4. They sometimes occur, and continue during the whole course of an inflammation of the stomach and bowels. And,
5. They occur in relapses, after the crisis of a fever.
The other states of the pulse indicate bleeding in every stage of fever, and in every condition of the system. I have taken notice, in another place, of the circumstances which render it proper in the advanced stage of chronic fever.
If all the states of pulse which have been enumerated indicate bleeding, it must be an affecting consideration to reflect, how many lives have been lost, by physicians limiting the use of the lancet only to the tense or full pulse!
I wish it comported with the proposed limits of this essay to illustrate and establish, by the recital of cases, the truth of these remarks upon the indications of bleeding from the pulse. It communicates much more knowledge of the state of the system than any other sign of disease. Its frequency (unconnected with its other states), being under the influence of diet, motion, and the passions of the mind, is of the least consequence. In counting the number of its strokes, we are apt to be diverted from attending to its irregularity and force; and in these, it should always be remembered, fever chiefly consists. The knowledge acquired by attending to these states of the pulse is so definite and useful, and the circumstances which seduce from a due attention to them are so erroneous in their indications, that I have sometimes wished the Chinese custom of prescribing, from feeling the pulse only, without seeing or conversing with the patient, were imposed upon all physicians.
To render the knowledge of the indications of blood-letting, from the state of the pulse, as definite and correct as possible, I shall add, for the benefit of young practitioners, the following directions for feeling it.
1. Let the arm be placed in a situation in which all the muscles which move it shall be completely relaxed; and let it, at the same time, be free from the pressure of the body upon it.
2. Feel the pulse, in all obscure or difficult cases, in both arms.
3. Apply all the fingers of one hand, when practicable, to the pulse. For this purpose, it will be most convenient to feel the pulse of the right hand with your left, and of the left hand with your right.