The relation of gout and rheumatism to Dupuytren's contraction of palmar fascia, with results of treatment by Adams' operation : being a thesis for the M.B. degree at Cambridge University / by Charles Edward Hedges.

  • Hedges, Charles Edward, 1866-
Date:
[1897]
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Licence: Public Domain Mark

Credit: The relation of gout and rheumatism to Dupuytren's contraction of palmar fascia, with results of treatment by Adams' operation : being a thesis for the M.B. degree at Cambridge University / by Charles Edward Hedges. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    chronic irritation reflexly causing contraction of the palmaris longus tendon, and subsequently affecting the palmar fascia, for he says that in almost all the cases which he examined he found the tendon stand out prominently from the others at the bend of the wrist; although I carefully looked out for this prominence, 1 failed to find it so, even in one case. He also states farther on, that out of 700 patients he exa- mined in some infirmary, he found 70 cases of Dupuytren’s contraction. It seems almost impossible to believe this, as out of 2000 patients whom I examined in four different in6r- maries, I was only able to find 24 cases, and this including those with only the primary dimpling of the skin. Is it possible that he included several cases of spastic contraction of the tendons in cases of paralysis, of which there were several instances? I also think his percentage of females attacked is far too high, i to 4 males, as Keen only gives it as I in 15 males out of 187 cases. My own statistics will give it at about i to 8 out of 64 cases. Professor Humphry, speaking on the discussion of this paper of Noble Smith’s, suggested that in causation the truth probably lay between the two opinions of a local and constitutional cause. He pointed out that pressure on palm of hand fell more strongly on ring-finger, and hence the reason why this was most often primarily affected ; he also pointed out the limited extension of this digit alone. In 1885, Lockwood read a paper before the Pathological Society “ On Contraction of the Digital and Palmar Fascia.” He brought forward three cases, (i.) A girl, aged 21, who had had her finger contracted as long as she could remember. Having had occasion to amputate the finger, he found the fascia to be thickened and shortened, but otherwise normal. He says the case was probably one of heredity. (2.) Male, aged 21. No occupation. Six other members of same family similarly affected. Lockwood says he has recently seen other cases which strongly support the view of heredity. (3.) A male, aged 45. On dissection of the hand affected with Dupuytren’s contraction, urate of soda was found in the thickened bands of fascia. Although there was no clinical history of the case, it can scarcely be doubted that the thickening and contraction was due to inflammation set up by the urate of soda. At the end of his paper he says : “ Without doubt an enumeration of the causes of contraction of the digital and palmar fascia, putting aside the cases of congenital shortening, would be merely a recital of the various affections which are capable of causing chronic inflammation.”