Page:Tropical Diseases.djvu/978

920 Symptoms.—The disease commences as a narrow groove in the skin almost invariably on the inner and plantar side of the root of the little toe. It may occur in one foot only, or in both feet simultaneously, or it may affect one foot after the other. The groove, once started, deepens and extends gradually round the whole circumference of the toe. As it deepens—it may be, though not necessarily, with some amount of ulceration—the distal portion of the member is apt to swell to a considerable size, as if constricted by a ligature. (Fig. 224.) There is little or no pain, although there may be inconvenience from the liability to injury to which the dangling and now everted toe is exposed. In the course of years the groove slowly deepens, and finally the toe drops off or is amputated. The groove may either correspond with a joint or it may be formed over the continuity of a phalanx. In rare instances, after the two distal phalanges have dropped off or been amputated, the disease recurs in the stump, and the proximal phalanx in its turn is thrown off. Of the other toes, the fourth is the one which is most frequently affected; very rarely is the third, or second, or great toe attacked. In the Army Medical Museum at Washington, U.S.A., there is a wax model representing a case of this or a similar affection, in which all the toes had been thrown off and the disease was making progress in the leg.

Ainhum is very rare in women or children, being most common in adult males. It runs its course in from one to ten or even more years.

On section it is found, as a rule, though not invariably, that the panniculus adiposus of the affected toe is much hypertrophied, that the bone is infiltrated