The citizen. (Frederick City, Md.) 1895-1923, 1895-08-23
TIMELY MEDICAL TOPICS.
A Series of Brief Treatises on
What To Do i'll Emergencies,
What Not To Do and Other
Hints of Value.
prepared Weekly, Tor the Citizen.l

prepared Weekly Tor the Citizen.l
PARONYCHIA, wHITLow OR FELoN.
A felon is all Inflammation of a fin
ger, rarely Of toe, subsequent upon
traumatism, usually of slight charac-
ter; it may be but scratch, or prick or
little abrasion, permitting of the en-
trance of septic germs. 1t may be OF
moderate or great severity, according
to the virulence of the organism and
the general state and resisting power of
the individual affected. 1t is more
common upon the right hand, aud us
ually commences upon the last pha-
lanX.
1t may he superficial or deep, in the
latter case beginning rs such or he
coming So toy extension from the I'M
der surface of the germ, favored in
the pulp of the finger by the fibrous
threads that tie 1t down to the bone.
The Superficial variety is more
common and less troublesome, affect
ing one finger or several in succession,
or at the same time, AS often is the
case in debilitated subjects, especially
children, and located generally around
and under the nail. The inflamma-
ton may be light and subside quickly;
or somewhat more severe, causing SUI
bepidermal, Serious or purulent effu-
siOns. The former is absorbed in few
hours or days; the latter is associated
with liberation, bat soon heals, though
often leaving a scar which is red and
tender for some time.
In much enfeebled individual. the
inflammation may tie of high grade,
the pain intense, the swelling decided,
the supperation abundant, and may
cause the loss of part or the whole of
the nail, aud the development of fun
gOus, aud granulatiOms the disease, Of
ten in neglected cases, lasting for
weeks or months until the necrosed
nail il thrown off
The ITedtHdW varies with the Sc
verify of the inflammation. Rest and
elevation of the part and cold applica-
tons are all that is required in the
milder cases. The use of hot fomenta-
tlous, simple or medicated, together
with complete and prompt evacuation
Of the pus, is indicated where suppera-
tion occurs. In the graver cases, early
incision and the administration of ton
les aud anodyneS are necessary.
Change of residence, if it can be effect
az soon as evident that it must be lost,
and iodoform, corrosive sublimate, nj
trate of lead, carbolic acid and other
similar agents may be applied to the
liberated surface
Deep WhiHOtO or FelOn: usually COM
mences on the palmar aspect of the
last phalanX, though it may originate
in an injury of the first or second pha-
lanx, or more rarely, upon the dorsum
In few hours it may be, or more
commonly within a day or two, after
the receipt of the injury the finger be-
comes painful, tense, hot, and throb-
bling, with accompanying elevation of
temperature and acceleration of pulse.
These symptoms rapidly increased in
severity, especially the pain and ten
sion, and are both aggravated by the
dependent position. Resolution rarely
occurs, suppuration usually taking
place. Associated with the deep collec-
ton of pus, there is often a superficial
abscess that may be mistaken for the
real disease.
TREATMENT.
Though at times the application Of
cold, or the tincture of iodine, or car
bollc acid, or a blister has afforded re-
lief, in the great majority of cases, such
treatment is of no value. Carbolic
acid has been known to produce gam
creme of the finger. So strong is the
probability of the formation of pus,
that it is better to employ hot antisep-
tic solutions or lamentations from the
beginning, and if with two, or at most
three days, decided improvement does
not take place, free incision should be
made to the bone, when it is the last
phalanx that is affected, to the tendon
when the first or second, since in the
former locality the disease is almost
certain to have gone down to the peri
osteum, while in the latter, it very
probably is, as yet, teno-synovitis,
and the intensity of the tendon may
be preserved by cutting the sheath.
The after treatment should be thor
oughly antiseptic. Often, in spite of
early incision and proper dressing. ne
crosis of the last phalanX occurs. When
it does. it is likely to stop at the epiph-
yseal line, and the dead bone can be
removed later without opening the ar
ticulati0n. Necrosis of the second or
first phalanx will generally necessitate
amputation, though tolerably useful
finger may at times be secured by
simple removal of the necrOsed bone