Five Quarts_ A Personal and Natural History of Blood - Bill Hayes [17]
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 motion was translated simultaneously onto a strip of paper, forming a steady sequence of squiggles. To the medical community, an instrument that could provide an objective reading of the pulse was an important advance (the modern blood pressure cuff is the sphygmograph’s direct descendant). However, while Broadbent used various models throughout his career, he was never a full convert. In The Pulse he praised the machine’s ability to mimic what a skilled physician could do by hand but emphasized that it was “not an infallible court of appeal.” The device was tricky to operate—it wasn’t like placing a thermometer under a tongue. In fact, Broadbent maintained, many of the “niceties of information” were out of its reach; no machine could ever replace the power of human touch.
In mastering the language of the pulse, Broadbent was linked to a timeless tradition, one transcending cultures and medical philosophies. The physician-priests loyal to the lion-headed Egyptian goddess Sekhmet relied on pulse palpation to reach their diagnoses, as evidenced by tomb inscriptions circa 2000 B.C., and medical papyri from this same era contain repeated reference to the pulse. “The heart speaks out of the vessels of every limb,” one particularly lovely line translates. In the history of medicine, however, the literature of ancient China is unmatched in its extravagant attention to deciphering the body’s rhythmic code.
The Chinese text called Huang Ti Nei Ching Su Wen (The Yellow Emperor’s Classic of Internal Medicine) is one of the world’s earliest and most famous medical guides. Although the work is attributed to the legendary first ancestor of the Chinese nation, historians concede that it is the product of neither a single writer nor single time period but rather a compilation of many teachings over hundreds of years. The oldest portions may date as far back as the fifth century B.C. To me The Yellow Emperor’s Classic is best appreciated not for its physiological accuracy but for its richness of ideas. All of the disciplines of traditional Chinese medicine sprang from its theories.
The entirety of what Broadbent could read at the wrist pulse was just the starting point for what The Yellow Emperor’s Classic describes. By applying varying pressure to different points along that single stretch