A brief journey into the history of the arterial pulse

Abstract

Objective. This paper illustrates the evolution of our knowledge of the arterial pulse from ancient times to the present. Several techniques for arterial pulse evaluation throughout history are discussed. Methods. Using databases including Worldcat, Pubmed, and Emory University Libraries' Catalogue, the significance of the arterial pulse is discussed in three historical eras of medicine: ancient, medieval, and modern. Summary. Techniques used over time to analyze arterial pulse and its characteristics have advanced from simple evaluation by touch to complex methodologies such as ultrasonography and plethysmography. Today's understanding of the various characteristics of the arterial pulse relies on our ancestors' observations and experiments. The pursuit of science continues to lead to major advancements in our knowledge of the arterial pulse and its application in diagnosis of atherosclerotic disease.

Figure 1

Clepsydra or Greek water clock: a portable water clock used by Herophilus for the purpose of arterial pulse examination. This water clock was capable of containing a specified amount of water for natural pulse beats of every age.

Figure 2

Pulsilogy of Sanctorius: this device consisted of a scale of inches and a cord with a movable weight marked with a transverse line. The physician would move the pendulum and note the pulse with his fingers simultaneously. Then, the physician would change the length of the line until the speed of the running pendulum would coincide with the pulse rate, thus showing the pulse rate as the number of inches.

Figure 3

Herrison's sphygmometer: this device was composed of a graduate glass tube containing mercury with a semiglobular ball at one end. With the semiglobular end being placed over an artery, it would show the action of the vessel and the force of its impulse. It was designed in a manner that would enable the examination of the pulse in relation to its force, regularity, and rhythm.

Figure 4

Ludwig's kymograph (wave writer): this device was able for the first time to graphically record hemodynamic measures.

Figure 5

Marey's sphygmograph: this device had graphical recording capabilities of the arterial pulse. Applying this device to the wrist would record the motion of the arterial pulse and enable the examiner to interpret rate and rhythm.

Figure 6

Mahomed's sphygmograph: this device was a revised form of Marey's sphygmograph with an added screw. It was capable of measuring the pressure needed to occlude the arterial wave along its graphical recordings of the arterial pulse wave dynamics.

Figure 7

Graphical depictions of the arterial pulse wave form by Mahomed in an asymptomatic male (a) and female (b) with arterial hypertension. Reproduced from [80].

Figure 8

(a) This graph illustrates time marker as the lowest line, cardiogram tracing as the line above that, and femoral pulse waves as the two top tracings. (b) Distance “a” represents the distance between aortic arch and the position of the microphone over the femoral artery “Reproduced from [91] with permission from BMJ Publishing Group Ltd.”