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Paul Of Aegina

Another extremely important writer in these early medieval times, whose

opportunities for study in medicine and for the practice of it, were

afforded him by Christian schools and Christian hospitals, was Paul of

AEgina. He was born on the island of AEgina, hence the name AEginetus, by

which he is commonly known. There used to be considerable doubt as to

just when Paul lived, and dates for his career were placed as widely

> apart as the fifth and the seventh centuries. We know that he was

educated at the University of Alexandria. As that institution was broken

up at the time of the capture of the city by the Arabs, he cannot have

been there later than during the first half of the seventh century. An

Arabian writer, Abul Farag, in The Story of the Reign of the Emperor

Heraclius, who died 641, says that among the celebrated physicians who

flourished at this time was Paulus AEginetus. In his works Paul quotes

from Alexander of Tralles, so that there seems to be no doubt now that

his life must be placed in the seventh century.

The most important portion of Paul's work for the modern time is

contained in his sixth book on surgery. In this his personal

observations are especially accumulated. Gurlt has reviewed it at

considerable length, devoting altogether nearly thirty pages to it, and

it well deserves this lengthy abstract. Paul quotes a great many of the

writers on surgery before his time, and then adds the results of his own

observation and experience. In it one finds careful detailed

descriptions of many operations that are usually supposed to be modern.

Very probably the description quoted by Gurlt of the method of treating

fishbones that have become caught in the throat will give the best idea

of how thoroughly practical Paul is in his directions. He says: It will

often happen in eating that fishbones or other objects may be swallowed

and get caught in some part of the throat. If they can be seen they

should be removed with the forceps designed for that purpose. Where they

are deeper, some recommend that the patient should swallow large

mouthfuls of bread or other such food. Others recommend that a clean

soft sponge of small circumference to which a string is attached be

swallowed, and then drawn out by means of the string. This should be

repeated until the bone or other object gets caught in the sponge and is

drawn out. If the patient is seen immediately after eating, and the

swallowed object is not visible, vomiting should be brought on by means

of a finger in the throat or irritation with the feather, and then not

infrequently the swallowed object will be brought up with the vomit.

In the chapter immediately following this, XXXIII, there is a

description of the method of opening the larynx or the trachea, with the

indications for this operation. The surgeon will know that he has opened

the trachea when the air streams out of the wound with some force, and

the voice is lost. As soon as the danger of suffocation is over, the

edges of the wound should be freshened and the skin surfaces brought

together with sutures. Only the skin without the cartilage should be

sutured, and general treatment for encouraging union should be employed.

If the wound fails to heal immediately, a treatment calculated to

encourage granulations should be undertaken. This same method of

treatment will be of service whenever we happen to have a patient who,

in order to commit suicide, has cut his throat. Paul's exact term is,

perhaps, best translated by the expression, slashed his larynx.

One of the features of Paul's Treatise on Surgery is his description

of a radical operation for hernia. He describes scrotal hernia under the

name enterocele, and says that it is due either to a tearing or a

stretching of the peritoneum. It may be the consequence either of injury

or of violent efforts made during crying. When the scrotum contains

only omentum, he calls the condition epiplocele; when it also contains

intestine, an epiplo-enterocele. Hernia that does not descend into the

scrotum he calls bubonocele. For operation the patient should be placed

on the back, and, the skin of the inguinal region being stretched by an

assistant, an oblique incision in the direction in which the blood

vessels run should be made. The incision should then be stretched by

means of retractors, until the contents of the sac can be lifted out.

All adhesions should be broken up and the fat be removed, and the hernia

replaced within the abdomen. Care should be taken that no loop of

intestine is allowed to remain. Then a large needle with double thread

made of ten strands should be run through the middle of the incision in

the end of the peritoneum, and tied firmly in cross sutures. The outer

structures should be brought together with a second ligature, and the

lower end of the incision should have a wick placed in it for drainage,

and the site of operation should be covered with an oil bandage.

The Arab writer, Abul Farag, to whose references we owe the definite

placing of the time when Paul lived, said that he had special

experience in women's diseases, and had devoted himself to them with

great industry and success. The midwives of the time were accustomed to

go to him and ask his counsel with regard to accidents that happen

during and after parturition. He willingly imparted his information, and

told them what they should do. For this reason he came to be known as

the Obstetrician. Perhaps the term should be translated the

man-midwife, for it was rather unusual for men to have much knowledge of

this subject. His knowledge of the phenomena of menstruation was as wide

and definite. He knew a great deal of how to treat its disturbances. He

seems to have been the first one to suggest that in metrorrhagia, with

severe hemorrhage from the uterus, the bleeding might be stopped by

putting ligatures around the limbs. This same method has been suggested

for severe hemorrhage from the lungs as well as from the uterus in our

own time. In hysteria he also suggested ligature of the limbs, and it is

easy to understand that this might be a very strongly suggestive

treatment for the severer forms of hysteria. It is possible, too, that

the modification of the circulation to the nervous system induced by the

shutting off of the circulation in large areas of the body might very

well have a favorable physical effect in this affection. Paul's

description of the use of the speculum is as complete as that in any

modern text-book of gynaecology.