. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. lage, so thatthe function of the joint was destroyed. After furthertreatment with fomentations, the whole finger be-came swollen and the skin assumed a pale, glisteningappearance (glossy skin), indicating necrosis of thewhole basal phalanx. Under an anaesthetic an incision was made, andthe first and second phalanges were found to be somuch destroyed that they were removed. As already mentioned, punctured wounds of theterminal phalanx, beyond the insertion of the tendon,often lead to i
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. lage, so thatthe function of the joint was destroyed. After furthertreatment with fomentations, the whole finger be-came swollen and the skin assumed a pale, glisteningappearance (glossy skin), indicating necrosis of thewhole basal phalanx. Under an anaesthetic an incision was made, andthe first and second phalanges were found to be somuch destroyed that they were removed. As already mentioned, punctured wounds of theterminal phalanx, beyond the insertion of the tendon,often lead to infection of the periosteum. Commenc-ing in acute inflammation with pain and swelling,they often assume a more chronic condition. If anincision is not made in the acute stage there may beextensive destruction, even of the whole finger;especially after treatment with poultices. In theabove case an early incision would have saved thefinger and restored normal function. Glossy skin (Paget) is a condition which affectschiefly the phalanges of the fingers, after badly cov- 224: Bockenheimer, Atlas. Tab. Fig. 95. Ianaritium ossale et articulare. Rebman Company, New-York. ered amputation stumps, or after too-long immo-bilization. This condition may extend over the wholefinger. The skin is at first thickened, bluish red,and cold to the touch; later on it becomes pale yel-low and has an appearance like parchment. The cir-culation is bad and there are often neuralgic painsand a feeling of coldness. It may finally lead to trau-matic neurasthenia. This condition can be pre-vented by avoiding too long immobilization and byproviding the amputation stumps with sufficient well-nourished flaps. 225 PANARITIUM TENDINOSUM (Tendincms Whitlow)Plate LXXMI, Fig. 96. This is a case of subcutaneous whitlow, followinga punctured wound, which rapidly spread to thetendon-sheath of the thumb. A severe form ofinfection was indicated by the acute redness andswelling, severe pain, high temperature and
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