Facies hippocratica

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The Facies hippocratica ( Latin for hippocratic face ) is a typical facial expression in dying ( moribund ) or seriously ill patients. In addition to the so-called churchyard roses , the facies hippocratica is a known prognostic sign of imminent death in the early medical history , if it was preceded by a long agony .


The facies hippocratica results from a relaxation of the facial muscles and an increasing restriction of the blood flow in the peripheral parts of the body ( centralization ). A pale facial skin, sunken cheeks and eyes and a "pointed nose" are characteristics of this facial expression. The hippocratica facies are often found in severe peritonitis ( peritonitis abdominalis ), which is why this special form of the facies is also known as the abdominal facies or the peritoneal facies .


The name still in use today and introduced by early doctors such as Galenos goes back to Hippocrates of Kos , who was the first to describe this facial expression very precisely in the second chapter of his book Prognostikón (Προγνωστικόν, prognoses ). He goes into various signs that suggest imminent death and that can be seen in the eyes, lips, ears and facial skin. However, Hippocrates also includes the previous course of the disease and possible other circumstances in this prognosis:

“First observe the patient's face to see whether it looks like it does in healthy people, especially whether it looks like it usually does, for in that case it would be best; but if it is the opposite of what it usually is, then it is worst. That would be the following case: Pointed nose, deep-set eyes, sunken temples, cold and shrunken ears, bent back earlobes, rough, tense and dry facial skin, yellow or dark, bluish or leaden color of the whole face. If the face looks like this at the beginning of the illness and it is not yet to be suspected according to the other signs, then one must ask whether the patient was sleepless or whether the bowel movements were very fluid or whether he was a little hungry. If he affirms any of these, then one has to consider the condition to be less bad, because if the face looks like this as a result of these causes, it decides for the better within day and night. If, on the other hand, he denies all of this and the illness does not come to a standstill during the time mentioned, then one must know that the patient is close to death. "

- Hippocrates : Prognostikon

The prognosis of the diseases was very important in earlier medicine, especially the insight into when medical action was pointless and whether the doctor consulted also recognized this. In predicting an imminent death, the healer saved himself from the accusation of obvious failure if the patient dies soon. The knowledge of the exact signs of death or incurable illness was one of the bases for the trustworthy position of the doctor; it was also connoted as a "secular version of the prophecies": "Prognostic intuition made a good impression and raised the gifted healer above quacks and fortune-tellers".

Individual evidence

  1. Facies Hippocratica in Dietrich W. Busch, Carl Ferdinand von Gräfe, Christoph Wilhelm von Hufeland, HF Link and J. Müller: Encyclopedic Dictionary of Medicinal Sciences , Verlag von Veit et Comp., Berlin (1834), Volume 11 (Encanthisma - Fallkraut), p. 701
  2. Quoted from Henry E. Sigerist: The doctor in Greek culture . Zurich 1963, p. 58
  3. ^ Roy Porter: The Art of Healing . Heidelberg, Berlin 2003, p. 62, ISBN 3-8274-1454-7