The deformities induced by gout, rheumatism, and rheumatoid arthritis fall more directly within the domain of the physician, while those due to tuberculous or traumatic lesions are of more immediate concern to the surgeon, but the characters which distinguish the various conditions from each other are of interest for every practitioner. The chief points bearing upon diagnosis are as follows: In the _gouty form_ the personal and family history of the patient, the acute and painful nature of the local inflammatory attacks, the presence of urate of soda deposits in the part, and the evidence of similar disease in other portions of the body. In _chronic rheumatism_, which is more often present in women and in the poorer classes, the moderately painful attacks of synovitis with crepitation, and evidence of wearing away of cartilage. In _chronic rheumatoid arthritis_ the presence of bony outgrowths around the margin of the articulation is the main element of distinction from the latter condition. In _tuberculous disease_ the personal and family history, the soft fusiform swelling, the tendency to breaking down of the morbid tissue, and the more or less complete destruction of the articular capsule in the later stages. Contractions with ankylosis may also occur in acute rheumatism and acute rheumatoid arthritis, and in a peculiar neuropathic condition simulating the latter. These will be referred to in connection with the contractions of the toes. In the traumatic forms the history and marks of injury will usually be sufficient for diagnosis; but it must, of course, be understood that common injuries, by weakening the resistance of the part, may localise the attack of a specific disease, such as tuberculosis or gout, and hence the onset of tubercular or gouty arthritis may coincide with an ordinary traumatism. It is, as a rule, only in the tuberculous and traumatic forms that the surgeon is consulted. The treatment must, of course, be based on general principles; but it is necessary to recollect that an ankylosed finger-joint nearly always renders the digit worse than useless, especially if the articulation be fixed in the position of extension. It is only necessary to mention that contractions without joint lesion may occur in the fingers as a result of disease or injury of the bone. Simple fracture in the neighbourhood of an articulation may produce a deformity closely resembling that of dislocation. Caries or necrosis may also lead to a breach of continuity in the shaft of a bone, and various distortions may follow the cure of the disease. CONTRACTIONS OF PARALYTIC AND SPASTIC ORIGIN FOLLOWING LOCAL INJURY. A complete account of the various conditions falling under this denomination would require an entire course of lectures, and it is hence necessary to confine our attention to those forms which belong to the surgeon rather than to the physician.