Bedsore

Bedsore, a form of ulceration or sloughing, occasioned in people who, through sickness or old age, are confined to bed, resulting from pressure or the irritation of sweat and dirt. Bedsores usually occur when there is a low condition of nutrition of the tissues. The more helpless the patient the more liable he is to bedsores, and especially when he is paralysed, delirious or insane, or when suffering from one of the acute specific fevers. They may occur wherever there is a pressure, more especially when any moisture is allowed to remain on the bedding; and thus lack of cleanliness is an important factor in the production of this condition. In large hospitals a bedsore is now a great rarity, and this, considering the helplessness of many of the patients treated, shows what good nursing can do. The bed must be made with a firm smooth mattress; the undersheet and blanket must be changed whenever they become soiled; the drawsheet is spread without creases, and changed the moment it becomes soiled. Preventive treatment must be followed from the first day of the illness. This consists in the most minute attention to cleanliness, and constant variation in the position of the patient. All parts subjected to pressure or friction must be frequently washed with soap and hot water, then thoroughly dried with a warm soft towel. The part should next be bathed in a solution of corrosive sublimate in spirits of wine, and finally dusted with an oxide of zinc and starch powder. This routine should be gone through not less than four times in the twenty-four hours in any case of prolonged illness. The pressure may be relieved over bony prominences by a water-pillow or by a piece of thick felt cut into a ring. Signs of impending bedsores must constantly be watched for. Where one threatens, the skin loses its proper colour, becoming either a deadly white or a dusky red, and the redness does not disappear on pressure. The surrounding tissues become oedematous, and pain is often severe, except in a case of paralysis. As the condition progresses further the pain ceases. The epidermis now becomes raised as in a blister, and finally becomes detached, forming an excoriation and exposing the papillae. Even at this late stage an actual ulceration can still be prevented if proper care is taken; but failing this, the skin sloughs and an ulcer forms. In treating this, the position of the patient must be such that no pressure is ever allowed on the sloughing tissue. A hot boracic pad under oil-silk should be applied, the affected part being first dusted with iodoform. If, however, the slough is very large, it is safer to avoid wet applications, and the parts should be dusted with animal charcoal and iodoform, and protected with a dry dressing. When the slough has separated and the sore is clean, friar’s balsam will hasten the healing process. In any serious illness the formation of a bedsore makes the prognosis far more grave, and may even bring about a fatal issue, either directly or indirectly.

* * *