Chapter 21 - Domestic Management of the Sick Room
Choice of the Sick Room
Fumigation
Freezing Mixtures
Attendants
Prognostics
Bed Sores
Diet in Disease and Convalescence
Fluid Aliments

21.3 Freezing Mixtures

Freezing Mixtures. IN treating wounds, inflammation, etc., it is often quite important to have ice, where it is not to be obtained without manufacturing it. Accordingly, I give here a few directions for its immediate production. The salts used should be in a crystallized state, with as much water in them as possible without being damp. They should be coarsely pulverized at the time of using, and put into the water contained in a basin, or other suitable vessel. The water to be frozen should be in closed in a thin vessel, and immersed in the freezing mixture. To obtain extreme degrees of cold, the ingredients and the vessel should be cooled by one mixture before being mixed for another. To five drams of pulverized hydroclilorate of ammonia, and five drams of pulverized nitrate of potash (nitre), add two ounces of water, in a tin, stone ware, or glass vessel, and you may freeze water, sea water, milk, vinegar, or oil of turpentine. It will cause the thermometer to sink from 50' above zero to 100 above; that is, forty degrees. A mixture of five drams of sulphate of soda, and four drams of diluted sulphuric acid, will sink the thermometer seven degrees lower than the above, namely, down to 3' above zero, or twenty nine degrees below the freezing point. If six drams of sulphate of soda, four drams of hydrochlorate of ammonia, two drams of nitiate of potash, and four drams of diluted nitric acid be put together, the mixture will lower the thermometer 60'; that is, to 10' below zero, or 42' below the freezing point. Besides the above the following combination may be used: Muriate of ammonia, five ounces; nitrate of potash, five ounces water, sixteen ounces. Mix. Nitrate of ammonia, four ounces; crystallized carbonate of soda, four ounces; water, four ounces. Mix. Nitrate of ammonia and water, equal parts. Mix. Nitrate of ammonia and nitrate of potash, five parts each; sulphate of soda, eight parts; and water, sixteen parts. Mix. Phosphate of soda, nine parts; diluted nitric acid, four parts. Mix. Sulphate of soda, eight parts; muriatic acid, five parts. Mix. Sulphate of soda, six parts; nitrate of ammonia, five parts; diluted nitric acid, four parts. Mix. Freezing Mixtures with Ice. Snow or pounded ice, two parts; salt, one part. Mix. This will sink the thermometer to 5' below zero. Snow or pounded ice, four parts; salt, two parts; muriate of ammonia, one part. In this mixture the thermometer will go down to 12' below zero. Snow or pounded ice, twenty four parts; common salt, ten parts; muriate of ammonia, five parts; nitrate of potassa, five parts. Mix. Gives 18' below zero. Snow or pounded ice, twelve parts; common salt, five parts; nitrate of ammonia, five parts. Mix. Gives 25 ' below zero. Snow, eight parts; muriatic acid, five parts. Mix. Gives 27* below zero Snow, seven parts; diluted nitric acid, four parts. Mix. Gives 300 below zero. Snow, four parts; chloride of calcium, five parts. Mix. Gives 400 below zero. Snow, three parts; potassa, four parts. Mix. Gives 511 below zero, or 830 below the freezing point. The Nurse. When all the arrangements are completed in the sick room, little benefit can be anticipated if a proper nurse be not obtained to render them available to the invalid. Every female who wishes to act as a sick nurse should be obliged to serve a certain time as an assistant nurse in one of the public hospitals, and to receive a certificate of her efficiency before she leaves the establishment. The advantages which the public derive from a body of nurses educated in this manner must be obvious to every one. In hiring a sick nurse, the qualifications which should regulate our choice refer to age, strength, stealth, temper, disposition, habits and education. Age. She should not be under twenty~ five, nor above fifty five years of age. This period is fixed upon on account both of the physical powers and the moral conduct of the individual. Under twenty five, the strength of a woman has not reached its maturity, and is scarcely adequate for lifting patients in and out of bed, and for many other duties which require strength, connected with the office of a nurse; but the strength and the muscular power in females begin to fail after fifty five, when the natural transition from maturity to decay takes place. Strength. The foregoing remarks respecting age render it almost unnecessary to say that a woman of a naturally delicate frame of body is unfit for a sick nurse ; at the same time, a coarse, heavy, and masculine woman is, for many reasons, objectionable. Whilst strength is requisite, the frame should be such as to indicate activity. Health. None of the qualifications of a sick nurse are of more importance than health. An individual who herself requires attention is ill calculated to attend upon others. A woman who is asthmatic, or has any difficulty of breathing, or a habitual cough; who is rheumatic or gouty, or has any spasmodic affection; who is afflicted with palpitation; or suffers from periodical headache, vertigo, or a tendency to paralysis; or who is consumptive, or scrofulous; or has defective sight or hearing; or anything which causes decrepitude, is disqualified for a sick nurse. It is important, also, to ascertain that there is no hypochondriacal or hysterical tendency, nor predisposition. to mental depression. Temper and Disposition. It is scarcely requisite to say that an attendant upon the sick should possess a happy, cheerful, equal flow of spirits; a temper not easily ruffled; and kind and sympathetic feelings; but, at the same time, not such as to interfere with firm. ness of character. The expression of the countenance should be open and winning, so as to attract the good will and confidence of the invalid: a pleasing and gentle manner being more likely to gain esteem, and insure obedience to the orders of the physician, than the most persuasive argument, , which can be addressed to the understanding of the patient. A collected, cheerful expression of the countenance, in the attendant on the sick, is likely to inspire hope, and to aid the efforts of the physician for the recovery of his patient. The general disposition of a sick nurse should be obliging. Every title office, which the invalid may require to be done, should be performed at once, and without the smallest apparent reluctance, even when the necessity for its immediate performance is not absolute. There is also an earnestness of manner, which should, if possible, be acquiesced in by the sick nurse, as it impresses the idea that she feels deeply interested in the case; a circumstance which is always highly appreciated by the patient. Finally, it is unnecessary to say that a nurse should be honest, as no description of servant has so much in her power. But the honesty of the nurse is not to be measured by her respect for property; she must be above imposing on the physician, with respect either to medicines or to diet. Her religion, also, should be sincere, but not pharisaical; and although she may occasionally persuade her charge ,, to put his trust in God, the fountain of health," * yet she must recollect that preaching is not her province; and, when mistimed, even the best advice may prove not only profitless, but injurious; and this is especially likely to be the result when the doctrines she professes are of a controversial kind. With respect to gossiping, it is a detestable habit under any circumstances; but in a nurse it may be productive of the greatest danger, produce family feuds, and a thousand other evils. In her Habits, a sick nurse should be sober, active, orderly, and clean, and neat in her person. The first of these habits namely, sobriety is so essential a qualification in every attendant in the sick room, that it requires no comment. Happily, the desire for ardent spirits is now less frequent than formerly, when women were seldom employed as nurses until they were nearly superannuated, and until their habits, good or bad, were too firmly rooted to be removed. The Activity essential for a good nurse does not imply a bustling or fidgety manner, but a quiet, steady method of proceeding in the performance of her duties, equally devoid of fluster, turbulence or noise. This activity is generally associated with orderly habits; a most valuable qualification, and without which the sick room becomes a scene of confusion and disgust. Every medical man must have witnessed this state of disorder with regret, when, on visiting his patient, he finds no chair to sit upon until some article of bedding or of clothing be removed from it, and the seat dusted with the apron of the nurse; and when a former prescription, or anything else, is wanted, he must wait until the nurse rummages out half a dozen of drawers in search of it. Another quality, usually conjoined with activity and orderly habits in a nurse, is cleanliness in her own person and in that of her charge, as well as that of the sick room. The dress of a nurse should be simple and neat, without trimmings. Nothing is more out of place than a fine lady attempting to perform the duties of a nurse. Education. It may appear a refinement to talk of the education of a nurse; but there is not a greater difference between noon day and midnight than between an educated and an ignorant nurse. The former is often an aid to the physician, not only in carrying his orders into effect, but by observing and informing him of symptoms of great importance which have occurred during his absence; whereas the latter is a source of constant anxiety, and too often assumes the privilege of acting in direct contradiction to his orders, and according to her own opinion.

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