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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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Principles Of Prevention

( Originally Published Early 1900's )

A commander of an army in the midst of war, confronted or surrounded by the enemy will be constantly engaged in one of three orders of activities, which will be adopted according to conditions or circumstances at the time prevailing, these activities being namely, attack, defence and retreat.

When the forces of the enemy at any time seem to be inferior and at a disadvantage in position or preparation, he seizes the opportunity to make an attack; but when the situation is reversed, it is the part of wisdom to avoid conflict and sometimes the best tactics to retreat; while, if they seem equally matched, he may perhaps neither advance nor retire but aim simply to take the position of defence and stand his ground.

All agencies which tend to give rise in any way to disease are enemies of the body, intent upon its destruction, and must be resisted according to the same principles.

Colds as we have learned are the product of a multiplicity of causes, some direct prominent and near at hand; others indirect, subtle and remote. To the former class belong micro-organisms and certain special atmospheric conditions which are always in the front ranks in every attack. To the latter belong a great host of contributory causes which we designate as indirect causes, lo-cal and general, not always much in evidence, or obvious, but never-the-less of evil influence and just as important to be overcome.

Sometimes these hostile agencies of disease are of such threatening character, and so powerful that it would be foolhardy to throw ourselves among them, and thus fall a victim to their violence; at other times, however, our best policy is to bravely take the aggressive.

Let us consider some causes of colds that ought to be avoided. Disease germs are everywhere and always present, and cannot therefore be *altogether escaped. We may, however, take care not to expose ourselves to them when they seem to be present in overwhelming quantity or in certain conditions which seem to particularly favour their unpleasant activities.

You may not be able always to avoid coming in contact with some one who has a bad cold, but you can at least avoid close contact as in kissing, or you can take care not to come within range of blasts of infected aire discharged by acts of coughing or sneezing, wherein lie the greatest danger. You may also take precaution not to use a towel, handkerchief, or napkin that may have been used by persons who are infected; but one must, on the other hand, not go to extremes in his precaution, as we sometimes witness in those who are hipped on the subject, and develop such absurd phobias as to be afraid to shake hands, touch door knobs, or pieces of money for fear of infection.

An infant or very young child ought particularly to be kept away from an individual with an acute cold. On account of its tender age it has not developed good defence reaction or immunity against cold, and when a cold does occur there is danger that it may become very serious,—possibly developing into pneumonia. Elderly persons and those who have become enfeebled and run-down from any cause should likewise exercise especial precaution, and I would particularly emphasise the danger generally not sufficiently taken into account, of falling a prey to colds when one is mentally as well as physically depressed, or fatigued. If one finds himself at the end of the day in a state of anxiety or worry from the cares and responsibilities of his office, he should not go into a crowded, stuffy, badly ventilated place. It would be far better to take a little recreation in the outside air, making it a point from time to time to take deep inhalations. A game of golf, a horse-back ride, or a brisk walk will quicken the circulation and stimulate deep respiration, with invigorating effect.

Special mention should be made of the dangers of swimming pools. Here is where the germs flourish, multiply, and grow active. So far it has seemed impossible, notwithstanding all the various methods of purification and sterilisation, to render a pool used by a number of persons at one time perfectly hygienic. You may insist on thorough preliminary bathing and scrubbing, but there is no way to prevent germs getting into the water through which they seem to pass with extraordinary celerity from the unhealthy noses and throats to the healthy ones. In fact studies have been made, which prove that this will easily occur and every nose and throat specialist can testify from experience in his own practice to numerous cases of sinusitis and middle ear inflammation that have arisen from contaminated pools. It is because of so many disastrous experiences of this kind that special committees have been appointed by national medical societies to investigate the evils and inform the general public on the subject.*

Atmospheric influences giving rise to colds are, like the bacteriologic, always with us and cannot be altogether avoided. We have none of us our habitation in

"Olympus, the reputed seat
Eternal of the Gods, where never storms
Disturb, rains drench, or snows invade, but calm
The expanse, and cloudless shines with purest day"

In the mundane sphere upon which we live and move and have our being, we must expect, on the contrary, to meet with the various inclemencies of the weather. In this so-called temperate zone we have to adjust ourselves not only to the great variations of the seasons but, also, often to certain unexpected variations of temperature, moisture, and movement of the air that may occur within only a few hours.

Aged persons, invalids, and those of naturally weak constitution or debilitated by disease may be justified in migrating to regions where the climate is mild and equable, and the rigours of winter are unknown, but for the individual of average health, with his life before him, this is a practice to be heartily condemned.

If we constantly evade the asperities of the weather we shall not be able ever to resist them, but if we expose ourselves in a reasonable way, we increase our powers of endurance, and make ourselves gradually less susceptible to their harmful effects. There is good reason indeed to accept the view of Huntington that no nation has ever risen to greatness except in a climate marked by storms, and sudden variations in temperature and humidity, not only from season to season, but also from day to day.

There are, however, limitations beyond which the individual may not be exposed without harmful results. Colds, we have found, occur because of great extremes, and great and sudden variations, and unnatural relations in the physical characteristics of the atmosphere. How far these influences may be borne with safety and when they must be avoided as dangerous to health, must often be determined by the co-existence of contributory causes. One may very well endure cold when in good physical condition and blessed with especially robust circulation and vigorous vascular reaction, but not so the anemic individual who leads habitually a sedentary life, and whose skin circulation is sluggish and inactive.

It must be remembered especially that to be exposed to cold while exercising, and while resting are two very different things. We see boys on the coldest days stripped to the waist and with bare legs, doing the Marathon practices with entire impunity, but how soon one would develop pneumonia in such a costume standing still or sitting ! For the milder exercises one must be bet-ter protected in cold weather, especially in the case of a high wind which may cause a very rapid abstraction of body heat. The danger is particularly great in periods of rest and relaxation, with the body overheated, and perhaps in a state of perspiration. It is therefore advisable with the finish of a game of tennis, or other active sport on a cold or windy day, not to sit around without an overcoat or some kind of wrap.

There is much danger in remaining standing in cold halls or carrying on long conversations standing on street corners, because in these circumstances the abstraction of cold is not counter-acted by the heat production of muscular exertions. It has been often remarked that long exposure to a slightly reduced temperature is much more likely to cause cold than the short exposure to a much lower one. In the former case there is no incentive to exertion, and chilling often occurs because of the absence of the reaction which naturally follows a decided cold stimulus.

The frequency with which colds are contracted upon attendance at a funeral is proverbial. Standing with head uncovered and feet perhaps on cold damp ground is enough to explain some cases ; but I believe we should account as an additional factor the general depression of spirits which prevails on such occasions. As with regard to germs, we believe the atmospheric factors more easily take hold of those who are mentally, as well as physically, depressed.

Leonard Hill lays much stress as a cause of colds, on the inequality of the temperature of the air in the upper and lower strata of houses and theatres, public halls, etc., in that while the floors may be cold and drafty the upper layers of the air will be warm and stuffy; so that while the soles of our feet have become chilled, our heads are enmeshed in warm and stagnant air, this being just the reverse of the usual, natural outdoor relations. Furthermore does it not accord with the formula of health, bequeathed to posterity by the great physician Boerhaave, as the quintessence of the accumulated experience of his professional life, "Head cool, feet warm and bowels open"

Under all circumstances one should avoid a draft. Aria di fenestra, colpo di balestra, says an old Italian proverb, meaning that the shot from a cross bow is not more deadly than the draft of air striking you from a half open window.

It is not a draft when the air, no matter how cold, comes from all directions and strikes the body from all sides, so that danger lies not in riding in an open carriage, but in a closed one with a blast of air striking the back of the neck through a partially open window; one need not fear half so much a room with all doors and windows open, as the insidious current through some small, hardly discoverable crevice. The menace of a draft is greatly enhanced if the surface of the body is at the time encased in warm layers of air and even more so if in a state of perspiration.

A badly ventilated living apartment is a condition, of course, to be avoided; and a prolonged stay in any habitation, private or public, in which many persons are congregated is prejudicial to the health, if the air be allowed to become stale and stagnant; likewise it is important, from the standpoint of colds, to be exposed as little as possible to a dust polluted atmosphere.

Diogenes of Apollonius, who lived about five centuries B.C., meditating upon some problems that have also agitated modern thought, offered an explanation of the superiority of man over the lower animals that seems to have escaped some of the controversialists of our own day. It was owing, he said, to man's upright position, by reason of which his nasal organs are farther removed from the earth so that he is not compelled to inhale so much of the contaminated air of the earth's surface.

There is a real danger, we feel certain, from the air blown into our faces from unclean streets, on a windy day, carrying diseased micro-organisms directly into the upper respiratory passages. Harmful effects are also sometimes produced by noxious fumes and gases connected with certain manufacturing processes and other causes; and from the smoke and dust of railroad travel, as also from chemical irritants and mineral dust connected with certain occupations.

Special mention should be made of gases used as a weapon of warfare. It is not generally realised that during the last war that of about 230,000 battle casualties treated in the hospitals for American troops, over 71,000 were on account of gas.

As consulting laryngologist at one of the larger hospital centres in the zone of advance, the author had exceptional opportunities to witness the devastating effects of the gas upon the upper air passages of our soldiers. It was especially during the forty-seven days of almost continuous fighting in the Meuse-Argonne drive, that train-load after train-load of gassed patients were brought to this centre.

At that time the gas almost exclusively used, was the so-called mustard gas, which acts as an intense irritant of the mucous membranes. In practically all these cases bacteriological invasion followed, so that our hospital wards were filled with patients who, in addition to severe burns sometimes producing extensive ulceration in the membrane, had developed severe attacks of rhinitis, pharyngitis, and laryngitis, of an infectious character.

In addition to the regular symptoms, it was observed that a great many of these cases suffered from more or less impairment of the senses of smell and taste, sometimes amounting to almost complete loss.

This we assume to be the result of the special effect of the gas, acting upon the nerve endings of the special senses, which might very well account for the insidiousness of its action, so often remarked.

Mustard gas has a tendency to settle in low damp localities, clinging to the ground for many hours after being deposited there. A history was frequently obtained of soldiers having slept in such places, unconscious of the danger that lurked all about them, to awake next morning to find themselves badly gassed. The gas having first taken prisoner the natural guardian of the air passages, the sense of smell, its continued injurious action was unsuspected.

Severe as these cases were, the use of gas of this type, contrary to general opinion, was evidently not the most inhuman form of warfare. The fatality was only 2%, as compared to 5% from rifle balls, 6% from shrapnel and 20-26% from sabre wounds and airplane bombs. In from two to four weeks most of the gas cases were ready to be sent back to the front, and it was really very seldom that there were any serious after effects.

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