Raynaud's phenomenon of occupational origin, or thevibration syndrome of hand and arm, was first recognized in North America by Dr. Alice Hamilton in the limestone quarries of Bedford, Indiana around 1890 to 1900. It is a tribute to the American pioneers in this area that the Acoustical Society of America now formally recognizes Biological Response to Vibration as a technical area. The objective of this paper is to highlight gaps of information regarding mechanisms of vascular, neurological, and musculo‐skeletal damage caused by vibration. Also addressed is evidence that high noise level may act synergistically to the development of vibration syndrome of the hand and arm. Areas of research currently active in psychophysical and neurophysiological investigations to increase our understanding of tactile and spatial discrimination are discussed. Although the importance of sensory loss or “fine touch” is understood there is neither a proven objective scientific test with which the syndrome can be diagnosed nor is there a scale of damage assessment. Determining the exact role of the central nervous system in assessing damage from vibration is difficult in view of nonspecific symptoms reported from Eastern Europe and from Japan. To complicate matters still further, there is the possibility that repeated, rapid mechanical movements of the hand and arm associated with handling heavy tools produce Carpal Tunnel Syndrome but that the injury is not directly attributed to vibration. Therefore, it follows that there could exist an element of Carpal Tunnel Syndrome in many vibration syndrome cases. Clearly, there is an area within the framework of the Acoustical Society of America for worldwide cooperative efforts to solve many fundamental problems concerned with the effect of vibration on a hand or arm.