In June 2019, when the then President Trump was accepting the media, he disliked White House Chief of Staff Mick Mulvaney, who was coughing on the side, and said, "If you want to cough, please leave the room. You can't cough." Once the video was leaked, it triggered widespread controversy from the outside world. Those who support Trump believe he adheres to proper social etiquette, while those who oppose him regard it as another example of Trump bullying subordinates.
With the spread of the new coronavirus, more and more people are paying attention to cough-related knowledge. How does Western medicine understand cough? In order to treat coughs, what methods has Western society racked its brains to come up with? How did the social etiquette around coughing emerge?
How to identify cough
As the founder of Western medicine, ancient Greek physician Hippocrates who lived in the 5th century BC proposed the "Humoral Theory", which believed that the human body is composed of four body fluids: blood, mucus, yellow bile, and black bile. If they are in balance, the person is healthy, otherwise diseases will occur. According to Hippocrates, pneumonia and the cough associated with it are caused by excess bile and body fluids entering the lungs. In addition, the characteristics of tuberculosis recorded in his "Epidemiology" include thick sputum produced by coughing. In addition to the composition of personal body fluids, Hippocrates believed that the environment also had an important impact on human health. He especially rejected water mixed with soft, stagnant water and rainwater. He emphasized that in winter, when this water encounters snow and freezes, the water quality will remain turbid, and mucous diseases and coughs will occur.
The combination of humoral theory and temperament theory. Source/Wikipedia
As the inheritor and developer of Hippocratic ideas, Claudius Galen, a ancient Roman physician who lived in the 2nd century AD, also mentioned cough and phlegm in his writings. Tuberculosis Patients with tuberculosis experience constant coughing, which is an important symptom of their illness and is also caused by an imbalance of body fluids. More importantly, Galen emphasized that in addition to body fluids, a person's temperament also has an impact on the occurrence of cough symptoms. For example, if the "heat" in the brain is too strong, mucus will easily be secreted from the nose and mouth.
While pointing out the symptoms of cough, Hippocrates and Galen also put forward their own suggestions on how to prevent and treat it. The core of it is to restore the balance of body fluids in the human body. Hippocrates believed that rain was best for health, but in the slimy winter, food was best dry, warm, and not mixed with water. Galen also proposed that good food produces healthy humors, while bad food produces bad humors. For example, garlic and onions are the best plants for removing heavy body fluids. Compass grass, native to North Africa, was also used to treat coughs as early as the 7th century BC, but it needed to be diluted with wine or water before taking it. In addition, Galen particularly praised the role of barley soup, emphasizing that for patients with lung diseases who have phlegm, it can not only nourish the body, but also provide strength to various parts of the body through nutrition and help remove harmful body fluids.
Honey is also a food often mentioned by Galen for treating coughs. It is still an important choice of folk anti-cough food to this day (it is recommended to take it diluted) . At the same time, Galen emphasized that people who do not exercise regularly should stay away from pork and the special bread eaten by athletes to prevent the body from producing too thick and too cold body fluids. Hippocrates even advocated taking emetics every two weeks during the six months of winter to release excess mucus from the body during that period.
The Greeks' love for honey can be reflected in their utensils. Source/planet bee foundation
The thoughts of Hippocrates and Galen had an important influence on the medieval Western Europe and the Arab world. Later generations' prescriptions for dietary therapy and dietary supplements were elaborated on the basis of their books. The book "Flowers of Medicine" written in Salerno in southern Italy in the 13th century mentioned that black pepper can relieve coughs. The principle is that it can promote the flow of mucus. To this day, through a casual search on the Internet, we can still see that black pepper and honey are still circulated as a folk remedy for relieving coughs.Coincidentally, the popular pear stewed with pepper on the Internet has the same principle. It not only promotes the flow of mucus, but also supplements vitamin .
Who discovered the cure for coughs?
In addition to dietary therapy, Galen's writings also involved the direct use of drugs, believing that opium could be used to treat coughs. This conclusion was also inherited by the 16th-century Swiss doctor Pallassus. He received relevant medical training in Renaissance Italy and then practiced in Switzerland and France. He also used opium to treat coughs.
In addition to Galen, Dioscrides, a famous doctor who lived in the first century AD, also gave suggestions on how to use medicine to treat coughs. Although his scope of activities was mainly limited to Asia Minor in today's Turkey and Syria, he did not gain the reputation of Galen, but his "Medical Chronicle" is also a classic in medicine, recording more than 600 kinds of plants, animals and mineral raw materials. In addition to the well-known poppy, Dioscrides also used myrtle, which was widely available locally, to treat lung infections .
As Europe stepped up its pace of foreign exploration and expansion at the end of the 15th century, the spread of diseases around the world accelerated, and more and more drugs came into European sight. Whooping cough originated in northwest Africa and first spread among animals and then humans, infecting many populations in Europe and Asia around 1600. In 1578, a major whooping cough epidemic occurred in Paris, France. The "Columbian Exchange" of the Age of Discovery brought whooping cough to the New World, causing huge disasters to the locals who had no immunity. The process lasted for centuries. The Mandans on the North American prairie formed nine huge villages around 1750, but 50 years later they were reduced to two villages due to the combined attacks of whooping cough and smallpox. Since the beginning of the 16th century, indigenous people in South America and the Caribbean have used Guaiac, a local native product, to treat diseases such as coughs and tonsillitis. Interestingly, guaiac wood was brought back to the Old World by Europeans, mainly to cure gonorrhea that originated in the New World.
For the Aztecs who died of smallpox, it can be seen that cough was also one of its important symptoms. Source/science
The above information about cough medicines is based on daily observation and experience. This situation did not change until the rise of industry and the emergence of modern chemical and pharmaceutical industries at the end of the 18th century.
In 1804, German pharmacist Friedrich Sertuna isolated morphine from opium and noticed its analgesic and cough-relieving effects. During the course of the experiment, Sertuna himself became addicted to drugs. In 1827, morphine was officially mass-produced in Germany by the future pharmaceutical giant Merck. In 1874, British chemist Charles Wright used acetic acid and morphine to synthesize diacetylmorphine, which later became known as heroin. However, the discovery of heroin did not attract attention at the time. It was not until the end of the 19th century that the German pharmaceutical company Bayer synthesized the substance again, which attracted outside attention. In 1898, the company marketed heroin, an analgesic and cough suppressant, as an alternative to morphine. It can be seen from the name derived from Greek myth that the company has high hopes for this drug, which can be used to treat coughs caused by pneumonia and tuberculosis. Due to its highly addictive properties, the drug was eventually discontinued in 1910. Compared with heroin, codeine was actually discovered more than 40 years ago, but its commercial promotion was far less than the former. Codeine is also derived from the many active ingredients of the opium poppy, and its addictiveness is far less than that of heroin. However, there are still problems in this regard. It was not until the dextromethorphan launched in the 1950s that the combination of safety and cough-relieving effect was achieved.
Advertisement for heroin to treat coughs. Source/newsweek
How to cough in a civilized manner?
In addition to using drug treatment, what should cough patients and doctors do to prevent more infections? Hippocrates believed that tuberculosis was hereditary, but warned his students not to come into contact with terminally ill patients to prevent death. Aristotle also believed that tuberculosis was contagious.In addition, Hippocrates also experienced the Plague of Athens. According to Thucydides records, most patients developed cough symptoms. Hippocrates noticed that the craftsmen in the blacksmith shop were less likely to be infected by the plague, and then believed that fire had a cleansing function. Legend says that he often used fire to clean the air and slow down the spread of disease. The ancient Roman architect Vitruvius in the 1st century BC believed that most cough patients lived in areas with prevailing north or northwest winds, so relevant walls should be built to protect people from the wind.
After experiencing the Black Death in the late Middle Ages, Western medicine achieved major breakthroughs in how to prevent and treat infectious diseases. Doctors believe that the air exhaled by patients contains disease-causing "seeds" and will pollute the air. Therefore, people should stay away from epidemic areas and keep the air in their homes flowing and clean. The beak-shaped masks commonly seen in pictures were also born during the Black Death to protect medical staff from the disease. On this basis, Girolamo Fracastoro, an Italian medical scientist during the Renaissance, proposed that the invisible virus spreads tuberculosis through bodily fluids coughed out by patients. Additionally, he believes the virus can survive on a patient's clothing for two to three years. Affected by this, in 1699, the Italian Republic of Lucca stipulated that patients' clothing and bedding must be destroyed. Twenty-one years later, British physician Benjamin Marton once again emphasized that the tiny organisms coughed up by patients spread the virus. It was not until 1882 that German scientist Robert Koch officially discovered tuberculosis bacterium . Five years after the discovery of tuberculosis bacteria, Scottish physician Robert Philip has taken another step towards advancing tuberculosis prevention and treatment. In Philip's eyes, the family is an important link in the prevention and treatment of tuberculosis, and relevant knowledge needs to be popularized to reduce the spread of infection and disease. As one of the industrial cities, Edinburgh was once one of the hot spots for tuberculosis due to the large concentration of industrial workers who lacked nutrition. After the unremitting efforts of Philip and the government, the mortality rate dropped significantly.
As for the cough etiquette that we are now familiar with, it is a product of the early 21st century. According to research by scholars, the term "cough etiquette" did not appear frequently in English conversations until around 2000. The high incidence of influenza, as well as the subsequent outbreaks of SARS and avian influenza, prompted governments around the world to take all means to slow the spread of the disease and ensure public health safety. Among them, the United States began to promote correct "cough etiquette."
Proper cough etiquette. Source/alberta health services
Prior to this, the most common way to cough was to cover the mouth with hands. Although this can prevent the spread of the virus in the air, it can also easily cause the virus to attach to the hands and spread as the hands come into contact with others. This is especially true in Western societies where handshakes are often practiced.
Although frequent hand washing can effectively reduce this risk, it cannot fundamentally eliminate the problem. So "cough etiquette" came into being. This etiquette requires patients to stay away from other people when coughing, or at least turn their backs to others, and cover their mouth and nose with a tissue. Discard the tissue after coughing and wash their hands immediately. If you don't have a tissue with you, cough into your elbow rather than your palm. If the patient coughs frequently, it is recommended to recuperate at home and only return to work after the frequency of coughing decreases. After the outbreak of the new coronavirus, the U.S. health department updated the "cough etiquette" and added the wearing of a mask covering the mouth and nose to better reduce the risk of disease transmission.
However, when the health department first formulated these relevant recommendations, I am afraid they never thought that patients who recovered from the new coronavirus would still experience a very long cough period a few years later. 50% to 70% of patients would have a persistent cough, which lasted an average of 19 Within days, 5% of patients will even cough for more than four weeks. The Omicron variant especially attacks the part where air is sucked into the lungs from the trachea, which further aggravates the patient's cough symptoms. It is necessary to have a correct mental understanding of this, instead of staying in the self-consolation of "most people will be asymptomatic" and the huge psychological gap that comes with it.
cough steps.Source/People’s Daily Overseas Edition
Theoretically, as long as the antigen test is negative for three consecutive days, it can be considered recovered. The cough at this time is only helping to expel the dead virus from the body and is not contagious. A persistent cough makes people always doubt whether their lungs are healthy. During this period, cases of white lung that appeared from time to time in the country heightened people's fears. Under this circumstance, recipes such as salt-steamed oranges and pepper-stewed pears have appeared to help people get through this difficult period of coughing. Although some popular science articles emphasize that these folk remedies can only have a psychological effect, they still have a certain auxiliary role in treating coughs, that is, replenishing water and vitamins in the body, increasing humidity, so as to relieve dryness, discomfort and congestion in the throat, and help discharge phlegm. It should be pointed out that there is no need to add salt when eating oranges, because it does not have the effect of relieving asthma and relieving coughs. Excessive salt intake can easily cause bronchospasm and worsen coughing. At the same time, drinking herbal tea can also have the same effect. For more severe coughs, you can follow your doctor’s advice and take appropriate medications that have the effect of resolving phlegm and relieving asthma.
In addition, the British health department has also given other methods to help expel phlegm, including lying on your side or lying prone with your hands folded in front of you and supported by your knees when coughing, walking moderately, keeping the room moist, etc., to promote the discharge of fluid in the lungs.
Meanwhile, the British Lung Association also advises that taking deep breaths from time to time and then exhaling the air through the mouth can also help relieve coughs.
A more comfortable position when coughing. Source/People's Daily
These previous experiences have important reference significance for the present. I believe that as long as you pay attention to moisturizing, take in sufficient water and vitamins and other nutrients, pay attention to rest, not be too tired, and relax your mind, most people can rely on their own resistance to get through this difficult cough period. However, for the elderly, immunodeficiency patients and other frail people, even if the antigen has been shown to be negative, if the cough has not been relieved for a long time, accompanied by the discoloration of the sputum, suffocation, decreased blood oxygen levels and other symptoms, please seek medical treatment in time and take a CT scan to identify whether there is indeed a lung infection and treat it.
Source: National Humanities and History
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