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Medieval Sourcebook:
Paul of Aegina: Epitome - On The Fracture of the Thigh and Nose

Byzantine medicine made use of the works of earlier Greek doctors such as Galen. But Byzantine medical textbooks were often the standard work - for instance the pharmacology text of Nicholas Myrepsos remained the main text in Paris until 1651. This is an extract from the 7th century text, the Epitome by the Paul of Aegina, which remained basic until the end of the empire. Byzantine hagiographical sources emphasize the miraculous and faith healing. Here we see a very different, and more practical, approach towards medicine.bein its text.

On Fracture and Contusion of The Thigh and The Nose

The case of a broken thigh is analogous to that of the arm, but in particular, a fractured thigh is mostly deranged forwards and outwards, for the bone is naturally flattened on those sides. It is to be set by the hands, with ligatures, and even cords applied, the one above and the other below the fracture. When the fracture takes place at one end, if' at the head of the thigh, the middle part of a thong wrapped round with wool, so that it may not cut the parts there, is to be applied to the perinaeum, and the ends of it brought up to the head and given to an assistant to hold, and applying a ligature below the fracture, we give the ends of it to another assistant to make extension. If lt is fractured near the knee, we apply the ligature immediately above the fracture, and give the ends to an assistant, with which to make extension upwards; and while we put a ligature round the knee to secure it, and while the patient lies thus, with his leg extended, we arrange the fracture. Pieces of bone which irritate the parts, as has been often said, are to be taken out from above; and the rest of' the treatment we have already described in the section on the arm. The thigh gets consolidated within fifty days. The manner of arranging it afterwards will be described after delivering the treatment of the whole leg.

The under part of the nose being cartilaginous does not admit of fracture, but it is liable to be crushed, flattened, and distorted; but the upper part being of a bony substance is sometimes fractured.... When, therefore, the nose is fractured in its under parts, having introduced the index or little finger into the nostril, push the parts outwards to their proper position. When the fracture is of the inner parts this is to be done with the head of a probe immediately, during the course of the first day, or not long afterwards, because the bones of the nose get consolidated about the tenth day. But they are to be put into the proper position with the index-finger and thumb externally. In order to prevent the bones from changing their position, two wedge-like tents, formed of a twisted rag, are to be applied, one to each nostril, even if but one part of the nose be deranged, and these are to be allowed to remain until the bone or cartilage gets consolidated....

If the nose become inflamed we may use some anti-inflammatory application to it, such as that from juices [diachylon], the one from vinegar and oil, and such like; or a cataplasm of fine wheaten flour boiled with manna or gum may be applied, both for the sake of the inflammation and in order to keep the nose in position. When the nose is distorted to either side, Hippocrates directs us, after it has been restored to its proper position, to take a piece of leather of a finger's breadth, and having spread one of its ends with taurocolla or gum, to fasten one extremity of it on that side of the nose to which it inclines, and after it dries to bring the thong by the opposite ear to the occiput and forehead, and to fix the other end of the thong firmly there, so that the nose being drawn sideways may take the proper position in the middle. This practice, however, is not much approved of by the moderns. If the bones of the nose are broken into small pieces we must make an incision or enlarge the wound, and having removed the small bones with a hair forceps, unite the divided parts with sutures, and use the applications for recent wounds and those of an agglutinative nature.

Translated and edited by Francis Adams, from The Seven Books of Paulus Aegineta (London, 1843), vol. 2, 443-44, 466-67.)

This text is part of the Internet Medieval Source Book. The Sourcebook is a collection of public domain and copy-permitted texts related to medieval and Byzantine history.

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(c)Paul Halsall Mar 1996
halsall@murray.fordham.edu