PRESIDENT WESTERN OPTHALMOLOGIC AND OTO-LARYNGOLOGIC ASSOCIATION, NEW ORLEANS, LA.
Hygiene is that branch of medical science which relates to the preservation and improvement of the health. As the prevention of disease is more important than its cure—in fact, superior to all methods for its cure—this is a subject which demands our most earnest attention. Hygiene is not limited to the preservation and improvement of the health of the individual, but includes that of whole communities. As, however, the health of a community depends upon the state of the health of the various families composing it, and this again of its members, the proper understanding of the hygienic laws by each individual is of the utmost importance.
For some reason, however, the subject of hygiene or the prevention of disease does not create the enthusiasm caused by methods advocated for its cure. A Koch, who publishes to the world a supposed means of curing tuberculosis, or a Behring, who introduces the serum therapy of diphtheria, arouses an interest which is limited only by the four corners of the world. The modest worker in sanitation, however, who explains the means of the development of these diseases, and the conditions and laws by means of which they may be prevented, is looked upon without interest and frequently with disfavor. But in spite of these conditions, the laws of hygiene are gradually becoming more farspread, and their influence is felt more with each advancing year.
The nose, throat, and ear are so intimately connected with the other parts of the body that their health depends to a large extent upon the condition of the system in general. The laws of hygiene and their application which refer to the body in general are also applicable to these parts, and whatever condition benefits the former will have a useful influence on the upper respiratory passages, and, inversely, any injurious effect will injure the health of these organs.
The physiology of this region is of much importance. Formerly the nose was considered principally in its relation to the organ of smell. This is a most important function, as it is a constant sentinel over the air we breathe and the food we eat. It is a curious circumstance that many of the functions that are referred to the organ of taste really belong to that of smell. In eating ice cream, for instance, the sense of taste simply informs us that it is sweet or otherwise, but the flavor is perceived only by the sense of smell. A proof of this is that where this function is destroyed, all ability in this direction disappears, and the patient thus affected will frequently complain that his sense of taste is defective, not realizing that it is the sense of smell which performs this act.
The nose, however, has a much more important function to perform—viz., in respiration. Strange to say, however, this has only recently been realized, and it is even yet not well understood. You have all observed that, when you had a severe "cold" which prevented nasal breathing, the next morning the mouth and throat were dry and parched and frequently inflamed, the voice sometimes hoarse, and there was a general feeling of depression. While the progress of the inflammatory process may be a factor in this, still the mechanical obstruction of the nose from any cause whatsoever will have a similar effect. In patients in whom, for various reasons, an artificial opening has been made in the trachea, the air of the room has to be heated to an almost intolerable point and saturated with moisture, or severe bronchial inflammation will soon develop in the patient, simply because the nose has not taken an active part in the act of respiration. These effects, therefore, clearly demonstrate that the nasal passages have an important function to perform in the breathing process. Summarized in a few words, it is simply to warm, moisten, and clean the air which we inhale.
The healthy nostrils are anatomically and physiologically so formed that when the current of air passes through them it will have been freed of its mechanical impurities, warmed to within a few degrees of the temperature of the body, and moistened to saturation. This has been experimentally demonstrated.
The opening of the passage of the ear into the throat has several objects, the most important being ventilation and the adjustment of the atmospheric equilibrium. This passage leads outward until it enters the cavity of the middle ear, which is closed by the drum on the outside, thus separating it from the external canal of the ear. We know that atmospheric pressure varies at different times and in different altitudes. It is much less, for instance, at the top of a mountain than at the seaside. The opening into the throat allows the air to enter, and adjusts the atmospheric pressure within the ear to these various external conditions. Those of you who have ascended Lookout Mountain by means of the incline cable car may have noticed the adjustment taking place by a peculiar click when different altitudes were reached.
So intimately are the nose, throat, and ear connected that it is unusual to find one affected to any considerable extent without the others being involved. While the rules of hygiene in general are applicable to the nose, throat, and ear, there are certain special conditions which deserve consideration. One of the most common causes of injurious effects to the nose, throat, and ear is the so-called "cold." The cold in this connection is, of course, understood to be simply the cause, the condition itself being a peculiar inflammation of the parts concerned. As cold is so frequently a cause of diseases of these parts, it would be well to consider under what circumstances it develops and the best mode of prevention.
I have often noticed that persons who suffer most frequently and severely from colds usually insist that they exercise the greatest care to avoid exposure. They have dressed in the warmest clothing, wrapped the neck in the heaviest mufflers, remained in the closest rooms, and avoided every draught, and yet they continually "take cold." The street urchin, on the other hand, with only two or three garments and without shoes, and who lives out of doors, suffers less frequently from this affection.