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The great Hebrew scholar and physician Moses Maimonides was born in Cordoba, Spain, ca.1135. Pupil of the famous Ibn Rushd (Averroes), he became like his teacher a polymath, writing about ethics, metaphysics, religious law, and even astronomy. Much of his medical knowledge was acquired in Fez, Morocco, where he had to flee with his family at the age of thirteen when the fanatic Berber Almohad dynasty conquered Andalus and faced unbelievers with the option of conversion or death (1148).
After leaving Cordoba, Maimonides and his family wandered about southern Spain for about a decade. In 1159 they reached Fez and in 1165 they embarked for Acre in the Holy Land, where prospects were limited because the numbers of Jews had been reduced by the events of the Crusades to only a few families. Arriving in Egypt around 1168, they settled in the old capital of Fustat, now absorbed into modern Cairo. Maimonides first worked in the diamond trade with his brother David, but when this brother drowned on a business trip to India (ca.1170), he was obliged to practice medicine to support his family even though he would have preferred to lead a life of contemplation and philosophy. His practice growing and his reputation spreading, he became physician to the vizier of Egypt in 1174 and to the Sultan Saladin in 1180. Successful in his practice, he also treated other historical figures such as King Richard the Lionheart. He remained the physician of Saladin until his death in 1193 and continued to serve his son and successor until his own death in 1204 at age sixty-nine.
Working for the Sultan was by no means an easy task. In a letter written during the life of Saladin or of his son he describes how he had to rise early, travel on his animal from Fustat to the royal palace in Cairo, and start his day by attending to the sultan’s many children and concubines and to other officers of the palace. He could not leave Cairo at any time and had to be always available. Returning to Fustat in the late afternoon, he would find his office full of people, Jews and Gentiles, waiting to be examined. Exhausted and hungry, he often continued writing prescriptions and directions for his patients until late into the night.
Yet despite this busy practice he still found time to write much, about ethics, metaphysics, philosophy, as well as ten books on medicine. He wrote on asthma, hemorrhoids, pneumonia, depression, fits, rabies, poisons, and drugs. He recognized liver disease and described emphysema and clubbing of the fingers. He advised on climate and recommended exercise, cleanliness, and bathing once a week. Wine was to be drunk only in moderation. Stools were to be always kept soft, using mild remedies at first but more potent ones if necessary. Physicians were advised to try conservative methods first, preferably diet, before escalating therapy to more drastic methods; and they were to recognize psychosomatic disease and distinguish it from organic symptoms. Surgeons were to be brief in their operations and cause as little pain as possible. Patients were advised not to flit from one doctor to another because they would get too many opinions and end up confused; and when seriously ill should heed only the advice of a seasoned physician. The doctors themselves should not be under the delusion that they knew everything and could cure everything, and were to be cultured, learned, and humble.
Instruction about sexual matters, dedicated to the nephew of Saladin, was detailed. Intercourse should be consensual, not too often, not by the sight of a lamp, not in gardens, orchards, or public places; not when the man is angry, drunk, or thinking of another woman; not with another married woman; not during menstruation and only after a ritual bath. The wife should fear her husband, who should rule over her like a king or prince but treat her gently and satisfy her needs. He may have intercourse with her whenever he wishes, even in an unnatural manner, and may kiss any part of her body. Intercourse carried out when standing or sitting is enfeebling and may not lead to conception. Rape is forbidden, as is lesbianism and onanism; and an unmarried man may not hold his private parts when urinating, but a married man may do so.
Maimonides also had much to say about diet. His extensive rules often make sense on general health principles, especially in the days before refrigeration, but many are also rather quaint. Foods definitely to be avoided are mushrooms, truffles, old salted cheese and large fish, and bitter or foul-smelling food that has been sitting around for a long time. Other foods that could be eaten but only in small quantities include the meat of big oxen or big goats, cabbage, broad beans, lentils, chickpeas, leek, onions, garlic, barley bread, radishes, and mustard. Some foods may be eaten in the winter but not in the summer. Fruit should never be eaten to excess. Honey and wine are bad for children but good for the elderly.
Maimonides recommended eating only when hungry, drinking only when thirsty, and stopping to eat when one’s stomach feels half full. Before sitting down for dinner one should check that one does not need to use the bathroom. Walking before dinner is recommended to allow the body to warm. During meals one should not drink water, but only a little mixed with wine; and always sit in one’s place or lean on the left side when one eats. One should not exert oneself or sleep right after a meal but wait until the food has digested. One should sleep eight hours a day, not sleep on one’s back but rather on one side, first on the left side but ending up on the right. Sleep during the day is not recommended.
Some of the advice given by Maimonides is consistent with what was regarded as appropriate at the time. He recommended many different medical concoctions that had to be prepared specifically for different ailments: excrement of goat mixed with barley and vinegar for infections of the hand; mustard oil trickled into the ear to restore hearing; ground cattle hoof to shrink an enlarged spleen and stimulate sexual desire. Eating too many walnuts could cause untoward effects.
Maimonides wrote in Hebrew or in Arabic, generally using Arabic script. In Hebrew he is often referred to by the acronym Rambam; in Arabic his name was Abu Imran Musa bin Maimun. He has gone down in history as one of the great philosophers of the Middle Ages, whose works continue to be read and cited to this very day. Notable among these are his comments on the Hebrew Bible and Talmud, written when he was only thirty-one years old, and later his Precepts for the Perplexed, in which he attempted to reconcile religious precepts with the scientific and philosophic thought of the day. He wrote about the existence and eternity of God, the prophets, good and evil, and the coming of the Messiah. He based much of his writing on the philosophy of the ancient Greeks and the great Islamic writers; and he believed that it was a religious duty to heal the sick. He died in 1204 and was buried in Tiberias, Galilee. The epitaph on his grave says that “from Moses to Moses there arose none like Moses.”
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GEORGE DUNEA, MD, Editor-in-chief