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This examination is best carried out lying on the back with the knees well bent and held wide apart. With good light and a large hand mirror, the external vagina and its component parts can be visualized easily.

Fig. 111. Much of the female genital system, excluding the vagina, is within the abdomen. Only the vaginal entrance is visible externally, without the aid of instruments.

1. Examine the skin of the vulva, the labia majora and minora, surrounding and enfolding the entrance of the vaginal vault. Note any irritation, redness, ulceration, or sore on these skin structures, along with areas of drying, leathery whitening or skin cracking. These possibilities may mean leukoplakia or cancer of the vulva.

2. Feel the labia themselves, and note any one-sided ball-like enlargement under the skin, creating a bulge which may possibly be sore. An enlargement here may be a Bartholin cyst.

3. Look closely at the condition of the urinary exit, the dimpled-like opening just inside of the entrance into the deeper vagina. Observe any polyp-like reddened or bleeding growth about it. The possibility here is a urethral
polyp or caruncle.

4. Examine closely the entrance of the true, or deep vagina. An irritated blanched and cracking skin, covered possibly with a coating of pus or streaked with blood, is the appearance of vaginitis when it occurs.

LABIA MAJORA
CLITORIS
LABIA MINORA
ORIFICE OF VAGINA
URINARY OPENING

Fig. 112. External female genitalia include only the unimportant skin folds about the vaginal entrance. The urinary tract exit is visible recessed into this region. Most diseases of the external genitals are not serious.

5. With a hand separating the labia on each side, strain with great effort as in child birth or at stool, and note any balloon-like or other structure from the vagina coming into view. Such structures may be a fallen bladder, called a cystocele, a fallen uterus, called a prolapsed uterus, or a fallen rectum, called a rectocele.

6. After gentle soap and water cleaning of the vagina and hands, insert one finger into the vagina and feel the rounded cervix, high in the vaginal vault. Normally, the tissue here is soft and smooth, and any grossly rough, ir
regular or bleeding areas may include the possibilities of cancer or cervicitis.

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Cancer of the Prostate Gland. Cancer of the prostate gland behaves exactly like non-cancerous enlargement of the prostate, and is treated in essentially the same manner-removal of the gland. Cancer, however, which has a characteristic feel to the finger, and a distinguishing appearance under the microscope, can spread to other sections of the body, just like any other cancer.

There is divided opinion about the prevalence of pros-tatic cancer, but some authorities state that nearly one-half of all males over sixty develop cancer in the prostate, of a low degree of malignancy.

The treatment of prostate cancer in addition to its removal, includes the use of hormones effective in slowing these growths considerably. Obviously such treatment is very technical and can be obtained only through a physician familiar with prostatic diseases.

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Growths of the Prostate. One of the most common and troublesome difficulties for males beyond the age of fifty is non-

Fig. 109. The prostate gland’s tendency to enlarge with age can cause great difficulty with urination. Because the narrow urinary channel runs through the prostate, pressure from an enlarging growth may completely blockade the urine’s outlet. Surgical removal cures the condition.

cancerous enlargement of the prostate gland which creates urinating difficulties known the world over. Developing gradually from an unknown cause, the symptoms begin as a slow starting stream of urine, which becomes greatly weakened and at times even dribbling. There might be a full minute or more of waiting before urination commences, and the weak urinary stream is only a faint shadow of the forceful stream of urination known in youth.

The enlarging prostate not only obstructs the urinary flow, but also makes nearly impossible complete emptying of the bladder which, like a half emptied glass of water, is refilled quickly. This makes frequent urination necessary, sleep is interrupted possibly five to ten times a night. With each urination, however, only a small portion of the urine present escapes from the overfilled bladder and the urge to urinate quickly returns. Several aids of doubtful value, in common practice to encourage urinating ability, include the psychological benefit of running water from a nearby faucet and sitting in a tub of warm water.

Prostate growth difficulties often follow an uneven course, worse one day than another, but progressive worsening may eventually find these people unable to urinate at all, and a state of semi-emergency arises. At this stage a mechanical drainage of urine from the bladder must be done by introducing a small tube through the urethra into the urinary bladder, to provide an orifice for the escape of the entrapped urine.

The permanent cure of prostate hypertrophy, calls for the mechanical removal of the prostate tissue which is squeezing and obstructing the urinary channel. This operation, called prostatectomy, is usually done directly through the urethra itself, by means of a slender electrical cautery specially devised for this purpose. Removal of the prostate gland, properly done, restores urinary function as known in youth. This operation does not interfere with sexual relations, so far as erection of the penis is concerned, but it does usually render a male sterile. As most prostate gland operations are done after fifty or sixty years of age, sterility is usually not of great concern.

Fig. 110. Once the prostate gland is removed, the urinary stream again becomes forceful.

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Prostate difficulties

Infection of the Prostate. Most prostate infections are incurred during youth in the active sexual years and are caused

PROSTATE NORMAL

Fig. 108. The prostate gland has a minor sexual and hormonal function. The urine must pass through the prostate gland as through a worm hole in an apple. An infection or growth may close this narrow channel.

by gonorrhea and similar infections. However, in later years, prostate infections are more often due to focal points of infection, such as the teeth or tonsils. When the prostate gland harbors infection, it tends to spread, not only into the urinary tract, but to the rest of the body as well. In youth, or in later years, prostate infection is very stubborn and difficult to eradicate completely. It is often the underlying cause of arthritis and headaches, and complete cure of this infection becomes very important.

Treatment of prostate infections cannot be accomplished by drinking large amounts of water, flushing the kidneys or other simple remedies. The complete cure of these infections is often very difficult and time consuming, even for the experienced physician who must direct the patient through many weeks of scheduled treatment before effective cure is certain.

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Erection Difficulties. After the age of fifty, varying with the individual, erection of the penis, and sexual activity, are not as frequent as in earlier years. Unusual episodes through the years, such as accidents may also affect this function considerably.

As a result of trauma, scar tissue can form on the penis and a painful erection called Peyronie’s Disease may result. The scar tissue along one side of the penis will not stretch, and creates a curve in the penis of such magnitude that intercourse is difficult or impossible. The scar tissue in these cases is very dense, and is similar to the scar contraction sometimes seen in the palm of hard-working men. Because the scar tends to contract, and has no ability to stretch, erection difficulty becomes very great and requires considerable medical skill for any kind of satisfactory treatment.

An erection that is normal except that it is painful and unrelated to sexual function is known as priapism. This difficulty is often seen in the later years of life, and is usually due to some body disease which affects the nervous system, the blood, or the penis itself. The treatment of priapism demands careful and complete physical examination to determine, if possible, the bodily disease responsible for this and perhaps other conditions.

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Scrotal Hernia, Rupture into the Scrotum. Long-standing hernias or ruptures frequently descend into the scrotum and create enlargement of the scrotal sac. When standing or straining, the mass appears to fall outside of the lower abdomen, underneath the skin, and find its way into the scrotum, which then may balloon-up to the size of an orange or more. Usually these enlargements return to the abdomen when lying down, or when pressure is placed under the enlargement in the scrotum.

Hernia is an age-old condition that has been treated by numerous means. The simplest thing to do is to wear a truss, but they are often exceptionally cumbersome, frequently quite painful and usually limit the physical ability through necessary tightness of the truss.

A truss will not heal a hernia, and any such claim is misleading. It is common to find men who have worn a truss twenty or more years in an attempt to “fix” their rupture, but they finally realize the hernia has been slowly enlarging all along. Only a few who wear a truss for hernia, are satisfied with the end results.

Other treatments for hernia have been injections of various waxes and sands into the hernia itself. This form of treatment has had occasional success, but more often produces undesirable results or makes the hernia condition even worse. Fortunately, these practices are almost extinct today.

Surgical operation for rupture is most satisfactory. There is complete healing, complete comfort, and a strengthened body wall usually follows the hernia operation. It is thought, that within six months of a surgical hernia repair, the repaired region will have grown stronger than the same region of the average person. These operations are not completely fool-proof, but it is by far the most satisfactory treatment available for hernia.

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Testicle Diseases-Absence, Pain, Tumors. Absence of the testicle at any age is nearly always a physical defect, present since childhood. It is usually an undescended testicle, which has remained unnoticed in the abdomen. Many men with just one external testicle have fathered several children, and have noticed no lack of virility through the absence of one testicle.

The atrophic, smaller size of one testicle, often noticed in adult men, is most often the result of serious virus infections in childhood-especially mumps. The smaller sized testicle remains the same throughout life, but has no significance so far as male hormone, virility, or sexual ability is concerned. The affection of both testicles in this manner, however, usually renders a man sterile.

Pain in the testicle is quite common, because it is a very sensitive organ, and trauma or other pressure causes immediate and severe pain. The sudden onset of unexplained severe pain of the testicle however, usually heralds an infection within the testicle or its tract, the epididymis, especially if accompanied by a mild blood discharge from the urethra. The infected testicle sometimes produces a bloody discharge, and its severe pain is markedly increased by any pressure, jarring or slight trauma. The pain forces the patient to drop his work and seek effective treatment. After diagnosing the difficulty, the physician may prescribe antibiotics, ice bag coverage, and occasionally incision and drainage in a surgical manner.

Tumor growth of the testicles, other than water cysts, are not very common after the age of fifty years. Most growth of the

Fig. 107. Scrota I hernia is simply a large ordinary hernia in the male. The protruding hernia mass, often the intestine, descends into the scrotum which may become the size of a football.

testicles that are cancerous in nature, are found during early youth and adolescence but there is no guarantee, that a growth of the testicle will not occur in the later years of life. Because of this, any growths or enlargements of the testicles, whether they be painful or not, should command an early visit to the physician for an examination.

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Cysts, Hydrocele, Spermatocele. Hydrocele and spermatocele, commonly called water cysts, occur frequently in the male genital tract. They are felt in either side of the scrotum as a smooth, balloon-like enlargement, which slowly may enlarge to the size of a lemon or orange. Although these cysts are usually painless,

Fig. 106. Hydrocele or water cyst of the spermatic cord presents a smooth, soft enlargement above the testicle. In a dark room, light shines through it easily, distinguishing it from other scrotat difficulties.

they frequently become a nuisance because of their size and location about the testicles.

The so-called water cysts, in the scrotum on the cord of the testicles, can easily be identified in the following manner: In a dark room, a flashlight is placed against the back of the scrotum, so that its rays shine through the scrotum. Water cysts will illuminate readily, whereas, the solid testicles or possibly other growth, appear as dark, non-illuminated masses.

Hydrocele is not a condition leading to malignancy or serious disease. A needle may be used to drain the enclosed fluid of the cyst for temporary relief, but afterward, the fluid nearly always reforms to fill the cyst again. The cysts are readily removed by simple surgical operation for lasting and satisfactory results.

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Chancroid-Ducrey Infection. Chancre-like sores on the penis and other parts of the body, often thought to be syphilitic in nature, are sometimes caused by non-venereal types of bacteria and organisms such as the Ducrey bacillus. There are other infective types of penile sores, sometimes closely resembling chancres, but not due to any particular bacteria, and thought possibly the result of simple chronic irritation.

Cancer of the Penis. Malignant growths of the penis are not common but they do occur occasionally and usually after the age of fifty. They appear most often on the head of the penis and are sometimes thought caused by chronic irritation from the contracted fore-skin of phimosis, mentioned previously. Cancers can start in a very unsuspicious manner, and are usually blamed on some coincidental and trivial accident. They may also be mistaken for syphilis or some simple infection, because in this region, cancers may look like sores in any other region of the body. Like all cancers however, they differ in one respect they do not heal. They may also be somewhat painful, have a tendency to bleed and to enlarge rapidly.

Cancer of the penis differs from many other cancers in one important distinction. It travels extremely fast and can spread throughout the body at a very early stage. Therefore, any sore on the penis, should be seen by the physician. This is especially true after the age of fifty, because it is only through very early diagnosis that effective treatment of cancer of the penis can be obtained.

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The male genitals are beset with a definite group of difficulties. Some of them are common in both young and old, but most of these troubles occur after the age of fifty. They may arise from infection, the physical state of the genital organs, malignant and non-malignant growth, erection difficulties and urinary problems due to prostatic disease.
Infection of the Penis. Infection at the end of the penis often occurs because the fore-skin cannot be retracted to expose the head of the penis for cleaning. This contracted and narrowed fore-skin, called phimosis, keeps the head of the penis wet, contaminated, and an ideal breeding ground for infection.

Infection of the penile skin may be due to scratching from fungus, louse, or bacterial infection. The dark, moist skin of the penis and groin invite not only infections common to skin all over the body, but also the fungus infections which seek damp, dark skin areas in which to breed.

Fig. 105. A penile sore usually brings up the question of venereal disease. However, the penis may be afflicted with skin diseases found anywhere on the body. It is only logical to wash hands before, as well as after, touching this organ.

A widely known infection inside the penis is gonorrhea, often called by other names. This infection can be acquired at almost any age, but usually from just one source-sexual relations with an infected person. The disease produces copious amounts of pus draining out of the urethra, starting about a day after sexual intercourse. The pussy discharge and accompanying burning urination last about one week, but will respond rapidly to the physician’s administration of the proper antibiotic.

Chancre of Syphilis. Syphilis, the venereal disease, down through the ages has been heralded by the chancre, a shallow, ulcerated, painless sore on the penis, which lasts two to three weeks. It develops about two weeks after sexual intercourse with an infected person, as a small pimple or boil, which soon breaks down into the shallow painless ulcer. Syphilis is then a systemic disease, with the causative spirochete circulating in the blood, in the salivary secretion, and in other parts of the body, and a blood test will show a positive serology to establish the definite diagnosis of syphilis.

Drugs now available are extremely effective in the treatment and cure of this disease, when properly administered by a physician, but repeated checks are desirable to determine the effectiveness of treatment.

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The Genital region

The genitals of both sexes are of great interest in later years. What can be expected as normal sexual activity after fifty seems almost a hidden question and an understanding of male and female physical problems is difficult to obtain.

Examination of the Male Region

Examination of the external genital system in the male requires only privacy, a well-lighted room which can be darkened, and a small flashlight.

Fig. 104. The male genital organs and urinary system are closely associated; while in sexual use, the urinary function of these organs is temporarily blocked. Because the testicle cannot function at body temperature, it is located outside the scrotum where temperatures are lower.

1. Examine the head of the penis for any reddened irritation or pus, after the prepuce skin is pulled back. Also observe any discharge of pus from the urethra, when the penis is squeezed gently. These findings possibly indicate internal infection of the penis or prostate.

2. Examine the entire skin of the penis and scrotum. Note here, any open sore, whether or not it is painful. These
skin findings include the possible chance of syphilis, the Ducrey bacillus chancroid, an early cancer of the penis,
boil-like infections or large sebaceous cysts (blackheads).

3. Examine the scrotal sac, which holds the testicles, in a dark room, by stretching the scrotum over the lens of a flash light. Feel any painless enlargement in the scrotum above the testicles, through which light passes easily. Light transparent enlargements in the scrotum may mean hydrocele or water cysts.

4. Examine the testicles within the scrotum. One testicle is normally higher than the other, but notice any pain in either testicle with gentle palpation or squeezing. Note also any apparent shrinkage or any firm enlargement in one
or both testicles. Such findings might indicate the presence of testicular tumors, atrophy, or infection.

5. Examine the urinating ability. Determine if there is a lengthened period of time required before urination begins, and compare the force of the urinary stream with earlier years. Note also any burning during or just after
the act of urination. Hesitant urination and weakened or burning urinary stream may mean prostatic difficulties.

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Brown urine which turns black on standing contains the body pigment melanin and may mean a tumor growth in the body. Clear urine which turns black on standing or after drying on cloth might indicate the rare disease ochronosis, which produces a bluish-black pigment in the whites of the eyes and about the ears and nose. A blue color, an occasional reddish tint and even a yellowish green fluorescence in the dark, may occur from ingesting certain elements often used in laxatives and vitamins.

The normal urine forms a slight white foam when shaken moderately. If considerable foam forms, almost like a soap solution, there is probably protein in the urine, indicating disease. If the foam in the urine is yellow, it is probable again that bile has entered the urine. The odor of urine is characteristic, well-known and after standing for several hours, changes in the urine normally bring about an ammonia odor. An odor of sweet fruit in the urine is an indication of acetone and most probably means severe diabetes. A foul odor sometimes noticed in urine results almost entirely from infection.

A simple test for sugar in the urine is tasting it. A drop on the fingertips, if tasted, usually reveals the presence of sugar. This of course, may mean diabetes, in which sugar is so frequently found in the urine. A matter of continual interest in the urine, is its acidity or alkalinity. In health the urine reflects the body’s normal acidity, exactly as it is in the blood stream and this measurement is routinely ascertained in laboratory urine analysis. When the body goes through punishing episodes, such as pneumonia or diabetes, the body itself becomes a trifle on the acid side and the urine responds by quickly excreting the excess acid to again bring the body acid balance back to its normal level. In other instances, especially in ulcer patients, the body may become more alkaline than is usual, because of long periods of alkaline medications for stomach difficulties. The urine then becomes distinctly more alkaline to again help the body regain its acid alkaline balance.

Personal testing of urine for acidity or alkalinity is now easily possible by using inexpensive litmus paper which indicates acid levels of urine through changes in its color. Most drug stores carry some form of litmus paper. These personal observations bring to light many abnormalities of urine but do not make a complete or definite diagnosis of certain disease. However, obvious abnormalities in the urine as described above, should not be overlooked through sheer ignorance, as such findings are clear warnings that something has gone amiss within the body and that it is time for the schooled study and opinion of the physician.

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The Urine

Through the ages, the urine has always been held in high esteem as an index of the body’s state of health. Its variations, amount, color, odor and clarity have meant many things to many men, but usually the importance of the urine as an indicator of disease, has been much over estimated. There are specific laboratory tests of many kinds, each designed to wrest from the urine a fact or two which may indicate certain forms of disorder to the doctor schooled in medicine. These laboratory tests in medical circles are a study in themselves, but the person unschooled in medical ways can know several important facts about his health, with only an elementary study of urine.

The volume of the daily urine in the average adult is about one and one-half quarts, depending, of course, upon habits of fluid intake. This can be easily measured by a simple recording of the urine’s volume with the use of a quart bottle. At times a large increase in the volume of the urine results from over indulgence, overeating or perhaps occasional fleeting diseases. However, a constant large increase in daily urine amounts, far exceeding one and one-half quarts may indicate the possibility of certain diseases, especially after the age of fifty years. Some of these disease possibilities are uremia, hyperthyroidism, diabetes or simply nervous people drinking too much water.

The time of urination reveals that about four times as much urine is secreted in the daytime as during sleep. This is because most of the day happens to be waking hours rather than sleeping time, and also because drinking of fluids stops during the sleeping hours. Abnormally large amounts of urine may be encountered during the sleeping hours, and occasionally are found due to poor kidney function, or beginning heart failure, where collection of fluids within the body are held until a lying-down position is assumed.

The appearance of normal urine is clear, without any haziness or sediment which may float on the urine or settle to the bottom. When the urine is cloudy or hazy, this appearance may be significant of pus, blood, crystals, or bacteria themselves. Normal urine is straw colored, but it may change to nearly any color which is probably its most noticeable variation a person will observe. A red color is usually due to blood, coming from the kidney, bladder, prostate gland, or the testicles. This, of course, is a serious finding with possibly great significance. A deep yellow or brown colored urine frequently means bile in the urine. Bile enters the urine when a person becomes jaundiced, because bile intended for excretion into bowel matter is forced in to the urinary stream.

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Kidney Stones. A stone in the kidneys is fairly common and may occur in youth though it is more frequent in the senior years of life. Stones are caused by many different factors, some of which include faulty body metabolism of minerals like calcium, bone diseases, parathyroid disease and possibly kidney in-

Fig. 103. The genito-urinary system is concerned with regeneration and clearing impurities from the bloodstream. Kidney stones can produce pain from a mild ache to a knife-like horror, mostly felt in the back under the lowest ribs but possibly extending to the testicles. The, stones may remain “silent” for many years. The “water” system also is a very delicate balancing machinery, preventing acidity or alkalinity.

fections themselves. Pain of the kidney stone is most characteristic. It is usually a severe cramp-like pain, felt in back and traveling around to the front and down the abdomen, into the scrotum of the male, or the sides of the vagina in the female. Such pain is characteristic and practically diagnoses itself as kidney and urinary tract pain. Often at this stage, a stone in the urinary tract can be seen with the x-ray, and following the cramp-like pain, the patient may pass a gravel-like stone in his urine. If the stone cannot pass itself, it may be necessary to remove it surgically, with the size of the stone often determining what form of treatment is required. The prevention of kidney stones is most difficult, but in people who have already experienced such trouble, relief may be found in a way of life, eliminating certain foods and incorporating others in the diet. The physician must be consulted for treatment of stones or a risk will be present which possibly means a rapid deterioration of kidney functions.

Uremia. Uremia is a well-known disease caused by a failure of kidney function to clear out many waste substances which otherwise pile up in the blood and eventually produce unconsciousness and death. The disease is produced if the kidneys are suddenly lost as through an accident, but will also occur over a long period from diseases which slowly deteriorate kidney function. Uremia progresses as kidney function falls to less than thirty percent of its original ability.

Uremia is a difficult disease to recognize and also to treat. As it begins, its sufferers might appear sleepy, lethargic and mentally unbalanced. In its very latest stages, there often appears the characteristic uremic frost, a fine powdery snow or frost about the skin of the uremic patient. Long before this stage however, the person with uremia has usually lapsed into an unconscious state.

Treatment of uremia is very technical and possible only by the physician. It is diagnosable with accuracy only after definite laboratory tests have been performed to indicate the presence and extent of kidney failure. It is of interest that the disease uremia has become so well established as general knowledge in the minds of so many people.

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Nephritis. Diseases of the kidney tissue, itself due to infection or degeneration, frequently are termed nephritis or Bright’s Disease. This group of kidney diseases involves the tiny blood vessels, tubes and tissue of the kidney and produces toxins which circulate through the entire body. These infections usually due to the streptococcus bacteria, can range from a mild insignificant infection to one which is overwhelming and serious. Though they may start in youthful years, these infections may not present their most serious effects until later years when the kidney is possibly and suddenly found completely worn out by years of continuing infection.

Infections in the kidney of the nephritis group invite diseases of the heart and blood vessels, especially high blood pressure with its attending difficulties. Pain is sometimes absent, but frequently is felt in the back, just under the ribs on the affected side. Blood is usually present in a cloudy appearing urine, and fever is often the most prominent and obvious symptom. Treatment of kidney infection cannot be effected by advertised mineral waters or kidney pills, claimed to flush out the kidneys. Successful treatment of kidney disease demands expert and rigid medical therapy from a physician well versed in kidney diseases.

Pyelitis. Infection of the kidney’s urinary tract, called pyelitis, involves the “end” of the kidneys, after the urine has been formed. It usually is not found alone, but associated with infection of the entire kidney organ, and is often noticed by the sufferer himself who may find blood or pus in the urine and have considerable burning pain during urination. Pain of the kidney alone is often felt in the back and sides and to many people this type of pain identifies kidney pain.

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The Kidney

In the back of the abdomen lies the kidney, the main portion of our urinary system, designed to excrete from the body poisonous wastes along with excesses of water, salt, acids and other body chemicals. In health, the kidneys work silently and call no attention to their important functions, but disease causes them to cry out in the language of pain, fever, and bloody urine.

Fig. 102. The kidney may be seen in the posterior part of the abdomen if the intestine is removed. The kidney has six times enough function to support life, but total loss of kidney activity means uremia and death.

Kidney pain is most often felt in the back just under the lowest ribs, possibly extending around and down into the testicles. It varies from the mild ache of a slight infection to a knife-like horror in serious infection or in passage of a kidney stone.

Fever in a severe kidney infection often reaches 103 with severe chills, while a smouldering, long-standing infection may produce only a half-degree fever in the afternoons. When fever is due to kidney difficulties, urinary and other kidney symptoms are also present to help identify it.

Blood in the urine in minute amounts is usually not visible. In slightly larger quantities, however, it begins appearing as a smokey rust, and darkens with greater quantities to finally assume the color of blood itself. Passing blood may be only an isolated instance and perhaps entirely painless, but it is always of great significance and should be thoroughly and quickly investigated.

The kidney structure embraces a tremendous number of small blood vessels and any disease of the blood vessels, therefore, also involves the kidneys. This is particularly true of high blood pressure, hardening of the arteries and diabetes.

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Hernia Pain. Hernia or rupture may be hard to see in fat people and unknown to many others. Hernias present for a long time usually produce dull aching, but when they are just beginning, getting larger, or they cannot be reduced, soreness is often very great. It is usually the contents of the hernia like the intestines which produces pain, as the ordinary hernia, once formed, is practically painless.

General (entire) Abdominal Pain. Pain all over the abdomen

Complete abdomen

Fig. 100. The entire abdomen may be involved in spreading diseases like peritonitis, internal bleeding or gaseous distention.

may reflect infection or disease all over the abdomen, such as peritonitis or obstruction of the intestine.

Pain of Peritonitis. Peritonitis, as we have seen, is an inflammation of the abdominal or peritoneal cavity. When the whole cavity is inflammed, pain is felt everywhere; when the peritonitis is localized (confined to one area), the pain also is localized to that area.

Obstruction of the Intestinal Tract. Similar to the kink of a garden hose, an obstruction blocks the passage of the intestine. Pain is felt first as a cramp when the obstructing kink occurs,

Fig. 101. Obstruction of the intestinal tract is often a result of hernia. If the obstruction is severe, gangrene may follow, necessitating surgery as a lifesaving measure.

but soon the whole intestine may “balloon-up” and pain is felt everywhere. It later may develop into peritonitis.

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Pain of the Abdominal Wall (Shingles). As in the chest, shingles pain may suddenly appear in the abdominal wall. The typical burning pain is often thought to be appendicitis or other internal disease. The appearance of the rash along the painfully involved nerve route makes identity of the pain obvious.

Lower Abdominal Pain. Abdominal pain below the umbilicus, in later life, will generally be due to the colon, appendix, ovary, uterus, bladder and hernia. Pain and discomfort due to

Lower abdomen

Fig. 99. The lower abdomen is below the umbilicus down to the groin. Difficulties here include hernia, appendicitis, colon disease and troubles with the urinary tract.

the menstrual cycle, of course, are no longer present after the change of life.

Pain of the Colon and Intestinal Tract. Pain from the large and small intestine is identified by the cramp, a pain felt every few minutes-the typical pain of intestinal origin. Often called gas pains, it ranges from slight discomfort to severe anguish, with a measure of relief in between cramps. These pains are felt below the umbilicus and above the groin and will be readily identified as pain of the intestine when the characteristic cramping is remembered.

Appendicitis produces discomfort more than real pain when it begins. It is felt about the umbilicus and is nearly always accompanied by nausea and vomiting. After a short time (8-12 hours), the pain moves into the right side, fairly low in the abdomen and eventually, a soreness of the right lower abdomen predominates. If the abdomen is pushed inward, even lightly, considerable pain will be felt directly over the inflamed appendix. In younger years, appendicitis is not so difficult to identify, but in later years, when it is not so common, the pain of appendicitis is harder to identify.

Pain of the Female Organs. Pain in diseases of the main portion of the uterus is felt in the lower abdomen, down the inner surface of the legs and, at times, in the lower back. It is quite variable. The ovary, at fifty years of age, may be the site of severe pain but variability of the pain (in the female only), is very great and can be interpreted only by the physician.

Urinary Bladder Pain. Bladder pain is felt when the bladder is over-stretched with urine. This pain begins as a distressful fulness and proceeds to extreme pain when the bladder cannot be emptied. Tapping over the bladder region (low in the abdomen) is very painful, and welcome relief is obtained when the bladder finally is emptied. Another bladder pain is experienced when the inside wall is irritated and inflamed (cystitis). As the bladder in this condition empties itself, the irritated walls touch each other to cause a brief knife-like pain.

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Gall bladder Pain. Pain from the gall bladder is felt on the right side in the upper abdomen. It starts as a dull ache but increases steadily to its peak, in about an hour and is called a colic because of its “come and go” nature. It may also go through to the back and be felt just under the right shoulder blade. As inflammation of the gall bladder develops, the severity of pain also develops and the upper abdomen becomes very tense and painful when touched.

Liver Pain. Pain of liver origin is usually not severe. It is more often a dull aching soreness of the upper abdomen, mostly on the right side and sometimes is felt in the right shoulder as well. The area just below the ribs on the right side is painful when tapped and when a deep breath is taken.

Pancreas Pain. It is most difficult to pin down pancreas pain generally. Often, laboratory tests and x-rays are necessary to make certain of the origin of the pain. Pancreas pain usually is severe and boring in the middle of the upper abdomen and straight through into the back. The pain increases to an agonizing state and may remain for several days. It is made worse by eating. Sitting straight up or leaning forward affords a small measure of relief, but real relief demands a hypo from the physician.

Pain in the Side of the Abdomen. The side of the abdomen includes pain caused by the kidneys and the ureter leading down

Side of abdomen

Fig. 98. The side of the abdomen is a vague area. It is the site of kidney and muscle spasm difficulties.
into the bladder. Abdominal wall pain is also present in this location.

Kidney Pain comes in two distinct types; dull aching pain and colicky cramping pain. The dull ache of kidney infection is felt in back just under the ribs and pushing or punching of this area may be very painful. The colicky cramping type pain is felt not only in the back, but running to the front of the abdomen and down into the groin region. This is called kidney colic; it can be excruciating and means that kidney stone possibly is being milked along to the outside. Such severe pain is never forgotten.

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Pain in the abdomen nearly always means something is wrong inside. It is nature’s warning signal to us and though it is about as welcome as “the plague,” it is rarely present without a good reason. To be brave about abdominal pain may mean strong character but certainly not long life, and serious disease in the abdomen is often allowed to progress to death’s door and beyond, simply because the pain was thought to be nothing serious.

When an organ within the abdomen is the source of pain, there is always some difficulty deciding which is the involved organ. Pain itself, however, gives many clues and frequently identifies its source.

How can we recognize a serious pain? Of the many pains and discomforts which are common in the abdomen, some are serious and others are of little importance.

A serious possibility is present-
1. If the pain has begun very recently (not months ago), and is very severe.
2. If the pain is associated with distention (blowing-up) of the abdomen.
3. If nausea and vomiting are present.
4. If the abdomen is hard or rigid and if pressing upon it causes great pain.
5. If it is also accompanied by bloody or tarry bowel movements.

Any of these characteristics lends importance to abdominal pain, whereas absence of all of them would accompany the probability of pain of lesser importance. Some of these less important pains might be stomach-ache due to “too many green apples,” minor food poisoning or mild constipation. Unimportant abdominal disturbances with mild pain are very common but in the event of any doubt, the physician should be consulted to rule out any serious possibility.

To study abdominal pain, let us examine each area of the abdomen separately to see which organ can produce pain in each area. Then we can study these organs individually and learn to identify the pain of each organ.

Upper Abdominal Pain. Abdominal pain above the umbilicus is likely to be caused by the stomach, liver, gallbladder or pancreas.

Stomach Pain. Pain from the stomach is felt in the upper abdomen. It is usually felt in the mid-line, occasionally goes through to the back and is caused mainly by ulcer and cancer.

Upper abdomen

Fig. 97. The upper abdomen is above the umbilicus and below the chest. Difficulties in this region include stomach, gallbladder, pancreas and liver-spleen diseases.

Peptic Ulcer and (gastritis) produces a burning or gnawing pain in the upper abdomen close to the mid-line, and has a characteristic identifying mark. It is relieved by food or alkali and it returns when the stomach is empty. Cancer Pain is about the same as ulcer pain, though not quite as severe and some people may have additional pain just as food is put into the stomach. In large, far-advanced cancer of the stomach, pain may be felt in the back, neck and elsewhere, depending upon spread of the disease. Stomach cancer cannot be identified with any certainty by the pain it produces. This is a job strictly for the physician.

Keywords: Skin, Head, Eye, Ear, Cancer, Face, Lips, Teeth, Thyroid, Chest, Breast, Lungs, Heart, Nail, Asthma, Tongue, Neck, BP, Migraine, Scalp, Eczema, Shingles