(5) The appearance of the dicrotic is not retarded if an elastic tube
is placed between the periphery and the place where the instrument is
adjusted. If the dicrotic were due to a wave reflected at the periphery
it would be retarded because the wave would have to travel a distance
so much greater.
These arguments prove the impossibility of the theory of the peripheral
origin of the dicrotic wave. Also the other hypothesis meets with a
number of serious difficulties, and we mention the following facts
which are arguments not against any special form of this theory, but
against any hypothesis which starts from the assumption that the
dicrotic elevation is due to a wave travelling from the heart to the
periphery.
(1) The descent of the catacrotic phase ought to be a succession of
diminishing waves, but not a slow descent with merely small elevations.
(2) This hypothesis accounts for none of the abnormal pulse forms.
(3) The blood ought to push against the semilunar valves with a
force not less than 1/2 - 2/3 of the force of the contraction of the
ventricle, because this is about the relative height of the first
secondary elevation with regard to the primary wave, which is due to
the contraction of the ventricle.
(4) It does not account for the disappearance of the dicrotic
elevation through lack of elasticity of the arterial wall: for the
dicrotic elevation is most marked in youth, becomes lower in old age,
and disappears in diseases like atheroma and arteriosclerosis, which
impair the elasticity of the arterial wall. Landois's theory overcomes
this theory only apparently, although the dicrotic would be absent, yet
in that case the descent of the primary wave ought to be as steep as
its ascent.
(5) This theory is refuted by the experiment of v. Kries, who proved
the existence of the dicrotic if the heart is replaced by a valveless
bag.
The obvious impossibility of making the theories agree with the facts
does not permit one to accept any of them. All of them are based on the
supposition that the dicrotic elevation is due to a wave travelling in
the blood, and this belief is founded on the following argument: If a
wave travels in the blood the sphygmographic curve shows an elevation;
the dicrotic elevation is an elevation in the sphygmographic curve.
Therefore, the dicrotic elevation is due to a wave travelling in the
blood. This fallacy is responsible for the astonishing fact that the
refutation of one of two apparently contradictory statements does not
prove the other. It is characteristic of the present state of the
problem concerning the origin of the dicrotic elevation, that a modern
writer[63] calls it "inextricably complicated."
Public-domain text, read in full here on John Shaqi.
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