operations to cut off the blood supply of the thyroid should first
be done, and the patient's heart allowed to improve before a
thyroidectomy is performed.

Men with hypertension without kidney or arterial excuse are likely
to have been athletes, or to have done some severe competitive work,
or, as above stated, to have labored hard, or to have worked at high
tension, or in great excitement, or with mental worry, all of which
tend, as long as there is health, to increase the blood pressure.
These men may add weight from the age of 40 on, or they may be thin
and wiry. Besides the hypertension there is likely to be a too
sturdily acting heart, which is often hypertrophied, and there is an
accentuated closure of the aortic valve. There may be dizziness, or
no head symptoms at all. Nicotin is likely to be an etiologic factor
in this class.

These women and these men may all be improved by proper treatment,
and the condition may not develop into arteriosclerosis or
nephritis.

Neurotic conditions, and in some instances neurasthenic conditions,
may show a blood pressure higher than normal. Lead may be a cause of
increased blood pressure, and diabetics occasionally have a high
pressure, although more frequently there is a lowering of blood
pressure in diabetes.

Richman believes that syphilis is the most common cause of
hypertension and arteriosclerosis without renal disease. When
arteriosclerosis and renal disease are combined, of course the
highest systolic readings occur. He thinks that when high tension