On whitlow / by W. Morrant Baker.

  • William Morrant Baker
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: On whitlow / by W. Morrant Baker. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    made into the tendon-sheaths in all cases in which they may possibly be affected; and to assert, as a fact, that in very many cases of supposed thecal whitlow the disease is not essentially thecal, I do not propose to enter 011 the whole subject of the treatment of whitlow, true or false. The general principles of surgery must be, here as elsewhere, our best guide. But I would add one remark as to the best place for the application of the knife, when the opening of the theca cannot be avoided; or, in other words, when the case is really one in wrhich pus or other fluid is confined within it. I have already expressed an opinion that the usual method of incising the theca is not the best. It is true that a free incision o along the front of the finger gives the most complete exposure of the inflamed internal surface ; and were this the only considera- tion, it would be above criticism. But, unfortunately, while the immediate effect is good, the ultimate result is very often calami- tous ; that is to say, the patient recovers with a finger of which the flexor tendons are either hopelessly tethered by adhesions, or in which, from their sloughing, they are absent altogether. Fre- quently, moreover, there is enough scarring and contraction, or even withering of the finger to be objectionable, apart from the disablement, more or less, arising from its stiff condition. Can these results, even in the case of true thecal whitlow, be avoided ? Of course, not always ; but I believe that in some cases they can ; and that sufficient relief may be given to the tense and suppurat- ing theca by less “heroic” measures than the free incisions com- monly recommended. On the whole, I am disposed to think that the incision recommended by Mr. Christopher Heath is the best in most cases of thecal whitlow of a finger. In a lecture pub- lished in the Medical Times and Gazette, June 18, 1881, Mr. Heath, whom 1 am glad to claim as an advocate for the exercise of great caution with respect to opening the tendon-sheath at all, writes in reference to true thecal whitlow, “ If it is not shortly arrested, incisions will be necessary ; and it is here that mistakes are often made. The incisions, whether made along the centre or the sides of the finger, ought not to open the theca or sheath of the tendons, for if the sheath is opened in this position the tendons invariably slough, and the patient is left with a stiff finger. For this reason, incisions on each side of the finger are safer than one in the centre, that may unawares let out the tendons, which will look perfectly healthy at the moment, but soon become sodden and softened.” Speaking of a case in which matter had formed in the sheath and required evacuation, Mr. Heath adds: “I proceeded to. evacuate the matter by making an incision through the palmar fascia, over the head of the meta- carpal bone. You will remember that the superficial palmar arch