increased (nearly one fourth), but that the quantity of urine and of insensible perspiration (skin and lungs) was unaltered.

SECTION VIII.

LIQUIDS.

I. WATER.

The effect of increased quantities of cold water has been a matter of much dispute. It was believed by Becquerel, Chossat, and Professor Lehmann, that tissue metamorphosis was increased; while Lecanu, Bidder, and Schmidt,1 have doubted this effect. Bidder and Schmidt, indeed, found that in cats a large addition of water to the circulation absolutely lessened the urea, the sulphuric and the phosphoric acid of the urine. Falck's2 experiments are also opposed to the first opinion, but they extended over too short a period of time to be satisfactory.

3

Lately, many and elaborate experiments have been made by Böcker, Becher, Genth, and Mosler," and from an analysis of all these observations the following statements are drawn. They accord with the views of Lehmann, Chossat, and Becquerel.

The drinking of large quantities of water, of medium temperature, may produce different effects, according as the water is taken in a fasting system, and when it is merely added to the ordinary diet.

(a) When large quantities of water (of mean temperature) are drunk in a fasting system.

The excess of water speedily passess out, and in great measure by the kidneys; some portion, however, issues by the intestines,

1 Die Verdauungssaefte und der Stoffwechsel, 1852, p. 343.

2 Vierordt's Archiv, 1853, p. 151.

3 Zeitsch. der K. K. Gesellsch. der Aerzte zu Wien, April, 1854, p. 308. See also a very interesting article on this and allied points in the B. and F. Med.-Chir. Review for October, 1854, by Dr. Chambers.

4 Ludwig's Phys., 1st edition, Band ii.

5 Untersuchungen ueber den Einfluss des Wassertrinkens auf den Stoffwechsel, von Genth. Wiesbaden, 1856.

Archiv des Vereins fur wiss. Heilk., Band iii, p. 398.

Mosler's elaborate paper has been criticised by Professor Radiche (Wunderlich's Archiv, 1858), but although the experiments are not numerous, they appear to me so uniform that I have adopted the results, without hesitation.

as the water of the faces (though not the solids, Böcker) is usually augmented; and in some cases a small quantity of the water escapes, either by the skin or lungs, or both (insensible perspiration). The greater the quantity of water, the greater is the amount passing off by the bowels and insensible perspiration (Ferber).1

The flow of water from the kidneys causes the urine to become pale, dilute, and of low specific gravity (urina potûs). According to Falck, the increase commences in the first hour, but the maximum of increase is in the second hour after a large, and in the third hour after a smaller, quantity of water; there is also a certain geometrical ratio between the water drunk and that passed by the kidneys. If the water is increased two-fold, that of the urine is increased three-fold. Ferber has also found the increase to occur in the second or third hour, according to the amount of water drunk; in about six hours the additional water has passed off, unless, in consequence of previous loss by sweating, &c., any of it is retained altogether by the body.

2. The urea is augmented (Böcker, Mosler, Becher) at first, but subsequently sinks below its normal amount; so that there is a kind of compensation. The amount of increase varies, but is sometimes very great-as much as 70 to 80 per cent. in twentyfour hours. It has, therefore, been supposed that the water simply acts as a diluent, and, without increasing metamorphosis, carries off a large amount of the urea which always exists in the blood and tissues ;3 but subsequent observations seem to show that it must also augment the exchange of tissue.

.3

3. The condition of the pigment and extractives is uncertain. 4. The uric acid lessens or disappears (Böcker). It must, however, be remembered that in highly dilute urine the uric acid is not readily detected, and it certainly requires additional experiments to prove that there is an absolute lessening of uric acid.

No observations have been made on the hippuric acid.

5. The sulphuric acid is not increased (Böcker).

6. The phosphoric acid is slightly lessened (Böcker).

7. The chlorine is at first augmented; but after the effect of the water is passing off (after the fourth hour), it falls below its normal amount, as if (as may be the case with the urea) it

4

1 Archiv für Heilkunde, 1860, p. 249.

2 Vierordt's Archiv fur phys. Heilk., 1853, p. 151.

3 Strahl, Lieberkühn, and Picard (?), have proved the existence of urea in the blood. In some lower animals, it is present in large quantity in the liver and in the muscles; and in man, though not present in muscles, may it not be in the liver and spleen?

Hegar, op. cit., p. 23. Ferber, quoted by Vierordt, Grundriss der Phys., 1860, p. 191; and in Archiv für Heilk., 1860, Band i, p. 248.

had been, as it were, merely mechanically carried out by the excess of water. The time of increase is in the first hour, if the water be in large amount; in the second, if the water is in less quantity. There appears to be a limit to the action of water in this respect; and Ferber noticed that 1200 c.c. (about 2 pints) caused as much excretion of chlorine as 1800 c.c.

(b) When (the mode of life being equable) the diet is the usual one, or is regulated for the experiment, and when a large additional quantity of water is taken during the twenty-four hours, the following are the results:

All the additional

1. The water of the urine is increased. water drunk is not, however, excreted by the kidneys; the fæces are usually more watery (Böcker's and most of Mosler's cases). The insensible perspiration (skin and lungs) is also generally augmented, though this is not always the case; and the amount of augmentation varies, apparently, according to individual peculiarity. In some of Mosler's cases it was great; in others trifling. It has been assumed that the formation of water in the body is increased, but the experiments require to be much more precise (Böcker).

2. The urea is increased. All the experiments (Böcker, Mosler, Genth) are in accordance, and I believe (in spite of some strictures by Radiche on Mosler's figures) that this important point may be considered settled. Genth found the mean daily increase, with very great quantities of water, to be no less than 14 grammes, or 216 grains, over the amount passed with the same diet, but without an excess of water. Böcker's results show a much smaller increase (3 grammes, or 46 grains, daily).

In

Nor is it likely that this increase is to be attributed only to the mere diluent effect of the water, aiding the transudation of urea through the renal glomeruli; for it is not only long continued, but is accompanied by an increase in other ingredients, and (if the diet be the same) by a very rapid loss of weight. It must, then, be attributed to actual increase of disintegration. Mosler's own case, the loss of weight, and the attendant weakness, were so great as to compel him to discontinue his experiments. His appetite became ravenous, but he would not gratify it, as he was on a regulated diet, i. e., a diet that kept him at a constant weight before the large excess of water was taken. Had Mosler indulged his appetite, possibly the formative processes might have kept pace with the destructive, and his weight and strength would have been sustained. This apparently occurs when the "water-cure" is used in a proper way; while, on the

other hand, when the digestive and formative powers of the system are low, the diluent and disintegrating effects of excessive waterdrinking are not compensated by an increased supply of nutriment, and injurious results follow.

The effect of water in increasing disintegration varies in different persons; it is greatest in persons of weak habit (in whom it may cause almost a febrile state), and in children, in whom the tissue metamorphoses are normally more active than in adults (Mosler). As a rule, it is greater in women than in men. The effect is also greater when the outer temperature is high; and as a corollary to this, it is greater when the water is warm than when it is cold (Mosler). Bodily exercise increases the disintegrating influence of water, and augments still more the urea.

3. The effect on the "extractives" and pigment has not yet been satisfactorily determined.

4. The uric acid has been found lessened by Genth and Böcker. Mosler did not determine the amount of this substance. This is corroborative of the observations already made on the lessening of the uric acid by water taken during fasting. If the fact be admitted, it is an interesting one. Are the tissues yielding uric acid less metamorphosed, while those yielding urea are more so? or is the urea really increased at the expense of uric acid, as supposed in Liebig's celebrated hypothesis?

Nothing is known of the amount of hippuric acid.

5. The sulphuric acid is augmented (Mosler, Böcker, Genth). The mean amount of increase in Böcker's experiments was 0.34 grammes, or 5.24 grains, daily; in Genth's experiments, it was 0.5 grammes, or nearly 8 grains, daily. It must be assumed that this is owing to increased disintegration and oxidation of the sulphur of certain tissues.

6. The phosphoric acid is augmented, but in a much less degree than in the case of the sulphuric acid.

7. The chlorine is much augmented at first, but the amount falls afterwards; so that, on the whole, the increase is trifling. This was to be expected, as no excess of chloride of sodium is introduced, and as the body retains a certain amount of this substance with great tenacity.

8. As the sulphuric and phosphoric acids are both increased, it must be supposed either that the phosphates are all converted into salts, with one atom of fixed base, or that the absolute amount of the bases is increased. This has not yet been proved by experiment with regard to soda, potash, lime, or magnesia.

Ammonia, however, has been shown, by Neubauer, to be

1 Ueber der Ammoniak-gehalt des normalen Menschen Harns., Journ. für prakt. Chem., Band Ixiv.

increased by large quantities of water (from 0-8351 grammes in twenty-four hours to 1926 grammes in one case, and from 0.6361 grammes to 15579 grammes in another). Small quantities of water produced no effect.

While it may therefore be admitted that drinking large quantities of water not only increases the transudation in the kidneys (by rendering the blood temporarily more dilute, and increasing lateral pressure in the kidney vessels?), but that it augments tissue metamorphosis to such an extent as to cause rapid loss of weight, unless digestion and assimilation be good, and food be freely supplied, it remains quite uncertain on what particular tissues the water acts. From some analyses of blood, by Böcker, it may be concluded that this fluid maintains its integrity pretty steadily, and that the excess of water is speedily got rid of, either by the kidneys or by transudation into organs. If any ingredient suffered it was the blood-cells. It would be a most interesting inquiry to determine what organ becomes richest in water under these circumstances; whether the lungs, the spleen, the liver, or other parts.

It may be suggested that excessive water may not cause actual disintegration of tissue, but may merely cause the albuminous food to pass at once into urea, as some portion is supposed to do in the hypothesis of the "luxus-consumption," by Bidder and Schmidt. Water would then merely check tissue formation, but would not increase tissue disintegration. But the doctrine of the "luxus-consumption" seems now to be so doubtful that this view need not be discussed.

II. ALCOHOL.

That alcohol (as well as ether) passes off with the breath, when taken in any quantity, is sufficiently perceptible; but it has generally been supposed, since the experiments of Bouchardat and Sandras, that it is not excreted with the urine unless it is taken in very large amount. The statement of Duchek (based, however, on no satisfactory analyses), that alcohol is very rapidly transformed into aldehyde in the blood, and that this substance is then more or less rapidly oxidized into acetic, oxalic, and carbonic acids, &c., also obtained general credence, and seemed to warrant the common opinion that alcohol is a food, belonging to the class of carbo-hydrates, and that its combustion gives out an equivalent proportion of heat. Arguments for the use of alcohol, in health and disease, have been based on this belief; and the late Dr. Todd, in particular, strongly urged the claims of alcohol to the rank, not only of a stimulant, but of a valuable food.

Yet it is at present by no means certain that alcohol is so