A practical treatise on medical diagnosis : for students and physicians . t be confounded with enlargement on the right side due to an innomi-nate aneurism. (See Aneurism). The distinction can usually be madewithout difficulty. (For lymphatic glands of neck, see The Glands). The Vessels of the jSTeck. The large veins of the neck forman accurate clue to the state of the circulation within the veins. Theirclose proximity to the heart in the direct line which the blood takes to THE DATA OBTAINED BY OBSERVATION, 127 reach the heart causes other changes which indicate the state of thecirculation in
A practical treatise on medical diagnosis : for students and physicians . t be confounded with enlargement on the right side due to an innomi-nate aneurism. (See Aneurism). The distinction can usually be madewithout difficulty. (For lymphatic glands of neck, see The Glands). The Vessels of the jSTeck. The large veins of the neck forman accurate clue to the state of the circulation within the veins. Theirclose proximity to the heart in the direct line which the blood takes to THE DATA OBTAINED BY OBSERVATION, 127 reach the heart causes other changes which indicate the state of thecirculation in that organ. (For a description of these changes |seeArteries and Veins.) The observation of the thorax and abdomen will be considered undersections devoted to affections of the respective regions. The Extremities. The Hands. Color. Observations of thecolor of the hands is of service in estimating the general hue and colorof the individual, as changes are noted earlier in the distant points ofthe circulation. (See the Skin—color.) Shape. Changes in the shape Fig. Pseudo-muscular atrophy. Claw-hand. (Gray.) are pronounced in many affections. The spade-like hands of myxcedemahave been referred to, the peculiar shape of the hands in acromegaliaand pulmonary osteo-arthropathy described, and the appearance inrheumatoid arthritis also discussed. In piogressive muscular atrophy(chronic anterior myelitis) the shape of the hands is peculiar. TheFrench name main-en-grife is applied to it. Both hands are affected,although it may have begun in one before the other. From wastingof the muscles voluntary power is lost. The thenar muscles and theinterossei are the first to suffer. The thenar eminence becomes flat-tened, the base of the first metacarpal bone more prominent. Theatrophy of the abductor indicis is so conspicuous that the normalprominence near the thumb when it is adducted gives place to a hollowbeside the metacarpal bone. There are marked depressions betweenthe metacarpal b
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