Whooping-Cough
WHOOPING-COUGH, or HOOPING-COUGH (syn. Pertussis, Chin-cough) , a specific infective disease of the respiratory mucous membrane, of microbic origin (see PARASITIC DISEASES), manifesting itself by frequently recurring paroxysms of convulsive coughing accompanied with peculiar sonorous inspirations (or whoops). Although specially a disease of childhood, whoopingcough is by no means limited to that period but may occur at any time of life. It is one of the most dangerous diseases of infancy, the yearly death-rate in England and Wales for each of the five years 1904-1908 being greater than that from scarlet fever and typhoid added together. The majority of these deaths were in infants under one year, 97% in children under 5 years (Tatham). It is more common in female than in male children. There is a distinct period of incubation variously estimated at from two to ten days. Three stages of the disease are recognized, viz. (i) the catarrhal stage, (2) the spasmodic or paroxysmal stage, (3) the stage of decline.
The first stage is characterized by the ordinary phenomena of a catarrh, with sneezing, watering of the eyes, irritation of the throat, feverishness and cough, but in general there is nothing in the symptoms to indicate that they are to develop into whooping-cough, but the presence of an ulcer on the fraenum linguae is said to be diagnostic. The catarrhal stage usually lasts from ten to fourteen days. The second stage is marked by the abatement of the catarrhal symptoms, but at the same time by increase in the cough, which now occurs in irregular paroxysms both by day and by night. Each paroxysm consists in a series of violent and rapid expiratory coughs, succeeded by a loud sonorous or crowing inspiration the " whoop." During the coughing efforts thp air is driven with great force out of the lungs, and as none can enter the chest the symptoms of impending asphyxia appear. The patient grows deep-red or livid in the face, the eyes appear as if they would burst from their sockets, and suffocation seems imminent till relief is brought by the " whoop " the louder and more vigorous the better. Occasionally blood bursts from the nose, mouth and ears, or is extravasated into the conjunctiva of the eyes. A single fit rarely lasts beyond from half to three-quarters of a minute, but after the " whoop " another recurs, and of these a number may come and go for several minutes. The paroxysm ends by the coughing or vomiting up of a viscid tenacious secretion, and usually after this the patient seems comparatively well, or, it may be, somewhat wearied and fretful. The frequency of the paroxysms varies according to the severity of the case, being in some instances only to the extent of one or two in the whole day, while in others there may be several in the course of a single hour. Slight causes serve to bring on the fits of coughing, such as the acts of swallowing, talking, laughing, crying, etc., or they may occur without any apparent exciting cause. In general children come to recognize an impending attack by a feeling of tickling in the throat, and they cling with dread to their mothers or nurses, or take hold of some object near them for support during the paroxysm; but although exhausted by the severe fit of coughing they soon resume their play, apparently little the worse. The attacks are on the whole most severe at night. This stage of the disease usually continues for thirty to fifty days, but it may WHYMPER WHYTE-MELVILLE be shorter or longer. It is during this time that complications are apt to arise which may become a source of danger greater even than the malady itself. The chief of these are inflammatory affections of the bronchi and lungs and convulsions, any of which may prove fatal. When, however, the disease progresses favourably, the third or terminal stage is announced by the less frequent paroxysms of the cough, which generally loses in great measure its " whooping " character. The patient's condition altogether undergoes amendment, and the symptoms disappear in from one to three weeks. It is to be observed, however, that for a long period afterwards in any simple catarrh from which the patient suffers the cough often assumes a spasmodic character, which may suggest the erroneous notion that a relapse of the whooping-cough has occurred.
In severe cases it occasionally happens that the disease leaves behind it such structural changes in the lungs (emphysema, etc.), as entail permanent shortness of breathing or a liability to attacks of asthma. Further, whooping-cough is well known to be one of those diseases of early life which are apt to give rise to a weakened and vulnerable state of the general health, or to call into activity any inherited morbid tendency, such as that towards consumption.
As regards the treatment in mild cases, little is necessary beyond keeping the patient warm and carefully attending to the general health. The remedies applicable in the case of catarrh or the milder forms of bronchitis are of service here, while gentle counter-irritation to the chest by stimulating liniments may be employed all through the attack. In mild weather the patient may be in the open air. An abdominal binder should be worn night and day in order to prevent the occurrence of hernia. Systematic disinfection of the sputum by means of a solution of corrosive sublimate or by burning should be practised in order to check the spread of infection. In the more severe forms efforts have to be employed to modify the severity of the paroxysms. Numerous remedies are recommended, the chief of which are the bromides of ammonium or potassium, chloral, codeine, etc. These can only be safely administered under medical advice, and with due regard to the symptoms in individual cases. During convalescence, where the cough still continues to be troublesome, a change of air will often effect its removal.
Note - this article incorporates content from Encyclopaedia Britannica, Eleventh Edition, (1910-1911)
