1893 Journal of the American Medical Association (JAMA)  
Concluded from page 888). Part III. Dissatisfied Patients.-There are two classes of patients who visit a physician for consultation, with regard to suspected or painful disease of the upper air passages, that are almost certain to be dissatis¬ fied with the promises given them : one, those who expect to be cured in a few weeks at most ; the other, those who have come to the conclusion, because of many disappointments, that the disease can not be cured. The First Visit to a Physician.-Take an
more » ... ysician.-Take an individual of the first class, about thirty-nine years of age, who has had little or no painful experiences connected with the disease. He is conscious of a little more flow of secretion in the back part of the throat than he thinks should take place. He has been clearing his throat every morning for five or six years, but seldom has gagging spells with these efforts ; and were it not that he has heard the subject spoken of very frequently, or has read in the newspapers of the symptoms of nasal disease quite similar to his own, he would not be any more mentally disturbed than he has been physically troubled by the presence of the flow. But all of these circumstances are sufficient to cause him to consult a physician, thinking that he will very quickly be completely cured. When informed that his complaint is a chronic one, conse¬ quently it has been progressing so painlessly that he has been entirely unconscious of the injurious and comparatively permanent changes that have taken place in the blood vessels and nerves, as well as in the mucous membrane of his nasal passages, and that it will take a rather long course of treat¬ ment before the recuperative powers of his system can repair the damages thus insensibly produced, he is surprised. He can not understand why it is that it takes so long to cure a painless and almost sensationless disease. When informed, as he should be, that the blood vessels of the nasal passages were so slowly enlarged that no pain was produced, though the inflammation was injurious, nevertheless, and that so long as the inflammation exists, these in¬ jurious effects will continue to increase ; also that this slow process can not be eradicated except by slow degrees, he will still remain unconvinced, unless he has confidence in the physician. He may, how¬ ever, be so favorably impressed with these state¬ ments as to place himself under the physician's care. Many times it is difficult to control such a patient in regard to hygiene ; and the more ignorant he is as respects the laws of health, the less is he controlled, especially if he has contracted any bad habits-as have the great majority of such persons-such as the use of tobacco or stimulants. As he has had little or no pain of which to be relieved, he will feel but slight change as a result of the local applications used by his physician, unless he is cognizant of the decrease of the flow of secretion in the nasal passages and throat, and observes that he is not taking cold as frequently nor to so severe a degree as formerly. If these two important evidences of improvement are 1 The term, "naso-mucositis," is formed from the word mucosa, the mucous membrane, with the usual termination, "itis," that indicates its inflammation, and the prefix naso-, which limits the inflammation to the nasal passage. not observed and do not produce a decidedly favora¬ ble impression upon his mind, the continued restraint in regard to his habits will be almost certain to cause him to discontinue medical treatment. If he does discontinue treatment, in a few months he will find himself taking cold far more frequently and in a severer degree than formerly. Having heard some of his friends recommend one of the latest "catarrh cures," advertised in the newspapers and shown in the drug store windows, he may expend a few dol¬ lars for it. This "cure" may give him a little relief for a short time. Then he will find to his sorrow that the "thing is doing more harm than good. "6 He now discontinues his self-treatment and finds that his air passages are more comfortable without the much advertised " cure. " With the next change of the season, either spring or fall, he is made certain, by frequent and severe colds, that he has nasal disease of a painful form. He may now visit ojie of the many advertising men who promise a cure for a small sum paid monthly. These trials will consume about six months' time, when in disgust he will try the virtues of a change of climate. Usually the wily advertising man suggests this course to get rid of a troublesome customer. It makes but little difference where he goes, he will improve in health, much to his delight. The dis¬ continuance of injurious methods of treatment and the change together being the cause thereof. In six months he takes another cold, which causes a severe cough ; and for this he visits a physician who pre¬ scribes and the cough disappears. In a week or two, another but more severe cold is taken ; the prescrip¬ tion does noi cure the cough this time. His strength is now affected ; he loses in weight ; he goes to a large city and consults some one who has a reputa¬ tion for curing lung troubles. He is told that his lungs are all right, but that his stomach and it may be, his liver, are out of order. If calomel-that best of all killers'of microbes which now have a rich soil in his primee via-is given in small quantities and continued for some time, he will suddenly improve greatly, showing the intimate relation between the stomach and bowels.' He is now thoroughly aroused and takes good care of himself, discontinues all excesses, especially tobacco and stimulants, which he is satisfied are injurious to him, and remains in comparatively good health for some months. Overgrowths in the Nasal Passages.-At the next change of the season he takes another cold, which is so severe as to almost shut off his nasal respiration. All this time his rhinitis has been progressing pain¬ lessly. He has the nasal obstructions removed and is greatly relieved ; feeling as though he had another lease on life and comfort.8 These obstructing masses are the result of years of continued inflammation, and this inflammation will not be reduced by the mere removal of the growths. If the reduction of the inflammation is not brought about, either before this removal or afterward, one or two years at most, with no unusual exposure, are all that is required 6 All these "sure cures" are composed of materials that at first afford relief but afterward surely inflame the nasal passages. I have examined eighty-four of these " cures." Of these, carbolic was in sixty-four; camphor in forty-nine; and cubebs in forty-eight. All of these agents will produce a cooling and relieving effect the first few times they are used, but in a short time the injurious effects will be experienced. 7 While the calomel will destroy the microbes in the stomach and bowels, it will not check the supply which comes from the nasal passages. 8 These operations are essential to the permanent recovery of such a case, but after the removal, one should receive a course of local painless applications, followed by supplementary courses.
doi:10.1001/jama.1893.02420770019001h fatcat:wkdrwamiavgtjlvnnr45qn5dni