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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

 Read More Articles About: The Common Head Cold

Predisposing Causes

( Originally Published Early 1900's )

That universal plague, which we call the common head cold, stands to-day as a mockery and a reproach to our boasted civilisation. It has steadily increased in spite of it, probably indeed as a result of it.

Modern medicine with all its triumph 'over disease has to confess itself impotent to prevent its occurrence and stem its progress, and this has seemed to have inclined the profession to assume an ignoble attitude of indifference toward this malady, as one too trivial to be worthy of its dignified consideration.

When, however, we reflect upon the frequency of its occurrence, the extent of its distribution, the possibilities for harm in its complications and consequences, we are forced to a realisation of the fact that it is an affliction of greater importance to the health, happiness, and efficiency of man-kind, than many of the rarer and more dreaded diseases.

As noted in the Preface, when we compute the losses as measured only in economic values, from this wide-spread malady, we find that they reach staggering proportions. It is unfortunate that the profession manifests so little interest and neglects scientific study of this disease, for the uninstructed public, left to its own devices, wanders in a maze of ignorance, holds to archaic ideas, and concocts fanciful theories of its origin, nature and cure.

The pathology of the day of Hippocrates is still perpetuated in the commonly used French name for head colds, rhume de cerveau, derived from the idea that the excessive discharge is of cerebral or brain origin, just as the name of pituitary body, perpetuates the false pathology that this organ is the source of the pituitary or nasal mucus.

Pliny, one of the most learned of the ancients, and deeply versed in oriental lore, announced with the finality and conviction born of acknowledged authority : "I find that a cold is checked by any one who will kiss the nostrils of a mule." I am sure, if he could make the same announcement today and get sufficient publicity, that he would at once have faithful followers, expert in the practice and enthusiastic in the preaching of this queer doctrine.

To understand a disease so that we can success-fully treat it, we must have an accurate knowledge of its pathology; to understand a disease so that we can prevent it, the most essential thing is to have a complete knowledge of its cause.

We are here concerned especially with the latter requirements, but in any case we should begin with an intelligent understanding of the nature of the disease in question.

It is not the disease which we should fear but its causes, and the prime need of medical science is to seek out and to give each its due weight and interpretation, never, unfortunately, such an easy business, because causes are always numerous, and modify one another greatly in their operation.

We have thought that a logical classification of the causes of colds might be made as follows :

1. Direct (Exciting) Causes.

a. Bacteriological

b. Meterological

2. Indirect (Predisposing) Causes.

a. General

b. Local

A word with regard to the direct or exciting causes of colds.

We are of the opinion that in recent years an over-emphasis has been placed upon the rôle of micro-organisms in the causation of colds and as a consequence of this, an over-dependence upon the use of vaccine and local antiseptics in their cure. We hold that colds are directly superinduced by the joint action of micro-organisms and of certain unfavourable atmospheric factors and that one is as necessary as the other.

It seems very unreasonable to exclude the atmospheric factor in the causation of colds in the respiratory organ, for the latter was created especially to deal with our atmospheric environment and we should naturally expect it to be influenced by it, just as the eye is influenced by light, the ear by sound, and the stomach by food.

Furthermore, the nose is particularly designed to react to humidity and temperature, the physical properties of the atmosphere which have most to do with causing colds.

We protest therefore against the too exclusive bacteriologic theory of colds, because, in addition to what we have already noted, this theory has been responsible for a certain tendency to place too little reliance on general health and body resistance, and on the various causes which we would designate as predisposing.

The search for predisposing causes of colds goes back into the early life, environment, and habits of the individual; we must ascertain when the predisposition began to be formed, and this consideration is of vital importance, because it may give the key to the question why we catch cold. We are all constantly exposed to inclement weather, and the micro-organisms we have constantly in our midst. Why does one person con-tract cold and the other escape, exposed to the same conditions? Because in one case the soil was favourable, and in the other not. The prevention of colds is therefore never accomplished by expedients of the moment; it can only be assured by years of earnest devotion at the temple of Hygeia.

When a patient appears before us and complains that he is very subject to colds, we inquire as to his exposure to exciting causes, and we review all possible predisposing ones. For an individual case, this review is never a simple matter because the predisposing causes are numerous, complicated, and sometimes obscure. It is therefore the duty of the profession to broadcast such authentic information as it may have, so that the individual informing himself upon the subject in general may apply what best fits his own case, and profit by it.

We remarked in the beginning that colds are the accompaniment of our higher civilisation. The more artificial methods of life devised for ease, comfort, and luxury, by relieving nature of making the necessary reactions towards its environment, cause the human body to lose its birth-right of vitality and vigor, and become soft, tender, and lacking in resistance. And so what we call the conveniences of life, are offset by their attendant hygienic drawbacks.

The overheated home in winter paralyses our heat producing mechanism, the ever present fan of summer upsets the cutaneous circulation, the automobile touring mania fills our air passages with dust, the rich and highly seasoned food overstrains the gastric and hepatic functions. In general, we eat too rapidly, drink too much, smoke too often, dress too heavily and work too hard. We exercise too little, get not enough fresh air, take insufficient sleep, rest too seldom, and have too few diversions.

For laying the foundation for future trouble in the air passages, there is nothing equal to over-heated places of abode. Homes, shops, offices, factories, schools, churches, theatres, lecture halls, public conveyances, are generally heated above hygienic requirements, because so many people demand it and are dissatisfied unless an undue heat is maintained.

In England and the Continent we find people comfortable and content in a temperature 65 to 68 F., which hygienists have agreed upon as most salutary. In this country we find temperature maintained more often above 70 than below, quite often around 75 and 80, and at times even higher. It is inevitable that persons living habitually in such an atmosphere must develop an inertia of the heat regulating apparatus, a sluggishness of the skin circulation, and poor response on exposure to the stimulus of cold air.

The worst thing about confined air over-heated, is that such air is likewise over-dry, a very bad thing for the mucous membrane of the respiratory tract. Air has an increasing capacity for watery vapour with rising temperature. Air, that at a lower temperature had a proper humidity, has with heating come to have a relative low humidity and therefore is excessively and unhealthfully dry. With its increasing affinity for water, it abstracts water from the air passages, which places them under a severe strain, especially as the nasal function has become inactive and sluggish because of the heat.

The air of a room in which the ventilation is poor or which is occupied by too many persons may become vitiated by an excessive proportion of carbonic acid gas, derived not only from animal exhalation, but likewise from coal, charcoal, and other fuel burned, and in less degree from plant life. On the average, each man exhales about 5 gallons of this gas per hour, so that it has been estimated that mankind alone pours into the atmosphere one billion and a half tons of carbonic acid gas in the course of a day, to say nothing of that coming from plants, that from from -organic material, and that derived from the combustion going on in our houses, factories, etc.

Fortunately, in the outside air this gas which we call CO2 diffuses so rapidly that little harm results, but in crowded places it may reach unhygienic proportions. Some hold that CO2, per se, is not a dangerous component of the air when in excess, but that the harm of a crowded place is in the accompanying poisonous animal exhalations, and a still more modern theory is that ventilation is not at all a matter of the components of the atmosphere, but that the suffocation experienced is due to high temperature, humidity and lack of movement in the air. Whatever be the truth, we may always look upon CO2 as a measure of the purity of the air. In the country, air contains on an average of 0.03 per cent, in the cities 0.04 per cent. If in any situation it reaches 0.06 we are breathing an unwholesome atmosphere. In work rooms, offices, schools, etc., there should be at least 1000 cubic feet of space allowed for every occupant.

If we have not permitted our senses to become dulled by long habituation, we are generally able to appreciate an unhygienic air without measuring it. We are conscious that it is close, stuffy, unpleasant to our olfactory sense and uncomfortable to our bodies. If we remain in it too long, we become restless, nervous, and irritable. The correction is simply plenty of fresh air without draft, and it is better from time to time to open all the doors and windows freely and permit complete change than to allow a small amount of air to enter for a long time. The cold fresh air has an immediate stimulating effect upon the circulation, as well as upon the respiratory passages, and we feel its invigorating effects at once on mind, body, and spirit.

Some persons are obliged to pass much time in a vitiated atmosphere, by the necessity of their occupation. This is true of those who are employed in the dusty trades,—masons, stone-cutters, rail-road employes, etc.—or those in factories attended with fumes of irritating gas. Others are obliged to work in an atmosphere of cold and humidity, as employes in ice factories and cold storage places, some again in an atmosphere of high temperature and humidity, as in steam laundries.

Such persons develop regularly certain forms of catarrh and naturally acquire the local cause of lessened resistance to colds. They should change their occupations if possible, but they are not as much to blame as those who disregard these unhygienic situations and become indifferent, ending by having their senses so obtunded or dulled that they are not aware of them.

The arrival of the vacuum cleaner should be heralded as a great hygienic advance, taking the place of the broom and the old feather duster, which in the hands of the energetic house maid, so successfully filled the air with dust from the floor, furniture, upholstery and drapery. Unfortunately with the increased craze for touring, what we miss in the dusty room at home, we get with interest on the dusty roads abroad, helped by the velocity of the winds or the velocity of our travel.

There is no subject more important than dress, when considering the problem of the disposition to cold. The object of dress is primarily to economise the body energies by preventing undue loss of heat to the surrounding cold air. In performing this function there must result a certain restriction in the operation of nature's own automatic machinery designed for the same cause, and as inefficiency follows inaction, we then acquire a weakened heat-regulating vasomotor mechanism and a greater susceptibility to the effects of temperature variations. However, clothes we must wear, and all that we can do is to take care that they are suitable. We can see to it that they are neither insufficient nor excessive; not of improper material nor improperly worn.

The chief requisites for clothes from a hygienic standpoint are as follows: (1) they should be poor conductors of heat; (2) they must be efficient absorbers of moisture ; (3) they must have permeability; (4) they should be of as little weight as possible; (5) they should allow unrestricted body movement ; (6) they should not make undue compression on any part of the body.

Poor heat conduction is the quality of clothes necessary to proper warmth and therefore more important for winter weather and in cold climates. Air is distinguished for its property of conducting heat poorly, for which reason it is of great advantage that winter clothes be of a material which in the interstices may contain much air. Nature is known to make use of this physical fact in the construction of both the feathers of birds and the fur of animals. The winter fur of animals, it has been observed, differs from that of summer, not in density or amount, but in its greater porosity.

It is very essential that the clothes we wear next to the skin shall have a high degree of absorptive power, and with it the property of giving up the moisture readily but not too rapidly. Remember that about three pints of water are given through the skin daily, and in addition we have a considerable amount of oily material,—product of the sebaceous glands. When not promptly absorbed, the surface of the skin will become covered with a thin layer of oily sub-stances mixed with scales and epithelia, which tend to clog up the excretory ducts and hinder healthy skin function. This indicates not only that clothes should have good absorptive powers but that they should be frequently changed.

See to it that no material is worn of such dense and impenetrable structure that it does not allow the air to penetrate to the skin, a very necessary condition. Leather, fur, rubber and such impenetrable goods should therefore only be worn for urgent reasons and never for a long time. They should always be discarded as soon as the necessity for wearing them has passed.

Care should be taken not to overtax the body energies by wearing clothes of great weight. It is not the thickness of clothes that gives it warmth, but, as pointed out, its weave and the porosity of its fibres.

That dress should never be worn so as to impede movement or make undue compression on any part of the body is self-evident. Fortunately, body lacing is not practised as in former days but we see instances of harmful compression from shoes, garters, belts, collars and hats. An excessively tight collar may so compress the superficial vessels of the neck as greatly to impede the circulation and give rise to marked collateral congestion evident in the mucous membrane of the throat.

In regard to a choice of material for underwear there is difference of opinion. Woollen is of all goods the poorest in heat conduction, and it is also a good absorbent. In cold climates, it is certainly best for the outer garments and for those much out of doors perhaps also for underclothes, but there is some disadvantage in its tendency to shrink and lose its porosity. Linen and cotton are not quite such poor heat conductors, but they have excellent absorbent properties and they readily give up their moisture,—linen a little more rapidly than cotton. They are accordingly probably better material for underwear in temperate and warm climates.

In the last year or so, silk has become a popular material for underwear especially with women, which we consider to be a rather fortunate thing, with the tendency of women to wear less clothes. While not equal to wool as a protector against cold, it has double the heal; conserving value of cotton or linen. It also has some advantage over linen in that it absorbs and gives up moisture slowly and therefore there is less danger of chilling, when exposed to cold air after heavy perspiration.

We will mention only for the purpose of condemning it the habit of wearing fur caps, neck scarfs, mufflers, leather vests and the like. These special extra coverings only tend to bring about a greater softness of the parts so protected and so to give rise to the very thing they are intended to prevent.

Sudoriferous glands are known to be particularly numerous over the surface of the neck and feet, and therefore for physiological reasons we should especially avoid covering these parts with impermeable material. Unfortunately, we have no satisfactory substitute for leather as a foot covering, and we must continue to have this weak point in our lines of defence, the most common gateway for the entrance of colds.

Great emphasis is properly placed nowadays on the rôle of autointoxication and the influence it has in cold catching. The by-products of disordered metabolism (tissue changing) circulating in the blood give rise to constant irritation in the mucous membrane leading to congestion and preparing the way for infection.

It seems to be generally agreed that the most common dietetic error consists in the ingestion of excess of proteins with faulty elimination, giving rise to an excessive richness of the blood. The proper proportion of protein intake is about 10%, but the average person takes nearer 20% and not a few as high as 30%. We are giving good advice to the chronic cold catcher if we advise him to eat less meat and more vegetables. The meats especially to be condemned are sweet breads, liver, kidney and high games, and we should include in our prohibitive order the putrefactive cheese, and for some people tea and coffee.

Care must be taken that we allow sufficient vitamins, so important for the vitality and general well-being. This can be assured by a generous allowance of milk, yolk of egg, whole grain, and fresh vegetables. As in the case of clothes we more often err by wearing too much, than too little, so with food, it is more often excess rather than insufficiency that is at fault.

The author of "Paradise Lost" was a good hygienist as well as a great poet. Apropos of the subject, hear what he has to say:

"There is," said Michael, "if thou well observe

The rule of Not too much, by temperance taught
In what thou eat'st and drink'st, seeking from thence
Due nourishment, not gluttonous delight,
Till many years over thy head return ;
So may'st thou live, till like ripe fruit thou drop
Into thy mother's lap, or be with ease
Gathered, not harshly plucked, for death mature."

So far the causes we have considered are all of external origin. There are some predisposing causes of colds, arising within the body, due to a disordered condition of some of the viscera, or to general systemic states. Any disease which tends to give rise to congestion of the respiratory tract indirectly makes the subject more susceptible to colds by creating a condition of lowered resistance in these parts. A leaky heart for instance, when not compensated, gives rise to a general passive congestion which includes the mucous membrane. Diseases of the stomach and the liver are also frequently responsible for an obstinate catarrhal condition of the respiratory passages. Disorder of the eliminating organs, kidneys, intestinal tract and skin are, above all others, those which have the most unfavourable influences.

There are many cases of catarrhal disease which require attention to the condition of the intestinal tract, rather than sprays and swabs; cases that would benefit more from a dose of calomel than from an operation on the septum. Too much stress cannot be placed upon the part played by the skin and its influence upon the respiratory tract—its influence for good, if the cutaneous circulation is active and responsive, its influence for evil if it is inactive and sluggish.

The nasal organs in addition to their olfactory and respiratory functions have certain duties to perform in connection with the heat regulating operation of the body. While about 78% of the heat of the body is eliminated by the skin, most of the remainder is eliminated by the nose, and in this capacity the latter organ must be regarded as a sort of adjunct to the skin, and therefore susceptible to and profoundly influenced from this quarter. There is in fact a close relationship between the blood supply of these two systems through the sympathetic nervous system.

The mucous membrane may also suffer from defective elimination as a result of sluggish skin with inactive glands, just as it suffers from poorly functioning kidneys and intestinal organs. An extra burden of elimination is thrown upon the respiratory membranes by the toxins which are not eliminated by the usual channels.

Various disorders of the blood itself may have to be considered as possible causes of colds. Anemia in its different forms, especially chlorosis, must be thought of, and it is well known that leukemia may give rise to various disturbances in the upper air passages. Finally we need only mention certain general body states (or dyscrasias), supposed especially to predispose to disorders in the upper air passages, and favour the tendency to catch cold. We hear most often mentioned the uric acid or lithemic diathesis, or the condition spoken of as status lyuipaticus or lymphatic diathesis, and more recently attention has been called to an especial peculiar irritability of the sympathetic and parasympathetic nervous system, in which hay-fever conditions are especially prone to develop.

We have now to consider those predisposing causes resident within the nasal passages them-selves. Because of the presence of certain kinds of disease, or certain kinds of malformation of structure, the nasal organs become as it were, loci minoris resistentiae, or places of lessened resistance, falling thereby more readily a prey to attacks of fresh inflammation. A chronic catarrh is sometimes spoken of as a chronic cold while often, in fact, it is only the result of persistent and repeated attacks, each leaving as it were some souvenir of its visit by a residue of inflammation. Now since the chronic condition once established, in its turn, constitutes a locus minoris, predisposing to the acute attack, there is thus created that most dreaded thing, the vicious circle. How particularly urgent therefore the removal of these local lesions.

In children the adenoids are the most prolific causes of head colds. We do not need to press the point, as it is usually recognised by parent, as well as by a physician. A child who is almost never without a cold, while his nasopharynx is filled up with adenoid vegetation, becomes promptly a normal child in this respect immediately after their removal.

In the adult we hold the diseased sinus as more often responsible for attacks of acute rhinitis than any other cause. In the case of the ever-present cold, the cold that never seems to leave, or that too soon returns with added virulence, we may confidently look for a focus of infection in one of the sinuses,—ethmoid, maxillary or sphenoid.

The fault is sometimes with other kinds of lesions, especially obstructive lesions that give rise to pressure and interfere with drainage» It may be a deviation of the nasal septum, an out-growth or spur formation on the septum; a polypoid growth, an enlarged turbinai, or some other condition. But whatever it be, if pathologic, it must be corrected in the cold-disposed individual, if we wish to cure him, having always at the same time in mind the general condition of the patient, and the fact that other causes may be present besides the one we see.

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