Surgery : complete volume / C. R. Whittaker.

  • Charles Richard Whittaker
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : complete volume / C. R. Whittaker. Source: Wellcome Collection.

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    What are the Principles of Treatment ? 1. To remove the persistent cause, 2. To scrape away the epithelial lining with a sharp spoon, and then pack with iodoform gauze, and thus encourage heal- ing from the bottom of the sinus. Describe a Whitlow. A whitlow is an acute septic inflammation of a finger or a toe. Five varieties are found—(a) purulent blister or sub- cuticular ; (b) around the nail sulcus ; (c) subcutaneous; (d) involving the tendon sheath (“thecal”); and (e) sub-peri- osteal. The affected part becomes red, painful, and throbbing. Superficial lymphangitis is usually present with some tender- ness of the axillary glands. With the exception of the subcuticular form, constitutional reaction generally occurs, such as insomnia and a slightly elevated temperature. Give the Treatment of Whitlow. Induce passive liyper?emia by means of Bier’s bandage, or Klapp’s suction-bell. Bier’s bandage is applied round the limb well above the seat of the injury, the constriction being maintained for about twenty hours daily. Care must be taken not to apply the bandage too tightly or gangrene may result, Klapp’s bell is used as follows :—Smear the edge of the bell with vaseline, and lower the pressure in the bell by means of a suction pump. Keep the bell on for about ten minutes, then remove for ten minutes, and so on for about three-quarters of an hour. In addition to passive hyperaemia note :— (1) If the nail be affected, remove a portion under local anaesthesia to facilitate drainage. (2) In the subcutaneous variety incise the area of finger involved, but do not open the tendon sheath, and do not apply carbolic acid or gangrene may follow. (3) The thecal form is especially dangerous when it occurs in the thumb or little finger owing to their communication with the forearm. A small incision should be made in the affected sheath, avoiding the digital vessels and nerves, and passive hypenemia employed.
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