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[The arterial pulse: from oblivious to revival?]
Mario Morpurgo1, Luigi Bergamaschini
1Divisione di Cardiologia, Ospedale San Carlo Borromeo. mariomorpurgo@libero.it
Insights
The pulse examination, a practice dating back to ancient civilizations, remains relevant in modern medicine. Despite technological advances, understanding pulse characteristics aids in diagnosing cardiovascular diseases and patient assessment.
Area of Science:
- Cardiology
- Medical History
- Clinical Semeiology
Context:
- The clinical significance of arterial pulse examination has been recognized since antiquity.
- Historical medical practices, including pulse analysis, were integral to diagnosing illnesses and understanding patient character.
- Early medical traditions in China, India, Greece, and Rome emphasized pulse study.
Purpose:
- To highlight the enduring clinical relevance of pulse examination in patient assessment.
- To trace the historical evolution of pulse analysis from ancient descriptions to modern technological applications.
- To underscore the connection between pulse characteristics and cardiovascular health, emotional states, and organ function.
Summary:
- Pulse examination, a practice with ancient roots, has evolved significantly with technological advancements.
- Historically, pulse analysis was used for diagnosis, prognosis, and even character assessment.
- Modern techniques like pulse wave velocity and augmentation index measurements have advanced cardiovascular disease epidemiology.
Impact:
- Reaffirms the value of basic clinical skills in contemporary medical practice.
- Connects historical medical observations with modern cardiovascular disease research.
- Emphasizes the pulse as a vital sign for understanding overall patient health.
Abstract:
It seems reasonable to suppose that there is some relationship between the fanciful descriptions of arterial pulse dating back to ancient times and the more sophisticated data stemming from the technological advances of recent years. The clinical evidence derived from "the flowing blood" has always been associated with diseases of the heart and vessels and indeed of apparently unrelated organs, as well as with emotional states. Centuries before the Christian era, Chinese and Indian doctors seat great store by the study of the pulse which was described in imaginative terms and considered a clue to a person's character and illnesses. This subject was just as important to Greeks and Romans: to mention just one famous name Galeno, who wrote extensively about pulses. Up to the 18th century many European Universities had chairs entitled: "De pulsibus et urines" and from this time onwards sphygmic doctrine gained an ever-growing space in the scientific literature in the attempt to establish diagnostic and prognostic connections (often rather whimsical ones) between different kinds of pulses and so-called "crises of cerebral, thoracic and abdominal organs". Between the mid 18th century and the end of the 19th century the study of pulses was mainly focused on identifying arrhythmias and valvular defects even though we still find descriptions of "alternating" and "paradoxical" pulses accompanied by somewhat ambiguous explanations. From the second half of the 20th century the possibility of measuring the pulse wave velocity and the "augmentation index" has led to remarkable advances in epidemiological studies of cardiovascular diseases. This work would like to draw the readers' attention to the relevance a simple semeiological practice such as the examination of the pulse still has in the clinical approach to a patient even in these modern times.
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