SECT. LXXXV.—ON PTERYGIA ABOUT THE NAILS.
The pterygium is a fleshy excrescence about the nails, covering part of the nail, and being commonly formed in the large fingers and toes. But those in the feet arise most commonly from an accident, whereas, those in the hands arise from whitlow, the inflammation being neglected and turning to pus. For, the pus being allowed to remain, corrodes and corrupts the root of the nail, and often destroys the whole of it, but generally the one half, while a portion of it uncorroded is left at the root of the nail, and sometimes the whole root is left uncorroded. Sometimes, too, it corrupts the bone, when a disagreeable smell arises from it, and the extremity of the finger becomes swelled and appears livid. They are to be treated, then, by cutting and removing all the remaining part of the nail with the point of a scalpel, and then burning both the ulcerated and cut part with cauteries. For, the pterygium is a spreading disease, and does not stop unless burnt, so that, if neglected, it affects the whole finger. If, while the nail and bone remain sound, the inner angle of the nail sink down and pierce the adjacent flesh, it occasions inflammation; and in this case the irritating portion is to be raised upon a thin probe, or some such thing put under it, and removed with the point of a scalpel, and the excrescence eaten down with an escharotic medicine. And most cases are cured by being treated in this way. But if larger, it is first to be cut out with a scalpel, and then the medicine is to be used.
Commentary. We have given an account of the ancient treatment of pterygia by medicines towards the end of the [Third Book].
Celsus recommends excision with the knife and the application of cauteries or strong caustics afterwards. (vi, 19.)
Aëtius and Oribasius trust to septic and caustic applications without an operation. Antyllus (apud Rhasis Cont. xxxvi,) recommended excision and burning when the discharge from the ulcer is fetid.
Albucasis, like our author, recommends us to cut off the piece of nail that is attached, and then to apply a burning iron to the part. The burning, he adds, is of great consequence. When the bone is diseased he directs us to take it out, which generally may be done at the joint. (Chirurg. ii, 9.)
Haly Abbas likewise directs us to cut off the piece of nail and apply the cautery. He says, if this be neglected the bone is apt to become diseased. When pus is seated below the nail, he recommends us to introduce the head of a probe under it, and cut upon it with a knife; after which a caustic medicine is to be applied to the flesh. (Pract. ix, 66.)