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The Common Cold
The Common Head Cold:
 Colds In General

 Anatomical Outlines

 Nose And Throat Functions

 Highways For The Invasion Of Disease

 Predisposing Causes

 Atmospheric Factors

 Colds And Micro-organisms

 Symptoms, Complications And Sequelae

 Principles Of Prevention

 Methods Of Prevention

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Symptoms, Complications And Sequelae

( Originally Published Early 1900's )

It seems almost superfluous to describe the symptoms and characteristics of a cold; for who is it that has not had an opportunity to become familiarly acquainted with them through the unwelcome process of personal experience? The most familiar experiences, however, are not al-ways very analytically observed, and so with regard to the ordinary cold, we will find the in-formation of the patient inaccurate and his judgment unreliable.

One of the commonest errors is to mistake a pseudo-cold for a genuine one. As a result of mechanical or chemical irritants there often occurs a congestion in the nasal membrane that resembles a true rhinitis, but is only of temporary duration, and does not run a typical course.

Many individuals too are subject to nasal affections which are classed as "vaso-motor" at-tacks. The nasal membrane develops a peculiar sensitiveness to a specific irritant, generally the pollen of plants or some albuminoid substance in the dust, and not infrequently the emanation from certain animals. The attacks are of a more or less paroxysmal character, marked by sudden swelling of the mucous membrane with discharge of watery secretion accompanied by uncontrollable sneezing. The paroxysm occurs in the presence of the irritant and disappears just as suddenly in case of its withdrawal. These cases are very closely allied to hay fever, but the latter is distinguished in its seasonal occurrence, generally about the middle of August, and persisting to the time of the first frost. Genuine hay fever is rather more violent in its manifestations, usually affects the eyes, and is not infrequently associated with attacks of asthma.

We must distinguish also from the ordinary head cold, attacks of sinusitis. A simple common acute rhinitis or coryza involves only the lining membranes of the nasal fossa, and its contained structure, the septum and the turbinais.

But surrounding the nasal fossa and connected with it by small openings or channels is a series of bone cavities lined with a mucous membrane continuous with that of the nose proper as more fully explained above in our chapter, Anatomical Outlines.

One or several of these sinuses can become acutely inflamed, usually by extension of the rhinitis. We may generally suspect that sinusitis has occurred when the symptoms are extraordinarily violent and persistent, and when the discharge is very abundant and of a yellow, purulent character, and especially coming more from one side of the nose than the other, or dropping back into the throat. There is apt to be headache and sometimes severe pain over the region of the sinus, but this is often absent.

Frontal sinusitis is inflammation of the cavity in the frontal bone just above the nose. It is the one which is usually attended by the very severe pain in the region of the eyebrows.

Maxillary sinusitis is inflammation of the sinus lying in the cavity of the upper cheek bone,—the antrum. It is the one most frequently affected, and often without pain at all, or only a little aching of the upper teeth in that region.

Ethmoiditis is inflammation of the series of little air-cells which constitute the ethmoid labryinth, lying just between the eyes ; and sphenoiditis, inflammation of the cavity lying at the base of the skull just posterior to the nasal cavity. Inflammation of these latter cavities is known to cause serious involvement of the eyes.

The early recognition of sinusitis is of great importance, because; if not promptly treated and cured, it tends to become chronic, and cause the cold to persist or to return on slight provocation.

Sinus inflammation is not necessarily accompanied by pain, and the symptoms are occasionally obscure. Every case of cold therefore which does not seem readily to subside, or presents any of the sinus symptoms above mentioned, demands expert medical attention.

A competent specialist can immediately tell if a sinus is affected and which one, and can apply measures which will bring speedy relief, more easily done the earlier the case is seen.

A cold in the head or acute rhinitis is inflammation of the mucous membrane lining the interior of the nose, and like any other inflammation rep-resents the reaction which takes place in nature's effort to ward off and nullify the damage of a severe and persistent irritant.

Nature's chief and most active agent of defence is the circulation. It becomes immediately prominent on the appearance of the exciting cause, the blood flowing to the part affected in super-abundance, carrying nutriment to the tissue and myriads of white cells, or phagocytes, to devour and destroy the hostile germs.

In the beginning, the vessels are widely dilated and the circulation quickened, stimulating the cells and the glands, which in turn become active, producing abundant secretion.

As the fight thickens the circulation becomes, however, slowed, and white cells and the fluid escape through the wall of the vessels into the surrounding tissues. The nasal membranes will then be observed to present the cardinal symptoms of inflammation, viz., redness, heat, pain and swelling, and with them naturally disturbance and loss of function.

We have referred to the peculiarity of the nasal mucous membrane in the fact of the presence there of a mass of very vascular tissue called the erectile tissue. It consists of a great network of interlacing vessels which have properties of unusual expansion and contraction. When these vessels are distended the membrane, of course, be-comes swollen, accounting for the stuffiness or stoppage of the nose in acute colds, and their contraction accounts for the freedom of the pas-sages occasionally obtained. The escape of serum from the blood, together with heightened activity of the myriads of glands with which the membrane is provided, explain the abundant discharge which is inevitable. There is no acute pain in an ordinary uncomplicated rhinitis, but the inflamed membranes are extremely sensitive, and so in-tolerant of the slightest touch that sneezing is a frequent and sometimes annoying symptom.

Every head cold, in reference to its manifestation, has three stages ; first the preliminary or dry stage, second the stage of watery secretion, and the third stage of mucous secretion.

The first may be of but a few hours duration, when one experiences a general feeling of malaise and discomfort and perhaps a slight chilliness or "creepy" feeling. At this time the nose may be a little full and stuffy but dry, and there is a tendency to sneeze.

The second stage is marked by copious watery secretions from the nose, and the general increase of constitutional symptoms. Following a chill or at least chilly sensation, there will come a slight fever, when the skin will be hot and dry, with headache, furred tongue and disturbance of digestion. At the height of the cold one's mental operations are always somewhat hampered,—there is lessened capacity to concentrate attention, with mental hebetude or irritability.

After a few days, it may be a week, this stage is succeeded by the third, the stage of mucous secretion. The acute symptoms now subside, to be replaced by a certain degree of general weakness and lack of energy. The secretion from the nose instead of being watery becomes thick and mucoid, at first white glairy, and then yellowish and sometimes with an admixture of blood. The nasal stoppage is less intensive and of less duration.

If a cold in the head be confined to the nasal cavity proper, there would be less to worry about, but unfortunately it manifests an uncontrollable tendency to spread. This is owing to the fact that the same membrane that lines the nose extends to the (1) throat, (2) to the surrounding sinuses, (3) to the ear, and (4) to the eyes, so that the inflammation naturally travels to these parts.

Some throat involvement almost invariably follows an acute rhinitis. This may be due partly to the nasal obstruction which causes mouth breathing, which is damaging to the membranes of the throat, and the lower respiratory tract, but for the most part it is due to direct extension, first to the post-nasal space, and then to the pharynx, tonsils, larynx and bronchial tubes. Nearly always it is observed that an acute tonsilitis or laryngitis has been preceded by an acute rhinitis, and then of course the duration of one's attack of cold is greatly lengthened and its seriousness increased.

We have referred to the tendency of sinus trouble to develop in connection with every severe acute head cold. Each sinus is in communication with the nose by some sort of opening or passage-way, through which the mucous membrane extends into the sinuses and through which the infection naturally travels. All those severe intractable inflammations of the sinus, were first ordinary head colds. When there is much and persistent swelling of the mucous lining in the neighbourhood of the sinus openings these, by becoming closed, cause the sinus secretion to be imprisoned. Without aeration and without drainage the sinuses go from bad to worse, and collections of pus form in them, which, if neglected, may lead in time to serious disease of the bone (necrosis).

The inflammation from the interior of the nose can reach the eyes through the lachrymal duct, a duct formed for the outlet of an excess of tears. Conjunctivitis or pink eye is a common complication of a coryza, and often will not be cured until the nasal trouble is corrected.

The danger of ear involvement is ever present in connection with even the mildest form of acute head cold. The Eustachian tube is the connecting link between the nose and the ear. This is a tube about an inch and a half in length, which runs from the post nasal space outward to the middle ear, constituting a sort of ventilating shaft, that keeps the tympanic or drum cavity supplied with air necessary to proper function and in a normal state of health. When the lining membrane of the canal becomes swollen by involvement from a cold, the result is rarefaction of the air of the tympanum, with a state of congestion, rendering it vulnerable to infection. In acute rhinitis, infection is very liable to travel through this tube, lined as it is with the same kind of mucous membrane as the nose, and if virulent organisms gain entrance, they may set up a suppurative process, constituting an abscess. The result is a perforation of the drum-head, with injury to the delicate structure of this region, and a greater or less degree of deafness.

We are fortunate if the process does not go farther and attack the mastoid, a serious matter in itself, and still more serious because of the possibility that from here the infection may travel still further and involve the contiguous part of the covering of the brain (meningitis), or the great veins in this region, or the brain itself.

See then what havoc may be wrought by the machinations of a simple cold ! We have not over-drawn the picture, as any physician will testify who has followed his cases from beginning to end, and witnessed the direful results that have followed small and apparently negligible beginnings.

How important to prevent when prevention is possible, instead of waiting for grave lesions to occur whose removal is conjectural! Our first duty is to prevent a cold's occurring, but, this failing, our next is to prevent complications. This is usually possible by wise and skilful treatment, when dealing with a patient who is intelligent and willing to co-operate. It sometimes happens that the patient is in the greatest danger when least aware of it, and is more ill when the pain has subsided, a fact which the average individual has difficulty in realising, having formed the habit of regarding disease as altogether synonymous with physical pain.

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