INDICATIONS OF SICKNESS
By indications of sickness we mean all evidences of deviation from a
normal physical condition. They may be apparent only to the person in
whom they occur, or to a second person only, or to both. These
deviations, commonly called the symptoms of sickness, are always
important to notice, whether the conditions they indicate are serious or
not.
Early symptoms of sickness are often slight; hence they easily pass
unnoticed. Yet a slight trouble, easily checked in its early stages,
may, if neglected, grow into a serious or even fatal disorder: just as a
burning match, which anyone could extinguish instantly, may kindle a
fire beyond the power of an entire city to control.
It is important, then, to notice even slight symptoms of sickness,
first, in order to determine the nature of the trouble, and second, in
order to institute treatment as early as possible. It is, however,
hardly less important to observe symptoms accurately during the entire
course of an illness. A patient's progress can be determined only by
careful comparison between present and past conditions.
Many symptoms can be detected only by methods requiring scientific
apparatus as well as the knowledge and skill of a physician, but very
pronounced symptoms are generally evident to anyone. The neighbors do
not need to be told when a person has advanced tuberculosis; neither is
an expert required to see that something ails a man with a broken leg.
Furthermore less pronounced symptoms may often be clearly seen by any
observant person, even by those not specially trained. Accordingly it is
important for every woman who has charge of others, sick or well, to
form the habit of noticing unusual appearances of any kind. This habit
is one that most people must take pains to acquire, because people
generally see only the things that their own experience in life has
taught them to see. An added difficulty is the fact that when illness
begins it is not a trained observer, but the untrained sufferer or
untrained member of his family who decides whether to send for the
doctor and thus to set in motion the machinery for treatment and cure.
All the training and experience of a physician are required in order to
decide what symptoms indicate, and to prescribe proper remedies.
Diagnosis, or the process of determining the nature of illness from the
symptoms observed, is often exceedingly difficult; it must take into
consideration not one symptom only but the presence or absence of a
number of symptoms. Untrained persons who attempt to make diagnoses are
frequently led astray by the fact that actual causes of trouble may be
situated far from the places where symptoms are felt or observed. For
instance, the real cause of headache may lie in a region far removed
from the head; and so-called heart-burn, which is caused by disordered
digestion, has nothing to do with the heart. Again, an early symptom of
tuberculosis of the hip joint is pain under the knee; a mother is
clearly not doing the best thing when she assumes that any pain in a
joint means rheumatism, and therefore doses her suffering child with the
medicine that "helped" his rheumatic grandfather. No untrained person is
equipped to make a diagnosis, and still less to prescribe medicine or
treatment.
Symptoms, like all other forms of discomfort, tend to trouble a patient
in proportion to the amount of attention that he gives them. Hence, in
order to avoid calling his attention to them unnecessarily they should
be observed so far as possible without his knowledge; when it is
unavoidable for him to realize what is going on, observation should be
made a matter of routine, so that his interest may not be especially
excited. For instance, everyone who has seen the routine medical
inspection of school children realizes how little attention the children
themselves give to the process, apparently regarding it merely as one of
the many inexplicable proceedings of grown people. On the other hand,
children who know their symptoms are over-anxiously watched soon learn
to watch themselves and to exaggerate every little ache and pain.
Symptoms may be divided into two classes: first, objective symptoms, or
those that can be noted by an observer, like cough, pulse rate, or color
of the skin; and second, the subjective symptoms, which are apparent
only to the person affected, like pain and fatigue. The success of any
woman who cares for the sick depends to a large extent upon her
quickness and accuracy in noticing and reporting these symptoms and
their variations. It should be remembered that pronounced symptoms are
not the only ones of importance: even slight symptoms that continue over
an appreciable length of time may be of very great importance. A brief
description of some important symptoms follows, in order to help persons
without technical training to describe the symptoms as well as to
observe them.
OBJECTIVE SYMPTOMS
TEMPERATURE.--Bodily heat is produced by slow burning of food materials,
which goes on for the most part in actively working muscles and glands.
Heat thus generated is distributed by the blood to all parts of the
body, but the surface of the body is generally cooler than the interior.
In health the body temperature varies only a few degrees, no matter how
much the temperature of its surroundings varies; consequently a
temperature is abnormal if it is higher or lower than the usual
temperature of a healthy person.
The temperature is taken by means of a clinical thermometer placed
either in the mouth, the rectum, or the armpit (axilla).
[Illustration: FIG. 10.--CLINICAL THERMOMETER.]
To take the mouth temperature, first wash the thermometer, using cold
water and absorbent cotton or clean soft cloth. Next shake it until the
mercury thread registers 96° or below. It is well before purchasing a
thermometer to see whether it can be shaken down easily. Next place the
thermometer in the patient's mouth, with its bulb under his tongue; he
must then keep his lips closed until it is removed. Leave the
thermometer in his mouth for two minutes. Then remove the thermometer,
read the temperature and record the result. Clean the thermometer at
once, using first cold water and soap, and then alcohol, 70%.
The mouth temperature of a healthy person is about 98.6° F. This
statement holds true if the person has been sitting with his mouth shut
for a little while before his temperature is taken; but a hot bath,
breathing through the mouth, eating or drinking, and so forth may cause
marked temporary changes.
The temperature in the rectum generally varies less than the temperature
in the mouth unless it is taken when the rectum contains fecal matter.
The temperature should be taken by rectum in babies and young children,
restless, drowsy, or delirious patients, patients who cannot be trusted
to keep the thermometer under the tongue, mouth breathers, and in any
patients who have difficulty in keeping the mouth shut. The temperature
is normally about half a degree higher in the rectum than in the mouth.
In order to take a temperature by rectum, adults generally find it more
convenient to lie on the side and prefer, if they are able, to insert
and hold the thermometer themselves; but the attendant should be
certain that they can do so without breaking the thermometer. Rectal
thermometers should be lubricated with oil or vaseline before using;
they should be inserted about two inches, left in three minutes, and
cleansed in the same way as the mouth thermometer. A thermometer used to
take rectal temperatures should never be used in the mouth.
In taking the temperature of a baby place him on his back, hold him
firmly with his legs elevated, and carefully insert the bulb of the
thermometer, well oiled, for about one inch. Keep the child quiet, and
hold the thermometer in place three minutes. Great importance should not
be attached to a slight fever of short duration. The temperature of a
child is much more easily affected by slight causes than that of an
adult, and rectal temperatures between 97.5° and 100.5° should not cause
anxiety unless continued.
Temperatures taken in the axilla are less accurate than those taken by
mouth or rectum. Consequently the method is less often used. The axilla
should first be wiped; then the thermometer should be inserted and held
for 5 minutes by pressing the arm tightly against the chest wall. The
temperature in the axilla is normally about half a degree lower than in
the mouth.
The temperature varies somewhat according to the time of day. It is not
unusual for the mouth temperature of persons who are entirely healthy to
be as low as 97° in the early morning, or as high as 99° in the late
afternoon, and probably most people's temperatures vary as much as a
degree during the twenty-four hours. Even greater variations that are
not long continued have little if any significance in people who feel
well.
Decided variations either above or below normal are highly important
symptoms. A temperature below 98° is called subnormal, and one above
99.5° is called fever. The number of degrees of fever does not
necessarily bear a direct relation to the severity of an illness. Thus,
it does not follow that one person is twice as sick as another, because
his temperature is twice as many degrees above normal. All symptoms,
including variations in temperature, must be considered in connection
with one another, and it is generally impossible to state the
significance of any one symptom taken by itself.
The temperature should be taken once or twice a day as a matter of
routine in almost every form of illness, and oftener when the patient's
condition requires it. Also it should be taken as a matter of routine
whenever there is indication of beginning sickness; especially when
there is headache, pain, sore throat, coated tongue, cough or cold,
chill, vomiting, diarrhœa, or rash. It is not a good plan to take
one's own temperature oftener than necessary, or indeed anyone's;
certainly not a baby's, since frequent use of the thermometer may
irritate the rectum.
PULSE.--Each time the heart beats, blood is forced out from the heart
into the arteries, thus causing an expansion of the arterial walls. This
expansion, called the pulse, can be felt in some places where arteries
lie close to the surface of the body. The character of the pulse beat
and its rate, or the number of times the beat occurs each minute, give
information about the heart and blood vessels; taken together they are
perhaps more important than any other one symptom.
[Illustration: FIG. 11.--TAKING THE PULSE AT THE WRIST. NOTE THE
POSITION OF ARM. (_From "Elementary Nursing Procedures," California
State Board of Health._)]
The pulse rate varies much more than the temperature. It differs in
different individuals and at different ages, and it often shows great
temporary changes, especially during exercise or eating, or as a result
of excitement, fear, or other emotion. Definite statements in regard to
normal pulse rates are hard to make, because different individuals
though in perfect health show marked variations; we generally say,
however, that the pulse rate of a normal man at rest is about 72 a
minute, and that of a normal woman is about 80 a minute. At birth the
pulse is quickest; it may then be from 124 to 144. From the 6th to the
12th month it may be from 105 to 115 a minute, and from 90 to 105
between the 2d and 6th years. About the time of puberty it reaches the
adult rate, and during old age it may be decidedly slower than the adult
rate.
What we chiefly want to know about the pulse is
1. Its rate, or number of beats per minute,
2. Its force,--whether weak or strong,
3. Its rhythm,--whether regular or irregular.
Much practice is necessary before the pulse rate can be counted with any
degree of accuracy, and wide experience with both normal and abnormal
pulses is required in order to judge its strength, rhythm, or other
characteristics.
The pulse may be felt most conveniently on the thumb side of the front
of the wrist. The pulse should be counted while the patient is lying
down, and the watch used must have a second hand. To count the pulse,
one should place two or three fingers (not the thumb) on the patient's
wrist, and after the pulse has been felt distinctly for a few beats, the
exact time by the second hand of the watch should be noticed and the
counting begun immediately. It is generally best to count for half a
minute, multiply the result by two to get the rate for a whole minute,
and then to repeat for another half minute. The two results should agree
within two beats, if the patient is quiet. A greater variation than two
beats may mean that the pulse rate is varying, but when it is counted
by inexperienced persons the apparent difference is generally the result
of inaccurate counting, and it may be necessary to count two or three
times more. The force of the pulse varies also in different individuals;
it is, however, important to notice when it grows stronger or weaker in
the same person. Normally the pulse-beat is regular like the ticking of
a clock; it is called irregular if a few rapid or slow beats are
followed by others of a different rate. During sickness the pulse should
be counted whenever the temperature is taken, or oftener; and the result
should be written down at once. The pulse of a sick person often shows
changes both in rate and character; these changes are generally
important and should be noticed.
RESPIRATION.--Variations in the rate and character of respiration or
breathing should be noticed. The normal rate of respiration for an adult
at rest is 16 to 20 each minute, but it may be much faster, especially
during muscular exercise. In babies the rate is about 30 to 35 a minute,
and 20 to 25 in little children. The respirations, especially of babies,
can best be counted during sleep by placing the hand lightly on the
chest or abdomen. Since the respiration rate is partly under a person's
control, it is almost sure to alter if the patient knows it is being
counted; hence when the patient is awake it is better to keep one's
fingers on his wrist, to place his hand upon his chest, and then to
count the rise and fall of the chest while apparently counting the
pulse. Sometimes it is possible to count the respirations merely by
watching the rise and fall of the nightgown or bed clothes. The
respiration is usually counted for a full minute. A watch with a second
hand must be used, and the result should be recorded immediately.
In certain forms of sickness breathing may become rapid, especially if
the lungs or air passages are affected. In addition to the rate anything
unusual about the breathing should be noticed whether it seems difficult
or painful; if noisy, whether the sound is like snoring, or wheezing, or
sighing, and so on.
GENERAL APPEARANCE.--Any unusual expression of the face should be noted;
whether it is drawn, pinched, anxious, excited, or dull and stupid; and
also, whether the face is thin, swollen, or puffy under the eyes. The
condition and appearance of the skin are significant: the skin may be
dry, moist and clammy, hot or cold; its color, and the color of the face
especially, may be flushed or pale or slightly yellow or blue. A bluish
tinge about the nose, tips of the fingers, or the feet should be
specially noticed. Reddened or discolored areas on any part of the body
may be important, and also eruptions, rashes, swellings, or sores. It
should be noticed whether the abdomen is normal or whether it is
distended and hard.
Strength or weakness is indicated to some extent by the way the patient
moves, and by his ability to walk, stand, sit, hold up his head, feed
himself, or turn in bed without assistance. The position he habitually
takes is sometimes significant; in heart affections, for instance, he
may be unable to lie down, in pleurisy he ordinarily lies on the
affected side, and during abdominal pain he generally draws the knees
up.
SPECIAL SENSES.--The special senses are frequently disturbed in
sickness. The eyes may be blood-shot; the patient may be over-sensitive
to light, or see spots floating before the eyes, or he may be unable to
see at all. The pupils of the eyes may be unusually large or small, or
one may be large while the other is small. Swelling, redness, or
discharge from the eyes should be noticed. Hearing and touch and smell
may be impaired; or they may be abnormally acute, and cause real
suffering. Taste may be impaired, especially when the nose is affected
or when the mouth is not clean. Discharge from the nose or ears should
be reported. Not only discharge, but also trouble of any kind, such as
pain, tenderness, or swelling, is important if situated in or near the
ears.
THE VOICE is often much altered in sickness. It may be weak, hoarse, or
whispered. Speech may be clear or thick, or the ability to speak may be
entirely lost; in extreme weakness speaking is generally difficult, and
may be impossible. Moaning, groaning, and other unusual sounds should be
noted. A loud, sharp cry at night with or without waking, if a repeated
occurrence, may be an early symptom of some diseases of children.
THE TONGUE in health is red and moist; when extended it is somewhat
pointed and can be held steadily. In sickness it may be cracked, dry and
parched, or if the patient is not properly cared for, it may be covered
with white, yellow, or brown coating; in many exhausting illnesses it is
flabby and trembling. In scarlet fever the tongue is often a vivid red
color, and is then called strawberry tongue. The odor of the breath may
be foul from decay or neglect of the teeth, from indigestion,
constipation, nasal catarrh, or special diseases.
THE THROAT and tonsils are sometimes red and swollen as in simple sore
throat; or they may be covered by white patches.
THE GUMS may be swollen, tender, or bleeding. A collection of sticky
brownish material may appear on the teeth and gums of neglected
patients.
COUGH when present may be: dry, or accompanied by expectoration;
painful, frequent, loud, or whooping; and worse by day or by night. The
sputum may be yellow, white, gray, rusty, blood-streaked, dark, or
frothy. The amount of sputum should be noticed as well as its
appearance.
APPETITE or absence of appetite should be noted, and also the amount of
food actually eaten by a patient; the amount eaten is frequently not the
same as the amount carried to him on a tray.
If VOMITING occurs, the color, consistency, amount, and general
appearance of the vomitus should be noted; if its appearance is unusual
the vomitus should be saved for the doctor's inspection.
EXCRETIONS.--The number of bowel movements is important, and also their
character. The consistency of the feces may be hard, soft or fluid;
their color may be any shade of brown, yellow or green, from black to
clay color. They should be saved for the doctor to see if appearance or
odor is unusual.
THE URINE in health is clear, amber colored, and slightly acid. From 30
to 50 ounces should be excreted in 24 hours; the amount varies, however,
especially according to the amount of fluid taken. It is important to
notice whether the urine is scanty or greatly increased in amount, dark
or pale, clear or cloudy, and whether sediment is deposited after
standing. It is essential that urine should be voided in sufficient
amount; the necessity for watching its quantity is frequently overlooked
in the home care of the sick. Frequency of urination should also be
noted. Inability to urinate, particularly where the urine has previously
been scanty, is serious if continued; it should be reported to the
doctor without delay. Inability to control the bladder and bowels are
also symptoms to be reported.
LOSS OF WEIGHT is significant in both adults and children, and failure
of babies and children to gain in weight is a danger signal.
SLEEP.--The number of hours a patient sleeps should be noticed and
recorded as accurately as possible. The word of the patient on this
subject is not sufficient evidence. Character of sleep should also be
noted, whether it is quiet or restless, and whether the patient sleeps
lightly or is difficult to arouse.
MENTAL CONDITIONS.--It is important to watch carefully the mental
condition of a patient; whether, for example, he is normal, or
depressed, irritable, restless, apathetic, dull, excited, wandering,
delirious, or unconscious. Hasty judgment of mental conditions should
be avoided, but close attention to them is necessary.
SUBJECTIVE SYMPTOMS
PAIN is the most important subjective symptom and should never be
disregarded. Bodily pain does not occur in persons who are in all
regards physically and mentally well; hence pain is a sign that
something, small or great, is out of order.
"Of all symptoms pain is the one which interests patients
the most. We here emphasize the truth, too little
understood, that pain is an unpleasant sensation, nothing
more, and is _never_ imagined. Imagination may be its
cause, but the pain thus produced hurts just as truly as
pain produced by a real disease. Pain is only a phenomenon
of consciousness; it is always real, even that felt in a
dream. If the patient is too unconscious to feel it, there
simply is no pain, no matter how badly the person's body is
injured." (Emerson: Essentials of Medicine, p. 356.)
One should remember that no possible method exists to measure the
intensity of pain exactly, or to describe its quality accurately.
Therefore in describing pain, it is best to use the patient's own
language. Four points should especially be observed, (1) its location;
(2) its character, which may be dull or sharp, stabbing, throbbing or
continuous, slight or severe; (3) the time at which it is worst; certain
diseases, for instance, are characterized by more severe pain at night;
(4) it should be noticed whether the pain is relieved or increased by
change of position, eating or drinking, heat or cold, or the like. Pain
may be felt in a part far from the place where the trouble really lies;
thus a dislocated shoulder causes pain in the elbow.
Pain is always a danger signal, although the significance is not always
so great as the sufferer thinks. The more attention a patient gives to
his pain, the more severe it always becomes, therefore his attention
should not be called to it unnecessarily. A good observer, however, can
get much information by noticing the patient's expression, position,
motions, etc., without constantly asking him how he feels. Although many
persons overestimate pain, others persistently disregard it, either
because they are unwilling to take the necessary measures to remedy it,
or because they wish to appear heroic. Both courses of action are
mistaken; everyone should realize the folly and danger of bearing pain
if it is possible to remove the cause.
Nausea, fatigue and malaise are other subjective symptoms; malaise is
the name given to a general feeling of physical discomfort not
restricted to any one part of the body. All three are abnormal when
there is not apparent or sufficient cause.
RECORDS.--An accurate record should be kept of the patient's symptoms,
medicine, diet, treatment, etc., so that the doctor may have a
continuous record, and so that another person taking charge temporarily
may know just what has been done for the patient. The record must be
written; otherwise details cannot be remembered exactly. It should be as
simple and concise as possible; it is the place for facts, not for
opinions, and if inaccurate it is worse than none. It is better not to
keep the record in the patient's room, for the patient should not see
his own record, nor hear its contents discussed. The doctor usually
writes his orders on the record sheet itself, or on a separate sheet to
be attached to the record for reference. Blank record forms can be
purchased, but a form that is made at home is entirely satisfactory. An
example of a daily record sheet follows.
RECORD
------+----------+----+-----+-----+----------------+----+-----+-------
Date | Hour |Tem.|Pulse|Resp.| Diet and |B.M.|Urine|Remarks
| | | | | medicine | | |
------+----------+----+-----+-----+----------------+----+-----+-------
1916 | | | | | | | |
Jan. 1|4 p.m. |100°| 76 | 24 |Medicine | | |
|5 p.m. | | | | | 1 |℥ vii|
|6 p.m. | | | |Supper: | | |
| | | | | Baked potato, | | |
| | | | | toast, fruit, | | |
| | | | | tea. | | |
|8 p.m. | | | |Medicine | | |Sponge
| | | | | | | |bath.
|9:30 p.m. | | | | | | |Asleep.
Jan. 2|3 a.m. | | | | | |℥ ix |
|8 a.m. |99° | 74 | 22 |Medicine | | |Patient
| | | | | | | |slept
| | | | | | | |most
| | | | | | | |of the
| | | | | | | |night.
|8:30 a.m. | | | |Breakfast: | | |
| | | | | Cereal, orange,| | |
| | | | | toast, coffee. | | |
|9:30 a.m. | | | |Bath. | | |
|11:30 a.m.| | | | | | |Sat up
| | | | | | | |1 hour.
------+----------+----+-----+-----+----------------+----+-----+-------
TUBERCULOSIS, CANCER, AND MENTAL ILLNESS.--As we have seen, early
symptoms of sickness are always important; yet it seems worth while to
mention particularly the early symptoms of tuberculosis, cancer, and
mental disorders, because each of these diseases, though curable in
many cases when taken in the early stages, is serious and often fatal
if neglected. Certain facts relating to their cause and prevention
should be known to everyone. Tuberculosis, long our greatest cause of
death, is gradually growing less; but cancer and mental disease are now
on the increase.
TUBERCULOSIS.--Every year tuberculosis causes the death of about 150,000
people in the United States. It is caused by the bacillus tuberculosis,
a germ which may attack any tissue of the body, although it most
frequently affects the lungs of grown people, and the bones and glands
of children. The disease is not inherited, but susceptibility to it
appears to be; it is readily communicated from person to person. The
germ of tuberculosis is so widely distributed that probably few persons
over 30 years of age have not been infected with it at some time,
although the infection may have been too slight to be noticed. Indeed,
most people have probably been infected many times, though without
serious results.
Tuberculosis is spread chiefly in two ways: (1) through any bodily
discharges from infected persons, especially through the nose and mouth
discharges; (2) through milk from infected cows. The ways by which the
disease is spread indicate methods of prevention. Milk, especially for
children, should either be pasteurized or should come from cows that
have been tested and proved to be free from the disease. Other methods
of prevention include avoiding any and all bodily discharges of infected
persons, and increasing bodily resistance as far as possible. Good food,
sufficient rest and fresh air are not only important preventives, but
also the most efficacious means of cure. Persons who suffer from
insufficient food, exposure, bad housing, long hours, and bad conditions
of work are especially susceptible to tuberculosis, and thus it is
rightly called a disease of poverty.
Early symptoms of tuberculosis include cough, hoarseness, loss of
appetite, pain in the side, loss of weight, getting tired easily,
feeling run down, rise in temperature in the afternoon, night sweats,
expectoration, and spitting blood. No one, nor even several, of these
symptoms necessarily indicates the presence of tuberculosis; on the
other hand, even the cough is not necessarily present when tuberculosis
actually exists. When one or more of these symptoms appears and
continues, a thorough examination should be made by a doctor;
examination can do no harm, certainly, if tuberculosis is not found, and
if it is, immediate treatment is of the greatest importance. No known
drug or medicine is a cure for tuberculosis. Successful treatment
depends on taking the disease in time and in following the doctor's
advice unremittingly.
CANCER.--The cause of cancer is not known. All the evidence, however,
goes to show that it is neither communicable nor hereditary. Cancer may
occur on the skin, stomach, or other organs; in women it most commonly
occurs in the breast or uterus (womb). In both sexes it occurs most
frequently after 40 years of age. No known medicine will cure cancer;
salves and ointments have no effect. Radium and _x_-ray should not be
relied upon if the cancer can be removed by operation. Safety consists
in removing the growth entirely, and complete removal is possible only
in the early stages.
Early diagnosis is consequently of the greatest possible importance, and
an examination can do no harm in any case. Warts and moles on the skin
may develop into cancer, and should be removed if they show signs of
irritation. Loss of appetite and weight, any disturbance of the stomach
or intestines, and sores that refuse to heal should lead a person to
consult a physician; the same is true of any lump in the breast, and of
irregular or persistent bleeding from the uterus in women over forty.
The fact that pain is not present in cancer until the late stages leads
many persons to neglect the trouble until it is too far advanced for
operation. Time is all-important; hope depends on operation in the early
stages when there is a very great probability of permanent cure.
MENTAL ILLNESS.--Insanity, like cancer, is increasing. Like both cancer
and tuberculosis, hope lies in prevention and early treatment; and like
them both, in its early symptoms it is too often unrecognized or
neglected.
Many people are surprised to learn that known, avoidable causes are
responsible for the condition of about 50% of the insane patients now
under treatment. Chief among these known causes is a communicable germ
disease called syphilis, to which is due the disease called paresis, or
"softening of the brain." About 25% of patients admitted to hospitals
for the insane are there from the effects of habitual use of alcohol,
even in "moderate" quantities. Other cases of insanity result from
diseases of the heart, arteries, and kidneys, and still others have been
traced to the poisons of tuberculosis, typhoid, diphtheria, and other
communicable diseases. Prevention of insanity caused by these diseases
depends upon prevention or complete cure of the diseases themselves.
Still other causes of insanity are known. Hereditary nervous weakness
may predispose to insanity, and for such persons, those whose nervous
resistance is naturally not very great, the stress of living may prove
too much. Mental breakdowns are rarely caused by overwork unless
accompanied by worry or bad hygienic conditions, but they result not
infrequently from bad mental habits.
"The average person, little realizes the danger of brooding
over slights, injuries, disappointments, or misfortunes, or
of an unnatural attitude towards his fellowmen, shown by
unusual sensitiveness or marked suspicion. Yet all these
unwholesome and painful trains of thought, may if persisted
in and unrelieved by healthy interests and activities, tend
towards insanity. Wholesome work relieved by periods of
rest and simple pleasures and an interest in the affairs of
others, are important preventives of unwholesome ways of
thinking. We should train ourselves not to brood, but to
honestly face personal difficulties."--(Why Should Anyone
Go Insane?, by Folks and Ellwood.)
Prevention of insanity consequently depends chiefly upon avoiding
alcohol and communicable diseases, especially syphilis; upon good
hygiene, self-control, and avoidance of bad mental habits; and upon
adopting a program of living and working that will not overtax one's
nervous strength. Sleeplessness, unusual nervous fatigue following
slight exertion, and diminished power to control the emotions, are among
the danger signals. And when a person becomes unusually depressed or
morose, excited or irritable, suspicious, unreasonable, or "queer," it
is probable that expert medical advice should be obtained as quickly as
possible.
EXERCISES
1. What is a symptom? Why are early symptoms especially important?
2. Distinguish between objective and subjective symptoms.
3. Tell all you can about normal and abnormal variations in the body
temperature. What symptoms would lead you to take a person's
temperature?
4. Describe the method of taking temperatures.
5. How should you cleanse a clinical thermometer? What are the dangers
of neglecting to cleanse it properly?
6. Describe both normal and abnormal pulse and respiration.
7. Discuss the significance and importance of pain.
8. Describe early symptoms of tuberculosis, cancer, and mental illness.
What is the first step to be taken when any one of these symptoms
appears?
9. What symptoms of all those mentioned in this chapter did you notice
in the last sick person with whom you had anything to do?
10. What are the essentials of a good daily record? The following is an
account that a mother gave of the first twenty-four hours of a child's
illness. Make a chart for the patient, and include in it all the
information the mother gave. Which do you consider more useful, your
chart or the narrative?
"Yesterday, October 10th, Johnny came home from school about half past
three, and said he was too cold to play outdoors. He lay down and slept
till about five, when he vomited a large amount of undigested food. I
took his temperature and found that it was 103.8°, pulse 126, and
respiration 28. At 10 that night his temperature was 102.5°, pulse 116,
and respiration the same as before. The next morning at 8 he had a
temperature of 100.6°, pulse 114, respiration 24. At noon his
temperature was 101°, pulse 118, respiration 24; and at 4 o'clock his
temperature was 100.6°, pulse 122, respiration 22. The doctor came at 6
o'clock yesterday afternoon; according to his orders I put Johnny to
bed, gave him half a tablespoonful of castor oil at 6.30, and a special
gargle. His throat was red and sore and he seemed to feel very
miserable. The doctor took a culture from the child's throat. At 8.15
and again at 8.50 he had fluid bowel movements. At 9.30 he had a glass
of milk, after which he slept until 6 a.m. when his bowels moved again
and urine was passed. He passed eight ounces of urine at noon and four
ounces at 3.30. He drank a glass of water at 6 this morning, and at 6.30
I gave him a cup of hot broth. At 8 he had a glass of milk, but at 10 he
refused everything but a glass of water. At 1.30 he had a large dish of
ice cream. He had a cool sponge bath last night at 9, and a cleansing
bath this morning at 8.45. This morning his throat was still sore but
not so red, and I saw that he gargled every half hour when he was awake.
This afternoon he seems brighter and asked for his harmonica, so his
throat is probably more comfortable."
FOR FURTHER READING
Essentials of Medicine--Emerson, Chapters XVI, XVII.
The Human Mechanism--Hough and Sedgwick, Chapter XII.
Notes on Nursing--Florence Nightingale, Pages 105-136.
Why Worry?--Walton.
Those Nerves--Walton.
Tuberculosis: Its Cause, Cure, and Prevention--Otis.
Publications of the National Association for the Study and Prevention of
Tuberculosis--105 East 22d Street, New York City. (Pamphlets free on
request.)
Publications of the National Committee for Mental Hygiene--50 Union
Square, New York City. (Pamphlets free on request.)
Publications of the Mental Hygiene Committee of the State Charities Aid
Association--105 East 22d Street, New York City. (Pamphlets free on
request.)
Publications of The American Society for the Control of Cancer--25 West
45th Street, New York City. (Pamphlets free on request.)