The sphygmograph in America: writing the pulse.

The sphygmograph (literally a "pulse writer") was 1 of the first "instruments of precision" to be used in examining the cardiovascular system. In the 1860s and 1870s, some physiologically oriented American practitioners began using European sphygmographs to evaluate patients with a variety of cardiovascular and other disorders, study the action of drugs, assess arterial tension, and determine what was referred to as the "state of the circulation." Three previously unrecognized Americans modified existing European models or constructed original instruments of their own design. Two of these American "sphygmograph men" published the results of their novel experimental work, and the third produced a successful commercial model. Despite early expectations that the sphygmograph would reveal precise information about cardiovascular disease, the various models proved frustrating to use in practice. Recorded sphygmograms defied precise interpretation and correlation with clinical and pathologic findings. The sphygmograph, which faded from practice by the 1890s, helped prepare practitioners for more durable technologies such as the sphygmomanometer and electrocardiograph, which entered practice early in the 20th century. The sphygmograph and its American champions were overshadowed and quickly forgotten.

Yellow fever in the Americas.

Dutch slave traders brought yellow fever to the Americas from Africa during the mid-seventeenth century. For the next two and a half centuries, the disease terrorized seaports throughout the Americas. Proof of the mosquito hypothesis was delayed because of two aspects of the disease: patients are viremic only during the first several days of clinical illness, and most mosquitoes require about 2 weeks of viral incubation before becoming infectious. Control of Aedes aegypti in urban centers failed to eliminate the disease because of its transmission by tree-hole-breeding mosquitoes that spend their winged lives mainly in forest canopies. Yellow fever continues to be a significant public health problem in parts of South America and Africa.

The power to terrify: eclampsia in 19th-century American practice.

Throughout the 19th century, eclampsia was among the most dreaded complications of pregnancy. Conflicts arose over proposed etiologies and therapeutic modalities. Bloodletting and other harsh therapies reflected the prevailing humoral, neurovascular, and toxicologic theories. The role of untrained and professional nurses in the lying-in room of an eclamptic woman emerges from the literature of the time. An appreciation of the history of eclampsia provides context for the modern obstetric nurse.