COUGHS AND COLDS
"The power and corrigible authority of this lies in our wills."
_Othello_.
It might seem as though the will had nothing to do with such very
material ailments as coughs and colds, and yet the more one knows
about them, the clearer it becomes that their symptoms can be
lessened, their duration shortened, their tendencies to complications
modified, and to some extent at least, they can be almost literally
thrown off by the will to be well. The idea of a little more than a
generation ago that coughs and colds would be most benefited by
confinement to the house and as far as possible to a room of an
absolutely equable temperature has gradually given way before the
success of the open-air treatment for tuberculosis and the meaning of
fresh air in the management of pneumonia cases. Fresh, cold air is
always beneficial to the lungs, no matter what the conditions present
in them, though it requires {197} no little courage and will power to
face the practical application of that conclusion in many cases. When
it is bravely faced, however, the results are most satisfactory, and
the respiratory condition, if amenable to therapeutics, is relieved or
proceeds to get better. Of course it is well understood that any and
every patient who has a rise in temperature, that is whose temperature
is above 100 deg. F. in the later afternoon hours, should be in bed. Under
no circumstances must a person with any degree of fever move around.
This does not mean, however, that such patients should not be
subjected to fresh, cold air. The windows in their room or the ward in
which they are treated should be open, and if the condition is at all
prolonged, arrangements should be made for wheeling their beds out on
the balcony or placing them close to a window. The cold air gives them
distinctly chilly feelings and sometimes they complain of this, but
they must be asked to stand it. Of course if the cold disturbs their
circulation, if the feet and hands get cold and the lips blue, the
patients are not capable of properly reacting against the cold and
must not be subjected to it. Their subjective feelings of chilliness,
however, must {198} not be sufficient to keep them from the ordeal of
cold, fresh air; on the contrary, they must be told of the benefit
they will receive from it and asked to exert their wills to stand the
discomfort with just as little disturbance as possible.
People suffering from coughs, no matter how severe, should get out
into the air regularly, if they have no fever, and should go on with
their regular occupation unless that occupation is very confining or
is necessarily conducted in dusty air. Keeping to the house only
prolongs the affection and makes it much more liable to complications
than would otherwise be the case. Sufferers from these affections
should not go into crowds, should avoid the theaters and crowded cars,
partly for the sake of others--because they can readily convey their
affection to them--but also for their own sake, because they are more
susceptible to other forms of bacteria than those already implanted in
their own systems and they are much more liable to pick up foreign
bacteria in crowds than anywhere else. They should be out in the open
air, particularly in the sunlight, and this will do more to shorten
the course of a cough and cold than anything else.
{199}
They need more sleep than before and should be in bed at least ten or
eleven hours in the day, though if they should not sleep during all of
that time, they need not feel disturbed but may read or knit or do
something else that will occupy them while they retain a recumbent
position. They should not indulge in long, tiresome walks and in
special exertion, but should postpone these until the cough has given
definite signs of beginning to remit.
With regard to the cough itself, it must not be forgotten that the
action of coughing is for the special purpose of removing material
that needs to be cleared from the lungs and the throat and larynx. It
should not be indulged in except for that purpose. It requires a
special effort, and while the lungs and other respiratory passages are
the subject of a cold, these extra efforts should not be demanded of
them unless they are absolutely necessary. Almost needless to say,
people indulge in a great deal of unnecessary coughing. Some of this
is a sort of habit and some of it is due to that tendency to imitate,
so common in mankind. Every one has surely heard during religious
services, in a pause just after heads have been bowed in prayer or for
a {200} benediction, a single cough from a distant part of the church
which seemed to be almost the signal for a whole battery of coughs
that followed immediately from every portion of the edifice. If some
one begins coughing during a sermon or discourse, others will almost
inevitably follow. Coughing, like yawning, is very liable to
imitation.
The famous rule of an old-time German physician was that no one was
justified in coughing or scratching the head unless these activities
were productive. Unless you get something as the result of the
coughing, it should not be indulged in. There are a great many people
who cough much more than necessary and who delay the progress of their
betterment in that way. Whenever material is present to be coughed up,
coughing is not only proper but almost indispensable. It is the
imitative cough, the coughs which indicate overconsciousness of one's
affection, the coughs that so often almost unconsciously are meant to
catch the sympathy of those around, which must be repressed by the
will, and when the patient finds that he really has to cough less than
he thinks, he will be quite sure that he is getting better and will
actually improve as a consequence of this feeling.
{201}
Coughs need an abundance of fluid much more than medicine, and warm
fluids are better than cold; the will must be exercised so as to
secure the taking of these regularly. At least a quart of warm liquid,
milk if one is not already overweight, should be taken between meals
during the existence of a cough. Hot milk taken at night will very
often secure much better rest with ever so much less coughing than
would otherwise be the case. The tendency to take cough remedies which
lessen the cough by their narcotic effect always does harm. Coughing
is a necessary evil in connection with coughs, and whatever
suppression there is should be accomplished by means of the will.
Remedies that lessen the coughing also lock up the secretions and
disturb the system generally and therefore prolong the affection and
do the patient harm. Most of the remedies that are supposed to choke
off a cough have the same effect. Quinine and whiskey have been very
popular in this regard but always do harm rather than good. Their use
is a relic of the time when whiskey was employed for almost every form
of continued fever and when quinine was supposed to be good for every
febrile affection. We know now that quinine has no effect {202} except
upon malarial fevers, and then only by killing the malarial organism,
and that whiskey is a narcotic and not a stimulant and does harm
rather than good. Those who did not take the familiar Q. and W. have
in recent years had the habit of administering to themselves or to
their friends various laxative or anodyne or antiphlogistic remedies
that are supposed to abort a cough or cold and above all, prevent
complications. All of these remedies do harm. Every single one of
them, even if it makes the patient a little more comfortable for the
time, produces a condition that prevents the system from throwing off
the infection which the cold represents as well and as promptly as it
otherwise would.
It requires a good deal of will power to keep from taking the many
remedies which friends and sometimes relatives insist on offering us
whenever a cold is developing, but the thing to do is to summon the
will power and bravely refuse them. Medicine knows no remedies that
will abort a cold. The use of brisk purgatives, sometimes to an extent
which weakens the patient very much the next day, is simply a relic of
the time when every patient was treated with antimony {203} or calomel
and free purgation was supposed to be almost as much of a cure-all as
blood-letting. There is no reason in the world to think that the
emptying of food out of the bowels will do any particular good, unless
there is some definite indication that the food material present there
should be removed because it is producing some deleterious effect.
The longer a physician is in the practice of medicine the less he
tries to abort infectious diseases, and coughs and colds are, of
course, just infections. They must run their course, and the one thing
essential is to put the patient in as good condition as possible so
that his resistive vitality will enable him to throw off the infection
as quickly as possible. It requires a good deal of exercise of will
power on the part of the physician to keep from running after the many
will-o'-the-wisps of treatment that are supposed to be so effective in
shortening the course of disease, but any physician who looks back at
the end of twenty years will know that his patients have reason to be
thankful to him just in proportion as he has avoided running after the
fads and fancies of current medicine and conservatively tried to treat
his patients rather than cure their diseases. The patient is ever so
much {204} more important than his disease, no matter what the disease
may be.
Above all, for the cure and prevention of coughs and colds people must
not be afraid of cold, fresh air. A good many seem to fear that any
exposure to cold air while one has a cough may bring about pneumonia
or some other serious complication. It must not be forgotten, however,
that the pneumonia months in the year occur in the fall and the
spring, October and November and March and April producing most deaths
from the disease, and not December, January and February. The large
city in this country which may be said to have the fewest deaths from
pneumonia is Montreal, where the temperature during December and
January is often almost continuously below zero for weeks at a time
and where there is snow on the ground for three or four months in
succession. The highest death rate from pneumonia is to be found in
some of our southern cities which have rather mild winters and rather
equable temperature,--that is, no considerable variation in the daily
temperature range. Cold air is bracing and tonic for the lungs and
enables them to resist the microbe of pneumonia, and it is now
recognized {205} by physicians that personal immunity is a much more
important factor in the prevention of the disease than anything else.
Coughs and colds and bronchitis and pneumonia, the respiratory
diseases generally, are much less frequent in very cold climates than
in variable regions. Arctic explorers are but rarely troubled by them,
even though they may be exposed to extremely low temperatures for
months. Men subjected to blizzards at thirty and forty degrees below
zero may have fingers and toes frozen but do not have respiratory
affections. Some years ago, it was noted that one of these Arctic
expeditions had spent nearly two years within the Arctic Circle
without suffering from bronchial or throat disease and within a month
after their return in the spring most of them had had colds. Nansen
and his men actually returned from the Arctic regions where they had
been in excellent health during two severe winters to be confined to
their beds with grippy colds within a week of their restoration to
civilization, with its warm comfortable homes and that absolute
absence of chill which is connected in so many people's minds with the
thought of coughs and colds.
The principal reason why colds are so {206} frequent in the winter
time in our cities and that pneumonia has increased so much is mainly
because people are afraid of standing a little cold. Office buildings
are now heated up to seventy degrees to make the personnel absolutely
comfortable even on the coldest days, and as a consequence the air is
so dry that it is more arid--that is more lacking in water vapor, as
the United States Public Health Service pointed out--than Death
Valley, Arizona, in summer. People dress too warmly, anticipating
wintry days and often getting milder weather and thus making
themselves susceptible to chilling because the skin is so warm that
the blood is attracted to the surface. Will power to stand cold, even
though at a little cost of discomfort, is the best preventive of
coughs and colds and their complications and the best remedy for them,
once the acute febrile stage has passed.
{207}