78 CLINICAL DIAGXOSTICS. 



By the strength of the pulse we mean the force with 

 which it Hfts the finger palpating it. We distinguish a 

 strong (pulsus forfis) and a weak (pulsus dcbilis). In 

 hypertrophy of the heart the pulse is strong; in parenchyma- 

 tous degeneration of the cardiac muscle, it is weak. The 

 degree of weakness shown by the pulse indicates the severity 

 of the attack. We form an estimate of the strength of the 

 pulse by noting whether it is readily compressible or not. 



The hardness of the pulse is due to the distention of the 

 arterial wall and is greatest at the acme of a wave. The 

 pulse is hard (pulsus durus) in severe pain, peritonitis, tetanus 

 and acute brain diseases, fin inflammation of serous mem- 

 branes generally the pulse is hard]. The opposite of a hard 

 pulse is the soft pulse [pulsus iiwllis). 



Besides the above the 'following kinds of pulse deserve 

 mention: Trembling pulse (p. treniulus), where the wave 

 in the distended artery is so small that only a slight trembling 

 can be felt. Thready pulse (p. filifonnis) is one which is sO' 

 small, weak and soft as to be hardly perceptible. If asso- 

 ciated with this pulse the visible mucous membranes are 

 cyanotic, it shows deficient heart's strength and justifies a bad 

 prognosis. The zviry pulse is a small, tense and very hard 

 pulse. Occurring in colic it is a bad sign. A less marked 

 wiry pulse may be noted in aortic stenosis and in chronic 

 nephritis. 



The arch of the pulse wave may become changed in dis- 

 ease. If the wave is very abrupt, we speak of a hopping,. 

 swift pulse (p. celcr) ; if, on the contrary, the wave is much 

 prolonged, it is spoken of as a "sluggish" pulse (p. tardus). 



A quick pulse (p. cclcr) is associated with mild cases 

 of cardiac hypertrophy, plainly marked in aortic insufficiency^ 

 In the latter case it is due to the regurgitation of the blood,, 

 which occurs at systole, into the hypertrophic left ventricle. 

 In both these instances the pulse is full and strong. Remark- 

 ably in heart's weakness a p. celcr is present. However, here 



