By Sergei POPOV, Dr. Sc. (Med.), S. M. Kirov Military Medical Academy
Our modern scientific knowledge concerning the system of blood circulation owes its origin to the famous English physician and anatomist, Dr. William Harvey and his fundamental work "On the Motion of the Heart and Blood in Animals" (1628). A century later, with the advent of the Newtonian mechanics, attempts were made to determine on a living object the physical characteristics of the functional state of the system of blood circulation. In 1773 English researcher Stephen Hales conducted the first ever measurements of arterial pressure (AP) on a horse. During this operation he inserted a metal tube into the artery of the thigh and connected it with a vertically positioned glass tube; as soon as claps or forceps were removed from the artery, blood in the tube rose to a height of about 250 cm and its level started oscillating up and down in step with the palpitation.
The first to measure the arterial pressure of a patient was Dr. Fevr (1856) and he did it during femur amputation. The pressure was of 120 torr (the "torr" unit of pressure, equal to one mm of mercury column per cm square, was adopted in honor of the Italian physicist Evangelista Torricelli). But for some very obvious reasons a "gory" method of this kind could not be used in medical practice.
An important step towards solving the problem was made in 1896 by the Italian medic Riva-Rocci. He suggested clamping the humeral artery with a special cuff consisting of a rubber sleeve 4 to 5 cm wide and 40 cm long, placed into sheath of silk fabric. The device was tightly placed upon the shoulder of a patient and connected to a mercury manometer of an original design; air was pumped into the sheath from a cylinder until pulsebeat on the radial artery disappeared. The value of only systolic ("maximum") pressure was assessed by manometer readings at the moment of pulse appearance in the course of a gradual pressure release in the cuff. For a practicing doctor, however, one-sided data of this kind are clearly insufficient since blood pressure in arteries during every cardiac cycle is rhythmically pulsating in step with the heartbeat; it reaches its maximum during heart contraction (systole), and becomes minimal during diastole.
The fundamental solution of the problem of measuring the systolic and diastolic arterial blood pressure in man is associated with the discovery of Dr. Nikolai Korotkov (1874 - 1920) from St. Petersburg. Its history is both interesting and instructive.
During the Russo-Japanese War (1904 - 1905) the Russian army was suffering heavy losses. At that time a young surgeon Dr. Korotkov of the Military-Medical Academy volunteered to the front and became commander of a sanitary squad. In preparation for his departure he closely studied special books, talked with professors and doctors who had personal experience of attending to the wounded and mastered the technique of measuring systolic arterial blood pressure. Later, on the battlefield where he was attending to wounded soldiers with injuries of major arteries, he was struck with the idea of how to reduce the number of invalids disabled by dressings of blood vessels. With this aim in mind he had to find some indications which could help him guess in advance "the fate" of a wounded limb: whether it would remain "viable" after the dressing of an injured artery or would simply turn necrotic and had to be amputated. According to official records Dr. Korotkov personally conducted 35 surgeries on wounded soldiers suffering from traumatic aneurysms (local expansions of lumens of arteries). And each of these surgeries was significant in its own way, being associated with a concrete human destiny, pain, despair and hope.
While keeping up his consistent and resolute efforts, Dr. Korotkov, once recalled an advice given by Professor Nikolai Pirogov (1810 - 1881) Corresponding Member of the St. Petersburg Academy, honored as the founding father of field surgery. His advice was-in difficult cases of identification of aneurism-one should auscultate blood vessels. This is what Dr. Korotkov started to do and he was able to hear certain noises which changed in a regular way under certain conditions.
He established that if the Riva-Rocci cuff is placed upon the shoulder and pressure within is brought up to the pulse disappearance in the radial artery, one can hear no sounds during diastola; if then the pressure in the cuff is gradually reduced, there appear in the same place first tones, then noises, then loud tones whose intensity gradually diminishes and, finally, all of these sounds fade completely. And it was that regular alteration of sounds which Dr. Korotkov discovered during decompression of bronchial artery in his experiments on dogs which he conducted after his return from the army. It provided the basis for his discovery of the "sonic" method of measurement of systolic and diastolic arterial blood pressure in man.
Dr. Korotkov made his first report on the new sonic (auscultatory) method of blood pressure measurements in patients on November 8, 1905 at a scientific conference in the Military-Medical Academy. The report was entitled "On the problem of methods of blood pressure investigation" and its excerpts were published in the journal "Proceedings of the Imperial Military-Medical Academy", 1905, No. 4, vol. XI.
Shortly after Dr. Korotkov's method was further developed in St. Petersburg clinics of the outstanding surgeon and founder of our urology Professor S. Fyodorov, and our leading therapist and specialist on peripheral blood circulation, Professor M. Yanovsky, after which it found its triumphant way to all countries within a short time. At the present time this method is a generally recognized world standard of arterial pressure measurements and assessments. It marked a new epoch in studies of the functional conditions of the cardiovascular system in both patients and healthy individuals. It laid the foundation of the doctrine of hypertension and other forms of abnormal, arterial pressure. Thanks to its simplicity, accuracy and easy accessibility the method has passed with flying colors nearly a century-long practical tests in different conditions as experienced by a doctor and a medical-researcher.
And it is really regrettable that our own memory of the classic of world medicine has been so ungrateful. Two prominent experts in this field, Dr. M. Jasher and Dr. E. Brien, wrote some time ago in an article "In Search of Korotkov": Who could think that Korotkov, whose name is constantly mentioned in medicine, and whose method is daily used in broad medical practice, could be ignored by historians of medicine.
All of these considerations have been behind the three decades of my own scientific- historical studies for the purpose of reconstructing-on the basis of authentic facts and archive documents-the image of Dr. Korotkov as a person, medical mind and scientist. Thanks to the assistance of the American Bristol Myers Company it has been possible to publish in Russian a book called "Physician Nikolai Korotkov" (St. Petersburg, 1996) and a book in English "Nikolay S. Korotkov: a Story of an Unknown Doctor and immortal name" ("Amipress", 1998).
In 1998 we established the "Memorial Society named after N. Korotkov". On its initiative a memorial board was opened on October 29, 1998 on the building of the Surgical Clinic of the Military-Medical Academy where Dr. Korotkov conducted his studies.
It is a known fact that one flaw of Dr. Korotkov's method is that it cannot be used for continuous registration of blood pressure of a patient for a long time. The main snag is venous hemostasis (bloodflow arrest) which occurs below the cuff. In view of this fact present-day science has introduced some improvements into the technique of arterial blood pressure measurements. With the help of a special device Korotkov's tones are translated into visual signals, or numbers, which can be read out from the registering instrument and shown on a display. The measuring cuff has been fitted with an automatic compressor, the phonendoscope has been replaced with a microphone and doctor's ears "equipped" with an electronic device. This adds up to an original method-monitoring of arterial blood pressure which makes it possible for the doctor to assess its changes at intervals from one to eight times every hour during 24 hours a day. But no matter how great has been the progress of medical science in cooperation with the technical thought, all of these achievements will always rest on the simple, accessible and elegant method of Dr. Korotkov. That is why the general importance of his discovery cannot be overestimated. More than 30 percent of the population in many countries are suffering from arterial hypertension, and Dr. Korotkov's method makes it possible to control the effectiveness of the applied therapies.
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