Medicine
Early warnings
John Linklater
The first signs or symptoms of serious disease may often be surprisingly trivial and painless, thus tempting patients to delay a visit to their general practitioner and, thereby, jeopardising their chance of a successful cure.
Patients, not unnaturally, tend to judge the gravity of a physical change in terms of the pain or inconvenience that it causes. An anxious young woman is more likely to turn up in a surgery with a dragging feeling in a breast, or with a sore nipple, than she is with a painless nodule the size of a pea. Yet the nodule is the more likely to be a breast cancer.
Every woman should be taught to examine her own breasts in the approved way at regular intervals, to discover any small, discrete, definite lump. This may well prove to be a harmless cyst, but, if she finds it at an early stage and consults a doctor, she will at least ensure that a cancer is not allowed to spread to other parts. An inverted nipple may, equally, be perfectly harmless but it may also be the first and only warning of a fibrous thickening of the internal structure of the breast caused by early cancer.
Irregular vaginal bleeding is usually dysfunctional, and caused by a hormone imbalance. It may,
however, be the sign of cancer of the uterus and therefore merits a detailed gynaecological examinatnni, especially if it takes place after the menopause. However small the loss of blood may be, an intermenstrual or postmenopausal bleed may never be safely disregarded. • A spot or two of blood lost after coitus is most commonly the result of a vaginal infection and easily treated. It may also be caused by a new growth. Statis,9callY, the most likely new growth 's a harmless polyp which can easily be removed, but a cancer Rroduc es the same symptoms. aPid consultation is particularly UnPortant nowadays because a full Investigation may entail a diagnostic curettage, or scrape, and th. e waiting list for these admis,slons has been greatly lengthened °Y.the 300,000 hospital bed days , which are occupied each year with abortion cases. Blood loss, however trivial, must always be fully and satisfactorily accounted for, whether from the vagina, urethra, rectum, lungs or stomach. A small infection of the U°se is probably the most common cause of a trace of blood coughed apparently from the lungs, but L'oY patient to whom this has PPened would be well advised to q.lscuss it with a general practitloner, in order to exclude tuberculosis, which is rare, and cancer of the bronchus, which is all too common and kills 24,000 Men and 5,000 women each year. Haemorrhoids are by far the kthost common cause of. rectal ,Oleeding. There is nothing, i"LoNvever, to prevent a cancer of Lue rectum from developing uehind the camouflage of piles, so that the blood loss from the cancer appears to have a benign °rIgin. The most common cause of a change of bowel habits is an ialtivvitting change of diet, but a evel cancer can also produce the same effects. Changes in body weight,' of rnore than half a stone in either direction over a period of one or tWo months, can indicate the early 2nset of disease, and should be ulsoussed with a doctor who will either be able to reassure or to Investigate. The onset of Unquenchable thirst for water, accompanied by the passage of `°Pious urine, is the sign of the :3nset of diabetes and must be .1reated without delay. 8Y contrast with signs and Whole such as these, there is a whole range of vague aches and 1,13ains and sensations such as "eadaches, which feel like pres,,SUre or a tight band. These are "sOally evidence of heightened anxiety rather than disease. The Patient should certainly consult a cloCtor in the first instance, but ,Should be prepared to accept a lagnosis of anxiety and to resolve matter by reorganising his af'airs or leading a more natural and healthy or balanced life. We generally take too little exercise, and many of us become Overweight. We cannot expect. to °e free from periods of nagging !0‘v back pains or aching legs, and „Insistence upon total freedom 'rcIth all the petty aches of the
flesh will eventually force the general practitioner to prescribe when he would prefer not to do so. We thus consume increasing quantities of analgesics which usually harm us in other ways.
There are many more such common signs of early, treatable disease. Most of us know perfectly well that a widespread publication of all the possible indications of mental and physical disorder could only exacerbate our latent hypochondria, but a sound knowledge of the cardinal and unmistakable warnings is a valuable asset. The Health Education Council might do worse than to organise a television series of short, instructional films on these lines and thus help the public to distinguish the apparently trivial, painless early warning of grave disorders and diseases.
Previous page
