93 
PATHOLOGY. 
diagnofis is the general surface, in which the follow¬ 
ing circumftances are to be attended to; viz. i. The fur- 
face in general; as to colour, tumidity, or (hrinking of 
the integuments; oedema or anafarca, corpulency or 
emaciation, roughnefs or fmoothnefs of the Ikin, drynefs 
or moifture of the Ikin, and temperature, 2. The hands 
and feet in particular. 3. The elementary cutaneous 
aftedtions. 
And here again the circumftances of age, fex, and 
temperament, are to be noticed with the fame minute- 
nefs as in regard to the face. That part of the cutane¬ 
ous expanfion which envelopes the tongue has always been 
noticed as an important indication of the exiftence of dif- 
eafe. It Ihould be viewed with regard to, 1. Its moifture or 
drynefs, whether general or partial. 2. Its being with 
or without fur, clean or loaded, fwollen or indented. 
3. The enlargement or difappearance of its papillae. 4. 
Itscolour. 5. How protruded. 6. The internal mouth in 
general, and the tafte and breath, fliould likewife be ex¬ 
amined. 
The attitude in difeafe is next to be confidered. This 
fubjedt comprifes a vie w of, 1. The pofition. 2. Changes 
of pofition. 3. The caution obferved in moving; or 
the oppofite ftate of writhing, or of jadtitation. 4. The 
ftate or eft'edts of mufcular adtion ; and the ftate of muf- 
cular power or debility. 
The healthy pofture of infants during fleep is various. 
The young infant ufually lies on its back, often with 
its hands and arms raifed above its head, or laid upon its 
cheft, or fpread open, and with its lower extremities 
drawn upwards. When it is laid on its fide, the upper 
and lower limbs are ftill placed in a ftate of complete 
flexion and relaxation. The pofture ufually remains un¬ 
changed, unlefs the infant be difturbed by external ob- 
jedts of fenfe, internal emotions, or difeafe. 
In the healthy and undifturbed fleep of adult perfons, 
the ufual pofture is that on one fide, the body being fre¬ 
quently inclined rather to the prone than to the fupine 
pofition. The head and Ihoulders are generally forne- 
what raifed, and, together with the thorax, bent gently 
forwards. The thighs and legs are in a ftate of eafy flex¬ 
ion. The pofition is apt to be changed from time to 
time, the perfon lying on one or other fide alternately. 
The attitude, motions, and manner, are confiderably 
influenced by the temperament, the degree of bodily 
ftrength, by the ftate of the mental operations, and by 
the paflions. In a ftate of great debility, whether from 
age or difeafe, the body uniformly falls into the fupine 
pofition ; and the recovery of the ufual pofition of the 
fide is always a fign of returning ftrength. 
Thefe, then, are the morbid appearances which are to 
be regarded in fymptomatology. As to the fecond head 
of morbid fymptoms, uneafy or painful fenfations, they 
are the moft frequent concomitants and figns of all dif- 
eafes. Few difeafes are free at leaft from uneafinefs : for, 
as there is a degree of pleafurable feeling belonging to 
the healthful adiion of all the organs of the body; fo, 
when thefe are interrupted and difturbed, the fick man 
fuffers pain, anxiety, and various difagreeable fenfations. 
Befides the various modifications of pain which we de- 
feribe by comparing them with the fenfations produced 
by different caufes, i'uch as a burning, (tinging, (tabbing, 
gnawing, pain ; a (hooting, throbbing, binding, pain, 
and fo forth ; itching, tingling, a fenfe of laflitude, of 
torpor, or numbnefs, of ltupor, of heat, of cold, of 
weight, naufea, giddinefs, faintnefs, ringing in the ears, 
and a multitude of uneafy feelings, indicate the varieties 
of difeafe. Sometimes the feverity of thefe feelings 
conftitutes the principal part of the difeafe ; and they 
agitate and diftrefs or terrify the patient fo much, that 
they become more dreadful than even the apprehenfion of 
death ; indeed, in many cafes, thefe painful fenfations 
are by no means deftitute of danger, from whatever 
eaufe they originate, as they may wear out the powers of 
life by their inceffant irritation. 
The third means of diagnofis is the confideration of 
impeded or deranged functions. This is a fubjedt of the 
greateft ufe in pradtical medicine ; for, as the knowledge 
of healthy function is the grand defideratum in all our 
inveftigations of the animal frame, fo a knowledge of 
their derangements may be confidered the principal part 
of the ftudy of difeafe. Thefe derangements often con- 
ftitute individual difeafe ; often, on the other hand, they 
are indicative of general or remote difeafe. It is for the 
latter purpofe that we now confider them; and it need 
hardly be remarked that the two previous methods of 
diagnofis which we have confidered, are, in a great mea- 
fure, fubfervient to this. In regard to derangement of 
the digejlivefundtion , independently of the examination 
of the tongue, breath, &c. before enumerated, we have 
to confider, firftly, the function of the pharynx and 
cefophagus, as it affedts deglutition. Secondly, Of the 
ftomach; and herein of the appetite, third, hiccup, 
erudtation, naufea, vomiting, and the matters rejected. 
Thirdly, Of the bowels; as conftipation, diarrhoea, te- 
nefmus, involuntary (tools, flatulency, borborigma, dif- 
tention ; the ftate of the faeces; difeharges of mucus, 
blood, or pus. 
The fundlion of refpiration is next in order; and this 
fubjedl comprifes a view of, 1. The mode of refpiration. 
2. The effedl of a full infpiration. 3. The kinds of 
cough and of expedtoration. 4. Sneezing, gaping, &c. 
5. The ftate of the voice. 6. The phenomena mani- 
fefted by the ftethofeope, and the pulfation of the heart. 
In the circulatory J'yJlem, the moft important diagnoftic 
appearances are to be noticed with peculiar care. That 
alternate dilatation and contradtion of the arteries, 
which is called the pulfe, is the chief mean by which we 
are guided in afeertaining the nature of acute difeafes. 
The following divifions of this phenomena have been 
made. The flow pulfe, the quick pulfe, the Joft pulfe, 
the hard pulfe, the intermitting pulfe, and th e full pulfe. 
Many other varieties have been enumerated by different 
authors, by Galen, Bordeu, Nihel, Bellini, and Maflaria ; 
but they are entirely fanciful. 
Before we proceed to deferibe the varieties of the pulfe, 
it will be neceffary to fpeak of the many difcrepancies 
it exhibits in health. Thefe anomalies had not efcaped 
the penetrating eye of Celfus. He aptly obferves, “ Ve- 
nis enim maxime credimus, fallaciffimae rei; quia ftepe 
iftae leniores celeriorefve funt, et astate, etfexu, et cor- 
poruin natura : faepe eas concitat et refolvit fol, et bal¬ 
neum, et exercitatio, et metus, et ira, et quilibet alius 
animi affedhis : adeo ut, cum primum medicus venit, 
folicitudo, asgri dubitantis, quomodo illi fe habere vide- 
atur, eas moveat. Ob quam caufam, periti medici eft, 
non protinus ut venit, apprebendere manu brachium ; 
fed primum refidere hilari vultu, percontarique, que- 
madmodum fe habeat: et ft quis ejus metus eft, eum 
probabili fermone lenire; turn deinde ejus corpori raa- 
num admovere. Quas venas autem confpedtus medici 
movet, quam facile mille res turbant !” Lib. iii. cap. 6. 
I11 our own time, Dr. Falconer has paid much attention 
to thefe circumftances ; and has fliown that, before we 
can derive any information from the pulfe, it will be ne¬ 
ceffary to obferve the varieties which exift in its natural 
ftandard, and alio the changes to which it is fubjedted by 
common caufes. The ftandard natural pulfe has been 
varioufly eftimated : perhaps theexadleft computation is 
that which reckons 73 beats in the fpace of a minute. 
The pulfe is generally, however, quicker than this in 
women, in perfons of fanguineous temperament, and 
in young children. The increafe of pulfe in women ap¬ 
peared to be in the ratio of one feventh more than in man. 
As to children, according to Dr. Heberden, “the pulfe 
of a healthy infant afleep on the day of its birth is be¬ 
tween 130 and 140 in one minute: and the mean rate 
for the firft month is 120 ; for during this time the artery 
often beats as frequently as it does the firft day, and I 
have never found it beat flower than 108. During the 
firft 
