THE idea of this paper has been growing in my mind for several years, a result no doubt, of a growing feeling of inefficiency and futility when following the procedures that have been taught us and are still practised by most of us. It is true that people expect things to be done when they have complaints. Their minds must be treated as their bodies. But let us understand that it is psychic and not practical treatment, less we fool ourselves as well as our patients.
Perhaps, it is due to the fact that I am a very poor actor and feel disgusted with myself when I do things that I feel will be of no value to satisfy my patient and get a fee that has prompted their presentation. I mean this to be anything but a highly technical or scientific paper, just a practical discourse on the misconceptions of diagnosis of everyday procedures in our practice.
It is in the office care of the affections of particularly the nose, however, the larynx and the ear come in for their share, that the usual diagnosis and treatment are so absurd. In my opinion, most of the treatment applied to the office patient is worse than nothing. Why does this condition exist ? Not because all physicians are charlatans or are ignorant. But because affections of the nose and throat are the most common of all ailments.
And because humans have so long had a religious faith; first in priests, then the medicine man, then the true medical man and his concoctions and now in scientific medicine as we know it. These people go to the physician for treatment of symptoms, and treatment they must have, because it is a faith similar if not identical to our religious faith. Consequently, the physician, if he wishes to keep in contact with his people and also live must treat these conditions and he must, in any instances, satisfy their faith.
The fact that many of these conditions do not respond to our therapeutic methods accounts for the great variety of questionable cures. The profession appears sometimes to have followed these methods so long that it believes them itself, and is not doing all it can for its patients. Perhaps if the methods are scrutinized a little more minutely, much of the worthless may be discarded so that a few things a little more pertinent may be used.
With this idea in view, let us consider the common cold. It is the most common of all the diseases. There are many indications that it is infectious and contagious. Still, there are instances when it has not seemed to be infectious, but rather a systemic reaction. A controversy has existed in the past concerning its cause and consequently of its treatment.
It seems now that the etiology is pretty well established and both infectious and systemic reactions exist. It is evident now that there occurs a virus infection of the upper respiratory tract that produces the symptoms known as a cold. It is also very evident that there exists vasomotor reactions, that at the onset, are very similar to infections, that they are instigated or are aggravated by cold and sudden drops in temperature.
So having the acute rhinitis divided into acute virus infections and acute allergic reacts, the treatment of acute infections will be considered. Prophylaxis is the first step in all treatment. It is known that isolation almost eliminates colds but modern society does not permit isolation. Some people have inherently a greater susceptibility to colds than others and the susceptible persons wish to attain the lack of susceptibility of their neighbors. This, as yet, is one of the impossibilities of accomplishment, but a good physician never ceases to try, even if some of his efforts are ridiculous.
Since the cold was thought to be infectious, cultures of the affected part were made. Not a specific, but a variety of bacteria were found. Immediately, vaccines were made and are still made for the prevention of colds. It is now evident that not these bacteria, but a filterable virus is the cause of colds and that the visible bacteria are secondary invaders.
Consequently, if it is possible to increase the immunity to these bacteria, that only prevention of the secondary invasion, and less severe colds can be expected. Practically, they are very popular. The popularity enhanced, perhaps, by the extolling of the manufacture, the desire of the patient to use serums and the desire of the physician to impress the patient by using the most scientific medicine.
This is exemplified in the report of the use of vaccines by the health service upon the students of one of our large universities. The students were divided into three groups. The first group was given a mixed cold vaccine at regular intervals. The second group was given sterile water by the same method at the same intervals. The third group was used as a control.
At the end of the year, the first reported that they had had many less colds, the average showing about two a year per person. The second group reported that they had had many less colds, the average about two each for the year. The control group reported the average of two colds each person. This report shows why vaccine therapy is popular and why its logical use is questionable.
There now exists the vitamin era. There can be no doubt about the necessity of vitamins for general well being of an individual. There are many people suffering from avitaminosis from improper diet. Still, a large percentage of people do not suffer from avitaminosis and still have colds. When this period of wishful prescribing of vitamins for all ailments passes, a sane level of vitamin therapy will be established, which will have its place in medicine.
The extensive list of therapeutic agents used for colds is indicative in reverse ratio of their effectiveness. Similar therapeutics as such, or as copied by most drug houses selling cold tablets are probably as effective as anything. Still, honestly, I have never seen a real infection of the nose that I felt was terminated by the use of these drugs. Perhaps they may be less severe, who can say, but none are terminated. And the same may be said of the things used for their physiologic action. These not only do no good, but may be harmful.
To me, one of the most absurd treatments is catharsis. It is said that catharsis stimulates elimination of toxins. What toxins? Are there normally toxic materials in the digestive tract? If so how do we live? Or why do we not arrange a continuous purge? Or is it to remove the toxins resulting from the cold in the nose? How have they reached the digestive tract? The real action of the cathartics is to dehydrate the system producing acidosis, one of the conditions that promotes infection.
As further evidence that internal therapeutics have not solved the cold question, physicians have taken to the local and external use of drugs and certain physical forces. For many years, camphor, menthol, and eucalyptus have been popular remedies.
None of these have any antiseptic value nor do they increase the breathing space of the nose. It has been definitely proven that these drugs cause swelling of the nasal tissues and any apparent benefit the patient might imagine comes from the antiseptic effect upon the mucosa. Antiseptics, such as the colloidal silver salts and some of the mercurials have been applied to the nasal cavity and throat in various ways, as tampons sprays and drops.
If these compounds can have any antiseptic effect upon the bacteria of this area in the short space of time that it is in contact with the surface, and if the bacteria do kindly come out of the tissues onto the surface, these tampons and sprays may have some bacteriocidal action. But even with a careful tamponing or thorough spraying, probably only a small part of the surface can be treated.
While, the drop method, unless the patients lie on their backs with their heads hanging, is even less satisfactory because the fluid dropped into the nose simply runs down the floor of the nose into the throat. It is inconceivable that any appreciable bacteriocidal effect can take place and such drugs interfere with the normal protective mechanism of the nose.
It is known that the nasal cavity, including the associated sinuses has certain protective mechanisms to repel all foreign substances, including bacteria from within the nose. The nasal mucosa is lined with ciliated epithelium and upon the surface of this ciliated epithelium is a thin layer of mucus. This mucous layer is being continuously moved along by the action of the cilia, thus removing any foreign material, including bacteria that come in contact with the surface. Any medication that destroys or removes this mucous layer or interferes with the action of cilia of the nose, removes the major protective and reconstructive physiologic action present in these parts.
Now, any irrigation or medication that removes this lining layer of mucus from the nasal cavity, or interferes with the action of the cilia, are definitely harmful. And, it has been shown by definite experimentations that all the drugs commonly used in the nose with one exception, stop the ciliary action for an indefinite time. The one exception is weak solutions of ephedrine in saline.
