Volume 1

Differential diagnosis / by Richard C. Cabot.

  • Cabot, Richard C. (Richard Clarke), 1868-1939.
Date:
1912-1918
Catalogue details

Licence: Public Domain Mark

Credit: Differential diagnosis / by Richard C. Cabot. Source: Wellcome Collection.

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    properly make us take his statement with a grain of salt. Chronic suffering is pretty sure to leave its mark on the face and body. In cases of suspected malingering, when an individual states that a certain motion or a certain pressure upon a supposedly tender point causes great suffering, we may control his statement to a certain extent by measuring the peripheral blood-pressure at the time. Severe pain almost always causes a notable rise in blood-pressure, and if we find noth¬ ing of the kind, we may rightly conclude that if pain is present, it is probably not intense. DEGREE OF PAIN I have long been accustomed to compare, as a matter of routine and in every case, the extent and quickness of the knee-jerks with the patient’s statement regarding his own suffering. I have found that those who describe all their troubles as “terrible,” “awful,” “fearful,” and the like, are very apt to have lively knee-jerks, and that those who are more moderate in their expressions have usually less active reflexes. It seems quite probable that there is a parallelism here between reflex sensibility and sensitiveness to pain. Those who respond to a given stimulus by an exaggerated knee-jerk might well be expected to respond to a given cause of pain by an exaggerated complaint. So it has seemed to me as a result of many observations, and I have come to believe that people are more likely to be oversensitive and to exaggerate their suffer¬ ings when the knee-jerks are unusually lively. This is, of course, a very rough and uncertain method of measuring pain, and would perhaps be more truly described as an attempt to meas¬ ure the severity of the cause of pain, rather than of the pain itself. We are greatly in need of some more accurate method of estimating how much people suffer. For the present, we have to judge largely by such uncertain evidences as were mentioned in the last section—facial expres¬ sion, bodily movement, the accounts of onlookers, and the evidences of such physical changes as pain might produce. In addition to these we get a certain amount of information by asking: “Does the pain prevent you from working?” “Does it prevent sleep?” “Does it take away appetite, the capacity for movement and en¬ joyment in the ordinary functions of life?” We know that certain races—for example, the Chinese—are much less sensitive than others to pain in that they exhibit far less evidence of “shock” after a bullet wound or a disembowelment. We can only guess at the sensory side of this phenomenon, but the absence of the ordinary organic effects produced by the same injury in a Caucasian gives us some