Lectures on clinical surgery : delivered in the Hôtel-Dieu of Paris / by Baron Dupuytren ; collected and published by an association of physicians.

  • Dupuytren, Guillaume, 1777-1835.
Date:
1835
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on clinical surgery : delivered in the Hôtel-Dieu of Paris / by Baron Dupuytren ; collected and published by an association of physicians. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    be extended almost as much as in the natural state. Wishing to spare the patient the pain of a new incision, M. Dupuytren endeavored to prolong the section of the aponeurosis, by passing the bistoury transversely and deeply beneath the skin, towards the outer edge of the hand, in order to diseno-a»e the little finger, but in vain. He could only succeed in slightly dilating the inci- sion in the aponeurosis; he, therefore, determined on making a transverse incision opposite the articulation of the first and second phalanx of the little finger, and thus renewed its extremity from the palm of the hand; but the rest of the finger remained flexed. Then a new incision divided the skin and aponeurosis opposite the corresponding metacarpo-phalangial articula- tion ; it was followed by some relief, but its success was still incomplete. Lastly, an incision was made transversely, opposite to the middle of the first phalanx itself, and instantly the little finger was extended with the utmost ease; this result showing clearly that the last division had reached the point of insertion of the aponeurotic digitation. But little blood flowed from the incisions. The hand was dressed with dry lint, the fingers, were kept ex- tended, by means of an appropriate machine fastened to the back of the hand. During the day that the operation had been performed, and the following night, there was little or no pain, but some slight uneasiness caused by the continual extension ; the next morning, the hand was the seat of some swell- ing, resulting from the compression of the machine, which had been made by an unskillful workman. On the morning of the 14th, a machine invented by M. Lacroix was substituted, consisting of a demi-cylinder of pasteboard, terminated by metallic plates, which could be lengthened or shortened at will, and ending in a kind of thimble, which embraced the extremity of the fingers. The patient at first experienced some relief; but during the evening the irri- tation returned, the pain was redoubled, and the hand became much swelled. Then, without removing the machine, M. Dupuytren ordered the parts to be kept constantly wet with a cold solution of the sacch. saturni; under this treatment the pain and tension diminished, and he became more comfortable. The 15th, the lint was removed, suppuration was scarcely established, the hand was yet engorged, and a sensation of tension felt along the diseased fingers. Extension was still kept up, as well as the cold applications. 16th, Only a slight tension in the hand, stiffness of the fingers; suppuration was com- pletely established. 17th, The severity of the symptoms diminished, the.ex- tension of the fingers could be increased without pain. Afterwards the swell- ing and tension disappeared, the wounds began to cicatrize but slowly on account of the separation of their edges, effected by the position in which the hand was purposely kept. On the 2d of July, the wounds had entirely cica- trized. The mode in which this took place should be preserved, as they observed a progression in proportion to the degree of influence exercised upon them by the extending power. Thus there was perceived to close successively, 1st, that incision corres- ponding to the articulation of the first and second phalanges of the annular finger ; 2d, that opposite to the middle of this first phalanx; 3d, that relating to the metacarpo-phalangial articulation of the little finger; 4th, and lastly, the one first made, corresponding to the metacarpo-phalangial articulation of the annular finger. The patient used the extending machine for more than a month, in order to guard against the contact of the edges of the aponeurotic 2