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 LIBRARY OF CONGRESS. 
 
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 UNITED STATES OF AMERICA. 
 
THE 
 
 Action, Therapeutic Value and Use 
 
 Carlsbad Sprudel Salt 
 
 (POWDER FORxM) 
 
 AND ITS RELATION TO THE 
 
 CARLSBAD THERMAL WATER 
 
 Dr. W. JAWORSKI, 
 
 DEMONSTRATOR AT THE UNIVERSITY OF KRAKOW. 
 
 CLINICAL EXPERIMENTAL RESEARCHES MADE AT THE UNIVERSITY CLINIC OF 
 PROF. KORCZYNSKI IN KRAKOW. 
 
 H 1 C T A D V zjPYRIGHT ^ 
 
 u i c i n r\ I pr 16 1891 
 
 \ ^WiMSTO^' 
 
 BY THE TRANSLATOR, ^-^_ '« ' 
 
 v: L. A.., 
 
 TOBOLDT, M.D., 
 
 ASSISTANT DEMONSTRATOR OF PHARMACY, UNIVERSITY OF PENNSYLVANIA; 
 EDITOR JOURNAL OF BALNEOLOGY AND MEDICAL CLIPPINGS, ETC. 
 
 PHILADELPHIA: 
 
 P. BLAKISTON, SON & CO 
 
 IOI2 WALNUT STREET. 
 , 1891. 
 

 -#> 
 
 Copyrighted, 1 891, by A. L. A. Toboldt, M. D. 
 
 WM. F. FELL & CO., 
 
 ELECTROTYPERS AND PRINTERS, 
 
 I220-24 Sansom Street, 
 
 PHILADELPHIA. 
 
PREFACE. 
 
 The increasing interest manifested in this country in natural mineral 
 waters and in products derived therefrom, coupled with the almost total 
 lack of really scientific research in this branch of medicine, have been the 
 incentives that have led to the translation of this work from the German 
 of the renowned balneologist, Dr. W. Jaworski. 
 
 As the Carlsbad Thermal Waters have for over 200 years held such a 
 prominent place in the treatment of disease in Europe, and as American 
 physicians are becoming more and more impressed with the importance of 
 making themselves familiar with the therapeutic value of these as well as 
 other mineral springs, a systematic and scientific treatise, together with care- 
 fully tabulated experiments, must of necessity prove acceptable. 
 
 Works without number have preceded the present one, and very many of 
 them have been carefully examined by the translator. Dr. W. Jaworski has 
 improved on his predecessors in not contenting himself with experiments on 
 animals, but has himself made a long series of most careful clinical experi- 
 ments on human subjects. His researches are therefore entitled to much 
 greater weight and consideration than those previously recorded. 
 
 THE TRANSLATOR. 
 
CONTENTS. 
 
 PACE 
 
 Section i. Preface, 9 
 
 I— EXPERIMENTS TO DETERMINE THE INFLUENCE OF CARLSBAD SPRUDEL 
 SALT ON THE APPEARANCE OF THE STOOLS. 
 
 Section 2. Annotation of Experiments, 12 
 
 Experimental Series I, 13 
 
 Section 3. Grouping of the Results from Experimental Series I, .... 22 
 
 Section 4. Special Experiments made to Determine the .Nature of the 
 
 Evacuations under the Influence of the Sprudel Salt, . . 26 
 
 Section 5. Resume of the Effect on the Evacuation of the Bowels after 
 
 the Administration of Sprudel Salt, 28 
 
 Section 6. The Action of the Solution of Sprudel Salt Administered by 
 
 the Rectum, 29 
 
 Section 7. Resume of the Action of the Sprudel Salt used by Injection 
 
 per Anum, 31 
 
 II-EXPERIMENTS MADE WITH CARLSBAD SPRUDEL SALT (POWDER FORM) 
 ON THE FUNCTIONS OF THE STOMACH. 
 
 Section 8. Description of the Method of Experimenting, ....... 32 
 
 Table of Experiments. 
 Section 9. Deductions from the Table of Experiments, 50 
 
 Section 10. The Effect of Additional Doses of Sprudel Salt upon the 
 
 Functions of the Stomach, 57 
 
 Section ii. Changes in the Entire Gastro- Intestinal Functions after Con- 
 tinued Use of the Sprudel Salt 58 
 
 Section 12. The Total Result of the Influence of Sprudel Salt on the 
 
 Entire Gastro-Intestinal Function, 64 
 
 III— CLINICAL DEDUCTIONS BASED UPON THE EXPERIMENTS MADE. 
 
 Section 13. The Restrictions and Contra-Indications in the Use of the 
 
 Carlsbad Sprudel Salt, 67 
 
 Section 14. Indications for the Use of Sprudel Salt, 69 
 
 vii 
 
Vlll CONTENTS. 
 
 MODE OF USE OF THE SPRUDEL SALT (POWDER FORM). 
 
 PAGE 
 
 Section 15. Application of the Sprudel Salt by the Mouth, 73 
 
 Section 16. The Dietetic Regime During a Treatment with Sprudel Salt, 75 
 
 Section 17. Use of the Sprudel Salt in Washing out the Stomach — Appa- 
 ratus for Gastric Irrigation and Aspiration, 77 
 
 Section iS. Use of the Sprudel Salt per Rectum S3 
 
 Section 19. Length of Time and Directing of the Sprudel Salt Treatment, 84 
 
 Concluding Remarks, 86 
 
 APPENDIX. 
 
 Section 20. The Relation of the Sprudel Salt to the Carlsbad Thermal 
 
 Waters, 87 
 
 Section 21. The Action of the Thermal Water and Sprudel Salt when- 
 used Jointly, 90 
 
 Section 22. Experiments to Determine the Influence of Exercise upon the 
 Behavior of the Thermal Water and Sprudel Salt Solution 
 in the Stomach, 92 
 
 Dietary, 95 
 
THE 
 
 ACTION, THERAPEUTIC VALUE AND USE 
 
 OF THE 
 
 CARLSBAD SPRUDEL SALT 
 
 (POWDER FORM), 
 
 AND 
 
 ITS RELATION TO THE CARLSBAD THERMAL WATER. 
 
 SECTION I. 
 
 PREFACE. 
 
 Already in a work entitled " Keyserlichen Baad-Medici," by Strobel- 
 b>erger, published in 1630, a remedy is mentioned by the name " unser 
 warmes Baadsalz," which was added to the Carlsbad Thermal Waters to 
 promote the action of the bowels. The chemical composition of this salt 
 cannot be positively determined, as the manner in which it was prepared is 
 not given. It is only in the inaugural dissertation of Friedrich Hoffman 
 (1734), that mention is made of the fact that in the preparation of the salt 
 the Sprudelwasser was evaporated, filtered, cooled and allowed to crystallize.. 
 The remaining mother-liquor was repeatedly evaporated and cooled until no 
 more crystals were obtained. At that time the salt was obtained only in 
 small quantities. The " Brunnensalz " was obtained in larger quantities in 
 1764, and at the suggestion of the experienced and very astute Carlsbad 
 physician, Dr. Becher, prepared in an essentially modified manner. 
 
 The natural heat of the spring was utilized and the water of the Sprudel 
 evaporated on the spot, and thereby several crystallizations obtained. The 
 crystals thus obtained were repeatedly redissolved in ordinary water, and 
 again crystallized until they ceased to react alkaline. This " Brunnensalz " 
 
 9 
 
IO THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 of Becher was therefore pure Glauber's salt. This mode of preparation was 
 not adhered to so strictly later on, and the purification was not carried so 
 far as Becher had carried it, or the same was omitted entirely ; thus it came 
 that until quite recently a product was brought into the market that was 
 either pure Glauber's salt or else contained small quantities of sodium car- 
 bonate and sodium chloride amounting in the most favorable cases to only a 
 few per cent. And it remains a puzzle why this coarsely crystallized salt, 
 which appeared, until recently, in four-cornered bottles under the name of 
 " Sprudelsalz," should for more than one hundred years be preferred to the 
 cheaper, ordinary Glauber's salt. 
 
 After the chemist Gottl, in 1870, succeeded in conducting the Sprudel 
 water, without changing its composition and without clogging the pipes, 
 to any desirable distance, a very large and commodious municipal building 
 was erected for the preparation of the Carlsbad salt in 18 78-1 8 79. It was 
 as late as 1880, however, that the city council of Carlsbad decided, at a 
 meeting specially convened for the purpose, to obtain a product which, in 
 its composition, would be as near identical with that of the Sprudel water 
 as possible. According to the findings and works of Prof. Ludwig (Ueber 
 das Sprudelsalz, Wr. Med. Blatter, 1881, No. 1 bis 5) it was shown that 
 such a product could be obtained by partly evaporating and filtering the 
 Sprudel water ; the filtrate to be evaporated almost to dryness and exposed 
 to the action of the carbonic acid gas. According to these directions a new 
 Carlsbad product has been produced, for the past four years, in the muni- 
 cipal establishment, under the exemplary direction of the city chemist, Dr. 
 Sipocz, whose well-known scientific and technical training and researches 
 afford a guarantee for the accurate and scientific accomplishment. The 
 mode of procedure is as follows : The Sprudel water is boiled, the sediment 
 formed is removed by filtration, the filtrate is evaporated until a salt is ob- 
 tained which still contains a certain per cent, of water, whereupon it is 
 exposed to the action of the carbonic acid of the Sprudel spring itself, until 
 it becomes saturated. The product thus obtained forms a white, finely 
 crystalline powder, which is sent out into commerce in cylindrical bottles 
 under the name of " Natiirliches Karlsbader Sprudelsalz (pulver form)." 
 The chemical composition of the same, according to repeated analyses of 
 Dr. Sipocz, is as follows: — 
 
 Sodium sulphate, 43- 2 5 P er cent. 
 
 Sodium hydrocarbonate, 36.29 " 
 
 Sodium chloride, 1 6.8 1 " 
 
 Potassium sulphate, 3.06 " 
 
 Lithium hydrocarbonate, 0.39 " 
 
 Sodium fluorate, 0.09 " 
 
 Sodium borate, 0.07 " 
 
 Silicic acid anhydride, 0.03 " 
 
 Iron oxide, 0.01 •' 
 
PREFACE. I I 
 
 I have myself repeatedly analyzed the Sprudel Salt as found in com- 
 merce, and found the quantitative deviations of the main constituents to 
 vary at the most but 2 per cent. I found, for instance, by trituration with 
 normal HCl, the percentage of sodium bicarbonate to be 33.5 per cent, to 
 36.0 per cent. ; with barium chloride the percentage of sodium sulphate 46.0 
 per cent, to 47.5 per cent.; with silver nitrate the percentage of sodium 
 chloride 16.0 per cent, to 17.0 per cent. I have also always found the 
 desired result, based on analysis by weight, that all carbonates exist as acid 
 salts in the Sprudel Salt (powder form), which goes to prove that the same 
 has been prepared conscientiously and carefully. The natural Carlsbad 
 Sprudel Salt (powder form) therefore contains, with the exception of the 
 silicic acid, aluminium oxide and the carbonates of calcium, magnesium, of 
 iron and manganese, all of the soluble constituents of the Sprudel water, in 
 the same combinations and quantitative relation in which they exist in the 
 Sprudel water. I will treat later on in the chapter on the relation of the 
 Sprudel Salt (powder form) to the Sprudel water. According to its chemical 
 composition, the Sprudel Salt (powder form) is therefore a very desirable 
 saline medicine, and it remains incomprehensible why, in the practice of 
 some physicians, the crystalline should still be preferred to the Sprudel Salt 
 (powder form), so that, at present, more must still be made of the former 
 than of the latter. Inasmuch as I had found slight variations in the chemical 
 composition of the Sprudel Salt, variations that were unavoidable, it became 
 a matter of importance to me to obtain a homogeneous product of identical 
 chemical composition for my clinical experiments. To obtain such a one I 
 applied direct to Dr. Sipocz, director of the municipal works, who, with the 
 obliging consent of the Mayor, Herr E. Knoll, not only placed such a one at 
 my disposal, but instituted a special quantitative analysis of the same. Ac- 
 cording to the analysis, the preparation used in my experiments was found to 
 be of the following composition in relation to the main constituents : Sul- 
 phates, calculated as sodium sulphate, 46.56 per cent.; sodium chloride, 
 17.45 per cent. ; sodium hydrocarbonate, 35.70 per cent. 
 
 According to the analysis of Prof. Ludwig and Prof. J. Mauthner, the 
 dry residue for the Sprudel water was calculated as being 5.5168 grm. per 
 litre. As during the evaporation the silicic acid, the carbonates of man- 
 ganese, iron, calcium and magnesium are separated as an insoluble residue, 
 4.9527 grm. soluble constituents remain in Sprudel water which forms a cor- 
 responding quantity of Sprudel Salt (powder form). This quantity of Spru- 
 del Salt dissolved in one litre of distilled water was to furnish one litre of 
 artificial Sprudel water, without the above mentioned precipitated insoluble 
 combinations. With the Sprudel Salt of the above composition I have in- 
 stituted a series of experiments on the clinical patients of the medical clinic 
 of Prof. Korczynski, in Cracow. The same afforded information on the 
 following points : — 
 
 1. At what time after the ingestion of the Sprudel Salt (powder form), 
 
12 THE ACTION" OF CARLSBAD SPRUDEL SALT. 
 
 in what number and with what accompanying phenomena do the stools 
 appear ? 
 
 2. What is the nature of the succeeding stools ? 
 
 3. What change do the several constituents of the Sprudel Salt expe- 
 rience in the intestinal canal ? 
 
 4. What doses, what concentration, and temperature of the Sprudel 
 Salt solution are the most proper to act upon the intestine with as much 
 energy as possible ? 
 
 5. What is the action of the Sprudel Salt solution when introduced in 
 the rectum ? 
 
 6. In what manner is the acid gastric secretion influenced by the Spru- 
 del Salt when taken once and when continued for a longer time ? 
 
 7. What influence does it exert upon the digestive ferment and the 
 digestive power of the gastric juice ? 
 
 S. What is the condition of the mechanical capability of the stomach 
 after continued use of the Sprudel Salt? 
 
 9. Is the action of the Sprudel Salt identical in healthy and diseased 
 conditions ? 
 
 10. May the action of the Sprudel Salt, after absorption, be observed 
 on other"organs than the stomach and intestinal canal? 
 
 11. In what relation does the Sprudel Salt stand to the Carlsbad water, 
 /. e. , is their action upon the stomach and intestinal functions identical? 
 
 I.— EXPERIMENTS TO DETERMINE THE INFLUENCE 
 
 OF THE CARLSBAD SPRUDEL SALT ON THE 
 
 APPEARANCE OF THE STOOLS. 
 
 SECTION II. 
 
 ANNOTATION OF EXPERIMENTS. 
 
 These experiments were performed in the following way : — 
 The persons experimented upon took early, fasting, one or more nor- 
 mal doses of Carlsbad Sprudel Salt at intervals of f£ to j4 an hour. There- 
 upon the time when the first and the succeeding passages appeared was noted. 
 A normal dose was considered to consist of 5 grm. Sprudel Salt dissolved in 
 250 c. c. distilled or ordinary water. The solution was drank either at the 
 ordinary temperature of a living room, 18 to 20 C, or heated to 50° C. 
 
ANNOTATION OF EXPERIMENTS. 13 
 
 On account of brevity and to afford an oversight, the observations obtained 
 are arranged in Experimental Series: — 
 
 I. The appearance of the stools under the action of the Sprudel Salt in 
 34 individuals is there recorded. To these we add 3 other cases from 
 Section 4, and 3 from Section n, in whom the passages, although for an- 
 other object, were subjected to a still more careful examination, so that the 
 experiments upon the influence of Sprudel Salt on the evacuations is based 
 on 40 cases. Of the 34 in Series 1 there are 7 with normal action of the 
 bowels, 7 with catarrhal affection of the bowels, 15 with habitual consti- 
 pation — cause not precisely determined, the majority probably depending 
 upon atonic intestinal weakness — 1 case with severe hemorrhoidal knots, 
 and 4 cases showing a partial impermeability of the intestinal canal. Six 
 other cases are found further treated of in Sections 4 and 3. 
 
 EXPERIMENTAL SERIES I. 
 
 I. L. W., set. 20, artisan; healthy, without any intestinal complaints. 
 Stools regular and compact. 
 
 Experiment 1. — {a) The last passage early in the night before the experi- 
 ment. Early, fasting, 5 grm. of Sprudel Salt in 250 c. c. distilled water at 
 iS° C, were taken. No passage until early the next day, of the usual con- 
 sistence and without special symptoms. 
 
 Experiment 1. — (F) 5 grm. Sprudel Salt dissolved in 250 c. c. artificial 
 Seltzer water also remained without effect. 
 
 Experiment 2. — The last stool early in the morning before the experiment. 
 5 grm. Sprudel Salt in 250 c. c. of distilled water at 18 C, were taken 
 early, fasting ; after half an hour the same dose was repeated ; not until 
 evening (after 12 hours) did a passage, without special effort, follow. 
 
 II. P. L., ?et. 22, farmer. Catarrhal gastric symptoms. Passages reg- 
 ular every day. 
 
 Experifnent j. — (a) 5 grm. Sprudel Salt were without effect on the 
 passages. 
 
 Experiment j. — (£) Last passage on the day before the trial. 5 grm. 
 Sprudel Salt were taken dissolved in 250 c. c. of distilled water early, fast- 
 ing; the same dose was repeated after half an hour. After 3^ hours com- 
 pact and pappy masses in the stool without special effort. There was no 
 second passage that day. 
 
 Experiment 4. Last passage on the day before the trial. The same 
 directions as in 3 (<£), with the exception that the Sprudel Salt solution 
 was taken heated to 55 C. After 3^ hours a passage composed of compact 
 and pappy masses, accompanied with a feeling of fullness and oppression in 
 the abdomen. 
 
 III. R. J., aet. 30, tradesman. Nervous dyspeptic symptoms. Passages 
 usually regular, with tendency to diarrhoea. 
 
14 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 Experiment 5. — Last passage on the day before the trial. 5 grm. Spru- 
 del Salt dissolved in 250 c. c. were taken fasting, at 20 C, followed by a 
 walk. After 2 hours a pappy stool without special effort, after 3 hours a 
 second similar passage. 
 
 Experiment 6. — On the day following the last trial, 5 grm. Sprudel 
 Salt dissolved in 250 c. c. of distilled water at 20 C, were taken. After 
 half an hour the same dose repeated, thereupon moderate exercise in the 
 garden. After 1 hour a pappy stool, after 1^ hours a second, followed 
 during the afternoon by two watery passages with sharp pains. 
 
 Experiment 7. — Last passage the day before. Early, fasting, 10 grm. 
 Sprudel Salt in 250 c. c. distilled water at 18 C. were introduced by means 
 of the stomach tube. After 2 hours a pappy stool ; in the afternoon, two 
 more watery passages without inconvenience. 
 
 Experiment 8. — Last passage early before the trial. Exactly the same 
 as in 7, with the exception that the solution was administered heated to 
 55 C. After 2 hours a pappy stool ; in the afternoon three watery passages 
 accompanied with pain. 
 
 IV. M. M., set. 24, farmer. Dilatation of the stomach, with symp- 
 toms of a partial impermeability of the large intestine. Passages regular 
 every day. 
 
 Experiment p. — Last passage on the day before the trial. Early, fast- 
 ing, 5 grm. Sprudel Salt in 250 c. c. distilled water at 18 C, were taken. 
 An ordinary passage during the afternoon. 
 
 Experiment 10. — Last passage the day before. Early, fasting, 5 grm. 
 Sprudel Salt in 250 c. c. distilled water at 18 C, were taken. After half 
 an hour the same dose was repeated. In this, as also in a number of other 
 cases, colicky pains would follow the ingestion of the Sprudel Salt; the bowels, 
 however, would not be moved until the afternoon, and be of ordinary con- 
 sistence. 
 
 V. P. S. , set. 32, military officer. Hypochondriacal mood and con- 
 stipation, in consequence of atonic intestinal weakness. Stool hard, not 
 daily, irregular. 
 
 Experiment 11. — (a) 5 grm. Sprudel Salt in 250 c. c. distilled water 
 invariably remained without effect. 
 
 Experiment 11. — (£) 10 grm. Sprudel Salt in a single as well as 
 divided dose remained without effect. Only nausea was produced. For the 
 purpose of evacuating the bowels Sprudel Salt solution was therefore given 
 per rectum. 
 
 VI. K. L., set. 25, country girl. Nervous dyspeptic symptoms with 
 atonic intestinal weakness. Passages retained for several days. 
 
 Experiment 12. — 5 grm. Sprudel Salt in 250 c. c. distilled water at 18 
 C, were without result in repeated trials. 
 
 Experiment 13. — Last passage three days ago. Early, fasting, 5 grm. 
 Sprudel Salt in 250 c. c. of distilled water were taken, and repeated in half 
 
ANNOTATION OF EXPERIMENTS. I 5 
 
 an hour. In many similar trials only nausea and "boring" pains in the 
 abdomen were produced, but no passage. Sprudel Salt in solution was 
 then given in the form of a clyster. 
 
 VII. S. T., set. 22, shoemaker. Hypochondriacal mood, atonic in- 
 testinal weakness ; passages retained for days. 
 
 Experiment 14. — Repeated use of 5 grm. Sprudel Salt in 250 c. c. of 
 distilled or Seltzer water at 18 or 55 C, only caused weight and other un- 
 pleasant sensations in the abdomen, but no passage. Solution of Sprudel 
 Salt was used per rectum. 
 
 VIII. G. W., aet. 45, laborer. Carcinoma and dilatation of the stomach. 
 Atonic intestinal weakness. No passages for four to five days. 
 
 Expermient 15. — 5 as also 10 grm. Sprudel Salt in 250 c. c. distilled 
 water at 18 C, caused nausea, but no passage. 
 
 Experiment 16. — Last passage 5 days ago. Early, fasting, 15 grm. Spru- 
 del Salt in 250 c. c. of distilled water at 18 C, were introduced through the 
 stomach tube. After 7 hours a passage, composed of a hard and pappy mass. 
 
 Experiment 17. — Last passage 4 days ago. Early, fasting, 15 grm. of 
 Sprudel Salt in 250 c. c. distilled water at 18 C, introduced through the 
 stomach tube. After 6^ hours a hard, after 9 hours a second watery passage. 
 
 IX. H. Z., aet. 28, a seamstress. Atonic intestinal weakness. No pas- 
 sage for several days. 
 
 Experiment 18. — Last passage 3 days ago. Early, fasting, 15 grm. Sprudel 
 Salt in spring water at 18 C, was administered in three doses at intervals 
 of half an hour. Nausea, but no passage was produced. Two following 
 similar trials produced the same negative result. 
 
 Experiment 19. — Last passage 3 days ago. Early, fasting, four 5 grm. 
 doses Sprudel Salt, each dissolved in 250 c. c. distilled water at 18 C, were 
 taken at intervals of half an hour. Slight nausea. After 4 hours the first, 
 and after 4^ hours a second watery passage, without pain. . In the after- 
 noon two more watery evacuations, followed early the next day by a pappy 
 stool. 
 
 X. Cz. K., aet. 26, accountant. Atonic intestinal weakness. No pas- 
 sages for 2 to 4 days. • 
 
 Experi?nent 20. — (a) Twice repeated doses of 5 grm. Sprudel Salt re- 
 mained without effect. 
 
 Experiment 20. — (J?) Last passage 3 days ago. Early, fasting, 5 grm. 
 Sprudel Salt in 250 c.c. spring water, at 16 C, were given and repeated in 
 half an hour. After 20 minutes a rumbling and passing of wind ; after 1^ 
 hours the first, and after 1^ hours the second watery evacuation. 
 
 Experiment 21. — Last passage 4 days ago. The same direction, with the 
 exception that the Sprudel Salt was dissolved in soda water. After 15 min- 
 utes rumbling and passing of wind, after three-fourths of an hour a hard, 
 after i}i hours a second pappy, and during the day 2 more watery evacua- 
 tions. 
 
1 6 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 XI. P. B., aet. 45, laundress. Insufficientia mitralis. Emphysema pul- 
 monum. Obstipatio. No passage for several days. 
 
 Experiment 22. — Last passage 2 days ago. Early, fasting, 5 grm. Sprudei 
 Salt in spring water at the ordinary temperature, were administered. After 
 a few minutes nausea and retching set in. Difficulty of breathing and palpi- 
 tation, but no passage. Two similar trials produced the same effect with 
 reference to the symptoms. The Sprudei Salt, therefore, had to be discon- 
 tinued. 
 
 XII. R. N., aet. 33, official. Nervous, sensitive individual. Passages 
 irregular, with tendency to diarrhoea. 
 
 Experiment 23. — Last passage 3 days ago. Early, fasting, 5 grm. Sprudei 
 Salt in 250 c.c. distilled water at the ordinary temperature, were taken. 
 After \y 2 hours a pappy ; during the day 3 watery evacuations without pain. 
 The headache from which the patient suffered disappeared after every admin- 
 istration of the Sprudei Salt. 
 
 Experiment 24. — Last passage the day before. The same dose, but dis- 
 solved in 250 c.c. soda water. After 1 hour and during the day 2 more 
 evacuations. 
 
 In numerous other trials, 5 grm. Sprudei Salt were always sufficient to 
 produce copious evacuations. 
 
 XIII. W. N., aet. 32, clerk. Atonic intestinal weakness. Bowels moved 
 every second or third day. 
 
 Experiment 25. — Last passage 2 days ago. Dose of 5 grm. Sprudei Salt 
 only caused a rumbling in the bowels, but no passage ; the following was, 
 therefore, at once tried on the next day. 
 
 Experiment 26. — Early, fasting, 5 grm. Sprudei Salt were taken, dissolved 
 in 250 c.c. distilled water at 18 C, and repeated in half an hour. With 
 rumbling and straining, a compact stool was produced after 1^ hours. 
 
 Experiment 27. — Last passage 2 days ago. The same as above, but dis- 
 solved in carbonic acid water. Fifteen minutes after the first dose rumbling 
 and passing of wind ; after an hour a compact, after 1^ hours and after 1^ 
 hours 2 watery, greenish and bad-smelling stools. 
 
 Experiment 28. — Last passage 2 days ago. The same proceeding, only 
 that artificial Seltzer water was used as the solvent. After ij£ hours rumbling 
 and copious passage of flatus ; after three-fourths of an hour a compact, and 
 after 1, as also 1% hours, 2 more watery, ill-smelling, greenish passages. 
 
 Experiment 29. — Last passage 2 days ago. Early, fasting, 10 grm. 
 Sprudei Salt dissolved in 500 c.c. distilled water at 18 C, were taken at one 
 dose. The large quantity of liquid could only be swallowed with great effort ; 
 produced a bad taste, nausea and retching. Not until after 1^ hours did a 
 compact, and a few minutes later a larger watery evacuation take place. 
 
 Experiment 30. — Last passage 2 days ago. Early, fasting, 5 grm. Sprudei 
 Salt was taken in 250 c.c. distilled water at 18 C. This dose was repeated 
 after half an hour, and in 1 hour thereafter a third dose was taken. After 
 
ANNOTATION OF EXPERIMENTS. 1 7 
 
 i '_ hours, accompanied with a great deal of rumbling, a pappy evacuation ; 
 after i3/£ and 2)( hours watery stools with burning in the rectum. During 
 the afternoon 2 more watery passages. 
 
 XIV. M. F., set. 28, school-teacher. Atonic intestinal weakness. Passages 
 retained 3 to 4 days. 
 
 Experiment 31. — Last passage 3 days ago. Early, fasting, 5 grm. Sprudel 
 Salt were taken dissolved in 250 c.c. distilled water; after half an hour the 
 same dose. A sensation of fullness in the abdomen was produced, with 
 nausea and retching, but no passages. 
 
 Experiment 32. — Last passage 3 days ago. Early, fasting, 5 grm Sprudel 
 Salt were taken in 250 c.c. distilled water at 18 C, and repeated in half 
 an hour, to be followed by a third half an hour later. The first dose was 
 speedily followed by nausea, the second by retching, and the third by vomit- 
 ing. The stool, consisting of a compact pappy mass, appeared 6 hours later. 
 
 Experiment 33. — Last passage 3 days ago. Early, fasting, 5 grm. Sprudel 
 Salt were taken in 250 c.c. soda water at the ordinary temperature ; the same 
 dose repeated after half an hour. Nausea and vomiting were produced, but 
 no stool appeared on that day. The Sprudel Salt, therefore, had to be given 
 by the rectum. 
 
 XV. P. O., aet. 54, clerk. Great atonic intestinal debility with hsemor- 
 rhoidal knots. The bowels can only be opened by means of injections. 
 
 Experiment 34. — Last passage by means of injections of water 2 days 
 ago. Early, fasting, 5 grm. of Sprudel Salt were taken, dissolved in 250 c.c. 
 rain-water at ordinary temperature. The same repeated after half an hour. 
 Rumbling, a sense of fullness and straining was produced and prolapse of 
 hemorrhoidal knots, but no passage. 
 
 Experiment 35. — Last passage by means of injections of water 3 days 
 ago. The same as above, with the difference that artificial Seltzer water was 
 used as the solvent. After an hour, amidst severe straining, prolapse of a 
 part of the rectum together with haemorrhoidal knots, there appeared a stool 
 consisting of a ball of feces tinged with mucus and blood. After 1^ and 
 1 y^ hours this was followed by watery passages deeply colored with blood. 
 In this case the Sprudel Salt was discontinued. 
 
 XVI. K. C, aet. 25, student. Catarrhal disease of stomach. Severe 
 atonic intestinal weakness with hypochondriacal mood. Evacuation of the 
 bowels is generally only accomplished by means of injections of water. 
 
 Experiment 36. — (a) Doses of 5 grm. Sprudel Salt, dissolved either in 
 250 c.c. of distilled or soda water, produced no stools. Only rumbling 
 being produced. 
 
 Experiment 36. — (&) 10 grm. Sprudel Salt taken at one dose also produce 
 no effect. Neither could the passages be expedited by exercise. 
 
 XVII. K. B., aet. 24, student. Catarrhal disease of stomach ; atonic 
 intestinal weakness. No passage for 3-4 days at a time. 
 
 Experiment 38 . — Last passage 4 days ago. Early, fasting, 5 grm. Sprudel 
 
1 8 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 Salt were taken in 250 c.c. distilled water at the ordinary temperature, the same 
 dose repeated in half an hour. After 3 hours a passage consisting of balls 
 of feces and a watery fluid; after 4, as also after 5 hours two more watery 
 stools. The patient experienced a great sense of relief in the abdomen 
 after the stools. 
 
 XVIII. W. K., aet. 26, clergyman. Catarrhal disease of stomach and 
 bowels. Passages generally produced by means of injections of water. 
 
 Experime?it 39. — Last stool 2 days ago, produced by means of injection 
 of water. 2 hours after supper 5 grm. Sprudel Salt in 250 c.c. distilled water 
 at 1 8° C. were taken; the same dose repeated in half an hour. During the 
 night rumblings in the abdomen, sleep disturbed. Not until morning 
 (after 12 hours) a mushy stool. 
 
 Experiment 40. — Last passage 3 days ago. 4 hours after dinner 5 grm. 
 Sprudel Salt were taken dissolved in 250 c.c. of distilled water at 18 C; 
 the same dose repeated after half an hour. The patient complains of great 
 distention of the stomach followed after three hours by a copious watery 
 stool, accompanied by the passage of much flatus ; during the night a 
 second passage. 
 
 XIX. C. M., aet. 60, a functionary employed at the desk. Suffering 
 from atonia intestinorum incipiens post enteritidem acutam. No passage 
 for 2-3 days at a time. 
 
 Experiment 41. — For a long time 5 grm. Sprudel Salt was taken early, 
 fasting, dissolved in 250 c.c. of soda water at the ordinary temperature. 
 Regularly after 3-4 hours this was followed by a single passage without any 
 sensation whatsoever. After 3 weeks' use of the Sprudel Salt the stools were 
 regular. 
 
 XX. F. G., aet. 22, student. Catarrhal affection of stomach and bowels. 
 Bowels not moved for 2-3 days. 
 
 Experiment 42. — In 5 trials, 5 grm. Sprudel Salt dissolved in 250 c.c. 
 spring water and taken, would, after 1 to 1^2 hours, produce 2-3 thin, 
 watery passages without especial inconvenience. 
 
 XXI. Z. R., aet. 50, teacher. Catarrhus exacerbans intestini crassi. 
 Evacuation of bowels only to be accomplished by the use of injections of 
 water. 
 
 Experiment 43. — Last passage produced by means of injections of water 
 2 days ago. Early, fasting, 5 grm. Sprudel Salt in 250 c.c. of spring water 
 at the ordinary temperature, and repeated in half an hour. After 1^ hours 
 a compact stool, and after 1^ hours a second watery passage mixed with 
 blood, and accompanied with straining and a burning sensation in the rec- 
 tum. The patient feels himself much exhausted during the remainder of 
 the day. 
 
 Experhnent 44. — Last passage 2 days ago. The same directions as 
 above ; as solvent, however, soda water was used. After 1 hour a pappy, 
 mucous stool, consisting of hard balls of feces; after \V 2 hours, at short 
 
ANNOTATION OF EXPERIMENTS. 1 9 
 
 intervals, numerous watery stools colored with blood, accompanied with a 
 great deal of tenesmus and burning, so that the patient himself refused to 
 continue the use of the Sprudel Salt. 
 
 XXII. M. A., jet. 28, drawing teacher. Catarrhal disease of the 
 stomach. Symptoms of a partial obstruction of the intestine. Bowels 
 irregular during a number of days. 
 
 Experiment 45. — Last passage 2 days before. 5 grm. of Carlsbad Sprudel 
 Salt in 250 c.c. distilled water at 55 C, were taken early, fasting. After 6 
 hours a hard stool ; early the following day a second, pappy passage. 
 
 Experiment 46. — Last passage 2 days before. 5 grm. Carlsbad Sprudel 
 Salt in 250 c.c. of distilled water at 18 C, were taken fasting, early in the 
 morning. In half an hour the same dose was repeated. After 2 hours 
 nausea and vomiting set in, to be followed shortly by a large stool. 
 During the night sharp pains were felt, confined to one spot j these were fol- 
 lowed by 2 pappy passages. The following day the patient complained of 
 general weakness. These symptoms supervened after every administration 
 of 10 grm. of Carlsbad Sprudel Salt. 
 
 XXIII. K. P., aet. 22, laborer. Symptoms of dilatation of the stomach 
 and stenosis of pylorus. Atonic intestinal debility. The bowels confined 
 for 8-10 days at a time. 
 
 Experiment 47. — Bowels open 9 days before. 4 hours after dinner 15 
 grm. Carlsbad Sprudel Salt dissolved in 250 c.c. spring water at 17 C, were 
 administered through the stomach tube. After 4 hours great flatulency, fol- 
 lowed by nausea and pain in the abdomen. Not until 9 hours after, a 
 copious passage, consisting of hard and pappy masses. On account of the 
 distress in the abdomen the patient was restless and without sleep the whole 
 night. 
 
 XXIV. S. T., aet. 39, cabinet maker. Excepting hsemicrania spastica, 
 no evidence of any disease could be found. Passages daily, but with a ten- 
 dency to constipation. 
 
 Experiment 48. — Last passage the day before. Early, fasting, 5 grm. of 
 Sprudel Salt were taken, dissolved in spring water at the ordinary tempera- 
 ture. After 2 hours a pappy stool, without effort ; no more passages that 
 day. Cold and warm solutions in 5 trials produced identical results. 
 
 Experi?nent 49. — Last passage the day before. 5 grm. of Carlsbad Spru- 
 del Salt were given early, fasting, dissolved in 250 c. c. of spring water at 
 the ordinary temperature. After 2 hours a pappy and during the day another 
 semi-liquid passage, without pain. The patient feels relief from his ailment 
 during the day after this dose. 
 
 XXV. H. K., aet. 50, workman in factory. Well-nourished; atonia intes- 
 tinalis, with dyspeptic troubles. Stools once every third day, hard and 
 difficult to pass. Patient generally resorts to purgatives. 
 
 Experiment 50. — (a) Last passage the day before. Early, fasting, 5 grm. 
 Carlsbad Sprudel Salt were taken in 250 c. c. spring water at 50 C, and 
 
20 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 repeated in half an hour. Immediately following the second dose, a firm 
 passage, followed in half an hour by a pappy one, and another during the 
 afternoon. The patient feels much better when taking the salt ; no sense of 
 weight in abdomen, better appetite and less stomach trouble. 
 
 Experiment 50. — (£) Last passage the day before. Early, fasting, 5 grm. 
 of Carlsbad Sprudel Salt were taken, dissolved in 250 c. c. Miihlbrunnenwasser 
 at 50 C. ; this dose was repeated in half an hour. This was followed by a 
 single passage without pain, 2 hours after the last dose ; during other trials 
 not until later in the day. 
 
 XXVI. P. L., set. 40, single. Hysteria. Nervous individual. Everyday 
 or every other day a moderately hard passage. 
 
 Experiment 51. — Last passage 2 days before. 5 grm. Carlsbad Sprudel 
 Salt were given early, fasting, dissolved in 250 c. c. distilled water. After 
 3 hours a pappy stool, and during the day 4 more liquid passages, with sharp 
 pain in both hypochondriac regions. The patient feels " much relieved in 
 the abdomen " on the days of trial. 
 
 Experiment 52. — Last passage the day before. 10 grm. Carlsbad Sprudel 
 Salt in 250 c. c. distilled water at 50 C, were administered through the 
 stomach tube. A pappy stool after fifteen minutes, and during the day a large 
 number of watery passages, accompanied by continuous straining and pain 
 in the hypochondriac region, followed by general exhaustion. 
 
 Even the dose of 5 grm. Carlsbad Sprudel Salt was in this individual too 
 large. 
 
 XXVII. N. S., aet. 40, shoemaker. Catarrhus intestini cressi subs, ob- 
 stipatione. Passages every 3 or 4 days, with difficulty. 
 
 Experiment 53. — Last passage 3 days ago. 10 grm. Carlsbad Sprudel Salt 
 in 250 c. c. distilled water at 18 C, were taken early, fasting. After one 
 hour a soft stool without pain, no more during the day. 
 
 XXVIII. S. A., aet. 35, peasant woman. Great dilatation of the stomach 
 and constipation. In the stomach, whose capacity, as measured, was 6 litres, 
 remnants of food could always be found early, fasting. According to her 
 statement she would not have a passage for weeks at a time. 
 
 Experiment 54. — Last passage 10 days ago. Successive doses of Carlsbad 
 Sprudel Salt to 20 grm. in 250 c. c. distilled water, administered through the 
 stomach tube, never produce a passage, but severe pain in the stomach, dis- 
 tention in the region of the stomach and burning in the abdomen. 
 
 XXIX. S. C, aet. 45, farmer. Ectasia majoris gradus. Stenosis pylori 
 post ulcus. Haematemesis. Would go weeks without having a passage. The 
 capacity of the stomach, according to measurement, was 5 litres. 
 
 Experiment 55. — Last passage 7 days ago. Successive doses of Carlsbad 
 Sprudel Salt to 20 grm. in 250 c.c. spring water, administered through the 
 stomach tube, produced no evacuation of the bowels, but disturbed sleep, 
 due to distress in the stomach and general exhaustion. To collapse, probablv 
 owing to repeated hemorrhages in the stomach, the patient finally succumbed. 
 
ANNOTATION OF EXPERIMENTS. 21 
 
 XXX. P. K., aet. 35. Gastritis mucosa et gastectasia majoris gradus. 
 Obstipatio. No passage for days. 
 
 Experiment jd. — Last passage 4 days ago. Doses up to 20 grm. Carls- 
 bad Sprudel Salt produce no evacuation of the bowels. 
 
 Experiment 57. — Last passage 5 days before. A dose of 30 grm. Carlsbad 
 Sprudel Salt in 250 c.c. distilled water, administered by the stomach tube, 
 produced no stool, but also no pain. The bowels had to be forced open by 
 means of infusion of senna. 
 
 XXXI. K. J., ret. 30, driver. Catarrhal disease of stomach, with atony 
 of the large intestines. No passage for 3 or 4 days, causing much discomfort. 
 
 Experiment 58. — Last passage 3 days before. Five grm. Carlsbad Sprudel 
 Salt were taken in 250 c.c. spring water at 18 C. After 9 hours a passage 
 without any distress. 
 
 Experiment jp. — Last passage 3 days ago. Early, fasting, 5 grm. Carls- 
 bad Sprudel Salt were taken in 250 c.c. Miihlbrunnenwasser at 50 C. No 
 passage during the whole day, but peculiar sensations in the abdomen. 
 
 Experiment 60. — Last passage 2 hours before the taking of the salt. Early, 
 fasting, 5 grm. Carlsbad Sprudel Salt were taken in 250 c.c. Miihlbrunnen- 
 wasser at 50 C. The same dose repeated in 15 minutes. The patient 
 suppressed the desire to go to stool immediately after the second dose, there- 
 fore he had no passage until 1^ hours, and after 12 hours a second. Patient 
 feels much relieved in the abdomen. 
 
 Experiment 61. — Last stool 3 hours before the trial. The same dose as 
 above, substituting distilled water as the solvent. After the second dose 
 desire to go to stool, which was suppressed by the patient; he, therefore, 
 had no passage that day, but felt a dull sense of fullness in the abdomen 
 during the day. 
 
 XXXII. H. Z., set. 18. Obstipatio minoris gradus. No passage for 2 to 
 3 days ; in addition to this, indefinite sensations in the abdomen. 
 
 Experiment 62. — Last passage the day before. Early, fasting, 5 grm. 
 Carlsbad Sprudel Salt were taken in 250 c.c. Miihlbrunnenwasser. The 
 patient remaining seated, after 1 hour a movement of the bowels, followed 
 in 3 hours by a second pappy evacuation. 
 
 Experiment 6j. — Last passage the day before. The same dose as above, 
 with the exception that the patient took a walk. A desire to go to stool was 
 felt in 15 minutes; this was suppressed by the patient, who, however, had a 
 passage 1 hour later, and after four hours a second. 
 
 XXXIII. H. J., set. 32. With the exception of an occasional sense of 
 oppression felt in the chest, nothing abnormal could be detected. Bowels 
 moved regularly once or twice daily. 
 
 Experiment 64. — Last passage 2 hours before taking the salt. Five grm. 
 Carlsbad Sprudel Salt, dissolved in 250 c.c. Miihlbrunnenwasser, at 50 C, 
 were taken early, fasting. The patient remained quietly seated. After 
 
22 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 2 hours a passage, and during the day 2 more pappy evacuations. Feels 
 weak and exhausted. 
 
 Experiment 65. — Last passage the day before. The same dose as above, 
 with the exception that the patient takes a walk. After 3 hours a passage, 
 in the afternoon a second, with weakness and lassitude. 
 
 Experiment 66. — Last passage 2 hours before the trial. The same direc- 
 tions as above, with the exception that distilled water was used as solvent. 
 The patient promenades in the garden. After 4 hours a passage ; in the 
 afternoon a second pappy evacuation. The patient complained of slight 
 headache. 
 
 XXXIV. R. P., get. 37. Excepting nervous eructations, nothing abnor- 
 mal to be detected. Bowels move daily, as a rule, but the passages are hard 
 and voided with difficulty. 
 
 Experiment 67. — Last passage the day before. Early, fasting, 5 grm. 
 Carlsbad Sprudel Salt were taken in 250 c.c. Miihlbrunnenwasser at 50 C. 
 The same dose repeated after 15 minutes. The patient remained quietly 
 seated indoors. Bowels moved in half an hour, followed during the day by 
 a number of watery stools. 
 
 Experime7it 68. — Last passage the day before. The same directions as 
 above, with the exception that the patient takes a walk during the time of 
 observation. After 15 minutes desire to go to stool, and after 30 the first 
 evacuation of the bowels, followed during the day by three watery passages. 
 
 A number of further experiments produced the same result. But on con- 
 tinuing the trials the patient complained of a general sense of weakness and 
 distress in the head. 
 
 SECTION 3. 
 GROUPING OF THE RESULTS FROM EXPERIMENTAL SERIES I. 
 
 1. Carlsbad Sprudel Salt must positively be acknowledged to be a remedy 
 which expedites the movements of the bowels, for in 34 (really 40) cases 
 examined it was only in 3 (XXVIII, XXIX, XXX) in which even maximum 
 doses failed, and these all were severe cases of dilatation of the stomach. 
 
 2. The consistence of the stools is generally such that the first one is solid, 
 or consisting, generally, of balls or masses of feces, the succeeding ones 
 pappy to watery. The later stools are light yellow in color and not feculent, 
 but smelling rather of sulphuretted hydrogen. 
 
 3. The time of the appearance of the first passage after taking the salt 
 differs widely; in case XXVI, for instance, the first passage appeared in 15 
 minutes, in case XXXIV after half an hour, but in other cases later — in case 
 XXXI even as late as 9 hours, when it was almost impossible to positively 
 decide if the passage would have resulted even without the action of the 
 
GROUPING OF RESULTS FROM EXPERIMENTAL SERIES I. 23 
 
 salt. The time of appearance of the stools was dependent upon a number 
 of circumstances. 
 
 (a) Upon the nervosity or torpidity of the individual. In nervous indi- 
 viduals with a tendency to diarrhoea (III, XXVI, XXXIV), the passages may 
 take place soon after the taking of the salt (after %-\ hour) ; in torpid 
 individuals with atonic intestinal muscular development, however, much 
 later, up to several hours (IX). The stools were also late in cases of 
 catarrhal affection of the bowels. In cases of intestinal obstruction (pyloric 
 or intestinal stenosis) the passages set in even later (in case XXIII as late as 
 9 hours), or even not at all (XXIX). 
 
 (/>). The deportment of the patient after taking the salt influences the 
 evacuations very much. The patients feel soon after taking the salt a desire 
 to go to stool, and if they do not at once give way to it the evacuation will 
 be delayed, as in cases XXXII, XXXIV, or may even fail to set in at all 
 (XXXI, 61), when the accumulated fecal masses may either be demonstrated 
 in the caecum or in the left flexure. 
 
 (c) The quantity of the salt taken has, however, the greatest influence 
 on the passages. This will be treated of in detail below. 
 
 4. The evacuations after taking the Sprudel Salt were, in the majority of 
 cases, excepting a painless rumbling in the abdomen, generally painless and 
 not followed by disagreeable symptoms. For of the 40 individuals observed, 
 28 bore the administration very well; in the other 12 cases the following was 
 noticed: — 
 
 In cases of general nervousness (III, VI, XIV, XXVI) the patient com- 
 plained of nausea, pain in the abdomen, and felt weak after the evacuations. 
 In cases of partial intestinal impermeability (IV, XXII, XXIII, XXIX), 
 as also in cases complicated with great dilatation (IV, XXIII, XXVIII, 
 XXIX), severe abdominal complaints, as nausea, flatulency, eructations, 
 even vomiting, sharp pain in the abdomen, and sleeplessness were produced. 
 In one case (XXI) of acute catarrh of the bowels, taking of the salt was fol- 
 lowed by burning, and passage of blood, as also in case (XV) of hemor- 
 rhoidal knots. In case (XI) of mitral insufficiency, retching, oppression 
 and palpitation followed the administration of the salt, so that its use had 
 to be discontinued. 
 
 5. In reference to the dose, the following has been demonstrated: — 
 
 (a) The smallest quantity of Carlsbad Sprudel Salt tried was 5 grm., 
 which the physician in private practice may assume to be one teaspoonful. 
 This quantity of salt was given dissolved in 250 c.c. of water, and in this 
 concentration is of a moderately salty, not unpleasant taste. In 27 indi- 
 viduals who took this dose fasting it only acted in 9 cases; seven of these 
 cases (III, XII, XIX, XX, XXIV, XXVI, XXXII) were extremely nervous 
 individuals. Of the 9 individuals cited, 2 (III, XXIV) had regular daily 
 passages; in 3 cases (XII, XXVI, XXXIII) the passages were irregular, with 
 a tendency to diarrhoea, and in 4 cases (XIX, XX, XXII, XXXIII) the 
 
24 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 bowels were constipated. The dose of 5 grm. generally only acted after the 
 lapse of some time ; only in two cases (XXII, XXVI) the bowels were 
 opened inside of an hour, while in other cases it took 2-4, or even 6 hours. 
 (XII). The dose of 5 grm. produced in 4 cases only one stool, whilst in 5 
 cases with a tendency to diarrhoea, 2-3 evacuations during the day. 
 
 (£) The dose of 10 grm. Carlsbad Sprudel Salt was tried, dissolved in 250 
 c. c. of water. This concentration, however, was not deemed practical, as 
 the patients, on account of the bad taste and the nausea which generally 
 followed, did not like to take it, so that the solution had to be given with 
 the stomach tube (III). The solution of 10 grm. Carlsbad Sprudel Salt in 
 500 c.c. of distilled water was then tried, but the patient could not take 
 such a large quantity of salty liquid at one dose; it caused nausea and retch- 
 ing (XIII, 29). It was, therefore, deemed expedient to administer the 10 
 grm. in two doses, of 5 grm. each, dissolved in 250 c. c. of water and given 
 (fasting) half an hour apart. In 33 cases where this was tried it proved effi- 
 cacious in 23, but in to cases the dose of 10 grm. remained without effect. 
 Of these, 2 cases (IX, 18; XIX, 33) were cases of atonic, habitual constipation 
 with idiosyncrasies against saline drugs; 4 cases of constipation combined 
 with nervous ailments of the stomach, or gastric catarrh. (V, 11; VI, 13; XVI, 
 36; XVIII, 37) and 4 cases of constipation connected with great dilatation of 
 the stomach (VIII, 15; XXIII, 54; XXIX, 55; XXX, 56). The earliest at 
 which the evacuations took place, ^ to ^ of an hour, after the administra- 
 tion of the first dose (X, 21; XXVI, XXXIV, 67, 68) the latest after 3 hours 
 in case XVIII, 40, which was combined with gastric catarrh. The average 
 time at which the bowels were moved was 1 to 2 hours after the taking of 
 the salt; in 23 successful cases, it times. There were mostly a number of 
 passages at different intervals when 10 grm. of the Carlsbad Sprudel Salt was 
 taken. One passage only was produced in 3 out of 23 people ; in these 3 cases 
 (I, II, IV) the bowels Were moved regularly every day. A greater number 
 of passages was produced in 3 nervous individuals, having a tendency to diar- 
 rhoea (III, XXVI, XXXIV) ; in these cases 4 passages during the day followed 
 the taking of the salt, as in these individuals the dose of 5 grm. already 
 acted severely. 
 
 The accompanying symptoms attending the administration of 10 grm. 
 Sprudel Salt, which quantity in private practice is equivalent to two tea- 
 spoonfuls, were observed in a few individuals. The above mentioned 3 
 nervous persons complained, after abundant passages, of lassitude, a general 
 sense of weakness and headache ; in case XXII, of partial impermeability 
 of the bowel, vomiting and violent pain in the abdomen set in before 
 the stools. 
 
 Two divided doses of 5 grm. each, and one 10 grm. dose of Sprudel Salt, 
 which were tried alternately in 5 persons (III, 78; XIII, 29 ; XXXIV, XXXVI, 
 XXXVII), did not alter the time of the appearance of the stools. There 
 was greater frequency of the passages and longer continued action, therefore 
 
GROUPING OF RESULTS FROM EXPERIMENTAL SERIES I. 25 
 
 more complete cleaning out of the bowels, after divided than after one large 
 dose. 
 
 (c) The dose of 15 grm. Carlsbad Sprudel Salt was either given at once in 
 a solution of 250 c. c. of water, and in this case given by the stomach tube, 
 or divided in 3 parts of 5 grm. each in 250 c. c. of water and given, fasting, 
 at intervals of half an hour. This dose had no effect in 4 individuals out of 
 9 cases tried, in which smaller doses were without effect. Of these cases 3 
 were cases of great dilatation of the stomach (XXVII, XXVIII, XXIX), and 
 1 case (IX, 18) of severe habitual constipation which, however, were cured 
 after one year. The action of doses of 15 grm. Carlsbad Sprudel Salt, in 
 those cases in which they were attended with success, did not differ in the 
 time at which they began to operate from the cases in which 10 grm. doses 
 were given, but in the greater frequency and duration of the watery evacu- 
 ations during the rest of the day. The former dose (15 grm.) was more 
 frequently attended with disagreeable symptoms, such as vomiting, pain and 
 burning in the abdomen. These symptoms were especially severe when the 
 passages were delayed by an obstruction to the progress of the contents of 
 the bowels (XXIII, partial impermeability), or the Carlsbad Sprudel Salt 
 failed to act and accumulated in the intestinal canal. The dose of 15 grm. 
 (equal to 3 teaspoonfuls) must, therefore, be considered the maximum dose 
 for the therapeutic use of the Sprudel Salt. 
 
 (d) Larger doses, 20 to 30 grm. were also tried. In case IX, 19, of habit- 
 ual constipation, 20 grm. were required to produce the desired effect without 
 any severe accompanying symptoms. On the other hand, in cases of great 
 dilatation of the stomach (XXVIII, XXIX, XXX) these or even larger doses 
 failed. The salt produced in the first 2 cases only severe pain in the stomach. 
 
 6. The nature of the solvent used also influenced the effect produced by 
 the Sprudel Salt. 
 
 (a) The different temperatures of the solutions (in cases II and III) showed 
 no decided influence upon the result. A warmed solution of Carlsbad Spru- 
 del Salt only had the disagreeable addition of being less agreeable to the 
 taste and more apt to produce nausea and retching. 
 
 (£) Soda or Seltzer water used as solvent for the Sprudel Salt (in cases 
 XIII, 27, 28 ; XIX, 41 ; XXI, 41) showed that, in comparison with ordinary 
 water, the effect was much more prompt and continuous when the former 
 were used than when ordinary water was employed, in addition Soda and 
 Seltzer water made the solution much more palatable, so that much more 
 concentrated solutions can be borne by the patients ; I therefore, in private 
 practice, order the Sprudel Salt dissolved in a carbonated water. 
 
 (f) To promote the purgative effect of the thermal waters at Carlsbad, 
 Sprudel Salt is frequently added (5 grm. to a beaker). I have in 4 cases 
 (XXV, XXXI, XXXIII, XXXIV) made trial of the Sprudel Salt in this 
 way, using at one time 5 to 10 grm. Sprudel Salt in 250 c.c. distilled water 
 at 50 C, and the next time the same quantity dissolved in 250 c.c. bottled 
 
26 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 Muhlbrunnenwasser warmed to 50 C. The results were, however, even in 
 the same individual, not always the same. At one time the solution of 
 Sprudel Salt in Muhlbrunnenwasser was more efficacious ; at another time 
 the solution in distilled water (XXV) ; so that the question in this direction 
 is not as yet settled. One thing, however, is certain, that 5 grm. Sprudel 
 Salt act more energetically upon the functions of the intestines than a glass 
 of Carlsbad Thermal water. 
 
 7. The influence of exercise on the action of the salt was studied during 
 the summer in 3 cases, the patients on one day being required to remain 
 quietly in their room and on the next to take a promenade in the clinical 
 garden. The patients reported that during exercise, after taking the salt, 
 they would feel a much more decided inclination to go to stool than when 
 confined to their room, provided they would not repress this desire, when 
 the evacuation would be delayed. It is, therefore, well to uphold the opinion 
 that by exercise the action is expedited. 
 
 8. In the general condition of the patients, after the use of the Sprudel 
 Salt, very little change was noticed in the majority of cases. The patients 
 felt relieved after the evacuations ; if the salt, however, was given for a num- 
 ber of days consecutively, then the patients complained of a sense of weak- 
 ness, languor, confusion of ideas and headache, and became more anaemic 
 (XXXIII, XXXIV). 
 
 SECTION 4. 
 
 SPECIAL EXPERIMENTS MADE TO DETERMINE THE NATURE 
 
 OF THE EVACUATIONS UNDER THE INFLUENCE 
 
 OF THE SPRUDEL SALT. 
 
 To gain a better insight into the modus of the appearance of the passages, 
 I have made 5 examinations upon the 3 following individuals (which are to 
 be added to Series I). The examinations were made of fractionally-collected 
 passages. Inasmuch as I had determined by previous experiment that the 
 filtrate of the normal fecal masses made with distilled water reacted alkaline, 
 contained chlorides and traces of sulphates, making it impossible to detect 
 the constituents of the Sprudel Salt that may have gotten into the passages, 
 I have added to the Sprudel Salt in all the experiments 0.5 grm. potassium 
 ferrocyanide or carmine. If the passages after the Sprudel Salt thus prepared 
 were red or colored blue with ferric chloride, the conclusion must be drawn 
 that the constituents of the Sprudel Salt must also be present. 
 
 XXXV. Sz. J., aet. 23, laborer, suffering from catarrhal gastritis. Bowels 
 moved regularly every day, and contained no mucus. 
 
 Experiment 6g. — Five grm. Sprudel Salt with 0.5 grm. ferrocyanide of 
 potassium, dissolved in 250 c.c. of cold distilled water, were given early, 
 fasting; in half an hour the identical dose was repeated. Within an hour 
 
SPECIAL EXPERIMENTS. 2/ 
 
 rumbling in the intestines and inclination to go to stool, passage of intestinal 
 gases ; it was, however, not until 3^ hours that a sausage-like stool was 
 voided, which was not colored blue with ferric chloride. In 15 minutes 
 there was another passage, of a mushy consistence and light-yellow color, 
 which was rendered blue by ferric chloride. The patient had another 
 passage on the following day, which was also colored blue by the reagent ; 
 and another passage on the third day, which gave a faint reaction only. 
 There was no reaction on the fourth day. The following experiment was 
 not made until the fifth day. 
 
 Experiment 70. — Early, fasting, 10 grm. Sprudel Salt and 0.5 grm. 
 potassium ferrocyanide were administered, dissolved in 250 c. c. cold dis- 
 tilled water ; in half an hour another 5 grm. Sprudel Salt in ^ litre water, 
 but without the addition of ferrocyanide of potassium, were administered. 
 Soon after the first dose great rumblings, passing of wind and a desire to go 
 to stool set in, whereupon, one hour after taking the first dose, a sausage-like 
 stool, surrounded by a yellow, mushy mass, was passed. The sausage-like 
 stool gave no reaction with ferric chloride, whilst the mushy mass gave a 
 distinct blue color. During the day there were a number of watery mucous 
 stools of light-yellow color, emitting the odor of sulphuretted hydrogen, in 
 all of which the presence of potassium ferrocyanide could be demonstrated. 
 
 XXXVI. J. D., set. 34, servant. Passages hard, generally every other 
 day ; otherwise healthy. 
 
 Experiment 71. — Early, fasting, 5 grm. Sprudel Salt in ^ litre distilled 
 water without the addition of potassium ferrocyanide were administered ; after 
 half an hour the same dose, but with 0.5 grm. of potassium ferrocyanide. An 
 hour after taking the first dose a hard stool was passed, preceded by a slight 
 rumbling and passage of wind. The matter passed had an alkaline reaction 
 and the ferric chloride failed to produce the blue color. An hour thereafter 
 a mushy stool was passed without giving the blue color. A third dose of 5 grm. 
 Sprudel Salt with 0.5 grm. ferrocyanide of potassium was given. After half an 
 hour there was a copious, watery, yellowish-green, bad-smelling evacuation, 
 which contained pieces of undigested meat and which gave a strong blue 
 color with the salt of iron. After 2^ and 3^ hours there were several 
 more discolored, watery stools mixed with mucus, and having an alkaline 
 reaction, in which the abundant presence of ferrocyanide of potassium 
 could be easily demonstrated. The. filtrate of the watery stools did not 
 effervesce with If CI, but gave an intense cloudiness with BaC/ 2 . 
 
 Experiment 72. — On the following day the same patient took early, fast- 
 ing, 10 grm. Sprudel Salt in ^ litre distilled water without the addition of 
 ferrocyanide of potassium. After 1^ hours hard fecal masses were passed, 
 and in 15 minutes thereafter a mushy, yellow, gelatinous mass. The solid 
 gave with ferric chloride a distinct blue color; the mushy mass, however, 
 barely gave a faint greenish blue coloration. After two hours there were two 
 more watery passages, reacting alkaline, which gave no reaction whatever 
 
28 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 with the ferric salt ; the filtrate, however, gave a decided precipitate with 
 Bad,. 
 
 XXXVII. D. F., set. 18, shoemaker. Perfectly healthy; bowels regular. 
 
 Experiment 73. — 10 grm. Sprudel Salt dissolved in 500 c. c. of distilled 
 water, the solution highly colored with carmine, were introduced into the 
 stomach by means of the stomach tube. After a few minutes there were 
 slight nausea and eructations, then rumblings and passage of flatus. After an 
 hour a piece was passed having the form of a sausage and consisting of a 
 thick, yellow mass, reacting alkaline. After half an hour there was a second 
 almost watery stool, of a red color, which did not effervesce with HCl, but 
 produced a decided cloudiness with BaCI 2 . 
 
 The reaction of the urine was determined in many cases after the admin- 
 istration of the Sprudel Salt. The same invariably reacted alkaline several 
 hours after the use of large doses. The urine was specially examined in the 
 last three individuals, inasmuch as the same had to be collected carefully 
 apart from the stools. In experiment 69, the urine still reacted acid after 
 4 hours, after 6 hours alkaline, and gave, acidulated with nitric acid a 
 blue coloration with ferric chloride. Still, on the following day, potas- 
 sium ferrocyanide could be demonstrated in the acid urine. In experiment 
 70 the urine after 2 hours reacted acid, after 3 hours neutral, and only after 
 4 hours alkaline, with a per cent, of ferrocyanide of potassium, and even on 
 the day following traces of ferrocyanide could be demonstrated in the 
 acid urine. In experiments 71 and 72, where there was no disease of the 
 stomach, the urine reacted neutral after if£ hours, after i*4 alkaline, and 
 effervesced on the addition of HCL This continued during 9 full hours 
 after taking the salt. In the healthy individual, in experiment 73, the 
 urine reacted alkaline in one hour after taking the Sprudel Salt. In passing, 
 it may be here mentioned that in no case could the presence of ferrocyanide 
 of potassium be detected in the saliva. 
 
 SECTION 5. 
 
 RESUME OF THE EFFECT ON THE EVACUATION OF THE 
 
 BOWELS AFTER THE ADMINISTRATION OF 
 
 SPRUDEL SALT. 
 
 The total result of the researches on the above-mentioned 37 individuals, 
 in reference to the appearance of the stools after taking Sprudel Salt, is the 
 following: — 
 
 1. The action of the Sprudel Salt manifests itself soon after taking the 
 same by rumblings in the abdomen, sometimes nausea, desire to go to stool, 
 which must be heeded by the patient lest the passages be thereby delayed 
 or even prevented. 
 
ACTION BY RECTAL ADMINISTRATION. 29 
 
 2. Mostly after J 4 -Jj an hour there is passing of flatus, and frequently 
 also eructations. 
 
 3. With increased desire to go to stool there follows, occasionally, in half 
 an hour, a hard evacuation of fecal masses from the lowermost section of 
 the intestine, followed, from the upper section, by mushy, and later on 
 frequently by numerous watery passages, coming from the uppermost part 
 of the intestinal canal. 
 
 4. In the first passage, generally, nothing abnormal can be observed; not 
 until the second and the following can the constituents of the Sprudel Salt, 
 bile and mucus be found. Of the constituents of the Sprudel Salt, the 
 sodium sulphate and chloride can be detected, but not the bicarbonate. 
 
 5. The completeness with which the bowels are emptied depends, aside 
 from individual peculiarities and the pathological condition of the intestinal 
 canal, mainly upon the dose; 5 grm. may be considered the minimum one, 
 10 grm. the medium, and 15 grm. the maximum dose. 
 
 6. The bowels are generally evacuated without much trouble or effort. 
 
 7. Carbonated waters as solvents for the Sprudel Salt, as also exercise, 
 facilitate the action. 
 
 The physiological significance of these facts will be specially treated in 
 connection with the influence of the salt on the functions of the stomach. 
 The clinical deductions will also receive a special chapter at the end of this 
 treatise. 
 
 SECTION 6. 
 
 THE ACTION OF THE SOLUTION OF SPRUDEL SALT 
 ADMINISTERED BY THE RECTUM. 
 
 The same was studied in three individuals. 
 
 XXXVIII. D. W., get. 35, official. Suffering from habitual constipation; 
 no passage for 2 or 3 days at a time. 
 
 (a) Ordinary lukewarm spring water was used in the experiments. The 
 maximum quantity that could, by means of Hegar's funnel, be introduced 
 into the intestine amounted to 2-2}^ litres. These copious enemas were 
 given on three evenings at bedtime. The patient could, when lying on the 
 back, retain the liquid 5-10 minutes, after which water, with fecal masses, 
 and at the end a yellow-colored, bad-smelling, mushy mass came away. A 
 second passage followed during the night or on the following day, although 
 the presence of liquid in the csecum and in the flexures manifested itself by 
 audible gurgling after the evacuation. 
 
 (£) A week after these preliminary experiments these abundant injections 
 were continued during 2 weeks every second day, with the difference that a 
 1 per cent, solution of Sprudel Salt (10 grm. to 1 litre) was added thereto. 
 The following differences manifested themselves in the use of the warm 
 
30 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 water and the solution of Sprudel Salt : At the first trial only i litre of the 
 solution could be introduced, because the patient could not retain the same 
 as well as the plain water. In the other trials the patient became accus- 
 tomed to the same, so that 2 litres of the solution could be introduced, but 
 it could not be retained longer than 5 minutes because of the desire to go 
 to stool. The quantity of fluid fecal masses which came away after the use 
 of the Sprudel Salt solution appeared to be much more abundant, and pos- 
 sessed a more penetrating odor than when plain spring water was used. 
 The gurgling in the caecum and flexures was very apparent. Following this, 
 and preceded by rumblings, there was regularly, during the night, a second, 
 mushy, yellow passage, having the odor of H 2 S, and also on the following 
 day there was another mushy evacuation. On the seventh and eighth days 
 of the experiment the stools were mixed with streaks of blood and red- 
 colored shreds of mucus, the patient feels a burning in the rectum during 
 the evacuations, and the experiments were therefore discontinued. 
 
 XXXIX. H. S., set. 54, hatter; well built and well nourished. No 
 passage for several days. Injections of Sprudel Salt were used, not only on 
 account of the habitual constipation, but rather on account of the gall-stones, 
 which distended the gall-bladder so that it protruded 4 fingers below the 
 ribs. 
 
 (a) The patient was directed to inject, every evening, 5 grm. Sprudel Salt 
 in one-half litre of lukewarm water, and to retain the same as long as possible, 
 even during the entire night. On the first evening the solution could not be 
 retained, but passed out at once without any stool ; it was, however, retained 
 by the patient on the second evening, and was followed during the night by 
 2 passages, a hard and a soft one. On the third and fourth evenings it was 
 followed during the night by a small evacuation ; on the fifth day it was not 
 followed by a passage, so that the patient had retained the solution the whole 
 night. 
 
 (<£) Ten grm. Sprudel Salt in one half litre lukewarm water were now 
 ordered to be injected and to be retained as long as possible. The 5 days 
 of observation showed the following : On the first evening the solution 
 passed, with a mushy stool, after an hour ; on the second there was a watery 
 evacuation in an hour, and, not until morning, a second mushy one ; on the 
 third evening, after an hour, there was a watery passage ; on the fourth a 
 mushy one, after an hour, and another such in the morning. There were 
 no traces of blood in the passages, but the patient complained of burning in 
 the rectum. In this patient the urine of the night, examined in the morn- 
 ing, reacted alkaline and effervesced with HCL The patient continued the 
 Sprudel Salt injections (10 grm. to 1 glassful of spring water), and informed 
 me that he went to sleep after the injection, and did not until morning have 
 2 mushy passages. 
 
 In passing, it may be mentioned that, owing to the continued use of 
 the injections of Sprudel Salt, the long diameter of the gall bladder 
 
RESUME OF ACTION BY ANAL INJECTION. 3 1 
 
 was reduced by -*j finger-widths, and the sensitiveness of the swelling 
 much diminished. 
 
 XL. E. M., a:t. 25. Convalescent from perityphlitis. In consequence 
 of the disease, an atonic weakness of the intestinal muscles had developed, 
 so that there was no passage without some help. Warm spring water injec- 
 tions (i}4 to 2 litres) were used; they, however, only caused but few fecal 
 masses to pass with the stools; a sense of weight and fullness in the abdomen 
 remained. One tablespoonful (20 grm.) Sprudel Salt was, therefore, ordered 
 at one injection. After the solution of Sprudel Salt had been retained for a 
 number of minutes, in addition to hard fecal balls, yellow fluid masses also 
 came away; and during the night, or the next day, there would almost regu- 
 larly be a thick, mushy evacuation. The patient felt herself invariably 
 relieved after injections of Sprudel Salt, and always requested the addition of 
 the same to the warm water. Later on, after the patient was able to leave 
 her bed, the bowels regulated themselves. 
 
 SECTION 7. 
 
 RESUME OF THE ACTION OF THE SPRUDEL SALT USED BY 
 INJECTION PER ANUM. 
 
 The cited experiments prove that a solution of Sprudel Salt in the form 
 of injection not only empties the lower bowel of its contents and washes 
 away the mucus, but also exerts a powerful stimulation to the peristaltic 
 action of the bowels. But, as after the first evacuation the solution still re- 
 mained in the pockets of the intestines, it exerts a further stimulation upon 
 the intestinal tube whereby an additional quantity of the contents of the 
 bowel is passed downwards, and not only an evacuation is caused as in the 
 case of the simple warm water, but is followed during the day by several 
 mushy passages. When the solution of Sprudel Salt is retained a large part 
 of the salt soon passes through the venous system of the pelvis into the 
 urine, which is made alkaline, and the patient soon after the injection passes 
 a quantity of clear, faintly acid urine. It is, therefore, best, when the pelvic 
 organs are to be energetically acted upon, to give the Sprudel Salt by enema. 
 Long continued use of injections of concentrated solutions of Sprudel Salt 
 produces, in its train, additional disagreeable subjective and objective symp- 
 toms, as burning and severe straining, as also capillary hemorrhage from the 
 mucous membrane. 
 
 I will treat of the effect of the long continued use of the Sprudel Salt 
 per os, upon the functions of the intestines, farther on, when treating of the 
 functions of the stomach. 
 
II.— EXPERIMENTS MADE WITH CARLSBAD SPRUDEL 
 
 SALT (POWDER FORM) ON THE FUNCTIONS 
 
 OF THE STOMACH. 
 
 SECTION 8. 
 DESCRIPTION OF THE METHOD OF EXPERIMENTING. 
 
 A second series embracing 150 experiments were made upon 27 clinical 
 cases to determine the influence exerted by the Sprudel Salt (powder form) 
 upon the functions of the stomach. To determine this the following method 
 was employed : — 
 
 The respective cases of the institution experimented upon were put upon 
 the same diet and under observation for a number of days. The subjective 
 as well as the objective symptoms on the part of the stomach and intestinal 
 canal were, first of all, carefully observed and examined. To get as com- 
 plete a picture of the condition of the stomach as possible, not only was the 
 stomach capacity determined by means of the stomach volumeter of Ja- 
 worski, but also the chemical and mechanical function of the stomach were 
 examined in a number of ways during the time of observation. In the first 
 place the secretory power of the stomach was determined in a twofold 
 manner by means of ice water. In the majority of cases 100 c. c. of dis- 
 tilled water brought to the freezing temperature by means of ice, and which 
 I will, therefore, call ice water, was introduced into the stomach by means 
 of the stomach tube, after the lapse of ten minutes 300 (in some cases 100) 
 c. c. of distilled water at the temperature of the room were poured into the 
 stomach by the same means. The contents of the stomach thus diluted, were 
 then removed by means of Jaworski's stomach aspirator, measured and 
 filtered. In the filtrate the free hydrochloric acid, mucus and digestive 
 power and degree of acidity were determined. In other cases 200 c. c. of 
 ice water prepared in the above manner were introduced into the stomach 
 by means of a stomach tube attached to a funnel filled with ice, after ten 
 minutes the gastric juice was aspirated without first diluting the same, and 
 the contents of the stomach examined in the same manner as above. The 
 details of the chemical examination I will speak of directly. On the follow- 
 ing day the digestive chemism and mechanism of the stomach was tested by 
 means of the egg albumen test: Early, fasting, the persons experimented 
 upon took one hard-boiled egg without the yelk and 100 c. c. distilled 
 water at the ordinary temperature. After 5 to 6 (sometimes after 2) quarters 
 
 32 
 
DESCRIPTION OF THE METHOD OF EXPERIMENTING. 33 
 
 of an hour ioo c. c. of distilled water were poured into the stomach through 
 the stomach tube, then aspirated and set aside for analysis, but the stomach 
 was thoroughly cleansed by passing water through a rinsing apparatus so as 
 to determine the amount of still undigested fragments of albumen present. 
 The contents of the stomach first aspirated were measured, filtered, the amount 
 of free hydrochloric acid and the degree of acidity of the filtrate were deter- 
 mined, and also tested for pepton, syntonin and mucus, in the manner 
 described below. 
 
 The action of the solution of Sprudel Salt (powder form) upon the human 
 gastric juice outside of the organism was observed. Specimens of 25 c.c. 
 of an active gastric juice, obtained by means of ice water, were either neutral- 
 ized with Sprudel Salt solution or brought to different degrees of alkalinity 
 and agitated ; hereupon it was acidified with hydrochloric acid, and brought 
 to the acidity — 1-10 c.c. of one-tenth normal alkali per 100 gastric juice. 
 The specimens in which the degree of alkalinity had been brought to above 
 4 c.c. one-tenth normal acid per 100 gastric juice failed, after being acidu- 
 lated, to digest the albumen. The digestive ferment was therefore completely 
 killed by the solution of Sprudel Salt, and its action could not again be 
 restored by the addition of HCl. After having become acquainted with 
 the digestive conditions in the stomach, with the number and condition of 
 the stools of the individual under observation, preliminary experiments were 
 made upon them. 
 
 To be able to determine the influence exerted upon the functions of the 
 stomach, during the experiments with Sprudel Salt solution by the water 
 introduced into the stomach, as well as the stomach tube, the experiments 
 were first made, in the majority of individuals, with distilled water, observing 
 the same conditions of quantity, temperature, time, etc., as in the case of the 
 experiments made with solutions of Sprudel Salt (powder form). 
 
 The main experiments were made early in the morning, in the following 
 manner: The patients were given, either to drink or by the stomach tube, 
 solutions of 5, 10 or 15 grm. Sprudel Salt in 250 c.c. distilled, soda or Carls- 
 bad Thermal waters early, fasting. Frequently larger doses of Sprudel Salt 
 were given ; 5 grm. were dissolved in 250 c.c. of water, and repeated at inter- 
 vals of fifteen minutes. In both cases the patient either remained quietly 
 seated or else walked about on the days of experimentation for 1-5 quarters 
 of an hour, whereupon 100 c.c. distilled water, at the temperature of the 
 room, were introduced into the stomach by means of the stomach tube, the 
 contents of the stomach were then aspirated and placed into the receiving 
 bottle. The liquid was measured, filtered, and the filtrate chemically ana- 
 lyzed in the following manner : — 
 
 For free hydrochloric acid: One drop of a 0.2 per cent, methyl violet 
 
 solution was introduced into a beaker glass containing 10 c.c. of the filtrate. 
 
 The violet coloration either shading into blue, or becoming decidedly blue 
 
 to sky-blue, depending upon the amount of HCl present in the gastric fluid. 
 
 3 
 
34 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 The tests of this reaction with gastric juice showed that a shading into blue was 
 not produced until a per cent, of HCl was used which was equal to 3-4 c.c. 
 of one-tenth normal alkali per 100 parts of liquid ; with 6 c.c. the coloration 
 was almost blue, with 8 c.c. already intensely blue, and above that sky-blue. 
 On the contrary, in samples of gastric juice which were acidified with lactic 
 or acetic acid, no blue coloration could be observed by 3-4 times as great 
 acidity. The reactions behaved in the same manner, also, when pepton or 
 soluble albumen was present in the gastric juice. This reaction could not be 
 used in those cases in which bile coloring matter had been mixed with the 
 gastric juice. The acidity or alkalinity of the filtered gastric juice, as also 
 of the solution of Sprudel Salt used, was determined with a one-tenth nor- 
 mal alkali, by boiling the solution with hydrochloric acid until a permanent 
 red color was produced. Sulphates were tested for in the filtered liquid by 
 means of hydrochloric acid and barium chloride, and the following grades 
 or degrees observed : Precipitate, intense or slight cloudiness, intense or 
 slight opalescence, traces. The solution of Sprudel Salt examined in this 
 way showed a copious precipitate. To test for mucus, concentrated acetic 
 acid was used, and the reaction classified as either cloudy or opalescent. 
 The contents of the stomach were also tested for soluble egg albumen (syn- 
 tonin) by means of officinal acetic acid and ferrocyanide of potassium, 
 and the reaction classified as either cloudy or opalescent. The test for 
 pepton, by means of a 5 per cent, solution of potassium hydrate and 1 per 
 cent, solution of sulphate of copper, was performed in this way : To 10 c.c. 
 of the filtered gastric liquid 2 c.c. potassium hydrate solution were added, 
 then by means of a pipette so many drops of a solution of CuSO± were 
 added until the liquid began to take on a rose-red coloring, which was the 
 case when the gastric liquid contained traces of pepton ; after this there was 
 added enough sulphate of copper solution until the red liquid began to take 
 on a violet-blue shade. From the number of cubic centimetres of the solu- 
 tion of sulphate of copper needed the relative quantity of pepton could be 
 determined. 
 
 The digestive power of the clear gastric fluid was tested in the following 
 manner: In 2 small vials, each containing 25 c.c. of the gastric fluid, was 
 placed a disk of egg albumen, 1 c.c. in diameter and 1 mm. in thickness, 
 weighing 0.06 grm. (This was cut, by means of a double knife, from a 
 recently hard-boiled hen's egg.) In one vial the liquid was acidified with 
 1 drop concentrated officinal hydrochloric acid, but not the other, and both 
 placed in an air-bath of ^8°-4o° C. In case the gastric fluid reacted alka- 
 line, it was first carefully neutralized with HCl, and then the drop of HCl 
 was added. The time was now noted when the disk of albumen disappeared, 
 and the liquid tested for pepton and soluble albumen after the digestion, in 
 the manner described above. If the disk of albumen did not disappear after 24 
 hours or was dissolved with a putrid odor and no pepton reaction produced, 
 the contents of the stomach were deemed completely devoid of digestive 
 
DESCRIPTION OF THE METHOD OF EXPERIMENTING. 35 
 
 qualities, and, indeed, if the liquid acidified with hydrochloric acid did not 
 digest, it was looked upon as being free from pepsin, and, in case the same 
 was originally acid and still did not digest, it was decided that there was a 
 lack of free HCl. Thereby it was also possible to decide if the acidity of 
 the gastric contents was dependent upon free HCl or only upon organic 
 acids. Direct experiments were made to determine the necessary degree of 
 acidity of the gastric fluid for digestion. Repeatedly, 25 c.c. of acid gastric 
 juice neutralized with one-tenth normal alkali and nearly neutral gastric juice 
 were respectively brought to the acidity of 1, 2, 3 to 10 per cent, by volume 
 one-tenth normal alkali per 100 of gastric fluid, and by means of the before- 
 mentioned disks of egg albumen the digestive power was tested. With an 
 acidity of 1 and 2 per cent, by volume one-tenth normal alkali per 100 gas- 
 tric liquid, no digestion was demonstrable, but a peculiar odor of fresh bread 
 was observed. With an acidity of 3 there already appeared a slight pepton 
 reaction, and the disk of albumen had for the most part disappeared after 24 
 hours. With an acidity of 4, the disk was dissolved in from 6 to 12 hours, 
 and the pepton reaction was very marked. The higher the degree of acidity 
 of the gastric fluid the more speedily did digestion progress, so that with an 
 acidity of 10 the disk of egg albumen was dissolved in from i}4 to 2 hours. 
 If the contents of the stomach were originally strongly alkaline, it would 
 occasionally dissolve albumen disks without first being acidified, but the 
 digestive liquid contained no pepton and only dissolved albumen was demon- 
 strable. 
 
 The chlorides were determined by testing the neutralized filtrate obtained 
 from the contents of the stomach, to which 1 drop of chromate of potassium 
 solution had previously been added (according to Mohr) by means of one- 
 tenth normal silver nitrate solution. I have shown in the treatise, " Ueber 
 das Verhalten des Kissinger und Karlsbader Wassers im Magen ' ' {Deutsch. 
 Arch.f. kl. Med., B. xxxv), that this method of determination gives exact 
 results, and that the substances containing N. do not prejudice the result, if 
 the test be performed with the contents of the empty stomach. It is worthy 
 of mention, however, that when the chlorides have been removed from the 
 stomach they are not characterized by so sharp a color reaction as is the case 
 in aqueous solutions of the same. An excess of silver nitrate is not followed 
 by a red coloration, but the white color of the precipitate strikes a yellowish 
 tint, which shows the point of saturation of the chloride with nitrate solu- 
 tion \ when more is added the precipitate becomes orange, but not red. The 
 c.c. of one-tenth normal silver nitrate solution to 100 c.c. of gastric fluid are 
 given in trial Series II, column/, as chlorides. 
 
 The 26 cases examined in the same way are the following : — 
 

 a 
 
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 experimented 
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 After 12 
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 Pale wine- 
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 120 
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 55° 
 
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 18° 
 
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 Ice water. 
 
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 brunnen 
 
 water. 
 
 5 grm. 
 
 250 
 
 •^uarauadxa jo -ox | -©" § 5! § ^ 3 
 
 IO to to r- 
 
 
 ■< 
 
 
 r 
 
 VIII. — K. 
 C., set.35, 
 clergy- 
 man. In- 
 cipi en t 
 gas trie 
 catarrh. 
 
 IX.-K.M., 
 set. 2 5, 
 peas ant 
 girl. 
 Hysteria 
 with 
 nervous 
 gast r ic 
 pheno- 
 mena 
 (vomitus 
 n e r v o- 
 sus). 
 
a §—:§ S 9 m » S'gS 1 
 
 , 3*«£>a>3o C s.Sa;'Bfe 
 < H 
 
 
 •CO • 
 
 P 
 
 es» \m 
 
 fc. Si 
 
 < 
 
 1-3 ™ ".a 
 
 « 2 •3'S-* 
 
 Ci— b o>cn 
 
 -« P 
 
 •«s- 
 
 ZZJS a e-ro « 
 
 3.2p rt ^ 
 
 O rQ --J OO 
 
 ,3 a «■* 
 
 p 
 
 a 2 
 
 fa H 
 
 o 3 o - 
 
 -a P.-5 
 o 
 
 « B 3 
 
 o 3 M 88 * 
 
 *> 2 is -a-* 
 
 <~ ja a «» cn 
 
 < P 
 
 S V < 
 P 
 
 "T3T3 Tf< 
 B «CN 
 
 ro ■"*< "Si 
 
 > s. 2 «*s 
 •3 2 S-Sf"*. 
 
 .2 c4 -a a » < 
 ft P 
 
 
 0) 
 
 
 
 
 a* 
 
 
 
 eS 
 
 ~ " 
 
 
 B.U 
 
 
 
 O 
 
 
 
 
 1 
 
 
 .i 
 
 
 -d 
 
 
 a. 
 
 
 3 
 
 an 
 aa 
 
 2 O 
 
 <D 
 
 c 
 
 
 09 
 
 c3 
 
 
 
 
 
 O 
 
 
 Ph 
 
 
 •8J, 
 
 CD'S 
 
 •o a 
 
 — (3 flO 
 MB.S 
 
 53 
 
 
 
 
 
 
 
 
 
 tz5 
 
 
 
 
 
 £ 
 
 
 
 g 
 
 
 
 
 
 
 
 
 "0 
 
 * 
 
 
 03 
 
 Sh 
 
 05 
 
 >> 
 
 a 
 
 2- « . 
 
 
 00 
 
 DO 
 
 
 
 CO 
 
 
 
 CO 
 
 
 
 CO 
 
 
 
 02 ^ ° 
 
 
 
 
 00 
 
 5. 
 
 OO 
 
 
 
 00 
 
 
 
 00 
 
 CO 
 
 
 
 CO 
 
 •3 
 
 
 CO 
 
 
 
 
 "0 
 
 
 
 © 
 
 O, 
 
 4) 
 
 
 
 «*-oS 
 
 
 CD 
 
 
 
 <s 
 
 
 
 09 
 
 
 9 
 
 3 
 CJ 
 
 "_' 
 
 o 
 
 
 Colo r 1 e 
 decid 
 opalesce 
 
 o 
 
 09 
 
 I* 
 
 U 
 
 o 
 
 ■r. 
 
 = 
 - 
 
 a o 
 
 bf 
 
 a! 
 
 o 
 a 
 
 = 
 en 
 
 Colo r 1 
 fain 
 opales 
 
 Colorle 
 
 
 O 
 
 33 
 
 p, 
 
 O 
 
 a 
 o 
 
 a> 
 
 o 
 
 © 
 
 "3 
 
 o. 
 A 
 
 
 
 a" 
 
 « 
 
 Sh 
 
 CJ 
 
 S 
 
 3 
 
 Sh 
 O 
 
 
 P 
 
 
 
 O 
 
 
 u 
 
 
 
 
 CJ 
 
 
 
 O 
 
 o 
 
 
 
 CJ 
 
 
 
 o 
 
 
 
 
 
 
 
 
 
 
 
 cu ~ . 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 nject 
 Occ. 
 rated 
 100 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 _ 
 
 
 
 
 
 
 
 
 
 
 
 
 CM 
 
 
 
 (^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 CO 
 
 
 
 
 
 
 
 o 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 cm a 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 <* 
 
 
 
 
 
 o.S <^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 - 
 
 
 
 + 
 
 
 + 
 
 
 
 
 r " 1 
 
 
 
 CN 
 
 CN 
 
 
 
 <* 
 
 
 
 + 
 
 
 
 +* 
 
 CN 
 
 
 
 CN 
 
 
 c-i 
 
 
 
 3 
 
 
 
 
 
 
 
 
 
 
 
 
 CN 
 
 
 
 CN 
 
 „ 
 
 
 
 .. 
 
 
 _ 
 
 
 
 water 
 14° 
 
 — 
 
 00 
 
 - 
 
 CO 
 el 3 
 
 
 
 „ 
 
 _ 
 
 
 _ 
 
 „ 
 
 
 1 
 
 % 
 
 1 
 
 "3 
 
 - 3 
 
 
 
 
 
 
 
 
 
 OP 
 
 If 
 
 
 
 
 
 
 
 
 
 
 
 £ 
 
 * 
 
 
 OcNhJ-B &ccn 
 
 a Tj? 10 a 
 
 pS *4 El 
 
 WcN t C«-a CXC 
 
 w - «-© 
 
 o - tXlO 
 
 ■ CN — "Z CJ 
 
 pE « e. g co 
 
 *-. . .2 ."-t -3 » 
 
 1^ 
 
 [«i*S35l 
 

 i 
 
 < 
 - 
 
 
 * 
 
 Th6 stomach 
 rinsed before 
 the experi- 
 ment. 
 
 The stomach 
 rinsed before 
 the experi- 
 ment. 
 
 
 13 CO 
 • H © 
 
 .2 <»0 
 
 j3 © P 
 
 H 
 
 H 
 H 
 H 
 
 
 H 
 
 1 
 
 © 
 
 fid 
 
 as 
 
 *,g 
 
 CO«j 
 
 ■*) 
 
 O 
 
 o 
 
 8 
 
 •not j 
 -893i(i9q^j9;jY 
 uopoBaa uo^daj 
 
 ^ 
 
 
 Very 
 faint. 
 
 Faint. 
 
 Very 
 faint. 
 
 Distinct. 
 Faint. 
 
 
 1DR 
 jo uopippy Jayy 
 
 a. 
 
 After 9 
 hours 
 
 Undigest- 
 ed after 
 48 hours 
 
 After 7 
 hours. 
 
 Undigest - 
 ed after 
 24 hours 
 
 After 12 
 hours. 
 
 After 22 
 hours. 
 
 After 3 
 hours. 
 
 After 4 
 hours 
 
 Undigest - 
 
 ed after 
 
 1 24 hours 
 
 •uorj 
 -saSia; aq^jaijB 
 uop'oBa^: uo^daj 
 
 o 
 
 : ° 
 
 o • • • 
 
 Odor of 
 
 putre- 
 faction. 
 
 "IDH jo non 
 -ippy ^noq^iAV 
 
 8 
 
 Undigest- 
 ed after 
 24 hours 
 
 Undigest - 
 ed after 
 24 hours 
 
 Undigest- 
 ed after 
 24 hours 
 
 pi 
 
 s 
 
 H 
 
 CO 
 
 8 
 
 •pioy ot^ 
 -aoy pa^Bjjuao 
 -uoq v(\\t&. snonj^; 
 
 s* 
 
 Faint opa- 
 lescence 
 
 Opales- 
 cence. 
 
 ... 
 
 Opales- 
 cence. 
 
 Slight 
 opa 1 e e- 
 cence. 
 
 © ^ j 
 
 •apti 
 -oiqo ranuBg 
 q % i m. sa^Bqd[ng 
 
 ~ 
 
 
 Cloudi- 
 ness. 
 
 
 
 
 
 O p a 1 e s- 
 cence. 
 
 Pre c i p i- 
 tate. 
 
 *UI^ 70H o^J 
 
 -y* 
 
 : : 
 
 : : : : 
 
 
 m pguiB^uoo 
 sapuoiqo jo '% m V 
 
 '3 
 
 o 
 
 •a 
 
 1 
 
 o 
 © 
 
 ■*-J 
 
 
 
 
 ^•jipyoy jo 99j3aa 
 
 ..• 
 
 0.2 
 
 
 
 •i^tun 
 -B 2[ i y jo 99iSaa 
 
 *» 
 
 : o 
 
 OS 
 
 Neutral 
 
 7.2 
 
 3.2 
 3.2 
 
 0.2 
 
 1.2 
 
 32.0 
 
 •pinbri otj^sbq pajBi 
 -id's y 9qi jo uorripuoo 
 
 &> 
 
 Colorl ess; 
 mucoid. 
 
 Whitish; 
 mucoid. 
 
 Colo r 1 e s s ; 
 o p ales- 
 cent. 
 
 Whitish; 
 clo u dy; 
 flocculen t 
 
 Colo r 1 e s s ; 
 clear. 
 
 Colo r 1 e s s ; 
 mucoid. 
 
 Colo r 1 e s s ; 
 
 opales- 
 cent. 
 
 Colo r 1 e s s ; 
 mucoid. 
 
 •I9^BA\. P9IH1ST(I -09 
 
 001 jo uopoafai gqi 
 jg^jB pa^BJidsy pinyj 
 
 0U^8B£) JO* -OD JO - 0^ 
 
 •^ 
 
 300 injected; 
 400 a s p i- 
 rated. 
 
 115 
 
 300 injected; 
 230 a s p i- 
 rated. 
 95 
 
 75 
 200 
 
 300 injected; 
 260 aspi- 
 rated. 
 75 
 
 215 
 
 •qoBrao^g aq^ ut utBcu 
 
 -aa: o% paAionv sbm. 
 
 uormyog aq-v sjq % jo -ox 
 
 •ai 
 
 © s ■* 
 ~a 
 
 ©a cm •* _f_ 
 
 ©.2 <N <N 
 
 *"a 
 
 •Sni8l9Q S99jS9(J Ut 
 
 uotinjpg ^[Bg topnadg 
 9 q' % jo ejn^BJ9dra9x 
 
 ti 
 
 Ice water. 
 
 18° 
 
 Distilled 
 
 water. 
 
 Ice water. 
 
 18° 
 
 Distilled 
 
 water. 
 
 Ice water. 
 
 18° 
 
 Distilled 
 
 water. 
 
 30° 
 
 Distilled 
 
 water. 
 
 •p9JS93nj JLd%VJ& 
 
 paiipsia jo *oo pub 
 ^reg ppnadg -BraaS jo 'o& 
 
 o 
 
 100 
 
 Distilled 
 
 water. 
 
 5 grm. 
 250 
 
 100 
 
 Distilled 
 
 water. 
 
 5 grm. 
 
 250 
 
 5 grm. in 
 250; af- 
 ter y 2 
 hour 5 
 grm. in 
 250 cc. 
 
 100 
 Distilled 
 water. 
 5 grm. 
 
 250 
 
 •^uoraugdxa; jo -o^ 
 
 •o 
 
 ^H CM 
 
 to to 
 
 co ■<* to to 
 to to . to to 
 
 r~ co C3 
 to to to 
 
 
 
 
 e 
 
 XI.— w. 
 W., set. 
 30, far- 
 mer. Di- 
 latation 
 o f stom- 
 ach with 
 r e m - 
 nants of 
 food ear- 
 ly in the 
 morning 
 
 XII.— M. 
 C, set. 
 24, far- 
 me Di- 
 latati o n 
 of stom- 
 a c h 
 without 
 subj ec- 
 tive gas- 
 tric ail- 
 ments. 
 
 XIII.— M. 
 A. set. 28, 
 artist. 
 Catar- 
 rh us 
 ve n t r i- 
 culi mu- 
 cosus. 
 

 The stomach 
 complete l y 
 freed from 
 remnants of 
 food with 
 distilled 
 water before 
 the experi- 
 ments. 
 
 ThelOOcc.dis- 
 tilled water 
 were notin- 
 jec ted be- 
 fore aspira- 
 ting. 
 
 
 
 i 
 
 
 Faint. 
 
 Pretty 
 distinct 
 
 Distinct. 
 
 Faint. 
 
 Distinct. 
 
 
 Faint. 
 
 Barely a 
 
 trace. 
 
 Trace. 
 
 Dist i n c t 
 trace. 
 
 
 Faint. 
 
 After 12 
 hours. 
 
 Undigest- 
 ed. 
 
 After 5 
 hours. 
 
 After 7 
 hours. 
 
 A Iter 12 
 hours. 
 
 Undigest- 
 ed after 
 24 hours 
 
 After 26 
 hours. 
 
 Undigest- 
 ed after 
 24 hours 
 
 After 4 
 hours. 
 
 After 8 
 hours. 
 
 Undigest- 
 ed after 
 24 hours 
 
 After 24 
 hours. 
 
 o © a - 
 
 : © 3 O 
 
 "3 &<2 
 
 o 
 
 .2 
 
 -3 ft«S 
 
 o 
 
 : o " © • o o 
 
 ... 
 
 Undigest- 
 ed after 
 24 hou rs 
 
 Undigest- 
 ed after 
 24 hours 
 
 Undigest- 
 ed after 
 24 hours 
 
 ... 
 
 'indigent - 
 ed after 
 24 hours 
 
 u 
 
 s : © o 
 
 - © w 
 
 h 
 
 Opales- 
 cence. 
 
 Trace. 
 
 De c i d e d 
 opa 1 e s- 
 cence. 
 
 pal es- 
 cence. 
 
 Trace. 
 
 Distinct 
 trace. 
 
 Trace. 
 
 De c i d e d 
 opa 1 e s- 
 cence. 
 
 
 
 Opales- 
 cence. 
 
 Precipi- 
 tate. 
 
 Pr e c i p i- 
 
 tate. 
 
 p a 1 e s- 
 cence. 
 
 C 1 o u d i - 
 ness. 
 
 
 
 
 Only or- 
 ganic 
 acids. 
 
 : : : : 
 
 
 : : | : : ■ 
 
 20.0 
 22.0 
 
 12.5 
 
 00 ■<*« 
 ©' o" 
 
 12.0 
 5.6 
 
 © © . . 
 i-" co : - 
 
 o oc ; : 
 
 "<1* CO 
 
 2.5 
 
 26.0 
 
 ... 
 
 0.4 
 
 : : © © 
 
 io i-i 
 
 Colo r 1 e s 8 ; 
 opales- 
 cent. 
 
 Colo r 1 e 8 s ; 
 mucoid. 
 
 Colorless; 
 frothy. 
 
 Opalescen t ; 
 mucoid. 
 
 Whitish; 
 mucoid. 
 
 Brown ; 
 smeary 
 food-rem- 
 nants. 
 
 Lemon-yel- 
 low. 
 
 Decided 
 lemon-yel- 
 low ; clou- 
 dy; nitrate 
 yellow. 
 Decided yel- 
 low; filtrate 
 yellow. 
 Faint lem- 
 on-yellow. 
 
 IC CO o O 
 
 oo o r- oo 
 
 150 injected; 
 350 aspi- 
 rated. 
 
 Nothing in- 
 jected; 210 
 aspirated. 
 
 © lO CO 
 CO 1-4 © 
 CO CO i-H 
 
 80 
 
 No water in- 
 jected; 100 
 cc. a s p i- 
 rated. 
 
 120 
 110 
 
 CO CO CO ^ o.2 "* 
 CO g 
 
 © -* CO 3 
 
 © © .2 *# •<* 
 
 55° 
 
 Distilled 
 
 water. 
 
 55° 
 
 18° 
 Soda 
 water. 
 
 18° 
 
 Distilled 
 
 water. 
 
 Ice water. 
 
 19° 
 
 Distilled 
 
 water. 
 
 19° 
 
 18° 
 
 Distilled 
 
 water. 
 
 18° 
 Ice water. 
 
 55° 
 Distilled 
 water. 
 
 10° 
 
 Distilled 
 
 water. 
 
 — ■ © . •"OS ^ "* 
 
 o ~ a '- S o . . _! . 
 
 »o m a © u m Q.->-3fl. 
 co © a •— occ-> r © <r> o ~ o 
 
 "*"£ ft « CCCO*sJ3 OCCO 
 S IQ 
 
 100 
 
 Distilled 
 
 water. 
 
 5 grra. 
 250 
 
 250 
 
 Distilled 
 
 water. 
 
 5 grm. 
 250 
 
 10 grm. 
 250 
 
 100 
 
 Distilled 
 
 water. 
 
 200 
 
 Distilled 
 
 water. 
 
 5 grm. 
 250 
 
 5 grm. 
 250 
 
 S -^ 1 
 
 oo --co eo -* io © f- ho © © -- 
 t^r- r- i— t- t^- r- r- r» t^ t~- oooo 
 
 
 XIV. — R. 
 C , set 60, 
 farmer. 
 Dilatatio- 
 ventric u- 
 li majoris 
 g r a d u s. 
 Food 
 remnants 
 fasting. 
 
 XV. — G. 
 M., ait. 45, 
 farmer. 
 Carcino- 
 ma and 
 dilatation 
 o f stom- 
 ach. Food 
 remnants 
 fasting. 
 
 XVI. — M 
 
 L., set. 40, 
 single. 
 Nerv o u s 
 f e male 
 with sub- 
 jective 
 gastric 
 ailinen t s 
 and re- 
 tarded di- 
 gestion of 
 albumen. 
 

 < 
 
 w 
 
 
 *9 
 
 The patient has remained 
 quietly seated during 
 the time of observation. 
 
 A walk in the garden 
 during time of observa- 
 tion. 
 
 Reinained quietly seated 
 during time of observa- 
 tion. 
 
 A walk in the garden 
 during time of observa- 
 tion 
 
 Reinained quietly seated 
 during time of observa- 
 tion. 
 
 A walk in the garden 
 during the time of ob- 
 servation. 
 
 V o 
 
 88 -r. 
 
 M a 
 
 2 '3 
 
 •52 g 
 
 pa© 
 
 p 
 
 H 
 H 
 
 H 
 O 
 
 ss. 
 
 fa H 
 
 © & 
 
 °w 
 ^ H 
 
 8 
 
 •uorj 
 -saSi<j_ aqj jajjB 
 uopoBag uo^da<j 
 
 V.' 
 
 Trace. 
 
 Pretty 
 dis- 
 tinctly 
 
 
 
 
 '1DH 
 
 jo uopippy jayy 
 
 a, 
 
 After 3 
 hours. 
 
 After 12 
 hours. 
 
 After 7 
 hours. 
 
 After 4}4 
 hours. 
 
 Undigest- 
 ed after 
 24 hours 
 
 Undigest- 
 ed after 
 24 hours 
 
 •nor* 
 -saSid aq; laijB 
 noipBay; uojdaj 
 
 © 
 
 Pr e 1 1 y 
 di s- 
 tinct. 
 
 Distinct 
 
 Distinct 
 trace. 
 
 a 
 Q 
 
 10R JO noil 
 -ippy ;noq;i^ 
 
 8 
 
 After 5% 
 hours. 
 
 After 2}/ 2 
 hours. 
 
 Incom- 
 plete 1 y 
 dige st- 
 ed after 
 24 hours 
 
 Undigest- 
 ed after 
 24 hours 
 
 plet e 1 y 
 digested 
 after 24 
 hours. 
 
 Si aa 
 
 a> t : 
 
 « o 
 
 < 
 
 14 
 
 •pray oil 
 
 -aoy pa^si^na'a 
 -uoo q;tiAV snonjf 
 
 S* 
 
 
 
 
 
 Faint 
 
 opales- 
 cence. 
 
 
 
 
 
 
 
 Trace. 
 
 Barely a 
 trace. 
 
 CD 
 
 ° s 
 
 H 
 
 •apu 
 -oiqo ranuB'a 
 q % t Ai sa^Bqd[ng 
 
 - 
 
 Milky 
 cloudi- 
 ness. 
 
 Decided 
 opa 1 e s- 
 cence. 
 
 Moderate 
 opa 1 e s- 
 cence. 
 
 Moderate 
 clou di- 
 ness. 
 
 ^ 3 m 
 
 ■jaioiA I^qraj\[ 
 q^I^i \0H aaij 
 
 •« 
 
 Distinct 
 
 Intense. 
 Faint. 
 
 ... 
 
 Dou b t- 
 ful. 
 
 Trace. 
 
 
 m pauiu^uoo 
 sapuoiqo"jo-?rav 
 
 Is 
 
 ©fa 
 
 ■•^ 
 
 20.0 
 
 27.5 
 28.0 
 
 8.8 
 37.3 
 
 11.0 
 33.0 
 33.0 
 
 35.0 
 23.0 
 
 A^rptoyjoasiSaci 
 
 ■^ 
 
 to o -^ o o o . . lo 
 
 t~^ •># ■»* r-5 co co '• ' Uo : 
 
 -B2iiY jo aajSaa 
 
 « 
 
 19.2 
 
 22.0 
 
 o 
 
 •pxnbti othsb£) parai 
 -idsy aqi jo uorrtpnoo 
 
 &a 
 
 Co 1 o r 1 e a s ; 
 faintly opa- 
 lescent. 
 
 Co 1 o r 1 e s s ; 
 distin c 1 1 y 
 opalescent. 
 
 Colorless; 
 faintly opa- 
 lescent. 
 
 Colorless; 
 disti u c 1 1 y 
 opalescent. 
 
 Colorless; 
 opalescent. 
 
 Faint lemon- 
 yellow; opa- 
 lescent. 
 
 Co 1 o r 1 e s s ; 
 strongly 
 opalescent. 
 
 Colorless; 
 frothy. 
 
 •jaiBAV paiipsid -oo 
 001 jo uopoafui aq; 
 aajjB parejidsy pmi j; 
 
 OU^SBQ JO ' '00 JO '0^ 
 
 S 
 
 No water 
 injected ; 
 100 cc. as- 
 pirated. 
 Nothing in- 
 jected; 180 
 cc. aspirated 
 120 
 
 110 
 140 
 
 100 
 160 
 170 
 
 Nothing in- 
 jected ; 180 
 cc. aspirated 
 110 
 
 •qoBinxns aqi ui uibui 
 -a^ o; paAvonB sbav 
 noimiosaqi'SJq^Jo-OM 
 
 <c 
 
 O O 2 <M IM CN CNCN(M|Oa, 
 
 "a pa - 
 
 •sntsjao saaaSaa ui 
 noiin[6g ^bs ppiudg 
 a q i jo ajnrBiadmex 
 
 13 
 
 20° 
 
 Ice water. 
 
 50° 
 Distilled 
 water. 
 
 50° 
 
 50°Muehl- 
 
 brunneu 
 
 water. 
 
 Ice water. 
 
 50° 
 Distilled 
 water. 
 
 •pajsaSni .isjbaV 
 panpstd JO *oo puB 
 ■rpjs lapnidg -souSjo *ox 
 
 w 
 
 100 
 Distilled 
 water. 
 
 200 
 
 Distilled 
 
 water. 
 
 5 grm. 
 
 250 
 
 250 Muehl- 
 
 brunnen 
 
 water. 
 
 ii 
 
 5 grm. 
 250 
 
 200 
 Distilled 
 water. 
 5 grm. in 
 250; after 
 % hour 5 
 grm. in 
 250. 
 
 •^narauadxa jo *ox 
 
 id 
 
 ^ co^ ioo r^ooo 
 ao oooo oooo 000000 
 
 O ^H 
 
 o> o 
 
 
 3 
 
 
 e 
 
 >£ 8Jh3.«H5 ex- cj a a a 
 X 
 
 XVIII.- 
 B. A., 
 set. 24, 
 h e a 1- 
 thy Is- 
 rae 1 • 
 ite. 
 Com- 
 
« S3 
 SJ 
 
 a a . 
 
 in 
 
 r- 
 
 ^ Si 
 
 ■• 
 
 « o 
 
 CO ~ « ° 
 
 ja o ™ o 
 
 ~ 5 c-H 
 
 a-,3 3 
 
 — -a 
 
 SB 09 ' sc 
 
 £ a . c 9 
 
 a3"u C -" 
 
 2 a 30 
 
 co o 
 
 bfifl 
 
 2 a « 
 
 S* 3 Si- 
 's aa 
 
 11 
 
 I* 
 
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 x> o 
 
 C c 5! 
 
 S = a> 
 
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 a"* 
 
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 c3 cj «- 
 
 |^ 
 
 £*a 
 
 
 
 
 «-> . 
 
 ^j g 
 
 
 
 3 8 
 
 
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 u a) 
 
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 s 
 
 
 : S F* 
 
 
 
 
 
 
 09 J3 
 
 
 
 
 p 
 
 
 fa 
 
 Q 
 
 
 • u 00 
 
 
 
 
 
 -a co 
 
 
 ^ 
 
 
 
 
 CO 
 
 ' « 03 
 
 aft 
 LOU 
 
 h 2 
 
 CO 3 
 
 ,, 
 
 
 M 
 
 : « « 
 
 C 
 
 n 
 
 x 
 
 
 
 Si 03 
 ^3 
 
 0>v- 
 
 
 -^ 2 
 
 
 
 =Jj« 
 
 r 
 - 
 
 93 
 $4 
 
 O 
 -a 
 
 
 
 
 E3 « CN 
 
 t> 
 
 <i 
 
 
 
 Q 
 
 
 <1 
 
 
 
 
 «! 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 : S 
 
 u 
 
 = 
 
 Distinc 
 trace 
 
 as£ 
 
 fa 
 
 
 3 
 
 
 
 
 _a 
 
 gn 
 P 
 
 CO 
 H 
 
 •J2 es 
 
 No odo 
 of pu 
 trefac 
 tion. 
 Trace. 
 
 g_ 0^ . 
 
 " » M s- 't 
 
 o»«>^ 5 
 
 a prt asj= 
 
 *» o 
 
 <w.a 
 
 p 
 
 r d r d ■<* 
 
 C Old 
 
 V S3 
 fa 
 
 a as a 
 o a.co 
 
 Dec idee 
 ppa 1 e s 
 ceuce. 
 
 Very fain 
 traces. 
 
 co 
 u 
 
 aS 
 
 1 
 
 CO 
 
 a co 
 
 ^j aS 
 
 Q 
 
 Do u b t- 
 ful. 
 
 3 
 
 
 a co 
 
 ■l-C CC 
 
 >>a 
 
 t- CO 
 
 CO -*> 
 
 > 
 
 5.S h 
 
 10 
 
 O 
 
 O 
 
 
 
 
 IO 
 
 IO 
 
 IO 
 
 10 
 
 IO 
 
 10 
 
 
 
 
 
 
 
 00 
 CM 
 
 CM 
 
 -t" 
 
 CO 
 
 CO 
 
 
 CM 
 
 S3 
 
 CO 
 
 t^ 
 
 O 
 CO 
 
 50 
 
 IO 
 
 CM 
 
 CM 
 
 
 
 CO 
 
 
 
 CO 
 
 CO 
 
 
 
 -# 
 
 
 
 w 
 
 Tf 
 
 
 
 
 CN 
 
 
 
 >o 
 
 10 
 
 CM 
 
 O 
 
 CM 
 
 CO 
 
 CM 
 
 co 
 
 CO 
 
 10 
 
 
 t^ 
 
 IC 
 
 w 
 
 
 
 
 
 
 
 
 
 
 
 O 
 
 
 <N 
 
 CN 
 
 
 
 
 
 
 
 
 
 
 
 O 
 
 CO 
 
 
 3 *3 
 
 w c ° "5 
 
 3 CO 
 
 o s*> 
 O 
 
 a^a 
 
 ■■H 03 
 
 fa 
 
 ; o o 
 3 
 
 C o O mi 
 O 
 
 o a cj 
 
 TlcS co 
 
 3 Q 
 
 22 
 
 7! ^ 
 o a 
 
 o 
 
 — « --H co 
 
 1§S 
 
 9-° 
 
 co c-2 co •• <*> il 
 
 
 O J2 
 IO ~^ 
 
 S-^2 iS 
 
 - O i. o 
 
 3 a LV= .• 
 
 ^ 3 « u o 3 ^ 
 
 ?£^c!2^ 
 
 u 2 CO 
 
 co = a 
 
 asS 5- 
 
 & s 
 
 COJ3 
 
 ■S|3-2 
 
 CM. 
 
 •M 
 
 10 
 
 ac •_ i — 3 
 "5.0 tbai 2 
 
 ^ .^aJ-« — ^SO- 3 - ^ 
 | - , !-58iv.©a8-<Ci!-'0«*a«JCl3fS 
 
 S-a^asaaSaS^S^ 
 

 
 
 
 
 Si 54 
 
 •J 
 
 CD > 
 
 
 
 1* 
 
 
 
 
 
 g« "2 s 
 
 C0J 
 
 "2« 
 
 J — 
 
 
 
 i! 
 
 « 
 
 
 
 
 £Z i 
 
 £\° 
 
 b0° 
 
 
 
 ►,© 
 
 
 
 
 
 a> ° op 1 © 
 
 CD O 
 
 CD O 
 
 
 
 ^'s 
 
 *" 
 
 
 
 3 2 -c <o 
 
 = 2 
 
 J3 CD 
 
 
 
 §<a 
 
 
 
 
 
 ^^ .s- 
 
 ■O*" 
 
 a "43 
 
 
 
 
 
 
 abD bD 
 
 O bJD 
 
 '" to 
 
 
 
 CD bo 
 
 
 
 
 
 C 3 .M a 
 
 . fl a . 
 
 a a . 
 
 
 
 a a . 
 
 
 
 
 
 He's 3"3"S 
 
 c"S"S o 
 
 15'" a 
 
 
 
 '3'Z a 
 
 
 
 
 
 CD ^ *> 'C 
 
 z - = .2 
 
 %*% 
 
 
 
 a=-2 
 
 
 
 
 
 D3 < 
 
 <s* 
 
 -»J 
 
 
 
 n 
 
 •aota 
 
 
 
 
 
 
 
 CD 
 
 
 
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 •sgSid aqi J9JJB 
 
 ^ 
 
 
 
 
 3 
 
 3 
 
 g 
 
 
 
 a 
 o 
 
 uopouea: uo;d9<j 
 
 
 
 
 
 
 
 H 
 
 
 
 
 
 
 
 
 ■ i- CO 
 
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50 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 SECTION 9. 
 DEDUCTIONS FROM THE TABLE OF EXPERIMENTS. 
 
 If the experimental results are examined, they will be found to differ 
 widely. The influence of the salt on the functions of the stomach is there- 
 fore not always the same. It depends upon three circumstances : (a) above 
 all upon the pathological condition of the stomach, (J?) upon the dose of 
 Sprudel Salt, and (V) upon the circumstances accompanying the ingestion of 
 the salt, as solvent, and temperature of the same. In reference to point (a) 
 this shows a difference of deportment in the Sprudel Salt, depending upon 
 the presence of (a) an alkaline or slightly acid gastric secretion (X-XVI, 
 also XXIII), (/9) an acid gastric secretion (VI-IX, also XVII, XVIII, XX, 
 XXI, XXIV), ( r ) an excessively acid secretion (I-V, also XIX, XXII, 
 XXV, XXVI), or lastly upon (d) a high grade of gastric dilatation (XI, 
 XII, XIV, XV, XIX). 
 
 i. When does the Sprudel Salt disappear from the stomach ? is the question 
 that obtrudes itself upon our notice in experiments of this kind. Placed in 
 this wise it is, however, impossible to solve it, inasmuch as the different 
 constituents of the Sprudel Salt do not disappear at the same time, because 
 the resorptive power of the gastric mucous membrane differs for the different 
 salts, as I have demonstrated is the case in man (Zeitschr. f. Bio/., xix, 
 p. 398). To obtain comparative results it is, therefore, necessary to confine 
 ourselves to the disappearance of one constituent of the Sprudel Salt. This 
 is not possible with sodium bicarbonate, as it undergoes a chemical change 
 produced by the acidity of the stomach in addition to resorption. The 
 sodium chloride, which could be easily determined quantitatively in the 
 gastric juice, has the disadvantage that the chlorides already present in it 
 materially influence the results obtained. There remains then only the 
 third constituent, the sulphates, that could be used as a test for the disappear- 
 ance of the Sprudel Salt. The sulphates, which are entirely foreign in the 
 normal condition of the contents of the stomach, are not influenced by the 
 gastric acid and can be very easily and distinctly detected by means of 
 barium chloride. 
 
 (a) If, therefore, the disappearance of the sulphates from the stomach are 
 taken as indicative of the disappearance of the Sprudel Salt, then column 1 
 shows that when 5 grm. doses were employed they disappeared in half an 
 hour only in two cases (I, 3; X, 54), in which there was no disease of the 
 stomach present ; in all other cases, however, much later. In the majority of 
 the cases the sulphates disappeared from the stomach entirely in the fourth 
 quarter of an hour, i. e. , within an hour. Only in cases of dilatation of the 
 stomach their disappearance is markedly delayed. After one hour large 
 quantities of sulphates were still to be found in all cases of dilatation (XIV, 
 74; XV, 76; XI, 62), and in the case (XIX, 101) of dilatation of the stomach, 
 
DEDUCTIONS FROM THE TABLE OF EXPERIMENTS. 51 
 
 which was examined after two hours, they were still present in small quanti- 
 ties. In all experiments where 10 grm. doses of Sprudel Salt were given the 
 table shows that still after one hour a large quantity of Sprudel Salt was found 
 in the stomach. In all cases the chloride of barium causes a cloudiness or 
 precipitate in the gastric fluid. If the 10 grm., as was generally the case, 
 were divided into two 5 grm. doses and given half an hour apart, there was 
 much less sulphate found when the stomach was examined after the lapse of 
 2 or 4 quarter-hours after the administration of the last dose than when one 
 large 10 grm. dose had been given (X, 58-60). The time of disappearance 
 of the 10 grm. doses varied greatly. In case of acid gastric secretion (I, 8; 
 V, 29 ; IX, 49; XII, 66) the sulphates had almost entirely disappeared after 
 6 quarter-hours. In other cases, as in acid catarrhal disease (VIII, 44) the 
 sulphates disappear at the end of the second hour, and in dilatation of the 
 stomach (XV, 77) sulphates may even be found on the following day. It 
 may, therefore, be assumed that in the majority of cases a dose of 5 grm. 
 Sprudel Salt disappears from the stomach in 4, and a 10 grm. dose after 6 
 quarter-hours. In some pathological conditions the disappearance may be 
 very perceptibly delayed. 
 
 Inasmuch as larger quantities of Sprudel Salt required still longer time to 
 disappear from the stomach, and as it is rather difficult to keep the patient 
 fasting for hours, and as in addition to this, as will be observed below, larger 
 quantities of Sprudel Salt very much affected the gastric function, I have for- 
 borne from making any experiments in this direction with larger doses than 
 10 grm. 
 
 (^) It is a rather delicate thing to speak of the disappearance of the 
 chlorides from the stomach, as I have already mentioned. I have endea- 
 vored to determine the same for other purposes in some cases, and placed 
 them in the table, column /. Only this much may be inferred therefrom, 
 that, after the lapse of several quarter-hours after the ingestion of the solution 
 of Sprudel Salt of the strength employed, 82.6 c. c. one-tenth normal silver 
 solution to 100 salt solution, according to my method, the percentage of 
 chlorides was usually found to be smaller than in the empty stomach, and 
 invariably smaller than when obtained by the ice-water method (XVI, 78, 
 79, 81 ; XVII, 82, 83, 85; XVIII, 90, 91; XIX, 97, 101, 103; XXIV, 
 124, 125). The percentage of chlorides in the gastric contents after the 
 taking of Sprudel Salt diminishes to a certain minimum (XIX, 101, 102), 
 whereupon it begins to rise again. 
 
 At this place mention may be made of the circumstance, to which I now 
 give more attention in my examination of the stomach, that the secretion of 
 the chlorides from the gastric mucous membrane also increases in abnormal 
 acid hypersecretion, and that in greater degree than the secretion of acid, 
 whilst in acid insufficiency the quantity of chlorides also appears diminished. 
 Compare, for instance, the cases XIX, 97 ; XXII, 116; XXIII, 120, 121. 
 
 (f) The disappearance from the stomach of the bicarbonates, the percent- 
 
52 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 age of which corresponds to 90.4 c. c, one-tenth normal acid solution per 100 
 c. c. salt solution, is easily determined by the cessation of the alkaline re- 
 action of the gastric contents, and does not go hand in hand with the disap- 
 pearance of the sulphates, because, in addition to their absorption and 
 mechanical removal from the stomach, they continually suffer chemical de- 
 composition by the gastric juice. The length of time the bicarbonates 
 remain in the stomach is, therefore, relative, according to the case. When 
 5 grm. or more of Sprudel Salt are given at one dose the carbonates may 
 already disappear after the first quarter-hour if they happen in an acid gastric 
 secretion, as I have repeatedly assured myself in cases of gastric dilatation 
 with acid hypersecretion, associated with retention of food remnants. If 
 these cases be eliminated then the table will show, column k, that in the nine 
 cases cited suffering from acid hypersecretion the bicarbonates have already 
 disappeared before the lapse of half an hour ; in the four cases designated 
 as moderate acid secretion and approaching nearer to the normal, this oc- 
 curred in two (VI, 32 ; XVII, 84), in the other two cases (VII, 38 ; IX, 46) 
 the gastric contents were at this time strongly alkaline, owing to sodium car- 
 bonate. In the stomachs with acid insufficiency, on the contrary, the sodium 
 carbonate only disappeared in half an hour in the single case (X), and in 
 every other case decided alkalinity is noticed, in the cases XIV, 74, and 
 XVI, 80, even 26 and 5 degrees alkalinity. 
 
 When a 10 grm. dose is administered the carbonates will disappear in the 
 following manner : In all cases of acid hypersecretion the carbonates have 
 disappeared from the stomach after one hour. In the 4 cases examined of 
 moderate acid secretion this was not the case in one instance ; the acid con- 
 tents even effervesced with HCl (VIII, 41). Not until five quarter-hours in 
 case XVIII, 94, 95 ; after six quarter-hours in case VII, 39, and after two 
 hours in case VIII 44, did the carbonates leave the stomach. In cases of 
 acid insufficiency the time of disappearance was extended even more, but not 
 so much as might be expected. For, as noticed in case XIII, 72, it was 
 almost as long as in acid secretion. As an average, it may be stated that the 
 carbonated alkalies of the Sprudel Salt will disappear from the stomach 
 when 5 grm. doses are given in three quarter-hours, and when 10 grm. doses 
 are given at the end of two hours. In all cases in which the carbonates 
 were found larger quantities of sulphates were also present, so that it appears 
 that the bicarbonates of the Sprudel Salt are more quickly absorbed in the 
 intestinal canal than the sulphates, inasmuch as no carbonates could be found 
 in the passages, but only sulphates, as is mentioned in Section 4, whilst the urine 
 is found to be alkaline upon examination after the ingestion of Sprudel Salt, 
 and the carbonates could be demonstrated by the effervescing of the urine 
 upon the addition of an acid. 
 
 2. The chemical function of the stomach undergoes a decided change in 
 every direction under the influence of the Sprudel Salt. 
 
 (a) The acidity of the gastric juice, as would be expected and may be 
 
DEDUCTIONS FROM THE TABLE OF EXPERIMENTS. 53 
 
 seen in column /, is changed to alkalinity. This takes place only in the first 
 moments, the alkalinity thereupon decreases, and the gastric acid becomes 
 free. The time when free acid again appears depends upon the individual 
 and upon the dose employed. With a dose of 5 grm. Sprudel Salt the 
 acidity of the gastric juice in strongly acid secretion, with the exception 
 of case III, was very marked in half an hour after the administration of 
 the salt. In case IV, 22, it was not only greater than that of the empty 
 stomach, but exceeded even the acidity obtained by the egg albumen method. 
 In cases of moderate acid gastric contents, on the contrary, the gastric acid 
 was regenerated in two cases after half an hour, but not in two others, in 
 which it required one hour (IX, 47). In alkaline gastric juices no strongly 
 marked acid secretion follows the disappearance of the carbonated alkalies, 
 still, in one case of alkaline secretion (XIII, 71, 72) a slight tendency to 
 acid secretion was noticed. 
 
 When 10 grm. doses of Sprudel Salt are given the appearance of free gas- 
 tric acid is much delayed. In strongly acid secretions the gastric acid is 
 regenerated, on an average, in 1 hour after the ingestion of the salt, in 
 moderately acid after 6 quarter-hours (IX, 49), or even later — in case VIII, 
 44, after 2 hours. In weak acid gastric secretion a decided alkalinity of the 
 gastric juice is still present after 6 quarter-hours (X, 59). The regeneration 
 of the gastric acid begins, therefore, under ordinary circumstances, after the 
 administration of a 5-grm. dose in 3 quarter-hours, and after a 10 grm. dose 
 at the end of 2 hours. 
 
 The secretion of acid under the action of the Sprudel Salt, however, shows 
 certain peculiarities. In cases VI and IX, where the degree of acidity of 
 the gastric juice was examined after 2, 4, 6 and 8 quarter-hours, it will be 
 seen that the acidity rises to a certain height much stronger than when ob- 
 tained by the ice-water method (experiments 30, 35), and falls from this 
 maximum very quickly to even below the degree of acidity of the empty 
 stomach (experiment 31, 36), so that, in reference to the action of the 
 Sprudel Salt upon the secretion of acid, 3 stages may be observed: the 
 stage of latent acidity, the stage of increase of acidity, and the stage of 
 fall or reduction of acidity. This great cycle of secretion probably does 
 not last much longer than 2-3 hours, depending upon the dose administered. 
 
 (3) The digestive power of the gastric juice, which is measured by the 
 time required to digest the egg-albumen disk, shows, under the influence of 
 the Sprudel Salt, very characteristic changes. An alkaline gastric juice, of 
 course, does not digest at all of itself. But it is only exceptionally a patho- 
 logical condition of the stomach in which the alkaline contents of the 
 stomach would not digest an albumen disk after acidification with HCl, so 
 that there are only exceptional cases in which the digestive ferment is totally 
 absent (XIII, 67; XIV, 73). If the solution of Sprudel Salt, however, is 
 put into the stomach, the gastric juice in all cases loses its digestive power 
 so completely (as was found in trials outside of the organism, as cited in 
 
54 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 Section 8) that it, even after decided acidification with HCl, failed to affect 
 the albumen disk at all, as is demonstrated by the numerous trials on the 
 table, column/. A gastric juice rendered strongly alkaline by means of 
 solution of Sprudel Salt may of itself dissolve an albumen disk (II, 13 ; VIII, 
 41 ; X, 53, 55), but does not digest the same, as no pepton can be demon- 
 strated in the solution. If the degree of alkalinity diminishes to a certain 
 point after the imbibition of the Sprudel Salt, then it may, in rare cases 
 (XII, 65, 66; XIII, 70), show a slight digestive power after acidification 
 with HCL This degree of alkalinity lies between 3 and 4 ; in other cases, 
 however (IX, 46, 48), no trace of digestive power manifests itself at this 
 degree of alkalinity. With the appearance of free gastric acid the digestive 
 power is slowly regenerated. To insure a complete digestion of the albu- 
 men disk, however, the degree of acidity must at least reach to 5-6 (VI, 36; 
 IX, 49). But even at this degree of acidity, at which the contents qf the 
 stomach obtained from the empty stomach or by means of the ice-water 
 method, would invariably digest, in other cases the gastric juice called forth 
 by means of the Sprudel Salt appears incapable of digestion (1, 2,6, 7, IV, 
 21, 24; VI, 30, 32, 33; XVIII, 94, 95), and the acidity had to rise much 
 higher or HCl had to be added to obtain a complete digestion of the albu- 
 men disk. It would therefore appear that either the gastric acid is more 
 rapidly regenerated than the digestive ferment, which would point to 
 free acid, and by the Sprudel Salt more strongly affected pepsin-forming 
 anatomical elements, or that the salts still present in the stomach prevent 
 the action of the pepsin, as may be seen by the columns n, 0, in the experi- 
 ments I, 7 ; IV, 24; VI, 32, 2>2>> as l° n g as tne contents of the stomach, 
 show a greater percentage of salt, the gastric juice cannot be made tho- 
 roughly efficient, even when HCl is added (IV, 24; VI, 32; IX, 46, 48; 
 XVII, 84). The condition found in the experiments, that the maximum of 
 digestive power does not rise with the maximum of the acidity of the gastric 
 juice, but rather generally falls with the same, will be hereby understood. A 
 complete digestive power of the gastric juice after a dose of 5 grm. Sprudel 
 Salt sets in, in cases of hyperacid secretion, with the exception of case III, 
 after 2 quarter-hours ; not then, however, in cases of moderate acid secretion. 
 This, however, took place in the two experiments instituted for the purpose 
 in case VI, 34, after one hour, but not in case IX, 47. Where the secretion 
 reacted alkaline, naturally no gastric juice capable of digestion could be ob- 
 tained in any case, not even, as in case XV, where the gastric contents 
 reacted acid, which was, as was demonstrated in that case, not due to HCl, 
 but depended upon organic fermentation acids. 
 
 After 10 grm. doses of Sprudel Salt the appearance of a gastric juice thor- 
 oughly capable of digesting was very much delayed. In cases of acid hyper- 
 secretion a gastric juice capable of digesting appeared after 5 quarter-hours 
 only in the one case, XIX, 103, and after 6 quarter-hours in case V, 29 ; 
 in other cases, as, for instance, IV, 25, it failed to appear even after & 
 
DEDUCTIONS FROM THE TABLE OF EXPERIMENTS. 55 
 
 quarter-hours. Of course, this was still less the case in cases of moderate 
 acidity, where, for instance, in case VIII, 44, of pretty decided acid reac- 
 tion, the gastric juice was neutral after two hours. 
 
 . For the majority of cases it may, therefore, be assumed that a gastric 
 juice capable of digesting reappears in the stomach after the administration 
 of a 5-grm. dose of Sprudel Salt in one hour, and after a 10-grm. dose after two 
 hours. 
 
 4. The gastric juice obtained under the influence of the distilled water 
 and the Sprudel Salt solution shows still other differences which show them- 
 selves already in the appearance of the gastric contents. 
 
 (a) The gastric liquid obtained by means of distilled water appears, in 
 the majority of cases (for instance, in cases II, XX, column g), more cloudy 
 and full of suspended particles than when obtained after the ingestion of 
 solution of Sprudel Salt. The solution of Sprudel Salt dissolves the mor- 
 phological constituents (dead cells, fermentation organisms) from the walls 
 of the stomach, and contains the same not suspended, but dissolved or in a 
 semi-dissolved condition. The gastric fluid, therefore, appears the clearer 
 after the ingestion of the Sprudel Salt, the longer time is allowed to elapse 
 before it is removed from the stomach; i. e., the longer the morphological 
 constituents were in contact with the solution of Sprudel Salt. 
 
 (£) The Sprudel Salt generally produces a ropy, mucous, gastric fluid, 
 which is difficult to filter ; which, when alkaline or slightly acid, invariably 
 shows traces of mucus (Table, column g), and that the more, the greater the 
 quantity of Sprudel Salt has been introduced into the stomach (IV, 20, 
 24, 25 ; VII, 37, 3 S, 39 ; XVII, 82, S8, 89; XVIII, 90, 91, 92). With 
 greater acidity of the gastric fluid, the mucus is, however, not demonstrable 
 with concentrated acetic acid, although it certainly is present therein ; for 
 the presence of an albuminoid in the gastric juice is demonstrated by tha 
 violet-red reaction after addition of solution of sulphate of copper to the 
 gastric fluid neutralized with potassium hydroxide. The mucus has prob- 
 ably undergone a certain modification, not yet fully determined, in the acid 
 gastric contents. As a rule, no reaction for mucus is obtained in the filtrate of 
 a gastric fluid obtained by distilled water, although the same may frequently 
 be seen in the form of thread-like masses or mucous flakes — these remaining 
 on the filter. 
 
 (c) The color of the gastric fluid (Table, column g) appears, under the 
 influence of the Sprudel Salt, more frequently yellow than when distilled 
 water only has been employed. Especially that aspirated in the first half- 
 hour after the ingestion of the salt is colored yellow. This yellow color is 
 caused by the pouring in of bile into the stomach, which points to the fact 
 that a copious secretion of bile, and strong peristaltic movements of the 
 upper portion of the intestinal canal, is produced by the action of the Spru- 
 del Salt, which is really the case in the beginning of the action, owing to 
 the stimulus of a warmer and more concentrated solution. If the bile has 
 
$6 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 but recently been poured into the stomach, or perhaps been poured in during 
 its excretion, then it is light yellow, and the nitrate is of the same color. 
 But if the bile has been retained in the stomach for a longer time, then 
 yellow or green flakes are formed. The gastric fluid appears, according to 
 the acidity, either greenish-yellow or bluish-yellow, and the filtrate of the 
 same color or else rosy-red. 
 
 (V) The digestive power of the gastric juice obtained by means of dis- 
 tilled water, especially ice water, shows itself much more active than when 
 obtained by means of Sprudel Salt, when the samples are compared and are 
 of the same degree of acidity, 'and that sufficient for digestion. This refers 
 as well to the rapidity of peptonization as also to the reaction for pepton. 
 The time for peptonization in the table, column «, I, 27 ; VI, 30, 32, in spite 
 of the same degree of acidity of the gastric juices in both cases, was invaria- 
 bly longer when Sprudel Salt was used than when distilled water was employed, 
 and this is also frequently the case when the acidity after Sprudel Salt exceeds 
 that after distilled water, as in cases IV, 21, 24; XX, 106, 108. In the com- 
 pleteness of the power of peptonization a still greater difference was observed 
 in the two kinds of gastric fluid. If the gastric juice obtained by means 
 of Sprudel Salt solution without or after acidification completely dissolved 
 the albumen disks, the digestive fluid failed to give a red color reaction of 
 pepton, as was the case when obtained by distilled water, but a violet, or a 
 shade of violet, as shown in the cases VI, 30, 33, and IX, 45, 49, column 
 n, o, p, r. It is therefore very probable that the gastric juice obtained by 
 means of Sprudel Salt cannot produce the final product of digestion pepton, 
 but stops at the intermediate product of digestion, the propepton, which 
 modification of albumen lies between the acid albumen and the pepton 
 proper. 
 
 5. The action of cold and warm Sprudel Salt solution on the function of 
 the stomach may be seen in the experiments I, 4, 5 ; II, 12, 13 ; III, 16, 17; 
 IV, 24, 25 ; V, 27, 28 ; XIII, 68, 70 ; XVI, 80, 81, in which the Sprudel Salt 
 was dissolved once in distilled water at 18 , another time at 55 . When a 
 warm saline solution was administered, a much larger quantity of fluid and 
 much larger percentages of bicarbonates and sulphates were found in the 
 stomach than when a cold solution was administered ; furthermore, that the 
 appearance of the acidity and digestive powers of the gastric juice appear 
 much later when a warm solution is injected than after a cold solution. 
 Only, exceptionally, in case VIII, 41, 43, no difference was noticeable in 
 the action of a cold and warm solution of Sprudel Salt. A warm solution, 
 therefore, remains for a longer time in the stomach, and influences its func- 
 tion also for a longer time than a cold solution. 
 
 6. The different influence of the soda water as solvent for the Sprudel 
 Salt as compared with distilled water may be observed from the experiments 
 I, 5, 6; II, 13, 14; VI, 32, 33 ; VIII, 41, 42; XII, 70, 71. From these it 
 will be noticed that when soda water was used in case of alkaline gastric se- 
 
EFFECT UPON THE FUNCTIONS OF THE STOMACH. S7 
 
 cretion the alkalinity was Less ; in acid secretion, however, the acidity rose 
 higher and quicker than when distilled water alone was used, so that the 
 maximum of acidity and digestive power is arrived at sooner, but also falls 
 more rapidly in the first than in the last case. The disappearance of the 
 salt from the stomach, as demonstrated by the reaction of the sulphates, is 
 much expedited by the soda water, probably on account of the stimulation 
 to absorption of the free carbonic acid and its power of increasing peristalsis. 
 Soda water increases and at the same time shortens the stimulating action of 
 the Sprudel Salt on the entire gastric function. 
 
 SECTION lO. 
 
 THE EFFECT OF ADDITIONAL DOSES OF SPRUDEL SALT 
 UPON THE FUNCTIONS OF THE STOMACH. 
 
 i. To obtain information on this point, a 5 grm. dose was administered 
 in case X, 54, and aspirated after 2 quarter-hours, the gastric liquid obtained 
 digested and contained no sulphates. If, immediately thereafter, another 
 similar dose was introduced into the stomach (experiment 55), and aspirated 
 after 2 quarter-hours, the gastric liquid obtained entirely failed to digest and 
 contained a large quantity of sulphates. If this was again repeated (X, 53, 
 56), it was found that, after aspirating 3 quarter-hours later, the liquid 
 obtained, although containing no sulphates, the digestive powers of the gas- 
 tric juice had not yet been regenerated. It therefore follows that the injury 
 to the gastric function is increased by repeated doses, and the stimulating 
 effect appears reduced. In addition, it may be mentioned that larger doses 
 lower the gastric function much more and are much less stimulating upon 
 the gastric function than small doses. For in case XII, 65 and 66, the gas- 
 tric liquid, after 5 and 10 grm. doses, was kept at the same reaction, still the 
 gastric liquid obtained after the 5 grm. Sprudel Salt digested quicker and 
 more completely than that obtained after 10 grm. 
 
 2. The action of the Sprudel Salt upon the gastric function when used for 
 a longer time differs on the last day from that of the first. Experiments V, 
 27 and 27 (<£), as also XIII, 68, 69, of the table, which were made after two 
 weeks' use of the Sprudel Salt under the same conditions, demonstrate that 
 the stomach reacts much more strongly during the first days of the use of the 
 salt than in the following. The acidity in the later days becomes less, the 
 quantity of sulphates in the stomach greater and the digestive power much 
 more reduced. 
 
58 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 SECTION 11. 
 
 CHANGES IN THE ENTIRE GASTROINTESTINAL FUNCTIONS 
 AFTER CONTINUED USE OF THE SPRUDEL SALT. 
 
 In what way, however, the continued use of Sprudel Salt influences the 
 gastro-intestinal function, I have had the opportunity to observe and closely 
 study, especially in 3 cases. Inasmuch as the individual experimented upon 
 was continually under my control at home and could finally be discharged 
 with decided improvement of 'his diseased condition, I will give the history 
 of his disease in detail. 
 
 W. N., set. 47, married; Catholic; village shoemaker from Krzeszow. 
 According to his own account, he has suffered for the past 4 years from gas- 
 tric ailments. They manifest themselves generally after eating food that is 
 difficult of digestion, and consist of fullness, oppression, frequently burning 
 and pains in the stomach radiating to the back and chest ; in addition there 
 are sour eructations. Concerning vomiting, the patient states that it occurred 
 only 2 or 3 times during his illness, and then consisted of food only. The 
 patient has appetite for all kinds of food, but fears to take any quantity, 
 fearing thereby to cause the gastric pains. The patient describes his pains 
 as being very severe, is much depressed and gives the impression of being a 
 hypochondriac. Had no evacuation of the bowels for several days at a time, 
 the stools then consisting of several balls. The patient also complains of 
 great weakness since the appearance of the disease. 
 
 Physical examination revealed the following : The individual is well built, 
 but very moderately nourished ; color of skin and face pale. Nothing ab- 
 normal could be found in any organ, with the exception that a peculiar suc- 
 cussion in the region of the stomach could be produced during the afternoon, 
 but which was never found early, fasting. The patient was placed upon a 
 simple and uniform diet, lasting during the entire period of treatment and 
 observation. This daily consisted of the following : For breakfast, a half 
 litre boiled milk, two boiled eggs and a roll ; for dinner, meat soup, a ration 
 of beef or an allowance of roast beef with gravy and half a roll; evenings 
 at 8 o'clock, a glass of tea with sugar, two soft boiled eggs and half a roll. 
 
 The patient was now subjected to an internal examination of the stomach, 
 according to the Krakauer method, the details of which are given in the 
 table under No. XXV :— 
 
 (a) Examination of the empty stomach (experiment 132) with 100 c.c. 
 distilled water showed a pure gastric juice, containing, however, a large per- 
 centage of ZTC/and of intense digestive power. 
 
 (<£) The egg albumen method (experiment 133) showed a similar result in 
 reference to the acidity. 
 
 (<:) The beefsteak method (experiment 136) also shows a high degree of 
 acidity and mechanical weakness of the powers of the stomach. 
 
INFLUENCE ON (.ASTRO-INTESTINAL FUNCTIONS. 59 
 
 (y) With the gastric volumeter the capacity of the stomach was found to 
 be 3100 c.c, at a water pressure of 22 cm. 
 
 (<*) The microscopical examination of the contents of the fasting stomach 
 showed whole heaps of round, single and double cell nuclei. 
 
 This examination led to the diagnosis of an acid disease of the gastric 
 mucous membrane in connection with a dilatation of moderate degree (in 
 comparison with the average stomach capacity of the Polish peasants). 
 
 The treatment was begun on the 19th of March, 1884. The Sprudel Salt 
 was administered during the entire period of treatment by means of the 
 stomach tube, in a 5 per cent, watery solution. From the 19th of March to 
 the 5th of April — i. e., during 16 days — 10 grm. Sprudel Salt were intro- 
 duced at 7 a.m. into the empty stomach, and again 10 grm. at 6 p.m. (20 
 grm. daily). During these 16 days of treatment, the patient had 2 mushy 
 passages the first 4 days ; later on, 3 at different times during the day, which 
 afforded him much relief of the abdominal pains. The patient felt, alto- 
 gether, subjectively better from day to day, had more confidence to eat, and 
 developed a voracious appetite. The former dread of victuals disappeared 
 to such a degree, that the patient occasionally allowed himself to take other 
 food than the above-described diet ; but as the deception was brought to 
 light by means of the stomach tube, he submitted to the prescribed regime. 
 From the 6th to the 10th (during 4 days) 30 grm. Sprudel Salt were given 
 daily, 20 grm. at 6 a.m., fasting, and 10 grm. at 6 p.m. Whilst during the 
 previous period the patient felt quite well — so much so, in fact, that he wished 
 to return home — there appeared a change in the subjective symptoms of the 
 patient during these days. He complained of sleeplessness, startling dreams, 
 headaches, feeling of heat in the head (although, objectively, no local increase 
 of temperature could be noticed), general weakness, then followed nausea, 
 eructations after eating, and a disagreeable feeling along the entire oesophagus. 
 Although the passages remained of the same number (2-3 daily), they were 
 more watery. During this second period — i. e., in the third week of the 
 treatment — observations w r ere made of the gastric function early, fasting, 
 before the administration of the salt. They showed the following compared 
 with the condition before the treatment : The acidity and digestive power 
 of the contents of the stomach, fasting, much reduced (table, experiment 
 137) ; the same was also shown by the albumen (experiments 138 and 139} 
 and ice-water method (experiment 140); at no time could sulphates be dis- 
 covered in the fasting stomach from the previous day. Although objectively 
 there was found a beneficial change in the gastric functions, on account of 
 the subjective gastric ailments, the dose of the Sprudel Salt had to be reduced. 
 On the nth and 12th of April, the dose of 20 grm. Sprudel Salt was again 
 returned to. The general subjective ailments, however, did not subside, and 
 a want of appetite and disgust for food set in ; in addition, there was tenes- 
 mus, very watery stools during the day, and severe burning in the rectum, 
 so that to alleviate the intestinal symptoms recourse had to be had to opium 
 
60 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 suppositories, and the dose of Sprudel Salt reduced to 10 grm. daily, taken 
 at one dose, fasting, from the 13th to the 17th of April. Not until then did 
 the subjective symptoms begin to subside, the number of passages were 
 reduced to 3, and the condition improved to such a degree that, on the 
 18th and 19th of April, 20 grm. were again given daily (*. e., 10 grm. early, 
 fasting, and 10 grm. in the evening), whereupon the treatment with Sprudel 
 Salt was discontinued. There was a pause made in the treatment with 
 Sprudel Salt from the 20th to the 23d of April, but the same diet, however, 
 was continued. During this time the patient complained of no ailment 
 whatsoever. The following, however, was now noticed, and found to continue 
 until the end of the following period of observation : The original voracious 
 appetite has given place to a feeling of satiety, and the patient, who, at the 
 beginning of the treatment, continually complained of hunger and wanted 
 more food, felt completely satiated with the prescribed diet, so that he occa- 
 sionally refused the roll at dinner, because he felt no desire for it. Further- 
 more, the passages did not return to normal, in spite of the fact that the 
 Sprudel Salt was discontinued ; there would always be 2-3 mushy passages, 
 accompanied with straining, and this condition continued still for a number 
 of days, during which the patient remained under observation. After an 
 intermission of 3 days, the examination of the gastric function, compared 
 with that before the treatment, showed the following result : The secretion 
 of the gastric mucous membrane has become much less, inasmuch as the 
 gastric liquid aspirated in the first and last experiments had become con- 
 siderably less. 
 
 The acidity of the contents of the fasting stomach is, according to experi- 
 ment 142, reduced from 13 to 4, the rapidity of digestion from 4 to 15 hours. 
 According to the ice-water method, however (experiment 143), the acidity 
 was reduced from 17 to 3, the time of digestion from 3 to 22 hours. Accord- 
 ing to the albumen method (experiment 144), however, the acidity was 
 reduced from 42 to 6.5, and the digestion from 4 to 24 hours. The beef- 
 steak method (experiment 141) also showed less acidity (24), which, however, 
 for the most part was dependent upon the fatty acids (drops of grease were 
 seen floating on the gastric fluid). The capacity of the stomach, measured 
 at this time, appeared somewhat smaller (2900 c.c), in spite of greater height 
 of the water column (26 c.c), i. e., the vital contractility of the gastric walls 
 has become somewhat stronger owing to the treatment. In reference to the 
 mechanical power, it must be admitted that it also had become improved, 
 for, in spite of the reduced chemism of digestion, less undigested albumen, 
 as also fewer particles of meat, were found by the albumen,* as also by the 
 
 * It occasionally happens that with the albumen method, even in a chemically normal 
 stomach, isolated pieces of albumen will be brought to light, even after two hours, if the 
 stomach is carefully rinsed ; these, however, have sharp and entire margins, and have prob- 
 ably been retained in the folds of the mucous membrane ; if they are in addition tinged 
 
INFLUENCE ON GASTROINTESTINAL FUNCTIONS. 6 1 
 
 beefsteak method, than were found at the beginning of the treatment. The 
 patient was now allowed to return to his home without any subjective ailments 
 whatsoever, and with the conviction that he was cured. 
 
 The second case examined in the same direction was S. B., ?et. 23, village 
 servant. He came to the clinic on June 3d, on account of violent subjective 
 gastric ailments. External physical examination showed nothing abnormal, 
 the internal examination of the stomach, however, executed in precisely the 
 same manner as in the above case, showed the following : On June 4th the 
 clear gastric contents of the fasting stomach of the degree of acidity 22, 
 with very intense hydrochloric acid reaction, and containing 32 per cent, of 
 CI. The artificial digestion finished after 3^ hours, peptonization complete. 
 On June 5th the albumen method also yielded a clear gastric fluid of the 
 acidity 22, extremely intense HCl reaction and 38 per cent. CI. The arti- 
 ficial digestion completed after 3% hours, peptonization complete. On 
 June 6th the capacity of the stomach was 2500 c.c, with the water column 
 at 12 cm. The patient was ordered to takeatablespoonfulof Sprudel Salt in 
 two glasses of warm water, fasting. He only took the same for eight days, 
 then remained a whole week without medicine, until he again came up for 
 examination on June 22d. He said that he felt better and could now eat 
 more, because the constriction and burning in the region of the stomach 
 was much less. The internal examination of the stomach, made on June 
 2 2d, showed the following : The clear contents of the stomach obtained, 
 fasting, showed a degree of acidity of 11, an intense HCl reaction and 31 
 per cent, per c.c. of CI; the artificial digestion was finished in five hours. 
 The ice-water method, performed on June 23d, showed the acidity to be 18 
 degrees, very intense HCl reaction, 30 per cent, per c.c. of CI. Digestion 
 was completed in four hours. On June 24th the capacity of the stomach 
 was 2300 c.c. at n cm. water column. It will, therefore, be seen that here 
 also, after but a short use of the Sprudel Salt, a tendency to a reduction 
 of the acid secretion and lessening of the gastric ailments was produced. 
 
 A similar state was also found in the individual cited under XIX of the 
 table. The ordinary physical examination revealed no cause for the gastric 
 ailments of the patient. The internal examination of the stomach, made 
 before the beginning of the treatment with Sprudel Salt, showed the following : 
 The contents of the stomach, fasting, was clear, acidity 12 degrees, hydro- 
 chloric acid reaction strong, artificial digestion completed in 4 hours, pepto- 
 nization complete. The albumen method showed even after 6 quarter-hours 
 the stomach contents to contain traces of flocculent pieces of albumen, acid- 
 ity 22, intense HCl and peptone reaction. In addition there was obstinate 
 
 yellow, then it may be assumed that they have returned from the duodenum into the stomach. 
 The termination of digestion is not demonstrated so much by the absolute disappearance of 
 the pieces of albumen as by the rapid reduction of the acidity of the gastric fluid to normal. 
 To obtain uniform results from the internal examination of the stomach, it is advantageous 
 to introduce the necessary diluent (100 to 200 c.c. of water) five minutes before aspiration. 
 
62 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 constipation lasting several days, in consequence of which the patient com- 
 plained of oppression and weight in the abdomen. The patient was ordered 
 two teaspoonfuls of Sprudel Salt, each dissolved in a glassful of warm water, 
 to be taken at intervals of one hour. He continued their use during two 
 weeks, taking them early, fasting, and had during this time two to four mushy 
 passages during the day. After discontinuing the salt there was one passage 
 daily ; the patient declared that his abdomen was relieved ; had no oppres- 
 sion and gastric flatulence, but felt a sense of warmth in the region of the 
 stomach, belched from time to time and felt weak. After having discon- 
 tinued the salt for ten days the patient was subjected to an internal examina- 
 tion of the stomach, which demonstrated the following : The contents of the 
 fasting stomach clear as water, 7 degrees acidity, distinct HCl reaction, 
 artificial digestion completed in five hours, peptonization pretty distinct. 
 The albumen method showed the contents of the stomach, after 6 quarter- 
 hours, to be clear as water, barely containing traces of flocculi, but of an 
 acidity of only 2 degrees, no HCl reaction, no pepton nor albumen reaction; 
 artificial digestion only completed after 4^ hours, with the help of HCL 
 The gastric digestion was, therefore, almost completed in the proper time. 
 
 In this case the acid secretion was already much reduced after two weeks' 
 use of the Sprudel Salt, the gastric digestion and the evacuations of the 
 bowels brought to nearly normal, and most of the subjective gastric ailments 
 removed. 
 
 If these three instructive cases are more closely analyzed, it will be seen, 
 especially from the first carefully observed case, that the long continued (one 
 month) use of larger quantities of Sprudel Salt had entirely altered the 
 gastro-intestinal functions. The excessive acid secretion was changed to acid 
 insufficiency, the too energetic digestive power was much reduced, without 
 at the same time weakening, but rather increasing the mechanical power. 
 The stomach capacity and the gastric contractility have also been benefited. 
 The condition of the stomach which was found by the treatment with Sprudel 
 Salt, recalled the characteristics of mucous gastric catarrh, inasmuch as the 
 last aspirations of the gastric contents contained much gelatinous mucus, 
 which was not observed in any case before the treatment; and I am of 
 opinion, judging from examinations with Carlsbad water, that, if in this case 
 the experiments had not been stopped, but the treatment continued for two 
 more weeks with Sprudel Salt or some other saline remedy, a mucous catarrh 
 with total loss of the digestive chemism would have been produced. Although 
 one can never judge of the functional or anatomical condition of the stomach 
 by the subjective gastric ailments, still attention must here be called to the 
 change in many feelings before complained of. The ravenous appetite, which 
 was only held in check by the fear of the pain following the ingestion of food 
 and the empty feeling about the stomach, gave place to a feeling of satiety 
 and fullness after the acidity had been reduced. Furthermore, in reference 
 to the functions of the intestines, the habitual obstinate constipation was 
 
INFLUENCE ON GASTROINTESTINAL FUNCTIONS. 63 
 
 changed into diarrhoea (in the third above described case to almost normal). 
 This is the more noteworthy, because it is generally assumed in practice that 
 the salines, when given in large doses for a longer time, are followed by ob- 
 stinate constipation. 
 
 The very important fact, which I have verified in reference to the Carlsbad 
 water by experiment, is, therefore, also true of the Sprudel Salt, that, when con- 
 tinued for a time it lowers the digestive chemism, the i?icrease or exacerbation of 
 whichy according to my observations, is the cause of the majority of gastric dis- 
 orders. It accomplishes this, however, without enfeebling the mechanism. If, 
 however, the change in the function of the intestine, which was noticed in this 
 case, was to be sought in the exacerbation of the intestinal mechanism, or in the 
 stimulation or irritation of the intestinal mucous membrane, cannot here be 
 more definitely stated, on account of the want of methods for examining the 
 intestinal functions. I feel disposed to assume the latter to be the case, on 
 account of the fact that large quantities of Sprudel Salt exert a local action 
 even on the lowest portions of the intestinal tract, there causing burning 
 and even capillary hemorrhage. I have used in my experiments in the first 
 case above cited, the largest quantities of Sprudel Salt, and in the most con- 
 centrated solution that it is possible to use in man. This was necessary and 
 possible, because this case belonged to the category suffering from the great- 
 est degree of acid hypersecretion and constipation at the same time. In 
 less advanced cases, of course, smaller doses would suffice. I would also 
 call attention to the fact that, by the method here mentioned by me, the 
 influence of single as also repeated doses of every medicine upon the func- 
 tion of the stomach may be studied directly upon the human being, and will, 
 therefore, lead to more useful results than if they were determined by ex- 
 periments upon animals. 
 
 I am much less able to report anything definite concerning the behavior 
 of the Sprudel Salt when long continued in cases of gastric acid insufficiency. 
 In this direction I have had the opportunity to observe but few cases in the 
 above manner. I have generally, in such cases, given 5 grm. Sprudel Salt 
 in y^ litre soda water cooled by means of ice, and directed it taken early, 
 fasting, for a number of days. Of three such cases there was in one case a 
 distinct alleviation of the subjective symptoms ; in two other cases there was 
 no improvement. Objectively there was found in the case that improved, 
 disappearance of the organic acids, appearance of slight traces of hydrochloric 
 acid and artificial power of digestion, as also the more rapid disappearance 
 of the albumen from the stomach. The facts of the case must, however, be 
 more fully established by additional cases, so as to ascertain if small doses 
 of Sprudel Salt are able, the same as Carlsbad water, to improve the chemism 
 and mechanism of digestion in acid insufficiency. 
 
64 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 SECTION 12. 
 
 THE TOTAL RESULT OF THE INFLUENCE OF SPRUDEL SALT 
 ON THE ENTIRE GASTRO-INTESTINAL FUNCTION. 
 
 If the individual, partial results obtained be summed up as a whole, so as 
 to delineate a collective idea of the action of the Sprudel Salt on the whole 
 intestinal function, the following will be seen : — 
 
 i. If moderate doses (5-10 grm.) Sprudel Salt, in watery solution, be in- 
 troduced into a stomach deviating but slightly from the normal, the gastric 
 acid and digestive ferment are primarily totally destroyed ; the digestive 
 property of the gastric contents are completely arrested. At the same time 
 the mucus is dissolved and other morphotic constituents and fermentation 
 organisms are converted into a semi-soaked condition and appear suspended 
 in the contents of the stomach. Already in the first quarter of an hour the 
 salt introduced proves itself a powerful stimulant to call forth the mechani- 
 cal and chemical functions of the entire digestive canal. The excited 
 mechanical activity of the stomach manifests itself by passing the saline solu- 
 tion on into the intestine, by the presence of bile in the stomach, by occa- 
 sional nausea and eructations, and in nervous individuals even by vomiting 
 of the salt. The movements of the stomach soon start the intestinal peristalsis, 
 for already in the first quarter-hour rumbling is produced in the abdomen and 
 intestinal gases voided. The intestinal peristalsis soon increases, manifest- 
 ing itself by a desire to go to stool, and in a short time, 1-2 quarter 
 hours, the lowermost section of intestine is emptied of fecal masses. The 
 lower the saline solution penetrates from the stomach into the intestine, 
 the stronger the stimulation to intestinal movements becomes, more liquid 
 and gaseous contents are produced, mixed with saline solution in the large 
 intestine, and produce in consequence liquid passages strongly colored with 
 bile and having a penetrating odor, and these may be followed when very 
 large quantities of salt are used by additional watery passages coming from 
 the uppermost portions of the intestinal canal, which contain only salt, and 
 cause the burning. Such an excitement of the intestinal tract, lasting a 
 number of hours, is followed by a relaxation of the mechanical powers, and 
 although the salt still fills recesses of the intestine, which manifests itself by 
 the succussion sound, it remains quiet and the evacuations cease. It may 
 therefore be assumed that the alvine evacuations following the Sprudel Salt 
 are rather dependent upon increased peristaltic action than upon profuse 
 mucus secretion, and that the body of the same consists of the contents of 
 the entire intestinal tract mixed with unabsorbed saline solution. The fol- 
 lowing circumstances prove this : (a) The rapid manifestation of the action 
 of the salt upon the movement of the whole intestinal tract already in the 
 first quarter-hour, whilst it is still almost wholly present in the stomach. (^) 
 The rapid passage of the gastric contents into the stools (the saline solution 
 
INFLUENCE ON GASTROINTESTINAL FUNCTIONS. 65 
 
 may appear in the evacuations in half an hour). (V) Occasionally, in 
 spite of the large quantity of salt taken, only one or two solid passages are 
 produced, owing to the excited peristaltic action, the saline solution, how- 
 ever, remaining for a long time in the intestinal tract on account of the 
 relaxation of the intestinal mechanism, which always comes on near the end 
 of the evacuations, allowing the solution to remain until it is slowly entirely 
 absorbed. 
 
 The stimulation of the gastro-intestinal tract to chemical action by the 
 salt is synchronous with the above-described mechanical action, but is re- 
 stricted in the main to its upper division, and consists in the stimulation of 
 the secretion of gastric juice and of the secretion of bile. An abundant acid 
 secretion is produced in the stomach, which, however, is made latent by the 
 action of the alkalies (the first stage), until these latter are neutralized by the 
 gastric acid. This takes place, as a rule, in the third quarter-hour after 
 ingestion of 5 grm., and at the end of the second hour after the ingestion of 
 10 grm. Sprudel Salt. After this period the secretion of acid progresses 
 still further (stage of excitation), probably owing to the stimulation of the 
 small quantity of salt still present in the stomach. After a certain time the 
 secretion of acid reaches its maximum, which is higher and reached more 
 rapidly after 5 grm. than after 10 grm. From here on the acidity decreases 
 more rapidly (stage of decrease of reduction) than it had previously in- 
 creased, and that to below that of the empty stomach, so that during a 
 certain time there will be a period of acid insufficiency (lassitude). 
 
 All these stages run their course within 2-3 hours. The digestive ferment, 
 which had been destroyed by the Sprudel Salt, is regenerated in a similar 
 way and synchronous with the gastric acid, with the difference that the re- 
 generation of the same proceeds much slower than the gastric acid, so that 
 the time of greatest efficiency of the gastric juice is later than the maximum 
 of acidity. The original digestive power, however, which existed before 
 the experiments does not return for several hours. 
 
 As soon as the saline solution enters the duodenum, which certainly occurs 
 in the first quarter-hour, a stimulation of the same and of the biliary passages 
 is produced, from which, most probably, the accumulated bile is poured 
 copiously, and finds its way, for the most part, into the stools, but not infre- 
 quently also into the stomach. 
 
 The absorption of the constituents of the saline solution progresses paral- 
 lel with the stimulation of the mechanism and chemism of the gastro-intes- 
 tinal functions. The sulphates have disappeared from the stomach in 1-1^ 
 hours, and are swept away, for the most part, with the fluid passages. The 
 carbonates, however, are not to be found in these ; they may, however, be 
 detected in the urine in 1 hour, and render it alkaline, so that the sodium 
 bicarbonate maybe looked upon as the constituent of the Sprudel Salt that 
 is absorbed in greatest quantity. 
 
 Two small doses of Sprudel Salt, up to 5 grm., stimulate only the function 
 
 5 
 
66 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 of the upper portions of the digestive canal; larger doses, over 10 grm., are 
 exhausting and harassing upon the function of the upper portion and strongly 
 stimulating upon the lower portion of the intestinal canal. If, however, they 
 are given in divided doses, the exhaustion of the function of the upper por- 
 tion is much less. The lassitude only follows the subsequent repeated doses, 
 whilst the first are stimulating. 
 
 When long continued, the stimulating action of the Sprudel Salt upon the 
 gastro-intestinal function becomes less and less, until it finally ceases entirely. 
 
 3. The influence of the Sprudel Salt upon the functions of the stomach, 
 when long continued, consists of the reduction of the acid secretion and 
 digestive power, with, at the same time, no alteration or increase in mechani- 
 cal power, which shows itself in decreased sensitiveness of the organ against 
 chemical and mechanical irritations. A continued use of large doses of 
 Sprudel Salt is accompanied with lowering of the general nutrition and sub- 
 jective changes in the general condition (feeling of weakness, dullness of the 
 head). The anatomical causes of these functional changes in the stomach 
 cannot be determined by our present knowledge of the connection between 
 the functional and anatomical lesions of the stomach. In what sense the 
 intestinal function is changed by the continued use of the Sprudel Salt I 
 can only refer to my conjectures in § n. 
 
 Small quantities of Sprudel Salt continued for a certain time in some not 
 well-defined cases of gastric acid insufficiency act as a stimulant to the acid 
 secretion and the gastric mechanism. 
 
 Sprudel Salt may, therefore, be called a "stomach salt " par excellence, 
 which, in a single small dose, acts as a stimulant; when long continued, how- 
 ever, lowering the chemical functions of the stomach, while the former old- 
 fashioned crystallized Sprudel Salt principally acts upon the intestine, and 
 may, therefore, be designated a purgative. 
 
 4. From the foregone the following clinical observations and facts are 
 easily understood : — 
 
 (a) That all remedies which stimulate the function of the stomach and 
 bowels, given together with the Sprudel Salt (powder form) increase its action. 
 Therefore, soda and seltzer water used as solvents of the Sprudel Salt are more 
 powerfully stimulating upon the gastric chemism and intestinal mechanism, 
 than an ordinary watery solution of the same. In the same way does exer- 
 cise act, after the ingestion of the salt, in promoting evacuation of the 
 bowels. 
 
 {p) That the action of the Sprudel Salt takes place only at certain intervals 
 momentarily and lasts as long as the intestinal peristalsis continues, and 
 that, in case the patient misses this intestinal movement, which manifests 
 itself in a desire to go to stool, the passage fails to follow, although the 
 bowels are completely filled. 
 
 (c) That in nervous individuals the Sprudel Salt exerts a greater influence 
 upon the function of the bowels than in torpid individuals. 
 
CONTRAINDICATIONS TO THE USE OF THE SALT. 6j 
 
 (d) That in irritated conditions of the large intestine the Sprudel Salt 
 which reaches there calls forth a feeling of burning and of pain. 
 
 (e) That in cases of constriction of the pylorus, as also in case of partial 
 impermeability of the intestinal canal after introduction of the Sprudel Salt, 
 abdominal distress, pain and griping supervene, which may be ascribed to 
 the collection of the saline solution and the irritation of the same in one 
 place. 
 
 Ill— CLINICAL DEDUCTIONS BASED UPON THE 
 EXPERIMENTS MADE. 
 
 I now come to treat of the therapeutic use of the Sprudel Salt, based partly 
 upon the material presented and partly upon experience in private practice. 
 Inasmuch as the individuals experimented upon, as well as the experience 
 of physicians heretofore in the use of the new Carlsbad salt do not quite 
 suffice to establish positive indications for its use, I will first treat of the 
 much more positive theme of the restriction in the use of the Sprudel Salt. 
 
 SECTION 13. 
 
 THE RESTRICTIONS AND CONTRAINDICATIONS IN THE USE 
 OF THE CARLSBAD SPRUDEL SALT. 
 
 As the Sprudel Salt is not a remedy which endangers life, it is self-evident 
 that there are no absolute contraindications for the same. Under the head 
 of contraindications only such cases can be meant in which the pathological 
 condition is not ameliorated or even made worse, or where, on account of 
 the symptoms caused, the use of the Sprudel Salt is not deemed advantageous. 
 
 i. Above everything it must be emphasized that the systematic use of 
 large doses, above 15 grm. (3 teaspoon fuls), given daily for some time, is 
 not advisable ; inasmuch as such large doses, as has been demonstrated by 
 the experiments, completely lower the digestive chemism of the stomach, 
 arrest the resorptive power of the small intestines, cause a mucous gastric 
 catarrh, and occasion a condition of irritation of the large intestine. 
 General nutrition thereby suffers very much, and the patients feel subject- 
 ively very bad. If it were desired to continue the use of a larger dose than 
 15 grm. the rest would have to be given per rectum, which, however, could 
 not be long continued on account of the irritation of the intestine from 
 above and below. 
 
68 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 2. In cases of insufficient gastric secretion, larger doses than 5 grm. Sprudel 
 Salt given continuously are always to be avoided, as also the taking of the 
 solution warm. There is danger in these cases of complete suppression of 
 the acid secretion and of hastening the production of the mucus secretion. 
 
 3. In cases of great dilatation of the stomach, in which the much delayed 
 emptying of the stomach manifests itself by the retention of remnants of 
 food until the following day, or in cases of stenosis of the pylorus, it is not 
 justifiable to attempt to force a movement of the bowels by larger doses of 
 Sprudel Salt. The greatest subjective abdominal ailments are caused there- 
 by, because the solution of salt can neither be quickly emptied into the intes- 
 tine nor be absorbed, irritates the walls of the stomach and destroys the 
 secretory elements of the gastric mucous membrane, and still, in the majority 
 of cases there is no evacuation of the bowels produced. 
 
 4. In all diseased conditions of the large intestine which are still accom- 
 panied by very intense irritation, as, immediately following acute enteritis, 
 dysentery, acute proctitis, as also in ulcerated conditions of the rectum, large 
 doses of Sprudel Salt dare not be used, as there is danger of even detaching 
 pieces of diseased muc6us membrane, occasioning hemorrhages and subjec- 
 tively very painful tenesmus and burning during defecation. 
 
 5. In partial impermeability of the intestinal tract, the bowels dare not be 
 forcibly moved by the systematic use of Sprudel Salt, inasmuch as the solu- 
 tion of the salt accumulates in the section of intestine in front of the stenosis 
 and frequently causes very disagreeable subjective gastric ailments. 
 
 6. In cases of very severe constipation, the systematic use of Sprudel Salt 
 as a purgative, given per os, is not to be recommended, because the large 
 doses necessary in these cases are followed by the ailments enumerated 
 under 1. 
 
 7. In persons who are much emaciated, or who suffer from great nervous- 
 ness or have a valvular disease of the heart without compensative hypertro- 
 phy, it is best to abstain from the systematic use, especially of large quantities, 
 of Sprudel Salt by the mouth, because the lowering of the general nutrition 
 and weakness, and thereby the nervousness, become much greater. 
 
 8. Although the use of Sprudel Salt by the rectum is permissible in all 
 diseases excepting those enumerated under 4, still it is necessary to guard 
 against the systematic use of too concentrated solutions of the salt. The 
 maximum of concentration dare not exceed 5 per cent. 
 
INDICATIONS FOR THE USE OF SPRUDEL SALT. 69 
 
 SECTION 14. 
 
 INDICATIONS FOR THE USE OF SPRUDEL SALT. 
 
 In reference to the clinical indications for the use of Sprudel Salt, I can 
 only give positive data of such as concern the pathological conditions of the 
 gastro-intestinal canal ; for the others, however, I can give more or less well 
 founded conjectures. I must here observe that the indications of the Carlsbad 
 Sprudel Salt (powder form), which is a combination of a number of different 
 salts, are entirely different from those of the former Sprudel Salt (crystallized), 
 which is composed almost entirely of sulphate of sodium. Inasmuch as the 
 Sprudel Salt (powder form) is only of recent introduction, and accurate 
 practical experience is still wanting concerning it, it is difficult to set up in- 
 fallible indications based on experience. The chief pathological conditions 
 in which Sprudel Salt may be used with advantage and success are, in the 
 main, those which call for the use of the Carlsbad Thermal Waters, whereby, 
 however, that must always be borne in mind which is given in the previous 
 chapter under the head of contraindications. 
 
 1. Above all, and looked upon by myself as a specific at the present time, 
 is the Sprudel Salt in the treatment of simple acid and catarrhal gastric 
 hypersecretion, a disease which lies at the foundation of at least one-half of 
 all the gastric ailments, and especially amongst the male portion of the Polish 
 Israelites. In these cases medium doses (10 grm.), and in greater hyperse- 
 cretion larger doses (15 grm.) must be given during a long period, system- 
 atically. The solution of Sprudel Salt must be taken warm (40 C.) and 
 somewhat concentrated (3 per cent, to 5 per cent.). It is desirable to have 
 the solution remain as long as possible in the stomach, and for the salt to act 
 energetically upon the mucous membrane, this being best accomplished by 
 the above procedure. As nervous individuals, as, for instance, most Israel- 
 ites are, cannot tolerate large doses of Sprudel Salt for a long period, it is 
 better to begin the treatment with moderate (10 grm.) doses. 
 
 2. In insufficiency of the gastric acid, which is much less frequently met 
 with in practice, Sprudel Salt may also be used with a view to its stimulating 
 effect. In these cases, however, only small doses, 5 grm. at the most, may 
 be given in a perfectly cool solution, preferably made with carbonic acid 
 water, and the patient must be warned not to take larger doses on his own 
 responsibility. And should it become necessary to produce evacuation of 
 the bowels, it is better to accomplish this by using the salt in the form of an 
 injection by the rectum, than to give it by the mouth. All cases of insuffi- 
 ciency of acid secretion cannot, however, be cured in this way ; if the gastric 
 acid does not become regenerated, a further continued use of Sprudel 
 Salt is unavailing and even harmful. Therefore, when the internal gastric 
 examination, after the continuous use of the Sprudel Salt for two weeks, does 
 not show an increase in the acidity, but rather a decrease of the same, it 
 
JO THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 is best to discontinue the use of the Sprudel Salt. In these cases it may 
 probably be assumed that the secretory apparatus of the gastric mucous 
 membrane has undergone a retrogressive anatomical metamorphosis. 
 
 3. The passing dyspepsia, caused by excesses in the use of alcoholic bever- 
 ages, and generally known as " swelled- head/' subsides after the ingestion 
 of a small (5 grm.) dose, dissolved in right cold or carbonic acid water, 
 and taken early, fasting, and is followed by a most excellent appetite. A 
 dyspepsia caused by overloading the stomach requires larger doses (10-15 
 grm.), also given in a perfectly cold solution. In these cases the action of 
 the salt on the bowel must also be made to manifest itself. 
 
 4. In gastric ulcer, the old-fashioned crystallized Sprudel Salt has been 
 recommended in various quarters, especially by Leube, given in a warm 
 solution (1 teaspoonful to y 2 litre of lukewarm water). I think that all that 
 has been said in favor of the crystallized is still more true of the Sprudel 
 Salt, powder form. I would only suggest that the Sprudel Salt, powder form, 
 be given several days after the arrest of the hemorrhage, for fear of loosen- 
 ing the thrombus by the alkaline solution and thereby renewing the bleeding. 
 
 5. For the purpose of washing out the stomach in cases of gastric dilata- 
 tion, accompanied with weakened muscular power or with stenosis of the 
 pylorus. The purpose in these cases is to remove the mucus, fermentation 
 organisms and the putrefying food remnants; to arrest fermentation, as also 
 to reduce the acid hypersecretion which is so often present. The larger 
 quantities of Sprudel Salt which would be necessary for this purpose could 
 not be given by the mouth in these cases without aggravating the gastric 
 ailments. Nothing remains but to remove the gastric contents and to wash 
 out the cavity with a solution that at the same time acts therapeutically upon 
 the mucous membrane. For this purpose a solution of Sprudel Salt is well 
 adapted, inasmuch as it dissolves the mucus, causes the morphotic constitu- 
 ents and ferment organisms to swell up and acts well upon the mucous mem- 
 brane. 
 
 These five indications stamp the Carlsbad Sprudel Salt (powder form) as 
 a true stomach salt. 
 
 6. As an occasional purgative the Sprudel Salt belongs to the best-disposed 
 of these remedies, and may be used in all cases where the contraindications 
 mentioned in the preceding chapter do not exist. As to the size of the 
 dose, the physician must be guided by the history of the case, by inquiring 
 as to the dose of other purgatives or mineral waters which the patient is in 
 the habit of taking, or if the patient be inclined to diarrhoea. Although 
 the medium dose is 10 grm., it will be found too large in nervous individ- 
 uals and too small in very torpid ones. As a purgative the Sprudel Salt is 
 best given dissolved in spring or soda water. 
 
 7. In habitual constipation of moderate degree the Sprudel Salt- (powder 
 form) will be found to be more successful even than the Carlsbad thermal 
 waters themselves. The quantity of Sprudel Salt in these cases, when 
 
INDICATIONS FOR THE USE of SPRUDEL SALT. /I 
 
 systematically used, should not exceed 10 grm. ; in fact, had better be less. 
 The solution must be drank cold. In case larger doses are necessary it is 
 advisable to order them taken in soda water, or better still, in a carbonated 
 mineral water, as Szczawnica, Giesshiibler or Krondorfer water. By the 
 use of these solvents the dose of the Sprudel Salt may frequently be reduced 
 to 5 grm., because of the somewhat stimulant action of the mineral water 
 itself upon the intestine. In very severe cases of constipation a part of the 
 salt may be given by the rectum. 
 
 8. In intestinal catarrh accompanied with constipation. In these cases 
 the object is to remove the masses of mucus, to stimulate the mucous 
 membrane and muscular coat of the intestines. These indications are well 
 supplied by the Sprudel Salt, in fact, even better than by the Carlsbad water, 
 as the latter does not reach the lower portion of the bowels, and hence can- 
 not produce any local action there as the Sprudel Salt does, which even 
 passes out with the stools. In intestinal catarrh, medium (10 grm.) doses 
 at least should be given, and those in a lukewarm solution, as this remains 
 longer in the intestinal canal, and can therefore act better locally. But as 
 large doses when long continued are generally not well borne, and lower the 
 function of the stomach, it is always more advantageous, and also more 
 adapted to the nature of the pathological condition, to allow at least part of 
 the Sprudel Salt to act locally by means of an injection. At least in the first 
 days of the treatment copious, warm injections of Sprudel Salt are to be 
 ordered; they should wash out the intestine as high up as the caecum. 
 Later on, smaller injections may be ordered, which the patient is to retain 
 during the whole night. The concentration of the injections for the pur- 
 pose of washing out the mucus is at first 3 per cent. ; later on, however, 1 
 per cent. 
 
 9. Catarrhal Jaundice. — In most of these cases the desideratum is to 
 remove the obstruction in the bile ducts and biliary passages. Inasmuch as, 
 according to the experiments cited, the Sprudel Salt very much favors the 
 evacuation of the bile, obstructive jaundice is a very good subject for treat- 
 ment with Sprudel Salt. The dose used must be larger, 10-15 grm., and, 
 so as to get the solution to remain in the upper portion of the intestinal 
 canal as long as possible, the solution must be drunk warm (30-40 C), and 
 the treatment continued systematically for at least 14 days. 
 
 10. In chololithiasis, or gall-stones, success may also be expected from the 
 use of the Sprudel Salt, which may be termed a concentrated Carlsbad water ; 
 a case successfully treated is described in Section 6, case XXXIX. The 
 mode of administration must be similar to that in catarrhal jaundice, but as 
 it probably, in these cases, would be an advantage to give even larger doses 
 of the salt, a part of the same may be given by the rectum at bed-time. 
 The injection, per rectum, of simple water in diseases of the liver, as prac- 
 ticed in Mossler's clinic at Greifswald (E. Peiper, Zeitschr. f. klin. Med., 
 
*]2 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 Bd. iv, p. 403), were accompanied with very favorable results; so much 
 the more may be expected of the use of a solution of Sprudel Salt. 
 
 11. In fatty liver and in the first stage of cirrhosis of the liver, the desid- 
 eratum is to accelerate the circulation of the portal system and the flow of 
 bile ; this is accomplished effectually by the use of Carlsbad water, hence 
 success may also be expected from the use of the Sprudel Salt. It also appears 
 advantageous, in addition to the administration of moderate doses (up to 10 
 grm.) of the Sprudel Salt by the mouth, to at the same time administer 
 some by the rectum, inasmuch as the solution can by this means more readily 
 reach the portal system. 
 
 12. In general adiposis, or excessive accumulation of fat throughout the 
 system, the desideratum is to reduce the general nutrition, or rather to use 
 up the deposited fat and prevent its proliferation. The Sprudel Salt, given 
 in large doses, accomplishes this result, and at the same time prevents a new- 
 deposition of fatty tissue by materially reducing the peptonizing and resorp- 
 tive power of the gastro-intestinal canal. Therefore, in the treatment of 
 adiposis, the Sprudel Salt may be used, accompanied with a proper diet. It 
 must be given in large doses, 15-20 grm., daily, dissolved in lukewarm 
 water. It would be advantageous to have the patient take his meal soon 
 after taking the Sprudel Salt. By so doing he will be satisfied with less food, 
 and the nourishing properties of the food would be reduced to a minimum 
 by coming in contact with the salt in the small intestines, where it would 
 reduce the peptonization and absorption to a minimum. 
 
 Until recently, the crystallized Sprudel Salt, which may be looked upon 
 simply as a brisk purge, was used by the profession, but now, when a salt is 
 being obtained from the Carlsbad water, which is a blending of so many 
 salts, and which may be looked upon as, in addition to being a purgative, to 
 having other effects peculiar to itself, and really representing the mineral water 
 from which it is obtained, clinicians may now use the same in all those cases 
 in which the Carlsbad water has proven itself a specific, or in which alkaline 
 muriatic mineral waters are indicated as : — 
 
 13. In Diabetes Mellitus, where the Carlsbad water arrests the formation 
 of sugar in so many cases. On account of a want of material the mode of 
 use of the Sprudel Salt in these cases is not given in detail. It may, how- 
 ever, be stated that warm solutions are to be preferred. 
 
 14. In Pyelitis, Cystitis, and Renal Calculi. — In these cases a warm, not 
 too concentrated solution, which acts as a diuretic and renders the urine 
 strongly alkaline, would be of signal service. 
 
 15. In some cases of bronchitis, to favor the secretion of mucus, the Spru- 
 del Salt should be of great service, because of its large quantity of sodium 
 bicarbonate and sodium chloride, at the same time reducing the venous 
 engorgement by its action on the bowels. 
 
 It is, therefore, to be hoped that the Sprudel Salt will, in the course of 
 
APPLICATION OF THE SPRUDEL SALT BY THE MOUTH. 73 
 
 time, be subjected to further clinical research, and that its indications and 
 use will be still further extended. 
 
 MODE OF USE OF THE SPRUDEL SALT (POWDER FORM). 
 
 The Sprudel Salt (powder form) is used by the mouth, by the rectum and 
 to wash out the gastro-intestinal canal. 
 
 SECTION 15. 
 
 APPLICATION OF THE SPRUDEL SALT BY THE MOUTH. 
 
 i. The most judicious time to administer the Sprudel Salt is the morning, 
 on an empty stomach, in fact, as soon as the patient awakes. In gastro- 
 intestinal diseases this is the only time admissible, for in these hours the 
 salt can act upon the quiescent organ entire and, without alteration by other 
 influences, unfold its action. Also in diseases of distant organs the early 
 morning is the most appropriate time, because at this time the several con- 
 stituents of the salt do not experience any abnormal changes in the upper 
 digestive passages, are best absorbed and passed into the circulation. They 
 then produce their action upon an organism that is affected the least by ex- 
 ternal influences (as is only the case in the morning). If the Sprudel Salt 
 is introduced into a full stomach during the course of digestion, the entire 
 digestive activity will be at once arrested, and when medium doses are used 
 the food is passed into the lower portions of the intestine, there, by irrita- 
 tion, causing subjective abdominal ailments; when larger doses of the salt 
 are used it is passed out with the stools. If it is desired to evacuate the 
 bowels when the stomach is full, it is, as a rule, necessary to give a dose 
 twice as large as would be necessary in an empty stomach. If, exceptionally, 
 it is desirable to use the Sprudel Salt during the day, it is judicious to wait 
 until 6 to 7 hours after eating. 
 
 2. Dose of the Sprudel Salt. — A single small dose of Sprudel Salt is a tea- 
 spoonful (5 grm.), a medium dose two teaspoonfuls (io grm.), and a large 
 dose 3 teaspoonfuls (15 grm.). As a rule, only one teaspoonful of the salt 
 dissolved in a goblet of water is taken, this is equal to a concentration of 
 about 2 per cent. Solutions of greater concentration than 5 per cent, are 
 not to be used. Medium and large doses are divided into 2 or 3 small ones, 
 as a single large dose would require either a larger quantity of liquid, or else 
 would be introduced into the stomach in a too concentrated solution. In 
 both cases, as is seen by the experiment, the gastric function is too much 
 affected ; in addition, more concentrated or larger quantities of Sprudel Salt 
 solution introduced into the stomach cause nausea and vomiting. 
 
 3. The Solvents. — Sprudel Salt is always given in solution, generally in 
 
74 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 distilled rain-, river- or spring-water. The use of spring water is, however, 
 not advantageous, as a part of the sodium carbonate is converted into calcium 
 carbonate and makes the whole liquid cloudy. A solvent very much to be 
 recommended, inasmuch as it assists the action of the Sprudel Salt and im- 
 proves the taste, is soda water, also Kissingen, Szczawnica, Bilner and 
 Krondorfer waters. These solvents are, however, intended for making cold 
 solutions, and may be prepared by placing the dose (5 grm.) of salt to be 
 taken into a tumbler, add thereto ^ glassful of mineral water and dissolve 
 the salt, immediately before taking the dose the tumbler is filled with the 
 mineral water. A cold solution of Sprudel Salt vs> made most judiciously by 
 placing the requisite quantity of Sprudel Salt in a glassful of the solvent in 
 the evening and allowing it to stand over night outside of the window. As 
 soon as the patient awakens in the morning he has a well-cooled solution of 
 the salt, the undissolved portion of which immediately disappears upon 
 agitation. A lukewari?i solution may have a temperature of 36 C, and a 
 warm solution of 50 to 55 C. Solutions having a higher temperature must 
 not be used, as they affect the gastric mucous membrane too much and cause 
 changes in its structure. A warm solution generally acts less upon the 
 bowels than a cold one. A warm solution of Sprudel Salt must not be made 
 by first placing the salt in cold water and then warming the same ; the salt 
 must be dissolved in water already warmed, as the sodium bicarbonate would 
 be partly decomposed by the heating and converted into the caustic mono- 
 carbonate. 
 
 4. Intervals between Doses. — A certain time must be allowed to elapse 
 between the doses when the dose of Sprudel Salt is to be repeated. If the 
 individual dose be 1 teaspoon ful of the salt the intervals between the doses 
 will be governed by the following : The immediate effect of the alkalies 
 of a 5 grm. dose lasts 3 quarter-hours, for in the third quarter-hour they 
 are neutralized by the gastric acid. Every following dose acts longer on 
 the gastric mucous membrane and affects the gastric function more than the 
 preceding ; doses given at shorter intervals produce evacuation of the bowels 
 quicker than when given at longer intervals. Inasmuch as in gastric diseases 
 it is desirable that the action of the salt be as long continued as possible, 
 longer intervals are indicated in these cases, the most judicious being three- 
 quarters of an hour. If, however, the acid hypersecretion in the stomach 
 be great, a 5 grm. dose repeated in half an hour will answer the purpose very 
 well. An interval of half an hour between two doses of 5 grm. is also the 
 general rule for all other cases. If 15 grm. be given in three divided doses, 
 the first interval may well be half an hour, but the second must be at least 
 three-quarters of an hour, so as not to affect the gastric function too much 
 or to paralyze the intestinal functions. If a rapid evacuation of the bowels 
 be desired the first interval is best shortened to one-quarter of an hour. 
 
 5. The Behavior whilst taking the Sprudel Salt. — The conduct of the 
 patient whilst taking the Sprudel Salt should be the same as when drinking 
 
DIETARY DURING TREATMENT. 75 
 
 a mineral water. As exercise favors the evacuation of the bowels, the patient 
 does well to take some exercise in the open air during the intervals; but he 
 must be enjoined not to suppress the desire to go to stool too long, but attend 
 to it at once, or else the evacuation will not take place at all. 
 
 SECTION 16. 
 
 THE DIETETIC REGIME DURING A TREATMENT WITH 
 SPRUDEL SALT. 
 
 (#) The first question in this direction is, When, after taking the Sprndel 
 Salt, shall breakfast be eaten ? Here the consideration must not be lost 
 sight of, that the Sprudel Salt be allowed to act uninterruptedly as long as 
 possible. This cannot, however, take place if the intestinal canal is made 
 to exercise its digestive function by means of food, and the solution of 
 Sprudel Salt is chemically changed by being mixed with the food. It is best 
 to allow the salt to exert its action as long as possible. This is, primarily, 
 especially necessary in diseases of the stomach. As the action of the salt 
 upon the gastric mucous membrane does not cease until the third stage, the 
 stage of depression, during the treatment of gastric diseases by means of 
 Sprudel Salt, no food should be placed into the stomach until this period. 
 Although the stage of reduction or depression sets in at different times, 
 according to the case and dose given, as a rule, however, it may be said to 
 set in in 1-1^ hours, and after a io-grm. dose after 2 hours. Breakfast 
 must, therefore, be postponed to 1^-2 hours after taking the Sprudel Salt 
 in gastric diseases, and in some cases, as in dilatation, even longer. If the 
 food is taken sooner, then not only is the full action of the salt lost, but also 
 the proper beneficial effect of the nourishment, for the peptonization and the 
 power of absorption of the entire gastro-intestinal tract is much weakened ; 
 in addition to this, undigested remnants of food are driven into the lower 
 portions of the intestines by the stimulant effect of the salt upon the peri- 
 stalsis, where they produce conditions of irritation and cause subjective ail- 
 ments; this circumstance is the more critical when the gastric ailment is 
 complicated by an intestinal disease. It is, therefore, readily understood 
 why patients who take saline remedies or mineral waters for a long time do 
 not lay on flesh, in spite of the quantity of food taken. In all other cases 
 of disease, also, the physician must endeavor to keep the patients, who fre- 
 quently have a voracious appetite after taking the Sprudel Salt, from taking 
 breakfast as long as possible. Only in one case would it be indicated to 
 allow the patient to take breakfast at the end of the first hour, so as to satisfy 
 the feeling of hunger and to prevent the patient getting the full benefit of 
 the food as much as possible ; this is the case in the treatment of corpulency 
 with saline remedies or mineral waters. 
 
j6 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 (Jf) The next question concerns the quality and quantity of nourishment 
 during a systematic treatment with Sprudel Salt. Even though the diet must 
 always be adapted to the individual and to the disease, still, it is best to have 
 a certain general standard or rule to follow. This may be derived from the 
 following considerations : During the use of the Sprudel Salt the entire in- 
 testinal tract is thrown into a condition of irritation, the peptonization and 
 power of absorption is weakened for the first half of the day, and by the con- 
 tinued use the general nutrition is much lowered. On account of these circum- 
 stances, as also not to do harm by the diet in the special case, but to assist the 
 therapeutics as much as possible, it is well to use a moderate, unirritating but 
 strong and easily-digested diet, as is done in Carlsbad. It is, therefore, 
 necessary to abstain from all chemically-irritating articles of food and con- 
 diments, as fat and very greasy food, strong spices, all strong alcoholic bev- 
 erages; also mechanically-irritating food, tough meat, raw fruit, all foods 
 that leave a great quantity of indigestible residue in the intestines and remain 
 too long in the gastro-intestinal canal, having a tendency to undergo fer- 
 mentation and keep up the condition of irritation of the intestinal mucous 
 membrane (most vegetables and compotes, farinaceous articles of food known 
 to be difficult of digestion, large quantities of any starchy food) ; lastly, all 
 articles of diet, even those considered very easy of digestion, which are 
 known, from the history of the patient, to disagree with him. As regards 
 sour foods and acid drinks, it is best to abstain from the same, as nothing 
 definite is known of their effect on the gastro-intestinal tract ; at the most, 
 something acidulous may be allowed in the evening; this holds good espe- 
 cially in gastric acid deficiency. The daily quantity of food must also be 
 regulated, so that the main meal come at noon or during the afternoon — i. e., 
 not until the irritation of the intestinal canal has subsided and its digestive 
 and resorptive power been again restored. Therefore the following may be 
 taken as a bill of fare during treatment with Sprudel Salt : At breakfast, 
 according to habit, tea, milk or coffee, with little bread (at n o'clock, in 
 case of excessive hunger, 2 soft-boiled eggs) ; at 1 o'clock, dinner, con- 
 sisting of beef soup with grits, or bouillon, roast meat without fat (veal, beef, 
 chicken, deer), beefsteak, or chopped meats (cutlet, etc.), or stewed meats 
 (veal, chicken) ; with these may be taken potato puree or a little compote 
 and a slice of wheat bread ; at 5 o'clock, coffee, or, better still, a cup of wine 
 soup, 1-2 eggs beaten up in white wine ; at 8 o'clock, tea and a portion of 
 roast meat, the same as at dinner, or a dish prepared from eggs with chopped 
 ham ; with this some bread. Tea may be substituted, in some cases, by a 
 glass of white wine or beer. Modifications will have to be made in this bill 
 of fare according to the disease ; in the treatment of diabetes mellitus, adi- 
 posis and diseases of the liver, an entirely different regime must be insti- 
 tuted. In addition, I would like to observe that the use of the alcoholic 
 beverages which irritate the intestinal canal must, if possible, not be allowed; 
 on the other hand, a wine soup, given 2-3 times a day, may be ordered in 
 
SPRUDEL SALT IN GASTRIC IRRIGATION. J7 
 
 certain cases ; this is generally well borne by most patients suffering from 
 gastric disease. The regulated diet prescribed must always be insisted upon, 
 as the majority of patients who need a so-called Carlsbad treatment have 
 acquired their disease by an irrational diet or excesses at table ; therefore, 
 much may be expected from a rational regime continued for some time. 
 
 SECTION 17. 
 
 USE OF THE SPRUDEL SALT IN WASHING OUT THE STOM- 
 ACH—APPARATUS FOR GASTRIC IRRIGATION AND ASPI- 
 RATION. 
 
 For use in washing out the stomach, a solution is generally made of 2-3 
 tablespoon fuls of Sprudel Salt in 2-3 litres of river or rain water, heated to 
 from 5o°-55° C. The solution is generally used warm. It is not justifiable to 
 undertake to wash out the stomach without first obtaining the assurance of 
 the absence of contraindications (great atheromatous degeneration of the 
 blood-vessels, advanced valvular disease of the heart, bleeding gastric ulcer 
 or degenerating carcinoma of the stomach). It is also necessary to first 
 accustom the patient to the continued retention of the stomach tube. This 
 is absolutely necessary in a successful treatment. As to time of day, it will 
 be found that the operation is best performed late in the evening, as at this 
 time the stomach is emptied of contents that frequently irritate the gastric 
 mucous membrane — a condition of things always present in gastric dilatation 
 and mechanical insufficiency. If no supper is allowed after the operation, 
 the diseased organ will be allowed more than 12 hours rest, and the full 
 effect of the operation and of the Sprudel Salt upon the stomach is not 
 altered by food. In addition to this, there is the agreeable assurance from 
 the patient the next day that he has spent the night without distress — 
 quietly sleeping — awaking in the morning with an appetite. 
 
 In the following diseased conditions I found the operation of washing out 
 the stomach with solution of Sprudel Salt of service : — 
 
 1. In many cases of gastric symptoms associated with loss of appetite and 
 bad taste in the ?nouth, but in which, by internal examination of the stomach, 
 no severe functional disturbance could be discovered, the dyspeptic symptoms 
 disappeared after washing out the stomach three times. The positive action 
 in these gastric cases, which probably have a nervous origin, may, in all 
 probability, be referred, in great part, to the psychical action of the manipu- 
 lation. 
 
 2. Chronic acid hypersecretion, a very frequent form of disease, but which 
 is by some authors described under the not very appropriate name of dyspep- 
 sia acida, as being particularly infrequent, may be looked upon as the first 
 stage of catarrhal gastric disease. This is distinguished by the large percent- 
 
yS THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 age of hydrochloric acid in the gastric contents at all times of the day (even 
 in the empty stomach), by motor disturbances of the stomach, as shown 
 by the frequent finding of changed greenish or bluish bile-coloring matter 
 in the stomach, as also by the much-delayed digestive mechanism, which 
 appears to be dependent upon spasm of the pylorus, caused by the irritation 
 of the gastric contents. The anatomical changes in the gastric mucous 
 membrane in this form of disease may be demonstrated in the gastric con- 
 tents by the excessively large quantity of sharply-defined, round-cell nuclei, 
 which appear singly or in groups of 2-3, frequently glistening, and which 
 are deeply stained by anilin. The origin of these must be ascribed to the 
 glands of the fundus and to the destruction by the intensely digestive gastric 
 juice of the glandular cells, of which nothing is left but the nuclei. For if, 
 for instance, a piece of mucous membrane that has been torn from the fundus 
 of the stomach by passing the stomach tube, is placed in a strongly acid, 
 natural gastric juice, and the proper digestive temperature maintained, and 
 examined daily under the microscope, the disappearance of the elements will 
 be noticed every day more and more, with the appearance of numerous cell 
 nuclei and fat globules. There is no better remedy for this diseased condi- 
 tion than washing out the stomach with warm solution of Sprudel Salt. The 
 pretty concentrated (three to five per cent.) solution is applied in the even- 
 ing. When there is great acidity of the gastric contents, when even after 
 washing out the stomach in the evening an appreciable quantity of strongly 
 acid liquid collects in the stomach in the morning, which is always the case 
 when this condition is associated with gastric dilatation, it is of advantage 
 to wash out the stomach with solution of Sprudel Salt early in the morning 
 before any food is taken ; i. e., twice daily. A number of such cases I have 
 treated here in Carlsbad with success by washing out the stomach with large 
 quantities of Muehlbrunnen water, allowing no supper and ordering the 
 proper dose of thermal water to be drank early in the morning, fasting. 
 
 3. The above described condition is generally found in stomachs affected 
 with ulcer, especially of the pars pylorica. In these cases the washing out 
 of the stomach with solution of Sprudel Salt' produces the same beneficial 
 effect as in the latter cases, by stopping the frequently hyper-acid secretion 
 of the gastric juice, which must aid in the formation of the ulcers. If, how- 
 ever, there is well-founded suspicion of gastric ulcer, the washing out of the 
 stomach must be made with much greater care than in the former case. The 
 solution of Sprudel Salt must be more diluted (one to two per cent.), only 
 used once daily — in the evening — for the first three days, then every other 
 day, and later once or twice weekly. For in the same manner in which an 
 excess of acid may injuriously affect the diseased places, so also may an excess 
 of alkali prove deleterious. 
 
 4. In the second stage of gastric catarrh, in which the gastric acid secre- 
 tion has given place to the mucus secretion, a condition of things so fre- 
 quently found in drinkers, the washing out of the stomach with Sprudel Salt 
 
SPRUDEL SALT IN GASTRIC IRRIGATION. 79 
 
 solution affords symptomatic relief of the gastric ailments. This condition, 
 which is diagnosed under the microscope by numerous chalice epithelial 
 cells, granulated cutaneous cells filled with fatty dots, also isolated fat 
 globules in the gastric contents, is, however, objectively not much improved 
 by the use of solutions of Sprudel Salt in this manner, still the appetite is 
 generally improved after its use, and the fullness and disagreeable oppres- 
 sion in the stomach are also removed. The stomach must be washed out 
 for the first few days with more concentrated solutions (3 per cent, to 4 
 per cent.) so as to rid the walls of the adhering mucus and to stimulate the 
 mucous membrane ; the later treatments should be made with weaker solu- 
 tions and at intervals of two or three days. For the latter cold solutions 
 made with soda water are to be preferred. 
 
 5. The above cited condition approaches that found in carcinoma of the 
 stomach, in which, according to my researches, a neutral or even alkaline 
 gastric fluid is generated, which, however, possesses no digestive power even 
 after being acidulated with HCl. The action of the washing of the 
 stomach with solutions of Sprudel Salt in these cases is, however, much less 
 than in the former. The patient only experiences relief in those cases in 
 which the new formation has been the cause of copious accumulations of 
 mucus or dilatation of the stomach with decomposed food remnants. 
 
 If it has been decided to wash out the stomach with solutions of Sprudel 
 Salt so as to afford relief in these cases, it is necessary to use all the caution- 
 ary measures enumerated in cases of ulcer, under 3. It is generally found, 
 in washing out carcinomatous stomachs, that, even if great care is exercised, 
 very numerous pieces of mucous membrane, tinged with blood, will be 
 brought to light, that are characteristic of this degeneration. 
 
 From the foregone it will be noticed that washing out the stomach with 
 Sprudel Salt solutions may accomplish the following, either : (a) Reduction 
 of the excessively intense acid gastric secretion; the result of the treatment to 
 be determined from time to time by internal examinations of the stomach. 
 (J?) Ridding the organ of irritating contents, as microorganisms or pro- 
 ducts of digestion undergoing decomposition ; information which is neces- 
 sary to gain by examining the contents of the fasting stomach from time to 
 time microscopically. (7) Symptomatic removal of subjective gastric symp- 
 toms, which is successfully accomplished even in many nervous cases. Or 
 lastly, (d) The mechanical relief of the stomach by increasing its mechanical 
 power, which, of course, is not peculiar to washing out the stomach with any 
 particular solution. According to my opinion, this latter therapeutic factor 
 is of most importance; for according to my observations, dating over many 
 years, the delay of the passage of the contents of the stomach through the 
 pylorus is in by far the majority of cases the real cause of the gastric ailment. 
 Whilst great changes in the digestive chemism may be endured for a long 
 time without subjective gastric ailments, these latter very speedily show 
 themselves as soon as a change in the digestive mechanism supervenes. 
 
80 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 In reference to the modus operandi of washing out the stomach, there are 
 several methods that may be employed. In many cases the simple siphon 
 contrivance* of Ziemssen, or the one modified by Rosenthal, may be 
 employed. For ordinary cases this is the simplest and most convenient 
 method. It, however, frequently disappoints the practitioner: a certain 
 degree of rarefaction of the air in the stomach, a lurch with the stomach 
 tube, interrupts the flow of the contents of the stomach; it becomes neces- 
 sary, in order to reestablish the flow, to pour in more water ; concerning 
 the quantity of liquid remaining in the stomach, however, there always 
 remains some doubt. In cases of dilatation of the stomach, or when the 
 same is filled with solid particles of food, such as are especially under con- 
 sideration, the expedient generally fails. It is also impossible to make a 
 more careful examination of the stomach by this method. It is necessary 
 to have recourse to suction pumps. The ordinary suction apparatus with 
 rod and piston, on account of the great suction power which cannot be 
 regulated, is too dangerous to the mucous membrane, and is also unhandy. 
 
 The best apparatus, both for aspiration and irrigation, one which I have 
 used for years for experimental, diagnostic and therapeutic purposes, is 
 illustrated on page 81. 
 
 A is an aspirator bottle holding a number of litres, filled with ordinary 
 water ; at its lower part near the bottom is the tubulure g closed hermetically 
 with a rubber stopper through which the small tube gh passes ; to this is at- 
 tached a rubber hose having a clamp at h and terminating in another bottle 
 of the same construction D. The aspirator bottle is hermetically closed 
 
 * After going to press, Prof. Ewald published a procedure by which to obtain the con- 
 tents of the stomach without the help of any aspirating contrivance whatever. {Berl. kl. 
 Wochenschr., 1886, Nr. 3.) The procedure consists in passing a soft stomach tube into the 
 stomach, and then getting the patient to cough and strain with the diaphragm, and at the same 
 time exerting pressure by means of the hand over the stomach, producing artificially vomiting 
 and retching movements. This procedure may, in the absence of a stomach pump, assist the 
 physician in an emergency, but can, in fact, only be looked upon as a makeshift ; as the 
 experiments instituted for the purpose by me have shown: I. Frequently only so small an. 
 amount of fluid is obtained from the stomach that it will not suffice for all the tests ; if, how- 
 ever, after this procedure, the stomach is aspirated, quite a large quantity of gastric fluid may 
 still be obtained. 2. If the stomach contains solid particles of food, these will completely 
 obstruct the openings in the stomach tube, so that nothing will pass out, unless the contents 
 of the stomach are vomited and pass out by the side of the tube and are mixed with mucus 
 from the mouth. 3. This method cannot be used to determine when digestion is ended, as 
 all the particles of food cannot be obtained from the stomach. 4. When exact experiments 
 are made it cannot be hoped to obtain accurate results, as it must be assumed that the forcible 
 efforts at vomiting must alter the secretions and possibly cause the bile to flow into the 
 stomach. 5. The intense efforts at retching and vomiting which are made during this pro- 
 cedure make the use of the same appear hazardous, when there is suspicion of ulcer, carci- 
 noma of the stomach, in heart disease, severe emphysema of the lungs, atheroma of the 
 blood-vessels and in general debility. In some cases, however, on account of its simplicity,, 
 this procedure may be recommended, for instance, when the ice-water method is used. 
 
SI'KL'DEL SALT IN GASTRIC IRRIGATION. 
 
 81 
 
 with a rubber stopper /, through which is inserted the small tube w. The 
 bottles A and D may be advantageously replaced by similarly constructed 
 tin vessels. 
 
 B is a vessel holding several litres of Sprudel Salt solution ; /" is a glass 
 siphon tube. Instead of B any kind of vessel or bottle may be used. 
 
 C is a graduated bottle, or a similarly constructed vessel, filled with dis- 
 tilled water for experimental purposes. This vessel is supplied below at k 
 either with a tube and discharging pipe /, or else with a siphon tube the 
 same as in the vessel B. 
 
 E is a receiving bottle holding 2-3 litres hermetically closed with 
 
 a rubber stopper q, having two openings ; through one of these openings 
 passes the shorter and narrower glass tube z for the purpose of connecting 
 with the aspirator bottle A by means of the rubber hose v z, which may be 
 closed at v ; through the other opening passes the bent glass tube s r, which 
 extends lower down, having a larger bore (1-2 ctm. in diameter). The 
 stopper q may be very conveniently replaced by a stop-cock having a double 
 bore, Exs a reserve vessel constructed exactly like E. It is of advantage to 
 have a number of such bottles in reserve. 
 
 n, o, p is a T-shaped glass tube having a diameter of 1-2 ctm. The 
 one arm, a 0, is inserted into a soft rubber stomach tube, the connection 
 6 
 
82 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 being made air-tight ; if the latter is funnel-shaped at o, which is a con- 
 venient arrangement, a perforated rubber stopper must first be inserted into 
 the funnel and then the arm a o inserted into the opening in the stopper. 
 By means of the second arm, a n, connection is made at n between the 
 Sprudel Salt solution, B, and the stomach tube o. This connection may be 
 cut off by means of a clamp, m. The third arm,^ a, connects the stomach 
 tube o with the receiving bottle E by means of a rubber tube, r p, which may 
 be cut off at x. 
 
 If, now, it is desired to wash out the stomach by means of the above- 
 described aspirator, no regard need be had as to whether the stomach be 
 empty or full. All that is necessary is to open all the clamps on the siphon 
 tube i, m, n, and thereby allow it to fill up with the Sprudel Salt solution. 
 When this has been done all the clamps are closed, excepting the one at m, 
 through which the desired quantity of solution flows into the stomach 
 through n o. Now the clamp at m is also closed, and time is allowed for the 
 Sprudel Salt solution to act upon the gastric contents when the clamps h, v, x 
 are opened (m remains closed) so as to aspirate the contents of the stomach. 
 As regards the opening of the clamps, which must always be supplied with 
 long handles, they are most conveniently pushed over on to the adjacent 
 glass tubes. The bottle A now aspirates the air from E and the liquid out 
 of the stomach, which flows in a stream through the tube r s into the re- 
 ceiving bottle E. When the liquid ceases to flow into E or the aspiration 
 suddenly stops, x (and h) are closed (or compressed with the fingers) and m 
 is opened, to allow of the flow of another quantity of Sprudel Salt solution 
 into the stomach, whereupon m is also closed ; time allowed for the action of 
 the solution on the gastric mucous membrane, and then x (and K) are opened, 
 whereby the gastric contents are transferred to E. If the air in the stomach 
 has become greatly rarefied, the aspiration will be interrupted. It is then 
 necessary, after closing the rubber tube at x, to squeeze the same obliquely 
 at/ with the fingers, so as to introduce the air into the stomach, which takes 
 place with a hissing noise, when x is again opened. The stomach-tube dare 
 not be moved to and fro in case the air has become rarefied, until air has first 
 been introduced into the stomach in the above described manner at p, or 
 else the gastric mucous membrane is pressed or sucked into the fenestra of 
 the stomach-tube. If, by repeated introduction and aspiration of the saline 
 solution from the stomach (a sort of stomach douche), the bottle E has be- 
 come filled, the clamps v and h are closed and the bottle exchanged for the re- 
 serve bottle F. In the same way, as soon as the bottle A has become 
 empty and D filled, A is placed upon the floor and D in its place, with the 
 stopper / closed hermetically, to act as aspirator bottle. It is more con- 
 venient for the experimenter to place the aspirator bottle A by the side of 
 the patient, beside the bottle C. The physician who watches the patient 
 and who must hold the stomach tube at o with his fingers, can thereby regu- 
 late and if necessary stop the flow of water, and so prevent any waste. This 
 
USE OF THE SPKUDEL SALT PER RECTUM. 83 
 
 apparatus will be found to be very convenient when the operation of wash- 
 ing out the stomach must be done frequently, and repeated observations and 
 experiments made. One can thereby operate with the greatest convenience 
 and assurance, and without interruption, arriving at the most accurate ex- 
 perimental results in a manner the least disagreeable to the patient. The 
 apparatus may be constructed by the physician himself in any hospital and 
 modified to suit the convenience and exigencies of the case. 
 
 SECTION 18. 
 
 USE OF THE SPRUDEL SALT PER RECTUM. 
 
 The Sprudel Salt is used by the rectum in a warm solution (36°-4o° C), 
 preferably made with rain or river water. A solution of 2-3 tablespoonfuls 
 of Sprudel Salt in 2 litres of water is preferred. The solution is best intro- 
 duced by means of Hegar's funnel, in the evening, before bed-time; it is 
 only to be done in the morning in case it disturbs the sleep. The injections 
 may be either large and abundant or small. The above solution is used for 
 the abundant or copious i?ijections ; it is necessary in this case to try to intro- 
 duce enough solution so that part of it may get into the caecum. To accom- 
 plish this 2-3 litres are necessary, and when the solution reaches the caecum 
 the patient experiences in it, as also in the entire abdomen, a feeling of 
 tension. The most judicious manner in which to order the injections is the 
 following : Enough solution is introduced into the rectum until the patient 
 experiences a strong feeling of tension ; the patient is then to assume the 
 horizontal position, lying on the back, and remain so (about ten minutes) 
 until a strong desire is experienced to go to stool, which the patient is to 
 give way to, whereupon the patient shall continue evacuating the bowels as 
 long as anything will come away. The patient may be recommended to 
 assist the evacuations by stroking the abdomen with the hand in the direction 
 of the large intestine, beginning at the caecum, and at the same time making 
 efforts at straining. Should there continue to be a desire to go to stool after 
 the main passage the patient is to give way to the same, and should this be 
 the case during the night he should get up and have a passage, as, should he 
 fail to do so, the fecal masses forced into the large intestine from above would 
 continue to fill it up for a long time. In some patients the large injections 
 cannot be used, as they are not able to retain such large quantities of liquid ; 
 hence, it is difficult in these cases to clean out the large intestine and to act 
 locally upon it. One must be satisfied to use small injections in these cases ; 
 these are also better borne by patients with heart disease. 
 
 Small injections are made by dissolving 1-2 teaspoonfuls of Sprudel Salt 
 in a teacupful of either river or rain water, introduced into the rectum pref- 
 erably in the evening, and retained as long as possible. If the small injec- 
 
84 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 tions have for their object the introduction of the salt into the circulation of 
 the blood-vessels, they must be retained all night, in spite of the desire to go 
 to stool. If they are employed to evacuate the bowels, the desire to go to 
 stool may be heeded after 1-2 hours. When the Sprudel Salt is given by 
 the rectum for a long time, capillary hemorrhages occasionally set in. In 
 that case, the injections must be stopped for several days, or less concentrated 
 solution or even pure water are to be used, or, finally, as will be found very 
 judicious, give the injections every other night. 
 
 The Sprudel Salt may be used in the form of injections in all cases with 
 the exception of the contra-indication cited in Section 13, and deserves much 
 more attention than heretofore. It frequently happens that injections of 
 plain water used to evacuate the bowels do not produce any discharge of 
 fecal matter ; the addition of Sprudel Salt in these cases will accomplish the 
 desired result. In intestinal therapeusis the gastric function is saved by the 
 injections, in addition to which they act locally upon the part affected. In 
 diseases of other abdominal organs, the injections do not only save the gastric 
 function, but enable larger quantities of the Sprudel Salt to reach the circu- 
 lation of these organs. It is therefore always best in certain cases to divide 
 the dose of Sprudel Salt so that one part will reach the circulation per os, 
 the other per rectum. 
 
 SECTION 19. 
 
 LENGTH OF TIME AND DIRECTING OF THE SPRUDEL SALT 
 
 TREATMENT. 
 
 The length of time of the treatment naturally depends in every case upon 
 the success ; a term that would be applicable to all cases cannot be given. 
 Another question in this direction may be of importance : how long the 
 Sprudel Salt may be taken without detriment to the organism. The effect 
 of the continued use of the Sprudel Salt shows itself mainly in the change of 
 the gastro-intestinal function and in the general health. According to my 
 observations, I would infer that the continued use during six weeks of small 
 and medium doses (5-10 grm.), and during four weeks of large doses (15 
 grm.) could be borne under ordinary circumstances without great alteration 
 of the organism. If, in a special case of disease, success follows the use of 
 the Sprudel Salt treatment, but it is noticed that the treatment will require 
 longer than four or six weeks, it is well to divide the same into periods of 
 three to four weeks, allowing an interval of from one to two weeks to inter- 
 vene between. 
 
 It is absolutely necessary to direct the treatment, as thereby it is not only 
 possible to give assurance of the progress of the treatment, but also data to 
 determine the dose of the Sprudel Salt, the length of time the treatment is 
 to last, if the same is to be continued, interrupted, or considered as ended. 
 
DURATION AND INTERVALS OF TREATMENT. 85 
 
 The direction must, however, be based upon objective clinical examinations: 
 In diseases of the liver upon physical examination of the liver; in diseases of 
 the urinary apparatus, in diabetes, upon chemical analysis of the urine; in 
 diseases of the intestines upon examination of the stools; in adiposis by de- 
 termining the body weight, but in this case the degree of muscular weakness, 
 and above all the action of the heart and the possibly engendered intestinal 
 catarrh, must be taken as a guide, whether it will not be well to discontinue 
 the treatment for a time. Especially in diseases of the stomach is it neces- 
 sary to control or direct the treatment; hence I will here make a few obser- 
 vations in this connection from my own experience. 
 
 Just as it is necessary to determine, by internal examination of the stomach, 
 the degree of acid secretion, power of digestion and gastric capacity, if the 
 Sprudel Salt treatment be indicated and what dose is to be employed, so 
 also is it necessary to direct and control the treatment, and the most proper 
 time to make the internal examination is the third week of the treatment. 
 If, for instance, it will be found that in acid hypersecretion the acidity of 
 the gastric contents has only been reduced very little, it will then be neces- 
 sary to increase the dose of the Sprudel Salt, but if a very great reduction is 
 found it will be necessary to reduce the quantity of the salt. If the degree 
 of acidity, determined by the modified ice-water method, be six degrees, 
 and just as much after an albumen digestion lasting a half to three-quarters 
 of an hour, then the treatment may be considered as ended, as a further con- 
 tinuance of the Sprudel Salt would produce a total acid insufficiency and 
 digestive incapacity. This cannot be determined from the subjective symp- 
 toms of a patient with a gastric disease, and, therefore, no positive deduc- 
 tions as to the favorable or unfavorable course or the termination of the 
 treatment can be drawn therefrom. It is, for instance, impossible to assert 
 positively, judging by the subjective symptoms, if the gastric contents are 
 strongly acid or entirely devoid of acidity, inasmuch as the most diverse 
 objective pathological conditions are described by patients just alike. One 
 thing I have often noticed in treatment with Carlsbad Sprudel Salt or 
 Carlsbad water, when, before the treatment, a patient suffering from exces- 
 sive hypersecretion complained of a voracious appetite, this would, after a 
 certain time, be much diminished and give way to a sense of satiety. This 
 occurred in the period when the acidity was much lowered. If, however, a 
 case of acid insufficiency is treated with small doses of Carlsbad water or 
 Sprudel Salt, then the first thing to be determined is whether it is a case in 
 which the normal secretion may be lowered, or the anatomical change in the 
 secretory apparatus is such as would appear irreparable. If the internal ex- 
 amination, after two weeks of treatment, shows that the original acidity is not 
 at all increased or has even become less and the secretion of albumen from 
 the stomach is delayed, then success from a continuation of the treatment is 
 not to be expected ; there is even danger of destroying the remaining diges- 
 tive chemism by the continued use of the Sprudel Salt. Subjective sensations 
 
86 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 are here also not much to be trusted. In some favorable cases of gastric 
 insufficiency treated with Carlsbad water I have noticed that during the 
 course of treatment the patients asserted that they got a good taste in the 
 mouth, had a very good appetite and even felt a sort of hunger. In these 
 cases the internal examination showed an increase in the originally very low 
 degree of acidity of the gastric juice. It may again be mentioned that there 
 are very much fewer cases of acid insufficiency than of hypersecretion, and 
 that in the former cases there are fewer cases benefited. 
 
 It may be easily seen from the foregoing that it is necessary, in every treat- 
 ment of a gastric disease with objective success, to examine the stomach 
 internally before and during the treatment, and that the cessation of the 
 subjective symptoms cannot be taken as a criterion of the cure of the disease. 
 In what manner to examine and direct a gastric treatment may be gleaned 
 from the cases in Section n. It is, however, seldom, especially in Carlsbad, 
 that an objective control of the treatment is possible. It becomes necessary 
 to be satisfied with misleading subjective symptoms. When, for instance, in 
 a gastric affection in which the previously voracious appetite disappears, or 
 when the previous want of appetite is improved by a Carlsbad treatment, 
 and gives place to a loss of appetite and gastric distress, it then becomes 
 necessary to discontinue the treatment. 
 
 CONCLUDING REMARKS. 
 
 To what constituent of the Sprudel Salt may especially be ascribed the 
 physiological and therapeutic action produced, cannot positively be affirmed, 
 because the action of the numerous components of the Sprudel Salt have not 
 yet been clinically investigated upon man. The beneficial action of the 
 Sprudel Salt is rather to be found in the condition which Prof. Leube * 
 emphasizes for the Carlsbad water, which "amongst all other alkaline saline 
 springs has taken the first place in gastric therapeutics," namely, in the happy 
 combination of its constituents. The Sprudel Salt may well be compared to 
 " an extract of the Carlsbad water," possessing the happiest combination of 
 the most active saline remedies which are present in the Thermal water. 
 Besides this there is a second important factor to be considered, that the 
 many saline substances present in the Sprudel Salt, and demonstrated by 
 chemical analysis to be present there in only very small quantities, produce 
 a very decided action upon the intricate actions of the cell elements of the 
 gastro-intestinal mucous membrane ; and it is on this account that the 
 original natural Sprudel Salt will always be superior to the artificial product. 
 
 * Ziemssen. " Handbuch der speziellen Fathologie und Therapie." vn, H. 2, pp. 109, no. 
 
APPENDIX. 
 
 SECTION 20. 
 
 THE RELATION OF THE SPRUDEL SALT TO THE CARLSBAD 
 THERMAL WATERS. 
 
 As the Sprudel Salt had its origin in the desire to furnish a product con- 
 taining all of the constituents of the Carlsbad waters, my desire has been to 
 ascertain if the pharmacodynamic and therapeutic action of the Sprudel Salt 
 and Carlsbad water are identical or not, inasmuch as from a practical stand- 
 point it was desirable to ascertain whether or no, clinically, the Sprudel Salt 
 might be used instead of the Carlsbad waters. At first nothing seemed 
 easier than to make parallel experiments upon the same individual to ascertain 
 the influence upon the gastric function once with the Thermal waters then with 
 the Sprudel Salt The insurmountable difficulty, however, arose of placing 
 both products under the same experimental conditions. As is well known, the 
 Carlsbad Sprudel Salt is produced by evaporation of the Carlsbad Sprudel 
 water and the removal of the insoluble constituents. One litre of Sprudel 
 water, according to Ludwig's and Mauthner's analysis, produces 5.5168 grm. 
 dry residue in which there are 4.9527 grm. soluble constituents. It may, 
 therefore, be assumed that this latter quantity of Sprudel Salt dissolved in one 
 litre of distilled water would be equal to one litre of Sprudel water as regards 
 the soluble constituents. When, however, I dissolved 4.9527 grm. of Sprudel 
 Salt in distilled water and determined in the artificial water thus obtained 
 the main constituents, sodium carbonate, sodium sulphate and sodium 
 chloride, quantitatively, I found that it did not entirely correspond to the 
 neutral Sprudel water as far as these constituents were concerned. I found 
 by analyzing, with the same reagents and at the same time, the bottled 
 Sprudel water and the imitated Sprudel to contain in 100 parts of liquid the 
 following : — 
 
 Bottled Sprudel Water. Sprudel Water made from Sprudel Salt. 
 
 Alkalinity, . . . 35.4 c. c. 22.4 c. c. T L normal sulphuric acid. 
 
 Chlorides, . . . 22 6 c. c. 20.4 c. c. -^ normal silver-nitrate solution. 
 
 Barium sulphate, 0.494 grm. 0.381 grm. 
 
 From the above it will be seen that the natural Sprudel water is much 
 stronger so far as the main constituents are concerned, and what concerns us 
 most here, the relation of these constituents one to the other has been changed ; 
 although the percentage of chlorides in both liquids did not differ much, 
 
 87 
 
88 APPENDIX. 
 
 the percentage of sulphates was diminished by -J-, and the alkaline carbo- 
 nates, the most important agent upon the gastric function, to almost y$ in 
 the Sprudel Salt solution. The influence of these liquids upon the organ- 
 ism cannot, therefore, be compared in figures. It is impossible to find a 
 quantity of Sprudel Salt which, when dissolved in water, would be quantita- 
 tively of equal value with the Sprudel water. From a chemical standpoint 
 of view there are two quantitatively heterogeneous solutions under consider- 
 ation. 
 
 i . Still, I have made parallel examinations with the above mentioned Spru- 
 del Salt solution which was intended to imitate the Sprudel water and the 
 Sprudel water itself, to ascertain the action of both upon the gastric func- 
 tion. Case XXI, 114, 115, of the table, is one of these cases. It was found, 
 as might be expected, and was observed in a number of other cases, that the 
 depressing or lowering effect of the Sprudel Salt solution upon the stomach 
 was greater than that of the natural Sprudel water. The acidity appeared 
 higher after taking the Sprudel water, although it contained more alkaline 
 carbonates, the sulphates disappeared more rapidly, and the gastric juice 
 appeared more capable of digesting than when the Sprudel Salt solution had 
 been taken. 
 
 2. As it did not appear opportune to test both remedies pharmacodynami- 
 cally upon the ground of chemical principles, the question was taken up 
 from a practical clinical standpoint. The pharmacodynamic action of the 
 usual minimal doses of Sprudel water and Sprudel Salt were compared. For 
 this purpose, with accurately weighed and measured quantities of 250 c.c. 
 of Miihlbrunnenwasser on the one hand, and 5 grm. Sprudel Salt in 250 
 c.c. distilled water on the other, parallel experiments were made on the 
 same individuals under the same conditions as regards gastric function. The 
 mode of examination was identically the same as given above in Section 2. 
 The experiments made for this purpose are mentioned in the table in their 
 proper place. The experiments not only demonstrate that, after the inges- 
 tion of a quarter litre of Carlsbad water, a gastric juice of acid reaction, and 
 capable of digestion, appears sooner than when 5 grm. Sprudel Salt has been 
 taken, which quantity really represents a litre of the Thermal water, but that 
 the maximum of acidity after the Carlsbad water is much higher in less than 
 half an hour than after the Sprudel Salt ; it is even higher than the acidity 
 obtained by the irritation of ice water. In case I, 5, the acidity with 
 Sprudel Salt after half an hour was 3.6, with Miihlbrunnenwasser, however, 
 14.0; in case V, 28, with Sprudel Salt, 1.6 ', with Miihlbrunnenwasser, how- 
 ever, 13.2; in case IX, 46, with Sprudel Salt 3.4 degrees alkalinity, with 
 Thermal water 12.4 degrees acidity. In case XIX, the figures were 3.4 and 
 22.0; in case XXV, 0.8 and 15.4. In alkaline gastric juice the alkalinity 
 after Carlsbad water was less than after Sprudel Salt solution with the same 
 mode of experimentation ; in case X, 57, degree of alkalinity, after Sprudel 
 Salt solution, 2.0, and after the Thermal water, 1.2. In case XIII, 70, the 
 
RELATION OF SPRUDEL SALT TO CARLSBAD THERMAL WATERS. 89 
 
 differences were 4.0 and 2.8. In these experiments, therefore, the super- 
 irritated gastric function is relieved more by the Sprudel Salt than by the 
 Thermal water, which is very probably owing to the larger quantity of fixed 
 constituents of the Sprudel Salt. 
 
 3. If the facts set forth under 1 and 2 are placed in juxtaposition, and the 
 results which I have obtained and published concerning Carlsbad water 
 compared from a pharmacodynamic point of view with the results of my 
 experiments with Sprudel Salt, the following difference will be noticed 
 between the Carlsbad water and the Sprudel Salt from a practical point of 
 view. 
 
 {a) Single doses of Carlsbad water stimulate the acid secretion of the 
 gastric mucous membrane to a greater degree than single doses of Sprudel 
 Salt. The maximum of acidity after Carlsbad is not only much higher, but 
 is reached much quicker than after Sprudel Salt. 
 
 (J?) The gastric juice becomes capable of peptonization sooner after Carls- 
 bad water than after Sprudel Salt. 
 
 (V) The stimulation to acid secretion lasts much longer with Carlsbad 
 water than with Sprudel Salt, so that I had to wait hours in my experiments 
 with Carlsbad water until the degree of acidity was reduced to that of the 
 empty stomach. 
 
 (d*) The salts disappear more rapidly from the stomach after the ingestion 
 of the Carlsbad water than after taking a Sprudel Salt solution. 
 
 (J) Warm Carlsbad water is more stimulating to the gastric function than 
 cold, whilst with Sprudel Salt the opposite is the case. 
 
 CO Whilst the quantity of Carlsbad water ordinarily taken influences the 
 intestinal function but very little, the ordinary doses of Sprudel Salt exert a 
 very marked influence upon the entire intestinal canal. 
 
 (g) As regards the final result of a continued use of Carlsbad water and 
 of Sprudel Salt, both remedies correspond very closely with one another. 
 Given in large doses the digestive chemism is lowered by both, and fre- 
 quently stimulated by small ones. The general health and nutrition is 
 affected in the same way by large doses. The alteration in the intestinal 
 function may be noticed more frequently and in a higher degree after Spru- 
 del Salt than after Carlsbad water. 
 
 4. As regards the clinical deductions derived from these observations, 
 the following may be assumed therapeutically: — 
 
 (a) Carlsbad water is to be preferred in many cases of independent gas- 
 tric diseases, whilst Sprudel Salt is especially indicated when the stomach 
 and intestinal canal are both involved, but also is of most service in dilata- 
 tion of the stomach associated with acid hypersecretion, as small doses 
 appear well suited to lower the gastric function. 
 
 (3) Sprudel Salt has qualitatively the same therapeutic effect as the Carls- 
 bad water, but quantitatively, at least in one respect, not : Carlsbad water 
 is more stimulating. 
 
90 APPENDIX. 
 
 (V) Whether or no the Sprudel Salt is to be preferred to the Carlsbad 
 water in other diseases I am not prepared to say, on account of the want of 
 comparative study; speculative deductions would be of no use, and in 
 practice even dangerous, because it is impossible to know if the changes 
 in the more distant organs are produced in the organs themselves by 
 the direct action of the solution of Sprudel Salt introduced, or whether 
 they are the result of reflex action. 
 
 SECTION 21. 
 
 THE ACTION OF THE THERMAL WATER AND SPRUDEL 
 SALT WHEN USED JOINTLY. 
 
 I have studied the Sprudel Salt in still another connection with the Carls- 
 bad water. It is customary in Carlsbad to increase the action of the Thermal 
 waters by the addition of 5 grm. Sprudel Salt to the glass of water, to 
 avoid the drinking of too large quantities of water at one time ; or rather, 
 it is ordered by the physicians here, to act upon the bowels. It has been 
 studied how a solution of 5 grm. Sprudel Salt in 250 c.c. Miihlbrunnen or 
 Sprudel water behaves in the stomach. The experiments made to determine 
 this, and cited in the table, were upon the individuals XVII, XVIII, XIX, 
 XXII ; they show in every case that after taking such a mixture, compared 
 with Carlsbad water alone, the alkalinity of the gastric contents lasts com- 
 paratively very long, the sulphates remain a much longer time in the 
 stomach, the acid secretion appears much later, the maximum of acidity is 
 much less, and the digestive power of the gastric juice is much diminished. 
 In case XVII, 87, 89, after taking Miihlbrunnen water alone, a gastric juice 
 capable of digestion with an acidity 3.6 appeared after 2 quarter-hours; 
 after taking the mixture, a gastric juice appeared incapable of digestion with 
 an alkalinity 22.0. In case XIX, 98, 99, the acidity after 1 hour was respect- 
 ively 22.0 and 3.4, and not until 2 hours after taking the mixture was an 
 acidity of 8.4 reached. In case XX the reaction 2 quarter-hours after 
 taking the Miihlbrunnen water was 10.6 acidity; after taking the mix- 
 ture, 22.8 alkalinity and possessing no digestive power. After repeated 
 doses of the Thermal water alone, on the one hand, and of the mixture on the 
 other, the relation of the acidity was as follows : In case XXIII, 93, 94, 
 after 5 quarter-hours, 5.6 acidity, but 12.5 alkalinity, when repeated doses 
 of the mixture were given. If the behavior of the mixture taken by itself 
 is compared with a solution of Sprudel Salt in distilled water, the same dif- 
 ferences qualitatively will be noticed as when the Thermal waters and the 
 mixture are compared, only the differences are quantitatively less. In case 
 XVII, 84, 89, the acidity after Sprudel Salt is 1.0 ; after taking the mixture 
 the alkalinity is 22.0. In case XIX, 101, 102, after 2 hours the acidity is 
 
CONJOINT ACTION OK THERMAL WATER AND SPRUDEL SALT. 9I 
 
 respectively 16 and S. In case XIX, 103, 104, the acidity is 5.0 in 5 quarter- 
 hours after taking 2 doses of Sprudel Salt ; after two doses of the mixture 
 the alkalinity is 30, and a precipitate in the test for sulphates. It follows, 
 therefore, that mixtures of Thermal water and Sprudel Salt remain much 
 longer in the stomach than when either are taken separately, that the acid 
 secretion and digestive power are affected much longer by the mixture than 
 when Carlsbad water or Sprudel Salt alone is administered ; that the maxi- 
 mum of acidity, under the influence of the mixture, not only appears later, 
 but is less, than when either alone is taken. Taken as a whole, the mixture 
 of Sprudel Salt and Carlsbad water reduces the digestive chemism in a high 
 degree, wherefrom the following practical deductions may be made: — 
 
 (a) The mixture of Thermal water and Sprudel Salt is of advantage in 
 strongly-acid hypersecretion, especially when complicated with dilatation of 
 the stomach, and perhaps by disease of the biliary passages. In cases of gas- 
 tric acid insufficiency it is positively to be avoided. 
 
 (<£) The intervals between the doses of the mixture must not only be longer 
 than when the Thermal water alone is taken, but also than when Sprudel Salt 
 alone is employed ; they must be set at 2-3 quarter-hours. Breakfast must, 
 accordingly, be postponed much longer after the use of such a combination, 
 and must not be allowed before the lapse of two hours, if it is at all desirable to 
 have some regard for the gastro-intestinal function and to get the full benefit 
 of the food. 
 
 (V) Only the first doses of Thermal water are to be taken w T ith the addition 
 of Sprudel Salt, the following doses to consist of Thermal water alone, and 
 not vice versa, because in the latter case concentrated solutions come in 
 contact with the stomach already debilitated by drinking water, affect its 
 function still more and remain in the stomach too long, so that they enter 
 the intestine very late, and therefore also generally fail to move the bowels. 
 To make more than two additions of Sprudel Salt of 5 grm. to a glassful of 
 Thermal water would tax the gastric function too much. If, therefore, 3 
 glasses of Thermal water be ordered, with two additions of Sprudel Salt, 5 
 grm. are put in the first glass ; in half an hour the second is ordered, with 
 the second 5 grm. After 3 quarter-hours the third glassful of Thermal water 
 is drank alone, and not until the end of the second hour, or even later, after 
 the last glass is breakfast to be taken. In adiposis, of course, the interval 
 between the taking of the water and food may be reduced one-half. 
 
92 APPENDIX. 
 
 SECTION 22. 
 
 EXPERIMENTS TO DETERMINE THE INFLUENCE OF EXER- 
 CISE UPON THE BEHAVIOR OF THE THERMAL WATER AND 
 SPRUDEL SALT SOLUTION IN THE STOMACH. 
 
 Lastly, I have tried to elucidate another question experimentally. Does the 
 customary promenade taken during the ingestion of the Carlsbad water, the 
 Sprudel Salt solution, as also the mixture of the same, exert any influence 
 upon their behavior in the stomach. I have had to disregard this factor 
 from my previous examinations of Carlsbad water, as they were made during 
 the winter months. As I have made my experiments with Sprudel Salt for 
 the most part during the summer months of the year 1884, I embraced this 
 opportunity to get the patients at one time to walk in the clinical garden 
 (according to the suggestion of my colleague, Gluzinski) immediately after 
 taking the solution, another time to remain quietly seated in the room. In 
 these experiments, in addition to all the usual chemical examinations of the 
 gastric contents made heretofore, the chlorides in the filtrate were determined 
 quantitatively with one-tenth normal silver solution, and that for the purpose 
 of obtaining more data to judge of the behavior of the saline constituents 
 of the Thermal water and of the Sprudel Salt in the stomach. In the six 
 cases examined and incorporated in the table of experiments it was found 
 that in the case of Sprudel, as well as for Miihlbrunnen water (case XVII, 
 85, 86), the chlorides and sulphates disappeared from the stomach sooner 
 after exercise than when the patient remained quietly seated. When a solu- 
 tion of Sprudel Salt, however, was used (experiments 84, 85) the reverse was 
 the case, and when a mixture of Thermal water and Sprudel Salt was used 
 (experiments 88, 89) the exercise as well as the resting remained without 
 influence upon the behavior of the same in the stomach. In the case XVIII, 
 experiments 91-95, it was found in all three combinations that the behavior 
 of the same in the stomach was exactly the same when the patient remained 
 quietly seated as when he walked about, although the aspirations were 
 not made until after 5 quarter-hours of industrious walking. In case XX, 
 108-111, when Miihlbrunnen water was used, the conditions in the stomach 
 were exactly identical after sitting and walking, whilst after taking the saline 
 solution the alkalinity and the percentage of chlorides in the gastric contents 
 were less after walking than after sitting. Incase XXII, 117-119, where 
 three doses of Sprudel water had been given, and aspiration not performed 
 until after six quarter-hours, the quantity of the salts in the gastric contents 
 were found to be less after walking, the acidity on the other hand diminished. 
 The cases XXIII and XIX also failed to give a decisive result. These 
 experiments therefore demonstrate : — 
 
 (a) That in cases in which bodily exercise manifested any influence, the 
 same showed itself in the more rapid disappearance of the salts from the 
 
INFLUENCE OF EXERCISE UPON ACTION OF THE SALT. 93 
 
 stomach, so that it would appear as if the disappearance from the stomach 
 was hastened by the possible gastric movements. Walking, however, appears 
 to exert no influence upon the secretion of acid. 
 
 (J>) Whilst, therefore, walking is of decided advantage when drinking the 
 mineral waters or solution of Sprudel Salt, to stimulate the intestinal func- 
 tion, promenading to influence the gastric function is not necessary, still, 
 however, when possible, to be recommended. As it is generally desirable to 
 influence the entire gastro-intestinal tract when mineral spring waters or 
 Sprudel Salt solution are ordered, bodily exercise during a mineral water 
 treatment is in place, as it offers the additional advantage of the general 
 stimulating effect of a sojourn in the cool morning air. 
 
 In closing this treatise I feel constrained to tender my sincerest thanks to 
 the Director of the Clinical Institute in Cracow, Professor Korczynski, who 
 has also in this work kindly favored me with his very valuable scientific and 
 material help. 
 
DIETARY. 
 
 This dietary, which is meant to supplement the one in the body of the 
 book, is by no means intended to be complete or as covering anything more 
 than a few of the most salient points, still, it may perhaps prove of value in 
 the absence of a more exhaustive work on the subject. 
 
 Briefly as the subject is treated here, it may not be out of place to call 
 attention to a few cardinal principles relating to the taking of food and its 
 digestion or solution. 
 
 A point to be remembered is that not so much depends upon the kind of 
 food taken, as is generally supposed, always providing that it is sound and 
 properly prepared, as upon the manner or way in which the food is eaten, 
 the meals arranged, and the circumstances under which they are taken. 
 
 Let it be remembered that digestion begins in the mouth, with the very 
 important acts of mastication and insalivation, here being the only place 
 where the food can be comminuted and subdivided so that the saliva, gastric 
 and other digestive juices may act properly upon it. If this one act is not 
 properly performed, all the others will be more or less hampered, retarded, 
 and in some cases entirely prevented from doing their share in the proper 
 digestion or solution of the food. 
 
 If the meals be taken hurriedly, especially when heated and exhausted, 
 discomfort will inevitably follow. If there is not time sufficient to take the 
 food properly, at ease and in comfort, it is best not to take the meal at all 
 at that time, but to substitute a very light lunch consisting chiefly of liquid 
 food that is easily digested, and arranging for the meal proper when more 
 time may be taken. The chief meal of the day, the dinner, may thus be 
 postponed until after business hours and a light lunch substituted. 
 
 Such light lunch may consist of a cupful of bouillon, which is made by 
 beating up the yolk of an egg into a cupful of hot broth or consomme, or a 
 cupful of beef-tea may be taken with a piece of toast or cracker, or a glass- 
 ful of Johann Hoff's Extract of Malt (Eisner), or even a glassful of plain 
 hot water, if none of these be accessible; this latter, in most cases, is to be 
 preferred to tea or coffee. Under no circumstances should there be large 
 quantities of these liquids taken, and cold drinks ought never to be allowed. 
 
 We will now proceed to the consideration of the diet best adapted to 
 patients suffering from diseases for which the Carlsbad Sprudel Salt (powder 
 form) is especially recommended. 
 
 95 
 
g6 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 Acute Gastric Catarrh. — The indications with regard to food in this 
 disease are to limit it in quantity and quality, so as to prevent any undue 
 irritation by the food, and to allow the irritated and inflamed mucous mem- 
 brane of the stomach as much rest as possible. Therefore nothing in the 
 form of food proper must be allowed between meals. In severe cases food 
 had best be abstained from altogether for a day, or even two days, nothing 
 but Johann Hoff's Extract of Malt (Eisner) or hot water being allowed. In 
 all these cases the food had better be liquid as much as possible, consisting 
 of meat broths, milk diluted with soda water or lime water, whey, junket, 
 etc. Solid food had better be returned to very gradually, and to assist its 
 digestion be followed by Johann Hoff's Extract of Malt (Eisner). On 
 recovery care must always be had to avoid any and every exciting cause. 
 
 Chronic Gastric Catarrh. — This often being a sequel to the acute, 
 what has been said in reference to that also applies here. Always remem- 
 bering to avoid the cause, be it indiscretions as to eating or drinking or 
 over haste, or inopportune times in taking the meals. The dietetic treatment 
 in these cases must be strict and systematic. In many cases an exclusive 
 milk diet answers very well, and with the aid of the Carlsbad Sprudel Salt 
 will frequently effect a cure. But in employing this diet it will always be 
 well to have regard to the peculiarities and idiosyncrasies of the patient as 
 regards the digestion of milk. Should there be any discomfort experienced, 
 before abandoning this diet, it may be advisable to try giving the milk 
 mixed with Giesshiibler, a most delightful, natural aerated water, or with 
 lime-water ; in other cases it may be necessary to skim off the cream or add 
 a little salt; again, in others, it may be well to peptonize or predigest it. 
 No matter how the milk be taken it is always necessary to drink it very 
 slowly, as when large quantities enter the stomach at once they may form 
 one solid mass of curd that will be almost impervious to the gastric juice, 
 and really act like a foreign body. Bearing this in mind it will, in some 
 cases, be found advantageous to substitute buttermilk which, if fresh, will 
 be better borne by the majority of patients. Niemeyer suggests that " when 
 the patient is hungry let him eat buttermilk, and when he is thirsty let him 
 drink buttermilk." In some cases it is well to employ the whole milk, 
 skimmed milk and buttermilk interchangeably, and at times add to the milk 
 either salt, bicarbonate of sodium, lime-water, or, best of all, some aerated 
 water. * Another expedient that will be found to work well, when the 
 milk is not well borne, is to either whip it or shake it thoroughly ; this will 
 make it seem much lighter, and it will be found easier to digest. To accom- 
 
 * The best of all aerated waters will be found to be those that are charged by nature with 
 carbonic acid gas ; these are far superior to any and all those which are charged artificially ; 
 they are better borne by the stomach, and do not cause the unpleasant distention and dis- 
 comfort so frequently experienced when the artificial waters are used. Of all the natural 
 aerated waters the Giesshiibler will be found to answer the requirements in these cases best. 
 
DIETARY. 97 
 
 piish this the milk may be placed in an ordinary preserve jar, closing it 
 and then shaking for a minute or two vigorously; of course, the jar must 
 not be filled and not shaken too long. In the chronic gastric catarrh 
 caused by the abuse of alcoholic beverages, it will be found best to mix the 
 milk with carbonic acid water or plain soda, or better still, "Giesshiibler " 
 water. 
 
 As to the quantity to be taken, this must necessarily vary with the indi- 
 vidual as well as with the severity of the case, varying from a few ounces 
 every two hours at first, in severe cases, to a little over a pint taken three or 
 four times a day. The majority of cases met with in practice will be found 
 to be such as will improve very much under a plain bread and milk or crack- 
 ers and milk diet. 
 
 The milk diet, however, will not be well borne by some patients, no matter 
 how it is varied and how combined, and for those it will be necessary to get 
 up a dietary that will in blandness and unirritating qualities approach this as 
 near as possible. In these cases it is necessary to avoid starchy food as much 
 as possible, and to give the patient nourishing broths, into which the yolk 
 of egg has been beaten, with toast. Later on, when the severe symptoms 
 have somewhat subsided, oysters, raw or panned, may be added to the 
 dietary. Then fresh fish of the kind that is not too greasy ; later on, the 
 meat of fowl, game, etc. Always avoiding greasy and starchy food. The 
 vegetables may be added in the following order, beginning with lettuce, 
 then spinach, salsify, tomatoes, etc. ; and not until the patient is almost well 
 may he return to potatoes and pastry. Condiments and sauces are to be 
 avoided. Coffee and tea as well as whiskey, brandy, beer, wine, etc., unless 
 in very debilitated conditions, must not be allowed. In these cases it will 
 be found that every indication will be met by Johann Hoffs Extract of 
 Malt (Eisner). 
 
 Ulcer of the Stomach. — What has been said concerning chronic gas- 
 tritis holds good in ulcer of the stomach, always bearing in mind that the 
 object here is to give as little food as possible, and so allow of the healing 
 of the ulcer. In cases where dangerous hemorrhages have occurred, it is 
 best to keep the stomach absolutely quiet and feed by the rectum. 
 
 Dilatation of the Stomach. — Here the object is to avoid overloading 
 the stomach by either solid or liquid food, hence to give the food in as con- 
 centrated a form as possible. Starchy and sweet food had better be avoided, 
 and the regime laid down under chronic gastritis followed as near as pos- 
 sible. 
 
 Dyspepsia or Indigestion. — Here it will be necessary to inquire into 
 the quantity as well as quality of the food, as to the manner and circum- 
 stances and time of taking it, etc. As to the kind of diet best suited to the 
 case, it will be found that in some a plain bread and milk or crackers and 
 milk diet will answer the purpose where there is no individual peculiarity or 
 idiosyncrasy regarding the digestion of milk. In very severe cases the diet 
 7 
 
98 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 recommended for chronic gastritis will be found the best. In milder cases, 
 the avoidance of the particular food that is known to be especially prone to 
 bring on an attack, with a temporary abstinence regarding greasy food and 
 pastry; in men, the cutting down of the allowance of tobacco and absti- 
 nence from drinking spirits and beer or wine will suffice, especially when 
 the treatment with Carlsbad Sprudel Salt is carefully carried out. 
 
 The dyspeptic should be especially cautioned against eating immediately 
 after severe mental or physical work, or performing such toil immediately 
 after a meal. As to the use of tea and coffee, it will be found that in them- 
 selves they are in the majority of cases not hurtful ; it is only when taken 
 too often or in too large a quantity that they are harmful. 
 
 Chronic Constipation. — Here again the cause of the trouble must be 
 inquired into, and if possible removed. The habits of the patient as to 
 exercise must be looked after, etc. As a too concentrated diet, consisting 
 chiefly of nitrogenous and too easily digested animal food, with very little 
 or no residue to excite and stimulate the nerves of the intestinal mucous 
 membrane, may be a cause, this must also be looked after. Then, again, 
 the constipation may be caused by the too often repeated contact of over- 
 stimulating diet and too stimulating residue, thereby exhausting the excita- 
 bility of the intestinal nerves ; in other cases, too dry a diet may be the 
 cause of the trouble, etc. Persons who live on a too exclusive diet of any 
 kind must be directed to add a larger number and variety of dishes to their 
 bill of fare. If green vegetables and fruits have been avoided, these must 
 be added, etc. The various kinds of brown bread, those made from whole 
 meal, may sometimes be advantageously added to the diet. When these or 
 other foods having a large percentage of irritating, undigested residue have 
 been used in excess, they had better be dropped entirely, as they in some 
 cases will produce the very evil they are intended to correct. 
 
 Diarrhoea. — When uncomplicated with other disease is either acute or 
 chronic, the one temporary, the other sometimes very difficult to cure. The 
 rule in both cases to observe is to avoid all food that leaves a large quantity 
 of undigested residue behind to irritate the mucous membrane. Green 
 vegetables, acid fruits, nuts, potatoes, coarse brown bread, rich, greasy or 
 acid dishes should be avoided. 
 
 The best diet in these cases is milk, which is best taken boiled or in the 
 form of buttermilk, especially when the latter is fresh and obtained from 
 sweet milk; should this not answer, Koumiss maybe used instead. Next to 
 milk in efficiency comes raw meat, then peptonized foods, and if these, for 
 any reason, cannot be taken, then bland farinaceous foods, such as arrow- 
 root, rice, tapioca, etc., flavored with cinnamon, nutmeg or cloves, may 
 be substituted. 
 
 Diseases of the Liver. — These cases do best on a diet as free from fat 
 and starchy food as possible. Coffee, beer, wine and spirits, as well as 
 tobacco, are best avoided. 
 
DIETARY. 99 
 
 A mixed diet, consisting of lean beef and mutton, or chicken, with greens, 
 acid fruits, especially lemons, is generally well borne. In very severe cases 
 the diet laid down under chronic gastritis will be found of advantage. 
 
 Diabetes Mellitus. — Of this disease there may be said to be three 
 different kinds of cases : slight cases, which, when Carlsbad Sprudel Salt is 
 used, need no special diet ; medium cases, which had better, in addition to 
 the use of Sprudel Salt, submit to a somewhat restricted diet, and severe 
 cases, which must adhere strictly to the diet prescribed. In these cases all 
 articles of food containing starch or sugar must be avoided. Patients, 
 however, may eat meats of all kinds (excepting liver), poultry, game, fish, 
 oysters, eggs, cheese, butter, milk and cream. Of vegetables they may eat 
 tomatoes, lettuce, celery, water-cress, chickory, dandelion, spinach; greens 
 of any kind, such as turnip or beet tops, onions, cabbage, cauliflower, 
 string beans, radishes, mushrooms, truffles, Brussels sprouts, asparagus, 
 salsify, artichokes, cucumbers and pickles. All kinds of nuts excepting 
 chestnuts. Of beverages they may have tea and coffee without sugar, 
 Rhine wine, brandy, whiskey, gin, rum, arrack, apple-jack, the various 
 aerated mineral waters, etc. 
 
 To be avoided is sugar and all food containing it, syrup, honey, bread, 
 wheat and rye flour, cornmeal, arrowroot, sago, tapioca, oatmeal, barley, 
 potatoes, beets, parsnips, carrots, rhubarb, peas and beans, sweet fruit, 
 chocolate, sweet cider, malt liquors, champagne, sweet wines, etc. 
 
 As to the matter of bread in diabetes, this problem has always been the 
 one most difficult of solution. All the diabetic flours and breads so far 
 introduced have invariably contained a very large percentage of starch, so 
 as to make them unfit for use in this disease. Recently, however, there has 
 been introduced into the market a Gluten,* not a Gluten flour, that con- 
 tains but a mere trace of starch ; this is much preferable to all the gluten 
 flours. In very grave cases the bread may be directed made from this Gluten 
 alone, and as the case improves wheat flour may be added thereto in gradu- 
 ally increasing quantities, so that it may be positively known at any time 
 how much starch is being introduced into the system ; and if care and judg- 
 ment be exercised, the quantity which the patient can assimilate can very 
 easily be ascertained, and never any more introduced than the system can 
 appropriate. The exact quantity can be determined by examination of the 
 urine ; after it has once been freed from sugar, and kept so for several weeks, 
 then wheat flour may be added to the Gluten, decreasing the quantity as 
 soon as sugar may be detected in the urine. 
 
 As to the best mode of making this Gluten into bread, it will be found 
 that by the use of cream of tartar and bicarbonate of sodium it will be made 
 quite light enough ; of course, milk and eggs are always added. 
 
 * This Gluten is manufactured by the Crystal Springs Manufacturing Company, Boston, 
 Mass., and by them given the name, " Poluboskos." 
 
100 THE ACTION OF CARLSBAD SPRUDEL SALT. 
 
 Rheumatism. — In these cases a fruit and. vegetable diet will be found 
 most advantageous. Acid fruits, such as lemons, are especially to be recom- 
 mended. Among the vegetables that are to be preferred in these cases may 
 be cited tomatoes, all kinds of greens, such as lettuce, water-cress, spinach, 
 etc., celery, cabbage, sauer-kraut, cauliflower, string beans, asparagus, salsify, 
 pickles, etc. Especially to be avoided are starchy and saccharine articles of 
 food, such as potatoes, corn-starch, arrowroot, beets, oatmeal, pastry, sweet 
 fruits, malt liquors and wines. 
 
 To acid fruits and the vegetables allowed, there may be added beef and 
 mutton in moderation, fish, oysters and eggs. 
 
 Gout. — Here a mixed diet will be found best, the nitrogenous (such as 
 meats) and saccharine articles (such as contain sugar) used only in limited 
 amounts. The free use of pure water is of great importance. Especially to 
 be avoided are pastry, malt liquors and sweet wines. 
 
 Adiposis or Obesity. — To decrease the amount of fat in these cases 
 the patient may be allowed to eat lean beef, lean mutton, lean ham, chicken, 
 dried beef, game, eggs (only one at a meal), fish of all kinds excepting 
 catfish and salmon, buttermilk. Of vegetables he may eat asparagus, cauli- 
 flower, onions, spinach, cabbage without a butter dressing, celery, tomatoes, 
 radishes, lettuce, water-cress and greens of all kinds. Of fruits he may 
 eat oranges, lemons, grapes, cherries, berries of all kinds, peaches and sour 
 apples. 
 
 Not more than four ounces of bread must be allowed, unless it be the 
 gluten bread recommended for diabetics. Water, tea and coffee without 
 cream and sugar, may be indulged in but very sparingly. 
 
 Especially to be avoided are fats in any form, starchy food, such as rice, 
 oatmeal, hominy, potatoes, pies, puddings and all such food as contains 
 sugar; also malt liquors of all kinds, and lastly as little liquid had better be 
 taken as the patient can possibly get along with. 
 
 A. L. A. Toboldt, M. D. 
 
 822 N. Broad Street, Philadelphia. 
 
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