A bed sore is gangrene, or death of the tissue of the affected parts. The bony prominences such as the lower part of the spine, the shoulder blades, elbows, and heels are the parts most likely to be affected. Moisture, wrinkles, crumbs, and a too long continuance in one position are the pre-disposing causes, therefore these conditions must all be guarded against.

The presence of moisture is generally due to perspiration, or discharge from wound, bowels or bladder. When the two latter are the causes pads made of oakum or jute placed in cheese-cloth or old muslin, put on the patient like a child's diaper, will save the bed linen. These must be changed as often as necessary, and the patient well washed with warm water and soap; dusting with a little talcum, starch, or rice powder will help to keep the skin dry and soft and it will also prevent chapping. Crumbs and wrinkles must also be guarded against. By keeping the draw sheet tightly drawn and tucked far under the mattress the latter will be overcome; the former must be looked for after every meal; brushing them out with the hand is the most efficient way, but a small whisk-broom may be used.

At least twice a day all parts likely to be affected, especially the back, should be washed with warm water and soap, rubbed with 50 per cent alcohol, and dusted with talcum. This not only helps to prevent bedsores but is unspeakably refreshing to the weary invalid. Avoid using too much powder or it will cake and do more harm than good.

A preparation of equal parts collodion and castor oil painted over the surface will often prevent a breakdown of the tissue, by forming an artificial skin.

Avoid Moisture

Artificial Skin

Frequent change of position is another important means in the prevention of bed-sores. Prop the patient over on her side by putting a couple of pillows lengthwise behind her, one under her shoulders, the other under the lower part of her back. Rings made of batting or sheet wadding wound with bandages are excellent mediums for relieving pressure. They should be made with the hole just large enough to permit of the bony prominence fitting into it. When the patient has to lie for some time on her back, often considerable relief is given by flexing the knees. They can be supported either by a pillow doubled and tied to hold it so (the pointed side placed next the body), or a cylindrical pillow made like the old-fashioned bolster, only smaller and stuffed with hair. Small pillows or hot water bags filled with cool water, placed under the small of the back, will help to make a long continuance of the dorsal position bearable.

All pillows should be shaken and turned frequently. If the skin should become broken, the resulting sore should be washed daily with bichloride of mercury 1-2000, and a dressing applied. Gauze soaked in balsam of Peru or an ointment made of castor oil and zinc oxide powder are generally found efficacious.

Relieving Pressure

Care of a Sore

Changing The Mattress With The Patient In Bed

Wadding Ring, to Relieve Pressure