Knutsen, C.A.
Sandefjord Sulphur Bath

Del 2

Christiania, 1884 - 62. s.

Skin Diseases.

Psoriasis is the form that appears most frequently at the bath. As a rule, in the treatment of this so stubborn disease, care is taken, that the skin be spared every unnecessary irritation, for which reason the patient lies quietly in his lukewarm sulphur bath, without the usual treatment, after which there is a careful rubbing in with lukewarm gytje over the whole body, with successive changes to cold shower bath, or pouring over of water and careful drying of the body; besides, separate from the bath, there is local treatment with poultices of milkwarm gytje upon the parts most affected and several times daily washing with sulphureous water. Mineral-water drinking, according to circumstances.

A lady 24 years old, came first to the bath in 1877. The sickness had appeared a year ago and she had the year before been at an iron bath, without any sign of improvement. The disease was especially localised in her face and at the roots of her hair. Her father was suffering from the same disease. She was partially chlorotic and suffering from bronchitis, and a sluggish stomach. After 7 weeks bathing and daily use of the gytje poultice over the forehead and brows, where the eruption was very disfiguring, and a rubbing in of gytje at the hairy parts, together with mineral water drinking, the cutaneous eruption disappeared, and there only remained slight indications of marks; else she was perfectly sound and healthy, and her weight had encreased from 123 to 125 pounds. On her arrival at the bath in 1878 there only appeared a very small spot on the forehead and a slight peeling off on the hairy parts of the head, on the other parts of the body only very slight eruption was apparent, which had not shown signs of dispositiorh to encrease. After 6 weeks' cure, as in the preceding year, the eruption had disappeared and all functions were in order. Her weight had encreased from 125 to 128 pounds.

A farmer, 30 years of age, was afflicted with skin disease, for the first time at the age of thirteen, and this had continued to plague him ever since, except with rare, somewhat free intermissions, as some kind of eruption there always was in the elbows, legs and head. On arrival at the bath in 1874 there were characteristic psoriasis spots, from the size of a lentil, to that of the flat hand, spread over almost the whole body, and in particular a considerable loosening of scurf from the head causing occasional itching. After 6 weeks' cure the eruption upon the arms was much paler, the skin of the afflicted places was on a level with the surface of the sound skin, the head quite free. When he again appeared, to undergo treatment at the bath in 1878, he stated that towards the end of Autumn, after last year's bathing, the eruption had gradually disappeared, without leaving any trace, and on inspection of the whole body, the skin almost all over was white and even, without any sign of scurf, only at the ends of the elbows, about the size of a shilling, the skin appeared to be somewhat darker and covered with extremely fine scurf, in the same manner a couple of small spots at the hair roots, and on both sides of the shin bone, two large ones ; very slight itching of the skin. After one month's cure, the discolouration at the elbows had almost disappeared, and the skin of the rest of the body was as normal.

Manufacturer N. N. 21 years of age, came to the bath in 1882, with psoriasis spots spread over the whole body, considerably raised over the surface of the skin, and particularly troublesome on the back of the hands, so that he was constantly obliged to use gloves. The father too was very much plagued with this disease. After one month's cure the spots became thinner, with lighter parts in the centre; no itching.

He returned in 1883 and stated, that the breaking out had continued up to Christmas, but after that time had steadily become less, so that, at the present, eruptions appeared only upon the elbows and cap of the knee. After another month's cure he, left with only a few inconsiderable spots about the elbows and knees.

Herpes circinoides. Skipper N. N. 27 years old, from Nordland, who used the bath in 1876, a year and a half ago, was affected with skin disease, which caused extraordinary itching, particularly during the night. Over the whole of his body, particularly upon the underextremeties and nates, there was seen an extended eruption of vesicles, in some places collected in circular groups; several of which were ulcerating; in the neck several large furuncles, and behind the left ear a swollen glandule as large as a walnut. The patient had almost always been under medical treatment and used much and many things, both internally and externally, without effect; he was now in despair about his innumerable sufferings, which left him no rest, and were worst during night, and he was exceedingly impatient. After 6 weeks' treatment, the patient left, cured; the eruption having disappeared, and all itching ceased. He was healthy and well pleased with the result.

Eczema chronicum does not come very rarely under our treatment. Miss N. N. 22 years of age, came under cure in 1883. She had for many years been suffering from chlorosis, with headache and debility. A year ago a breaking out appeared on her back, which has troubled her ever since and defied all medical treatment. This eruption caused excessive itching, particularly at night, when in bed; of course disturbing her night's rest; this itching also occurred during the day, in warm weather. The eruption suppurated and formed crust. Stools and menses, in order. The whole back, particularly the lumbar region, appeared very darkly discoloured, covered with vesicles and a number of large and small pustules and boils. The skin felt indurated, like thickened parchment. After a month's treatment, with gytje poultices daily, upon the back, the itching and all the eruptions disappeared, and the skin regained its natural thickness, softness and elasticity.

Neuralgies.

The most frequent nervous pains, of peripheric origin, that come under treatment at the bath, are those, often very obdurate ones, arising from ischiaticus, trigeminus, and the intercostal nerves, and particularly is schiatica a constant and welcome guest of the bath, where it is treated with pretty certain prospect of being cured. Nor is it seldom, that there appears crural neuralgy, the so-called ischias antica, with the pains concentrated on the forepart and inside of the thigh, with its peculiar influence upon the gait. The treatment consists in a daily application of warm, prepared gytje to the affected part, after which a warm sulphur bath, with shower and dush and while in the bath, and immediately after taking it, energetic massage, along the tractus of the nerve stem. When the cure has proceded awhile, rubbing in with medusa is made use of, according to circumstances.

Miss N. N. 20 years old, came to the bath in 1879. The previous Autumn she had incurred her sickness by sitting on a cold damp bank. She had mostly been confined to her bed and had suffered acutely. On her arrival she was not able to support herself the least on the right leg; was only able to stand by the aid of 2 crutches, but could not walk, and felt acute pain at the slightest touch along the course af the nerve. The pain extended to the knee and downwards into the foot; the whole extremity felt rather cool, and was in a high degree atrophied and scarcely half the circumferance of the left leg. She was pale, weak, and only slept at night after morphine injection. After 17 days' treatment the temperature of the leg began to rise, the pains to abate, and she slept well, without morphine, (the use of which the patients are, as a rule, weaned from at the bath). Four weeks from the commencement of the cure, one crutch was discarded, 8 days after, the other also, and she was rapidly improving and continued steadily to do so after her return home, so that the leg, in due time, regained its wonted stoutness and strength, and she has been able both to walk and dance.

An unmaried lady from Kragerø, 28 years of age, sought the aid of the bath in the Summer of 1881. She had, for many years, been suffering pains in the right side of the face, which had encreased in frequency and intensity, in particular last Winter, and were as acute as that kind of pain can be, so that she had been obliged to keep within doors the whole Winter. Sometimes the right eye was strongly blood-shot, sometimes the pain transplanted itself to the neck and tongue. She had used massage, electricity and several kinds of embrocations, all to no use, and beside her other sufferings she had also had the services of a quack doctor, who by the help of some strong, wonderful salve, had procured her a number of deep, wonderfully deforming scars, half over her face. Formerly she had been stout and buxom; she was now thin and pale; had little appetite and little night sleep, on account of pain.

During the cure her pains gradually abated in violence, and she was able to enjoy a sound, refreshing sleep; her appetite became excellent, and after 6 weeks' stay, her weight had encreased from 116 to 120 pounds. She was, however, never free from pains, though incomparably less acute, and she was advised to come again next year. Not long after her arrival at home the pains disappeared entirely; they have not again returned, nor has the patient.
A patient, 66 year of age, came to the bath, for the first time in 1879, suffering from intercostal neuralgy. He had caught the sickness the year before, at the commencement complicated with herpes zoster, which went over to gangrene of the skin, in several places. After the healing of the sores the neuralgy remained, for which sickness he had employed the services of several medical men. He felt constant pains, as from glowing coal, down his side, with the usual points douloureux. He improved considerably towards the end of the bathing cure, and particularly so after his return home, and has continued to frequent the bath regularly every Summer, because the pains, which are entirely away at night, have gradually diminished, so that at last he feels them to a certain degree, only on directing his thoughts to the place.

Should the afore-named forms of sickness be of specific origin, they are made the objects of special treatment. With neuralgy and lameness of central origin, which is of very common occurrence, the greatest care must ever be taken for the prevention of central congestion, the neccessary means for which object we always have at hand at the bath, besides which the causal indication for the general treatment of these diseases must always have a place in the first rank.

Of less common diseases may be mentioned a case of incipient, progressive muscle atrophy, in a girl 16 years of age, who had incurred this disease by excessive piano playing, and came to Sandefjord in 1879.

The muscles of both arms were considerably relaxed. The rest of the body well nourished; she felt great weariness in her right shoulder and arm, as soon as she made the slightest attempt to play, and on the back of her right hand, and the interstices between 5th and 4th, and also between the 4th and 3rd metacarpal bone; there were perceptible in-sinkings. After having gone through a cure, including the bath, inductive electricity, gytje and medusa, she has continued her artistic education and been able to play, up to 4 hours daily.

Chronic Bone- and Joint Diseases.

In these diseases, whether of dyscrasic or of traumatic origin, the dissolving action of this bath and its powerful influence upon resorption are of great importance, with regard to the fluid and firm exsudations in the joints and about the parts affected.

A boy of 17 years, from Jarlsberg, came to the bath, for the first time, in 1875. His pains in the left hip began 5-6 years earlier, and the whole of last year he was bedridden. The patient, pale and suffering, was brought in for examination by his parents, the father supporting him by one arm and the mother by the other. He had difficulty in sitting and was unable to stand alone, even with the help of 2 crutches, as he was utterly unable to rest upon his feet, much less walk. The left hip was considerably larger than the right, about which plenteous firm exsudations were discharged, and the hip joint was immoveable. He began the cure on the first of June. On the 16th it is protocolled, that the discharge was less and softer, and on the 26th, that he walks with ease, with the help of a stick, and even without that assistance. Somewhat later an abscess formed itself on the outside of the thigh, and this had to be opened, for which reason he was obliged to refrain from the bath for some time. He left considerably improved and came to the bath again in the Summer of 1876. After having bathed 7 weeks, it appears by the books, that on his departure the hip was much less than last year; the thigh joint almost immoveable, but he can walk where he will, without any assistance, and has grown strong, stout and healthy. Both times the cure consisted in the use of the sulphur baths and warm gytje poultices upon  the thigh, one hour daily, and all night; and presumably it is the Sandefjord gytje, which has played the principal part in this case and is entitled to the principle honour of the result.

Nervousness.

There is opportunity in Sandefjord for overburdened bodies to get rid of a mass of weight by the aid of sulphureous water and a good will ; but on the other side, as the statistics show, there is proportionally a considerable number of patients, pale, relaxed, anemic individuals, with sleepless nights, headache, low spirits and all those wretched plagues, which most generally bad digestion and too willing nerves have agreed to encumber us with, during our sojourn upon earth. It is our ferro-sulphureous water and, if necessary, some other mineral-water, our variously adopted bathing processes, fresh sea air and excellent seabaths, which, under circumstances of so much sickness of the above kind, cause the baths to be visited and the results to be the most successful.

Scrofula.

No less obscure in its origin and nature than rheumatism and many other diseases, is certainly this sickness which, with its various chronic processes of inflauimation and respective sickly products, in the various tissues and different places, in the skin, in the mucous membranes, periost &c., and especially in the lymphatic glands, all of which go under the general denomination of scrofula.

This disease is not unfrequently represented at the bath, and in general, in children and young persons, in whom often the protracted gastro- entero- catharrh has been the precurser, and thus these patients, in a special degree, are remarkable for being in a poor state of nourishment. One might beforehand think, that under treatment of such young patients, there might be difficulties with regard to the use of our sulphureous water for inward use, but this is by no means the case; on the contrary, as a rule, this water, that seems to most adults to be rather disagreable, is really enjoyed with great appetite by the above mentioned class of children. It must be pure instinct, which with irrepressible force causes the child to drink, what no one can imagine as belonging to the category, called sweets for children. From this reason also it is therefore always necessary to be careful and enjoin upon parents and guardians to see, that moderation be observed, and that there be not consumed more than the ordered quantity; otherwise as one may very easily understand, immediate disaster may be the consequence. With regard to these, little, pale, debilitated, scrofulous, often rachitic patients, besides the other salts contained in the water, those of iron and lime must be of great importance, and it is remarkable to see the powerful effect upon the digestive organs and the consequent improvement in strength and appearance, at a very early stage of the cure. It follows of course, that bathing must be its accompaniment, should the patient's strength allow it (in general the sulphureous bath) and always, in the beginning, very small doses of the sulphureous water should be given for drinking, which, thereafter, methodically and with due regard to digestion, sometimes may be encreased to a certain degree, but must never exceed 1 or 2 small, glasses, at the most 3, daily.

Besides the necessary diatetic and hygienic regimen, there is also the customary treatment, should no other indication make the use of any other special means necessary, about which later.

A school teacher 33 years of age, whom in my earlier practice, I had under treatment, a couple of years, for swellings of glands on the neck, using the customary means, amongst which, iodkalium without any particular result, I again met in 1875 as a bath patient in Sandefjord, where the 2 foregoing Summers he had been under the treatment of another surgeon. He was remarkably pale, considerably emaciated, and appeared very suffering and exhausted. On the right side of the neck there were several hard glands, suppurating on the surface, as well as several other large and small, superficial sores, with relaxed, undermined borders, over the fore surface of the breast, down to the lowest end of os sternum. He bathed 6 weeks in the sulphur bath, had gytje poultices upon the sores daily, and drank 1/4 glass of sulphur water at the spring, twice in the morning, and 1/4 bottle of pyrophosphoric iron water daily. He left the bath improved, feeling well, and the sores, for the most part, healed. On his arrival at the bath, the next year, he said that during the past year he had felt much better than before; he was still thin limbed, but the muscles were firmer and the complexion perfectly fresh. On the foreside of his breast there was still to be seen a single superficial sore, and in the submaxilar region, a small ulcus, covered with a thick crust. This time he only drank sulphureous water, he had also the same treatment as in the preceding year, and after a month's stay at the bath he left, without any swollen gland, the sore completely healed, and feeling himself in every respect healthy and strong.

Syphilis.

During the first 5 years of my function as superintending physician in Sandefjord, there appeared only single cases of constitutional syphilis, which at that time were treated with the bath's own means, exclusively, and in a few cases the result under the circumstances was satisfactory. In the treatment of this disease I have always, in the first place, endeavoured to keep up the physical powers of the patient, and regarding this as the main point have adopted all the treatment, both inward and outward, so, that at least there shall always be a balance between income and outgo. Thus the patient must be spared both violent evacuation and exhausting bathing, and as much as possible, avoid every thing, that can bring down, or have a weaking effect. It is a fact, that in Sandefjord the appetite of the patient often is sharpened to an astonishing degree, to which the fresh pure sea air, most certainly, contributes considerably Thus according as the organs of digestion allow, the patients are advised to take strong nourishing food, egg, and meat daily, and with sound, nutritious diet and the encreased tissue change, which soon begins to take place under a careful and methodical use of our methods of cure, it seems, a priori, not improbable, that there may be a renewal of the old Adam. It is of the very greatest importance for the patient's stay at the bath, that the utmost discretion be observed, concerning this delicate disease, and therefore, an account of the special cases is always, stated in such a manner as not to be recognised by others.

A patient, 35 years of age, 6 years previously, had got a violent chancre, after which all due secondaries, and finally signs of inflammation in the right foot, near the ancle, with fistulous ducts, and ulcers, which afterwards, spite all kinds of treatment, remained the same. On examination there was found a considerable swelling of the affected part, and several ulcers, with sharply defined borders; especially one large, deep one, which was very painful on being touched The patient had to use two crutches and always have the sick leg bent at the knee, so that it might not come near or in contact with the ground, which caused the intenseset pain. He had taken a mass of mercury and kept his bed half a year, during which time, constantly, until the last, he had his foot bound round with mercurial plaster. He improved rapidly, during the use of our general sulphur cure; after 4 weeks the swelling had disappeared, and after 6 weeks the deep sore was pretty nearly healed, and the other sores had closed, all tenderness had vanished and the functions of the sick leg completely re-established, but I am inclined to think,
that the curative effect of the bath stands in close connection with the immediately previous mercurial treatment.

Especially in the very latest time the majority of the bath guests, suffering from constitutional syphilis, or the so-called dyskrasi, has steadily been on the encrease al the various sulphur baths, so that at some even the principal number, by the side of the rheumatic and exantimatic diseases, have been syphilitic, for inst. in Aachen, where in 1882 of 4-5000 patients, it is computed, that of this number 3/5, are suffering from this sickness (Beissel). In our day we have got over the idea, that, under the treatment of these unfortunate sufferers, we had no use for the two principal conditions for a normal blood mixing: nourishing food and fresh air, and both of these fundamental conditions for healing and health can be offered in full measure during a bath cure. It may certainly be allowed, that also several other baths, such as the sool-baths, sea-baths &c. promote the removal of the latent particles of virus, and elimination of the same from the body, but, with regard to the sulphur bath, this is the case in a still higher degree, which it must be allowed causes a greater promotion of tissue change and a quicker encrease of all secretions. That the mercurial dyskrasi or the so-called mercurialismus, arising from the frequent use or misuse of mercury, is quickly cured by a sulphur bath cure, is a fact well known enough; likewise that certain remnants of syphilis, in certain cases, may also completely disappear under the renewing, and blood-cleansing effects of sulphureous water, but for the rest, no experienced bath physician now ascribes any specific effect to the sulphur baths, with regard to the treatment of syphilis - but all are agreed in regarding them as excellent aids during the use of those specific remedies, which are considered indispensible. Where the signs of mercurialism are predominant over the syphilitic, iodide of potassium is frequently made use of, and especially is it often necessary to resort to this remedy as the surest and promptest means against the intense pains, partly in the head and partly in other parts of the body, which may sometimes overwhelm the syphilitic patient during the cure; but principally is it the mercurial preparations, which are made use of, in connection with a sulphureous water cure, and all experienced doctors at the sulphur baths agree, that mercury, in this combination, works quickly, securely and yet mildly.

It is therefore this so-called mixed cure, with its two factors: sulphur bath and mercury, which by the most conversant and experienced authorities is considered to be the most advantageous, effective and sure method, and it is this method, which has been made use of for a long time at the various sulphur baths, on a large scale, and especially in Aachen.

It had for a long time been a matter of importance for me to ascertain, whether the bath alone, by its own power, could gain mastery over the disease in question, but in most cases I was obliged to acknowledge, that this was beyond its sphere, whereas, after what I have repeatedly seen performed in the above named manner at foreign sulphur baths, and what I have seen stated on this subject, together with my own experience, as bath doctor, l must, when all was well overweighed, come to this decided conclusion, that the combined method against syphilitic affections also deserved to be introduced into Norway, where, as far as I am aware, it had not hitherto been made use of, and there was so much the more encouragement to make use of this renowned mode of treatment, especially at our powerful sulphur baths in Sandefjord, where in this manner it was practised for the first time in the Summer of 1880, upon patients suitable for the purpose, and with the most satisfactory results, as to cure.

It must be remarked, that, as a rule, there is premised a preparatory cure; that mercury be used only for anointing, and with great caution during a longer or shorter section of the bath cure, the anointing cure being suspended as soon as the sickly phenomena have disappeared, or should there appear the slightest sign of salivation, which however has not taken place in any of those cases in which the cure has been employed here, except in one single passing case, in regard to which the use of mouth water several times daily, and a frequent inspection of the mouth is of the greatest importance, that there still be taken great care, no less with regard to the inward use of the sulphureous water, than of the sulphur baths, and that during all this, there must be had a constant regard both to the physical and mental condition of the patient. It is a matter, of course, that the cure be made use of with discretion, without causing any sensation or uneasiness in the mind of the patient, and it must also be considered as an important matter in the treatment of the disease in question, that the patient shall enjoy a free and agreable existence, while at the same time making use of an easy and mild cure ; a light and lively humour under these circumstances will the more surely lead to his perfect recovery.

It is not so seldom, that individuals come to the bath, who for a longer or shorter time have feared that they have had syphilis, and still believe, that they are not perfectly cured, and imagine that the disease yet remains, thereby suffering an incessant martyrdom from the fear that an insignificant symptom as for inst. a slight redness in the throat may be a sign of the slumbering disease in his body. Such individuals may often live in the most desperate hypocondrical state of mind, and belong to not the least pitiable sufferers at the bath, although they may participate in social life and so appear to the outside world, that no unitiated would suspect for a moment, that they were suffering under any sickly pressure. Under such circumstances the sulphur cure is not less indicated as a trial cure; it is not seldom that the sulphur cure is a diagnostic reagent for syphilis, and if no breaking out takes place, during the cure or very shortly thereafter, but on the contrary some innocent symptom about which the patient has been anxious, may disappear, the stay at the bath has not been the least satisfactory, the patient thereby having gained a belief in his recovery, and consequently peace of mind and contentment, of which many instances can be brought forward, that have occurred during my practice in Sandefjord.

On the other hand, it may happen that patients come, who have been suffering from syphilis, but for a long time have not displayed any visible sign of the disease, - they have only occasionally felt rheumatic-like pains, which neither the patient nor his surgeon have considered as being in connection with the disease, but after 2-3 weeks' bathing the truth comes to light. The pains may encrease to an excessive degree, or there may appear characteristic eruptionsens and ulcerations upon the mucous membranes and skin, which then make the use of the mixed cure necessary.

Such a patient was at the bath in 1880, he was 56 years of age, and in 1856 had syphilis, with secundaria, for which he was treated with mercury - sublimate cure up and down - thereafter salivation cure and so clear mixture, since which he had only been plagued with frequent pains in his limbs most in the Winter. At present he was suffering the same pains and a stiffness in his arms and legs, so that he had difficulty in dressing himself; in other respects he was in a good state, and the natural functions were in order. Already after 8 days' sulphureous water treatment, internally and externally, there appeared a foul ulcer on the right thigh, which steadily encreased, and became worse during the next 8 days' treatment in the same manner, for which reason the anointment cure was put into requisition together with the other previous modes of treatment. After 14 days the sore had healed, and after the completed cure the patient was free from his pains and left the bath in the best state of health. Weight on arrival 152 pounds, on departure 152 1/2.

A patient 50 years old, 18 months ago got a chancre with its usual consequences, for which symptomatic treatment and iodide of potassium had been made use of. At present he is suffering from headache and pains in different parts of the body, the sensibility of the skin was reduced on the whole of the left of the body, as well as the strength of the left arm and leg, no inconvenience in speech, slight redness of the mucous membrane under the roof of the mouth, and upon several parts of the body red swollen scars after healed ulcers, the stomach sluggish, appetite poor. After 8 days' bathing the scars broke open and the sores widened daily, and became worse during the following 14 days, so the bathing had to be stopped, and after a time, when he could resume the cure, the anointment cure was simultaneously made use of. After ended mixed cure all the sores were completely healed, no pains or sickly feelings were present, and the patient left with great content and in a state of perfect health. Weight encreased from 122 1/2 to 126 pounds.

A patient, 32 years old, from same year, 8 years ago had had syphilis, with secundaria, and for 8 years had suffered from flying pains in the limbs, mostly in the joints, in the loins and hips, never swellings about the same, sometimes pains in the neck; the pains were especially felt in the Winter, whereas he was free from them in Summer; it was said he had been quit all syphilitic symptoms, but in the last 4 years but occasionally had white blisters in his mouth, partly upon the tongue and partly upon the gums and on the palate; last Winter he had had kidney colic with emission of gravel. On his arrival at the bath, he was sound and healthy in appearance, and his functions were in the most desirable order, only, on inspection of the cavity of the mouth, could be observed 5-6 closely-lying small, superficial sores upon the hard palate. We commenced at once with the sulphur bath and at the same time with the drinking of Vichy. During the bathing there arose spinal pains with stiffness and slight pains in the limbs, which however soon ceased, whilst the sores of the palate gradually became larger and deeper, so, after about a month's treatment, it was considered the anointing ought no longer to be delayed. Vichy was suspended, instead of which was commenced the drinking of sulphureous water, and the sulphur baths were continued as formerly. After this the sores soon began to diminish in a perceptible degree, and after 17 anointings there was a scarcely perceptible trace of only a couple left. He had no pain, was all well and has not presented himself at the bath since.

Referring to the before mentioned great extent of rheumatism, it becomes necessary to state, on the other side, that it cannot be denied in many cases, that this same rheumatism has to bear the burden, where the
disease has nothing at all to do with rheumatism but only passes under this address. It is certainly so, that rheumatic pains stand in connection with the state of the weather, that they frequently make themselves felt on or before changes in weather, and therefore there is nothing more usual, than for patients on describing their pains to speak of their becoming worse before „other weather." Other pains, besides the rheumatic, may also make themselves felt under similar circumstances, but it has become traditional with regard to rheumatism to connect it with weather. Either one does not pay further attention to, whether there really does come other weather - who can always hold watch over the weather - or there may come other weather, which may easily happen, or it may not come at all, at all events, where the patient is residing, but then there is no reason why, it is said, not a change in the weather may have taken place in the neighbourhood, at some distance from the residence of the patient - perhaps at the Antipodes - and that is always a comfort for them of course, the disease is in connection with the oftcited weather change, therefore the patient must be suffering from rheumatism, and nothing else. Besides about rheumatism the patient may often talk about neuralgic pains, and suffering „nervous headache" which is placed in connection with mental exertion, or neuralgy, seems to be considered a tolerably innocent affair; should the disease one day go over into a new, more distressing phase, well, that is regarded as an affair for itself and perhaps nobody thinks about spectres from long by-gone days.

At a bath like ours there is good opportunity for observation in that direction. It is not seldom that patients come to the bath, without any instigation from others, to get rid of, what they call, their „flights", or rheumatism; about these persons, when particulars are inquired into, we are told, that they have had their flights for some time, for several years - 20 or even more; that these flights have consisted, more or less, in pressing pains, partly at the back of the head, and partly in the forehead and neck, accompanied with dizziness, which is particularly troublesome when lying down, and afterwards when they move their heads upon the pillow, and sometimes vomitings; or the patient may describe his pains as, grinding, pressing like a needle, or a knife, in certain parts of the head, breast, abdomen, arms, legs, or in various places, by turns, without any pathological change being discernible; or the patient may state, that he is suffering from peculiar twitchings, which resemble electric shocks, sometimes only in one part of the body and sometimes in several, alternately; these twitchings may only occur once a day, and most frequently in the evening, after the patient has gone to bed, and assumed a horizontal position, with or without the pains described, or the twitchings may occur just at the moment, when the patient is on the point of falling asleep, so that his sleep is repeatedly disturbed, and the twitchings and pains may be so continuous and intense, that he is compelled to leave his bed to seek relief, which he often obtains, by assuming a perpendicular position. These twitchings are felt in the same manner in daytime, on the patient's lying down, for inst. on a sopha, and especially when he becomes drowsy and about to fall asleep; sometimes the described symptoms may have quite vanished, for 3-4 weeks, and in other cases they may appear regularly. On closer examination, under these circumstances, it may possibly be found that there are more or less prominent derangements of the nervous function, which may put one on the track, or a suspicious scar may be discovered, a swollen gland, a nodule, or by mild and humane proceedings, from the patient's own mouth one may obtain intelligence of the former presence of lues. It may be,
that the patient has no consciousness of having been infected, or such infection may have occurred so far back in time, I that he cannot imagine, there can be any connection there with and his present indisposition, so, in good faith, he conceals the fact, or it may be he has his reasons for so doing, but certain it is, at all events, that have these twitchings occurred, when he assumed a horizontal position, then we have succeeded, although at second hand, in getting to know, that there has been venerial infection beforehand. In this case the usual anti-rheumatic treatment will scarcely produce any improvement, more likely the reverse; there may arise pains, which may not have been felt previously, and these may encrease in an enormous and almost insupportable degree, so that the patient lies sleepless, night after night, and his general health begins to fail, or there may appear the afore-mentioned affections of the skin, the mucous membranes, periosteum &c. The ordinary rheumatic pains may also often awaken, or become worse, particularly at the commencement of the cure, but they rarely, if ever, equal the afore-named pains in intensity, and are of less duration. The awakened, excessive pains or other revelations of the dormant luetic poison are easily explained as a consequence of the forcible tissue change, which the bath cure initiates, in conformity with Wirchow's metastase-theory, according to which, whilst certain deposits are dissolved in one of the organs, often lying deep and hidden from observation, particles of virus are set afloat in the blood stream, which irritate the nervous system, and are eliminated through the secretions or deposit themselves in fresh places and there become the cause of a new eruption. Under these circumstances it is therefore, that experience repeatedly teaches us, that it is the use of specific means, by which relief can be obtained for the patient, and which on the whole shall be of the greatest, positive use.

That strongly constituted individuals, in the prime of life, with wholesome, strong food, and living under good hygienic circumstances, may master, and in the course of time eliminate the virus, may really be the case, and there are numerous instances, that it does not leave behind any further consequences, either as regards the patient, his wife or children, but yet therapeutic treatment may be both timely, and necessary. Should the fore-named pains in the head, as well as the pains and twitchings in the limbs, also, continue for years, it may then be presumed, even should they not make themselves known during intervals of lengthened periods, and without any palpable clinical eruption, it may however be considered probable, that the enimical matter, though only in infinitesimal remains, is still in the human body, and that the lurking enemy is, perhaps, only awaiting some convenient occasional cause to enter into a new and eventful phase, this may arise from catching cold, depressing mental influence, over-indulgence in Baccho or Venere, alteration in living, or from other causes; it may come stealthily, successively, or like lightning on a sunny day; the pains in the head may have been there long before the apoplectic or epileptic-like attacks make their appearance, sight-nerve atrophi or other occompaniments of organic brain disease; as well as excentric pains may exist for a long series of years, as isolated symptoms of disease, before the further signs of spinal disease make their appearance; but it is to be feared, that the lengthened irritative process, which, presumably, originally takes place in the menigeal films, may gradually produce the well-known degenerations in the central parts of the nervous system, with the respective derangements of the functions, which after having reached a higher degree of developement are more difficult to be re-established, even though the progress of the disease may be arrested, and improvement take place under proper treatment. As said, the pains are not without a cause and surely not without a design; they are the work of wisdom and Providence, these pains - a cry for help in distress - an awakening warning.