WHITLOW is an inflammation affecting the phalanges of the fingers, and generally proceeding to suppuration. The part attacked, however, is not confined to the fingers ; the same disease may also appear in the toes. Paronychia and Onychia are terms which are used to express the same disease. Surgical authors describe several forms of whitlow, or paronychia, according to the textures which the inflam mation attacks. Thus it may be situated in the skin, the cellular tissue under the ekin, the tendons or theca of the fingers or toes, in the periosteum, or it may be seated in the cellular tissue under the nail When the inflammation is confined to the skin, vesicles appear, which quickly advance to suppuration, and the case requires little attention. When the subcutaneous cellular tissue is affected, the case is more serious, though it seldom extends : there is throbbing pain of the part, and there may be severe constitutional disturbance, and suppuration is a less or greater length of time in taking place. The whitlow under the nail differs from this form only in situation. In these cases only the cellular tissue under the cutis is affected, and no great danger or mischief is to be apprehended from the whitlow. When, however, the inflammation extends to the tendons, periosteum, and bone, then the symptoms are very severe ; and by extending from the finger affected, up the arm, and involving a large extent of surface, fatal consequences have sometimes been the result. The commence ment of this form of whitlow is indicated by Is burning, shooting, throbbing pain of the finger, with a varying degree of constitutional disturbance. Sometimes the febrile symptoms are very violent ; and when the arm is involved, delirium and other alarming symptoms come on. At first there is no perceptible change iu the part affected : at
length, however, slight swelling cornea on, which may extend up the arm, even to the axilla. In these cases a small quantity of matter is collected under the flexor tendon of the finger. or under the periosteum, in which latter clue the bone is tnostly affected with caries. _ 1Vhitlows may be caused by some external injury, euch as a prick from a needle, pin, thorn, or other pointed object, or they may arise spontaneously. The latter not unfrequently occura in young persons who are apparently in a good state of health.
In the treatment of whitlow the inflammation can rarely be subdued before it proceeds to suppuration. It may however be tried, and cold lotions and local bleeding, with general antipLlogistie treatment, will sometimes subdue the inflammation. When matter is formed, the best thing that can be done is to get rid of it as soon as possible, and this must be done by cutting down quite upon the seat of inflammation and pain. When matter is formed, ease its immediately given by its being diaelarged ; and oven should an incision be made before suppura tion has taken place, it will alleviate the symptoms. Where matter is formed extensively under the tendons, free incisions should be made wherever it is collected. Where caries of the bone exists in whitlows, it may be sometimes a question as to whether amputation is not the most effectual treatment. Where whitlow occurs under the pail, the matter may be discharged either by an incision uuder the nail from the side, or by seraping the nail and making the incision from above.