SEMIOLOGY. 13 



Lodies in the soft structures, or some disturbance of the vas- 

 cular or special nervous supply. 



2. Thorax, a. Circulatory System. — Here the indications 

 by which we may be directed in forming an estimate either of 

 the nature or extent of disturbance are central as well as peri- 

 pheral. Attention must be given to the position of the heart, 

 its sounds and impulse, as also to such symptoms as cardiac 

 dyspnoea and palpitation. In our patients, however, it is pro- 

 bable that the peripheral indications — those afforded b}^ the 

 state of the pulse — are more generally depended upon. 



Regarding the pulse as the vibration or beating of the 

 arteries from afflux of the blood in response to the contrac- 

 tions of the heart, we find that its difterent characters or con- 

 ditions in disease are referable to — (1) the number of pulsations 

 or beats in a given time ; (2) to the rapidity or degree of 

 quickness with Avhicli each pulsation is accomplished ; (3) to 

 the character or volume, hardness or strength of each pulsa- 

 tion ; (4) to the equality or inequality either of the pulsations 

 themselves or of the intervals occurring between each ; (o) to the 

 various impressions each pulsation may produce on the finger. 



h. Respiratory System. — While observing and noting the 

 condition of respiratory function, we have to recollect that 

 between the function of respiration and that of circulation, 

 i.e. between the entrance and expulsion of atmospheric air 

 from the lungs and the contraction of the heart and propulsion 

 of the blood through its appropriate channels, there is in health 

 a tolerably constant relationship, Avhich relationship) is not 

 observed in disease. We may find the cardiac contractions 

 much increased in number without a corresponding relative 

 increase in the respirations. In disease disturbance of the 

 respiration may and does occur, both in respect of the rapidity 

 or frequency with which the act is performed, and also as to 

 the character of the act. 



In our clinical examinations and observations of disease, we 

 are particularly required to note the number of the respirations 

 per minute : whether easy, calm, and full-drawn, or difiicult, 

 painful, cut short when half accomplished and irregularly 

 carried out. Also it is needful to remember a few cardinal 

 facts in connection with the performance of this act, which, it 

 neglected, even accurate observation may mislead, such as — 



