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]
Catalogue details

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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    Sex.—Cases of any degree of severity are rare in women. Of 39 cases, 25 were in men and 14 in women, but in only 8 of these was there any contraction of the fingers. Age of onset.—Most cases of non-traumatic form begin after fifty years of age. He does not believe in the influence of occupation as a cause of the disease; he states that it is very rarely found amongst soldiers and sailors. Shoemakers are said to suffer more than others, but this is not borne out by statistics. The disease is more frequently seen in those not employed in manual labour ; perhaps the thickening of the skin may in some way prevent the underlying fascia from irritation. » Constitutional condition of his 39 patients :—i gout; i a,cute rheumatism; 3 rheumatoid arthritis; 6 chronic rheumatism ; gouty inheritance in 3 other cases. Anderson says his own conclusions are based upon patients in hospitals, and hence the remarkable absence of gout or neurotic disposition. Race and climate.—Very rare in Eastern countries, cf. Japan and India and Central Asia Inheritance.—Unquestionably a strong predisposition to here- dity in the disease. Cause.—Disease is of no more than average frequency in certain employments in which men are peculiarly and constantly liable to palmar friction. Some source of hritation must be present, and it has been suggested that this may be a gouty deposit (Lockwood). This experience is exceptional, as the majority of patients in this country are not, and have not been, subject to gout or rheumatism. Anderson says the changes are more suggestive of chronic rheumatism than gout; but even the probability of this origin is not supported by observed facts. He believes strongly in the agency of a specific micro-organism which gains access to the palm of the hand by slight traumatism of the epidermis with the finger-nails. I don’t think any one attached any importance w'hatever to Anderson’s remarks about the causation of the disease being due to a specific micro-organism ; the only evidence he brought forward was the growth of a yellow nodule on agar, liquefying the medium in which it was placed and the tube being odour- less ; sections of it stained with fuchsin and Gram’s method showed no organism under -jV immersion. He finishes by saying that he hoped to publish this and other experiments in extenso within a short time, but since that time no further statements upon the subject have appeared substantiating his theory.