Illustrative Case.--L. C., a man, aged fifty-six years, stonemason by trade, is a stocky, thick-necked individual. He had never been ill in his life until a year ago, when he fell from his chair unconscious. He had a right-sided hemiplegia which has cleared up so completely that except for a very slight drag to his foot he walks perfectly well. He came in complaining of shortness of breath and cough. There was no swelling of the feet. Here evidently was left-heart decompensation. Examination showed the blood pressure to be 240-130-110, pulse irregular, 104 to the minute. There were cyanosis and rales throughout both chests. The urine was normal in color, specific gravity 1025, small amount of albumin, few casts, hyaline and granular. The phthalein elimination was 65 per cent in two hours. Under rest, purgatives, and digitalis he was much improved. He has since had two other apoplectic strokes, the last of which was fatal. When these patients are seen with acute cardiac decompensation, there are, of course, much albumin and many casts in the urine, and the phthalein output is, for the time being, decreased. Group C. This might be called the arteriosclerotic high-tension group (Stone's cardiac group). The cases are usually over fifty years old. They are men and women who have lived high and thought hard. Often they have had periods of great mental strain. Many men in this group were athletes in their young manhood. Many have been fairly heavy drinkers, although never drinking to excess. They are usually well nourished and inclined to stoutness. The pressure picture is high systolic with normal or only slightly increased diastolic and large pulse pressure. The arteries are large, full, fibrous, usually tortuous. The heart is very large, the apex far down and out. There is no polyuria; nycturia is uncommon, quite the exception. The urine is normal in color, amount, and specific gravity. Albumin is only rarely found and hyaline casts are not invariably present. The phthalein excretion is quite normal and the excretions of salt and nitrogen are also normal. The terminal condition in most of the patients in this group is cardiac decompensation. They may have several attacks from which they recover, but after every attack the succeeding one is produced by less exertion than the preceding one, and it becomes more and more difficult to control attacks. Eventually the patients become bed- or chair-ridden, and finally die of acute dilatation of the heart. Occasionally patients in this group may have a cerebral attack, but in my experience this is uncommon. Pathologically the heart is large, at times true _cor bovinum_, dilated and hypertrophied. The cavity of the left ventricle is much dilated. The aorta is dilated and sclerosed.