WHOOPING-COUGH. 101 



become permanently occluded by the catarrh, so that no more air can 

 penetrate to the vesicles in which they terminate, that which they 

 already contain becomes absorbed, the vesicles collapse, their walls 

 touch, and atelectasis is established. If the catarrh spread from the 

 bronchioles into the air-cells, a catarrhal pneumonia is set up. We have 

 already stated that nearly ah fatal cases show traces of these complica- 

 tions. It should always awaken suspicion if the coughing-fits begin to 

 lose then* characteristic features, if an additional short, dry cough arise, 

 if the patient grow short of breath, if the palms of the hands burn, if 

 the sleep be troubled, the general health be disturbed, or other febrile 

 symptoms appear. In all such cases we must repeatedly and carefully 

 search for the signs of capillary bronchitis, of atelectasis, or of catarrhal 

 pneumonia. Croup of the larynx or pulmonary vesicles is far easier of 

 recognition, partly on account of the acuteness and violence of its initial 

 symptoms, and partly because its signs are so obvious and unmistakable. 

 This complication, however, is rare. 



The cerebral symptoms which sometimes appear in whooping-cough 

 scarcely ever arise from apoplexy, meningitis, or hydrocephalus. The 

 vessels of the brain, if normally nourished, are not apt to tear, even 

 though subjected to very severe pressure from within ; moreover, dis- 

 eases like meningitis and acute hydrocephalus are not to be induced by 

 a simple and transitory hyperaamia. The convulsions, etc., which take 

 place during whooping-cough, and which seldom endanger life, proceed 

 either from a temporary venous obstruction with cedematous infiltration 

 of the brain, followed by arterial anaemia, or else they are eclamptic 

 seizures, caused by reflex action. 



DIAGNOSIS. As the coughing-fits in this disease are, in my opinion, 

 undistinguishable from those of any severe laryngo-bronchial catarrh 

 arising from cold, or from the cough produced by the entrance of a 

 foreign body into the larynx, or that which may be provoked in an ex- 

 tremely susceptible subject (such as an hysterical woman) by the most 

 trifling irritation indeed, as the cough owes its character to physio- 

 logical processes, precisely like those which occur in the other varieties 

 of cough we deem it idle to talk of a differential diagnosis of the par- 

 oxysms. The epidemic appearance of the disease, its almost exclusive 

 occurrence among children, its obstinacy, and long duration will prevent 

 error. In infants at the breast, and very little children, the peculiar 

 cough and reflex symptoms of the glottic muscles are sometimes absent, 

 and, unless the expectoration of copious tenacious secretion and the 

 prevalence of an epidemic of whooping-cough be borne in mind, the 

 true nature of the affection may be overlooked. 



PROGNOSIS. One must be aware how rarely children become apo- 

 plectic, or die in a whooping-cough fit, ere one can witness a paroxvsm 



