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The Common Cold
The Common Head Cold:
 Colds In General

 Anatomical Outlines

 Nose And Throat Functions

 Highways For The Invasion Of Disease

 Predisposing Causes

 Atmospheric Factors

 Colds And Micro-organisms

 Symptoms, Complications And Sequelae

 Principles Of Prevention

 Methods Of Prevention

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Methods Of Prevention

( Originally Published Early 1900's )

While certain of the contributory causes of colds are unavoidable, there are a great many which could and should be prevented. As we have elsewhere pointed out, cold catching is closely connected with what we call the comforts of civilisation, and is largely due to our unhygienic habits of living. It is not enough that we recognise these causes. We must know how to circumvent their evil influence, by the substituting of the practice of proper methods of life until they become fixed habits.

First and foremost of the evils to be condemned, and probably the most prolific single cause of colds in this country, is the overheating of our living and working apartments. The harmfulness of breathing very warm air lies in the circumstance that air, as it becomes warm, becomes also relatively dry. The super-heated air in its avidity for moisture tends to abstract the natural moisture secreted by mucous membranes of the nasal passages, so that these passages become unduly dry and parched, and cannot perform their normal functions.

One of the important purposes of the serum secreted by the nasal mucous membrane, is undoubtedly to protect against infections; we observe how the secretion is increased and, at the same time, sneezing provoked in the event of any irritation of the membranes, and it is known to have an effect that is directly inhibitory to the growth of micro-organisms. The parching of the parts in the dry over-heated air in which many persons remain for hours must have the effect of inviting the germs to do their worst.

The ideal atmosphere is considered to be that of 68 degrees F. with a relative humidity of about 40 or 50 per cent. And this is, if we would but realise it, the most comfortable as well as the most healthful. We have allowed our temperature sensations to become vitiated by habit and there is a desire for more and more heat, like the vitiated taste for more sweets, for more tobacco or more alcohol. At a temperature of 68, it is not difficult to maintain a humidity of 35 or 40, but let the temperature rise to about 75, which is not uncommon in our American homes, and you will discover if you will make use of a reliable hygrometer, that your relative humidity has dropped to the very unhealthful ratio of about 20%.

Unfortunately there does not exist any artificial means of maintaining it at the desired level. For households of moderate size, it is estimated that many gallons of water would be required, and this is found to be impracticable. One of the unfortunate features of the situation is that with the air very dry one may feel a chilly sensation even with great heat, because of the increased loss of heat with moisture from the body by evaporation, so that the result is that persons living in a hot air continuously demand greater and greater heat.

Next to improper methods of heating houses, we believe the most important indirect cause of colds, consists in improper methods of dress. We have alluded to this in Chapter VI, but the subject is so important that we go into it again with further detail, at risk of some repetition.

For civilised people clothes are necessary for reasons for modesty and protection and to economise the heat of the body. It is estimated that people in moderate circumstances, not affluent, spend about 15% of their income for clothes, compared to 20% for rent and 25% for fuel, a sum more than necessary for the mere purposes stated, and indicating that decoration is an important secondary motive. Dress may be harmful, from the standpoint of health, in being too heavy or too light, covering too much surface or too little, too constrictive, or of a material which interferes with the normal functions of the skin. Harm is also done in wearing clothes which are unsuitable to one's mode of life or to the season or the climate in which one lives.

It is necessary to have enough clothes to protect from chilling of the body, and especially so with old people, children, and invalids. Children must be always well clad in cold weather, because they have in proportion to their weight a greater surface of skin from which heat may be lost by conduction, convection, and evaporation; and old people and invalids, because their powers of heat production are diminished.

A greater fault than underdressing, however, is that of overdressing. It is said that Venus springing from the foam of the sea and wafted by gentle breezes over the surface of the waves, landed at The Isle of Cyprus, where she was received and properly attired by the Seasons. There is no authority for the belief that they then and there clothed the beautiful goddess of love in furs. It is too evident that Venuses of to-day are not guided in their choice of apparel by the same ad-vice, for certainly the wise and experienced Sea-sons would be shocked to see them on the coldest days in winter, arms and chest completely naked and legs almost so, and in the summer draped in northern furs.

Furs and heavy wraps, when necessary to be worn out of doors because of the extreme coldness of the climate, should be immediately discarded on entering a warm interior. To sit through a lecture, or the church service, or spend the morning shopping or the afternoon at tea, when the temperature of these indoors places is probably about 75 degrees F., with the same heavy fur coats and wraps that one wore outside, is to send a cordial invitation to the Demon "Cold" to come and do its worst.

Special protective dress for particular parts of the body is seldom necessary for man or woman, as it is usually impractical to wear such only when needed, and to discard it when not.

Ear muffs and boas, scarfs, chest protectors, leather vests and leather jackets, are for the most part hygienic misfits; one becomes accustomed to them, and unable to dispense with them, and nevertheless is always in danger of being caught without them when most needed.

Aeration of the skin is essential to healthy skin function. The wearing of dense impermeable dress is something as much as possible to be avoided, because it keeps out the air and because the evaporation of the sweat secretion is hindered by impermeable stuff. It is probably on account of the necessity of wearing leather shoes, that colds are more often contracted by way of the feet than any other way. Frequent change of shoes and stockings, not only day to day, but once if possible in the course of the day is a useful precept to follow and necessary for those subject to damp perspiring feet. If because of rain, snow, sleet and slush one must sometimes wear rubbers, arctics or mackintoshes, at least the precaution should be taken to discard them when indoors or to wear them as little as possible.

The question of underclothes is one of much interest in relation to the susceptibility to colds. A maxim of first importance to be emphasised above all others, is that the underwear for the average individual in this climate should be of the same weight the year round. This is simply because most of us spend the greater part of our time indoors and in a temperature which is as warm if not warmer than the usual outdoor weather of summer. If we adopt a heavy flannel for the winter season, then during all the time that we remain in our warm (and generally too warm) homes and offices, we will suffer from overheating of the body, our skin surface will be constantly bathed in unhealthy perspiration, and we become more and more tender, and more and more susceptible to colds. If, on the contrary, we adopt a light underwear the year round, we are comfortable indoors and on going out on a cold winter day we can protect ourselves from cold by suitable wraps and overcoats. The Russians, despite their severely cold climate, are said to catch colds with relatively little frequency, and in no small part is this probably to be attributed to the habit of wearing a simple coarse linen underwear, putting on heavy coats for the icy blasts of their outdoor winter life.

As to whether we should wear next to our skin, garments of wool or of linen, is a matter to be determined not only by climate, but by one's mode of life and one's age and state of health. Woolen material is a poorer conductor of heat than linen, and therefore somewhat warmer. It is best for those who must spend much of the time exposed to very cold weather, and probably for the aged and enfeebled.

A matter of much importance in underwear is its property with regard to the absorption of moisture, because the skin is constantly eliminating heat by evaporation. Wool is slow in absorbing moisture and slow in giving it up. A woolen garment will therefore remain a relatively long time saturated, and when this is the case, chilling can take place from rapid loss of heat. Linen, ordinarily does not conserve the heat of the body as well as woolen material, because its fibres do not contain as much air which is a poor conductor. It can be so woven as to improve its character in this particular, and it has an advantage over wool in that the moisture is more readily absorbed and so interferes less with normal cutaneous functions. In our climate it seems therefore for the average person the preferable material for undergarments, and apparently for the same reason as that given in Ezekiel to the chosen people, "They shall be clothed with linen garments and no wool shall come upon them: they shall not gird themselves with anything that causeth sweat."

Any one who seriously strives to avoid all the causes of colds, must be careful not only as to the air he breathes, and the clothes he wears, but also as to the food he eats. That colds are often toxic in origin is one of the important teachings of our generation, well emphasised by Stucky, Dwyer, Shurley, and others of our leading rhinologists.

If the intestinal canal were uncoiled and extended, its length would be seen to be 5 or 6 times the length of his body. From this extensive surface, there is therefore a large possibility for absorption of toxins, if the food be indigestible, and intestinal action sluggish. Overloading the stomach is a hygienic fault at all times to be avoided, but, from the standpoint of colds, care should be particularly taken to guard against excessive ingestion of the nitrogenous foods. It is from the red meats in particular, when taken in large quantities, that end-products are formed, which give rise to excessive acidity of the blood and various toxic conditions.

One does well then, on general principles, to restrict his proteins, and increase the use of fresh vegetables, fruits and fruit juices, to exclude cheese, meats and beans, rich highly seasoned food, pastries, fried articles and hot, freshly baked breads. Tea and coffee taken in excess, are probably to be ranked as, in some cases, factors, and to be avoided by those especially prone to colds.

It is common belief that alcohol is of value in protecting against cold, and helps to prevent catching cold. The physiological effect of alcohol is to bring about, shortly after being ingested, a dilatation of all the little arterial blood vessels throughout the skin, and cause a determination of a great part of the blood from the interior of the body to its surface. This is often very notice-able in the flushing of the face. The effect of this is to produce a glow and general feeling of warmth, even in spite of a surrounding cold temperature, but remember, that at the same time there is an actual loss of body heat which naturally takes place from the warm blood circulating in the surface.

Nature does exactly the opposite thing on exposure to cold; it causes the blood vessels to con-tract in the cutaneous surface and the blood to be driven inward, because it is the aim of nature to conserve the body heat. Alcohol therefore in case of exposure to cold, while giving a sense of warmth and well being, is really antagonising the natural mechanism of defence, and is causing actually a greater loss of body heat and lessening the powers of resistance. Now, after one has been exposed to severe cold and then comes into a warmer environment, the tone of the cutaneous vessels naturally relaxes, and the contraction is superseded by a dilatation such as that produced by alcohol. At this time "just a little drink will do no harm," and may be useful to those whose natural reactions are sluggish.

There are many people who do not react well from a cold exposure. We sometimes see at bathing places, persons who after coming in from the water are shivering and cold, with blue lips and goose skin, instead of having a normal glow. For such persons a dose of brandy or other alcoholic beverage is definitely indicated to promote reaction and prevent loss of heat.

"Before the dip, never a sip,
After the dip, you need a nip."

happens to be then a seaside doggerel, not with-out physiological basis.

The excessive use of alcohol, is to be scrupulously avoided by persons susceptible to colds, not only on general grounds, but because this agent has a special deleterious local effect. The mucous membrane of the nose and throat of regular drinkers will nearly always develop a state of chronic congestion and irritation, which will show exacerbations with every new indulgence.

Closely associated in our minds with the habit of using alcohol is the tobacco habit. There are not lacking authentic observations of the effect of tobacco, proving the deleterious effect of its excessive use upon the digestion and upon certain parts of the nervous system, and, it appears, that even its moderate use, if long continued, has a decidedly unfavourable effect, hindering the normal growth of the body arid the development of the intellectual faculties in young persons. In the habit of smoking, the fumes are brought constantly in contact with delicate membranes of the nose and throat passages. Whether the effect is to be attributed to nicotine or to ammoniacal vapours or other substances,—the products of incomplete combustion, may not be determined, but it is certain that it acts as a local irritant. Congestion of these parts therefore is bound to result from its continued or excessive use, and since congestion renders the parts susceptible to infection, it is obviously a bad influence.

We have often observed that the effect of smoking is not always confined to the smoker. Any person who spends an evening in the company of smokers, especially in close, stuffy, ill-ventilated rooms, will often show the, next day a congestion of the throat, just as marked, we believe, and in many cases more so, than that of the ones who did the smoking.

In the warfare against colds, it is necessary also that certain internal causes be sought for and removed. In the last analysis all causes are of external origin, but it is more convenient to list as internal causes of colds certain general and lo-cal body conditions, whose relationship is evident and near at hand, rather than their ultimate re-mote causes. The chief general internal conditions are diseases of the heart, liver, gastro-internal tract, kidney, and skin.

Serious organic heart troubles cannot be removed, but it is imperative that they be recognised if present, as much can be done in the way of proper methods of living and medical treat-ment to keep them under control. This is very important to prevent passive congestion in the mucous membranes of the nose and throat as well as of other organs.

The liver in a large measure performs for the body the functions of a filtration plant, serving to remove or make harmless impurities which have gained entrance to the system and are circulating in the blood. As a result of certain external causes, as various infections, or a too stimulating diet, or alcohol in excess, these functions will come to be imperfectly performed with deleterious consequences to all parts of the body. The diagnosis and treatment of such conditions is a matter requiring the advice of a competent physician.

Of prime importance in connection with the occurrence of colds, is the state of the so-called eliminative organs of the body, the gastro-intestinal tract, kidneys and skin, for, when they become disordered, toxic products accumulate which by their irritating effects upon the respiratory membranes give rise to the so-called "toxic colds."

The chief underlying cause of cold catching is certainly for many persons to be traced to a disturbed state of their digestive processes. It is fatuous to expect any permanent benefit from the use of sprays, douches, inhalations or any other local treatment, when the real trouble is a state of general systemic auto-toxication, the result of sluggish gastro-intestinal functions. These are common faults in individuals who lead a sedentary life, get very little exercise, and over-eat.

The kidneys are organs also, which are concerned in the removal of waste products of nutritional change, especially those formed by the ingestion of nitrogenous substances. They must not be over-taxed, and they must be kept active by drinking freely of water.

From what has been already said about the skin, and its close relationship with the nasal organ, in connection with heat regulation, we should readily realise how easily the nasal mucous membrane can be affected in case of derangement of the cutaneous functions. When one goes from a warm place to a cold one, the blood vessels normally contract to conserve heat; when from cold places to warm ones they should dilate to allow needed escape of heat. But, if the skin is in a bad condition, its vessels relaxed and sluggish, these necessary skin reactions will be lacking; the vessels will fail to respond in a normal way to temperature changes, with immediate ill effect upon the respiratory organs.

The skin moreover is an important eliminative organ, having a close relationship with the kidneys in the performance of this function. There are some two million sweat glands distributed over the surface of the skin from which there is the escape of an average of three pints of water daily, and, in addition, a number of sebaceous glands which excrete oily substance. These glands are extremely minute, and may easily become clogged and ineffective from the accumulation of oily material mixed with the dust and scaly material cast off from the outer layer of the skin. The old fashioned idea, that there is danger of catching cold when one goes outside with the "pores all open" ought evidently to be exactly reversed, as the real danger is with the pores all closed. Cleanliness of the skin then, as well as a good healthy tone of its circulatory vessels, are both to be taken into account in all schemes to prevent cold. The latter is probably the most important of all factors, of which we shall have something to say when discussing the subject of hardening.

Finally, of causes to be removed we must mention the local ones. Any kind of trouble in the nose that interferes with breathing or that produces pressure or irritation, is harmful to the mucous membrane and acts as a predisposing cause of head colds. Nasal obstruction is, in many instances, due to malformation in the interior of the nose, which in turn is, in most cases, the result of injury to the nose during early life when the parts were tender and flexible. Obstruction, how-ever, is frequently due to the presence of a simple inflammatory growth, known as nasal polyps. These are non-malignant, but they nevertheless may grow to great size, are frequently of multiple occurrence, and show a tendency to recur after removal. They are of soft gelatinous-like substance, grow in pendulous masses from the sides of the nasal cavity, and are called polyps from their fancied resemblance to the sea mollusc or polypus. It is important that they be removed as soon as recognised, and if one wants to guarantee against their recurrence it is quite necessary that the ethmoid cells be radically operated upon, because there is in all cases underlying disease of these sinuses.

We have already spoken of adenoids and of the rôle they play in the causation of colds. In young children they are by far the commonest cause of head colds, in fact, some children with adenoids seem to be almost never without colds. They usually cause nasal obstruction, but not necessarily, because these growths, especially in a capacious throat, may be located in a way not to obstruct the posterior openings of the nasal passages. They predispose to colds because they are structures very vulnerable to the attacks of micro-organisms, and the infection quickly spreads throughout all the nasal membranes. These growths therefore should be suspected in every child that has frequent colds, and, if discovered, should be removed without delay.

As, in nearly all instances, the tonsils, which are of a similar nature, are likewise involved, they too should be removed at the same time.

We have been hearing in recent years a great deal of sinuses and sinus colds. As these are cavities hollowed out of bone and situated adjacent to the nasal passages and communicating with them, and since they are lined with mucous membrane continuous with that of the nose, it is only natural that they would become involved by extension of any inflammation there.

The fact is, sinus disease is not only caused by inflammation in the nose proper but in turn will cause it. It often happens that the sinuses become filled with pus or muco-pus, and by reason of closure or unfavourable situation of the channel of communication, the pus remains pent up in the cavity, so that you have what amounts to a closed abscess. That is, of course, a constant men-ace, acts as a focus of infection, and predisposes the patient to colds of the severest type.

The chief evidence of sinus affection is the presence at one time or another of abundant, thick, yellow discharge from the nose, and the presence of pain in cheek, or forehead, or one-sided head-aches, although in many cases pain is completely lacking. In every case of severe cold which is persistent or shows tendency to recur, the sinuses ought to be carefully examined. Brilliant results will follow properly directed treatment. In cases of only short standing, mild intervention will generally prove successful; in chronic cases, or those in which the bone has become diseased, radical surgical measures may be necessary.

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