As a rule when the terms, "water balance" or "Cwater exchange," occur in clinical literature, the writer has in mind merely a comparison between the water which enters the body as food and drink with the water which leaves it as urine. Sometimes the water of the stool is also included. *A statement that includes merely these increments of water is inaccurate and liable to be misleading, since it fails to take into account (1) the large amount of water that is evaporated from the skin and lungs; (2) the water that is formed by oxidation of the food; (3) water physically held as part of the protoplasm, but set free when the organism derives some of its energy by burning its own tissues.We propose to describe a system which permits the observer to obtain an accurate account of all the sources and the total amount of water that becomes available for the organism on the one hand; and of the amount of water that leaves the organism on the other hand.In working out a plan for dealing with all the increments of water, it is helpful to think of them under two separate headings: (1) Those that may be measured by standard laboratory methods; and (2) those whose value is obtained indirectly by calculation. The first group includes the water that the subject drinks as such, and the water contained in the food, urine and stool. The second group consists of the water evaporated from the skin and lungs, the water that is a byproduct of the combustion of materials, and water made free when body tissue is burned.

The medical profession in general, believes that there are two kinds of obese persons-those who have become fat because they overeat or under-exercise; and those composing a second group whose adiposity is not closely related to diet, but is caused by an endocrine or constitutional abnormality.The first apparently scientific support of the hypothesis that obesity was often of endogenous origin, came with the finding that some obese persons had an abnormally low basal metabolic rate, on the basis of body weight. When, however, it was shown that the expenditure of energy is proportional to the surface area and not the weight, it was found that most such persons have a normal basal metabolic rate. However, it is true that there remains a small group of fatpeople whose basal rate is definitely low.Later writers maintained that a common cause of endogenous obesity was to be found in a lessened specific dynamic response to food. But the increase in metabolic rate caused by food is relatively small, so that a method possessed of a high degree of accuracy is needed in order to deal quantitatively with this phenomenon. Our prolonged study of this question has convinced us that the inherent error in the method to date, when it is applied to the human subject, is such that it precludes the possibility of making quantitative statements regarding the specific dynamic response to food in man.Other writers have attributed endogenous obesity to a constitutional anomaly of the cells which somehow lowers the rate of intracellular oxidations.

No abstract

No abstract

No abstract