Preventable Diseases Part 5

On the other hand, don't fall into the widespread delusion that because air is cold it is necessarily pure. Some of the vilest air imaginable is that shut up in those sepulchres known as "best bedrooms," which chill your very marrow. The rheumatism or snuffles you get from sleeping between their icy sheets comes from the crop of bacilli which has lurked there since they were last aired. The "no heat in a bedroom" dogma is little better than superst.i.tion, born of those fecund parents which mate so often, stinginess and puritanism. Practically, the room which will _never_ have a window opened in it in winter is the one without any heat.

Similarly, the air in an underheated church, hall, or theatre is almost sure to be foul. The janitor will keep every opening closed in order to get the temperature up. Some churches are never once decently ventilated from December to May. The same old air, with an ever richer crop of germs, is reheated and served up again every Sunday. The "odor of sanct.i.ty" is the residue of the breaths and perspiration of successive generations. Cleanliness may be next to G.o.dliness, but it is sometimes an astonishingly long step behind it.

The next important step is to keep clean, both externally and internally: externally, by cold bathing, internally, by exercise. The only reason why a draft ever hurts us is because we are full of self-poisons, or germs. The self-poisons can be best got rid of by abundant exercise in the open air and plenty of pure, cold H2O, internally and externally.

Food has very little to do with these autotoxins, and they are as likely to form on one diet as another. In fact, they form normally and in states of perfect health, and are poisonous only if retained too long.

It is simply a question of burning them up, and getting rid of them quickly enough, by exercise, with its attendant deep breathing and perspiration. The lungs are great garbage-burners. Exercise every day till you puff and sweat.

A blast of cold air suddenly stops the escape of these poisons through the skin and throws them on the lungs, liver, or kidneys. The resulting disturbance is the second commonest form of a "cold," and covers perhaps a third of all cases occurring. This is the cold that can be prevented by the cold bath. Keep the skin hardened and toned up to such a pitch that no reasonable chill will stop it from excreting, and you are safe.

Never depend on clothing. The more you pile on, the more you choke and "flabbify" the skin and make it ready to "strike" on the first breath of cold air. Too heavy flannels are cold-breeders, and chest-protectors inventions of the evil one. Trust the skin; it is one of the most important and toughest organs in the body, if only given half a chance.

But the most frequent way in which drafts precipitate a cold is by temporarily lowering the vital resistance. This gives the swarms of germs present almost constantly in our noses, throats, stomachs, bowels, etc., the chance they have been looking for--to break through the cell barrier and run riot in the body.

So long as the pavement-cells of our mucous membranes are healthy, they can keep them out indefinitely. Lower their tone by cold, fatigue, underfeeding, and their line is pierced in a dozen places at once. One of the many horrifying things which bacteriology has revealed is that our bodies are simply alive with germs, even in perfect health. One enthusiastic dentist has discovered and described no less than _thirty-three_ distinct species, each one numbering its billions, which inhabit our gums and teeth. Our noses, our stomachs, our intestines,--each boasts a similar population. Most of them do no harm at all; indeed, some probably a.s.sist in the processes of digestion; others are camp-followers, living on our leavings; others, captive enemies which have been clubbed into peaceful behavior by our leucocyte and anti-body police.

For instance, not a few healthy noses and throats contain the bacillus of diphtheria and the diplococcus of pneumonia. We are beginning to find that these last two groups will bear watching. Like camp-followers elsewhere, they carry knives, and are not above using them on the wounded after dark. In fact, they have a cheerful habit of taking a hand in any disturbance that starts in their bailiwick, and usually on the side against the body-cells.

Finally, while clearly realizing that the best defense is attack, and that our chief reliance should be upon keeping ourselves in such fighting trim that we can "eat 'em alive" at any time, there is no sense in running easily avoidable risks, and we should keep away from infection as far as possible. If a child comes to school heavy-eyed, hoa.r.s.e, and snuffling, the teacher should send him home at once. He will only waste his time attempting to study in that trim, and may infect a score of others. Moreover, it may be remarked, parenthetically, that these are also symptoms of the beginning of measles, scarlet fever, and diphtheria, and two-thirds of all cases of these would be sent home before they could infect any one else if this procedure were the rule.

If your own child develops a cold, if mild, keep him playing out-of-doors by himself; or if severe, keep him in bed, in a well-ventilated room, for three or four days. He'll get better twice as quick as if at school, and the rest of the household will escape.

When you wake with a stuffed head and aching bones, stay at home for a few days if possible, out of regard for your customers, your fellow-clerks, or your office force, as well as yourself. If one of your employees comes to work shivering, give him three days' vacation on full pay. If it runs through the force, you'll lose five times as much in enforced sick-leaves, slowness, and mistakes. Above all, don't go to any public gatherings,--to church, the theatre, or parties,--when you are snuffling and coughing. You are not exactly a joy to your beholders, even if you don't infect them. It is advisable, and well worth the trifling trouble and expense, to fumigate thoroughly with formalin all churches, theatres, and schoolrooms at least once a month. Reasonable and public-spirited precautions of this sort are advisable, not only to avoid colds themselves, which are disagreeable and dangerous enough, but because mild infections of this sort are far the commonest single means of making a breach in our body-ramparts through which more serious diseases like consumption, pneumonia, and rheumatism may force an entry.

Colds do not "run into" consumption or pneumonia, but they bear much the same relation to them that good intentions are said to do to the infernal regions. They release the lid of a perfect Pandora's box of distempers--tuberculosis, pneumonia, rheumatism, bronchitis, Bright's disease, neuritis, endocarditis. A cold is no longer a joke. A generation ago a prominent physician was asked by an anxious mother, "Doctor, how would you treat a cold?"

"With contempt, madam," replied the great man.

That day is past, and has lasted too long. Intelligently regarded and handled, they are the least harmful of diseases; neglected, one of the most dangerous, because there are such legions of them. To sum up, if you wish to revel in colds, all that is necessary is to observe the following few and simple rules:--

Keep your windows shut.

Avoid drafts as if they were a pestilence.

Take no exercise between meals.

Bathe seldom, and in warm water.

Wear heavy flannels, chest-protectors, abdominal bandages, and electric insoles.

Have no heat in your bedroom.

Never let anything keep you away from church, the theatre, or parties, in winter.

Never go out-of-doors when it's windy, or rainy, or wet underfoot, or cold, or hot, or looks as if it was going to be any of these.

Be just as intimate and affectionate as possible with every one you know who has a cold. Don't neglect them on any account.

CHAPTER V

ADENOIDS, OR MOUTH-BREATHING: THEIR CAUSE AND THEIR CONSEQUENCES

In all ages it has been accounted a virtue to keep your mouth shut--chiefly, of course, upon moral or prudential grounds, for fear of what might issue from it if opened. Then came physiology to back up the maxim, on the ground that the open mouth was also dangerous on account of what might be inhaled into it. Oddly enough, in this instance, both morality and science have been beside the mark to the degree that they have been mistaking a symptom for a cause. This has led us to absurd and injurious extremes in both cases. On the moral and prudential side it has led to such outrageous exaggerations as the well-known and oft-quoted proverb, "Speech is silver, but silence is golden."

Articulate speech, the chiefest triumph and highest single accomplishment of the human species, the handmaid of thought and the instrument of progress, is actually rated below silence, the attribute of the clod and of the dumb brute, the easy refuge of cowardice and of stupidity.

Easily eight-tenths of all speech is informing, educative, helpful in some modest degree; while fully that proportion of silence is due to lack of ideas, cowardice, or designs that can flourish only in darkness.

It is not the abundance of words, but the scarcity of ideas, that makes us flee from "the plugless word-spout" and avoid the chatterbox.

Similarly, upon the physical side, because children who breathe through the mouth are apt to have a vacant expression, to be stupid and inattentive, undersized, pigeon-breasted, with short upper lip and crowded teeth, we have leaped to the conclusion that it is a fearsome and dangerous thing to breathe through your mouth. All sorts of stories are told about the dangerousness of breathing frosty air directly into the lungs. Invalids shut themselves scrupulously indoors for weeks and even months at a stretch, for fear of the terrible results of a "blast of raw air" striking into their bronchial tubes. All sorts of absurd instruments of torture, in the form of "respirators" to tie over the mouth and nose and "keep out the fog," are invented, and those who have the slightest tendency to bronchial or lung disturbances are warned upon pain of their life to wrap up their mouths whenever they go out-of-doors.

As a matter of fact, there is exceedingly little evidence to show that pure, fresh, open air at any reasonable temperature and humidity ever did harm when inhaled directly into the lungs. In fact, a considerable proportion of us, when swinging along at a lively gait on the country roads, or playing tennis or football, or engaged in any form of active sport, will be found to keep our lips parted and to inhale from a sixth to a third of our breath in this way, and with no injurious results whatever. Nine-tenths of all the maladies believed to be due to breathing even the coldest and rawest of air are now known to be due to invading germs.

Nevertheless, mouth-breathing in all ages has been regarded as a bad habit, and with good reason. It was only about thirty years ago that we began to find out why. A Danish throat surgeon, William Meyer, whose death occurred only a few months ago, discovered, in studying a number of children who were affected with mouth-breathing, that in all of them were present in the roof of the throat curious spongy growths, which blocked up the posterior opening of the nostrils. As this ma.s.s was made up of a number of smaller lobules, and the tissue appeared to be like that of a lymphatic gland, or "kernel," the name "adenoids" (gland-like) was given to them. Later they were termed _post-nasal growths_, from the fact that they lay just behind the rear opening of the nostrils; and these two names are used interchangeably. Our knowledge has spread and broadened from this starting-point, until we now know that adenoids are the chief, yes, almost the sole primary cause, not merely of mouth-breathing, but of at least two-thirds of the injurious effects which have been attributed to this habit.

Mouth-breathing is not simply a bad habit, a careless trick on the part of the child. We have come to realize that physical bad habits, as well as many mental and moral ones, have a definite physical cause, and that _no child ever becomes a mouth-breather as long as he can breathe comfortably through his nose_.

This clears the ground at once of a considerable amount of useless lumber in the shape of advice to train the child to keep his mouth shut.

I have even known mothers who were in the habit of going around after their helpless offspring were asleep and gently but firmly pushing up the little jaw and pressing the lips together until some sort of an attempt at respiration was made through the nostrils. Advertis.e.m.e.nts still appear of sling-like apparatuses for holding the jaws closed during sleep.

To attempt to stop mouth-breathing before providing abundant air-s.p.a.ce through the nostrils is not only irrational, but cruel. Of course, after the child has once become a mouth-breather, even after the nostrils have been made perfectly free, it will not at once abandon its habit of months or years, and disciplinary measures of some sort may then be needed for a time. But the hundred-times-repeated admonition, "For heaven's sake, child, shut your mouth! Don't go around with it hanging open like that!" unless preceded by proper treatment of the nostrils, will have just about as much effect upon the habit as the proverbial water on a duck's back. No use trying to close his mouth by any amount of opening of your own.

Fortunately, as does not always happen, with our discovery of the cause has come the knowledge of the cure; and we are able to say with confidence that, widespread and serious as are disturbances of health and growth a.s.sociated with mouth-breathing, they can be absolutely prevented and abolished.

What, then, is the cause of this nasal obstruction, and when does it begin to operate? The primary cause is catarrhal inflammation, with swelling and thickening of the secretions, and it may begin to operate anywhere from the seventh month to the seventh year. A neglected attack, or series of attacks, of "snuffles," colds in the head, catarrhs, in infants and young children, will set up a slow inflammation of this glandular ma.s.s at the back of the nostrils--a tonsil, by the way--and start its enlargement.

Whether we know anything about adenoids themselves or not, we are all familiar with their handiwork. The open mouth, giving a vacant expression to the countenance, the short upper lip, the pinched and contracted nostrils, the prominent and irregular teeth, the listless expression of the eyes, the slow response to request or demand, we have seen a score of times in every schoolroom. Coupled with these facial features are apt to be found on closer investigation a lack of interest in both work and play, an impaired appet.i.te, restless sleep, and a curious general backwardness of development, both bodily and mental, so that the child may be from one to four inches below the normal height for his years, from five to fifteen pounds under weight, and from one to three grades behind his proper school position. Very often, also, his chest is inclined to be narrow, the tip of his breastbone to be sunken, and his abdomen larger in girth than his chest. Is it possible that the mere inhaling of air directly into the lungs, even though it be imperfectly warmed, moistened, and filtered, as compared with what it would be if drawn through the elaborate "steam-coils" in the nostrils for this purpose, can have produced this array of defects? It is incredible on the face of it and unfounded in fact. Fully two-thirds of these can be traced to the direct influence of the adenoids.

These adenoids, it may briefly be stated, are the result of an enlargement of a _tonsil_, or group of small tonsils, identical in structure with the well-known bodies of the same name which can be seen on either side of the throat. They have the same unfortunate faculty as the other tonsils for getting into hot water, flaring up, inflaming, and swelling on the slightest irritation. And, unfortunately, they are so situated that their capacity for harm is far greater than that of the other tonsils. They seem painfully like the chip on the shoulder of a fighting man, ready to be knocked off at the lightest touch and plunge the whole body into a scrimmage. Their position is a little difficult to describe to one not familiar with the anatomy of the throat, especially as they cannot be seen except with a laryngeal mirror; but it may be roughly stated as in the middle of the roof of the throat, just at the back of the nostrils, and above the soft palate. From this coign of vantage they are in position to produce serious disturbances of two of our most important functions,--respiration and digestion,--and three out of the five senses,--smell, taste, and hearing.

We will begin with their most frequent and most serious injurious effect, though not the earliest,--the impairment of the child's power of attention and intelligence. So well known is their effect in this respect that there is scarcely an intelligent and progressive teacher nowadays who is not thoroughly posted on adenoids. Some of them will make a snap diagnosis as promptly and almost as accurately as a physician; and when once they suspect their presence, they will leave no stone unturned to secure an examination of the child by a competent physician, and the removal of the growths, if present. They consider it a waste of time to endeavor to teach a child weighted with this handicap. How keenly awake they are to their importance is typified by the remark of a prominent educator five or six years ago:--

"When I hear a teacher say that a child is stupid, my first instinctive conclusion is either that the child has adenoids, or that the teacher is incompetent."

The lion's share of their influence upon the child's intelligence is brought about in a somewhat unexpected and even surprising manner, and that is by the _effects of the growths upon his hearing_. You will recall that this third tonsil was situated at the highest point in the roof of the pharynx, or back of the throat. The first effect of its enlargement is naturally to block the posterior opening of the nostrils.

But it has another most serious vantage-ground for harm in its peculiar position. Only about three-fourths of an inch below it upon either side open the mouths of the Eustachian tubes, the little funnels which carry air from the throat out into the drum-cavity of the ear. You have frequently had practical demonstrations of their existence, by the well-known sensation, when blowing your nose vigorously, of feeling something go "pop" in the ear. This sensation was simply due to a bubble of air being driven out through this tube from the back of the throat, under pressure brought to bear in blowing the nose. The luckless position of the third tonsil could hardly have been better planned if it had been devised for the special purpose of setting up trouble in the mouths of these Eustachian tubes.

Just as soon as the enlargements become chronic, they pour out a thick mucous secretion, which quickly becomes purulent, or, in the vernacular, "matter." This trickles down on both sides of the throat, and drains right into the open mouth of the Eustachian tube. Not only so, but these Eustachian tubes are the remains of the first gill-slits of embryonic life, and, like all other gill-slits, have a little ma.s.s of this same lymphoid or tonsilar tissue surrounding them. This also becomes infected and inflamed, clogs the opening, and one fatal day the inflammation shoots out along the tube, and the child develops an attack of earache.

At least two-thirds of all cases of earache, and, indeed, five-sixths of all cases of deafness in children, are due to adenoids.

Earache is simply the pain due to acute inflammation in the small drum-cavity of the ear. This in the large majority of cases will subside and drain back again into the throat through the Eustachian tube. In a fair percentage of instances, however, it will break in the opposite direction, and we have the familiar ruptured drum and discharge from the ear. In either case the drum becomes thickened, so that it can no longer vibrate properly; the delicate little chain of bones behind it, like the levers of a piano, becomes clogged, and the child becomes deaf, whether a chronic discharge be present or not.

This is the secret of his "inattention," his "indifference,"--even of his apparent disobedience and rebelliousness. What other children hear without an effort he has to strain every nerve to catch. He misunderstands the question that is asked of him, makes an absurd answer, and is either scolded or laughed at. It isn't long before he falls into the att.i.tude: "Well, I can't get it right, anyhow, no matter how I try, so I don't care." Up to five or ten years ago the puzzled and distracted teacher would simply report the child for stupidity, indifference, and even insubordination. In nine cases out of ten, when children are naughty or stupid, they are really sick.

Not content with dulling one of the child's senses, these thugs of the body-politic proceed to throttle two others--smell and taste. Obviously the only way of smelling anything is to sniff its odor into your nose.

And if this be more or less, or completely, blocked up, and its delicate mucous membranes coated with a thick, ropy discharge, you will not be able to distinguish anything but the crudest and rankest of odors. But what has this to do with taste? Merely that two-thirds of what we term "taste" is really smell. Seal the nostrils and you can't "tell chalk from cheese," not even a cube of apple from a cube of onion, as scores of experiments have shown. We all know how flat tea, coffee, and even our own favorite dishes taste when we have a bad cold, and this, remember, is the permanent condition of the palate of the poor little mouth-breather. No wonder his appet.i.te is apt to be poor, and that even what food he eats will not produce a flow of "appet.i.te juice" in the stomach, which Pavloff has shown to be so necessary to digestion. No wonder his digestion is apt to go wrong, ably a.s.sisted by the continual drip of the chronic discharge down the back of his throat; his bowels to become clogged and his abdomen distended.