PATHOLOGY.' 188 
termination of the difeafe is not fo happy. The patient 
emaciates; he has profufe night-fweats, and the cough 
l’.arafl'es him to fuch a degree as to prevent his reding by 
night. The expectoration is prodigious, and becomes 
much more purulent. The dyfpncea is greatly increafed, 
the pulfe is very quick, and there are regular evening 
exacerbations. The patient at length dies exhaufted.” 
Haftings) 275. 
B. verminofa ; from worms in the intedines, liver, 
or other abdominal organs. Common to children with 
large bellies, and pale emaciated countenances; and dill 
more fo to dieep labouring under the difeafe- called rot, 
and vvhofe livers are uiually loaded with the Fafciola 
hepatica, or fluke. 
3. Bex convulfiva, (Pertuflis, Cull.) Whooping- 
cough ; chin-cough,"or more correCtly kin-cough or 
kind-cough ; literally “ child’s cough,” from the Ger¬ 
man kind, achild. The cough convulfive,and fufFocative, 
accompanied with a fhrill reiterated whoop,and frequent¬ 
ly with vomiting ; contagious. 
This malady commences as an ordinary catarrh. In 
the fpace however of a fortnight or three weeks, the 
fymptoms undergo a change, and the difeafe exhibits a 
convulfive cough, in which the expirations are made 
■with fo much rapidity and violence, and are fo long and 
frequently repeated, that the whole air feems to be ex¬ 
pelled from the lungs, and the patient appears to be in 
danger of fuffocation. At length a full ajid violent in- 
fpirption is necelfarily made for his relief, which, from 
the iinufual velocity with which the air rufhes in, or 
from the fpafmodic contra&ion of the glottis, produces 
a peculiar found or whoop: thefe actions alternate until 
mucus is expectorated, or the contents of the ftomach 
partially ejefted. Thefe evacuations commonly put an 
end to the coughing, and the patient remains free from 
it for fome time after. But the duration of the paroxyfm 
and the relief obtained are very different in different in- 
ftances. Frequently the expeftoration or vomiting 
takes place after the firft or fecond coughing; but fome- 
times this happens only after feveral alternate coughings 
and whoopings; and, in very fevere cafes, the paroxyfm 
ends in the complete exhauftion of the patient, without 
any difeharge whatever. 
The fits of coughing return at various intervals, rarely 
obferving any exaft period. They happen feveral times 
in the courfe of the day, and more frequently in the 
night. In general they come on without any obvious 
caufe ; but they are alfo brought on fooner and more 
•violently by various fources of irritation, as by confide- 
rable bodily exertion, fuch as running, or even laughing, 
turning from fide to fide in bed, diftending the ftomach 
by food, or irritating it by fuch as is indigeftible or acri¬ 
monious. Fretting and crying commonly bring on the 
fit. Though the paroxyfms come on fuddenly, the pa¬ 
tient has commonly fome warning, which excites his 
alarm ; and, to avoid the violent and painful concufiion 
which the coughing occafions to the whole body, he 
fometimes throws himfelf on the ground, or clings faft 
to any thing that is near him, or demands to be held 
faft by any perfon that be can come at, and will even run 
acrofs the room for that purpofe, with terror and fup- 
piication exprefled in his countenance. In alrnoft every 
cafe of the difeafe, dyfpncea is prefent. Frequently there 
is a difficulty of breathing, not only immediately before 
and after the •fits of coughing, but, in the more fevere 
cafes, the patient pants on the leaft exertion, as if he had 
run a race, or performed fome feat of bodily ftrength. 
When there is little expecloration, and that of a thin 
mucus only, the fits of coughing are violent, and conti¬ 
nue long : but, as the expefforated matter foon becomes 
confiderable and very thick, as it is more readily expec¬ 
torated, the fits of coughing are of fhorter duration. If 
the fits are violent and long continued, they necelfarily 
interrupt the free tranfmiffion of the blood through the 
lungs, and confequently the return of blood from the 
Vjjl. XIX, No. 1256. 
head. This gives rife to turgefcence and fufftifion of the 
"'face, and fometimes occalions haemorrhage from the nol'e. 
Sydenham fpefks of the whooping-cough as unconnec¬ 
ted with fever; Dr. Cullen remarks, that “It is conr 
ftantly in fome degree prefent ; but with evident exa¬ 
cerbation towards evening, continuing till next morn¬ 
ing.” (Firft Lines, mccccx.) Dr. Watt alfo obferves 
upon this point, “as far as tny experience goes, I am 
difpofed to believe, that, even in the miideft cafes, as- 
long as the kinks (paroxyfms) continue, there is always 
fome part of the day when the prefence of fever can be 
dete&ed. It may be fo flight as hardly to deferve no¬ 
tice ; but (till, to an attentive obferver, who has oppor¬ 
tunities of feeing the patient day and night, it is abun¬ 
dantly obvious. I have remarked it even in thofe fa¬ 
vourable cafes, where the appetite continued good, and 
where the patients feemed to fuffer little or nothing in 
their general health.” 
Indeed the phenomena of increafed heat and aflive 
pulfation have been fo generally noted, that it feems 
furprifingthat they fhould haveefcaped Sydenham’s (ufu- 
ally) dole obfervation. 
With regard to the nature of whooping-cough, it 
feems evidently a fpecies of bronchitis, or inflammation 
of the mucous membrane of the lungs, which has thefe. 
circumftances peculiar to it, that it elicits a fecretion 
pofleffing contagious properties, and that it is connected 
with fpafmodic action of the mufcles of the glottis and 
of the cheft. The low degree of febrile irritation it fome¬ 
times produces will prevent many from according the 
term inflammation to the malady. This is however of 
no confequence ; the prefence of difeafed fecretion no one 
will deny 5 and that the irritation this arifes from is very 
prone to bring on unequivocal fymptoms of inflamma¬ 
tion, is equally indifputable. Dilfeflion of fatal cafes 
has invariably fhown rednefsand diftentionof capillaries 
on the nervous membrane, or effufion of pus or flakes 
or coagulated lymph. In fome cafes diforganization has 
been propagated to the fubftance of the lungs. In fopie 
very young fubjedts, indeed, fuffocation has occurred 
from the long irritation of the mucus having kept up 
coughing till the cheft was emptied of air, and the glot¬ 
tis has been clofed, firft by the fpafm of its mufcles, and 
afterwards by the preffure of the atmofphere ; and here 
diffedtion has furniffied little evidence of inflammation.. 
The courfe and event of this difeafe are very uncertain. 
In the miideft form in which it appears, it commonly 
continues from one to three months; and, in the more, 
fevere, con.fiderably longer. Even after it has nearly or 
wholly ceafed, an accidental expofure to cold occafions a 
relapfe. 
The treatment of Bex convulfiva follows clearly out of 
the views before taken of its nature. I11 the firft place, 
we have to guard againft inflammation fpreading to any 
alarming extent. In proportion, therefore, as the dyfp- 
ncea and fever are fevere, and as the patient is ftrong 
and plethoric, it becomes necelfary to employ blood-letting, 
and even to repeat it according to the urgency of the 
circumftances. Even in more delicate and younger chil¬ 
dren, fome evacuation may be neceffary by means of the 
lancet, in the commencement of the difeafe; and local 
bleeding, by leeches applied to the cheft, may be reforted 
to, where general blood-letting is deemed inadmiflible. 
The difficulty of the tranfmiffion of blood through the 
lungs fhould be watched* and early attacked by this effi¬ 
cient remedy, or the difeafe will often baffle all the fub- 
fequent efforts that can be made. Moreover the treat¬ 
ment of dyfpepfia fhould be kept clofely in view. The 
inflammation of the membrane, and the convulfive aflion 
of the refpiratory mufcles, are of courfe connected with 
nervous irritation ; and hence we muft be careful that 
all excitement of the nervous fyftem be withheld. Ab- 
ftemioulnefs and the ufeof purgatives have the two-fold 
effect of inducing a right aftion of the chylopoi’etic vif- 
cera, and of diminifhing inflammation, 
3 B Every 
