850 HEKRY A. MATTILL 



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 on the excretion of uric acid (Ludwig; Laqueur(a); Klemperer; Gilar- 



doni; Bradenburg; Leva (a) ; Croce (&)); if the amount excreted is 

 changed at all it is just as apt to be increased as decreased by alkaline 

 waters. The same may be said of various alkaliries administered as such 

 (Herrmann; Strauss(a) ; Salkowski(fr) ; Gorsky). v. Xoorden remarks 

 upon the two centuries of treatment of gout with alkalies in the absence of 

 any findings even upon gouty patients, to justify the supposed ability of 

 alkalies and alkaline mineral waters to remove uric acid. In nephrolithia- f 

 sis on the other hand alkalies often seem to increase the uric acid output 

 considerably. 



A decreased urinary acidity is also often desirable in glycosuria and 

 can be secured by the ingestion of large amounts of alkali (10-40 gr. 

 XallCOo, even 100 gr. daily) amounts which are not supplied by the drink- 

 ing of large amounts of mineral waters. In milder forms of such acidosis 

 the amount of alkali in some mineral waters may be adequate to render 

 the urine alkaline. The transitory nature of this reduction in acid is ob- 

 vious as is also the fact that the reduction in acid excretion is not. the real 

 object. Any reported improvement in diabetic conditions resulting from 

 mineral water cure can not be credited to the water but must be explained 

 by the many other contributing factors. 



The acidosis of nephritis particularly as it is related to retention of 

 phosphates in the blood (Marriott and Howland(a)) requires further 

 investigation as to the therapeutic value particularly of calcium and of 

 the alkaline mineral waters containing it. 



The fate of alkalies and their influence on the blood and tissues are 

 questions that have not been answered for the isolated elements and their 

 salts, much less for their wide variety of combination as they occur in 

 mineral waters. Too little is known of the role of mineral substances in 

 the processes of metabolism profitably to employ the information in a 

 consideration of mineral waters. 



Bitter Waters. Bitter waters depress the secretion of gastric juice 

 and may cause a secretion of water into the stomach, similar to their be- 

 havior in the intestine. In experiments on Pawlow dogs the inhibitory 

 effect was not observed if saline and carbonated waters were added 

 (Odaira). Acidity is said not to be markedly changed by the administra- 

 tion of 30 per cent sodium or magnesium sulphate solutions though pepsin 

 is decreased (Heinsheimer). Pancreatic secretion is also interfered with 

 (Pevvsner), even by relatively small doses when food is given an hour 

 afterward (Bickel(r)). These waters are laxative in their action and 

 a less complete utilization of all the food constituents is to be expected as 

 a result of their use. Such findings have been reported for nitrogen and 

 fat utilization by many investigators (Leva (a) ; Vahlen ; Katz(ft) ; Dapper 

 (a) ; Jacoby). In a metabolism experiment on eight persons Kolh found 

 fecal carbohydrate also increased as well as ash. Such waters have been 



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