘ Kirsch Wasser’ and ‘ Chartreuse,’
&c. There is also a habit of sitting out under the
trees, in the gardens of the hotel, to listen to
travelling musicians and prestidigitateurs. Time
creeps on, and with it the almost imperceptible, but
not less certain and injurious, night chill. These
INTERNAL ACTION OF THE SULPHUR 35

two counteracting agents, to the good effects of the
waters of Aix, ought to be shunned.”

A glass of Hunyadi Janos, or Birmenstorff water,
taken early in the morning for some days, and
’ repose, aided by a temperate regimen, will speedily
remove this supposed thermal fever.

Formerly, la poussée would have been discussed
as a critical phenomenon, but it is now known to
be simply the result of local irritation produced by
the sulphur, the natural heat of the water, or its
vapour impregnated with sulphuretted hydrogen.
It occurs rarely in bathers who do not follow a too
prolonged treatment, or who do not drink too great
a quantity of the Eau de Challes; but it is seen to
occur often in the shampooers, “ doucheurs and
doucheuses,” as their duties oblige them to remain
many hours in contact with the sulphurous prin-
ciple. It then attacks, by preference, the inner
part of the thighs and the legs. It is characterised by
a rubeoloid eruption, more or less diffuse, but not
elevated above the skin. It is unaccompanied by
any febrile phenomenon, and disappears simul-
taneously with the removal of the cause that pro-
duced it.

There is one point to which I would especially
draw the attention of physicians, namely, the proper
36 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

time they should advise their patients to visit Aix.
This very important subject has never even been
hinted at in the different pamphlets written about
the waters of Aix-les-Bains. I always suggest to
my English brethren, that they had better dissuade
their patients from going to Aix, from the middle of
July to the end of August. During this time, the
heat is somewhat trying, and it might counteract
the beneficial effects of the waters in persons not
accustomed to such a warm climate. The months of
July and August, however, are preferred by the
élite of French society. Our season is then in its
full glory. The months which seem most suitable
for those suffering from any serious complaint, or
who fear the great heat, are May, June, and Sep-
tember, to the middle of October.
CHAPTER V
THERAPEUTICS

Rheumatism, acute and subacute—Arthritis—Rheu-
matoid Arthritis, or Osteo-Arthritis—Hydrar-
throsis—Strumous and Rheumatismal Affections
of Joints—Muscular Rheumatism—Sciatica

Raevmatism is, of all diseases, the one which is
most successfully treated by the waters of Aix.
“These waters are specific as regards it,” says Dr
Lombard, of Geneva (‘Une Cure aux Eaux d’Aix’).
And Dr Guillard adds, “They have a right to
claim for their portion—rheumatic affections, whe-
ther they be simple, or cum materid—those which
M. Durand-Fardel attributes to the Mont Dore,
and those even for which he does not find sufficient a
beneficial thermality, a moderate amount of sulphur,
and which demand, according to him, the waters of
La Bourboule, and those of the sea. All, in fact,
even after having resisted the artificial vapours of
38 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

large cities, and natural waters more mineralized
than ours, but less gifted as regards thermality,
volume, mode of employment, thanks to our in-
stallation so ingeniously varied, find at Aix relief
or cure” (‘ Compte-rendu des Eaux d’Aix en Savoie,’
1858. Par le Dr Guillaud).

Acute rheumatism is one of the forms of this
affection in which the action of the waters is most
promptly felt, especially when the affection is
recent. My father thus expresses himself on this
subject in his Presidential Report for the year 1857.
“ Although it may be understood that the treatment
by mineral waters is only applicable to chronic
affections, it is not so in articular rheumatism. In
this form of the disease, the thermal treatment can
be tried with great success in the subacute stage ;
that is to say, immediately after the acute state has
passed, the invalid ought to be sent to Aix as soon
as he is able to bear the journey. The febrile state
is not always a contra-indication for their employ-
ment. It is true, that in these cases the baths and
the douches cannot be employed, but recourse can
be had to the sulphurous vapours; they are well
borne by invalids, who soon experience from them
happy results.” The intimate relation which exists
between this form of rheumatism, and endocarditis
THERAPEUTICS 39

and pericarditis, explains the success of the waters
of Aix in these affections. Dr Binet, of Geneva,
willingly permits me to put forth here the testimony
of his experience. He has seen several cases of
rheumatismal endocarditis, in infants, completely
cured after a course at this thermal station. The
evidence of Dr F. Vidal, whose experience is great,
is also explicit on this subject. He has told me,
that several of his patients, afflicted with disease of
the heart, not complicated with severe and irre-
mediable disorders, have improved, both in respect
of the circulation and the rheumatism, under the
sedative and tonic treatment. Every year a great
number of invalids, who have had one or several
attacks of acute rheumatism, come to Aix to get
rid of the sequel of this affection, and to avoid a
relapse. Their hope, I am happy to say, is usually
realised, and the reputation of the waters of Aix, in
these cases, is a fact about which all hydrologists
are agreed.

Subacute rheumatism ought to be regarded as a
distinct species. “In this form,” says Dr E.
Besnier (‘Dictionnaire des Sciences Médicales’—
Rheumatisme), “resolution will be slow, opposition
to therapeutic means more marked, the consecutive
lesions much more important and more obstinate;
40 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

functional alterations, articular crackling noise,
periarticular sclerosis, pseudo-ankylosis much less
rare. The contrast is very remarkable as regards
acute articular rheumatism, which, even after its
gravest forms, only rarely leaves consecutive lesions
of this order.”” A residence at Aix will be the most
efficacious means to produce a rapid disappearance
of the articular stiffness, and to facilitate the absorp-
tion of the exudation.

The diagnosis between subacute rheumatism and
certain cases of chronic gout, in which the large
and small articulations are attacked without the
production of tophaceous deposits, is often very
difficult, and the physician, undecided as to the
affection, would have the same indecision as regards
the expediency of a course at Aix; but when I have
demonstrated (see Chapter VI, Gout) that the waters
of Aix give equally satisfactory results in the chronic
form of these two maladies, he should have no
further hesitation about the. treatment.

Case I.—Severe subacute rheumatism in a patient
whose father was gouty, presenting the difficulty of
diagnosis just mentioned.—Lord X—, nearly forty-
five years of age, was sent to me by Dr Langdon
Down with the following letter :
THERAPEUTICS 4]

“ Dear Sir,

«* * * T have sent a patient of mine, Lord X—,
to Aix-les-Bains, and have advised him to consult
you. I shall be obliged if you will give his case your
best attention. He has been for some time the
subject of rheumatism in consequence of imprudence
in hunting, which has exposed him to ‘getting very
wet. Latterly, however, the symptoms are those of
gout—podagra—which he inherits from his late
father. He is just recovering from asubacute attack,
and I hope will be able to leave London on Monday,
reaching Aix-les-bains on Wednesday. I have
restricted him from wines, allowing him only a ditile
whiskey with Apollinaris water, preferring that he
should take the water alone. When he had a high
temperature, I gave him salicin with advantage, now,

and until he reaches you, he is taking quinine.
« Yours faithfully,

“« J. Lanepon Down.”

Lord X— informed me that for the last three
years he had suffered continually in the knees,
ankles, and feet; the latter were a little swollen,
and very stiff. He walked with great difficulty by
the aid of two sticks. His general health was good.
There were no tophaceous deposits on the external
42 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

ear; the affection had not commenced in the large
toe. His father had been gouty.

Towards the end of the treatment, the stiffness
and puffiness of the ankles and small articulations
had almost entirely vanished, and Lord X—
could walk without the assistance of his sticks,
which he had not been able to do for three years.

This case well demonstrates the efficacy of the
waters of Aix in those bastard forms, where rheu-
matism, accidently produced by cold, grafts itself
upon a gouty diathesis. ‘The gouty, very sensible
to atmospheric vicissitudes, are predisposed to rheu-
matism. Gout does not only predispose to rheu-
matism; it can,in blending itself with it, modify the
expression of it, principally in subjects who have
had a previously gouty arthritis, or who are
hereditarily predisposed to the articular manifesta-
tions of gout.” (‘Clinique Médicale.’ Par le Dr
Néel Gueneau de Mussy, Paris, 1874, p. 287).

Case II.— Subacute rheumatism contracted in
India. Hereditary predisposition. Recovery. —
Colonel M— was specially recommended to me
by Mr Arthur Noverre, and Dr Garrod. I append
the letter which the former wrote me touching the
case.
THERAPEUTICS 43

“ Dear Sir,

“The bearer of this note, Colonel M—, had
rheumatism of some form or other hanging about
him for some years in India. I may add there is
rheumatism in his family, and that a younger
brother has had rheumatic fever twice in his life.
Colonel M— came from India in March. In April,
he had an attack of erysipelas of the face and head.
As soon as that passed off, he had an attack of
rheumatic fever. There was at the time, and all
through, a moderation in the symptoms; the
perspirations were not so profuse as usual; the
swelling of the joints was not very great, but there
was a remarkable helplessness in all the joints. The
fever did not run high; the temperature varied from
101° to 108°, soon fell, but remained at about 100° for
weeks; and, as you see, although he has been about
for six weeks, he has not yet recovered the perfect
use of the finger-joints, and has daily some fresh
symptoms of rheumatism in one joint or another

x * X,

* Yours very truly,

«© Artuur Noverre.”

Colonel M— left Aix much benefited, and Mr
44, THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Noverre informed me, some months after, that the
treatment at Aix had completely cured his patient.

In acute rheumatic synovitis, localised in one
joint, when the inflammatory symptoms have dis-
appeared, the local vapour and douche baths with
shampooing, if commenced early, will be found
beneficial in removing the remaining stiffness.

* Tn this affection” says Mr W. Adams, “ the acute
symptoms generally continue for three or. five
months. Suppuration is often feared, but no liability
to this process exists. It terminates neither in
suppuration nor ulceration, but in the effusion of
lymph, and organisation of adhesions, within and
surrounding the joint. The most frequent cause of
this affection is the previous existence of gonorrhea,
but sometimes a history only of leucorrhcea can be
traced, hence the propriety of the term ‘ Genital
Rheumatism.’ In subacute and chronic rheumatic
synovitis, the knee-joint is generally affected, and the
form of the swelling corresponding to the synovial sac
is diagnostic; fluctuation is distinct; there is some
increase of heat and a little pain, but no rednesss of
the skin, and no disposition to suppuration or
ulceration” (‘ Lettsomian Lectures delivered before
the Medical Society of London in 1869.’ By
William Adams, F.R.C.S.)
THERAPEUTICS 45

The vapour baths, and the douche, employed with
prudence, will aid in promoting the absorption of the
fluid, and in causing the puffiness to subside, and
the articular stiffness to disappear. Gonorrhcea also
forms a complication of subacute synovitis, and
though only one joint is generally affected, both
knee-joints may be involved, and rheumatie iritis be
an accompaniment.

We now arrive at a form of rheumatism very
common in England, Ireland, and Scotland, which,
to my knowledge, has not been studied in an
adequate manner by hydrological physicians who
have written on the waters of Aix-les-Bains, and
about which I desire to lay stress here in a very
special manner.

During the last five years* I have had the care of
a number of invalids afflicted with this affection,
and I have been able to study, with benefit, the
modifications stamped on the disease by the thermal
sulphurous treatment. I wish to submit for consi-
deration, not only the result of my experience, but
also the opinions of two eminent physicians,
whose works are as well known in France as in

* The notes which follow are part of a paper read before the

Société @Hydrologie Médicale of Paris at its meeting the 19th
March, 1877.
46 THE SPAS QF AIX-LES-BAINS AND MARLIOZ

England. I refer to the late Dr R. Adams, of
Dublin, and to Dr Garrod, who speak of the waters
of Aix in terms which I shall have pleasure in
reproducing a little later.

It does not pertain to the limits of this book to
give the history of this affection, nor even to
enumerate all the names of the different authors
who have taken note of it. Haygarth, R. Adams,
.Garrod, Fuller, in England; Cruveilhier, Deville,
and Broca, E. Vidal of Paris, Charcot, and Ernest
Bernier, in France, have given a description of it.
It has been successively named rheumatic gout,
chronic rheumatic arthritis, rheumatism of He-
berden, rheumatoid arthritis, osteo-arthritis, arth-
rite séche, usure des cartilages articulaires, rheuma-
tisme articulaire chronique, &c.

Between rheumatism and this form of arthritis,
the resemblance seems, at first, complete enough ;
both are produced by the same influences ; they have
almost the same origin. But chronic articular
rheumatism exhibits itself by its progressive
advance, by the lack of fever, by the absence of
complication on the part of the heart (Garrod) ;
lastly, by its tendency to ulcerate the articular
cartilages, and to eburnate the osseous surfaces. It
can be confounded also with the rheumatism which
THERAPEUTICS 47

frequently follows urethral affections ; the history of
the disease will furnish data in this case for a
correct diagnosis.

According to Professor Charcot, only in a sixth
of his cases had he been able to trace it to heredi-
tary causes. It attacks individuals of all ages, and
without distinction of sex. Dr Garrod says,
** Everything, which causes debility and loss of tone
in the circulation, acts as a predisposing cause, and
it is not unfrequently excited by the same causes
which had led to acute rheumatism, more especially —
by cold and moisture.”

All the articulations can be the seat of this dis-
ease, which affects the internal ear by ankylosis of
the ossicles, the larynx, the jaws, the neck; lastly,
it is often complicated with psoriasis, prurigo,
eczema, but very rarely with endocarditis or peri-
carditis.

If, at the onset, the almost fatal progress of this
affection be not checked, it very soon terminates by
invading all the joints. The invalid loses, little by
little, the use of his limbs, and even of his jaws.
The superior cervical vertebre are also attacked,
causing absolute rigidity of theneck. At length, the
unfortunate sufferer, helpless and impotent, drags
48 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

to the grave an existence as terrible to himself as for
those who are around him.

The waters of Aix-les-Bains have happily the
power of arresting the progress of this sad disease,
and of curing it, when the treatment has not been
delayed too long. In fact, in the first stage of the
affection, when the joints are swollen from accumu-
lation of fluid in their cavities (chronic synovitis),
the waters greatly facilitate its absorption ; and
later, when the joints diminish in size and resist the
touch more firmly, the internal sulphurous tréat-
ment by the Eau de Challes (which acts here doubly
through the large proportion of iodine it contains,
and through the sulphur, which is, at the same time,
tonic and stimulant) combined with the external
treatment (which must be employed with much
circumspection), will be found,—in inciting all the
functions,—to raise the vital forces, to give tonicity
to the circulation, and to ameliorate or cure the
deformities already very marked in the different
joints. With Dr Garrod, I think the administration
of alkalies is altogether useless, and perhaps even
hurtful, in this form of rheumatism ; but, like him,
I always advise, before and after the cure at Aix, a
tonic and reconstituent treatment of quinine, iron,
and cod-liver oil.
THERAPEUTICS 49

There are cases in which improvement would have
been more rapid, and success more pronounced, had
patients been advised to undertake, after leaving
Aix, a supplementary course of undoubted and ener-
getic reconstituent waters, or simply the living in a
dry and elevated locality.

This practice is followed and recommended by Pro-
fessor Gubler, who insists rightly, in his remark-
able work,‘ Du Traitement Hydriotique des Maladies
Chroniques,’ upon the necessity of auxiliary cures.
It is also the practice of Dr Garrod, who gene-
rally advises a supplementary season at Schwal-
bach Spa, or St. Moritz. The latter should be
undertaken during the months of July, and August,
on account of the pure and invigorating atmo-
sphere. lastly, as the greater portion of the
invalids of whom we speak inhabit a cold and humid
climate, they should be advised to pass the winter
following the treatment, in a warm and dry latitude.

It is to the combination of all these adjuvants,

“that the great number of results, obtained in the
treatment of this affection, is due. I have not the
presumption to accord to the waters of Aix an
exclusive specific, for other sulphurous stations,
placed in the same conditions, could also give very
good results.

4,
50 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

I would notice, en passant, the danger to which
invalids, attacked with osteo-arthritis, expose them-
selves in using Turkish baths. They are now in
fashion in the great cities, and are much abused.
Not to be accused of pleading pro domo med, I will
here quote the opinion of a physician, whose im-
partiality and experience are above suspicion. “My
experience of its use,” says Dr Garrod, “may be
thus summed up:

“1, During the time the patient is taking the
bath, and for a short time afterwards, a feeling of
relief from pain is experienced, and the injured
joints become much more movable.

“2, It is very seldom that permanent benefit is
obtained from its use in rheumatoid arthritis.

“3. It very often does much mischief from in-
ducing debility.”

The following is the opinion of Dr Robert
Adams on the treatment of this. affection by the
waters of Aix :— Among the watering-places on
the Continent which have long maintained a reputa-
tion for being useful in cases of chronic affections of
the joints, we should not omit to mention Aix-
les-Bains. The town is exquisitely situated (as
described to me by one of my patients, a young
medical man whom I had induced to go there), and
THERAPEUTICS 51

is surrounded by the most magnificent mountains,
the valleys of which are filled with the richest crops.
Besides, close to the town, is Lake Bourget, one of
the most beautiful lakes I have ever seen, on which
excursions are made in boats by invalids, and the
pleasure of fishing enjoyed.” Then follows a
description of the methods of treatment employed
at Aix. Lastly, the letter terminates with these
lines:

“Since I last wrote, I am happy to be able
to say that I have made a most marked improve-
‘ment. Iam now able to walk about my room, and
up and down stairs, without the assistance of my
stick; and I have even been able to walk a little
about the town without this aid! The pain in my
left shoulder, which has been so annoying during
the last six weeks, has nearly disappeared ; in truth,
in every respect, the improvement has been most
signal. Dr Bertier, the resident physician, thinks
that I may return home in a fortnight.” Dr
Adams concludes his remarks on Aix by another
trenchant observation :—“I may here also refer to
another example, illustrative of the good effects and
mode of application of the waters of Aix-les-Bains,
in a case where an obstinate chronic arthritic affec-
tion of the knee existed, and which had previously
52 THE SPAS OF AIX-LES-BAINS AND MARLIOZ,

resisted much varied treatment. The case was that
of a gentleman, et. 27. He was a learned and
literary man, who, for some time previous to his
having this affection of the joint, had been ex-
hausted by too much mental labour. When I saw
him, he had a chronic arthritic affection of the knee,
attended with a set of somewhat anomalous sym-
ptoms. He complained of a sense of coldness of
the joint, and of uneasiness in it, which seemed to
be relieved only by the constant application of cloths
saturated with cold water. The patient was lame,
and disabled from all kinds of exercise, except that
of a carriage. As the affection of the joint had
hitherto resisted all treatment, this gentleman
resolved to take a course of the waters at Aix-les-
Bains, where he sojourned for six weeks, and he
derived the greatest benefit from following the
means usually resorted to there for the treatment of
chronic affections of the joints. Having heard of
the complete recovery of the knee-joint in this case,
‘I wrote to the patient, and, knowing him to be a
man of much intelligence, requested him to give me
his opinion as to the merits of the waters of Aix-les-
Bains, and as to the mode in which they had been
administered in his case.” (‘A Treatise on Rheu-
matic Gout, or Chronic Rheumatic Arthritis of all
THERAPEUTICS 53

the Joints,’ by Robert Adams, Surgeon to Her
Majesty the Queen, &c.)

The judgment of Dr Garrod upon the waters of
Aix is not less explicit :

“Since the publication of the last edition of this
work, I have had considerable experience of the
value of the treatment by mineral waters at various
spas, both British and foreign. The waters I have
found most beneficial in rheumatoid arthritis are
those of Aix-les-Bains, at which place the douche
forms a most important part of the treatment ;
with the douche is usually combined the internal use
of the waters either of Aix, or Marlioz, or Challes,
I have seen numerous cases of rheumatoid arthritis,
in its earlier stages, most signally benefited by this
treatment, and in several, the disease seemed to have
been completely arrested. The Aix treatment is
also peculiarly valuable when there has been any
skin complication, and one instance will be men-
tioned, further on, in which the effect of the waters
appeared to be almost marvellous.”

Case III.—Rheumatoid arthritis, and extensive pso-
riasis marvellously benefited by treatment ; especially
by a course of Aix-les-Bains waters.—A gentleman,
73 years old, came under my care in January, 1874.
54 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

His history was as follows :—As far as hereditary
predisposition was concerned his mother’s father was
gouty. His own health had been fairly good
throughout life. When about fifty years of age,
however, spots of psoriasis appeared in different parts,
and the disease became much more severe ten
years ago, the whole back being covered with it.
Three months ago, the left thumb was attacked with
pain and swelling; afterwards the toes were
affected. When first seen, several joints of the
hands and feet were swollen, painful, tender, and
stiff; there were pains in the shoulders, and various
other parts. As far as the skin was concerned, there
was a large patch of psoriasis covering nearly the
whole of the back, also many swollen spots both on
the upper and lower extremities.

Under a treatment, consisting chiefly in the
administration of iodide of iron, arseniate of iron,
and cod-liver oil, varied from time to time with
other tonics, he improved considerably, but did not
become well, so at the end of August I sent him to
Aix-les-Bains ; there he underwent the ordinary
course pursued at the place, and became well as to
the skin, and much better as to the joints, which
continued to improve after he left... .”

I further quote the two following interesting
THERAPEUTICS 55

cases. They are selected from among numerous
observations in‘ my practice.

Cast IV.—Severe rheumatoid arthritis with threat-
ened deformity ; recovery.—A lady from Ireland,
Mrs D—, was sent to me in September, 1875, by
Dr Garrod, and Dr Reginald Thompson, of London.
She was about thirty-five years of age. The general
state of health was not satisfactory. She had had
no children. She told me, that she rode a good
deal on horseback during cold and wet weather.
The wrists and the joints of the fingers, were more
or less deformed, swollen, and painful. She could
only half shut her hands. The knees, ankles, and
the small articulations of the feet, were somewhat
enlarged, and very tender. She walked with much
difficulty ; there was crackling noise, and stiffness in
the knees, and the shoulders. The physicians, who
sent her to Aix, recommended her not to return to
England after her treatment, but to pass the winter
in the south. She quitted Aix after a residence of
twenty-five days, which had effected a great relief.
As I had asked her to give me some news of
herself, she wrote me, six months after her departure,
the following letter :

“« After I left Aix-les-Bains last October, I spent
56 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

a little time in Italy, and then went on and stayed
some time at Nice. It got so very cold there, that
I returned to Ireland in December, as I knew I
would have many more comforts at home. I paid
my London doctor a visit on my way, and he said I
was much better, and that the gout had been
arrested. Indeed, I have been wonderfully well all
this winter, and able to get about without any pain.
I cannot speak too highly of the baths at Aix.”

In two subsequent letters, this lady informs me
that the recovery has been permanent.

Lastly, the following observation fully proves
that advanced age, and a great general weakness,
are not contra-indications of treatment of this affec-
tion by the waters of Aix.

Case V.—Rheumatoid arthritis of the neck and
shoulders, accompanied with great prostration, in
a gentleman aged 70 ; much improved by treatment.—
Major-General G— came to consult me in May. .
1876, according to the advice of Dr Garrod. He
was tall in stature, but very bent, and presented al!
the features of great debility. He stated, that he
began to suffer from rheumatism, and to lose his
energies during the last winter, which he had passed
THERAPEUTICS 57

in a very cold part of Scotland. He had felt very
well, and robust the preceding year. His London
physician told him that he was suffering from rheu-
matic gout in the neck, and shoulders. He could
not, indeed, move the head to the left or right, and
it was much bent upon the breast. He experienced
severe pain in raising the arms, and heard a crack-
ling noise in the joints ; he was besides troubled with
a very fatiguing cough. He begged me to tell him,
if I believed frankly, whether his feeble state was
due to rheumatism, or otherwise if age had caused
the general feebleness in him. I told him that
rheumatism had produced all the evil, and that I
hoped to see his strength and energy restored to
him at Aix. He commenced a course of treatment
with all the necessary precautions, and bore well the
douches with the customary shampooing. After
eighteen douches and six baths, he left Aix in a very
satisfactory state of health. About three months
after his departure, I received from him the fol-
lowing letter :

« After your kind attention to me while at Aix,
it is only right I should tell you how I have
benefited.

«We remained in Switzerland, after leaving Aix,
and went to Kissingen about the 12th of July, when
58 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

I commenced taking the waters, and shall have
taken them for twenty-eight days, in a day or so,
when we return to England. About a fortnight
after leaving Aix, I gradually got more strength,
and the rheumatic pains decreased in acuteness.
Since then, I have continued to improve, and can
now walk well, hold myself erect, and turn my head
without much pain. Of course, I feel changes of
weather, but I sleep well, and my digestion is
good.”

Were it not that I feared to lay myself open to
repetitions, and to exceed the limits to which I
would restrict myself, I could multiply examples,
and observations. Those which I have reported,
I hope will suffice to prove the efficacy of the
waters of Aix-les-Bains in this form of rheumatism,

During the last five years, I have had the care of
thirty-two invalids affected with osteo-arthritis of
different degrees. Out of this number, nine have
appeared radically cured after one or two courses
of treatment at Aix; ten have been much relieved ;
in five cases, the affection had undergone a positive
arrest ; in the seven other cases, the local disorders
were too advanced to hope for a lasting amelioration,
notwithstanding, the general state appeared to be
modified in a favorable manner, but I have lost
THERAFEUTICS 59

sight of the invalids of this last category. In one
case, despite the treatment, the disease continued its
fatal progress, accelerated by the development of
pulmonary phthisis.

Chronic hydrarthrosis is also an affection which
the waters of Aix are always able to correct or cure,
as they assist in effecting the absorption of liquid
still diffused, or in relieving the stiffness and the
puffiness of which the joint is the seat.

In strumous affections of the joints, where the
inflammatory symptoms have been checked, and
there is little pain, and no tendency to suppura-,
tion, where the affection is rather a white swelling
of the soft tissues than of the hard ones, and, lastly,
in those cases accompanied with effusion, which
seem as much under the influence of rheumatism as
of scrofula, the vapour and douche baths, skilfully
employed, can confer quite unhoped-for benefits.

The following note bears out this statement :

Case VI.—Periostitis ; effusion into both knees;
white swelling to first degree ; recovery by resolution,
following the thermal treatment.—In the month of
July, 1873, I was consulted by Mr R—, Interne des
hépitaux de Lyons, for articular troubles of the knee
simulating the onset of a white swelling. I made
60 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

him follow a very strict treatment, after which he
recovered completely. He is now a physician him-
self in a city of the Department de I’Ain, and con-
ducts, without difficulty, the duties of a large
practice. In recognition of the waters of Aix, he
has sent me the following very interesting notes of
his illness :

“The pathological antecedents are summed up in
erysipelas of the face and scalp, acquired in the hos-
pital, the 10th of September, 1872. The progress
of this malady was normal ; the convalescence, not-
withstanding, was slow. The 27th of October of
the same year, the patient, without any known
cause, had a slight periostitis of the inner condyle
of the left tibia. Three days after, he experienced
some ague pain in the corresponding knee, and two
days later, in the left knee. The swelling was rather
noticeable; walking was possible, but complete
extension, and flexion were very painful. The 10th
of November, under the influence of a vapour bath,
a slight effusion showed itself in both joints. The
suffering was somewhat increased by it. Several
vesicatories were successively applied. Under the
influence of this medication, and after repeated
paintings with tincture of iodine, the swelling
diminished without disappearing entirely. The
THERAPEUTICS 61

winter passed without any appreciable change. The
treatment consisted of tonics, and iodine applica-
tions. In March, 1873, the invalid was sent to the
south, An immovable bandage was there applied to
the left-knee, after the diseased part had been lubri-
cated with a hundred grains of mercurial ointment,
and enveloped in a wax-cloth, according to the
advice of M. Courty, Professor at Montpelier. This
treatment produced a subacute inflammatory reac-
tion, and very marked pain on movement. As the
malady continued its progress, two lines of Vienna,
paste were applied upon the lateral parts of the
patella tendon, and the joint again kept at rest for
a month, The right knee during this time remained
stationary, with a little effusion, and a little puffi-
ness in the region of the patella.” On the 15th of
July, the patient was sent to Aix-les-Bains. At that
time the right knee presented the state above
described. The left knee was swollen, the synovial
membrane thickened, movements painful and very
limited, the depressions effaced ; the synovial mem-
brane under the patella had extended to each side
of the patella tendon; the lateral cul-de-sacs, and
the parts above the patella, were slightly thickened,
and there was a little effusion. The duration of the
hydromineral treatment was thirty-five days. At
62 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

the end of three weeks, the range of movement was
more extended, so that the patient could walk on
level ground almost without halting. At the close
of the thermal treatment, he could mount the stairs,
but he could not descend them. The right knee
had a slight increase of effusion. Two months after
the treatment, the synovia was entirely absorbed
from the two sides, and the movements of the knee
completely restored. From time to time, neverthe-
less, some lancinating pains were still felt; but
another course of the waters, in 1874, accomplished
the cure.

We had probably to do here with a white swelling
of the left knee affecting the soft parts, and rather
under the influence of rheumatism than scrofula,
for the subject presented otherwise the appearances
of perfect health. He had had neither gonorrhea
nor syphilis; there was no history of scrofula in his
family. I was enabled, in this case, to prolong the
treatment by reason of the vitality of the patient,
the chronicity of the lesions, and the marvellous
progress which each day’s treatment effected on the
malady.

Lastly, to conclude the subject of articular rheu-
matismal affections, I will mention that termed
“periarthrite scapulo-humérale,”’ and studied by
THERAPEUTICS 63

M. Simon Duplay from a surgical point of view
(‘ Arch. générales de Médecine,’ November, 1872).
Dr de Cereuville, of Lausane, in an excellent work
(‘ Bulletin de la Société Médicale Lausanne,’ Mars,
Avril, 1874), assigns a rheumatismal origin to this
affection. Invalids, who are attacked by it, are very
quickly relieved by the waters of Aix, if they submit
to the treatment from the onset of the malady. It
is one of the rare cases which would quite justify the
simultaneous employment of electricity, and the
thermal cure.

Muscular rheumatism, the seat of which is vari-
able, is a form of rheumatism which has nothing in
common with the preceding. Its nature is but
little known, and that little badly defined, yet it can
produce grave disorders, among others—atrophy—as
seen in the deltoid rheumatism of Duchenne.

“In muscular rheumatism,” says Dr Bernier (loc.
cit.), “‘it is the muscular apparatus, viewed in its
widest sense, which is attacked by rheumatism ; just
so, it is the entire articular system which is affected
in articular rheumatism.” It is generally produced
by the sudden cooling of the body whilst perspiring.
But in a patient tainted with rheumatism, causes
the most trivial in appearances, such as atmospheric
influences, excess, fatigue, any injury, can give rise
64 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

to its manifestation in the different muscles. It is
met with rather frequently, and may accompany
acute, or chronic articular rheumatism.

Dr Hayem (‘ Dictionnaire des Sciences Médicales-
Musculaire’) has very well differentiated this form of
rheumatism from ordinary myositis, in which there
is swelling, hardness, protrusion, sharp pain on
pressure, redness of the skin. None of these
symptoms, except the pain, are met with in mus-
cular rheumatism. The douche, vapour bath, and
shampooing, will counteract with advantage the
chronic form of the affection, and prevent the
consecutive atrophy.

Infants affected with chorea, or rheumatic neuro-
pathy, and patients attacked by those morbid mani-
festations which are classed under the name of
“vague rheumatism,” will also derive much good
from a residence at Aix.

Rheumatism can invade the nervous system, and
produce various neuralgias called, “‘ rheumatic neu-
ralgias,’ of which the most frequent is Sciatica.
This affection is treated with the greatest success
at Aix.

A volume could be filled with cases of Sciatica
cured at this sulphurous spa. I have treated
many during the last two years, and, in all, the |
THERAPEUTICS 65

recovery has been very nearly as complete as the
one related a little further on.

I have, in my case-book, the history of a gentle-
man, aged thirty-five years, who presented all the
characters of syphilitic sciatica so admirably studied
by M. Fournier (‘Lecgons sur la Syphilis,’ 1876.)
The patient was sent to me in July, 1874, by Dr
Garrod. He recovered perfectly. I met him in
London two years after his treatment by the waters
of Aix, and was thus enabled to assure myself that
there had not been a relapse.

Gouty Sciatica is also treated at Aix with the
greatest success. A most interesting case will be
found in the following Chapter on Gout.

In some cases of Sciatica connected with Diabetes,
of which I have had to conduct the cure, the
general treatment of the Diabetes, combined with a
special thermal treatment for the local symptoms,
has given marvellous results.

Casz VIIL* Odstinate Sciatica in a young lady
causing Curvature of the Spine ; recovery.—Dr Bil-
lard, of Paris, sent me in June, Miss de W— with
the following note :

* Miss de W— is attacked with a very rebellious

* This case has been communicated by my father.

5
66 THE SPAS OF AIX-LE-BAINS AND MARLIOZ

' sciatica. I sent her last year to the spas of Neéris,
from which she derived but imperfect benefit. She
came again under my care, during a part of the
winter, after the reappearance of the pains in the
autumn. Miss de W— lives in the north, in a cold and
damp locality. I think the waters of Aix may cure
my patient, in whom I take the greatest interest.”

With Miss de W—, besides the persistence of the
pains (which had lasted two years), there was
marked curvature of the spine. After a rather
strict treatment, the pains passed off, and the spine
resumed its natural position. On her way to Paris
in the following month of August, Miss de W—
presented herself again to Dr Billard, who wrote
me the following letter :

«Two days ago I parted with Miss de W—, who
returns to the north almost completely recovered.
I am very happy about it, and I thank you most
especially in my own name for the skilful attentions
you have given her. J have been enabled to watch
her, besides, on her journey for three or four days.
The deviation (of the spine) amounts to nothing.
The pains have vanished.”

Miss de W— returned the following year to
undergo a second treatment, which completed the
cure.
THERAPEUTICS 67

I find in the work by Dr L. Brachet this note.

* Case of Sciatic Neuralgia. Ten applications of
Electricity, twelve douches, and four baths. Success.
—M. B—, 30 years of age, of a strong constitution
and bilious temperament, had suffered for three years
from an affection which had attacked the whole
of the right inferior extremity. He attributes the
cause of it to the camp, and the exigencies of a
military life. He reached Aix the 28rd of May,
18738, after having submitted, without any result, to
a painful treatment of artificial douche and vapour
baths, the application of the ‘Marteau de Mayer,’
revulsives, &c. The pain continued, with some
feeling of acuteness in the course of the sciatic
nerve, which the invalid traced with his finger. At
the level of the great trochanter and of the external
malleolus, pressure caused a most acute pain.
Flexion and extension of the leg were painful ;
walking and standing on the right foot, impossible.
The pain never went away completely ; sleeplessness,
also, had already much enfeebled and emaciated the
patient.

“We subjected M. B— to aseries of douches. After
the second douche, there was exacerbation of the
pain. We, nevertheless, continued the same medi-
cation, alternating it with some sittings of the con-
68 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

tinued current, one pole being placed upon the
origin of the sciatic, the other being applied to the
corresponding muscles. This treatment lasted thirty-
one days, after which the patient left cured. Since
then, he has had no relapse.”

After reading this note, it is true, some doubts
might arise in the mind: ought the recovery to be
attributed to the thermal treatment, or better, to
the electricity; and what portion of the success
belonged to each of these medications? Very fortu-
nately for the waters of Aix, and Dr Brachet can
bear witness with me, it is proven, by numerous
observations, that sciatica, whether from cold or
rheumatism,—which is especially the question here,
—was cured equally as well by the thermal treat-
ment alone, a long time before the. introduction
of electricity was dreamt of in thermal treatment.
It is, then, to the waters of Aix alone that we must
attribute the success obtained.

This leads me very naturally to say a few words
about Electricity as an adjuvant to the Thermal cure.
Dr L. Brachet, following in this the practice of
certain -hydropathic physicians, establishes, as a
method, the simultaneous employment of electricity
and the thermal treatment, as proved by the cases of
sciatica, rheumatic arthritis, chronic general rheu-
THERAPEUTICS 69

matism, and paralysis, which he has treated at Aix
by electro-thermal medication. He foresees the,
adverse arguments which would be directed against
his method when he says :

“We may, perhaps, be accused of confusion in the
combined employment of this electro-thermal medi-
cation. We may be asked, perhaps, if our cures are
due to electricity, to shampooing, to the douche, the
sulphur, or to the thermality of our waters? We do
not care, provided that our patients attain, if not
recovery, at least relief, and if we know that the
relief or recovery is instigated by this double medi-
cation without offering the risks of any fatigue,
There is no need to refer to important physiological
laws in order to appreciate that the application of
the continued current is a happy adjuvant of the
thermal medication (vapour and douche baths,
shampooing).”

I have not the presumption to judge here the
usefulness of a method which others will estimate
with better authority. Nevertheless, I think that
the natural adjuvants of the waters of Aix,—Marlioz,
St Simon, Challes, ferruginous waters, &c.,—form a
complete group, which fulfils in the happiest and
most efficacious manner, without it being necessary
to look for other auxiliaries, all the requirements
70 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

and indications of sulphurous therapeutics. Accord-
ingly, I restrict the use of the electro-thermal treat-
ment to those rare cases in which the physician,.
who sends his patient to Aix, thinks it necessary to
recommend this double medication.
CHAPTER VI
GOUT—GOUTY SCIATICA

“THERE is no question,” says Professor Charcot,
“ that the admirable works on analysis and patholo-
gical histology, which have already made familiar
amongst us the name of Dr Garrod, have inaugu-
rated, for the theory of gout, the era of positive
cognizances.” The discovery of an excess of uric
acid in the blood of patients affected with gout has,
indeed, thrown a new light upon this study. But, as
it does not come within the province of this work to
describe an affection of which an erudite and
detailed history will be found in the treatise by Dr
Garrod (8rd edition), I approach, without preamble,
the principal therapeutic indications of the waters of
Aix in this malady.

It is in the chronic form of this affection that the
waters are beneficial, and in the cedema and stiffness
which remain after the attack.
72 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

The cedema shows itself especially at the inferior
extremities, but it can be observed also at the knee
or the hands. “ In using mechanical appliances for
joints stiffened by gout,” says Dr Garrod, “ the
cause of such rigidity should never be lost sight of,
for injury may be induced by a too harsh mode of
procedure; gentle means, continued over a length-
ened period, are most likely to be attended with
success. In such cases, the use of mineral baths, as
those of Aix-la-Chapelle, Aix-les-Bains, Wiesbaden,
Toeplitz, and Buxton, is often of considerable benefit,
and douche baths and shampooing are especially
indicated.”

When the tophaceous deposits are formed, they
often endeavour to eliminate themselves by ulcer-
ating through the skin, and sometimes without
causing any inflammatory trouble; in this case
only, and at this last stage of their progress, as it
would be, at that time, but to augment the pains,
and to check the work of elimination by using
astringents, local vapour baths are of material use
in facilitating this elimination.

In gouty sciatica, of which further on I quote a
marvellous cure by the waters of Aix, also in affec-
tions of the skin, such as prurigo, pityriasis,
psoriasis, dry eczema, when connected with the
GOUT—GOUTY SCIATICA 73

gouty diathesis—in these cases I have always seen
the Aix waters effect remarkable results.

In assisting the functions of the skin by vapour
and plain sulphurous baths, in utilising the douche,
with shampooing and the passive movements, gouty
persons are placed under favorable conditions to get
rid of their articular complaints, and to avoid
relapses, always to be feared. The douche is in
itself a real exercise, which gives tone to the
organism, and relieves its vital forces. Moderate
exercise, according to Lehmann and Charcot, is one
of the best means to prevent the uric diathesis.

Lastly, the efficacy of these different balneatory
means is pointed out by Dr Garrod in the following
lines :—“‘ The importance of a proper attention to
the skin will be at once evident, when we reflect
that itis by means of this surface that much acid
matter is constantly secreted, and that when the
cutaneous function is suppressed, the blood becomes
less alkaline, and a fit of gout may be thereby
occasioned ; for this reason cold often acts as an
exciting cause of gout, and warmth tends to ward off
the disease.”

We have already seen that the sulphurous water
of Challes, taken internally, is diuretic, and that it
can render the urine alkaline. It stimulates also
74 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

the functions of the kidneys, which have lost, in the
gouty, a great portion of their excretory power;
and, in aiding the urinary secretion, it furthers
also the expulsion of a greater quantity of uric
acid, which it thus prevents accumulating in the
blood. Can it be asserted that the sulphurous
thermal treatment, applied internally and exter-
nally, suffices alone to produce this result? We do
not think so; it ought to be further aided by a
special regimen. It is necessary, in a word, that
invalids carefully avoid all excesses of the table.
An attack of gout, which sometimes occurs during
treatment, and which the invalid nearly always
attributes wrongfully to the effect of the waters, is
the more often due to an error of diet. The
sumptuous living of the grand hotels, with the
temptations, excuses these excesses, but it also
exonerates the physician who prescribes a strict
regimen.

When an invalid delays coming to Aix until
dropsy, anemia, and consumption, the ultimate
attendants of this affection, have undermined the
constitution, the waters, so powerful when the
vital forces are still unexhausted, can do nothing to
check the general atony, or the march of the
malady. i .
GOUT—GOUTY SCIATICA 75

Case VIII.—Passive swelling and considerable
stiffness of the articulations of the ankle and of the
foot, arising from a violent attack of Gout ; complete
recovery after a single cure at Air —Mr X—, a
well-known London barrister,and a Queen’s Counsel,
was sent to me in May, 1875, by Dr Garrod, who
recommended him to me as one of his best friends.
Mr X— was nearly forty-five years of age, of a strong
and robust constitution. He was subject to attacks
of gout (it was hereditary in his case). The last
attack came on at the commencement of February,
1875, so violently that he was obliged to remain in
bed for several weeks. In the course of the attack,
the legs, the ankles, and the feet were puffed up and
swollen, and the corresponding articulations were
very stiff. He was scarcely able to walk by the aid
of two sticks, and then with the greatest difficulty.
There were no appreciable tophaceous deposits.
After four weeks’-treatment at Aix, this gentleman,
who had gradually recovered the use of his limbs,
could walk for three or four miles without the
least fatigue. When I saw him in London in the
month of April of the following year, he told me
that his recovery had been perfect. He had had no
pain, or the slightest attack of gout since his
residence at Aix, and he had been able to enjoy,
76 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

during the autumn, many shooting parties without
being exhausted. Lastly, he believed himself to be
quite cured. He interrogated me as to the advisa-
bility of another season at Aix as a preventive
measure: I replied that I did not deem such neces-
sary. During my last visit to London, in February,
1877, I learnt from Dr Garrod that Mr X— had not
had the slightest relapse.

The following interesting case is taken from Dr
Quissac’s work entitled, ‘De la Goutte et des Eaux
Minérales.’

“ Notes of a case of obstinate Gouty Sciatica ; five
weeks’ treatment at Aiax-les-Bains ; complete reco-
very.—Mr —, nearly 30 years of age, of a bilious, san-
guine temperament, of robust constitution, subject
to an irregular gout, wearied by suffering for many
days from a sharp pain in the region of the right
instep, applied upon this part a nearly cold linseed-
meal poultice. Some hours later, the pain in the
foot had vanished, but it was succeeded by acute
pain in the posterior region of the thigh, in the
course of the sciatic nerve. In vain it was tried to
bring back the inflammation to its primitive seat—
all means failed. Leeches were applied in the track
of the nerve, then flying blisters, and lastly, the
GOUT—GOUTY SCIATICA 77

actual cautery. No progress was made. The invalid
walked with much pain, supported by crutches. The
pains did not cease in the track of the nerve; they
were specially very sharp on movement of the limb.
The saline waters of .... were recommended. The
patient went to the place, drank the waters, took
the baths and the douches. No benefit accrued
after a month’s residence. The state of matters
remained the same until the commencement of the
summer of the following year. He then went to the
sulphurous spa of Aix, in Savoy, a cripple walking by
the aid of crutches. He there made.use of the waters
internally, and externally by baths and douches. A
speedy amelioration showed itself, he made rapid.
progress, and after five weeks’ treatment, threw
away his crutches, and recovered the complete use
of his limb. Twelve years have since elapsed, and
the sciatica has not returned. Mr — is not
altogether cured of the gouty diathesis, for now and
again he suffers from intestinal colic, cramps of the
stomach, sometimes from palpitations of the heart,
with uneasiness in the region of this organ, some-
times from pains in the joints, or in the lumbar
region; but these various symptoms, although very
inconvenient, do not continue for many days, as
they succumb speedily to well-directed remedies.
78 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

The health, with the exception of these attacks, is
very good.”

T could add to these notes many others not less
interesting, but I must not go beyond the limits I
have laid down. I will confine myself to the case of
Sir Dominic Corrigan, who came to Aix in 1875 to
be cured of some gouty stiffness and puffiness in the
lower joints. He derived much benefit from the
thermal treatment, as he affirms himself, in the fol-
lowing letter he wrote to me in April, 1876, when
recommending to me one of his friends :

« My pear Dr Bertier,

“Give my friend, the Very Reverend the Dean
.... your best attention, and you will much oblige
me. I have a-great sympathy with him, for he has
been a fellow-sufferer. Thanks to you, and to Aix-
les-Bains, I am now quite well.

“ Gratefully yours,
“D. Corrigan.”

I deem myself happy in concluding with the
opinion of Dr Garrod upon the waters of Aix in the
treatment of Gout.

“In Gout the Aix treatment is found most useful
in the following class of cases:

“1st. When it manifests itself in cutaneous
GOUT —GOUTY SCIATICA 79

eruptions, especially in the form of psoriasis, or
eczema, whether combined or not with joint.
affection.

© 2nd. When there is considerable passive swelling
and stiffness left after the attacks of articular gout,
or in forms of gout not connected with portal con-
gestion, and in which the influence of the other
thermal indifferent waters, as those of Wildbad and
Toeplitz, is usually found beneficial.

“To Dr F. Bertier, of Aix, I am indebted for much
valuable information concerning the course of treat-
ment followed at the establishment, and for many
details contained in his pamphlet on the Mineral
Waters of Savoy, which want of space prevents me
from incorporating in the present work.”
CHAPTER VII

AFFECTIONS OF THE STOMACH AND THE GENITO-
URINARY APPARATUS

Dyspepsia— Blennorrhagia —Leucorrhea— Ovaritis
— Chronic Uterine Catarrh—Chronic Metritis—
Fungoid Growths—Dysmenorrhea—Sterility

Dyspepsia, to speak correctly, is but one of the
symptoms of a class of affections, such as rheu-
matism, herpetism, gout, which are almost always
cured or improved at Aix. Consequently, it is
understood that the thermal treatment, in acting
upon the cause, also acts upon the effects which
have proceeded from it.

Chronic Enteritis, and dyspepsia connected with
rheumatism, are also much ameliorated by sedative
and tonic modes of treatment, and by drinking the
waters of Challes or Marlioz. One of the first
effects of these waters consists in regulating and
stimulating the digestive functions.
AFFECTIONS OF THE STOMACH, ETC. 81

Chronic vesical catarrh, chronic blennorrhagia in
man, and leucorrhcea in the female, are relieved by
the waters of Aix and of Marlioz. “For such
‘ cases,” says Professor Gubler, speaking of leucor-
rheea (loc. cit.), “the internal. employment of
tonic reconstituent or alterative waters is insuffi-
cient ; it is indispensably necessary to have recourse
to the topical treatment of baths and injections,
associated with the assistance of the ordinary irri-
gator, or better, by means of the speculum tube of
Wickham. The indications fulfilled by these irri-
gations in the bath are :—Ist, To perfectly cleanse
the surfaces; 2nd, to allay any remains of inflam-
mation; 8rd, to invigorate the tissues; 4th, to
neutralise the acidity of the urethro-vaginal pus
reaction, of which I was the first to point out the
existence and to demonstrate the constancy; and
5th, to destroy the lower organisms, so abundant
and so various, which multiply in this product of
secretion, and play, in my opinion, the part of fer-
ments, transforming the alkaline mucus of the
uterine cavity into acid vaginal pus.”

As to chronic blennorrhagia in man, I cannot do
better than give here a very interesting unpublished
and verbal communication from my excellent friend
Dr Diday, of Lyons. Several times he has seen,

6
82 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

under the influence of a thermal treatment at Aix,
old urethral exudations revive and pass, during or
soon after the season, into a subacute or semiacute
state.

This effect, interesting to study from a physio-
logical point of view, has also its therapeutic import-
ance. First, a revival is sometimes very useful
(especially when obtained without recourse to any
local means of injection or sounding) in certain
cases where the blennorrhagic inflammation has,
several times during its course, abandoned the
urethra for the neck of the bladder and the epidi-
dymis. Then by the ordinary means—copaiba
injections, &c.—the flow cannot be influenced
without aggravating or reproducing either cystitis
or epididymitis. And as to these two inflammatory
complications, if they are treated by appropriate
means, without fail there is realised, in mitigating
them, a proportionate exacerbation of the flow—a
real syllogistic circle—from which nature alone is
able to disengage herself with security, but from
which she does not always disengage herself, and
never, at least, without much loss of time.

The thermal treatment of Aix, in reviving the
acute element of the urethral phlegmasia, extin-
guishes all disposition to the return or perpetuation
AFFECTIONS OF THE STOMACH, ETC. 83

of vesical or testicular inflammation. Once the
irritation of the urethral inflammation is realised, it
must be, left to wear itself out; the which it does not
take long to do.

This same effect, this prudent revival, obtained
by the thermal treatment, that is to say, in the
most natural manner, without the intervention of
local irritants, is also the best solution to be hoped for
in exudations deprived of complications. The physi-
cian who will verify such an effect from the treat-
ment at Aix, ought to be informed, that it is of
consequence to respect this mode of action, treacher-
ous in appearance, but, in reality, in the highest
degree advantageously brought forth by our Naiade.
Its severities are never of long duration. It is
necessary to suffer this returning acute stage to
persist for some time, and to interfere only when
after several days it has spontaneously made room
for a period of positive chronicity.

Amenorrhea, metritis, chronic catarrh of the
uterine neck and fungous growths, are treated with
success by the waters of Aix or Marlioz, according
to the case, and chiefly when they are connected
with rheumatism. :

I am happy in being able to put forth here the
testimony of an eminent physician of the Paris
84 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

hospitals, Dr Bernutz, as his remarkable works on
the Diseases of Women place in the front rank the
value of the action of mineral waters in uterine
affections. He has communicated to me a most
interesting note upon a case of Fungosity of the
Uterus (for which M. Récamier advised the employ-
ment of the curette) occurring in a young woman,
seven months after confinement, and accompanied
with continual losses of blood. M. Nélaton several
times cauterised these fungoid granulations, without
obtaining a lasting effect. The patient was sent in
succession to the ferruginous waters of Luxeiul,
then to St. Sauveur (Hautes-Pyrenées) without
further result. At last Dr Bernutz advised the
waters of Marlioz externally, and internally in pro-
gressive doses up to a litre a day. This totally
eradicated the troublesome affection. During the
winter which followed the cure, the patient had a
slight relapse. Dr Bernutz, thinking that the
excellent results obtained before had been especially
produced by the sulphur, advised her to drink the
transported Eau de Challes, but it produced no
amelioration. He then made her try again the
water of Marlioz, which was continued for some
weeks, and again her state improved in a remarkable
manner, The following spring, after a residence at
AIFECTIONS OF THE STOMACH, ETC. 85

Aix, her recovery was completed. She has had no
relapse.

I believe I was the first to call the attention of
physicians to the remarkable effects of the waters of
Marlioz, taken especially en boisson, in cases of
catarrh and of fungosities of the uterus. Since that
time (1873) numerous cases of recovery have been
recorded, thus confirming this remarkable property
of the springs.

To conclude I will quote the following note, which
is short and decisive.

A lady was sent to me by Dr Playfair, with the
following letter of introduction :

“JT have asked my patient, Mrs D., to place herself
under your care should occasion require. She came
home from C., suffering from a very severe form of
chronic uterine catarrh with anteflexion, &c.”’ The
watchful attentions of Dr Playfair had already
brought about a marked amelioration in the state of
this patient. The general health, however, left much
to be desired, and there was besides grave mental
and physical depression. - The combined action of
the waters of Aix and of Marlioz had the happiest
effects, and the invalid left Aix entirely cured by
the treatment.

Impotence and nocturnal emissions are also suc-
86 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

cessfully treated at Aix; and many sterile women,
after having been relieved by treatment of the
mucous obstruction in the neck and the cavity of the
uterus, have borne children. ‘“ We have besides
seen these waters succeed in cases of Sterility,
and especially when it appeared to depend upon a
delicate and very nervous constitution ” (Daquin).

According to Kuss, of Strasbourg, iodine in large
doses renders the plasma of the blood more fluid ; it
augments the number of blood-corpuscles, accelerates
the circulation, and raises the temperature; the
combustions are incited, fat and the elements of
new formations are destroyed in more considerable
proportions, very soon the glands and various en-
gorgements diminish and disappear. This latter
action explains the means by which the waters of
Challes and of Marlioz—which contain a certain
quantity of iodine—employed for a long time inter-
nally and externally, subdue chronic engorgements
of the ovary and of the uterus.

« Hepatitis, chronic ovaritis, engorgements of the
spleen and of the uterus, have been observed to yield
to the administration of the alkaline iodized waters
of Coise, of Saxon, or the iodo-sulphurized waters
of Challes, and of Krankenheil. The employment of
waters of this class appears to us especially indi-
AFFECTIONS OF THE STOMACH, ETC. 87

cated when the engorgement, of which there is
question, leagues itself to a lymphatic temperament,
or when the patient presents the signs of the scro-
fulous diathesis” (‘Traité Général Pratique des Eaux
Minérales de France et de l’Htranger” Par MM.
Petrequin et Socquet).

Iodine is besides aphrodisiac ; moreover it excites
and increases the catamenia, and hence the success
of the waters of Challes and of Marlioz in ame-
norrheea and dysmenorrhea. We hasten to add
that they must be employed when the active con-
gestion of the uterus has given place to a state of
atony and chronic engorgement.

“ When women are of a ruddy complexion, and
the catamenia a little free, and at the same time
painful, iodine, it is true, increases the flow of blood,
but it augments simultaneously the intensity of the
pains” (‘Traité de Thérapeutique.’ Par Trousseau
et Pidoux). In this case I think, with Dr Martin
Damourette, we should prescribe the alkaline waters,
and reserve the iodo-sulphuretted for lymphatic,
scrofulous women, in whom there are no signs of
irritation.
CHAPTER VIII

GENERAL AFFECTIONS. DIATHESIS

Chlorosis.— Anemia.—Debility.—Scrofula.—
Syphilis.— Cutaneous Diseases

I nave already spoken of the excellent results
obtained in Chlorosis by the stimulant medication.
I would add that Anzmia, and Paludal cachexia, are
combated with the same advantages by the same
means. We must, in order to rouse the organism
from its torpor, excite it briskly by the douche and
the vapour bath, then afterwards pass to a tonic
treatment.

«The mineral water of Marlioz, by reason of the
iron and manganese it contains, appears to us most
especially invoked to contend against intermittent
fevers with the cachectic state, in powerfully favour-
ing the regeneration of the blood-corpuscles”
(Petrequin et Socquet, op. cit.).

The waters of Aix by themselves would be almost
GENERAL AFFECTIONS 89

useless against the different manifestations of
Scrofula, but combined with the iodized springs of
Marlioz and of Challes, they give very satisfactory
results. This is the opinion of MM. Petrequin and
Socquet: “We praise them highly (and we have
ourselves derived good effects from them) in scrofula,
goitre, skin affections—as the itch, ringworm,
scald head—in scrofulous ulcers, mercurial salivation,
larval or degenerated syphilis, tertiary syphilis,
scurvy, caries, ozena, scrofulous ophthalmia, pul-
monary catarrh, leucorrheea.”

The herpetic eruptions which affect the lymphatic
or scrofulous temperament, the different affections
of the skin in the gouty and rheumatic, certain
cases of obstinate cutaneous diseases—lichen, pso-
riasis inveterata for example—which cannot be cured
without sensibly exciting them, are much relieved at
Aix by the stimulant medication.

Casz IX.—Chronic Eczema of the legs in a gouty
person, quickly relieved by the thermal treatment.—
In July, 1875, Mrs H— came to Aix to consult me
by the advice of her physician, Dr Tilbury Fox, who
wrote me the following letter :

“ My patient, Mrs H—, has suffered from Eczema,
and is a semi-gouty subject. She needs a mild
90 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

course of sulphur waters, and a change of air, which
I think Aix-les-Bains can afford. She will not bear
any very depressing treatment. Will you therefore
put her through a mild course of waters ?”

Mrs H— had, on her arrival at Aix, an eczema °
occupying a certain portion of the anterior aspect
of both legs. The able treatment carried out by
Dr Tilbury Fox had already much benefited her.
The eczema disappeared completely after a residence
at Aix, and the general health improved. Mrs H—
revisited Aix the following autumn—September,
1876—for a second season. She told me that she
found herself so much better for the treatment at
Aix, that she had had no further need to consult her
physician in London; but that lately the malady
having threatened to recommence, she had decided
to come to Aix without delay to obtain a perma-
nent cure.

I will admit that the treatment at Aix has each
time caused, at the commencement, a slight exacer-
bation of the symptoms; these, however, have sub-
sided little by little, giving place to a remarkable
amendment.

Cast X.—Psoriasis, much improved by the thermal
treatment, and drinking the Eau de Challes—In
GENERAL AFFECTIONS 91

June, 1875, Mrs S—, a very rheumatic lady about
35 years of age, was introduced to me by Dr
Garrod. According to my advice, she followed out
the external thermal treatment, conjointly with the
internal use of the sulphur water, for a psoriasis
guttata very widespread, occupying all the lower
part of the back. Some months after the departure
of Mrs S— I had the pleasure of receiving from her
the following letter, which shows again the utility of
employing simultaneously the waters of Aix and
those of Challes in certain obstinate cases.

« As you so kindly expressed a wish to hear from
me some time after my return home, I have great
pleasure in telling you that my treatment at Aix-
les-Bains has proved most beneficial to my health.
In accordance with your good advice, I have taken
the “ Challes” water after a month’s rest, a dose of
five ounces twice a day, twelve bottles altogether,
and certainly the ‘ psoriasis,’ which perhaps you
remember lingered on my back, has nearly disap-
peared, and no fresh spots have broken out. I feel
most grateful to you and Dr Garrod for your kind
attention and good advice.”

The application of thermal waters to the treat-
ment of Syphilis,” says M. Durand Fardel, “is a
point upon which the greatest harmony appears to
92 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

exist amongst observers, at least with almost very
trifling objection” (op. cit., p. 704).

In the first and second stage of constitutional
syphilis, the waters of Aix themselves operate
neither. upon the lesion nor upon the diathesis, but
they produce in those who make use of them a very
great tolerance for mercury. They favour the elimi-
nation of this medicament by the skin, prevent its
accumulation in the different organs, and protect
the patient lastly from salivation, and the other
accidents mercury can originate.

“A very important fact,” says M. Constantin
Janus, “upon which Fontan has justly insisted, is
the complete harmlessness of mercury upon the
buccal mucous membrane, when it is given even in
considerable doses conjointly with sulphurous water.
We do not know to what cause to attribute this
effect. Shall we say that the mercury combines
with the sulphur to form an insoluble sulphur, and
in consequence becomes inert in our organs? Or
contrariwise, must we admit that the metal escapes
and vaporises itself with the perspiration produced
by the elevated temperature of the douches and
baths?” (‘Guide Pratique aux Principales Eaux
Minérales de France,’ &c. Par le Dr Constantin
Janus, 1851).
GENERAL AFFECTIONS 93

In this affection it is very necessary to assist the
cutaneous functions. In reality, patients whose
skins act well, those who live in warm countries, or
who follow a course at a sulphurous thermal station,
better support mercurial preparations, and recover
more easily from syphilis than individuals placed
under opposite conditions. We know it is difficult
to make labourers, engaged in sewer work, follow a
complete mercurial treatment; their occupation,
necessitating their living continually in damp places,
renders them very subject to colds, and the mercury
being imperfectly eliminated by the skin, very soon
saturates their organisms, and produces the dis-
orders of which all are cognisant.

In the tertiary stage, and in mercurial cachexia,
the water of Challes, which is rich in iodide of
potassium, can be combined with great advantage
with the tonic balneatory treatment.

My excellent friend Dr L. Blanc, in a remarkable
study upon the action of sulphur in the treatment of
syphilis, has demonstrated :—1st. That Sulphur
provokes the elimination of Mercury by the skin.
2nd. That it opposes its accumulation in the
organism, and gets rid of the accidents which result
from it, such as diarrhoea, stomatitis, and the mer-
curial cachexia.
94. THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Lastly, I quote the terms in which Professor
Gubler describes another important property of the
waters of Aix. ‘ When there is a doubt about the
signification of certain symptoms which might be
attributed to syphilis; or better, when, in the absence
of all manifestation, there is notwithstanding reason
to think that the specific cause has not exhausted
its noxious action, certain stimulating mineral waters
can be applied to as a kind of touchstone, in order
to provoke an eruptive poussée, in the train of which
will persist some characteristic lesions permitting
the determining, in full knowledge of the cause, of
an appropriate treatment. This trial test is most
usually assigned to the spas of Aix (Savoy), and
Luchon.”

Cas—E XI.—Constitutional Syphilis successfully
treated without mercury, by tonics and a course of
douche baths at Aixv—In June, 1873, Mr R—,
aged 45 years, called on me with the following letter
of introduction from Dr Diday, of Lyons:

“The patient who conveys to you this note has
been afflicted for some time with a syphilis, happily
tolerably benign, attended to the present without
the specific. He trusts, and I also, for a radical
cure by simple means: those half tonic, half
GENERAL AFFECTIONS 95

modificative of the cutaneous circulation as you direct
at Aix, are well indicated, Make good use of them,
I pray you, in the interest of this esteemed patient,
who has besides a taint of anemia, and of syphilo-
phobia. The Douches Hcossaises are of the number
of agents I hope to see you approve of in this case ;
but I leave to your judgment what you believe
should be prescribed after having seen, studied, and
proved this organism.”

Mr R— was greatly strengthened by the treat-
ment at Aix; no eruption was produced on the skin,
he has had no relapse.

Casz XII.—Tertiary Syphilis—general feebleness ;
great improvement by the thermal treatment.—Mr
X—, aged 55 years, came to consult me in July,
1876, and brought me the following letter from Mr
Alfred Cooper :

“«* Allow me to introduce to you a great friend of
mine, Mr X—, who will place himself under your
care. He has been suffering from rupial sores on
the head, with lupus of nose, which I have stopped
for him, &c.”

The treatment prescribed by Mr Alfred Cooper
had already much improved the head lesions, but
there remained still very sensible traces of them.
96 THE SPAS OF AILX-LES-BAINS AND MARLIOZ

There was besides in this patient a state of general
feebleness of the whole organism. The thermal
treatment in imparting a fresh vigour to the con-
stitution eradicated what remained of the syphilitic
affection. In quitting Aix Mr B— told me that he
seemed to have become ten years younger.
CHAPTER IX
AFFECTIONS OF THE NERVOUS SYSTEM

Paralysis —Hemiplegia.—Spinal, Diphtheritic, and
Typhoid Paralysis—Locomotor Ataxy.—Para-
lysis from Pressure.—Hysterical, Anemic or >
Chlorotic, Mercurial, and Facial Paralysis.—
Paralysis Agitans.—Chorea.— Glosso-pharyngo-
laryngeal Paralysis

Paratysis can be divided into two great classes.
1st, Organic paralysis, in which there exists a lesion,
or some alteration in the substance of the nerve;
2nd, Inorganic paralysis, or sine materia, in which,
on the contrary, no trace of alteration is found in
the nerve tissue.

I. To the first division belong Peripheric Paralysis
due to any compression, and Cerebral Paralysis.

Ist. It includes Hemiplegia or Cerebral Apoplexy,
for which the thermal’treatment has so much the
‘more chance of succeeding as, in the first three

weeks, there be no appearance of muscular contrac-
7
98 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

tion, and the sulphurous treatment be commenced at
an early period of the accident, that is to say, imme-.
diately after the cessation of the febrile movement,
‘© when the malady has entered into a formal way of
resolution.” (Durant Fardel, op. cit.)

The treatment by the waters of Aix powerfully
aids nature in the work of absorption or reparation.
My father has besides remarked in his long prac-
tice, that far from inducing a fresh hemorrhage, the
thermal cure seems, on the contrary, to remove the
chances of it by facilitating the vascular circulation
and the action of all the organs.

2nd. Apoplexy of the spinal marrow, and Spinal
Paralysis in children. Patients affected with these
diseases should commence the treatment as soon as
possible, for there is never a fear of relapse.

3rd. Tabes Dorsalis, so often caused by sexual
excess, the abuse of wine and tobacco, demand the
soothing and tonic method of treatment.

4th. Diphtheritic Paralysis and Typhoid Paralysis,
which especially attack the posterior muscles of the
thigh and leg, and the extensors of the fingers,
demand the stimulant treatment, that is to say, the
douche and vapour bath, shampooing, with the em-
ployment of passive movement. This treatment
often prevents the fatty degeneration of the affected
AFFECTIONS OF THE NERVOUS SYSTEM 99

muscles, and advantageously supersedes the exhibi-
tion of strychnine, too often given without effect.

5th. Sometimes, also, Locomotor Ataxy at its onset
in the purely nervous stage with simple molecular
change, has been cured at Aix. Dr Alfred Hudson,
of Dublin, related to me, on my recent visit to
Ireland, the interesting history of a patient attacked
with Locomotor Ataxy, to which he was called in
consultation a few years ago. In questioning the
invalid, he ascertained the fact of some very distinct
rheumatismal antecedents, and advised a trial of
the waters of Aix-les-Bains. The recovery was radi-
cal and complete after some weeks of treatment. It
will hence be advantageous to have recourse to the
waters of Aix in analogous cases.

6th. Lastly, according to Dr J. Braun, “ In Para-
lysis from Pressure, in consequence of scrofulous or
syphilitic vertebral enlargements, and gouty exuda-
tions, the treatment of such cases cannot be re-
stricted to attending only to the causal indication,
because the paralysis in itself is an urgent symptom,
which, if possible, demands alleviation. Strong
courses of warm baths are the principal remedy.”
‘On the Curative Effects of Baths and Waters.’ By
Julius Braun. Translated, with Notes, by Hermann
Webber. P. 168.
100 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Speaking of Organic and Central Paralyses, Pro-
fessor Gubler writes, “ All that we dare hope is to
xouse the cutaneous sensibility, to restore the peri-
phery, to increase the capillary circulation, to aid
nutrition, and to reanimate muscular contractility ;
mineral waters, no more than other therapeutic
agents, have no direct influence over the medullary
or cerebral lesions. The hydriatic cure is then only
a simple palliative, serving to retard the atrophy of
the paralysed members, and also to ensure the more
rapid return of their motor functions, when the
neural cicatrix shall have formed.”

II. The Paralysis of the second class — sine
materida—is much more efficaciously treated at Aix

‘than the last named. The stimulant or soothing
‘method, applied according to the degree of the pa-
tient’s nervous excitability, gives excellent results in
Hysterical Paralysis, which sometimes affects a limb,
sometimes a group of muscles. This affection is
neatly always accompanied by tonic muscular con-
tractions, which, in this case, do not interfere with
the recovery, and are not attended with the same
dangers as in hemiplegia.

Anzmic or Chlorotic Paralysis; Paralyses which
follow grave acute maladies, nervous exhaustion ;
Reflex Paralyses, those which are due to any shock,
AFFECTIONS OF THE NERVOUS SYSTEM 101

or to fright, not having produced organic disorders
in the nervous tissues ; lastly, the sudden paralysis
of a group of muscles produced by the action of‘ cold
upon a nerve, often disappear very rapidly by means
of the stimulant treatment of the waters of Aix.

I will name, also, the paralyses caused by Metallic
poisoning, saturnine poisoning for example, in which
the thermal treatment easily combats the muscular
retractions, and the other usual accidents.

In concluding the subject of those nervous affec-
tions which derive great benefit from the waters of
Aix, I would mention Facial Paralysis from cold, said
to be from rheumatism, from compression of the facial
nerve in the Fallopian canal, from simple congestive
tumefaction of the neurilemma, and that which fol-
lows from lying on the ground, or against a damp
wall, or in a railway journey with the windows open ;
Lastly, Paralysis Agitans at the onset, Chorea, Facial
Neuralgia (tic douloureux), the origins of which are
sometimes rheumatismal.

As aiding the thermal cure, I believe it is judicious
to advise the patient, after quitting Aix, to have a
special tonic treatment at Spa, Kissingen, or St
Moritz. The pure air of this last place and its
chalybeate water should gain for it the preference,
102 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Case XIII.—Hemiplegia following Cerebral
Hemorrhage, Glosso-pharyngo-laryngeal Paralysis ;
marked improvement.—A friend, Dr Emile Leriche,
a distinguished surgeon at Macon, sent me in J uly,
1874, the letter further on, recommending me one of
his patients. Mr P—, aged forty-five years, had
hemiplegia of the whole of one side of the body. He
could not take a.step without assistance; he spoke
with the greatest difficulty; the saliva escaped,
despite his efforts, from the mouth; lastly, he pre-
sented the characteristic symptoms of glosso-
pharyngo-laryngeal paralysis.

“JT send you Mr P— a Parisian merchant, in
whom the events of the war brought on cerebral
hemorrhage and hemiplegia, which have been
treated by several physicians, amongst them by
Professor Asenfeld. When I commenced to see
him in October last, a seton, which had been in-
serted into the neck for a long time, had produced
a grave adenitic suppuration, which compelled me to
abolish the isssue. I have not had to repent of
this; on the contrary, after a month’s treatment,
Mr P— became much better, and in March
motility had very notably progressed upon the
previous state, when, at the commencement of
April, a cold displayed the misfortunes of glosso-
AFFECTIONS OF THE NERVOUS SYSTEM 103

pharyngo-laryngeal paralysis, which have painfully
reacted upon the general condition. The patient
has been very long in recovering. Happily there
has been marked improvement for the last six
weeks, and as the thermal treatment has not yet
been tried, I believe that there will be much to be
gained by the waters of Aix. Idirect him to you for
this, and I look forward to your report on the
return of my patient.”

After four weeks’ treatment by the douche, and an
appropriate shampooing, the invalid could walk
alone into his room; his strength was doubled; he
spoke much more clearly; finally sensibility and
movement gradually returned in the paralysed
limbs. Dr Leriche, delighted with the results
obtained by the first treatment, again sent the
invalid to Aix the following year, when still more
permanent relief was obtained.
CHAPTER X
AFFECTIONS OF THE RESPIRATORY APPARATUS

Chronic Catarrh,—Bronchitic, Laryngeal, Nasal.—
Follicular Pharyngitis—Pulmonary Phihisis.—
Asthma

Tue waters of Marlioz and Aix, taken internally,
or by inhalations, spray, pulverised douche, or
atomised inhalations, yield very satisfactory results
in clergyman’s sore-throat, or follicular disease of
the pharyngeal membrane, whether it be dry or
granular; especially when it has not invaded the
larynx and the vocal cords. Catarrh and inflam~
mation of the pharynx, of the larynx, and of the
nasal passages, after topical treatment has removed
the acute stage, are treated with success by the
same means.

They succeed, besides, in atony and feebleness of
the mucous membrane of the pharynx, larynx, and
bronchial tubes, “when,” says Dr Charles Fauvel,
the membrane is soft, tomentous and varicose—in
AFFECTIONS OF THE RESPIRATORY APPARATUS 105

that state to which the Germans have given the
name of ‘ venosity.’ ”’

They are also potent in reducing the size of soft
and swollen tonsils in infants. According to Dr
Charles Fauvel who follows, in these cases, the
practice of his late teacher, Dr Blache, the sulphur
cure should always be prescribed before consenting
to operate on these glands gorged with blood, the
ablation of which is often full of danger.

These different affections are especially amenable
to the treatment of the waters of Marlioz, but the
inhalation and pulverization rooms of Aix, of
natural lukewarm water, have likewise their efficacy
in some definite cases.

The internal treatment by the water of Challes,
and the external stimulant, or the soothing and
tonic treatment, according to the case, should be
employed concurrently when the affections of the
respiratory apparatus are related to a lymphatic or
debilitated temperament, or are connected with
rheumatism. Such are, rheumatic coryza, which
often produces a kind of eczema or impetigo pilaris
of the upper lip; chronic retro-pharyngeal granu-
lations, sometimes called “ herpetiques,” but which
are more often under the influence of rheumatism ;
lastly, some laryngeal alterations produced by the
106 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

same cause, rheumatic asthma, chronic and rheu-
matic bronchitis, &c. The judgment of the physi-
cian, his tact and experience, will be sure guides in
the employment of a medication, which is the more
effectual as it is the more complete.

Case XIV. Chronic Congestion and Thickening of
the Nasal Passage, &c ; great improvement after
the Thermal Treatment.—Mr G— came to consult
me in September, 1874, by the advice of Dr
Morell Mackenzie, from whose letter of intro-
duction I extract the following :—“I have recom-
mended Mr. G— to place himself under your care
whilst at Aix. He is suffering from thickness of
the mucous membrane of the nares and congestion,
and does not think that he has received much
benefit from treatment. His nares and nasal
sinuses are naturally very narrow, and hence his
case has proved tedious. I have every confidence,
however, that the excellent waters of Aix, taken:
under your judicious supervision, will bring about a
healthy condition. . . . I think Mr G— should
take the waters at Marlioz. .. .”

This patient, after fifteen days’ treatment, experi-
enced such great relief, that he wrote to one of his
friends, the Editor of the ‘Porcupine’ newspaper,
AFFECTIONS OF THE RESPIRATORY APPARATUS 107

of Liverpool, a long and interesting letter about
Aix. The following is a part of it:—“One day I
take a hot douche, sitting upon a stool, while two of
the bathmen rub me as they do in Turkish baths.
All this time two hoses are playing upon me with
great force, just as if the water came from a ‘ Clint’
fire-engine. I then go and stand on the opposite
side of the chamber, and catch hold of an iron bar;
for, if you do not do this, you would be dashed
against the wall. On the following day I go to the
Marlioz baths and sit in a room where the water
plays like a fountain, inhaling the fumes for about
three quarters of an hour. After that I go into
another room, and have a spray douche for my
throat and nostrils. I also drink several of the
waters, none of which are very disagreeable. I
have only been here about a fortnight, and yet I
find both my throat and nostrils much relieved. I
can now breathe with tolerable comfort, and the
discharges of phlegm, &c., which were so dis-
tressing, are now comparatively slight and natural.

In this patient the functions of the skin were out
of order; there was besides a taint of rheumatism.
These reasons decided me to have recourse both to
the douches of Aix and the waters of Marlioz in
108 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

internal and topical application. The result was
very satisfactory.

Case XV. Sebaceous Acne about the External
parts of the nose; Chronic Congestion of the Internal
parts of the Nares ; much improved by treatment.—
In June, 1875, Dr Garrod recommended to me the
Honorable X— in the following letter :

**I beg to introduce the Honorable X—. He
has some skin affection about the nose, a redness,
&c. I hope the waters and baths at Aix-les- Bains
may prove of value. He is very anxious to get rid
of it. He is going to St Moritz afterwards, and
then to the Rhine, Belgium, and Holland. His
general health is good, but he is very tall, and not
very strong... .”

This gentleman, nearly twenty-two years of age,
had been afflicted for a long time with an intense
sebaceous acne, limited to the ale of the nose,
forming a persistent greasy surface. The interior
of the nose was congested, and the secretion very
abundant; the redness extended to the pharynx.
The treatment consisted of general lukewarm
douches to give tone to the system, and in local
treatment of sulphurous irrigation of the nostrils,
and external pulverization, The Eau de Challes
AFFECTIONS OF THE RESPIRATORY APPARATUS 109

was given internally. The improvement was very
marked after this double treatment. In 1876 the
Honorable X— revisited Aix to perfect the recovery.
The sebaceous secretion was much’ diminished, the
congestion of the nose scarcely manifest. At his
departure this time there was further obvious im-
provement,

Case XVI.—Pharyngeal Catarrh complicated
with Chronic Spasmodic Contraction of the Ciso-
phagus, continuing for five years ; recovery after one
course of the waters of Aiv—A very interesting
case was sent to me in August, 1876, by Dr. Charles
Fauvel, who wrote me the following letter :

“TI very specially recommend to you one of my
old patients, Mr G—, Attaché to the Minister of
Agriculture and Commerce, afflicted with pha-
ryngeal catarrh, and chronic spasmodic contraction
of the cesophagus. JI beg you to subject Mr
G— to the Eau de Challes en boisson, the bains
and douches of Aix, and the inhalations of
Marlioz.”

After having followed out for twenty-five days
this treatment, to which I further added gargling
with the Eau d’Alun, this invalid left greatly
improved. His general health, very debilitated, was
110 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

sensibly strengthened; the catarrh had almost ceased ;
and the chronic spasmodic contraction, which had
continued for five years, producing frequent and
troublesome vomiting and regurgitation, appeared to
have lessened in severity. Dr Charles Fauvel told
me, the following January, that his patient had
called, two months after his treatment at Aix, to
tell him of the complete recovery from the ca-
tarrh and the cesophageal spasm of which he had
complained.

Cast XVII.—Chronic Congestion, with loss of
power of the Vocal Cords; marvellous cure by two
courses of Aia-les-Bains waters—Mr Lennox
Browne, in August, 1873, directed Capt. H— to me
with the following letter:

‘T shall be obliged by your giving your very best
attention to my friend and patient Capt. H—,
who by my advice comes to Aix, and will afterwards
go on to St Moritz. He has had congestion, with
loss of power of the vocal cords, especially of the
left, the result, I believe, of straining the voice
from a wrongly taught method of singing. He has
also a very sluggish liver; I should like him to have
a spray inhalation of the waters of Marlioz, to

, drink the same, and to bathe either there or at Aix,
AFFECTIONS OF THE RESPIRATORY APPARATUS 111

as you may wisely think best, but the bathing in
moderation... .”

When I examined Capt. H— with the laryngo-
scope, I found some chronic congestion of the larynx,
with atony of the mucous membrane, and feebleness
of the vocal cords. The strict treatment followed
brought about the best results, and the recovery
was complete after a second residence at Aix the
following year. Since then the voice has gained in
force and volume, and Capt. H— can sing for a
length of time without experiencing fatigue.

Case XVIII.—Follicular Disease of the Throat ;
much improved by treatment.—In June, 1876, I
received the following letter from an English
confrére.

* Drs Quain and G. D. Pollock, of London, have
recommended me to place my daughter under your
care for a few weeks. She has been suffering
for some months from follicular disease of the
throat.”

This young lady derived much benefit from the
waters of Aix.

A well-known actress of the Opera Comique, of
Paris, Miss D—, of a nervous temperament, had
almost completely lost her voice. She regained the

t
112 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

use of it after a course of the waters of Aix. Nearly
every year she repairs to Aix to strengthen the
respiratory mucous membrane, and to add tonicity
to the vocal cords.

Miss P. R—, the marvellous interpreter, in
London, of the works of Offenbach, was obliged last
year to abandon the stage on account of an “ obsti-
nate congestion of the mucous membrane of the
posterior nares” which affected her voice in the
middle notes. She has written me that she is much
better, and that she will be able to resume her
engagements again, thanks to the efficacy of the
treatment she followed, under my direction, at Aix.

I could furnish numerous examples of throat
affections relieved by the waters of Marlioz and
Aix, especially cases of clergymen, orators, and pro-
fessional singers, in whom marvellous cures have
been effected. It is very important that a thorough
laryngoscopic examination be made of patients who
resort to the waters of Aix for affections of the
throat, if they do not bring a precise diagnosis from
their physician. I have seen some injurious mis-
takes committed in treatment by neglecting this
rule. Among other examples, I will quote the case
of a patient whose physician made him submit every
day to the spray inhalations at Marlioz, for a sup-
AFFECTIONS OF THE RESPIRATORY APPARATUS 113

posed chronic laryngitis, which proved to be a
polypus of the vocal cords. As the hoarseness of
the voice was increased. by this untimely treatment,
the patient came begging me to examine him with
the laryngoscope. I discovered a polypus of the
right vocal cord, accompanied with congestion of the
larynx. A few local applications of a solution of
perchloride of iron mitigated the inflammation.
Having accustomed the patient to the passage of
instruments, I had the pleasure of seeing the ex-
traction of the polypus skilfully effected at one
sitting by Dr Morell Mackenzie. The treatment of
Aix or Marlioz employed in cases of polypus, what-
ever may be their nature or situation, can only
increase the evil by aggravating the symptoms.

In laryngoscopic examination I use the frontal
reflector. It requires, it is true, longer practice for
its management, but experience has convinced me of
the superiority of this mode of examination.

When discussing the soothing action of the waters
of Aix and Marlioz, I pointed out the fact that a
class of asthmatics derived great benefit from the use
of the sulphurous inhalation, cold or lukewarm. I
would now remark on the action of these waters in
Pulmonary Phthisis.

Daquin and Socquet, at the commencement of this

8
114 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

century, called the attention of physicians to the
effects of the waters of Aix in Phthisis, ‘ They
succeed’? says Daquin, “in recent Tubercular
Phthisis, which is not yet accompanied with fever :
also, it is noted, that the inhabitants of Aix rarely
become asthmatical, and very few die from pulmonary
consumption; they have prompt recoyrse to the
drinking of these waters in the most trifling colds,
and for the slightest affection whatever of the.chest ”
(op. cit.) Such was also the opinion of M. Charles
Despine, “It is from this principle of their action
in catarrh,” says he, “that in some way may be
accounted the almost constant success which has
followed the use of the sulphurous waters, internally
and externally, in pulmonary phthisis.”

These qualities were lost sight of until 1853, when
my father published the résumé of his observations
upon this important subject. I may be permitted to
reproduce some passages of his interesting pamphlet,
where he describes the good effects of the waters of
Aix in, what he calls, the period of predisposition to
consumption.

“Tt is the state to which so many young subjects
from ten to twenty years of age appertain, pale,
thin, emaciated, with soft skins; having a narrow
chest, embarrassed in respiration after the slightest
_AFFECTIONS OF THE RESPIRATORY APPARATUS 115

fatigue ; subject to frequent epistaxis, to insomnia ;
sometimes presenting the appearance of health, but
with a very pronounced lymphatic temperament.
It is undoubted, and all authors who have interested
themselves in this question acknowledge, that for
' these organisms, the use of the waters of Aix will
produce the happiest results. In fact, the baths, the
piscines, the gentle douches even, combined with a
tonic regime, increase the activity of the digestive,
respiratory, and cutaneous functions: by these
means the lymphatic temperament is contended
against, strength and vigour restored to the consti-
tution, and the patient defended from the attacks of
consumption.” (‘ Remarques sur 1’Action des Eaux
d’ Aix dans la Phthisie Pulmonaire,’ par le Dr L.
Bertier, 1853).

It is the soothing and tonic medication which
exclusively succeeds in the treatment of Consumption.
Now, the springs of Aix and Marlioz ably combined,
as we have seen, leave nothing to be desired in the
employment of this method of treatment.

In order to conclude more authoritatively, I deem it
useful to recall here the words of Professor Gubler,
whose work, ‘Du Traitement Hydriatique des
Maladies Chroniques,’ assigns scientific grounds for
balneotherapy.
116 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

After having laid down the principal indications—
Ist, of Tuberculosis, rather suspected than demon-
strated; 2nd, of the Pulmonary affection, well
characterised, the author thus proceeds :

“ Thirdly, the signs of the Tubercular affection are
unmistakable, but the pulmonary lesions progress
slowly without awakening much reaction; to this
chronic form, ordinarily accompanied with a bron-
chitic catarrh more or less considerable, the
sulphurous waters, generally recommended, are
suitable.

“ Nevertheless, the sulphurized sodic or calcic
waters are not absolutely excluded from the treat-
ment of subjects who have had some spitting of
blood, or who, besides, have a tendency at times to a
slight movement of evening fever ; it is only neces-
sary, in these cases, to administer them with caution,
and to set aside, by a methodic employment, their
stimulating effects. Without doubt, as has been
well demonstrated by my erudite friend M. Pidoux,
a slight artificial hemorrhage, is nothing so terrible,
yet it is preferable to avoid it. This will be effected
nearly always by administering small doses of the
waters to the exclusion of the baths, and by keeping
the patient also from the congestive action of a high
thermality of the waters, and from an exalted tem-
AFFECTIONS OF THE RESPIRATORY APPARATUS 117

perature in the salles d’inhalations. If despite these
precautions, a hemorrhagic inflammation supervenes,
the hydriatic cure itself should not be accused of
it, but rather accessory circumstances, such as
fatigue of the voyage, or canicular warmth, or better
still, suppression of a menstrual epoch. Borden was
profoundly convinced of this innocuousness of the
sulphurous waters, rightly administered, seeing that
he used to call them “‘ the sweetest of all bechics” : and
we think that they only impart all their therapeutic
effects on condition of meriting the title which has
been conferred on them by the celebrated hydro-
logic physician. The rédle of the substitutional
agent attributed to the waters, sulphurous, sodic, or
calcic, appears to me very limited, and I think that
it is upon their action alterative, metatrophic, or
metamorphic, that the chief reliance should be
placed. Now this intimate parenchymatous action
will be accomplished so much the better as the
medicinal water, creating no opposition, penetrates
the more easily into the plasma and the organic
woof.

Then all the therapeutic results will be so much
the more guaranteed as the integration of the
‘molecules of sulphur shall have been more completely
effected.
118 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Besides, whatever may be the physiological
process by the aid of which the sulphurous waters
improve the morbid state of the tuberculous, their
efficacy is incontestable, and the experience of ages,
every day confirmed, justifies the favour which they
enjoy with the public, and physicians themselves.”
CHAPTER XI
SURGICAL AFFECTIONS

Fractures.—Stiffness of Tendons.—Sprains.— Caries.
—Pseudo-ankylosis. — Wounds by Firearms.—
Diseases of the Eye

“Tae stimulant sulphurous, and chlorinated
sodic waters are beneficial,” says Professor Gubler,
“in resolving inflammatory engorgements, from
which arise ankylosis, white swellings, and other
lesions which belong to the external pathology. It
does not matter whether these lesions be of dia-
thetic origin, or due to internal causes, or whether
they originate from external violence, such as blows,
wounds, and other traumatisms ; all are opportunely
modified by the waters of Aix, Grévolx, Ax,
Luchon, Baréges, or those of Salins (Savoy), Salins
(Jura), Salies, &c.” (loc. cit.).

When after a fracture, the formation of the
callus is retarded by an intercurrent affection, or by
120 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

the imperfect vitality of the whole constitution, the
thermal treatment singularly aids the work of
repair. I have recently had under my care a young
patient, in whom syphilis had prevented, for several
months, consolidation of the fractured bone. The
cure at Aix favoured in a remarkable manner the
desired deposition of the bony elements.

The sequel of fractures, such as passive swelling,
articular stiffness, pseudo-ankylosis, &c., have an
effectual remedy at Aix. The tendinous contrac-
tions which follow acute, severe, and chronic affec-
tions, typhoid fever for example, are admirably
treated by the stimulant method—the vapour and
douche baths with shampooing and passive move-
ments.

The pain, swelling, and stiffness which seem to
persist sometimes in the joints, as sequel of a
sprain, vanish on submitting the affected part to the
action of the local vapour or douche bath.

The stimulating qualities of our waters are also
serviceable when the question is, How to obtain an
eliminative inflammation, to give passage, maybe,
to a sequestrum or a foreign body ?

In wounds by firearms and burns they also
furnish conspicuous results, as proved by the
observations of Drs Davat, Vidal, Guillard pére,
SURGICAL AFFECTIONS 121

Brachet, and Blanc, published during the disastrous
war of 1870.

A learned hydrologist, the late Dr Petrequin,
whose remarkable works are justly appreciated, was
the first who sought to open a new path for a
thermal medication in Diseases of the Eye (‘De
l’ Action des Eaux d’ Aix dans les Maladies des Yeux,’
par Petrequin, 1852). I could quote some cases
of iritis, conjunctivitis, and sclerotitis, of a gouty
or rheumatic origin, which would fully demons-
trate the beneficial action of the waters of Aix in
these affections.

In nearly all the notes of cases published in this
handbook improvement began after the first douches,
and recovery followed a single course of treatment.
That this will be the absolute rule must not. be
taken for granted. In fact, it occurs very fre-
quently that invalids are not relieved during the
time they follow the thermal treatment. It is often
some weeks, or even some months, after having
undergone it that improvement is felt.

In many cases, it is necessary to return two or
three successive years to Aix to obtain a complete
recovery. ‘Sometimes,’ says Dr Maximin Le-
grand, “the sulphurous thermal stimulation con-
tinues after the time occupied by the bathing
122 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

process. The perspirations repeat themselves in
certain invalids with a kind of periodicity at the
hours of the vapour and douche bath. It is only
when these phenomena cease recovery is effected.”
APPENDIX

 

Natural Adjuvants to the Waters of Aix

1. Mar.ioz

Tue springs of Marlioz are highly charged with
sulphur and soda, and slightly with iodine and
bromine.

The park at Marlioz, in the centre of which is
built the Establishment of that name, is connected |
with Aix by a beautiful avenue three quarters of
a mile long, having a footpath and a row of high
trees on either side.

Marlioz is private property, and the enterprising
owner of this establishment, Mr Mottet, has in
every way studied the comfort, amusement, and re-
finements of his visitors.

The Establishment is situate on the south side of
Aix, at the same altitude, 850 feet, and enjoys the
124 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

like advantages of climate. From this point of
view, the station is much preferable to that of Alle-
vard, which is 1640 feet above the level of the sea,
and subject, besides, to very great variations of tem-
perature, unfavorable to patients with delicate lungs
or weak chests. On the other hand, the degree of
mineralization, the locality, the site itself, give the
Establishment undoubted superiority over that of
Allevard. ‘“Invalids who intend to pass a season
at Allevard should provide themselves with light
clothing for the excessive heat of the middle of the
day, and with warm aud thick clothes for the even-
ings and mornings, when the temperature falls sud-
denly several degrees. It is one of those peculiar
French stations to which we must not go too early, or
leave too late.” (‘Des Principales Eaux Minérales
de l'Europe.’ Rotureau.)

Three springs. arise in the park at Marlioz, and
although they present the same chemical composi-
tion, they each have a different name. There is the
Bonjean Spring, the Spring of Asculapius, and the
Adelaide Spring.

According to MM. Petrequin and Bonjean, they
mark 24° to 30° by the sulphydrometer (‘ De
PAction des Eaux Minérales d’Aix,’ par M. Petre-
quin, 1852). Their temperature is about 14° C.
APPENDIX 125

(57° Fahr.), and the total out-turn about fourteen
hundred gallons a day.

A chemical analysis of the waters of Marlioz
has been made by Mr J. Bonjean. 11 is as follows:

ANALYSIS OF THE WATER OF MARLIOZ
TEMPERATURE, 57° FanR

In 1000 grains of water—

 

 

Sulphuretted hydrogen é - 6°70 grs.
Carbonic acid i ; . 464 ,,
Iodine . F . « 0:0001944 gr.
Bromine s 5 $ - 0:0000515 ,,
Sulphide of sodium . » . + 0067 35
Sulphate of soda ‘ % + 0°025 35
# of lime ‘ * « 0:002 59
Pr of magnesia 2 - 0018 $5
Chloride of sodium . ‘ - 0018 53
s of magnesium . - 0014 a
Carbonate of lime . ‘i . 0186 Pa
a of magnesia ‘ - 0012 ‘s
a of soda. ‘ - 0040 5
Silex . é 3 F . 0006 oe
Carbonate of iron . : » 0013 ae
s of manganese 3 - 0001 3
Sulphate of iron : . - 0:007 ”
Glairine ‘ a . indeterminate quantity
Loss . > ‘ 3 . 0017 »
Total . - 07426 55

The waters of Marlioz are feebly bromo-iodide,
126 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

but strongly sulphurised (more than the springs of
the Pyrenees). They contain some iron and man-
ganese, and are, besides, slightly alkaline.

The Establishment at Marlioz possesses—

A very fine Pump Room.

Two large inhalation rooms.

Nine private rooms for baths.

A cold douche.

Two douches ascendantes.

Two complete apparatus for atomised and spray
inhalation.

Four douches de siége et ascendantes.

In speaking of the therapeutic indications of the
waters of Aix (consult, besides, ‘Medical Guide to
the Waters of Marlioz,’ by Dr Macé), I have set
forth, every time the opportunity has presented
itself, the importance of the waters of Marlioz either
alone, or combined with the thermal treatment of the
former. I will not then revert to the subject, but
will only add that the waters of Marlioz are specially
successful in affections of the respiratory passages,
and in uterine diseases, whenever atony or feeble-
ness of the mucous membrane has to be treated.
APPENDIX 127

2. CHALLES

“Tue cold springs of Challes contain iodine and
bromine, and are highly mineralised with sulphide
of sodium.

“The springs of Challes are situate about three
miles from Chambéry. They were discovered in
1841, by Dr Domenget. They issue from the fissures
of a cleft rock veined with bands of carbonated and
crystallised calx.

“This mineral station is situate in an expansive
and beautiful valley. From the terrace of the
chateau, which overlooks the springs, the view ex-
tends along the chain of the Dauphine Alps, their
summits, covered with the eternal snows, present a
magnificent spectacle, equal to that of the Bernaise
Alps seen from Le Gensly, at Berne.

“There are three springs: the large spring, the
small spring, and the Spring du Puits.

“The first is only strongly mineralised, the two
others are less so, and have not, besides, been ana-
lysed. Itis only then the first which will be con-
sidered in this work.

«The temperature is about 12° C. (58° Fahr.),

« The Establishment of Challes is situate about 985
feet above the level of the sea. The mean temperature
128 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

of the months during the season is 22° C. (71° F.).
The season at Challes is from the 1st of May to the
15th of October.”

According to Professor Gubler, “ Challes, the most
mineralised of the sulphurous springs, is twenty
times richer in sulphide of sodium, than waters
highly favoured in this particular.”

I append the latest analysis of the Waters of
Challes made by the distinguished chemist, Dr

Corrigou.

ANALYSIS OF THE WATER OF CHALLES

In 1000 grains of water—
Soufre (représentant l’acide sulfhydrique gr. )

libre). : og | Oe
» représentant lacide sulfhydrique cobel Hoke
combiné a l'état de sulfhydrate par Ja
de sulfure ' + Oouag | Palanes a
» état de monosulfures '. 071128 Féin de
probablement & l'état de poly- pultate de
sulfure . * - 00189 pa
» aPétat d’hyposulfite . - 0°0050 Oar Hie
Acide sulfurique . . - 0:0390
»  Silicique 7 s - 00092
»» carbonique libre ou & l’état de
bicarbonate 7 -» 01162
»  carbonique fixe : oP
» phosphorique : + 0°00057
» hitrique ° ‘ + 00011
Chlore . ‘ . + 0:0870

Brome . . - 0:0016
APPENDIX

Iode

Soude

Potasse .

Ammoniaque

Chaux

Magnésie

Alumine

Fer 2

Manganése

Cobalt

Cuivre

Plomb .

Antimoine

Arsenic . .
Matiére organique dialysée
non dialysée

ed »

Total

129

0:0089

04749
00057
0:0022
0°0856
0:0021
0:00022
0:00039
traces nettes.

traces a peine sensibles.

traces trés-nettes.
id.

traces ?

0°000007

abondante.

assez abondante.

1:023887

According to Dr Carrigou, this remarkable

quantity of sulphur, authenticated by analysis, is of
equal value, in combining the elements together, to
gr. 0'4788 of mono-sulphite of sodium for every
1000 grains: Baréges only contains gr. 0:040,
Cauterets gr. 0°019, and Luchon gr. 0-071.

We have seen that these Waters are employed at

Aix chiefly when it is found necessary to unite the
external sulphurous thermal treatment with the
internal cure.

Dr Casalis, Inspector of the Waters at Challes,

9
130 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

has written a very instructive pamphlet on their:
therapeutic properties. We beg to refer the reader
to it.

3. St. Simon

The Waters of St Simon, situate about three
quarters of a mile from Aix, are limpid, inodorous, and
colourless; the reaction is alkaline, and the tempera-
ture from 19°8° to 24° C. (67° to 75° Fahr.). Accord-
ing to M. de Kramer, they contain :

In 1000 grains of water—

Carbonate of lime . . 0°23521 grs.
3 of magnesia . . 016162 ,,
Chloride of magnesium - 000029 ,,
Sulphate of magnesia . - 001124 ,,
»  Ofpotashh . . 000391 ,,
» of soda 2 - 0°00889 ,,
Silicic acid . Z - 0°00825 ,,
Alum, iron . : . 000172 ,,
Organic matter . - 0°02062 ,,
Loss . . - 0°002626 ,,
Total . - 0469216 ,,

M. Petrequin has discovered some traces of iodine.
These waters are much used as a table beverage.
They are very well tolerated by the stomachs of
APPENDIX 131

_ nervous and delicate persons, and are useful in
gastralgia, vesical catarrh, and in gravel and gouty
complications.

4, CHALYBEATE SPRING

A highly ferruginous spring has been recently
discovered near the Establishment of Aix, on the
property of Dr Davat. It furnishes an abundant
supply, and is a welcome and useful auxiliary to the
sulphurous waters of Aix-les-Bains and Marlioz.
182 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

PRACTICAL INSTRUCTIONS

The journey from Paris to Aix is by Macon,
Bourg, and Culoz. Aix is a station on the Paris
Railway to Turin. It is fourteen hours’ distant from
Paris, and four hours from Geneva and Lyons.
This latter city is besides connected with Aix by a
regular steamboat service by.lake and by the river
Rhone. There are two direct trains from Paris to
Aix; the night express which leaves Paris at
8 p.m. and reaches Aix at 10 a.m.; and another
express at 11 a.m., which arrives at Aix at 2 a.m.
For this latter train carriages must be ordered from
the hotels to meet travellers at the station at two
o’clock in the morning.

The Waters of Aix were celebrated in the time of
the Roman Republic. They were successively
called Aquz Allobrogum and Aque Domitianz,
from the name of Domitian, the proconsul of
Julius Cesar, who was the first to construct baths
of any magnitude at Aix. At a later date they
took the name of Aque Gratiane, doubtless to
perpetuate the remembrance of the benefits which
the Roman Emperor Gratian bestowed upon the
town.
APPENDIX 1383

The remains of monuments of this ancient
period discovered at Aix, testify to the high repute
in which these Waters were held in the estimation of
the Masters of the Old World. But this reputation
was afterwards obscured for several centuries, enve-
loped as it were, in the cataclysm of the ruin of the -
Roman Empire, and the invasion of the barbarians
into Gaul.

The restoration of the hot baths at Aix was
begun by a king of Sardinia, Victor Amédeus
III, who, together with his Court, sojourned at Aix,
in 1784. This prince built, for that age, a very
remarkable medical establishment, which, further
enlarged during the reign of Charles Albert, may
be regarded as the nucleus of the present magnifi-
cent edifice, the admiration of all visitors.

‘The progressive increase in the number of
bathers rendered necessary a proportional develop-
ment of the balneatory appliances. The local
authorities did all in their power to raise the
pecuniary resources required. New and important
buildings were undertaken with the concurrence of
the whole province of Savoy, but the enlargement
of the baths at Aix was only carried out upon a
rather extended scale by a caterer for public amuse-
ments, who leased the Assembly Rooms and the
1384 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Thermal Establishment. And this lease, having
been discontinued in 1855, before the completion of
all the buildings, the French Government under-
took to finish them after the reunion of Savoy
with France. More than two million francs have
since been spent to place the establishment in its
present state, and to erect a Hospital for poor
bathers. The springs, the buildings, the park
which is adjacent to them, all are now the property
of the State.

The town of Aix is most picturesquely situate
on the lower slopes of the hills which form the base
of the mountain of Revard. Meadows, fields inter-
spersed with vines, and gardens where the fig, the
almond, the pomegranate even, flourish luxuriantly,
stretch between the dwellings set apart for
bathers and the poetic lake of Bourget. Nature
has here created a most lovely and fertile valley,
closed in and protected from northerly winds by the
vast spurs of the Alps and by a nearer range of lofty
wooded hills.

The settled population of the town is about five
thousand inhabitants. Its altitude above the level
of the sea is about 850 feet, The mean tempera-
ture, during the favorable season for residence, is
70° Fahy. Atmospheric variations are at this time
APPENDIX 135

hardly perceptible. The Thermal Establishment is
open the whole year round, and thanks to the
‘mildness of the climate, the Waters can be used at
any time of the year; but, as a rule, invalids only
reside at Aix from the lst of May to the Ist of
November, and that is the most favorable season
to follow out a thorough treatment. The months
of May, June, and September, should be selected
by persons who fear the intense heat of the
summer.

Happy in its topographical conditions, the valley
of Aix enjoys a most salubrious climate. No
epidemic has ever visited it.

Daquin, who wrote in 1773, tells us on this
subject that, “when the plague was raging at
Chambéry in the year 1564, the Senate and the
Parliament of the Duke of Savoy left that town at
the beginning of November to hold their sittings at
Aix, where, on account of the salubrity of the air,
they resided until the end of the month.”

Cholera has never exercised its destructive infiu-
ence here, and in 1871, whilst the smallpox cruelly
ravaged certain parts of France and Switzerland, as
well as neighbouring states, Aix was completely
protected from this scourge.
136 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Curiosities and Antiquities

The Roman Catholic Church is remarkable for its
simplicity. The choir dates from the thirteenth
century; it is in the purest Gothic style. This
church, the only one which the town of Aix pos-
sesses, is altogether insufficient for the wants of
Divine Worship. A subscription list is open in the
vestry for its reconstruction.

There is also a Chapel for Anglican worship,
where the English service is held at 11.30 a.m. and
3.30 p.m. The Chaplain is supplied by the Colonial
and Continental Church Society.

In a new building erected at the entrance to the
park is a Chapel for Presbyterian worship.

The Hospital is built behind the Thermal Estab-
lishment. Queen Hortense, the mother of Napo-
leon ITI, furnished the first funds for its construc-
tion in 1813. Since then numerous acts of
generosity have permitted its enlargement and
improvement. It is set apart for poor bathers, who
have the free use of the establishment if they are
provided with a certificate of distress.

The Chateau of the Marquis of Aix is a well-
preserved edifice. of the fourteenth century, and
especially celebrated for its beautiful staircase. It
APPENDIX 137

possesses a museum, originated by the Vicomte Le
Pic, containing some interesting objects, which we
will briefly mention :—Lacustrous collections of the
Lake of Bourget and other places; prehistoric col-
lections principally from the caverns of Savigny,
near La Biolle ; Roman and Gallic collections, with
coins, pottery, &c.; pictures, engravings, drawings,
&c.; China, earthenware; a beautiful, very rare
collection of old Italian dolls ; specimens of minera-
logy, &c. The Library, in course of formation, the
Bureau de la Mairie, the “ Justice de Paix,” the
Police, the Special Commissariat, the Post Office,
are all in the same building.

The Assembly Rooms

The Assembly Rooms at Aix are some of the most
beautiful and best suited for the purpose to be met
with in France, and, like the Thermal Establishment,
are the production of the architect Pellegrini. They
are the central point of meeting for strangers.
Three times a week—Tuesday, Thursday, and Sun-
day—there is a ball. For the balls held on Thurs-
day evening dress is necessary. The élite of Cham-
béry faithfully patronise these soirées daysantes. An
excellent Italian orchestra performs the other
1388 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

evenings: this company includes some first-rate
solo players. Once a week there is a special con-
cert, or artistic representation. Independently of
the interior amusements, the grand season, or rather
the summer warmth initiates Venetian fétes in the
gardens attached to the Assembly Rooms. The
laying out of this “‘ spacious salon de verdure” has
been carried out to facilitate the organisation of
those brilliant nights & giorno to which the bands of
the garrison at Chambéry furnish their co-operation.
A display of fireworks generally terminates these
fétes about ten o’clock. The ball in the saloons is
continued to a late hour of the night.

The Assembly Rooms are open from the lst of
May to the lst of November. Shareholders and
subscribers only are admitted. The subscription
begins after the introduction by a shareholder, or
by two well-known subscribers; exception is made
only in favour of guests, who are required on enter-
ing to present their letter of invitation. Ordi-
narily, the physician, or a friend who is a sub-
scriber, makes the presentation.

In the Lecture Hall of the Assembly Rooms will
be found the principal French and English News-
papers, and the most important Periodicals.

Above the Place des Bains rises a Roman Arch in
APPENDIX 139

perfect preservation. It was erected by Lucius
Pompeius Campanus, in honour of the family of
Pompey, about the fourth century. A number of
inscriptions in Latin can be deciphered upon it.
There are further, at Aix, some remains of Roman
Baths to be seen at the Pension Chabert.

Thermal Grottos

“An interesting underground gallery, leading to
the caverns whence the Alum water rises, was
widened in 1855, and may be visited at any time on
procuring tickets (price fifty cents. each, at the office
of the Establishment) ; and once a week, during the
season, it is illuminated, 2 giorno, from two to four
o’clock of the afternoon. The caverns on these
days may be seen by strangers at a charge of one
franc each.

“There are two distinct stories adorned with
massive projections of admirable lightness, and with
graceful cupolas produced from the limestone, from
which the thermal water issues by the corrosive
action of sulphurous vapours.” (Dr C. Despine,
op. cit.).
140 THE SPAS OF AIX-LES-BAINS AND MARLI10Z

EXCURSIONS

Open-air exercise is an important adjuvant
to the cure at Aix. The environs are so pic-
turesque, the panoramas so varied, that it would be
possible to fill a volume regarding them. I will
only point out briefly the principal excursions to be
made on foot, by carriage, by steamboat, and by
railway. Persons desirous of a complete guide to
the excursions about Aix should. purchase Dr
Forestier’s book entitled, ‘Des Promenades d’Aix-
les-Bains, ou Vade Mecum,’ new edition; or the
smaller guide by Charles Besancon.

Excursions on Foot

I will commence with those the nearest :

1. From Aix to the Park of Marlioz, distance one
mile by way of Chambéry. The return may be
made by the rocks which overhang Marlioz. This
doubles the distance.

2. From Aix to Chantemerle by the Boulevards
des Cétes, distance one mile. Request to see the
Villa Perret, from whence the view is very fine. The
proprietor of the house is an excellent photographer,
a pupil of Nadar.
APPENDIX 141

8. The Bois Lamartine, and the Maison du
Diable. The latter is so called on account of the
dark colour of its walls, and the legends attached to
the building. The devil is to-day succeeded by an
English gentleman, whose hospitality is proverbial
amongst his countrymen. ‘To reach it, we must
follow the road which leads to the “ Petit Port,” as
far as the first bridge of stone, turn to the right, and
then take the first road to the left, which leads up
the hill. Opposite the farm, at some paces from
the fountain, whose water is very soft and refresh-
ing, you keep to the right and reach a small espla-
nade, from whence a pretty view is obtained. If
you return to Aix by the same route, the promenade
occupies about an hour. Otherwise, if you wish to
visit the site where the most affectionate of poets—
Lamartine, wrote his charming versification ‘Le
Lac,’ follow along the road which ascends to the
summit of the hill. ‘You will find,” says Dr
Forestier, ‘‘ on the side of the lake, a path leading
towards a cottage; keeping to the left, it conducts
by a gentle ascent to the edge of a precipice; this is
the “Saut de la Pucelle.” Proceed a few steps
further in the same direction, and you will be able
to sit, like Lamartine, under those three trees hence-
forth consecrated to the worship of poetry. Then
142 THE SPAS OF AIX-LES-BAINS AND MARLI10Z

peruse again those lovely verses of the poet, of which
I will only quote a few stanzas:

 Ainsi toujours poussés. vers de nouveaux rivages,

Dans la nuit éternelle emportés sans retour

Ne pourrons-nous jamais, sur ]’océan des Ages,
Jeter lancre un seul jour.

“O lac! rochers muets, grottes, forét obscure,
Vous que le temps épargne, ou qu'il peut rajeunir,
Gardez de cette nuit, gardez belle Nature

Au moins le souvenir !”

You may retrace your steps by the same way as
you came, or better, follow the hill to the right and
you will reach the pretty little church of Tresserve.
A few paces before coming to it, the road turns
abruptly to the left, and leads to Aix in half an
hour.

4. The hill of Tresserve-—Take the first road to
the right at the end of the town, as in going
to Marlioz. The little church is reached in half an
hour. You can follow the hill to the left, in passing
through the village, to a cross where the road
divides into two portions; the one to the left
descends towards Marlioz—the shorter ; the other,
to the right, will be described further on (Promenade
en Voiture d’Aix a Terrenue). This promenade
would occupy two hours and a half.

5. The Grand Port.—Cross to the left the Pro-
APPENDIX 143

menade du Gigat, planted with horse-chestnut trees,
at the northern extremity of the town. Follow the
pretty road bordered by plane trees. The lake is
reached in three quarters of an hour. The steam-
boats depart from the Grand Port.

6. The Petit Port.—Pass under the Maison du :
Diable, and leave it on the left. After having
crossed the village of Cornin there is a bridge, and
to the right a road which runs along a watercourse
to the lake.

7. St Simon.—Route de Genéve at the north of
the city. The spring of St Simon is reached in
twenty minutes” walking. It is to the left of the
route. This water is extolled in gout, certain
affections of the stomach, of the kidneys, and of the
bladder. 2

Excursions on Foot, or on Donkey

1. The village of Trévignin.—A beautiful shaded
road with pretty views. Ask to see the monster
chestnut tree measuring thirty-six feet in circum-
ference. The time occupied in going and returning
is about two hours.

2. Monxy, Clarafond, and return by Drumettaz
(the same distance).
144 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

3. La Dent du Chat.—A mountain about 5000
feet high. A guide is necessary. Terms should be
made before starting for the journey. The usual
charge is twelve francs. A carriage or a boat is
taken first as far as Bourget, thence the summit of
the mountain is reached in three hours by a very
gentle ascent. The view obtained embraces Mont
Blanc, the valley of Chambéry and that of the
Rhone as far as Lyons.

4. Le Grand Revard.—Altitude 5070 feet. A
guide is also necessary for this excursion, which is
an easy one as the Grand Revard Society has
constructed an excellent mule path by which the
summit of the mountain can be attained on foot or
by donkey in three hours by way of Pertuiset.
Another hour is required to reach the Chalet, and
then half an hour to arrive at the highest point
(Grand Revard).

This mountain is not abrupt and steep as the pre-
ceding. Its sides are covered with magnificent
forests of pines, rich pastures, chalets with numerous
cows, and several springs of delicious water. The
air is very balmy and bracing. We hope to see a
comfortable hotel shortly built here for bathers
desirous of resting from the summer heat and the
fatigues of treatment.
APPENDIX 145

5. La Dent du Nivolet (5070 feet). Two hours
are occupied in going in a carriage from Chambéry
to the village of Les Déserts; another two hours in
reaching, on foot, the Dent. The return to Aix can
be made in a carriage by the valley of Beanges, the
defile of Plain-Palais, Noyer, Lescheraine, Cusy,
and Grésy in five hours, or, on foot, in four hours,
by proceeding along the summit of the mountain to
Pertuiset (see Grand Revard). Upon the Dent du
Nivolet rises a cross, sixty feet high, erected by
the Comte de Fernex. From Nivolet, the view
extends along the valley of Graisivandau and Cham-
béry, and a great part of the Alps. For these three
mountain excursions it is expedient to carry some
provisions, for nothing can be procured en route.

6. The Lemnoz (5600 feet). In four hours by car-
riage we reach Leschaux, thence in two hours, on
foot or on mule, we arrive at the Hotel Chatel.

From the summit of this mountain there is a mag-
nificent view of Mont Blane, and the vast chain of the
Alps, and the three lakes of Geneva, Annecy, and
Bourget. Near the top is a comfortable hotel
chalet, where one can remain a fewdays. The air is
pure-and balmy. Visitors would flock thither if
there was a good mule path from Leschaux to
Lemnoz.

10
146 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Excursions in Carriages

1. From Aix to St Innocent, and to Brison. At
St Innocent stop and see the celebrated Angora
rabbits, whose hair assists in the weaving of a host
of articles for the rheumatic—gloves, gaiters, chest
preservers, &c. From St Innocent to Brison occu-
pies three quarters of an hour along the side of the
lake. The whole journey is performed in two hours
and a half. The route being exposed to the sun, it
is pleasanter to take this promenade on acloudy day,
or after sunset.

2. Tresserve. Terrenue. Return by the lake and the
chateau “ Bon Port.’ During the residence of Sir
Dominic Corrigan at Aix, I had this promenade
pointed out to him. He has thus described it:

“I will not enact the part of a tourist’s guide, but
there is one drive, of abont two hours, so beautiful,
that I cannot omit to notice it here for its lights
and shades, its scenery of rock and vines, its chest-
nut woods, and its water. I have to thank Dr
Bertier for it. On a card he wrote the following
directions :—‘ Aller 4 Tresserve en voiture, traverser
le village, et revenir par le lac en passant par

Terrenue.’ ”
APPENDIX 147

We ascended the village by zigzag roads, bordered
with acacias and vines. On our left was spread
out far below us, the valley with its cultivated
fields, its vines and its tall poplars; beyond lay
cliffs of chalk-rock, contrasting in their horizontal
white abruptness with the verdure below, and
when we rose to our high level, the beautiful lake
below on our right scarcely rippled on its surface,
and on its opposite side, the towering rocky border
rising, not too abruptly, covered with shrubs and
verdure to the top, varied by stripes of bare rock.
Our road, as we descended beyond the village, lay in
similar zigzag roads to those by which we had
ascended, bordered by magnificent old chestnut trees
in full verdure and full fruit. Arrived at the turn
homewards, we reached the far end of the lake, and
our route lay along a level causeway, built in the water
of the lake but near its border; on each side of us, as
we drove along for some miles, shoals of small fish
darted here and there among the stems of the typha
and the water-lillies—yellow, blue, and white—with
their floating leaves and lovely flowers, while above
them fluttered myriads of beautiful painted butterflies,
or, skimmed along like hawks, the gauze-winged
dragon flies.”

3. From Aix to St Girod by Grésy, Chateau de
148 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Loche, returning by Albens. A distance occupying
thiee hours. Arrange for all charges before
starting.

4. From Aix to Mery by Mouxy and Clarafond,
returning by Viviers and Marlioz. Time nearly
two hours.

5. From Aix to the Waterfall at Grésy, and to
the mill of Primoz, The Waterfall is a very in-
teresting one. Its celebrity is connected with the
death of Baroness de Broce, who was drowned in it
before the eyes of her friend Queen Hortense, the
mother of Napoleon III. The route which leads
to the mill of Primoz is very picturesque. Time
nearly two hours and a half.

6. From Aix to Bourget. “There is an excellent
restaurant at the Hotel Ginet upon the lake. The
chef de cuisine was attached to the establishment of
the unhappy Emperor Maximilian. From Bourget a
fine road traverses the mountain by the “Col du
Chat,” which is reached in an hourandahalf. The
view is splendid, and increases in proportion as we
advance.

In the village of Bourget is an old church which
dates to the thirteenth century. Regarding the
Church of the Old Priory, and the other Antiquities
of Bourget, consult the interesting book of M.
APPENDIX 149

Mailland, ‘ Bordeau et son Chateau Féodal.’ This
drive occupies two hours and a half.

7. From Aix to the Grand Chartreuse. This
occupies six or seven hours. To prevent fatigue
the excursion should extend to twodays. Accommo-
dation for the night can be obtained at the Convent,
or at St Laurent du Pont, Ladies are not ad-
mitted into the interior of the Convent; they are
lodged in an adjacent establishment conducted by
Sisters. This rule goes back to the customs of
Dom Guignes, forty-four years after the death
of St Bruno, the founder of the Order. ‘Nous ne
permettons jamais aux femmes d’entrer dans notre
enceinte; ni le sage, ni le prophéte, nile juge, ni
Vhéte de Dieu, ni les enfants, ni méme le premier
modéle sorti de ses mains, n’ont pu échapper aux
caresses et aux tromperies des femmes. Qu’on se
rappelle Solomon, David, Samson, Loth, et Adam
lui-méme.”

In the environs, visit the Chapel of St Bruno and
Notre Dame de Cosalibus in the middle of the wood
of firs, about half an hour from the Monastery. From
the Convent to the Grand Som (height 6500 feet)
requires three hours.

8. The Chételard.—The valley of Bauges. It
takes four hours to go to Chatelard, and a further
150 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

four hours from Chatelard to St Pierre. From the
latter town the return to Aix can be accomplished in
an hour by railway.

‘« Beyond the village of Grésy, the road gradually
ascends along the Sierroz stream, where (three hours
from Aix) stands the village of Cusy, with the ruins
of an ancient castle; there the road makes a sharp
turn to the south east ascending along the left bank
of the Cheran.

“ Three singular peaks, or rather obelisks of rock,
rise abruptly from the valley. One hour from
Cusy, the Cheran is crossed by a very ancient
bridge, Pont de Bauge. Not far from the bridge is
the entrance to the Grotte de Bauge, or cavern which
contains a subterranean lake, 216 feet below the
level of the entrance, and approached by a gallery
about 270 yards in length. The road crosses the
torrent near the village of Lescheraines, and in less
than one hour from the Pont de Bauge, reaches
Chatelard, a little town 2500 feet above the sea. A
very fine view of the valley and the surrounding
mountains is obtained from the ancient castle which
belonged to the author’s father.

“The road descends from Chatelard to St Pierre
d’Albigny, turns aside from the valley of the Cheran
at the pretty village of Ecole, where there is a good
APPENDIX 151

Café and an Inn, and in one hour from Chitelard
passes St Reine, the highest village.

‘An ascent of three quarters of an hour leads to
Col du Fréne, which commands a very fine view of
the valley of the Tsére and the ranges beyond it;
the road descends in long zigzags, but a pedestrian
may avoid these, and so reach in one hour St
Pierre d’Albigny ”—(Baron Despine, op. cit.)

Excursions by Steamer or small Boats

A regular steamboat service plies every day round
the lake. It stops an hour and a half at the Abbey
of Haute-Combe.

Omnibusses start from La Place Centrale at half-
past twelve and return at half-past four o’clock. Small
boats can be hired for fishing and the different
excursions of Bordeau le Bourget &c., either from
the Grand or Petit Port. (See Tariff.)

“The favourite excursion is to Haute-Combe, on
the opposite or north-west shore of the Lac du
Bourget. The Monastery, beautifully situated by
the side of the lake, and at the foot of the Mont du
Chat, was founded in 1125. The gothic Chapels
were the burial places of the Princes of Savoy.
152 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Among them is an Archbishop of Canterbury, son of
Count Thomas of Savoy, who died in 1270. The
building was pillaged and desecrated at the French
Revolution; the coffins were opened and rifled, and
the monuments, paintings, and stained glass, broken
and effaced. It was restored (1824) by Charles
Felix, King of Sardinia, as nearly as possible to its
original condition ; the tombs were renovated, the
walls painted afresh, and the windows replenished
with Bohemian glass. About half a mile behind
the Abbey is an intermittent spring, called ‘ Fontame
des Merveilles” (Baron Despine, loc. cit.)

It is surrounded by venerable chestnut trees.
The site is a happy one and well chosen for picnics.
At the northern extremity of the lake, is the Chateau
de Chatillon, and vis-a-vis to the Grand Port, with
its back to the mountain, the Chateau Féodal de
Bordeau, which faces a third chateau, that of Bon
Port, the property of an English gentleman, Joseph
Charlton Parr de Warrington Esq.

Excursions by Railway

1. Excursion to Annecy, and the “Gorges du Fier,”
which are “near the picturesque feudal castle of
APPENDIX 153

Montrotier, 33 kilométres* from Aix (an hour and
a quarter by rail), 7 kilométres from Annecy, and
500 métres} from the station of Lovagny.

« As remarkable as that of Trient (Switzerland),
this gorge is due to the corrosion of the calcareous
rocks, 300 feet in height, between which the river
Fier has hollowed out its bed. These rocks,
singularly contorted, are covered with trees and
climbing plants which hang in graceful festoons
over the abyss.

“The length of the defile is 250 métres. Its
breadth from 40 to 10 métres, and it has been
rendered accessible by a gallery constructed by
means of voluntary subscriptions in 1869.

“This gallery consists of an aérial footway, the
wooden flooring of which is supported by 54
brackets of iron, with railings of the same metal.
The water occasionally rises 26 métres in six hours.

“Excellent restaurants will be found either at
the railway station, or at the entrance of the gallery.

“Leave Aix at 8.20 am., arrive at Annecy at
10 a.m. Breakfast there at the Hotel Verdun. At
11 make the tour of the picturesque lake of Annecy
on board the steamer, and on returning, stop at

* A kilométre = 1093 yds., 1 ft., 10 inches.
+ A métre = 1, 0, 387,,
154 THE SPAS OF AIX-LES-BAINS AND MARLIOZ

Lovagny to see the gorge, taking up the train
thence, which returns to Aix in time for dinner at
6 p.m.

The Public Museum in the Town Hall at Annecy
will also be found very interesting from its
collection of remains of lacustrian habitations,
from bones from our mountain caverns, its epi-
graphic collection, and the well-arranged collections
of the birds and minerals of the country.” (Baron
Despine, op. cit.)

2. From Aix to Chambéry takes twenty minutes.
There are six trains a day. The Hotels are very
good, Hotel de France, Hotel de la Métropole, &c.
The drive to the Eaux des Challes occupies two
hours, a visit to the house of Jean Jacques
Rousseau, aux Charmettes, anhour. In the city we
find the Chateau with its old chapel, the Préfecture,
the Fountuin of Elephants erected in honour of
General de Boigne, who after having made a large
fortune in the Indies, loaded the city of Chambéry
with benefits—the Palais de Justice, &c.
APPENDIX 155

Booksellers, Stationers
Mr Henry Bolliet, Place Centrale.
Mr Gaspard Bolliet, Rue de Chambéry.
Select Library
At the clergyman’s house adjoining the church.
Depét de Gaze de Chambéry, Tissus de poils de Lapins
Angoras de St Innocent, Prix de Fabrique

Mr N. Domenget, Place Centrale.

Gun and Pistol Gallery

Collombert, Rue de Genéve.

Bankers

Messrs Antonioz and Foret.
The Credit Lyonnais.
The Caisse Commerciale.
_ 157

GENERAL TARIFF
Assembly Rooms

PRicr oF SUBSCRIPTION

One person . - ‘ 2 : 3 . 26 francs.
A married couple ‘ é Fi : . 4 ,,
A family of three persons. < ‘ - 5B
A family of more than three persons . - 6 y
Admission for one day . - ‘i m av 1B gy

Children of subscribers under eight years of age are admitted
free.

The above is the subscription for the whole season. The tariff
is slightly lowered in May and September, when half subscrip-
tions are generally issued. It does not vary during the other
months of the season.

Public Carriages
The Scale of Charges for hiring carriages is fixed as follows :
“Course” in the town—
For one or two persons . 7 . é . 1 france.
For two or four persons r ‘ . 2 francs.
* Course” out of the town—
By the hour without reference to the number of persons.

Carriage with one horse s i . . 8 francs.
Ke », two horses i ‘. ‘ « & ws
Fares
1. From Aix to St Innocent and Brison, and back :
A carriage with one horse Doh . 9 francs.
A carriage with two horses . ‘ « V2 sy

2. The tour of the lake by Tresserve, Terrenue, and Bon Port,
or by Marlioz, Viviers, and Bon Port: ,
A carriage with one horse. ‘ - 8 francs.
A carriage with two horses. - sil ss
158 GENERAL TARIFF.

8. From Aix to Mery by Mouxy, Claraford, Viviers, and
Marlioz :
A carriage with one horse. : . 9 francs.
A carriage with two horses . « » 2b w
4. From Aix to the mill of Primoz :

A carriage with one horse. 5 . 9 francs.
A carriage with two horses . ‘ « 12) ws

5. From Aix to Bourget :
A carriage with one horse. i . 11 francs.
A carriage with two horses. ‘i » Ib

Carriages Plying at the Railway Stations

The price of places in these carriages is fixed as follows :
Each person . s . . é j . 75 cents.
Each package above twenty kilogrammes . 50 ,,
Packages under twenty kilogrammes are carried free of charge.

Donkeys
The Scale of Fares for donkeys is fixed as follows :
1. For an hour (each hour the same) ; . 1 franc.
2. Forhalfaday . : - $ ‘ . 4 francs.
3. Foraday . $ 5 i - 5 « F %
Boating

The Tariff for boats, with two boatmen, carrying six passengers,

is:

For Haute-Combe . : . ‘ ‘ . 8 francs.
» Bordeau ‘ Z F ‘ io “Sy
» Le Bourget . ‘4 5 ‘ 7 a WB ls
» Brison, St Innocent ‘ : ‘ we 3B.
Bon Port ‘ " ‘ ¥ r « BB «

» Chatillon and Saviéres . ‘ - o AB 5
GENERAL TARIFF. 159

The Fares for excursions to other parts of the lake are charged

for by the hour.
For boats for two rowers:
The first hour. r . é i 7 . 8 frances.
The secondhour . 7 3 ‘ 3 . 2fr. 50¢,
Each hour after. ‘ . i ; . 2 francs.

Tariff of the Bathing Establishment

Abath . fe ° a ‘ ‘ . 1fr. 50cent.
The douche with two doucheurs, from . 2 fr. to 2 fr. 50c.
3 one 8 . 1lfr. 50c¢.

Inhalations and pulverisations . ‘ - ifr.
Porters. : . A ‘ a - 60 cents.
Double ticket . , js ‘ « 1 fr.

The charge for attendance is not included in the above-men-
tioned tariff.

 

PRINFED BY J. E. ADLARD, BARTHOLOMEW CLOSE, E.C.
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