80 CLINICAL DIAGNOSTICS. 



disease. At times there exists a close relationship between 

 an irregular and an inequal pulse. A small wave follows 

 closely a larger one, so that there is a regular alternation of 

 weak and strong beats. It denotes beginning heart's weak- 

 ness. 



3. By the strength of the pulse we mean the force with 

 which it lifts the finger palpating it. We distinguish a 

 strong (pulsus fortis) and a weak (pulsus debilis). 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. 



4. 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. [In inflammation of serous mem- 

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

 pulse is the soft pulse (pulsus mollis). 



5. As combinations of varied degrees of size, strength 

 and hardness of the pulse are noted, special but superfluous 

 kinds are spoken of: Trembling pulse (p. tremulus), where 

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

 trembling can be felt. Thready pulse (p. filiformis) is one 

 which is so small, weak and soft as to be hardly perceptible. 

 If associated with this pulse the visible mucous membranes 

 are cyanotic, it shows deficient heart's strength and justifies 

 a bad prognosis. The zciry 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. 



6. The arch of the pulse wave may become changed in 

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

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

 prolonged, it i<= spoken -~>f ?s a "sluggish" pulse (p. tardus). 



