The right middle finger, normal phalanx, and the right index finger, the middle of the second phalanx, were contracted by deep furrows, with enlargement of the part beyond the constriction in the former instance. On section this presented exactly the appearances which I found in the specimens of "Ainhum" which I described last year. His hypothesis with regard to the method in which the strangulation or amputation is effected is also the same as that which I suggested. Dr. Menzel's case, however, as well as that recorded by Erichsen in his work on Surgery (Vol. II., page 298, sixtu edition) to which reference is made by the reporter, and which had escaped my notice in writing my paper last year, differs from those which occur in this part of India, in the fact that it was congenital; whereas the disease, as it exists here, commences after the individual has attained to, or even passed,

the right thumb, which

was

at the middle of the first

age. The disease would appear also to have been in his case, while in the cases occm-ring in the practice of Dr. Wise and myself, the disease, when it has once commenced, has advanced with varying degrees of rapidity, till the middle

stationary

patient comes to seek relief from the annoyance caused by the pendulous mass over which he has no control. " Ainhum" moreover, commencing in this^manner in adult life, has not yet been observed in the fingers. For these reasons I think that it must have a place in the Nomenclature provisionally distinct from that of Spontaneous Strangulation when this is congenital. Since the publication of my paper in August last I have had the opportunity of examining a fourth specimen of "Ainhum." This case occurred in the practice of AssistantSurgeon Udoy Chand Dutt, Civil Medical Officer, Noakhally, (a station in Eastern Bengal) who was kind enough to send me a history of the case as well as one of the diseased toes which he had removed. In this instance the toes affected were the fourth of the right and the fourth and fifth of the left

(In

foot.

the cases which I have

already recorded the disease was symmetrical in two of the three cases). The disease appears to have begun in the right and left fourth toes simultaneously, about three or four was

confined to the fifth toes, and

years later.

previously, It

and to have affected the other toe somewhat

had, however,

advanced most

rapidly

in the

right

fourth toe, in which spontaneous amputation had nearly been completed, so that it was capable of being removed by the touch of a scalpel. The extremities of the other affected toes

pendulous, the phalangeal bones naviug not yet undergone any appreciable change. The man who furnished the specimens was a Muhammadan cultivator, sixty years

had not become

of age.

Surgeon U. C. Dutt believes that the disease is in his district, and he recollects at least one case in which amputation had to be performed for a toe hanging only by a slender attachment to the foot; but before the publication of my paper he was not aware of the specific Assistant

not uncommon

character of the disease.

specimen which he sent me has been presented to the College Museum, but 1 made the following note of its pathological condition at the time of its receipt, the 9th of October 1873 :?" Distal phalanx normal in shape ; its cancellous tissue opened out, and filled with yellowish oily fat (commencing fatty degeneration) ; distal interphalangeal joint intact; distal end of second phalanx bony, the remainder of the bono converted into fibrous tissue; no bone at point of spontaneous amputation; fatty and fibrous tissues increased in quantity; skin not so much hypertrophied as in former cases." Considerable interest is attached to this curious morbid process, inasmuch as all the cases which have yet been recordI think it ed in India have been found in Eastern Bengal. right to draw the attention of the profession a second time t0 the existence of "Ainhum" in India, in order that furtber information with regard to is localization may be elicited. The

Medical

"AINHUM," OR SPONTANEOUS AMPUTATION OF THE TOES.

V

By

Alexander

Crombie, M.D.,

Materia Medico. and Clinical

Medicine, College, Calcutta. In the number of this Journal for August 1873, I gave a short account of three cases of "Ainhum," proving the existence of this disease in Eastern .bengal. My attention has again been called to this subject by the report of a paper on "Spontaneous Strangulation of the Fingers" by Menzel, in the London Medical Officiating Professor of

Medical

Record of the 4th of March 1874, Dr. Menzel's case was that of a woman aged forty-four, with marked congenital deformities of all the fingers and toes, except