114 THE TREATMENT OF DISEASES. 



wheezing commences, often to such an extent as to sound as if a whole orchestra of 

 fiddles were tuning in the chest, and to make so much disturbance as to arouse those 

 in the same or an adjoining room. The patient half wakes up, and changes his 

 position, by which he gets a little ease, and then falls asleep again, but only to have 

 his distress and dreams renewed, and again partially to wake and turn. Shortly, 

 the increasing difficulty quite wakes him, but only perhaps for a minute or two ; 

 lie sits up in bed with a distressing half-consciousness of his condition, gets a 

 temporary abatement, sleep overpowers him, and he falls back, to be again awoke, 

 and to again sit up ; and so the miserable fight between asthma and sleep may go on 

 for an hour or more, the dyspnoea arousing the sufferer as soon as sleep is fairly 

 established, and sleep again overpowering him as soon as the wakefulness and change 

 of position have a little abated the extremity of his sufferings. By-and-by the 

 struggle ceases, and sleep is no longer possible ; the increasing shortness of breath will 

 not allow the patient to forget himself for a moment ; he becomes wide awake, sits 

 up in bed to lie down no more, throws himself forward, plants his elbows on his knees, 

 and with fixed head and elevated shoulders labours for his breath like a dying man. 



When once the paroxysm is established, the asthmatic offers a very striking and 

 very distressing spectacle. If he moves at all, it is with great difficulty, creeping by 

 stages from one piece of furniture to another. But most commonly he sits fixed in 

 a, chair, immovable, unable to speak, or even perhaps to move his head, in answer to 

 questions that may be put to him. His back is rounded, and his gait stooping ; 

 indeed, his whole figure is deformed. His chest, back, and shoulders are fixed ; 

 lie cannot even turn his head from side to side, so that when he looks from object 

 to object he merely moves his eyes, like a person with a stiff neck ; his shoulders 

 are raised to his ears, and his head thrown back and buried between them. In order 

 the better to raise his shoulders, and at the same time to spare muscular effort in so 

 doing, his elbows are fixed on the arms of his chair, or his hands planted on his 

 knees ; or he leans forward on a table, or sits across a chair, and leans over the back 

 of it ; or he stands grasping the back of a chair, and throwing his weight upon it ; 

 or leaning against a chest of drawers, or some piece of furniture sufficiently high to 

 rest his elbows on in a standing position. At every breath his head is thrown back, 

 his shoulders still more raised, and his mouth a little opened, with a gasping move- 

 ment ; his expression is anxious and distressed ; the eyes are wide open, sometimes 

 strained, turgid, and suffused ; his face is pallid, and perhaps slightly blue ; the labour 

 of breathing is such that beads of perspiration stand on his forehead, or even run 

 in drops down his face. He is so engrossed with his sufferings and the labour of 

 breathing, that he seems unconscious of what is going on around him ; or else he 

 is impatient and intolerant of the assiduities of those who are in vain trying to give 

 him some relief. 



During the attack, the heat of the body falls, and the extremities become cold, 

 blue, and shrunken. At the same time, the perspiration produced by the violent 

 efforts at respiration may be very profuse. It is this union of coldness and sweating, 

 combined with the duskiness and pallor of the skin, that gives to the asthmatic so 

 much the appearance of a dying man. The pulse during a severe attack is always 

 small, and is sometimes so feeble that it can hardly be felt. 



