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 Sénecas, 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 persécutions. 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.

16. Every week at least a man should take a warm bath. One 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, 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.