After rotating in internal medicine for the past two months, it’s clear to me that medicine is an art that requires the awareness of all the senses… Through vision we can detect any lesions, changes of color, and general health of our patients. Through touch we can determine the location, size, shape, and texture of an abnormal mass or organ. Through our ears we can distinguish between types and degrees of heart murmurs or lung congestions. We can even determine any enlargements or shifts of position of organs via our ears when we percuss. In past times, we as the medical profession used to taste the urine of patients to detect diabetes (or so the legend goes). Thank goodness we don’t do that anymore. However, another sense I am starting to learn more and more about in my rotations is the often forgotten, but nevertheless important sense of smell. Smells can tell you a lot about a situation, and the hospital has tons of them, not all of which are pleasant. There are the smells of patient hygiene, smells of excrement, and most importantly, smells of diseases.
After seeing countless patients, you eventually pick up what different things smell like. I’ve seen my attending come into a room, and immediately know what organism is causing the patient’s diarrhea, through the unique egg-like smell of clostridium difficile, and treat the patient accordingly. Another of my attendings was able to come into the examination room, and suspect a vaginal infection in a patient simply from the smell of the room, before even a physical exam. I’ve smelled a few gangrenous lesions as well, and it is probably the worst out of the bunch.
So as you can see, smell can be another revealing dimension in the art of diagnosis. In fact, a machine has been invented recently to analyze the odors of stool samples to identify different gastrointestinal infections. The Odoreader is still undergoing clinical trials, but has the potential to be a fast and inexpensive method of diagnosis, and can possibly even be used in the future for respiratory and urinary diseases as well.
Here are some other smells to take note of in medicine:
- Ketoacidosis — fruity odor, due to acetone from ketosis.
- Pseudomonas — grape-like odor.
- Phenylketonuria (PKU) — “mousy” smell (what exactly does a mouse smell like? a pet store?)
- Arsenic poisoning — garlic smell. Don’t confuse it with someone who just ate garlic bread.
- Cyanide poisoning — burnt almond smell.
On a related note, wouldn’t it be cool if a smell-generating machine is invented that could be used in medical school to teach what different infections, conditions, and diseases smell like?