Among the complications involving the circulatory organs the mild est ones arc the previously mentioned congestive phenomena. As a result of congestion in the lesser circulation there may occur a primary dilatation with subsequent hypertrophy of the right ventricle. Only in greatly reduced children where the violent paroxysms of coughing are excessive is this hypertrophy wanting and, the heart not being equal to the demands in such cases, sudden heart failure may occur. Other complicating heart diseases, such as endocarditis and pericarditis, are very rare.
On the other hand, the peripheral vessels may at times sustain an injury from the toxin of whooping-cough. While no histological proof for such alteration of the vascular wall has as yet been forthcoming, cer tain clinical observations make it appear almost positive. Thus in the course of pertussis in weak children we notice a distinct oedema of the subcutaneous cellular tissue, although neither the heart nor the urine furnishes us any data for a satisfactory explanation. Moreover, we are inclined to assume that the factor of congestion alone is hardly suffi cient for the production of cutaneous, subconjunctival, and intracranial haemorrhages, but that the vascular walls must have a weakened power of resistance to be ruptured by increased blood pressure.
Among the nervous complications and sequelte of whooping-cough, convulsions are the most frequent. Their typical course is character ized by the occurrence of clonic-tonic spasms during the convulsive stage and following a coughing paroxysm involving either a limited muscular area, or, as in epileptic attacks, all of the voluntary muscles, especially those of the extremities. Such eclamptic seizures usually follow the paroxysms, but at times they may occur between and independently of the coughing attacks. The convulsions are always multiple, a single attack hardly ever occurring. Frequently there coexists a fever. Between the several spasmodic seizures which are always attended with loss of consciousness there may persist psychical disturbances, stupor, and rigidity of the neck. The convulsions occur usually in chil dren during the first year of life, who in other was show a great irri tability of the cortical centre. They indicate a severe and dangerous complication. During and between the eclamptic seizures, a remission of the whooping-cough attacks, both in number and intensity, is observed.
French medical writers mention, besides the convulsions (convul sions externes), also spasm of the glottis (convulsions internes) as a frequent complication of whooping-cough.
Clinically a typical picture of meningitis complicating pertussis is sel dom met with. The rare occurrence of tuberculous meningitis is in strik ing disproportion to the frequency of tuberculous affections of the lungs.
Cerebral paralyses, either hemiplegic or diplegic, have recently be come known as more frequent complications of whooping-cough (Bock enjos, Valentin, Neurath). They appear under the usual types of cere bral paralysis, either as monoplegias, hemiplegias, diplegias, sometimes combined with bulbar symptoms, or paralysis of the muscles of the eye or of the sense organs.
In the category of cerebral paralyses probably belong also disease pictures suggestive of multiple sclerosis following pertussis. Fried reich's ataxia likewise has been observed after whooping-cough. Among the psychic disturbances manifesting themselves during the course of pertussis we find insanity (in the form of hallucinations), complete imbecility (as shown by Baginsky's illustrative examples), symptoms of pavor nocturnus, etc. W. Konig saw permanent idiocy follow whoop ing-cough, but usually the psychic complications of pertussis are of a transitory character.
Sudden blindness after whooping-cough as a result of hemorrhages into the anterior chamber or retinal detachment or central lesion,—the visual power usually soon returning,—auditory disturbances due to a complicating otitis media or to a direct lesion of the nervous apparatus, and disturbances of sensibility are among the sense disturbances that at times complicate whooping-cough.
Among the spinal cord disturbances may be mentioned a flaccid paralysis of distinct spinal character, which however cannot be readily explained (haemorrhage, myelitis, poliomyelitis). Pains in the legs and loins, disturbances of sensation, difficulty in the evacuation of the bowels or urine may complicate the paralyses (Bernhardt, Luisada). Also poly neuritis (Faiclherbe, Aldrich), Landry's ascending paralysis (Mobius, Hagedorn), and a case of so-called pseudotabes (Simionesco) have been observed after whooping-cough.