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ASYMMETRICAL BLOOD PRESSURE
1287
ventricle
associated with great apposition of bone, completely the higher reading is the significant one. altering the normal architecture ; but appositioni The possibility of asymmetry should be borne in mind, preponderates. In von Recklinghausen’s generalised1 especially in examination for life assurance. Serious osteitis fibrosa widespread resorption is the essential, error may result from an estimation which is just ,
focal and relativelyT within the normal limits in one arm, if it happens This seems to be the only definite to be 10 mm. Hg of mercury higher in the -other insignificant. difference. less it is, of course,, untested arm. None the histological The paper describes among others the case of a big difference, and the contention of Germanspeaking pathologists that " osteodystrophia fibrosa " a man, aged 36, in whom at one examination the is a great unity, with many subdivisions such as; pressure in the right arm was 170/130, and in the Paget’s disease and von Recklinghausen’s disease, left arm 130/80. A cervical rib was found on the seems to ignore what has been discovered throughleft side. This was removed surgically, and afterwards the asymmetry in the blood pressure gradually experimental physiology and biochemistry. It is difficult to agree with O’Reilly and Race in disappeared until five months later the pressure in their analogy between Hodgkin’s disease and osteitis the right arm was 150/85 and in the left 142/86. deformans. Paget’s disease and granulomatous Stieglitz and Probst endeavour to explain this case inflammations appear to be poles apart. The available by the assumption that the cervical rib, by pressure evidence suggests that osteitis deformans has a on the brachial plexus, produced a decrease in the chemical and not an inflammatory origin, and the tone of the vessels in the left arm, and that as a result histologist who assures us that the changes seen in a compensatory hypertension developed in an attempt the bones of hyperparathyroidism and of osteitis to maintain an efficient circulation. In the absence of deformans differ only in degree, leaves us free to hope any organic cause the asymmetry in the arterial that the aetiology of Paget’s disease is in some way tension probably tends to be transient, but it may analogous to that of hyperparathyroidism. If Paget’s be recurrent, and the suggestion is made that the disease be comparable to Hodgkin’s disease, then the continued reduction of the arterial pressure in a cause must lie inside the bones. This is unthinkable. limb, from whatever cause, may be a factor in the The cause must surely be just as much outside the production of " essential hyperpiesia " by producing bones in osteitis deformans as it is outside the bones a prolonged compensatory arterial hypertension. in generalised osteitis fibrosa. We even feel entitled to expect a solution of this problem in that near future when methods of gauging inorganic salt metabolism TREATMENT OF BRONCHIAL ASTHMA have advanced beyond the crude standards of to-day. IT has long been realised that asthma is a symptom or syndrome rather than a disease, and it has been established that the larger proportion of those ASYMMETRICAL BLOOD PRESSURE from this syndrome show a hypersensitivity suffering IT is customary to take the blood-pressure reading of the mucous membrane of the respiratory tract from one arm only, and the time involved in making to a variety of stimuli. These stimuli may also an additional estimation on every patient would be a produce, either independently or in conjunction with serious consideration to busy practitioners. Yet if asthmatic symptoms, such phenomena as vasomotor the observations of E. J. Stieglitz and D. W. Probst1 rhinitis, and urticaria. As Sir James hay-fever, are of general application, there is a real danger in Dundas-Grant said at a meeting of the section of unilateral estimations, for they found that in 15 per of the Royal Society of Medicine last laryngology cent. of cases where the reading was taken from one week, " the nasal mucosa is the detonator and asthma arm only the systolic pressure in the other arm was is the explosion." Prof. van Leeuwen, of Leyden, higher or lower by as much as 10 mm. Hg and 5 mm. who opened the discussion, supported the view that Hg diastolic. These findings, which agree closely the etiology of vasomotor rhinitis is nearly always with the experiences recorded by W. E. Kay and allergic, and said that the white or bluish-grey K. D. Gardner in 1925/have been arrived at as the on the nasal mucous membrane characteristic patches result of the examination of 600 patients, all adults, of vasomotor rhinitis were present in 90 per cent. comprising private patients, dispensary patients, of 200 cases of asthma treated in his clinic. Of these and applicants for life assurance, the age-groups 200 cases 46 per cent. showed abnormalities of the ranging from 18-60 years. The determinations were septum, 5 per cent. had polypi, and 32 per cent. taken with mercury manometers and repeated read- showed abnormalities of the turbinates ; 26 per cent. ings on the right, left, and again on the right arm had had operations on the nose prior to admission. were made in all cases of asymmetry of the arterial He had observed that there was generally no direct tension. Such asymmetry is apparently not very relation between nasal abnormalities and the asthma, unusual, and the teaching that it is limited to casesand concluded that as a rule the effectiveness of antiof aortic aneurysm and trauma will have to be allergic therapy was not dependent on the nasal reconsidered. Stieglitz and Probst carried theircondition, though in rare cases an operation on the investigations further and attempted to find whatnose or cauterisation has undoubtedly brought relief. types of cases were more likely to give different He recommended the postponement of operation as readings, apart from such obvious causes as cervical long as possible while specific and non-specific rib, injury to a limb with resulting atrophy, arterio-(desensitisation was being tried. Mr. Walter Howarth venous aneurysm, and the like. They found that it[agreed that the results of nasal treatment were was more common in adults with hypertension, and( disappointing ; 10 per cent. of his cases showed in those showing marked vasomotor instability, sexi mprovement after cauterisation, and there were a not being a factor ; they showed also that the higher few definite cures. He was, however, more favourably systolic and diastolic readings were generally foundlisposed towards nasal interference in vasomotor on the right rather than on the left side. Since the r°hinitis, in particular the establishment of a free origin of the pressure is the pumping force of the left irway and empirical cauterisation. Approaching the subject from the pathological standpoint, Dr. A. F. 1 Amer. Jour. Med. Sci., 1932, clxxxiv., 335. 2 Calif, and Western Med., 1925, xxxiii., 578. Wright stressed the importance of secondary bacterial
and excessive
apposition
is
’
,
THE
ventricle
associated with great apposition of bone, completely the higher reading is the significant one. altering the normal architecture ; but appositioni The possibility of asymmetry should be borne in mind, preponderates. In von Recklinghausen’s generalised1 especially in examination for life assurance. Serious osteitis fibrosa widespread resorption is the essential, error may result from an estimation which is just ,
focal and relativelyT within the normal limits in one arm, if it happens This seems to be the only definite to be 10 mm. Hg of mercury higher in the -other insignificant. difference. less it is, of course,, untested arm. None the histological The paper describes among others the case of a big difference, and the contention of Germanspeaking pathologists that " osteodystrophia fibrosa " a man, aged 36, in whom at one examination the is a great unity, with many subdivisions such as; pressure in the right arm was 170/130, and in the Paget’s disease and von Recklinghausen’s disease, left arm 130/80. A cervical rib was found on the seems to ignore what has been discovered throughleft side. This was removed surgically, and afterwards the asymmetry in the blood pressure gradually experimental physiology and biochemistry. It is difficult to agree with O’Reilly and Race in disappeared until five months later the pressure in their analogy between Hodgkin’s disease and osteitis the right arm was 150/85 and in the left 142/86. deformans. Paget’s disease and granulomatous Stieglitz and Probst endeavour to explain this case inflammations appear to be poles apart. The available by the assumption that the cervical rib, by pressure evidence suggests that osteitis deformans has a on the brachial plexus, produced a decrease in the chemical and not an inflammatory origin, and the tone of the vessels in the left arm, and that as a result histologist who assures us that the changes seen in a compensatory hypertension developed in an attempt the bones of hyperparathyroidism and of osteitis to maintain an efficient circulation. In the absence of deformans differ only in degree, leaves us free to hope any organic cause the asymmetry in the arterial that the aetiology of Paget’s disease is in some way tension probably tends to be transient, but it may analogous to that of hyperparathyroidism. If Paget’s be recurrent, and the suggestion is made that the disease be comparable to Hodgkin’s disease, then the continued reduction of the arterial pressure in a cause must lie inside the bones. This is unthinkable. limb, from whatever cause, may be a factor in the The cause must surely be just as much outside the production of " essential hyperpiesia " by producing bones in osteitis deformans as it is outside the bones a prolonged compensatory arterial hypertension. in generalised osteitis fibrosa. We even feel entitled to expect a solution of this problem in that near future when methods of gauging inorganic salt metabolism TREATMENT OF BRONCHIAL ASTHMA have advanced beyond the crude standards of to-day. IT has long been realised that asthma is a symptom or syndrome rather than a disease, and it has been established that the larger proportion of those ASYMMETRICAL BLOOD PRESSURE from this syndrome show a hypersensitivity suffering IT is customary to take the blood-pressure reading of the mucous membrane of the respiratory tract from one arm only, and the time involved in making to a variety of stimuli. These stimuli may also an additional estimation on every patient would be a produce, either independently or in conjunction with serious consideration to busy practitioners. Yet if asthmatic symptoms, such phenomena as vasomotor the observations of E. J. Stieglitz and D. W. Probst1 rhinitis, and urticaria. As Sir James hay-fever, are of general application, there is a real danger in Dundas-Grant said at a meeting of the section of unilateral estimations, for they found that in 15 per of the Royal Society of Medicine last laryngology cent. of cases where the reading was taken from one week, " the nasal mucosa is the detonator and asthma arm only the systolic pressure in the other arm was is the explosion." Prof. van Leeuwen, of Leyden, higher or lower by as much as 10 mm. Hg and 5 mm. who opened the discussion, supported the view that Hg diastolic. These findings, which agree closely the etiology of vasomotor rhinitis is nearly always with the experiences recorded by W. E. Kay and allergic, and said that the white or bluish-grey K. D. Gardner in 1925/have been arrived at as the on the nasal mucous membrane characteristic patches result of the examination of 600 patients, all adults, of vasomotor rhinitis were present in 90 per cent. comprising private patients, dispensary patients, of 200 cases of asthma treated in his clinic. Of these and applicants for life assurance, the age-groups 200 cases 46 per cent. showed abnormalities of the ranging from 18-60 years. The determinations were septum, 5 per cent. had polypi, and 32 per cent. taken with mercury manometers and repeated read- showed abnormalities of the turbinates ; 26 per cent. ings on the right, left, and again on the right arm had had operations on the nose prior to admission. were made in all cases of asymmetry of the arterial He had observed that there was generally no direct tension. Such asymmetry is apparently not very relation between nasal abnormalities and the asthma, unusual, and the teaching that it is limited to casesand concluded that as a rule the effectiveness of antiof aortic aneurysm and trauma will have to be allergic therapy was not dependent on the nasal reconsidered. Stieglitz and Probst carried theircondition, though in rare cases an operation on the investigations further and attempted to find whatnose or cauterisation has undoubtedly brought relief. types of cases were more likely to give different He recommended the postponement of operation as readings, apart from such obvious causes as cervical long as possible while specific and non-specific rib, injury to a limb with resulting atrophy, arterio-(desensitisation was being tried. Mr. Walter Howarth venous aneurysm, and the like. They found that it[agreed that the results of nasal treatment were was more common in adults with hypertension, and( disappointing ; 10 per cent. of his cases showed in those showing marked vasomotor instability, sexi mprovement after cauterisation, and there were a not being a factor ; they showed also that the higher few definite cures. He was, however, more favourably systolic and diastolic readings were generally foundlisposed towards nasal interference in vasomotor on the right rather than on the left side. Since the r°hinitis, in particular the establishment of a free origin of the pressure is the pumping force of the left irway and empirical cauterisation. Approaching the subject from the pathological standpoint, Dr. A. F. 1 Amer. Jour. Med. Sci., 1932, clxxxiv., 335. 2 Calif, and Western Med., 1925, xxxiii., 578. Wright stressed the importance of secondary bacterial
and excessive
apposition
is
’
,
THE