Old-Time Makers of Medicine — Ch. 3 Great Jewish Physicians, part 1/2

GREAT JEWISH PHYSICIANS[3]

Any account of Old-Time Makers of Medicine without a chapter on the Jewish Physicians would indeed be incomplete.

They are among the most important factors in medieval medicine, representing one of the most significant elements of medical progress.

In spite of the disadvantages under which their race labored because of the popular feeling against them on the part of the Christians in the earlier centuries and of the Mohammedans later, men of genius from the race succeeded in making their influence felt not only on their own times, but accomplished so much in making and writing medicine as to influence many subsequent generations.

Living the segregated life that as a rule they had to, from the earliest times (the Ghettos have only disappeared in the nineteenth century), it would seem almost impossible for them to have done great intellectual work.

It is one of the very common illusions, however, that great intellectual work is accomplished mainly in the midst of comfortable circumstances and as the result of encouraging conditions.

Most of our great makers of medicine at all times, and never more so than during the past century, have been the sons of the poor, who have had to earn their own living, as a rule, before they reached manhood, and who have always had the spur of that necessity which has been so well called the mother of invention.

Their hard living conditions probably rather favored than hampered their intellectual accomplishments.

It is not unlikely that the difficult personal circumstances in which the Jews were placed had a good deal to do at all times with stimulating their ambitions and making them accomplish all that was in them.

Certain it is that at all times we find a wonderful power in the people to rise above their conditions.

With them, however, as with other peoples, luxury, riches, comfort, bring a surfeit to initiative and the race does not accomplish so much.

At various times in the early Middle Ages, particularly, we find Jewish physicians doing great work and obtaining precious acknowledgment for it in spite of the most discouraging conditions.

Later it is not unusual to find that there has been a degeneration into mere money-making as the result of opportunity and consequent ease and luxury.

At a number of times, however, both in Christian and in Mohammedan countries, great Jewish physicians arose whose names have come to us and with whom every student of medicine who wants to know something about the details of the course of medical history must be familiar.

There are men among them who must be considered among the great lights of medicine, significant makers always of the art and also in nearly all cases of the science of medicine.

A little consideration of the history of the Jewish people and their great documents eliminates any surprise there may be with regard to their interest in medicine and successful pursuit of it during the Middle Ages.

The two great collections of Hebrew documents, the Old Testament and the Talmud, contain an immense amount of material with reference to medical problems of many kinds.

Both of these works are especially interesting because of what they have to say of preventive medicine and with regard to the recognition of disease.

Our prophylaxis and diagnosis are important scientific departments of medicine dependent on observation rather than on theory.

While therapeutics has wandered into all sorts of absurdities, the advances made in prophylaxis and in diagnosis have always remained valuable, and though at times they have been forgotten, re-discovery only emphasizes the value of preceding work.

It is because of what they contain with regard to these two important medical subjects that the Old Testament and the Talmud are landmarks in the history of medicine as well as of religion.

Baas, in his "Outlines of the History of Medicine," says: "It corresponds to the reality in both the actual and chronological point of view to consider the books of Moses as the foundation of sanitary science.

The more we have learned about sanitation in the prophylaxis of disease and in the prevention of contagion in the modern time, the more have we come to appreciate highly the teachings of these old times on such subjects.

Moses made a masterly exposition of the knowledge necessary to prevent contagious disease when he laid down the rules with regard to leprosy, first as to careful differentiation, then as to isolation, and finally as to disinfection after it had come to be sure that cure had taken place.

The great lawgiver could insist emphatically that the keeping of the laws of God not only was good for a man's soul but also for his body."

With this tradition familiarly known and deeply studied by the mass of the Hebrew people, it is no surprise to find that when the next great Hebrew development of religious writing came in the Talmud during the earlier Middle Ages, that also contains much with regard to medicine, not a little of which is so close to absolute truth as never to be out of date.

Friedenwald, in his "Jewish Physicians and the Contributions of the Jews to the Science of Medicine," a lecture delivered before the Gratz College of Philadelphia fifteen years ago, summed up from Baas' "History of Medicine" the instructions in the Talmud with regard to health and disease.

The summary represents so much more of genuine knowledge of medicine and surgery than might be expected at the early period at which it was written, during the first and second century of our era, that it seems well to quote it at some length.

"Fever was regarded as nature's effort to expel morbific matter and restore health; which is a much safer interpretation of fever, from a practical point of view, than most of the theories bearing on this point that have been taught up to a very recent period.

They attributed the halting in the hind legs of a lamb to a callosity formed around the spinal cord.

This was a great advance in the knowledge of the physiology of the nervous system.

An emetic was recommended as the best remedy for nausea.

In many cases no better remedy is known to-day.

They taught that a sudden change in diet was injurious, even if the quality brought by the change was better.

That milk fresh from the udder was the best.

The Talmud describes jaundice and correctly ascribes it to the retention of bile, and speaks of dropsy as due to the retention of urine.

It teaches that atrophy or rupture of the kidneys is fatal.

Induration of the lungs (tuberculosis) was regarded as incurable.

Suppuration of the spinal cord had an early, grave meaning.

Rabies was known.

The following is a description given of the dog's condition: 'His mouth is open, the saliva issues from his mouth; his ears drop; his tail hangs between his legs; he runs sideways, and the dogs bark at him; others say that he barks himself, and that his voice is very weak.

No man has appeared who could say that he has seen a man live who was bitten by a mad dog.'

The description is good, and this prognosis as to hydrophobia in man has remained unaltered till in our day when Pasteur published his startling revelation.

The anatomical knowledge of the Talmudists was derived chiefly from dissection of the animals.

As a very remarkable piece of practical anatomy for its very early date is the procuring of the skeleton from the body of a prostitute by the process of boiling, by Rabbi Ishmael, a physician, at the close of the first century.

He gives the number of bones as 252 instead of 232. The Talmudists knew the origin of the spinal cord at the foramen magnum and its form of termination; they described the oesophagus as being composed of two coats; they speak of the pleura as the double covering of the lungs; and mention the special coat of fat about the kidneys.

They had made progress in obstetrics;

described monstrosities and congenital deformities; practised version, evisceration, and Caesarian section upon the dead and upon the living mother.

A.

H.

Israels has clearly shown in his 'Dissertatio Historico-Medica Inauguralis' that Caesarian section, according to the Talmud, was performed among the Jews with safety to mother and child.

The surgery of the Talmud includes a knowledge of dislocation of the thigh bone, contusions of the skull, perforation of the lungs, oesophagus, stomach, small intestines, and gall bladder;

wounds of the spinal cord, windpipe, of fractures of the ribs, etc. They described imperforate anus and how it was to be relieved by operation.

Chanina Ben Chania inserted natural and wooden teeth as early as the second century, C. E."

There is a famous summing up of the possibilities of life and happiness in the Talmud that has been often quoted--its possible wanting in gallantry being set down to the times in which it was written.

"Life is compatible with any disease, provided the bowels remain open; any kind of pain, provided the heart remain unaffected; any kind of uneasiness, provided the head is not attacked; all manner of evils, except it be a bad woman."

There are many other interesting suggestions in the Talmud.

Sometimes they have come to be generally accepted in the modern time, sometimes they are only curious notions that have not, however, lost all their interest.

The crucial incision for carbuncle is a typical example of the first class and the suggestion of the removal of superfluous fat from within the abdomen or in the abdominal wall itself by operation is another.

That they had some idea of the danger of sepsis may be gathered from the fact that they suspected iron surgical instruments and advised the use of others of less enduring character.

The Talmud itself was indeed a sort of encyclopedia in which was gathered knowledge of all kinds from many sources.

It was not particularly a book of medicine, though it contains so many medical ideas.

In many parts of it the authors' regard for science is emphatically expressed.

Landau, in his "History of Jewish Physicians," closes his account of the Talmud with this paragraph: "I conclude this brief review of Talmudic medicine with some reference to how high the worth of science was valued in this much misunderstood work.

In one place we have the expression 'occupation with science means more than sacrifice.'

In another 'science is more than priesthood and kingly dignity.'

"[4] After all this of national tradition in medicine before and after Christ, it is only what we might quite naturally expect to find, that there is scarcely a century of the Middle Ages which does not contain at least one great Jewish physician and sometimes there are more.

Many of these men made distinct contributions to medical science and their names have been held in high estimation ever since.

Perhaps I should say that they were held in high estimation until that neglect of historical studies which characterized the eighteenth century developed, and that there has been a reawakening of interest in our time.

We forget this curious decadence of the later seventeenth and eighteenth centuries which did so much to obscure history and especially the history of the sciences.

Fortunately the scholars of the sixteenth and early seventeenth centuries accomplished successfully the task of printing many of the books of these old-time physicians and secured their publication in magnificent editions.

These were bought eagerly by scholars and libraries all over Europe in spite of the high price they commanded in that era of slow, laborious printing.

The Renaissance exhibits some of its most admirable qualities in its reverence for these old workers in science and above all for the careful preparation by its scholars of the text of these first editions of old-time physicians.

The works have often been thus literally preserved for us, for some of them at least would have disappeared among the vicissitudes of the intervening time, most of which was anything but favorable to the preservation of old-time works, no matter what their content or value.

During the second and third centuries of our era, while the Talmudic writings were taking shape, three great Jewish physicians came into prominence.

The first of them, Chanina, was a contemporary of Galen.

According to tradition, as we have said, he inserted both natural and artificial teeth before the close of the second century.

The two others were Rab or Raw and Samuel.

Rab has the distinction of having studied his anatomy from the human body.

According to tradition he did not hesitate to spend large sums of money in order to procure subjects for dissection.

At this time it is very doubtful whether Galen, though only of the preceding generation, ever had the opportunity to study more than animals or, at most, a few human bodies.

Samuel, the third of the group, was an intimate friend of Rab's, perhaps a disciple, and his fame depends rather on his practice of medicine than of research in medical science.

He was noted for his practical development of two specialties that cannot but seem to us rather distant from each other.

His reputation as a skilful obstetrician was only surpassed by the estimation in which he was held as an oculist.

He seems to have turned to astronomy as a hobby, and was highly honored for his knowledge of this science.

Probably there is nothing commoner in the story of great Jewish physicians than their successful pursuit of some scientific subject as a hobby and reaching distinction in it.

Their surplus intellectual energy needed an outlet besides their vocation, and they got a rest by turning to some other interest, often accomplishing excellent results in it.

Like most great students with a hobby, the majority of them were long-lived.

Their lives are a lesson to a generation that fears intellectual overwork.

During the fourth century we have a number of very interesting traditions with regard to a great Jewish physician, Abba Oumna, to whom patients flocked from all over the world.

He seems particularly to have been anxious to make his services available to the scholars of his time.

He looked upon them as brothers in spirit, fellow-laborers whose investigations were as important as his own and whose labors for mankind he hoped to extend by the helpfulness of his profession.

In order that it might be easy for them to come to him without feeling abashed by their poverty, and yet so that they might pay him anything that they thought they were able to, he hung up a box in his anteroom in which each patient might deposit whatever he felt able to give.

His kindliness towards men became the foundation for many legends.

Needless to say he was often imposed upon, but that seems to have made no difference to him, and he went on straightforwardly doing what he thought he ought to do, regardless of the devious ways of men, even those whom he was generously assisting.

While we do not know much of his scientific medicine, we do know that he was a fine example of a practitioner of medicine on the highest professional lines.

With the foundation of the school at Djondisabour in Arabistan or Khusistan by the Persian monarch Chosroes, some Jewish physicians come into prominence as teachers, and this is one of the first important occasions in history when they teach side by side with Christian colleagues.

Djondisabour seems distant from us now, lying as it does in the province just above the head of the Persian Gulf, and it is a little hard to understand its becoming a centre of culture and education, yet according to well-grounded historical traditions students flocked here from all parts of the world, and its medical instruction particularly became famous.

According to the documents and traditions that we possess, clinical teaching was the most significant feature of the school work and made it famous.

As a consequence graduates from here were deemed fully qualified to become professors in other institutions and were eagerly sought by various medical schools in the East.

With the rise of the strong political power of the Mohammedans enough of peace came to the East at least to permit the cultivation of arts and sciences to some extent again, and then at once the eminence of Jewish physicians, both as teachers and practitioners of medicine, once more becomes manifest.

The first of the race who comes into prominence is Maser Djawah Ebn Djeldjal, of Basra.

To him we owe probably more than to anyone else the preservation of old scientific writings and the cultivation of arts and sciences by the Mohammedans.

He prevailed on Caliph Moawia I, whose physician he had become, to cause many foreign works, and especially those written in Greek, to be translated into Arabic.

He seems to have taken a large share of the labor of the translation on himself and prevailed upon his pupil, the son of Moawia, to translate some works on chemistry.

The translation for which Maser Djawah is best known is that of the Pandects of Haroun, a physician of Alexandria.

The translation of this work was made toward the end of the seventh century.

Unfortunately the "Pandects" has not come down to us, either in original or translation, but we have fragments of the translation preserved by Rhazes, the distinguished Arabian medical writer and physician of the ninth century, and there seems no doubt that it contained the first good description of smallpox, a chapter in medicine that is often--though incorrectly--attributed to Rhazes himself.

Rhazes quoted Maser Djawah freely and evidently trusted his declarations implicitly.

The succeeding Caliphs of the first Arabian dynasty did not exhibit the same interest in education, and above all in science, that characterized Moawia.

Political ambition and the desire for military glory seem to have filled up their thoughts and perhaps they had not the good fortune to fall under the influence of physicians so wise and learned as Maser Djawah.

More probably, however, they themselves lacked interest.

Toward the end of the seventh century they were succeeded by the Abbassides.

Almansor, the second Caliph of this dynasty, was attacked by a dangerous disease and sent for a physician of the Nestorian school.

After his restoration to health he became a liberal patron of science and especially medical science.

The new city of Bagdad, which had become the capital of the realm of the Abbassides, was enriched by him with a large number of works on medicine, which he caused to be translated from the Greek.

He did not confine himself to medicine, however, but also brought about translations of works with regard to other sciences.

One of these, astronomy, was a favorite.

He made it a particular point to search out and encourage the translation of such books as had not previously been translated from Greek into Arabic.

While he provided a translation of Ptolemy he also had translations made of Aristotle and Galen.

It is not surprising, then, that the school of Bagdad became celebrated.

Jewish physicians seem to have been most prominent in its foundation, and the most distinguished product of it is Isaac Ben Emran, almost as celebrated as a philosopher as he is as a physician.

One of his expressions with regard to the danger of a patient having two physicians whose opinions disagree with regard to his illness has been deservedly preserved for us.

Zeid, an Emir of one of the chief cities of the Arabs in Barbary, fell ill of a tertian fever and called Isaac and another physician in consultation.

Their opinions were so widely in disaccord that Isaac refused to prescribe anything, and when the Emir, who had great confidence in him, demanded the reason, he replied, "disagreement of two physicians is more deadly than a tertian fever."

This Isaac, who is said to have died in 799, is the great Jewish physician, one of the most important members of the profession in the eighth century.

His principal work was with regard to poisons and the symptoms caused by them.

This is often quoted by medical writers in the after time.