2. The _choking of peripheral vessel_ areas by the severe vessel contraction leads to an over-filling of the central areas. This appears not only from our autopsies. In all available records of autopsies which pertain to cases of death from cold in the water after sea disaster, we find uniformly a severe over-filling of the right heart. 3. It is to be calculated that, under the effect of the low blood temperature, the _heart_ itself becomes severely _hypodynamic_. It has been proved long ago in animal experimentation that a Vorhof flutter can be developed by the overloading and cooling of the isolated heart. Besides a physical damaging of the heart musculature by the cold, we must also keep in mind the _damaging by pathological products of metabolism_. Next, the sharp increase in blood sugar may be connected with the increased outpouring of adrenalin. The constancy of this increase of blood sugar during the temperature drop is, however, remarkable. One may well assume that this flow of adrenalin exhausts itself with the continuance of the temperature drop. With this there would have to be a rapid decrease in the blood sugar if the oxidation processes were to continue undisturbed. The decrease in the alkali reserve or the development of an acidosis argues strongly for an injury. Animal experiments, with general cooling, give grounds for believing that the intermediary metabolism is disturbed during drops in temperature; but this change is also discussed in connection with local freezing of the human being and has been proved to a certain extent. Furthermore, not only this disturbance shows a transition between general and local damage by cold. In both cases there occurs an increase in viscosity, which points to a change in the capillary walls and indicates the conclusion that there is a change in the permeability of those walls for protein and water. The heart-death remains prominent, the regular increase of spinal fluid pressure with severe cooling of the neck and back of the head leaves it unsettled whether, in addition, this has pathognomonic significance for the outcome. With a fluid pressure of 420 mm. it must in fact be assumed that this participates in the development of bradycardia. The detection of an increase in fluid pressure is also not without significance for therapy. One may think of a lumbar or suboccipital puncture as a measure to be prescribed. After a lumbar puncture there occurs a transformation of the slow form of arrhythmia into the rapid form. It must remain undecided whether such measures, which delay a rapid, active rewarming, are to be recommended for practical application in the sea-rescue service.