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High Blood Pressure

( Originally Published 1921 )

One of the reasons for writing a book that is to be read by people who are not doctors is that it may remove some of the fear that is suffered by those who have become the victims of certain conditions. A case in point is high blood pressure.

By high blood pressure is meant a condition of the circulatory machine in which there is found a greater pressure of blood in the blood vessels than is natural. The name does not always mean exactly this, but refers to the quantity found by certain instruments. Blood pressure is measured by finding how much an artery must be prest upon to squeeze out the blood from it so that the pulse can not be felt beyond where the pressure is made.

The usual form of instrument consists of an air-bag that is fastened to the arm and is blown up to the necessary amount to press the blood out of the artery. Another and simpler way of measuring blood pressure is to have a bag with fluid in it connected with another rubber bag by a rubber tube. One bag is placed over the artery, and the other bag is raised until the necessary pressure is found.

High blood pressure is caused by hardening of the arteries which makes it hard for the blood to circulate, combined with the increased activity of the heart in its efforts to overcome this difficulty. Any activity of the body tends to raise the blood pressure and any demand for the activity of any organ does the same thing.

Blood pressure is raised by digestion ; it is raised by mental activity, and indeed, by almost any demand upon the body. In fact, it is fair to say that the common cause for high blood pressure is the demand of the system for a high blood pressure for some particular purpose.

When the kidneys are defective and cannot do their work easily, as in the case of Bright's disease, the blood pressure is raised in the hope of making the kidneys work and of carrying off the waste products of the body. If a part of the brain is damaged and the blood can not circulate in it, nature raises the blood pressure to supply that part of the brain with blood.

The trouble is that when blood pressure is raised for the beneficent purpose of carrying on the activities of the body, it is apt to go up too high and to stay up and become an evil, in that it causes degeneration of the blood vessels and further damage to the heart.

High blood pressure is one of the earliest and most common indications of organic disease of the heart, blood vessels, kidneys, and brain. Once in a while, blood pressure is so high that it is necessary to reduce it with drugs that have that power, but as a rule, unless the cause that demands high blood pressure can be remedied, it is not safe to interfere a great deal with the pressure directly. What may be a necessary and beneficent pressure in one patient may be too high for safety in another.

Young healthy people should have a pressure not very far from 120 mm of mercury. Older people can go up to 145, and children seldom go above 100. The measurement is always expressed in the pressure caused by a corresponding column of mercury and is measured in millimeters.

Under some circumstances, nurses are allowed to measure blood pressure, and in high blood pressure cases any sudden fall without accountable reason should be regarded with anxiety, as should also any great rise in blood pressure.

The nurse should realize that high blood pressure usually exists for some good reason, and generally because some defective organ requires a high blood pressure for its activity, and that until the organic trouble is relieved, pressure is better not reduced.

Of late years, high blood pressure has been one of the signs of heart trouble that has caused the greatest anxiety to the greatest number of people. This has been increased by the fact that the life insurance companies have laid much stress upon it in deciding whether they would expect a long life for those who wished to be insured.

High blood pressure always means that the person who has it is not perfectly sound, but it also means that nature is making a definite effort to make up for some defect in the organs, and in that respect it is a favorable sign. A moderate increase in blood pressure, when discovered early, and when it leads to a suitable modification of a person's habits and suitable treatment of existing organic disease, has proved to be the means of prolonging many lives beyond the point that would have been possible if the person had been neglected; and while the insurance companies did go to extremes when this form of examination first came into use, they are now disposed to modify their opinion with respect to those who they believe will take proper care of themselves. Some time ago a woman came to me in distress because she had neglected to pay her insurance policy and the company had refused to let her go on with her policy because she had high blood pressure. I wrote the company (a prominent one) the following letter, and she was given back her policy.

DECEMBER 5, 1918. To THE INSURANCE COMPANY,

New York City. Dear Sirs:

I have examined Miss B. G. carefully and find her suffering from a moderate amount of arteriosclerosis, but otherwise in good general condition.

She has told me that she is threatened with the loss of an insurance policy in your company, due to her neglect to pay premium, occasioned by not receiving the premium notice that she was accustomed to rely upon to remind her of the payments.

She tells me that this policy has only fourteen years to run, and that it is a policy of small amount but of much importance to her. It .seems to me that, while she is not a perfect risk, she may safely be expected to outlive the duration of the policy, and that no injustice would be done to the company if she were allowed to continue the payment of the premiums.

Faithfully yours,
Louis F. Bishop, M.D.

Blood pressure is like money. We should pray not to have too little and not to have too much. If we are slightly damaged as to our hearts and blood vessels, we try to have as little as we can get along with. When we get old and are much worn out, we want to keep our pressure high and even, as that is the way to get along best.

One of the happiest days in my own work was when I discovered this truth and commenced to stop the fruitless attempt to reduce blood pressure in people who were ill. The results in my own observation were so happy that I went out to preach this doctrine to the profession, and I value highly a letter I received from a really strong man who is the head of a big institution, in which he described his return to work after hearing this doctrine. He went through his wards where there were a number of persons in advanced stages of heart and kidney trouble, who were being treated for their high blood pressure. He described how he stopped the treatment and instead introduced measures to raise their blood pressure, and how many of them were so restored in a short time that they were able to go out.

There is only one rational method to approach the question of high blood pressure, and that is to try so to improve the general condition of all the organs that there is no need for this pressure. When this happens, nature will reduce it promptly without further help. If this can not be done, it is much better that the pressure should remain, because if we reduce pressure without improving the condition. of the organs that have made it necessary, inevitable harm is done, and we open the road to failure of the functions of the liver, kidneys, and probably other glandular organs, resulting in auto-intoxication and perhaps dropsy.



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