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of potassium internally, together with good food, suitable hygienie surroundings, and appropriate external means.
If the chlorate of potassium be employed, with the aids just named, upon persons afflicted with scrofula, it will be found that the remedy will fulfil all that I have claimed for it, and will place such individuals in such a healthy coulition that in case of marriage the issue will be sound and healthy.
SPAYGMOGRAMS: WITH NOTES OF AUTOPSIES.
By H. R. HOPKINS,
BUFFALO, N. Y.
The sphygmograph has been before the profession for nearly twenty years; its uses and advantages have been ably presented by eminent writers and speakers, various modifications and inprovements in its mechanism have been introduced, and yet it has no place among the clinical aids of the practical physician. Evidently we have before us a case of arrested development, and one that must have been a bitter disappointment to the men who heralded with so much enthusiasm the advent of the newcomer. What are the reasons for this delay of appreciation and recognition of the value and work of the sphygmograph ? Plainly the cause is the fact that in a measure there has befallen this instrument that which so frequently befalls beautiful theories and well-constructed hypotheses, the failure to stand the test of verification. The sphyymograph has not done the work which commands recognition. In the hands of a few expert observers it does reveal the secrets of the circulation of the blood in an encouraging way; but even these few men are obliged to real its characters by faith rather than by sight; while in the bands of the average observer its records are uncertain, contradictory, and discouraging. Is this failure for the reason that the end sought is from the nature of things unattainable, or is the delay that which is incident to real growth? The settlement of this question cannot but be of interest; it needs no argument to establish the fact that the phenomena of the circulation of the blood, physiological and pathological, are the most complex, the most universal, and the most important that can engage the attention of the physician. Equally true is it that of all methods of studying physiological phenomena, the graphic method is by far the most successful; consequently we are not surprised that the inventor of the sphygmograph-an instrument which has
for its work the task of making apparent the otherwise imperceptible qualities of the pulse, and of fixing these qualities in a legible and permanent record-should herald his discovery as one that was to be of the utmost practical importance. It hy no means follows, because twenty years bave passed without bringing the realization of these bopes, that the premises upon which a great future for the new instrument was claimed were untenable ; that study in this direction must of a necessity be fruitless; that this was another attempt to attain the unattainable.
If the fundamental proposition, that, besides the number of beats per minute, the pulse has other qualities of the greatest physiological and pathological interest, be true, then the inventor of the sphygmograph had reason for his expectations, and the time has not yet come for his complete discouragement. Strong magnifying glasses were used in the study of anatomy more than two hundred years ago, but the achromatic objective and the science of histoloyy are works of our own day.
Every one who has used the sphygmograph will bear witness, that, imperfect and unsatisfactory as it is, it unquestionably demonstrates that there are in the pulse important qualities imperceptible to the touch. What these qualities are, what relations they bear to health and to disease, are questions upon whichi the sphygmograph must furnish much information before it enters upon its future. In order to gain this information there must be many observers, and very many observations; the instrument must be made infinitely more sensitive, more precise, and more uniform in its performance than at present. Observations will always be vitiated by personal and instrumental errors. The work of eliminating these errors, of drawing the proper inferences and reaching safe generalizations, can only be done by correcting the labors of one man by the aid of the labors of others. As a step in this direction, your attention is called to the accompanying traces.
In presenting these sphygmograms, I wish to say that they are printed from a copperplate prepared by Mr. Henry Chandler, of Buffalo, and are perfect fac similes of the originals, now in my possession.
I have omitted to note, as I also fail to observe, the pressure under which they are taken, being convinced that there is only one pressure appropriate to a given pulse, and that the trace itself
can be relied upon to show whether the right or the wrong pressure was used in its taking.
In general, the degree of pressure requisite to obtain traces is determined, not so much by the state of the pulse as by the quality and quantity of the tissues of the wrist. In general this is the case; but on arteries, where the tension is high, more pressure is needed than on those of low tension, quite irrespective of the state of the overlying parts. If this is the case, I cannot see the propriety of registering the pressure used, as the degree of arterial tension will record itself in the trace, and the condition of the parts has no special bearing upon the subject.
The traces were taken from subjects whom I have had frequent opportunities of observing, and I am confident that each trace is characteristic of the pulse which it represents, and that this was the habitual pulse of the individual.
They are selected for the reason that, in each case the peculiarity of the pulse was plainly apparent to the touch. This was particularly the case in Figs. 4, 5, 6, and 7, which are examples of high arterial tension. In each of these the artery was overfull between beats, could be traced far up the forearm; could be rolled under the finger like a tendon, and in varying degrees were long, hard, and persistent pulses.
The autopsies were made in the presence of several members of the profession, and there was no disagreement as to the pathological conditions present. With the exception of Fig. 8, they were taken with Poud's sphygmograph, rebuilt by Mr. A. M. Edwards, of Buffalo, who is at work upon the matter of determining how simple and accurate an instrument can be devised for this purpose. Fig. 8 was taken with his instrument.
I submit these traces to the criticism of the profession, be. lieving that each trace, in its way, represents something of the peculiarity of its subject, and also believing that we have only to diligently observe, record, and compare observations in order to furnish data, from which will be drawn the deduction that many of our chronic diseases have characteristic sphygmograms; that the peculiarity of the circulation is one of the earliest manifestations of disease, and that its recognition is of the utmost diagnostic and prognostic importance.
Figs. 1 and 2 were taken from patients in the Buffalo General Hospital, from cases of ataxia of long standing; Fig. 1 of two, and Fig. 2 of five years.