The examination of the pulse : including a description of the sphygmograph / by Byrom Bramwell.

  • Bramwell Byrom, Sir, 1847-1931.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: The examination of the pulse : including a description of the sphygmograph / by Byrom Bramwell. 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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    10 15). This is chiefly the case where there has been some previous elevation of temperature, or where the nerve irritability of the heart is increased. 3. In deranged innervation of the heart (paralysis of the vagus or irritation of the sympathetic, the latter being the most common cause). In some of these cases the pulse is extremely rapid, as in exophthalmic goitre. 4. In some cases of organic cardiac disease, especially mitral lesions (see fig. 14), and to a less extent in aortic regurgitation (see fig. 11). The Clinical Significance of Increased Frequency of the Pulse. Increased frequency of the pulse, when not merely temporary, is very suggestive of the presence of pyrexia. It is, however, per se, an unreliable sign of fever, for, on the one hand, fever may be present without increased frequency of the pulse, as in typhoid and meningitis; or, on the other, increased frequency of the pulse may occur without fever, or even with a low temperature, as in pro-agonistic collapse. In order to ascertain the cause of the increased frequency of the pulse, the first step is to ascertain the presence or absence of pyrexia (by means of the thermometer). If there is no pyrexia, the causes mentioned under heads 2, 3, 4 must be looked lor. Diminished Frequency of Pulse (slow pulse). The chief pathological conditions associated with a slow pulse are:— 1. Functional derangement of the heart, as in some cases of gout, jaundice. 2. Organic lesions of the heart, as fatty degeneration, aortic stenosis (see fig. 13). 3. Organic lesions of the nervous system, causing irritation of the vagi or their roots, as meningitis, compression, etc. 4. In the rapid defervescence of fever the frequency of the pulse is often very strikingly diminished. The Clinical Significance of a Slow Pulse. Where it occurs per se—i.e., without any obvious cause, as in senectus—it is of little importance. The possibility of its being due to irritation about the roots of the vagi must be remembered, and the symptoms of disease at the base of the brain, medulla, looked for. In other cases its clinical significance depends upon the cause of the associated condition, jaundice, etc., etc. The Rhythm of the Ptdse. In health the pulse is perfectly regular both in time1 and volume (see fig. 10).