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pressed (preferably in a concentric manner) the greatest amplitude of the arterial pulsation will be observed when the amount of the compression is equal to the lowest pressure within the vessel under consideration. That the principle is faultless has been demonstrated experimentally by Howell and Brush (i). This minimum pressure being found in the arteries during the diastole of the ventricles the name of diastolic pressure has also been applied to it. The instruments which have been devised to meas- ure the arterial pressure in man are numerous. They may be grouped into three classes: i. Instruments using a mercury manometer to indicate the amount of compression to Is 30mg Of Cialis Safe which the artery is subjected. 2. Instruments using an aneroid drum. 3. Instruments using compressed air Is 30mg Of Cialis Safe with a water indicator. The aneroid and compressed air instruments are gradu- ated in millimetres or centimetres of mercury. These instruments may be classified, furthermore, into those employing a cuff by means of which circular com- pression of a segment of a limb may be exerted (up- per arm, finger, wrist) and those employing Is 30mg Of Cialis Safe a pad either solid or fluid for the compression of an indi- vidual artery, usually the radial (Oliver). The great majority of instruments employ circular compression of the upper arm and, therefore, meas- ure the pressure in the brachial artery. In estimat- ing the systolic pressure it is customary to observe the disappearance of the arterial pulsation Is 30mg Of Cialis Safe at the ra- dial (method of Riva-Rocci), occasionally at the brachial below the cuff, at any rate always at some distance from the point of compression. This method of applying Marey's principle is essentially faulty and the results obtained are necessarily erroneous. Indeed it can be shown that while the pulse has dis- appeared at the radial there is a pronounced pulsa- tion in that portion of the brachial artery under compression. Pachon (2), who demonstrated this fact by means of his instrument (to be described presently), and the sphygmosignal of Vaquez, gives the following theoretic explanation of his experi- mental finding : The pulse wave has its origin in the contraction of the ventricle and represents a certain amount of kinetic energy. This wave of pressure spreads from the root of the aorta to the end of the arterial system and in so doing loses energy little by little owing to friction against the sides of the vessels. .\s the resulting distention of the arterial walls is normally extremely slight (Poiseuille) very little e.xternal work is performed Is 30mg Of Cialis Safe by the pulse wave. If, however, a segment of an artery is compressed so that a portion of its internal pressure is counter- balanced, that segment will yield to a greater extent to the distending force of the pulse wave and the vessel Is 30mg Of Cialis Safe wall will begin to move. In other words, external work will be done. The compression may be such that the extent of the movement of the ves- sel wall (hence the amount of work done by (he pulse wave) will exactly balance the amount of en ergy possessed bv the wave. At this moment the pulse wave is entirely utilized in performing me- chanical work, it is, therefore, absorbed at this point and no pulsation can be felt below it; the blood flow, however, has not been interrupted, the intermittent flow has merely been changed into a continuous one. This explains why wide cuffs with a larger area for the absorption of the pulse wave, give lower figures than narrow ones. It serves to explain also why the arterial pressure in man ap- pears so low in comparison to that observed in the BACHMANN: ARTERIAL PRESSURE. ther mammalia. Benczur (3) reached practically le same conclusions by the combined use of the Recklinghausen and Gartner instruments. Marey's principle for the determination of the linimum or diastolic pressure has been more cor- ;ctlv applied in that the oscillations of the com- ressed artery are transmitted directly to the instru- lent and their amplitude noted. As stated by 'achon (4), however, the instrument which is to ^produce these pulsations must have both a great nd a constant sensibility. The mercury manometer as naturally a constant sensibility, but owing to the lertia of the Is 30mg Of Cialis Safe mercury this sensibility is but slight, irely not sufficient to enable one to compare dif- ;rences in the amplitude of oscillations at various ■vels of Is 30mg Of Cialis Safe pressure. Everyone who has used the iercur\- manometer for the determination of the iastolic pressure is impressed Is 30mg Of Cialis Safe with its imperfec- ons for this purpose. A few investigators have Jiight to overcome this defect by placing an elastic tg in connection with the cuff through which com- , nation the arterial pulsations are taken up and ' ansmitted, by appropriate means, to a tambour to .' magnified and graphically recorded (Erlanger, skew). The first objection to this method is that le bag cannot be made sensitive on account of the ;latively high pressure to which it must be sub- cted. The second objection is that such a bag has 3t a constant sensibilit}- at various pressure levels. he amplitude of its oscillations will be smaller the reater its state of tension (distention), the force : the- oscillations remaining the same. It will, lercfore, lead to error to compare the amplitude ■ oscillations obtained at various pressure levels. .*\11 these objections have been removed in the mple and ingenious instrument devised recently by achon (5). The main features in the construction ' this instrument, which he names a sphygmome- ic oscillometer, can best be understood by refer- ng to Fig. I. t'lG. \ — Diagram showing tlic relatioD of the essential parts_ of chon's sphysfmomctric oscillometer. (After Pachon.) B is a rigid -lallic box hermetically scaled and containing in its interior an eroid drum a with which Is 30mg Of Cialis Safe is connected the lever «. M is an eroid manometer which indicates the level of the pressure in the lire system. The box, manometer, aneroid drum o, and the cuff e normally in free communication by means of the tubes d, e, f. »e pressur*.- can be raised in the system by means of the pump P: Is 30mg Of Cialis Safe can be lowered by allowing tlic air to escape by unscrewing the ' Ive t. The cuff and the aneroid a can be cut off from the rest the apparatus by compressing the rubber tube d by means of the ipTe»sor c (called separator hy Pachon). The position of the aneroid a is in the interior