The onset of whooping cough is gradual and for some time the child
is usually supposed to be suffering from a cold or bronchitis. This
first or catarrhal stage has nothing which is characteristic. There is
a cough which gradually increases in severity. As the cough becomes
more severe it assumes also more of a paroxysmal character with a
tendency to recur at certain intervals. After about two weeks with
the appearance of typical paroxysms the second or paroxysmal stage is
entered upon. This lasts about six weeks on an average. The number of
paroxysms varies greatly. There may be but one or two in 24 hours, or
one may occur every hour. On an average about 10 to 15 are observed
during 24 hours. They are apt to be most severe at night. When a
paroxysm of coughing begins the child sits up and if old enough tries
to get hold of something for support. The paroxysms consists of a
series of expiratory coughs following in such rapid succession that
the child is unable to get its breath. These have been compared to the
explosions of a motor cycle, or those of a machine gun. At the height
of a severe paroxysm the face is red or blue as in choking, saliva
flows from the mouth, the tongue protrudes and is blue, the child
struggles for breath, when finally, maybe only after several seconds,
the spasm relaxes somewhat and air is drawn through the narrowed
opening in the larynx with a peculiar crowing sound which is known
as the whoop and has given the name of the disease. Such a series of
events often is repeated several times in quick succession. Finally
the end comes with vomiting which not only gets rid of the mucus in
the throat but also empties the mucus from the air tubes. The child
now falls down on the bed exhausted, the skin wet with sweat and it
often falls to sleep. The struggle of the little patient in its efforts
to get its breath cannot fail to awaken the sympathy of anyone who
witnesses it. In older children the paroxysms are better borne and the
general strength is not much affected. In young children with frequent
paroxysms and loss of food from vomiting much depression and weakness
develops. When there are frequent severe seizures the face in the
intervals has a woe-begone expression, the skin is dusky and the eyes
dull.