RT Journal
A1 Nusynowitz ML
T1 HOlmesian observation without deduction
JF JAMA
JO JAMA
YR 1969
FD September 29
VO 209
IS 13
SP 2056
OP 2057
DO 10.1001/jama.1969.03160260060023
UL http://dx.doi.org/10.1001/jama.1969.03160260060023
AB To the Editor:— 
    At the risk of sustaining a compound fracture of the radius and ulna from patting myself on the back, I would like to relate an incident which points out that despite the sophistication of modern medical equipment, the eyeball, properly used, remains an excellent diagnostic tool.A 40-year-old drug company detail man presented at the Endocrine-Radioisotope Clinic, William Beaumont General Hospital, to expound on the virtues of his wares. One good look and a handshake led to the inescapable conclusion that the gentleman was suffering from acromegaly; subsequent laboratory and radiologic studies confirmed the diagnosis. Questioning revealed that he had difficulty with his bite because he thought the lower teeth were moving forward and that his hands and feet had been enlarging over the years.From the duration of symptoms and a review of old photographs it was determined that the (now) patient had had the disease