A Doctor's Journal
The Common Cold
You would think that the common cold should be easy enough to study; but it is not so easy as it looks. Colds often seem to spread from one person to another, so it is often assumed that the cold must be infectious; but there are some puzzling observations which don't fit in with this theory. An investigator in Holland examined some 8,000 volunteers, from different areas, and came to the conclusion that in each group the colds all appeared at the same time—transfer of infection from case to case couldn't account for that. Yet at the Common Cold Research Unit in Salisbury the infection theory has been tested out; two series of about 200 people each were inocu- lated, one with salt water, and the other with secretion from known cold victims. Only one of the salt-water group got a cold, compared with 73 in the other group.
In the BM! the other day there was a report of a meeting, 'The Common Cold—Fact and Fancy,' at which one of the speakers reported a study of colds made in Cirencester over the last five years. Three hundred and fifty volunteers had kept diary records of their colds, and on an aver- age each had had seven every year, with an annual `morbidity' of seventy days. So nearly one-fifth of our lives is spent in more or less misery, coughing and sneezing. There was a close tie-up of the number of colds with external temperature—for each 1° Fahrenheit fall in temperature there was a 1 per cent. rise in the cold rate. Also there was noted a close relation between the cold rate and the dryness of the air, indoors and outdoors. Some widely held beliefs about the common cold have turned out not to be true. It seems that old people are just as liable to colds as the young; sailors in isolated weather ships have just as many colds while on board and not in contact with the outside world as when on shore. It is a truism that common illnesses pose more problems than the rare. The rare disease is by comparison much easier to handle. There aren't so many cases and all of them have been intensively studied; some- one has read up all the literature about the disease and published a digest of it. There will be more facts and fewer fancies. The rare disease, too, attracts research workers. The young man, look- ing about for a subject for his thesis, is more likely to choose 'Blood vanadium levels in left-handed mongols' than 'Why some patients leave one doc- tor and go to another,' which is socially and prac- tically much more important. Part of the reason for this is the current tendency to ntimber- worship. Anything that can be quantified, ex- pressed in digits and subjected to probability tests is `science'; everything else is not. This erroneous belief is at the root of much faulty thinking in medicine.
The final speaker at the meeting said that proneness to colds was influenced by mood and psychological make-up. Susceptibility to infection varies from one person to another, and in the same individual from one time to another—re- sistance to infection is affected by many things, one of which is stress. In general practice one will see the patient who is afflicted with crops of boils when he is 'run-down' after a crisis in his life; he recovers, the boils clear away and then later on he runs into another crisis, can't cope, and boils break out once more. Lowered resistance, as well as propinquity, may account for some colds.
Some snuffy illnesses which look like colds are really cases of vasomotor rhinitis—a disorder of the lining membrane of the nose, which is not in- fectious, but a disorder of function set in motion by the nervous system. Treatment of this disorder of function is difficult, since the causes are often quite obscure. In 1954 three workers at Guy's Hospital took a sample of patients with
R' from the clinic and went into the physical and emotional background of illness. The number of patients fully explored was small, some thirty or so, and too much weight should not be given to the findings; yet these were 'interesting in them- selves and point the way for a larger-scale investi- gation. In four-fifths of the series there was found to be some relationship between stress and the VMR, and in eight of these stress seemed to be the chief causal factor. In some patients every attack of rhinitis followed some stress-producing situa- tion: frustration at work, jealousy and friction at home, disappointment in love. Resentment fre- quently triggered off bouts of sneezing. Five of the eight patients had other tension symptoms, such as fatigue, 'indigestion,' various bodily pains or migraine. In short, then, vasomotor rhinitis, in some people at any rate, must be placed in the category of stress disorder; hence it is unlikely to clear up for good until the underlying tensions have been relieved in some way. Medical remedies in themselves can only suppress symptoms. As an American doctor, according to the New Yorker, has recently advised : 'Don't shake the bottle, shake your mother-in-law.'
MILES HOWARD
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