A Show of Hands

Nobody nowadays would seriously suggest limiting a medical examination to a look at the patient's hands, poked daintily through a curtain, as was once the case with high-ranking Moslem women. But, says the University of Pennsylvania's Dr. Theodore J. Berry, there is still much to be said for a show of hands. In a new book, The Hand as a Mirror of Systemic Disease (F. A. Davis Co., Philadelphia; $15), he reminds his colleagues that a variety of serious diseases can be detected by the study of a patient's hands.

Bowler's Thumb. Internist Berry's handbook is an up-to-date endorsement of old-fashioned observation. When a patient has hands with swollen-tipped, "clubbed" fingers, and if there is also reddish-brown coloration to the skin at the base of the nails, says Dr. Berry, the man is suffering from cyanotic heart disease. "Blue babies" (with Fallot's tetralogy) develop similar signs, but when surgery has sealed the leak between the right and left sides of the heart, the clubbing and the discoloration dramatically disappear. If the pigmentation is not present, the spatulate fingers are usually due to lung disease.

One of Dr. Berry's chapters would have delighted Sherlock Holmes, with illustrations of such occupational trademarks as cellist's callus (on the tip of the left pinkie) and bowler's thumb (with a thickened joint). But one anomaly, known among gypsy fortune tellers as "murderer's thumb," indicates nothing: a wide, short thumb and nail are found as often on professional golfers as on stranglers.

Blue, White & Yellow. Azure crescents in the fingernails sometimes mean that a patient is suffering from Wilson's disease, a disorder that causes copper to collect in the brain, liver and cornea of the eye, and results in progressive tremor. Addison's disease, a serious malfunction of the adrenal glands, shows up in yellow fingernails. Vertically ridged nails may be a sign of nerveroot damage. Liver trouble sometimes results in opaque white nails that will not change color even when squeezed.

The spider man in the freak show and the gangling giant on the basketball court may have a common bond. Marfan's syndrome, first recognized in 1896 by French Pediatrician Bernard-Jean Antonin Marfan, is marked by excessive long-bone growth; it gives people elongated arms, legs, fingers and toes, angular heads and faces. One of the surest signs of Marfan's syndrome is a condition known as arachnodactyly--a spidery hand with long, slender fingers of exceptional dexterity. Many such people succumb to some form of heart disease early in life. One suspected Marfan type who escaped this fate was Abraham Lincoln, who had the hands of a skinny giant.

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