Paul of Aegina and his medical handbook

The technical literature of antiquity is generally hard for us to access.  Few would perhaps be able to venture much beyond Galen and Hippocrates for ancient medical writers.

This evening I learned of the existence of Paulus Aeginata, Paul of Aegina, a 7th century compiler of a medical encyclopedia.  An article by Vivian Nutton, From Galen to Alexander, mentioned a certain “Paul”, who was translated by Francis Adams in 1834.  Nutton (p.2) states:

The most obvious difference between the medicine of the second and that of the sixth century A.D. can be summed up in one word, Galenism, in both its positive and its pejorative meanings. Instead of the variety of great names that can be cited for the second century-Galen, Rufus, Soranus, Antyllus, maybe even Aretaeus-and the evidence from both literary and epigraphic texts for new interests and ideas on surgery, the fourthand later centuries present us with a dull and narrow range of authors-the summarizers, the encyclopaedists-who have been studied not for themselves but for the earlier sources they happen to encapsulate. Oribasius, Aetius, Alexander, Paul are the medical refrigerators of antiquity: we are concerned with their contents, not their mechanics or their design.

…

We are in a quandary also because our conception of how medicine works has changed drastically; and it is not surprising that the last major work of medico-historical value to be done on them was over a century ago by Francis Adams, whose third and final volume of his great translation of Paul appeared in 1847. The reason for this is simple: to Adams, Paul was transmitting a living medicine, one that could still be used in his daily practice in Scotland. and it was precisely for this reason that Adams, on the basis of his own experience as a doctor, could reach such a sound judgment on the merits of this compiler.

It is a useful, not to say frightening, reminder how far medical knowledge has advanced in 150 years.

This naturally led me to do a Google search.  I was able to find vol.2 (1846) and vol. 3 (1847), but not vol. 1.  This 1834 work may be the first volume, perhaps.

 However a browse suggests that the subject matter will not be of interest except to those interested in the history of medicine.  I had hoped for something on antiquity, but sadly not.  But perhaps the preface by Paulus himself will be of interest.  In the interests of readability I have paragraphed it.

It is not because the more ancient Writers have omitted any thing relative to the Art that I have composed this Work, but for the purpose of giving a compendious course of instruction. For, on the contrary, every thing is handled by them in a proper manner, and without any omissions, whereas the moderns have not only in the first place neglected the study of them, but have also blamed them for prolixity. Wherefore, I have undertaken the following Treatise, which, as is like, will serve as a Commentary to those who may choose to consult it, whilst it will prove an exercise to me.

For it appears wonderful that Lawyers should be possessed of compendious, and, as they call them, popular legal Synopses, in which are contained the heads of all the Laws, to serve for immediate use, whilst we neglect these things, although they have it generally in their power to put off the investigation of any point for a considerable time, whereas we can seldom or rarely do so; for in many cases necessity requires that we act promptly, and hence Hippocrates has properly said, “The season is brief.”

For their business is generally conducted in the midst of cities, where there is an abundant supply of books, whereas physicians have to act not only in cities, in the fields, and in desert places, but also at sea on board of ships, where such diseases sometimes suddenly break out as, in the event of procrastination, would occasion death, or at least incur the most imminent danger. But to remember all the rules of the healing art, and all the particular substances connected with it, is exceedingly difficult, if not altogether impossible.

On this account, I have collected this Epitome from the works of the ancients, and have set down little of my own, except a few things which I have seen and tried in the practice of the art. For being conversant with the most distinguished writers in the profession, and in particular wit Oribasius, who, in one work, gave a select view of every thing relating to health, (he being posterior to Galen, and one of the more modern authors,) I have collected what was best in them, and have endeavoured, if possible, not to pass by any one distemper.

For the work of Oribasius, comprehending 70 books, contains indeed an exposition of the whole art, but it is not easily to be procured on account of its bulk, whilst the epitome of it, addressed to his son, Eustathius, is deficient in some diseases altogether, and gives but an imperfect description of others, sometimes the causes and diagnosis being omitted, and sometimes the proper plan of treatment being forgotten, as well as other things which have occurred to my recollection.

Wherefore, the present work will contain the Description, Causes, and Cure of all diseases, whether situated in parts of uniform texture, in particular organs, or consisting of solutions of continuity, and that not merely in a summary way, but at as great length as possible. But in the first place, we will give an exposition of every thing that relates to Health and Regimen. The last book contains an account of simple and compound Medicines. 

I find a few more details by a Google Books search. 

Paul lived in Alexandria, and an iambic in some of the manuscripts says that he was “well-travelled”.  The work is extant in quite a number of Greek manuscripts, and was edited by J. L. Heiberg in the Corpus Medicorum Graecorum.  It seems that the Pragmateia — the Greek title — was translated into Syriac sometime in the 8th or 9th century, although only fragments of this survive, in quotation.  It was then translated into Arabic by Hunain ibn Ishaq in the 10th. ¹

His surgical techniques include the methods of castration (book 6, chapter 68), which he states:

The object of our art being to restore those parts which are in a preternatural state to their natural, the operation of castration professes just the reverse. But since we are sometimes compelled against our will by persons of high rank to perform the operation, we shall briefly describe the mode of doing it.

The eye-watering details may be omitted.

1. Peter E. Pormann, The oriental tradition of Paul of Aegina’s Pragmateia, Brill (2004).