CHAPTER XXI THE PREVENTION AND CARE OF COLDS AND SOME (Part 1)

CHAPTER XXI THE PREVENTION AND CARE OF COLDS AND SOME . OTHER INFLAMMATIONS 1. Hygiene and Physical Efficiency. — A most important aim of personal hygiene is the maintenance of the highest working efficiency of the body. We should not be content with the avoidance of serious maladies like smallpox, diphtheria, and consumption, but should try also to avoid those minor ills which, though temporary and rarely fatal, may seriously interfere with our capacity for usefulness and enjoyment. The importance of avoiding constipation has already been pointed out (p. 128). The present chapter will be devoted to the practical consideration of such com- mon complaints as colds, rhewmatism, and diarrhea, all of which are accompanied by inflammatory conditions in some internal organ or organs, and are favored by exposure to cold, drafts, or dampness, which chill the skin and drive the blood into the internal organs. 2. Some Common Complaints and the Conditions which favor them. — We shall not give any extended account of the nature of the complaints mentioned in the preceding paragraph, for their exact causes are still obscure. Two points, however, should be emphasized for all of them. 1. The exposure to cold is not usually the cause of these diseases but only favors their development. It is the general experience of arctic travelers that they suffer very little or not at all from “colds.” Nansen and his men were away in. the Fram for more than three years, and during a large part of that time Nansen and Johannson journeyed on sleds ; 380 Oi PREVENTION AND CARE OF COLDS 381 or afoot, exposed to the worst rigors of an arctic climate. At times, after getting into their sleeping bags, they had to thaw out their frozen clothing by the heat of their own bodies before they could go to.sleep; and yet not one of them had “a cold” until their return to Norway, when an epidemic of colds broke out among them. This and numerous similar experiences of others suggest strongly that colds are largely infectious diseases ; but we must not forget that dampness and drafts are favoring conditions for their development. The experience of the race on this point is abundant and conclusive. 2. Hach of these diseases is characterized by a condition of inflammation. We shall not attempt to describe the exact nature of inflammation ; it is sufficient to recall features of it familiar to every one. The sting of a bee or hornet or the bite of a mosquito results in local inflammation of the skin ; a severe case of sunburn presents a similar condition over larger areas; a wound of any kind often shows more or less of the same inflammatory process. The part becomes red, indicating the presence of an increased amount of blood ; it is swollen, partly because of the greater quantity of blood and partly because of the greater quantity of lymph present in the tissue ; it is usually hot; and it is often painful. At times, as in the case of a wound or boil, pus, or “ matter,” may be formed. One or more of these conditions is present in an inflamed organ during the diseases mentioned. When we have a cold in the head (rhinitis) the vascular membrane lining the nasal cavity is the seat of trouble ; in a sore throat it is the pharynx and larynx (pharyngitis and laryngitis) ; in a cold on the chest (bronchitis) it is the ciliated mem- brane of the trachea and bronchi; similarly in catarrhal - attacks of the stomach and intestine it is the mucous membrane of these organs; and we must think of these inflamed tissues of the respiratory and alimentary tracts as 382 THE HUMAN MECHANISM presenting somewhat the same condition as that seen in the skin during a bad case of sunburn. They all have an exces- sive amount of blood within them ; they are more or less swollen, —as when one’s “nose is stopped up ”; there is an unusual amount of fluid in the tissue; and there is, besides, generally a transudation of this fluid to the surface, as in the “running of the nose.” 3. Congestion during Inflammation. —The presence of an excessive quantity of blood in the capillaries of an organ is known as “congestion” ; and this may be of two kinds, —active (or arterial), due to an excessive supply from the | arterial reservoir; or passive (or venous), due to some inter- ference with the outflow into the veins.! In a cold, congestion of the inflamed area begins as an active congestion ; the arteries are widened, the pressure in the capillaries is increased, and the blood flows much more rapidly. This is essentially the same thing — only in greater degree — that oceurs when the arterioles of the stomach dilate during digestion, or those of the skin during exposure to warmth. This initial vascular stage is succeeded by one of passive congestion, caused by the adhesion of white blood corpuscles to the capillary walls, thereby diminishing the bore of the tube, and so making difficult the outflow into the veins; the velocity of the blood through the capillaries is lessened, pressure within them is increased (why ?), and they become gorged with blood. Such is the vascular condition in an organ when an inflammatory process is at its height ; the characteristic feature is the narrowing of the outlet of the capillaries and the consequent excess of pressure within them. 4. Dangers connected with Congestion.— A decidedly con- gested condition is undesirable because it is a predisposing 1 The artificial model described on page 142 may easily be used to show the difference between arterial and venous congestion. With the nozzle in the far end of the rubber tube, the tube may be congested (or swollen) with water by more rapid pumping (active congestion) or by narrowing the outlet (passive congestion), PREVENTION AND CARE OF COLDS 383 cause of these inflammatory diseases. It is not the only cause nor the exciting cause of the disease ; but a congested organ may succumb to an attack of disease and so become readily inflamed where it would have escaped had its vascular con- dition been normal. For example, the normal intestine may be the seat of some unusual bacterial action (see Chapter VIII, p. 125) and suffer no damage therefrom, while the same bacterial action may give rise to catarrhal inflamma- tion, accompanied by diarrhea, if it occurs when the in- testinal blood vessels are congested. Or again, whatever the cause of an ordinary cold may be, bacterial or other- wise, it is probable that its attack upon the perfectly nor- mal organism may be and frequently is resisted; while at another time a congested condition of the nose, the throat, or the bronchial tubes may permit the disease to gain a foothold at that point. In other words, the congestion alone will not cause colds in the head or on the chest, or diarrheal troubles in the intestine ; something else is needed. We may have the congestion without the cold, and we may also succumb to acold without the preliminary congestion ; but the presence of congestion often presents to an infecting agent the weak spot which is needed in order that the latter shall secure a foothold and do damage. 5. The Avoidance of Congestion during Colds, etc. The Care of Catarrhal Conditions. — Again, whenever an inflam- matory process is established, there is, as we have seen, more or less of passive congestion; under these circumstances everything should be done to avoid arterial dilation in the inflamed area. Suppose there is catarrhal inflammation of some part of the small intestine, accompanied by diarrhea; the outlet into the veins is narrowed and there is conse- quently more or less “backing up” of the blood in the capillaries (passive congestion). This congestion is kept within moderate limits so long as the arterioles maintain a good tonic constriction and so limit the amount of blood 384 THE HUMAN MECHANISM which can flow in; if, however, they are made to dilate widely, — by eating a hearty meal for example, — this check is removed, blood flows in under high pressure, and the congestion is increased. Hence in all such catarrhal — Fic. 111. Experiment to show the effect of arterial constriction in relieving capillary congestion In the upper figure, constriction of the tube at A results in distention (con- ’ gestion) of the tube between the pump and the fingers; if, however, the tube be also constricted at B, as in the lower figure, pressure falls between A and B, and the congestion is relieved. attacks the diet should be very light and preferably con- fined to those things which are easily digested and absorbed. 6. The Care of Colds, etc. —Again, when suffering from any of these inflammatory diseases of internal organs the greatest care should be taken to avoid chilling the skin, because this means (Chapter XIJ) compensating dilation in the inflamed area, and therefore increase of congestion there. One should be warmly clad (not overclad); the living and sleeping rooms, though well ventilated, should not be cold; when a cold sleeping room cannot be avoided some cover- ing for the head is often useful, as this part of the body is not protected by the bed covering; cold baths should be vee ree ee ee we ee ah tle ee Dae, ae Ee ie PREVENTION AND CARE OF COLDS 385 discontinued ; and, above all, dampness should be avoided. In severe cases it is often necessary for the patient to go away from a damp climate to a dry one. The key to the situ- ation, so far as the management of the circulation is con- cerned, consists in keeping in the skin its full share of blood. A brief chilling of even a comparatively small area of the skin (e.g.cold feet) may produce a congestion in the inflamed organ capable of undoing the healing work of hours or days. A word must be said in this connection about the “ fresh- air” cure for colds, etc. There is no doubt that being in the fresh, dry air, even if it is cold air, and preferably out of doors, is better for a cold or any other catarrhal condition than remaining in a closed room. But this should never involve the chilling of any portion of the skin; one should be warmly clad, even the head and neck being well pro- tected. It makes little or no difference that we breathe cold air; but it makes a very great difference whether or not the skin is exposed to cold air. In taking care of colds and similar troubles it is well to remember that the inflammation is only one of the un- favorable conditions against which the system is struggling. Consequently we should not expect the disease to yield in all cases to our measures for keeping the skin warm. At times a hot bath, a drink of hot lemonade, or other meas- ures for bringing the blood to the skin checks a threatened cold; but,none of these measures is of great value after the disease has once obtained a foothold. It is then a struggle between the body and the disease ; and we can do more by merely avoiding the chilling of the skin than by taking measures to produce marked cutaneous dilation. The true policy, in other words, is to give the living body every chance to cure itself, and this is best done by not calling on it to do too many other things at the same time. Thus muscular exercise, ordinarily one of our best means of keeping the blood in the skin, is not usually \ 386 THE HUMAN MECHANISM advisable when a cold is at its height, because an added - strain would thereby be imposed on the already sorely taxed system. Later, when the worst is over, itis a valuable aid, though it should not be too vigorous until one is on the road to complete recovery. ! . « Stuff a cold and starve a fever” is one of those pithy sayings whose very pith may be poisonous. A full meal when we have a cold in the head often clears up the nasal congestion for a time (probably by drawing the blood to the stomach and intestine) and so deludes us into suppos- ing that our “stuffing” has done good. It may also, and~ doubtless often does, support and reénforce the body in its battle with the disease. What it may do, however, is to overtax the body with the digestion of a heavy meal; the meal may not be properly digested; bacterial processes in the excessive mass of food may produce abnormal and poisonous substances (see Chapter VIII) which gain admis- sion to the blood, and the “last state” of the patient may be “worse than the first.” 7. Measures for stopping Colds. —- When one “feels a cold coming on,” that is, early in the struggle, active measures should first be taken to dilate the blood vessels of the skin. A hot bath before going to bed, and hot drinks such as hot lemonade, may be tried. If the cold does not promptly yield to these measures, rest in bed is usually the best treatment. The nervous system is frequently in no condition to sustain hard work of any kind, and hence, until the cold begins to clear up, it is well to confine the diet to easily digestible foods in moderate quantity, and to remain very quiet. Few people, unfortunately, act on this principle. “It’s only a cold” is made the excuse for meeting every engagement that may have been made, or for attempting to do full work. Sometimes, perhaps gener- ally, no serious results follow, but at other times the penalty is heavy. PREVENTION AND CARE OF COLDS 387 Very often a cold is a more serious matter than we suppose. Only physicians appreciate how often it is the sign of more serious disease! While we cannot say that one should always stop work until the cold is overcome, we do say that limiting work to the minimum and secur- ing all the rest possible is always advisable and should be the rule rather than the exception. We may, unknown to ourselves, be nursing more than a cold; and, even if we are not, we always hasten the cure by taking care of ourselves. 8. The Use of Drugs for Catarrhal Conditions.— A remedy very frequently resorted to for colds and other inflamma- tory troubles is the taking of some drug. Large fortunes have been made by the sale of “cough medicines” and the like. Some of these “‘remedies” are worse than use- less; others may do no harm, and some may be useful. But none of them are cures. The cure of the cold is effected not by the drug but by the system of the patient; the drug can do no more than remove some condition which stands in the way of the healing effort of the organism. The severe coughing of a bad case of bronchitis is often irritat- ing to the inflamed surface of the air passages, and may stand in the way of clearing up the inflammation. Here a drug may do good, though it should be taken only on the advice of a physician, and never on the strength of newspaper testimonials to its wonderful virtues. But the use of these medicines does not render unnecessary the measures we have outlined as the proper treatment. It is worse than foolish to dose oneself with drugs when a cold is coming on, and then attempt to do full work; often the only result of such folly is a complete “ knocking out of the stomach ”’ by the drug. The average “cough medi- cine” is especially likely to do this. 1 In typhoid fever a ‘‘cold on the chest”’ is frequently the first outward indication of the disease. 388 THE HUMAN MECHANISM 9. The Belief in Drugs.— A century ago the attitude of men and women toward practical hygiene consisted largely in living in ignorance of the workings of the body, taking little or no care of it, and then whenever bad feel- ings appeared “taking something simple” to cure them. This course of conduct was persisted in until something happened, — and something usually did happen, sooner rather than later, — when recourse was had at once to drugs. The doctor was the man who knew what drug to “give” for each disease. He was expected to “prescribe”; and if he did not prescribe something, he failed to satisfy his patient, - who concluded that the physician did not understand the disease. The attitude of the public was largely that of neglecting personal, individual care of the health and mean- time implicitly believing that, no matter what happened, some drug could be swallowed which would set matters right. Medicine, and especially personal hygiene, have now advanced beyond this crude condition. To-day we realize as never before that the individual is responsible for the intelligent care of his health. The time is probably coming when he will be held as responsible for the care of his body as he is to-day for the care of his morals. At the same time, drugs are being much less used by the best physicians. It is not true that all drugs are useless; quite the con- trary; but it is true that careful nursing often counts for more than does the use of drugs. Typhoid fever is to-day often treated with no drugs at all, and the tendency to use drugs in other diseases is distinctly lessening. The wise physician is often hampered in his work by the survival of this old-fashioned belief in the all-sufficiency of drugs. Instances of