02 PRACTICE OF MEDICINE. 



whooping inspiration depends on spasm of the glottis. The face be- 

 comes swollen and livid in the paroxysm, and particularly during 

 the whooping. The fit terminates by the expectoration of a colour- 

 less and scarcely frothy phlegm, and in many cases by vomiting 

 also. The paroxysms at first recur several times every day, being 

 always more severe towards evening, but less so during the night. 

 After a certain time, they only return in the morning and evening ; 

 and towards the end of the disease, in the evening only. The dura- 

 tion of whooping-cough varies from a few weeks to several months. 

 Before it terminates, the paroxysms become shorter, lose their pecu- 

 liar characters, and are attended by an expectoration more decidedly 

 mucous. This disorder may be complicated with bronchitis, or 

 pneumonia ; which are the chief sources of danger : — or it may 

 cause cerebral symptoms, or sometimes a real apoplexy. The 

 younger the child, the greater the danger. In some cases, the 

 disease degenerates into a chronic mucous catarrh, with emaciation, 

 and other symptoms resembling phthisis. In the intervals of the 

 paroxysms, the patient coughs but little, preserves his appetite and 

 strength, and has rarely any fever, except in the case above men- 

 tioned, or in the onset of a very severe attack. 



Physical signs. — In the intervals of cough, the respiratory mur- 

 mur varies on different points of the chest ; at one part it is lost ; at 

 another it is slight ; at a third it is puerile ; there is some degree of 

 sibilus and crepitus. The sound of the chest, on percussion, is good 

 and unimpaired. The lungs do not become inflated during the strong 

 inspiratory effort producing the whoop ; for not only is the rima 

 glottidis spasmodically affected, but in all probability the whole of 

 the ramifications of the respiratory tree participate in this morbid 

 action ; for, during that period, if the ear is applied to the chest, no 

 rhonchus or respiratory murmur is heard, except for a moment be- 

 tween each cough. The great tendency of pertussis, in young 

 children, to pass into pneumonia, oedema pulmonum, or intense 

 bronchitis, makes frequent auscultation of the chest very necessary. 



At the first invasion, this disease may be mistaken for croup, or 

 suffocative catarrh. 



Morbid appearances. — The most probable theory of the nature of 

 whooping-cough is, that it is a peculiar irritation of the laryngeal 

 branches of the ^^^^ vagum. When it terminates fatally, it is 

 usually upon the supervention of peripneumonia or oedema pul- 

 monum ; in the first case, the lung will be found to contain san- 

 guinolent serum, and here and there a lobule hepatized ; in the 

 second, a large quantity of highly spumous and colourless serum 

 follows the scalpel on section of the pulmonary tissue. In some 

 cases, the meninges of the brain are much injected ; in rare in- 

 stances there is also some effusion. 



Treatment. — In the early stages, the indications are, to avert in- 



