and occiput. In the right
pectoral and posterior aspect of the right axillary region, and over
the buttocks, the affected skin hung in heavy pendulous flaps. His left
arm was free from disease. His head grew so heavy that at length he had
great difficulty in holding it up. He slept in a sitting or crouching
position, with his hands clasped over his legs, and his head on his
knees. If he lay down flat, the heavy head showed a tendency to fall
back and produce a sense of suffocation. For a long time he was an
inmate of the London Hospital, where special quarters were provided for
him, and it was there that he was found dead, April 11, 1890; while in
bed his ponderous head had fallen backward and dislocated his neck.

Ainhum may be defined as a pathologic process, the ultimate result of
which is a spontaneous amputation of the little toe. It is confined
almost exclusively to negroes, chiefly males, and of African descent.
In Brazil it is called "ainham" or "quigila." "Ainham" literally means
to saw, and is doubtless a colloquial name derived from a supposed
slow, sawing process. The Hindoo name for it is "sukha pakla," meaning
dry suppuration.

In 1866 da Silva Lima of Bahia, at the Misericordia Hospital, gave the
first reports of this curious disease, and for quite a period it was
supposed to be confined to Brazilian territory. Since then, however,
it has been reported from nearly every quarter of the globe. Relative
to its geographic distribution, Pyle states that da Silva Lima and
Seixas of Bahia have reported numerous cases in Brazil, as have
Figueredo, Pereira, Pirovano, Alpin, and Guimares. Toppin reports it in
Pernambuco. Mr. Milton reports a case from Cairo, and Dr. Creswell at
Suez, both in slaves. E. A. G. Doyle reports several cases at the
Fernando Hospital, Trinidad. Digby reports its prevalence on the west
coast of Africa, particularly among a race of negroes called Krumens.
Messum reports it in the South African Republic, and speaks of its
prevalence among the Kaffirs. Eyles reports it on the Gold Coast. It
has also been seen in Algiers and Madagascar. Through the able efforts
of Her Majesty's surgeons in India the presence of ainhum has been
shown in India, and considerable investigation made as to its etiology,
pathologic histology, etc. Wise at Dacca, Smyth and Crombie at
Calcutta, Henderson at Bombay, and Warden, Sen, Crawford, and Cooper in
other portions of Southern India have all rendered assistanc