Wandering with Whitlow-wort: what do flowers and fingernails have in common?

by Carol Ann McCormick, Curatrix of the University of North Carolina at Chapel Hill Herbarium (NCU)

 

Several years ago Mark and I headed on a road trip as our summer vacation.  Our goal was a cabin near Land O’ Lakes, Wisconsin, and we’d planned to visit my college roommate in Chicago, but our route and stops along the way depended on the weather, our energy level,  and other road trip intangibles.

We got an early start on a hot Friday morning in July. As usual, I drove while Mark navigated using a combination of DeLorme Atlas & Gazetteers ¹, state maps of varying vintages obtained from rest area welcome centers, and my mobile phone.  By late morning we were in Wythe County in southern Virginia, and Mark navigated us to the trailhead for High Rocks in the Big Survey Wildlife Management Area.

In the interests of full disclosure / confession (and a reminder to myself to be better prepared for my next visit), access to Big Survey WMA is limited to those possessing a Virginia hunting license, a freshwater fishing license, a boat registration, or a Restore the Wild Membership.  We had none of those, but as it was a spur of the moment visit, a very hot weekday, and we’d seen no other vehicles on the road for  many miles, we decided to risk all and take to the trail.  We were also getting rather peckish, and the prospect of lunch with a breeze and a view from High Rocks was too tempting to let a possible parking ticket deter us.²

The hike to High Rocks is 2.9 miles total, in and out the same trail, and while it was not terribly steep or difficult, it was slow going for me on the 93° F day.^{3 , 4}   Once at the Rocks we did enjoy the breeze, the view, our lunch, and plenty of water.  We had the trail to ourselves on the way up and down.

As it is anathema to Mark to return exactly the way we came, he decided we could shorten our hike back by heading straight east from the Rocks — we would meet the trail as it curled around, further downslope.  As the forest understory was rather sparse, it seemed do-able and we wandered down the gentle slope.  Soon we were walking through large patches of a plant that I did not recognize at all — it was ankle- to mid-calf high, with rather sparse foliage and minute flowers.  I stopped twice to make iNaturalist observations, and as I had a plant press in the car, I collected a few plants for the University of North Carolina at Chapel Hill Herbarium (NCU Accession #675442).  My mystery plant turned out to be Paronychia canadensis (L.) Alph. Wood.  Common names for this plant include “Smooth Forked Nailwort” and “Canada Whitlow-wort”.^{5 ,6}  

I already knew that “wort” means “plant” in Old English, but I saw no resemblance to iron nails in this rather delicate wispy plant.⁷  And what in the world is “whitlow”… and for that matter, what is the meaning of the genus, “Paronychia“? The genus name is Greek — ” παρωνυχία from para, “around”, onyx, “nail” and the noun suffix -ia.”²¹ A quick search of the internet revealed that paronychia is also an affliction — inflammation around fingernails or toenails resulting from trauma, irritation or infection.

Understanding dawns — nailwort as in fingernail, not iron nail.  The plant’s genus refers to a disease of fingernails… it’s all coming together now.  I start to examine my fingernails… paranoid that paronychia may strike at any moment.

“Paronychia can develop when bacteria enter broken skin near the cuticle and nail fold, causing an infection. The cuticle is the skin at the base of the nail. The nail fold is where the skin and nail come together. Healthcare providers treat paronychia with antibiotics to kill the infection. Providers may also drain pus (thick, infectious fluid that builds up around a wound). They may also culture the fluid to see what specific bacteria might be causing the infection. Sometimes, the infection comes back or symptoms last for weeks (chronic paronychia). Chronic paronychia is more commonly caused by irritation from occupational or environmental exposures. Less often, it may be caused by a chronic bacterial or fungal infection. Anyone can get a bacterial nail infection, but it’s more common among people who:

• Are exposed to irritants: Detergents and other chemicals can irritate the skin and lead to a nail bed infection. People who work with chemicals and don’t wear protective gloves have a higher risk.
• Bite their nails or cuticles: Nail biting or picking at the cuticles can create tiny cracks in the nails or cuts in the skin. Bacteria may enter the skin through these small cuts.
• Have certain skin conditions: People who have underlying skin conditions may be more likely develop nail infections.
• Work with water: Bartenders, dishwashers and other people with jobs that require their hands to be wet have a higher risk of developing paronychia.”⁸

Local dermatologist Dr. Dean Morrell adds, “Acute paronychia is usually caused by Staphyllococcus bacteria.  In chronic paronychia, yeast (Candida) is usually the culprit.  Non-infectious causes such as trauma, ingrown nails and/or over aggressive home ‘procedures’/ manicures could cause paronychia.”⁹ Not only am I going to be more careful trimming my nails, I’m also going to have even more respect for restaurant workers.

Now, on to “whitlow” another a common name for this plant.  “Whitlow is a very painful and infectious viral disease of the thumb and fingertips.”¹⁰ A viral disease of the nails? Ewwww.  Now I’m really starting to get paranoid, but I read on and learn that whitlow comes in two types.  “Herpetic Whitlow” happens when Herpes simplex virus (type 1 or 2) enters a break in the skin around your nails.  The virus causes painful blisters — think of cold sores on your fingertips.  Owww.  Who gets herpetic whitlow? “Herpetic whitlow can affect anyone at any age, but the condition is most common in:

• Children who suck their thumbs.
• Healthcare workers, like dental hygienists and respiratory therapists with exposure to peoples’ mouths (oral mucosa).
• People exposed to genital herpes.
• Athletes, like wrestlers, who have close contact with others.
• People with a weakened immune system.

Infection is uncommon. An estimated 2 people per 100,000 receive a herpetic whitlow diagnosis in the United States.”¹¹  Just as cold sores have no cure, “there isn’t a cure for herpetic whitlow. Treatment simply helps relieve signs and symptoms and makes them go away faster.”¹¹

But what about the second type of whitlow, “Melanotic Whitlow”? Having progressed from treatable bacterial/fungal disease (paronychia) to just-wait-until-it-gets-better viral disease (herpetic whitlow), what could be worse?  Yep, cancer of the nail. “Melanotic whitlow [is] a malignant disease of the nail-bed marked by the formation of nodules of neoplastic tissue about the border and beneath the nails. The growth is characterized by the formation of melanin and a tendency to spread by way of the lymphatics…. The condition is rare, though obviously not so rare as the literature would indicate,” according to Arthur Hertzler, M.D. in his 1922 paper.¹² Apparently, now, nearly 100 years later the medical profession calls melanotic whitlow “subungual melanoma, or nail melanoma”, and is, as its name suggests, a skin cancer under your nail.What does it look like? “Subungual melanoma usually has a distinct shape. Some may describe it as looking like you drew a line on your nail with a black or brown marker. It appears as a dark line on your nail and runs from bottom to top. This streak or stripe may start small but grow to cover the entire nail and extend to the cuticle (skin part of your nail)… Anyone can get subungual melanoma. However, you may be at a higher risk of developing melanoma under your nail if you’re between 50 and 70 years old and darker-skinned. It’s more common in people of African-American, Asian or Hispanic descent. Subungual melanomas are rare and account for 0.7% to 3.5% of all melanomas worldwide.”¹³

The question in my mind still lingers — why is this plant so closely associated with diseases of the fingers?  The Doctrine of Signatures was a theory that if a plant resembled part

of the human body, that was God’s “signature” on the plant that it could be used to treat diseases of that part of the human body.¹⁴  The three lobed leaf of Hepatica resembles the human liver, so according to the Doctrine of Signatures the plant could be used to treat liver diseases. Gray’s Manual of Botany, my go-to for plant name origins, says that the genus name alludes to “plants with whitish scaly parts, once supposed to cure [paronychia].”²⁶ I suppose the whitish scaly parts resemble fingernails? Is there a European or Asian Paronychia that resembles human fingernails, so it was used to treat paronychia and whitlow? Paronychia macedonica ssp. macedonica certainly has scaly white parts; if you have a very vivid imagination, the sepals could look like fingernails.  You would certainly break a few fingernails as you wandered to find it, as it grows on rock cliffs.²⁵

A perusal of the internet gave me no definitive answers as to a particular Paronychia used to treat paronychia, though I did find an interesting paper by Soleymani et al. describing how Bahā’ al-Dawlah Nūrbakhshī Razi in 1501 accurately described herpetic whitlow.¹  Alas there is no mention of Paronychia in Anne Van Arsdall’s book, “Medieval herbal remedies: the old English Herbarium and early-medieval medicine,” conveniently available on-line through the University of North Carolina at Chapel Hill library.¹⁶  I walked across campus to Davis Library to see if I could find any reference to Paronychia to treat paronychia or whitlow in herbals.  Very soon I realized that my lack of knowledge of Greek, Latin, and Arabic would be an insurmountable impediment to fully appreciating anything from these herbals other than the illustrations.  I spent a few happy hours perusing A Medieval Herbal: A facsimile of the British Library Egerton MS 747, and even found an illustration of one of my ancestors collecting plants. ¹⁷

I hold that many times in life, it’s not What you Know, it’s Whom you Know.  I turned to Dr. Michael McVaugh, professor emeritus of University of North Carolina at Chapel Hill History Department “whose research focuses on the growth of medical and surgical learning in the Middle Ages, particularly as shaped by the 13th- and 14th-century universities… Most recently he has been engaged in a series of studies investigating aspects of the process of translation of medical literature in the Middle Ages:  translations between Arabic and Latin, between Hebrew and Latin, and between Latin and European vernaculars.”¹⁸  Just the person I need to help me! “I’ve found Francis Adams’ translation of Paulus Aegineta  7-book surgery available on-line from the HathiTrust, and of what Paulus (ca 625 – ca 690) has to say about whitlow,” Dr. McVaugh wrote.

SECT. LXXXI. — ON COMPLAINTS ABOUT THE NAILS; AND, FIRST, OF WHITLOW.
Whitlow is an abscess forming about the root of the nail. When, therefore, the whitlow is small and but commencing, galls with honey repress it, and prevent the formation of an abscess;  or the trochisk of Musa [banana], or the Here [?], in water. When a preternatural growth of flesh has taken place, the object is to consume and break it with things that are not of a corrosive nature… When it suppurates, having opened it and evacuated the fluid, soak a sponge in water, and apply; or apply a cataplasm of lentils pounded with water; or palm-plaster with wine; or green or dried roses macerated in water, and pounded; or dried barley-flour with water. The flour of lupines mixed with honey, or wine and honey is good for whitlow.²⁰

Paulus’ commentary and recipes for treating whitlow, bruised nails, diseased nails, and leprous nails goes on for several pages, as does Francis Adams’ commentary citing other ancient physicians such as Oribasius (ca. 320-403), Ibn Sina (Avicenna; ca. 980- 22 June 1037), and Abū al-Qāsim Khalaf ibn al-‘Abbās al-Zahrāwī al-Ansari (Alsaharavius; ca. 936 – 1013).^22,23,24  Alas, I see no mention of a plant resembling Paronychia in Paulus’ commentary on complaints about the nails — but I will keep up the search.  Or rather, I will rely on the Kindness of Strangers, as Dr. McVaugh has posted my inquiry on a medieval medicine listserv.

Our roadtrip to Wisconsin was greatly enjoyable, and our discovery of Paronychia canadensis on the first hike of that trip set the tone for our wanderings.  We hiked and botanized in the Red River Gorge in Kentucky, the Chiwaukee Prairie in Wisconsin, Wilderness State Park in Michigan, New River Gorge National Park in West Virginia, and Stone Mountain State Park in North Carolina before returning to Alamance County. If your travels take you to Vilas County, Wisconsin, I can heartily recommend the Enchanted Loon Inn on Moccasin Lake, SW of the town of Land O’ Lakes.  After taking a spin around Moccasin Lake in the canoe or kayak provided gratis, sit on the dock, enjoy the loons calling, and read The Year of Wonders by Geraldine Brooks.  Though it is Plague, not Paronychia, which shapes the narrative of this historical fiction, it will put you in the mood to wander through some medieval herbals.  Happy Trails to you!

 

SOURCES:

1.  DeLorme Atlas & Gazetteers “the Outdoor Enthusiasts’ Choice” enthuses a purveyor of the digital version of the Gazetteer.  Mark uses the paper versions.  We have a well-worn copy for North Carolina ; we borrowed from Dr. Robert Peet Gazetteers for several states for our trip.
2. I promise to fork over the$25 for a Restore the Wild Membership before I visit again this fall. I figure a wonderful hike with a new plant is worth the money.
3. https://gohikevirginia.com/high-rocks-wytheville/
4. https://www.wunderground.com/history/daily/us/va/wytheville/KROA/date/2021-7-30
5. “Paronychia canadensis” entry in:  LeGrand, H., B. Sorrie, and T. Howard. 2024. Vascular Plants of North Carolina [Internet]. Raleigh (NC): North Carolina Biodiversity Project and North Carolina State Parks. Available from https://auth1.dpr.ncparks.gov/flora/index.php.
6. “Paronychia canadensis” entry in: Weakley, A.S., and Southeastern Flora Team. 2024. Flora of the southeastern United States Web App. University of North Carolina Herbarium, North Carolina Botanical Garden, Chapel Hill, U.S.A. fsus.ncbg.unc.edu Accessed Aug 28, 2024.
7. “Wort” entry in: https://www.etymonline.com/word/wort
8. https://my.clevelandclinic.org/health/diseases/15327-nail-infection-paronychia#:~:text=Paronychia%20is%20nail%20inflammation%20that,the%20base%20of%20the%20nail.
9. Personal communication, Dr. Dean S. Morrell to McCormick, email dated 20 March, 2024.
10. https://www.physio-pedia.com/Whitlow
11. https://my.clevelandclinic.org/health/diseases/24681-herpetic-whitlow
12. Hertzler, A. E. Melanoblastoma of the nail-bed (Melanotic Whitlow). Arch Derm Syphilol. 1922;6(6):701–708. doi:10.1001/archderm.1922.02360060046004\
13. https://my.clevelandclinic.org/health/diseases/subungual-melanoma
14. Wikipedia contributors, “Doctrine of signatures,” Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/w/index.php?title=Doctrine_of_signatures&oldid=1239855009 (accessed August 28, 2024).
15. Soleymani, Samaneh, Narges Tajik, Mehrdad Karimi, and Arman Zargaran. 2020. The early report of herpetic whitlow by Baha’ al-Dawlah Razi in 15th Century CE.  Le Infezioni in Medicina, 3: 450-452.  https://www.infezmed.it/media/journal/Vol_28_3_2020_21.pdf
16. Van Arsdall, Anne. Medieval herbal remedies: the old English Herbarium and early-medieval medicine.  Milton Park, Abingdon, Oxon: New York, NY: Routledge, 2023, 2nd ed.
17. A Medieval Herbal: A facsimile of British Library Egerton MS 747. Introduction by Minta Collins, List of Plants by Sandra Raphael. The British Library. 2003.
18.  “Michael McVaugh” UNC College of Arts and Sciences: History: People.  https://history.unc.edu/emeritus/michael-mcvaugh/
19.  Personal communication, McVaugh to McCormick, email of 28 August 2023.
20.   Paulus, Aegineta, and Frances Adams. The Seven Books of Paulus Ægineta. London: Printed for the Sydenham Society, 184447. https://babel.hathitrust.org/cgi/pt?id=uc1.b3419706&seq=711
21. Wikipedia contributors, “Paronychia,” Wikipedia, The Free Encyclopedia,https://en.wikipedia.org/w/index.php?title=Paronychia&oldid=1242790514 (accessed August 28, 2024).
22. Wikipedia contributors, “Al-Zahrawi,” Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/w/index.php?title=Al-Zahrawi&oldid=1240544526 (accessed August 28, 2024)
23. Wikipedia contributors, “Avicenna,” Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/w/index.php?title=Avicenna&oldid=1242326984 (accessed August 28, 2024).
24. Wikipedia contributors, “Oribasius,” Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/w/index.php?title=Oribasius&oldid=1168749393 (accessed August 28, 2024).
25. https://osogovonature.com/2022/01/29/paronychia-macedonica-chaudhri-subsp-macedonica/
26. Fernald, Merritt Lyndon. 1950. Gray’s Manual of Botany, 18th ed. Van Nostrand Reinhold Company, New York.