Mean of six mineral-water days (600 c.c. of mineral water added to same food). The pulse was little affected by the water; the respirations were invariably lessened in number. It will be observed that, during the normal days, the excretions in all the persons surpassed the ingesta,-the body lost weight; but during the use of the mineral water, the loss of weight was less in two, and was changed into increase of weight in one, from retention of water. What was the cause of the action of this spring on the solids of the urine? The temperature of the water, 17°-8 Reau. (72° Fah.), cannot have had much effect, if Mosler's investigations on simple water can be relied on. The water itself may be supposed to have some influence, but its quantity was not great. Was it, then, the mineral ingredients which caused the increased excretion of solids? We have seen that chloride of sodium has little effect; and yet chloride of sodium is the chief ingredient in the Nauheim spring. Are the other salts more efficacious, or do they add to the effect of the chloride? Or is it a conjoint effect of temperature, water, exercise, chloride of sodium, and the other ingredients, such as the bicarbonate of lime, the chloride of calcium, or the free carbonic acid? No answer can be given to this question till each agent has been investigated singly. Whatever may be the ultimate answer to this inquiry, Beneke's facts seem sufficient to prove that the action of this water is as above described, and that it may be a possible curative agent. The desire for food was not, or very little, increased by its use, as in the case of many mineral waters.1 When the bath of Nauheim water was combined with the internal use of the water, it was found that the intestinal Each of the three experimenters took, in the twenty-four hours, as much solid food as they liked, restricting themselves to 2400 grammes of fluid. The solids taken excretions, the skin and lung excretion, and the urine, were all increased; the increase was not always greater than when the mineral water was taken without the bath; when it was greater, as sometimes occurred, this arose from increased kidney excretion. The increased excretion occurred during the day, i. e., in the hours immediately following the use of the agent, while, during the night, there was compensatory lessening of excretion. As in the former case, water was retained in the system, but in less quantity than with the mineral water alone. As in all former experiments, individual peculiarities determined whether the increased elimination affected most the kidneys or the skin and lungs. The urea and the SO, of the urine were increased equally as in the drinking experiments, in two cases; more so in the third case. The phosphoric and uric acids were little altered. All the chloride was not eliminated, but a little was retained in the system; so that here an important difference arises between the internal use of the mineral water per se, and with the bath. Did the bath lessen the exit of chloride by the skin? The pulse was lessened in frequency, as by the bath alone, and the respiration was also lessened. The desire for food was greater; and more being allowed, the body, in spite of the augmented disintegration and elimination, increased in weight. The chief modification introduced by the bath was a greater diuretic effect. Vichy waters.-The extensive use of the waters of Vichy, and their acknowledged beneficial effects, would have led, we should have supposed, to a thorough examination of the condition of the urinary ingredients. But this has not yet been properly done. The Vichy waters render the urine alkaline. According to Petit, two glasses (containing 2 grammes of bicarbonate of soda) alkalinize the urine, and this continues for seven hours; three glasses make the urine alkaline for twenty-four hours; and five glasses in twenty-four hours (= 5 grammes, or 77 grains, of bicarbonate), with bathing, keep it permanently alkaline. Probably, however, great individual variations occur. Petit affirms that the perspiration is also alkaline. The Friedrickshall waters.-Mosler has lately contributed an elaborate paper on this subject. The Friedrickshall waters contain, in 16 ounces, 46 grains of NaOSO, 39.5 grains of MgOSO, 10 grains of CaOSO,, 61 grains of NaCl, 30 grains of MgCl, a little carbonate of magnesia, and insignificant quantities of other ingredients. Mosler's researches show the effect of different quantities on the body-weight, the intestinal 1 Du mode d'action des Eaux Min. de Vichy. Paris, 1851. 2 Archiv für wiss. Heilk., 1860, Band v, p. 1. excretions, and the water, urea, SO3, NaCl, and uric acid of the urine. The experiments were conducted on two healthy males and one rather unhealthy female, and extend over periods of twenty-seven or thirty-six days, viz., eight or nine days before the use of the water, nine or eighteen during, and nine afterwards. The general results of the first two cases were these: 1. The weight of the body was not materially altered. 2. The intestinal excretions were generally augmented, and in some cases, when the amount of water was large, they were greatly so (from a mean of 160 to 190 grammes, in twentyfour hours, to 500 to 646 grammes). Food had an influence on this if the water was taken before food, the fæces were augmented; if after food, this was not the case, or so in a less degree. It was undetermined whether the augmentation was due to increase in the solids of the fæces, or merely to liquid. 3. If the fæces were not increased, or if the amount of water drunk was very large, the quantity of urine was augmented; and it was so in proportion to the water drunk, and inversely to the amount of intestinal discharge. The urea was decidedly, though slightly, increased when the bowels were not acted upon; and Mosler concludes that "the increase of urea rose and fell in inverse proportion to the action of the water on the intestines." In this case, indeed, the antagonism of the bowels and kidneys, as regards urea, is clearly brought out, just as we have seen, in other instances, the antagonism of the skin and kidneys. The amount of increase in the urea was not great (about 6 to 8 per cent.). The chlorine and sulphuric acid were, of course, increased, as so much was introduced with the drink, and comparatively little can have passed off by the stools, even when the action of the water was chiefly on the bowels. The uric acid, in one series of experiments, was lessened; but the experiment requires repetition. The pulse, respirations, and temperature were unaltered by the water. In the third case given by Mosler (a woman, not perfectly well), the water was given in large quantities (1000 grammes per diem); the fæces were augmented from 205 to 1169 grammes (mean of nine days); the quantity of urine was also augmented one third; the urea was not determined. The bodyweight, in spite of the diarrhoea, increased, for the appetite improved, and unlimited food was allowed.1 1 Mosler has also less carefully examined the effect of the water in many diseases. He found it particularly useful in uterine engorgements and in chronic lung affections. It is evidently a powerful eliminative. The use of the chalybeate mineral waters need not detain us. Nothing is known, except they add iron to the blood, and have a general tonic effect. The effect of the sulphur waters has, unfortunately, not yet been properly traced out, and it seems undesirable to allude to statements not based on accurate modes of observation.1 2. Metals and their Preparations. Antimony emerges in part or altogether by the kidneys; its mode of combination is uncertain, and the rate at which it passes out is also unknown. Two preparations only of antimony have been yet examined. The effect of tartar emetic has been investigated by Böcker,2 Beigel, and Ackermann.4 Böcker took, in nine days, 23:46 grains (= 2.6 grains daily). The appetite was greatly diminished (one third), and this probably accounted for the fact that, with the exception of the water, which was slightly increased, all the urinary constituents were lessened; thus: The solids were lessened by 7·169 grammes in each 24 hours. Urea Uric acid Fireproof salts 4.874 Volatile salts and extract 2.307 The only alteration of importance was, therefore, in the urea; and Böcker's experiments leave it undetermined, whether there was actual lessening of metamorphosis, or retention, from the effect on the heart or the nervous system, or whether the impaired digestion would account for the diminution. The CO2 of the lungs was found to be increased. 2 Beigel's experiments were made on two men, who took in each twenty-four hours 2 grains of tartar emetic, during four days. Great nausea was caused, and probably there was loss of appetite, though nothing is said on this point. The urine was sometimes increased, sometimes lessened in quantity; the urea was invariably decreased (by about 5 grammes in each 1 Considering the very extensive use of mineral waters, and their undoubted utility, it is very surprising that so little has been hitherto done to trace out their effects on the excretions. The observations of Genth, Beneke, and Mosler, however, promise well for the future; and if any one has opportunity to pursue this inquiry, I would strongly recommend him to follow the method Beneke has adopted in his treatise on Nauheim. 2 Beitrage zur Heilk., 1849, vol. ii, p. 324. 3 Untersuch. über die Harn. und Harnstoffmengen von H. Beigel (Aus "Nova Acta," &c., besonders abgedruckt). Wien, 1856, p. 49. 4 Zeitschrift für rat. Med., Band ii, p. 241. See a review by the Author in the Brit. and For. Med.-Chir. Rev., April, 1859. twenty-four hours). Beigel attributes this to the tartar emetic, and not to the want of food; but this opinion may be questioned, and, on the whole, Beigel's experiments do not seem entitled to much weight, as the conditions of the experiments are imperfectly given. Ackermann's experiments are quite at issue with the above. From a very careful series of observations, he found that 1. Tartar emetic augmented the "insensible perspiration" (skin and lungs) greatly (by half, or, other cases doubled, or even more than doubled). This was, no doubt, partly owing to the skin, but perhaps also to augmented pulmonary CO, as Böcker found this to be increased. 2. The stomach and intestinal secretions were increased, and there was often vomiting and purging. 3. The urinary water and the chloride of sodium were lessened, no doubt from an increased passage by the skin and bowels. The urea, however, was greatly augmented, and apparently in accordance with the dose of the medicine; the pigment and uric acid were also, but less constantly and less largely, increased. It is not yet evident whether the ureal increase was owing to augmented elimination or augmented formation. Ackermann's analyses are not numerous enough, nor repeated at sufficiently short periods, to prove this. But of the increase there seems no doubt. Tartar emetic is, therefore, an eliminator of urea, even if it does not increase its formation. The effect of the golden sulphuret of antimony has been examined by Böcker. All the constituents of the urine were increased, as shown in the following table, in which the mean results are given: In each twenty-four hours, in grammes. |