ric, as formerly stated, nor is it
simultaneous in different toes. There are no associated constitutional
symptoms, no tendency to similar morbid changes in other parts, and no
infiltration elsewhere. There is little or no edema with ainhum. In
ainhum there is, first, simple hypertrophy, then active hyperplasia The
papillae degenerate when deprived of blood supply, and become horny.
Meanwhile the pressure thus exerted on the nervi vasorum sets up
vascular changes which bring about epithelial changes in more distant
areas, the process advancing anteriorly, that is, in the direction of
the arteries. This makes the cause, according to Eyles, an
inflammatory and trophic phenomenon due mainly to changes following
pressure on the vasomotor nerves.

Etiology.--The theories of the causation of ainhum are quite numerous.
The first cause is the admirable location for a furrow in the
digito-plantar fold, and the excellent situation of the furrow for the
entrance of sand or other particles to make the irritation constant,
thus causing chronic inflammatory changes, which are followed
subsequently by the changes peculiar to ainhum. The cause has been
ascribed to the practice of wearing rings on the toes; but von Winckler
says that in his locality (British Guinea) this practice is confined to
the coolie women, and in not one of his 20 cases had a ring been
previously worn on the toe; in fact all of the patients were males.
Digby says, however, that the Krumens, among whom the disease is
common, have long worn brass or copper rings on the fifth toe. Again
the natives of India, who are among those most frequently afflicted,
have no such custom.

Injury, such as stone-bruise, has been attributed as the initial cause,
and well-authenticated cases have been reported in which traumatism is
distinctly remembered; but Smyth, Weber, and several other observers
deny that habits, accidents, or work, are a feature in causation.

Von During reports a curious case which he calls sclerodactylia
annularis ainhumoides. The patient was a boy about twelve years old,
born in Erzeroum, brought for treatment for scabies, and not for the
affection about to be described. A very defective history led to the
belief that a similar affection had not been observed in the family.
When he was six years old it began on the terminal phalanges of the
middle fingers. A myxomatous swelling attacked the phalanges and
effected a complete absorption of the terminal pha