The reasons for refusing medicines are various; some say they are perfectly well and need no medical treatment, others think the medicine injures them, that it turns their skin black, or poisons them, or that it is wrong to take it, or displeasing to God; ideas much like those that we learned were the causes for the refusal of food. Attendants are to use every effort to get patients to take medicine, and may employ as much force as they were instructed to use in giving food, but no more.
Patients should not be deceived about medicines, nor told by attendants that it is nothing, that it is only a little water, or some nice drink that is sent to them, nor should an attempt be made to give them, by trying to disguise them in food or drink, except by the permission of a physician. Patients should, on the other hand, be told that it is medicine, that the doctor ordered it for them, that it is for their good to take it, that it is given to help them get well.
The giving of medicine and food is among the most important and frequent duty that an attendant is called upon to perform, or assist others in doing. Attendants must remember that many medicines are injurious or even poisonous, if not properly given, or if mixed with other medicines, or if given to the wrong patient; they should therefore, never make a mistake, or, if by carelessness they commit one, should immediately report it.
Opium and Some of its Preparations.—Opium is a medicine that is very frequently given to patients in an asylum. The ordinary dose is one grain. Tincture of opium, or laudanum, is opium dissolved in alcohol. Ten minims equal one grain of opium. Camphorated tincture of opium, or Paregoric, is a weaker alcoholic solution, with some camphor, and flavored with a pleasant aromatic. One half a fluid ounce equals a grain of opium. Morphine is a white powder extracted from opium. An eighth of a grain about equals a grain of opium.
Opium, in some of its forms, is a common household remedy. To an adult, not more than one grain should be given; it should not be repeated more than once, nor less than six hours after the first dose. It would be better if never given, except by a physician’s order. Under no circumstances should any one but a physician give it to a weak or old person, or to a young child.
Opium, is given in ordinary doses to relieve pain, to check diarrhœa, to relax spasm of muscles, and to produce sleep. The sleep from opium is generally quiet and refreshing, and one from which the patient can be easily aroused.
An attendant will frequently be told when the medicine is given and directed to note and report its effect.
Opium Poisoning.—The taking of opium is a frequent way of committing suicide by persons outside of asylums. Sometimes patients manage to save their doses, or they steal it from the tray, or, if there is some sent to the ward for repeated doses, they secure it through the carelessness of an attendant, or occasionally it is secretly sent to patients by officious outside friends,—thus poisoning by opium sometimes occurs among asylum patients.
The full symptoms of poisoning are profound coma, pupils contracted to pin-points, and which do not respond to light; very slow respiration, often not more than four or six times a minute, but heavy and labored. Sometimes the effect of the drug is but partial, the patient can be aroused for a moment, but falls to sleep again, or the symptoms may be even less pronounced.
The treatment of opium poisoning, before the physician comes, consists in giving very strong coffee, or tea, an emetic, and in trying to keep the patient awake by walking him about, or, if this is not possible, to keep him from falling into deeper coma, by shaking, calling loudly in the ear, and striking and slapping the body with wet towels.