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Hippocrates · Prognostic §21-23

Prognosis of Headache, Earache, and Throat Affections

Passage 9 of 10 · Greek

Summary

The author details the prognosis of headache, ear pain, and throat diseases (including cynanche) accompanied by fever, explaining the differences in disease progression by patient age and the safe timing for uvula surgery.

§2121.
21.
Κεφαλῆς δὲ ὀδύναι ἰσχυραί τε καὶ ξυνεχέες ξὺν πυρετῷ· ἢν μέν τι τῶν θανατωδέων σημείων προσγίγνοιτο, ὀλέθριον κάρτα.
Strong and continuous headaches accompanied by fever: if any of the deadly signs are added, it is very fatal.
Εἰ δὲ ἄτερ τῶν τοιούτων σημείων ἡ ὀδύνη ὑπερβάλλοι εἴκοσιν ἡμέρας, ὅ τε πυρετὸς ἔχοι, ὑποσκέπτεσθαι χρὴ αἵματος ῥῆξιν διὰ ῥινῶν, ἢ ἄλλην τινὰ ἀπόστασιν ἐς τὰ κάτω χωρία·
But if, without such signs, the pain exceeds twenty days and the fever persists, one must suspect a rupture of blood through the nostrils, or some other metastasis to the lower parts.
ἔστ᾿ ἂν δὲ ἡ ὀδύνη ᾖ νεαρὰ, προσδέχεσθαι χρὴ ὡσαύτως αἵματος ῥῆξιν διὰ ῥινῶν, ἢ ἐκπύησιν, ἄλλως τε ἢν ἡ ὀδύνη περὶ τοὺς κροτάφους καὶ τὸ μέτωπον ᾖ· μᾶλλον δὲ χρὴ προσδέχεσθαι τοῦ μὲν αἵματος τὴν ῥῆξιν τοῖσι νεωτέροισι πέντε καὶ τριήκοντα ἐτέων, τοῖσι δὲ γεραιτέροισι τὴν ἐκπύησιν.
And as long as the pain is recent, one must likewise expect a rupture of blood through the nostrils, or suppuration, especially if the pain is about the temples and the forehead; but one must rather expect the rupture of blood in those younger than thirty-five years, and suppuration in the older.
§2222.
22.
Ὠτὸς δὲ ὀξείη ὀδύνη ξὺν πυρετῷ ξυνεχεῖ τε καὶ ἰσχυρῷ δεινόν· κίνδυνος γὰρ παραφρονῆσαι τὸν ἄνθρωπον καὶ ἀπολέσθαι.
An acute pain of the ear with a continuous and strong fever is dangerous; for there is a risk that the patient will become delirious and perish.
Ὡς οὖν τουτέου τοῦ τόπου σφαλεροῦ ἐόντος, ταχέως δεῖ προσέχειν τὸν νόον τοῖσι σημείοισι πᾶσιν ἀπὸ τῆς πρώτης ἡμέρης.
Therefore, as this place is hazardous, one must quickly pay attention to all the signs from the first day.
Ἀπόλλυνται δὲ οἱ μὲν νεώτεροι τῶν ἀνθρώπων ἑβδομαῖοι καὶ ἔτι θᾶσσον ὑπὸ τουτέου τοῦ νουσήματος· οἱ δὲ γέροντες πολλῷ βραδύτερον· οἵ τε γὰρ πυρετοὶ καὶ αἱ παραφροσύναι ἧσσον αὐτέοισιν ἐπιγίγνονται, καὶ τὰ ὦτα διὰ τοῦτο φθάνει ἐκπυΐσκεσθαι· ἀλλὰ ταύτῃσι μὲν τῇσιν ἡλικίῃσιν ὑποστροφαὶ τοῦ νουσήματος ἐπιγιγνόμεναι ἀποκτείνουσι τοὺς πλείστους.
Younger people die on the seventh day or even sooner from this disease; but the elderly die much slower; for fevers and delirium occur less in them, and because of this, the ears suppurate first; but in these ages, relapses of the disease occurring kill most of them.
Οἱ δὲ νεώτεροι, πρὶν ἐκπυῆσαι τὸ οὖς, ἀπόλλυνται· πλὴν ἀλλ᾿ ἤν γε ῥυῇ πῦον λευκὸν ἐκ τοῦ ὠτὸς, ἐλπὶς τῷ νεωτέρῳ περιγενέσθαι, ἤν γε καὶ ἄλλο τι αὐτέῳ ἐπιγένηται χρηστὸν σημεῖον.
The younger, however, die before the ear suppurates; unless white pus flows from the ear, in which case there is hope for the younger person to recover, provided some other good sign also appears in him.
§2323.
23.
Φάρυγξ δὲ ἑλκουμένη ξὺν πυρετῷ δεινόν· ἀλλ᾿ ἤν τι καὶ ἄλλο σημεῖον γένηται τῶν προκεκριμένων πονηρῶν εἶναι· , προλέγειν δεῖ ὡς ἐν κινδύνῳ ἐόντος τοῦ ἀνθρώπου.
An ulcerated throat with fever is dangerous; but if any other of the signs previously judged to be bad also occurs, one must foretell that the patient is in danger.
Αἱ δὲ κυνάγχαι δεινόταται μέν εἰσι, καὶ τάχιστα ἀναιρέουσιν, ὁκόσαι μήτε ἐν τῇ φάρυγγι μηδὲν ἔκδηλον ποιέουσι, μήτε ἐν τῷ αὐχένι, πλεῖστον δὲ πόνον παρέχουσι καὶ ὀρθόπνοιαν· αὗται γὰρ καὶ αὐθημερὸν ἀποπνίγουσι, καὶ δευτεραῖαι, καὶ τριταῖαι, καὶ τεταρταῖαι.
And squinancies (cynanches) are most dangerous, and kill most quickly, which produce nothing visible either in the throat or in the neck, but cause the greatest pain and orthopnea; for these suffocate even on the very first day, and on the second, the third, and the fourth.
Ὅσαι δὲ τὰ μὲν ἄλλα παραπλησίως πόνον παρέχουσιν, ἐπαίρονται δὲ, καὶ ἐρυθήματα ἐν τῇ φάρυγγι ποιέουσιν, ὀλέθριαι μὲν κάρτα, χρονιώτεραι δὲ μᾶλλον τῶν πρόσθεν, ἢν τὸ ἐρύθημα μέγα γίγνηται.
But those which cause similar pain in other respects, but swell up and produce redness in the throat, are indeed very fatal, but more prolonged than the former, if the redness becomes large.
Ὁκόσοισι δὲ ξυνεξερευθείη ἡ φάρυγξ καὶ ὁ αὐχὴν, αὗται δὴ χρονιώτεραι, καὶ μάλιστα ἐξ αὐτέων τινὲς περιφεύγουσιν, ἢν ὅ τε αὐχὴν καὶ τὸ στῆθος ἐρύθημα ἔχῃ, καὶ μὴ παλινδρομέῃ τὸ ἐρυσίπελας ἔσω.
And those in whom the throat and the neck are red together are indeed more prolonged, and especially some of them escape, if indeed both the neck and the chest have redness, and the erysipelas does not retreat inward.
Ἢν δὲ μήτε ἐν ἡμέρῃσι κρισίμῃσιν ἀφανίζηται τὸ ἐρυσίπελας, μήτε φύματος ξυστραφέντος ἐν τῷ ἔξω χωρίῳ, μήτε πῦον ἀποβήσσῃ, ῥηϊδίως τε καὶ ἀπόνως ἔχειν δοκέῃ, θάνατον σημαίνει, ἢ ὑποστροφὴν τοῦ ἐρυθήματος.
But if the erysipelas does not disappear on critical days, nor after a tumor has formed on the outer part, nor if pus is coughed up, and the patient seems to be easy and painless, it signifies death or a retreat of the redness.
Ἀσφαλέστερον δὲ τὸ οἴδημα καὶ τὸ ἐρύθημα ὡς μάλιστα ἔξω τρέπεσθαι· ἢν δὲ ἐς τὸν πλεύμονα τραπείη, παράνοιάν τε ποιέει, καὶ ἔμπυοι ἐξ αὐτέων τινὲς ὡς τὰ πολλὰ γίγνονται.
It is safer for the swelling and the redness to turn as much as possible outwards; but if it turns to the lungs, it produces delirium, and some of them for the most part become suppurated.
Οἱ δὲ γαργαρεῶνες ἐπικίνδυνοι καὶ ἀποτάμνεσθαι καὶ ἀποσχάζεσθαι, ἔστ᾿ ἂν ἐρυθροί τε ἔωσι καὶ μεγάλοι· καὶ γὰρ φλεγμοναὶ ἐπιγίγνονται τουτέοισι καὶ αἱμοῤῥαγίαι· ἀλλὰ χρὴ τὰ τοιαῦτα τοῖσιν ἄλλοισι μηχανήμασι πειρῆσθαι κατισχναίνειν ἐν τουτέῳ τῷ χρόνῳ.
The uvulae are dangerous both to cut off and to scarify as long as they are red and large; for inflammation and hemorrhages occur on these; but one must try to reduce such things by other devices during this time.
Ὁκόταν δὲ ἀποκριθῇ πᾶν, ὃ δὴ σταφυλὴν καλέουσι, καὶ γένηται τὸ μὲν ἄκρον τοῦ γαργαρεῶνος μεῖζόν τε καὶ περιφερὲς, τὸ δὲ ἀνωτέρω λεπτότερον, ἐν τουτέῳ τῷ καιρῷ ἀσφαλὲς διαχειρίζειν.
But when the whole has separated, which indeed they call "grape," and the tip of the uvula becomes larger and round, and the upper part thinner, at this opportune time it is safe to operate.
Ἄμεινον δὲ καὶ τὴν κοιλίην ὑποκενώσαντα τῇ χειρουργίῃ χρέεσθαι, ἢν ὅ τε χρόνος ξυγχωρέῃ, καὶ μὴ ἀποπνίγηται ὁ ἄνθρωπος.
And it is better to use surgery after having evacuated the bowels, if indeed time permits and the patient is not suffocating.

Notes

  1. 21ἔστ᾿ ἂν δὲ ἡ ὀδύνη ᾖ νεαρὰ — The clause with ἔστ' ἄν followed by the subjunctive ᾖ expresses temporal duration ('as long as the pain is recent'). It should not be confused with the meaning 'until', which usually occurs in other contexts, but here designates a continuing period.
  2. 23τῶν προκεκριμένων πονηρῶν εἶναι· — The genitive τῶν προκεκριμένων is a partitive genitive depending on the preceding indefinite pronoun τι. The infinitive phrase πονηρῶν εἶναι serves to complement the meaning of the passive perfect participle προκεκριμένων ('which have been pre-judged to be bad').
  3. 23ἐπικίνδυνοι καὶ ἀποτάμνεσθαι καὶ ἀποσχάζεσθαι — The infinitives ἀποτάμνεσθαι and ἀποσχάζεσθαι are epexegetical (explanatory) infinitives qualifying the adjective ἐπικίνδυνοι ('dangerous'). The subject, οἱ γαργαρεῶνες ('the uvulae'), is the patient of these passive actions ('to be cut off', 'to be scarified').

Cite this passage

Hippocrates, Prognostic §21-23. Humanitext Reader, https://reader.humanitext.ai/en/text/urn:cts:greekLit:tlg0627.tlg003.humanitext-grc1:21-23

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