Every intercurrent infectious disease (measles, varicella, diphtheria) diminishes the prospects of a cure, both for the whooping-cough and the complications, even if a momentary diminution of the daily number of paroxysms simulates an amelioration.
The prophylaxis of whooping-cough in its main features is based on the details of its course and of the infection. The most important precautionary measures include the early segregation of the afflicted child from the healthy. As the symptoms of the initial stage are usually ambiguous and not characteristic and as they must certainly be regarded as infectious, the pressure of an epidemic of pertussis should warn us to look upon every coughing child as a whooping-cough suspect.
The prophylactic measures belong partly to the domain of public hygiene, and partly to the individual or family. Above all, every child suspected of whooping-cough should be kept away from the school, nursery, or kindergarten, and its brothers and sisters, as well as the other inmates of the house, should be segregated during the entire duration of the disease, unless they have had whooping-cough themselves and are removed from all contact with the patient. Moreover, superinten dents of public playgrounds and parks should exclude children sick with whooping-cough, or reserve grounds'for them provided with cus pidors containing disinfectants. Separate compartments in railroad cars, as recommended by many, would be a desirable arrangement, whereas the use of public vehicles should be prohibited.
Private prophylaxis includes strict isolation of the affected child from the healthy ones in order to prevent the spread of the disease. It might not be unwise in certain cases, provided the age is sufficient. and constitution good, to allow the brothers and sisters to be visited by the infection, in order to guard against the possibility of a future invasion of the house after months or years. Indirect transmission, through soiled objects, must likewise receive proper attention.
Prophylaxis also includes protection from a whooping-cough epi demic in case of change of location of the stricken individuals. Thus during the hot season many summer resorts and sanatoria that are largely frequented are apt to be endangered, so that the exclusion of a newly arrived child stricken with whooping-cough is a justifiable measure of self-protection.
When received at a hospital for contagious diseases, every child suspected of whooping-cough must be kept away from the wards in tended for other diseases, and thus by adequate isolation a domestic epidemic be guarded against, as it is well known how fatal any com bination with other infectious diseases may become. Considering the high whooping-cough mortality in hospitals, the admission of children stricken with pertussis should wisely be confined to such cases as come from the very lowest of social and hygienic surroundings and for such individuals hospital treatment would indeed signify a relative amelioration.
When the whooping-cough has run its course, all the rooms should be thoroughly disinfected.
Treatment.—The therapy of pertussis rests nowadays on mere empiricism. An etiological treatment was attempted by Manicatide (whooping-cough serum), but the theoretical basis of his curative serum s still very questionable and practical results of a convincing nature are wanting. Drug treatment has at its disposal an arsenal of means that increases from one day to another. Theoretical considerations, adver tisements, a personal liking for a certain remedy, etc., are frequently the determining factors that bring the highsounding recommendation accompanying the latest drug. For the valuation of the efficacy of a medicament proper attention must be paid to the stage of the disease at which the remedy is tried and to the external factors influencing the disease, such as hygiene, climate, etc.
Of especial value for the treatment of whooping-cough are hygienic measures. In a fresh, warm, dust-free atmosphere without drafts, a numerical decrease of paroxysms may always be observed. A rational fresh-air treatment without moving about much and where all chance of chilling is carefully avoided usually brings about an improvement; nay, often the paroxysms disappear so rapidly that an abortive course suggests itself. The much-vaunted change of air is of value only if it is equivalent to an improvement of the climatic conditions. During the inclement season or when complications and febrile temperatures pre clude out-door life, the so-called two-room system is recommended, one room being thoroughly aired while the sick child stays in the other.