NAILS, DISEASES AND INJURIES OF THE.
lit-itits the implication of the nail in ztntr 1 in. rl id processes—such as syph . is, t nulls, leprosy, etc.—there are sev tra ,trittiv local divisions that require spt.L..11 notice.
Contusion.
Ct ntti,ion of a nail by a blow, a com t ris,ion, etc., is a common occurrence.
nliss ,tdrcientiv marked to cause de struLtion of the matrix, such an injury is usuallv slight, the acute pain ex cricneid at first quickly disappearing. When, however, the traumatism is seri ous and the nail is torn off, severe suf fering is induced, which may persist quite a long time. Again, infection of the expo.sed tissues may occur, leading to inflammation and suppuration.
TREATMENT.—Slight cases of contu sion require no treatment. After a few minutes the pain generally decreases, then ccases, and the ecchymosis that shows through the nail is generally elim inated through the growth of the nail.
In severe cases the finger or toe should be immersed in a saturated solution of I orax, then dressed with iodoform—or, preferably, with orthoform—if pain con t:nues. The dressing should be changed every day where a toe is the seat of in jury. If the nail is partly torn off, it ,hould be carefully cleansed along with the underlying tissue, replaced, and held in place with a bandage applied over the d ressirw.
Onychia.
This is an inflammatory disorder of the nail popularly called a "run-around," which may follow an injury such as that first described or the introduction tween the nail and the underlying tissues of infectious matter, along with a foreign body: a thorn, a splinter, etc. The finger tip becomes warm and congested, and severe pain generally accompanies the local inflammatory process. An abscess is formed after a few days, the pus being evacuated through the aperture formed by the offending body. If none such ex ists, the nail may become softened and perforated. When the accumulation of pus is marked, there may be febrile and other symptoms denoting general in volvement.
Case of Briimische's in which a neg lected paronychia gave rise to chills, fol lowed by a purpuric eruption, pain and swelling in the joints, bloody diarrhcea, transitory beart-symptonis, and limma turia, which persisted for some months.
There was probably an invasion of mi crobes from the paronychia, from which endocarditis ulcerosa and embolism of the affected organs resulted. J. Levison (Satellite of the Annual, Sept., '92).
In the vast majority of cases, however, the symptoms generally become less marked and involution soon follows, sometimes after the loss of the nail. This is always replaced, though not al ways by as perfect a nail as the one shed. TREATMENT.—The Old treatment by poultices is now supplanted by antiseptic methods that tend to destroy the infec tious germs instead of affording them suitable conditions for development. Hot-water baths--as hot as can be borne —sometimes speedily arrest the process. Alcohol acts in the same manner. If a splinter or other infectious body have penetrated the tissues, the pus-cavity can usually be penetrated withont pain with an hypodermic needle and washed out with a 1 to 5000 bichloride solution. Bathing the finc..rer in such a solution at frequent intervals, or, better still, leaving it therein an hour several times a day, sometimes arrests the infectious process early in its career. Whenever there is an accumulation of pus imprisoned, how ever, it had better be liberated by an incision and washed out with the hyp odermic syringe. Peroxide of hydrogen 1 part in 3 is very effective in such cases.
Malignant Onychia.
This is a complication of the disorder just outlined, which may occur in per sons who are constitutionally weak or adynamic or in so-called "scrofulous" or lymphatic children. It usually affects the index finger, the thumb, or the big toe, and is the active manifestation of a local ulcerative process in the matrix of the nail. The latter becomes brownish or black-, and is shed, leaving underneath a granular fungous mass which shows no tendency to heal. The finger sometimes becomes enormously enlarged and dis charges considerable fcetid pus. Necro sis of the bone of the phalanx involved occasionally follows.