CPGM Glossary - ὑδροκέφαλον

ὑδροκέφαλον
Medical Branches / Pathology: Diseases

var. ὑγροκέφαλον
lat. hydrocephalus

Definition

Condition characterized by the accumulation of watery fluid (ὑδατῶδες ὑγρόν) in the head, as the name implies. The loci in which fluid gathers are three or four according to the sources. The ancient notion of hydrocephalus is considerably different from that of modern medicine and includes a broader range of medical afflictions. The ὑδροκέφαλον (πάθος) – the compound can be either a noun or adjective – has been recognized as a pathological and clinical condition since the days of Hippocrates, so that it has been clearly described by Greek and Latin physicians with investigation into its etiology, symptomatology, diagnosis, treatment and surgery. The only papyrological attestation of hydrocephalus is a medical catechism of the late II-beginning of the III century CE (GMP I 6), that is paralleled by the so called ‘continental’ tradition of the Latin Pseudo-Soranian Quaestiones medicinales (as is preserved in MS Carnot. 62, fol. 13r-v).

Contents

A. Linguistic section

1-2. Etymology & General linguistic commentary

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Descriptive compound formed from the Greek words ὕδωρ, ‘water’, and κεφαλή, ‘head’, expressing the cause and localization of the disease respectively, i.e. ‘water in the head’. Both these nominal lexemes participate in a wide range of compound-nouns and adjectives as first or second component. Some of them represent medical technical terms for diseases and discomfort, e.g. κεφαλγία, «headache» (LSJ9 945 s.v.), μυιοκέφαλον / μυοκέφαλον, «a complaint in the eyes, in which the uvea protrudes like a fly’s head» (LSJ9 1151 s.v.), ὑδροκήλη, «water in the scrotum, hydrocele» (LSJ9 1845 s.v.), ὑδρόμφαλον, «umbilical hernia supposedly due to accumulation of fluid» (LSJ9 1845 s.v.).

Even though the Greek compound ὑδροκέφαλον appears for the first time in the Latin Celsus ([3]) – with the somewhat problematic exception of [2] in the form ὑγρ- (vd. infra, C 1) –the Latin borrowing has only a few attestations: it is found in the abridged Latin version of Soranus’ Gynnaikeia by Muscio (XVII 29,10 [93,5 Rose] quaerendum est ne forte hydrocefalus sit hoc est aquam inter cutem capitis habeat) and in the Latin translation of the Pseudo-Soranian Questiones medicinales ([7]), from which CGL III 601,37 Goetz igrocefalis fagolentus sanguis inter membranam et cutem is taken. The word is spelled in different ways in the manuscript tradition of the Questiones medicinales: the neuter transliteration hydrocefalon in [7] and the masculine ydrocephalus (l. hydrocephalus Rose) in item 250 (An. II 273,25 Rose), drawn from the MS Cottonianus Galba E IV, and in item 336 in MS Lincoloniensis 220, fol. 39v.

The only graphic variant of Greek ὑδροκέφαλον seems to be ὑγροκέφαλον, as occurs also in other compounds where ὑδρο- and ὑγρο- are apparently semantic equivalents (even if the form in ὑγρο- is less attested), such as in the just mentioned case of ὑδροκήλη / ὑγροκήλη.
The word does not spawn derivatives in the ancient languages.

According to LSJ9 1845 s.v., the compound is an adjective in [9], i.e. τὸ ὑδροκέφαλον πάθος, «the hydrocephalic / hydrocephalus condition», «the water-in-the-head affliction», implying that the neuter noun ὑδροκέφαλον is an abbreviated form for this, and perhaps the adjectival use is the older – although unattested previously [9] in our extant sources – and that the substantive has originally come into being through ellipsis of πάθος. The same structure is found in [10] and [11]. Some factors make clear the adjectival nature of ὑδροκέφαλος. First of all the word-formation, since adjectives with κεφαλή as the second component end, as a rule, in -κέφαλος, several of which are attested in medical authors, e.g. ἁδροκέφαλος, ἀκέφαλος, ἀνεγκέφαλος, δικέφαλος, μακροκέφαλος, μεγαλοκέφαλος. From a syntactical point of view, another factor is word-order, since the position of the word ὑδροκέφαλος between definite article and its noun makes it an adjectival modifier of πάθος. Finally, the word is surely a noun-modifier in the expression τὰ ὑδροκέφαλα βρέφη, «hydrocephalic neonates», in Aët. XV 15,143 and 22,11-2 (74,2 and 121,6-7 Zervos), see also Sor. Gyn. IV 11, 3,3-4 (CMG VI 142,12-3 Ilberg) εἰ μὲν ὑγροκέφαλον εἴη τὸ βρέφος (corr. ὑδρ- in Ermerins’ edition [p. 290,16]), as well an in Paul.Aeg. VI 74, 3,7-8 (CMG IX 2, 116,20-1 Heiberg) ὑδροκεφάλου μὲν ὄντος τοῦ ἐμβρύου, «the foetus being hydrocephalic».

Furthermore, in modern Greek ὑδροκέφαλος, -η, -ο remains an adjective, along with ὑδροκεφαλικός, -ή, -ό, evidently formed in modern times, whereas ὑδροκεφαλία is the abstract formation.

The noun ὑδροκέφαλον – phonetically and graphically adapted – lives on in medical technical terminology of other modern languages, which borrowed it directly from Greek or by way of later Latin, sometimes forming derivatives by adding suffixes. Examples are: English ‘hydrocephalus’ (also ‘hydrocephaly’) and derivatives ‘hydrocephalic’ and ‘hydrocephaloid’; Italian ‘idrocefalo’, ‘idrocefalia’, ‘idrocefalico’; German ‘Hydrozephalus’; French ‘hydrocéphalie’, ‘hydrocéphales’.

3. Abbreviation(s) in the papyri

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B. Testimonia – a selection of representative sources

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C. Commentary

1. ὑδροκέφαλον and its medical sources

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Hydrocephalus was a common illness in antiquity, as confirmed by the finding of numerous hydrocephalic skulls dating from the period 2500 BCE to 500 CE, such as a skeleton with a hydrocephalic cranium discovered in Saqqara dating back to the I Dynasty. Maybe also the elongated skull of the pharaoh Akhenaton (XVIII Dynasty) was due to hydrocephalus, but it might even represent a symbolic artificial deformation.

The earliest scientific description of hydrocephalus in Greek medical literature is found in a long passage ascribed to Hippocrates. In [1] the compound ὑδροκέφαλον is not mentioned explicitly, but the author refers to this condition with the periphrasis ὕδωρ ἐπὶ τῷ ἐγκεφάλῳ, ‘water on the brain’. After the list of clinical symptoms and signs such as violent headache, chills and fever, visual disturbance, dim-sightedness, intolerance for sounds and vomiting, he focuses on the treatment and recommends specific diets, purges, sneeze-inducing inhalants and medications. Surgery is considered an intervention of last resort, i.e. an incision at the forehead and trephination to the brain, thus suggesting the locus where ‘water’ lurks and the way it might be drained. The proposal to empty out fluid by means of perforation along that part of the skull is evidence of the fact that hydrocephalus being described is an external form. According to GIJERRIS-SNORRASON 1991, 290 «Hippocrates’ medical and surgical treatment was the first of combined therapeutic proposals».

The first attestation of the compound occurs in [2] in the form ὑγροκέφαλος. Even if it is likely that the variant ὑγροκέφαλος is semantically equivalent to ὑδοκέφαλος in the other medical texts (vd. supra, A 1-2), the term seems to acquire a more generic value here. Thus, it might be referred not to hydrocephalic disease but to the fact that children are general considered to possess moist heads. This may suggest that the compound does not represent an actual terminus technicus in the Aristotelian passage and that it is simply used in a literal way. The context itself seems to lead to this impression, and the use of assertions such as ὁ δὲ ἐγκέφαλος ὑγρός· διὸ καὶ ἡ κεφαλὴ ἀεὶ μάλιστα and ἡ δὲ τοῦ τόπου τούτου ὑγρότης φθειρῶν ποιητική. δηλοῖ δὲ ἐπὶ τῶν παίδων, when coupled with the ancient notion that moisture is the cause of lice, suggests that the discussion focuses in a general way and does not intend a specific case of hydrocephalus.

The earliest extant attestations of the noun in its more usual form ὑδροκέφαλον date back to the I cent. CE. The term is mentioned only once in Aret. SD II 1, 13,2 (CMG II 64,33 Hude) κεφαλὴν ἐπὶ ὑδροκεφάλῳ, but the disease is previously named in [3] ὑδροκέφαλον Graeci appellant. Celsus gives an accurate description of this condition with its symptoms and causes. Etiology influences treatment and hydrocephalus seems to be classified by type and perhaps, by Celsus’ time numbered. First of all, the chronic form is considered. It occurs when a humor causes the scalp to swell up, producing a tumor-like formation which indents when the finger presses down, and it is said to be ‘listed second’ (quod secundo loco positum est). Then the acute form, that is defined non pestiferum tamen vehemens, is described in detail with its therapy. Celsus records known causes (hot and cold weather) and unknown ones, recommending the most suitable treatments, such as drying medicaments and scarification. Finally, a different type of hydrocephalus in which humor collects into the head (dissimile est id genus, quod umorem in caput contrahit), requires surgery when drying therapies are ineffective. This kind, otherwise, is to be treated like dropsy, with exercise, sweating, diet and diuretics. The hydrocephalus referred to by Celsus, as well as by the majority of ancient medical sources (vd. infra), is an extracranial condition, caused by an extracerebral accumulation of fluid.

The Pseudo-Galenic author of the Introductio sive Medicus formulates the earliest anatomical-pathological classification of fluid collections in the head, first naming the four loci in which fluid gathers, moving from innermost to outermost ([4]), then distinguishing treatments according to the locus of accumulation ([5]): two or three straight incisions are necessary to treat hydrocephalus between subcutaneous and infrapericranial area, whereas more invasive cutting is recommended to remove subcranial fluid. Finally, the kinds of hydrocephalus between the meninges and the brain are said to be incurable (ἀθεράπευτα, ὀλέθριον). Another Pseudo-Galenic work ([6]) provides the first definition of this condition as a συλλογὴ ὑδατώδους ὑγροῦ ἢ αἵματος τοῦ τρυγώδους, thus specifying the qualitative composition of fluids collecting in the layers – this is the likely meaning of the generic word σώματα, «bodies» – surrounding the head.

Late antique compendiasts gather elaborate accounts by previous physicians, whose writings have otherwise been lost. Oribasius ([9]) preserves the long account by the Greek surgeon Antyllus (II cent. CE). The author does not give an etiological explanation of the affliction apart from the improper handling by midwives during birth. He especially focuses on: the shape of the tumor-like formation (ὄγκος); the three loci where humor gathers, moving from outermost to innermost, since a fourth accumulation (i.e. between the meninges and the brain) is said to be impossible (ἀδύνατος) because lethal; the appearance of the ὄγκος depending on the area of the head where fluid collects and related symptoms. Finally, he gives a detailed report on surgery in relation to the localization of fluid buildup (vd. infra, C 2).
Aëtius preserves two versions of the account on hydrocephalus by Leonidas (middle-end of the I cent. CE). The two versions are quite similar in content, but the second one (in XV 12,1-80 [34,12-37,18 Zervos]), that is the only one explicitly mentioned by Photius (Bibl. cod. 221, 180b 5-9 Bekker), is more than 30 lines longer and much more detailed, especially in the section devoted to therapy and surgery. In [10], as in [6], the condition is defined as an accumulation of watery fluid (ὑδατώδες ὑγρόν), which is τρυγῶδες, «like lees or dregs, thick» (LSJ9 1830 s.v.), and δίαιμον, «bloody» (LSJ9 395 s.v.). The hydrocephalus that occurs from either known or unknown causes, is described as four types and the final one, that between the meninges and the brain, is deadly. Symptomatology is determined by the quantity of fluid and the area in which it gathers. So, the author divides the fluid buildup under the skull between the bone and the meninx into two different forms: if the fluid is sparse the head is heavy, there is dizziness and senses are weak, whereas when fluid is abundant the sutures distend and progressive enlargement of the head occur, the locus of the accumulation is obviously recognizable, as fluid yields to the finger’s pressure. Finally the author focuses on therapy and surgery. Aëtius refers to hydrocephalus also in other passages. Doubtful, however, is the presence of the word hydrocephalus in XVI 23,41 (32,1 Zervos), a chapter by Philumenus on the extraction of the foetus (ἐμβρυουλκία) and its dismemberment (ἐμβρυοτομία). The compound noun appears in Zervos’ edition of Book XVI (Leipzig 1901) εἰ δὲ ὑπερβάλλοι τῷ μεγέθει ἡ κεφαλὴ ἢ φύσει ἢ δι' ὑδροκέφαλον. Nonetheless Roberto Romano (Torino 2006), reconstructs the text by the collation of several manuscripts , because judged Zervos’ edition unreliable. Romano’s simpler version of this passage omits explicit mention of hydrocephalus, i.e. the cause of the iargeness of the head «either by nature or because of the hydrocephalus»: εἰ δὲ ἐκβάλλοι τῷ μεγέθει ἡ κεφαλή (p. 312). The last of the compendiasts Paulus Aegineta presents an extract from an anonymous author ([11]), similar in content to the accounts of the other physicians, providing definition, etiology, details on the shape of the tumor in relation to its location in the head, symptoms, treatment and surgery. Thus, when fluid is formed between the skin and pericranium the tumor is soft, the swelling elevated, readily yielding to touch and ultimately virtually painless; when it is located between the pericranium and bone the swelling is harder, yields more slowly and is more painful; when fluid collects between the meninx and bone the swelling yields only to strong pressure. In the last case the fluid escapes through the distended cranial sutures, the head enlarges, especially the forehead, the eyes are fixed and shed tears, and pain is greater; surgical treatment, however, is nonetheless not advisable. The loci of fluid accumulations are but three, moving from outermost to innermost. Among the causes mentioned is the rupture of one or more vessels and consequent conversion of the extravasated blood into an inert fluid (κατὰ ῥῆξιν ἀγγείου ἢ ἀγγείων καὶ εἰς ἀργὴν οὐσίαν τοῦ ἐκχυθέντος αἵματος μεταβεβλημένου): this is likely the reason why the ὑδατῶδες ὑγρόν is defined τρυγῶδες and δίαιμον, as already said.

Although the discussions on hydrocephalus preserved by the Byzantine compendiasts differ among themselves in terms of phraseology and vocabulary, from a medical point of view they are similar and refer to extracranial collections of liquid. Nevertheless, the concept of pernicious swelling (ὄγκος) in intracranial position is present.
In late antiquity and in the early medieval period (900-1100 CE) Arab and Persian physicians, in particular Rhazes, Avicenna, Ali Abbas and Albucasis, continued to pass on the writings of Greek authors, including descriptions of hydrocephalus along with all the rest. For instance, Rhazes borrowed his report mostly from Antyllus ap. Oribasius and Paulus, whereas Avicenna reworked freely the accounts by Aëtius and Paulus. Furthermore, Albucasis, very much the surgeon, as well as a physician, devoted one of his treatises to neurosurgical diseases, among which infantile hydrocephalus, due either to an excessive mechanical compression at birth or to other, unknown causes.

The only papyrological evidence for hydrocephalus is [8], a papyrus scrap containing a fragment of medical catechism copied on the back of a roll previously used perhaps for accounts. Hydrocephalus is discussed in ll. 3-18, and it is explicitly mentioned in ll.5 and 7. The discussion is divided into three sections, each heading introduced by a question: the first set of question-and-response involves the definition of hydrocephalus (ll.3-6); the second set calls for differential diagnosis according to the four loci where fluid accumulation gathers, moving from outermost, the subcutaneous layer between scalp and pericranium, to innermost, that between the meninges and the brain (ll 7-10); the final question (l.11) makes inquiry about the etiology of hydrocephalus and the response follows in ll.12-8, interspersing information on symptoms and treatment; little however can be read in these lines with confidence. As is the case with [5] τὰ δὲ μεταξὺ μήνιγγος καὶ ἐγκεφάλου ἀθεράπευτα and [9] διάστασις τῶν ῥαφῶν ἀθεράπευτός ἐστιν, the papyrus catechism eschews invasive procedures with the adjective ἀθεράπευτος in l.18. The compiler of this papyrus seems to have chosen sources similar to what is excerpted by the Byzantine compendists, probably the best information on the topic at their disposal. Nevertheless, no one of these Greek author seems to be the direct source of the papyrus. On the other hand, the text displays close affinities with the ‘continental version’ of the Latin Pseudo-Soranian Quaestiones medicinales ([7]) as preserved in a manuscript from Chartre, MS Carnot. 62, fol. 13r-v (X cent.). Thus, it is likely that the source of this Latin translation was, at least in the section on hydrocephalus and perhaps also terêdôn, the Greek erôtapokrisis of which the papyrus is a lacunose copy. Indeed, although the Latin translator omitted the etiology of hydrocephalus, the two texts have the same formal layout.

As already pointed out, ancient medical writers usually list the loci of fluid accumulations from outermost scalp to innermost brain, although in [4] the order is reversed, from innermost to outermost. The loci are explicitly four in [7], perhaps four in [8], while only three loci are explored in [9], the fourth being labelled as impossible for a patient to sustain, and thus fatal. In the same manner [10] focuses on three loci but mentions a fourth, labelling it lethal. [11] claims there are three loci, but omits the innermost, presumably because he too considers it untreatable.

Analysis of Greek and Latin sources reveals that the ancient notion of hydrocephalus is different from that in modern medicine, as disease descriptions from ancient physicians include a broader range of medical conditions, such as the babies with misshapen heads, or the hydroceles, the extracranial tumors, subdural hygromata, subcutaneous hematomas, etc. These are no longer regarded as a type of the disease hydrocephalus, while the ancient meaning of hydrocephalus as an extracranial affliction (vd. supra) does not overlap with modern hydrocephalus, a condition marked by abnormal accumulations of fluid in the cavities and lateral ventricles of the brain. The ὑδατῶδες ὑγρόν of ancient authors is no doubt cerebrospinal fluid (CSF), a colorless bodily fluid produced from arterial blood by the choroid plexus; this fluid surrounds the brain and the spinal cord. Modern hydrocephalus, also termed ‘hydrodynamic CSF disorder’, results in progressive enlargement of the cranium due to raised intracranial pressure along the sutures of the skull. Hydrocephalus permanently damages the brain, posing risks to both physical and cognitive development. According to modern classification, hydrocephalus is either ‘communicating’ and ‘non-obstructive’, whenever a connection between the ventricles and the spinal subarachnoid space allows the CSF to pass from the brain to the spinal cord. Or it is ‘non-communicating’ and ‘obstructive’ when the flow of the cerebrospinal fluid is blocked in the ventricular system of the head. These two forms of hydrocephalus are sometimes congenital, i.e. present at birth, due to inherited genetic abnormality, and at other times acquired, i.e. developing at the time of birth or afterward. Symptoms of hydrocephalus include: neurological disorders such as mental retardation, epilepsy, convulsions; vomiting and nausea; headaches; lethargy and drowsiness; irritability or other changes in personality; poor coordination; blurred or double vision.

2. ὑδροκέφαλον in practice

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In antiquity the first step in treatment of hydrocephalus involves modification of diet, dehydration cures, purgatives, diuretics, sneeze-inducing inhalants and medications, as is illustrated in particular by [1] and [3]. Only when these therapies do not succeed, do Celsus and the far earlier Hippocratic physician-author of Morb. II 15 (X/2 149,1-150,7 Jouanna) recommend surgery. Sometimes unguents and plasters are used to treat hydrocephalics. Aëtius gives us four examples of such therapeutic procedures: in [10] he claims that the third day after surgery one should apply an ἔμπλαστρος κολλητική, a ‘plaster able to close wounds’, in order to advance the healing process (see also Id. XV 12,42-3 and 71 [36,5-6 and 37,9 Zervos]). Aetius prescribes a remedy that medicates both catarrh and hydrocephalus and this involves anointing the forehead with a σμῆγμα κεφαλῆς made from sodium carbonate, iris, aristolochia, calamint and oxymel (VI 54, 9-13 [CMG VIII 2, 197,7-11 Olivieri); Aetius also claims that a plaster made with Althaea officinalis and another made with capers heal hydrocephalic neonates (τὰ ὑδροκέφαλα βρέφη; XV 15,143 and 22,11-2 [74,2 and 121,6-7 Zervos]). Also Alex. X (II 453,7 Puschmann) refers to a remedy for hydrocephalics made with copper sulphate, sodium carbonate, aloe, white lead, oil and vinegar.

Ancient physicians give accurate accounts of surgery for hydrocephalics. The degree of surgical intervention depends upon the locus of the fluid accumulations and on the dimensions of the swelling produced by them. The type of hydrocephalus located most further within are considered incurable (ἀθεράπευτα). For instance, [5] recommends draining the hydrocephalic fluids out from under the skull by means of excision, but defines as ‘incurable’ the subcranial collection between the meninges and the brain, for it is often recognized as lethal (see e.g. [9] and [10]). On the other hand, [9] speaks favorably of surgery only in case of external accumulation (a single incision as big as the tumor itself if this remains small, and two or more incisions when it is more voluminous, see also Aëtius in [10]), whereas if fluid collects beneath the skull he eschews surgery and claims that the operation is likewise useless when the swelling is without distension of the sutures. If, however, the physician cuts off the prominent parts of the bone denuding meninges, the patient will suffer of convulsions. A similar description is found in Paul.Aeg. VI 3, 2,1-12 (CMG IX 2, 47,3-14 Heiberg): when fluid gathers in the deep-down within (εἰς τὸ βάθος) and the whole head is distended (κεφαλὴ πᾶσα διίσταται), the author abandons all surgical intervention, although – he claims – some surgeons remove a piece of brain by trephination (τὴν χειρουργίαν ἀπαγορεύσομεν, εἰ καὶ μάλιστά τινες τῶν χειρουργῶν περιτρυπήσαντες ἐκομίσαντο τὸ ὀστέον); if fluid collects between the skin and the pericranium, and the swelling is small, he suggests to make one transverse incision through the middle (εἰ δέ γε μεταξὺ δέρματος καὶ περικρανίου συνίσταται τὸ ὑγρόν, μικροῦ μὲν ὄντος τοῦ ὄγκου μίαν διαίρεσιν κατὰ μέσον ἐγκαρσίαν ἐμβαλοῦμεν); finally, if the fluid is lodged between the pericranium and the skull, and the swelling is greater, two incisions intersecting one another in the middle are recommended, otherwise, in case it is even larger still, three incisions imitating the form of the Greek letter Η. This latter is an interesting detail unknown from the other sources (εἰ δὲ μεταξὺ περικρανίου καὶ ὀστέου, καὶ μείζων ὁ ὄγκος εἴη, δυσὶ κεχρήμεθα διαιρέσεσι τεμνούσαις κατὰ μέσον ἀλλήλας, εἰ δ' ἔτι μείζων, καὶ τρισὶ μιμουμέναις τὸ Η στοιχεῖον). Furthermore, post-operative instructions are also provided (see [11]): after having evacuated fluid and applied bandages, the author suggests binding up the wound and soaking it with wine and oil until the third day. Apply tents and scrape the bone lightly, if the bone heals slowly.

Useful for hydrocephalic surgery and resultant suppurations are also the reports adjacent in both ‘continental’ and ‘insular’ traditions of the Pseudo-Soranian Quaestiones medicinales: chisel between the skin and the head for pouring out the accumulated fluid (inter cutem et testam incidimus et fundimus humorem), but if humor collects all around the head, then cut the whole head at intervals (per intervalla), so as to accomplish fluid evacuation. Make one or two incisions along the side (si autem circa totum fuerit caput, secamus quasdam partes totius vastitatis per intervalla ut inde defluat humor, et facimus unam incisionem vel duas in latum). Alternatively, when the buildup of fluid occurs under muscles, drain the humor by using a scalpel (cum autem sub musculis collection fuerit […] smiliario incidente humorem defluere facimus). Finally, the bandage labeled lepus sine auribus («hare without ears»), that is not referred to in any of the Greek accounts of hydrocephalus, is mentioned (utimur autem epidesmo cui est nomen lepus sine auribus).
In sum, perforation and chiseling are the surgical procedures of choice and they are usually employed by ancient medical authors in discussions of surgery for hydrocephalus.

As to surgical implements, the instrument ordinarily employed is the scalpel, as in the aforementioned case, i.e. Greek σμιλάριον/σμίλη and Latin smiliarius. For instance, Leonidas ap. [10] mentions a σμιλάριον, whose little handle (λαβίδιον) is used for safe surgical separation of tissue layers and muscle (Aët. VI 1,52-3 [CMG VIII 2, 124,28-9 Olivieri]: ἔπειτα ὑποδιαιρεῖν τὸ σῶμα διὰ τοῦ λαβιδίου τοῦ σμιλαρίου ἀσφαλῶς). Aetius entions an alternative to the «common sclapel» (Aët. XVI 23,41-2 (32,1-2 Zervos): διελόντα αὐτὴν (sc. τὴν κεφαλήν) τῷ πολυτόμῳ σπαθίῳ ἢ τῷ κοινῷ σμιλίῳ, the everyday «cutting knife»; πολύτομον σπαθίον is the chisel to use on the head. Other (quite similar) surgical implements are referred to by Paul.Aeg. VI 74, 3,8-9 (CMG IX 2, 116,21-2 Heiberg): πολυπικῷ σπαθίῳ ἢ κατιάδι ἢ σκολοπομαχαιρίῳ κρυπτομένῳ κατὰ τοὺς δακτύλους τὸ κρανίον διελεῖν: a πολυπικὸν σπαθίον, «knife for removing polypi» (LSJ9 1442 s.v. πολυπικός), and a κατιάς, «lancet» (LSJ9 927 s.v., a σκολοπομαχαίριον, «a pointed surgical knife» (LSJ9 1613 s.v.).

Hydrocephalus was routinely fatal until effective surgical techniques were generally made available, such as antisepsis, anesthesia, and the like. Even as late as the last decade of the nineteenth century and the first decades of the twentieth, no rational method of therapy had been discovered for hydrocephalics, and a record of successful surgical treatment for hydrocephalus was slow to be achieved. Indeed, many of the procedures now in use where conceived of in the early days of the twentieth century, such as the insertion of a shunt system and a ventricular catheter, a flexible but sturdy plastic tube, and a valve. Various types of cerebral shunts divert the excess of cerebrospinal fluid (CSF) into another bodily cavity, such as abdomen, peritoneum, even a chamber of the heart, or elsewhere into the circulatory system, where it can be safely drained and absorbed back into the blood stream.

D. Bibliography

1. Lexicon entries

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2. Secondary literature

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E. CPGM reference(s)

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Isabella Bonati