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How to Cough

Updated on March 24, 2013

Why did we think coughing in our hands was a good idea?

Think about it. “Cover your mouth when you cough.” Wasn’t that advice given to all of us when we were children? Which led to you covering your mouth with your hand and thus leading to covering your hand with phlegm. Phlegm that was probably full of whatever pathogens that caused you to be coughing in the first place. Why did we ever believe that this was a good idea?

The answer lies in history or more specifically both fashion and medical history.

Today, the usual reason that someone is suffering from an overproduction of mucus and sneezing or coughing is a viral infection, usually known as a cold or “flu.” These viruses are contagious, meaning they spread by contact. Someone sneezes in their hand and then fondles the card reader at the check out line or gives you are hearty handshake. Now the germs are all over your hand and pretty soon you scratch your nose or wipe your lips, and now you have a cold too.

But back in the day public health officials weren’t worried about colds. What they wanted to stop the spread of was tuberculosis. Prior to the introduction of antibiotics, the pasteurization of milk, and the better housing and food available in the 20th century, tuberculosis was one of mankind’s most virulent parasites. It killed and it killed and it killed. In a lot of places, if you weren’t starved or perished violently or accidently and didn’t die as a child or in childbirth, you died of tuberculosis. And one of the most common forms was pulmonary tuberculosis, where the lungs are infected.

Now, unlike a cold, tuberculosis isn’t contagious, it’s infectious. In other words you don’t get it from touching, because it needs to get directly from someone else’s lungs into yours, and people don’t typically rub lungs. So how can something get from someone else’s lung into yours? That’s right, they could have a coughing fit and spew an aerosol mist of sputum and germs several feet around them for you to inhale and soon you have a fatal disease too. So “cover your mouth when you cough” was born.

But where does fashion come in? Well, back in those days everyone carried a cloth handkerchief. Men kept it in their pocket and women stored it in their purse. If you felt like sneezing or coughing you were supposed to pull it out and use it. So officially people weren’t snotting all over their hands. But you know what? Back then they probably said, “So we get a cold—big deal. At least you’re not spraying death mist all over us.”

Why didn’t people just cough on their shoulder—the approved method of public mucous expression today? Perhaps it was because clothes were comparatively very expensive 100 years ago. A basic pair of pants or a dress cost the equivalent of 100 dollars and up, and even a cheap suit could be the equivalent of 400 or 500 dollars in today’s purchasing power. People didn’t wash their clothes very often either, since you had to wash them by hand, or pay a laundry to do it. So dirtying up your arm wasn’t something that occurred to people back then as an option.

Lucky us. We don’t have a lot of tuberculosis around and most strains still respond well to antibiotics. Our clothes are inexpensive, thanks to global trade. So now our public health message needs to be stop coughing in your hands! If you don’t have access to a wad (face it, one won’t do) of tissues, quickly turn your head into your shoulder and upper arm area and let ‘er rip!

The rest of the country thanks you.

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