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Hippocrates · On the Sacred Disease §9-10

Age Differences in Prognosis and Effects of Temperature

Passage 6 of 9 · Greek

Summary

Explains the difference in the pathological processes of epilepsy between adults and the elderly, and details how temperature changes lead to the flow of phlegm due to the contraction and relaxation of the brain.

§99.
9.
Τοὺς δὲ πρεσβυτέρους οὐκ ἀποκτείνει, ὁκόταν ἐπιγένηται, οὐδὲ διαστρέφει· αἵ τε γὰρ φλέβες εἰσὶ κοῖλαι καὶ αἵματος μεσταὶ θερμοῦ, ἃ οὐδὲ δύναται ἐπικρατῆσαι τὸ φλέγμα, οὐδ’ ἀποψῦξαι τὸ αἷμα, ὥστε καὶ πῆξαι, ἀλλ’ αὐτὸ κρατέεται καὶ καταμίγνυται τῷ αἵματι ταχέως·
But the disease does not kill adults when it attacks them, nor does it distort them; for their veins are hollow and full of warm blood, which the phlegm cannot overcome, nor can it chill the blood so as to congeal it, but the phlegm itself is overcome and quickly mixed with the blood.
καὶ οὕτω παραδέχονται αἱ φλέβες τὸν ἠέρα, καὶ τὸ φρόνημα γίνεται, τά τε σημήϊα τὸ προειρημένα ἧσσον ἐπιλαμβάνει διὰ τὴν ἰσχύν.
And thus the veins admit the air, consciousness returns, and the aforementioned symptoms attack them less owing to their strength.
Τοῖσι δὲ πρεσβυτάτοισιν ὁκόταν ἐπιγένηται τοῦτο τὸ νούσημα, διὰ τοῦτο ἀποκτείνει ἢ παράπληκτον ποιέει, ὅτι αἱ φλέβες κεκένωνται καὶ τὸ αἷμα ὀλίγον τέ ἐστι καὶ λεπτὸν καὶ ὑδαρές.
But when this disease attacks the very old, it either kills them or paralyses them; and this because their veins are empty, and their blood is little, thin, and watery.
Ἢν μὲν οὖν πολὺ παταῤῥυῇ καὶ χειμῶνος ἔῃ καιρὸς, ἀποκτείνει· ἀπέπνιξε γὰρ τὰς ἀναπνοὰς καὶ ἀπέπηξε τὸ αἷμα, ἢν ἐπ’ ἀμφότερα ὁ κατάῤῥοος γένηται· ἢν δὲ ἐπὶ θάτερα μοῦνον, παράπληκτον ποιέει· οὐ γὰρ δύναται τὸ αἷμα ἐπικρατῆσαι τοῦ φλέγματος λεπτὸν ἐὸν καὶ ψυχρὸν καὶ ὀλίγον, ἀλλ’ αὐτὸ κρατηθὲν ἐπάγη, ὥστε ἀκρατέα εἶναι ἐκεῖνα καθ’ ἃ τὸ αἷμα διεφθάρη.
If, then, the flux is abundant and it is the winter season, it kills; for it blocks the breath and congeals the blood, if the flux takes place on both sides; but if on one side only, it paralyses; for the blood, being thin, cold, and scanty, cannot overcome the phlegm, but being itself overcome, it congeals, so that those parts where the blood was corrupted become powerless.
§1010.
10.
Ἐς δὲ τὰ δεξιὰ μᾶλλον καταῤῥέει ἢ ἐς τὰ ἀριστερὰ, ὅτι αἱ φλέβες εἰσὶ κοιλότεραι καὶ πλέονες ἢ ἐν τοῖσιν ἀριστεροῖσιν· ἀπὸ γὰρ τοῦ ἥπατος τείνουσι καὶ ἀπὸ τοῦ σπληνός.
It flows down more to the right side than to the left, because the veins on the right are wider and more numerous than those on the left; for they extend from the liver and from the spleen.
Ἐπικαταῤῥέει δὲ καὶ ἀποτήκεται τοῖσι μὲν παιδίοισι μάλιστα, οἷσιν ἂν διαθερμανθῇ ἡ κεφαλὴ ἤν τε ὑπὸ ἡλίου, ἤν τε ὑπὸ πυρὸς, καὶ ἐξαπίνης φρίξῃ ὁ ἐγκέφαλος· τότε γὰρ ἀποκρίνεται τὸ φλέγμα.
The flux and melting occur especially in children whose head is heated, whether by the sun or by fire, and the brain suddenly chills and shivers; for then the phlegm separates.
Ἀποτήκεται μὲν γὰρ ἐκ τῆς θέρμης καὶ διαχύσιος τοῦ ἐγκεφάλου· ἀποκρίνεται δὲ ἀπὸ τῆς ψύξιός τε καὶ ξυστάσιος, καὶ οὕτως ἐπικαταῤῥέει.
For it melts from the heat and relaxation of the brain, and separates from its cooling and contraction, and thus flows down.
Τοῖσι μὲν αὕτη ἡ πρόφασις γίνεται, τοῖσι δὲ καὶ ἐπειδὰν ἐξαπίνης μετὰ βόρεια πνεύματα νότος μεταλάβῃ, ξυνεστηκότα τὸν ἐγκέφαλον καὶ εὐσθενέοντα ἔλυσε καὶ ἐχάλασεν ἐξαίφνης, ὥστε πλημμυρεῖν τὸ φλέγμα, καὶ οὕτω τὸν κατάῤῥοον ποιέεται.
For some children this becomes the cause, and for others, when a south wind suddenly succeeds north winds, it relaxes and slackens the brain which was contracted and strong, so that the phlegm overflows, and thus makes the flux.
Ἐπικαταῤῥέει δὲ καὶ ἐξ ἀδήλου, φόβου γινομένου, ἢν δείσῃ βοήσαντός τινος, ἢ καὶ μεταξὺ κλαίων μὴ οἷός τε ἔῃ τὸ πνεῦμα ταχέως ἀναλαβεῖν, οἷα γίνεται παιδίοισι πολλάκις· ὅ τι δ’ ἂν τούτων αὐτῷ γένηται, εὐθὺς ἔφριξε τὸ σῶμα, καὶ ἄφωνος γενόμενος τὸ πνεῦμα οὐχ εἵλκυσεν, ἀλλὰ τὸ πνεῦμα ἠρέμησε, καὶ ὁ ἐγκέφαλος ξυνέστη, καὶ τὸ αἷμα ἔστη, καὶ οὕτως ἀπεκρίθη καὶ ἐπικατεῤῥύη τὸ φλέγμα.
It also flows down from unseen causes, when fear arises, if a child is frightened by someone shouting, or if, in the middle of crying, he is unable to draw his breath quickly, as often happens to children; and whichever of these happens to him, his body immediately chills, and becoming speechless he does not draw his breath, but the breath stands still, the brain contracts, the blood stops, and thus the phlegm separates and flows down.
Τοῖσι μὲν παιδίοισιν αὗται αἱ προφάσιες τῆς ἐπιλήψιός εἰσι τὴν ἀρχήν.
For children, these are the causes of epilepsy at the beginning.
Τοῖσι δὲ πρεσβύτῃσιν ὁ χειμὼν πολεμιώτατός ἐστιν· ὅταν γὰρ παρὰ πυρὶ πολλῷ διαθερμανθῇ τὴν κεφαλὴν καὶ τὸν ἐγκέφαλον, ἔπειτα ἐν ψύχει γένηται καὶ ῥιγώσῃ, ἢ καὶ ἐκ ψύχεος εἰς ἀλέην ἔλθῃ καὶ παρὰ πυρὶ καθίσῃ, τωὐτὸ τοῦτο πάσχει, καὶ οὕτως ἐπίληπτος γίνεται κατὰ τὰ προειρημένα.
For old men, winter is the most hostile season; for when they heat the head and brain by a large fire and then go into the cold and chill, or when they go from the cold into the warmth and sit by the fire, they suffer this very same thing, and thus become epileptic in the manner described above.
Κίνδυνος δὲ πολὺς καὶ ἦρος παθέειν τωὐτὸ τοῦτο, ἢν ἡλιωθῇ ἡ κεφαλή· τοῦ δὲ θέρεος ἥκιστα, οὐ γὰρ γίνονται μεταβολαὶ ἐξαπιναῖοι.
And there is great danger of suffering this same thing in spring also, if the head is exposed to the sun; but least of all in summer, for there are no sudden changes.
Ὁκόταν δὲ εἴκοσιν ἔτεα παρέλθῃ, οὐκ ἔτι ἡ νοῦσος αὕτη ἐπιλαμβάνει, ἢν μὴ ἐκ παιδίου ξύντροφος ἔῃ, ἀλλ’ ἢ ὀλίγους ἢ οὐδένα· αἱ γὰρ φλέβες μεσταί εἰσιν αἵματος, καὶ ὁ ἐγκέφαλος συνέστηκε καὶ ἐστὶ στρυφνὸς, ὥστε οὐκ ἐπικαταῤῥέει ἐπὶ τὰς φλέβας· ἢν δ’ ἐπικαταῤῥύη, τοῦ αἵματος οὐκ ἐπικρατέει, πολλοῦ καὶ θερμοῦ ἐόντος.
When twenty years have passed, this disease no longer attacks, unless it has been nurtured with him from childhood, or only in few or no cases; for the veins are full of blood, and the brain is contracted and firm, so that it does not flow down into the veins; and if it should flow down, it does not overcome the blood, which is abundant and warm.

Notes

  1. 9ἃ οὐδὲ δύναται ἐπικρατῆσαι τὸ φλέγμα — The relative pronoun `ἃ` (neuter plural) refers back to the state of the veins (being hollow and full of warm blood). The subject of the infinitive `ἐπικρατῆσαι` is `τὸ φλέγμα`, while `ἃ` serves as its direct object.
  2. 9ἐκεῖνα καθ’ ἃ — The demonstrative pronoun `ἐκεῖνα` (neuter plural) refers to 'the parts of the body' affected by the congealing of the blood. The relative pronoun `ἃ` introduces a relative clause meaning 'in/along which.'
  3. 10τοῖσι μὲν αὕτη ἡ πρόφασις γίνεται, τοῖσι δὲ — The dative demonstrative pronouns `τοῖσι` function as datives of relation or reference pointing to different groups of patients (children), forming the contrastive structure 'for some, this is the cause, and for others...'
  4. 10μεταξὺ κλαίων — The adverb `μεταξύ` directly combined with the present participle `κλαίων` forms an idiomatic construction emphasizing simultaneous action, meaning 'in the middle of crying' or 'while crying.'

Cite this passage

Hippocrates, On the Sacred Disease §9-10. Humanitext Reader, https://reader.humanitext.ai/en/text/urn:cts:greekLit:tlg0627.tlg027.humanitext-grc1:9-10

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