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The neglect of this subject by the general surgeon probably arises from the fact that few of these cases are referred to him, and, like other people, surgeons prefer to talk, teach, or write about that which comes most often under their special care. In our schools the teaching of the surgery of the hand con- sists in telling the student how to perform amputa- tions, or reduce fractures or dislocations, while the topic of how to deal with motrin gel caps hand infections, which, by the way, are more frequent than all three former conditions put together, is hurriedly passed over, or, if dealt with at all, is wrongly taught. If you doubt it, just ask yourself motrin 500 mg if you were not taught that through and through drainage was the best way to deal with palmar phelgmon? A knowledge of the gross anatomy of the hand is a sine qua non to the intelligently successful treat- ment of any infection in finger, hand or forearm, and I would motrin b like to call attention to it briefly whats in motrin by means of the diagrams herewith shown. The most common site for the entry of infection is the distal phalanx, and Fig. 1 shows a diagram sketched from a section through any distal phalanx 666 COrUIIU.X: SURGICAL TREATMllXT OF HAND INFECTIONS. close to the proximal end of the nail. In the centre note the bone covered tightly evei"T\vhere (except under the nail motrin discontinued and over its articular surface), with periosteum. Under the nail, filling motrin products up the interval between it and the bone and strongly adherent to both, is a fibrous layer — the matrix of the nail. Fic. 1. — Diagram of cross section through distal phalan.\; a, fold of nail; b, nail; c, matrix of motrin 18 nail; d, bone covered with periosteum; e, fibrous trabeculae of pulp reaching from periosteum to skin. This layer has very slight resistance to infection and, once infected, there is no room for the inflam- matory exudate motrin commercial to be thrown out. Even very slight inflammatory reaction produces such pressure be- tween bone and nail that the blood supply at the point is cut motrin gel off or diminished and spread of the infection ensues. This is why infections of the matrix of the nail are so slow in getting well. I remember a strong, healthy young man, whose thumb nail, partly undermined with pus, had been treated for a motrin eq period 800 milligram motrin of nine weeks, and then, as he expressed it, motrin 100 mg "was worse than ever." He had been accused of syphilis but his Wassermann reaction was negative, and motrin pm coupon his thumb got well without any antiluetic treatment in about eight or ten days when he was treated surgically. The quickest and best way to deal with an infected matrix is to remove that portion of the nail overlying the infected area —wide removal so that there will be no overhang- ing edges — and apply a moist, mild antiseptic or normal saline dressing. Keep the part at rest and change the dressings often. Never allow a dress- ing motrin 500 to become dry before healing begins, and there- after it is better to use an ointment. In Fig. 1 notice how the soft parts roll up over the sides of the nail ; Fig. 2 shows a longitudinal section through the same phalanx. In this figure note the fold of soft parts — skin and subcutaneous tissue carried forward over the back of the nail. This fold over the back and along the sides of the nail is perhaps the most commonly infected part of the finger, this tissue being much exposed to injury. The bacteria get into the injured tissue and suppuration on the deep a.spect of the fold ensues, for here they find moisture, warmth and darkness, while extra strength motrin injured tissue makes for them a good culture medium. It is but a short distance around the root or side of the nail to the matrix, and if this becomes infected the overlying part of the nail must come off. For the ordinary slight infections hardly more cvs motrin than a splint and alcohol pack are needed. If, how- ever, the condition does not yield to such measures the fold should be cut through at once. It is worth doing under anesthesia. It can be properly done only when the patient feels no pain. Cut through the fold backward from its motrin 1000mg free edge on each side until the incision reaches back as far as the root of motrin ad the nail extends. That is nearly half way from the edge of the fold to the joint. One must be careful not to open the joint. Fig. 3. The fold thus incised motrin printable coupon can now be turned back as a flap. The underlying nail root is examined to make sure that the matrix under it is not infected. Pus under the nail looks yellowish white. If there is pus under it remove the nail widely ; then lay a thin bit of rubber

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