ASTHMA. 115 



The l''ii-_rtli of time required for an attack to attain its maximum intensity differs 



much in different cases. In some, within a quarter of an hour of the first seizure 



:it seems almost at the point of death; in others, the shortness of breath 



>n, getting deeper and deeper for hours. The time that it lasts, too, 



, .rivutly from a few minutes to many days. It is veiy rarely that it remains 



of greatest intensity ; in an hour or two the severity of the paroxysm 



way, and, even should it not completely disappear, the patient experiences a 



if inexpressible relief. Sometimes the attacks come on quickly, and as quickly 



ompletely subside, so that in half an hour the whole thing may be over, and the 



\\vll as ever. This, however, is rarely the case, except as the result of 



iimediate adoption of remedial measures, as when the patient, on finding the 



asthma on him, at once gets out of bed, and sits or stands, leaning against some 



piece of furniture, keeping himself thoroughly awake, or smokes till he feels sick, 



or takes an emetic. In many cases, the attack subsides soon after breakfast, 



or towards noon ; but the patient is fit for nothing for the rest of the day. 



In others it lasts the entire day, gradually abating towards evening, so that the 



:-t has a good night, and awakes well the next morning. Again, it may get 



gradually worse as night comes on, so that the second night is worse than the first. 



In some cases, the onset and departure are alike sudden ; in others they are both 



gradual. There is generally some particular time at which the spasm yields, and the 



:it passes from a state of agony to a condition of very endurable suffering ; 



he generally knows when this has taken place, and feels that the crisis is over. 



In some cases, the spasm remains at an unvarying standard, and the sufferer grinds 



on all day without respite. More commonly, however, he experiences aggravations 



and abatements, for half an hour or so breathing perhaps as if each breath would be 



his last, then getting an hour or two's comparative ease, then getting worse again ; 



then better, and so on throughout the day. These aggravations are frequently due 



to some exciting cause, such as taking food, laughing, or yielding to sleep, against 



which therefore, as long as his attack lasts, the asthmatic is obliged most scrupulously 



to guard himself. Nothing is so certain as food to induce these exacerbations ; 



and, since asthma in no degree interferes with appetite, the enforced starvation 



to which the patient is reduced becomes an additional source of suffering ; fainting 



with hunger, he dare not let a particle of food pass his lips; and as long as his 



paroxysm continues, so long must he starve. 



When the spasm finally subsides it generally does so coincidently with the first 

 appearance of expectoration. Up to this time the wheezing has been dry, and there 

 has been no cough, or, if any, a short single dry one ; the first appearance of loose 

 cough is the harbinger of relief. The expectoration is very often of the consistence 

 of jelly, or thick like arrowroot, of a pale grey colour, occurring in distinct pellets, 

 about the size of a pea. 



It is a curious thing that in asthma the paroxysms occur at regular and definite 

 periods. In many instances, this periodicity is most marked ; as the period charac- 

 teristic of the particular case recurs, the attack is predicted with the greatest 

 certainty, and never fails to appear at the right time. Asthma is essentially an 

 engagement-keeping complaint. In the length of the intervals, although in each 



