ar V 
 19126 
 
 Francke H, Bosworth, 
 
fyxmll Winivmxi^ Jilratg 
 
 THE GIFT OF 
 
 ij..U...ai 
 
 kZS^^S^ Z£,lMJ.lL. 
 
 1357 
 
arV19126 
 Taking cold / 
 
 Cornell University Library 
 
 3 1924 031 260 965 
 olln.anx 
 
The original of tliis book is in 
 tlie Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924031260965 
 
CONSUMPTION. 
 
 HORSFORD'S ACID PHOSPHATE 
 
 Has been used with good effect in consumption, and also 
 •when complicated with indigestion. In night sweats it has 
 commonly given speedy benefit. It is agreeable to the taste, 
 is well tolerated, and does not constipate the bowels. 
 Indicated in all wasting and dfibilitating diseases. 
 
 Dr. J. A. Meek, Gleacoe, Minn., says: "It seems to be almost 
 universally useful when there is a tendency to tubercle. I have also 
 used it to great advantage in a diversity of cases of defective nutrition." 
 
 Dr. F. C. Hawley, Canandaigua, N. Y., says: "I have used it in 
 cases of phthisis and inflammation of the lungs, where there was great 
 prostration, constant cough and profuse expectoration, with marked 
 benefit." 
 
 Dr. W. M. W. Davison, Parsons, Kan., says; "I have used it 
 with decided and certain benefit in consumption. I do not intend to 
 convey the impression that I have cured consumption with it, but it has 
 relieved its distressing symptoms, such as lowness of spirits, weakness 
 of mind and body, nervous irritation," etc. 
 
 Dr. A. Thompson, Lowell, Mass., says: "I have found it a valu- 
 able helper in nervous debility and incipient consumption." 
 
 Dr. Thos. Phillips, Austin, Minn., says: " I have used it in the 
 insomnia of phthisis pulmonalis, with immediate good." 
 
 Dr. T. H. Briggs, Battle Creek, Mich., says; " I always prescribe 
 it in phthisis and debility, physical or nervous, and have been pleased 
 with the results obtained." 
 
 Send for descriptive circular. Physicians who wish to test it will be 
 furnished a bottle on application, without expense, except express 
 charges. 
 
 Prepared under the direction of Prof. E. N. Horsford, by the 
 
 BUMPOEr CHEMICAL WOBZS, Frovidence, H. I. 
 
 Beware of Substitutes and Imitations. 
 
 €A.jmOJ!f:—Be sure the word ** JSorsford'a" is Printed on the lahel. 
 A.II others are spurious, Never sold in hulh. 
 
— ron — 
 
 Respiratory Affections. 
 
 Respiratory diseases are always endemic, and at certain seasons of 
 the year epidemic. Many a, successful patent medicine man owes his 
 fortune to a happy or unhappy combination of cough remedies, and not 
 a small portion of the regular phy.sician's practice is made up of pre- 
 scribing "cough mixtures." How many of those generally in use accom- 
 plish much more than to disturb the digestion or nauseate the patient we 
 leave it to the experience of all fair-minded physicians to determine. It 
 is certain many of these mixtures are inefficient. 
 
 It was but natural, therefore, that a wide trial should have been 
 made of modern additions to the Materia Medica. in this troublesome 
 class of affections, and of those proving themselves of value, the follow- 
 ing deserve special mention, and need only a wider knowledge of their 
 merits to make their use very general; 
 
 Naragamia Alata. Grindelia Robusta. 
 
 Cocillana. Quebracho. Myrtus Ghekan. 
 
 Verba Santa. Lippia Mexicana. 
 
 Among formulae we manufacture, we may also mention ANO- 
 DYNE PINE EXPECTORANT and BRONCHIAL SEDA- 
 TIVE, preparations which are agreeably tasting and combine expecto- 
 rants and respiratory sedatives already well known to the medical pro- 
 fession. 
 
 Descriptive literature of these drugs sent on request to physicians. 
 
 PARKE, DAVIS & COMPANY, 
 
 DETROIT AND NEW YORK. 
 
TAKING COLD. 
 
 BY 
 
 FRANCKE H. BOSWORTH, M. D., 
 
 Professor of Diseases of the Throat in the Bellevue Hospital 
 Medical College of New York. 
 
 1891. 
 GEORGE S. DAVIS, 
 
 DETROIT, MICH. 
 
Copyrighted by 
 
 GEOEQE S. DAVIS. 
 
 1891. 
 
TABLE OF CONTENTS. 
 
 PAGE 
 
 Cold, abortion of 44 
 
 course of. 17 
 
 general treatment of 43 
 
 how we take i 
 
 local treatment of 49 
 
 parts affected by 8 
 
 Laryngitis 64 
 
 Pharyngitis 60 
 
 Rhinitis 51 
 
 Tonsillitis, Acute (or quinsy) 65 
 
 Follicular . 67 
 
PREFACE. 
 
 It seems somewhat singular that taking cold has not 
 been the subject of more full consideration in our ordinary 
 text-books of clinical medicine, especially when we consider 
 the fact that such a large number of diseases are the direct 
 results of an exposure to cold. This is probably due to the 
 fact that a systematic treatise on medicine includes a descrip- 
 tion simply of specific diseases, whereas taking cold is not 
 ordinarily placed in the catalogue of absolute diseased condi- 
 tions. The importance, however, of clearly uederstanding 
 the rationale or method by which a morbid condition arises 
 from an exposure to cold cannot be over-estimated. More- 
 over, I am disposed to think that, not only among the laity, 
 but even among medical men, somewhat vague and indefin- 
 ite views are entertained in regard to this matter. In the 
 sixteenth volume of Ziemssen's Cyclopaedia, there is a some- 
 what elaborate article on "Slight Disorders Caused by 
 Taking Cold," by Seitz, who treats the subject in what seems 
 to me an exceedingly abstruse and impractical manner. As 
 far as I know, this was the only chapter in any of our stand- 
 ard text-books, until my own work on Diseases of the Throat 
 and Nose appeared in 1881, wherein a chapter was devoted to 
 this consideration. This was followed by a chapter on the 
 same subject by Woakes, in the third edition of his book on 
 Post-Nasal Catarrh, and subsequently Seller devoted a chap- 
 ter to this subject. In a later work published by myself on 
 Diseases of the Nose and Throat, in the first volume, I have 
 devoted a chapter to the same subject. 
 
 The following pages are practically an elaboration of 
 the views previously set forth by myself. I have endeavored 
 
vm. 
 
 to tieat the subject in as practical a manner as possible, and 
 whereas this little monograph is intended, as I understand 
 it, for the profession, I have endeavored to adapt it for the 
 laity as- well. The subject, I think, is a much larger one 
 than it is generally considered to be, and hence, in the effort 
 to condense it within the scope of the series of publications 
 in which it appears, I have been compelled to pass over many 
 points which seem worthy of consideration, while others have 
 been treated briefly and somewhat hurriedly. That part of 
 the subject, however, which I deem of the greatest impor- 
 tance, viz., the manner in which we take cold and the proper 
 method of preventing it in the wise regulation of our habits 
 of life, especially with reference to bathing and clothing the 
 body, I have treated at such length as will, I hope, clearly 
 convey the ideas which it has been my endeavor to advocate. 
 
 F. H. B. 
 
 26 West Forty-sixth street, New York city. 
 
TAKING COLD. 
 
 HOW WE TAKE COLD. 
 
 While as a matter of personal experience taking 
 cold is quite familiar to most of us, if we were to ask 
 ourselves why we take cold, and just how we take 
 cold, we might find it by no means an easy question to 
 answer. In the minds of most people the word " cold " 
 is naturally associated with low temperature, and they 
 confuse thf idea of taking cold with that of absolute 
 cold, regarding the penalty which they suffer as the 
 result of an exposure to cold, as due somehow to a 
 direct loss of heat from the body. 
 
 Now, this is an entirely erroneous idea. The body 
 is constantly losing heat, radiating it in large quanti- 
 ties sometimes, without in any way suffering there- 
 from; in fact, the radiatioil of heat from the body is a 
 constant process and a conservative one. Further- 
 more, when the demand for heat is very great, as 
 when the thermometer ranges below the freezing- 
 point, the supply is fully equal to the demand. A 
 swimmer will plunge into the water at a temperature 
 of 25° to 30° below that of his body and remain im- 
 mersed for hours even without suffering, and yet the 
 loss of heat by radiation must necessarily be very 
 great. This loss is thoroughly made up by the rapid 
 heat-production which is going on in the system as 
 the result, in part, of the vigorous exercise which he 
 
is compelled to keep up during his immersion. Again, 
 in the Turkish bath, after spending some time in a hot 
 room at a temperature of from 160° to "190, one 
 plunges directly into a cold bath, not only with impu- 
 nity but with a sense of refreshment and invigoration. 
 We have here, then, instances wherein the absolute 
 loss of heat from the body is very great indeed, and 
 yet the process is attended with no danger to the gen- 
 eral system, in the way of taking cold or other penalty. 
 We must, therefore, look further for some rational 
 explanation of the method by which, and .the reason 
 why we take cold. 
 
 In order to understand this, it is first necessary 
 to understand what bodily heat is, or, as it is usually 
 termed in works of physiology, animal heat. What is 
 the source of animal heat ? As we know, the tempe- 
 rature of the body in health is constantly maintained, 
 at all seasons and at all time, at a temperature of 98^°. 
 Any variation from this standard, be it even very 
 small, constitutes a condition of disease. In former 
 times, many theories were proposed by physiologists 
 to account for this equable and unvarying tempera- 
 ture of the body. As we know, the process of oxida- 
 tion in chemistry is attended with the development of 
 heat. When physiologists recognized the fact that 
 the blood came oxygenated from the lungs, they con- 
 ceived the idea that here was the source of heat in the 
 body; in other words, that the lungs acted as a sort of 
 furnace for supplying heat to the whole body in the 
 
— 3 — 
 
 process of oxidation of the blood. This theory, how- 
 ■ever, very soon became untenable when it was discov- 
 ered that the temperature of the blood in the lungs 
 "varied in no appreciable degree from that in the ex- 
 tremities of the body or portions the farthest distant 
 from the lungs. As advances were made in our 
 knowledge of animal chemistry, the fact became 
 known that all the processes of nutrition, viz., the 
 growth and development of the body, really consti- 
 tuted a form of oxygenation, a process attended with 
 the evolution of heat, and that in this process of nu- 
 trition of the body, heat production was going on in 
 every organ and tissue of the organism. This, then, 
 is the source of animal heat, and the process is not 
 confined to any one portion or member of the organ- 
 ism, but goes on everywhere, maintaining not only 
 the lungs and the heart and other internal organs at 
 an equable temperature of 98 1°, but maintaining the 
 limbs, at the furthest extremities even, at this same 
 temperature. Now, clinical experience teaches us, 
 with reference to taking cold, that the penalty of the 
 •exposure is incurred not from subjecting the whole 
 "body to a lower temperature, but only a portion of it. 
 If, for instance, we sit in a warm room with a draft of 
 air striking the back of the neck, all other portions of 
 the body being protected, or if we venture out on a 
 damp evening in thin slippers, chilling the feet, the 
 immediate result, almost invariably, is a cold. We 
 see, therefore, how this results from exposure of a 
 
— 4 — 
 part of the body and not of the whole. And, further- 
 more, this cold which has arisen from chilling the 
 feet or the back of the neck, has resulted in an attack 
 of inflammation of the bronchial tubes, perhaps, or a 
 cold in the head. In other words, an exposure of one 
 portion of the body has resulted in an attack of in- 
 flammation in a tract or locality entirely separate and 
 distinct from the one exposed. This needs some ex- 
 planation. We have seen before how animal heat is 
 generated in all portions of the body, but like all 
 other processes which go on in the human organism, 
 this process of heat-production is governed by the 
 central nervous system, and any disturbance of heat- 
 production in one portion of the body leads to a dis- 
 arrangement, as it were, of the whole system. 
 
 Let us liken, if we may, this central nervous sys- 
 tem which governs the whole matter of warming the 
 body, to a chandelier, say, with five gas-jets. If they 
 are all lighted and burning with a steady flame, this 
 constitutes health. Now, if we turn out a portion of 
 them, two or three perhaps, we find that the others 
 flare up with an increased intensity, which we may 
 liken to a diseased condition here. Now, if one of 
 the burners is somewhat weakened, it flames up above 
 the globe of the chandelier in an abnormal jet; this 
 we may liken to the inflammation which is caused by 
 our taking cold. 
 
 Or, let us take another illustration. The body is 
 a house; the central nervous system is a furnace in 
 
the cellar which regulates the warming of all the 
 rooms, the registers of which are supposed to be in 
 proper order. Now, from some cause the registers in ' 
 a portion of the house are closed, the heat from the 
 furnace makes its way into others in a greatly in- 
 creased volume; and further, if in any one of the 
 rooms the register is broken and the flow of heat is 
 permitted abnormally, it escapes here in a far greater 
 ■extent than in any other, heating this room in an un- 
 natural way; thus imitating, in a way, the inflamma- 
 tory condition which results from exposure to cold. 
 
 Coming back to the human body. We have used 
 •as synonymous terms heat-production, on the one 
 hand, and growth or nutrition on the other, in that 
 they are practically one and the same thing. Now, if 
 the central nervous organization which governs heat- 
 production and nutrition is disturbed or upset in hav- 
 ing this process of nutrition shut off, or arrested, in 
 ■one portion of the body, the back of the neck or the 
 feet in the illustration which we used on a previous 
 page, we can easily see how the central nervous force 
 which governs it, being the same as before, must ex- 
 ercise the same amount of energy as before, and fur- 
 thermore, that energy must be sent out through some 
 of its channels. Now, if this is arrested in one part 
 it goes out with increased intensity to another. In- 
 flammation, practically, is simply an exaggerated con- 
 dition of health. In other words, in inflammation the 
 normal processes of health go on, but with greatly in- 
 
— 6 — 
 
 creased intensity. And so we see how the draft of air 
 on the back of the head or a chilling the feet, hamp- 
 ering or arresting the processes of nutrition and heat- 
 production in the portion of the body thus exposed, 
 and thereby tending to an increase of the nutritive 
 processes or heat-production in some other portion of 
 the body, may result in an attack of bronchitis or cold 
 in the head. 
 
 Another question comes up here which can be 
 only answered by our experience in the matter, and 
 that is. How do we take cold? We do not take cold 
 ordinarily from a draft of cold air, — there must be- 
 something else. We do not take cold if the cold air 
 strikes a portion of the body which is not accustomed 
 to be protected. We may face a blast of cold wind 
 from the north at a temperature many degrees below 
 zero with absolute impunity, for, as we have said be- 
 fore, it is not a low temperature that causes a cold. 
 We may sit with our backs oftentimes exposed out- 
 doors to the coldest winds, and suffer no inconve- 
 nience. We cannot sit with our back to a draft with 
 the temperature at 40° without incurring great risk- of 
 contracting a cold, providing there is sufficient moist- 
 ure in the air to chill the skin; and this is a practieat 
 point in this question which we learn from experience, 
 that the most dangerous draft is one not at a low tem- 
 perature, but one in the neighborhood of 33° or 45', 
 and furthermore, one in which the atmosphere is laden 
 with moisture. The fact that a draft of air of the 
 
temperature of zero is not dangerous, is probably ac- 
 counted for in that the atmosphere at low tempera- 
 tures can contain but a very small amount of moisture. 
 Experience teaches us, therefore, that the greatest 
 danger is met with in a draft of air of a moderately 
 low temperature and containing moisture: Why this 
 is so it is not easy to explain; the fact remains as a 
 matter of constant and oft-repeated experience. The 
 action of air in motion is to arrest or hamper, for the 
 time being, the nutritive processes which are going on 
 in that portion of the body which is exposed, or, in 
 other words, to arrest those forces or processes in 
 this portion of the body which are generating heat, 
 with the result of developing increased nutrition or 
 increased heat-production in some other portion of 
 the body. This increased heat- production constitutes, 
 inflammation. 
 
 That low temperature alone is not responsible for 
 colds is still further evidenced by the fact that the 
 winter season, perhaps, is the one in which, of all 
 others^ we are least liable to take cold. Certainly of 
 the four seasons, those in which we are most exempt 
 from taking cold are the summer and the winter 
 months; whereas the time when we are especially 
 liable to take cold is in the moderately cool days of 
 spring and fall, seasons in which the prevailing condi- 
 tion is one of an atmosphere largely charged with 
 moisture, and one also which is specially characterized 
 by chillng winds, and in which the temperature ranges 
 at from 35° to 45". 
 
THE PARTS AFFECTED BY TAKING COLD. 
 
 Another question which arises here, is as to the 
 location of the inflammatory process which results 
 from taking cold. Jn the majority of cases, an expos- 
 ure to cold results in an acute inflammation of the 
 mucous membrane which lines the nasal passages; in 
 other cases it gives rise to a sore throat, or swollen 
 tonsils; in other cases bronchitis, or, again, an attack 
 of irritable bladder, or perhaps lumbago. This is very 
 easily explained, when we say that the inflammation 
 which results from exposure to cold locates itself in 
 the weakest part. If a man is liable to rheumatic 
 troubles, an exposure to cold will result in an attack 
 of rheumatism; if a man has any bronchial weakr.ess, 
 • an exposure will be followed by an attack of bronchi- 
 tis. In most instances, as we know, an exposure to 
 cold gives rise to an acute coryza, or an ordinary cold 
 in the head, simply on account of the fact that the 
 mucous membrane which lines the nose is in a state of 
 mild chronic inflammation in a very large portion of 
 the community in our temperate climates. In other 
 words, most people have mild chronic nasal catarrh, 
 as it is termed, which is perhaps the source of a very 
 slight inconvenience or perhaps may be scarcely no- 
 ticed at all, and yet jvhen a cold is contracted this 
 chronic inflammation lights up into an active, acute 
 process. It is very commonly said that chronic trou- 
 bles, such as chronic catarrh, chronic bronchitis, ton- 
 
_ 9 — 
 
 sillitis, etc., are the result of repeated colds or attacks 
 of acute inflammation. I am disposed to think that 
 the process is really reversed, and that in most 
 instances the chronic inflammation sets in first, and 
 that these repeated colds, as the result of slight ex- 
 posure, are caused by, and become a prominent symp- 
 tom of the mild chronic trouble. 
 
 It may be interesting in this connection to give a 
 brief description of the anatoniy and the physiology 
 of the upper portion of the air passages^ for these are 
 the parts which become the seat of attacks of acute 
 inflammation in a very large majority of instances 
 when a cold is contracted. 
 
 In the accornpanying cut there is shown a sec- 
 tional view of the nose, mouth, pharynx, trachea and 
 oesophagus. Th6 upper portion of the cut shows the 
 nasal fossa or nasal cavity, a large wedge-shaped cav- 
 ity which forms the upper portion of the breathing 
 apparatus. There will be noticed' on the wall of this 
 cavity three scroll-shaped projections, marked supe- 
 rior, middle and inferior turbinated bones. These 
 projections serve the purpose" of increasing the sur- 
 face over which the mucous membrane lining the na- 
 sal cavity is distributed. Below the posterior portion 
 of the nasal fossa is found a large space called the 
 pharynx, and below this the oesophagus, simply a tube 
 lined with a well lubricated mucous membrane. Im- 
 mediately in front of the pharynx is the cavity of the 
 mouth, separated from the nasal cavity by the hard 
 
— 10 — 
 
 
 gtii 
 
 
palate, and behind that is the soft palate, to the latter 
 being attached the little soft projection, the pendu- 
 lous uvula. Immediately below the soft palate is a 
 small mass of lymphatic glands called the tonsil. In 
 the floor of the mouth we notice the tongue, immedi- 
 ately behind which is the epiglottis, beneath which we 
 find the larynx and windpipe and entrance to the 
 lungs. These cavities are united in the performance 
 of a number of different functions. The nose is usu- 
 ally regarded as the organ of the sense of smell. This 
 function of the nose, however, is comparatively unim- 
 portant compared with other functions which I shall 
 presently allude to. Distributed in the upper portion 
 or the nasal cavity are the terminal filaments of the 
 olfactory nerve. During the act of inspiration minute 
 particles of odorous bodies are carried into the nasal 
 cavity and come in contact with these minute termi- 
 nations of the olfactory nerve, and their peculiar qua- 
 lity are thus appreciated. The nose also gives certain 
 resonant qualities to the voice which we all recognize, 
 in that when the nose is stopped-up with a cold in the 
 head, a tumor or otherwise, the voice assumes a hard, 
 disagreeable tone, owing to the fact that this resonant 
 function of the nasal cavity is abolished. The nasal 
 character of the voice constitutes that pleasing reson- 
 ance which we recognize in every good voice. Our 
 English friends accuse us, as a nation, of talking 
 through the nose. The Americans, as a rule, make 
 use of the nasal tones in the voice to a far greater ex- 
 
tent than the English. It is a matter of taste, for we 
 all recognize in the peculiar tones of the voice of 
 Englishmen an absence of the nasal tones, which to 
 American ears is not entirely agreeable. 
 
 The three rounded scroll-like projections which 
 we notice on the outer walls of the nasal cavity are 
 called the turbinated bones. Upon these turbinated 
 bones and beneath the mucous membrane are located 
 two large masses of blood-vessels, which are called 
 the turbinated bodies. The function of these masses 
 of blood-vessels is to pour out upon the surface of the 
 mucous membrane a clear watery fluid whose design 
 is to moisten the air that is taken into the lungs. 
 Nature designed the riasal cavities as the entrance to 
 the lungs, and placed there this apparatus in order 
 that every breath of air which is taken into the lungs 
 should be so thoroughly warmed, cleansed and moist- 
 ened that when it reached the lung tissue it should 
 possess no irritating qualities whatever. These 
 masses of blood-vessels which we have called turbin- 
 ated bodies, in the course of the twenty-four hours 
 secrete about a pint of water; so that the air in going 
 to the lungs, and passing over the surface of these 
 bodies, takes up this moisture so completely, that 
 when it reaches the bronchial tubes it is in a state of 
 absolute saturation. Otherwise, one can easily per- 
 ceive that if the ordinary out-door atmosphere reached 
 the bronchial tubes it would dry the membrane which 
 lines them to such an extent as to seriously injure 
 
— 13 — 
 these passages. Moreover, the lung tissues are exceed- 
 ingly delicate, and air of the ordinary temperature 
 taken directly into the bronchial tubes would be a source 
 of irritation, unless its temperature were previously 
 raised. Furthermore, any impurities, such as particles 
 of dust, or other matter, which the ingoing current of 
 air in respiration may contain, lodge upon and adhere 
 to the walls of the moist and tortuous passages of the 
 nasal cavity, thus purifying the inspired air before it 
 reaches the lungs. We thus find in the nasal cavity 
 an exceedingly delicate and intricate apparatus which 
 warms moistens and cleanses the inspired air before 
 it enters the lungs. The nose thus becomes really an 
 exceedingly important part of the breathing appara- 
 tus, far more so than has usually been supposed, fully 
 justifying my assertion that the nose is of much 
 greater importance as a part of the respiratory appa- 
 ratus than as the organ of olfaction. 
 
 These turbinated bodies, before mentioned, which 
 pour out in the course of the twenty-four hours nearly 
 a pint of fluid into the nasal cavity, must necessarily 
 be regulated with a very great degree of nicety, in or- 
 der that this secretion of water may adjust itself to 
 the varying degrees of moisture which the air contains. 
 Thus, on some days when the outer air is saturated, 
 these organs have little duty to perform, or, again, 
 when the air is abnormally dry, they are in a state of 
 constant activity. Now, in a state of activity a large 
 amount of blood necessarily circulates through them; 
 
— 14 — 
 when not called upon for large duty, but little blood 
 circulates. In this way the blood-supply is constantly 
 changing, and thus a condition is created in which 
 disturbances are exceedingly liable to occur, these 
 disturbances constituting a mild chronic catarrh. 
 
 In this connection it might be stated that herein 
 lies what has been, even in medical literature, a source 
 of much misconception, I refer to the use of the term 
 chronic catarrh. Now, practically, there is no such 
 disease as chronic catarrh, the name meaning nothing 
 other than a discharge from the nose, and from that 
 it has grown to cover the whole category of diseases 
 which may be met with in the nasal cavity. We 
 should recognize the fact, then, that the term chronic 
 catarrh is a meaningless one, and conveys no idea 
 other than that one has "something the matter with 
 the nose." Furthermore, in a majority of instances, 
 what we call chronic catarrh is merely some disturb- 
 ance of this intricate apparatus which we have 
 attempted to describe as located in the nose for 
 warming, cleansing and moistening the ingoing cur- 
 rent of air in respiration. 
 
 Now we can understand how, if as the result of 
 chronic inflammation in the mucous membrane of the 
 nasal chamber, this apparatus becomes hampered in 
 its action or disturbed in some way, and therefore fails 
 to properly prepare the ingoing current of air in res- 
 piration so that it shall do no injury, a diseased con- 
 dition of the mucous membrane below may ensue. 
 
— '5 — 
 Now, it is a matter of constant observation that a 
 chronic inflammation of the mucous membrane of the 
 nose is very soon fcllowed by a chronic inflammation 
 of the mucous membrane of the larynx, or the wind- 
 pipe, or the large bronchial tubes, as its direct result; 
 in fact, I am disposed to think that a bronchitis or a 
 laryngitis is an exceedingly rare event except as sec- 
 ondary to and dependent upon a chronic inflammation 
 of the mucous membrane lining the nasal cavity. 
 
 If, now, we understand what the function of the 
 membrane lining the nose is, and how very liable this 
 function is to become disturbed or disarranged, I think 
 we have made it clear how a chronic inflammation, 
 mild in character perhaps and giving rise to no appre- 
 ciable symptoms, is an exceedingly common occur- 
 rence in this membrane; in fact, the chronic inflam- 
 mation of this membrane, perhaps, is met with more 
 frequently than an inflammation in any other portion 
 of the body. Hence, as the point of greatest weak- 
 ness, an exposure to cold in the large majority of in- 
 stances results in a cold in the head. Furthermore, 
 each attack of acute inflammation of this membrane 
 leaves the part in a little worse condition than it was 
 before. The chronic inflammation has advanced a 
 little with each attack, thereby rendering it more sus- 
 ceptible to another cold, or, in other words, each cold 
 is contracted more easily than the former one, and 
 thus the habit of taking cold becomes more fixed as 
 the chronic inflammation advances. But, as we have 
 
— i6 — 
 
 already tried to make clear, as the result of trouble 
 with the nose, a mild chronic inflammation of the mu- 
 cous membrane lining the trachea; the larynx and 
 bronchial tubes soon sets in, and with each recurring- 
 season the colds in the head becorne of a severer type 
 and are attended with an attack of hoarseness or a 
 loss of voice, or, if the inflammatory process has 
 extended further down, a bronchitis with cough and 
 expectoration accompanies the cold. As the diseased 
 condition of the upper air-passages progresses, a new 
 feature sets in now, which is somewhat curious, and 
 that is, that the colds, instead of commencing in the 
 head, commence in the parts below. A patient may 
 for years be liable to colds in the head, and finally, as 
 the disease travels down, his cold settles in the bron- 
 chial tubes or in the larynx, leaving the nasal-passages 
 clear, and they only become involved later and sec- 
 ondarily. In other words, as the results of cold and 
 exposure, he becomes hoarse, loses his voice, perhaps, 
 commences to cough and expectorate, and after his 
 cold has lasted a few days it Seems to travel up into 
 the head, the nose becomes occluded, he sneezes and 
 has watery discharges, and it passes off apparently in 
 •this direction, the invasion of the nasal cavity being 
 accompanied with relief to the portions below. 
 
 We thus have tried to explain briefly the parts 
 ordinarily affected by a cold and the reason why a 
 cold,, apparently by preference, attacks these portions 
 of the body. As regards those colds which attack 
 
— 17 ~ 
 
 the kidneys or bladder, or other portions of the body, 
 there is nothing of special interest to suggest, other 
 than that those who, from inheritance or acquirement, 
 suffer from rheumatism, or cystitis, or kidney disorders, 
 of course are more liable, as the result of exposure, to 
 have a cold settle in these parts where their special 
 and individual weakness may lie. 
 
 THE COURSE OF A COLD, 
 
 A cold is not really a mere local inflammation, 
 because one rarely contracts a cold without feeling 
 more or less general disturbance. Its onset is rarely 
 marked by a fully developed chill, but usually there 
 are quite well marked chilly sensations, pains in the 
 bones, a feeling of general weakness, loss of appetite, 
 a dull headache, perhaps, and other evidences that the 
 whole system is affected by it. Furthermore, these 
 symptoms usually set in before the local inflammation 
 shows itself. This, I think, unquestionably must be 
 accepted as teaching us that the cold has affected the 
 whole system in some way.; or, in other words, as evi- 
 dence of the correctness of the view advanced in the 
 earlier pages, that an exposure really acts indirectly 
 through the central nervous system in the manner 
 which we have already tried to make clear, primarily 
 arresting heat-productiou in a certain portion of the 
 body, which, being recognized by the central nervous 
 system, creates a disturbance there, in consequence of 
 which an excessive amount of nerve-force is sent out 
 
— i8 — 
 
 to the point of the greatest weakness, there setting up 
 inflammatory action, the effect on the nervous system 
 being evidenced by the feeling of general depression, 
 with fever. The constitutional disturbance may last 
 from twelve to twenty-four hours, when the local 
 inflammatory process manifests itself at the point of 
 selection. These symptoms, of course, need not be 
 s'pecifically described. The only point we make in 
 this connection is, the fact of a cold really being a 
 constitutipnal disturbance as well as a local inflamma- 
 tion. 
 
 PREVENTION OF A COLD. 
 
 A proper and intelligent understanding of how to 
 avoid taking cold is of far more importance to us than 
 to know how to treat a cold. While, practically, there 
 is no specific method of treating a cold which will pre- 
 vent the inflammatory process which results therefrom 
 from doing a certain amount of permanent mischief, a 
 knowledge of certain general laws of right living will 
 enable us to avoid the evil results of exposure to cold, 
 certainly in a majority of instances. 
 
 These preventive measures consist practically in 
 the proper regulation of the clothing, the maintenance 
 of the skin in its best functional' activity by the daily 
 use of the bath, the proper ventilation of our living 
 and sleeping apartments, and certain other more gen- 
 eral measures. These, perhaps, would be best dis- 
 cussed in detail. 
 
— 19 — 
 
 CLOTHING. 
 
 It is an old and popular fallacy that we wear 
 clothes to prevent taking cold. As a matter of fact, 
 we should wear clothes only to protect ourselves from 
 low temperature. For the accomplishment of this 
 purpose, furtherniore, it is the height of unwisdom to 
 wear more than just sufficient clothing to protect our- 
 selves from the weather. The instant that we put on 
 more than is sufficient for comfort, we are liable to do 
 mischief. Furthermore, in wearing clothing it should 
 be equably distributed over the whole body. The in- 
 stant we clothe one portion of the body at the expense 
 of another, or in excess of another, we are liable to do 
 ourselves a harm. 
 
 The most important part of our clothing is the 
 underwear, in that, lying next to the skin, it is a mat- 
 ter of no little moment that it should be of such tex- 
 ture as to interfere in the least degree with what is, 
 perhaps, the most important function of the skin, viz., 
 that of perspiration. As before stated, there is more 
 heat generated in the body than is sufficient to keep it 
 at the normal, temperature of 98|°. This excess of 
 heat is dissipated by means of perspiration. This 
 perspiration is going on constantly, day and night. 
 It is estimated by physiologists that about i6 oz. of 
 water is dissipated from the surface of the body of an 
 adult in the course of twenty-four hours. This is 
 called insensible perspiration, in that it goes on with- 
 
20 
 
 out the patient being conscious of it, or without it 
 being perceptible. As we know, all evaporation is at- 
 tended with a loss of heat, which becomes latent. 
 Evaporation and perspiration are practically one and 
 the same thing. , Hence, we see that by this insensible 
 perspiration the heat of the body is dissipated. When 
 we undergo violent exercise we generate heat rapidly 
 in the, body. This must make its escape rapidly. In 
 this case the perspiration or evaporation of water from 
 the surface of the body becomes excessive, showing 
 itself in the profuse perspiration \7hich occurs during 
 vigorous exercise. It is the insensible perspiration 
 which is of importance to us. The texture of the 
 garment worn next to the skin should be such as will 
 in the least degree interfere with this physiological 
 process. If we examine the fibre of the different fa- 
 brics which are worn, viz. : cotton, silk, linen and wool, 
 we will find a very notable and striking difference be- 
 tween the first three of these and the last. The fibre 
 of cotton, silk and linen is an absolutely straight, in- 
 elastic fibre. When woven into a textile fabric the 
 result is a somewhat dense, felt-like, impermeable 
 cloth. As the result of this impermeability, when 
 worn next to the skin, it has a tendency to hamper 
 and interfere with this process of insensible perspira- 
 tion or heat-radiation. If, on the other hand, we ex- 
 amine the wool fibre, we shall find a highly elastic, 
 curling fibre, being absolutely unique and differing 
 ■from all other fibres in this respect. When woven 
 
into a textile fabric, wool makes a highly elastic and 
 exceedingly porous cloth, which, when worn next to 
 the skin, interferes with this process of insensible per- 
 spiration or heat-radiation less than any other known, 
 textile fabric. Hence, the underwear should be 
 made of pure wool, as affording a fabric incompara- 
 bly superior to all others. 
 
 A practical illustration of this is very strikingly 
 shown in the fact that one may wear a thin all-wool 
 suit of underwear through a warm summer's day with- 
 out perspiring, and even undergo a certain amount of 
 physical exercise with the same immunity from un- 
 pleasant perspiration. Clothe the same individual 
 with a suit of cotton underwear and subject him to 
 the same physical condition, and in a comparatively 
 short period the cotton underwear will be saturated. 
 The explanation of this is comparatively simple. The 
 perspiration is absolutely unhampered by the woolen 
 underwear; the escape of heat and the escape of 
 moisture goes on rapidly through them. The wool 
 does not take up the moisture of the perspiration and 
 does not become sodden and wet by it. On the other 
 hand, the cotton fabric does not permit this insensible 
 perspiration to pass through it, which is equivalent to 
 saying that the heat of the body is retained by the 
 cotton, and furthermore the moisture of the insensible 
 perspiration lodges in the meshes of the cotton fabric 
 in such a way as that in a comparatively short time it 
 is saturated. It is commonly believed that woolen 
 
wear is much warmer than cotton, and that cotton 
 should be worn in summer for comfort. As a matter 
 of fact the woolen wear is much the cooler of the two, 
 and for the reason above stated. Cotton feels cooler 
 to the touch perhaps than wool, on account of its phy- 
 sical quality. Wool is a poor conductor of heat, while 
 cotton is a good heat-conductor. This physical prop- 
 erty of heat-conduction, however, has nothing what- 
 ever to do with the regulation of our clothing. Any 
 fabric worn next to the skin fcr three minutes will be 
 warmed to the body-temperature, and after that oc- 
 curs heat-conduction ceases to be a factor in the com- 
 fort or discomfort of our body wear. Linen is often 
 worn as a matter of comfort on account of its special 
 quality as a heat-conductor. Linen is cooler to the 
 touch than any other fabric, and yet the linen fibre is 
 similar to the cotton fibre. The question is not to 
 provide the body with a good heat-conductor or non- 
 ductor; it is to clothe the body with a highly porous 
 fabric which shall not interfere with heat-radiation or 
 perspiration. A silk garment is agreeable to the 
 toifch and pleasing to the eye, and yet, I take it, silk 
 would never be worn as underwear were it not the 
 most expensive fabric in the market. It is undoubt- 
 edly a source of great satisfaction and pride^to many 
 people, but not really, I think, a source of comfort, 
 that their underwear is of raw silk and imported. A 
 knit fabric is always more elastic and more porous 
 than a woven one; hence, I think, knit underwear pos- 
 
— as- 
 sesses an advantage over that from the loom. The 
 underwear in our temperate climates should be just 
 sufficiently heavy to keep the body warm, and no 
 more. I know of no greater mistake than the wearing 
 of very .thick underwear as a protection from taking 
 colds. A suit of underwear fitting closely to the skin 
 serves a better purpose in keeping the body warm, 
 than a very much heavier garment thrown loosely 
 over the shoulder. Hence, it is rarely necessary to 
 wear other than the thinner of the knitted material 
 generally used iti the -manufacture of undersuits. 
 
 Few habits are more universal than that of chang- 
 ing one's underwear two, three, or even four times in 
 the course of the year, in order to adapt it to the va- 
 rious changes of temperature in our varying seasons. 
 No greater mistake could possibly be made. One 
 should wear the same thickness of underwear the 
 whole twelve months. I know of no more important 
 direction than this as a protection and preventative 
 from taking cold. Practically, we spend a large por- 
 tion of the twenty-four hours, both in summer and 
 winter, in about the same temperature. In other 
 words, we keep our houses in winter at a temperature 
 of about 68° to 70°. This does not vary to a very 
 great degree from the average temperature of the 
 summer months. Furthermore, in winter we are ac- 
 customed to, and necessarily must, wear heavier outer 
 clothes; these latter affording ample protection from 
 the cold weather of our springs and winters. More- 
 
— 24 — 
 
 over, this change of underwear in our climate involves 
 the exercise of an amount of judgment and discretion 
 that none of us possess. One never knows when to 
 make a change from spring to winter wear, and when 
 the change is made, in a majority of instances, the 
 wearer has made a mistake and has put it on too soon 
 or has put it on too late, and suffers either with exces- 
 sive heat, or a chill, with its resulting mischief. In 
 fact, nothing is more hopeless than to attempt to 
 adapt ourselves to the varying changes of temperature 
 in the very fickle climate of our temperate regions. 
 It cannot be done, and when the attempt is made it 
 is almost invariably a mistake. Our protection is not 
 in adapting our clothing to the various fluctuations of 
 a fickle thermometer, but to so inure ourselves to the 
 changes of temperature that we can meet them With 
 impunity. This we may do by breaking up the habit 
 of wearing too heavy clothing and accustoming our- 
 selves to get on with just sufficient clothing to keep 
 ourselves comfortable. There is much more comfort 
 in wearing little clothing than in wearing too much. 
 The man who always puts on an extra coat for a five 
 or ten degree fall in the barometer, is the man who 
 invariably suffers most from cold weather. 
 
 It is important to bear in mind that the warmth 
 and comfort of the body is not so much dependent on 
 the amount and thickness of the clothing, as on a 
 healthy and vigorous cutaneous circulation, for it is 
 by the skin that the feeling of cold is appreciated, and 
 
— 25 — 
 if the circulation of the blood here is maintained at the 
 normal standard, a low temperature is far less liable 
 to cause discomfort. 
 
 Wearing, then, a thin suit of all-wool underwear 
 through the cold of winter and the warmth of sum- 
 mer, we make ourselves comfortable, according to the 
 demands of the outside temperature, by changing our 
 outer garments. This is always an easy thing to do. 
 A change of underwear, however, to meet a rise or fall 
 of temperature in the course of the day, is a 'duty 
 which most of us would be disposed to shirk. 
 
 As regards outer-wear, house-coats and over- 
 coats, that is a matter which is easily regulated. Most 
 of us wear these garments with reference to comfort. 
 In general, the rule must be to clothe the body evenly 
 and equably — not too much in one portion, not too 
 little in another. 
 
 Nature has provided the head with an ample cov- 
 ering in the hair. I question if the Almighty ever 
 intended that we should wear hats. Wearing hats is 
 a fashion, and not a comfort or a- necessity. It is a 
 fashion which we have indnlged in at the expense of 
 a healthy growth of hair to a large proportion of man- 
 kind. Women are rarely affected with bald head, be- 
 cause women's head-covering is an airy trifle. There 
 is no question in my mind that the prevalence of bald 
 heads in our day is the result of wearing heavy felt 
 and silk hats. Anyone who has been much in Lon- 
 don cannot fail to have noticed the Blue-coat School 
 
— 26 — 
 
 boys, with long, blue surtouts and satchels, noticeable 
 for their ruddy faces aijd luxuriant growth of hair. 
 Somewhere in the last century, it is said, *n epidemic 
 of eczema of the scalp broke put in the school, which 
 necessitated a general order forbidding the wearing of 
 caps or other head-wear. The order has never been 
 rescinded, and to this day the BlucTCoat School boys 
 go bareheaded through the streets of London, with 
 the result that noticing about them is more noticeable 
 than the magnificent, aud luxurious growth of hair. 
 The conventionalities, of life, however, demand, that 
 we should wear hats. It is a necessary evil, but can 
 be to an extent mitigated, by making them of as light 
 a material as possible and seeing that the crowns are 
 properly ventilated. 
 
 The neck requires no protection except from the 
 severity of a very low temperature. Nothing can be 
 more pernicious than the habit of muffling up the 
 neck. With many people there seems to be an idea 
 that an exposure of the neck results in a sore throat, 
 and therefore to protect oneself from sore throat one 
 must cover up the neck. The skin of the neck has no 
 more connection with the mucous membrane of the 
 throat, than the top of the head with the sole of the foot; 
 in fact, a sore throat is contracted far more frequently 
 from wetting the fept than from cold air on the neck. 
 
 The body, in the same way, should be covered 
 equably and with suificieut clothing to keep it com- 
 forta:ble. This clothing should be equably distributed 
 in front and behind. 
 
— 27 — 
 
 Another pernicious habit which is very prevalent 
 is that of Wearing extra protection for the chest, put- 
 ting pads, wads of cotton aud extra covering of that 
 sort over the thorax, with the idea of thus protecting 
 the lungs. One does; not take cold on the lungs from 
 an exposure of the chest. The region of body ex- 
 posed to a draft has nothing whatever to do with the 
 part in which the inflammation results. The habit of 
 coddling one portion of the body at the expense of 
 another invariably results in some weakness. Extra 
 protection for the walls of the chest weakens the 
 whole system; it does not protect ind it does not 
 weaken the chest especially; it is only a part of a vi- 
 cious habit of clothing. The worst possible place to 
 wear a chest-protector is across the chest; the best 
 possible place to wear a chest-protector, probably, is 
 on the soles of the feet. In other words, the chest- 
 protector is a misnomer; it should never under any 
 circumstances be worn. The same may be said of 
 chamois-leather garments worn under the vest. They 
 retain heat and moisture, hamper perspiration, and are 
 in every way objectionable except in extremely cold 
 weather. The limbs should be clothed warmly and com- 
 fortably in the same manner as the trunk of the body. 
 
 The feet, coming in contact as they do with the 
 cold and oftentimes damp pavement, require more 
 protection perhaps than other parts of the body, but 
 this protection should be on the soles of the feet. A 
 damp, cold pavement is always a menace, while 
 
— 28 — 
 
 siiAply a cold pavement is not. In other words, if we 
 get our feet damp we are liable to take cold, but our 
 limbs may be frozen off without taking cold. This 
 illustrates the point already discussed in a former 
 page, of how we take cold as the result of a damp at- 
 mosphere at a moderate temperature rather than in a 
 cold, dry atmosphere. In this way the cold and damp 
 pavement, with thin-soled shoe, is very apt to give one 
 a chill, followed by sore throat, bronchitis, or some 
 other disorder. Hence, the sole of the shoes should 
 be abundantly thick, sufficient to prevent the soles of 
 the feet feeling the cold and dampness through them. 
 The upper portion of the foot does not require the 
 same protection, and should be clothed with reference 
 to comfort. Wearing rubbers, while a necessity, is 
 oftentimes a mischievous necessity. A ri;ibber over- 
 shoe that covers the whole foot, contracting it, hamp- 
 ering its motion, retaining moisture and retarding cir- 
 culation, is always objectionable. In exceedingly cold 
 weather the ordinary arctic shoe sold in the shops af- 
 fords ample protection from cold. In damp weather, 
 the slight rubber which only covers the sole of the 
 shoe is infinitely better than the rubber shoe which 
 covers the whole foot. 
 
 As regards overcoats, there is little need' be said, 
 further than to enter a mild protest against the exces- 
 sive use of furs both' for male and female wear which 
 has become such a prevalent fashion. In our climate 
 in late years, a sealskin overcoat or a sealskin dolman 
 
— 29 — 
 
 is undoubtedly a beautiful garment, and yet the Lord 
 designed a sealskin for an animal whose principal ha- 
 bitat is in the Arctic Ocean. I do not believe it is in 
 any way adapted for the wear of men and women in 
 temperate zones. Of course, it is better adapted for 
 the loose-fitting dolman than for the tight-fitting 
 sacque; and yet we have not many days in our cli- 
 mate which are sufiiciently cold to warrant the wear- 
 ing of a sealskin, or days in which the wearer is not 
 exceedingly liable to beconje overheated and thus 
 thrown into a perspiration. As a consequence, imme- 
 diately upon the removal of the furs, the wearer is 
 liable to feel a sense of chilliness, followed by a more 
 or less well-developed cold. 
 
 It is a matter of some importance, after having 
 adopted a system of clothing, to maintain it with a 
 certain degree of consistency. This, perhaps, is not 
 always possible,, and yet it is a rule which .should be 
 borne in mind. 
 
 The requirements of modern society compel the 
 wearing of what is called full dress at evening enter- 
 tainments. This is always attended with a certain 
 amount of exposure, in that what we call full dress is 
 usually of thinner material than ordinary day-wear, 
 and yet, being worn indoors, the exposure is compara- 
 tively limited in the case of men. Full evening dress 
 among women usually involves the, exposure of the 
 neck and portion of the chest and shoulders. There 
 can be no question that this is, technically, a violation 
 
— 3° — 
 of the laws of health, and yet, from a practical point 
 of view, women do not, as a rule, suffer from the 
 wearing of low-necked dresses unless there be some 
 special bronchial or pulmonary weakness which ren- 
 ders them liable to the penalty of even a very slight 
 exposure. There would be no objection to the wear- 
 ing of low-necked dresses, if ladies dressed habitually 
 in this manner. . The exposure lies in the change from 
 the high-necked to the low-necked costume. It would 
 be infinitely better and more sensible if society were 
 less rigorous in the enforcement of this law. As long, 
 however, as ladies are willing to submit to the de- 
 mands of society, they must assume the risk. I repeat 
 again, then, that as regards this question of clothing, 
 it should be always borne in mind that the object of 
 wearing clothes is simply to protect oneself from the 
 discomfort, or even sufEering, which one would expe- 
 rience if exposed to low temperature insufficiently 
 clad, and that in no way does the mere wearing of 
 clothes protect us from taking cold. It is only by the 
 proper regulation and harmonious and equable distri- 
 bution of our clothes over the body that we protect 
 ourselves from taking cold. By the wearing of exces- 
 sive clothing we contract a habit which is exceedingly 
 pernicious in its results in that, even in a moderate 
 temperature, we are compelled to wear unnecessarily 
 heavy clothing in order to be comfortable. The re- 
 sult of this is a peculiar susceptibility or liability to 
 take cold on very slight exposure. The deduction 
 
— 31 — 
 therefore is that, as far as clothing is concerned, we 
 aid ourselves immensely in the avoidance of a cold by 
 so regulating our clothing that we inure ourselves to 
 the wearing of but fn'odetately heavy clothes even in 
 the colder days of winter. Not only am I confident 
 that in this way we are less' liable to take cold, but 
 also that we are vastly more Comfortable in the end. 
 A person who is only comfortable in wiriter with thick 
 flannel underwear and .heavy topwear, is always shiv- 
 ering in a comparatively slight blast of cold air. On 
 the other hand, one 'who has inured himself to the 
 wearing of moderately thick under and topwear, will 
 face the coldest blast of midwinter not only without 
 suffering but with a sense of invigoration and exhila- 
 ration. I do not say, of course, that these rules are 
 of universal application. We cannot, of course, carry 
 them to this extent in the case of invalids or of young 
 children, or those in advanced life. 
 
 As regards the point made on a previous page as 
 to the wearing of woolen underwear, this rule, I think, 
 is of universal application both as regards the charac- 
 ter of the wear and the habit of wearing the same 
 thickness in summer and winter. In people in a'dvanced 
 life, however, the heat-prbdncing powers are some- 
 what feeble — the bodily functions are not carried on 
 with the vigor which characterizes middle age or 
 youth. Hence, old people will require warmer and 
 ' more clothing than young men or women. The same 
 must be said in regard to children, and yet even in 
 
— 32 — 
 
 these cases, as far as their years — whether advanced or 
 early— will permit, this hardening process as regards 
 clothing should always be borne in mind and carried 
 out to such an extent as wisdom and discretion permit. 
 With respect to those already enfeebled by disease, of 
 course no general law can be suggested. The regula- 
 tion of the clothing must be based entirely on the char- 
 acter and extent of the disease from which they suffer. 
 
 BATHING. 
 
 While I regard the proper regulation of clothing 
 as of great importance in enabling us to avoid taking 
 cold, I am disposed to think that the . proper use of 
 the bath in one of its various forms possesses even 
 greater value. I think it a somewhat prevalent im- 
 pression that the prominent use of the bath is for 
 cleanliness. This I regard as an entirely mistaken 
 view. Human beings are not filthy creatures as a 
 rule, at least to that extent as that a bath every day 
 is absolutely necessary for cleanliness. Furthermore, 
 the daily use of the bath as a cleansing agent is not 
 to be regarded as thereby a promoter of health. We 
 are often told that as the result of a bath the pores of 
 the skin are kept open, and thereby their functions 
 aided aud perhaps stimulated. By the pores of the 
 skin I suppose are meant the sweat glands. These 
 glands have but feeble tendency to become occluded, 
 and even when they do become occluded the result is 
 purely a local one, resulting in a mild form of skin 
 
— 33 — 
 eruption. So also in regard to the sebaceous follicles 
 by which the skin is lubricated. These perhaps be- 
 come occluded more frequently than do the sweat 
 glands; the result is merely a localized eruption. 
 Now, whether it be the sweat glands or sebaceous fol- 
 licles that are occluded it is but a trifling affair, and 
 does not, as a rule, react on the general system. I 
 do not believe, therefore, that the bath has any spe- 
 cial effect in keeping these pores, as they are called, 
 open, nor, even if it does do so, do I regard this as a 
 matter which requires any very special attention. 
 Nature herself takes care of this matter practically. 
 This idea of the pores of the skin having anything to 
 do with taking cold is the one which I desire to com- 
 bat. It is through the sweat glands, of course, that 
 perspiration takes place, and this is regulated by the 
 heat-producing nerve center, probably located in the 
 upper portion of the spinal cord. A cold is con- 
 tracted, as we halve tried to make clear before, by 
 some disturbance of equilibrium in that control of 
 heat-production throughout the body which is exer- 
 cised by this body-heat center in the medulla. Of 
 course, in exactly the same way, we repudiate the 
 popular idea that the pores of the skin are opened by 
 perspiration and that during perspiration we take 
 cold. The condition of the pores of the skin in this 
 case have probably very little to do with this matter. 
 Cold does not enter through these open pores; in fact, 
 the pores are not open, their calibre being practically 
 
 3 ss 
 
— 34 — 
 the same at all times. The daily use of a bath, if we 
 regard it as purely for cleansing purposes, is entirely 
 an aesthetic matter. If one goes for seveiral days 
 without a bath, there is a certain accumulation of 
 effete material on the surface of the body which is ill- 
 smelling and offensive. We remove this by the bath 
 because it is offensive, and not because health de- 
 mands that it be removed. I do not mean to say 
 that there may not be some deleterious effect from 
 allowing this matter to remain in contact with the skin; 
 but, if this is true, it is of a somewhat trivial charac- 
 ter. Furthermore, that this effete matter which accu- 
 mulates on the surface of the skin may to an extent 
 hamper the process of perspiration, whereby the ani- 
 mal heat of the whole body is nicely adjusted and 
 kept at an absolutely fixed standard in health, I do 
 not deny. My main point here is that the effect of 
 this is, to a large extent, over-estimated. I think we 
 attain a far better conception of the true value of the 
 bath in regarding it as a stimulant and invigorant to 
 the whole system. Its primary action is to stimulate 
 the circulation of blood in the skin, and here lies its 
 direct action upon the respiratory function which is 
 not aided by keeping the pores of the skin open, but 
 is notably aided when we aid and stimulate the circu- 
 lation of blood through the cutaneous tissues, for, of 
 course, perspiration cannot be active unless the blood 
 circulation is active. In other words, the perspiration 
 does not depend in any way upon the permeability of 
 
— 35 — 
 the sweat glands, but upon the activity of the capil- 
 lary circulation in the periphery of the bulbous portion 
 of the sweat glands. It also stimulates the circula- 
 tion throughout the whole body, adding strength and 
 vigor to the entire system. Furthermore, the best ac- 
 tion of the bath does not lie in the cleansing qualities 
 of the water so much as in its temperature. In other 
 words, the best action of a bath is obtained in the 
 cold bath. A warm bath at the temperature of the 
 body, I believe to be of no practical value. Many 
 individuals are almost morbid on the subject of clean- 
 liness, and take daily a warm bath and rub the skin 
 with soap and water. This performance simply satis- 
 fies morbid scruples, and practically accomplishes 
 little more. To lie in a tub of warm water at the 
 temperature of the body of a cold morning is rather 
 an agreeable sensation, perhaps, and many of us are 
 tempted to indulge in it, but I think it is a rare excep- 
 tion that one does not emerge from it with a sense of 
 feebleness and relaxtion, and perhaps depression, 
 which may continue even for several hours. On the 
 contrary, after a cold bath, the feeling of refreshment 
 and invigoration constitutes a sensation of a totally 
 different character —one's vital powers are stimulated, 
 the circulation is active, there is a sense of warmth 
 and comfort diffused throughout the body with the 
 reaction which follows the cold, and a general tonic 
 effect is produced which remains for hours, perhaps, 
 after the bath has been taken. I am confident, then, 
 
- 36- 
 
 that in the use of the cold bath, we possess a measure of 
 'the greatest possible value to us in enabling us to avoid 
 taking cold in our temperate climate, characterized as 
 it is by such marked and great seasonal, and even diur- 
 nal, changes in temperature and humidity. Of course, 
 it is not every one that can take a cold bath daily. 
 For those who can, this should be enjoined as a hy- 
 gienic measure where there is any liability to taking 
 cold or a tendency to catarrhal .or bronchial disorders. 
 Undoubtedly the best method of taking a cold 
 bath is to lie down in a tub of cold water and sponge 
 freely over the head, neck and shoulders from one tO' 
 three minutes according to circumstances, the tem- 
 perature of the water being as it comes from the hy- 
 drant. This measure should be carried out summer 
 and winter, without reference to season. No law can 
 be laid down applicable to every individual; nor do 1 
 think, as a rule, that physicians are competent to give 
 other than general directions. In these matters every 
 individual is a law unto himself. If a cold bath is 
 followed by a feeling of depression with sluggish cir- 
 culation, chilly sensations, etc.; in other words, if the 
 bath is not followed by prompt reaction characterized 
 by warmth and vigor, it is a pretty clear that a cold 
 bath cannot be endured in this individual case. If, 
 on the other hand, the reaction is prompt on emerg- 
 ing from the bath, the indications are perfectly clear 
 that it does good. Of course, on emerging from the 
 bath one should undergo a vigorous rubbing with a 
 
— 37 — 
 coarse towel, until the skin is sufficiently dry to throw 
 a robe over the body — the exercise attendant upon 
 this rubbing adding very much to the promptness 
 with which the reaction sets in. A shower bath, I 
 think, differs in no special way from the tub bath, un- 
 less perhaps in creating a more notable primary shock. 
 As a rule, I think the tub bath should be preferred. 
 Where the tub bath is inadmissible on account of the 
 failure of a prompt reaction, a cold sponge-bath 
 should be enjoined. This may be taken at night or 
 in the morning, according to choice. As a rule, the 
 use of the bath in the morning after a night's sleep is 
 more invigorating, and proves an agreeable prepara- 
 tion for the day's work. In regard to the warm bath, 
 if one desires to make use of such, its ill effects, of 
 course, may be counteracted by dashing cold water 
 ■over the body on emerging from it, practically convert- 
 ing it into a cold bath of short duration. Occasionally, 
 where I have wanted to obtain the good effects of a 
 cold bath, in the case of delicate individuals, I have 
 ■directed them to use the cold sponge above the waist 
 in the morning and below the waist in the evening, 
 and, if necessary, to moderate the temperature of the 
 water from the hydrant by the addition of a little 
 warm water, merely taking the chill from it. 
 
 Surf bathing enjoys considerable repute as a 
 liealthful measure. Many attribute^ this, ignorantly I 
 think, to the action of the salt in the sea water, and 
 we find in our drug stores various preparations of salt 
 
~38- 
 on sale and recommended for converting the ordinary 
 water supply into an artificial sea water, and at our 
 seaside resorts sea water is introduced into the hotels- 
 through pipes, or is carried up in large vessels, in or- 
 der to give the guests the benefit of a salt water bath 
 in their chambers. I do not believe that sea water 
 possesses any special virtues for bathing purposes. 
 On the contrary, I think it rather objectionable on ac- 
 count of its saline qualities from a purely sesthetical 
 point of view. In other words, I do not think that 
 sea water is as agreeable to the skin as the ordinary 
 domestic water supply in the house. The real virtue 
 of a surf bath lies perhaps, to no small extent, in the 
 temperature of the water; but its great value lies in 
 the vigorous exercise to which one is subjected wh» 
 goes into the sujrf. Except in an unusually quiet sea, 
 one is in a constant state of exercise when in the surf, 
 either to avoid the breakers or to maintain one's equi- 
 librium, the result of which is that the circulation is- 
 stimulated to. an unusual activity, animal heat is manu- 
 factured with greater rapidity and any untoward effect 
 of the cold is obviated. The temperature also, I 
 think, has a notable effect, in that it is a number of 
 degrees lower than the still water of our rivers or 
 bays which are used for bathing purposes during the 
 summer months, and therefore renders the bath more 
 stimulating and invigorating. 
 
 The daily use of a cold bath is, of course, not 
 available to all. In old age and in infancy and early 
 
— 39 — 
 childhood the vigor of the system is, perhaps, not 
 equal to a cold plunge. Still, in these cases I think 
 we should, as far as possible, make use of the benefi- 
 cial effect of cold water where there is any liability to 
 cold or a tendency toward catarrhal troubles. If the 
 cold plunge is not available, the cold sponge should 
 be used, modifying the temperature of the water of 
 the bath until its use is attended with no unpleasant 
 symptoms, but is used rather with good effect. 
 
 The Turkish bath is indulged in not only as a 
 luxury but as a hygienic measure. That it is a luxury 
 I think few who have enjoyed its allurements will 
 question. That it is a hygienic measure, I think is 
 open to serious question. The procedure is to place 
 a patient from ten to thirty minutes in a room whose 
 temperature is from i6o° to 185", or even more, 
 whereby a profuse perspiratian is produced. After 
 this the patient is taken into an outer room, laid on a 
 marble slab and scrubbed with soap and water sup- 
 posed to be about the temperature of the body, after 
 which he is put under a shower or into a cold plunge 
 until the body becomes thoroughly cooled. There is 
 no objection to a man's spending ten minutes or a 
 half hour even in a room with a temperature of 180°, 
 and yet when we come to look at it seriously, it seems 
 rather an absurd thing to do. The object of this is 
 to open the pores of the skin — to flush the sweat 
 glands, as it were. The next step, however, of 
 placing a patient in this abnormally heated condition 
 
— 40 — 
 
 on a marble slab in a room at a temperatuje of 70°, 
 and scrub him by detail with the water at a tempera- 
 ture of 80°, is something of a risk, for after such a 
 profuse perspiration one is liable to take cold. The 
 whole body being wet, evaporation takes place rap- 
 idly, and a little chill is experienced in one portion or 
 another of the surface. The scrubbing process gene- 
 rally lasts about fifteen minutes. A man in perfect 
 health goes through this' rubbing and scrubbing with 
 impunity, and he is perhaps the better for it. Unless, 
 however, a man is in robust health, I think the Turk- 
 ish bath is something of a risk. Certainly to take a 
 Turkish bath in order to break up a cold, is almost 
 unvariably an unwise procedure. The effect of it 
 usually is to aggravate rather than to benefit the cold. 
 While, therefore, not intending to condemn the Turk- 
 ish bath in all cases, I think we should stop and ques- 
 tion the wisdom of its use in each individual instance. 
 It should never be prescribed for the breaking up of 
 a cold, and it should rarely be made use of except by 
 individuals in a fairly vigorous state of health. As a 
 preventive measure to break up the habit of taking 
 cold, I am disposed to think its use is of limited value. 
 
 EXERCISE. 
 
 It is scarcely necessary to say that all individuals 
 should take a certain amount of exercise every day, 
 for its effect in toning up the whole system and stimu- 
 lating the various functions of the body into a healthy 
 
— 41 — 
 State of activity. This may be indoor or outdoor ex- 
 ercise. I have no disposition to enter here upon a 
 discussion of the advantages of gymnastics, whether 
 of the home variety, with dumb-bells and rubber 
 straps, etc., or that in the regular gymnasium, as these 
 have no special direct bearing on the prevention of a 
 cold. A certain amount of outdoor exercise every 
 day, I think, adds very much to the general tone of 
 the body, and aids notably in our endeavors to correct 
 the habit of taking cold. This may be done by walk- 
 ing, horseback riding, or in other forms. The only 
 question for discussion here is that of the kind of 
 weather in which one should go out of doors. This, 
 perhaps, has no special bearing on exercise, and yet I 
 think it is one on which there are many mistaken ideas 
 prevalent. I regard it as a wise and safe rule to take 
 a certain amount of exercise every day, and that this 
 should be done in the open air if possible. The im- 
 portant point, and the one on which I would lay spe- 
 cial emphasis here, is that the condition of the outdoor 
 weather should not have a great degree of influence 
 upon us. Many people are accustomed to confine 
 themselves closely to the house when the east wind 
 blows, or when the weather is damp or rainy. This, 
 I think, is unwise. It is a very simple thing to pro- 
 tect oneself from any ill effects that can be experienced 
 from an east wind or from rain. The same also should 
 be said of night air. It is a popular impression that 
 night air is irritating. Night air is the only air there 
 
— 42 — 
 
 is to breathe at night, and there is nothing in night air 
 that is in the slightest degree irritating to the air pas- 
 sages. Night air contains a considerable amount of 
 moisture. Now, when the air is moist and in motion, 
 we have conditions favorable for taking cold — a point 
 which has been fully discussed in a previous page. 
 We take cold, therefore, more easily in a damp night 
 air than in a dry mid-day atmosphere; but there is no 
 reason why we should take cold if we understand how 
 we take cold, and therefore how to avoid it. If prop- 
 erly clad and properly protected, therefore, there is 
 no more objection to going out in the night air than 
 in the day time. I emphasize again, therefore, that 
 this popular prejudice against night air is based on a 
 wrong impression. It is not the night air that is inju- 
 rious or that is irritating to the air passages, but it is 
 the peculiar condition of the air, moisture-laden and 
 of a lower temperature than during the day, which 
 presents conditions under which one may take cold if 
 not wisely fortified against it. 
 
 I think it will be understood, from what has been 
 said before, that the measures already discussed in 
 regard to clothing, bathing, etc., constitute methods 
 by which we fortify ourselves against any bad effects 
 of night air. In other words, we get ourselves into 
 such a condition that we go out at night with impu- 
 nity. Furthermore, one method by which we become 
 susceptible to cold is by remaining indoors whenever 
 the weather is in any degree unfavorable— in other 
 words, by coddling. 
 
— 43 — 
 The point which we have endeavored to make in 
 regard to clothing is, that it should in no wise hamper 
 the prominent function of the skin, viz., that of regu- 
 lating the animal heat of the body by means of perspi- 
 ration. Keeping this in mind, we can easily appreciate 
 why a sealskin, or in fact the skin of any animal, being 
 almost absolutely impervious, furnishes a covering for 
 the human body which is exceedingly liable to be 
 mischievous in this direction. Of course, in certain 
 portions of our country where, during the winter, the 
 temperature ranges in the neighborhood of zero and 
 below, furs become essential, in that when one ven- 
 tures out of doors during the prevalence of cold 
 weather, the sole object of clothing is to retain animal 
 heat, and no condition exists in which heat-radiation 
 becomes necessary; hence, no function of this charac- 
 ter is hampered. In the temperate zones, however, I 
 am confident that the wearing of furs is capable of 
 doing much mischief. 
 
 TREATMENT OF A COLD. 
 
 Recognizing the fact that an exposure to cold re- 
 sults both in a local inflammatory process and a gene- 
 ral systemic condition, our measures of treatment, 
 necessarily, must be directed to both. In many in- 
 stances, undoubtedly, a cold can be broken up, or 
 aborted, as we call it, at its onset. The period 
 during which this can be accomplished usually is from 
 twenty-four to thirty-six hours after the exposure. 
 
— 44 — 
 Hence, measures for the accomplishment of this 
 should always be instituted, if opportunity presents, in 
 preference to local measures of treatment. 
 
 THE ABORTION OF A COLD. 
 
 This procedure practically consists in the use of 
 remedies which act upon the general system. The 
 first effect of a cold, as we have already learned, is in 
 a disturbance of the equilibrium of heat-production 
 throughout the body; this being arrested, as we un- 
 derstand it, in only a portion of the economy. In 
 general, then, our first effort in aborting a cold will 
 be to restore, as far as possible, this animal heat. 
 Perhaps no better method of accomplishing this pre- 
 sents to us than the resort to hot drinks, together 
 with the hot foot-bath; in other words, the use of 
 heat both internally and externally. There probably 
 is no special virtue in any of the usual decoctions of 
 hot tea prescribed, although, as a matter of routine, 
 perhaps, we give chamomile tea as hot as can com- 
 fortably be borne, in which, possibly, two or three 
 tablespoonfuls or more of whiskey is added. A far 
 more palatable drink is the hot toddy or hot whiskey 
 punch. The external application of heat is accom- 
 plished by the immersion of the feet in hot water, 
 while the body is well covered by blankets. I think 
 the hot foot-bath, in all cases, is preferable to immers- 
 ing the whole body in a bath, in that there is less lia- 
 bility to chill the skin on emerging from the bath. A 
 
— 45 — 
 steam bath answers an excellent purpose, although, 
 perhaps, not as good as the small foot-bath. A very 
 convenient method of administering a steam bath is 
 to place a patient in a chair and invest him thor- 
 oughly with blankets, extending to the floor, thus cov- 
 ering his whole body. Beneath the chair, a cup of 
 boiling water is placed over a lighted spirit lamp. 
 The steam which escapes is necessarily confined by 
 the blankets thrown over the patient, the result being 
 the inducement, very soon, of a somewhat copious 
 perspiration. The apparent object of the hot drinks 
 and foot-bath are the production of more or less pro- 
 fuse perspiration. This is not really the object to be 
 accomplished, so much as the evidence that it has 
 been accomplished — the real object being the restora- 
 tion of the equilibrium of heat-production throughont 
 the whole body. 
 
 In addition to the diaphoresis, we possess two 
 remedies which, I think, have a notable influence on 
 the general condition which results from taking cold. 
 These are quinine and opium. What the action of 
 these drugs is I do not propose to discuss at length. 
 Probably the quinine acts as a nerve stimulant and 
 tonic, while the opium acts somewhat as a stimulant 
 and sedative, apparently somewhat contradictory ef- 
 fects, although in the end the results are most happy. 
 
 In connection, then, with our hot drinks and 
 foot-bath, we administer lo to 15 grs. of quinine with 
 the physiological dose of opium. This, I think, is 
 
- 46 - 
 
 best administered in the form of the Dover's powder, 
 lo grs. of which should be taken in connection with 
 the quinine. When the diaphoresis has been thor- 
 oughly established, the patient should be vigorously 
 rubbed with a warm towel until the skin is not only 
 dry but in a comfortable glow, and then placed in bed. 
 The action of the bath and the opiates tend to pro- 
 duce a quiet sleep. It is not desirable, after retiring 
 to bed, that the diaphoresis should continue, although 
 it is not easy always to avoid it. The mistake cer- 
 tainly should not be made, after retiring, of covering 
 the body too heavily with bed-clothing, thus produc- 
 ing additional perspiration. After the diaphoresis 
 which results from the foot-bath has been accom- 
 plished, nothing further can be done in this direction, 
 for, as we understand it, the sweating is to be accepted 
 as evidence that the equilibrium of heat- production is 
 restored. Hence, after the body has been rubbed dry, 
 the patient may be allowed to sit up for ten or fifteen 
 minutes, or even longer, until something of a cooling 
 process has taken place; for, as we have repeated so 
 frequently in previous pages, a cold results from the 
 exposure of a portion of the body, and not the whole 
 body. I think it altogether possible that, after a pro- 
 fuse perspiration, one might stand in a state of abso- 
 lute nudity without contracting a fresh cold, even for 
 a considerable length of time, especially if the body 
 during this time is being vigorously rubbed. After 
 this his covering need be nothing more than is de- 
 manded by absolute comfort. 
 
— 47 — 
 
 In connection with the above measures, it is al- 
 ways well to administer a laxative. For this purpose 
 I know of nothing better than lo grs. of calomel or 
 blue mass, to be followed in the morning by a seidlitz 
 powder or a glass of bitter water. It seems to be a 
 somewhat popular idea that one is specially liable to 
 take cold after taking a mercurial laxative. I cer- 
 tainly never have seen any justification for this idea; 
 indeed, for years it has been my practice, not only in 
 the effort to abort a cold but even in the treatment of 
 the later stages of the results of an exposure, to ad- 
 minister a mercurial laxative in preference to any 
 other, its action on the liver seeming to have a very 
 beneficial effect, not only on the general systemic con- 
 dition which accompanies the cold, but also on the 
 local morbid process which results from it. 
 
 If these measures have been inaugurated suffi- 
 ciently early and properly carried out, the result will 
 be that the patient will waken on the following morn- 
 ing, after a somewhat refreshing sleep, more or less 
 completely relieved of any evidences of the attack. 
 Even if the cold has not been completely aborted, I 
 am confident that the local morbid process, in the 
 majority of instances, will be very markedly amelio- 
 rated. 
 
 If it is found on the following morning that the 
 remedies have acted favorably, there seems no reason 
 why the patient should not get up and go about his 
 ordinary avocations. The habit of confining a patient 
 
— 48 — 
 
 to bed, or to the house, for one or two days or longer, 
 I think is of doubtful benefit, although this is still a 
 very common practice among physicians. Of course, 
 we speak now simply of those colds which develop in 
 an ordinary acute catarrhal inflammation of some por- 
 tion of the upper air-tract, such as a cold in the head, 
 a pharyngitis or a laryngitis. 
 
 While, then, I think we are safe in directing our 
 patients to get up and go about, it is altogether wiser 
 that for at least the following five or six days they 
 should be put under the use of internal medication. 
 For this purpose nothing is better, perhaps, than qui- 
 nine in 2 or 3-grain doses, administered three times 
 daily. Where quinine is not tolerated, we give from 
 3 to lo grs. of salicine three times a day. 
 
 I have made the assertion that the abortive treat- 
 ment of a cold may not be notably successful after 
 thirty-six hours following its onset, and yet, even if 
 measures of treatment are not instituted until even 
 the second day, or later, I think oftentimes very much 
 can be accomplished by carrying out the plan of treat- 
 ment outlined above, not perhaps with any hope of 
 breaking up the attack, but with the confident expec- 
 tation of ameliorating the severity of its symptoms in 
 a marked degree. Hence, if the severity of a cold 
 warrants subjecting the patient to such procedure, 
 this should always be done as early as possible. 
 
 As regards the use of the Turkish bath for the 
 breaking up of a cold, I have already expressed my- 
 
— 49 — 
 self somewhat fully on that subject. What was said 
 there, I simply repeat here. It is an exceedingly un- 
 wise and somewhat venturesome experiment, and one 
 which probably, in the majority of cases, will result in 
 aggravating the symptoms rather than in alleviating 
 them. 
 
 LOCAL TREATMENT OF A COLD. 
 
 Failing to abort the cold, or to arrest the devel- 
 opment of the local inflammatory process, subsequent 
 measures must be directed toward the treatment of 
 such local lesion as may have resulted from the expos- 
 ure. Of these, undoubtedly by far the most freqnent 
 is cold in the head. Following this, somewhat in the 
 order of frequency, are the affections of the air-pas- 
 sages below, viz., an inflammation of the mucous 
 membrane lining the vault of the pharynx, or an 
 acute , naso-pharyngitis, an acute pharyngitis, sub- 
 acute tonsillitis, acute laryngitis, acute tracheitis, 
 acute tonsillitis or quinsy. The above are practically 
 all catarrhal inflammations, viz., an inflammation 
 characterized by hypersemia and hypersecretion, in 
 which the secretion is of a purely fluid mucus or muco- 
 pus. 
 
 In addition to the above, we might state here 
 that we very frequently meet with sore throats which 
 are apparently the result of taking cold, and which 
 are regarded by many physicians even as caused by 
 an exposure to cold, and yet I question very seriously 
 
— 5° — 
 whether an exposure has any causative relation what- 
 ever to the attack. I refer to what is ordinarily de- 
 signated as an acute follicular tonsillitis, in which the 
 prominent morbid lesion consists of a fibrinous exuda- 
 tion in the crypts of the tonsils. This disease, I am 
 confident, belongs to that class of affections which are 
 due to a specific poison. It results from the deposit 
 on the mucous membrane of a specific germ, which 
 excites a local inflammatory process at its point of 
 lodgment, while at the same time the germ makes its 
 way into the general circulation, giving rise to a fe- 
 brile movement, something in the nature of one of the 
 exanthematous fevers. The same, I think, is un- 
 doubtedly true of a croupous tonsillitis, or pharyn- 
 gitis, the ordinary membranous sore throat, and 
 croupous laryngitis, true croup. I think we should 
 embrace croupous pneumonia in the same category. 
 In other words, I believe, as regards the air-passages, 
 that any local inflammatory process which results 
 simply from an exposure to cold gives rise to a catar- 
 rhal inflammation, and nothing more; and, further- 
 more, that this catarrhal inflammation is attended by 
 a degree of fever which is purely symptomatic of the 
 extent of the morbid local lesion. Where we have to 
 do with a croupous exudation or a false membrane, in 
 any form, whether in a true croup or croupous laryn- 
 gitis, or in an acute follicular tonsillitis, or in a croup- 
 ous pneumonia, we have to deal with a systemic dis- 
 ease, attended with a characteristic local lesion, this 
 characteristic consisting of a fibrinous exudation. 
 
— SI — 
 
 Any discussion, then, of the treatment of those 
 local diseases which result from taking cold, is com- 
 pleted in the discussion of the catarrhal inflammations 
 affecting the upper air-tract. We therefore confine 
 ourselves to these disorders. Unquestionably an expos- 
 ure may result in an attack of inflammation involving 
 the eye, stomach, muscles, bladder, etc. This branch 
 of the subject, however, is not so clearly associated 
 with exposure to cold in ordinary practice, in that, in 
 the very large majority of instances, undoubtedly, the 
 manifestation of a cold in this region consists merely 
 in an exacerbation of a chronic condition. 
 
 Returning now, then, to the diseases of the upper 
 air-passages, we simply present the prominent feat- 
 ures of the treatment of these, in the order in which 
 they have been enumerated above: 
 
 Acute Rhinitis. — It is not often that a patient re- 
 gards a cold in the head as of sufficiently serious char- 
 acter to warrant his placing himself in a physician's 
 care; hence, the doctor's duty usually is completed in 
 giving certain general directions and prescribing cer- 
 tain local measures, to be carried out in the hands of 
 the patient himself. This disease manifests itself in 
 practically three stages. In the first stage, the mu- 
 cous membrane lining the nasal cavity is enormously 
 swollen, distended with blood, while its secretory 
 function is for the time being arrested — the membrane 
 is in a state of what is called inflammatory stasis. 
 This lasts for a few hours, or may be protracted for 
 
— 52 — 
 perhaps a day, when it is followed by a profuse secre- 
 tion of watery serum, which , pours out from the nos- 
 trils in large quantities, trickling down upon the upper 
 lip. This lasts from one to two days, and is followed 
 by a slowly developing muco-purulent discharge, the 
 serum being surcharged with mucus corpuscles to such 
 an extent as to render it somewhat opaque; and fin- 
 ally, at the end of four or five days, it becomes a 
 bright yellow, thick muco-pus. The subjective symp- 
 toms accompanying this development of the local le- 
 sion consist mainly of nasal stenosis, with frontal head- 
 ache, and pain referable to the root of the nose, water 
 in the eyes, intolerance of light, and that train of 
 symptoms which is quite familiar to us all. 
 
 The first or dry stage, lasting but twenty-four 
 hours at most, belongs to the stage of the disease 
 when abortive treatment is most successful. The lo- 
 cal measures of treatment are generally called for after 
 the secretion has set in. For the relief of this, many 
 drugs have been recommended and many plans of 
 treatment suggested. I have little faith in the ordi- 
 nary local astringent applications in^this affection. I 
 have never seen any good accomplished by such local 
 remedies as tannin, sulphate of zinc, sulphate of cop- 
 per, nitrate of silver, or that class of drugs, whether 
 in weak or strong solutions. The apparent object of 
 each of these remedies is to control secretion. Now, 
 in a cold in the head, the primary morbid lesion con- 
 sists in a dilatation of the blood-vessels of the venous 
 
— S3 — 
 sinuses which make up the turbinated bodies. When 
 these blood-vessels are enormously distended, hyper- 
 secretion is the necessary result. The only way by 
 which a secretion possibly can be arrested, lies in the 
 reduction of the venous hypersemia. Our remedies 
 which are capable of acting in this manner are com- 
 paratively few. Cocaine possesses the power of abso- 
 lutely emptying the blood-vessels of the mucous niem- 
 brane. Unfortunately, however, this action of cocaine 
 persists only for about two or three hours, when the 
 ■distension recurs again. In ordinary cases I have not 
 much hesitation in making use of this drug, although 
 it should be borne in mind that cocaine has a peculiar 
 stimulating and semi-inebriating eifect on the general 
 system, and is not always well borne by patients. In 
 addition to this, it is undoubtedly true that many pa- 
 tients contract the habit of using cocaine somewhat 
 ■carelessly, in order to obtain this stimulation. Whereas 
 I do not regard cocaine as in any way as dangerous a 
 ■drug as opium, as regards the contraction of any co- 
 caine habit, yet I think no physician is warranted in 
 prescribing it without bearing in mind the fact that, 
 in many instances, its habitual use is attended with 
 most unfortunate results, and that, by a simple pre- 
 scription for a cold in the head, a patient may get into 
 3. somewhat mischievous and even deleterious habit. 
 In prescribing cocaine, then, we prescribe it guard- 
 ■edly and, furthermore, in somewhat small doses. I 
 have known a solution of 2 grs. to the ounce, and even 
 
— 54 — 
 less, to have an excellent effect in relieving a patient 
 of the ordinary distressing symptoms of a cold in the 
 head, whereas certainly a solution of this strength can 
 scarcely be charged with producing any constitutional 
 effect. Unfortunately, these weak solutions are not 
 effective in all cases. I think, however, we are justi- 
 fied in prescribing a i per cent, solution of cocaine, 
 to be applied in a small cologne atomizer every two- 
 hours or more, according to the symptoms. This 
 may be given in watery solution or, what is better 
 still, suspended in fluid cosmoline or the voschano oil, 
 which is an exceedingly agreeable application to the 
 nasal mucous membrane. Schieffelin & Co. have re- 
 cently placed upon the market an exceedingly nice 
 preparation of fluid cosmoline containing benzoine, 
 which comes under the name of Benzoinol, of which 
 I have made • frequent use in place of the voschano 
 oil. Cocaine is not soluble in these petroleum oils, 
 but a suspension is easily made by first dissolving the 
 cocaine in a small amount of water and then adding- 
 the oil. 
 
 The use of some form of opium locally applied 
 to the nose is attended with excellent results often- 
 times, not perhaps in controlling inflammatory action, 
 so much as in the allaying of pain and control- 
 ling, to an extent, the annoying irritation which, 
 exists in the upper parts of the nasal cavity. Fol- 
 lowing out this view we may, I think, safely prescribe 
 as follows: 
 
— 55 — 
 
 B Cocainae muriatis grs. x. 
 
 Morphinae ". " v to x. 
 
 _ Aquffi 5 J- 
 
 M. Sig. — Use with atomizer every 3 hours. 
 
 As before stated, the fluid cosmoline or benzoinol may 
 be substituted for the ounce of water in the above 
 prescription, in which case it will be necessary to use 
 the Burgess or Magic atomizer for the application. 
 In lieu of an atomizer, the above fluids can be applied 
 to the nose by an ordinary dropper and drawn in by 
 insufflation. 
 
 It is sometimes more convenient to prescribe 
 these remedies in the form of a powder, in which case 
 we may give as follows: 
 
 3 Cocainae hydrochloratis grs v. 
 
 Pulv. magnesiae § ss. 
 
 to which may be added, if advisable, a grain of mor- 
 phine. 
 
 Those drugs which belong to the mint series 
 seem to have a notably agreeable action on the in- 
 flamed mucous membrane of the nose. Just what 
 this action is, I am by no means certain. These may 
 be given in the form of a snuff, as follows: 
 
 9 Menthol, pulv grs. ij. 
 
 Bismuth sub. carb 3 j. 
 
 Saccharae albae 3 iss. 
 
 Camphor is a remedy which of late years has come 
 much into vogue in these disorders, and undoubtedly 
 
-56- 
 
 has an excellent effect, and may be added to either of 
 the, above prescriptions for snuffs, in the proportion of 
 2 grs. to the ounce. 
 
 There are certain remedies which are useful in 
 the form of inhalations, such as acetic acid, ammo- 
 nia, iodine, etc. Patients always find their use agree- 
 able, both on account of the relief experienced, and 
 the facility with which they are applied. A popular 
 German remedy, known as Hager's, is as follows: 
 
 5 Carbolic acid i pint. 
 
 Strong alcohol 3 pints. 
 
 Caustic ammonia i pint. 
 
 Distilled water 2 pints. 
 
 M. 
 
 This is placed in an open-mouthed bottle, and the 
 fumes inhaled through the nose. An old-fashioned 
 domestic remedy consists in the placing upon a stove 
 of a cup containing equal parts of vinegar and water, 
 the fumes of. which are driven off by the heat and 
 pervade the room in which the patient sits. Based 
 somewhat on this method is the remedy recommended 
 by Fritsche, as follows: 
 
 ^ Acidi acetici glacialis 
 
 Acidi carbolici aa grs. ij. 
 
 Mist, oleo-balsamic " viij. 
 
 Tinct moschi. '" i. 
 
 M. 
 
 This is a somewhat dainty little prescription, which 
 can be placed in a lady's vinaigrette for inhalation. 
 
— 57 — 
 
 The above methods of local relief afford us meas- 
 ures by which much can be attained in the way of 
 ameliorating the attack, and, used in connection with 
 the internal medication suggested before, we may re- 
 move very much of the discomfort which accompanies 
 the inflammatory process; and yet it must be under- 
 stood that they are not directly curative. 
 
 I know of but one measure that is unfailing in 
 the arrest of an attack of acute rhinitis, and that con- 
 sists in a very simple plan of local treatment, which is 
 to be carried out by a physician only. A ten or twenty 
 per cent, solution of cocaine if sprayed into the nasal 
 cavities, the parts being watched carefully, and a suf- 
 ficient time allowed to elapse until the membrane is 
 not only completely anaesthetised, but also completely 
 exsanguinated. This is recognized by ocular inspec- 
 tion and by means of the probe, which should be 
 passed over the membrane to test not only its sensi- 
 bility but the extent to which the blood has been ex- 
 pelled. When this is accomplished, it will make itself 
 evident by the appearance of the mucous membrane, 
 in a pale pinkish . tinge, clinging closely to the turbi- 
 nated bones beneath. When this condition has been 
 obtained, the membrane is to be carefully wiped off 
 repeatedly by means of pledgets of cotton until it is 
 absolutely dry on portion covering the anterior pro- 
 jection of the lower turbinated bone. When the 
 membrane is thoroughly dry, a few crystals of chromic 
 acid are to be fused on the end of a small probe, after 
 
-58- 
 
 which the superficial portion of the mucous mem- 
 brane, covering the prominent area t)ver the lower 
 turbinated bone, is cauterized in a small, rounded 
 disk from one-quarter to one-third of an inch in diam- 
 eter. The action of the chromic acid is to coagulate 
 the albumen in the superficial layers of the mucous 
 membrane, thus changing the soft, yielding and elas- 
 tic membrane on that portion, into a hard inelastic 
 slough. What is accomplished now is, that the blood 
 having been expelled from the membrane, the local 
 conditions which constituted inflammation have been 
 eliminated. The return of the blood to the part is 
 prevented by thus rendering the superficial layer of 
 mucous membrane inelastic by chromic acid. The 
 effect of this slight, superficial cauterization of a lim- 
 ited portion of the area of the membrane covering 
 the lower turbinated bone is to diminish the blood 
 circulation in the whole of the membrane covering 
 the lower turbinated body. This little operation may 
 be. done on one side or both at the same sitting, 
 although I think, as a rule, it is preferable that a few 
 hours certainly should elapse, or better twenty-four, 
 when, if necessary, the operation may be repeated on 
 the other side. I have repeated this procedure in 
 such a very large nnmber of cases with perfect suc- 
 cess, that I do not hesitate to describe it as by far the 
 most successful means that we possess for arresting 
 the local lesion of an ordinary cold in the head. This 
 procedure, furthermore, explains the action of caus- 
 
— 59 — 
 tics in the nasal mucous membrane in an exceedingly 
 interesting way. It is a somewhat popular impression 
 that a morbid lesion in the nasal cavities presents 
 some form of diseased membrane which requires de- 
 struction. I know of no inflammatory condition in 
 the nasal mucous membrane which requires destruc- 
 tion, or in which destruction of tissue is in any way 
 indicated. The action of caustic is beneficial, then, 
 not as a destructive agent but as directly controlling 
 the circulation and thereby controlling the inflamma- 
 tory process. 
 
 I might add, at this point, in regard to the treat- 
 ment of a cold in the head, that we possess a remedy 
 of undoubted efficacy in heat, which oftentimes will 
 succeed in giving not only marked relief but even in 
 curing an attack of cold in the head. One way in 
 which this can be applied is by means of the hot wa- 
 ter pack laid across the forehead and bridge of the 
 nose, remaining in contact with the integument until 
 the local symptoms disappear. Perhaps a more effi- 
 cient method of making use of heat is in the form of 
 the ordinary nasal douche, a current of water, as hot 
 as can be borne, being passed through the nasal cavi- 
 ties, entering one nostril and escaping from the other. 
 In this way, the passing of one or two quarts, or even 
 a gallon, of hot water once or twice a day, will tone 
 up the blood-vessels to such an extent as that the 
 hyperaemia may be markedly relieved. 
 
 These procedures are mentioned only as meas- 
 
— 6o — 
 
 ures at our command for the relief of a cold in the 
 head, although I know of nothing so sure in its action 
 and as prompt as the cauterization described above. 
 The chromic acid is specifically mentioned as afford- 
 ing a cauterizing agent superior to any other within 
 my knowledge, in that it is unirritating, easily con- 
 trolled, and produces a superficial slough, which re- 
 mains in contact with the mucous membrane without 
 irritating it. On the contrary, it protects it really, 
 until the parts beneath it have been so far renewed as 
 to tolerate the expulsion of the slough. When the 
 slough coming away at the end of two or three days, 
 it practically leaves a healthy membrane beneath it. 
 
 Acute Pharyngiti^s, — This is a name usually given to 
 an ordinary catarrhal sore throat, and consists in an 
 inflammation of the mucous membrane, not only of 
 the pharynx, but also of the soft palate and uvula. 
 The tonsils are liable to be the seat of notable swell- 
 ing at the same time. This affection is not ordinarily 
 of a very serious nature, and yields readily to mild 
 remedies, such as a gargle of a weak solution of alum, 
 borax, chlorate of potash, tannin, etc. A very nice 
 way of using the chlorate of potash in an attack of 
 this sort is in the folloiwng prescription: 
 
 9 Chlorate of potash gr. xxjc. 
 
 Pul V acaciae 
 
 Sacch. alb aa | ss. 
 
 A small portion of , this is to be taken on the tongue 
 and allowed to melt in the mouth. In the act of de- 
 
— 6i — 
 
 glutition it is distributed over and comes thoroughly 
 in contact with the parts. It should be borne in mind 
 that the pharynx belongs properly to the food tract, 
 and a diseased condition in this region is frequently 
 associated with disturbance of the digestive appara- 
 tus. Hence, it is well to direct the patient to take for 
 a few days a small dose of bitter water before break- 
 fast each morning, to produce a slightly laxative effect 
 on the bowels. Painting the parts with a lo-gr. solu- 
 tion of nitrate of silver, or tannin and glycerine, is 
 always attended with good results. 
 
 Acute ISfaso-pharyngitis. — This is an acute inflam- 
 mation of the mucous membrane lining the vault of 
 the pharynx. It is ordinarily regarded as a form of 
 cold in the head, and I think a mistake is not infre- 
 quently made in failing to make a differential diagno- 
 nosis between an acute naso-pharyngitis and an acute 
 rhinitis or an ordinary attack of influenza. The two 
 conditions, however, are totally distinct, although the 
 symptoms are somewhat similar; In acute naso-pha- 
 ryngitis, while there is considerable irritation of the 
 nasal cavity, there is no active inflammation of its mu- 
 cous membrane giving rise to stenosis, with profuse 
 discharge. Sneezing occurs, although this is not di- 
 rectly symptomatic of the naso-pharyngeal disorder. 
 The prominent symptonis consist of a deep-seated 
 pain in the region between the nose and throat, aggra- 
 ated somewhat on deglutition, with a semi-deceptive 
 sensation of abnormal dryness or stiffness of the 
 
— 62 — 
 
 parts. In addition to this, there is considerable con- 
 stitutional disturbance, the thermometer showing a 
 temperature of from ioi° to 103°, while the feeling of 
 general depression or malaise is always quite notable. 
 Furthermore, while a cold in the head lasts usually 
 from three to eight days, an acute naso-pharyngitis 
 may persist for a month or even longer, the active fe- 
 brile disturbance subsiding, but a more or less sense 
 of discomfort, with hypersecretion, persisting to the 
 end. The secretion is discharged both into the fauces 
 and through the nasal cavities, and consists of a semi- 
 transparent, whitish-gray, somewhat tenacious mucus. 
 An important feature in the treatment of this dis- 
 ease consists in the administration of general tonics, 
 which should be given early in the attack and contin- 
 ued while the symptoms persist. If the patient is 
 anaemic, iron should be given, but the prominent indi- 
 cation is in the use of barks. Of these I prefer the 
 salicine or willow bark in 10-gr. doses, given four 
 times daily, increasing the dose, if necessary, to 15 or 
 even 20 grs. For the same purpose, quinine in 3 to 
 S-gr. doses may be administered, although I think 
 usually the salicin will give better results. The local 
 application to be used here consist in the daily use 
 of the post-nasal syringe, the fluid being a solution of 
 borax or chlorate of potash of the strength of 5 to 10 
 grs. in an ounce of water, the ternperature of which 
 should be from 70° to 80°, or even hotter, if such can 
 be borne. This should be done at the hands of a 
 
-63 - 
 
 physician or by the patient himself, if he can acquire 
 the necessary dexterity, by means of the ordinary 
 post-nasal syringe, or by the Warner douche. An ex- 
 cellent substitute for the post-nasal douche is the 
 Thudichum nasal douche, from half a gallon to a gal- 
 lon of the hot fluid being allowed to pass through the 
 nasal chambers in this way. A certain amount of re- 
 lief can be accomplished by painting the parts with 
 the glycerole of tannin, or better still, perhaps, a 5 to 
 lo-gr. solution of nitrate of silver. This may be 
 passed directly through the nasal chambers, or up be- 
 hind the palate, by means of a properly curved cotton- 
 holder. In the early stage of the attack much can be 
 accomplished by the use of aconite, which in many 
 cases seems to exert almost a specific influence on the 
 course of this disease, if administered sufficiently early. 
 This should be administered in the form of the alka- 
 loid aconitia in doses of one-five-hundredth of a grain. 
 I usually direct the patient to take each morning after 
 breakfast one dose every hour, until four have been 
 taken, and repeat the same on the second, third and 
 fourth days, if necessary; the administration of the 
 drug being governed somewhat by the results. Occa- 
 sionally, where I have been unable to observe the 
 patient carefully, I have directed the aconitia to be 
 administered every hour in the above dose, until evi- 
 dences of its physiological effect have been obtained, 
 in the tingling of the lips and extremities, with the 
 characteristic burning sensation m the fauces. 
 
-64 - 
 
 Acute Laryngitis. — This is the name we give to an 
 acute inflammation involving the mucous membrane 
 lining the larynx. It is mild in character, and gives 
 rise merely to hoarseness and loss of voice. A cer- 
 tain amount of gravity attaches in the minds of the 
 laity to any impairment of the voice, but as a matter 
 of fact a mere loss of voice is ordinarily a somewhat 
 trivial symptom. It becomes grave, of course, in con- 
 nection with phthisis, syphilis Or cancerous disease, 
 and perhaps it is this association which leads the laity, 
 as a rule,' to attach so much seriousness to its occur- 
 rence. In the very large majority of cases, if not all, 
 it is secondary to trouble Of the air-passages above. 
 The course of events is as follows: A chronic rhini- 
 tis, or a chronic naso-.pharyngitis, then arises — a mild, 
 chronic inflammation of the mucons membrane lining 
 the larynx. In consequence of this chronic laryngitis, 
 there develops a tendency to slight colds, under the 
 influence of which the mild chronic inflammation in 
 the larynx is lighted up into an acute process, causing 
 hoarseness and loss of voice. These latter two symp- 
 toms constitute practically the only symptoms, al- 
 though occasionally we may meet with more or less 
 irritation, hypersecretion and cough. The proper 
 treatment of this affection consists in the relief to such 
 disease as may be found in the air-passages above. 
 This ordinarily will be quite sufiicient to relieve the 
 local condition of the larynx, although undoubtedly 
 prompter relief may be accomplished by the local ap- 
 
-6s - 
 
 plication of astringents directed to the laryngeal cav- 
 ity. Of these we may use, by means of the spray, any 
 of the following: 
 
 Argenti nitras gr. ij. to § i. 
 
 Liquor ferri perchloridi ... 3 x to | i. 
 
 " Cupri sulphas gr. iij. to § i. 
 
 Zinci sulphas gr. v. to | i. 
 
 inhalations by means of the steam atomizer, or by 
 applying heat to certain of the volatile oils or resins, 
 such as benzoin, eucalyptol, pinus canadensis, cam- 
 phor and creosote. These are often used with a cer- 
 tain amount of relief, although not prominently indi- 
 cated the main resource for successful treatment of 
 this affection being in treatment of the diseased con- 
 dition of the parts above. 
 
 Acute Tonsillitis, or Quinsy. — This affection I re- 
 gard, in a very large majority of instances, as a mani- 
 festation of the rheumatic habit. Hence, while local 
 applications, such as we have spoken of iri connection 
 with acute pharyngitis, may afford a certain amount 
 of relief, the prominent indication for treatment con- 
 sists in the administration of anti-rheumatic remedies. 
 Of these none is to be relied upon with more certainty 
 than the salicylate of soda, as follows: 
 
 Q Sodii salicylatis 3 ij. 
 
 Aquae § vj. 
 
 M Sig. — A tablespoonful every two hours. 
 
 In the early stages of the attack there may be given, 
 
 in connection with the above prescription, 3 minims 
 
 5 55 
 
— 66 — 
 
 of tincture of aconite, to be continued until its consti- 
 tutional effect has been produced, after which, of 
 course, its administration is permanently abandoned. 
 In addition to the internal administration of the sali- 
 cylates, much relief can be afforded to local symp- 
 toms, while at the same time the progress cf the dis- • 
 ease, in many cases, may be arrested or mitigated, by 
 directing the patient to apply bicarbonate of soda to 
 the inflamed region. This is easily accomplished by 
 simply wetting the finger and dipping it into the 
 soda and passing it well into the fauces, spreading it 
 over the swollen palate and tonsils. This plan of 
 treatment ignores entirely the old-fashioned domestic 
 remedies, such as poultices, cold compresses, hot 
 compresses, boiled onions, and other external appli- 
 cations. Their efficacy is exceedingly doubtful, and 
 in many cases they add to the discomfort of the suf- 
 ferer. 
 
 The tendency of this disease is toward suppura- 
 tion, and our earlier efforts are confined mainly to abor- 
 ting this; failing this, we endeavor to hasten suppura- 
 tion. If the latter is threatened, it becomes neces- 
 sary to thoroughly examine the parts by means of the 
 forefinger inserted into the fauces, in order to detect 
 the earliest evidence of suppuration and also to detect 
 the point at which the abscess tends to approach the 
 surface; this information being used as a guide to the 
 free use of the knife. Of course,- when the abscess 
 has been opened and the pus evacuated, the attack is 
 
-67 - 
 
 practically cured. Even where the suppurating point 
 is not discovered by palpation, I think much relief is 
 often given by puncturing the tumefaction in the 
 fauces by means of a slender, sharp-pointed bistoury, 
 in order to relieve the vascular tension by blood- 
 letting, thereby giving a certain amount of relief to 
 the pain which attends the progress of the disease. 
 
 Acute Follicular Tonsillitis. — I do not regard this 
 disease as the result of a cold, but rather consider it 
 as one closely allied 'to croup and diphtheria. It is 
 not, however, from a clinical standpoint, usually asso- 
 ciated with either of these diseases, nor does it mani- 
 fest any tendency to develop into them. The disease 
 is really, I think, a constitutional affection, with a 
 local manifestation in the fauces, which consists of a 
 fibrinous exudation in the crypts of the tonsils. As 
 evidence of the constitutional character of the disease, 
 we usually have its onset marked by a well-developed 
 chill or by decidedly chilly sensations. This is fol- 
 lowed by notable febrile disturbance, the temperature 
 rising to 103° and 104°, and even higher in young 
 children. It runs its course in from five to seven 
 days, and disappears spontaneously. The local exu- 
 dation into the tonsils gives rise to an amount of pain 
 referable to these regions, which is very great at 
 times, while at the same time the general disturbance 
 and prostration is quite marked. The indications for 
 treatment consist in the administration of anti-febrile 
 remedies, according to the extent of the fever; while 
 
— 68 — 
 
 the local symptoms are usually combated, by 
 the administration of a solution of tincture of iron 
 and glycerine in the strength of one drachm to the 
 ounce. This is to be given in from half a teaspoonful 
 to a teaspoonful dose every two hours. I know of no 
 better remedy for controlling the localized pain in this 
 disease than the above, in that in its passage over the 
 parts it seems to have a specific action, not only on 
 the local catarrhal inflammation but on the exudation 
 also, while at the same time it gives marked relief to 
 the painful symptoms. If this disagrees with the sto- 
 mach, it may be necessary to make local application 
 to the parts of perchloride of iron. 
 
 After the local inflammation subsides, it is well 
 to administer some general tonic, in that the patient 
 is liable to be left in a condition of considerable pros- 
 tration after the disease passes away. 
 
 The main importance which attaches to acute 
 follicular tonsillitis really, I think, consists in the ac- 
 curacy of the diagnosis. This is easily made, and 
 should always be made with confidence, on account of 
 the exceeding gravity which attaches in the minds of 
 parents to any exudation in the fauces of children. I 
 believe that not infrequently follicular tonsillitis is 
 confounded with diphtheria. That there is no direct 
 connection between the two diseases, I am confident. 
 Furthermore, the characteristic appearances are so 
 distinct as to render a diagnosis quite certain in all 
 cases; indeed, the affection is oftentimes designated 
 
- 69 - 
 
 as a diphtheritic sore throat, which of course is an er- 
 ror: The diagnostic points consist in the fact that in 
 diphtheria the temperature is low, the exudation is a 
 broad membrane, thick and velvety in appearance," 
 yellow in color, and giving rise, as a rule, to no local- 
 ized pain or inflammation at its onset. In follicular 
 tonsillitis, on the other hand, the fever is high, the 
 exudation appears simply at the orifices of the cr3'pts 
 and does not usually give rise to a membrane; there 
 is considerable localized pain, with inflammation. Fur- 
 thermore the color of the exudation is of a bluish- 
 white, opaque tint, meagre in its distribution, showing 
 no efflorescence or tendency to spread. 
 
— OF — 
 
 GEORGE S. DAYIS, Publislier. 
 
 THE THERAPEUTIC GAZETTE. 
 A. Monthly Journal of Physiological and. Clinical Therapeutics. 
 
 EDITED BY 
 
 SUBSCRIPTION PRICE, $2.00 PER YEAR. 
 
 THE INDEX MEDIOITS. 
 
 A Monthly Classified Record of the Current Medical Literature of the World, 
 
 COMPILED UNDER THE DIBBOTION 07 
 
 DR. JOHN S. BILLINGS, Surgeon U. S. A., 
 
 and DR. ROBERT FLETCHER, M. R. C. S., En". 
 
 SUBSCRIPTION PRICE, $ 1 0.OO PER YEAR. 
 THE AMERICAN" LANCET. 
 
 EDITED BT 
 
 T.-pi A TtJtrs oounsrois, nyc. id. 
 
 A MONTHLY JOURNAL DEVOTED TO REGULAR MEDICINE. 
 SUBSCRIPTION PRICE, $2.00 PER YEAR. 
 
 THE MEDICAL. AGE. 
 
 EDITED BY 
 
 B. -TW. i>.A.x,3ia:E!U, -A., aye., oyt. u. 
 
 A Semi-Monthly Journal of Practical Medicine and Medical Ne\vs. 
 SUBSCRIPTION PRICE, $ 1 .OO PER YEAR. 
 
 THE TSTESTERN MEDICAL REPORTER. 
 
 EDITED BY 
 
 J. B. :^.A.m>E!R, -A.. 3yc., js/l. 3d. 
 
 A MONTHLY EPITOME OF MEDICAL PROGRESS. 
 SUBSCRIPTION PRICE, $ 1 .OO PER YEAR. 
 
 THE DRUGGISTS' BULLETIN. 
 
 EDITED BY 
 
 3B. "vr. i».A.ij3>a::E!u, .a., dve., Dye. u. 
 
 A Monthly Exponent of Pharmaceutieal Progress and Ne"ws. 
 
 SUBSCRIPTION PRICE, $1.00 A YEAR. 
 
 New subscribers taking more than one journal, and accompanying subscription 
 by remittance, are entitled to the following special rates. 
 
 GAZETTE and AGE, $2.b0 ; GAZETTE, AGE and LANCET. $4.00 ; LANCET 
 and AGE, $2.50 ; WESTERN MEDICAL REPOETEE or BULLETIN with any of 
 the above at 20 per cent, less than regular rates. 
 
 Combined, these journals furnish a complete working library of current medi^ 
 cal literature. All the medical news, and full reports of medical progress. 
 
 GEO. S. DAYIS, Publish.er, Detroit, Micli. 
 
IN EXPLANATION 
 
 OF 
 
 Tie Physicia ns' Leis ure Liinary. 
 
 We have made a new departure in the publication of medical books. As you 
 no doubt know, many of the large treatises published, which sell tor tour or five or 
 more dollars, contain much irrelevant matter of no practical value to the phy^- 
 clan, and their high price makes it often impossible for the average practitioner to 
 purchase anything like a complete library. 
 
 Believing that short practical treatises, prepared by well known authors, con- 
 taining the gist of what they had to say regarding the treatment of diseases com- 
 monly met with, and of which they had made a special study, sold at a small price, 
 would be welcomed by the majority of the profession, we have arranged for the 
 pubUcation of such a series, calling it Xbe Pbyslclans' Ijelsnre Iilbrary. 
 
 This series has met with the approval and appreciation of the medical profes- 
 sion, and we shall continue to issue in it books by eminent authors of this country 
 and Europe, covering the best modem treatment of prevalent diseases. 
 
 The series will certainly aSord practitioners and students an opportunity 
 never before presented for obtaining a working library of books by the best authors 
 at a price which places them within the reach of all. The books are amply illus- 
 trated, and issued in attractive form. 
 
 They may be had bound, either in durable paper covers at 36 Cts. per copy, 
 or in cloth at 50 Cts. per copy. Complete series of 13 books in sets as announced, 
 at $2.50) In paper, or cloth at $6.00j postage prepaid. See complete list. 
 
 PHYSICIANS' LEISURE LIBRARY 
 
 PRICEi PAPER, 25 CTS. PER COPY, $2.50 PER SET; CLOTH, 50 CTS. PER COPY, 
 $5.00 PER SET. 
 
 SEEUES I. 
 
 Inhalers, inhalations and Inhalants. 
 By Beverley Robinson, M. D. 
 
 The Use of Electricity in the Removal of 
 Superfluous Hair and the Treatment of 
 Various Facial Blemishes. 
 By Geo. Henry Fox, M. D. 
 New. Medications, Vol. I. 
 
 By Dujardin-Beaumetz, M. D. 
 
 New Medications. Vol. II. 
 
 By Dujardin-Beaumetz, M. D. 
 
 The Modern Treatment of Ear Diseases. 
 By Samuel Sexton, M. D. 
 
 The Modern Treatment of Eczema. 
 By Henry G. Piffard, M. D. 
 
 Antiseptic Midwifery. _ 
 
 By Henry J. Garngues, M. D. 
 On the Determination of the Necessity for 
 Wearing Glasses. 
 
 By D. B. St. John Roosa, M. D. 
 The Physiological, Pathological and Ther- 
 apeutic Effects of Compressed Air. 
 
 By Andrew H. Smith, M. D. 
 GranularLids and CantagiousOphthalmla> 
 
 By W. F. Mittendorf, M. D. 
 Practical Bacteriology. 
 
 By Thomas E. Satterthwaite, M . D. 
 Pregnancy, Parturition, the Puerperal* 
 State and their Complications. 
 
 By Paul F. MundU, M. D. 
 
SERIES II. 
 
 The Pjagnosisand Treatment of Haemor- 
 rhoids. 
 
 By Chas. B. Kelsey, M. D. 
 Diseases of the Heart, VoJ. I. 
 
 By Dujardin-Beaumetz, M. D. 
 Dioeases of the Heart, Vol. II. 
 
 By Dujardin-Beaumetz, M, D, 
 The Modern Treatment of Diarrhoea and 
 Dysentery. 
 
 By A. B. Palmer, M. D. 
 Intestinal Diseases of Children, Vol. I. 
 
 By A. Jacob!, M. D. 
 
 Intestinal Diseases of Children, Vol. II. 
 By A. Jacobi, M. l . 
 
 The Modern Treatment of Headaches. 
 By Allan McLane Hamilton, M. D. 
 
 The Modern Treatment of Pleurisy and 
 Pneumonia, 
 
 By G. M. Garland, M. D. 
 Diseases of the Male Urethra. 
 
 By Fessenden N. Otis, M. D. 
 The Disorders of Menstruation. 
 
 By Edward W. Jenks, M. D. 
 The Infectious Diseases, Vol, I. 
 
 By Karl Liebermeister. 
 The Infectious Diseases, Vol. II. 
 
 By Karl Liebermeister. 
 
 SERIES III. 
 
 Abdominal Surgery. 
 
 By Hal C. Wyman, M. D. 
 
 Diseases of the Liver. 
 
 By Dujardin-Beaumetz, M. D. 
 
 Hysteria and Epilepsy. 
 
 By J. Leonard Corning, M. D. 
 
 Diseases of the Kidney, 
 
 By Dujardin-Beaumetz, M. D. 
 
 The Theory and Practice of the Ophthal- 
 moscope. 
 
 By J. Herbert Claiborne, Jr., M. D. 
 
 Modern Treatment of Bright's Disease, 
 By Alfred L. Loomis, M. D. 
 
 Clinical Lectures on Certain Diseases ot 
 Nervous System. 
 
 By Prof. J. M. Charcot, M. D. 
 The Radical Cure of Hernia. 
 
 By Henry O. Marcy, A. M., M. D., 
 L. L. D. 
 Spinal Irritation. 
 
 By William A. Hammond, M. D, 
 Dyspepsia. 
 
 By Frank Woodbury, M. D. 
 The Treatment of the Morphia Habit 
 
 By Erlenmeyer. 
 The Etiology, Diagnosis and Therapy of 
 Tuberculosis. 
 
 By Prof. H. von Ziemssen. 
 
 SERIES IM. 
 
 Nervous Syphilis, 
 
 By H. C.Wood, M. D. 
 
 Education and Culture as correlated' to 
 the Health and Diseases of Women. 
 By A. J. C. Skene, M. D. 
 
 Diabetes. „ „ . , „ „ 
 By A. H. Smith, M. D. 
 
 A Treatise on Fractures. 
 
 By Armand Despr^s, M. D. 
 Some Major and Minor Fallacies concern- 
 ing Syphilis. 
 
 By E. L. Keyea, M. D. 
 Hypodermic Medication. 
 
 By Bourneville and Bricon. 
 
 Practical Points in the Management of 
 Diseases of Children. 
 By I. N. Love, M. D. 
 
 Neuralgia. 
 
 By E. P. Hurd, M. D. 
 
 Rheumatism and Gout. 
 
 By F. Le Roy Satterlee, M. D. 
 Electricity, Its Application in Medicine. 
 
 By Wellington Adams, M.D. [Vol.1] 
 Electricity, Its Application In Medicine. 
 
 By Wellington Adams, M.D. [Vol.11] 
 Auscultation and Percussion. 
 
 By Frederick C. Shattuck, M. D. 
 
SERIES -a. 
 
 Taking Cold. 
 
 By F. W. Bosworth, M. D. 
 
 Practical Notes on Urinary Analy- 
 sis. 
 
 By William B. Canfield, M. D. 
 
 Practical Intestinal Surgery. Vol.1. 
 Practical Intestinal Surgery. ToI.H' 
 
 By F. B. Robinson, M. D. 
 Lectures on Tumors. 
 
 By John B, Hamilton, M. D., LL. D. 
 
 Pulmonary Consumption, « Ner- 
 vous Disease. 
 
 By Thomas J . Mays, M . D . 
 
 Lessons In the Diagnosis and 
 Treatment of Eye Diseases. 
 By Casey A. Wood, M. D. 
 
 Diseases of the Bladder and Pros- 
 tate. 
 
 By Hal C. Wyman, M. D. 
 
 Artificial Anaesthesia and Aneea- 
 thetlcs. 
 
 By DeForest Willard, M. D., and Dr. 
 Lewis H. Adler, Jr. 
 
 Cancer. 
 
 By Daniel Lewis, M. D. 
 
 The Modern Treatment of Hip Dis- 
 ease. 
 
 By Charles F. Stillman, M. D. 
 
 Insomnia and Hypnotics. 
 
 By Germain Sei. 
 
 'Translated by E. P. Hurd, M. D. 
 
 BOOKS BY LEADIWa AUTHORS. 
 
 SEXUAL IMPOTENCE IN MALE AND FEMALE $3.00 
 
 By Wm. A. Hammond, M. D. 
 PHYSICIANS' PERFECT VISITING LIST i . 50 
 
 By G. Archie Stockwell, M. D. 
 A NEW TREATMENT OF CHRONIC METRITIS 50 
 
 By Dr. Georges Apostoli. 
 CLINICAL THERAPEUTICS 4.00 
 
 By Dujardin-Beaumetz, M. D. 
 MICROSCOPICAL DIAGNOSIS 4.00 
 
 By Prof. Chas. H. Stowell, M. S. 
 PALATABLE PRESCRIBING i.oo 
 
 By B. W. Palmer, A. M,, M. D. 
 UNTOWARD EFFECTS OF DRUGS 2.00 
 
 By L. Lewin, M. D. 
 SANITARY SUGGESTIONS (Paper) aj 
 
 By B. W. Palmer, M. D. 
 SELECT EXTRA-TROPICAL PLANTS 3.00 
 
 By Baron Ferd. von Mueller, 
 TABLES FOR DOCTOR AND DRUGGIST 2.00 
 
 By Eli H. Long, M. D. 
 
 GEORGE S. DAVIS, PubUsher, 
 
 ^. O. Box -i'T'O Detroit, ll^lcDa-