Two Hippocratic Treatises on Sight and on Anatomy: Edited and Translated with Introduction and Commentary by Elizabeth M. Craik (Studies in Ancient Medicine) (Studies in Ancient Medicine)

TWO HIPPOCRATIC TREATISES ON SIGHT AND ON ANATOMY

STUDIES IN ANCIENT MEDICINE EDITED BY

JOHN SCARBOROUGH PHILIP J. VAN DER EIJK ANN HANSON NANCY SIRAISI

VOLUME 33

TWO HIPPOCRATIC TREATISES ON SIGHT AND ON ANATOMY Edited and Translated with Introduction and Commentary BY

ELIZABETH M. CRAIK

LEIDEN • BOSTON 2006

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ISSN 0925–1421 ISBN-13: 978-90-04-15396-7 ISBN-10: 90-04-15396-9 © Copyright 2006 by Koninklijke Brill NV, Leiden, The Netherlands Koninklijke Brill NV incorporates the imprints Brill, Hotei Publishing, IDC Publishers, Martinus Nijhoff Publishers and VSP. All rights reserved. No part of this publication may be reproduced, translated, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the publisher. Authorization to photocopy items for internal or personal use is granted by Brill provided that the appropriate fees are paid directly to The Copyright Clearance Center, 222 Rosewood Drive, Suite 910 Danvers MA 01923, USA. Fees are subject to change. printed in the netherlands

CONTENTS

Preface and Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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part i. on sight Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II. Transmission and Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III. Content and Expression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV. Place in the Hippocratic Corpus: Provenance and Date. . . . . V. Place in the History of Ophthalmology. . . . . . . . . . . . . . . . . . . . . . . . References and Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conspectus Siglorum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Text and Translation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary of Ophthalmological Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diagrams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. The Eye: anterior view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. The Head: lateral view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Section of the Eyeball . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 3 4 8 15 19 29 31 37 38 49 113 115 115 115 116

part ii. on anatomy The Hippocratic Treatise On Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Text and Translation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II. Anat. and the HC: content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III. Anat. and the HC: expression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV. The Demokritean dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

119 119 121 124 129 155 155 157 162 164 168

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contents

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Index of Authors and Texts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 General Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

PREFACE AND ACKNOWLEDGEMENTS

The two short texts published here, both transmitted in the Hippocratic Corpus but surely neither by the historical Hippocrates, are very different in nature and origins. On Sight is a sketchy surgical manual on eye afflictions, perhaps originating in North Africa, and On Anatomy an allusive account of basic human anatomy with evident Demokritean connections. I am very grateful to Cambridge University Press for permission to republish here with slight alterations in presentation my article ‘The Hippocratic Treatise On Anatomy’ from Classical Quarterly 48 (1998), 135– 167. The original pagination is indicated. An Appendix has been added to take account of a new Budé text: M.-P. Duminil, Hippocrate: CUF t. 8, Ulc., Oss., Cor, Anat. (Paris, 1998). The ‘background’ to On Sight is discussed in my paper ‘The Hippocratic Treatise Peri Opsios’ in Hippocrates in Context, edited by P.J. van der Eijk (Leiden, 2005), 191–207; I hope readers will refer to this for amplification. I need not repeat all the acknowledgements made in note 1 of On Anatomy, but wish to reiterate thanks to the Wellcome Trust for the award of a research leave fellowship, which gave temporary relief from a demanding post at the University of St. Andrews, and facilitated a change in research direction. After a brief return to St. Andrews, I took up a post at Kyoto University in 1997. Work on the treatise On Sight was begun in Kyoto just before retirement in 2002. I have benefited from the comments of participants at several seminars in Japan, especially from those of Professor Noburu Notomi, who supported presentation of the work in its very first and very last stages at Kyushu University in spring 2002 and at Keio University in autumn 2005. From September 2003 to September 2005 I held at the University of St. Andrews an Emeritus Research Fellowship, awarded by the Leverhulme Trust, to complete this book. I am most grateful to the Trust for their support, which enabled me to spend some time in London at the Wellcome Trust Centre for the History of Medicine at UCL and to make brief visits to Cambridge, Oxford, Paris, Florence, Modena, Rome and Venice to collate manuscripts. I express

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preface and acknowledgements

thanks to all the hard-working librarians who have given indispensable aid. I am particularly grateful to two scholars who made time to read and comment on a complete draft: Professor Vivian Nutton and Professor Philip van der Eijk. Professor Nutton saved me from Galenic error and Professor van der Eijk suggested that the work might be published in this series. I owe special thanks also to Dr Thomas Rütten who gave generous help with the manuscript tradition just when I most needed it. Professor Heinrich von Staden provided valuable bibliographical aid. In medical matters, I have been fortunate to be able to call on colleagues in the Bute Medical School, University of St. Andrews: Mr Robin Clark read sections of the commentary at various stages and gave much practical guidance and Dr David Sinclair organized and led a useful seminar on the anatomy of the eye. Above all, Dr Susan Whiten has provided essential information at many points and has very kindly supplied the diagrams, adapted from her book The Flesh and Bones of Anatomy (forthcoming, Elsevier Press). Mr David Spalton, a consultant ophthalmic surgeon in London with a special interest in cataract surgery, communicated his general views of the text. Finally, I wish to thank Dr John Ball of IT services, University of St. Andrews, for adroit rescue from several technological impasses, and to express my gratitude to all at Brill involved in the execution of this complex task.

part i ON SIGHT

INTRODUCTION

I. Title The titles given to Hippocratic works seem in some cases to be based on later commentators’ superficial impressions of their content. The title περ ψιος in itself gives little idea of the actual content of the treatise; it was doubtless adopted because the first words are α ψιες and the word ψις is soon repeated, in 2. Similarly, the treatise now called Bones—though it begins with the word στα ‘bones’ and with an enumeration of the bones in the body—is really about the vessels, and was known to Galen as ‘Vessels, attached to Mochlicon’ (linguarum Hippocratis explicatio 19. 128 K.). In view of the initial plural, we might have expected a plural rather than a singular for the title; and indeed the manuscripts vary in the title given at the end, some having τλος τν περ ψων. The term ψις used three times in the work—in 1 (plural), 2 (singular) and 8 (singular)—can be either abstract or concrete in sense. In the former case, it is always singular ‘vision’ (the sense in 2 and 8), while in the latter it may be singular or plural, with reference to the seeing organ, ‘eye(s)’ or to the central ‘seeing part’ of the eye, that is iris with pupil (the sense in 1; cf. Loc. Hom. 13.6 [6.302 L.]; Epid. 4. 30 [5.174 L.]); or perhaps pupil alone, though for this the word κορ was available. It can also mean ‘dream’, a particular thing ‘seen’ (Hdt. 3. 30, 8. 54 etc.). This range of meanings is paralleled by κο, ‘sense of hearing’, ‘ear’, ‘something heard’. The term ψις is more often abstract than concrete in the Hippocratic Corpus (as de Arte. 11 [6.20 L.]). Translators and commentators have wrestled with the sense. Most opt for a title based simply on vision such as, ‘de visu’, ‘de la vision’; but the meticulous Foesius preferred ‘de videndi acie’, and this choice of title is ossified in the standard modern abbreviation, Vid. Ac. It is difficult to find a single translation acceptable throughout: ‘vision’ or ‘sight’ can serve for both abstract and concrete senses, but become impossible when a plural is required. The translation Organ of Sight conveys the full range of meaning, but is somewhat cumber-

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some; accordingly, for ease of reference, the title is here rendered simply On Sight.1

II. Transmission and Reception On Sight occupies a mere four pages of Greek in the modern printed text.2 The treatise is brief and allusive in content; in addition, the text is seriously corrupt. In part, the pervasive corruption lies in the technical nature of the work, which deals with procedures naturally unfamiliar to scribes, as indeed to scholars. In part, it lies simply in visual or aural error on the part of scribes, liable to make mistakes when faced with difficult and unfamiliar material, and liable to treat such a short piece as relatively unworthy of attention. Sichel laments the ‘état de mutilation tel qu’il est impossible de reconstituer un texte irréprochable’; Ermerins finds both the corrupt state of the text and its technical content such obstacles to comprehension that he declines to translate large parts of it; Joly concurs that ‘les problèmes … ne comportent pas de solution tranchée’.3 A further problem is that, while there is no shortage of mss containing the work, the tradition is uniform and so uniformly corrupt.4 The extant tradition depends entirely, directly or indirectly, on the tenth century ms M (Marcianus 269). In the absence of evidence from the separate strand of the tradition represented by V (Vaticanus gr. 276, twelfth century) and mss descended from V such as C, much used by Littré (Parisinus gr. 2146), the deep-seated corruption in the text with its single medieval source is intractable. We may contrast the tradition of, for instance, Epidemics 7.5 Sichel knew readings of M through information from Daremberg, but did not recognise M’s early date, priority and relative importance. Similarly Ermerins knew M only indirectly, through readings communicated by Cobet. Sichel collated and recorded the readings of the recentiores, especially the Parisian recentiores, with great thoroughness. Ermerins supplemented Sichel’s critical appa-

See Craik, 2005; cf. Montfort, 2003, 46–50. Sichel ap. Littré 9, 152–161 (1861); Ermerins 3, 279–283 (1864); Joly, CUF 13, 168– 171 (1978). 3 Sichel 152; Ermerins Praefatio XL–XLI; Joly 163. 4 See Diels, 1905 and 1907. 5 But see Jouanna, 2000, 95–97 on closeness of M and V. 1 2

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ratus with information from one further ms in the Netherlands. Joly collated M and relied on Sichel for the rest. For this edition, I have seen almost all mss (see conspectus siglorum). Several minor mistakes in Joly’s representation of the text of M have been corrected (κα 1.2; τε, 2.1; article  to be included, 3.3; article τν to be omitted, 7; σοι ‘you’ to be omitted, 9.2; λλ’ ‘but’ to be omitted, 9.3).6 Such variations as preference in M for uncontracted verbal forms, for γγνονται rather than γνονται and for κως rather than πως are not recorded in the critical apparatus. On checking Sichel’s apparatus for the recentiores, I find many instances where the punctuation is wrongly recorded. This is unsurprising, as versions of the punctuation vary greatly (especially in relation to headings or quasi introductory material) and are frequently awry, betraying a complete lack of comprehension on the part of scribes: there is a tendency to reduce the text to staccato bursts of short clauses, or apparent semantic units, which are devoid of overall syntactic sense. I have not thought it worthwhile to record these different versions, which have no interest except as a means of suggesting links among the recentiores. Scrutiny of the mss merely reinforces the impression of careless transmission. It is remarkable that several obvious errors in M go almost universally uncorrected: ατμαται, 1.1; αλασσοειδ , 1.2; μηλησ"ω, 4.1. There is an almost total lack of marginalia (even in mss where these abound for other works) and such glosses as do exist are banal in the extreme (in G, δε#ων glossed βρχων, 3.2). There is, however, a general regard for marking new topics: a red initial letter or a small space precedes a separation into ‘chapters’ similar to that adumbrated in notes by Cornarius, then pioneered in his text by van der Linden, refined by Iugler and followed in modern editions. M has a sizeable space only before 7 init. but has slight spaces before each of the repeated &πειτα ‘then’ conjunctions in 3.1; while there is not complete unanimity in the recentiores over the existence or placing of these sense divisions there is most general agreement over the start of our chapters 7, 8 and 9 – R, however, has spacing before 4, 7 and 8 and Laur. only before 6 and 8. In M, f. 212 starts with the words ' κ(τωεν 3.3 and ends with the words )πανιες δ*, 7.1. At both points, where scribal inattention is explicable, the text is particularly problematical and can be understood

6

Cf. Anastassiou, 1980.

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only with substantial extension and emendation. In defence of the scribe of M—generally known to be faithful and reliable—it may be added that many readings emended by editors are perfectly acceptable in the context of the rough and elliptical Greek of this work. (See on 1.1, 2.1, 4.1 etc.) Although the precise nature of the relation of the later mss to M and to one another is much debated and there is no agreement on details of classification, the general lines of affiliation are clear. The mss H and I are both close to M, either through faithful copying or—as has been suggested—because they share a common (lost) source; they are in turn the basis of the later tradition. The consensus view that I had a great influence on the later tradition—for instance being source of F, source in turn of G, source in turn of Z—is corroborated in the case of this work. That different sources can be seen in R is clear also: R agrees more often with H (and is familiar with the second hand in H) but, at the same time, shares several readings with I. There is no evidence from this treatise that R had access to significant material extraneous to the tradition of MHI. Detail in the critical apparatus is confined to the readings of M, H, I, R.7 (See further on π(+η, 1.1; ,σχυρς, 3.3; ξυσμς, 6.1; κοιλης κ(αρσις, 9.1; πλ(γιον, 9.1; ο γ/ρ συμφρει, 9.2.) In the final analysis, precise textual study is of no help whatsoever in retrieving the original lost text of this work. As elsewhere, it may be suspected that scribes were more concerned with general fidelity to content than with an exact record. In this edition and commentary, clues to the source and nature of corruption are sought in other Hippocratic works, and in parallel passages of Celsus and Galen. This is, of course, a hazardous enterprise. It must be stressed that, where emendations are suggested on this basis, they lay no claim to verbatim restitution of the lost original; rather to recovery of the lost gist expressed in wording which is possible and plausible. The only justification is that manifest nonsense is here converted to patent sense fitting its context. Earlier editors and translators made distinctive contributions, in line with their work on other Hippocratic treatises. Both Calvus and Cornarius, generally conservative and literal, used translation as a means of explication and interpretation. Calvus, using the ms W at Rome in 1512, made the obvious correction of μηλησ"ω to μιλησ"ω, 4.1 and recorded the variant, or intelligent conjecture, ξ#σιος for κρσιος, 4.2; see also on the significance of the translation scapulares ‘scapulars’, 3.1.

7

On M, see esp. Jouanna, 2000; on H, esp. Duminil, 1998, 28.

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Cornarius’ annotations, comprising both observations and corrections made in his personal copy of the Aldine text of 1526, survive, as was realised by Sichel, who checked and recorded his notes in the copy at Göttingen; from this it is possible to see the use Cornarius made of further ms sources (as )ρυρ( for )ρυρα, 3.4).8 Foesius, thanks to an influential patron, had access to three mss held in the royal library at Fontainebleau where they were transferred in 1544 and catalogued in 1550; he had also seen the Vatican ms now known as R.9 Foesius printed a text in line with the current vulgate, but permitted himself deviations from this in translation and comment; see on 4 and 7. Van der Linden followed Foesius but not slavishly; he was familiar with Ermerins’ ms Q. The philological value of these early printed texts lies primarily in the access of scholars then to a wider range of manuscript sources than we now possess (see app. crit.). In practice, however, the sources they cite add little to our knowledge and do not mitigate our dependence on M. The medical value of these early printed texts is considerable, especially for such surgical works as On Sight. All contributors were practising doctors who had personal experience of bloodletting and cupping—and of such activities before Harvey’s work of 1628 changed our perception of the blood vessels and their course in the body; see especially on 3.1. It has commonly been asserted that there is no ancient reference to On Sight, which would authenticate its place in the Hippocratic Corpus of antiquity.10 This negative view has now been contested with regard to the Galenic gloss 1τρακτον, relevant to 4.1.11 To this can certainly be added Erotian’s gloss φολδα, relevant to 6 and possibly also ολ" relevant to 4.1. Both fall in the appropriate position in Erotian’s list: in the third category, Therapeutics, placed with the lost work On Wounds and Missiles, between Head Wounds preceding and Fractures with Articulations following; see also for διαφανσι 2 and 5, for τ(χα, 3.4, and for ξυσμς 6.1. That many words glossed by Galen are present in the treatise confirms that the vocabulary has a Hippocratic, if at times recondite, character (see on 2, 4, 6, 7 and 9). Hesychios too contains much of relevance to the work (see on 2, 3 and 4).

8 9 10 11

See now the thorough treatment of Montfort, 2003. Foesius, preface lectori candido; Omont, 1888. Joly 163; Nachmanson, 1917, XIX. Anastassiou and Irmer, 1997.

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introduction III. Content and Expression

Short works—we may compare the still shorter On Anatomy and the somewhat longer Dentition—are peculiarly difficult to interpret, and to place in the wider context of the Hippocratic Corpus and other writings. To argue that different works of the Corpus belong together, a conjunction of similar content and similar language is required. Many associations in content can be explained simply by access to a common pool of knowledge, from which items might be taken and reworked. Unless it is unusually esoteric, or there is a high concentration of coincident elements, content is not a reliable indicator. Language may be somewhat more reliable, though here too caution in interpretation is imperative. Where such elements as vocabulary, or grammatical and syntactical features, or use and frequency of particles and pronouns are shared—especially where these are distinctive or non-standard—they may be pointers to a common tradition. On Sight is a manual of surgery, giving instructions for surgical procedures to be followed and, to a lesser extent, for drugs to be applied in different ocular affections or diseases or, rather, to treat different sets of ocular symptoms. Retrospective diagnosis of Hippocratic cases is always hazardous, but here the conditions can be more or less plausibly identified as follows: cataract (1), weeping sores and their complication ectropion (2), trachoma and its effects (4), papilloma or chalazion (5), ‘night vision’ (7), recurrent seasonal allergy or conjunctivitis (9). The procedures are: cautery of the vessels (1.1, 2; 3) or of the eyelid (4), cutting and/or scraping of the eyelid (5), letting blood by phlebotomy or cupping (3; 7; 9), cutting the scalp (4.2), trephination of the skull (8), purging the head and/or the body generally (1.1, 2; 4; 7; 9), applying ointments and poultices (6; 9). All these procedures, some gentle and others drastic, are boldly indicated, but care and caution are likewise enjoined. The first requirement of a surgeon is a secure knowledge of the anatomy of the parts on which he operates. We might expect this knowledge to be expressed in technical language. However, our author displays no awareness of the complexity of the eye’s anatomy. Few technical terms are used, apart from the repeated ψις already noted. No word, apart from ψις, is used for pupil, iris or cornea and there is no reference to the nature or number of μνιγγες ‘membranes’ (coats or tunics) of the eye; this contrasts with reference to three membranes in

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Places in Man.12 There is frequent reference to the βλφαρον ‘eyelid’ (2; 4.1; 5 bis; 6 bis), but no word except ρξ ‘hair’ for eyelash (5). The rather vague στεφ(νη ‘circle’, ‘ring’ is used for the eyeball and the rather general χνδρος ‘cartilage’ or σ(ρξ ‘flesh’ for the inside of the eyelid (4.1). The author operates not only on the eyelids but also on the head more generally, and here his knowledge seems more extensive, though it is still not technical in expression. He cuts into the βργμα ‘bregma’ or the vertex in two different procedures, either in order to release blood, or in order to gain access to the skull for trephination (4.2; 8). Apart from bregma, no anatomical terms are used for parts of the head. The skull is simply στον ‘the bone’ (3.1, 2, 4; 8). The φλβες ‘vessels’ are important to his practices (1.1; 3.1, 3 ter; 9. 1), but there is only one indication of particular vessels and their location, and that is unclear (3.1). Despite the disconcerting absence of anatomical nomenclature, our doctor was evidently familiar with the general anatomy of the head, knowing where to cut and how to trephine: he would know exactly where the bone of the skull was thickest and exactly where the flesh of the scalp was thinnest, and be able to trace the location of the sutures and of the inion, occipital protuberance; he would have some idea of the course of the main blood vessels. Even in Head Wounds, rather vague terms are used for regions of the head: κορυφ ‘top’ or ‘vertex’ is not a well-defined anatomical term, and the words for ‘forehead’, and ‘brows’ are somewhat vague also.13 Use of the term πισεν ‘behind’ to indicate posterior orientation in the body seems to show a nascent striving for precision (3.1 bis; cf. πρσεν, 1. 2, and &νδοεν, 2). The paucity of anatomical terminology may indicate simply that the surgeon was not concerned, or not here concerned, with names for bodily parts; it need not suggest ignorance of these, far less inability to operate safely and effectively. The author’s pathology, like his anatomy, is almost devoid of technical terminology and the lack of nosological specification is striking. The rather crude term διαφερεσαι ‘be destroyed’ describes loss of sight (1.1; 8). The only abstract noun for a disease is ‘ophthalmia’ (9), in general usage applied indiscriminately to eye trouble; to this we may add a case designation ‘sufferer from night blindness’ (7). The absence of such terms for sight impairment as μα#ρωσις (appropriate to 1) and μβλυ12 13

See Craik, 1998, 105. Cf. Hanson, 1999, 99.

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ωπα (appropriate to 8) common even in non-medical authors, and the

absence of any reference to treatment of eye injuries, is remarkable. In this practical work, prognosis is more important than diagnosis. Diagnosis is by appearance (1) or by the patient’s report of discomfort (6) or of loss of vision (8). In practice, the physician considers two broad categories: problems where the eye, but not the eyesight, is affected (2) and problems where the eyesight, but not apparently the eye, is affected (8); he differentiates between sudden and gradual loss of sight (1) and between child and adult patients (2). The writer seems familiar with a wide range of problems, even if he does not apply names to them. This may be a merit: in practice, many eye conditions display similar symptoms, or take many forms; for example, conjunctivitis—perhaps the most common of all eye diseases—may be classified as catarrhal, purulent etc; and trachoma has many complications, including trichiasis and entropion. If the author has any knowledge of terms for the diseases here described, he does not display it. We cannot assume that names were unknown or unavailable; it may be simply that the author is not concerned with nomenclature and that the modern quest for nomenclature and definitions is bound to be of limited success. The author is no more concerned to expound his views on physiology than on anatomy and pathology. However, it is evident from his practices—purging the head and body, cauterising the vessels—that he subscribes to this common theory: that flux of peccant matter (usually viewed as phlegm) from the head is the major cause of disease in general, and that such matter concentrated at the eyes is the cause of the most common eye disorders. It is evident too that he subscribes to a refinement of this, postulating two different types of flux from two different parts of the head to two different locations in the body (here, two different regions of the eye): superficial upper flux, from the area above the skull, or the scalp, and deep lower flux, from the area under the skull, or the brain. The fluids mentioned, apart from blood, are 4δρωψ ‘moisture’ (removed on trephination, 8) and ,χ5ρ ‘ichor’ fluid with a watery or bloody appearance (4.1). There is some awareness of pulsation in the vessels (3). It is apparent that the author believes that an excess of matter in the head flows down through the vessels, and that this noxious flux can be arrested by cautery or venesection. This was the desired effect. As to the actual effect, it must be supposed that he cured some of the people at least some of the time, as his practice would depend on his establishing a reputation and securing the respect of physicians and the trust of patients.

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The text, then, is not about anatomy, physiology or pathology, but about surgery and therapy with especial emphasis on cautery. Cautery was commonly used to arrest haemorrhage, to burn off excess tissues, to lance abscesses and, as in On Sight, to eliminate noxious bodily moisture. It would have the additional unappreciated benefit of combating infection. Cautery, like cupping, might be dry (a less invasive treatment involving no break in the skin and no bleeding) or wet. In dry cautery, the instrument is used simply to apply gentle warmth to the body, commonly but not always to the blood vessels. Even when the instrument is used to address the vessels, it may just be placed alongside (παρακαειν ‘burn beside’, 3.3) apparently with a view to changing the consistency or the movement of their contents. Alternatively, in wet cautery, the instrument is placed across them (διακαειν ‘burn over’, 3.3 quater; cf. treatment of the eyelids, 4.1) apparently with the intent of actually breaking the wall of the vessel—surely vein, not artery—or even severing it. In both wet and dry procedures, sponges might inserted between the surgeon’s instrument and the patient’s skin ()γκατακαειν ‘burn in and down’), possibly in an attempt to mitigate the pain, to control the severity of the heat, or to mop up blood (but see further on 3.2). Similarly, in dry cupping, the cupping instrument is applied to the surface of the skin and left there, with the aim of drawing out noxious stuff from the unbroken skin by suction, while in wet cupping the skin is broken or scarified in order to remove blood or noxious matter from a vessel or elsewhere. Thus, the verb καειν, lit. ‘burn’, med. ‘cauterise’ does not necessarily or always involve extreme heat, far less branding and scarring; it is simply ‘heat, using a cauterising instrument’. The practices of cutting and cautery are often allied, as alternative or successive ways to address a problem: to drain or burn out an excess of fluid, reducing it by incision or by application of heat; to stop flow by creating a barrier. Celsus too viewed these as alternative ways to eliminate noxious matter from the vessels. Many elements in the doctor’s pharmacopoea are everyday items from the domestic store cupboard, such as olive oil (3.3), garlic (7) and honey, applied (3.2) or ingested (7). Sponges and fine wool are also part of his stock-in-trade (3, 4.1). In preparation, an ointment must be ‘in consistency like myssotos’, a culinary paste (6); the simile conveys a homely atmosphere. Similarly, the verb used of thoroughly heated cauterising instruments ‘well-roasted’ (3.2) is one with a regular culinary nuance. It may be that the doctor simply requisitioned items, such as sponges, from the patient’s kitchen. Such improvisation is commended

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in Articulations (Artic. 7 [4.86 L.]). However, there is evidence too of specialist supplies. The most commonly named specific is a derivative of copper, evidently copper sulphate, perennially favoured to treat certain ulcerative eye conditions, such as trachoma: 1νος χαλκο6 ‘flower of copper’ (4.1, 6; slightly different terminology in 5). A second ingredient in an eye salve, specified without indication of quantities or proportions, is unripe grape juice. This is a seasonal item but there may have been procedures (?ancillary to wine manufacture), to preserve it for use throughout the year (6). Arum root, used in cautery, would be more readily stored (3.2). The preparation of an eye ointment detailed (6) demands a ‘grindstone’ (or perhaps rather a pestle and mortar), a strainer, and a special container of red copper. The ‘couch’ where the patient is positioned in preparation for surgery (3.1) would ideally be one regularly used by the doctor performing the operation and appropriately positioned, height and light source being important considerations, but might be rather a piece of ordinary household furniture which came to hand. Cupping vessels are explicitly mentioned once (9.1) and required by implication elsewhere (7); scalpels would be required in order to let blood (3.1, 9.1) and to cut into the scalp (4.2, 8), and a sawing instrument would be needed for trephination (8). A scraping instrument or rasp, or material of some unspecified sort is needed to scrape the lids (2; 4. 1, 2) and another special blade is needed to ‘thin’ them (4.2). Finally, different instruments for cautery either of metal (3.1) or of wood (4.1) are used; these are sometimes required to be delicate (‘not thick’, 1). A means of heating these would also be required. The absence of technical terms for instruments is as marked as the absence of anatomical and other medical terminology noted above. The eye surgery seen in Paul of Aigina is described in very different terms, with such dedicated instruments as a βλεφαρξυστον ‘raspatory to treat the eyelids’ and πτερυγοτμον ‘knife to excise a pterygium’ and many others (Paul 3. 23, 6. 15 etc.) The drugs to be used for the most routine treatments are not specified: it is taken for granted that the doctor will know how to purge the head by nasal insertions and the body by laxatives (1.1, 2; 4. 2; 7; 9.1); exceptionally, elaterion lit. ‘driver’ is once indicated for drastic purging (7). It is assumed too that he will know which applications will have a particular effect, such as ‘astringent’ (δριμ#ς, 9.2), and what drug will be effective to stop a flow of blood (&ναιμος, 4.2). When poultices are indicated, their composition is left to the doctor’s discretion (9). The shorthand ‘give the further treatment’, i.e. ‘continue to treat as appro-

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priate’ (,ητρε#ειν τ/ λοιπ(, 5) presupposes practical experience. There is some evidence of observation, though this is somewhat subjective in character (comments on different colours of the seeing part of the eye, 1); the doctor sets store by ‘signs’ (change in nature of discharge, 4.1). There is some evidence also of careful interrogation of the patient (comments on whether the onset of the affection has been sudden or gradual, and with or without apparent cause, 1); the patient’s report of symptoms may condition the choice of treatment deemed appropriate (presence or absence of pain, that is of headache, 9). Some store is laid on seasonal factors (in ophthalmia, 9). The patient’s diet may be restricted and his environment monitored (in ophthalmia, 9). The instructions given are often expressed in a peremptory and authoritative fashion. The doctor treats (ποιε7ν, 2; also , σαι, 8 and 8ησις, 1.1, ,ητρε#ειν, 5) and the patient is on the receiving end of treatment (π(σχειν, 1.1, 3.3). Instructions are confident, often expressed in terms of what ‘should’ be done (χρ ‘one should’ 1.1; 3.3 bis; 4.1, 2; 8). The clinical approach throughout is pragmatic. It is important to recognise cases where treatment would be useless (οκ 9ν :φελοης ποιων οδ*ν ‘you could not help by any action at all’, 2). The doctor’s concern is with what will or will not ‘work’; hence repetition of the verb συμφρει ‘it is beneficial’ (1.2 bis; 9.1 bis, 2 quarter, 3 bis). There is much room for discretion: letting blood helps in some cases of ophthalmia (9.1) and poultices are helpful in certain specified circumstances (9.2). Although the doctor must act decisively (,σχυρς ‘strongly’ in cautery, 3.3; ;ς μ(λιστα ‘as much as possible’ in pressure for cupping, 7) he must also act with due care and caution (ατ< τ< φαλμ< σκεψ(μενος ‘considering the actual eyes’, 2; συχ+ διαερμανειν ‘heat gently’, 3.1; τ=ν σ(ρκα 'κσην εμαρστατα δ#ν+η ‘the flesh … as much as you can, very gently’, 5.1; φυλασσμενος ‘with care’, 4; 5.1). He must recognise the signs which indicate that it is time to stop scraping the lids (4.1), and know what follow-up procedures are appropriate (4.2). Long-term treatment seems to be envisaged; thus the processes of vascular healing after cautery and of lid repair and regrowth after scraping seem to be monitored (3; 4. 2). Where injunctions are given for procedures to be followed, the address is sometimes direct, in the second person: ‘you could not aid’, ‘when you cauterise’, ‘when you scrape’, ‘you should pour’ (2; 3.3; 4.1; 6); jussive infinitives with nominative participles are particularly common (2; 3.1 and 2 repeatedly; 4; 5; 6; 7). A favoured syntactical structure is a chain of loosely linked participles, indicating successive

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steps in treatment or preparations for treatment, used in conjunction with jussive infinitives. There is much use of the adverb &πειτα ‘then’ to indicate clearly successive stages in procedures to be followed. Verbal expressions ‘it is beneficial’ and ‘it is expedient’ are much used also (συμφρει and χρ discussed above; cf. &ργον 4. 2). Jussive subjunctives too are used: once of the practitioner (6), once of an aide (3.1) and once of the patient (7.1). The work begins abruptly, with asyndeton, and the use of τοια#τη ‘such’ (sc. such as before) indicates loss of context. The end is similarly abrupt and the editorial thesis of Joly and others that the text is a mere disjointed fragment is plausible. The extreme brevity of the surviving text and the fact that it considers relatively few eye diseases add to the impression that we are dealing with a lacunose piece, possibly an excerpt from, or partial summary of, a much larger work. The extent and nature of textual corruption is consonant with this possibility: there are lacunae even in the text as transmitted (especially in 3, 7 and 9, but probably not between 2 and 3, pace Sichel and others). Although the sporadic use of headings or quasi-introductory phrases (the basis of the modern division into ‘chapters’) may be vestigial evidence of a degree of organisation, some major transitions in thought are unmarked (3 init.). Within several chapters the content is uneven, surgical instructions sitting incongruously alongside general comments and advice: the presence of such disparate material is particularly marked in 3 and 9. Overall, the work is a series of disconnected jottings, elliptical, allusive, and telegraphic in expression. The syntax is primitive and inelegant. Paratactic sentence structures predominate. Subordinate clauses, where used, are not well integrated but appended in a loose agglomeration (2). There is a marked tendency to careless or otiose repetition, especially repetition of the demonstrative pronoun (1, 6, 9), and there may be a trace of Doric idiom (neuter plural noun with verb in plural, 3.4). These features are typical of early Greek prose writing. In addition, the grammatical forms are rough, functional and unidiomatic to the point of solecism, with particular oddities in the use of prepositions.14 The vocabulary is functional. However one salient feature is a tendency to employ compound verbs. In some instances, these are semantically significant, conveying precise surgical nuances (διακαειν and )γκατακαειν discussed above); in others

14

See Craik, 2005, 204–205.

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the compound is used where the simple verb would suffice (διαβλπω, διαερμανω, διασημανω, διαχρω, διαχωρζω). The content, with its stress on practical instruction and disregard of matters not germane to that immediate concern, suggests a target audience of trainee physicians. The form, with its strongly didactic tone, in conjunction with loosely juxtaposed clauses and truncated elliptical expression, suggests the format of notes intended to accompany a set of lectures or demonstrations. While such notes may be made and kept by pupils as well as teachers, our treatise seems to mirror the attitudes of one giving, not receiving, instruction: the magisterial, authoritative and abrupt expression seems to be directed at a learner, receiving instruction from an experienced practitioner. Surgery above all must be taught by demonstration and participation; the work we have may have originated as a relatively unimportant adjunct to the manual business.

IV. Place in the Hippocratic Corpus; Provenance and Date Much medical writing is essentially derivative and repetitive in character. Even modern textbooks can be shown to parrot one another, especially where factual material is presented. In antiquity, where it was impossible to establish prior claim by definitive publication, where the notion of plagiarism was lacking, and where medical scientists worked in collaborative or combative groups, such repetition is inevitable. It may be said that all the Hippocratic works are mixed and derivative to some degree, and that few, if any, are original in an accepted literary sense: the words ‘redactor’ rather than ‘author’ and ‘compile’ rather than ‘compose’ are appropriate. The integrity of the Hippocratic canon has been increasingly questioned, to a point where it has been suggested that the very concept of a Corpus is flawed:15 while individual Hippocratic writings have much in common and can be regarded as groups or clusters, it is possible to parallel much of the content of the Hippocratic Corpus in fragments of many medical authors, including those whose views are summarised in the papyrus known as Anonymus Londinensis, and in fragments of the Presocratics, as well as in the Aristotelian Corpus. (For Vid. Ac. and the Aristotelian Problemata, see especially on 1, 2 and 9.) It remains likely that there was direct interaction

15

See Nutton, 2004, 61–66; van der Eijk, forthcoming.

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between some of the authors represented in the Hippocratic Corpus and the quest for affinities remains meaningful. It is immediately evident that there are general similarities in On Sight with the practices and so with the expression and vocabulary of such surgical works as Articulations and Sores, also with the surgical procedures in the gynaecological and nosological treatises—though none of these works is so uncompromisingly surgical in content or so aggressively peremptory in expression as On Sight. Unsurprisingly, there are particular resemblances with works featuring cautery; for instance, the term 1τρακτος for a cauterising instrument occurs only in On Sight and in Internal Affections. The extreme brevity and rugged idiom of On Sight compound the difficulties of making such comparisons. However, there is no doubt that in both content (on eye flux and on cautery) and expression (style, syntax and grammar) On Sight particularly resembles Places in Man. The author of Places in Man seems to have a particular interest in the eye: different kinds of ocular flux are classified at length and treatments are specified: eye salves (13.1, 2 [6.298, 300 L.]); purging the body by enemas and laxatives (13.1, 4 [6.298, 300 L.]); purging the head by errhines (13.2, 4 [6.300 L.]); cautery of the vessels in the temples (13.7 [6.302 L.]); and, in an extreme case, making incisions in the scalp to the bone (13.5 [6.300 L.]). Similarly, in On Sight, according to type of symptoms, the treatments are: eye salves (6; 9.2, 3); purging the body (7.1; 9.1); purging the head (1.1, 2; 7.1; 9.1); cautery of the vessels (1.1, 2; 3.1–4) and incising the scalp (4.2; 8). There is also cautery almost up to the bone of the skull (3.1–2). In both works too, trephining is practised, as is venesection or cupping. Treatment of the eyelids as prescribed in On Sight is by similar methods; that is, by surgical cutting and burning, and by ointments or lotions. In both works, detailed instructions are given as to how cautery of the vessels should be performed. These instructions are given in similar terminology and with a similar emphasis in content (Loc. Hom. 40 [6.330 L.]; Vid. Ac. 3). The theory of flux from the head, underlying the therapy advocated for eye conditions, is explicitly presented in Places in Man and implicitly present in On Sight (especially in 9, in language similar to that of Glands, a treatise close in details of its theoretical stance to Places in Man). The same theory can be seen, in different guises, in other works which are concerned with symptoms and therapy of diseases stemming from the head, notably in Diseases 2, Internal Affections and Affections, and notably where cautery is the preferred practice. In both Places in Man and

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Glands: it is the ‘marrow’ which carries noxious flux to lower parts of the body (Gland. 11, 14 [8.564, 570 L.]). Similarly, in Koan Prognoses, a list of diseases not found before puberty includes κατ(ρρους νωτια7ος ‘flux in the back’ (Coac. 5. 502 [5.700 L.]) and in Internal Affections, two types of phthisis are related to abnormal functioning of the ‘marrow’: in one, the ‘marrow’ becomes filled with blood (or the hollow vessels filled with bile and phlegm) and in the other, the ‘marrow’ becomes dry, with blockage in the ‘small vessels’ from the brain—here, cautery of the neck is prescribed (Int. 12, 13 [7.192, 200 L.]; cf. Loc. Hom. 21 [6.312 L.]). There is a further nexus of associations with treatises which detail ingredients and preparation of recipe cures, Affections, Regimen in Acute Diseases, Diseases of Women 1; Affections is unusual in referring to a work on drugs sometimes called pharmakitis (Aff. 15, 23, 28, 40 [6.224, 234, 240, 250 L.]) sometimes ta pharmaka (Aff. 4, 18, 29 [6.212, 228, 240 L.]). (It is usually supposed that a particular treatise is intended. However, the different modes of allusion seem to suggest a fluid body of material; and as in Greek idiom the definite article is frequently used in place of a possessive pronoun, it may be that the meaning is ‘your’— rather than ‘the’—recipe book, the reader being enjoined to refer to his files on drugs.) There are marked affinities also with Prorrhetic 2 (18–20 [9.44, 46, 48 L.], theoretical prognosis for eye conditions) and with certain passages of Epidemics (practical treatment of eye conditions). Other passing or incidental similarities can be identified: belief in the importance of the seasons in the aetiology of disease, pervasively evident in Airs, Waters and Places and seen intermittently in Epidemics and Aphorisms features in the treatment of ophthalmia at the end of On Sight. The procedures of the treatise can be paralleled in various works: Hippocratic surgeons cut different parts of the head for different supposed conditions, with different purposes, in different ways and with different follow-up procedures. The main expedients are, briefly: a single cut in order to saw or pierce the bone, usually treatment for skull fracture but also to release unwanted moisture; a single cut, usually in the forehead or the bregma to release excessive or noxious matter; multiple cuts in the scalp, to release excessive or noxious matter. The recommendations in Physician that if only one cut is required, incision should be swift; while if several are required, incision should be slow indicate a general interest in such surgery (Medic. 5 [9.212 L.]). The author of Affections, while discussing head diseases, states his intention to write separately on diseases of the eye (Aff. 5 [6.214 L.]); he further, while treating diseases of the belly, states his intention to

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write on cases of suppuration, of phthisis and of gynaecological ailments (Aff. 33 [6.244 L.]). Inevitably, there has been speculation on common authorship, and inevitably On Sight is a contender for the work supposedly projected on the eye.16 The range of works proposed by the author of Affections resembles the range proposed by the author of Articulations, and the question of interrelated authorship between major and minor works resembles that between Articulations and Glands. It is very likely that Hippocratic authors, who had to be versatile in their clinical practice, chose to be versatile in their written output also. But establishing common authorship—as opposed simply to common influence and interaction—is an elusive and perhaps ultimately impossible goal. Although On Sight has some common content with Affections, common expression suggests rather a grouping with Places in Man, Glands, Fractures, Articulations, parts of Epidemics and some of the gynaecological works. The abrupt manner is reminiscent of the aphoristic works, especially of the unpolished Koan Prognoses and there are some similarities in vocabulary also with this collection.17 The treatise is dated to the end of the fifth or beginning of the fourth century by Joly, on the basis of its supposed ‘Knidian’ content, especially the stress on cautery, traditionally associated with the name of Euryphon and regarded as a Knidian practice; but cautery may more properly be regarded as an ancient practice, persisting in pockets everywhere.18 It has been argued, on the basis of language, that Places in Man is an early work, originating in Italy or in Sicily.19 In view of the similarities noted, it may be suggested that On Sight has a similar date and provenance. It may then be conjectured that the author had affiliations with the west Greek thinkers Alkmaion of Kroton and Empedokles of Akragas, both known to have taken a particular interest in the eye. However, although thinkers with an interest in the workings of the eye and doctors with an interest in diseases of the eye might well have found their activities complementary, the severely practical tone of On Sight militates against direct comparison with these highly theoretical and philosophical writers. Although Alkmaion was said to have dissected the eye, it is unlikely that this bears any relation to the activi-

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2005. 17 18 19

See Rodriguez Alfageme, 1993 on use of particles in Aff. and Vid. Ac.; also Craik, See Craik, 2002, 288, n. 3; also 2005. Joly 164; Thivel, 1981, 281–282. Craik, 1998, esp. 22, 28–29, 33.

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ties of our doctor: even if true, the dissection was doubtless of an animal (just as Demokritos from Thracian Abdera was said to have dissected animals, cutting into the bregma, with an interest in sense perception).20 Another possible source for the work is north Africa: there is good fifth century evidence that ‘Egypt’ produced the best ophthalmologists; papyri confirm an earlier specialist interest in ophthalmology; Libyan Kyrene was a prominent medical centre. Trachoma, a disease given much attention in On Sight, has a peculiar association with Egypt. If the piece is based on the work of someone whose first language was not Greek and who was not entirely at home with the idiom, the vagaries in expression are more explicable.21

V. Place in the History of Ophthalmology Modern works, aimed to assist the hard-pressed family doctor in diagnosis of ocular problems, suggest that the first distinction should be between gradual and sudden loss of sight, and that each of these subdivisions should then be classified further on an anatomical basis, working posteriorly from cornea to retina to choroid and optic nerves. And in ophthalmic pathology, topics are generally grouped together with reference to the part affected. Unable to examine the inside of the eye and unaware of its full complexity, the ancient practitioner uses a more crude yardstick, and thinks primarily in terms of ocular flux. In the development of ophthalmology in antiquity, increasing anatomical knowledge is evident and well documented.22 In the Hellenistic period great advances were made by Herophilos and Erasistratos: Herophilos had a particular interest in vision and the connections between eye and brain; also in the structure of the eye, where he distinguished four membranes.23 But still, the theory of flux and therapy based on it continued to survive and pervade ancient ophthalmology centuries later. Both Galen and Celsus, despite awareness of the huge advances in ocular anatomy and physiology initiated by Herophilos and developed by Demosthenes Philalethes, and despite practical advances in surgical techniques, subscribe to the same general scheme of beliefs 20 21 22 23

Lloyd, 1975. For detailed argument, see Craik, 2005. For general discussion, see Hirschberg, 1899 and Magnus, 1901. See von Staden, 1989, 570–576.

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as their Hippocratic predecessors. (A rare attempt to classify eye troubles with reference to the parts affected survives in the pseudo-Galenic introductio seu medicus 14. 767–777 K.; in this classification—though not in discussion of theory or description of treatment—the anatomical advances of the great Alexandrians are apparent.) Already Alkmaion put forward theories of sense perception based on the concept of ‘ducts’ leading from brain to eye (DK 24 A 5 = Thphr. de sens. 25) and similar concepts of psychophysiology can be seen not only in the Hippocratic Corpus (Loc. Hom. 1.3, 2.2 [6.276, 280 L.]; Carn. 17 [8.604 L.]), but also in the works of Aristotle (GA B 6. 744a8 and elsewhere).24 Both the supposed route and the postulated function of these ‘ducts’ were variously understood. Certainly there was progress towards understanding of the location and importance of the optic nerve, and certainly it came to be envisaged that pneuma ‘breath’ was conveyed from brain to eye (as already supposed, Morb. Sacr. 7 [6.374 L.]). But the theory of ducts or channels from the head has a much wider and simpler, more material, significance. The related theories of physiology, that optical wellbeing depended on the proper functioning of the ducts, which conveyed pure moisture to the healthy eye, and pathology, that the sight was affected if the ducts became blocked or flooded or conveyed peccant moisture to the diseased eye, can be seen pervasively in Greek medical texts of all eras. These theories are allied with the common general theory of a κατ(ρρους ‘downward flux’ from the head to various parts of the body through various channels, including channels linking the brain, via the cerebral or spinal fluid, to the lower body (Epid. 2. 4. 2 [5.126 L.]; Oss. 12 [9.182 L.]). Effects on the eye are described both in the Hippocratic Corpus (eye and lungs, Aer. 10 [2.46 L.]; cf. Aph. 3. 12 [4.490 L.]) and in related medical authors (eye, ear, and nose in Dexippos, Anon. Lond. XII. 22–26; eye and joints in Diokles fr. 137; night blindness caused by ‘moisture and excess’, Arist. GA 5. 1). Formulations in Galenic texts, though expressed in more sophisticated language, belong fundamentally to the same perception as that prevailing in the Hippocratic era. Thus, the author of Places in Man states that φλβια ‘little vessels’ from the brain nourish the eye with pure moisture but ποσβννυσι τ/ς ψιας ‘extinguish the organs of sight’ if they happen to dry up (Loc. Hom. 2.2 [6.280 L.]), while Galen tells us 24 On Aristotle, see von Staden, 1989, 157, n. 54; on Diokles, see van der Eijk II, 2001, 267.

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that when, in spite of no apparent disease affecting the eye, it happens that πλεσαι τ=ν πτικ=ν α8σησιν ‘the sense of sight is lost’, the cause is a νε6ρον ‘a nerve’ or ‘a duct’ from the brain swelling, damaged or blocked by a flux of moist matter (de locis affectis, 8. 218 K.; cf. on various destinations of a defluxion the pseudo-Galenic introductio seu medicus 14. 742 K. and on the different effects of moisture in different parts of the head—below skin, below bone, between membrane and bone—ibid. 14. 782 K.). Commenting on the Hippocratic Prognostic (Prog. 2 [2.114 L.], an account of ‘signs’ to be detected in the eyes of patients), Galen interprets through extensive paraphrase but still writes of ‘flux carried down from the head’ and gives its aetiology as πλ ος ‘excess’ or some kind of φλεγμον ‘inflammation’ or ‘phlegmatic content’ in the brain. Further, the same theories with the same rationale persist, perpetuated by Oreibasios and others, even in Paul of Aigina, who describes the cause of eye ailments as an acrid defluxion and makes a clear distinction between types situated above or below the skull.25 Surgical procedures too remain constant over the centuries. The operations performed in On Sight, other Hippocratic works and the Aristotelian Problemata (cautery of the vessels in the temples, πυκνο6ντες το?ς τν @γρν πρους ‘thickening up—i.e. reducing the width of—the channels of the fluids’ and scarification of the scalp) are paralleled in evidence from papyri for excising the temples and other areas of the scalp.26 Paul of Aigina describes attempts to dissipate or evacuate peccant matter by applying a cupping instrument to the back of the head, by scarification, by applying leeches to the temples and by poultices.27 Galen and Celsus, in conjunction with such Hippocratic writers as the authors of Prorrhetic 2, Diseases 2 and Places in Man, provide direct aid to understanding the abbreviated and allusive content of On Sight (see on 1, 3, 9) or have indirect corroborative relevance to it (see on 4, 6, and especially 7). This is evidence for the long currency and inherent conservatism of the physiological theories and surgical procedures concerned, rather than for direct influence of the earlier texts, though it seems likely that Celsus drew directly at least on Prorrhetic 2.28 In general, Galen—or contemporaries whose work has found its way into the Galenic corpus—favoured non-invasive procedures in treating the eye. 25 26 27 28

See Adams I 1844, 411–412; III 1847, 248. See Marganne, 1994, esp. 1–14. Adams I 1844, 420–421. See Pardon, 2005.

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Thus his remedy for accumulated rheum is simple: the problem is to be removed by a soft sponge with warm water (de remediis parabilibus, 14. 341 K.). He approves the simple Hippocratic recommendations of the aphoristic texts—neat wine, baths, vapour baths, phlebotomy, purging (Aph. 6. 31 [4.570 L.])—and regards the physician’s role as merely to aid nature (cf. the view that spontaneous diarrhoea gives relief in ophthalmia, Coac. 2. 220 [5.632 L.]). According to a later (Arabic) version, he lauded practitioners who cured by drugs alone, rather than by excision, not only growths such as pterygion and chalazion but also serious eye diseases such as cataract and trachoma (de optimo medico cognoscendo, CMG Suppl. Orientale 4. 10. 2). Trepanation was known but rarely practised.29 Celsus is much more interventionist. Archaeological finds of surgical kits, especially from Roman Gaul, confirm the evidence of Celsus for the practice of eye surgery; according to one modern ophthalmologist—writing before a further spectacular find near Lyon—these ‘could almost still be used’.30 Most of the conditions addressed (though not by name) in On Sight are of central and perennial importance in the history of ophthalmology: cataract, glaucoma, trachoma, recurrent conjunctivitis, night blindness. All of these conditions were addressed by ‘Susruta’, to whom is attributed a series of works in classical Sanskrit; this composition has its origins several centuries BC, but betrays several historical layers and different hands. The works show formidable clinical skill, including knowledge of how to couch cataracts, dislodging the lens of the eye. Like the surgeon of our treatise, Susruta favoured the use of general purgatives before starting specific ocular treatment; treatments used by both include scarification, venesection, cautery in the temporal region, use of copper sulphate for trachoma, prescription of (cooked) goat or sheep liver eaten with honey for night blindness and prescription of unguents mixed in a copper vessel; advice given by both is to avoid smoke, fire and bright lights.31 The ophthalmologists of ancient Egypt (known from Ebers papyrus, c. 1500 BC) knew a similar range of diseases and practised some of the same responses. In Kahun 1, in a gynaecological context, a meal of ‘fresh’ (possibly raw) liver is prescribed for a patient suffering loss of vision and neck pain. In Ebers 351, Rocca, 2003, 266, n. 1. Dolffus, 1968; on the find of 1975 see Feugère, Künzl, Weisser, 1985 and Jackson, 1996, 2249. 31 See Biyadhar, 1939, 1947; Wujastyk, 2003, 63–64. 29 30

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roasted ox liver is to be pressed to the eyes for sharu disease, regarded by some editors as night blindness.32 The names of many ophthalmologists over the centuries are associated with advancements in the understanding of and controversies over therapeutic methods for cataract and glaucoma. Celsus had attempted surgery for cataract in its early stages. Even after Rufus systematised the distinction between the two diseases, they were frequently spoken of together, and not clearly differentiated.33 Paul of Aigina regarded cataract as sometimes curable, glaucoma as always incurable.34 Cataract surgery was long a hit and miss affair, frequently the province of itinerant barbers, not of professional surgeons. Palliative couching remained the standard method until the middle of the eighteenth century, when a cataract was first successfully extracted by Daviel (in 1752); however, controversy still centred on the true nature of cataract (a disease of the lens or a structure in front of the lens) and so on the rival methods, some declaring fragmentation or discission was always to be preferred to extraction. Failure in skill and purulent infection were long hazards.35 In the nineteenth century, the initiation of iridectomy for glaucoma was a notable advance.36 However, the annals of the new professional bodies concerned with ophthalmology continue to be dominated by the question of how best to treat these two dominant diseases. Even today glaucoma and senile cataract, together with senile macular lesions and myopic chorioretinal atrophy, can be viewed as major causes of blindness and it is conceded that the underlying aetiology of these and many other eye disorders remains obscure.37 Trachoma too has generated a vast literature.38 The condition became prevalent in England in the early nineteenth century. Troops who had served in the Napoleonic wars were carriers and sufferers. In London, a special institution for blind ex-army personnel suffering from ‘Egyptian ophthalmia’ (a misleading designation) was founded—this later developed into Moorfields Eye Hospital—and ophthalmologists 32 See for the evidence Hirschberg, 1899, 1–19; Nunn, 1996, 200 and for different estimates of its significance Marganne, 1993 and Craik, 2005. 33 Marganne, 1979. 34 Adams I 1844, 420. 35 Blodi, 1996; on the designation ‘cataract’, see Fischer, 2000. 36 Kronfeld, 1996. 37 Cf. Sorsby, 1963, 505. 38 For a general survey, see Tower, 1963; on late antiquity, see Savage-Smith, 1984, 2000.

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vied with one another to discover a ‘cure’ for the condition.39 Trachoma has a tendency to associations with military operations, though this may be merely because of the overcrowding common in armies. It may have been carried to Greece from Egypt. However, it is not confined to these regions: there was an epidemic of Asian origin in Japan in 1897, affecting soldiers of the recent Sino-Japanese war. Treatment by scraping (to allow the release of noxious matter) and burning (to sterilize and accelerate wound closure) followed by application of a copper-based salve (as an astringent and haemostatic) remained standard until the twentieth century. Sichel adumbrates the history of medical fashions in recognising and addressing this condition and finds the method described in On Sight still ‘fort efficace et généralement usitée’. According to Duke-Elder, writing on this ‘immense subject’, copper still excelled, used as ‘blue stone’, a pointed crystal of copper sulphate held in a wooden holder and used for daily scouring of the lids. Other expedients were scarification with a knife and subsequent strong massage with antiseptics; or rubbing with a curette, hard brush or sandpaper; or attack on groups of blebs by galvanocautery— essentially detergent and caustic substances.40 A bizarre misinterpretation of a passage in On Sight led to a notorious dispute over the proper means of scarifying the eyelids. Woolhouse was a successful but highly controversial oculist of France and England in the late seventeenth to early eighteenth century. His career embraced extremes of effectiveness in practical operation and failure in conceptual understanding: on the one hand he performed iridectomy and restored patients’ sight; on the other he opposed the view that cataract was situated in the crystalline lens. Claiming a unique understanding of the Hippocratic method where a ‘spindle’ was employed, he used a teasle or thistle-like plant to perform surgery which he termed technically ophthalmoxusis or more popularly ‘degourdissement’, ‘degonflement’ on the internal surface of upper and lower lids for trachoma and many other conditions. He attracted both disciples (most notably B.D. Mauchart, professor of ophthalmology at Tubingen) who followed his practices, and enemies who regarded him as a charlatan operating for personal profit.41 39 On William Adams (later knighted as Sir William Rawson), John Cunningham Saunders and John Vetch, see Gorin, 1982, 73. 40 Sichel 123, 148; Duke-Elder II 1938, 1593, 1619, 1622; cf. Lawson, 1903, 535. 41 See Haller, 1755, 315–338 and Triller, 1766, 72 for trenchant criticism.

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Night blindness (7), a deficiency disease affecting the sight, is another important perennial condition. In general men are more susceptible to night blindness than women and, even among children, boys more prone than girls.42 Hippocratic authors knew this: the author of Prorrhetic 2 is correct, though too categorical, in differentiating between the sexes; in Epidemics 6, where night blindness is seen especially in children, the different developments and mutations of the disease in men and women are noted, and the author conjectures that the reasons for the relative incidence were that women were intrinsically less susceptible, or that women were more confined indoors. Λ μαι ‘rheum’ in the eyes (2—on the term see on 2.1) is indicative of underlying infection, which might have many precipitating causes and which, in the absence of good preventative hygiene and of drugs which could serve as antibiotics, must have been common and incurable. The inexorable progress of chronic eye disease to complete loss of sight can be seen from successive plays of Aristophanes, where Neokleides is mercilessly and unsympathetically portrayed: in around 392 he is simply γλ(μων ‘blear-eyed’ (Eccles. 254, 398); and in 388 he is completely blind, hoping for a miracle cure from Asklepios (Ploutos 665, 717–725). Archedamos too was characterized as ‘blear-eyed’ (Ar. Ran. 588, cf. Lys. 14. 25). A differentiation is imputed to the eyes of males and females in On Sight, and more explicitly in Prorrhetic 2. This may not be altogether fanciful, especially as the additional symptom ulceration is attributed by the author to women; but may rather indicate vigilant observation. It is now recognised (first noted in 1870 and confirmed by further studies) that there is a type of purulent conjunctivitis typical of young girls in which there is an association between primary vulvo-vaginitis and secondary conjunctivitis, or conjunctival gonorrhea.43 When Helmholtz in 1850 demonstrated the ophthalmoscope to the Physical Society of Berlin, exploration of the inner eye became possible for the first time. This completely altered understanding of the function of the eye and made obsolete the work of many—including Sichel, the editor of On Sight for Littré, who had been working for many years on a book entitled Iconographie Ophthalmologique without knowledge of the fundus.44 Many failed to capitalise on the new technology, which 42 43 44

Jayle et al., 1959, 176. See Duke-Elder II 1938, 1579. On Sichel as ‘a tragic person’ see Gorin, 1982, 84–85.

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only gradually became accepted.45 In modern ophthalmology the ‘slitlamp’ (a combination light and microscope for examination of the eye) is ubiquitous; but of course our surgeon saw only what could be seen with the naked eye. Some of the areas selected for cutting and cautery by the physician of On Sight (3) coincide with the points targeted by modern oriental practitioners treating eye disorders by acupuncture or (especially) moxibustion, and their practices have a very long history.46 Of course there is a ready explanation for these similarities in treatment: as human physiology is constant, it is intrinsically probable that doctors of different societies at different times should treat similar afflictions in a similar way simply because they separately have discovered an effective treatment on an empirical practical basis. After all, doctors do not cut and burn for fun, but in the hope of a cure; and they do not advocate treatments which never work, or at least seem to work. Even today, the reasons for the undoubted effectiveness of the practice of acumoxa is not understood; the treatment seems to stimulate the body to resist disease and to become stronger, but its workings, especially in relation to particular diseases, where it acts not merely as a palliative but actually as a remedy, are mysterious. It has been suggested that acupuncture raises the red corpuscle count and enhances blood circulation; that it stimulates the nervous system (perhaps through specific neurological reactions between parts treated and parts affected); that it provokes responses in the cerebral cortex which in turn react on the organs. It is possible to review anatomical data seeming to vindicate some of our surgeon’s ideas and practices: there is an external blood supply to the skull by the temporal arteries; there is a direct link of cerebro-spinal fluid to the eyeball through the optic nerve.47 In visual function, the ocular blood circulation is fundamentally important and systemic diseases undoubtedly affect the complex physiology of the eye. Disputes over the proper methods in ophthalmology permeate works of the nineteenth century: even such an apparently simple question as the desirability of exclusion of light was still debated, as were the pros and cons of dividing or opening the temporal artery, the choice of scissors or knife for surgery and the choice of agents or procedures to treat 45 46 47

Duke-Elder, 1958. For discussion, see Craik, forthcoming; see also Charlevoix, 1754. On the orbital blood supply, see Spalton et al., 2005, 674–675, fig. 20.7 and 20. 8.

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the palpebral surface.48 Trepanation was still sometimes practised to alleviate cerebral seizures accompanied by sight loss, through drainage of pus collected between bone and dura.49 In the early years of the twentieth century, many of the procedures found in On Sight were still advocated: local blood-letting (scarification and cupping at the temples; bleeding by leeches); application of heat; cautery by a ‘burnt wood’ needle; ‘grattage and swabbage’ for trachoma, with instruction to rub with gauze wrapped in a wooden spatula, after bleeding had completely stopped; and for night blindness ingestion of liver of ox, goat or sheep fried in oil and well seasoned (5 to 10 ounces, three times a day).50 For this reason, the selected reference books cited here are drawn from a range of dates, roughly a generation apart. The most modern authority noted is David Spalton, a distinguished consultant ophthalmologist who was kind enough to scan this commentary in draft form. He concluded: ‘It seems he described a number of diseases and one can only guess at what the modern diagnosis is; in some ways this does not seem important as the treatment was the same.’

48 49 50

Vetch, 1820, 16–17, 38–39, 81 etc. Hirschberg I 1982 (tr. Blodi), 93, n. 403. Wood, 1909, 78–79, 79–80, 81, 83, 801.

REFERENCES AND ABBREVIATIONS Anon. Lond. BMD CIH CMG CUF DK DR Duke-Elder Ermerins Erot. Foesius Gal. GMT HC Hsch. Joly LSJ Sichel

Anonymus Londinensis (ed. Jones, London, 1947) Black’s Medical Dictionary (39th edn, London, 1999 and repr.) Colloque International Hippocratique Corpus Medicorum Graecorum Collection des Universités de France (Association G. Budé) H. Diels and W. Kranz, Die Fragmente der Vorsokratiker (6th edn, Berlin and Zurich, 1952) C. Daremberg and C.E. Ruelle, Oeuvres de Rufus d’Éphèse (Paris, 1879) Sir W.S. Duke-Elder, Text-Book of Ophthalmology (London, 1932–1954) ed., vol. 3 (Utrecht, 1864), 278–283; praefatio XL–XLI Erotian (ed. Nachmanson, 1918) ed., cited with volume and page ref. to revised edn (Geneva, 1657 and 1662) Galen, cited with volume and page ref. to C.G. Kühn, Claudii Galeni Opera Omnia (Leipzig, 1821–1830) [K.] W.W. Goodwin, Syntax of Moods and Tenses of the Greek Verb (London, 1889) Hippocratic Corpus Hesychios, cited with page ref. to K. Latte, Hesychii Alexandrini Lexicon (Copenhagen, 1953) ed. (Paris, 1978), 163–171 H.G. Liddell, R. Scott, and H.S. Jones, Greek-English Lexicon ed. ap. Littré ed. vol. 9 (Paris, 1861), 152–161

Abbreviations for ancient authors and works (including Hippocratic treatises) follow LSJ.

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CONSPECTUS SIGLORUM memorantur in app. crit.: M H I R

Marcianus gr. 269, s. X Parisinus gr. 2142, pars antiquior, s. XII Parisinus gr. 2140, s. XIII Vaticanus gr. 277, s. XIV

memorantur in comm.: Ca E F G J K Laur. Mut. O Q U W Z

Cantabrig. Caius Coll. 50, s. XV Parisinus gr. 2255, s. XV Parisinus gr. 2144, s. XIV Parisinus gr. 2141, s. XV Parisinus gr. 2143, s. XIV Parisinus gr. 2145, s. XV Laurentianus 74, 1, s. XV Mutinens. Estensis gr. 220, s. XV Baroccianus 204, s. XV Vossianus fol. 10, s. XVI Urbinas 68, s. XIV Vaticanus gr. 278, a. 1512 Parisinus gr. 2148, s. XVI

non vidi: Haun. Mo.

Hauniens. Gl. Kgl. 224, s. XVI Monacensis gr. 71, s. XV

TEXT

I 1. α ψιες α διεφαρμναι, ατματοι μ*ν κυαντιδες γινμεναι, )ξαπνης γνονται, κα )πειδ/ν γνωνται, οκ &στιν 8ησις τοια#τη. α δ* αλασσοειδε7ς γινμεναι, κατ/ μικρCν )ν πολλ" χρν"ω διαφερονται, κα πολλ(κις ' Dτερος φαλμCς )ν πολλ" χρν"ω 4στερον διεφ(ρη. το#του δ* χρ= κααρειν τ=ν κεφαλ=ν κα καειν τ/ς φλβαςE κFν ρχμενος π(+η 5 τα6τα, Gσταται τC κακCν κα ο χωρε7 )π τC φλαυρτερον.

2. α δ* μεταξ? τ ς τε κυαντιδος κα τ ς αλασσοειδος, Fν μ*ν ν"ω )ντι γνωνται, πρεσβυτρ"ω γινομν"ω καστανταιE Fν δ* πρεσβυτρ"ω )ντι γνωνται )των Hπτ(, βλτιον 'ρ+ κα τ/ μεγ(λα π(νυ κα λαμπρ(, κα πC πρσεν 'ρ+ μ*ν, σαφως δ* οIE κα  τι 9ν π(νυ πρCς ατCν τCν 10

φαλμCν προσ+ , κα το6το, 1λλως δ* οδν. συμφρει δ* το#τ"ω κα6σις κα κ(αρσις τ ς κεφαλ ςE αJμα δ* το#τοισιν ο συμφρει φιναι, οIτε τ+ κυαντιδι, οIτε τ+ αλασσοειδε7.

II 1. τ/ λημα )ν το7σιν φαλμο7σι, τ ς ψιος @γιος )ο#σης τν νεωτρων νρ5πων, Kν τε ηλεα +L, Kν τε 1ρσην, οκ 9ν :φελοης ποιων οδν, 15

1 MΙπποκρ(τους περ ψιος fere codd. | ατματοι edd.: ατμαται codd. 2 τοια#τη codd.: τοια#τ+ησιν Heidel 4 )ν πολλ" χρν"ω 4στερον διεφ(ρη M fere recc.: )ν πολλ" χρν"ω διεφ(ρη 4στερον R: 4στερον om. Asulanus: )ν πολλ" χρν"ω forsitan delendum 6 τα6τα codd.: τατ/ fortasse Joly 5 π(+η MHI: εραπε#+η H2 R fere recc. 8 πρεσβυτρ"ω γενομν"ω M H2I: novit Foesius | φλαυρτερον M: φαυλτερον recc. πρεσβυτρ"ω γινομν"ω H 9 γνωνται (γγνωνται, γνωνται) recc: γγνονται M | post Hπτ( lacunam indicant Iugler et Sichel | 'ρ+ κα τ/ μεγ(λα π(νυ MH (sed del. κα H2): 'ρ+ τ/ μεγ(λα δ* π(νυ IR 10 ατCν Ermerins: HωυτCν MIR: HαυτCν H fere recc. 11 1λλως MH: 1λλο H2IR fere recc. 11–12 κα6σις κα κ(αρσις MH: κ(αρσις κα 13 αλασσοειδε7 edd.: αλασσοειδ κα6σις H2: κ(αρσς τε κα κα6σις IR fere recc. codd. 14 τ/ λημα Craik: τC μμα MH: κα τC μμα IR fere recc. 15 λεια M (vel ηλεα) recc.:  λυς Joly | Kν τ’ 1ρσην MI fere recc.: ε8 τε 1ρσην HR | :φελοης M: :φελεης recc.: :φελοις Joly | οδ*ν van der Linden: ο*ν codd.

TRANSLATION1

I 1. As for the visual parts, destroyed, when these become spontaneously lapis-like, they become so all of a sudden, and once they do become so, there is no such treatment. As for those which become sea-like, they are destroyed gradually, over a long time, and often the second eye is destroyed a long time later. Of this person, one should purge the head and cauterise the vessels; and if he has this done at the beginning, the trouble is arrested and does not go on to get worse. 2. In cases where the parts are intermediate between lapis-like and sealike: if they become so when someone is young, they settle down when he gets older; if they become so when someone is older than seven years, he sees quite well things which are really big and bright, and he sees ahead, but not clearly, and whatever he sets right in front of the eye, he sees that too, but nothing else. For this person, cautery and purging the head is beneficial. It is not beneficial to let blood in these people, either in the lapis-like or the sea-like case. II 1. In the case of sores in the eyes, where the visual part is sound, in younger people, whether the person is female or male, you could not help by any action at all, as long as the body is still growing. But when it

1 (…) indicates addition of material to amplify translation; […] indicates editorial deletion of intrusive content from text; … indicates editorial insertion to text

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Dως 9ν αIξηται τC σμα &τι. ταν δ* μηκτι αξ(νηται, ατ< τ< φαλμ< σκεψ(μενος τ/ βλφαρα λεπτ#νειν, ξ#ων, Fν δοκ+ προσδε7σαι, κα )πικαων &νδοεν μ= διαφανσιν.

III 1. &πειτα ναδσας, τ/ σκλεα )κτενας, δφρον @ποες φ’ οP στηρζηται τ+ σι χερσ, μσον δ τις )χτω, &πειτα διασημνασαι τ/ς νωτιαας 5 φλβας, σκοπε7ν δ* πισεν. &πειτα καειν παχσι σιδηροισι κα συχ+η διαερμανειν, πως 9ν μ= Qαγ+ αJμα καοντι. προαφιναι δ* το6 αGματος, Fν δοκ+ καιρCς εRναι. καειν δ* κα πρCς τC στον πισεν.

2. &πειτα )νες σπγγον Sλαιωμνον )γκατακαειν, πλ=ν το6 π(νυ πρCς ατ" τ" στ"ωE Fν δ* προσδχηται τ" καυστηρ"ω τC σπογγον, Dτερον 10 λιπαρ5τερον )νες )γκατακαειν. &πειτα το6 1ρου μλιτι δε#ων, )ντιναι τ+ σιν )σχ(ρ+ησιν.

3. ταν δ* φλβα παρακα#σ+ης F διακα#σ+ης, )πειδ/ν )κπσ+η  )σχ(ρη, 'μοως τταται  φλ*ψ κα πεφ#σηται κα πλρης φανεται, κα σφ#ζει τε 1νωεν τC )πιρρονE Fν δ* διακεκαυμνος +L τε κ(τωεν, τα6τα π(ντα 15 Tσσον π(σχει. διακαειν δ* χρ= αUτις, Fν μ= τC πρτον διακα#σ+ης. τ( τε σπγγια χρ= ,σχυρς )γκατακαειν, πρCς τ ς Qεο#σης φλεβCς μVλλον.

4. α )σχ(ραι α μVλλον πτηε7σαι τ(χει )κππτουσιν. α καιμεναι ολα πρCς τC στον καλλονες γνονται. )πειδ/ν δ* τ/ Dλκεα @για γνωνται, αUτις ναφυσνται κα )παρονται, κα )ρυρα ε,σι παρ/ τC 1λλο, κα 20 Wσπερ ναιρησμεναι φανονται, Dως 9ν χρνος )πιγνηταιE κα κεφαλ ς καυεσης κα στεος, 'μοως δ* κα παντ τ" σ5ματι που 9ν καυ+ .

1–2 ατ< τ< φαλμ< Ermerins: ατ"ω τ" φαλμ" codd. 2 λεπτ#νειν MHIR: λεπτ#νει Asulanus | προσδε7σαι codd.: προσδχεσαι Triller 4 φ’ codd.: )φ’ van der Linden 4–5 στηρζηται MHIR: στηρζεται fere recc. 5 &πειτα διασημνασαι codd.: διασημνασαι (del. &πειτα) Ermerins 6 σιδηροισι fere recc.: σιδηροισιν M 9 σπγγον MHIR: σπογγον Foesius ex 8 καειν … πισεν codd.: del. Ermerins Fevr. ms novit | post )γκατακαειν lac. in ras. I 11 μλιτι MHR: )ν μλιτι I fere recc. 13 F διακα#σ+ης del. Ermerins 14–15 τε 1νωεν … τε κ(τωεν Craik: τε κ(τωεν … ' κ(τωεν codd.: τι κ(τωεν (del. ' κ(τωεν) Ermerins: τε κ(τωεν … (del. ') κ(τωεν Joly 17 ,σχυρς MI: κανς HR, Foesius ex Fevr. ms novit 18 τ(χει HIR: τ(χι aut ταχ# M (?cum corr.): τ(χι recc. nonnulli: τ(χιστα Foesius ex Fevr. et reg. mss novit 20 )ρυρα MHIR: )ρυρ( Cornarius 21 ναιρησμεναι codd.: ναρρηξμεναι Foesius ex Serv. ms novit: ναρραγησμεναι Ermerins | φανονται recc.: φανωνται M | Dως 9ν fere recc.: Dως Lν M 22 'μοως δ* κα codd.: 'μοως κα (del. δ*) Joly | παντ codd.: )ν παντ Ermerins | 9ν fere recc.: Fν M

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is no longer growing, considering the actual eyes, attenuate the eyelids, scraping, if you think they need this too, and cauterising from the inner part, but not with white-hot instruments. III 1. Then (set the patient) on a couch from which he can lean with his hands; get his legs outstretched; tie on (a ligature). Let someone hold his waist. Then trace the vessels of (= running to) the back, and examine from behind. Then cauterise with thick (metal) instruments and heat gently, so that there is no haemorrhage as you cauterise. Let blood in advance, if it seems the right course. Cauterise towards the bone (= skull) from behind. 2. Then put in place a sponge soaked in olive oil. Cauterise over it, but not right up to the bone. If the patient accepts the sponge with the instrument, put in place another, better-oiled, and cauterise over it. Then moisten arum (root?) with honey, and put this on the eschars (= scabs). 3. When you have cauterised by or through a vessel, once the scab has fallen off, the vessel is stretched and swollen and apparently full just as before. And it beats when the flux comes from above, but if the patient has been cauterised when the flux comes from below he experiences all this to a lesser degree. You must cauterise through (the vessel) again, if you did not cauterise through (it) the first time. You should cauterise over sponges strongly, especially in the case of a vessel which haemorrhages. 4. Scabs which are relatively well browned fall off quickly. Scars in cautery towards the bone turn out better. When the sores are healed, the scars are swollen and raised and red compared with the rest (of the flesh) and look as if they will remain raised, until time has passed. It is the same when the head is cauterised or the chest or in all the body, wherever there is cautery.

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text IV

1. ταν δ* ξ#+ης βλφαρα φαλμο6, ξ#ειν ε,ρ"ω Μιλησ"ω, οIλ"ω, κααρ", περ 1τρακτον περιειλων, ατ=ν τ=ν στεφ(νην το6 φαλμο6 φυλασσμενοςE μ= διακα#σ+ης πρCς τCν χνδρον. σημε7ον δ* ταν ποχρ+ τ ς ξ#σιος, οκ &τι λαμπρCν αJμα &ρχεται, λλ/ ,χ<ρ α ματ5δης F @δατ5δης. ττε δ* χρ τινι τν @γρν φαρμ(κων, που 1νος )στ χαλκο6, το#τ"ω 5 νατρ7ψαι.

2. 4στερον δ* τC τ ς ξ#σιος κα τC τ ς κα#σιος, ταν α )σχ(ραι )κπσωσι κα κεκααρμνα +L τ/ Dλκεα κα βλαστ(ν+η, τ(μνειν τομ=ν δι/ το6 βργματος. ταν δ* τC αJμα πορρυ+ , χρ= διαχρειν τ" )ναμ"ω φαρμ(κ"ω. 4στερον δ* το#του &ργον κα π(ντων τ=ν κεφαλ=ν κα ραι. 10

V 1. τ/ βλφαρα τ/ παχ#τερα τ ς φ#σιος, τC κ(τω ποταμ<ν τ=ν σ(ρκα 'κσην εμαρστατα δ#ν+η, 4στερον δ* τC βλφαρον )πικα6σαι μ= διαφανσι, φυλασσμενος τ=ν φ#σιν τν τρχων, F τ" 1νει πτ" λεπτ" προστε7λαι. ταν δ* ποπσ+η  )σχ(ρη, ,ητρε#ειν τ/ λοιπ(. VI 1. 'πταν δ* βλφαρα ψωριYV κα ξυσμCς &χ+η, 1νεος χαλκο6 β5λιον 15 πρCς κνην τρψας, [&πειτα τC βλφαρον ποτρψας ατο6] κα ττε τ=ν φολδα το6 χαλκο6 τρβειν ;ς λεπτοτ(την. &πειτα χυλCν μφακος διηημνον παραχας κα τρψας λε7ον, τC δ* λοιπCν )ν χαλκ" )ρυρ" παραχων, κατ’ λγον νατρβειν, Dως 9ν π(χος γνηται ;ς μυσσωτςE &πειτα, )πειδ/ν ξηραν+ , τρψας λε7ον χρ σαι. 20

1 ξ#ειν codd.: ξ#ειν εRτα καειν Sichel: lacunam indicat Ermerins | μιλησ"ω recc. nonnulli: μηλησ"ω MHIR 2 το6 φαλμο6 del. Ermerins 3 πρCς τCν χνδρον codd.: πρCς τC στον Ermerins | ταν ποχρ+ Anastassiou: ταν πχρη codd.: τε πχρη Ermerins 4 &ρχεται MHR: )ξρχεται H2I fere recc. 5 χρ τινι fere codd.: τινι om. R 5–6 το#τ"ω νατρ7ψαι codd.: νατρ7ψαι (del. το#τ"ω) Ermerins 7 τC (bis) 9 τ" )ναμ"ω φαρμ(κ"ω codd.: codd.: del. Ermerins | ξ#σιος M: κρσιος fere recc. )ναμ"ω τινι φαρμ(κ"ω Ermerins 10 το#του codd.: π(ντων Ermerins | κα π(ντων codd.: del. Ermerins 11–12 σ(ρκα 'κσην codd.: σ(ρκα ;ς 9ν Joly 14 τ/ λοιπ( recc.: τ/ λυπα M: ;ς τ/ λοιπ( indicat Calvus 15 ξυσμCς MHR: κνησμCς I | 1νεος Ermerins: 1νος codd. 16 &πειτα τC βλφαρον ποτρψας ατο6 codd.: del. Craik | ττε codd.: τδε Foesius 17 λεπτοτ(την MHR: λεπτοτ(τον I: λεπττατα recc. nonnulli

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IV 1. When you scrape the lids of the eye, scrape with soft clean Milesian wool, winding it round the spindle(-shaped instrument), with care for the actual eyeball; do not cauterise through, up to the cartilage. It is a sign when there is enough scraping that it is no longer bright blood which comes, but bloody or watery matter. Then you should rub on one of the liquid drugs containing flower of copper. 2. Afterwards—with regard to the procedure of scraping and the procedure of cautery—when the scabs fall off and the wounds have been cleaned and it is growing, then make a cut through the front of the head. When the blood flows out, one should anoint the wound with a drug to stop bleeding. Afterwards, it is appropriate also to purge the head in all cases. V 1. When the eyelids are thicker than is natural, cut away the flesh below, as much you can, very gently and afterwards cauterise over the eyelid, not with white-hot instruments, with care for the point where the lashes grow, or apply heated very fine flower (of copper). When the scab falls off, give the further treatment. VI 1. Whenever the eyelids are itchy and there is an irritation, rub a piece of flower of copper on a grindstone, [then rub the patient’s eyelid] and at that time rub the flakes of copper as fine as possible. Then you must pour alongside (the flakes) the strained juice of unripe grapes and rub smooth; then pour the rest (of the grape pulp) alongside (the other ingredients) into (a vessel of) red copper and gradually rub together until it is like myssotos in consistency. Then, when it has dried, rub smooth and apply.

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text VII

1. νυκτ(λωποςE φ(ρμακον πιντω )λατριον, κα τ=ν κεφαλ=ν κααιρσω. κα κατασχ(σας τCν αχνα ;ς μ(λιστα, πισας πλε7στον χρνον, )πανιες δ* διδναι )ν μλιτι β(πτων σκροδα :μ/ καταπιε7ν μγιστα ;ς 9ν δ#νηται Zν F δ#ο κα Tπαρ βος.

VIII 1. Kν τι ο φαλμο @γιε7ς )ντες διαφερωνται τ=ν ψιν, το#τ"ω χρ= 5 ταμντα κατ/ τC βργμα, )παναδεραντα, )κπρσαντα τC στον, φελντα τCν 4δρωπα, , σαιE κα ο4τως @γιε7ς γνονται.

IX 1. φαλμης τ ς )πετεου κα )πιδημου συμφρει κ(αρσις κεφαλ ς κα τ ς κ(τω κοιλης κ(αρσις. κα ε, &χοι τC σμα, αGματος φαρεσις συμφρει πρCς &νια τν τοιο#των λγημ(των, κα σικ#αι κατ/ τ/ς φλβας. 10 σ7τος λγος 1ρτος, κα 4δατος πσις. κατακε7σαι δ* )ν σκτ"ω, π τε καπνο6 κα πυρCς κα τ<ν 1λλων λαμπρν, πλ(γιον, 1λλοτε )π τ/ δεξι(, 1λλοτε )π’ ριστερ(. 2. μ= τγγειν τ=ν κεφαλν, ο γ/ρ συμφρει. κατ(πλασμα δ#νης μ= )νεο#σης, λλ’ ;ς Qε#ματος )πχοντος, ο συμφρει, ο,δημ(των νωδ#νων. 15 κα )πειδ/ν τ/ δριμα φ(ρμακα τ ς δ#νης )ναλειφμενα διαχειρισ+ , [ τε δ#νη μ= πα#σηται μετ/ τ=ν )σ(λειψιν το6 φαρμ(κου, ττε συμφρει καταπλ(σσειν τν καταπλασμ(των  τι 9ν δοκ+ συμφρειν.

1 νυκτ(λωποςE φ(ρμακον πιντω IR: νυκτ(λωπος φ(ρμακον πιντω M fere recc.: νυκτ(λωψ φ(ρμακον πιντω Foesius ex Serv. ms novit | τ=ν κεφαλ=ν recc.: κεφαλ=ν M 2 κατασχ(σας Foesius ex Serv. ms novit: κατ(ξας codd. 3–4 διδναι )ν μλιτι β(πτων σκροδα :μ/ καταπιε7ν μγιστα ;ς 9ν δ#νηται Zν F δ#ο κα Tπαρ βος Craik: διδναι )ν μλιτι β(πτων Tπαρ βος :μCν καταπιε7ν μγιστον ;ς 9ν δ#νηται Zν F δ#ο codd. 5 Kν τι Craik: Kν τινι codd.: ε8 τινι Joly | διαφερωνται Craik: διαφεροιεν codd 8 )πετεου fere recc.: )πετου H: )πετου I: )π’ α,του Μ 9 κοιλης κ(αρσις MHR: κοιλης I | ε, M: ε, εU Ermerins 11 σκτ"ω fere codd.: σκτοι Foesius ex Serv. ms novit 12 πλ(γιον Foesius ex Serv. ms novit: πλαγων MI: φυλαττμενος HR: πλαγως Cornarius: πλ(γιος Joly 14 ο γ/ρ συμφρει MIR: )πειδ= ο συμφρει H 14–15 )νεο#15 λλ’ ;ς codd.: κα 1λλως Ermerins: 1λλως Joly | σης codd.: )νιο#σης Asulanus )πχοντος fere codd.: πχοντος nonnulli 15–17 ο συμφρει, ο,δημ(των νωδ#νων. κα )πειδ/ν τ/ δριμα φ(ρμακα τ ς δ#νης )ναλειφμενα διαχειρισ+ , [ τε δ#νη μ= πα#σηται μετ/ τ=ν )σ(λειψιν Craik: ο συμφρει. ο,δημ(των νωδ#νων κα μετ/ τ/ δριμα φ(ρμακα τ ς δ#νης )ναλειφμενα )πειδ/ν [ τε δ#νη πα#σηται κα διαχωρισ+ μετ/ τ=ν )σ(λειψιν codd. 18  τι 9ν R:  τι Lν M:  τι Fν H:  τι 1ν σοι Ι

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VII 1. (Treatment for) night blindness: let him drink as drug elaterion and let his head be purged; cut into the neck; exert as much pressure as possible for a long time; release; dip in honey and give to swallow one or two raw cloves of garlic as big as possible and ox liver. VIII 1. If somehow the eyes, though sound, are destroyed in their visual faculty, you should treat this case by cutting into the forehead, folding back the skin, sawing the bone and removing the moisture. In this way, they are cured. IX 1. In the case of opthalmia recurring annually and locally, purging of the head and purging of the lower belly are beneficial. If he should have the physique, drawing blood is beneficial for some troubles of this kind, and cupping vessels applied to the blood vessels. Food: a little bread and water to drink. He should lie in the dark, away from smoke, fire and other bright things, on his side, sometimes to the right and sometimes to the left. 2. Do not moisten the head, for it is not beneficial. A poultice is not beneficial if there is no pain, but apparently continuing flux, while the swellings are not painful. And when astringent drugs have been used as ointments for pain, and the pain does not abate after the application of the drug, then it is beneficial to apply any of the poultices you think may be beneficial.

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3. οδ* διαβλπειν συμφρει πολ?ν χρνον, δ(κρυον γ/ρ προκαλε7ται, ο δυν(μενος ' φαλμCς πονε7ν πρCς τ/ λαμπρ(E οδ* συμμ#ειν πολ?ν χρνον, Fν &χ+η Qε6μα ερμCν μ(λισταE ερμανει γ/ρ τC δ(κρυον ,σχμενον. Qε#ματος δ* μ= &χοντος, μετ/ το6 ξηρο6 τ=ν @π(λειψιν συμφρει ποιε7σαι. 5

2 ' φαλμCς πονειν MI fere recc.: πονειν ' φαλμCς H | λαμπρ(. οδ* M: λαμπρ(. 4 μετ/ το6 ξηρο6 MH fere recc.: μετ( τε το6 ξηρο6 ο δ* H: λαμπρ(E λλ’ οδ* I H2IR: μετ( γε το6 ξηρο6 Cornarius 5 περ ψιος vel τλος τν περ ψιος vel τλος περ ψιος MΙπποκρ(τους vel τλος τν περ ψων habent nonnulli

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3. It is not beneficial to gaze continuously for a long time, for the eye, unable to contend with the brightness, summons a tear. It is not beneficial either to keep the eyes closed for a long time, especially if there is a hot flux. For pent-up tears cause heat. (Even) if the flux does not persist, it is beneficial to apply as ointment a drying substance.

COMMENTARY

I Three deleterious conditions are detailed, all with reference to perceived change in the colour of the ψιες ‘visual parts’. (On the sense of the term, see Introduction I.) No names are applied to these conditions. In each case, description of the salient symptom in terms of colour is followed by brief comment, outline prognosis and recommended treatment, if any: (i) ‘lapis-like’, sudden unprovoked onset, no treatment avails; (ii) ‘sea-like’, gradual onset, second eye often affected later, early treatment by cautery and purging is effective; (iii) an intermediate colour, the young recover within seven years but older people do not, cautery and purging are palliatives. Attempts by commentators to isolate and identify these conditions in modern terms are tentative and inconclusive. Foesius notes qualis in suffusione aut glaucomate contingit, ‘such as happens in cataract or glaucoma’. Sichel suggests that (i) is glaucoma and (ii) cataract, but finds the rest of the passage ‘très-obscur et à peu près inintelligible’. Ermerins is uncertain about glaucoma, favouring rather cataract in its different manifestations and different stages. Joly outlines further candidates, but is ultimately non-committal: (i) ‘… Il pourrait s’agir du glaucome, mais alors, c’est la cornée qui est affectée … S’il s’agit de l’irits, c’est bien la pupille qui est en cause, mais elle devient difforme et gris foncé’; (ii) ‘On pense à la cataracte non reconnue comme telle et donc avec traitement hors de propos. S’il s’agissait en réalité de la cornée, ce serait … une kératite’; (iii) ‘Distinction assez illusoire. Il faut songer soit à la cataracte soit à une kératite …’1 In truth, it is difficult to advance beyond these judgments. Condition (i), coming on suddenly and without apparent cause, does not seem to fit either cataract or glaucoma, as both usually come on slowly and 1 Foesius I 736, n. 1; Sichel 137–138; Ermerins Prolegomena XL; Joly 173 in successive ‘notes complémentaires’.

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insidiously. (However, occasionally in cataract the second eye deteriorates rapidly after the first has done so slowly; and the onset of glaucoma can be sudden, giving rise to the acute crisis of detached retina, which manifests as greyness, the retina hanging into the eye like a grey balloon.) Also, although glaucoma is marked by a greenish reflex in the early stages, this passes and the cardinal sign is not the colour of the pupil at all, but the fact that the eye is solid and hard. Condition (ii), with its gradual development, one eye frequently following the other, fits the common pathology of cataract. Condition (iii), with its elusive ‘intermediate’ coloration and the subdivision according to age of patient a, young and b, older is more complex. Condition (iii) b again fits cataract, which is typically a disease of the elderly (though it can present at any age, and can be congenital); condition (iii) a, where recovery is said to occur, seems to correspond rather to intraocular inflammation, whether inflammation of the cornea—keratitis— or inflammation of the iris and ciliary body—iritis, iridocyclitis. (Keratitis is a disease, usually short-lived, of youth and adolescence and iritis is common in such systemic diseases as diabetes. In both, haziness of the eye is a feature.)2 It is surprising that γλαυκς ‘grey’ does not feature in our author’s choice of palette, as it does in Prorrhetic 2 (Prorrh. 2. 20 [9.48 L.]). Similarly, in other treatments of the diseases of old age, both theoretical in Aphorisms and practical in Epidemics, words of this root occur (μβλυωπαι ‘cases of dimness’ and γλαυκ5σιες ‘cases of glaucous eyes’, Aph. 3. 31 [4.502 L.]; )γλαυκ5η  ψις, ‘the eyes were glaucous’, case of an old woman with miscellaneous other troubles, Epid. 4. 30 [5.174 L.]). Of course, despite the term ‘glaucous’, none of these passages implies the particular condition of glaucoma, which at this time could not have been differentiated from cataract. Rufus is the first physician known to have recognized the difference (frg. 116 DR), seen later in Oreibasios, Paul of Aigina and others.3 In practice, glaucoma and cataract frequently coexist in the elderly, cataract being an almost inevitable ultimate complication of glaucoma. In Galenic works the two conditions are frequently discussed together; both are seen as affections arising without external precipitating injury. 2 See Lawson, 1903, 134–136; Duke-Elder II 1938, 1877–1944, esp. 1879–1890; Bedford, 1971, 50–51, figs 30, 31 and 90–91, figs 60, 61; Trobe and Hackel, 2002, 109–110, 180–181; Spalton et al., 2005, 350, fig. 11. 38, 225, fig. 8. 6 and 248, fig. 8. 55. 3 Marganne, 1979.

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The author correctly observes that changes in colour are diagnostically significant and he makes a commendable effort to classify three conditions, viewed by him as distinct and different, by adding further information. This is a good methodological starting point, but it is only a starting point. It is not clear even whether the perceived changes are thought to affect pupil alone or pupil and iris or cornea or the eye more generally. The modern potential for differential diagnosis is vast; for instance if we suppose the reference to be to the area of the eyes, rather than to the eyeball, a further candidate for (iii) is hemangioma, a soft bluish swelling in the eyelid caused by a benign and often self-limiting tumour. In any case, the coloration in the three conditions is so vaguely described as to render them indistinguishable. Any physician would be hard put to it to differentiate between conditions by verbal description alone: colour photography is an invaluable adjunct in the modern textbook or online database: thus, ‘haziness’ is a term commonly applied to many different conditions, including cataract, glaucoma and keratitis. The author of Prorrhetic 2 likewise lists three colour changes—specifically with reference to the κρη ‘pupil’—but regards all three conditions as hopeless: α δ* κραι γλαυκο#μεναι F ργυροειδες γινμεναι F κυ(νεαι, οδ*ν χρηστν ‘where pupils become grey or silvery or lapiscolour, nothing can be done’, Prorrh. 2. 20 [9.48 L.]. The colour correspondences are inexact: even the word translated ‘lapis-colour’ is not identical in formation to the term ‘lapis-like’ in our case (i) and the correspondence of ‘silvery’ and ‘grey’ to our cases (ii) and (iii) is at best rudimentary (see further below). It may be that a single condition is envisaged in Prorrhetic 2, and the author, striving for precision, offers three alternative descriptions for a colour or range of colours which he finds hard to describe. Certainly, when Celsus searches for colour words to describe the pathology of the eye, it is in an attempt to discriminate between different types or stages of suffusio ‘cataract’: the distinction is an important determinant of whether particular cases are sanabiles ‘curable’ and so of whether and when surgery should be attempted. In Celsus’ scheme, again tri-partite, there is hope if the cataract is small and has colorem … marinae aquae vel ferri nitentis ‘the colour of sea-water or of gleaming metal’; the situation is worse if it is large and caeruleus ‘dark-blue’ (7.13–14). Broadly, Celsus’ scheme corresponds with that of On Sight: (i) dark-blue in both is bad; (ii) sea-colour in both is not so bad; (iii) intermediate in On Sight (? corresponding with metal-colour in Celsus) is likewise not so bad.

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The treatment prescribed here is consonant with that advocated throughout the work. Purging the head (that is, irrigation by errhines, drugs inserted in the nose) is recommended also at 4.2 and 7; cautery (that is, application of heated instruments to the affected parts or to the vessels) is advised also at 2, 4.1–2, 5, 7 as well as being the subject of the long section 3; phlebotomy (that is, letting blood by cutting the vessels) here abjured is the preferred treatment at 7 and cautiously admitted at 9.1. From the stress on nasal purging, it can be seen that the author of On Sight subscribes to the common view that in disease noxious stuff might be diverted from one part of the body (eyes) to an orifice (nose) for expulsion. Implicitly, the conditions so treated are attributed to a flux of noxious matter descending from the head and affecting the eye. It is notable that Celsus too regarded letting blood from the forehead or the nostrils, cautery of the vessels in the temples, and expulsion of phlegm by gargling, as well as smokeinhalations and acrid ointments, as beneficial in the early stages of cataract, when it could be treated medicamentis ‘by drugs’ without need for surgery, imperative later; significantly, he sums up victus optimus est qui pituitam extenuat, ‘that regimen is best, which can thin down phlegm’ (6. 6. 35). The author plunges in medias res, with asyndeton particularly remarkable in the first sentence. The syntax is predominantly paratactic, broken by one temporal clause, one indefinite relative and three similarly phrased conditional clauses. Antithetical sentences and clauses are favoured: Fν μ*ν ν"ω … Fν δ* πρεσβυτρ"ω and 'ρ+ μ*ν, σαφως δ* οI. The final οIτε … οIτε is similar in balanced effect. The first sentence is clumsily repetitious in phrasing, γινμεναι … γνονται … )πειδ/ν γνωνται. The verb διαφερεσαι too is repeated three times. There is conspicuous redundant repetition of pronouns, especially demonstrative pronouns: τοια#τη (or, as commonly emended, τοια#τ+ησιν), το#του, τα6τα, κα το6το, το#τ"ω, το#τοισιν. The alliteration of κααρειν … κεφαλ=ν … καειν and κα6σις κα κ(αρσις τ ς κεφαλ ς suggests a mantra of the trainee physician, but may be simply fortuitous. The repetition πολλ(κις … )ν πολλ" χρν"ω seems to seek emphasis and διεφ(ρη is a gnomic aorist. In section 2, where an attempt is made to describe precisely the nature and degree of sight loss, different points are made in a jerky sequence: big bright things visible; vision straight ahead impaired and peripheral vision lost; things brought close visible.

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1. διεφαρμναι … διαφερονται … διεφ(ρη ‘destroyed … destroyed … destroyed’ (or, perhaps, ‘damaged … damaged … damaged’): this sense of διαφερεσαι (passive) indicates pathological decline to an irretrievable point. Here of blindness (cf. 8 below; also Pl. R. 517a and, of deafness, Hdt. 1. 38), the verb is common in the gynaecological treatises of abortion or miscarriage; in Places of Man it is used of severe pain (change and ‘destruction’ of the appropriate nature of any bodily part is the origin of bodily pain, Loc. Hom. 42.1 [6.334 L.]) and in Koan Prognoses, of facial collapse (‘destruction’ of the face a mortal sign, unless caused by the reversible conditions sleeplessness, starvation or stomach upset, Coac. 2. 209 [5.628 L.]). ατματοι ‘spontaneously’, ‘without discernible precipitating cause’ (cf. Foesius Oeconomia ατομ(τως sponte magisque naturae vi quam morbi, ‘spon-

taneously and more by action of nature than of disease’).4 Both adjective and adverb are favoured in the HC (one hundred occurrences), frequently opposed to expressions involving πρφασις ‘cause’. The μν solitarium implies an opposition to damage where the cause can be determined. All mss have the incorrect form ατμαται, evidence of the mechanical copying which typifies the tradition of On Sight. κυαντιδες ‘lapis-like’, ‘like lapis lazuli’, ‘bluish’, ‘dark blue’: Greek colour terms are notoriously difficult to translate.5 LSJ renders κυαν7τις

‘bluish grey’ with the explicatory addition ‘in glaucoma’; the addition begs the question. (On differentiation between cataract and glaucoma, see Introduction V.) κυ(νεος (contracted κυανο6ς) is the regular adjective indicating composition of, or more commonly similarity to, κ#ανος a dark-blue enamel or lapis lazuli; Latin caeruleus is equivalent. Already in Homer, usage is wide: of hair, ships, clouds, sea; later, the adjective was used to qualify minerals, flowers, birds, or objects of striking blue colour. Sometimes sheen or texture, rather than hue, seems to be implied. (See Demokritos, DK 68 A 135 = Thphr. de sens. 77; Aristotle col. 796a18.) κυανο6ς coexisted with the less common form κυαν(ο)ειδς, lit. ‘like κ#ανος’ (differentiated by Demokritos, loc. cit.); from Euripidean usage of the sea (Hel. 179, cf. 1502; also κυαναυγς, E. Alc. 261) it is evident that the distinction made by the author from αλασσοειδς ‘sealike’ will be hard to define. But, unlike αλασσοειδς following, κυαν7τις 4 5

See also Iugler, 1792, 50. See Maxwell-Stuart, 1981, esp. 1–6; also Platnauer, 1921, 161.

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is not a regular colour term and the formation of κυαν7τις is itself peculiar. The formation -7τις is an adjectival suffix (feminine) which in some cases became substantival. In the HC, such adjectives are applied especially to φλψ ‘vessel’ (e.g. α ματ7τις, πατ7τις) and to types of νσος ‘disease’, or in some cases to both (σπλην7τις ‘disease of the spleen’ Morb. 1. 3 [6.144 L.], but ‘vessel at the spleen’ Morb. 1. 26, 28 [6.194, 196 L.]; Aff. 20 [6.230 L.]). Some terms seem to bypass the adjectival stage, and are found only as substantives: the transition can be seen in passages where adjectival and substantival usage coexist ()ς φσιν νεφρτιδα ‘to a wasting disease of the kidney’, Int. 15 [7.204 L.] followed by πC δ* νεφρτιδος ‘from the kidney disease’, Int. 18 [7.210 L.]). Some names for illnesses have no adjectival analogues: for example, φρεν7τις, πλευρ7τις, ρρ7τις, ‘phrenitis’, ‘pleuritis’ and ‘arthritis’. The first two were regarded as traditional names for ‘acute’ diseases (given by the ρχα7οι ‘ancients’, Acut. 5 [2.260 L.]); if the view that it is an old form is correct, later writers were adapting and extending pre-existing formations. The practice had a long future, the suffix being firmly embedded in English and other European languages to denote a disease with local inflammation (tonsillitis etc.). The development in ancient usage is part of the general development of technical terms, not only in medicine but in other sciences also.6 Another range of -7τις technical terms relates to minerals, and another still to plants. Both can be seen in the HC, especially in the gynaecological treatises (minerals χαλκ7τις, χρυσ7τις and vegetable matter λοκων7τις ‘earth-almond’). In some such formations, the idea of similarity is apparent (e.g. σπογγ7τις ‘sponge-like’ applied both to stone and plant) but this similarity rarely relates to colour: thus, ργ7τις, sc. 1μπελος, is a vine with white grapes, but the colour element is already there initially, and so too with χλωρ7τις, sc. λις, a grass-green stone.7 )ξαπνης ‘all of a sudden’, ‘suddenly’: this adverb is more common in the HC than the synonymous )ξαφνης (eighty-eight versus fiftyeight occurrences; there are also eight of the adjective )ξαπναιος).

Patterns of preference in such ordinary vocabulary, where choice may be subconscious, can be significant in establishing groups of works of common provenance. An author’s usage tends not to be for one or the other exclusively but )ξαπνης is preferred in the gynaecological For other such formations, see Kretschmer and Locker, 1963, 324–326. See Langslow, 2000, 270–271, on the ‘lexicalist’ versus ‘derivationalist’ controversy in the development of suffixes, and the argument, 274, that a suffix can exhibit a kind of ‘polysemy’. 6 7

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texts; and exclusively used in Internal Affections and Diseases 2 (ten and five occurrences respectively).8 οκ &στιν 8ησις τοια#τη ‘there is so such treatment (sc. as that previously described)’: M’s τοια#τη, nominative singular with 8ησις, is altered by editors following Heidel to τοια#τ+ησιν, dative plural, sc. with dative plural of ψις.9 However, M’s reading can stand if we suppose, as is

intrinsically probable, that our text followed on prescriptive material now lost. (But cf. τοιο#των λγημ(των, 9.1, with reference to the topic of ophthalmia, newly introduced.) Such a designation of treatment found to be effective, in terms of same or similar treatment useful for different cases, is prevalent in the surgical treatises Fractures and Articulations (Fract. 10 [3.450 L.]; Artic. 19, 31, 38, 62 [4.132, 146, 166, 268 L.]). Ermerins keeps τοια#τη but paraphrases in translation, non est curatio, quae malum superare valeat, ‘there is no treatment effective to surmount the trouble’. αλασσοειδε7ς ‘sea-like’: here the formation to express similitude is regular. The suffix -οειδς occurs in the HC of likeness in a general or abstract sense (νωποειδς, εοειδς ‘man-like’, ‘godlike’); also concretely with regard to shape (κοτυλοειδς ‘spoon-like’); or as perceived by the sense of touch, with respect to hardness (λιοειδς ‘stone-like’), texture (σπογγοειδς ‘sponge-like’), or temperature (φλογοειδς ‘fiery’); or the sense of sight, especially with respect to colour (μολυβδοειδς ‘lead-like’, σιδιοειδς ‘like pomegranate peel’, @αλοειδς ‘like glass’).10

The incidence of the suffix is marked in the gynaecological treatises, in Articulations and in Internal Affections, and several formations, like αλασσοειδς here, are unique to a single treatise: ταινιοειδς ‘ribbon-like’ and δημιοειδς ‘fat-like’ only in Articulations, κεφαλοειδς ‘head-like’ only in Internal Affections; κροτωνοειδς a kind of root and δαφνοειδς a kind of plant only in Nature of Woman (Artic. 47, 78 [4.202, 312 L.]; Int. 6, 27 [7.180, 238 L.]; Nat. Mul. 32, 33 [7.358, 370 L.]). With this grouping there is an outlier, υμοειδς, unique to Airs, Waters and Places. Sometimes the -οειδς suffix accompanies or replaces the -5δης suffix, which seems to be a special medical variant on it, generally but not always indicative of a pathological condition:11 exceptionally, Xenophon uses 8 9 10 11

Cf. Craik, 1998, 189. Heidel, 1914, 193. See Kretschmer and Locker, 1963, 228–231. Op de Hipt, 1972.

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ρρ5δης in the sense ‘well-jointed’ (X. Cyn. 4. 1). The Latin suffix -osus

which combines the characteristics of both Greek suffixes, expressing both pathology and similitude may be compared.12 The two formations may coexist, as in the case of @δρωποειδς and @δρωπι5δης: there are twelve Hippocratic instances of each, the former in the gynaecological works, Diseases 4, Regimen 3 and Drugs; the latter in Epidemics 2, 4, 5, 7 and Koan Prognoses. κατ/ μικρCν )ν πολλ" χρν"ω ‘gradually, over a long time’: the identical

pairing of adverbial phrases occurs in Prorrhetic 2 (Prorrh. 2. 43 [9.74 L.]), of skin diseases. το#του ‘of this person’: the demonstrative regularly refers to the patient, especially in contexts where patients with different conditions, requiring different treatment, are discussed. κααρειν τ=ν κεφαλ=ν κα καειν τ/ς φλβας ‘purge the head and

cauterise the vessels’: the physician is presumed to know what drug to use in purging the head (for the recommendation cf. 4. 2 and 7. 1) and where and how to perform cautery (cf. 2. 1, 4. 1–2, 5, 7. 1 and especially 3. 1–4). Purging the head was such a routine matter (commonly a treatment for eye flux, as Loc. Hom. 13. 2, 4 [6.300 L.]) that specification of drugs is rare; but it is known that celery juice, onion (juice), myrrh and ‘flower of copper’ were among materials used (Morb. 2. 19, 22, 25 [7.34, 38, 40 L.]). κFν ρχμενος π(+η τα6τα ‘and if he has this done at the beginning’: sc. the beginning of the treatment, or of the problem. In H π(+η is written but corrected to εραπε#+η a synonymous lectio facilior; this reading (in

W, tr. Calvus si curetur ‘if treated’, followed also by Cornarius) preponderates in the tradition. The expression τα6τα (or τ(δε) π(σχειν is used both in description of symptoms and (more rarely, as here) in description of treatment; the two senses can coincide in close proximity (Epid. 5. 8 [5.208 L.]). In the latter sense, it is used especially of postulated treatment, which if followed would be or would have been successful (cf. Epid. 5. 7 [5.208 L.]; Epid. 5. 26 [5.226 L.]; Nat. Mul. 13 [7.330 L.]; Mul. 2. 112 [8.242 L.]).

12

See Langslow, 2000, 340–342.

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Gσταται τC κακCν ‘the trouble is arrested’: the verb is used similarly, of

arresting phlegm (Morb. 3. 1 [7.118 L.]), bile (Int. 35 [7.252 L.]) or pain (Int. 51 [7.292 L.]).

κα ο χωρε7 )π τC φλαυρτερον ‘does not go on to get worse’: the corollary expression )π τC βελτον (of amelioration) is used in the case histories of Epidemics. φλαυρς ‘bad’, a common enough word in Greek, is considerably less common in the HC than might have been expected (sixty-one occurrences, of which twenty-five are in Koan Prognoses; there is a cluster also in Fractures and Articulations).

2. α δ* μεταξ# ‘intermediate’: sc. ψιες ‘the visual parts’. ν"ω … πρεσβυτρ"ω γενομν"ω … πρεσβυτρ"ω )ντι … )των Hπτ( …

‘when someone is young … older … when someone is older than seven years’: the genitive is comparative. A disease affecting the eyes, and commonly recurring in the seventh or fourteenth year, is described in Diseases 2 (Morb. 2. 12 [7.20 L.]). The period suggests a belief in the importance of the number seven associated with ancient, especially Pythagorean, numerology: seven days is commonly significant in the description of fevers. Sichel, following Jugler, supposes a lacuna after )των Hπτ(, but the fractured nature of the Greek precludes confidence. There is probably some minor corruption: the mss punctuate variously (some having a sense break after βλτιον 'ρ+ ‘sees quite well’) and disagree on connectives (κα or δ or even, unidiomatically, both). καστανται ‘settle down’: the change from the simple Gστασαι to the compound καστασαι seems to be merely stylistic variatio. For the sense, cf. τC το6 φαλμο6 κατστη ‘the condition of the eye (bloodshot and weeping) settled down’ (Epid. 7. 11 [5.384 L.]). πC πρσεν ‘ahead’, ‘in front’: this is a slightly odd expression, the

preposition, lit. ‘from’, being otiose in conjunction with the suffix conveying the same sense, ‘from’. However, we may compare Plato ε,ς τC πρσεν &τι ζητσαντες ‘still searching ahead’, lit. ‘to (the area) from the front’ (Sph. 258c). The implication here is loss of peripheral vision: the patient sees ahead, but only ahead and even that not well. A second point is made in the next sentence: the patient is short-sighted. Compare the description of the μ#ωψ ‘short-sighted person’ in the Aristotelian Problemata: he brings things up close towards him in order to see

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them, whereas the πρεσβ#της ‘aged person’ removes things to a distance from him (Probl. 31. 25, 959b). το#τοισιν ‘in these people’ or ‘patients’: demonstrative, as above. Phlebotomy is more commonly expressed by φεναι το6 αGματος

genitive (VC 18 [3.250 L.]; cf. Aff. 22 [6.234 L.]).

τ+ αλασσοειδε7 ‘in the sea-like case’: the dative is read for the unani-

mously incorrect accusative of the mss.

II It is stated that a certain condition which may appear in childhood is to be left alone until the sufferer is fully grown, then treated by surgery to the eyelid. The first consideration is that the transmitted text gives nonsense. The opening words τC μμα )ν το7σιν φαλμο7σι ‘as to the eye in the eyes’ are meaningless, and the ensuing genitive absolute, introducing ψις ‘sight’ merely compounds the difficulty. Sichel finds the chapter ‘très-obscur’; he translates, ‘Quant à la vision des yeux, la pupille ayant conservé son état normal …’ but notes that there is no parallel for μμα in the sense of ‘vision’; his diagnosis is ‘une amblyopie amaurotique survenant sur des individus jeunes …’ Ermerins too comments on the difficulty of the passage; following Foesius verbatim he translates et oculorum visum, cum videndi acies sana fuerit … ‘and the vision of the eyes, when the eyesight is sound …’, but notes that it is not at all clear what is intended by the μμα, and declines to attempt identification of the disease. Joly translates (but without justification) ‘Quant à la vue elle-meme, la pupille étant saine …’ and comments that this problem might be ‘une myopie, laquelle … se stabilise après la croissance’; he notes that the treatment envisaged might occasionally be effective in serious cases, ‘en provoquant une vasodilation’.13 The word μμα, said by LSJ to be poetic and rare in prose, is in itself unexceptional, being Ionic rather than poetic (seventy-three occurrences in the HC and in some works, such as Prorrhetic 1, preferred to φαλμς). A simple emendation, corroborated by Hippocratic parallels, notably in Prorrhetic 2 (Prorrh. 2. 18 [9.44, 46 L.] discussed below), gives perfect sense: τ/ λημα )ν το7σιν φαλμο7σι ‘as to sores in the eyes’. The 13

Sichel 138; Ermerins Prolegomena XL; Joly 173, ‘notes complémentaires’.

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corruption is readily explained, on grounds both of visual similarity, which would be especially marked at the majuscule stage,14 and of intrinsic plausibility, a technical term being supplanted by a common word, apparently suitable in context. The emendation has the added merit that it provides a quasi-heading at the start of a new topic, as is common in such nosological accounts (cf. the emphatic first words of 1, 5, 7 and 9). The term λμη with the common diminutive form λημον refers to noxious matter collecting in or flowing from the eyes: ‘rheum’, ‘discharge’, ‘secretions’. Properly speaking, ‘rheum’ is not a disease but a symptom. Here, it can be viewed as a protracted irritation in the eye which might lead to any one of a range of chronic conditions: the characteristic symptoms of conjunctivitis (soreness, grittiness, eyelids sticking together overnight with secretions at lid margins) and of blepharitis (red eyelids with scaling along the margins) are essentially similar to conditions such as entropion, where the lower lid is rolled over and the lashes irritate the eye, and ectropion or eversion of the lids, where there is similar concomitant irritation.15 For the latter there is copious archaeological evidence.16 In Prorrhetic 2 (Prorrh. 2. 18 [9.44, 46 L.]), echoed as λημα σμικρ/ περ ατ/ς (sc. τ/ς ψιας) ‘small sores around the sight’ in Koan Prognoses (Coac. 2. 214 [5.630 L.]) there is a long and detailed discussion of φαλμο … λημντες ‘eyes suffering sores’, where different developments of such a condition are considered. In this passage, λμη (singular) is a key word, repeated eight times, cf. the diminutive λημα (plural) of Koan Prognoses. Throughout the passage, attention is paid to the nature of the discharge, which may be mingled with tears, white and soft (prognosis good) or yellow and livid (prognosis bad) or dry (prognosis pain, but short-lived) and also to the type of swelling, with regard to its size, pain and dryness, and to the type of tears, with regard to their heat and salty quality. In sum, the doctor should consider τ/ )κ το6 φαλμο6 Qοντα ‘the stuff flowing from the eye’. The feared outcome is Dλκος ‘a lesion’, ‘ulceration’ which might affect both pupil and lids (κνδυνος τ+ τε κρ+η Hλκω ναι κα το7σι βλεφ(ροισι) and in extreme cases Qωγμ ‘rupture’ of the eye; this is described in the ensuing chapter and is evidently prolapse of the eye contents, seen today only in major Cf. Jouanna, 2000, 98 for such corruption in M and mss derived from M. See Bedford, 1971, 42–43, figs 26, 26a, 44–45, figs 27, 27a and 136–137, fig. 94; Trobe and Hackel, 2002, 3–4, 5–8, 63–64; Spalton et al., 2005, 107. 16 Chaviara-Karahaliou, 1990, 138; Gourevitch and Grmek, 1990, 58–60. 14 15

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eye accidents. The account in Prorrhetic 2 is surely one of the sources, and probably the main source, for Celsus’ account of the complications of inflammation of the eye (see especially 6. 6. 10, 6. 6. 31). Celsus may be familiar also with On Sight in listing many different types of vesicae ‘growths’ on the upper eyelids and allowing for some which generally occur in children (7. 7. 3). A precise prediction is made for cases where the swelling subsides but tears persist and discharge continues: in the case of men there will be ‘eversion’ of the eyelids (lit. ‘turning away’: the same verb )κτρπειν is commonly used of the womb leaving its proper place); in the case of women and children, both ulceration and eversion of the lids (cf. the differentiation between male and female patients in On Sight ). Thus, the constant shedding of teary matter, not in itself problematical, leads to problematical complications. Similarly, the appearance of sores in the region of the pupils is declared a bad sign in parallel passages of Prognostic, a treatise possibly by the same author as Prorrhetic 2, as in Koan Prognoses (λ μαι, Prog. 2 [2.116 L.] and λημα, Coac. 2. 214 [5.630 L.]). Symptoms of spring ophthalmias detailed in Epidemics 1 include streaming, pain, and troublesome σμικρ/ λημα ‘small sores’ (Epid. 1. 2. 4. [2.616 L.]). A succinct but clear description of eye troubles is found in Ancient Medicine, there embedded in an account of the pathological effects of flux to nose, eyes and throat, i.e. chest (VM 18–19 [1.612, 616 L.]). The processes in the three fluxes are presented as parallel, with parallel features.17 The account in Ancient Medicine has strong similarities with material in Prorrhetic 2: emphasis on discharge called λμη, ulceration of the eyelid (here clearly the lower lid, as it is stated that ulceration may extend to the cheek), ulceration in the eye (τCν μφ τ=ν ψιν χιτνα ‘the tunic around the sight’, i.e. the sclerotic membrane); symptoms of streaming, pain and inflammation. There is one salient difference: in Ancient Medicine, the formation of a sore is viewed as the resolution of the problem, release coming through ‘coction’ and ‘thickening’ of the ‘streaming matter’ (μχρι 9ν τ/ Qε#ματα πεφ+ κα γνηται παχ#τερα κα λμη π’ ατν +L). More commonly, as in On Sight and Prorrhetic 2, the sores themselves are viewed as problematical or potentially so. But in the Aristotelian Problemata, tears in eye pain are described as cold, because τC μ*ν 1πεπτον ψυχρν, ‘the unconcocted 17 On the sequence, see Craik, 1998, 138 and on parallelisms Jouanna, 1990, 199, n. 3; 200, nn. 5, 6.

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is cold’ (Probl. 31. 23, 959b20). The theory of flux follows similar lines in many treatises. In Places in Man, treatment for flux to the eyes with attendant ocular ulceration and rupture aims to remove δ(κρυον συμπεπηγς ‘coagulated tear’ or τC συνεστηκς ‘coagulated material’ from the eye (Loc. Hom. 13.1, 7 [6.298, 302 L.]). In Glands, matter in flux from the brain, causing disease if it is not removed, is uniquely designated λ#ματα ‘impurities’, ‘purgations’ (Gland. 12 [8.564 L.]): it may be suspected that this apparent hapax legomenon is in fact another corruption of λημα, this time by an aural error of a notoriously common type. (The language is similar to that of VM: verb Hλκο7 below in 12 [8.566 L.] and Dως ποκρσιος, a reference to coction, above in 11 [8.564 L.].) Dexippos of Kos held similar views of disease-inducing flux: bile and phlegm melt and in more liquid form lead to ichors and sweats which putrefy and thicken, bringing Lχον, μ#ξας, λμας—troubles in ears, nose and eyes (Anon. Lond. XII. 22–26). In this section, strongly didactic, the pupil reader is directly addressed with second person singular verbs, as in the warning οκ 9ν :φελοης (where Joly needlessly emends to :φελοις) but he must work using his own discretion Fν δοκ+ προσδε7σαι. Imperatival infinitives and nominative participles again occur: σκεψ(μενος … λεπτ#νειν, ξ#ων κα )πικαων. The syntax is jerky, with conditional and temporal clauses piled up, and with a genitive absolute (rare in this work) equivalent to a conditional clause awkwardly preceding another genitive phrase. 1. τ/ λημα ‘in the case of sores’: the term was widely used in a metaphorical sense (most famously applied by Pericles to the island Aigina seen in relation to the Peiraieus, Arist. Rh. 1411a15, Plu. Per. 8) and proverbially (Ar. Nu. 327); the prevalence doubtless reflects a high incidence of eye disease. Lexicographers (but not Erotian, who often fails to help where help is most needed) explain. Hesychios glosses the plural as α περ το?ς κανο?ς τν φαλμν πεπηγυ7αι συστ(σεις ‘collections of matter fixed about the corners of the eyes’ and as )κρουσαι τν

φαλμν κααρσαι ‘impurities flowing from the eyes’, and the singular as λευκCν @γρCν )ν φαλμο7ς συνιστ(μενον, κααρσα ‘white moist stuff gathered in the eyes, impure matter’ (Latte, 1953, 592, 593). The terms γλ(μων or γλαμυρς are cognate, the latter used of bleary eyes (as Mul. 2. 116, 119 [8.250, 258 L.] and Mul. 1. 105 [8.228 L.]), the former used of blear-eyed people (cf. Hesychios on these forms). Galen glosses γλαμυροE γλημ5δεις κα @γρο ‘bleary: bleared and moist’ (linguarum Hippocratis explicatio, 19. 91 K.). See also Pollux Onom. 2. 4. 65 and 4. 25. 184

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for the inclusion of λμη and λημVν in eye diseases and LSJ on cognate forms from EM. Hesychios’ glosses γλ(μοςE μ#ξα ‘blear: mucus’ and γλαμυξιVνE γλαμVν, λημVν ‘to have bleary mucus: to be bleary, bleareyed’ (Latte, 1953, 378) are a telling indication that peccant matter from eyes and nose was viewed as essentially the same; furthermore the gloss λ(μαςE μ6ς (Latte, 1953, 569) is probably an error for μ#ξας. This can be seen too in the standard medical view that noxious stuff at the eyes could be expelled through the nose. (But μ#ξα has a wider semantic range than λμη. Though generally used of nasal mucus, it can refer to other body fluids also.)18 τ ς ψιος @γιος )ο#σης ‘where the visual part is sound’: i.e. provided it

does not affect the sight or, in the terminology of 1 above, where the organ is not ‘destroyed’. τν νεωτρων νρ5πων ‘in younger people’: here, till mid teens, when

growth is complete. The change from plural to singular (ad sensum) is readily acceptable. Kν τε ηλεα +L, Kν τε 1ρσην ‘whether the person is female or male’: M’s ηλεα can stand, as 1νρωπος is common gender (cf. Lys. 1. 15). The

injunction to wait until adulthood before attempting surgery is sensible; a similar policy, similarly expressed can be seen in Articulations (Artic. 62 [4.264 L.]). ατ< τ< φαλμ< σκεψ(μενος ‘considering the actual eyes’: the dative singular of the mss could be understood as ‘considering (the patient’s) eyelids with his (the operator’s) eye’—but this is intolerably otiose—or as ‘with (i.e. as well as) the eye, considering the eyelids’—but this is cumbersome. Neither interpretation makes acceptable sense. Further, the verb σκπτεσαι ‘consider’ is invariably followed by the accusative (or by a preposition) in the HC and the plural rather than singular of ‘eye’ is required. For these reasons, Ermerins’ emendation of the unidiomatic dative singular to the accusative dual is very attractive, though the dual number is rare in the HC, occurring only in the gynaecological works and in Epidemics 5. The verb is used in a similar sense to φυλ(σσεσαι below, 5.

18

See Craik, 1998, 19, 127.

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τ/ βλφαρα λεπτ#νειν ‘attenuate (refine, reduce) the eyelids’: make λεπτς ‘thin’, as opposed to παχ#ς ‘thick’ (cf. 5 init.) On the recommended

procedures, ‘scraping’ if necessary (here perhaps with a needle rather than a scalpel) and cautery, see on 4 below. &νδοεν ‘from the inner part’: here, from the inner part of the eyelid, that is the inner corner of the eye (pace Joly ‘en dedans’; this would require giving the sense ‘evert’ to λεπτ#νειν). The author writes with standard anatomical precision: with this term compare πισεν, 3.1 (bis) and κ(τωεν, 3.3 of ‘directions’ in the body. μ= διαφανσιν ‘not with white-hot instruments’: the injunction that

the instruments should not be too hot is sensible for the delicate eye area; elsewhere instruments are to be very hot, for armpit (Artic. 11 [4.106 L.]) or rectum (Haem. 2 [6.436 L.]); cf. also Steril. 222 [8.430 L.]. Erotian (Δ 18) glosses διαφανσι (same case as here and 5 below), but probably with reference to Articulations (Artic. 11 [4.106 L.]); also (T 34) τ/ διαφανα σιδρια ‘white-hot instruments’, but probably with reference to Haemorrhoids (Haem. 2 [6.436 L.]).19 III The subject of this chapter is cautery of the vessels; but the crucial information about which vessels, in which part of the body, are to be cauterized is unclear, and the expected information about the reasons for the procedure is lacking. It must be conceded that the transition from discussion of miscellaneous ways to address particular eye problems in Chapters 1 and 2 above to detailed surgical instructions for an unspecified general problem, where the eye is not even mentioned, in Chapter 3 is abrupt and the introductory word ‘then’ lacks context. However, the immediately preceding phrase )πικαων μ= διαφανσιν ‘cauterising, but not with white-hot instruments’ clearly leads to, even if it does not actually introduce, the excursus on cautery; the connection is clear enough in this author’s loose, almost stream of consciousness, manner. It is possible that, if oral discourse was the original medium, the mention of cautery prompted a learner’s question, which is answered at length. Or, if we think in terms of written compo19

Nachmanson, 1917, 381, 645; 439, 484.

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sition, it may be that the whole chapter has been lifted from a work on cautery, without proper adaptation to its new position. That such manuals existed is intrinsically probable. The close resemblance of material here with passages of Places in Man (Loc. Hom. 13 and 40 [6.302 and 330 L.]) in both content and expression suggests at least a common stock of lore, and possibly a common written source. Sichel comments that we have ‘préceptes généraux sur le mode d’exécution de l’ustion des veines’, asserting (wrongly, see below) that cautery in the back is taken as an example, ‘comme applicable à un plus grand nombre de maladies’ and (rightly) that cautery in all parts of the body is believed to follow the same principles. He wonders, following Cornarius, whether the chapter is somehow misplaced. Ermerins allows cautery to be relevant because of its use in ophthalmology, but finds the sense awkward and has recourse to some emendation and extensive deletion. Joly sees no relevance in the chapter, commenting dismissively ‘Ce chapitre semble égaré dans une oeuvre d’ophtalmologie’.20 It is here argued that cautery of the vessels in the back of the head and neck is intended, and that the purpose is to arrest a flux of noxious matter primarily affecting the eyes and secondarily threatening lower parts of the body. Our surgeon, who clearly allows for uniformity in the general practice of cautery at the end of the chapter, was doubtless familiar with different procedures, for different conditions, but his main concern is surely with ophthalmology. The effects on the eyes of two types of flux (cf. Places in Man 1.3, 13.3 [6.276, 300 L.]) are here allusively indicated: flux A (superficial, mucuslike in content, coursing from the scalp to the temples, with potential to stray further, if unchecked) and flux B (deep, salty in content, coursing from the brain to the inner corners of the eyes, with potential to stray dangerously further if unchecked—and viewed as hard to arrest). In ancient ophthalmology, cautery of the vessels of the temples was a routine treatment for flux A; in the case of flux B, other vessels were addressed, the aim always being to prevent peccant matter from spreading further down the body. In Places in Man the vessels which ‘press on the eye, those which constantly beat and are situated between ear and brow’ are cauterised (Loc. Hom. 13.7 [6.302 L.]). In Diseases 2 these vessels are cauterized, but treatment extends comprehensively to six other vessels of the head: two alongside the ears, two at the inner corners of the eyes, and two πισεν τ ς κεφαλ ς &νεν κα &νεν )ν τ+ 20

Sichel 139; Ermerins Prolegomena XL and 280, n. 3; Joly 169, n. 1.

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κτιδι ‘behind the head on either side at the occiput’ (Morb. 2. 12. 6; cf. 2. 1 and 2. 8 [7.22 L.; 7.8, 10 L.]). In addition, cautery of the neck was practised in order to stop the progress of noxious matter to the flesh πισεν ‘behind’ by the vertebrae and to divert it to the nose for expulsion (Loc. Hom. 21.1 [6.312 L.]). The usage of πισεν ‘behind’ in these passages to indicate the back of the head or neck, rather than the back itself, parallels usage here; similarly a contrast between &μπροσεν and πισεν with reference to the front and back of the head can be seen in Head Wounds (VC 2, 3 [3.192, 194 L.]). It is important to note that the adjective νωτια7ος with or without the substantive μυελς is commonly applied to the spinal fluid, rather than to the blood vessels of the back (Artic. 45, 46, 47 etc. [4.190, 196, 202 L.]; Mochl. 1 [4.342 L.]; Gland. 11, 14 [8.564, 570 L.]); and while

στον may refer to the sacrum (usually as τC ερCν στον) it is not used of the backbone generally. Thus, the vessels loosely designated ‘of the back’ may be more precisely designated as the vessels which run from head to neck and to back, that is those through which the νωτια7ος μυελς ‘marrow’ or ‘spinal fluid’ was believed to course from the brain to the lower body. The simple term στον lit. ‘bone’ is commonly used of the skull, where context makes it clear that the skull is intended (as throughout Head Wounds): the term κρ(νιον ‘cranium’ occurs only twice in the HC (lower jaw joins the cranium at the temples, VC 2 [3.190 L.]; see also Epid. 7. 124 [5.468 L.]), though it may have been popularly used (cf. E. Cy. 683). It may be added that the bones of the neck, the cervical vertebrae, were recognised to be continuous with those of the back. Confirmation that the author’s concern is with specialist matters of ophthalmology comes from Celsus. Several points in Celsus’ account of eye therapy pick up and illumine passages of On Sight, where the narrative is compressed and allusive to the point of unintelligibility, notably the phrases ‘having bound’ and ‘having traced’: Celsus explains how a ligature is placed round the patient’s neck, and how the vessels of the temples and the top of the head are marked with black ink (7. 7. 15 H). Further, Celsus’ leisurely explanation permits emendation of the puzzling repeated phrase ‘from below’ in 3.4. In an extended discussion of treatments for phlegm descending from the head to the eyes (7. 7. 15), Celsus distinguishes between a flux of phlegm from the upper vessels that lie between skull and scalp, i.e. above the skull; and a flux of phlegm from the lower vessels that lie between skull and membrane of the brain, i.e. below the skull. The first case is common and readily treated, the second is serious and intractable. The reason for this is

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that the vessels in the first case are accessible (above the skull, coursing to the temples) whereas in the second they are inaccessible (below the skull, coursing from brain to eye). Celsus allows for the possibility of flux from both sources simultaneously. Celsus is quite emphatic that this knowledge is widespread, and that procedures to arrest the flow of phlegm by treating the vessels are a matter of common and universal practice, ‘celebrated not only in Greece but among other peoples too, to the extent that no part of medicine is more widely practised throughout the world’. While the aim was universal, a wide range of diverse procedures was used in different communities and at different dates to attain it: some made a series of incisions at various points in the scalp; some used cautery at various points instead or as well. This considerable local variation in the choice of the precise point to be targeted is corroborated by the evidence of other medical authors, and by papyri of ophthalmological content.21 In some societies too the procedure was routinely applied to neonates (among the Ethiopians, Severus ap. Aetius 7. 93) or to young children (at the age of four years, among the Libyans, Hdt. 4. 187. 2), while in others it was a response to a pathological state. A Galenic work supplements and verifies the substance of Celsus’ account. In a late section of de methodo medendi, a vast compilation in 14 books occupying over 1, 000 pages in Kühn’s edition, similar views on aetiology and therapy are propounded. As it is the head which sends Qε6μα ‘flux’ to the eyes, the head must be treated first; sometimes flux comes from the brain and sometimes from the vessels; when it comes from deep γγε7α ‘pockets’ (sc. in the brain) it is hard to treat; the general treatment is by phlebotomy. Detailed instructions for this are given: shave the head; carefully address the vessels πσω ‘behind’ and those by the ears and those in the forehead and brows; cut those which beat most; it is better to apply a rope (βρχον, lit. ‘noose’) before cutting. It is explicitly stated that some doctors cut out part of the vessels in the belief that this is the only effective treatment (10. 937–942 K.). The vessels treated are ‘those in the back of the head, in the region of the ears, and those in the temples’. There is not much reference to cautery in Galen; but he does recommend cautery )π τν Qευματιζομνων

φαλμν ‘for eye flux’ (introductio seu medicus 14. 782 K.). Celsus gives an account of two positions adopted for eye surgery: the patient may be seated on a chair facing the doctor (surgery on the 21

See Marganne, 1994, esp. 147–172, with figs 13–18.

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right eye), or have his back to the doctor and his head resting on the doctor’s lap (surgery on the left eye); the two positions are designed to give good light and easy access for a right-handed practioner (7. 7. 4). The second of these two positions resembles that of On Sight. In any case, the general intent of our surgeon’s preparations is now clear and the scene in the surgery can be visualized as follows. The patient lies prone, legs extended, on a couch, probably leaning on the floor with his hands in such a way that the head is below the level of the trunk, causing the vessels in the head to become engorged and so more visible. His waist is held—presumably to keep the patient in place, or to press him hard down—by ‘someone’, who may be the doctor’s attendant or perhaps a member of the patient’s household. The surgeon is sitting (or standing, depending on the height of the couch) alongside or slightly in front, where he can reach over the head of the patient, in such a way that he can apply a ligature to the neck, trace the precise location of the vessels of the head (in the crown and occiput; also beside the ears, in the temples and in the neck)—or perhaps even the entire course of the vessels is to be traced for purposes of didactic demonstration—and then operate with instruments handed to him by an assistant. The language is entirely in accord with the rest of the work. The sentence structures are primarily paratactic. Nominative aorist participles are used in conjunction with jussive infinitives. There is asyndeton (especially in 4). Triadic expressions are used of the swelling of the vessels in 3 and, with variatio, in 4. Several unidiomatic or elliptical expressions (πλ=ν το6 π(νυ πρCς ατ" τ" στ"ω, 'μοως τταται, τα6τα π(ντα Tσσον π(σχει, πρCς τ ς Qεο#σης φλεβCς μVλλον, παρ/ τC 1λλο) may arise simply from the functional nature of the work, or from distortion in transmission, or may betray imperfect linguistic knowledge on the part of the writer. Although the language is consistent, there is a certain unevenness of content. Sections 1–2 are uncompromisingly surgical, clearly indicating a series of steps to be followed by the doctor, each introduced by &πειτα ‘next’. Sections 3–4 contain more general comments and advice, some of it aphoristic in character. A similar unevenness characterizes Chapter 9 below. 1. &πειτα ‘then’: editors agree in supposing a lacuna before the first of the five ‘then’ conjunctions; but in this breathless composition the Greek can readily be understood as it stands as a series of memos. There is a double parenthesis after the first ‘then’ conjunction, which is recapitulated in the second: ‘Then (having bound, having stretched

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out the legs, having set below a couch from which he can lean with his hands)—let someone hold his waist—then …’ The aorist participles indicate preparatory actions, and the associated infinitives main procedures (in reverse order: see translation): ναδσας, )κτενας, @ποες followed by διασημνασαι, σκοπε7ν then in section 2 )νες followed by )γκατακαειν and δε#ων by )ντιναι. This is a series of technical instructions, to be followed in a precise sequence. A similar use of piled up participles can be seen at 7.1 and 8.1 below; a similar use of ‘then’ can be seen in 6 below (three times repeated). The use of ττε in 4.1 and 4στερον in 4.2 is also sequential but less precise. ναδσας lit. ‘having bound’: the verb applies not to the patient himself

but to the ligature. Similar expressions are used of attaching sponges or swabs (as in preparations for succussion, Mul. 2. 144 [8.318 L.], Steril. 248 [8.460 L.]) and of the related process of applying a bandage as a tourniquet to arrest any uncontrolled bleeding after venesection (see practical instructions on what to do if bleeding continues after phlebotomy, Ulc. 26 [6.430 L.]; more theoretical comments on the use of ligatures when cutting, especially in the arm, Medic. 8 [9.214 L.]; explanation of different types of ligatures either to accelerate or to arrest bleeding, Epid. 2. 3. 14 [5.116 L.]). Hesychios glosses a range of cognate words ναδσμη, ναδσομαι, ν(δημα (να ‘up’ with root δω ‘bind’) all with reference to garlands etc. tied on the head (Latte, 1953, 149); the prefix may suggest attention to the upper part of the body. )κτενας lit. ‘having outstretched’: cf. Mul. 2. 144 [8.316 L.]. These two first instructions are reminiscent of the many passages in Fractures and Articulations which specify that when bandaging is carried out the limbs must be in a particular position for treatment; either straight, as in the case of the leg, or flexed, as in the case of the arm (cf. Fract. 15 [3.470, 472 L.]). δφρον … φ’ οP στριζηται ‘a couch from which he can lean’: editors have unanimously disregarded the preposition π ‘from’, understanding it as, or even emending it to, )π ‘on’; Joly, for example, following

Sichel verbatim, translates ‘… on lui fait prendre avec les mains un point d’appui sur le siege où il est assis …’ However, it is clear that the patient leans not on, but from, the couch. The couch is not here a special surgical appliance, like an operating table; the word is the ordinary one for a household seat. Other Hippocratic passages where a ‘couch’ is spec-

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ified are in Physician (general requirements, Medic. 2 [9.206 L.]), Articulations (for a patient with dislocated shoulder, Artic. 7 [4.92 L.]) and in the gynaecological treatises (for birthing, fomentations and other procedures). μσον δ τις )χτω: ‘let someone hold his waist’: there may be an implicit metaphor from wrestling (cf. Ar. Nu. 1043, with scholiast);22 but the literal sense predominates. Simply, the patient’s movements are to be restrained. Explicit instructions that the patient be kept immobile are given with regard to surgery for haemorrhoids (Haem. 2 [6.438 L.]) or where pus is to be expelled (Morb. 2. 47b. 4 [7.70 L.]). The mss are at variance over punctuation, and the reference of τ+ σι χερσ. Instead of referring to the patient’s hands, leaning from the couch, this would, with a comma after στηρζηται, refer to the assistant’s hands, holding the patient. For τις in the sense ‘(doctor’s) assistant’, cf. Artic. 16 [4.128 L.]. διασημνασαι τ/ς νωτιαας φλβας, σκοπε7ν δ* πισεν ‘trace the ves-

sels of (= running to) the back, and examine from behind’: Sichel recognises that the terse instruction intends ‘marquer avec une substance colorante telle que l’encre’ but does not refer to the corroborative matter in Celsus (cited above). The tautology of the insistent stress on the location ‘behind’ and on surgery ‘behind’ troubles Ermerins, who comments testily that one would hardly look for these vessels &μπροσεν ‘from the front’; Joly finds that ‘les derniers mots ne semblent pas donner un sens satisfaisant’. Foesius too found the reading obscure: he took the passage to treat ustionem … venarum quae sunt in dorso ‘cautery of the vessels of the back’ but he did perceptively note that this is an odd designation for the upper part of the back and seems to have understood that the neck (rather than the back) is intended, in commenting that in urendo venas … colli tendines et nervos vitari volunt ‘in cautery of the vessels, they wish the tendons of the neck and the nerves to be avoided’; Aristotle had warned of the dangers of hitting a neuron while cauterizing the vessels (HA 3. 5).23 As Foesius notes, Calvus translates scapulares and may have known a reading :μιαας ‘in the shoulders’; however, he, or an early emendator, may simply be trying to alleviate a perceived problem. As argued above, the solution lies in the precise sense 22 23

See Iugler, 1792. Sichel 139; Ermerins 280; Joly 169, n. 2; Foesius I 736, n. 4.

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of νωτιαας not ‘of the back’ but rather ‘coursing to the back’. The verb διασημανειν occurs six times in the HC but only here in the middle form. The simple form is common, with over two hundred occurrences and the middle of the simple verb is used in a way similar to use of the compound here in Fractures (Fract. 3 and 5 [3.422, 434 L.]). The usage is in line with the author’s general preference for compound verbs. παχσι σιδηροισι ‘with thick (or ‘wide’) instruments’: such instruments are to be used, because of their slower and gentler action. It can be seen from other passages describing the practice of cautery that different types of instruments were regarded as appropriate in different situations (see especially Artic. 11 [4.106 L.]; Int. 18, 28 [7.212, 242 L.]). Cauterising instruments were most usually made of metal (as clearly here, σιδριον lit. ‘iron’; 3.2 καυστριον lit. ‘burner’ is not inconsistent, but simply a more general term). They might also be of wood dipped in hot oil as in Internal Affections (‘boxwood spindles’, Int. 28 [7.242 L.]) or of vegetable matter of certain types (cf. the material used in oriental moxibustion). συχ+η διαερμανειν ‘heat gently’: gentle application of heat would be

less likely to cause haemorrhage; compare the similar general passage on the practice of cautery in Places in Man (Loc. Hom. 40 [6.330 L.]). προαφιναι δ* το6 αGματος, Fν δοκ+ καιρCς εRναι ‘let blood in advance,

if it seems the right course’: a cautious approach to blood-letting is apparent throughout this work. As cautery and phlebotomy fulfilled broadly similar functions (to reduce unwanted bodily moisture or eliminate fleshy tissue), it seems that individual practitioners or corporate groups favoured use of one or the other method. The use of the term καιρς ‘proper circumstances’ indicates adherence to the standard practice of studying the relevant circumstances of the patient’s condition (cf. ε, &χοι τC σμα, 9.1 below; το6 αGματος φεναι Fν μ= σενσ+η, Morb. 2. 73 [7.112 L.]). After a discussion of kairos in medicine the author of Diseases 1 gives examples of improper treatment. Cutting and burning are included: the doctor should not use these methods inappropriately, and if using them should not fall short in length and depth of surgery (Morb. 1. 5–6 [6.146, 148, 150 L.]). The prefix προ- ‘in advance’, ‘beforehand’ is commonly used in expressions of preparatory surgical procedures, such as προπυρι(ω ‘fumigate beforehand’.

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καειν δ* πρCς τC στον πισεν ‘cauterise towards the bone from

behind’: this final instruction of section 1 is reminiscent of the most effective treatment, according to Celsus, which was the Afrorum curatio ‘the therapy practised by the Africans’, in which verticem usque ad os adurunt ‘they burn the crown of the head right through to the bone’. However, perhaps the point to be targeted here is not the κορυφ ‘crown’, or top of the head; but rather the ,νον, ‘occiput’ or a point at the base of the skull (cf. Morb. 2. 12 [7.22 L.], noted above). 2. This further phase of the treatment indicates how to continue cautery by applying a sponge impregnated with olive oil. The purpose of the sponge is not made clear. It might be interposed to protect the flesh from the instrument (as a sponge is placed over a cauterized area in the mouth for protection when the patient is eating, Morb. 2. 32 [7.50 L.]), or used as absorbent material to mop up (cf. Artic. 38 [4.168 L.]), but is more probably intended to allow deeper penetration by the oil. Foesius supposes that the sponge is used alone as an alternative to the metal (spongiam oleo fervente tinctam intelligo, qua ustio fiat ‘I understand this as a sponge dipped in boiling oil, to carry out the cautery’) but this ignores τ"ω καυστηρ"ω, a phrase certainly difficult in context and deleted by Ermerins as an ‘absurd’ insertion.24 Sichel, followed verbatim by Joly, translates ‘si l’éponge adhère au cautère’, but ‘adhere’ would be a very strange sense for προσδχεσαι. The verb is common in the sense ‘accept’ (LSJ I) or ‘admit’ (LSJ II) of a patient accepting or tolerating a particular type of food or drink (especially in Epidemics; see Epid. 7. 43 [5.410 L.] etc.); it is particularly used in the context of a doctor experimenting and adapting treatment to a patient:  τι 9ν μ(λιστα προσδχηται (with reference to the patient) πειρ5μενος (with reference to the doctor) ‘trying whatever she will tolerate’ (especially in the gynaecological works; see Nat. Mul. 40 [7.384 L.] etc.). It is unclear why the patient might not tolerate the sponge: perhaps it would make the cautery more bulky and uncomfortable over a wider area; perhaps hot oil would be more unbearable even than hot metal. There is a (remote) possibility that ‘sponge’ refers to a special kind of fungus used in cautery; it has been suggested that this fungus was known to have an effect such as that of penicillin.25

24 25

Foesius I 688 and 736, n. 6. Nielsen, 1974, 83–86.

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Later arum coated with honey is applied. Arum was used to close wounds and in various eye troubles (Diosc. 2. 167). The telegraphic prose fails to specify which part of the arum plant is to be used (probably the root, as usually elsewhere),26 or in what form (probably ground up, as usually elsewhere), or in what quantity. We may contrast a passage in Diseases 2, where the precise amount of pulverised arum root is specified, to be used in combination with salt, honey and other ingredients in an orally administered medicine for a lung complaint (Morb. 2. 47.2 [7.66 L.]). There are parallels in Affections for the use of fabric in conjunction with the cauterising instrument (Aff. 29, 31 [6.242, 244 L.]). σπγγον ‘sponge’: the variant σπογγον recorded by Foesius is doubtless

influenced by the diminutives following. )γκατακαειν ‘cauterise over’: the unusual double compound, lit. cau-

terise in and down’ shows the preference for compound forms already noted. This type of compound has the following distribution: very noticeable in Places in Man ()παναρργνυμι, )παναχρμπτομαι and )παν(χρεμψις, )παναφρω, )παναχωρω); marked in the gynaecological works ()γκαεψ(ω, )γκαννυμι, )γκαστημι, )γκατατλλω) two occurrences in Acute Diseases ()γκατακλεω, )γκαταλεφω); one each in Epidemics 4 and Regimen 1 ()γκατακλεω). καυστριον ‘(little) instrument’ (for cautery): the diminutive is hapax in the HC, while σπογγον ‘little sponge’ following is common. Diminu-

tives are especially frequent in the gynaecological works, but there is a related crop in some of the surgical works; e.g. of nineteen Hippocratic occurrences of μολυβδον ‘lead’ all are gynaecological except for a few in Articulations and Mochlicon, and one in Fistulas. μλιτι δε#ων ‘moisten with honey’: The addition of )ν (I and mss

derived from I) does not affect the sense. G has the typically unhelpful gloss βρχων. )σχ(ρη ‘eschar’: throughout, 3. 2, 3. 4; 4. 2; 5, this word, lit. ‘hearth’ or ‘fire’ is used in a transferred sense of the scab or cicatrice formed on wounds after cautery; cf. Celsus 5. 26. 33C.27 26 27

See Petrequin I 1877, 377, n. 21. See Chadwick, 1996, 114.

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3. Section 3 begins with predictions for what can be expected after cautery, when the cicatrice falls off. These instructions, with stress on the need to διακαειν ‘cauterize thoroughly’ (or rather ‘right across’ or ‘right through’) are close to those of Places in Man (Loc. Hom. 40 [6.330 L.]). The verbs διακαειν and διατμνειν describe not incision but section right through the vessel (and on the importance of the point of section, see Haem. 5 [6.440 L.] and Artic. 68 [4.282 L.] with Mochl. 34 [4.376 L.]).28 The latter part of section 3 returns to consider conditions of cautery itself; after this intervention, section 4 continues discussion of the aftermath of surgery in a somewhat repetitive fashion. The sense of 'μοως lit. ‘in the same way’ is quite unclear (the same as before; the same as it ought to be; the same as in some other unspecified case; or perhaps ‘the same throughout’, i.e. ‘evenly’). Nor is it clear whether the appearance of the vessels, described as stretched or extended and full or swollen, is being presented as a desirable and normal or an undesirable and abnormal state. The similar description in 4 seems to be of a good condition, after healing. The verb is used of the vessels both in health (Oss. etc.) and in sickness (in a type of phthisis, vessels διαττανται and some are very red, Int. 12 [7.194 L.]; in a type of dropsy, vessels διαττανται throughout the body, black and thick, Int. 26 [7.234 L.]; in a type of jaundice, vessels ττανται throughout the body, pale and unnaturally big and thick, while other vessels ττανται blackish in colour, Int. 36 [7.256 L.]; cf. also Acut. Sp. 5 and 7 [2.406 and 424 L.]). Here, the beating of the pulse in the vessels seems to indicate conditions requiring surgery, rather than the normal condition of the patient after recovery. Abnormal beating of the pulse is commonly regarded as a pathological symptom, as in Epidemics 7 (pulse in the brows a sign of fever, Epid. 7. 3 [5.368 L.]) and especially in Diseases 2 (two passages where, as here, swelling is mentioned in conjunction with beating, Morb. 2. 4.1, 2 and 15.1 [7.10 and 28 L.] and a passage where it is enjoined that cautery should continue until the beating of the vessels is arrested, Morb. 2. 12.6 [7.22 L.]). Pulsation with sight loss is a symptom displayed by βλητο ‘stroke patients’ (Morb. 2. 8 and 25 [7.16 and 38 L.]; Morb. 3. 3 [7.120 L.]). 1νωεν … κ(τωεν ‘from above … from below’: with the reading τε κ(τωεν … ' κ(τωεν the repeated κ(τωεν ‘below’ is problematical.

28

See Petrequin I 1877, 351, n. 6.

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Where we have two closely placed phrases, parallel in expression, we expect them to be parallel in sense also. Ermerins emends the first expression and deletes the second; he also reads διακεκαυμνη feminine for masculine (sc. φλψ), and translates similiter vena tenditur, et inflata est et pulsat, quia ab inferiore est id, quod influit; sin perusta est, haec omnia minus patitur, ‘the vessel is similarly stretched and swollen and it beats because the matter which flows in comes from below; but if it is thoroughly cauterised it suffes all this to a lesser degree’. Sichel does not emend and translates very loosely: ‘lorsque le sang afflue de bas en haut … à une partie inférieure du dos’. But the point of this is quite unclear. Joly emends the second expression by deleting ', then essentially follows Sichel’s translation, ‘… elle bat lorsque le sang afflue de bas en haut; si la cauterization profonde est faite en bas (du dos), tout cela a lieu à un moindre degré …’; he explains, with acknowledgement to Thivel, that cautery was being effected at as low a point as possible in the body in order to prevent the upwards return of peccant humours.29 Certainly, the verb )πιρρω frequently suggests the flow of noxious stuff (Gland. 3 [8.558 L.], Ulc. 24 [6.428 L.] and VM 19.1 [1.616 L.]); certainly too, care was frequently taken in selection of the best point for surgery, with a view to stopping disease going to another point in the body (Int. 18 [7.210 L.]; cf. Morb. 3. 15 and 16 [7.140 and 142 L.]); and the supposed reference to a flux of peccant matter downwards in the body is consistent with the author’s pathological stance. But if this is the point, the expression is unduly contorted, and there remains a lack of parallelism between two apparently corollary expressions. With the emendation proposed the reference is to two opposed locations, rather than to two identical locations. The reference is to flux from the upper part of the head, or flux from the lower part. Flux from the upper part runs to the temples, and so the pulse is a good diagnostic indicator; flux from the lower part (the brain) runs to the inner corners of the eyes, and so the pulse is not significant in diagnosis (Loc. Hom. 13.3 [6.300 L.]; Celsus 7. 7. 15). 4. General statements on the ideal conditions of the eschars or scabs and on the healing process conclude this section on cautery. The first two sentences break the flow somewhat and are rejected as marginal

29

Joly 169, n. 3.

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notes by Ermerins. The terms )σχ(ραι ‘scabs’, ‘cicatrices’, Dλκεα ‘lesions’, ‘wounds’ and ολα ‘scars’ are interrelated, following one other in sequence; in Places in Man, instructions are given for the use of drugs to ensure that, after eye surgery, the lesion is drawn together, and the final scar slight (Loc. Hom. 13.7 [6.302 L.]). From the gloss (Souda) of eschars as κο7λα Dλκη ‘hollow wounds’, it may be seen that following cauterisation scabs tended to remain depressed. τ(χει ‘quickly’: the mss are oddly confused over the form of this common adverb. In M, the end of the word is blurred. While most recc. read τ(χει, there is evidence also for τ(χι (Ca. Mut.) and τ(χιστα (E). Erotian’s gloss Τ 15 τ(χαE ταχως related by Nachmanson to the lost work on Wounds from Missiles may be related rather to On Sight.30 )πειδ/ν τ/ Hλκεα @για γνωνται ‘when the sores are healed’: the plural verb after neuter plural subject may be a trace of Doric idiom.31 )ρυρα ε,σι … ναιρσομεναι φανονται ‘are … red … look as if they

will remain raised’: the future participle is suspected by several editors, on the grounds that it seems to make no sense; but Ermerins’ Wσπερ ναρραγησμεναι ‘as if about to break out’ and Foesius’ ναρρηξμεναι ‘about to break out’ are no better. Sichel takes the subject to be φλβες ‘vessels’; rather it is ολα ‘wounds’ (sc. on vessels), there being an easy mental transition from Dλκεα ‘sores’ to ολα ‘wounds’. The expression is typically loose and the reference of the fem. adj. ‘red’ may be to any of the fem. nouns in the vicinity—οIλαι, φλβες or &σχαραι. που 9ν καυ+ ‘wherever there is cautery’: some doctors who put their

faith in cautery seem to have practised it wholesale. Thus, Euryphon, named as an archetypal practitioner, was mocked in comedy as burning his patients all over the body (Pl. Com., fr. 652 K.). Comprehensive cautery is recommended for several cases in Internal Affections. In the case of a kidney disease believed to course from head to throat to spine to feet and back again (with bloodshot eyes as one symptom), cautery was indicated at shoulder, hip-joints, buttocks, thighs and various points in the lower leg (Int. 18 [7.212 L.]). And to counter supposed dryness of 30 31

Nachmanson, 1917, 85 and 1918, 367. Cf. Craik, 1998, 22–23.

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the spinal fluid (attributed to blockage in the small vessels leading to the ‘marrow’, and in the passage from the brain) the instructions are to cauterise multiple regions of the body with multiple (some twenty in all) eschars: sacrum, back and neck (Int. 13 [7.200 L.]). Cautery of the chest or side was regularly undertaken to eliminate empyema, a complication of many diseases affecting the lung. Cautery of the back was relatively rare. Cautery of the upper back was indicated, with cautery of the chest, in certain cases (Morb. 2. 53.4 [7.82 L.]; cf. also Morb. 2. 62 [7.96 L.]); this was sometimes a last resort (Int. 1 and cf. 2, 8 [7.172, 174, 186 L.]). Diseases supposedly affecting the back were subject to much speculation: dropsy, phthisis and even pleurisy might be canvassed (Morb. 3. 16 [7.144 L.] and Morb. 2. 56 [7.88 L.]; also, more theoretical in slant, Loc. Hom. 15, 21–23 [6.308, 312, 314 L.] and Gland. 14 [8.570 L.].) It was recognised that the nexus of blood vessels in the back was complex (Oss. 14 [9.186 L.]). Celsus too viewed surgery on the vessels as essentially the same, wherever in the body it had to be practised (7. 31). IV In the first section, procedures to scrape and cauterise the eyelid are outlined, precautions are indicated and drugs for post-operative treatment are specified. The second section seems to specify follow-up procedures, cutting into the forehead and purging the head; the former procedure is elsewhere prescribed as a drastic last resort, and the latter is usually the first rather than the final recourse. It is strange that, after the lids have healed, further surgery is proposed: it may be suspected that the text is corrupt, and that part of the second section is misplaced or intrusive. The treatment described in the first section is regarded by Sichel, followed by Joly, as a response to ulceration caused by trachoma. Sichel devotes much space to discussion of this chapter and the next, which he takes with it: the subject is ‘un traitement chirurgical rationnel des granulations palpébrales’ or ‘paupières trachomateuses’. Ermerins is non-committal on the nature of the disease, allowing merely agitur de palpebrarum rasione et ustione ‘the subject is scraping and cauterizing the eyelids’; he links the chapter rather with what precedes in Chapter 3. However, this is achieved at the expense of drastic emendation (see below on στεφ(νην το6 φαλμο6 ‘eyeball’ and on χνδρον ‘cartilage’). Joly, like Sichel, finds the treatment impressive: ‘Tout ce chapitre

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… qui traite indubitablement des granulations du trachoma, est très judicieux dans sa précision et ses conseils’.32 The term trachoma, in origin a general word for ‘roughness’, has become a specific term applied to the highly contagious trachoma virus and its ravages. Trachoma is a chronic destructive inflammation of the conjunctiva, characterized by the formation of granules on the eyelid; it typically starts in the conjunctival fold of the upper lid, but eventually involves the cornea and the deeper tissues of the lid.33 It was probably endemic in ancient Egypt and familiar throughout the Greco-Roman world. Trachoma, though now virtually unknown in developed countries with good hygiene, remains the most common cause of blindness in the world as a whole. It is unlikely that the Greek doctors were able to distinguish between trachoma of this specific kind and other kinds of inflammation or ulceration of the eyelids, viewed as a concomitant of protracted eye disease. Certainly, they treated the symptoms of the trouble without awareness of its viral origin (the causative agent, chlamydia trachomatis, not being identified till 1962) and contagious character. Sichel’s argument that condition and cure were known in antiquity, rather than being ‘discovered’ by William Adams in the nineteenth century is thus only partly valid. There is no certain Hippocratic parallel to our passage. The term τρ(χωμα, concrete ‘a rough condition’ does not occur in the HC, though related forms are found: τρηχ#σματα ‘rough patches’ once (Epid. 2. 3. 1 [5.102 L.]), and τραχυσμς ‘irritation’ twice (Acut. 60 [= 16, 2.356 L.] and Mochl. 42 [= 41, 4.392 L.]). The abstract noun τραχ#της ‘roughness’ occurs also, as does the adjective τραχ#ς ‘rough’, but most commonly of tongue or mouth and never of the eyelids. However, several passages may be relevant to the pathology of trachoma. One is a rather vague description of the complications of a serious disease where there are pustules and rashes on the brow such that one eyelid grows into the other and there is acute swelling (Acut. Sp. 26 [= 10, 2.446 L.]); another is a brief reference to trichiasis, which is a recognized consequence of trachoma (Acut. Sp. 61 [= 29, 2.516 L.]); still another is a description of a purulent eye disease, with deep sores and ulceration of the eye (Epid. 4. 44 [5.184 L.]); finally a reference to pro32 Sichel 140–148, at 140 and 141; Ermerins Prolegomena XL and commentary 281; Joly 170, n. 1. Iugler, 1792 devotes nine pages to 3 and a mere page to 4. 33 See Duke-Elder II 1934, 1593–1628; Spalton et al., 2005, general description 102– 103 and illustration of stages 103–104, figs 4. 36–41.

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tracted ‘dry opthalmias’ causing internal and external growths on the eyelids, affecting the sight and known as σ6κα ‘figs’ is reminiscent not only of the effects of trachoma but also of the term σ#κωσις, later used of the disease (Epid. 3. 3. 7 [3.84 L.]; cf. Scribonius Largus 37).34 There is no direct parallel, either, which might explain the rationale for the follow-up procedures described in the second section: cutting into the forehead and purging the head. However, a comparison with Places in Man (Loc. Hom. 13 [6.300 L.]) seems to show similar ideas and practices to those implicit here, perhaps in response to the same condition. In a discussion of flux to the eyes, the most extended treatment (13.3–5) is of a condition where mucoid material has accumulated between flesh and skull, leading to Dλκεα ‘sores’ on the head. The explicit statement that there is no ulceration on the eyelid (οχ Hλκο6νται τ/ βλφαρα) suggests that such ulceration might have been expected, or perhaps that the condition is a variant on one where such ulceration featured. The treatment is mild purging of the head and purging below; if the noxious stuff is not eliminated through a natural orifice the doctor is instructed to cut into the head, right up to the bone, with a view to getting it out. There are similarities also with Diseases 2 (Morb. 2. 13 [7.22 L.], in a passage following the disease discussed above in relation to Vid. Ac. 3). For a disease where there are Dλκεα ‘sores’ on the head (cf. Loc. Hom. above) the treatment is to purge and if that fails to καταταμε7ν τομ/ς ‘cut cuts’ (cf. τ(μνειν τομ=ν δι/ το6 βργματος here, Vid. Ac. 4; ταμντα κατ/ τC βργμα 8 below is different, being a prelude to trephining) in the head, anoint, then plaster with wool, wine, oil and cypress, that is, with anti-haemorrhaging drugs; similarly, to arrest bleeding sawdust of cypress is one ingredient specified in Fistulas (Fist. 9.3 [6.456 L.]). The idea of the doctor in On Sight may be that removal of nasty stuff from the top of the head will prevent its descent to the eyes and so recurrence of trachoma. It may be added that the supposed pathology of flux of peccant matter from inner or outer parts of the head leads to treatment of many diseases by various types of incision which show some features in common with the treatment here: water in the head treated by cutting into bregma and piercing bone (Morb. 2. 15; cf. 8.1 below [7.28, 30 L.]); vessels overfull of blood treated by cutting into forehead and applying a pad of ‘greasy wool’ (Morb. 2. 18 [7.32 L.]). Finally, we may compare the treatment prescribed in Affections for a disease characterized by pain 34

See Pearlmann, 1969, 1072.

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and dizziness in the head: the first recourse is to cleanse the head, and let blood from the nostrils or from the forehead; if this brings no relief, then the doctor must cut the head or cauterize the vessels ‘in a circular motion’ (Aff. 2 [6.210 L.]). A passage in the Aristotelian Problemata shows the universality of such treatments for ‘excess’ or ‘moisture’ leading to flux to the eyes (Probl. 31). Later, the specific names periskythismos and hypospathismos were given to surgical cutting at different points in the head, to arrest flux (with a generally ‘circular’ configuration, as in Affections).35 Celsus was aware of many of the complexities of diseases affecting the eyelids: carbuncles could arise from inflammation, sometimes on the eyes, sometimes on the lids (6. 6. 10). And he treats of variations in the development of trachoma: aspritudo ‘roughness’ (Greek trachoma) follows inflammation but also induces inflammation (6. 6. 26). Celsus subscribes to the view that a discharge of rheum is a concomitant of trachoma (7. 7. 15). A common treatment was to scrape the hard and thick lids with a fig-leaf, a rasp or a scalpel, and then to rub medicaments on the under-surface; but Celsus himself advocates rather appropriate diet, exercise, baths and fomentations. Dioscorides recommends a series of specifics for trachoma; these include fig leaves, unripe grape juice and, in various forms, copper. Galen too addressed the problems of trachoma, which he regarded as a difficult condition, almost impossible to treat, and outlined expedients of different doctors; these include cleansing drugs, scraping and wiping away the oozing stuff with a sponge (de compositione medicamentorum secundum locos, 12. 709–711 K.) The language contains direct address to the doctor, in the second person: ταν δ* ξ#+ης and μ= διακα#σ+ης. As above, nominative participles and infinitives are used, ξ#ων … περιειλων. The demonstrative pronoun is redundantly repeated, το#τ"ω νατρ7ψαι (deleted by Ermerins, who often fails to recognize this idiom) and 4στερον δ* το#του.36 1. ταν δ* ξ#+ης … ξ#ειν ‘when you scrape … scrape’: after the temporal clause and jussive infinitive, the ensuing words refer to procedures not of scraping but of cautery. Editors have either postulated a lacuna after ξ#ειν (Ermerins) or have inserted words to clarify the tran35

For full details of types of cutting, and late medical sources detailing these, see Marganne, 1994, 152–167; for a succinct description, see Jackson, 1996, 2247. 36 See Craik, 1998, 23, n. 28.

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sition from scraping to cautery: εRτα καειν Sichel and ξ#ειν )πικαων Triller. However, perhaps the transmitted text can stand on the supposition that the general condensation and ellipse typical of this work has led to a tacit move from scraping to cautery and so to an apparent conflation of these techniques. The verb ξ#ω ‘scratch’, ‘scrape’, ‘saw’ occurs twenty-eight times in the HC, most frequently in the general non-medical sense of ‘grate’, applied to recipe ingredients, especially in the gynaecological treatises (fifteen occurrences) but also in technical medical senses, applied to abrasions in the body causing discomfort (Aff. 23 [6.234 L.]; Morb. 3. 11 [7.130 L.]) or, as here, to the medical procedure of abrading, especially bone (VC 14, 19 [3.236, 252 L.]; Morb. 2. 24 [7.38 L.]). The instrument ξυστρ ‘rasp’ is typically used on bone (VC 14, 19 [3.236, 254 L.]). ε,ρ"ω Μιλησ"ω οIλ"ω κααρ" ‘with soft clean Milesian wool’: this material was regarded as especially fine. Though specified only here and in Infertile Women (Steril. 221 [8.426 L.]), it was nevertheless probably the material of choice where it was available. Strabo remarks (12. 8. 16) that Laodikeia remarkably produced wool superior in softness even to that of Miletos. Egyptian cotton was similarly prized (Morb. 2. 33, cf. 35 [7.50, 52 L.]). Soft clean wool is required for bandages and poultices in many passages of the surgical and gynaecological works. Although wool was not generally used for the apparent purpose here (cf. specification of linen for use on the eyes and sponges for use on wounds, Medic. 2 [9.208 L.]) whether swabbing (if cutting) or protection from direct contact with the instrument (if cautery), the use of wool in bandaging after surgery on the head may be parallel. Erotian’s gloss Ο 25 ολ" )ρ"ωE τ" μαλακ" related by Nachmanson to the lost work on Wounds from Missiles may be related rather to On Sight: the case is the same, though the ordering of words is different.37 The most natural meaning of οUλος applied to wool is ‘soft’; but an alternative sense is ‘fleecy’ or (apt to the context) ‘compacted’; see LSJ s.v. οUλος (B) 3, perhaps cognate with ε8λλω ‘pack tightly together’. Hesychios glosses as both cπαλν ‘soft’ and συνεστραμμνον ‘compacted’ (Latte, 1953, 793). περ 1τρακτον περιειλων ‘winding it round the spindle(-shaped instrument)’: the spindle is a spindle-shaped instrument for cautery (cf. κα6-

37

See Nachmanson, 1917, 365 and 1918, 66.

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σαι δ* )ν πυξνοισιν τρ(κτοισι β(πτων )ς &λαιον ζον ‘cauterise with boxwood spindles, dipping them in boiling oil’, Int. 28 [7.242 L.]). Galen’s gloss 1τρακτονE ο μνον τCν ε,ς τC ερουργCν χρσιμον, λλ/ κα τC ξ#λον το6 βλους ‘not only that useful in weaving but also the wood of the instrument’ (linguarum Hippocratis explicatio, 19. 86 K.) with the same case as On Sight, not as Internal Affections, probably refers to our treatise and so indicates that the work was known to Galen.38 The verb ‘winding’ is oddly suggestive of winding on wool for spinning. The purpose of the action is the same as that of the ‘pledget of cotton-wool’ recommended by Duke-Elder. A famous, or rather infamous, interpretation of 1τρακτος not as ‘spindle’ but as τρακτυλς ‘spindle-thistle’ (on which see Thphr. HP 6. 46, etc.; cf. Hesychios τρακτυλλςE φυτCν κανδες ‘a prickly plant’, Latte, 1953, 275) is discussed at length by the commentators Iugler and Sichel; also by the learned medical authors Haller and Triller.39 (See also Introduction.) There is no real basis for the alternative interpretation; but an expression in Epidemics σον σπνδυλον τρ(κτου (Epid. 5. 25 [5.224 L.]) was cited as corroboration for the sense ‘thistle’. The expression there is ambiguous, as the word σπνδυλος lit. ‘vertebra’ may be applied to anything which resembles a vertebra in shape; here, a stone extracted from the vagina of an elderly patient (who had presumably put it there as a child) is described as ‘as big as the whorl of a spindle’ or ‘as big as the head of a spindle-thistle’. ατ=ν τ=ν στεφ(νην το6 φαλμο6 φυλασσμενος ‘with care for the

actual eyeball’: the verb is similarly used in 5 below; also, in the same participial expression, in other treatises where delicate surgical procedures are performed (trephining VC 18, cf. 21 [3.250, 258 L.], Mochl. 35 [4.378 L.]; vapour bath Morb. 2. 26.3, 47b. 3 [7.42, 68 L.]; fumigation Mul. 1. 75 [8.164 L.]; incision Mul. 1. 70 [8.148 L.]) or hazardous prescriptions made (Loc. Hom. 13 [6.300 L.], Aff. 33 [6.244 L.] and cf. Aff. 11, 12, 13 [6.218, 220 L.]).40 More generally, it may be used, as below 9, of the patient guarding against such adverse weather conditions as too much wind, sun etc. (Morb. 2. 15.3, 2. 50.5, 2. 51.5 [7.28, 78, 80 L.]; Morb. 3. 2 [7.120 L.]; Vict. 4. 90 [6.656 L.]; Int. 9 [7.188 L.]). The term στεφ(νη might be used of various ring-shaped bodily parts, such as the 38 39 40

See Iugler, 1792, 66; Anastassiou and Irmer, 1997, 458–459. Iugler, 1792, 60–69; Haller, 1755, 315–338; Triller I 1766, 463–485. See Petrequin I 1877, 509 with n. 8 and II 1878, 604 with n. 8.

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sutura coronalis and the sphincter ani (Pollux 2. 39 and 211). Ermerins deletes το6 φαλμο6 ‘of the eye’ and understands the ‘ring’ to be the coronal suture of the skull; he further reads below τC στον ‘bone’ (sc. skull) for τCν χνδρον ‘cartilage’. He then interprets the pasasage as referring to cautery in the head, around the coronal suture. There are indeed ancient parallels for such cautery (especially in Aretaeus); and they may be relevant to Chapter 4.1, but not to this passage. Here the στεφ(νη is simply the ‘eyeball’ or ‘globe’ though in later authors it is more specifically applied to the limbus, the rim of the cornea where it joins the sclerotic (Gal. Commentary on Prognostic, 18 (2). 47 K. and Ruf. Onom. 26).41 μ= διακα#σ+ης πρCς τCν χνδρον ‘do not cauterize through, up to the cartilage’: χνδρος is used of any bodily cartilage, either general (Aph. 6. 19 [4.568 L.]) or particular, such as that in the chest in the area of the breastbone (Epid. 7. 3 [5.370 L.]), in the nose (Loc. Hom. 3 [6.280 L.]), or in the ear (Artic. 40 [4.176 L.]). Here, it refers to the tarsal plates, dense connective tissue in the lids, curved to conform with the shape of the globe of the eye; these resemble cartilage in consistency, being composed of densely compacted collagen and elastic fibres.42 In essence, this means, ‘do not cauterize too deeply’ (verb διακαειν) and Sichel comments on the danger attending such surgical procedures on the eye, ‘danger qu’aujourd’hui nous connaissons suffisament’.43 The syntax, μ with aorist subjunctive, is a prohibition, not a subordinate final clause. σ=με7ον ‘it is a sign’: a guide to signs, especially bad or mortal signs, is a standard feature of many Hippocratic treatises, especially Prognostic, Prorrhetic 2 and Koan Prognoses. ταν ποχρ+ τ ς ξ#σιος ‘when there is enough scraping’: the subjunc-

tive is required.44 The verb ‘be enough’ is usually, but not invariably, impersonal and followed, as here, by the genitive case. It occurs only eight times in the HC (elsewhere once each in Aer., Fract., Mochl., VC, Mul. 1 and twice in Steril.). 41 See Magnus I 1998 (tr. Waugh), 47–48 on the possible translations ‘margin’, ‘rim’, or ‘conjunctiva’ all finally rejected in favour of ‘eyeball’. 42 Duke-Elder I 1932, 207. 43 Sichel 141. 44 See Anastassiou, 1980 and cf. GMT § 192. 2.

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λαμπρCν αJμα ‘bright blood’: the adjective λαμπρς (‘bright’ of lights,

1.2; 9.1 and 3) is especially used of the fluids present in the healthy eye, perhaps associated with the common belief that fire was present in the eye. It is a bad sign when the eyes lack brightness (Mul. 2. 116 [8.250 L.]). The related idea of reflection in the eye is evident in the verbs )μφανεται, Loc. Hom. 3.3 [6.280 L.] and καταφανεται, Morb. 2. 1 [7.8 L.]. In the latter passage, the adjective ‘bright’ is three times repeated: when phlegm penetrates the vessels of the eye, the ‘brightness’ in the eye is not as ‘bright’ and there is not the same reflective quality as when it was ‘bright’ and ‘pure’. Cf. also the explanation of sight as a reflection of ‘light and all bright things’ and its corollary that anything which is not bright is not so reflected, Carn. 17.1 [8.606 L.]. These ideas may be related to those of Alkmaion (DK 24 A 5 = Thphr. de sens. 26; A 10 = Aet. 4. 13. 12) and Empedokles (DK 31 B 84 = Arist. de sens. 437b23).45 In Plato’s Timaios the eyes are said to conduct light by means of the pure fire which flows through them, a fire which does not burn but gives light to the eyes (Pl. Ti. 45b2–46a2; 58c), and in the Aristotelian Problemata, there is fire in the eyes, but fire without heat, and for this reason the eye has no sensation of cold (31.22, 959b15). The bright eye is pure and healthy; and the bright blood of the eye is pure and healthy. The adjective is applied to blood twice in Koan Prognoses (7. 593 and 611 [5.722 and 726 L.]); it is applied also to urine, likewise ‘bright and pure’ in health (Epid. 7. 80; cf. 7. 78 [5.436, 434 L.]). ,χ<ρ α,ματ5δης F @δατ5δης ‘bloody or watery matter’: ichor, in Homer the blood of the gods, is in the HC body fluids altered in some way, usually noxious in character. Here we might have expected the transition to be from (bad) oozing matter to (good) bright blood, not, as the text has it, vice versa. Thus Foesius, though keeping the vulgate reading, expresses reservations and notes, satis tamen derasam esse palpebram apparet, si pro cruenta et aquosa sanie, sanguis sincerus et purus effluat, ‘the lid seems to be sufficiently abraded if in place of bloody and watery stuff clear pure blood flows out’.46 It has been argued that ichor can describe blood serum oozing from a wound after the flow of blood; and that such usage, where ichor is not harmful (found also in Ulcers, Diseases of Women and Heart) may indicate a later date for the work.47 However, the 45 46 47

See Longrigg, 1993, 58–60 and 72. Foesius I 736. Duminil, 1977, 74 and 76.

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distinction seems to me anachronistic, and alien to ancient ideas. Galen glosses @δατ5δεαςE @δρωπικ(ς (linguarum Hippocratis explicatio, 19. 148 K.). τινι τν @γρν φαρμ(κων, που 1νος )στ χαλκο6, το#τ" νατρ7ψαι

‘rub on one of the liquid drugs (lotion, or a runny paste or ointment) containing flower of copper’: the doctor is expected to be familiar with the range of drugs available. Calvus’ translation liquido medicamento, in quo aeris flos sit, ‘with a liquid drug containing flower of copper’, is followed in essence by later translators and here. The expression, however, is odd and the use of που ‘where’ is peculiar (hence Foesius’ comment πο ον fortasse legendum ‘“such as” should perhaps be read’);48 also το#τ"ω is tautologous. It may be that we should amplify the expression to translate, rather, ‘rub on some liquid drug: where flower of copper is available, use that’. Lotions of copper salts (both sulphate of copper, popularly known as ‘blue stone’, and nitrate of copper) are powerful astringents and haemostatics, especially useful in eye diseases in antiquity and modern times (Morb. 3, frequently and see also Dioscorides 5. 77; the Galenic de simplicium medicamentorum temperamentis ac facultatibus 12. 242 K.; de compositione medicamentorum secundum locos, 12. 701 K.). There is an extensive literature on the subject of therapy by copper.49 Flower of copper is oxidized copper, or copper oxide, formed in the smelting process: water was poured on the hot melted metal to make it set more quickly and the small particles which spattered out in response to sudden cooling were known as ‘flowers’.50 The lack of specification of quantity or weight in the ingredients is usual; in any case, minerals were liable to variation due to inherent impurities and vagaries in processing. νατρ7ψαι ‘rub on’: Joly translates ‘faire une onction’; but the idea of

friction or massage is certainly present in the verb, by contrast with

διαχρειν below (cf., in a similar context, Morb. 2. 13 [7.24 L.] and, more generally, Off. 17, 23, 24 [3.322, 328, 332 L.]). The prefix να-

literally ‘throughout’ is semantically otiose, unless perhaps it implies repetition and improvement (see LSJ on the prefix in composition of verbal forms). The verb is repeated in 6 below, applied both to patient Foesius I 736, n. 10. See Majno, 1991, 490, n. 85; Douthwaite, 1963, 370 ff.; Nielsen, 1974; Nutton, 1985, 143; BMD s.v. ‘copper’. 50 See Nielson, 1974, 42; cf. Majno, 1991, 490, n. 85. 48 49

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(for which cf. Mul. 2. 185 [8.366 L.], Artic. 9 [4.102 L.], Morb. 3. 10 [7.130 L.]) and medication (for which cf. Mul. 1. 109 [8.232 L.], Morb. 3. 17 [7.156 L.], Ulc. 12 [6.412 L.]). 2. 4στερον δ ‘afterwards’, ‘later on’: the adverb, twice repeated here (cf. 5 below), intends a different time-scale from &πειτα ‘then’ in 3 above. The collocation is uncommon; Ermerins emends in 5 and tinkers in 4. However the repetition of the demonstrative should be retained and the extension to all cases is appropriate. τC τ ς ξ#σιος κα τC τ ς κα#σιος ‘with regard to the procedure of scraping and the procedure of cautery’: the expression, though peculiar is readily understood. ταν … κεκααρμνα +L τ/ Dλκεα κα βλαστ(ν+η ‘when … the wounds have been cleaned and it (sc. σ(ρξ ‘flesh’) is growing’: perfect partici-

ple is used with present subjunctive. This sentence is another instance of the compression so evident throughout the work. The sense implicit is that wounds must be properly cleaned to avoid premature formation of granulation tissue and with it premature closure over bulging flesh. An explicit statement in Head Wounds elucidates: ‘When it has been cleaned, the wound should become quite dry; for in this way it would become sound most quickly, the growing flesh being dry and not moist, and in this way the wound would have no excess flesh’ (VC 15 [3.244 L.]; cf. Ulc. 6, 8 [6.404, 406 L.] with Galen’s exposition in de methodo medendi, 10. 281 K.; also Loc. Hom. 38 [6.328 L.] on techniques to heal wounds which have closed prematurely).51 Proper healing of wounds on the eyelids must have been particularly problematical: trachoma was liable to leave permanent scarring. The language here resembles that of Head Wounds and Ulcers: βλαστ(νειν ‘grow’ occurs in both as a technical term of knitting tissue. τ(μνειν τομ=ν δι/ το6 βργματος ‘make a cut (lit. ‘cut a cut’, cognate

accusative) through the front of the head’: the bregma, simply glossed by Hesychios as ‘the middle of the head’ (Latte, 1953, 345), is the point formed by the intersection of the sagittal and coronal sutures, that is the anterior fontanelle, where the bones of the newborn do not make full contact with each other. As it is the point in the vault of 51

See Petrequin I 1877, 274, n. 3; also Craik 1998, 193–195.

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the skull where the bone is thinnest and weakest, and where there is least and thinnest flesh, wounds there are especially dangerous (VC 2, cf. 13 [3.188, 230 L.]). Incidence of the anatomical term bregma in the HC (not in Loc. Hom.) is as follows: Morb. 2 (six times); Mul. 1 and 2 (twice each); VC (four times), also Epid. 5, 6, 7; Prorrh. 1 and Coac. Foesius translates sectionem per sinciput facere ‘make an incision in the top of the head’ and comments haec videtur esse quaedam @ποσπαισμο6 species ‘this seems to be a sort of hypospathismos’; this reference to a type of eye operation common in late antiquity was overlooked by later commentators.52 τ" )ναμ"ω φαρμ(κ"ω ‘with a drug to stop bleeding’: LSJ ‘for staunch-

ing blood’; Sichel ‘qu’on met sur les plaies récentes’ perhaps echoing Foesius, medicamento quod cruentis vulneribus imponitur;53 Joly, ‘qui l’arrête’. The definite article suggests one particular drug and perhaps this is intended, there being one par excellence (cypress favoured in the same operation, Morb. 2. 13; but fine salt followed by compress, 18 [7.24, 32 L.]). Ermerins deletes the article, adding instead τινι. If we follow this reasoning, τ" understood as contracted τινι might be kept, with change only in word order (cf. τινι τν @γρν φαρμ(κων above, 4.1; also μετ( γε το6 ξηρο6 read by Cornarius below, 9.3). The blood is apparently staunched as soon as the wound is made; similarly cutting and immediate healing is the treatment for the ‘stricken’ in the laconic instructions of Diseases 2 (σχσαι ατο6 τC βργμα κα )π=ν πορρυ+ τC αJμα συνες τ/ χελεα ,Vσαι κα καταδ σαι ‘cut into the bregma and when the blood flows bring the edges together and bind them up’, Morb. 2. 25 [7.40 L.]; cf. Morb. 3. 3 [7.122 L.]). The vasculature of the scalp is such that bleeding from even shallow wounds is profuse, the blood vessels tending to remain open when cut, especially in the arteries, which anastomose freely with one another. τ=ν κεφαλ=ν κα ραι ‘purge the head’: the reason for this is to stop

further noxious matter descending from head to eyes, and to allow noxious matter in the eyes to descend to and be eliminated from the nose. Calvus, translating omnium ultimum negotium est, ‘last of all it is appropriate’, regards π(ντων as neuter (of treatments), rather than masculine (of patients). 52 53

Foesius I 688, 736, n. 11. Foesius I 689.

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V Corrective cutting and cautery are applied to the eyelid, when it is ‘thicker’ than is natural. Editors’ attempts to identify this condition conflict. Foesius comments huic vitium simile πτ λωσις medicis dicitur, ‘a trouble similar to this is called ptilosis by doctors’. Sichel believes that this chapter too relates to trachoma, ‘surtout aux granulations trèsvolumineuses, fongiformes ou sarcomateuses’; if this is correct, the topic may be loosely connected with the idea of excess tissue forming in the healing process, 4.2. Ermerins remains agnostic: de palpebris iusto crassioribus; sed quo vitio crassae factae sint, non constat, ‘on lids which are quite thick; but it is not clear by what trouble they are made so’. Joly takes the condition to be ‘une conjonctivite printanière bien décrite’ and understands the operation to be on the lower lid not, as in 4, to the upper lid.54 Indeed, the author’s vague description militates against precise identification. But perhaps pterygion (a fibro-vascular membrane arising at the inner corner of the lower lid, sometimes growing over the cornea and impeding vision) has more claim to consideration than Foesius’ ptilosis (a disease of the lids where the edges are swollen and inflamed and the lashes fall off) as the former is a Hippocratic term and the latter is not. (But admittedly there is a paucity of Hippocratic, though a multitude of Galenic, parallels.) The condition pterygion is briefly mentioned in Prorrhetic 2 (Prorrh. 2. 20 [9.48 L.]). Reference in Diseases 2 to a condition where the eyelids seem to overhang, or be pendulous, and where the vision is blurred is probably unrelated (Morb. 2. 19 [7.32 L.]; cf. also Int. 4 [7.178 L.]). Celsus accurately describes the formation of a pterygion, Lat. unguis, and recommends that it be cut out if it has become established and crassitudo ‘thickness’ has developed through time (7. 7. 4). Galenic sources (many of doubtful attribution, but it is the date which is relevant here) give a very long list of eye troubles, classified according to location: affections inside the lids include ‘roughness’ and ‘thickness’, affections outside the lids include ‘pustules’ and affections at the inner corners of the lids include pterygion; there is also a trouble where the lids seem ‘rather swollen and constantly stream’ (introductio seu medicus, 14. 767 K, 771 K.; on pterygion cf. also de remediis parabilibus, 14. 410 K.; de tumoribus

54

Foesius I 736, n. 12; Sichel 143; Ermerins XL; Joly 173.

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praeter naturam, 7. 732 K.; on ptilosis cf. de methodo medendi 10. 1004 K.) In addition to pterygion many types of palpebro-conjunctival cysts or lesions might be said to cause ‘thickness’ in the lid. Common conditions of this type include conjunctival papilloma (typically lower lid), where there is a tumour or an overgrowth of skin along the lid margin—such growths are not harmful, but are usually removed for cosmetic reasons by simple excision, not extending deeply into the tissues; and chalazion (typically upper lid), which is a chronic inflammatory granuloma caused primarily by the retention of secretion from a tarsal gland—the regular treatment is incision and curettage.55 The expression is inelegant and the connection jerky. The initial words, with asyndeton, indicate the problem to be treated; a second phrase in loose apposition indicates the treatment, expressed in two phases by nominatives with infinitives in instructions. Finally, an adverbial clause is followed by general instruction for ongoing therapy. Once again, nominative participles with jussive infinitives are employed to express instructions, ποταμ<ν … )πικα6σαι … φυλασσμενος … προστε7λαι.

1. παχ#τερα τ ς φ#σιος ‘thicker than is natural’: the term φ#σις ‘nature’, ubiquitous in Hippocratic medicine, is used in two distinct ways in this short section: first of the nature appropriate to a bodily part (the eyelid, its size) and second of the intrinsic character of a bodily part (the eyelashes, their position or perhaps their delicacy). Sichel’s interpretation of the second φ#σις in a concrete sense recalling the root φ#ω ‘grow’, intending the point where the lashes grow or have their roots, tr. ‘l’implantation des cils’, is here followed;56 but a reference to the delicacy of the eyelashes, in the sense that they are easily scorched, would be appropriate also. The term βλφαρις ‘eyelash’ (Ar., Arist., X.) is unnecessary as in context ‘hair’ is clear. τC κ(τω ποταμ<ν τ=ν σ(ρκα 'κσην εμαρστατα δ#ν+η ‘cut away

the flesh below (lit. as to the area below) as much as you can, very gently’. This is yet another instance of odd, compressed expression and emendation is unnecessary. The location κ(τω ‘below’ is ambiguous: 55 See Duke-Elder V 1952, 4976–4981, 5031–5033; Bedford, 1971, 166–167, figs 118– 120; Trobe and Hackel, 2002, 9, 98; Spalton et al., 2005, 48 with fig. 2. 36, 49 with fig. 2. 39, 51 with fig. 2. 45, 106 with fig. 4. 44. 56 Cf. already Foesius I 736, n. 13.

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reference might be to the lower lid, or to the lower part of the upper lid, or simply to the area below the growth. Caution is constantly enjoined: the doctor must work ‘very gently’, with instruments which are not too hot (clearly here metal; perhaps a reason not to link this chapter with the preceding one on trachoma, treated by wooden instruments) and ‘taking care’ (see on 2 above for avoidance of ‘white-hot’ instruments, and for ‘considering’). )πικα6σαι ‘cauterise over’: the compound expresses a precise operation. The variation between )πικαω ‘cauterise over’, παρακαω ‘cauterise by’ (3.3), διακαω ‘cauterise through’ (3.3, four times repeated; 4.1) and the simple verb καω (1.1; 3.1, three times repeated) is not for stylistic effect

but has important semantic weight. Similarly, in Head Wounds there is significant variation in the verbs used of trephination: πρειν ‘trephine’ used without regard to depth, διαπρειν ‘trephine through’ used to indicate complete perforation of the bone to the dura and )κπρειν ‘trephine out’ (commonly with φαιρε7ν ‘take away’) used to indicate ‘trephine and remove’.57 τ" 1νει πτ" λεπτ" προστε7λαι ‘apply heated very fine flower (of copper)’: the adjective λεπτς (5 and 6) may refer to quality (‘fine’) or

quantity (‘slight’); here surely the former, in the sense ‘finely ground’.58 The verb προστλλω is used seven times in the HC but the only parallel for the sense ‘apply’ is in Sores ()λατριον λεπτCν προστε7λαι, Ulc. 14 [6.418 L.]). ,ητρε#ειν τ/ λοιπ( ‘give the further treatment’: i.e. ‘continue the usual

treatment’. Foesius, following Cornarius, keeps this text, but translates as if reading [;ς] τ/ λοιπ( sc. Dλκεα, ‘treat like other lesions’.59 The verb ,ητρε#ω is especially favoured in the surgical works Articulations, Fractures and Head Wounds though not confined to these (cf. τ/ λοιπ/ ,ητρε#ειν τC Dλκος, VC 14 [3.242 L.]). Similar expressions are: , σαι ;ς κα τ/ λοιπ(, Int. 24 [7.228 L.]; τ/ λοιπ/ εωρε7ν, Coac. 3. 483 [5.692 L.]; τ/ λοιπ/ εραπε#ειν, Mul. 2. 110 [8.238 L.].

57 58 59

Cf. Hanson 1999, 117. See Petrequin II 1888, 180, n. 3 on Fract. 26 [3.502 L.]. Foesius I 689, 736, n. 13.

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Instructions are given on the preparation of a salve for irritation of the eyelid. Sichel sums up the condition as ‘ophthalmie catarrhale avec érosion’, having introduced it more elaborately as ‘conjonctivite … fréquente, due aux vicissitudes de la température atmosphérique … qui est accompagnée de démangeaisons, d’érosion des angles, etc. …’ Ermerins succinctly notes palpebrarum psoriasis et pruritus memorantur, ‘rash and irritation of the lids are discussed’ and Joly simply states ‘blépharite’.60 The interrelation of terminology for various forms of eye irritation can be clearly seen in the pseudo-Galenic definition of ξηροφαλμα, lit. ‘dry ophthalmia’ as a condition where the inner corners of the eye are rough and inflamed with red lids, acrid tears, ulcration, roughness and, related to the term used here, are κνησμ5δεις ‘showing irritation’ (introductio seu medicus, 14. 769 K.) Blepharitis, an extremely common disease, is now viewed as taking two main forms: simple squamous (scaly) blepharitis and more complex purulent follicular blepharitis.61 The ingredients and preparation of the recipe for this salve have certain correspondences with those for eye-pastes detailed in Acute Diseases and in Diseases of Women 1 (grape juice, ‘burnt copper’, grindstone and phrase λε7ον τρψας, all in Acut. Sp. 65–66 [5.520 L.]; grape juice in Mul. 1. 102–105 [8.224, 226, 228 L.]; cf., for lesions of the head, grape juice, flower of copper, and use of red copper vessel, in Ulc. 12, cf. 17 [6.412, 420 L.]); but there are some features peculiar to On Sight, especially in vocabulary: the term β5λιον ‘little lump’ is a Hippocratic hapax legomenon, as is φολς ‘scale’. The extreme compression typical of On Sight renders the sense obscure; but parallels permit the amplification essential for comprehension. (See translation.) There is copious evidence, especially from Roman antiquity, of a huge demand for eyesalves and an extensive industry in their manufacture, marketing and distribution. Celsus lists at length the recipes of many different doctors. The section is carelessly written, with careless overuse of the verb τρβειν, used alike of preparation of ingredients and application to the patient: τρψας … ποτρψας … τρβειν … τρψας … νατρβειν … τρψας. Various steps in the preparation are distinguished by use of introductory &πειτα ‘then’, ‘next’ (cf. 3.1 above). Nominative participles Sichel 159, 148; Ermerins XL; Joly 170. Duke-Elder V 1952, 4949–4968; Bedford, 1971, 42, figs 26 and 26a; Trobe and Hackel, 2002, 3–4, 59–60; Spalton et al., 2005, 107. 60 61

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and jussive infinitives are again prevalent, varied by the jussive subjunctive παραχας ‘you must pour’. 'πταν ‘whenever’, introducing the section, is used only here in On Sight; perhaps the conjunction indicates the common incidence of blepharitis and the frequency with which the physician would prescribe this treatment. 'πταν δ* βλφαρα ψωριYV κα ξυσμCς &χ+η ‘whenever the eyelids are itchy and there is an irritation’: elsewhere, the verb ψωριVν is used of

bladder discomfort (Aph. 4. 77 [4.530 L.]; Nat. Hom. 14 [6.66 L.]) and the substantive ξυσμς is used of lung conditions (Loc. Hom. 14.8 [6.306 L.]; Morb. 2. 58.1 [7.90 L.]). The synonymous κνησμς seen in I and mss derived from I may be an old variant. κνησμς is more common in the HC (twenty occurrences against eight of ξυσμς and one of ξυσμ) and is used in Prorrhetic 2, seen here to have many resonances with On Sight, of irritation in the forehead associated with dim vision and redness in the eyes (Prorrh. 2. 30 [9.60 L.]). However, the occurrence of ξυσμς or ξυσμ in works which have other affinities in vocabulary with On Sight (Morb. 2, Loc. Hom., gynaecological treatises) is in its favour. Also, ξυσμς is difficilior being glossed by the more common κνησμς by Erotian (Ξ 2, from Epidemics 5), Galen (linguarum Hippocratis explicatio, 19. 125 K.; cf. 112 K.) and Hesychios (Latte II 730, 92).62 1νεος χαλκο6 β5λιον πρCς κνην τρψας lit. ‘having rubbed a piece

of flower of copper on a grindstone’: the only other occurrence of κνη ‘grindstone’ in the HC is in recipes for ‘watery’ eyes in the two passages of Acute Diseases noted above—σποδCς ‘ash’ ground with fat and μφ(κιον πικρ ς μφακος ‘sour grape juice’; χαλκCς κεκαυμνος ‘burnt copper’ mixed with saffron and sweet wine (Acut. Sp. 65 and 66 [= 32, 33, 2.520 L.]). &πειτα τC βλφαρον ποτρψας ατο6 lit. ‘then having rubbed his eyelid’: this phrase should be deleted, as instructions for use of the paste ought not to precede instructions for mixing it; also the reference of ατο6 (? the patient) is unclear. Ermerins, who regards the passage as hopelessly corrupt, suggests (but does not print) emendation of the verb to )πιστρψας ‘having turned over’ and deletion of ατο6 κα ττε.

62

See Jouanna 1983, 110, 102; Craik 1998, 149.

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κα ττε τ=ν φολδα το6 χαλκο6 τρβειν ;ς λεπτοτ(την ‘and at that time rub the flakes of copper as fine as possible’: the word for ‘flakes’ is hapax in the HC. Foesius in Oeconomia, in an aside s.v. φολλιδ5δης from Epidemics, relates Erotian Φ 13 φλιδα χαλκο6E τ=ν λεπδα to this passage.63 The accusative case and the placing of the gloss in Erotian provide strong support for this judgment, which has gone unnoticed by later commentators, including Nachmanson who is unjustifiably sceptical that φλιδα relates to On Sight on the grounds that the work is not cited by Erotian: this is circular argument and general lack of citations can be readily explained by the shortness of the work. Duminil on Ulc. 13. 1 [6.416 L.] with no justification but citing Erotian reads φολδα for codd. λεπδα.64 Galen glosses λεπτ(E ο4τως )νοτε καλε7 τ/ ραι( (linguarum Hippocratis explicatio, 19. 118 K.); that Galen cites usage in Places in Man shows another instance of convergence in vocabulary. &πειτα χυλCν μφακος διηημνον παραχας κα τρψας λε7ον ‘then you

must pour alongside (the flakes) the strained juice of unripe grapes, and rub smooth’: that is, make a well in the dry ingredients and pour in the liquid ones. The adjective ‘smooth’, twice repeated, is proleptic. The phrase is formulaic in such instructions, seen especially in the gynaecological and surgical treatises (Ulc., Fist., Haem.) and in Internal Affections. The same form of the verb (χω ‘pour’, aorist &χεα) can be seen in Affections, in a recipe for an emetic mixing melicrat with vinegar, and the same expression δCς πιε7ν, ‘administer to drink’, occurs in both works (Aff. 15 [6.224 L.], Vid. Ac. 7). In a salve mentioned by Aristophanes, garlic, fig-juice and spurge are key ingredients (Ar. Pl. 665). Grape-juice, a mild astringent, is a standard ingredient in recipes for eye salves. That Galen cites it as a Hippocratic specific for the eyes may indicate familiarity with On Sight (de methodo medendi, 10. 940 K., de compositione medicamentorum secundum locos, 12. 702 K.; cf. commentary on Acut., 15. 916 K.) Dioskorides describes the process of pressing unripe grapes to extract the juice in early summer, then leaving it in the sun to evaporate; he regards it as a good treatment for rough eyelids. Acetic acid was a common ingredient in collyria, frequently mixed with copper compounds, then filtered and evaporated to form crystals.65 63 See also Foesius I 736, n. 15 on aeris squamam ‘scale of copper’, as of a fish or a serpent, used to treat ulceration of the lids. 64 Nachmanson 1917, 360; Duminil, 1998, 63; see also 43. 65 See Nielson, 1974, 26–28, 50.

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τC δ* λοιπCν )ν χαλκ" )ρυρ" παραχων ‘then pour the rest (of the

grape pulp) alongside (the other ingredients) into (a vessel of) red copper’: red copper is frequently specified as the appropriate material for mixing such salves, the intent being to enhance the copper content of the mixture; there is an extended set of instructions in Galen and the further injunction that the prepared mixture should be stored in a copper box (de compositione medicamentorum secundum locos, 12. 709–711, 738). μυσσωτς ‘myssotos’: a savoury dish based on garlic or onion (Galen linguarum Hippocratis explicatio, 19. 124 K.; Loc. Hom. 47. 5 [6.346 L.]; Epid. 2. 6. 28 [5.138 L.]); on its consistency cf. Ulc. 12, 17 [6.412, 420 L.]. )πειδ/ν ξηραν+ ‘when it has dried’: that the procedure, here telescoped, would take several days is indicated in parallel passages.

VII The treatment of ‘night blindness’, an anomaly of vision marked by impairment of dark adaptation, is outlined. Night blindness takes two main forms, distinguished in a modern account which could almost be a translation of Galen’s formulation (introductio sive medicus, 14. 776 K.; cf. linguarum Hippocratis explicatio, 19. 124 K.), as day-blindness, where ‘the patient sees poorly in good illuminations and normally in the dusk’ and night-blindness, where ‘vision in moderate illumination is good, but in feeble illumination it is deficient’.66 The converse formulation, followed by Sichel—nyctalopie as ‘cécité de jour, vision de nuit’ and héméralopie as ‘cécité de nuit, vision de jour’—is confusingly current also.67 Night blindness is not a substantive disease, but a symptom associated with deficiency of vitamin A (sometimes called ‘the ophthalmic vitamin’), which is present in animal fats such as milk, butter and eggs; and, above all, in liver. Night blindness can occur both in individuals suffering from any condition which depletes blood vitamins, especially such febrile conditions as pneumonia, pulmonary tuberculosis or malaria; and also in communities affected by famine or severe malnutrition. In ancient medicine, symptoms such as night blindness and even fever were frequently regarded and treated as diseases in their own 66 67

Duke-Elder I 1932, 973; see also II 1938, 1423 and Jayle et al., 1959. See Sichel 149.

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right. There was, however, much awareness of, and interest in, the ways in which different ‘diseases’ might interact, developing or mutating into something apparently different, and the Hippocratic doctors were fully aware of the typical associative context of night blindness, recognizing the ways in which it tended to accompany other illnesses; also, more generally, the ways in which the eye might be affected by complications in other apparently unrelated diseases.68 The text of this short chapter is compressed, or, rather, truncated and corrupt. There are two main problems, relating to two aspects of the prescribed treatment, which is expressed in a series of superlatives: first (surgical), two things are done to the patient’s neck ‘as much as possible’ and ‘for a very long time’, but M’s κατ(ξας ‘having broken’ is nonsense and πισας ‘having pressed’ is unclear; second (dietary), the patient is to eat a lot of raw liver with honey, but this injunction is both intrinsically improbable and quite unparalleled, and further the expression is unclear. Sichel keeps κατ(ξας but describes the verb as obscure and probably corrupt; he takes it in the sense of ‘l’appui des ventouses scarifiées’. Ermerins reads κατασχ(σας ‘having cut’ but leaves the entire section untranslated, dismissing it as locus male scriptus ‘a badly transcribed passage’ and more severely totus locus pessime se habet ‘the whole passage is in a dreadful condition’; in the introduction he commits himself only to the curt nyctalopis curatio describitur ‘a treatment for night-blindness is described’. Joly marks the verb with daggers of corruption, and attempts no translation.69 The second problem has attracted considerable scholarly interest. The loosely appended expression ‘one or two’ is unclear, as is the reference of μγιστον ‘very big’. Debate has centred on whether one or two huge ox livers are to be eaten (so Joly, ‘il faut faire avaler, crus et trempés dans du miel, un ou deux foies de boeuf, aussi gros que possible’), whether one huge ox liver is to be eaten one or two times (so Sichel, ‘il faut faire manger, une ou deux fois, un foie de boeuf cru aussi gros que possible, trempé dans du miel’), or in one or two portions (so Ermerins, who suggests the insertion of μρος ‘portion’).70 The difficulties may be resolved by comparison with content in other treatises (especially Diseases 2, Prorrhetic 2 and Epidemics 6; but also Diseases 3, Epidemics 2, Koan Prognoses, Prognostic and Places in Man). In particular, from the association of night blindness with the disease 68 69 70

See Grmek, 1980, 221. Sichel 150; Ermerins XL; Joly 171. See also Bier, 1928 and Gourevitch, 1980.

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known as κυν(γγχη ‘the choker’ it is possible to put the treatment here prescribed in a wider context. (This disease is commonly likened to diphtheria and frequently translated ‘angina’ or ‘quinsy’ but as its main distinguishing symptom—and distinctive etymological derivation, lit. ‘dog-strangling’—is a sensation of choking, it is here designated simply ‘the choker’.)71 We can emend and expand the text to give a sense in accord with parallel treatments of night blindness and associated conditions in the HC and other sources. However, while the text may be satisfactorily explicated in this way, and it is clear that something has been lost, restoration is offered for example only. It does, however, seem certain that a reference to garlic has dropped out. The two aspects of the therapy prescribed are: first, cupping (as Sichel perceived, on the basis of medical probability, but without emendation or argument); and second, a dietary régime of (raw) garlic and (cooked) liver. The condition of night vision is discussed in Prorrhetic 2 (Prorrh. 2. 33 and 34 [9.64, 66 L.]) from a theoretical standpoint: it tends to affect boys and young men, who sometimes recover spontaneously in seven months time; elimination of noxious matter, especially downwards, is beneficial; patients with this disease or a flux of tears of long duration should be asked if they suffered headache before these concretions. As in On Sight, it is explicitly stated that purging is useful in therapy, and implicitly supposed that bodily fixation is significant in aetiology. A more pragmatic approach to the condition is found in Epidemics 6 (Epid. 6. 7.1 [5.332 L.]): night blindness is associated in a particular year with painful ‘ophthalmias’ and with other symptoms or ailments, above all, with coughs, pneumonia and ‘chokers’.72 The doctor of Epidemics 6 found the array of symptoms intractable. Treatments essayed, without great success, included laxatives, emetics and phlebotomy, including surgery on the tongue. Among the patients some endured great pain, especially those who suffered from swollen vessels in the temples and the neck. Night blindness is associated with a similar range of unpleasant symptoms in a shorter account in Epidemics 4 (Epid. 4. 52 [5.192 L.]): ears and mouth are affected (toothache and mouth ulcers); there is cough, fever and digestive disorders. The association between eye trouble and ‘the choker’ appears also in Epidemics 2 (Epid. 2. 6. 12 [5.134 L.]), in the brief instructions ‘carry out phlebotomy for the chok71 72

1980.

See Grmek, 1989, 337–338; cf. Craik, 1998, 185–186. Littré used the phrase ‘le toux de Périnthe’ for the pathology; see also Grmek,

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ing disease and for opthalmia’. Also, there is a full clinical description of symptoms apparent in ‘the choker’: the focus here is on appearance of, and sensations in, neck, throat and jaws (Epid. 2. 2. 24 [5.94, 96 L.]). There are many other references to the same disease, or rather, perceived group of diseases. In Koan Prognoses (Coac. 2. 357–372 [5.660, 662 L.]), many bad or mortal signs are specified in the group of diseases designated τ/ κυναγχικ( ‘the choker types’: much attention is paid to observation of throat (internal) and neck (external) and when the disease ‘turns to’ the lung, sufferers either die in seven days or become purulent; in Prognostic (Prog. 23 [2.174 L.]) ulceration of the throat is a similarly bad sign. Bleeding from the neck is there regarded as the safest and best course but it is recognized that there are dangers in the treatment as well as in the condition itself. Writing on throat ulceration, the author refers to the risks attendant in cutting the uvula; the verbs used are ποτ(μνεσαι and ποσχ(ζεσαι (discussed further below). In Affections also (Aff. 4 [6.212 L.]), the verb σχ(ζειν is used of the same operation: if the swelling of the uvula does not go down, the treatment is πισεν ξυρσαντα τ=ν κεφαλν, σικ#ας προσβ(λλειν δ#ο, κα το6 αGματος φαιρειν ;ς πλε7στον, κα νασπ(σαι πσω τC Qε6μα το6 φλγματος, ‘after shaving the back of the head, apply two cupping

vessels, draw off as much blood as possible and draw backwards the flow of phlegm’; then, if there is still no amelioration, the knife is applied, σχ(σαντα μαχαιρ"ω … σχ(ζειν. ‘having cut with a knife … cut’. In Diseases 3 (Morb. 3. 10 [7.128, 130 L.]) discussion of ‘the choker’ leads to treatment of παρακυν(γχη, ‘a variant on the choker’: for this, phlebotomy of vessels in the chest, bleeding from the arms (if the patient is strong enough), incision of the vessels under the tongue and purging with elaterion are all prescribed; this meshes with material following on treatment of ‘the choker’ in Diseases 2. Similarly, in Regimen in Acute Diseases (Acut. Sp. 9–10 [= 6, 2.412 L.]) therapy of two forms of ‘the choker’ is by phlebotomy of vessels in the arms and under the tongue. Purgation by elaterion and bleeding from the arm are both prescribed also in Places in Man (Loc. Hom. 30 [6.322 L.]). In Diseases 2, several kinds of ‘choker’ are discussed and differentiated. These passages provide illumination of the treatment adumbrated in our treatise. In the first brief mention of ‘the choker’ in Diseases 2 (Morb. 2. 9 [7.16 L.]), only one type is noted. Its locus is in the jaws and the area of the neck, sometimes also under the tongue or somewhat above the chest. In the ensuing section, the author proceeds to

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discuss the clearly related disease σταφυλ ‘the grape’, where surgery on the swollen uvula is imperative.73 In the second part of Diseases 2, three different types of ‘the choker’ are discussed at some length and followed by a discussion of ‘the grape’. In these three instances of ‘the choker’, the differences lie in symptoms, development and, accordingly, therapy indicated, also to some extent in the supposed aetiology and site of the trouble. The treatment in the first type (Morb. 2. 26.2 [7.40 L.]) is to apply a cupping vessel to the first cervical vertebra, then after shaving the hair beside the ears, to apply cupping there, and once pressure is established, to leave the cupping vessel in place for as long a time as possible (πρCς τCν σφνδυλον τCν )ν τ" τραχλ"ω τCν πρτον … παραξυρσας … κα )π=ν ποσφγξ+η τ=ν σικ#ην )Vν προσκε7σαι ;ς πλε7στον χρνον).74 Extensive follow-up treatment includes purging by suppositories or enema. The treatment in the second type (Morb. 2. 27 [7.42 L.]) is to apply a cupping vessel as in the first, then to apply a sponge soaked in hot water to neck and jaws; again, there are extensive further recommendations in which a new element is the prescription, where empyema is developing, of a bedtime snack of raw garlic, as many cloves as possible (σκροδα :μ/ τρωγτω ;ς πλε7στα) accompanied by neat strong wine. In both cases, fumigation too is practised. The third type (Morb. 2. 28 [7.46 L.]) differs from the others: it is less serious; treatment is by dietary manipulation and application of poultices. Also, the ‘back of the tongue’ is affected.75 In this respect, it seems to serve as a transition to ‘the grape’, the subject of the ensuing section (Morb. 2. 29 [7.46 L.]); there too the jaws are swollen but the main problem lies in the uvula, which must be pressed against the palate and its extremity cut (ποπισας διαταμε7ν 1κρον). From these parallels in the treatment of ‘the choker’, which in incidence is associated with night blindness in Epidemics 6, it is evident that the procedures so peremptorily indicated in our text are application of cupping and consumption of raw garlic. Blood-letting (phlebotomy or venesection) was a favoured Hippocratic recourse in many diseases; but—in part because it was so familiar, in part because it was a technique learned by observation rather than by reading—few descriptions of it survive. Celsus exceptionally gives a description, stressing 73 74 75

See Jouanna, 1983, 222–223, n. 6; 140, n. 8. On the text, see Jouanna, 1983, 232–233, n. 1. See Jouanna, 1983, 235, n. 7.

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its importance in diseases which, like ‘the choker’, constrict the throat (2. 10. 1–17). The use of honey-coated garlic—presumably the honey intended to make the garlic more palatable, or easier to swallow, like a sugar-coated pill—is repeated in a prescription to purge a strong patient overcome by fever brought on by fatigue or by a journey in the section on fevers in Diseases 2: σκροδα δο6ναι )ς μλι β(πτων (Morb. 2. 43.3 [7.60 L.]). In a long series of cleaning-out prescriptions found in Internal Affections, all vegetables save garlic are proscribed; of garlic the patient is to eat as many (but it is not clear whether the plural indicates cloves or heads) as possible, raw, baked or boiled: … ;ς πλε7στα τρωγτω κα :μ/ κα πτ/ κα Hφ( (Int. 21 [7.220 L.]). Garlic, especially when eaten raw, was widely regarded as having laxative and diuretic properties (Aff. 54[6.264 L.], Vict. 2. 54 [6.556 L.]; on honey cf. Aff. 58 [6.266 L.]). One element remains to be explained: the presence of (?raw) ox liver. I can discover no case of a patient being made to eat raw liver, with or without honey. It is not used even in poultices or pessaries, though various unlikely and unappealing animal applications are specified, especially in the gynaecological works. Thus, bull bile is common (see Mul. 1. 75 [= 84, 8.168, 206 L.], Nat. Mul. 32 [7.362 L.]) and in one place we find the specification of dry bull bile with fine honey (Ulc. 12, 13 [6.414 L.]). Other parts used are ‘ox marrow’ with almonds and flour boiled in water to form a paste for use as an ointment (Nat. Mul. 100 [7.416 L.]; cf. Mul. 1. 34 [8.82 L.], and perhaps 90 [8.214 L.] ‘ox flesh’, an ingredient in a pessary). In another passage, a pessary as emmenagogue includes pig and ox bile mixed with honey (Mul. 1. 74 [8.156 L.]). The poultices prescribed for ‘the choker’ were of a less unpleasant type: flour boiled with wine and olive oil (Morb. 2. 28.3 [7.46 L.]) or a mixture including elaterion and honey (Mul. 1. 97 [8.224 L.], close in context to recipes for eye ointments at 102 and 105 [8.224, 228 L.]). Emendation such as δδοναι )ν μλιτι β(πτων Tπαρ βοCς :μCν καταπλ(σσειν (or καταπλ(σμα) μγιστον ;ς 9ν δ#νηται Zν F δ#ο μρας ‘prescribe as a poultice raw ox liver, dipping it in honey, as big as possible, for one or two days’ might be considered; but it is unlikely that poultices are relevant here. The regular treatment for night blindness, authenticated in a wide range of later sources—Herophilos, Celsus, Paul of Aigina, Aretaeus, Galen and Pliny—was to give a meal of liver, while using the cooking steam or juices as an eye-lotion (gravy from roasting, de compositione medicamentorum secundum locos, Gal. 12. 802 K; wine used in boiling, Plin.

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NH 28. 47).76 Frequently, goat’s liver is specified, perhaps because the goat was supposed to have good night vision (billy-goat to be preferred, Celsus 6. 6. 38). While there may be an element of sympathetic magic in the prescription, there is also a sound nutritional basis, which could not have been understood but which could have been appreciated through years of empirical observation and pragmatic prescription. Night-blindness is caused by a deficiency of vitamin A, and liver is a rich source of that vitamin (hence the cod liver oil, once forced into children). Liver is occasionally prescribed in the HC for other conditions: in Diseases of Women foods prescribed to correct a ‘red flux’ include ox or goat liver cooked in the ashes (Mul. 2. 110 [8.236 L.]). A prescription to control a flux of menstrual blood and one to control a putative flux of some other kind of blood might be thought parallel. The association here traced between ‘the choker’ and night-blindness in the Hippocratic Corpus continued in later medical writers: Aretaeus describes two forms and two methods of treatment of ‘the choker’. As in On Sight, cupping and purging feature. Treatment is drastic: to cut the vessel in the elbow and to make the incision quite large (τ(μνειν … μζονα δ* τ=ν τομ=ν σχ(ζειν) so that the blood flows freely—and he admits that some patients have died under the knife— or incise similarly in the leg or elsewhere in the arm; then to administer elaterion, said to be the drug of choice, to purge the patient (CA 7). There is a slight awkwardness in that the subject of the first sentence, with its two jussive clauses (a construction used only here in the work) is the patient, while the subject of the second sentence, with three nominative participles followed by an imperatival infinitive (with another participle β(πτων ‘dipping’ loosely attached and a further explanatory infinitive καταπιε7ν ‘to swallow’ dependent on it), is the doctor; but the sense is clear and the jerky Greek is characteristic of the work. νυκτ(λωπος ‘(treatment for) night blindness’: the etymology of the word, lit. ‘blind in vision at night’ involves a tautology. The punctuation, which varies wildly in later mss, is managed differently by different editors. Sichel reads νυκτ(λωπος φ(ρμακονE ‘a drug for the sufferer from night blindness’. Ermerins objects, as not just drugs but all medendi methodus ‘method of treatment’ is involved; he argues that some such word as ,ητρεη ‘treatment’ must be understood after the initial genitive. 76 For a review of the evidence, see already Foesius I 736; also von Staden, 1989, 423–426; Gourevitch, 1980, 178–182.

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Foesius, followed as frequently by Van der Linden, suggests emendation to the nominative, to create a sentence, νυκτ(λωψ φ(ρμακον πιντω )λατριον.77 φ(ρμακον … )λατριον ‘drug elaterion’: the term (lit. ‘driver’) is used

generally of any drug with laxative properties; also specifically of one such drug, based on an extract of wild cucumber (Galen linguarum Hippocratis explicatio, 19. 97 K.)78 The writer, usually concerned with surgery and not with internal treatment, only here recommends purging of the body (sc. by use of laxatives); purging of the head (sc. by nasal insertions) is prescribed also 1.2 and 4.1. But, as noted above, purging is a regular element in treatment recommended for ‘the choker’. Ermerins regards the stress on treatment rather than prognosis as a suspicious aspect of the section. τ=ν κεφαλ=ν κααιρσω lit. ‘let him be purged as to his head’: the

patient is the subject of the verb which may be passive (as translated: doctor is agent) or middle (translate ‘purge his head for himself ’: patient is agent). κατασχ(σας lit. ‘having cut’: M’s reading κατ(ξας ‘having broken’ (a verb usually applied to fractures of bones) gives unacceptable sense. It has been suggested that the aorist is not from κατ(γνυμι ‘break’ but from κατ(γω ‘draw down’ (sc. the head, so that the patient could drink juices from liver);79 however aor. 1 κατ ξα is implausibly rare for the regular κατγαγον and no 1γειν verb takes that form in the HC. The reading κατασχ(σας has some authority, being known to Foesius, who however retains M’s reading, tr. pertundito ‘strike hard’.80 That it is correct is evident once the context (cutting the skin in preparation for the application of cupping vessels in the process of wet cupping) is understood. The simple verb σχ(ζειν is used for incision with a scalpel in Affections (the head, Aff. 2; the uvula, Aff. 4 [6.210 L.]), Internal Affections (vessels in the groin, Int. 21; the elbows, Int. 37 [7.220, 258 L.]) and in the surgical treatise Sores (aor. part. pass. ‘the part incised’, Ulc. 24 [6.428 L.]). The simple verb σχζειν ‘lance’ is similarly used (Morb. 2.

77 78 79 80

Ermerins 282; Foesius I 736, n. 16. Cf. Craik, 1998, 172. Montfort, 2003, 44. Foesius I 736, n. 17.

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18, 25, 36 [7.32, 40, 52 L.]), as is the compound ποσχ(ζειν (vessel in the arm, Morb.1. 28 [6.196 L.]; uvula, Prog. 23 [2.178 L.]). While there is no Hippocratic parallel for κατασχ(ζειν, the formation is similar to κατατμνειν (twelve occurrences, including Ulc. 22 [6.426 L.] and Morb. 2. 13, 15, 27 [7.24, 28, 44 L.]). The prefix κατα- is apt for the surgeon’s hand bearing down on his patient; similar formations are κατακρο#ειν (cut or lance swellings, varices etc., Ulc. 24, 25 [6.428, 430 L.]; break the skin, avoided where dry-cupping is to be practised, Loc. Hom. 12.1 and 22 [6.298, 314 L.]), and κατασπVν (draw off blood, Loc. Hom. 30 [6.322 L.]).81 ;ς μ(λιστα ‘as much … as possible’: the phrase is common in prescrip-

tions or instructions for preparation (cf. VC 13 [3.228 L.], Loc. Hom. 27 [6.318 L.]).

πισας … )πανιες ‘exert pressure … release’: the pedestrian verb πιζειν ‘press’ corresponds to the colourful ποσφγγειν ‘squeeze tight’, ‘com-

press’ in one of the parallel passages of Diseases 2 (Morb. 2. 26 [7.40 L.]). The corollary process, letting go, is expressed with the same verb )πανημι in Fractures, with reference to releasing the pressure of splints (Fract. 21 [3.486 L.]). Cornarius ingeniously but erroneously expands πισας to λιμ" πισας, supposing that the reference is to a regimen of light or fasting diet.82 καταπιε7ν ‘to swallow’: the compound is rare, but occurs also in Diseases

of Women 1 and 2.

VIII Trephining, or trephination, trepanation, is recommended for a case of blindness not attributable, from the diagnostician’s point of view, to any discernible problem in the eyes. Sichel, perhaps following Foesius’ designation (hoc vitium oculi μαρωσις Graecis dicitur cum oculis bene habentibus videndi acies laborat, ‘this eye trouble, when, though the eyes are sound the vision is affected, is called amaurosis by the Greeks’) summarises 81

See Iugler, 1792, 44 and 73 for ingenious suggestions: καταμ#σσω, καταξ#ω, κατα-

ξανω. 82

See rebuttal, Foesius I 736, n. 17.

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‘amaurose traitée par la trépanation’; Ermerins makes no judgement on the nature of the disease: quis morbus sit, de quo agit, nescio, ‘I do not know what is the disease concerned’; Joly, perhaps quoting Hérode, his adviser on specialist ophthalmic matters, comments ‘utile dans les cas de processus expansif intracranien, cette intervention énergique serait néfaste dans les autres’.83 It remains peculiarly difficult to diagnose and treat the cause of deteriorating eyesight, there being many causes— some hereditary, some age-related—for loss of vision in an eye which remains normal in appearance. Our doctor’s first assumption is ocular flux: from the instruction, to trephine and remove ‘moisture’, it is evident that the supposed cause is a flux of moisture from the head, affecting the eyes; it is evident too that the moisture is envisaged to be deep in the head, under the bone. (On two types of flux, see 3.3; on treatment of superficial flux, see 4 above.) The Hippocratic doctors had recourse to trephining, surgery in which a sawing or piercing instrument was applied to the bone of the skull, in a variety of circumstances. The most common was in cases of fracture, or head injury (VC passim, especially 9 on indications and 21 on technique [3.210, 256 L.]; Loc. Hom. 32 [6.324 L.]). In general, trephining has three broad motivations: first, to treat fractures by draining a dangerous blood clot, or by disimpacting the fragments for removal; second, to remove dead bone exposed in a wound; third, to look for pus when fever and headache suggest its presence under the skull.84 The third is similar to that here, and to Galen’s use of trepanation to relieve pressure by draining a phlegmatous lesion on the head (Hippocratis de medici officina liber et Galeni in eum commentarius, 18B. 808 K.).85 For other types of head surgery, cutting with a single incision or with multiple incisions into the bregma, see above on 4. The procedures applied here are readily paralleled in Diseases 2. In the first part of that treatise (Morb. 2. 1 [7.8 L.]), the cause of disease is summarily indicated in terms of the head overheating, causing phlegm to melt and cause flux in various parts of the body, notably parts of the head (eyes, throat etc.); several cases are outlined (Morb. 2. 1–11 [7.8–18 L.]), then elaborated in the second, more developed, part of the work (Morb. 2. 12 83 Foesius I 736, n. 19; Sichel 159; Ermerins XL; Joly 174. Cf. also Hirschberg I 1982 (tr. Blodi), 133 on the ‘daring treatment of amaurosis by trephining the skull and draining cerebrospinal fluid’. 84 Martin, 2003, 329–330. 85 See Rocca, 2003, 257.

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[7.18 L.] onwards). In that part a patient who is suffering from pain in the region of the eyes and disturbed vision (μβλυ5σσει) is given the same treatment as the patient in On Sight 8, that is treatment to pierce the bone, thereby releasing fluid pressing on the brain (Morb. 2. 15 [7.28 L.]; cf. Celsus 8. 3; Galen linguarum Hippocratis explicatio, 19. 129 K.).86 In Places in Man, flux from the brain, that is flux of ‘salty’ fluid, by contrast with the noxious mucoid matter involved in flux from the top of the head is believed to cause blindness (Loc. Hom. 13.3; cf. 2.2 [6.300, 278 L.]); conversely, in On Sight the sight is unaffected. As above, there is an accumulation of participles indicating stages in treatment (cut, move skin, saw bone, remove moisture). At the same time, there is a change from imperatival infinitives to χρ, expressed or understood, with accusative and infinitive. The formula ‘so they are cured’ is common to Places in Man and Diseases 2 (Loc. Hom. 13.5 [6.300 L.], Morb. 2. 32 [7.50 L.]). The same adjective ‘sound’ is used of sight (similarly in 2) and of patient (similarly in 3.4). 1. Kν τι ο φαλμο @γιε7ς )ντες διαφερωνται τ=ν ψιν ‘if somehow the eyes, though sound, are destroyed in their visual faculty’: Joly, retaining τινι dative and διαφεροιεν optative, emends Kν to ε, to correct the syntax of the conditional clause, tr. ‘if someone’s eyes, though sound, should destroy the visual faculty’. However, this formulation (ε, with optative, suggesting an unlikely case), though regular and almost formulaic in the expression ε8 τινι … χρ= … , σαι in Places in Man, is odd in the context of this work where the regular expression throughout is Kν with subjunctive, just as all temporal clauses are introduced with )πειδ(ν or ταν. A further oddity is that τις would occur only here in On Sight of the prospective patient and the statement that the healthy eyes ‘destroy’ the eyesight is very awkward. The emendation suggested here corrects these anomalies, and the verb διαφερεσαι is passive as in 1 above. )παναδεραντα ‘folding back’: the verb δρω lit. ‘skin’, ‘flay’ suggests

skinning an animal, as, of a sheep, in Haemorrhoids (Haem. 4 [6.440 L.]). But it is the mot juste for an operation such as this where tissues are neatly separated from bone. Paul of Aigina uses the compound @ποδρειν in describing a similar operation on the scalp (Paul Aeg. 6. 6;

86

For procedures of piercing vs sawing, see Jouanna, 1983, 228, n. 6.

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see LSJ s.v. δρω 2, anat., ‘separate by avulsion’, Herophil. ap. Gal. de anatomicis administrationibus 2. 349 K. and cf. ibid. 2. 719 K. for the sense ‘strip off the scalp, expose, lay bare’, in dissection.) The formation )παναδρω, with its double prefix, is in keeping with this author’s expression. Similar verbs in the surgical treatises are )παναρργνυμι ‘rupture again’ in Fistulas and )πανακλ(ω where the sense of the prefix is uncertain, in Fractures.87 φελντα τCν 4δρωπα ‘removing the moisture’: the ‘moisture’ is moisture from the brain; cf. 4δωρ, lit. ‘water’, in the related procedure, Morb. 2. 15 [7.26 L.].

IX The final chapter deals with ophthalmia as a seasonal disorder. Sichel uses the expression ‘ophthalmie épidémique’ as a heading, and elaborates ‘Il s’agit ici des ophthalmies épidémiques, déterminées par les variations brusques de la température atmosphérique, épidémies encore si fréquentes de nos jours. Elles s’observent surtout lors des changements des saisons.’ Ermerins, similarly, and with his usual strictures against the character of the writing sums up the content as … de lippitudine annua et epidemia; de tumore cum dolore et sine dolore in eo morbo; deinde fluxionis absentia in illo. Puto saltem de his rebus agi in capite pessime descripto. ‘On seasonal and epidemic ophthalmia; on swelling with and without pain in that disease; then on the absence of flux in it. At least, I think these are the topics discussed in a very badly transcribed chapter.’ Joly repeats Sichel’s ‘ophthalmie épidémique’, adding in a note, ‘Il pourrait s’agir d’une allergie.’88 The first two sections (of which the second has suffered serious textual corruption, here addressed by comparison with parallel passages in Galen and in Celsus) offer a series of general precepts for the treatment of cases of ophthalmia; 3 is more general still, apparently moving from treatment of seasonal ophthalmia to aphoristic comments applicable not only to this eye ailment but to many others. These general comments seem out of place in the work, but they may arise from an inherent ambiguity in the term ‘ophthalmia’, applied equally to a specific or a general eye ailment. 87 88

See Petrequin II 1888, 139, n. 6 and 7, ‘tirer en bas’ or ‘en arrière’ or ‘à soi’. Sichel 159, 150; Ermerins XLI; Joly 171, 174.

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The ophthalmia of On Sight may correspond to the modern ‘hay fever’ (allergic rhinitis characterized by a blocked, runny nose and itchy watering eyes) brought on in sensitive people by histamine release on exposure to the pollen of grasses, trees and other plants, and now routinely treated by antihistamines and steroid sprays. There are some three million sufferers each year in the UK alone.89 However, the prevalence of allergic reaction as a diagnosis is a relatively recent phenomenon; and it may be that we should here think more generally of vernal and aestival conjunctivitis. The aetiology of this is uncertain, and allergic reaction is only one theory; it is common, with a striking seasonal pattern, in the Mediterranean littoral, where it may be attributed to such environmental factors as dusty conditions aggravated by dry heat and where simple palliative measures to protect the eyes from dust, heat and sun are the standard response.90 ‘Ophthalmia’, often used in the plural, is a general term for eye ailments in the HC and other ancient medical texts. Thus, in Prorrhetic 2 the word is used of all types of eye disease, whether of long or short duration (Prorrh. 2. 21 [9.48 L.]). In Glands, it is applied, in an allembracing way, to the condition which results from a flux to the eyes and causes the visual parts to swell (Gland. 13 [8.568 L.]). In Diseases 1, ophthalmia is included in a list of diseases which are not in themselves fatal; in grouping eye affections with such joint diseases as kedmata, podagre, ischias and arthritis the physician seems to show an awareness of their inherent affinity (Morb. 1. 3 [6.144 L.]). Ophthalmias are linked with flux or streaming eyes in Epidemics 1 (Epid. 1. 2. 4 [2.616 L.]) and the term is used in various treatises of seasonal eye irritations, vernal (Aph. 3. 12 [4.490 L.]), aestival (Aer. 10 [2.42 L.]) or autumnal (Aph. 3. 14 [4.492 L.]; Epid. 7. 45 [5.412 L.]: in the latter case, treatment includes phlebotomy and purging the head, as in Vid. Ac.). The association with the disease known as ‘the choker’ has already been noted and the curative recommendation for both ophthalmia and the choker in Epidemics 2 is, as here, phlebotomy (Epid. 2. 6. 12 [5.134 L.]). In the Aristotelian Problemata the question of seasonal summer fevers and ophthalmias is addressed (Probl. 1. 8, 859b). It is stated that ophthalmias come about when excess stuff in the head melts (τηκομνης τ ς περ τ=ν 89

See BMD, s. v. Duke-Elder II 1938, 1697–1699, 1705; Trobe and Hackel, 2002, 63–68; Spalton et al., 2005, 118, figs 5. 4 and 5. 5 for allergic conjunctivitis and 120, fig. 5. 6 for vernal keratoconjunctivitis. 90

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κεφαλ=ν περιττ5σεως) and is followed by fever; for heat in the body is fever and heat in the eyes is ophthalmia. Here again ophthalmia is a key word for eye trouble from its most common source, flux. Also in the Problemata the question is raised why some people ‘who have suffered from ophthalmia’ see more clearly; and it is speculated that their eyes have been cleansed through tears, as ‘the secretion which forms on the eye covers the sight’ (31. 9, 958b; cf. also 2 above). Ophthalmia is the first mentioned eye disease in the list of the lexicographer Pollux (Poll. 2. 4. 65; cf. 4. 25. 184). In Galenic texts, ophthalmia is discussed in many passages; the expression τα7ς καλουμναις

φαλμαις ‘so-called ophthalmias’ suggests that it is regarded as a technical term or perhaps rather as a catch-all (de compositione medicamentorum secundum locos, 12. 702 K.). These include a description of ophthalmia as the most common eye disorder (ibid. 12. 711–714 K.); an account of its symptoms as reddening of the white, swelling of the eyelids, and pain when the eyes are closed, or touched; also a prescription (bathing the eyes with rosewater) for summer ophthalmias and three prescriptions (including flower of copper, softened in honey) for ointments to treat protracted ophthalmia (de remediis parabilibus 14. 342, 343 K.; cf. introductio seu medicus, 14. 768 K.). Galen, adding material to the Hippocratic account of unfavourable signs in the eye (Prog. 2 [2.114 L.]) instances ophthalmia, with drunkenness, as causing reddening of the whites of the eyes (in Hippocratis Prognosticon commentaria 1. 10 = Heeg, CMG 5. 9. 2, 222).91 Celsus deals at great length with lippitudo (Greek ophthalmia, in both a general and a specific sense), first named in a list of spring diseases stemming from umoris motu ‘movement of moisture’ (2. 1. 6). In his subsequent discussion of the notae ‘signs’ which allow prognosis: tumor ‘swelling’, pituita ‘discharge’, lacrima ‘tear’ and dolor ‘pain’ all feature (6. 6. 1); he regards lippitudo as an illness with an obvious (unstated) cause (proem 30). The ordering of topics is similar to that in On Sight: where there is inflammation, the patient should lie in bed, in a dark place, and take no food and even, if possible, no drink; bleeding is recommended in appropriate cases (si in fronte venae tument, si firmo corpore materies superest ‘if the vessels in the forehead are swollen; if there is superfluous matter in a robust frame’); poultices may be applied to the vessels (ut compressis venis pituitae impetum cohibeat ‘in order to control the

91

See Savage-Smith, 1984, 177 with n. 55.

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surge of phlegm by compression of the vessels’) or to the surface of the eye itself. It is recognized (6. 6. 8D) that failure to recover from the pain, inflammation and flow of matter is a common eventuality. In de remediis parabilibus (14. 342–344 K.) Galen has several sections on eye troubles, including one on ‘summer’ ophthalmias, which are protracted in character. The treatment for flux from the eyes ()π τν κατ/ το?ς φαλμο?ς Qευματισμν) is in the first instance little to eat and water to drink; avoidance of all company; avoidance also of strong odours, dust, smoke and light from sun and lamp. If the flux persists and there is additionally pain, phlebotomy and complete fasting is prescribed, to be followed by applications ()πιτιμενα) and poultices (καταπλ(σματα) of plant matter such as green vine leaves mixed with wine and fine flour. The ordering of topics is again similar to that here, and there is the same stress on the appropriateness of poultices when pain supervenes. From these parallel passages in Celsus and Galen (neither necessarily directly dependent on On Sight, but both drawing on a stock of material, more or less homogeneous in character) the corruption in section 2 can be addressed. The first sentence is not problematical, but thereafter the Greek is confused and the sense unclear. After this point, Ermerins offers no translation, noting certum est hunc locum vitiis scatere ‘it is certain that this passage is full of errors’ and merely making tentative suggestions for emendation. It is here argued that the main problem is disruption in the ordering of the text and that the correct sequence of words can be restored once the sequence of thought is appreciated. The general drift of our passage is that the relation between pain, discharge and swelling is important in diagnosis, a point stressed not only by Celsus and Galen but also by the author of Prorrhetic 2 (Prorrh. 2. 18 [9.44 L.]), and that the relation between ointments and poultices is important in therapy. The presence or absence of pain is given particular emphasis. However, there is an erratic move from the topic of painless swellings (which should not be poulticed) and painful swellings (which may be poulticed after ointments have been tried, if these prove ineffective). Some manipulation of word order with slight alteration of punctuation and modest emendation gives good sense, in accord with that of Celsus and Galen. In palaeographical terms, the disruption can readily be explained: delete μετ( (wrongly written because of μετ( following), read )πειδ/ν (misplaced by the intrusive μετ(); read διαχειρισ+ for the meaningless διαχωρισ+ and insert negative μ before πα#σηται.

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The style remains telegraphic, with simple sentence structure broken by a few conditional or temporal subordinate clauses. Bald or incomplete sentences have the air of jottings, or rough notes. The verb συμφρει is used repeatedly (eight times; cf. 1 above, twice), without regard for stylistic variation. As in 1 above, the alliteration of κ(αρσις … κοιλης may be consciously affected, or merely formulaic. The sudden end, like the disconnected beginning, confirms the impression that the work was not written as a co-ordinated whole, but is a series of notes intended for personal use or limited circulation. 1. )πετεου κα )πιδημου ‘recurring annually and locally’: M’s nonsensical )π’ α,του is evidently a corruption of )πετεου, a reading known to or originating with Cornarius. The adjective restored is otherwise not found in the HC; but gains support from Plato’s )πτεια νοσματα ‘illnesses recurring annually’ (Pl. R. 405c). The adjective )πιδμιος is surprisingly rare in the HC, and rare enough to be glossed by Hesychios. It occurs most frequently (four times) in Internal Affections, a treatise seen here to have certain other features in common with On Sight in both content and expression, applied there to types of phlegm and to jaundice; elsewhere it is found only in Epidemics 7 (Epid. 7. 59 [5.424 L.]) and in one of the late letters (Ep. 17 [9.354 L.]).92 κ(αρσις κεφαλ ς κα τ ς κ(τω κοιλης κ(αρσις ‘purging of the head and purging of the lower belly’: the second κ(αρσις ‘purging’ found in

MHR is lost in I and mss descended from I. ε, &χοι τC σμα ‘if he should have the physique’ (lit. ‘the body’): bleeding is prescribed in addition to the less invasive purging of head and body for those patients who are strong enough to withstand it. Foesius’ translation si corpus sanguine redundet ‘if the body has too much blood’ reflects the rationale of his own contemporary practice of bloodletting.93 The phrase is odd in expression, but attention to the patient’s physique is commonly recommended: with regard to administering food and drink in Affections (Aff. 47 [6.258 L.]), to phlebotomy in Regimen in Acute Diseases (Acut. Sp. 3 [= 2, 2.398 L.]) and to purging head and body, and drawing blood from arms in Diseases 2 (Morb. 2. 73 [7.112 L.]). (The previous section, Morb. 2. 72 [7.108, 110 L.], deals with ‘phrenitis’ a 92 93

Cf. Jouanna, 1974, 242, n. 2. Foesius I 689.

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condition where, as at Vid. Ac. 9 the patient shuns the light; also as at Vid. Ac. 9 head and belly are to be purged and few foods allowed.) Such variation in treatment, at the physician’s discretion, is a feature of the practical and surgical treatises, commonly expressed in the formulation συμφρει πρς ‘it is beneficial for’ (Epid. 5. 68, 7. 65 [5.244, 430 L.]; Fract. 4 [3.430 L.]; VC 19 [3.254 L.]). πρCς &νια τν τοιο#των λγημ(των ‘for some troubles of this kind’: the

expression indicates that the author views opthalmia as having different manifestations, which might respond differently to treatment; this reflects a transition from ophthalmia as a specific condition, to ophthalmia as a general ailment. Galen glosses λγματα ‘troubles’ as a synonym for νοσματα ‘diseases’ (linguarum Hippocratis explicatio, 19. 74 K.) The incidence in the HC is wide, with a particular concentration in Koan Prognoses (seventy-one of one hundred and ninety-four occurrences). σ7τος ‘food’: the prescription of only a little bread and just water to

drink, in conjunction with the advice not to moisten the head, suggests a regime of reducing the patient, the natural consequence of a supposition that the illness is precipitated by an excess of moisture accumulating in the head. )ν σκτ"ω, π τε καπνο6 κα πυρCς κα τν 1λλων λαμπρν ‘in the dark,

away from smoke, fire and other bright things’: the injunctions seem sensible; on avoidance of light, cf. Hebd. 35 [8.657 L.]; of smoke, cf. Morb. 3. 2 and 16 [7.120, 148 L.]. Joly follows Jouanna in remarking that this instruction is unique to these works, but observes that the context in Morb. 3 is not ophthalmological.94 Avoidance of smoke as an irritant to the eyes and of light as damaging the eyes feature also in the Aristotelian Problemata (31. 21, 28, 959b). πλ(γιον ‘on his side’: the injunction that the patient lie on his side

seems otiose (but perhaps lying on the back would make it more difficult to avoid light). Joly reads πλ(γιος, nominative in place of M’s πλαγων, genitive plural. Cornarius suggested πλαγως, adverb and van der Linden πλ(γιον, accusative. This last gives most idiomatic Greek: accusative and infinitive, in instructions to the patient (not nomina94

Joly 174; Jouanna, 1974, 491, n. 4.

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tive and infinitive in address to the physician). The manuscript error of omega for omicron is a common one, explicable both visually and aurally. Foesius knew ms evidence for πλ(γιον, but retained πλαγων translating ex obliquo ‘obliquely’.95 Though the adjective is very commonly opposed to ρς ‘straight’, there seems little point to this sense here; we may contrast a passage in Articulations, where the patient must sit ‘sideways’ on a high chair for the practical reason that his arm can go over the back of the chair, in readiness for treatment of a dislocated shoulder (Artic. 7 [4.92 L.]). 2. That the head should not be moistened (sc. with water, or oil, or soothing lotions) again indicates the supposed presence of flux from the head; this might be aggravated by addition of fluids, even externally, and the ensuing mention of swelling further suggests the presence of noxious or excessive or misplaced matter. But there are elsewhere instructions not to wet the head, even when other parts are being bathed (Morb. 3. 6, 16 [7.124, 148 L.]; Int. 7 [7.184 L.]; Aff. 26, 27 and cf. 37 [6.238, 246 L.]). The injunction not to moisten head wounds occurs categorically in Head Wounds (VC 13 [3.230 L.]) and, more generally, with reference to any wounds, in Sores (Ulc. 1 [6.400 L.]; cf. also Artic. 40 [4.172 L.]). In these passages too, the context involves a move from proscription of moisture to the question of poultices. The surgical injunctions of Sores further resemble those of On Sight in recommending a very light diet, with water to drink ( λιγοσιτειν … 4δωρ ξυμφρει, Ulc. 1 [6.400 L.]; reiterated κα μ= τεγγτω κα λιγοσιτετω κα πιντω 4δωρ, Ulc. 24 [6.428 L.]). ο γ/ρ συμφρει ‘for it is not beneficial’: the variant )πειδ= ο συμφρει gives the same sense and is important only in establishing the

divergence in the later tradition between mss derived from H and mss derived from I. Similarly below, the inclusion or omission of σοι is indifferent semantically. Scribes were probably unconcerned with such minor differences. κατ(πλασμα ‘poultice’ or ‘plaster’: the term embraces all kinds of cura-

tive materials plastered on the skin, sometimes but not always contained in a fabric bandage.96 95 96

Foesius I 689. See Petrequin I 1887, 243, n. 1 and 483, n. 3; also Duminil, 1998, 51, n. 3.

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δυν ς μ= )νεο#σης, λλ’ ;ς Qε#ματος )πχοντος ‘if there is no pain, but apparently continuing flux’: for the genitive absolute, cf. ο,δματος μ= προσεντος ‘in the absence of swelling’, Ulc. 10 [6.408 L.]. Joly reads 1λλως, which might refer to a persistent, but useless, flow of discharge, or of tears. The verb )πχειν has two main senses (apparently rather

contradictory; but both involve a recognized usage of the prepositional prefix and ambiguity is rare): ‘prevail’, ‘continue’ or ‘pause’, ‘stop’. Both senses are found in the HC: the former is surely intended here. The term Qε6μα may be used both of flux (abstract) and of content of flux such as discharge (concrete); sometimes there is a shift from abstract to concrete (as Loc. Hom. 13 [6.298 L.], both generally of flux to the eyes and particularly of a type of discharge). The phrase here clearly anticipates the genitive absolute in the final sentence, possibly misplaced, of 9.3. ο,δημ(των νωδ#νων ‘while the swellings are not painful’: this phrase is tautologous after δυν ς μ= )νεο#σης, but the repetition is not untoward

in the Greek of On Sight. Flux and pain go together in many contexts (cf. πηλλαγμνου το6 Qε#ματος κα τ ς δ#νης, ‘when both flux and pain have passed’, Morb. 2. 19 [7.34 L.].) δριμα φ(ρμακα ‘astringent drugs’: see VC 14 [3.236 L.] (vinegar); Aff. 38 [6.248 L.] (for suppuration); Mul. 1. 74 [8.158 L.] (1γοντα αJμα ‘to draw blood’) and cf. Mul. 2. 165 [8.344 L.], Nat. Mul. 24 [7.342 L.], Morb. 2. 47 [7.66 L.]. The doctor is supposed to know which drugs would act in appropriate ways: astringent agents, as here, or drying agents, as below.

The verb διαχωρζεσαι ‘be separated’ is very rare and there is no other Hippocratic usage; further the sense is inapposite. The proposed διαχειρζεσαι ‘treat’ gives the precise sense required. The verb occurs in Affections, Prognostic and Diseases of Women 2 (Mul. 2. 111 [8.240 L.]), while the related substantive διαχειρισμς occurs in Epidemics 2 (Epid. 2. 3. 2 [5.104 L.]); the incidence is in accord with the general pattern of vocabulary in On Sight. μετ/ τ=ν )σ(λειψιν ‘after the application’ (of ointment): the substantive is a hapax. But the verb ε,σαλεφω is found in Nature of Woman. Similarly we find @π(λειψις just below, 9.3; Galen glosses @π(λειπτονE &γχριστον φ(ρμακον (linguarum Hippocratis explicatio, 19. 148 K.). The otiose )σ- and

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@π- prefixes are in accord with the stylistic preferences of our writer;

and once again this preference links On Sight linguistically with a limited group of treatises. The following may be compared: ε,σακο#ω (Loc. Hom.; Mul. 1 and 2; Prorrh. 2); ε,σαναγκ(ζω (Artic.); ε,σ(παξ (Mul. 1); ε,σαφ(σσω (Nat. Mul. only, 14 occurrences); ε,σβανω (Loc. Hom.); ε,σλ(ω and ε8σλασις (VC); ε,στρυπ(ω (Oss.); ε,σφοοιτ(ω (Morb. 2); ε,σωω (Artic.; Fist.; gynaecological works). The suffix -ις or -σις is also of interest. Medical terms of this formation describe the use of procedures in treatment; whereas words of -μα formation denote the procedure itself. Examples are ,(σις and 8αμα, υμασις and υμαμα, πυρασις and πυραμα. (Compare also the hapax @περνησις Loc. Hom. 47. 8 [6.346 L.], and note the exception ε8σλασις of a medical condition.) Where the medical usage is not a coinage, but depends on a more general word which predated it, that general word continues to exist and there is no formation in -μα. Examples are μχλευσις and μοχλς, φαρμ(κευσις and φ(ρμακον. Similarly, in Latin, -tio as a suffix has some stylistic or ‘technical’ significance; and -tura is used in medical parlance.97 3. προκαλε7ται ‘summons’: the verb occurs only five times in the HC (here, and in Fract., Epid. 6, Prorrh. 1, and Coac.). Advice to keep the eyes neither open for too long nor shut for too long might seem to apply in all circumstances, not just in the case of this ailment. However, Sichel finds here a mark of the experienced practitioner and Joly a judicious recommendation to avoid secondary infection.98 The emphasis on the nature of the matter in flux continues (cf. Prorrh. 2. 18 [9.44 L.], echoed Celsus 6. 6. 1, hot is bad; Loc. Hom. 13 [6.300 L.], pent-up matter is dangerous). ,σχμενον ‘pent-up’: the verb occurs (passive, most often of urination)

in the surgical treatises, Epidemics and elsewhere (but not in theoretical works on flux and fixation). The final sentence (on the presence of discharge) seems to belong earlier (in 9. 2, see above); here it is a tangential return to a previous topic. μετ/ το6 ξηρο6 ‘a drying substance’: drying ointments would include

poultices intended to draw off noxious moisture. For a drying drug applied in the case of slight flow, cf. Loc. Hom. 13.2 [6.300 L.]. 97 98

Cf. Langslow, 2000, 292, 300. Sichel 151; Joly 174.

GLOSSARY OF OPHTHALMOLOGICAL TERMS Blepharitis Canthus

inflammation of the lid margins angle at outer (lateral) and inner (medial) corners of eyelid Cararact disease of the lens marked by opacity in the lens or lens capsule Chalazion painless cyst developing in tarsal gland Choroid vascular layer between sclera and retina Ciliary body part of the eye connecting iris and choroid Conjunctiva mucous membrane lining the marginal edges and the inner aspect of the lids and covering the cornea Conjunctivitis inflammation of the conjunctiva Cornea anterior transparent part of sclerotic membrane Ectropion eversion of the lid margin (usually lower lid), condition when the lid is turned away from the eyeball, exposing the conjunctiva Entropion inversion of the lid margin (usually lower lid), condition when the lid is turned towards the eyeball, causing irritation to the cornea from the lashes Eyelids upper and lower tissue, serving to cover and protect the eye, with lashes on their margin Fundus point on retina, opposite pupil, through which nerve fibres and blood vessels travel Glaucoma disorder (or group of disorders) characterised by high intraocular pressure due to build up of aqueous humour in the eye Iris the coloured portion of the eye, perforated by the pupil Keratitis inflammation of the cornea Lens colourless body contained in capsule behind iris, involved in transmission of light to retina Limbus junction between (opaque) sclera and (clear) cornea Papilloma overgrowth of skin Pterygium conjunctival lesion, triangular fold of tissue growing from nasal area over the cornea Pupil the central aperture (black to the naked eye) of the iris Retina sensitive layer (innermost of three ‘coats’ of the eye) involved in transmission of nerve impulses to the brain Sclera, sclerotic the white portion of the eye, a tough encapsulating fibrous membrane (outermost of three ‘coats’ of the eye) Tarsus, tarsal plate plate of fibrous tissue supporting the eyelid

114 Trachoma Trichiasis Visual cortex

glossary of ophthalmological terms serious infectious keratoconjunctivitis condition of ingrowing eyelashes, allied with entropion part of the brain which processes information from the eye

DIAGRAMS

Diagram 1. The Eye: anterior view

Diagram 2. The Head: lateral view

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Diagram 3. Section of the eyeball

part ii ON ANATOMY

THE HIPPOCRATIC TREATISE ON ANATOMY 1 ‘Anatomy is the basis of medical discourse’ (Hipp. Loc. Hom. 2 [6.278 L.]) Introduction On Anatomy (Anat.) is the shortest treatise preserved in the Hippocratic Corpus (HC). It describes the internal configuration of the human trunk. The account is for the most part descriptive, function being largely disregarded and speculation completely eschewed. Though systematic it is unsophisticated: two orifices for ingestion are linked by miscellaneous organs, vesssels, and viscera to two orifices for evacuation. There is a clear progression in two parallel sections: first, trachea to lung, lung described, location of heart, heart described, kidneys to bladder, bladder described, bladder to genitals, conclusion; and second, oesophagus to belly, location of diaphragm, location of spleen, location 1 Appreciative thanks are due to the director and trustees of the Wellcome Trust for the award of a research leave fellowship which released me from arduous teaching duties at the University of St. Andrews to pursue work on the Hippocratic treatise Places in Man (ed., tr., and comm., forthcoming, Oxford University Press). This paper is a parergon of that work. I am most grateful to Professor Vivian Nutton (WIHM and University College London), who first drew On Anatomy to my attention and who commented most helpfully on drafts of this paper at successive stages. I am grateful also to Mr James Longrigg (University of Newcastle-upon-Tyne) for advice on the pre-Socratic background, to Sir Kenneth Dover (St. Andrews) for comments on the ‘style’ of the piece, and to Professor Jacques Jouanna (Sorbonne) for invaluable aid in checking and communicating the readings of the ms V. Assistance of a different but equally important kind was afforded by those who answered my countless (doubtless often silly) anatomical questions with great good sense and good humour; especially Dr Donald Coid, whose copy of Gray’s Anatomy has now become even more thumbed and tattered; Dr Ann Dally, who introduced me to the ways of Wimpole Street; and Dr Susan Whiten, who, with Mr Robin Clark, gave me an unforgettable and highly instructive tour of visual aids in the Department of Anatomy at St. Andrews. Without the encouragement and support of all these friends, I should never have completed this paper. In the final stages, it was improved by the comments of the referee (anonymous) and the editors (Stephen Heyworth and Christopher Collard) of CQ. For any remaining errors or misapprehensions, I am alone responsible.

[page 135]

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and description of belly (close to liver), belly to intestine/colon, colon to rectum and anus, conclusion. The fragment offers good basic topographical or regional anatomy (the organs studied as they lie in relationship with one another in the different regions of the body). That the work is concerned with human anatomy is certain from the precise description of lung and liver, with features peculiar to human organs; and is corroborated by frequent references to comparative anatomy, with which familiarity is apparently assumed. Such anatomical knowledge, based on extensive observation of animals (probably sacrificial victims as well as laboratory specimens), may have been corroborated by some human dissection, perhaps of the aborted foetus or exposed infant, in conjunction with opportunistic observation of war wounded and accident victims. While the syntax is bald, telegraphic, and asyndetic, the vocabulary is recondite, and poetic. There is erratic omission of the article and recurrent use of compendious comparisons. These features suggest that Anat. may be an abridgement of a fuller and more flowery account; this hypothesis is supported by several passages where erroneous or unclear information apparently results from excessive compression or // imperfect comprehension of a source. The vocabulary is markedly Demokritean and there are strong affinities with Ep. 23, the supposititious letter of Demokritos to Hippocrates on ‘the nature of man’. As there are similarities also, both in content and in expression, with Oss., a composite work which is related in turn to Epid. 2, case histories of patients in Thrace and adjacent regions, and with the similarly located Epid. 6, the putative earlier version(s) of Anat. may plausibly be attributed to a North Greek strand of scientific and medical endeavour. In this paper a new text is presented, followed by translation, commentary, and discussion incorporating conclusions on origin and date. At the same time, the paper has a wider thrust, concerning the development of ancient anatomical knowledge and scientific terminology. The conclusions have important implications for our understanding of the formation of the HC, both as originally composed and as subsequently constituted.

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References and Abbreviations Vatican gr. 276 twelfth century

V

Anat. is preserved in a further six mss, all recentiores and apparently without independent value. See H. Diels, Die Handschriften der antiken Ärzte, Teil I (1905), p. 31 and also B. Alexanderson, Die hippokratische Schrift Prognostikon (Göteborg, 1963), pp. 70, 77–78, 110. These are: – – – – –

Paris 2146 and Paris 2255 = C and E on which Littré relied. Bologna 3632. Holkham 282, now in Oxford (by the same hand as Paris 2146). Munich 71. Vatican, Palatine 192.

Calvus

Latin translation of Hippocratic writings (1525, preceding Aldine editio princeps of Asolanus, 1526). Cornarius ed. and Latin trans. (Basle, 1538). Foesius ed. and Latin trans. (Frankfurt, 1595; also Oeconomia, Frankfurt, 1588). van der Linden ed. and Latin trans. (Leiden, 1665). Triller Opuscula Medica vol. 2, 1st edn (Leiden, 1728); and 2nd edn (Leipzig, 1766): medico-philological commentary on Anat., intended as specimen for complete Hippocratic edition. Littré ed. and French trans. (Paris, 1839–1861; Anat. occupies 8. 536–541, published 1853). Ermerins ed. and Latin trans. (Utrecht, 1851–1864; Anat. occupies 3. 287–288, published 1864). BVD GA DK DR HC Ibycus, TLG K.

Black’s Veterinary Dictionary (14th edn, 1982). Gray’s Anatomy (30th edn, 1949). H. Diels & W. Kranz, Die Fragmente der Vorsokratiker (10th edn, 1961). C. Daremberg and E. Ruelle, Oeuvres de Rufus d’Éphèse (Paris, 1879). Hippocratic Corpus. computer search of TLG database. C.G. Kühn, Claudii Galeni Opera Omnia (Leipzig, 1821–1830).

Abbreviations for ancient authors and works (including Hippocratic treatises) follow Liddell–Scott-Jones. // The following modern works are referred to by author’s name and date: M.-P. Duminil, ‘La description des vaisseaux dans les chapitres 11–19 du traité de la Nature des Os’, Hippocratica (Paris, 1980), 135–148.

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L. Edelstein, ‘The History of Anatomy in Antiquity’, Ancient Medicine: Selected Papers of Ludwig Edelstein, edd. O. and E.L. Temkin (Baltimore, 1967; first German publication, 1932), pp. 247–301. W.A. Greenhill, ‘Adversaria Medico-Philologica’, British and Foreign Medico-chirurgical Review 34–38 (1864–1866). C.R.S. Harris, The Heart and the Vascular System in Ancient Greek Medicine (Oxford, 1973). J. Irigoin, ‘La formation du vocabulaire de l’anatomie en grec: du mycénien aux principaux traités de la collection hippocratique’, Hippocratica (Paris, 1980), 247–257. J. Jouanna, Hippocrate (Paris, 1992). G.E.R. Lloyd, ‘The Development of Greek Anatomical Terminology’, Science, Folklore and Ideology (Cambridge, 1983), pp. 149–167. J. Longrigg, Greek Rational Medicine (London, 1993). I.M. Lonie, The Hippocratic Treatises On Generation, On the Nature of the Child, Diseases IV: A Commentary (Berlin and New York, 1981). J. Mansfeld, The Pseudo-Hippocratic Tract περ βδομδων (Assen, 1971). R.B. Onians, The Origins of European Thought (Cambridge, 1952). F. Skoda, Médecine ancienne et métaphore (Paris, 1988). W.D. Smith, The Hippocratic Tradition (Ithaca, NY and London, 1979). W.D. Smith, Hippocrates: Pseudepigraphic Writings (Leiden, 1990). H. von Staden, Herophilus. The Art of Medicine in Early Alexandria (Cambridge, 1989). O. Temkin, ‘Hippocrates as the Physician of Democritus’, Gesnerus 42 (1985) 455–464.

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ON ANATOMY TEXT AND TRANSLATION

TEXT Περ νατομ ς2

I 1. gΑρτηρη )ξ Hκατρου φαρυγγρου τ=ν &κφυσιν ποιευμνη )ς 1κρον πνε#μονος τελευτYV, κρκοις ξυγκειμνη 'μορυσμο7ς, τν περιηγων cπτομνων κατ’ )ππεδον λλλων.

2. ΑτCς δ* ' πνε#μων ξυνεξαναπληρο7 τ=ν χλυν, τετραμμνος )ς τ/ 5 ριστερ(, πντε @περκορυφ5σιας &χων, iς δ= καλουσι λοβο?ς, τεφρνης χροι ς τυχ5ν, στγμασιν ρφν5δεσι κεκεντημνος, φ#σει )<ν τενρηνι5δης. 3. Μσ"ω δ’ ατ"ω  καρδη )γκαδρυται, στρογγυλωτρη καεστεσα π(ντων ζ"5ων. gΑπC δ* καρδης )ς Tπαρ βρογχη πολλ= κακει, κα μετ/ 10 βρογχης φλ*ψ μεγ(λη καλευμνη, δι’ Tς οUλον τC σκ νος τρφεται.

4. ΤC δ* Tπαρ 'μορυσμην μ*ν &χει το7ς 1λλοις jπασιν, α μορρωδστερον δ )στι τν 1λλων, @περκορυφ5σιας &χον δ#ο, iς καλουσι π#λας, )ν δεξοις τποις κεμενον. gΑπC δ* τουτου σκαλνη φλ*ψ )π τ/ κ(τω νεφρν ποτενουσα. 15

3 'μορυσμο7ς V: 'μοιορυσμο7ς van der Linden 3–4 cπτομνων Ermerins: cπτομνη V 5 ξυνεξαναπληρο7 Ermerins: συνεξαναπληρο7 V 5–6 τετραμμνος )ς τ/ ριστερ( V: τετραμμνος ε,ς τ/ μφτερα vel μφστερνα vel τ/ 1μφω στρνα Cornarius: τετρημνος &ς τε τ/ δεξι/ κα τ/ ριστερ( van der Linden: τετραμμνος )ς τ/ δεξι/ κα )ς τ/ 6 @περκορυφ5σιας Ermerins: @ποκορυφ5σιας V 7 ρφν5δεσι ριστερ( Ermerins Foesius: ρφοναγσιν V: φρ5δεσι van der Linden: φρυεσι Littré 7–8 τενρηνι5δης Foesius: )<ν τ* ρηνι5δης V 10–11 βρογχη πολλ= κακει, κα μετ/ βρογχης edd.: μετ/ βρογχη V: βρυχη φλ*ψ κακει, κα μετ/ τ ς βρυχης van der Linden 12 'μορυσμην V: 'μοιοιορυσμην van der Linden | jπασιν V: [πασιν Triller 14 κεμενον Ermerins: κειμνας V 15 νεφρν recc.: νεφρν V 2

A Budé text by M.-P. Duminil is promised.

[page 138 // page 139]

TRANSLATION

I 1. The trachea, taking its origin from each side of the throat, ends at the top of the lung; it is composed of similar rings [to other creatures’], the circular parts touching one another on the surface. 2. The actual lung, inclined towards the left, fills the chest cavity. The lung has five projecting parts, which they call lobes; it has an ashen colour, is punctuated by dark spots, and is in nature like a honey-comb. 3. In the middle of it the heart is situated: it is rounder than [that of] all creatures. From the heart to the liver a large tube goes down, and with the tube the vessel called the great vessel, by means of which the entire frame is nourished. 4. The liver has a similarity to [that of] all other creatures, but is more blood-suffused than [that of] others. It has two projecting parts, which they call gates; it lies in the right part [of the body]. From the liver a slanting vessel extends to the parts below the kidneys.

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text

5. Νεφρο δ* 'μοιορυσμο, τ=ν χροι=ν δ* )ναλγκιοι μλοισιν. gΑπC δ* τουτων χετο σκαληνοειδες )ς 1κρην κορυφ=ν κ#στιος κε7νται. 6. Κ#στις δ* νευρ5δης οIλη κα μεγ(λη. mΕκαεν κ#στιος μσα σχα πφυκε. 7. Κα τ/ μ*ν Dξ ν/ μσον )ντCς φ#σις )κοσμη.

5

II 8. Ο,σοφ(γος δ* πC γλ5σσης τ=ν ρχ=ν ποιε#μενος )ς κοιλην τελευτYV, oν δ= κα )π σηπτικ ς κοιλης στμαχον καλουσι.

9. ΠρCς δ* κ(νης πισεν [πατος φρνες πεφ#κασι. gΕκ δ* πλευρ ς νης, λγω δ* ριστερ ς, σπλ=ν ρξ(μενος )κτταται 'μοιρυσμος 8χνει ποδς. 10

10. Κοιλη δ* [πατι παρακειμνη κατ’ ε5νυμον μρος ολομελς )στ νευρ5δης. gΑπC δ* κοιλης πφυκεν &ντερον 'μοιρυσμον, μακρν, πηχων οκ &λασσον δ5δεκα, HλικηδCν )ν κλποις )νειλο#μενον, o καλουσιν &νιοι κλον, δι’ οP  παραφορ/ τ ς τροφ ς γγνεται.

11. gΑπC δ* κλου πφυκεν ρχCς λοσιος, σ(ρκα περιπληα &χων, )ς 15 1κρον δακτυλου τελευτν.

12. Τ/ δ* 1λλα  φ#σις διετ(ξατο.

1 μλοισιν V: μηλεοισιν Triller 2 )ς 1κρην van der Linden: 1κρην V 3 Dκαεν κ#στιος μσα σχα Craik: Dκαε κ#στιος μεσοχ= ε8σα V: Hκ(σταε δ* κ#στιος μετοχ= ε8σω recc.: &γκας δ* κ#στιος μετοχ= ε8σω Triller: Dκαεν δ* κ#στιος μετοχ= ε,ς o Littré: )κ δ* τ ς κ#στιος μετοχτευσις &ξω Ermerins 5 φ#σις V: φ#σι Ermerins 7 )π σηπτικ ς V: )πισημαντικς vel )πισμως Cornarius ap. Foesium | καλουσιν edd.: καλουσι V 8 πφ#κασιν edd.: πεφ#κασι V 9 'μοιρυσμος edd.: 'μοιορυσμ" V 11 ολομελς V: ολομνη recc.: ολομελ+η van der Linden: ολουμνη Triller 12 μακρCν ap. Foesium: μικρCν V 13 )ν κλποις V: )ς κλπους van der Linden 14 κλον V: κλον recc. | γγνεται recc.: γνεται V 15 κλου V: κ5λου recc. | περιπληα V: πολυπληα van 17 Post διετ(ξατο der Linden 15–16 )ς 1κρον V: κα )ς 1κρον van der Linden lacunae signa Ermerins: fortasse διετ(σσετο Craik

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text

127

5. The kidneys are similar [to other creatures’] and in colour are like [those of] sheep. From them slanting ducts reach to the top edge of the bladder. 6. The bladder is all sinewy and large. At a distance from the bladder come, centrally, the genitals. 7. In these six parts [bodily] nature has been arranged internally in the middle. II 8. The oesophagus, taking its origin from the tongue, ends at the belly; they call it ‘mouth’ for the putrefying belly. 9. From the backbone, behind the liver, comes the diaphragm. On the false side, I mean the left, the spleen begins, and extends, similar to a footprint. 10. The belly, lying beside the liver, on the left side, is all sinewy. From the belly comes the intestine, which is similar [to other creatures’], long, no less than twelve cubits, in coils entangled in folds. Some call it the colon, and by it the passage of the food occurs. 11. From the colon comes last the rectum, which has fleshy tissue, and which ends at the extremity of the anus. 12. The rest, nature has organized.

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COMMENTARY 1. On the trachea see GA 1270, 1275: ‘The trachea, or windpipe, is a cartilaginous and membranous tube … continued downward from the lower part of the larynx … The cartilages … vary from sixteen to twenty in number. Each is an imperfect ring which occupies the anterior two-thirds or so of the circumference of the trachea. … Two or more of the cartilages often unite, partially or completely’. The author, then, is correct about the rings and about the rings ‘touching’ one another. Nothing, however, is said about the branching of the windpipe into the right and left extrapulmonary bronchi, which lead separately to right and left lung. ρτηρη: in Greek medicine, the term ρτηρη (or ρτηρη τραχε7α, whence trachea; cf. Celsus’ ‘arteria aspera’) eventually prevailed for the trachea or windpipe. But in the HC the terminology of trachea and bronchial tubes is ambiguous and inconsistent, even within individual treatises and, at times, within individual sections of them (cf. Int. 1 [7.166 L.] on ρτηρη, φλβια, and σ#ριγγες all connected with the lung). The term βργχος is used not only of the bronchial tubes but generally of the area between throat and lung and, conversely, ρτηρη may be applied to the bronchial tubes; also the two terms may be found together (as Loc. Hom. 3.5, 10.1, 14.2, 14.7 [6.282, 294, 304, 306 L.], where βργχος is trachea and ρτηραι, or by tacit substitution ορτε7ς, are bronchial tubes). In the HC, the trachea is rarely simply ρτηρη (but see Epid. 7.12 and 25 [5.388, 394 L.]). Most commonly, the term ρτηραι is, like φλβες, applied to the important hollow bodily tubes, ducts, or vessels through which fluids (not only blood) were believed to course, and is analogous to the term νε6ρα applied to the solid links in the body, i.e. tendons, sinews, muscles, ligaments as well as (occasionally) nerves. In some passages ρτηρη is ambiguously used, both of trachea and of vessel (Epid. 2.4.1 [5.122 L.] ~ Oss. 5 [9.170 L.]). In a later distinction, generally agreed to have been formalised by Praxagoras, the arteries were believed to convey πνε6μα and the veins blood through the body. Thus, in accord with Rufus’ explanation (Anat.

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commentary

65, 183 DR) that the φλβες carry blood and the ρτηραι blood to some extent but rather πνε6μα ‘air’, Pollux (2.5) defines ρτηραι as paths for air analogous to φλβες, for blood. The connection between ρτηρα as trachea and as artery is probably that both were regarded (rightly in the case of the former) as conveying air. The derivation is uncertain. Possibilities are from α8ρω ‘lift’, presumably because the lungs seemed ‘suspended’ by the trachea, and the heart by the aorta (which, however, itself must be from ορτω ‘suspend’); or from ραρσκω ‘fit’, presumably because the ρτηρη seemed to ‘fit’ parts of the body together (and for this notion, cf. Oss. 1 [9.168 L.], the intestines Kρτηται); as did the 1ρρα, ‘joints’.3 )ξ Hκατρου φαρυγγρου: this term is not used elsewhere in the HC, but is common in late medical writers.4 It is glossed (s.v. φαρ#γαρον) by Hsch. As a technical locative term, it does not differ in sense from the common term φ(ρυγξ (cf. Rufus φ(ρυξ δ* F φαρ#γερον Onom. 62, 141 DR) or occasional term λ(ρυγξ this being the interior of the τρ(χηλος or αχν (but both of these are used for other narrow parts also, such as the neck of the bladder or of the womb). Pollux differentiates between φ(ρυγξ, start of oesophagus and λ(ρυγξ, of trachea (2.4.207). // Unsurprisingly, the adjective Hκ(τερος, ‘each (of two)’ is especially common in bodily description (legs, kidneys Carn. 5 [8.590 L.]); but the usage here, of each [side of the] throat is unexpected. However, from τρ(χηλος τ/ μρεα ατο6 Hκ(τερα &να κα &να δνας &χει, Gland. 7 [8.560 L.] (cf. Hκατρωεν, Gland. 4 [8.558 L.]), it seems that the throat was regarded as essentially bipartite, possibly because of its connection, in breathing, with the two nasal passages. (φ(ρυγγες is occasionally used in the plural, as πC κεφαλ ς κατ/ τ/ς φ(ρυγγας, Mochl. 39 [4.386 L.].) τ=ν &κφυσιν ποιευμνη: the technical expression &κφυσις with reference to trachea has the same significance as the more general term ρχ in

the parallel description of oesophagus in 8 below, i.e. ‘starting-point’, ‘inception’. Like the related terms πφυσις, ‘excrescence’, ‘protuberance’ (for which )πφυσις is a common manuscript variant) and παρ(φυσις, it is common in anatomical contexts, especially in Artic., Fract. and Mochl.; also Oss. (e.g. Artic. 45 [4.190 L.], Fract. 12 [3.460 L.], Mochl. 1 [4.340 L.]; Oss. passim). The terms are typically but not exclusively 3 4

See Greenhill (1864–1866), Irigoin (1980). Ibycus, TLG: Aretaeus, Aetius, Galen, and Oribasius.

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commentary

131

medical or biological. The circumlocution τ=ν &κφυσιν ποιευμνη, with abstract noun plus ποιε7σαι standing for verb with same root as the noun, recurs in 8 below, τ=ν ρχ=ν ποιε#μενος = verb ρχμενος, as ρξ(μενος, 9. This is by stylistic preference, the verb being available as alternative: as ποπφυκε, Loc. Hom. 3.6 [6.282 L.] and )κπεφ#κασιν, Oss. 4 [9.170 L.]. )ς 1κρον πνε#μονος: the substantival form ‘top point’, ‘extremity’, ‘edge’ is used again below, )ς 1κρον δακτυλου: this use is uncommon

in Attic Greek, but is a regular alternative in the HC, particularly for bodily extremities, as in plural τ/ 1κρα, Acut. 30 [= 9, 2.290 L.]; and repeatedly in Artic. The adjectival form is here used once (1κρην κορυφν, 5). The singular form πνε#μων is dominant in the HC (and the rare plural is both preceded and followed by the singular, Gland. 14 [8.568, 570 L.]). From the expression ‘the top of the lung’, and the use throughout of the singular, it is evident that the author regarded the lung as a single joined organ, as indeed did Aristotle (HA 1.16.495b; PA 669b). The original form πλε#μων gave way to πνε#μων presumably because of a supposed connection with πνε6μα: from the heroic age the lung was known to be vital to life (Hom. Il. 4.528 etc.).5 τελευτYV: this verb, repeated three times in this short piece (1, trachea ending at lung; 8, oesophagus at belly; 11, rectum at anus) is regularly used of the location of bodily parts in the anatomical treatises. For the use of the preposition )ς, cf. κε7σαι )ς below, 5. κρκοις ξυγκειμνη 'μορυσμο7ς: the sense of κρκοις is evident, but the

expression, forerunner of the modern term ‘cricoid’ cartilage, is unusual in Greek. Pollux (1.94, on rings for ships’ hawsers) regards κρκος as poetic for κρκος or κ#κλος. Elsewhere in the HC, the noun occurs only in Mochl. 41 [4.392 L.], where it denotes a ‘loop’ attached to a piece of apparatus (1γκυλαι in the excerpted text, Fract. 30 [3.520 L.]). The compound verb )γκρικω occurs Oss. 18 [9.194 L.] in the phrase )νεκρκωσεν πρCς τ=ν 1καναν (glossed Erotian E 38 )νδησεν). Celsus’ expression constat ex circulis quibusdam (4.1.3) shares the metaphor. For the compound verb, of bodily composition, see Fract. 9 [3.448 L.] // 5 Maladies of the lung and respiratory tract occupy much space in the HC: see especially Int. init. [7.166 L.] and Loc. Hom. 14 [6.302 L.].

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commentary

(foot and hand composed of many small bones); and see κε7σαι below (4, position of liver and 5, position of ureters; also παρακε7σαι (10, belly in relation to liver). The concatenation of terms 'μορυσμο7ς, 'μορυσμην, 'μοιρυσμοι, 'μοιρυσμον, 'μοιρυσμον (connected respectively with rings of trachea, 1; with liver, 4; with kidneys, 5; with spleen, 9; with intestine, 10) is arresting;6 and we may add )ναλγκιοι (connected with the kidneys, 5): throughout, the author is concerned with comparisons, expressed in consistent terminology. In scientific writing, technical terms are liable to be repeated; indeed, variation can be misleading and obscure the sense. Suda (s.v. Qυσμς) glosses: κατ/ gΑβδηριτικ=ν δι(λεκτον σημανει τC σχ μα, κα Hτραις δ* λξεσιν οχ Hλληνικα7ς ο περ τCν gΑβδηρτην Δημκριτον χρνται. Other late commentators (Philoponus, Eustathius), per-

haps using the same source, reiterate this information on the Abderite sense of Qυσμς (σχ μα, &κτασις, σις, δι(στασις, τ#πος), and there is good evidence that Qυσμς and related words were favoured by Demokritos; see further below. Whatever the authentic Hellenic character of the ‘other words’ allusively mentioned in the Suda, it seems unduly harsh to imply that the semantic extension of Qυσμς (Ionic for Attic Qυμς) ‘form’ is not admissible Greek. It seems rather to have been a matter of stylistic preference; cf. E. El. 772 (in hendiadys with τρπος) also H.F. 130, Supp. 94. The sense ‘shape’ is dominant: see Arist. Metaph. 985b16, identification with σχ μα, also Hdt. 5.58, of letters, and Artic. 62 [4.268 L.], of boots; but coexists with more abstract usage, as in Septim. passim. Hsch. glosses QυσμοδσαιE συγκρνεσαι, ‘compare’, precisely in line with the sense of the related words here. τν περιηγων cπτομνων κατ’ )ππεδον λλλων: neither περιηγς ‘circular’ nor )ππεδος ‘level’, ‘plane’ occurs elsewhere in the HC. The former term, which Hsch. glosses as κυκλοτερς, περιφερς, is used 6 Following van der Linden, Triller emends the two occurrences of 'μο- to 'μοιο-. However, this is unnecessary, as the difference between 'μο- words (from 'μς ‘one and the same’) and 'μοιο- words (from 'μο7ος ‘like, resembling’) is not always strictly maintained; except that whereas 'μο- words can mean ‘similar’, 'μοιο- words cannot mean ‘the same’. Thus 'μοειδς (close in nuance to 'μορυσμς here) can mean either ‘of like form’ or ‘uniform’; and coexists with 'μοιοειδς, which must mean ‘of like form’. In our passage, no instance of 'μορυσμς imperatively demands the sense of sameness rather than similarity; and only one (the case of the spleen) demands the sense of similarity rather than sameness. The Greek is ambiguous, but reference to comparative anatomy (‘rings like [those in other animals]’) is more probable than to ‘a series of rings’; see further below.

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commentary

133

by Empedokles (DK 31 B 27.4 = Plu. Mor. 926d; cited also Stob.).7 The term )ππεδος is common in many of the pre-Socratics, including Philolaus, Pythagoras, Anaximander as well as Demokritos, typically in mathematical contexts (as Demokritos DK 68 B 155 = Plu. Mor. 1079e). The vocabulary of this phrase is somewhat alien to the HC, with technical terms of general scientific writing rather than of medicine. Rufus, arguing for the primacy of medical terminology by analogy with learning methods in other skills, cites geometry, where the pupil first learns στιγμ=ν κα γραμμ=ν κα )ππεδον, ‘point, line, and plane’ (Onom. 5 = 133–134 DR). The manuscript reading cπτομνη is retained by early editors (glossed μμνη, προσδεδεμνη, i.e. ‘attached’). Without λλλων this would be acceptable Greek; but as the text stands it is impossibly awkward. The nominative singular feminine of the // participle was doubtless scribal error, following ποιευμνη … ξυγκειμνη and failing to anticipate the change to the genitive absolute construction. 2. On the colour, mottling and texture of the lung, see GA 1285: ‘The substance of the lung is of a light, porous, spongy texture … in adult life the colour is a dark slaty-grey, mottled in patches.’ (The lung is rose-pink in all young creatures; the characteristic dark pigmentation, in animals as in humans, is due to breathing an impure atmosphere.) There can be no doubt that the author here describes human anatomical features: five lobes; in fact two (superior and inferior) in the left lung and three (superior, middle and inferior) in the right. The configuration of lobes in the lung is peculiar to different creatures: in the Equidae the lung is not divided into lobes at all; in cattle the lungs are divided into lobes by deep fissures, the left lung having three and the right lung four or five lobes; in the pig the left lung is like that of the ox while the right has an additional apical lobe, itself often in two parts; in the dog each lung has three large lobes, but the right has a small extra lobe and there may be one or more accessory lobes in either lung (BVD, s.v. ‘lung’). ατCς δ* ' πνε#μων: this initial expression contrasts with the bald

resumption of comment, often without even the article, on other organs (liver, bladder, kidneys) picked up from preceding sentences. But cf. ατ= δ* (vessel), Oss. 12 [9.182 L.], bis. 7 Ibycus, TLG: 46 occurrences, most Hellenistic or later, but found in Hesiod, Aischylos and Plato.

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commentary

ξυνεξαναπληρο7 τ=ν χλυν: the triple compound is a remarkable formation.8 Double συν- compounds are common enough (32 instances, many occurring several times over, in the HC); and πληρω is a verb commonly made compound (in the HC as ποπληρω, )κπληρω, )πιπληρω, συμπληρω). But the triple compound with συν- is unparalleled in the medical treatises of the HC, though note συνεισκατοικω Ep. 23 [9.394 L.]. χλυς lit. ‘tortoise’ is used by extension of things of tortoise shell, commonly the lyre; or of tortoise shape, as ‘arched’ parts of the body, typically as here the chest and cf. E. El. 837 of a bull; cf. also Pollux 2.177 χελ5νιον explained ‘arched part of the back’. See also χελ#νειον (of the chin), Ep. 23 [9.394 L.]. As ‘arched’ is a somewhat inappropriate descriptive term for the chest (even the chest when a deep breath has been taken), the metaphor may rather relate (i) to similarity with a tortoise shell, protecting vital parts of the body; for the idea, though coupled with anatomical misconceptions, cf. ' 5ρηξ καλεμενος, )ν "p τC [παρ στεγ(ζεται de Arte 10 [6.18 L.]; or (ii) to similarity with the lyre, through a realization that the voice comes from, and is somehow amplified by, the chest: cf. the idea that the lung is hollow, with the σ#ριγξ source of the voice, Morb. 4.56 [7.604 L.]. The usage of καρος ‘chest’ throughout Loc. Hom. (3.6; 10.1, 2; 14.1, 5, 10 [6.282, 294, 302, 304, 308 L.]) shows the same metaphor. τετραμμνος )ς τ/ ριστερ(: the phrase ‘inclined (lit. turned) to the left’9

seems at first sight to give an inaccurate description of the position of the two lungs and to conflict with the author’s awareness (evident in what ensues) of the central position of the heart. Ermerins suggests ‘turned to the right and to the left’, on the supposition that a phrase has been lost; Cornarius’ tentative emendations (see apparatus) would give a similar sense, ‘turned to both sides’. Triller ingeniously // moots τετραμμνος )ς τ’ ρυστ ρα, ‘adapted to drawing’, on the grounds that the purpose of the lungs is inhalation; it is not clear whether he intended τ’ to be particle or elided neuter plural article; but neither is possible Greek. (Van der Linden’s emendation τετρημνος ‘pierced’, for τετραμμνος, ‘turned’, is to be rejected, as it would anticipate τενρηνι5δης, ‘honey-combed’, if, as is likely, this is to be read 8

Hence Triller tr. ‘coadimplet’, following Cornarius in preference to Foesius’ ‘implet’. Τρπεσαι is a common verb of orientation in the body, not only of bodily parts; but also of disease, pain, bile, phlegm, etc. 9

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below; and description of the position of the lungs is more appropriate here than description of their appearance.) Littré rejects any emendation, on the grounds that in ancient anatomical texts there is room for ‘les erreurs materielles et les fausses opinions’. But there are two other possibilities. (i) The text is sound and the author not in error. As noted above, the author implies there is only one lung; and viewed in this way the lung may be regarded as ‘turned to the left’: there is a more acute angle on the left side than on the right, due to the position of the heart (see GA 1286), so that (GA 1290) the right lung is ‘shorter’— though ‘broader’—than the left. We may then retain the manuscript reading and translate ‘inclined towards the left’, ‘deflected to the left’. (ii) A phrase describing the position of the heart has been misapplied to the lungs, possibly through telescoping of a source. Cf. the description of the human heart, contrasted with that of other creatures, μικρCν ε,ς τ/ ε5νυμα παρεκκλνουσα, Arist. P.A. 665b–666b. πντε @περκορυφ5σιας: the term @περκορυφ5σις occurs only here applied to the eminences or elevations of the lung (λοβο) and of the liver (π#λαι); it implies a simple form κορυφ5σις, not found either. The word is thus doubly recondite, prefix being added to rare or invented form. κορυφ occurs frequently in the HC as elsewhere with the meaning ‘top’, as of bladder, 5 below; and especially as crown of head, as Loc. Hom. 3 [6.280 L.]; but the only usage of κορυφ similar to this passage, and the affinity is striking, is in the description of vessels in the region of the liver, one said to pass δι/ τν κορυφν κα το6 δρματος ‘between the tops [of the lobes] and the skin’, Oss. 18 [9.194 L.]. iς δ= καλουσι λβους: this is the first of five comments on nomenclature in Anat.: here, projections of lung; cf. projections of liver iς καλουσι π#λας, oesophagus oν δ= κα )π σηπτικ ς κοιλης στμαχον καλουσιν, intestine o καλουσιν &νιοι κλον, and the vessel μεγ(λη καλουμνη.

With this information there is clear awareness of possible variation in terminology (&νιοι ‘some’) and perhaps of etymological rationale for terminology (especially if the emendation )πισημαντικς or )πισμως is adopted, 8). The author is setting out the accepted terminology, which ‘they’ use, with a slightly didactic tone (δ, δ= κα). τεφρνης χροης τυχ5ν, στγμασιν ρφν5δεσι κεκεντημνος, φ#σει )<ν τενρηνι5δης: the appearance of the lung is described in three succes-

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sive participial phrases loosely strung together, the first two relating to colour and the third to ‘nature’, ‘character’ (here perhaps close to ‘texture’). (i) The first description ‘ashen’ is clear. Although τφρινος is a hapax, the word τφρη ‘ash’ occurs in the gynaecological treatises of the HC. (ii) The second description is textually uncertain. The word στγματα ‘spots’ (glossed Hsch. ποικλματα) is not used elsewhere in the HC and κεκεντημνος, ‘punctuated’, lit. ‘pricked out’, is metaphorical, though readily understood; it is used of the pricking of pain Morb. 2.59 [7.92 L.]. The adjective ρφοναγσιν is not credible Greek; palaeographically, the slightest change mooted (by Triller) is to ρφναγενσιν // or ρφνογενσιν supposed to be equivalent to ρφν5δεσιν. But Triller himself rejects these fanciful forms in favour of Foesius’ ρφν5δης. The various conjectures ρφν5δεσι (Foesius), φρ5δεσι (van der Linden), φρυεσι (Littré)—all reasonably close to the non-word ρφοναγσιν—mean, respectively, ‘dark’, ‘foamy’, and ‘protruding’. Of these the first seems anatomically best and alone is paralleled in the HC, Progn. 24 [2.184 L.], of darkness before the eyes.10 (iii) In the third phrase, the word division τ* ρηνι5δης has otiose and misplaced τ; and the single word τερηνι5δης ‘like ash’ merely replicates ‘ashen’ just before. Foesius’ emendation τενρηνι5δης ‘honeycombed’ gives an unusual word, in keeping with the author’s elaborate vocabulary. It is attributed to Demokritos, in zoological and embryological writings (DK 68 A 155, citation from Ael. HN 12.20, on the formation of horn). Hsch. glosses τερηνιδες πολ? κα κενCν κηρον, κα ραιν. The most salient characteristic of the lung is generally thought to be its spongy texture; cf. Oss. 13 [9.186 L.], V.M. 22 and many later medical writers, including Celsus 4.1.3 [1.626 L.], ‘spongiosum’. 3. The author is correct that the heart is ‘in the middle of the lung’ (i.e. between the lungs), but the allegation that the human heart is peculiarly round cannot be sustained. The heart is in fact neither round, nor heart-shaped; but rather amorphous, or somewhat pouch-shaped (GA 697 fig. 678). The reference to the two descending parts (βρογχη πολλ= … κα φλψ μεγ(λη) is probably to the prominent vessels, the aorta and vena cava: see GA 1415, fig. 1230.

10 As Foesius translated ‘notis cavernosis compunctus’, it seems that he finally elected to emend with a word meaning ‘cavernous’, perhaps ντρ5δης.

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)γκαδρυται: this compound does not occur elsewhere in the HC, though the simple δρ#ω is common, often used of a bone ‘sitting’ in place, Fract., Artic.; and there are seventeen other Hippocratic )γκατα-

compounds.11 The sense of the verb here is close to that in Ep. 23 [9.394 L.], συνδρυται of eyes (cf. )γκαμενοι, of eyes, Epid. 2.2.24 [5.96 L.]), )νιδρυσμνοι of kidneys and )νιδρυσμνη of bladder,12 and also the notion of the heart as ‘ruler’, καρδη βασιλς. Cf. also the descriptions of the heart )νδρυται … ;ς )κ παντCς το6 σ5ματος τ/ς νας &χουσα, Oss. 19 [9.196 L.]; and περ μσον … )ν γ/ρ το7ς τιμιωτροις τC τιμι5τατον καδρυκεν  φ#σις, Arist. P. A. 665b–666b.13

στρογγυλωτρη … π(ντων ζ"5ων: the Greek expression is slightly illogical; lit., ‘rounder than all creatures’. Hence Ermerins suggests π(ντων τν )ν ζ"5"ω (i.e. ‘of all animal organs’). But there is a compendious

comparison (cf. ‘hair like the graces’, sc. the graces’ hair); and in ‘all creatures’, ‘other’ is readily understood, i.e. ‘rounder than that of any other creature’. Similar comparisons are made below, 4 and 5. For this universal anatomy, cf. τοσο6τον )ς τCν 1νρωπον ποδεξω κα τ/ 1λλα ζ"α, Carn. 1 [8.584 L.]. The alleged roundness of the human heart may be based simply on a view that roundness is a ‘good’ state; cf. Pl. Ti. 33 b, c, the κσμος is spherical because the // sphere is the most perfect of shapes; circular motion is connected with rational activity. Other descriptions of the heart are: σχ μα μ*ν 'κοη πυραμς, Cord. 1 [9.80 L.] and κωνοειδς Ep. 23 [9.394 L.]; but ‘somewhat rounded’, Arist. H.A. 496. βρογχη πολλ= … φλ*ψ μεγ(λη: two links between heart and liver are

indicated. But the terminology is opaque and the brevity and baldness of this text of uncertain date and context renders identification problematical. First, it must be stressed that there is no particular emphasis on the links: the author is simply describing the area between heart 11 The verb )γκαιδρ#ω is common in post-classical, especially ecclesiastical, writers (Ibycus, TLG: 47 occurrences, headed by 7 in Nicephorus Gregoras,); but there are good fifth century antecedents. Euripides uses it of establishing a cult image, λαβε7ν 1γαλμ’ gΑηνν τ’ )γκαιδρ6σαι χον, I.T. 978 and employs καιδρ#ειν with similar nuance, I.T. 1481; cf. also Ba. 1339. 12 So earlier editors; but Smith (1990) corrects to )νδρασμνοι and )νηδρασμνη. 13 For the compound verb, there is a parallel in a Demokritean citation, with regard to dream images ‘deeply penetrating’ the body )γκαταβυσσο6σαι τ/ ε8δωλα δι/ τν πρων ε,ς τ/ σ5ματα, DK 68 A 77 = Plu. Mor. 734 f.

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and liver. There is no indication that either heart or liver is peculiarly important in bodily function. The two links are: (i) βρογχη πολλ and (ii) φλ*ψ μεγ(λη καλευμνη, by which the whole body is nurtured. βρογχη is any tube (commonly but by no means exclusively the aorta) or system of tubes (commonly the bronchial tubes); and πολλ may mean ‘many a’ or ‘big’ (cf. Hsch. πολ? γ/ρ ντ το6 μγα). φλ*ψ μεγ(λη commonly refers to the vena cava; but the term could be simply general and descriptive rather than technical and specific. If  were to be added, the technical use would be certain, but nothing can be deduced from its omission in this terse work. On τρφεται as a possible aid to identification, see below. Other descriptions (in different authors of different dates) of the aorta are as ρτηρη μεγ(λη, μεγστη, ρ, παχε7α, πνευματικ, and of the vena cava are as φλ*ψ κολη, κοιλοτ(τη, πατ7τις. But the vena cava is sometimes designated ρτηρη, perceived to be different from the other φλβες (by reason of its character, economically described by Triller ‘cum ratione tunicae, tum ratione motus et pulsus’) and Galen uses the term μεγ(λη (with or without the addition πρCς π#λας) for the portal vein, which is, after the vena cava, the body’s largest. The identification which best fits the tenor of the treatise, with its careful attention to location and strict paring down to essentials is as follows: (i) =aorta and (ii) = vena cava, with πολλ and μεγ(λη synonymous, and the difference between the adjectives only a matter of stylistic variatio. This seems the simplest interpretation, consonant both with the Greek text and the salient anatomical ‘links’ in the thoracic cavity. And cf. the very similar δ#ο γ/ρ ε,σι κο7λαι φλβες πC τ ς καρδηςE τ+ μ*ν οIνομα ρτηρηE τ+ δ* κολη φλψ, Carn. 5 [8.590 L.]. Here too the statement that vessels ‘come from’ the heart may be a matter of simple observation, not necessarily precluding the view that (other) vessels ‘come from’ the head. Aristotle orders his material similarly (transition from heart to vessels, P.A. 667b) but the tenor is very different, as the fundamental importance of the heart is recognised; as also in the sophistic treatise on nutriment, Qζωσις φλεβν Tπαρ, Qζωσις ρτηριν καρδηE )κ το#των ποπλανVται )ς π(ντα αJμα κα7 πνε6μα κα ερμαση δι/ το#των φοιτYV, Alim. 31 [9.110 L.].14 // 14

But several other identifications have been canvassed: 1. (i) = ducts and (ii) = vena cava. The βρογχη πολλ of the mss is taken by LSJ to be an imaginary system of ducts connecting the heart with the liver; similarly Littré translates ‘beaucoup de tuyaux’. Harris (1973), pp. 82–83 is impressed by the contrast between βρογχη πολλ and the great vein; and translates ‘many a bronchia [= artery?]’ finding here ‘a double system of blood vessels centred on the heart, with veins and

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δι’ Tς οUλον τC σκ νος τρφεται: the word σκ νος is used four times elsewhere in the treatises of the HC: 1, of premature infants (σκνεα Hπτ(μηνα—emendation of codd. σκινσα Septim. 1 [7.436 L.]), 2 = 3 of a body after death (τC το6 σ5ματος σκ νος Hebd. 52 [8.673 L.] = Aph 8.8. [1.402 L.]); 4, ο πταμοι ν/ τC σμα, το7σιν 1ρδεται τC σκ νος Cord. 7 [9.84 L.], as well as in the [Demokritean] letter, Ep. 18 [9.384 L.], ολομελην το6 σκνεος. In all these instances, the word is the body either in the abstract or in its non-living state (before birth or after death). The term is much used by Demokritos: DK 68 A 152 = Ael. N.H. 6.60 of the embryo; B 37, B 57, B 187, B 223, B 270, B 288 (all Stobaios citations), of corporeal opposed to mental or spiritual being.15 The statement that the whole frame is nourished or nurtured by the great vessel opens up further problems. The verb may allude to the common conception of blood passing to different parts of the body and distributing nourishment as needed. For this common idea, cf. [vessels] α τρφουσι τ/ς σ(ρκας, Loc. Hom. 3.6 [6.282 L.]; also the vessel τρφιμς τε κα &ναιμος which τρφει τCν μυελν, Oss. 16 [9.190 L.]. The conception that the vena cava played an important part in this life-giving process might have arisen from the observation that the vena cava collapses on death. arteries clearly distinguished’. But the trouble with this is that even if βρογχη may represent a plurality, φλψ (μεγ(λη) does not; and it is hard to extract a ‘system’ from a tube; also the vessels are not ‘centred on’ the heart, but merely leading from it. In short, a distinction between veins and arteries cannot be read into this bald text. 2. (i) = vena cava and (ii) = aorta. Objection: aorta is rarely described as φλψ, though for this designation, cf. Carn. 5.2 [8.590 L.], quoted above. 3. (i) = vena cava and (ii) = portal vein. Triller compares Aristotle’s προσπεφ#κασι γ/ρ τ" [πατι αPται δ#ο φλβες μγισται  μ*ν καλουμνη π#λη,  δ* κολη and, while admitting that vena cava is usually that called μεγ(λη, argues that πολλ (‘spatiosam, amplam, maximam’) may here be a substituted descriptive term. 4. (i) = (ii), both refer to vena cava, with emendation of βρογχη to βρυχη (adj., ‘deep’). This is the emendation of Caspar Hoffman adopted by van der Linden (see apparatus). Objection: Greek is awkward, and anyway there is no real need to emend. 5. (i) = vena hepatica and (ii) = vena cava inferior. Ermerins (taking his starting point from van der Linden, who however restricted the reference to a single deep vein, the great vein) reads  μεγ(λη and supposes the reference is to two veins, the vena hepatica and the cava inferior. Interpretations 3, 4, 5 seem open to the fundamental objection that the location is too low in the body to be right; 2 is terminologically awkward; 1 presses the Greek into excessively advanced anatomical knowledge. 15 It occurs many times in Ti. Locr., a précis of Pl. Ti. preserved in some Platonic mss, apparently (so Taylor ed., 1928) in an attempt to give a superficial Pythagorean colouring to the work. It becomes extremely common in post-classical Greek, for instance in Eusebius (Ibycus, TLG).

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But if the author is here working from an aborted foetus, a particular vessel which linked via umbilical cord to placenta, might seem to ‘nourish the frame’.16 Cf. the notion expressed that nutriment is breath in the lung, food in the belly while  δ* ρχαιοτρη τροφ= δι/ το6 )πιγαστρου +T ' μφαλς, Alim. 30 [9.110 L.]. 4. The author describes the situation and character of the liver, also the number of lobes. Cf. GA 1400, ‘The liver … is situated in the upper and right parts of the abdominal cavity … owing to its great vascularity, wounds of the liver cause considerable haemorrhage. … The liver is divided … into a large right and a much smaller left lobe.’ Once again, there is no doubt that human anatomy is being discussed. The liver varies greatly in character in different kinds of animal; the horse liver has three lobes; the ox only one distinct lobe; the sheep is similar; the pig has four main lobes and the dog six or seven lobes (BVD, s.v. ‘liver’). The slanting vessel // is probably to be identified with the portal vein, which conveys blood to the liver from the intestines (GA 854 and 855, fig. 787); it follows the downward course here implied and overlies (is anterior to) the vena cava. Another candidate is the splenic artery which is ‘remarkable for the tortuosity of its course’ (GA 779), but this goes across the body rather than downwards. 'μορυσμην μ*ν &χει το7ς 1λλοις jπασιν, α μορρωδστερον δ )στι τν 1λλων: the second half of the sentence qualifies the first half; the liver is similar (μν) in general to the livers of all other animals, but different (δ) in relative ‘bloodiness’.17 Cf. Aristotle τ/ δ* [πατα τν τετραπδων κα τν ":οτκων κα τν ,χ#ων &νωχρα τν πλεστων, P.A. 673b29; also Herophilos on the liver οχ 'μοως … οχ μοιον … )ν jπασιν

16 Triller’s emendation (above n. 14.3) has some such rationale: the umbilical vein by which ‘revera infantis corpusculum nutritur’ could readily be associated with the portal vein. However, Triller does not exclude the vena cava in this connection; and the latter is rendered likely by the fact that the course of blood from placenta is through umbilical vein to ductus venosus to inferior vena cava; before, at birth, the ductus venosus collapses with the collapse of the umbilical vein; see C.W.F. Burnett, The Anatomy and Physiology of Obstetrics (London, 1953), pp. 129–134. It is not impossible that there was some observation of this if the aborted foetus was examined (though observation of the ductus venosus is not recorded until the sixteenth century). 17 Triller’s emendation [πασιν ‘to all other livers’ is made on the grounds that the human liver, though resembling that of some animals, such as cow and sheep, is not like that of all other creatures; but this objection seems to be met by the qualification in the second part of the sentence.

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(von Staden, 1989, 182–183). An alternative interpretation is possible: ‘to all other organs of the body’. Aristotle comments that heart and other organs all have α ματικ= φ#σις and are α ματικ/ τ=ν μορφν, also that the spleen is α ματωδς (P.A. 647a, 670b); but he regards the heart as even more ‘bloody’ than the liver, τC δ* [παρ α ματικ5τατον μετ/ τ=ν καρδαν τν σπλ(γχνων (P. A. 637b). In view of the author’s stress on comparative anatomy, the former interpretation is preferable. For the bloody character of the liver, cf. &ναιμον, V.M. 22 [1.632 L.]; πολυαματον, Empedokles DK 31 B 150 = Plu. Mor. 683e. The bloody nature of the liver might be perceived without the theory that it was crucial in the distribution of the blood through the body. The associated vein is  α μρρους  παχεη καλεομνη φλψ as Oss. 7 and 12 [9.172, 182 L.]. Of fifteen instances of α μρρους in the HC, four are in Oss. 7 and 12 [9.172, 182–184 L.]. α ματωδς is more common, with seventythree occurrences in the HC; but is applied to wounds, not to vessels. @περκορυφ5σιας &χον δ#ο, iς καλουσι π#λας: the projecting parts here

called ‘gates’ are more commonly called ‘lobes’ (as in the case of the lung), while the term ‘gate’ is normally applied not (as here) to an eminence, but to a depression or indentation, especially the fissure through which the portal vein enters (see von Staden, 1989, 229). There are several such indentations, the two main ones being the points of entry of the vena cava inferior and the portal vein (GA 1405, fig. 1221). The term ‘gate’ is dismissed by Rufus as appropriate to augury, not to human anatomy (and the distinguishing features of animal livers were well known from minute examination in the course of augury following animal sacrifice; of all the organs it must have been most generally familiar—see e.g. E. El. 828 sqq.); Rufus also states that the term ‘gates’ was applied by ‘old doctors’ to the attachment to the vena cava inferior (Anat. 28, 175 DR). It is possible that the odd terminology is the result of drastic summarization: the excrescences have been given the name gates, instead of lobes, while some description of gates is lost. Differentiation is clearly implied Oss. 10 [9.180 L.] = Epid. 2.4.1 [5.122 L.] )π π#λας κα λοβν, and cf. Pl. Ti. 71c1–2 λοβν … δοχ(ς … π#λας. Hsch. has both terms: π#λαςE )κτροπ(ς and λβιονE τC 1κρον το6 [πατος. The number of lobes is variously given. Rufus believed there were four or five. Whereas in Oss. 10 [9.180 L.] a single lobe is envisaged, it is clearly stated in Oss. 1 [9.168 L.] that there are five ([πατος πντε λοβο) and in Oss. 18 [9.192 L.]—as here in Anat.—that there are two (in the expressions τCν δεξιCν λοβCν τCν πατια7ον and μεταξ? δ#ο λοβν). The [page 149]

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minor // excrescences of the caudate lobe and the quadrate lobe (GA 1405, fig. 1221) perhaps confused the issue; but inspection of different species would lead to different conclusions. )ν δεξοις τποις κεμενον: κεμενον (neut. sg.) is Ermerins’ emendation of κειμνας (fem. pl.) and makes the liver lie on the right of the body, rather than the ‘gates’ on the right of the liver. The general statement is in accord with the rudimentary anatomical description of the text.18 σκαλνη φλ*ψ )π τ/ κ(τω νεφρν ποτενουσα: the adjective, not used

elsewhere in the HC, is used by Demokritos (so DK 68 A 37 = Simp. in cael. 294.33, and, allegedly based on Aristotle, 132 = Thphr. C.P. 67.2); and is extremely common in a wide range of other authors of all dates. Hsch. glosses by σκλιον, πολ#γωνον.19 The expression τ/ κ(τω is compressed, sc. μρη. The compound verb is used only twice in the HC, here and (in a temporal sense) Epid. 4.7 [5.146 L.], though both τενειν and ποτενειν are very common.20 5. The author describes the kidneys, of which (GA 1418) ‘The cortical substance is reddish-brown in colour’. The ureters are correctly described as slanting, each being (GA 1422) ‘a thick-walled, narrow, cylindrical tube which … runs downwards and medially’ and ‘crosses’ various parts before (1423) ‘finally the ureters run obliquely through the wall of the bladder’. The position of the ureters relative to each other varies from 2.5 cm to about 5 cm, according to whether the bladder is contracted or distended (GA 1429); and their position relative to 18 Triller, keeping κειμνας, argues that the phrase does not relate to location at all, either of the organ or of its gates, but to function: in his view δεξις means not ‘dexter’ but ‘receptorius, acceptorius’, from root δχομαι and describes the place which receives ‘succum chylosum’ and puts it in the receptacle of the liver. There is some slight support for this ingenious idea from Hsch. s.v. δεξςE τν )ν τ" [πατι μερν παρ/ το7ς #ταις καλουμνη δξη; and perhaps from Hsch. attribution to Demokritos of usage of the verb to describe blood vessels δεξαμεναE )ν τ" σ5ματι φλβες Δημοκρτου (DK 68 B 135). However, Triller’s interpretation is to be rejected for these reasons: δεξις is so familiar in other senses, τποι clearly suggests a definite location in the body (cf. title of Loc. Hom.); and the writer of this treatise is concerned throughout with description, not with function. 19 Triller regards this vessel as the descending vena cava (λοξν Galen de ven et art diss.); but a vessel other than the ‘great’ one, argued above to be the vena cava, seems intended. 20 There is some usage of ποτενειν in Aristotle and Plato and much in later Greek; it is favoured by Joannes Chrysostom, Galen, Eusebius, and Simplicius (Ibycus, TLG).

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the internal urethral orifice varies correspondingly. The author regards the ureters as reaching the top of the bladder, in accord with his topto-bottom presentation of anatomy. As their actual position (GA 1425, fig. 1243) is rather reaching the ‘edge’, the translation ‘top edge’ is appropriate. νεφρο δ* 'μοιορυσμο, τ=ν χροι=ν δ* )ναλγκιοι μλοισιν: as in the case of the liver, it is not immediately clear what is meant by the ‘similarity’ of the kidneys; 'μοιορυσμο, sc. ε,σι = (of the liver) 'μορυσμην &χει. In view of the apparent stress on comparative anatomy, the most likely explanation is ‘like the kidneys of other creatures’; cf. the observation of Aristotle (correct only of the unborn infant in utero) that human kidneys are μοιοι … το7ς βοεοις … οχ 'μαλε7ς Wσπερ ο τν προβ(των κα τν 1λλων τν τετραπδων, P.A. 671b. But other possibilities are: ‘like each other’ (as they obviously are) or ‘like other organs’; cf. κα εRδος καρδης ο νεφρο &χουσιE κα οPτοι κοιλ5δεες, Oss. 4 [9.170 L.]. Comments on shape and colour are // pervasive in such descriptions; cf. Rufus, σχματι περιφερε7ς, χροιYV φακ5δεις, Anat. 51, 181 DR. Here, the ensuing comparison helps to resolve the question. Whereas in the case of the liver the ensuing phrase qualifies the likeness, in the case of the kidneys it amplifies: the kidneys have a similarity to those of other creatures, and further in colour they are like sheep, i.e. (in another compendious or compressed comparison) the kidneys are like [those of] sheep in colour. Cornarius, Foesius, and van der Linden all took τ=ν χροιν with 'μοιορυσμο, i.e. ‘renes vero colore inter se similes’ (Foesius tr.) and continued by understanding the ensuing comparison with reference to apples, ‘malorum speciem prae se ferunt’ (Foesius tr.). Clearly, their translation is based on the perception that the kidneys are like apples in shape, rather than in colour; but necessitates deletion of δ. The interpretation of the ambiguous μλοισιν as ‘sheep’ not ‘apples’ begins with Triller;21 it greatly aids the sense and it may now be noted that in the HC the sense ‘sheep’ predominates over the sense ‘apple’ (15 to 12). The noun sometimes refers to animals generally, as Hsch. notes μ λαE κοινς μ*ν π(ντα τ/ τετρ(ποδα, κατ’ )πικρ(τειαν δ* τ/ πρβατα κα αRγες. Erotian refers the cognate adjective to sheep, Σ 56, στατι μηλε"ω ντ το6 προβατε"ω. μ λα γ/ρ τ/ πρβατα. Treatment by mutton fat, Nat. Mul. 32 21

The interpretation is commended by A. von Haller, Bibliotheca Anatomica (Zurich 1774–1777), vol. 1, p. 20. Triller’s emendation of μλοισιν to μηλεοισιν is not necessary; though it would render the animal sense certain rather than probable.

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[7.366 L.] etc. and by boiled mutton, Morb. 2.69 [7.106 L.] etc. are described by use of the word. )ναλγκιοι is epic and exclusively poetic, cf. Parmenides DK 28 B 8. 43 = Simp. In Ph. 144.29. It serves as a synonymous alternative to 'μοιορυσμο, also used in a simile, 9 below. The variatio avoids immediate repetition in a single sentence.

χετο σκαληνοειδες )ς 1κρην κορυφ=ν κ#στιος κε7νται: Hsch. and Suda gloss χετς as σολν. Elsewhere the ureters are προι or occasionally φλβες. The preposition, added by van der Linden, is required. In a very similar expression of progress from larynx to bladder, fluid is said to go )ς 1κρην κ#στιν, Oss. 1 [9.168 L.]; cf. also Rufus, προι κατ/ κορυφ=ν κ#στεως συν(πτουσι.

6. The author completes the downward description with a brief account of the bladder and its outlet. νευρ5δης οIλη κα μεγ(λη: cf. ‘vesica nervosa’, Celsus 4.1.11. The adjective οUλος is an epic and Ionic (though not in Herodotos) form for λος

‘all’.22 μσα σχα: the emendation suggested is based on V’s reading, unknown to Littré and others, who based emendations on the corrupt recc.23 It gives the required sense, completing the description of the trunk (cf. Rufus, thorax extends πC κλειδν // μεχρ τν α,δοων): some reference to the final point outside the body is required, by analogy with 11 below. ‘Centrally’ is in accord with the constant reference to the position of the bodily parts throughout. σχα is palaeographically close to V; but other candidates, giving similar content, might be ρχεις 22 Triller punctuates κ#στις δ* νευρ5δης, οIλη, κα μεγ(λη, tr. ‘vesica quae nervosa, constrictiva est et expansiva’. There is some force in his assertion that ‘res … ipsa id postulat’; but the parallels for this extraordinary meaning attributed to οIλη are not altogether convincing: Hsch. glosses s.v. οUλοςE συνεστραμμνος and scholiast Ar. Ran. 1067 οUλον associated with ε8λειν, ε,λε7ν, viz. ‘coarctare, complicare, in angustum cogere’. 23 Earlier emendations (see apparatus) may be briefly considered: the interpretation of Triller (with reference to the sphincter, tr. ‘The constriction of the bladder is deep within’) involves a level of detail out of keeping with the rest of the treatise; that of Littré (tr. ‘From a distance is the working of the bladder for the purpose for which it exists’) involves obscure sense and unidiomatic expression; that of Ermerins (tr. ‘From the bladder there is a channel outside’) gives good sense, but is very distant from the mss. (Triller emends on the basis of Galen’s gloss &γκαςE )ν β(ει and interprets on the basis of the Suda μετοχE ' περβολος—i.e. ‘ambitus, circulus, orbiculus’, commenting ‘in ima vesicae parte sive cervice, orbiculus quidam, sive orbicularis est ambiens quidam musculus a natura formata est’.)

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(cf. the course of the vessels )ς το?ς ρχιας κα )ς τCν ρχν, Oss. 17 [9.192 L.], and )κ δ* σ5ματος κρεμαστο )κτCς ο,κην νμονται … ρχεις, Ep. 23 [9.396 L.]) or 8σχιον, e.g. ρχε7ς μσοι πεφ#κασιν or μετ/ (‘after that’) 8σχια πφυκε (cf. ,σχ"ω στμα, Ep. 23 [9.396 L.]). Or if a reference to the urinary tract is postulated, we might consider χετς, e.g. νκαεν )κ κ#στιος χετCς πφυκε. Or the adverb κ(τωεν may be lost (cf. κ(τωεν το6 μφ(λου, Aff. 15 [6.224 L.]). In any case, reference as throughout is primarily, and probably exclusively, to the male body. 7. The author sums up the previous description: the six parts are apparently trachea, lung, heart, liver, kidneys, bladder; and τ/ μ*ν Dξ in 7 seems at first sight to correspond with τ/ δ* 1λλα in 12. Seven, not six, was a significant number for Pythagoreans and others. In the numerology of anatomical lists, seven is regular; six is quite anomalous. If not fortuitous, it may result from a deliberately paradoxical count, or more probably from counting the kidneys as one, instead of as two. The list of seven vital organs (σπλ(γχνα) was typically tongue, heart, lung, liver, spleen, two kidneys; the bladder included here would normally belong rather in a list of organs transporting food and breath. While this kind of listing is particularly common in post-Posidonian literature,24 there are pre-Socratic antecedents also; and in the HC see especially Carn. (where heart, lung, liver, spleen, and kidneys form a group, 5–9 [8.590–596 L.], as do trachea, oesophagus, belly, and intestines, leading to bladder and rectum, 3 [8.586 L.]). να μσον, )ντς: the two phrases are in apposition, and  )ντCς φ#σις is not intended. Similar prepositional expressions are used in Oss.: κατ/ μσον, 10, κατ/ τC μσον, 12, )ς τC )ντς, 16 and cf. )ντς, 17 [9.180, 182,

190, 192 L.].

φ#σις )κοσμη: the concepts κσμος and φ#σις are ubiquitous in philosophical and scientific writing, with subtly changing senses and nuances. One expects the allusive phrases φ#σις )κοσμη, 7 and  φ#σις διετ(ξατο, 12 to be parallel statements, giving parallel conclusions. But there are two differences: the omission of the article in 7, though this may be insignificant in the context of this bald work, where the article is commonly absent; and the change from the passive voice in 7 to the 24 On such lists, and their possible importance as a source for Hebd., see Mansfeld (1971), pp. 197–202.

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middle in 12. (A small and tempting emendation from διετ(ξατο, which must be aorist middle, to διετ(σσετο, which is ambivalent as imperfect middle or passive, would eliminate the latter problem; the change from aorist passive to imperfect passive would be much less troublesome to consistent sense than the change from passive to middle form.) The sense in 7 seems to be ‘the body’, ‘the bodily organism’, concrete, i.e.  )ντCς φ#σις sc. το6 σ5ματος; for which cf. τα6τα δ* π(σχει δι/ τ=ν φ#σιν το6 σχματος, VM 22 [1.630 L.] and especially two passages αPται πηγα φ#σιος νρ5που and &στι δ* ργανα το7σιν  φ#σις cρπ(ζει τCν ρα, Cord. 7 and 8 [9.84 L.]. It approaches the somewhat more abstract sense, ‘bodily nature’, evinced for example Hebd. 5 [8.636 L.] // (human); Artic. 13 [4.116 L.] (human vs. animal); Nat. Mul. 1 [7.312 L.] (female); and is at some great distance (though there is commonly a microcosm ~ macrocosm analogy) from the wide sense of such passages as φ#σιν δ* π(ντων εο διεκσμησαν, Vict. 1.11 [6.486 L.]. See further on 12 below. 8. The author here starts again (similar descriptions of ‘origin’ and ‘end’ of oesophagus as of trachea); and goes on to give a rudimentary description of the digestive process, 8–11. The description is anatomically correct. ‘The oesophagus, or gullet, is a muscular canal … extending from the pharynx to the stomach. It begins in the neck at the lower border of the cricoid cartilage’ (GA 1340 and 1341, fig. 1167). The implied physiology is, however, mistaken: the oesophagus is apparently seen as the start of a parallel process of ingestion and excretion: air (and, presumably, some fluid) via trachea ~ food via oesophagus. ο,σοφ(γος: the term occurs also Loc. Hom. 3 and 20 [6.282, 312 L.]; but not elsewhere in the HC.25 Galen’s gloss (19. 125 K.) probably relates to Loc. Hom., not, as Foesius supposes, to Anat. The more usual term for oesophagus is the second given here, στμαχος, e.g. Cord. 2 [9.80 L.], Alim. 25 [9.106 L.], Morb. 4.56 [7.608 L.]. This occurs already in Homer (κατ/ στομ(χοιο μελα ‘base of neck’, Il. 17.47; cf. Il. 3.292 and 19.266, throat of sacrificial victims). Rufus cites both terms "p δ* τ/ στια κα τ/ ποτ/ ε,ς τ=ν κοιλαν κ(τεισι, στμαχος κα ο,σοφ(γος Onom. 157, 155 DR.26 The derivation is doubtless (Irigoin, 1980) from ο8σειν + φαγε7ν, i.e. ‘transporting what is eaten’. 26 In the HC, the term στμαχος is applied also to the mouth of the womb. Only 25

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)ς κοιλην … )π σηπτικ ς κοιλης: Erotian K 35 defines κοιλη as πVσα  το6 δι(φραγμα ερυχωρα, κα  το6 5ρακος δ* )νοτε. κα  γαστ=ρ ατ. Usage with reference both to upper cavity (chest) and to lower

cavity (abdomen), these being separated by the diaphragm, is ubiquitous in the HC. The sense of the preposition )π is unclear; it is either ‘towards’ (LSJ I.3b and c), or ‘in respect of ’ (LSJ III.4). The idea that digestion involved putrefaction—food being digested by a putrefying process and nutriment then conveyed to the liver for conversion into blood—was commonly associated with Empedokles (τ/ς πψεις τ ς τροφ ς φασι γνεσαι … gΕμπεδοκλ ς δ* σψεις, DK 31 A 77 = Galen de def.med., 19.372 K.); Galen regarded it as old-fashioned, δηλοντι παλαι( τις Lν συνεια το#τοις το7ς νδρ(σιν 1σηπτα καλε7ν jπερ με7ς 1πεπτα λγομεν (DK ibid. = in Hipp. Aph. 6.1, 18A.8 K.; cf. also  δ* πψις &οικεν εRναι σ ψις ;ς gΕμπεδοκλ ς μαρτυρε7 … DK 31 B 81 = Plu. Quaest.Nat.

912c; cf. DK 31 B 61 = Simplicius; and see Longrigg, 1993, 74). There are further traces of this notion in the expression στια 1σηπτα ‘unputrified food’ occurring in Aff., Vict. 3, Morb. 1. Emendations to )πισμως or )πισημαντικς are therefore unnecessary. The idea of putrefaction was important in early Greek attempts to explain change and development of various kinds, including the formation of the world and animal life (Demokritos, DK 68 B 5 = Diod. 1.7.3; cf. Carn. 3 [8.586 L.], also Pl. Phd. 96b). In medicine, the proper healing of wounds and maturation of illnesses depended on the formation and expulsion of pus or similar matter (e.g. Loc. Hom.). // 9. The locations of diaphragm and of spleen are cursorily and somewhat inaccurately indicated. The author does not know, or does not care, about the precise inter-relation of these anatomical features, being concerned only with general proximity. ‘The diaphragm is a domeshaped, musculofibrous septum which separates the thoracic from the abdominal cavity, its convex upper surface forming the floor of the former, and its concave upper surface the roof of the latter … The muscular fibres may be grouped according to their origins into three parts— sternal, costal, and vertebral’ (GA 567). While the diaphragm might be described as ‘coming from’ the backbone, in the sense that the vertebral part is linked with the lumbar vertebrae by two pillars or crura (GA 568), this is scarcely its salient positional feature and it is connected later, as in NT, Soranus, and Galen, did the word take over as ‘stomach’, a sense firmly fixed in Latin and hence modern European languages.

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equally with ribs and with sternum. Furthermore, the diaphragm certainly lies above, not behind, the liver. The spleen ‘is situated principally in the left hypochondriac region of the abdomen … lies between the fundus of the stomach and the diaphragm’ and is ‘of an oblong flattened form’ (GA 1476). With correction and amplification of the text we might state that the diaphragm separates the spleen from the left lung and pleura, and from the ninth, tenth, and eleventh ribs. πρCς δ* κ(νης πισεν [πατος φρνες πεφ#κασι: the term 1κανα is properly the backbone or spine, for which the general Q(χις ‘back’ is

commonly used. The former term occurs in Artic. and Mochl. but rarely elsewhere in the HC (apart from Oss.—fin., but not init.—only in Morb. 2 and Mul. 1). Demokritos uses the word in a riddling sentence, )ν γ/ρ ξυν" ,χ#ι 1καναι οκ &νεισιν DK 68 B 151 = Plu. Sympos. 643c; cf. also Diog. Apoll. DK 64 B 6 = Simp. In Ph. 153.13. The account in Anat. seems to be a garbled version of material which is much more clearly presented elsewhere in the HC: Tπαρ … φωρμκει σμικρCν κ(τωεν φρενν. φρνες δ* προσπεφ#κασι τ" [πατι iς ο Qηδιον χωρσαι Epid. 2.4.1 [5.122 L.]; verbatim also in the account of Oss. 10 [9.180 L.]. The liver was generally described as ‘below’ the diaphragm, as already by Homer, Tπαρ @πC πραπδων (Il. 11.579; cf. von Staden, 1989, 228). The term φρνες, applied to the lung in Homer (Onians, 1952), later denotes the diaphragm, important in the respiratory function, as well of course as the thinking faculty. )κ δ* πλευρ ς νης, λγω δ* ριστερ ς, σπλ=ν ρξ(μενος τταται: Aris-

totle linked the spleen with the liver, and described the location of both with reference to the diaphragm: (liver below the diaphragm on the right, spleen on the left) H.A. 496b15 and (spleen a false liver) P.A. 669b28. The two are treated as parallel also by Rufus (spleen and liver below lung, liver on right and spleen )ναντως ττακται το#τ"ω) Anat. 28, 175 DR; cf. also the description of the spleen, πναντι ε4δει, πρVγμα μηδ*ν α,το#μενος, Ep. 23 [9.396 L.]. This is the only instance where the first person is used in the passage, and it may be contrasted with the third person used in the repeated statements of nomenclature. The most likely explanation is that the author is attempting personal exegesis of his source, ‘my interpretation is …’. In doing so, he introduces a misunderstanding, possibly through compression or misunderstanding of his source, which probably referred to the false ribs, or to the spleen as a ‘false’ liver. The [page 154]

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word νος, ‘false’, lit. ‘bastard’, is regularly applied to the ‘false’ ribs, the five ribs not connected with the sternum so called in contrast with the seven ‘true’ ribs so connected, defined ναι δ* πλευραE α μ= περανουσαι πρCς τC στρνον Ruf. Onom. 94, 145 DR. Confusion can arise // through the ambiguity of πλευρ, ‘rib’ or ‘side’. There is no instance where the meaning ‘left’ is imperatively demanded for νος (and LSJ does not recognize this sense), but the expressions παρ/ τ=ν νον πλευρ=ν, with reference to the direction of vessels, Oss. 14 [9.188 L.] and περ τ=ν νον πλευρν, with reference to the site of pain, Judic. 51 [9.292 L.] are doubtful, as is the description by Pollux of the ν στις … @πC τ=ν νην πλευρ(ν, τ=ν )ν ριστερο7ς μεχρ τ=ς λαγνος παρκουσαν

(2.4.207). The spleen itself is described as ‘false’ by Aristotle, i.e. useless, by comparison with the concomitant liver (PA 669b and cf. πρVγμα μηδ*ν α,το#μενος, Ep. 23 [9.396 L.]; somewhat similarly, the moon was said to give a ‘bastard’ light, compared with the sun, Ph. 1.628). 'μοιρυσμος 8χνει ποδς: Rufus uses the same analogy, with similar terminology κε7ται ' σπλ=ν κατ/ τC ε5νυμον @ποχνδριον, παρεκτεινμενος )π μ κος νρωπν"ω 8χνει Anat. 28, 175 DR. Such similes are

common in anatomical contexts: Oss.; Cord. 1, 5, 10 [9.80, 84, 86 L.].

10. Belly (stomach) and intestine are described. Although the belly might loosely be said to ‘lie beside the liver on the left’, more properly it lies inclined to the left below both liver and spleen. ‘The stomach is the most dilated part of the digestive tube, and is situated between the end of the oesophagus and the beginning of the small intestine. It lies in the epigastric, umbilical, and left hypochondriac regions of the abdomen, and occupies a recess bounded by the upper abdominal viscera, and completed in front and on the left side by the anterior abdominal wall and the diaphragm’ (GA 1362–1363). The adjective ‘sinewy’ is apt: ‘the wall of the stomach consists of four coats: serous, muscular, areolar and mucous … and the muscular coat has three layers of muscular fibres’ (GA 1367). κατ’ ε5νυμον μρος ολομελς )στι νευρ5δης: ε5νυμος, lit. ‘good-

omened’ is used for ‘left’ by a common euphemism; cf., in an anatomical context (embryology), Epid. 6.4.21 [5.312 L.] and also Empedokles DK 31 A 83 = Athen. 3.78; cf. also Rufus, quoted above. The bladder is similarly νευρ5δης οIλη, 6 above. The sense of ‘sinewy’ is in both cases probably ‘elastic’, ‘subject to dilatation’. Rufus uses the same adjective [page 154 // page 155]

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of parts of the belly, Anat. 10, 178 DR and 42, 179 DR. But the word is appropriate also to appearance, as the empty stomach has prominent folds and wrinkles.27 The adjective ολομελς has evidently the same sense as οUλον above, 3. But it occurs elsewhere in the HC only Cord. 8 [9.86 L.] (heart as a whole, opposed to its component parts). The sbs. ολομελη or ολομελεη occurs Alim. 23 [9.106 L.] (with reference to the whole body, opposed to μρος ‘part’ of it) and several times in the phrase περ δνων ολομελης ‘on glands in general’. This appears in the treatise Glands itself in 1 (the first sentence of the work) and in 7 [8.556, 560 L.] as well as the version of the title given in ms V; and with reference to a work on glands (possibly the surviving Glands) in Artic. 11 [4.108 L.] and in Galen 18A.379 K. There is an occurrence also in Ep. 18 [9.382 L.], where it is urged by Demokritos that doctors should assess afflictions not only by inspection but by gauging το?ς Qυμο#ς and should treat τC π(ος ολομελην τε το6 σκνεος. It has a ‘scientific’ flavour in the Pythagorean equation of number τ+ ολομελεYα το6 // ορανο6, ‘with the totality of the heavens’, DK 58 B 27 = Arist. Metaph. 1092b26. Hsch. glosses ολομελ+ηE καλου ‘on the whole’. &ντερον 'μοιρυσμον: the term &ντερον is applied to the entire lower digestive tract, i.e. both the small intestine (comprising duodenum, jejunum, ileum) and the large intestine (caecum, appendix, colon terminating in rectum and anal canal); only occasionally is such an expression as τC κ(τω μρος το6 )ντρου used (as, with reference to an enema, Acut. 19 [= 6, 2.264 L.]). Like words for ‘belly’, ‘stomach’, with which it is commonly linked (γαστρ, Carn. 3 and 6 [8.586, 594 L.]; νηδ#ς, Carn. 13 [8.600 L.]; κοιλα Morb. 4.54 [7.596 L.]) it is extended in usage to cover a large visceral region. Rufus regards the γαστρ as the ‘upper belly’ and the κλον as the ‘lower’, Onom. 169–173, 156–157 DR. The ‘similarity’ is left unexplained, but is illumined by two parallel passages (again from Oss. and Epid.) where human and canine intestines are compared: τ/ κλα &χει κυνCς μεζω. Kρτηται δ* )κ τν μεσοκ5λων. τα6τα δ* )κ νε#ρων πC τ ς Q(χιος @πC τ=ν γαστρα, Oss. 1 [9.168 L.] (note compendious comparison, as Anat. 3, 4, 5); and with slight variation τ/ κλα &χει οJα κυνς, μεζω δ, Epid. 6.4.6 [5.308 L.]. It seems that, through compression of his source, the author fails to explain the 27 Triller’s emendation ολουμνη, tr. ‘cicatricatus’ or ‘rugis incisus’ imports a needlessly explicit reference to this aspect.

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similarity intended, namely to the viscera of the dog. Cf. BVD, ‘The large intestine [of the dog] has a course somewhat like that of man’. μακρν, πηχων οκ &λασσον δ5δεκα: Foesius’ μακρν for μικρν is

guaranteed by the sense (as all the intestine is included) and the word order (as description, not definition, is here required). The length of the intestine is correctly estimated (twelve cubits being five to six metres) and the description is accurate: ‘The small intestine is a convoluted tube … about 6.5 metres long’ with ‘a short curved portion’ and ‘a long greatly coiled part’. ‘The large intestine … is about 1.5 metres long’ (GA 1370, 1372, 1380).28 HλικηδCν )ν κλποις )νειλο#μενον: Hλικηδν is a hapax in the HC (though Hλικοειδς is found, Morb. 4.40 [7.560 L.], with reference to ‘convoluted’ vessels), and )νειλε7ν too is a hapax (though ε,λε7ν is quite

common, used for instances of intestines, Mul. 2; of humours, Morb. 4; and various other compound forms occur). Hsch. glosses Hλικηδ5νE κυκλοειδ=ς συστροφ. The expression of Ep. 23 [9.396 L.] is close: ε,λε7ται περ κοιλην &ντερα. Cf. also κα τ/ &ντερα κα τ=ν νηδ?ν )νειλξατο, Oss. 18 [9.194 L.]. Celsus’ expression is similar: ‘in sinus vehementer implicitum’, 4.1.7. The term ‘folds’ is used in the HC only here and, of the womb, Nat. Pue. (also verb κολπω of membranes, ibid.). In literary contexts, it is regularly applied to ‘folds’ of the female body, especially the bosom and the womb.

o καλουσιν &νιοι κλον: there are similar comments on divergent terminology Morb. Sacr. 17 [6.392 L.] (φρνες a misnomer for diaphragm) and Carn. 4 [8.588 L.] (μυελς a misnomer for spinal marrow). That κλον, read by V, not κλον, is the correct form is guaranteed by an Aristophanic pun on the verb κολ(ζειν (future middle) πα7’ ατCν νδρικ5τατα κα γ(στριζε κα το7ς )ντροις κα το7ς κλοις πως κολYV τCν // 1νδρα, Eq. 455.29

11. Colon, rectum and anus are briefly described. 28 Reference to the length of the intestine was a common element in lists of the seven organs transporting food and breath; see Mansfeld (1971), p. 197. 29 Pollux finds an etymological link, involving digestive suffering, 2.209; for other fanciful etymologies based on an original meaning τροφ ‘food’ for κλον, see Ath. 262a.

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πφυκεν ρχCς λοσιος: the same verb is found as in 6, 9, 10. The adjective λοσιος is exclusively poetic, though λο7σος is used also in prose. The term ρχς occurs Oss. 3, 9, 14, 17 [9.170 L.]; also Carn. 3 [8.586 L.]. σ(ρκα περιπληα &χων: lit. ‘having abundant flesh’. Van der Linden’s emendation πολυπληα (commonly adopted) is unnecessary, as περιπλης is just as common as πολυπλης and gives comparable sense (Ibycus, TLG). His addition of κα would give a smoother connection, but is not necessary in this telegraphic style. For the sense, cf. jτε @γρο6 )ντος το6 τε ρχο6 κα τ ς σαρκCς μαλακ ς, Fist. 1 [6.448 L.]. )ς 1κρον δακτυλου τελευτν: for the expression (neuter of adjective, used substantivally, followed by genitive), cf. 1 above. In the HC, the term δακτ#λιον is used elsewhere only in Haem. Galen glosses κ#κλος, τροχσκος, 19.92 K.

12. A summing up apparently parallel to that of 7 ends the second part of the description. Ermerins’ belief that there is a lacuna ‘nam non absolvitur sed abrumpitur periodus’ may be correct; but the abruptness does not of itself necessarily indicate this, as the syntax is somewhat fractured throughout. τ/ δ’ 1λλα  φ#σις διετ(ξατο: the sense of φ#σις in 7 above is ‘[bodily]

nature’, a concrete and passive entity which is organized by something external to itself, sc. perhaps universal nature; here the sense of  φ#σις is ‘[universal] nature’, an abstract and active principle which organizes something, sc. apparently the body. (Cf. Rufus )κησμεσα rν παρσχε το7ς μρεσιν  φ#σις σιν τε κα νομασαν Anat. 2, 169 DR; and the view that men are &ργα φ#σιος, Ep. 11 [9.326 L.].) Neither sense is difficult; but the switch from one to the other is generally felt to be awkward; however, there is a similar shift in Ep. 23, discussed further below. If the two passages are parallel, the ‘other parts’ of the body (oesophagus, stomach, diaphragm, spleen, intestine, colon) described 8–11 are parallel to the six parts (trachea, lung, heart, liver, kidneys, bladder) enumerated 1–6. But the phrase may refer to further material, passed over (cf. Arist. Po. 1449a28). Or τ/ δ’ 1λλα might be adverbial, ‘as to other parts’ (not specified). Other possibilities are that a reference to ‘other creatures’ or to ‘other works’ (cf. Carn. fin. [8.614 L.]) has been lost; or even that φ#σις in Anat. 7 and 12 is shorthand for ‘[sc. my [page 157]

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treatise on the] nature [of the body]’, with oblique reference to some other work where he has explored other matters and reference in the verb to his own embellished style.

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I. Background The origins of Greek anatomy lie in the Homeric epics, which display an extensive knowlege of the effects of battle wounds on different bodily parts. Attempts at systematic description begin with the pre-Socratics, still imbued with the attitudes and forms of early verse writing. Analysis of the body into the different components skin, flesh, bones, and viscera linked by hollow channels or vessels conveying fluids (primarily φλβες conveying blood) and by solid threads (termed νε6ρα and // including cords, sinews, ligaments, nerves, muscles) had a long currency, with little apparent consensus.30 Outline surveys such as Anat. must have been composed throughout antiquity, and constantly copied, corrected, imitated, and excerpted. It is always difficult to assess the extent and nature of influence or interaction in such cases of common content of a factual nature, especially where the very existence of direct contact (rather than the use of common sources) must be in doubt. The brevity of the fragment adds to the problem of the universality of its subject matter. Other writers follow the same descriptive sequence from ‘top’ downwards, with the trunk regularly treated as an entity. More specifically, discussion of the organs regularly centres on location, size, and colour. Judgement must rest not only on scrutiny of content but on an inevitably somewhat subjective assessment of similarities in approach, arrangement, and expression. The problem of intertextuality within the HC is acute; and even more so when later authors, such as Celsus and Rufus, are considered. Indirect evidence for the presence of Anat. in versions of the HC circulating in antiquity (or, rather, in the putative versions which can 30

Even in the Pneumatic school of medicine, influenced by Posidonius and the Stoics, the seven )ντCς μρη and the seven καολικ/ μρη were defined in various ways; see Mansfeld (1971).

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be reconstructed from the lists of glosses constructed by grammarians and others) is scanty. The list of Erotian (dating from the time of Nero, c. A.D. 50, and referring to many earlier authorities, including Bakcheios, Epikles, and Herakleides) includes no words from Anat., but the brevity of the treatise may account for this. Galen glosses no words from Anat. either (unless ο,σοφ(γος relates to Anat.; but Loc. Hom., from which many other terms are glossed, is a much more likely source). The loss of Galen’s comments on Hippocratic anatomy (advertised De Plac. Hipp. et Plat. 6.8) is unfortunate, but there is no doubt some truth in his assertion that practical demonstration took the place of written treatises on anatomy.31 There is some reason to suppose that Celsus, writing an outline of human anatomy (4.1.1–13) and Rufus of Ephesus, writing an account of anatomical terminology (Onom.), knew the work. But the evidence is not unequivocal. Celsus is concerned with ‘sedes’ of parts of the body; and especially their relative positions. Thus, such terms as ‘incipiunt’, ‘fertur’ and ‘descendens’ are used, 3. And the description is practical, stressing colour, the ureters being ‘albae’, 10; or texture, the lung being ‘spongiosus’, 4. Nomenclature features: ‘nominant’, 3; ‘Graeci vocant’, 10. Celsus (like many others, including the author of Ep. 23) includes the head, 2; before describing the parallel ‘itinera’ of ‘aspera arteria’ to lung and of ‘stomachus’ to ‘ventriculus’, 3. Lung, heart, and diaphragm are briefly mentioned, 4; then liver, gall-bladder, spleen, kidneys, 5. From this outline of the ‘viscerum … sedes’, Celsus goes on to the digestive process and the different parts from oesophagus and stomach, 6, to bowels, 7. The course of the ureters from kidneys to bladder is outlined, 10, and the bladder itself described, 11. One salient difference of content between Celsus and the writer of Anat. (but a feature in common with Ep. 23) is that he pays attention to differences in male and female anatomical layout: differences in bladder, 11, are mentioned before a description of womb and reproductive system, 12–13. Several phrases in Celsus are close enough to phrases in Anat. to qualify as translation or at least paraphrase. The most striking parallels in phraseology are these: ‘constat ex circulis quibusdam’ (of // trachea: note metaphor, toned down by ‘quibusdam’ and correspondence ‘circulus’ ~ κρκος); ‘is spongiosus’ (of lung: note the initial pronoun); ‘in sinus vehementer implicitum’ (of intestine: note correspondence ‘sinus’ ~ κλπος); ‘vesica … nervosa’ (of bladder). 31 On the tradition, see Smith (1979) and von Staden (1989); on terminology see Lloyd (1983) and Skoda (1988).

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Rufus aims at a correct account of anatomical terminology, rather than at the consecutive description seen in Celsus. The closest parallels to Anat. in expression are these: lung colour is τεφρCν κα @πλευκον, the spleen resembles a footprint, and the term φαρ#γερον is used. Pollux provides no independent evidence and was probably utilising Rufus directly in compiling the medical section of his great lexicon. In the case of Hsch., several glosses suggest familiarity with Anat., or at least with a work or works employing similar diction: περιηγς, τενρηνιδες and χετς are glossed. There is, then, some reason to suppose that Celsus and Rufus, as well as later lexicographers, knew Anat.; but none to confirm that it was then regarded as Hippocratic.

II. Anat. and the HC: content There is no parallel in the HC for the narrowly anatomical content of Anat., with its exclusion of physiology and pathology. Elsewhere, attempts at anatomy are incorporated in general schemes (Loc. Hom.), or are allied with theory (Carn.) or address physical function (Cord., Oss.) or are embedded in discussion of treatment (Epid., Artic., Fract., Mochl.). But how, and indeed whether, the work continued is unknown; and the similar precision of Oss. 1 [9.168 L.] and Loc. Hom. 6 [6.284 L.], which list bones, gives way to more elaborate and leisurely expression. The titles of treatises often give little clue to their actual content: the author of Carn., a work primarily on the viscera, refers to his own earlier work on the vessels, περ μ*ν οUν τν φλεβν ε8ρητα μοι πρτερον, Carn. 5 [8.590 L.]; and promises future work on the essential character of the human constitution, based on the number seven, τ ς δ* φ#σιος τ=ν ν(γκην … )γ< φρ(σω )ν 1λλοισιν, Carn. fin. [8.614 L.] The work itself deals in a wide-ranging way with the formation of lungs, liver, spleen, kidneys; also flesh, limbs, nails, teeth, hair and the senses hearing, smell, sight, and speech. Mochl. begins στων φ#σις [4.340 L.] and Oss., with implied comparative anatomy, i με7ς ατο )ξ νρ5που στων κατεμ(ομεν [9.168 L.]. But overall, the subject of Oss. is not bones at all, but vessels. The nature of many Hippocratic treatises raises fundamental questions of authorship: they may have been the common property of a professional group, pooling ideas and information in an age innocent of concepts of plagiarism and publication, though not immune from professional rivalries. Oss. is a composite text, stitched together from [page 159]

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heterogeneous and even inconsistent elements and some of its content is identical with passages in Epid. 2.32 The treatise is an amalgam of bits, some of which are replicated elsewhere: Oss. 8 [9.174 L.] = Arist. H.A. 3.3, where Aristotle gives his source as Syennesis of Cyprus; Oss. 9 [9.176 L.] = Nat. Hom. 11 [6.58 L.]; Oss. 4–7 and Oss. 10 [9.170, 172, 178 L.] = Epid. 2.4.1 [5.120 L.]. The last part of Oss. has been identified with the treatise on vessels mentioned by Galen as an appendage to Mochl., )ν τ" περ φλεβν o προκε7ται τ" Μοχλικ", Galen 19.128 K. However, it is likely that the first person throughout represents the same editorial voice. In Epid. also there are repetitions and other elements which make unity of authorship highly unlikely and suggest a process of redaction and compilation: either editorial activity carried out by a single author or case notes from // different hands, recording impressions of different doctors. Mochl. is a summary of Artic. and Fract., carefully executed and often keeping the original expression. Another common element is the presence of disagreement (as Anat. 10, on terminology) or polemic: 1λλος δ’ αU τις τν ,ητρν Fract. 3 [3.422 L.]; cf. also polemic against Herodikos, Epid. 6.3.18 [5.302 L.]. It is in this scheme that Anat. has some place. Anat. has affinities of content particularly with Oss. (and confirms the relationship between Oss. and Epid. 2); also with Epid. 6: see on 3, 4, 5, and especially on 9 (liver and diaphragm), and 10 (intestines). Anat. comprises a description of the internal configuration of the human trunk. The precision is exemplary. The continuous schematic arrangement is evident in the repeated π—six times, four with )ς, one with )π and one alone; or )κ—twice, one with )ς and one alone. It is precise in its stress on start and finish (&κφυσις, ρχ, τελευτVν); on situation, orientation, and extent (κε7σαι, τρπεσαι, τενεσαι); on size, shape, and colour; and particularly on relative position in the body— top, bottom, front, back, right, left, or middle—cf. proximal, distal, anterior, posterior etc. (1κρος, κ(τω, πισεν, δεξις, ριστερς, μσος, ε5νυμος). The treatise records organs and viscera, i.e. in Greek terms σπλ(γχνα. Flesh, bones and cords are not mentioned at all, and vessels are mentioned only incidentally, as links. The author is writing a comparative study, expounding human anatomy by reference to the anatomy of mammals in general, with which he takes his readers to be familiar: see on 1, 3, 4, 5, and 10. Simply, he is following the proce32 This was already noted by Littré; see now Duminil (1980) for analysis of structure and content.

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dure recommended by Aristotle (H.A. 1.16.494b21–24): in the absence of dissection, it is necessary to refer to animals similar to man to understand human anatomy. Aristotle examined many different mammals (e.g. hare, deer, mouse, hyena, ass, leopard, weasel, all listed P.A. 667a; seal and ox, ibid., 671b) and Herophilos still depended largely on comparative anatomy, despite the availability to him of humans (von Staden, 1989, 182–183). Other Hippocratic authors refer to animals, either in general, as τοσο6τον )ς 1νρωπον ποδεξω κα τ/ 1λλα ζ"α, Carn. 1 [8.584 L.]; and Wσπερ κα το7σιν 1λλοισι ζ"5οις jπασιν, with reference to two halves of the brain, Morb. Sacr. 3 [6.366 L.]; or with reference to particular animals: the ox (thighbone), Artic. 8 [4.94 L.]; the pig (lung), Cord. 2 [9.80 L.]; the dog (intestines), Epid. 6.4.6 [5.308 L.] and Oss. 1 [9.168 L.]; cf. also Demokritos’ study of dog and pig embryology DK 68 A 151 = Ael. N.A. 12.16 (cf. Nat. Pue. 31 [7.540 L.]) and the vignette of Demokritos at home, surrounded by heaps of animal carcases, which he is laying out and dissecting in order to examine their σπλ(γχα, with a view to assessing the significance of χολ, Ep. 17 [9.350 L.]. It may be supposed that Anat. belongs to a period when dissection was not practised on human cadavers, a period when knowledge was gleaned from observation of butchered sacrificial victims (of which the σπλ(γχνα were particularly familiar) and from animal dissection; and that knowledge of the interior of the human body would depend on chance supplementary findings from observation of injuries to citizens on the battlefield (cf. V.C.) or to slaves in industrial accidents, such as must have occurred in mills and mines. That dissection of human cadavers was not practised in mainland Greece in the fifth and fourth centuries has been cogently argued often enough; but perhaps classical scholars make insufficient allowance for medical curiosity.33 Examination of aborted foetuses or stillborn infants might have been relatively easy (cf. on 3); and conventions obtaining in such semi-barbarous regions as Thrace may have differed from those of Athens. Certainly many // intellectuals, including Herodotos and Demokritos, travelled to Egypt, where they had opportunities to observe the anatomical procedures involved in mummification (cf. Hdt. 2.86). Theoretical modification too might obtrude (cf. view of the heart, 3). See Edelstein (1932, tr. 1967; but Edelstein suggests in a cryptic footnote that Demokritos may have been an exception and this notion has a bearing on Anat.), Lloyd (1975), Longrigg (1993). 33

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Although Anat. is remarkably free from explicit theoretical comment or doctrinal content, some views which are implicit can be extracted. From the pathway postulated trachea-lung-kidneys-bladder, it seems that the writer believes that some fluid enters the body via the trachea. This view is explicitly and forcefully expounded by the author of Cord., and supposedly corroborated by an experiment which involves dissecting a pig, after giving it coloured fluid to drink (Cord. 2 [9.80 L.]). The author of Oss. init. shares this view: πτον δ* δι/ φ(ρυγγος κα στομ(χουE λ(ρυγξ )ς πλε#μονα κα ρτηρηνE πC δ* το#των )ς 1κρην κ#στιν, Oss. 1 [9.168 L.]; though a somewhat different (or perhaps

merely more detailed) route is postulated in the drink-kidneys-bladder sequence which follows, Oss. 4 [9.170 L.]; similarly drink, air, and blood all pass through the lung, Oss. 13 [9.184 L.]. The expression of Oss. 1 [9.168 L.] is close to that of Anat. 5; and the postulated route of fluids is the same. The belief that fluid could enter the body via the trachea seems to be implied in the medical orthodoxy regarding treatments for lung disorders (among the most common of all Hippocratic ailments and ranging from mild infections of the respiratory tract to pneumonia): warm drinks are recommended to render the lung moist and so to dislodge pus, Morb. 3.16 [7.142 L.]; drink is required to moisten the lung and encourage expectoration, Morb. 1.28 [6.196 L.]; liquid medicine is to be administered to clear pus when the lung dries out, Aff. 9 [6.216 L.]; trouble ensues if the lung dries up @πC δψης ναγκαης, Loc. Hom. 26 [6.316 L.]. (And the medical view was generally known: Alcaeus frg. 94; Euripides frg. 983 N.) But the matter was controversial: it is disputed by Aristotle (P.A. 664b) and with an emphatic introductory verb )ναντι5σομαι argued that fluids pass not to the lung but to the κοιλη, Morb. 4.56 [7.606 L.].34 The parallel working of bladder and belly is similarly presented elsewhere in the HC and in other medical writings: e.g. κοιλη and κ#στις parallel Morb. 4.38 [7.556 L.] and Acut. Sp. 15 [2.474 L.]; κ#στις and &ντερον parallel Mul. 1.34 [8.80 L.] al.; ρχς and κ#στις parallel Carn. 3 [8.586 L.]; δ#ο μ*ν γ/ρ α τC σιτον δεχμενα τε κα φιε7σαι, de Arte 10 [6.16 L.]; also περ μ*ν τ ς το6 πνε#ματος διοικσεως τα6τα … περ δ* τ ς τροφ ς ναγκα7ον @πομιμνσκειν μετ/ τα6τα, Anon. Lond. 24.18–20 and the necessary parts +T τε δχονται τ=ν τροφ=ν κα +T τC περττωμα φιVσιν, also  τε φ(ρυγξ κα ' καλο#μενος ο,σοφ(γος, Arist. P.A. 655b and 664a.

34

See Lonie (1981), pp. 361 sqq.

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Despite the broad accuracy and precision of the work, it displays only the most rudimentary knowledge of the body’s workings.35 The descriptions of the regions between heart and liver, liver and kidneys are just that, descriptions; and there is no indication whatsoever that the importance of heart and liver is recognised. There is no justification for imputing to the author the perception that the heart has a peculiarly important place as centre of the vascular system; see on 3. Despite detailed reference to the lobes of the lung and of the liver (the latter somewhat confused), there is nothing on the chambers of the heart and no awareness of the heart’s complex structure. Similarly, the statement that the liver is α μορρωδστερον may, but need not, imply a view of the liver as producer of blood for the rest of the body; and the interpretation of the vessel which ‘nurtures’ the body is problematical. The references to the belly as σηπτικ takes a primitive view of the digestive process, reminiscent of Empedokles; and the adjective applied to the liver, α μορρο6ς ‘blood-suffused’, has an Empedoklean analogue also. // Sometimes, the writer of Anat. seems to be at a loss or mistaken: see on 2, 4, 9. These lapses might result from misunderstanding of a technical source by a writer or excerptor without technical knowledge or from hastily and carelessly executed summary. Compression seems to lead to unclear exposition and even to the elision of essentials: see on 9 and 10, where the parallel versions of Oss., in conjunction with Epid. 2 and Epid. 6, help to elucidate the sense. The consistent use of the third person may imply that the writer is not himself a medical expert, or is distancing himself from other practitioners; the first person is used only once and introduces an error: see on 9. Treatises evidently written by practitioners tend to use the first person plural in giving nomenclature for anatomical or diagnostic terms (V.M. 19 [1.618 L.]of yellow bile; Carn. 17 of the tunic of the eye, cf. 2 [8.606, 584 L.]); whereas more rhetorical treatises tend to use the third person (de Arte 10 [6.16 L.] of muscle). But there is a wide range from firm to tentative expression and the common use of the passive militates against generalization: veins are described, as Anat. 3, in such expressions as α μρρους  παχεη καλεομνη φλψ, Oss. 7 [9.172 L.] and τ=ν κολην φλβα καλεομνην, Loc. Hom. 3.5 [6.282 L.].

35

Triller’s commentary constantly superimposes his own knowledge on the text.

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There is nothing in the content to suggest any knowledge of the advances made in Alexandria; and nothing to suggest familiarity even with Aristotelian biology. In particular, the ignorance of the structure and function of the heart suggests a date before the research activities of the Lyceum.

III. Anat. and the HC: expression The vocabulary of Anat. has many unusual features, which, like the content, show affinities with Oss. A common concentration of anatomical terms in anatomical works has no implications for direct connections, far less for common authorship or shared school of thought. However, the use of different terms for the same parts of the body can be significant; and it is noteable that the author of Anat. shares a preference for 1κανα with the author of Oss. fin. [9.182 sqq. L.] (ten instances 11–19: 12, 13, 14, 15, 16; five instances 18), as opposed to the author of Oss. init. [9.168 sqq. L.], who like the author of Mochl. and Artic. uses Q(χις (nine instances 1–10; three instances 1, 3; two instances 7; two instances 9, 10). In general usage, there are further parallels with Oss. and with Epid. 2 and 6: see especially on 2, 3, 4, 7, 9, 10. Such coincidences in general medical terms and in non-technical vocabulary become cumulatively significant, especially when these are allied with common ground in doctrinal content. On the basis of this analysis, Anat. can be firmly aligned with Oss., and with certain parts of Epidemics; also to some extent with Mochl. and with Carn. Clearly the author sought out a recondite vocabulary; and it is in the nature of this that many words are not commonly found elsewhere. In some instances, the parallel usage is entirely from verse; λοσιος ‘last’ is common but exclusively poetic and )ναλγκιος is epic. The poetic texture is reinforced by the use of simile (see on 9) and figurative language (κεκεντμενος, )γκαδρυται); these devices however are typical of anatomical writing in general. There are runs of dactylic rhythm (τν περιηγων, with synizesis, cπτομνων κατ’ )π- and -τραμμνος )ς τ/ ριστερ(), and some attempt seems to be made to end sentences with spondees, molossi, or still longer sequences of long syllables (λλλων, τενρηνι5δης, π(ντων ζ"5ων, )κοσμη, νευρ5δης). These are all features of early prose style, influenced by epic patterns of expression; and in material of this kind the rhythm (like the stress on counting—lobes of lung, gates of liver, six key parts—and on naming— [page 162]

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‘they call’) might originally have served as an aide-mémoire. Another feature of the stylistic register belonging to // early prose style is the use of abstract noun plus verb &χειν, in preference to a verb of the same root. While the vocabulary is recondite, the syntax is uncontrived, with compound rather than complex sentences. Such loosely connected writing is typical of early prose. Connection is simple (δ and κα) after asyndeton in the first sentence. Like Mochl., the terse summary Oss. init., and the compressed annotations of Epid., it eschews words which are semantically otiose, such as the definite article and the verb ‘to be’. The general, apparently arbitrary, omission of the article in Anat. is remarkable: it is usually omitted with such adjectives as 1κρος, μσος, πVς, and, most obviously, in the case of the bodily parts.36 This characterizes summaries, but is a common feature also of the aphoristic style affected by Herakleitos; and is seen also in certain Hippocratic texts, such as Alim. Similarly the compendious comparisons recurrent in the text characterize both terse and poetic writing styles. Anat. is bald, yet still stylistically arresting. Resemblances with Demokritos are explored in the next section. However, there are certain resemblances too with other pre-Socratics: περιηγς and ε5νυμος are certainly used by Empedokles; as are )ναλγκιος and ολομλης by Parmenides (both in the same fragment, DK 28 B 8, lines 43 and 5 = Simp. In Ph. 144.29); and )ππεδον by many writers on scientific subjects. However, these may be chance findings. Caution may be induced by the reflection that two of the more colourful, and apparently recondite, anatomical terms of Anat. occur in Euripides: χλυς (El. 837) and 1κανα (El. 492 and Tro. 117). Euripides shows some precision in anatomical knowledge; the first datable use of the term κολη φλψ is in Ion 1011. As in the case of content, nothing in language is incompatible with an early date, and the stylistic register is that of early prose.

36 Comparison of usage in Mochl. shows that in paraphrasing Artic., the author often repeats the base text almost verbatim while omitting such otiose words as the definite article: e.g. Mochl. 8 [4.354 L.] (1κρος without article) ~ Artic. 18 [4.132 L.] (1κρος with article). But it is omitted in both model and précis, Mochl. 12 [4.356 L.] ~ Artic. 22 [4.134 L.]; and in Fract. 4 1κρην τ=ν χε7ρα is followed in the next section by )ς χε7ρα 1κρην [4.430, 432 L.]. Similarly, in the compressed annotations of Epid., 1κρος is commonly used without the article (6.1.3, 4.19 [5.266, 156 L.]); cf. also )ς 1κρην κ#στιν, Oss. 1 and μχρις 1κρων πλευρων, Oss. 5 [9.168, 170 L.].

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discussion IV. The Demokritean dimension

An affinity of Anat. with the work of Demokritos of Abdera37 was long ago noted.38 Strong, and relatively early, traditions linked Demokritos with Hippocrates: Celsus described Hippocrates as ‘pupil’ of Demokritos (Proem 8; there are similar accounts in the later Vitae of Soranos, Tzetzes, and Suda). Demokritos was a most prolific writer on a great range of scientific subjects. Many of his works have titles similar to those of Hippocratic treatises: περ νρ5που φ#σιος F περ σαρκς, περ διαιτ ς F διαιτητικ(.39 He was much revered in later antiquity. But there are pressing // problems of authenticity: many citations are not of Demokritos but of Demokrates, and there were allegedly early forgeries, detected by Kallimachos.40 The extant fragments indicate that the style of Demokritos was sometimes functional, sometimes elaborate, but certain recurrent distinctive features can be isolated: a liking for compound words and compound verbs, and a tendency to poetic idiom with neologisms.41 Certain catchwords recurrent in the citations suggest that he was a natural target for imitation, forgery, and pastiche. The key idea of ‘similarity’, expressed in the root Qυσμς, may be seen as peculiarly Demokritean. In addition to treatises on the subject περ τν διαφερντων Qυσμν and περ μειψιρρυσμιν (‘on different dispositions’ and ‘on changing dispositions’ DK 68 B 8a and 139; 37 This was a highly prosperous region, with an important trade in grain: evidently it had its own cultural as well as economic vitality; but of this little direct evidence survives. Like Demokritos, the ‘sophist’ Protagoras came from Abdera. (Demokritos is never described as a sophist, though in many respects his intellectual activity corresponds to that typical in the sophistic movement. For some reason, he did not interest Plato.) 38 See already Triller (1766), p. 258, who regarded the author as ‘aut ipsum Democritum aut alium Abderitum philosophum’; echoed more sceptically by Ermerins (1864), Prolegomena to Anat., XLII, finding a sophistic attempt ‘Democriti personam induere’. 39 Cf. also the descriptions of Demokritos searching out ληεην νρωπνης φ#σεως, Ep. 17 [9.378 L.], as an interpreter of φ#σις and κσμος, Ep. 20 [9.386 L.], and as the writer of περ φ#σιος νρ5που, Ep. 23 [9.394 L.]. There are some seventy titles, according to Diogenes Laertius, DK 68 A 33 = D.L. 9.45–49; but on the sources of D.L. see the sceptical remarks of W.K.C. Guthrie, History of Greek Philosophy (Cambridge, 1965), vol. II, p. 388, n. 1. 40 See RE s.v. Bolos of Mende on later attempts to lend respectability to spurious writings by arrogating the name of Demokritos; cf. especially Plu. Sympos. 641b. 41 Roman critics admired Demokritos’ style, finding it poetic. Cicero describes him as ‘ornate locutus’ (DK 68 A 34 = Cic. de orat. 1.11.49). There is considerable evidence that he affected an arcane vocabulary: Kallimachos compiled a πναξ τν Δημοκρτου γλωσσν κα συνταγμ(των and Hegesianax wrote a work περ τ ς το6 Δημοκρτου λξεως.

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cf. also Ep. 18 fin. [9.382 L.]), there are incidental references in many fragments—which cannot all be inventions of forgers or of writers of pastiche—to the terms Qυσμο6ν (DK 68 B 197 = Stob. 3.4.70), μεταρυσμο6ν (B 33 = Clem.Strom. 4.151 = Stob. 2.31.65), and )πιρυσμη (B 7 = Sext. 7.137). That Qυσμς is pervasive in his physical system may be seen in the argument that colour arises from elements mixed διαταγ+ τε κα Qυμ" κα προτροπ+ (DK 68 A 125 = Aet. 1.15.8). Demokritos does seem to have been preoccupied with the idea of form, and especially of sameness in form; cf. 'μοιοσχμων, DK 68 A 128 = Aet. 4.19.13 and 'μοσχημονε7ν A 135 = Thphr. de sens. 50; also 'μοφυε7ς A 61 = Simp. in cael. 569, cf. παντοας μορφ/ς κα σχματα παντο7α κα κατ/ μγεος διαφορ(ς A 37 = Simp. ibid. 294; and 'μοιτης B 164 = S.E. M. 7.116; note too his view that the μορφ of man is recognizable τ" τε σχματι κα τ" χρ5ματι B 165 = Arist. PA 640b.42 (See also on 2, 3, and 4 for Demokritean usage.) Supposed relations between Hippocrates and Demokritos are described in the Hippocratic letters.43 The letters fall into three distinct groups: 10–17, 18–21 and 22–24. Ep. 23, the Demokritean letter to Hippocrates περ φ#σιος νρ5που is particularly relevant to this discussion; but there is much of significance also in 10–17, in 18, and in 20. In Epp. 10–17, the main voice is that of Hippocrates, called to Abdera to treat the supposedly mad Demokritos. There are several comments on πλουσην τ=ν φ#σιν ‘the richness of nature’, and Ep. 17 ends with the designation of Demokritos as ληεην νρωπνης φ#σεως )ξιχνε#σαντος κα νοσαντος, ‘tracking down and considering the true nature of man’ [9.378 L.]. Epp. 18–21, which purport to be an exchange between Demokritos and Hippocrates // (18 from Demokritos; the others from Hippocrates) seem to have been composed for the express purpose of displaying knowledge of the corpora of these two writers. In Ep. 18 the expression ββλοι @π’ )με7ο γραφε7σαι [9.382 L.] is followed up by clear reference 42 Perhaps this preoccupation of Demokritos in some degree anticipates the Aristotelian attempt to distinguish parts of the body as 'μοιομρη or νομοιομρη, the latter being such as hand, face which do not by division become two of the same thing, HA 1.1 init. But we need not look beyond the HC to find similar ideas in circulation; cf. 'μοεηνη Loc. Hom. 1 [6.278 L.] (of the organic unity of the body), 'μτροπος Vict. 1.6 [6.478 L.] and 'μφυλος Nat. Hom. 3 [6.38 L.]. Rather, the abstract principle of sameness and difference, with respect to shape and colour, is here given pragmatic implementation in study of the colour and shape of the bodily organs. 43 On the letters, see Smith (1990), edition with translation and commentary, especially pp. 102–105 on Ep. 23; see also Littré IX. 392; DK 68 C 6; Temkin (1985).

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to the titles of works by Demokritos.44 This letter ends with a positive concatenation of Demokritean vocabulary, in the recommendation that the doctor should consider Qυμο#ς … ολομελην τε το6 σκνεος [9.382 L.]. Ep. 19 (general statements on madness), Ep. 20 (on the place of chance in medicine), and Ep. 21 (on the use of hellebore) have elements demonstrably lifted from the HC, with some misunderstandings and additions imported by the excerptor;45 and doubtless Demokritean elements are similarly present throughout 18. Epp. 22–24 have a different manuscript tradition from the other letters.46 The content is somewhat mixed: in Ep. 22 Hippocrates writes to his son Thessalos, urging the study of mathematics on the grounds that it is closely allied with medicine; Ep. 23 is the Demokritean letter which concerns us here; in 24 Hippocrates writes to King Demetrios, recommending ways to maintain health. Ep. 24 is prefaced by the statement πρτερον μ*ν σπουδ(ζοντες … περ τ ς νρωπνης φ#σιος )ν κεφαλα"ω εωρ σαι τ/ μρη τα6τα ξυγγρ(ψαντες … πεστελαμεν [9.398 L.]. (It has been supposed that this is a reference to Ep. 23. This seems unlikely, as Ep. 23, the odd one out in this rather ragged sequence, is Demokritean. It may be rather that Anat., which has strong affinities in content and expression with Ep. 23, was known and referred to by the author of Ep. 24, who believed the work to be Hippocratic.) The preamble of Ep. 23, leading in to the anatomical discourse, is regarded by Smith as detachable.47 This preamble justifies the study of medicine by all, on the grounds that bodily malaise affects mental function. The proem is taken to be Demokritean in the second to third centuries A.D.: the words of the letter σοφη μ*ν γ/ρ ψυχ=ν ναρ#εται παων, ,ητρικ= δ* νο#σους σωμ(των φαιρε7ται [9.394 L.] are reiterated in ,ητρικ= μ*ν γ/ρ κατ/ Δημκριτον σ5ματος νσους κεται, σοφη δ* ψυχ=ν παν φαιρε7ται (DK 68 B 31 = Clem. Paed. 1.6, conceivably an independent source drawing not on the letter but on a work of Demokritos, the source also of the letter; the connection with Ep. 23 is noted DK ad loc.). There are some striking similarities in phraseology between this letter and Anat.: συνδρυται (of the faculty of sight) ~ )γκαδρυται (of the heart), χελ#νειον (of the chin) ~ χλυς (chest), ε λε7ται περ κοιλην &ντερα ~ &ντερον … HλικηδCν )ν κλποις )νειλο#μεSee Smith (1990), p. 93, n. 1. See ibid., p. 95, n. 1 and p. 99, n. 1. 46 Ibid., p. 42. 47 The author ‘borrowed the anatomy and composed the proem’; cf. 32 ‘detachable philosophic … proem’. 44 45

[page 165]

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167

νον (similar expressions of inestines), νευρ5δης κ#στις (both of bladder).

Similarities in spirit are even more striking. It is particularly remarkable that the nuances of the concepts κσμος and φ#σις are parallel, and allied with the pervasive concept of order in or aptness to bodily function, and to the craft in design of the living organism. There is even a parallel change in use of φ#σις. At the beginning of the anatomical description, we find φ#σιος νρωπνης @πογραφ= εωρην &χει τοινδε (same sense as Anat. 7); and at the end  δ* σ5ματος )ν μυχο7ς φ#σις )ξτευξε παντ(μορφα σπλ(γχνων γνη (same sense as Anat. 12 [9.394, 398 L.]). (In the latter passage, Ermerins reads σ5ματος, linking this genitive with )ν μυχο7ς: this attractive emendation tones down but does not alter the abstract sense of φ#σις.) There is in Ep. 23 much stress on the notion that the organs are fashioned or marshalled by ‘nature’ to serve [the nature of] the body; φ#σιος 4πο δεδημιο#ργηται (sex organs) and συνσεως δημιουργ+η συνδεσμε#μενα // (stomach and intestines), until death ends their service; cf. here )κοσμη and διετ(ξατο. In the letter the nouns δημιουργς and δημιουργ+η, the verb )ξτευξε, and the expressions of the bodily parts εκοσμYα χρτα κοσμε6σι (hair), ρμοσμνοι λλλοισι (trachea and oesophagus), συνηρμοσμνον (chin) are more elaborate than, but similar in spirit to, Anat. 7 and 12. These ideas accord well with known Demokritean views of man ‘governed’ by divinity, the two being microcosm and macrocosm, as )ν τ" νρ5π"ω μικρ" κσμ"ω ντι κατ/ τCν Δημοκρτον, and of origins in general as )γκοσμο#μενον κατ/ λγον where Qυσμς, τροπ, διαιγ play a part (DK 68 B 34 = David Prol. 38.14 and A 38 = Simp. In Ph. 28.15). However, with these similarities in phraseology and spirit, there are fundamental divergences. The overall tenor is completely different: the letter is mannered and pompous, whereas Anat., despite its poetic touches, is spare and functional. There are differences too in attitude to bodily function, and in anatomical sophistication. In the letter, the organs are the seat of the emotions (the heart of anger, the liver of desire). The letter is full of theoretical notions, whereas Anat. is practical and descriptive. Furthermore, whereas the anatomy of Anat. is primitive, and contains no elements which suggest a post-classical date (though, unlike the letter, Anat. gives such precise details as the number of lobes in lungs and liver), that of Ep. 23 displays insights which seem to follow the work of Herophilos and Erasistratos. These are listed by Smith as: the comment on the uselessness of the spleen; the description of the bladder, woven from vessels; the concept that swallowing is accompanied by a shove; the insight that the brain directs the limbs [page 165 // page 166]

168

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via the nerves.48 To these may be added: it is πνε6μα, not drink, which enters by the trachea; the term lungs, not sg. lung, is used; the heart is not ‘round’, but ‘conical’ and in general there is attention to, and some understanding of, function. The two texts, Ep. 23 and Anat., are related in a complex fashion. The most plausible hypothesis is that both are derived, directly or indirectly, from the same Demokritean text, but by writers with entirely different purposes. That there are Demokritean elements in Anat. is assured. But Demokritean need not mean ‘by Demokritos’. Nothing militates against the supposition that this is an excerpt of a genuine work by Demokritos; but it might be a pre-Alexandrian forgery (to be linked with those allegedly detected by Kallimachos), or a later pastiche (to be linked with the epistolary tradition). However, the theory of guileless abridgement seems more probable. As the comparative anatomy which features so prominently in Anat. belongs not with Ep. 23 (though cf. the presentation of Demokritos in Ep. 18) but with Oss. and Epid. 2, it may be supposed that the writer is adapting more than one text. The doctor(s) involved in the writing or compilation of Epid. 2, 4 and 6 practised at Abdera, Ainos, and other such northern centres. The common elements in expression between these, Oss., Anat., and the works of Demokritos is some indication of interaction between Hippocratics and Demokriteans in fifth-century Thrace; and between their later imitators. This can only be glimpsed, hardly reconstructed.49

V. Conclusion This extraordinary little piece has found its way into the HC by accident. It is an // unoriginal and uncritical summary of earlier anatomical works, incorporating Demokritean material. There is a nexus of related Hippocratic texts, most notably Oss. The date of the anonymous redactor is indeterminate, but may be as early as the fourth century. The treatise is a unique testimonial to the nature and extent of ancient anatomical knowledge, and an important document linking the lost Demokritean corpus with certain Hippocratic texts. Smith (1990), p. 33. See Jouanna (1992), pp. 48–50 on Hippocrates’ connections with North Greece and pp. 36–37 on Hippocrates and Demokritos; also Longrigg (1993), pp. 66–69, 93–97 on Demokritean ideas in the HC. 48 49

[page 166 // page 167]

APPENDIX M.-P. Duminil, Hippocrate: CUF t. 8, Ulc., Oss., Cor, Anat. (Paris, 1998) appeared soon after the first publication of this article in Classical Quarterly. It is not uncommon in scholarship that a text or subject long neglected is simultaneously the subject of more than one study. It is proper that, on republication of my article, some account is taken of Duminil’s work. D’s text, as is conventional in the Budé series, is prefaced by a short general introduction (‘Notice’) and accompanied by a translation, with only a few notes. Accordingly, D’s treatment is necessarily much less detailed than my own; on the whole it is descriptive rather than evaluative. In the ‘Notice’, D discusses title (found to be inappropriate, as the work gives a partial rather than a detailed study of anatomy) and content (found to be biological rather than medical). Parallels with Demokritos and others are noted; but D places more emphasis on similarities with (pseudo-) Rufus of Ephesus. The manuscript tradition is then briefly described. I do not discuss differences which do not affect the sense, such as D’s preference for contracted forms, e.g. το#του not τουτου, and for ξυνrather than συν- forms. Otherwise, the main differences in the two texts are as follows: – (I. 1 = D’s 1) D keeps nominative singular cπτομνη V while I, following Ermerins, emend to genitive plural cπτομνων (for reasons, which I still think valid, see commentary 143–144). I note that D translates as if reading the genitive plural. – (I.4 = D’s 3) D keeps κεμενας V while I, following Ermerins, emend to κεμενον (for reasons, which I still think valid, see commentary 150). – (I. 5 = D’s 4) D reads χετο σκαληνοειδε7ς 1κρην [κορυφ=ν] κ#στιος κεαται while I read χετο σκαληνοειδες )ς 1κρην κορυφ=ν κ#στιος κε7νται. D’s deletion of the substantive on the grounds of tautology seems odd, and it still seems to me that the preposition

170

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is required; D’s preference for κεαται a rare form of the third person plural may be justified (κεανται V). – D reads )γκ/ς δ* κ#στιος μετοχ= ε8σω πφυκε while I read Dκαεν κ#στιος μσα σχα πφυκε. D seems unaware that her emendation, based on a Galenic gloss, was anticipated by Triller (for full discussion, see commentary 151–152). – (II.10 = D’s 6) D keeps μικρν V while I, following Foesius, emend to μακρν (for reasons, which I think compelling, see commentary 150). – D fails to note that there are different manuscript readings of adjectives and substantives beginning 'μο- or 'μοιο- (see commentary 143, with n. 6). Although there are some points of disagreement in interpretation (for example, whether the word μλοισιν refers to ‘apples’ as D believes, or to ‘sheep’ as I prefer) there are points of agreement also (for example, that the phrase βρογχη πολλ refers to the aorta, and that the expression )π σηππτικ ς κοιλης can stand).

INDEX OF AUTHORS AND TEXTS Aetius

66

Alkaios

160

Alkmaion DK 24 A 5

18 20, 83

Anaximander

133

Anonymus Londinensis 15, 160 XII 22–26 (Dexippos) 20, 61 Aretaios Aristophanes Eccles. 254, 398 Eq. 455 Nu. 327 1043 Pl. 665 717–725 Ra. 588 1067 Aristotle col. 796a GA 5.1 6 HA 1.1 1.16 3.3 3.5 Metaph. 985b PA 637b 647a 655b 664a

82, 98, 99, 130 25 151 61 69 25, 92 25 25 144, n. 53 20 20 165, n. 131, 159 158 69 132 141 141 160 160

664b 667a 669b 670b 671b 673b Po. 1449a Probl. 31.21 31.22 31.23 31.25 31.28 Rh. 1411a

160 159 131, 148, 149 141 143, 159 140 152 15, 21, 79 109 83 60–61 57–58 109 61

Athenaios 262a

151, n.

Celsus

6, 11, 19, 21–22, 23, 60, 65–67, 69, 71, 79, 90, 97–98, 104, 106–107, 129, 155–157 164 106 106 98 156 131, 136 151 144 106, 112 107 60, 79 79 60 52 99 60 67, 87

proem 8 proem 30 2.1.6 2.10.1–17 4.1.1–13 4.1.3 4.1.7 4.1.11 6.6.1 6.6.8 6.6.10 6.6.26 6.6.31 6.6.35 6.6.38 7.7.3 7.7.4

172

index of authors and texts

7.7.13–14 7.7.15 7.7.31 8.3

51 65, 74, 79 76 103

Demokritos

19, 120, 132, 133, 136, 139, 150, 159, 164–168 142, 165 165 137 165 165 142 53, 165 159 139 136 147 165 164 166 165 167 139 139 142, n. 164 148 133 165 165 139 165 139 139 139

DK 68 A 37 DK 68 A 61 DK 68 A 77 DK 68 A 125 DK 68 A 128 DK 68 A 132 DK 68 A 135 DK 68 A 151 DK 68 A 152 DK 68 A 155 DK 68 B 5 DK 68 B 7 DK 68 B 8 DK 68 B 31 DK 68 B 33 DK 68 B 34 DK 68 B 37 DK 68 B 57 DK 68 B 135 DK 68 B 139 DK 68 B 151 DK 68 B 155 DK 68 B 164 DK 68 B 165 DK 68 B 187 DK 68 B 197 DK 68 B 223 DK 68 B 270 DK 68 B 288

Demosthenes Philalethes 19 Diokles fr. 137

20

Dioskorides

72, 79, 84, 92

Empedokles DK 31 A 77

18, 161, 163 147

DK 31 A 83 DK 31 B 27 DK 31 B 61 DK 31 B 81 DK 31 B 84 DK 31 B 150

149 133 147 147 83 141

Erotian Δ 18 Ε 38 Κ 35 Ξ2 Ο 25 Σ 56 Τ 15 Τ 34 Φ 13

7, 61, 156 63 131 147 91 80 143 75 63 92

Euripides Alc. 261 Ba. 1339 Cy. 683 El. 492 772 837 Hel. 179 1502 HF 130 Ion 1011 IT 978 1481 Supp. 94 Tro. 117 fr. 983 N. Euryphon

53 137, n. 65 163 132 134, 163 53 53 132 163 137, n. 137 132 163 160 18, 75

6, 7, 19–22, 50, 66, 87, 98, 102, 106– 107, 130, n., 142, n., 147, n., 156 de anatomicis administrationibus 2.349 K 104 2.719 K. 104

Galen

index of authors and texts de compositione medicamentorum secundum locos 12.701 K. 84 12.702 K. 92, 106 12.709–711 K. 79, 93 12.711–714 K. 106 12. 738 K. 93 12. 802 K. 98 de compositione medicamentorum temperamentis et facultatibus 12.242 K. 84 Hippocratis de medici officina liber et Galeni in eum commentarius 18 (2).808 K. 102 Hippocratis de articulis liber et Galeni in eum commentarii 18 (1).379 K. 150 in Hippocratis Prognosticon commentarii 106 18 (2).47 K. 82 introductio seu medicus 14.742 K. 21 14.767–777 K. 20, 87, 93 14.768 K. 106 14.769 K. 90 14.782 K. 21, 66 linguarum Hippocratis explicatio 7, 144, n., 156, 170 19.74 K. 109 19.86 K. 81 19.91 K. 61 19.92 K. 152 19.97 K. 100 19.112 K. 91 19.118 K. 92 19.124 K. 93 19.125 K. 91, 146 19.128 K. 3, 158 19.148 K. 84, 111 de locis affectis 8.218 K. 20–21 de methodo medendi 10.281K. 85 10.937–942 K. 66 10.940 K. 92 10.1004 K. 88

173

de optimo medico cognoscendo 22 de placitis Hippocratis et Platonis 156 de remediis parabilibus 14.341 K. 22 14.342, 343, 344 K. 106, 107 14.410 K. 87 de simplicium medicamentorum temperamentis et facultatibus 12.242 K. 84 de tumoribus praeter naturam 7.732 K. 88 Herakleitos

163

Herodotos 1.38 2.86 3.30 4.187 5.58 8.54

53 159 3 66 132 3

Herophilos

19, 98, 140, 159

Hesychios

7, 61–62, 68, 81, 85, 91, 108, 130, 132, 136, 138, 142, 143, 144, 150, 151, 157

Hippocrates, HC Acut. 5 [2.260 L.] 19 [2.264 L.] 30 [2.290 L.] 60 [2.356 L.] Acut. Sp. 3 [2.398 L.] 5 [2.406 L.] 7 [2.424 L.] 9–10 [2.412 L.] 15 [2.474 L.] 26 [2.486 L.]

17, 72, 92 54 150 131 77 108 73 73 54, 96 160 77

174

index of authors and texts

61 [2.516 L.] 77 65–66 [2.520 L.] 90, 91 Aer. 17, 55, 82 10 [2.42, 46 L.] 20, 105 Aff. 16, 17, 111, 147 2 [6.210 L.] 17, 79, 100 4 [6.212, 214 L.] 17, 96, 100 5 [6.214 L.] 17 9 [6.216 L.] 160 11, 12, 13 [6.218, 220 L.] 81 15 [6.224 L.] 17, 92, 145 18 [6.228 L.] 17 20 [6.230 L.] 54 22 [6.234 L.] 58 23 [6.234 L.] 17, 80 26 [6.238 L.] 110 27 [6.238 L.] 110 28 [6.240 L.] 17 29 [6.240, 242 L.] 17, 72 31 [6.244 L.] 72 33 [6.244 L.] 18, 81 37 [6.246 L.] 110 38 [6.248 L.] 111 40 [6.250 L.] 17 98 54 [6.264 L.] 58 [6.266 L.] 98 47 [6.258 L.] 108 Alim. 163 23 [9.106 L.] 150 25 [9.106 L.] 146 30 [9.110 L.] 140 31 [9.110 L.] 138 Aph. 17 Aph. 3 12 [4.490 L.] 20, 105 14 [4.492 L.] 105 31 [4.502 L.] 50 Aph. 4 77 [4.530 L.] 91 Aph. 6 19 [4.568 L.] 82 31 [4.570 L.] 22 de Arte 134, 160, 161 10 [6.16 L.] 11 [6.20 L.] 3

7, 16, 18, 55, 57, 72, 89, 110, 112, 131, 137, 148, 157, 159, 162 7 [4.86, 92 L.] 12, 69, 110 8 [4.92, 94 L.] 159 2 9 [4.102 L.] 85 11 [4.106, 108 L.] 63, 70, 150 13 [4.116 L.] 146 16 [4.128 L.] 69 18 [4.132 L.] 163, n. 19 [4.132 L.] 55 22 [4.134 L.] 163, n. 31 [4.146 L.] 55 38 [4.166, 168 L.] 55, 71 40 [4.172–176 L.] 82, 110 45 [4.190–196 L.] 65, 130 46 [4.196 L.] 65 47 [4.202 L.] 55, 65 62 [4.264–268 L.] 55, 62, 132 68 [4.282 L.] 73 78 [4.312 L.] 55 Carn. 157, 162 137, 159 1 [8.584 L.] 2 [8.584 L.] 161 3 [8.586 L.] 145, 147, 150, 152, 160 4 [8.588 L.] 151 5–9 [8.590–596 L.] 145 5 [8.590 L.] 130, 138, 139, n., 151, 155, 157 6 [8.594 L.] 150 13 [8.600 L.] 150 17 [8.604, 606 L.] 20, 83, 161 19 [8.614 L.] 152, 157 Coac. 18, 57, 82, 86, 94, 109, 112 2.209 [5.628 L.] 53 2.214 [5.630 L.] 59–60 Artic.

index of authors and texts 2.220 [5.632 L.] 22 2.357–372 [5.660, 662 L.] 96 3.483 [5.692 L.] 89 5.502 [5.700 L.] 17 7.593 [5.722 L.] 83 7.611 [5.726 L.] 83 Cord. 83, 157 1 [9.80 L.] 137, 149 2 [9.80 L.] 146, 159, 160 5 [9.84 L.] 149 7 [9.84 L.] 139, 146 8 [9.84, 86 L.] 146, 150 10 [9.86 L.] 149 Epid. 17, 56, 71, 112 Epid. 1 1.2.4 [2.216 L.] 60, 105 Epid. 2 94, 120, 158, 161, 162–163, 168 2.2.24 [5.94, 96 L.] 96, 137 2.3.1 [5.102 L.] 77 2.3.2 [5.104 L.] 111 2.3.14 [5.116 L.] 68 2.4.1 [5.120, 122 L.] 129, 141, 148, 158 2.4.2 [5.126 L.] 20 2.6.12 [5.134 L.] 95, 105 2.6.28 [5.138 L.] 93 Epid. 3 78 3.3.7 [3.84 L.] Epid. 4 72, 168 4.7 [5.146 L.] 142 4.19 [5.156 L.] 163, n. 4.30 [5.174 L.] 3, 50 4.44 [5.184 L.] 77 4.52 [5.192 L.] 95 Epid. 5 62, 86, 91 5.7, 8 [5.208 L.] 56 5.25 [5.224 L.] 81 5.26 [5.226 L.] 56 5.68 [5.244 L.] 109 Epid. 6 25, 86, 94, 112, 120,

175

158, 161, 162–163, 168 6.1.3 [5.266 L.] 163, n. 6.3.18 [5.302 L.] 158 6.4.6 [5.308 L.] 150, 159 6.4.21 [5.312 L.] 149 6.7.1 [5.332 L.] 95 Epid. 7 4, 86 7.3 [5.368, 370 L.] 73, 82 7.11 [5.384 L.] 57 7.12 [5.388 L.] 129 7.25 [5.394 L.] 129 7.43 [5.410 L.] 71 7.45 [5.412 L.] 105 7.59 [5.424 L.] 108 7.65 [5.430 L.] 109 7.78 [5.434 L.] 83 7.80 [5.436 L.] 83 7.124 [5.468 L.] 65 Epp. 10–17, 18–21, 22–24 165, 166 Ep. 11 [9.326 L.] 152 Ep. 17 [9.354–378 L.] 108, 159, 164, n., 165 Ep. 18 [9.382 L.] 139, 150, 165–166 Ep. 19 [9.382 L.] 165–166 Epp. 20, 21, 22 164, n., 166 Ep. 23 [9.394, 396 L.] 120, 134, 137, 145, 148, 149, 151, 152, 164, n., 166–168 Ep. 24 166 Fist. 72, 92, 104, 112 1 [6.448 L.] 152 9 [6.456 L.] 78 Fract. 7, 18, 57, 82, 89, 104, 112, 137, 157 3 [3.422 L.] 70, 158 4 [3.430, 432 L.] 109, 163, n. 5 [3.434 L.] 70, 163, n.

176 9 [3.448 L.] 10 [3.450 L.] 12 [3.460 L.] 15 [3.470, 472 L.] 21 [3.486 L.] 30 [3.520 L.] Gland. 1 [8.556 L.] 3 [8.558 L.] 4 [8.558 L.] 7 [8.560 L.] 11 [8.564 L.] 12 [8.564 L.] 13 [8.568 L.] 14 [8.568, 570 L.] Haem. 2 [6.436, 438 L.] 4 [6.440 L.] 5 [6.440 L.] Hebd. 5 [8.636 L.] 35 [8.657 L.] 52 [8.673 L.] Int.

index of authors and texts 131 55 130 68 101 131 16, 17, 18 150 74 130 130, 150 17, 65 61 105 17, 65, 76, 131 92, 152 63, 69 103 73

146 109 139 16–17, 55, 75–76, 81, 92, 108 1 [7.166, 172 L.] 76, 129, 131, n. 2 [7.174 L.] 76 4 [7.178 L.] 87 6 [7.180 L.] 55 7 [7.184 L.] 110 8 [7.186 L.] 76 9 [7.188 L.] 81 12 [7.192, 194 L.] 17, 73 13 [7.200 L.] 17, 76 15 [7.204 L.] 54 18 [7.210, 212 L.] 54, 70, 74, 75 21 [7.220 L.] 98, 100 24 [7.228 L.] 89 26 [7.234 L.] 73 27 [7.238 L.] 55 28 [7.242 L.] 70, 81 35 [7.252 L.] 57 36 [7.256 L.] 73 37 [7.258 L.] 100 51 [7.292 L.] 57

Iudic. 51 [9.292 L.] Loc. Hom.

149 9, 16, 18, 21, 64–65, 72, 78, 86, 91, 94, 112, 156, 157 1 [6.276, 278 L.] 20, 64, 163, n. 2 [6.278, 280 L.] 20, 103, 119 3 [6.280, 282 L.] 82, 83, 129, 131, 134, 135, 139, 146, 161 6 [6.284 L.] 157 10 [6.294 L.] 129, 134 12 [6.298 L.] 101 13 [6.298, 300, 302 L.] 3, 16, 56, 61, 64, 74, 75, 78, 81, 103, 111, 112 14 [6.302–308 L.] 91, 129, 131, n., 134 15 [6.308 L.] 76 20 [6.312 L.] 146 21–23 [6.312, 314 L.] 76 21 [6.312 L.] 17, 65 22 [6.314 L.] 101 26 [6.316 L.] 160 27 [6.318 L.] 101 30 [6.322 L.] 96, 101 32 [6.324 L.] 102 38 [6.328 L.] 85 40 [6.330 L.] 16, 64, 70, 73 42 [6.334 L.] 53 47 [6.346 L.] 93, 112 Medic. 2 [9.206, 208 L.] 69, 80 5 [9.212 L.] 17 8 [9.214 L.] 68 Mochl. 72, 82, 148, 158, 162, 163 1 [4.340, 342 L.] 65, 130, 157 8 [4.354 L.] 163, n. 12 [4.356 L.] 163, n. 34 [4.376 L.] 73 35 [4.378 L.] 81

index of authors and texts 39 [4.386 L.] 130 41 [4.392 L.] 131 42 [4.392 L.] 77 Morb. 1 147 3 [6.144 L.] 54, 105 5–6 [6.146–150 L.] 70 26 [6.194 L.] 54 28 [6.196 L.] 54, 101, 160 Morb. 2 16, 21, 86, 94, 96, 112, 148 1 [7.8 L.] 65, 83, 102 1–11 [7.8–18 L.] 102 2 [7.8, 10 L.] 64–65 4 [7.10 L.] 73 8 [7.16 L.] 73 9 [7.16 L.] 96 12 [7.18 L.] 57, 65, 71, 73 13 [7.22, 24 L.] 78, 84, 86, 101 15 [7.26, 28, 30 L.] 73, 78, 81, 101, 103, 104 18 [7.32 L.] 78, 86, 101 19 [7.32, 34 L.] 56, 87, 111 22 [7.38 L.] 56 24 [7.38 L.] 80 25 [7.38, 40 L.] 56, 73, 86, 101 26 [7.38, 40, 42 L.] 81, 97, 101 27 [7.42, 44 L.] 97, 101 28 [7.46 L.] 97, 98 29 [7.46 L.] 97 32 [7.50 L.] 71, 102, 103 80 33 [7.50 L.] 35 [7.52 L.] 80 36 [7.52 L.] 101 43 [7.60 L.] 98, 197 47 [7.66, 68, 70 L.] 69, 72, 81, 111 50 [7.78 L.] 81 51 [7.80 L.] 81 53 [7.82 L.] 76 56 [7.88 L.] 76 58 [7.90 L.] 91 59 [7.92 L.] 136 62 [7.96 L.] 76 69 [7.106 L.] 144

72 [7.108, 110 L.] 73 [7.112 L.] Morb. 3 1 [7.118 L.] 2 [7.120 L.] 3 [7.120 L.] 6 [7.124 L.] 10 [7.128, 130 L.] 11 [7.130 L.] 15 [7.140 L.] 16 [7.142–148 L.] 17 [7.156 L.] Morb. 4 38 [7.556 L.] 40 [7.560 L.] 54 [7.596 L.] 56 [7.604–608 L.]

177 108 70, 108 84, 94 57 81, 109 73, 86 110 85, 96 80 74 74, 76, 109, 110, 160 85 56, 151 160 151 150

134, 146, 160 Morb. Sacr. 3 [6.366 L.] 159 7 [6.374 L.] 20 17 [6.392 L.] 151 gynaecological works 54–55, 56, 69, 71, 72, 80, 91 Mul. 1 17, 82, 86, 101, 112, 148 34 [8.80, 82 L.] 98, 160 70 [8.148 L.] 81 74 [8.156, 158 L.] 98, 111 75 [8.164, 168 L.] 81, 98 90 [8.214 L.] 98 97 [8.224 L.] 98 102–105 [8.224–228 L.] 90 102 [8.224 L.] 98 105 [8.228 L.] 61, 98 109 [8.232 L.] 85 Mul. 2 86, 101, 112, 151 110 [8.236, 238 L.] 89, 99 111 [8.240 L.] 111 112 [8.242 L.] 56 116 [8.250 L. 61, 83

178

index of authors and texts

119 [8.228 L.] 61 144 [8.316, 318 L.] 68 165 [8.344 L.] 111 185 [8.366 L.] 85 Nat. Hom. 3 [6.38 L.] 165, n. 11 [6.58 L.] 158 14 [6.66 L.] 91 Nat. Mul. 112 1 [7.312 L.] 146 13 [7.330 L.] 56 24 [7.342 L.] 111 32 [7.358, 362, 366 L.] 55, 98, 143 33 [7.370 L.] 55 40 [7.384 L.] 71 98 100 [7.416 L.] Nat. Pue. 151 31 [7.540 L.] 159 Off. 82 17 [7.322 L.] 84 23 [7.328 L.] 84 24 [7.332 L.] 84 Oss. 3, 73, 112, 120, 130, 148, 149, 157–163, 168 1 [9.168 L.] 130, 141, 144, 150, 157, 159, 160, 163, n. 3 [9.170 L.] 152 4–7 [9.170–172 L.] 158 4 [9.170 L.] 131, 143, 158, 160 5 [9.170 L.] 129, 163, n. 7 [9.172 L.] 141, 161 8 [9.174 L.] 158 9 [9.176 L.] 152, 158 10 [9.178, 180 L.] 141, 145, 148, 158 12 [9.182, 184 L.] 20, 133, 141, 145, 159 13 [9.184, 186 L.] 136, 160

14 [9.186, 188 L.]

76, 149, 152 139, 145 145, 152 131, 135, 141, 151 19 [9.196 L.] 137 Prog. 82, 94, 111 2 [2.114, 116 L.] 21, 60, 106 23 [2.174, 178 L.] 96, 101 24 [2.184 L.] 136 Prorrh. 1 58, 86, 112 Prorrh. 2 17, 21, 25, 82, 94, 112 18–20 [9.44–48 L.] 17 18 [9.44, 46 L.] 58–59, 107, 112 20 [9.48 L.] 50, 51, 87 21 [9.48 L.] 105 30 [9.60 L.] 91 33 [9.64 L.] 95 34 [9.66 L.] 95 43 [9.74 L.] 56 Septim. 132 139 1 [7.436 L.] Steril. 82 221 [8.426 L.] 80 222 [8.430 L.] 63 248 [8. 460 L.] 68 Ulc. 16, 83, 85, 92 1 [6.400 L.] 110 6 [6.404 L.] 85 8 [6.406 L.] 85 10 [6.408 L.] 111 12 [6.412 L.] 85, 90, 93, 98 13 [6.416 L.] 92, 98 14 [6.418 L.] 89 17 [6.420 L.] 90, 93 22 [6.426 L.] 101 24 [6.428 L.] 74, 100, 101, 110 25 [6.430 L.] 101 26 [6.430 L.] 68 Vict. 1 72 165, n. 6 [6.478 L.] 11 [6.486 L.] 146 16 [9.190 L.] 17 [9.192 L.] 18 [9.194 L.]

index of authors and texts Vict. 2 54 [6.556 L.] Vict. 3 Vict. 4 90 [6.656 L.] VC

98 56, 147

81 7, 9, 82, 86, 89, 102, 112 2 [3.188–192 L.] 65, 86 3 [3.194 L.] 65 9 [3.210 L.] 102 13 [3.228, 230 L.] 86, 101, 110 14 [3.236–242 L.] 80, 89, 111 15 [3.244 L.] 85 18 [3.250 L.] 58, 81 19 [3.252, 254 L.] 80, 109 21 [3.256, 258 L.] 81, 102 VM 61 18–19 [1.612–616 L.] 60–61 19 [1.616, 618 L.] 74, 161 22 [1.626–632 L.] 136, 141, 146

Homer Il. 3.292 4.528 11.579 17.47 19.266

53, 83, 148, 155 146 131 148 146 146

Lysias

25, 62

Oreibasios

Plato Phd. 96b R. 405c 517a Sph. 258c Ti. 33b, c 45b–46a, 58c 71c and Ti. Locr.

179 133, n., 142, n., 164, n. 147 107 53 57 137 82 141 139, n.

Pliny

98–99

Plutarch

61

Pollux

61–62, 82, 106, 130, 131, 134, 151, n., 157

Poseidonios

155

Praxagoras

129

Protagoras

164

Pythagoras, Pythagoreans 57, 133, 139, n., 145, 150 Rufus

23, 50, 129–130, 133, 141, 143, 144, 146, 148, 149–150, 152, 155–157, 169

21, 50, 130, n.

Scribonius Largus

78

Parmenides

143, 163

Strabo

80

Paul of Aigina

12, 21, 23, 50, 98, 103

Theophrastos

81

133

Xenophon

56

Philolaus

GENERAL INDEX Abdera, 19, 132, 164, n., 165, 168 acupuncture, 26 anatomy comparative, 120, 129–166 foetal, 140, n., 143 Homeric, 155 regional, 120, 155 arteries, see vessels belly, 119–120, 149–150 bladder, 119, 144–145, 156, 167 body fluids, 129 bile, 17, 57, 61, 134, n. blood, 10, 83, 96, 99, 129–130 ichor, 10, 61, 83–84 mualos, 65, 76 muxa, 61–62 phlegm, 10, 17, 21, 52, 57, 61, 65, 83, 96, 102, 105, 107, 108, 134, n. pus, empyema, 27, 69, 76, 97, 102, 147, 160 sweat, 61 tears, 59–61, 106 urine, 83 water, ‘moisture’, 10, 103 Calvus, 6, 56, 69, 84, 86 Cornarius, note also critical apparatus, 5, 6–7, 56, 64, 86, 89, 101, 108, 109, 134, 143 Demosthenes Philalethes, 19 diaphragm, 119, 147–148, 156 diseases, see also eye ‘choker’, 95–98, 105 dropsy, 73, 76 jaundice, 73, 108 joint diseases, 105 malaria, 93

phthisis, 73, 76 pleurisy, 76 pneumonia, 93, 95, 160 stroke, 73, 86 tuberculosis, 93 dissection, 120, 159 drugs, see medicaments Egypt, 22, 24, 77, 80, 159 Erasistratos, 19 eye anatomy, note also glossary and diagrams, cornea, 8, 19, 51, 82 fundus, 25 iris, 3, 8, 51 lash, 9, 88 lid, 9, 76–79, 87–89 limbus, 82 membranes, 8–9, 19, 60 opsis, 3–4, 49 optic nerves, 19, 26; cf. ducts, 20, 21 pupil, 3, 8, 51 retina, 19, 50 tarsal plates, 82, 88 diseases, note also glossary, amaurosis, 9–10, 101 amblyopia, 9–10 blepharitis, 59, 90, 91 cataract, 8, 22, 23, 24, 49–51, 53 chalazion, 8, 22, 88 conjunctivitis, 8, 10, 22, 25, 59, 105 ectropion, 8, 59 entropion, 10, 59 glaucoma, 22, 23, 49–51, 53 iritis, 50 keratitis, 50, 51

182

general index night blindness, 8, 9, 22, 23, 25, 27, 93–101 ophthalmia, 9, 13, 78, 94, 95–96, 104–112 papilloma, 8, 88 pterygion, 22, 87–88 ptilosis, 87 rheum, 25, 58–63 trachoma, 8, 10, 12, 19, 22, 23, 24, 27, 76–79, 85, 87–89

flux, 10, 16, 20, 52, 61, 64–65, 74, 110 ocular flux, 16, 19, 20–21, 61, 64–66, 78, 102, 107, 111 Foesius, note also critical apparatus, 7, 37, 49, 58, 69, 71, 72, 75, 83, 84, 86, 87, 89, 92, 100, 101, 108, 110, 136, 143, 151, 170 grammar, see style head, note also diagram 2, bregma, 9, 17, 19, 78, 85–86, 102 crown, vertex, 9, 71 inion, occiput, 9, 65, 67, 71 heart, 119, 135, 136–138, 145, 156, 161, 167 Herophilos, 19, 98, 140 kidneys, 119, 142–144, 145, 156, 157, 160 Knidos, Knidian, 18 Kos, 61 Kyrene, 19 language, see style, terminology Libya, 19, 66 liver, 119–120, 135, 140–142, 145, 148, 154, 156, 167 lung, 20, 72, 76, 91, 96, 119–120, 129, 131, 133–140, 145, 156, 160, 161, 168 medicaments, see also therapy, 8, 11, 17 arum, 12, 72 bile (animal), 98

choice, dosage, 12, 56, 72, 84, 111 copper, 12, 22, 24, 56, 79, 84, 89, 90, 91–93, 106 cypress, 78, 86 elaterion, 12, 96, 100 fig (juice, leaves), 79, 92 fungus, 71 garlic, 11, 92, 95, 97–98 grape (juice), 79, 90, 91, 92 honey, 11, 22, 72, 94, 98, 106 industry, 90 liver, 22, 27, 95, 98–99 myssotos, 93 olive oil, 11, 71, 78 saffron, 91 salt, 72, 86 vinegar, 92, 111 wine, 12, 22, 78, 91, 97, 98, 107 Miletos, Milesian, 80 moxibustion, 26, 70 number, numerology, 57, 145, 150 oesophagus, 119, 146–147 ophthalmoscope, 25–26 pain, 11, 13, 22, 53, 57, 59–60, 78, 95, 103, 104, 106, 107, 111 papyri (ophthalmological), 66 Ebers, 22 Kahun, 22 pathology, see also diseases, 9–10 prognosis, 10, 17, 49, 59 pulse, 73, 74 Pythagoras, Pythagoreans, 57, 133, 145, 150 Sicily, 22 signs, 13, 21, 53, 60, 73, 82, 83, 96, 106 spleen, 54, 119, 132, 141, 145, 147, 148–149, 152, 156, 157, 167 sponge, 11, 22, 68, 72, 79, 80, 97 style, 8, 13–15 adverbial clauses (conditional), 52, 61, 108 (temporal), 52, 61, 79, 106

general index alliteration, 52, 108 antithetitical style, 52 aphoristic style, 67, 104, 108, 163 article, omitted, 120, 138, 145, 163 asyndeton, 14, 52, 67, 88, 120, 163 compendious comparison, 120, 137, 143, 150, 160 compound verbs, 14–15, 61, 70, 72, 89, 101, 103, 131, 134, 137, 141, n., 142, 151, 164 compression, ellipse, 6, 14, 15, 65, 67, 84, 85, 88, 90, 94, 120, 142, 148, 150, 161, 163 connective particles, 18, n., 57 dialect, Doric, 75 dialect, Ionic, 132, 144 didactic tone, 13, 15, 61, 67, 135 diminutives, 72 dual number, 62 epic expression, 144, 162 genitive absolute, 111, 133 jussive (imperatival) infinitive, 13–14, 61, 67, 68, 79, 88, 91, 99, 103 jussive subjunctive, 14, 91 metaphor, 69, 131, 134, 136, 156 oral discourse, 63 parataxis (compound sentences), 14, 52, 67, 163 participles, 13, 68, 81, 90–91, 99 poetic tone, 143, 164 prepositions, 14, 131 pronouns, demonstrative, 14, 52, 56, 58, 79, 84 rhythm, metrical elements, 162 simile, 15, 149, 162 suffix (adjectival), 54, 55–56 (substantival), 112 triadic expression, 67 variatio, 67, 143 surgery cautery, 10, 11, 12, 16, 17, 18, 22, 26, 27, 49, 52, 63, 64–67, 79, 89 cupping, 8, 11, 12, 16, 27, 96, 98, 100

183

cutting, 8, 11, 16, 21, 26, 66, 78–79, 85, 88, 102 instruments, 12, 63, 70, 79, 80–81, 89 phlebotomy, venesection, 16, 22, 52, 58, 70, 94, 95, 96, 97, 105, 108 scarification, 22, 24, 27 scraping, 12, 24, 63, 76, 79–80 trephining, trepanation, 8, 9, 12, 16, 22, 27, 78, 81, 101–104 Susruta, 22 syntax, see style terminology, nomenclature, 120, 132, 135, 148, 151, 161 anatomical, 8–9 technical, 8, 12, 54, 112, 132 vocabulary, choice, 54–55, 120, 162–163 therapy, see also surgery diet, 13, 79 environment, weather, 13, 22, 81 exercise, 79 fumigation, vapour bath, 81 ointments, salves, 8, 11, 12, 16, 22, 24, 52, 84, 98, 106, 107, 111, 112 poultices, 8, 12, 13, 107, 110 purging of head (errhines) and body (emetics, enemas, laxatives), 8, 10, 11, 12, 16, 22, 49, 52, 56, 76, 77, 78, 86, 95, 98, 100, 108, 109 Thrace, 120, 159, 168 throat, 130, 132 trachea, 119–120, 129–130, 145, 156, 160, 168 veins, see vessels vessels, 10, 11, 63–66, 69, 73–74, 86, 95, 96, 129–130, 135, 137–140, 155 aorta, 136, 137–138, 155 portal vein, 140–141 splenic artery, 140 vena cava, 136, 137–138, 139, 141 wool, 11, 78, 80

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