Some clinical observations on blood pressure with special reference to the effect of prostatic massage / by David Murray Cowie.

  • Cowie, David Murray, 1872-1940.
Date:
[1910?]
Catalogue details

Licence: Public Domain Mark

Credit: Some clinical observations on blood pressure with special reference to the effect of prostatic massage / by David Murray Cowie. Source: Wellcome Collection.

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    wm 66526800S22 UNNI recognizing small as well as great changes is most satisfactory. Instruments which eliminate as far as possible the personal equation should be chosen. The study of a pulse tracing made with the sphygmograph gives an idea of the pressure at a glance. It does not however unless in conjunction with a mercury manometer, give any trust- worthy record of changes that can be ex- pressed. The chief use of the sphygmo- graph is for recording and interpreting the movements of the heart and the blood coursing through the blood channels. The mercury manometer is the only in- strument of precision we have at our com- mand for clinical records. It is now well agreed that the best form of apparatus 1s one after the idea of the Riva Rocci ma- These instruments register the systolic pressure and may be connected with a tambor and chymograph for the registration of the diastolic pressure. The systolic pressure is obtained by taking the reading after the The diastolic registers the maximum pulsation of the chine with wide armlet, 12 cm’s. first return of the pulse. artery and is always considerably lower than the systolic. When a blood pressure is reported it is usually understood to be systolic unless otherwise stated. The force of the heart, the resistance against which it acts, nervous, and psychic influences are the factors which sustain and alter blood pressure. All of these fac- tors must be considered when we endeavor to interpret the estimated blood pressure in a given case. Under normal conditions the pressure is higher after exertion, higher after sitting than after lying. There is al- ways a tendency for the pressure to as- sume a level. This is well illustrated in the case of the athlete. At the beginning of a forced run there is an enormous rise in the pressure due to the enforced heart strain. This gradually sinks and assumes a new level when the runner gets his so-called second wind, and returns to normal after the run» [he: same 1s’ true; bitetosas less extent, of the patient who comes to the of- fice for observation. When he enters, par- ticularly if he has come up a flight of stairs, his pressure is often ten or fifteen millimeters higher than after he has re- mained quiet for a few minutes. The effort of taking off the coat and rolling up the sleeve gives a record on the manometer sev- eral points in advance of the record ob- tained during rest. In making permanent records it is therefore necessary to record a pressure level. The pressures I will re- port are all pressure levels. My plan is to take the pressure immediately after taking off the coat and twice after having re- mained quiet for five or ten minutes, the last two records must harmonize closely. ° Suggestion has a powerful effect on ar- terial pressure. A man is sitting quietly reading a book, something he reads causes a quick uncontrollable flush to come into his face, something has momentarily low- The effect of mental emotion on blood pressure has been well ered his pressure. illustrated by the classical case of John Hun- ter, the victim of angina pectoris who said “My life is in the hands of any rascal who chooses to annoy and tease me.” Uncon- sciously in susceptible individuals mo- mentary changes may be produced by the attitude we assume toward them. The in- creased blood in the splanchnic system during the digestion of a meal causes low- ering of the peripheral blood pressure. Normally there is always a balance main- tained; but in those individuals who com- plain of chilliness and clammy hands after is an over balance on the meals there
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