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A CLINICAL STUDY OF DISEASES OF THE CIRCULATION OF THE EXTREMITIES: A DESCRIPTION OF A NEW METHOD OF EXAMINATION

BARNEY BROOKS, M.D.; FRED A. JOSTES, M.D.
Arch Surg. 1924;9(3):485-503. doi:10.1001/archsurg.1924.01120090002001.
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There is, at the present time, no accurate method of estimating the extent of diminution in the circulation of the extremities, resulting from disease of the blood vessels. Furthermore, it is often impossible, by methods of examination now used, to determine whether or not actual circulatory disturbance exists. The absence of any of the clinical manifestations of circulatory disease, when a good pulse is present in all the large arteries and the color of the skin is normal, may be taken as conclusive evidence of normal circulation. The presence of gangrene or of even a marked blanching of the skin of an extremity is undisputed evidence of a deficient circulation of blood. Between these two extremes, however, are found the greatest number of instances of disease of the blood vascular apparatus, and, in these instances, it is impossible to estimate with accuracy the degree of diminution of circulation, and often

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