No abstract

In a separate paper ( 1 ) we have described effects resulting from variation of sodium intake in normal subjects, which we attribute to changes in adrenal cortical activity. It is the purpose of this paper to describe some additional effects of considerable physiological interest that were observed in the course of that study. METHODSThree normal young adults were maintained throughout the study on a constant diet adequate in calories and protein with a very low sodium (about 9 mEq.) and chloride (about 25 mEq.) content. At definite periods 480 mEq. of sodium were administered orally daily either as sodium chloride or as sodium citrate. The analytical methods and diet are described in detail in the previous report (1). RESULTSThe complete data of this study were presented in a separate paper (1). Only data pertinent to the present discussions will be presented here. Table I shows the weights of our three normal subjects for the three days before, during and following sodium administration. It is evident that with sodium chloride administration a much more marked gain of weight occurred than with sodium citrate. Each subject was on a maintenance caloric intake so that practically all weight changes occurring over such short periods as these are due to change in body fluid content. Table II shows the changes in urinary sodium, chloride and potassium excretion that occurred before, during and following each period of sodium administration. No significant changes in fecal sodium, chloride, and potassium were noted and these are not recorded here. It is seen that with administration of sodium chloride there is in each case a parallel increase in both urinary sodium and chloride as would be expected. Following the 1 This study was aided by a grant from the United States Public Health Service. sodium citrate administration a similar increase in sodium excretion is noted; however, chloride excretion remains unchanged, or if anything, slightly decreases. Table II shows further that with the sodium chloride administration no significant increase in potassium excretion occurred except in the case of M. L., whose urine potassium content rose from about 40 mEq. in 24 hours to 88 mEq. the first day of sodium chloride administration. In subjects W. C. and E. W. a significant decrease in potassium excretion occurred after cessation of sodium chloride administration. On the first day of sodium citrate administration, a very definite increase in potassium excretion took place in all subjects. This was followed, after omission of sodium citrate, by a decrease to unusually low levels of potassium excretion. Table III shows the data we have collected re-

The characteristically altered physiologic pattern in chronic constrictive pericarditis is the resultant of the diminished cardiac expansibility. A widespread infiltrative myocardial disease in which cardiac expansibility was equally limited should simulate the former entity very closely. This extremely rare entity is illustrated in this case report.

Although residence visits may occupy a large share of a physician's working day, statistical knowledge concerning these visits is largely a matter of conjecture and hearsay. This study was inspired by a great variation in opinion among the older practitioners in our community regarding their impression of residence visits. We felt that by analyzing 1,000 consecutive residence visits some useful, and to a large extent unknown, statistical information could be obtained.In order to make such a study, its basic unit\p=m-\theresi-dence visit\p=m-\hadfirst to be defined and then that definition rigidly followed. All patients 13 and under were automatically excluded. As