SURGERY.
On li Ingrowing” of the Toe-Nail. By H. J. M’Dotjgal, Esq.—
[Mr. M’Dougal relates the following case : a gentleman was brought to
him with an affection of the great toe which rendered him quite unable
to walk, from the pain which pressure of the foot upon the ground occa-
sioned. Mr. M’D. says:]
On examination, the toe was found slightly swollen, and with a red-
dish, erythematous blush extending up the foot. There was a very
little fungoid granulation by the side of the nail, touching which was by
no means so painful as pressure either on the under part of the toe, or
on the upper and inner surface of the nail. The edge of the nail was
quite invisible.
I directly proposed the usual operation of division of the nail in the
centre, and eversion of the affected side. This had been proposed by
two surgeons, whom the patient had previously visited, and was deci-
dedly objected to. Being left to my own resources, therefore, I pro-
ceeded to scrape away, with an angle of glass, the inner surface of the
nail (holding aside the flesh with the left hand) until its structure had
become so thin that, with a pair of scissors, I was easily enabled to
divide it for a short distance, and with forceps to lift out the piece in
the corner. This gave little or no relief, and I was induced to seek
further for the cause of the pain and distress felt on touching the toe.
A horny-looking surface filled the space from which the piece of nail
had been removed ; and, on scraping round this with the point of the
scissors, I succeeded in turning out a hardened mass of collected epithe-
lium scales, nearly as large as the seed of a sweet pea. The surface
underneath was red, and secreted a sanious matter. Perfect relief en-
sued on the removal of this extraneous matter, and the patient congratu-
lated himself on his own obstinacy in not consenting to the very painful
operation of losing half his nail. A morsel of dry lint completed his
cure in twenty-four hours, and a little occasional attention to the part
has since saved him from further suffering.
I am not aware that the condition I have described above has been
noticed by any surgical Writer in our language, with the exception of
Mr. Colles, of Dublin, who refers to it as only occurring on
one side of the nail. I can quite conceive, however, that with
a little attention many persons might be saved the exquisitely
painful and barbarous operation now so often used, of tearing
asunder the inflamed matrix, confessedly one of the most tender
parts in the whole structure of man.—Med. Times, March \Qth, 1850,
p. 195.