On the injuries and diseases of bones : being selections from the collected edition of the clinical lectures of Baron Dupuytren, Surgeon-in-chief to the Hôtel-Dieu at Paris / translated and edited by F. Le Gros Clark.
- Guillaume Dupuytren
- Date:
- 1847
Licence: Public Domain Mark
Credit: On the injuries and diseases of bones : being selections from the collected edition of the clinical lectures of Baron Dupuytren, Surgeon-in-chief to the Hôtel-Dieu at Paris / translated and edited by F. Le Gros Clark. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![tlie size of a hazel-nut, and as hard as the other. He rarely had any pain in the affected parts, the inconvenience occasioned to him being the only cause of complaint. I anticipated that these tumours Avould prove to be either spina-ventosa or exostosis, but more probably the former : and that the excavated bone was filled Avith cancerous matter. In such case, the disease would most probably burst its exist- ing barrier and attack the soft parts; therefore it appeared the wisest course to remove the affected part at once. But then came the question as to the removal at the same time of the metacarpal bone. My objections to this step were, in the first place, the doubtful nature of the disease, which might after all turn out to be exostosis; and further, that the sacrifice of a metacarpal bone or any part of it, is inadmissible where it can be avoided. I may here remark that the recommenda- tion of some authors to remove even the projecting head of a metacarpal bone is to be deprecated, as this operation is at- tended with much more risk than the simple removal of the finger at the metacarpo-phalangeal articulation: and the same remarks are applicable to the corresponding operation on the foot: in either case the practice is a great abuse, and should be discountenanced.^ Some operators have even advised the removal of the hand at the wrist-joint, where the fingers were the seat of cancerous affections : but the dread of the disease returning, which is pleaded as the reason for this proceeding, has been very unnecessarily exaggerated, as I have frequently proved in the course of practice. Guerin^s finger was accordingly amputated at the meta- carpo-phalangeal articulation; and in a fortnight the part was entirely healed. On examining the affected phalanx the bone was found to be dilated and reduced to a mere osseous shell, thin and unresisting : there was no trace of medullary mem- brane, but the cavity was occupied by a grayish-white matter ' [The specific objections to the operation in question are not given by the author, but may be thus stated. As regards the immediate effects, there is injury to the pal- mar vessels and nerves, and the risk of troublesome hemorrhage: as regards the remote effects, there is impaired use of the hand, which renders the unnecessary sacri- fice of the head of a metacarpal bone altogether unjustifiable, when the subject of the operation is a labourer or mechanic. Sightliness is tlic only argument in favour of the additional mutilation.—Tb.]](https://iiif.wellcomecollection.org/image/b23982573_0453.jp2/full/800%2C/0/default.jpg)
