Paul of Aegina

Paul of Aegina was a Byzantine Greek physician who worked in the seventh century CE, probably the last major medical writer of Greco-Roman antiquity. He compiled a seven-book Epitome of Medicine designed as a portable reference for physicians in remote locations — a practical manual for doctors who could not carry a full library. His surgical book, the sixth of the seven, became the most detailed surviving account of ancient surgical practice and was used by every major Arabic medical encyclopaedist. Through these Arabic intermediaries, Paul’s surgical descriptions passed into the Latin West and shaped European surgery for centuries. He stood at the end of a tradition and, by compressing it into usable form, ensured it survived.

Life and Context

Almost nothing is known of Paul’s biography. He came from the island of Aegina, near Athens. His dates are uncertain, but he is generally placed in the seventh century, making him a near-contemporary of the Arab conquest of Alexandria in 642 CE. Temkin divides Byzantine medicine into two phases: the Alexandrian period ending with that conquest, and the Constantinopolitan period that followed (Temkin, 1977). Paul belongs to the last generation of the Alexandrian phase — the final moment when late antique Greek medical learning was still being actively compiled rather than passively received.

Walsh notes that in Asia Minor, a series of distinguished contributors produced medical literature that compiled and digested earlier important medical writings, often enriched by their own experience (James J. Walsh, 1920). The anonymous author of Medicine in the Middle Ages describes how Greek medicine produced celebrated physicians such as Alexander Ætius, Alexander Trallian, and Paulus Ægineta at Alexandria, but that the school fell and disappeared by the end of the seventh century (Unknown, undated).

Temkin observes that Paul, along with Stephanus and Alexander of Tralles, can be assumed to have been Christian, though the positive indications are weak. For all practical purposes, their works could have been written by pagans, demonstrating how little bearing their religion had on their medical writing (Temkin, 1991).

The Epitome as a Portable Manual

Paul conceived his work as a vade mecum — a portable medical manual for doctors who could not afford delay. Temkin preserves Paul’s own justification: he found it strange that lawyers possessed compendious legal synopses while physicians had nothing comparable, even though lawyers could postpone investigation while physicians could rarely do so, since “in many cases, necessity requires that we act promptly, and hence Hippocrates has properly said ‘the season is brief.’” Paul noted that physicians have to act not only in cities but in the field, in isolated places, and aboard ship (Temkin, 1991).

This is not the language of a scholar writing for other scholars. It is the language of a practitioner who understood that medicine happens in conditions where libraries are unavailable. The genre — Temkin calls it the “medical manual” to distinguish it from the classroom lecture (Stephanus) and the experienced practitioner’s personal record (Alexander of Tralles) (Temkin, 1991) — shaped everything about how Paul organized his material.

Method: Compilation Without Commentary

Paul’s method was compilation in the strictest sense. Nutton describes how the great late antique medical encyclopaedists — Oribasius, Aetius, and Paul of Aegina — assembled verbatim extracts from earlier writers into mosaics of opinion, with almost no original commentary, gradually reducing alternatives and attributing everything to Galen (Nutton, 2023). Paul was the last and most compressed of these compilers. Where Oribasius had filled seventy books, Paul condensed the same tradition into seven.

Temkin frames this compression as an achievement rather than a failure. Late antique medical history should be reframed as an accomplishment of transmission: the compendium tradition, Latinization, and popularization were necessary adaptations that preserved the heritage of Greek medicine for subsequent centuries. Sacrifices had to be made to ensure the preservation of what was most essential (Temkin, 1977).

Porter notes that Oribasius played an important role as mediator and synthesizer of Galen, preserving excerpts from many authors otherwise lost and shaping the package of Galenism that dominated later centuries (Porter, 1997). By Porter’s account, by AD 500 in Alexandria a Galenic canon of sixteen books had emerged, taught with commentaries in a set order, giving Galenism a dogmatic air analogous to how Christ’s teachings were theologized by the Church (Porter, 1997).

Book Six: Surgery

Paul’s most consequential contribution was his sixth book, on surgery. The technical sophistication of late antique surgical practice that Paul inherited and preserved was considerable: a surgeon at Rimini around 257—258 CE possessed over 150 instruments, many displaying subtle differences from others of the same type, implying a high degree of specialization and expertise (Nutton, 2023). Siraisi describes Paul’s surgical book as “the most detailed account of ancient surgical practice to have come down to us,” and notes that it was extensively utilized by all the major Arabic medical encyclopaedists — Rhazes, Haly Abbas, Albucasis, and Avicenna (Siraisi, 1990). Their works thus provided the Latin West with substantial surgical writing ultimately deriving from the Hippocratic corpus, transmitted through Paul.

Albucasis drew especially heavily on Paul. Siraisi notes that Albucasis organized his material strikingly originally — making cautery the subject of a lengthy special section and accompanying his exposition with numerous illustrations of surgical instruments — but the surgical content itself came largely from Paul (Siraisi, 1990). Through Albucasis’s Latin translation in twelfth-century Spain, Paul’s surgical knowledge entered the Western surgical tradition that would run through Roger Frugard, Bruno Longoburgo, and Guy de Chauliac.

Psychiatry: Melancholy and Mania

Walsh credits Paul (alongside Aretaeus) with anticipating Kraepelin’s manic-depressive concept. Both physicians had noted that in most patients, melancholic and maniacal stages alternated in the same person. Walsh argues that “these early medieval students of mental disease anticipated to a rather startling extent our most recent conclusions with regard to the essential insanities” (James J. Walsh, 1920).

Ullmann notes that Paul also transmitted the medical interpretation of lycanthropy — a form of melancholy in which patients believed themselves wolves. Galen knew nothing of this condition, but Oribasius, Aetius, and Paul took over the interpretation of Marcellus of Side, and through Paul the Arabs learned about lycanthropy as a psychiatric category (Ullmann, 1978).

Anatomical Terminology

Temkin demonstrates through careful philological work that the anatomical terms “vena basilica” and “vena cephalica” — long attributed to Arabic coinage by Hyrtl’s influential 1879 hypothesis — actually existed in Greek before they appear in Arabic, and predate both Constantinus Africanus and the Arabic medical tradition (Temkin, 1977). The terms appear in Byzantine Greek phlebotomy texts, indicating they belong to the practical medical vocabulary of everyday Byzantine practice — the language of the phlebotomist rather than the learned anatomist (Temkin, 1977).

Transmission to the Arabic World

Paul’s Epitome was among the Greek medical texts translated into Arabic during the ninth-century translation movement. Saad and Said report that Hunayn ibn Ishaq and his team rendered the entire body of Greek medical texts — including all the works of Galen, Oribasius, Paul of Aegina, Hippocrates, and the Materia Medica of Dioscorides — into Arabic by the end of the ninth century (Saad Said, 2011).

Paul’s importance to Arabic medicine was not primarily theoretical. It was surgical and practical. His Book Six gave Arabic surgeons their most complete single account of Greek surgical procedures. His pharmacological sections were used alongside Dioscorides. Riddle’s study of Dioscorides notes that Paul of Aegina appears in the long chain of authors who transmitted and adapted classical drug knowledge (Riddle, 1985).

Transmission to Anglo-Saxon England

Paul’s influence extended even to early medieval England. The author of Anglo-Saxon Leechcraft reports that the great monasteries at Winchester, Malmesbury, and Glastonbury — founded in the eighth century — contained in their libraries the works of Aretaeus, Alexander of Tralles, and Paul of Aegina, from which monks received medical instruction (Henry S. Wellcome, 1912). The Leech Book of Bald, written around 900-950 CE, shows the influence of Alexander of Tralles, Paul of Aegina, and Rhazes clearly traceable in its prescriptions (Henry S. Wellcome, 1912).

Renaissance Recovery

Tobyn notes that Fuchs was able to use a new Greek edition of Paul of Aegina published in Venice in 1528 and revised in Cologne in 1534 and Basel in 1538, demonstrating how the availability of new editions of classical medical texts directly shaped Renaissance herbal practice (Tobyn Denham Whitelegg, 2011).

Assessment

Paul was not an original thinker. No modern historian claims otherwise. His significance lies in what he preserved and how efficiently he preserved it. Temkin’s framework — which identifies Paul as representing the “medical manual” genre at the twilight of antiquity (Temkin, 1991) — captures his role precisely. He was the last compiler of a tradition that was about to be transmitted, in altered form, to a new civilization. The fact that Arabic surgeons turned to his Book Six rather than to Galen’s own surgical writings tells us something about the practical superiority of Paul’s compressed, manual-style presentation over Galen’s discursive and argumentative prose.

See Also

• Galen
• Hippocrates
• Oribasius
• Aetius of Amida
• Alexander of Tralles
• Albucasis
• Byzantine Medicine
• Arabic Medicine
• Rufus of Ephesus
• Leech Book of Bald

Sources

Primary evidence for this page comes from:

• Nutton, V. (2023). Ancient Medicine (3rd ed.). London: Routledge. [Source ID: nutton-ancient-medicine-2023]
• Temkin, O. (1991). Hippocrates in a World of Pagans and Christians. Baltimore: Johns Hopkins. [Source ID: temkin-hippocratespagans-1991]
• Temkin, O. (1977). The Double Face of Janus. Baltimore: Johns Hopkins. [Source ID: temkin-doublefacejanus-1977]
• Temkin, O. (1973). Galenism: Rise and Decline of a Medical Philosophy. Ithaca: Cornell. [Source ID: temkin-galenism-1973]
• Siraisi, N. G. (1990). Medieval and Early Renaissance Medicine. Chicago: University of Chicago Press. [Source ID: siraisi-medievalmedicine-1990]
• Walsh, J. J. (1920). Medieval Medicine. London: Black. [Source ID: walsh-medieval-medicine-1920]
• Porter, R. (1997). The Greatest Benefit to Mankind. London: HarperCollins. [Source ID: porter-greatestbenefit-1997]
• Ullmann, M. (1978). Islamic Medicine. Edinburgh: Edinburgh UP. [Source ID: ullmann-islamicmedicine-1978]
• Saad, B. & Said, O. (2011). Greco-Arab and Islamic Herbal Medicine. Hoboken: Wiley. [Source ID: saad-said-greco-arab-islamic-herbal-2011]
• Tobyn, G. et al. (2011). The Western Herbal Tradition. Edinburgh: Churchill Livingstone. [Source ID: tobyn-et-al-western-herbal-tradition-2011]
• Payne, J. F. (1912). Anglo-Saxon Leechcraft. London. [Source ID: anglo-saxon-leechcraft-1912]