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would not like Dr. Gilkey to take my technique as a short-cut which would replace the skilled and "thoughtful application of five senses omitting the sense of taste and adding common sense."He states that in progressive ab¬ dominal disease there is involun¬ tary localized splinting and a tem¬ porary increase in the amount of pressure necessary to cause discom¬ fort. I am not aware of this phe¬ nomenon being reported in the lit¬ erature, but do believe that the pre¬ cise measurement of the pressure applied (which can be gauged only by an objective and accurate mea¬ surement of pressure such as sug¬ gested by my technique) will per¬ mit us to draw clinical conclusions such as he suggests.Dr. Gilkey's arguments seem to center around one premise, that the physician practicing over the years develops a sense of the amount of pressure he applies and that this pressure is always identi¬ cal. In a further study to be pub¬ lished shortly, the blood pressure cuff technique was tested against the physician's own estimate of the pressure which he applied to the abdomen. Thirty physicians were asked to apply pressure on an ab¬ domen on several different occa¬ sions with and without the sphygmomanometer. Each time the phy¬ sician was requested to apply the pressure which he was accustomed to using when examining patients. It was found that no physician ap¬ plied the same amount of pressure on three repeated tests. The ex¬ tremes ranged between 15 and 30 mm in as many as 40% of the cases.No test is to be used to the ex¬ clusion of common sense. The value of this test lies in its use as an addi¬ tional aid to the physician in refin¬ ing his sense of palpation.

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