PERTUSSIS, OR WHOOPING-COUGH.
the mortality lessens markedly with the age of the patient isolation thus becomes a question of vital importance. This is to be decided upon by the peculiar nature of the patient's surroundings, and as it generally will be required for S or io weeks under ordinary circumstances, there is no use in beginning a system of isolation in a half-hearted way, nor is there any use in insisting upon it where it is almost certain to break down in a few weeks. Moreover, no plan of isolation should be accepted which will confine the patient to one room during the entire illness. As a rule in this country the patient's parents, who generally think that they know a good deal beforehand about such a common disease, refuse to carry out a system of rigid isolation. The writer's practice is to warn the patient's relatives of the danger which might arise if some weakly member of the family were to catch the contagion, and to urge upon them the advisability of placing two rooms in the house at the disposal of the invalid, and advise that the others should be sent away.
One large well-ventilated sleeping and one play-room, especially in the winter-time, and at all times when possible, should be provided for the: invalid. This is a matter of more importance than nurses and parents can be made to see. As will be mentioned later on, disinfection being necessary during as well as at the termination of the illness, everything capable of being injured by the fumes of burning sulphur should be removed. The air of the room can be medicated by the methods to he mentioned later on; the temperature of the chamber is an important matter. In severe cases requiring to be kept indoors the temperature of the room should be kept at 6o° F., hut it is a serious mistake to do this and permit the child to go out into the cold air. The second room in these cases can be used as an " intermediate " chamber.
Open-air treatment is of vital importance later on, and when the season permits it may be started as soon as the disease declares itself. Moder
ately strong children, even in smart attacks, not only are safe, hut are much better for being out all through the attack. Plenty of fresh air is really of more importance than medicine in the long illness. Of course, in severe weather, with rain and cold, or during the prevalence of the spring east winds, or in the presence of any bronchial complications, outdoor exercise must be forbidden. Cushing, whilst insisting that rest in bed greatly lessens the cough during the early stage, and as the paroxysms are more frequent at night, which he considers to be due entirely to the vitiated condition of the sleeping-room, urges that the best sedative to the cough and paroxysm is cold winter night air, which should be freely admitted through the widely opened windows of the bedroom. It would be both irrational and dangerous, however, to surround the patient in the daytime with an atmosphere at F. and expose him at night to one below freezing-point. The best routine procedure is to open the windows and door of the adjoining second room to their fullest extent in order to keep the air at night as pure as possible, and at the same time to temper it by an open fire in the sleeping apartment. The most thorough and complete ventilation must be alwa) s carried out, no matter what the temperature of the room, direct draughts being avoided.
Feeding is of great importance, and in the management of weakly young children will turn the scale for or against recovery. The usual fluid diet which experience has proved to agree best with the child is to be continued, provided it he wholesome and highly nutritious. A varied diet does best with grown-up children. After the paroxysms have become thoroughly established and the appetite begins to fail, the patient must be coaxed to take milk or other nutritious fluid nourishment as beef juices, beef jelly, nr clear soups between meals.