Symptoms.—The earliest symptoms are like those of a common cold, with considerable fever. They begin probably a fortnight after infection has been received. The child is restless and feverish, pale and without appetite. Its breath ing is quickened. It sneezes and has an irri table cough. The cough is very troublesome day and night, but specially at night. Fits of coughing come on ; a quick short series of coughs ends in a long-drawn whistling breath, followed by another long cough. Some de fluxion may be expelled at the end of the fit of coughing, and vomiting often occurs. After a week or a fortnight the fever lessens and the cough begins to be marked by the peculiar whoop, that gives the name to the disease. The cough still comes on in fits or paroxysms, in ordinary cases every hour, in severe cases every half-hour, and in bad cases even oftener. The child knows when it is going to come on by a tickling sensation. It becomes quiet and frightened, rushes to its mother or nurse, rises if it is lying down. The fit begins with a deep indrawn breath, which is followed by a rapid series of short coughs, becoming weaker, till all air seems driven out of the chest ; the face becomes swollen and bluish ; the veins are seen full of blood ; the eyes are starting, the skin wet with sweat; the child seems on the point of choking, when the spasm, preventing the entrance of air into the lungs, begins slowly to yield, and as the air enters the narrowed opening in the windpipe it produces a long, whistling or crowing sound, the " whoop" of the disease. Two or three such attacks may occur quickly after one another, till the child is quite exhausted and faint. Often some defluxion is expelled towards the eud of the attack, and vomiting is produced. The great strain on the blood-vessels may cause bleeding from the nose or other parts of the air-passages, and the eyes may become blood-shot. The child soon re covers and seems all right till another tit of coughing occurs. This stage lasts from four to six weeks or even longer, though sometimes it may be only two weeks, and then the spasms • become fewer and less severe and defluxion is more free. Recovery is slow, and may often take many months.
The dangers of whooping-cough are the oc currence of bronchitis, of inflammation of the lungs, and of convulsions. The younger the
child the greater is the risk of bronchitis rapidly overspreading both lungs. Without such com plications recovery ought to take place, though death may occur during the spasm.
Treatment.—The child should be kept in a room constantly maintained at a moderate de gree of heat. The air should be kept moist by steam from a kettle on the fire. The child should be clothed in flannel, and should get light nourishing food in small quantities often. The bowels should be kept regular by castor-oil or syrup of Benne. The medicine to be given is bromide of ammonium and belladonna. Chil dren stand large doses of belladonna, and the quantity may, therefore, be steadily increased in the following way : Let a mixture be made containing 64 grains of bromide of ammonium in 1 ounce of simple syrup (solution of sugar) and 3 ounces of water. Give a tea-spoonful of this every two or three hours. This is to be continued throughout the first week, and to it occasionally may be added four or five drops of ipecacuaulia wine. When the second stage conies on, the same solution of bromide of am monium is to be used, and to each tea-spoonful, as it is about to be given, add three drops of tincture of belladonna. If the child stands this quantity well, after one or two days' experience, five drops of the tincture may be added to each dose, and after a further experience of a day or two with the five-drop dose, seven drops may be added to each dose, and even ten drops. As soon as the black of the eye appears very large, uo further increase in the quantity of bella donna is to be made. The object of the bella donna is to relieve the spasms of coughing, and, as soon as they begin to yield, the quantity of belladonna is to be gradually diminished. To help recovery of strength, when the disease is evidently over, nothing is so useful as change of air. This should not be sooner than six weeks after the commencement of the illness. As a tonic to aid recovery, a half to a tea-spoonful dose, according to age, of syrup iodide of iron may be given thrice daily. Disinfection should be practised as described on pp. 516 and 517.