Correct Methods Of Making Diagnosis Of Stomach Ache
( Originally Published 1936 )
We have been discussing in detail the dangers inherent in the household management of what is often contemptuously referred to as "an old-fashioned stomach ache (or belly ache)."
"Well, what then," asks the exasperated amateur family diagnostician and drug dispenser, "would the professional diagnostician do?"
A fair question, and here is an attempt at a fair answer.
In the first place, the modern physician recognizes that the ordinary acute discomfort in the general region of the midline is very likely to be something serious—acute appendicitis, gallstones, kidney stone, a strangulated hernia, intestinal obstruction, perforation of a stomach ulcer, peritonitis or acute pancreatitis. Perhaps even distant organs—the heart, the lungs, the spinal cord—may be the real seat of the trouble, and the pain a referred one. Granted that all these put together do not occur as frequently as those minor upsets of intestinal irritability from indigestible food or food poisoning which might be classified as old-fashioned belly ache, still the first four at least are very common diseases, and so serious that no chances should be taken. So the careful diagnostician always takes them into account.
With that in mind he first inquires into the story of the attack. Each of these conditions has its characteristic mode of onset, its symptoms are a little different from the others. The location of pain, whether it is continuous or colicky, whether accompanied by nausea and vomiting or diarrhea or locked bowel—the answer to each of these tells its story. They are far more significant than what the patient has been eating lately. Then the history of previous attacks of a similar nature is valuable—appendicitis, gallstones and kidney stones are all likely to be recurrent.
After that, probably the most important thing to know is whether the patient has a fever—appendicitis should in most instances create a fever. Examination of the abdomen itself should reveal by the tenseness or laxity of the muscles whether serious trouble is brewing underneath or not.
A count of the white cells of the blood is never neglected by the experienced physician in such cases. This procedure, which the ingenuity of many men has made quite simple by this time, is designed to show whether infection of a certain kind is at the bottom of the disturbance.
If certain germs are present, or certain structures are invaded, the infection is combated by the white cells or phagocytes of the blood. These cells are the soldiers of the body. They engulf and destroy germs. In times of peace—that is, in times of health—these soldiers stay in barracks. A few patrol the highways of the body—that is all. But when invasion threatens, all the reserves are called out, and the number of phagocytes in the highways is increased five or six times.
The diagnostician takes advantage of this. He takes a sample of blood and finds out how many are present. And just as you would decide if you saw a photograph of a city street and counted 500 soldiers to the block that this meant real trouble, so the diagnostician decides the same thing when he sees an extra number of these soldiers of the body in the blood under his microscope.