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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http://www.pakistanlink.com/Opinion/2007/Sept07/21/07.HTM
