§ 484. The internal Treatment in Whitlows, is the same with that in other inflammatory Distempers. The Patient must enter upon a Regimen more or less strict, in Proportion to the Degree of the Fever; and if this runs very high, and the Inflammation be very considerable, there may be a Necessity for several Bleedings.
The external Treatment consists in allaying the Inflammation; in softening the Skin; and in procuring a Discharge of the Matter, as soon as it is formed. For this Purpose,
1, The Finger affected is to be plunged, as soon as the Disorder is manifest, in Water a little more than warm: the Steam of boiling Water may also by admitted into it; and by doing these Things almost constantly for the first Day, a total Dissipation of the Malady has often been obtained. But unhappily it has been generally supposed, that such slight Attacks could have but very slight Consequences, whence they have been neglected until the Disorder has greatly advanced; in which State Suppuration becomes absolutely necessary.
2, This Suppuration therefore may be forwarded, by continually involving the Finger, as it were, in a Decoction of Mallow Flowers boiled in Milk, or with a Cataplasm of Bread and Milk. This may be rendered still more active and ripening, by adding a few white Lilly Roots, or a little Honey. But this last must not be applied before the Inflammation is somewhat abated, and Suppuration begins; before which Term, all sharp Applications are very dangerous. At this Time, Yeast or Leaven may be advantagiously used, which powerfully promotes Suppuration. The Sorrel Pultice, mentioned [§ 480], is also a very efficacious one.
§ 485. A speedy Discharge of the ripe Matter is of considerable Importance, but this particularly requires the Attention of the Surgeon; as it is not proper to wait till the Tumour breaks and discharges of itself; and this the rather, as from the Skin's proving sometimes extremely hard, the Matter might be inwardly effused between the Muscles, and upon their Membranes, before it could penetrate through the Skin. For this Reason, as soon as Matter is suspected to be formed, a Surgeon should be called in, to determine exactly on the Time, when an Opening should be made; which had better be performed a little too soon than too late; and a little too deep, than not deep enough.
When the Orifice has been made, and the Discharge is effected, it is to be dressed up with the Plaister [Nº. 66], spread upon Linen, or with the Cerecloth; and these Dressings are to be repeated daily.
§ 486. When the Whitlow is caused by a Humour extravasated very near the Nail, an expert Surgeon speedily checks its Progress, and cures it effectually by an Incision which lets out the Humour. Yet, notwithstanding this Operation is in no wise difficult, all Surgeons are not qualified to perform it, and but too many have no Idea at all of it.
§ 487. Fungous, or, as it is commonly called, proud Flesh sometimes appears during the incarning or healing of the Incision. Such may be kept down with sprinkling a little Minium (red Lead) or burnt Alum over it.
§ 488. If a Caries, a Rottenness of the Bone, should be a Consequence, there is a Necessity for a Surgeon's Attendance, as much as if there was a Gangrene; for which Reason, I shall add nothing with Respect to either of these Symptoms; only observing, there are three very essential Remedies against the last; viz. the Bark, [Nº. 14], a Drachm of which must be taken every two Hours; Scarifications throughout the whole gangrened Part; and Fomentations with a Decoction of the Bark, and the Addition of Spirit of Sulphur. This Medicine is certainly no cheap one; but a Decoction of other bitter Plants, with the Addition of Spirit of Salt, may sometimes do instead of it. And here I take leave to insist again upon it, that in most Cases of gangrened Limbs, it is judicious not to proceed to an Amputation of the mortified Part, till the Gangrene stops, which may be known by a very perceivable Circle, (and easily distinguished by the most ignorant Persons) that marks the Bounds of the Gangrene, and separates the living from the mortified Parts.