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 ,

35

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 .

36

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

37

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 ) .

38

R E F E R E N C E S

1. Thompson-Rowl ing J. Respiratory Diseases in Egypt. In Diseases in Antiquity (Don Brothwel l and A.T. Sandi son , editors) T h o m a s , Springf ie ld , I l l inois , 1967.

2. Ebel l B . The papyrus E b e r s . Levin and Munksgaard, Copenhagen, 1937. 3. Neuburger M. History of Medic ine . Transi , by Ernst Playfair. Oxford Univers i ty Press , London,

1910-1925. 4. Major R. A. His tory of Medic ine . T h o m a s , Springfie ld I l l inois , 1935. 5. Marock G. Die Geschichte des Bronch ia las thmas . Kleviert , Quankenbüch , 1934. 6. Littré E . (Editor) Œuvre Complète d 'Hippocrate . Bai l l ière, Paris , 1839-1861. 7. Lypourl is D.D. Hippocrat ic Medic ine . Niko la ides , Thessa lonik i , 1972 ( in Greek). 8. Adams F. (Ed. and trans i . ) . The Extant Work of Aretaeus the Cappadocian. Printed for

S y n d e n h a m Society , London, 1856. 9. Keeney, E.L. The His tory of As thma ; From Hippocrates to Meitzer. J. Allergy, 35, 215, 1964. 10. Rosenblat t M.B. History of Bronchia l Asthma. In Bronchia l Asthma ( E . B . Weiss and M.S . Segal

ed i tors ) . Litt le , B r o w n and Co., Bos ton , 1976. 11. Kühn C G . (Edi tor) Clavdii Galeni Opera Omnia. Libraria Cnoblochi i , Lipsiae, 1821-1833. 12. Furniss D.A. Asthma-a note on i ts h is tory. Med. His t . , 8-26, 1980.

39

ROCHE une recheiche

médicale consacrée par

I importance de ses découvertes

ANESTHESIOLOGIE ENDOCRINOLOGIE NUTRITION PHTISIOLOGIE PSYCHIATRIE MEDECINE PSYCHOSOMATIQUE NEUROLOGIE CANCEROLOGIE PARASITOLOGIE CHIMIOTHERAPIE ANTI-INFECTIEUSE CHIMIOTHERAPIE ANTI-FONGIQUE

Produits "Roche" 52, Boulevard du Parc 92521 Neuilly-s-Seine Cédex - Tél. : 637.77.00.