Despite widespread and sometimes unnecessary use of numerous laboratory tests in day-by-day clinical practice, diagnostic methods that require no special apparatus and that depend only on simple observation can play an effective role in obtaining clinical information about patients. In this connection, the human hand is a unique organ from which an extraordinary amount of clinical information may be derived. According to Silverman and Littman,1 examination of the hand will often disclose interesting and occasionally revealing information about the cardiovascular status of patients. In a general way, the size of the hand is proportional to the rest of the body, and a rough approximation of the cardiac silhouette is obtained by examination of the size of the fist.2 Under normal conditions the outline of the fist and the orthodiagraphic silhouette coincide, a small fist usually indicating a small heart.
Excessive palmar sweating constitutes one of the more striking