Knutsen, C.A.
Sandefjord Sulphur Bath

Del 1

Christiania, 1884 - 62. s.

Sandefjord is a town with a population of 2500 inhabitants, and is situated in one of the most beautiful districts of southern Norway - in the county of Jarlsberg & Laurvig (North lat, under 50 ° 8') at the end of Sandefjordsfjord, which, with an influx of about 11 kilometer (on both sides bounded by hills) from the open sea, flows directly into the town. On the western side of the Fjord is Vigsfjord, then more westerly Laurvigsfjord, and so, a little more westerly, we have Fredriksværn, then Langesund, the opening to Skiensfjord, at the end of which is Skien, over which town the way goes to picturesque and lovely Thelemarken. To the east of Sandefjord, there are the Fjords called Midtfjord, Lahellefjord, and Tønsbergfjord, running to the well known historical town of Tønsberg, and Christianiafjord.

Sandefjord is a beautiful little town, with broad streets, and neat log-built houses, surrounded by gardens and parks. Good lodgings can be had, and there are several hotels and restaurants. The environs are especially remarkable on account of the abundance of rich flora, variation in scenery, several high mountains with delightful views over sea and land, in the immediate vicinity, and several antiquarian remains: close to the town there was exhumed in 1880 the now very celebrated „Vikingeskib".  Here is also good opportunity for sailing, as well as shooting and fishing. From the town there are everywhere good roads, and steamers and the railway furnish daily access to the outside world. By rail the distance to Skien is covered in 2 hours, and Christiania in about 4. The town is especially celebrated as a bathing place, and amongst the places in the environs, most cherished by patients, may be named Kamfjordvarden, Mokollen, Huviken, Haga, Vindalen, Jettegryderne - out in the Fjord, and by Hjertnæs - Stub, Randviken, Sørbyøerne, and the fish abounding Gogsjø.

Sandefjord Bath.

As is well known, this bath has been completely reformed since 1876. The warm bath house, for sulphur baths, has been rebuilt, and carefully furnished with cosey, comfortable bathing rooms, the number of which will be encreased this year, on account of the encreased demand. The sea bath has been rebuilt, and has both open, and covered bath rooms, as well as a swimming basin. The coffee rooms and restaurations, amongst which a new „Kursal", with theatre, and dining room, answering to the requirements of the times &c. have been erected in a beautiful park, and, in close proximity, surrounded by private houses, where lodgings may be had.

Sandefjord Sulphur Bath.

According to analyses, by Prof. Adolph Strecker in 1855, the sulphur water in Sandefjord, 1000 oz. of mineral water contains 21,8187 oz. solids, viz.:

1000 volumes of water, under normal barometrical circumstances, and by the temperature of the spring, 10,3 Celsius, contain 1 volume of free carbonic acid, and of sulphuretted hydrogen 12,017.

Sandefjord's mineral waters, therefore, amongst the natural mineral waters, belong to the group of sulphur chlornatrium waters, and on account of their influence upon the tissue changes and their consequent dissolving and loosening effect upon the human body, they exert considerable influence upon the digestive organs, and therefore are of great importance in such diseases as belong to the class of rheumatism and scrofula, and all those ailments that are in connection with sickly discharges on the surface of the body, and in various internal organs, consequent upon inflammation or deranged blood circulation. Besides which the effect of sulphur is beneficial in cases of skin disease, and chronic catarrh, especially in the air passages.

Rheumatism.

The majority of the patients, who frequent Sandefjord Bath, have hitherto been rheumatic, and these have been steadily on the encrease; and with regard to the treatment of gouty and rheumatic diseases, the baths have been employed as follows. As a rule, the water in each bath is heated up to 35 or 36 degrees C., after which there is a moderate reduction of temperature, by making use of a dusch bath (2-3 degrees C., under the temperature of the water in the bath), and thereafter a very short shower bath, which, according to circumstances, is 3-4 degrees colder than the dusch. Under certain circumstances the shower bath is not made use of in the first part of the cure. It is to the warmer bathing, without the immediately following, violent cooling, that, during the treatment of patients, I ascribe the principal and fundamental effect. This mode of treatment is continued so long as the most acute pains and stiffness remain, after which the heat of the bath is kept at the same temperature, that of the dusch also and the shower bath being carefully and gradually reduced, during an interim of 5-8 days, according to circumstances. Of course, as a rule, the well-known modes of proceeding, during the bath cure, are made use of, for instance, flagellation, brushing, friction with warm „gytje" (sea-mud) and with diverse species of sea-weed, and the usual massage, as well as, after each daily bath, separate limbs or the whole body, (after the custom of the ancient Romans and Grecians), is well rubbed with Provence oil, which makes the body lithe and comfortable, causing a feeling of lightsomeness and insuring the patient against taking cold. The patients are requested to lie upon blankets, and towards evening, under certain circumstances, their beds are warmed by means of bed-warmers. In this manner, especially in the commencement of the cure, we steadily protect the patients against a sudden or excessive cooling by any violent alteration of temperature during the bath, and only towards the end of the cure we come down to lower degrees in the shower bath, but seldom under 24-22 degrees Celsius.

Every rheumatic patient is cautioned, on departure, against taking cold baths, cold friction or cold shower baths, on arriving at home, it being my decided opinion, as far as my experience serves, that nothing is more conducive to continuation of rheumatic pains, than a violent cooling of the skin, even though a reaction may be caused afterwards, which, however, is uncertain to be produced at home, where under all circumstances well exercised and trustworthy bath servants are difficult to obtain. This is however said with all respect for the hardening treatment, which else in so many cases may be of service.

Besides the baths, as a rule, daily cataplasms of warm sea-mud (gytje) are applied to the most afflicted parts of the body. These applications are made use of in the gytjerooms, which are specially arranged in separate compartments quite secured from draughts, and have perfect ventilation; here the patients generally lie one hour daily, immediately previous to taking the bath.

For many years, during the treatment of rheumatic affections of the joints, chronic exsudations from other causes, lymphoms and other tumours, I have experimentally washed the afflicted part with an ordinary solution of iodkalium, on applying the gytje poultices, and have also moistened the poultice itself with the same solution, without thereby obtaining better or quicker result than by the use of gytje alone, and any absorbtion of the salts of iodine by the skin I beforehand might have known, could not take place, therefore whenever the use of iodine has been put into requisition, in connection with the general treatment, I have afterwards prescribed it, in the old certain doses, to be taken internally. A potent remedy, which is often made use of in Sandefjord, in the treatment of gouty, and rheumatic patients, is the „slam" bath - a mixture of prepared sea-mud and sulphureous water, of the consistency of thick gruel. The slam-baths belong to our most heroic cure means, and must be made use of with great care and tact, particularly with regard to the presence of abnormity of the heart, or for great, robust individuals with disposition to congestion of the lungs or brain. A good means to prevent these latter cases, (while in the bath), is an application of cold gytje to the head. The usual temperature of the slam-bath is 38 degrees Celsius, rising gradually to 40-42 degrees, and is employed about 30 to 45 minutes, after which the patient enters the clenasing bath, which, as a rule, is of 3 to 4 degrees lower temperature than the slam-bath. These baths are generally made use of in 2-3 renewals during 3-6 consecutive days; great care being taken with regard to the strength of the patient, and whether the state of health improves or otherwise during this treatment. When, from any cause, the use of the slam-bath is suspended, the ordinary sulphur bath is made use of during the interim, (should not a perfect refrain from all kinds of bathing for a single day be considered necessary). After the slam-bath, in winter clothing, as quickly as possible - should not at stay in the warm corridor on account of bad weather be advised - the patient must repair to his home, where he must await perspiration in bed, and therefore remain at home several hours, or according to circumstances, the rest of the day.

The Sandefjord gytje, which is especially rich in organic matter - in 1000 parts gytje, 99,2 (Strecker) - has in later years been rendered still more active, by having been previously, for a considerable time, in a deep, carefully isolated, and well covered cistern, well irrigated and constantly saturated with sulphureous water from one of our richest sulphur springs. This is the so-called prepared gytje, which is made use of in the slam-baths, for friction, as poultices, and an addition to the sulphur baths, and the bath is, by nature, so richly supplied with sulphureous water and gytje, that the sulphur baths can always be served with such a strength as the doctor may consider necessary.

The internal use of the sulphureous water, as a medical remedy, I consider of great importance, as I ascribe to this water a peculiar and active influence upon both arthritic and rheumatic diathesis, and long experience proves distinctly, that patients, who under the cure, will also, at the same time, make a methodical and prescribed use of the water cure, will more certainly and quickly regain their health.

It is a well known fact, with regard to the presence of chronic disease, that the number of rheumatic patients is legio, and the remedies they are advised to make use of are, as a rule, quite as numerous as they are useless. A cold is reckoned as a principal cause of the disease, and especially residence in cold, damp, draughty dwellings, and therefore it is not to be wondered at, that we also, in our dear, old Norway have got our share of the evil. That chronic rheumatism plays a considerable and extensive role in our country is also well known; in the yearly reports to the medical authorities this appears as one of the most strongly represented classes of disease, and from several districts it is noted, that but very few adults may be said to be free from it, and, that it is rare to meet with a person over 30 years of age, who is not a sufferer from this painful affliction. This must appear both reasonable and natural, when we reflect upon the situation of the country and the harshness of its climate, in connection with the circumstances and mode of living amongst the lower classes of the community. Colds after hard work and the various hardships, endured on Fjeld and Fjord, are often the usual lot, with insufficient food into the bargain, couplied with want of woollen clothing next the skin; storm and sudden alteration in climatic temperature, in these cases, have much to do with the consequences. That woollen under-clothing is made use of by very few, is unfortunately but too true, and were these not very expensive articles, which the poorer classes are unable, at all times, to have at hand, the wearing of the flannel waistcoat ought to be made as compulsory by law, as vaccination and other medical institutions, employed in the sanatory service. Much disease, particulary rheumatism, consumption (chest disease), and other misery would thereby be prevented. Flannel upon the body from childhood and gymnastics at school may confidently be reckoned amongst the pillars of society.

As before mentioned and as medical statistics repeatedly show, it is rheumatism, which, in a prepondering degree, furnishes our bath with patients, and yet it is to be deplored, that only a small fraction of the great number of sufferers understand how to use, or have the opportunity of subjecting themselves to a methodical thoroughgoing medical treatment, that is completely victorious even over the gravest forms of this painful and often lifelong disease. In the neglected and inveterate cases our potent slam-bath, which is the only one in this country, is of special importance, while the necessity and use as early as possible of obtaining thorough and methodical medical treatment will be advised and fully explained by any qualified and experienced surgeon.

A. F., ship-captain, 44 years of age, during his voyage, in the Autumn of 1879, had an attack of acute rheumatism, went ashore in France, and was for a lengthened time treated by French doctors with salicyl in large quantities ; came home ill, and thereupon spent 6'/2 months of pain and suffering in bed. He was afflicted to such a degree, that his doctor was uncertain, whether in his helpless condition, he might be exposed to the hardships of transport, and, on the whole, was a suitable subject for a course of bathing. The doctor paid a visit to the bath to have a personal conference with me about the case, and I emphatically advised his being conveyed hither. He was transported, partly by land and partly by water, well packed up in his bed, and on arrival was considerably weak. He was particularly stiff in the knees, hips, shoulders and hands; poor appetite and sleep often disturbed by pain. He endured his course of sulphur and slam-bath two whole months, but had to keep his bed the whole time, and to be borne into and out of the bath. He was obliged to lie in bed a couple of months after his return home and had then spent 12 months in bed, when an improvement began to take place, steadily and gradually as usually, not so that it is apparent from day to day, but on the other hand is observable, when one contrasts the state between 2 weeks or a month. It is traditional that bath patients always entertain hopes of improvement in health about Christmas, and not without reason, for after the altered mode of living at the bath and the considerable encroachment upon the various functions of the body, the organs require time to accustom themselves to the old modes and circumstances, and, as a rule, there does elapse so long a period after the bathing course, before recovery or any considerable improvement has taken place.

Our patient presented himself at the bath again, in 1851, in the middle of June, with this remark that „probably he might not be recognisable" and this really was the case. The right hand could not be properly stretched, nor the left completely doubled; on bending the knees, there was a creaking sound, the feet were swollen, rather tender and stiff; hips free, during motion of the head there was also a slight creaking sound; he complained of a slight pressure about his chest, had a pale, somewhat swollen appearance, but else healthy, lively and in good spirits. Weight 161 pounds.

He bathed 7 weeks, during which period, besides the sulphur bath, and other treatment, he made use of 15 slambaths, and, on his departure, felt well in every respect; no feeling of weakness, only the hands and feet a little stiff; else free and able to move about. Weight as on arrival, 161 pounds.

He was advised to come again to the bath the ensuing year and repeat the course for the perfect recovery of his health, but in the Spring he felt himself so completely restored, that he resumed his former occupation as shipper and went to sea.

H. L. 47 years of age, came to the bath in 1881. He experienced his first rheumatic pains 10 years previously; 4 years ago had rheumatic fever, and since then has had to keep his bed every Winter, but improved during Summer, Last Summer he was even able to walk a little, with the aid of a stick, but afterwards was compelled to remain in bed until he came to the bath, the 1st of July. He was pale, and very emaciated, there was considerable contraction, and anchylosis in both knee joints, particularly the left, with incipient subluxation also in the right elbow joint and fingers of the right hand, with swellings of the joints between these and metacarpus; the left shoulder was stiff, the neck, as well as the spine, considerably bent forward. He had always either to ride or be carried. After bathing one month he was able to walk a little by help of crutches. The affection in the left knee was obdurate, but after going through the whole course he departed, considerably improved.

The reason why I have especially drawn attention to this case, is the circumstance, that it was in consequence of the sensible advice and counsel of non-medical persons, and after inquiring from me, a correspondence between me and the clergyman at the patient's native place, that this wretched, brokendown man sought assistance at the bath, after his private doctor, according to the patient's account, had counselled him against taking the journey, as most likely it would prove useless and superfluous. There is not the slightest doubt that, if this man had been sent to the bath a few years earlier, even had it only been one year earlier, when he was able to walk, the chance of his cure would have been much greater, even had it been found necessary to repeat the treatment, which now must be considered as much more imperative. Neglected treatment of cases of this class is in the first place a sorrow and misfortune for the patient in question, and, with regard to the labouring classes, of little pleasure for their parishes, as such individuals often become a burden upon them for the rest of their lives.

Deforming Inflammation of the Joints.

Under the head of rheumatism there is an affection, which properly speaking, does not belong to this sickness, the so-called „arthritis deformans" or nodosa. Of this disease there occur, every year, not a few cases, and in various stages, from the incipient "synovit" to the gravest forms, with greatly swollen joints, contractures, deformity of the limbs and more or less impaired function of the same. With regard to the cure result in these cases, which ought to be a matter of deep concern with every conscientious medical man, the favourable effect of the sulphur baths, in connection with the slam-baths, and daily application of warm gytje poultice upon the part affected, at the commencement of the disease has been evident, before the deformity and derangement of the functions have become developed in any very considerable degree; particularly where the treatment has been repeated during several successive years. The progress of the disease has clearly been arrested and suspended, and even not inconsiderably swollen joints have been reduced, if not quite to their natural dimensions, and all tenderness or soreness has disappeared, so that the patient has regained his vigour and been enable to resume his daily avocations. In inveterate cases, in the strongly developed stages of the disease, there is certainly prognosis mala, but also sometimes there is attained freedom from pain and greater flexibility and power in the diseased limbs, and I have seen the rare case, that a married lady 46 years of age, who for 19 years had been helplessly confined to her wheeled chair, after bathing one season, was able to walk alone a couple of times across the floor.

A carpenter, 30 years of age, came to the bath, for the first time in 1876. In the course of two years there had gradually developed a tenderness and stiffness in his hands, with successive swelling of the various finger joints, and the same with regard to the toes, as well as soreness in the knees. Each finger on both hands, with the exception of the thumb, had deviated towards the ulnar side; else all well. The patient who was the head of a family and a very orderly and clever workman, had for a long time been quite unable to work, because it was impossible with his sore and swollen hands to handle the axe. He left, after having gone through the whole course of treatment, almost free from pain, and getting on well, but returned to the bath again in 1877. He had then had 3 painful attacks during the Winter, before Christmas, and each time had to keep his bed, from 3-8 days, but after that time the state of his health had steadily improved, and what was of the greatest consequence, he had been able to work daily, after leaving the bath, with the exception of the few days that he had been obliged to keep his bed. Most of the joints of both hands were still swollen and the deviation of the fingers the same; there was also soreness and stiffness in the toes; whereas all disease in the knees had disappeared; in all other respects he was healthy and strong. He again repeated his cure as in the preceding year, and then left the bath much better than when he arrived, but his hands were still swollen, particularly the right one. His weight had encreased from 122 to 129 pounds. A third time he was under treatment, in 1878, although the whole time he had been healthier than ever before ; had not kept his bed a single day and had always been able to work. His hands were still swollen and weak; else he was well. After one month's treatment he left the bath; a little stiff in the wrists, but otherwise quite well. His weight had this time encreased from 120 to 128 pounds.

Keeping in view the favourable results obtained in such cases, there must be sufficient inducement to make use of the effective aid of the named treatment, as early as possible, more especially in the very first commencement of a sickness, which so easily may become fatal for the patient, if allowed to run its usual tardy course, and the treatment of which at home must certainly, in most cases, produce but very little benefit.

Gout.

The beneficial effects of the bath in cases of real gout (arthritis) have also long since been proved. The solving of the well known discharges in this sickness, must be ascribed to the strong alcalic-saline properties of the sulphur bath, beside the beneficial influence of the contained sulphur upon the functions of the skin in connection with the strictly enforced diet. The tissue change is quickened during the cure, the secretion of the kidneys is encreased, and the natural decomposition of albumen becomes restored. There have been old gouty patients at Sandefjord, who after a continual cure, during 3 successive years have got the better of their stiffness and pain, and been for ever rid of their urate concretions from the kidneys. Several patients have, for a series of years, made use of our bath-cures, one month every Summer, as a preservative against the malignant proneness, and it has been proved that where the bath has been neglected a single Summer, the attacks have made their appearence again the ensuing Winter.

Chronic Catarrh.

One disease, which has appeared to be easy of treatment in Sandefjord, is chronic catarrh, particularly in the air passages. It has often been the case, that patients, who have come to the bath on account of other diseases, during the cure have also been relieved of their catarrh, whilst some specially for this disease came to the bath for treatment, and the results have been excellent. As co-operative aids during treatment for these diseases may be reckoned sulphur's acknowledged influence upon the secretion of the mucous membrane, the deriving effect of the baths upon the skin, as well as their abating and quieting power upon the nervous system, besides the topical effect upon the mucous membrane in the organs of respiration, by inhalation of the sulphuretted hydrogen, evaporated while taking the bath. In cases of disposition to taking cold, which very often is the case, very early during the cure a sea-cold shower bath is made use of, and a cold extra shower bath daily. As a powerful assistant means for promoting the mucous discharge from the lungs, use is sometimes made of a slight medusa rubbing upon the chest every other day, or less frequently, according to circumstances.

A commercial clerk was at the bath in 1878, during one season. He had for 2 years been constantly suffering from catarrh in the chest, and violent congestion, particularly in the morning, and early part of the day, sometimes looseness of bowels; else well. After a cure of about 8 days the catarrh had considerably abated, after 14 days it appears by the books, that coughing and violent secretions of mucus arose after the medusa application; after 4 weeks the catarrh was gone, and the medusa only produced inconsiderable secretion; after 6 weeks all the functions were in order.

A girl of 3 years, from Finmarken, was under treatment at the bath the same year, for 5 weeks. From the first days of her life she had suffered from a constant cough and an excess of mucus. The child was pale and limp. The cough frequent; a constant flow from the nose; a diffused rattling was heard over both lungs, and the child had never had night's rest, on account of the cough. Sulphureous water was employed internally; after the bath dry friction, and also rubbing of the breast with oil, and the little patient left the bath, bodily strengthened and with a healthy complexion; the efflux from the nostrils had disappeared, all coughing and mucous secretion from the lungs ceased, and night's rest undisturbedly quiet.

A Danish lady, Miss N. N. 31 years of age, was sent to the bath in 1576 for obstructio alvi, but she was, at the same time, suffering from an obdurate chronic catarrh in the stomach, as well as one in the breast, which, in the statement of her doctor, had existed since the foregoing winter, and on which account she was then wearing a respirator. On her arrival her cough was unremitting, so that it was with difficulty that she could be examined; her breath was short, and she was pale, thin and very weak; her appetite was very poor, and she was only able to take very small portions of biscuit and milk; even the latter not always; the bowels often constipated for 8 days, nor any evacuation without having taken pills.

By a careful and methodical use of the sulphureous water internally, in portions, from a wine glass, to half an ale glass, 3 times daily, partly in the morning at the spring, and partly during the day, evacuations began their course already after the elapse of 2 days; the cough became less frequent, and night's rest good. After 7 days' cure appetite began to utter itself, and she felt well, after having partaken of fish and beaf broth. After 3 weeks, it appears: the appetite is better, and the patient can now enjoy an egg, which she has been unable to do for several years, and after 6 weeks, appetite very good, eats roast veal every day and feels well. After simultaneously with the water drinking having bathed fully 6 weeks in the sulphur bath, she then took a sea bath for 14 days. On departure the stools were daily, all coughing long disappeared, and she was able to be on the move the whole day; she was plump and fat, with a healthy, almost blooming appearence so that it was not easy to recognize her by those, who had only seen her on her arrival.

Obstruction.

From a sluggish blood-circulation in the organs of the abdomen, or lack of activity in the alimentary canal, with the consequent many sickly inconveniences, partly derangement of nutrition and well-being, on the whole, and partly of the function of single organs only, the sulphureous water of Sandefjord is particularly indicated. Its active influence upon the blood stream, particularly in the abdomen, and its prompt action upon the peristaltic motion, are in most cases perceptible, but the treatment must be conducted with many variations to suit the patients' conditions, with great patience, and if even during the cure there has to be waged an unceasing war, sometimes without creating the desired activity of the bowels, still one has generally the satisfaction of seeing the patient return the next year with the pleasing intelligence, that he does not know his own stomach again - to such a degree has it improved.

Mrs. N. N. 3S years of age, for many years had been suffering from an obstinate sluggish stomach; everything had been tried without effect, during which time an almost complete deafness had gradually developed itself, so that she was scarcely able to hear when one shouted into her right ear. After an unremitting use of the cure in Sandefjord, she experienced the delightful result, that after her return home, her stomach gradually came into the most desirable order, and she had also the pleasure of experiencing, that the hearing of her right ear gradually improved, according as her stools became regular and daily.  She presented herself again at the bath the ensuing year 1880, and then stated, that her stools had been daily, and that she had scarcely ever made use of a purgative during the whole year, and what she was not the least proud of was, that her hearing was restored in the right ear. The dissolving and loosening effect of the bath cure had freed her from her frequent and violent congestions to the head, and, at the same time, liberated the functions of that ear, which was yet reparable, so that one could speak to her in tones as is usual, when speaking to people, whose hearing is normal. She again went through her bath cure and returned home well and pleased.

The warm gytje cataplasms, which mostly are applied over the whole of the abdomen, 1-2 hours daily, or every other day, according to the state of the patient's physical powers, play a great part, in connection with the other means of cure, in all irregularities of the stomach, especially in the portal and hæmorrhoidal circulation, and is perhaps the most active factor in the resorption of even the deeplying exsudations, after inflammation in the abdomen, universal or partial, for instance, after the so frequently occuring typhlites and perityphlites, with the thereof accompanying compression or tightening of the gut.

A punctual and regular diet, with fixed meal-times, and simple easily digestible food are also reckoned as of considerable importance during the cure.

A patient 40 years of age, was 6 weeks at the bath in 1883. For the first time got typhlit in 1879, and had since suffered from obstipation; relapse of the disease in 1881 and 1882. Since last January often long constipation and frequent pains in the bowels, especially violent colic pains in the right side, every morning on rising. Had been at several baths amongst which Marienbad.

His stomach remained sluggish, no stool for 48 hours ; excrement consists of small hard lumps, like those from sheep, together with a quantity of mucus. He is a powerfully built man, though, at present, very thin, with a pale and suffering appearance. He commenced the cure with a warm sea-water bath, but, on account of his weak state, was only able to take a bath every other day, and lie with a gytje poultice on, every other day. 1/2 a glass of sulphureous water twice a day produced certain and quick evacuation every morning. Diet the whole time unchanged: breakfast 8 o'clock, 1 egg, hardish cooked, stale wheaten bread with butter; coffee with boiled milk. Luncheon 12 o'clock, a little wheaten bread with butter, a small beefsteak, or cold meat, 1 poached egg, 1 large glass of Bordeaux wine. Dinner 4 o'clock, broth or rice milk, roast meat or fish (not fat fish), mashed potatoes, egg, spinage, cauliflower, buttered egg, boiled macaroni, 1 1/2 glass Bordeaux. Evening 7,15-7,30, tea with milk and a small biscuit. Bedtime 9,30-10.

His appetite by degrees became so voracious, that he felt hunger between meal-times; the quantity of mucus decreased, and the lumps became larger, and at last the excrement was coherent, even, and sufficient every day; the pains in the morning had almost entirely ceased; his strength was encreasing the whole time, and his appearance was greatly improved. His weight encreased from 121 to 126 pounds.

It must be stated, to the credit of the patient, that all the cure rules were observed by him with the most scrupulous order and precision, and especially did he follow the dietary rules with rigorous exactness.