How to Care for the Insane: A Manual for Nurses

by William D. Granger

It is impossible to speak of the varied causes of insanity, or of the equally varied manifestations of the disease and conduct of the patient at its onset, but there are a few conditions which, being present, give a character to a particular case, and suggest the care required.

Sometimes, as has been said, the patient partly realizes his condition, and is willing to come to the asylum, and in every way to conduct himself in accordance with the rules and requirements.

Sometimes the onset is slow and the symptoms so obscure as to attract little attention. Following this, more decided symptoms may appear; the patient may become violent, noisy, destructive, or sleepless, or he may try to commit suicide or homicide, or do some other act of violence; or the great restlessness, moaning, crying, and sleeplessness of melancholia may come on, or the patient may refuse, for several days, all food. The reason for bringing such patients to the asylum is that they can no longer be kept at home.

Following the treatment that has been described, these patients will frequently in a short time become more quiet, self-controlled, and more easily influenced and cared for.

The earlier stages of insanity are frequently accompanied by considerable disturbance of bodily health. The appetite is poor, the digestion disordered, the bowels constipated, the breath foul, the secretions of the skin changed and often offensive, the temperature a little elevated, the pulse rapid, and the heart weak. Sometimes, on the other hand, the temperature is normal, or a little below, while the hands are cold and clammy. In addition, nutrition is frequently impaired, so that the food taken by patients does not seem to properly nourish and strengthen. All of these symptoms are not present in a given case; sometimes most of them may be, and again but few are to be noticed.

The important lesson to learn in the care of these cases is that such patients may rapidly pass into a more serious condition, in which there is great exhaustion, which is always alarming, and may even result fatally.

Recent cases, such as have been spoken of, need our best care, closest attention, and kindest nursing. The patient should daily take sufficient food, which, if necessary, should be enforced, and the opportunity for sleep promoted. A few days, or a day, without food and sleep may bring on alarming symptoms.

For these patients, milk is the best article of diet; it is most easily given and readily taken; it should be given by the glassful, or if not able to do this by the spoonful. Some patients, for reasons not always known, will refuse food one hour and take it freely the next; it should, therefore, be frequently offered. With milk as a basis, we may add to it, as we are able. Raw egg, gruel, boiled rice, oatmeal, custard, and bread are adjuncts that are nutritious and easily given.

It makes but little difference why patients refuse food, except that a knowledge of the reasons may enable us to overcome their disinclinations. The thing to remember is that they must in some way be made to get enough.

Care of Patients with Insanity, Accompanied by Exhaustion.—There is a condition associated with acute mania or melancholia—though it is sometimes seen in connection with the more chronic forms of insanity,—of exhaustion so overpowering, that it may be rightly compared with the exhaustion of typhoid fever. It may last a few days or a month, or more, if it does not sooner terminate fatally. Instead of the quiet delirium of typhoid fever there is generally violent mania or frenzy. Neither mind nor body is quiet; sleep seems to have fled. The patient may be destructive, constantly out of bed, fighting care, refusing food, and wetting and dirtying himself. With these unfortunate conditions there generally is fever, often to a considerable degree, the heart is feeble, the pulse rapid, the tongue and lips dry and cracked, the teeth covered with sordes, and the body emaciated. Every case does not present all these symptoms, nor show such alarming exhaustion. There are many degrees of severity in this sickness.