524 CIRCULATION OF BLOOD AND LYMPH. 



pathological conditions, however, a secondary wave more or less 

 clearly marked may appear, as is shown, for instance, in the 

 tracing given in Fig. 214. Such waves are recorded in cases of 

 stiff arteries or stenosis of the semilunar valves. In the normal 

 individual an anacrotic pulse in the radial may be obtained, 

 according to von Kries.f by raising the arm. He believes that 

 in this position the reflection of the pulse wave from the periph- 



Fig. 216. — Sphygmograms illustrating the effect of variations in blood-pressure, partic- 

 ularly upon the position of the dicrotic wave and notcli : n, Tlie dicrotic notcli ; d, the 

 dicrotic wave. A, Sphygmogram while blood-pressure was relatively low. B, Sphygmo- 

 gram with higher blood-pressure. (Mackenzie.) 



ery is favored, and that the anacrotic wave is simply a quickly 

 reflected wave. An opposite interpretation, however, is given 

 by von Recklinghausen, who states that conditions which lead 

 to a diminution in vascular tone and a dilation of the arteries 

 produce "weak reflection" and an anacrotic pulse. Constric- 

 tion of the small arteries in any system favors quick reflection 

 in the artery supplying the system and produces a pulse with a 

 sharp-pointed apex. 



Characteristics of the Pulse in Health and in Disease. — 

 By mere palpation the physician obtains from the pulse valuable 

 indications concerning the heart and the circulation. The fre- 

 quency of the heart beat is at once made evident, so far at least as 

 the ventricle is concerned. One may determine readily whether 

 the frequency is above or below the normal, whether the rhythm 



* Von Kries, "Studien zur Pulslehre," 1892. 



