Palpitation, or disturbed action of the heart, may depend upon inflammation of its membranes (pericarditis, endocarditis), enlargement (hypertrophy or dilatation), valvular disease, anaemia, with weakness, nervous irritability (nervousness), as from strong coffee, tobacco, etc., dyspepsia, brain disorder.

A FEVER pulse is moderately rapid, and in the early stages of an attack, strong; later, soft and compressible. When violent acute inflammation of any organ is present, it is quickened, hard, and rather full, as a rule.

A nervously-disturbed pulse is quick (jerking rather than rapid), and variable, under excitement or repose.

In extreme weakness, most of all in the dying state, the pulse is nearly always rapid and small, or "thready." A pulse of 150 or 160 in a minute, is almost always a sign of death. Very rarely is the pulse slow in the dying state.

Slowness of the pulse is most marked in compression of the brain (as in apoplexy,, fracture of the skull, ox hydrocephalus, i.e., water on the brain), and in opium poisoning. Occasionally the pulse is very slow in cases of heart disorder.

Irregularity of the pulse is natural to a small number of persons, at least in childhood or in old age, without other signs of disease. It may be, otherwise, a transient symptom, particularly during convalescence from a fever. It is distinctly related to disease present, in certain cases of heart disease (when it is serious) and in the third stage of acute meningitis (inflammation of the brain). Excessive smoking of tobacco sometimes produces irregularity of the pulse.

FEELING THE PULSE

FEELING THE PULSE

A double pulse is met with in many instances of continued fever, typhus or typhoid.

Slowness of the capillary circulation is occasionally shown, in morbid states, by the tardy return of the blood when displaced by pressure, as on the back of the hand or the cheek. In the veins, likewise, this is notably seen in the collapse of cholera.