The question of the value of the diastolic pressure reading in examinations for life insurance is not yet settled to the satisfaction of all medical directors. Certain medical directors with clinical experience behind them, lay great stress on the increased diastolic pressure and consider a persistent diastolic of 100 mm. really more significant as an indication of hypertension than a systolic pressure of 160 mm. Other directors pay little or no attention to the diastolic reading. Should an applicant show a systolic above the average normal on several successive readings, he is declined. When one takes into consideration the psychic effect of knowing that he is being examined for high blood pressure, it seems unfair to refuse insurance on such grounds as is constantly done.
Up to the present there are no extensive series of life-expectancy tables in which hundreds of thousands of cases are analyzed from the diastolic pressure values. There are many such tables for the systolic pressures alone. In the tabulation of such statistics one must not lose sight of the important fact that the figures are taken by thousands of men of varying capacity and different degrees of intelligence. Such studies to be of any real value must be taken from records made at the home offices by capable men. We shall await these tables with interest. In the meantime we must be permitted to have the impression that the diastolic pressure has been much neglected. This has no doubt been due to the difficulty of measuring it with any degree of accuracy. Now with the auscultatory method and the correct place to read the diastolic pressure the results of blood pressure estimations should begin to have some value for statistical data.
Clinically the diastolic is probably more important than the systolic. Until proof is brought to the contrary we shall believe that in life insurance examinations it has the same importance.
CHAPTER XV.
PRACTICAL SUGGESTIONS
The time spent in obtaining a careful history of a case is time well spent. Often the diagnosis can be made from the history alone, the physical examination merely adding confirmation to the data already obtained.
The younger the patient who has arteriosclerosis, the more probable is it that syphilis is the etiologic factor. A denial of infection should have little weight if the history of possible exposure is present. Miscarriages in a woman should arouse the suspicion of lues in her husband. The complement-fixation reaction will often clear up an apparently obscure diagnosis.
There are various ways of examining a patient but there is only one right way; the examination should be made on the bare skin. However skillful one may be in the art of physical diagnosis, he can gather few accurate data by examining over the clothes even if he use a phonendoscope.