THE PULSE. 527 



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 

 is regular or irregular. By the same means one can determine 



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

 ularly upon the position of the dicrotic wave and notch : n, The dicrotic notch ; d, the 

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

 gram with higher blood-pressure. (Mackenzie.) 



whether the pulse is large (pulsus magnus) or small (pulsus parvus), 

 whether the wave rises and falls rapidly (pulsus celer) as happens 

 in the case of insufficiency of 'the aortic valves, or whether in one 

 phase or the other it is more prolonged than normal (pulsus tardus). 

 It seems obvious, however, that a more satisfactory conclusion may 

 be reached in all such cases by obtaining a sphygmographic record. 

 In the works devoted to clinical methods numerous such sphygmo- 

 grams are described. By mere pressure upon the artery one can 

 determine also approximately whether the blood-pressure is high 



