The general treatment of toxaemia must be carried out, and in cases due to infection by streptococci, anti-streptococcic serum may be used.

In a few cases, amputation well above the seat of disease, by removing the source of toxin production, offers the only means of saving the patient.

WHITLOW

The clinical term whitlow is applied to an acute infection, usually followed by suppuration, commonly met with in the fingers, less frequently in the toes.  The point of infection is often trivial—­a pin-prick, a puncture caused by a splinter of wood, a scratch, or even an imperceptible lesion of the skin.

Several varieties of whitlow are recognised, but while it is convenient to describe them separately, it is to be clearly understood that clinically they merge one into another, and it is not always possible to determine in which connective-tissue plane a given infection has originated.

Initial Stage.—­Attention is usually first attracted to the condition by a sensation of tightness in the finger and tenderness when the part is squeezed or knocked against anything.  In the course of a few hours the part becomes red and swollen; there is continuous pain, which soon assumes a throbbing character, particularly when the hand is dependent, and may be so severe as to prevent sleep, and the patient may feel generally out of sorts.

If a constricting band is applied at this stage, the infection can usually be checked and the occurrence of suppuration prevented.  If this fails, or if the condition is allowed to go untreated, the inflammatory reaction increases and terminates in suppuration, giving rise to one or other of the forms of whitlow to be described.

The Purulent Blister.—­In the most superficial variety, pus forms between the rete Malpighii and the stratum corneum of the skin, the latter being raised as a blister in which fluctuation can be detected (Fig. 9, a).  This is commonly met with in the palm of the hand of labouring men who have recently resumed work after a spell of idleness.  When the blister forms near the tip of the finger, the pus burrows under the nail—­which corresponds to the stratum corneum—­raising it from its bed.

There is some local heat and discoloration, and considerable pain and tenderness, but little or no constitutional disturbance.  Superficial lymphangitis may extend a short distance up the forearm.  By clipping away the raised epidermis, and if necessary the nail, the pus is allowed to escape, and healing speedily takes place.

Whitlow at the Nail Fold.—­This variety, which is met with among those who handle septic material, occurs in the sulcus between the nail and the skin, and is due to the introduction of infective matter at the root of the nail (Fig. 9, b).  A small focus of suppuration forms under the nail, with swelling and redness of the nail fold, causing intense pain and discomfort, interfering with sleep, and producing a constitutional reaction out of all proportion to the local lesion.