The purpose of reporting this interesting case is to call attention to a very simple but exceedingly valuable procedure as an aid in the diagnosis and treatment of some puzzling types of parietal pain. Because of their curious nature such pains are often confused with deep seated visceral pain. As a result of such confusion extensive diagnostic and more extensive therapeutic procedures are used in attempting to find the source of the elusive pain when much simpler measures will suffice if applied first.
My interest in this method was aroused about a year ago when I was asked to see an Italian laborer who had been incapacitated for several years with left upper quadrant pain following an injury. So many diagnostic procedures had failed to reveal the cause of the pain that he had been generally labeled as a neurotic and malingerer. I was immediately attracted by the patient using the index finger to point to the location of the pain, which was at the outer border of the left upper rectus muscle, and by the marked agony that he appeared to suffer on attempting to rise from the supine position. Because of the extremely sensitive condition of the small area in which he located the pain, it seemed analogous to some other local pains about the head in which excellent results had been obtained by injecting the painful areas with local anesthetic. Immediately after the injection the patient was able to perform any and all movements involving the abdominal. . .