How to examine a sick person | Where there is no Doctor

To find out the needs of a sick person, first you must ask important questions and 

then examine him carefully. You should look for signs and symptoms that help you tell 

how ill the person is and what kind of sickness he may have.

Always examine the person where there is good light, preferably in the sunlight — 

never in a dark room.

There are certain basic things to ask and to look for in anyone who is sick. These 

include things the sick person feels or reports (symptoms), as well as things you 

notice on examining him (signs) . These signs can be especially important in babies 

and persons unable to talk. In this book the word ‘signs’ is used for both symptoms 

and signs.

When you examine a sick person, write down your findings and keep them  

for the health worker in case he is needed.

 QUESTIONS

Start by asking the person about her 

sickness. Be sure to ask the following:

What bothers you most right now?

What makes you feel better or 

worse?

How and when did your sickness 

begin?

Have you had this same trouble 

before, or has anyone else in 

your family or neighborhood 

had it?

Continue with other questions 

in order to learn the details of the illness.

For example, if the sick person has a pain, ask her:

Where does it hurt? (Ask her to point to the exact place with one finger.)

Does it hurt all the time, or off and on?

What is the pain like? (sharp? dull? burning?)

Can you sleep with the pain?

If the sick person is a baby who still does not talk, look for signs of pain. Notice 

his movements and how he cries. (For example, a child with an earache sometimes 

rubs the side of his head or pulls at his ear.)

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GENERAL CONDITION OF HEALTH

Before touching the sick person, look at him carefully. Observe how ill or weak he 

looks, the way he moves, how he breathes, and how clear his mind seems. Look for 

signs of dehydration.

Notice whether the person looks well nourished or poorly nourished. Has he been 

losing weight? When a person has lost weight slowly over a long period of time, he may 

have a chronic illness.

Also note the color of the skin and eyes. These sometimes change when a person 

is sick. (Dark skin can hide color changes. So look at parts of the body where the skin 

is pale, such as palms of the hands or soles of the feet, the fingernails, or the insides of 

the lips and eyelids.)

• Paleness, especially of the lips and inside the eyelids, is a sign of anemia . Skin may also go lighter as a result of tuberculosis, or 

kwashiorkor.

• Darkening of the skin may be a sign of starvation.

• Bluish skin, especially blueness or darkness of the lips and fingernails, may 

mean serious problems with breathing or with the heart. Blue-gray color in an unconscious child may be a sign of cerebral malaria .

• A gray-white coloring, with cool moist skin, often means a person is in shock .

• Yellow color (jaundice) of the skin and eyes may result from disease in the liver 

(hepatitis, cirrhosis, or amebic abscess, or gallbladder. It may also occur in newborn babies, and in children born with 

sickle cell disease.

Look also at the skin when a light is shining across it from one side. This can show 

the earliest sign of measles rash on the face of a feverish child.

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TEMPERATURE

It is often wise to take a sick person’s temperature, even if he 

does not seem to have a fever. If the person is very sick, take the 

temperature at least 4 times each day and write it down.

If there is no thermometer, you can get an idea of the 

temperature by putting the back of one hand on the 

sick person’s forehead and the other on your own or 

that of another healthy person. If the sick person has 

a fever, you should feel the difference.

It is important to find out when and how the fever comes, how long it lasts, and how 

it goes away. This may help you identify the disease. Not every fever is malaria, though 

in some countries it is often treated as such. Remember other possible causes. For 

example:

• Common cold, and other virus infections. The fever is usually mild.

• Typhoid causes a fever that goes on rising for 5 days. Malaria medicine does not 

help.

• Tuberculosis sometimes causes a mild fever in the afternoon. At night the person 

often sweats, and the fever goes down.

How to Use a Thermometer

 Every family should have a thermometer. Take the temperature of a sick person 4 times a day and always write it down. How to read the thermometer (using one marked in degrees centigrade—°C):

3. Leave it there for 3 or 4 minutes. 

4. Read it. (An armpit temperature will read a little lower than a mouth reading; in the anus it will read a little higher.)

 5. Wash the thermometer well with soap and water.

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BREATHING (RESPIRATION)

Pay special attention to the way the sick person breathes—the depth (deep or 

shallow), rate (how often breaths are taken), and difficulty. Notice if both sides of the 

chest move equally when she breathes.

If you have a watch or simple timer, count the number of breaths per minute (when 

the person is quiet). Between 12 and 20 breaths per minute is normal for adults and 

older children. Up to 30 breaths a minute is normal for younger children, and 40 for 

babies. People with a high fever or serious respiratory illness breathe more quickly than 

normal. For example, more than 30 shallow breaths a minute in an adult usually means 

pneumonia, as does 60 breaths a minute for a newborn baby.

Listen carefully to the sound of the breaths.

 For example:

• A whistle or wheeze and difficulty breathing out can mean asthma.

• A gurgling or snoring noise and difficult breathing in an unconscious person 

may mean the tongue, mucus (slime or pus), or something else is stuck in the 

throat and does not let enough air get through.

Look for ‘sucking in’ of the skin between ribs and at the angle of the neck (behind 

the collar bone) when the person breathes in. This means air has trouble getting 

through. Consider the possibility of something stuck in the throat, pneumonia , asthma , or bronchitis (mild sucking in.

If the person has a cough, ask if it keeps her from sleeping. Find out if she coughs 

up mucus, how much, its color, and if there is blood in it.

Pay attention to the strength, the rate, and the regularity of the pulse. If you have a 

watch or timer, count the pulses per minute.

    PULSE (HEARTBEAT)

The pulse gets much faster with exercise and when a person is nervous, 

frightened, or has a fever. As a general rule, the pulse increases 20 beats per minute 

for each degree (°C) rise in fever.

When a person is very ill, take the pulse often and write it down along with the 

temperature and rate of breathing.

It is important to notice changes in the pulse rate. For example:

• A weak, rapid pulse can mean a state of shock.

• A very rapid, very slow, or irregular pulse could mean heart trouble .

• A relatively slow pulse in a person with a high fever may be a sign of typhoid .

EYES

Look at the color of the white part of the eyes. Is it normal, red, or yellow? 

Also note any changes in the sick person’s vision.

Have the person slowly move her eyes up and down and from side to side. 

Jerking or uneven movement may be a sign of brain damage.

Pay attention to the size and color of the pupils (the black ‘window’ in the center 

of the eye). If they are very large, it can mean a state of shock. If they are 

very large, or very small, it can mean poison or the effect of certain drugs. If there is 

a white glow, it can mean cataracts or cancer.

Look at both eyes and note any difference between the two, especially in the size 

of the pupils:

 

A big difference in the size of the pupils is almost always a medical emergency.

• If the eye with the larger pupil hurts so badly it causes vomiting, the person 

probably has GLAUCOMA.

• If the eye with the smaller pupil hurts a great deal, the person may have 

IRITIS, a very serious problem.

• Difference in the size of the pupils of an unconscious person or a person who 

has had a recent head injury may mean brain damage. It may also mean 

STROKE.

Always compare the pupils of a person who is unconscious or has had a 

head injury.

EARS, THROAT, AND NOSE

Ears: Always check for signs of pain and 

infection in the ears-especially in a child with fever 

or a cold. A baby who cries a lot or pulls at his ear 

often has an ear infection.

Pull the ear gently. If this increases pain, the 

infection is probably in the tube of the ear (ear 

canal). Also look for redness or pus inside the ear. 

A small flashlight or penlight will help. But never 

put a stick, wire, or other hard object inside the ear.

Find out if the person hears well, or if one side is 

more deaf than the other. Rub your thumb and fingers together near the person’s ear to 

see if he can hear it.

Throat and Mouth: With a torch (flashlight) or sunlight examine the mouth and 

throat. To do this hold down tongue with a spoon handle or have the person say 

‘ahhhhh...’ Notice if the throat is red and if the tonsils (2 lumps at the back of the throat) 

are swollen or have spots with pus . Also examine the mouth for sores, 

inflamed gums, sore tongue, rotten or abscessed teeth and other problems.

Nose: Is the nose runny or plugged? (Notice if and how a baby breathes through 

his nose.) Shine a light inside and look for mucus, pus, blood; also look for redness, 

swelling, or bad smell. Check for signs of sinus trouble or hayfever.

 

SKIN

It is important to examine the sick person’s whole body, no matter how mild the 

sickness may seem. Babies and children should be undressed completely. Look 

carefully for anything that is not normal, including:

• sores, wounds, or splinters

• rashes or welts

• spots, patches, or any unusual markings

• inflammation (sign of infection with 

redness, heat, pain and swelling)

• swelling or puffiness

• swollen lymph nodes (little lumps in the 

neck, the armpits, or the groin,

• abnormal lumps or masses

• unusual thinning or loss of hair, or 

loss of its color or shine

• loss of eyebrows 

Always examine little children between the 

buttocks, in the genital area, between the fingers 

and toes, behind the ears, and in the hair (for 

lice, scabies, ringworm, rashes, and sores).

THE BELLY (ABDOMEN)

If a person has pain in the belly, try to find out exactly where it hurts.

Learn whether the pain is steady or whether it suddenly comes and goes, like 

cramps or colic.

When you examine the belly, first look at it for any unusual swelling or lumps.

The location of the pain often gives a clue to the cause (see the following page).

See if the belly is soft or hard and whether the person can relax his stomach 

muscles. A very hard belly could mean an acute abdomen—perhaps appendicitis or 

peritonitis.

Feel for any abnormal lumps and hardened areas in the belly.

If the person has a constant pain in the stomach, with nausea, and has not been 

able to move her bowels, put an ear (or stethoscope) on the belly.

If the person has a constant pain in the stomach, with nausea, and has not been able to move her bowels, put an ear (or stethoscope) on the belly, like this:

MUSCLES AND NERVES

If a person complains of numbness, weakness, or loss of control in part of his 

body, or you want to test it: notice the way he walks and moves. Have him stand, sit, 

or lie completely straight, and carefully compare both sides of his body.

Face: Have him smile, frown, open his eyes wide, and squeeze 

them shut. Notice any drooping or weakness on one side.

If the problem began more or less suddenly, think of a head 

injury, stroke, or Bell’s palsy .

If it came slowly, it may be a brain tumor. Get medical advice.

Also check for normal eye movement, size of pupils, 

and how well he can see.

Arms and legs: Look for loss of muscle. Notice—or measure—

difference in thickness of arms or legs.

Watch how he moves and walks. If muscle loss or weakness affects the whole 

body, suspect malnutrition or a chronic (long-term) illness like tuberculosis.

If muscle loss and weakness is uneven or worse on one side, in children, think 

first of polio; in adults, think of a back problem, a back or head injury, or 

stroke.

Check for stiffness or tightness of different muscles:

• If the jaw is stiff or will not open, suspect tetanus or a 

severe infection of the throat or of a tooth. If the 

problem began after he yawned or was hit in the jaw, he may 

have a dislocated jaw.

• If the neck or back is stiff and bent 

backwards, in a very sick child, suspect 

meningitis. If the head will not bend forward 

or cannot be put between the knees, 

meningitis is likely.

• If a child always has some stiff muscles and 

makes strange or jerky movements, he may be spastic.

• If strange or jerky movements come suddenly, with loss of consciousness, he may 

have seizures. If seizures 

happen often, think of epilepsy. 

If they happen when he is ill, the 

cause may be high fever or dehydration or tetanus  or meningitis.

To check for loss of feeling in the hands, feet, or other parts of the body:

Have the person cover his eyes. Lightly touch or prick the skin in different places. Ask him to 

say ‘yes’ when he feels it.

• Loss of feeling in or near spots or patches 

on the body is probably leprosy.

• Loss of feeling in both hands or feet 

may be due to diabetes or leprosy.

• Loss of feeling on one side only 

could come from a back problem  or injury.

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