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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    Kirby in 1849 put down all such cases as of gouty origin. Amongst my 60 cases will be found two cases of fibroid induration of portions of penis. In one patient, aged 57, a printer, who had suffered from Dupuytren’s contraction for some time, and both hands were affected, there was a well- marked history of gout. Along the dorsum of the penis there extended a hard fibroid mass from just behind glans to near its root. On erection of the penis its point was directed against the abdominal wall. . In the second case, that of a bootmaker aged 59> both hands were affected with Dupuytren’s contraction. There was a well- marked family history and personal history of gout. Tophi in ears, there were marked fibroid induration of the sheath of corpus spongiosum, causing penis to be bent upwards on erection. I have also quoted the observations of Sir James Paget in the earlier part of this paper with regard to the occurrentse of this phenomenon. The association of the two conditions, and the mai’ked occurrence of one of them in association with gout, makes it very probable that this disease plays not an unimpor- tant part in being a factor in the causation of the other. Dr. Archibald Garrod, writing in St. Bartholomew’s Hospital Eeports for 1893, reports three cases characterised by the presence of nodules or cushions of fibrous tissue upon the finger- joints ; in one of them it was associated with Dupuytren’s con- traction of palmar fascia. Case I.—Male, aged 20, clerk, suffered from dyspepsia. He came of a markedly gouty stock, his paternal grandfather being a martyr to the disease, and his father had Dupuytren’s con- traction of the fingers. His mother was said to be somewhat rheumatic. Nodules about half the size of a hazel-nut pro- jected from the dorsal aspect of several of the joints of the fingers of both hands ; skin over them was freely movable. The lumps were first noticed at the age of 13, and they have steadily increased in size. The most remarkable point about the case is that an elder and younger brother of the patient are said to suffer from similar deformities. Case II.—A woman, aged 50, with no personal or family history of gout, but with typical Heberden’s nodes upon the terminal joint of her right index finger. There were no signs of rheumatoid arthritis in any other joint. The nodules were similar in character to those in the first case. Some of them had existed at least thirty years. No complaint of pain made. She ascribes their appearance to resting upon the affected joints whilst scrubbing floors. Case III.—Male, aged 43. No personal or family history of