I think there can be no doubt that there is a period, often of months, when there is only increased contraction of the muscular coats of the arteries. This is due to the increased strain of life generally, and is in consonance with our experience generally of muscular overgrowth and overwork. Huchard called this “the pre-sclerotic stage.” I think we may say that any pressures at about fifty years of age below 120 mm. are a sign of debility, and above 150 mm. are signs of threatening arterial trouble. Over sixty there is a natural tendency to hardening of the arteries, and many men seem to lead healthy lives with a pressure of 160 mm. Still, with a pressure of that height they cannot afford to put any excessive strain on their arteries. At about eighty there is a decided tendency for pressure to fall, even if there has been plus pressure before. It is rare to find high pressure over ninety for the reason that people who live to that age must have had healthy hearts and arteries all the time, but even in them we not infrequently find passing rises; these are often missed, but they cause much mental distress and even delusions, but at this age, under treatment, the pressure soon falls and the mind clears. I had one lady who lived to ninety-seven, and during the last six years of her life she had visions and slight delusions when her pressure rose, but in the intervals her mind was quite clear. She learned to recognize the cause of her trouble. This rule of normality stands pretty true for the majority of people, but in practice we find a good many individual exceptions: in such, the personal equation has to be solved. Women often, even in advanced age, have very low pressures, even 120 mm. to 125 mm., and seem to carry on quite well. They again get a period of high pressure about the climacteric, which with careful treatment disappears, and their subsequent years from about fifty-five to seventy-five are often the best and the happiest working years of their lives. It is not uncommon both in men and women who have led strenuous but healthy lives to find, about sixty, steady pressures of 160 mm. to 170 mm., without causing any symptoms of illness or distress. These people, though one cannot consider them safe lives from the insurance point of view, have learned to manage themselves and seem to have set up a new, personal normal which is an effective compromise. If one has been able by careful observation to satisfy oneself about such a case, it would certainly be unwise to try to lower that pressure point. Even in cases where there is manifest disease of some standing, one has to find out the best working point of pressure for the individual. They can live and work fairly comfortably at 160 mm. or 170 mm., but if you lower the pressure to 140 mm. or 150 mm., their hearts get irregular and they feel good for nothing; but I think we may make a working rule that a pressure of 180 mm. and over should be lowered; the danger to the