406 SANITARY CONDITIONS 



firmness. Occasionally the extra digit is so closely joined, that it is contained 

 in the same common envelope of skin. It can be amputated at any time, but 

 it is best to remove it shortly after birth. If the hand or foot are completely 

 formed, as in the case of the right hand and foot in the illustration, an 

 operation is unnecessary. 



AINHUM OR RING-TOE. 



This disease usually appears first as a small groove on the inner and 

 plantar surface of the base of the little toe and gradually deepens and extends 

 around the whole circumference until the toe is separated from the rest of the 

 foot. In the meantime the distal portion of the toe is apt to swell up to con- 

 siderable size. (Plate LXXVIII, Fig. 1.) This may occur on one foot or on 

 both feet simultaneously. The fifth or little toe is most frequently affected, 

 next in order the fourth, very rarely the third, second or great toes. But cases 

 have been reported where all the toes have been involved and the disease has 

 extended to the leg. Usually this condition is without especial pain, though 

 in one or two cases a considerable amount of shooting pain was complained 

 of, extending up to the foot; especially when the toe was bruised or struck 

 against anything. 



We found the natives very anxious to part with the members thus dis- 

 eased, and, in fact, occasionally brought about a more rapid amputation 

 by the use of string. Almost invariably, under ordinary precautions, the 

 stump heals up without any bad results. The general condition of health does 

 not seem to be a determining factor in this peculiar disease. 



Ainhum is most common in males and rare in women and children. We 

 saw a number of cases of this interesting disease while in the Bahamas, and 

 found it chiefly confined to pure blacks, although, occasionally, occurring in 

 mulattoes. 



Nothing is known concerning the etiology of this disease. By some it is 

 considered a trophic nervous affection, or a form of sclerodermia, while 

 others recently have suggested a relationship with anesthetic leprosy. Pos- 

 sibly irritation and wounds from going barefoot may be a factor. An 

 interesting case of ring-toe in a colored boy of seven who had also developed 

 tubercular leprosy on his left cheek was brought to our attention. (Plate 

 LXX, Fig. 2.) 



We amputated a number of ring-toes and brought them back with us for 

 study, with a view of staining, especially for lepra bacilli. Sections of these 

 toes showed considerable development of the fatty parts, especially of the sub- 



