Introduction of the blood pressure cuff into U.S. medical practice: technology and skilled practice

The history of the sphygmomanometer, or blood pressure cuff, raises useful questions about the acceptance of new medical technologies. When the blood pressure cuff first appeared in U.S. medical practice in the first decade of the 1900s, it generated some concern and debate among physicians. Review of the medical literature, a systematic study of patient records from Massachusetts General Hospital, and consideration of events in Boston during this period suggest that physicians faced several important choices associated with the early acceptance of the cuff. The introduction of the blood pressure cuff presented physicians with several different, competing methods for assessing the force of a patient's blood flow. Physicians chose to use the cuff in a manner that preserved their exclusive use of the new tool and maintained a high level of skill for their individual practices. An early proposal to introduce the new blood pressure cuff as a simple tool for nursing use met with resistance. Many physicians initially favored a competing practice of assessing the force of blood flow by pulse palpation. Physicians eventually dropped the practice of subjectively palpating the force of blood flow and came to rely increasingly on the measurement of blood pressure using auscultation. Even after adopting the cuff into practice, however, they had little interest in completely standardizing the use of the blood pressure cuff across the practices of individual physicians.