Diet.—A baby, in order to thrive, must have suitable food, given at regular intervals. During the first few months of life no other food cantake the place of mother's milk. Breast-fed babies are more robust than bottle-fed babies; more than this, they are less likely to contract infectious diseases or to suffer from digestive disorders. The number of bottle-fed babies who die every year is three times as great as the number of breast-fed babies who die. Many mothers do not understand the risk involved in weaning small babies; and so every year many little lives are lost, and lost needlessly. When poverty forces nursing mothers to wean their babies and seek work outside their homes, one can only say that a society which tolerates such a waste of infant life is indeed regardless of its own welfare.
—A baby, in order to thrive, must have suitable food, given at regular intervals. During the first few months of life no other food cantake the place of mother's milk. Breast-fed babies are more robust than bottle-fed babies; more than this, they are less likely to contract infectious diseases or to suffer from digestive disorders. The number of bottle-fed babies who die every year is three times as great as the number of breast-fed babies who die. Many mothers do not understand the risk involved in weaning small babies; and so every year many little lives are lost, and lost needlessly. When poverty forces nursing mothers to wean their babies and seek work outside their homes, one can only say that a society which tolerates such a waste of infant life is indeed regardless of its own welfare.
Special conditions, of course, may make it undesirable for a mother to nurse her baby. No one but the physician is competent to decide this; not even neighbors, grandmothers, other members of the family, or the mother herself. Where artificial feeding must be used, it should be carefully adapted to the individual child, and in consequence it must be prescribed by the doctor. Patent foods, notwithstanding the claims on their printed labels, should be used only under his advice.
Intervals of Feeding.—Little milk is secreted during the first two days after the birth of a child. The baby should, nevertheless, be put to thebreast as soon as he has had his first bath, if the mother is sufficiently rested. Always before and after nursing the mother's nipples should be washed in water that has been boiled. Nursing should be repeated at intervals of six hours during the first two days.
—Little milk is secreted during the first two days after the birth of a child. The baby should, nevertheless, be put to thebreast as soon as he has had his first bath, if the mother is sufficiently rested. Always before and after nursing the mother's nipples should be washed in water that has been boiled. Nursing should be repeated at intervals of six hours during the first two days.
The following schedule for the feeding of healthy babies is given by Holt in "Care and Feeding of Infants." (1917.)
During the period when seven feedings are given in 24 hours the following hours will be found convenient: 6 a.m., 9 a.m., 12 m., 3 p.m., 6 p.m., 10 p.m. and 2 a.m. The 2 a.m. feeding is the one omitted when the number of feedings is reduced from seven to six. Food should be given on exactschedule time; the baby if asleep should be waked for any meal except the one due at 2 a.m.
Water.—Pure boiled water should be given regularly even to a young baby. He is often satisfied with a little warm water if he is fretful between the hours of nursing. Water may be given from a cup, a spoon, or a bottle; it is desirable, however, for the baby to learn to drink from a cup before the period of weaning begins.
—Pure boiled water should be given regularly even to a young baby. He is often satisfied with a little warm water if he is fretful between the hours of nursing. Water may be given from a cup, a spoon, or a bottle; it is desirable, however, for the baby to learn to drink from a cup before the period of weaning begins.
Weaning.—Ordinarily, a baby should be fed from the breast until he is seven months old, either exclusively or with the exception after the second month of one bottle-feeding in twenty-four hours. This exception will do the baby no harm and may be a great relief to his mother. Partial breast-feeding should continue if possible through the ninth month, but every baby should be entirely weaned by the time he is one year old. It may be necessary, if either the baby or the mother is not thriving, to change the food before the ninth month; but it is desirable not to make the change in hot weather. Healthy babies, it should be remembered, increase in weight constantly, and steady gain in weight is the best indication that a baby's food is suitable.
—Ordinarily, a baby should be fed from the breast until he is seven months old, either exclusively or with the exception after the second month of one bottle-feeding in twenty-four hours. This exception will do the baby no harm and may be a great relief to his mother. Partial breast-feeding should continue if possible through the ninth month, but every baby should be entirely weaned by the time he is one year old. It may be necessary, if either the baby or the mother is not thriving, to change the food before the ninth month; but it is desirable not to make the change in hot weather. Healthy babies, it should be remembered, increase in weight constantly, and steady gain in weight is the best indication that a baby's food is suitable.
Nursing Bottles and Nipples.—Nursing bottles should be of heavy glass, cylindrical in shape, without angles or corners to make cleaning difficult.The number of bottles provided should be two or three more than the number of feedings given in 24 hours.
—Nursing bottles should be of heavy glass, cylindrical in shape, without angles or corners to make cleaning difficult.The number of bottles provided should be two or three more than the number of feedings given in 24 hours.
Short black rubber nipples which slip over the neck of the bottles should be selected. They should be of such a shape that they can easily be turned inside out; a nipple turner costs little, and is well worth the price. Nipples should be discarded when they become soft or when the opening grows so large that the milk runs in a stream rather than drop by drop.
As soon as the baby has finished his meal, the bottle should be removed from his mouth, rinsed in clear hot water, and left standing filled with cold water until a convenient time for boiling all the bottles to be used during the next 24 hours. Sufficient time must be allowed for the bottles to cool thoroughly between the time when they are boiled and the time when they are refilled. When it is time to boil the bottles they should be placed in an agate or other suitable kettle, covered with water, and boiled vigorously for three minutes. A cloth placed in the bottom of the kettle will help to prevent the bottles from breaking. After the bottles have been removed from the boiling water, they should be stoppered at once, either with rubber stoppers or plugs of sterile cotton. The stoppers, if used, should be boiled with thebottles; sterile cotton may be purchased by the package.
An easy and satisfactory method to care for rubber nipples is the following: Provide as many nipples as the number of feedings given in 24 hours, and another, if desired, to be used in case of accident; provide also two cups of ordinary white enamel, each one large enough to hold all the nipples at once. One cup should have a cover; the other should not. To avoid mistakes it is well to have the cups different in shape. As soon as each feeding is finished the nipple should be thoroughly cleansed under running water by scrubbing it inside and out with a nipple brush. The nipple thus cleansed is placed in the cup without a cover. When all the nipples have been used, cleansed, and collected in the uncovered cup, they are transferred into the other cup; water is added, the cup is covered and its contents are boiled for three minutes. The nipples remain covered in the boiled water until needed; they are removed one by one for the successive feedings. Care must be used in removing a nipple to take it by the rim, not to touch other nipples during the process and not to dip the fingers into the water. The best way is to remove them by means of a glass rod, which is boiled with the nipples and kept with them in the cup when not in use. Thereare several advantages of this method of caring for nipples: it is easy; it reduces to a minimum the necessary handling of the nipples after boiling; and it reduces the probability of using the wrong nipple, since boiled nipples are always in one kind of receptacle and used nipples in another. It also prevents the too common practice of continuing to keep nipples in a supposedly antiseptic solution long after the solution has become badly soiled.
Tablesof diet for children over one year of age may be found in the Appendix,page 322.
of diet for children over one year of age may be found in the Appendix,page 322.
Bathing.—Usually the cord has separated and the navel has entirely healed by the time a baby is 10 days old. After this time a daily tub bath should be given; it should be given not less than one hour after feeding. The temperature of the room should be from 70-72°, measured by a thermometer placed in the part of the room where the bath is to take place. In order to avoid chilling or tiring the baby the bath should be given quickly, without confusion or interruption; success can be achieved by using even a moderate amount of foresight. Before undressing the baby everything to be used should be collected and placed within easy reach,—clean clothing, soft towels, 2 wash cloths, pure white soap, powder, absorbent cotton, etc. The bath tub should last of all befilled with water, and its temperature tested by means of a bath thermometer. The temperature of the water should be from 98° to 100°. After the baby is three months old slightly cooler water should be splashed over his chest, back, neck, and arms just after he is removed from the tub, and as he grows older the temperature of his cool splash can be reduced. Children who become accustomed to cool water in this way take kindly to their cold showers later.
—Usually the cord has separated and the navel has entirely healed by the time a baby is 10 days old. After this time a daily tub bath should be given; it should be given not less than one hour after feeding. The temperature of the room should be from 70-72°, measured by a thermometer placed in the part of the room where the bath is to take place. In order to avoid chilling or tiring the baby the bath should be given quickly, without confusion or interruption; success can be achieved by using even a moderate amount of foresight. Before undressing the baby everything to be used should be collected and placed within easy reach,—clean clothing, soft towels, 2 wash cloths, pure white soap, powder, absorbent cotton, etc. The bath tub should last of all befilled with water, and its temperature tested by means of a bath thermometer. The temperature of the water should be from 98° to 100°. After the baby is three months old slightly cooler water should be splashed over his chest, back, neck, and arms just after he is removed from the tub, and as he grows older the temperature of his cool splash can be reduced. Children who become accustomed to cool water in this way take kindly to their cold showers later.
The baby's face should be washed first and dried carefully, while his body is still covered. Next the head should be washed; a little soap should be used, but it must on no account enter the eyes. Next the entire body should be soaped with the hand; and then the baby should be placed gently in the bath, his head and shoulders supported by the attendant's left hand and forearm. Care should be taken to rinse off all the soap. The baby should not stay in the tub more than 2 or 3 minutes; after he has been removed from the tub he should be wrapped at once in a soft bath towel. He should be dried gently but thoroughly by patting with soft, warm towels rather than by rubbing. Folds of the skin should be dried with special care. A little powder may be applied, but a baby who is kept both clean and dry will not need much powder, if any. The baby shouldnext be quickly dressed, with as little turning and moving as possible. Clothing should be drawn on over the feet instead of over the head, and the petticoat should be placed inside the slip so that the two garments may go on simultaneously.
Eyes.—Secretion accumulating in the corners of a baby's eyes should be removed by means of a bit of absorbent cotton moistened in boiled water. The secretion should be wiped away gently; a different piece of cotton should be used for each eye, and a piece that has been used should not be put back into the water. Further than this, eyes in a normal condition do not need cleansing.
—Secretion accumulating in the corners of a baby's eyes should be removed by means of a bit of absorbent cotton moistened in boiled water. The secretion should be wiped away gently; a different piece of cotton should be used for each eye, and a piece that has been used should not be put back into the water. Further than this, eyes in a normal condition do not need cleansing.
Every person who handles a baby should be very sure that her hands are clean; she should be doubly sure before she touches his eyes, since a baby's eyes are peculiarly susceptible to infection from any source. More than a quarter of all totally blind persons in the United States became blind by infection of the eyes at birth. Blindness of the new born can be prevented in practically all cases if the doctor uses a preparation of silver in the baby's eyes immediately after birth. This treatment is effective and entirely safe.
If at any time the eyelids look red or swollen, or if a drop of matter appears between the lids, the physician should be summoned at once. Totalblindness may result if treatment is delayed even a few hours.
Mouth.—The mouth should be rinsed after feeding by giving the baby a teaspoonful of boiled water. Until the teeth come it does not require other cleansing, and attempts to clean it may injure the delicate membranes that line it. Indeed, except in an emergency, fingers should not be inserted into a baby's mouth. The teeth when they appear should be cleaned by means of a soft tooth-brush.
—The mouth should be rinsed after feeding by giving the baby a teaspoonful of boiled water. Until the teeth come it does not require other cleansing, and attempts to clean it may injure the delicate membranes that line it. Indeed, except in an emergency, fingers should not be inserted into a baby's mouth. The teeth when they appear should be cleaned by means of a soft tooth-brush.
Nostrils.—The nostrils need no cleaning other than removal of mucus that can easily be reached by means of a piece of cotton. If a little vaseline is placed in the nostrils on a small piece of absorbent cotton in the early morning, collections of mucus will usually be softened so that they can be removed easily at bath time.
—The nostrils need no cleaning other than removal of mucus that can easily be reached by means of a piece of cotton. If a little vaseline is placed in the nostrils on a small piece of absorbent cotton in the early morning, collections of mucus will usually be softened so that they can be removed easily at bath time.
Genital Organs.—The genital organs of girl babies should be gently washed twice a day, using absorbent cotton, and tepid water. Treatment other than cleanliness is ordinarily unnecessary. Vaseline may be applied if the genitals are slightly reddened; any discharge or abnormal appearance should be reported to the doctor. In the case of boy babies the foreskin should be gently drawn back twice a week after immersion in the tub; after the parts have been gently washed withabsorbent cotton, it should be drawn forward again. No force should be employed in retracting the foreskin; the physician should be consulted if it cannot be retracted easily.
—The genital organs of girl babies should be gently washed twice a day, using absorbent cotton, and tepid water. Treatment other than cleanliness is ordinarily unnecessary. Vaseline may be applied if the genitals are slightly reddened; any discharge or abnormal appearance should be reported to the doctor. In the case of boy babies the foreskin should be gently drawn back twice a week after immersion in the tub; after the parts have been gently washed withabsorbent cotton, it should be drawn forward again. No force should be employed in retracting the foreskin; the physician should be consulted if it cannot be retracted easily.
The Development of Habits.—During his first few months crying is a child's only means of expression, and he quickly learns to make effective use of his limited opportunities. It is important for the mother to distinguish between crying caused by pain, illness, or hunger, and crying caused by temper. These cries are more or less distinctive, but no one can be sure in every case just what a crying baby is attempting to express.
—During his first few months crying is a child's only means of expression, and he quickly learns to make effective use of his limited opportunities. It is important for the mother to distinguish between crying caused by pain, illness, or hunger, and crying caused by temper. These cries are more or less distinctive, but no one can be sure in every case just what a crying baby is attempting to express.
A cry caused by hunger is fretful and often interrupted by sucking the thumb; it ceases when the child is fed. A cry caused by indigestion is similar; the child is relieved for a short time by feeding, but soon begins to cry again. If he has acute pain, such as earache, the cry is sharp, repeated at frequent intervals and accompanied by other symptoms of distress, such as restlessness, contraction of the features, and drawing up the legs. In serious illness the cry is usually feeble, fairly constant except when the child is asleep, and exaggerated by slight causes.
A limited amount of crying is useful exercise for a baby, and should not distress his mother unduly.Moreover, crying may be merely the expression of a wish to be taken up, to be played with, carried about or otherwise amused, to be given a pacifier, or to be indulged in other bad habits. If not indulged in these ways he may cry from temper. The cry of temper is loud and violent, accompanied by vigorous kicking or by holding the body rigid. Proper treatment of the baby may prevent many months of discomfort, and spare him the formation of his first bad habit. All other possible causes for crying should be eliminated. If the child continues to cry when he is warm and dry and comfortable, "It should simply be allowed to cry it out. This often requires an hour and in extreme cases two or three hours. A second struggle will seldom last more than ten or fifteen minutes and a third will rarely be necessary" (Holt). Gas may form in the child's stomach during prolonged crying. It is consequently permissible to take him up after 15 minutes, and hold him erect; he generally expels gas at once, and immediately experiences relief. As soon as he is relieved, he should go back to his crib.
Exercise.—Exercise is essential to the development of the body, but during the first few weeks warmth and quiet are so important that a baby should not be disturbed except for necessary care. His position, however, should be changed occasionally; if he lies on the same side constantly the soft bones of the head may become misshapen from pressure. As the baby grows older he needs more exercise, and he may be given an opportunity for it by removing his outer clothing and placing him on a bed in a warm room for a short time each day. Unnecessary handling is not good for a baby at any age.
—Exercise is essential to the development of the body, but during the first few weeks warmth and quiet are so important that a baby should not be disturbed except for necessary care. His position, however, should be changed occasionally; if he lies on the same side constantly the soft bones of the head may become misshapen from pressure. As the baby grows older he needs more exercise, and he may be given an opportunity for it by removing his outer clothing and placing him on a bed in a warm room for a short time each day. Unnecessary handling is not good for a baby at any age.
After he becomes more active, he may play on a mattress or thick blanket placed on the floor. The blanket should be covered with a washable pad or rubber cloth and clean sheet, and the whole should be surrounded by a fence at least two feet high. In such an enclosure a baby may safely be left to play if protected from draughts and cold. Elevated pens that can be folded when not in use are more convenient but more expensive than the home-made arrangement. As soon as a child begins to run about he takes ample exercise, and he may even need to be guarded from too great fatigue, especially toward bedtime. Games and play should be adapted to the age of the child and sufficiently varied to exercise all portions of the body; but they should not be too violent nor too prolonged. Some supervision of children's play is necessary, but they should be given as much freedom as possible and allowed to develop their own initiative.
Play and Toys.—The desire for play does not develop until a child is about six months old. At this age toys that can be washed, such as those of hard or soft rubber, should be selected. A baby instinctively carries everything to his mouth,—first his thumb, then playthings, and later whatever he may find, no matter how unsuitable. For his safety and protection this habit should be overcome as soon as possible, and he must learn to put nothing in his mouth except food and drink. Relatives are nearly always tempted to give too many and too fragile toys; they merely teach a child to be destructive and constantly to expect something new. Toys are the first possessions of which a child is conscious, and through them many desirable qualities may be developed: neatness and order, gentleness and a feeling of protection toward the helpless doll or Teddy bear, and unselfishness in sharing special treasures with playmates. Later the child may be given pets and made responsible for their care; but animals should not be subjected to unintentional cruelties from small children.
—The desire for play does not develop until a child is about six months old. At this age toys that can be washed, such as those of hard or soft rubber, should be selected. A baby instinctively carries everything to his mouth,—first his thumb, then playthings, and later whatever he may find, no matter how unsuitable. For his safety and protection this habit should be overcome as soon as possible, and he must learn to put nothing in his mouth except food and drink. Relatives are nearly always tempted to give too many and too fragile toys; they merely teach a child to be destructive and constantly to expect something new. Toys are the first possessions of which a child is conscious, and through them many desirable qualities may be developed: neatness and order, gentleness and a feeling of protection toward the helpless doll or Teddy bear, and unselfishness in sharing special treasures with playmates. Later the child may be given pets and made responsible for their care; but animals should not be subjected to unintentional cruelties from small children.
Footnotes:[1]An area including about two-thirds of the population of the United States.
[1]An area including about two-thirds of the population of the United States.
[1]An area including about two-thirds of the population of the United States.
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 determinedonly 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 thenature 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.
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.
—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.
Fig. 10.—Clinical Thermometer.
The temperature is taken by means of a clinical thermometer placed either in the mouth, the rectum, or the armpit (axilla).
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 thepatient'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 thethermometer 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.
—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.
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 befrom 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. Aboutthe 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 iscounted 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 thepatient 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.
—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 thepatient 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 discoloredareas 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.
—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 discoloredareas 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 ofany kind, such as pain, tenderness, or swelling, is important if situated in or near the ears.
—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 ofany kind, such as pain, tenderness, or swelling, is important if situated in or near the ears.
The voiceis 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.
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 tonguein 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.
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 throatand tonsils are sometimes red and swollen as in simple sore throat; or they may be covered by white patches.
and tonsils are sometimes red and swollen as in simple sore throat; or they may be covered by white patches.
The gumsmay be swollen, tender, or bleeding. A collection of sticky brownish material mayappear on the teeth and gums of neglected patients.
may be swollen, tender, or bleeding. A collection of sticky brownish material mayappear on the teeth and gums of neglected patients.
Coughwhen 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.
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.
Appetiteor 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.
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.
Ifvomitingoccurs, 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.
If
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 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 urinein 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 offluid 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.
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 offluid 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 weightis significant in both adults and children, and failure of babies and children to gain in weight is a danger signal.
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.
—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 judgmentof mental conditions should be avoided, but close attention to them is necessary.
—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 judgmentof mental conditions should be avoided, but close attention to them is necessary.