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A study is presented of 39 hypertensive patients on treatment with hexamethonium bromide by subcutaneous injection. The patients were drawn from the complicated-essential, malignant, or renal groups of hypertension, and uncomplicated cases were not included. Details of treatment routine and general management are given, as it is felt that these are of great importance in the achievement of successful results. Five patients died whilst on treatment and it was discontinued for various reasons in six others, but 28 patients received regular therapy for periods varying between three and fifteen months and were seen at least once a month in the out-patient clinic. After the development of a very variable amount of tolerance to the drug during the first four to eight weeks, all patients were able to be stabilized on a dose which gave an average blood-pressure level much below that found in the control period. Reduction in mean systolic pressure ranged from 20 to 90 mm. Hg and in mean diastolic pressure from 8 to 40 mm. Hg, and the maximum reductions-for example, one to two hours after an injection-were often twice as great. Hypertensive headaches (often very severe and incapacitating) were almost completely relieved in 15 out of 19 cases, and lessened in frequency and severity in the other four. Giddiness disappeared and encephalopathic attacks did not recur, except in one instance. Shortness of breath from cardiac causes was generally improved and in several cases there was striking relief from acute cardiac dyspnoea. Diminution in cardiac volume was demonstrated in five out of seven cases after three to six months' treatment, and in seven out of 16 cases electrocardiographic signs of left ventricular hypertrophy were altered towards the normal. Retinopathy was strikingly improved in all severe cases, papilloedema subsiding, and extensive exudates and haemorrhages becoming reabsorbed, with restoration of normal vision after about six months' treatment. One instance of coronary thrombosis and two major and two minor cerebral vascular accidents occurred during treatment, but in two of the latter the blood pressure was high at the time. No evidence of increased damage was found among patients with impaired renal function. A recent development has been the occurrence of dyspnoea and symmetrical opacities in the lung fields on x-ray examination in three patients after fifteen, nine, and seven months' successful treatment. The pathogenesis of this is still obscure. Side-effects were troublesome in proportion to the size of the dose and thus most severe in the cases developing a higher degree of "tolerance." The problem of " tolerances" is discussed and some suggestions are made regarding its nature.

Effects of Hexamethonium on Normal Individuals in Relation to Its Concentration in the Plasma