Arthrocentesis in the past. Comment on an article by Aceves-Avila et al.

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Sir, Aceves-Avila et al. [1] emphasize the rarity of descriptions of this intervention in ancient European medical literature. However, some references can be found. Arthrocentesis is in fact mentioned in the Hippocratic corpus. In Chapter 41 of the treatise Internal affections, it is stated: ‘If the patient swells up in the joints somewhere, and the swelling does not go down, apply a cupping instrument, and draw blood; if the swelling is in the knees, pierce into the knees with the point of a triangular needle, but do not pierce any of the other joints.’ [2]. I have not found other descriptions of arthrocentesis in modern translations of treatises from the Hippocratic corpus and some other classical or medieval authors: Celsus, Paul Aegina, Albucasis and Guy de Chauliac. The Hippocratic manuscripts in Greek became accessible to the medical community through printed Latin translations from 1525 onwards. But so far I have not found any reference to the arthrocentesis mentioned above. In European surgical textbooks from the late 17th to the 19th century, descriptions of arthrocentesis or incision of a swelling joint can be found [3–5]. However, the authors warn against complications or lack of effect, i.e. rapid return of the swelling, and the procedure does not seem to have been performed commonly. It should also be remembered that classical medical theory probably discouraged doctors from performing arthrocentesis. According to this theory, peccant fluids very dangerous to the internal organs could move to the less important peripheral parts of the body: muscles, joints and skin. Aggressive treatments of these parts, such as arthrocentesis, might drive the fluids inwards again with disastrous results [6]. Instead, gentle treatments, such as fomentation, cupping, promotion of perspiration and passive or active motion, were used to expel the peccant matter from the external parts.

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