Touching as Knowing: The Social Circulation of the Pulse
Yijie Huang | University of Cambridge
We think we know the pulse well. Put your index finger and middle finger of one hand upon the inside of the wrist of the other. Press the skin. Count the number of beats you feel for 60 seconds. In so doing, as the NHS guideline suggests, ‘you can check your heart by taking your pulse and counting how many times your heart beats in a minute’. In a similar way, you can also check the pulse of someone else. We are surrounded by, and are used to, a set of facts in which the pulse is a number per minute, counting is the standard method of the diagnosis, and the practice is easy to conduct. These facts are supposedly quotidian: the NHS website categorises the pulse-checking entries among ‘common health questions’.
Taking these facts for granted, we have almost forgotten the complex historical process of understanding the pulse and its legacies, amongst which timekeeper-assisted counting is quite a late innovation. Since antiquity, Greco-Roman doctors practised pulse-taking as a major form of diagnosis. Galen of Pergamon (129-c.216), whose corpus has widely been esteemed as the canon of medicine by learned physicians from the medieval period into the Renaissance, wrote strikingly about the pulse.(1) Sundry, tedious, and obscure at times, his immense amount of descriptions of the pulse gesture to an epistemic encounter in which the practitioner’s touch dominates the exploration and explication of the body. The touch, as Galen suggested, requires persistent textual learning and tactile training to become sophisticated. Beginners need assiduous exercise to feel basic differences of pulse magnitude, force, speed, and frequency. As their experience accumulates, they may grasp more complicated variations in regularity and hardness and better perceive Galen’s connotations of ‘ant-like’, ‘gazelle-like’, and other implicit terms.
Evidently, the tactile nature of pulse-taking means that it is expertise hard to form. To perceive the corporeal meanings of pulse language, one must master the craft of fingers, which, nevertheless, must resort to text perusal. Some scholarship depicts this mode of pulse-taking as a connoisseur’s touch. Think of the wine-tasting critics. While most individuals have normal taste, theirs are extraordinarily acute to detect even slightly varied qualities of wine. Their gustatory sense is highly incarnated and individualised: even though they may tell and write their tasting experience, it can never be fully conveyable to others. ‘Connoisseur’ suggests fairly comparable conditions in the context of pulse diagnosis, casting light upon a touch of dexterity, education, and esotericism.
One interested in early modern medicine may wonder if this demanding touch might have contributed to securing pulse knowledge within the communities of learned medicine. In early modern England, learned physicians occupied only a small proportion of the entire practitioner population in the medical marketplace, and the college education did not necessarily promise their superiority in exact practices. Against enormous numbers of competitors holding highly plural expertise, learned physicians could not claim their capability of healing as a concomitant of medical degrees or certificates. Instead, it needed to be demonstrated, defended, and propagated.
Hence, learned physicians’ deployment of the imagery of pulse-taking ought to be considered critically. The coat of arms of the College of Physicians of London granted in 1546 offers a compelling example (Figure 1). Our attention would be easily caught by the hand vertically touching the wrist of the horizontally placed arm and taking the pulse. Stretching down through the sleeve of argent and azure clouds with golden rays of sunlight, the palpating hand is endowed symbolically with divine knowing and healing. The College of Physicians, by selecting this image as their emblem, entitled the pulse-taking touch to the embodiment of their distinctive medical legitimacy and authority. This careful choice presupposes a typical, if not exclusive, connection between the know-how of pulse diagnosis and the identity of learned medicine.
Did the pulse remain a secret of college physicians as they claimed, which neither their less-educated competitors nor patients could not well understand? A glance at John Sadler’s The Sick Womans Private Looking-Glasse (1636) suggests not. Sadler’s treatise addresses women’s reproductive systems with a focus on many related illnesses. By reading the treatise, female readers, despite receiving no formal education of medicine, were expected to learn how to report physical discomfort properly to their (male) physicians. In chapter six, Sadler discussed the suffocation of the mother, an urgent state where the movement of the womb towards the diaphragms and stomach is believed to disrupt respiration and cause death. When detailing symptoms, Sadler emphasised that one must be cautious to differentiate them from those occurring in other analogous illnesses such as syncope and lethargy. During a syncopathic episode, ‘both respiration and pulse is taken away’, whereas for suffocation, ‘commonly there is both respiration and pulse though it cannot well bee perceived’. By taking the pulse, one could also distinguish lethargy from suffocation, since the pulse “in one is great and in the other little”. Sadler’s notes suggest that to accurately detect the approach of suffocation, the companions of the patient, often female given the normal setting of a woman’s sickbed in this period, must examine her pulse: not just its appearance or disappearance, but its particular features.
To save a woman’s life from deadly suffocation, female hands (and minds) had to be told about the pulse. How did they access the abstruse, hardcore, and purportedly male-dominated pulse knowledge? Who taught them to differentiate which pulse was large and which was soft? In what ways did they engage in the diagnosis instead of being constrained only as the recipient of the other person’s touch? Was the tactility of the pulse from their perspective different from that of learned men, and if so, how? We do not know. Their perceptions and conceptions, together with those of the huge yet less heard part of the medical marketplace – midwives, nurses, surgeons, and those condemned as ‘charlatans’, ‘witches’, ‘empirics’, and so forth – are unfortunately seldom preserved.
But even scattered fragments, like the implication of female pulse knowledge in Sadler’s treatise, provide important clues. First, there has been a long prosperous episteme in which the corporeal-medical meanings of the pulse were shaped, comprehended, and exercised through touch. The tactility of the pulse determined and cultivated the essential, although not perfect, circulation of its bounded knowledge against sensory, political, and social barriers.
This brings my second point about the recent resort of pulse diagnosis to overwhelmingly numerical analysis. The application of time-keeping instruments and quantitative norms in pulse diagnosis is often taken as a testimony of progress that medical quantification makes overqualification. Yet when the English physician John Floyer (1649-1734) applied a pulse watch to count the pulse, he studied and practised medicine in a world where the pulse-taking touch was negotiable and comprehensible despite the difficulty. Indeed, he acknowledged the power of touch in explicating the pulse himself. This reminds us to challenge the problematic narrative that watches and numbers emerged from the failure of hands and words in telling the pulse. On the contrary, we shall reconsider the making of the quantified pulse upon the much-overlooked prevalence, resilience, and change of the pulse-taking touch.
(1) Galen composed 16 thematic books on the pulse, which were equally compiled into 4 large treatises. See them in Karl Gottlob Kühn, ed., ClaudiiGaleni Opera Omnia, Vol. VIII & IX (Cambridge: Cambridge University Press, 2012),https://www.cambridge.org/core/books/claudii-galeni-opera-omnia/61A6FD8E41735896BFC07D89AD8FA656, https://www.cambridge.org/core/books/claudii-galeni-opera-omnia/1F8A2C0C1CC11A95EAA4E4CFADA3C1C9#fndtn-contents. Accessed 10 August 2021.
Shigehisa Kuriyama, “Pulse Diagnosis in the Greek and Chinese Traditions,” in Beyond the Body Proper: Reading the Anthropology of Material Life, eds. Margaret Lock and Judith Farquar (Durham and London: Duke University Press, 2007), pp. 595-607.
John Sadler, The Sick Woman's Private Looking-Glass (London: Printed by Anne Griffin for Philemon Stephens and Christopher Meredith, 1636).
Mark Jenner and Patrick Wallis, eds., Medicine and the Market in England and Its Colonies, c. 1450-c. 1850 (Basingstoke: Palgrave Macmillan, 2007).
John Floyer, The Physician’s Pulse-Watch, Vol. 1 (London: Printed for Sam. Smith and Benj. Walford, 1707); The Physician’s Pulse-Watch, Vol. 2 (London: Printed for J. Nicholson, 1710).
Yijie Huang is a PhD candidate in the Department of History and Philosophy of Science, University of Cambridge. Her PhD research explores the knowledge and practice of pulse diagnosis in late seventeenth-century English medicine through the lens of John Floyer and his innovative treatise The Physician’s Pulse-Watch (1707 &1710).