I. Water and Salt metabolism has been discussed both in their theoretical and in their
2. A series of experiments was conducted on normal human subjects to prove or disprove
certain conceptions of salt metabolism.
3. In general these conceptions were substantiated and, arising from this work the
clinical applications are as follows:
A. To diminish the mortality and morbidity from operations both water and electrolytes
must be given in adequate amounts to restore or maintain normality. Two main types
of problem therefore, may confront the surgeon.
I. The case which comes under his care with depleted fluids and electrolytes
and rules have been given for the restoration of both to normal.
2. The case which in hospital after operation loses electrolytes and fluids
from vomiting, fistulae, etc. Such a case can be maintained in fluid balance by
the application of the rules of water balance enunciated by W. G. Maddock and
detailed in this paper. The electrolyte balance can also be maintained by the administration
of a volume of 0.9% sodium chloride solution equal to the volume of the abnormal
fluid losses (vomitus, drainage from fistulae etc.) without endangering the patient
by overloading him with sodium chloride.
B. The following table shows the degree of accuracy which results from the application
of these rules, and I feel that, although much further work is needed fully to
substantiate our claims, the clinical administration of sodium chloride has been
placed on a sound basis.