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The Common Cold.
701 This may well be the cold in a week or more. its pure form. The absence of black currant tea, inclement weather, the irritation of tobacco, and so forth, may simply encourage a secondary implantation Vaccination may be of the catarrhal bacteria. immensely helpful in receptive individuals because it helps them to resist the secondary catarrhal part of the disease to which so much of its misery is dueblocked nose, aching antrum, and general discomfort. Without knowing the causative organism, it is hardly possible to evaluate the influence of the soil on which the infection falls and its surroundings. Many persons never " catch cold " from sitting in a draught or getting their feet wet. But it is undoubted that many others do, and the liability to this inconvenient susceptibility seems to increase a great deal with age. The presumption is that this is due to auto-infection, the probability of becoming a carrier of the cause in a sinus becoming greater with increasing years and a larger total of attacks. The problem of chronic infection of mucous membranes is ill-understood ; its elucidation would be helpful in gonorrhoea where infection persists in the same intractable way. There is here a rich field awaiting collective inauirv.
lasting
THE
LANCET.
ZOJVDO: S’T IlRD 4 Y, APRIL 8, 1922.
The Common Cold. we progressed in the suppression of epidemic disease that what was taken as a
So far have
mortal trivial incident of normal life a hundred years ago has risen to be the curse of civilisation. The standard of health and comfort which we now demand requires the common cold to be taken in hand with all the seriousness that has reduced typhoid fever to its present precarious state. At present hardly anything is known about the disease or diseases which pass under that name, for indeed it is still quite uncertain whether the condition is a single multiform infection or a group of various infections with a convergent symptomatology. It is easy enough to isolate from the mucosa of the nose and throat a variety of bacteria, and the fact that during the acute stage these are often obtained in pure culture has encouraged different investigators to attach aetiological importance to Hoffmann’s bacillus, the Micrococcus catarrhalis, streptococci, pneumococci, Pfeiffer’s influenza bacillus and its mimics, and other more or less well-known forms. Attempts to correlate different types of the ordinary disease with differences in the bacterial flora have not been illuminating. Some evidence in favour of the causal role of these microbes has, however, been obtained from the effect of preventive inoculation with them. This has proved in many cases useless, but in a certain number of people the method has been helpful to a greater or less degree in diminishing the number of attacks or in reducing their severity. It is noteworthy in this connexion that the expert bacterio-therapeutist generally uses a mixture of organisms and not a single sort for his vaccine. The empirical discovery that a mixture gives better results does not, however, show that the disease is a multiple one. At the moment it seems most likely that none of the described organisms can be put down as the actual cause of the common cold, and that they are secondary and subsidiary infections implanted on the operations of the unknown agent which our belief in a world of cause and effect requires us to discover. KRUSE in Germany, FOSTER in America, and more recently Dr. M. H. GORDON of St. Bartholomew’s, have found in the nasal secretion in acute catarrh representatives of the organisms which, at or beyond the limit
of microscopical visibility, are at present described as "filtrable viruses."Prom the nature of the case it will obviously be difficult to establish their aetiological position, but enough positive infections in man have been effected to make it reasonable to take their causative relationship to the common cold as a useful working hypothesis, which is at any rate not inconsistent with the facts as we know them. On this view the disease is in parallel with measles and influenza in which many of the severe symptoms and most of the worst results are due to streptococci, pneumococci, and other bacteria which are not the cause of the disease, but for which the original infection prepares a suitable field. More careful clinical analysis of the cold along the lines of Dr. OLIVER HEATH’S interesting paper in our present issue will no doubtvield fruitful results. Common knowledge of the laymen’s sort tells us at once, however, that we often have the early symptoms of a cold which, with or without the exhibition of some domestic specific, disappear in 24 to 48 hours without the more usual sequelae of profuse and troublesome catarrh
The Bashfulness of Medicine. "
longer endure how the populace torture and hourly with their demands for the impossible. Because I have penetrated a little farther into the mystery of Nature’s ways, they believe that, like the Gods, I can relieve "them through some magic or supernatural means, and charm good fortune ; when. after all I am but a common mortal like others." me
I
can no
daily
- Virchow.
IN these words attributed to VIRCHOW is to be found the humility of the real healer, one who by his researches into the nature of causes of death let a flood of light into the secret chambers of life. Dr. Louis 1. HARRIS quotes them effectively in a public health bulletin1 and compares the humility of the master with the effrontery of the charlatan and the quack. He goes on to question how the public can be made to appreciate the contrast between the claims of physicians on the one hand and the shameless pretensions of the practitioners of the many medical cults and irregular forms of healing on the other. In America, it appears, the challenge of the situation has thus far failed to bring forth leaders with large vision, and this failure in America, as here, has been attended with serious peril to the public health. The modesty of knowledge need not and should not prevent the organisation and cooperation without which the medical profession can accomplish nothing large in the public interest. Dr. HARRIS frankly envies the success of the Life Extension Institutein New York which performs an important type of medical service to the general community on terms which in producing health also produce dividends, and with the aid of a publicity department with the range of a brass band. What an individual medical man may not do without incurring reproach a medical society as an organisation can do with propriety, and he draws a picture of what any county or well-organised district medical association might achieve as the medical service agency for its To take an instance very pertinent at the own area. present time. Such a local medical service agency could, at the proper season, set out simply by means of 1 Remedies for Certain Defects in Medical Organisation and Service. By Louis I. Harris, Dr.P.H., M.D., Director, Bureau of Preventable Diseases. Monthly Bulletin of the Department of Health, City of New York, December, 1921. 2 See " The Value of Periodic Health Examinations," THE LANCET, 1921, ii., 1289.
lasting
THE
LANCET.
ZOJVDO: S’T IlRD 4 Y, APRIL 8, 1922.
The Common Cold. we progressed in the suppression of epidemic disease that what was taken as a
So far have
mortal trivial incident of normal life a hundred years ago has risen to be the curse of civilisation. The standard of health and comfort which we now demand requires the common cold to be taken in hand with all the seriousness that has reduced typhoid fever to its present precarious state. At present hardly anything is known about the disease or diseases which pass under that name, for indeed it is still quite uncertain whether the condition is a single multiform infection or a group of various infections with a convergent symptomatology. It is easy enough to isolate from the mucosa of the nose and throat a variety of bacteria, and the fact that during the acute stage these are often obtained in pure culture has encouraged different investigators to attach aetiological importance to Hoffmann’s bacillus, the Micrococcus catarrhalis, streptococci, pneumococci, Pfeiffer’s influenza bacillus and its mimics, and other more or less well-known forms. Attempts to correlate different types of the ordinary disease with differences in the bacterial flora have not been illuminating. Some evidence in favour of the causal role of these microbes has, however, been obtained from the effect of preventive inoculation with them. This has proved in many cases useless, but in a certain number of people the method has been helpful to a greater or less degree in diminishing the number of attacks or in reducing their severity. It is noteworthy in this connexion that the expert bacterio-therapeutist generally uses a mixture of organisms and not a single sort for his vaccine. The empirical discovery that a mixture gives better results does not, however, show that the disease is a multiple one. At the moment it seems most likely that none of the described organisms can be put down as the actual cause of the common cold, and that they are secondary and subsidiary infections implanted on the operations of the unknown agent which our belief in a world of cause and effect requires us to discover. KRUSE in Germany, FOSTER in America, and more recently Dr. M. H. GORDON of St. Bartholomew’s, have found in the nasal secretion in acute catarrh representatives of the organisms which, at or beyond the limit
of microscopical visibility, are at present described as "filtrable viruses."Prom the nature of the case it will obviously be difficult to establish their aetiological position, but enough positive infections in man have been effected to make it reasonable to take their causative relationship to the common cold as a useful working hypothesis, which is at any rate not inconsistent with the facts as we know them. On this view the disease is in parallel with measles and influenza in which many of the severe symptoms and most of the worst results are due to streptococci, pneumococci, and other bacteria which are not the cause of the disease, but for which the original infection prepares a suitable field. More careful clinical analysis of the cold along the lines of Dr. OLIVER HEATH’S interesting paper in our present issue will no doubtvield fruitful results. Common knowledge of the laymen’s sort tells us at once, however, that we often have the early symptoms of a cold which, with or without the exhibition of some domestic specific, disappear in 24 to 48 hours without the more usual sequelae of profuse and troublesome catarrh
The Bashfulness of Medicine. "
longer endure how the populace torture and hourly with their demands for the impossible. Because I have penetrated a little farther into the mystery of Nature’s ways, they believe that, like the Gods, I can relieve "them through some magic or supernatural means, and charm good fortune ; when. after all I am but a common mortal like others." me
I
can no
daily
- Virchow.
IN these words attributed to VIRCHOW is to be found the humility of the real healer, one who by his researches into the nature of causes of death let a flood of light into the secret chambers of life. Dr. Louis 1. HARRIS quotes them effectively in a public health bulletin1 and compares the humility of the master with the effrontery of the charlatan and the quack. He goes on to question how the public can be made to appreciate the contrast between the claims of physicians on the one hand and the shameless pretensions of the practitioners of the many medical cults and irregular forms of healing on the other. In America, it appears, the challenge of the situation has thus far failed to bring forth leaders with large vision, and this failure in America, as here, has been attended with serious peril to the public health. The modesty of knowledge need not and should not prevent the organisation and cooperation without which the medical profession can accomplish nothing large in the public interest. Dr. HARRIS frankly envies the success of the Life Extension Institutein New York which performs an important type of medical service to the general community on terms which in producing health also produce dividends, and with the aid of a publicity department with the range of a brass band. What an individual medical man may not do without incurring reproach a medical society as an organisation can do with propriety, and he draws a picture of what any county or well-organised district medical association might achieve as the medical service agency for its To take an instance very pertinent at the own area. present time. Such a local medical service agency could, at the proper season, set out simply by means of 1 Remedies for Certain Defects in Medical Organisation and Service. By Louis I. Harris, Dr.P.H., M.D., Director, Bureau of Preventable Diseases. Monthly Bulletin of the Department of Health, City of New York, December, 1921. 2 See " The Value of Periodic Health Examinations," THE LANCET, 1921, ii., 1289.