_Class and occupation._—It is very difficult to obtain any information of statistical value as to the proportionate distribution of the complaint in the “classes” and “masses,” and there is great difference of opinion upon the question amongst our best authorities. It is at any rate certain that our workhouses contain a considerable number of examples, and that the disease is also very often found in men and women of the educated ranks. The same doubt exists with reference to the influence of occupation, but there is no question that the earlier observers greatly exaggerated the importance of this factor. It appears, indeed, that in various callings which involve much rough treatment of the palm the affection is even less common than in the rest of the community. Its infrequency amongst soldiers has been already remarked, and Mr. Johnson Smith informs me that it is very rare amongst sailors. In about two hundred patients at the Seamen’s Hospital, whom he was kind enough to examine in order to put the question to the test, only one example of the disease was found, and this was probably of traumatic origin. Shoemakers have been said to suffer frequently, and for mechanical reasons, but there seems to be no substantial foundation for the belief. I have only met with one of the craft so affected, and by a somewhat curious coincidence the disease was of older date, and more severe in the left hand than in the right. This man told me that he had never seen or heard of the complaint amongst his fellow workmen. Two of the worst cases in my own series were in clerks. With reference to the question of occupation, it may be remembered that the affection is bilateral in nearly two-thirds of the cases, and that the left hand is affected almost as frequently as the right—in my own cases in the proportion of six to seven. This and the other facts named would appear to negative the view that mere friction and pressure of the palm by tools or other objects habitually held within the hands can account for the disease. On the contrary, it is possible that habitual rough usage of the hands, by leading to epidermic thickening, protects the deeper structures; and that the horny-handed toiler is proportionately less liable to the disease than his more fortunate and more tender-palmed fellow citizen. Nevertheless, when the condition has once started it is likely that its progress would be hastened by any external source of irritation, and hence the strong conviction of the sufferers as to the mechanical origin of their deformity.