SOME TRUTHS ABOUT VITTEL = = = CONTREXEVILLE AND MARTIGNY. = PRACTICAL HINTS To my Medical Brethren. BY H. J. JOHNSTON=LAVIS, M.D., M.R.C.S., &c., Of Beaulieu (A.M.} and Vittel (Vosges). SOME TRUTHS about Vittcl - AND /VLartignv) PRACTICAL HINTS To my Medical Brethren BY H. J. JOHNSTON -LAVIS, M.D., M.R.C.S., &c., Of Beaulieu (A.M.) and Vittel (Vosges). THE GETTY RESEARCH INSTITUTE LIBRARY Halsted VanderPoel Campanian Collection THE GETTY CENTER LIBRARY PREFACE. In consequence of the rivalry of these neighbouring stations, a number of false statements are constantly being made by partizans of one of these localities with the object of depreciating the others. These statements are seized hold of and believed by the physicians living in other parts of France or abroad, who have not been able to verify the truth for themselves, and by patients who are often unable to form a correct judgment. The assertion that one water is " more mineralized" than another has unfortunately been pro- mulgated in books on the subject written by local medical men, who, I regret to say, have not at the same time put before the public what they mean by mineralization, or stated how much of that "mineralization" is beneficial or objectionable. From my start in practice I prescribed largely Contrexe- ville water until, about seven years ago, some of my French confreres drew my attention to the advantages of Vittel water, which I then took to prescribing. Not long after, I had to resort to these springs for my own personal use. Before fixing on any particular station, I carefully investi- gated the merits of each one, and then decided which I should patronize. After those inquiries, practice at Vittel has given me favourable opportunity to still further study the subject. A residence of many years in Italy, in one of the 12 richest thermo-mineral districts in the world, and rather extensive geological and chemical studies of volcanic phenomena, placed me, may I be permitted to say ? in an almost unique position, besides my medical knowledge, to come to scientific conclusions on such a subject. Those conclusions I have endeavoured in these few pages to put in a concise and assimilable form, considering it my duty to place before my English and American confreres the actual substantial facts. SOME TRUTHS ABOUT VITTEL, CONTREXEVILLE and MARTIGNY Amongst the western foot-hills of the Vosges, chiefly in the upper reaches of the Vair and Mouzon, a considerable number of mineral springs gush out from the upper Muschelhalk. Some of these springs run to waste, but others are iitilized at Vittel, Contrexeville and Martigny. This utilization dates from Roman occupation of Gaul, but during mediaeval times, Martigny and Vittel seemed to have been abandoned, whilst Contrexeville was visited by a certain number of invalids, and in consequence was known abroad. The two neighbouring stations had then only a local repute. Just fifty years ago, Louis Bouloumie recog- nised the superiority of the Vittel springs, acquired the property, then open fields, and installed the first modest building of the "Etablissement." For many years progress was slow, but steadily the place and waters became more and more known, and about ten years ago Vittel jumped into wide-world reputation. Its progress since then has been phenomenal, the reasons for which will be here summarised. MINERALIZATION OF THE WATERS. A great amount of rivalry exists between these three stations, each oiie declaring its water to be superior to that of the other neighbouring spas. Let us inquire into the truth of this, but let us premise by saying that all the springs of the neighbourhood, whether captured and used or allowed to run to waste, are of great value in diseases of the kidneys and urinary organs, where such occur, associated with excessive production of uric acid and its allies. The waters may be described as mild alkaline sulphated bicarbonated ones. They consist of a solution of sulphates and bicar- bonates of soda, magnesia and lime, with chlorides of magnesium and sodium, small quantities of potash and strontium. Traces of iodine, arsenic and lithia are per- ceptible. A deadly literary or pseudo-scientific warfare has waged between the backers of the rival waters, and by the last pamphlet,* terrible to relate, Contrexeville seems to have come out victorious over its rivals, the results of which I here give : Contrexeville ... ... mgr. 4 - 39 per litre. Martigny ... ... mgr. O24 Vittel ... ... ... mgr. O2G Before long we shall no doubt receive another pamphlet by some new analyst, who will find more lithium in the water of Martigny or Vittel or some other spring of the district. How ridiculous this storm in a teapot is will be evident to the reader when he is informed that the amount of lithium in any of these springs is so small that, to get the equivalent of an ordinary daily dose of that drug, he would have to drink from about 500 to 4,000 bottles or more of any of these waters in 24 hours ! The really active principles of these springs are undoubtedly the sulphates, carbonates and chlorides of magnesia, soda and potash, and to some extent the bicarbonates. The objectionable element is the sulphate * " M. Franckel Sur le lithium dans las Eaux MMrales des Vosges. Ann. d' Hydro), ct Cliinat. mcdicalex, Dec., 1903." of lime in all of them. This compound, Avhen kept within reasonable limits, is tolerated by the stomach ; but when its percentage reaches a certain point, that organ becomes irritated, and treatment has to be stopped. I have re- presented in a graphic form the proportion of active and objectionable constituents of each of the principal springs in use. CONTREXEVILLE Pavillion Anal! Debray. MARTI GNY Anal? Jacquemin. VITTEL Grand Source Anal? Jacquemin. DELETERIOUS ELEMENT ELEMENT OF DOUBTFUL VALUE SULPHATE OF LIME CARBONATE OF LIME SULPHATES AND CHlORIDES&cOF POTASH, MAGNESIA, SODA,L!THIA, STRONTIA.ic. People are constantly told at Contrexeville that the water there is more highly mineralized than that of Vittel. The above diagrams show what such a statement means. I wonder what those same people would think if they were told that the sulphate of lime in a plastered wine was good for them, and made the wine "stronger." The whole gist of the question is to get a diuretic water easy of rapid absorption and the best borne by the digestive organs. If the strength of the " mineralization " of water is its only merit, then Contrexeville must cede the place to Martigny, and another neighbouring spring, Rond 8 Jiiiittson; but I think the great superiority of Vittel water over the others exploited in the region is amply demonstrated. In prescribing Contrexeville waters, the maximum daily amount that can be given a patient is smaller than can be given at Vittel, as the sulphate of lime being more concen- trated, the limit of the stomach tolerance is more quickly reached. This defect is still more strongly marked with Martigny water. The consequence is that where, as in calculosia, we desire to drive a large amount of water through the system, Vittel is so much more advantageous and effective than either the springs of the other two places. Some people are led to believe from this that the so-called ' more mineralized " or " stronger " waters are the best, whereas the contrary is in reality the case. Furthermore, the bottling arrangements at Contrexeville are of a primitive kind, leaving loopholes for the contamina- tion of the bottled water. This may explain the nasty taste and smell sometimes on opening of a bottle of Contrexeville water. Bacteriological examination should be made from time to time on bottles of exported waters, not only from this, but all springs. Another possible source of contamina- tion we shall refer to later on. Martigny also does not possess any modern bottling arrangements, but I noticed much greater cleanliness in the process. At Vittel, the bottle as it arrives from the factory is cleaned, sterilized, then brushed and rinsed in some of the water of the spring ; then filled, capsuled, burnished and labelled, all by machinery. The corks are previously sterilized by superheated steam. In fact, some 10 or 12 minutes converts the glass maker's product into a filled and labelled bottle of the "Grande Source " or the " Source Salee " that will keep for months or years, and is, of course, free from contamination. The consequence of these facts concerning composition and bottling has brought Vittel rapidly into favour, as proved by the following statistics extracted from a pamphlet written 9 by Dr. Bonrsier, who, as consulting physician and shareholder in the Contrexeville Company, cannot be taxed of partiality for Vittel. Bottles j Bottles Exported. Exported. Contrexeville, 1900 ... 1,208,000 Vittel, 1900 ... 1,703,000 1904... 1,707,000 1904 ... 4, '354,000 (" NOTE. In 1905, 4,872,920 bottles of Vittel were exported.") That is to say, the sale of Vittel water which in 1900 was little above Contrexeville, attained in 1904 three times as much. The following graphic curve shows the annual export of bottled waters of the Vittel " Grande Source " and the " Source Salee" during the last nine years. A Graphic Curve showing the Annual Export of Bottled Waters of the Vittel " Grande Source''' and "Source Saler " during the Last Nine Years. Years. i305V4-.872.92D 1 1901 A A l 302, J ' ~j> 3.706591 o H 03 | L-r-- / / [ H VQ O 3.034.304 ? K M 2.55G.28* 1 o S 1 974.19S ^ 1.582.918 l.iTS.HO l.OOJ 889 ft | 1899 t I398 ^E= !S9T>fc 1 =- more striking example could be given than this curve 10 as demonstrating the rapidly growing favour shown to these waters by the medical profession prescribing them. For the last six years the annual increase of exports has averaged over half-a-million bottles, and the consumption of 1905, as seen above, has reached nearly Jive million bottles. Curiously enough this increase is largely due to the consumption in France, where the French physicians have learnt the great value of these waters in the uric acid diathesis; but both English and American physicians are only just beginning to appreciate their advantages. TOPOGRAPHICAL POSITION. Strange tales are rife as to the relative altitude of these different spas. I have myself heard on several occasions the statement made that Vittel was 1,000ft. lower than Contrexeville, and by people who were accustomed to travel by road and railway between the two places. When I drew attention to what sort of a railway line it would be for a drop of 1,000ft., or 330 metres, in a distance of 3| miles, the truth dawned upon them. As a matter of fact, the two railway stations stand at the same level to a few inches (about 1,100ft.), and the fall from the station to the two " Etablissements " is practically the same. Martigny is somewhat at a higher level. Anyone can verify this easily, as every French railway station bears a clearly inscribed mark of the actual height above mean sea level. When we compare the actual situation of these three stations the marked inferiority of Contrexeville to its twa sisters is most striking. The so-called Park of Contrexeville, not more than a lai'ge garden, overcrowded with the " fitablissement " buildings, the Casino, shops, shooting- galleries, &c., is practically surrounded and crowded in by the town buildings that occupy the slopes of the almost gorge- like valley, and the drainage, dust and foul air from the habitations must inevitably tend to gravitate towards this so- called Park at the bottom of a narrow valley. In fact, thi& 11 garden is in part made over the arched-in streams, the waters necessarily contaminated by surface drainage higher up the valleys, which flow beneath it in close and very dangerous proximity to the "Pavilion" and "Souveraine" springs. The unbearable stench during the summer at the lower exit of these streams, near the croquet grounds and close to the English church, is obviously a crying danger to those who frequent the " Park," not to speak of drinking the water of the springs but a few metres distant. I have paced out the intervening ground between the river and the Pavilion spring, as well as intervening obstructions admit, and make it, roughly, 25 metres. The soil must be alluvial, and, therefore, very permeable. In fact, the topographical and geological position is such that all the surface drainage from the houses of Contrexeville in the neighbourhood must tend to percolate towards the springs. We all know what a Lorraine village is, with many houses looking on to its reeking dunghill. A walk through the village, up the valley from the springs, is illustrative. Both Vittel and Martigny have large open and extensive parks. The former right away from the town, the latter on its borders, where on the hottest day free circulation of air and pleasant breezes replace the stuffy atmosphere of Con- trexeville, with its narrow shut-in valleys surrounded by houses. At Vittel the beautiful Park extends away continuous, with the fine racecourse, which is said to be the second best of its kind in France. This broad meadowy plain is flanked by the rolling hills and the golf links on one side, and the pine woods, that stretch away to Chatillon, on the other. At Vittel and Martigny the hotels are scattered through the Park, and not crowded up against the houses and hovels as at Contrexeville. The consequence is that the climate is fresher and more bracing at Vittel and Martigny, and this breezy atmosphere sweeps the hotels, instead of the stagnant air at Contrexeville. The consequence of this and the other facts laid before 12 you is that many old habitues of Contrexeville now go regularly to Vittel or Martigny. The result is that while the 96 97 93 99 1900 01 02 03 04 I9( ^* ^^^ <^ / y ^7 / / ^ ^v,/ Pv2_ V jr ^Jj ?_ ^S^ s^ 2_ / / / / / / ^ / ^/^ ^\ .^s^ c ONTRE. KEVILL m .*< \j^ ^ , " NI^*^"^ ^^*^~ ^ *^ ^^ ^^^ ^~ isllllllll Curves showing the increase of visitors yearly for treatment by the Vittel and Contrexeville waters, based chiefly on figures by Dr. Boursier (loc. cit.) of Contrexeville. There is some confusion between visitors and water drinkers, but the latter bear a definite ratio to the former. The baths and other balneological arrangements at all the three places were certainly behind the times of late years. This defect has been met by Vittel, which is now construct- ing a very fine bathing annexe in time for 1906 season. The old building will be left, and utilised for medicated baths and other special purposes, whilst in the new part every modern method and appliance has been contemplated, and will be carried out to make the hydrotherapeutic resources of the first order. The remaining factor that influences the treatment of any invalid is the moral effect of his surroundings. Here Vittel stands far and away superior to either Martigny or Con- trexeville. If the internal decoration of the Contrexeville Casino surpasses that of Vittel, it is more than compensated for by loftier position and charming views of that at Vittel; and above all by the very high class of the theatrical companies that perform there nightly. The best artists and pieces that are to be seen in Paris can be enjoyed here with- out all the crush, foul atmosphere, and other inconveniences of the theatres of the capital. The operetta companies who perform on alternate evenings give no unworthy display of light musical farces. A good orchestra performs during the hours of water- drinking, and, as a change from time to time, military bands play in the Park. Continuous, and extending away for some miles, is a meadow-plain some half-a-mile broad, on which is situated the race-course, with its elegant and comfortable grand stand. Here races are held from July 15th to 17th, and 30,000 to 40,000 francs are distributed in prizes. The western flanks of this valley are in part covered with pine and other woods, and slope up to the forest-capped Chatillon, so that one can start on woodland rambles within two minutes from the centre of the "Etablissement." The eastern rolling hills are now in part laid out by James Braid as golf links, only six minutes' walk from the " Etablissement " and most of the hotels, and eight minutes from the station. A fine golf pavilion and restaurant is at the disposal of the devotees of that game. Both the links and the adjoining 14 vine and forest-clad hills afford fine views in all directions. Not only is golf a pleasant adjunct to the treatment, but a very useful one in many cases. In the Park itself new tennis courts, English croquet lawns and bowling greens have been freshly made from Carter's seed, so that Vittel is almost unique in this respect amongst French spas. There is a gymnasium, croquet and other games for children, and daily representations of a first-class Punch and Judy, and children's dances are given during the season. Close at hand is the pigeon shooting and archery grounds. In wet weather the covered promenade, the finest in Europe, flanked by the park on one side, the pump rooms, bath and shops on the other, affords plenty of space for exercise between drinking the prescribed glasses of water. It would be out of place here to refer to the many other attractions of minor importance, and I think I have said enough to explain the remarkable and rapidly growing choice given to Vittel in preference to the two rival neighbours. Martigny, if well managed, has a future before it, but must of necessity take many years to catch up Vittel. Contrexe- ville, which lives on its ancient reputation, is so unfortunately situated and so badly administered that, without an enormous outlay, it cannot bring itself up to modern requirements, and even then will always be handicapped by its unfortunate topographical position and shut-in atmosphere. DOHERTY it CO., Printers, (i, Great Newport Street, St. Martin's Lane, London, W.C. :i(if>3 Telephone No. 3039 (Gerrard).