How to Care for the Insane: A Manual for Nurses

by William D. Granger

The arms are then to be brought to the side, and pressed strongly against the lower ribs. This last movement drives the air out of the lungs, and makes an expiration. These manipulations should be repeated, slowly and regularly, about sixteen times a minute, and should, when there is the slightest hope of life, be continued at least thirty minutes. The heart should be listened to, in order to hear if it still beats. Warmth, by hot-water bags, bricks, and soapstones should be secured, care being taken not to burn the skin. The limbs may be gently rubbed with warm cloths, though it is not so important as some well-meaning people think. The rubbing should be towards the heart.

As the breathing begins, it should be still aided by the artificial means as long as necessary. When the patient can swallow, teaspoonful doses of brandy or whiskey, to two or three of water, may be given and repeated several times. As soon as possible the patient should be put in a warm bed, and milk and light food given.

Care of Patients when First Burned.—When a patient’s clothing is first on fire, dash water over him if near at hand, if not wrap him in a blanket or some heavy woollen garment, and smother the fire. Then unroll the patient and extinguish the smouldering pieces of clothing. The clothing must be cut and clipped off. Great care must be taken not to tear open the blisters. If any application is made, it may be by linen cloths soaked in sweet or castor oil, or equal parts of linseed oil and lime-water, or a layer of flour and molasses may be applied over the burned surface. These bland substances act largely by excluding the air, which, if blowing ever so quietly, is always painful and irritating, and they also protect the wound from the irritation of the bed and body clothing. Burns from scalding are practically treated in the same way as burns from fire.

Care of Frost-bites.—Toes, fingers, ears, and noses are most frequently frozen. They will sometimes freeze in a few minutes on a very cold day. After a part is frozen there is no feeling of cold or pain, and it looks perfectly white, and is so stiff it may be broken.

Persons who are frost-bitten should not be taken into a warm room. They should be left in a cool room, and the frozen part rubbed with cold water, or ice, or snow. As these last melt they melt the frozen flesh. If the parts are thawed too quickly gangrene is liable to follow.

Care of Patients in States of Unconsciousness.—This is not an accident, but a frequent emergency. The medical word for unconsciousness is coma. It may be partial or complete, may come on suddenly or slowly, or may be accompanied by convulsions or paralysis. The more frequent causes of coma, are epilepsy, the convulsions of paresis, blows on the head, hemorrhage in the brain or apoplexy, some diseases of the brain, sunstroke, and some poisons.

When coma comes on, attendants should observe, if it is slow or sudden; if the patient complains of pain in the head; if the respirations are changed, and how; the condition of the pupils, whether large, contracted, uneven, or changeable; if the mouth and face are drawn to one side; if there is any paralysis of the arms or legs; if there are any convulsions, or twitching of muscles; if the patient can be aroused, and from time to time observe and count the pulse.

Apoplexy is a term that is much used, and is a condition of coma, caused by pressure on the brain. This organ is in a tight, rigid box, the skull. If the fluid of the brain is much increased, or blood-vessels ruptured, pressure is the result, and the soft tissues yield, rather than the bony covering. This pressure may destroy or injure the cells and fibres, and so interfere with the function of the part. Another way that apoplexy occurs is by plugging of an artery of the brain, so that it cannot deliver blood to the part to which it goes, and consequently the part loses its ability to perform its function. The plugging is most frequently due to a small clot floating in the blood, and which is usually formed in the heart.

Paralysis and apoplexy are often, through ignorance, used synonymously, but they really mean very different conditions. Paralysis is a loss of power of contracting a muscle, due to disease or injury of the nervous system; it frequently follows or is associated with apoplexy.

In the case of apoplexy, and most conditions of coma, there is generally little for the attendant to do. The patient should be put to bed, with light coverings, and the head raised on pillows. Do not annoy the patient by trying to rouse him, and do not give stimulants.