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quently several days later we make an- artery and is always considerably lower other observation with only our memory than the systolic. When a blood pressure to serve us as a comparison of the de- is reported it is usually understood to be gree of alteration. The feeling of many systolic unless otherwise stated. pulses in the interim has doubtless dis- The force of the heart, the resistance torted our accuracy of judgment.

against which it acts, nervous, and psychic In making blood pressure records I influences are the factors which sustain have frequently found my previous opin- and alter blood pressure. All of these ion of the character of the pulse altered factors must be considered when we enby its expression in millimeters of mer- deavor to interpret the estimated blood cury. The hard full pulse with an up pressure in a given case. Under normal stroke that strikes the finger with quick conditions the pressure is higher after exforce is never misinterpreted. It is al- ertion, higher after sitting than after lyways one that goes with high tension. ing. There is always a tendency for the Shading differences of such a pulse are pressure to assume a level. This is well difficult to recognize. For the most of us illustrated in the case of the athlete. At some instrumental means of recognizing the beginning of a forced run there is an small as well as great changes is most enormous rise in the pressure due to the satisfactory. Instruments which eliminate enforced heart strain. This gradually as far as possible the personal equation sinks and assumes a new level when the should be chosen. The study of a pulse runner gets his so-called second wind, and tracing made with the sphygmograph gives returns to normal after the run. The an idea of the pressure at a glance. It same is true, but to a less extent, of the does not however unless in conjunction patient who comes to the office for obserwith a mercury manometer, give any trust- vation. When he enters, particularly if worthy record of changes that can be ex- he has come up a flight of stairs, his prespressed. The chief use of the sphygmo- sure is often ten or fifteen millimeters graph is for recording and interpreting the higher than after he has remained quiet movements of the heart and the blood for a few minutes. The effort of taking coursing through the blood channels. off the coat and rolling up the sleeve gives

The mercury manometer is the only in- a record on the manometer several points strument of precision we have at our com- in advance of the record obtained during mand for clinical records. It is now well rest. In making permanent records it is agreed that the best form of apparatus is therefore necessary to record a pressure one after the idea of the Riva Rocci ma- level. The pressures I will report are all chine with wide armlet, 12 cm's. These

pressure levels. My plan is to take the instruments register the systolic pressure pressure immediately after taking off the and may be connected with a tambor and coat and twice after having remained quiet chymograph for the registration of the for five or ten minutes, the last two records diastolic pressure. The systolic pressure must harmonize closely. is obtained by taking the reading after the Suggestion has a powerful effect on first return of the pulse. The diastolic

arterial pressure.

A man is sitting quietregisters the maximum pulsation of the ly reading a book, something he reads causes a quick uncontrollable Aush to come disease the pressure is unchanged. An into his face, something has momentarily attack of angina pectoris occurred in a lowered his pressure. The effect of men- patient while Norris was taking his blood tal emotion on blood pressure has been pressure. He noted a rapid rise of fifty well illustrated by the classical case of mm., followed by gradual fall coincident John Hunter, the victim of angina pec- with the disappearance of the pain. It has toris who said “My life is in the hands of also been demonstrated by Beyer, Rhomany rascal who chooses to annoy and tease berg, and Miller that pleasurable emotions, me.” Unconsciously in susceptible indi- agreeable odors and tastes produce marked viduals momentary changes may be pro- peripheral vaso-dilation, while excitement, duced by the attitude we assume toward worry, unpleasant odors, tastes, noises, and them. The increased blood in the

the other sensations bring about vaso-consplanchnic system during the digestion of striction. Stimulation of the sciatic nerve a meal causes lowering of the peripheral by the Faradic current increases blood blood pressure. Normally there is always pressure. Mental pain such as that presa balance maintained; but in those indi- ent during an attack of melancholia inviduals who complain of chilliness and duces hypertension which disappears with clammy hands after meals there is an over relief from the state of anxiety. It is also balance on the splanchnic side amounting quite well known that the motor exciteto stagnation. On the other hand any- ment of mania causes hypotonia, the rething producing

producing constriction of the verse of the condition found in melansplanchnic vessels causes a rise in pres

cholia. sure. A few days ago I was called to see EFFECT OF PROSTATIC MASSAGE ON BLOOD a patient with subinvolution of the uterus.

PRESSURE I had a book bound very tightly above A short time since I examined a patient the uterus. In an hour's time the patient's who complained of some urinary sympface became red and she complained of toms. I found that he had a slightly ensevere headache. Loosening the bandage larged prostate which I massaged for one stopped the headache. This can be ex- or two minutes. I had previously taken plained on the same grounds as Oliver's his blood pressure and decided to take it test for the differentiation of undue again. I was interested to note dissplanchnic congestion. Oliver observed tinct lowering in the pressure. The prosthat when a weight is placed over the ab- tatic massage experiments which I report domen of a patient with subnormal pressure this afternoon were planned in the bedue to hypotonia an elevation of blood pres- ginning to control my first observation sure results from the dislodgement of which I thought might be due to some instagnated blood in the abdomen.

strumental defect. It will be seen from Curschmann has shown that pain pro- the illustrations that similar and definite duces a rise in blood pressure. When he changes occur in the three cases cited. applied the Faradic current over the up- Charts 1, 2 and 3 are from records of per part of the thigh in normal persons the same individual. This patient, male, and malingerers a distinct rise in pres- aged 62, had a distinct hypertonia, subject sure occurs, whereas in hysteria and spinal to considerable variation under nervous

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CHART 2. CASE I. This chart shows the marked effect of posture commonly seen in hypertonia as well as of

prostatic massage.

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CHART 3. CASE I. Showing the initial rise and subsequent fall in pressure after prostatic massage.

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a pressure record was taken and a fall of over ten millimeters recorded. The patient then sat up, after ten minutes the pressure resumed the normal point.

Exp. 2. The second observation was made a week later. This time the massage was continued only 112 minutes. An observation was made one minute later and the same reading was obtained, in four minutes a fall of 15 millimeters was recorded and in ten minutes the pressure was back to the previous lying pressure. One minute after sitting up the pressure assumed the sitting pressure previously obtained. No fall in pressure immediately following the massage suggested further observation on the time period of the reaction.

Exp. 3. The manipulations produced a little pain. One minute after the pressure had risen 25 millimeters, then gradually fell as is shown in the chart until five minutes when it reached a point 16 millimeters below the lying pressure.

CASE II, chart 4 shows very little effect from prostatic massage, there is however a tendency to an initial rise and a subsequent fall in the pressure. Prostate negative.

CASE III. Prostate slightly enlarged, groove not obliterated, lobes distinct. Cen


CHART 4. CASE II. After prostatic massage practically no change is observed in the pressure although the initial rise and subsequent fall

are indicated.

terior urethra and distinct lessening in the size of the organ. The manipulations were continued 3 minutes, 3 minutes later

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