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 spec