Review of fifty-five cases in a period of two years which ended fatally. In the author's five eases, the complica tions, which only existed in some, were not the primary cause of death. The danger-signal, particularly in young in fants, was either a developing stupor or an attack of prostration from which they recovered temporarily to go into a state of increasing stupor and ex haustion until death. In studying the larger series of fatal eases it was found that a catarrhal affection of the mucous membrane is the most probable compli cation and liable to prove the most fatal by lowering the resistance of the body to the toxic effects of the infection. Average age of the fatal cases was less than one year and duration three weeks. Most of the deaths occurred between April and September. M. H. Hull (Phila. Med. Jour., Feb. 7, 1903).
Treatment.—Treatment of this disease is, by general confession, not satisfactory. While it is among the hopes that may be realized in the future, that we shall be able to limit the duration and severity of an attack by some antitoxin, at the pres ent no internal medication appears to be able to effect any distinct reduction in what may be regarded as the typical course of the disease. Nevertheless, by careful hygiene and judicious manage ment we may do much to lessen the num ber and severity of the spasms and pre vent complications.
The patient should breathe a pure air not too dry, the temperature of which should not be allowed to vary much from G5° F. Cold draughts, strong winds, and sudden atmospheric changes are to be avoided as liable to increase the catarrhal conditions present and give rise to severe pulmonary complications. During the cold season of the year it is well to con fine the patient strictly to two rooms, one of which should be thoroughly aired while the other is occupied. General baths should be omitted; the child should be dressed warmly, and so long as any fever be present it should be kept in bed. Nutrition must be maintained; the diet should be nourishing, but simple and di gestible. If vomiting recurs frequently, food must be given in small quantities and at short intervals. Excitement of all kinds is to be avoided.
A threatening paroxysm may be ar rested sometimes when in the house by carrying the child to an open window, where it takes several deep inspirations.
The fresh-air treatment is one of the most efficacious, if not the only one, for the management of a case of whooping cough. The child should pass the entire day out-of-doors, not only in the warm season, but even at all times of the year, provided it be not stormy. It is con sidered only necessary to prevent the child from running or talking or other wise provoking an access of coughing. Ullmann (Jahr. f. Kinderh., etc., B. 40,
H. 1, '95).
Theoretically, antiseptics should oc copy a prominent place in the treatment of this disease, and many attempts have been made to modify the course of an attack by the topical application of such drugs. Moncorvo claims much benefit from the application of 1- or 2-per-cent. solution of resorcin to the nasal passages, pharynx, and larynx by means of a brush or spray.
Two hundred and ninety children suffering from whooping-cough treated by method introduced by Moncorvo, namely: by applications of a 2- to 3 per-cent. solution of resorcin to the glot tis with a fine sponge. The resorcin is to be used without previous cocainiza tion. In the 290 cases treated no other therapeutic measure was employed. Children under two years of age seemed to get well more easily than older ones. After a few applications by the practi tioner the treatment is carried out by those in charge of the patient. Roskam (Ann. de la Soc. Med.-chir. de Lige, Feb., '97).
The benefit derived from creasote vapor is very soon apparent. In many cases a cure is effected in five or six days; in very virulent attacks it may require as many weeks, though this is exceptional. It does not interfere with other methods of treatment. The in halation appears to be free from danger except where the chest is full of moist sounds, in which case its action should be carefully watched. No fresh case of infection has been seen to arise in a family the healthy members of which have been exposed to the influence of the vapor.
Creasote-vapor can be employed in various ways: with steam by means of a kettle or steam-spray producer; by use of a dry or moist inhaler; by sprinkling on a cloth hung up to dry in a room; by vaporizing over a spirit-lamp, etc. All these means are more or less effect ual; but the more continuous the inhala tion, the better the result obtained.
The method of treatment personally found most satisfactory is the following: One should commence at once with the continuous inhalation of creasote by sus pending creasote cloths both in the day and night chambers. The density of the vapor employed can easily be regulated by varying the number of cloths. Any accompanying bronchitis should be treated, and the lungs cleared of all moist sounds as much as possible be fore using any special internal anti spasmodic remedies. Antipyrine may be given in suitable doses in all cases where the lungs ire fairly clear, provided that the circulation is good. Expecto rants may be combined with the anti pyrine. The chest and upper part of the spine should be treated by counter-irri tation. Good air, warm clothing, light and wholesome food are necessary in all eases. J. E. Godson (Birmingham Med. Review, Apr., 1901).