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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    origin of it, and sought to establish the theory that it was of a reflex nervous origin, consequent on a traumatism. The sequence of events, he suggests, is as follows:—(i.) Slight traumatism of palm; (2.) spinal impression provoked by the peripheral impression; (3.) reflex influence to part originally injured, producing hypenemia and new growth; (4.) through the tense contraction, a second series of reflex symptoms, such as neuralgias, &c., and a reflection of the trouble to the opposite side. He brings forward many cases in support of this theory, ^ but such cases, if common in America, are rarely if ever met with in Itngland. J3oth Adams and Keen state they have never seen the various painful neuralgias and neurotic affec- tions he so graphically describes, and not in a single case I have examined did one complain of any “pain shooting up the arm and down the opposite side,” and the various other neuroses which he enumerated. Besides this, the patients will often tell you that the dimpling of the skin commenced almost simultaneously in both hands. Neither Keen nor Adams will allow of this nervous origin of ]3upuytren’s contraction, except in so far as gout and rheumatism are possibly nervous in their remoter origin. Besides, if we are to regard the causation of the deformity as due to this reflex nervous in- fluence, we should expect to see the disease of much greater frequency amongst the labouring classes, whereas we find most cases of Dujniytren’s contraction in those who do no hard manual labour. By making this statement I am taking it for granted that Adams is correct in stating that the deformity is more common amongst patients who are well-to-do, and consequently have no need to do hard manual labour. In about 2000 cases of infirmary patients over forty years of age, I found only 24 cases, which is about 1.2 per cent., and at least four-fifths of the cases occur after that age. Sir Dyce Duckworth and Garrod also state that the disease is much more common amongst those who lead a sedentary life. Abbd brings forward 10 cases to support his theory; in the first two the contraction started in the left hand, whereas the patients used their right hands in their trade of cloth-cutting; in his eight other cases there was distinct rheumatic history in three cases, and in two others finger contractions existed in members of the same family. In 1884, Noble Smith read a paper before the Clinical Society, in which he denied gout and rheumatism as a cause, but allowed that there was some constitutional cause at work in addition to some local cause. He regarded the primary cause as some