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There were no other lesions except a small sacral bed-sore, a small fibromyoma of the uterine fundus, small slightly cystic ovaries, a slight dural thickening, and possibly a slight general cerebral atrophy. Patient was a Protestant iron-worker of 59 years, who had lost an eye and had become unable to work about three months before death. Aortic, cardiac, renal lesions at autopsy.
In operation cases, care must be taken that irritating chemicals used to purify the skin do not collect under the patient and remain in contact with the skin of the sacrum and buttocks during the time he is on the operating-table. There is reason to believe that the so-called "post-operation bed-sore" may be due to such causes.
The acute bed-sore is a rapidly progressing form of ulceration, often amounting to gangrene, of portions of skin exposed to pressure when their trophic nerve-supply has been interfered with. [Illustration: FIG.
In old and debilitated patients the septic absorption taking place from a bed-sore often proves a serious complication of other surgical conditions. From this cause, for example, old people may succumb during the treatment of a fractured thigh. The granulating surface left on the separation of the slough tends to heal comparatively rapidly. Prevention of Bed-sores.
If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease, but of the nursing. I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices.
Certain forms of bed-sore are also due to prolonged pressure. Pressure sores are also known to have been produced artificially by malingerers and hysterical subjects. [Illustration: FIG.
Oliver Appleton, the first reported American bleeder, died at an advanced age, owing to hemorrhage from a bed-sore and from the urethra. Fortunately the functions of menstruation and parturition are not seriously interfered with in hemophilia. Menstruation is never so excessive as to be fatal. Grandidier states that of 152 boy subjects 81 died before the termination of the seventh year.
The acute bed-sore usually occurs over the sacrum or buttock. It develops rapidly after spinal injuries and in the course of certain brain diseases.
The chronic bed-sore begins as a dusky reddish purple patch, which gradually becomes darker till it is almost black. The parts around are œdematous, and a blister may form. This bursts and exposes the papillæ of the skin, which are of a greenish hue. A tough greyish-black slough forms, and is slowly separated.
In advanced cases of general paralysis of the insane, a peculiar form of acute bed-sore beginning as a blister, and passing on to the formation of a black, dry eschar, which slowly separates, occurs on such parts as the medial side of the knee, the angle of the scapula, and the heel.
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