unnecessary exertion as having a tendency to aggravate his dyspnoea; he speaks but little, and when questioned usually replies with a motion of the head. In ordinary respiration the inspiratory movement is twice as long as the expirium, the latter, except in forced expiration, being a purely passive act. In asthma this rule is reversed, the expiratory movement being four or five times as long as the inspirium, and is often so slow that it fills the whole of {187} the pause which usually intervenes between the completion of one respiration and the beginning of another. It is sometimes so slow "that it seems as though the lung would never empty itself." In the desperate struggle for breath the respiratory muscles are exerted to the utmost in futile endeavors to expand the chest; with each inspiration there is an elongation of the thorax, but no lateral movement. The chest moves up and down, but there is no expansion; "the muscles tug at the ribs, but the ribs refuse to rise" (Salter), the walls of the chest remaining immovable. Notwithstanding the all but tetanic contraction of the diaphragm, there is during each inspiration a sinking in of the epigastrium, and in severe cases also of the spaces above and below the clavicles. During expiration the abdominal muscles, especially the recti, are hard and tense, the pressure thus exerted being sometimes sufficient to expel the contents of the lower bowel and bladder.[3] The transversus is also tightly contracted, and a cross furrow above the umbilicus indicates that the contraction of its upper half is opposed to the contents of the abdomen forced down by the distended lung (Biermer). Although the dyspnoea is great, there is no increase in the frequency of the respirations so long as the patient remains quiet, but, on the contrary, they are often less frequent than in health. This slowing of the respiration is also observed in the dyspnoea from laryngeal stenosis in croup, etc.; but in these cases we do not have the prolonged expiration which is so characteristic of asthma (Biermer). At every breath which the patient takes there is a peculiar wheezing sound which may be heard distinctly all over the room; it is usually heard only during expiration, but some authors (Biermer) claim that it is also audible during inspiration. [Footnote 3: Bamberger's case, as quoted by Riegel, _Ziemssen's Pathologie u. Therapie_, Leipzig, 1875, Band iv. 2, S. 282.]