Five Quarts: A Personal and Natural History of Blood by Bill Hayes Read Free Book Online Page A

makes them ideally situated for palpation, examination by touch.
    In American Sign Language, the sign for “doctor” is the finger-spelled letter
d
tapped inside the wrist, which captures in a simple gesture the most fundamental part of a medical exam, the iconic act of taking the pulse. Performed in every culture, this basic diagnostic test is as old as the practice of healing itself. The careful placing of two or three fingers along a tiny stretch of artery used to be considered an art form, a notion largely lost in the mad shuffle of contemporary health care. One needs to page back a good hundred years or so to rediscover a time when this vital sign retained all of its, well, vitalness. I’ve found no more erudite an advocate than Sir William Henry Broadbent, personal physician to Queen Victoria and author of a unique monograph,
The Pulse
(1890). In its pages Sir William is a spirited defender of what he calls “the educated finger.” In an early passage he subjects the wrist and its pulse point to a curious clinical analysis, as if describing a patient with an odd case history. He is long-winded, but endearingly so: “At first sight it seems strange that the radial artery, which supplies [blood to] merely the structures of a part of the hand—a few small bones with their articulations, a few muscles and tendons, the skin and nerves distributed to it—should afford the varied and far-reaching knowledge we look for in the pulse. The hand is not essential to life, it contains no organ of any importance, and
a priori
it might have been supposed that the variations in the circulation of the blood in so small a member could have no significance.” There is little about this passage I do not love, from the doctor’s crisp visual dissection to the delicious irony he’s blinded to in his academic fervor: If not for the irrelevant hand, he could not even take the pulse, let alone write about it. But I digress. The distinguished doctor, who’d practiced medicine for more than thirty years by the time his book was published, goes on to state without equivocation that the wrist pulse is a “trustworthy index,” a reliable gauge for the entire circulatory system.
    A portrait reproduced on the frontispiece of his memoirs broadens my sense of the man: Seated, he looks the very essence of “bedside manner”—compassionate, patient—as though he’s just asked, “What seems to be the problem?” A stout gentleman in his late sixties, I’d guess, the doctor is dressed in a dark formal suit with a wide satin cravat. A pocket watch is comfortably secreted in his closed palm. Perhaps he can feel the tick of its clockwork against his skin.
    In his day the pulse opened a personal dialogue with the body, and a skilled clinician could glean an astonishing array of insights, far beyond a tally of heartbeats per minute. With nothing but his fingertips, Broadbent claimed he could assess the condition and health of the arteries, calculate blood pressure, and discern the emotional well-being or physical ailments of a patient. Even a person with profound sleeplessness was implicated by his pulse. The insomniacal artery, Broadbent wrote, was “full between the beats” and could be “rolled under the finger,” while the pulse waves themselves ended abruptly, as if exhausted from the effort.
    An impetus for writing his treatise was Broadbent’s grave concern that physicians’ tactile skills were eroding (or, among young doctors, not fully maturing) as technology was relied upon more and more. Back in the late 1850s, when he’d begun his lengthy career at London’s St. Mary’s Hospital, a newfangled device had started attracting notice, the “sphygmograph,” an ingenious though initially clunky contraption that could create an ink tracing of a patient’s pulse. It worked this way: With the wrist upturned, the forearm was immobilized. A small sensor plate rested atop the pulse point and, in essence, rode the gentle waves; the