04. THE ABDOMEN

ABDOMINAL DISEASES | GALL BLADDER | PANCREAS | LIVER | COLON | UTERUS + OVARY | ABDOMEN PAIN | KIDNEY

Abdominal troubles of advancing years are much more signifi­cant than those of youth. Within the abdomen, the factory of the body, any organ may have difficulty, but these organs, their functions and diseases are very vague to most people and study of them is very enlightening.

Examination of the Abdomen

Examine the bare abdomen in a well lighted room, before a full length mirror, in both standing and reclining positions.

1. Observe the abdominal skin for a yellow discoloration, called jaundice, frequently associated with gallbladder and liver disease.
2. Observe the hair growth over the chest and abdomen. An abundance of hair popularly indicates manliness in male, but masculine hair distribution on the female may mean ovarian or adrenal gland difficulty.
3. In lying-down position, we normally can see our toes. If the abdomen rises to block this view then it is abnormally enlarged. If a "spare tire" can easily be lifted, it is possible that we are overweight.
4. Examine the skin for visible blood vessels. A few fine veins and skin blemishes are usually present at the age of fifty, but large vivid veins may signal cirrhosis or similar liver disease.
5. Feel the abdomen—the fifty year old skin should have a doughy firmness. A tight shiny skin in a ballooned-up ab­domen may mean excessive fluid or tumor growth inside

Fig. 73. The abdominal region is the vague container of vague or­gans. Its many diseases and many symptoms produce multitudes of con­fusing complaints. It is actually easily understood with a simple study of its mechanics. The abdomen is the factory of the body. Food enters here, is ground up and chemically digested. The useful part is absorbed into the body, but the useless portion is separated and thrown out as waste. It is the most efficient factory in the world.

and if a "pit" remains after firmly pressing the finger into the skin, abnormal swelling is present, possibly indicating heart or kidney disease.
6. While lying down, feel the abdomen above the navel. The normal abdomen slopes downward from the ribs, both sides are alike, and no tenderness is present. Tender en­largements in the right side may signal liver, gallbladder or right kidney disease. Enlargement in the left side could indicate disease of the stomach, left kidney or spleen. It is difficult to feel these organs separately or accurately. Feel the abdomen in the navel region. A mass in this region of any size is distinctly abnormal and could be a tumor growth of the intestines, colon, or even of the major blood vessels themselves. Enlargement at the navel which ap­pears when standing and straining, but disappears when lying down, is likely to be a rupture (hernia). Feel the abdomen below the umbilicus or navel. It is nor­mally not tender or painful in any way. A definite soreness suggests possible disease such as appendicitis, bowel diffi­culties, or ovarian difficulty in the female. A movable ball-like mass in the lower abdomen of the female could mean growth of the ovaries or uterus.

9. In the standing position observe any visible enlargement in the lower abdomen. Strain purposely and note any pro­trusion which appears just to the side of the pubic bone.

This is likely a hernia or rupture, which is usually not painful and often falls back into the abdomen on lying down.

Abdominal Diseases

Peptic Ulcer (Stomach Ulcer, Duodenal Ulcer). A peptic ulcer is a painful sore in the stomach or its outlet, that looks like a canker sore of the mouth, with its crater-like appearance varying from the size of a matchhead to an inch or more in diameter.

Fig. 75. The stomach brings joy to all people at all ages, but it is a victim of modern "push." Ulcers are believed to be a result of too much stress and "hepped-up" living in a world with an uncertain future. The usual active ulcer appears as an enlarged cold sore or small "volcano."

We have these ulcers, because the stomach, unlike anywhere else in the body, is continually secreting acids that retard and prevent the healing of sores or ulcerations. Thus is an ulcer born.

Pain of an ulcer is easy to identify. It is a burning sensation in our upper abdomen, that goes away with eating or drinking— especially milk or alkali. The pain returns when the stomach is empty and the ulcer again becomes a clear target for stomach acids to attack.

Ulcer is a disease of adult life and is about four times more common in men than in women. It occurs and recurs most fre­quently in the springtime and fall, a fact which has never been explained, but even love and taxation have been offered as pos­sible explanations!

Besides pain, an ulcer can cause three other well-known diffi­culties.

1. Serious bleeding of an ulcer may occur. This is recognized by vomited blood or black, tarry stools.
2. Blowout (Penetration) of the ulcer produces immediate severe abdominal pain, a grave medical situation.
3. Obstruction to passage of any food caused by long-standing ulcer is recognized by persistent vomiting, and continuous abdominal distress.

Neglect of an ulcer can lead to these serious consequences. On the other hand, it is easy for a competent physician to accurately diagnose an ulcer by evaluating symptoms, examining the pa­tient, and x-raying his stomach.

Ulcer care consists of diet, medication and possibly surgery. The ulcer diet excludes ulcer provoking foods, such as spicy, greasy and rough, popcorn-like foods. Medications used in ulcer care are mainly acid blotters and neutralizers, plus drugs, de­signed to slow down over-activity of the stomach. At least five out of every six ulcers are successfully treated with diet and medication, while the person goes about his daily work routine. About one ulcer out of ten becomes so severe that it can't heal, and then surgical operations, which have gained high respect, become necessary.

The physician's advice for ulcer difficulty is most important even after an ulcer is cured. The patient must be informed con­cerning diet, the advisability of using tobacco and alcohol, and all other items that have an influence upon ulcer disease. Occa­sionally, an ulcer patient will refrain from seeing his physician because he fears the cure might be worse than the disease. How­ever, most successful patients have just one regret—that they did not seek expert medical treatment for their ulcer earlier than they did.

Cancer of the Stomach. Cancer of the stomach is a very serious disease, much rarer than the ordinary ulcer, and found among men twice as often as in women. It accounts for about 30 percent of all cancer deaths each year in the United States, which means that nearly 75,000 people a year die of stomach cancer in this country alone.

This treacherous disease is usually silent in its beginning and

Fig. 79. Cancer of the stomach includes about 30 per cent of all can­cer. It can be removed surgically but often is too far grown when dis­covered. It is thought never to derive from an ordinary ulcer.

remains so until far advanced. Its cause is still unknown, but stomach cancer is found more often among the poor than among the wealthy, and heavy drinkers have much more stomach can­cer than nondrinkers.

Like most cancers, stomach cancer is a disease of later years. It might appear in a man of fifty years or over, who has a loss of appetite, indigestion, and possibly pain similar to ulcer distress —relieved by eating food or liquid. Often there is a vague sick feeling in the abdomen, spoiling any desire for food and conse­quently small meals usually result in weight loss of great propor­tion. Unfortunately, the story of stomach cancer is not always the same, and frequently early symptoms are ignored. After the age of fifty years, any kind of stomach upset, lasting more than several days, should prompt a visit to the physician for an exam­ination, possibly including an x-ray of the stomach to determine if a cancer problem exists. There is no other disease of the body in which early diagnosis is more important in achieving a final cure than in cancer of the stomach.

Achlorhydria (No Acid in the Stomach). The normal stomach secretes hydrochloric acid, which aids in digestion of foods. Fre­quently, we find people who have less than the normal amount of acids in their stomachs, and about one out of ten who possess little or no hydrochloric acid at all. When such a situation is found, hydrochloric acid is frequently given along with food at mealtime, and this therapy often results in improved appetite and digestion to the great satisfaction of the patient.

The Gall bladder

Gallstones (Cholelithiasis). Gallstones are present in about seven percent of our population. They increase with years, so at

the age of seventy-five, almost one-third of the people have stones present. Women have four times as much gall bladder trouble as men, and the typical patient with gallstones is "fair, fat and forty."

Gallstones are formed by the gall bladder itself through its water-absorbing action. Just as salt crystals form in the pan of evaporating salt water, salt or stone forms in bile from which water has been absorbed. From this point, irritation by the stones and inflammation are only steps away.

Gallstones present varying symptoms. Most people have no trouble with them and do not even know of their presence.

Others have vague indigestion and are bothered by "gas," while still others have exceptionally severe pain requiring diet, medi­cation and occasionally an operation. It is well to know that gall-

Fig. 81. The gall bladder when severely inflamed has a greatly thick­ened wall and may contain stones and pus. It then has the appearance of a boiled lobster.

stones can never be dissolved in any manner, regardless of their kind, location, or length of time they have existed.

Gall bladder Attack (Acute Cholelithiasis). A gall bladder at­tack usually arises suddenly as a result of gallstones. The irrita­tion started by the stones progresses rapidly to a highly inflammed stage in which the former toy balloon appearance begins to look more like a boiled lobster and the gall bladder, filled with pus, is very tender to the touch. There is usually an accompanying high fever, sweating and chills, nausea and vomit­ing, and frequently great pain in the right abdomen. The at­tacks may last a week and are frequently accompanied by some degree of jaundice. People who have had these acute attacks dread another such gruesome episode.

The inflamed gall bladder may have many complications and requires the best medical attention. Frequent severe pain usually convinces the gall bladder patient that the easiest way out is to have his gall bladder removed.

Chronic, Recurring Infection of the Gall bladder. Once the gall bladder has become acutely inflamed, it is likely that a low degree of irritation will persist indefinitely. In the presence of irritating stones, frequent flare-ups may occur to make the gall bladder's future even more miserable, with continuing indiges­tions, gas and inability to tolerate fatty, greasy foods.

Some people with gall bladder disease are carried along com­fortably by their physician on proper diets, but for the severely diseased and stone-containing gall bladder, the doctor may ad­vise surgical removal. This is particularly true in the elderly pa­tient, who usually will have more difficulty with his gall bladder from year to year.

Sound advise from a good physician in gall bladder disease has no substitute.

Cancer of the Gall bladder. Cancer in the gall bladder usually becomes known only after the gall bladder has been removed be­cause of pain, stones or infection. Cancer is found in about 1 percent of all gall bladders removed, and in this group the out­look is dark indeed.

Gall bladder stones have been blamed for the irritation which is probably responsible for cancer, and for this reason, many doctors recommend removal of the gall bladder whenever stones are found.

The Pancreas

Pancreas difficulties

Diseases in the pancreas are uncommon and difficult to diag­nose when they do occur. Infection, cancers, and wasting-away of this gland produce body difficulties such as great pain, jaundice, and intense prolonged diarrhea.

The physician's investigation alone can bring to light pan­creatic difficulties, because this organ in its hidden away loca­tion, cannot be felt, examined or in any way be mechanically in­vestigated. Complex laboratory tests must be relied upon to uncover any disease in this organ.

Diabetes Mellitus (Sugar Diabetes). Diabetes properly is a dis-

Fig. 83. Pancreatitis is an irritation of the pancreas itself. It is thought to be caused by stone formation within it, repeated bouts of alcoholism, and irritation with liver bile.

Fig. 84. The pancreas also produces the hormone insulin which is poured into the bloodstream. Absence of insulin means diabetes, unless it is given by hypo as a replacement.

ease of the pancreas, because its failure to manufacture the hormone insulin is directly responsible for the disease. The pancreas manufactures insulin in normal health, but in dia­betes, because of a lack of insulin, the body fails to properly use sugar. Sugars from our food, needed as body builders, are not utilized, but lost through the urine. The strength, vigor and repair of the body falls below par and serious complications then arise.

Normally, sweets and starches we eat are absorbed as sugar and policed in the bloodstream by insulin from the pancreas, so that the body can use it. In diabetes, where insulin is lacking, there is a resulting flood of sugar into the body during eating, and it actually spills over into the urine through the kidneys. The urine is even sweet to taste.

Several difficulties attend the diabetic person. Probably the best-known of these difficulties is diabetic coma, where the dia­betic condition actually produces unconsciousness. Many dia­betics carry cards on their person, informing strangers what to do for them in case they should be found unconscious. Another well-known difficulty of diabetics is poor blood circulation, espe­cially in the toes. Unfortunately with the diabetic of senior years, gangrene of the toe may become rapidly apparent follow­ing the slightest injury or infection, and the most delicate care is necessary to prevent such unfortunate complications.

Diabetes starts most often between the ages of forty-five and fifty years, twice as often in women as in men, and especially in married women who have had children. Diabetes seems to be a racial characteristic which afflicts the Jewish race heavily for some unknown reason. Inheritance also is a factor in diabetes and if any one of our close relatives is found to have this disease, we ourselves are possible candidates and an examination for diabetes is in order.

The biggest reason for diabetes seems to be "obesity." The reason is not clear, but schooled opinion exists that the fat per­son is continually looking down the gun barrel of diabetes. Stress also is thought responsible for bringing about diabetes, and the stress of a severe burn, high fever, pregnancy or severe emotional upset is very often the straw that breaks the back of the diabetic candidate. Examination after such episodes often reveals, for the first time, the presence of diabetes.

Control of diabetes means control of sugar within the body. In light diabetes, restriction of sugar in the diet may be sufficient, but in severe diabetes, insulin (which should have been manu­factured by the pancreas) becomes necessary for effective treat­ment. Diabetics usually wonder why they cannot take insulin by mouth and the reason is that the hormone insulin, is also a protein, and if taken by mouth like other foods, is simply di­gested away. There is beginning use, however, of drugs taken orally which do have a pronounced effect in some cases of dia­betes, and eventually it is probable that complete treatment of diabetes may be entirely by the oral route rather than by the unwelcome hypodermic route.

Effective treatment of the diabetic person whether by diet restriction, insulin usage, or both, usually enables these people to carry on a normal and active life within very wide boundaries.

THE LIVER

Diseases of the Liver

Jaundice. Yellow jaundice is a diseased state in which bile ac­cumulates in the blood stream, and colors all the body tissues yellow. This is first noted in the whites of the eyes, but even­tually it covers the entire body and may even be seen in urine

Fig. 85. The liver is normally smooth and soft, and weighs about five to eight pounds in adults. The "factory" organ, it manufactures many body necessities, but its functions are so numerous that not all of them are known.

and perspiration which may have a yellowish tint.

Jaundice, a complex medical problem, is usually caused by one of three situations.

1. It may be an inherited disease, involving the spleen.
2. It may be due to gallstones blocking the duct from the liver.
3. Jaundice may be caused by an infection of the liver itself, called hepatitis.

Uncovering the exact cause of jaundice may be a very taxing problem even for the most learned of physicians. Besides re­quiring an accurate and lengthy history of the jaundice, a de-

Fig. 86. The liver ordinarily is tucked up under the ribs, but in disease may enlarge greatly to occupy nearly half of the abdomen. In such diseases, it becomes quite tender and is occasionally accompanied by jaundice.

tailed examination is necessary along with numerous laboratory tests to confirm or dispel all possibilities. We should realize that only the physician is qualified to recognize the extremely serious possibilities of this disease, and though its cause may be deeply rooted, jaundice is often completely relieved through good medi­cal treatment. Delay in seeking adequate treatment may be fool­hardy, but attempts at home remedy or drug store cures for jaundice are open invitations to disaster.

Hepatitis. Often caused by a virus, hepatitis is an infection of the liver in which painful swelling of the liver may be felt on the right side. It is a disease which may have a long course to recovery, with an uncertain future, but most patients eventually make a recovery. This disease has a slow onset, and is accom­panied by a usual fever, a distinct loss of appetite, vomiting and diarrhea. Jaundice also frequently occurs with hepatitis, a dis­ease which demands the very best of medical care.

Cirrhosis of the Liver. Although cirrhosis is about the best-known liver disease, it is still poorly understood. The liver has a roughened, hobnail appearance which was formerly thought to be the direct result of chronic alcoholism. As its cause still re­mains a mystery, it may exist undetected for many years.

Fig. 87. Cirrhosis of the liver creates a hob-nailed appearance and leathery texture. Sometimes connected with chronic alcoholism, the dis­ease means eventual destruction of the liver and death.

Occasionally, swelling of the abdomen from an accumulation of watery fluids within may arouse the patient's suspicion that something is wrong. At other times sudden vomiting of large amounts of blood from a ruptured, enlarged vein within the stomach is the first indication of disease. In the late stage of cirrhosis, blood cannot circulate easily through the liver and is forced to find and build new channels through which to flow. Large veins can then be seen on the surface of the abdomen and the skin covering the chest wall of these individuals. Cirrhosis usually is diagnosed after it has existed a long time, and is then considered incurable but the physician can usually prolong life comfortably through medication, blood transfusions, diet, and other measures.

Obscure Liver Disease. Other diseases of the liver are com­monplace, but they are poorly understood and difficult to recog­nize even by experienced physicians. Continued study of liver function and disease is being carried on constantly in many medical research programs.

THE COLON

The colon, or large intestine, consists of the final five feet of the intestine and measures about one-fifth of the entire intes-

Fig. 88. The pathway of food within the abdomen includes a small storage depot—the stomach; a digesting and absorbing tract—the small intestine; and the collecting, condensing and excreting mechanism—the colon. The stomach and colon are subject to many diseases; the small intestine relatively few.

tinal tract. Its primary function is the condensing of residue as it nears the anus for the final defecation of this waste material. Defecation is mostly an automatic mechanism, but as is well-known, this reflex easily can be subdued and controlled by the will.

Very little regard is given to the colon for its contribution to routine civilized living, however, there is obvious truth in the saying, "civilization itself is founded upon an intact sphincter of the colon."

Diseases of the Colon

Appendicitis. The appendix, attached to the first portion of the colon, has gained great notoriety in people of the upper age group. Usually we think of appendicitis as occurring in children and young adults, and this thinking is correct. People under forty years of age have four out of every five cases of appendicitis,

Fig. 89. Appendicitis still claims over 2000 lives annually in the United States. It occurs most often in youth but is far more dangerous and pro­duces most of its fatalities in senior years.

and less than one in a hundred die. However, one out of every five cases of appendicitis is found in people over forty years of age, and in this age group are found three-fourths of all deaths from appendicitis. This forces the conclusion that appendicitis is about twelve times more dangerous if we should have it after the age of forty years.

As if to prove this, approximately 2,500 United States citizens die each year from appendicitis, and most of the deaths occur between the ages of sixty-four and seventy-four years.

Although appendicitis is much more common in youth, it is obviously much more serious in later years because:

1.The aged appendix has a much weaker defense mechanism than it had in youth, and the infection develops much faster and more seriously.

2.The appendix, which is not difficult to recognize in youth, is usually labeled "atypical," in later life, and the usual symptoms of appendicitis are much harder to recognize.

3.We grow accustomed to aches and pains here and there. Many of these difficulties are well tolerated with a little patience, but a serious attack of appendicitis may hide among these every-day irritations until irreparable damage is done, and treatment is futile.

Appendicitis may be most difficult to diagnose, even for the expert physician, and no one should attempt to make this diagnosis on himself, not even a doctor. Everyone, however, should include some information about a typical appendicitis picture, because over 2,000 deaths a year in the U. S. might be prevented if only the possibility of appendicitis were considered in time.

The usual story of appendicitis might begin with vague nau­sea, progressing gradually to vomiting. Moderate pain is felt all over the abdomen at first but it gradually localizes low in the right side. A soreness in the appendical region along with fever and possible bloating help to complete the picture. The whole process may begin and grow to obvious proportions in six to twenty-four hours.

In contrast to this usual story of appendicitis, is the atypical course of the disease in later years. The patient with a severe attack of appendicitis, may appear to be only slightly ill for the first several days. Nausea, if present, frequently does not pro­gress to vomiting. Pain in the abdomen might be only a slight discomfort, and may not localize into the lower right side of the abdomen. Temperature usually is not elevated in proportion to the seriousness of the disease.

This picture might easily be more complicated by the pres­ence of other chronic disease symptoms, such as constipation, arteriosclerosis or gall bladder disease.

This explanation helps us to understand why appendicitis in later life is more dangerous, and that after the age of fifty, ab­dominal pain should not be "taken like a man," but handled more wisely by calling the family physician.

Colitis. Sometimes named irritable colon, colitis is a very com­mon disease intimately associated with the nervous system.

Its main characteristic is frequent painful spasms of the colon along with periods of diarrhea and constipation. There is no definite cause of colitis but its beginning appears to involve emotional factors concerned with disappointments in life greater than one can stand. A person afflicted with colitis is said to be "speaking with his colon" when he cannot speak with words.

Relief from colitis is frequently obtained when the state of tension or nerves is properly treated. This is best accomplished by a person schooled in the ways of psychological lessening of fears and tensions.

Occasionally a difficulty thought to be colitis is found to be caused by foods, drugs or allergies of unsuspected sources. Fortu­nately, these cases mistaken for colitis are completely cured with dietary restrictions regarding foods or avoidance of particu­lar drugs.

Diverticulitis. Diverticulitis, sometimes called left-handed ap-

Fig. 90. Diverticulitis is caused by inflamed out-pockets which become sore and resemble appendicitis. It is found in 1 out of 20 adults and fre­quently causes bleeding found in the bowel movement.

pendicitis, is distinctly a disease of the later age group. It is an inflammation of the many appendix-like outpockets in the colon, which occur in about five percent of all people over the age of forty and like the appendix, these outpockets become inflammed and a source of severe pain and bleeding. It is usually the con­stipated, obese and older person who has most difficulty with this disease, because the number of diverticulae present in the colon increases with age.

The irritation in these diverticulae is thought to originate with seeds or other small particles in the fecal material. Preven­tion of diverticulitis then embraces a diet which eliminates seeds, bones, nuts and other sharp articles which can easily lodge within these outpockets and start trouble. In severe cases of diverticulitis, surgery may become necessary to remove the seg­ment of colon seriously inflammed. This disease frequently is suspected to be cancer of the colon and necessitates a close in­vestigation by a physician to make the correct diagnosis.

Constipation. A most frequent complaint of people in their later years is constipation, as a prolonged time between bowel movements, or as great difficulty in bowel evacuation when it does occur.

Wide confusion exists concerning what is normal for bowel activity. In youth, we are moving about quickly, and bowels are of little concern, but in later life, fast moving activity is just a memory and bowels become a great concern.

It is also true that bowel matter is unequaled in its universal abhorrence, and to seek disposal as quickly and completely as possible, is only natural for every person. This usually means a bowel movement is desirable every day and anything less than a daily movement in a person with time enough to notice, im­mediately establishes the complaint of constipation. An estimate of bowel activity for most people is one movement a day, but while desirable, it does not necessarily indicate good health.

Bowel activity, more than anything else, reflects activity of the entire body. Compare the action in the colon of a person who is bed-ridden, with the colon of a physically active, hardworking person. Without any doubt, the colon subjected to a shaking-up by body activity will be far more active and regular.

One function of the colon is to absorb water out of the fecal waste. If the bowel moves through the colon rapidly as in very active people, water absorption cannot be completed and a soft or liquid bowel movement results. If the bowel movement how­ever, moves very slowly through the colon, as it does in inactive people, all moisture becomes absorbed and a hard, granular or marble-like stool is produced.

In ordinary constipation attention is necessary only for the two factors of diet and regular activity, to effect satisfactory bowel action. The diet to avoid constipation calls for sufficient fiber-type foods, which absorb water to form a moist stool, and a healthful stimulant for the bowel can also be obtained from the juices of prunes, grapes and other fruits. Regular activity in exercising the entire body, also stimulates the colon and aids in promoting daily bowel action.

Physics, Laxatives, and Enema. The sale of bowel stimulants and constipation cures is soaring because constipation is invited in later life by our trend toward sedentary rather than active leisure hours. Television is an outstanding contributor to this annoying situation.

Strong physics such as castor oil, irritate the intestinal tract and stimulate great waves of propelling activity, forcing the in­testinal stream to gush through the colon and anus. Other physics, such as Epsom Salts and the well-advertised bulk laxa­tives, have a great blotter-like action which draw large quanti­ties of water into the intestinal tract to make the bowel move­ments large and watery. The enema is probably the simplest way of putting water into the bowel to clear the colon. Though probably much overdone, an enema is essentially harmless, is quite simple to perform, and is often used in hospitals.

There are times when physics, laxatives and enemas are of value and even necessary, but most of the time their effect can be obtained by drinking more water, including a little more fiber in the diet, and getting regular exercise. Remedies for constipation however, will probably champion our drug store counters for many years, as our population ages and our seden­tary lives create more drug store dependents among us.

Cancer of the Colon. Cancer of the colon and rectum is a severe disease of the older age group, but its outlook is nearly four times better than cancer of the stomach and chances of its cure are better than 50 percent. An important factor of colon cancer as in cancer everywhere, is the question of spread of this

Fig. 91. Cancer of the colon is announced nearly half the time by rectal bleeding. It is a disease of senior years and can be treated satis­factorily when discovered early.

disease to the rest of the body. About the best thing that can happen in cancer of the colon, is to find it early before it has extended.

Discovering a colon cancer requires a physician for exact diag­nosis, but we can help the physician, and ourselves, by watching for the symptoms which often accompany this disease. These symptoms though very common and frequently brushed aside, are worthy of notice.

Bleeding from the rectum is often the first indication of any trouble in the colon. Bleeding is most often caused by hemor­rhoids and not by cancer, but it is always a sign that something is definitely wrong and the physician should be consulted at once.

A difference in the usual manner of bowel movements, occa­sional constipation or diarrhea is common in adult years, but these difficulties, if sudden and persistent, may signal definite colon trouble and an examination is in order.

Pain. This is a large word and covers a lot of ground, but when it comes from the colon it has several identifying marks. An aching pain in the rectum, with a feeling of fullness and a sensation of continuing bowel movement, sometimes arises from a growth, and should not be ignored. Cramping or griping pain when due to the colon is felt low in the abdomen. When caused by a tumor, the colon attempts to move the unwelcome growth along and these attempts we feel as powerful contractions or cramps.

General symptoms such as loss of weight and general weakness are present in cancer but also in other diseases such as mental disease, gall bladder disease and others, and these difficulties also must be considered. Obviously a competent physician's examina­tion is necessary to accurately diagnose cancer of the colon.

ABDOMINAL CAVITY

Fig. 92. Hernias are weak spots in the abdominal wall, usually re­sulting from inherited muscle and fascial weakness. Popular fallacy, based on legal compensation, places the blame on injury incurred at work.

Treatment of colon cancer is strictly a surgical procedure, essentially consisting in removing the segment of colon contain­ing the cancer. The problem is a complex one and the operation must be done by an experienced surgeon. The prospects of com­plete recovery are very good when the cancer is discovered and removed before it has spread to other regions of the body.

Hernia

The abdominal wall is built of layers of strong muscles and fascia which normally hold the abdominal contents within the03+

Fig. 93. Hernia in females is much rarer than in males. It occurs, however, in the same regions and manner as in the male.

abdomen wall. A hole in this wall however, allows the inner con­tents of the abdomen to protrude through it. Such a hole is a hernia and when large enough, allows some of the abdominal contents to fall out of the abdomen when we stand, and fall back in when we lie down.

Hernias are usually present since birth, and occur more often in men than in women. They can be small at first, but can eventually become very large. It is popular to disregard this real beginning of a hernia and to blame it on accidents or strains occurring at work. An injury at work constitutes legal grounds for compensation.

Ordinarily hernias are found low in the male abdomen, where they are usually noticed as a bulge, slightly to one side under the pubic hair, on one or both sides. This area is called the inguinal region and is the site for most hernias. The reason for

Fig. 94. Hernia in the male is most often in the lower abdomen, called the inguinal region. Usually found on the right side, it is treated best by surgical operation. A truss also is found satisfactory in some people.

Fig. 95. Rupture (hernia) may entrap and strangulate a portion of intestine at any time; immediate operation then becomes necessary to save life. It is best to have hernia operation performed before serious trouble arrives—not afterward.

this is probably that the abdomen which was built for a horizon­tal position, is given a great deal of upright use.

The most serious fact about hernias is their tendency to strangulate when the abdominal contents are pushed out through the hernia and imprisoned so tightly they cannot return. The blood supply may become choked off and immediate surgery is then necessary to save the patient's life. This danger is an im­portant reason for surgical repair of most hernias.

The Uterus

The uterus, or womb, an abdominal organ, is located in the lowest portion of the abdomen, and is a major part of the female sexual system. It is normally the size of a hen's egg, and is diffi­cult to feel within the abdomen unless it is quite enlarged.

Enlargements of the uterus are very common before and after the menopause, and are felt when possible in the lower center abdomen. One tumor enlargement, the fibroid, is the most com­mon of all tumors, and may become large enough to appear as a pregnancy. These larger tumors can easily cause pain, low in the back and on the inner sides of the thighs. Tumors, or growths, of the uterus are of great variety, and have long techni­cal classifications.

The physician's examination is required to correctly identify these enlargements and other uterine diseases and to prescribe the proper treatment for them.

The Ovary

The two ovaries are the fundamental heart of the female sex­ual system, and are located in the lower abdomen, one on each side of the uterus. They are the source of the menstrual cycle before the menopause and lose this function after the change of life, but remain as a frequent source of both large and small growths within the abdomen.

The normal ovaries are too small to feel, but when enlarged, they can range from apple-size to watermelon-size. Sometimes they are hard and sometimes cystic, like water-filled balloons and frequently tax the physician heavily for correct identification. Occasionally ovarian growths give clues to their identity through their hormonal influences. For instances, one specific tumor of the ovary produces a masculine hormone which produces in women, a growth of beard, deepening of the voice, and hair growth on the chest. Another growth of the ovary has a feminizing influence, and occasionally will restart the menstrual period long after the menopause.

Statistics show that after the menopause about fifteen women in every thousand will develop an ovarian tumor, and nearly three-fourths of these will be cancer. It is well to remember that

Fig. 96. The uterus and ovaries are the machinery of the female re­productive systems. In them, however, minor or major diseases can arise and sometimes require hospital care.

a mass low in the abdomen is difficult sometimes even for the physician to identify, and very often the exact character of such a tumor cannot be determined until seen at operation, and studied under the microscope. Because of the serious possibili­ties with ovarian growths, the physician frequently advises their operative removal.

PAIN IN THE ABDOMEN

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.

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.

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

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.

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

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.

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

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 agarden 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.

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.

Diseases of the kidney

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.

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.

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.

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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