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How to Interpret Nature’s Warning Signals
By Studying the information given here on the nature of local and referred pain, and the special plate illustrating the sites affected by various disorders, much useful knowledge will be acquired of the possible significance of any pain experienced. The reader should also consult the headings.
Pain is undoubtedly the most effective advertisement of the existence of disease or disorder anywhere about the body. By thus calling attention to the existence of disease, it is eminently serviceable to man, but it does more. Whatever scientific interest may attach to pain and its interpretation, the patient's principal preoccupation is how to get rid of it. Nature gives him some help here. He finds usually that rest of the painful part secures more or less relief, and very often this compulsory rest is the main factor in healing the disorder which causes the pain.
In very many instances the site of pain gives a correct indication of its source. It requires no knowledge of physiology, for example, to associate a foreign body in the eye or some other eye disorder with pain in this organ or to suspect mischief in a tooth which is painful; but the ordinary person is little, if at all, likely to associate pain at the back of the head with disorders of the eyes or teeth in the absence of other indications closely related to those organs. It is, however, the fact that pain at the back of the head or elsewhere on the head away from the eyes or teeth, may have its source in one or the other; and there are many other instances.
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Pain Felt Far From Its Source
Pain may be caused by irritation of the endings of a sensory nerve, and the source and site of the pain will then correspond; but the irri tation may be occurring at some point on the trunk of the nerve, or where the nerve leaves the spinal cord. Pressure on the fibres of the sciatic nerve within the pelvis by a tumour, or even by a loop of bowel distended with faeces, may give rise, for instance, to pain in the thigh, the leg, or the foot- that is to say along the whole course of the nerve. But the irritation need not even directly affect the nerve in a branch of which the pain appears to originate; painful impressions travelling up one nerve may, through the con nexions by means of the sympathetic nervous system (q.v.) of this nerve with others in the spinal cord, lead to such disturbance of these others that the pain appears to be coming through them and to have its source, therefore, somewhere along their routes.
When inflammation affects, say, the appendix, the trouble may have extended in the course of some hours to the peritoneum lining, that portion of the abdominal wall which lies immediately over the organ, and from irritation of the nerve endings of the sensory nerves supplying that part of the abdominal wall pain will be felt actually over the appendix. But it is not so at the beginning of the disease. At this stage the irritation of the tissues of the appendix sends impressions along the branches of the sympathetic nerves supplying the part, but these impressions would not be interpreted as pain were it not for the fact that these sympathetic branches are connected with ordinary spinal nerves. The spinal nerve which is specially related to the sympathetic nerves supplying the appendix is the 10th dorsal nerve, which travels round the chest wall between the 10th and llth ribs. This nerve, when it comes forward, passes on to the abdominal wall and ends in the neighbourhood of the navel. Hence, at the beginning of appendicitis the pain is not felt over the organ itself, but round the navel (see also photographs under heading Appendicitis).
©2004 PanAmerican Institute
An examination of the photographs on the plate will show instances of the site of pain being, with reference to the organ with which it is connected, unexpected and almost bizarre.
In hip-joint disease for example, there may be no pain in this joint, while severe pain is felt in the knee, and cases have actually occurred in which valuable time was wasted in treating a perfectly healthy knee from misapprehension of the significance of pain there. The explanation of this transference of pain is that both joints are supplied by the same nerves.
Pain over the liver is an obvious enough consequence of disease in this organ, but pain at the top and back of the right shoulder also may be due to liver disease or congestion. The liver lies in close contact with the under surface of the diaphragm, so that disease of the former may extend to the latter. The nerve which supplies the central part of the diaphragm supplies sensation to the skin over the shoulder, and in this fact we have a simple explanation of the transference of pain.
The fact that pain felt at some part of the belly may be due to pneumonia or pleurisy is readily explained by the fact that the nerves between the ribs, which are irritated by the inflammation of the pleura in their neighbourhood, pass downwards to the skin of the belly. Disease of the womb may cause pain in the breast, nor is this surprising in view of the close sympathetic connexion between the organs, as evidenced by the changes which take place in the breast during pregnancy. Disease of the ovaries may cause pain on the ante front aspects of the thigh or at the heel, because the ovaries lie near the network nerves from which these parts are supplied, and conceivably irritation of the nerve fibres may take place, the pain not being felt at the site of irritation but in the nerve endings in the skin.
A word of warning must be said to the student of the information conveyed in the photographs.
The mere fact that someone has pain at particular spot must not lead at once to L disquieting conclusion that it is certainly due to one of the more or less serious disorders which are mentioned as possible causes in any particular instance.
Expert and thorough examination may be necessary to interpret the pain in a particular case, and it should be remembered that the less serious explanations are much more frequent than the more serious ones. It nevertheless only prudent, when a pain complained of which is at all severe or which persists in spite of simple treatment, that a doctor should be asked for his opinion as its significance.