Lectures on children's diseases : A handbook for practitioners and students.

  • Henoch, E. H. (Eduard Heinrich), 1820-1900.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on children's diseases : A handbook for practitioners and students. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    has in fact been proved, by laryngoscopic examination to occur, at least on the mucous membrane of the larynx and trachea.1 Everyone, however, who has once heard a fit of whooping cough must admit that there is something more in it than the mere catarrh—namely, a nervous element. It is this that gives the peculiar character to the attacks and manifests itself on the one hand by the spasmodic violence of the expirations, and on the other hand by apncea, and by the crowing sound of spasmus glottidis. I would further remind you of the symptoms de- scribed (p. 453) as constituting the aura of the attack, and also of the almost invariable vomiting. I grant that the retching and vomiting of mucus at the end of the violent paroxysms must be regarded simply as a mechanical act, resulting from the violent contraction of the abdominal muscles in coughing; for we fre- quently see the same thing result in children especially from other violent paroxysms of coughing having nothing to do with whooping cough, if the stomach is very full. We must remember, however, that many children vomit even when the whooping cough is very slight; and likewise that cases occur in which the vomiting forms the most prominent feature of the paroxysm, and may even excite serious anxiety by its persistence. I have known children who, after a short attack with no crowing what- ever, at once brought up the whole contents of the stomach, while others even in the intervals of the paroxysm vomited all their food and gradually sank into a state of serious debility, although no cause for this could be found in the digestive organs themselves. Such vomiting cannot be looked upon as other than nervous. It is as yet an open question whether a reflex excitability of the medulla oblongata acting through the vagus is to be blamed here, and in what way exactly the specific contagion exerts such an influence on the central nervous system. It is at any rate certain that pathological anatomy gives us no explanation of it, and that other changes which are found post-mortem- especially the much-talked-of enlargement of the bronchial glands—are only to be regarded as sequelae or compli- cations of the disease. Whooping cough often occurs in more or less extensive ' Rehn (Wiener med. Wochenschr., 1866, 52 and 53), Meyer-Hilni (Zeitschr. f. Hin. Med., i., Heft 3), and Herff (Deulsches Arch./, klin. ifed., Bd. xxxix. No. 3 und 4), describe this catarrh while Bossbach (Berl. Hin, Wochenschr., 18 1880) was unable to satisfy himself of its presence.