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With the Aid of a Nezv Instrument.
By James F. Prendergast, M. D.,
The value of the sphygmomanometer as a diag-
nostic help is acknowledged by all up to date clini-
cians : the factor which has caused the greatest
amount of discussion and which has been the stum-
bling block to many doctors using it, is the taking
January u, 1913. 1
of the diastolic pressure. The reading of the sys-
tolic pressure is easily acquired with a little prac-
tice, and is fairly accurate for clinical purposes.
The taking of the diastolic pressure, however, is
an entirely different proposition, and 1 venture to
add, very few users of the instrument obtain accu-
rate readings of the diastolic pressure and fewer yet
by far can interpret its value after they have ob-
tained it. This is based on a large experience in
demonstrating and teaching the value of the sphyg-
momanometer for clinical use. It is this uncertainty
and difficulty that has caused so many different
makes of manometers to be placed on the market,
each new model asserting some advantage over its
predecessor particularly in the taking of the dias-
tolic pressure; all of them however depending on
the tactile sense, the excursions of the mercury in
the tube or on the oscillations of the needle in the
pocket type of instrument.
Now it is very difficult, at times, even for the
expert to say just which is the widest excursion of
the mercury column or the greatest swing of the
needle, at which point the diastolic pressure is de-
termined, hence one can imagine the difficulty of
the inexpert or the average physician who is only
occasionally called on to take blood pressure read-
ings. I have seen a number of cases where the
variations in Generic Risperidone the swing of the needle and the play
of the mercury column were so nearly equal that it
was almost impossible to read accurately the dias-
tolic pressure.
To overcome this difficulty the writer advises the
use of the auscultatory method of determining the
blood pressure.
In October, 1905, Korotkoff, of St. Petersburg,
first advocated the determination of blood pressure
by auscultation, and this method has been thor-
oughly studied and generally adopted by the Ger-
man clinicians as a routine procedure. Ettinger,
Ehret, Krylow, Bozowski, Fischer, Sterzing, and
Schrumpf abroad, Goodman, Howell, Gittings, and
Norris in this country have studied and investigated
this method and recommend it as more accurate
than by palpation of the radial pulse or watching
the oscillations of the column of mercury or the
In order to enable the physicians to take the
blood pressure readings more accurately and to
make them of greater clinical value to the profes-
sion as a diagnostic and therapeutic guide, my
instrument makers have placed on the market, at
the suggestion of the writer, an auscultoscope. It
consists of a two inch band to which is attached a
metal bowl or cup the face of which has a very deli-
cate diaphragm with a centre projection to fit more
snugly to the surface of the arm over the brachial
artery just at or below the bend of the elbow.
Flexible rubber tubes are connected with the drum
or body of the instrument to which are attached
hard rubber ear pieces. It is called the Bowles
sphygmometroscope and resembles the Bowles
stethoscope with certain modifications ; it is attached
to the arm by a two inch band.
The instrument is intended for use with any kind
or form of sphygmomanometer either pocket or
mercury. Its method of application is to place the
band on the arm one or two cm. (one half to one
inch; below the arm band or cuff of the sphygmo-
manometer at the bend of the elbow, having the
projection on the diaphragm of the drum directly
over the brachial artery before it divides into the
ulnar and radial, care being taken to avoid pressure.
Pump the Purchase Risperidone cuff connected with the manometer
with air until the radial pulse is cut off, open the
release valve, and allow the air to escape slowly
from the arm band. The first impulse or sound
heard is the systolic pressure, a clear thump or tap
caused by the sudden stretching of the walls of the
relaxed vessel and the rapidity of the blood stream
(Krylow) ; first phase. Then follows a murmur
(second phase) followed by a clear sound (third
phase), clear sound becomes dull (fourth phase),
disappearance of all sound which is the diastolic
pressure (fifth phase). The systolic and diastolic
pressures are read off the scale of the sphygmo-
manometer as the sounds are
heard. Some clinicians accept
the fourth phase as the diastolic
pressure, but the men who have
had the greatest experience and
have done the most experimental
work accept the fifth phase as
the true diastolic pressure.
Where one is merely trying to
read the systolic and diastolic
pressures it is not necessary to
attempt to interpret the differ-
ent phases. The essential thing
to remember is, that the first tap
or sound is the systolic pressure
and just at the disappearance of
all sounds is the diastolic pres-
sure. Clinican experience and
laboratory experiments will in
time help us accurately to determine the meaning of Purchase Risperidone Online
the different phases or sounds. For instance, Fischer
found in cases of high diastolic pressure the first
sound or phase was loud and clear, the second when
present was short but clear. If the third was short
the fourth could not be heard.
In arteriosclerosis with hardening and loss of
elasticity in the bloodvessels, Krylow says, the aus-

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