Carlsbad, in Bohemia, situated on the banks of the Topel, in a narrow valley twelve hundred feet above the sea, is one of the principal, as it is the oldest of German Spas. The season is from the end of May to the end of September; at other times the climate is "rough," though in May it is often not more than fresh and bracing. Among the advantages of Carlsbad, Braun reckons the careful diet, and among the disadvantages "an excessive use of coffee." The valley is rich in warm springs, which differ little in their fixed constituents though much in their temperature and gaseous contents. The Sprudel, which forms a fountain several feet high, giving off clouds of vapor, has a temperature of 164° F., contains 11.8 cub. in. carbonic acid, and sulphate of soda 18 gr., chloride 7 gr., carbonate 10 gr., with a little lime, magnesia, and iron. The Schloss-brunnen at 124° F. contains 17 cub. in. carbonic acid. The Markbrun-nen at 130° F. contains in addition some iodide and bromide of sodium.

Carlsbad waters are efficacious in several forms of dyspepsia, e.g., when gastralgia and flatulence occur principally after meals, and when catarrhal conditions of the stomach or intestine are present, and morning vomiting, or diarrhoea alternating with constipation. For corpulence, with its various troubles, they are a tolerably sure and gentle remedy, independently of violent evacuations. In jaundice, and a tendency to gall-stones and allied conditions, the waters diminish the inflammation and tumefaction in the gall-ducts, and thus enable calculi to pass more easily. In hepatic and splenic enlargement following malarial fevers, especially if constipation be marked, and in passive hyperaemia of the portal system and abdominal viscera occurring in stout florid persons with a tendency to haemorrhoids, and generally sluggish venous circulation, Carlsbad waters are very effective. "Old Indians with enlarged livers often derive remarkable benefit." The hypochondriasis dependent more or less on the above-named conditions is also relieved. In gout and gouty conditions without much joint-affection, especially in patients with abdominal plethora and commencing atheromatous change in the vessels, in rheumatoid arthritis, sciatica, and in the tendency to uric acid concretions and consequent catarrhal affections of the urinary organs, Carlsbad waters are often quite as useful as the stronger alkaline waters. In cases of the slower and milder form of diabetes, the use of Carlsbad waters has rapidly and considerably diminished the excretion of sugar, and after some months has effected great improvement in the general condition in many instances. Even in serious cases, provided they are not very acute and rapid in their onset, and not accompanied by phthisis, the same waters have often effected an improvement, and checked the progress of the disease.

In these observations I find myself in agreement with Seegen and Braun, and have only to add that the course at Carlsbad need not, and should not, be so conducted as to "purge, lower, and starve" the patient. We sometimes hear complaints of the depression and debility induced, and certainly, an excessive use of the waters is very lowering, but effective therapeutical results may be obtained without this. The diet, though restricted, should be nourishing, exercise moderate, not exhausting, and mental and bodily rest for some time after the treatment is very desirable. Baths of the cooled mineral waters are often beneficial, but are less used now than they formerly were.

Marienbad, also in Bohemia, and about five hours' drive from Carlsbad, is situated in a broad and beautiful valley, about nineteen hundred feet above the sea. The air is not mild, but is pure and dry, "and colds are less often taken here than at Carlsbad." The season begins somewhat earlier, viz., at the beginning of May, and it lasts until the end of September. Marienbad is the principal representative of cold gaseous sulphated soda waters, and the springs most used, the Kreuz and the Ferdinandsbrunnen, are stronger than the Carlsbad springs, and contain more free carbonic acid. They are more aperient, and given therefore in smaller doses (one to six tumblerfuls), or to patients who need more purging. In other respects, and excepting in diabetes, these waters are used like those of Carlsbad. They contain some iron, which, however, is not of importance, unless in the Kronprinz-Rudolf spring.

The Carolinen and Ambrosius springs are gaseous, weak in saline constituents, but containing some iron. The Marienbrunnen is used for drinking as well as for water and carbonic acid baths. The Moor or mud-baths at this Spa are also in request, and are prepared with black mineral powder brought from a neighboring peat-bed. The gas-baths relieve myalgic and neuralgic pain, and soothe the general nervous system, while they stimulate that of the uterus; the mud-baths stimulate the skin and promote the healing of ulcerations, and the absorption of glandular swellings.

Franzensbad, near Edgar, in Bohemia, thirteen hundred feet above the sea, has a fresh climate and good arrangements. The waters resemble those of Carlsbad, but are colder, and have more carbonic acid, and also more sulphate of soda (18 to 27 gr., with chloride, carbonate, and some iron). The treatment at this Spa has always been milder and more stimulating than at Carlsbad, and better adapted for anaemic, weak, thin, and perhaps hypochondriacal or hysterical subjects. In such cases, and especially in women who have become anaemic with spinal irritation and uterine disorder, benefit is obtained here when stronger and more pronounced chalybeates would not agree. Digestion is promoted, the nervous system strengthened, and the circulation stimulated.

Mud and gas baths are also much used here, and are beneficial in chronic skin disease and ulceration, rheumatism, gouty deposits, and par-alyses when no active central disease is present.

Tarasp, in the Lower Engadine, canton Grisons, situated on the River Inn, amid fine Alpine scenery, four thousand feet above the sea, has recently risen into fashion, and is one of the most interesting and valuable Spas. The rarefied pure air acts as a powerful stimulant or tonic, and the summer climate is temperate and pleasant, while the conditions of life are much more simple than at Carlsbad, Vichy, Marienbad, etc. The ingredients of the waters are the same as those of Franzensbad, Marienbad, or Carlsbad; the chief springs are the great, or St. Lucius, spring, and the little, or St. Emerita, spring, having 16 gr. of soda sulphate, 29 gr. of chloride, about 40 gr. of bicarbonate, 17 gr. of lime, 7 gr. of magnesia, an effective proportion of iron, and a large amount of carbonic acid.

These are used in the cases already described as suitable for Carlsbad and Marienbad, except that there is not yet an equal experience as to diabetes; on the other hand, cases of bronchial catarrh, and even of tuberculosis in an early stage, and especially when complicated with hepatic troubles, have derived much advantage at Tarasp.