Hippocrates, Volume III: On Wounds in the Head (Loeb Classical Library, No. 149)

[I

\

THE LOEB CLASSICAL LIBRARY FOUNDED BY JAMES LOEB,

LL.D.

EDITED BY f T. E.

PAGE,

t E. CAPPS, ph.d., ll.d. L. A.

POST,

C.H., LITT.D.

t

l.h.d. E. H.

W. H. D. ROUSE,

WARMINGTON,

HIPPOCRATES VOL.

Ill

litt.d.

m.a.; f.r.hist.soc.

*rotr.-

REDUCTION OF THE SHOULDER e/x/3oA;) (o/jou 6 6cct

JOINT.

tov Karc^u^ovros

HIPPOCRATES WITH AN ENGLISH TRANSLATION BY Da. E. T.

WITHINGTON

VOL

III

LONDON

WILLIAM HEINEMANN LTD CAMUIUDGE, MASSACHUSETTS

HARVARD UNIVERSITY PRESS MCMLIS

First Printed

Reprinted Reprinted Reprinted

.

1928

.

1944

.

1059

1948

Printed in Great Britain by The University Press, Aberdeen

CONTENTS PACK

translator's preface

....,.6a\p67rdSeo-is and V7roSecr/xiSes.

—

The under-bandages and the folded pieces of linen called o-7rAr/res (pads or compresses) were usually soaked in some application, the most " important being two forms of cerate," (1) white or which of consisted wax liquid, liquefied in olive oil or oil of roses, 2 supposed to prevent inflammation, while (2) (which was the same with the addition of Ointments.

"

xx

Surgery, XII.

*

XVIII(2). 3G5.

GENERAL INTRODUCTION some pitch x ) was used for inflamed or open wounds, and was supposed to have anodyne properties and to favour the production of healthy pus wine and oil were also used. 2 ;

Splints.

—Of the ordinary

splints (vdpOrjKes)

we know

The name (like the Latin ferulae) curiously little. were stalks of an umbelliferous that they implies 3 on separately Celsus 4 tells us plant. They were put 5 they were split ( ftssae) and Paulus that they were of the large nature The or in wool flax. wrapped hollow splint (aukr/v), the canalis of Celsus, 6 is not It altogether certain, in spite of much description. is usually taken to be gutter-shaped, but Galen tells us 7 that it went right round the limb, more so than did the box splint (yXoxraoKo/jiov), from which it also it was therefore differed in being circular outside ;

;

But the limb could be put upon it, so it must have been opened, and, indeed, we hear of an opened (dvoi/cTos) solen in the Galenic 8 Perhaps this was a gutter splint, and the writings. used in later times, for Paulus, who says form only the solen was made of earthenware as well as wood, uses crwA^i/oeior/? in a sense which must mean "like a. So also in Soranus (1. 85) a baby's pillow is gutter." to be hollowed, crwA^voeiSois, so as not to go right round its head but Rufus uses the word of the so it spinal canal, and Dioscorides of a funnel pipe, " hollow will be prudent to keep to the ambiguous tubular and cylindrical.

:

1

2

XVIII(2). 538. In the case of club foot the ointment was stiffened with

resin. 3

The giant

*

VIII.

T

XVIII(2). 504.

fennel, light

10. 1.

*

and strong, used by the Bacchants. VI. 99.

6

VIII.

*

XIV.

10. 5.

795.

xxi

GENERAL INTRODUCTION The writer's account of more complicated "machines" can only be made clearer by illus-

splint."

trations. 1

In conclusion we must mention a theory which brings together, and throws light upon, most of these Wounds in the Head has a place by itself, treatises. to be considered shortly, the other four have peculiar In Fractures the Greek ay/Mos (for Karay/xa) is titles. strange, as observed by Galen. Joints clearly means Reduction of dislocated joints, and is so given in our oldest MS., but the correction seems too obvious to be correct. 2 Both these treatises have abrupt beginnings, are probably mutilated and certainly in " " disorder, yet they rank in the first class of genuine works of Hippocrates. In (or About) a Surgerij, often

ambiguously shortened to Surgery, but more instructively expanded to Concerning things done i?i the Surgery, is a collection of notes, chiefly on bandaging, and is obviously derived in part from Fractures, yet it contains at least one passage requisite to explain a statement in Fractures. Lastly the Mochlicon

(Leverage), usually rendered Instruments of Reduction, begins with a chapter on the Nature of Bones, while the rest is almost entirely an abridgment from Joints. The Hippoeratic Corpus contains a treatise on the Nature of Bones which, after a very few remarks on that subject, is occupied by a variety of confused accounts of blood vessels. It is a wreck which has gathered debris from various sources }^et it contains several peculiar words which are quoted in the ;

1

See Appendix Supplementary Note. the irepl &p9pwu of Apollonius and Galen may be an abbreviation ; following which example we shall call it "Joints." :

2

xxii

Still,

GENERAL INTRODUCTION Hippocratic Lexicons of Erotian and Galen as being

The author of closely connected with Mochlicon. Joints says he intends to write a treatise on the veins and arteries and other anatomical matters. This condensed summary may suffice to lead up to

—

the following inferences The Hippocratic part of the Nature of Bones originally came after the first chapter of Mochlicon, which is really its first chapter. This treatise, thus enlarged, had as Preface our Surgery, the whole being an abridgment from an earlier work by the great Hippocrates "for use in the Surgery," which was perhaps its original title (see p. 56). Such a work would be well adapted either for teaching or for refreshing a surgeon's memory. Of the larger and older work our Fractures and Joints are important fragments, but there was probably an Introduction (now lost) containing the passage now extant in Surgery necessary to explain This earlier work the later statement in Fractures. :

also have comprised an original treatise by Hippocrates on bunes and blood vessels, of which Both part of our Nature of Bones is an abridgment. these surgical works got broken up, and assumed something like their present form before reaching the haven of the Alexandrian Library. Littre has hints of the above theory, but it is more fully worked out by O. Regenbogen, 1 who The seven books of carries it a step further. Epidemics were, even before Galen's time, divided into three sections: I and III were universally held to be the oldest and most genuine; II, IV, VI,

may

1

Op.

cit.,

infra.

xxiii

GENERAL INTRODUCTION 1 which, as Galen says, are not composed works memoranda but {virofxvrjjxaTa), were (avyypdix/xaTa) generally supposed to have been compiled by Thessalus, son of Hippocrates, from his father's

note-books; V and VII, as Galen remarks, are beyond the range of the Hippocratic spirit (yvw/xr]), and, we may add, within that of the Macedonian 3 artillery, which indicates a date later than 340 B.C. Galen has his doubts about the single authorship of the middle section, and these are shared by modern critics; but there is no doubt that Epidemics II, IV and VI are closely connected with the three works, we have ventured Surgery, Bones, Mochlicon, which to call an abridgment, but which, if we had not got a good deal of the original, might aptly be termed 2

memoranda.

Not only do whole passages

in either

set correspond verbally, or almost verbally, but there are peculiar philological similarities ; in particular the

verb Spav, which, before the rise of drama, was and a few typically Doric, occurs in all six treatises, others belonging to what may be called the middle Hippocratic period, but neither in the earlier nor It is not found, for instance, in the later ones. Fractures or Joints, nor in Epidemics V and VII. Perhaps it is not too fanciful to suggest that after the triumph of Sparta (404 b.c) these strangers from Cos, who had their surgeries along the northern edge of the Greek world from Perinthus to Crannon, have remembered that they too might claim to

may

2 XVII. 579. Cf. also VII. 825, 854. Littre tries, not very successfully, to get them all into the fifth century. V. 16 ff. The date of Epidemics V, VII, is fixed by the siege of Daton where a patient (94) was wounded by "an arrow from a catapult." 1

VII. 890.

8

xxiv

GENERAL INTRODUCTION be Dorians and might have expressed the claim by 1 occasional use of a strong Doric word.

Anyhow,

the evidence we can expect that and Mochlicon formed part of an " abridgSurgery " ment used in tbe first half of the fourth century the practitioners who compiled Ep demies II, IV, by VI, while Fractures, Joints and Wounds in the Head 2 belong to the previous generation. Some little evidence as to the order of these treatises is given by grammarians. They point out that the infinitive used as imperative, characteristic of older Greek, is especially prominent in the During the fifth century it was Hippocratic Corpus. being driven out by the imperative and became demoralised in the process. This "depraved" use was shown mainly by the substitution of the accusative for the nominative of the participle to represent the second person imperative. 3 Now, as regards our " treatises, depraved infinitives'-' occur only in Surgery and Mochlicon, and are absent from Fractures and Joints, except those parts of the latter which are We thus have further interpolated from Mochlicon. evidence that these chapters are interpolated, and that Surgery and Mochlicon are not by the author of there seems

Fractures

—

all

Join Is.

1 The popularity of the Athenian dramatists, who use the word frequently, is perhaps a simpler explanation. 2

Cf. Schulte, op. cit., infra. "In cases of the second person the subject is in the nominative, but when the infinite is equivalent to the third of the imperative, its subject is in the accusative." 3

person

Goodwin, Greek Moods and

Tenses, p. 784.

XXV

GENERAL INTRODUCTION Manuscripts, Editions and Commentaries

The Hippocratic manuscripts and editions have volumes by a more already been discussed in these competent authority. The chief MSS. of the surgical works are: (1) B (Laurentianus 74. 7) ninth or tenth century, referred to above, and described in detail by Schone in the preface to his Apollonius,

M

(Marcianus Venetus 269) (Vaticanus Graecus 276), and V, with their progeny, twelfth century. form the basis of all editions up to the last by Kiihlewein (Teubner, 1902), in which B is for the first time Unfortunately the whole of Mochlicon fully utilised. and the last five chapters of Wounds in the Head have been cut out of this oldest MS. The chief editors have paid marked attention to

(Teubner, 1896); eleventh century

(2)

;

(3)

V

M

1

these treatises, and Petrequin's Chirurgie d' Hippocrate text and translation with very copious notes and labour by a appendices, the fruit of thirty years' the most represents probably surgeon practising documedical ancient of treatment any thorough It is to this work that the present edition ments. is mainly indebted. Francis Adams translated the treatises in his 2 He could spare Genuine Works of Hippocrates. less time and had fewer advantages than Petrequin.

—

—

The

translation, based upon Littre's text, is straightforward and readable, and the notes have special value owing to the author's practical experience in almost Hippocratic circumstances, though they are i

8

XXVI

Paris, 1877-1878. Sydenham Society, 1849.

GENERAL INTRODUCTION sometimes

flatly opposed to the views of the equally experienced Petrequin. Since the appearance of Scheme's beautiful edition of Apollonius of Kitiirm (Illustrated Commentary on the Hippocratic Treatise on Joints), German scholars have paid much attention to the subject. Schone himself attempted to show that Fractures— Joints at any rate was a genuine work of the great Hippocrates, but was opposed by the eminent scholar Hermann More recently, three interesting Theses on Diels. 1 4 the connections, 2 grammar 3 and style respectively of the surgical treatises have appeared. Their con-

tents are very briefly outlined in the introductions, will repay study by those interested in the

and

5

subject. 1

2 3

Diels, Sitzungsberichte tier k.p. Akademie, 1910, Regenbogen, 0., Symbola Hippocralea, 1914.

Schulte,

E

p.

1140f.

Observational Hippocrateac

Grammatkae, 1914 Questiovwm Hippocraticarum capita duo, 1914 See also Kiihlewein, H., Die chirurgischen Schriften ales Hippocrates, Nordhausen, 1898. 4

Kramer,

,

.).,

6

Abbreviations

=

in

Notes

M. V. the three chief MSS. noted above. Erm. Pq. Kw. the three more recent editors Ermerins 1S5G, Petrequin and Kiihlewein as B.

=

:

above.

XXV11

HIPPOCRATES ON WOUNDS

VOI

.

III.

IN

THE HEAD

INTRODUCTION No

Hippocratic work has attracted more attention

than this short treatise. All the prominent Alexandrian medical commentators discussed it, and it works. is in Erotian's list of genuine Galen, of a a wrote fragment only though course, commentary, All ancient writers on the subject from survives. 1 At the Celsus to Paul us had it before them. Renaissance it attracted the attention both of anatomists and surgeons, and continued to do so Its genuineness has almost to our own times. who doubt hardly been questioned except by those whether Hippocrates wrote anything. This celebrity is perhaps equally due to its The former may excellence and its peculiarities. be seen in its clear descriptions and magisterial The language; the writer teaches with authority. latter are two: its account of the sutures, and its

With regard to the as to trephining. former, we may say that, as modified by Galen to the effect that the H form is the only normal one, it is fairly correct so far as it goes, and that it is much better than the later account of Aristotle that men have three sutures radiating from a 2 centre and women one, which goes in a circle. of view this The ancients (and Vesalius) accepted doctrine

—

1

In Oribasius,

XLVI.

21.

2

Hist.

Anim.

1. 7.

INTRODUCTION the sutures, but all surgeons, from the post-Hippocratic age onwards, have been troubled by his rule as to trephining, which may be condensed as follows

:

—

is contused or fissured, you should trephine at once, but an open depressed fracture does not usually "come to trephining," and is less dangerous in short, an injured skull should have a hole made in it if there is not one already.

If

the skull

;

The Alexandrians,

as

we

gather

from

Celsus,

"the ancients," he says (piously rejected leaving Hippocrates unnamed), advised immediate and operation, but it is better to use ointments this:

—

The vast majority of surgeons wait for symptoms. have done so, but many have regretfully wondered, after the patient's death, whether the Hippocratic " Hippomight not have saved a life. trephining " V. 27) crates (as the supposed author of Epidemics praised by Celsus, and many others, for confessing that he thought a fissure was a suture and so left a is

Symptoms appeared later; untrephined. he trephined on the fifteenth day, but the patient died on the sixteenth yet this is just what any later surgeon would have done, even had he patient

;

The reader will find in Littre extensive quotations from French Pelrequin surgeons, and from our own Percival Pott, on the probability of lives being saved by preventive trephining used as an operation of choice before it is obviously necessary, but the Hippocratic rule is no more likely to be reintroduced than is the use of vigorous venesection, which would also doubtless sometimes save life. The use of the common word tjju'wv as a semirecognised the

fissure.

and

3

INTRODUCTION technical term for a complicated surgical instrument brings us to another noticeable point in the treatise there seems to be an attempt to establish a medical :

Eminent theologians have recently controversy on St. Luke's alleged medical language by declaring that the Greeks had none, "the whole assumption of medical language in any ancient writer is a mare's nest," x but if the writer of Acts had told us that St. Paul at Lystra got a hedra in the region of the bregma which penetrated to the diploe, they would have been fairly confident that he was a physician who made a rather pedantic use of his medical vocabulary. Here are three simple Greek words which are given such peculiar meanings that they have to be defined and not translated. vocabulary. settled the

The last term had some difficulty in keeping, or 2 recovering, the somewhat unnatural sense here given to it, and probably did so only through the prestige of this little work. Hedra could not be saved even by the authority of Hippocrates and his care in It is that form of skull injury which is defining it. mark (or seat) by the weapon, and varies and shape accordingly from a prick to a gash, but without depression, " for then it becomes a depressed fracture." It included mainly what are now called "scratch fractures" and, as Galen says, would also comprise an oblique slice anoo-KeirapIt was too vague to last, and was partly vtcr/xos. left as its

in size

—

replaced by

made some 1 2

—

incision. Its vagueness has lyKoirr) confusion in the treatise, for though

Jackson and Lake, Prolegomena to Ads, II. 355. the porous bone tissue between the two hard layers

i.e.

of the skull bones.

INTRODUCTION there is little doubt that Hippocrates intended to describe five forms of skull injury as is twice asserted by Galen later scribes by splitting up the hedra have tried to make seven, though, strange to say, no MS. mentions a sixth. Several cases in Epidemics V. seem intended as 1

—

—

illustrations to this treatise. A patient with contusion of the skull is trephined largely down to the

he gets inflammatory swelling of the face and is purged the Hippocratic rules being thus followed, he recovers (V. 16). The patient with fissure (V. 27) is left untrephined till it is too late A girl dies because the trephining was insufficient. She has spasm on the side opposite diploe,

(erysipelas)

:

the injury (V. 28).

These cases are more remarkable because skull have nothing to do with epidemics, and there is no such notice of bodily fractures or disinjuries

Epidemics V., as we have seen, probably belongs to the third Hippocratic generation, when the rules of the Master, as to the treatment of wounds in the head, may have begun to be called in locations.

question.

With regard to the style of the treatise, every reader will be struck by the frequent repetition of the same words and phrases, often unnecessarily. This occurs in another manner and to a less extent Fractures and Joints, where we shall discuss it further in considering the probability of a common authorship. in

1

XVIII(2). 672. Orib. as above.

nEPI TON EN KE^AAHI

TPOMATON I. Twv avOpwirctiv ai /cecpaXal ovBev o/xottw? acpcaiv avrals, ov8e ai pacpal t?}? K€(f)aXf]