ASTHMA. 113 



at the onset of an attack pass large quantities of clear pale urine, almost like 

 water. 



Of all the circumstances attending the commencement of an asthma attack, none 

 are more constant than the time of its occurrence. This is almost invariably in the 

 morning, between three and six. In some cases the usual time is the evening ; 

 in some just after getting into bed or going to sleep ; whilst in others there is no 

 particular time at all, the attack coming on at any hour of the day or night, on the 

 (M-cui -mire of some particular exciting cause, such as a fit of laughter, or an over- 

 distvndrd stomach. In the large majority of cases, however, the shortness of breath 

 first declares itself on the patient waking in the morning, or rather in waking him 

 from his sleep when he has had but half a night's rest. There are probably two 

 reasons for the attack coming on at this time : one being the horizontal position of the 

 body, and the other the greater readiness with which sources of irritation act during 

 sleep. That the position of the body tends to induce the attack we know, because an 

 extra pillow may prevent it. Some asthmatics dare not go to sleep after the com- 

 mission of any imprudence in eating or drinking, whereas they may be guilty of any 

 irregularity with impunity provided they only keep awake for some time afterwards. 

 In one case, for example, an asthmatic would often sit up half the night after taking 

 supper, because he knew that if he went to sleep his asthma would come on imme- 

 diately, but by waiting till the supper was fairly digested, the stomach empty, and 

 the source of irritation removed, he might go to sleep fearlessly, and have a good 

 night's rest. A curious circumstance with regard to the time of the attack is that it 

 varies according to the intensity of the cause; the more intense the source of 

 irritation, the shorter the sleep before the asthma puts a stop to it. We are told of 

 an asthmatic who was always awoke by his disease with an earliness proportionate 

 to the size of the, supper he had taken. Certain airs disagreed with him just as did 

 food before sleeping ; and if the two causes acted conjointly he would wake with 

 asthma much earlier than if they acted singly. Thus, if he went to a place that did 

 not agree with him, he might wake about five o'clock with his asthma, and the same 

 if he ate supper in a place that did agree with him ; but if he took supper whilst 

 staying at a place that did not agree with him, he would get no sleep after two 

 or three o'clock. In many cases it would appear that this morning occurrence of 

 asthma is an essential feature, and is not dependent on external circumstances. 

 This peculiarity was noticed in an asthmatic night-porter, whose duties compelled 

 him to turn night into day. He went to bed at seven o'clock in the morning, and 

 slept till one or two. But although the ordinary time of sleeping and waking were 

 thus transposed, the asthma came on at the usual hour, from five to six in the 

 morning, towards the end of his vigil, and when he was awake. 



We must now consider the phenomena which characterise an attack of asthma. 

 For the following description, as for many of the statements contained in this 

 article, we are indebted chiefly to a medical writer, who was himself a great sufferer 

 from this complaint. The patient goes to bed in his usual health, with or without 

 premonitory symptoms ; he goes to sleep, and sleeps for two or three hours ; he then 

 becomes distressed in his breathing, and dreams perhaps that he is under some 

 circumstance that makes his respiration difficult. While yet asleep, the characteristic 

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