Smell as a diagnostic marker.

The odour emitted by the patient may be one of the first major clues leading to an early diagnosis. Certain dermatological conditions produce an obnoxious smell and several metabolic diseases are associated with a characteristic odour. Schizophrenia and several rare inborn errors of metabolism associated with enzyme deficiencies are linked with distinctive body odour. THE status of body odour has varied with race and time. It is interesting to note that while some races attribute special significance to body odour, e.g. sexual prowess or attraction, history shows that several ancient cultures went to great lengths to eliminate the smell-the Romans by building bath houses all over the Empire, and in many older archaeological sites perfume jars are found. Oddly enough, in direct contrast, the Japanese have virtually no body odour whatsoever. It is recorded that Queen Elizabeth I had perfume in her gloves and surrounded herself with herbs and spices. Toilet waters and colognes were already in common use in the 18th and 19th centuries and within the last 40 years, deodorants and anti-perspirants have become common in every home. It is an essential part of the neurological examination to test the patient's sense of smell, and unilateral anosmia can be an excellent sign drawing attention to a frontal lobe tumour. Epileptic patients can experience, just preceding a convulsion, an aura of a strong or unusual smell. These two examples illustrate how the patient's sense of smell can be used as an aid to diagnosis, but no matching emphasis as a diagnostic tool is given to the odour emitted by the patient. An extreme example of how the odour from the patient can be helpful is with regard to the integrity of the sphincters of bladder and bowel. This incontinence may herald a case of dementia, neuro-logical problems such as disseminated sclerosis or cord lesion, a urethrocoele or prostatic disturbance. The overall smell from a person is derived from the body's secretion and excretion; sweat and sebum from the skin, secretions from the naso-pharynx and lungs; as well as urine, faeces, colonic flatus and vaginal discharge. However, body odour is mainly produced by the apocrine glands' secretion-particularly those in the axilla. Other modified apocrine glands tend to be maximally situated in the perineal region and the areola of the breasts. When the secretion reaches the surface of the skin it is odourless but develops a characteristic, offensive odour if left …