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
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.
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