so little trouble that no medical advice is sought—this is especially the case when the contraction is limited to the little toe; in others the suffering is so great that the patient begs the surgeon to remove the offending member with the knife, and remains absolutely crippled until an operation is practised for his relief. When the deformity affects more than a single digit, an interval varying from a few months to five or six years may elapse before the second attack appears. As a rule, it is the corresponding toe on the opposite foot that suffers, but occasionally a neighbour is selected; or even the distal joint of the same or another toe. [Illustration: FIG. 10. A. Diagram showing position of bones in hammer toe, involving the proximal joint; 1. Metatarsal bone; 2. Head of first phalanx; slight groove corresponding to position of dorsal border of base of second phalanx; 3,4, and 5. Callosities due to boot pressure; 6. Bursa over contracted joint; 7, 8. Shoe. The arrow indicates the direction in which the pressure of the upper leather tends to force downwards the head of the metatarsal bone towards the sole. B. Dissection of first inter-phalangeal joint in hammer toe; C. The same preparation after section of plantar fibres of lateral ligaments.] _Morbid anatomy and pathology._—The earlier opinions upon the pathology of hammer toe were very conflicting. Gosselin, who dissected a specimen, was unable to find any lesion. Fano, in 1855, mentions as the chief defect a cartilaginous nucleus in the extensor tendon. Blum described a luxation of the first phalangeal joint, with a thickening of the whole capsule, and maintained that the contraction of the toe was due to a peri-arthritis set up by the inflammation resulting from corns—a curious example of “hysteron proteron.” Blandin attributed the affection to a shortening of the plantar fascia; Boyer to a retraction of the extensor tendons; Roche and Sanson to a contraction of the flexor tendons, and other surgeons to a paralysis of the interossei, but no attempt was made to separate true hammer toe from the arthritic and traumatic deformities which simulate it. It is now beyond doubt that the essential seat of the contraction is in the joint itself. The specimen represented in B, C, Fig. 10, is one prepared by myself in 1882 from a toe which had been amputated by a colleague. It showed that the deformity was not affected by section of the tendons, but that it yielded immediately upon division of the plantar fibres of the lateral ligaments where they blended with the glenoid plate. This observation, which has been confirmed by a dissection of Mr. Walsham’s, was not published until 1887, and it was by Mr. Shattock, who, working independently, had found the same lesion, that the condition was first made known at the Clinical Society in the same year. The preparation illustrating his paper is now in the museum of St. Thomas’s Hospital, as well as a second dissection demonstrating