Most of the acute infections to which man is heir enter the body through the nose and mouth. Common colds, influenza, tonsillitis, pneumonia, scarlet fever, diphtheria, infantile paralysis, and so on, through a long list of diseases, find their way into the body through this portal. Measures which reduce the ineffective material which gains access to the nose and mouth, such as frequent washing of the hands and keeping them away from the face, the use of individual drinking glasses, and the avoidance of exposure to persons with these diseases, are all Worth while. There is, however, little or nothing of value in the Way of local preventive measures to suggest. In fact, the best advice that can be given to most persons concerning the care of the nose and throat is briefly expressed by: "Whatever you do do, don't."
The alleged value of gargles, nasal douches, jellies, sprays, or drops, the so-called "control by nasal hygiene," is based on nothing more than advertising propaganda. Furthermore, the regular use of such preparations without medical advice is pernicious. These preparations usually give temporary relief of nasal stuffiness but they also interfere with the normal protective mechanism of the nasal mucous membrane and in time may cause sufficient irritation to give rise to a chronic catarrhal condition. When this occurs, the medication still gives temporary relief, so the natural inclination is to use it more frequently.
There is a possibility also that over a period of time there way be enough absorption of these substances to be deleterious. Snuffers of cocaine or of snuff soon learn that absorption from the mucous membrane of the nose is prompt and efficient. In like manner, other substances are absorbed and in some cases the effects might well be cumulative and toxic.
Obstruction to Breathing
The most frequent cause of obstruction to breathing is the common cold, a condition of such importance that we have devoted several articles to its consideration. Uncomplicated colds rarely last more than a week or two, but the sinus infections which may complicate them are frequently protracted. The other common causes of chronic nasal obstruction are adenoids in children and allergic conditions, nasal polyps, and abnormalities of the nasal septum in older persons. Lasting relief can be expected only by eliminating the cause of the obstruction, whatever this may be. Self-medication merely aggravates the trouble.
Adenoids is the dull, pinched, stupid expression of the mouth breathing child cries for relief. Susceptibility to colds and ear infections, impaired hearing, and a deformed upper jaw are among the other results of chronic mouth-breathing by children. The usual cause of this is adenoids, an overgrowth of tonsils like tissue located in the upper part of the pharynx behind the nose. Fortunately this can be relieved by a simple surgical procedure.
Abnormalities of the Nasal Septum
The septum is the partition between the two sides of the nose. It is composed in part of cartilage and in part of bone. Theoretically the septum should be straight but it rarely is. In fact, a perfectly straight septum is just as rare as an artistically perfect nose. Although most deformities of the septum are of little or no consequence, they occasionally are of sufficient seriousness to interfere with breathing. This not only is annoying but also predisposes to colds and sinus infection. In such cases an operative procedure to straighten the septum is indicated.
The term "sinus infection" is now used almost as loosely as nasal catarrh was in the past; many persons who because of some nasal stuffiness think they have sinus infection do not have it at all. On the other hand, sinus infection is of such frequency and seriousness that it merits careful diagnosis and treatment.
The sinuses are cavities in the bones of the face which are connected by small openings with the nasal easily and are lined with mucous membrane which is (continuous with the mucous membrane of the nose. It is probable that when a waste cold has existed for several days without much improvement, the inflammation has extended to the membranes lining the sinuses, especially to the lower sinuses, which do not drain so easily as the upper group. In the majority of instant, even though some inflammation has extended to the sinuses, the condition will heal promptly as the individual's resistance increases and the natural forces of repair improve under the general measures advisable in these conditions.
The actual cause of sinus disease is infection from the nose, but predisposing factors are violent blowing of the nose, a hypersensitive allergic nasal mucous membrane, diving, swimming with the nose in the water, possibly damp climates, and the promiscuous use of sprays, oils, and antiseptics in the nose during acute colds.
Acute sinus infections often clear up without treatment or with the application of such simple measures as heat, steam inhalations, rest, and improved nasal drainage. Occasionally, however, the infection is so severe or drainage so inadequate that pus accumulates in the sinus. This, also, may clear up promptly or it may develop into a sub acute or chronic condition. In acute sinus infection local symptoms of nasal discharge, pain, and headache, as well as general symptoms of fever, fatigue, general aches, and cough, are the rule. In chronic sinus disease, on the other hand, the local symptoms may be entirely absent. Occasionally infection from a sinus may be carried by the blood to other parts of the body, such as the joints, kidneys, heart, or brain. It is a condition potentially so serious calls for adequate medical supervision and treatment.
The sneezing, sniffling, and nose blowing, commonly called "hay fever," occur with greater or lesser frequency the year round. In fact, hay fever and related allergic conditions, such as asthma, hives, and certain eczema, headaches, and digestive disturbances, occur whenever the substance to which an individual is sensitive gains access to the body in sufficient quantities
The symptoms considered typical of hay fever may be produced by pollen of plants, grasses, or trees, by the dander or hair of animals, by lint, feathers, foods, and many other substances. The pollen, however, are the only substances of this sort which are definitely seasonal. Most cases of spring hay fever are due to grass pollen, although even before the grasses begin to pollinate there are some cases, usually considered spring colds, which are due to the pollen of trees. The pollen of most of the flowering plants is relatively large and heavy and is carried from one plant to another by bees or other insects; hence, they are rarely responsible for hay fever. On the other hand, the pollen of grasses, trees, and many other plants are wind-borne and spell misery to hundreds of thousands of persons each year. Such pollen grains may be carried enormous distances and to great heights by air currents.
The most common causes of spring hay fever, frequently called "spring colds" or "rose colds," are the pollen of trees and grasses, while the pollen of ragweed, Wormwood, Russian thistle, and pig weed are responsible for most of the fall hay fever. Goldenrod, long thought to be the cause of fall hay fever, has been exonerated. It and other flowering plants have been suspected in connection with hay fever because they happen to flower at the time that weeds with inconspicuous flowers are pollinating.
After a physician has determined the cause of one's hay fever, the simplest way to prevent it is to live, at least during the half fever season: in a region in which the pollen to which one it sensitive do not exist. Another way to reduce exposure to pollen is to spend most of the day during the hay fever season in filtered air. This gives relief in many cases.
For the unfortunate hay fever victims who cannot move away during the hay fever season and whose homes and places of work are not air-conditioned, there is still considerable hope of obtaining relief, for it is usually possible so to increase one's tolerance that one will be free from symptoms or at least reasonably comfortable even though exposed to high concentrations of pollen. This is accomplished by having a series of injections of the pollen to which one is sensitive. In order to be effective this treatment must he based upon an accurate diagnosis of the causes of the hay fever and the inclusion in the treatment material of all the pollen which are responsible for symptoms. Failure to do these two things has been the reason of many of the unsatisfactory results from this type of preventive treatment of hay fever in the past.
Temporary relief in hay fever and other allergic conditions run frequently are obtained by the use of a relatively new group of drugs called antihistamines.
With so many tonsils being removed one naturally wonders what the tonsils are for. Actually there is no certain evidence as to their purpose, although it is generally thought that they have some sort of protective function, ineffective though this seems to be in most cases.
In childhood, tonsils and adenoids are naturally large but both decrease in size during later life. There are three conditions which make removal of the tonsils and adenoids advisable:
(1) repeated attacks of acute tonsillitis or quinsy;
(2) Enlargement of tonsils and adenoids to the point of causing obstruction to the nose or the Eustachian tube;
(3) Reasonable suspicion that the tonsils are serving as a focus of infection. In the event of a serious disease condition in which other possible focus of infection has been eliminated, it is sometimes advisable to sacrifice the tonsils even though the local condition does not offer adequate proof of tonsil infection.
Miraculous results cannot be expected from removal of the tonsils; but when definite indications for tonsillectomy exist, sufficient improvement may be expected to amply justify the Operation. Tonsillectomy is not a dangerous procedure if adequate precautions are taken to safeguard against accident. Undoubtedly many tonsils have been needlessly removed in the past and more will be sacrificed in the future. On the other hand, the indications for the removal of tonsils and adenoids are being more accurately defined and medical opinion on the subject of tonsillectomy is becoming more and more conservative.
by Susan Cruise