1. Mr. M. F., aged forty-six years, catarrhus gastricus.

The patient suffers from pressure in the region of the stomach after eating; bloating, belching, and constipation, his troubles dating from an attack of appendicitis twenty years ago. Frequent alcoholic excesses and abuse of tobacco. Recently, considerable increase of his trouble, particularly of the belching and constipation.

March 6, 1895. Aspiration of the stomach contents an hour and a quarter after a test breakfast. The material obtained consisted of mucus that had a neutral reaction. Patient was ordered to drink 300 c. c. of Rakoczy in the morning on an empty stomach.

March 9. One hour after a test breakfast an abundant quantity of bread and mucus was aspirated. Reaction faintly acid. Hydrochloric acid reaction equaled zero. No lactic acid.

March 15. Removal of the stomach contents one hour after breakfast. Hydrochloric acid reaction positive. Total acidity equaled 0.16 per cent.

April 12. Total acidity equaled 0.17 per cent. Hydrochloric acid reaction positive. Patient no longer complains of subjective distress.

2. Karl R. Gastritis chronica following alcoholic excesses.

The patient had been a soldier in the French Foreign Legion, and had indulged in alcoholic excesses. He had been in the habit of drinking 1/4 of a liter of absinthe and 5 liters of wine a day, occasionally as much as 3/4 of a liter of absinthe, and 8 liters of wine. He is at present suffering from chronic rheumatism, cirrhosis of the liver, and gastric catarrh.

October 19, 1895. Acidity, 0.13 per cent. No free hydrochloric acid; no free lactic acid.

From now on, daily, 3/10 of a liter of Homburg Elizabeth water.

October 22. 0.17 per cent. acidity. Free hydrochloric acid can be demonstrated. No lactic acid.

October 25. 0.16 per cent. acidity. Free hydrochloric acid. No lactic acid.

October 28. 0.15 per cent. acidity. Free hydrochloric acid. No lactic acid.

3. Lorenz Sch., aged twenty years; acute gastritis.

The patient is neuropathic, and has been suffering for some days from vomiting and diarrhea following the use of unripe fruit. In addition he is afflicted with great irregularity of the pulse and hyperaesthesia of the pharnyx.

September 7, 1895. Acidity, 0.09 per cent. No free hydrochloric acid. From now on daily 3-10 of a liter of Homburg water.

September 10. Acidity, 0.19 per cent. No free hydrochloric acid.

September 13. Acidity, 0.23 per cent. Free hydrochloric acid. No more vomiting. Normal bowel action.

4. Bunt, aged forty-six; gastritis following alcoholic excesses. Incipient pulmonary phthisis.

Was perfectly healthy until about three weeks ago. At that time loss of appetite, frequent vomiting, particularly after eating sweet or fat articles of food, the vomiting occurring immediately after eating. For a number of days recently vomiting of mucous, bile-stained masses in the morning before breakfast. Has been in the habit of drinking fifteen glasses of beer a day, with a liter of cider and five or six glasses of whisky.

The liver moderately enlarged; the urine free from albumin; the stomach not dilated. The gastric contents was tested with an Ewald test breakfast on December 17. Total acidity, 0.06 per cent. Hydrochloric acid deficit, 0.03 per cent. No lactic acid.

The patient received 600 c. c. of Rakoczy daily.

December 19. Acidity, 0.11 per cent. Hydrochloric acid deficit, 0.01 per cent.

December 29. Acidity, 0.06 per cent. Of this due to free hydrochloric acid, according to Mintz, 0.01 per cent.

January 3. Acidity, 0.11 per cent. Of this due to free hydrochloric acid, according to Mintz, 0.04 per cent.

As soon as the patient began to drink Rakoczy water he ceased vomiting. The appetite improved, and the size of the liver was reduced considerably.

5. F. R., aged fifty-four; gastritis following alcoholic excesses; chronic alcoholism.

Patient had previously been healthy; came to the hospital on account of swelling of the feet. Complained of poor appetite; had been in the habit of drinking ten glasses of beer and 3/4 of a liter of whisky a day.

Liver and spleen not enlarged. Urine contains a moderate amount of albumin. There is a tremor of the hands.

The gastric contents after a test breakfast was as follows :

On January 7, total acidity, 0.14 per cent. Of this, due to free hydrochloric acid, according to Mintz, 0.03 per cent.

On January 8, total acidity, 0.13 per cent. Of this, due to free hydrochloric acid, according to Mintz, 0.03 per cent.

Patient is ordered to drink 600 c. c. of Rakoczy every day on an empty stomach.

On January 11, total acidity, 0.20 per cent. Of this, due to free hydrochloric acid, according to Mintz, 0.01 per cent.

On January 14, total acidity, 0.26 per cent. Of this due to free hydrochloric acid, according to Mintz, 0.14 per cent.

The appetite is restored; patient has gained 2.4 kilos in eight days.

6. C. R., aged 60 years; subacute gastritis.

Complains of a feeling of pressure in the gastric region after eating. This has persisted for five days. The appetite is poor; has been in the habit of drinking from three to four glasses of beer and twelve pfennigs' worth of schnapps a day.

The liver is not enlarged; the urine contains a moderate amount of albumin; there is a tremor of the hands.

Examination of the gastric contents with Ewald's test breakfast.

On January 6, 1896, total acidity, 0.08 per cent. Free hydrochloric acid, zero; lactic acid, zero.

The patient is ordered to drink 600 c. c. of Rakoczy every day on an empty stomach.

On January 11, 1896, total acidity, 0.19 per cent. Free hydrochloric acid, according to Mintz, 0.07 per cent.

The appetite is restored, the urine is free from albumin, and the patient by his own request is dismissed.

7. J. H., aged 32 years; gastritis following alcoholic excesses; cirrhosis of the liver.

The patient was never sick before. Had been in the habit for the last few years of drinking from ten to twenty glasses of beer a day and from twenty to twenty-eight pfennigs' worth of schnapps. Complains of loss of appetite.

The stomach is not enlarged, nor sensitive to pressure. The liver is hard, enlarged, and sensitive to pressure. Arterio-sclerosis.

Examination of gastric contents with an Ewald's test breakfast gives the following results :

On December 22, total acidity, 0.12 per cent. Free 25 hydrochloric acid, zero; lactic acid, zero. The patient is ordered to drink 400 c. c. of Rakoczy a day.

December 28. Total acidity, 0.21 per cent. Free hydrochloric acid, according to Mintz, 0.08 per cent.

December 30. Total acidity, 0.19 per cent. Free hydrochloric acid, according to Mintz, 0.02 per cent.

January 3, 1896. Total acidity, 0.19 per cent. Free hydrochloric acid, according to Mintz, 0.02 per cent.

January 8. Total acidity, 0.19 per cent. Free hydrochloric acid, according to Mintz, 0.07 per cent.

The appetite is restored; the liver is decreased in size by at least two cm., and is less sensitive to pressure than before.

In addition to the cases reported above, numerous other cases of acute and chronic gastritis have been reported in the meantime, in which the condition of subacidity that existed in the beginning disappeared under the prolonged use of saline mineral waters (Kissingen and Homburg), while at the same time the digestive disturbances of the patient also improved. The results were particularly favorable in those forms of gastric catarrh that followed alcoholic excesses and the immoderate use of tobacco. Equally favorable results were obtained in a few cases of phthisis and in patients suffering from icterus due to biliary stasis. In all of these disorders it has been known empirically for some time that saline waters are a proper remedy.

Whereas many of the results were exceedingly favorable, we must not conceal the fact that occasionally bad results or no results at all were obtained.

Cases of anacidity and subacidity that were of nervous origin proved to be particularly obstinate. The subjective disturbances of the patients, it is true, seemed to improve under the continued use of saline mineral waters, and it was often possible to increase the weight of the patients considerably when sufficient nourishment was administered, but in no case was an increase of the acidity obtained. The same negative result was obtained in a number of cases of phthisis with fever. All that we succeeded in doing in such cases was to improve the appetite by the use of saline waters, but we did not succeed in increasing the production of hydrochloric acid. Nevertheless, the increase of the appetite itself had to be considered a therapeutic result of some value. In a few cases of phthisis the hydrochloric acid secretion improved together with the appetite.

The following case cannot be included in the above category, for in this patient all the symptoms improved with Homburg water, while at the same time hyperacidity developed; as this hyperacidity had not existed before, the excessive secretion of hydrochloric acid became an indication for interrupting the use of the mineral water.

8. Mr. L. H., aged thirty-two years; nervous dyspepsia.

Ten years ago tuberculosis of the apices of the lungs. Recovery. In 1887 the patient developed frequent gastric disturbances and intolerance for alcohol. Severe "after-jag" (Katzenjammer), with vomiting of bile, even after a slight alcoholic excess. Much nausea, pain on pressure, and spasmodic contractions in the region of the stomach. Recently the symptoms have become aggravated after a period of relative improvement.

Dilatation of the stomach cannot be determined positively, but a very large quantity of stomach contents can be aspirated through the stomach pump. The amount of stomach contents is larger after a test breakfast than the test breakfast itself.

July 20, 1895. Acidity, 0.19 per cent.; hydrochloric acid reaction negative; no lactic acid. The patient is ordered to take 400 c. c. of Homburg Elizabeth water in the morning.

On July 30, 1895, acidity, 0.22 per cent.; hydrochloric acid reaction positive.

On August 9, 1895, acidity, 0.31 per cent.; hydrochloric acid reaction very positive.

The patient's symptoms are very much less severe. In view of the increase in the hydrochloric acid secretion, the use of Homburg water was stopped, and the patient was treated by dietetic regulations thereafter.