Part 6

The onset of whooping cough is gradual and for some time the child is usually supposed to be suffering from a cold or bronchitis. This first or catarrhal stage has nothing which is characteristic. There is a cough which gradually increases in severity. As the cough becomes more severe it assumes also more of a paroxysmal character with a tendency to recur at certain intervals. After about two weeks with the appearance of typical paroxysms the second or paroxysmal stage is entered upon. This lasts about six weeks on an average. The number of paroxysms varies greatly. There may be but one or two in 24 hours, or one may occur every hour. On an average about 10 to 15 are observed during 24 hours. They are apt to be most severe at night. When a paroxysm of coughing begins the child sits up and if old enough tries to get hold of something for support. The paroxysms consists of a series of expiratory coughs following in such rapid succession that the child is unable to get its breath. These have been compared to the explosions of a motor cycle, or those of a machine gun. At the height of a severe paroxysm the face is red or blue as in choking, saliva flows from the mouth, the tongue protrudes and is blue, the child struggles for breath, when finally, maybe only after several seconds, the spasm relaxes somewhat and air is drawn through the narrowed opening in the larynx with a peculiar crowing sound which is known as the whoop and has given the name of the disease. Such a series of events often is repeated several times in quick succession. Finally the end comes with vomiting which not only gets rid of the mucus in the throat but also empties the mucus from the air tubes. The child now falls down on the bed exhausted, the skin wet with sweat and it often falls to sleep. The struggle of the little patient in its efforts to get its breath cannot fail to awaken the sympathy of anyone who witnesses it. In older children the paroxysms are better borne and the general strength is not much affected. In young children with frequent paroxysms and loss of food from vomiting much depression and weakness develops. When there are frequent severe seizures the face in the intervals has a woe-begone expression, the skin is dusky and the eyes dull.

COMPLICATIONS

Occasionally a child dies in a severe paroxysm from strangulation. Most deaths are, however, dependent upon complications. Of these the most frequent is pneumonia, which is not uncommon in infants. Convulsions also cause many deaths. They may occur during the paroxysms of coughing and if repeated are very dangerous. The great congestion of the blood vessels of the head during the paroxysms sometimes leads to rupture of blood vessels, so, that nose-bleed is not infrequent. Hemorrhage into the brain may occur. Bleeding beneath the conjunctiva of the eye-ball results in red blotches over the white of the eye. These may be small or the blood may spread over the entire white portion of the eye-ball causing a most striking appearance. Bleeding into the loose tissues of the eye-lid may occur, producing a “black eye”. This has been mistaken as due to injury and should be remembered as something which may occur spontaneously during whooping cough.

In infants disturbances of digestion are frequent, and intestinal disorders in them are grave and add materially to the danger of the disease.

After recovery permanent damage to the heart may remain. The condition brought about by the disease also favors the rapid progress of any tubercular disease which otherwise might be of little moment.

PREVENTION

It is important that small children be kept away from this disease as long as possible. It is particularly difficult to limit the spread of the disease by isolation because the period of greatest contagiousness is that in the beginning when the child is supposed to have a cold. An older child in a family contracts the disease at school or in play with other children, and before he is suspected of having the disease, the younger members of the family have been infected. A vaccine has been prepared from the bacillus of whooping cough which appears to have some value in preventing and rendering milder the disease. As this is harmless it ought to be given to young children as soon after exposure as possible in the hope that it may prevent the disease or make it milder if it develops. After the paroxysms have been established the vaccine seems to be less useful.

TREATMENT

Many cases, especially in older healthy children, require little treatment. When paroxysms are frequent and severe, remedies to reduce them are desirable, and of these paregoric seems to do as well as any. If vomiting occurs frequently the loss of food is of importance. In such cases easily digested food should be given as soon after a paroxysm as possible so as to allow time for digestion and absorption before another paroxysm occurs. The feeding is of great importance in infants. A simple mechanical appliance is of considerable use to these children. It consists of a firm binder fastened snugly about the entire abdomen. It should come up over the lower ribs, and be held in place by straps over the shoulders. This gives support to the abdomen during coughing, enables the child to endure the paroxysms easier, and also supports the weaker points of the abdominal wall and so prevents the development of hernias or ruptures. Of all measures used in the treatment of whooping cough the most important is the furnishing of fresh air. In suitable weather the children should be kept out of doors all day, and at night should have plenty of fresh air. This is equally the case when pneumonia complicates whooping cough.

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TRANSCRIBER’S NOTES

Obvious errors and omissions in punctuation have been fixed.