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This painful affection consists in the gathering of pus in the tissues of a finger as a result of infection. According to the depth at which the matter collects, whitlows are classified as subcuticular, parenchymatous and thecal.
A subcuticular whitlow is one occurring in the cuticle, that is, outside the true skin. lt begins as a small red spot, estremely tender, and giving rise to throbbing. ln a few hours thr pain usually ceases and a small bleb replaces the red spot. The bleb or blister contains pus, often thin and milky; and very infections. The treatment is to prick the blister and cut away the raised cuticle with line-pointed scissors, a quite painless procedure. Fomentations are then applied until the raw area is dry.
A parcnohymatous whitlow is one that has affected the pulp of the finger, the pus lying in and beneath the true skin. It is a more painful form and lasts longer. Unless the pain soon subsides the finger should be lanced to prevent the pus spreading deeply. Even if no actual pus has yet formed, the relief of the tension by means of an incision made under gas or after freezing the part removes the danger of an extension of the tronble. Fomentations will then be applied, and at each change of dressing the linger should be immersed for half an hour or more in iodine water (5-20 drops tincture of iodine per wineglass) as hot as can comfortably be borne.
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1. Pus quite superficial.

2. Abscess pressing on a nerve and causing acute pain.

3. Abscess opening into and infecting the tendon sheath.

4. Connexion of tendon sheaths wiih the large; sheath at the wrist.

The thecal form (theca, a sheath) is the most dangerous of the three as the name implies, the sheath of the tendons on the palmar surface of the finger is attacked, and this always results in some degree of permanent disability.
The finger tendons move freely in the sheath, and when the pus has broached the latter its easiest method of spread is to extend in the sheath towards the palm. The whole finger is swollen, dusky red and tender, and the patient feels severely ill, "shivery" and worn out with pain. Often in such a severe infection the glands in the armpit become swollen and painful, and may break down to form an abscess.
The treatment is operative and no time should be lost. After the surgeon has provided a free exit for the pus he usually advises continuous immersion in a bath of hot saline or hot iodine water for hours at a time. While the hand is in the bath the patient should make efforts, gentle at first, to move the various joints of the affected finger, for it often happens that the bone becomes infected, partial necrosis of the phalanx may result, and a fragment of bone may be extruded, thus adding to the disability.
The later treatment is directed towards restoririg the action of the affected digit, as tar as it is recoversble, by passive and active movements. Purposive re-educative movements, such as the endeavour to pick up small objects, are of great service.
In order to prevent a whitlow from forming, all small pricks and abrasions should be carefully cleansed and disinfected; if, in spite of these precautions, signs of inflammation appear the finger should be rested. See Pus; Tendon.