unusual to find one affected to any considerable extent without the
others being involved. While the rules of hygiene in general are
applicable to the nose, throat, and ear, there are certain special
conditions which deserve consideration. One of the most common causes
of injurious effects to the nose, throat, and ear is the so-called
"cold." The cold in this connection is, of course, understood to be
simply the cause, the condition itself being a peculiar inflammation
of the parts concerned. As cold is so frequently a cause of diseases
of these parts, it would be well to consider under what circumstances
it develops and the best mode of prevention.
I have often noticed that persons who suffer most frequently and
severely from colds usually insist that they exercise the greatest
care to avoid exposure. They have dressed in the warmest clothing,
wrapped the neck in the heaviest mufflers, remained in the closest
rooms, and avoided every draught, and yet they continually "take
cold." The street urchin, on the other hand, with only two or three
garments and without shoes, and who lives out of doors, suffers less
frequently from this affection.
"Colds" have truly been called a product of modern civilization. The
trouble was rare among the aborigines and is more common among the
cultured than among the laboring classes. If we make a plant an
exotic, we must keep it in the conservatory, and even here it is not
free from danger. On the other hand, if we wish to harden it and make
it proof against atmospheric and climatic changes, we must prepare it
by judicious exposure for these conditions. The warm clothing which is
thought to be a protection against cold is frequently the most fertile
cause. It relaxes the body, moistens the skin, and the perspiration
which is induced especially prepares the unresisting body for its
attacks. This applies especially to warm covering around the neck, to
which the air has periodic access. Except in unusually severe weather,
the throat requires no more covering or protection than the face.
The method of having only two systems of underclothing, the heavy to
be worn until it is quite warm, and _vice versa_, is also a source of
danger. There should be three changes: one of the lightest texture for
the warm weather of summer, a medium for spring and fall, and the pure
wool for winter, which in this climate need not be very heavy.
Waterproof shoes, rubbers, furs, etc., are not recommended for
customary use, and should be worn only when absolutely indicated.
The best preventive of recurrent colds is the judicious use of the
sponge or cold shower bath. The ordinary bath should usually be of a
temperature not disagreeable to the body, but after the question of
cleanliness has been attended to, an application, either by means of a
sponge or shower, of ordinary cold water should be made. This should
be of short duration, and friction with a coarse towel follow at once.
When properly conducted, a reaction sets in so that there is no danger
from this, and the toning effect of the method is of the utmost value
in the prevention of colds. This applies, of course, only to persons
in ordinarily good health. Even in these cases there are rare
occasions in which this method is not advisable, and it may on general
principles be stated that it should not be used by persons who do not
react promptly. As stated, however, the application of cold water
should be only momentary. The daily application of cold water to the
throat and chest is also a useful practice for strengthening these
parts.
In addition to these means there are certain injurious conditions that
it would be well to avoid. One almost universally present in large
cities is that of dust. The constant inhalation of the small particles
of sand and of organic impurities of which dust is composed has an
irritating effect on the delicate lining of the nose and throat, which
may develop a chronic inflammation, resulting in injury to both the
throat and ear. This evil, however, can be prevented by the artificial
watering of our streets.
Excessive tobacco smoking produces injurious effects in the nose and
throat. Of all forms of smoking, the cigarette is the most injurious,
and allowing the smoke to pass through the nostrils the most
dangerous. Occasionally ladies inhale the smoke of a closed room
where the male members of the household are smoking, and this is
injurious to a delicate throat.
Loud and excessive talking is sometimes a factor in throat diseases.
The former is more apt to be exercised in transit in our steam or
electric cars, and members of the theatrical profession realize this
so well that they rarely use their voice while traveling. In excessive
talking, in addition to the mechanical wear and tear of the throat,
the respiration is usually spasmodic, a combination that is likely to
lead to evil results. At puberty, when the voices of boys and girls
are changing, the former sometimes almost an octave and the latter
usually a note or two, special care should be taken of the voice, and
singing or vocal exercises should be discontinued until the change has
been finally established.
The effect of singing on the throat is of much interest, but it is one
of such an extensive character that it can be only casually referred
to here. The exercise required in singing improves the healthy throat
in the same manner that exercise benefits the body in general. The
diseased throat, however, may be injured by this practice, as no form
of vocal culture can remedy a mechanical interference in its action.
The method of singing is also of the utmost importance; an erroneous
one may not only injure a promising voice, but may also have a bad
effect on a normal throat. The subject of register requires careful
consideration. The placing of the voice in the wrong register is
fruitful of evil; the ambition of the singer to reach a few notes
higher or lower than her range may also work severe injury to the
throat.
The throat may be improved or strengthened by any of the forms of
exercise, especially the out-of-door, which have been advised for the
health in general. In addition to this, breathing exercises are of
special value. These consist of taking deep inhalations through the
nose, holding the breath for a few seconds and then gently expiring
it, the body in the meanwhile being free from all restraint from tight
clothing. The practice of this exercise for five minutes mornings and
evenings will have a remarkable effect in developing the chest and
throat.
In order to anticipate serious complications, children should be
taught to allow their mothers to examine their throats freely and
without resistance. I feel especially the importance of this subject,
as I have frequently seen children almost sacrificed on account of the
nervous dread of having their throats examined, or by their inability
to control themselves. The method is exceedingly simple: the child is
placed facing a bright window, and the handle of a spoon placed on the
tongue and so depressed that the posterior part of the throat can be
distinctly seen. At first this may be difficult, but the child soon
becomes accustomed to the manipulation and the throat may then be
examined without difficulty. Another advantage of this procedure is
that the mother becomes familiar with the normal appearance of the
throat, and can easily note any change due to disease.
In view of the important function of the nose in warming, cleaning,
and moistening the inspired air, the greatest care should be taken to
teach children to breathe through the nostrils. When only a portion of
the air enters through the mouth, the irritation is not as marked as
when all the air is inhaled in this manner, but it nevertheless
develops a condition of chronic irritation which is easily recognized
by one familiar with its appearance, and which may lead to important
complications. In many cases, mouth breathing is not due to habit, but
to some obstruction in the nostrils or throat. These cases form a
proper subject for the consideration of the physician. After the
removal of any existing obstruction, children will sometimes, from
force of habit, continue to breathe through the mouth, but this can
usually be overcome by attention and firmness on the part of the
parents.
The prevention of grave throat diseases, such as diphtheria,
necessarily forms a subject of much interest to the public in general
and to mothers in particular. The causation of this disease has been
much cleared up in later years, and we now know that the important
factor is a bacillus--a small organism of the vegetable kingdom--which
is the cause of this disease and a necessary material for its
propagation. Bacteriologic investigations have shown that the
so-called "membranous croup" is in by far the largest number of cases
identical with diphtheria, and the same precautions which apply to the
latter should therefore also be carried out in this disease.
As diphtheria is strictly an infectious disease, and one which must be
directly or indirectly contracted from a similar case, there is no
sanitary reason why this dreaded malady in the course of time should
not be entirely eliminated from the earth. In view of the fact that
diphtheria is so frequently present in our larger cities, this may
appear at present a Utopian idea. It is not so many years ago,
however, when smallpox was almost universal, and yet we now but rarely
have it in our midst. Not only is this the case, but the health
authorities are severely criticised when a number of these cases
exist, as indicating that there has been a lack of watchfulness in
carrying out certain well-known means of prevention.
While we have at the present time no means of inoculation that will
permanently protect against infection from diphtheria, still it is not
of such an infectious character as smallpox, as the cases are usually
limited to children, and its spread may therefore be more easily
prevented. Not only should children who have had diphtheria be
prevented from returning to school until infection is no longer
possible, but other children of the same household should also be kept
at home. A few years ago a certain school in this city was rarely
without a case of diphtheria among its pupils for many months. I am
convinced that had the principal of the school or the parents insisted
upon the other children of the infected household remaining at home,
the spread in this direction would have been arrested and much
suffering avoided.
When a patient has recovered from diphtheria, thorough disinfection is
a most important measure. Unfortunately, however, many persons
consider it a hardship if articles which can not be disinfected are
destroyed, and many will even use every endeavor to prevent the
representatives of the Board of Health from carrying out their
regulations. In this way the germ of the disease remains on the
premises, and under suitable conditions again finds another victim in
the household. To illustrate this, I recall an instance some years ago
in which I was called in consultation to see a most malignant case of
diphtheria. The little patient fortunately recovered, and the premises
were thoroughly disinfected, the parents being anxious to avoid any
repetition of the dreaded malady. Five months later, however, a
younger child became ill, and was found to have diphtheria. In view of
the vigorous efforts which had been made to disinfect the house
thoroughly, and of the fact that the child could not have contracted
it elsewhere, not having left its home for several weeks, the cause at
first appeared a mystery. Careful inquiry, however, soon elicited a
fact which clearly explained the case. The first patient had used a
mouth-organ just before its illness, and when this was abandoned, the
toy was carelessly thrown on the top of a bookcase, the nature of the
child's illness at the time not being known. The second child, just
before its illness, had accidentally found this toy and used it
frequently. This experience explains the necessity of disinfection in
all its details, and also illustrates the tenacious character of the
germ which produces this disease.
Our knowledge of the specific cause of scarlet fever is not as
complete as that of diphtheria, but we have much useful information
which is of importance from a hygienic standpoint. As in diphtheria,
the specific poison is probably produced in the throat of the patient,
and may therefore be spread by the dried secretion from the mouth and
throat. The most common means of contagion, however, is the skin,
which peels off in the later stage of the disease, infection being
produced by the inhalation into the nostrils of some of the diseased
particles.
A predisposing factor which applies alike to diphtheria and all other
throat affections is the abnormal condition of the nose and throat.
When these important parts are in an unhealthy condition, where mouth
breathing exists and other conditions inimical to normal health, the
patient is more predisposed to all forms of maladies of this region,
and the attack when developed is more apt to be of a serious
character. The more ordinary forms of sore throat, such as tonsilitis,
are frequently due to defects in the sanitary conditions and
surroundings of the home. While modern sanitary plumbing, when
properly constructed, adds much to the convenience of the household,
it is a certain menace to all its members if, through improper
construction or defective ventilation, decomposing matter collects in
the waste pipes and vitiates the atmosphere of the rooms. Many
recurrent cases of tonsilitis are due to this cause. Even the ordinary
stationary washstands may be a source of danger, especially in the
bedroom, unless thoroughly ventilated and care exercised that the
traps are not filled with decomposing matter. A physician of large
experience in this city is so imbued with the danger of this form of
plumbing that he condemns it _in toto_. When well constructed and well
ventilated, however, they can not be the source of danger in the
household.
Tuberculosis, which is responsible for so enormous a mortality,
frequently also affects the throat as well as the lungs. Although it
usually originates within the chest, it sometimes finds its primary
origin in the throat, and in a large percentage of cases the throat
affection forms a complication of tuberculosis of the lungs. In spite
of the numerous remedies which have been advocated for the cure of
this disease, it must be admitted that our chief reliance is in proper
nourishment and climatic effects, and that hygiene is the sheet-anchor
which will eventually rescue us from this terrible foe of the human
race.
Recent investigations tend to prove more and more that tuberculosis is
inherited in but rare cases; that inheritance is simply a predisposing
factor, and that the real cause is infection. As an illustration of
this, all have seen instances in which there had been apparently no
cases in a family for ten or fifteen years, when from some cause one
case develops, and this is soon followed by other cases in the same
family. Whatever rôle heredity may play in these cases, this simply
shows that the first case produced the infectious material which found
a suitable soil in the other members of the family and developed a
similar disease. The inheritance theory has been the source of much
injury by causing members of the afflicted family to submit to the
apparently inevitable instead of instituting measures for its
prevention. The infectious product in tuberculosis is not the breath,
as is so frequently believed by the laity, but simply the
expectoration which comes from the diseased lungs or throat. When this
is allowed to come in contact with clothing or other material in the
room, it becomes dry and loads the atmosphere with a dust which
contains the infectious bacillus, which may cause a similar disease in
a person predisposed by heredity or sickness to this affection.
The germ of tuberculosis is the seed, and the predisposed person the
soil, and it requires a combination of both to develop the disease. To
illustrate the necessity of suitable conditions for the development of
plants--for it is now almost universally admitted that the germ of
tuberculosis is a micro-organism which belongs to the vegetable
kingdom--I remember some years ago, while in North Europe, seeing in a
hothouse a plant which is here commonly known as the "four o'clock."
The gardener in charge of the conservatory considered it a remarkable
plant, but difficult to propagate, and stated that it was absolutely
impossible to raise it out of doors. In this part of the world,
however, we know that this plant grows so easily that once established
in a garden it is difficult to keep it within limits. In both of the
cases we have the same seed, the difference being only in the soil and
the conditions favorable for its development. The absence of either
the seed or the soil will absolutely prevent tuberculosis, and if the
laws of hygiene are properly carried out, both in destroying the seed
and in preventing the formation of a suitable soil, favorable effects
will soon be shown.
Hygiene in regard to patients demands simply that the infectious
character of the expectoration be destroyed. The vessels for this
purpose should contain some disinfecting solution, should be cleaned
regularly, and handkerchiefs, towels, or other material with which the
expectoration has come in contact should be sterilized by being placed
for at least half an hour in boiling water. This is necessary not only
for those in the same room with the patient, but also for the patient,
as it is quite possible that a former expectoration may produce
reinfection of the patient himself.
Another method of contracting tuberculosis is by means of animals,
such as cows, used for food and milking, which are known to be subject
to this disease. It has been shown in some localities that one cow out
of every twenty-five was affected with tubercular disease. This
suggests the importance of having competent veterinarians to examine
not only the meat which is sold, but also the cows used for milking
purposes. Where there is the slightest doubt as to the nature of the
meat or milk, the former should be thoroughly cooked and the latter
sterilized before using.
In this connection it would be well to refer to the subject of
spitting in street cars and in public places. While this nuisance is
the subject of danger to every one in the street cars, especially in
winter, when the windows are closed and a large amount of impurities
is inhaled, it is more particularly so to ladies, whose skirts, in
spite of every care, are soiled by the filthy expectoration, thus
making them subject not only to the inhalation in the car, but also
to carrying the infectious material to their homes.
The danger of this condition is not merely speculative. It has been
bacteriologically demonstrated that the organisms of various
contagious diseases thus find a lodging place in our cars and public
places, and experiments on animals, in which the inoculation has
developed diseases, have shown that these organisms retain their
vitality in these places and may propagate disease under favorable
conditions.
A factor in the spread of diseases of the throat and mouth that should
not be overlooked is kissing. Unfortunately, this matter has usually
been treated with much levity, and where a sanitarian is bold enough
to condemn the habit he is frequently made the subject of all forms of
ridicule in the public press.
The tender lining of the lips, mouth, and throat, and its large blood
supply, make it peculiarly susceptible to contagion, and I have no
doubt that the habit of kissing is responsible for many cases of
infection. Last year I noticed a lady coming from a house from which a
diphtheria flag was flying, who walked to the corner to take the
street car, when a nurse with a small child approached. The lady
without hesitation stooped down and kissed the little child. As it is
well known that a healthy person may transmit a disease without
incurring the disease himself, this lady voluntarily risked the danger
of inflicting this disease upon the innocent child. It is not an
uncommon thing for nurses to kiss the children under their charge, and
here in New Orleans even the colored nurses sometimes practice this
habit, occasionally with the permission of the parents. In fact, a
fashionable lady on one occasion told me, when I remonstrated with her
about this, that she feared to hurt the feelings of the old nurse, who
had been a valuable servant in the family for many years.
How often this habit is productive of evil results is of course only
speculation. I recall, however, an instance in which two small
children of one family developed a specific disease which originated
in the mouth and affected the whole system. Examination proved this to
have been caused by a nurse, a white woman, who had been in the habit
of kissing the children. If women will voluntarily incur risks
by using kissing as a form of salutation in all stages of
acquaintanceship, I would at least request that the innocent children
be spared the possible consequences.
The subject of the hygiene of the ear is so intimately connected with
conditions influencing the nose and throat, which have already been
explained, that but few words are needed to cover this part of my
subject. In general, the best care of the ear is to leave it alone.
Ear scoops are injurious; the ear should be cleaned simply on the
outside, and nothing, as a rule, should be inserted into the external
canal. I have seen many cases of abscess and the most severe
inflammation due to endeavors to clean the ear with the omnipresent
hairpin and other objects used for this purpose. The use of cotton in
the ear in general is to be condemned. It produces an artificial
condition in the outer canal of the ear which reduces its physical
resistance and makes it more liable to injury from exposure. The ear
is sometimes injured by the entrance of cold water. This happens
occasionally during ordinary bathing, but more frequently in outdoor
bathing and in swimming. In surf bathing, where the water is thrown up
with considerable force, it is much more liable to enter the external
orifice of the ear, and severe inflammation may originate from this
cause.
Salt water has been claimed to be more injurious than fresh, but my
personal experience leads me to believe that it is more a question of
temperature than of the quality of the water. Some years ago a large
reservoir was built by an educational institute near this city, the
water, which was quite cold even in summer, being supplied by an
artesian well. The tank was used for bathing purposes, but earache
soon became so frequent among the boys that the use of the reservoir
for this purpose had to be entirely abandoned. In ordinary bathing,
the entrance of water into the ear can easily be avoided. In swimming
or surf bathing it is advisable to use a pledget of lamb's wool to
close the opening of the ears. Ordinary cotton soon becomes saturated
and is of no use in this connection, but the wool, which is slightly
oily, forms an excellent protection in these cases.
The "running ear" is a diseased condition which should not be tampered
with by the inexperienced, but which should not be neglected. The old
idea that the child will outgrow it, or that it is a secretion of the
head which if interfered with would prove dangerous, has been fruitful
of many cases of deafness and even more serious complications.