AN
INAUGURAL DISSERTATION
ON THE
HOOPING COUGH.

 

AN
INAUGURAL DISSERTATION
ON THE
PERTUSSIS, OR HOOPING COUGH.
Submitted to the Examination
OF THE
Rev. PETER STUDDIFORD, V. D. M. & P. T. Præs.
AND TO THE
TRUSTEES AND FACULTY
OF
QUEEN's COLLEGE NEW-JERSEY;
FOR THE DEGREE OF
DOCTOR OF MEDICINE,
With the Rights and Immunities thereunto appertaining.
By ABRAHAM CORNELISON,
OF NEW-YORK.
Unda impellitur unda,
Urgeturque prior venienti, urgetque priorem.
OVID. METAM.
NEW-YORK:
Printed by T. and J. SWORDS, Printers to the Faculty of Physic of
Columbia College, No. 27, William-Street.
1793.

 

TO
NICHOLAS ROMAYNE, M. D.
Whose Usefulness as a Teacher and Practitioner of Medicine
justly merits the Attention of every Well-wisher
to Humanity;
AND,
In whom are united all the Qualifications necessary to render
him a useful Member of Society:
THIS
DISSERTATION
Is inscribed, with every Mark of Respect, by his Friend
and former Pupil,
The AUTHOR. 

 

AN
INAUGURAL DISSERTATION
ON THE
HOOPING COUGH.
AMONG the diseases incident to the human
body, those which have raged as epidemics, have
particularly attracted the attention of Physicians.
At no period of life is a contagious disease more
distressing than during infancy and childhood: In
that helpless stage of life symptoms must be more
manifest before they can be known; and when they
are known, much difficulty attends the administra-
tion of remedies for their relief.
I have for these reasons chosen for the subject
of this Dissertation, the Hooping Cough, Pertussis, a
disease, which, though it commonly affects infants
and 

(8)
and children, yet sometimes attacks any age and
sex, and has at times put on such serious symptoms
as to prove fatal. This disease, although it com-
monly affects persons but once in the course of life,
has yet on some occasions its attacks two or three
times repeated on the same individual.
History of the Disease.
THE Pertussis is a contagious disease which
affects almost every person once in the course of
their lives, and children appear to be mostly its
subjects; still there are not instances wanting of its
affecting persons at different periods of life. But
how little do adults experience its baneful effects in
comparison to those infants who cling for support
to their mother's breasts.
This disease generally comes on with all the ap-
parent symptoms of catarrh arising from cold, and
sometimes goes off in this manner, without putting
on

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on the convulsive cough;* but it does not fre-
quently terminate so favourably, for generally after
a few days it puts on its characteristic symptoms.
Doctor CULLEN has defined this disease to be,
"Morbus contagiosus; tussis convulsiva, strangulans,
cum inspiratione sonora, iterata; saepe vomitus."†
The most peculiar and characteristic symptoms of
this disease are the convulsive coughings, which are
made with an increased frequency and violence of
the expiratory motions, when the muscles of the
abdomen and thorax are spasmodically affected.
The Hooping Cough differs from every other
form of coughing, as the expiratory motions are con-
vulsively made; the air being thrown out of the
lungs, a full inspiration suddenly succeeds, whereby
the air forcing itself into the glottis with great and
unusual velocity, causes that peculiar sound which we
call the Hoop. Hence the name of Hooping Cough.
B When
* CULLEN's Practice of Physic, and Dr. WALLIS on the
Prevention of Diseases.
† Synop. Nosol. CULLEN, G. lvii.

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When this sonorous inspiration has happened,
the coughing is frequently renewed as before, until
the contents of the stomach are vomited up, or a
quantity of acrid mucus discharged from the lungs;
either of these evacuations puts an end to the parox-
ism, when the patient returns to a degree of com-
fort.
Different opinions have been entertained respect-
ing the seat of this disease. One very erroneous
opinion is, that the intestines are affected.* Ano-
ther opinion, not quite so erroneous as the former,
is, that the stomach and lungs are both affected.†
That the stomach suffers from the contagion is
not very probable, although vomiting frequently
happens. The contagious matter particularly affects
the trachea and lungs, proves a source of irritation
to them, and excites that violent spasmodic cough
which affects the stomach, and causes vomiting from
the effects of sympathy. Instances occur daily of
extraneous matter getting in the trachea, and there
proving
* Vide Dr. BUTTER's Treatise.
† Vide Treatise on the Diseases of Children, 1772.

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proving an irritation, which excites coughing to a
violent degree, and generally ends in vomiting; the
truth of which every person must be convinced of
by experience.
When this disease puts on its peculiar symptoms,
it continues without any limited duration, frequently
two, three, and four months, with a variety of
symptoms.
There are no exact periods between the fits of
coughing; they frequently occur in the day, and
still more frequently at night; and the patient hav-
ing some knowledge of its approach, with fear of
its convulsive tortures, catches hold of his nearest
object until the paroxism is over. When the
coughing is over, the patient appears fatigued, with
a hurried breathing, but is soon relieved.
In the beginning of the disease there is little or no
expectoration; the cough is violent, and of long du-
ration; but when an expectoration of mucus comes
on, or a vomiting follows the coughing, the pa-
tient feels himself relieved, and has a desire for food.
In 

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In coughing, the free transmission of blood is in-
terrupted through the lungs, which prevents the re-
turn of blood from the head. This causes that suf-
fusion and fullness of the vessels of the face; whence
the eyes become prominent, and their vessels fre-
quently ruptured, and blood is discharged from them,
and sometimes from the nose and ears. Cases have
occurred when the vessels of the lungs have been
ruptured and an hæmoptysis followed.
Although this disease frequently takes place with-
out pyrexia or febrile symptoms, still it is far from
always being the case; for I have observed several
cases, in the beginning of which a considerable
degree of pyrexia was evident. I believe, in op-
position to Doctor CULLEN, that the fluids do un-
dergo a change; and Doctor MORRIS farther justifies
my opinion, by relating a case where the patient
was blooded, and the blood put on an inflammatory
appearance; or, in his own words, it was covered
with size.*
That
* Vide Lond. Med. Observ. vol. iii. 

(13)
That a symptomatic pneumonia may be brought
on in consequence of the violent agitation of the lungs
in coughing, I do readily believe; but being
foreign to this subject, we cannot give it a con-
sideration here.
Diagnosis.
THE knowledge of distinguishing diseases is
not less important than that of their cure; it there-
fore particularly claims the attention of the Physi-
cian.—As this disease, of which I have given the
history, has symptoms so peculiar to itself, we shall
find no difficulty in giving it its proper arrangement
when it occurs; for though this disease may in the
beginning have some symptoms resembling catarrh,
yet, when we attend to its progress, considering at
the same time the prevailing epidemic, we cannot
hesitate in determining rightly concerning this com-
plaint.
The 

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The symptoms of the Measles differ so much
from those of the Hooping Cough, that they can-
not be confounded: while the former is always ac-
companied with pyrexia, followed by eruptions,
dispersed over the body, which, in a few days, goes
off in scales, in the latter there is seldom any
pyrexia; no eruptions ever appear, but the disease
continues its peculiar and characteristic symptoms,
as described in the history. There is an acrid dis-
charge in the Measles from the nose and eyes, but
this is said to be also peculiar to the Pertussis,* and
therefore cannot be a distinguishing symptom.
Predisponent and Exciting Causes.
PREDISPOSITON is that state of body which
renders it susceptible of being acted upon by conta-
gious matter. A state of debility, or one verging
towards it, appears to favour the operation of con-
tagion;
* Vide Dr. WALLIS on the Prevention of Diseases. 

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tagion; and from this we account for its affecting
particularly children, who are especially in that state;
while adults, who have acquired vigor and activity,
frequently escape. But will not many object to
this, and say there is no predisposition necessary?
if this were so, why does it not attact the robust as
frequently as the infirm? and why not adults as fre-
quently as children? A predisposition is indeed not
always necessary, for many are affected merely from
the application of the contagious matter; the nature,
essence, and qualities of which is as yet unknown,
and only particularly attracts our notice, as being the
remote or exciting cause of this disease. Although
this contagion affects some of the functions necessary
to life, still its effects are not so deleterious as the
infectious matter of some other diseases, which pro-
duce the greatest debility, and not unfrequently im-
mediate death; while this is slow in its operation
and its progress, but sometimes increases in violence,
until it brings on some symptomatic complaint, in
which manner it most frequently proves fatal. It
has also proved fatal sometimes when the disease had
occurred only a few days, on which occasion the air
vessels 

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vessels of the lungs have been found full of mucus.
This has occurred mostly in persons debilitated pre-
vious to their contracting the disease, and particu-
larly to infants.
Proximate Cause.
IN the beginning of this disease we observe no
spasmodic affection of the lungs, but an evident
increased action of the excretory vessels, so that the
mucus glands discharge freely. The effects of the
contagious matter debilitates the system, and in con-
sequence all the characteristic symptoms of the dis-
ease are induced. This plainly proves that there
is a spasmodic affection at the seat of the disease,
which we shall consider as its proximate cause.—
Though this disease does not appear at first to be
accompanied with much debility, yet it soon be-
comes such; and we shall therefore observe two dif-
ferent modes of treatment in the same disease at
different periods.
Prognosis. 

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Prognosis.
TO prognosticate the future event of this disease,
it is highly necessary that due attention be paid to
the appearance of symptoms which have presented
themselves, to the patient's constitution, and the dis-
eases to which he has previously been subject.
We have observed in the history, that children
suffer most from this disease, and the younger they
are the more liable to meet with an unfavourable ter-
mination, while those advanced in years are more se-
cure; and Doctor CULLEN justly observes, that more
die under two years than above it.
Children who are born of asthmatic and phthisical
parents, and are asthmatic themselves, are in great
danger from this disease.
When this disease begins with the form of catarrh,
accompanied with fever, difficulty of breathing, and
cough, with little or no expectoration, it sometimes
proves fatal.
C An 

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An expectoration of mucus, whether too small of
too great in quantity, is attended with danger; as
the latter may tend to produce great debility, the
former a difficulty of breathing, and frequently suffo-
cation, the mucus being still contained in the lungs.
Violent paroxisms of coughing have proved dan-
gerous by occasioning apoplexy and epilepsy; but
these accidents do not frequently happen; and the
danger of this disease arise mostly from the fever
and dyspnœa attending it. These ate the symptoms
which principally denote an unfavourable event.—
We shall now endeavour to point out some symp-
toms which are more favourable.
If this disease is fully formed, and the fits do not
return with frequency and violence, the expectora-
tion be moderate, and the patient, in the absence of
the fits, feels easy, his appetite continues to increase,
sleeps well, and is troubled with no fever or diffi-
culty of breathing, we may be justifiable in forming
a favourable prognosis; and if the symptoms con-
tinue daily to become more favourable, the disease
will soon altogether disappear.
Where 

(19)
Where paroxisms terminate by vomiting, succeed-
ed by a desire for food, such cases are generally with-
out danger.
A moderate hemorrhage from the nose has fre-
quently proved salutary; but when immoderate, is
commonly pernicious and dangerous.
Method of Cure.
THE cure of this disease is both difficult and te-
dious, whether we endeavour to moderate its vio-
lence, when it has a fatal tendency, or to shorten
its course when mild. When the contagion is pre-
sent and continues to act, we know not how to ex-
pel it from the system; neither do we know how to
correct its acrimony; but it is probable this conta-
gion continues to act only for a certain time, and
then ceases, when the disease continues merely from
the power of habit; but should the contagion be sup-
posed 

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posed to continue to act, the patient should be re-
moved, if possible, to some other place.
From what we have said, we shall conclude that
the indications of cure must be differently adapted,
according to the period of the disease. In the be-
ginning the medicine must be given with a view to
prevent or moderate its violent effects, and tendency
to a fatal termination; and when the disease has con-
tinued sometime, and its violence abated, our en-
deavours must be to check or interrupt its course, or
cause it to disappear sooner than it would have done
if left to nature.
To fulfil the first indication, an antiphlogistic plan
must be observed, by avoiding every means which
may tend to increase the action of the heart and ar-
teries, such as animal food, spirituous liquors, and
all kinds of severe exercise, &c. In plethoric sub-
jects, where the pulse is increased in frequency and
fullness, and where the blood seems to be transmit-
ted through the lungs with much difficulty, bleeding
appears necessary, and may sometimes be repeated.
But diseases which are tedious in their cure, and
prove 

(21)
prove debilitating, and are of a spasmodic nature,
do not admit the loss of much blood, therefore,
great caution is requisite in bleeding, and particu-
larly children, who experience mostly its bad effects.
Costiveness frequently attends this disease, and
ought by all means to be removed; and no pur-
gative is more suitable than the compound powder of
jallop finely pulverised, to prevent griping; manna
and senna have also been used with the same good
effect. 
Calomel has been used for this and the like pur-
pose, and it frequently proves serviceable, and per-
haps more so when a quantity is taken in the system,*
as it may tend to correct its acrimony and moderate
the violence of the disease.
Symptoms of an inflammatory affection of the
lungs sometimes occur in this diseases; to remove
which blistering appears to be the most proper means:
They may, if necessary, be repeated, and ought to
be applied as near as possible to the part affected.
Issues have not that good effect, as a considerable
time
* Vide Dr. WILLIS.

(22)
time is wasted before any discharge is brought on,
while the inflammatory symptoms continue to in-
crease, and they prove very inconvenient; therefore
blisters are to be preferred.
Emetics appear to be more serviceable in this
disease than any other remedy, as they interrupt the
return of the spasmodic cough; they likewise de-
termine powerfully to the surface, thereby taking
off determination to the lungs, and by agitating
the thoracic vicera, they promote the expectoration
of mucus. Antimonial emetics appear to be the
most proper, and they may occasionally be repeated,
although they have been condemned as improper,*
contrary to the experience of almost every judi-
cious Physician. Small doses of antimonial emetics
may be given with advantage in the intervals of
vomiting, if there be any inflammatory symptoms
present.
These are the remedies which are to be admi-
nistered in the first stage of the complaint, when
the contagious matter is supposed to act; but when
the
* Vide BROWN's Elements. 

(23)
the disease continues by the power of habit, or
from debility, a different indication appears neces-
sary; tonics and antispasmodics appear most useful,
by causing a change in the system, and thereby in-
terrupting the convulsive paroxisms.
Costor has sometimes been used in this disease;
and Doctor MORRIS takes notice of its proving
serviceable to his children, while they were sent in
the country to enjoy a change of air, to which I
conceive we are to attribute more relief than to the
castor, as it appears to have frequently proved in-
effectual.
Musk has likewise been employed as an antispas-
modic, but has not proved so successful as to advise
its frequent administration.
Opium appears to possess all the properties of the
two last medicines mentioned, but in a higher de-
gree; and its administration is certainly adviseable
when there are no inflammatory symptoms present,
as it tends to moderate and interrupt the return of
the spasmodic cough.
To 

(24)
To restore the tone of the system, and thereby
moderate the violence of the disease, and cause it
to terminate favourably, perhaps no medicine has
merited more attention from experience than the
Peruvian Bark; it may with safety be administered
when the disease appears to be of a debilitating na-
ture, in such quantities as the patient can conveni-
ently bear. The best form of administering bark
is in substance, as we then can have the benefit of
all its virtues; it should therefore, if possible, be
given in this manner, mixed with a quantity of wine;
but as children do not readily take it in this form,
we should administer that preparation which appears
to be next in quality, a preparation with magnesia,
namely, the cold infusion.
Good living, accompanied with a moderate use
of wine and exercise, enjoying at the same time a
country air, contributes much to the cure of this
complaint.
The Tincture of Cantharides has been used with
success; it appears to be of a stimulating nature,
causing a great change in the system, and thereby
interrupting 

(25)
interrupting the spasmodic cough which occurs
from habit.*
The good effects of cold in this disease must be
evident, when we consider it to partake of a debili-
tating nature; and Doctor SYDENHAM takes notice
of this disease yielding as the autumnal cold ad-
vances: And may we not readily believe that cold
tends to brace the relaxed fiber, and give vigor and
energy to debilitated systems? I therefore conceive
that cold bathing, if properly conducted, will prove
beneficial at any period of the disease, when debility
be present.
* Vide LETSOM's Med. Memoirs.
D