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Hippocrates · On Injuries of the Head §8-10

Contra-Fissure, Indications for Trepanning, and Examination

Passage 4 of 11 · Greek

Summary

The author introduces the fifth type of wound (contra-fissure) and the impossibility of its diagnosis, categorizes which bone injuries require trepanning (sawing), and outlines the contact and non-contact diagnostic procedures as well as the importance of inquiry for discovering invisible fractures.

§88.
8.
Ὀστέον τιτρώσκεται ἄλλῃ τῆς κεφαλῆς, ἢ ᾗ τὸ ἕλκος ἔχει ὥνθρωπος, καὶ τὸ ὀστέον ἐψιλώθη τῆς σαρκός· πέμπτος οὗτος τρόπος.
The bone is wounded in another part of the head than where the man has the wound, and the bone is bared of flesh; this is the fifth way.
Καὶ ταύτην τὴν ξυμφορὴν, ὅταν γένηται, οὐκ ἂν ἔχοις ὠφελῆσαι οὐδέν.
And this misfortune, when it occurs, you would not be able to help at all.
Οὐδὲ γὰρ, εἰ πέπονθε τὸ κακὸν τοῦτο, οὐκ ἔστιν ὅκως χρὴ αὐτὸν ἐξελέγξαντα εἰδέναι εἰ πέπονθε τὸ κακὸν τοῦτο ὥνθρωπος, οὐδ᾿ ὅκοι τῆς κεφαλῆς.
For not even if he has suffered this evil is there any way by which one must, having examined him, know if the man has suffered this evil, nor where in the head.
§99.
9.
Τούτων τῶν τρόπων τῆς κατήξιος ἐς πρίσιν ἀφήκει, ἤ τε φλάσις ἡ ἀφανὴς ἰδεῖν, καὶ ἤν πως τύχῃ φανερὴ γενομένη, καὶ ἡ ῥωγμὴ ἡ ἀφανὴς ἰδεῖν, καὶ ἢν φανερὴ ᾖ.
Of these ways of fracture, those which require trepanning (sawing) are: the bruising which is invisible to the sight (and if it somehow happens to become visible), and the fracture (crack) which is invisible to the sight (and if it is visible).
Καὶ ἢν, ἕδρης γενομένης τοῦ βέλεος ἐν τῷ ὀστέῳ, προσγένηται ῥωγμὴ καὶ φλάσις τῇ ἕδρῃ, καὶ ἢν φλάσις μοῦνον προσγένηται ἄνευ ῥωγμῆς τῇ ἕδρῃ, καὶ αὕτη ἐς πρίσιν ἀφήκει.
And if, an indentation of the missile having occurred in the bone, a crack and bruising accompany the indentation, and if bruising alone accompanies the indentation without a crack, this too requires trepanning.
Τὸ δ᾿ ἔσω ἐσφλώμενον ὀστέον ἐκ τῆς φύσιος τῆς ἑωυτοῦ, ὀλίγα τῶν πολλῶν πρίσιος προσδεῖται· καὶ τὰ μάλιστα ἐσφλασθέντα καὶ μάλιστα καταῤῥαγέντα, ταῦτα πρίσιος ἥκιστα κέχρηται·
But the bone depressed inwards from its natural position requires trepanning only in a few of many cases; and those which are most depressed and most shattered require trepanning least of all.
οὐδὲ ἕδρη αὐτὴ ἐφ᾿ ἑωυτῆς γενομένη ἄτερ ῥωγμῆς καὶ φλάσιος, οὐδὲ οὐτὴ πρίσιος δεῖται· οὐδ᾿ ἡ διακοπὴ, ἢν μεγάλη καὶ εὐρέη, οὐδ᾿ αὐτή· διακοπὴ γὰρ καὶ ἕδρη τωὐτόν ἐστιν.
Nor does the indentation itself occurring on its own without crack and bruising require trepanning; nor does a cleft, if it is large and wide, require it; for a cleft and an indentation are the same thing.
§1010.
10.
Πρῶτον δὲ χρὴ τὸν τρωματίην σποπεῖσθαι, ὅπη ἔχει τὸ τρῶμα τῆς κεφαλῆς, ἐἴτ᾿ ἐν τοῖσιν ἐσχυροτέροισιν, εἴτ᾿ ἐν τοῖσιν ἀσθενεστέροισι, καὶ τὰς τρίχας καταμανθάνειν τὰς περὶ τὸ ἕλκος, εἰ διακεκόφαται ὑπὸ τοῦ βέλεος, καὶ εἰ ἔσω ἤϊσαν ἐς τὸ τρῶμα· καὶ ἢν τοῦτο ᾖ, φάναι κινδυνεύειν τὸ ὀστέον ψιλὸν εἶναι τῆς σαρκὸς, καὶ ἔχειν τι σίνος τὸ ὀστέον ὑπὸ τοῦ βέλεος.
First, one must examine the wounded man, where he has the wound in the head, whether in the stronger parts or in the weaker, and inspect the hair around the wound, whether it has been cut through by the missile, and whether it has gone inwards into the wound; and if this is so, one should state that the bone is in danger of being bared of flesh and of having some damage from the missile.
Ταῦτα μὲν οὖν χρὴ ἀπόπροσθεν σκεψάμενον λέξαι, μὴ ἁπτόμενον τοῦ ἀνθρώπου· ἁπτόμενον δ᾿ ἤδη πειρᾶσθαι εἰδέναι σάφα, εἴ ἐστι ψιλὸν τὸ ὀστέον τῆς σαρκὸς, ἢ οὔ·
These things, then, one must say after having observed from a distance, without touching the man; but then, touching him, one must try to know clearly whether the bone is bared of flesh or not.
καὶ ἢν μὲν καταφανὲς ᾖ τοῖσιν ὀφθαλμοῖσι τὸ ὀστέον ψιλόν· εἰ δὲ μὴ, τῇ μήλῃ σκέπτεσθαι.
And if the bared bone is visible to the eyes, well and good; but if not, one must examine with the probe.
Καὶ ἢν μὲν εὕρῃς ψιλὸν ἐὸν τὸ ὀστέον τῆς σαρκὸς, καὶ μὴ ὑγιὲς ἀπὸ τοῦ τρώματος, χρὴ τοῦ ἐν τῷ ὀστέῳ ἐόντος τὴν διάγνωσιν πρῶτα ποιέεσθαι, ὁρέοντα ὅσον τέ ἐστι τὸ κακὸν, καὶ τίνος δεῖται ἔργου.
And if you find the bone bared of flesh and not healthy from the wound, you must first make the diagnosis of what is in the bone, seeing how great the evil is and what treatment it requires.
Χρὴ δὲ καὶ ἐρωτᾷν τὸν τετρωμένον, ὅκως ἔπαθε καὶ τίνα τρόπον.
And one must also ask the wounded man how he was hurt and in what manner.
Ἢν δὲ μὴ καταφανὲς ᾖ τὸ ὀστέον, εἰ ἔχει τι κακὸν ἢ μὴ ἔχει, πολλῷ ἔτι χρὴ μᾶλλον τὴν ἐρώτησιν ποιέεσθαι, ψιλοῦ ἐόντος τοῦ ὀστέου, τὸ τρῶμα ὅκως ἐγένετο, καὶ ὅντινα τρόπον·
But if it is not visible whether the bone has any damage or not, although the bone is bared, one must make the inquiry much more, how the wound occurred and in what manner.
τὰς γὰρ φλάσιας καὶ τὰς ῥωγμὰς τὰς οὐ φαινομένας ἐν τῷ ὀστέῳ, ἐνεούσας δὲ, ἐκ τῆς ὑποκρίσιος τοῦ τετρωμένου πρῶτον διαγινώσκειν πειρῆσθαι, εἴ τι πέπονθε τουτέων τὸ ὀστέον ἢ οὐ πέπονθεν, ἔπειτα δὲ καὶ λόγῳ καὶ ἔργῳ ἐξελέγχειν πλὴν μηλώσιος.
For as for the bruises and cracks which do not appear in the bone but are present, one must first try to diagnose from the answer of the wounded man whether the bone has suffered any of these or not; and then examine it both by reasoning and by observation, except by probing.
Μήλωσις γὰρ οὐκ ἐξελέγχει, εἰ πέπονθέ τι τουτέων τῶν κακῶν τὸ ὀστέον, καὶ εἴ τι ἔχει ἐν ἑωυτέῳ, ἢ οὐ πέπονθεν· ἀλλ᾿ ἕδρην τε τοῦ βέλεος ἐξελέγχει μήλωσις, καὶ ἢν ἐμφλασθῇ τὸ ὀστέον ἔσω ἐκ τῆς φύσιος τῆς ἑωυτέου, καὶ ἢν ἰσχυρῶς ῥαγῇ τὸ ὀστέον, ἅπερ καὶ τοῖσιν ὀφθαλμοῖσι καταφανέα ἐστὶν ὁρῶντα γιγνώσκειν.
For probing does not prove whether the bone has suffered any of these evils, or if it has anything in itself, or has not; but probing does prove an indentation of the missile, and if the bone is depressed inwards from its natural position, and if the bone is severely fractured—things which are also visible to the eyes to recognize by seeing.

Notes

  1. 8ἄλλῃ τῆς κεφαλῆς — Meaning "in another part of the head." The adverb ἄλλῃ governs the partitive genitive τῆς κεφαλῆς. It is used correlatively with the following ἢ ᾗ... ("than where...") to explain a contra-fissure (a fracture occurring on the side opposite the site of impact).
  2. 8οὐκ ἂν ἔχοις ὠφελῆσαι — The verb ἔχω followed by an infinitive means "to be able to" (here in the potential optative form with ἄν). Together with the double negation οὐκ ... οὐδέν, it expresses a strong denial: "you would not be able to help at all."
  3. 9ἐς πρίσιν ἀφήκει — The conjunctions ἤ τε ... καὶ ... ἤν ... form the subjects of the verb ἀφήκει (which is singular, either representing multiple subjects or used impersonally). The phrase ἐς πρίσιν ἀφήκει is an idiomatic expression meaning "comes to sawing" or "requires trepanning." The genitive Τούτων τῶν τρόπων at the beginning of the sentence is a partitive genitive depending on them.
  4. 10φάναι κινδυνεύειν τὸ ὀστέον ψιλὸν εἶναι — A chain of infinitives depending on the impersonal verb χρὴ in the main clause. It functions as χρὴ ... φάναι ("one must state"), which takes the accusative and infinitive construction κινδυνεύειν ... ("to be in danger of") as its object, inside of which τὸ ὀστέον ψιλὸν εἶναι ("the bone to be bared") is nested as the subject-accusative of κινδυνεύειν.
  5. 10πλὴν μηλώσιος — "Except by probing." An exclusion phrase using the preposition πλὴν (governing the genitive). It modifies the preceding ἐξελέγχειν ("to examine/verify"), indicating that while verification by reasoning (λόγῳ) and observation (ἔργῳ) is recommended, probing should be excluded because it is useless for identifying invisible cracks or bruises, a reasoning explained in the subsequent γάρ clause.

Cite this passage

Hippocrates, On Injuries of the Head §8-10. Humanitext Reader, https://reader.humanitext.ai/en/text/urn:cts:greekLit:tlg0627.tlg007.humanitext-grc1:8-10

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