II. On The Effect Of Saline Mineral Waters. Part 2

1. Mr. von K.

a. (Without water.) The stomach contents very small, containing distinct remnants of bread; a thick layer of fat forms at the top of the aspirated material. Acidity, 0.33 per cent. Free hydrochloric acid, 0.20 per cent.

b. (With water.) The stomach found completely empty.

c. (Without water.) The result of the examination of the stomach contents the same as in a. Acidity, 0.31 per cent. Hydrochloric acid reaction was strong; free hydrochloric acid not determined quantitatively.

d. (With water.) The stomach found completely empty.

In the second and third cases the stomach was found completely empty after each aspiration performed one hour after the test breakfast. These two observations teach us, at least, that the use of the saline mineral waters does not impair gastric digestion, despite the administration at the same time of abundant quantities of fat, and that the simultaneous administration of water and fat at all events does not interfere with the normal propulsion onward of the food from the stomach. In the first case it could even be positively demonstrated that the motility of the stomach was improved by the administration of mineral water before the test breakfast.

The second method by which we can determine the effect of eating fat together with a saline drinking cure is to study fat digestion experimentally. In this way it can be definitely determined whether the eating of fat is harmful or not. We considered it the proper method to subject the total digestive powers of the whole digestive tract to examination, that is, to examine the faeces while at the same time taking into consideration the composition of the diet. In case such determinations of the assimilative powers of the digestive tract of these patients are coupled with a study of the general health of the individual, they are certainly of decided value. If one should find, for instance, that the absorption of fat proceeds in a faultless manner, while at the same time the patient suffers no distress and enjoys general well-being, then no one can be justified in advancing any further objections to the administration of fat together with saline waters.

Older metabolic experiments performed many years ago in patients who were drinking saline or bitter waters yield very little information that can be utilized to elucidate the above inquiry. This is due to the fact that no quantitative determinations of the constituents of the faeces were ever undertaken, that the nitrogen of the faeces was never determined, and above all that no fat analyses of the stools were made. The earliest determination that we can utilize at all was performed by von Noorden. We communicate the main results of this study in this place in brief outline.

The patient was a woman of fifty years, suffering from an advanced degree of habitual constipation. From April 15 to 17, 1890, she was given a diet that consisted of white bread, scraped meat, milk, butter, and salt. Each day she received 77 grams of fat (according to a careful analysis of the food). In addition she drank every morning 350 c. c. of Hunyadi water on an empty stomach. Her general health remained unimpaired, while the evacuation of the bowels proceeded with greater facility, although there was still some constipation. The faeces contained 2.98 grams of fat a day, corresponding to 3.87 per cent. of the ingested fat. The absorption of fat was consequently excellent. It may be well to mention in this place that the results of this experiment first induced us to carry on our investigations further. The experiment that we have just recorded is of particular importance, because it was carried out in a patient suffering from a condition in which saline laxatives are frequently administered for therapeutic purposes.

Later another metabolic experiment that we can utilize for our purposes was published by J. Katz, the experiment being instigated by von Noorden. In view of the scanty material that is at our disposal in this field, this investigation is of considerable value, even though it was performed in a healthy individual (viz., on the investigator himself). We are fully aware of the fact that it is a precarious matter to apply the results obtained in a healthy individual to a sick individual, and to transfer conclusions from the reaction of the healthy body to the reaction of the diseased body.

The analyses in this very exact series of investigations were performed in the laboratory of N. Zuntz, under the personal supervision of this investigator. The task set was to study the effect of Harzburg Crodo water on metabolic processes. This water contains 14.9 grams of sodium chloride to the liter. The other ingredients in this water are insignificant in quantity as compared to its content of sodium chloride. The daily diet (meat, white bread, rice, butter, milk, beer, sugar, salt, tea) contained: 17.14 grams of N.; 125 grams of fat; 311 grams carbohydrates.

It will be seen from this table that neither the absorption of the nitrogenous constituents of the diet nor the absorption of the large quantities of fat contained in the diet were reduced, although Katz drank quantities of the mineral water that were larger than those ordinarily prescribed in practice.

We can add two other investigations to these experiments in healthy individuals, as follows: The first is an experiment on one of the authors; the second is an experiment performed on our laboratory servant, S.

Experiment On C. Dapper

Experiment On S

It may be well to mention in connection with this report that in Dapper's case (the subject being perfectly healthy) an endeavor was made at the same time to reduce fat, and that in the course of the nineteen days of the investigation a loss of 3.5 kilos was brought about. It will be seen clearly from the table that in spite of the enormous consumption of Rakoczy and Kissingen Bitter waters, despite the energetic action of the bowels that was brought about by the use of these waters, and despite the enormous consumption of fat that greatly exceeded the customary quantities eaten here in Germany, the food was exceedingly well assimilated. The fluctuations observed on the different days on which water was taken and water was not taken lie strictly within the boundaries that are observed in healthy subjects on different days, when they are living on a similar dietary.