With the onset of respiratory difficulty, it seems almost as if the children were suddenly awakened and made to realize the struggle before them. Little children seem to age in a few hours. One sees a heedless, careless, child become all at once wide-awake, high-strung, alert to the matter in hand, and this is, breathing. The whole mind and body appear to be concentrated on respiration. Respiration becomes an active, voluntary process, and every breath represents hard work.
The child gives the impression of one who has a fight on his hands, and who knows perfectly how to manage it. All he wants is to be left alone, not to be interfered with, to be allowed to carry out his fight on his own lines. Instinctively he husbands his strength, refuses food, and speaks, when speech is necessary, quietly and with few words.
One little child of four, so helplessly paralyzed that she was unable to move, but with a mind that seemed to take in the whole situation, said to the nurse clearly but rather abruptly between her hard-taken breaths, "My arm hurts;" "Turn me over;" "Scratch my nostril;" and then when the doctor approached, "Let me alone, doctor!" "Don't touch my chest." Pressure on the chest, tight neck bands, anything that obstructs easy respiration is immediately resented.
The child demands constant attention, is irritated unless everything is done exactly as he wishes it, and often shows an instinctive appreciation for some especially efficient nurse. He is nervous, fearful, and dreads being left alone. The mouth becomes filled with frothy saliva which the child is unable to swallow, so he collects between his lips and waits for the nurse to wipe it away. He likes to have his lips wet with cold water, but rarely attempts to take it into his mouth, for he knows he cannot swallow it. During the whole course it is remarkable that cyanosis is absent. There is a little bluish tingeing of the lips and tongue, but much more distinctive is the pallor, which is sometimes striking. Sweating is profuse. Then, as respiration gets weaker, the mind becomes dull, and with the occasional return of a lucid interval, he gradually drifts into unconsciousness. An hour or more later respiration ceases.This particularly alert, keen mental state has been much less noticeable in small babies. They tend to be dull and drowsy most of the time; but in the older children this alertness has been such a characteristic feature of the fatal cases, that it is preferable to find a child in a stuporous condition, rather than with a mind whose nervous acuity seems due to a perception of impending danger.