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Hippocrates · In the Surgery §1-4

Basic Conditions for Surgery: Lighting, Posture, and Skill

Passage 1 of 4 · Greek

Summary

This section outlines the basic requirements for surgery in the clinic, specifying the uses of natural and artificial light, the optimal postures of the physician and the patient, and the necessary training for hand dexterity.

§1## ΚΑΤ᾿ ΙΗΤΡΕΙΟΝ. 1.
## IN THE SURGERY 1.
Ἢ ὅμοια ἢ ἀνόμοια ἐξ ἀρχῆς· ἀπὸ τῶν μεγίστων, ἀπὸ τῶν ῥηΐστων, ἀπὸ τῶν πάντη πάντως γιγνωσκομένων.
Either similar or dissimilar from the beginning; starting from the greatest, from the easiest, from those known in every way and entirely.
Ἃ καὶ ἰδεῖν, καὶ θιγεῖν, καὶ ἀκοῦσαι ἔστιν· ἃ καὶ τῇ ὄφει, καὶ τῇ ἁφῇ, καὶ τῇ ἀκοῇ, καὶ τῇ ῥινὶ, καὶ τῇ γλώσσῃ, καὶ τῇ γνώμῃ ἔστιν αἰσθέσθαι· ἃ, οἷς γιγνώσκομεν ἅπασιν, ἔστι γνῶναι.
Which it is possible to see, to touch, and to hear; which it is possible to perceive by sight, by touch, by hearing, by smell, by taste, and by intellect; which it is possible to know by all the means by which we know.
§22.
2.
Τὰ δ᾿ ἐς χειρουργίην κατ᾿ ἰητρεῖον· ὁ ἀσθενέων· ὁ δρῶν οἱ ὑπηρέται· τὰ ὄργανα· τὸ φῶς· ὅκου· ὅκως· ὅσα· ὅκως· ὅκου τὸ σῶμα, τὰ ἄρμενα· ὁ χρόνος· ὁ τρόπος· ὁ τόπος.
The matters pertaining to surgery in the surgery: the patient; the operator; the assistants; the instruments; the light; where; how; how much; how; where the body and the instruments [are]; the time; the method; the place.
§33.
3.
Ὁ δρῶν, ἢ καθήμενος, ἢ ἑστεὼς, ξυμμέτρως πρὸς ἑωυτὸν, πρὸς τὸ χειριζόμενον, πρὸς τὴν αὐγήν.
The operator, either sitting or standing, proportionately with respect to himself, to the part operated upon, and to the light.
Αὐγέης μὲν οὖν δύο εἴδεα, τὸ μὲν κοινὸν, τὸ δὲ τεχνητόν.
There are two kinds of light: the natural and the artificial.
Τὸ μὲν οὖν κοινὸν οὐκ ἐφ᾿ ἡμῖν· τὸ δὲ τεχνητὸν, καὶ ἐφ᾿ ἡμῖν.
The natural is not in our power, but the artificial is in our power.
Ὧν ἑκατέρου δισσαὶ χρήσιες, ἢ πρὸς αὐγὴν, ἢ ὑπ᾿ αὐγήν.
Of each of these there are two uses: either facing the light or under the light.
Ὑπ᾿ αὐγὴν μὲν οὖν ὀλίγη τε ἡ χρῆσις, καταφανής τε ἡ μετριότης.
Under the light, the use is small, and its moderation is manifest.
Τὰ δὲ πρὸς αὐγὴν ἐκ τῶν παρεουσέων, ἐκ τῶν ξυμφερουσέων αὐγέων, πρὸς τὴν λαμπροτάτην τρέπειν τὸ χειριζόμενον· πλὴν ὁκόσα λαθεῖν δεῖ, ἢ ὁρῇν αἰσχρόν· οὕτω δὲ τὸ μὲν χειριζόμενον ἐναντίον τῇ αὐγῇ, τὸν δὲ χειρίζοντα, ἐναντίον τῷ χειριζομένῳ, πλὴν ὥστε μὴ ἐπισκοτάζειν· οὕτω γὰρ ἂν ὁ μὲν δρῶν ὁρῴη, τὸ δὲ χειριζόμενον οὐχ ὁρῷτε.
But in facing the light, from the available and convenient lights, one must turn the part operated upon towards the brightest, except such parts as must be hidden or are indecent to see; thus, the part operated upon should be opposite the light, and the operator opposite the part operated upon, except so as not to throw a shadow; for thus, the operator would see, while the part operated upon would not be obscured.
Πρὸς ἑωυτὸν δὲ, καθημένῳ πόδες ἐς τὴν ἄνω ἴξιν κατ᾿ ἰθὺ γούνασιν διάστασιν δὲ, ὀλίγον ξυμβεβῶτες· γούνατα δὲ ἀνωτέρω βουβώνων σμικρὸν, διάστασιν δὲ, ἀγκώνων θέσει καὶ παραθέσει.
With respect to himself, for one sitting, the feet should be in an upward direction, in a straight line with the knees, but separated slightly; the knees slightly higher than the groins, and their distance apart [such as to allow] the placing and supporting of the elbows.
Ἱμάτιον, εὐσταλέως, εὐκρινέως, ἴσως, ὁμοίως, ἀγκῶσιν, ὤμοισιν.
The cloak should be neatly, orderly, equally, and similarly arranged on the elbows and shoulders.
Πρὸς δὲ τὸ χειριζόμενον, τοῦ μὲν πρόσω καὶ ἐγγὺς, καὶ τοῦ ἄνω, καὶ τοῦ κάτω, καὶ ἔνθα ἢ ἔνθα, ἢ μέσον.
With respect to the part operated upon, either far or near, and above, and below, and on this side or that side, or in the middle.
Τοῦ μὲν πρόσω καὶ ἐγγὺς ὅριον, ἀγκῶνας ἐς μὲν τὸ πρόσθεν γούνατα μὴ ἀμείβειν, ἐς δὲ τὸ ὄπισθεν, πλευράς· τοῦ δὲ ἄνω, μὴ ἀνωτέρω μαζῶν ἄκρας χεῖρας ἔχειν· τοῦ δὲ κάτω, μὴ κατωτέρω, ἢ ὡς τὸ στῆθος ἐπὶ γούνασιν ἔχοντα, ἔχειν ἄκρας χεῖρας ἐγγωνίους πρὸς βραχίονας· τὰ μὲν κατὰ μέσον οὕτως· τὰ δὲ ἔνθα, ἢ ἔνθα, μὴ ἔξω τῆς ἔδρης, κατὰ λόγον δὲ τῆς ἐπιτροφῆς προσβαλλόμενον τὸ σῶμα, καὶ τοῦ σώματος τὸ ἐργαζόμενον.
The limit of far and near is that the elbows should not pass the knees forward, nor the ribs backward; of above, that the hands should not be held higher than the top of the breasts; of below, not lower than having the hands at right angles to the upper arms, as if having the chest on the knees; those in the middle are thus, and those on this side or that side, not outside the seat, but the body and the part being operated upon should be applied proportionately to the turning.
Ἑστεῶτα δὲ, ἰδεῖν μὲν ἐπ᾿ ἀμφοτέρων βεβῶτα ἐξ ἴσου τῶν ποδῶν ἅλις, δρῇν δὲ τῷ ἑτέρῳ ἐπιβεβῶτα, μὴ τῷ κατὰ τὴν δρῶσαν χεῖρα· ὕψος γούνατος πρὸς βουβῶνας, ὡς ἐν ἕδρῃ· καὶ τὰ ἄλλα ὅρια τὰ αὐτά.
For one standing, it is possible to see him standing equally on both feet, but he should operate supported on one foot, not the one on the side of the operating hand; the height of the knee to the groins should be as in sitting, and the other limits the same.
Ὁ δὲ χειριζόμενος τῷ χειρίζοντι τῷ ἄλλῳ τοῦ σώματος μέρει ὑπηρετείτων, ἢ ἑστεὼς, ἢ καθήμενος, ἢ κείμενος, ὅκως ἂν ῥήϊστα, ὃ δεῖ, σχῆμα ἔχων διατελέῃ, φυλάσσων ὑπόῤῥυσιν, ὑπόστασιν, ἔκτρεψιν, καταντίαν, ὡς ὃ δεῖ, σώζηται καὶ σχῆμα καὶ εἶδος τοῦ χειριζομένου, ἐν παρέξει, ἐν χειρισμῷ, ἐν τῇ ἔπειτα ἕξει.
Let the patient assist the operator with the other part of the body, either standing, or sitting, or lying down, so that he may easiest remain in the necessary posture, guarding against slipping down, sinking, turning aside, or opposing, so that the posture and shape of the part operated upon may be preserved as required, during presentation, operation, and subsequent state.
§44.
4.
Ὄνυχας μήτε ὑπερέχειν, μήτε ἐλλείπειν· δακτύλων κορυφῇσι χρῆσις·
The nails should neither project beyond nor be shorter than [the fingertips]; the use of the tips of the fingers.
ἀσκέειν, δακτύλοισι μὲν ἄκροις, τὰ πλεῖστα λιχανῷ πρὸς μέγαν· ὅλῃ δὲ, καταπρηνεῖ· ἀμφοτέρῃσι δὲ, ἐναντίῃσιν·
One must practice with the fingertips, mostly the index finger against the thumb; with the whole hand, with it prone; with both hands, opposing each other.
δακτύλων εὐφυΐα, μέγα τὸ ἐν μέσῳ τῶν δακτύλων, καὶ ἀπεναντίον τὸν μέγαν τῷ λιχανῷ.
The natural aptitude of the fingers is a wide space between them, and the thumb opposed to the index.
Νοῦσος δὲ δι᾿ ἣν καὶ βλάπτονται, οἷσιν ἐκ γενεῆς ἢ ἐν τροφῇ εἴθισται ὁ μέγας ὑπὸ τῶν ἄλλων δακτύλων κατέχεσθαι, δῆλον.
The disease because of which they are harmed, in those in whom from birth or in rearing it has been customary for the thumb to be held down by the other fingers, is obvious.
Τὰ ἔργα πάντα ἀσκέειν ἑκατέρῃ δρῶντα, καὶ ἀμφοτέρῃσιν ἅμα (ὅμοιαι γάρ εἰσιν ἀμφότεραι), στοχαζόμενον ἀγαθῶς, καλῶς, ταχέως, ἀπόνως, εὐρύθμως, εὐπόρως.
One must practice doing all works with each hand and with both together (for both are similar), aiming at doing them well, beautifully, quickly, painlessly, rhythmically, and easily.

Notes

  1. 1ἔστιν αἰσθέσθαι — The verb "ἔστιν" is used impersonally like "ἔξεστι", taking the aorist middle infinitive "αἰσθέσθαι" to mean 'it is possible to perceive'.
  2. 1οἷς γιγνώσκομεν ἅπασιν — The relative pronoun "οἷς" is attracted into the dative case (dative of instrument) by its antecedent "ἅπασιν". This is a typical example of relative attraction.
  3. 3τὸ δὲ χειριζόμενον οὐχ ὁρῷτο — Adopting "ὁρῷτο" (third-person singular present passive optative of ὁράω) found in some manuscripts, which combined with the particle "ἄν" in the main clause, expresses a potential result: 'so that the part operated upon would not be unseen (obscured)'.
  4. 4ἀσκέειν — The infinitive is used as an imperative (imperative infinitive). Throughout this text, several infinitives function as commands without any governing finite verb to outline practical instructions.

Cite this passage

Hippocrates, In the Surgery §1-4. Humanitext Reader, https://reader.humanitext.ai/en/text/urn:cts:greekLit:tlg0627.tlg008.humanitext-grc1:1-4

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