Bronchitis and catarrhal pneumonia are other common consequences of whooping-cough. The pulmonary catarrh, which is one of the characteristic features of the disease, is easily aggravated, and readily invades the smaller tubes of the lung. In a young child, too, a bronchitis seldom remains a bronchitis, but the inflammation quickly travels to the fine bronchioles and air-vesicles. Thus a catarrhal pneumonia is easily set up. In a severe case of pertussis the breathing becomes more and more oppressed and the face more and more livid as the catarrhal inflammation extends itself ; but when the terminal tubes are reached and catarrhal pneumonia begins, the change is at once announced by new symptoms. The whoop ceases ; the temperature rises to 102° or 103° ; the breathing is quickened and laboured, and the pulse-respiration ratio is perverted ; the face is livid ; the flares are widely expanded. Although there may be no percussion dulness, a physical examination of the chest reveals some of the signs connected with this dan gerous condition. Sometimes a fit of convulsions ushers in the complication. If the pneumonia be extensive the child generally dies. If it be moderate, and the attack of whooping-cough be nearing its close, he may recover, but his life may be said to hang on a thread, for the occurrence of a little collapse, still further reducing the amount of breathing space left to him, may at once determine the fatal issue.
Emphysema of the lung, which often occurs, is a complication of little gravity. It usually occupies the upper lobes and anterior borders of the lungs. It is produced mechanically by forcible distention of the air-vesi cles, air being driven from the lower parts of the lungs into the upper por tions during the spasmodic cough, or rather during the violent contrac tions of the diaphragm which immediately precede the cough when the glottis is closed. In the severer cases there is some dilatation of the smaller bronchi as well as of the air-cells. The condition is an acute one, and usually subsides when the disease passes off. In scrofulous children, however, it may remain as a permanent lesion.
Of these complications emphysema is one of early occurrence. Col lapse and catarrhal pneumonia occur late in the disease, as a rule, when the child's strength is reduced and his nutrition impaired.
Besides the above accidents others may occur. Laryngitis is seen sometimes, but if not severe acids little or nothing to the danger of the case. Pleurisy and pericarditis are occasionally found, but these do not, like the preceding, follow naturally from the complaint, and are not often met with.
Sequelce. —When the disease has passed off consequences, local and constitutional, may be left behind. Any diathetic taint, previously dor mant, is-often roused into activity. Scrofulous children may become subject to chronic discharges, inflammations, and other signs of that constitutional condition ; syphilis in babies may first manifest itself during or after an attack of whooping-cough ; and acute tuberculosis is a not unfrequent sequel to the disease. Measles and pertussis seem to have a certain affinity in that they both produce an especially injurious effect upon scrofulous children. In such subjects chronic caseous enlargements of
the cervical and bronchial glands are common : catarrhal inflammation of the lungs tends to pass into a chronic stage and produce serious mischief, and chronic bronchitis with emphysema may make the child a permanent Acute tuberculosis, when not the consequence of hereditary diathetic tendency excited by the occurrence of whooping-cough, may be set up as a result of softening of caseous bronchial glands, and this at a -considerable interval of time after the primary disease has come to an end.
Besides these constitutional conditions there are other local conse quences of whooping-cough which it is important to be aware of.
Laryngismus stridulus is sometimes a relic of the disease, the spasm persisting although the other symptoms have ceased. This is not com mon, and probably only occurs in the subjects of rickets.
Children who have lately passed through an attack of whooping-cough are often slow to recover their strength and healthy appearance, even although they are innocent of any diathetic taint, and have no chest af fection to set up pyrexia and be a cause of weakness. A group of symp toms is often noticed in such subjects which I have elsewhere described under the name of " mucous disease,"' and which indicates a marked degree of impairment of nutrition. The child is languid and pale, or has a clingy sallow complexion ; he loses flesh, is easily tired, and sleeps badly at night. There is .often some discolouration under the eyes, and the complexion may turn suddenly ghastly white, as if the child were going to faint. Often he does faint ; and he frequently complains of a stitch in the side and is subject to flatulent pains about the belly. The tongue pre sents a peculiar appearance. It has a glossy slimy look, is often coated with a thin gray fur, and the large papilke at the sides, although not prominent, are unusually distinct. A curious irritability is a characteristic feature of the disorder. The child is capricious and fretful, and often cries without cause. He quarrels needlessly with his brothers and sisters, and is sometimes quite a torment in the nursery. At night he dreams and often wakes up in violent panic. The " night terrors " of children usu ally occur in the subjects of this derangement, and sometimes the child gets out of bed and wanders about in his sleep. These symptoms have no progression. They are better and worse. Sometimes the child seems almost well ; then, in a day or two, he is as bad as ever. The patients are subject to what are called "bilious attacks." They are seized suddenly with vomiting and purging, which lasts for twenty-four hours or a day or two, and at these times get rid of large quantities of thick mucus both from the stomach and bowels. After this relief they seem better for a time. They are less irritable and languid, their temper improves, and their rest at night is no longer disturbed. After a few days, however, the symptoms return, and continue until they are again relieved in the same way. As a rule, the bowels are rather costive, and an aperient always brings away much mucus with the stools.