Paul of Aegina: basic Greek surgery

We think of a surgical patient as passive, lying down, unconscious. In medieval surgery, the patient was a participant in that he was certainly conscious, and therefore he could help out by putting his (or her) body in various useful positions. The surgeon also needed assistants, who helped by holding the patient in that position, probably by holding him down so he couldn’t struggle, and by massaging or moving body parts.

In Paul of Aegina’s 7th century medical book, that’s the picture we get. When Paul treated a man for dangerous varicose veins, it was a cooperative procedure. The doctor tied a string around the leg at one or another places, and the man walked back and forth as directed, while the doctor outlined the problem spot in ink. When he drained excess fluid collecting in the abdomen, he asked the patient to stand while assistants pushed and massaged the fluid as low in the body as possible. When kidney stones needed to move into the bladder or urinary tract, the doctor’s assistants shook the patient until the stones moved.

When Dr. Paul drained fluid from the abdomen, he cut a small hole through the peritoneum, the layer just below the skin, and inserted a little copper tube. (I was wondering what they used for draining a healing wound, and that must be the answer: copper or silver tubes.) Greek medicine was cautious about suddenly draining everything, because a careless doctor might drain away the life force. It was better to ask the standing patient to lie down, and use the inserted drain to improve the situation bit by bit over several days.

Paul’s descriptions don’t take into account the patient’s pain, first because it was obvious; it went with the territory. It seems likely that opium had made its way to the Greek world by the 600s, so they may have been dealing with a groggy patient. However, it doesn’t say.

The most painful procedures seem to go with the greatest immediate danger. For an infected liver, Paul used a small cauterizing tool to actually burn, not cut, through the skin at the lower back, until there was a hole through which to drain it. That must have been unbearable, but it was a deathbed operation already. Similarly, his operation to fix a fistula (an improper hole/passage between the anus and some other place) involved a pretty severe experience for the patient, as the doctor grappled with access to the interior. On the other hand, I think those are typically fatal as well. So….hard choices in ancient times.

We don’t know how much of this was practiced in Northern Europe, but probably not much. Paul of Aegina’s book came to Europe via Arabic, so it probably showed up first in Cordoba’s library circa 850. It may have been translated into Latin in the following centuries, but it didn’t have wide circulation until the 14th century, with the expansion of medical schools.

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