use, a straight-backed chair, turned upside down, is very good. Bed-rests of netting, secured at each end to the bedstead, are said to be very cool and airy. They can be so arranged as to swing the patient quite off the bed. For a weak patient, with an inclination to slip down to the foot of the bed, Cullingsworth's roller-pillow is valuable. This is a cylindrical cushion, some four inches thick, with a strip of stout webbing at each end fastening it securely to the head of the bed. The patient, as it were, sits upon this, and is supported by it. There are an endless number of invalids' beds made to tip up at various angles, and several forms of patent apparatus for lifting and holding up the patient while the bed is arranged under him. A very simple and useful appliance for helping the invalid to help himself, is a strap with a handle, pendant from a hinged crane over the bed, or from a ring in the ceiling.

Small pillows, of various sizes and shapes, are frequently serviceable. Rubber air-cushions are especially comfortable. They should be smoothly covered, and the cover sewed, not pinned, on. In some cases an airor water-bed will be called for. They are both made of rubber the former is filled by bellows, the latter connected with a hose. The air-mattress may be put on an ordinary bedstead, but the water-bed lies in a wooden trough. An old blanket or cloths must be put under it to keep it from sticking. The water with which it is filled should be at a temperature of 70° Fahr., and should be renewed every two weeks. Cover with a blanket before putting on the usual bedding. Care must be taken to avoid pricking water or air cushions, or beds.

Crumbs in a bed constitute one of the minor miseries of sickness, and can not be too carefully looked out for.

From

There should be a regular crumb hunt after each meal. A well-cared-for bed is evidence of a good nurse. neglect or ignorance of its proper management very serious consequences may arise in the form of bed-sores.

These result from continued pressure upon prominent parts of the body, and may vary from slight abrasions of the skin to deep wounds. They appear most frequently upon the lower part of the back, the hips, shoulders, elbows, or heels, but may develop wherever the conditions are favorable. There is liability to them in all cases of long confinement to the recumbent posture, especially where there is a much lowered vitality -as in paralysis, fevers, and old age. Very heavy and very emaciated patients are alike predisposed to them, and they are among the most trying complications of surgical cases, where motion is restricted. Bed-sores are frequently occasioned by bad nursing, and the cases are rare in which a good nurse can not avert their formation. They are more easily prevented, than cured when once established. Preventive measures consist in keeping the parts thoroughly clean, and the surface under them dry and smooth, in hardening the skin, and so far as possible relieving the local pressure. This precautionary treatment should be commenced at the beginning of any long sickness, without waiting for manifest signs of danger. The parts most subjected to pressure must be frequently washed with soap and water and thoroughly dried. A draw-sheet should be placed under the patient, which must be changed as often as it becomes damp from any cause, and the greatest pains must be taken to keep it free from wrinkles, crumbs, and inequalities of any kind. The patient's clothes must not be permitted to get into folds or creases under him. The skin may be hardened by bathing several times

daily with alcohol, brandy, or eau-de-Cologne, or a solution of bichloride of mercury in alcohol, two grains to the ounce. Follow this by rubbing in well a small quantity of some simple ointment, to keep the skin supple. Finally, dust the parts with some fine powder, to absorb the moisture of the skin. Oxide of zinc is perhaps the best. Lycopodium powder is very fine and soft, but has the disadvantage of staining the bedding. It must be borne in mind also that it is highly inflammable, and must not be used in the vicinity of a lamp. Fine starch or the ordinary toilet powder used for infants will answer.

Where the danger is extreme, or the skin already abraded, it may be protected by covering with strips of soap-plaster, or by the application with a broad brush of a single coat of flexible collodion, or solution of gutta-percha. The pressure may be relieved by frequent changes of position, when such are practicable, by circular pads or air-cushions, or where the tendency is very marked, by the use of a water-bed. The latter equalizes the pressure, and is, in case of paralysis, or prolonged incontinence of urine, the only efficient safeguard.

The first symptom of a bed-sore evident to the patient is usually a pricking sensation, or a feeling as if he were lying on something rough. Or there may be no subjective indication whatever. A patient may be delirious, paralyzed, or too weak to complain, and a bedsore be far advanced before it is discovered, unless constant vigilance has been exerted in this direction. On this account daily and careful examination should be made of such parts as are especially subjected to pressure, and the first discovery of reddening or roughening of the skin, or of pain on pressure, be accepted as a

warning of serious import. If these symptoms pass unnoticed or uncared for, the discoloration will become deeper, and the inflammation progress until sloughing

ensues.

After a bed-sore is actually formed, its treatment belongs properly in the province of the surgeon, but it is often delegated to the nurse. After the skin is broken it is customary to discontinue the use of spirit, or to dilute it, as, although still useful, it causes pain, and to dress with oxide-of-zinc ointment or vaseline. A mixture of tannic acid and oxide of zinc, a scruple of each, worked up into an ointment with an ounce of vaseline, is sometimes recommended. When a slough has formed, its separation is hastened by the use of charcoal or chlorinated poultices. As it becomes detached, it almost invariably reveals greater extent of injury than its superficial appearance would have led one to anticipate, often laying bare the deeper tissues even to the bone. Poulticing should not be continued longer than is necessary to remove the gangrenous portion, as it tends to soften and break down the neighboring parts.

Brown-Séquard advises alternate applications of heat and cold, an ice-bag for ten minutes, followed by a warm poultice for an hour. After the separation of the slough, the resulting ulcerated surface is treated with some stimulating and disinfecting remedy, as balsam of Peru, tincture of catechu, or carbolic acid, 1-40, applied on lint, only within the limits of the sore. An excellent application at this stage, is that known as Wood's mixture, equal parts of powdered catechu, red cinchona, and gum camphor, mixed into a thin paste with balsam of Peru. This makes an indelible stain. Tannic acid also stains. Iodoform, either in powder or in the form of an ointment, may be used.

Cover the lint with a piece of oiled muslin or rubber tissue, of a little larger size, and confine the dressings in place by adhesive strips, not by bandages. They must be renewed at least once a day, and the surface of the sore washed with some disinfectant solution before it is reapplied. Remove all pressure by circular pads. The general strength of the patient must be supported, and circulation as far as possible promoted, as the immediate cause of bed-sores is defective nutrition. If neglected, they may result fatally, as the constant discharge may prove too great a drain upon an already debilitated patient, or pyæmia may supervene from its reabsorption into the blood.