. Modern surgery, general and operative. eumatism, or osteo-arthritis; others, to traumatism, syphilis,organic nervous diseases, arteriosclerosis, reflex irritation, or neuritis. In one-fourth of the cases heredity seems to be influential. If due to traumatism, theright hand should suffer most frequently; but it occurs in the left hand nearlyas often as in the right (P. Jansen, in Arch. f. klin. Chir., Bd. Ixvii, H. 4).Working men are not more liable to it than others. Jansen examined speci-mens from 7 cases and found connective-tissue hypertrophy and circulatorydisturbance, the contraction be
. Modern surgery, general and operative. eumatism, or osteo-arthritis; others, to traumatism, syphilis,organic nervous diseases, arteriosclerosis, reflex irritation, or neuritis. In one-fourth of the cases heredity seems to be influential. If due to traumatism, theright hand should suffer most frequently; but it occurs in the left hand nearlyas often as in the right (P. Jansen, in Arch. f. klin. Chir., Bd. Ixvii, H. 4).Working men are not more liable to it than others. Jansen examined speci-mens from 7 cases and found connective-tissue hypertrophy and circulatorydisturbance, the contraction being a result of the above-named processes. Symptoms.—Dupuytrens contraction is indicated by a small hard lumpor crease which appears over the palmar surface of the metacarpophalangealjoint. This nodule grows and the corresponding finger is gradually pulleddown. In some cases the tip of the finger is forced against the palm. Theskin becomes dimpled or puckered. In some cases the interphalangeal joints ofthe contracted finger 530 —Dupuytrens contraction otthe middle finger. Trigger-tinger or Jerk-linger Treatment.—Fibrolysin, which is a soluble combination of thiosinamin andsalicylate of sodium, has been used hypodermatically in Dupuytrens con-traction and, it is claimed, with success (Schwalbach). In very slight andearly cases the wearing of a splint at night, associated with daily manipulationand massage retards the development of the deformity. In treating Dupuy-trens contraction subcutaneous multiple incisions may be made, the tensefascia and the fasciocutaneous fibers being cut. The finger is straightenedand is placed upon a straight splint, which is worn continuously for a weekor ten days and is worn at night for at least a month. A more satisfactoryoperation is that of Keen. He divides the skin by a V-shaped cut, the baseof the V being downward, lifts up the flap, and dissects out the contractedtissue. A valuable method is that of McCurdy. He makes a long
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