to have been seen in those who wear shoes; but, unless it could be shown that such individuals had always worn shoes, this objection to the explanation offered would not apply. I have seen a negro in whom the entire integument of the little toe was involved in a sclerodermia, and the part in consequence was shrunken and hidebound, whilst the little toe of the other foot was affected with well-marked ordinary ainhum; the process was diffuse, as it were, on the one side, localized on the other.
The tail in certain species of monkey is liable to a similar disease. I have had under observation for some time a pet monkey in which the part corresponding to the distal vertebra dropped off in consequence of an ainhum -like linear constriction. Two months later the next vertebra was similarly amputated, and later a third groove formed a little higher up the tail.
Treatment.— It has been suggested that division of the constricting fibrous band would delay the evolution of the disease. In the early stage this might be tried. When troublesome, the affected toe should be amputated.
BIG HEEL, OR ENDEMIC HYPERTROPHY OF Os CALCIS
Maclean (Journ. ofTrop. Med., November 1, 1904) describes a peculiar form of enlargement of the os calcis which he observed at Kaziankor, Gold Coast, West Africa, among Fantis and Kroos. The disease begins somewhat suddenly, being preceded by fever and accompanied by pain and tenderness which reach their maximum in about a month, gradually diminishing during the succeeding one or two months. Concurrently with the pain a swelling of the external surface of the os calcis, rarely of the tarsal bones, makes its appearance. Sometimes one heel only, sometimes both heels are affected. The swelling may be so considerable as to be quite evident both to touch and sight. It subsides to a certain extent, though not altogether, as the pain diminishes. Locomotion is seriously interfered with by the pain,
