WHITLOW, or PARONYCRIA, is a painful inflammatory affection of the phalanges of the fingers, almost always proceeding to suppuration. There are several varieties of this affection, according to the texture primarily attacked; thus, it may be situated in the skin, the cellular (or connective) tissue beneath the skin or under the nail, the ten dons or tendinous sheaths running along the fingers, or the periosteum. If the skin be the seat of inflammation, vesicles appear, which soon discharge pus, after which relief is rapidly afforded. Such cases require little care or attention, and give rise to hardly any constitutional disturbance. If the cellular tissue is the primary seat of inflamma tion, there is a painful sensation of tenseness and throbbing of the part, and often con siderable febrile disturbance, until the pus can be evacuated. Although this form is painful, no serious mischief is to be apprehended. When, however, the tendons and their sheaths, or the periosteum, are affected, a much more serious form of whitlow is developed, which has been already discussed in the article TENDON. In this form, the suppuration may extend up the arm, and occasion destruction of the joints, and even death.
Whitlow may originate either spontaneously, or after an external injury, such as a prick from a needle, thorn, etc. In the treatment of the milder forms, the finger or
thumb should be held for half an hour or longer in water as hot as can be borne, after which lunar caustic should be rubbed freely over the painful surface; and if there are any febrile symptoms, the patient may take a powder, consisting of 4 grains of calomel, 3 of James's powder, and 3 of Dover's powder, at bed-time, to be followed in the morn ing by an ordinary black draught. The hot local baths should be carried on till matter shows itself; and, as soon as its presence and seat are determined with certainty, an incision should be made to admit of its escape. Even if suppuration has not takeh place, a free incision into the inflamed part often gives great relief. There is a pernicious popular idea that the application of cobblers' wax, or some other stimulating substance, will draw the inflammation to the surface, and bring the whitlow "to a head." There is reason to fear 'that a considerable number of fingers are annually sacrificed to this delusion. As it is not always easy to state in an early stage how a whitlow may turn out, it is advisable that surgical aid should always be at once obtained.