TI-IE DU]3LIN JOURNAL OF

M E D I C A L S C I E N C E .

O C T O B E R i, 1887.

PART L

ORIGINAL COMMUNICATIONS.

ART. X I . - - A Holirla b, at Mon~ Dote. By WILLIAI~[ THOMSON, M.A., F.R.C.S. ; Surgeon to the Richmond Hospital; General Secretary to the Academy of Medicine in Ireland.

TRESE are days in which springs and baths are becoming more and more popular with the sick public. The patient expects that his medical attendant shall be able to give him all the necessary information about some particular place to which a friend has suggested that he should go. I t is not always easy to satisfy such a demand, because the literature is vast, and if one seeks light in a compendium, the statements are often so condensed as to be of comparatively little value. Yet the knowledge must be got some- how, and in no way better than by a personal v~sit. Then comes the question--Seeing that life is short, how shall I make best use of my t ime? For the list of baths on the Continent is lon~, and when the special virtues of each have been considered and weighed, it is hard to say which should win our favour. All have means of attracting the health-seekers, who, wearied of bottles, are anxious to t ry what the medicine of pure air, plus some special spring, may do for them ; and when we see the crowds who yearly pass into Germany and France with this sole object, carrying untold gold with them, we have reason to regret that Nature did not supply our own country with more of her abundance.

Circumstances led me this summer to Mont Dore, and the story I have to tell may convey some information to those who have not

VOL. L X X X I V . - - N O . 190, T H I R D SERIES. T

266 A ttoliday at Mont Dote.

visited it, or who know of it only from handbooks of health-resorts. The little town is situated in Auvergne, southern France--a district in itself extensive~ little known, but remarkable for its richness of landscape, and the satisfying repose which it offers to any who need new strength or rest for tired body or mind. You can reach it in twenty-four hours from London, but that means travelling to your destination straight on. I t is better, perhaps, to break the journey at Paris--certainly so, if the traveller is at a]l weak or debilitated. You leave the Orleans Station in Paris either morning or evening, and reach Mont Dore in about twelve hours, of which ten are spent in the train. I f you travel by night you can have the luxury of a coupd lit, but it is expensive--nearly a pound in addition to your ordinary first-class fare. For those who can sleep in spite of the continuous rattle of the train, it is, how- ever, a distinct gain. The covpd is most comfortable, and is properly equipped with a lavatory, without soap, however. Passing over a steadily rising plateau, you come in the early morning to Eygurande, and from this the train begins to make a very marked ascent. The country is made up of many small hills, and you pass along the narrow valleys between, or plunge into tunnels, emerging now and then into a bit of bright landscape which would please the most exacting. Here and there the railway track lay high above a lovely stream, and beyond this there rose ever-recurring waves of ground, rich with covering of pine and beech, and ash loaded with brilliant berries. The immediate foreground was green with luxuriant ferns, or purple with heather, which gave the place almost the aspect of a Scotch scene--an illusion which was only dispelled by the occasional appearance of a peasant in blue blouse and clogs, leading his team of oxen along some mountain road.

We reached Laqueuille about 7 30 in the morning, and turned out. This station is on the road to Clermont-Ferrand, near which is Royat, and before it was available the journey to Mont Dore from the train was made by diligence, and occupied about six hours. Now, however, it is reduced to two. The diligence is a huge omnibus, with a top compartment for second class passengers, well sheltered by waterproof curtains from the rain. To me, after a night of unrest, an outside seat was specially attractive, for the morning air was crisp and invigorating, and the early sun was lighting up the hill-sides, or causing them to form curious shadowy outlines on the low-lying pasture land. Then, after much tootling with a horn, our driver gave reins to his four serious-looking steeds, and we

By MR. WILLIAM THOMSON. 2(;7

jogged off towards Mont Dore. The table-land from whleh we started was a couple of thousand feet high, but far away towards the south we could see the jagged shapes of mountains reaching up into the clouds, which clung to them with close embrace. The road was perfect ; the long stretch of undulating valley, over which we looked, fertile ; but we sought in vain for a teeming population. Beyond a few country carts, and some houses scattered here and there, there was nothing to divert the attention from the scene of placid loveliness which lay below us.

An hour's drive brought us to a clump of mountains which we had 'seen earlier, and a turn in the road gave us a view of Bourboule lying in the valley on our right some hundreds of feet below. J~t looked a very clean and comfortable little town, with its circle of villas. Over the roof tops we could see the domes of the baths, for which, like Mon~ Dore, it is celebrated. But we came no nearer for more minute inspection. Speedily we passed the road leading to Bourboule, which left ours sharply on the right, and we lumbered along as the horses strained at their load tO the encouraging "houps" of the'driver. There was no view of our destination yet to be had; we seemed to be going straight into the base of a mountain, but a quick turn brought us round it, and opened to us a view of the upper Dordogne valley, in which Mont Dote lies nestled. The view was certainly beautiful and impressive. In a few minutes we were completely shut into a deep scoop in the mountains, which are on every side. East and west of this valley, not a quarter of a mile wide, the slopes rose with abruptness, the lower stretches covered with grass of the most vivid green; then on the west side were forests of fir trees of varying shade, mingled with ash and belts of beech, reaching to the very summit. The eastern wall looked like the embattlements of some old fortress springing sheer up two hundred feet from the termination of a sharp grassy declivity, and bearing upon it a crown of graceful firs. A couple of miles away in front, at the southern end, towered the Pic de Sancy, 6,000 feet high, outtopping its companions, its sharp bare peaks standing out hard and clear against the morning sky, while stretched between all were meadows which for brightness of colour and luxuriance of growth would put even Ireland's Emerald into the shade. Midway, the Dordogne, springing from the junction of the Dote and Dogne at the upper end, rolled northwards, making countless cascades as it rushed among the boulders which form its bed.

268 A Holiday at Mont Dote.

Like other things, Mont Dore at a distance and Mont Dore at close quarters differ. From afar it is a picturesque little town, with many red-tiled roofs, from among which there rises the spire of the solitary village church. I t looks as full of repose as is the surrounding country. But you find as the diligence rumbles through its single main street that it is full of lit~ at this early hour. Bathers are hurrying to or from the baths, clad in curious costumes, or porters are bearing patients in closed Sedan chairs across the little square which bears the name of Place des Thermes. The first impression on those who have seen other bathing centres is disappointing. The streets are very narrow, and, in many cases, very dirty. The houses, which are mainly hotels, are crowded upon one another everywhere. The architecture is cold and unattractive ; the workmanship coarse, the painting has lost its freshness, and altogether you feel that there is needed here some one who, with a sense of art, could put his hand over all, and smooth and soften most things you see about you, and make the town worthy in some degree of the setting in which it lies. But you find in the end that while the hotels are good, bad, and indifferent, they are better inside than they appear to be, and that without luxury you can at least be comfortable.

The sun was shining with great intensity when we arrived, and I was told that the weather had been excessively hot for some weeks. But in a few hours clouds began to come up in thick black masses over the Pic de Saucy, and roll down into the valley. Then the whole sky became dark, the air close and still, and a loud crash, which seemed to shake the earth, heralded a great thunder storm. The peals followed in rapid succession, like mingled booms of heavy guns and the horrible crackle of hundreds of mitrailleuse, and were echoed time after time as the great waves of sound rolled from cliff to cliff. The lightning flashed with almost blinding vividness ; the rain fell in sheets ; the gulleys were soon overflowing; and the Dordogne speedily changed from a pure stream to a torrent of turbid yellow water. The storm lasted for some hours. In the week which followed we had only two fine days. There were no less than three thunder storms of minor intensity, and the temperature quickly fell from biting heat to severe cold. Although it was August we were glad to gather round the bright wood fires, and those who ventured out when it was not raining did so in Ulsters and other substantial wrap- pings. These variations sometimes happen even in J u l y ; but

By MR. WILLIAM THOMSON. 269

altogether the climate is most pleasant, and the early mornings are delightful.

The district of Mont Dore has long been famous for its hot springs. Centuries ago, when the Romans were settled here, the healing virtues of the waters were reeognised, and there exist, evea now, at various places, the remains of the splendid baths which they constructed. This narrow valley was one of the places to which the sick most resoi'ted ; and in the little " p a r e " are I)ortions of the great bath--massive and quaintly carved stone blocks and pil lars-- in which they found a medicine for their ills, or satisfied their desire for luxury. The springs, however, enjoyed little more than a local celebrity until the beginning of the present century, when Michael Bertrand made their uses more widely known. Now Mont Dore enjoys a great reputation ; but by far the greater number of health- seekers are French. The English are few and far between, and I did not meet a single German.

The origin of this valley was undoubtedly volcanic. Indeed the whole of Auvergne bears the characteristic marks which indicate what were the primary shaping forces. That it is even now close to subterranean regions which may again become the source of trouble to this fair country is shown by the high temperature of the waters which are poured out in such enormous quanti t ies-- here, at Bourboule, and at Royat, thirty miles away. In Mont Dore the temperature in some of the springs is as much as 113 ~ F., and in certain of the baths this heat has to be moderated before they can be used by patients. There are in all nine springs, but those which appear to be in most general use as curative agents are the Madeleine, the C6sar, the Pavilion, and the Ramond. The principal--the Madeleine--contains in one quart the following : - -

Oxygen . . . . 0"65 Nitrogen . . . . 8"64 Free carbonic acid - - - 0"3522 Bicarb. of sodium - - - 0"5362

,, potassium - - - 0"0309 ,, lithium - - - traces ,, calcium - - - 0"3423 ,, magnesium - - - 0"1757 ,, and protox, of iron - - 8"0207

Oxide of manganese - - traces Chloride of sodium - - - 0"3~85 Sulphate of sodium - - - 00761

270 .,4 Holida~j at Mont Dote.

Arseniate of sodium - - - 0"00096 Biborate of sodium, and iodide and fluoride

of sodium . . . . traces Silieic acid - - - 0"16,54 Alumlnium - 0"0112 Organic and bituminous substances - traces

The diseases which are treated here are many, but those of the respiratory passages take the first place. Thus m the early stages of tubercular phthisis, even when hmmoptysis has occurred, cures are claimed by the medical men. But in chronic bronchitis, asthma, emphysema, tracheitis, some forms of laryngitis, unresolved pneumonia, pleuro-pneumonia, and granular pharyngitis, my inquiries from several patients and my own experience showed results of a very remarkable nature. But my list does not exhaust the diseases which are treated here, for rheumatism and others are also to be found among those which it is asserted the Mont Dore waters have conquered.

The bathing establishment is a large building on the cast side of the little Place des Thermes, and near at hand is another known as the Salle d'Aspiration. Both buildings are commodious, and the attention shown to visitors leaves little to be desired. But they share in a marked degree the general character of tile town. They have been built for many years, and they have a rather used-up appearance. The exterior is essentially bleak, and internally they lack those attractions in decoration and design which some rival and newer establishments present. The reason of all this is that they are held on lease, and the lease will expire in a year. The authorities wish to have the whole place remodelled and brought up to the latest standard, and they demand a much higher rent for a longer period. The little community is therefore in a perturbed state, l~[ore important to them than any other earthly question i s - -Who will be the new " Concessionaire," and when will they begin to feel the increased influx of money which the pro- mised improvements must necessarily bring them.

The equipments consist of baths made of stone and filled with the water from the springs, foot baths, douches (cold and hot, and of steam), appliances for spraying the throat and nose, and halls in which steam is breathed by the patients. The "course" generally lasts twenty-one days, sometimes a shorter time, or it may have to be stopped if it does not agree with the patient. I t varies also as to order and nature, and every one must first seek the advice of a

By MR. WILLIAM THOMSON. 271

doctor to have the schedule of t reatment drawn up, or to know whether he is at all fit to take the course. The next thing to be done is to provide a thick flannel costume to be worn going to and returning from the baths. For men the garments consist of stockings and trousers in one, a sort of shooting-jacket with a large hood, and a pair of clogs. The ladies are appropriately attired in like material, but there is a variety of colour and pat tern which gives picturesqueness to the bathers as one watches them paying their morning visit to the establishment.

The baths are open from 4 a.m. to 10 a.m., and again from 2 p.m. to 5 p:m. The method of procedure (say in a case of bronchitis) is after this fashion : - - A t a fixed hour two porters call at your hotel, pack you into a closely-shut wooden Sedan chair, and carry you to the Madeleine spring, where you are presented with a tumblerful of the not unpleasant water. Then you are conveyed to the aspiration room, which you enter only in bathing costume, and find yourself in a temperature of 90 ~ and in an atmosphere thick with steam--so thick that you cannot see more than a few feet ahead. Here you stay for half or three quarters of an hour, then wrap yourself up, enter a chair, go back for another drink at the Madeleine, then to your hotel, where you get into bed at once, only waiting to have the sheets thoroughly warmed by means of a charcoal pan. You probably perspire very freely for an hour. Then, if you have not gone at the unearthly hour of 4, you may get up, have some breakfast, and go out to the park. In the afternoon' you will take a foot bath, perhaps, for ten or fifteen minutes, and the day's work is done.

Of course the system is modified according to the special nature of the case. There may be douches or full baths instead of foot- baths. Sometimes symptoms are produced which may cause alarm. Some patients present themselves who can derive no benefi t --and for this reason all should make quite sure of their condition before they start on a journey which may only end in disappointment.

There can be no doubt that great numbers either recover or are much bettered by a course at Mont Dore. Two cases were under my observation, where a change absolutely marvellous was pro- duced in a week. In one of asthma, where the patient suffered from violent paroxysms three or four times a day, with copious expectoration--ln spite of visits to Bournemouth, Rostrevor, Blarney, and other home heal th-resorts-- the attacks absolutely disappeared, and the cough and expectoration become almost nil.

272 A Holiday at Mont Dote.

He had wasted from 14 stones weight to 9�89 stones, and in three weeks he increased 8 lbs.

That the virtue does not lle in the waters alone I am sure. As in all such health-resorts there are several factors which produce the result, and here the water is aided by altitude--for the town is nearly 4,000 feet above the sea--and by the exquisitely clear and balmy air. Then the patients are well fed, and if they are able they can make daily excursions on horseback or in a carriage up the mountains which enclose the valley, and add many hundreds of feet to the already considerable height at which the town is placed.

It is an interesting fact--which is pointed to with great pride-- that the inhabitants of the valley are exceptionally healthy. Con- sumption is said to be completely unknown, there is an absence of all epidemics, and amongst the bathers acute affections, acquired on the spot, are hardly ever encountered by the doctors. Of course rival places claim superior advantages. La Bourboule prints in large letters that its waters have a greater quantity of arseniate of sodium than those of Mont Dore. Then someone suggests that the minerals in Bourboule waters are variable in amount, because they are acquired as the waters pass through certain formations. Bourboule resents this strongly, gives proof to the contrary, and sags in return that it has a more fixed climate and sumptuous accommodation ; while the residents at Mont Dore point out that while they enjoy whatever cool there is, Bourboule, more than a thousand feet below, lies sweltering in the sun. So the rival claims are urged. But both stations have their special advantages, and it will be the business of the patient to find out which is likely to suit his particular condition. As regards Mont Dore, there is only one higher health resort in France--Bar~ges. When the lower villages are hot and stuffy this is comparatively bracing. True, in July and early August the sun sometimes glows fiercely, but there is pleasant shade under the trees, and on the adjacent heights there is almost always a cool air which tempers the pervading heat, and is deliciously refreshing.

Life at Mont Dore is certainly not violently exciting. Indeed, after the sights have been seen, one becomes somewhat anxious to have something more stirring. But its quiet is a distinct advantage to the invalid who is compelled to take things as they come. The morning is spent at the baths, or in the park, or in reading the numerous Paris newspapers, which have nothing more interesting

By MR. WILLIAM THOMSON. 273

than the latest city horror, or, better still, in listening to a very excellent hand, which plays from half-past nine to halt~-past ten. Or if you like you may stand in the Place, and watch the bathers as they pass to and fro--some who are not very ill strolling quietly to the first spring, clothed in plain or variegated flannels; others being carried at a swinging trot by a pair of porters. Suddenly, with blowing of horn and cracking of whip, the morning diligence from LaqueuiIle rolls up the street, and then a crowd of hotel servants, male and female, rush frantically after it, and range themselves around in expectation of captives. They are very orderly however. They do not shout, and are kept at a civil distance by the solitary gendarme of the town. I t is only in their faces, as they succeed or fail in carrying off a prize, that they exhibit their feel- ings. Then quiet reigns for a time, until the whole town rever- berates with clanging hells. They are hung outside the hotels, and are such as are used at home for summoning workmen to a factory ; here they are employed to call visitors to meals. One begins, then dozens crash in as a chorus, each bell-ringer apparently trying to drown the elangour of all the rest, until the din is terrible. Fortu- nately, it only lasts about five minutes, although it seems longer ; but you get accustomed to it, and soon cease to think strongly.

Quiet once more during d@uner, save the clatter of many voices, and you have to determine how you will spend the rest of the day. If it is fine, you will probably go on an excursion; if it is wet, retire to the casino, and try to play French billiards with cricket balls. For the excursions there are plenty of horses and donkeys, most of them very good, and landaus, or small arm-chairs borne by porters. The prices for short journeys are, however, excessive, and it would be an advantage if the authorities fixed a tariff as they do for the baths. The favourite excursions are to the Pie de Sancy, the Capucin, the Gorge d'Enfer, the Serpent Waterfall ; besides which there are many other places worth seeing. From the top of Saucy a magnificent panorama of lakes and mountains and valleys spreads out for fifty miles round, and on a fine day the dim outlines of distant snow Alps can be made out. Grass covers the mountains almost to their smnmits, and the ascents can generally be made without much difficulty or danger.

Mont Dore has its pare, casino, and theatre. The pare is small, and decidedly ready for improvement. At the casino there is the inducement for mild gambling at the game of petits c]~evaux, or baccarat ; and in the afternoons now and then dances are given for

274 Abort ion: its .~Etiology and Treatment.

the children. The theatre is very good ; old French comedies and comic operas are presented, and occasionally some really good actors make their appearance. So the visitor can fill up the day not unpleasantly.

The season opens about the middle of June, and closes on the 15th of September. The period is thus short, because the weather at the extremes of the season is unreliable. The snow often falls before the actual day fixed for the close, but sometimes patients can stay until October with advantage. But the arrivals begin to cease about the second week in August, the hotels are practi- cally empty towards the middle of September, the doctors take their departure, and Moat Dore soon goes into its winter sleep.

.ART. X I I . - - A b o r t i o n : its .LEtiology and Treatment. a By ALEX. DEMeSEY, M.D., Q.U.I. ; L.R.C.S.I . ; Physician and Gyn~e- cologist to the Mater Infirmorum Hospital, Belfast ; Vice-Presi- dent, Ulster Medical Society, &c.

IN the treatment of abortion, as in every other pathological con- dition, a correct knowledge of its mtiology is necessary. The adop- tion of a general routine plan of treatment for all cases will often result in failure and disappointment. The usual practice, when called upon to see a case of threatened abortion, is to ascertaiu whether there is much h~emorrhage or pain, and to examine the condition of tile os. I f only slight h:emorrhage is present, and little or no pain, and if the os is not dilated, an effort is made to arrest the abortion. On the other hand, when hsemorrhage is profuse, and has been going on for some days, and when this is accompanied with pains and dilatation, treatment directed to the speedy emptying of the uterus is adopted.

I look upon this plan of procedure as a rather rough and ready way of dealing with these cases, and not in keeping with our know- ledge of the causation of abortion.

In a practical discussion like the present it would be out of place to do more than briefly refer to a few of the principal features in the ~etiology and pathology of abortion, and I will only do so to exemplify the treatment adopted for different conditions. Abortion is the dissolution of the partnership between the ovum or foetus and the mother. I t is a visible evidence of their inability to agree. The initiative in the process of severance may be (1)on

a Read before the Ulster Medical Society, 1887.