Paul of Aegina: The 7th-Century Byzantine master of surgery

The 7th century marked a dramatic turning point for the Byzantine Empire. Amid territorial losses and geopolitical shifts across the Mediterranean, Byzantine intellectual life continued to produce extraordinary scholars. Chief among them was Paul of Aegina (Paulus Aegineta), a 7th-century physician and master surgeon. Standing at the historical threshold between the Greco-Roman world and the early medieval era, Paul created a surgical legacy that defined medical practice in Byzantium, the Islamic Caliphates, and Renaissance Europe for over a millennium.

Life in 7th-century Alexandria.

Born on the island of Aegina around 625, Paul of Aegina trained and practiced during a period of profound transformation. He earned the titles Periodeutes (traveling physician) and Iatrosophistes (professor of medicine).

Little is known about his life. He settled in Alexandria, the crown jewel of Eastern Mediterranean medical education. He lived through the Arab conquest of the city in 642 and elected to remain there, continuing to practice medicine, teach, and consult under the new administration.

His exceptional expertise in obstetrics and pediatrics earned him widespread renown among local practitioners and midwives, who recorded his authority under the Arabic title Al-qawābilī (“The Accoucheur”). Paul maintained his clinical practice in Alexandria until his death around 690.

The work: The Epitome of Medicine.

Paul’s main surviving work is his seven-book medical encyclopedia, the Epitome of Medicine (Epitomês iatrikês biblía heptá). In classic Byzantine encyclopedic fashion, Paul compiled, organized, and refined the medical knowledge of predecessors like Hippocrates, Galen, and Oribasius into a systematic handbook.

• Book I: Hygiene and Dietetics. Covers daily regimen, preventative health, and care across age groups.
• Book II: Fevers and Pathology. Details systemic illnesses and fevers.
• Book III: Topographical Afflictions. Analyzes diseases arranged in a head-to-toe order, including hydrocephalus and internal disorders.
• Book IV: Cutaneous Conditions. Covers skin diseases, intestinal parasites, and external lesions.
• Book V: Toxicology. Details insect stings, venomous bites, and antidotes.
• Book VI: Surgery. Provides direct instructions for complex surgical operations.
• Book VII: Pharmacy and Materia Medica. Catalogs 90 minerals, 600 plants, and 170 animal products.

Islamic sources also credit Paul with separate, now-lost treatises on gynecology (De mulierum morbis) and pediatric care.

Main contribution to surgery and clinical practice.

While Byzantine scholarship is often associated with compilation, Paul of Aegina introduced crucial surgical innovations in Book VI of his Epitome. He operated with remarkable technical precision, advancing several fields:

• Spine Care and Neurosurgery: Paul rejected the long-standing belief that spinal surgery was inevitably fatal. He became the first recorded physician to perform and recommend laminectomies for severe spine fractures. He also refined trephination procedures for skull trauma.
• ENT and Abdominal Surgery: He provided precise operational protocols for tracheotomies, tonsillectomies, bladder catheterization, lithotomies for bladder stones, and abdominal paracentesis for ascites. He was also the first surgeon to operate on the lower cervical lymphatic system.
• Trauma and Reconstructive Procedures: His method for managing nasal fractures remained the standard protocol for centuries. He also developed early surgical treatments for gynecomastia and hermaphroditism to restore physical function.
• Inguinal Hernia Repair: Paul devised a surgical hernia technique using a probe to compress the intestine, securing the wall with sutures while preserving both the testicle and peritoneum.

A lasting legacy across Byzantium, the Islamic World, and the West.

Paul of Aegina served as the vital link transferring Greek medical science to the medieval world.

The Byzantine and Islamic Worlds

Within Byzantium, the Epitome of Medicine became a standard reference for centuries. Its impact expanded dramatically in the 9th century when scholar Hunayn ibn Ishaq translated the text into Arabic.

Book VI became the core foundation for medieval Islamic surgery. Key medical authorities of the Islamic Golden Age — including Rhazes (Al-Razi), Avicenna (Ibn Sina), and Haly Abbas — cited Paul extensively. In 11th-century Islamic Spain, surgeon Al-Zahrawi (Albucasis) embedded Paul’s surgical procedures directly into his influential medical compendium Al-Tasrif.

Western Europe

Portions of Paul’s work entered Western Europe early, with Book III translated into Latin in northern Italy around 800. The full Greek text was printed in Venice by the Aldine Press in 1528, followed by several Latin translations that guided Renaissance surgeons such as Hieronymus Fabricius.

In 1844, Francis Adams completed the standard English translation for the Sydenham Society of London. Paul’s historical prominence was formally commemorated in 1753 when botanist Carl Linnaeus named the plant genus Aeginetia in his honor.

Through his life and work,Paul of Aegina represents the resilience and adaptability of Byzantine scholarship during the 7th century. By combining classical Greco-Roman medical theory with original surgical innovation, his work preserved, advanced, and transmitted medical knowledge across cultural boundaries for over a thousand years.

Source

Primary Sources and Critical Editions

• Adams, F. (Trans.). (1844–1847). The Seven Books of Paulus Ægineta (3 vols.). Sydenham Society. (Standard English translation with comprehensive historical commentary).
• Heiberg, J. L. (Ed.). (1921–1924). Paulus Aegineta: Hypomnêma (2 vols.). Teubner. (Standard Greek critical edition).
• Berendes, I. (Trans.). (1914). Paulos’ von Aegina des besten Arztes sieben Bücher. E. J. Brill. (German translation).

Secondary Literature

• Gurunluoglu, R., & Gurunluoglu, A. (2003). Paul of Aegina: Landmark in surgical progress. World Journal of Surgery, 27(1), 18–25.
• Guardasole, A. (2023). Dysfunction (δυσέργεια) and deformity (ἀπρέπεια) in Paul of Aegina’s surgical chapters. In M. Gerolemou & G. M. Chesi (Eds.), Body Technologies in the Greco-Roman World (pp. 19–34). Liverpool University Press.
• Pormann, P. E. (2004). The Oriental Tradition of Paul of Aegina’s Pragmateia. E. J. Brill.
• Salazar, C. F. (2017). Continuity and innovation in Paul of Aegina’s chapters on headaches and migraines. In L. Lehmhaus & M. Martelli (Eds.), Collecting Recipes: Byzantine and Jewish Pharmacology in Dialogue (pp. 175–193). De Gruyter.
• Markatos, K., Korres, D., Kaseta, M. K., Karamanou, M., & Androutsos, G. (2018). Paul of Aegina (625–690): His work and his contribution to neurologic surgery: Trephinations and laminectomies in the Dark Ages. World Neurosurgery, 110, 160–163.
• Missios, S., Bekelis, K., & Roberts, D. W. (2014). Neurosurgery in the Byzantine Empire: The contributions of Paul of Aegina (625–690 AD). Neurosurgical Focus, 37(1), E8.
• Papapostolou, D., Karandreas, A., Mavrommatis, E., Laios, K., & Troupis, T. (2021). Paul of Aegina (ca 625–690 AD): Operating on all, from lymph nodes in the head and neck to visceral organs in the abdomen. Journal of Investigative Surgery, 34(12), 1334–1339.
• Skoulakis, C. E., Manios, A. G., Theos, E. A., Papadakis, C. E., & Stavroulaki, P. S. (2008). Treatment of nasal fractures by Paul of Aegina. The Journal of Laryngology & Otology, 122(6), 553–556.