102 DISEASES OF THE TRACHEA AND BRONCHI. 



without anxiety. Experience accordingly teaches that the mothers, \\ho 

 at first are dreadfully alarmed, by-and-by grow only too careless, and at 

 last, without further solicitude or attention, calmly await the advent of 

 the twentieth week, when, as they think, the disease is to subside, 

 Children who are but a month or two old encounter the greatest danger, 

 not because " their foramen ovales is as yet unclosed," " and a com- 

 mingling of blood from the two sides of the heart threatens to 

 cause acute cyanosis," but because of obstacles to which they so often 

 succumb hi other bronchial catarrhs, the facility with which their little 

 bronchi become occluded, imperilling life by atelectasis, or by deficient 

 oxygenation without atelectasis. The danger arising from these com- 

 plications, as well as that occasioned by the sequelae, has already been 

 treated of in detail. 



TREATMENT Prophylaxis. As whooping-cough scarcely ever oc- 

 curs except as an epidemic, and as it is often infectious, prophylaxis 

 demands, where circumstances permit, an avoidance of places where the 

 epidemic prevails, and separation of the sick from the well, particularly 

 from those small, weak, scrofulous children to whom the disease would 

 bring great danger. 



As, moreover, the predisposition is augmented by catarrh, and by 

 every irritant which can give rise to catarrh, it is well, in seasons of 

 epidemic whooping-cough, to protect children with the utmost care from 

 taking cold, and to treat the most simple catarrh with the same solici- 

 tude and precaution with which, in cholera-times, we put patients upon 

 a rigid diet for every trifling diarrhoea, and look upon it as a dangerous 

 illness. During epidemics I have kept children continuously confined 

 in one room from the moment that any slight unsuspicious cough arose, 

 and kept up a uniform temperature day and night for several weeks in 

 succession, and have frequently seen children remain free from whoop- 

 ing-cough, while it developed among their relatives who had been 

 attacked in similar manner, but who had been less carefully nursed. 

 The indicatio causalis cannot be met, as we are not able to neu- 

 tralize nor to remove the prevalent epidemic influence which excites 

 the disease. 



The happy effects which whooping-cough patients often obtain by 

 change of abode are perhaps to be accounted for by the exemption from 

 continuous or repeated exposure to the exciting cause of the disease, 

 which they thus acquire. Whenever an extensive epidemic prevails 

 about the dwelling of a patient of mine, I am in the habit of advising a 

 temporary migration to some region free from the disorder. 



The indicatio morbi calls for the same general treatment which we 

 have recommended for other laryngeal and bronchial catarrhs. Recog- 

 n ition of the fact, that in whooping-cough we have a catarrh to deal 



