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.