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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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