. Physical diagnosis . Fig. 240—Rachitic deformity of leg bones. i. Gout, which is especially prone to attack the metatarso-phalan-geal joint of the great toe, producing all the classical signs ofinflammation. 2. Gangrene is usually the result of arteriosclerosis (see Fig. 241)with or without diabetes mellitus, but may result (as in the fingers)from arterial spasm or local asphyxia (Raynauds disease). 3. Perforating Ulcer.—In diabetes and sometimes in tabes atrophic or nutritional ulcer may develop in the toe or tarsus as a 436 PHYSICAL DIAGNOSIS result of nerve influences similar to those whi
. Physical diagnosis . Fig. 240—Rachitic deformity of leg bones. i. Gout, which is especially prone to attack the metatarso-phalan-geal joint of the great toe, producing all the classical signs ofinflammation. 2. Gangrene is usually the result of arteriosclerosis (see Fig. 241)with or without diabetes mellitus, but may result (as in the fingers)from arterial spasm or local asphyxia (Raynauds disease). 3. Perforating Ulcer.—In diabetes and sometimes in tabes atrophic or nutritional ulcer may develop in the toe or tarsus as a 436 PHYSICAL DIAGNOSIS result of nerve influences similar to those which produce Charcotsjoint or herpes zoster in the diseases just mentioned. It is calledperforating ulcer because of its stubborn progression despite a planof treatment that checks ordinary infectious abscesses. Actual per-foration is not often Fig. 241—Arteriosclerotic gangrene. 4. Tender toes after typhoid fever result from an infectiousneuritis. 5. Mortons disease (metatarsalgia) means pain in the tarsus ata small spot near the distal end of one of the three outer toes, alwaysassociated with compression of the foot by tight boots and probablydue to pinching of the external plantar nerves between the metatarsalbones. It is relieved by proper shoes. CHAPTER BLOOD. Examination of the Blood. The essentials of blood examination as a part of physical diagnosisare as follows: I. Hemoglobin test (Tallqvist) in all cases. II. Study of a stained blood film in most cases. III. Total leucocyte count (Thoma-Zeiss) in many cases. IV. Count of red corpuscles and Widal reaction in a few cases. V. Coagulation time, rarely. I will now give a brief account of each of these methods and of theinterpretation of the data obtained by them. /. Hcemoglobin. (a) The Tallqvist scale consists of ten strips of red-tinted papercorresponding
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