Exaggerated forms of distortion of the fingers may occur in rheumatoid arthritis, gout, or chronic rheumatism, and in various nervous affections,[2] but these rarely call for surgical treatment. CONTRACTIONS ARISING FROM INTERRUPTED EVOLUTION OF THE FLEXORS OF THE FINGERS, WITHOUT PARALYTIC OR SPASTIC COMPLICATIONS. This condition necessarily belongs to the pre-adult stage of development. It is characterised by persistent flexion of one or more digits, without any articular abnormality, and unassociated with spasm or paralysis, but the contraction is of a different kind from that found in hammer finger and hammer toe. The degree of flexion varies with the position of the hand, and when the wrist is strongly bent forwards the fingers may be extended, perhaps completely, but extension of the wrist is accompanied by a return of the contraction, the degree of which increases progressively as the wrist extension is carried nearer to its limit. The power of grasp is little impaired. Any attempt to overcome the flexion by violence is met by powerful resistance, and great pain is induced. If the patient be anæsthetised, the contraction remains unaltered, but the resistance is felt to be of a peculiar elastic character, and yields to a slight extent during the application of passive force. The defect leads to great interference with the functions of the hand. The pain caused by anything that tends to stretch the shortened muscles induces a voluntary exaggeration of the flexion, and after a time the control over the extensors is apt to become impaired. The causes are often obscure, but some examples have been traced to traumatic injuries of the flexor side of the forearm in infancy or childhood. In any case the essential factor appears to be a trophic lesion of local or central origin, which retards or arrests the due growth of a muscle or a portion of a muscle without causing its atrophy or paralysis. The following cases will serve to illustrate the phenomena so far as they have come under my own observation: