II. On The Effect Of Saline Mineral Waters. Part 4

Similar conditions were observed in the second patient, who was suffering from typical gout. He had suffered a number of severe gouty attacks in the spring of 1900, and had lost much strength, partly as the result of the attacks themselves, and partly because he had imposed certain rigid dietary restrictions upon himself. Whereas he weighed about 80 kilos in the winter preceding these attacks, he now only weighed 66.5 kilos. An analysis of the stomach contents revealed a considerable degree of hyperacidity (acidity, 0.38 per cent.; free hydrochloric acid, 0.24 per cent.). At the time when this analysis was performed, one of the joints of his foot was still in a condition of gouty swelling. He was placed upon a diet containing 3/10 of a liter of cream, with 30 per cent. of fat; 200 grams of butter, 6 eggs, and Graham bread, dishes made from flour, plenty of vegetables and fruit, and once a day an abundance of meat of any kind (with the exclusion of internal organs). In addition, he received 400 c. c. of Homburg Elizabeth water in the morning on an empty stomach, and in the evening before retiring 3 grams of sodium bicarbonate, dissolved in 200 c. c. of Seltzer water. The eggs, cream, and butter contained about 280 grams of fat. The fat contained in the other articles of diet was not determined, but amounted to at least 20 grams, so that the patient approximately consumed 300 grams of fat a day. The faeces deposited during the next four days contained 24.4 grams of ethereal extract, so that every 300 grams of fat contained in the diet deposited an average of 6.1 grams only of fat in the faeces a day, amounting to 2.03 per cent. This sum, it will be seen, is far below the normal average. At the end of three weeks the patient had gained 6.2 kilos; the gastric contents examined three-quarters of an hour after a test breakfast showed an acidity of 0.26 per cent. The gouty swelling that at the beginning of the treatment was already in a retrogressive stage had completely disappeared, and no trace of it had remained. In the three years and a half that have intervened since that time, the patient suffered only one mild gouty relapse.

Finally, we desire to report the case of a patient with diabetes mellitus. In this disease it is important to give as much fat as possible with the diet, particularly if the carbohydrates must be much reduced. If it were true that fat and saline mineral waters cannot be taken together, then the latter should be excluded from the dietary of diabetics. We can hardly refrain from concluding that many patients afflicted with severe forms of glycosuria are rendered weaker by a sojourn at one of the watering places simply because so many of the attending physicians exclude fat from the diet or at least reduce it considerably. In general, there is not the slightest reason for doing this, and in case a patient should really be found now and then in whom the saline water and a diet containing much fat do not seem to agree, then a conscientious physician should certainly reason that the fat is much more important for the patient than the particular saline water of the watering place.

In our investigation we intentionally, for the sake of the experiment, created extreme conditions, that is, we gave abnormally large amounts of fat with unusually large amounts of mineral water. The patient suffered from a mild degree of glycosuria. He reported a gouty history, and as a result of poor care and food at home was very much reduced. The goal that we aimed at was to give this patient an abundant diet, and in this way to attempt to give him strength. This goal was reached, for the patient who entered the hospital in a miserable condition was dismissed at the expiration of a few weeks, fully capable of performing his work and earning his living. His daily diet consisted, on an average, of 400 grams of Rademann's "Erdnussbrod"; 140 grams of eggs; 120 grams of butter; 60 grams of cheese; 250 grams of beef; 20 grams of lard; 50 grams of bacon; 150 grams of sauerkraut; 200 grams of sausage; 30 grams of dried cabbage, (prepared with meat broth and bacon); 700 c. c. of coffee; 650 c. c. of meat broth, and 400 c. c. of beer. The food was carefully analyzed. The following table shows the utilization of this food, with and without the addition of Homburg Elizabeth water.

The general health of this patient was excellent throughout the time he was taking the mineral water, and his appetite splendid. He had a movement of the bowels from one to three times a day, the stools being of a pultaceous consistency. As will be seen from the table, the absorption of the food was in no way impaired by the enormous quantities of saline water that the patient drank. This was the more remarkable because in this instance the absorption of fat was less favorable from the beginning than is ordinarily the case. According to the statement made by Von Noorden in his text-book, only about 6 per cent. of the large quantities of ingested fat should properly reappear in the faeces. In this particular case 8.6 per cent. appeared in the stools, even before Homburg water was administered. This loss of fat was slightly increased when 600 c. c. of Homburg water were taken, although the increase was so small that it was almost a negligible quantity. Later, even though the amount of water was increased, the loss of fat as compared with the amount of fat ingested decreased again. We are inclined to attach no importance whatever to these fluctuations, for they occur within the same boundaries in any healthy subject. We attach particular importance, however, to the main result of this study, namely, that no marked decrease in the assimilation of fat occurred, despite the simultaneous administration of maximum quantities of fat and mineral water together.

In order to test the effect of other mineral waters and salt mixtures on the absorption of fat, we performed another investigation with Carlsbad Sprudel salt. This investigation was published some time ago. The daily diet in this case consisted of 400 grams of chopped beef, 150 grams of white bread, 400 grams of potato, 125 grams of butter, 500 c. c. of coffee, and 1500 c. c. of beer.