Two Hippocratic Treatises on Sight and on Anatomy: Edited and Translated with Introduction and Commentary by Elizabeth M. Craik (Studies in Ancient Medicine) (Studies in Ancient Medicine)

TWO HIPPOCRATIC TREATISES ON SIGHT AND ON ANATOMY

STUDIES IN ANCIENT MEDICINE EDITED BY

JOHN SCARBOROUGH PHILIP J. VAN DER EIJK ANN HANSON NANCY SIRAISI

VOLUME 33

TWO HIPPOCRATIC TREATISES ON SIGHT AND ON ANATOMY Edited and Translated with Introduction and Commentary BY

ELIZABETH M. CRAIK

LEIDEN • BOSTON 2006

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ISSN 0925–1421 ISBN-13: 978-90-04-15396-7 ISBN-10: 90-04-15396-9 © Copyright 2006 by Koninklijke Brill NV, Leiden, The Netherlands Koninklijke Brill NV incorporates the imprints Brill, Hotei Publishing, IDC Publishers, Martinus Nijhoff Publishers and VSP. All rights reserved. No part of this publication may be reproduced, translated, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the publisher. Authorization to photocopy items for internal or personal use is granted by Brill provided that the appropriate fees are paid directly to The Copyright Clearance Center, 222 Rosewood Drive, Suite 910 Danvers MA 01923, USA. Fees are subject to change. printed in the netherlands

CONTENTS

Preface and Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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part i. on sight Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II. Transmission and Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III. Content and Expression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV. Place in the Hippocratic Corpus: Provenance and Date. . . . . V. Place in the History of Ophthalmology. . . . . . . . . . . . . . . . . . . . . . . . References and Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conspectus Siglorum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Text and Translation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary of Ophthalmological Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diagrams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. The Eye: anterior view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. The Head: lateral view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Section of the Eyeball . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 3 4 8 15 19 29 31 37 38 49 113 115 115 115 116

part ii. on anatomy The Hippocratic Treatise On Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Text and Translation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II. Anat. and the HC: content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III. Anat. and the HC: expression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV. The Demokritean dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

119 119 121 124 129 155 155 157 162 164 168

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contents

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Index of Authors and Texts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 General Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

PREFACE AND ACKNOWLEDGEMENTS

The two short texts published here, both transmitted in the Hippocratic Corpus but surely neither by the historical Hippocrates, are very different in nature and origins. On Sight is a sketchy surgical manual on eye afflictions, perhaps originating in North Africa, and On Anatomy an allusive account of basic human anatomy with evident Demokritean connections. I am very grateful to Cambridge University Press for permission to republish here with slight alterations in presentation my article ‘The Hippocratic Treatise On Anatomy’ from Classical Quarterly 48 (1998), 135– 167. The original pagination is indicated. An Appendix has been added to take account of a new Budé text: M.-P. Duminil, Hippocrate: CUF t. 8, Ulc., Oss., Cor, Anat. (Paris, 1998). The ‘background’ to On Sight is discussed in my paper ‘The Hippocratic Treatise Peri Opsios’ in Hippocrates in Context, edited by P.J. van der Eijk (Leiden, 2005), 191–207; I hope readers will refer to this for amplification. I need not repeat all the acknowledgements made in note 1 of On Anatomy, but wish to reiterate thanks to the Wellcome Trust for the award of a research leave fellowship, which gave temporary relief from a demanding post at the University of St. Andrews, and facilitated a change in research direction. After a brief return to St. Andrews, I took up a post at Kyoto University in 1997. Work on the treatise On Sight was begun in Kyoto just before retirement in 2002. I have benefited from the comments of participants at several seminars in Japan, especially from those of Professor Noburu Notomi, who supported presentation of the work in its very first and very last stages at Kyushu University in spring 2002 and at Keio University in autumn 2005. From September 2003 to September 2005 I held at the University of St. Andrews an Emeritus Research Fellowship, awarded by the Leverhulme Trust, to complete this book. I am most grateful to the Trust for their support, which enabled me to spend some time in London at the Wellcome Trust Centre for the History of Medicine at UCL and to make brief visits to Cambridge, Oxford, Paris, Florence, Modena, Rome and Venice to collate manuscripts. I express

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preface and acknowledgements

thanks to all the hard-working librarians who have given indispensable aid. I am particularly grateful to two scholars who made time to read and comment on a complete draft: Professor Vivian Nutton and Professor Philip van der Eijk. Professor Nutton saved me from Galenic error and Professor van der Eijk suggested that the work might be published in this series. I owe special thanks also to Dr Thomas Rütten who gave generous help with the manuscript tradition just when I most needed it. Professor Heinrich von Staden provided valuable bibliographical aid. In medical matters, I have been fortunate to be able to call on colleagues in the Bute Medical School, University of St. Andrews: Mr Robin Clark read sections of the commentary at various stages and gave much practical guidance and Dr David Sinclair organized and led a useful seminar on the anatomy of the eye. Above all, Dr Susan Whiten has provided essential information at many points and has very kindly supplied the diagrams, adapted from her book The Flesh and Bones of Anatomy (forthcoming, Elsevier Press). Mr David Spalton, a consultant ophthalmic surgeon in London with a special interest in cataract surgery, communicated his general views of the text. Finally, I wish to thank Dr John Ball of IT services, University of St. Andrews, for adroit rescue from several technological impasses, and to express my gratitude to all at Brill involved in the execution of this complex task.

part i ON SIGHT

INTRODUCTION

I. Title The titles given to Hippocratic works seem in some cases to be based on later commentators’ superficial impressions of their content. The title περ ψιος in itself gives little idea of the actual content of the treatise; it was doubtless adopted because the first words are α ψιες and the word ψις is soon repeated, in 2. Similarly, the treatise now called Bones—though it begins with the word στα ‘bones’ and with an enumeration of the bones in the body—is really about the vessels, and was known to Galen as ‘Vessels, attached to Mochlicon’ (linguarum Hippocratis explicatio 19. 128 K.). In view of the initial plural, we might have expected a plural rather than a singular for the title; and indeed the manuscripts vary in the title given at the end, some having τλος τν περ ψων. The term ψις used three times in the work—in 1 (plural), 2 (singular) and 8 (singular)—can be either abstract or concrete in sense. In the former case, it is always singular ‘vision’ (the sense in 2 and 8), while in the latter it may be singular or plural, with reference to the seeing organ, ‘eye(s)’ or to the central ‘seeing part’ of the eye, that is iris with pupil (the sense in 1; cf. Loc. Hom. 13.6 [6.302 L.]; Epid. 4. 30 [5.174 L.]); or perhaps pupil alone, though for this the word κορ was available. It can also mean ‘dream’, a particular thing ‘seen’ (Hdt. 3. 30, 8. 54 etc.). This range of meanings is paralleled by κο, ‘sense of hearing’, ‘ear’, ‘something heard’. The term ψις is more often abstract than concrete in the Hippocratic Corpus (as de Arte. 11 [6.20 L.]). Translators and commentators have wrestled with the sense. Most opt for a title based simply on vision such as, ‘de visu’, ‘de la vision’; but the meticulous Foesius preferred ‘de videndi acie’, and this choice of title is ossified in the standard modern abbreviation, Vid. Ac. It is difficult to find a single translation acceptable throughout: ‘vision’ or ‘sight’ can serve for both abstract and concrete senses, but become impossible when a plural is required. The translation Organ of Sight conveys the full range of meaning, but is somewhat cumber-

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some; accordingly, for ease of reference, the title is here rendered simply On Sight.1

II. Transmission and Reception On Sight occupies a mere four pages of Greek in the modern printed text.2 The treatise is brief and allusive in content; in addition, the text is seriously corrupt. In part, the pervasive corruption lies in the technical nature of the work, which deals with procedures naturally unfamiliar to scribes, as indeed to scholars. In part, it lies simply in visual or aural error on the part of scribes, liable to make mistakes when faced with difficult and unfamiliar material, and liable to treat such a short piece as relatively unworthy of attention. Sichel laments the ‘état de mutilation tel qu’il est impossible de reconstituer un texte irréprochable’; Ermerins finds both the corrupt state of the text and its technical content such obstacles to comprehension that he declines to translate large parts of it; Joly concurs that ‘les problèmes … ne comportent pas de solution tranchée’.3 A further problem is that, while there is no shortage of mss containing the work, the tradition is uniform and so uniformly corrupt.4 The extant tradition depends entirely, directly or indirectly, on the tenth century ms M (Marcianus 269). In the absence of evidence from the separate strand of the tradition represented by V (Vaticanus gr. 276, twelfth century) and mss descended from V such as C, much used by Littré (Parisinus gr. 2146), the deep-seated corruption in the text with its single medieval source is intractable. We may contrast the tradition of, for instance, Epidemics 7.5 Sichel knew readings of M through information from Daremberg, but did not recognise M’s early date, priority and relative importance. Similarly Ermerins knew M only indirectly, through readings communicated by Cobet. Sichel collated and recorded the readings of the recentiores, especially the Parisian recentiores, with great thoroughness. Ermerins supplemented Sichel’s critical appa-

See Craik, 2005; cf. Montfort, 2003, 46–50. Sichel ap. Littré 9, 152–161 (1861); Ermerins 3, 279–283 (1864); Joly, CUF 13, 168– 171 (1978). 3 Sichel 152; Ermerins Praefatio XL–XLI; Joly 163. 4 See Diels, 1905 and 1907. 5 But see Jouanna, 2000, 95–97 on closeness of M and V. 1 2

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ratus with information from one further ms in the Netherlands. Joly collated M and relied on Sichel for the rest. For this edition, I have seen almost all mss (see conspectus siglorum). Several minor mistakes in Joly’s representation of the text of M have been corrected (κα 1.2; τε, 2.1; article  to be included, 3.3; article τν to be omitted, 7; σοι ‘you’ to be omitted, 9.2; λλ’ ‘but’ to be omitted, 9.3).6 Such variations as preference in M for uncontracted verbal forms, for γγνονται rather than γνονται and for κως rather than πως are not recorded in the critical apparatus. On checking Sichel’s apparatus for the recentiores, I find many instances where the punctuation is wrongly recorded. This is unsurprising, as versions of the punctuation vary greatly (especially in relation to headings or quasi introductory material) and are frequently awry, betraying a complete lack of comprehension on the part of scribes: there is a tendency to reduce the text to staccato bursts of short clauses, or apparent semantic units, which are devoid of overall syntactic sense. I have not thought it worthwhile to record these different versions, which have no interest except as a means of suggesting links among the recentiores. Scrutiny of the mss merely reinforces the impression of careless transmission. It is remarkable that several obvious errors in M go almost universally uncorrected: ατμαται, 1.1; αλασσοειδ , 1.2; μηλησ"ω, 4.1. There is an almost total lack of marginalia (even in mss where these abound for other works) and such glosses as do exist are banal in the extreme (in G, δε#ων glossed βρχων, 3.2). There is, however, a general regard for marking new topics: a red initial letter or a small space precedes a separation into ‘chapters’ similar to that adumbrated in notes by Cornarius, then pioneered in his text by van der Linden, refined by Iugler and followed in modern editions. M has a sizeable space only before 7 init. but has slight spaces before each of the repeated &πειτα ‘then’ conjunctions in 3.1; while there is not complete unanimity in the recentiores over the existence or placing of these sense divisions there is most general agreement over the start of our chapters 7, 8 and 9 – R, however, has spacing before 4, 7 and 8 and Laur. only before 6 and 8. In M, f. 212 starts with the words ' κ(τωεν 3.3 and ends with the words )πανιες δ*, 7.1. At both points, where scribal inattention is explicable, the text is particularly problematical and can be understood

6

Cf. Anastassiou, 1980.

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only with substantial extension and emendation. In defence of the scribe of M—generally known to be faithful and reliable—it may be added that many readings emended by editors are perfectly acceptable in the context of the rough and elliptical Greek of this work. (See on 1.1, 2.1, 4.1 etc.) Although the precise nature of the relation of the later mss to M and to one another is much debated and there is no agreement on details of classification, the general lines of affiliation are clear. The mss H and I are both close to M, either through faithful copying or—as has been suggested—because they share a common (lost) source; they are in turn the basis of the later tradition. The consensus view that I had a great influence on the later tradition—for instance being source of F, source in turn of G, source in turn of Z—is corroborated in the case of this work. That different sources can be seen in R is clear also: R agrees more often with H (and is familiar with the second hand in H) but, at the same time, shares several readings with I. There is no evidence from this treatise that R had access to significant material extraneous to the tradition of MHI. Detail in the critical apparatus is confined to the readings of M, H, I, R.7 (See further on π(+η, 1.1; ,σχυρς, 3.3; ξυσμς, 6.1; κοιλης κ(αρσις, 9.1; πλ(γιον, 9.1; ο γ/ρ συμφρει, 9.2.) In the final analysis, precise textual study is of no help whatsoever in retrieving the original lost text of this work. As elsewhere, it may be suspected that scribes were more concerned with general fidelity to content than with an exact record. In this edition and commentary, clues to the source and nature of corruption are sought in other Hippocratic works, and in parallel passages of Celsus and Galen. This is, of course, a hazardous enterprise. It must be stressed that, where emendations are suggested on this basis, they lay no claim to verbatim restitution of the lost original; rather to recovery of the lost gist expressed in wording which is possible and plausible. The only justification is that manifest nonsense is here converted to patent sense fitting its context. Earlier editors and translators made distinctive contributions, in line with their work on other Hippocratic treatises. Both Calvus and Cornarius, generally conservative and literal, used translation as a means of explication and interpretation. Calvus, using the ms W at Rome in 1512, made the obvious correction of μηλησ"ω to μιλησ"ω, 4.1 and recorded the variant, or intelligent conjecture, ξ#σιος for κρσιος, 4.2; see also on the significance of the translation scapulares ‘scapulars’, 3.1.

7

On M, see esp. Jouanna, 2000; on H, esp. Duminil, 1998, 28.

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Cornarius’ annotations, comprising both observations and corrections made in his personal copy of the Aldine text of 1526, survive, as was realised by Sichel, who checked and recorded his notes in the copy at Göttingen; from this it is possible to see the use Cornarius made of further ms sources (as )ρυρ( for )ρυρα, 3.4).8 Foesius, thanks to an influential patron, had access to three mss held in the royal library at Fontainebleau where they were transferred in 1544 and catalogued in 1550; he had also seen the Vatican ms now known as R.9 Foesius printed a text in line with the current vulgate, but permitted himself deviations from this in translation and comment; see on 4 and 7. Van der Linden followed Foesius but not slavishly; he was familiar with Ermerins’ ms Q. The philological value of these early printed texts lies primarily in the access of scholars then to a wider range of manuscript sources than we now possess (see app. crit.). In practice, however, the sources they cite add little to our knowledge and do not mitigate our dependence on M. The medical value of these early printed texts is considerable, especially for such surgical works as On Sight. All contributors were practising doctors who had personal experience of bloodletting and cupping—and of such activities before Harvey’s work of 1628 changed our perception of the blood vessels and their course in the body; see especially on 3.1. It has commonly been asserted that there is no ancient reference to On Sight, which would authenticate its place in the Hippocratic Corpus of antiquity.10 This negative view has now been contested with regard to the Galenic gloss 1τρακτον, relevant to 4.1.11 To this can certainly be added Erotian’s gloss φολδα, relevant to 6 and possibly also ολ" relevant to 4.1. Both fall in the appropriate position in Erotian’s list: in the third category, Therapeutics, placed with the lost work On Wounds and Missiles, between Head Wounds preceding and Fractures with Articulations following; see also for διαφανσι 2 and 5, for τ(χα, 3.4, and for ξυσμς 6.1. That many words glossed by Galen are present in the treatise confirms that the vocabulary has a Hippocratic, if at times recondite, character (see on 2, 4, 6, 7 and 9). Hesychios too contains much of relevance to the work (see on 2, 3 and 4).

8 9 10 11

See now the thorough treatment of Montfort, 2003. Foesius, preface lectori candido; Omont, 1888. Joly 163; Nachmanson, 1917, XIX. Anastassiou and Irmer, 1997.

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introduction III. Content and Expression

Short works—we may compare the still shorter On Anatomy and the somewhat longer Dentition—are peculiarly difficult to interpret, and to place in the wider context of the Hippocratic Corpus and other writings. To argue that different works of the Corpus belong together, a conjunction of similar content and similar language is required. Many associations in content can be explained simply by access to a common pool of knowledge, from which items might be taken and reworked. Unless it is unusually esoteric, or there is a high concentration of coincident elements, content is not a reliable indicator. Language may be somewhat more reliable, though here too caution in interpretation is imperative. Where such elements as vocabulary, or grammatical and syntactical features, or use and frequency of particles and pronouns are shared—especially where these are distinctive or non-standard—they may be pointers to a common tradition. On Sight is a manual of surgery, giving instructions for surgical procedures to be followed and, to a lesser extent, for drugs to be applied in different ocular affections or diseases or, rather, to treat different sets of ocular symptoms. Retrospective diagnosis of Hippocratic cases is always hazardous, but here the conditions can be more or less plausibly identified as follows: cataract (1), weeping sores and their complication ectropion (2), trachoma and its effects (4), papilloma or chalazion (5), ‘night vision’ (7), recurrent seasonal allergy or conjunctivitis (9). The procedures are: cautery of the vessels (1.1, 2; 3) or of the eyelid (4), cutting and/or scraping of the eyelid (5), letting blood by phlebotomy or cupping (3; 7; 9), cutting the scalp (4.2), trephination of the skull (8), purging the head and/or the body generally (1.1, 2; 4; 7; 9), applying ointments and poultices (6; 9). All these procedures, some gentle and others drastic, are boldly indicated, but care and caution are likewise enjoined. The first requirement of a surgeon is a secure knowledge of the anatomy of the parts on which he operates. We might expect this knowledge to be expressed in technical language. However, our author displays no awareness of the complexity of the eye’s anatomy. Few technical terms are used, apart from the repeated ψις already noted. No word, apart from ψις, is used for pupil, iris or cornea and there is no reference to the nature or number of μνιγγες ‘membranes’ (coats or tunics) of the eye; this contrasts with reference to three membranes in

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Places in Man.12 There is frequent reference to the βλφαρον ‘eyelid’ (2; 4.1; 5 bis; 6 bis), but no word except ρξ ‘hair’ for eyelash (5). The rather vague στεφ(νη ‘circle’, ‘ring’ is used for the eyeball and the rather general χνδρος ‘cartilage’ or σ(ρξ ‘flesh’ for the inside of the eyelid (4.1). The author operates not only on the eyelids but also on the head more generally, and here his knowledge seems more extensive, though it is still not technical in expression. He cuts into the βργμα ‘bregma’ or the vertex in two different procedures, either in order to release blood, or in order to gain access to the skull for trephination (4.2; 8). Apart from bregma, no anatomical terms are used for parts of the head. The skull is simply στον ‘the bone’ (3.1, 2, 4; 8). The φλβες ‘vessels’ are important to his practices (1.1; 3.1, 3 ter; 9. 1), but there is only one indication of particular vessels and their location, and that is unclear (3.1). Despite the disconcerting absence of anatomical nomenclature, our doctor was evidently familiar with the general anatomy of the head, knowing where to cut and how to trephine: he would know exactly where the bone of the skull was thickest and exactly where the flesh of the scalp was thinnest, and be able to trace the location of the sutures and of the inion, occipital protuberance; he would have some idea of the course of the main blood vessels. Even in Head Wounds, rather vague terms are used for regions of the head: κορυφ ‘top’ or ‘vertex’ is not a well-defined anatomical term, and the words for ‘forehead’, and ‘brows’ are somewhat vague also.13 Use of the term πισεν ‘behind’ to indicate posterior orientation in the body seems to show a nascent striving for precision (3.1 bis; cf. πρσεν, 1. 2, and &νδοεν, 2). The paucity of anatomical terminology may indicate simply that the surgeon was not concerned, or not here concerned, with names for bodily parts; it need not suggest ignorance of these, far less inability to operate safely and effectively. The author’s pathology, like his anatomy, is almost devoid of technical terminology and the lack of nosological specification is striking. The rather crude term διαφερεσαι ‘be destroyed’ describes loss of sight (1.1; 8). The only abstract noun for a disease is ‘ophthalmia’ (9), in general usage applied indiscriminately to eye trouble; to this we may add a case designation ‘sufferer from night blindness’ (7). The absence of such terms for sight impairment as μα#ρωσις (appropriate to 1) and μβλυ12 13

See Craik, 1998, 105. Cf. Hanson, 1999, 99.

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ωπα (appropriate to 8) common even in non-medical authors, and the

absence of any reference to treatment of eye injuries, is remarkable. In this practical work, prognosis is more important than diagnosis. Diagnosis is by appearance (1) or by the patient’s report of discomfort (6) or of loss of vision (8). In practice, the physician considers two broad categories: problems where the eye, but not the eyesight, is affected (2) and problems where the eyesight, but not apparently the eye, is affected (8); he differentiates between sudden and gradual loss of sight (1) and between child and adult patients (2). The writer seems familiar with a wide range of problems, even if he does not apply names to them. This may be a merit: in practice, many eye conditions display similar symptoms, or take many forms; for example, conjunctivitis—perhaps the most common of all eye diseases—may be classified as catarrhal, purulent etc; and trachoma has many complications, including trichiasis and entropion. If the author has any knowledge of terms for the diseases here described, he does not display it. We cannot assume that names were unknown or unavailable; it may be simply that the author is not concerned with nomenclature and that the modern quest for nomenclature and definitions is bound to be of limited success. The author is no more concerned to expound his views on physiology than on anatomy and pathology. However, it is evident from his practices—purging the head and body, cauterising the vessels—that he subscribes to this common theory: that flux of peccant matter (usually viewed as phlegm) from the head is the major cause of disease in general, and that such matter concentrated at the eyes is the cause of the most common eye disorders. It is evident too that he subscribes to a refinement of this, postulating two different types of flux from two different parts of the head to two different locations in the body (here, two different regions of the eye): superficial upper flux, from the area above the skull, or the scalp, and deep lower flux, from the area under the skull, or the brain. The fluids mentioned, apart from blood, are 4δρωψ ‘moisture’ (removed on trephination, 8) and ,χ5ρ ‘ichor’ fluid with a watery or bloody appearance (4.1). There is some awareness of pulsation in the vessels (3). It is apparent that the author believes that an excess of matter in the head flows down through the vessels, and that this noxious flux can be arrested by cautery or venesection. This was the desired effect. As to the actual effect, it must be supposed that he cured some of the people at least some of the time, as his practice would depend on his establishing a reputation and securing the respect of physicians and the trust of patients.

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The text, then, is not about anatomy, physiology or pathology, but about surgery and therapy with especial emphasis on cautery. Cautery was commonly used to arrest haemorrhage, to burn off excess tissues, to lance abscesses and, as in On Sight, to eliminate noxious bodily moisture. It would have the additional unappreciated benefit of combating infection. Cautery, like cupping, might be dry (a less invasive treatment involving no break in the skin and no bleeding) or wet. In dry cautery, the instrument is used simply to apply gentle warmth to the body, commonly but not always to the blood vessels. Even when the instrument is used to address the vessels, it may just be placed alongside (παρακαειν ‘burn beside’, 3.3) apparently with a view to changing the consistency or the movement of their contents. Alternatively, in wet cautery, the instrument is placed across them (διακαειν ‘burn over’, 3.3 quater; cf. treatment of the eyelids, 4.1) apparently with the intent of actually breaking the wall of the vessel—surely vein, not artery—or even severing it. In both wet and dry procedures, sponges might inserted between the surgeon’s instrument and the patient’s skin ()γκατακαειν ‘burn in and down’), possibly in an attempt to mitigate the pain, to control the severity of the heat, or to mop up blood (but see further on 3.2). Similarly, in dry cupping, the cupping instrument is applied to the surface of the skin and left there, with the aim of drawing out noxious stuff from the unbroken skin by suction, while in wet cupping the skin is broken or scarified in order to remove blood or noxious matter from a vessel or elsewhere. Thus, the verb καειν, lit. ‘burn’, med. ‘cauterise’ does not necessarily or always involve extreme heat, far less branding and scarring; it is simply ‘heat, using a cauterising instrument’. The practices of cutting and cautery are often allied, as alternative or successive ways to address a problem: to drain or burn out an excess of fluid, reducing it by incision or by application of heat; to stop flow by creating a barrier. Celsus too viewed these as alternative ways to eliminate noxious matter from the vessels. Many elements in the doctor’s pharmacopoea are everyday items from the domestic store cupboard, such as olive oil (3.3), garlic (7) and honey, applied (3.2) or ingested (7). Sponges and fine wool are also part of his stock-in-trade (3, 4.1). In preparation, an ointment must be ‘in consistency like myssotos’, a culinary paste (6); the simile conveys a homely atmosphere. Similarly, the verb used of thoroughly heated cauterising instruments ‘well-roasted’ (3.2) is one with a regular culinary nuance. It may be that the doctor simply requisitioned items, such as sponges, from the patient’s kitchen. Such improvisation is commended

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in Articulations (Artic. 7 [4.86 L.]). However, there is evidence too of specialist supplies. The most commonly named specific is a derivative of copper, evidently copper sulphate, perennially favoured to treat certain ulcerative eye conditions, such as trachoma: 1νος χαλκο6 ‘flower of copper’ (4.1, 6; slightly different terminology in 5). A second ingredient in an eye salve, specified without indication of quantities or proportions, is unripe grape juice. This is a seasonal item but there may have been procedures (?ancillary to wine manufacture), to preserve it for use throughout the year (6). Arum root, used in cautery, would be more readily stored (3.2). The preparation of an eye ointment detailed (6) demands a ‘grindstone’ (or perhaps rather a pestle and mortar), a strainer, and a special container of red copper. The ‘couch’ where the patient is positioned in preparation for surgery (3.1) would ideally be one regularly used by the doctor performing the operation and appropriately positioned, height and light source being important considerations, but might be rather a piece of ordinary household furniture which came to hand. Cupping vessels are explicitly mentioned once (9.1) and required by implication elsewhere (7); scalpels would be required in order to let blood (3.1, 9.1) and to cut into the scalp (4.2, 8), and a sawing instrument would be needed for trephination (8). A scraping instrument or rasp, or material of some unspecified sort is needed to scrape the lids (2; 4. 1, 2) and another special blade is needed to ‘thin’ them (4.2). Finally, different instruments for cautery either of metal (3.1) or of wood (4.1) are used; these are sometimes required to be delicate (‘not thick’, 1). A means of heating these would also be required. The absence of technical terms for instruments is as marked as the absence of anatomical and other medical terminology noted above. The eye surgery seen in Paul of Aigina is described in very different terms, with such dedicated instruments as a βλεφαρξυστον ‘raspatory to treat the eyelids’ and πτερυγοτμον ‘knife to excise a pterygium’ and many others (Paul 3. 23, 6. 15 etc.) The drugs to be used for the most routine treatments are not specified: it is taken for granted that the doctor will know how to purge the head by nasal insertions and the body by laxatives (1.1, 2; 4. 2; 7; 9.1); exceptionally, elaterion lit. ‘driver’ is once indicated for drastic purging (7). It is assumed too that he will know which applications will have a particular effect, such as ‘astringent’ (δριμ#ς, 9.2), and what drug will be effective to stop a flow of blood (&ναιμος, 4.2). When poultices are indicated, their composition is left to the doctor’s discretion (9). The shorthand ‘give the further treatment’, i.e. ‘continue to treat as appro-

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priate’ (,ητρε#ειν τ/ λοιπ(, 5) presupposes practical experience. There is some evidence of observation, though this is somewhat subjective in character (comments on different colours of the seeing part of the eye, 1); the doctor sets store by ‘signs’ (change in nature of discharge, 4.1). There is some evidence also of careful interrogation of the patient (comments on whether the onset of the affection has been sudden or gradual, and with or without apparent cause, 1); the patient’s report of symptoms may condition the choice of treatment deemed appropriate (presence or absence of pain, that is of headache, 9). Some store is laid on seasonal factors (in ophthalmia, 9). The patient’s diet may be restricted and his environment monitored (in ophthalmia, 9). The instructions given are often expressed in a peremptory and authoritative fashion. The doctor treats (ποιε7ν, 2; also , σαι, 8 and 8ησις, 1.1, ,ητρε#ειν, 5) and the patient is on the receiving end of treatment (π(σχειν, 1.1, 3.3). Instructions are confident, often expressed in terms of what ‘should’ be done (χρ ‘one should’ 1.1; 3.3 bis; 4.1, 2; 8). The clinical approach throughout is pragmatic. It is important to recognise cases where treatment would be useless (οκ 9ν :φελοης ποιων οδ*ν ‘you could not help by any action at all’, 2). The doctor’s concern is with what will or will not ‘work’; hence repetition of the verb συμφρει ‘it is beneficial’ (1.2 bis; 9.1 bis, 2 quarter, 3 bis). There is much room for discretion: letting blood helps in some cases of ophthalmia (9.1) and poultices are helpful in certain specified circumstances (9.2). Although the doctor must act decisively (,σχυρς ‘strongly’ in cautery, 3.3; ;ς μ(λιστα ‘as much as possible’ in pressure for cupping, 7) he must also act with due care and caution (ατ< τ< φαλμ< σκεψ(μενος ‘considering the actual eyes’, 2; συχ+ διαερμανειν ‘heat gently’, 3.1; τ=ν σ(ρκα 'κσην εμαρστατα δ#ν+η ‘the flesh … as much as you can, very gently’, 5.1; φυλασσμενος ‘with care’, 4; 5.1). He must recognise the signs which indicate that it is time to stop scraping the lids (4.1), and know what follow-up procedures are appropriate (4.2). Long-term treatment seems to be envisaged; thus the processes of vascular healing after cautery and of lid repair and regrowth after scraping seem to be monitored (3; 4. 2). Where injunctions are given for procedures to be followed, the address is sometimes direct, in the second person: ‘you could not aid’, ‘when you cauterise’, ‘when you scrape’, ‘you should pour’ (2; 3.3; 4.1; 6); jussive infinitives with nominative participles are particularly common (2; 3.1 and 2 repeatedly; 4; 5; 6; 7). A favoured syntactical structure is a chain of loosely linked participles, indicating successive

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steps in treatment or preparations for treatment, used in conjunction with jussive infinitives. There is much use of the adverb &πειτα ‘then’ to indicate clearly successive stages in procedures to be followed. Verbal expressions ‘it is beneficial’ and ‘it is expedient’ are much used also (συμφρει and χρ discussed above; cf. &ργον 4. 2). Jussive subjunctives too are used: once of the practitioner (6), once of an aide (3.1) and once of the patient (7.1). The work begins abruptly, with asyndeton, and the use of τοια#τη ‘such’ (sc. such as before) indicates loss of context. The end is similarly abrupt and the editorial thesis of Joly and others that the text is a mere disjointed fragment is plausible. The extreme brevity of the surviving text and the fact that it considers relatively few eye diseases add to the impression that we are dealing with a lacunose piece, possibly an excerpt from, or partial summary of, a much larger work. The extent and nature of textual corruption is consonant with this possibility: there are lacunae even in the text as transmitted (especially in 3, 7 and 9, but probably not between 2 and 3, pace Sichel and others). Although the sporadic use of headings or quasi-introductory phrases (the basis of the modern division into ‘chapters’) may be vestigial evidence of a degree of organisation, some major transitions in thought are unmarked (3 init.). Within several chapters the content is uneven, surgical instructions sitting incongruously alongside general comments and advice: the presence of such disparate material is particularly marked in 3 and 9. Overall, the work is a series of disconnected jottings, elliptical, allusive, and telegraphic in expression. The syntax is primitive and inelegant. Paratactic sentence structures predominate. Subordinate clauses, where used, are not well integrated but appended in a loose agglomeration (2). There is a marked tendency to careless or otiose repetition, especially repetition of the demonstrative pronoun (1, 6, 9), and there may be a trace of Doric idiom (neuter plural noun with verb in plural, 3.4). These features are typical of early Greek prose writing. In addition, the grammatical forms are rough, functional and unidiomatic to the point of solecism, with particular oddities in the use of prepositions.14 The vocabulary is functional. However one salient feature is a tendency to employ compound verbs. In some instances, these are semantically significant, conveying precise surgical nuances (διακαειν and )γκατακαειν discussed above); in others

14

See Craik, 2005, 204–205.

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the compound is used where the simple verb would suffice (διαβλπω, διαερμανω, διασημανω, διαχρω, διαχωρζω). The content, with its stress on practical instruction and disregard of matters not germane to that immediate concern, suggests a target audience of trainee physicians. The form, with its strongly didactic tone, in conjunction with loosely juxtaposed clauses and truncated elliptical expression, suggests the format of notes intended to accompany a set of lectures or demonstrations. While such notes may be made and kept by pupils as well as teachers, our treatise seems to mirror the attitudes of one giving, not receiving, instruction: the magisterial, authoritative and abrupt expression seems to be directed at a learner, receiving instruction from an experienced practitioner. Surgery above all must be taught by demonstration and participation; the work we have may have originated as a relatively unimportant adjunct to the manual business.

IV. Place in the Hippocratic Corpus; Provenance and Date Much medical writing is essentially derivative and repetitive in character. Even modern textbooks can be shown to parrot one another, especially where factual material is presented. In antiquity, where it was impossible to establish prior claim by definitive publication, where the notion of plagiarism was lacking, and where medical scientists worked in collaborative or combative groups, such repetition is inevitable. It may be said that all the Hippocratic works are mixed and derivative to some degree, and that few, if any, are original in an accepted literary sense: the words ‘redactor’ rather than ‘author’ and ‘compile’ rather than ‘compose’ are appropriate. The integrity of the Hippocratic canon has been increasingly questioned, to a point where it has been suggested that the very concept of a Corpus is flawed:15 while individual Hippocratic writings have much in common and can be regarded as groups or clusters, it is possible to parallel much of the content of the Hippocratic Corpus in fragments of many medical authors, including those whose views are summarised in the papyrus known as Anonymus Londinensis, and in fragments of the Presocratics, as well as in the Aristotelian Corpus. (For Vid. Ac. and the Aristotelian Problemata, see especially on 1, 2 and 9.) It remains likely that there was direct interaction

15

See Nutton, 2004, 61–66; van der Eijk, forthcoming.

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between some of the authors represented in the Hippocratic Corpus and the quest for affinities remains meaningful. It is immediately evident that there are general similarities in On Sight with the practices and so with the expression and vocabulary of such surgical works as Articulations and Sores, also with the surgical procedures in the gynaecological and nosological treatises—though none of these works is so uncompromisingly surgical in content or so aggressively peremptory in expression as On Sight. Unsurprisingly, there are particular resemblances with works featuring cautery; for instance, the term 1τρακτος for a cauterising instrument occurs only in On Sight and in Internal Affections. The extreme brevity and rugged idiom of On Sight compound the difficulties of making such comparisons. However, there is no doubt that in both content (on eye flux and on cautery) and expression (style, syntax and grammar) On Sight particularly resembles Places in Man. The author of Places in Man seems to have a particular interest in the eye: different kinds of ocular flux are classified at length and treatments are specified: eye salves (13.1, 2 [6.298, 300 L.]); purging the body by enemas and laxatives (13.1, 4 [6.298, 300 L.]); purging the head by errhines (13.2, 4 [6.300 L.]); cautery of the vessels in the temples (13.7 [6.302 L.]); and, in an extreme case, making incisions in the scalp to the bone (13.5 [6.300 L.]). Similarly, in On Sight, according to type of symptoms, the treatments are: eye salves (6; 9.2, 3); purging the body (7.1; 9.1); purging the head (1.1, 2; 7.1; 9.1); cautery of the vessels (1.1, 2; 3.1–4) and incising the scalp (4.2; 8). There is also cautery almost up to the bone of the skull (3.1–2). In both works too, trephining is practised, as is venesection or cupping. Treatment of the eyelids as prescribed in On Sight is by similar methods; that is, by surgical cutting and burning, and by ointments or lotions. In both works, detailed instructions are given as to how cautery of the vessels should be performed. These instructions are given in similar terminology and with a similar emphasis in content (Loc. Hom. 40 [6.330 L.]; Vid. Ac. 3). The theory of flux from the head, underlying the therapy advocated for eye conditions, is explicitly presented in Places in Man and implicitly present in On Sight (especially in 9, in language similar to that of Glands, a treatise close in details of its theoretical stance to Places in Man). The same theory can be seen, in different guises, in other works which are concerned with symptoms and therapy of diseases stemming from the head, notably in Diseases 2, Internal Affections and Affections, and notably where cautery is the preferred practice. In both Places in Man and

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Glands: it is the ‘marrow’ which carries noxious flux to lower parts of the body (Gland. 11, 14 [8.564, 570 L.]). Similarly, in Koan Prognoses, a list of diseases not found before puberty includes κατ(ρρους νωτια7ος ‘flux in the back’ (Coac. 5. 502 [5.700 L.]) and in Internal Affections, two types of phthisis are related to abnormal functioning of the ‘marrow’: in one, the ‘marrow’ becomes filled with blood (or the hollow vessels filled with bile and phlegm) and in the other, the ‘marrow’ becomes dry, with blockage in the ‘small vessels’ from the brain—here, cautery of the neck is prescribed (Int. 12, 13 [7.192, 200 L.]; cf. Loc. Hom. 21 [6.312 L.]). There is a further nexus of associations with treatises which detail ingredients and preparation of recipe cures, Affections, Regimen in Acute Diseases, Diseases of Women 1; Affections is unusual in referring to a work on drugs sometimes called pharmakitis (Aff. 15, 23, 28, 40 [6.224, 234, 240, 250 L.]) sometimes ta pharmaka (Aff. 4, 18, 29 [6.212, 228, 240 L.]). (It is usually supposed that a particular treatise is intended. However, the different modes of allusion seem to suggest a fluid body of material; and as in Greek idiom the definite article is frequently used in place of a possessive pronoun, it may be that the meaning is ‘your’— rather than ‘the’—recipe book, the reader being enjoined to refer to his files on drugs.) There are marked affinities also with Prorrhetic 2 (18–20 [9.44, 46, 48 L.], theoretical prognosis for eye conditions) and with certain passages of Epidemics (practical treatment of eye conditions). Other passing or incidental similarities can be identified: belief in the importance of the seasons in the aetiology of disease, pervasively evident in Airs, Waters and Places and seen intermittently in Epidemics and Aphorisms features in the treatment of ophthalmia at the end of On Sight. The procedures of the treatise can be paralleled in various works: Hippocratic surgeons cut different parts of the head for different supposed conditions, with different purposes, in different ways and with different follow-up procedures. The main expedients are, briefly: a single cut in order to saw or pierce the bone, usually treatment for skull fracture but also to release unwanted moisture; a single cut, usually in the forehead or the bregma to release excessive or noxious matter; multiple cuts in the scalp, to release excessive or noxious matter. The recommendations in Physician that if only one cut is required, incision should be swift; while if several are required, incision should be slow indicate a general interest in such surgery (Medic. 5 [9.212 L.]). The author of Affections, while discussing head diseases, states his intention to write separately on diseases of the eye (Aff. 5 [6.214 L.]); he further, while treating diseases of the belly, states his intention to

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write on cases of suppuration, of phthisis and of gynaecological ailments (Aff. 33 [6.244 L.]). Inevitably, there has been speculation on common authorship, and inevitably On Sight is a contender for the work supposedly projected on the eye.16 The range of works proposed by the author of Affections resembles the range proposed by the author of Articulations, and the question of interrelated authorship between major and minor works resembles that between Articulations and Glands. It is very likely that Hippocratic authors, who had to be versatile in their clinical practice, chose to be versatile in their written output also. But establishing common authorship—as opposed simply to common influence and interaction—is an elusive and perhaps ultimately impossible goal. Although On Sight has some common content with Affections, common expression suggests rather a grouping with Places in Man, Glands, Fractures, Articulations, parts of Epidemics and some of the gynaecological works. The abrupt manner is reminiscent of the aphoristic works, especially of the unpolished Koan Prognoses and there are some similarities in vocabulary also with this collection.17 The treatise is dated to the end of the fifth or beginning of the fourth century by Joly, on the basis of its supposed ‘Knidian’ content, especially the stress on cautery, traditionally associated with the name of Euryphon and regarded as a Knidian practice; but cautery may more properly be regarded as an ancient practice, persisting in pockets everywhere.18 It has been argued, on the basis of language, that Places in Man is an early work, originating in Italy or in Sicily.19 In view of the similarities noted, it may be suggested that On Sight has a similar date and provenance. It may then be conjectured that the author had affiliations with the west Greek thinkers Alkmaion of Kroton and Empedokles of Akragas, both known to have taken a particular interest in the eye. However, although thinkers with an interest in the workings of the eye and doctors with an interest in diseases of the eye might well have found their activities complementary, the severely practical tone of On Sight militates against direct comparison with these highly theoretical and philosophical writers. Although Alkmaion was said to have dissected the eye, it is unlikely that this bears any relation to the activi-

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2005. 17 18 19

See Rodriguez Alfageme, 1993 on use of particles in Aff. and Vid. Ac.; also Craik, See Craik, 2002, 288, n. 3; also 2005. Joly 164; Thivel, 1981, 281–282. Craik, 1998, esp. 22, 28–29, 33.

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ties of our doctor: even if true, the dissection was doubtless of an animal (just as Demokritos from Thracian Abdera was said to have dissected animals, cutting into the bregma, with an interest in sense perception).20 Another possible source for the work is north Africa: there is good fifth century evidence that ‘Egypt’ produced the best ophthalmologists; papyri confirm an earlier specialist interest in ophthalmology; Libyan Kyrene was a prominent medical centre. Trachoma, a disease given much attention in On Sight, has a peculiar association with Egypt. If the piece is based on the work of someone whose first language was not Greek and who was not entirely at home with the idiom, the vagaries in expression are more explicable.21

V. Place in the History of Ophthalmology Modern works, aimed to assist the hard-pressed family doctor in diagnosis of ocular problems, suggest that the first distinction should be between gradual and sudden loss of sight, and that each of these subdivisions should then be classified further on an anatomical basis, working posteriorly from cornea to retina to choroid and optic nerves. And in ophthalmic pathology, topics are generally grouped together with reference to the part affected. Unable to examine the inside of the eye and unaware of its full complexity, the ancient practitioner uses a more crude yardstick, and thinks primarily in terms of ocular flux. In the development of ophthalmology in antiquity, increasing anatomical knowledge is evident and well documented.22 In the Hellenistic period great advances were made by Herophilos and Erasistratos: Herophilos had a particular interest in vision and the connections between eye and brain; also in the structure of the eye, where he distinguished four membranes.23 But still, the theory of flux and therapy based on it continued to survive and pervade ancient ophthalmology centuries later. Both Galen and Celsus, despite awareness of the huge advances in ocular anatomy and physiology initiated by Herophilos and developed by Demosthenes Philalethes, and despite practical advances in surgical techniques, subscribe to the same general scheme of beliefs 20 21 22 23

Lloyd, 1975. For detailed argument, see Craik, 2005. For general discussion, see Hirschberg, 1899 and Magnus, 1901. See von Staden, 1989, 570–576.

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as their Hippocratic predecessors. (A rare attempt to classify eye troubles with reference to the parts affected survives in the pseudo-Galenic introductio seu medicus 14. 767–777 K.; in this classification—though not in discussion of theory or description of treatment—the anatomical advances of the great Alexandrians are apparent.) Already Alkmaion put forward theories of sense perception based on the concept of ‘ducts’ leading from brain to eye (DK 24 A 5 = Thphr. de sens. 25) and similar concepts of psychophysiology can be seen not only in the Hippocratic Corpus (Loc. Hom. 1.3, 2.2 [6.276, 280 L.]; Carn. 17 [8.604 L.]), but also in the works of Aristotle (GA B 6. 744a8 and elsewhere).24 Both the supposed route and the postulated function of these ‘ducts’ were variously understood. Certainly there was progress towards understanding of the location and importance of the optic nerve, and certainly it came to be envisaged that pneuma ‘breath’ was conveyed from brain to eye (as already supposed, Morb. Sacr. 7 [6.374 L.]). But the theory of ducts or channels from the head has a much wider and simpler, more material, significance. The related theories of physiology, that optical wellbeing depended on the proper functioning of the ducts, which conveyed pure moisture to the healthy eye, and pathology, that the sight was affected if the ducts became blocked or flooded or conveyed peccant moisture to the diseased eye, can be seen pervasively in Greek medical texts of all eras. These theories are allied with the common general theory of a κατ(ρρους ‘downward flux’ from the head to various parts of the body through various channels, including channels linking the brain, via the cerebral or spinal fluid, to the lower body (Epid. 2. 4. 2 [5.126 L.]; Oss. 12 [9.182 L.]). Effects on the eye are described both in the Hippocratic Corpus (eye and lungs, Aer. 10 [2.46 L.]; cf. Aph. 3. 12 [4.490 L.]) and in related medical authors (eye, ear, and nose in Dexippos, Anon. Lond. XII. 22–26; eye and joints in Diokles fr. 137; night blindness caused by ‘moisture and excess’, Arist. GA 5. 1). Formulations in Galenic texts, though expressed in more sophisticated language, belong fundamentally to the same perception as that prevailing in the Hippocratic era. Thus, the author of Places in Man states that φλβια ‘little vessels’ from the brain nourish the eye with pure moisture but ποσβννυσι τ/ς ψιας ‘extinguish the organs of sight’ if they happen to dry up (Loc. Hom. 2.2 [6.280 L.]), while Galen tells us 24 On Aristotle, see von Staden, 1989, 157, n. 54; on Diokles, see van der Eijk II, 2001, 267.

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that when, in spite of no apparent disease affecting the eye, it happens that πλεσαι τ=ν πτικ=ν α8σησιν ‘the sense of sight is lost’, the cause is a νε6ρον ‘a nerve’ or ‘a duct’ from the brain swelling, damaged or blocked by a flux of moist matter (de locis affectis, 8. 218 K.; cf. on various destinations of a defluxion the pseudo-Galenic introductio seu medicus 14. 742 K. and on the different effects of moisture in different parts of the head—below skin, below bone, between membrane and bone—ibid. 14. 782 K.). Commenting on the Hippocratic Prognostic (Prog. 2 [2.114 L.], an account of ‘signs’ to be detected in the eyes of patients), Galen interprets through extensive paraphrase but still writes of ‘flux carried down from the head’ and gives its aetiology as πλ ος ‘excess’ or some kind of φλεγμον ‘inflammation’ or ‘phlegmatic content’ in the brain. Further, the same theories with the same rationale persist, perpetuated by Oreibasios and others, even in Paul of Aigina, who describes the cause of eye ailments as an acrid defluxion and makes a clear distinction between types situated above or below the skull.25 Surgical procedures too remain constant over the centuries. The operations performed in On Sight, other Hippocratic works and the Aristotelian Problemata (cautery of the vessels in the temples, πυκνο6ντες το?ς τν @γρν πρους ‘thickening up—i.e. reducing the width of—the channels of the fluids’ and scarification of the scalp) are paralleled in evidence from papyri for excising the temples and other areas of the scalp.26 Paul of Aigina describes attempts to dissipate or evacuate peccant matter by applying a cupping instrument to the back of the head, by scarification, by applying leeches to the temples and by poultices.27 Galen and Celsus, in conjunction with such Hippocratic writers as the authors of Prorrhetic 2, Diseases 2 and Places in Man, provide direct aid to understanding the abbreviated and allusive content of On Sight (see on 1, 3, 9) or have indirect corroborative relevance to it (see on 4, 6, and especially 7). This is evidence for the long currency and inherent conservatism of the physiological theories and surgical procedures concerned, rather than for direct influence of the earlier texts, though it seems likely that Celsus drew directly at least on Prorrhetic 2.28 In general, Galen—or contemporaries whose work has found its way into the Galenic corpus—favoured non-invasive procedures in treating the eye. 25 26 27 28

See Adams I 1844, 411–412; III 1847, 248. See Marganne, 1994, esp. 1–14. Adams I 1844, 420–421. See Pardon, 2005.

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Thus his remedy for accumulated rheum is simple: the problem is to be removed by a soft sponge with warm water (de remediis parabilibus, 14. 341 K.). He approves the simple Hippocratic recommendations of the aphoristic texts—neat wine, baths, vapour baths, phlebotomy, purging (Aph. 6. 31 [4.570 L.])—and regards the physician’s role as merely to aid nature (cf. the view that spontaneous diarrhoea gives relief in ophthalmia, Coac. 2. 220 [5.632 L.]). According to a later (Arabic) version, he lauded practitioners who cured by drugs alone, rather than by excision, not only growths such as pterygion and chalazion but also serious eye diseases such as cataract and trachoma (de optimo medico cognoscendo, CMG Suppl. Orientale 4. 10. 2). Trepanation was known but rarely practised.29 Celsus is much more interventionist. Archaeological finds of surgical kits, especially from Roman Gaul, confirm the evidence of Celsus for the practice of eye surgery; according to one modern ophthalmologist—writing before a further spectacular find near Lyon—these ‘could almost still be used’.30 Most of the conditions addressed (though not by name) in On Sight are of central and perennial importance in the history of ophthalmology: cataract, glaucoma, trachoma, recurrent conjunctivitis, night blindness. All of these conditions were addressed by ‘Susruta’, to whom is attributed a series of works in classical Sanskrit; this composition has its origins several centuries BC, but betrays several historical layers and different hands. The works show formidable clinical skill, including knowledge of how to couch cataracts, dislodging the lens of the eye. Like the surgeon of our treatise, Susruta favoured the use of general purgatives before starting specific ocular treatment; treatments used by both include scarification, venesection, cautery in the temporal region, use of copper sulphate for trachoma, prescription of (cooked) goat or sheep liver eaten with honey for night blindness and prescription of unguents mixed in a copper vessel; advice given by both is to avoid smoke, fire and bright lights.31 The ophthalmologists of ancient Egypt (known from Ebers papyrus, c. 1500 BC) knew a similar range of diseases and practised some of the same responses. In Kahun 1, in a gynaecological context, a meal of ‘fresh’ (possibly raw) liver is prescribed for a patient suffering loss of vision and neck pain. In Ebers 351, Rocca, 2003, 266, n. 1. Dolffus, 1968; on the find of 1975 see Feugère, Künzl, Weisser, 1985 and Jackson, 1996, 2249. 31 See Biyadhar, 1939, 1947; Wujastyk, 2003, 63–64. 29 30

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roasted ox liver is to be pressed to the eyes for sharu disease, regarded by some editors as night blindness.32 The names of many ophthalmologists over the centuries are associated with advancements in the understanding of and controversies over therapeutic methods for cataract and glaucoma. Celsus had attempted surgery for cataract in its early stages. Even after Rufus systematised the distinction between the two diseases, they were frequently spoken of together, and not clearly differentiated.33 Paul of Aigina regarded cataract as sometimes curable, glaucoma as always incurable.34 Cataract surgery was long a hit and miss affair, frequently the province of itinerant barbers, not of professional surgeons. Palliative couching remained the standard method until the middle of the eighteenth century, when a cataract was first successfully extracted by Daviel (in 1752); however, controversy still centred on the true nature of cataract (a disease of the lens or a structure in front of the lens) and so on the rival methods, some declaring fragmentation or discission was always to be preferred to extraction. Failure in skill and purulent infection were long hazards.35 In the nineteenth century, the initiation of iridectomy for glaucoma was a notable advance.36 However, the annals of the new professional bodies concerned with ophthalmology continue to be dominated by the question of how best to treat these two dominant diseases. Even today glaucoma and senile cataract, together with senile macular lesions and myopic chorioretinal atrophy, can be viewed as major causes of blindness and it is conceded that the underlying aetiology of these and many other eye disorders remains obscure.37 Trachoma too has generated a vast literature.38 The condition became prevalent in England in the early nineteenth century. Troops who had served in the Napoleonic wars were carriers and sufferers. In London, a special institution for blind ex-army personnel suffering from ‘Egyptian ophthalmia’ (a misleading designation) was founded—this later developed into Moorfields Eye Hospital—and ophthalmologists 32 See for the evidence Hirschberg, 1899, 1–19; Nunn, 1996, 200 and for different estimates of its significance Marganne, 1993 and Craik, 2005. 33 Marganne, 1979. 34 Adams I 1844, 420. 35 Blodi, 1996; on the designation ‘cataract’, see Fischer, 2000. 36 Kronfeld, 1996. 37 Cf. Sorsby, 1963, 505. 38 For a general survey, see Tower, 1963; on late antiquity, see Savage-Smith, 1984, 2000.

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vied with one another to discover a ‘cure’ for the condition.39 Trachoma has a tendency to associations with military operations, though this may be merely because of the overcrowding common in armies. It may have been carried to Greece from Egypt. However, it is not confined to these regions: there was an epidemic of Asian origin in Japan in 1897, affecting soldiers of the recent Sino-Japanese war. Treatment by scraping (to allow the release of noxious matter) and burning (to sterilize and accelerate wound closure) followed by application of a copper-based salve (as an astringent and haemostatic) remained standard until the twentieth century. Sichel adumbrates the history of medical fashions in recognising and addressing this condition and finds the method described in On Sight still ‘fort efficace et généralement usitée’. According to Duke-Elder, writing on this ‘immense subject’, copper still excelled, used as ‘blue stone’, a pointed crystal of copper sulphate held in a wooden holder and used for daily scouring of the lids. Other expedients were scarification with a knife and subsequent strong massage with antiseptics; or rubbing with a curette, hard brush or sandpaper; or attack on groups of blebs by galvanocautery— essentially detergent and caustic substances.40 A bizarre misinterpretation of a passage in On Sight led to a notorious dispute over the proper means of scarifying the eyelids. Woolhouse was a successful but highly controversial oculist of France and England in the late seventeenth to early eighteenth century. His career embraced extremes of effectiveness in practical operation and failure in conceptual understanding: on the one hand he performed iridectomy and restored patients’ sight; on the other he opposed the view that cataract was situated in the crystalline lens. Claiming a unique understanding of the Hippocratic method where a ‘spindle’ was employed, he used a teasle or thistle-like plant to perform surgery which he termed technically ophthalmoxusis or more popularly ‘degourdissement’, ‘degonflement’ on the internal surface of upper and lower lids for trachoma and many other conditions. He attracted both disciples (most notably B.D. Mauchart, professor of ophthalmology at Tubingen) who followed his practices, and enemies who regarded him as a charlatan operating for personal profit.41 39 On William Adams (later knighted as Sir William Rawson), John Cunningham Saunders and John Vetch, see Gorin, 1982, 73. 40 Sichel 123, 148; Duke-Elder II 1938, 1593, 1619, 1622; cf. Lawson, 1903, 535. 41 See Haller, 1755, 315–338 and Triller, 1766, 72 for trenchant criticism.

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Night blindness (7), a deficiency disease affecting the sight, is another important perennial condition. In general men are more susceptible to night blindness than women and, even among children, boys more prone than girls.42 Hippocratic authors knew this: the author of Prorrhetic 2 is correct, though too categorical, in differentiating between the sexes; in Epidemics 6, where night blindness is seen especially in children, the different developments and mutations of the disease in men and women are noted, and the author conjectures that the reasons for the relative incidence were that women were intrinsically less susceptible, or that women were more confined indoors. Λ μαι ‘rheum’ in the eyes (2—on the term see on 2.1) is indicative of underlying infection, which might have many precipitating causes and which, in the absence of good preventative hygiene and of drugs which could serve as antibiotics, must have been common and incurable. The inexorable progress of chronic eye disease to complete loss of sight can be seen from successive plays of Aristophanes, where Neokleides is mercilessly and unsympathetically portrayed: in around 392 he is simply γλ(μων ‘blear-eyed’ (Eccles. 254, 398); and in 388 he is completely blind, hoping for a miracle cure from Asklepios (Ploutos 665, 717–725). Archedamos too was characterized as ‘blear-eyed’ (Ar. Ran. 588, cf. Lys. 14. 25). A differentiation is imputed to the eyes of males and females in On Sight, and more explicitly in Prorrhetic 2. This may not be altogether fanciful, especially as the additional symptom ulceration is attributed by the author to women; but may rather indicate vigilant observation. It is now recognised (first noted in 1870 and confirmed by further studies) that there is a type of purulent conjunctivitis typical of young girls in which there is an association between primary vulvo-vaginitis and secondary conjunctivitis, or conjunctival gonorrhea.43 When Helmholtz in 1850 demonstrated the ophthalmoscope to the Physical Society of Berlin, exploration of the inner eye became possible for the first time. This completely altered understanding of the function of the eye and made obsolete the work of many—including Sichel, the editor of On Sight for Littré, who had been working for many years on a book entitled Iconographie Ophthalmologique without knowledge of the fundus.44 Many failed to capitalise on the new technology, which 42 43 44

Jayle et al., 1959, 176. See Duke-Elder II 1938, 1579. On Sichel as ‘a tragic person’ see Gorin, 1982, 84–85.

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only gradually became accepted.45 In modern ophthalmology the ‘slitlamp’ (a combination light and microscope for examination of the eye) is ubiquitous; but of course our surgeon saw only what could be seen with the naked eye. Some of the areas selected for cutting and cautery by the physician of On Sight (3) coincide with the points targeted by modern oriental practitioners treating eye disorders by acupuncture or (especially) moxibustion, and their practices have a very long history.46 Of course there is a ready explanation for these similarities in treatment: as human physiology is constant, it is intrinsically probable that doctors of different societies at different times should treat similar afflictions in a similar way simply because they separately have discovered an effective treatment on an empirical practical basis. After all, doctors do not cut and burn for fun, but in the hope of a cure; and they do not advocate treatments which never work, or at least seem to work. Even today, the reasons for the undoubted effectiveness of the practice of acumoxa is not understood; the treatment seems to stimulate the body to resist disease and to become stronger, but its workings, especially in relation to particular diseases, where it acts not merely as a palliative but actually as a remedy, are mysterious. It has been suggested that acupuncture raises the red corpuscle count and enhances blood circulation; that it stimulates the nervous system (perhaps through specific neurological reactions between parts treated and parts affected); that it provokes responses in the cerebral cortex which in turn react on the organs. It is possible to review anatomical data seeming to vindicate some of our surgeon’s ideas and practices: there is an external blood supply to the skull by the temporal arteries; there is a direct link of cerebro-spinal fluid to the eyeball through the optic nerve.47 In visual function, the ocular blood circulation is fundamentally important and systemic diseases undoubtedly affect the complex physiology of the eye. Disputes over the proper methods in ophthalmology permeate works of the nineteenth century: even such an apparently simple question as the desirability of exclusion of light was still debated, as were the pros and cons of dividing or opening the temporal artery, the choice of scissors or knife for surgery and the choice of agents or procedures to treat 45 46 47

Duke-Elder, 1958. For discussion, see Craik, forthcoming; see also Charlevoix, 1754. On the orbital blood supply, see Spalton et al., 2005, 674–675, fig. 20.7 and 20. 8.

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the palpebral surface.48 Trepanation was still sometimes practised to alleviate cerebral seizures accompanied by sight loss, through drainage of pus collected between bone and dura.49 In the early years of the twentieth century, many of the procedures found in On Sight were still advocated: local blood-letting (scarification and cupping at the temples; bleeding by leeches); application of heat; cautery by a ‘burnt wood’ needle; ‘grattage and swabbage’ for trachoma, with instruction to rub with gauze wrapped in a wooden spatula, after bleeding had completely stopped; and for night blindness ingestion of liver of ox, goat or sheep fried in oil and well seasoned (5 to 10 ounces, three times a day).50 For this reason, the selected reference books cited here are drawn from a range of dates, roughly a generation apart. The most modern authority noted is David Spalton, a distinguished consultant ophthalmologist who was kind enough to scan this commentary in draft form. He concluded: ‘It seems he described a number of diseases and one can only guess at what the modern diagnosis is; in some ways this does not seem important as the treatment was the same.’

48 49 50

Vetch, 1820, 16–17, 38–39, 81 etc. Hirschberg I 1982 (tr. Blodi), 93, n. 403. Wood, 1909, 78–79, 79–80, 81, 83, 801.

REFERENCES AND ABBREVIATIONS Anon. Lond. BMD CIH CMG CUF DK DR Duke-Elder Ermerins Erot. Foesius Gal. GMT HC Hsch. Joly LSJ Sichel

Anonymus Londinensis (ed. Jones, London, 1947) Black’s Medical Dictionary (39th edn, London, 1999 and repr.) Colloque International Hippocratique Corpus Medicorum Graecorum Collection des Universités de France (Association G. Budé) H. Diels and W. Kranz, Die Fragmente der Vorsokratiker (6th edn, Berlin and Zurich, 1952) C. Daremberg and C.E. Ruelle, Oeuvres de Rufus d’Éphèse (Paris, 1879) Sir W.S. Duke-Elder, Text-Book of Ophthalmology (London, 1932–1954) ed., vol. 3 (Utrecht, 1864), 278–283; praefatio XL–XLI Erotian (ed. Nachmanson, 1918) ed., cited with volume and page ref. to revised edn (Geneva, 1657 and 1662) Galen, cited with volume and page ref. to C.G. Kühn, Claudii Galeni Opera Omnia (Leipzig, 1821–1830) [K.] W.W. Goodwin, Syntax of Moods and Tenses of the Greek Verb (London, 1889) Hippocratic Corpus Hesychios, cited with page ref. to K. Latte, Hesychii Alexandrini Lexicon (Copenhagen, 1953) ed. (Paris, 1978), 163–171 H.G. Liddell, R. Scott, and H.S. Jones, Greek-English Lexicon ed. ap. Littré ed. vol. 9 (Paris, 1861), 152–161

Abbreviations for ancient authors and works (including Hippocratic treatises) follow LSJ.

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CONSPECTUS SIGLORUM memorantur in app. crit.: M H I R

Marcianus gr. 269, s. X Parisinus gr. 2142, pars antiquior, s. XII Parisinus gr. 2140, s. XIII Vaticanus gr. 277, s. XIV

memorantur in comm.: Ca E F G J K Laur. Mut. O Q U W Z

Cantabrig. Caius Coll. 50, s. XV Parisinus gr. 2255, s. XV Parisinus gr. 2144, s. XIV Parisinus gr. 2141, s. XV Parisinus gr. 2143, s. XIV Parisinus gr. 2145, s. XV Laurentianus 74, 1, s. XV Mutinens. Estensis gr. 220, s. XV Baroccianus 204, s. XV Vossianus fol. 10, s. XVI Urbinas 68, s. XIV Vaticanus gr. 278, a. 1512 Parisinus gr. 2148, s. XVI

non vidi: Haun. Mo.

Hauniens. Gl. Kgl. 224, s. XVI Monacensis gr. 71, s. XV

TEXT

I 1. α ψιες α διεφαρμναι, ατματοι μ*ν κυαντιδες γινμεναι, )ξαπνης γνονται, κα )πειδ/ν γνωνται, οκ &στιν 8ησις τοια#τη. α δ* αλασσοειδε7ς γινμεναι, κατ/ μικρCν )ν πολλ" χρν"ω διαφερονται, κα πολλ(κις ' Dτερος φαλμCς )ν πολλ" χρν"ω 4στερον διεφ(ρη. το#του δ* χρ= κααρειν τ=ν κεφαλ=ν κα καειν τ/ς φλβαςE κFν ρχμενος π(+η 5 τα6τα, Gσταται τC κακCν κα ο χωρε7 )π τC φλαυρτερον.

2. α δ* μεταξ? τ ς τε κυαντιδος κα τ ς αλασσοειδος, Fν μ*ν ν"ω )ντι γνωνται, πρεσβυτρ"ω γινομν"ω καστανταιE Fν δ* πρεσβυτρ"ω )ντι γνωνται )των Hπτ(, βλτιον 'ρ+ κα τ/ μεγ(λα π(νυ κα λαμπρ(, κα πC πρσεν 'ρ+ μ*ν, σαφως δ* οIE κα  τι 9ν π(νυ πρCς ατCν τCν 10

φαλμCν προσ+ , κα το6το, 1λλως δ* οδν. συμφρει δ* το#τ"ω κα6σις κα κ(αρσις τ ς κεφαλ ςE αJμα δ* το#τοισιν ο συμφρει φιναι, οIτε τ+ κυαντιδι, οIτε τ+ αλασσοειδε7.

II 1. τ/ λημα )ν το7σιν φαλμο7σι, τ ς ψιος @γιος )ο#σης τν νεωτρων νρ5πων, Kν τε ηλεα +L, Kν τε 1ρσην, οκ 9ν :φελοης ποιων οδν, 15

1 MΙπποκρ(τους περ ψιος fere codd. | ατματοι edd.: ατμαται codd. 2 τοια#τη codd.: τοια#τ+ησιν Heidel 4 )ν πολλ" χρν"ω 4στερον διεφ(ρη M fere recc.: )ν πολλ" χρν"ω διεφ(ρη 4στερον R: 4στερον om. Asulanus: )ν πολλ" χρν"ω forsitan delendum 6 τα6τα codd.: τατ/ fortasse Joly 5 π(+η MHI: εραπε#+η H2 R fere recc. 8 πρεσβυτρ"ω γενομν"ω M H2I: novit Foesius | φλαυρτερον M: φαυλτερον recc. πρεσβυτρ"ω γινομν"ω H 9 γνωνται (γγνωνται, γνωνται) recc: γγνονται M | post Hπτ( lacunam indicant Iugler et Sichel | 'ρ+ κα τ/ μεγ(λα π(νυ MH (sed del. κα H2): 'ρ+ τ/ μεγ(λα δ* π(νυ IR 10 ατCν Ermerins: HωυτCν MIR: HαυτCν H fere recc. 11 1λλως MH: 1λλο H2IR fere recc. 11–12 κα6σις κα κ(αρσις MH: κ(αρσις κα 13 αλασσοειδε7 edd.: αλασσοειδ κα6σις H2: κ(αρσς τε κα κα6σις IR fere recc. codd. 14 τ/ λημα Craik: τC μμα MH: κα τC μμα IR fere recc. 15 λεια M (vel ηλεα) recc.:  λυς Joly | Kν τ’ 1ρσην MI fere recc.: ε8 τε 1ρσην HR | :φελοης M: :φελεης recc.: :φελοις Joly | οδ*ν van der Linden: ο*ν codd.

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I 1. As for the visual parts, destroyed, when these become spontaneously lapis-like, they become so all of a sudden, and once they do become so, there is no such treatment. As for those which become sea-like, they are destroyed gradually, over a long time, and often the second eye is destroyed a long time later. Of this person, one should purge the head and cauterise the vessels; and if he has this done at the beginning, the trouble is arrested and does not go on to get worse. 2. In cases where the parts are intermediate between lapis-like and sealike: if they become so when someone is young, they settle down when he gets older; if they become so when someone is older than seven years, he sees quite well things which are really big and bright, and he sees ahead, but not clearly, and whatever he sets right in front of the eye, he sees that too, but nothing else. For this person, cautery and purging the head is beneficial. It is not beneficial to let blood in these people, either in the lapis-like or the sea-like case. II 1. In the case of sores in the eyes, where the visual part is sound, in younger people, whether the person is female or male, you could not help by any action at all, as long as the body is still growing. But when it

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Dως 9ν αIξηται τC σμα &τι. ταν δ* μηκτι αξ(νηται, ατ< τ< φαλμ< σκεψ(μενος τ/ βλφαρα λεπτ#νειν, ξ#ων, Fν δοκ+ προσδε7σαι, κα )πικαων &νδοεν μ= διαφανσιν.

III 1. &πειτα ναδσας, τ/ σκλεα )κτενας, δφρον @ποες φ’ οP στηρζηται τ+ σι χερσ, μσον δ τις )χτω, &πειτα διασημνασαι τ/ς νωτιαας 5 φλβας, σκοπε7ν δ* πισεν. &πειτα καειν παχσι σιδηροισι κα συχ+η διαερμανειν, πως 9ν μ= Qαγ+ αJμα καοντι. προαφιναι δ* το6 αGματος, Fν δοκ+ καιρCς εRναι. καειν δ* κα πρCς τC στον πισεν.

2. &πειτα )νες σπγγον Sλαιωμνον )γκατακαειν, πλ=ν το6 π(νυ πρCς ατ" τ" στ"ωE Fν δ* προσδχηται τ" καυστηρ"ω τC σπογγον, Dτερον 10 λιπαρ5τερον )νες )γκατακαειν. &πειτα το6 1ρου μλιτι δε#ων, )ντιναι τ+ σιν )σχ(ρ+ησιν.

3. ταν δ* φλβα παρακα#σ+ης F διακα#σ+ης, )πειδ/ν )κπσ+η  )σχ(ρη, 'μοως τταται  φλ*ψ κα πεφ#σηται κα πλρης φανεται, κα σφ#ζει τε 1νωεν τC )πιρρονE Fν δ* διακεκαυμνος +L τε κ(τωεν, τα6τα π(ντα 15 Tσσον π(σχει. διακαειν δ* χρ= αUτις, Fν μ= τC πρτον διακα#σ+ης. τ( τε σπγγια χρ= ,σχυρς )γκατακαειν, πρCς τ ς Qεο#σης φλεβCς μVλλον.

4. α )σχ(ραι α μVλλον πτηε7σαι τ(χει )κππτουσιν. α καιμεναι ολα πρCς τC στον καλλονες γνονται. )πειδ/ν δ* τ/ Dλκεα @για γνωνται, αUτις ναφυσνται κα )παρονται, κα )ρυρα ε,σι παρ/ τC 1λλο, κα 20 Wσπερ ναιρησμεναι φανονται, Dως 9ν χρνος )πιγνηταιE κα κεφαλ ς καυεσης κα στεος, 'μοως δ* κα παντ τ" σ5ματι που 9ν καυ+ .

1–2 ατ< τ< φαλμ< Ermerins: ατ"ω τ" φαλμ" codd. 2 λεπτ#νειν MHIR: λεπτ#νει Asulanus | προσδε7σαι codd.: προσδχεσαι Triller 4 φ’ codd.: )φ’ van der Linden 4–5 στηρζηται MHIR: στηρζεται fere recc. 5 &πειτα διασημνασαι codd.: διασημνασαι (del. &πειτα) Ermerins 6 σιδηροισι fere recc.: σιδηροισιν M 9 σπγγον MHIR: σπογγον Foesius ex 8 καειν … πισεν codd.: del. Ermerins Fevr. ms novit | post )γκατακαειν lac. in ras. I 11 μλιτι MHR: )ν μλιτι I fere recc. 13 F διακα#σ+ης del. Ermerins 14–15 τε 1νωεν … τε κ(τωεν Craik: τε κ(τωεν … ' κ(τωεν codd.: τι κ(τωεν (del. ' κ(τωεν) Ermerins: τε κ(τωεν … (del. ') κ(τωεν Joly 17 ,σχυρς MI: κανς HR, Foesius ex Fevr. ms novit 18 τ(χει HIR: τ(χι aut ταχ# M (?cum corr.): τ(χι recc. nonnulli: τ(χιστα Foesius ex Fevr. et reg. mss novit 20 )ρυρα MHIR: )ρυρ( Cornarius 21 ναιρησμεναι codd.: ναρρηξμεναι Foesius ex Serv. ms novit: ναρραγησμεναι Ermerins | φανονται recc.: φανωνται M | Dως 9ν fere recc.: Dως Lν M 22 'μοως δ* κα codd.: 'μοως κα (del. δ*) Joly | παντ codd.: )ν παντ Ermerins | 9ν fere recc.: Fν M

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is no longer growing, considering the actual eyes, attenuate the eyelids, scraping, if you think they need this too, and cauterising from the inner part, but not with white-hot instruments. III 1. Then (set the patient) on a couch from which he can lean with his hands; get his legs outstretched; tie on (a ligature). Let someone hold his waist. Then trace the vessels of (= running to) the back, and examine from behind. Then cauterise with thick (metal) instruments and heat gently, so that there is no haemorrhage as you cauterise. Let blood in advance, if it seems the right course. Cauterise towards the bone (= skull) from behind. 2. Then put in place a sponge soaked in olive oil. Cauterise over it, but not right up to the bone. If the patient accepts the sponge with the instrument, put in place another, better-oiled, and cauterise over it. Then moisten arum (root?) with honey, and put this on the eschars (= scabs). 3. When you have cauterised by or through a vessel, once the scab has fallen off, the vessel is stretched and swollen and apparently full just as before. And it beats when the flux comes from above, but if the patient has been cauterised when the flux comes from below he experiences all this to a lesser degree. You must cauterise through (the vessel) again, if you did not cauterise through (it) the first time. You should cauterise over sponges strongly, especially in the case of a vessel which haemorrhages. 4. Scabs which are relatively well browned fall off quickly. Scars in cautery towards the bone turn out better. When the sores are healed, the scars are swollen and raised and red compared with the rest (of the flesh) and look as if they will remain raised, until time has passed. It is the same when the head is cauterised or the chest or in all the body, wherever there is cautery.

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text IV

1. ταν δ* ξ#+ης βλφαρα φαλμο6, ξ#ειν ε,ρ"ω Μιλησ"ω, οIλ"ω, κααρ", περ 1τρακτον περιειλων, ατ=ν τ=ν στεφ(νην το6 φαλμο6 φυλασσμενοςE μ= διακα#σ+ης πρCς τCν χνδρον. σημε7ον δ* ταν ποχρ+ τ ς ξ#σιος, οκ &τι λαμπρCν αJμα &ρχεται, λλ/ ,χ