Symptoms.—­There is an incubation stage, but it is hard to determine its length.  After the appearance of the symptoms there are three stages; the catarrhal, the spasmodic, and the stage of decline.

The First Stage.—­This is characterized by a cough which is more troublesome at night.  One can be suspicious, when instead of getting better in a few days, it gets worse and more frequent, without any seeming cause.  After four or five days the cough may be accompanied by vomiting, especially if the cough occurs after eating.  There may be some bronchitis, and if so there will be one or more degrees of fever.  Fever is present as a rule, only during the first few days, unless there is bronchitis.  As the case passes into the spasmodic or second stage, the paroxysms of coughing last longer, the child becomes red in the face and spits up a larger amount of mucus than in ordinary bronchitis.  This period of the cough without a whoop, may last from five to twelve days.  In some cases there is never a whoop.  The child has a severe spasmodic cough, followed by vomiting.  Usually at the close of this stage the incessant cough causes slight puffiness of the eyelids and slight bloating of the face.

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Spasmodic or Second Stage.—­The peculiar whoop is now present.  The cough is spasmodic.  The child has distinct paroxysms of coughing which begin with an inspiration (in-breathing) followed by several expulsive, explosive coughs, after which there is a deep, long-drawn inspiration which is characterized by a loud crowing called the “whoop.”  This paroxysm may be followed by a number of similar ones.  When the paroxysm is coming on the face assumes an anxious expression, and the child runs to the nearest person or to some article of furniture and grasps him or it with both hands.  It is so severe sometimes that the child will fall or claw the air, convulsively.  In the severest and most dangerous types, a convulsion may come on in a moderate degree, the face is red or livid, the eyes bulge and when the paroxysm ends a quantity of sticky tenacious mucus is spit up.  In other cases there is vomiting at the end of the paroxysm.  There is frequently nose-bleed.  In the intervals the face is pale or bluish, eyelids are puffy and face swollen.  There is little bronchitis at this period in the majority of cases.  In some cases the number of paroxysms may be few.  There are generally quite a number during the twenty-four hours.

Stage of the Decline.—­In this stage the number and severity or the paroxysms lessen.  They may subside suddenly or gradually after four to twelve weeks.  The whoop may reappear at times.  The cough may persist, more or less, for weeks after the whoop is entirely gone.

Complications.—­Bronchitis is common, it may be mild or severe.  It may run into capillary bronchitis and this is dangerous.

Diagnosis.—­Continued cough, getting worse and spasmodic, worse at night, livid face when coughing, causes great suspicion as to its being whooping-cough.  The whoop will confirm it.