Bed-sores

Bed-sores are often a very troublesome complication of disease, to which a patient is liable when, confined for a long time to bed, he is either unable or is not allowed to change his position. They attack the skin over bony prominences, especially the lower parts of the spine, the haunch bones, the heel, and the elbow. The skin becomes red at first, and its surface is gradually abraded; this may end in the death of a portion of the skin, which separates as a slough, and a deep ulcer appears beneath it. General debility, the continued fevers (especially typhoid), paralysis, and old age, are strong predisposing causes. The immediate causes are continuous pressure on the affected parts and a lack of care in nursing; as, for instance, incomplete cleanliness, where the evacuations escape involuntarily, and where the undersheet is not kept smooth and free from irritating particles. The patient sometimes complains of a sense of discomfort at the parts, as if he were lying on dry crumbs of bread; at other times, he seems to feel nothing. Hence, in all cases of prolonged confinement to bed, the parts naturally pressed upon by the weight of the body should be carefully examined every day or two, as prevention is far easier than cure. When a long confinement to bed is expected, attempts should be made to thicken the cuticle, and enable it to bear pressure better, by rubbing the skin with a stimulant such as spirits or eau-de-Cologne. If the part, when first seen, looks red and rough, further damage is often prevented by covering it with a piece of calico, on which soap-plaster has been spread; the local pressure may be removed by air-eushions specially constructed for cases of this kind, and in many instances Arnott's Water-bed (q.v.) affords great comfort. If the case is one in which it is admissible, the patient should be made to alter his position frequently. Should an abrasion form, it must be painted over with a layer of collodion, which forms a protective covering to the part; at this stage, also, all pressure must be removed from the part if possible. When the dusky colour of an insulated piece of skin shows that a slough is forming, a water-dressing must be applied and renewed every eight hours. It consists of four layers of boric lint cut a little larger than the size of the livid portion of skin. The lint, wrung out of hot water, is covered by a piece of oiled silk that overlaps it for half an inch in every direction. When the slough separates, a similar dressing should be continued for the ulcer, on the surface of which a little iodoform is sprinkled before the water-dressing is applied. In severe cases, where there is enlargement of the sores, or increased discharge from them, a 'prone couch' should be used, on which the patient lies on his face. This gives great relief, and allows healing to take place.