How to Care for the Insane

Many asylum patients were ill with various chronic conditions, but accidents and self-inflicted injuries also kept doctors busy. In How to Care for the Insane by Dr. William Granger (1886), the author discusses some particular issues that nurses might confront:

A cut throat: Patients may cut their throats from ear to ear and do really little injury, or they may make a small stabbing wound and divide a large blood-vessel and die almost immediately, or they may cut the windpipe and not cut the blood-vessels. Little can be done by the attendants to stop the flow of blood, even if the great blood-vessels are not cut. The head should be kept bent forward and the chin pressed against the chest.

Injury from Eating Glass: Patients sometimes eat glass . . . In the treatment do not give an emetic or a cathartic. Such food as has a tendency to constipate the bowels, and such as will also enclose the glass and coat its sharp edges, is to be given. Potatoes, especially sweet, oatmeal, or thick indian-meal pudding, are appropriate. Cotton, which is generally at hand, will, if swallowed, engage the glass in its fibres, and so protect from injury.

Patients and Nurses in Female Ward B, Weston State Hospital, 1924, courtesy West Virginia & Regional History Collection

State Hospital Nurses, circa 1914, courtesy Missouri State Archives

Injury with Needles: This is a self-injury, but it may be severe and require immediate attention. Patients may open a vein or an artery with a needle, or plunge it into the eye. But the more common way is for a patient to stick many needles under the skin, sometimes to the number of several hundred. Sometimes patients introduce them near the heart or lungs, and as a needle will often “travel” when in the flesh, it may work its way into a deeper part, and so a number get into the lungs or the heart, causing death . . . An attempt or desire to so injure one’s self should be guarded against by the attendants, and if accomplished should be at once reported to the physician, that efforts may be made to extract the needle.