Further arguments against both the first description of cholesteatoma by Hippocrates, and the allusion to the tympanic m
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LETTER TO THE EDITOR
Further arguments against both the first description of cholesteatoma by Hippocrates, and the allusion to the tympanic membrane in the Ebers Papyrus Albert Mudry1 Received: 7 June 2020 / Accepted: 17 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, After reading the response to my letter [1] by the authors [2] of the “First description of cholesteatoma by Hippocrates” [3], I am now even less convinced by their argument. They might well have added a further extract from Hippocrates, but this can hardly support their original thesis, because it is taken completely out of historical context. Their new quote relates to “flux from the head” and its seven possible ways of egress, one of them being the ear. During Hippocrates’ time, ear discharge was supposed to come from the brain and not from the ear. Thus, this text must be interpreted in the light of this contemporary belief: the fistula might simply act as a ‘safety valve’ for the supposed flux from the brain. It is impossible to know whether or not this safety mechanism had its own tract (i.e., it was a true fistula) or if it simply used the external auditory canal as a conduit, which is not specifically mentioned in the Corpus. It is surely far more likely however, that the so-called fistula is nothing more than the drainage of pus through a tympanic perforation (which would be in keeping with the contemporary concept of flux from the head). I agree that “The term fistula was related to a discharge from the ear, and it was not located elsewhere”, but I disagree that the fistula has its own specific drainage track. The statement that “Abscesses located around the ear are rare in clinical practice” has nothing to do with these Hippocratic texts. Hippocrates never mentioned it, nor did he even This comment refers to the article available online at https://doi. org/10.1007/s00405-020-06048-x. * Albert Mudry [email protected] 1
Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305‑5739, USA
describe clinical signs leading us to suppose there might be an abscess. A fistula is a pathological connection between two cavities or between a body cavity, (normal or pathological—such as an abscess) with the outside. Neither is the case here. Hippocrates clearly described a case of swelling around the ear in his Prognostic 18: “Whenever, from pneumonia an abscession takes place to the ears, while gathering occur in the lower parts and fistula forms, the patient recovers” [4]. Another translation says, “When abscesses form about the ears…” [5]. My learned colleagues’ comment that “However, the foul and painless smell is typically found in a patient with cholesteatoma” surely fails to take into consideration that the subject period is in the pre-antibiotic era, when it was not only frequent, but usual for a chronic suppurative otitis media to have a bad smell. This was underlined by Politzer a good few centuries later in 1882, when he says,
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