WHOOPING-COUGH. 



97 



ANATOMICAL APPEARANCES. Owing to the idea that whooping- 

 cough is an affection of the nerves, special attention has been paid to 

 the post-mortem condition of the par vagum and medulla oblongata. 

 In a few cases it has been claimed that the neurilemma of the par 

 vagum was relaxed or swollen, or that enlarged bronchial glands have 

 been found so situated as to press upon the par vagum, or hyperaeraia 

 of the medulla oblongata and its membranes has been observed. Such 

 observations, however, are but solitary; those, in which anatomical 

 investigation fails to find derangement, either of nerves or central 

 organs, are vastly more numerous. 



There is no doubt but that, in whooping-cough, the respiratory 

 mucous membrane undergoes some anatomical alteration, but to demon- 

 strate its existence in the cadaver is a task of great difficulty. Owing to 

 the richness in elastic fibres of the mucous membrane of the larger air- 

 passages, any hyperaemia, which may have existed during life, disappears 

 totally after death, leaving no trace behind. A moderate degree of 

 swelling, relaxation, and infiltration of the mucous membrane may 

 readily elude close observation, to say nothing of the post-mortem 

 changes which may take place in these conditions also. However, the 

 contrast between the symptoms during life and the appearances after 

 death is no greater nor more puzzling in whooping-cough than it 

 is in other catarrhal complaints. As this disorder, when simple and 

 uncomplicated, very seldom ends fatally, we find almost always, in the 

 cadaver of a whooping-cough patient, gross, palpable lesions, which are 

 the results of the complication which has been the cause of death. In 

 particular, we find that permanent inspiratory inflation (alveolar ectasy, 

 see above) which even the best recent authorities still persist in con- 

 founding with emphysema, wide-spread atelectasis, catarrhal pneumo- 

 nia in its several stages, and, far more rarely, croup of the air-passages 

 or lungs, meningitis, or hydrocephalus. As these lesions do not depend 

 upon the whooping-cough itself, but upon its complications, we refer to 

 the appropriate chapters for further discussion upon these subjects. 



SYMPTOMS AND COURSE. It is customary to recognize three stages 

 m whooping-cough : the catarrhal stage, the convulsive stage, and the 

 stage of decline. 



The catarrhal stage, in many instances, begins with violent catarrhal 

 fever, with reddening of the conjunctiva, and great intolerance of light 

 The patient sneezes incessantly, and is tormented by a distressing cough. 

 No one, without knowledge of the prevalence of an epidemic, could 

 predict the approach of a whooping-cough at this stage of its develop- 

 ment ; nay, so far from receiving recognition as the incipient period of 

 the disease, it is often mistaken for an intercurrent accident, in spite of 

 its development into whooping-cough at a later period. In a few davs 

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