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Hippocrates · On Injuries of the Head §2-3

Vulnerability of Cranial Regions and Injuries on Sutures

Passage 2 of 11 · Greek

Summary

This section explains why the bregma is the most vulnerable and fatal part of the skull due to its thinness, details the anatomical characteristics and better prognoses of the temple and posterior regions, and discusses the danger of injuries on the sutures.

§22.
2.
Παχύτητι δὲ καὶ λεπτότητι, ξυμπάσης τῆς κεφαλῆς τὸ ὀστέον λεπτότατόν ἐστιν καὶ ἀσθενέστατον τὸ κατὰ βρέγμα, καὶ σάρκα ὀλιγίστην καὶ λεπτοτάτην ἔχει ἐφ᾿ ἑωυτέῳ ταύτῃ τῆς κεφαλῆς τὸ ὀστέον, καὶ ὁ ἐγκέφαλος κατὰ τοῦτο τῆς κεφαλῆς πλεῖστος ὕπεστιν.
In terms of thickness and thinness, of the whole head, the bone at the bregma is the thinnest and weakest, and the bone has the least and thinnest flesh upon itself at this part of the head, and the brain lies underneath this part of the head in the greatest quantity.
Καὶ δὴ, ὅτι οὕτω ταῦτα ἔχει, τῶν τε τρωσίων καὶ τῶν βελέων ἴσων τε ἐόντων κατὰ μεγέθος, καὶ ἐλασσόνων, καὶ ὁμοίως τε τρωθεὶς καὶ ἧσσον, τὸ ὀστέον ταύτῃ τῆς κεφαλῆς φλᾶταί τε μᾶλλον καὶ ῥήγνυται, καὶ ἔσω ἐσφλᾶται, καὶ θανασιμώτερά ἐστι καὶ χαλεπώτερα ἰητρεύεσθαί τε καὶ ἐκφυγγάνειν τὸν θάνατον ταύτῃ ἤπου ἄλλοθι τῆς κεφαλῆς·
And indeed, because these things are so, even when the wounds and missiles are equal in size, or smaller, and whether one is wounded in like manner or less, the bone at this part of the head is more bruised, fractured, and depressed inwards; and wounds here are more fatal and more difficult to cure and to escape death than anywhere else in the head.
ἐξίσων τε ἐόντων τῶν τρωμάτων καὶ ἡσσόνων, καὶ ὁμοίως τε τρωθεὶς καὶ ἧσσον, ἀποθνήσκει ὁ ἄνθρωπος, ὁταν καὶ ἄλλως μέλλῃ ἀποθανεῖσθαι ἐκ τοῦ τρώματος, ἐν ἐλάσσονι χρόνῳ ὁ ταύτῃ ἔχων τὸ τρῶμα τῆς κεφαλῆς, ἤπου ἄλλοθι.
Even when the wounds are equal or smaller, and whether one is wounded in like manner or less, the man who has the wound at this part of the head dies in a shorter time than anywhere else, when he is otherwise destined to die from the wound.
Ὁ γὰρ ἐγκέφαλος τάχιστά τε καὶ μάλιστα κατὰ τὸ βρέγμα αἰσθάνεται τῶν κακῶν τῶν γιγνομένων ἔν τε τῇ σαρκὶ καὶ τῷ ὀστέῳ· ὑπὸ λεπτοτάτῳ γὰρ ὀστέῳ ἐστὶ ταύτῃ ὁ ἐγκέφαλος καὶ ὀλιγίστῃ σαρκὶ, καὶ ὁ πλεῖστος ἐγκέφαλος ὑπὸ τῷ βρέγματι κεῖται.
For the brain most quickly and most of all perceives the evils occurring in the flesh and the bone at the bregma; for the brain is under the thinnest bone and the least flesh at this part, and the greatest part of the brain lies under the bregma.
Τῶν δὲ ἄλλων τὸ κατὰ τοὺς κροτάφους ἀσθενέστατόν ἐστιν· ξυμβολή τε γὰρ τῆς κάτω γνάθου πρὸς τὸ κρανίον, καὶ κίνησις ἔνεστιν ἐν τῷ κροτάφῳ ἄνω καὶ κάτω ὥσπερ ἄρθρου· καὶ ἡ ἀκοὴ πλησίον γίγνεται αὐτέου, καὶ φλὲψ διὰ τοῦ κροτάφου τέταται κοίλη τε καὶ ἰσχυρή.
Of the other parts, that at the temples is the weakest; for there is the joint of the lower jaw with the skull, and there is movement up and down in the temple as of a joint; and hearing is near it, and a large, hollow, and strong vessel stretches through the temple.
Ἰσχυρότερον δ᾿ ἐστὶ τῆς κεφαλῆς τὸ ὀστέον ἅπαν τὸ ὄπισθεν τῆς κορυφῆς καὶ τῶν οὐάτων, ἢ ἅπαν τὸ πρόσθεν, καὶ σάρκα πλέονα καὶ βαθυτέρην ἐφ᾿ ἑωυτέῳ ἔχει τοῦτο τὸ ὀστέον.
But all the bone of the head behind the vertex and the ears is stronger than all the front part, and this bone has more and deeper flesh upon itself.
Καὶ δὴ, τουτέων οὕτως ἐχόντων ὑπὸ τῶν τε τρωσίων καὶ τῶν βελέων ἴσων ἐόντων καὶ ὁμοίων, καὶ μεζόνων, καὶ ὁμοίως τιτρωσκόμενος καὶ μᾶλλον, ταύτῃ τῆς κεφαλῆς τὸ ὀστέον ἧσσον ῥήγνυται καὶ φλᾶται ἔσω· κἢν μέλλῃ ὥνθρωπος ἀποθνήσκειν καὶ ἄλλως ἐκ τοῦ τρώματος, ἐν τῷ ὄπισθεν τῆς κεφαλῆς ἔχων τὸ τρῶμα, ἐν πλέονι χρόνῳ ἀποθανεῖται·
And indeed, since these things are so, under wounds and missiles that are equal and similar, or even larger, and whether one is wounded in like manner or more, the bone at this part of the head is less fractured and depressed inwards; and if a man is otherwise destined to die from the wound, having the wound at the back of the head, he will die in a longer time.
ἐν πλέονι γὰρ χρόνῳ τὸ ὀστέον ἐμπυΐσκεταί τε καὶ διαπυΐσκεται κάτω ἐπὶ τὸν ἐγκέφαλον διὰ τὴν παχύτητα τοῦ ὀστέου, καὶ ἐλάσσων ταύτῃ τῆς κεφαλῆς ὁ ἐγκέφαλος ὕπεστι, καὶ πλέονες ἐκφυγγάνουσι τὸν θάνατον τῶν ὄπισθεν τιτρωσκομένων τῆς κεφαλῆς ὡς ἐπιτοπολὺ, ἢ τῶν ἔμπροσθεν.
For owing to the thickness of the bone, it takes a longer time for the bone to become purulent and for the suppuration to pass downwards to the brain, and less brain lies underneath this part of the head, and as a general rule, more of those wounded in the back of the head escape death than those in the front.
Καὶ ἐν χειμῶνι πλέονα χρόνον ζῇ ὥνθρωπος ἢ ἐν θέρει, ὅστις καὶ ἄλλως μέλλει ἀποθανεῖσθαι ἐκ τοῦ τρώματος, ὁκουοῦν τῆς κεφαλῆς ἔχων τὸ τρῶμα.
And in winter a man lives a longer time than in summer, when he is otherwise destined to die from the wound, wherever on the head he has the wound.
§33.
3.
Αἱ δὲ ἕδραι τῶν βελέων τῶν ὀξέων καὶ κουφοτέρων, αὐταὶ ἐπὶ σφῶν αὐτέων γινόμεναι ἐν τῷ ὀστέῳ, ἄνευ ῥωγμῆς τε καὶ φλάσιος, ἢ ἔσω ἐσφλάσιος (αὗται δὲ γίνονται ὁμοίως ἔν τε τῷ ἔμπροσθεν τῆς κεφαλῆς, καὶ ἐν τῷ ὄπισθεν), ἐκ τουτέων ὁ θάνατος οὐ γίνεται κατά γε δίκην, οὐδ᾿ ἢν γένηται.
But the marks of sharp and lighter missiles, when they occur in the bone by themselves, without fracture, bruising, or depression inwards (and these occur in like manner both in the front of the head and in the back), from these, death does not occur in the ordinary course of things, even if it should occur.
Ῥαφὴ δὲ ἐν ἕλκει φανεῖσα, ὀστέου ψιλωθέντος, πανταχοῦ τῆς κεφαλῆς τοῦ ἕλκεος γενομένου, ἀσθενέστατον γίγνεται τῇ τρώσει καὶ τῷ βέλει ἀντέχειν, εἰ τύχοι τὸ βέλος ἐς αὐτὴν τὴν ῥαφὴν στηριχθέν· πάντων δὲ μάλιστα ἐν τῷ βρέγματι γενόμενον κατὰ τὸ ἀσθενέστατον τῆς κεφαλῆς, καὶ αἱ ῥαφαὶ εἰ τύχοιεν ἐοῦσαι περὶ τὸ ἕλκος, καὶ τὸ βέλος αὐτέων τύχοι τῶν ῥαφῶν.
But when a suture appears in a wound, the bone being denuded, wherever on the head the wound may be, if the missile happens to have lodged in the suture itself, it becomes the weakest part to resist the wound and the missile; and most of all if it occurs at the bregma, in the weakest part of the head, and if the sutures happen to be around the wound, and the missile happens to strike those sutures.

Notes

  1. p.190τῶν τε τρωσίων ¦p.190¦ καὶ τῶν βελέων ἴσων τε ἐόντων — Genitive absolute construction, also governing the subsequent καὶ ἐλασσόνων, expressing a concessive sense: 'even when the wounds and missiles are equal in size, or smaller.'
  2. p.192ἐμπυΐσκεταί τε καὶ διαπυΐσκεται — The former verb refers to the formation of pus within the bone (becoming purulent), while the latter, with the prefix δια-, refers to the process of the pus penetrating through the bone downwards to the brain (suppurating through). The thickness of the bone acts as a barrier, causing these two processes to take longer.
  3. p.194κατά γε δίκην — An idiomatic phrase meaning 'in the ordinary course of things' or 'naturally'. It indicates that simple marks of missiles (ἕδραι) do not naturally or directly cause death by themselves.

Cite this passage

Hippocrates, On Injuries of the Head §2-3. Humanitext Reader, https://reader.humanitext.ai/en/text/urn:cts:greekLit:tlg0627.tlg007.humanitext-grc1:2-3

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