urinary excretion,* for the insensible perspiration (skin and lungs) was increased 12 per cent., and the intestinal excreta were augmented from 149 (5 ozs. av. nearly) to 195 grammes (63 ozs. av.) daily.

The effect, then, of this bathing was to augment three excretions, to lessen one; and the lessening of this one was sufficient to reduce the amount of the egesta below that of the ingesta, and to cause the body to gain weight. Lehmann believes that the assimilative and formative processes were increased in energy, and that many of the eliminative processes were lessened by the use of the bath. Whether this be so, or whether disintegration or excretion were merely checked without augmentation of formation of tissue, cannot yet be known. After the bath was left off, the urinary solids increased above the average even of the antebath period; this did not depend on great lessening of the cutaneous excretion, for this remained still somewhat increased, and the explanation of the fact is not easy, unless the bath had merely checked excretion for the time.

It remains, of course, to inquire what credit is to be given to these elaborate experiments of Lehmann, of which our space compels us merely to give an outline. The most obvious objection is, that before the experiments the body was not in a very fit condition-it was losing weight considerably, so that something was amiss either with assimilation or disintegration. Otherwise, the experiments seem numerous enough to permit us to attach considerable weight to them.

On the whole, perhaps, it may be safely concluded that the natural saline warm baths differ from simple warm-water baths in causing a much greater diaphoretic, and a much less diuretic effect. They have not apparently the eliminative action over the urea which warm simple-water baths probably possess; but, on the contrary, they rather seem to aid assimilation and to lessen the exit of nitrogen from the system. If these conclusions be correct, therapeutical rules for the use of these baths at once arise, and we trust that confirmation, or the reverse, of these interesting experiments will soon be given us.

4. Sea-bathing.-The effect of sea-baths (and sea air) has been investigated by Beneke, and has been already reviewed by us. We notice it here merely to remark that Radiche has shown some of Beneke's conclusions to be not warranted by his own figures, when these are subjected to a rigid analysis. No doubt Beneke will, as soon as he can, repeat his experiments.

5. Cold wet sheet. The result of the application of the cold wet sheet has been inquired into by Wundt.§ Two women who were being treated for slight hysteria in the clinic of Hasse at Heidelburg were selected for the experiments. The wet sheet was applied for four hours; the body was found to lose weight faster with, than without, the sheet; the excreta were in fact almost doubled, and this was chiefly shown in the water, the urea, and the chloride of sodium of the urine. The cutaneous exhalation was sometimes slightly increased, sometimes lessened, and Wundt believes that water was absorbed through the skin. The effect on the skin was much less marked than the previous statements of the effect of the sheet would have led us to anticipate.

When the sheet was continued for six hours, the effect was comparatively less marked, as if the first application of the sheet was followed by more energetic action.

Until these experiments have been confirmed, it would be quite premature to speculate on the mode of action of the wet sheet.

6. Medicinal Baths.-No one has yet investigated, to our knowledge, the quantitative influence on the excreta of medicinal water baths. Nasse states that a warm bath containing carbonate of potash increased the urinary flow to double; but as this effect is also produced by simple water, it does not follow that the carbonate of potash had any effect.

The water of the urine was lessened by 162 c. c. (5 fld. ozs.), and the solids by 3 grammes (46% grains) daily. + One curious fact was noticed, that during the bath the alkaline phosphates of the urine were increased, but the phosphate of lime was much lessened. As the phosphate of lime is supposed by many to be especially connected with Increased tissue-building, Lehmann supposes that this fact strengthens the notion that assimilation was improved. Vol. xvii. § Archiv des Vereins für wiss. Heilk., Band iii. p. 85.

It seems clear that very few, if any, medicinal substances are absorbed through the skin when applied in the form of baths. To refer only to recent experiments: Homolle could detect no trace of iodine after baths of iodide of potassium, or of cyanurets or hydrocyanic acid, after baths of ferrocyanide of potassium. He states, however, that potash increases in the urine after baths of carbonate of potash. The urinary chlorides were not increased, but the reverse after a bath of chloride of sodium. Kletzinsky* could not detect in the urine any of the following substances after bathing in solutions-iodide of potassium, ferrocyanide of potassium, sulphate of magnesia, borax, acetate of lead, nitric acid, sulphuret of potassium.

Duriant could not detect the entrance of iodide of potassium, carbonate of potash, ferrocyanide of potassium, rock salt, nitre, alum, sulphate of magnesia, sulphate of quinine, infusion of digitalis, and infusion of belladonna.‡

Braunes could detect no iodine in the urine after foot-baths of iodide of potassium and of iodine, when the evaporation of iodine and absorption through the lungs were prevented by a layer of oil on the water of the bath.

Although all these recent experiments agree in the fact that no absorption of these substances can be proved, it does not follow that no effect is produced on the urine. It is a curious fact, that the acidity of the urine is often very much altered.

Durand Fardel found the urine to be alkaline during and after the use of the Vichy baths (bicarbonate of soda), and Musset has observed the same fact from the Plombières water.

It might be supposed that this was owing to actual absorption of those alkaline waters; but the same fact was noticed by Homolle after baths of chloride of sodium, iodide of potassium, and ferrocyanide of potassium. The alkalinity was even sometimes greater than after an alkaline bath.

Poulet has indeed noticed the production of alkaline urine after acid baths, so that we must look to some other cause, probably to some special action on the skin, rather than to absorption of alkali.

The decrease of acidity (though not alkalinity) was noticed by Spengler** from the baths of Ems. Absolute alkalinity of the urine has been found by Durian after baths of iodide of potassium (200 grammes in cold and warm baths for two hours); of carbonate of soda (230 grammes); of carbonate of potash (230 grammes); of ferrocyanide of potassium, of chloride of sodium, of nitre, of sulphate of magnesia, alum, nitric acid (200 grammes in bath); sulphate of quinine and infusion of belladonna (2 lbs. of the leaves).

On the other hand, sea bathing increases the acidity (Beneke), and so do also the Wiesbaden saline baths (Neubauer). The Oeynhausen baths produce little effect, but rather tend to increase the acidity than otherwise (L. Lehmann). The action of these natural baths contrasts therefore in this respect with medicinal baths of chloride of sodium.

The effect of these various substances on the solids of the urine, and on the cutaneous, pulmonary, and intestinal excreta, has not, to our knowledge, been yet made out.

We have brought these fragmentary contributions to the important subject of Balneology before our readers, not with the hope that by their means we can build up a complete theory of the influence of the baths, nor with the idea that it would be wise at present to attempt such a thing. But as there seems to be a disposition to prosecute these inquiries, and as the experiments are constantly increasing in accuracy and extent, we have thought that it might be interesting

Canstatt's Jahresberichte for 1858. Löschner's Report on Mineral Waters, p. 96.

† Archives Gén., Fév. 1856.

Archiv für path. Anat., Band xi. p. 295.

As noticed by Melssner, however, all these experiments were made at temperatures which Durian himself considers unfavourable for absorption.

De l'alcalisation de l'urine, chez les malades au traitement thermal de Vichy-L'Union Med., 1858, Nos. 18-20. L'Union Méd., 1858, No. 84.

** Ueber die Absorption in den Bädern su Ems, Deutsche Klinik, 1854. No. 22.

merely to record what has hitherto been done, without seeking to enunciate anything like decided conclusions, so that at a future time we may be able to refer to this article, and to use or correct its details, without having the necessity of again stating them. We have not alluded to the influence of baths on the pulse and respiration-an important point, which has been investigated by Sieveking, Beneke, Wiedasch and others as this also will be considered with greater propriety when we are in a position to speak positively as to the chemical results of baths on the various excreta.

We may be permitted, however, to make a few statements, which these late investigations into the use of baths seems to warrant.

1. It is probable that cold and hot hip-baths of simple water increase for the time the flow of urine; but it would appear that baths of a medium temperature (70°-88° Fahr.) do not have this effect. The effect apparently does not arise from absorption of water or impairment of cutaneous transpiration. 2. It is probable that the cold and hot-hip baths augment the elimination of urea for the time, and perhaps the uric acid, the chloride of sodium; but the experiments, though numerous, and accordant, require to be repeated, and the amount of the other urinary constituents cannot be held to be at all determined.

3. The experiments are not sufficiently precise to prove the effect of the baths on the "insensible perspiration" (skin and lungs): as far as they go they indicate an increase.

4. The effect on the intestinal excretion is also uncertain, but there would appear to be here also an augmentation.

Altogether, therefore, it would seem probable that these baths have an eliminative and (as all the excretions are increased) disintegrating influence.

General Simple Water Baths:—

1. The water of the urine is temporarily increased by cold and hot baths. 2. The acidity of the urine is diminished.

3. An alteration in the excretion of urinary solids is doubtful, but it is probable that the urea is increased; the amount of the other solids is uncertain.

4. The effect on the "insensible perspiration" is doubtful, but it is probably somewhat increased by the warm baths (increase of cutaneous transpiration).

5. The intestinal excreta are not very much affected.

Altogether, the effect of the general hot and cold baths is very similar to that of the hip-baths. As far as can at present be seen, it is eliminative, and perhaps disintegrating.

Natural Saline Warm Baths (Wiesbaden and Oeynhausen; chiefly chloride of sodium):

1. The water and solids of the urine are probably not increased; are indeed in some instances decidedly lessened.

2. The acidity is increased (Wiesbaden) or unaffected (Oeyenhausen).

3. The solids of the urine are lessened in amount.

4. The "insensible perspiration" is greatly augmented.

5. The intestinal excretion is increased.

These baths check urinary, but augment cutaneous and intestinal, excretions. Medicinal Baths:

1. The substances dissolved in the baths are not absorbed through the skin. 2. The acidity of the urine is lessened as a rule; often, complete alkalinity is produced; and this is not apparently attributable to the alkalinity of the

baths.

3. The effect on the constituent parts of the various excreta is not known. The chief point which seems to flow from these general conclusions is, the antagonism between warm baths of simple water, and the natural saline (chloride of sodium) water baths. The former are probably diuretic, and moderately only diaphoretic. The latter (if Lehmann's experiments may be received as the rule,

and Neubauer's experiments be considered exceptional) are especially diaphoretic, and not at all diuretic, but even the reverse. As far, therefore, as the experiments enable us to see, the simple warm water baths are chiefly eliminative by the urine, the saline baths by the skin; and the effect of the former is sufficient to cause for the time increased wasting of the body, while that of the latter may, in spite of the diaphoresis, check urinary excretion sufficiently to arrest permanently a loss of weight going on in the system. The one set of baths are, therefore, weakening; the others strengthening. Further than this, facts do not warrant our proceeding, and we must leave for future and more rigorous investigation an exact determination of the effect produced on the individual ingredients of the various

excreta.

In conclusion, we would direct the attention of all those engaged in these inquiries to Professor Radiche's most important paper. Unless calculations are properly made, the most accurate experiments will only lead to fallacies. We can perhaps never reach mathematical certainty in such inquiries, but we can give to them a much higher degree of probability than they have yet possessed, by a rigid analysis of the numerical results.

REVIEW XII.

Nutrition in Health and Disease. By JAMES HENRY BENNET, M.D., Licentiate of the Royal College of Physicians, Physician Accoucheur to the Royal Free Hospital, &c.-London. 8vo, pp. 220.

THERE is a class of publications, very numerous in the present day, in which physicians take occasion to edify the laity with a little physiology and a few pathological and practical views not usually of a very original kind-the real practical view being that the said laity, struck with what appears to them as a very clever performance, should consult the writer whenever they think that their own cases come within the scope of his observations. We should have been inclined to refer the book before us to this department of medical literature, had not the author announced what he seems to consider as an especial and important object of its publication. At the beginning of the preface he says:

"My object in writing the following work has been forcibly to draw attention to the fact, often overlooked, that the imperfect performance of the digestive and nutritive functions leads slowly, but surely, to ill health, to disease, and to death."

Further on, he adds:

"I trust that I shall not be considered presumptuous if I express the hope that this little work may contribute to convince my medical brethren of the imperative necessity of studying dietetics in connexion with chemistry and physiology."

Now, if Dr. Bennet could keep his countenance while he was writing these passages, it was more than we have been able to do while reading them.

We should have supposed that no person, whether of the medical profession or not, who was sufficiently educated to understand the general meaning of the words "digestion" and "nutrition," could be so stupid as not to perceive the consequences here ascribed to the imperfect performance of these functions.

Again, what benighted portion of our fraternity are studying dietetics otherwise than in connexion with chemistry and physiology?

Our author seems to have a wonderful propensity to create errors for the purpose of demolishing them. Thus he tells us:

"The general impression, not only with the public, but with many members of the medical profession, appears to be that nitrogenous food and stimulants are synonymous with assimilation and strength. The undeniable fact that between the two lies a gulph, occupied by all the varied digestive processes, the imperfection of any one of which neutralizes the resulthealthy nutrition-is thus overlooked." (pp. 60, 61.)

We submit that this is not the impression with many members of the medical profession, nor with any members of the same who have not taken leave of their wits. Neither is it the impression with the public. Did Dr. Bennet never hear the popular allusion to food going into an "ill skin," where the recipient remained lean, and poor in condition, notwithstanding the ingestion of all manner of good things? Now this "ill skin" is merely a homely kind of metaphor, expressive of defect in the digestive and assimilative functions.

We may now proceed to some general notice of the contents of Dr. Bennet's book. The first chapter is on "Digestion and Nutrition in Health," and contains a fair view of the commonplaces of the subject; but neither this nor the following, "on Nutrition, considered generally," presents anything requiring especial comment. Chapter III. is on the "Nutritive Requirements in Man, considered with reference to Temperature, Climate, and Social Occupation." Here also the scientific physiologist will not meet with much to detain him, though the popular reader may find some information. There is one passage of startling interest to ladies who have attained to "what certain people call a certain age," with an accompanying degree of embonpoint. In their case the fat

"Stretches the yielding skin, and thus conceals the ravages of time, the results of diminishing nutritive power. To many women this change constitutes a second youth, and may even impart to them a charm and loveliness which they never presented in their earlier age." (p. 66.)

So far, so good-but evil days are to come:

"The deposit of fat often continues, especially when the tendency is constitutional, or the diet liberal, and the habits of life indolent. In such cases it may increase by degrees, until the abdomen becomes protuberant, the hips massive, and until the chin, neck, and shoulders blend into one." (p. 66.)

A sad state of affairs indeed, in which the human shows an alarming tendency to retrograde into the arachnoid type!

Chapter IV. is on "Defective Nutrition," and the section of it which most claims our attention is that on Urinary Deposits. On this subject Dr. Bennet's views are rather peculiar in more ways than one; and we shall here notice them as they occur throughout the work, without confining ourselves to this particular chapter and section. He has arrived, it appears, at a general conclusion, which may, perhaps, be best enunciated by an extract from the preface:

"There is one point on which I join issue with many who have specially treated of urinary deposits. I believe that too much importance has been attached to the differential diagnosis of the different morbid salts which are found in the urine as a result of disordered digestion and nutrition. I attribute even more importance to the presence of these deposits, as evidences of perturbation of the digestive and nutritive processes, than is usually attributed to them; but after many years' research, I have not been able to establish to my own satisfaction that the different morbid salts have always, or indeed generally, a different pathological meaning. It appears to me that, in disordered nutritive states, all, or nearly all, may occur, and constantly do occur, under the same circumstances."

Our author here speaks of "many years of research," and in other places he alludes to his own "experiments" and "observations" on this subject; but he has nowhere condescended to enter into any particulars respecting these researches, experiments, and observations: and really, when a man differs on such very general grounds, from high authorities, who are backed by elaborate and detailed experiments and observations, we must be excused from attaching any importance