Dupuytren's contracture, 126 years after it was described by Dupuytren, remains a disease of unknown etiology. On the basis of histological studies of specimens from sixty-one patients we conclude that Dupuytren's contracture is a fibrous-tissue proliferation arising within the palmar fascia in intimate association with thick-walled vessels together with an increase in capillary vascularity. This tissue undergoes the well known stages of maturation of fibrous tissue until a firm, relatively avascular, contracted scar is formed. The pathological changes do not suggest to us that the lesion is due to trauma, inflammation, or neoplasm. Further study is needed to determine the significance of iron pigment in the early lesions. Surgery is the only form of treatment which will produce any lasting benefit in this disease, although administration of tocopherol and irradiation may produce some temporary improvement. The operation must be fitted to the individual patient. Complete excision of the palmar fascia is indicated in most cases; however, partial excision of the fascia and fasciotomy have their place in selected cases. With proper choice of operation and careful attention to operative details excellent or good results can be expected in between 80 and 90 per cent of patients operated upon.