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By Sherwin Nuland
Next Book/Schocken Books
One of the greatest physicians of the Middle Ages died just over 800 years ago. Moses Maimonides (1138-1204) led a fascinating life: writing many books, seeing patients and serving as one of the most important rabbis of his time, and his religious influence remains to this day.
Born and brought up in Spain at the end of the golden age of Arab/Jewish scholarship, severe persecution of the Jews - first by the Muslims and then followed by Christian religious fanatics - resulted in wrenching population transfers, mass murder and enforced conversions. Escaping Spain, Maimonides's family spent time in Morocco, moved on to Palestine and finally found a reasonably peaceful sanctuary in Fustat, within walking distance of Cairo.
At first, Maimonides, like his father before him, was primarily known as a rabbinical scholar, becoming one of the foremost Halachic authorities of his day. In these pre-printing press days it was amazing to learn how, for example, his "Letter to the Jews of Yemen" quickly spread throughout the Jewish world, at first in Islamic countries and then throughout the Christian-ruled ones as well.
Given the less than gentle politics of the Islamic Middle East of today and throughout history, the political context of this missive seems timeless. In Maimonides's day, Yemen had become a Shiite stronghold.
Like the Almohed Muslims - who had chased Maimonides out of Spain and Morocco - the Yemenite Shiites offered the "infidels" a fairly unpalatable choice of conversion or death. Despairing of what to do, the community leaders in Yemen appealed urgently to Maimonides to ask his advice. He wrote back to reassure them and to offer some wise counsel as to how they should hang on.
As described by the author, noted surgeon Dr. Sherwin Nuland, "Though addressed to the Yemenites [Jews], it was a message of hope to all who were living in torment under the oppressions common in almost every land. It was in many ways a statement of its author's commitment to his faith and the meaning that he found in his people's suffering."
Maimonides, a highly moral man, did not believe in making a living out of his religious work, which he considered a calling. In his view, a man, even one as famous for his religious learning as was he, had to find honest work. Maimonides chose medicine.
It is unclear how he received his training, but like the Jewish and Muslim savants of his day, he was expected to have broad knowledge beyond religion: philosophy, mathematics, astronomy and medicine were all subjects with which he was familiar.
And despite the times and his utter devotion to the Jewish religion, he was a confirmed rationalist. For example, Maimonides scoffed at the study of astrology, pointing out that the true study of the skies was astronomy. Believing firmly in free will, he enjoined his followers to "Purge your thoughts of astrology, the way one cleanses a sullied garment of filth... Pay no heed when someone speaks of a superior or inferior conjunction of stars."
Even more relevant to today's world, he scoffed at those who looked for hidden messages in the verses of the Bible. He urged his followers to: "Employ your reason and you will be able to discern [in the Bible] what is said allegorically, figuratively and hyperbolically, and what is meant literally." And with respect to those who claimed to be the returning Messiah (of which there were a goodly number in his day), Maimonides advised that such impostors should not only be put away but reported to the Muslim authorities. "In that manner the people will be saved from persecution and peace and harmony will be restored to the community." What he would have thought of the posters of the Lubavitcher Rebbe festooning our streets is quite obvious.
Given his vast learning and common sense, it is no surprise that Maimonides succeeded as a physician. As one steeped in the Arabic language and its vast scientific literature of the day, he was privy to the enlightened world of Muslim medicine. In the 12th century, this system was clearly far superior to anything then known in the Christian world. As were all practitioners of the Muslim/Jewish medicine of the day, he was a keen student of both Hippocrates and Galen, on whose theories medicine was then based. But Maimonides, unlike many of his contemporaries, was not afraid to disagree with received authority, and his writings often reflect his skepticism of some of Galen's pronouncements.
MAIMONIDES LIVED by an incredible work ethic. A medical colleague wrote asking if he could visit, but Maimonides politely put him off with the following passage, much quoted, which describes the physician's workday:
"I live in Fustat and the Sultan resides in Cairo; these two places are two Sabbath limits... approximately one and a half miles distant from each other. My duties to the Sultan are very heavy. I am obliged to visit him every day, early in the morning, and when he, any of his children or any one of his concubines are indisposed, I cannot leave Cairo but must stay during most of the day in the palace. It also frequently happens that one or two of the officers fall sick and I must attend to their healing. Hence, as a rule, every day, in the morning I go to Cairo. Even if nothing unusual happens there, I do not return to Fustat until the afternoon. Then I am famished, but I find the antechambers filled with people, both Jews and Gentiles, nobles and common people, judges and policemen, friends and enemies - a mixed multitude who await the time of my return.
"I dismount from my animal, wash my hands, go forth to my patients and entreat them to bear with me while I partake of some light refreshment, the only meal I eat in 24 hours. Then I go to attend to my patients and write prescriptions and directions for their ailments. Patients go in and out until nightfall, and sometimes even, as the Torah is my faith, until two hours or more into the night. I converse with them and prescribe for them even while lying down from sheer fatigue. When night falls, I am so exhausted that I can hardly speak."
Space does not allow for a detailed description of Maimonides's medical works which comprised 10 treatises. In his view, a person owed it to himself to look after his own body - after all, it was a gift from on high. Reflecting a modern approach, Maimonides taught that one's personal lifestyle affected his or her health. As a geriatrician, I was intrigued by his view that "...only one in a thousand persons dies a natural death [old age]; the rest die early because of ignorant or aberrant behavior."
As well, as Nuland points out, "...his worldview embraced not only the clinical treatment of disease, but its psychological and spiritual aspects, as well as the ethical concerns that arose from his uniquely Jewish perspective and his uniquely compassionate nature."
But Maimonides was not merely an ethereal spiritualist, prescribing some kind of mixture of homeopathy and pyramids; rather, he was grounded in the medical concerns of his day - which not surprisingly turned out to be not so different from those of ours. For example, his first treatise, "On Sexual Intercourse," was written probably at the behest of the nephew of Saladin the famous conqueror of the Crusaders. This young man, Al Muzaffar Umar ibn Nur ad Din, was faced with the difficult situation of "the increase of a large number of concubines."
As Nuland points out, Maimonides's instructions offered "...the proper use of herbal agents, aphrodisiac and anaphrodisiac foods, and manual activities such as massage of the coccyx, anal sphincter and upper thighs." Needless to say, Maimonides, a great believer in moderation, had already advised ad Din to severely cut down on his excessive sexual activities. The record does not indicate the patient's compliance with this prescription.
Keeping to the nether parts of the body, Maimonides also wrote a short manual on hemorrhoids. Although he recommended surgery as a last resort (ligature or the application of a hot iron - ouch!), Maimonides prescribed a surprisingly modern regimen of a high-fiber diet as well as various creams such as zinc oxide.
Studying Maimonides's biography and writings gives us a glimpse into the role of the often persecuted Jewish doctor in the medieval Islamic and Christian worlds. Among the Jews, Maimonides was famous for his rabbinical teachings. Among the Muslims of the day, he worked as a physician under the sponsorship of the greatest of Muslim leaders, Saladin (who, among his other accomplishments, defeated and captured the crusader leader, Richard).
Legend has it that the English king, having heard of the great physician, invited Maimonides to return with him to England as his personal doctor. Our hero politely refused - in part perhaps because the small Jewish community of the Sceptred Isle had been forced by the lords and ladies of the day to pay Saladin's ransom price for the Lion-Hearted (and empty-pocketed) king.
Maimonides's story opens a window not only into medieval history and politics, but also into the development of Judaism and advanced medicine. His mother, had she lived to see him as an adult, would indeed have been proud.
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