Catarrh – Characteristics and History
Catarrh is now regarded as inflammation of the mucous membranes, especially of the air pas-sages, together with the production of a muroid exudate. Simple though this definition is, it bears evident traces of the history of the disease.
The name derives from Hippocrates’ use of katarrhoos, a “flowing down” of humors from the head. In that use, the term was probably not yet technical, and so akin to a Latin word such as defluxio. In commenting on Hippocrates, how-ever, Galen distinguishes general “downflow-ing” from a more precise meaning of “catarrh” – that is, defluxion from head to lungs, producing hoarseness and coughing.
The Greek word became catarrhus in Latin and a technical term with, increasingly, Galen’s meaning attached to it. Although it is tempting to identify catarrhus with catarrh, we have to remember that for Galen and doctors down to the seventeenth century, catarrhus could not be defined without reference to Galenic pathology. Catarrhus was a process in which the brain, preternaturally affected by cold, produced a qualitatively unbalanced humor in excessive quantity that passed down through the pores in the palate and by way of the trachea to the lungs. This unspoken assumption behind the name is paralleled by that behind the modern definition: We make the assumption that the “inflammation” of the definition results from infection by an organism. The identity of the organism gives us the ontology of the disease. A similar situation existed in all historical periods; that is to say, definitions of disease have always carried with them some part of a theory of causation. (Purely empirical accounts of disease are descriptions of symptoms.) To put it another way, disease in Western medicine has traditionally been seen as disordered function. But function is a process, and knowledge of it depends on knowledge of how the body works.
In the eighteenth and nineteenth centuries, there were a number of different so-called systems of physiological knowledge, in each of which what was indicated by a single disease name was seen differently. For example Franciscus de Le Bo¨e (F. Sylvius), as an iatrochemist, divided catarrhs into groups distinguished by the chemical qualities of the humor produced. As a hydraulically inclined mechanist, Hermann Boerhaave thought of catarrh in terms of obstruction of the small vessels, which caused swelling. Indeed, his most frequent use of the term was as an adjective to describe angina. “Angina” was any difficulty in breathing, and catarrhous angina was the result of swollen membranes. Although membranes also played an important part in the new tissue pathology of early nineteenth century Paris, the Parisian view of the body, and therefore disease, was again different. Marie Francois Bichat stressed the sympathies between membranes and their ability to secrete and imbibe the fluids of the cavity they lined. To this were added the new techniques of physical diagnosis by percussion and stethoscope.
Catarrh again became a disease of membranes, of excessive secretion, and of fluids moving audibly in their cavities. Some Bichatian sympathy of membranes seems to lie behind the early nineteenth century notion of a catarrh of the urinary bladder. This opinion was recorded by R. Hooper, who also sharply distinguished common catarrh – a cold, and particularly a cold in the head – from epidemic catarrh, which is identified with influenza. The modern meaning is derived from the former.