IK-GROWING OF THE TOE-NAIL. 33y JOHX
SIIORTT, M.D., F.L.S., M.R.C.P.L.,
General Superintendent
of
Vaccination, Madras
Presidency.
?
This deformity?for I can call it nothing else?is generally brought about by the use of tight shoes, the toes being compressed together, and the pressure excited by the shoe causes the quick on either side to press against the nail of the great toe, and slightly overlap it, whilst the nail gets embedded in the flesh or soft parts on either side; and to this, when we add the pernicious habit that frequently prevails of cutting the nail close to its attachment, resorted to as a remedy, but which, on the contrary, only tends to aggravate the disease by permitting the soft parts the more completely to overlap the ends of the nail. The nail, now in its growth, enters the flesh, and produThose who have ces the pain and inflammation of the part.
suffered from this affection
can
understand the amount of agony
produces ; whilst the ends of the nail, acting as an irritant or foreign body, keep up a constant discharge of matter, followed by exuberant granulations, causing so much pain and annoyance to the patient that he is frequently obliged and discomfort it
to go about bare-footed to obtain relief. Probably, the bug-bear "fashion" has much to do with the production of this deformity, and there can be no mistake that,
instead of the shoe being made to fit the foot, the foot is squeezed into as small a shoe as it can enter, giving rise to much suffering and causing the in-growing of the nail, corns, bunions, &c. The treatment I have read of and seen practised hitherto, consists in the evulsion of the
nail, close-cutting of the nail, expedients have been resorted to, to remedy this defect. Jn the Lancet of Saturday, 18th April, 1866, ?so. 17, page 456, a case treated by Mr. Curling is reported, in which the whole of the bulbiform enlargement close up to the outer edge of the nail was cut out, leaving the in-growing nail exposed and overhanging the raw surface; and it is stated that Mr. Curling explained that when the surface healed, the cicatrix would contract and so make the nail overhang more and thus complete the cure. I have been in the habit of treating this deformity for many years successfully in a painless and bloodless manner, and it is my purpose to describe this in the present paper. Clipping the nail, as already stated, tends only to aggravate the disease ; evulsion of the nail again is but a temporary expedient, causing much pain and suffering to the patient; and cutting away of the bulb or projecting quick may possibly prove a more permanent remedy : but this is only realized by laying up the patient and putting him to pain in the process of operation. The manner in which I have been treating this disease or deformity, seems to have been very little known in practice. "When we examine the growth of the nails in the extremities, it and various other
will be found that in 99 out of 100 cases, the nail naturally takes on a more or less convex form, and the pressure exerted by a tight shoe favors the overlapping of the nail by the quick, and the penetration of the nail into the flesh, which is a fact that cannot be overlooked. I have never as yet met with a case in either a shoe-less or loose-slipper-wearing native. The remedy is both simple and Our object, in the first instance, should be to reverse the natural form of the nail by rendering its convex surf ice concave, and this is effected by shaving with a sharp penknife the centre of the nail to the breadth of a line from its root to its apex, and this part should be rendered so thin as
painless.
blood start through. When this has peilets of cotton-wool, well dusted with powdered burnt alum, should be gently inserted with the aid of and every four or five a probe under either end of the nail, days the shaving of the centre should be repeated, the cottcnalmost to make the been
done,
small
THE IXDIAN MEDICAL GAZETTE.
256
wool pellets renewed, and slightly enlarged on each, occasion. The result of this method of rendering the centre thin hy shaving and gently raising either extremities of the nail, readily renders the
convex
surface somewhat concave, and the ends of the
only raised, but thrown out over and out of the quick. At the same time, the use of the burnt alum represses discharge, destroys morbid granulations, and relieves pain ; and all that is subsequently necessary is that as the nail grows out and extends beyond the quick, to take care not to cut it short, but invariably to maintain its growth in line with the quick, and the cure is effected without further trouble in perhaps ten days or a fortnight. I have tested this plan in a large number of cases for the past fifteen years, with perfect success and satisfaction. Immediately after the operation the patients are relieved of pain, and go about with a loose pair of shoes. In the worst cases of corns, I never resort to any particular kind of treatment, beyond insisting on the use of a thoroughly loose pair of shoes or boots, having the " uppers" made of the softest leather procurable, and in the course of two or three months the corns vanish, in consequence of the pressure whic'n gave rise to the nail are not
disease having been removed.
"
[September 1,
1866.
SIIORTT, M.D., F.L.S., M.R.C.P.L.,
General Superintendent
of
Vaccination, Madras
Presidency.
?
This deformity?for I can call it nothing else?is generally brought about by the use of tight shoes, the toes being compressed together, and the pressure excited by the shoe causes the quick on either side to press against the nail of the great toe, and slightly overlap it, whilst the nail gets embedded in the flesh or soft parts on either side; and to this, when we add the pernicious habit that frequently prevails of cutting the nail close to its attachment, resorted to as a remedy, but which, on the contrary, only tends to aggravate the disease by permitting the soft parts the more completely to overlap the ends of the nail. The nail, now in its growth, enters the flesh, and produThose who have ces the pain and inflammation of the part.
suffered from this affection
can
understand the amount of agony
produces ; whilst the ends of the nail, acting as an irritant or foreign body, keep up a constant discharge of matter, followed by exuberant granulations, causing so much pain and annoyance to the patient that he is frequently obliged and discomfort it
to go about bare-footed to obtain relief. Probably, the bug-bear "fashion" has much to do with the production of this deformity, and there can be no mistake that,
instead of the shoe being made to fit the foot, the foot is squeezed into as small a shoe as it can enter, giving rise to much suffering and causing the in-growing of the nail, corns, bunions, &c. The treatment I have read of and seen practised hitherto, consists in the evulsion of the
nail, close-cutting of the nail, expedients have been resorted to, to remedy this defect. Jn the Lancet of Saturday, 18th April, 1866, ?so. 17, page 456, a case treated by Mr. Curling is reported, in which the whole of the bulbiform enlargement close up to the outer edge of the nail was cut out, leaving the in-growing nail exposed and overhanging the raw surface; and it is stated that Mr. Curling explained that when the surface healed, the cicatrix would contract and so make the nail overhang more and thus complete the cure. I have been in the habit of treating this deformity for many years successfully in a painless and bloodless manner, and it is my purpose to describe this in the present paper. Clipping the nail, as already stated, tends only to aggravate the disease ; evulsion of the nail again is but a temporary expedient, causing much pain and suffering to the patient; and cutting away of the bulb or projecting quick may possibly prove a more permanent remedy : but this is only realized by laying up the patient and putting him to pain in the process of operation. The manner in which I have been treating this disease or deformity, seems to have been very little known in practice. "When we examine the growth of the nails in the extremities, it and various other
will be found that in 99 out of 100 cases, the nail naturally takes on a more or less convex form, and the pressure exerted by a tight shoe favors the overlapping of the nail by the quick, and the penetration of the nail into the flesh, which is a fact that cannot be overlooked. I have never as yet met with a case in either a shoe-less or loose-slipper-wearing native. The remedy is both simple and Our object, in the first instance, should be to reverse the natural form of the nail by rendering its convex surf ice concave, and this is effected by shaving with a sharp penknife the centre of the nail to the breadth of a line from its root to its apex, and this part should be rendered so thin as
painless.
blood start through. When this has peilets of cotton-wool, well dusted with powdered burnt alum, should be gently inserted with the aid of and every four or five a probe under either end of the nail, days the shaving of the centre should be repeated, the cottcnalmost to make the been
done,
small
THE IXDIAN MEDICAL GAZETTE.
256
wool pellets renewed, and slightly enlarged on each, occasion. The result of this method of rendering the centre thin hy shaving and gently raising either extremities of the nail, readily renders the
convex
surface somewhat concave, and the ends of the
only raised, but thrown out over and out of the quick. At the same time, the use of the burnt alum represses discharge, destroys morbid granulations, and relieves pain ; and all that is subsequently necessary is that as the nail grows out and extends beyond the quick, to take care not to cut it short, but invariably to maintain its growth in line with the quick, and the cure is effected without further trouble in perhaps ten days or a fortnight. I have tested this plan in a large number of cases for the past fifteen years, with perfect success and satisfaction. Immediately after the operation the patients are relieved of pain, and go about with a loose pair of shoes. In the worst cases of corns, I never resort to any particular kind of treatment, beyond insisting on the use of a thoroughly loose pair of shoes or boots, having the " uppers" made of the softest leather procurable, and in the course of two or three months the corns vanish, in consequence of the pressure whic'n gave rise to the nail are not
disease having been removed.
"
[September 1,
1866.
