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On 7 August 1954, the world 42 km marathon record holder, Jim Peters, collapsed repeatedly during the final 385 metres of the British Empire and Commonwealth Games marathon held in Vancouver, Canada. It has been assumed that Peters collapsed from heatstroke because he ran too fast and did not drink during the race, which was held in windless, cloudless conditions with a dry-bulb temperature of 28 degrees C. Hospital records made available to us indicate that Peters might not have suffered from exertional heatstroke, which classically produces a rectal temperature > 42 degrees C, cerebral effects and, usually, a fatal outcome without vigorous active cooling. Although Peters was unconscious on admission to hospital approximately 60 minutes after he was removed from the race, his rectal temperature was 39.4 degrees C and he recovered fully, even though he was managed conservatively and not actively cooled. We propose that Peters' collapse was more likely due to a combination of hyperthermia-induced fatigue which caused him to stop running; exercise-associated postural hypotension as a result of a low peripheral vascular resistance immediately he stopped running; and combined cerebral effects of hyperthermia, hypertonic hypernatraemia associated with dehydration, and perhaps undiagnosed hypoglycaemia. But none of these conditions should cause prolonged unconsciousness, raising the possibility that Peters might have suffered from a transient encephalopathy, the exact nature of which is not understood.

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Three groups of five men each were dehydrated overnight in the heat (115 degrees F) on two occasions (D1 and D2) to approximately 5.5% of their starting body weight. During the 3-week period between D1 and D2, one group (AC) was acclimatized to heat and physically conditioned, the second group (C) was physically conditioned and the third group (S) remained sedentary. The response to work after dehydration was assessed by the following criteria: pulse rate (P), rectal temperature (Tr) and maximal oxygen intake (Max. VO2). Pulse rates during and after walking and after running were elevated with dehydration. This elevation was reduced in groups AC and C at D2 as compared to D1, but not in group S. An elevation in T1 with walking also occurred with dehydration, but this elevation was not significantly different at D2 as compared with D1 in any group. Physical conditioning elicited an elevation in Max. VO2 (group AC and C), but the elevation was no greater in group AC than in group C. Dehydration was associated with an equal decrement in Max. VO2 at D1 and D2 in all groups, but the conditioned men (AC and C) maintained a relatively higher Max. VO2 than group S. Thus, physical conditioning was associated with enhanced work performance during dehydration (assessed by the above criteria), whereas acclimatization to heat did not appreciably supplement this effect.

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In an attempt to discern the paradigms underlying our medical practice (more specifically paediatrics) over the last 30 years, it was found that these are rather similar to the ones prevailing at the beginning of this period--all wrong-doings were attributed to outside forces which had to be neutralized; the obsession to standardise the internal milieu; the compulsion to always do something, little attention being paid to collateral effects; the ends justifying the means and the charm of technology.

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The difficulties of managing dehydration in infants, along with the special problems of infant feeding in the wake of the industrial revolution, led to the specialty of pediatrics. The scientific and clinical beginnings that preceded the specialty are reviewed; much that came later can be credited to pediatric scientists.

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OBJECTIVE: To describe the evolution of rehydration therapy for cholera and diarrheal dehydration from its beginning in 1832 to the present. To reaffirm the central role for extracellular fluid (ECF) expansion and question the continued teaching of deficit therapy in many current pediatric texts. METHODOLOGY: I reviewed the rationale underlying three treatment strategies: rapid parenteral infusions of saline solutions to restore ECF; deficit therapy to replace specific electrolyte and water losses; and oral rehydration therapy (ORT) to effect both. I used crude mortality rates as the measure of outcomes. RESULTS: (1) Beginning in 1832 for cholera and 1918 for infant diarrheal dehydration, parenteral saline infusions were infused to replace losses of salt and water; they were very effective in salvaging moribund dehydrated patients by quickly restoring ECF volume and renal perfusion. Mortality rates dropped from more than 60% to less than 30%. (2) Deficit therapy as it evolved in the 1950s defined potassium and other fluid and electrolyte deficits and replaced them using specific but complicated fluid and electrolyte replacement regimens. Mortality rates dropped to single digits. (3) ORT, with intravenous expansion of ECF volume when indicated, rapidly corrected specific fluid and electrolyte disorders with a very simple therapeutic regimen. Mortality rates dropped to less than 1%. CONCLUSIONS: The simpler, more effective ORT regimen should be taught as standard therapy for diarrheal dehydration. Principles of body fluid physiology should be taught in their own right.

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Se describe las características epidemiológicas de un brote de Deshidratación Aguda Grave (DAG) ocurrida en la Provincia de Huaura, del Departamento de Lima. El estudio se hizo durante 17 semanas epidemiológicas de la sexta a la vigésima segunda *3 de Febrero al 1 de Junio* en que se atendió a 3605 pacientes. Los datos se obtuvieron de los registros de la Unidad del Cólera, del Hospital Docente de Huacho, UDES Lima Norte, MINSA. Los primeros casos atendidos provenían de las localidades agro-rurales de Humaya y Vilcahuaura del distrito de Huaura y Andahuasi del Distrito de Sayán. Simultáneamente en la población de Carquín, que está situado en la region Chala cercana a la desembocadura del río Huaura. DAG se propagó muy rápidamente a las campiñas de los Distritos de Santa María, Végueta, Hualmay y Huacho. Los coprocultivos fueron positivos a Vibrio cholerae 01 biovar Eltor subserovar INABA. Las poblaciones más atacadas fueron las agro-rurales y urbano-marginales. La edad comprendida entre 16-55 años ocupó el 73 por ciento de los casos. No hubo diferencia entre los porcentajes de morbilidad por sexo

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