The popularity in many cultures of Jewish physicians – many of whom are regarded as more skillful and even more ethical than their non-Jewish counterparts – is not a phenomenon of only the past century. It existed as long as 1,000 years ago, as exemplified by two Jewish doctors that are the focus of two new English-language books.
The first is the 227-page Isaac Israeli: The Philosopher Physician, written by Prof. Kenneth Collins, Prof. Samuel Kottek and Dr.
Helena Paavilainen, about a physician who lived in Egypt two centuries before Maimonides (the Rambam) and was an expert on Jewish philosophy and on urine and its connection to disease. Although his surname sounds contemporary, he would have been known in the Jewish world as Yitzhak ben Shlomo, in Latin as Isaac Judaeus (“Isaac, the Jew”) and in the Muslim world as Ishaq ibn Suleyman al-Israili (meaning Isaac, the Israelite”). The book on his philosophy, published in 1958, calls him “Isaac Israeli,” but the second is not really a surname – just an indication that he was Jewish.
Isaac Israeli was a remarkable and relatively unknown Jewish physician, and the new book – not the typical subject of bestsellers – is likely to lift him out of obscurity in medical and Jewish circles The other volume is the 293-page In the Pathways of Maimonides: Studies in Maimonides, Medical Ethics and Jewish Law, by Prof.
Kenneth Collins, Prof. Edward Reichman and Prof. Avraham Steinberg – written specially as a tribute to Dr. Fred Rosner, who has just marked his 80th birthday and is considered to be the “father of Jewish medical ethics,” when the accepted “grandfather” was the late former British chief rabbi Lord Immanuel Jakobovits. It was published by the Maimonides Research Institute of Haifa and New York, which issued around three years ago Moses Maimonides and His Practice of Medicine, also authored by Rosner, Kottek and Collins. Reichman is an expert in clinical emergency medicine, education and bioethics at Einstein and received his rabbinical ordination at Yeshiva University’s REITS theological seminary. Israel Prize laureate Steinberg is a veteran pediatric neurologist, rabbi and expert in medical ethics and Halacha, as well as head of the editorial board of the Talmudic Encyclopedia.
ROSNER, WHO recently came on aliya and lives here with his children, their spouses and grandchildren, was born in Germany and lived in Berlin in the 1930s. He was a professor of medicine at Yeshiva University’s Albert Einstein College of Medicine, professor of internal medicine at Mount Sinai School of Medicine and director of the department of medicine at Queens Hospital Center, all in New York City. Rosner was only three years old when he and his older brother were on the last of the Kindertransport trains to the UK and later reunited with his parents.
He moved on to the US, graduating with a bachelor’s degree from Yeshiva University and earning an MD at Einstein as a member of its first graduating class in 1959. He has published almost 800 articles and chapters in books on all aspects of Jewish medical ethics and Jewish medical history, as well on aspects of hematology, including leukemia and anemia, immunology and general medicine.
He is also an expert on the Rambam.
Kottek is an emeritus professor of the history of medicine at the Hebrew University and Collins a former medical historian at the University of Glasgow who now resides in Jerusalem.
The first volume comes as quite a surprise, as who would have thought that Isaac Israeli – born in the middle of the ninth century in Fayyum, an Egyptian town about 100 kilometers from Cairo – is considered by medical historians as legendary and is considered one of the greatest Jewish physicians of all time. In his chapter on him, Collins notes that he had a long life, dying at the age of 100 around 950 CE. He worked as an oculist, possibly in Fostat (old Cairo) and moved to what is now Tunisia when half of his life was past.
Most of his writings were in Arabic and, a p p a re n t - ly, his aphorisms for Jewish physicians were in Hebrew.
He earned enough of a reputation as a doctor to be asked to tend the first Fatimid ruler, Ubayd Allah al-Mahdi.
The basis for much of his philosophy was Plato, while that of his knowledge of anatomy came from Hippocrates, who was born in 460 BCE on the Greek island of Kos, and Galen, the Greek physician, surgeon and philosopher in the Roman empire some 800 years before Isaac Israeli’s birth. “His writings often show an originality of thought, and references to his works can be found widely in Arab and European sources,” Collins wrote.
“His philosophy seems to have made little impact in the Muslim world. In the Jewish world, his influence has been noted in writings more than decades and centuries after his death. “The desire by Jewish physicians, excluded from the early medical schools of Christian Europe and unfamil iar with their Latin texts, for medical works in Hebrew produced a steady steam of translations into Hebrew,” including that of Isaac, who was credited for the first mention of tracheotomy (making a hole in the windpipe to allow breathing when it was difficult or impossible) in Arabic.
Isaac wrote 50 aphorisms on medicine, which deal with general thoughts on doctors (“The physician should not tarry too long, for most diseases will not stay in waiting.
Acute diseases need quick decision and treatment”) to comments on “quacks and impostors,” practical medicine, medical etiquette and professional directions: “The higher the fees you require, the higher will be the repute of your cures. To those who you attend gratuitously, your practice will seem trivial.” He also wrote a book on fevers and another on dietetics.
But Isaac is probably best known (among those who have studied his works) for his Book of Urine, of which many early translations have survived. In it, he explains to other doctors the different shades of the natural liquid waste produce, its sedimentation (turbidity), odor and even taste! Based on his findings, centuries later other doctors produced “wheels” with different colors of urine pointing out possible diseases that could be diagnosed from them.
Isaac was also an expert on medicinal plants that could affect the urine and bodily systems that are also detailed in the volume.
Urine tests in health fund labs are, of course, part of every medical examination today. But, writes transplantation medicine specialist Dr. Anthony Warrens of Glasgow, Oxford, London and Boston, “if we believe that the reason for the abnormality in the urine is the failure to eliminate a particular substance, we are now in a position to measure the presence of that substance in the urine and the resumed concomitant accumulation of it in the blood.”
THE MAIMONIDES book is very different, with over a dozen chapters ranging from topics like doctors’ strikes, respiratory brain death and the Orthodox Jewish approach to hospice care to pikuah nefesh (forgoing observance of the rules of Shabbat or holidays to save lives) to honoring one’s parents and prostate cancer management.
Sixteen leading lights in medical ethics, Judaism and medicine wrote the chapters.
Centuries before the invention of the MRI and CT scans, x-rays, aspirin and antibiotics, the sphygmomanomter and even the thermometer, the medieval rabbi and philosopher Maimonides was a brilliant physician who treated the patient rather than the illness and espoused moderation and disease prevention.
The great sage, especially during the last decade of his life as court physician to the sultan in Cairo, devoted himself to medicine and his patients, and wrote 10 impressive works in Arabic including volumes on asthma, poisons and their antidotes, hemorrhoids and digestion, cohabitation and health promotion, as well as a glossary of drug names in Arabic, Syrian, Greek, Spanish, Persian and Berber.
Rosner translated many of the Rambam’s medical works into English over a period of five decades.
Born in Cordoba in the Almoravid Empire (Spain) on the eve of Passover in 1135, Maimonides also lived for a time in Morocco and the Holy Land. He took up the profession at the age of 37 after the death at sea of his brother David, a merchant of precious stones, and needed the income to support himself and his family, including his sister- in-law and nephew, He died in Egypt in 1204 and was buried in Tiberias, on the shores of the Kinneret. His medical services, especially to Muslim royalty and Jewish common people, were so much in demand, that the Rambam would arrive home in Fostat exhausted, hungry and weak. Some scholars have even suggested that his health declined and he died prematurely because of his endless work as a physician.
Speaking of Rosner, Reichman wrote: “We hope this [book] will be a fitting tribute to a man who tries to walk in the pathway of Maimonides.”
In the chapter on strikes by physicians, emeritus Prof. Shimon Glick – a US-born endocrinologist and medical administrator who was dean of Ben-Gurion University’s faculty of health sciences, Jewish medical ethics expert and ombudsman of the Health Ministry – states unequivocally that he is opposed to them. There were doctors’ strikes in Israel in 1976 (58 days), 1983 (117 days), 2000 (217 days) and 2011 (intermittently over several months). When Glick himself refused to go along when he colleagues around the country did strike, the Israel Medical Association threatened to bring him up for disciplinary charges. In response to this, he argued that striking violated the IMA’s own proposals for a charter for patients’ rights, and the association canceled its plans.
To those doctors who argue that without striking, they cannot attain their goals – getting higher salaries for themselves and funding to improve the health system – Glick suggested compulsory arbitration rather than a walkout to reach a settlement.
Steinberg, who headed a committee for several years that prepared legislation for the Terminal Patients Law, deals with the very complicated issue of respiratory (lower- brain) death and when it is permissible to remove organs for transplant. Rabbis argued for many years over lower-brain death (when the individual ceases breathing but his or her heart is artificially kept breathing), often finding themselves at odds with physicians. Leading ultra-Orthodox (haredi) rabbis also frequently disagreed with senior modern Orthodox rabbis.
Orthodox (especially haredi) Jews have had long had a natural aversion to and distrust of the concept of hospice care for terminal patients, writes Dr. Edward Burns of Einstein, an internal medicine specialist and hematologist and Montefiore Hospitals in New York, explaining that observant families are likely not to trust staff who might violate Jewish law.
He goes in depth into whether one is permitted or not to pray for the death of a person who is gravely ill and in extreme pain and the implications of DNR (Do Not Resuscitate) and DNI (Do Not Intubate) instructions to medical staffers. Giving blood transfusions, dialysis treatment, antibiotics and chemotherapy as palliative care and whether a terminal patient could be removed from a respirator are also discussed.
Collins, in his chapter on the ethics of clinical judgment, writes that “Maimonides worked in an era where some medical treatments were effective and some were actually dangerous, yet it is clear from his writings that he always aimed to be the insightful physician, basing his reputation on his knowledge and experience.”
This second volume contains much food for thought for rabbis, doctors and medical ethicists who are willing to devote many hours to studying its conclusions.