BY HENRY M. SMITH, M. D., NEW YORK.

Without attempting to give any name to the following disease we publish the history of the case as one rarely, if ever, met with in this country. It is interesting in itself, aside from Therapeutics.

On the 30th of September last there came to the Central Homoeopathic Dispensary, in this city, a young man enquiring for a homoeopathic hospital which he had been told was here. He had come from Camden, N. J., in the hope of finding in such an institution the rest he needed, and the medication required. He presented the following appearance:

The thumb and fingers of the right hand were gone from the metacarpo-phalangeal articulation. On the left hand the thumb was missing from its metacarpo-phalangeal articulation and all the phalanges of the fifth finger had gone. All that remained was about half of the first phalanx of the index finger, one-third of the first phalanx of the fourth finger and the first phalanx of the third finger. He had lost the toes of both, feet from the metatarso-phalangeal articulation with the exception of the first phalanx of the left fifth toe which was then denuded and coming off.

On the hands were a number of hard red pustules from one-eighth to three-eighths of an inch in diameter. With this exception the skin appeared smooth and dry, and over the three remaining joints of the left hand were deep fissures. Where the fingers had been, the skin had healed, as over a stump after an amputation. There was no sensibility in the arms below the elbow, nor had there been for years. The legs were likewise insensible from the knee down. The feet differed in appearance from the hands; instead of the skin being dry and cracked it was soft and moist, and had disappeared on the soles, leaving ulcers on each foot its entire breadth. Otherwise than this disease of the hands and feet, he said his health was good. In cold damp weather he was troubled with a cough, but of this was always speedily relieved by homoeopathic medicine. The patient was intelligent, had received a common education, and up to the time of his father's death, in April last, the family were in such circumstances as to allow his residing at home. From him we learned the following facts:

W. T., aged 24, born in Demarara, of English parents, was one of twenty children. When a few months old was vaccinated, and at the time when the pustule should show itself small black sores were observed on the arm which discharged a thick black pus. It was sometime before these ulcers healed, after which there appeared small yellow spots on various parts of the body. For these the physician recommended vapor sulphur baths, which were continued a long time without any benefit. The child was sent to the Island of Barbadoes and finally to England, but no apparent benefit was derived from any treatment, and all further was discontinued.

One evening he was playing battle-door and shuttle-cock, and the following morning observed a swelling in the palm of his right hand. This was lanced by his physician and discharged freely. From this time he has had no use of his hand. The fingers became flexed, and he was unable to open them by any action of the extensor muscles. They were not anchylosed as he could readily open the fingers with the other hand. Shortly after this occurrence, which took place a few miles out of the city of Liverpool, he removed into the city and for some months was an inmate of the family and under the care of Dr. Imlach, an old school practitioner. He received here no benefit to his hand. He does not remember that it was ever put in splints or any mechanical means used to straighten the fingers.

In this condition he came to this country, and was placed under the care of Dr. J. R. Andrews, a homoeopathic practitioner. Previous to consulting Dr. Andrews, a fissure in the skin was observed on the distal end of the index finger of the right hand. The nail came out and the fissure spread, making, as he said, “four slits,” antero-posteriorally and laterally, as far as the last joint. The phalanx became circumscribed with dry skin which was poulticed with bread and water, and peeled oft until the bone was denuded and was knocked or fell off.

In this way the third phalanges of all the fingers of the right hand were lost. The fifth finger of the left hand was next affected, the disease extending no further than the second joint. The disease returned to the right hand, this time extending only half the length of the second phalanges. Next the thumb of the left hand became affected and healed. The right foot was attacked next; what was supposed to be a corn appeared on the sole of the foot, between the first and second toe, a piece of bone came out and the foot healed. Again to the right hand the disease returned, and successively the fingers were lost in the same manner as described above. The left hand again became the seat of the disease, first the thumb was involved, then the second joint of the fifth finger, again the thumb, finally the second and third finger until the hands were left in the condition as at first described.

As soon as the left hand was involved there was felt a tingling sensation extending from the affected finger to the elbow, ceasing just as soon as the fissure appeared. There was no sensation in the hand or arm after the hand was first attacked. With the right hand it was somewhat different, there was no tingling and he does not remember having any sensation after the swelling in the palm. From the left hand the disease returned to the right foot, where the “corn” had previously been. Instead of commencing at the ends as was the case with the fingers, the joints of the toes first sloughed away leaving the ends hanging. The vessels were seen, he says, “like strings” which soon disappeared, when the hanging portions fell off. Ail sensation left the foot soon after the sore appeared.

In reply to enquiries made of Dr. Andrews, he says, after describing the swelling in the right hand, “the disease from that time increased rapidly, so much so that in a short time some of the phalanges of the upper and lower extremities sloughed away. He was in this condition when placed under my treatment, in this condition he remained sometime before I could see any improvement in his case, but under the use of Arsenic, Hepar, Conium, Silicea, Merc. iod., Rhus., Lachesis, Nitric acid, Sulphur and the preparations of Kali and other remedies, the parts assumed a more healthy appearance and gradually improved, and the parts entirely healed. During the treatment he was placed under strict regime. He continued convalescing for a time, occasionally taking medicine. His uncle then sent him to school and placed him to board with a friend who was very indulgent to him, allowing him to expose himself and indulge in all kinds of food that was injurious to his case, consequently after a time he returned to me again with his fingers and toes in a very bad condition. From that time until the present he was very irregular in taking medicine. The boy has been neglected by those having him in charge for the last few years, they taking but little interest in his case, the consequence was he became disheartened, and for the last three or four years I have prescribed for him occasionally. His mother informed me that she had seen the disease frequently in Demarara, but confined entirely to the black population, with the exception of his case. A suggestive circumstance she also mentioned to me was, that the disease became arrested after the phalanges were destroyed, and she was not aware of any case extending beyond the fingers and toes.”

The patient was present at the October meetings of the Hahnemann Academy and New York County Homoeopathic Medical Society that the members might have an opportunity of examining the case, none of whom had heard of such an one before, and were unable to say what it was. When we thought of reporting the case, we intended quoting from the various authors the diseases nearly resembling it, but it being of no practical importance we concluded to give it, not as an instructive, but an interesting case.