848 HENRY A. MATTILL 



been stated that the mineral content of the blood usually increases, always 

 within physiological limits after drinking various mineral waters, with 

 proportionate changes in A (v. Szabohy ; Grube), but most observations 

 are to the effect that the molecular concentration of the blood is maintained 

 with great tenacity (Grossmann; Strauss(c)) though here again the be- 

 havior of normal cases may not properly indicate that of pathological ones. 

 The tissues rather than the blood are the regulating factors in this con- 

 nection (Bogert, Underhill and Mendel). 



Alkaline Waters, Including Carbonated. Earlier work on the im- 

 mediate effect of alkaline waters taken with a meal on gastric secretion was 

 inconclusive because the variations found were within normal limits. 

 Later work indicates that such waters taken with food have very little in- 

 fluence (v. Noordeii and Dapper (a) ; King and Hanford). When given 

 before meals in the usual spa fashion sodium carbonate according to some 

 earlier investigations has very little if any effect on the secretion of 

 hydrochloric acid (Reichmann), according to others a stimulation up to 

 the point of neutralization and perhaps beyond (Linossier and Lemoine) to 

 an abnormally high amount. The earlier work on Carlsbad water (alka- 

 line-saline, containing also small amounts of Glauber's salts) which pointed 

 to a slightly stimulating effect on hydrochloric acid secretion for the gen- 

 eral digestion period has been supplanted by results secured on dogs with 

 accessory stomach or human cases with esophageal fistula. According to 

 Bickel(6) such water has no influence on gastric secretion, although clin- 

 ically favorable results are reported both in hyperacidity and hypoacidity. 

 However, it cannot be claimed that these effects are other than temporary 

 and transient. Dieting, according to v. Noorden, is a much more satis- 

 factory and efficient remedy. According to Sasaki these waters are 

 generally slightly inhibitory, a statement with which most later investi- 

 gators are in agreement (Bickel(d) ; Casciani(fr) ; Heinsheimer; Pime- 

 now; Rozenblatt). 



The results obtained with alkaline-saline waters from certain Rou- 

 manian springs suggest that chlorid and bicarbonate are to an extent an- 

 tagonistic in their influence on gastric secretion and that the resultant 

 effect is dependent on the proportions present (Teohari and Babes). 



Carbonated waters are generally found to be stimulating in their ef- 

 fect on the gastric mucosa (Penzoldt(6) ; Casciani(a)(&) ; Coleschi(a.)) 

 and also on pancreatic secretion (Becker) (perhaps as a result). The 

 stimulating action of alkaline waters containing CO 2 is therefore to be 

 credited to the influence of CO 2 as neutralizing the inhibitory tendency of 

 the alkali. Gaseous CO 2 in the stomach stimulates secretion and acidity 

 in the accessory stomach (Pincussohn) and such stimulation of alkali as 

 has been observed is credited to CO 2 formation (Pimenow) since about the 

 same results are obtained when using water saturated with CO 2 . The ef- 

 fect of calcium carbonate in producing a "stormy" (Heinsheimer) increase 



