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ity to do so-is a distinguishing symptom of dysentery. Constipation is very common, and is often produced by over-use of cathartics or clysters. Diarrhoea may exist even with impacted fæces, the patient having frequent small movements without unloading the bowels. What is passed under such circumstances will be either fluid, or small, dark, hard masses, known as scybala. This is important to remember, for a nurse is too apt to have the idea that the patient's bowels must be all right if they move daily, without regard to the quantity passed. Eructations of gas, borborygmi, rumblings in the intestines, and tympanites, distention of the abdomen by gas, are all noteworthy, as also dysuria, painful passage of urine, and suppression, retention, or incontinence. The latter is no evidence that the bladder is empty. There are many important indications to be derived from the urine which will be spoken of later.

In women, the menstrual function calls for special observation; the regularity in the appearance of the catamenia, whether accompanied, preceded, or followed by pain, and any related phenomena.

Hæmorrhage from any organ is always more or less important. Even a nose-bleed may be an initial symptom of typhoid. The color, quantity, and general character of any discharge are to be carefully observed.

Pain is always a subjective symptom, though most often accompanied by others which are objective. Pain implies life and reaction, and its absence is not always a favorable indication. With an extreme degree of shock there is no pain. Sudden cessation of pain during the progress of severe organic disease, generally heralds the approach of death. Pain may be inflammatory or neuralgic; the former is increased by pressure, the latter relieved by it. Get the patient to describe

the kind of pain he feels, as well as to locate it; to tell whether it is acute, dull, aching, stinging, burning, steady, spasmodic, etc. Exaggerated sensibility is called hyperæsthesia; diminished or lost sensibility, anæsthesia. Either may be general or local. Partial anæsthesia is often conjoined with loss of muscular power-paralysis. If the lower half of the body is so affected, it is called paraplegia; paralysis of the lateral half is hemiplegia. In hemiplegia the temperature may be found a degree, or a degree and a half, higher on the paralyzed side than on the other. Aphasia, loss of the power of speech, occurs most often in connection with right hemiplegia.

Incoherence of speech, muttering, slowness of comprehension, loss of interest, unusual irritability of temper, difficulty of swallowing, a tendency to spill food or drop things, and picking at the bedclothes, are all symptoms of gravity. Involuntary muscular contractions vary from slight spasms, as cramps, to severe convulsions. Subsultus, twitching of the muscles, and many little nervous motions may be so classed. Note the frequency and persistency of movement, if the convulsions are general, or confined to one part of the body, whether or not the patient is unconscious, if the attack is sudden, and the mental state before and after it.

Under disorders of consciousness are included all sorts of delusions and hallucinations, delirium, and stupor. Note the kind of delirium, if quiet, busy, or maniacal; if persistent, or only occasional, and when it is most violent. Try if the patient can be roused from stupor. Complete insensibility, from which the patient can not be awakened, is known as coma. Profound coma, which does not terminate within twenty-four hours, may be regarded as almost certainly fatal. Con

tinuous sleeplessness, with partial unconsciousness, constitutes coma-vigil, also an almost invariably fatal symptom. Insomnia is always ominous in proportion to its duration. It is important to note how much sleep a patient gets, at what time, whether it is quiet or disturbed, the occurrence of dreams, talking in sleep, etc. A patient will often think he has been awake all night, when, in fact, he has had several hours of sleep without realizing it. The nurse should be able to state the facts accurately.

The degree of intensity of all symptoms, the time and order of appearance, and the combinations, are to be observed. Often a symptom, which by itself would be insignificant, becomes in its relations with others of grave import. If uncertain whether a circumstance is of any value, still make note of it, for it is better to report to the physician a dozen superfluous items, than to omit one of importance. Do not trust too much to memory, but keep a little memorandum-book in which to note facts, and take down orders. A sheet of foolscap ruled, after the following plan, gives a good form for bedside notes.

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CHAPTER VII.

Modes of administering medicines-Medication through the skin— Hypodermic injections-Inhalations-Medication by the stomach -Preparations of drugs-Care of medicines-The nurse's responsibility-Peculiar actions of drugs-How to disguise disagreeable tastes-Doses for children-To give medicine by force-Measurements-Abbreviations-List of drugs in common use.

MEDICINES may be introduced into the system either through the skin, the mucous membrane, or the subcutaneous tissue, with the same constitutional results, but differing in degree, and in the time required to produce them.

There are three ways of introducing medicine through the skin, known respectively as the enepidermic, the epidermic, and the endermic methods. In the first, the medicinal agent is simply placed in contact with the skin to be absorbed, so far as may be, by it. If friction is employed to hasten absorption, the method becomes epidermic. In the endermic method, the cuticle is removed by blistering, and the medicament sprinkled over the raw surface. Absorption is then much more rapid. This is now but rarely practiced, as, although sometimes effective, it is painful and somewhat uncertain.

Endermic medication has been largely superseded by hypodermic or subcutaneous injections. These the nurse will so frequently have to give, that she must be thoroughly familiar with the process. There are two

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