Mohammedans. It was their teaching that aroused Moslem scholars from the
apathy that had characterized the attitude of the Arabian people toward
science at the beginning of Mohammedanism. As time went on, other great
Christian medical teachers distinguished themselves among the Arabs. Of
these the most prominent was Messui the elder, who is also known as
Janus Damascenus. Both he and his father practised medicine with great
success in Bagdad, and his son became the body-physician to Harun
al-Raschid either after or in conjunction with Gabriel Bachtischua. Like
his colleague or predecessor in official position, he, too, made
translations from the Greek into Arabic. Another distinguished Arabian
Christian physician was Serapion the elder. He was born in Damascus, and
flourished about the middle of the ninth century. He wrote a book on
medicine called the "Aggregator," or "Breviarium," or "Practica
Medicinae," which appeared in many printed editions within the century
after the invention of printing. During the ninth century, also, we have
an account of Honein Ben Ischak, who is known in the West as
Johannitius. After travelling much, especially in Greece and Persia, he
settled in Bagdad, and, under the patronage of the Caliph Mamum, made
many translations. He translated most of the old Greek medical writers,
and also certain of the Greek philosophic and mathematical works. The
accuracy of his translations became a proverb. His compendium of Galen
was the text-book of medicine in the West for many centuries. It was
known as the "Isagoge in Artem Parvam Galeni." His son, Ishac Ben
Honein, and his nephew, Hobeisch, were also famous as medical
practitioners and translators.
Still another of these Arabian Christians, who acquired a reputation as
writers in medicine, was Alkindus. He wrote with regard to nearly
everything, however, and so came to be called the philosopher. He is
said altogether to have written and translated about two hundred works,
of which twenty-two treat of medicine. He was a contemporary of Honein
Ben Ischak in the ninth century. Another of the great ninth-century
Christian physicians and translators from the Greek was Kostaben Luka.
He was of Greek origin, but lived in Armenia and made translations from
Greek into Arabic. Nearly all of these men took not alone medical
science, but the whole round of physical science, for their special
subject. A typical example in the ninth century was Abuhassan Ben Korra,
many of whose family during succeeding generations attracted attention
as scholars. He became the astronomer and physician of the Caliph
Motadhid. His translations in medical literature were mainly excerpts
from Hippocrates and Galen meant for popular use. These Christian
translators, thoroughly scientific as far as their times permitted them
to be, were wonderfully industrious in their work as translators, great
teachers in every sense of the word, and they are the men who formed
the traditions on which the greater Arabian physicians from Rhazes
onward were educated.
It would be easy to think that these men, occupied so much with
translations, and intent on the re-introduction of Greek medicine, might
have depended very little on their own observations, and been very
impractical. All that is needed to counteract any such false impression,
however, is to know something definite about their books. Gurlt, in his
"History of Surgery," has some quotations from Serapion the elder, who
is often quoted by Rhazes. In the treatment of hemorrhoids Serapion
advises ligature and insists that they must be tied with a silk thread
or with some other strong thread, and then relief will come. He says
some people burn them _medicinis acutis_ (touching with acids, as some
do even yet), and some incise them with a knife. He prefers the
ligature, however. He calmly discusses the removal of stones from the
kidney by incision of the pelvis of the kidney through an opening in the
loin. He considers the operation very dangerous, however, but seems to
think the removal of a stone from the bladder a rather simple procedure.
His description of the technique of the use of a catheter and of a
stylet with it, and apparently also of a guide for it in difficult
cases, is extremely interesting. He suggests the opening of the bladder
in the median line, midway between the scrotum and the anus, and the
placing of a canula therein, so as to permit drainage until healing
occurs.
Even this brief review of the careers and the writings of the
physicians of early Christian times shows how well the tradition of old
Greek medicine was being carried on. There was much to hamper the
cultivation of science in the disturbances of the time, the gradual
breaking up of the Roman Empire, and the replacement of the peoples of
southern Europe by the northern nations, who had come in, yet in spite
of all this, medical tradition was well preserved. The most prominent of
the conservators were themselves men whose opinions on problems of
practical medicine were often of value, and whose powers of observation
frequently cannot but be admired. There is absolutely no trace of
anything like opposition to the development of medical science or
medical practice, but, on the contrary, everywhere among political and
ecclesiastical authorities, we find encouragement and patronage. The
very fact that, in the storm and stress of the succeeding centuries,
manuscript copies of the writings of the physicians of this time were
preserved for us in spite of the many vicissitudes to which they were
subjected from fire, and war, and accidents of various kinds for
hundreds of years, until the coming of printing, shows in what
estimation they were held. During this time they owed their preservation
to churchmen, for the libraries and the copying-rooms were all under
ecclesiastical control.
III
GREAT JEWISH PHYSICIANS[3]
Any account of Old-Time Makers of Medicine without a chapter on the
Jewish Physicians would indeed be incomplete. They are among the most
important factors in medieval medicine, representing one of the most
significant elements of medical progress. In spite of the disadvantages
under which their race labored because of the popular feeling against
them on the part of the Christians in the earlier centuries and of the
Mohammedans later, men of genius from the race succeeded in making their
influence felt not only on their own times, but accomplished so much in
making and writing medicine as to influence many subsequent generations.
Living the segregated life that as a rule they had to, from the earliest
times (the Ghettos have only disappeared in the nineteenth century), it
would seem almost impossible for them to have done great intellectual
work. It is one of the very common illusions, however, that great
intellectual work is accomplished mainly in the midst of comfortable
circumstances and as the result of encouraging conditions. Most of our
great makers of medicine at all times, and never more so than during the
past century, have been the sons of the poor, who have had to earn their
own living, as a rule, before they reached manhood, and who have always
had the spur of that necessity which has been so well called the mother
of invention. Their hard living conditions probably rather favored than
hampered their intellectual accomplishments.
It is not unlikely that the difficult personal circumstances in which
the Jews were placed had a good deal to do at all times with stimulating
their ambitions and making them accomplish all that was in them. Certain
it is that at all times we find a wonderful power in the people to rise
above their conditions. With them, however, as with other peoples,
luxury, riches, comfort, bring a surfeit to initiative and the race does
not accomplish so much. At various times in the early Middle Ages,
particularly, we find Jewish physicians doing great work and obtaining
precious acknowledgment for it in spite of the most discouraging
conditions. Later it is not unusual to find that there has been a
degeneration into mere money-making as the result of opportunity and
consequent ease and luxury. At a number of times, however, both in
Christian and in Mohammedan countries, great Jewish physicians arose
whose names have come to us and with whom every student of medicine who
wants to know something about the details of the course of medical
history must be familiar. There are men among them who must be
considered among the great lights of medicine, significant makers always
of the art and also in nearly all cases of the science of medicine.
A little consideration of the history of the Jewish people and their
great documents eliminates any surprise there may be with regard to
their interest in medicine and successful pursuit of it during the
Middle Ages. The two great collections of Hebrew documents, the Old
Testament and the Talmud, contain an immense amount of material with
reference to medical problems of many kinds. Both of these works are
especially interesting because of what they have to say of preventive
medicine and with regard to the recognition of disease. Our prophylaxis
and diagnosis are important scientific departments of medicine dependent
on observation rather than on theory. While therapeutics has wandered
into all sorts of absurdities, the advances made in prophylaxis and in
diagnosis have always remained valuable, and though at times they have
been forgotten, re-discovery only emphasizes the value of preceding
work. It is because of what they contain with regard to these two
important medical subjects that the Old Testament and the Talmud are
landmarks in the history of medicine as well as of religion.
Baas, in his "Outlines of the History of Medicine," says: "It
corresponds to the reality in both the actual and chronological point of
view to consider the books of Moses as the foundation of sanitary
science. The more we have learned about sanitation in the prophylaxis of
disease and in the prevention of contagion in the modern time, the more
have we come to appreciate highly the teachings of these old times on
such subjects. Moses made a masterly exposition of the knowledge
necessary to prevent contagious disease when he laid down the rules with
regard to leprosy, first as to careful differentiation, then as to
isolation, and finally as to disinfection after it had come to be sure
that cure had taken place. The great lawgiver could insist emphatically
that the keeping of the laws of God not only was good for a man's soul
but also for his body."
With this tradition familiarly known and deeply studied by the mass of
the Hebrew people, it is no surprise to find that when the next great
Hebrew development of religious writing came in the Talmud during the
earlier Middle Ages, that also contains much with regard to medicine,
not a little of which is so close to absolute truth as never to be out
of date. Friedenwald, in his "Jewish Physicians and the Contributions of
the Jews to the Science of Medicine," a lecture delivered before the
Gratz College of Philadelphia fifteen years ago, summed up from Baas'
"History of Medicine" the instructions in the Talmud with regard to
health and disease. The summary represents so much more of genuine
knowledge of medicine and surgery than might be expected at the early
period at which it was written, during the first and second century of
our era, that it seems well to quote it at some length.
"Fever was regarded as nature's effort to expel morbific
matter and restore health; which is a much safer
interpretation of fever, from a practical point of view, than
most of the theories bearing on this point that have been
taught up to a very recent period. They attributed the halting
in the hind legs of a lamb to a callosity formed around the
spinal cord. This was a great advance in the knowledge of the
physiology of the nervous system. An emetic was recommended as
the best remedy for nausea. In many cases no better remedy is
known to-day. They taught that a sudden change in diet was
injurious, even if the quality brought by the change was
better. That milk fresh from the udder was the best. The
Talmud describes jaundice and correctly ascribes it to the
retention of bile, and speaks of dropsy as due to the
retention of urine. It teaches that atrophy or rupture of the
kidneys is fatal. Induration of the lungs (tuberculosis) was
regarded as incurable. Suppuration of the spinal cord had an
early, grave meaning. Rabies was known. The following is a
description given of the dog's condition: 'His mouth is open,
the saliva issues from his mouth; his ears drop; his tail
hangs between his legs; he runs sideways, and the dogs bark at
him; others say that he barks himself, and that his voice is
very weak. No man has appeared who could say that he has seen
a man live who was bitten by a mad dog.' The description is
good, and this prognosis as to hydrophobia in man has remained
unaltered till in our day when Pasteur published his startling
revelation. The anatomical knowledge of the Talmudists was
derived chiefly from dissection of the animals. As a very
remarkable piece of practical anatomy for its very early date
is the procuring of the skeleton from the body of a
prostitute by the process of boiling, by Rabbi Ishmael, a
physician, at the close of the first century. He gives the
number of bones as 252 instead of 232. The Talmudists knew the
origin of the spinal cord at the foramen magnum and its form
of termination; they described the oesophagus as being
composed of two coats; they speak of the pleura as the double
covering of the lungs; and mention the special coat of fat
about the kidneys. They had made progress in obstetrics;
described monstrosities and congenital deformities; practised
version, evisceration, and Caesarian section upon the dead and
upon the living mother. A.H. Israels has clearly shown in his
'Dissertatio Historico-Medica Inauguralis' that Caesarian
section, according to the Talmud, was performed among the Jews
with safety to mother and child. The surgery of the Talmud
includes a knowledge of dislocation of the thigh bone,
contusions of the skull, perforation of the lungs,
oesophagus, stomach, small intestines, and gall bladder;
wounds of the spinal cord, windpipe, of fractures of the ribs,
etc. They described imperforate anus and how it was to be
relieved by operation. Chanina Ben Chania inserted natural and
wooden teeth as early as the second century, C.E."
There is a famous summing up of the possibilities of life and happiness
in the Talmud that has been often quoted--its possible wanting in
gallantry being set down to the times in which it was written. "Life is
compatible with any disease, provided the bowels remain open; any kind
of pain, provided the heart remain unaffected; any kind of uneasiness,
provided the head is not attacked; all manner of evils, except it be a
bad woman."
There are many other interesting suggestions in the Talmud. Sometimes
they have come to be generally accepted in the modern time, sometimes
they are only curious notions that have not, however, lost all their
interest. The crucial incision for carbuncle is a typical example of the
first class and the suggestion of the removal of superfluous fat from
within the abdomen or in the abdominal wall itself by operation is
another. That they had some idea of the danger of sepsis may be gathered
from the fact that they suspected iron surgical instruments and advised
the use of others of less enduring character.
The Talmud itself was indeed a sort of encyclopedia in which was
gathered knowledge of all kinds from many sources. It was not
particularly a book of medicine, though it contains so many medical
ideas. In many parts of it the authors' regard for science is
emphatically expressed. Landau, in his "History of Jewish Physicians,"
closes his account of the Talmud with this paragraph:
"I conclude this brief review of Talmudic medicine with some
reference to how high the worth of science was valued in this
much misunderstood work. In one place we have the expression
'occupation with science means more than sacrifice.' In
another 'science is more than priesthood and kingly
dignity.'"[4]
After all this of national tradition in medicine before and after
Christ, it is only what we might quite naturally expect to find, that
there is scarcely a century of the Middle Ages which does not contain at
least one great Jewish physician and sometimes there are more. Many of
these men made distinct contributions to medical science and their names
have been held in high estimation ever since. Perhaps I should say that
they were held in high estimation until that neglect of historical
studies which characterized the eighteenth century developed, and that
there has been a reawakening of interest in our time. We forget this
curious decadence of the later seventeenth and eighteenth centuries
which did so much to obscure history and especially the history of the
sciences. Fortunately the scholars of the sixteenth and early
seventeenth centuries accomplished successfully the task of printing
many of the books of these old-time physicians and secured their
publication in magnificent editions. These were bought eagerly by
scholars and libraries all over Europe in spite of the high price they
commanded in that era of slow, laborious printing. The Renaissance
exhibits some of its most admirable qualities in its reverence for these
old workers in science and above all for the careful preparation by its
scholars of the text of these first editions of old-time physicians. The
works have often been thus literally preserved for us, for some of them
at least would have disappeared among the vicissitudes of the
intervening time, most of which was anything but favorable to the
preservation of old-time works, no matter what their content or value.
During the second and third centuries of our era, while the Talmudic
writings were taking shape, three great Jewish physicians came into
prominence. The first of them, Chanina, was a contemporary of Galen.
According to tradition, as we have said, he inserted both natural and
artificial teeth before the close of the second century. The two others
were Rab or Raw and Samuel. Rab has the distinction of having studied
his anatomy from the human body. According to tradition he did not
hesitate to spend large sums of money in order to procure subjects for
dissection. At this time it is very doubtful whether Galen, though only
of the preceding generation, ever had the opportunity to study more than
animals or, at most, a few human bodies. Samuel, the third of the group,
was an intimate friend of Rab's, perhaps a disciple, and his fame
depends rather on his practice of medicine than of research in medical
science. He was noted for his practical development of two specialties
that cannot but seem to us rather distant from each other. His
reputation as a skilful obstetrician was only surpassed by the
estimation in which he was held as an oculist. He seems to have turned
to astronomy as a hobby, and was highly honored for his knowledge of
this science. Probably there is nothing commoner in the story of great
Jewish physicians than their successful pursuit of some scientific
subject as a hobby and reaching distinction in it. Their surplus
intellectual energy needed an outlet besides their vocation, and they
got a rest by turning to some other interest, often accomplishing
excellent results in it. Like most great students with a hobby, the
majority of them were long-lived. Their lives are a lesson to a
generation that fears intellectual overwork.
During the fourth century we have a number of very interesting
traditions with regard to a great Jewish physician, Abba Oumna, to whom
patients flocked from all over the world. He seems particularly to have
been anxious to make his services available to the scholars of his time.
He looked upon them as brothers in spirit, fellow-laborers whose
investigations were as important as his own and whose labors for mankind
he hoped to extend by the helpfulness of his profession. In order that
it might be easy for them to come to him without feeling abashed by
their poverty, and yet so that they might pay him anything that they
thought they were able to, he hung up a box in his anteroom in which
each patient might deposit whatever he felt able to give. His kindliness
towards men became the foundation for many legends. Needless to say he
was often imposed upon, but that seems to have made no difference to
him, and he went on straightforwardly doing what he thought he ought to
do, regardless of the devious ways of men, even those whom he was
generously assisting. While we do not know much of his scientific
medicine, we do know that he was a fine example of a practitioner of
medicine on the highest professional lines.
With the foundation of the school at Djondisabour in Arabistan or
Khusistan by the Persian monarch Chosroes, some Jewish physicians come
into prominence as teachers, and this is one of the first important
occasions in history when they teach side by side with Christian
colleagues. Djondisabour seems distant from us now, lying as it does in
the province just above the head of the Persian Gulf, and it is a little
hard to understand its becoming a centre of culture and education, yet
according to well-grounded historical traditions students flocked here
from all parts of the world, and its medical instruction particularly
became famous. According to the documents and traditions that we
possess, clinical teaching was the most significant feature of the
school work and made it famous. As a consequence graduates from here
were deemed fully qualified to become professors in other institutions
and were eagerly sought by various medical schools in the East.
With the rise of the strong political power of the Mohammedans enough of
peace came to the East at least to permit the cultivation of arts and
sciences to some extent again, and then at once the eminence of Jewish
physicians, both as teachers and practitioners of medicine, once more
becomes manifest. The first of the race who comes into prominence is
Maser Djawah Ebn Djeldjal, of Basra. To him we owe probably more than to
anyone else the preservation of old scientific writings and the
cultivation of arts and sciences by the Mohammedans. He prevailed on
Caliph Moawia I, whose physician he had become, to cause many foreign
works, and especially those written in Greek, to be translated into
Arabic. He seems to have taken a large share of the labor of the
translation on himself and prevailed upon his pupil, the son of Moawia,
to translate some works on chemistry. The translation for which Maser
Djawah is best known is that of the Pandects of Haroun, a physician of
Alexandria. The translation of this work was made toward the end of the
seventh century. Unfortunately the "Pandects" has not come down to us,
either in original or translation, but we have fragments of the
translation preserved by Rhazes, the distinguished Arabian medical
writer and physician of the ninth century, and there seems no doubt that
it contained the first good description of smallpox, a chapter in
medicine that is often--though incorrectly--attributed to Rhazes
himself. Rhazes quoted Maser Djawah freely and evidently trusted his
declarations implicitly.