Losing Touch: The Controversy over the Introduction of Blood Pressure Instruments into Medicine HUGHES EVANS Blood pressure measurements are an expected feature of American health culture. The machinery is integral to a doctor’s office, and the measurements typically start the physical examination. Previously found solely in medical settings, blood pressure machines, or sphyg momanometers, have made their way into more ordinary settings. In fact, their presence in supermarkets and airports comes as no surprise to most Americans. Like weight and heart rate, blood pressure has become a statistic that Americans know about themselves. Entrenched in images of medicine and health, blood pressure is an expected feature of the doctor/patient interaction that has assumed symbolic significance in our society. And yet, in spite of their mundane modern setting, blood pressure machines are a product of the mid- to late-19th-century physiology laboratory. They did not become a regular feature of medical practice until after 1910. The concept of high blood pressure as a disease was only introduced in 1913.1 It was years before this controversial notion of a virtually symptomless disease met widespread acceptance. In fact, the introduction of blood pressure machines, and hence blood pressure measurements, caused an uproar in the American medical community. Physicians felt threatened by the apparatus and the implications of incorporating it into medical practice.2 The technology Dr. Evans is a pediatric resident at the University of Alabama at Birmingham School of Medicine. She thanks Mark Barrow, Merriley Borell, Charlotte Borst, Ruth Schwartz Cowan, Naomi Rogers, Barbara Rosenkrantz, and the Technology and Culture referees for their comments and suggestions on earlier versions of this article. It was presented, in modified form, at the 1989 Sacramento, California, meeting of the Society for the History of Technology. ‘Theodore Janeway introduced the notion of essential hypertension. See Theodore Janeway, “A Clinical Study of Hypertensive Cardiovascular Disease,” Archives ofInternal Medicine 12 (1913): 755-98. '-’In an interesting essay on the electrocardiogram, for instance, Joel Howell shows how resistance to clinical instrumentation and preconceived notions about its applica-© 1993 by the Society for the History of Technology. All rights reserved. 0040-165X/93/3404-0002S01.00 784 The Introduction of Blood Pressure Instruments into Medicine 785 and the scientific, rational thinking it epitomized implied new ap proaches to medical knowledge, education, and practice. This article is a case study of the incorporation of the progressive ideals of efficiency and objectification into American medicine. I will examine the controversy over the introduction of blood pressure devices that occupied American doctors in the years between 1890 and 1915. Instead of merely analyzing the designs of the various instruments invented for clinical use, I concentrate on the reasons why many doctors felt ambivalent and even antagonistic toward the new instrumentation? Similar in some ways to a contemporaneous tension between artisan and factory worker, this symbolic struggle between man and machine was carried out in the professional arena of medicine with subsequent reverberations on medical education and practice. Physicians for and against the machine highlighted the debate by waging a battle between the two most popular measurers of blood pressure: the finger and the sphygmomanometer. Characterizing blood pressure held an honored place in medical tradition. Since ancient times doctors have palpated the pulse in the belief that the throbbing of the blood vessel transmitted information about an individual’s state of health.4 Pulse diagnosis was central to both Greek and Chinese medicine? Until early in this century, most physicians estimated blood pressure by feeling the force of the arterial pulsation. A doctor noted the hardness of the artery, the power of the arterial thrust, the speed with which the pulse reached its peak and tions blinded physicians to some of the electrocardiograph’s most important uses. See Joel Howell, “Early Perceptions of the Electrocardiogram: From Arrhythmia to Infarction,” Bulletin of the History ofMedicine 58 (1984): 83-98. For original sources on physician reaction to blood pressure machines and other technology, see Joel D. Howell, ed., Technology and American Medical Practice, 1880—1930 (New York, 1988); and James M. Edmonson, Nineteenth Century Surgical instruments: A Catalog of the Gustav Weber Collection at the Howard Dittrick Museum of Historical Medicine (Cleveland...