HOSPITALS The Rectal Thermometer
Near dawn every morning, a nurse walks into the hospital room, wakes the patient and subjects him to what for many remains a humiliating procedure, although it has become routine: insertion of a rectal thermometer. "The importance of this entrenched practice," said last week's Journal of the American Medical Association, "is so universally accepted that, like the mechanics of normal breathing, it is rarely discussed or even considered."
The time has come for doctors to reflect on it, says the A.M.A., because the entrenched practice can be fatal. The University of Minnesota's Dr. Justin J. Wolfson recently reported a case in which an eight-day-old baby died because the thermometer had pierced the wall of its rectum. Actual perforation of the rectum appears to be rare, says the A.M.A., but "injury to the rectum by the thermometer is not uncommon. Severe bleeding, ulceration, abscesses, hematomas and scarring have been reported." Autopsies indicate that rectal injury may occur in more than 6% of patients.
What is needed, says the A.M.A., is a thermometer that will not cause injury. But no U.S. manufacturer has yet produced a safer thermometer at an economic price. A safer design, used in Scandinavia, has a slender sensing tip, similar to the American, but then broadens out to a flat shank, thick enough to prevent too deep a penetration. The best the A.M.A. can suggest is that nurses and mothers be instructed in how to insert a thermometer correctly, and told never to leave a child or a debilitated patient alone with the thermometer in place.