The diagnosis of whooping-cough can be safely established by the physician when he has observed a typical paroxysm. We have certain methods of producing an attack. For instance, by introducing a_ spa tula into the pharynx we may provoke choking and vomiting. But con tinued pressure with the finger on the trachea or thyroid cartilage usually suffices. Tickling the nasal mucous membrane or of the external audi tory meatus accomplishes the same result.
Enumerating the positive data to be taken into consideration for a. diagnosis of whooping-cough, we find: I. After a slightly characteristic catarrhal stage the typical parox ysms set in with spasmodic expirations and few intervening crowing inspirations, terminating with the production of a tenacious, glairy mucus. Children in the first years of life commonly swallow their spu tum. In whooping-cough the gagging and vomiting voids the sputum.
2. The cough is often more frequent. by night. It may be caused by hearing and seeing a paroxysm in another child.
3. of an objective clinical examination are: lung signs neg ative in spite of the violent coughing: permanent lymphatic congestion (puffed face, swelling of the eyelids), sublingual ulcer, subconjunctival haemorrhages.
4. Urinary symptoms (Blumenthal-Hippius), blood findings (leuco cytosis).
5. Exposure to infection, existence of an epidemic, same disease in brothers or sisters.
6. Failure of antispasmodic medication (belladonna, morphine) in the customary doses, so long as the disease is on the ascent.
Diagnostic difficulties are encountered at the beginning of the ca tarrhal stage, as anything typical of whooping-cough is absent. In this phase an examination of the urine and of the blood and perhaps the history of exposure to infection may facilitate the diagnosis.
In very young children in whom the paroxysms pursue an atypical course, without crowing inspiration, and in the so-called "formes frustes" of pertussis, and finally when severe complications frustrate the parox ysms (pneumonia, convulsions), the history may at times enable us to make a diagnosis, yet it is frequently impossible to be positive at once.
vigorous older children whooping-cough is, on the whole, a harmless disease; but for the weak, chronically sick, and especially very young children, it is often of fatal significance. Because
the younger ages are largely involved, the mortality from whooping cough is statistically rather high. In the years 1895 to 1901, according to the statistical year-book of Vienna, 15,711 cases were reported as having occurred in that city, of which 1052, or 6.6 per cent., terminated fatally.
A comparison of whooping-cough with measles and scarlet feNer for the three years 1899 to 1901 furnishes the following results: According to Pres] the aggregate mortality from the following four infectious diseases for Austria during the year 1883 was: According to the above data whooping-cough occupies the second place among the more dangerous infectious diseases. The late sequelie of pertussis (tuberculosis) evidently being left out of consideration, the mortality from whooping-cough probably is much higher.
As an illustration of the greater danger of exposure to infection dur ing the earlier ages we present the following Vienna statistics for the years 1899 to 1901: Infants are generally the most endangered. Owing to frequent vomiting, their nutrition is easily affected. Moreover, they are expcsed to pulmonary complications, resulting in a mortality of 95 per cent.. However, the very youngest of infants (in the first weeks of life) seem to endure the disease somewhat better—a fact observed by Porak and Durante during a_ domestic epidemic which had broken out in a pavilion intended for premature infants.
Of the greatest prognostic importance is the intensity of the affec tion, which may be influenced by various factors, such as reaction of the individual, character of the epidemic, season of the year, and hy gienic conditions. An indication of the intensity of the disease is the number of attacks. According to Trousseau, over sixty attacks a day constitute a bad prognosis. Periods entirely free from attacks along with undisturbed well-being are the signs of a favorable normal course of the disease.
From the above-mentioned complications, besides pulmonary affec tions, a fatal termination may be induced by cardiac insufficiency, great losses of blood (epistaxis), and cerebral complications (hfemor rhage).