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The most common serious reaction encountered in the conduct of artificially produced fever therapy is a state of collapse which may appear at any time during the treatment. In 1100 treatments given in our clinic between 1930 and 1937, there was a 1 per cent mortality, and many other serious collapse reactions which were in some way concerned with the water and salt excretion and intake during the treatment. Some of the patients in the early period lost from 3 to 5 kgm. in body weight during short treatments of 5 hours, while others lost little or no weight during prolonged treatments (10 to 27 hours) at 41.50 C. Later in this period, when the water intake was better adjusted and sodium chloride administration was included during treatment, the loss in weight was reduced, and the collapse state was less often encountered. Yet it still occurred at odd times in the year and in a curious sequence of cases. It bore no relation to the disease for which the patient was being treated nor to the length of treatment administered, and often occurred in what ordinarily would be termed a "perfectly healthy young adult." This collapse state has many of the "ear marks" of what is termed surgical or traumatic shock in that there is an absence of sweating and urine, pallor, cold extremities even with rectal temperatures of 41.5° C. or higher, fall in blood pressure and venous pressure, retardation of the skin capillary response to digital pressure, cyanosis, and coma. Fatal outcome may be precipitated by a maniacal state before the coma ensues. Caffeine and adrenalin are ineffective, and oxygen-carbon dioxide mixtures are only of temporary benefit. In the early stages, vomiting prevents the ingestion of water, although concentrated 2 to 25 per

THE RELATIONSHIP OF DEHYDRATION AND OVERHYDRATION OF THE BLOOD PLASMA TO COLLAPSE IN THE MANAGEMENT OF ARTIFICIAL FEVER THERAPY 1