The anatomy of the cerebral complications of pertussis has recently been made the subject of close investigation (Neurath). Certain nega tive necropsy findings in well-marked clinical pictures, suggestive now of htemorrhagic effusions or embolism, now of encephalitis, and again of meningitis, have given rise to the supposition that histological changes might be found which escape the free eye. It is undeniable that intra cranial haemorrhages are clinically more frequently diagnosed than anatomically verified. In such a lesion of the vascular wall (called ancurysmatic dilatations by Vidal) plays a greater role in pathogenesis than the increased intravenous pressure.
Neurath found in a series of cases which during life presented symptoms mostly of cerebral irritation, a pronounced meningeal infil tration (mononuclear leucocytes), hyperemia, and meningeal hemor rhage from inflammation—findings analogous to those obtained in other acute infectious diseases such as typhoid fever, scarlet fever, and sepsis. Tic is inclined to attribute to this meningitis simplex a pathogenetic explanation of the development of a number of cerebral complications, in addition to the other anatomical data (embolism, hemorrhage, encephalitis, etc.). This assumption seems to find a support in the re sults obtained by .Bertolotti and others in lumbar punctures systemati cally performed on children suffering with whooping-cough. They found the puncture fluid to abound in mononuclear leucoeytes.
With regard to the digestive tract, apart from a prolapse of the rectum mentioned previously, we find now and then gastric and intes tinal catarrhs. Acute nephritis, sometimes ushered in with fever, is rel atively seldom met with, but it may occur and be attended with ummic symptoms. A complicating otitis media, occurring during the course of pertussis, probably starts from the nasopharyngeal space. Among the cutaneous affections we find, besides the hemorrhages already mentioned, sometimes erythema, pemphigus, urticaria-like effforescences (even non medicamentous). They may exhibit a htemorrhagic character.
Constitutional disturbances, anaemia and scrofula, are not rarely the sequele of whooping-cough. Their severity is in proportion to the severity and duration of the basal disease and the intercurrent affections.
Whooping-cough is often found associated with other acute infec tious diseases. This fact can be accounted for only by an increased disposition, due either to the opening up of portals of infection or to a general weakening of the resisting powers. Especially in hospitals with
insufficient accommodation for isolation, certain disease combinations are apt to occur. Foremost among the latter are measles, which more frequently follows than precedes pertussis. Varicella is likewise often a complication, whereas scarlet fever is rarely found associated with pertussis.
The diagnosis of whooping-cough in typical eases is easy, its symp toms and course as a rule being so characteristic that the history alone suffices. Still in many cases conditions have to be considered which may simulate whooping-cough.
.The most important symptom of whooping-cough is the typical paroxysm. A spasmodic cough caused by tuberculosis of the bronchial glands may in numerous cases suggest a staccato cough. In such cases the course of the disease is important for a differential diagnosis. In whooping-cough the cough increases in a typical manner from the onset through the catarrhal stage (1 to 2 weeks) up to the beginning of the paroxysms, the latter usually terminating with vomiting. During the intervals the child feels well. The lungs, on examination. do not yield any results differing from the normal. On the other hand, in enlarge ment of the bronchial glands there is no climax, the coughing attacks preventing the recognition of the distinct. whooping inspirations. Vom iting is rare, and the children convey the impression of being constitu tionally stricken individuals (scrofulosis), and frequently exhibit hectic fever, while an examination of the thorax reveals dulness and bronchial breathing between the shoulder blades.
A pertussis-like hysterical imitation cough Inay be distinguished from true whooping-cough by the hysterical stigmata of the afflicted children, by the cessation of cough during sleep, by the absence of certain signs of pertussis (puffed face, sublingual ulcer). Whooping cough may, without much difficulty, be distinguished from a reflex cough caused by hypertrophy of the tonsils, and from the symptoms. provoked by inhalation of foreign bodies.
Finally, the history will exclude the existence of pertussis in those cases in which a catarrh, coining on long after whooping-cough has been cured, causes paroxysm-like attacks by bringing into activity the ner vous paths which, through the ordeal of pertussis, have undergone a. certain training.