Two of my patients--old ladies well over seventy--have had hyperpiesis for twelve years or more; they were condemned by good men many years ago. They have lived on hippurate almost without breaks all these years, and it has kept their pressure down to a reasonable working-point. With both I have tried thyroid treatment with very slight success; they always come back to their hippurate as the well-tried friend. I have another patient aged ninety-four, who has had periods of high pressure for twenty years, and if she misses her daily dose the pressure goes up and her head gets giddy and confused. It is a very wholesome medicine, causes no gastric disturbance, and is easily soluble; from 5 to 15 grains a day are generally needed. If there are gouty symptoms I give the lithia salt; if not, the sodium. The benzoates have, I believe, much the same action, but they are not easily digested and large doses are required. In bad and obstinate cases the hippurate and thyroid treatment sometimes act well together. I have written now all that I know from personal experience about the treatment of this complicated condition we call arterio-sclerosis; and many of the symptoms and much of the treatment I have been able to watch and verify for myself by almost hourly contact with it. Nevertheless, this treatment will have to stand the racket and assaults of both friendly and hostile critics, and so it should be. In the practice of medicine we must be prepared to maintain our position and to give a reason for the faith that is in us, for the issues are so great and affect others rather than ourselves. I have said that this is somewhat of an occupation disease: it is a vicious circle, not originating necessarily in any vice, but in the pressure of life and the stress of circumstances. The causes often we cannot remove entirely, but only modify, and so we are compelled to treat symptoms only; our ambition and longing will be to do much more than this--to bring about a perfect reform; but in the management of this, as in most morbid conditions, compromise, with as much true wisdom as we can squeeze into it, is the only practical policy. Our endeavour must be to break the vicious circle whenever and wherever we can. The lowering of pressure does not sound a great thing in itself, but it immediately lessens the work of the heart, sets more free the circulation of blood in the brain, often restores the power of sleep and so ensures comparative rest all round. It thus gives us a breathing space in which we can consider and attack the origins of evil. In conclusion I ask my readers to consider well Sir Clifford Allbutt’s most wise words on this question: “In entering upon the discussion of vaso-dilatation, as contrasted with agents which bring about this change indirectly by modifying the causes of morbid constriction, we have to consider how far mere dilatation--brought about, that is to say, immediately and singly--serves any good purpose.