My own feeling is that the most successful means of treatment of acute high tension is without the use of drugs. The most important measure is absolute rest in bed. This often suffices to lower the blood pressure and to arrest the symptoms produced by high tension. Venesection I believe is also of value. True the arterioles appear to contract almost immediately upon the lessened quantity of blood, or there is immediate interchange of serum from the tissues which brings the blood volume back to the original amount. Whatever happens the pressure is not greatly reduced, at times not reduced at all, but often the symptoms are relieved. Hot packs or sweat baths assuredly do reduce the pressure in many cases. This seems to me to be an exceedingly valuable measure. Finally the diet should be nourishing, but very light, not too much fluid should be ingested, and the bowels should be freely opened. With the fibrolysin of Merck, I have had no experience. Some men assert that they have had good results from its use, but on the whole the evidence is not highly favorable. Morphine is invaluable. No drug is of such value in the nocturnal dyspneic attacks that occur in the late stages of arteriosclerosis when the heart or the kidneys are failing. Morphine not only relaxes spasm and quiets the cerebral centers, but is an actual heart stimulant under such conditions, and should never be withheld, as the danger of the patient's becoming addicted to its use is more fanciful than real. However, morphine, at times, suppresses the secretion of urine. So that if after trial the urine becomes scanty and the edema increases, recourse must be had to other drugs. The various hypnotics may be used with caution. One which seems to be very useful is adalin. As heart stimulants, one may use strychnine, spartein, caffein, or camphor. In desperate cases, where a rapidly diffusible stimulant is needed, a hypodermic syringeful of ether may be given, and repeated in a short while. Several years ago a so-called serum was brought out by Trunecek which was said to have a favorable effect on the metabolism of the vessel walls. It was given at first hypodermatically or intravenously but the former method was painful. It was later stated that given by mouth it acted just as well. The results with the Trunecek serum have not come up to the expectations that the early favorable reports promised. The original serum was composed as follows: NaCl, 4.92 gm.; Na_2SO_4, 0.44 gm.; Na_2CO_3, 0.21 gm.; K_2SO_4, 0.40 gm.; aqua destil. q. s. ad. 100.0 c.c. Later this was modified for internal use to the following prescription: R_{x} Natrii chlor. 10. gm. Natrii sulphat. 1. gm. Natrii carbonat. 0.40 gm. Natrii phosphat. 0.30 gm. Calcii phosphat. Magnesii phosphat. aa. 0.75 gm. M. Ft. cachets No. XIII.