A Medieval
Physician Is Remembered
By Dr. Syed Amir
Bethesda, MD
During
a visit to Spain several years ago, we stayed
in a hotel in Cordoba that was very close to the
ancient Jewish quarters. Known as Juderia, the
township had witnessed a period of great florescence
when the city was the capital of Western Islamic
Caliphate. Only yards away from the hotel, stood
the statue of Musa ibn Maymun, popularly known
as Maimonides, the medieval philosopher,
Jewish rabbi and physician. Born in Cordoba more
than eight hundred years ago, his appearance,
with beard, head gear and general attire, looks
no different from Muslim nobleman of that age.
The quaint feature of the statue, crafted with
a metal alloy and erected by the Spanish Government
in front of his ancestral house, is that so many
visitors over the years have touched or kissed
its feet, in a gesture of reverence and recognition
of his stature as a scholar, that the original
metal glaze had completely faded. Time seems to
have stood still in the Jewish quarters, as even
today it has narrow cobbler streets, wrought iron
gates, high white washed walls with windows adorned
with hanging flower baskets. Modern-day vehicles
cannot negotiate the narrow streets of the former
Jewish quarters, which no longer house any Jewish
people. They were driven out long ago or forced
to convert after the Christian conquest.
Maimonides was born in the year 1135 when the
Islamic power in Spain had passed its peak and
Andalusia had fragmented into small kingdoms and
principalities, referred to by Arab historians
as Taifas States. During the golden period of
the Caliphate, Andalusia had witnessed an unprecedented
flowering of human civilization, a virtual explosion
of knowledge and scholarship, when students from
all parts of the world came there to attend its
renowned universities and seek knowledge at its
celebrated libraries. The Islamic capital of Cordoba
rivaled Baghdad and Constantinople in magnificence
and brilliance. Most significant, Andalusia had
produced a unique culture, rooted in tolerance
and based on peaceful coexistence of people of
different faiths. The spectacular progress recorded
in science, medicine, mathematics, and philosophy
was fueled by the liberal policies promoted by
the Umayyad Caliphs, especially Abdur Rehman III
(912-929), his successors, al Hakam II (961-976)
and al Mansur (977-1002). Muslim, Jewish and Christian
scholars enjoyed the intellectual freedom to discuss
and debate the medical, ethical and philosophical
questions of the time, some writing scholarly
books that have not lost their relevance even
after the lapse of many centuries. Contemporary
historians marvel at the example of religious
tolerance and acceptance of differences that was
set in Muslim Spain at a time when even the concept
of such liberalism was unknown elsewhere.
Unfortunately, Al Andulus’ high noon lasted
less than two hundred years and the country was
then ravaged by internal strife and instability.
Soon, it was invaded successively by the Berber
armies of the Almoravid and Almohad (ca 1063-1269)
dynasties from North Africa that sought to impose
some civil order and temporarily thwarted the
relentless advance of Christian forces from the
North. When Maimonides was born in Cordoba, the
Almoravid dynasty was in its final throes and
was soon overwhelmed by the Almohads. While the
new rulers succeeded in temporarily uniting the
country, unfortunately, in some respects, they
behaved much like the present day Taliban, frozen
in the past, intolerant of minorities, rigid in
their interpretation of the religious doctrines
and extremist in their outlook and attitude. They
sought to impose a puritanical order on a population
that had achieved an advanced level of cultural
sophistication. Maimonides’ Jewish family
had to flee first to Morocco and then to Egypt
to escape persecution. Similar troubles also drove
one of the most renowned Muslim philosophers and
physicians of the Middle Ages, Ibn Rushd, also
known in Europe as Averroes, to North Africa.
Maimonides has over time become a transcendent
figure, with a living presence among the Jewish
community, and is revered much like a saint. Many
hospitals around the world are named after him
and numerous cities have Maimonides societies
where doctors discuss and debate issues related
to bioethics and medicine. Often forgotten, however,
is the fact that Maimonides lived and worked his
entire life among Muslims, authored his landmark
books in Arabic and never lost his attachment
to the city of his birth, Cordoba.
A recent book by Dr. Sherwin Nuland, professor
at Yale University, an established author and
surgeon, has renewed interest in the work and
achievements of this medieval religious scholar
and physician. The most interesting aspect of
Nuland’s book, entitled simply Maimonides.
is its exploration of Maimonides’ work as
a physician. Driven from home by religious fanaticism,
Maimonides finally settled in Fustat, close to
present-day Cairo, where he found the environment
supportive, enabling him to freely pursue his
eclectic interests. His reputation grew to the
extent that he was appointed personal physician
to Sultan Salah Uddin Ayubi, the legendary Muslim
hero, renowned for his chivalry, and his son,
Malik al-Fadal. Maimonides served mostly at the
royal court at Cairo, tending to the medical needs
of al-Fadal and his family. He led a busy life
there as he explained in the following sentences
to discourage an acquaintance from visiting him:
“I dwell at Fostat, and the sultan resides
at Cairo, about a mile and a half away. My duties
to the Sultan are very heavy. I am obliged to
visit him every day, early in the mornings and
when any of his children are indisposed. Hence,
I repair to Cairo very early in the day and if
nothing unusual happens, I do not return to Fustat
until the afternoon. Then, I am almost dying of
hunger. I find the antechamber filled with people
who wait for the time of my return. I attend to
my patients and write prescription for their various
ailments. Patients go in and out until nightfall.
I get so exhausted that I can scarcely think.”
The time when Maimonides lived was the era when
Islamic medicine reached its zenith; the various
disciplines of science and philosophy were dominated
by illustrious Muslim physicians and scientists;
the most prominent among these were Abu-Baker
Mohammed ibn-Zakariya al-Razi (865-925), and Ibne-Sina
(980-1037). Both were also prolific writers and
their famous books, al-Hawi and Qanun, respectively,
embodied a systematic compilation of knowledge
of medicine drawn from Greek, Persian and Hindu
sources, expanded and refined by them. In the
Middle Ages, physicians in addition to being healers
were considered philosophers and wise men as well.
This is how the term Hakim originated
and why the practitioners of modern-day Tibb-e-Unani
in Pakistan and India are addressed by this title.
Maimonides followed in the tradition of his luminous
Muslim predecessors. The science of medicine and
therapy, however, had not much deviated from the
general principles set by the Greek physicians,
Hippocrates (460 BC) and Galen (129 AD). Not much
was known, for example, about human anatomy, and
the disease process was considered to be the malaise
of the whole body, not of specific organs. Good
health, it was believed, depended on the proper
balance of four liquids (named humors): blood,
yellow bile, black bile and phlegm. Galen maintained
that their imbalance caused all illnesses. Therefore,
certain procedures, such as bloodletting and the
use of purgatives and enema, were employed to
restore the optimal balance. A range of herbs
and botanical products were also employed to achieve
this objective. However, few if any of these agents
had been tested for evidence of curative properties
by what today we would consider scientific techniques.
Most therapies were based on anecdotal evidence,
rather than on any experiential or experimental
evidence. Paradoxically, Galen was so sure that
he had found whatever there was to find that he
confidently declared two millenniums ago: “Whoever
seeks fame by deeds, need only become familiar,
at small cost of trouble, with all that I have
achieved by active research during the course
of my entire life.”
Maimonides authored a total of ten books on medicine,
all in Arabic, including volumes devoted to asthma,
constipation, sexual intercourse, in addition
to a whole book, meticulously cataloging nearly
two thousand drugs, the great majority of which
were herbal in origin. Whereas, most of the treatments
and therapies documented in his books would not
be approved today by any Human Studies Review
Board at any recognized medical center for use
in humans, in a few instances, his recommendations
made some eight centuries ago, still make sense,
such as a diet rich in roughage for the treatment
of hemorrhoids. At the request of the Sultan of
Egypt, who was suffering with periodic episodes
of melancholy at the time, he wrote a ninety-page
long treatise which was very popular and widely
circulated in its time. Maimonides recommended
the consumption of wholesome food, exposure to
clear air and water and admonished that one should
not rush into treatment of every minor ailment,
as nature usually takes care of such things. The
advice is just as sound today as it was in his
days.
Professor Nuland closes the final chapter of his
book on a timeless quotation from Maimonides:
“The more perfect a person becomes in one
of the sciences, the more cautious he grows, developing
doubts, questions and problems that are only partially
solved. And, the more deficient one is in science,
the easier it would be for him to understand every
difficulty, making the improbable probable and
eager to explain things he does not truly understand
himself.”
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