_Constitutional condition._—If a generalisation would be permissible solely upon the cases in my own list, I should be inclined to think that the patients were rather above than below the average in health. Twenty-six out of the thirty-nine had passed threescore and ten when they came under my notice, and with four exceptions all were in good physical condition, and one (a woman with fairly well-marked contraction in both hands) had reached the span of ninety-three years. In each case careful inquiries were made with reference to the inheritance or past or present existence of gout, rheumatism, and rheumatoid arthritis, and the result, confirmed as far as possible by direct examination of the patients, was altogether contrary to my preconceived notions on the subject. Of the whole number, only one had suffered from gout, one from rheumatic fever, three from rheumatoid arthritis (all in women, whose Dupuytren’s disease was limited to slight palmar lesion), and six from mild subacute or chronic rheumatism. A possible gouty inheritance was traced in three cases. All were free from nervous disorders except two of the women, who were subject to neuralgias of an ordinary kind, and one (aged seventy-three) with a double contraction of thirty years’ standing, who was suffering from hemiplegia of three years’ duration. No complaint as to the digestive functions was made in any case. The evidence brought forward by different observers with regard to constitutional tendency appears to be extremely conflicting. Thus, Dr. Keen, whose contribution is one of the most careful records we possess, found no fewer than forty-two gouty patients out of forty-eight cases; and Mr. Adams expresses his opinion that the disease is a gouty thickening of the palmar fascia. Dr. Abbe of New York, on the other hand, has noticed a remarkable frequency of nervous symptoms in connection with Dupuytren’s contraction, and believes that the complaint is of neuropathic origin, while other surgeons have in like manner assigned to rheumatism, rheumatoid arthritis, alcoholism, and other conditions an important causative relation with the disease. There is, of course, no doubt that such widespread affections as gout and rheumatism, neuroses and alcoholism are present in certain cases—it would be strange were it not so; but it is noticeable that the writer who gives a prominent place in the causation to any one of these conditions always holds the claims of the rest in very low esteem; and it appears probable that the associated constitutional tendencies noticed in the different groups of cases depended rather upon the particular class or set from which the observer drew his patients than upon any essential connection between the local and internal affections. My own experience of the disease has been based principally upon cases in hospitals, and hence the remarkable absence in my series of the neurotic or gouty predispositions