A Respiratory Etiquette Debate

The consensus of the etiquette experts is that a yawn or a sneeze is only one degree removed from the gravest of all social errors – eating peas with a knife. – Photo source, Pinterest 

WASHINGTON, Oct. 18– Just as the nation was moving safely out of the hay-fever season into winter's cold-in-the-head era, the question of the proper etiquette for sneezing arose today and split the ranks of the distinguished scholars who have studied the subject. It seems to be a clear-cut fight, winner take all, between Dr. Severance Burrage, professor of public health at the University of Colorado, on one side, and the United States Government and Mrs. Emily Post on the other. 

FAVORS SNEEZE 

Burrage came out flatly in favor of a good, healthy uninhibited sneeze. He went through a process which we Americans have come to refer to as hurling a defi at the Namby-Pamby persons who seem to stifle sneezes and yawns. The argument runs that as an expression of your personality, there is nothing like a leisurely 80-second yawn, which closes with a contented “ho hum.” Never suppress one; not even when the boss, just back from his vacation, tells you for the third time about the view from his hotel window and how he and the missus got the room for $5 a day dirt cheap, with meals included. But there is another point that Burrage wishes to hammer home:

“Influenza, pneumonia and other diseases often are caused by the contamination of food and utensils by food handlers whose fingers have been placed over the mouths to settle a sneeze or a yawn.” Stop shuddering, Mrs. Post, and just tell the court in your own words why you disagree with the doctor. The witness testifies that sneezes and yawns must be suppressed at any cost or the social fabric of the nation will collapse. The consensus of the etiquette experts is that a yawn or a sneeze is only one degree removed from the gravest of all social errors – eating peas with a knife. To the support of the etiquette experts rushes the United States public health service with a charming little essay on how influenza germs leap from yawn to yawn and from sneeze to sneeze. The author writes lyrically:

ONLY ONE VOICE

“True, I am only one voice, but I lift up that voice like a foghorn on a misty morning to protest against the habit of the tobacco clerks who dampen their fingers on their tongues and then serve a harmless customer with a package of cigarettes.” But the public health service goes even further. Not only does it want to suppress yawns and sneezes, but it wants to do something about kissing too. “The Chinese custom,” the essay continues, “of bowing and shaking one's own hand is far more desirable from a sanitary standpoint.” Begging your pardon, United States public health service, but the comment that comes readily to the mind is: “Kerchoo!” — By Harry Ferguson (United Press Correspondent), 1933

Etiquette Enthusiast, Maura J Graber, is the Site Editor for the Etiquipedia© Etiquette Encyclopedia

CDC Respiratory Etiquette

How they practiced respiratory etiquette during Hollywood’s Golden Age — Photo source, Pinterest  

The national Centers for Disease Control and Prevention (CDC) urge all individuals to observe “respiratory etiquette” to prevent the spread of infectious diseases, including influenza (flu), colds and pneumonia.

The principles of respiratory etiquette are simple:

1. Cover your nose and mouth when coughing or sneezing. Do this either with a tissue or your inner elbow.
2. Wash your hands frequently. This is the single most important thing you can do to stop the spread of disease.
3. In a hospital or medical setting, masks should be worn by anyone who has symptoms of respiratory infection (cough, fever). If you are in a waiting room and have these symptoms, please ask for a mask to wear so that others will not get sick. —Anne Arundel Medical Center, 2018

Etiquette Enthusiast, Maura J Graber, is the Site Editor for the Etiquipedia©️ Etiquette Encyclopedia 

Sneeze Snub is Influenza Etiquette

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Avoid worry and turn your back on sneezes — In a time when the world faces another influenza pandemic, and briefly changes the etiquette for greeting others (avoid handshaking by touching elbows and avoid cheek kissing by putting one’s hand over one’s heart), it’s time to take a look at what was taught a hundred years ago. –An image of a Red Cross nurse published in Illustrated Current News, 1918. — Photo source, National Library of Medicine

Cover Coughs and Sneezes 🩺 Wash Hands Frequently and Thoroughly 🩺 Self Quarantine if Sick 🩺 Avoid Handshaking 🩺 Forego Cheek Kissing 🩺 Work from Home if Possible 🩺 Avoid Large Crowds🩺 Avoid Others Who May be Sick

The following is a summary of the talk given last week by Dr W. W. Crawford on the subject, “Preventive Measures Against Colds and Influenza.” An ordinary so-called cold may be the forerunner of such specific diseases as Measles, Influenza, Whooping Cough, Bronchitis and Tuberculosis. The germs of Colds and Influenza leave the body in the secretions of the mouth and nose, and enter the body through the same route. It is health etiquette to turn your back on sneezes. Remember coughing, sneezing and dust spread Influenza, and overcrowding helps these along. 

Remember, the close relationship between the nose and throat with the ears and sinuses. Therefore, see to it that your nose and throat are kept clean. Keep away from a house when the lady is sweeping with a broom or buy her a vacuum cleaner. Immunity may be artificial or natural. Keep your natural immunity up to the highest possible point by leading clean, wholesome lives. A great deal to do in keeping well is in your hands. Remember, doctors are only human and cannot do the impossible.— From an article in the San Diego Union, 1920

Etiquette Enthusiast, Maura J Graber, is the Site Editor for the Etiquipedia©️ Etiquette Encyclopedia 

Health Benefits of Good Manners

The Other Side of Civility... In which the university's expert on all things civil (politely) argues that our good manners aren't just good for others — they're good for us, too. – By P.M. Forni, Illustration by David Plunkert

Tom, a supervisor from marketing, notifies Rob that he has been unhappy for a while with Rob's teamwork. Rob eventually complains to Tom's boss that he is being singled out unfairly by his incompetent supervisor. Things come to a head in the company's cafeteria when Tom accuses Rob of disloyalty and end-running. As anger-laced words fly back and forth, a cascade of catecholamines is released into Tom and Rob's brains and bloodstreams. Catecholamines are hormones and neurotransmitters that, together with the stress hormone cortisol, are main factors in the stress response. They mobilize the body's resources in the presence of perceived danger. As Tom and Rob raise their voices, they are totally under the influence of these endogenous chemicals. From dilation of the pupils to more of their blood being sent to their brains, hearts, and muscles, to glycogen being broken down to glucose in their bloodstreams for fuel, they are in full fight-or-flight alert.

This activation of their bodies' emergency systems, however, is not without a price. Neurochemicals such as epinephrine, norepinephrine, and cortisol increase blood pressure, sometimes to dangerously high levels. They affect the metabolism of cholesterol and triglycerides, which contribute to atherosclerosis. Well known to weaken the immune system, they block the activity of the macrophages (the killers of tumor cells). Although one catecholamine-assisted altercation will not kill Tom or Rob, a repeated engagement of their stress response will add substantially to the wear and tear of their organs and blood vessels. If they find themselves often in the grip of hostility and anger, they may sooner or later face serious cardiovascular disease and other ailments. One of the wisest things Tom and Rob can do for themselves is choosing congeniality as their default mode of relating to the world. This time, however, they go their separate ways in a huff.

As children, most of us looked at good manners as something between boring and burdensome that we were expected to do, at our parents' prodding, for others' sake. Growing up, we vaguely perceived good manners as good but still saw them as benefiting others. This view has clear merit. Civility, politeness, and good manners (which I treat as one here) are indeed "something" we do for others. We are civil when we believe that other people's claim to comfort and happiness is as valid as our own, and we back up belief with action (such as letting someone merge into the flow of traffic).

Good manners, however, are also something we do for our own sake. They are good for us because as a basic code of relational skills they help us manage our relationships, which are crucial to our well-being and health. Although as adults we may have developed a more sophisticated understanding of manners, chances are that our early bias (that they are for others' sake) still looms large. This may lead us to the wrong conclusion that in the fast-paced, highly competitive and stress-laden environment in which we live, good manners are a luxury we can't afford. I suggest that we balance this view by looking instead at good manners as a precious life-improvement tool for the very people who have them. Maybe slowing down in the name of kindness would allow us to connect meaningfully with someone. Maybe this would help us in the pursuit of our goals — both professional and personal. This is as good a time as any to look at the other side of manners: the expedient side.

"Manner" comes from manus, the Latin word for "hand." Thus, manners are ways of handling. We exhibit good manners when we handle well our daily encounters with others — when we handle others, that is, with care and consideration. As relational skills based on empathy, good manners prove crucial when it comes to establishing and maintaining connection and rapport. Humans are hyper-social creatures. We inherited the genes of ancestors who banded together and shared their prey at the end of the day's hunt. Group identity inevitably shapes our personal identity. "Plays well with others" defines the well-adjusted child, and "team player" the employee every workplace wants. If life is a relational experience, then we'd better hone our abilities to relate. As hyper-social beings, our happiness or unhappiness depends, to a large extent, upon the quality of our relationships. As a general rule, better manners mean more harmonious relationships and thus an increased quality of life.

According to clinical psychologist Arthur Ciaramicoli, the co-author, with Katherine Ketcham, of The Power of Empathy, empathy benefits the very person who has this emotional ability: "Individuals who have high relational skills are more successful personally and professionally. People who have developed the capacity for empathy, in particular, have the ability to understand and respond to others based on the facts discerned rather than with generalities. When we know how to listen with compassion and grace we will always attract others in whatever walk of life we live. Corporate managers, educators, etc., all are more successful when they have the ability to read others accurately. Of course, in our personal lives, these abilities make us better friends, spouses, and parents," Ketcham says.

By being good citizens of our little world of family and friends, we build the foundation of our social support. Common sense and good physicians agree: Social connections are good for us. The meaningful presence of others in our lives helps us remain healthy — both physically and mentally. It is good to be a member of a family, a religious congregation, a charity initiative, or a support group. We all need loyal friends, empathetic co-workers, good neighbors, and thoughtful strangers around us. Isolation invites illness. To cope and thrive we need social support. To build and manage social support, however, we need social skills.

When we treat others with kindness and consideration, we show them that we value them as persons. This motivates them to remain in our lives, and as a result we continue to enjoy the rewards of connecting. Until three or four generations ago, a large amount of the support we needed came from our extended families. Today, as we often turn to friends, acquaintances, and even strangers for support and care, being likable can be a substantial advantage. An elementary but powerful truth to always keep in mind is that social skills strengthen social bonds. Social skills are thus an invaluable quality-of-life asset — in fact, they are nothing less than determinants of destiny.

The strengthening of social bonds gives us opportunities to confide. Confiding is good medicine. As we open ourselves up to a good listener, we get our sorrows off our chests, gain insights into our predicaments, and invite sanity into our lives. Disclosing is often the beginning of healing. Pioneers in mind-body medicine such as James Pennebaker, Janice Kiecolt-Glaser, and Ronald Glaser have paved the way to the scientific realization that confiding is also good for our immune system. There is a direct correlation between self-disclosure and resistance to disease. It is in part thanks to our relational skills that we manage to make and keep the friends among whom we can choose our confidants. The more trustworthy friends we have and the closer we are to them, the more likely it is that we find among them the right persons with whom to open up.

If you are considerate, people will like you and trust you; if they like you and trust you, they will let you help them; by helping them, you will help yourself. The ability to maintain good relationships makes us successful at helping and volunteering, which feels good and is good for us. Researcher Allan Luks has studied extensively the state of well-being he calls "helper's high." This state, similar to a "runner's high," occurs in people who volunteer for good causes. Luks believes that it is the release of endorphins in the volunteer's body that allows him or her to experience elation followed by calm. Although less intensely, helper's high also occurs in volunteers when they recall the experience of helping. Especially when it is not felt as an obligation, helping appears to release hormones and neurotransmitters that strengthen the immune system and are generally good for your health.

Feeling good about ourselves and our relationships makes us more inclined to laugh. From time immemorial, human beings have felt that laughing is good for them. Now we have the science to back up intuition. Laughter increases blood flow, reduces the effects of stress (by reducing the amount of cortisol, the stress hormone that can cause so much cardiovascular damage), and gives our immune system a boost. Laughter appears to be accompanied by the release of endorphins, the biochemical compounds that suppress pain and induce states of well-being. Happy people are less likely to suffer from high blood pressure and heart disease. The inclination to laugh seems to have a protective effect on our hearts. Although our individual propensity to laugh may be genetically programmed, the circumstances of life will also determine the amount of laughter we enjoy. Relational skills can make us happier and give us the gift of much-needed hearty, healthful laughs.

Common sense and good physicians agree: Social connections are good for us. The meaningful presence of others in our lives helps us remain healthy. Such positive emotions are not only good for our health, they are good for our thinking as well, according to psychiatrist and author Edward Hallowell: "Basically, emotion acts as the doorkeeper to advanced thinking. When a person is in a good mood, feeling content and in harmony with his surroundings, the door is wide open. He can do what his cerebral cortex is uniquely equipped to do: think flexibly; perceive irony and humor; perceive shades of gray, subtlety, complexity; bear with the frustration of not knowing the answer, and allowing conflicting points of view simultaneously to balance in his mind without either overpowering the other; wait, before bringing premature closure; ask for help; empathize with others; give to others; put the needs of others before his own; give help; inspire others."

Civility, according to Yale law professor Stephen Carter, "is the sum of the many sacrifices we are called to make for the sake of living together." In our times of relentless self-indulgence, it is good to keep in mind that restraint and sacrifice are necessary for functioning well among others. Yes, sacrifice is part of civility. It is a sacrifice, however, that we make for our own sake as well as others'. (Also, we often reach a point where we do not perceive acting civilly as a sacrifice anymore, but rather as a necessary part of who we are.) Civility is powerfully linked to expediency — it is a very efficient and captivating way of pursuing self-interest.

Let us go back to Tom and Rob. In this second version of events, instead of firing an angry salvo, Tom calls Rob to his office and suggests that they try to resolve their differences rationally and fairly. Tom admits to criticizing Rob without giving him clear alternative directions. In turn, Rob acknowledges giving Tom's boss an unduly harsh assessment of Tom's abilities as a supervisor. They both apologize and pledge remedial action. As they reminisce about their long-standing employment in the company, their contested issues seem to be settling themselves, and the goodwill is almost palpable on both sides. Although there is no fight-or-flight reaction this time, it does not mean that their coming together in a civil and congenial way has no neuroendocrine basis.

Just being in the friendly presence of one another rewards Tom and Rob with lowering levels of stress and as a consequence a better functioning of their immune systems. Their stress reduction is aided by the release of the hormone oxytocin, of growth hormone, and of EOPs, the brain opioids. Their congenial mindset is connected to an increased level of the neurotransmitter serotonin in their brains. Together with keeping their hostility in check, serotonin has the effect of invigorating their sense of self-esteem, and thus makes them less defensive and more cooperative. The oxytocin that, in the meanwhile, is generously released, strengthens the social bond between the two co-workers. Under the sway of their feel-good hormones, Tom and Rob can think more clearly and in more sophisticated ways. As their conversation wanders, they exchange good, imaginative ideas on how to run their unit: a welcome, unexpected result of a meeting called to administer intensive care to a relationship between co-workers. – Johns Hopkins Magazine, 2003 

For the article, P.M. Forni, author of “Choosing Civility: The Twenty-five Rules of Considerate Conduct, consulted Johns Hopkins cardiologists Ilan Wittstein and James Weiss, psychiatrist and author Edward Hallowell, Harvard psychiatrist John Ratey, clinical psychologist and author Arthur Ciaramicoli, Johns Hopkins psychiatrist Rudolf Hoehn-Saric, University of Maryland neurologist Stephen Reich, and Johns Hopkins neurologist Guy McKhann. 

Etiquette Enthusiast, Maura J Graber, is the Site Editor for the Etiquipedia© Etiquette Encyclopedia