WHITLOW. 



2. The grezt defideratum is to difcharge the matter as 

 foon after its formation as poffible. 



3. The laft thing is to heal the wound. 



With refpeft to the firft indication, experience proves, 

 that the inflammation, in a very early ftage of the complaint, 

 may fometinics be difperfed by the adoption of ordinary 

 antiplilogiftic treatment. Here topical bleeding, efpecially 

 the prompt and repeated application of leeches to the painful 

 part feveral times in the day, is highly commendable ; and the 

 inflamed finger and hand may be covered with a cold, dif- 

 cutient, faturnine lotion, together with which means fome 

 writers advife the whole limb to be bound with a circular 

 roller. Others fpeak highly of the good effefts of an early 

 immerfion of the afFefted finger in very warm water, or in 

 lotions made of alcohol, vinegar, oil of turpentine, &c. and 

 ufed as hot as can be borne. Callifen ftates, that he has 

 alfo frequently obferved great benefit arife from the affufion 

 of fuch lotions on the part. He even afferts, that the pain 

 and more deeply-feated inflammation of the finger may be 

 fometimes checked by applying cauftic or a blifter to the 

 integuments. When the patient's fufferings are very great, 

 the exhibition of opium is indifpenfable after bleeding has 

 been duly praftifed. The fame writer alfo affirms, that 

 eleftricity has been found ufeful at the very commencement 

 of a whitlow. 



When two days elapfe without any probability of refolu- 

 tion taking place, fuppuration ought to be promoted by 

 the immediate and continued ufe of emollient poultices and 

 fomentations. Nor Ihould the furgeon wait for the abfcefs 

 to point, but make an opening with lefs lofs of time, in 

 proportion as the cafe becomes worfe. In examples where 

 the pain is exceedingly violent, the jncifion fhould not be 

 deferred beyond the fourth day from the beginning of the 

 pain. The opening ought alfo to be made at the part 

 which was firft painful, and thence the cut fhould be con- 

 tinued longitudinally, and as deeply as the fituation of the 

 matter. The lancet, indeed, if requifite, muft be intro- 

 duced down to the bone, by which means a fmall quantity 

 of deeply-feated confined matter may frequently be voided, 

 and the pain and progrefs of the difeafe at once flopped. 

 Even when no matter is difcharged from the opening, an 

 early incifion fometimes fpeedily relieves very fevere cafes of 

 whitlow; probably (as Callifen obferves) on the principle 

 of removing tenfion, and occafioning hemorrhage from the 

 part. In thofe inftances, in which an incifion has not been 

 praftifed in due time, and the matter under the tendinous 

 theca has fpread extenfively up the hand and arm, it is 

 fometimes neceffary to make the opening free and ample, 

 without injuring, however, the annular ligament. The dif- 

 charge of the abfcefs, and the evacuation of blood from the 

 incifion, are followed by almoft immediate relief. When 

 the matter is lodged under the periolleum, the bone is 

 moftly found affefted with necrofis. In cafes of this de- 

 fcription, there are fome praftitioners who prefer the re- 

 moval of the difeafed phalanx, to awaiting a tedious and un- 

 certain cure by the procefles of nature. CaUifen, however, 

 informs us, that he has often feen the dead portion of the 

 bone exfohate, leaving the reft in a itate of prefervation. 



When a whitlow under the nail cannot be difperfed, the 

 matter (hould be let out by an opening, praftifed through 

 the tranfparent part of the nail, or by the fide of it. Some 

 furgeons adopt the plan of fcraping the nail, fo as to render 

 It as thin as poflible, before they cut through it, which is 

 an ingenious and commendable method. See Callifen's Syft. 

 Chir. Hod. t. i. p. 293. 295. 



In the fifth volume of the Medico-Chirurgical Tranfac- 



tions, Mr. Wardrop has defcribed a very inveterate and 

 troublefome fpecies of whitlow, which, from its malignant 

 charaAer, he has called the onychia rralhna. " The com- 

 mencement of this difeafe is marked by a degree of fwell- 

 ing, of a deep red colour, in the foft parts at the root of the 

 nail. An oozing of a thin ichor afterwards takes place at 

 the cleft, formed between the root of the nail and foft parts, 

 and at laft the foft parts begin to ulcerate. The ulcer ap- 

 pears on the circular edge of the foft parts at the root of 

 the nail ; it is accompanied with a good deal of fweUing, and 

 the fliin, particularly that adjacent to the ulcer, has a deep 

 purple colour. The appearance of the ulcer is very un- 

 healthy, the edges being thin and acute, and its furface 

 covered with a dull yellow, or brown-coloured lymph, and 

 attended with an ichorous and very fetid difcharge. The 

 growth of the nail is interrupted, it lofes its natural colour, 

 and at fome places appears to have but Httle conneftion 

 with the foft parts. In this ftate (fays Mr. Wardrop), I 

 have feen the difeafe continue for feveral years, fo that the 

 toe or finger became a deformed bulbous mafs. The pain 

 is fometimes very acute ; but the difeafe is more commonly 

 indolent, and accompanied with little uneafinefs. This 

 difeafe affefts both the toes and the fingers. I have only 

 obferved it on the great toe, and more frequently on the 

 thumb, than any of the fingers. It occurs, too, chiefly in 

 young people ; but I have alfo feen adults affefted 

 with it." 



With regard to the treatment of the fpecies of whitlow 

 named by Mr. Wardrop onychia maligna, all local applica- 

 tions have in many inftances proved quite inefieftual, and the 

 part been amputated. The only local treatment which Mr. 

 Wardrop has ever feen relieve this complaint has been the 

 evulCon of the nail, and afterwards the occafional application 

 of efcharotics to the ulcerated furface. We have feen a 

 fimilar plan occafionally fucceed, and the applications which 

 appeared to anfwer bed. were, arfenical lotions, Plunket's 

 cauftic, or a very ftrong folution of the nitrate of filver. 

 Nothing, however, will avail till the nail is removed, and its 

 total feparation fometimes takes up a good deal of time, un- 

 lefs the patient fubmit to the great pain of having it Cut 

 away. 



Mr. Wardrop tried with fuccefs the exhibition of 

 mercury in four cafes of the onychia maligna. The medi- 

 cine was given in fmall dofes at firft, and afterwards in- 

 creafed, fo as to affeft the gums in about twelve or fourteen 

 days. The fores in general foon affumed a healing ap- 

 pearance when the fyftem was in this ftate, and the bulbous 

 fwelling gradually difappeared. Wardrop in Medico-Chir. 

 Tranf. vol. v. p. 135, &c. 



Mr. Pearfon has publiftied an account of a peculiar fort of 

 whitlow, to which he affixes the epithet venereal. He ob- 

 ferves, that it generally appears in the form of a fmooth, 

 foft, unrefifting tumour, of a dark red colour, and is 

 fituated in the cellular membrane about the root of the nail. 

 It is attended with an inconfiderable degree of pain in the 

 incipient ftate ; but as fuppuration advances, the pain in- 

 creafes in feverity. The progrefs of the abfcefs to matura- 

 tion is generally flow, and is feldom completed. 



When the matter is evacuated, the nail is generally found 

 to be loofe, and a very foul but exquifitely fenfible ulcer is 

 expofed ; and confiderable floughs of cellular membrane, &c. 

 come away, fo as to render the fore fometimes very deep. 

 The difcoloured and tumid ftate of the /kin commonly ex- 

 tends along the finger, confiderably beyond the margin of 

 the ulcer. In fuch cafes, the integuments of the finger be- 

 come remarkably thickened, and the cellular membrane is fo 

 3G 2 firmly 



