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favouring the view that the seat of hyper-resistance is in thecapillaries rather than in the arterioles. It must be remem-bered, however, that local arteriolar dilatations are continu-ally occurring throughout the body and are amply sufficient,in cases of widespread arteriolar hypertonus, to cause con-siderable local augmentations of intra-arteriolar pressure.It is scarcely necessary to say that in my explanation ofprolonged high blood pressure I fully concur with ProfessorAllbutt’s view-in which he has for some years stood alone-to the effect that elevation of blood pressure does not dependdirectly upon arterio-sclerosis. No degeneration short ofa widespread obliterative change in the arterioles, so pro-nounced as to render a compensatory vaso-dilatation impos-sible, is in my opinion likely to cause a permanent increaseof resistance and I, at least, have never met with such acase.

Dr. William Russell and Dr. H. Oliphant Nicholson are em-phatic in their statements that it is quite common to get lowblood pressure with arterial hypertonus. I believe that I am

stating a mere physiological truism when I say that, exceptin cases of decided cardiac inadequacy, a general hypertonusof the systemic arterioles necessarily leads to augmentationof the systemic arterial pressure, but Dr. Nicholson at leastdoes not appear to accept this proposition. He refers tocases of hypertonus accompanying severe abdominal pain,tympanites or any form of shock ...... peritonitis or shock," inwhich the pressure is frequently low, in spite of " a generalarteriole contraction," apparently inferring from the hyper-tonus of certain superficial arteries, such as the radials,the existence of a general systemic hypertonus of thearterioles. I submit that such an assumption is notwarranted. Hypertonus of the radial arteries might con-ceivably go along with hypotonus of the radial arterioles-though I admit the unlikelihood of this-and it is

certainly consistent with a widespread relaxation of deep-seated arterioles. Whenever, with radial hypertonus and asound heart, the radial pressure is low we should suspecthypotonus of some large vascular area, and it is well knownthat in all cases of shock there is extreme relaxation ofthe splanchnic arterioles, causing a rush of blood into thesplanchnic veins and a fall of arterial pressure, a factwhich sufficiently explains the low radial pressure in thecases just referred to. The object of the hypertonus in areasother than the splanchnic in these cases is, presumably, tokeep what little blood there is in the arteries from escapingtoo rapidly into the veins. Whether with the contraction ofthe superficial arteries frequently observed in tuberculousmeningitis there is a similar relaxation of internal vesels Icannot, of course, say, but I should myself be much moreinclined to attribute the low pressure which Dr. Nicholsonhas observed in these cases to such relaxation than to theonly alternative-namely, a primary feebleness of the cardiacbeat.

I have suggested that protracted augmentation of arterialpressure has for its object an augmented renal excretion andthat to this end there takes place a concomitant augmenta-tion of the intra-renal arterioles. How can one doubt, totake an instance, the urgent necessity in advanced " granularkidney " (in which possibly five-sixths of the originalsecreting structure have been removed) of a vigorous renalcirculation, in order to stave off the on-coming of fataluraemia—in order "to parry the stoke of death." if I may be

permitted Professor Allbutt’s graphic figure ; and whatmeans so competent to secre this end as the one suggested ?Does not the extreme hypertonus so frequently observed inuraemia tell, as plainly as anything can tell, of the brave fightwhich the vaso-motor system is making against the forces ofdeath ? and is it not more rational to regard such hypertonusrather as a manifestation of the many-sided vis ??Mc&<7’<a’than as an act of suicide ?-which it most certainly would bedid the intra-renal arterioles share in the hypertonus. More-over, the increased flow of urine in all but the last stages ofgranular kidney testifies to the activity of the renal circula-tion in this affection.

Dr. Nicholson contends that this interpretation is not ofuniversal application and I can well believe that there are

exceptions to it. I do not, however, think that puerperaleclampsia with hypertonus can be brought forward as one ofthem. It is true that, in spite of the hypertonus and in-creased blood pressure observed in this malady, "the secre-tion of urine is notably diminished, and as hypertonus andincreased blood pressure become more pronounced the urinemay be suppressed altogether" ; but this suppression does notprove that the intra renal arteries are not dilated-it results,

I submit, from a grave perversion (as testified by the occur-rence of albuminuria) in the functions of the kidneys, owingto the rush of toxins towards the renal tubules in their madeffort to escape from the body.

In conclusion, Sirs, I trust that I may be permitted to expressmy deep appreciation of the eloquent and thought-stimulat-ing paper which has evoked this discussion. Though hemay not be successful in carrying his audience with him onall points Professor Allbutt will, I doubt not, be more thancontent if he succeeds in duly impressing upon the youngergeneration of physicians what are after all the most

important words of his paper : "I cannot urge too stronglythe perils of neglecting these incipient increases of bloodpressure and the importance of educating the finger in theearly detection of them." He who misses the lessons to belearnt from a clinical study of blood pressure is a poorphysician indeed, for he loses many a valuable opportunityof helping his patients. To the teachings of three men inthis department of clinical medicine-Sir William Broadbent,Professor Allbutt, and Dr. George Oliver-I owe a debtwhich I cannot well exaggerate ; and it is pleasant to havean opportunity of recording the fact.

I am, Sirs, yours faithfully,Wimpole-street, March 8th, 1903. HARRY CAMPBELL.

AN EARLY SYMPTOM OF TYPHOID FEVER.

I To the Editors of THE LANCET.SIRS,-I have noticed in the history of many cases of

typhoid fever the presence of an early symptom-viz., afeeling of stiffness of the neck. In some cases it appearsbefore any other symptom during the period of incubation,in others it appears coincidently with malaise and headache.Its presence, as a rule, is only elicited by direcc inquiry, noimportance having been attached to it. In young childrenit is frequently shown to be present by signs of pain whenthe head is turned, as when being washed. While residentmedical officer in the Children’s Hospital in Liverpool I foundthat the nurses observed this in many of the cases of earlyenteric fever. In several cases of enteric fever in adultsthis symptom has been the only one for three or four days,sometimes combined with sore-throat, before the onset ofother symptoms.-I am, Sirs, yours faithfullv,

BRUCE C. KELLY, M.B., C.M. Edin., M.R.C.S. Eng.,L.R.C.P. Lond.,

Formerly House Physician, Edinburgh Royal Infirmary, and SeniorResident Medical Officer, Hospital for Children, Liverpool.

Wells, Somerset.

THE EFFECTS OF BORIC ACID AS ANINTERNAL MEDICINE.

To the Editors of THE LANCET.

SIRS,-Your annotation in THE LANCET of March 14th,p 749, on the disturbing -efEects of boric acid on the

digestion of healthy persons and invalids when taken

internally is one that I can entirely indorse. Speakingpersonally it is about the only thing I know of whichis capable of giving me indigestion at almost a moment’snotice. I have otten recognised it in this way whenadministered in conjunction with milk, butter, pottedshrimps, and many other articles of diet. For medicinalpurposes I have long discarded it for this reason in

appreciable doses. So far back as 1886 I have advocatedand largely used in practice a substitute for boric acidwhich is free from this serious objection and possesses theproperties claimed for boric acid whether taken internallyas a medicine or used as a lotion for washing out the bladder.As an article of commerce for preserving such foods as I haveinstanced I believe it has similar advantages. In thechemical world it is known under the name of boracite andis thus described :-

"I3oracite, a borate of magnesia with chloride of magnesium, con-taining when pure 62-5 per cent. of boracic acid (anhydride). Itcrystallises in the cubic system, often in hemihedral or tetrahedralforms, and is remarkable for being pyro-electric-that is, for exhibitingelectrical polarity when exposed to a change of temperature. Themineral is further notable for its anomalous optical properties ; thus aray of light in passing through a crystal of boracite suffers doublerefraction, contrary to the general rule that crystals belonging to thecubic system are not capable of thus affecting light. The probableexplanation of this anomalous behaviour on the part of boracite isbeyond the scope of this article. Boracite is usually found in associa-tion with deposits of rock salt and gypsum. The mineral occurscrystallised at Luneburg, in Hanover, and at Stassfurt, near

Magdeburg; the latter locality also yields a massive boracite called