Commentary. See most of the authorities referred to in [Section LXXIX].
Aëtius and Oribasius treat whitlow upon the same plan as our author, namely, by using cooling and astringent applications, such as galls, alum, and pomegranate-rind at the commencement; and after it has burst and fungous flesh has got up, by applying strong caustic and corrosive medicines, such as arsenic, verdigris, quicklime, and the flakes of copper. Neither of these authors, however, say anything about making an early incision of the part affected with whitlow, which must be considered a defect in their method of practice. Octavius Horatianus, however, seems to have had it in view to recommend an early opening, when he says, “Si saniem sanè collegerit, locum pungis.” In fact, it is as soon as the part becomes gorged with blood, and before the matter has had time to be properly formed, that an opening should be made.
Avicenna is exceedingly minute in his directions for treating whitlow. He recommends at first the finger to be put into hot vinegar. Then various astringent and repellent applications are to be used, among other ingredients containing camphor. These are afterwards to be changed for emollient and sedative applications prepared with opium. When matter forms, it is to be let out by a small opening. Haly Abbas recommends at first the seed of fleawort pounded in vinegar or snow, to cool and deaden the sensibility of the part. When these do not answer, he advises suppurative applications; and when the abscess does not open readily, he approves of an incision with the edge of a lancet. When the pain is violent and obstinate, he recommends opium, henbane, and vinegar to be added to the applications. He mentions that Hippocrates recommends an application of galls and vinegar for whitlow. Alsaharavius describes whitlow by the name of alcahas. He recommends us to bleed at the commencement, then to use a plaster of vinegar and opium, or a piece of cloth moistened in snow or cold water, and frequently changed, or to put the finger into hot oil. If these means do not succeed, suppuration is to be encouraged; and as soon as matter forms it is to be let out. Avenzoar describes a species of malignant whitlow, of which we have seen some few cases. He says it spreads up the hand, and occasions corruption of it. He recommends free incision, and relates a case in which very bad effects resulted from neglecting this practice. (iii, 2, 37.) This is perhaps the same disease that is described by Alsaharavius (Pract. xxix, 1, 25), and by Albucasis (Chir. i.)
Rhases says that common people put the finger into hot oil. He also recommends hot vinegar and hot water. (Contin. xxxvi.)
Celsus directs us to make an opening around scabrous nails, and then to apply a composition consisting of red arsenic, nitre, common arsenic, and liquid pitch. Under the use of this application, the diseased nails fall off and healthy ones come in their place. Haly Abbas and Alsaharavius also recommend applications containing arsenic. Alexander Aphrodisiensis mentions that leuce occurs more commonly on the hands than the feet, and in children rather than in adults. This arises, he says, from the feet being more exercised than the hands, and from children eating more voraciously than adults. (Probl. i, 146.) The compositions recommended in the ‘Euporista’ of Dioscorides for leprous nails are arsenic and water, sandarach, quicklime, and burnt lees of wine with pitch, the juice of thapsia and mustard with vinegar, &c. See also M. M. v, 122.
For bruised nails, Aëtius strongly commends a mixture of fossil salt with water and oil. Avenzoar speaks of privet (alcanna) with olive-oil.
For bloody nails, Nonnus recommends a mixture of verdigris and axunge.
Avicenna, among other applications resembling those of the Greeks, recommends a plaster of cypress-nuts and savin.
For pterygia, Celsus, among other applications, makes mention of a mixture of arsenic, quicklime, and chalcitis, in equal proportions. If this application fail, he directs us to use the actual cautery. Aëtius and Oribasius recommend the most powerful escharotics, such as verdigris, misy, sori, chalcitis, and arsenic. These applications are mentioned likewise by Rhases. (Contin. xxxvi.)