Whitlow

Whitlow, a name applied loosely to any inflammation involving the pulp of the finger, attended by swelling and throbbing pain. In the simplest form, which is apt to occur in sickly children, the inflammation results in a whitish vesicle of the skin, containing watery or bloody fluid. In all such cases, where the deeper structures are not implicated, no radical local treatment is needed, although the illness is an indication for constitutional treatment. The inflammation is not usually spoken of as whitlow unless it involves the deeper structures of the last joint of the finger, in which case it is associated with intense pain. As the result of a scratch or prick of the finger septic germs enter the skin and give rise to an acute inflammation, with throbbing and bursting pain. If the germs do not spread from that spot, they set up an acute localized attack of erysipelas which may end in a superficial abscess. More often, however, they make their way to the periosteum of the last bone of the finger, and involve it in a devastating inflammation which may end in death (necrosis) of that bone. Sometimes the germs find their way into the tendon-sheath, and, spreading into the palm of the hand, cause a deep abscess with, perhaps, sloughing of the tendon, and leaving a permanently stiffened finger. In some cases amputation of the finger is eventually called for. Whitlow is especially apt to occur in people who are out of health, as in them the micro-organisms of the disease meet with less resistance. So soon, therefore, as the acute stage of the disease is over, tonic treatment, with quinine and iron, is needed. The local treatment of whitlow demands a free incision into the area in which the germs are undergoing cultivation, and the sooner that this is done the better. It is wrong to wait for an abscess to be formed. A prompt incision may actually prevent the formation of abscess, and the easing of the tension of the inflamed tissue by the incision gives immediate relief. Perhaps, even in the early stage of the disease, a bead or two of pus may find exit, but whether there is abscess or not, the depths of the wound should be swabbed out with some strong carbolic or mercuric lotion in order to destroy the germs. The hand should then be placed upon a splint with antiseptic fomentations around the finger. It should, moreover, be kept well raised, or worn in a sling. (E. O.*)