This is an epidemic and contagious disease, mostly confined to early childhood, and seldom occurs but once in the same person. It is probably most easily communicated in the second stage. There are two distinct stages, the catarrhal and spasmodic stage.
The first stage commences with the symptoms of an ordinary catarrh or cold. There is watery discharge from the nose and eyes, sneezing, coughing, languor restlessness, and febrile symptoms. Sometimes however the fever is severe and the cough very painful, at first dry,but afterwards with profuse expectoration; and sometimes, but very rarely, the catarrhal symptoms are entirely wanting.
This stage may last only a few days, and rarely continues more than two weeks.
As the catarrhal symptoms subside, the second or the nervous, spasmodic, or convulsive stage commences, in which the characteristic symptoms of the disease present themselves. The cough occurs in paroxysms, is very violent, and consists of a series of forced and quick expirations in such quick successions, that the patient seems almost in danger of suffocation. The face and neck are swollen and livid, the eyes protruded and full of tears; at length one or two inspirations are made with similar violence, which produce that peculiar sound, compared to a whoop, from which the disease takes its name. The paroxysms, or a rapid succession of them, usually last from one to fifteen minutes, and generally terminate in a profuse expectoration of ropy mucus or vomiting. The child is conscious when the attack is about to commence, and flies to some object for support, until it has subsided. The paroxysms may occur in rapid succession, not more than ten or fifteen minutes apart, or there may not be more than five or six during the twenty-four hours. As the disease declines, the paroxysms gradually decrease in frequency and violence, until they entirely cease. This second stage may last only two or three weeks, or it may continue five or six months.
The first stage of hooping cough is, as we have already seen, characterized by symptoms of an ordinary catarrh, and appearance and duration of the peculiar cough and whoop mark the period of the second stage. Simple hooping cough is seldom attended with danger, but when it becomes complicated with some other difficulty, the danger may be imminent. Let us briefly glance at some of these complications.
1. Complicated with Bronchitis and Pneumonia. - The presence of bronchitis or pneumonia may be indicated in the first stage by an incessant cough, painful and difficult breathing and high fever. In the second stage there will be a return of fever, which will continue during the intervals of the paroxysms of coughing and be accompanied with hurried and difficult respiration. The prominent symptoms indicating a complication of these affections, are a greater amount of fever than usual, and the respiration quick, hurried and difficult. The expectoration is also more difficult, the sputa being less profuse and of a puriform appearance. In violent cases the cough may lose entirely its spasmodic character, and exhibit only the cough of bronchitis or pneumonia.
2. Complicated with Infantile Remittent. - A disordered condition of the bowels may occur, marked by unhealthy discharges, loss of appetite and foul tongue. If these symptoms are allowed to continue for some time, the infantile remittent may make its appearance, sometimes commencing with a rigor, but usually coming on gradually. The paroxysms of coughing are more frequent, and the breathing quick, hurried and unequal. Fever has distinct remissions in the morning and increases toward evening.
3. Complicated with congestion of the Brain, Convulsions or Hydrocephalus. - These complications occur chiefly in infancy about the period of the first dentition, and may generally be anticipated before they are fully developed. We should fear their occurrence, where the cough is of great severity, and the face remains livid for a considerable length of time. The first symptoms may be sleepiness and heaviness after the fits of coughing, or spasmodic twitchings of the face or extremities, or perhaps the first indications that the brain is affected, may be coma or a fit of convulsions. These complications occurring at any time, are exceedingly dangerous, but more especially so during the period of the first dentition.
The treatment of the first stage should be the same as that indicated by an ordinary catarrh or cold.
Aconite may be given on the first appearance of the febrile symptoms.
Belladonna may be given, if the cough is worse at night, and if there is headache and sore throat. It is particularly useful both in the first and second stage, where symptoms of congestion to the head are present.
One drop, or ten globules, in a tumbler half full of water, a teaspoonful once in two or three hours.
Stibium or Ipecac. will be indicated, particularly in the commencement of the disease, where there is sneezing, watery discharge from the eyes and nose, pain on the forehead over the eyes, dry, hard or suffocative cough.
A powder once in two or three hours. If there is severe pain about the head, soreness of the throat, Belladonna may be given in alternation.
One drop, or twelve globules, in a tumbler half full of water, a teaspoonful once in two or three hours.
Dry cough accompanied with vomiting, agitation and sometimes bleeding at the nose; especially where it is more violent after midnight.
A powder, or three globules, once in three hours.
Hoarseness, watery discharge from the nose, with soreness of the nostrils: dry, fatiguing cough, generally occurring in two successive fits, bleeding from the nose, and vomiting.
A powder, or three globules, once in two hours.
Loose cough with watery discharge from the eyes, thick discharge from the nose, hoarseness and inclination to vomit after coughing, occasional diarrhoea.
Same as Dulcamara.
Either separately or in alternation, and sometimes also with Ipecac. or Stibium will be indicated, where there are symptoms of a complication of bronchitis or pneumonia.
Violent concussive cough, with rattling of mucus, suffocating respiration, and sometimes ejection of blood from the nose and mouth.
Two drops of the first dilution, in eight tablespoonsful of water, a teaspoonful once in three hours.
Vcratrum may be given if the violence of the paroxysms continues unabated, and especially if there is great weakness, fever, and cold perspiration, and also when during the paroxysms there are pains in the chest and abdomen, involuntary emission of urine, and vomiting.
Same as Hyd.-acid.
Especially in violent cases, with loud and hoarse cough, and where there is no fever. or the febrile symptoms are strongly marked, with shuddering and heat, aggravation of symptoms during repose; and also where there is vomiting of food or slimy water.
One drop, or six globules, in a tumbler half full of water, a teaspoonful once in two or three hours. It may also be followed by Veratrum.
When during the paroxysm there is rigidity of the body, with suspended respiration, and loss of consciousness; vomiting after the paroxysm, and rattling of mucus in the chest, when not coughing.
A powder, or three globules, once in one or two hours.
Particularly where the attack threatens to proceed into the second stage, or where from the first the cough is of a convulsive kind, appearing especially in the evening, attended with sore throat and shooting pain in the head and chest.
Cina is especially indicated, when, in addition to the usual characteristics of the disease, worm symptoms are present.
Iodine will be of benefit, where the cough is excited by a constant tickling in the bronchia, with excessive anguish before the fits, and undulating respiration during the attack.
Where there is danger of convulsions, or congestion to the brain, Hellebore, Belladonna, and Hyosciamus are the prominent remedies. Consult Convulsions and Hydrocephalus. Where there are symptoms of Remittent fever, consult Infantile Remittent. And should the disease become complicated with bronchitis or pneumonia. Consult Cough and also Bronchitis and Pneumonia.
The frequency of the repetition of the medicines must be guided in a measure by the severity of the symptoms. Where they are violent, the remedy may be given as heretofore directed, but in the decline of the disease, and where the attack is light, a dose morning, noon, and night will be sufficient.
The rooms should be freely ventilated, taking care, however, that the child does not take cold. After the severity of the symptoms are over, but the disease still continues for a long time, a change of air will often prove highly beneficial. If no fever is present, there need be no change of diet, but if more or less fever attends the disease, the diet should consist of arrow-root, gruels, etc.