Arterial hypertonus, sclerosis and blood-pressure.

  • William Russell
Date:
1907
Catalogue details

Licence: In copyright

Credit: Arterial hypertonus, sclerosis and blood-pressure. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    tonic contraction, as I have already said, can be followed by the finger, so that tliere is no doubt whatever as to its taking place. What the blood-pressure is inside that tightened-up artery is a totally different problem, and one which can only be dealt with and investigated indirectly. I submit that the readings do not represent blood-pressure. That the state of the arterial wall is sufficient to explain them is probably not far from the precise truth. In fact, my belief is that not only in chronic kidney disease, but in all disorders, the arterial wall has to be given a prominent place when htemomanometer readings are interpreted. That being so, vessel thickening, whenever present, takes from htemomanometer readings the value which has been attributed to them as records of real blood-pressure. At the same time, it must be equally insisted upon that these records are of interest and of value, and are not to be put aside as worthless,—the fate which has befallen them at the hands of not a few very able and critical physicians. With arteries such as are invarialily met with in advanced interstitial nephritis high readings will always be got; but, as has been shown in the preceding cases, there is a wide range of movement in the readings, according to the condition of the patient, although the high level is always maintained. This range indicates the margin within which remedies act, and the effect of these will be found to be use- fully defined and represented by the readings. Had I to make the choice I would select to have my fingers rather than the htemomanometer; but I am glad to have both, for the instrument gives me a record of numbers which I can pre- sent to others, while the skill of my fingers belongs entirely to myself, and cannot be transferred to a chart. The instru- ment, in such cases as those recorded, gives a minute record from hour to hour, and day to day, of the state of the arteries ; and as my contention is that the varying degree of arterial contraction depends upon the condition of the blood, the readings indicate that condition, and they thus become an invalualjle guide to treatinent, and to the daily management of these critical cases. It ia desirable, however, to accentuate the point that a high pressure is not necessarily an indication that relaxing and reducing treatment is to l)e adopted. In