93 DISEASES OF THE TRACHEA AND BRONCHI. 



die fever abates ; the redness of the conjunctiva and the photophobia sub- 

 side, together with the catarrh of the Schneiderian membrane. But the 

 cough becomes more obstinate and persistent, and, at the end of each 

 paroxysm, an astonishing quantity of a tenacious, viscid, transparent 

 mucus fills the mouth and fauces. This peculiar, adhesive, copious 

 secretion is pathognomonic of whooping-cough in its second stage, 

 and establishes the diagnosis almost with certainty even at this period. 

 Soon, however, the cough assumes a peculiar character ; it is accom- 

 panied by violent reflex action of the muscles of the larynx, causing 

 spasmodic closure of the glottis. From this point we date the begin- 

 ning of the convulsive or whooping stage. 



The coughing-fit begins with a long-drawn, clear, piping sound 

 (produced as the air is slowly drawn into the constricted glottis). 

 Then follows a series of short, rapidly-interrupted, expiratory coughs 

 (the air, though vigorously expelled, being unable to force open the 

 glottis for more than a moment at a time), and this, in turn, is succeeded 

 by the crowing, long-drawn inspiratory act. Thus the " whoop" alter- 

 nates with the cough, the latter finally becoming almost inaudible, until 

 at last (though often not until after lapse of some minutes) the viscid 

 secretion is brought up, and is removed intuitively by the mother, or 

 else, what is more frequent still, is ejected by vomiting, together with 

 some of the contents of the stomach. As shown elsewhere, spasmodic 

 closure of the glottis during forced efforts at inspiration impedes the 

 current of the jugulars, producing acute cyanosis. The patient grows 

 deep red, or bluish, the fauces becomes swollen, the eyes shed tears, 

 and seem as if about to burst from their sockets ; the tongue looks thick 

 and blue ; the patient seems to be on the verge of suffocation. Bleed- 

 big from the nose and mouth and ears often takes place, and ruptures 

 of vessels occur in the conjunctiva, which becomes infiltrated with blood 

 so as to disfigure the patient for days and weeks. Haemorrhage from 

 the ear is caused by rupture of the membrana tympani. 



The vomiting, which in bad cases empties the stomach of all its con- 

 tents whenever the child coughs, is not always the only indication of 

 the forcible compression of the abdomen. Sometimes we may observe 

 involuntary evacuations of faeces and urine, although this is rare. At 

 others, rupture or prolapsus ani is produced. 



A sensation of tickling in the throat usually precedes each fit of 

 coughing, the number of which, in the course of a day and night, may 

 amount to twenty-four or upward. The children recognize these pre- 

 cursors of an attack with dread. They cling anxiously to their nurses, 

 seek a support for the head, or begin to cry. After the paroxysm, 

 they remain awhile exhausted, and suffering from pain along the in- 

 sertiort of the abdominal muscles. Soon, however, they recover, begin 





