On contractions of the fingers (Dupuytren's and congenital contractions) and on "hammer-toe" / by William Adams.

  • William Adams
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: On contractions of the fingers (Dupuytren's and congenital contractions) and on "hammer-toe" / by William Adams. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    Fig. ].—Dupuytren's contraction, involving the middle, riug, and little fingers in the right hand—entirely palmar in the middle and ring fingers, hut phalangeal in the little finger, after an injmy to the joint from a severe blow. The patient, a gentleman, set. 55, upon whom I operated in February, 1864. In the palm of the hand are seen two prominent cords, or bands cf palmar fascia, leading from the first phalanges of the middle and ring fingers towards the centre of the palm of the hand ; the second phalanges of these two fingers were not involved in the' contraction. The little fi.nger is drawn down partly by one of the central bands, and partly by an external lateral band. In this finger, also, the second phalanx was contracted, and drawn down at a right angle with the first, partly by fascial contraction, and partly by articular changes resulting from rheumatic gout and aggravated by an accident. This gentleman had for many years been engaged in the diplomatic service, in which he still continues, and had not used this hand in any special manner. He is a member of a very gouty family, and although he has not suffered from acute gout in the great toe, he has been subject to other gouty affections, and many of the articulations of the fingers were a little enlarged and altered in shape by rheumatic gout. The contraction of the little finger had commenced five years previously, after a severe injury, and the middle and ring fingers between three and four years before he came to me. The effect of the contraction, chiefly from the drawing down of the middle fingers, was to interfere with his power of writing, so that his signature was scarcely legible. Six punctures were made at the operation, and the extension was made as rapidly as It could be borne by the patient—an instrument similar to that represented in Fig. 12 being used. The middle and ring fingers were straightened in a fortnight, but the little finger took nearly six weeks, and then the contraction between the first and second phalanges could not be completely overcome in conse- quence of ai'ticular changes. Drawing taken from a cast. Fig. 2.—The same hand as shown in Fig. 1 thirteen years after operation. The middle and ring fingers remained permanently cured, with full power of flexion ; and all trace of contraction in the palm of the hand had disappeared. The contraction of the little finger, which never could be brought quite straight, from alterations in the joint, had relapsed to some extent, between the first and second phalanges—but the first phalanx remains on a straight line with the metacarpal bone. Drawing taken from a catt. This gentleman has been frequently seen by me since the operation, and I am able to state that up to the present time—December, 1891— twenty-seven years after the operation, no recontraction has taken place in the middle and ring fingers, which he can use with perfect freedom. Nor has the contraction of the little finger, which was of traumatic origin, increased beyond that represented in Fig. 2. But in the left hand a similar contraction, which commenced ten years ago, has been steadily increasing. From his age, however, and the little inconvenience the contraction occasions, he is not desirous of submitting to any operation. It is remarkable that Dupuytren's contraction, evidently of constitutional origin, should be developed in the opposite hand at a late period, without any relapse occurring in the hand operated upon ; a continuance and extension of the morbid process rather than relapse. Fig. 3.—Dupuytren's contraction involving the middle, ring, and little fingers in the right hand—entirely palmar—occurring in a medical man,
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