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How to Care for the Insane

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<div class="figcenter"><ANTIMG src="images/cover.jpg" alt="" /></div>     <h1>HOW TO CARE FOR THE INSANE</h1> A MANUAL FOR NURSES   BY WILLIAM D. GRANGER, M.D. PROPRIETOR-PHYSICIAN, VERNON HOUSE, MT. VERNON, N. Y. FORMERLY FIRST ASSISTANT PHYSICIAN BUFFALO STATE HOSPITAL, BUFFALO, N. Y. MEMBER AMERICAN ASSOCIATION OF SUPERINTENDENTS OF HOSPITALS FOR THE INSANE. MEMBER NEW YORK NEUROLOGICAL SOCIETY.   SECOND EDITION. REVISED.   <table border="0" cellpadding="0" cellspacing="0" summary="table"> <tr><td colspan="3" align="center">G. P. PUTNAM’S SONS</td></tr> <tr><td align="center">NEW YORK</td><td> </td><td align="center">LONDON</td></tr> <tr><td align="center">27 WEST TWENTY-THIRD ST.</td><td> </td><td align="center">27 KING WILLIAM ST., STRAND</td></tr></table> The Knickerbocker Press 1891     COPYRIGHT G. P. PUTNAM’S SONS 1886   Press of G. P. Putnam’s Sons New York     <hr style="width: 50%;" /> <h2>NOTE TO SECOND EDITION.</h2>   At the time of starting a training school, in 1883, the author was unaware that like work was commencing at the McLean Asylum, Somerville, Mass., by Dr. Campbell Clark and others in Scotland, and in New South Wales. Each was independent, and each worked out the problem independently. Thus, far separated efforts showed the time had come when attendants must be evolved into trained nurses. The most gratifying feature has been the unanimous approval by American superintendents and the establishment of training schools in almost every asylum in the land, often under the most difficult conditions and at a great sacrifice of the precious time and strength of the medical staff. The increasing number of these schools and pupils demands a second edition of this little manual. Vernon House, Mt. Vernon, N. Y., March 21, 1891.     <hr style="width: 50%;" /> <h2>INTRODUCTION.</h2>   The writer began in October, 1883, at the Buffalo State Asylum for the Insane, a course of instruction to the women attendants upon their duties and how best to care for their patients. This has been regularly continued till it has become a fixed part of the asylum life, and has developed into a system of training, and now a class of attendants has nearly completed its studies. Since July, 1885, instruction has been given to men attendants. In April, 1885, the Superintendent, Dr. J. B. Andrews, who had encouraged the school from its conception, asked the Board of Managers to officially recognize it. They adopted the recommendation and fixed the qualifications for admission, the pay and privileges of its members, and provided for a certificate as a trained nurse and an attendant upon the insane, to be given to all, who at the end of two years successfully finished the full course of instruction. The writer believes that all attendants should be regularly instructed in their duties, and the highest standard of care can be reached only when this is done. He also believes that every person who is allowed to care for the insane will be greatly benefited by such instruction, and will be able to learn every thing taught, if the teacher uses simple methods and is patient to instruct. As a rule they enter upon the study with interest, and soon a skilled corps is formed, who are competent to fill the responsible positions, and control the unstable class that drift in and out of an asylum. Even the dullest are awakened to new zeal, and are advanced to positions of trust they could not otherwise have filled. A brief outline of the course of instruction of the school may be of interest. The first year is spent in learning the routine of ward work and filling minor positions. The attendants are changed from ward to ward, and have the care of all classes of the insane. They first receive instruction in the printed rules of the asylum. Every rule relating to the duties of attendants is read and explained, and special attention is called to the performance of the following duties: <div class="blockquot">a. Duties to officers. b. Duties to each other. c. Duties to patients. d. Duties to the institution. </div> Thus the new attendants early get an outline of their duties in the special care of the insane. After this comes instruction in elementary anatomy and physiology. They are taught of the bones, joints, muscles, and organs of the body, food and digestion, the circulation and respiration, waste and repair, animal heat, and the nervous system. In order to be ready for advanced instruction the elements of physiology must be thoroughly learned. The teaching must be adapted to the ability and wants of those instructed. Having fixed the limit of duties required of an attendant, it is easy to fix the limit of instruction. It is an error to teach too much medicine, for then we begin to make physicians. All that is needed is attendants who are able to do their work intelligently, and, keeping this object in mind, lectures by a physician, devoid of too much detail, but simple, direct, and plain, are better than instruction from any of the text-books. With notes of the lectures furnished, and with repeated recitations, any lesson is readily learned. This way of instructing, by lectures, notes, and recitations, is continued throughout the entire two years. A course in hygiene follows the lectures in physiology. Instruction in these three studies occupies the first year. An attendant who, at the end of this time, successfully passes an examination in them, and who has been faithful in his duties, is ready to receive the advanced instruction of the second year. This includes the nursing of the sick, the management of emergencies, and finally the special work of caring for the insane. The wits of an attendant upon the insane have to be sharpened in many directions not required of a general nurse. The text-books on nursing may properly be followed by another, which shall aid one skilled as a nurse to perform the varied and difficult duties incident to the care of the insane and the wards of an asylum. To furnish this is the object of this manual. A brief review of the physiology of the nervous system is introduced for the aid of students, in reading the chapters on the mind and insanity. To teach any thing metaphysical or pathological may seem questionable. The class, however, has not only been interested in the simple study of the phenomena of the mind, but has been able to comprehend and profit by the lectures on this subject. The lectures on the care of the insane were given to the class almost as they appear in these pages. The suggestion was made that if they were printed they would find a place in the hands of attendants in other asylums. This is the reason of their publication. To my colleague, Dr. A. W. Hurd, I wish to tender my thanks for the valuable assistance he has given me in the preparation of this manual. I am greatly indebted to Dr. Andrews for his ever kind but critical advice. But for his encouragement and help neither the work of instruction nor the preparation of these pages would have been begun, nor success, if success be gained, achieved.     <hr style="width: 50%;" /> <h2>CONTENTS.</h2> <table width="65%" border="0" cellpadding="0" cellspacing="5" summary="table"> <tr><td> </td><td align="right">PAGE</td></tr> <tr><td>Introduction</td><td align="right">iii</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER I.</td></tr> <tr><td>The Nervous System and Some of its More Important Functions</td> <td align="right">1</td></tr> <tr><td class="dent">Nerve Centres.—Brain and Spinal Cord.—The Nerves.—Nerve Cells and Fibres.—Motor and Sensory Nerves.—The Five Organs of Special Sense.—Nerve Impulses.—The Brain and Nervous System Always Busy.—Need of Rest.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER II.</td></tr> <tr><td>The Mind and Some of its Faculties</td> <td align="right">7</td></tr> <tr><td class="dent">Mind and Matter.—Life.—Relation of Mind and Brain.—Faculties of the Mind.—Intellectual Faculties.—Will.—Emotions.—Instincts.—Moral Faculties.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER III.</td></tr> <tr><td>Insanity; or, Disease of the Mind</td> <td align="right">13</td></tr> <tr><td class="dent">Insanity a Change.—Involves Disease of the Brain.—Delusions.—Hallucinations.—Illusions.—Incoherence.—Mental States.—Mania.—Melancholia.—Dementia.—Monomania.—Emotional Insanity.—Dipsomania.—Moral Insanity.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER IV.</td></tr> <tr><td>The Duties of an Attendant</td> <td align="right">22</td></tr> <tr><td class="dent">What an Attendant Should First Learn.—The Relation of Attendants to Patients.—The Character of an Attendant.—Relation to the Institution.—How and What to Observe.—Systematized Plan of Observation.—Control and Influence of Attendants over Patients.—Care and Study of the Individual.—Liberty to be Allowed Patients.—Self-Control of Patients to be Encouraged.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER V.</td></tr> <tr><td>General Care of the Insane</td> <td align="right">33</td></tr> <tr><td class="dent">Reception of New Patients.—Work and Employment.—Patients’ Care of Themselves.—Walking.—Clothing.—Bathing.—Serving of Food.—Bed and Rising Time.—Night Care.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER VI.</td></tr> <tr><td>Care of the Violent Insane</td> <td align="right">45</td></tr> <tr><td class="dent">Need of Studying Each Case.—Constant Attention and Oversight.—Value of Employment and Out-Door Exercise.—Restriction and Idleness.—Paroxysms of Violence; How Cared For.—How to Hold or Carry a Patient.—Danger of Injury.—Struggles to be Avoided.—Care of Destructive Patients.—Use of Restraint, Seclusion, and Covered Bed.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER VII.</td></tr> <tr><td>Care of the Homicidal and Suicidal Insane, and of Those Inclined to Acts of Violence</td> <td align="right">53</td></tr> <tr><td class="dent">Delusions of Suspicion.—Homicidal Patients.—Suicidal Patients.—Self-Mutilation.—Incendiary Patients.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER VIII.</td></tr> <tr><td>Care of Some of the Common Mental States and the Accompanying Bodily Conditions</td> <td align="right">60</td></tr> <tr><td class="dent">Care in the Earlier Stages.—Insanity with Exhaustion.—Symptoms of Danger.—Care of Dementia, Early Dementia, Chronic or Terminal Dementia.—Convalescence.—Relapse.—Epilepsy.—Paresis.—Care of Paralytics, the Helpless, the Bed-ridden.—Bed-Sores.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER IX.</td></tr> <tr><td>Some of the Common Accidents among the Insane, and the Treatment of Emergencies</td> <td align="right">71</td></tr> <tr><td class="dent">Certain Classes of Insane Liable to Injury.—Fractures.—Wounds.—Bites.—Blows on the Head—Cut Throat.—Wounds of the Extremities with Hemorrhage.—Sprains.—Choking.—Artificial Respiration.—Burns.—Frost-bites.—States of Unconsciousness.—Apoplexy.—Sunstroke.—Poisoning.—Eating Glass.—Injury with Needles.</td></tr> <tr><td> </td></tr> <tr><td align="center">CHAPTER X.</td></tr> <tr><td>Some Services Frequently Demanded of Attendants and How to do Them</td> <td align="right">85</td></tr> <tr><td class="dent">Administration and Effects of Medicine.—Opium, Chloral, Hyoscine, and Hyoscyamine; Doses, Effects, Poisoning, Treatment.—Stimulants.—Applications of Heat and Cold.—Baths and Wet Packing.—Hypodermic Injections.—Forcible Feeding with Stomach-Tube.—Nutritive Enemata.</td></tr></table>     <hr style="width: 50%;" /> HOW TO CARE FOR THE INSANE.   <div style="break-after:column;"></div>

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