tions of chloroform may be necessary to control the convulsions when they are very severe.

Belladonna, atropine, hyoscine and scopolamine in toxic doses produce similar symptoms. The patient is wide awake, active and restless, the mouth and throat are very dry, the tongue is red, the skin is hot and flushed, the eyes are very bright, the pupils are widely dilated and do not react to light, the pulse is weak and rapid, the respirations are much increased in rate and there may be a busy, talkative delirium. "As wild as a hare, as red as a beet, as dry as a bone," is a very old description of belladonna poisoning. Wash the stomach at once with potassium permanganate solution, apply heat to the extremities, and hot and cold alternately to the head, and give artificial respirations.

To summarize. In case of poisoning first get rid of the poison by an emetic or lavage; or knowing the drug which has been taken give the antidote if it is available. The emetic should be wisely chosen and administered with care, for vomiting may increase an injury to the stomach which is already severe. Less damage is usually inflicted by using the stomach tube. When possible the fluid used for lavage should contain the antidote. Having gotten rid of the poison and administered the antidote the physical symptoms should be treated. The cathartic and cardiac and respiratory stimulants are prescribed by the physician, but in an emergency the nurse should give those which she knows would be prescribed.

CHAPTER IX

NURSING IN THE ORGANIC PSYCHOSES

SENILE PSYCHOSIS

Senile psychosis is a form of mental disease occurring late in life, characterized by a gradual, progressive mental weakness, manifested especially by failure of memory, forgetfulness and inability to recall recent happenings.

Physical symptoms. There are no outstanding physical symptoms peculiar to senile mental disorder, but are the obvious signs of old age, — an old-looking and usually wrinkled skin due to loss of fat, muscular weakness and tremors, loss of appetite, headache, dizziness, insomnia, dull looking eyes sometimes with clouding of the cornea and sometimes with cataract, and varying degrees of deafness.

Mental symptoms. Sensation is usually dulled, and perception faulty, for these patients do not understand clearly, often misidentify persons and may be disoriented as to time and place. The memory defect is usually marked, for while remote events can still be recalled accurately, the power to retain and recall recent happenings is greatly diminished and impaired. The tendency to reminisce and to live much in the past is strong. Fabrication is quite common and the gaps in memory are readily filled with imagined events. Attention is interfered with and is fixed with difficulty. The ideas tend to become more and more limited and the same ones recur over and over (perseveration). Illusions and hallucinations may be present; and delusions are quite common, some of the more common ones being that the clothing and personal property have been stolen, that they are very badly treated, cruelly abused,

poisoned, etc. The patients are self centered and are interested principally in what concerns themselves. They may be dissatisfied, irritable, distrustful, suspicious, anxious, depressed, unsympathetic and indifferent, and the mood may change frequently and without apparent cause. In conduct they may be orderly and quiet, coöperate well with the nurses and give very little trouble, or they may be untidy, meddlesome and restless. The restlessness often becomes more marked at night, and they seem to be continually getting in and out of bed and wandering about the ward whenever supervision is relaxed. They hoard all kinds of worthless objects and articles and secrete as many as possible on their persons. Sometimes they are quarrelsome, threatening, abusive, profane and obscene, easily excited, and become resistive when they think they are being dictated to or managed, especially by those who are younger than they.

Nursing procedures. Inasmuch as insomnia is a prominent symptom, special attention should be given to the diet, for in the aged food bears a close relation to sleep.1 Hot milk or some hot liquid food at bedtime will often overcome restlessness and sleeplessness; and a small quantity of hot milk given in the early morning when the patient wakes will frequently insure sleep again. The diet should consist of easily digested foods and milk in abundance if it is well digested. Soft foods must be provided when the teeth have been lost or are defective. The mouth and teeth must be carefully cleansed at least twice daily, using a tooth brush or swab and some antiseptic wash. Sufficient clothing of suitable texture must be provided, and care exercised that these patients are properly dressed, for many forget to put on all the necessary articles when dressing and will fail to take them off when going to bed.

The bowels and bladder must be watched, for sensation being dulled, they often become distended without apparent discomfort. Regularity of elimination should be established, and thereby not only benefit the patient, but save much time 1 Friedenwald and Rührah, "Dietetics, Food for the Aged."

and unnecessary labor for the nurses. Regular bathing in tub or shower is necessary to keep the skin in good condition. If the patient is helpless, bed baths must be given with the same regularity. Bathing is often a source of much friction, for many old people do not enjoy it and become quite impatient and irritable and sometimes difficult to manage. It is a good plan to take away, at this time, all the trash and worthless objects which the patient has been hoarding. If the patient is confined to the bed special care must be given to the back and other prominent points to prevent pressure sores. Frequent bathing with soap and water to insure cleanliness, followed by brisk rubbing with alcohol to dry the skin and zinc oxide ointment well rubbed in, will do much to prevent bed sores, even in cases of incontinence. The bones are fragile, and fractures occur easily, and much care must be exercised in lifting and moving the patient to avoid injury. Enclosing the bed by boards placed at the sides will prevent a restless patient from falling. Bruises are easily acquired and persist for a very long time, and the prompt application of cold will frequently prevent marked discoloration.

In the nursing of the mental symptoms little can be accomplished. Make and keep the patient as comfortable and contented as possible, avoiding all sources of irritation. Control them by letting them think they are having their own way. The most stubborn and resistive patients can be managed by a nurse who is sympathetic and uses tactful methods. It is best not to agree with the delusions, for this tends to confirm them, and one can be truthful about the illusions and hallucinations and say "I do not see it" or "I do not hear it," etc. The assurance, repeated over and over, that the nurse is looking after the patients and that so far as she can prevent it no harm or annoyance shall come to them, brings relief and satisfaction for a while, at least. Nothing is gained by argument, except to make them irritable and unhappy, for many of their delusions are fixed and cannot be changed.

Occupations, exercise and diversions. Old people as a rule do not like new forms of work and will not show any interest in them, but rather a distaste for them. As they live much in the past, whatever is associated with their lives at earlier periods will be more likely to arouse interest. Knitting a wash cloth or a bag in which to carry their own belongings, crocheting or knitting a bit of lace for some garment, sewing an apron or kitchen holder, patchwork squares and darning are some of the ways in which the women may be occupied. They enjoy scrap-books and will help to make them occasionally. They do not like to be too much directed in their work, and will oftentimes show a good deal of resentment and become quite irritable, so it is better to allow them to do the work as they have formerly done it and so keep them contented as well as busy.

It is more difficult to employ the old men, for the normal man when in the house likes to lounge about, to read and smoke, and there seems to be little in the activity of the household to appeal to them. They usually are more interested and do better work if they can go out to find some occupation, as if going to business. Reading the newspapers and magazines, whittling to make garden sticks, simple toys and bird houses from small wooden boxes, tying knots, chair caning and light carpentry are some of the ways in which they may be employed. Calendars on which the weather can be recorded from day to day in colors are easily made and are a continual source of interest. Cardboard 8×10 inches can be clocked into spaces and numbered for each day of the month. When the day is pleasant and the sun shines 2 yellow disk is pasted on; when cloudy a gray disk is used and when stormy a black disk makes the record. When the weather in a single day is variable a small portion of each color may be used to make the record accurate to weather devotees, of whom there are usually many among the aged; the observation and correct record required by this simple means affords much pleasure.

Music is enjoyed by all; and reading aloud will afford