F.* M.* | | +--------+--------+ | | | | | F. F. F.* M.* \----v----/ | +--------+--------+--------+--------+--------+--------+ | | | | | | | F. F.* M. M. F.* M. F.* | +--------+--------+ | | | F. M.* F.* * The Asterisk indicates the members of the family who suffered from hammer toe. M. and F. signify sex. The subjoined pedigree of a family in which the affection has arisen, illustrates the descent through four generations. It was noted that the children attacked were those who presented most resemblance in feature and temperament to the grandfather. The deformity usually appeared about the age of four, and was confined to the second toe. “Double-jointed” thumbs were also an inheritance in the family. In another example the condition developed in five children out of eleven. Here too there was a history of “double-jointedness” in the fingers and thumb, extending through three generations; and an aunt on the male side was also the subject of hammer finger. This association of hammer toe with other developmental irregularities is significant enough to deserve attention. In addition to the instances mentioned, there are amongst the seventy-three surgical cases on my list three accompanied by hallux flexus, and one with retraction of both little toes; and there is little doubt that coincidences of a like kind would more frequently be found were it always possible to ascertain the facts by inquiry. _Seat of attack._—In surgical cases the toe most commonly affected is the second. In my list of 73 patients who had applied for treatment, this digit was affected in all but four, while the third was attacked in five, the fourth in one, and the fifth in three cases. In one instance the affection of the third toe was symmetrical, each afforded only a single example; but if all cases of contraction of the joint for 30° or more be counted without reference to symptoms, the condition is far more frequent in the little toe than in the others. Thus in an examination of a series of 800 children under sixteen years of age the little toe was found to be involved in forty-one cases, nearly all of which were double, while the second toe was affected in six only, and the third toe in five. It may be noted also that the projection of the extremity of the second toe beyond that of the first—a condition regarded as a type by the ancient sculptors—was present in only three instances. This is confirmed by Professor Flower, who failed to find a single instance in many hundreds of children.