COUGHING

The character of the cough is also instructive. A frequent, loud,
nearly painless cough, at first tight and later loose, is heard
in bronchitis. A short, tight, suppressed cough, which is
followed by a grimace, and, perhaps, by a cry, indicates some
inflammation about the chest, often pneumonia. There is a brazen,
barking, "croupy" cough in spasmodic croup. In inflammation of
the larynx, including true croup, the cough may be hoarse,
croupy, or sometimes almost noiseless.

The cough of whooping cough is so peculiar that it must be
described separately when considering this disease. Then there
are certain coughs which are purely nervous or dependent upon
remote affections. Thus the so-called "stomach cough" is caused
by some irritation of the stomach or bowels. It is not nearly so
frequent as mothers suppose. Irritation about the nose or the
canal of the ears sometimes induces a cough in a similar way.
Enlarged tonsils or elongated palate or throat irritation may
also produce a cough.

THE BREATHING

The breathing of a young child, particularly if under one year of
age and awake, is always slightly irregular. If it becomes very
decidedly so, we suspect disease, particularly of the brain. A
combination of long pauses, lasting half a minute or a minute,
with breathing which is at first very faint, gradually becomes
more and more deep, and then slowly dies away entirely, goes by
the name of "Cheyne-Stokes respiration," and is found in
affections of the brain. It is one of the worst of symptoms
except in infancy, and even then it is very serious.

The rate of respiration is increased in fever in proportion to
the height of the temperature. It is increased also by pain in
rickets, and especially in some affections of the lungs. Sixty
respirations a minute are not at all excessive for a child of two
years with pneumonia, and the speed is frequently decidedly
greater than this.

Breathing is often very slow in disease of the brain,
particularly tubercular meningitis. Poisoning by opiates produces
the same effect. Frequent deep sighing or yawning occurs in
affections of the brain, in faintness, or in great exhaustion,
and may be a very unfavorable symptom. Breathing entirely through
the mouth shows that the nose is