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Special Report on Mineral Waters (1902)

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Part I--General Discussion of Mineral Waters, continued

Chapter III--Therapeutics of Mineral Waters

Action on the System

The questions frequently asked are: "How do mineral waters act on the system?" "What particular value have they over pharmaceutical preparations containing the same ingredients?" A study of the theory of solution as recently developed (see chapter V) has led us to believe that in dilute solutions we have the chemical substances existing in the "ionic" condition. It is easy to understand that in this condition the medicinal substances are more readily assimilated by the system, or, in other words, that extremely dilute solutions will have a different therapeutic effect from more concentrated solutions (North American Journal Homeopathy, (3) XIII, pp. 529-537).

Mineral waters may be used, as previously noted, either externally or internally. Every extended treatise on the therapeutic action of such waters pays special attention to the use of the warm or cold bath as a curative agent.

In Kansas there are a large number of waters especially adapted to bathing, but, as the state is geologically remote from those sections where great folding and uplifting of strata have occurred, warm or thermal springs are not known.

Some Popular Fallacies

It is generally admitted that mineral waters are particularly adapted to the cure of chronic or long-standing diseases. Doctor Anderson says (Mineral Springs and Health Resorts of California, p. 12): "Mineral springs are not 'cure-alls.' As a rule too much is claimed for them. The many marvelous cures cited and the many improbable and ridiculous statements seen on printed circulars do more harm than good. Sensible people are not going to believe that a 'magnetic' mineral water is going to save a bad case of consumption, or that any' mineral water' cures heart disease, etc. On the other hand, it would be quite as flagrant an error to suppose that all reputed beneficial effects of mineral waters were only the result of extravagant or interested imaginings. . . . To obtain the greatest possible benefit from springs, it is absolutely essential that the patient first consult his regular physician. .. The indiscriminate use of mineral waters, either for drinking or bathing purposes, cannot be too strongly condemned; for while they look bland and harmless, they are potent therapeutic agents which may accomplish much good if judiciously employed, but may also do much harm and may be followed by serious if not fatal results in careless hands."

Scientific Use of Waters

"All we need at American health resorts and mineral watering-places is to follow the natural scientific regime which has been worked out for centuries in Europe. There every patient confides in his physicians, and medical men value the mineral springs more, apparently, than we do in America. The patient is ordered to this or that spring for two or three months. He places himself entirely under the care of his family physician and the resident physician at the springs. Patients who are able to walk get up at six A. M. and walk to the springs, drink the prescribed amount of water, and walk from one to two miles before breakfast. They take their meals regularly; their diet is carefully regulated for each disease. They retire early, exercise freely, use the baths or drink the waters regularly, and improve twice as fast in Germany, France, and England, for the same class of diseases and with the same--almost the identical--mineral-water treatment as we have in America, simply because they follow a regular scientific system."

In regard to the therapeutic action of the substances usually found in mineral waters, the author cannot do better than to quote from Doctor Crook (Mineral Waters of the United States and their Therapeutic Uses, p. 39): "It may be said without fear of dispute that the most frequent, as well as the most important, component of a mineral spring is the water itself. Aside from its absolute necessity to the preservation of all forms of life, this agent possesses certain very important therapeutic properties, some of which may be considered at this time. When ordinary pure water is swallowed it is almost immediately taken up by the radicles of the gastric veins, passing directly to the liver, and from thence into the systemic circulation. Its manifold functions in the body are fully treated in works on physiology. For our purpose, it is sufficient to notice its influence on the emunctories. Water is actively diuretic, not only increasing the liquid flow of the urine, but, if taken in large quantities, greatly augmenting the amount of solids--urea, uric acid, etc.--escaping from the system in a given length of time. It thus aids in the process of tissue metamorphosis, and may be said, so to speak, to 'flush the system.' It also dilutes the urine, renders it lighter in color and specific gravity, and sometimes relieves it of irritating qualities."

Water in large quantities thus becomes useful in certain kidney diseases, characterized by stagnation of the renal circulation and suppression of the urine. It is also valuable in acid states of the urine, characterized by scalding on urination, and a frequent desire to empty the bladder, symptoms which are observed in numerous affections of the genito-urinary passages. In warm weather, water is also diaphoretic, and, aside from its grateful, cooling and refreshing effects, it thus has some influence as an antipyretic in febrile states of the system. According to Maillart, of Geneva (Revue du Med., March, 1891), typhoid fever may be treated internally by copious draughts as a definite method. Five to six quarts may be administered daily, during the whole of the febrile period, and there are no contra-indications. The good results which have been observed are no doubt due to oxidation of the toxins and refuse material, which are thus rendered soluble and eliminated. When taken cold in considerable quantities, water also stimulates the peristaltic action of the small intestines, and thus has a certain cathartic influence.

Advantages of Using Natural Waters

Considerable has been written in regard to the action of natural mineral waters being entirely different from what could be obtained from artificial preparations of the same ingredients. It is true that some ingredients may be present in small quantities, so small, in fact, that they are neglected by the ordinary analyst, and yet they may be present in large enough quantity as ions to have a therapeutic effect. Ordinarily, however, the taking of a mineral water is beneficial, more because of the conditions under which it is taken than because it is made in nature's laboratory rather than that of the chemist. The hygiene and climate of the surroundings of the mineral-water resort or sanitarium have a very important effect on the health of the patient. There are regular meals, and of food that is prescribed by a physician; there is sufficient exercise, especially in the open air; there is the freedom from care and business; there is pleasing scenery and society. All these, with the drinking of an abundant supply of water--a thing too often neglected at home--tend to improve the health of the patient, entirely aside from the beneficial effects of the water taken under the advice of a physician. If baths are also prescribed, they are of the right kind, temperature and duration to assist nature in its efforts to throw off a diseased condition. It is extremely difficult to have these conditions at home.

Ions are Present in Solution

According to the modern ionic theory, a large percentage of the ingredients of mineral waters are present as ions, because they are metallic salts in dilute solutions. When the waters are very concentrated, as in the case of the Crabana, Hunyadi, Carlsbad, and also the Abilena, of Kansas, it is fair to assume that some of the ingredients are undissociated (see chapter V). In general, then, it is necessary to consider the therapeutic action of ions of a certain kind, as Na, Ca, or SO4, or of solutions in which we have a large variety of ions. In the latter case the therapeutic action of a given ion may be modified by the presence in the solution of others. In most cases we are compelled to consider the action of salts when at least two kinds of ions are present. The science of medicine has hardly progressed far enough, since the modern theory of solution was proposed, to enable us to tell positively the action of ions of a single kind, in the absence of all others, except in a few cases.

List of Elements

The substances (ions) usually found in mineral waters are:

or base-forming
or acid-forming

Besides these there are some very rare ingredients found in such small quantities that their therapeutic action has not been studied.

Acid and Alkaline Waters

Waters are divided into three classes, as far as their reaction is concerned, namely, neutral, acid, and alkaline.

It is admitted that dilute acids and alkalies have an ion action, due to the presence of the characteristic acid hydrogen or of hydroxyl. They also produce osmotic changes and exert ordinary salt action. They also modify the process of digestion and absorption. Acids and alkalies are not absorbed as such in the body; if in the intestines they are neutralized by the carbonates, or in the stomach by the hydrochloric acid of the gastric juice. The system is so constructed that it can take care, for a time, at least, of an excess of acid or alkali. This is done by a change in the composition of the urine; so acids and alkalies are excellent diuretics, increasing the ammonia of the urine at the expense of the urea.

As acid salts have some of the properties of acids, it follows that mineral waters containing these salts would have some acid characteristics. Acids in the stomach assist the action of the pepsin in digestion; they also increase the flow of the gastric juice. Acids are very useful in that variety of dyspepsia in which not enough acid is secreted.

"All acids convert proteide into acid-albumins, which are insoluble in moderately strong, but soluble in concentrated or very weak acids. Upon this precipitation of proteids depends their astringent action.

"Alkalies will reduce the acidity of the chyme, and thus increase the alkalinity of the intestinal fluids, even if they are themselves neutralized and absorbed before reaching the duodenum. In this way they may favor the emulsification of fats, and the action of the pancreatic ferments, if there is not sufficient alkali in the intestine." In a normal condition of the system, this action would be of no value, but where there is an excess of mucus, or too great acidity, the alkalies are very useful. On account of the action of the undissociated salt, the secretion of the urine is increased.

The free acids that are found in waters are sulfuric and occasionally hydrochloric. The sulfuric acid is derived from the oxidation of pyrite (FeSs). The Rio Vinagre, in South America, is supplied by such acid springs, and it is estimated that it carries daily to the ocean an amount of acid equal to 82,720 pounds of oil of vitriol and 69,638 pounds of concentrated muriatic acid. There are some noted springs of this character, as, for instance, the Oak Orchard acid water, in New York, the Texas salt springs, and the Thermal acid springs of California. The Abilene, Kan., artesian well contains a notable quantity of free hydrochloric acid.

Waters of this class usually contain an abundance of such elements as iron and aluminum, so that their therapeutic properties may be considered as being due to these elements. "Being very astringent, the stronger acid waters are useful in relaxed states of the mucous membranes, especially when characterized by diarrhea and dysentery. They have also been used with great effect in hemoptysis, colliquative sweats, and in depraved and impoverished conditions of the body; due to intemperance or specific diseases."

For chronic lead poisoning acid sulfate waters may be used, as they form with the lead an insoluble lead sulfate which, passes from the system. Waters containing carbonates dissolved in an excess of carbon dioxid (carbonic-acid gas) are not included in this class, as, on account of the extreme weakness of carbonic acid and the fact that it so readily escapes, these waters soon react alkaline.

This carbonic-acid gas, however, is one of the most important chemical as well as therapeutic constituents of water. It not only renders many mineral substances soluble, but it gives the water an agreeable, pungent taste, and assists digestion, aids the flow of saliva, and allays gastric irritability.

The alkaline waters are extremely numerous, and their reaction is usually due, as noted above, to the escape of the carbon dioxid. The metal associated with the acid may be potassium, sodium, lithium, calcium, magnesium, or iron. As a class, according to Doctor Cross, "they form a very efficacious and speedy remedy in the treatment of acid dyspepsia and flatulence." They also act as stomachics, if given before meals, by stimulating the peptic glands.

Having a diuretic tendency, the alkaline carbonated waters tend to correct the acidity of the urine, and are of great service, in fevers, rheumatism, gout, vesical irritation, diabetes, etc. In Europe they have long held high favor in the treatment of meritis, leucorrhea, as well as other female pelvic disorders. When combined with salines, as they often are, forming the great alkaline-saline groups of waters, and because they dissolve the mucus, they are of much value in catarrhal conditions of the gastro-intestinal tract with the engorgement of the portal system. They have further been found useful in obesity.

The lithontriptic value of these waters is well established. In many cases where there is a tendency for mineral material to collect around an organic nucleus these waters are useful, as they are alkaline, and dilute the urine and prevent the formation of calculi. In gout, as the excessive acid condition of the blood is modified, the uric acid is more readily eliminated.

Excessive acidity in the alimentary canal, which leads to gastro-intestinal catarrh, is benefited by the use of alkalies. If this acidity is in. the stomach it may be neutralized by the use of waters containing sodium bicarbonate; if in the intestine, and, cathartic action is not desired, calcium bicarbonate or calcium phosphate can be employed.

Therapeutic Action of Individual Elements

A.-Base-forming Elements

Aluminum is not often present in large quantity in waters that are used for drinking, but, as previously noticed, it is a common constituent of acid waters, like some of the alum springs of Virginia. Comparatively little can be said of the action of the aluminum ion, but the alums are used locally as astringents, and internally in gastric catarrh, enteralgia, gastralgia, lead colic, etc.

Ammonium is not present in large enough quantities to produce any decided effect, as far as known. In fact, since it is produced by the decomposition of organic matter, sanitary chemists are disposed to look upon it with suspicion, as indicative of contamination of the water. This is not necessarily the case, however, because some waters have been found containing ammonium salts as a natural constituent. From a study of the ammonium ion, it is evident that it has a marked action on the secretions, especially saliva, mucus, and sweat. It is used as a local expectorant, and as a stimulant of the respiratory centers, for cough and asthma.

Barium, in its ion actions, resembles the organic groups. Its most important systemic action is a slowing of the heart and a rise in blood pressure. It is said that when barium is given in very dilute solutions the amount absorbed is very small, and is deposited in the bones. It may be of use also in the treatment of cancerous, scrofulous and other morbid growths.

Calcium compounds are very abundant in mineral waters. The carbonates are very alkaline in action, and in large doses may cause constipation. They are used in chronic diarrhea. They are also used with advantage in cases of uric-acid gravel and calculi. Calcium chlorid is said to have a diobstenent effect, and to promote the secretion of urine, perspiration, and mucus. The use of water containing it is recommended in "scrofulous diseases, and in chronic eczema and impetigo, connected with a lymphatic temperament."

Calcium sulfate is one of the chief constituents in water that make it permanently" hard." It is not considered of any special advantage in waters, though perhaps such waters might be used where there is not sufficient lime in the bones.

"The importance of the calcium ion arises from the fact that it is a universal constituent of protoplasm, only a few of the lower fungi being able to dispense with it. It appears to be mainly fixed in the nuclei, while in the extra-nuclear portion its place seems to be taken by magnesium. It appears to be essential not only to the living protoplasm, but also to inorganized ferments. Calcium, as well as potassium, seems to be essential to living protoplasm. . . . The gradual withdrawal of calcium from the body, by withholding it from the food, leads, in animals, to effects which closely simulate those of rickets and osteomalaria. There is, however, some difference. In calcium starvation but little bone is formed, yet this contains the normal amount of calcium. In rickets the amount of bone is even excessive, but it is very poor in calcium. In man these conditions are characterized by a diminished amount of calcium in the bones. The thought lay near at hand to employ calcium, particularly calcium sulphate, in the treatment, of these diseases, but the results have been somewhat disappointing, as might be deduced from theoretical considerations. The condition is somewhat similar to that existing in chlorosis, for, except in the experimental disease, the cause of the disorder is never to be found in the- inefficient supply of calcium salts, since the amount of these in the organism is always more than enough to supply the organism. The real cause must be sought in the abnormal absorption or utilization of these ions. Calcium salts have also been given in hemophilia to increase the coagulability of the blood. Although the last word has not been spoken on this interesting subject, it would seem that hemophilia is not usually dependent on the deficiency of lime salts. Nevertheless most clinicians report very favorable results. Further than this, there would not seem to be any rational therapeutic indications for the calcium ion, the calcium salts only being useful on account of the acids with which they are combined or by virtue of their alkaline action." [Text-book of Pharmacology, Sollman, page 569]

Iron is regarded as one of the most useful substances to be found in a mineral water. As it is found in the hemoglobin of the blood, and as it occurs in the lymph, chyle, gastric juice and other liquids of the body, it must be extremely important in the animal economy. Chalybeate waters "produce a constructive metamorphosis, creating more red blood corpuscles, thereby increasing the specific gravity of the blood and of the bodily weight, reproducing a healthy glow and the rosy cheek on the faded and bleached-out face." [Mineral Waters of the United States, Crook, page 49.] By the use of the hemoglobometer, it has been shown that "the deficiency of the coloring matter of the blood, observed in anemic states, may be readily made up by the administration of a carefully selected chalybeate water. It matters not though iron be present in small quantities, and few of the carbonated iron waters contain more than five or six grains per gallon. The blood contains normally about forty-five grains of iron, and this quantity cannot be permanently increased by consuming large quantities. It is probable that the deficiency, no matter how produced, never exceeds fifteen or twenty grains."

The tendency, then, is to increase the appetite, promote digestion, and relieve a languid or depressed condition of the system. Though the iron occurs sometimes as sulfate and chlorid, yet the most common combination is the bicarbonate, and this is supposed to be the form in which it most readily enters the circulation. For special notes on the occurrence of iron in mineral waters, see Part II. "The indications for the use of the iron waters are numerous. In slow convalescence from acute diseases, the anemic states resulting from a severe operation or difficult confinement, in all forms of hemorrhage not due to fulness of the vessels or fragility of their coats; in amenorrhea when due to chlorosis, in the debilitating catarrhs of the uterus and vaginal mucous membrane, and in the various cachexias, the chalybeate waters may be confidently expected to render valuable aid." Those who are of a plethoric habit, or who are troubled with vertigo, should avoid the use of iron waters.

A number of theories have been advanced to explain the action of iron on the system. Among others may be mentioned the theory that it is of value because of the direct absorption and gradual utilization of the iron, whether the substance given is a body that dissociates with iron as an ion, or whether the iron is only a constituent of an organic body or of the food. Another theory is that iron given in an "organic" form can be absorbed, but inorganic iron simply stimulates digestion and absorption, and does not itself enter into the blood. It seems to be pretty well established that organic iron may become a part of the hemoglobin, and inorganic iron, while incapable of this change, assists the organism to utilize the organic iron, so both kinds of iron are of value. The term "chalybeate" has been applied to iron waters from the name of a very ancient people, the Chalybes, who worked in iron.

Lithium is a rare ingredient in mineral waters, but those that contain it have acquired considerable reputation in the treatment of disease. It is usually considered as present in the form of carbonate or bicarbonate, mixed with carbonates of the other alkalies. It is probable that many of the so-called lithia waters contain too small a quantity of this ingredient to be of any therapeutic value. As first pointed out by Andrew Ure, lithium forms a soluble salt with uric acid, and this has led to the extensive use of lithia waters in cases of uricemia. For uric acid, sand, gravel, and calculi, and in gout and rheumatoid arthritis, as well as in phosphatic deposits in the appendix, and in concretions, lithium waters have been used with success. As an ion, lithium has an action midway between that of potassium and sodium. It has a tendency to increase the excretion of nitrogen.

Magnesium has a characteristic action on the system. As carbonate, it is useful in "acid eructations and pyrosis, and in sick headaches, when accompanied by constipation. It is also of value in checking the formation of uric acid gravel and calculi." This latter action is no doubt due to its alkaline character. As chlorid, magnesium is often found in saline waters and brines. It is useful to increase the flow of bile, and as a mild purgative. It is as a sulfate, however, that we are most familiar with the action of magnesium. Like sodium sulfate, it promotes the process of endosmosis and exosmosis, and, by abstracting the watery elements of the blood, increases the intestinal secretions. "Even if the quantity is small, it will tend to promote regularity of the bowels when taken continuously. The best results are observed in disordered conditions of the stomach, liver, and bowels, with concomitant symptoms of constipation. In sluggish states of the liver, characterized by a sallow countenance, yellowness of the conjunctiva, coating of the tongue, and hemorrhoids, the sulfated saline waters are speedily efficacious."

In eliminating the various chronic infections from the system--scrofulous, syphilitic, and malarial--as well as in expelling lead, mercury, and other metallic poisons, they furnish us important and useful applications. For purgative effects, physicians recommend that the waters be taken on an empty stomach, before breakfast, and that a brisk walk in the open air follow the drinking of the water. These waters should not be taken when there is a chronic inflammatory condition of the stomach or intestines, or in case of general debility.

It seems probable that the magnesium in water acts as an undissociated salt, as, although soluble, the magnesium ion is incapable of absorption into the blood. "Magnesium is practically, the only non-absorbable cation which can be used as a cathartic. Why certain ions should be capable of absorption, and others not, cannot be satisfactorily explained." [Text-book of Pharmacology, Sollman.] Magnesium salts are converted into acid carbonates in the small intestines according to the equation:

MgSO4 + Na2COa + H2O + CO2 = MgH2(CO3)2 + Na2SO4.

It is quite immaterial what particular salt be given, as the hydrate, chlorid or sulfate are all converted into the carbonate. However, in the case of the sulfate, the sodium sulfate which is formed is, of course, also a cathartic; so the effect is doubly large. The hydrate and carbonate, on the other hand, possess also the action of alkalies.

Manganese is not a very common ingredient in mineral waters, or at least it is present in so small a quantity that it is not often reported. There are some waters, however, in which it is present, in notable quantities, and one or two that are strongly impregnated have been recently found in Kansas. In most analyses the manganese is considered to be present as bicarbonate or sulfate. As manganese is normally present in the blood, it might be supposed to be of considerable value therapeutically, and, indeed, much is claimed for it by some. It promotes the flow of bile, and is no doubt useful on account of its tonic and reconstructive properties. It is so often associated with iron in mineral waters that we have not often an opportunity to study its action alone. Recent authorities claim that manganese is not absorbed at all into the system, unless given in corrosive doses.

The Potassium ions seem to have no special therapeutic action, as they are so rapidly excreted. Potassium compounds are quite similar to those of sodium. As carbonate, it corrects acidity and acts as a diuretic in connection with other alkalies.

Sodium salts are very abundant in waters, on account of their great solubility. As sodium and chlorin ions possess very slight toxicity, their combinations are chosen when the action of other ions is to be studied. In some waters the carbonate and bicarbonate is very abundant. As sodium carbonate is found in the blood, saliva, urine, and other fluids of the body, it would be thought to be of importance in substances taken into the body. Sodium-carbonate waters have the general properties of alkaline waters, and are the best for use when alkaline waters are indicated. There are no waters in Kansas that at all correspond to the Saratoga waters, for instance, in abundance of carbonated alkalies. Their effect on the system can hardly be ascribed to the presence of the sodium ion, or to the potassium ion, which is often present. They have a marked action on the mucous membranes and increase the secretions. As previously noticed, catarrhal conditions of the stomach or intestines, especially when accompanied by chronic diarrhea, or when there is too great acidity in the alimentary canal, may be treated with success by waters containing sodium carbonate. The activity of the skin and kidneys will be increased. It is by some asserted that diabetes may be successfully treated with these waters, and sugar may be caused to disappear entirely from the urine.

Sodium as a chlorid is even more abundant than sodium carbonate. As brines are common either in the surface springs or in the deep bored wells, there is no ingredient of more importance. Most authorities assert that salt is actually necessary for a healthy growth of the body, as it is a constituent of almost every structure. It has much to do, no doubt, with the regulations of exudation and absorption, and assists in maintaining the fluidity of the albuminoids in the blood. As so many of the effects of these waters are no doubt due to the chlorin ion, rather than the sodium, the further consideration will be deferred until chlorin is discussed.

Strontium, though found in small quantities in a few waters, has, so far as known, little therapeutic value. In general, it resembles barium, although somewhat weaker in its action. It is suggested that, "being an intestinal antiseptic, however, it is possible that considerable quantities of the strontiated waters might be found useful in flatulence, intestinal torpor, summer diarrhea, etc." It is usually considered as present in the form of bicarbonate, accompanying similar salts of calcium and magnesium. "In dilute solutions only very small amounts are absorbed from the stomach; none from the intestines, since it is converted into phosphates, in which form it is generally deposited in the bones."

B.-Acid-forming Elements

The acid-forming elements or ions have necessarily, to some extent, been discussed above, as there have not been enough experiments to "pick out," so to speak, the therapeutic action of the acid from the base.

Arsenate waters are not common, though a small quantity of arsenic in water might make it a valuable remedial agent on account of its action as an alterative. According to Doctor Anderson (Mineral Springs and Health Resorts of California, page 26), "Arsenical waters have proved highly beneficial in irritative dyspepsia, chronic gastric catarrh, gastralgia and entralgia. Jaundice with catarrh of the bile ducts and chronic cirrhosis of the liver are improved by these waters. The waters are highly extolled in chlorosis and anemia, chronic malarial toxaemia, hemicrania, and malarial neuralgia, and in cutaneous diseases, scrofulous sores, and syphilitic contaminations. The skin diseases most benefited are the chronic scaly variety--especially psoriasis, eczema, pemphigus, and old cases of acne. For these diseases the waters containing both iron and arsenic are especially serviceable, taken one hour after meals. Menorrhagia and functional impotence are also improved by a course of these arsenated and chalybeate springs, with wholesome food and free outdoor exercise." Arsenical waters would be most naturally found in mineral localities where such metals as antimony, copper, bismuth, cobalt and nickel occur.

Borates occur abundantly in the waters from some localities, and they are found in small quantities in brines and associated with alkaline waters. Borax or sodium borate is the combination usually reported. In California large quantities are obtained commercially. The water may be used in "renal and vesical catarrh depending upon the uric acid diathesis." It has also been found useful in clergymen's sore throat, alleviating the inflammation, and strengthening the vocal cords. As a gargle the water is very useful. Boric acid and borax are used in the preservation of food, and they are probably less injurious than other substances.

Bromide occur especially in brine, associated with chlorids and sometimes iodids. It is evident that the therapeutic value is directly connected with the bromin of the associated salt, for quite similar effects are obtained whether the positive element be sodium, potassium, or some other metal. The bromids are more soluble than the chlorids, and this fact is taken advantage of by crystallizing out the salt (NaCl) first, and using the mother-liquor for the commercial manufacture of bromin. Bromin is very often associated with magnesium in mineral waters.

These waters are essentially alterative, and are used in the treatment of rheumatism, gout, goiter, etc. As they hasten retrograde tissue metamorphosis, they are of use in diminishing the weight of the body. In cases of poisoning with mercury or lead, bromides have been used with success. As sedatives, to relieve wakefulness and over brain work, and in cases of epilepsy, these waters are recommended, and since they promote absorption and elimination of used-up material, bromin waters can be utilized in the treatment of scrofulous tumors, ulcerations, and chronic cutaneous diseases.

Carbonate waters have been discussed under alkaline waters, as, so soon as the gas escapes, the waters show an alkaline reaction. The gas carbon dioxid itself, however, when dissolved in water, is agreeable to the taste, and very often grateful to the stomach. The very extensive use of artificial carbonated beverages, "soda-water," sweetened and flavored, it is true, shows the favor in which a solution of this gas is held. Except in a general way, little is known in regard to the action of carbon-dioxid gas, for in most waters it is assumed to be present to form alkaline carbonates. The activity of carbon dioxid is not destroyed by neutralization, as is the case with other acids. "When absorbed it is fixed in the form of sodium bicarbonate, which is dissociated so readily that it acts both as an acid and an alkali. It has a somewhat specific effect in diminishing vomiting. On account of the stimulation of the sensory nerves of the mucous membranes with which it comes in contact, it is a general reflex stimulant."

"In moderate quantities, it stimulates the flow of saliva, aids digestion, slightly accelerates the pulse, renders the mind clear, and the person cheerful. The imbibition, however, of large quantities, causes sickness, vomiting, headache, vertigo, a tottering gait, and even asphyxia." [Mineral Springs of the United States and Canada, Walton, page 63] Bathing in water charged with carbon dioxid causes a prickling sensation, which lasts for some time, and persons in health, on leaving the bath, experience a pleasing exhilaration, and the inclination to muscular activity is greatly increased.

Chlorids are as abundant as sodium in waters, and it is probable the therapeutic effects of common salt are due to the chlorine ion rather than to the sodium. Sodium chlorid, when taken into the system, increases the flow of the gastric juice, bile and pancreatic juice, stimulates the appetite, and assists digestion. Waters containing it possess a slight aperient effect, and it tends to prevent putrefactive changes. The quantity of urea excreted and the secretions from the bronchial tube are increased. So, for gastric, hepatic and intestinal disorders the salt waters are useful. This is especially true where there is an insufficiency of digestive fluids, with dry stools, a furred tongue, and disagreeable taste in the mouth, with loss of appetite. On account of their strong diuretic action, these waters may be used in cases of rheumatism, gout, and scrofula. When other positive ions, as well as sodium, are present, the action of the chlorin ion is modified. This may be seen in the case of magnesium chlorid, which has more marked cathartic properties than has sodium chlorid.

There is frequently more Fluorin in mineral waters than has been reported. This is because chemists regard it of so little importance that they neglect to test for it. Chas. Lepierre has recently shown that in the waters of the north of Portugal as much as twelve millegrams per liter of fluorin is sometimes found. Its therapeutic action is not well understood.

The Hydrocarbonate or acid carbonate in some cases indicates the condition of the ions when under pressure, for when this pressure is relieved some of the carbon-dioxid gas escapes and only carbonates are present. It is due, as has been previously stated, to the excess of carbon dioxid that such salts as calcium and magnesium carbonates are dissolved. The "acid carbonates" thus formed play an important part in digestion and absorption.

Iodids, although occurring usually with chlorids and bromids, are considered more active therapeutic agents. Their action is quite similar to that of the latter. They find their most useful application in treatment of chronic bronchitis, catarrhs, rheumatism, and in other chronic disorders. These waters have long been celebrated for their alterative character. In fact, some such springs were recommended for the cure of scrofula, obesity, etc., before it was known that they contained iodin. When there is stomachic irritation,and acute inflammation these waters are contra-indicated, as they will do harm rather than good. Although the quantity usually found is small, seldom as much as one and one-half grains of the potassium or sodium salt in a gallon of water, yet the amount is sufficient to produce a decidedly beneficial effect on the patient for whom such waters are indicated. This would seem to confirm the theory that in many cases the ions of a substance are extremely active, and in just the condition to act therapeutically upon the system.

Some authors believe that there is little evidence of ion action in the case of iodin, such as exists in bromid, but that the effects are due to the un dissociated salts, especially in the case of potassium iodid. Doctor Sollman believes that since this salt is extremely diffusible and penetrates so rapidly into the cells, and as it contains two of what he calls "foreign molecules," the liberated iodin ion may very likely combine with the proteids, substituting itself for the chlorid. It is also to be noted that the iodid readily decomposes with the separation of free iodin and hydriodic acid, both of which are irritants and tend to form another class of bodies with the proteids.

The iodin tends to remain a long time in the body, probably on account of its combination with the proteids. It is believed that the iodin, combined into an organic compound, is excreted in the urine.

The iodids are used with success in the third stage of syphilis, but it is not known at present whether this is due to ion action or to the general action of the undissociated salt. There is similar doubt in regard to the way in which the iodids act in chronic rheumatism and asthma.

The Nitrates act both in the ionic condition and as undissociated salts. As the action in the ionic form is largely upon the mucous membranes, this may result in gastritis, in diuresis and perhaps nephritis at the place of exit. We are most familiar with the salt potassium nitrate, but it must be borne in mind that the action of this salt upon the system is not due to that of the nitrate ion alone; in fact, the potassium ion increases the action of the nitrate. This salt would act more strongly than the sodium nitrate. While nitrates are to some extent reduced in the body to nitrites, this action takes place so slowly that the action of the latter is not perceptible.

Nitrates are so seldom present in water in any quantity, that the action of these waters on the system has not been studied. We know that nitrates are poisonous if taken in large quantities, and even in small amounts they no doubt have some effect on the system.

Phosphates also are not often found in notable quantity. With the exception of the alkaline phosphates, the salts are usually insoluble. Sodium phosphate has a somewhat cathartic action. The calcium phosphate might be useful to increase the quantity of lime salts in the body.

Silicates are usually mentioned in reports on mineral-water analysis, but very often the analyst makes no distinction between the insoluble suspended matter and the true silica which may be in solution. It is a well-known fact that alkaline waters, especially if warm, have a tendency to dissolve silica from the rocks and soil, thus producing sodium or potassium silicate. When the water is evaporated with an acid this silica is rendered insoluble and separates out. Waters that are strongly siliceous "petrify" wood or other substances which are placed in them. One author states that siliceous waters, taken internally, are useful in cases of cancer and leprous ulcerations, and it is also stated that by the use of these waters albumin and sugar have been made to disappear from the urine.

The Sulfates are of great importance, as has been previously stated in the discussion of sodium and of magnesium sulfate. It is evident that the sulfate ion has a therapeutic value, for we see it in such salts as sodium, sulfate and magnesium sulfate; salts which have a distinct cathartic action.: -It is difficult to study the action of the sulfate apart from the metallic ion. It must be admitted, however, that the sulfate, etc., acts as a purgative. Sulfates are useful, as mentioned under magnesium, more from their action as undissociated salts than from any action as ions. Although the sodium sulfate has a bitter taste, it is of great importance as a constituent of mineral waters like the Abilena. Sodium sulfate, when entering the system through intravenous injection, produces a copious diuresis. The discussion of the sulfate as occurring in acid waters may be found here.

Sulfur is an ingredient of a large number of waters. We are familiar with the characteristic odor of hydrogen sulfid, sometimes compared to decayed eggs. In mountainous volcanic regions, springs containing sulfids, sulfates, common salt and other ingredients are frequently found. There is often seen in the spring, or in the water that escapes from it, a white or yellowish deposit of sulfur, and by the precipitation of sulfur the water has a milky appearance. This is due to the oxidation of the hydrogen sulfid by the oxygen of the air, water being formed. The separated sulfur after a time settles to the bottom of the vessel in which it is drawn. In the southeastern part of Kansas, where deep wells are used as a source of water-supply, the sulfur water which is pumped up is allowed to stand in reservoirs till the excess of gas has, escaped or been oxidized and most of the sulfur has settled.

Doctor Schweitzer, in discussing the therapeutic action of these waters (Mo. Geol. Surv., III, p. 36), says: "To attempt an explanation of the medicinal effects of sulfur water is difficult, and apt to result in disappointment. That such waters are potent in their effects upon the skin, the mucus membrane in general, and those of the air passages in particular, as also upon the liver and the whole portal region, is demonstrated in many cases. It is likewise known that the efficacy of such waters does not depend so much upon the free sulfureted hydrogen gas which they contain as upon the sulfids and perhaps other sulfur compounds from which, after their getting into circulation, sulfureted hydrogen is evolved. The free gas, inhaled, or in solution in water, taken into the stomach, rapidly leaves the body without producing any apparent effect, while, when eliminated from sulfids that had entered into circulation, it manifests its presence by the appearance of a characteristic absorption band in the blood, and also by its quick and powerful effects upon the organism at large. Waters, therefore, which contain soluble sulfids--a rather unstable and easily decomposable class of bodies--are of much greater therapeutic value than waters merely rich in gas, although that gas be chiefly sulfureted hydrogen."

Some authorities believe that these waters have an alterative action, equal to that of mercury in syphilitic diseases. Sulfur water no doubt has a marked action on the liver, and assists this organ in the production of bile, which in turn assists so materially in digestion; hence, it is used in the treatment of chronic malarial diseases where there is a tendency to enlarged spleen and liver, hepatic congestion, and accompanying symptoms.

Sulfur waters have been used with success in rheumatism, gouty inflammation, and chronic joint injuries. They are especially valuable in such cases when used in the form of a hot or mud bath. Many people afflicted with cutaneous diseases are greatly benefited by bathing in these waters and at the same time taking them internally. Medical treatment with sulfur waters should be taken under the advice of a competent physician, as, if too long continued, they may have a destructive action on the system.

As free sulfur acts only to the extent to which it is converted into sulfids--a slow process--the irritation produced by the direct use of free sulfur is mild but prolonged, and this is true in the intestines, where it is dissolved by the sodium carbonate, as well as on the skin. In mineral waters some of the sulfur separates out on standing, as noted above, so free (molecular) sulfur would be present in the stomach soon after drinking the water. Only a little of this would be dissolved, but this would be expected to produce a mild cathartic action. As the sulfids are oxidized in the body and eliminated as sulfates, it is asserted that if taken into the stomach they do not produce any systemic ion action.

Objections to the Use of Mineral Waters

It is sometimes urged against the use of mineral waters that this involves a kind of "polypharmacy," or that a large number of substances are administered when we really desire to get the effect of only one or two. The same thing, however, might be urged against the use of many organic drugs, for here we have a large number of substances present, and we only want the effect of a few with which we are particularly conversant. Again, it has been urged that we do not fully know the composition of the mineral waters that we prescribe; but this is also true of many drugs; so the objection is not a valid one.

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Kansas Geological Survey, Geology
Placed on web April 7, 2017; originally published 1902.
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