And,
first, there is a change in the expression of countenance; to a fine
blooming appearance, which perhaps the patient previously had, there has
succeeded a dark yellowish cast,--a change which gradually spreads over
the whole body. For some time the patient may have remarked a gradual
loss of strength, and now he complains of want of appetite and
disordered digestion, and more particularly of shooting pains in the
back and muscles of the chest. Cough likewise supervenes, which may
either be quite dry, or at most accompanied with a little pure mucus.
There is also a greater or less degree of oppression, accompanied with
palpitation of heart, not only after a severe fit of coughing, but after
every exertion of the lungs. As yet no local deviation from the normal
condition is seen on examination of the chest by percussion or
auscultation." "The disease meanwhile passes into the third stage. The
features of the patient now become more and more changed and
deteriorated, and betray a deep melancholy. The colour of the face,
which had been hitherto of an earthly hue, becomes blackish, as also the
cornea, whereby the eye loses its lustre. The appearance of the patient
becomes still more frightful from the great loss of flesh, and the dark
skin hanging loose on his bones. The fat not only seems to have
disappeared, but the muscular substance also--the whole frame being
shrivelled. The patient complains of increasing weakness, diminished
appetite, flying pains often concentrated at the pit of the stomach; and
coughs much. The expectoration is for the most part difficult, and
consists of masses of mucus, either greyish, or tending to a black
colour. A black streak is frequently observed running through the
whitish mucus; one half of it may be white, the other black, or
occasional black points may be observed throughout the mass, and
sometimes, though rarely, blood. Dyspnoea is usually connected with
the cough. It now begins to tell upon the patient, and is so
characteristic, that the disease has been named asthma metallicum. The
disturbance of the digestive organs increases the disease,--the appetite
is entirely lost,--the tongue is covered with a white fur--there is an
oppression at the stomach after a full meal--frequent eructations, and a
tendency to constipation. The distress of the patient becomes increased
in consequence of the shooting pains in the muscular system." "In the
fourth and last stage, all the external appearan