water salt acid found action carbonic constituents baths contain springs
MINERAL WATERS. No absolute line of demarcation can be drawn between ordinary and mineral waters. There is usually in the latter an excess of mineral constituents or of temperature, but some drinking waters contain more mineral constituents than others that are called mineral waters, and many very pure waters, both cold and warm, have been regarded for ages as mineral springs.
As to the origin of mineral waters, there is much in what the elder Pliny said, that waters are such as the soil through which they flow. Thus in limestone and chalk districts an excess of lime is usually present ; and the waters of a particular district have much resemblance to each other - as in the Eifel, in Auvergne, and in the Pyrenees. But this is only a partial explanation, for waters are by no means necessarily uniform throughout a particular geological formation. We do not know with any certainty the depth from which various mineral waters proceed, nor the various distances from the surface at which they take up their different mineral constituents.
The source of the temperature of thermal waters remains a subject of much uncertainty. Among the assigned causes are the internal heat of the globe, or the development of heat by chemical or electrical agencies in the strata through which they arise.
Their occasional intermittence is doubtless often dependent on the periodical generation of steam, as in the case of the Geysers. A few geological facts are certain, which bear on the origin of mineral waters. Such springs are most abundant in volcanic districts, where many salts of soda and much carbonic acid are present. They occur most frequently at meetings of stratified with unstratified rocks, in saddles, and at points where there has been dislocation of strata.
The diffusion of mineral waters is very extended. Pliny was quite correct in observing that they are to be found on alpine heights and arising from the bottom of the ocean. They are found at the snow in the Himalayas and they rise from the sea at Baim and Ischia. They are to be found in all quarters of the globe, but more particularly in volcanic regions, as in the Eifel and Auvergne, in the Bay of Naples, and parts of Greece, in Iceland, New Zealand, and Japan. But there are few countries in which they are not to be found, except in very flat ones and in deltas of rivers, - for instance, in the north of France, where they are very few, and in Holland, from which they are absent. France, Germany, Italy, and Spain, as well as Greece, Asia Minor, and the Caucasus, are all rich in mineral waters. The British Isles have a fair though not very large proportion of them. There are a few in Sweden and Norway. They are abundant in the United States, less so in Canada. They are found in the Azores and in the West India Islands. Of their occurrence in the interior of Africa or of Australia we know little ; and the same is true of South America. But they are met with in Algiers, in Egypt, and in the Holy Land. The vast Indian peninsula has for its size a comparatively small supply.
As the effects of mineral waters on the bodily system have been found to be different from those of drinking waters, an explanation of this has been naturally sought for. It has been imagined that there is something special in the nature of mineral waters, that their heat is not ordinary heat, that their condition is a peculiar electric one. Some French modern writers even say that they have a certain life in them, that their constitution is analogous to that of the serum of the blood. But we must pass by these speculations, and be guided as far as possible by ascertained facts, respecting the action on the system of water, of heat and cold, and of the mineral constituents present.
Mineral waters, when analysed, are found to contain a great many substances, although some of them occur only in very minute quantities : - soda, magnesia, calcium, potash, alumina, iron, boron, iodine, bromine, arsenic, lithium, caesium, rubidium, fluorine, barium, copper, zinc, manganese, strontium, silica, phosphorus, besides extractive matters, and various organic deposits known under the name of glairin or baregin. Of gases, there have been found carbonic acid, hydrosulphuric acid, nitrogen, hydrogen, oxygen, and ammonia. Of all these by far the most important in a therapeutic point of view are sodium, magnesia, and iron, carbonic acid, sulphur, and perhaps hydrosulphuric acid. These substances, detected separately by chemists, are in their analyses combined by them into various salts, if not with absolute certainty, undoubtedly with a close approximation to it. Those combinations are very numerous, and some waters contain ten to twenty of them ; but there are always some predominating ones, which mark their character, while many of them, such as casium, rubidium, or fluorine, occur in mere traces, and can not be assumed to be of any real importance. Mineral waters therefore resolve themselves into weaker or stronger solutions of salts and gases in water of higher or lower temperature. For medical purposes they are used either externally or internally, for bathing or for drinking. As the quantity of salts present commonly bears but a very small proportion to that of the fluid containing them, water becomes a very influential agent in mineral-water treatment, about which it is therefore necessary to say something.
For the action of hot and cold baths the reader is referred to the article BATHS. But it may be observed here that, according to the most generally received opinion, the cutaneous surface does not absorb any portion of the salts in a mineral-water bath, although it may absorb a little gas (an alkaline water, for instance, at most acting as a slight detergent on the skin), and that neither salts nor gases have any action on the system, except as stimulants of the skin, with partial action on the respiratory organs.
It seems to be ascertained that drinking considerable amounts of cold water reduces the temperature of the body, diminishes the frequency of the pulse, and increases the blood pressure temporarily. Water when introduced into the stomach, especially if it be empty, is quickly absorbed ; but, although much of the water passes into the veins, there is no proof that it ever produces in them, as is sometimes supposed, a state of fluidity or wateriness. Therapeutically, the imbibition of large quantities of water leads to a sort of general washing out of the organs. This produces a temporary increase of certain excretions, augmented diuresis, and a quantitative increase of urea, of chloride of sodium, and of phosphoric and sulphuric acids in the urine. Both the sensible and the insensible perspirations are augmented. A draught of cold water undoubtedly stimulates the peristaltic action of the intestines. On the whole water slightly warm is best borne by the stomach, and is more easily absorbed by it than cold water ; and warm waters are more useful than cold ones when there is much gastric irritability.
In addition to the therapeutic action of mineral waters, there are certain very important subsidiary considerations which must not be overlooked. An individual who goes from home to drink them finds himself in a different climate, with possibly a considerable change in altitude. His diet is necessarily altered, and his usual home drinks are given up. There is change in the hours of going to bed and of rising. He is relieved from the routine of usual duties, and thrown into new and probably cheerful society. He takes more exercise than when at home, and is more in the open air, and this probably at the best season of the year. So important has this matter of season and climate been found that it is an established axiom that waters can be used to the greatest advantage during the summer months and in fine weather, and during the periods most convenient for relaxation from business. Summer is therefore the bath season, but of late years provision has been made in many places, with the aid of specially constructed rooms and passages, for carrying out cures satisfactorily during the winter season, e.g., at Aix-la-Chapelle, Wiesbaden, Baden Baden, Baden in Switzerland, Dax, Vichy, and Bath. The ordinary bath season extends from the 15th of May to the 20th or 30th September. The season for baths situated at considerable elevations commences a month later and terminates some ten days earlier. Mineral waters may be employed at home, but patients seldom so use them; and this necessarily limits the time of their use. It is common to declare that the treatment should last for such or such a period. But the length of time for which any remedy is to be used must depend on its effect, and on the nature of the particular case. It is found, however, that the continued use of mineral waters leads to certain disturbances of the system, which have been called crises, such as sleeplessness, colics, and diarrhoea, and to skin eruptions known as la poussee. This cause, and also certain peculiarities of the female constitution, have led to the period of three weeks to a month being considered the usual period for treatment. A certain after-treatment is often prescribed - such as persistence in a particular diet, visiting springs or climates of a different and usually of a tonic character, or continuing for a certain time to drink the waters at home. It may be added that the advantage of having recourse to mineral waters is often felt more after than during treatment.
Since improved methods of bottling have been discovered, and the advantage of an additional supply of carbonic acid has been appreciated, the export of waters from their sources has increased enormously, and most of the principal waters can now be advantageously used at home. It may be added that many of the artificial imitations of them are excellent.
The history of the use of mineral waters can only just be alluded to. They have been employed from the earliest periods, and traces of Roman work have been found at most of the European baths which are now in favour, - at almost all the thermal ones. Occasionally new springs are discovered in old countries, but the great majority of them have been long known. They have varied in popularity, and the modes of applying them have also varied, but less so than has been the case with most of the ordinary medicines. Warm waters, and those containing small quantities of mineral constituents, appear to have remained more steadily in favour than any other class within the appropriate sphere of mineral waters, which is limited to the treatment of chronic disease.
The attempt has been made to range mineral waters according to their therapeutic action, according to their internal or external use, but most generally according to their chemical constituents so far as they have been from time to time understood ; and a judicious classification undoubtedly is a help towards their rational employment. But their constituents are so varied, and the gradations between different waters are so finely shaded off, that it has been found impossible to propose any one definite scientific classification that is not open to numberless objections. Thus a great many of the sulphur waters are practically earthy or saline ones. Yet because they contain very minute amounts of such a gas as hydrosulphuric acid, an ingredient so palpable as always to attract attention, it is considered necessary to class them under the head of sulphur. The general rule is to attempt to class a water under the head of its predominant element ; but if the amount of that be extremely small, this leads to such waters as those of Mont Dore being classified as alkaline or arseniated, because they contain a very little soda and arsenic. The classification in the following table, which is that usually adopted in Germany, has the merit of comparative simplicity, and of freedom from theoretical considerations which in this matter influence the French much more than the German writers. The more important constituents only are given. The amount of solid constituents is the number of parts to one thousand parts of the water ; the temperature of thermal springs is added. The waters are classified as indifferent, earthy, salt, sulphuretted, iron, alkaline, alkaline saline - with subvarieties of table waters and purging waters.
In addition to their solid constituents, gas is present in many waters in considerable quantity. There is a little oxygen and a good deal of nitrogen in some of them ; the quantity of hydrosulphuric acid, even in strong sulphuric waters, is wonderfully small ; but the volume of carbonic acid present is often very large, - for instance, in the case of Kissingen, Schwalbach, and Selters. Carbonic acid is so generally diffused that it is practically a very important agent in the therapeutics of mineral waters. Springs that contain it are far the most agreeable to the taste, and consequently most popular with patients. The immediate effect of the carbonic acid which they contain is that of pleasant stimulation to the stomach and system, although it can scarcely be said to approach, as some have thought, the slighter forms of stimulation from alcoholic drinks. Extremely little appears to be known of its actual operation on the system : a part of what is swallowed is returned by eructation, and a part passes on to the intestines ; whether any appreciable quantity reaches the blood is doubtful. There is no question that carbonic acid increases diuresis. Practically it is found to aid digestion, helping the functions of the stomach, and in a slight degree the peristaltic action of the intestines. The increased flow of urine may be caused by its favouring the absorption of water by the stomach. In some baths carbonic acid is so abundant that precautions have to be taken to prevent its tendency to accumulate on account of its heavy specific gravity. Carbonic acid gas, used as a bath, proves stimulating to the skin and to the general system ; but its employment has not answered the expectations formed of it.
InditTerent Waters scarcely vary in chemical qualities from ordinary drinking water ; but they are usually of higher temperature. Their therapeutic action, which is mainly exercised through baths, has been explained on the theory of peculiarities of their electric or thermal condition, about which we know nothing definite, and on the presence in some of them of a large quantity of nitrogen. It has also been ascribed to the various organic substances in some of them, such as glairin, which when collected is sometimes useful as a cataplasm. These waters are not often much drunk, but any efficiency they may have in dyspepsia and perhaps in neuralgic diarrheas must be attributed to the favourable action of hot water on the digestion. The waters of this class, especially the hotter ones in the form of baths, are extremely useful in resolving the effects of inflammation, in thickenings of the joints, and in chronic rheumatism and gout. They also are often effective, especially the cooler ones, in neuralgia and in some hysterical affections. They are sometimes prescribed in urinary affections, in which case they probably assist by dilution. The effects of many of these waters are aided by the baths often being situated at considerable elevations and in out-of-the-way spots, whence the Germans called them T-Vildbeicler. They are very widely diffused, being found in all quarters of the globe, especially in volcanic districts. There are many in New Zealand; in Americo, the hottest are in the West and in California.
Earthy Waters. - These differ chiefly from the indifferent waters in containing an appreciable quantity of salts, among which sulphate or carbonate of Irene or of magnesia predominates. The great majority of them are of high temperature. They produce the same effects as the indifferent waters, but are perhaps less efficacious in neuralgic affections, while they are more employed in some of the chronic scaly eruptions. There was formerly a tendency to consider these waters useful in urinary affections ; but at the present day it is only the colder ones that have come into repute for the expulsion of gravel and biliary calculi and in the treatment of affections of the bladder generally. Some of them have also of late years been considered to exercise a favourable influence on scrofula, and to be useful in the early stages of pulmonary phthisis. This has been attributed to the salts of lime present in them, although it is known that most of its salts pass through the system unaltered. Many of these baths, such as Leuk and Bormio, enjoy the advantages of great elevation, but Bath, otherwise one of the best of them, lies low.
Salt Waters are so called from containing a predominant amount of chloride of sodium. They also generally contain chlorides of magnesia and of lime, and occasionally small amounts of lithium, bromine, and iodine. They further often contain a little iron, which is an important addition. The great majority of the drinking wells have a large supply of carbonic acid. There are cold and hot salt springs. Sometimes they are used for drinking, sometimes for bathing ; and the double use of them is often resorted to.
The normal quantity of common salt consumed daily by man is usually set down at about 300 grains. The maximum quantity likely to be taken at any well may be 225 grains, but commonly not more than half of that amount is taken. The increase to the usual daily amount is therefore probably not much more than one-third. Still it may be presumed that the action of a solution of salt on an empty stomach is different from that of the same amount of salt taken with food. Salt introduced into the stomach excites the secretion of gastric juice, and favours the peristaltic actions, and when taken in considerable quantity is distinctly aperient. We thus see how it is useful in dyspepsia, in atony of the stomach and intestines, and sometimes in chronic intestinal catarrh. Salt when absorbed by the stomach appears again in the urine, of which it increases the amount both of fluid and of solid constituents, especially of the urea. It seems therefore to be pretty certain that considerable quantities of salt taken into the circulation increase the excretion of nitrogenous products through the urine, and on the whole accelerate the transformation of tissue. Salt is thus useful in scrofula by stimulating the system, and also in anaemia, especially when iron is also present. In some German stations, as at Soden, carbonated salt waters arc considered to be useful in chronic laryngitis or granular pharyngitis.
Baths of salt water, as usually given, rarely contain more than 3 per cent. of chloride of sodium, some of the strongest perhaps from 8 to 10 per cent. Their primary action is as a stimulant to the skin, in which action it is probable that the other chlorides, especially that of calcium, and still more the carbonic acid often present, co-operate. In this way, and when aided by various processes of what may be termed water poultices and packing, they are often useful in removing exudations, in chronic metritis and in some tumours of the uterus, and generally in scrofula and rachitis, and occasionally in sonic chronic skin affections.
The French accord high praise to sonic of their thermal salt waters in paralysis, and sor e German ones are used in a similar way in spinal affections. 7 he salt waters are sometimes so strong that they must be diluted for bathing. In other cases concentrated solutions of salt are added to make them sufficiently strong. These waters are widely diffused, but on the whole Germany is richest in them, especially in such as are highly charged with salt. The Kissingen springs may be considered as typical of the drinking wells, and sea-water of bathing waters. The air of salt-works and pulverization of the water are employed in German baths as remedial agents.
Salt springs are found in many quarters of the world, but the chief carbonated groups for drinking purposes occur in Germany, and at Saratoga in America, where very remarkable wells indeed are to be found. France and England have no springs of this class. The stronger wells, used chiefly for bathing, occur where