These results are, of course, significant of increased metabolism, and, as such, can only partially be reconciled with the unquestionably beneficial therapeutical results derived from the Schroth treatment. The underlying conception of this method of dietotherapy, devised by a simple peasant and placed upon a scientific basis by Cantani, a celebrated Italian physician, is the increased combustion of the tissues induced by intense restriction of water-drinking. At the same time the consumption of food, especially of fats and proteins, is diminished almost to vanishing point, because the sole item of the menu is dry rolls, of which the patient is allowed to eat as many as his deficient appetite demands. After the absolute deprivation of liquid of any sort for two or three days, a drinking day is permitted, but this is limited to a little - say a pint and a half of light white wine, preferably good unadulterated Rhine wine or Moselle. The wine should, however, not be drunk cold, but slightly warmed, although in the summer months it is permissible after drinking the first two glasses warm to finish the rest cold. As the acidity of the wine becomes more apparent after warming, a very little sugar may be added. The whole must not be drunk at one sitting, but consumed in small quantities by sipping it at intervals throughout the day. After this "drinking" day two or three "thirst" days must ensue, and during all this time the patient is allowed to eat as many stale rolls as he desires. If the thirst becomes absolutely unbearable, not more than one wineglassful per day of oatmeal gruel mixed with sugar and lemon-juice is permitted, and this heroic restriction of liquids is maintained for many weeks.

The final factor in the regimen consists in the application of moist packs every evening, and it is claimed by Schroth that by this means a certain quantity of fluid is, by cutaneous absorption, supplied to the tissues without in any way disturbing the alimentary functions. Jurgensen, however, who has experimented carefully with the system, and who is responsible for the addition of the libation of wine as described above, has disproved this assertion and demonstrated conclusively that no liquids are absorbed by the intact skin.

This treatment has been carefully studied by Dr. Sandoz, who has utilised the researches and experiences of Landauer, Dennig, and others, and the results of his investigations are as follows: In the first place only from 300 to 500 c.c. of urine are eliminated daily in a subject taking 500 c.c. as a beverage, and about 300 c.c. in his food, although a great deal more may be excreted by the obese. This is accounted for by the fact that the diet is a dechlorinated one, and, as in the obese there is practically always a retention of chlorides, the suppression of the chlorides in the food liberates the oedema liquids present in the tissues. It is noteworthy that the urinary secretion increases or tends to increase during the dry days, despite the diminution, or at least restriction, of the amount of fluid taken. The water excreted by the skin and lungs, more especially in the case of the former, is much diminished. The body-weight is greatly lessened, as much as 7 to 10 pounds being lost in a week, and a five days' dry regimen in dogs has sufficed to reduce the weight of muscle tissue by 75 per cent. There is a decided daily increase in nitrogenous metabolism, a greater proportionate amount of nitrogen being eliminated during the "dry" period than during the administration of liquids.

As the food was chiefly carbohydrate containing a very limited quantity of protein, and almost no fat, and as the appetite was extremely limited, not more than five or six rolls of 1,000-1,200 calories food value were consumed daily. The balance required was mainly provided by the tissues, and hence histolysis was present to a considerable degree. As a rule, however, much less food, say two or three rolls of 400 to 600 calories value, was required, and so the resulting destruction of albumins was intensified.

The periodical use of wine not only increased the excretion of water, and with it of urinary nitrogen, but by dilating the cutaneous capillaries favoured the loss of heat, and thus to maintain the body heat a further combustion of the tissues became necessary. The wet packs were alternately cold and hot, the former extracting more heat from the body, whilst the latter, by encouraging the rise of temperature, determined still further destruction of tissue poisons.

The curative results of this treatment in cases of rheumatism are stated to be almost incredible, and especially notable is the swift disappearance of all pain. The urine becomes extremely dark and high coloured, with a thick uratic deposit, and adverse critics of this mode of treatment declare that this is simply due to high concentration from the exclusion of moisture from the system, but this view is contradicted by the fact that if the cure be persisted in the urine gradually assumes a lighter colour, and eventually becomes quite clear pale yellow, or "straw" colour. In support of the view that there is increased tissue combustion, especially on the drinking days, the sediment of the urine is much increased directly after these days, as compared with the thirst days.

The advocates of this system claim that it is capable of working apparent miracles in cases otherwise incurable amongst them being rickets and its sequelae, crooked spine and limbs, gout, haemorrhoids, varices, hypochondria, chronic cutaneous disorders, fistulas of all kinds, and even stricture of the urethra. The thirst, which is at first almost unbearable, subsequently diminishes, and is somewhat relieved by the cold compresses. Appetite, which in the early days practically vanishes, gradually improves, and this is encouraged by the increasing moisture and cleansing of the tongue. This is a point worthy of emphasis, that, contrary to expectation, all cures characterised by dietetic restrictions are attended by a dry, thickly-furred tongue, but as the cure proceeds it is claimed that the tongue becomes moist and finally presents a uniform healthy red colour.

On the other hand von Noorden reports that "some of the cases developed signs of scurvy, and a few of them died." Cantani's Views. - Cantani, who employed this treatment with great success in gout, rheumatism, gravel, diabetes, etc, contended, in opposition to those who maintain that uric acid is formed in the kidney, that it developed in every tissue without exception throughout the body. The kidneys, of course, produce a certain amount of uric acid proportionate to their size, in common with all the other tissues, but they do not form it as a rule in their secreting cells. He asserts that while in the healthy individual uric acid is chiefly formed in the kidneys, in the unhealthy, whose blood is charged with large amounts of uric acid, it likewise develops in almost all the organs of the body. Its development depends upon the fact that more nutritive matter is received than can be utilised, and whenever this takes place uric acid is formed. In other words, he supports the view that instead of metabolism proceeding to its fullest extent of urea formation, it stops short at uric acid. This, being absorbed into the blood, is then deposited wherever there is local irritation in joints or elsewhere. In contradistinction to Haig, who avers that uric acid is chiefly introduced in the food and must be excreted directly by the kidneys, Cantani considers it as an anomalous metabolic product of the nitrogenous foods and tissues, and that it is possible by increased metabolism, consequent upon a fresh supply of oxygen, to burn it up into urea, and so have it excreted.

Manifestly Cantani's exposition of the physiological action of the Schroth "roll cure" was purely an incursion into the realm of theory, as we know that the metabolism of uric acid proceeds along well-defined lines of its own, and whatever its relations with urea may be, they are not nearly of such an essentially intimate character as he has suggested. The explanation of any beneficial results of a dry diet cannot be a question of oxidation solely, because, although there is an increased disintegration of tissue protein, this is effected by hydrolysis, and so, as might have been anticipated, Salomon has proved clearly and decisively that there is never an increased consumption of oxygen during a period of thirst.

Reduction of blood quantity and blood-pressure will, however, mean relief to the heart, and the blood being hypotonic, an absorption of fluid, presumably laden with toxic matters, will take place from the tissues. Jurgensen has shown that the specific gravity of the blood serum rises as high as six parts in a thousand, and in Dennig's observation on a thirst case the residue left after drying the blood serum was over 1 per cent. greater after the cure than before, showing a loss of quite 13 per cent. of its water. Both the red cell count and the proportion of haemoglobin rose appreciably in this case. In experiments upon a dog, Straub demonstrated that the normal muscular tissue after five days' thirst lost over a quarter of its fluid contents, and as it is known that pigeons die when they lose 22 per cent. of the water in their bodies, it is easy to realise what an extremely dangerous procedure a severe thirst cure may be.

There is an undoubted rise in the excretion of nitrogen during a thirst cure, which has been proved to be due to an increased decomposition of protein. The marked increase in the excretion of nitrogen during a thirst cure is an indication of the autolysis of the tissues which we know to take place, and doubtless accounts for the feverish condition present, the temperature in some cases rising as high as 104° F.

In its original form the treatment has had practically no vogue in this country, and hence we are dependent for information as to its results - beneficial or otherwise - on reports from the Continent, many of which are from lay practitioners. We may consider it, however, as a fairly powerful plea for the adoption of moderation in diet, although its mode of action is rather clumsy and not altogether free from danger. One is rather relieved to find that patients undergoing the treatment are recommended not to engage in hard work, strenuous exercise, or fatiguing walks, a counsel of safety in strong contrast with the heroic exertions chronicled of those who embark upon the still more severe restrictions practised in the fasting system. Patients are also enjoined under no circumstances to take milk, which produces acid fermentation, and, according to Cantani, may jeopardise health or even produce rheumatism. It is a little surprising that the expectorations of the patient should be so astonishingly copious. They are at first thick, tough, gelatinous - evidently inspissated mucus - but later on become muco-purulent, yellowish green, pus-like, malodorous, and not infrequently accompanied by nausea. Whether this be due to an infective process producing bronchitis, which may be the explanation of the high temperature, or the result of the latter, is not apparent.

As we should expect, in common with fasting cases, there is considerable perturbation in the colon, the stool being suppressed for days or even weeks, and then a hard motion covered with mucus and blood being evacuated with much discomfort. This exaggerated constipation often alternates with diarrhoea, when copious evacuations of offensive faeces and mucus with much "blood and matter" are reported to occur, and this corresponds with our knowledge of muco-membranous colitis, a disease largely dependent upon constipation.