Christian as well as Arabian rulers at all times during the Middle Ages.
It would be quite impossible in the limited space at command here to
give any adequate mention of what was accomplished by these Jewish
physicians, whose names we have scarcely been able to more than
catalogue, nor of the place they hold in their times. As the physicians
of rulers, their influence for culture and the cultivation of science
was extensive, and as a rule they stood for what was best and highest in
education. The story of one of them, who is generally known in the
Christian world at least, Maimonides, given in some detail, may serve as
a type of these Jewish physicians of the Middle Ages. He lived just
before the flourishing period of university life in the thirteenth
century brought about that wonderful development of medicine and surgery
in the west of Europe that meant so much for the final centuries of the
Middle Ages. His works influenced not a little the great thinkers and
teachers whose own writings were to be the foundations of education for
several centuries after their time. Maimonides was well known in the
Western universities. Though his life had been mainly spent in the East,
and he died there, there was scarcely a distinguished scholar of Europe
who was not acquainted directly or indirectly with his works, and the
greater the reputation of the scholar, as a rule, the more he knew of
Maimonides, Moses AEgyptaeus, as he was called, and the more frequently he
referred to his writings.
IV
MAIMONIDES
The life of one of the great Jewish physicians, who has come to be known
in history as Maimonides, is of such significance in medical biography
that he deserves to have a separate sketch. Born in Spain, his life was
lived in the East, where his connection as royal physician with the
great Sultan Saladin of Crusades fame made his influence widely felt. He
is a type of the broadly educated man, conversant with the culture of
his time and of the past, knowing much besides medicine, who has so
often impressed himself deeply on medical practice. While the narrow
specialists in each generation, the men who are quite sure that they are
curing the special ills of men to which they devote themselves, have
always felt that whatever of progress there was in any given time was
due to them, they occupy but little space as a rule in the history of
medicine. The men who loom large were the broad-minded, humanely
sympathetic, deeply educated physicians, who treated men and their ills
rather than their ills without due consideration of the individual, and
who not only relieved the discomfort of their patients and greatly
lessened human suffering, and added to the sum of human happiness in
their time, but also left precious deeply significant lessons for
succeeding generations of their profession. Hippocrates, Galen,
Sydenham, Auenbrugger, Morgagni, these are representatives of this great
class, and Maimonides must be considered one of them.
Moses Ben Maimum, whose Arabic name was Abu Amran Musa Ben Maimum Obaid
Alla el-Cordovi, who was called by his Jewish compatriots Ramban or
Rambam, was born at Cordova in Spain, on the 30th of March in 1135 or
1139, the year is in doubt. It might not seem of much import now after
nearly eight centuries, but not a little ink is spilt over it yet by
devoted biographers.
We are rather prone to think in our time that the conditions in which
men were born and reared before what we are pleased to call modern
times, and, above all, in the Middle Ages, must have made a distinct
handicap for their intellectual development. Most of us are quite sure
that the conditions in medieval cities were eminently unsuited for the
stimulation of the intellect, for incentive to art impulse, for uplift
in the intellectual life, or for any such broad interest in what has
been so well called the humanities--the humanizing things that lift us
above animal necessities--as would make for genuinely liberal education.
We are likely to be set in the opinion that the environment of the
growing youth of an old-time city, especially so early as the middle of
the twelfth century, was poor and sordid. The cares of the citizens are
presumed to have been mainly for material concerns, and, indeed, mostly
for the wants of the body. They were only making a start on the way from
barbarism to something like our glorious culmination of civilization. As
"the heirs to all the ages in the foremost files of time" we are
necessarily far in advance of them, and we are only sorry that they did
not have the opportunity to live to see our day and enjoy the benefits
of the evolution of humanity that is taking place during the eight
centuries that have elapsed.
As a matter of fact, there was much more of abiding profound interest in
real civilization in many a medieval city, much more general
appreciation of art, much more breadth of intelligence and sympathy with
what we call the humanities, than in most of our large cities. The large
city, as we know it, is eminently a discourager of breadth of
intelligence. Specialism in the various phases of money-making obscures
culture. Maimonides, born in Cordova, was brought up amid surroundings
that teemed with incentives of every kind to the development of
intelligence, of artistic taste, and everything that makes for
cultivation of intellect rather than of interest in merely material
things.
It is well said that it is hard to judge the Cordova of old by its
tawdry ruins of to-day. The educated visitor still stands in awe and
admiration of the great mosque which expressed the high cultivation of
the Moors of this time. It is a never-ending source of wonder to
Americans. The city itself has many reminders of that fine era of
Moorish culture and refinement of taste and of art expression, which
made it in the best sense of the word a city beautiful. The Arab
invaders had found a great prosperous country which had been the most
cultured province of the Roman Empire, and on this foundation they made
a marvellous development. "The banks of the Guadalquivir," says Mr. S.
Lane-Poole in "The Moors in Spain" (London, 1887), "were bright with
marble houses, mosques, and gardens, in which the rarest flowers and
trees of other countries were carefully cultivated, and the Arabs
introduced their system of irrigation which the Spaniards both before
and since have never equalled." The greatest beauty of the city, of
course, had come, and some of it had gone, before Maimonides' time. So
much remains in spite of time and war, and many unfortunate influences,
that we can have some idea how beautiful it must have been in his youth
seven centuries ago, and how even more beautiful in the foretime. Of the
great mosque writers of travel can scarcely say enough. Mr. Lane-Poole
says: "Travellers stand amazed among the forest of columns which open
out apparently endless vistas on all sides. The porphyry, jasper, and
marbles are still in their places; the splendid glass mosaics, which
artists from Byzantium came to make, still sparkle like jewels in the
walls; the daring architecture of the sanctuary, with its fantastic
crossed arches, is still as imposing as ever; the courtyard is still
leafy with the orange trees that prolong the vistas of columns. As one
stands before the loveliness of the great mosque, the thought goes back
to the days of the glories of Cordova, the palmy days of the Great
Khalif, which will never return."
Of all the countries in which the Jews all down the centuries have lived
there is probably none of which they have been more loud in praise than
Spain. Their poets sang of it as if it were their own country; for
centuries the people were happier here than probably they have been
anywhere else for so long a period. Elsewhere in this book I have called
attention to all that Spain meant in Europe during all the centuries
from the beginning of the Roman Empire down to the end of the Middle
Ages. Maimonides was fortunate in his birthplace, then, and while
circumstances compelled the family to move away, this change did not
come until a good effect had been produced on the mind of the growing
youth. Even when persecution came, Maimonides clung to Spain with a
tenacity born of deep affection and emphasized by admiration for all
that she was and had been. Cordova was the jewel of the Spain of this
time, and though much less than she had been in the long preceding time,
when she was the birthplace of Lucan and the two Senecas, or even than
what she had been in Abd-er-Rahman's days, or when she was the
birthplace of Averroes, still she remained wonderfully beautiful and
attractive, winning and holding the affections of men.
Maimonides' father, Maimum Ben Joseph, was a member of the Rabbinical
College of Cordova, and famous for his knowledge of the Talmud. There
are some writings of his on mathematics and astronomy extant. He
directed the education of his son, who, like many another distinguished
scholar in later life, seems to have exhibited very little talent in his
early years. There is no rule in the matter. Precocity often
disappoints. Genius is often dull in childhood, but there are exceptions
that prove both rules. The basis of education in Spain at that time
among the Jews was the Bible, the Talmud, mathematics, and astronomy, a
good rounded education in literature, the basis of law, and some exact
physical science. After his preliminary education at home Maimonides
studied the natural sciences and medicine with Moorish teachers.
Nature-study, in spite of frequent expressions that declare it new in
modern times, is as old as man. He also received a grounding in
philosophy as a preparation for his scientific studies. At the age of
twenty-three he began the composition of a commentary on the Talmud,
which he continued to work at on his journeys in Spain and in Egypt.
This is considered to be one of the most important of this class of
works extant, though, almost needless to say, similar writings are very
numerous.
In the light of wanderings in philosophy during the centuries since, it
is rather interesting to quote from that work the end of man as this
Jewish philosopher of the middle of the twelfth century saw it. Recent
teleological tendencies in biology add to the interest of his views.
According to Maimonides, "Man is the end of the whole creation, and we
have only to look to him for the reason for its existence. Every object
shows the end for which it was created. The palm-trees are there to
provide dates; the spider to spin her webs. All the properties of an
animal or a plant are directed so as to enable it to reach its purpose
in life. What is the purpose of man? It cannot lie alone in eating and
drinking or yielding to passion, nor in the building of cities and the
ruling of others, since these objects lie outside of him, and do not
touch his essential being. Such material striving he has in common with
the animal. A man is lifted from a lower to a higher condition by his
reason. Only through his reason is he placed above the animals. He is
the only reasonable animal. His reason enables him to understand all
things, especially the Unity of God, and all knowledge and science serve
only to direct man to the knowledge of God. Passions are to be subdued,
since the man who yields to passion subjects his spirit to his body, and
does not reveal in himself the divine power which in him lies in his
reason, but is swallowed up in the ocean of matter."
Not long after Maimonides passed his twentieth year the family,
consisting of the father and his two sons, Moses and David, and a
daughter, moved from Cordova to Fez, compelled by Jewish persecutions.
Here it is said that they had to submit to wearing the mask of Islam in
order to lead a peaceful existence. This has been doubted, however, and
his whole life is in flagrant contradiction with any such even apparent
apostasy from the faith of his fathers. Father and son took advantage of
the opportunity of intercourse with Moorish physicians and philosophers
to increase their store of knowledge, but could not be content in the
political and religious conditions in which they were compelled to live.
About 1155, then, they went to Jerusalem, but found conditions even more
intolerable there, and turned back to Egypt, where they settled down in
Old Cairo. In 1166 the father died, and after this we learn that the
sons made a livelihood, and even laid the foundation of a fortune, by
carrying on a jewelry trade. Moses still devoted most of his time to
study, while his brother did most of the business, but the brother was
lost in the Indian Ocean, and with him went not only a large sum of his
own money, but also much that had been entrusted to him by others.
Maimonides undertook to pay off these debts and at the same time had to
meet the necessities not only of himself and sister, but also of the
family of his dead brother. It was then that he took up the practice of
medicine and succeeded in making a great name and reputation for
himself. He continued to write, however, and completed his commentary on
the Talmud.
About the age of fifty Maimonides, as seems to be true of a good many
men who live to old age, became rather discouraged and despondent about
himself. He refers to himself in his letters and writings rather
frequently as an old and ailing man. He had nearly twenty years of
active life ahead of him, but he had the persuasion that comes to many
that he was probably destined to an early death. His son was born
shortly after this time, and that seems to have had not a little to do
with brightening his life. While in Egypt Maimonides married the sister
of one of the royal secretaries, who, in turn, wedded Maimonides'
sister. Maimonides took on himself the education of his son, who also
became a physician, though his father was not to have the satisfaction
of watching his success in the practice of his chosen profession. This
son, Abraham, became the physician of Malie Alkamen, the brother of
Saladin, and, besides, was a physician to the hospital at Cairo. _His_
son, David, the grandson of Maimonides, practised medicine also at Cairo
till 1300. He in turn left two sons, Abraham and Solomon, who achieved
reputation in the chosen profession of their great-grandfather.
Maimonides, after the birth of his son, became one of the busiest of
practising physicians. Indeed, it is hard to understand how he had the
time to do any writing in his busy life. Still less can we understand
his time for teaching. He was the physician to Saladin, whose relations
with Richard Coeur de Lion have made him known to English-speaking
people. Every morning, as the Court physician, Maimonides went to the
palace, situated half a mile away from his dwelling, and if any of the
many officials and dependents that then, as now, were at Oriental
courts, were ill, he stayed there for some time. As a rule he could only
get back to his own home in the afternoon, and then he was, as he says
himself, "almost dying with hunger." Knowing the scantiness of the
Oriental breakfast, we are not surprised. There he found his
waiting-room full of patients, "Jews and Mohammedans, prominent and
unimportant, friends and enemies," he says himself, "a varied crowd, who
are looking for my medical advice. There is scarcely time for me to get
down from my carriage and wash myself and eat a little, and then until
night I am constantly occupied, so that, from sheer exhaustion, I must
lie down. Only on the Sabbath day have I the time to occupy myself with
my own people and my studies, and so the day is away from me." What a
picture it is of the busy medical teacher at all times in the world's
history, yet it must not be forgotten that it is from these busy men
that we have derived our most precious lessons in caring for patients
rather than disease, in the art of medicine rather than medical
science--and their practical lessons have been valuable long after the
fine-spun theories of the scientist that took so long to elaborate have
been placed definitely in the lumber room.
His reputation as a writer on medical topics is not as great as that
which has been accorded him for his writings on philosophy and in
Talmudic literature, but he well deserves a place among the great
practical masters of medicine, as well as high rank among the physicians
of his time. There is little that is original in his writing, but his
thoroughgoing common sense, his wide knowledge, and his discriminating,
eclectic faculty make his writings of special value. As might have been
expected, the Aphorisms of Hippocrates attracted his attention, and,
besides, he wrote a series of aphorisms of his own. The most interesting
of his writings, however, is a series of letters on dietetics written
for the son of his patron Saladin. The young prince seems to have
suffered from one of the neurotic conditions that so often develop in
those who have their lives all planned for them, and little incentive to
do things for themselves. The main portion of his complaints centred, as
in the case of many another individual of leisure, in disturbances of
digestion. Besides, he suffered from constipation and feelings of
depression. Doubtless, like many a young person of the modern time, he
was quite sure that these symptoms portended some insidious organic
ailment that would surely bring an early death. When fathers, having
done all that there is to do, just expect their sons to enjoy the
fruits of the paternal accomplishments, conditions of this kind very
often develop, unless the young man proceeds to occupy himself with even
more dangerous distractions than he finds in unending thought about his
own feelings.
The rules of life and health that Maimonides laid down in these letters
have become part of our popular medical tradition. Probably more of the
ordinarily current maxims as to health have been derived from them than
would possibly be suspected by anyone not familiar with them. In various
forms his rules have been published a number of times. A good idea of
them can be obtained from the following compendium of them, which I
abbreviate from a biographical sketch of Maimonides by Dr. Oppler, which
appeared in the "Deutsches Archiv fuer Geschichte der Medizin und
Medicinische Geographie" (Bd. 2, Leipzig, 1879).
1. Man is bound to lead a life pleasing to God if he wants to
have a healthy body, and he must hold himself far from
everything that can hurt his health and accustom himself to
whatever renews his strength. He should eat and drink only
when hungry and thirsty and should be particularly careful of
the regular evacuation of his bowels and of his bladder. He
must not delay either of these operations, but as far as
possible satisfy the inclination at once.
2. A man must not overload his stomach but be content always
with something less than is necessary to make him feel quite
satisfied. He should not drink much during the meal and only
of water and wine mixed, taking somewhat more after digestion
has begun and after digestion is completed, in moderation
according to his needs. Before a man sits down to table he
should note whether he has any tendency to evacuation and
should make the body warm by movement and activity. After this
exercise he should rest a little before taking food. It is
very beneficial after work to take a bath and then the meal.
3. Food should be taken always in the sitting position. There
should be no riding nor walking, nor movements of the body
until digestion is finished. The man who takes a walk or any
strenuous occupation immediately after eating subjects himself
to serious dangers of disease.
4. Day and night should be divided into twenty-four hours. Men
should sleep for eight hours, and so arrange their sleep that
the end of it comes with the dawn, so that from the beginning
of sleep until sunrise there should be an eight-hour interval.
We should all leave our beds about the time that the sun
rises.
5. During sleep a man should lie neither on his face nor on
his back but on his side, the beginning of the night on his
left and at the end on his right. He should not go to sleep
for three or four hours after eating and should not sleep
during the day.
6. Fruits that are laxative, as grapes, figs, melons, gourds,
should be taken only before meal time and not mixed with other
food. It would be better to let these get into the abdominal
organs and then take other food.
7. Eat what is easily digestible before what is difficult of
digestion. The flesh of birds before beef and the flesh of
calves before that of cows and steers. (Birds were then
thought more digestible than other flesh; we have reversed the
ruling. The note shows how light and digestible their flesh
was considered and the reason therefor.)
8. In summer eat cooling food, acids, and no spices. In
winter, on the contrary, eat warming foods, rich in spices,
mustard, and other heating substances. In cold and warm
climates one should eat according to the climatic conditions.
9. There are certain harmful foods that should be avoided.
Large salt fish, old cheese, old pickled meat, young new wine,
evil-smelling and bitter foods are often poisonous. There are
also some which are less harmful, but are not to be
recommended as ordinary nutritive materials. Large fish,
cheese, milk more than twenty-four hours after milking, the
flesh of old oxen, beans, peas, unleavened bread, sauerkraut,
onions, radishes and the like. These are to be taken only in
small quantities and only in the winter time and they should
be avoided in the summer. Beans and lentils are to be
recommended neither in winter nor summer.
10. As a rule one should avoid the eating of tree fruits, or
not eat much of them, especially when they are dry and even
less when they are green. If they are unripe they may cause
serious damage. Johannesbrod is very harmful at all times, as
are also all the sour fruits, and only small amounts of them
should be eaten in summer or in warm countries.
11. The fruits that are to be recommended dry as well as
fresh, are figs, grapes, and almonds. These may be eaten as
one has the appetite for them, but one should not accustom
himself to eat them much, though they are healthier than all
other fruits.
12. Honey and wine are not good for children, though they are
beneficial for older people, especially in winter. In summer
one-third less of them should be eaten than in winter.
13. Special care should be taken to have regular movements of
the bowels that carry off the impurities of the body. It is an
axiom in medicine, that so long as evacuations are absent, or
difficult, or require strong efforts, the individual is liable
to serious disease. Every medical means should be taken to
overcome constipation in order to escape its dangers. For
this purpose young people should be given salty food,
materials that have been soaked in olive oil, salt itself, or
certain vegetable soups with olive oil and salt. Older people
should take honey mixed with warm water early in the morning
and four hours later should take their breakfast. This
proceeding should be followed up from one to four days until
the constipation is overcome.
14. Another axiom of medicine is that so long as a man is able
to be active and vigorous, does not eat until he is over-full,
and does not suffer from constipation, he is not liable to
disease. Even such men, however, are much safer if they do not
take food that may disagree with them.
15. Whoever gives himself up to inactivity, or puts off
evacuations of the bowels, or suffers from constipation, will
be sure to suffer from many diseases and will see his strength
disappear even should he eat the best food in the world and
make use of all the remedies that physicians have. Immoderate
eating is a poison for men and the cause of many diseases
which attack them. Most diseases come from either eating too
much or partaking of unsuitable food. That was what Solomon
meant with his proverb: "He who puts a guard over his mouth
and his tongue protects himself from many evils," that is to
say, whoever protects his mouth from the overindulgence in
food and his tongue from unsuitable speech protects himself
from many evils.