The value lies not in the occasional estimation compared with some other one reading, but in the frequent estimation and in the visualization of the blood pressure picture. For the great majority of diseases the blood pressure has no particular value except to show that the circulation is not materially disturbed. The limits of normal are rather wide, so that consideration of the patient's age, sex, build, etc., will give us some idea of a base line, so to speak, for any one person. Wide departures from relatively normal figures are important, but are not diagnostic or, rather, pathognomonic. I can not help but feel that the diastolic pressure is _the_ most important part of the blood pressure picture. Persistent high diastolic pressure means increased work for the heart, which, if acting for a long time against the high peripheral resistance, must eventually hypertrophy. The arteries become thickened, lose their wonderful elasticity, fibrous tissue is deposited in their walls, and the vicious circle is established which leads to pathologic hypertension. Blood pressure readings must be intimately mixed with brains in order to be of any great value in diagnosis or prognosis. CHAPTER VIII SYMPTOMS AND PHYSICAL SIGNS =General= Well developed arteriosclerosis shows four pathognomonic signs: (1) hypertrophy of the heart; (2) accentuation of the aortic second sound; (3) palpable thickening of the arteries; and (4) heightened blood pressure. However, it must not be inferred that these signs must be present in order to diagnose arteriosclerosis. It has already been said that a very marked degree of thickening, with even calcification of the palpable arteries, may occur with absolutely no increase of blood pressure, and at autopsy a small flabby heart may be found. While arteriosclerosis is usually a disease which is of slow maturation, nevertheless cases are occasionally seen which develop rather rapidly. The peripheral arteries have been noticed to become stiff and hard in as relatively brief a time as two years from the recognized onset of the disease. Since involution processes are physiologic, as has been described (vide infra), arteriosclerosis may assume an advanced grade and run its course devoid of symptoms referable to diseased arteries. It is doubtful whether the sclerosis itself could produce symptoms, except in cases later to be described, were it not that the organs supplied by the diseased arteries suffer from an insufficient blood supply and the symptoms then become a part of the symptom-complex of any or all the affected organs.