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Hippocrates · Prognostic §1-2

Importance of Prognosis and Death Signs in the Face

Passage 1 of 10 · Greek

Summary

Explains the vital importance of prognosis for physicians, and details how to observe the patient's face (the classic Hippocratic facies) and eyes in acute diseases to foresee impending death.

§1## ΠΡΟΓΝΩΣΤΙΚΟΝ 1.
PROGNOSIS 1.
Τὸν ἰητρὸν δοκέει μοι ἄριστον εἶναι πρόνοιαν ἐπιτηδεύειν·
It seems to me to be best for the physician to cultivate prognosis.
προγιγνώσκων γὰρ καὶ προλέγων παρὰ τοῖσι νοσέουσι τά τε παρεόντα καὶ τὰ προγεγονότα καὶ τὰ μέλλοντα ἔσεσθαι, ὁκόσα τε παραλείπουσιν οἱ ἀσθενέοντες ἐκδιηγεύμενος, πιστεύοιτ᾿ ἂν μᾶλλον γιγνώσκειν τὰ τῶν νοσεόντων πρήγματα, ὥστε τολμᾷν ἐπιτρέπειν τοὺς ἀνθρώπους σφέας ἑωυτοὺς τῷ ἰητρῷ.
For by foreknowing and foretelling, in the presence of the sick, the present, the past, and the future, and by explaining thoroughly what the sick omit, he would be believed to understand the cases of the sick better, so that men would dare to entrust themselves to the physician.
Τὴν δὲ θεραπείην ἄριστα ἂν ποιέοιτο, προειδὼς τὰ ἐσόμενα ἐκ τῶν παρεόντων παθημάτων.
And he would conduct the treatment best, if he foreknew the future from the present symptoms.
Ὑγιέας μὲν γὰρ ποιέειν ἅπαντας τοὺς ἀσθενέοντας ἀδύνατον· τοῦτο γὰρ τοῦ προγιγνώσκειν τὰ μέλλοντα ἀποβήσεσθαι κρέσσον ἂν ἦν·
For to make all sick people healthy is impossible; for this would have been better than foreknowing what is going to happen.
ἐπειδὴ δὲ οἱ ἄνθρωποι ἀποθνήσκουσιν, οἱ μὲν πρὶν ἢ καλέσαι τὸν ἰητρὸν, ὑπὸ τῆς ἰσχύος τῆς νούσου, οἱ δὲ καὶ ἐσκαλεσάμενοι παραχρῆμα ἐτελεύτησαν, οἱ μὲν ἡμέρην μίην ζήσαντες, οἱ δὲ ὀλίγῳ πλέονα χρόνον, πρὶν ἢ τὸν ἰητρὸν τῇ τέχνῃ πρὸς ἕκαστον νούσημα ἀνταγωνίσασθαι· γνῶναι οὖν χρὴ τῶν παθέων τῶν τοιουτέων τὰς φύσιας, ὁκόσον ὑπὲρ τὴν δύναμίν εἰσι τῶν σωμάτων, ἅμα δὲ καὶ εἴ τι θεῖον ἔνεστιν ἐν τῇσι νούσοισι, καὶ τουτέου τὴν πρόνοιαν ἐκμανθάνειν.
But since men die, some before calling the physician, by the strength of the disease, and others even after calling him, died immediately, some living for one day, and others for a little longer time, before the physician could contest each disease by his art; therefore one must know the natures of such diseases, how far they are beyond the power of bodies, and at the same time whether there is anything divine in the diseases, and learn thoroughly the prognosis of this.
Οὕτω γὰρ ἂν θαυμάζοιτό τε δικαίως, καὶ ἰητρὸς ἀγαθὸς ἂν εἴη· καὶ γὰρ οῦς οἷόν τε περιγίγνεσθαι, τοὐτους ἔτι μᾶλλον δύναιτ᾿ ἂν ὀρθῶς διαφυλάσσειν, ἐκ πλείονος χρόνου προβουλευόμενος πρὸς ἕκαστα, καὶ τοὺς ἀποθανουμένους τε καὶ σωθησομένους προγιγνώσκων καὶ προαγορεύων ἀναίτιος ἂν εἴη.
For thus he would be justly admired, and would be a good physician; for those who are capable of surviving, he would be able to preserve even better by taking thought beforehand for each thing from a longer time, and by foreknowing and foretelling those who will die and those who will be saved, he would be free from blame.
§22.
2.
Σκέπτεσθαι δὲ χρὴ ὧδε ἐν τοῖσιν ὀξέσι νουσήμασι· πρῶτον μὲν τὸ πρόσωπον τοῦ νοσέοντος, εἰ ὅμοιόν ἐστι τοῖσι τῶν ὑγιαινόντων, μάλιστα δὲ, εἰ αὐτὸ ἑωυτέῳ.
One must examine as follows in acute diseases: first, the face of the sick man, whether it is like those of healthy people, and especially, whether it is like itself.
Οὕτω γὰρ ἂν εἴη ἄριστον, τὸ δ᾿ ἐναντιώτατον τοῦ ὁμοίου, δεινότατον.
For thus it would be best, but that which is most opposite to the likeness is most dangerous.
Εἴη δ᾿ ἂν τὸ τοιόνδε· ῥὶς ὀξεῖα, ὀφθαλμοὶ κοῖλοι, κρόταφοι ξυμπεπτωκότες, ὦτα ψυχρὰ καὶ ξυνεσταλμένα, καὶ οἱ λοβοὶ τῶν ὤτων ἀπεστραμμένοι, καὶ τὸ δέρμα τὸ περὶ τὸ μέτωπον σκληρόν τε καὶ περιτεταμένον καὶ καρφαλέον ἐόν.
And it would be of this kind: a sharp nose, hollow eyes, collapsed temples, cold and contracted ears, and the lobes of the ears turned back, and the skin about the forehead hard, stretched, and dry.
Καὶ τὸ χρῶμα τοῦ ξύμπαντος προσώπου χλωρόν τε ἢ καὶ μέλαν ἐὸν, καὶ πελιὸν, ἢ μολιβδῶδες.
And the color of the whole face being pale or even black, and livid, or lead-colored.
Ἢν μὲν οὖν ἐν ἀρχῇ τῆς νούσου τὸ πρόσωπον τοιοῦτον ᾖ, καὶ μήπω οἷόν τε ᾖ τοῖσιν ἄλλοισι σημείοισι ξυντεκμαίρεσθαι, ἐπανερέσθαι χρὴ, μὴ ἠγρύπνησεν ὁ νοσέων, ἢ τὰ τῆς κοιλίης ἐξυγρασμένα ᾖ ἰσχυρῶς, ἢ λιμῶδές τι ἔχῃ αὐτόν· κἢν μέν τι τουτέων ὁμολογέῃ, ἧσσον νομίζειν δεινὸν εἶναι· κρίνεται δὲ τὰ τοιαῦτα ἐν ἡμέρῃ τε καὶ νυκτὶ, ἢν διὰ ταύτας τὰς προφάσιας τὸ πρόσωπον τοιοῦτον ᾖ.
If, then, the face is such at the beginning of the disease, and it is not yet possible to judge from the other signs, one must ask further, whether the sick man has been sleepless, or his bowels have been violently loose, or he has some hunger; and if he confesses to any of these, one should consider it less dangerous; and such matters are decided in a day and a night, if the face is such because of these reasons.
Ἢν δὲ μηδὲν τουτέων φῇ εἶναι, μηδὲ ἐν τῷ χρόνῳ τῷ προειρημένῳ καταστῇ, εἰδέναι χρὴ ἐγγὺς ἐόντα τοῦ θανάτου.
But if he says none of these is the case, and it does not recover in the aforementioned time, one must know that he is near death.
Ἢν δὲ καὶ παλαιοτέρου ἐόντος τοῦ νουσήματος, ἢ τριταίου ἢ τεταρταίου, τὸ πρόσωπον τοιοῦτον ᾖ, περὶ τουτέων ἐπανε ρέσθαι, περὶ ὧν καὶ πρότερον ἐκέλευσα, καὶ τἄλλα σημεῖα σκέπτεσθαι, τά τε ἐν τῷ ξύμπαντι προσώπῳ, τά τε ἐν τῷ σώματι, καὶ τὰ ἐν τοῖσιν ὀφθαλμοῖσιν.
And if, when the disease is of longer standing, either on the third or fourth day, the face is such, one must ask further about those things which I previously ordered, and examine the other signs, both in the whole face, and in the body, and in the eyes.
Ἢν γὰρ τὴν αὐγὴν φεύγωσιν, ἢ δακρύωσιν ἀπροαιρέτως, ἢ διαστρέφωνται, ἢ ὁ ἕτερος τοῦ ἑτέρου ἐλάσσων γίγνηται, ἢ τὰ λευκὰ ἐρυθρὰ ἴσχωσιν, ἢ πελιὰ, ἢ φλέβια μέλανα ἐν ἑωυτέοισιν ἔχωσιν, ἢ λῆμαι φαίνωνται περὶ τὰς ὄψιας, ἢ καὶ ἐναιωρεύμενοι, ἢ ἐξίσχοντες, ἢ ἔγκοιλοι ἰσχυρῶς γιγνόμενοι, ἢ αἱ ὄψιες αὐχμῶσαι καὶ ἀλαμπέες, ἢ τὸ χρῶμα τοῦ ξύμπαντος προσώπου ἠλλοιωμένον ᾖ, ταῦτα πάντα κακὰ νομίζειν καὶ ὀλέθρια εἶναι.
For if they avoid the light, or shed tears involuntarily, or are distorted, or one becomes smaller than the other, or the whites of them become red, or livid, or have black veins in them, or rheum appears about the eyes, or they are either projecting, or become deeply hollowed, or the eyes are dry and dim, or the color of the whole face is altered, all these must be considered bad and fatal.
Σκοπέειν δὲ χρὴ καὶ τὰς ὁποφάσιας τῶν ὀφθαλμῶν ἐν τοῖσιν ὕπνοισιν· ἢν γάρ τι ὑποφαίνηται τοῦ λευκοῦ, τῶν βλεφάρων μὴ ξυμβαλλομένων, μὴ ἐκ διαῤῥοίης ἢ φαρμακοποσίης ἐόντι, ἢ μὴ εἰθισμένῳ οὕτω καθεύδειν, φλαῦρον τὸ σημεῖον καὶ θανατῶδες λίην.
And one must also observe the showing of the eyes in sleep; for if any of the white is visible, the eyelids not closing, unless it is from diarrhea or purging, or unless he is accustomed to sleep thus, the sign is unfavorable and very fatal.
Ἢν δὲ καμπύλον γένηται, ἢ πελιὸν, ἢ ὠχρὸν βλέφαρον, ἢ χεῖλος, ἢ ῥὶς, μετά τινος τῶν ἄλλων σημείων, εἰδέναι χρὴ ἐγγὺς ἐόντα θανάτου· θανατῶδες δὲ καὶ χείλεα ἀπολυόμενα, καὶ κρεμάμενα, καὶ ψυχρὰ, καὶ ἔκλευκα γιγνόμενα.
And if a eyelid, lip, or nose becomes distorted, livid, or pale, along with some of the other signs, one must know that he is near death; and it is fatal also for the lips to become loose, hanging down, cold, and pale.

Notes

  1. 1Τὸν ἰητρὸν — Serves as the subject accusative of the infinitive ἐπιτηδεύειν, which together form an accusative with infinitive (AcI) construction serving as the subject of the impersonal verb δοκέει.
  2. 1τοῦτο γὰρ τοῦ προγιγνώσκειν τὰ μέλλοντα ἀποβήσεσθαι κρέσσον ἂν ἦν — An apodosis of a contrary-to-fact conditional with the particle ἄν and the imperfect indicative ἦν, representing an impossible situation. The genitive article with the infinitive, τοῦ προγιγνώσκειν, functions as a genitive of comparison dependent on κρέσσον.
  3. 1εἴ τι θεῖον ἔνεστιν — An indirect question introduced by εἴ. In the Hippocratic corpus, the "divine element" (τι θεῖον) refers not to supernatural intervention but to those natural forces beyond human control, such as seasonal and atmospheric changes.
  4. 2μὴ ἠγρύπνησεν — An indirect question introduced by μὴ after the verb of asking, ἐπανερέσθαι, meaning "whether perhaps he has been sleepless," rather than serving as a simple negative.

Cite this passage

Hippocrates, Prognostic §1-2. Humanitext Reader, https://reader.humanitext.ai/en/text/urn:cts:greekLit:tlg0627.tlg003.humanitext-grc1:1-2

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