Certain digestive troubles may arise. Vomiting at the end of a fit of coughing is a familiar symptom. Usually it is of little consequence. If, however, the attacks of cough occur very frequently, and are followed in each case by sickness, the child's nutrition is visibly affected ; for almost all the food taken is vomited before there is time for digestion to begin. Even if vomiting is not excessive, there is often considerable interference with nutrition, for the catarrhal condition of the gastric mucous membrane is ill adapted to further healthy digestion. In many cases, no doubt, the tough mucus which coats the wall of the stomach prevents the food from being properly mingled with the digestive juices. It is not uncommon, as M. Rilliet long ago pointed out, for food to be vomited little changed sev eral hours after a meal. On account of the mucous flux in the bowels worms are a frequent complication, and diarrhoea is easily excited. A cer tain amount of looseness of the bowels is present in a large majority of the cases of pertussis, and considerable quantities of mucus are passed in the stools.
Nervous accidents form a very important class of complications. Some times the laryngeal spasm is exaggerated. It is not uncommon to see a child at the end of the long expiratory cough, instead of at once beginning to whoop, remain for some seconds with darkened face, staring eyes, and open mouth, making agitated movements and vainly striving to overcome the spasmodic contraction which is closing the entrance to his lungs. If prolonged the spasm adds greatly to the gravity of the case, and may even determine the fatal issue. This is especially likely to happen if the per tussis is complicated with serious lung mischief. In a case which came under my own notice—a child of seven years of age, both of whose lungs were the seat of catarrhal pneumonia—the spasms were very violent and prolonged, and in one of them the patient died. In a case recorded by Drs. Meigs and Pepper, whooping-cough complicated a case of laryngismus stridulus, and the child died in a spasm. Sometimes the patient falls into a state of syncope from which he can be roused only with the greatest difficulty.
The semi-asphyxiated state in which the patient is often left after a severe paroxysm of cough may be a cause of general convulsions. Eclamp tic attacks, indeed, often complicate pertussis ; but although their occur rence should give rise to great anxiety, the seizures are not necessarily fatal. If the convulsion be the consequence merely of deficient aeration of the blood, the return of free respiration removes the danger for a time ; but if the same condition be frequently renewed, the child's state is a very anxious one. So, also, convulsions excited by embolisms or congestions of the cerebral vessels, thrombosis of the cranial sinuses, or diffused collapse of the lungs, are very serious. These generally occur late in the disease and are almost invariably fatal. There are two forms of eclampsia liable to happen which are less dangerous. One of these is due to an exaggeration of the nervous excitement which is an ordinary symptom of the disease. In highly sensitive children it is probably not uncommon for convulsions to take place from this cause, especially if the strength has been quickly reduced by copious epistaxis. So, also, the onset of an inflammatory com
plication is often indicated by a convulsive fit, and these attacks, like the preceding, are often recovered from. If, however, a convulsive fit occur late in the disease, when there is much consolidation of lung, the child seldom recovers. In connection with this subject it is well to remember that convulsions occurring in the course of whooping-cough may be due only indirectly to that disease. The tendency to eclamptic attacks which is common in early life is, no doubt, heightened by the state of ner vous excitement in which the system is maintained by the illness. At any rate it is common, especially in rickety children, to find convulsions su pervene in the course of whooping-cough upon very slight gastric or in testinal irritation. Convulsions pertussis without being followed by ill consequences may be, no doubt, often attributed to this cause.
Another important group of complications consists of the pulmonary lesions which may occur in the course of whooping-cough. These, on ac count of the nature of the complaint and the tender age of the patient, are readily excited, and often brimg the illness rapidly to a close. In fact, the liability to these accidents constitutes in most cases the chief danger of the disease.
Collapse of the lung is one of the commonest and most fatal of these complications. In a severe case of whooping-cough in a young child this accident may happen at any time. Indeed, it may be said that at the end of every violent paroxysm of coughing the patient is threatened with col lapse of the lung, for all the conditions which conduce to this disaster are present together. Thus the spasmodic cough almost empties the lungs of air ; the ropy mucus in the tubes offers an obstacle to its re-entrance ; and the state of exhaustion in which the patient is left weakens the force of the inspiratory act. The mechanism of collapse of the lung and the symptoms and signs which result from it are described at length in another place. It will be sufficient here to remark that the occurrence of collapse is often indicated by an attack of convulsions, and if the area of lung affected be large, sudden death may even ensue. In the less serious cases the child lies back with his head low ; his face is pale or slightly livid and covered with a cold sweat ; the eyelids and lips are dull red or purple ; the flares act, and the respirations are frequent and shallow. There is no fever ; often the temperature is lower than natural. On examination of the chest we find a little dulness at one or both bases behind ; the breathing is bron chial, and sometimes loose crackling rhonchus may be heard at the lower part of each lung. The whoop generally ceases when collapse occurs, but the fits of coughing continue, although in a modified form, and add greatly to the exhaustion of the patient. These cases almost invariably end in death. The child lies quietly, as if unwilling to stir a muscle. He takes food with difficulty and seems afraid to swallow. If lifted up suddenly he may die from syncope : often the end is preceded by a convulsion.