CIRCULATORY DISTURBANCES REFLEXLY INAUGURATED BY STIMULATION OF THE CELIAC PLEXUS

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Abstract
Circulatory disturbances coincident with surgical manipulations in the upper part of the abdomen have frequently been described. A transitory initial rise in the blood pressure succeeded by a fall as a rule follows manipulation of the abdominal viscera. Recently, in a case in which a difficult cholecystectomy was performed, at the stage when operative manipulation was maximum, an unusual phenomenon was observed in the course of routine sphygmomanometry by the auscultation method. The blood pressure, which had remained constantly within normal limits with a difference of 60 mm. of mercury between the systolic and the diastolic level, suddenly became unobtainable for twenty minutes, although the peripheral pulse could still be palpated and was not materially altered in rate. At first, the mercury column being allowed to fall very slowly, a single beat was heard at about the level of the previous systolic pressure. Within a few minutes this single beat

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