should not bathe when hungry, nor after eating until the food
is digested, and bathe the whole body in warm but not too hot
water and the head in hot water. Afterwards the body should be
washed in lukewarm and cool water until finally cold water is
used. One should pour neither cold nor even lukewarm water on
the head, nor bathe in cold water in the winter time, nor when
the body is tired and in perspiration. At such times the bath
should be put off for a while.
17. As soon as one leaves the bath one should cover oneself,
and especially cover the head, so that no draught may strike
it. Even in summer, care must be taken to observe this rule.
After this one should rest for a while until the heat of the
body passes off and then should go to table. If one could
sleep a little just before a meal it is often very beneficial.
Neither during the bath nor immediately after it should cold
water be drunk, and if there is an inappeasable thirst a
little wine and water or water and honey should be taken. In
winter it is beneficial to rub the body with oil after the
bath.
18. Venesection should not be practised frequently, for it is
only meant for serious illness. It should not be permitted in
winter or summer, nor during the months of April or September
(the "r" months). After passing his fiftieth year an
individual should abstain from venesection. Venesection should
not be practised on the day when one takes a bath or goes on a
journey or returns from it. On the day when it is practised
less than usual should be eaten and drunk, and the patient
should give himself to rest, undertake no work nor bothersome
occupation, and take no walk.
19. Whoever observes these rules of life faithfully I
guarantee him a long life without disease. He shall reach a
good old age, and when he comes to die will not need a
physician. His body will remain always strong and healthy,
unless of course he has been born with a weak nature, or has
had an unfortunate bringing up, or should be attacked by
epidemic disease or by famine.
20. Only the healthy should keep these rules. Whoever is ill
or a sufferer from any injuries, or has lost his health
through bad habits, for him there are special rules for each
disease, only to be found in the medical books. Let it be
remembered that every change in a life habit is the beginning
of an ailment.
21. If no physician can be secured, then ailing people may use
these rules as well as the healthy.
These rules are, of course, full of the common sense of medicine that
endures at all times. For the tropical climate of the Eastern countries
they probably represent as good advice as could be given even at the
present time. With them before us it is not surprising to find that on
other subjects Maimonides was just as sensible. Perhaps in nothing is
this more striking than in his complete rejection of astrology.
Considering how long astrology, in the sense of the doctrine of the
stars influencing human health and destinies, had dominated men's minds,
and how universal was the acceptance of it, Maimonides' strong
expressions show how much genius lifts itself above the popular
persuasions of its time, even among the educated, and how much it
anticipates subsequent knowledge.
It is well to remind ourselves that as late as the middle of the
eighteenth century Mesmer's thesis on "The Influence of the Stars on
Human Constitutions" was accepted by the faculty of the University of
Vienna as a satisfactory evidence not only of his knowledge of medicine,
but of his power to reason about it. At the end of the twelfth century
Maimonides was trying to argue it out of existence on the best possible
grounds. "Know, my masters," he writes, "that no man should believe
anything that is not attested by one of these three sanctions:--rational
proof as in mathematical science, the perception of the senses, or
traditions from the prophets and learned men." His biographer in the
monograph "Maimonides," published by the Jewish Publication Society of
America[5], expresses his further views on the subject in compendious
form, and then gives his final conclusion as follows:
"'Works on astrology are the product of fools, who mistook
vanity for wisdom. Men are inclined to believe whatever is
written in a book, especially if the book be ancient; and in
olden times disaster befell Israel because men devoted
themselves to such idolatry instead of practising the arts of
martial defence and government.' He says, that he had himself
studied every extant astrological treatise, and had convinced
himself that none deserved to be called scientific. Maimonides
then proceeds to distinguish between astrology and astronomy,
in the latter of which lies true and necessary wisdom. He
ridicules the supposition that the fate of man could be
dependent on the constellations, and urges that such a theory
robs life of purpose, and makes man a slave of destiny. 'It is
true,' he concludes, 'that you may find strange utterances in
the Rabbinical literature which imply a belief in the potency
of the stars at a man's nativity, but no one is justified in
surrendering his own rational opinions because this or that
sage erred, or because an allegorical remark is expressed
literally. A man must never cast his own judgment behind him;
the eyes are set in front, not in the back.'"
While Maimonides could be so positive in his opinions with regard to a
subject on which he felt competent to say something, he was extremely
modest with regard to many of the great problems of medicine. He often
uses the expression in his writings, "I do not see how to explain this
matter." He quotes with approval from a Rabbi of old who had counselled
his students, "teach thy tongue to say, I do not know." In this, of
course, he has given the best possible evidence of his largeness of mind
and his capacity for making advance in knowledge. It is when men are
ready to say, "I do not know," that progress becomes possible. It is
very easy to rest in a conscious or unconscious pretence of knowledge
that obscures the real question at issue. A great thinker, who lived in
the century in which Maimonides died, Roger Bacon, set down as one of
the four principal obstacles to advance in knowledge indeed, as _the_
one of the four that hampered intellectual progress the most, the fact
that men feared to say, "I do not know."
One of the most interesting features of Maimonides' career for the
modern time is the influence that his writings exerted over the rising
intellectual life of Europe within a half century after his death. Most
people would be rather inclined to think that this Jewish author of the
East would have very little influence over the thinkers and teachers of
Europe within a generation after his death. He died in 1204, just at the
beginning of one of the great productive centuries of humanity, perhaps
one of the greatest of them all. In literature, in art, in architecture,
in philosophy, and in education, this century made wonderful strides.
Two of its greatest teachers, Albertus Magnus and his pupil, Thomas
Aquinas, quote from Moses AEgyptaeus, the European name for Maimonides at
that time, and evidently knew his writings very well. Maimonides was for
them an important connecting link with the world of old Greek thought.
Others of the writers and teachers of this time, as William of Auvergne,
and the two great Franciscans, Alexander of Hales and Duns Scotus, were
also influenced by Maimonides. In a word, the educational world of that
time was much more closely united than we might think, and it did not
take long for a great writer's thoughts to make themselves felt several
thousand miles away. Maimonides was, then, in his own time one of the
world teachers, and, in a certain sense, he must always remain that, as
representing a special development of what is best in human nature.
V
GREAT ARABIAN PHYSICIANS
In order to understand the place of the Arabs in medicine and in
science, a few words as to the rise of this people to political power,
and then to the cultivation of literature and of science, are necessary.
We hear of the Arabs as hireling soldiers fighting for others during the
centuries just after Christ, and especially in connection with the story
of the famous Queen Zenobia at Palmyra. After the destruction of this
city we hear nothing more of them until the time of Mohammed. During
these six and a half centuries there is little question of education of
any kind among them except that at the end of the sixth century, the
Persian King Chosroes I, who was much interested in medicine, encouraged
the medical school in Djondisabour, in Arabistan, founded at the end of
the fifth century by the Nestorian Christians, who continued as the
teachers there until it became one of the most important schools of the
East. It was here that the first Arab physicians were trained, and here
that the Christian physicians who practised medicine among the Arabs
were educated.
Among the Arabs themselves, before the time of Mohammed, there had been
very little interest in medicine. Gurlt notes that even the physician of
the Prophet himself was, according to tradition, a Christian.
Mohammed's immediate successors were not interested in education, and
their people mainly turned to Christian and Jewish physicians for
whatever medical treatment they needed. When the Caliphs came to be
rulers of the Mohammedan Empire, they took special pains to encourage
the study of philosophy and medicine; though dissection was forbidden by
the Koran, most of the other medical sciences, and especially botany and
all the therapeutic arts, were seriously cultivated.
Until the coming of Mohammed, the Arabs had been wandering tribes,
getting some fame as hireling soldiers, but now, under the influence of
a feeling of community in religion, and led by the military genius of
some of Mohammed's successors, whose soldiers were inspired by the
religious feelings of the sect, they made great conquests. The
Mohammedan Empire extended from India to Spain within a century after
Mohammed's death. Carthage was taken and destroyed, Constantinople was
threatened. In 661, scarcely forty years after the _hegira_ or flight of
Mohammed, from which good Mohammedans date their era, the capital was
transferred from Medina to Damascus, to be transferred from here to
Bagdad just about a century later, where it remained until the Mongols
made an end of the Abbasside rulers about the middle of the thirteenth
century. At the beginning the followers of Mohammed were opposed to
knowledge and education of all kinds. Mohammed himself had but little.
According to tradition, he could not read or write. The story told with
regard to the Caliph Omar and the great library of Alexandria, seems to
have a foundation in reality, though such legends usually are not to be
taken literally. Certainly it represents the traditional view as to the
attitude of the earlier Moslem rulers to education. Omar was asked what
should be done with the more than two million volumes. He said that the
books in it either agreed with the Koran, or they did not. If they
agreed with it they were quite useless. If they did not, they were
pernicious. In either case, they should be done away with, because there
was an element of danger in them. Accordingly, the precious volumes that
had been accumulating for nearly ten centuries, served, it is said, to
heat the baths of Alexandria for some six months--probably the most
precious fuel ever used. Fortunately for posterity, the edict was not
quite as universal in its application as the story would indicate, and
exceptions were made for books of science.
In the course of their conquests, however, the Mohammedan Arabs captured
the Greek cities of Asia Minor. They were brought closely in contact
with Greek culture, Greek literature, and Greek thought. As has always
been the case, captive Greece took its captors captive. What happened to
the Romans earlier came to pass also among the Arabs. Inspired by Greek
philosophy, science, and literature, they became ardent devotees of
science and the arts. While not inventing or discovering anything new,
like the Romans they carried on the old. Damascus, Basra, Bagdad,
Bokhara, Samarcand all became centres of culture and of education. Large
sums were paid for Greek manuscripts, and for translations from them.
Under the famous Harun al-Raschid, at the end of the eighth century,
whose name is better known to us than that of any others, because of the
stories of his wandering by night among his people in order to see if
justice were done, three hundred scholars were sent at the cost of the
Caliph to the various parts of the world in order to bring back
treasures of science, and especially of geography and medicine. It is an
interesting historical reflection that the Japanese and Chinese are
doing the same thing now.
The Arabs were very much taken by the philosophy of Aristotle, and it
became the foundation of all their education. Greek thought, as always,
inspired its students to higher things. Soon everywhere in the dominions
of the Caliphs, philosophy, science, art, literature, and education
nourished. Medicine was taken up with the other sciences and cultivated
assiduously. Freind, in his "Historia Medicinae," says that the writings
of the old Greeks which treated of medicine were saved from destruction
with the other books at Alexandria, for the desire of health did not
have less strength among the Arabs than among other nations. Since these
books taught them how to preserve health, and were not otherwise
contrary to the laws of the Prophet, that served to bring about their
preservation. Freind also calls attention to the fact that grammars and
books which treated of the science of language were likewise saved from
destruction. Besides the library, the Arabs, after their conquest of
Alexandria in the eighth century, came under the influence of the
university still in existence there.
In the West, in Spain, the Arabs enjoyed the same advantages as regards
contact with culture and education as their conquest of the Eastern
cities and Alexandria brought them in the East. While it is not
generally realized, Spain was, as we have pointed out, the province of
the Roman Empire in the West that advanced most in culture before the
breaking up of the Empire. The Silver Age of Latin literature owes all
of its geniuses to Spain. Lucan, the Senecas, Martial, Quintilian, are
all Spaniards. Spain itself was a most flourishing province, and under
the Spanish Caesars, from the end of the first to about the end of the
second century, increased rapidly in population. Spain was the leader in
these prosperous times, and the tradition of culture maintained itself.
When Spain became Christian the first great Christian poet, Prudentius,
born about the middle of the fourth century, came from there. He has
been called the Horace and Virgil of the Christians.
The coming down of the barbarians from the North disturbed Spain's
prosperity and the peace and culture of her inhabitants, but it should
not be forgotten that the first medieval popularization of science, a
sort of encyclopedia of knowledge, the first of its kind after that of
Pliny in the classical period, came from St. Isidore of Seville, a
Spanish bishop.
There has been considerable tendency to insist that Spanish culture and
intellectuality owe nearly all to the presence of the Moors in Spain.
This can only be urged, however, by those who know nothing at all of the
Spanish Caesars, the place of Spain in the history of the Roman Empire,
and the continuance of the culture that then reached a climax of
expression during succeeding centuries. On the contrary, the Moors who
came to Spain owe most of their tendency to devote themselves to culture
and education to the state of affairs existent in Spain when they came.
There is no doubt that they raised standards of education and of culture
above the level to which they had sunk under the weight of the invading
barbarians from the North, and Spain owes much to the wise ruling and
devotion to the intellectual life of her Moorish invaders. All the
factors, however, must be taken together in order to appreciate properly
the conditions which developed under the Arabs in both the East and the
West. The Arabs invented little that was new in science or philosophy;
they merely carried on older traditions. It is for that that the modern
time owes them a great debt of gratitude.
RHAZES
The most distinguished of the Arabian physicians was the man whose
rather lengthy Arabian name, beginning with Abu Bekr Mohammed, finished
with el-Razi, and who has hence been usually referred to in the history
of medicine as Rhazes. He was born about 850 at Raj, in the Province of
Chorasan in Persia. He seems to have had a liberal early education in
philosophy and in philology and literature. He did not take up medicine
until later in life, and, according to tradition, supported himself as a
singer until he was thirty years of age. Then he devoted himself to
medical studies with the ardor and the success so often noted in those
whose opportunity to study medicine has been delayed. His studies were
made at Bagdad, where Ibn Zein el-Taberi was his teacher. He returned to
his native town and was for some time the head of the hospital there.
Later he was called by the Sultan to Bagdad to take charge of the
renovated and enlarged hospital of the capital. His medical career,
then, is not unlike that of many another successful physician,
especially of the modern time. At Bagdad he had abundant opportunities
for study, and the ambition to make medicine as well as to make money
and gain fame.
His studies in science were all founded on Aristotle. Though he was
called the Galen of his time, and looked up to the Greek physician as
his master, even the authority of Galen did not override that of the
Stagirite in his estimation. One of his aphorisms is said to have been,
"If Galen and Aristotle are of one mind on a subject, then surely their
opinion is true. When they differ, however, it is extremely difficult
for the scholar to decide which opinion should be accepted." He drew
many pupils to Bagdad, and, when one knows his teaching, this is not
surprising. Some of his aphorisms are very practical. While the
expressions just quoted with regard to Galen and Aristotle might seem to
indicate that Rhazes was absolutely wedded to authority, there is
another well-known maxim of his which shows how much he thought of the
value of experience and observation. "Truth in medicine," he said, "is a
goal which cannot be absolutely reached, and the art of healing, as it
is described in books, is far beneath the practical experience of a
skilful, thoughtful physician." Some of his other medical aphorisms are
worth noting. "At the beginning of a disease choose such remedies as
will not lessen the patient's strength." "When you can heal by diet,
prescribe no other remedy, and, where simple remedies suffice, do not
take complicated ones."
Rhazes knew well the value of the influence of mind over body even in
serious organic disease, and even though death seemed impending. One of
his aphorisms is: "Physicians ought to console their patients even if
the signs of impending death seem to be present. For the bodies of men
are dependent on their spirits." He considered that the most valuable
thing for the physician to do was to increase the patient's natural
vitality. Hence his advice: "In treating a patient, let your first
thought be to strengthen his natural vitality. If you strengthen that,
you remove ever so many ills without more ado. If you weaken it,
however, by the remedies that you use you always work harm." The simpler
the means by which the patient's cure can be brought about, the better
in his opinion. He insists again and again on diet rather than
artificial remedies. "It is good for the physician that he should be
able to cure disease by means of diet, if possible, rather than by means
of medicine." Another of his aphorisms seems worth while quoting: "The
patient who consults a great many physicians is likely to have a very
confused state of mind."
Some idea of Rhazes' strenuous activity as a writer on medical subjects
may be obtained from the fact that thirty-six of his works are still
extant, and there are nearly two hundred others of which only the
titles have been preserved. Some of these are doubtless the works of
pupils and students of succeeding generations, published under his name
to attract attention. His principal work is "Continens," or
"Comprehensor," which owes its title to the fact that it was meant to
contain the whole practice of medicine and surgery. It includes
references to the writings of all previous distinguished medical
writers, from Hippocrates to Honein Ben Ishac, also known as
Johannitius, a Christian Arabian physician, one of Rhazes' teachers. The
most frequently quoted of these authorities are Galen, Oribasius,
Aetius, and Paul of AEgina. The work, however, is not made up entirely of
quotations, but contains many observations made by the author himself.
Gurlt says that the foundation of the theoretic medicine of Rhazes is
the system of Galen, while in practice he seems to cling more to the
aphorisms of Hippocrates. He has many practical points which show that
he thought for himself. For instance, in wounds of the abdomen, if the
intestines are extruded and cannot be replaced, he suggests the
suspension of the patient by his hands and feet in a bath in order to
facilitate their return. If they do not go back readily, compresses
dipped in warm wine should be used. Cancer he declares to be almost
incurable. He has much to say about the bites of animals and their
tendency to be poisonous, knew rabies very well, and knew also that the
bites of men might have similar serious consequences.
It is impossible to give any adequate idea of the thoroughly practical
character of Rhazes' medical writing in a few lines, but it may suffice
to say that there is scarcely any feature of modern medicine and surgery
that he does not touch, and oftener than not his touch is sure and
rational and frequently much better than the advice of successors long
after him in the same matters. An example or two will suffice to
illustrate this. In the treatment of nasal polyps he says that whenever
drug treatment of these is not successful, they should be removed with a
snare made of hair. For fall of the uvula he suggests gargles, but when
these fail he advises resection and cauterization. Among the affections
of the tongue he numbers abscess, fissure, ulcer, cancer, ranula,
shortening of the ligaments, hypertrophy, erythema of the mucous
membrane, and inflammatory swelling. In general his treatment of the
upper respiratory tract is much farther advanced than we might think
possible at this time. He advises tracheotomy whenever there is great
difficulty of respiration, and describes how it should be done. After
the dyspnea has passed the edges of the wound should be brought together
with sutures. It is not surprising, then, to find that the treatment of
fractures and luxations is eminently practical, and, indeed, on any
subject that he touches he throws practical light.
In the introduction to his edition of the works of Ambroise Pare,
Malgaigne says that the first reference to a metal band in connection
with trusses is to be found in Rhazes. Hernia was, of course, one of the
serious ailments that, because of its superficial character, was rather
well understood, and so it is not surprising to find that much of our
modern treatment of it was anticipated. The manipulations for taxis, the
use of a warm bath for the relaxation of the patient by means of heat
and by putting the head and feet higher than the abdomen while in the
bath, and the employment of various kinds of trusses to prevent
strangulation of the hernia recur over and over again, in the authors of
the Middle Ages. Many of the suggestions are to be found in the early
Greek authors, but subsequent writers give a certain personal expression
to them which shows how much they had learned by personal observation in
the employment of various methods.