Extracts from:

Model Answers to Questions for Mental Nurses

by Hector MacPhail 1928 [Second edition 1932 - Reissued as two volumes in 1940. These extracts from Mental Nursing Final Examination Questions and Answers, with a Forward dated 1944. The Forward welcomes the second edition and says "The contents have been slightly revised".]

1: Enumerate the methods by which patients may be artificially fed. Describe fully the apparatus and feed used. Give the method of administration in one of these feeds.

[The May 1902 paper included a question "What are the special points to be attended to in feeding paralytic and helpless patients?"]

6: What poisons and infections are liable to produce insanity?

7: What are the common bodily derangements met with in mental disorders, and what are the mental symptoms with which they are associated?

30: In what cases may suicidal attempts be made? How do they arise, and how do you guard against them? [This was in the May 1902 paper]

32: What precautions would you take to prevent the escape of patients?

[The May 1902 paper included a question "State briefly how you would guard against and discover escapes; what precautions would you take aganist homicidal impulses; and what do you understand by special observation?]

34: Describe a nurses's duties in supervising a continuous bath. For what type of patient is it used?

48: What is hydrotherapy? Write what you know regarding this form of treatment

51: Describe amentia and enumerate the different varieties

66: What causes are recognized as important in the occurrence of mental illness?

68: What do you mean by 'heredity,' and what influence has it on mental disease?

104: If in charge of a shopping walk, how would you act if a patient escaped?

What poisons and infections are liable to produce insanity ?

The following poisons and infections are liable to produce insanity:

Drugs: alcohol; belladonna; cannabis indica; chloral; cocaine, and other habit-producing drugs.

Trade Poisons, such as lead and arsenic.

Toxaemia from Acute Infections, such as puerperal fever, influenza, typhoid, typhus, scarlet fever, and pneumonia.

Systemic Diseases, such as phthisis, cancer, uraemia, diabetes, and intestinal toxaemia.

Diseases Produced by Micro-organisms, of which syphilis is the most important.

What are the common bodily derangements met with in mental disorders, and what are the mental symptoms with which they are associated?


Digestive Disorders. - These may be partly due to diminished secretion of saliva, and inability to swallow it owing to diminished pharyngeal reflexes, or they may be due to interference with the secretions of internally secreting glands.

Constipation occurs in most cases of indigestion, in cases of acute mental disorder, and especially in melancholia.

Cardio-vascular Disease. - The mental condition may be one of excitement and nocturnal restlessness, a tendency to depression; or it may be agitation, restlessness, apprehension, and severe excitement may occur.

Diabetes. - This disease is often accompanied by agitation, irritability, and depression, or the patient may become much confused.

Dysentery. - The causal organism is commonly found in the faeces of acute cases; old, demented, and degraded patients are especially liable to contract and transmit the infection.

Gout. - The patient during the attack suffers from marked depression and morning irritability.

Menstrual Irregularities, of which amenorrhcea is common in mental disorders, conduce towards irritability, impulsiveness, and peevishness.

Bright's Disease. - Depression often occurs in the chronic form of this diseases.

Uraemia. - This disease may be accompanied by confusion, acute excitement, hallucinations, occupation delirium, or convulsions.

Syphilis. - This disease may be connected with mental disorder in many ways.

Pulmonary Tuberculosis. - In the terminal stages of this disease there is usually marked depression with suicidal tendencies.

Myxcedema. - In this disease there is dullness and slowness of intelligence; the emotional reaction and memory are defective. The mental symptoms may be more marked, when there may be delusions and hallucinations, or even mania.

Exophthalmic Goitre.-The patient suffers from undue apprehension, irritability, and fears which may be obsessional in their vividness and intermittence; restlessness may progress to acute mania, and death may be due to profound exhaustion from toxaemia.

Acromegaly. - In this disease there is often irritability, marked depression, and progressive dementia.

Addison's Disease. - Depression, irritability, and signs of exhaustion occur in this disease.

Describe a nurses's duties in supervising a continuous bath.
For what type of patient is it used?


1. A nurses's duties are to:-

Obtain from the Medical Officer exact instructions as to temperature and duration of the bath.

Prepare the bath and have everything ready before disturbing the paptient.

Attend to the patient's bowels and bladder before he enters the bath.

See that warm blankets and towels are at hand. See that a folded blanket is placed at the bottom of the bath, that the patient is placed in a reclining position with the feet towards the tap end of the bath, and that a comfortable support is arranged for the patient's head.

Remember that the temperature of the bath is usually about 98 [degrees] F., that the temperature must be maintained evenly throughout the duration of the bath by the addition of hot water, and that great care is necessary in adding hot water.

Bear in mind that the temperature of the bath should always be tested by a bath thermometer, and that the water should be moved about with the hand, so as to keep the temperature of the whole as even as possible.

Remember that the patient should lie immersed in the bath for half an hour the first day, one hour the second day, two hours the third day, three hours the fourth day, and so on up till six or seven hours or longer, according to the doctor's orders.

Use tact - should the patient become restless - to keep him quiet during the treatment.

Remember that this is an exhausting method of treatment which may induce headache, fainting or prostration, and that this may be guarded against by applying to the head a cloth wrung out of cold water and by giving an extra supply of nourishment during the treatment in the form of beef-tea, milk or cocoa with biscuits.

Watch carefully for adverse symptoms, such as the pulse becoming weak and irregular and the face cyanosed.

Act promptly on observing signs of fainting by running off the water immediately, and then cover the patient with blankets, lifting him out and on to a bed when his condition improves. Remember that when the patient is immersed for a. long period it may be necessary for him to pass all his emunctories in the bath, and that such necessitates lifting the patient out and renewing the bath.

Dry the patient quickly and thoroughly with a couple of towels after remaining in the bath for the prescribed period, and then put to bed in a warm nightdress.

See that the bath is left clean and dry and that the bathroom is in a tidy condition.

What is hydrotherapy? Write what you know regarding this form of treatment



The Warm Bath is essentially the cleansing bath. It stimulates the skin to proper elimination, removes waste matter from the body surface, relieves fatigue by relaxation of the muscles, and produces a sedative effect if prolonged. Owing to its sedative effect the ideal time is just before bed-time.

Prolonged Bath. See Question No. 34.

Cold Bath. Its chief effect is the reaction produced by the sudden sensation of cold. It stimulates the general circulation and produces a sudden stimulation of metabolism. The reaction should be promoted by vigorous rubbing with a dry towel.

It is also used for the reduction of fever.

A cold bath should not be taken at night, nor for at least two hours after a meal, and should never be administered until the patient's physical condition has been determined by examination.

Cold Pack is used to reduce fever; to act as a circulatory stimulant, a sedative to the nervous system, to allay nervous irritability, lessen delirium and induce sleep.

It may be contra-indicated on account of the feeble condition, or the mental effect upon the patient, e.g., the patient may believe that the process of wrapping him in a sheet is a preparation for his burial.

Hot Pack is usually used to induce copious perspiration and acid excretion in certain kidney diseases.

It may be used to subdue excitement of a violent character.

The wet pack has rather gone out of fashion, because there was reason to believe that some patients regarded it as a punitive measure.

The Needle Spray. It stimulates the sensory nerves of the skin mechanically by its weight apart from its temperature.

It serves as a beneficial stimulus in stuporous conditions.

The Cold Shower is valuable for its tonic effect, and is sometimes given daily to patients suffering from states of stupor, so as to overcome certain resistance in the nervous system.

Cold, Tepid or Hot Sponging may be used to reduce a persistently high temperature, and is useful in allaying restlessness and producing sleep.

Sitz Bath is one in which the patient sits in a special tub - usually for 12 minutes - so that the abdomen and thighs are immersed in water and the feet on the floor.

Its uses are:
To relieve congestion of the pelvic organs.
A remedy for retention of urine.
To relieve tenesmus.
To induce menstruation and relieve dysmenorrhoea.
To relieve painful haemorrhoids.

Turkish Bath. - It produces a soothing and refreshing experience, but it may produce temporary violent fluctuation of the blood-pressure and should not be taken oftener than once a week.

It has not been found efficacious in the treatment of mental cases.

Electric Baths of various kinds are sometimes given to mental patients, and are said to be found of especial benefit in the treatment of stuporous cases, and some cases of dementia praecox.

Supervision is of the utmost importance, and the strictest attention must be paid to the details of administration. Whether the patient is in a bath for the purpose of cleansing or treatment or in a 'wet pack,' he must never be left. The prolonged bath, however tedious the watch, and however quiet the patient, demands the constant care of the nurse.

amentia, and enumerate the different varieties

The term 'amentia' literally means absence of mind This term is now applied to mental deficiency.

Mental deficiency is a state of mental defect dating from birth or arising in such early childhood that the individuals never develop a normal mind, but remain for ever mentally deficient.

Some authorities state that mental deficiency runs in families independently of insanity, that it has special features of its own, and that actual insanity has nothing to do with it; while others maintain that mental deficiency arises in the offspring of families saturated with insanity. Neuropathic heredity is regarded by many as the most frequent cause.

The physical characteristics consist for the most part of stigmata of degeneration, such as deformed ears, exceptionally large or small ears, unduly narrow or broad palates, receding or prominent chins or brows, abnormally large or small skulls, misshapen limbs, with webbed or supernumerary fingers or toes.

Briefly the general mental characteristics are:-

Inability to attend and easily distracted.

Lack of the faculty of forming judgments and concepts.

Failure to profit by past experience and inability to plan the future.

Unusually poor memory for such things as are taught at school, or hypermnesia which is limited in range.

Emotional instability which is liable to be shown in impulsive outbursts of violence or screaming.

Inability to understand the real difference between right and wrong.

Some are capable of being guided by the fear of punishment rather than by a desire to act correctly.

Some are persistently obnoxious and intractable; others are amenable and capable of a certain degree of affection.

Three degrees of mental deficiency are recognized in the Mental Deficiency Act, 1913, in addition to moral imbecility:

a. Idiots.- Persons so deeply defective in mind from birth or from an early age as to be unable to guard themselves against common physical dangers. The mentality of an idiot is considered to be that of a child of three years or under.

b. Imbeciles.- Persons in whose case there exists from birth or from an early age, mental defectiveness not amounting to idiocy, yet so pronounced that they are incapable of managing themselves or their affairs, or, in the case of children, being taught to do so. The mentality is that of a child between the age of three and seven.

c. Feeble-minded Persons.-Persons in whose case there exists from birth or from an early age, mental defectiveness, yet so pronounced that they require care, supervision, and control, for their own protection or for the protection of others, or in the case of children, that they by reason of defectiveness appear to be permanently incapable of receiving proper benefit from instruction in ordinary schools. The mentality of an adult is that of a child between the age of twelve and fifteen years.

Moral Imbecile. - The moral defect may be associated with normal intelligence, so that moral imbecility is not an intellectual defect in the ordinary sense and does not come within the category of amentia.

The following special varieties (which include most cases) are based on the cause of the mental deficiency or on some associated character:-

a. Genetous Idiots, or imbeciles or morons. - The disease process in the brain occurred in those cases before birth.

b. Mongolian Idiots. - These are so named because they bear facial resemblance to normal members of the Mongolian race.

c. Epileptic Idiocy. - This is due to epilepsy beginning in early life.

d. Paralytic Idiocy. - This is associated with paralysis brought about through injury to the brain at birth.

e. Cretinism. - This is due to defective secretion of the thyroid gland, which is unduly small in children so affected. The condition becomes apparent, as a rule, between six and seven months and the second year.

f. Inflammatory Idiocy. - This is ascribed to infections of the central nervous system, such as encephalitis and meningitis.

g. Idiocy by Deprivation. - This is due to concurrent blindness and deafness. Thus the individual is deprived of the senses by means of which he may learn.

h. Microcephalic Idiocy. - This is due to smallness and insufficient growth of the brain, the skull being usually less than 17 in. in circumference.

i. Hydrocephalic Idiocy. - This is due to the brain being distended with cerebrospinal fluid.

j. Syphilitic Idiocy. - A special variety used to be attributed to syphilis, but it has now been discovered that nearly 50 per cent of mental deficiency is probably due to this cause.


What causes are recognized as important in the occurrence of mental illness?


The following factors are recognized as important in the causation of mental illness.

Hereditary predisposition towards the disease. See Question No. 68.

Age of the individual, and the physical and mental stress incidental to the different periods of life, i.e., stresses accompanying the physical or mental adjustments at puberty, in connection with the menstrual functions and child-birth, at the menopause; and during the involutional and senile period.

Effects of Physical Disease, impairing the nutrition and metabolism of the brain, through alteration in the blood supply, e.g., cardiac and respiratory disease, or toxins of various kinds - uraemia, diabetes, alcohol, trade poisons - such as lead and microbial infection_which act injuriously on the nervous system.

Disease of the Central Nervous System, e.g., vascular degeneration, cerebral tumour, abscesses, meningitis, cerebral haemorrhage, embolism and thrombosis, all of which may give rise to mental symptoms.

Trauma or Head Injury may be followed by mental symptoms, as the result of actual damage to the brain, or by precipitating the onset in a predisposed individual.

Syphilis may be associated with mental disorders in various ways.

Disease of the Endocrine System. - The thyroid and pituitary disorders may cause mental symptoms.

Effect of Special Experience._Mental stresses due to unpleasant experiences; such as fright, exposure to danger, bereavement, business worries, love affairs and nervous shocks:-

Over-Education._Hard study in the case of a person of unstable nervous constitution, when it leads to insufficiency of sleep is bound to have a deleterious influence.

What do you mean by 'heredity,' and what influence has it on mental disease?


1) Heredity is the transmission of qualities of like kind with those of parents or ancestors to their offspring.

The material basis of inheritance in all ordinary cases of sexual reproduction is the union of the reproductive cells of the female (ova) and the reproductive cells of the male (spermatozoa).

When the ova are fertilized by the spermatozoa, the physical characteristics of both parental families are mingled and the inheriting must be dual.

There is a complete hereditary equipment of paternal origin and another of maternal origin, and these form the warp and woof of the organism, though it does not follow that both will be equally expressed. The offspring may exhibit an intimate mixture of the characters of its two parents.

It frequently happens that an hereditable characteristic of a parent is unexpressed in the development of the offspring but reappears in the third generation.

It should be remembered that all that is inherited is a predisposition towards the disease, and not the mental disease itself. Bacterial disease, such as tuberculosis, cannot from its very nature be transmitted as such, yet constitutional predisposition towards tuberculosis is certainly hereditable.

The offspring of near relations tend to inherit the characteristics of both parents in an exaggerated form, but there is no evidence that the children of near relations (such as first cousins) are specially predisposed to insanity, if both stocks are healthy.

Hereditary influence is said to be:-

a. Direct when the father of the patient has been mentally afflicted.

b. Collateral when mental disease appears only amongst brothers, sisters, cousins, aunts, and uncles of the patient.

c. Atavistic or Reversive when any of the ancestors but not the patient's parents have been mentally afflicted; this means skipping a generation.

d. Similar when the inherited mental disease is of the same type, in members of the same family.

e. Dissimilar when the mental disorders in a family bear little resemblance to the diseases of the ancestors.

Hereditary influence may be antedating in character, that is, the appearance of the mental disorder at an earlier age in the offspring than in the parents; thus a parent who develops manic-depressive insanity at the age of thirty years, may beget a child who develops dementia praecox at the age of puberty.

2. Among the general predisposing causes of insanity, heredity is undoubtedly the first in importance, and there seems little doubt that nervous disorders have their roots in some germinal defect and are therefore in various degrees transmissible.

In the case of female mammals it is improbable that a seriously impaired nervous system will admit of normal nutrition of the foetus, and thus a nervous disorder due to arrest of development may reappear in the offspring.

It is generally believed that a father is more likely to pass his mental abnormalities on to his daughters, and a mother to her sons; the insanity of the mother, however, is considered more dangerous.

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amentia 51

bath 34

continuous bath 34

cretinism 51

epileptic idiocy 51

feeble-minded 51

genetous idiots 51

hydrocephalic idiocy 51

hydrotherapy 34 - 48

idiocy by deprivation 51

idiots 51

imbeciles 51

inflammatory idiocy 51

mental defect 51

mental deficiency 51

microcephalic idiocy 51

mongolian idiots 51

moral imbecile 51

morons 51

paralytic idiocy 51

stigmata of degeneration 51

syphilitic idiocy 51