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]
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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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    In 1876 Madelung of Bonn states the cause to be absorption of the fat of the palm of the hand, which occurs in old people, thus more easily exposing the palmar fascia to pressure and injury. This leads to a chronic inflammatory process, thickening and subsequent contraction of the inflammatory tissue. This theory will not, however, explain those cases which occur before the age of 40, nor will it explain the cases in which the deformity occurs in both hands, and in those who do no manual labour. Nor will it explain those cases, which are not at all uncommon, in which the contraction commences several years after active life has ceased. In 1877 Post of New York puts down the cause of Dupuy- tren’s contraction to constant irritation of the integument setting up a chronic inflammation, which spreads to the fascia beneath. In 1880 Fothergill had frequently noticed these contrac- tions of palmar fascia in gouty subjects; and Gilbart Smith quotes, as an indication of its heredltaiy character, a family, three brothers of which, all the subject of gout, suffered from Dupuytren’s contraction. In 1881 Dr. Myrtle admits its heredity, but does not admit of gout or rheumatism as a cause, for the following reasons:— (i.) It is never met with amongst women, whereas gout is partial to the fair sex; (2.) many, and worst cases, cannot boast of a gouty progenitor, and never exhibited a symptom of gout or rheumatism; (3.) remedies for gout no good for this affliction. Against these three objections of Dr. Myrtle’s must be urged:— (i.) That he is totally wrong in stating that it never occurs in women ; it is rare in women, and so is gout rare in the fair sex ; (2.) statistics show that most of the cases have either a gouty or rheumatic history; (3.) what remedies are there which are known to have any influence over the chronic thickening of the capsule and fibrous structures around joints affected with gout and rheumatoid arthritis ? In the same year Reeves published a paper in the Lancet contradicting Dr. Myrtle’s statement about its occurrence in women, but at the same time stating that he did not believe in gout or rheumatism as a sole condition predisposing to the disease. He states, as result of his ex]ierience, several causes, (i.) Rheumatism and gout, (2.) injury and occupation, (3.) heredity, (4.) neurosis. He had three cases on whom he operated which were followed by an acute attack of gout. In 1884, Abbd of New York read two papers before the New York Academy of Medicine, advancing a theory of neurotic origin of the disease ; he entirely rejected the gouty