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British Spas from the International Point of View.
112
together with the We have in England, Scotland, and Wales types of all important Congress on Tuberculosis, meet in September. the principal waters-muriated, sulphuretted, indifferent, Certainly this is the most favourable month for such earthy, alkaline sulphated, iron, strong salt, and brine. It gatherings, but this great clash of congresses is unfortunate. cannot, therefore, be solely a matter of the waters that takes Most specialists will feel obliged to attend their own so many of our British patients abroad yet brings so few particular meeting, and will be unable to be present at foreigners to our shores. There must be some other reason or congresses less intimately connected with their work, reasons for the paucity of foreign health-seekers visiting us. whereby these congresses will lose that criticism from the The explanation is partly to be found, no doubt, in lack outside which is of the greatest practical value, and which of knowledge on the part of those living on the continent destroys any tendency to abuses of mutual admiration. concerning the nature and existence of the medicinal waters There is still great need of better international organisa- of Great Britain. To illustrate this point Dr. WOOD mentions tion in these matters. This was forcibly stated when that in a well-known German manual describing the health the International Association of the Medical Press met resorts of Europe there is no mention of any at all in at Budapest the year before last. It was then even urged England ; and, again, that in a similar French publication, that perhaps the International Committee of the Medical in its forty-ninth year of issue, whereas six pages are Press might serve as the link of union between all allotted to Spain, two are considered appropriate for this the international congresses of the medical and allied country, while various errors and omissions sufficiently
All
these last-mentioned congresses,
very
No further movement has been taken in this no one can deny that more systematic arrangedirection, ment is needed, and perhaps it might be obtained in this sciences.
but
way.
British
from the International Point of View.
Spas
A STRONG contrast is noticeable between the
large number of visitors, wholly or partly in search of health, from Great Britain to foreign spas and the very few foreigners who from like motives seek health or amusement, or both, in the spas and watering-places of this country. The reasons for this disparity are discussed and critically examined with clear insight by Dr. NEVILLE WOOD in an article on British Health Resorts for Foreign Invalids, which appeared in THE LANCET of Jan. 7th, p. 12. Dr. WOOD at once takes the broad ground that it is short-sighted policy, however patriotic it may seem, to exhaust our efforts in endeavours to keep the Briton from foreign countries, instead of demonstrating that British health resorts offer substantial benefits to foreign invalids also, and aiming thus to redress the adverse balance. A permanent commercial success in the long run is dependent rather on supplying the thing really needed than in endeavouring to palm off on him "something just as good." There are patients to whom Great Britain cannot supply the things needful, or at least desirable, for their greatest advantage. Such patients ought to go abroad, if they can afford it, where these desirables can be found, since the rapidity or completeness of their relation to health can be aided thereby. This is particularly the case in regard to certain requirements whose effect is of the psychic order. On the other hand, there are many others who can obtain all that is requisite
indicate the absence of
competent revision. This, however, due to indifference on the part of foreigners, entirely for Dr. WOOD found that the editor of one such work had vainly endeavoured to procure in London any authentic account of the British spas, while a request was made to is not
Dr. WOOD for
an
addendum
on
British seaside resorts to
the German translation of his work onSpa as
well
offer of
as an
a
Treatment,"
French translation of
a
work
on
British spas. Ther*} is considerable difference of opinion as to the precise manner in which "spa " treatment produces its beneficial effects.
Some authorities maintain that
the waters themselves have but
little, if any, effect,
to which the
insist that the
and
is submitted is
regime patient Other responsible for the improvement that ensues. physicians, again, maintain that the waters have a very definite action, although the exact explanation of the To manner in which they act is by no means definite. these factors must be added a third factor-namely, the psychic-and this in a large number of cases is a powerful In the continental resorts, especially those of one. Germany, the daily life of each patient is carefully laid down ; every detail in the hotels and environment of the town is made subservient to therapeutic
certain outdoor amusements, such as few of the spas golf, to be obtained, and at many social attractions are a powerful factor. The majority of the visitors, however, are there for treatment and not for amusement, and so the whole of a patient’s attention is directed to the daily routine prescribed by the doctor. From a purely medical point of view this plan has advantages. Social amusements, such as dances and concerts, are indeed provided, but for the most part they are held outside the hotels, and terminate at a seasonable But still further- hour, so that invalids may find health without being disturbed for them in various resorts at home. and this forms the main thesis of Dr. WOOD’S article-there by younger visitors, who seek only pleasure and no treatment. are many foreigners who would find at our English health- Another feature of most of the continental resorts is the resorts, for precisely the same reason that should lead complete manner in which the surrounding country is supcertain Britons abroad, advantages that they could not plied with good restaurants or cafes, whereby daily afternoon obtain at continental spas. exercise is encouraged. Added to these characteristics from Attention is often centred too exclusively on the composi- the point of view of the British visitor is the change from one tion of the waters at foreign watering-places, yet the country to another, the complete difference in thought and
composition
of the waters at various British resorts is
similar to that of
one or
closely
other of the well-known spas abroad.
measures ; there
tennis, and
at
are
a
surroundings adding already mentioned.
to the
psychic
influence which
we
have
It is here that Dr. WOOD makes
a
113 laid to heart at more than one Ministry of the Interior where the lesson it conveys may one day have to be would experience the advantages to be derived from a complete change of scene, environment, and ideas that our repeated. Whether the scene of repression and capture be the interior of a garrison, or a lunatic asylum, or, as in invalids experience in European sojourn. the recent case, a criminally occupied tenement, the agencies Dr. WOOD points out one advantage which the spas in this employed must always be far in excess of those apparently country enjoy over some of the more favoured continental sufficient. The impression on the individual or individuals spas-namely, the cooler climate of Britain, favouring, as it aimed at must be produced that the means of capture and does, all kinds of outdoor exercise. He describes clearly coercion make resistance hopeless. In lunatic asylums, espethe categories of foreign invalids for whom our spas are cially south of the Alps, this, the psychological, element in with the violently aggressive or recalcitrant subject typically suitable, including those who thrive in a rela- dealing has long been left out of account, with consequences all too tively cool climate and are able to walk well; those who deplorable both to the party coercing and the party coerced. in association with a complete change of environment No maniac is ever so furious as not to be impressed by the derive benefit from baths that are neither very hot nor taken overwhelming forces antagonising him ; thebelva umana’ necessarily in close succession ; and, of course, those whose shares the instinct of his animal counterpart in resigning maladies are held to be suitable for treatment by the principal himself to foroe majeure. Forty years ago the columns of THE LANCET were the arena of animated discussion on waters in this country. Foreign physicians might learn much alleged deeds of violence perpetrated in lunatic asylums on from a visit to the spas of this country. They would find the patients whose recalcitrancy had goaded the personnel out appliances excellent in every way, and would probably arrive of self-control, and cases were referred to in which the at the conclusion insisted on by Dr. WOOD that con- keeper had thrown the lunatic down and by travelling tinental health resorts should not be regarded as competing over his prostrate body on his knees had fractured with British health resorts nor British with continental. one or more of the ribs and thus reduced the wretched In this connexion a suggestive remark is made by Dr. man to impotency-with traumatic pleurisy as the result. Evidence was adduced that once deeds of violence, WOOD, who has found that when treating foreigners in occurring rarely, if at all, in the British Isles, were London the sick-room temperature usually has to be kept by no means uncommon in Francs and Italy, where the from one to three degrees Centigrade higher than would personnel in charge of the inmates of asylums was so be tolerable to English patients. Whether this be due to inadequate in number that loss of temper on the part of the longer and colder winters of continental stations having the keeper, goaded past endurance by refractory cases, drove led to more efficient methods of domestic heating, or to the him to the hideous practice cf rib-breaking referred to. Such abuses having become known, the remedy of reinforcing more uniform exposure of the body to a higher mean temperathe personnel and bringing it up to something like the ture during the warmer summers, it certainly suggests that proportion regarded as de riguer in the British Isles was foreign invalids may with advantage to themselves find in put in practice on the continent. The violent lunatic, many of our winter stations convenient summer resorts ati overawed by the superior force antagonising him, ceased to the time when they are largely deserted by Britons. Britishl be refractory, relapsed into sudden calm, and so spared the and continental health resorts might prove complementary togrersonz-nel the extra call on its patience, and himself the rough usage of an angry and provoked attendant. Thepsychoone another in this respect, as, probably, in many others. logy of intimidation,’ thus recognised in treatment, now explains the lessened frequency of deeds of violence in the asylums of Southern Europe. The same influence must be used where degenerate man, exemplified in the violent criminal, the revolutionary desperado, the law-defying, lawsubverting anarchist, manifests his baneful activities ; he too Ne quid nimis." must see the hopelessness of contending with overwhelming
strong point, for obviously foreign invalids at British resorts
’
Annotations. "
THE
’
PSYCHOLOGY OF INTIMIDATION.
"No incident has of late years so impressed the Italian imagination," writes our Florence correspondent, "as the siege of the foreign anarchists in the City of London. The previous acts in the drama which culminated in Sidneystreet were not without precedentabroad ; the assassination of agents of the public force in the discharge of their duty is by no means unexampled, paiticularly south of the Alps. But the siege of theFort Chabrol’ in Paris, and that of the Via Ottivianoin Rome, sink into insignificance beside the blockade and bombardment of the tenem nt in the Whitechapel quarter, de’ended as it was with a desperation that taxed the resources of the ’ centre of civilisation’ to overcome. At first the foreign critic of the besieging party was inclined to censure, if not to ridicule, its members and equipment, but gradually, as the circumstances became known, the censure nnd ridicule gave place to genuine admiration of the combined forethought, promptitude, and effect with which the operations were carried out. Nothing short of the means employed could have availed the public force in the time at their disposal, and the result is being
I force."
-
CHOLERA IN MADEIRA. WHILE the cholera epidemic at Madeira appears to be undoubtedly on the decline, the island is still practically isolated and postal communication is fitful. We have received a further letter from our special correspondent there, dated Dec. 31st, 1910, in which he says: "The official figures on the 30th of December show a total of 1245 the commencement of the cases and 360 deaths since 1 In Funchal itself case was reported on the epidemic. 30th inst., and the outlying parishes yielded 5 cases. The of the disease seems far spent, and the mortality, much lessened now, was never very heavy in percentage. No English person has been attacked, nor any of the Portuguese above the lowest stratum of their society. The medical work has been good, and illustrates emphatically the proficiency of our Portuguese colleagues in modern bacteriological and clinical methods." It is interesting to receive so excellent a report of the progressiveness of our Portuguese colleagues, and we hope that their efforts will now be vigorously seconded and their
activity
together with the We have in England, Scotland, and Wales types of all important Congress on Tuberculosis, meet in September. the principal waters-muriated, sulphuretted, indifferent, Certainly this is the most favourable month for such earthy, alkaline sulphated, iron, strong salt, and brine. It gatherings, but this great clash of congresses is unfortunate. cannot, therefore, be solely a matter of the waters that takes Most specialists will feel obliged to attend their own so many of our British patients abroad yet brings so few particular meeting, and will be unable to be present at foreigners to our shores. There must be some other reason or congresses less intimately connected with their work, reasons for the paucity of foreign health-seekers visiting us. whereby these congresses will lose that criticism from the The explanation is partly to be found, no doubt, in lack outside which is of the greatest practical value, and which of knowledge on the part of those living on the continent destroys any tendency to abuses of mutual admiration. concerning the nature and existence of the medicinal waters There is still great need of better international organisa- of Great Britain. To illustrate this point Dr. WOOD mentions tion in these matters. This was forcibly stated when that in a well-known German manual describing the health the International Association of the Medical Press met resorts of Europe there is no mention of any at all in at Budapest the year before last. It was then even urged England ; and, again, that in a similar French publication, that perhaps the International Committee of the Medical in its forty-ninth year of issue, whereas six pages are Press might serve as the link of union between all allotted to Spain, two are considered appropriate for this the international congresses of the medical and allied country, while various errors and omissions sufficiently
All
these last-mentioned congresses,
very
No further movement has been taken in this no one can deny that more systematic arrangedirection, ment is needed, and perhaps it might be obtained in this sciences.
but
way.
British
from the International Point of View.
Spas
A STRONG contrast is noticeable between the
large number of visitors, wholly or partly in search of health, from Great Britain to foreign spas and the very few foreigners who from like motives seek health or amusement, or both, in the spas and watering-places of this country. The reasons for this disparity are discussed and critically examined with clear insight by Dr. NEVILLE WOOD in an article on British Health Resorts for Foreign Invalids, which appeared in THE LANCET of Jan. 7th, p. 12. Dr. WOOD at once takes the broad ground that it is short-sighted policy, however patriotic it may seem, to exhaust our efforts in endeavours to keep the Briton from foreign countries, instead of demonstrating that British health resorts offer substantial benefits to foreign invalids also, and aiming thus to redress the adverse balance. A permanent commercial success in the long run is dependent rather on supplying the thing really needed than in endeavouring to palm off on him "something just as good." There are patients to whom Great Britain cannot supply the things needful, or at least desirable, for their greatest advantage. Such patients ought to go abroad, if they can afford it, where these desirables can be found, since the rapidity or completeness of their relation to health can be aided thereby. This is particularly the case in regard to certain requirements whose effect is of the psychic order. On the other hand, there are many others who can obtain all that is requisite
indicate the absence of
competent revision. This, however, due to indifference on the part of foreigners, entirely for Dr. WOOD found that the editor of one such work had vainly endeavoured to procure in London any authentic account of the British spas, while a request was made to is not
Dr. WOOD for
an
addendum
on
British seaside resorts to
the German translation of his work onSpa as
well
offer of
as an
a
Treatment,"
French translation of
a
work
on
British spas. Ther*} is considerable difference of opinion as to the precise manner in which "spa " treatment produces its beneficial effects.
Some authorities maintain that
the waters themselves have but
little, if any, effect,
to which the
insist that the
and
is submitted is
regime patient Other responsible for the improvement that ensues. physicians, again, maintain that the waters have a very definite action, although the exact explanation of the To manner in which they act is by no means definite. these factors must be added a third factor-namely, the psychic-and this in a large number of cases is a powerful In the continental resorts, especially those of one. Germany, the daily life of each patient is carefully laid down ; every detail in the hotels and environment of the town is made subservient to therapeutic
certain outdoor amusements, such as few of the spas golf, to be obtained, and at many social attractions are a powerful factor. The majority of the visitors, however, are there for treatment and not for amusement, and so the whole of a patient’s attention is directed to the daily routine prescribed by the doctor. From a purely medical point of view this plan has advantages. Social amusements, such as dances and concerts, are indeed provided, but for the most part they are held outside the hotels, and terminate at a seasonable But still further- hour, so that invalids may find health without being disturbed for them in various resorts at home. and this forms the main thesis of Dr. WOOD’S article-there by younger visitors, who seek only pleasure and no treatment. are many foreigners who would find at our English health- Another feature of most of the continental resorts is the resorts, for precisely the same reason that should lead complete manner in which the surrounding country is supcertain Britons abroad, advantages that they could not plied with good restaurants or cafes, whereby daily afternoon obtain at continental spas. exercise is encouraged. Added to these characteristics from Attention is often centred too exclusively on the composi- the point of view of the British visitor is the change from one tion of the waters at foreign watering-places, yet the country to another, the complete difference in thought and
composition
of the waters at various British resorts is
similar to that of
one or
closely
other of the well-known spas abroad.
measures ; there
tennis, and
at
are
a
surroundings adding already mentioned.
to the
psychic
influence which
we
have
It is here that Dr. WOOD makes
a
113 laid to heart at more than one Ministry of the Interior where the lesson it conveys may one day have to be would experience the advantages to be derived from a complete change of scene, environment, and ideas that our repeated. Whether the scene of repression and capture be the interior of a garrison, or a lunatic asylum, or, as in invalids experience in European sojourn. the recent case, a criminally occupied tenement, the agencies Dr. WOOD points out one advantage which the spas in this employed must always be far in excess of those apparently country enjoy over some of the more favoured continental sufficient. The impression on the individual or individuals spas-namely, the cooler climate of Britain, favouring, as it aimed at must be produced that the means of capture and does, all kinds of outdoor exercise. He describes clearly coercion make resistance hopeless. In lunatic asylums, espethe categories of foreign invalids for whom our spas are cially south of the Alps, this, the psychological, element in with the violently aggressive or recalcitrant subject typically suitable, including those who thrive in a rela- dealing has long been left out of account, with consequences all too tively cool climate and are able to walk well; those who deplorable both to the party coercing and the party coerced. in association with a complete change of environment No maniac is ever so furious as not to be impressed by the derive benefit from baths that are neither very hot nor taken overwhelming forces antagonising him ; thebelva umana’ necessarily in close succession ; and, of course, those whose shares the instinct of his animal counterpart in resigning maladies are held to be suitable for treatment by the principal himself to foroe majeure. Forty years ago the columns of THE LANCET were the arena of animated discussion on waters in this country. Foreign physicians might learn much alleged deeds of violence perpetrated in lunatic asylums on from a visit to the spas of this country. They would find the patients whose recalcitrancy had goaded the personnel out appliances excellent in every way, and would probably arrive of self-control, and cases were referred to in which the at the conclusion insisted on by Dr. WOOD that con- keeper had thrown the lunatic down and by travelling tinental health resorts should not be regarded as competing over his prostrate body on his knees had fractured with British health resorts nor British with continental. one or more of the ribs and thus reduced the wretched In this connexion a suggestive remark is made by Dr. man to impotency-with traumatic pleurisy as the result. Evidence was adduced that once deeds of violence, WOOD, who has found that when treating foreigners in occurring rarely, if at all, in the British Isles, were London the sick-room temperature usually has to be kept by no means uncommon in Francs and Italy, where the from one to three degrees Centigrade higher than would personnel in charge of the inmates of asylums was so be tolerable to English patients. Whether this be due to inadequate in number that loss of temper on the part of the longer and colder winters of continental stations having the keeper, goaded past endurance by refractory cases, drove led to more efficient methods of domestic heating, or to the him to the hideous practice cf rib-breaking referred to. Such abuses having become known, the remedy of reinforcing more uniform exposure of the body to a higher mean temperathe personnel and bringing it up to something like the ture during the warmer summers, it certainly suggests that proportion regarded as de riguer in the British Isles was foreign invalids may with advantage to themselves find in put in practice on the continent. The violent lunatic, many of our winter stations convenient summer resorts ati overawed by the superior force antagonising him, ceased to the time when they are largely deserted by Britons. Britishl be refractory, relapsed into sudden calm, and so spared the and continental health resorts might prove complementary togrersonz-nel the extra call on its patience, and himself the rough usage of an angry and provoked attendant. Thepsychoone another in this respect, as, probably, in many others. logy of intimidation,’ thus recognised in treatment, now explains the lessened frequency of deeds of violence in the asylums of Southern Europe. The same influence must be used where degenerate man, exemplified in the violent criminal, the revolutionary desperado, the law-defying, lawsubverting anarchist, manifests his baneful activities ; he too Ne quid nimis." must see the hopelessness of contending with overwhelming
strong point, for obviously foreign invalids at British resorts
’
Annotations. "
THE
’
PSYCHOLOGY OF INTIMIDATION.
"No incident has of late years so impressed the Italian imagination," writes our Florence correspondent, "as the siege of the foreign anarchists in the City of London. The previous acts in the drama which culminated in Sidneystreet were not without precedentabroad ; the assassination of agents of the public force in the discharge of their duty is by no means unexampled, paiticularly south of the Alps. But the siege of theFort Chabrol’ in Paris, and that of the Via Ottivianoin Rome, sink into insignificance beside the blockade and bombardment of the tenem nt in the Whitechapel quarter, de’ended as it was with a desperation that taxed the resources of the ’ centre of civilisation’ to overcome. At first the foreign critic of the besieging party was inclined to censure, if not to ridicule, its members and equipment, but gradually, as the circumstances became known, the censure nnd ridicule gave place to genuine admiration of the combined forethought, promptitude, and effect with which the operations were carried out. Nothing short of the means employed could have availed the public force in the time at their disposal, and the result is being
I force."
-
CHOLERA IN MADEIRA. WHILE the cholera epidemic at Madeira appears to be undoubtedly on the decline, the island is still practically isolated and postal communication is fitful. We have received a further letter from our special correspondent there, dated Dec. 31st, 1910, in which he says: "The official figures on the 30th of December show a total of 1245 the commencement of the cases and 360 deaths since 1 In Funchal itself case was reported on the epidemic. 30th inst., and the outlying parishes yielded 5 cases. The of the disease seems far spent, and the mortality, much lessened now, was never very heavy in percentage. No English person has been attacked, nor any of the Portuguese above the lowest stratum of their society. The medical work has been good, and illustrates emphatically the proficiency of our Portuguese colleagues in modern bacteriological and clinical methods." It is interesting to receive so excellent a report of the progressiveness of our Portuguese colleagues, and we hope that their efforts will now be vigorously seconded and their
activity