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]
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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![If it were solely of tranmatic origin, we should expect it to alfect one class of mechanics more than another. As regards the theory of Al)b(*, I have partially discussed this in the early part of this paper, and can only add now that only in one sense can I admit of its being nervous in origin, and that is in the same sense in whicli Cliarcot’s disease and rheumatoid arthritis are said to be due to lesions of the trophic nerves going to the part affected, and are thus said to be nervous in their origin; or in the same sense as the formation of urate of soda in the body is said to be controlled by the central nervous system. I have already discussed Anderson’s theory of a micro- organistn being the cause, and also the theory of reflex contrac- tion of the palmaris longus of Noble Smith. Now to what do the statistics and various authorities which I have fpioted lead one to believe to be the cause of this affec- tion ? Firstly, that the cases must be divided into two classes :— (i.) True Dupuytren’s contraction, in which there is no history of traumatism. (2.) halse Du])uytren s contraction, in which there is a distinct traumatic history. In this class of cases it is as common to see the disease in childhood as in old age. T’he seat of the initial lesion is single, and the affection is con- fined to the injured hand, and even finger. The contraction in these cases progresses very rapidly to a certain point, and then ceases to get worse. Of course there is always the difficulty in saying how much of the deformity is due to the traumatism, and how much to the predisposing cause. It is just the same in gout and rheu- matism as in tuberculosis; a slight injury to the knee may be just the exciting cause reipiired to set up acute tubercular 'arthritis in that joint, just as a slight injury may set up acute irout or a gouty inflammation in one predisposed to the disease. ^ Now with regard to the causation of true Dupuytren’s con- traction I believe it to be a constitutional disease for the various reasons:—(I.) Kesults of statistics. (2.) Marked heredity. (t, ) Age of its onset. (4.) Occurrence in women, and yet its rarity in the sex, who are, as a rule, exempt from hard labour and ffout (5.) Occurrence more often in men exempt from manual labour. (6.) Its involving of left hand so frequently and often before, or even without right. (7.) Involvement of both hands, more often than one alone, point to a general cause (8) Occasional appearance as a congenital disease, fo I Analocry to contraction of plantar fascia and other fibrous siuctures.° I also believe that tliere is more than one consti- tutional diathesis wliich predisposes to the defornnty to enu- merate which would be to enumerate all the causes of chi-omc](https://iiif.wellcomecollection.org/image/b22335390_0014.jp2/full/800%2C/0/default.jpg)
