In the above figures I am presuming that the auscultatory method of
determining pressure has been used. It must also be manifest that, the
earlier treatment begins, the more sure will be the success. It may be
that all our theories will meet the ultimate fate of so many others and
be abandoned, or partially disproved, but the practical therapeutic
results will remain--an increased capacity for work and considerable
prolongation of the later years of life.
For a short and graphic description of the two methods of estimating
pressures I am poaching from an excellent book called _Blood-pressure
Technique Simplified_, by Dr. W. H. Cowing, of America (pp. 12–15):--
“There are two methods of determining blood pressure, that by
oscillation, and that by auscultation.
“We will first describe the method by oscillation.
“Place the bag over the arm with the two tubes well under the arm and
over the brachial artery. Wrap the remainder of the sleeve around
the arm much the same as you would apply a bandage, tucking at
least six inches of the sleeve under the last fold. Then place the
sphygmomanometer in one tube and the bulb in another, and you are ready
for reading. Care should be taken not to put the sleeve on tight enough
to cause any apprehensive feeling in the patient.
“Place the finger lightly over the radial artery and send the pressure
in the cuff to the point where the pulse has entirely disappeared,
then advance the hand about 2 cm. above this point of disappearance,
then release the air gradually and note the first perceptible pulse
wave felt by the palpating finger at the wrist. This represents the
true systolic or maximal pressure.
“Having now obtained the systolic or maximal pressure, release the air
gradually by means of the escapement valve, and note where the largest
oscillation or movement of the hand takes place, and the lowest point
of this largest oscillation is the diastolic or minimal pressure.
“For example, if the largest oscillation occurred between the divisions
90 to 96, 90, being the lowest, would be the reading.
“It is well to bear in mind to keep the eye concentrated on the scale
divisions, for the travel of the hand can be accurately determined when
this is done.
“In determining systolic (maximal) pressure, the pulse becomes more
feeble as the pressure advances, and when taken with the ends of the
fingers, the pressure of the fingers is involuntarily increased, so
that a very sensitive pulse may be closed off entirely by the finger
pressure; while, if taken with the ends of the fingers resting on the
upper curve of the bone of the wrist, permitting the balls of the
fingers to rest lightly over the radial, thus bringing in contact with
the pulse the most sensitive part of the fingers, any extra pressure
that might result would be directed against the bone and not the pulse.
Public-domain text, read in full here on John Shaqi.
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