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Updated: June 9, 2025
The bottle of the gall subtracts from thence all the superfluous choler; whence it is brought to another shop or work-house to be yet better purified and fined, that is, the heart, which by its agitation of diastolic and systolic motions so neatly subtilizeth and inflames it, that in the right side ventricle it is brought to perfection, and through the veins is sent to all the members.
He finds that patients with uremia ordinarily should not be subjected to the Karell cure, such patients needing more fluid. As long as the patient remains in bed, and as long as his ability to exercise is at a minimum, gentle massage is advisable. In these cases of cardiac weakness, with or without dropsy, unless the diastolic pressure is very high, digitalis is valuable.
On the other hand, in neurasthenics the blood pressure is generally lowered. As he points out, there is often a very great increase in the systolic blood pressure at the menopause, while the diastolic pressure may not be high. This makes a very large pressure pulse. This suggests the possibility of disturbances of the glands of internal secretion.
Failing circulation in pneumonia, if accompanied by low blood pressure, requires different treatment from the failure of circulation in these cases when the blood pressure is high. Hence the relationship of the systolic to the diastolic pressure in pneumonia is of very great importance in deciding on the proper treatment.
When there is circulatory defect or abnormal blood pressure, exercise may not increase the systolic pressure, and the pressure pulse may grow smaller. As a working rule it should be noted that the diastolic pressure is not as much influenced by physiologic factors or the varying conditions of normal life as is the systolic pressure.
Of course it should be recognized that the systolic pressure thus obtained will generally be some millimeters above that obtained with the finger, perhaps the average being equivalent to about 5 mm. of mercury. The diastolic pressure will often range from 10 to 15 mm. below the reading obtained by other methods.
It should be remembered that just before death venous pressure is likely to rise, and this may raise the diastolic pressure. With the progressive toxemia of typhoid fever the blood pressure will become lowered from the myocardial degeneration. As in other infections, the blood pressure will fall in scarlet fever; but if it suddenly rises, a kidney complication is to be looked for.
It may be stated that in determining the systolic and diastolic pressure in the peripheral arteries, the ordinary stethoscope is as efficient as any more elaborate auscultatory apparatus.
With the understanding that the difference is only a few millimeters, which is of very little importance, when the diastolic pressure is below 95, it seems advisable to urge the reading of the diastolic pressure at the beginning of the fifth phase.
In arteriosclerosis the systolic pressure may be high while the diastolic is low; hence there is a large pressure pulse. If the heart becomes weak the systolic pressure will drop, and any improvement caused, especially in aortic regurgitation, is by an increase of the systolic pressure.
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