The Common Head Cold:
Principles And Practice Of Hardening
Home Care And Treatment
Nasal Obstruction And Mouth Breathing
Voice And Speech
Summary And Conclusions
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Principles And Practice Of Hardening
( Originally Published Early 1900's )
"Life," remarks Seneca, "is a state of warfare," and as a successful war cannot be waged by assuming always a defensive attitude, but requires at the proper times an active aggressive policy, so, in fighting the enemies of the body, there must be eventual failure if one adopts with-out change a course of inertia, inactivity, and evasion.
Yet we do see many people who believe implicitly that by shutting themselves indoors and never venturing forth, they are safe against the dangers of catching cold. As a matter of fact we know that this is the surest way to fall a victim, if not at the very time, then very easily later on. Colds are mainly for those who in this way have grown to be soft and susceptible. As the exercise of functions is essential to the development of vigour, the coddling habit can have no other effect than to lessen the powers of resistance; and a pampering process is the surest means to paralyse the natural forces of immunity.
A muscle seldom exercised grows soft and flabby, nerve cells become inert which are seldom stimulated; arteries relax when not frequently called into action; glands fail to secrete and atrophy if function is long suspended; and a joint that is never moved, in time becomes stiff and useless.
It has happened quite often to me to hear a patient complain bitterly of a severe cold, pro-testing that he has done nothing to contract it. "Doctor, I cannot understand for the life of me how I caught this cold. I have been more than usually careful, and have not done a thing so far as I know to make me catch it."
The answer is, it is not enough that one should do nothing to catch cold, it is necessary that one do many things to avoid such a result. One must, in fact, make special efforts and put into practice special procedures which have for their purpose the habituation of the body to the conditions which are recognised as the causes of colds, and thus make it capable of withstanding them. One seeks, in other words, to fortify the natural resistance of the organism and to augment the forces destined to overcome disease, by a process which is known as hardening.
In the case of colds, hardening methods are especially in order with reference to various atmospheric conditions, because these are ever present factors which cannot be escaped, and because means are available to reproduce at will the same or similar conditions, in measured dosage.
Hardening is concerned essentially with that mechanism of the body, which has to do with heat-regulation. Man is a homoiothermic animal, that is, his internal temperature must be kept uniform. To maintain at all times an equable internal temperature, he is provided with a special heat-regulating mechanism. This achieves its effect by the contraction and relaxation of the diminutive arteries which supply the skin, under the control of sensitive heat-regulating nerve centres in the spinal cord.
As elimination of heat depends upon the state of the cutaneous circulation and the accompanying activity of the sweat glands, it is clearly important that these functions should be always accurately responsive to atmospheric variations. This adaptability of the cutaneous vessels, as it may languish with disuse, so it may be cultivated by practice. Therein lies the value of hardening methods, which aim to exercise the vaso-motor mechanism of heat regulation. There have been some absurd doctrines taught and put into practice in the name of hardening, which we are convinced have done more harm than good. It will be well, therefore, to consider the true underlying principles, upon which correct hardening methods are based.
The first and fundamental principle that should be made to apply with regard to all hardening methods for colds is this : accustom the body only to those weather conditions to which in the ordinary course of existence the individual may expect to be exposed. Owing to the vicissitudes of our climate, we must encounter various atmospheric states with reference to cold and warmth, moisture and dryness, and movement of the air, to all of which it is desirable we should become accustomed.
One may take occasion to face all kinds of weather inclemencies in a reasonable way, but no good purpose is served, and much harm may be done by foolhardy exposure. To tramp around in the snow with bare feet, to go about on a cold windy day without hat or overcoat is a senseless fad, for which there is no valid excuse.
Hardening, by whatever methods may be chosen, must begin lightly, increase gradually, and never be excessive. It should be begun in a manner to make slight demand upon the vital energies. This is especially true in young children, whose reflex mechanisms are undeveloped and untrained. There is no greater hygienic error than to start a young child off suddenly with a routine method of hardening without due regard to the fitness of things. It is a practice fraught with much danger to the child's delicate organism.
The hardening process should have a gradual increase with such additions at each successive step as can be certainly and safely borne. The law of gradual increase of load, is one of nature's laws of which there are many illustrations. The muscles grow by exercise, and learn each day to lift a slightly heavier load, but the increase must be gradual and without excess. Great care should be taken that the limit of tolerance be not exceeded. The muscle loaded beyond capacity of endurance is strained. First comes fatigue, the danger signal; if this be not heeded, soon comes strain, then exhaustion, and finally degeneration with irreparable injury. "Everything in excess," said Hippocrates, "is averse to nature." In fact excess ends usually by defeating its own purpose. A muscle by exercise is strengthened, but over-exercise will cause serious strain and injury; a nerve cell grows efficient by normal function, but may be paralysed by over-stimulation.
The object of hardening is to prevent colds by exposure in a measured degree to the causes of colds; but if the exposure is excessive the result will be to cause colds instead of to prevent them. Therefore, whatever may be the means adopted with a view to hardening, see to it that it is not carried to a dangerous extreme, causing the very thing it has been our object to prevent.
Whenever exposure to cold is used as a stimulus for the purpose of hardening, it is essential that a healthy reaction be obtained.
An important requisite in the employment of hardening methods is a normal consciousness of temperature variations. Beside the nerves of common sensation there are distributed throughout the cutaneous covering, myriads of minute nerve endings, for the special sense of heat and cold. To have a reaction it is only necessary that the stimulus be a degree or so below the point of indifference.
Exposure to cold within physiological limits induces a normal reaction recognised by a healthy glow and general feeling of exhilaration, but if the stimulus be excessive and the reaction fail, the individual may experience an unpleasant shock, evidenced by chilliness or even a state of collapse. Individual differences must always be taken into account, as all persons are not constituted alike in their powers of reaction, and some have decided idiosyncracies in this particular. As the reaction is the real measure of the value of a cold stimulus, the latter should be graded with reference to this result. The sensation of the patient must not be ignored; children especially have often a great dread of cold in the form of the cold bath or cold shower, and harm has often been done to their nervous systems in forcing these measures on them.
Hardening methods designed to prevent colds should never be employed at the time that one has a cold. When one has already acquired a disease, all of the energies of the system should be occupied with efforts to get rid of it. It is not the proper time therefore to make extra demands, or tax the energies with additional burdens.
Beneficial as we know exercise to be, it is contrary to nature and positively harmful to persist in the exercise of a muscle that is already fatigued. Similarly, hardening methods, however valuable during the period of good health, or the interval between colds, are never to be adopted when the individual is struggling to get rid of an attack. A disordered mechanism cannot respond in a perfectly normal way. There is, in the case of individuals in the grip of a cold, an evidently disturbed balance in the heat regulating mechanism and an abnormal sensitiveness to thermic impressions.
When the patient therefore is suffering from the acute state of a cold, he should not be exposed to cold temperature, but remain indoors in a warm comfortable room. Instead of engaging in strenuous physical exertions, it is best for him to rest quietly in bed. It is entirely wrong then to employ cold baths, cold plunges or cold showers, which are so valuable as hardening methods at other times, but he should take only hot or warm baths.
The three methods employed for hardening against colds are by exercise, air, and water.
The beneficial influence of exercise upon the body economy has been long recognised by the general public as well as by the physician. People for the most part having a personal realisation of its freshening, invigorating effect, come to en-joy exercise and are inclined to continue its use; unfortunately it too often happens that because of the demands of business, society or other reasons, it is omitted. This omission should be always fought against, because with abstention a natural redolence too easily develops and a sedentary habit replaces the habit of exercise.
Muscular activity is essential for healthy living, and its benefit is not confined to the muscles themselves, but has its reflex throughout every organ and part of the body. The physiological explanation of its value is found in the increased flow of lymph and blood, and the increased chemical and physical change affecting all the tissue cells. Heart action is strengthened, respiration quickened, and the digestive functions improved. When muscular exercise is practised every day, one does not need to prescribe breathing exercises, because this must follow as a natural physiological need.
From the standpoint of colds the great value of exercise lies in the effect it has upon the cutaneous circulation. With increased muscular activity there is of course increased heat production, and the system aiming to maintain a normal balance rids itself of excess by bringing about dilatation of the small arterioles of the skin, and increased activity of the sweat glands. Thus is relieved the internal congestion which favours inflammation, and thus is acquired that discipline of the heat-regulating mechanism, which is the great object of all hardening methods.
The best exercises are those which engage the greatest number of muscles. The object is not to develop excessive strength in one or in a group of muscles, but to promote a healthy function of the body by general muscular activity. It is well then to vary the exercises in as many ways as possible. The most beneficial are those of various games and sports, for the reason especially that they are without conscious effort, and are attended with an agreeable exhilaration of the spirits.
Of course, we must accustom ourselves to air, and become hardened by exposure to various atmospheric variations, because air is our natural environment. We hear a great deal about the hygienic importance of having fresh air for our lungs, but very little attention is given to the equal necessity of having cold air for the skin.
As pointed out, atmospheric air is fairly constant in the proportion of its chemical constituents but very inconstant in its physical properties. It is the latter which are of importance to us from the standpoint of cold catching, and consequently in the consideration of the subject of hardening.
Inasmuch as in the ordinary transactions of life we cannot escape the vicissitudes of climate, it is incumbent upon us to harden ourselves to all of the physical variations of the atmosphere. Nothing is more absurd than the notion that the most healthful locality is one in which there is an even or equable climate, or that one should in one's own homes keep the temperature at a constant mark. One needs at times the stimulating effect of a change and above all the wholesome invigorating influence of cold.
If we have been shut up for hours in close, over-heated, ill-ventilated apartments, and we feel the need of fresh air, do not aim to let it in gradually, but throw open all the windows widely for a few minutes and let the cold in suddenly. This we have already recommended in the chapter on Causes. There is really no danger even on cold winter days, in catching cold in this way, and the the effect is magical.
Cold air has a good effect upon the breathing apparatus, in that it stimulates the lymph glands and causes a beneficial secretion of lymph, but its greatest value lies in its wholesome influence on the body surface. It is of great importance that the naked skin should become accustomed to feel fresh air. Benjamin Franklin saw this and advised as a useful rule of health that the body, divested of clothing, should be exposed a few minutes at least every day to the air. It is an excellent practice and the best means to counter-act the over-sensitiveness of the skin, due to its being usually enveloped in impermeable clothes.
"The Polar bear slept in his Polar bear skin,
Which shows not only the need of hardening, but also that hardening methods in the case of cold air, as with cold water, should begin lightly, in-crease gradually, and never be excessive.
There are many people who flatter themselves that they do all that is necessary for health's sake when, bundled from head to foot, they go for a ride through the city park. This they call taking an airing, but the only part of the body surface which gets the benefit is the face, which needs it least.
You know the story of the healthy savage, and his reply to the astonished traveller who could not comprehend how he could stand exposure to the cold weather almost naked. He said, "You have no clothes on your face. Have you?" "No." "Well, me all face." It is indeed astonishing how one can by practice, accustom the body even to quite cold air; beginning as we have said gradually and doing it a little more each day, with care not to go to excess.
When exercising at the time, it is perfectly safe to go out almost naked for a short time on the coldest day. As elsewhere noted, we are all familiar with the sight of young men doing the Marathon training exercises, trotting through the streets stripped to the waist and with bare legs. Sailors wear habitually low collars, exposing their necks to all kinds of weather, with impunity, and there are no statistics that I know of that indicate they are more subject to sore throat than other people.
There is no part of the body, which is so completely protected and so persistently deprived of air as are the feet, and it is the universal experience that there is no part of the body which is more sensitive, and which is more often responsible for colds. Youngsters roughing it in the country and going about a great part of the time barefooted have on this account a great advantage over us grown-ups, but opportunity should be taken by every one to aerate the feet when possible. We repeat here the advice given in another connection, to change shoes and stockings when-ever the feet are wet or damp, and if possible at any rate once in the course of the day.
Of all methods of hardening, the most valuable is the use of water, because it is susceptible to exact dosage, both as to temperature and duration of exposure. Bathing, first of all, has a certain hygienic usefulness from the standpoint of the skin. As a result of the secretion from the sweat and oil secreting glands, the surface becomes covered with a layer of oily matter, which left unwashed undergoes in time decomposition and gives rise to an objectionable odour. Furthermore it, clogs the openings of the minute sweat glands and interferes with their functions, which are, as already emphasised, of much importance in the heat regulating processes of the body.
The warm bath therefore is at times necessary, but it may be overdone, for used with too great frequency especially with soap, the skin may become dry and harsh. After a hot bath, the vessels of the skin are dilated and relaxed, and it is a good general rule that all hot baths should be followed by a short application of cold water in some form, as a shower or plunge.
Cold baths, both in the matter of temperature of the water and the length of time, must be different for different individuals according to their age and strength and previous habits, taking particular note of the character of the reaction which follows. There are some persons who have real idiosyncracies with regard to the cold bath, but there are certainly few, who cannot with a little gradual, careful training accustom themselves to a right cold bath and even in time come to enjoy it.
In experiments made in the case of dogs, it was found that if the animals were immersed in cold water for ten minutes for a number of days in succession they acquired quickly a power to withstand the cold. In the first and second days six degrees of temperature were lost at the end of the immersion, on the third and fourth days two and a half degrees, while in the end of a week there was a lowering of only a half degree of the dog's temperature.
In the case of man, it is not known whether or not there would be such a quick education of the heat regulating mechanism; at any rate, it is not necessary to undergo such a strenuous trial. One may begin with a temperature but little lower than that of body, and each day following, reduce the temperature of the bath only one degree. A genuine cold bath should be very short in duration, from ten to thirty seconds for most people, or at most not longer than sixty seconds. This will be sufficient to bring about a reaction lasting several minutes, and this reaction may be assured or increased by brisk friction with a coarse towel.
Cold baths should always be taken in a warm room, the best time being in the early morning following the regular morning exercises. It should not be taken within an hour after a full meal. Cold bathing should be completely suspended when one has been stricken with an acute cold.
The greatest precaution is necessary in the case of young children. Their reflexes are undeveloped and so one cannot always count upon the occurrence of a normal reaction. The water should be only a little below body temperature; or one may use with good effect a rub with a cold towel. Thoughtless use of routine cold baths in children has been known to have serious consequences to their nervous systems.
Even in grown persons the cold bath is without benefit if it be not followed by a good reaction, evident in the flushing of the skin and the general feeling of warmth and well being which immediately follows. Used in this way, the regular cold bath, tempered to the individual capacity, has a marvellous influence in overcoming sluggishness of the skin vessels, and training them to good vigorous response to the cold stimulus,—the best guarantee against the hazards of cold catching. The beneficial effect is felt throughout the whole system and there is general improvement in the nutrition of all the body cells; benefit is noted especially in the improved function of the respiratory and digestive organs.
Particular attention should be given to the feet, because they are encased so much of the time in impervious and often tight fitting leather, so that the circulation is impeded, and the vessels have become lax and sluggish. It is therefore a very natural craving that children have on the first warm day of spring to take off their shoes and go wading in the cool running water. In this light the wisdom of the advice given to the ancient her Theseus is readily understandable :
"This be thy guide, 0 man of woman born, Bathe well thy body at the break of dawn, But if ye would ablution make complete, Neglect ye not that pair of precious feet."
Sea bathing is doubly beneficial, because of the stimulating effect of the cold salt water, and the muscular exercise from battling with the waves. A common mistake made by bathers is to remain in the water too long. Fifteen to twenty minutes is for the average person sufficient, and those not accustomed should remain not longer than five minutes.
All good is cancelled and probably harm done, when one comes from the water with teeth chattering, skin goose-fleshed, and the lips purplish. One should immediately use the towel and put on clothes after the bath, as otherwise a good reaction would be lacking. There is much benefit to be derived from the salt air, and the rays of the sun, but they had better be before the dip, instead of afterwards. Also one should take care not to bathe too soon, that is, less than one hour after a regular meal. The best time is just before the meal hour.