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no doubt harmless, and the patient died of Cirrhosis of the liver. " Vircliow found the parasite in Wurzburg and Berlin, Wagner in Leipzig, Frericlis in Breslau, five times in 47 autopsies. Zenker first called attention to the occurrence of the larvte in man, having found it nine times in the liver in 168 autopsies. According to Zaeslin two cases occurred in Basel in 1,914 autopsies. At Kronstadt, larvae were found six times in 659 autop- sies, most frequently one or two specimens being found in the liver. Friedberger and Frohner state that the parasite is found more commonly in some districts than the others. They found it frequently in Berlin, but only exceptionally in Munich. Hering found it once only in Stuttgart, while Colin found it in 64 out of 630 Parisian dogs examined. The parasite seems to be present only in the larger breed of dogs, such as mastiff' and in the butcher's dogs, and was found oftenest in the ethmoidal cells firmly attached to the mucosa." The adult of L. serrata is more rarely found than the larval forms, but are most frequently found in the nasal and air passages of dogs and wolves. An account of these parasites is given in Castellani and Chalmers' new edition, page G21. Dr. K. C. Connor described a case of tetanus with a six-day incubation period ; he recovered and was treated with antitetanic serum. Lt.-Col. John L. Phillips, U. S. Army, Assistant Chief Sanitary Officer, and Dr. D. E. Keeder, describe diphtheria cases in the Canal Zone, where this disease is endemic, though it is sugges- ted that it is spread by visitors returning from the United States. Dr. Deeks and Dr. Connor describe cases of Pellagra and the former believes pellagra to be " due to a not Carbohydrate" auto-intoxication, alone due to but to all foods." sugar, " starchy Dr. Connor writes of atypical forms of plague." Dr. Clark and Dr. Darling have a valuable article on Status Lympbaticus. Dr. Henry Weinstein describes cases of Ainhum occurring in one family, in an African with a European name and in his family. The article gives a good account of the disease, and the cases reported are well illustrated. We quote the following remarks on this tropical disease, which has been very little written about since the late Dr. A. Crombie discussed its causation in these III. columns many years ago. CANAL ZONE MEDICAL ASSOCIATION.* F. C. Wellman reports a case of ainhum and summarizes the various theories advanced hitherto : October 1911 to March 1912. 1. Due to injury, foreign - (Vol. TV, Pt. 2.) bodies, etc. ... (Manson, Eyles). 2. Self-mutilation, instru- of the Canal Zone ments, etc. As usual the Congenital spontaneous proceedingsfull Medical Association are of interesting amputation (Proust.) 4. A form of mutilating matter. leprosy ... (Zambaco Pasha.) and Clark describe an unusual type 5. A form of troplio neurosis (Wucherer, Schenbe, Darling.) Drs. Darlino 6. A c a 1 iz e d Adami "Chronic forn of 1 o of called hy Scleroderma ??? (DaSilva tuberculosis, " Lima.) m a Jamaican Negro, hyperplastic tuberculosis In addition to the above, Wellman suggests that the 2^ Tho ?ime writers describe two cases ao-ed chigger (Sareopsylla penetrans) may be a causative factor Serrata in a native of infection by Lingua.ata in some of the cases. larva was hut It is reasonable for of discussion to of Central America. The parasitic, quite purposes combine 1 and 2 as belonging to the same category, J. C. C. Prass, Mount Hope, Canal Zone, Panama, namely, external influences. The cause of ainhum has 328 THE INDIAN MEDICAL GAZETTE. [Aug., 1913. been ascribed to injury by foreign bodies coming in The common entamoeba are E. histolytica, E. tetragena, contact with the most dependent part of the foot, the and E. coli* little toe. It is claimed that barefootedness of the class The parasitic forms are subdivided further into the but of people affected is a very important factor. Many parasitic nonpathogenic, E. coli, and into the authors, who have reported cases in the literature, have pathogenic E. histolytica and E. tetragena. While E. coli ruled out absolutely external injury. If barefootedness is not regarded as an organism that invades tissues, not a were a cause, the natives of many countries should be it is unlikely that if breaV in the mucosa or bowel affected, whereas most of the cases reported were in wall-should occur, E. coli might vegetate in the peri- negroes living in cities and wearing shoes. Da Silva toneal exudate for instance. Recently while taking Lima has not seen the disease in the barefooted temperatures by rectum of a monkey that had been inoculated from a case one Brazilians or among the Creoles. Why should the of measles, of the thermo- disease attack males almost exclusively and shun the meters was broken and penetrated the peritoneum barefooted women ? How is the hereditary factor to be through the rectum. Peritonitis ensued and at autopsy ruled out ? Although the natives of Africa, India, six days later, a yellow typical entamoebic inflammatorj- was seen over the Polynesia, and other parts of the globe inflict upon process extending peritoneal surface of the in the and about the caecum themselves many injuries by wearing ornaments upon large bowel, pelvis, exposed parts of the body such as nose, lips, toes, etc., Tn the exudate, were many entamoebas. yet ainhum could hardly be ascribed as due to them, The specific identification of entamoebae is of the 3. Proust contends that ainhum may be due to con- greatest importance to physicians and sanitarians. To genital malformations. He claims that as a result of the former, for the reason that some of them believe that some interference in the development of the foetus the pathogenic type recognized as E histolytica'^ some parts may become arrested, causing amputation able to specific medicaments, while the type recognized as of fingers and toes, and that the umbilical cord or E. tetragena is not so amenable to specific treatment To for the of fibrous projections may ensnare these parts causing the surgeon, identification pathogenic enta- arrested development, leading later on to spontaneous moeba1 in certain cases may determine his opinion as amputation. to the advisability of an exploratory operation for Zambaco Pasha is the most enthusiastic supporter, of entamoebic liver abscess, or performing a caecostomy. the theory that ainhum is a form of mutilating anesthetic The subject is of importance to sanitarians on account leprosy. He studied his cases in Syria and especially at of its relation to 'carriers,' and to the sanitary measures mode of Beirut where leprosy is very common. Many diseases directed specifically against the transmission."... " of obscure nervous origin such as syringomyelia, The cultivable species of the genus amoeba? are not morphea, scleroderma diffusum and ainhum are attributed parasitic in the intestinal tract of man When obtained by him to leprous manifestations. Dr. Collas who in cultures from the intestine, they probably are derived observed ainhum among Hindus is quoted as holding from cysts of amoebae that have been ingested with views similar to those of Zambaco Pasha water or food and have passed unchanged through the It is to be noted that all of his cases were Caucasians intestinal tract. of all ages and both sexes The lesions are described as The entamoeba? parasitic in the intestinal tract of occurring alike in hands and feet, fingers and toes, with man belong to a distinct genus. They are strictly irregular distribution. The clinical symptoms are those obligatory parasites and are incapable of multiplication of anesthetic leprosy with all the nervous symptoms? outside of the body of their host They cannot be anesthesia, analgesia, electrical and thermal disturbances, cultivated on Musgrave and Clegg's medium." together with muscular atrophy. There were also "Influenced by the cultural work of Musgrave, observed perforating ulcer, atrophy of the nails, and Clegg, and Walker, the doctrine of symbiosis as enun- pigmentation of the skin. Zambaco Pasha also has ciated by Musgrave was considered essential to an leanings toward the hereditary tendencies of leprosy understanding of the bionomics of entamreba?. This and considers the pathological findings in spontaneous doctrine usually has a stricter application than that, mutilating leprosy and ainhum as similar. made by Musgrave in his paper on bacterial symbiosis, De Brun takes issue with Zambaco Pasha. He, too, published in the Journal of Science, 1909, in Philippine' observed his cases at Beirut. In more than 900 cases which he stated that Symbiosis may be defined as observed by him not one was seen in which the fifth toe representing all phases of association between living was exclusively affected. Although he found a constrict- organisms. Beginning with commensalism on the one ing band in some of the fingers and toes it was rather hand, and including true parasitism on the other, in irregular, not circular as in ainhum. which either component is influenced in nutrition, Ainhum rarely begins before the period of adolescence ; metabolism, production, or in some other manner by occur ? ? ? ? ? ? anesthetic mutilating leprosy may at any age. the presence of the other.' . The racial factor is distinct in ainhum but not in leprosy. "In the work of the ' culturalists' it was found Although very seldom toes other than the fifth may be necessary to seed the nutritive plates with bacteria for involved ainhum by the often symmetrical process ; in the amoebae to live upon. In other words, the amoeba3 leprosy, fingers, toes, and other parts are affected. could not find ready-made or in any shape, nutritive (Polymorphism) Ulcers, fissures, suppuration, and other substances in the media which on the other hand were inflammatory conditions are seldom noticed in ainhum, amply nutritive for bacteria.

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