Journal of Hand Surgery (British and European
Volume)
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The Early History of Contracture of the Palmar Fascia : Part 1: The origin of the disease: the curse of the
MacCrimmons: the hand of benediction: Cline's contracture
D. ELLIOT
J Hand Surg [Br] 1988 13: 246
DOI: 10.1016/0266-7681(88)90078-2
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THE
EARLY
HISTORY
OF CONTRACTURE
OF THE
PALMAR
FASCIA
Part 1: The origin of the disease: the curse of the MacCrimmons:
the hand of benediction: Cline’s contracture
D. ELLIOT
From the Royal Victoria Infirmary, Newcastle-upon-Tyne
The earliest reference in surgical history to the
contracture of the palmar fascia which has become
known as “Dupuytren’s disease” is in the writings of
Felix Plater of Base1 in 1614. In the third volume of his
Observations, he described the case of a stone-mason
with this conditon (Fig. 1): the irrevocable drawing into
the palm of the hand of the ring and little fingers and
ridging of the palmar skin is pathognomonic. Plater’s
stone-mason, like many patients since, associated the
onset of the disease with a specific traumatic event,
though the relative timing of this injury and the onset of
the contracture are not recorded. Plater believed the
tendons to have contracted and pulled out of their
sheaths, so raising the palmar skin in ridges as they bowstringed across the palm, an interpretative error which
was to persist for 200 years.
It is surprising that no earlier reference to this
condition has been found in the Scandinavian literature
or in that of their subject races, since it has been
suggested that the disease originated in North Europe.
In Great Britain, this view is supported by the
apparently high incidence of the condition today in
those parts of the country which faced the Norsemen,
namely north-east England and the north and west of
Scotland both of which were invaded and
subsequently colonised, the former permanently and the
latter for nearly 500 years. Nothing of relevance has
come to light in the archeological investigation of
Fig. 1
Plater’s description of Dupuytren’s contracture,
1614.
CONTRACTION OF THE FINGERS OF THE LEFT
HAND INTO THE PALM. A certain well-known master
mason, on rolling a large stone, caused the tendons to the ring
and little fingers in the palm of the left hand to cease to
function. They contracted and in so doing were loosed from
the bonds by which they are held and became raised up, as two
cords forming a ridge under the skin. These two fingers will
remain contracted and drawn in forever.
Translation by J. B. St. Clair, 1987.
(Reproduced by kind permission of the Wellcome Institute
for the History of Medicine).
r4p
IN Mo~vs IMPBTENTI~
vitaeT;.j. Styracis 3, ij. Laricez 3.n. Cerz q.Cfiat
vnguen turn.
Man&dein fepofitk emplalttis,fomentatio hat
adhibebatur: R.rad.Althele,Bryonia,lreos,Lilio.
rum 4 recentium, inciforum, de fingulis quantum
p&lum
vulgare caperet, Abfynthij, Thymi,Saluiz an.M.j.Aor.Ch~morn,Meli~~.Sambuci an.P.j.
feminumLiui,Focnog.ao.coch~~.vel quatuor,coz
quaotur in deco&.2ointefiinorum Capitis & pe.
dutnvituli,
addita pauco Vine : Atquein deco&o manusfoueat hgulis matutinis.
Interea licet omnia in melius tenderent,fpesri;
jntegra5 ri$itutionis
The Royal Victoria Infumary,
tame0,
quia tempus
Nfignis artifex lapicida quidam,faxumimmenfum voluer,s, aded tendines in finif& maaus
vola ad digitor, annularem & minimum definew
tes, ei attra&i runt, vt illi h vinculis quib.retinErur
laxati, rleuati+e, duaschordas fib cute ten& in
alwn referrent, contrafii4ue duo hi digiti S; at-
I
tra&i,poReahnpcr
Received: 12 April 1988
Mr. D. Elliot, F.R.C.S.,
upon-Tyne, NE1 4LP
effh,
pr&wm aderat , thermas difiantes procul, ma.
gno Iabore & fumptu, lacp & alp&us iuperatis,
adijt. Quorum vfu, digitiamphtis akingi potitis
relaxari caeperunt. Et c&min reditu lacum
num, naui traijceret, tanta vertigine car.
e@,cum vomicu ab initio, vt necaare net
GAerepoffet , fed le&ichve&us ad nos,indeG; do.
mum duceretur. Vnde manus iterum relblutat
lint. @arum curam poRea defperans, cdm etim
puderet,denuci meovti confilio,cuinonadfineln
uCqueparuerat,neglexit.
manferint.
Queen Victoria Road, Newcastle-
2A6
THE
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JOURNAL
OF HAND
SURGERY
REVIEW ARTICLE:
THE EARLY HISTORY OF CONTRACTURE
Hadrian’s wall (stretching across the northern border of
England) to suggest that it was the Romans, and not the
North Europeans, who brought this disease to northeast England. However, the Anglo-Saxon medical
writings available to us make no mention of the
condition, though the monks recorded treatments for
other hand conditions and of some recognisable diseases
of the skin and superficial tissues. The omission of any
reference to contracture of the palmar fascia may
simply be a result of the fragmentary nature of the
record which has survived. When life expectancy was
short, by comparison with today, the incidence of this
disease of late middle and old age may have been small
and the disease considered comparatively trivial. Had it
affected a younger age group, one might have expected
more medical interest and, possibly, discussion of it in
the social literature, as flexion contracture of the fingers
would have been more than a little inconvenient to
fighting men.
The prevalence of the disease in the Western Isles of
Scotland is acknowledged in the legendary “Curse of
the MacCrimmons”.
The MacCrimmons held land
from the clan MacLeod of Skye (themselves of Norse
descent) and were musicians to the chieftains of this
clan. They were recognised to be pre-eminent among
players of the bagpipes. At the end of the 15th century,
the 8th chief of MacLeod endowed a college of piping
on Skye under the tutelage of the MacCrimmons and,
for the next 300 years, the chiefs of the Highland clans
sent their young pipers to Skye for periods of several
years to perfect their skills. Much of the ancient pibroch
music which has survived to the present time came from
this school and was composed by the MacCrimmons.
The MacCrimmons were believed to have been cursed
with a condition which bent the little finger - the socalled “cruimein curse” - making the playing of the
bagpipes impossible, for the little finger of the right
hand is singularly important in playing this instrument.
It is assumed that this curse must have been
Dupuytren’s disease, and not camptodactyly, since it
affected accomplished, and therefore mature, adult
pipers. The origin of the family and of the curse are lost
in the mists of time and no member of the clan now
survives. The available records in the Scottish National
Library contain no factual evidence that any of the
major figures in the clan suffered from this curse.
However, these records are also fragmentary in that
they only detail the lives of the best pipers of the family,
for the best piper of each generation would have been
selected as head of the family (in accordance with the
Celtic principle of Tanistry, whereby the successor to
this position was chosen by family election and not by
descent). In a society in which Dupuytren’s disease was,
and is, common and in which pipers stood second only
to the chieftain (a relationship which altered only after
the defeat of the Jacobites at Culloden, when the
VOL. 13-B No. 3 AUGUST
OF THE ?ALMAR
FASCiA
Heritable
Jurisdiction
Abolition
Act of 1747,
introduced to abolish the clan system, degraded pipers
“to the level of ordinary
musicians”),
it is
understandable that affliction of these men, with the
associated loss of their prestigious position, would have
been a matter of some note. The incidence of the disease
among pipers would have become correspondingly
magnified in the eyes of the local populace. Just as all
the pipers of the MacCrimmon family were unlikely to
have escaped the condition (by virtue of their ancestry),
many of today’s pipers have been similarly afflicted and
Dupuytren’s disease remains common among pipers, to
whom it is still known as the “Curse of the
MacCrimmons”.
However, there is no evidence that
they are more prone to this disease than any other of
their clansmen.
Another interesting but unsubstantiated relationship
is that of the hand of benediction and Dupuytren’s
disease. Illustrations of Dupuytren’s disease by the hand
of a saint are common: La Main de ieu from the church
of San Clement de Taul, in Catalonia, adorns the most
recent version of the G.E.M. monograph and the Manus
Apostolicus from the monastery of San Bruno, in
Terassa, Spain, illustrated an article by Dr. Juli
Bruner on Dupuytren’s disease in 7% Hand in 1970.
recent discussion of this subject by Dr. Redfern (1986),
in a correspondence newsletter of the Ameri.can Society
for Surgery for the Hand, dismissed the suggestion that
an early Pope who suffered from Dupuytren’s disease
might, by force of character, have stamped his own
disability on the church for all time. She explained how
the raised hand of benediction is represented differently
in the Western and Eastern traditions of Christian art,
the Greek form being more explicit in that the fingers are
held in the position of the letters IC XC, abbreviated
from IHCOYC XPICTOC or Jesus Christos. The Latin
form is less easily explained. She supports the theory that
its origin is much older than Christianity, and probably
represents the superimposition of a oman gesture,
from earlier times, on the Christian church, with the
adoption of this religion by the Empire in the 4th
century. This view is reinforced by a 4th century
representation of Pope Xystus II (257-258 A.D.) on a
gold glass, in the Museo Sacro in the Vatican: the Pope
faces another man called Timotheus whose hand is held
in the position of benediction, indicating that the
symbolic gesture was already in use at this early stage in
Church history. When this ornament was made, the
Church of Rome had barely survived the most
systematic attempt to destroy Christianity which the
Roman state ever mounted, namely the persecution of
the emperors Decius, Aurelian and Diocletian (Xystus
himself was executed with the whole diaconal college in
August 258). The bishops of Rome were struggling to
gain ascendancy over the great eastern sees of Antioch
and Alexandria: the period seems an unlikely setting for
1988
247
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D. ELLIOT
the origin of religious symbolism. The temporal power
of the papacy only became a significant feature in
European politics from the reign of Gregory I (590-604)
and the imperialistic Popes, such as Gregory VII
(1073-1085), Innocent III (1198-1216) and Boniface VIII
(1294-1304), were many centuries too late to have
imposed any deformity of the hand which they might
have suffered upon the Church.
A further feature of the hand of benediction which
makes the Dupuytren’s disease theory of origin unlikely
is the great variation of hand postures recorded in
religious art throughout the ages: the exact positions of
the ring and little fingers differ considerably, as can be
seen in the illustrations mentioned above and by
examination. of other early ecclesiastical statues and
paintings. For example, the dominant hand posture of
many of the statues in the cathedral of Notre-Dame in
Paris is more like the clawed hand of ulnar palsy than
that of Dupuytren’s disease. In contrast, the blessing of
the present Pope is given with an open hand held
sideways to the audience, with very little exaggeration of
flexion of the little and ring fingers. Whatever the truth,
it enhances the association that a statue of a saint, with
his hand held appropriately, adorns the church which
has replaced the house in the Place du Louvre which was
occupied by Dupuytren during the latter part of his
professional life.
The advent in Europe of the anatomist-surgeons of
the late 18th century sparked a revolution in surgery.
What had happened before is reflected in Cruveilhier’s
criticism of their predecessors as having seen many
diseased people but almost no diseases. The massive
determination
of the new men to explain their
observations of both normal and abnormal bodily
functions by morbid dissection is the foundation of
modern surgery. Foremost among these were the Hunter
brothers, and John Hunter is considered to be the father
of British surgery. Surprisingly, the voluminous works
of the Hunters contain few preparations of diseased
hands and none of contraction of the palmar fascia.
However, it was one of John Hunter’s pupils, Henry
Cline senior, who first dissected a hand with this
condition in 1777 and described its treatment by palmar
fasciotomy soon after.
Though little-known today, Henry Cline was a
prominent medical figure in London in his time. He was
born in 1750 and was apprenticed at the age of 17 to
Thomas Smith, surgeon to St. Thomas’s Hospital. On
the death of Thomas Else in 1781, Cline was appointed
Lecturer in Anatomy and Surgery to the hospital. Three
years later, he succeeded Smith as consulting surgeon to
St. Thomas’s. Cline dominated this hospital for 30
years, at a time when it was predominant among the
London hospitals, and his teaching played an important
part in the spread of the new discipline of surgery
throughout England. In 1811, at the age of 61, he retired
from his teaching appointment and, in the following
year, resigned his clinical post in favour of his son.
Having been appointed to the Court of Assistants of the
Surgical Company in 1796, he continued to serve on the
Court of the new College of Surgeons of England from
its inception in 1800. He was a member of the Court of
Examiners in 1810 and Master of the College in 1814. He
served as President of the College in 1823 (the title of
Master having been changed to that of President in
1821). He delivered the Hunterian orations in 1816 and
again in 1824. He died in 1826 at the age of 76.
Cline senior was a fervent supporter of John Hunter at
a time when the surgeons of London mostly considered
the latter’s manners uncouth, his speech archaic and his
lectures boring. Cline had scant respect for Else, his
predecessor in St. Thomas’s, and is reputed to have said,
on first hearing Else lecture, that “he thought he should
soon be able to do better than that”. By contrast, after
attending Hunter’s first course of lectures in 1775, Cline
wrote:
“Having heard Mr. Hunter’s lectures on the
subject of disease, I found them so far superior to
everything I had conceived or heard before, that
there seemed no comparison between the great
mind of the man who delivered them and all who
had gone before him.”
Whether this respect was mutual is not recorded. An
anecdote related by Palmer, in his Works of John
Hunter, F. R. S. (1835), says something of their very
different temperaments:
“The late Mr. Cline once excited his [Hunter’s] ire
by an offence of this kind. He had engaged Hunter
to meet him in consultation on a case in the
afternoon, but in the course of his morning rounds
saw another patient, respecting whom he wished to
take Hunter’s opinion, and accordingly, without
giving him previous notice, appointed to call with
him after the former engagement was ended. When
the first visit was over, Cline mentioned the second
appointment, on hearing of which Hunter got into
a towering passion, and asserted that Cline had
acted in the most unjustifiable manner in thus
deranging the whole of his arrangements for the
afternoon.”
Though Cline’s contribution to the expansion of
surgery in his time was by no means modest, perhaps his
most lasting influence on the development of the
speciality in England was as a link between John Hunter
and Astley Cooper. In 1784, the wayward Cooper was
sent by his parents, who despaired of his ever settling to
any profession, to his uncle, William Cooper, then
senior surgeon of Guy’s Hospital. At the time Guy’s and
St. Thomas’s hospitals were closely associated (and were
known as the “United Borough Hospitals” or the
“United Hospitals”) and William Cooper lodged his
nephew with Cline, newly appointed to the staff of St.
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REVIEW ARTICLE: THE EARLY HISTORY OF CONTRACTURE OF THE PALMAR FASCIA
Thornas’s. The younger Cooper quickly caught Cline’s
enthusiasm for anatomy, surgery, and for John Hunter.
He established a pace of work, both in the clinical
practice of surgery and in anatomical research, which,
continuing as it did for nearly 60 years, until shortly
before his death in 1841, was phenomenal. What Hunter
lacked in good manners and as an orator, the handsome
and pleasant Cooper possessed in abundance. His
industry and gift of communication were to extend and
spread Hunter’s work and philosophy in a manner of
which the dour Scot had himself been incapable.
In 1789, after an apprenticeship of five years, Cooper
was invited by Cline to share his lectures. This
partnership dominated surgical teaching in London for
22 years and, on the retirement of Cline in 1811, Cooper
continued to lecture with Cline’s son until the premature
death of the latter in 1820. However, Henry Cline junior
was a poor substitute for his father and was said to have
been a shy, sickly man and a monotonous lecturer.
Cooper frequently paid tribute to his teacher as the
origin of ideas which he, Cooper, popularised. He
dedicated his celebrated treatise on hernias to his
“Master in Surgery, Henry Cline” and asked that Cline
assist him in performing the operation on King George
IV of England for which he himself was knighted. The
King is reputed to have said “Well, I respect Cline and I
dare say he respects me, although we do not set our
horses together in politics”; (Cline was well-known to
have Republican leanings at a time when sympathy with
the new regime in France would not have found favour
in English court circles). Cooper is said to have
graciously handed the scalpel to the older surgeon to
complete the operation: Cooper’s own description is
slightly less gracious, “On the side on which Cline stood
I begged him to detach it which he did but it took up a
great deal of time on the whole”, and indicates a degree
of irritation which is inconsistent with Cooper’s image
in history and suggests that he had forgotten that Cline
was, by now, 71 years old and had been retired from
clinical practice for ten years! Sadly, the controversy
which led to the split of the United Hospitals (which was
precipitated
by a difference of opinion over the
appointment of Cooper’s successor) also led to the
estrangement of these two great friends.
Though Cooper was eventually to eclipse his mentor
and Cline’s name has submerged beneath those of
Hunter and Cooper, it was nevertheless Cline who first
recognised the true nature of the condition now known
as Dupuytren’s disease. In 1777, by coincidence the year
of Dupuytren’s birth, he dissected two cadaveric hands
with this contracture of the fingers. The entry in his
note-book (Fig. 2) records the involvement of the
palmar fascia and the effect of dividing it. He
recognised the disease as one of “laborious people”. In
one of his dissections, the disease involved all the
fingers. The record of his long career as a lecturer in
anatomy and surgery is fragmentary and the earliest
indication that his observations were passed. on to his
students are the lecture notes of Thomas Smart in 1787
(Fig. 3): here, Cline proposed an operative cure (by
palmar fasciotomy) though he had not performed the
procedure at this time. Smart also records Cline’s
description of traumatic cure of the disease by sudden
extension of the fingers. This has subsequently been
reported “for the first time” on two occasions: in 1879
by William Adams, the leading figure in the surgery of
Dupuytren’s disease in the second half of the 19th
and much more recently
by Grace,
century,
McGrouther and Phillips (1984).
Only a few of the preserved notes from the
Cline/Cooper lectures of the period 17841811 mention
the finger contracture and then only as an aside in a
lecture series which, though expanding each year, was a
fairly standardised course of anatomy and surgery,
Having recognised the nature of the disorder and
devised a treatment for it, their discussion of it is
dismissive, suggesting that it was little more than a
curiosity in their clinical practice. Thus, the lecture
notes of John Windsor, who came to London from
Manchester to learn his trade from the surgeons of the
United Hospitals and from Abernethy of Rarts. and
later returned to his native city as a surgeon to the Eye
Hospital, described the state of the art in 1808. After a
brief description of the anatomy of the palmar fascia,
the lecturer, Henry Cline junior, comments that:
“One or more of these tendinous columns of the
aponeurosis
palmaris
sometimes
becomes
contracted and thickened; most generally one only
but sometimes
more,
and
is affected,
proportionally so many fingers are bent into the
palm of the hand. The treatment is easy and
efficacious; it consists in cutting through the
aponeurosis with a common knife. In performing
the operation, carefully dissect through, fibre by
fibre, the aponeurosis palmaris, in order to avoid
the blood-vessels and nerves beneath; the finger or
fingers may be kept extended afterwar
splint, for the flexor muscle has in some degree
become shortened, and without this the disease
might be reproduced.”
There follows a brief discussion of the differential
diagnosis from Volkmann’s ischaemic contracture.
Cline echoes Plater’s description of the stone-mason’s
hand, reiterating what is the clinical hallmark of
Dupuytren’s
disease: “. . . the latter (aponeurosis
palmaris) feels like a very hard cord raising the skin.. .”
He then adds “... but the flexor are too low to start
thus, and are also bound down by the ligamenturn
annulare”, so excluding the flexor tendons from further
involvement in this disease in England.
Cooper, writing again of this condition in 1822, was
equally brief, but, perhaps, considerably more astute
VOL. 13-B No. 3 AUGUST 1988
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D. ELLIOT
Fig. 2
Henry CIine’s note-book, 1777.
(Reproduced by kind permission
of the Library of St. Thomas’ Hospital Medical School, London).
than has been realised. In a chapter on dislocations of
the fingers and toes in his book A Treatise on
Dislocations and Fractures of the Joints, Cooper wrote:
“The fingers are sometimes contracted in a similar
manner (he had been discussing the treatment of
hammer toes) by a chronic inflammation of the
thecae (the flexor tendon sheaths) and aponeurosis
of the palm of the hand, from excessive action of
the hand, in the use of the hammer, the oar,
ploughing,
etc. etc... When the thecae is
contracted, nothing should be attempted for the
patient’s relief, as no operation or other means
will succeed; but when the aponeurosis is the cause
of the contraction, and the contracted band is
narrow, it may be with advantage divided by a
pointed bistory, introduced through a very small
wound in the integument. The finger is then
extended, and a splint is applied to preserve it in
the straight position.”
(In the paragraph which follows, he describes the
successful conclusion to an operation on a Lincolnshire
farmer by his nephew, Bransby Cooper: this paragraph
ends with the comment “... he perfectly recovered the
use of his foot” which is confusing unless interpreted as
a return to the main topic of this section of the chapter,
viz. the surgical correction of hammer toe.)
Cooper’s discussion of the treatment of Dupuytren’s
disease was to be misquoted again and again in the
French literature, first by Dupuytren and then by those
who followed him, as an absolute statement that the
disease was incurable. In fact, Cooper had realised,
presumably as a result of long clinical experience (this
description of the management of the condition was
written 14 years after the lecture recorded by John
Windsor), that only disease of the palm was amenable
to fasciotomy and then only if the bands were narrow.
Surgery of the hand was undertaken at that time only
when injury and infection demanded attention. Without
anaesthesia, and with death from sepsis a not infrequent
sequel to surgery, there can have been few candidates
for elective hand surgery and few surgeons willing to
attempt more than the smallest of procedures. This may
explain the seeming lack of interest of the London
surgeons in this condition, and the limitations which
they set on the use of surgery for its cure.
It is of interest to speculate on why Dupuytren was
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REVIEW ARTICLE: THE EARLY HISTORY OF CONTRACTUREOF THE PALMAR FASCIA
Fig. 3 Notes of Thomas Smart, student, from a lecture by Henry Cline, 1787.
(Reproduced by kind permission of the Library of St. Thomas’ Hospital Medical School, London).
unaware of this work by the surgeons of the United
Hospitals, when most of the surgeons in England had
probably heard, directly or indirectly, of Cline’s
treatment of the condition, and when Astley Cooper
and Dupuytren communicated with and visited each
other on several occasions during the period which
preceded the latter’s famous lecture of 5 December
183 1, (Fig. 4). In this lecture, he admitted to having seen
30 or 40 cases himself over the previous 20 years of
practice. That he did not treat these surgically suggests
that, as he stated, he was unaware of the true cause of
the contracture before 1831. In 1822, he was the senior
editor of the second edition of Sabatier’s Mddicine
Opkratoire. Though he used this publication
to
introduce his classification and management of burns,
and discussed at length the treatment of the burned
hand, he made no mention of contracture of the palmar
fascia. He would have been conversant with the Trait4
des Maladies Chirurgicales, the massive work in eleven
volumes written by his first patron and teacher, Baron
Alexis Boyer, personal surgeon to Napoleon Bonaparte.
This work remained the main surgical text in France
until supplanted by the teaching of Dupuytren himself,
in the Lepns Orales..., in 1832. In the eleventh and
final volume, written in 1826, Boyer summarised French
surgical opinion of that time: he attributed this
VOL. 13-B No. 3 AUGUST
contraction of the fingers to a drying, harclening and
stiffening of the flexor tendons and the overlying skin, a
condition
which had been called “Crispatura
Tendinum”
by earlier writers. (Boyer has been
frequently misquoted as the source of this descriptive
Latin phrase: in keeping with most of his Trait&,which
was an aggregation of current surgical opinions rather
than a treatise of original ideas, the phrase was not
Boyer’s nor did he lay claim to it.) That Dupuytren
expressed no contrary view to the theory of Crispatura
Tendinum suggests that, in 1826, he concurred with the
popular view of the condition in Paris.
Whereas Dupuytren worked in an environment in
which the newly-introduced
medium of medical
journalism had flourished to the extent that Paris had at
least three weekly and two monthly medical journals,
Cline belonged not only to a different generation but
also to a less medically cosmopolitan city: even by 1830,
London had a much smaller medical press. Chne’s active
surgical life largely pre-dates medical journalism. He
wrote virtually nothing: his medium was the lecture and
it is only through the notes of his students and the
writings of his younger contemporaries,
particularly
Cooper, that his work is known It is likely that the only
knowledge Dupuytren had of Cline was that gleaned in
conversation with Cooper, In an era of great surgical
i988
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D. ELLIOT
“ Sir Astley’s
Episode
for
a
Guy’s
Pageant.
fame was European, so that distinguished foreign surgeons never failed to visit him at the
. . . . When he took leave he s&l tted
Hosp ital. We read of Dupuytren going round the wards with him.
the Mrorthy baronet on each cheek. The manner in which Sir Astley submitted to the ceremony affordedI no
small amusement to the pupils standing round.“--Wxrxs
AND BETTAKY’S HISTORY.
Fig. 4
DWUJrtren’s visit to
(Rel:produced by
Guy’s Hospital, London, in 1826.
kind permission of the Editor of the Guy’s
Hospital Gazette).
THE JOURNAL OF HAND SURGERY
252
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REVIEW ARTICLE: THE EARLY HISTORY OF CONTRACTURE
discovery with these two men pioneering the
treatment of aneurysms, Dupuytren the first to resect the
lower jaw and Cooper performing a hind-quarter
amputation (without anaesthesia) in 35 minutes - the
two men must have had so much to discuss that Cooper
may have forgotten even to mention this condition of the
hand about which he was consulted little, on which he
operated even less and for which the treatment was
considered to be “easy and efficacious.”
This paper is based on the first part of the Essay which was awarded the
Pulvertaft prize of the British Society for Surgery of The Hand in 1987. The
second and third parts will appear in our next two issues.
References
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Contraction). London, J. & A. Churchill, 1879: 11,
BOYER, A. Trait4 des Maladies Chirurgicales, Volume Il. Paris, Migneret,
1826: 55-56.
BROCK, R. C. The life and Work of Astley Cooper. Edinburgh, E. & S.
Livingstone, 1952.
BRUNER, J. M. (1970). The dynamics of Dupuytren’s disease. The Hand,
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CLINE, H. (Senior) Notes on Pathology and Surgery, Manuscript 28, London,
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OF THE PALMAR FASCIA
CLINE, H. (Junior) Notes of John Windsor (student) from a lecture by Henry
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VOL. 13-B No. 3 AUGUST 1988
253
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