Ethnomedical Approaches to the Common Cold

Tagged:  

Medical Anthropology

76A Pleasant Street Groton, Massachusetts 01450 USA

Email:timbatchelder@sprynet.com

The kinds of health problems that are most interesting for the anthropologist are ones that are widespread and not easily dealt with by biomedicine, and the common cold certainly qualifies. One recent study (Baer et al: 1999) looked at how people from Latin America understand the cold, as compared with middleclass Americans. What is fascinating for someone interested in alternative medicine are the diverse strategies employed by these study populations for dealing with the cold. These include herbal therapies, other natural products and therapies and avoidance of certain environmental health threats. By examining people's actual behaviors anthropologists are able to discover new and promising solutions for health concerns that can be tested further biomedically.

In this study four groups of Latin Americans were studied: Guatemalans in Guatemala; Mexicans in Guadalajara, Mexico; persons of Mexican descent in Edinburg, Texas (on the Mexican border); and Puerto Ricans in Hartford, Connecticut. A group of middle income Americans living in Tampa, Florida was added to see how a "mainstream" population sees the common cold in comparison.

The researchers did some fancy things with statistics to figure out that 29 people should be interviewed from each site (Romney, Weller, and Batchelder 1986; Weller and Romney 1988). To buffer this a bit they chose 40. To be included in the study a person had to be an adult and know about the illness. Women were preferred since they are more knowledgeable about healthcare and in charge of the household.

Like good social science researchers they started off with some qualitative research to generate hypothesis by looking at the causes, symptoms, and treatment of the cold using open-ended interviews and free-listing techniques (Weller and Romney 1988). Any response mentioned by at least 10% of the study population were combined with symptoms from the Cornell Medical Index, and the anthropological literature, into a true-false questionnaire that would allow them to generate some quantitative conclusions.

They used a technique which I am not aware of called consensus analysis (Romney, Weller, and Batchelder 1986; Batchelder and Romney 1988) that allowed them to figure out which answers were similar enough to establish a set of cultural beliefs. This technique also tells researchers to what degree informants fit into their culture, also called their cultural "competence."

Everyone in the study agreed that a cold cannot be caused by fright (susto) or witchcraft, a hard envious stare, food being stuck in the stomach, drinking hot liquids, eating too much, eating spoiled food, eating dry food, eating certain foods, sleeping late in the day, lying, drinking unboiled water, or by being overweight. They checked these factors to make sure that colds were seen as different from such common folk illnesses as susto (fright), mal de ojo (evil eye) and empacho (gastrointestinal blockage), as well as from diabetes.

On the other hand everyone agreed that colds can be caused by a lack of vitamins, low resistance, exposure to drafts/wind/ air, a change in the weather, not being properly clothed in cold weather, and by being around a person who has a cold. Thus, there is a sense that colds are linked to low resistance and to exposing the body to cold. The Latino informants agreed that colds can be caused by walking on a cold floor without shoes, by getting wet when you are sweating, and by being exposed to cold weather. In addition, the Texas, Mexico, and Guatemala samples agreed that eating or drinking icy things when one is sweating can cause a cold. The Latin American hot-cold system thus includes the concept that exposure of the body to cold, particularly when it is physically hot, is dangerous.

Interestingly, air pollution was linked to the cold by certain informants. The Guatemala, Mexico, and Connecticut informants all agreed that breathing smoke, air pollution, and living in an unclean house might all cause a cold; however, the Texas and Tampa samples disagreed.

Everyone agreed that most symptoms of a cold occur in the head and chest regions of the body and rarely in the gastrointestinal system. Thus a swollen or bloated stomach is not a symptom of a cold, nor is having a stomach ache, constipation, diarrhea, vomiting, or yellow skin. Seeing one's ribs while breathing is also not a symptom of a cold. True symptoms of a cold include red, inflamed eyes; watery eyes; sneezing; muscle and body aches; fever or fever and chills; hoarseness; breathing difficulty; a runny nose; a stuffy nose; mucus, itchiness in the throat; sore throat; chest congestion; headache; and decreased activity. Less visible symptoms such as myalgia, fevers, chills, inactivity and irritability, varied across sites. Thus, there was a decrease in consensus as the symptoms became less visible and moved away from the head and neck area.

To cure a cold, respondents agreed that it is advisable to drink liquids; use medicines given by a doctor; drink orange or lemon tea; use eucalyptus or camphor balm; and take vitamins. The treatments considered appropriate included burning prayer candles, putting holy water on the body in the shape of a cross, going to a sobadora (a healer who uses massage), exercising (and not exercising), drinking marijuana tea, drinking tea made with the addition of a few drops of gasoline, taking milk of magnesia, or using garlic. Avoiding getting upset is not felt to be a way to prevent a cold. An untreated cold is believed to turn into bronchitis or lead to pneumonia.

Biomedical treatments such as hospitals and aspirin/tylenol were rejected in Tampa which may be due to increased use of walk-in clinics and private physicians among middle-income Americans. Tampa informants were also unique in their view that a cold was not easily cured (but that an untreated cold would get better by itself) and that use of antibiotics was not an appropriate treatment.

The study also included some questions on the flu. In Tampa "the flu" was characterized by gastrointestinal symptoms (including nausea, diarrhea, and stomach ache), body aches and pains, fatigue, fever and sweating, as well as upper respiratory symptoms. Flu was considered to be more serious and more severe than a cold. The four Latino groups were asked to distinguish between the cold (catarro), resfriado and gripe. The main discoveries were that the latter two conditions may feature chills, cold hands and feet, and cold sweats which are not found in the cold.

Now, all of this may sound somewhat bizarre to biomedically-orientated readers. However, before we dismiss humoral approach to the common cold, such as avoiding drafts and prescribing "warming" natural products and natural therapies, we should note that biomedicine is itself somewhat confused on whether temperature can influence resistance to disease. Some studies have found correlations between low outdoor temperature and incidence of colds (Lidwell et al. 1965) while others have not (Douglas et al. 1967).

The most common ethnomedical treatment among the study population was orange or lemon tea. Eucalyptus tea or a spoonful of honey were also thought to be appropriate treatments in Guatemala, Mexico, and Connecticut. The Latin American panacea of chamomile/manzanilla tea was seen as an appropriate remedy for a cold by Connecticut and Guatemalan respondents. Guatemala and Connecticut informants also advocated use of spearmint/yerba buena tea while Guatemala participants emphasized the use of bitter tea/Verbena and cod liver oil.

Other Studies

Humoral theory defines health as consisting of a balance of hot and cold. If the body is exposed to temperature extremes its internal balance is upset and illness can result. However foods, medicines and diseases are not classified as hot or cold based on their actual temperature but rather on an innate quality of hotness or coldness (Foster 1979; Cosminsky 1975).

Exposure to cold is a commonly held cause of the common cold in many other cultures including Pakistan (Mull and Mull 1994), rural Bangladesh (Stewart et al. 1994), India (Chand and Bhattacharyya 1994), West Java (Kresno et al. 1994), Honduras (Hudelson 1994), and other cultures (Grove and Pelto 1994). Guatemalan Indians and urbanites were found to adhere to this cause according to Logan (1978) and Weller (1984:343) who noted that cold illnesses were treated with hot remedies. Harwood (1971:1154) found this etiology and treatment occurred among Puerto Ricans. Lieberman (1979), Spector (1991) and Pachter (1995) added that Puerto Ricans in Connecticut and New York City also treat the cold with warming therapies since it is considered cold. Likewise in Mexico both Indian and Mestizo communities (see, for example, Currier 1966; Lewis 1963; Fabrega and Manning 1973; Baer 1998; Young and Garro 1994) shared the hot-cold system and attributed colds to excess cold, treating it accordingly. Interestingly among Mestizos in Sonora Mexico, homemade cheese was considered cold and avoided during the cold. Current biomedical research suggests this may cause cold-like symptoms including congestion among those with dairy allergies. Among Mexican Americans Kay (1977:147) found that the treatment for a cold is directed to prevent complications, especially of the cold 'falling to the chest.' Specific remedies included applying hot cloths or menthol poultices of a substance such as Vicks.

Such concepts have been recorded in contemporary English populations. Helman (1978) found that in a London suburb colds were reported to occur when certain body parts, such as the top of the head, back of the neck, or the feet, were exposed to dampness or drafts. Other causes included going outside after washing one's hair or going into a cold room after a hot bath.

Middle-income or mainstream Americans maintain the hot-cold system as well which is quite shocking to biomedical researchers (Kleinman et al. 1978). Demers et al. (Demers et al. 1980:1092) studied people who were demographically and educationally similar to their physicians at the Group Health Cooperative of Puget Sound, Washington and found that a number of the explanatory models of illness collected were biomedically either incomplete or wrong. Boster and Weller (1990) compared Anglos with Mathews' (1983) Oaxaca sample and found that the Anglos had a humoral perspective much like the Mexicans, though to a lesser extent. In a study of European-American mothers' responses to treatment of colds, Pachter et al. (1998) found use of interventions that fit within the hot-cold theory of illness. Other studies (Specter 1991; Ragucci 1981) have focused on other ethnic communities, such as German, Italian, and Polish Americans. All three groups saw avoiding drafts as a way of preventing a cold. Similar beliefs are seen among African Americans: Snow (1993) found the belief that the intake of cold air through the pores of the skin is often responsible for upper respiratory infections.

On the whole, this study provides much interesting material on how various cultural groups view and respond to the common cold. Clearly there are a wide variety of approaches, many of which merit incorporation into the biomedical paradigm.

Bibliography

Baer, Roberta et al Cross-cultural perspectives on the common cold: Data from five populations Human Organization; Washington; Fall 1999.

Batchelder, William H., and A. Kimball Romney 1988 Test Theory without an Answer Key. Psychometrika 53:7192.

Boster, James, and Susan C. Weller 1990 Cognitive and Contextual Variation in Hot-Cold Classification. American Anthropologist 92:171-179.

Chand, Ashok Dyal, and Karabi Bhattacharyya 1994 The Marathi "Taskonomy" of Respiratory Illness in Children. Medical Anthropology 15:395-408.

Cosminsky, Shelia 1975 Changing Food and Medical Beliefs and Practices in a Guatemalan Community. Ecology of Food and Nutrition 4:183191.

Currier, Richard 1966 The Hot-Cold Syndrome and Symbolic Balance in Mexican and Spanish-American Folk Medicine. Ethnology 5:251-263.

Demers, Raymond Y., Rita Altarmore, Henry Mustin, Arthur Kleinman, and Denise Leonardi 1980 An Exploration of the Dimensions of Hiness Behavior. Journal of Family Practice 11:1085-1092.

Douglas, R. C. Jr., R. B. Couch, and K.M. Lindgren 1967 Cold Doesn't Affect the Common Cold in Study of Rhinovirus Infections. Journal of the American Medical Association 199(7):29-30.

Fabrega, Horacio, and Peter Manning 1973 An Integrated Theory of Disease: Latino-Mestizo Views of Disease in the Chiapas Highlands. Psychosomatic Medicine 35:223-239.

Foster, George 1979 Methodological Problems in the Study of Intracultural Variation: The Hot/Cold Dichotomy in Tzintzuntzan. Human Organization 38:179-183.

Grove, Sandy, and Gretel H. Pelto 1994 Focused Ethnographic Studies in the WHO Programme for the Control of Acute Respiratory Infections. Medical Anthropology 15:409-424.

Harwood, Alan 1971 The Hot-Cold Theory of Disease: Implications for Treatment of Puerto Rican Patients. Journal of the American Medical Association 216:1153-1158. 1981 Mainland Puerto Ricans. In Ethnicity and Medical Care. Alan Harwood, ed. Pp. 397-481. Cambridge, Mass.: Harvard University Press.

Helman, Cecil G. 1978 "Feed a Cold, Starve a Fever"-Folk Models of Infection in an English Suburban Community, and Their Relation to Medical Treatment. Culture, Medicine and Psychiatry 2:107-137.

Hudelson, Patricia M. 1994 The Management of Acute Respiratory Infections in Honduras: A Field Test of the Focused Ethnographic Study (FES). Medical Anthropology 15:435-446.

Iyun, B. Folasade, and Goran Tomson 1996 Acute Respiratory Infections-Mothers' Perceptions of Etiology and Treatment in South-Western Nigeria. Social Science and Medicine 42:437-445.

Kay, Margarita 1977 Health and Illness in a Mexican American Barrio. In Ethnic Medicine in the Southwest. E.H. Spicer, ed. Pp. 99-161. Tucson: University of Arizona Press.

Kleinman, Arthur, Leon Eisenberg, and Byron Good 1978 Culture, Illness and Care: Clinical Lessons from Anthropological and Cross-Cultural Research. Annals of Internal Medicine 88:251-258.

Kresno, Sudarti, Gall G. Harrison, Bambang Sutrisna, and Arthur Reingold 1994 Acute Respiratory Illness in Children Under Five Years in Indramayu, West Java, Indonesia: A Rapid Ethnographic Assessment. Medical Anthropology 15:425-434.

Lieberman, Leslie Sue 1979 Medico-Nutritional Practices among Puerto Ricans in a Small Urban Northeastern Community in the United States. Social Science and Medicine 13B:191-198.

Lewis, Oscar 1963 Life in a Mexican Village: Tepotzlan Restudied. Urbana: University of Illinois Press.

Lidwell, O. M., R. W. Morgan, and R. E. Williams 1965 The Epidemiology of the Common Cold. V. The Effect of Weather. Journal of Hygiene (London) 63:427-39.

Logan, Michael H. 1978 Humoral Medicine in Guatemala and Peasant Acceptance of Modern Medicine. In Health and the Human Condition: Perspectives on Medical Anthropology. Michael H. Logan and Edward E. Hunt, Jr., eds. Pp. 363-375. North Scituate, Mass.: Duxbury Press.

Mathews, Holly 1983 Context-Specific Variation in Humoral Classification. American Anthropologist 85:826-847.

McCombie, Susan C. 1987 Folk Flu and Viral Syndrome: An Epidemiological Perspective. Social Science and Medicine 25:987-993.

Mull, Dorothy S., and J. Dennis Mull 1994 Insights from Community-Based Research on Child Pneumonia in Pakistan. Medical Anthropology 15:335-352.

Nichter, Mark, and Mimi Nichter 1994 Acute Respiratory Illness: Popular Health Culture and Mother's Knowledge in the Philippines. Medical Anthropology 15:353-355.

Pachter, Lee 1994 Culture and Clinical Care. Journal of the American Medical Association 271:690-694.1995 Ethnomedical (Folk) Remedies for Childhood Asthma in a Mainland Puerto Rican Community. Archives of Pediatric and Adolescent Medicine 149:982-988.

Pachter, Lee, Sara Niego, and Perrti Pelto 1996 Differences and Similarities between Health Care Providers and Parents Regarding Symptom Lists for Childhood Respiratory Illnesses. Ambulatory Child Health 1:196-204.

Pachter, Lee, Tracy Sumner, Annette Fontan, Mary Sneed, and Bruce Bernstein 1998 Home-Based Therapies for the Common Cold among Anglo and Ethnic Minority Families: The Interface Between Alternative/Complementary and Folk Medicine. Archives of Pediatrics and Adolescent Medicine 152:1083-1088.

Ragucci, Antoinette T. 1981 Italian Americans. In Ethnicity and Medical Care. Alan Harwood, ed. Pp. 211-263. Cambridge, Mass.: Harvard University Press.

Romney, A. Kimball, Susan C. Weller, and William H. Batchelder 1986 Culture as Consensus: A Theory of Culture and Informant Accuracy. American Anthropologist 88:313-338.

Schreiber, Janet M., and John P. Homiak 1981 Mexican Americans. In Ethnicity and Medical Care. Alan Harwood, ed. Pp. 264-336. Cambridge, Mass.: Harvard University Press.

Snow, Loudell F. 1993 Walkin' Over Medicine. Boulder, Colo.: Westview Press.

~~~~~~~~

By Tim Batchelder

Share this with your friends