Facial Diagnosis

I grew up with the Readers Digest, although I do not think that was what my parents had in mind.
I was a very early reader. I had the activity pretty much nailed by the time I was three. I could
even do phonetic sounding out of words, as well as the obsessional dictionary searching that I
now do on line. I also had an obsessional interest in books intended for bigs.
The Readers Digest, to which my parents had some kind of a lifetime subscription or something,
was consistently to be found on top of my mothers bedside table which had actually been her
old hope chest. I would borrow the current copy of the Readers Digest in the morning when
they were still asleep, and generally return it before they would wake.
I will admit I had promised them to ask about anything I did not understand, but I have no memory
of ever having to do so.
Recently, my husband the movie buff and avid reader called my attention to a copy of RD
that he saw in some waiting room. He said it reminded him of me since I often will comment on
the condition of some movie or TV character based upon the appearance (or lack thereof) created
by makeup for the dramatic effect. Im not really diagnosing the character, as such merely
commenting on the realism of the makeup effects.
Husband-Dear has a fondness for classic swashbuckling movies and related novels, and told me
about Errol Flynns 1935 classic Captain Blood one of the best pirate films ever made (he claims
and critics seem to agree).
In this story, Dr. Peter Blood is sentenced to death for treating an enemy soldier during some
British rebellion. Dr. Blood responds by diagnosing his judge with kidney failure based upon his
facial appearance stating that the judge has already been sentenced to death by a Higher
Judge.
The RD article in question is about facial appearance and how various conditions may be
diagnosed from a visual inspection (although a good doctor will do blood tests, imaging or
whatever else needed if only to satisfy insurance companies).
I was a bit surprised, because not only is this not terribly topical, but I may have been the last of a
generation to have, in the course of her medical education, been steeped in classical (old
fashioned) clinical diagnostics.
And I mean old. Some of these go back to Hippocrates Yes, Him of The Oath.
The function of medical education in France, when I was a student, was primarily to produce
French country doctors, of which there never seemed to be enough. In our single course about the
business of medicine (given by a country doctor who drove in for lectures) we were told that
accounts of finances kept by hand in a bound notebook would be sufficient, and that it was
advisable to use no more than a single horizontal line to cross out any errors.
We were even told not to get greedy, and not to be dishonest, as we would make a decent living
and earn enough to raise our families.
We were told also to do a really good job and to be as thorough as we could with the physical
examinations, and with all clinical work, as we ought not to rely excessively on paraclinical
examinations. It was just a pain to drive in from the country to the city to get x-rays or blood
work or something fancy. You just had to save it for when your first line did not work and you had
a relationship with the patient.
Oy, thought I, who wanted every patient to enjoy the height of diagnostic science.
Still, there is an advantage here.
When you are acting as if you have to rely only on what you can see and feel, you have to learn an
awful lot.
We had a year to learn something called Semiology the science of diagnostic signs before
learning Therapeutics.
Semiology really is an English word. I just never heard anybody but I use it in English.
I was taught that every patient who showed up for a general physical had to be stripped,
completely.
An appropriate witness was always encouraged to be present if it made that person comfortable.
Northern France being pretty cold in the winter, adequate heating in the office was a necessity.
I knew I had the most classical of medical educations imaginable. When I studied anatomy, I
looked at Leonardo da Vincis drawings. And Vesalius.
When I looked at diagnostic signs, I looked at Hippocrates, and subsequent greats.
So a really good doctor ought to strip folks down and look at every inch of skin, not just look at
the patients face during a chat.
As it happens, the first symptoms in the Readers Digest list are indicative of dehydration.
This is one of those topics about which I am a reluctant expert.
I certainly have a tendency toward dehydration.
A list of surprising reasons not to get dehydrated did not surprise me.
I am writing this while sitting, albeit indoors, in a high elevation desert.
Dry, flaky skin or lips.
Not only are the assessment and treatment of dehydration common knowledge, but reading it off
the face, and Facial Diagnosis more generally seem to date back to Hippocrates.
We are talking 4th century B.C. here.
The Readers Digest concern about excess facial hair in women is a bit naive and oversimplified. A
lot of women get a little of this after menopause.
Has nobody but me ever gone to visit an older maiden aunt and found a delicate little razor in the
bathroom?
It can commonly mean just a little much male hormones (androgens) as summarized in this
link (Which opens a PDF document in your browser or downloads it to your hard drive. This
requires the free Adobe Acrobat reader to access.)
Polycystic ovary includes a lot of stuff, most of which you could almost start to guess if you look
a little bit at the rest of the patients body.
As for the next observation fatty deposits inside the eyelids we know that Leonardo da Vinci
at least observed them, because he painted them in the Mona Lisa (1506).
Admittedly, clinical description in a medical journal of fatty deposits around the eyelids does not
seem to have appeared until sometime in the early 19th century.
These can be associated with raised lipid (fat) levels in the blood and all the possible
consequences of same, but the raised blood levels seem to occur only 50% of the time.
Puffiness under the eyes? A physician I once worked with quite closely used to call them allergic
shiners.
I have really never needed these to tell that I have hay fever. The sneezing when pollens are in
the air takes care of that one.
It has pushed me to use a fair amount of under-eye concealing cosmetics. It may push others to
facial plastic surgery, I suppose.
Facial asymmetry, although it may isolated in facial palsy a.k.a. Bells Palsy can coexist with
a variety of other signs, indicate stroke.
That one is definitely call-911 or rush to the Emergency Room stuff, but at least usually it is hard
to miss.
Discolored complexion is so non-specific (can mean so many different things) that I probably
would not try to evaluate it without a strip-down-and look-at-all-the-skin physical let alone a
blood test.
(It is symptomatic, among other things, of poorly applied makeup)
Same problem with rashes and blotches. I would suggest checking out the rest of the skin.
Although the rash associated with Lupus erythematosis is memorable once you have seen one.
You may have heard of that diagnosis frequently as the disease to be ruled out on the medical
thriller TV series House, MD. On that show, it becomes a running joke, as it is always the first
diagnosis made and is always wrong.
Our facial indicators of disease end with receding chin as a sign of sleep apnea.
Seems to me the association of outer anatomy with sleep apnea is iffy at best. I mean, when I
first learned about sleep apnea, I learned that it happened basically in males with short necks. I
have diagnosed it, and had the diagnosis confirmed with sleep testing in tall thin women with
willowy necks, as well as every other anatomical type I think of.
The object here is not to put down Readers Digest, which seems to remain a good reference for a
general reader in a way that few periodicals seem to be these days.
If one person has a life saved, or an improvement in quality of life, from alerting the public to
facial diagnosis, that is fine, even great.
Me, Im just hoping I responded appropriately to my husbands suggestion I try to be topical.
One point here is that things which seem topical often are ancient or even iffy.
I am reminded of the (lovely) Isaac Asimov story where people who use computers and mechanical
calculators rediscover manual calculations with a pencil and paper.
Maybe, in these days of highly sophisticated (and expensive) diagnostic tests, we need to
rediscover the low cost (and even the beauty) of a really thorough physical examination by a
physician.