Dr James Le Fanu: 3 January
There was a time when doctors would literally sniff their way to what was amiss, picking out a case of diphtheria from a queue of sickly children because of its characteristic sweetish odour, or diagnosing typhoid in a patient with a rash and a fever, who also exuded the aroma of freshly baked bread. In the field hospitals of the First World War, surgeons were alert to the pervasive stench of rotten apples, typical of gas gangrene, while wounds that gave off the sweet whiff of grapes were infected with the bacterium pseudomonas.
Such exotic diseases are rarely seen nowadays so a physician’s olfactory skills are limited to more mundane disorders. The ‘secret’ drinker is readily sniffed out by the strong whiff of peppermint on his breath, which still cannot disguise the smell of alcohol secreted through the sweat glands. The whiff of ammonia from an elderly man suggests urinary problems, while a comatose young man whose breath smells strongly of acetone almost certainly has diabetes.
There is certainly no difficulty in identifying those whose unpleasant odours of halitosis are due to poor dental hygiene, but when the teeth are healthy, other explanations must be sought – such as the chronic infection of the stomach by the organism helicobacter pylori.
Foreign objects inserted by children up their nostrils can give rise to the vilest of odours, as paediatrician Dr Michael Franham reports. For a couple of months, a two-year-old had been afflicted by a body odour so unpleasant that her nursery school teacher banned her from the classroom – even the girl’s mother could not stand to be near her. However, ‘a thorough examination of the nose disclosed a piece of bathroom sponge with the same vile odour as that coming from the child. Within an hour of its removal, the smell had disappeared.’
There is also a group of rare syndromes known by the offensive odours they cause: cat’s-urine syndrome, sweaty-feet syndrome, rancid-butter syndrome and, commonest, fish-odour syndrome, where the breath and sweat smell strongly of rotting fish, due to the inability to metabolise (and thus render odourless) a chemical present in eggs, liver, offal and salt-water fish. There is no cure, though patients are much helped by learning they suffer from a recognised clinical disorder and are given dietary advice to avoid the relevant foods.
This week’s medical query comes courtesy of a lady in her early 50s who has had three operations for nasal polyps, the last of which resulted in so much blood loss that her surgeon advised she should not have any more. Recently, the polyps have returned, causing nasal congestion. ‘I am at a loss at what to do,’ she writes, as prescribed nose drops and nasal sprays have not improved matters.
These nasal polyps are caused by ‘an in ammatory condition of unknown cause’, for which the most effective treatment is undoubtedly surgical removal. When this is not advisable (as here), the best option is a combination of steroid medication taken both orally and as a nasal spray, which together control the symptoms in around three quarters of those affected.
Email drjames@lady.co.uk
Such exotic diseases are rarely seen nowadays so a physician’s olfactory skills are limited to more mundane disorders. The ‘secret’ drinker is readily sniffed out by the strong whiff of peppermint on his breath, which still cannot disguise the smell of alcohol secreted through the sweat glands. The whiff of ammonia from an elderly man suggests urinary problems, while a comatose young man whose breath smells strongly of acetone almost certainly has diabetes.
There is certainly no difficulty in identifying those whose unpleasant odours of halitosis are due to poor dental hygiene, but when the teeth are healthy, other explanations must be sought – such as the chronic infection of the stomach by the organism helicobacter pylori.
Foreign objects inserted by children up their nostrils can give rise to the vilest of odours, as paediatrician Dr Michael Franham reports. For a couple of months, a two-year-old had been afflicted by a body odour so unpleasant that her nursery school teacher banned her from the classroom – even the girl’s mother could not stand to be near her. However, ‘a thorough examination of the nose disclosed a piece of bathroom sponge with the same vile odour as that coming from the child. Within an hour of its removal, the smell had disappeared.’
There is also a group of rare syndromes known by the offensive odours they cause: cat’s-urine syndrome, sweaty-feet syndrome, rancid-butter syndrome and, commonest, fish-odour syndrome, where the breath and sweat smell strongly of rotting fish, due to the inability to metabolise (and thus render odourless) a chemical present in eggs, liver, offal and salt-water fish. There is no cure, though patients are much helped by learning they suffer from a recognised clinical disorder and are given dietary advice to avoid the relevant foods.
This week’s medical query comes courtesy of a lady in her early 50s who has had three operations for nasal polyps, the last of which resulted in so much blood loss that her surgeon advised she should not have any more. Recently, the polyps have returned, causing nasal congestion. ‘I am at a loss at what to do,’ she writes, as prescribed nose drops and nasal sprays have not improved matters.
These nasal polyps are caused by ‘an in ammatory condition of unknown cause’, for which the most effective treatment is undoubtedly surgical removal. When this is not advisable (as here), the best option is a combination of steroid medication taken both orally and as a nasal spray, which together control the symptoms in around three quarters of those affected.
Email drjames@lady.co.uk