In looking for indications of the state of the brain, we direct our attention to the mental phenomena of consciousness and co herence; we have to observe whether there be any degree of slowness of apprehension, or inability to understand and reply to questions; whether there be any wandering of thought, as ex pressed by talking, or muttering, or irrational acts ; and the relations which these bear to each other. The appearance of the eyes is closely connected with the state of the brain, as shown in strabismus, and dilatation or contraction of the pupil. Deafness is another important indication, especially when associated with discharge from the ear : so is the manner of speech, slow, hesitat ing, or imperfect. These objective phenomena are not all equally valuable ; strabismus and deafness may have nothing to do with the present state of the brain; incoherence may be simulated by hysteria ; want of consciousness by obstinacy ; the manner of speech may be a congenital defect; but they are each suggestive of further inquiry. In hysteria, we often meet with imitations of these various states, talking nonsense, singing, pretended sleep, cataleptic trance, &c. ; and if suspicion be aroused by the incon gruity of these with the general state of the patient, or if the history indicate any previous symptoms of an hysterical character, careful watching may trace consciousness when there is pretended stupor, or a method and artifice in the delirium, which disease never presents.
Subjective phenomena consist of statements of headache and giddiness, double or distorted or indistinct vision, tinnitus aurium, perversions of smell or taste, insomnia, loss of memory, &c.
The condition of the nervous system generally is indicated either by the condition of muscles, in paralysis, convulsion, or spasm ; or by sensations more purely nervous, pain, numbness, tingling, or amesthesia.
Disease in the chest is shown by lividity of face, hurry, labor, or difficulty in breathing ; by a history of cough or sensations of pain and dyspncea. These more probably point to the heart, if palpitation be complained of, with irregularity of pulse, and the dyspncea be felt in mounting a hill or going up stairs : they rather point to disease in the lungs, if cough be the more prominent symptom, accompanied by expectoration.
. Diseases of the digestive organs will have for their general signs, loss of appetite, or a sensation of craving; pain after food or occasional vomiting; constipation; diarrhcea; disordered states of the tongue without corresponding indications of fever ; pains in the epigastrium and in the abdomen ; fulness, tympanitic dis tension, hardness, tenderness, or fluctuation.
For the kidneys we have always the ready means of inspecting the urine, and, in cases of doubt, examining it chemically and microscopically. Pains in the loins, in the groin, testicle, or urethra : excessive, scanty, frequent, or painful micturition ought always to lead to further inquiries.
In females, it is generally desirable to ascertain the condition of the menstrual flux ; regular or irregular, scanty or excessive, the intervals being too long or too short, and its appearance being accompanied by pain or uneasiness. We ought also to learn whether there be any other vaginal discharge.
Eruptions on the skin, or distortions of bones and joint, do not readily escape observation; but, whenever pain on the surface is complained of, an inspection of the part is advisable, as it fre quently solves a doubt or a difficulty which all the description in the world fails to unriddle.
By such observations we determine whether further examina tion of any particular organ may be nece,ssary, not only in the way of instituting a more minute inquiry into symptoms. but also of making, when possible, a physical examination. Those con nected with states of innervation have a high importance in the phenomena of disease ; but here the physical aid is wanting, and too often we cannot get beyond a simple induction based upon the symptoms both general and special ; and to them we now proceed. •