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A Case for Diagnosis. Presented by Dr. A. Strauss.
P. S., a woman, aged 43, had had swelling and coldness of the hands for over twenty years, the hands and fingers being especially stiff in the morning. When she was first seen, in February, 1931, the hands were cold, red and puffy, and the fingers somewhat deformed, though she used them easily.
She had an operation on the right arm five years previously. She had abscesses of the bones in childhood. She suffered from flatulence, indigestion, pains in the middle of the chest and cardiac distress. Tonsillectomy performed seven years before had reduced the choking sensation.
The action of the heart was normal, and there was no history of paroxysmal asphyxia of the fingers. There was no progression of the condition. The skin of the dorsum was shriveled and atrophic, and the fingers were like pincushions, the region of the