16 DR. EMMONS’ REPORT. April, 
feat the good operation of the former, and render abortive the best 
of treatment. : 
The pulse may be examined on the side of the temple, on the 
lower jaw, or, better, on the left side, just at the point of the elbow. 
At the latter place we may ascertain the action of the heart. The 
average number of pulsations in a minute is forty. 
The points to be determined in the examination of the pulse are, 
its frequency, its qualities, whether hard, soft, full or bounding. 
The strength of the pulse is estimated by the force required to sup- 
press it under the finger. 
A. very important exercise of the judgment is not unfrequently re- 
quired in violent and dangerous diseases, for the pulse may be of 2 
deceptive character, not only in the commencement of the disease, 
but through its whole course, if the termination is fatal. The pulse 
in these cases will be found rather slow and small, that is, the artery 
feels smaller under the finger, but is not decidedly hard and wiry ; it 
is rather weak and its motion sluggish, and the first impression would 
probably be, that the patient was already in a debilitated state. But 
in the early stage of severe diseases, we must not thus reason or thus 
decide, without a careful examination of all the symptoms of the case. 
The heart, which is the centre of the circulatory system, may be 
obstructed in its movements by an engorgement of blood in its cavi- 
ties and the large vessels near it, and its free contraction and dilatation 
may be restrained. It may be drowned like a mill-wheel flooded 
with back water. 
The concomitant symptoms of such a state are, a blood-shot eye, 
coldness of the ear, horn and extremities, panting for breath, and 
protrusion of the tongue. The neck will be outstretched, to assist 
in the efforts of breathing, with a heaving of the flanks. Cases an- 
swering to this description would be ranked among the extremes, but 
they are not hopeless, if suitable measures of relief are adopted and 
pursued promptly and vigorously. 
Here I remark again, that bleeding is the first remedy and the only 
remedy which will be effectual, as without it, other remedies will not 
act with sufficient promptitude to save the patient. Bleeding pre- 
pares the way for the use of other means, which, without it, would not 
only afford no relief, but might increase the oppression. Bleeding, 
