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I i f ii. r I It needs only a superficial knowledge of attendants and their duties to come to the conclusion that a few practical notes treating of their relation to others and of their obligations to them- selves, would be of great benefit, not only to those about to engage in the service, but also to those who are already engaged in nurs- ing the insane. With this object in view, the following manual is appended to my usual report in the hope that it will be printed for the use of our attendants. I am indebted for hints to Dr. Domville's " Manual for Hospital Nurses," Dr. Winslow's "Hand- book for Asylum Attendants," and Dr. Smith's " Lectures on Nursing." I have felt for years the want of a plain, practical hand-book of advice and instructions for a deserving class, and I am sure that it will be received gratefully by those it is intended to benefit. To define accurately the responsibilities and duties of Asy- lum attendants in relation to themselves and others, it may be best to consider: — 1st, — Themselves. 2nd, — Their Superiors. 3rd, — Their Fellow- Attendants or Nurses. 4th, — The Patients entrusted to their care. Part I. The Attendants Duties as RcfjarcU Themselves. They should be scrupulously clean in person and dress. The attendants who have not acquired this, as a fixed habit, cannot appreciate its benefit in the patients. Such, as a rule, will only do in this respect, for themselves and others, whao they are obliged to do. The suits and dresses, of both male and female attendants, should never be out of order, always well brushed, cleanly and neat. Fussincss, continual talk, and a scolding tongue, are intolerable ^ ASVLUM KOU THE I.NSANK, t-OHnoH. nuisances in tl,o vaivls of an Asylun,, Snlky con.luct, a frown- in" faco, an.l a tlncatcning alUtn.l.., an; ciually onl of plaoc. TlTo cliccrfnl con..tcnanco, kin.lly .lisi.osilion, an.l good tcnn-ov avo inaispcnsaWc in a good atlondant. Tl.o less „,nan>on at.on of person, csnccially an.ong U,c te.nalo attendants, tlie let er. lo bo neal and tasty in d-.-e.s is one tWng, and to be dressed np for show is quite another. ^^^^ ^^ The Attendants' didics towanh their Siywriors. The responsibilities of attendants are groat. Tlioir duties are many, and often disagreeable. Many of the minor ones may « em insLificant in detail, but tbey are all of great nnportance, especially%vhen taken together. It should always bo remem- borod that on proper attention to the seeming tnfles, depends ■ „reh of the sueeesifnl working of the Asyhnn. The ofl.eors aro "Sponsible tor tho re.M.. but MU.ch of the ,neansU, aeeompbsh Srare in the hands of the attendants. The J"-)S-" .■ f'^- tie." and skill of tho Superintendent and his staff are of httle use „n ess these offleials be .ealously and loyally su^orted by a ta,th- M ar d ofleotual disoharge of their orde,. given fron, tnne to t.m. To attendants, in a greater or less degree, must bo o"t™sted th Mrsonal charge of the patients, and unless they combme in thui ■ EaL and disposition, firmness, kindness and earnestness in the r work, the best efforts of the offioers must end in disappoint- .nent and failure. No Asylum work can succeed where necessary "'at';:'^!:!! conduct of attendauts towards those who ai-e ■ Placed over thein should always be respect ul and obedient ta perforinodserviees,incivilities,rudoness.suUc„nessas a i.^dt ff lust correction, can never bo tolerated in the interest of d. c - 1 rl, d must lower the estimation of the character of an offend ■ "^ What ver may be the opinion of an attendant as to instructions ,iv t ; are to bo implicitly obeyed, as no such orfes are a. Scd to bo morally wrong. Any presumptuous attempt, at Jo familiarity nu't, sooner or later, load to ""l>loasan con- equences. In the discharge of duty, it is '----1^"^ '^ ^^^ place for everybody ami everybody in their 1>'''-- ^^ ^ f^^ »„,! honest endeavour is not forward au.l showy, but it neu s no ^ItoWvatioa in a Superintendent to be able to discriminate NK, r,ONDON. Sulky conduct, a frown- , avo equally out of vlaro. sposition, and good temper, The loss ornamentation of attendants, tlic better. To and to be dressed up for .rds their Superiors. ts are great. Their duties ^lany of the minor ones may r arc all of great importance, t should always be rcmem- the seeming trifles, depends the Asylum. The ofhcers are i\ of the means to accomplish lants. The judgment, discre- t and his staff arc of little use \ loyally supported by a faith- )rder.s given from time to time, degree, must be entrusted the d unless they combine in their , kindness and earnestness in oflicers must end in disappoint- rk can succeed where necessary dants towards those who are s be respectful and obedient. i, rudeness, sullenncss as a result .ierated in the interest of disci- )n of the character of an ofl'cndor. ,f an attendant as to instructions )V)eyed, as no such ordcr.s arc as- Any presumptuous attempts at I- later, lead to unpleasant con- duty, it is necessary to have a ,dy in their places. Self-respect Yard and showy, but it needs no ndcnt to be able to discriminate IIAND-]!00K KOIl AITKNOAN'IS. 5 between the worthy attendant and tl..- on. who endeavours to make capital out of sn.all perf..rm;,nr..,s. In the l-mg run tl>e counterfeit is found out to br a sham. Part III. The Attendants' duAies tovMrdsFelln.,.AIJenda,ls andScrcant.. Never suspect the conduct of co-workers unless there is absolute proof of wrong-doing. llcmcmb(,'r their is a great gulf between indiscretion and guilt. It is only just to suppose any of them innocent until proven to be otherwise. This rule of conduct will tend to prevent bickerings, heart-burnings, unfounded suspicions and petty jealousies. Tiiesc are the apples of discord in Asylums. The Golden Rule is the standard to go by in respect to the relation of the one with the other. Never carry about needless stories or complaints concerning fellow-attendants. The tattler is always and everywhere to be shunned as a a dangerous person. Be always ready to assist, as far as the rules of the establish- ment may permit, any attendant who may, from illness or other cause, be in need of extra help. .,,..1,1 Dc not interfere in the charge of another Attendant unless especially requested by such, or ordere.l by an officer to do so. Meddlesome people are always in trouble. ^^^^ ^^^^ own business and do our own wo-V. we will fin.l httle time to attend to the affixirs of others. It is as true in an Asykun as elsewhere, that we should sacri- fice part of ov.r liberty and con.fort for the benefit of others. Those who cannot do that are not qualified to be good attendants. If the rules of the Asylum have been flagrantly violated, repor to the proper officer, ard immediately. If not so done, aiul told after a time, it will be taken for granted that some petty revenge has prompted the revelation and not the interest of the insti ution. A report of this kind should be done openly " without fear, favour or affection." ^^^^^ ^^^ The Patients entrastcd to their Care. Special instructions to Attendants :— . . f Ist.-Uo not lose sight of the patients in charge tor fear of an escape. ASYLUM FOU THi; INSAN'K, LONDON. change in the d( 2ml, — Report to the Mt'dical Ofik'tr any picnnour or conversation. 31x1^ — Administer the medicine only an prescribed. 4th, — Notice any alteration in the general health — such as con- stipation, loss of appetite, unusual languor, drowsiness, ravenous appetite, suicidal or homicidal symptoms, periodic irregularities, any other unwonted change — and report immediately, as each of these symptoms may indicate conditions which materially in- fluence the patient's physical and mental health. 6th, — Be very cautious in conversation, and do not discuss with any patient the afl'airs of the Asylum, or talk about the other inmates to them or anyone else. Gth, — If accompanying a patient beyond the grounds of the Asylum, do not allow such to hold a conversation with any stran- ger, post any letters, or enter into a public-house. The latter is most reprehensible, and the Attendant is liable to dismissal. 7th, — Be kind, considerate, and courteous in your behaviour ; never resent anything that is done to you by a patient, but re- member that persuasion and kindness are better than force and harsh words, and endeavour to make the patient respect you. 8th, — Never express any opinion to the relatives or friends of the patient as to the progress of the case, but refer thera to the Medical Officer, who alone can give a correct opinion, 9th, — Give every letter written by a paiient to the Medical Officer, to post at his discretion, and do not assume this duty yourself, much anxiety being caused to the friends by allowing patients to post their own letters. 10th, — Do not receive bribes or money from a patient on any consideration whatever. 11th,— Use no restraint without being ordered by the Medical Officer, and never leave a patient alone when restrained. The great majority of patients appreciate kindness and resent rudeness. As a rule it is not hard to determine which Attendant is kindest ; not by a show of it in the presence of superiors, but by the gen- eral demeanour and estimate found among the patients. The influence of Attendants over patients may be gauged by the same rule. There are many exceptions to this rule in Asylums, ba-sed upon delusions or unfounded prejudices, but such arc ' ¥ ^ K, LONDON. • any clian^o in the do- is prescribed. noral licalth — such as con- uor, di'owsincss, ravenous ns, periodic irregularities, rt immediately, as each of ons which materially in- il health. on, and do not discuss with 1, or talk about the other ayond the grounds of the nversation with any stran- iblic-house. The latter is is liable to dismissal, irtcous in your behaviour ; you by a patient, but re- are better than force and ihe patient respect you. ) the relatives or friends of case, but refer thera to the correct opinion. ' a patient to the Medical do not assume this duty to the friends by allowing )ney from a patient on any ing ordered by the Medical one when restrained. The indness and resent rudeness, vhich Attendant is kindest ; P superiors, but by the gen- among the patients. The its may be gauged by the ons to this rule in Asylums, d prejudices, but such are f 9 > r ± HAND-nOOK lOlt ATI I ;N DA NTS. 7 often easily detected. While on duty, the whole attention must be directed to the one object of care and ov( rsi;^dit. Acci- dents are unlooked-for contingeiici.js und.Tthe best mann^Miiieiit, and come when not expcct..-d, but muiiy can be av(/Kl. d by con- stant vigilance. What we least expect suddeidy comes to pasn, and often through negligence or want of forethoiiglit. Whatevtr Attendants may think, either of the managemi^nt of patients un- der their charge, or of the personal treatment they receive, tliey should never say or do anything which would bo likely to lessen the influence of their superiors upon tlieir fellow-attendants, as well as upon those under their care. Even if an Attendant may have just grievances, unredressed for the time, from want of proper discrimination or judgment, a state of things which does not often happen and which, in nine out of ten times, will be corrected. Yet, if an Attendant have not patience to wait, it is far better to seek employment elsewhere than to remain a source of irritation and unhappincss to all with whom such may come in contact. There are many points on which an intelligent Attendant is able to render most material aid to a Medical Officer, by having better opportunities of obtaining from patients correct answers to necessary enquiries. Especial care must be taken as to the manner of making these enquiries, and as to their nature. They should on no account be made merely to gratify the curiosity of a nurse or to furnish gos- sip matter in the ward, nor should the patient be unnecessarily worried V- them; but on the other hand, patients should be encourag d to take the Attendants into their confidence, and tell anything they think may be useful in their mental treatment. In alUhe intimate intercourse of an Asylum, absolute truthful- ness is necessary, even when it may afTect the narrator. It is right, and in the end will be found to be best. A liar is found out at last, and is not fully trusted afterward until reformation is proved by a probation, which no officer is willing to wait for, where serious interests are at stake. No drunkard can ever bo relied upon at any time! The lazy often are experts in doing the least work in the*^longest time. They should have no place where hard tvnd unpleasant work is the rule, 8 ASYLUM FOR THE IXSANK, LON'DON. ( MEDICAL NOTES. CoNVULsivK Attacks. .' I propose giving a few of the lcaSANE, LONDON'. (c) Fits of crying or laughing extravagantly. (d) Palpitation of heart. 11. Mode of Seizure. (a) Gradual and partial loss of consciousness. )h) Face flushed, eyelids closed, pupils set. (0) Absence of froth at mouth, and bitmg of tongue. (d) No distortion of features. le) Patient knocks about-if not prevented. (/) Not followed by sleep. (a) Rarely occurs at night. _ This fovm of ecnplaint i. usually n«l ^vith in women and .s "'« " ifftefXmoly difficult to distinguish hotwcecn a con- ' "fitwhicht tho result „t epilepsy, and that caused by vulsive fi''7f7 r .^„tf„, an attendant to have exaet m- K» t thi: 7^ I will put the prominent symptcns of both in thi3 way. . 1. Is there any warning before a fit? | i. Does a patient cry out? } 3 Does the patient injure herself by biting the | •'• .. . .1 i„;i-;„rrf1iA furniture? J E. frequently. H. seldom. E. once. H. repeatedly. E. often. 4 Will the patient bear to have the eyes | ^ ^^J^^ touched? o .^v wfltpv in- 1 E. frequently. 6. Does the patient pass motions or water | ^ ^^^1^^^ voluntarily during a fit? .a.. "'tt\£'-i'-:aC stirs-:;.": too .nueh sy7f 'y ''f; 3^„ P, t„„,ards a patient. The pa- should ™«'', "l;;-;;" ™'*,'X f , "-' " oharact.nstio of the :£i::;t:nijrt:;pUe is the signal ror «i\' 1.1 <> w E, LONDON. igantly. ure. ousncs.s. Is set. itin^ of tongue. HAND-BOOK FOR ATTENDANTS. 11 ev ented. net with in women and is istingaish betwoeen a con- lepsy, and that caused by ttendant to have exact in- the prominent symptoms of ■ ■) E. frequently. t? I H. seldom. I E. once. ) H. repeatedly. ,yhltingthe| E. often. J furniture? 3 H. rarely, re the eyes I E. always, j H. rarely, or water in- \ E. frequently. ) H. seldom. ^ood deal of cunning, and re- ical of firmness ; but on the to withhold the expression of Lticnt's ailments, an attendant i towards a patient. The pa- that is characteristic of the ax attendant to notice whether •ore the expected visit of the lis appearance is the signal for beer unnoticed. Paralysis. 1 • .ftw lower part of the body, the patients In cases of paralysis of the lo^ cr P .^^ ^^^ ^^^^^ are in a pitiable condition lymgcm^^^^^^^^^ and having lost all con rol ^^l^^^ ,^^^,,,^^ or corn- urine are constantly ^'^^^S P^^^^'^ ,^^^, ,^ the care mand of such patients. They ^^'^ J^r... Those are very and attention of the ^ fondant fievryth ^^ ^^^^^ ^^ ^^^ the patient, the cov;rse oi ^^^erethe kindness and self- .orse. There are. per^^^^^^^^^ denial of a < 1 ^^^endan are m • j,^^^^ ^,,^ .vhatever final stages of a paretic patient. The be^ ^^ ^^^^ cause, should be kept clean and dry. 2'\,^^, avoided by this .onstant attention. Be -^^^^^^^ ^^,,,,,.fback ^^^^^'''''l^^tC^^l^s.o.c.rrno.. frequently than :r;7ntiow\n^^^^^^^^^ Insensibility, Delirium, Eaintnes^. 2. Avoid any >oughnos3 •" d'=?^ ° , „, afraid of a|ways b» «- ^/jtrl^t' ' ;„i:tn .aj-. Do noUttcnpt them or inclined to let tnem na assertion?, but to argue ,vith them, or to ^ ™^^;;[, t ttod in their ocr- at the sa™o time , ,s - - ' ^ JJ ^j t;.,,,,,,^ , u„o in rcroct versation a, po.s.b e. Th . san » ^^. ^ ^^^ j^_^^^_ ^_^;,,,,„_ notice, i2 ASYLUM FOK THE TNSANK, LOVDON. In a ca.so of falntncss, the patient slionld be at nnnc placed in a rocuiubcnt position, all tight clothing about the chest and neck should be loosened, and a supply of fresh cold air secured. The best restorative, and the handiest, is water dashed in the face, or a cold wet towel applied to face, neck and chest. Any volatile preparation of hartshorn, when applied to the nostrils should be used with care, for if used too much the lining membranes of the air passages might receive serious injury. . , Suicides and Homicides. An attendant must act promptly when suicide is attempted. What can bo done singly should never be leftlmtil assistance bo procured. A few seconds may mean life or death. To prevent self-destruction or manslaughter may need courage and determin- ation. These should not bo wanting at such trying times. De- cision at the right moment is invaluable to prevent a tragedy. If hanging be attempted, relief is needed at once by cutting down and loosening any constricting article which may be about the throat. If poisoning be attempted the patient may be induced to swallow at once any oil at hand, or two table-spoonfuls of mustard while a medical officer is being summoned. These remedies are always at hand, and may be of great service to the patient, irrespective of the kind of poison. The one coats the sttmiach against irritat- ing^ poisons, and the other will cause immediate vomiting. When a suicidal patient makes an attempt to end life by bleeding, when a serious attack is made by one patient on another, oi- when an accident occurs, it is well for the attendant to know that life is often saved by prompt action to arrest bleeding. There are three methods of stopping bleeding, which are at once in the power of an intelligent and active attendant. 1. Blood may often bo seen to flow from one small point only of a wound. Slight pressure over the spot with one finger will usually stop it, as long as the pressure is kept up, and often altogether; even after the pressure is removed. 2. With close attention to the beating of arteries in their own bodies, attendants can soon learn in many cases the exact spot on which' pressure should be made to check the flow in the main ri;, i,ovr)ON. hoiild be at once placed in ; about the chest ami neck ish cohl ah- secured. The atcr dashed in the face, or and chest. Any volatile d to the nostrils should be le lining membranes of the mCIDES. dicn suicide is attempted, r be left iintil assistance be life or death. To prevent leod courage and determin- at such trying times. De- le to prevent a tragedy. If it once by cutting down and ;h may be about the throat, may be induced to swallow spoonfuls of mustard while These remedies are always to the patient, irrespective the stomach against irritat- imediatc vomiting. When a 1 end life by bleeding, when cnt on another, or when an ondant to know that life is it bleeding. There are three are at once in the power of rom one .small point only of a with one finger will usually it up, and often altogether; jing of arteries in their own iiany cases the exact spot on jheck the flow in the main V HAND-r.OOK I'OU AT rilXDAN'T.S. 13 T V artery supplying the wound with blood. If th. bloed.ng con- tinue; in spite of pressure, as is ofte.i the case in wounds of the armories, the attendant should witlun.l avy. ^SVI.UM roll Tin: issask, i.osr>ox. ,t medicines appcr to tlu. alte,.la„ts to I.e rrclucing any very 1,0 lto,,>'cl>, l.ea,la,.l,e, .howsines.,, convuls.ve '"ovomcn^ o ;",e ,nnsel.., running at the eyes, nose, or n,outl,,a med.cal office, should be immediately informed of it. An attendant is never to prononnce an opunon on *« ™'"= ° «ny medicine administered. None l.nt a n,eJ,eal nran can pro pcrly deckle that question. Washing Patients. An attendant should not fail to see that all the patients are All dLii^in-uM T 1 J. „^ dnrriP ipouire a great deal irany where. This is often the most unpleasant part of an at- te° danfl work, but nothing should induce the attendant to shnnK f m dlin ' t. Health and comfort depend much on cave and Ittlion ^0 cleanliness. Soap and water, well appl.ed o paU™ s „,i At he classed as remedies for disease. Lice are often found on "Senb wtn admitted. The n.edlcal oflicer will give a suitable S ment. to be used under his direction. f-^J— ^ ^^ tain as a rule, poisonous ingredients, and should ™t 0"^^ *« ^^ with caution, but like all medicines n, a ward, should be kept "ICo" t"'S; should be got rid of as soon as possible. Disease and dirt are a well matched pair; let them never be found together. Eui.ES Fou Batiiis-o. . 1. An attendant is to he always present at bathing. 2 The bath is not to reach a greater ten.perature than nn, ty- eioht degrees Fahrenheit, except specially ordered by the med.c^ officer. Although a thern.omelor is the surest way of t^-f'S "^ . Kelt of the water, the hand of any person who .s accustomed to bathing patients is a suflleieiil guide. HAND-BOOK FOU ATTENDANTS. 17 4ANK, LONDON. lants to ha profluciiig any very lias vomiting, diarrhoea, pain C!s.s, convulsive movements of 3so', or moutli, a medical officer 'i it. ■ , ncc an opinion on the value ot but a medical man can pro- r ATIKNTS. to see that all the patients are 30. Some require a great deal )ct ; others can attend to their supervision in order to ensure lould be at least well washed eral times a day. Each patient , as necessary, but not seldomer never be tolerated in any form most unpleasant part of an at- Id induce the attendant to shrink tort depend much on care and id water, Avell applied to patients, disease. Lice are often found on lodical officer will give a suitable ircctioa. These preparations con- cnts, and should not only be used ines in a ward, should bo kept . got rid of as soon as possible, matched pair; let them never be 311 Bathin-g. ays present at bathing. X crrcatcr temperature than nuiety- )t''specially ordered by the medical ter is the surest way of testing the ■ any person who is accustomed to guide. 3. No person is to be allowed to remain in a batli longor than fifteen minutes at a time, unless specially ordered otherwise by the medical officer. Bkd-SOUKS. Bed-sores vary in degree from a slight abrasion of the skin, with a diffused redness around to largo, deep sores, involving all the flesh down to the bone. They occur over the prominent points of the patient's body, upon which the weight specially falls when in bed. > 1. It is evident then to prevent this the under sheet should be kept smooth and free from wrinkles and crumbs. 2. The patient should be kept as dry as possible, all discharges being cleaned away frequently. 3. The position of the patient should be varied as often as possible. 4). After being daily cleaned, it is p.-obable the medical officer will cause the wound to be washed with a strong solution of spirits of wine, and after having been thoroughly dried, cause it to be dusted with flour, starch, oxide of zinc, or some such appli- cation. These will be of little avail without cleanliness. 5. When the skin has once broken, the sores must be treated on the same principle as other similar wounds. Ventilation. Plenty of fresh air is as necessary for the attendants as for the patients. iVo one can be healthy without it. The windows, the doors, the chimney, and any special appa- ratus are the avenues either to let fresh air in or foul air out. Maintain an even temperature of say sixty-five to seventy degrees in the sitting-rooms and wards. The insane need more heat than a well person does. Avoid draughts. Pure air is the most pow- erful restorer of health at our command, for the want of it is the cause of more than half the diseases in the world. Judiciously use the ventilators, for they are the safety-valves of health. Foul smells are to be traced to their source and got rid of as soon as possible. They too often mean disease and death. If bad smells cannot be traced to any source in a ward, the fact ,.'V ASYLUM FOTl TlH: IN>^\NF-. LONDON'. / . f .,1 lo^t thev coinc from a sewer, a defective pipe. / rf c':;T a:!i t ti o..-,™ or i„.oa„.n, aan^co,. diseases. Night Attendants. more than one attendant is tio'^- i • • t^v nnv mpdicines prescribed. 3. Be cat»M to ''*™;"'»'^7"^„al>k: procure assistance. 4. If a patient is "-y.;X"™^Xf * kno." that resistance "t'.:: r o^il'^tLra^a ;.in sn..it at onee .itV ""YZ^t any restraint except by permission of a n,eaica. ■ °t Fit cases need constant watching lest they injure themselves or suffocate. , ,^rn^Ysines3, loud breathing, 7. Increased restlessness^m-na^dro^^^^^^^^ jumping in and »^<>f.^»?', ™" ^ Uy patients (the latter be.ng °^""V"mrwi* in ttrtelnations of acute mania) are lyTptoms wiich must be »P==;f yj;^**^, the impression that ^. Be careful not to leave l^^^e r»om «nd r 1^^^ .^^^^.^^^ the patient is asleep, espec.ally as in eases t^l assumed to a-ive the a tenJant^^ ^^^^ ^^ ^^^^ The supervision over a n-gl^l'^"''';!^ <=""™ ^^j,,,^ to trust to day attendants, so it is necessary to - '"'S '-'^^j^^ The un- rfldelity to duty of those who are on n,,* ser ^ ^^ expected visits of the -[-"^J^f^fn made more with this i^T- ''i: -:ctotri^.- of nndmg a .,.. %f rt;hing is not ^;XX^^^^^ day. Ind shouhl never be undertaken b> anj r V t i1 V I i.\ Dm a sewer, a defective pil>o, t of introducing daixgcrous DANTS. to keep awake. Never lie up in a few minutes. Sleep come you. Firjht against vcr and it' in going your rounds, room, avoid much conversa- ^edicines prescribed, lanageable, procure assistance, miner to know that resistance tnd will submit at once with- cpt by permission of a medical • King lest they injure themselves aal drowsiness, loud breathing, evin- delirium, sudden cessation t noily patients (the latter being erminr,tions of acute mania) are ly watched. , room under the impression that as in cases of suicidal insanity, ittendant. wa^.ch cannot be as strict as over ,ry to a large extent to trust to ,0 are on night service. The un- .tendant at all hours ^vlll be an ,nd are often made more with this , expectation of finding a mght- al work, as it involves sleeping by, 3rtaken by any who are habit«all> I, r i ■r' HAND-IiOOK FOll ATTENDANTS. 19 V -V V inclined to drowsiness. The ni-l.t watch wlio has to make a continual effort to keep awake, is in great danger of being caught napping, and conse(piently dismi-sed. Laying out thk Dead. When a patient dies, the eyes should be closed by a gentle pressure with the fingers for a few minutes, or a .small weight- a penny or similar coin-may be used to keep up the pressure. The limbs should be .straightene-l out carefully, and a neat and clean bandage applied under the lower jaw to support it; the arms should be placed by the side, and the lower extremities kept in position by means of a bandage connecting the great toes The clothes should then all be removed, and after the body has been thoroughly washed, they should be changed for a clean bedgown or shirt. . , , l Common decency— not to say humanity-requires that respect shall be paid to the body of the dead. Any undertaker, who is guilty of rudeness or indecency to even a pauper patient's body should at once be reported, so that his services may be dispensed with.