Complications and Sequels.—These are many and make whooping cough a critical disease for very young children. Bronchitis and pneumonia often complicate whooping cough in winter, and diarrhea frequently occurs with it in summer. Convulsions not infrequently follow the coughing fits in infants, and, owing to the amount of blood forced to the head during the attacks, nosebleed and dark spots on the forehead and surface of the eyes appear from breaking of small blood vessels in these places. Severe vomiting and diarrhea occasionally aggravate the case, and pleurisy and consumption may occur. The violent coughing may permanently damage the heart. Rupture of the lung tissue happens from the same cause, and paralysis sometimes follows breaking of a blood vessel in the brain. But in the vast majority of cases in children over two years old no dangerous sequel need be feared.
Outlook.—Owing to the numerous complications, whooping cough must be looked upon as a very serious disease, especially in infants under two years, and in weak, delicate children. It causes one-fourth of all deaths among children, the death rate varying from three to fifteen per cent in different times and under different circumstances. For this reason a physician's services should always be secured when possible.
Treatment.—A host of remedies is used for whooping cough, but no single one is always the best. It is often necessary to try different medicines till we find one which excels. Fresh air is of greatest importance. Patients should be strictly isolated in rooms by themselves, and it is wise to send away children who have not been exposed. Morally, parents are criminally negligent who allow their children with whooping cough to associate with healthy children. If the coughing fits are severe or there is fever, children should be kept in bed. Usually there is not much fever; perhaps an elevation of a degree or two at first, and at times during the disease. Otherwise, children may be outdoors in warm weather, and in winter on warm, quiet days. Sea air is especially good for them. It is best that the sick should have two rooms, going from one to the other, so that the windows in the room last occupied may be opened and well ventilated. Fresh air at night is especially needful, and the patient should sleep in a room which has been freshly aired. The temperature should be kept at an even 70° F., and the child should not be exposed to draughts. Vaporizing antiseptics in the sick room has proved beneficial. A two per cent solution of carbolic acid in water is useful for this purpose, or a substance called vapo-cresoline, with which is sold a vaporizing lamp and directions for use. A one per cent solution of resorcin, or of hydrogen dioxide, diluted with four parts of water, used in an atomizer for spraying the throat, every two hours, has given good results. In the beginning of the disease, before the whooping has begun, a mixture of paregoric and syrup of ipecac will relieve the cough, ten drops of the former with five of the latter, for a child of two years, given together in water every three hours. The bromide of sodium, five grains in water, every three hours during the day, for a child of two, is serviceable in relieving the fits of coughing in the day; while at night, two grains of chloral, not repeated, may be given in water at bedtime to secure sleep, in a child of two. The tincture of belladonna, in doses of two drops in water, three times daily, for a child of two, is also often efficacious. Quinine, given in the dose of one-sixth grain for each month of the child's age under a year; or in one and one-half grain doses for each year of age under five, is one of the older and more valuable remedies. It should be given three times daily in pill with jelly, or solution in water. Bromoform in doses of two drops for a child of two, and increasing to five drops for a child of six, may be given in syrup three times daily with benefit. Most of these drugs should be employed only with a doctor's advice, when this is possible. To sum up, use the vapo-cresoline every day. When no physician is available, begin with belladonna during the day, using bromide of sodium at night. If this fails to modify the whooping after five days' trial, use bromide and chloral. In severe cases use bromoform. During a fit of coughing and whooping, it is well to support the child's head, and if he ceases to breathe, he should be slapped over the face and chest with a towel wet with cold water. Interference with sleep caused by coughing, and loss of proper nourishment through vomiting, lead to wasting and debility. Teaspoonful doses of emulsion of cod-liver oil three times daily, after eating, are often useful in convalescence, and great care must be taken at this time to prevent exposure and pneumonia. Change of air and place will frequently hasten recovery remarkably in the later stages of the disease.
ERYSIPELAS.—Erysipelas is a disease caused by germs which gain entrance through some wound or abrasion in the skin or mucous membranes. Even where no wound is evident it may be taken for granted that there has been some slight abrasion of the surface, although invisible. Erysipelas cannot be communicated any distance through the air, but it is contagious in that the germs which cause it may be carried from the sick to the well by nurses, furniture, bedding, dressings, clothing, and other objects. Thus, patients with wounds, women in childbirth, and the newborn may become affected, but modern methods of surgical cleanliness have largely eliminated these forms of erysipelas, especially in hospitals, where it used to be common. Erysipelas attacks people of all ages, some persons being very susceptible and suffering frequent recurrences. The form which arises without any visible wound is seen usually on the face, and occurs most frequently in the spring. The period of development, from the time the germs enter the body until the appearance of the disease, lasts from three to seven days.
Erysipelas begins with usually a severe chill (or convulsion in a baby) and fever. Vomiting, headache, and general lassitude are often present. A patch of red appears on the cheeks, bridge of nose, or about the eye or nostril, and spreads over the face. The margins of the eruption are sharply defined. Within twenty-four hours the disease is fully developed; the skin is tense, smooth, and shiny, scarlet and swollen, and feels hot, and is often covered with small blisters. The pain is more or less intense, burning or itching occurs, and there is a sensation of great tightness or tension. On the face the swelling closes the eye and may interfere with breathing through the nose. The lips, ears, and scalp are swollen, and the person may become unrecognizable in a couple of days. Erysipelas tends to spread like a drop of oil, and the borders of the inflammatory patch are well marked. It rarely spreads from the face to the chest and body, and but occasionally attacks the throat. During the height of the inflammation the temperature reaches 104° F, or over. After four or five days, in most cases, erysipelas begins to subside, together with the pain and temperature, and recovery occurs with some scaling of the skin. The death rate is said to average about ten per cent in hospitals, four per cent in private practice. Headache, delirium, and stupor are common when erysipelas attacks the scalp. The appearance of the disease in other locations is similar to that described. Relapses are not uncommon, but are not so severe as the original attack. Spreading may extend over a large area, and the deeper parts may become affected, with the formation of deep abscesses and great destruction of tissue. Certain internal organs, heart, lungs, spleen, and kidneys, are occasionally involved with serious consequences. The old, the diseased, and the alcoholic are more apt to succumb, also the newborn. It is a curious fact that cure of malignant growths (sarcoma), chronic skin diseases, and old ulcers sometimes follows attacks of erysipelas.
Treatment.—The duration of erysipelas is usually from a few days to about two weeks, according to its extent. It tends to run a definite course and to recovery in most cases without treatment. The patient must be isolated in a room with good ventilation and sunlight. Dressings and objects coming in contact with him must be burned or boiled. The diet should be liquid, such as milk, beef tea, soups, and gruels. The use of cloths wet constantly with cold water, or with a cold solution of one-half teaspoonful of pure carbolic acid to the pint of hot water, or with a poisonous solution of sugar of lead, four grains to the pint, should be kept over small inflamed areas. Fever is reduced by sponging the whole naked body with cold water at frequent intervals. A tablespoonful of whisky or brandy in water may be given every two hours to adults if the pulse is weak. Painting the borders of the inflamed patch with contractile collodion may prevent its spreading. The patient must be quarantined until all scaling ceases, usually for two weeks.
CHAPTER III
Malaria and Yellow Fever
The Malarial Parasite—Mosquitoes the Means of Infection—Different Forms of Malaria—Symptoms and Treatment—No Specific for Yellow Fever.