Lectures on renal & urinary diseases / by Robert Saundby.

Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on renal & urinary diseases / by Robert Saundby. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    hard radial pulse so frequently present in contracting kidney ; and this fact, together with the accentuation of the second sound of the heart, has been particularly insisted on by Johnson. Sibson drew attention to the doubling of the first sound often accompanying these two phenomena, and explained all three as evidences of increased blood pressure in the aortic system. Galabin has shown that the high tension pulse occurs in all forms of renal disease, but is most constant in cases of con- tracting kidney. Our present purpose is to enquire into the nature and causes of these changes. This pulse of high tension can be readily recognised. In some cases the radial artery is hard and prominent, feeling, as has been said, like the spermatic cord, but without any un- evenness to suggest calcareous deposit ; in other cases there is nothing noteworthy about the feel of the vessel. The com- pressibility of the pulse can be best estimated by placing the forefingers of both hands side by side upon the artery, gradual pressure being made with the proximal finger, while the distal finger notes the effect upon the pulse. The sphygmographic tracing of the high tension pulse is characteristic. Fig. 7 represents a tracing from a normal pulse. The letter a is placed at the summit of the percus- sion up-stroke, which is caused by the sudden impulseof the ventricular systole, and corresponds in height to the force of the left ventricle. The letter b marks the dicrotic notch ; the little fall is due to the termination of the systole and the little rise to the recoil of the Fig.7. formal pulse tracing, a. At sum- mit of percussion upstroke; b, Dicrotic notch; a to b, Tidal wave. Fig. 8. Pulso tracing, acute nephritis, showing high tension with a relatively feeble ventriclo (myocarditis ?). Fig. 9. Pulse tracing; chronic nephritis with heart failure. High tension with a relatively fooblo ventriclo (brown atrophy p-nd incompetent aortic valves). vessels and the closure of the aortic valves. From a to b is the curve of the tidal wave, which lies below the straight line drawn from a to b. 1 he position of this tidal wave line is the