In the case of convulsions, if the attack can be connected with nervous agitation or the onset of an inflammatory complication, or if, after the fit, the child seem bright and well, there is still room for favourable anticipa tion. If, however, the seizure is symptomatic of diffused pulmonary col lapse ; if it occur in the course of an extensive pulmonary inflammation ; or if it be followed by drowsiness, squinting, or sign of cerebral lesion, there is little prospect of the child's recovery. Sometimes we can antici pate the occurrence of convulsions. If we find the child te be nervous and impressionable, and we notice that he displays unusual agitation and ex citement on the approach of the paroxysm, we may be prepared for an attack. So also if we find that the face becomes very blue during the cough, and that the spasm of the larynx is unusually prolonged, we may fear that an eclamptic attack may ensue. Laryngismus striclulus, as it supplies an additional obstacle to the aeration of the blood and tends to promote collapse of the lung, is an unfavourable sign. If it occur in combination with extensive lung mischief, the prospect is a very hope less one.
If the pulmonary catarrh becomes aggravated, the presence or absence of rickets is a very important matter. Softening of ribs is a great obstacle to efficient breathing ; and if the presence of thick mucus in the tubes pro vides an additional impediment to the entrance of air, the occurrence of collapse is imminent. If, with this, the spasms are violent, and the child seem much exhausted at the end of the fit of coughing, collapse of the lung may be considered inevitable. In such a case the prognosis is a very gloomy one.
If the catarrh pass to the small air-tubes and vesicles, and set up catar rhal pneumonia, the state of the child is serious. Still, if the patient be of healthy constitution and the pertussis of comparatively mild type, he has a chance of recovery. In a rickety child the prospect is very bad. In one of scrofulous constitution, if he cm not succumb immediately, there is every likelihood that a chronic consolidation of one or both lungs will be left behind.
Treatment.—The treatment of whooping-cough resolves itself into gen eral measures for preventing complications and furthering the normal working of the animal functions ; also, in special treatment for shortening the disease and diminishing violence of spasm.
If possible, the child should be confined to two rooms opening into one another, so that he may inhabit them alternately, and get the benefit of effi cient ventilation. Draughts should be avoided, and the temperature be kept as nearly as possible at 65° Fahr. If the rooms have no door of communi cation, the child should be taken from one to another, wrapped from head to foot in a blanket. Next, quiet and the avoidance of all sources of excite ment and irritation should be enforced. If old enough to be amused, quiet games and picture-books may be supplied ; and a teachable child is not to 'be worried with lessons if he is disinclined for them. His dress should be suitable to the season, but bare arms and legs must be forbid den, and the chest should be covered with cotton-wadding if the weather be changeable or cold.
In regulating the diet care should be taken not to overload the stom ach. Four small meals are better than three large ones, and attention must be paid to the patient's power of digesting fermentable articles of food. The mucus flux from the stomach and bowels, which is a prominent feature of the complaint, is an active agent in promoting acidity ; and starches must be given, therefore, cautiously and in limited quantities. A baby does well upon milk and barley-water (equal parts), and Mellin's food, with a pinch of bicarbonate of soda to each bottle. He may also have the yolk of an egg twice a week, and, if over ten months old, weak veal or chicken broth once in the day. After eighteen months the child may have minced meat, or fish, milk, eggs, and stale bread, but potatoes and farinaceous puddings are to be avoided. Well boiled cauliflower or greens
may be given if the patient will take them.
If the does not sufficiently unload the stomach of mu cus, nature may be aided by the occasional administration of an emetic. Sulphate of copper, as recommended by Trousseau, is very useful for this and may be given to a child of one year old in doses of half a grain every ten minutes until sickness is produced. Also, it is well to re lieve the bowels by an occasional dose of castor-oil. Looseness of the bow els, such as is common in this complaint, is at once arrested in most cases by a dose of this useful remedy.
Of special drugs for shortening and relieving spasm, so many have been recommended that the mere enumeration of them would occupy Many lines ; but of really serviceable drugs the number is much more lim ited. The treatment I have myself found to be most useful, and now inva riably adopt, is the following : '—Directly any peculiarity in the cough or the occurrence of spasm indicates the nature of the complaint, I at once begin the administration of sulphate of zinc and atropin. From a large experience of this combination I can speak positively as to its power of reducing spasm and shortening the disease. I begin with one-sixth of a grain of sulphate of zinc and half a drop of the solution of atropine (P. B.) in water sweetened with glycerine, each morning and evening for two days, and then three times a day. After a week the quantity of zinc is increased to one-fourth, and still later to one-third of a grain. The atropia, how ever, is given in frequently increasing quantities. Children, although they vary in their insusceptibility to this drug, can all take it in large doses ; and in whooping-cough where there is spasm to be overcome, the remedy is of little value unless given in doses sufficiently large to produce some of the physiological of the alkaloid. Excluding the belladonna rash, which is too uncertain in its appearance to be trusted, dilatation of the pupil is the earliest symptom that the system is responding to the action of the medicine. This sign is separated by a wide interval from the next earliest symptom—dryness of the throat. To be of service, the remedy should be pushed so as to produce some effect upon the pupil. With this object the dose should be increased every two days by a quarter of a drop of the atropine solution, watching the effect. In this way, with perfect safety, large quantities of the drug may be administered ; and so employed, I think no doubt can be entertained as to the value of the treatment and its influence in shortening the course of the spasmodic stage and reducing the violence of the attacks. If the spasm is exceptionally severe and seems to threaten partial asphyxia, it is wise to give in addition a nightly dose of bromide of potassium or ammonium (gr. iij.–iv.). There is one precaution which it is well to adopt during this stage. The paroxysms are often most frequent and severe at night when the child is asleep. The slightest move ment of air across the face, such as is produced by a person walking near the cot, will often excite an attack. These night seizures can usually be greatly reduced in number by an expedient suggested, I believe, originally by Dr. Marshall Hall. It consists in throwing a fine muslin curtain over the cot at night-time. The simplest plan is to have a couple of hoops ar ranged at the ends of the cot, like the "tilts " of a wagon, so as to support the curtain at a sufficient height. This arrangement, which corresponds to the mosquito curtain used in hot climates, does not interfere with a free supply of oxygen, while it effectually stops all wandering currents of air. So protected, a child will often sleep the night through without an attack.