The Influence of Water-Drinking with 
 
 Meals upon the Digestion and 
 
 Utilization of Proteins, Fats 
 
 and Carbohydrates 
 
 By HLNRY ALBRIGHT MATT1LL 
 
 A.B. Western Reserve University, 1906 
 A.M. Western Reserve University, 1907 
 
 THESIS 
 
 SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE 
 
 OF DOCTOR OF PHILOSOPHY IN PHYSIOLOGICAL CHEMISTRY IN THE 
 
 GRADUATE SCHOOL OF THE UNIVERSITY OF ILLINOIS 
 
 IQIO 
 
 EASTON, PA.: 
 
 ESCHENBACH PRINTING COMPANY 
 1911 
 
The Influence of Water-Drinking with 
 
 Meals upon the Digestion and 
 
 Utilization of Proteins, Fats 
 
 and Carbohydrates 
 
 By HENRY ALBRIGHT MATTILL 
 
 A.B. Western Reserve University, 1906 
 A.M. Western Reserve University, 1907 
 
 THLSI5 
 
 SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE 
 
 OF DOCTOR OF PHILOSOPHY IN PHYSIOLOGICAL CHEMISTRY IN THE 
 
 GRADUATE SCHOOL OF THE UNIVERSITY OF ILLINOIS 
 
 IQIO 
 
 EASTON, PA.: 
 
 KSCHENBACH PRINTING COMPANY 
 1911 
 
STUDIES ON WATER DRINKING. VIII. 1 THE UTILIZATION OF 
 
 INGESTED FAT UNDER THE INFLUENCE OF COPIOUS 
 
 AND MODERATE WATER DRINKING WITH MEALS. 
 
 BY H. A. MATTILI,. 
 
 Introduction. 
 
 Current Theories. Notwithstanding the fact that many persons are 
 accustomed to drinking considerable amounts of water with their meals, 
 and with no apparent ill effect, the opinion has been and still is somewhat 
 general, and the statement almost axiomatic, that the use of water with 
 meals is injurious and harmful. The arguments advanced in proof of 
 this statement are typical of that quasi-scientific reasoning which assumes, 
 a priori, the truth of certain antecedents ; the consequents must therefore 
 logically be true. 
 
 A concrete statement of the views as generally held by many in the 
 medical profession and, through them, by the general public, may be 
 cited from Carrington i 2 
 
 "We can lay down the definit and certain rule that it (water) should 
 never be drunk at meals, and preferably not for at least one hour after 
 the meal has been eaten. The effect of drinking water while eating is, 
 first, to artificially moisten the food, thus hindering the normal and 
 healthful flow of saliva and the other digestive juices; secondly, to dilute 
 the various juices to an abnormal extent; and thirdly, to wash the food 
 elements through the stomach and into the intestins before they have 
 had time to become thoroughly liquefied and digested. The effects of 
 this upon the welfare of the whole organism can only be described as 
 direful." 
 
 It needs no argument to prove that such effects upon the organism 
 would be direful, but the proof that such effects follow the drinking of 
 water with meals is entirely wanting. 1 On the contrary, experiments 
 have been made which show specifically that certain of these effects do 
 not follow. 
 
 1 Presented in abstract at the New Haven meeting of the American Society of 
 Biological Chemists, December, 1910; Proceedings, Vol. II, p. xiv. This paper and the 
 two following were presented in abstract before the Second International Congress of 
 Alimentary Hygiene and of the Rational Feeding of Man, Brussels, October, 1910; 
 Proceedings, Vol. I, Section II, p. 30. They were also presented by Mr. Mattill to the 
 Graduate School of the University of Illinois, in partial fulfilment of the requirements 
 for the degree of Doctor of Philosophy. 
 
 2 Although little experimental evidence substantiates the statement it will be 
 granted at the start, that any circumstance that induces insufficient mastication of the 
 food before swallowing is undesirable, the reason being that salivary digestion in the 
 stomach is not to be overlooked and further, that the movements of the alimentary 
 tract are insufficient to bring about the necessary fineness of division of the food par- 
 ticles. Therefore in all the discussion and experimental work that follows, water with 
 meals means the taking of water when the mouth is empty; the food is masticated, 
 as usual without the aid of water; water is never used to wash down the products of 
 incomplete mastication. 
 
 251861 
 
4 STUDIES ON WATER DRINKING. VIII. 
 
 i. The Effect of Water on the Digestive Juices. Saliva. The degree of 
 dryness of the food determins the amount of saliva poured out upon it, 
 the drier the food the larger the amount of saliva that is secreted. 2 The 
 kind of food introduced into the mouth determins also the physical 
 properties of the saliva. It will be argued, therefore, that the taking of 
 water with food prevents the normal secretion of saliva. In the experi- 
 ments that follow, however, since water is not mixed with the food while 
 this is in the mouth, the effect of water on the secretion of saliva is only 
 a residual one, that is, an effect due to the presence of whatever water 
 may remain in the mouth after swallowing. 
 
 Gastric Juice. The influence of water upon gastric secretion was in- 
 vestigated by Pavlov and Khizhin 3 and still earlier by Heidenhain* 
 and by Sanotskii 36 and their findings have been confirmed by later in- 
 vestigators, especially by Foster and Lambert. 4 The first mentioned 
 workers in experiments on dogs with Pavlov stomachs and divided vagi 
 showed that water stimulates the flow of gastric juice if comparatively 
 large amounts (400-500 cc.) are ingested, but that with small amounts 
 (100-150 cc.) in half the cases observed, not the least trace of secretion 
 could be found. "It is only a prolonged and widely spread contact 
 of the water with the gastric mucous membrane, which gives a constant 
 and positive result." 3 Since the vagi were divided, the effect of the 
 water must have been that of a chemical excitant. The later investi- 
 gators 4 in experiments on the influence of water when taken with food 
 showed that water causes not only a more voluminous secretion but also 
 a more acid secretion. 
 
 Pancreatic Jwce and Bile. Water also acts as an excitant of pancreatic 
 juice. 5 When 150 cc. of water are introduced into the stomach of a dog 
 the pancreas begins to secrete, or augments its flow, within a few minutes 
 after the water has entered the stomach. Since this amount of water, 
 according to Pavlov, is insufficient to excite a flow of gastric juice, the 
 secretion of pancreatic juice is not secondary to a secretion of the other, 
 but is a direct result of the presence of water hi the stomach. In dogs 
 with Pavlov pancreas fistulas Togami* has shown that in response to both 
 chemical and psychical stimuli there is evident parallelism between the 
 secretion of gastric juice and of pancreatic juice. Acids of all kinds act as 
 powerful excitants of pancreatic secretion. The flooding of the small in- 
 testin with larger amounts of acid chyme means an increased production 
 of pancreatic secretion and a consequent increased flow of pancreatic juice. 
 The biliary secretion has also been shown to respond to pancreatic secre- 
 tion and the digestive properties of the pancreatic juice are augmented 
 in a very marked way by the bile. Hence the increased acidity of the 
 gastric contents as a result of the stimulating action of water causes a 
 much more active digestive juice to be poured out upon the chyme as it 
 reaches the intestin. Furthermore, certain other experiments from this 
 
STUDIES ON WATER DRINKING. VIII. 5 
 
 laboratory have shown increased pancreatic activity 8 " to follow water- 
 drinking with meals, the index being the output of fecal amylase. 7 ' 7o 
 
 Intestinal Juice. The effect of water in the intestin has not been 
 demonstrated as clearly as its effect in the middle portion of the alimentary 
 canal. Under ordinary circumstances the intestinal juice is secreted 
 only by those portions of the tube with which the food is in contact. 
 Mechanical stimulation is effective in producing a secretion but it is shown 
 that such secretion is comparatively poor in enzymes and contains only 
 salt and water. When poured out upon food the intestinal juice is rich 
 in enterokinase, but much more powerful stimulants even than food in 
 this regard are the pancreatic enzymes; which one of them is active in 
 this direction is not yet known. 
 
 2. The Effect of Dilution upon Enzyme Activity. The reactions brought 
 about by enzymes are like all other chemical reactions in that they are 
 reversible. They do not proceed to completion unless the products 
 of the reaction are removed as formed. In a concentrated solution the 
 point at which the reaction comes to a standstill is reached sooner than in a 
 dilute one, and in many instances the equilibrium of a reaction mixture 
 may be disturbed by dilution; the reaction is forced toward completion 
 if water is added. In the light of this fact the increased activity of gastric 
 juice that has been observed under the influence of water may be due 
 to the effect of dilution fully as much as to the increased acidity that 
 accompanies it. 
 
 3. The Rapidity of the Passage of Food as Affected by Water. That 
 water begins to pass the pylorus soon after its ingestion has been shown 
 by von Mering. 8 To a large dog with duodenal fistula 500 cc. of water 
 were given through the mouth; within 25 minutes 495 cc. were collected 
 through the fistula. It is probable that when water ingestion is accom- 
 panied by the taking of food the passage of water is somewhat delayed. 
 In the experiments to be described it was shown that the equivalents of from 
 one-half to three fourths of the amount of water ingested during a meal, if 
 this amount was large, may be voided in the urine within 45-90 minutes 
 thereafter. These facts would seem to give some ground for the conten- 
 tion that the food elements might be washed through the stomach and 
 into the intestin before they were properly liquefied and digested. 
 
 It has been shown by Cohnheim 80 however that when the fundus is 
 filled with food material a specific mechanism comes into play after the 
 introduction of liquid. Along the smaller curvature there is formed a 
 trough which connects the antrum pylori with the cardiac opening, and 
 this trough has been demonstrated anatomically by Kaufmann. 86 In 
 this trough water flows past the bolus of food lying hi the stomach without 
 as much as washing any of the exterior away. Even when digestion 
 is at its height and when gastric juice is being secreted in large amounts, 
 almost neutral water is often found leaving the stomach. Cohnheim 
 
6 STUDIES ON WATER DRINKING. VIII. 
 
 further states that there is no dilution 01 tne stomach contents by liquid 
 food, and the accurate regulation of the pyloric sphincter is not disturbed 
 whether water is taken with the meal or not. 
 
 From the considerations thus briefly reviewed the facts regarding the 
 drinking of water with meals seem to be the following: (i) The ingestion 
 of large amounts of water with meals not only does not hinder the normal 
 flow of digestive juices, but acts as an excitant to their flow; (2) the 
 digestive juices are not made less efficient by dilution; on the contrary, 
 enzyme action is more complete the greater the dilution, within limits; 
 (3) while the food elements might perhaps be washed through the stomach 
 into the intestin more rapidly than is usual (contrary to Cohnheim's 
 belief), yet over against this is the greater amount and efficiency of the 
 digestive juices. The first two conclusions have been substantiated by 
 experiment. The question as to the completeness of the digestion of the 
 food and the degree to which it is utilized under the conditions of greater 
 dilution and supposedly more rapid movement through the alimentary 
 canal has had but little consideration. 
 
 The only experimental evidence upon the utilization of the fat of food 
 as influenced by the amount of water taken with meals comes from an 
 investigation by Ruzicka. 9 His conclusions were drawn from data ob- 
 tained in two experimental periods of two days each, on a bread and 
 meat diet, preceded, separated and followed by a day of milk diet. No 
 attempt was made to have the fat intake uniform from day to day. Dur- 
 ing the first period water was taken at times and in amounts found de- 
 sirable, except that none was taken during or immediately following a 
 meal. In the second period approximately the same amount of water 
 was ingested but it was taken during and immediately following the meals. 
 The feces data include dry matter, nitrogen, fat, ash, and carbohydrate 
 by difference. Simple ether extraction was employed in determining 
 fat. The balance of utilization was 94.5 per cent, in the first period as 
 against 95.1 per cent, in the second. The author draws the negative 
 conclusion that a moderate water ingestion at meal time has no harmful 
 influences on the utilization of the food. He emphasizes the adaptability 
 of the organism and supposes that it is a matter of the rapid absorption 
 of the superfluous water. More specific conclusions than these were 
 hardly justified, since neither diet nor water ingestion was absolutely 
 uniform as to time and amount, the water ingestion being particularly 
 variable; it ranged from 300 to 522 cc. at meal time. 
 
 The Fetes. The nature and composition of human feces seems generally 
 to be misunderstood. A recent statement is that the feces are chiefly 
 the unabsorbed residues of intestinal excretions. 10 Another statement 
 is to the effect that the feces consist chiefly of bacteria. 100 A micro- 
 scopical examination easily shows, however, that these claims are not 
 true. The composition of feces as given by Schmidt and Strasburger 11 
 is as follows : 
 
STUDIES ON WATER DRINKING. VIII. 7 
 
 (1) Indigestible material in the food. 
 
 (2) Undigested material, which has for some reason escaped the action 
 of the digestive juices. 
 
 (3) Residues of the digestive juices. 
 
 (4) Bacteria and the products of fermentation and putrefaction. 
 
 (5) Products of the epithelial wall, such as decayed cells, leucocytes, 
 etc. 
 
 Fats are almost always found in feces, the amount being increased 
 by an increase in the fats in the food. In addition to the food as a source 
 of fat are the digestive juices and the cells of the alimentary epithelia 
 which contain both fats and lipoids. 
 
 Many investigators believe that the percentage utilization of a given 
 foodstuff in an available diet is a subject whose importance has been 
 exaggerated. It is said that the percentage differences are so small as 
 to be inconsiderable, particularly in view of the fact that only small 
 quantities of a given substance are involved. Perhaps from the stand- 
 point of the mere existence of the organism this may be true, but the 
 question of continued efficiency is not a negligible one. It seemed prob- 
 able, at least, that an examination of the feces with regard to their con- 
 tent of fat might give an indication as to the efficiency with which the 
 fat of the food was digested under the influence of water ingestion with 
 meals. 
 
 Description. 
 
 General Plan. The general plan of these experiments was to determin 
 in a preliminary period the digestibility of fat in subjects living on a uni- 
 form diet. During a second period, with no change in diet, a given volume 
 of water was to be added to that taken normally with each meal, and in 
 a final period the conditions of the preliminary period should again obtain. 
 
 The subjects of the experiments were normal men, on the staff of 
 assistants in the Department of Chemistry. The daily periods began 
 and ended at 7 A.M., and the program was as follows: Body weights 
 were taken at 7 A.M., after urinating and defecating. So regular the 
 routine became that in only two or three instances throughout the eight 
 to nine weeks of the experiments defecation did not come at this time. 
 To insure accuracy, body weights were always taken without clothing. 
 The morning meal was taken at 7.30, the noon meal at 12 or 12.15, an d 
 the evening meal at 5.30 or 5.45. The three meals were identical and 
 consisted of graham crackers, butter, peanut butter, milk and water. 
 Smaller quantities of water were taken at stated hours during the day. 
 The men went about their duties as usual throughout the day and eve- 
 ning. 
 
 The urine was collected in 24-hour samples, the last portion being that 
 passed before weighing in the morning. The urine was analyzed for total 
 
8 STUDIES ON WATER DRINKING. VIII. 
 
 nitrogen, ammonia, urea, creatinine, creatine, lla total and ethereal sul- 
 fates, and indican. 11 * 
 
 The analysis of the feces was made on each individual stool. As passed 
 it was weighed and thoroughly mixed until uniform throughout. The 
 samples for analysis were then weighed out as quickly as possible to pre- 
 vent loss by evaporation, which is very rapid. Charcoal was used as a 
 "marker" to facilitate the separation of the feces of different periods; 
 where the uniformity of the diet is not to be interfered with this method 
 is the most satisfactory. One or two capsules (0.2 gram) of finely di- 
 vided charcoal were taken before breakfast on the day beginning a new 
 period. With but few exceptions the separations thus obtained were 
 very distinct and entirely satisfactory. 
 
 The length of time between the taking of food and the appearance of 
 the feces therefrom has been variously given. A recent statement is 
 that particles fed to a man are not usually passed in his feces for two or 
 three days. 10 The observations of the present experiments support the 
 opinion as given by Strasburger 13 that normally this period is 24 hours. 
 Throughout these experiments the charcoal given on one morning ap- 
 peared in the last portions of the feces passed the next morning, in all 
 but two cases, in both of which the separations were from an ordinary 
 mixed diet, that is, at the beginning or at the end of the experiment. 
 
 Methods. All analyses were made on fresh feces without previous 
 drying, and were always made in duplicate unless the amount of material 
 available was not sufficient. The analysis of the fresh stool 12 to our mind 
 is the ideal method of feces examination. Certainly in view of Shimidzu's 
 findings, mentioned below, we can place no dependence upon data ob- 
 tained from the analysis of the dried sample. 13a The analysis of each in- 
 dividual stool in the fresh condition of course demands the expenditure 
 of much more time and energy than are necessitated in the analysis of 
 composit samples of dried feces. However, the added accuracy and the 
 greater value of the data obtained by means of the "fresh" procedure 
 certainly warrant the extra effort. 
 
 The method selected for the determination of fat was that proposed 
 and developed by Kumagawa and Suto 14 with the modifications added 
 by Inaba. 15 This method, above all others, yields a product that can be 
 considered to be more nearly pure fat than that yielded by any other 
 methods of extraction. 1 The method as described by its authors is carried 
 out upon air-dried materials but for our determinations no air-drying 
 was employed. Shimidzu 150 has shown that the drying of tissues on the 
 
 1 This statement does not apply to the method of Folin and Wentworth (/. Biol. 
 Chem., 7, 421-6 (1910)), with which we have had no experience. It appeared after 
 the completion of this work. 
 
STUDIES ON WATER DRINKING. VIII. 9 
 
 water bath previous to the determination of their fat content by this 
 method causes a loss of fat which may exceed 10 per cent. The loss is 
 probably due to oxidation. It is probable, therefore, that in the deter- 
 mination of fat in feces by this method, the use of fresh material without 
 previous drying yields most accurate results. The procedure involves 
 the saponification of 5-10 grams of fresh feces by a 5 N sodium hydroxide 
 solution for several hours ; this is overneutralized with 20 per cent, hydro- 
 chloric acid, taking care to keep the mixture from becoming hot, and the 
 acid liquid is extracted with ether. Any precipitate remaining is dis- 
 solved in hot normal sodium hydroxide, heated for about 15 minutes and 
 extracted with ether ; the acid aqueous solution that was first drained off 
 is added and all the fat and fatty acid remaining go over into the ether 
 portion. The combined ethers are evaporated, the residue purified by 
 absolute ether and lastly by petroleum ether, and dried at 60 to constant 
 weight. The fatty acids so obtained were crystallin and almost color- 
 less ; care in preventing overheating during the first neutralization and a 
 sufficient drying of the last ether residue before taking up in petroleum 
 ether are essential to obtaining them in pure form. 
 
 It is evident that by this method the unsaponifiable substances are deter- 
 mined along with the fatty acid and the authors 14 give a satisfactory 
 procedure by which these may be determined. It was shown by Inaba 15 
 that the unsaponifiable substances in the feces amount to about 10 per 
 cent, of the total fatty acids determined and that a separation of these 
 substances is of importance, if most accurate results are desired. In- 
 asmuch as a uniform diet was fed in these experiments, any difference 
 in the fat content of the feces from one period to another was probably 
 subject to no correction on this account. 
 
 Experiments on Copious Water Drinking with Meals. 
 
 General Description. The first experiments on Subjects H and W 
 may now be considered in detail. Subject H was a tall well-proportioned 
 man weighing 70.22 kilograms at the beginning of the experiment. He 
 had been on a diet of comparatively simple variety and as he was not 
 fond of milk and drank neither tea nor coffee, water comprized the chief 
 liquid portion of his diet. Subject W was of smaller stature and weighed 
 63.2 kilograms at the beginning of the experiment. He was accustomed 
 to the diet as offered by a club table of the better grade and usually 
 drank water sparingly. He regularly smoked a cigar after the evening 
 meal and did so throughout the experiment. Both subjects were put 
 upon the same uniform diet of graham crackers, butter, peanut butter 
 and milk. It contained 180 grams of fat per day distributed for each 
 food and meal as follows : 
 
10 STUDIES ON WATER DRINKING. VIII. 
 
 Amount. Pat. 
 
 Oatmeal crackers 150 grams it . 7 grams 
 
 Peanut butter 20 9.2 
 
 Butter 25 21. i 
 
 Milk 450 (cc.) 18 .o 
 
 Water 100 cc. 
 
 Total, 60.0 
 
 In addition, 200 cc. of water were taken at 10 A.M., at 3 P.M., and again 
 in the evening or just before retiring, making a total of 900 cc. of water 
 per day during the three-day preliminary period. 1 On the morning 
 of the fourth day before breakfast charcoal was taken and during the five 
 days following one liter of water was added to the menu of each meal, 
 making noo cc. per meal and a total of 3900 cc. per day. On this diet 
 both subjects record a feeling of fulness that sometimes became tem- 
 porarily slightly uncomfortable. It was necessary to urinate frequently 
 especially during the first few hours after the meal ; for a short time after 
 eating there was a desire to remain quiet and inactive, as is the case after 
 any full meal ; within three-quarters of an hour or an hour, approximately 
 half the water taken at the meal was voided. Both subjects record that 
 the feeling of fulness and lassitude noted immediately after meals became 
 less marked after the second day of the water period. Both felt per- 
 fectly well at all times and had normal appetites. After the fourth day 
 H records that he did not notice the feeling of fulness which followed the 
 high water ingestion of the first few days of the water period. 
 
 The period of copious water ingestion lasted five days. On the morning 
 of the sixth day charcoal capsules were taken before breakfast and during 
 that and the two following, days the diet of the preliminary period was 
 resumed. The experiment ended with the taking of charcoal on the 
 morning of the fourth day of this period. 
 
 Discussion of Results. The data upon the excretion of fat in the feces 
 during these three periods are given in Tables I and II. 
 
 Subject H, Table I. The data show that the average daily excretion 
 of fat during the preliminary period was 8.37 grams, during the water 
 period 7.16 grams and 9.22 grams during the final period. The digestion 
 and absorption of fat were seemingly more complete during the water 
 period than during the preliminary period and upon the withdrawal 
 of water the excretion of fat rose to an amount that was higher than be- 
 fore the period of water ingestion. A slight gain in weight was recorded, 
 
 1 The water supply (see Fowler and Hawk, /. Exp. Med., 12, 390 (1910)) of this 
 community is from deep wells and for use in these experiments it was softened by the 
 addition of five liters of saturated lime water to thirty liters of the tap water. After 
 standing several hours or a day the precipitate was filtered off. This water had an 
 agreeable taste; its alkalinity was 70 to phenolphthalein, 180 to methyl orange, and its 
 hardness determined by soap solution was 92 parts per million. 
 
STUDIES ON WATER DRINKING. VIII. 
 
 II 
 
 70.29 kilograms on the morning of the first day of water and 70.88 kilo- 
 grams on the morning of the first day after the water. This gain of 600 
 grams was not lost for at least three months thereafter. 
 
 TABLE I. SUBJECT H. 
 
 Water period. 5 days. Final period. 3 day*. 
 
 Preliminary period. 3 days. 
 
 Number 
 of stool. 1 
 
 Number 
 of Stool. 1 
 
 Total 
 
 Average. . . 
 
 Fat. 
 
 2.16 
 5.65 
 3.58 
 
 16.59 
 7-80 
 
 35-78 
 7.16 
 
 Number 
 of stool. i 
 
 Fat. 
 6.06 
 
 TABLE II. SUBJECT W. 
 
 Water period. 5 days. 
 
 IO 
 
 ii T ~2 . 14 
 
 12 8.79 
 
 13 10.68 
 
 Total 27.67 
 
 Average. ... 9.22 
 
 Final period. 3 days. 
 
 Number 
 of stool. 
 
 Fat. 
 * 80 
 
 6 
 
 i 31 
 
 7 
 
 5.98 
 
 g 
 
 6 4.1 
 
 
 7 .OI 
 
 IO .... 
 
 2 64. 
 
 
 
 Total. . . . 
 Average. 
 
 ... 29.15 
 ... 5.83 
 
 Number 
 of stool. 
 
 II . . . . 
 
 Fat. 
 
 S c6 
 
 12 
 
 7 76 
 
 J-3 . . 
 
 1.84 
 
 14. 
 
 6 14. 
 
 Total 
 
 21 SO 
 
 Average. . . . 
 
 7.17 
 
 Fat. 
 
 3.23 
 
 5.16 
 
 9-73 
 
 7-00 
 
 Total 25.12 
 
 Average .... 8.37 
 
 Preliminary period. 3 days. 
 
 Number 
 
 of stool. Fat. 
 
 1 9.22 
 
 2 10. 60 
 
 3 3.85 
 
 4 7-QQ 
 
 Total 30.67 
 
 Average. ... 10.22 
 
 Subject W, Table II. During the preliminary period there was an 
 average daily excretion of 10.22 grams of fat in the feces. During the 
 water period this was reduced to an average of 5.83 grams per day and 
 in the final period it rose to 7.17 grams per day, an amount only slightly 
 above that of the water period. From these data it would appear that 
 during the period of copious water drinking the fats of the food were more 
 completely digested and absorbed than either before or after this period 
 and that this effect of the water drinking was not temporary but more 
 or less permanent. In the case of W also a slight gain in weight accom- 
 panied the experiment. On the morning of the first day of water his 
 weight was 63.46 kilograms; at the end of this period it was 64.16 kilo- 
 grams. This gain of 700 grams might be attributed to retained water, 
 except for the fact that it was not lost subsequently. After the lapse 
 of three months, during which time the subject was on an ordinary mixed 
 diet, his weight was identically the same as at the end of the water period 
 of this experiment. While great significance can not be attached to so 
 small a change in weight, even granted that it is not due to water, it must 
 nevertheless be borne in mind that the diet throughout the experiment 
 was absolutely uniform with the exception of the water ingestion. 
 1 Weights of all stools are included in the third paper of the series. 
 
12 STUDIES ON WATER DRINKING. VIII. 
 
 It seemed reasonable to assume that the decreased excretion of fat 
 during the water period was due to more complete utilization as a result 
 of the large volumes of water ingested, and several explanations could 
 be suggested. Of first importance was the direct stimulating effect of 
 water upon the digestive juices. In his first experiments on dogs Pavlov 3 
 found that a large amount of water (500 cc.) caused a flow of gastric 
 juice, while a small amount (150 cc.) in half the cases observed had not 
 the least effect. He states that the important factor is a prolonged and 
 widely spread contact of water with the gastric mucous membrane. 
 This contact can hardly be called prolonged because of the rapid passage 
 of water through the pylorus; this very circumstance, however, might 
 make a large volume of water effective as against a small volume in that 
 the former did secure a more widely spread contact than the latter, and 
 perhaps also for a slightly longer period of time. To obtain further 
 information on this point it was considered worth while to make another 
 experiment upon the effect of a smaller amount of water taken with meals, 
 but whose use should extend over a longer period of time. 
 
 Experiments on Moderate Water Drinking with Meals. 
 
 Description, Methods, Etc. The plan of the experiment was exactly 
 the same as that of the previous one. Two subjects were maintained on a 
 uniform diet of small water content for several days. Then during a 
 period of ten days in which the same diet was continued, 500 cc. of water 
 in addition to the usual amount were taken with each meal. In the 
 final period the conditions of the preliminary period were again in force. 
 The daily routine was the same as in the preceding experiment. Char- 
 coal was used to separate the feces of the different periods and the analyses 
 were made on each individual stool in a fresh condition. 
 
 After an interval of about three months W, of the preceding experi- 
 ment, again served as subject. In the meantime he had been at the same 
 table as before, had had much the same kind of food, and in general the 
 same dietary habits with the exception that he had formed the habit 
 of taking more water with his meals than before the first experiment. 
 His weight at the beginning of this experiment was 64.18 kilograms, 
 almost exactly the same as at the end of the first experiment. 
 
 Subject E was of the average build and weighed 73.6 kilograms. His 
 habits of eating were irregular. During the previous year he had for a 
 time lived on one substantial lunch-counter meal a day, 1 later on two, 
 and during the months preceding the experiment on three at a regular 
 table. He was accustomed, ordinarily, to taking considerable amounts 
 of water with his meals. 
 
 The food of each meal, and its fat content were as shown : 
 
 1 Howe, Mattill and Hawk, /. Am. Chem. Soc., 33, 570 (1911). 
 
STUDIES ON WATER DRINKING. VIII. 13 
 
 (In grams.) Amount. Fat. 
 
 Oatmeal crackers 150 12 .9 
 
 Peanut butter 20 9.2 
 
 Butter 25 21. i 
 
 Milk 400 (cc.) 16.0 
 
 Water 100 cc. 
 
 Total, 59.2 
 
 The diet of W was slightly reduced from what it had been before and 
 was as follows : 
 
 (In grams.) Amount. Fat. 
 
 Oatmeal crackers 125 10.8 
 
 Peanut butter 20 9.2 
 
 Butter 25 21 . i 
 
 Milk 400 (cc.) 16.0 
 
 Water 100 cc. 
 
 Total, 57.1 
 
 In addition, each man took 200 cc. of water at 10 A.M., at 3 and at 
 8.30 P.M., making a total water ingestion of 900 cc. per day during the 
 preliminary period. During the water period the addition of 500 cc. of 
 water to each meal made the total water ingestion 2400 cc. per day during 
 that time. 
 
 Discussion of Results. Subject W. On the diet as given, some little 
 difficulty was experienced in obtaining nitrogen equilibrium in the pre- 
 liminary period. Charcoal was taken on the morning of the eighth day, 
 but for the sake of keeping uniformity in the feces data it seemed best 
 not to change the diet. Six days passed and on the morning of the 
 fourteenth day charcoal was again taken and water added to the regular 
 diet. The separation of the preliminary period into two parts proved 
 to be a very important incident in view of what the feces data show 
 (Table III). 
 
 TABLE III. SUBJECT W. 
 
 I. 
 
 Preliminary 
 period. 7 days. 
 
 ii. 
 
 Preliminary 
 period. 6 days. 
 
 Water 
 period. 10 days. 
 
 Final 
 period. 5 days. 
 
 Number Number Number 
 of stool. Fat. of stool. Fat. of stool. 
 
 I. 12 ^O i * """* T/l 
 
 i 
 Ft. o 
 
 1.84 
 IO.I8 
 4.70 
 9.70 
 3-89 
 7-54 
 1-74 
 11-59 
 7-85 
 8.72 
 
 lumber 
 f stool. Fat. 
 
 24 3-54 
 
 oe 6 "\8 
 
 2 3.19 
 1. . 42^ 
 
 87 47 
 
 T e 
 
 Q . 8 O7 
 
 *D 
 
 16 
 
 26. . *. **6 
 
 44 71 
 
 10 10 52 
 
 17 
 
 27 .. 8 ^6 
 
 5 ... 12 20 
 
 II 321 
 
 18 
 
 28 * S4 
 
 6 5.06 
 
 12 5-97 
 
 IQ. . 
 
 29 4.08 
 
 Total 41-69 
 Average . . 5 . 96 
 
 I-l. . I QO 
 
 2O 
 
 Total ... 31.66 
 Average. 6.33 
 
 Total 41.24 
 Average . 6 . 89 
 
 21 
 
 22 .... 
 
 23 
 
 Total. . . . 
 Average. 
 
 67.75 
 6.78 
 
14 STUDIES ON WATER DRINKING. VIII. 
 
 During the time that intervened between his two experiments Subject 
 W, as has been mentioned, while on an ordinary mixed diet, continued 
 the habit of taking considerable water with his meals. As is evident 
 from the diet of the preliminary period the amount of water taken was 
 small and was, in fact, much less than he was accustomed to use. While 
 this restricted amount of water did not immediately make itself felt in 
 the first few days of the experiment, it did begin to show in the latter part 
 of the preliminary period by a seemingly less complete digestion and 
 absorption of fat. This is evident in an increase in the average daily fecal 
 output of fat during the second part of the preliminary period. The 
 average daily amount of fat excreted in the first part of this period was 
 5.96 grams as against 6.89 grams in the second part. Since the charcoal 
 separation of this preliminary period into two portions was clear and 
 definit this increase in fat in the feces during the latter part seems to 
 mean a less efficient digestion and utilization of the fat of the food. That 
 this evidence did not appear until some days after the amount of water 
 had been reduced indicates, as hi the first experiment, that the beneficial 
 effect which water had upon digestion and absorption did not cease with 
 the withdrawal of water, but was more or less permanent beyond the 
 time during which water was taken with the meals. The evidence given 
 by this finding was entirely unlocked for and seems to be of great im- 
 portance. 
 
 Attention should also be called to the comparison of the fat data of 
 this preliminary period with those of the preliminary period of the first 
 experiment, Table II. The average daily amount of fat excreted in the 
 preliminary period of the first experiment was 10.22 grams as against 
 5.96 in the second. The average percentage utilization of fat in the 
 former was 94.3 per cent, as against 96.5 per cent, hi the latter. These 
 data showing so pronounced an improvement hi the digestion and utiliza- 
 tion of fat are on an individual living on the same kind of food, but sepa- 
 rated by a period of three months in which water drinking with meals 
 was practiced. From these results the conclusion as to the effect of water 
 drinking with meals upon the utilization of fat is further strengthened. 
 
 It is further seen in Table III that the average daily excretion of fat 
 in the preliminary period, 6.89 grams, suffered but little change in the 
 water period, 6.78 grams, but was slightly decreased, 6.33 grams, in the 
 final period. Just why this decrease should have come in the final period 
 rather than during the water period is not clear. Perhaps there is a lag 
 in the appearance of the results of water drinking, just as it has been 
 shown that its effects are more or less permanent. In this case the 
 moderate amount of water may have had a stimulatory effect that was 
 not evident during the water period but made itself felt during the period 
 following. The question of individuality probably enters in also. From 
 
STUDIES ON WATER DRINKING. VIII. 15 
 
 a study of the data on Subject W during this experiment it may be con- 
 cluded that the effect of moderate water drinking with meals upon diges- 
 tion is in the same direction as that of copious water drinking but some- 
 what less marked. 
 
 Subject E. An examination of Table IV shows the variations in fat 
 excretion from one period to another to be small although similar to those 
 obtained before. The output of fat fell from 6.6 1 grams per day in the 
 preliminary period to 6.39 grams per day under the influence of moderate 
 water drinking, and again rose to 6.70 in the final period. 
 
 Again it appears that the effect of drinking water in moderate amounts 
 with meals is in the same direction as when large amounts are used, al- 
 though the differences observed are of a smaller order of magnitude; as 
 with the copious amounts, absolutely no harmful effects were to be ob- 
 served. With moderate amounts of water the inconvenience of dis- 
 posing of an unusual quantity of liquid after the meal was removed, and 
 the lethargic effects of a full meal, such as were noted under the experi- 
 ment on copious water drinking, were also avoided. 
 
 TABLE IV. SUBJECT E. 
 
 Preliminary period. 7 days. Water period. 10 days. Final period. 4 days. 
 
 Number 
 
 
 Number 
 
 Number 
 
 
 of stool. 
 
 Fat. 
 
 of stool. 
 
 Fat. of stool. 
 
 Fat. 
 
 I 
 
 3-79 
 
 9 
 
 3-33 20 
 
 .. 2.79 
 
 2 
 
 i.5i 
 
 10 
 
 5.85 21 
 
 .. 5-60 
 
 3 
 
 8.96 
 
 II 
 
 3.96 22 
 
 7-75 
 
 4 
 
 11.63 
 
 12 
 
 8.20 23 
 
 .. 7.88 
 
 5 
 
 3-92 
 
 13 
 
 9-78 24 
 
 .. 2.77 
 
 f. 
 
 8f.fi 
 
 
 
 
 
 
 
 
 
 
 7 
 
 5-20 
 
 15 
 
 7.07 Total 
 
 .. 26.79 
 
 8 
 
 2.63 
 
 16 
 
 3-63 Average 
 
 6.70 
 
 Total 
 
 46.30 
 
 7 
 18 
 
 2 . 90 
 
 9-59 
 
 
 Average 
 
 6.61 
 
 19 
 
 .. 3-io 
 
 
 
 
 Total 
 
 .- 63.91 
 
 
 
 
 Average 
 
 6.39 
 
 
 The results just given were obtained on subjects one of whom (W) 
 had lately become accustomed to drinking with meals ; the other of whom 
 (E) habitually took considerable water with his meals. In each case the 
 organism, though accustomed to the presence of water in the alimentary 
 tract during digestion, responded to an increase in its amount by a better 
 utilization of the fat of the food. The results obtained, therefore, prob- 
 ably represent the minimum rather than the maximum effect that may be 
 obtained by moderate water drinking with meals, and are such as might 
 safely be expected in any individual, but especially in one not accustomed 
 to drinking water under these conditions. 
 
1 6 STUDIES ON WATER DRINKING. VIII. 
 
 The Effect of Copious Water Drinking with Meals upon an Habitual 
 
 Water Drinker. 
 
 At this point an answer was sought to the question as to whether a 
 very large water ingestion with meals would show its effect upon digestion 
 even though relatively large amounts of water were habitually taken at 
 meal time. For this investigation Subject E seemed very well fitted; 
 during the experiment on moderate water drinking he had frequently 
 made it his boast that he was not drinking more water with his meals 
 during the water period than was his custom. It seemed advizable 
 therefore to try upon E the effect of such amounts of water as would be 
 copious for his digestive mechanism. 
 
 Description. Continuing with the same diet as in the final period of the 
 previous experiment, a period of six days was made the preliminary 
 period for this experiment. During the five days following this period 
 an addition of one and one-third liters of water was made to the water 
 ingestion of each meal. This is a larger amount of water than was used 
 in the first experiment on copious water drinking, where only 1000 cc. 
 additional were taken with each meal. A final period of three days 
 closed the experiment. On the very first day of this large water inges- 
 tion Subject E records that he had no trouble in drinking all of the water, 
 nor was any discomfort experienced throughout the experiment. 
 
 TABLE V. SUBJECT E. 
 
 Preliminary period. 6 days. Water period. 5 days. Final period. 3 days. 
 
 Number 
 of stool. 
 
 I . . 
 
 Number 
 Pat. of stool. 
 
 ... 2.75 8 
 
 Number 
 Fat. of stool. 
 
 7 17 14. 
 
 Fat. 
 * c8 
 
 2 
 
 4. 28 
 
 
 I 84. 11 
 
 i 87 
 
 
 10 87 
 
 IO 
 
 ii i^ 16 
 
 O'i 
 
 8 69 
 
 A 
 
 C QO 
 
 II 
 
 44.6 17 
 
 o 82 
 
 
 7 4/1 
 
 12 
 
 7-33 
 3 53 Total 
 
 18 96 
 
 6 
 
 8 5Q 
 
 1 1 
 
 7 
 
 I .07 
 
 Total 
 Average 
 
 Average. . . 
 31-68 
 
 6.34 
 
 . 6.24 
 
 Total 
 
 
 41 .80 
 
 Averaee. . 
 
 6.Q7 
 
 Discussion of Results. Table V shows that the average daily excretion 
 of fat in the preliminary period, 6.97 grams, fell to 6.34 grams in the water 
 period, and the daily average value for the final period, 6.24 grams, was 
 even slightly less than for the water period. The effect of copious water 
 drinking with meals is seen to be in the same direction when the organism 
 is accustomed to water drinking as when it is not, except that when water 
 drinking with meals is habitual the results are less striking than otherwise. 
 Inferences and Discussion. 
 
 All of the observations made have pointed to a decreased elimination 
 of fat in the feces when water was taken with meals, indicating a more 
 
STUDIES ON WATER DRINKING. VIII. 17 
 
 complete utilization of the fat of the food than without the water in- 
 gestion, and in most instances the evident better digestion continued for 
 several days beyond the period during which an increased water in- 
 gestion was practiced. A large amount of water was more efficient in 
 this regard than a small one and a more pronounced result was obtained 
 in persons not used to water drinking with meals than in those for whom 
 it was habitual. 
 
 The results of our experiments warrant more than a negative con- 
 clusion. The ingestion of water along with the food secures a better 
 utilization of the fat of the food as shown by a diminished excretion of 
 fat in the feces. It is possible to explain this result on the basis of four 
 different facts. 
 
 (i) The Stimulating Action of Water upon the Gastric Secretion and In- 
 dependently upon the Secretion of Pancreatic Juice and Bile. 
 
 The facts observed by Pavlov and his co-workers 3 mentioned above, 
 and the findings of Foster and Lambert 4 as to the stimulating action of 
 water upon the gastric secretion in dogs have also been observed in human 
 beings with gastric and esophageal fistulas. In some of the older in- 
 vestigations it was shown 16 ' 17 ' 18 that a purely psychic secretion, such as 
 is noted in dogs, is not as pronounced in man as in these animals. A 
 pleasant taste of food in the mouth caused a flow of gastric juice in some 
 instances, but whether, in general, such a secretion of gastric juice in man 
 arizes indirectly through stimulation carried by the blood or by the 
 nerves, or whether it is due directly to the contact of substances with the 
 mucous membrane of the stomach is uncertain. The observations of 
 Bogen, 19 Kaznelson, 20 and Sommerfeld 21 upon patients with gastric 
 fistulas have clearly demonstrated a psychic secretion. Most varied 
 stimuli through taste, smell, and sight of food, and through sounds asso- 
 ciated with the preparation of food called forth a secretion of gastric 
 juice. In the subject examined by Lavenson 22 no psychic secretion was 
 demonstrable but water was found to be a definit though not powerful 
 stimulus. Sommerfeld 21 was able to show that water had a stimulating 
 action upon the gastric secretion, and further, that the mere drinking of 
 water, after the manner of sham feeding, caused a flow of gastric juice. 
 It is claimed that saliva is not a factor in inducing gastric secretion. 
 The evidence adduced by Hemmeter 23 as to a salivary hormone producing 
 increased flow of gastric juice could not be verified by Loevenhart and 
 Hooker. 24 The stimulating factor may be mastication itself, including 
 the taste phenomena and also the desirability of the food. 
 
 In human beings as well as in the lower animals investigated the acidity 
 of the gastric juice is found to vary with the kind of food. The findings 
 of Foster and Lambert 4 on dogs with accessory stomach indicate not only 
 
18 
 
 STUDIES ON WATER DRINKING. VIII. 
 
 a more voluminous but also a more acid secretion when water is taken 
 with food and they suggest an automatic control in the stomach, such 
 that the chyme, no matter what its state of dilution, always has the same 
 optimum acid concentration. The increased acidity noted in the acces- 
 sory pouch may not actually exist in the stomach proper; here, by dilu- 
 tion, the acid concentration may remain unchanged. Certain other 
 experiments reported from this laboratory 24 * 1 apparently confirm this 
 view. If the stimulation of water is entirely a chemical one, however, 
 it is difficult to see why the mucosa of the pouch, which is not in contact 
 with the water, should respond as readily as the stomach itself, even 
 though it has the same nerve and blood supply. Any effect which the 
 accessory pouch shows may possibly be less marked than the one actually 
 secured in the stomach proper. 
 
 Whether an increased acidity and digestive power of the gastric juice 
 is of immediate importance in the digestion of fat is not clear. The 
 cleavage of fat by gastric lipase is very minimal in the normal acid re- 
 action of the stomach except when the fats are in the form of a natural 
 emulsion. London and Versilova 25 showed that in dogs the cleavage 
 of fat fed in such a form (egg-yolk) rose as high as 32 per cent, in the 
 stomach, due in part to gastric lipase and in part to regurgitated duodenal 
 juice. A similar observation has been made recently by Levites. 28 
 Kaznelson 20 found a lipase in the gastric juice of her patient. According 
 to Lavenson's observations 22 a regurgitation of bile and pancreatic juice 
 in the stomach occurred with great constancy when oil was given. 
 
 No absorption of fat takes place in the stomach. In the experiments 
 of London and Versilova 25 where one-third of the fat administered was 
 split in the stomach no absorption took place until this material reached 
 the ileum. As a result of their findings Camus and Nicloux 27 and also 
 Stire 28 emphasize the unimportance of gastric lipase. The fats undergo 
 practically no change in the stomach, and when they do it is as a result 
 of a regurgitated duodenal secretion. 
 
 In view of these facts the importance, for fat digestion, of the greater 
 quantity of gastric juice, or a greater acidity, or both, as a result of the 
 stimulating action of water with the food is to be sought rather in the 
 effect upon the secretion of the bile and the pancreatic juice. 
 
 (2) The Acid Chyme as an Excitant for the Flow of Pancreatic Juice 
 
 and Bile. 
 
 The formation of secretin from prosecretin is the result of an acid 
 reaction of the duodenum; the larger the amount of acid the greater the 
 stimulation given to the secretory action of the pancreas, and the flow 
 of bile is regulated by the same mechanism. That the efficiency of bile 
 in aiding the digestioa of fats by pancreatic lipase is due to the bile acids 
 
STUDIES ON WATER DRINKING. VIII. 19 
 
 has again been shown recently by Terroine. 29 The same investigator 
 has also shown 30 that at an optimum concentration of pancreatic juice 
 and of esters or whatever other substances are undergoing cleavage, the 
 hydrolysis is activated proportionately by increasing quantities of bile 
 salts. 
 
 Fat in small amounts is a regular constituent of pancreatic juice and 
 especially of the bile, and an increase in these secretions should cause 
 increased elimination of fat in the feces unless a compensation was found. 
 This increased excretion is not found, but, on the contrary, a constant 
 decrease is observed under the influence of water drinking with meals. 
 It follows from this that the digestibility of fat during the period of water 
 drinking with meals was increased even beyond what the data indicate, 
 since part of the excreted fat might come from the larger amounts of 
 digestive juices secreted under the stimulating influence of water. And 
 furthermore inasmuch as the fat values for the stools derived by the 
 Kumagawa-Suto technic include any cholesterol present, the increased 
 output of biliary cholesterol during the water period would also be a 
 factor tending toward an apparently augmented output of fecal fat dur- 
 ing this interval. 
 
 (3) Heightened Peristalsis and Increased Blood Pressure as Factors in 
 the More Complete Digestion and Utilization of Fat. 
 
 Peristalsis is known to increase with the volume of material within the 
 intestin. Whether a large amount of a liquid mass is as efficient in this 
 regard as an equal bulk containing less water is uncertain. The effect 
 of dilution and increased peristalsis brought on by purgatives was shown 
 by Ury 31 not to increase the amount of soluble foodstuffs or of their 
 products in the feces. His observations were limited to soluble protein 
 and to sugar. 
 
 Water begins to pass the pylorus very soon after its ingestion, and is 
 quickly absorbed. During the time that this water is in the tissues and is 
 flowing in the blood stream, the increased volume causes a rise in blood 
 pressure similar to the rise regularly following a meal. In duplicate 
 feeding experiments on a dog with gastric fistula Dobrovolskii 32 found 
 that after bleeding there was an almost complete stoppage of the process 
 of digestion during the first 3 hours, due in part to the decreased blood 
 pressure. No measurements of blood pressure were made during these 
 experiments on water drinking; it seems reasonable to assume, however, 
 that a greater blood pressure and a consequent stronger and more rapid 
 heart beat might also be factors in the more complete absorption of the 
 fat of the food when water is taken with meals. 
 
 Both of these factors, peristalsis and blood pressure, are to be investi- 
 gated as to the effect which large volumes of water with meals have upon 
 them. 
 
2O STUDIES ON WATER DRINKING. VIII. 
 
 (4) Dilution as a Factor in More Complete Utilization. 
 
 More important than any of the other factors, probably, is this one of 
 dilution. Like all other chemical reactions, those brought about by 
 enzymes are reversible. Governing these is the general principle ex- 
 pressed in LeChatelier's theorem which states that when a system in 
 equilibrium is subjected to a constraint by which the equilibrium is 
 shifted, a reaction takes place within the system which opposes the con- 
 straint, i. e., one by which its effect tends to be destroyed. Processes 
 within the system tend to counteract the effect of external changes. 
 Thus the dilution of any solution in which the reaction AB ~^~*' A -f B 
 had come to equilibrium would result in the formation of further amounts 
 of A and B in order to increase the total concentration of dissolved ma- 
 terial by way of counteracting the effect of dilution. The reaction would 
 be driven toward the right and would be brought more nearly to com- 
 pletion. Looked at in another way such a reversible reaction as given 
 above reaches an equilibrium whose constant is expressed by the equa- 
 tion C a X C b /C ab = K. The numerical value of this fraction as expressed 
 by K remains unchanged whatever the total concentration of the solu- 
 tion may be. If the solution is diluted, causing a reduction in all three 
 of the terms C a , C b and C^, the values C a and C b must diminish relatively 
 less rapidly than C ab in order that K should remain the same. And in 
 order to accomplish this some of the substance whose concentration is 
 C^ is transformed into the substances whose concentrations are C a and 
 C b . A concentrating of the solution would have the opposit effect. 
 Now all of the hydrolytic cleavages occurring in digestion are of the type 
 AB < > A + B, i. e., a single substance is broken up into two or more 
 products, and such reactions are brought the more nearly to completion 
 the greater the dilution in which they take place. The corresponding 
 synthetic reactions are accomplished by beginning with a high con- 
 centration of the corresponding decomposition products. 
 
 The failure to provide for the removal of the end-products, either by 
 dilution or by dialysis, has often been shown to prevent a reaction from 
 going to completion. In experiments upon the saponification of fats by 
 pancreatic juice obtained by fistula from a dog Terroine showed 33 that 
 the addition of oleic acid or of sodium oleate to olein emulsions rendered 
 saponification of the latter more difficult. The addition of glycerol to 
 suspensions of olive, castor, and cottonseed oils had the contrary effect 
 of making them much more readily saponifiable, but this was due to the 
 physical effect of the glycerol in making the emulsions more complete 
 and more permanent by virtue of decreasing the surface tension. In 
 his investigations upon human pancreatic juice Bradley 34 found that the 
 undiluted juice acted on ethyl butyrate less rapidly than when diluted 
 
STUDIES ON WATER DRINKING. VIII. "V.C 21 
 
 i : 10. The optimum dilution was found to lie between i : 15 and 
 i : 20. In experiments on the effect of bile salts on pancreatic juice 
 Terroine 35 found that the action was a physico-chemical one, directly 
 upon pancreatic juice, that if the time of the action was prolonged diges- 
 tion was retarded, and that if still more prolonged digestion was in- 
 hibited. Shorter periods resulted in maximum digestion. 
 
 In the light of these facts the better absorption and more complete 
 utilization of the fats attendant upon water ingestion with meals are a 
 result of the greater completeness of the hydrolytic cleavage under the 
 influence of dilution and of the accompanying more rapid removal of the 
 end-products. 
 
 Summary. 
 
 Experiments were performed on men living on a uniform diet; a pre- 
 liminary period of small water ingestion was followed by a period of large 
 water ingestion with meals, and this, in turn, by a final period with the 
 original conditions. 
 
 When one liter of water additional was taken with meals the average 
 daily excretion of fat in the feces was much reduced below that found 
 when a minimum amount of water was taken with meals; one and one- 
 third liters had a like effect; a similar but less marked reduction was 
 observed when 500 cc. of water were taken with meals. 
 
 The decreased excretion of fat observed during water drinking with 
 meals was usually evident for a number of days after water had ceased 
 to be taken in large or moderate amounts with meals indicating that the 
 beneficial influence of water was not temporary but was more or less 
 permanent. 
 
 A slight gain in weight accompanied the water drinking and this gain 
 was not subsequently lost. 
 
 After several months of moderate water drinking with meals a pro- 
 nounced improvement in the digestibility of fat was observed, the per- 
 centage utilization having risen from 94.3 to 96.5. 
 
 The better digestion and absorption of fat was probably due to the 
 following factors : 
 
 (1) Increased secretion of gastric juice and independently of pan- 
 creatic juice as a result of the stimulating action of water. 
 
 (2) Increased acidity of the chyme bringing about a more active secre- 
 tion of pancreatic juice and bile. 
 
 (3) Increased peristalsis due to larger volume of material in the in- 
 testin and increased blood pressure due to rapidly absorbed water. 
 
 (4) A more complete hydrolysis of the fats by lipase due to increased 
 dilution of the medium and consequent more rapid absorption. 
 
22 STUDIES ON WATER DRINKING. VIII. 
 
 REFERENCES. 
 
 i. Carrington, "Vitality, Fasting and Nutrition," p. 397 (Rebman, N. Y., 1908). 
 2. Fischer, "Physiology of Alimentation," p. 183 (Wiley, 1907). 3. Pavlov, "The 
 Work of the Digestive Glands," translated by Thompson, second edition, p. 112 
 (Griffin & Co., London, 1910). 30. Heidenhain, quoted by Pavlov, Ibid., p. 130. 
 36. Sanotskii, quoted by Pavlov, Ibid., p. 112. 4. Foster and Lambert, "Some Factors 
 in the Physiology and Pathology of Gastric Secretion," /. Exp. Med., 10, 820 (1908). 
 5. Pavlov, Ibid., p. 144. 6. Togami, "Influence of Certain Foods and of Emotion on 
 Pancreas Secretion," Z. physik-didt. Ther., 12,453 (1908); through Biochem. Centr., 8, 
 202. 6a. Hawk, Arch. Int. Med., 8, 382 (1911). 7. Wohlgemuth, Berl. klin. Woch- 
 schr., 47, 92 (1910). 70,. Fairhall and Hawk, unpublished. 8. von Mering, "Ueber 
 die Funktion des Magens," Verhandl. des Congresses f. innere Med., 12, 471-82 (1893). 
 8a. Cohnheim, Munch, med. Wochschr., 54, 2581 (1907). 86. Kaufmann, Z. Heilk., 28, 
 203 (1907). 9. Ruzicka, "Ein Selbstversuch iiber Ausnutzung der Nahrstoffe bei ver- 
 schiedenen Quantitaten des mit dem Mahle eingefiihrten Wassers," Arch. Hyg., 45, 409- 
 16 (1902). 10. Lusk, "Science of Nutrition," second edition, p. 46 (Saunders, 1909). 
 ioa. Strasburger, Z. klin. Med., 46, 413-44 (1902). n. Schmidt and Strasburger, "Die 
 Faeces des Menschen," p. i (Berlin, 1905). na. Howe and Hawk, unpublished. 116. 
 Hattrem and Hawk, Arch. Int. Med., 7, 610(1911). 12. Howe, Rutherford and Hawk, 
 "The Preservation of Feces," Jour. Am. Chem. Soc. 32, 1683-6 (1910). 13. Schmidt and 
 Strasburger, Ibid., p. 17. 130. Mendel and Fine, /. Biol. Chem., 10, 309 (1911). 
 
 14. Kumagawa and Suto, "Quantitative Bestimmung des Fettes und der 
 unverseifbaren Substanzen in tierischem Material," Biochem. Z., 8, 213-347 (1908). 
 
 15. Inaba, "Fettbestimmungen der Faces und einigen Nahrungsmittel nach der 
 Methode von Kumagawa-Suto," Biochem. Z., 8, 348-55 (1908). 150. Shimidzu, 
 Biochem. Z., 28, 237-73 (1911). 16. Hornborg, dissertation Helsingfors, 1903. 
 Quoted by Hammarsten (Mandel), "Textbook of Physiological Chemistry," p. 440 
 (Wiley, 1911). 17. Umber, "Die Magensaftsekretion des Menschen bei Scheinfutterung 
 und Rektalernahrung," Berl. klin. Wochschr., 42, 56 (1905). 18. Cade and Latarjet, 
 Compt. rend. soc. biol., 57, 496 (1904). 19. Bogen, Arch. ges. Phys. (Pfiuger), 117, 150 
 (1907). 20. Kaznelson, "Scheinfutterungsversuche am erwachsenen Menschen," Arch, 
 ges. Phys. (Pftuger), 118, 327-52 (1907). 21. Sommerfeld, "Zur Kenntniss der Magen- 
 saftsekretion," Arch. Kinderheilk., 49, 1-15 (1909). 22. Lavenson, "Observations on a 
 Child with Gastric Fistula," Arch. Int. Med., 4, 271-90 (1909). 23. Hemmeter, "Die 
 Wirkung der Totalexstirpation sammtlicher Speicheldriisen," Biochem. Z., n, 238-59 
 (1908). 24. Loevenhart and Hooker, Proc. Soc. Exp. Biol. Med., 5, 114-7 (1908). 240. 
 Wills and Hawk, Proc. Am. Soc. Biol. Chem., II, p. xxix (1911). 25. London and 
 Versilova, "Die Spaltung emulgierter Fette im Darmkanal des Hundes," Z. physiol. 
 Chem., 56, 545-50 (1908). 26. Levites, "Verdauung der Fette im tierischen Organ- 
 ismus," Z. physiol. Chem., 57, 46-8 (1908). 27. Camus and Nicloux, Compt. rend. soc. 
 biol., 68, 619-22 (1910). 28. Stire, Cent. ges. Phys. Path. Stoffvu., 4, 889-90 (1909). 29. 
 Terroine, Compt. rend. soc. biol., 68, 439-41 (1910). 30. Id, Ibid., 68, 518-20, 666-8 
 (1910). 31. Ury, "Das Vorkommen von gelosten Substanzen in den Faces bei gestei- 
 gerter Darmperistaltik," Salkowski Festschr., 385-96; through Jahresb. Tierchem., 34, 
 518 (1904). 32. Dobrovolskii, Z. physiol. Chem., 56, 408-16 (1908). 33. Terroine, 
 Biochem. Z., 23, 404-28 (1909). 34. Bradley, "Human Pancreatic Juice," /. Biol. 
 Chem., 6, 133-71 (1909); Ibid., 8, 251 (1910). 35. Terroine, Compt. rend. soc. biol., 
 68 754-5 (1910). 
 
STUDIES ON WATER DRINKING: IX. THE DISTRIBUTION OF 
 
 BACTERIAL AND OTHER FORMS OF FECAL NITROGEN AND 
 
 THE UTILIZATION OF INGESTED PROTEIN UNDER THE 
 
 INFLUENCE OF COPIOUS AND MODERATE WATER 
 
 DRINKING WITH MEALS. 
 
 H. A. MAT-TILL. 
 
 Introduction. 
 
 By far the larger part of the organic material eliminated in the feces 
 is of unknown nature and composition. A knowledge of the source of 
 fecal material is thereby made the more difficult to obtain. Three sources 
 are usually considered as contributing to the nitrogenous material ex- 
 creted as feces: (i) food residues, (2) residues of the digestive juices and 
 cellular material from the intestinal wall, (3) bacteria and their products. 
 Each of these in turn has been emphasized as the principal contributing 
 agent, but no attempt seems ever to have been made to determin the 
 "nitrogen partition" in the feces. 
 
 That the food residues of an available diet form any considerable part 
 of the excreted material has had to be denied since the early work of 
 Voit on fasting feces. In feeding expenmentr on dogs this investigator 1 
 showed that the amount of nitrogen in the feces was not proportional 
 to the amount of meat fed. No muscle fibers or protein could be de- 
 tected in the feces. Voit 2 showed that the material produced in an 
 isolated loop of the intestin of a dog was of a similar composition and con- 
 tained the same amount of nitrogen as the feces of the normal intestin 
 through which food was passing. Prausnitz,* in experiments on men, 
 showed that the composition of the feces varied with the diet and gave a 
 definition of normal feces as those resulting from the eating of any food 
 that is completely digested and absorbed. His data also show that the 
 amount of nitrogen in the feces is uninfluenced by the amount in the food, 
 although Schierbeck 4 finds considerable variation in this respect. Rub- 
 ner 5 found that in man the amount of feces and its nitrogen content 
 are determined entirely by the cellulose content of the diet. In the same 
 way he found that on a milk diet the resulting fecal mass was almost 
 directly proportional to the quantity of milk ingested. 
 
 It is entirely probable that on a diet whose constituents are not en- 
 tirely available the amount of feces is increased by the undigested cellu- 
 lose, and the nitrogen content is increased by the larger amount of diges- 
 tive juices secreted because of the larger volume of food and the accom- 
 panying increased peristalsis. 
 
 About one- third of the dry matter of human feces consists of bacteria, 
 and at least one-half of the nitrogen of feces is bacterial in its origin. c ' 7 ' 8 
 
24 STUDIES ON WATER DRINKING. IX. 
 
 Little is known as to the conditions upon which the growth of the intes- 
 tinal flora depends. In herbivora, whose food materials contain large 
 amounts of cellulose, the presence of organisms that bring about the de- 
 composition and utilization of this substance is an advantage. Even so, 
 only 45 per cent, of the energy of such food is utilized. In the intestin 
 of carnivora the existing micro-organisms are limited to unabsorbed 
 protein and the residue of the digestive juices for their food supply. In 
 man, living upon a diet that contains food material of both the available 
 and the unavailable kind, a condition midway between might be ex- 
 pected, just as the relative length of the intestin lies between that of 
 herbivora and carnivora. 
 
 A recent claim of Schottelius 11 is that the presence of bacteria in the in- 
 testin of vertebrates is a desirable condition. Among their functions 
 are the f ollowing : to prepare the food for absorption, to stimulate peris- 
 talsis, to inhibit the growth of pathogenic bacteria, and to render the body 
 immune to bacterial poisons and to pathogenic organisms in general. 
 The investigations looking toward a determination of the possibility of 
 normal life with a steril alimentary canal have yielded conflicting re- 
 sults; 9 ' 10 the nature of the animal, of its food and its digestive mechanism 
 are all important factors in deciding the question. 
 
 Since the supply of nutriment for the bacteria of the lower intestin must 
 consist mainly of the nitrogenous residues of the digestive juices and of the 
 unabsorbed foodstuffs that reach the large intestin, we should expect 
 a decreased bacterial growth when this food supply is decreased. An 
 increase in unabsorbed residues of digestive juices and foodstuffs should 
 result in an increased bacterial growth. It would seem reasonable to 
 suppose, therefore, that any influence leading to the incomplete diges- 
 tion and absorption of food, especially of its protein portion, in the ali- 
 mentary tract would result in increased elimination of nitrogen in the 
 feces, or in increased bacterial growth in the lower intestin, or in both 
 of these conditions. 
 
 It was thought that evidence on both of these points might be valua- 
 ble in determining the probable effect of water ingestion with meals. 
 
 The only earlier experimental evidence as to the influence of water 
 drinking with meals upon the utilization of food was ob tamed by Ruzicka 12 
 in an experiment upon himself. The conditions and routine of his ex- 
 periment are referred to in the previous paper on the utilization of fat. 
 During the first 2 -day period of his experiment when no water was taken 
 with the meals, 118.4 g. protein were ingested, 17.9 g. excreted; during 
 the second 2 -day period when water was taken with the meals, 125.9 
 g. protein were ingested, 16.5 g. excreted. Protein utilization was 84.9 
 per cent, in the first period and 86.9 per cent, in the second. Neith( 
 
STUDIES ON WATER DRINKING. IX. 25 
 
 diet nor water ingestion was sufficiently uniform to allow any but the 
 most general conclusions to be drawn. 
 
 More specific evidence comes from an investigation made in this labora- 
 tory by Fowler and Hawk. 11 Their subject was brought to nitrogen 
 equilibrium on a constant and uniform diet and continuing this diet 
 one liter of water was added to each meal for a time of five days ; this was 
 followed by a short final period in which the original conditions held. 
 It appears that the average fecal output per day and the average dry 
 matter per day in the feces were both much less during the water period 
 than during either of the other periods, and that the average amounts 
 during the final period were less than those of the preliminary period. 
 More detailed examination of the feces was confined to the determina- 
 tions of total and bacterial nitrogen on one stool in each of the three periods. 
 These findings showed that both these forms of nitrogen were much re- 
 duced in amount during the period of copious water ingestion and that 
 after water ceased to be used in unusual amounts these values did not 
 immediately return to the values found for the preliminary period but 
 were still lower than those during the final period. The authors con- 
 cluded that these findings indicated a more economical utilization of the 
 protein of the food. During the water period of five days the subject 
 gained approximately two pounds in weight, and continued to gain for 
 a number of months after the end of the experiment and the return to 
 ordinary mixed diet. It could not be said that the water drinking had 
 no effect, nor that it had an ill effect. 
 
 These conclusions as to the digestibility and availability of the foods 
 during water-drinking were based upon analyses of but three stools, 
 one in each of the three periods. The importance of the conclusion 
 reached seemed to justify more extensive experiments along the same line, 
 experiments in which each individual stool of the whole investigation 
 should be subjected to similar examination. The present investigation 
 was therefore planned on this basis. 
 
 Description. 
 
 General Plan. The general plan and routine of the experiment has 
 been described in the preceding paper. 
 
 Methods. All analyses were made on fresh feces without previous 
 drying. The samples usually weighed out with the approximate weights 
 were as follows : 
 
 (a) Two 2 -gram samples for total nitrogen. 
 
 (6) Two 2 -gram samples for bacterial nitrogen. 
 
 (c) Two 2 -gram samples for acid-alcohol extract. 
 
 Total Nitrogen. During the earlier experiments dried feces were used for 
 the total nitrogen determinations, with unsatisfactory results due 
 to loss of nitrogen during the drying. That there is such a loss the 
 
26 STUDIES ON WATER DRINKING. IX. 
 
 data clearly show; this has been observed before. 14 ' 140 In the later ex- 
 periments the determination of total nitrogen was made upon the fresh 
 material with satisfactory results. 
 
 Bacterial Nitrogen. The method for bacterial nitrogen is described in 
 another paper from this laboratory.* 
 
 Residue Nitrogen. As explained more in detail under the determina- 
 tion of bacterial nitrogen, residue nitrogen is that which comes from the 
 well-washed sediments in the sedimentation for bacterial nitrogen. It 
 represents undigested and insoluble nitrogen that occurs in the larger 
 particles of the feces. 
 
 Extractive Nitrogen. The sample for acid-alcohol extract was rubbed 
 up in a small Erlenmeyer flask with a known volume of 95 per cent, 
 ethyl alcohol made o . 2 per cent, acid with hydrochloric acid. The flask 
 was stoppered and was allowed to stand at room temperature for a week, 
 being shaken up at least once each day. Nitrogen was then determined 
 on an aliquot portion (one-half) of the alcohol originally added. This 
 represents such nitrogenous end-products as are below the proteose 
 stage, and the soluble nitrogen of the digestive juices and of the pig- 
 ments. Almost invariably this amount is less than that obtained by a 
 similar extractive method on the bacterial sample as described under 
 bacterial nitrogen. This may be due to the greater fineness of division 
 that is secured hi the case of the latter and perhaps also to the solvent 
 action of the 0.2 per cent, hydrochloric acid used in making the bac- 
 terial suspensions. 
 
 All determinations of nitrogen of whatever form were made by the 
 Kjeldahl method. Instead of metallic mercury, copper sulfate was used 
 as catalyst in the digestion. 
 
 Experiments on Copious Water Drinking with Meals. 
 
 As mentioned before, subjects H and W were put on the same diet; 
 the amounts had to be altered before nitrogen equilibrium was reached. 
 The quantity and composition as finally given were as follows: 
 
 Amount 
 (per meal). Nitrogen. 
 
 Graham crackers 150 grams 2 .087 grams 
 
 Peanut butter 20 " 0.882 " 
 
 Butter 25 " 0.020 " 
 
 Milk 450 (cc.) 2.360 
 
 Total 5.349 
 
 Protein 33-44 grams 
 
 Protein per day 100 . 32 
 
 On this diet a condition of nitrogen equilibrium was attained approx- 
 * Mattill and Hawk, /. Exp. Med., 14, 433 (1911). 
 
STUDIES ON WATER DRINKING. IX. 
 
 imately at the end of the third day. The exact nitrogen balance may 
 be seen from the following : 
 
 Subject H. Nitrogen in feces 2 . 153 
 
 Nitrogen in urine 14 .036 
 
 Nitrogen in excreta 16 . 189 
 
 Nitrogen in food 16 .046 
 
 0.143 
 
 Subject W. Nitrogen in feces 2 . 385 
 
 Nitrogen in urine 14 . 534 
 
 Nitrogen in excreta 16.919 
 
 Nitrogen in food 16 .047 
 
 TABLE I. SUBJECT W. 
 
 Nitrogen distribution. 
 
 0.873 
 
 Percentage of total 
 fecal nitrogen found in. 
 
 
 o 
 
 d 
 
 g 
 
 i| 
 
 2 
 
 S3 5 
 
 
 t* 
 
 2 
 
 1 
 
 .2? 
 
 'S 
 
 "s a 
 
 
 V 
 
 "S^ 
 
 ,-*. 
 
 w ^i 
 
 3 
 
 ** S So '.tJ 
 
 
 ll 
 
 || 
 
 it 
 
 Hi 
 
 !i 
 
 Q.ri * " 
 
 y.-5 -oj-i 
 
 w Wc -3,0 
 
 
 55 
 
 fe 
 
 fe 
 
 H 
 
 I 
 
 d <! 
 
 fc, 
 
 
 
 
 
 
 
 
 I 
 
 i .738 
 
 I.9II 
 
 1-737 
 
 
 0-445 
 
 tii 
 
 l-g-^ 
 
 2 
 
 2 . 
 
 2-333 
 O 9 ^ S 
 
 2.536 
 
 o 061 
 
 2.305 
 0.874. 
 
 
 0-599 
 o. 193 
 
 l* n 
 
 A 
 
 I 64.0 
 
 ** - V - 1 
 I 74.7 
 
 *j + **f*f 
 
 i 588 
 
 
 0.586 
 
 m 
 
 
 * . ^^y 
 
 ' /T-/ 
 
 - o 
 
 
 
 Total 6.633 7-J55 6.504 
 
 Average. 2.211 2.385 2.168 
 
 1.823 
 
 1.279 0.889 0.608 
 (calc.) (calc.) 
 
 23.3 
 23.6 
 
 20.1 
 
 33-5 
 
 25-5 
 
 
 c. . 
 
 
 (T 
 
 .387) 
 
 I . 2Q6 
 
 
 
 0.280 
 
 
 
 15.2 
 
 i 
 v< 
 
 6 
 
 7 
 
 0.301 
 
 I ^7 
 
 
 
 i 
 
 .287 
 
 All 
 
 0.268 
 
 I ^Q 
 
 
 
 0.085 
 o 4.16 
 
 
 
 28.2 
 2Q .O 
 
 y 
 
 t{ 10 
 
 g 
 
 8 
 
 1.499 
 1-653 
 O. 554 
 
 1-593 
 1.771 
 O-6AO 
 
 1.489 
 I.655 
 
 o. 598 
 
 
 
 0.402 
 
 0.458 
 
 o. 175 
 
 
 
 25-2 
 
 25-9 
 27.3 
 
 9 
 10. . . 
 
 Total. . . . 
 Average . 
 
 
 
 
 
 0.784 
 
 0-545 
 
 
 
 
 
 
 7 
 (i 
 
 .III 
 
 .422) 
 
 6.645 
 1.329 
 
 2.401 
 0.480 
 
 33-4 
 
 
 
 
 
 
 (calc.) 
 
 (calc.) 
 
 
 
 
 
 -o 
 
 ii. 
 
 I 4IO 
 
 T 
 
 JCQ 
 
 I ^64. 
 
 o 817 
 
 O 54.7 
 
 o 4.56 
 
 56.O 
 
 37 . 5 
 
 31 .2 
 
 II 
 
 12 
 
 1.805 
 
 I 
 
 .896 
 
 1.772 
 
 0.970 
 
 0.802 
 
 0.571 
 
 51.2 
 
 42-3 
 
 30.1 
 
 M 
 
 (S ro 
 
 I -a. . 
 
 0.448 
 
 (o 
 
 .431) 
 
 0.403 
 
 0.294 
 
 o. 109 
 
 0.122 
 
 65-6 
 
 24-3 
 
 27.2 
 
 
 j3 
 
 14 
 
 1.329 
 
 I 
 
 499 
 
 I.40I 
 
 0.866 
 
 0.535 
 
 0.373 
 
 57-8 
 
 35-7 
 
 24.Q 
 
 Total 
 
 4.992 
 
 5 
 
 .286 
 
 4-940 
 
 2.947 
 
 1.993 
 
 1.522 
 
 
 
 
 Average . 
 
 1.664 
 
 i 
 
 .762 
 
 1.647 
 
 0.982 
 
 0.664 
 
 0.507 
 
 55-7 
 
 37-7 
 
 28.8 
 
 
 
 
 
 
 0.972 
 
 0.675 
 
 
 
 
 
 
 
 
 
 
 (calc.) 
 
 (calc.) 
 
 
 
 
 
28 STUDIES ON WATER DRINKING. IX. 
 
 Discussion of Data from Subject W, Table I. As mentioned before 
 the determinations of fecal nitrogen in this experiment were unsatisfac- 
 tory because of the loss of volatil nitrogenous compounds in drying. 
 That nitrogen was lost is very evident from the values of bacterial + 
 soluble nitrogen which are in almost all cases larger than the correspond- 
 ing total nitrogen. The so-called bacterial + soluble nitrogen comes 
 from the determination of bacterial nitrogen and its significance will be 
 clear by referring to the description of the method as given in a recent 
 article. 1 If the acid suspension after removing the last sediment of non- 
 bacterial substance is not treated with alcohol, but is directly transferred 
 to Kjeldahl flasks, the nitrogen so determined is not only bacterial but 
 includes in addition all nitrogen that is soluble in 0.2 per cent, hydro- 
 chloric acid or that has become so during the time of manipulation. This 
 datum is spoken of as bacterial + soluble nitrogen. In later experi- 
 ments it was shown that the ratio of total nitrogen to bacterial + soluble 
 was fairly constant at i . 10 in the preliminary period and i .07 in the fol- 
 lowing periods. Applying this factor to the values under bacterial + 
 soluble nitrogen the values under fecal nitrogen (calc.) are obtained. 
 Although these are not values obtained by analysis, they are more cor- 
 rect than those actually obtained for the reasons given. Taking either 
 of these values, however, the average daily amount of total nitrogen 
 excreted during the water period is only two-thirds of the average daily 
 amount excreted during the preliminary period, and about four-fifths 
 the average daily amount of the final period. The average daily amount 
 in the final period is only slightly higher than that of the water period, 
 and only three-fourths of what it was in the preliminary, showing that the 
 good effect of the water is not immediately lost. 
 
 The question as to the kind of fecal nitrogen that was decreased in 
 amount cannot be answered on the basis of analytical data, since the 
 bacterial and acid-soluble nitrogen were not separated during the early 
 part of the experiment. From later experiments in which this separa- 
 tion was made, a factor was calculated and found to be very uniform for 
 different subjects throughout the various periods. On this basis 59 
 per cent, of the combined bacterial + soluble nitrogen is nitrogen be- 
 longing to bacterial substance. That the factor as applied does not 
 fall far short of representing actual conditions may be gathered from the 
 close agreement between the calculated values and those obtained by 
 actual analysis of the stools of the final period. Applying this factor to 
 the values for combined bacterial + soluble nitrogen the nitrogen of 
 bacterial substance in the preliminary period was i . 2 79 grams per day, 
 in the water period 0.784 gram per day, and in the final period 0.972 
 gram per day. These values indicate that bacterial nitrogen was de- 
 1 Mattill and Hawk, /. Exfi. Med., 14, 433 (1911). 
 
STUDIES ON WATER DRINKING. IX. 29 
 
 creased under the influence of copious water drinking and furthermore, 
 in common with the results found for total fecal nitrogen, this condition 
 was not transitory but more or less permanent. The same statement 
 may be made regarding the nitrogen soluble in o . 2 per cent, hydrochloric 
 acid. The acid-alcohol-soluble nitrogen averaged 25.5 per cent, of the 
 total fecal nitrogen during the preliminary period, 33.4 per cent, during 
 the water period, and 28.8 per cent, during the final. This may mean 
 that the digestion during the water period resulted in nitrogenous end 
 products which are more soluble. This increased percentage of acid- 
 alcohol-soluble nitrogen in the feces during the water period does not in- 
 dicate decreased absorption, for the absolute amount of this form of nitro- 
 gen in the feces is decreased from o . 608 gram during the preliminary period 
 to o . 480 gram in the water period and rizes only slightly above this value, 
 o . 507 gram, during the final period, showing that absorption of the solu- 
 ble end products is more complete under the influence of water. More 
 probably, however, this form of nitrogen represents the residual portion 
 of digestive and intestinal juices which are known to increase in amount 
 under the influence of water ingestion, especially the gastric and pan- 
 creatic secretions and the bile. If this is so, it is a very important fact, 
 for even though during copious water ingestion, the flow of these secre- 
 tions is stimulated, and as a result of increased peristalsis the amount 
 of cast-off cellular material in the intestin is increased, the amount of 
 fecal nitrogen instead of being increased, as, indeed, it must be from these 
 sources, is, on the contrary, actually decreased. It follows from this that 
 the digestibility of protein material during a period of copious water- 
 drinking was increased even beyond what the data indicate, since part 
 of the excreted nitrogen is known to come from the larger amounts of 
 digestive juices secreted under the stimulating influence of water. 
 
 Discussion of Data from Subject H, Table II. The values for total fecal 
 nitrogen, either those determined directly on dry feces or those calcula- 
 ted directly from the bacterial -f soluble nitrogen, show that the average 
 daily excretion of nitrogen was i . 833 g. (detd.) during the preliminary 
 period, 1.442 g. during the water period, and 1.636 g. during the final 
 period. It was thus much less during the water period than during 
 either of the others, and the average daily amount after the water was 
 less than that before it. 
 
 As with subject W, the kinds of fecal nitrogen that suffered a decrease 
 cannot be stated on the basis of analysis. The results on applying to 
 the value for bacterial + soluble nitrogen the factor 0.59, which was ob- 
 tained from later experiments, as has been explained, show that the aver- 
 age bacterial nitrogen per day was decreased from i . 155 in the prelimi- 
 nary to 0.875 m th e water period, rizing to 1.044 in the final. The 
 average daily output as determined for the final period is i . 128, showing 
 
30 STUDIES ON WATER DRINKING. IX. 
 
 that the factor used is accurate. The same proportionate differences are 
 to be noticed in the values for soluble nitrogen. It is evident that both 
 bacterial and soluble nitrogen in the feces underwent a marked decrease 
 during the period of copious water drinking. 
 
 TABLE II. SUBJECT H. 
 
 ~ Percentage of total fecal 
 
 Nitrogen distribution. nitrogen found in 
 
 
 1 
 
 | 
 
 -o -A ^ 
 2 2 o 03 
 
 3 
 
 it 
 
 2 
 
 i 
 
 
 fc* . 
 
 c 
 
 1 C . p fl 
 
 fl 
 
 ~ - 
 
 
 Number 
 
 p 
 
 p 
 
 3 -S 8 & " g 
 
 in i! :f 
 
 N m o 
 
 ?3a 
 
 5 1 
 
 *> " 
 
 2 
 
 a 
 
 ^ 
 
 j 
 
 o 6^6 
 
 o 743 
 
 o 675 
 
 o 208 
 
 
 28 o 
 
 2. ... 
 
 I .214 
 
 i .427 
 
 I .207 
 
 o 342 
 
 
 24.0 
 
 
 2 2O6 
 
 2 654 
 
 2 417 
 
 O 7^6 
 
 
 28. > 
 
 
 1 .44'? 
 
 
 1.486 
 
 
 
 70.0 
 
 
 
 
 
 
 
 
 Total 5.499 6.459 5.871 1.959 
 
 Average 1-833 2.153 1.957 i-i55 0.802 0.653 3. 3 
 
 (calc.) (calc.) 
 
 
 
 O "I4 
 
 0.537 
 
 0.502 
 
 
 
 o 
 
 .280 
 
 
 
 52 . I 
 
 Wits' on 
 
 6 . . 
 
 1 . 113 
 
 i .240 
 
 I l6? 
 
 
 
 n 
 
 AAn 
 
 
 
 TC 8 
 
 ill 
 
 7 
 
 o 695 
 
 O 76l 
 
 O 71 1 
 
 o 238 
 
 71 -J 
 
 pS 
 
 8 
 
 
 ^ .602 
 
 3.366 
 
 T . T7A 
 
 
 
 9 
 
 1.563 
 
 1.788 
 
 1.671 
 
 
 
 
 
 .655 
 
 
 
 36.6 
 
 Total . ... 
 
 . 7.2IO 
 
 7 .0^7 
 
 7 .417 
 
 
 
 
 
 .754 
 
 
 
 
 Average 
 
 . I .442 
 
 I . 587 
 
 I .48^ 
 
 0.875 
 
 O.6O8 
 
 O 
 
 . 551 
 
 
 
 74.. 7 
 
 
 
 
 
 (calc.) 
 
 (calc.) 
 
 
 
 
 
 
 
 10 
 
 1.229 
 
 I.4I5 
 
 1.322 
 
 0.819 
 
 0.503 
 
 O 
 
 503 
 
 57-9 
 
 35-6 
 
 35-6 
 
 iH 
 
 ii 
 
 0.442 
 
 0.477 
 
 0.446 
 
 0.302 
 
 0.144 
 
 
 
 .119 
 
 63-3 
 
 30.2 
 
 24.9 
 
 
 SK. 
 
 12 
 
 1.510 
 
 1.763 
 
 1.648 
 
 1.082 
 
 0.566 
 
 
 
 563 
 
 61 .4 
 
 32.1 
 
 31-9 
 
 
 
 13 
 
 1.726 
 
 2.028 
 
 1.895 
 
 1.180 
 
 0.715 
 
 
 
 .6 7 i 
 
 58.2 
 
 35-3 
 
 33.1 
 
 Total 
 
 4.907 
 
 5.683 
 
 5.3H 
 
 3-383 
 
 1.928 
 
 I 
 
 .856 
 
 
 
 
 Average 
 
 i 636 
 
 I 8Q4. 
 
 I 77O 
 
 i 128 
 
 o 647 
 
 o 
 
 610 
 
 cq 6 
 
 7A o 
 
 2,2 7 
 
 
 
 
 
 1.044 
 
 0.726 
 
 
 
 
 
 
 
 
 
 
 (calc.) 
 
 (calc.) 
 
 
 
 
 
 
 The percentage of acid-alcohol-soluble nitrogen rose from an average 
 of 30 . 3 in the preliminary to 34 . 7 during the water period and fell to 
 32.7 in the final, while the actual amount fell from 0.653 in the prelim- 
 inary to 0.551 in the water and rose to 0.619 gram per day hi the final 
 period. The actual amount of this form of nitrogen was considerably 
 decreased under the influence of water drinking. The suggestion may 
 be made again that the increased percentage output was probably due 
 to the increased volume of digestive juices, the secretion of which was 
 stimulated by the ingestion of water. 
 
STUDIES ON WATER DRINKING. IX 31 
 
 Summary. 
 
 The findings on both subjects in this experiment show a decreased 
 elimination of all forms of fecal nitrogen during the period in which water 
 (1000 cc. additional) was taken with each meal. No ill effects could be 
 seen and the beneficial effect of water was not temporary but was pro- 
 longed beyond the time during which water was taken. 
 
 Experiments on Moderate Water Drinking with Meals. 
 
 In the experiments upon protein utilization under the influence of a 
 water ingestion of 500 cc. with each meal, the same general methods 
 were employed. Total nitrogen determinations were made on the fresh 
 moist material and the loss in volatil nitrogen compounds due to dry- 
 ing was thus avoided. A more accurate and trustworthy separation 
 of the bacterial + soluble nitrogen was made by an efficient centrifuga- 
 tion of the final alcohol suspension from which the clear liquid had been 
 pipetted off. The nitrogen of the precipitated material could more truly 
 be called bacterial nitrogen, that of the liquid, acid-soluble nitrogen. 
 
 On the basis of the experience gained in this and similar investigations 
 we cannot agree with certain statements made recently by Mendel and 
 Fine 1 as to the determination of the total nitrogen content of feces. They 
 say: "The error incident to this procedure (drying), however, did not ap- 
 pear to us to warrant serious attention, at least until certain details of 
 metabolism operations, such, e. g., as the accurate division of feces be- 
 longing to successive periods, reaching a higher stage of perfection." If 
 we examin Tables I and II of the present paper it will be observed that 
 the values obtained by us for the combined bacterial and soluble nitrogen of 
 fresh feces are in nearly every instance larger than the total nitrogen values 
 obtained from the analysis of the same feces after drying. We are firmly 
 convinced that the ideal method of feces analysis embraces the examina- 
 tion of the individual stools in the fresh condition. This procedure, of 
 course, entails much more labor than the less accurate practice of utilizing 
 the dried feces, but we believe that the added accuracy richly compen- 
 sates the investigator. In certain connections the individual fresh stools 
 may be preserved for several days and an analysis made of a composit 
 sample of the moist feces. 146 
 
 Throughout most of this experiment the values for bacterial nitrogen 
 and for nitrogen in the alcohol extract of bacteria, that is the acid-solu- 
 ble nitrogen, were determined along with a determination of the bac- 
 terial + soluble nitrogen, that is, the same suspension without alcohol 
 treatment. The agreement between the last-named and the sum of the 
 first two is very satisfactory ; in almost all cases they would pass as dupli- 
 cates. The fact that the alcohol used was not previously freed from pos- 
 1 Mendel and Fine, /. Biol. Chem., 10, 309 (1911). 
 
32 STUDIES ON WATER DRINKING. IX. 
 
 sible traces of nitrogen may account for the uniformly higher values 
 given by the sum of the separate alcohol-soluble and bacterial determina- 
 tions. 
 
 It was found from these data that the bacterial nitrogen was 59 per 
 cent, of the combined bacterial + soluble nitrogen and this ratio was 
 used in the preceding experiment. The ratio of total fecal nitrogen to 
 bacterial-soluble nitrogen used in the first experiment was obtained from 
 the values for these forms in this experiment. In both Tables III and 
 IV this was approximately i . 10 in the earlier periods and 1.07 in the 
 later periods. 
 
 Acid-alcohol-soluble nitrogen was determined as before, and the de- 
 termination of residue nitrogen was made throughout this experiment. 
 
 The diet of subject W, who had served before, was slightly reduced 
 from what it had been in the preceding experiment. The amounts and 
 composition were as follows : 
 
 Amount (per meal). Nitrogen. 
 
 Graham crackers 125 grams i . 776 grams 
 
 Peanut butter 20" 0.868 
 
 Butter 25" 0.015 " 
 
 Milk 400 (cc.) 1.917 " 
 
 4-577 
 
 Protein 28 .61 
 
 Daily protein 85 . 83 
 
 The diet of subject E consisted of 
 
 Graham crackers 150 grams 2 . 120 grams 
 
 Peanut butter 20 a 0.868 " 
 
 Butter 25 " 0.015 
 
 Milk 400 (cc.) 1-917 " 
 
 4.920 
 
 Protein 3 . 75 
 
 Daily protein 92 . 25 
 
 For water ingestion see preceding paper. 
 
 Discussion of Data from Subject W, Table III. Because of the difficulty 
 experienced hi obtaining nitrogen equilibrium the preliminary period 
 of W was divided by taking charcoal on the eighth day, but with no 
 change in diet. On the i3th day W's nitrogen balance was as follows: 
 
 Nitrogen in feces i . 360 
 
 Nitrogen in urine 12 . 361 
 
 Nitrogen in excreta 13-721 
 
 Nitrogen in food 13 73 1 
 
 + 0.010 
 
STUDIES ON WATER DRINKING. IX. 33 
 
 The influence of a restricted amount of water and the latent period 
 after which its effects appeared, as explained in the previous paper, are 
 to be noted in the protein utilization as they were hi the fat utilization. 
 The average daily fecal nitrogen excretion during the first part of the pre- 
 liminary period rizes from i . 275 to i . 360 in the second part, bacterial -f 
 soluble nitrogen from 1. 142 to 1.233, acid-alcohol-soluble from 0.284 to 
 0.320, and residue nitrogen from o. 148 to o. 154. A comparison of the 
 nitrogen data of this preliminary period with the nitrogen data of the pre- 
 liminary period of the first experiment shows the average daily total 
 fecal nitrogen output to be 2 . 385 in the first as against i . 275 in the sec- 
 ond; bacterial + soluble nitrogen 2. 168 in the first as against i . 142 in 
 the second; acid-alcohol-soluble 0.608 as against 0.284. The average 
 percentage utilization of protein in the first experiment was 86.3 per 
 cent, as against 90 . 7 per cent, in the second. These data showing so 
 pronounced an improvement in the digestion and utilization of protein 
 are on an individual living on the same kind of diet, but separated by a 
 period of three months in which water drinking with ordinary meals 
 was practised. 
 
 With the fourteenth day 500 cc. of water were added to the diet of 
 of each meal and this was continued for ten days. A five-day period fol- 
 lowed in which the original conditions prevailed. 
 
 By referring to Table III it will be seen at once that the nitrogen of the 
 various periods presents no striking differences. 
 
 The values for total, bacterial and other forms show fluctuations which 
 are too small to admit of conclusions. The largest proportionate varia- 
 tion is seen in the residue nitrogen. This, as was explained, was ob- 
 tained from the solid material that was sedimented in the procedure 
 for bacterial nitrogen. Its percentage of the total nitrogen, 11.3, in the 
 preliminary period, fell to 9.5 in the water period, and still lower, to 
 8.2 in the final period. If these small differences are significant, they 
 point to a condition of better digestion. 
 
 Discussion of Data from Subject E, Table IV. On the diet given, the 
 nitrogen balance of Subject B at the end of the sixth day was as follows : 
 
 Nitrogen in feces i . 926 
 
 Nitrogen in urine 13 . 310 
 
 Nitrogen in excreta 15 . 246 
 
 Nitrogen in food 14.761 
 
 0-485 
 
 An examination of the data in Table IV again reveals no striking differ- 
 ences in the nitrogen values from one period to another. The variations 
 in average daily amounts of nitrogen in its various forms are, as in the 
 case of W, too small to be significant, with the possible exception of the 
 
34 
 
 STUDIES ON WATER DRINKING. IX. 
 
 
 
 O VN <3- o co O \O fr O 
 
 c\ 
 
 CO 
 
 M 
 
 10 
 
 10 
 
 
 CO 
 
 
 
 
 *3npiS9H to H M o oc *tf- MOOO 
 
 CO 
 
 2 
 
 vo 
 
 CO 
 
 M 
 
 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 a 
 
 3 jq Tj- CS CO ON CO VO CO O ON 
 
 CO 
 
 vO 
 
 ON 
 
 oo 
 
 00 
 
 
 10 
 
 
 M 
 
 -nios-'ajB-ppv ~ co "* N cs 
 
 rt- 
 
 Tj- 
 
 CO 
 
 CO 
 
 M 
 
 
 CO 
 
 
 '5 
 
 
 
 
 
 
 
 
 
 
 3 
 
 10 O 
 
 M 
 
 ON 
 
 
 
 * 
 
 H 
 
 
 10 
 
 
 
 
 ' S " s i 
 
 ^ 
 
 CN 
 
 ON 
 ro 
 
 CO 
 
 CO 
 
 
 * 
 
 
 ? 
 
 <N 00 
 
 
 
 
 
 O 
 
 
 
 vo 
 
 
 CO 
 
 
 % 
 
 {BU9)DBfI ^ ^ 
 iO iO 
 
 CO 
 IO 
 
 % 
 
 r 
 
 t^ 
 
 vO 
 
 
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STUDIES ON WATER DRINKING. IX. 
 
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38 STUDIES ON WATER DRINKING. IX. 
 
 values for the residue nitrogen. The percentage of the total nitrogen 
 found in this form during the preliminary period, n.i, fell to 10.2 in 
 the water period and rose to 10. 9 in the final. Similar variations, and in 
 the same direction, were noted with W. Attention may be called again 
 to the satisfactory agreement of the values for bacterial + soluble nitro- 
 gen with the values of the sum of these two determined separately, which 
 thus furnishes a valuable check on the determinations. 
 
 The protein data on Subjects W and E during this experiment on 
 moderate water drinking with meals do not justify the drawing of any 
 but negative conclusions ; they do not show that the use of water was 
 attended by any undesirable results. The data obtained on the utiliza- 
 tion of carbohydrate and fat during this period, which are presented in 
 the following and preceding papers, show that where analytical methods 
 are sufficiently exact to give significant results the effect of moderate 
 water drinking is in the same direction as that of copious water drinking, 
 though much less marked. 
 
 Copious Water Ingestion by an Individual Accustomed to Taking 
 
 Considerable Water with Meals. 
 
 Following the preceding experiment, a period of six days formed the 
 preliminary period for this experiment, the subject of which was E. 
 The diet was the same as before and at the beginning of the 5 -day water 
 period the nitrogen balance was as follows : 
 
 Nitrogen in feces i . 957 
 
 Nitrogen in urine 12 .775 
 
 Nitrogen in excreta 14 . 732 
 
 Nitrogen in food 14. 761 
 
 + 0.029 
 
 Discussion of Data on Subject E, Table V. Although both carbohydrate 
 and fat data (discussed in other places) show differences that signify an 
 increased utilization of these foodstuffs during the ingestion of one and 
 one-third liters of water additional with each meal, a comparison of the 
 data on the excretion of nitrogen in its various forms during the three 
 periods of this experiment allows no positive conclusions to be drawn. 
 The differences are too small to be significant. A negative conclusion, 
 however, is entirely justifiable, when it is seen that the absorption of 
 over four liters of water during the day, and most of this taken during 
 the meals, had no untoward effect upon the digestion and absorption 
 of the food. The probable reason for the fact that no change in the direc- 
 tion of better digestion could be noticed is that Subject E habitually 
 took considerable amounts of water with his meals, and the experimental 
 conditions were thus little different from the usual regime. 
 
STUDIES ON WATER DRINKING. IX. 
 
 39 
 
 > t-J 
 
 
 J> Hj 
 
 
 
 > H 
 
 
 
 
 II 
 1- 
 
 Final period 
 3 days. 
 
 < S- 
 . 
 
 Water period. 
 5 days. 
 
 P 
 
 Prel. period. 
 6 days. 
 
 M 
 
 M M M 
 
 HI HI 
 
 HI HI 
 
 
 
 
 
 
 
 O\ Cn 4* 
 
 . rt Co to 
 
 HI O V0 
 
 oo 
 
 P M ON 
 
 Cn 4* Co 
 
 f* !" 
 
 
 
 
 
 
 
 
 
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 8 
 
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 0.2 per cent. 
 
 ~ 
 
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 o o 
 
 
 
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40 STUDIES ON WATER DRINKING. IX. 
 
 General Discussion. 
 
 The general conclusion from all these findings is that during water in- 
 gestion with meals there is a better digestion and a more complete util- 
 ization of the protein food and that this effect is much less marked with a 
 small water ingestion than with a large one. It is also more or less per- 
 manent, with the result that in an individual accustomed to taking con- 
 siderable water with meals the effects of decreasing or increasing the vol- 
 ume ingested are not immediately obvious. 
 
 There is one objection to the conclusion that this is caused by water 
 drinking. It has frequently been observed in experiments on men that 
 the prolonged administration of a given diet causes the enzyme content 
 of the digestive juices so to change as to be best adapted to digesting 
 the food. It might be argued, therefore, that although the food was as 
 well digested during the latter part of these experiments as in the be- 
 ginning, this was a result of adaptation which counteracted the unde- 
 sirable effects of water drinking. A comparison of the data of the final 
 periods with those of the water periods is sufficient to show that the with- 
 drawal of water was accompanied by a pronounced change in favor of 
 the water drinking, or by no appreciable change in digestibility and util- 
 ization. 
 
 Any supposed effect of adaptation is also counterbalanced by the 
 effect of loss of appetite due to the monotony of the diet. Ixmdon and 
 Pevsner 15 found that in dogs the stomach contents were more rapidly 
 passed on to the duodenum when the factor of appetite was present than 
 when it was absent. They conclude that the larger amount of secretion, 
 that is, the appetite juice, was the cause. If there is any increased effi- 
 ciency in "appetite" juice over the ordinary secretion in man then the 
 digestive power of all the juices is at least not increased by the factor 
 of appetite after partaking of over one hundred meals that were abso- 
 lutely uniform in the kind and quantity of food they contained. 
 
 Evidence has been adduced in another place to show that the action 
 of water is not such as to cause undigested food particles to be washed 
 through the pylorus prematurely, and thereby place a more than pro- 
 portionate burden upon the lower digestive tract. That a premature 
 opening of the pylorus, resulting hi a shortening of gastric digestion, 
 is uneconomical, has been shown by Cohnheim. 16 The importance of 
 the stomach in protein digestion is not clear despite extensive experi- 
 mentation bestowed upon the subject. 
 
 London and Polovzova 17 ' 18 found that with but few exceptions proteins 
 are not absorbed in the stomach, but that with few exceptions most pro- 
 teins are made soluble in the stomach to about 78 per cent., the ratio be- 
 tween proteoses, peptones and residual substances being 59.3, 32.9, 7.8. 
 The soluble products of gastric digestion are quickly attacked by the in- 
 testinal juices. Examination of stomach contents 19 reveals the fact 
 that peptones, peptides and amino acids may be absorbed; while it is 
 
STUDIES ON WATER DRINKING. IX. 4! 
 
 shown that the enzymes of the stomach have the ability completely to 
 hydrolyze proteins to these end-products, yet it is also shown that the 
 length of time which pepsin requires to bring this about is far in excess 
 of the time in which protein remains in the stomach. 
 
 The importance of the stomach in protein assimilation has been em- 
 phasized recently by Carrel, Meyer and Levene, 20 who showed that after 
 removal of the larger part of the small intestin, although the absorption 
 of ingested protein is diminished, the rate of assimilation and retention of 
 the absorbed protein follows the same course as in normal animals. They 
 conclude that the stomach and not the intestin is the most important 
 organ for protein assimilation. London and Dmitriev 21 showed that the 
 removal of the small intestin in a dog results in the death of the animal 
 in about five weeks. Ordinarily, if as much as seven-eighths of the small 
 intestin is removed, carbohydrate and especially protein assimilation 
 rapidly return to normal but not so with the assimilation of fat. Some- 
 what similar results have been obtained by Underbill. 22 After resection 
 of 80 per cent, of the small intestin Axhausen 23 found that the absorp- 
 tion of protein as well as of fat was very much lower than normal. Re- 
 sults obtained after experimental removal of various portions of the ali- 
 mentary tract are always subjected to this correction that the different 
 organs may change their function and character in the direction of com- 
 pensation. Thus, after gastrectomy in dogs, Carrel, Meyer and Levene 24 
 observed a high nitrogen retention which disappeared in ten to twelve 
 weeks after the operation. The explanation suggested is that the pan- 
 creatic and intestinal secretions that are minimal immediately after 
 gastrectomy return to normal at a later period and protein is again fully 
 digested before absorption. They also note a hypertrophy of the upper 
 end of the duodenum after gastrectomy. 
 
 Since the presence of water along with food in the stomach is hardly of 
 long enough duration to affect either the food or the mucous membrane, 
 the changes for the better digestion and utilization of the protein ma- 
 terial that have been observed must take place principally in the intes- 
 tin. Some experimental work has been done on the absorption of pro- 
 teins by living membranes. Zunz 25 in experiments on dogs upon protein 
 digestion and absorption in the stomach and small intestin in situ has 
 shown that the osmotic pressure of the solutions of protein introduced 
 scarcely changes in the stomach when this is tied off, but in the small 
 intestin it tends toward that of the blood and usually becomes lower 
 than this. Surface tension is lower than that of the blood in both the 
 stomach and intestin. With low proteose content the surface tension 
 decreases in both regions. In the intestin, Zunz concludes, the digestive 
 processes tend to bring the concentration, osmotic pressure and surface 
 tension of the contents to the optimum for absorption. The organism 
 itself seems to strive to secure a dilution of the products of digestion 
 such that they can be most readily and completely absorbed. 
 
42 STUDIES ON WATER DRINKING. IX. 
 
 The phenomena of absorption still lack a unifying physical explanation ; 
 in fact, each investigation seems to disclose new and unknown factors. 
 Filtration, osmosis, the selective action of membranes and the nature 
 and behavior of colloids are some of the important factors, upon an un- 
 derstanding of which the solution of the many problems depends. 
 
 Conclusions. 
 
 Without attempting to suggest any further explanations than those 
 given at the end of the preceding paper, it may be said that the ingestion 
 of large amounts (1000 cc.) of water with meals caused the protein con- 
 stituents of the food to be more completely utilized, as shown by a de- 
 crease in all forms of nitrogen in the feces, including bacterial, 0.2 per 
 cent, hydrochloric-acid-soluble, acid-alcoholic extractive, and residue 
 nitrogen. 
 
 When 500 cc. of water were taken with meals no significant changes in 
 protein utilization could be observed, as there were in fat and carbohy- 
 drate; the protein data do, however, admit of the negative conclusion, 
 that absolutely no undesirable effects were to be observed as a result of 
 the ingestion of 500 cc. of water with the meals. Even when over four 
 liters of water were taken daily, with the meals, there was no indication 
 of untoward effects as a result. 
 
 As before, the beneficial results of water ingestion with meals were 
 not transitory, but were more or less permanent, extending beyond the 
 time of the experimental period. 
 
 REFERENCES. 
 
 i. Bischoff and Voit, "Die Ernahrung des Fleischfressers," p. 291. 2. Voit, "Bei- 
 trage zur Frage der Sekretion und Resorption im Diinndarm," Z. Biol., 29, 325- 
 97 (1892). 3. Prausnitz, "Die Chemische Zusammensetzung des Kotes bei ver- 
 schiedenartiger Ernahrung," Z. Biol., 35, 335-54 (1897). 4. Schierbeck, "Die chem- 
 ische Zusammensetzung des Kotes bei verschiedener Nahrung," Arch. Hyg., 51, 
 62-5 (1904). 5. Rubner, Z. BioL, 15, 115 (1879). 6. Strasburger, " Baktereinmenge 
 in menschlichen Faces," Z. klin. Med., 46, 413-44 (1902). 7. MacNeal, Latzer and 
 Kerr, "The Fecal Bacteria of Healthy Men," /. Inf. Dis., 6, 123-69 (1909). 8. 
 Mattill and Hawk, /. Exp. Med., 14, 433 (1911). 9. Schottelius, Arch. Hyg., 34, 
 210 (1898); Ibid., 42, 48 (1902). 10. Nuttall and Thierfelder, Z. physiol. Chem., 
 21, 109 (1895); Ibid', 22, 62 (1896). n. Schottelius, Arch. Hyg., 67, 177-208 (1908). 
 12. Ruzicka, Arch. Hyg., 45, 409-16 (1902). 13. Fowler and Hawk, /. Exp. Med., 
 12, 388-410 (1910). 14. Zaitschek, "Methodik der Bestimmung des Stickstoff- und 
 Eiweiss- gehaltes der Faces," Arch. ges. Physiol. (Pfliiger), 98, 595-613 (1903). 140. 
 Emmett and Grindley, Jour. Am. Chem. Soc., 31, 569 (1909). 146. Howe, Rutherford and 
 Hawk, Jour. Am. Chem. Soc., 32, 1683 (1910). 15. London and Pevsner, Z. physiol. Chem., 
 56, 384-7 (1908). 16. Cohnheim, Munch, med. Wochschr., 54, 2851 (1907). 17. Lon- 
 don and Polo vzova, Z. physiol. Chem., 49, 328-96 (1906). 18. Id., Ibid., 57, 113-30 
 (1908). 19. Zunz, Beitr. chem. Physiol. u. Path., 3, 339 (1903). 20. Carrel, Meyer 
 and Levene, Am. J. Physiol., 25, 439-55 (1910). 21. London and Dmitriev, Z. 
 physiol. Chem., 65, 213-18 (1910). 22. Underhill, Am. J. Physiol., 27, 366-82 (1911). 
 
 23. Axhausen, Grenzgeb. Med. Chir., 21, 55 (1910); through Biochem. Centr., 9, 639. 
 
 24. Carrel, Meyer and Levene, Am. J. Physiol., 26, 369-79 (1910). 25. Zunz, Mem. 
 couronn. et autr. mem. publ. par I'Acad. roy de medec. de belgique, 20, fasc. i ; through 
 T ahresb. TiercJiem., 38, 407 (1908). 
 
STUDIES ON WATER DRINKING: X. FECAL OUTPUT AND ITS 
 
 CARBOHYDRATE CONTENT UNDER THE INFLUENCE OF 
 
 COPIOUS AND MODERATE WATER DRINKING 
 
 WITH MEALS. 
 
 BY H. A. MATTILL. 
 
 Introduction. 
 
 It has been said that the amount of feces, as well as its nitrogen content, 
 depends entirely upon the cellulose content of the food materials, the 
 first being the result of the inability of the organism to digest cellulose, 
 the second being due to the increased desquamation of intestinal 
 epithelium as a result of heightened peristalsis and to an accompanying 
 increase in the amount of digestive fluids secreted. 
 
 Aside from possible traces of the less common complex carbohydrates, 
 the only carbohydrates ever present in normal feces under ordinary 
 conditions are cellulose and starch. It has been shown by Lusk 1 that the 
 decomposition of cellulose does not result in the formation of glucose, 
 and its nutritive value is probably in the fatty acids formed from it. 
 In a study of the digestibility of carbohydrate, therefore, a consideration 
 of the possible digestion of cellulose is unnecessary. 
 
 The source of starch in the feces is ingested vegetable food, the cellulose 
 envelopes of which, as a result of insufficient disintegration, have not 
 become accessible to the action of the digestive juices. The manner of 
 preparing the food has much to do with the extent of this disintegration ; 
 the efficiency of the mastication also plays a part, and the activity of the 
 digestive juices and the extent of the churning to which the food is sub- 
 jected in the intestin also have an influence. All other conditions re- 
 maining the same, the amount of carbohydrate found in the feces should 
 furnish some indication as to the digestibility of carbohydrate in the 
 organism, as well as to the extent of cellular disintegration by which 
 it has become available. In the series of observations reported in the 
 preceding papers on the utilization of protein and fat under the conditions 
 of water drinking with meals attention was also paid to the comparative 
 amounts of fecal dry matter and moisture, and to the utilization of carbo- 
 hydrate, although the diet consisted of almost completely available food 
 and contained little cellulose. 
 
 The early experiment of Ruzicka 2 previously referred to included certain 
 data upon total fecal excretion. During the first 2 -day period (no water 
 with meals) the total fecal dry matter was 46.2 grams against 42.0 grams 
 
44 STUDIES ON WATER DRINKING. X. 
 
 in the second 2-day period when water was taken with meals. The 
 total dry matter ingested during the first (no water) period was 783.3 
 grams, while the dry matter ingested in the second period was 842.5 
 grams. The carbohydrate intake and excretion (obtained by difference) 
 for the two periods were as follows: 
 
 period Second period 
 
 (no water). (water). 
 
 Grams. Grams. 
 
 Ingesta ................ 357.4 384.4 
 
 Excreta ................ 6.9 6.3 
 
 It is thus seen that the ingestion both of total dry matter and of carbo- 
 hydrate was larger in the water period than in the period when no water 
 was taken with the meals, while the excretion both of total dry matter 
 and of carbohydrate was smaller when water was taken with meals than 
 when none was taken. The diet was one of bread and meat, and analyses 
 are given which show that the feces were of relatively the same com- 
 position in both periods, 100 grams of the dry substance yielding 14.9 
 and 15.0 grams, respectively, of carbohydrate. 
 
 In the investigation of Fowler and Hawk 3 referred to in the previous 
 paper the elimination of fecal dry matter and moisture during the period 
 of water ingestion with meals was much less than during either the fore 
 or after period. No data were obtained on carbohydrate utilization. 
 
 Methods. In the paper on fat utilization will be found a description 
 of the method of collecting and preparing the sample. Moisture. Mois- 
 ture was determined, during one experiment, in porcelain crucibles, 
 during a second in lead caps. The latter method is much more satis- 
 factory. The samples were first air-dried for two or three days, and then 
 in an oven at 102, for two or three days. 
 
 Carbohydrate. Carbohydrate was determined by a modification of the 
 method of Strasburger. 4 The procedure was as follows: Five to 10 
 grams of feces were weighed out into a 200 cc. Erlenmeyer flask, and 5-7 
 grams of bone-black were added along with 100 cc. of 2 per cent, hydro- 
 chloric acid. This mixture was boiled for one and one-half to two hours 
 under a reflux condenser, allowed to cool, made alkaline with sodium 
 hydroxide to precipitate calcium salts and filtered with suction. 
 Ordinarily this took considerable time. The filtrate was clear and varied 
 in color from a dark straw to entire absence of color. This solution was 
 approximately neutralized and its reducing power was determined in an 
 aliquot portion by the method of Benedict. 6 The procedure of Stras- 
 burger involves the determination of sugar by the copper thiocyanate 
 method of Volhard-Pfliiger, and the time and labor required in this method 
 
STUDIES ON WATER DRINKING. X. 45 
 
 are considerably greater than for the method used in these experiments. 
 In most cases, also, satisfactory duplicates were obtained. The solu- 
 tions as prepared for the determination could never be allowed to stand 
 any length of time with neutral or slightly alkaline reaction as the de- 
 velopment of molds brought about decompositions and destruction of 
 sugar. When they were left standing they were always acidified. 
 
 Experiments on Copious Water Drinking with Meals. 
 
 The routine of the experiment on Subjects H and W has been de- 
 scribed in a preceding paper. The diet of both men contained carbohy- 
 drate as follows: 
 
 Amount (per meal). Carbohydrate. 
 
 Graham crackers 150 .o grams 108 . 8 grams 
 
 Peanut butter 20.0 3.2 
 
 Milk 450.0 (cc.) 25 .7 
 
 Butter (carbohydrate negligible) 25.0 
 
 Total, 137.7 
 For water ingestion see paper on fat utilization. 
 
 Discussion of Data from Subject W, Table I. The average amount of 
 feces passed per day during the preliminary period was 177.8 grams, 
 during the water period 119.3 grams, and during the final period 121.1 
 
 TABLE I. SUBJECT W. 
 
 Prel. period. 3 days 
 
 Total 533.5 138.1 395-4 7-5^5 
 
 Average (per day) 177.8 25.9 46.0 131.8 2.52 
 
 5 214.0 13.17 28.2 185.8 2.09 
 
 6 25.2 23.24 5.9 19.3 0.26 
 
 Number 
 of 
 stool. 
 
 j 
 
 Weight. 
 Grams. 
 
 14.7 O 
 
 Per cent, 
 dry 
 matter. 
 
 27 W 
 
 Amount 
 dry 
 matter. 
 Grams. 
 
 4.0 2 
 
 Amount 
 moisture. 
 Grams. 
 
 106.8 
 
 Car. 
 
 drate 
 Grams. 
 
 I -QSS 
 
 2 
 
 182 >; 
 
 2* 86 
 
 4.7 2 
 
 I?C -1 
 
 2 .71 
 
 
 66.0 
 
 27 . 21 
 
 18.0 
 
 4.8.O 
 
 1. 12 
 
 4 
 
 1^8 o 
 
 27 6? 
 
 ^2 7 
 
 IOS ."? 
 
 1.78 
 
 
 
 
 
 
 
 Water period. 5 days 
 
 7 94-0 27.34 25.7 68.3 1.51 
 
 8 102.8 28.85 2 9-7 73- 1 I -S 6 
 
 9 121.5 26.05 3i-6 89.9 1.87 
 
 10 39.0 29.83 n. 6 27.4 0.47 
 
 Total 596.5 ... 132.7 463.8 7.76 
 
 Average (per day) 119 .3 22.2 26.5 92.8 1.55 
 
 ii 104.5 25.48 26.6 77.9 1.40 
 
 Final period. 3 days 
 
 12 134.0 25.83 34-6 99-4 2.09 
 
 13 26.9 31.85 8.6 18.3 0.38 
 
 14 98.0 26.10 25.6 72.4 1.55 
 
 Total 363.4 95-4 268.0 5.42 
 
 Average (per day) 121.1 26.3 31-8 89.3 1.81 
 
46 STUDIES ON WATER DRINKING. X. 
 
 grams. A similar variation is observed in the fecal dry matter which de- 
 creases from 46 grams per day in the preliminary to 26.5 grams in the water 
 period and again rizes in the final to 31.8 grams. The average daily 
 amount of water in the feces of the preliminary period was 131.8 grams, 
 in the water period 92.8 grams and in the final period 89.3 grams. Not- 
 withstanding the large amount of water passed into the intestin during 
 the water period, there was less in the feces during that time than before; 
 the amount of water excreted in the feces in the final period was slightly 
 less than the amount in the water period. The total amount of feces 
 and of dry matter for the final period were only slightly higher than 
 those of the water period and not nearly as high as those of the prelim- 
 inary. 
 
 Digestion and Absorption of Carbohydrate. The average daily excre- 
 tion of carbohydrate during the preliminary period was 2.52 grams, 
 during the water period 1.55 grams, and during the final period 1.81 
 grams. It appears that the effect of the large amount of water was to 
 secure a better digestion and more complete utilization of the ingested 
 carbohydrate, and the influence of the water extended beyond the time 
 in which it was used. 
 
 The amount of carbohydrate in Stool No. 5, the first of the water 
 period is 2.09 grams, the largest amount during any day of the period. 
 This is the more striking since the entire stool contained only 28.2 grams 
 solid matter, of which 5.8 grams were fat. The total nitrogen was also 
 above the average, and the bacterial and extractive or acid-alcohol- 
 soluble portions were unusually low. All of these facts indicate in- 
 complete digestion of the food. Stool No. 5 was passed immediately 
 after breakfast on the morning of the second day of water. Before 
 breakfast Stool No. 4 had been passed; this contained none of the char- 
 coal that had been taken before breakfast on the morning of the day 
 before, the first day of the water. Charcoal was found in No. 5. W 
 records a feeling of pressure on the first day of water as well as on the 
 second, but on the second it seemed to increase. Stool No. 5 gives evi- 
 dence from its high content of water and of foodstuffs that it was forced 
 out before the time necessary for satisfactory digestion and absorption. 
 Notwithstanding that this, the first stool of the water period contained 
 undigested protein, fat and carbohydrate, nevertheless an examination 
 of the data shows that the average daily output of those substances was 
 markedly lowered under the influence of water ingestion. 
 
 Discussion of Data from Subject H, Table II. The average daily amount 
 of feces passed during the water period was less than that in either pre- 
 liminary or final periods. The average amount in the period after the 
 water is less than that in the period before the water. The average daily 
 dry matter suffered a similar drop during the water period. The amount 
 
STUDIES ON WATER DRINKING. X. 
 
 47 
 
 of water in the feces during the water period was also less than during the 
 preliminary or final periods showing that even with the large amounts 
 of water sent into the intestin the amount absorbed was actually more 
 than the excess administered. 
 
 TABLE II. SUBJECT H. 
 
 Number 
 of stool. 
 
 Weight. 
 Grams. 
 
 Prel. period. 3 days < 
 
 1 42.5 
 
 2 87.0 
 
 3 158.0 
 
 4 104.0 
 
 Per cent. 
 
 dry 
 matter. 
 
 29.42 
 26.54 
 26.57 
 26.21 
 
 Amount Car- 
 dry Amount bohy- 
 matter. moisture. drate. 
 Grams. Grams. Grams. 
 
 Average (per day). 
 
 
 oy* '3 
 I-JQ 5 
 
 26 8 
 
 
 
 CA.O 
 
 17 71 
 
 
 6 . 
 
 8l 7 
 
 27 OS 
 
 Water period 5 days 
 
 
 A*! Q 
 
 31 68 
 
 
 8 
 
 26Q. S 
 
 24. fl 
 
 
 
 141 o 
 
 22 OO 
 
 
 
 
 
 Total 
 
 
 580.2 
 
 
 Average (per dav) 
 
 
 117. 8 
 
 24.. 2 
 
 
 10 
 
 .... IOI .O 
 
 27.QO 
 
 
 ii 
 
 2C c 
 
 j-7 4.0 
 
 Final period. 3 days 
 
 12 
 
 112 O 
 
 27 QO 
 
 
 I -I. . 
 
 I4.I . 5 
 
 25 ,Q2 
 
 Total 
 
 
 380 o 
 
 
 Averaee Coer dav). 
 
 
 126.7 
 
 26.2 
 
 12-5 
 
 30.0 
 
 0-57 
 
 23.1 
 
 63-9 
 
 1.20 
 
 42.0 
 
 116.0 
 
 2.37 
 
 27-3 
 
 76.7 
 
 1. 80 
 
 104.9 
 
 286.6 
 
 5-94 
 
 35-0 
 
 95-5 
 
 1.98 
 
 9.6 
 
 44.4 
 
 0.66 
 
 22.8 
 
 58.9 
 
 1-45 
 
 13-6 
 
 29.4 
 
 0.82 
 
 65.6 
 
 203.9 
 
 3-89 
 
 31.0 
 
 IIO.O 
 
 1.87 
 
 142.6 
 
 446.6 
 
 8.69 
 
 28.5 
 
 89.3 
 
 1.74 
 
 24.1 
 
 76.9 
 
 i. 06 
 
 8-5 
 
 17.0 
 
 0-37 
 
 31-3 
 
 80.7 
 
 1.71 
 
 36.7 
 
 104.8 
 
 1.92 
 
 100.6 
 
 279.4 
 
 5.06 
 
 33-5 
 
 93-1 
 
 1.69 
 
 Carbohydrate. The data from the carbohydrate determinations are 
 not as striking as those from Subject W but the variations are in the same 
 direction. The average daily excretion during the preliminary period, i .98 
 grams, fell to 1.74 grams during the water period, and was still less, 1.69 
 grams per day, in the final period. 
 
 Summary. The findings obtained in this experiment show that during 
 the period when large amounts of water were taken with meals the total 
 amounts of feces, of fecal dry matter and of fecal moisture were less than 
 without the unusual amounts of water, and that a more or less permanently 
 better utilization of carbohydrate accompanied the water drinking. 
 
 Experiments on Moderate Water Drinking. 
 
 Before considering the data obtained in the experiment on moderate 
 water drinking a word of explanation should be given regarding Sub- 
 
48 STUDIES ON WATER DRINKING. X. 
 
 ject E. During the preceding year while he was serving as subject on 
 another metabolism experiment and was on a uniform diet a pronounced 
 intestinal fermentation made itself evident by a stool of high moisture 
 content. Although he was subject to a condition of this kind even on an 
 ordinary mixed diet he made no mention of this and was therefore accepted 
 for the present metabolism study. The condition was one apparently 
 peculiar to the organism and was not dependent upon such external 
 conditions as could easily be determined and controlled. Subject W 
 had served in the preceding experiment. 
 
 The diets of the two men were alike in composition but differed slightly 
 in quantity. 
 
 SUBJECT W. 
 
 Amount 
 (per meal). Carbohydrate. 
 
 Graham crackers 125 grams 90.6 grams 
 
 Peanut butter 20 3.2 
 
 Milk 400 (cc.) 22.8 
 
 Butter (carbohydrate negligible) 25 
 
 Total, 116.6 
 SUBJECT E. 
 
 Amount. Carbohydrate. 
 
 Graham crackers 150 grams 108 . 8 grams 
 
 Peanut butter 20 3.2 
 
 Milk 400 (cc.) 22.8 
 
 Butter (carbohydrate negligible) 25 
 
 Total, 134.8 
 For water ingestion see paper on fat utilization. 
 
 In addition to the weights of feces, dry matter and moisture, the values 
 for the daily excretion of dry bacteria are also given ; the values have been 
 calculated from the bacterial nitrogen values on the basis of a nitrogen 
 content of dry bacteria equal to 10.96 per cent.; this is more fully ex- 
 plained by us in a recent paper on the method for determining bacterial 
 nitrogen.* 
 
 Discussion of Data from Subject W, Table III. The separation of the 
 preliminary period of low water ingestion into two parts showed a con- 
 dition for carbohydrate and for total fecal output similar to that noted 
 for fat and protein. The average amount of feces passed per day during 
 the first part of this period was 89.0 grams, as against 104.6 grams in the 
 second. The average daily dry matter content during the first part of 
 this period was 23.9 grams as against 27.3 grams during the second part. 
 The differences are small but not inconsiderable. Carbohydrate also 
 shows an increase from 2.15 grams per day in the first part to 2.31 grams 
 in the second. Comparing this preliminary period with that of the first 
 experiment, the average daily amount of feces in the first experiment was 
 * Mattill and Hawk: J. Exp. Med., 14, 433 (1911). 
 
STUDIES ON WATER DRINKING. X. 
 
 49 
 
 TABLE III. SUBJECT W. 
 
 Number 
 of stool. 
 
 Amount 
 Per cent, dry 
 Weight. dry matter. 
 Grams, matter Grams. 
 
 Prel. period I. 7 days ' 
 
 155-5 
 39-2 
 63-7 
 72.0 
 
 201.8 
 
 90.9 
 
 Total 623 . i 
 
 Average (per day) . 
 
 Prel. period II. 6 days 
 
 7- 
 8. 
 
 9- 
 10. 
 n. 
 
 12. 
 13- 
 
 89.0 
 
 62.8 
 
 98.8 
 
 109.8 
 
 185.8 
 
 4 1.8 
 
 104.9 
 
 25.94 
 31-57 
 27.78 
 28.92 
 27.04 
 23-50 
 
 26.85 
 25.61 
 26.72 
 
 27.50 
 
 24.10 
 
 31.23 
 24.28 
 
 40-3 
 12.4 
 17.7 
 20.8 
 
 54.6 
 21.4 
 
 167.2 
 
 23.9 
 
 16.1 
 26.4 
 30-2 
 44-8 
 i3-i 
 25.5 
 
 24.0 32.87 7.9 
 
 Total 627.9 
 
 Average (per day) 104.6 
 
 31-6 
 H7.5 
 
 Water period . 10 days 
 
 15- 
 
 16. 
 
 17- 
 18. 
 19. 
 20. 
 
 21. 
 
 22. 
 23- 
 
 75-4 
 144.8 
 
 63-9 
 ii5-5 
 
 26.0 
 169.0 
 127.0 
 152-7 
 
 26.10 
 
 23.90 
 
 27.52 
 
 26.20 
 
 27.45 
 26.84 
 
 27.10 
 
 27.49 
 26.52 
 
 24.35 
 
 23.26 
 
 164.0 
 27-3 
 7-6 
 40.6 
 19.8 
 39-8 
 17.2 
 
 31-3 
 7.2 
 
 44.8 
 30.9 
 35-5 
 
 Total 1053.4 
 
 Bacterial Car- 
 Amount dry bohy- 
 moisture. substance, drate 
 Grams. Grams. Grams. 
 
 115.2 
 26.8 
 46.0 
 51-2 
 
 147.2 
 
 69.5 
 
 455-9 
 65.1 
 46.7 
 72.4 
 79.6 
 
 141.0 
 28.7 
 79-4 
 16.1 
 
 463.9 
 77-3 
 24.0 
 
 106.9 
 55.6 
 
 105.0 
 46.7 
 84.2 
 18.8 
 
 124.2 
 96.1 
 
 117.2 
 
 4.40 
 6.32 
 7.21 
 10.10 
 2.62 
 5.38 
 1.78 
 
 37.80 
 6.30 
 1.82 
 8.98 
 
 5.13 
 9.92 
 4.02 
 
 7-97 
 1.81 
 11.84 
 8.04 
 9.08 
 
 26. 
 
 1.14 
 1.92 
 1.89 
 
 5-22 
 1.74 
 
 I5-07 
 2-15 
 1-52 
 2.08 
 3.05 
 3.58 
 1.03 
 2.15 
 0.45 
 
 13-86 
 
 2.31 
 0.25 
 2.25 
 
 20 
 
 60 
 
 37 
 
 2-51 
 0.56 
 4.60 
 2-93 
 3-54 
 
 274.7 778.7 68.60 21.81 
 
 Average (per day) 105.3 26.12 27.5 77.8 6.86 2.18 
 
 Final period. 5 days < 
 
 Total 508.2 
 
 Average (per day) 101 .6 25 .90 
 
 177.8 grams as against 89.0 in the second; dry matter 46.0 grams in the 
 first as against 23.9 in the second; carbohydrate 2.52 grams in the first 
 as against 2.15 in the second. 
 
 Carbohydrate. An examination of the data upon carbohydrate excre- 
 
STUDIES ON WATER DRINKING. X. 
 
 tion during the ten-day water period reveals differences that are small 
 but nevertheless in the same direction as noted in the experiment on 
 copious water drinking. The daily average excretion in the preliminary 
 period, 2.31 grams, fell to 2.18 grams in the water period, and was still 
 lower, to 2.07 grams, in the final period. 
 
 Discussion of Data from Subject E, Table IV. The findings upon the 
 fecal output of Subject E during the three periods of this experiment 
 show variations so small that they admit of no conclusions. 
 
 TABLE IV. SUBJECT E. 
 
 ] 
 
 Dumber 
 of 
 stool. 
 
 I 
 
 2 
 
 ] 
 Weight. 
 
 Grams. 
 
 88.4 
 1O 2 
 
 J er cent, 
 dry 
 matter. 
 
 20. 8l 
 26.56 
 
 
 7 . 
 
 I7Q 2 
 
 27 OI 
 
 
 
 TQ7 Q 
 
 24. 67 
 
 Prel. period. 7 days ' 
 
 c . 
 
 76 o 
 
 26 17 
 
 
 6 . . 
 
 2O7 7 
 
 22 78 
 
 
 
 124 6 
 
 22 3O 
 
 
 8 
 
 4-4- O 
 
 20 4.2 
 
 
 
 
 
 Total 
 
 
 Q4.4. O 
 
 
 Average (per dav) 
 
 
 
 21 7O 
 
 
 
 76 c. 
 
 22 87 
 
 
 9. 
 10 
 
 I4.O Q 
 
 20 88 
 
 
 ii 
 
 63 8 
 
 20. 16 
 
 
 12 . . 
 
 1 60 o 
 
 24. 1O 
 
 
 11 
 
 24.7 ^ 
 
 IQ IQ 
 
 Water period. lodays' 
 
 14.. . 
 
 ITS V 
 
 22 .06 
 
 
 15 
 16 
 
 192.4 
 7Q 2 
 
 I9.58 
 
 24. ^8 
 
 
 
 CC Q 
 
 27 . 17 
 
 
 18 
 
 17-7 c 
 
 24. QI 
 
 
 IQ. . 
 
 
 27 .08 
 
 
 
 
 
 Total 
 
 Average (per day) 
 
 
 
 1385.5 
 
 118 6 
 
 22 T\ 
 
 
 2O 
 21 .... 
 
 67.3 
 
 117. 8 
 
 23.60 
 26.08 
 
 Final period 4 days 
 
 22 
 
 14.7 7 
 
 27 IQ 
 
 
 23 
 24. . 
 
 145-9 
 ^1 . 2 
 
 26-49 
 71 CC 
 
 
 
 
 
 Total 
 
 
 SOQ .Q 
 
 
 Averaee (oer dav} . . 
 
 
 127.5 
 
 2^.74. 
 
 18.4 
 
 70.0 
 
 
 2.48 
 
 8.0 
 
 22.2 
 
 . . . 
 
 1.18 
 
 41.2 
 
 138.0 
 
 
 4-98 
 
 47.8 
 
 146.1 
 
 . . . 
 
 7.21 
 
 20.1 
 
 56.8 
 
 
 2-37 
 
 47-3 
 
 160.4 
 
 
 5-31 
 
 27.8 
 
 96.8 
 
 
 3.49 
 
 12.9 
 
 3I-I 
 
 
 1.38 
 
 223.7 
 
 721.2 
 
 
 28.40 
 
 32.0 
 
 103.0 
 
 
 4.06 
 
 17-5 
 
 59-o 
 
 4.89 
 
 2.48 
 
 29.4 
 
 111.5 
 
 9.90 
 
 4-47 
 
 18.6 
 
 45-2 
 
 6.25 
 
 i-55 
 
 41.1 
 
 127.9 
 
 12.52 
 
 4.04 
 
 47-5 
 
 200. o 
 
 13-17 
 
 4.80 
 
 3I-I 
 
 104.2 
 
 9-29 
 
 3-33 
 
 37-7 
 
 154-7 
 
 9.88 
 
 4.18 
 
 19-5 
 
 59-7 
 
 4-77 
 
 i-33 
 
 15-2 
 
 40.7 
 
 3-88 
 
 1.48 
 
 43-2 
 
 130.3 
 
 12.25 
 
 3-68 
 
 14.4 
 
 37-i 
 
 4.06 
 
 1.17 
 
 315-2 
 
 1070.3 
 
 90.85 
 
 32-51 
 
 3i-5 
 
 107. i 
 
 9.09 
 
 3-25 
 
 15-9 
 
 5i-4 
 
 3.88 
 
 1.42 
 
 30.7 
 
 87.1 
 
 9.26 
 
 2.76 
 
 34-3 
 
 II3-4 
 
 9-74 
 
 3.46 
 
 38.7 
 
 106.2 
 
 11-34 
 
 4-53 
 
 9.8 
 
 21.4 
 
 1.78 
 
 0.81 
 
 129.4 
 
 380.5 
 
 36.0 
 
 12.98 
 
 32.3 
 
 95-2 
 
 9.0 
 
 3-25 
 
 Carbohydrate. The average daily excretion of carbohydrate dropped 
 from 4.06 grams to 3.25 grams during the water period, and stayed at 
 
STUDIES ON WATER DRINKING. X. 
 
 the same value in the final. This is a small difference to be significant 
 but on a uniform diet the evidence is creditable; it points to the same 
 conclusion for moderate water drinking that has been reached up to this 
 time for copious water drinking. 
 
 On the basis of these data it appears that the effect of a moderate 
 amount of water with meals is in the same direction as when large amounts 
 are used, although the differences observed are much smaller and not as 
 uniformly found as with the copious amounts of water. Absolutely 
 no harmful results could be detected. 
 
 Copious Water Drinking by an Habitual Water Drinker. 
 
 The experiment of 14 days, during the 5 -day water period of which 
 Subject E took 1333 cc. of water additional with each meal, remains to 
 be considered. 
 
 TABI,E V. SUBJECT E. 
 
 Amount Bacterial Car- 
 
 Amount dry bohy 
 
 moisture, substance, drate 
 Grams. Grams. Grams. 
 
 M 
 c 
 
 Prel. period. 6 days 
 Total 
 
 umber 
 f stool. 
 
 I 
 
 Per cent. 
 Weight. dry 
 Grams, matter. 
 
 35.2 28.88 
 66.0 28.48 
 202.2 24.65 
 129.2 24.89 
 I6I.3 21.43 
 I7I.8 22. 6l 
 34.6 27.24 
 
 dry 
 matter. 
 Grams. 
 
 IO.2 
 
 18.8 
 49.8 
 32.2 
 34-6 
 38.8 
 9-4 
 
 2 
 
 7 
 
 4 
 
 e 
 
 6 ... 
 
 
 
 800.3 
 133.4 
 90.3 
 
 37-2 
 249.4 
 
 74-7 
 258.0 
 52.6 
 
 24.21 
 
 20.15 
 27-33 
 23.57 
 26.57 
 14.81 
 30.23 
 
 193.8 
 32.3 
 18.2 
 
 IO.2 
 
 58.8 
 19.9 
 38.2 
 15.9 
 
 Average (per day) . - 
 
 Water period. 5 days 
 Total 
 
 g 
 
 
 9. . 
 10 . . . . 
 
 1 1 
 
 12 
 
 T-I 
 
 
 762.2 
 152.5 
 
 128.3 
 86.4 
 206.5 
 50.6 
 
 21 . 12 
 
 23.09 
 
 24-34 
 21.56 
 II .06 
 
 161 . i 
 32.2 
 29.6 
 
 21.0 
 
 44-5 
 5-6 
 
 Average (per day) . . 
 
 Final period. 3 days 
 
 Total 
 Average (per day) . 
 
 14. 
 
 je 
 
 16 
 
 17. . 
 
 
 471.8 
 tin. a 
 
 2 I . 36 
 
 100.8 
 33.6 
 
 25.0 
 
 47.2 
 
 152.4 
 
 97.0 
 
 126.7 
 
 133.0 
 25.2 
 
 2.80 
 
 6.32 
 
 15.64 
 
 9.92 
 
 10.99 
 
 11.54 
 3.32 
 
 1.02 
 2.03 
 5-59 
 3.17 
 3-73 
 4-43 
 0.97 
 
 606.5 60.52 20.94 
 
 3-49 
 
 loi.i 10.09 
 
 72.1 
 
 27.0 
 
 I9O.6 
 
 54-8 
 
 219.8 
 
 36.7 
 
 5-83 
 3-33 
 18.61 
 6.01 
 9.86 
 4.81 
 
 2.14 
 i. 06 
 7.72 
 1.52 
 6.42 
 1.23 
 
 60I.I 48.47 20.12 
 
 120.2 
 
 98.7 
 
 65.4 
 
 162.0 
 
 45-o 
 
 371.0 
 123-7 
 
 9.69 
 
 9.50 
 
 7.00 
 
 14.19 
 
 1-45 
 
 32.14 
 10.72 
 
 4.02 
 
 3-07 
 
 1-51 
 3.06 
 
 0-43 
 
 8.07 
 2.69 
 
 Discussion of Data from Subject E, Table V. An examination of the 
 data in Table V shows that the average amount of feces excreted per day 
 was 133.4 grams during the preliminary period, 152.5 grams during the 
 
52 STUDIES ON WATER DRINKING. X. 
 
 water period, and 157.3 grams in the final period. Tkis marked increase 
 during the water and final periods is not evident from the values for dry 
 matter. During the preliminary period this averaged 32.3 grams per 
 day, during the water period 32.2 grams per day, and during the final 
 33-6 grams per day, values which are strikingly uniform. 
 
 The apparent increase in the average daily amount of feces was thus 
 due to water only, and it would seem that the absorption limit of water 
 in the intestin had been reached. While no difficulty was experienced 
 in drinking the large volume of water, the limit for its absorption had 
 been passed. In the case of Subject W in the first experiment there was 
 no evidence of having reached the absorption limit, while some difficulty 
 was at first experienced hi ingesting and disposing of the large quantity 
 of water. This would lead to the conclusion that individuality and 
 dietary habit are important factors. 
 
 Carbohydrate. The average daily excretion of carbohydrate rose from 
 3.49 in the preliminary period to 4.02 in the water period, and fell to 
 2.69 in the final period. Stool No. 12 weighing 258 grams contained 
 6.42 grams of carbohydrate and only 38.2 grams of solid matter; there 
 was pronounced evidence of fermentation. It was passed 15 hours 
 before the usual time and was evidently the result of the intestinal con- 
 ditions previously mentioned, to which B was subject at times. A larger 
 amount of undigested material than was usual might therefore be ex- 
 pected, and its appearance could not be attributed to the effect of the 
 water. The fall in excreted carbohydrate during the final period is 
 marked, and shows rather conclusively that the high daily average out- 
 put during the water period was not due to the fact that water inter- 
 fered with the digestion of ingested carbohydrate but rather that the 
 unusual finding during the water period may logically be explained as 
 above. 
 
 Discussion. 
 
 The findings of decreased fecal output, both dry matter and moisture, 
 and a decreased elimination of carbohydrate during the periods of water 
 drinking indicate a more complete absorption of both water and dis- 
 solved material, with the exceptions noted above. It has been seen, in 
 the preceding papers, that this decreased excretion of solid matter was 
 the result also of a better utilization of the nitrogen (protein) and fat 
 of the diet. 
 
 If drinking water with meals brought about a more rapid emptying of 
 the stomach, the carbohydrates might reasonably be expected to give 
 the first evidence of this fact because of all the foodstuffs carbohydrates 
 are normally the first to leave the stomach and a shortening of the time 
 of their sojourn there might mean incomplete hydrolysis of starch by 
 salivary amylase. In experiments on dogs London and Polovzova 6 
 
STUDIES ON WATER DRINKING. X. 53 
 
 have shown that sucrose and erythrodextrin alone suffer a slight hy- 
 drolysis in the stomach, due not to enzymes but to hydrochloric acid, 
 and that under no conditions are carbohydrates absorbed in the stomach. 
 In the duodenum hydrolytic cleavage is very extensive but absorption 
 does not begin until the upper ileum is reached where the greater portion 
 of carbohydrate is absorbed. The great importance of the duodenal 
 juices in carbohydrate digestion is hereby emphasized. 
 
 This evidence may be of less value because of the fact that the saliva 
 of the dog has at most but a slight amylolytic power. 8a> 66> ** 
 
 In this connection it should also be noted that certain experiments 
 in this laboratory 7 have shown that the production of pancreatic amylase 
 is increased under the influence of water drinking, as would be supposed, 
 and this fact may account in part, for the better utilization of carbo- 
 hydrate. 
 
 As to the absorptive activity of the stomach toward carbohydrates, 
 von Mering 8 concluded from some of his observations that the various 
 sugars could be absorbed in the stomach, absorption being dependent 
 upon the concentration of the solution; that below 5 per cent, glucose 
 was not sensibly absorbed. 
 
 The experiments upon the absorption of carbohydrate solutions of 
 different concentrations in the intestin have been very clear in showing 
 the acceleration of absorption by dilution. In experiments on dogs with 
 intestinal fistulas Kaoru Omi 9 has found that in the absorption of solu- 
 tions of sodium chloride and glucose the percentage of sodium chloride and 
 glucose absorbed depends on the concentration of the solutions introduced 
 and is maximum for isotonic solutions. The absorption of cane sugar is 
 maximum at lower than isotonic concentration. The amount of water 
 absorbed diminishes with increasing concentration of the solute and at 
 slight hypertonicity absorption is checked. 
 
 London and Polovzova 10 have made similar experiments with solu- 
 tions of glucose on dogs with intestinal fistulas and the following are their 
 findings. With increasing concentrations of the glucose solutions intro- 
 duced, absorption of water in the intestin diminishes progressively. 
 With higher concentrations a diluting secretion begins to flow from the 
 wall of the intestin; its amount runs parallel with increasing concentra- 
 tion of the glucose solution, and at its maximum it may amount to one- 
 half the total quantity of blood in the animal. By this dilution and also 
 by absorption of sugar the concentration of the solution is brought down 
 to 6-8 per cent., a dilution at which absorption takes place very readily 
 in the lower intestinal tract. The secretion of the diluting fluid begins 
 with the coming in of the first glucose solution and continues fairly uni- 
 formly. Dilute glucose solutions seem better adapted to absorption than 
 concentrated ones. In the lower portions of the intestinal tract the con- 
 
54 STUDIES ON WATER DRINKING. X. 
 
 centration tends toward a value that is lower than isotonic. The diluting 
 secretion has a small amount of nitrogen (o.i per cent.) and possesses a 
 kinase, so that in part at least it represents an increased intestinal secre- 
 tion. For concentrated solutions absorption seems to take place in two 
 stages: in the proximal portion of the intestin the proper dilution is 
 reached, in the distal portion absorption takes place. The intestinal 
 wall differs from the stomach wall in that the latter does not dilute con- 
 centrated solutions. The absorption of water and of dissolved substances 
 must be considered as two independent and distinct processes, brought 
 about by different factors. The ability to regulate automatically the 
 concentration of substances to be absorbed is believed to be a part of the 
 function of the digestive juices. 
 
 Applying these findings to the experiments on water drinking with 
 meals the explanation for the more complete digestion and absorption 
 of carbohydrates during the period of water ingestion is facilitated. 
 Increased dilution is the effective factor. While it would seem in these 
 experiments that the water taken with a given meal is voided in the 
 urine before the bulk of the food material of that meal has reached the 
 intestin, nevertheless some of the food must be carried along with the 
 water. And further, since absorption is going on more or less contin- 
 uously in the intestin, the water taken with one meal aids in diluting the 
 products of the previous meal which are in the intestin. Not only is 
 enzyme action more complete in dilute solutions but such solutions are 
 also better adapted to absorption. When the solutions to be absorbed 
 are not dilute the organism must first make them so by pouring out a 
 diluting secretion; if they have been made dilute, the organism is spared 
 this task. 
 
 It has been shown by Mosenthal 11 that nitrogen to the amount of about 
 35 per cent, of the food nitrogen of a mixed diet is daily secreted in the 
 succus entericus of dogs, and that of this quantity an amount equal to 
 10 per cent, of the food nitrogen is excreted in the feces and an amount 
 equal to 25 per cent, of the food nitrogen is reabsorbed. The metabolic 
 significance of this reabsorption is not understood, but it is probably of 
 great importance. In cases of defective absorption the amount of fecal 
 nitrogen may easily be increased from this source and thus lead to the 
 drawing of wrong conclusions. It is obvious that for various reasons, 
 this possibility need not be considered in connection with water drinking. 
 
 That secretion and absorption are exothermic in their nature and re- 
 quire energy has frequently been shown and again recently, 12 - 13 and in 
 their first report of observations on the stimulating action of water upon 
 the gastric, mucous membrane, Foster and Lambert 14 suggest that a 
 physiological basis for the objection to copious water drinking with meals 
 may be found in the increased activity to which the glands are thus 
 
STUDIES ON WATER DRINKING. X. 55 
 
 forced. If glandular activity requires as much energy as other forms of 
 activity, this special and excessive secretion may be a form of extrav- 
 agance leading to the weakening and premature death of the cells. In 
 fact, they find that the juice excited by a meal following 5 or 6 hours 
 after a meal with water and its greater demands is less in amount than a 
 normal meal should excite. Whether this is a true gland fatigue, and 
 whether or not such observations point to a premature death of the 
 cells can be determined only by histological examinations. 1 Applying 
 this reasoning to the secretory activity of the intestin a similar form of 
 extravagance may be said to be caused in the intestin by insufficient 
 water ingestion with meals. If there is a loss in energy in the increased 
 flow of gastric juice by water drinking, this is more than compensated 
 by better digestion and absorption of food in the intestin, while the 
 needless energy used in preparing a diluting secretion for food which is 
 too concentrated is a direct loss uncompensated by any subsequent 
 factors making for better utilization of the food. The preservation of 
 the digestive efficiency of the intestin is probably of much greater 
 importance than that of the stomach, since it may be that the main 
 offices of the stomach are not those of a digestive nature. 15 
 
 Conclusions. 
 
 (1) It has been shown that in men living on a uniform diet the addi- 
 tion of 1000 cc. of water to each meal causes a decrease in the excretion 
 of fecal material, both dry matter and moisture. 
 
 (2) Under the same conditions a decrease in excreted carbohydrate 
 material was also observed. 
 
 (3) The better utilization of food material thus evident was not tem- 
 porary but appeared to extend for some time following the use of water. 
 
 (4) The ingestion of a smaller amount of water (500 cc.) and the use 
 of a large volume of water (1333 cc.) by one accustomed to drinking water 
 with meals showed a similar but less marked reduction in the excretion 
 of carbohydrate. 
 
 (5) The individual variations noted emphasize the fact that the find- 
 ings on two or three men possessing different dietary habits and accus- 
 tomed to ingesting varying volumes of water with meals may not be 
 generalized. 
 
 (6) The beneficial effects noted are probably due to the stimulatory 
 action of water upon the digestive secretions, to the increased dilution 
 which facilitates enzyme action and materially aids in absorption, and 
 to a conservation of the intestinal energy involved in the secretion of a 
 diluting fluid which is necessary when insufficient water is ingested. 
 
 (7) The average daily output of dry bacterial substance for the 66 
 stools completely examined was 8.27 grams. 
 
 1 Investigations of this character are contemplated. 
 
56 STUDIES ON WATER DRINKING- X. 
 
 (8) Many desirable and no undesirable effects were obtained by the 
 use of water with meals, and in general, the more water taken the more 
 pronounced were the benefits. 
 
 REFERENCES. 
 
 i. Lusk, Am. J. Physiol., 27, 467-8 (1911). 2. Ruzicka, Arch. Hyg., 45, 409-16 
 (1902). 3. Fowler and Hawk, /. Exp. Med., 12, 388-410 (1910). 4. Strasburger, 
 Die Faces des Menschen, p. 173. 5. Benedict, Jour. Biol. Chem., 3, 101-17 ( I 97)- 6. 
 London and Polovzova, Z. physiol. Chem., 56, 512-44 (1908). 6a. Nielsen and Terry, 
 Am. J. Physiol., 15, 406 (1906). 66. Mendel and Underbill, /. Biol. Chem., 3, 135 
 (1907). 6c. Garrey, Proc. Am. Soc. Biol. Chem., July, 1907. 7. Hawk, Arch. Int. 
 Med., 8, 382 (1911). 8. von Mering, Therap. Monats., 7, 201-4 (1893). 9. Kaoru 
 Omi, Arch. ges. Phys. (Pfluger), 126, 428-52 (1909). 10. London and Polovzova, 
 Z. physiol. Chem., 57, 529-46 (1907). n. Mosenthal, Proc. Soc. Exp. Biol. Med., 8, 
 40 (1910). 12. Brodie and Vogt, /. Physiol., 40, 135-72 (1910). 13. Brodie, Cullis 
 and Halliburton, Ibid., 40, 173-89 (1910). 14. Foster and Lambert, /. Exp. Med., 
 10, 820 (1908). 15. Taylor, Univ. Penn. Med. Bull., 22, 162-7 ( J 9O9)- 
 
 The author desires to express his gratitude to Professor Hawk for his 
 many suggestions and for his continued and valuable assistance in 
 carrying out this work. 
 
BIOGRAPHICAL. 
 
 Henry Albright Mattill graduated from Adelbert College, Western 
 Reserve University, in 1906 with the degree of Bachelor of Arts, magna 
 cum laude. In the years 1906-8 he was Assistant in Chemistry at the 
 University of Illinois, the first year in Quantitative and Food Analysis, 
 the second in General Chemistry and Qualitative Analysis. In 1907, after 
 completing the required work he received in absentia the degree of Master 
 of Arts from Western Reserve University. In the years 1908-10 he held 
 a fellowship in Physiological Chemistry in the University of Illinois, pur- 
 suing work in Physiological Chemistry, Physiology and Physical Chemistry, 
 leading to the degree of Doctor of Philosophy. He was Assistant Pro- 
 fessor of Physiology and Physiological Chemistry in the University of 
 Utah in the year 1910-11. 
 
 He is a member of the Phi Beta Kappa, Phi Lambda Upsilon, Gamma 
 Alpha Graduate Scientific Fraternity, Sigma XI, American Chemical So- 
 ciety, American Association for the Advancement of Science, American 
 Society of Animal Nutrition, and American Society of Biological Chemists. 
 
 PUBLICATIONS. 
 
 1. "The Diastatic Enzyme of Ripening Meat" (with A. W. Peters). 
 Proc. Am. Soc. Biol. Chem., i, 176 (1909). 
 
 2. "Studies in Fasting" (with P. E. Howe and P. B. Hawk) . Ibid., May, 
 1910. 
 
 3. "The Utilization of Ingested Fat under the Influence of Copious and 
 Moderate Water Drinking with Meals" (with P. B. Hawk). Ibid., Vol. II, 
 p. xiv (1911). 
 
 4. "A Method for the Determination of Bacterial Nitrogen in Feces" 
 (with P. B. Hawk). Ibid., Vol. II, p. xiv (1911). 
 
 5. "The Influence of Water Drinking with Meals upon the Utilization of 
 Proteins, Fats and Carbohydrates" (with P. B. Hawk). Proceedings, 2nd 
 International Congress of Alimentary Hygiene and of the Rational Feed- 
 ing of Man, Vol. i, Section II, p. 30 (1911). 
 
 6. "Nitrogen Partition of Two Men through Seven-Day Fasts following 
 the Prolonged Ingestion of a Low-protein Diet ; Supplemented by Com- 
 parative Data from the Subsequent Feeding Period" (with P. E- Howe and 
 P. B. Hawk). /. Am. Chem. Soc., 33, 568-598 (1911). 
 
 7. "A Method for the Quantitative Determination of Fecal Bacteria" 
 (with P. B. Hawk). Journal of Experimental Medicine, 14, 433 (1911). 
 
 8. "The Influence of an Excessive Water Ingestion on a Dog after a 
 Prolonged Fast" (with P. E. Howe and P. B. Hawk). Journal of Biologi- 
 cal Chem., 10, (1911). 
 
^ALIFORN