36 PERSONAL APPEARANCES IN HEALTH AND DISEASE. 



parts, as in the loose tissue under the eyelids. Many con- 

 ditions give rise to this, some depending on local disturb- 

 ances of the circulation, others on general blood conditions, 

 and thus it may be of grave and serious significance. 



Lastly, in the subjects of long-standing disease of the 

 heart or of the chest, there occurs often what is called 

 "clubbing" of the extremities. It is best seen in the 

 fingers, the tips of which become broad and rounded, 

 especially the soft palmar surface. But the same club- 

 bing may be seen at the extremity of the nose. In all 

 cases it is dependent on the slowing of the circulation 

 which takes place in such diseases, so that there is an 

 almost permanent condition of overfulness of the minute 

 blood-vessels of these extremities. 



CHAPTER III. 



CHANGES IN THE BONY FRAMEWORK. 



HAVING sufficiently alluded to changes in form produced 

 by alterations in the muscular structures (see p. 17 and 

 seg.), and in the fatty layer (see p. 24 and se#.) 9 we have 

 to consider now those due to alterations in the bones 

 and in the joints. Changes which occur in the shape 

 of the skeleton necessarily entail very marked deformity. 

 Some of these are the result of previous muscular failure, 

 others are due to affections of the joints, others to 



