BRONCHIAL ASTHMA IN MEDICALITERATURL E OF GREEK … · BRONCHIAL ASTHMA IN MEDICALITERATURL E OF...
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Spyros MARKETOS et Constantine BALLAS (Athènes, Grèce) C25 BRONCHIAL ASTHMA IN MEDICAL LITERATURE OF GREEK ANTIQUITY Bronchial asthma, a multidimentional and often contradictory medical problem even to the present day, should have from very early attacked the attention of man, both as sufferer and as medicine-man, who would have very much been impressed by its dramatic attacks. Though, we lack any certain knowledge about the ancientness of the disease. Both the structure of the respiratory system as well as the nature of bronchial asthma itself do not allow the existence of palaeopathological material so that any attempt to establish an early history of this disease should be based on circumstantial only evidence. Even in the Egyptian mummies, the lungs of which were removed and preserved by a special technique, so that there exists a « positive evidence of gross inflamatory changes in the lung and the pleura »(1) there cannot be any traces of asthma because of its true nature. So from Pharaonic Egypt there is only circumstantial evidence from the Papyri. The 53rd column of the Papyrus Ebers gives a series of remedies which Ebell (2) translates as « to eradicate asthma ». However there is some doubt as to the translation here(l). The term « asthma » is a Greek word, « a:o-§|i,Gc», which derives from the verb « a a ££iu » meaning to exhale with open mouth. The word « aod-ua » appears for the first time in the Iliad (0, 241, 0 10) with the meaning of a short-drawn breath, a hard breath or panting and similar is the meaning of the corresponding verb « a^ix^i^di » (K 379, E 585, K 96). Homer speaks about a warrior who died in the end of a furious battle with « asthma » and perspiration: «ax<xp Ttauetat ao&ixa rfd z'Sptog » (U O 241). With a very alike conceptual content the word « oco-Opia » is also used by Pindar (N. 10.139, N.3.84), Aeschylus (Pers. 484) and Plato (Pep. 568 D, 556 D). A. HIPPOCRATES The earliest text where the word ««c §[ia » is found s as medical term in the Corpus Hippocraticum. Examining the Hippocratic ideas about asthma it should be brought in mind as Neuburger (3) has pointed out, that the various types of disease recognised in Hippocratic pathology do not always correspond to the nosological entities differentiated by modern aetiological and anatomical methods. This is due to the fact that the ancients based their classification on the most salient symptoms, whereby many heterogenous diseases were grouped together into the same class. In the Hippocratic writings are to be found quite a few references to asthma, 35
Transcript of BRONCHIAL ASTHMA IN MEDICALITERATURL E OF GREEK … · BRONCHIAL ASTHMA IN MEDICALITERATURL E OF...
Spyros M A R K E T O S et Cons t an t i ne BALLAS (Athènes , Grèce)
C25
BRONCHIAL ASTHMA IN MEDICAL LITERATURE OF GREEK ANTIQUITY
Bronch i a l a s t h m a , a m u l t i d i m e n t i o n a l a n d often c o n t r a d i c t o r y m e d i c a l p rob lem even t o t h e p r e s e n t day, shou ld h a v e f rom very ear ly a t t a c k e d t h e a t t e n t i o n of m a n , b o t h a s sufferer a n d as med ic ine -man , w h o w o u l d h a v e very m u c h been i m p r e s s e d by i ts d r a m a t i c a t t a c k s . Though , w e lack any c e r t a i n knowledge abou t t h e a n c i e n t n e s s of t h e d isease .
Bo th the s t r u c t u r e of t he r e sp i r a to ry s y s t e m as wel l a s t h e n a t u r e of b ronch ia l a s t h m a itself do no t a l low t h e ex is tence of pa laeopathologica l m a t e r i a l so t h a t a n y a t t e m p t t o es tab l i sh a n ear ly h i s to ry of th i s d i sease shou ld be b a s e d on c i r c u m s t a n t i a l only ev idence . Even in the Egyp t i an m u m m i e s , t h e lungs of w h i c h w e r e r e m o v e d a n d p re se rved by a special t echn ique , so t h a t t h e r e exis ts a « posi t ive ev idence of g ross i n f l ama to ry changes in t h e lung a n d the p l e u r a »(1) t h e r e c a n n o t be any t r aces of a s t h m a because of i t s t r u e n a t u r e . So f rom P h a r a o n i c Egypt t h e r e is only c i r c u m s t a n t i a l ev idence f rom t h e Papyr i . T h e 53rd c o l u m n of the P a p y r u s Ebe r s gives a ser ies of r e m e d i e s wh ich Ebel l (2) t r a n s l a t e s a s « to e r a d i c a t e a s t h m a ». H o w e v e r t h e r e is s o m e doubt as t o t h e t r a n s l a t i o n h e r e ( l ) .
The t e r m « a s t h m a » is a Greek w o r d , « a:o-§|i,Gc», wh ich der ives f rom t h e verb « a a £ £ i u » m e a n i n g to exhale w i t h open m o u t h .
T h e w o r d « aod-ua » appears for t h e f i rs t t i m e in the I l iad (0, 241, 0 10) w i t h t h e m e a n i n g of a s h o r t - d r a w n b rea th , a h a r d b r e a t h o r p a n t i n g a n d s imi l a r is t he m e a n i n g of t h e co r re spond ing verb « a^ix^i^di » (K 379, E 585, K 96). H o m e r speaks abou t a w a r r i o r w h o died in t h e end of a fur ious b a t t l e w i t h « a s t h m a » a n d p e r s p i r a t i o n : «ax<xp T taue ta t ao&ixa rfd z'Sptog » (U O 241). Wi th a very a l ike concep tua l con ten t t h e w o r d « oco-Opia » is a lso u s e d by P i n d a r (N. 10.139, N.3.84), Aeschylus (Pe r s . 484) a n d P la to (Pep. 568 D, 556 D).
A. H I P P O C R A T E S
The ear l ies t text w h e r e the w o r d « « c § [ i a » is found s as m e d i c a l t e r m in the Corpus H ippoc ra t i cum. E x a m i n i n g the H ippoc ra t i c ideas a b o u t a s t h m a i t shou ld be b r o u g h t in m i n d as N e u b u r g e r (3) h a s po in ted out , t h a t t h e va r ious types of d i sease recogn ised in Hippoc ra t i c pa tho logy do no t a lways co r r e spond to t h e nosological en t i t i es d i f fe ren t ia ted by m o d e r n aet iological a n d a n a t o m i c a l m e t h o d s . This is d u e to t h e fact t h a t t h e anc i en t s based t h e i r c lass i f ica t ion on the m o s t sa l ien t s y m p t o m s , w h e r e b y m a n y h e t e r o g e n o u s d i seases w e r e g rouped toge the r in to t h e s a m e c lass .
I n t h e Hippocra t i c w r i t i n g s a r e t o b e found qui te a few re fe rences t o a s t h m a ,
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bu t n o n e of t h e m gives a olear-cut c l inical descr ip t ion , s imi l a r t o t hose conce rn ing so m a n y o t h e r d i seases . Descr ip t ions w h i c h m a k e Hippocra t i c nosography to appear vivid a n d m o d e r n even t o d a y (4). Al though severa l d i seases of t h e r e s p i r a t o r y sys t em, especial ly of t h e lungs , a r e exhaus t ive ly descr ibed by t h e Hippoc ra t i c w r i t e r s (3), n o n e of t h e m h a s d e d i c a t e d a special c h a p t e r t o a s t h m a . Ta lk ing abou t b u r d e n i n g o r d i s t u r b a n c e of t h e r e sp i ra t ion , t h e Hippocra t i c s u se r a t h e r i nd i sc r imina t e ly t h e t e r m s dyspnoea , t achypnoea , o r t h o p n o e a a n d a s t h m a . And the ques t ion t h e n a r i ses w h e t h e r by t h e t e r m a s t h m a they m e a n t a s e p a r a t e c l inical ent i ty , a s p leur i sy a n d p e r i p n e u m o n i a o r t hey m e a n t plainly a s y m p t o m (5). A ques t ion ve ry difficult to be a n s w e r e d .
T h e Hippocra t i c s t h o u g h t a d u l t s to b e m o r e liable t o a s t h m a (L i t t r e IV 498.500) (6), a local d isease of d i s t r i c t s exposed to w a r m w i n d s (L i t t r e I I 18) a n d t h r e a t e n i n g m a n m o s t l y a t a u t u m n a n d s u m m e r - t i m e (L i t t r e IV 496) (6). They recognized t h e pa roxysmica l m a n n e r of t h e a s t h m a t i c a t t a c k s , no t i ced t h e foamy expec to ra t ion (L i t t r e V 306) (6) a n d sugges t ed a s a p rognos t i c s ign t h e fo rma t ion of a h u m p b a c k before pube r ty (L i t t r e IV 574) (6).
An aet iological i n t e r p r e t a t i o n of a s t h m a is a t t e m p t e d in t h e Hippocra t i c t r e a t i s e « on t h e N a t u r e of Bones » — i n t e r p r e t a t i o n w h i c h is qu i t e in a c c o r d a n c e w i t h t h e prevai l ing Hippocra t i c concepts in A n a t o m y a n d Physiology : « T h e a r t e r y ( t r a c h e a ) w h i c h h a s l i t t le blood b u t a lot of « p n e u m a » [(— spiri t)] gives w i t h i n t h e spac iousness a n d looseness of t h e lung m a n y condu i t s w h i c h b e c o m e c h o n d r o i d on leaving t h e lung. S o m e t i m e s a foreign body e n t e r s in to t hese p a t h w a y s e i t he r w i t h d r i n k s o r w i t h t h e pass ing t h r o u g h « p n e u m a » o r blood, because t h e s e ve ins a r e such a n d t h e lung is spongy a n d it c a n c o n c e n t r a t e a lot of l iquid p r o d u c e d above, for t h e lung is t h e n a t u r a l p lace of t h e c o m i n g in l iquids . On t h e o t h e r h a n d , it is n o t sufficiently p r e s sed in to t h e veins , so t h a t n o t be ing a d v a n c e d rap id ly enough, t h e lung c a n n o t r e m o v e t h e foreign bodies . These bodies r e m a i n t h e r e fo rming a pe t r i f ica t ion (cal lus) w h i c h occupies t h e p a t h w a y s i m p e d i n g b o t h inhalat ion a n d exha la t ion a n d p r o d u c i n g t achypnoea . This s i t u a t i o n r e su l t s t o d i seases l ike a s t h m a a n d d ry phis is . T h o u g h in case t h a t in th i s s i t ua t ion t h e l iquid g a t h e r e d t h e r e is so m u c h i n c r e a s e d t h a t it c a n n o t be solidified ( to p r o d u c e a ca l lus) , it r o t s t h e lung a n d t h e p a r t s a r o u n d w i t h r e su l t t h e f o r m a t i o n of e m p y e m a s of t h e lungs a s wel l a s phis is . B u t these m a l a d i e s h a v e o t h e r causes a s wel l . »
B . A R E T A E U S
T h e bes t by any a c c o u n t cl inical desc r ip t ion of a s t h m a in a n t i q u i t y is given by Are taeus , a Greek phys ic ian b o r n in Cappadocia , a R o m a n p rov ince in Asia Minor , severa l c en tu r i e s a f te r Hippocra t i c t i m e s . H e probably l ived in t h e second half of t he f i rs t c e n t u r y A.D. (3), b u t h i s w o r k r e m a i n e d in obscur i ty un t i l 1552 w h e n a La t in t r a n s l a t i o n appea red in Venice , whi le t h e or ig ina l Greek tex t w a s pub l i shed t w o years l a t e r in Pa r i s (8).
A m a s t e r c l inician A r e t a e u s m a d e keen a n d objec t ive obse rva t ions a n d w r o t e a c c u r a t e a n d s imple descr ip t ions of severa l d i seases inc lud ing d iabe tes me l i t u s , epilepsy, p n e u m o n i a , pleur isy, t e t a n u s a n d a s t h m a . His knowledge of t h e r e sp i r a to ry d i s t u r b a n c e s in p a r t i c u l a r is r e m a r k a b l e .
A r e t a e u s t h e Cappadoc ian s h a r e d t h e Hippocra t i c sp i r i t a n d me thodo logy , b u t in c o n t r a s t to t h e Hippoc ra t i c s h e dea ls w i t h a s t h m a as a n a u t o n o m o u s cl inical en t i ty a n d no t as a s y m p t o m . Bu t , o n t h e o t h e r h a n d , t h e cl inical en t i t y A r e t a e u s n a m e s as a s t h m a h a s a w i d e r sense a n d it c a n n o t be ident i f ied w i t h t h e concep tua l c o n t e n t of t he t e r m a s t h m a in m o d e r n m e d i c i n e . I t s e e m s t h a t Are t aeus does n o t d i f fe ren t ia te b r o n c h i a l a s t h m a f r o m o t h e r d i seases p r o d u c i n g a pa roxysmica l dyspnoea , b u t h e p u t s all of t h e m toge the r u n d e r t h e s a m e label .
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The Cappadoc ian d i s t ingu i shes a c u t e f rom chron ic d i seases . A s t h m a is a ch ron ic d i sease to w h i c h h e h a s d e d i c a t e d a w h o l e chap te r , t h a t s t a r t s w i t h t h e def ini t ion of a b r o a d cond i t ion cal led a s t h m a . « If f rom r u n n i n g , g y m n a s t i c exercises, o r any o t h e r w o r k , t h e b r e a t h i n g b e c o m e s difficult, is ca l led « a s t h m a »(8) . Wi th in t h e f r a m e w o r k of th i s condi t ion h e p laces a nosological en t i ty ca l led « o r thopnoea » w h i c h co r r e sponds qu i t e a lot to t h e m o d e r n concep t of a s t h m a , a l t h o u g h they a re n o t i d e n t i c a l : « And t h e d i sease Or thopnoea is also cal led A s t h m a for in t h e p a r o x y s m s t h e pa t i en t s a lso p a n t for b r e a t h » (8). On t h e o t h e r hand , Are taeus m i g h t h a d recognized c a r d i a c a s t h m a (5), for h e says t h a t « ... if t h e h e a r t be affected t h e pa t i en t could no t s t a n d ou t long, for i t is t h e or ig in of r e sp i r a t ion a n d life » (8). H e t h e n accepts t h e Aris to te l ic t e ach ing of t h e import ance of h e a r t for t h e m a i n t a i n a n c e of life.
Are t aeus cons ide r s t h e lungs as t h e sea t of a s t h m a , b u t h e a lso acknowledges t h e « s y m p a t h e t i c » invo lvemen t of t h e d i a f r a g m a n d t h e t h o r a x , « t h e p a r t s w h i c h ass i s t in r e sp i r a t ion ».
The a s t h m a t i c a t t a c k is desc r ibed fully, ve ry accu ra t e ly a n d so vividly t h a t th i s a ccoun t is w o r t h of r e a d i n g even today . As p r o d r o m i c s y m p t o m s h e gives, « heav iness of t h e ches t , s lugg ishness t o one 's a c c u s t o m e d w o r k a n d to every o t h e r exer t ion , difficulty of b r e a t h i n g in r u n n i n g o r on a s teep road , t hey a r e h o a r s e a n d t roub led w i t h cough, f la tu lence a n d e x t r a o r d i n a r y eva lua t ions in t h e l ypochondr i ac region, r e s t l ennes s , h e a t a t n igh t sma l l a n d impercep t ib le , nose s h a r p a n d r e a d y for r e sp i ra t ion » (8). H e t h e n gives t h e d r a m a t i c p i c tu re of t h e a s t h m a t i c a t t a c k : « t h e cheeks a r e ruddy , eyes p r o t u b e r a n t , as if f r o m s t r angu la t i on , a rale d u r i n g t h e w a k i n g s t a t e , b u t t h e evil m u c h w o r s e in sleep, voice l iqu id a n d w i t h o u t r e sonance , a des i re of m u c h a n d of cold air , t hey eager ly go i n t o t h e open air , s ince no house suffices for the i r resp i ra t ion , they b r e a t h e s t and ing , as if des i r ing t o d r a w in all t he a i r w h i c h they possibly can inha le , and , in t h e i r w a n t of a i r t hey a lso open the m o u t h as if t h u s t o enjoy t h e m o r e of it, pa le in t h e c o u n t e n a n c e , except t he cheeks , w h i c h a re ruddy , swea t a b o u t t h e fo rehead a n d clavicles : cough incessan t a n d labor ious , expec to ra t ion smal l , th in , cold, r e sembl ing t h e eff lorescence of foam, n e c k swells w i t h t h e inf la t ion of t h e b r e a t h ( p n e u m a ) , t h e p r a e c o r d i a r e t r a c t e d , pu l se smal l , dense , compres sed , legs s l ende r : a n d if t he se s y m p t o m s inc rease , they s o m e t i m e s p r o d u c e suffocat ion, a f te r t h e fo rm of epilepsy » (8) .
When t h e cr is is t u r n to end the cough lessens , t h e expec to ra t ion b e c o m e s m o r e copious a n d r icher , t h e u r i n e inc reases a n d t h e voice b e c o m e s louder .
Are t aeus a t t e m p t s a specu la t ion r e g a r d i n g t h e cause of a s t h m a , a specula t ion t h a t is fully in a c c o r d a n c e w i t h h is b iomed ica l theory . H e t h o u g h t n a t u r e to be a sum-to ta l of o rgan ic forces kep t in equ i l i b r ium by the pace of t he o r g a n i s m . H e a r t is t h e c e n t r e of p n e u m a or i n h e r e n t w a r m by w h i c h t h e m i n d p e r f o r m s all t h e funct ions of t h e body. Disease r e su l t s f rom d e r a n g e m e n t of t h e h u m o u r s , t h e p n e u m a o r t h e pace (3). So c a u s e of a s t h m a is « a co ldness a n d h u m i d i t y of t h e p n e u m a , bu t t h e m a t e r i a l is a th ick a n d viscid h u m o u r » (8).
I t is n o t e w o r t h y t h a t Are taeus cons ide r s w o m e n m o r e sub jec t t o a s t h m a t h a n m e n , because t hey a r e « h u m i d a n d cold ». B u t m e n suffering f rom a s t h m a « die of i t m o r e speedi ly ». Chi ld ren h a v e a b e t t e r recovery , « for n a t u r e in t h e inc rease is ve ry powerful to h e a t ». Unfo r tuna te ly , t h e c h a p t e r on t h e t r e a t m e n t of a s t h m a of t h e Are t aeus w o r k h a s no t been p rese rved .
C. GALEN
The lucid cl inical p i c tu r e of a s t h m a given by Are t aeus c a n n o t be f o u n d in t h e w o r k of C laud ius Galen, t h e g r e a t e s t phys ic ian af te r H ippoc ra t e s in t h e anc ien t
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m e d i c i n e , w h o d o m i n a t e d w e s t e r n m e d i c i n e f o r m a n y c e n t u r i e s . A l t h o u g h a k e e n c l i n i c i a n G a l e n o b s c u r e s h i s c l i n i c a l o b s e r v a t i o n s b y h i s e f f o r t s t o r e c o n c i l e t h e m w i t h t h e s o o f t e n m i s i n t e r p r e t a t e d r e s u l t s o f h i s e x p e r i m e n t a l w o r k a n d w i t h h i s b i o p h i l o s o p h i c a l s y s t e m i n g e n e r a l (8 ) . G a l e n h a s m a d e s e v e r a l r e f e r e n c e s t o a s t h m a b u t w i t h o u t e m p h a s i z i n g i t s s p a s m o d i c f e a t u r e s . T h o u g h t h i s i s a c l i n i c a l r e t r o g r e s s i o n , G a l e n i n c r e a s e d t h e i n s i g h t i n t o t h e n a t u r e of t h e r e s p i r a t o r y d i s t u r b a n c e s a n d p a r t i c u l a r l y of a s t h m a , f o r h e a d v a n c e d t h e a n a t o m i c a l a n d p h y s i o l o g i c a l k n o w l e d g e of r e s p i r a t i o n , p r o d u c i n g e v e n e x p e r i m e n t a l a s t h m a o r a t l e a s t d y s p n o e a (5 , 9 ) .
I t h a s b e e n s u p p o r t e d t h a t t o G a l e n a s t h m a a n d d y s p n o e a w e r e t h e s a m e a n d b o t h t e r m s u s e d b y h i m t o d e s c r i b e e v e r y k i n d of d i f f i c u l t b r e a t h i n g i n d i s c r i m i n a t e l y ( 9 , 1 0 ) . B u t t h i s i s n o t t h e c a s e , f o r G a l e n d i s t i n g u i s h e s v e r y c l e a r l y a s t h m a f r o m d y s p n o e a i n q u i t e a f e w o c c a s i o n s . H e c e r t a i n l y t h o u g h t of a s t h m a a s a k i n d o f d y s p n o e a b u t m u c h s e v e r e r a n d m o r e s t r i k i n g .
G a l e n d e f i n e s d y s p n o e a a s a d i s t u r b a n c e b o t h of t h e i n h a l a t i o n a n d t h e e x h a l a t i o n ( K u h n X I X 420) , d u e t o a t h i c k e n i n g of t h e « p n e u m a » ( K i i h n V I I 957) (11 ) . I n c a s e t h e « p n e u m a » b e c o m e s m u c h t h i c k e r i t i s p r o d u c e d « a s t h m a » w h i c h i s a s u f f e r i n g b r i n g i n g a s t r o n g h a s t e f o r b r e a t h i n g a s w e l l a s d y s p o n e a , f o r c i n g s o m e p e o p l e t o s i t u p o r e v e n t o r a i s e u p » ( K i i h n X I X 420, X V I I A 596) (11 ) . H e g i v e s t h e n o r t h o p n o e a a s a n i n s e p a r a b l e c o m p o n e n t of a s t h m a , w h i l e h i s a c c o u n t o f t h e s t r o n g h a s t e f o r b r e a t h i n g s h o w s t h a t t h e s p a m o d i c m a n n e r o f a s t h m a d i t n o t e s c a p e h i m . T h i s i s c o n f i r m e d b y t h e f a c t t h a t i n a n o t h e r p o i n t G a l e n s p e a k s a b o u t t h e f r e q u e n t a n d v i o l e n t s p a s m o d i c r e s p i r a t i o n d u r i n g t h e a s t h m a t i c a t t a c k s ( K i i h n X I I I 105) (11) w h i c h h e c o m p a r e s e l s e w h e r e w i t h t h e e p i l e p t i c s e i z u r e s ( K u h n I X 196) (11 ) .
A s o t h e r s i g n s a n d s y m p t o m s o f a s t h m a G a l e n p r e s e n t s f r e q u e n t b r e a t h i n g a n d g r e a t e x p a n s i o n of t h e c h e s t ( K i i h n V I I 944, X V I I A 415, 596) (11 ) , r e d n e s s of t h e f a c e a n d h e a d a c h e ( X V I 662) . A l s o , h e p o i n t s o u t t h a t t h e a s t h m a t i c p a t i e n t s p r e f e r t o s l e e p i n a n u p r i g h t p o s i t i o n , f o r t h e y a r e a f r a i d o f d y i n g w h i l e a s l e e p ( K i i h n X I I I 105) (11) .
I n G a l e n ' s e x c e s s i v e w r i t i n g t h e t e r m a s t h m a c o v e r s t h r e e d i f f e r e n t c o n d i t i o n s , d e s c r i b e d q u i t e i n a g r e e m e n t w i t h t h e H i p p o c r a t i c t e x t s a n d t o s o m e e x t e n t w i t h A r e t a e u s w o r k (12) . H e s p e a k s f i r s t o f a l l a b o u t a s t h m a i n a l a r g e s e n s e , a s a k i n d of d y s p n o e a p r o d u c e d f r o m g y m n a s t i c e x e r c i s e s o r a n y o t h e r s t r o n g e f f o r t ( K i i h n X V I I I A 77, X V I I B 633) (11) . T h i s d i s t u r b a n c e of b r e a t h i n g m i g h t a p p e a r a l s o « w i t h o u t e x e r c i s e s w h e n t h e r e i s a l a c k o f r o o m i n t h e c a v i t i e s o f t h e l u n g » ( K i i h n X V I I B 633, A l s o : X V I I A 415, V I I 944) (11) . T h i s a s t h m a t i c c o n d i t i o n a c c o m p a n i e s i n f l a m m a t i o n s o f t h e r e s p i r a t o r y t r a c k , l i k e a n g i n a , p e r i p n e u m o n i a a n d l u n g e m p h y e m a ( K i i h n X V I I A 597, X V 772, V I I I 121) (11) . B e s i d e s t h i s s y m p t o m a t i c a s t h m a , G a l e n n a m e s a s t h m a a s w e l l a s o r t h o p n o e a a c h r o n i c d i s e a s e ( x p o ^ t o v r r a 6 o v i ) w h i c h i s a l s o d u e t o « a l a c k o f r o o m in t h e c a v i t i e s o f t h e l u n g », b u t i t r u n s w i t h o u t f e v e r ( K i i h n X V I I A 596, X V I I I A 77, X V 772) .
G a l e n t r i e d s y s t e m a t i c a l l y t o c o n f i r m h i s t h e o r e t i c a l o r c l i n i c a l c o n c l u s i o n s b y e x p e r i m e n t s i n a n i m a l s , b e c o m i n g w h e r e b y t h e f o u n d e r of e x p e r i m e n t a l p h y s i o l o g y . I n h i s t r e a t i s e « O n A n a t o m i c a l O p e r a t i o n s » h e g i v e s a d e t a i l e d a c c o u n t o f h i s e x p e r i m e n t a t i o n o n r e s p i r a t i o n . H e p r o d u c e d r e s p i r a t o r y d i s t u r b a n c e , t h a t i s a n a s t h m a - l i k e b r e a t h i n g b y c u t t i n g off t h e i n t e r c o s t a l m u s c l e s o r t h e i n t e r c o s t a l n e r v e s o r b y i n t e r s e c t i o n s of t h e c e r v i c a l s p i n a l c o r d ( K i i h n I I 676) (11 ) .
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