1^ Vl?"' IMAGE EVALUATION TEST TARGET (MT-3) 1.0 [fri- i^ I.I I/- 11^ U 116 11.25 V3 / f / ew Photographic Sciences Corporation ss "4 !\ <> 6^ as WIST MAIN STRUT WIISTIR.N.Y. MSM (716) •73.4503 '^ CIHM/ICMH Microfiche Series. CIHM/ICIVIH Collection de microfiches. Canadian Institute for Historical Microraproductions / Institut Canadian de microraproductlons historiquas Technical and Bibliographic Notes/Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. D D D D D D D Coloured covers/ Couverture de couleur I I Covers damaged/ Couverture endommagie Covers restored and/or laminated/ Couverture restaurie et/ou pelliculie I I Cover title missing/ Le titre de couverture manque I I Coloured maps/ n Cartes giographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur Bound with other material/ ReliA avec d'autres documents Tight binding may cause shadows or distortion along interior margin/ La re liure serrde peut causer de I'ombre ou de la distortion le long de la marge intArieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajoutAes lors d'une restauration apparaissent dans le toxte. mais, lorsque cela Atait possible, cas pages n'ont pas it^ filmies. Additional comments:/ Commentaires 8uppl6mentaires; L'Institut a microfilm^ le meilleur exemplaire qu'il lui a 6t6 possible de se procurer. Les details de cet exemplaire qui sont peut-Atre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la mAthode normale de filmage sont indiquAs ci-dessous. I I Coloured pages/ D Pages de couleur Pages damaged/ Pages endommagies Pages restored and/oi Pages restaur^es et/ou pellicul6es Pages discoloured, stained or foxet Pages dicoiordes, tachet^es ou piquAes Pages detached/ Pages d^tachdes Showthrough/ Transparence Quality of prir Qualiti intgale de {'impression includes supplementary materii Comprend du materiel supplimentaire Only edition available/ Seule Mition disponible r~y| Pages damaged/ I I Pages restored and/or laminated/ I I Pages discoloured, stained or foxed/ I I Pages detached/ I I Showthrough/ I I Quality of print varies/ I I includes supplementary material/ r~~| Only edition available/ Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partieliement obscurcies par un feuillet d'errata, une pelure, etc., ont Hi filmies 6 nouveau de fapon A obtenir la meillcure image possible. This item is filmed at the reduction ratio checked below/ Ce document est filmi au taux de reduction indiquA ci-dessous. 10X 14X 18X 22X 26X 30X y 12X 16X 20X 24X 28X 32X Th« copy film«d her* has b««n reproduced thanks to the generosity of: Medical Library McGill University IMontreal The images appeering here are the best quality possible considering the condition and legibility of the original copy and in Iceeping with the filming contract specificationa. L'exemplaire film* fut reproduit grftce A la ginArosit* de: Medical Library McGill University Montreal Lee imeges suivantes ont 4t4 reproduites avec le plus grand soin, compte tenu de la condition at de la netteti de l'exemplaire filmi. et en eonformiti avec les conditions du contrat de filmage. Original copies in printed paper covers are filmed beginning with the front cover and ending on the lest page with a printed or illustrated Impres- sion, or the beck cover when appropriate. All other original copiee are filmed beginning on the first page with a printed or illustrated impres- sion, and ending on the laat page with e printed or illustrated impression. Lee exempleires origineux dont la couverture en papier eat imprim4e sont fllmAs en commenpant par le premier plet et en terminant soit par la derniire page qui comporte une empreinte d'impreeaion ou d'illuatration. soit par le second plat, salon le cas. Tous les autres exempleires origineux sont filmis en commenpent per la premiere page qui comporte une empreinte d'impression ou d'illustration et en terminant per la derniAre page qui comporte une telle empreinte. The lest recorded frame on each microfiche shall contain the symbol — ^ (meenihg "CON- TINUED"), or the symbol y (meening "END"), whichever applies. Un dee symboles suhrants apparaltra sur la demlAre image de cheque microfiche, selon le cas: le symbols -^> signifie "A SUIVRE". le symbols ▼ signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one expoeure are filmed beginning in the upper left hand corner, left to right and top to bottom, aa many frames ae required. The following diagrama illustrate the method: Lea cartee, planches, tableaux, etc., peuvent Atre filmAa i dea taux de rMuction diffArents. Lorsque le document est trop grand pour Atre reproduit en un seul clichA, il est filmA A partir de I'angle supArieur gauche, de gauche A droite, et de haut en baa, en prenant le nombre d'Images nAcessaire. Les diagrammes suivants illustrent la mAthode. 1 2 3 1 2 3 4 5 6 A . ■<,<>, c H.T.^. Extracted froih the American Journal of the Medical Sciences for January, 1887. A SHORT ACCOUNT OF THE DISEASE CALLED "AINHUM," WITH THE REPORT OF A CASE.' By Fkancis J. Shepherd, M.D., PROFESSOR OF ANATOMY IN MCQILL UNIVERSITY ; SUROEON TO THE MONTREAL OENERAL HOSPITAL It was my fortuue, in the month of May last, to meet with a case of the rare disease called ainhum'^ at the Montreal General Hospital. So far as I know, it is the first case of the kind that has been met with in Canada. I am indebted to my house surgeon. Dr. H. S. Birkett, for the report of the case and the preparation of the specimen illustrating it. Case. — John B. S., set. forty-seven, colored, native of North Caro- lina, and by occupation a teamster, was admitted into the Montreal General Hospital from Cornwall, Ontario, May 12, 1886, suffering from a painful toe which he wished to have removed. HUtonj. Six years ago he noticed a small pimple on the outer side of the right I'ttle toe in the digito-plantar fold. He did not suffer any inconvenience or pain from the affection till four and a half years ago, when he noticed a constriction on pressure appearing in the digito-plantar fold. The foot was then slightly swollen and the toe was somewhat enlarged. With rest and poulticing the sore healed up and the pain and swelling of the foot disappeared, but the constriction remained and the toe continued enlarged. Four weeks ago the sore broke out again and the toe became very painful. The furrow, which had been increas- ing gradually, now rapidly deepened and the portion of toe beyond became much swollen and pained him greatly when he walked. Patient has always been healthy and lived in North Carolina till twenty years ago. No member of his family, to the best of his knowledge, ever had a similar affection of the toes. ( 'omiition on entrance. Patient, a strong, healthy, full-blooded negro, complains of inability to walk nuich on account of the severe pain in the little toe of tlie right foot. Uj)on examination this toe is found to be very much constricted at the digito-plantar fold, the constriction almost completely encircling the toe — In fact, it looks as if a string had '/ ' Ilt'nd before the ('iiiiailii Mia - Tliln is till- ui'itm iii M»ii, giivbtiv, AiiKUBt, 1886. ■WtUi^Mp-BlltH^liiiiT^^^HWiit "to »reDK:AL FACriTY Mc'OTlA. ^ been tied tightly round it. The portion of toe beyond the furrow con- sists of a soft ovoid mass, and is much larger than the normal toe. Nail quite healthy. The toe is very mobile and movement causes excessive pain. On the plantar aspect of the constriction is a small granulating sore which, on probing, is very sensitive. Foot not swollen. No other toe of either foot affected. Left little toe carefully examined and found perfectly normal. On the 14th of May the toe was amputated at the raetatarso-phalangeal joint, and the wound, under dry dressing and iodoform, rapidly healed. On dissection the amputated toe appeared to consist of much thickened skin and fibrous tissue. Adipose tissue normal. The bones presented a remarkable condition. The proximal phalanx was much atrophied and ended in a fine point, the whole bone looking something like a claw ; the joint between it and the middle phalanx had disappeared ; the middle phalanx was much reduced in size and eroded at its proximal end ; no distinct articulation could be made out between it and the ungual phalanx. This latter phalanx, though of proper length, was exces- sively thin and light. Showing the lino of constriction and the condition of the three p)ialant;ea. The metatarso-phalangeal joint was perfectly healthy, though the end of the phalanx entering into the joint was somewhat lessened in size and misshapen, but the articular surface was of full size. The disease called " ainhum " is one of great rarity ; it is peculiar to the dark races, not only to negroes, as was formerly supposed, for it occurs also in India among the native Hindoos. A very interesting report of four cases, by Dr. D. G. Crawford, of the Indian Medical Service, has lately appeared.' Dr. Crawford found that the disease was met with in about one out of every 2500 surgical cases treated at his Dispensary at Calcutta. In one of his cases the great toe was affected, in one the fourth toe, and in two the fifth toe. In no case was there any Edinltiirgh Mvdii'al Journal, Juyi', 1880, ar 1 apjiearance of syniinetry. The disease at one time was thought to attack the little toe only, but later observers have seen it in the fingers and even in the legs. It is said to occ\ir in intrauterine life, and to be the most frequent cause of congenital amputation.' Only very few cases have thus far been reported in North America ; in South America, however, it is comparatively common in the African negroes, but rarer in those born in Brazil. It is said to be a common affection on the West coast of Africa.'' The disease was first clearly described by Dr. J. F. da Silva Lima, of Bahia, Brazil, in 1867.^ In the cases described by him the affection was confined to the little toes of adults, but lately others have described it as occasionally being seen in children, and also, as mentioned above, affecting other toes, fingei-s, and even limbs. Dr. Silva Lima found the disease to be more common in men than women ; it is also said to be more prevalent in certain families, showing its hereditary, and, hence, constitutional nature. Tl»e only cases reported in North America are those by Drs. Hornaday and Pittman. In Dr. Hornaday's report of his case,* he refers to one previously reported by Dr. N. J. Pittman, in 1880, to the North Carolina ]Medical Society. It was the first case Dr. Pittman had met with in a practice extending over forty-two years. - Dr. Hornaday's case occurred in a negress aged ten. It is curious that the man whose case is narrated above is a native of North Carolina. As a rule, the affection commences as a furrow on the line of the digito-plantar fold of the little toe ; this furrow gradually deepens, and the end of the toe enlarges to double or treble its normal size, having a spherical shape. Generally there is no pain, inflammation, or ulcera- tion ; but when there is ulceration in the furrow, as in my case, the pain is excessive." As the furrow goes on deepening, it encircles the toe till the end is held by only a small pedicle. The toe does not lose its sen- sation, but from its great mobility it is subject to injury and painful knocks, and the patient in consequence applies for relief The toe is generally removed at the point of strangulation by knife or ligature. If lefl alone, it falls off itself. The wound always heals rapidly. It is asserted that the disease can be arrested in the early stages by free lon- gitudinal incisions cutting through the constricting fibres. The course of the disease is very slow, lasting some eight to ten years. According to Silva Lima, the disease is usually Jisymmetrical, the affec- tion in one toe being much further advanced than in the other. The 1 V. Stcdnian in Huck's Ucfcrcnco Iliinilliook, vol. i. p. III. " Dr. Koir Lt-xliu, wlio Iiuh lutely retiiriii'il lri)iii Uii- ('unii(u, whero he gp»iit twu years, telU me that ho noviT niPt with a oa«u wliilst tliero. ■' Onzcta Medira (il Ualiia, Aniu) I., No. 1:1, p. 146, qiiuted hy H. Woljer, Path. 800. Trans., It