Pulse At The Wrist
( Originally Published 1921 )
I HAVE been told that in some parts of China the sick person goes to the doctor but does not see him personally on account of some custom or superstition, but thrusts his hand through a curtain and allows the doctor to feel his pulse. The Chinese doctors are said to have described in their writings several thousands of different kinds of pulses, and they believe that they can tell he nature of disease by the pulse.
very physician and nurse has acquired first hand experience as to this, because whatever else may happen to an invalid he is sure to have his pulse felt by his professional attendant. For this reason it is quite important to discuss what the pulse tells and whether it always tells the truth. In other words, is the pulse at the wrist a safe guide to a knowledge of the condition of t' e body and to the administration of treat me t? The correct answer is that the pulse is not a safe guide to a person's condition, or a safe guide for treatment. No person with heart trouble or any other illness should attempt to judge of his condition by the pulse alone.
The pulse is merely a succession of waves that are caused in the blood stream by the activity of the heart, just as waves are caused in a pond when the reckless small boy rocks the row-boat. If the pond is quiet and the boy rocks the boat regularly, the waves spread out in beautiful circles over the surface of the pond. But if there are other disturbances in the water, or if the pond is full of floating ice or something like that, the waves are interrupted and disorderly. It is the same way with the pulse. If the body is perfectly quiet and everything is in order, each beat of the heart sends a little wave to the wrist 'that is felt as a beat of the pulse. But if the blood vessels are relaxed or contracted, or if there is any obstruction, the waves may become indistinct or much exaggerated or quite disordered. At the same time the heart may be beating in a perfectly safe manner. The size and location of the pulse at the wrist is hardly ever the same in any two people and is rarely the same in both wrists.
I remember, once, being present when a famous surgeon refused to operate in an urgent emergency, because the man's pulse could not be felt. Another physician standing on the other side of the bed exprest the belief that the man could stand the operation. About this time the man volunteered the information that he ever had had any pulse in the hand that Dr. William T. Bull was holding. Dr. Bull operated, and the man was cured.
It is very important that every one know the true nature of the pulse, that it is a wave which travels from the heart outward, just as a wave travels over the surface of the ocean. It has nothing whatsoever to do with the actual flow of the blood. The waves may be large and strong, and yet the blood may be flowing very little.
any people believe that the pulse indicates ho well the blood is flowing and yet can not grasp the idea that waves are one thing and the flow of the blood another. However, make a simple experiment. Go to the edge of a stream that is flowing gently along, throw in a stone, and notice that the waves travel up the stream just as fast as they travel down. If the waves we e a material thing that could not happen. It is really only a form of motion.
his misconception of the nature of the pulse, which I find so general among the people who believe that it represents the flow of the blood instead of simply the motion of the blood in the blood vessels, is the reverse of the error of the ancients, who only knew about the motion of the blood and did not know anything about its flow. We have talked so much about the circulation of the blood since Harvey discovered it in the sixteenth century that we attach altogether too much importance to it. The ancients considered the pulse as the surging to and fro of the blood, which carried the vital spirits throughout the body. In a way this was a more correct idea than the feeling that so many people have, that the flow of the blood is dependent upon the pulse.
The study of the pulse is a difficult and elaborate process, and is valuable as giving a knowledge of the nature of the heart beat only when interpreted by an expert. This is not to be undertaken by one who has not been thoroughly instructed. It is much better, for that reason, that people suffering from heart disease, and those who are not specially trained in the care of heart disease, should not observe the pulse at all; it is much better that they should judge of the condition of the heart by, the other signs of heart trouble, such as the condition of the breathing and the evidence of the circulation as shown by great pallor or great blueness of the face.
One of the greatest blunders that is made by amateur doctors is to stimulate what they call a weak pulse, and I have known many people who had suffered some accident to have been put in jeopardy by the abuse of heart stimulants, when in reality the slow, gently acting pulse was an evidence that the person was in good condition.
As a matter of fact, few hearts ever stop beating by the pulse becoming slower and more feeble. Heart failure takes place usually through the process of an increase of rate, which is almost always accompanied by an excited heart action. The heart has a great deal of reserve power that must be called upon and exhausted before the heart will stop. When the heart acts slowly, it is doing so because this reserve power has not been called upon.
In general, the pulse that is rapid and strong is a much greater indication of danger than the pulse that is slow and weak. The heart that is beating rapidly with great force is wearing itself out, while the one that is beating slowly and gently is saving its strength.
It is no easy task that I have undertaken to teach the true facts of heart disease in a simple way so that those who have not given the matter previous attention can understand. I know that it is possible to explain the beautiful discoveries about irregular hearts that have come to us in the last ten years. I know equally well how difficult it is to teach even students of medicine and nursing how to interpret the pulse as it is felt at the wrist. For that reason, my. counsel is not to attempt to learn this thing, but to accept the fact that the pulse as felt at the wrist has no great significance, as it can be observed by the sick person or ,by his friend; that conclusions had better be drawn as to the condition of the heart by the way the person really seems to be as to his breathing, and by the proper distribution of the blood as observed in the surface of the body, or by the evidence of congestion in one place or another.
Persons of experience learn to tell certain things by feeling the pulse; such as whether it is nearly natural, whether it is extremely weak, or very strong. While many people believe they can tell a good deal by feeling the pulse, the fact is that the meaning of the pulse is difficult to determine, and even those who have spent their lives in studying it at times are misled. As already indicated, the beat of the pulse is simply a wave that comes from the movement of the heart and has nothing to do with the actual flow of the blood. This is the important in the circulation. This simple fact is easily proved, because if a blood vessel is prest ard that no blood can pass, still the pulse be felt above the point of pressure.
Other fact that shows that the condition of pulse must not be taken too seriously in its apparent poorness of quality is that many persons with irregular pulses pulses that miss beats, take up wrong beats, and have beats of all sizes often show no evidence of poor circulation, while some of the worst cases of failure of circulation that we see are frequently accompanied by a strong and regular pulse.
It is to be noted, therefore, that the flow of the blood may be quite regular while the pulse is irregular, just as the amount of water that flows through a great river is very little influenced by the disturbance of the river from winds blowing across it.
While a superficial examination of the pulse is apt to mislead uninformed people and people who are thoughtless, still with instruments of precision much can be learned by the expert in studying the pulse. A person with heart trouble who can find a physician who will take the time and trouble to make careful tracings of the pulse and study its meaning is foolish indeed if he does not appreciate what is being done for him; he should submit with patience to what may seem tedious repetitions of observation. It is only by careful study that the true significance of the irregularity of the pulse can be determined.
When a nurse has learned the character of the pulse of her patient, she can often tell a great deal by it, but in the case of a patient whom. she does not know it is always better for her to be guided by the patient's general condition than by the apparent poorness of the pulse. A person who can lie down comfortably in bed and whose color is good, the extremities being warm, is ordinarily in no danger from heart failure. What the nurse should particularly observe is any change in the pulse from its natural character.
'While the pulse in the arteries has been studied for many years, the pulse in the veins has. only of late years received attention, and it is still difficult to describe and explain. If the neck is examined just above the collar bone while the person is lying down, there is noticed an irregular movement transmitted from the blood vessels to the surface. Part of this is the pulse in the arteries of the neck, but a good deal of it is the pulse in the veins.
This pulse in the veins is so gentle that it can barely be studied at all by the sense of touch, and delicate instruments must be used and much time and patience expended to find the meaning of the pulse in the veins. In a general way, however, a marked pulsation, beating in the neck of a person with heart disease, is a bad sign, and the cause of this beating should always be sought and corrected by a physician if possible.
The study of the pulse at the wrist gives information as to the condition of the power of the heart that propels the blood forward through the body. The study of the pulse in the veins gives information both as to the ventricles which propel the blood and the auricles which receive the blood; and also often throws great light on the condition of the heart muscle.
Ordinarily there is a close correspondence between the number of beats in the veins and the number of beats in the arteries; but in a rare disease that is sometimes seen, the pulse in the veins may be rapid while the pulse in the arteries is slow.
One should never neglect a visible pulsation in the neck that is beyond the pulse that is seen in healthy people.