Whooping-Cough as a Sequel of other Maladies

Although it is convenient to group whooping-cough among the infectious diseases, and although it is a clear case of a malady that comes in epidemics, yet its pathology is peculiar. It seems to be more a sequel of other diseases than an independent or primary affection. The whoop of the breath, from which it is named, is really proper to any convulsive cough of some infants or children. Adults, having undergone the change in the form and relative size of the larynx at puberty, have the convulsive cough usually without the whoop if they have it at all. After the successive influenzas of recent years (1889-92), many adults suffered from convulsive paroxysmal cough which was whooping-cough in all respects but the whoop, the choking fits, the blackness of the face, and the vomiting being, of course, all kept in subjection by the greater control of adults over their reflex actions.

It has been often remarked that the ordinary whooping-cough of children has followed epidemics of influenza, or widely prevalent catarrhs. Thus, Hillary records in July, 1753, an epidemic of whooping-cough, or “the fertussis,” all over the island of Barbados following the epidemic catarrh which was at a height in January of the same year. Whooping-cough had not been known in the island for many years past, “neither could I find by the strictest inquiry that I could make that any child or elder person did bring it hither[1243].” Willan, in his corresponding records of the succession of diseases at the Carey Street Dispensary, London, from 1796 to 1800, has the following:

“There was also among infants and children during the month of January [1796], an epidemic catarrh attended with a watery discharge from the eyes and nostrils, a frequent though slight cough, a shortness of breath, or rather panting, a flushing of the cheeks, great languor with disposition to sleep, and a quick small irregular pulse.... It was succeeded in February by the hooping cough.”

Measles, which is usually a catarrhal malady, has undoubtedly been followed by whooping-cough in many individual cases and in epidemics as a whole; and it may be that there is a closer association of whooping-cough with measles than with any other infectious disease. In the table on p. 647, the deaths by whooping cough in London from 1731 to 1830 have been reduced to ratios per cent. of the deaths from all causes, in a parallel column with the ratios of measles; it will be seen that the increase of both is equally remarkable towards the end of the table. But the Glasgow ratios abstracted by Watt show no such decided increase of whooping-cough from 1783 to 1812, side by side with the astonishing increase of measles; while his annual bills for the same period show that there were many deaths from whooping-cough in Glasgow for years before measles began to replace smallpox or to divide the mortality with it. The first high monthly mortalities from whooping-cough in Watt’s bills were from November, 1785, to the end of 1786; but there had been so little measles for twenty-four months before that epidemic began, that only one death from it is recorded all the time. Again, the great measles epidemic of 1808 in Glasgow was indeed followed by many deaths from whooping-cough in 1809; but, while the height of the measles epidemic was in May and June, 1808, it was not until April, 1809, that whooping-cough began to cause many deaths.

Glasgow: Deaths by measles and whooping-cough.

Whooping-cough Measles

1807

Nov. 18 2

Dec. 18 1

1808

Jan. 10 2

Feb. 20 2

March 12 5

April 18 71

May 9 259

June 9 260

July 2 118

Aug. 2 32

Sept. 2 22

Oct. 2 10

Nov. 4 4

Dec. 2 2

1809

Jan. 7 4

Feb. 6 4

March 7 2

April 16 1

May 22 4

June 25 4

July 22 6

Aug. 15 2

Sept. 35 4

Oct. 23 1

Nov. 36 2

Dec. 45 10

1810

Jan. 33 4

Feb. 32 4

March 19 3

Whatever correspondence or relation there may be between measles and whooping-cough, (and it has been remarked by many in the ordinary way of experience), it eludes the method of statistics[1244]. As for the catarrhs of infants and children other than those which are part of the actual attack of measles or influenza, they are so common from year to year, and even from month to month, (perhaps coincident with teething, or with chicken-pox or other slight febrile disturbance), that a statistical study of whooping-cough in relation to them could lead only to an empirical, and possibly bewildering, result. It may be more useful to consider the antecedent probability of some such relationship, arising out of the pathology of the convulsive cough.

Whooping-cough is not only a paroxysmal cough coming on in convulsive fits at intervals, but the paroxysms, as they recur for many weeks, or, as they say in Japan, “for a hundred days,” have none of the obvious occasions of coughing, such as catarrh of the mucous membrane, congestion of the lungs from hot or close air, irritation of the bronchial tubes from dusty particles or vapours, or the presence of tubercles in the substance of the lungs. Such irritants can, indeed, produce whooping-cough, as in the following instance of “artificial chincough” related by Watt:

Two children having quarelled in their play, one of them thrust a handful of sawdust into the mouth of the other. Some of the sawdust passed into the windpipe. After a short time the child began to have violent convulsive fits of coughing, in which the whoop was very distinctly formed. Expectoration in the course of a few hours removed all the irritation, and the coughing thereupon ceased.

But in natural or ordinary whooping-cough there is no mechanical irritation, there is nothing to cough up, the reflex action, violent and paroxysmal though it be, has apparently no motive. I have, in another work, offered an original explanation of the paroxysmal cough of children as being the deferred reaction, the postponed liability, the stored-up memory, of some past catarrhal or otherwise irritated state of the respiratory organs, to which I refer without attempting to summarize it here[1245].

The epidemicity of whooping-cough presents no more difficulty if the malady be viewed as the sequel or dregs of something else than if it be taken for an independent primary affection. The many infants and children that suffer from it together may have equally been suffering together from one or other of the various things of which it is assumed to be the sequel—influenza, measles, sore-throat, the bronchitis of rickets, simple bronchial catarrh of the winter, simple coryza. Again, it may be a secondary or residual affection with many, but a communicable disease to others. Much of the whooping-cough of an epidemic is believed by good authorities, such as Bouchut and Struges[1246], to be simply mimetic, or a habit of coughing acquired by hearing other children coughing in a particular way, just as chorea is sometimes acquired in schools or hospital-wards through the mere spectacle of it. But it may be doubted whether much of the whooping-cough which swells the bills of mortality is acquired in that way. The children that die of it are probably most of them such as had only escaped dying of the measles or other infective disease, or of the non-specific catarrh, which had preceded the whooping-cough.