Chapter VI

WHOOPING-COUGH.

It is singular that a malady so distinctively marked as whooping-cough is should figure so little in the records of disease from former times. Astruc could find no traces of it in the medical writings of antiquity or of the Arabian period. In modern times the first known account of an epidemic of it is under the year 1578, when Baillou of Paris included a prevalent convulsive cough as part of the epidemic constitution of that year, remarking in the same context that he knew of no author who had hitherto written of the malady[1234]. Yet, if whooping-cough had been as common in former times as it has been in quite recent times, it deserved a high place among the causes of infantile mortality. Doubtless it occurred in former times in the same circumstances in which it occurs now. Baillou in 1578 speaks of it as a familiar thing; and it can be shown from an English prescription-book of the medieval period that remedies were in request for a malady called “the kink,” a name which survives in Scotland (like other obsolete English words of the 15th century) in the form of “kink host[1235].”

In Phaer’s Booke of Children (1553) chincough is not named. It is perhaps more singular that the disease should be omitted from the list in Sir Thomas Elyot’s Castel of Health (1541), of maladies proper to three periods of childhood; for that list has every appearance of being an exhaustive enumeration[1236]. Still, it would be erroneous to suppose that the convulsive cough of children which is so common an epidemic incident in our time, and in some impressionable subjects is the almost necessary sequel of a coryza or catarrh, did not then occur in the same circumstances as now. When Willis, in his Pharmaceutice Rationalis of 1674, remarks that pertussis was left to the management of old women and empirics, he suggests the real reason why so little is said of it in the medical compends. Sydenham mentions it twice, and on both occasions in a significant context. Under the name of pertussis, “quem nostrates vocant Hooping Cough,” he brings it in at the end of his account of the measles epidemic of 1670, without actually saying that it was a sequel of the measles. His other reference to it, under the name of the convulsive cough of children, comes in his account of the influenza of 1679. In both contexts it is adduced as an instance of a malady much more amenable to bloodletting than to pectoral remedies, the depletion being a sure means of cutting short an attack that was else very apt to be protracted, if not altogether uncontrollable[1237]. One glimpse of it we get among the children of a squire’s family in Rutlandshire in the summer of 1661. On the 26th of May the mother of the children writes to her husband then on a visit to London[1238]:

“I am in a sad condition for my pore children, who are all so trobled with the chincofe that I am afraid it will kill them. There is many dy out in this town, and many abroad that we heare of. I am fane to have a candell stand by me to goo in too them when the fitt comes.” On 2 June, the children are still “all sadly trobeled with the chincofe. Moll is much the worst. They have such fits that it stopes theare wind, and puts me to such frits and feares that I am not myselfe.” In a third letter, the children “are getting over the chincofe. I desire a paper of lozenges for them”; and on 30 June, the children are better, but the smallpox is still in the village. It was probably from the latter disease that many were dying.

In Dr Walter Harris’s Acute Diseases of Infants[1239], the convulsive or suffocative coughs are mentioned in one place without being identified as chincough, while in two or three other places the malady is briefly referred to under its name. Thus, “corpulent and fat infants troubled with defluxions, and having an open mould, are most subject to the rickets, chincough, king’s evil, and almost incurable thrushes.” Again, chincough of infants is one of the inflammatory diseases that are “not altogether free from contagion”; and again: “Albeit that any notable translation of the subject matter of the fever into the lungs, and chincoughs, do advise bloodletting for the youngest infants, yet it is most evident that it is not a remedy naturally convenient for them.... And therefore its help is not to be invoked for all the diseases of infants except in the chincough or any other coughs that do attend and are concomitants of fevers that do suddenly begin”—showing his deference to Sydenham, his master.

Probably the “any other coughs” are those that he thus describes in another place (p. 26):

“Moreover he is often troubled with a slight, dry cough, though sometimes it is strangling and suffocative: with a dry cough because of the sharpness and acrimony of the humours that continually prickle the most sensible branches of the windpipe; but the choaking doth proceed from the abundance of serous and watry humours that so fill up and burden the small vesicles of the lungs that it cannot be cast off and discharged. But also they being endued with a great debility and weakness of nerves, and a superlative softness and delicacy of constitution, they are not able to subsist with that violent trouble of coughing, but do succumb under that unnatural and excessive motion of their breast, and their face is blackish as that of strangled people.”

These were cases of whooping-cough, although they are not so called. Among his eleven cases, Harris gives two in infants of the Marquis of Worcester; one had been “very often troubled with an acute fever,” and was found to be much weakened by a chincough when the physician was called to him; the other, an infant of eleven months, had at the same time an acute fever “and a cough almost convulsive.”

This inclusion, under the generic name of cough, of cases that had all the signs of whooping-cough, namely, the paroxysmal seizures, choking fits, and blackness of the face, is found also in the London bills of mortality. Although “coughs” are entered as the cause of a not very large number of deaths in the earlier annual bills, with an occasional special mention of whooping-cough among them, it is not until 1701 that “hooping cough and chincough” becomes a separate item, with six deaths in the year; next year the entry is “hooping cough” alone, with a single death, and so on for a number of years in which the deaths are counted by units; in 1716 they rise to eleven, and continue to be counted by tens until 1730, when 152 deaths are set down to “cough, chincough, and whooping-cough.” It would be a mistake to suppose that these figures during the first thirty years of the 18th century are anything like a correct measure of the number of infants in London who suffered from whooping-cough, or are at all near the number who might have reasonably been returned as dying from it. It was in that generation that the entries of the Parish Clerks became most indefinite as to the causes of death in infants, five-sixths of the enormous total of deaths under two years being entered under the generic head of “convulsions” and “teeth,” while the item “chrysoms” received the deaths under one month old.

The increase of whooping-cough in the following table, from units to tens, from tens to hundreds, and thereafter to a somewhat steady total of hundreds year after year, can hardly be explained except on the hypothesis of more exact classification of infantile deaths, corresponding to the actual decline of the article “convulsions” in the second half of the century.

Years Whooping-cough

1701 6

1702 1

1703 5

1704 0

1705 0

1706 2

1707 3

1708 3

1709 1

1710 5

1711 7

1712 3

1713 6

1714 6

1715 7

1716 11

1717 15

1718 24

1719 17

1720 33

1721 20

1722 21

1723 38

1724 25

1725 53

1726 37

1727 67

1728 21

1729 35

1730 152

1731 33

1732 65

1733 97

1734 139

1735 81

1736 130

1737 160

1738 69

1739 72

1740 280

1741 109

1742 122

1743 92

1744 46

1745 135

1746 95

1747 151

1748 150

1749 82

1750 55

1751 275

1752 188

1753 65

1754 336

1755 93

1756 199

1757 239

1758 84

1759 227

1760 414

1761 197

1762 300

1763 291

1764 251

1765 225

1766 213

1767 364

1768 262

1769 318

1770 218

1771 249

1772 385

1773 235

1774 554

1775 206

1776 181

1777 529

1778 379

1779 268

1780 573

1781 165

1782 78

(Continued in the table of measles deaths, p. 655)

It is not without significance that the vital statistics of Sweden were the first to give whooping-cough something like its rightful place among infantile causes of death: from 1749 to 1764 the deaths set down to that cause were 42,393, or an annual average of 2600, the epidemic year 1755 having 5832. In this we should find merely the influence of systematic nomenclature. Nosology, or the scientific classification of diseases, may be said to have begun under Linnaeus, who was for many years professor of medicine at Upsala before he became professor of botany, and was teaching a somewhat rudimentary nosology to the Swedish students of medicine before the great work of his friend and correspondent Sauvages made classifications general.

Concerning the year 1751, which has 275 deaths from whooping-cough in the London bills, Fothergill writes in May: “Great numbers of children had the hooping cough, both in London and several adjacent villages, in a violent degree. Strong, sanguine, healthy children seemed to suffer most by it; and to some of them it proved fatal where it was neglected or improperly managed”—the deaths having become more numerous towards the end of the year[1240]. At Edinburgh, during the second year of high mortalities in the famine-period 1740-41, whooping-cough has 101 deaths to 112 from measles, having had only a fourth part as many the year before (see p. 523). In the Kilmarnock register from 1728 to 1763, “kinkhost” is credited with a total of 116 deaths, about 3 on an annual average, measles having a total of 93 during the same thirty-six years. In Holy Cross parish, a suburb of Shrewsbury, chincough has 9 deaths in the ten years 1750-60, and 6 in the next ten years, measles having 4 and 15 in the respective periods, and convulsions 9 and 31. In Ackworth parish, chincough has no deaths in the ten years 1747-57, and 2 in the next ten years, “infancy” having 13 in each decade, “convulsions” and measles none in the first, 6 and 2 respectively in the second. Warrington, in the disastrous smallpox year, 1773, had 16 deaths from chincough and 34 from convulsions. In the two years 1772 and 1773, Chester had 33 and 10 deaths from chincough, 70 and 69 from convulsions, 17 and 13 from “weakness of infancy.”

Watt’s researches in the registers of all the Glasgow burial-grounds brought out the fact that whooping-cough during a period of thirty years, 1783 to 1812, had been a common and somewhat steady cause of death among infants, having made 4·51 per cent. of the annual total of deaths at all ages in the first six years of the period, and 5·57 per cent. in the last six years[1241]. This was a higher annual average ratio than in the London bills for the same period (see the tables at p. 647 and p. 655), and was probably the maximum in Britain, inasmuch as the Glasgow death-rate of infants was the worst from all causes.