Supremacy of the pulse within the medicine of the enlightenment

For the minority of the British sick poor, the healing process was conducted as an in-patient in one of the emerging British voluntary hospitals and infirmaries. But those with fevers and contagious diseases were excluded from admission. During the subsequent truncated physical examination, the character of the pulse received especially close attention. The diagnostic regard paid to the pulse assumed the same pre-eminent consideration as bloodletting was within the therapeutic armamentarium. Fever was not considered a symptom within British medicine during the 18th century; rather, it was regarded as a disease sui generis. Indeed, the pulse was regarded as the most reliable guide to the existence of a febrile illness, and variations in the pulse character directed the physician to adopt certain therapeutic modalities. The rapid bounding pulse was a signal of an inflammatory fever, whilst slow low amplitude pulses inferred a typhus-like aetiology. The importance of the pulse to the 18th century practitioner's understanding of sickness, whereby its pre-eminence was gradually replaced by clinical thermometry adopted fitfully during the mid-19th century.