Thermal spas became very popular in the 18th century and much ink was spilled in learned disquisitions on their waters, chemical components and medicinal properties. Nonetheless there are not that many sources which give a real feel of what it must have been like as a patient to "take the waters". One exception is this modest little guidebook to Plombières, which was published in nearby Remiremont in 1748. The title page tells that the author was Joseph Le Maire [Lemaire], the doctor attached to the Hôtel of the Abbess of Remiremont and a salaried physician in that town.
Doctor Le Maire informs us in his introduction that few medical men could rival his experience; he had practised medicine in Remiremont since 1712 and had regularly attended the seasons at Plombières for more than twenty-five years. In addition, in the 1740s he was placed in charge of the mineral waters at Bussang (the subject of a further book in 1750).
Dom Calmet in his Traité historique des eaux, also published in 1748, remarks that Le Maire had personally given him a copy of his essay, but that he had preferred to allow the doctor the courtesy of publishing separately (p.215). He does include several annotations made by Le Maire's to his own manuscript (mainly of a technical nature.)
The following is a brief summary / translation of Le Maire's work. Calmet's comments are also included where appropriate.
Introductory remarks
In his preface Le Maire notes that the waters of Plombières have secured a high reputation because they are gentle and safe; every day they bring about an astonishing number of cures. Nonetheless their efficacy can be greatly enhanced by following proper medical advice. In the thirty-six years that he has frequented the spa, Le Maire has seen few accidents that have not been caused either by ignorance or temerity (p.7).
He begins with a few preliminary cautions:
In general, the chief pitfall is excess in various forms - whether in the volume of water drunk, the amount of time spent in the baths, or the heat endured.
As much as the waters themselves, the dietary régime is a potential source of problems, "if one can call régime the way of life that has been followed here in the last eighteen to twenty years" (p.9). In earlier times innkeepers served food and drink suitable for invalids; but now the only concern is with flavour and the need to pander to customers' sensual pleasure.
Insufficient care is also taken to avoid the injurious effects of the air, particularly the evening chill of Plombières after a day in the baths. Le Maire has seen patients out late at night, working up a sweat by dancing, at a time when it was so cold and humid that a fire was needed indoors in one's chamber (p.10-11)
The chapters which follow give detailed advice on the various different methods of taking the waters - drinking fountains; baths and half-baths; steam rooms; showers.
Drinking the waters (p.13-25)
Dom Calmet gives potential
curistes a rundown of the standard procedure. The two "seasons" at Plombière are Spring and Autumn, avoiding the cold of Winter and the extreme heat of Summer; exact timing is dependent on the weather in any particular year. A stay usually lasts 19 or 20 days to allow time to undergo a purge and to rest.
On arrival, one must first find lodgings if this has not already been organised, ideally as close to the preferred bath as possible. One should then consult a doctor, who will inevitably suggest purgatives and advise on the pattern of bathing and/or drinking the waters (Traité, p.194-5).On the third or fourth day, the cure should begin by drinking two or three goblets of warm water taken from the source du Chêne; afterwards one should walk around as much as possible, to keep warm and to encourage the absorption of the water. On the next visit four or five goblets should be taken, then six or seven, increasing gradually each day to fifteen, eighteen or twenty - depending on how much the individual can tolerate without feeling sick or suffering knots in the stomach. Those who can pass the water easily, whether by ordinary means or by sweating, can drink larger quantities. As an aid a pinch of Polychrest salt (a common laxative) may be added to each goblet; but the best method is to drink gradually, at quarter-of-an hour intervals, whilst walking around, well-covered and with hot towels applied to the stomach from time to time. Having increased the volume taken for the first eight days, for the next eight days the amount can be gradually diminished (p.196-7)
Le Maire thought that at Plombières the practice of drinking the spring waters, as opposed to bathing, was comparatively recent; the physician Berthemin, writing in 1615, had dated it to the early years of the 17th century when Duke Henry II had been advised to drink the water to ease a stomach-ache. The design and location of the modern drinking Fountains - the Crucifix and that of the Bain-des-Dames - suggested that they had originally been used only to fill the baths. However, in Le Maire's day almost everyone drank the water, either on its own or as part of a cure; it was generally considered less risky than braving the baths and showers. The majority confined themselves to drinking the eau chaude from the hot springs; but the cold mineral water (eau savonneuse) could also be taken, either on its own or in combination; alternate glasses of hot water and mineral water were known as "les Eaux coupées".
(See Haumonté,
Plombières ancien et moderne p.51, for details of the drinking fountains. The first evidence for drinking the waters in fact goes back to the middle of the 16th century, but Le Maire was correct that it first became the vogue only in the 17th, when the fountains were rebuilt.)
18th-century valetudinarians had to be early risers! Le Maire instructs his patients to drink the waters on an empty stomach, starting between half-past-five and seven or seven-thirty in the morning; this should allow plenty of time before dinner, which, we are told, was generally served at eleven in Plombières. As to quantity, he confirms Dom Calmet's observation that it was necessary to work up gradually: four or five glasses was sufficient on the first day, increasing to ten in subsequent days, even twenty, if the individual's capacity allowed.
We are not told how big the glasses (or "goblets") were, but this sounds quite a lot of liquid, especially if it was hot. Closer to home, in Regency Cheltenham Spa, the standard requirement was a pint in the morning and a pint in the afternoon - quite a big ask given how evil tasting the Cheltenham waters are! At Plombières, in contrast, the water, whether "hot" or "soapy", was said to be palatable; sugared aniseed or lemon and orange peel could added - but Le Maire does not recommend this as it "excites the wind".
The water should be drunk slowly, over an hour-and-a-half or so. Some patients preferred to remain in bed to drink (Dom Calmet explains that the water was brought to them in a jug which was placed in a larger container of water and covered with a cloth to conserve the heat). But, where possible, a gentle promenade while imbibing is to be recommended. This was clearly the standard practice. It is easy to imagine the well-to-do curistes of the 1760s dawdling contentedly at Stanislas's Crucifix Fountain or strolling convivially under the pleasant arcades comparing their symptoms.
If a patient vomits persistently, Le Maire, somewhat pitilessly, advises them to proceed but more cautiously. There may be "mauvaises humeurs" which need to be evacuated, in which case a purgative is prescribed: there are plenty to choose from: Epsom salts; Seignette ["sel de Rochette"]; Glauber's salts, or an evil mixture of powdered rhubarb and Cream of tartar. (There is always a certain amusement in reading such lists of concoctions - but only from the safe distance of 250 years!)
The Baths (p.26-59)
Dom Calmet again explains the basics. The schedule is tight. Those
curistes who also intend to use the Baths after visiting the Fountain, must first allow themselves enough time to digest and pass the water. They then need to fit in the bath itself, time in bed to sweat and dry off, plus a period of rest, all before dinner at eleven. It is standard to gets ready in one's lodgings. One must undress completely. Men don full-length baggy pantaloons which fasten at the side rather than the front. Then comes a camisole which ties at the front and over that a dressing gown or cloak. The head is covered with a cloth bonnet, and there are also neckerchiefs and mules. The patient then proceeds to the Baths on foot followed by one of the female servants belonging to the house, who carries the rest of the equipment. On arrival the servant stows away the dressing gown and slippers somewhere dry. She helps the patient to enter the water, gives him a towel to wipe his face, then returns to the lodgings to prepare his bed for afterwards.
Most patients remains seated on the steps of the bath at the depth recommended by their doctor. Some can also be seen standing in the middle of the basin, where the water is at its deepest. One stays as long as possible, until one has sweated sufficiently, but without feeling too weak. The servant will then assist her charge out. She holds out up the bathrobe or some other drape behind his back to allow him to dress in dry clothes and slippers. He then hurries back to his lodgings, either on foot or by sedan chair, strips completely and gets into his bed, which has been well warmed and charged with covers.
The servant changes his bonnet, wipes his face, makes sure he is covered up to the chin; she returns with warm towels to place on his stomach, his face and head, and, if he cannot do so himself, on his back and legs. The patient remains until he is dry and rested, after which he can get up for his morning meal (Traité, p.197-8)
This was obviously not a world where swimming pools, or even large domestic baths, were familiar (though in fairness the water at Plombières could be VERY hot). Le Maire assumes his patients will need considerable reassurance. He begins with some basic definitions: a bath ("bain") is "the immersion of the whole body except for the head"; a "demi-bain" is to waist level. Baths may also be classified by temperature as "hot", "cold" or "tepid".
The good doctor goes on to give some essential preliminary instructions:
- It is imperative that a purgative is taken before entering the bath. A whole day's interval is recommended to ensure that the medicine has done its work and that the stimulating effects of immersion do not oblige one to "exit more quickly and earlier than planned". In thirty years of practice, Le Maire has seen only two or three patients suffer ill effects from purgatives whereas a hundred or more have regretted their neglect; several - he adds darkly - "paid dearly for their rashness" (p.23)
- It is recommended that one drink the waters before entering the bath.
- One should accustom oneself slowly to a hot bath, allowing time to immerse one's body by degrees.
Le Maire, writing in 1748, notes that the baths at Plombière now boasted a thermometer, not "just one of the kind in everybody's hands, filled with eau-de-vin" . Dom Calmet confirms that Le Maire did indeed have use of a mercury thermometer, the only one capable of withstanding the very hot water; he goes on to discuss some of his readings from 1743 and 1744.(Calmet
Traité historique, p.65)
According to Le Maire, a thermometer was not that useful for the medical practitioner since patient reaction would invariably indicate when the bath water was too hot to tolerate. His list of alarming symptoms escalates through heart palpitations, loss of appetite and sleep disorders to diarrhea and dysentery, fever, convulsions, retracted tendons - and finally apoplexy. Indeed, he adds cheerfully, for elderly people over-hot baths are "almost always fatal".
Le Maire has several examples of elderly unfortunates who have come to grief. In 1718 a certain Madame de ….., a sciatica sufferer in her sixties had entirely lost the use of her legs due to over-hot water; Le Maire never knew if she had recovered. A merchant from Epinal had been enticed into the hot Grand Bain where he had been seized by fever, and began spitting blood. A old lady of 78, with partial paralysis, had been much improved by carefully managed treatment in her room but went to her grave when she was persuaded to take a course in the baths. Young people, in contrast, almost invariably survived. Le Maire knew of only one young man who had died, succumbing to fatal convulsions after exposing himself to the double jeopardy of an over-hot bath and failure to take a purgative.(p.36-7)
A final case concerned a Capuchin father in his early forties who had been advised to take the hot waters of Plombières for rheumatism in his shoulder and arm. He spent his whole cure in the Grand Bain and took showers which were excessive in both heat and quantity. Apparently he remained in good health, but on his return home to Remiremont the pain in his shoulder become so excruciating that it could be relieved only by continual vigorous rubbing with a damp towel.
The different baths at Plombière varied in temperature. The Grand Bain was the hottest:
"The heat of the Grand Bain is so great that one has to be strong to bear it without inconvenience; I have never seen a hypochondriac or hysterical woman who could stand it even once without becoming ill." (p.38)
The Bain-des-Dames was less hot and, until recently, the Petit bain (the "Bain des Capucins") had been cooler still. However, the water was now piped in directly from a very hot source, with the flow controlled at the whim of the bathers - this meant that the temperature could no longer to be relied upon, and, in effect, the medical practitioner had one less bath at his disposal.
Should one bath in the morning or afternoon? Predictably Le Maire recommends the morning, preferably as soon as possible after drinking the waters, when one's stomach is still empty; several glasses of water may be reserved to drink in the bath itself. Bathing in the afternoons risks digestive problems and fatigue.
He counsels strongly against eating beforehand or taking food of any sort, even a bouillon or potage, into the baths themselves. He has yet another cautionary tale concerning a young man in his thirties who went into convulsions after consuming soup before bathing. Fortunately drinking chocolate - well mixed and without spices - has no such ill effects; indeed it "strengthens and cheers". (p.43)
Steam baths (Étuves) (p.49-55)
Le Maire informs us that in his day steam rooms were common in Germany, even outside the spa towns. They consisted of an oblong vaulted cabinet with only one entrance and a small hole in the roof to serve as an inlet for a pipe or tap for the shower. According to Dom Calmet, the two functioning "étuves" at Plombières could each accommodate ten people but were seldom if ever full. Steam was supplied by hot mineral water in a stone basin beneath the floor. The patients, would be shut inside with the assistance of their hired attendants. Once inside they would strip entirely apart from a towel for modesty, since as Dom Calmet observed, some chink of light would always penetrate the darkness. A serviette or handkerchief placed over the nose and mouth assisted breathing (Traité, p.200-1).
In Le Maire's view patients should be left to sweat it out for between a quarter-of-an hour to an hour at maximum. He advises some, by now familiar, precautions: drink the waters before entry; take a purgative; pace the timing carefully. If the shower fitted into the top of the cubicle is to be used, the occupants must agree this together beforehand. Immediately afterwards a servant should enter with fresh dry linen: a bonnet and bathrobe and scarf, plus dressing-gown or cloak. The patient should get into bed as soon as possible to dry off. Le Maire finishes by outlining different timetables for interspersing steam baths with bathing and rest, and by outlining possible symptoms of over-exposure: fast pulse, thirst, coughing, loss of appetite, sleepless, all of which are signs of "too great a movement in the humours". Unfortunately, the temperature of the steam baths was not susceptible to adjustment.
Showers ("La Douche") (p.59-73)
The showers were not intended, as today, for personal cleansing, but served a therapeutic purpose, by directing a stream of water on specific parts of the body.
A tub ("cuveau" or "baquet") of water would be suspended over the patient's head, usually at a height of three or four feet; according to Dom Calmet, it was about the size of two ordinary buckets. A tap or pipe in the bottom then allowed the water to be released onto the afflicted area. The tub would be constantly refilled by assistants wielded buckets, so that a continuous flow of water was maintained for as long as required. It was also possible to shower indoors, in which case the tub would be hoisted up on a plank supported by a frame and the sick person positioned below in a wooden bath.
According to Le Maire, "les douches" had been imported from Italy. They were used first in the steam rooms, then in dedicated cabinets set up in the Bathhouses themselves. Dom Calmet describes how patients in the Grand Bain climbed directly out of the water and entered a recessed area hidden from view by a thick curtain; here the "Maître des Douges" reigned supreme.
 |
| The showers in action. Illustration by Léopold Durand from Dom Calmet's Traité. |
Wherever the shower is situated, remarks Le Maire, it is not always to be taken "with impunity". Allowing water to fall on one's head can be particularly dangerous, even with the precaution of a protective sponge bonnet. The pressure of the water, combined with its heat, can damage the delicate tissues of the brain, or even of the face. In May 1714 one of Le Maire's patients, a soldier from the garrison at Strasbourg, had one of his eyes washed right out of its orbit (p.53). Even on the abdomen, showers can have ill effects, particularly if they are used to disperse tumours. In this case it is best to shower in the bath with the afflicted area under a cushion of water or else to use a protective layer of towels.
The force of the shower depends on a number of variables - the height of the water in the tub, the width of the hose and the degree of elevation. Most bathers have a fair idea of these factors. But the real danger comes from the heat of the water. Experiments show that birds survive only two minutes in an air temperature of 140 degrees, cats and dogs less than twenty minutes at 110 degrees. Who, then, can doubt the ill-effects of extreme heat on humans? Boiling water thickens and coagulates the blood, with circulation completely obstructed at just over 100 degrees Fahrenheit. All the hot springs in Plombières exceed this temperature. It is true that the bathers add cooler water from the Baths to their showers but, even so, there are a great many accidents from over-heating. Le Maire has some examples: In 1722 a Canon with sciatica, who was otherwise strong and healthy, was thrown into sudden convulsions; a few months later he died of an asthma attack. More recently, in 1743, a woman in her sixties successfully dissipated the numbness in her arms, only to succumb to breathlessness, headaches and fever from the hot water (p.61-62). In Le Maire's view it was not really necessary to make showers very hot since their real efficacy, which Le Maire does not doubt, comes from the movement created by the water on the afflicted part.
I
Various sage guidelines should be observed:
- Never take a shower before entering the bath or étuve, but only afterwards when one's bodily circulation has warmed up sufficiently.
- -Consider the timing carefully: give the bath attendant due warning and be prepared to receive towels, bath robe, bonnet and slippers immediately so to be able to return to one's lodgings without cooling down.
- Prepare for the ordeal by using the baths or steam baths on several consecutive days before embarking on any showers.
- When using the shower to treat a particular area of the body, one should still move around and ensure the water is not just concentrated on a single spot. Afterwards, rub the afflicted part vigorously.
In general, showers are of utility for any condition which involves obstruction of bodily systems, whether the circulation of blood, the glands or the secretory and excretory organs. They are also effective for stiff joints, retracted tendons and the "white tumours" associated with tuberculosis. They may be used to treat inflammatory disease, but in this case they can prove dangerous and require careful supervision.
Le Maire concludes his little book with a few chapters of more general advice:
Additional treatments:
Purging (p.76-86)
No surprises that this takes high priority! Le Maire informs us that it is essential for the digestive system to be purged at the beginning and end of a cure. Naturally, he has suitable cases to confirm the folly of neglect. In 1718 a certain priest had been afflicted by urinary retention so painful that it felt like red hot iron to pass water. Another incautious bather, an innkeeper from Remiremont had been confined to bed with fever for six weeks and permanently lost the movement in his hands (p.74-76)
Opinion varied, but the patient should leave an absolute maximum of four days before taking a purgative. This time Le Maire can call on his own personal experience. In May 1719 he himself was in Plombières as a curiste, taking the hot waters, when the press of business caused him postpone "the Medicine". On the eighth day he was seized by a headache and shivering, the prelude to a fever which was accompanied by fainting fits and such weakness that he could not get out of bed. He eventually recovered only after he had taken a purgative/laxative and it had done its work.
Le Maire was of the opinion drastic purgative medication should be banned from the spa. However, his approved list sounds fearsome enough: rhubarb, coffee, manna, senna leaves and pods, Seignette, Epsom salts, Seltzer salts, vitriolated tartar (potassium sulphate) and cream of tarter, Glauber's salts.. To this may be added - for the benefit of the poor and for certain disease involving muscular weakness - two stronger and commonly used laxatives, jalap root and scammony (p.79).
Enemas and Douches (p.85-6)
Enemas were not a standard treatment in Plombières but they were sometimes employed, using hot spa water or cold mineral water which was heated to the desired temperature. Le Maire remarks that they could profitably supplement laxatives in cases of constipation. Hot water injections were also of benefit for hardness of hearing, deafness, and ringing in the ears, for ulcers of the urinary tract and the womb, for anal fistulas, and for sinuous ulcers. The water from the slow-flowing St.Catherine Fountain was suitable for bathing the eyes.
Bleeding and Cups (p.87-89)
Le Maire's views are mercifully moderate here. Bleeding, an essential weapon in the 18th-century medical arsenal, is again not essential but may be profitable for certain conditions. "La Ventouse" or "le cornet"- the application of heated suction cups - is also effective for skin complaints and similar. Dom Calmet comments that ventouses and scarification are the remedies of the poor. They take place at one end of the Grand Bain, in full view and with some indecency since the blood which is shed recalls the horrors of the butchers shop. (Traité, p.202)
Getting in and out of the baths and étuves (p.90-97)
Whether or not one takes a shower, damp linen should be left in the Baths and replaced by dry protective clothing: bathrobe, bonnet, neckerchief, with a dressing gown or cloak on top. All haste should then be made to return home to bed without taking the air or cooling down. Care should be taken to ensure that the bed is of a correct temperature so that the patient dries off gradually.
Everybody appreciates the need to avoid a chill, but an over-heated bed can be just as dangerous. It is a common fallacy to believe that the waters are effective only in proportion to the amount one sweats. But too great a loss of fluid impedes circulation, an outcome be avoided at all costs, especially given that the majority of patients are afflicted with "obstructions" of various sorts. Experience bears out the theory; those who sweat only moderately benefit most from the waters, whereas excessive sweating only produces new afflictions. Often over-heated beds are principally to blame. Le Maire recalls the case of a certain Swiss gentleman from Neuchâtel who claimed that the waters had made him asthmatic but later admitted that he had sweated profusely in bed; a dose of Epsom salts soon put him right. Angry red heat blisters, caused by excessive heat, are also a frequently observed side-effect.
Diet (p.98 -102)
Attention to diet is essential to an effective cure, indeed in many cases it is all that is really needed. Extra care is necessary since taking the waters renders one temporarily weak. The importance of diet is shown by the experience of domestic servants who will often drink the spa water purely out of curiosity, without following any regime. Le Maire has seen seasons where almost all the servants have come down with fevers, brought about by imprudent diet and exposure to the air (p.99).
Le Maire considers it essential not only to drink the waters on an empty stomach, but also to fast for at least three hours afterwards. The only liquid that can safely be taken is plain drinking chocolate or, failing this, tea mixed with a little egg (?!) . Snacks of any sort, even bouillon, should be banned from the fountains.
As far as meals are concerned, there is problem with a good midday dinner, especially since the waters often work up an appetite. Supper must be light enough to ensure digestion is complete before the next morning's cure. Only boiled meat should be served; or plain roasts such as beef, lamb or poultry. "Black meat", pâtés, pastries, seasoned stews, mushrooms, salted and smoked meats are all forbidden. River birds - no doubt plentiful in Plombières - are a particular no-no. Le Maire also tells us, somewhat bizarrely, that fish, vegetables and "all sorts of lean foods" have always been considered unsuitable for those taking the waters.
Dom Calmet confirms: The typical regime involves eating early in the day, eleven o'clock for dinner and six for supper. In theory one must be satisfied with a dish of boiled meat in the morning and in the evening roast veal or chicken without spices, salads or crudities; a good wine is permitted, but taken moderately. Like Le Maire he too comments that these restrictions are often flouted: red meat dishes, salads, pastries - everything is served.(Traité, p.195)
The Baths or a tub? (p.102-12)
The majority of people, learned and intelligent included, are convinced that bathing in the communal Baths ("les bassins") is more efficacious than using a bathtub. Le Maire examines the pros and cons, and on the whole thinks bathtubs have their advantages. The most persuasive argument in favour of the Baths is the continual renewal of the water, which flows directly from the springs. However, a tub is much easier to use and can easily be replenished with buckets. In addition, minerals are less easily dissipated in the great volume of the bassins. The Baths are neither more "natural", a better temperature nor more effective because of their volume. They can be hazardous and impractical for many invalids, especially now that the waters of the Petit Bain have become so hot.
The book concludes with some more general consideration of timing (p.212-15)
- Would it be possible to take the Waters all year round?
- When is in fact the best season?
- What is the best length of time to rest between the two cures of the summer season?
Fifteen or twenty years ago, Le Maire observes, taking the Waters was strictly confined to the two customary "Seasons": Spring (from the middle of May to the end of June) and Autumn (from the end of the summer heat until the 25th September when the cold winds begin). This meant that the town was deserted for the whole of July and for a large part of August. This had changed in recent times and now there were a large numbers of invalids in Plombières throughout the summer. Those who still took two separate cures often left only a week to ten days between the sessions, so that they had completely finished by the end of August.
Le Maire points out, first of all, that the temperature and flow of the waters remain constant throughout the year. He has many examples of patients that have successfully undergone cures in winter, though they would have been vulnerable to chill. However, in summer, the extreme heat combined with the hot water is undoubtedly too dangerous. He also thinks twenty-five or thirty days is the minimum safe interval for the body to adjust between cures.
[We end rather abruptly here - but then so does the good doctor!]
References
For the available biographical details:
"LEMAIRE (Joseph)" in Dictionnaire des Vosgiens célèbres [écriVOSGES website]
Dom Calmet, Traité historique des eaux et bains de Plombières, de Bourbonne, de Luxeuil et de Bains . Nancy, chez Leseure (1748)
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