James Marcum
Waco, Texas, United States

Islamic and Jewish scholars, such as Al-Kindi (801–873 CE), Ali ibn Sahl Rabban al-Tabari (c. 838 – c. 870 CE), Al-Razi (865–925 CE), Al-Ghazali (1058–1111 CE), and Ibn-Rushd or Averroes (1126–1198 CE), among others, had a major impact on western Medieval medicine.¹ Two of the most prominent scholars, however, are the Islamic physician-philosopher Avicenna (980–1037 CE) and the Jewish physician-philosopher Moses Maimonides (1135–1204 CE). Both have been honored with the title of “Prince of Physicians.” But what exactly did they contribute to medicine to justify this honor?

Avicenna

In 980 CE, Avicenna was born Hussain ibn Abdullah ibn Hassan ibn Ali ibn Sina in the greater Khorasan region (now northeastern Iran).^2,3 He exhibited remarkable intellectual abilities as a child, and his family procured a first-rate education for him. By the age of ten, he had memorized the Qur’an and, by eighteen, as he remarked in his autobiography, he had learned as much as was known at the time. Avicenna began to study medicine at age sixteen and two years later began to practice the art. He was immensely successful as a physician, earning a well-deserved reputation, especially in the West. Avicenna lived during the Golden Age of Islamic culture and contributed to it through his immense writings (around 450 works, of which about 240 have survived), which influenced subsequent philosophers and physicians such as Ibn Al-Nafis (1213–1288 CE). Two of Avicenna’s best-known works are the Book of Healing (Book) and the Canon of Medicine (Canon).

The Book represents an encyclopedic work on philosophical and scientific topics.[4] The title refers not to medical healing per se, but rather to remedying a person’s ignorance. Avicenna composed the work over roughly a decade and saw its publication in 1027 CE. He expounded upon various topics in logic, the natural sciences, and metaphysics. In logic, Avicenna created a logical system to rival Aristotle’s. He was also instrumental in the development of inductive logic, in which premises do not entail conclusions, but only support them with a certain degree of probability.

In the Book, Avicenna also discussed topics in the natural sciences, including cosmology and physics, geography and geology, chemistry and metallurgy, and psychology and the mind. His metaphysical approach to scientific knowledge was empirical rather than conjectural. Experimentation and observation loomed large in his scientific method, providing certainty of scientific knowledge through contingent rather than absolute facts about the world. In other words, experimentation establishes that a particular causal relationship pertains to a phenomenon but not why it pertains to it. Of course, he cautioned that experimenters must be constantly vigilant about errors creeping into their work.

In the Canon, Avicenna expounds upon current medical knowledge and practice in an encyclopedic manner.⁵ Although completed in 1025 CE, the Canon remained a medical authority until as late as the early nineteenth century. The great clinician Sir William Osler remarked that, if marooned, the one book of practical medicine he would want is the Canon. Avicenna divided the Canon into five parts, including the general philosophical principles of medical knowledge and practice, simple drugs presented in alphabetical order, local diseases ranging from the head to the foot, general diseases such as fevers, and compound medicines. The major influences on Avicenna’s medicine were Hippocrates and Galen, especially the notion that knowing the cause of the disease was paramount in treating the patient. To that end, he subscribed to the humoral theory of health and disease. He also included additional factors in health and disease, such as diet and the patient’s mental or psychological state. In all, Avicenna advocated a holistic approach to health and disease.

Finally, his empirical and experimental approach to scientific knowledge influenced his approach to acquisition of medical knowledge, especially the efficacy of drugs and medicines. He described seven criteria critical for establishing a drug’s efficacy, including purity of the drug, testing the drug against one disease, use of control groups, varying drug concentration, long-term observation of drug effect, reproducibility of drug effect, and advantage of testing drugs in humans in contrast to animals. These criteria were later advocated by Peter of Spain in Dietary of Isaac and by John of St. Amand in Antedotary of Nicholas and Concordances.

Maimonides

Moses Maimonides or Rambam (an acronym for Rabbi Moses ben Maimon) was born on Passover eve, 1135 CE in Córdoba, Spain.⁶ During his youth, Maimonides studied a variety of subjects, including the Torah, philosophy, and medicine. Fleeing with his family from Islamic rule in 1148 CE, Maimonides eventually took up residence in Fustat (old Cairo), Egypt, where he lived for the rest of his life. After his younger brother drowned in the Indian Ocean on an expedition to increase the family’s economic fortunes, Maimonides was bedridden with grief for a year and never fully recovered. The death of his brother also left him impoverished, since the brother lost his and other family members’ savings at sea. Maimonides became a physician out of necessity. He prospered at the art, and he became physician to several court officials and to the sultan’s family. Maimonides wrote on a number of scholarly topics, including Jewish theology and law, philosophy, and medicine.⁷

In The Guide for the Perplexed (The Guide), which he wrote for his student Joseph ben Judah of Ceuta (1160–1226 CE), Maimonides strove to reconcile Aristotelian philosophy with the Jewish faith.⁸ His goal was to dispel the apparent contradictions between philosophy and theology, especially a literal reading of the Torah. Maimonides divided The Guide into three books. In the first, he discredited common theological anthropomorphisms attributed to God and argued for God’s incorporeal nature. The result was a theology that defined God solely in negative—not positive—terms. For example, God is not temporal, since to ascribe temporality to the divine is to imprison God in time; God is creator of time and not bound by it. In the next book, Maimonides turned to cosmology, which he modeled after Aristotle’s cosmology of a circular earth surrounded by concentric heavenly circles or spheres. However, he parted with the Greek philosopher in claiming that the universe is not eternal, but created and sustained by God. In the final book, Maimonides discussed metaphysical and moral foundations of the universe vis-à-vis his theology and cosmology: healthful and virtuous living emanates from right understanding and worship of God. Reactions to The Guide were mixed, with some accepting it and with others rejecting and condemning it. But its fame and influence spread with time.

Maimonides wrote ten treatises on general medical practice and specific medical topics and diseases.⁹ As for many of his predecessors, his philosophical approach to life influenced his approach to medicine. Maimonides based that philosophy on a holistic presupposition in which he treated patients not only as individuals but also in their personal and social contexts. This is the heart and soul of traditional medical philosophy, which was soon to change drastically. Maimonides displayed this philosophy best in Regimen of Health (Regimen), which he wrote in 1198 CE for the son of the sultan Saladin. The sultan’s son was prone to fits of depression due to excessive drinking and philandering. In the Regimen, Maimonides encouraged moderation in the use of wine, sex, and food. In addition, he praised the hygienic lifestyle, and he frequently washed his hands while attending his patients—of course, Jewish law prescribed frequent hand washing. Maimonides also wrote a treatise each on Hippocratic and Galenic medicine, in which he extracted important passages from their writings and commented on them. He wrote a copious tome of aphorisms based on Greco-Persian medical writings, which covered diverse medical topics from anatomy and physiology to diagnosis and therapy. Finally, he wrote treatises on specific diseases, such as hemorrhoids and asthma.

Conclusion

Given their accomplishments, both Avicenna and Maimonides were honored with the title of “Prince of Physicians”—a title that Vesalius attributed to the great Galen.¹⁰ Moreover, Avicenna was also called the “Persian Galen.”¹¹ And William Osler honored Maimonides with the princely title.¹² What justifies the bestowal of this title to both medieval figures is not simply their contributions to medicine and its practice, but also their larger philosophical and scientific contributions, which set the stage for substantial changes in medicine in the following centuries.

References

1. Roy Porter. Greatest Benefit to Mankind: A Medical History of Humanity. New York: Norton, 1997.
2. Peter Adamson, ed. Interpreting Avicenna: Critical Essays. New York: Cambridge University Press, 2013.
3. Jon McGinnis. Avicenna. New York: Oxford University Press, 2010.
4. Lenn E. Goodman. Avicenna, updated edition. Ithaca, NY: Cornell University Press, 2006.
5. Mones Abu-Asab, Hakima Amri, and Marc S. Micozzi. Avicenna’s Medicine: A New Translation of the 11th-Century Canon with Practical Applications for Integrative Health Care. Rochester, VT: Healing Arts Press, 2013.
6. O. Leaman. Moses Maimonides, revised edition. London: Routledge, 1997.
7. Herbert A. Davidson. Moses Maimonides: The Man and His Works. New York: Oxford University Press, 2005.
8. Moses Maimonides. The Guide for the Perplexed, second edition. M. Friedlander, trans. New York: Dover, 1956.
9. Fred Rosner. The Medical Legacy of Moses Maimonides. Hoboken, NJ: KTAN Publishing House, 1998.
10. Anthony Seaton. “Breaking with Galen: Servetus, Colombo and the Lesser Circulation.” QJM: An International Journal of Medicine 107, no. 5 (2014): 411-413.
11. Shireen Rafeeq. “Avicenna, The Prince of Physicians.” Hektoen International: A Journal of Medical Humanities 7, no. 1 (2015): https://hekint.org/2017/01/28/avicenna-the-prince-of-physicians/
12. Fred Rosner. “The Life of Moses Maimonides, A Prominent Medieval Physician.” Einstein Quarterly Journal of Biology and Medicine 19 (2002):125-128.