The Common Head Cold:
Principles And Practice Of Hardening
Home Care And Treatment
Nasal Obstruction And Mouth Breathing
Voice And Speech
Summary And Conclusions
Read More Articles About: The Common Head Cold
Summary And Conclusions
( Originally Published Early 1900's )
The object of this work has been to set forth for the benefit of laymen, the best and most recent knowledge of the profession on the subject of the origin and nature of the common cold and its complications,—why we catch them, how we can avoid them, and what we can do to get rid of them.
If the information is not altogether satisfactory, it is because our scientific knowledge is not in all respects final. It is regrettable, that so little serious attention has been devoted by the profession to the conquest of this universal plague which lies at the root of so much :morbidity and whose ravages cause such widespread suffering, not to mention the enormous economic waste resulting. Though there are many questions undetermined and debatable, nevertheless there are a number of facts upon which there is practically universal agreement.
First of all, it is necessary to strive to remove many false impressions with regard to the nature and origin of colds, and correct some absurd notions that are more or less prevalent as to their prevention and cure. To this end, a few basic facts in the anatomy and physiology of the organs concerned are indispensable.
The vital importance of nasal breathing cannot be too greatly emphasised. The delicate, highly specialised structures of the nose are formed to filter and purify the inspired air and, this failing, all the respiratory organs lying below, including the tonsils, larynx, and bronchial tubes, are injured by improperly prepared air, and therefore the easy prey of colds and infections.
One has only to consider that the special senses of smell, taste, hearing, the sense of orientation and the important function of speech, are located in the nose or its adjoining organs, to realise something of the disastrous results of diseases affecting these regions.
Where important functions lie, nature takes especial precaution to institute mechanisms of protection. Ignorance, neglect, abuse, are too often responsible for breaking down these de-fences, and then the upper respiratory tract becomes the entrance port for myriads of disease germs. Influenza, measles, scarlatina, diphtheria, pneumonia, cerebro-spinal meningitis, and probably also sleeping sickness and many other diseases, find their way into the system through the nose and throat, and are favoured by mucous membranes inflamed by the ordinary cold.
The causation of colds is a complicated question. There are two chief factors which are of equal importance as inciting agents, namely atmospheric conditions and micro-organisms, but in order that these factors shall be effective, the way must have been prepared by one or more so-called predisposing causes.
Predisposing causes, are subdivided into general and local. The general are those which appertain to the general state of the health, and the local are lesions of various kinds which are located in the nose and throat themselves. These predisposing causes being internal, are, in their turn, it must be understood, the result of certain external influences or conditions, and therefore, really represent intermediary stages in the chain of causation. The effective external conditions are especially such factors as impure air, drafts, irritating dust, overheated apartments, in-appropriate clothes, excessive or improper diet, excessive use of alcohol or tobacco, etc.
The local predisposing causes of colds are of great importance, and constitute in many cases the chief explanation of continuous and repeated attacks. Any disease in the nose and throat lessens the resistance of the parts, and renders them susceptible, but certain ones are of especial significance. In the case of children, the commonest cause of colds is the presence of adenoids ; in adults, the largest proportion of persistent and repeated colds can be traced to a diseased condition of one or other of the sinuses. Deviations of the nasal septum and other obstructive conditions within the nose do harm not only because of interference with proper nasal breathing but be-cause they obstruct the outlet of the sinuses. Diseased tonsils and sinuses favour colds because they invite infection, which frequently spreads to adjoining regions.
Atmospheric conditions, it must be insisted, are real and very important influences in the mechanism of cold catching. Colds are commoner in cold weather and in cold climates, and animal experimentation as well as personal experience attest the influence of low temperature in inducing inflammation of the air passages. It is only natural to suppose that the air tracts designed by nature to ultilise air for the benefit of the human body, might be injuriously affected by unusual atmospheric states. As the nasal functions in particular are concerned with the temperature and humidity of air, and the variations to which they have to be constantly adjusted, we have one explanation of the especial frequency of head colds as a result of violent changes in these atmospheric conditions.
It must be remembered that the respiratory function of the nose has a reciprocal relation with the function of the skin, in connection with the heat-regulating activities of the body. This is made possible through the intermediation of the so-called sympathetic nervous system which automatically controls the circulation in these organs, in response to variations in the temperature of the atmospheric environment. Drafts are bad because they interfere with the orderly adjust-ment of these related functions of nose and skin. A cold column of air blowing upon restricted areas of a generally overheated body, while the individual is at the time inhaling warm air, provokes a congested condition of the nasal circulation, a forerunner of colds.
Notwithstanding the evident influence of bad atmospheric conditions in the causation of colds, it is certain that these are not alone a sufficient cause, but there must be added another factor, viz., the presence of micro-organisms. This is strikingly proved by the experience of arctic explorers who are exposed to the worst possible weather conditions with complete immunity from cold catching.
That acute colds are, in a measure, of an infectious nature, is generally admitted by the best authorities, but so far no germ has been identified as a specific cause. Most of the bacterial growth found to be associated with these attacks is a secondary occurrence and not therefore to be regarded as the real causative agent. For this reason vaccines derived therefrom are of no real value in the cure of the malady. It is very doubtful if any serum or vaccine can be found to prevent recurrence, for the reason that colds do not belong to that class of diseases distinguished by the peculiarity that one attack confers subsequent immunity.
The idea of the bacterial origin of colds naturally raises the question of their contagiousness. Colds are no doubt in a certain degree contagious by close contact, and especially by exposure to the cough or sneeze of affected individuals. However, emphasis should be placed less on contagion than on the resistance of the individual, for colds do not occur unless the resistance is previously lowered by predisposing causes of either a local or general character.
Similarly, with regard to the use of antiseptic sprays, vapour, douches, or gargles, with the idea of destroying bacteria and so preventing or curing colds, while they are, properly used, helpful, it must be understood that it is impossible to get rid completely of all germs, and therefore a chief reliance should be rather placed in so building up body resistance as to render the bacteria harm-less.
The symptoms of a cold are known to everyone by personal experience. However, many persons take to be a cold what is only a mere irritation of the nasal passages, a sort of psuedo-cold, of a nature to be classed as hay fever or something similar. A lack of distinction in this respect has been often responsible for claims as to the efficacy of certain cold remedies which were not justified.
In the prevention of colds, we must take into consideration the nature and the intensity of the causative factors. It is of course imperative to avoid those of such severity as could not fail to break down resistance and cause disease,—atmospheric conditions of unendurable violence or infectious agents in overwhelming force. But all causes that fall short of a destructive degree must be faced, because this is the way we accustom ourselves to withstanding conditions that are inevitable and of building up against them our forces of resistance. In fact, for the avoidance of colds it is desirable that one should actively undertake special procedures which we speak of as "hardening," designed to train the forces of the body to withstand unfavourable influences.
In the practice of hardening we insist that certain principles be observed, (1) to accustom the body only to those weather conditions which may be regarded as inevitable in the ordinary experiences of life; (2) all hardening procedures should begin lightly, increase gradually and never be excessive; (3) whenever cold water is used for its hardening value, it is essential that a healthy reaction be obtained; and (4) hardening methods designed to prevent cold should never be employed during the existence of a cold.
It is not possible to enumerate in an exhaustive fashion every possible situation that has a bearing on the problem of colds. We may however cite a few practical rules of special importance from which others may be readily inferred, following the principles above outlined.
With regard to the atmospheric factor, we consider it important that one does not expose himself to a cold chilling air, when in a state of perspiration, or when greatly fatigued either bodily or mentally. One should avoid drafts when at rest in a close stuffy room. One should avoid at all times badly ventilated and badly heated apartments. There is an especial danger of contracting colds in those places in which the floor is cold and damp, and the upper strata of the room proportionately warm. Overheated apartments are one of the greatest evils of our American homes, and the most prolific cause of cold catching; but, on the other hand, there is danger in underheated living and working rooms, where the loss of heat from the body may go on insidiously with harmful results. There is especial danger in standing in cold halls or vestibules, or sitting quietly without exercise in cold places.
Getting the feet wet is a cause of colds familiar to us all since childhood days. The danger is much lessened by a prompt towel dry-rub of the feet, with change of foot-wear. The same thing applies to the clothes in general. Washington started the cold which ended his life by keeping on his overcoat for some hours indoors, although thoroughly wet from exposure to a snow storm.
With regard to the bacterial factors, it is probable that danger of exposure is increased by worry, and other depressing emotions, as well as by physical fatigue and a generally rim-down state of the health. The danger of contagion is in the direct exposure to the mucous membrane secretion, as spread by kissing, the sneeze, cough, or the use of handkerchiefs or towels of infected individuals.
Proper clothes are of great importanace for those who would escape colds. One of the most valuable rules to be observed, is to wear, as near as possible, underwear of the same weight throughout the year. One must guard against over-dressing, especially against remaining too long indoors with wraps, overcoats, furs and overshoes. There is danger, too, in insufficient dress. One cannot with impunity go lightly clad on cold raw days or in windy weather, unless constantly exercising. When in a state of perspiration the danger is increased. We warn against exposure to extreme cold immediately after indulging in a heavy meal, or using alcohol. The latter causes a marked determination of the blood to the sur-face of the body and so increases the dissipation of heat. Taking hot baths and going out doors immediately is hazardous for the same reason.
For the purpose of hardening the body against colds, frequent exposure of the naked skin to cold air and frequent use of cold water baths are indispensable. To be condemned are such fads as going bareheaded, and barefooted, and constantly without overcoats.
Exercise in the open is most valuable. People on camping, hunting and yachting parties almost never contract colds. Games requiring reasonable physical exertion are of great benefit and the benefit is increased no doubt by the accompanying pleasant mental diversion.
Instructions given for the intervals between colds do not apply to the time when one is in the grip of an attack. A cold once contracted, one should eschew strenuous exercise, avoid exposure to severe cold and sudden changes and refrain from taking cold baths. It is advisable to go on a light diet without meat, and with predominance of fruit and fruit juices. A laxative and a good sweat at the beginning of a cold is usually helpful, and if there is fever, one should go to bed, or at least rest quietly.
No one kind of medical treatment is good for all kinds of cold, or for the same cold at different stages. With the occurrence of any unusual symptom indicating a possible complication, as pain in the ear or cheek or forehead, or severe headache, a physician should be called.
For many individuals the tendency to contract colds, depends Upon some local lesion in the nose and throat which must be corrected. Nasal obstruction must be removed because it produces irritation, interferes with the drainage of the sinuses and interferes with the important function of respiration. Children with adenoids and dis-eased tonsils are in the constant throes of head colds ; and on account of the adenoids especially liable to serious trouble with the ears. It is best not to remove the adenoids of children under five years of age, but even this sometimes is necessary when they are evidently producing harm.
In adults tonsils often become infected, and serve as a starting place for inflammation which may have serious results. There should be no question of their removal in such circumstances. No harm is known to result from their removal, and the benefit has been attested by many thou-sands of cases. Hemorrhage following the operation is an accident not to be feared when the operation is done by a competent specialist, and care' taken to ligate all bleeding vessels at the time, in the manner recommended by the author.
An even more frequent cause of cold in adults is a diseased sinus. A pus focus in any of the paranasal sinuses will keep the nasal passages continually irritated and congested, so that these patients seem never to be free from a cold, and severe exacerbations may occur upon slight pretexts.
Contrary to general opinion there may be considerable disease in a sinus unaccompanied by pain, so that one cannot know that he is free except by examination by a competent specialist. One cannot even rely altogether upon a negative report from x-ray examination, as these have sometimes proved misleading.
One of the very inconvenient consequences of a spread of a cold downward is the involvement of the larynx, giving rise to hoarseness or loss of the voice. This is a matter of great concern to all persons, but especially to singers, lecturers, actors and public speakers.
Mouth breathing and the inhalation of dust, smoke and irritating gases, also the abuse of the voice, must be added as special causes of inflammation of these parts. These causes are therefore to be avoided as a means of prevention, and also during an attack, as otherwise they aggravate the situation and prevent recovery.
In conclusion, to answer very summarily the questions which we imagined to be asked in the beginning of this work, viz., how a cold is caught, how avoided and how if caught, gotten rid of, we must say, (1) that one is destined to catch cold if his resistance has been so lowered by predisposing causes, that it is unequal to the unfavourable action of the special exciting causes; (2) that to avoid a cold one must eliminate or as much as possible avoid the predisposing causes and one must accustom himself to the action of ordinary exciting causes, and build up a special resistance to the extraordinary ones, and (3) to get rid of a cold one should take care not to antagonise nature, but take measures which tend to assist her in her efforts to reduce the irritation due to the exciting causes, and to repair the damages done which result therefrom.
What these predisposing and exciting causes are and how they act; how by special precautions we can escape their evil effects or by special measures render them harmless; and what in the event of failure is best to be done,—these matters we have set forth in some detail, and attempted to fully explain, in the body of the book in chapters dealing in particular with these special subjects.