In the treatment of disease you will meet with several classes of difficulties. After having carefully investigated the morbid phenomena, and satisfactorily established the nature and cause of the suffering, you proceed to adopt the most appropriate plan of treatment. But at your next visit you find that the remedies which seemed to be clearly indicated, and which confidently promised relief, have failed to answer your expectations. Suppose a case of severe rheumatism claims your care: you have given the patient alkalines, colchicum and other approved anti-rheumatics; you have regulated his digestive functions; you have even been induced by the severity of his suffering to employ antiphlogistic remedies; and, according to theory, the patient ought long since to have left his bed and mixed with the healthy. But in sad reality, there he lies, still feeling pain in his joints, still unable to use his limbs, and pursue his avocations, perhaps to the injury of beloved persons depending on his exertions. What is your next step?

You subject all the prominent symptoms to a fresh examination, and you conclude, that, if you could raise the power of the nervous system, by giving quinine for instance, the functions of the muscles and muscular organs would be strengthened, and the morbid sensibility diminished. Some relief has been obtained, but only temporarily, and the pain, inconvenience, and disability, still exist or return, to the silent reproach of human skill. You attack the enemy from another point. You give iron to improve the strength of the vital fluid, and thus induce a more energetic organic metamorphosis. The contention between diminished irritability and increased nervous sensibility is often removed by raising the former, and thus restoring the equilibrium necessary to health. You may then resort to iodide of potassium, which frequently cures similar states of disease, by increasing the power of the absorbent vessels, and causing effete exudations to become absorbed and excreted. You have employed vapour baths, external derivatives and internal revulsives; and though each remedy (when judiciously selected) helped to allay the symptoms, still days, weeks, nay months have passed, the disease has become chronic under your hands, in spite of the most careful and approved treatment. You must not suppose that I fill your mind with imaginary fears. Though fortunately rare, such cases will occur, notwithstanding our daily progress, and the almost hourly discovery of some new remedy. It is at this stage that people throw themselves into the hands of quackery, relating how many bottles

of medicine and boxes of pills they have swallowed,' as they call it, how they have been given up by the profession, &c., &c. What gratitude will you earn, if, on the point of abandoning treatment, you remember that similar cases have been cured by a certain spa, and you are thus instrumental, by its recommendation, in restoring the patient's health while he is far removed from your sight?

Another class of difficulties ought not to be passed over, for they will occur in practical life. Your advice will occasionally be asked by persons complaining of some deviation in the function of certain organs, and still, after having accurately observed the phenomena, you may find that actual disease does not exist. There are states of transition between the normal performance of the harmonising human faculties and disorder. What seems functional derangement is perhaps, in this instance, only morbidly increased sensibility, or momentary predominance of one system or organ over another. A desire arises in your mind to recommend steps, which form the intermediate link between dietetic rules and pharmaceutic preparations. This you can satisfy by ordering a mineral water, the constituents of which act sometimes more ener getically than larger doses of the same remedies in the ordinary form. The reason probably is, their greater degree of solution. They enter the digestive organs as more congenial bodies, and their active principles, so finely divided, are fit to be immediately imbibed into the absorbent vessels, and to be assimilated without previously performing the tortuous route of digestion, as is the case with many artificially prepared medicaments. Very frequently, nature gives us distinct hints of a tendency to a disturbed equilibrium. Is it not very meritorious to combat these first deviations of natural functions, and thus often prevent the development of actual disease? From the imperfection of everything human, you will not, of course, always succeed. But I can affirm, from the experience I have had in the occasional administration of mineral waters for a number of years, that their effects in this respect are extremely gratifying. Often have I prescribed the one or the other, at first, as an innocent experiment or an expectative remedy, without hoping to find the beneficial results that actually ensued.

A gentleman, about thirty years of age, who began to study medicine, and afterwards turned to mercantile pursuits, underwent much anxiety and mental labour in the year 1846. For twelve years past he has felt daily, a few hours after each meal, a burning

sensation in the cardiac region, extending upwards to the shoulder; he was also frequently affected with headache in the occiput, particularly in the evening. He tried many remedies and dietetic changes in vain, and latterly carbonate of potash. He resides in a healthy suburb, daily takes much exercise, and lives with the greatest regularity. Finding the subjective phenomena unconnected with any structural or functional disorder, I considered the free carbonic acid, with carbonate of soda, and the other ingredients contained in Fachingen water, would improve his condition. I accordingly recommended this water, and was extremely gratified when, after some time, he declared himself entirely free from the inconvenience which had molested him so many years.

The name of mineral waters indicates that certain mineral substances are dissolved in the springs. If so, why could we not artificially produce the same combination, and expect similar results?

Because they mostly contain substances insoluble in ordinary water. But what agency keeps them in solution? It is carbonic acid gas thoroughly impregnating the water. Were we to employ any fixed acids to dissolve lime, magnesia, or iron, the chemical composition of other combinations would be changed. Carbonic acid not only dissolves the one substance without disuniting combinations of others, but it enters the system charged with these particles, and presents them to the mouths of the absorbent vessels in this highly diluted condition; it further promotes their direct absorption by exerting a stimulating power on the vascular and nervous systems. Thus you may understand why six-tenths of a grain of iron imbibed into the lacteals, with the above gas, may be more exciting and strengthening than three or four times the quantity of pharmaceutic carbonate of iron, which has to be dissolved in the gastric juice previous to absorption. A great many spas possess similar ingredients, but in different proportions; and their efficacy generally corresponds with the predominant constituents. Other ingredients admixed prevent a too powerful action on any organic sphere. Suppose sulphate of soda or magnesia to be the chief ingredient (as in Püllna, Saidschutz, &c.) the alvine evacuations might be excited in too high a degree, and the sanguification might become too much weakened to perform the nutritive function of the whole body. But carbonate of lime and of iron present in small proportions, give a certain check to the solvent and liquefying action, and increase the tone and resistance of the blood. Where iron is

the chief ingredient, a too vigorous excitement of the vascular system is prevented by the presence of a small quantity of lowering sulphates, and of solvent chlorides. But you will raise the objection, that we have been impressed with the great advantage of simple treatment, and of not employing too great a complication of remedies. It is certainly most desirable, in ordinary treatment, to fix the appropriate remedy in the simplest form, and then both success and non-success will improve your experience and therapeutic knowledge. But though it is necessary to be guided in the choice of the mineral waters by their chemical composition, each spa must be considered as one whole, acting on well-defined abnormal conditions with a more or less certain effect, according to the records of eminent English and foreign writers. Having informed you that a gaseous acid is the chief solvent of the mineral waters, you will at once see the difficulty of artificially imitating them. Nevertheless, the great advantage derived from their use induced several attempts to prepare fictitious mineral waters. Dr. Struve of Dresden succeeded, after years of unceasing labour, in producing fictitious mineral waters, which resemble the natural in taste, colour, specific gravity, and, above all, in the results of chemical analysis. He endeavoured to follow the process apparently employed by nature, and he argued that the effects must be likewise identical. What is called the Brighton pump-room' is one of these establishments; and many instances are on record of cures performed by these waters, and of specific effects only belonging to the respective natural waters. Some go even so far as to claim a preference for the artificial waters, from the circumstance of their being more easily obtainable, and of their losing less carbonic acid by distant carriage, &c., &c. But, though our present knowledge of chemistry can discover no perceptible difference, who could assert that some new test might not find substances in the springs, which were unknown at the time of their last analysis? Before the discovery of iodine and bromine, for instance, the efficacy of Kreuznach or Adelheidsquelle in scrofulous diseases might have been attributed to the presence of chloride of sodium and chloride of calcium. That there are active principles yet undiscovered in some mineral springs, we are justified in surmising, if we take cognisance of the astonishing changes produced by certain spas called 'chemically indifferent,' because their constituents are scarcely distinguished from those of common water. It is a singular fact that these very spas are among the

most powerful. Take for instance Wildbad, near Stuttgardt, which is particularly renowned for curing inveterate gout, arthritic paralysis, and contractions after wounds. What do you suppose its constituents to be? No more than 3 grains in 16 ounces, and these are about two grains of chloride of sodium, halfa-grain of carbonate of soda, some carbonate of magnesia, of lime, manganese and iron, with some silex. Are these few grains able to cause absorption of substances deposited in the joints, or to restore pliancy and power to limbs, which have for years resisted the manifold means that knowledge and experience have devised? Put the same ingredients into ordinary water of corresponding temperature, and see whether you will obtain results at all approaching those frequently experienced at Wildbad? Is it because the warmth of the water is identical with that of blood, and requires neither heating nor cooling? You have only to think of Gastein, in South Tyrol, the temperature of which is about 111° F., and which must be cooled for bathing, and still its reputation for the cure of atonic gout, of paralysis, and of spasms through deficient nervous power, almost surpasses that of Wildbad. What are its constituents? Still less, only 2 grains in sixteen ounces-viz., 14 sulph. of soda, then some sulph. of potash, chlor. of sodium, carb. of lime, &c. It is true, an undetermined quantity of animal substance, called glairine, has been found in it. But is that to explain the visible transformations happening within a short period before your eyes? Why can the spring of the 'hôpital' in Vichy be freely employed, whilst that of the 'Grande-grille' must be administered with great circumspection, though both possess nearly the same chemical constituents? Probably because the vegeto-animal substance, incapable of imitation, is more abundant in the former.

Another objection to artificial waters may be found in the supposition that many salts obtained by evaporation may possibly have been formed through this process, without having previously existed under the same combination; in fact, it may rather be a product than an educt of analysis. Nevertheless, they are excellent substitutes for the genuine waters; although when these latter can be obtained, it is my opinion that they ought decidedly to be preferred. On the other hand, great advantages may be derived from certain imitations; thus, at Gros-Caillou, rue de l'Université, Paris, they produce a solution of magnesia in an excess of carbonic acid, which is so saturated that a pint contains nearly half an ounce of magnesia; about six grains can