Licence: In copyright
Credit: Arterial hypertonus, sclerosis and blood-pressure. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
72/234 page 44
![the difficulty by inaintaming that the terms “ tension ” and “ pressure,” are synonymous. Personally I hold that whatever conduces to clearness of thinking is desirable, so I am quite ready to accept this definition of the terms, but I do not think that it is correct historically. It seems to me that our best clinicians meant more than this indicates, that to them there was a living and active relationship between the state of the vessel wall and the volume of blood inside it. Dr. Leonard Williams, in a lecture delivered at the Medical Graduates College, says : “ H^h arterial J,ension is an expression whicli is used as a synonym for ‘ higli blood-pressure,’ than which it is niore euphonious, but less correct.” Wliile Ijelieviug, as I do, that our ablest clinicians meant more than is here implied, the meaning of words is frequently modified, and it would greatly simplify the position were the term “ tension ” to be given up, or definitely used as synonymous with “ blood- ])ressure.” In the examination of the pulse two factors are com- monly considered, no matter what terms the observer uses to express his mental concept, namely, the condition of the arterial wall and the blood-pressure inside it. I’utting aside for the moment the first of these, the estimation of the pressure within the artery is undoubtedly taken as the index of the power of the heart. The “ strength ” of the pulse has no meaning clinically, save as an index of heart power. A “feeble” pulse means to the clinician a feeble heart; a “strong” pulse the reverse. That the pulse can reveal this is the warrant for “ feeling the pulse,” which is the custom of the clinician. The effect of the blood-]>ressure upon the arterial wall could, I ])resume, be expressed in terms of “ degrees of tension,” and it was tlie cidtured ap]>reciation of this which, 1 believe, marked the skill of our ablest physicians; hut it can easily be that the acquisition of this skill is now regarded as too difficult, for the internal ])ressure, whatever it be, is exercised u])on tubes which vary in thickness of wall, in size of lumen, and in the relation of wall to lumen. Tlie term “ tension,” unless only used as a somewhat rough indicator, has thus a very .sul)tle significance. Another aspect of this iiuestion may be referred to,](https://iiif.wellcomecollection.org/image/b28036591_0072.jp2/full/800%2C/0/default.jpg)
