Volume 19, 2007 - Brown University

The Hippocratic View of Epilepsy and Brain Function 35
the treatment best if he knows beforehand from the present symptoms what
will take place later. (Jones, 1923:7)
Pagel argues that prognosis is given even greater value than diagnosis. He
believes that the emphasis upon prognosis is a result of the inadequate treatment
available at the time: “The physician, knowing the limitations of his art the
comparatively small range of medical interference, makes prognosis the field of
his special interest” (Pagel, 1939:389).
While it is certainly the case that physicians had a very limited repertoire
of therapies, more general cultural factors may be involved in the Hippocratic
preference for prognostication. Oracles played a very significant role in Greek
society (Pagel, 1939:390). They were routinely consulted before city-states went
to battle and even before making mundane day-to-day decisions. Consequently
high importance was placed upon prediction of the future, and it is not surprising
that Greeks held their physicians to the same standard. The values and morays of
Greek society cannot be ignored when examining the Hippocratic approach to
medicine.
Hippocrates predicts different outcomes for a patient with epilepsy based
upon when he or she is first attacked and the severity of the attack. Small children
have very different prognoses based up the degree of attack or flow of
phlegm. If the phlegm is abundant and thick, then death is likely. The phlegm
overwhelms small veins and causes the patient’s blood to coagulate. However, if
the initial attack is minor the child will eventually recuperate, but will endure
lasting, though slight deformation wherever the phlegm filled the vein, for
instance the hand, eye, mouth or neck (Jones, 1923:163). He makes separate
predictions for the old and the very old. People who are old are not killed by
attacks of epilepsy due to the nature of their veins, which are large and filled
with hot blood. Thus phlegm is not able to chill the blood and cause it to clot.
The prognosis for the very old, however, is less optimistic—death or paralysis.
Their veins are relatively empty and contain blood, which is thin and watery
(Jones, 1923: 165). Hippocrates here not only identifies very specific prognoses
of people with a variety of different characteristics, but provides detailed explanations
of the reasons for these prognoses which are consistent with his overall
view of disease.
Hippocrates regards epilepsy stemming from infancy as a special case. He
believes that when the disease originates in infancy, it is nurtured, becoming a
habit, able to occur with slight provocation by weather or wind. According to
Hippocrates epilepsy is unique in infants because their brains are especially wet.
Consequently phlegm can more easily accumulate there, and it is difficult for the
body to remedy the large quantity of phlegm in this area through drying. In this
category of people epilepsy becomes “chronic” and “incurable” (Jones, 1923:
169). The brains of these people degenerate and they thus undergo seizures more
often.