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THE "COMMON COLD."
626 (2) That when too much quinine was given it had a tendency to make the sj)utttjii very viscid, and there was difficulty in expectoration. was counteracted by tr. jaborand., I1lx, added to rnist. ,stim. expect., i. (3) That quinine given when the crisis was expected had an unfavourable effect on the heart. The pulse was weak and thready, and the patient showed a tendency to collapse. (4) That quinine injections given judiciously and in moderate doses definitely had a good pneumococeicidal
Correspondence. "Audi alteram partem."
RHEUMATIC INFECTION IN CHILDREN. To the Editor
of THE LANCET. SIR,-.ts in part responsible for the emphasis effect on the which has been recently laid on the association pneumonia. between the rheumatic infection in children and
disease
(5) The mortality
even
in very
severe cases
of chronic malaria
cases
of double was
more
poverty, may I say that I used the term " poverty " than that of non-malarial cases, who had been free from only as denoting the class of children from which fever during the summer. hospital patients are drawn as opposed to that The result of the injections was as follows: In dealt with in private practice. That acute rheumatism Sarwakai, out of 40 cases of lobar pneumonia, there in its major forms is overwhelmingly a disease of were three deaths only. In Sararogha (civil), out of the former group no one could possibly deny. At 22 cases, there were three deaths. In Jandola there the B.M.A. meeting at Bath some criticised the use were no deaths amongst the first 30 cases treated, of the word " poverty " on the grounds that the while the average of deaths amongst the remainder infection is not so particularly common in the children was 15 per cent. Those were very bad cases of pneuof destitute and out-of-work families as in those of monia. On the other hand, in the brigade at Sarathe working artisan class. With the truth of this I rogha, where the cases of pneumonia were not treated altogether agree, though I do not yet understand the by quinine, the case mortality averaged 25 per cent.
of it. But it seems a pity to me to obscure the main issue by quibbling over the term " poverty " ; surely this is broad enough to carry the sense of the contrast we desire to stress. For the point is a very important one. Of all the outstanding rheumatic problems there is none of greater importance than that of the environmental influences which predispose to the infection in children, and here we have one great fact to go onnamely, the predilection of the disease for the poorer_ Let us, therefore, do nothing to obscure; classes. this fact. In opening the debate on rheumatism at; the Medical Section of the Portsmouth B.M.A. meeting two years ago I particularly emphasisedl the significance of this association and appealed to, workers in public health to find out and tell us the reason of it. At the Bath meeting this year the Public Health Section met the Children’s Section inL a discussion on the rheumatic problem, and told us; of their investigations. It was their presence which made the meeting so different from any previousi ones, so significant and encouraging. I am, Sir, yours faithfully, REGINALD MILLER. Harley-street, W., Sept. 12th, 1925. reason
,
.
QUININE IN PNEUMONIA. the Editor of THE LANCET.
To
SIR,-A record of over 200 cases of lobar pneumonia in the Wano Agency, North-West Frontier Province, India, treated with intravenous injections of quinine bihydrochloride, may be of more than local interest. In 1923-24 the death-rate of pneumonia in this It was noticed that there agency was very high. was a high incidence of malaria in the summer, followed by a high death-rate of pneumonia in the winter. As no other form of treatment seemed to lower the death-rate, I resolved to try intravenous injections of quinine. It was found that they had a very beneficial effect. The temperature came down, the restlessness subsided, and the pulse got better and stronger. As soon as a case was diagnosed as pneumonia a blood film was taken (which by the way in every case was negative for malaria parasites) and intravenous quinine gr. 7 in 10 c.cm. distilled water given. Another injection was given on the third day, and another on the fifth day, after which no more were No injection was given during the crisis. given. Quinine did not shorten the course of the disease or expedite the crisis. In about 50 per cent. of cases the crisis did not take place till the seventh or eighth day. If the pulse was weak quinine was given with 5 minims of adrenalin. The following points were noticed :(1) That patients with enlarged spleens, due to malaria, did not stand
a
good
chance with the
quinine treatment.
j
’
I am, Sir, yours faithfully, R. KHAREGAB, M.B., Captain, I.M.S.; Agency Surgeon, Wano.
THE "COMMON COLD." To the Editor of THE LANCET. SIR,-The season of " colds " is at. hand ; indeed, an epidemic has been already reported. It is a curious fact that the general public has not realised that the common application of the word " cold " is a complete misnomer and, moreover, actually misleading. There is a disarming simplicity about the word, and in the public mind it is associated with " draughts," " cold winds," and so forth, and the idea is inherent that prevention and even cure lie in the piling on of additional clothing. No doubt there is some connexion with atmospheric conditions, but the public mind has entirely failed to grasp that the symptoms which are grouped together cold " are due to invasion of under the name of a the system with micro-organisms of varying virulence, and that the results of such invasion are often disastrous. The lengths of the obituary columns in the daily papers during the winter are due mainly to deaths from respiratory complaints, many of which owe their origin to the common cold, and, in addition, it is well known to the medical profession that chronic and disabling diseases can be numerous traced to the same source. In consequence of this want of knowledge among the community few or no precautions are taken against " spreading infection. Sufferers from " only a cold fulfil their social functions as usual, and attend places of worship and of entertainment, quite regardless of the dangers to which they are subjecting their neighbours. The circumstances of many people suffering from colds are such that it is quite possible for them to remain in bed for the first few days, and if only they would do so, not only would their own disability be shortened, but many susceptible persons would be spared a similar infection. Moreover, it is certain that if such a course could be generally followed, the total number of " lost working days " would be diminished very appreciably. The time is ripe for a campaign by the health authorities against a complaint whose effects are so far reaching, but the first stage in such a campaign against the " common cold " and its unrealised dangers must be the discarding of its present and the name substitution of another more expressive of its actual nature. "
I am, Sir, yours faithfully, JOHN ALEXANDER DRAKE, M.D.
D.P.H. Harle3.-street, W., Sept. 12th, 1925.
Lond.,
Correspondence. "Audi alteram partem."
RHEUMATIC INFECTION IN CHILDREN. To the Editor
of THE LANCET. SIR,-.ts in part responsible for the emphasis effect on the which has been recently laid on the association pneumonia. between the rheumatic infection in children and
disease
(5) The mortality
even
in very
severe cases
of chronic malaria
cases
of double was
more
poverty, may I say that I used the term " poverty " than that of non-malarial cases, who had been free from only as denoting the class of children from which fever during the summer. hospital patients are drawn as opposed to that The result of the injections was as follows: In dealt with in private practice. That acute rheumatism Sarwakai, out of 40 cases of lobar pneumonia, there in its major forms is overwhelmingly a disease of were three deaths only. In Sararogha (civil), out of the former group no one could possibly deny. At 22 cases, there were three deaths. In Jandola there the B.M.A. meeting at Bath some criticised the use were no deaths amongst the first 30 cases treated, of the word " poverty " on the grounds that the while the average of deaths amongst the remainder infection is not so particularly common in the children was 15 per cent. Those were very bad cases of pneuof destitute and out-of-work families as in those of monia. On the other hand, in the brigade at Sarathe working artisan class. With the truth of this I rogha, where the cases of pneumonia were not treated altogether agree, though I do not yet understand the by quinine, the case mortality averaged 25 per cent.
of it. But it seems a pity to me to obscure the main issue by quibbling over the term " poverty " ; surely this is broad enough to carry the sense of the contrast we desire to stress. For the point is a very important one. Of all the outstanding rheumatic problems there is none of greater importance than that of the environmental influences which predispose to the infection in children, and here we have one great fact to go onnamely, the predilection of the disease for the poorer_ Let us, therefore, do nothing to obscure; classes. this fact. In opening the debate on rheumatism at; the Medical Section of the Portsmouth B.M.A. meeting two years ago I particularly emphasisedl the significance of this association and appealed to, workers in public health to find out and tell us the reason of it. At the Bath meeting this year the Public Health Section met the Children’s Section inL a discussion on the rheumatic problem, and told us; of their investigations. It was their presence which made the meeting so different from any previousi ones, so significant and encouraging. I am, Sir, yours faithfully, REGINALD MILLER. Harley-street, W., Sept. 12th, 1925. reason
,
.
QUININE IN PNEUMONIA. the Editor of THE LANCET.
To
SIR,-A record of over 200 cases of lobar pneumonia in the Wano Agency, North-West Frontier Province, India, treated with intravenous injections of quinine bihydrochloride, may be of more than local interest. In 1923-24 the death-rate of pneumonia in this It was noticed that there agency was very high. was a high incidence of malaria in the summer, followed by a high death-rate of pneumonia in the winter. As no other form of treatment seemed to lower the death-rate, I resolved to try intravenous injections of quinine. It was found that they had a very beneficial effect. The temperature came down, the restlessness subsided, and the pulse got better and stronger. As soon as a case was diagnosed as pneumonia a blood film was taken (which by the way in every case was negative for malaria parasites) and intravenous quinine gr. 7 in 10 c.cm. distilled water given. Another injection was given on the third day, and another on the fifth day, after which no more were No injection was given during the crisis. given. Quinine did not shorten the course of the disease or expedite the crisis. In about 50 per cent. of cases the crisis did not take place till the seventh or eighth day. If the pulse was weak quinine was given with 5 minims of adrenalin. The following points were noticed :(1) That patients with enlarged spleens, due to malaria, did not stand
a
good
chance with the
quinine treatment.
j
’
I am, Sir, yours faithfully, R. KHAREGAB, M.B., Captain, I.M.S.; Agency Surgeon, Wano.
THE "COMMON COLD." To the Editor of THE LANCET. SIR,-The season of " colds " is at. hand ; indeed, an epidemic has been already reported. It is a curious fact that the general public has not realised that the common application of the word " cold " is a complete misnomer and, moreover, actually misleading. There is a disarming simplicity about the word, and in the public mind it is associated with " draughts," " cold winds," and so forth, and the idea is inherent that prevention and even cure lie in the piling on of additional clothing. No doubt there is some connexion with atmospheric conditions, but the public mind has entirely failed to grasp that the symptoms which are grouped together cold " are due to invasion of under the name of a the system with micro-organisms of varying virulence, and that the results of such invasion are often disastrous. The lengths of the obituary columns in the daily papers during the winter are due mainly to deaths from respiratory complaints, many of which owe their origin to the common cold, and, in addition, it is well known to the medical profession that chronic and disabling diseases can be numerous traced to the same source. In consequence of this want of knowledge among the community few or no precautions are taken against " spreading infection. Sufferers from " only a cold fulfil their social functions as usual, and attend places of worship and of entertainment, quite regardless of the dangers to which they are subjecting their neighbours. The circumstances of many people suffering from colds are such that it is quite possible for them to remain in bed for the first few days, and if only they would do so, not only would their own disability be shortened, but many susceptible persons would be spared a similar infection. Moreover, it is certain that if such a course could be generally followed, the total number of " lost working days " would be diminished very appreciably. The time is ripe for a campaign by the health authorities against a complaint whose effects are so far reaching, but the first stage in such a campaign against the " common cold " and its unrealised dangers must be the discarding of its present and the name substitution of another more expressive of its actual nature. "
I am, Sir, yours faithfully, JOHN ALEXANDER DRAKE, M.D.
D.P.H. Harle3.-street, W., Sept. 12th, 1925.
Lond.,