The Common Head Cold:
Colds In General
Nose And Throat Functions
Highways For The Invasion Of Disease
Colds And Micro-organisms
Symptoms, Complications And Sequelae
Principles Of Prevention
Methods Of Prevention
Read More Articles About: The Common Head Cold
Colds In General
( Originally Published Early 1900's )
Never before, as at the present time has there been upon the part of the general public, such a keen appreciation of the value of hygienic knowledge, and such an earnest effort to benefit through the application of hygienic laws.
This tendency has been stimulated and fostered by the altruistic aims of medical practitioners. It was necessary that the medical profession should, itself, first awake to a proper realisation of the transcendent value of hygiene before it could communicate it to the world at large. It was necessary that it should free itself from its former exclusive and forbidding policy, based upon the theory that the mysteries of physic were for its votaries only, and that it was profane to communicate them to the outside world. But as hygiene has advanced in the esteem of medical writers and practitioners, it has gradually become evident that this branch of medicine is one that requires that the laymen be taken into the confidence of the physician.
Hygiene is the art and science which considers the preservation of health. As a science, it is concerned with every subject which may contribute any knowledge looking to the prevention of sickness and the postponement of death. As an art, t is interested in every means by which this knowledge may be successfully applied. Both philosophy and experience teach that the latter object is unattainable without the helpful and intelligent cooperation of the people toward whom these laudable objects are directed. In other words hygiene as an art requires the alliance of the doctor and layman, and the latter's aid as an ally is in direct proportion of his understanding of hygienic principles and his possession of hygienic facts.
When disease has already taken its hold on an individual, the unfortunate victim does right to call for aid, and quickly. Often-times, completely overcome mentally and physically, he is at the mercy of his foe, and must perish unless his professional protector, armed with sufficient knowledge, judgment and skill can come to his timely rescue and save him. But when the enemy is still afar off, and while the individual is still in normal possession of his strength and faculties, he is then his own best physician, and can save him-self by wisely following hygienic counsels. As in time of peace we must prepare for war, so it is in time of health we must prepare against disease.
If the practising physician, fighting enemies of the body already at work, can be likened to a soldier, fighting a personal foe, then the physician in the capacity of hygienist may be compared to the sober statesman, administering counsel tending to the happiness and prosperity of the state and looking to the warding off of evils which may effect the body politic.
The hygienist's duty is to the individual in the state of health, to keep him so; to warn him against the enemies of the body and to teach him how he may avoid them. This he does by instructing him in the laws of healthful living, and by pointing out the evil consequences of their violation, by making him acquainted with the structure of his own body and its functions, and showing him what disorders can come from its abuse and misuse.
It is no doubt a fact that a ceaseless warfare is being waged between the elements which make for health and those which make for disease; between the forces of degeneration and regeneration. This we knew in sort even before Lister and Pasteur revealed to us the myriads of unseen foes, which teem in our midst and threaten our destruction. What should we do to protect ourselves against them and survive in spite of them?
Intelligent beings determined to survive and triumph over the machinations of an ever-present enemy, will find that two methods can be adopted looking to that end, both equally important and necessary. They are (1) to destroy, or weaken the enemy, (2) to strengthen themselves.
So, with regard to man's health, efforts are to be directed not alone toward overcoming and destroying disease, but likewise, toward increasing the powers of resistance. To succeed in either of these purposes the first requisite is knowledge; knowledge of disease, knowledge of ourselves.
It is therefore within the province of hygiene, and we may say one of the most effective measures it possesses for prevention of disease and the preservation of health, to spread and popularise so far as it is practicable a knowledge of the human body, explaining the principles that govern its action and laying down rules and regulations for maintaining it in a state of health.
Hygiene without preachment would be like the play of Hamlet with Hamlet left out. As well might theologians confine religion to themselves, denying the necessity of spreading its doctrine among men, as hygienists fail to propagate hygienic knowledge. The very life of hygiene consists in a propaganda, just as the missionary spirit is the soul of Christianity.
The question may, however, be very properly raised as to the limit to which the professional man should go in his effort to instruct the public.
It is obviously unwise to attempt to convey in-formation of the character and extent of that suitable to the physician. People who have other things to do, and other subjects to learn, will have neither time, inclination, nor capacity for the minutiae of medical lore.
The general public must then be supplied only what it can absorb and utilise, and it is therefore the business of the hygienist to carefully select and judiciously prepare, out of the great abundance at hand, such material as will be suitable.
There is no subject, no matter how apparently abstruse and intricate, or how overburdened with material, which may not be classified and simplified and ultimately rendered fit for popular absorption. This the hygienist must do, keeping always in mind practical needs and practical purposes.
The particular ailment which is considered in this treatise needs above all others to be made the subject of hygienic education. This is true : first, because the common cold is the most frequent of all diseases; secondly, because the consequences are serious, and thirdly, because it is an affection which to a very great extent is preventable.
Of the actually serious nature of a common cold, there is no adequate appreciation on the part of the public, nor, for that matter, on the part of the medical profession as a whole. To regard whatever is common as of only inferior importance is an error to which all mankind is admittedly more or less liable. In fact, so widespread and so deep-rooted is this general tendency that it has taken a strong hold even upon our language, and we find that the adjective "common" is used synonomously with what is unimportant.
It is very likely that this secondary construction is frequently put upon the expression "a common cold". To such a misinterpretation of its true significance we desire to enter a protest.
The so-called "cold in the head" is certainly one of the most universal of ills to which flesh is heir. The doctor as well as the layman has had his personal experience of it. It affects alike the rich and the poor, the old and the young, the white and the black. It occurs in all climates, in all countries, and at all seasons. But this universality of its distribution, this commonness of the common cold, instead of giving rise to a sense of security and suggesting a policy of inaction, ought rather to have a reverse effect, and put us on our constant guard against an enemy that surrounds us on every side, and against attacks from which we are exposed at any time and in all places. A "cold in the head" is in fact the entering wedge of disease; it is a small break in the embankment which protects good health; it is a rust formed upon the constitution which, besides the harm it does of itself, favours the formation of additional deposits. It is a very true, as well as very witty, remark that was made by Woods Hutchinson when he said that man's life ought to be measured not by the years that pass over his head, but by the colds that pass through it.
The term "a cold" is generally used to embrace the process by which the malady arrives rather than the effect, as when we say such and such a disease is due to "catching cold." We are con-fining ourselves chiefly to the consideration of a cold localised in the nasal passages, because it is here that it occurs in its most typical form. If we know all about head colds, we shall know all about colds in general. It is by long odds the most frequent kind of cold and is as a rule the starting point of colds elsewhere in the body.
The nose standing at the very threshold of the respiratory tract is, in a sense, an internal organ with an external exposure, and it must bear the brunt of the attacking hordes of germs, together with the dust and other impurities entering with the inspired air. A very special reason why colds have their favourite seat in the nasal passages is because, in the performance of its respiratory functions, the nose has to both warm and moisten the inspired air and therefore must react to the variations in the physical properties of the surrounding atmosphere, which are looked upon as the chief cause of colds.
There is evidently still some idea abroad that a cold is something very different from an inflammation. We must recognise it however as, in fact, a form of inflammation, caused by the same agents, manifesting the same phenomena, and subject to the same general principles of treatment.
"Inflammation", says Grawitz, "is the reaction of irritated and damaged tissues which still retain vitality." It is accordingly not to be regarded, as was formerly thought, as the product of some force animating matter from within, but rather as the sum of reactions to certain causes and tending always towards repair. Inflammation is accordingly not an entity which destroys, but really a process representing nature's efforts against destruction.
The uncomplicated head cold, confined to the nasal passages is technically an acute rhinitis or coryza; when the inflammation has extended to the adjacent cavities known as sinuses, we have then a sinusitis, designated as frontal, ethmoid, maxillary (antral) or sphenoid, according to the particular cavity involved; if the pharynx is the chief seat of cold, the attack is known as pharyngitis ; and if the tonsils become involved we have tonsillitis. If the inflammation has gone lower down and attacked the larynx or voice box, the trouble is properly spoken of as a laryngitis; if still lower, affecting the bronchial tubes, we call it bronchitis.
It is in vain to imagine that this violent inflammation of the membrane lining the nasal cavity and of the spongy tissue lying therein, with its consequent intense engorgement of the blood-vessels, and over-activity of the different kinds of glands, with its copious exudation of serum into the submucous tissue, with its migration of leucocytes, with its over-production of mucus, with its desquamation or shedding of epithelia and in the later stages, with its formation of pus containing numerous pathogenic or disease producing bacteria,—it is in vain, I would say, to imagine that such a process is going to pass off without leaving some traces of its visit.
Undoubtedly, it has often injured these membranes, blood-vessels, and glands to such an ex-tent as to permanently harm them, and in such a manner as to make them more liable to future attacks. Frequent colds, especially if neglected, set up a catarrhal inflammation. The latter pre-disposes to catching colds, and thus is completed a beautiful example of the "vicious circle."
Another evil feature of a cold is its dangerous tendency to extend. It is probable that every acute rhinitis or head cold is complicated with more or less involvement of the neighbouring sinuses, and if it so happens that certain conditions are present, an empyema or abscess may be the result. The inflammation often travels up the Eustachian tubes, and, in children especially, gives rise to a suppurative middle ear inflammation; or it may travel downward, setting up a laryngitis or bronchitis, or, in young children, a broncho-pneumonia. Add to this that in the suckling infant acute rhinitis has serious consequences, because of its interference with the taking of nourishment, and we have some idea of the need of preventing, if possible, or that failing, exercising our best efforts to cure this affection.
If we can regard the nose and throat as internal organs, it may be stated that they are the only ones which are directly exposed at the same time to the baneful influences of external conditions. The mucous membrane lining of the air passages, because of certain points of analogy, has some-times been referred to as the internal skin, but compared to the thick epidermis, or cuticle forming the outer layer of the skin, the fine epithelial layer of the nasal membrane enclosing numerous blood vessels with thin walls must be considered as an exceedingly delicate and vulnerable structure.
Considering then, its delicate character, considering the importance and complicated functions which, as we shall see later, it has to perform, and considering that it has to come in contact with an atmosphere which we know is loaded with germs and grosser impurities, it should be no cause of wonder that disorders here are of common occurrence.
The serious nature of these affections of the upper air passages is not appreciated by those who consider only their immediate effects and their comparatively low mortality. The gravity of these disorders will be recognised as much greater when we consider their inherent progressive tendency and the serious ailments to which they may later give rise.
The importance of the functions of the nose and throat are not fully realised until they are injured or destroyed by pathological conditions.
Of the special senses, two, taste and smell, have their seat in these organs, and a third, hearing, is located in such close proximity that it invariably suffers from nasal and pharyngeal disease. In fact it is well understood that deafness has its origin in a great majority of cases, in catarrhal disease of the upper air passages.
The serious and far-reaching effects upon the general organism which must result from an interference with the respiratory function of the nose, we will discuss later.
Taste, smell, and hearing are the functions concerned with the perception of external impressions which are utilised by the intellectual centres of the brain for the formation and development of ideas. These vital avenues of sensation, which connect the mind with the external world, cannot be severed without great detriment to the individual, considered as a social unit in his relation with his fellow men.
Another important function which is menaced by affections in the upper air passages is speech, a function which may be considered as a complement to those just cited, in that it serves to convey to the outer world the ideas formed and stored in the brain, through the natural avenues for the egress of thought. Speech is not merely a matter of voice, affected only by disease in the larynx or voice box. It is a composite product of the action of the palate, lips, teeth and tongue, and essential to its proper formation, at least to its pleasing character, is a normal condition of the nose and nasal sinuses. Hoarseness is a special symptom of a cold in the larynx, but a cold in the head makes the voice woody and non-resonant and interferes considerably with proper articulation.
There has been of late considerable missionary work carried on among teachers, nurses and mothers, with regard to the effect of adenoids and diseased tonsils upon the physical and mental growth of the child, so that now there is a pretty general recognition of the importance of these maladies. But new children are constantly being born, and inexperienced mothers, nurses and teachers are constantly being made, so that it is imperative not to relax in this most profitable educational campaign, but to continue to teach, lecture and demonstrate, so that we shall have fewer and fewer children growing up with stupid and misshapen faces, irregular and distorted teeth, with undeveloped chests, and weak lungs, probably more or less deaf, and generally anemic and poorly nourished, because of the presence of these growths in the throat.
Recent investigations tend to show that rheumatism and serious heart inflammations may take their origin from inflamed tonsils. In children inflamed tonsils make them a much easier prey to measles, scarlatina and other infections of child-hood, and moreover, intensify illness and augment complications.
We have still left unsaid the various ailments and discomforts, which are the immediate results of diseased conditions of the upper air passages, the headaches, the throat soreness and the occasional horrible ozena, which may be such as to cause the unfortunate subject to be ostracised by his friends.
The third reason which we advanced for a hygienic study of nose and throat troubles is that they are in a large measure preventable. It is a fact that a very great proportion of such cases are due to ignorance of hygienic conditions and neglect of hygienic laws.
Many absurd, vulgar beliefs and false empirical practices still prevail with regard to the cause and cure of these maladies 'which have obstructed progress. If, in their place, we can institute a rational hygiene, if we can show, for example, the baneful influence of tobacco, alcohol, drafts and improper dress in causing these diseases, and the value of such factors as cold baths and exercise in avoiding them, much certainly will be accomplished in the way of healthier noses and throats, and incidentally sounder constitutions.