Hitting Nails

Eric Lis

Although we rarely think about them, adventurers probably injure their finger and toe nails constantly.

The nails of our fingers and does are extremely important. Nails probably first evolved as aids to sensation; our sense of touch is significantly more effective as a result of the hard backing reinforcing the otherwise soft and squishy bits with which we feel. From there, these early nail-like structures proved sufficiently useful that they developed into a variety of forms, ranging from our relatively delicate nails to the deadly talons and claws of the animal kingdom. Along the way, nails adapted to the different needs of various species. In our case, toe nails help us maintain balance while thin and flexible finger nails enhance our ability to manipulate small objects. In some animals, nails serve a more weapon-like function, optimized for either offense or defense, and in a great many animals they’re adapted for climbing one surface or another.

In the case of humans, our nails are many things, but not particularly durable, and this leaves us open to a number of different disorders and pathologies. Nail problems are extremely common in the modern world, even if they tend not to be the sorts of problems that bring people to the emergency department, and there’s one particular nail problem which is probably an even bigger problem for adventurers: the subungual hematoma.

Subungual hematoma results when a bruise (hematoma) forms under (sub) the nail (unguis). Because the nail is hard and unyielding, and the space between the nail and finger is very small, there’s limited space for the blood in the bruise to go, causing it to squish the surrounding tissues. Visually, the main part of the nail turns purple (the bruise, visible through the transparent nail) and the finger or toe often becomes a bit swollen-looking. Subungual hematomas can be extremely painful, but aren’t generally dangerous, although pools of blood can be a point where infection starts.

Broadly speaking, there are two kinds of subungual hematoma, both of which are likely quite common for adventurers. Acute hematoma results when the initial bruise is caused by one strong impact. In the modern world, this most commonly results from people slamming a finger in a door, but adventurers are probably more prone to develop them from the routine trauma of combat. More commonly, the hematoma results from repetitive mild injury, such as the constant lower-impact stress that runners place on their toes. Given that adventurers tend to do quite a lot of walking and running, at least in the levels before they all develop the ability to teleport or fly, and since they generally wear poorly made or ill-fitting boots, you would have to imagine that this is a constant issue for them. When repetitive trauma is the cause, the nail will turn purple or black in much the same way, but the condition is usually much less painful because less blood accumulates and there’s therefore less pressure on the tissues. Treatment of the hematoma is pretty straightforward; most require no treatment at all, but if there’s a great deal of pain, treatment is to relieve the pressure under the nail, either by drilling a small hole through the nail or else removing the nail entirely. With magical healing, subungual hematoma is, if anything, even simpler; any cure spell cast within five or ten minutes of the injury probably prevents the hematoma if it hasn’t formed yet, and while it seems like overkill, any disease-removing spell presumably clears it up instantly.

So, if that’s humans, how much of this holds true for non-human races in a fantasy setting? We can probably assume that elf nails are a lot like human ones, although one wonders if they might be adapted for climbing trees or something. It might be tempting to imagine that dwarf nails have adapted to handling big heavy rocks, and so perhaps are tougher or more durable, perhaps even incorporating metallic salts like calcium to take on a more tooth-like strength (even though this would probably make subungual hematoma even more painful for dwarves than for us). Many fantasy authors seem to assume that orcs have more claw-like nails than we do, but I wonder if they might instead have more gorilla-like nails, tougher but not necessarily sharper. Given how much nails can vary between species, establishing distinct nail characteristics between gnomes and halflings may be a rather clever way of helping to remind players that different species really are different. All humanoid races probably develop subungual hematomas in more or less the same way, but it wouldn’t be surprising if they were more painful or less painful for some than for others. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on July 3, 2016. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system