WHITLOW is a name applied loosely to any inflammation involving the pulp of the finger, attended by swelling and throbbing pain. In the simplest form, 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 affection is not usually spoken of as whitlow unless it involves the deeper structures of the last joint of the finger. These are in a peculiarly close relation to the surface; hence the liability to deep-seated formations of matter, from some slight scratch or prick (poisoned or otherwise) of the skin over the pulp of the finger, or even when there is no obvious external provocation. The intimate connexion of the surface with the deep structures is near the finger-tip; in that region there are certain regular bundles of strong fibres passing from the under layers of the skin, through the fat of the finger pulp, down to the free end of the bone, which is roughened and expanded in a very peculiar manner for their insertion. These fibres, which are proper to adults, serve to convey an inflammatory infection from the skin down to the bone, or to the periosteum or covering of the bone, and to the tendon (of the deep flexor muscle of the finger) inserted into that part of the last joint of the finger next to the hand. The peculiar danger of a whitlow is that, if it be not opened in time by a deep cut down to the bone along the middle line of the phalanx, the inflammation will attack the covering of the bone, and so produce mortification or necrosis of the latter, and then attack the insertion of the tendon, causing sloughing of ...it also. In this way a whitlow, which has been neglected or treated by temporizing and ineffective methods, often leads to a loss of the bony tip of the last finger-joint, or even of the whole of the joint, and to a proportionate shortening and deformity of the finger. In another class of cases, which are fortunately less common, the deep-seated inflammation travels along the various structures of the finger towards the palm of the hand. The inflammation extends inside the dense fibrous tunnel or sheath which contains and binds down both tendons upon the middle and proximal joints of the finger. In that confined space the inflammation becomes peculiarly virulent: the tension of the part gives the pain a bursting character; the redness and swelling extend all round the fingers and to the back of the hand and wrist; and the result of all this suppuration and sloughing may be rigidity and contraction of the fingers and hand. Whenever matter burrows in this way, the treatment must be by free incisions. In all cases of whitlow the general disturbance of health is excessive.
The general treatment of all whitlow inflammations consists at the outset in relief of a congested state of the system, where such exists, by a purge and by a restricted diet, in applying poultices or hot compresses to the affected finger, and in carrying the arm in a sling. The presence of matter will not be obvious by the ordinary signs of a gathering; attempts to let out the matter by anything short of a free and deep incision are likely to fail and to cause the loss of more or less of tue bone.
Whitlows have sometimes been observed to occur among a number of persons together, in a sort of epidemic, especially where the individuals are all subject to the same conditions of living, as among troops in garrison. These epidemics usually occur at a season (probably the spring) when erysipelas, carbuncles, and boils are prevalent.
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