DESCRIPTION OF THE DISEASE.—Hooping-cough commences with the symptoms of a common cold, which is more or less frequent. These symptoms continue from five days to fifteen; at the end of which time the cough changes its character, and assumes the convulsive form, which distinguishes the disorder. It occurs in paroxysms, varying with the severity of the disease from five to six in the twenty-four hours to one every ten or fifteen minutes; being generally more severe and frequent during the night than in the day.
During a paroxysm the expirations are made with such violence, and repeated in such quick succession, that the child cannot breathe, and seems in danger of suffocation. The face and neck become swollen and purple from suffusion; and the eyes prominent, injected, arid full of tears. The little one, with a forewarning of the attack, which it dreads, falls on his knees, or clings closely to any thing near him. The paroxysm terminates with one or two long inspirations, attended with that peculiar noise, or "whoop," from which the disease has derived its designation.
Sometimes the fit of coughing is interrupted for a minute or two, so that a little rest is obtained; and is then succeeded by another fit of coughing and another hoop, until after a succession of these actions the paroxysm terminates by vomiting, or a discharge of mucus from the lungs, or both.
The disease having continued at its height for two or three weeks, it begins naturally to decline; the paroxysms become less frequent and violent; the expectoration increases; the cough loses its characteristic hoop, and gradually wears away altogether; until at length, in two or three months from the first onset of the disease, the child is restored to perfect health. Sometimes, however, particularly in the autumn, and at other seasons on the occurrence of easterly winds, the paroxysms of cough will return,—it will assume its spasmodic character, and be accompanied with the "whoop," after a month, or even two or three months, of perfect and apparent recovery. Errors in diet will sometimes alone have a similar effect.
It is a disease which usually occurs during childhood, rarely affects the same individual twice, and is seldom seen in the very young infant.
In reference to the probable result of the disease, when it occurs in its mild and simple form in a healthy child, the termination is usually favourable; but it may at first assume this form, and afterwards become complicated, and consequently more or less dangerous, owing to injudicious management, or to various influences over which the mother has no control.
It generally appears as an epidemic, and at those seasons when catarrhal complaints are most prevalent, and affects many or several at the same time. Isolated cases, however, frequently occur, which seem to prove the disease to be infectious. Some persons deny that it is so. Mothers and nurses, however, who have not had the disease, will often contract it from the child under such circumstances, and thus it will be quickly propagated through the family. The nursing mother will occasionally take it from the infant at her breast. The child who has caught it from others whilst at school, and brought home in consequence, will communicate it readily to his brothers and sisters, although the disease did not exist previously in the family or neighbourhood, and was brought from a distant part of the country. All these instances are surely proofs of its infectious character, and point out the necessity of caution whenever hooping-cough may present itself in a family, and the necessity which exists for an early removal of the unaffected children from the sphere of its contagious influence. The infectious property diminishes as the disease declines.
MATERNAL MANAGEMENT.—In the mild and simple form of this disease the medical treatment is one rather of prevention than cure, and the maternal management consists in assisting, by watchfulness and care, the fulfilment of this design.
In these slighter cases little more is required of the mother during the Jirst stage of the disorder (that is, before the cough becomes spasmodic) than attention to diet, regimen, and the excretions. The diet should be farinaceous, with milk, or as may be otherwise directed. The child must be confined to a mild equable temperature; in fact, to his apartment. It is a popular error to suppose that at this time change of air is beneficial to the disease: at a later period it certainly is so, but now injurious, and attended with great risk. Should the weather be cold, the little patient must be warmly clad, and flannel worn next the skin; this latter precaution should always be taken in the winter, spring, and autumn. Purgatives and other medicines will be required, and ordered by the medical attendant; the chief attention, however, of the parent must be directed to any change she may observe in the symptoms, breathing, etc.; she must be all on the alert to notice the first signs of local inflammation. Of this, however, we shall speak presently.
During the early part of the second stage, that is, when the cough becomes spasmodic, assuming its peculiar sound, the same diet and regimen must be continued, and the same watchfulness observed, lest any inflammatory symptoms manifest themselves.