fore a nurse attending on a medical case must keep a careful watch over her own health, or she may catch the infectious disease from which her patient is suffering; or should she be nursing a surgical case, blood poisoning runs a much more serious course when its influence is brought to bear upon a weakened constitution. Women are often addicted to dosing themselves with powerful aperients; their digestion and health is often impaired in this way. The bowels may be best regulated by daily exercise, and always obeying with regularity the dictates of nature. In private or other nursing always say when you are going out, either for a couple of hours, or for the whole day. Some people think they will slip out for a walk without their patient knowing it. In this she will most likely be disappointed, the patient losing all confidence in his nurse, besides always worrying his brain for fear she should be about to absent herself without giving him due and proper warning of her intentions.

Exercise and recreation is as important for a nurse as it is for other people; as Miss Nightingale has it, "Let whoever is in charge keep this simple question in her head (not, How can I always do this right thing myself? but), How can I provide for this right thing to be always done?"

CHAPTER III.

Observation of symptoms—Rigors—Sleep—Pain—Posture-The skin -Appetite-Vomiting-Cough-Expectoration-Effect of remedies - Bowels - Urine — Tongue - Temperature taking - Respiratory movements-Pulse.

Observation of Symptoms.-By symptoms is meant certain signs or tokens of a deranged state of health which happen concurrently in different diseases. To be able to give an intelligent account of these signs and symptoms to the doctor, is to help him allimportantly in his treatment. It is difficult at first to observe and note various symptoms, but practice will make this quite easy. Whatever you do or say, be accurate, be truthful. Do not lie to hide your own negligences, as in this way you may endanger your patient's life. When asked a question, be candid, do not guess or attempt to answer by commencing, "I think;" say rather you do not know.

Inaccurate observation is not only useless, but misleading. Generalities in nursing are useless; take nothing for granted; verify everything by your own personal investigation, and with every known means of test. An untruthful, equivocating woman is useless as a nurse. In nursing a severe case you had better

commence by writing the patient's name, age, and day of the month on the top of a piece of foolscap paper, and take a note of everything, at the time it occurs, and when it occurs.

Rigors or Shivering Fits, during which a patient first feels hot and then cold, are often the precursors of serious complications. Some diseases are ushered in by a single rigor, others by a succession of shivering fits. To make the clinical or bed-side notes of a fever case, or a case of inflammation of some important organ, complete, they ought to commence from the first rigor.

Sleep. It is the want of sleep and local rest which causes half the miseries and diseases flesh is heir to. A certain amount of sleep is essential to health. Now the remarks made about the quantity of stimulants taken, apply with equal force to this subject-sleep. It is not enough for you to tell a surgeon that the patient has slept a little; this does not help him at all. People have different ideas of what constitutes a little ; also is he to understand that the patient slept soundly, or has he been disturbed by horrible dreams, and had merely a restless, unrefreshing doze? In making a note of sleep, describe what kind of sleep, and state from and to what hour he slept. If the night nurse would make some such note as this, "Slept soundly from twenty minutes to ten until a quarter to twelve, and that he slept again with one intermission of eighteen minutes from half past two until six o'clock

in the morning;" or, that "the patient dozed, restlessly kicking his bedclothes about, from half past ten until a quarter past eleven, at three o'clock he dozed again, interrupted by chattering delirium until half past four," the information to be gathered from this description would be a great help to the physician or surgeon in the treatment of his patient. In the first case, he would see at a glance that his patient had had two hours' good sound sleep in the early part of the night, which is more valuable than sleep procured towards morning or at day-break; in the second case the doctor would gather that his patient had passed a restless night, accompanied by muttering delirium and horrid dreams. This latter description would set him thinking, was this restlessness due to want of nourishment, or was it due to some other cause? Then, again, some patients cannot sleep because they are in pain.

Pain. It is the nurse's duty to observe and note the sort of pain, whether dull, aching pain, or stabbing, throbbing pain, also its duration and exact position, whether in calf of leg, ear, abdomen, or what not. She must also note whether the pain is persistent or intermittent, if relieved or not by the applications ordered, whether the pain disappears on the patient's attention being temporarily distracted, if pressure relieves or increases it.

Posture. The patient is sure to get into a position which will give him the minimum of pain and suffering, therefore a nurse must watch what position her charge

usually assumes; this will help the doctor considerably in arriving at a correct diagnosis, that is to say, help him to find out what is the matter with the patient.

People with severe pain in the abdomen, for instance, lie in bed with their knees drawn up; others suffering from advanced heart disease sit up in bed, leaning a little forward, and requiring to be propped up by pillows. Notice particularly the posture of the body during sleep; before getting off to sleep a patient will assume the easiest posture in which to lie. In pleurisy followed by effusion of fluid, the affected side is chosen to lie upon, for the healthy lung can then the more readily perform the extra strain of work which is thrown upon it. In severe cases of protracted illness, when the sufferer becomes very weak and exhausted, there is a tendency for the patient to sink down in bed; a nurse cannot give these too much attention, and must frequently lift them up and change their position. This tendency may also be borne in mind when making the bed, the mattress raised gradually towards the foot.

In doubtful surgical cases, especially in obscure injuries or diseases of joints, a knowledge of the position in which the limb falls during sleep is of immense value to the surgeon.

The Skin.-Note if the patient perspires freely, also state whether the skin is dry, moist, hot, cold, or clammy.

D