LAUSR

We have read with great interest the comments made by our esteemed colleague in his letter to the editor. The problem that arises seems mainly to be methodological. It seems indeed extremely difficult to make a retrospective diagnosis on ancient human remains, we have written and demonstrated it [1],and therefore, a fortiori, even more difficult when it is an ancient text, even from the Hippocratic collection. One of the main methodological pitfalls is to “stick” a current physiological vision on an ancient description. Modern physicians (MDs) do not think the same way, do not look at the symptoms and causes of illness in the same way. Even the anatomy is not described in a comparable way: some structures are not identified independently, others are incorrectly considered. We do not make this mistake, but we must not refuse the obvious: we must not exclude an abscess because « Hippocrates» does not mention it, we must not exclude a fistula because the consecrated term does not appear in the original manuscript. A description or a series of clinical signs is sometimes sufficient to offer an accurate diagnosis. Our esteemed colleague compares the Hippocratic treaties as if they were all in the same hand, which is a manifest error: Epidemics I, IV, V and Prorrhetic. The work of Jacques Jouanna has clearly shown that Epidemics treatises can be grouped into three subgroups written at different times by different practitioners: I and III; II, IV and VI; V and VII [2]. Our original article [3] therefore consists in a proposal for a retrospective diagnosis. But this one takes much more weight when one takes into account the frequency of the symptoms (and, as a matter of fact, one is obliged to be based on the current statistics, in populations which approach at most the ancient populations, in particular by a few specific criteria: lack of access to antibiotics, presence of poly-parasitism, etc.). Our colleague systematically criticizes each of the clinical signs presented by us, saying that each one is not characteristic of a cholesteatoma. This is a very regrettable bias, because it is precisely their association which is very suggestive of a cholesteatoma, as in clinical practice. This is, moreover, the very principle of medical diagnosis: bringing together what is scattered. We regret the ignorance of the sign of the “pipe smoker” by our esteemed colleague, which has however been described many times since the nineteenth century [4] and unfortunately reflects a serious semiological lack in our colleague who, however, recently published an article on peripheral facial paralysis. [5]. As for the Ebers papyrus and the description of the tympanic canals, this example perfectly illustrates the ambiguity of the translation of certain hieroglyphic anatomical terms, since in the various translations (spanning almost a century), the path indicated for this canal sometimes interests the temporal bone (external auditory canal stricto sensu), sometimes This reply refers to the comment available online at https ://doi. org/10.1007/s0040 5-020-06153 -x.