Paul of Aegina
PAUL OF AEGINA
(b. Aegina; fl. Alexandria, A.D.640)
The details of Paul of Aegina’s life are meager. He was born on the island of Aegina in the Saronic Gulf and studied and practiced medicine at Alexandria, where he remained after the Arabic invasion of 640.
Paul’s most important and only extant work is his seven-book medical encyclopedia, Epitome medicae libri septem. According to Islamic sources, he also wrote two other works, a volume on gynecology and one on toxicology. Muslim physicians considered him one of the most eminent of Greek medical authorities, and he is frequently quoted in their works. In the preface to his work, Paul indicated that he prepared his review of earlier Greek medical practices in order that physicians, regardless of where they found themselves, could have a brief synopsis of pertinent medical procedures. He did not claim to be original; and, indeed, he noted that he had added only a few practices of his own. His study was based primarily on Oribasius’ seventy-volume medical encyclopedia. Through Oribasius, Paul acquired and transmitted many of the Galenic medical concepts. Although he used other sources, unlike Oribasius, he did not cite them.
Paul divided the Epitome into the following sections:
|Book I.||Hygiene and regimen|
|Book III.||Bodily afflictions arranged topically|
|Book IV.||Cutaneous complaints and intestinal worms|
|Book VII.||Properties of medicines.|
In the first book Paul examined in some detail the general principles of hygiene. Beginning with an analysis of the problems of pregnant women, he proceeded to a review of the problems of hygiene in the successive ages of man. He was interested in the establishment of the proper regimen for every stage of human development. In the Galenic tradition he subscribed to the earlier Greek humoral pathology of the four elements with their respective qualities. Paul contended that through various forms of dietary, medical, and physical manipulations, a proper balance could be achieved in the body and man would thus enjoy good health. He provided instructions for the care of the eyes and teeth, the retention of hearing, and the problems of impotence. His attitudes toward the role of the temperaments is clearly based on Oribasius’ interpretation of Galen’s thoughts on this subject. Paul maintained that man is in his best temperament when he exists in a middle position between all extremes—leanness and obesity, softness and hardness, hot and cold, and wet and dry. Individuals have particular attributes as their bodies vary from the mean. Bodies with hot and dry temperaments differ substantially from those with cold and moist temperaments. Depending upon their constituency of humors, internal organs also have different temperaments. The numerous permutations of possible temperaments and humors both explain the diverse medical conditions of men and necessitate the numerous varieties of medicines and treatments. Since food is vital to sound health and to the balance of the humors, he presented a sustained discussion of dietary therapeutics with a description of numerous foods and their medicinal virtues.
In Book II, Paul analyzed the nature and manifestations of fevers as characteristics of particular diseases. He utilized the duration and degree of fever as one of the prognoses for the course of a disease. High fevers indicate an acute illness; low fevers, a chronic sickness. The pulse is another important prognostic tool, and he classified sixty-two varieties of pulse. He defined pulse
… as a movement of the heart and arteries, taking place by a diastole and systole. Its object is two fold; for, by the diastole, which is, as it were, an unfolding and expansion of the artery, the cold air enters, ventilating and resuscitating the animal vigour, and hence the formation of vital spirits; and by the systole, which is, as it were, a falling down and contraction of the circumference of the artery towards the centre, the evacuation of the fuliginous superfluities is effected [Adams, Seven Books, I, 202].
Paul also utilized alvine discharges, urine, and sputa as indications of the body’s conditions.
In Book III Paul surveyed ailments that affect the body. Beginning with afflictions of the hair, he proceeded through diseases of the head (eye, ear, nose, and throat) to mental problems and then to internal ailments (heart, stomach, kidney, liver, and uterus). He concluded with comments on corns, calluses, and nails. Paul’s topical approach enabled him to critique the general medical complications of the body’s organs and their respective treatments. He recommended bleeding for cephalalgia, hemicrania, phrenitis, erysipelas of the brain, and lethargy, and he encouraged diverse medicines and select bleedings for the control of epilepsy, melancholy, apoplexy, and nervous diseases. His review of the kidneys, liver, and spleen embodies the best traditions of classical medical thought. Kidney stones are formed by thick earthy humors that are heated by the body. Baths and compound medicines are methods of expelling these stones. Diseases and afflictions of the uterus, and complicated labors are examined thoroughly in the final passages of this book. Paul maintained that when the fetus is in a preternatural position it should be restored to its natural position.
… sometimes drawing it down, sometimes pressing it back, sometimes rectifying the whole. If a hand or foot protrude we must seize upon the limb and drag it down, for thereby it will be more wedged in, or may be dislocated or fractured; but fixing the fingers about the shoulders or the hip joint of the foetus, the part that had protruded is to be restored to its proper position. If there be a wrong position of the whole foetus, attended with impaction, we must first push it upwards from the mouth of the womb, then lay hold of it, and direct it properly to the mouth of the uterus [Adams, Seven Books, I, 648].
Paul did not describe podalic version, and Islamic surgeons followed his example and consequently failed to include this in their medical procedures. His comments on complicated labors were closely studied by Muslim medical thinkers.
Cutaneous afflictions and their treatments are outlined in Book IV. Some diseases, such as elephantiasis, leprosy, and cancer, could not be healed because it was impossible to find medicines that were stronger than the ailments; but it was possible in certain cases to control the progress of the disease. Paul’s description of cancer is abridged from Galen. According to Galenic theory, cancers are formed by the overheating of black bile. Because of the thickness of the humor that precipitated cancer, it was incurable. His description of the three types of intestinal worms (round, broad, and ascarids) is rather curious. The round worms were generated in the small intestinal membrane from bilious humors; the broad worm was converted from the intestinal membrane into a living animal; and ascarids, formed by bad diet, arose in the region near the rectum. All of these worms were to be treated with bitter astringents.
Toxicology was of interest to classical medical authorities; and in Book V Paul summarized the principal comments of ancient authors upon this theme. Information is provided for the treatment of bites or stings of vipers, mad dogs, spiders, scorpions, and crocodiles. This section terminates with a series of antidotes for henbane, fleawort, hemlock, wolfsbane, smilax, gypsum, arsenic, and lead.
Paul’s most important and original contributions are in Book VI, on surgery. He divided this book into a section that examines manual operations on the flesh and into passages that review treatment of fractures and dislocations. The work contains one of the most detailed descriptions of ophthalmic surgery in antiquity and describes procedures for the removal of cataracts, and operations for trichiasis, ectropion, cysts, symblepharon, and staphyloma. Surgical techniques for tracheotomies, tonsilectomies, nasal polyps, abdominal paracentesis, catheterization, hemorrhoidectomies, and lithotomies are outlined. Since bleeding was an important aspect of his medical procedures, he spared few details in his descriptions of venesection, cupping, cauterization, and ligation for bleeding vessels. In Book III Paul had sought to alleviate the problems of difficult labor with drugs and repositioning of the fetus, but in Book VI he offered surgical techniques for cases in which the fetus must be removed to save the mother’s life. This book concludes with a survey of useful methods for the treatment of fractures and dislocations.
His concluding book is a summary of simple and compound medicines used in the practice of the healing art. The majority of this information was derived from the Dioscoridian tradition, for Paul utilized ninety minerals, 600 plants, and 168 animals from Dioscorides’ De materia medica.
Paul’s Epitome provided Islamic physicians with their most substantial account of Greek surgical procedures. Al-Zahrawi and al-Razi used it extensively in their works, and Fabrici based much of his surgery on the techniques detailed in Paul’s sixth book. The Epitome also transmitted the whole range of classical Greek medical thought to the Islamic world.
I. Original Works. The editio princeps of Paul’s medical encyclopedia was the Aldine ed. (Venice, 1528). Francis Adams’ very satisfactory English trans. of Paul’s work, prepared for the Sydenham Society, The Seven Books of Paulus Aegineta, 3 vols. (London, 1844–1847), contains an excellent commentary on Paul’s relationship with Greek and Arabic medical traditions. Rene Briau prepared a Greek ed. and French trans. of Paul’s Book VI, on surgery, La chirurgie de Paul d’Egine (Paris, 1855); there is a German trans. by J. Berendes (Leiden, 1914).
II. Secondary Literature. For discussions of Paul’s contributions and thought see E. Gurlt, “Paulus von Aegina,” in Geschichte der Chirurgie, I (Berlin, 1898), 558–590; Signorelli Remo, “Ostetricia e ginecologia nel bizantino Paolo d’Egina e nell’ arabo Albucasi,” in Minerva medica, 58 (24 Nov. 1967), 4118–4131; and Konrad Straubel, “Zahn- und Mundleiden und deren Behandlung bei Paulos von Aigina” (diss., University of Leipzig, 1922).
Phillip Drennon Thomas