The Administration of Large Doses of Ascorbic Acid in the Prevention and Treatment of the Common Cold: Part II

* SPECIAL ARTICLE The Adminisfrolion of Lorge Doses of Ascorblc Acid in the Prevenfion qnd Treotmenl of ihe Common Cold Porl ll Edme Regnier, M.D. r i i i I Beginning at about the age of seven and following a tonsillectomy I began to be plagued with otitis media of which I suffered from 50 to 60 bouts over the next 20 years. These recurrent infections were treated by a series of different methods including Cubeb cigarette smoke blown into the ear by my mother, the local application of heat, sulfadiazine in nasal sprays and the earlier and later forms of injected penicillin which was useful as soon as I suffered ftom a sore throat if taken at the first signs of infection, but only for the secondary bacterial component of my double infection t'hich began with a virus which appeared to pass the sentence which was executed by the bacteria. I stumbled upon the emplop ment of ascorbic acid because of the advertisements for the bioflavonoids and vitamin C as 'beneficial in the prevention and treatment of the common cold. It was apparent that the mixture diminished the symptoms of the common cold for me and for my wife, but not enough for us to continue with its employment. Would larger doses perhaps be more effective? The doses were increased as each increment proved itself as giving better results until I reached a maximum aud satisfactory efiect. I did not permit myself to be dissuaded by the gloomy conclusions of others, whose work I continued to recognize had shown only that vitamin C had not been helpful against colds at tlze dosage used ìn their studíes, and not the unmeasured generality that this drug had been proven utterly useless against colds. I was then able to suppress colds, at will, in five subjects. There is no doubt that we really suffered from colds du'ring these suppressed versions of the disease, because we continued to be alare-but just aware-of whatever symptoms had been characteristic of our formerly unmodified colds. Although running of the nose would be practically non-existent, on rare occasions a single drop might appear at the nares; however, not ,a trâce of "itchiness" had accompanied it in its roll down the turbina,tes. The thickened stage of nasal discharge was never reached. Sneezing and coughing rilere quite unusual. A throat did not pro* ceed to "soreness" but, in some cases, there was a slight sensation of its presence. Hoarseness v/as uncommon. Headache was inconsequential. Malaise, if at all recognizable was usually so minor as to be undeserving of the Dame. Secondary bacterial invasions did not occur. I learned that the treatment had to be initiated early enough and needed to be continued at a high level for some time and then withdraw,n or diminished ; {f ,: i 4 f ;: ji: t: íì Ji. &, # 'ð r ii¡ 948 REGNIER_ASCORBIC ACID only gradually, It was noted that the infection so treated although suppressed appeared to last longer. When not treated the duration was usually from live tto seven days, but when.treated all evidence of the viral infection was not gone u,ntil eight to eleven d,ays had passed. It was as though the suppression of the inflammatory response was at the expense of some delay in the development of a completed imrnunity to the causative viruses, It seemed also that despite the clelay of imnediate immunity the development of the usual several wceks' of resistance was in no way retrrded, There were two objections to the treâtnìedt, It was expensive in thatthe cost of ,the cll:ugs was rnore than $25.00 for each cold; and there were two variables, the bioflavonoids and the ascorbic acid. Was it possible that the vitamin C alone was responsible for the obvíous effects, or lvas there a synergistic adtion of the so-called vitarnin P? The texts suggested that the latter substance demonstrated little phar:mticologicnl nctivity, although a clclìciency was thought to oause an incrc¿rse in the penleability of capillary w¿rlls. It elicl not seem fo nre that the Il¿rvonc ,factor in lemon juice (citrin) nncl in l{u,ngar:iern red pepper nnd consisting of n mixtrrre of flavones, edodictyol and hespericlin could be of any great importance. Nevcrthelcss, I initintcd a doubleblincl stucly using ascorbic acicl alone, nscorbic acid plus biollavonoids, flavonoicls only ancl, fourthly, n lactose plncebo with the two "vitamlns" prescnt either alonc or together in 200 mg quantitics, It w¿ts shortly obvious that tltcrc was no ncccl to continus cloubleblincl techniques. The continuecl $tudies we¡:e clone by the single blind .nrothod, As noted'in the introductory ¡:enrarks, a cold is ,a tenuous entity. Ïts treotmont required a high degree of .informality with much use of the telephone to encourâge the subjects to 949 continue to discipline themselves as regards the use of the ascorbic acid. Attention was intensive and supervision essential. At no time was any subject requested to take a dosage of ascorbic acid which had not been exceeded by members of my family and by me without ill efiects. I limited myself to 22 subjects, a number I could carefully supervise. Almost all were of professional stature. The majority were adults whose ages ranged from 30 to 50, with the extremes being five children younger than 12 (whose heatments. were supervised by adults) and the oldest subject was 73 years of age. My observations suggested that it might be'best to spare children colds completely where possible by quick control of the upper respiratory infections of the adults of the family and ordinarily to permit the cold to run its unmodified course if a child did catch one, even though the children are the most likely patients to develop secondary bacterial infections, fn any case, even for adults, the suppression of colds by ascorbic acid-at least as it stands nt present-is not a form of treatment ideally suìted to the capacities of every last patient. The patient must persis,t in taking his medicine as ordered and for the prescribed time. Surely I am aware of the possible danger of interfering with the development of naturally occurring antibodies or immune responses. Although there has not been a single serious consequence to the suppression of colds by ascorbic acid in more than 400 such trials, I still hesitate to state that prolongation of the activity of the virus may not give the organisms time and opportunity to modify their nature so that an attack on another organ or s)¡stem might occur. In actual practice there has been what probably amounts to a small increased incidence of transient muscle involvement, of soreness of 'the back or stiffness of the neck, :t :' .lj Il ' .il ii ü ìi ,, ii I ;i ,* 'n \ I Ë ;å 'ig ,); r T å .it :d: * i!l 1i J' I r 4 4 $ !; t i i! $ t i1 !. , 4 + i i !. : I 1 T i ìl l I ' I I I t ! ! I I 950 both of which, of course, may occur with untreated infections with vi¡uses of the upper paÍ of the respiratorY tract. The22 subjects mentioned have been studied systematically and under conditions which were as controlled as is possible in a clinical investigation of an affection such as the common cold. Some acted as what are commonly termed theh own controls in that they were sometimes permitted to sufier from untreated colds and at other times were treated by one or the other of the four trial "drugs" used successively in new colds. Equally valuable for comparative purposes were tle clinical courses of several individuals each treated differently at one and the same time during the course of a specific upper respiratory infection which affected several or all of the members of one household. None of the subjects was studicd for less than three years, and for almost all, the duratiou of observation was four or fi.ve years. In the past all had experienced from one to four colds each year with the usual number being three. While it was taken for granted ,that the memory of the incidence of past Ínfections may haræ been exaggerated, the minimal expected number of colds of the group overall was estimated to be approximately 225. But during the five-year períod of observation there were aotually only 160 upper raspiratory tract infections. The validíty of the treatment employed cannot be based on the reduction of expected colds, but if this is true it woulã cer. tainly suggest that the program had some sort of value as a prophylactic measure tôo. Of the 160 "cold incidents" tlere were 23 which could not be included in the results, because for the particular cold the subjects did not correctly follow the particular treatment prescribed for them. Some of these occur¡ed at the beginning of the study REVTEW OF ALLERGY, VOLUME 22, OCTOÊER, 1968 when the discipline involved in the taking of the drug according to schedule was being established and some at the end when some of the subjects were able to recognize the fact that they were beiug treated with a placebo and refused to proceed with a useless type of therapy. The Method of Treatment Within the ûrst 24 hou¡s of a typical infection which the patient recognizes as his usual earþ symptoms of a cold, and the sooner the bstter, the beginning dose of ascorbic acid of 600 or 625 mg is taken every three hours, Ascorbic acid is available ìn various tablet strengths and the patient may take, for example, three of the 2O0 mg tablets or two and one-half of the 250 mg tablets. The medication will work equally well when a single 200 mg tablet is taken every hour or when two tablets are administered every .two hours, but this more frequent ingestion only makes for unnecessariþ complicated treatment schedules. On the other hand, experience has taught me that four of the tablets taken every four hours are not as satisfactory, for the reason that during the earlier and more violent stages of the infeotion, the patient often becomes aware somewhere near the end of a three-hour period that symptoms are recur¡ing or are irnminent. It is actually sometiures'pleasant to look forward to the next dose to be taken. The need for a three-hour sshedule of doses parallels laboratory observations and data that the levels of ascorbic acid in .the plasma have retumed.to normal afte¡ the ingestion of quite large guantities in this time (8. N. Todhunte¡, R. C. Robbins and J. A. Mclntosh. J Nutrition 23:309 1,942). If the amount of ascorbic acid taken at bedtime is increased to 250 mg, there is no need to awaken the paiient at night for the "missed" dose provided that the first dose of the next day Ís also raised to 750 mg. Experience has ,.i¡¡¡iq!%il REGNIER_ASCORBIC ACID shown tl¡at a sustained release caosule for overnighr effect is thus not neêded. but its eventual availability would seem to have an obvious application in the treatment schedule. It was also learned that when the three-hour interval was exceeded ancl largcr inclividual droses were thus neecled, ,there was the disadvantage that they caused pyrosis (heartburnj. This w-ru.easily relieved by a small quaritity of bicarbonate of soda in water. Wren ascorbic acid is used at the closages clescribed and for only short periocls of time, gastrointestinal disturb¡inces are the only side efiects commonly noticccl. Atter severnl clays of thcsc high dosage levels, there máy be ¿ut cxcess of al¡clclminal gas, which most paticnts inlìnitcly prefer to the symptonrs of thc cold. which ,they are awaie woulcl clistrcss them were they not tnking their trscorbic acid. It should be notecl th¿rt other common methods of treating cold symptotns are not free of sidc cllccts, especially those of a sympathomimctic ty¡:e. Aftu tlie pntient has taken the large tfoscs prcscribccl for the initial stages oll thc colcl fr¡r somc three to four days, it is ¡rossi'trlc for him to clinrinish the qutrntitv of irscorbic ncicl, Thc threehour schcclt¡lc is still aclhered to, but the close of tho vitamilr is reduced to 375 to 400 mg, If thc reduction of the close hns becn prcmatulc, typical colcl symptoms wilI reflssert themselves witltin tr pcriclcl of 12 ]rours or less. Shoulcl this occur, it is necessary to return ,to the initinl size closes âs soon as possiblc; ancl despitc thcnr the symptoms may not be rc-abortecl for: as long as 12 to ltl hours (laboratoly clata, Toclhuntcr, et nl,, op. cit.). Should there bo llo recurrence of the typical synrptoms when the close l:as been reducecl ancl maintained ,at the lower lcvcl for two or three days, then a further recluotion in the quantity of ascorbic acicl taken may be attempted 'wlth the new closes taken at the three951 Itour intervals 'but consisting of only ?90 qt 250 mg. Afrer severãt days oi this dosage level the interval may be increasedrto four and six hours between the tablets of 200-250 mg dosage, and if there is no evidence õf anfrecurrence of the typical symptoms the use of the ascorbic acid may cease by the tenth to twelfth day of ,treatment. f't is interesting and should be remembered that as the ascorbic acid doses are reduced therc may occuronly rarely-one or two atypical symptoms which may not be recognized as accompaniments of a viral infection. There may be painful ,twinges of the muscles in unusual locations or "odd" headaches. These call for immediate increase in the dosage of the ascorbic acid as well as for a prolongation of the treatment period. If these complications-if so they may be termed-are recognized for what,they are, then the patient learns by practice to watch his own progress more carefully and to reduce the doses of the vitamin less quickly, in which case, with subsequent respiratory tract viral infections, such conrplications will appear less and less often. There are no practical objections to the continuation of the high initial doses entirely throughout the period of treatment. I felt that it is only judicious to employ as little of the drug as may be necessary. f was also interested in the determination of what the Iowest eftective dose might be. On one occasion I kept a cold active for approximately 27 days, alternately suppressing it and permi'tting it to recur by alterring the amounts of ascorbic acid I took, It was interesting,that each time I attempted to re-su'ppress the infection it became more difficutrt for me to do so. And finally I was forced to resort to pencillin to prevent the old "spinoff" of a viral infection into a bacterial invasion affecting my eâß. To ropeat, I have learned that it is advisable (and still safe) ,to en on the side of prescribing 'too large a dose of : I : ì ,i t : r ,i' ' ìt: .T ,t lj .A{ti ,i, I !, :È' ,?. ti '?: i; ., t; ,i il #¡ ?. :yl , "ui i. i ,t, ' 'g ü tw '.H '4. .: .& B :'k 't '¿^ :^ ,#. 'i ë "x '\ "i: '| fr t4 .* IE i* i$ i* jä tM :f! .¡ú :I !ål :1, l:I ',i *. rl ,þ :l l, 982 ascorbic acid in the later stages of a viral infection rather than too small a one. It seems to me that if one takes it upon himself to exercise a pharmacological authority which may actually extend the dur'ation of an i¡fection beyond the limits which would naturally occur if the infection were permitted to run its natural course, tben modified as that infection may now bg one must also assume full responsibility for seeing to it'that the ailment is thoroughly restrained until it is finally vanquished by the normally developed immunological response. Results In the treatment of 137 observed colds the prescribed doses were properly,taken. In 34 of these the treatment consisted of commercial duo-CVP, and the cold was satisfactorily suppressed in 31 instances. In another 50 colds the treatment consisted of ascorbic acid alone either as supplied by the U. S. Vitamin and Pharmaceutical Corporation, New York, or later, of other brands purchased looally and at ¡andom. Of these 50, the colds were nicely suppressed in 45. Of the eigbt failures in these two "successful" trials, six can be accounted for and will be recalled in the Discussion below. There was no overt clinical difierence between the colds suppressed by tbe ascorbic acid employed alone and tlose where it was combined with flavonoids. It nade no difierence what brand of vitamin C was taken as long as it was fresh. Among 29 medications with bioflavonoids alone, the cold was in no way visibly modified from what would have been ordinarily expected in 28 of the instances, Tn 22 of.24 instances in which the lactose-filled capsules alone were taken the colds were seemingly untempered and ordinary. All medications were issued in the orange duo-CVP capsules, except that during the later studies white tablets REVIEW OF ALLERGY, VOLUME 22, OCTOBER, 1968 of ascorbic acid were sometimes used. Not only were the capsules identical, no matter what they contained, but the schedules were identical as described herein; and any drugs which had not been taken were returned to me before the next cold appeared and needed io be treated. In this small group of subjects there was not one rrho failed to obtain successful results as regards his symptomatic response if his intake of ascorbic acid was both sufficient and well-timed. Judgment as to the successful suppression of the sympfoms of a cold must, at some point, be subjective and oannot be a quantitative and therefore rneasurable value, but as fat as the subjects themselves were concerned there was no question on,this point because the suppression of the symptoms was so gratifying. In contradistinction to the studies of others, no attempt was made to identify the specifc virus or vi¡uses responsible for any infection, Clinically, the colds showed a considerable, though characteristic variety and were, as noted previously, spread through a period of flve years or more. The majority of the subjects resided in Massachusetts, but some lived in Pennsylanvia and several in Hawaii. It seems reasonable t'o assume that ,there was in this sample a fair representation of the many viruses known to cause "colds." It should be noted that when treated the clinical courses of the patients, no matter where they resided, were very similar indeed, allowing for minor differences of no importance. I do not wish to imply that ascorbic acid should be thought of as a general anti-viral agent. I only asseverate that it may be employed to suppress the symptoms of a cold quite effectively. Now that we know how widely organisms which do not synthesize it vary in their needs for it, only additional studies can tell us how far its usefulness can be extended, l,i,ril...1,, , i tli ,1,, REGNIËR_ASCORBIC ACID Some Theoretical Considerations on fhe Role of Ascorbic Acid I have dutifully listed rhe textbook descriptions of the functions of ascorbic acid and have added to those some of the more rnodern concepts of its actions and the vnrintions in its requirements in human beings. I saw no point in expressing my personal opinions until the body of this communication had treen written. I do have some ideas of my own which are based on what I have observed and have developed along the lines of logic, Studies may pfove ther]l to be true, at least in part, but I rnust disclairn any certainiy if only because overconlìdence in similar speculations made in the past and later shown to be inaccurate acted only as obstacles to the use of higher doses of, the vitamin than had customarily been administerecl Two possibilities suggest themselves, and it m'ay be that neither is justifiable. If we limit our speculations to one aspect, the methocl of action; it is obvious thnt ascorbic acid suppresses the symptoms of the viral infection which is known ns the common colcl. The most obvious causos of these disconrforts are those associntetl with inflanrntation, As an exanrple, ,there is the hoarsencss which l'esults f¡:om an exud,atiorr of plnsrna nncl cells into the voc¿rl cords ancl tlìe surrounding mucous memtrrnnes. If it is true that ascorbic acicl decreases thc permeability of copill'nry vessels, then there woulcl be lcss thnn the normal Ínflamtrrntory rcsponse when it is taken. It may nlso be true thart dcspite in vitro stuclics to the cclntrary, ascorbic acid may render inclividual tissue cell membrnnes less ¡:ermcablc to the viruses, in whiclt c¿rse there ruight be what might læ tqmed a double-bnrreled action. l--fere .there would be a lessened cell penetration, and therefore fewer replic¿rtions of thc viruses, as well as the decreasccl pernteability of the capillary walls which is itself nnother aspect of 953 cell-wall effect. The fust of these, diminished respiratory cell penetrability, mrght explain the prophylactic success of ,ascorbic acid administration, and the second, decreased permeability of c3nillary walls, irs iymptom-suppressrve acnon. If these suppositions have any validity, they make for reasonable explanations of some of the failures and partial failures in this method of treatment of colds. Too small a quantity of ascorbic acid would not do what was intended or, what amounts to the same thing, if the ascorbic acid has been oxidized or has ofherwise deteriorated, the doses taken are not what they appear to be. It is too much to demand of the vitamin to expect it to be effective when the humidity of the ambient air is so low (Lubart, J. New York J Med 62:816 1962) that we have damaged mucotü¡ membranes, or when there is a secÕndary inflammation caused by exposure to fumes or high levels of smog, or if there is a swelling occasioned by an allergic response. Consideration must always be given to the possibility that all of the ascorbic acid administered is not absorbed when there is an abnorruality of the contents of the intestinal tract as there might be if a food such as yoghurt has been ingested in any large quantity recently. And we would have no right to expect ascorbic acid to be eflective in the presence of a mixed viral-bacterial infection or when the infection is chiefly or only bacterial in type. It is a fair question to ask why ascorbic acid administration is not efiective when begun only during the third or fourth days or later in the vi¡al infection. The answer is that it may be possible to diminish the extent of additional exudation, but many cell changes and much edema have already occurred and are not reversible, and there has been an opportunity for a maximum replication of the viruses. It might also be asked whether there . ; r J' ì. ¡, il i: il ,j, .t, I i,. :l l i1, ä 1i :i: t .. i. i,, il, : l L :' : :l 954 is not something of a risk in electing to limit the amplitude of the natural inflammatory response and perhaps suffer a diminution of the immunity which might otherwise have been acquired. It must be remembered that the viruses in question are tot, in the ordinary sense of the word, lethal; and the consequences of their presence are more often annoying rather than disabling except in special cases and epidemics where virulent organisms are widespread. In such circumstances are we not wÍse in doing what we can to hinder the evolvement of the inflammatory reaction which serves as a base for more serious effects and secondary infections even if this has been accomplished at the cost of a tenporary delay of some immunity. In any case, such immunity or lack of it can be shown to apply only to the one virus under consideration aud to its several related viruses, and not to any of the others with which the patient can subsequently become infected. Discussion As the ¡eader will have noted, it was not possible to write the usual type of exposition paper on the use of ascorbic acid in,the treatment of the symptoms of colds, because at every step along the road some discussion was necessary. What follows is also discussion but in terrrs of the work of other investigators and of some of my own observations which have not been touched upon, and which I think need emphasis. If I am coffect in the interpretation of my studies and a daily dose of five grams of ascorbis acid, at least at tÏe beginning is needed to suppress the symptoms of the common cold satisfactorily, and if the schedule described must be scrupulously followed, then it is not at atl astonishing that the results here reported difier from those of other investigators. These were studies concerned with the employment of one REVIEW OF ALLERGY, VOLUME 22, OCTOBER¡ 1968 g[am or less daily and one investigation in which three grams were used and discovered to be ineffeôtive, from which data it was perhaps too generally concluded that vitamin C was without any useful effect upon colds. I must insist that the exact quantity of the drug administered is critical, as is the schedule critical; smaller doses of ascorbic acid or longer intervals between doses may actually prolong the overall duration of symptoms of the cold itself. In other words, if the required amount of the vitamìn is not going to be taken, it is much better not to take any ascorbic acid at all. Mention has been made of the pyrosis and production of intestinal gas which may be,associated with high ascorbic level intake. The texts suggest that all excess amounts of vitamin C are rather casually excreted in the urine, but they rarely deal with any such dosage quantities as are required for the alleviation or suppression of the symptoms of colds. Because I was not able to tnd many references to tåe use of doses as large as those I found necessary, I needed to do some studying of the gastrointestinal effects of ascorbic acid for myself. I have personally taken five grams or more of ascorbic acid daily for several periods of as much as six months. Another member of my family took the same quantities but for not quite as long a rime. There seems to be no doubt that the normal intestinal flora rnay be converted into,a predominantly anaerobic type which produces an excess of intestinal tract gases that are both annoying and persistent (Lorraine G_a[, fBM Space Systems Laboratory, Washington, D. C., personal communìcation). It has been known that asco¡bic acid taken in a daily range of three to four grams may alter serum electrolytes as well as lead to a decrease in,the motitity of the intestinal tract (Danhof, I. 8., University of Texas, personal comjii:,i .¿' $¡; ¡ ,i I I i ¿ 1 ¿ i ìlf #ñ REGNIER-ASCORBIC ACID munication). This effect of the vitamin may well ûccount for the flatulence which, while only occasional, occurs too often to 'be thought of ai coinci_ dental._ ft was especially prominent in two subjects who perseveied in takins large doses of nscorl¡Íc acid for mucñ more than the recommended limit of 12 days. Excess gas is never more than transient if one sticks only to the recommended no-more-than-12-day courses. The dangers in interpretation of the prophylactic use of any drug are well krrown, because there is no method of being cer'tain that the disease in question would necessarily have affiicted the subject. It is, however, known that the so-called irnmunity to viral infections of the upper respiratory tract is shortJived ancì, in fact, tha.t some only confer immuníty ngainst themselves and perhaps for closely related viruses which have not changed antigenically. From observntions made over â span of a number of years it appears to me that whcn one is cxposed to an obvious source of Ínfection, as when a patient sncczes in ons's face, a dose of 600750 mg nf vit.rmin C will prevent a ¡:ossible colcl, especially when a second dosc <lf the same mngnitudc is taken threc houls l¿ter, Sboulcl this simple proplrylactic progrâm be followed faitlrfully, colds will occur less frequently nncl thcrc is ofterr no need to go on tcl thc trealment schedule which has been outlinctl. As notecl, it is diflicult. il not impossible, to validate stttisticrlly 0 progr¿un of prophylaxis tunlcss tlrc population studiecl as trented rncl ¿rs controls is ininrensely lalge. It is with somc hesitation, ,then, rthat I nlcnticln thc ex¡:ericrtce of thrce lrurses who huvc takcn the drug uncler my supcrvision ¿ìt ô rotc of 250 mg of ascofbic ncid daily for four consecutive se¿rsons. In an cnviroünent wlrere upper rcspiratory tract infectiotts are conrnron. cspecially that of a general hospital (f. B. Thom¿s Hospital, Peabody, Massachusetts.), each has been completely free of colds while most other nurÉes working in the same milieu havo been afficted on one or more occa- $ong, 1ec¡ssitating absence from duty. Each of the three was formerþ subjeót to frequent colds. Before going .to -the theater where one may be-exposed to many people suftering from colds, a prophylactic dose may,be taken before leaving home and another 750 mg dose upon returning with a gratifying absence of the usual possible infectiõns. As evidence of the harmlessness of such a program, it should be mentioned that one of the three nurses has taken vjtamin C daily for 12 years, during the ûrst eight on her own initiative and for the remaining four under my supervision. During the former period the dose was usually 100-200 mg daily. Proof that she had not developed an immunity from any visible subclinical infections was demonstrated when, at my request, she ceased taking the ascorbic acid for one season during which she was afflicted with two colds. Of these, one was treated successfully by the suppression method as outlined, and the other was permítted to run its course, which proved to be typical. Of course, a "series'n of one patient does not establish a hypothesis, but this patient's history is mentioned because of the long use of the vitamin with no o'bvious barm. When the physician-patient finds himself the unwilling host to one or more symptoms which nray or mây not be evidence of an upper respiratory tract invasion by a virus such as an unexplained gastroenteritis an othe¡- wise inexplicable headache or an erratic muscle ache, it may be wise to begin ascorbic acid therapy. If a disease not restrainable by the vitamin develops, this "insurance" has at least been inexpensive and safe. A¡d if the symptoms dr? suppressed then one may or may not choose to presume that the method of triatment was successful. 955 :! : :, l'; t, ii ii i4 Ìì ¡ì1 ii i,l i, t, iL 'út ilr :i ü fi li Ë :i; rii, ,& Í ii Í .A i :.1 I È + Í ,. È 't T Í T .{,. tt z f i Since he can never exactly repeat the circumstances and thus make a scientific and controlled experiment of the procedure. But he maY elect t9 coniinue with the ascorbic acid therapy too. It must be remembered that vitamin C is easily oxidized and therefore may lose its potenc¡ A bottle of tablets obtained from the hospital pharmacy may have been oPened months before being dispensed. It is therefore wise to purchase the smallest quantity of tabiets, usuaþ 100, it a PaPer-sealed bottle from a drug outlet or large pharmacy which sells a large volume of this and simila¡ products. For the treatment of each new cold it is best to begin with tablets from a new bottle. Mention has been made of the special susceptibility of some women to colds at certain timæ in the menstrual cycle. There seems to be a compensatory interval of about three days, pre-menstrual, when there is a natural coldsuppressive state during which it is not necessary to use ascorbic acid should a cold occur. 9s6 Summary ìVhat is usually referred to as the common cold has been reviewed in general terms, and the signs, symptoms REVTEW OF ALLERGY, VOLUME 22, OCTOBER, 1968 and the clinical course of viral infections have been described. The epidemiology of viral infections has been surveyed. The predisposition of human beings to viral infections has been commented upon. The mapitude of the problem of the common cold has been given consideration. The traditional treatment of the infections in question has been examined and criticized. The problem of scurvY has been canvassed and the mauy roles of ascorbic acid explored. The requirements of human beings for ascorbic acid have been discussed. My personal experiences with the use of ascorbic acid in the treatment of viral and the prevention of subsequent bacterial infections have been delineated. The method of treatment and prophylaxis of the common cold has been outlined and the results of both prophylaxis and treatment are analyzed. Theoretical considerations of the method of treatment and of some Possible d¡awbacls have been listed. A discussion of the roles of ascorbic acid in the prophylaxis and treatment of the common cold ends this review of the subject. I Broad Street Salem, Massachusetts tla" , * l$"'Å,,'Fr !'\iWW,,, .,,