B EDSORES.
Preventive treatment is of primary importance, and since the sores are almost invariably secondary to some bedridden condition the attention of the physician and nurse should always be directed to the possibility of their supervention in prolonged fevers, paralysis, fractures of the femur, &c.
Continuous pressure over some bony prominence being the main cause, the patient's position in bed will demand regular changing several times a day and occasionally through the night as well, so as to avoid the pres sure caused by the weight of his body being exercised for any length of time upon a particular part of the skin. Air or water cushions or extem porised pillows or small cushions stuffed with well-teased-out sheep's-wool having a central opening opposite to the bony prominence will he re quired. Smooth and creaseless linen draw-sheets should take the place of mackintoshes, as next to pressure the irritation of sweat and other secretions is a fruitful source of this opprobrium to nursing. The skin must he kept as dry as possible, and all parts of the patient's body in close contact with the hair mattress should be thoroughly cleansed at least twice a day with soap and water, and after carefully towelling they should be bathed with methylated spirit, whiskey, or eau de Cologne, which is permitted to dry spontaneously. If incontinence of urine or heces is present it is needless to say these operations must be carried out very frequently through the day and night. After the ablution has been finished, finely powdered Boric Acid, Fuller's Earth, Prepared Calamina, Talc or Huxley's Dusting Powder, should he gently rubbed into the parts.
In patients with abnormally dry skins, after the cleansing process has been completed, a little Lanoline may be advantageously used instead of the dusting powder; it is in such cases that creases in the sheets and the irritation caused by bread crumbs are liable to produce minute abrasions ending in sores. The acute sloughing bedsore, which follows spinal injuries, can only be effectually prevented by the early use of the water bed.
When permanent redness of the skin has already appeared, sometimes painting of the erythematous area with Flexile Collodion may avert the threatening abrasion, but if this has already occurred a piece of Soap plaster spread on soft chamois, or the application of an ointment of Zinc Oxide with to or 15 grs. to each ounce may prevent the abrasion developing into an ulcer if all moist applications be discontinued.
If the sore has already formed, the first step is to thoroughly cleanse it of all dead matter, and though the large sloughing gangrenous surface may sometimes require the application of a warm linseed poultice, in most cases a Boric Acid compress composed of several layers of lint soaked in a warm saturated solution of the drug is a better and safer remedy. As soon as the separation of all sloughs has been effected the granulating surface should be treated on general surgical principles, by the use of weak astringent and antiseptic lotions, as Alum (1 in too), Boric Acid (r in 50), Carbolic Acid (I in 4o), Spirit (r in 3), Corrosive Sublimate (1 in 500); Red Lotion (containing Zinc Sulphate, gr. ij. to the 5i.) gives good results in these cases. These require to be covered over with oiled silk, and occasionally the retained secretion under the silk and beyond the moistened edges of the lint tends to irritate the healthy skin, in which case dry dressings, lodoform Gauze, powdered Boric Acid, Sze., may be substituted. A thin sheet of perforated celluloid may be laid over the ulcerated surface.
Where the sore is small, ointments are more suitable, and the official Boracic, Zinc, Carbolic, Salicylic, or Iodoform unguents may be em ployed. In slowly healing or sluggish sores a pomade consisting of equal amounts of Basilicon Ointment and Balsam of Peru is a valuable prepara tion. Under the heading of Ulcers various other formulas will be found, any of which may be tried when the above-mentioned remedies fail. During the healing process the part must be kept free of all pressure by the use of the ringed sheep's-wool cushion already mentioned.
Bird's method of healing chronic bedsores in paralysed patients has been found by the writer to be efficacious after the failure of ordinary treatment. It consists in the application of a thin sheet of silver laid on the granulating surface of the ulcer; the silver has attached to it a bent wire of the same metal which is soldered to a small disc of copper at its other extremity; this is laid upon the healthy skin over a piece of wash leather or lint moistened with vinegar. The resulting galvanic action usually excites rapid healing. Sometimes a layer of sheet-lead laid over the sore excites new action in it.
Scraping or excision of the slough followed by the application of strong Carbolic Acid is sometimes resorted to by the surgeon where there is evidence that septic absorption is threatening or has already occurred.