b. The characters observable in the pulse are chiefly change of rate or frequency; of volume or fulness, and of force or firmness. These changes are, to a certain extent, expressive of really differ ent conditions of system ; but with reference to febrile action we have to consider their relation to each other, and to other con ditions, especially that of the skin. It is from these two sources that we derive evidence of the difference between inflammation, or inflammatory fever, and simple or continued fever. The skin is more apt to be moist when its temperature is raised by mation ; to be dry when it is the accompaniment of fever. The pulse has more frequency and less foroe in fever ; greater force, and commonly less frequency in inflammation. These distinctions are all-important in treatment, but in diagnosis they do no more than give a general impression that one or other condition is most probably present.
The age of the patient has an important influence over the fre quency of the pulse; sex and habit over its fulness and firmness.
The pulse may be quickened by mere excitement; the tongue may be at the same time coated from disorder of the bowels; but this condition must not be mistaken for fever, nor, if associated in a delicate female with pain in the left side, be taken as indicative of pleurisy. The state of the skin, as well as the absence of thirst and the character of the urine, will here probably de cide against any such supposition. Acceleration of pulse, to be important, must be constant and persistent, not transient and varying with temporary excitement, &c. Certain chronic states are also accompanied by acceleration of pulse, such, for example, as heart-disease ant] phthisis; and here again the indications from other sources, even without considering the special indications derived from its force or firmness, enable us to correct an impression of acute or febrile disorder.
Changes in volume chiefly give rise to impressions of the pulse being full or empty, large or small; but these are necessarily associated with conditions of hardness or softness, strength or weakness, which are expressive of changes in force. The impressions of this character are conveyed to the finger by the greater or less degree of compressibffity ; the pressure required to obliterate the current. Deviations occurring within the limits of health generally com bine fulness with firmness, weakness with smallness. We do not expect to find a similar pulse in a man of sedentary occupation, and in one of active, or perhaps labonous, pursuits: the pulse of the female has neither the fulness nor the force of the other sex. And while these point to real differences in constitution, which guide us in the adaptation of remedies, they are not the less to be borne in mmd in judging of the' extent of deviation in disease.
Certain names have been given to unusual combinations of the characters just mentioned, with which. the student must make himself acquainted : thus smallness, with force, gives rise to what is termed a hard pulse, or, in extreme cases, a wiry pulse; large ness, with want of force, to a soft pulse; emptiness and frequency to what is often called a rapid pulse.
Irregularity of pulse has very important bearings upon special forms of disease, but is of less consequence as a symptom of the general condition of the patient.
c. The state of the tongue is to be noted with reference to its coating and its degree of moisture; and the latter is probably of more importance than the former m its bearing on our present inquiry. The characters of its coating vary in thickness, extent, and color or general appearance: it may resemble a thin coating of white paint, or of paste, or look like buff-leather • the fur may be limita to the back of the tongue, or the tip and edges alone are left clean and red; a red streak may be observed in the centre, or the organ has a general patchy appearance; lastly, the coating is either white, yellow, or dark and brown. Sometimes, on the other hand, the tongue appears unusually clean, and has a smooth and peeled appearance, or is chapped, or marked by prominent papillae. Each of these conditions is again, associated with dif fering degrees of moisture or dryness. Sometimes the excessive moisture gives it an appearance of flabbiness or oedema. Its relation to the condition of the bowels must not be overlooked.
No organ more quickly indicates derangement, however slight: in every state it sympathizes, and many of the variations just mentioned have especial reference to particular forms of disease: but they have still greater signifi cance, as symptoms of the general condition of the patient; the least import ant being those in which the fur is confined to the back of the tongue, or is thick and yellow, and bears evidence of large accumulation. The moist, flabby, or cedematous condition is wholly opposed to the idea of febrile excitement; the red patch in the centre,.and the peeled or chapped condition of the mucous membrane, are very important evidence of the form which a febrile condition has assumed, but they may be in various degrees exhibited without the exist ence of fever, properly so called : on the other hand, a bright red tip and edges, or a dark brown far, are more decidedly characteristic of fever. As a general rule, dryness is more indicative of a febrile state than any appearance which the coating presents. Accidental circumstances must not be over looked : a patient in a weak state waking from a short sleep after taking food will have a dry tongue; one who has recently taken any fluid will have a moist one, in cases in which neither condition is persistent or permanent d. The state of the bowels and kidneys is at present to be con sidered only in, general terms, whether there be constipation or diarrhoea, abundant or scanty discharge of urine. These ques tions must again present themselves in investigating the separate organs, but the knowledge of the condition of the bowels is here necessary to qualify the observations made upon the condition of the tongue; and the quantity of the urine has a similar relation to the existence of thirst.