nt that is most likely fallacious.
However, there are well-authenticated cases in infants, and again in
persons over seventy years of age.

In some few cases the metatarso-phalangeal joint is affected; but no
case has been seen at the base of the ungual phalanx. The duration of
the disease is between two and four years, but Dr. Evans's case had
been in progress fifty years. It rarely runs its full course before a
year.

Ainhum begins as a small furrow or crack, such as soldiers often
experience, at the digito-plantar fold, seen first on the inner side.
This process of furrowing never advances in soldiers, and has been
given a name more expressive than elegant. In ainhum the toe will swell
in a few days, and a pain, burning or shooting in nature, may be
experienced in the foot and leg affected. Pain, however, is not
constant. There may be an erythematous eruption accompanying the
swelling. The furrow increases laterally and in depth, and meets on the
dorsal aspect of the toe, giving the toe the appearance of being
constricted by a piece of fine cord. As the furrow deepens the distal
end of the toe becomes ovoid, and soon an appearance as of a marble
attached to the toe by a fibrous pedicle presents itself. By this time
the swelling, if any, has subsided. The distal end of the toe bends
under the foot, and becomes twisted when walking, and causes
inconvenience, and, unfortunately, says Eyles, it is in this last stage
only that the Fanti presents himself. There is in the majority of cases
a small ulcer in or near the digito-plantar fold, which causes most of
the pain, particularly when pressed upon. This ulcer does not occur
early, and is not constant. The case under Pyle's observation showed no
ulceration, and was absolutely painless, the negress applying for
diagnosis rather than treatment. The furrow deepens until spontaneous
amputation takes place, which rarely occurs, the patient generally
hastening the process by his own operation, or by seeking surgical
treatment. A dry scab forms at the furrow, and when picked and repicked
constantly re-forms, being composed of horny desquamation or necrosis.

The histology of ainhum shows it to be a direct ingrowth of epithelium,
with a corresponding depression of surface due to a rapid hyperplasia
that pushes down and strangles the papillae, thus cutting off the blood
supply from the epithelial cells, causing them to undergo a horny
change.

The disease is not usually symmet