Some source of irritation, however, must be present, and it has been suggested that this is to be found in gouty deposits. In one case recently brought forward by Mr. Lockwood, uric acid crystals were actually present in connection with the bands; but this experience is exceptional. That the new tissue might become the seat of such a deposit in gouty subjects is more than probable, but in the majority of cases of Dupuytren’s contraction seen in this country the patients are not, and have not been, subject to gout. It would, moreover, be difficult to find any condition that presents less resemblance in its course and tendencies to known manifestations of the gouty poison. The changes, indeed, are much more suggestive of chronic rheumatism than gout, but even the probability of this source of origin is not supported by observed facts. The situation of the initial lesions, and the peculiar tendency of the new growth to feed like a parasite upon the tissues in which it spreads and which it replaces have led me to believe strongly that the active cause of the disease is a chronic inflammation probably set up by a micro-organism, which gains access to the subcutaneous tissue through accidental lesions of the epidermis overlying the bony prominences formed by the heads of the metacarpal bones. This would explain better than any existing hypothesis the persistent course of the disease and its proneness to recur after the most skillfully devised operation, while the almost constant limitation of the disease to the declining years of life corresponds mainly to lessened resistance in the bodily organism, and partly perhaps to senile absorption of the palmar fat cushion and atrophy of the protective thickening of the epidermis. The almost complete immunity of the foot is accounted for by the protection afforded by the shoes and stockings. Individual and inherited susceptibilities are exemplified here as in other complaints of known bacterial origin. To determine the question I have sought the experienced aid of my colleague, Mr. Shattock, in carrying out a series of bacteriological researches.