OBSERVATION OF THE SICK.—Correct nursing of the sick is impossible unless accompanied by careful observation. Care, however, is not the equivalent of anxiety. On the contrary, the display of anxiety is harmful to the patient, and may prevent the attentive observation of his systems. It is necessary, therefore, to proceed calmly and considerately if one intends to observe the patient conscientiously. Exact measurement of the body-temperature is one of the first requirements. This is clone with a clinical thermometer (see Fig. 308), which should be on hand in every household, as otherwise the onset of fever is apt to be overlooked. In order to judge correctly the course of the fever, frequent measuring of the temperature is necessary. This should he clone at least once a day, preferably between 5 and 7 p.m. In adults the temperature is usually taken in the armpit. The bulb of the thermometer is carefully inserted in the armpit, and the arm firmly pressed against the chest (see Fig. 310). Observe that the arm under which the thermometer is inserted should be supported ; not the thermometer (see Fig. 309). An ordinary thermometer should remain in this position for from 3 to 5 minutes before the temperature is read. If it he impossible to take the temperature in the armpit (owing to a bandage, for instance), the thermometer should be placed in the closed mouth. In children it is more practical to take the temperature in the rectum. The temperature there is from to i degree higher than in the armpit.
The respiration of the patient is to be observed as to frequency (usually 16 to 20 per minute) and regularity. If any painfulness be present, this should he noted. Correct breathing should take place without obstruction and without coughing. In children respiration is at times accompanied by a depression (drawing in) between the chest and the abdomen. The sputum raised by coughing is of great importance in judging of diseases of the chest. The patient should expectorate into a receptacle filled with clean water or with a disinfectant solution, and provided with a cover. When the sputum is blood-streaked, or shows a rusty or saffron-yellow appearance, serious involvement of the lung is probably present. The occurrence of nausea
and vomiting are important signs of disease, particularly in children. The vomitus is frequently of great importance in the diagnosis of disease. It should also be noted whether or not the patient appears relieved after having vomited.
The observation of urine and excrements is of the greatest importance. With regard to the urine, it should be noted whether it is clear or cloudy when voided, and whether it forms a deposit (sediment) upon standing.
The quantity of urine passed within each 24 hours should also he noted. Glass vessels should he used for the collection of the urine. The observa tion of the frequency and condition of the stools is of equal importance. Constipation persisting for more than 24 hours should always receive atten tion. In many gastric and intestinal affections of nurslings, an inspection of the stools is absolutely necessary ; and the diapers of the affected child should, therefore, always be kept for the physician to see. Other important points to note are the colour, odour, consistency, and number of stools during the day, and whether they are combined with blood, pus or mucus.
The condition of the patient's skin must be carefully watched, and the attendant must find out from time to time whether it is perspiring, cold and clammy, or dry and hot. It is obvious that skin eruptions should never be overlooked. Any abnormally pale, yellowish, or red colour of the skin requires special attention. The appearance of scales upon the skin of children is of great significance.
The mental condition of a patient is of paramount importance. Inco herent talk is a significant sign in individuals who are apparently healthy ; still more so in persons who are known to be ill. Delirium at night calls for strict surveillance, although this condition need not give rise to fear or apprehension. The same applies to sudden, spasmodic movements, to screaming, and to grinding of the teeth. The fact that a patient loses the faculty of moving an arm or a leg should, of course, never escape the notice of the attendant.