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]

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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$In 1882, ]\.een of New \ork read two papers on Dupuytren's contraction, which were published in the Philadelphia Medical I^mes of 1882. He collected 253 cases, including the 70 of Noble Smith already referred to. Sex affected— i female to 15 males. Occupation of 123 cases in which it was noted—74 non- manual ; 49 manual. Hands affected of 184 cases. Both 103 times; right 58 times; left 23 times. Bight hand thus involved 161 times; left hand, 126 times. Out of 214 cases in which it was noted which finger was affected, in only 11 was the thumb affected, and in 24 the forefinger. The ring and little finger bore the brunt of the affection. Heredity.—Out of 198 cases there were 50 of heredity. Of 95 cases, in 64 distinct personal or hereditary history of gout; in 31 it was excluded. Dr. Keen maintains the view of a constitutional origin, and this he states to be, as a rule, gout or rheumatism. He says the patients are rarely free from the “ minor manifestations of gout,” as Sir James l^aget calls them. He has seen it follow on acute rheumatism, although Adams excludes this as a cause of the affection. In 1885 Stevenson quotes a case in which there is a family history of Dupuytren’s contraction for three generations with no history of gout. In 1891, in a series of lectures at the Royal College of Surgeons, William Anderson divides cases of Dupuytren’s con- traction into two classes, (i.) True Dupuytren’s contraction, with no traumatic history, and a tendency to multiplicity of lesion. (2.) Those cases which are the result of a wound and confined to the part in direct relation to the injury. In his statistics we find the following facts:— Hand affected.—Bilateral in 24 cases out of 39. Bight hand affected in 10 cases out of 39. Left hand affected in 5 cases out of 39. Of eight patients, six of whom were women, the band was purely palmar, with no contraction of the fingers. In only one case was it associated with disease of the plantar fascia. He points out that the seat of the initial lesion is situated at a spot where the finger-nails come in contact with* the palm of the hand. Out of 2600 adults, 33—i.e. 1.27 per cent.—were found suffering from various stages of this affection. Out of 800 children under 15, none were affected.$