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22
During the spring term a student psychologist from
the Department of Child Study of Birmingham University
spent three weeks helping and observing in the work of
the Educational Psychologist.
4 PAEDIATRIC CLINIC.
Dr. Elchon Hinden, Paediatrician to Whipps Cross
Hospital has kindly submitted the following report on
the work of the Paediatric Clinic.
"One of the commonest causes for referral to the
paediatric clinic is abdominal pain. This disorder,
when met with in a " cold" school clinic, is likely to
be different from what the family doctor sees in his
surgery. He is bound to consider the acute inflammations
- appendicitis, pyelitis, even acute tonsillitis. But by
the time the child comes to a second opinion clinic,
months, even years, may have passed, and this consideration
greatly limits the diagnostic field.
" In fact, there are very few organic conditions that
cause long-standing abdominal pain in this age group.
Peptic ulcer, that sharp-toothed eroder of the adult' s
peace-of-belly, is hardly known in school-children;
gallstones are even rarer; and abdominal tuberculosis,
once a constant danger, went out as pasteurisation came
in. Certain renal conditions, such as hydronephrosis,
do still have to be considered, but they are far from
common and usually declare themselves by disturbing
micturition. Occasionally a severe attack especially
when associated with vomiting will so simulate acute
appendicitis that operation perforce is performed; but
the appendix is found guiltless, and the attacks recur
with unhindered rhythm, Looking back over our shoulder
for the clue we may have missed, we call the disease
'functional" only wishing somebody would explain the
mechanics to us.
" I think that we can identify two groups of
children among the sufferers from tummy-ache. In one
of these groups, the attacks are regularly precipitated
by emotional stress, by excitement, even by pleasurable
excitement. This observation is an old one; we find in
the Bible that the bowels were considered the seat of
the emotions.