IN my opinion the result of the observations carried
out in the series of cases described in the thesis,
fully proves the great importance of a regular and
careful estimation of the blood- pressure during the
progress of a case of lobar pneumonia.
Whilst my results do not altogether agree with
those obtained by some of the observers on the same
subject, they no less emphatically point to the value
of the sphygraometer both as a prognostic agent and a
I find that the crisis is practically always fol-
lowed by a slight fall in the blood -pressure, although
such a fall may be quite temporary.
If the blood -pressure in millimetres of mercury
is above the pulse rate in beats per minute, it is by
no means certain that a recovery will result.
But if we exclude patients in the higher ranges
of life, and those in whom, owing to arterial or nephritic disease, we expect a hyper normal pressure,
then, as a general rule, we may say that when the
blood-pressure in millimetres of mercury is above the
pulse rate in beats per minute, a favourable termination
to the case may be expected.
On the other hand, when the blood-pressure is
below the pulse rate, this is not to be regarded as an
infallible warning of death. In children certainly
this is not true, and in many other cases recovery has
followed in spite of the above position being recorded.
But when the blood-pressure in millimetres of mercury
is far below the beats per minute of the pulse,
then a very hopeless outlook is foreboded.
I would especially lay stress on observing the
variations in the relation of the blood-pressure to
the pulse rate during the illness: and with regard to
this the following rules may be laid down: - That a
rising pulse rate accompanied by a falling or stationary
blood-pressure; or a falling blood -pressure with a
rising or stationary pulse, is to be looked upon with
gravity as a sign of impending cardiac failure.
In other words, it must be looked upon as serious
when the blood-pressure which at first is above, begins
to come closer to the pulse rate; and if the original
position becomes changed then very grave danger is
This fact is fully borne out by many cases in the
The converse is equally true - i.e., that where
the blood pressure is at first below but later becomes
nearer and finally above, the pulse rate, a hopeful
view may be taken.
It follows that if the sphygmometer readings
point to impending or threatened cardiac failure, steps
will be taken to stimulate the heart. In this way,
then, the regular recording of the blood-pressure and
the comparison of its height with the rate of the
pulse, will indicate the necessity or otherwise of
therapeutic measures of cardiac stimulation.