It is an inflammation of the thumb or of one of the fingers, which terminates in suppuration. There are two distinct varieties of this inflammation, a superficial and a deep-seated one. The superficial form, Whitlow, Run-Around, is generally seated immediately around and beneath the nail, commencing either at the side of the finger, upon its dorsal surface, or at its extremity. Without much, if any swelling, the part is of a dusky reddish aspect, tender on pressure, and exquisitely painful, throbbing violently and incessantly, and causing more or less constitutional disorder. Two or three days after these phenomena present themselves, matter is observed beneath the epidermis, which is elevated into a yellowish vesicle at the side and ‘root of the nail. In many cases pus is also situated beneath the nail, especially at its posterior extremity, and sometimes, again, it is found chiefly, if not exclusively, in the cellular substance, immediately beneath the true skin. The inflammation generally extends some distance up the finger, and occasionally even over a considerable portion of the hand, which may be considerably swollen, stiff and painful. Not infrequently a reddish line, indicating the course of an absorbent vessel, is seen running along the limb, as high up, perhaps, as the axilla.
In the deep-seated variety, Felon, the inflammation involves all or nearly all the structures of the finger, and is frequently followed by the destruction of one or more of the phalanges. The pain is of extraordinary severity, depriving the patient of sleep for days and nights together, throbbing, tensive and diffused, often extending as high as the elbow, and even to the shoulder, steady and persistent, but greatly aggravated by a depending position, and only subsiding with evacuation of the inflammatory deposits, or the death of the parts. The swelling also is great, sometimes enormous, involving both finger, hand and wrist. The skin is red and edematous, puffy, erysipelatous in aspect, and the whole limb is often stiff and useless. In consequence of the inflammatory action, pus forms deep among the tissues, in the connecting cellular substance, within the sheaths of the tendons, and beneath the periosteum and spreading in all directions, causes extensive destruction, burrowing along the finger and hand.
In neglected cases even gangrene may occur, followed by sloughing of the tendons, and exfoliation of the phalanges. This grave form is always attended with well-marked constitutional disturbance. The patient, tortured with pain, is feverish and unable to sleep, his appetite is lost, his head, back, and limbs ache, the face is flushed, and the pulse is strong, hard and frequent. In some cases delirium is present.
THERAPEUTIC HINTS
Ammonium carb. – I have seen the nightly pain which had deprived the patient of sleep for several nights, relieved in a few hours, and the morbid process staid at the same time by one or two doses of Ammonium carb.
Anthracinum – Where there is sloughing, with terrible burning, and when Arsen. gives no relief.
Apis – According to Wolf, a specific, especially after the abuse of Sulphur. The characteristic pain is burning-stinging.
Arsenicum – When the sore assumes a gangrenous aspect, burning like fire, with anxious restlessness. Worse about midnight.
Bryonia – In the commencement, where there is a gastric-rheumatic disposition, white or yellowish-coated tongue, dry feeling in the mouth, without thirst, or great thirst, bitter taste in the mouth, dry, hard stool, as if burnt.
Causticum – Recommended by Goullon, to be used externally and internally.
Graphites – According to Kreussler, superficial inflammation about the root of the nail, with burning and throbbing pain, and subsequent inflammation and proud flesh.
Hepar – Violent, throbbing, “gathering” pain. It accelerates suppuration.
Lachesis – According to Hering, in severe cases, where the inflamed portion assumes a purplish hue, or becomes gangrenous.
Ledum – When the whitlow is the consequence of the prick of a needle, a splinter, etc.
Lycopodium – When there are the following constitutional disturbances : frequent belching, bloatedness of the region of the stomach and belly, pressure and heaviness, and sometimes throbbing in the precordial region, burning in the stomach and esophagus, nausea, sensation of twisting, crawling and emptiness in the stomach, accompanied by frequent yawning, congestion to the head, cold feet, dry stool, red, burning urine, mental irritability.
Malandrinum – Suppuration of all the fingers and toe-nails. (Straube.)
Mercurius – When the inflammation extends to the sheaths of the tendons and ligaments of the joints, and in superficial whitlows.
Natrum sulph – suppuration at the root of the nail, with deep-red swelling of the whole phalanx, and great painfulness; the patient looks sickly and pale, feels weary and dull in the head, especially in the morning, has no appetite, and is chilly and feverish in the evening. The pain is easier out-of-doors than indoors. Prominent causes: damp region, damp walls.
Rhus tox. – Where there are rheumatic pains in the limbs, worse during rest and on beginning to move, sensation in the limbs as of going to sleep, and formication, tired feeling, and sweating from any little exertion, erysipelatous redness of the in- flamed part.
Sanguinaria – Suppuration of the roots of all the finger-nails.
Silica – Deep-seated inflammation, affection of the bone, proud flesh, terrible pain, worse in bed, very important after Hepar.
Stramonium – It is most important when the pain is almost unbearable, driving to despair. It ameliorates it at once, and hastens benign suppuration.
Sulphur – According to Wolf, when Apis is not sufficient on account of latent psora.
Excerpted from: Special Pathology and Diagnostics with Therapeutic Hints – C. G. Raue, MD (1882)
