Active Ingredients. - The skin of grapes is properly rejected in eating them: the remaining contents are juice, semi-solid matter, and pips, all of which should be consumed. The important ingredients of grapes are water, sugar (both grape and fruit), gum, tannin, azotized matters, bitartrate of potash, sulphate of potash, tartrates of lime, magnesia, alum, and iron; chlorides of potassium and of sodium, tartaric, citric, racemic, and malic acids.

The relative proportions vary considerably, more especially those of the sugar and of the acids: and these differences of course have important practical bearings. The variations in the proportion of albuminoid matter also appear to be of some consequence.

Physiological Action. - After what has been said of the complicated chemistry of the grape, it must be evident that a complete account of its physiological action is impossible. Certain leading facts, however, are quite established.

In the first place, the large amount of water in the juice of the grape renders this fruit highly diuretic when eaten in quantities. The action is much assisted by some of the other ingredients, particularly the vegetable acids (which are burnt in the organism, and pass off in the urine as alkaline carbonates), and the salts of potassium, sodium, etc.

With less constancy, but still with much frequency, grapes act in a laxative or even a decidedly purgative manner; and if this irritant effect be carried to excess, particularly in children and delicate persons, there may be excoriation of the tongue, chronic diarrhoea, and an aphthous condition of the whole alimentary canal.

Again, in the early stages of the treatment, grapes are sometimes found to produce excitement of the heart and circulation, but this effect is usually only temporary.

Grapes are undoubtedly nutritious. The small amount of albuminoid matter does not count for much in this way, but is far from valueless; the sugar, on the other hand, is doubtless highly useful, not merely as a combustion-food, but for storing up, in the shape of unburnt excess, as fat, and possibly in other forms of tissue.

Therapeutic Action. - This subject, though important, is strangely neglected in most English works on therapeutics. The "grape-cure is certainly not an exploded quackery, but an important instrument in the hands of the medical man, as testified by a large number of excellent observers. At the present day there are numerous grape-countries where, during the vintage, sick persons are treated on the plan of eating three to six lbs., or even much more than this, per diem. The principal places are Meran, in the Tyrol; Vevay, on the Lake of Geneva; Durkheim, in Bavaria; Bingen, Rudesheim, Kreuznach, St. Goar, etc., on the Rhine banks; Grunberg, in Silesia; Aigle, in Savoy. No doubt, like every other cure, the grape-treatment has often been indiscriminately and mischievously applied; but it is a powerful remedy in appropriate cases.

The remarks made on the physiological action of the grape indicate the probability of there being at least two ways in which the treatment may be efficaceous. In fact, according as the grape contains much sugar and little acid, or vice versa, there will be a preponderance either of the so-called "alterative" purgation, or of the alimentary and tonic effects.1

Abdominal Plethora. - The conditions which are especially benefited by the laxative action of the grape-cure are those which are somewhat vaguely grouped under the denomination of "abdominal plethora." There are numerous cases in which the biliary secretion is inactive, and the digestion feeble, in consequence of sluggish portal circulation. In these instances it is proper to administer grapes that are hot over-ripe, and, as a rule, the comparatively non-saccharine kinds. The same course should be adopted with women suffering from abdominal congestion which has given rise to amenorrhoea, with its accompanying train of symptoms - headache, vertigo, oppression, and palpitation of the heart. In not a few cases it will be found (especially where there has been very marked engorgement, and even a tendency to solid enlargement of the liver or of some other abdominal viscus), that the grape-cure is not a sufficiently energetic remedy to commence with, but that it comes in very effectively after a preliminary course of powerful mineral waters and other medicinal agents. A case which came under the observation of Dr. Bezencenet pere is in this respect very striking. A middle-aged woman suffered from marked hypertrophy of the liver, for which disorder she had long been treated, when, being in poor circumstances, it was proposed by a benevolent society to contribute funds for her comfort. Dr. B. begged that the money might be applied toward the necessary expenses of a grape-cure, and accordingly the patient was supplied for six weeks with five pounds of grapes daily. At the expiration of that time the engorgement of the liver and all the accompanying morbid symptoms had completely disappeared.

1 This is well explained by H. Carchod, in his "Cure de Raisins," Paris: J. B. Bailliere et fils, 1860, to which the reader may also be referred for lists of nearly all the important works on the grape-cure.

Another case of Dr. B.'s shows what the grape cure may do, even unaided, for the removal of serious hepatic engorgement. A young lady was tapped for ascites; after the operation the liver was found to reach as low as the umbilicus, and was very hard. Being a homceopathist, she would not take ordinary drugs; she was persuaded to adopt the grape-cure, and in a few weeks the liver was completely righted. She married, and bore children, and had no return of hepatic mischief until twenty-five years later.

Chronic Catarrhs of the Mucous Membranes are frequently benefited by the grape-cure. Dr. Cossy reports a typical example of this action, in relation to pulmonary catarrh: - A man aged 30, previously of good health and appearance, got a cough, at first dry, and then accompanied by much greenish-yellow expectoration; no haemoptysis occurred, but night-sweats, fever, and dyspnoea to a considerable degree came on, and he was much weakened, so that suspicions of phthisis naturally arose. On examination of the chest (eleven months after the appearance of the first symptoms) the physical signs were those rather of pulmonary catarrh than of phthisis. The grape-cure was persevered in for five weeks, and at the end of that time the man was substantially cured.

The mucous catarrhs of the intestines, and even true dysentery, appear to be greatly benefited by the use of grapes. The authoritative names of Pringle, Sydenham, and many others, may be quoted in support of this statement.

Chronic catarrhs of the urinary mucous membrane are also said to be much amended by the grape treatment.

Dyscrasic Maladies, so-called, are sometimes most happily modified by the grape cure. Among these, skin-disorders of the eczematous, ecthy-matous, and impetiginous classes, linked to the herpetic or the rheumatic diathesis, have proved most amenable. As regards the phthisical diathesis, the evidence seems much more doubtful; and it may be questioned whether the supposed cures (other than those of mere pulmonary catarrh) were not effected rather by change of climate than by the specific treatment.

As a Tonic Mode of Treatment, adapted to convalescents from acute diseases and the effects of haemorrhages, and from various states of debility, there seems ample evidence that the reconstituent powers of the grape-cure are often very efficacious. The digestion is strengthened, the appetite is increased, and the patients make a very considerable amount of flesh. For these purposes the sweeter grapes are preferable.

It would be impossible to enumerate all the diseases which have been confidently said to be curable by means of grapes; the above are those respecting which there is trustworthy evidence of real benefit having resulted. At the same time, a few words must be said as to the accompanying diet. Formerly, especially by Germans, it was recommended to keep the patient almost entirely without other food; but except in a very few cases, in which something like a starvation-cure might be necessarily expected to do good, this plan is not a sound one. It is possible that abdominal engorgements, due solely to over-eating, and to intemperance in drink, might be greatly benefited by a short course of almost exclusive grape diet. But proper nutrition for any extended length of time cannot be maintained in this way, and for delicate subjects it is altogether improper. Moderate meals, with Bordeaux wine in moderation, may legitimately be allowed.

It should be added that there are persons who do not well bear the grape-cure. Women do not bear it so well as men, and children least satisfactorily of all.