RECENT CONTRIBUTIONS TO SPHYGMO- 
GRAPHIC SCIENCE 
BY 
A . B . ISHAM, M . D . 
PROFESSOR OF PHYSIOLOGY IN THE CINCINNATI COLLEGE OF 
MEDICINE AND SURGERY. 
[reprinted from “archives of medicine,” august, 1879.] 
NEW YORK 
G. P. PUTNAM’S SONS 
182 fifth avenue 
1879 Recent Contributions to Sphygmographic Science. 
The most valuable recent contributions to this comparatively 
new branch of medical science, have been made by Dr. A. T. 
Iveyt. His papers present purely original work, and they are as 
follows : 
1. The New Sphygmograph.—Paper read before the American 
Medical Association, May, 1875 ; abstract in N. Y. Medical Record, 
May 22, 1875 ; published in full in N. Y. Medical Journal, Jan- 
uary, 1876, and Cincinnati Clinic, April 29, 1876. 
2. Cardiographic and Sphygmographic Studies; with demon- 
strations of the Form, Relationship and Chronometry of the Car- 
diac and Arterial Movements, and interpretations of the graphic 
curves.—N. Y. Medical Journal, July, 1877, and Cincinnati Clinic, 
Aug. 25 and Sept. 1, 1877. 
3. Cardiographic and Sphygmographic Studies; demonstrating 
the time-differences of pulse-wave between different arteries; 
duration of the heart-carotid, and presphygmic intervals ; time 
relations of secondary waves, and the velocity of pulse-wave 
along different arteries.—N. Y. Med. Jour., Feb’y, 1878 ; Clinic, 
Apr. 13, 1878. 
4. The Human Heart's Revolution, and Relation to it and each 
other of Ventricular Systole and Diastole.—N. Y. Med. Jour., 
July, 1878 ; Cin. Lancet and Clinic, Aug. 31, 1878. 
5. The Velocity of the Pulse-Wave and Duration of the Ven- 
tricular-Carotid, and Ventricular-Presphygmic intervals in Young 
Children.—N. Y. Med. Jour., July, 1878 ; Cin. Lancet and Clinic, 
Aug. 31, 1878. ARCHIVES OF MEDICINE. 
6. Observations on Bertha Von Hillern s Pulse.—Cin. Clinic, 
Apr. 20, 1878. 
7. O'Leary's Pulsations.—Cin. Lancet and Clinic, July 13, 1878. 
8. The Pulsations of the Fontanel; their Form and Mechanism, 
and Relations to the Pulsations of the Heart and Arteries and Move- 
ments of Respiration.—Cin. Lancet and Clinic, Sept. 21, 1878. 
9. The Influence of Muscular Exercise upon the Arterial and 
Cardiac Pulsations.—Cin. Lancet and Clinic, Nov. 2, 1878. 
10. The Sphygmographic Indications of Heart Disease—Mitral 
Regurgitation.—Lancet and Clinic, March 22, 1879. 
11. The Sphygmographic Indications of Heart Disease—Aortic 
Obstruction.—Lancet and Clinic, April 19, 1879. 
11. The Influence of the Respiration upon the Form, Rhythm and 
Succession of the Cardiac and Aiderial Pulse-Curves.—Lancet and 
Clinic, June 7, 1879. 
The instrument used by Dr. Keyt is one invented and perfected 
by himself It consists of two uniform sphygmographs and a chron- 
ograph arranged and combined in one apparatus, so that one 
writes its record above the other upon the same smoked glass 
tablet. The sphygmographs receive the pulsations through the 
media of elastic membranes, and a column of alcohol above each 
membrane conveys them to the writing levers. The chronograph 
runs by clock-work, and writes fifths of seconds. By means of 
this combined instrument the pulsations at two different points can 
be simultaneously traced, their characters studied and compared, 
and their time relations determined. Without further description 
it may be said that the work of the instrument furnishes ample 
proof of its efficiency and accuracy. By no other instrument 
known to the profession could such results have been obtained. 
Tig. 1 shows exactly the principle of the instrument, although the 
details of construction, as since improved by the inventor, differ 
considerably from this representation. 
The articles are all illustrated with original actual tracings from 
which the author formulates his conclusions. The plates, with 
tracings of superior excellence and appropriate markings, show the 
results of the various experiments, and exhibit on their face in- 
con tesfible proofs of the fidelity of the work. A few plates are 
here reproduced to show the method and style of the illustrations. 
The following is a summary of the facts and conclusions an- 
nounced : 
1. In the normal human cardiogram, ventricular systole be- 
gins at the] lowest point of the main ascending line, and changes ABSTRACTS AND SUMMARIES 
3 
into diastole at the highest point of the main descending line. In 
very fine cardiograms there are three waves at the top pertaining 
to systole, and three at the bottom pertaining to diastole. The 
systolic up-stroke and first wave are interpreted as caused by the 
commencing contraction of the ventricle and dis- 
charge of blood therefrom, and the two subsequent 
waves by the sustained ventricular contraction under 
the resistance to the escape of blood as the aorta be- 
comes filled. The diastolic down-stroke is interpre- 
ted as produced by the relaxation of the ventricle, 
the first rise by the refilling of the ventricle, and the 
two subsequent small waves by auricular contraction 
and discharge. 
2. In the normal arterial trace there are three 
major waves and three minor ones—the latter, how- 
ever, very imperfectly shown. They are interpreted 
as produced, the first by the first blood driven from 
the ventricle, the second by the last blood driven 
from the ventricle, and the third, which is a double 
wave, by the shock and rebound from the closure 
FIG. I, 4 
ARCHIVES OF MEDICINE. 
of the aortic valves. The minor waves are occasioned suc- 
cessively by auricular contraction, auricular discharge, and the 
first shock of ventricular contraction, these influences being 
transmitted to the closed aorta. Thus the first two are ven- 
tricular systolic, and the third, or aortic, and the minor 
waves are ventricular diastolic. The first is as much a fluent, or 
“ tidal” wave, as the second. The term ‘‘percussion or shock,” 
as applied to the first pulse-wave, is discarded as conveying an 
erroneous idea. 
FIG. 2. 
FIG. 3. 
FIG. 4. ABSTRACTS AND SUMMARIES. 
FIG. 5. 
FIG. 6. 
Time—differences. 
3. The average time-difference between the beginning of the 
- earpulto dice and the beginning of the dorsalis pedis pulse is 
.1458 second. 
4. The average carotid-femoral time-difference, .0704 sec- 
ond. 
5. The average femoral-dorsalis pedis time-difference, .0732 
second. 
6. The average carotid-radial time-difference, .0797 second. 
7. The average radial-dorsalis pedis time-difference, .058 sec- 
ond. 
8. The average femoral-radial time-difference, little or none. 
9. The average ventricular-carotid time-difference, .0884 sec- 
ond, with pulse at 72 per minute. 
10. The average ventricular-carotid transit time, .0279 sec- 
ond. 6 
ARCHIVES OF MEDICINE. 
11. The average ventricular presphygmic interval, or time be- 
tween the beginning of ventricular contraction and that of aortic 
expansion is .0605 of second, with pulse at 72. 
Velocities of the pulse-wave. 
12. The mean average velocity of the pulse-wave from the 
carotid point to the dorsalis-pedis, 361 inches per second. 
13. The same from the carotid to femoral is 269 inches per 
second. 
14. The same from the femoral to dorsalis pedis is 464 inches 
per second. 
15. The same from the carotid to radial is 290 inches per 
second. 
Corollaries. 
16. The rate of transmission of the pulse-wave along different 
portions of the arterial tree is not uniform, but considerably di- 
verse. 
17. The rate is minimum for the aorta, maximum for the arte- 
ries of the lower extremity, and intermediate for those of the upper 
extremity. 
18. Along the same arterial line the rate increases as the dis- 
tance from the heart increases. 
19. In the same healthy individual, in the same arteries, the 
rate is subject to a limited variation. 
20. In different healthy individuals, in the same arteries, the 
rate is subject to marked diversity, of which the widest is in the 
aorta. 
21. Both in the same and different healthy individuals, the 
presphygmic portion of the systole of the ventricle is liable to con- 
siderable variation. 
Time-Relations of the Secondary Waves. 
22. The interval between the beginning of the pulse and its 
acme of expansion is the same in all parts of the arterial system. 
23. In certain conditions of the vessels and circulation the 
second wave keeps close time with the first in the onward flight, 
while in certain other conditions of the same the second falls not- 
ably behind the first in the progress from the heart. 
later in the distal than in the prox- 
imal pulses, and latest in the pulse most distant from the heart. ABSTRACTS AND SUMMARIES. 
Phenomena in Young Children. 
25. The mean velocity of the pulse wave in the arterial tree is 
much slower in young children than in adults. 
26. In such comparison the greatest diversity is in the lower 
extremities, where the velocity of the pulse-wave in young chil- 
dren does not exceed one-half that in adults. 
27. While in adults the velocity of the pulse-wave is much 
faster in the lower extremities than in the trunk and upper extrem- 
ities, in young children such difference does not obtain. 
28. The mean velocity of the pulse-wave increases with age. 
(Inference.) 
29. The time-difference between the beat of the heart and 
the carotid pulse is nearly the same in young children as adults. 
30. The presphygmic interval is notably less in young children 
than in adults. 
Rhythmic Changes and their Influence. 
31. The velocity of the pulse-wave is not appreciably modified 
by changes of pulse rhythm. 
32. The velocity of the pulse-wave normal to the individual 
is closely preserved under ordinary physiological variations of the 
circulation. 
33. The presphygmic interval changes with changes of rhythm, 
the period being longer with rare and shorter with frequent pulsa- 
tions. 
34. In the normal heart the rhythm of its movements is con- 
tinually changing, and the variation pertains to the duration of 
its entire revolution, and to that of both systole and diastole. 
35. The duration of diastole changes in much greater degree 
than that of systole. 
36. A longer systole may go with a shorter pulsation, and a 
shorter systole with a longer pulsation. 
37. Invariably a longer diastole goes with a longer pulsation, 
and a shorter diastole with a shorter pulsation. 
38. In the normal heart, beating at about 75 to the minute, the 
average ratio of systole to diastole is very nearly as 2 to 3 ; and 
the average ratio of the cardiac systolic portion of the pulse to 
the cardiac diastolic is closely as 1 to 2. 
39. The cardiac systolic portion of the pulse compared with 
the cardiac diastolic portion increases with increase of pulse 
frequency. 8 
ARCHIVES OF MEDICINE. 
40. The fontanel pulsates in unison with the heart ; the basal 
line and amplitude of its trace fall in inspiration and rise in expi- 
ration : its pulsation begins as early as that of the temporal ar- 
tery in front of the auditory meatus. 
The Fontanel. 
The Influe?ice of Respiration. 
41. The respiration greatly modifies the form of heart traces ; 
the more perfect cardiograms being traced during the respiratory 
pause, while very imperfect or illegible ones are traced during the 
respiratory act. 
42. Inspiration depresses the basal line, depresses the ampli- 
tude, and accelerates the pulse ; while expiration raises the basal 
line, raises the amplitude, and slows the pulse. 
43. The stages of respiration have no appreciable effect upon 
the duration of the heart-carotid intervals, nor on the velocity of 
the pulse-wave along the upper extremity. 
Heart Disease. 
44. In mitral regurgitation the arterial pulse, as respects the 
beginning of cardiac systole, is markedly delayed. In this con- 
dition a variety of pulse-forms-*****present, and no special form of 
cardiac or arterial trace is characteristic. 
45. In aortic stenosis the formula is : Heart’s pulsation with 
sustained systole ; arterial pulsation with sloping ascent and 
rounded or flattened top ; interval between beginning of- cardiac 
systole and beginning of arterial pulse, normal. 
46. In the condition of heavy aortic valves without stenosis, 
the formula is : Heart’s pulsation with sustained systole ; arterial 
pulsation well formed ; interval between beginning of cardiac 
systole and beginning of arterial pulse, abnormally long. 
47. In the conjoined condition of stenosis and heavy valves, the 
formula is : Heart’s pulsation with sustained systole ; arterial pul- 
sation both typically deformed and abnormally delayed after the 
beginning of cardiac systole. 
The author announces his intention to publish more on the 
sphygmographic indications of heart disease, and that he has a 
paper ready on the sphymographic features of aneurism. 
[A. B. ISHAM, M.D., Professor of Physiology in the Cincinnati 
College of Medicine and Surgery.} AEOHIVEIS OF ZMIZEEDIOHNUE 
A BI-MONTHLY JOURNAL 
Edited by Dr. E. C. Seguin, in conjunction with Thomas 
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Vf atthew D. Mann, M. D., Physician to the New York Dispensary, 
31ass for Diseases of Women, in charge of Obstetrics, and Diseases of 
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