While he believes that a systolic pressure of over 160 mm. is pathologic, he does not find that any definite prognostic conclusions can be drawn from the height of the pressure. Of course the most important concomitant symptoms of high pressure are cardiac, renal, and cerebral, and the typical headache, as he terms it, is a symptom of serious import. In considering headache in persons over 40, we must eliminate the eye headaches produced by the need of presbyopic glasses or by the need of stronger lenses, as this need is a frequent cause of headache. Dizziness and vertigo may occur without headache, and drowsiness, though not so frequent a symptom as insomnia, often occurs. Janeway finds that all kinds of apoplectic attacks may occur from simple transient aphasia to complete hemiplegia, and thirteen of his patients who had died and thirteen of those living at the time of this report showed failure of eyesight as an initial symptom of arterial disease. Janeway deplores the too frequent diagnosis of neurasthenia in these patients. This diagnosis probably accounts for the frequency with which neurasthenics have been said to have high blood pressure. Patients with high blood pressure may show all kinds of symptoms simulating neurasthenia, but hypertension is a much better diagnosis than neurasthenia for such patients, and will lead to more rational treatment. Ninety-seven of these patients had hemorrhages somewhere, most frequently epistaxes, sometimes hemoptysis. Janeway did not find that purpuric spots on the skin occurred early in the disease in any of his patients. Gastro-intestinal disturbances were not much in evidence unless the kidneys were insufficient. Intermittent claudication in the legs occasionally occurred. While angina pectoris and edema of the lungs were not infrequent causes of death in men, it was a rare cause of death in women. Dyspnea is a frequent symptom, and one for which many patients seek medical advice. A constant systolic blood pressure of over 200 shows a probability that the patient will ultimately die either of uremia or of apoplexy. Janeway found that those patients who are to die from cardiac weakness show cardiac symptoms early in their disease. He found that rapid continuous loss of weight pointed to an early fatal termination. Of the 212 patients who had died, seventy-one had shown cardiac insufficiency at the time of the first examination; twenty-one showed albumin or casts at that time. Of course it should be repeatedly emphasized that chronic interstitial nephritis may be in evidence with either albumin or casts alone, or without either being present.