The Midday Meal

The patient will then go home and rest for a while, till at about one o'clock the pangs of hunger become irresistible. He betakes himself to one of the many large airy restaurants furnished with balconies or shady gardens, where he can take his midday meal in the open air. Dinner is frugal and strictly kurgemass. It may consist of a course of fish, meat, or fowl, the orthodox green vegetables and cheese, with a single glass of lager beer or claret; no bread or sweets are allowed.

The afternoon is spent in strolling along the beautiful paths of the forest, or in walking through the valley to one of the gardens, where a delightful classical concert given by Labitzky's band may be enjoyed, while sipping coffee under the shade of the trees.

The evening meal is taken about seven, and consists of a bowl of bouillon or a couple of poached eggs, or some dish making an equally light repast. For those who are well enough, and who can enjoy social pleasures, there is an excellent theatre and frequent dances at the Curhaus from eight to twelve, at which visitors are expressly requested to attend en toilette de ville. Most patients, however, seek their beds at about nine o'clock, having been sufficiently tired out by this idle day of drinking water, bathing, and taking pic-nic meals to the strains of an excellent band.

The influence of this peaceful life and the strict diet enforced on the diabetic patient is quite remarkable. It is ascribed by many to the waters; but it is, I believe, a fact that these waters may be taken at home, where the patient is subjected to the usual worries, anxieties, and work of daily life, and they will not produce the same result as when taken whilst he is living a quiet, open-air life, free of care, in Carlsbad. The cure is, in fact, not only a water cure, a bath cure, and a diet cure; but a music cure, a fresh-air cure, and a laissez-aller life cure. In a very short time these beneficial influences are felt. The diabetic loses his dyspepsia, his depression of spirits, and his extreme thirst, and he gains strength and begins to feel again that life can be enjoyed.

Careful daily examinations of the urine show at the same time that the percentage of sugar steadily diminishes; in fact, in most cases of diabetes minor it will entirely disappear in the course of three or four weeks' treatment. The cure is, however, not a permanent one; it is generally necessary for the patient to return to Carlsbad every year. In fact, the remembrance of freedom from his troubles becomes, as soon as they return the following year, persuasion enough to induce him to think of another visit to the springs. Men occupying responsible and important public posts have been known to be visitors at Carlsbad for twenty, thirty, and even forty years in succession, thus preserving their health and their possibilities of public usefulness and of personal enjoyment of life, by an annual stay of three or four weeks at Carlsbad.

MARIENBAD is nineteen miles south of Carlsbad, and its waters closely resemble those of Carlsbad, excepting that they are of a much lower temperature, ranging from 43o to 50° Fahrenheit. The springs were first brought into notice in 1870 by the abbot of the convent of Tepel, and since then Marienbad has become a very fashionable resort, and is crowded in the summer with visitors. It is preferred by some to Carlsbad, owing to the fact that it is situated on a hill 2000 feet above the sea level, instead of in the defiles of a narrow valley like Carlsbad. The air is fresh, in fact at times even chilly; but the beauty of the environs, the extent and variety of the walks through the forests, and the general gaiety of the place, make Marienbad one of the favourite spas of Bohemia.

VICHY is another spa greatly resorted to by diabetics. It is eight hours by rail south of Paris, and is situated in a pleasant valley 800 feet above the sea level on the bank of the river Allier. The waters are alkaline, and contain a large amount of bicarbonate of sodium. They vary in temperature. Some are hot, others nearly cold. The waters come from immense underground reservoirs, which may be visited by passing along dark subterranean passages. The effect of drinking these alkaline waters daily, seems to be to maintain the fluids of the body in an alkaline condition, to promote oxidation and quicken tissue change, and to improve assimilation. Thus they have the opposite effects of fattening the thin and thinning the fat; the former by improving digestion, increasing assimilation, and aiding the formation of flesh; the latter by rapidly oxidising inert and unnecessary fat tissue.

The influence of Vichy waters on diabetes is often very marked. In 100 cases treated by Barthey, fifty lost all traces of sugar; in sixteen it was greatly diminished; while in thirty-four it remained stationary, although digestion was improved. Slight cases of diabetes improve greatly at Vichy, but more severe cases require protracted treatment and frequent return to the spa. The dietetic treatment is strictly enforced at Vichy, but there is much to amuse and distract the patient, and to make his period of "cure" pass pleasantly.