100 DISEASES OF THE TRACHEA AND BRONCHI. 



catarrh. Other changes depend upon the complications. During the 

 paroxysm, according to Wintrich, while the forced expiratory efforts 

 continue, the percussion sound is shorter, feebler, and duller. This is 

 probably due to the fact that, during the act in question, the air within 

 the lungs undergoes considerable compression, and is thus made to press 

 so heavily upon the pulmonary tissue and the thoracic walls that the 

 latter are brought to so high a degree of tension that they cannot be 

 set into vibration by percussion. Upon auscultation, no respiratory 

 murmur can be heard during the protracted, sonorous inspiration. 

 During the interrupted expiratory act likewise, although the vibration 

 of the chest is communicated to the ear, no murmurs are distinctly 

 audible. 



Whooping-cough terminates in recovery in a large majority of cases. 

 According to popular belief, such an event cannot occur before the 

 eighteenth or twentieth week, a prejudice shameful for a physician, and 

 highly dangerous to the laity, whom it betrays into a stupid laisser 

 aller, and into all sorts of heedlessness. Under judicious treatment and 

 systematic nursing, it is almost always possible to bring the disease to a 

 close in from four to six weeks. 



In other cases, which are by no means rare, the malady terminates 

 in an incomplete recovery ; umbilical and inguinal hernia result, and, 

 what is still more common, that attenuation of the lung-substance and 

 dilatation of the air-vesicles, hereafter to be described as emphysema. 

 It is owing to the latter sequel of whooping-cough chat many children, 

 after having the disease, remain short of breath for the rest of their 

 lives. The assertion, so often made, that whooping-cough may leave 

 tubercles behind it, is to be accepted with some reserve. So long as the 

 terms phthisis and tuberculosis were synonymous, such a statement was 

 quite allowable. There is no doubt that a great number of children 

 who have suffered from whooping-cough perish, sooner or later, from 

 consumption of the lungs ; but it is with comparative rarity that the 

 form of consumption of which they die is -the tuberculous form, due to 

 the development and subsequent destruction of miliary nodules in the 

 lungs. Most of the children, in whom the signs of phthisis appear, a 

 few weeks or months after their having whooping-cough, are suffering 

 from chronic catarrhal pneumonia, with cheesy metamorphosis, and sub- 

 sequent destruction of the inflamed lung-substance. In such cases, 

 catarrhal pneumonia, which has complicated the original disease, instead 

 of undergoing resolution, results in the condition above described a 

 form of phthisis much more common than tubercular phthisis. 



When a case terminates fatally it is almost always in consequence 

 of complications, some of which consist merely in abnormal extension 

 of the disorder, or in the effects of its intensity. If any of the bronchi 





