important branch of thermal practice is at this moment a subject of serious consideration at Carlsbad. The want of good douches is the more surprizing that the following quotation, from Wenzel Payer’s work, seems to prove that Carlsbad was the first place in Germany, where that powerful remedy was introduced: Et miror saepe mecum quod nullus medicorum per Germaniam dutiâ (douche from gutta, gocchie) utatur, quia in nulla patriâ, magis necessaria esset. It is at least probable that Payer, having learned the utility of the douche, did not neglect to establish it at Carlsbad.
Our medical institutions can be therefore divided into three distinct periods. During the first, bathing alone was usual. The second period, and certainly the most important, dates from Wenzel Payer, on whose suggestion, in 1521, the internal use of the waters was added to bathing. The third began so late as 1827, when the application of steam was joined to drinking and bathing. The junction of these three curative means has manifestly increased the fame of Carlsbad, and, although often prescribed to the same patient, drinking remains in general the most essential part of the cure. A great number accomplish it without water or vapour-baths; but bathing without drinking is rare.
Formerly, when the purgative effect of the waters was deemed the most important, physicians encouraged plentiful drinking; but, since their alterative and slowly desobstruent action has been better under-
