Smells in clinical surgery – this is a subject I do not remember reading or hearing about much. I sometimes raise the topic with students. On at least one occasion I have found it saved the life of a patient, and it has improved the care of other patients on several occasions.
Everyone knows the following smells:
Highly significant at bedside:
Diabetic ketosis in a patient with acute abdomen and previously undiagnosed diabetes
Mousy [mouse faeces] smell of clostridial sepsis
Sweet faeculent smell of pseudomonas pyocyaneus pus, which is mainly on the blue dressing, where the nurses have not noticed that there is an infection, an easy signal for the prescription of silver sulphadiazine cream.
Stinking smell of E coli pus
Lack of smell of staph aureus pus
Others in ward:
Aspirates in various stages of bowel obstruction
In operating theatre:
Faint whiff of colonic gas from a small colonic perforation
Typical burnt armpit smell of diathermy cutting of breast fibroadenosis
Fried smell of diathermised normal breast tissue
Other smells I am not able to describe clearly:
Infected varicose ulcers
So-called abdominal breath once considered a feature of appendicitis
The above is an informal list where I have doubtless left out many common ones and some interesting obscure ones. I would be grateful for any additions from others, which can be emailed straight to me, or posted WITHOUT reprinting the whole of the above message.
A few months ago I wrote about the 93 year old man with a a strangulated inguinal hernia extending down to his knee. While replacing the bowel in the abdominal cavity I smelled a faint whiff of faeces, which the other two at the operating table did not notice. When I withdrew small bowel again I found two tiny punctures in dilated ileum, leaking a little liquid faeces, which I had to oversew gently. They were from the “autraumatic” De Bakey forceps. Since then I use a spongeholder for handling or replacing fragile bowel, where my fingers can not do the job.
As a new resident in an English hospital I had a fit middle-aged man die 4 days after an ordinary cholecystectomy, because his diabetic ketosis was not recognised till too late. The nurse’s record of glycosuria on admission was not noticed because it was hidden in the usual mess of unimportant admission information. [This is part of another study on data availability in clinical surgery]. More awareness of clinical smells might have saved his life. Others may have had similar instances they can remember.