- Email: [email protected]
Maimonides' Treatise on Asthma
128
SPECIAL REPORT Maimonides'Treatise on Asthma SU8811IlJnn Muntner, MD. °
Maimonides (1135-1204) was body-physician to King Saladin, the wisest and most astute ruler in the world of Islam. Apart from his monumental halakic compendium, Mishne Tora, his classic Talmudic commentaries and his still valuable ventures in the fields of philosophy and astronomy, Maimonides also wrote ten medical treatises. These include the book on Asthma; Poisons and their Antidotes: Regimen Sanitatis; Aphorisms of Moses; De Coitu; Commentary on the Aphorisms of Hippocrates; On Haemorrhoids; The Names of the Simplicia in the Materia Medica; Medica! Responsa; and Compendia of the Opera Galeni. Written in Arabic, most of these treatises were rendered into Hebrew in his lifetime and some into Latin, soon after his death. Everything he wrote-theology, religious law, and medicinebears the mark of method and orderliness, and is imbued with rational thinking which leaves no room for superstition of any kind. The book on Asthma was written for the benefit of Saladin's son and heir, an asthmatic. Its first Hebrew version, based on the Arabic manuscript, was published in Jerusalem in 1940; the English translation appeared much later.>' It deals with the asthmatic condition both from the etiologic and symptomatologic points of view, devotes much space to dietary considerations (in the widest sense of the word) and dwells on its psychotherapeutic implications, Benvenisti of Zaragoza was the first to translate the book into Hebrew, naming it Sefer llamis'adim (Foods and Diet); another Hebrew version stems from Xativa. Both versions date from the 13th century and are extant in numerous manuscripts as described by Steinschneider' and myself. The first Latin rendering was done by Blasius in 1302, another by di Capua in the 14th century.v" In his book on asthma, Maimonides presents his views on medicine at large, with special emphasis on the duties attending the medical practitioner. He is forcefully outspoken against the quackery rampant among the medical profession of his day. Every patient, he says, requires individual treat°rernsalem, Israel.
48
ment, which is especially true in cases involving psychic conditions. In his view, proper diet is conducive to mental health. Of particular importance is Chapter VIII where the role of clean air and the interplay of emotional and hormonal states is amply discussed. Certain disturbances, in his opinion, do not respond either to dietary or to pharmaceutical remedies, but belong rather to the sphere of psychology and ethics. The main task of medicine, according to Maimonides, is the teaching of preventive measures, a theory he stressed in all his medical Writings. Maimonides recognized the psychosomatic character of asthma, stressed its importance and advocated the treatment of this disease by an allround physician. It is not without interest to compare Cecil's widely acknowledged Textbook of Medicine' with what Maimonides has to say in this connection. After discussing all the available remedies for bronchial asthma, Francis M. Rackman, the author of the chapter, goes on to say: "Finallv it should be said, whereas treatment of asth~a is important, treatment of a patient as a whole is more important. For asthma the physician must be a doctor in every sense," In addition to the wealth of medical and hygienic advice it offers, much of which is of value even today, the book on Asthma brings to light autobiographic and hitherto unknown episodes from his professional past which have so far escaped his biographers. Unlike his other medical writings, the discussion is not confined to psychosomatic diagnosis and therapy hut illuminates his methods as a medical practitioner, as well as his fight for the truth as he saw it and is a contribution to the history of medical treatment in the Middle East and to medical history at large. The book cites a great number of long-forgotten popular remedies and sheds light on some important aspects in the history of Morocco, where Maimonides acquired the bulk of his medical knowledge. You will also find there some basic truths of medical art and quotations from ancient and contemporary writers (such as Hippocrates, Galen, Razi, ibn Zohr and others) whose works are, for DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
MAIMONIDES' TREATISE ON ASTHMA
the most part, lost to us. All things considered, there still remains in the book on Asthma a sound kernel of practical advice on the treatment of bronchial asthma which has not yet been superseded. Fol1owing are some quotations from Maimonides, some verbatim and others paraphrased: In his Preface to the book, the author says in all modesty: "I have no magic cure to report, all I have in mind is a rational conduct of life." This is followed, inter alia, by an enumeration of symptoms in an asthmatic patient and a description of various constitutions. Hair, it says, weighs heavily on a patient's head and may lead to allergies. The book, although written for the ruler, is intended to be of use to other sufferers as wel1. Thereupon fol1ows a discussion of the relative climatologic merits of Alexandria and Cairo. In Chapter 1:4, Maimonides criticizes the ancient physicians for not paying sufficient attention to exercise, and suspension of coitus in certain maladies, to which he devotes a special section (X:8) (of particular interest in the Middle East where men of consequence kept amply furnished harems). Chapters II-III deal with fatty and fatproducing foods and suggest a cure for obesity. Here mention is made of bronchitis and pulmonary alveoli. In Chapter IV Maimonides discusses foods and dishes popular in Egypt and Spain of his day. Of special note is his insistence, when referring to Spain, as "our country in the West" (IV:4) i.e, Spain (IV:6)-after more than 30 years had passed since he left that country. Chapter V treats of the quantity of food proper to a man with asthma and of physical exercise before and after mealtime. As to the time for meals and snacks, much is said in Chapter VI:4 and IX:15. Chapter VII deals with beverages and illustrates the way in which Maimonides approaches the Islamic ban on wine-drinking for both the healthy and the sick. Substitutes are suggested. In VII:2, the author cites a drink of this type which he says he learned from his teacher in Morocco. There is a curious rendering of the word inflammation in Benvenisti's Hebrew translation; instead of the modem "daleqet" he writes "lehava," literal1yflame, inflammation. Chapter VIII is among the most interesting and important because it deals with air purification and the interplay of body and soul in all diseases. especially in asthma. DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
129 This is what Maimonides has to say in this respect: It is well known that clean, fresh air is advisable for all people, whether healthy or sick; with the latter, air purification is of primary importance. This means that on hot days the air should be conditioned by spraying and sprinkling the Hoor with scented water, by flowers, heat-abating leaves, and draft. On rainy days, the room temperature should be raised by fumigation with dried herbs. Cold, humid air is very harmful in this condition and excessive heat and warmth should be avoided as much as possible. The impact of mental suffering, such as agitation and obstinacy, is to impair mental activity and physical wel1-being so much so that one's appetite for food is completely lost when in mental anguish, fear, mourning or distress. In such a condition a man cannot even use his voice properly because his agitation affects his respiratory organs and he cannot exercise them at will. The weight of the accumulated gas residue within him keeps him from walking erect and inhaling a sufficient volume of air. Should this condition endure, a man cannot avoid falling ill and if it takes on a chronic character, death is not long in coming. AIl this is universalIy known and should not detain us here. On the other hand, gaiety and liveliness have the opposite effect; they gladden the heart and stimulate blood circulation and metabolic processes. However, when people indulge to excess in the pursuit of pleasure, which sometimes happens with the ignorant and the foolish, they too invariably falI sick and may even sink altogether; their soul is burdened with decay and hastens to leave the body, their hearts fail to function and death becomes inevitable. The cure of these two kinds of psychic states and their prevention lies not in food recipes, neither in drugs alone, nor in regular medical advice. It belongs rather to other spheres of professional knowledge, by which we mean the philosophic virtues taught by the philosophers who are engaged in the study of ethics, morals, etc. Undoubtedly, these psychologic methods are a greater help in these emotional disorders and a better safeguard against them for they uncover the nature of such conditions and the best way to cure them by learning from experience and failure. Furthermore, the philosophic virtues guard a man against extreme emotional states. They keep a man from falling into brutish emotionalism on mournful or joyous occasions as happens with the ignorant multitude.
49
SUSSMANN MUNTNER
130
While listing the various remedies which might help in individual cases, Maimonides recalls the "modem " Egyptian physicians (XII :I), again mentions remed ies sold "in our country in the West" and discusses contemporary doctors and medical writers (111:3). He tells about a young woman whom he cured of asthma (XII I :S) having treat ed her in a manner unprecedented in modem and ancient literature. "We learned it from our teachers ," he says, "who were greatly experienced in it. Th e greatest doctors in the West approved of such treatment and we witnessed it in person." In Chapter XIII:l it says: Fresh air is much more important than food. This is followed by a discourse on the harmful effect of city air, of built areas , on the advantages of suburban living (XIII :4) . Chapter XIII :5 cautions against resorting to medicaments at a time when nature is in a position to effect a cure on its own so that remedies become superfluous, often harmful! Comp arative notes on medicine at large are found in Chapter XIII :6. Chapter XIII :IO speaks of FIGURE 1. Original Anlbic manuscript, written in Hebrew letters , contain ing references to Maimonides' Book on Asthma (Paris, 1211) (evidence of aging is apparent).
In the world of pure reason they are no more than ludicrous, idle specters which vanish away . For a man like Your Highness it is fitting that he adopt these proph ylactic measures and follow in the footsteps of the just and (learned ) prophets, laugh at death in his face and follow the laws of nature and necessity . In Chapter IX, on constipation and purgatives, Maimonides falls baek on Avenzoar of Seville and warns that the latter should be taken only on expert advice . He also offers a prescription of his own making ( LX:l 5) . The role in asthma of sleep , massage and c0habitation is fully discussed in Chapter X. Maimonides quotes a saying from his own Regimen Sanitatis: "Diseases are individual and should be treated as such" (XI :2). The patient, not the disease, should be the subject of medical treatment (XIII:3l) . Ch apter XI deals with doctors and charlatans. "He who puts his life in the hands of a physician skilled in his art but lacking scientific training is not unlike the mariner who puts his trust in good luck." A doctor with much theoretic knowledge and little experience is no more reliable than one who has wide experien ce but little or no scientific training.
50
FIGURE
2. Hebrew translation by Joshua Xativa .
DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
131
MAIMONIDES' TREATISE ON ASTHMA
modesty such as pious men resort to when deliberately understating their knowledge even if they are experts in their vocation ... I state the truth as it is" (XIII:27). "The physician should be a practiced experimenter" (XIII:28). A further elaboration of the Hippocratic view on the art and duties of medicine is given in XIII:30. The doctor should treat the patient as a whole. Maimonides illustrates the point with a case of a young man in Morocco who was unnecessarily subjected to blood-letting and died as a result of it. This is followed by an exchange of words between the attending physicians and the populace. In Chapter XIII:38, an account is given of the untimely death of the young King of Morocco through the fault of his doctors. Famous medical names are cited, teachers of Maimonides, among them two Jews. The case described, he says, should serve as an aid to the advancement of medical science and the relief of suffering humanity. "Anything which might be cured with simple remedies should not be treated with combined remedies" (XIII:45); in this he upholds the practice of Egyptian doctors who adhere to this rule. Finally, there is a description of certain rich patients who are not content with a single physician FIGURE 3.
century).
Hebrew translation by Moses Ibn Tibbon (13th
medical errors and of what they can lead to. In Chapter XIII:13, the Hippocratic view is contrasted with that of quacks and charlatans: "Help the patient, do not harm him," Maimonides gives a short description of his student days and medical training in Chapter XIII: 18, while Hippocrates' and Galen's bedside manner is discussed in XIII:19. Aristotle is quoted as saying: "Most people die of medicine," Medicine, says Maimonides, is a science essential to man, at any time, anywhere; not only in times of illness but in health as well (preventive medicine). Provided, of course, the doctor is a true doctor, not a charlatan. In XIII:25, the Greeks are reputed as having relied upon nature whenever doubt arose with regard to any disease. "Having heard all this, Your Highness should in no way conclude that I am the right man in whose hands you might place your body and soul for treatment. Heaven be mv witness that I mvself know well that I belong to those who are not'perfect in this art and shrink from it (for lack of adequate experience). Again, heaven be my witness that the words I say are not motivated by any DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
FI<:UR E
century).
4.
Latin tra nslation by [ohann di c..pua (14th
51
132
SUSSMANN MUNTNER
for one and the same disease and call in various unallied doctors, according to their paying ability. The damage to both physician and patient from such practices is pointedly brought home. On the other hand, there is much praise for the concerted action of allied physicians at the patient's bedside, for no man can know everything (XIII:47, 49). The book ends with a philosophic reflection on the eventual harm to the cause of truth when diagnosis is tainted with hate or love between fellow consultants. A recent review of the book on Asthma contained this statement. "It is hoped that these few brief quotations from Maimonides' Treatise on Asthma will stimulate the reader to examine this work more closely and perhaps avidly read the entire book since it is now available in the English language.'?"
REFERENCES S.: Moshe ben Malmon (Maimonidesi, The Book on AsthmtJ, Rubin Mass, Jerusalem, 1940.
MUNTNER,
S.: Maimonides, Sefer Hakatzeretb (The Book of Asthma) or Sefer Hamis'adim, Geniza, Jerusalem, 1963. 3 MUNTNER, S.: Moshe ben Maimon, On Haemorrhoids; On the Increase of Physical Vigour; On AsthmtJ; Mnssad
2
MUNTNER,
Harav Kook, Jerusalem, 1965. MU"'"TNER, S.: The Medical Writings of Moses Malmonides, Treatise on AsthmtJ, Lippincott, Philadelphia, 1963. 5 STEINSCHNEIDER, M.: Die Arabische Lileralur der [uden, J. Kauffman, Frankfurt a.M., 1902. 6 STEINSCHNEIDER, M.: Die Hebriiischen Obersetzungen des Millelaller. und die [ude» als Dolmetscher, Berlin, 1893. 7 CECIL, R. L.: A Textbook of Medicine, Philadelphia, 1947, Francis M. Rackman, Diseases of Allergy, p. 540. 4
8
MUNTXER,
(Regimen 1957.
S.: Moshe b. Maimon, Hanhagal Habriuth
Sanilalis), Mossad
Harav Kook, Jerusalem
S.: Maimonides, Regimen Sanitatis oder Diiiletik fur die Seele und den Korper. Mit Anhang der Medizinischen Responsen and Ethik des Maimonides
9 MuNTNER,
10
(German Translation). S. Karger, Basel-New York, 1966. ROSNER, F.: Moses Alaimonides' Treatise on AslhmtJ, Medical Times, October, 1966.
Reprint requests: Dr. Muntner, Prophets Street 54, Jerusalem. Israel
FREEDOM OF SCIENCE VERSUS POLITICS The guillotine was in use in various parts of Europe for centuries prior to the French revolution. It is named after a French physician who is given credit for its mechanical improvement. Dr. Guillotine had only narrowly escaped this gruesome instrument of execution at the time he was found to be too vociferous about severe punitive measures of the revolutionaries. Less fortunate was the fate of the great chemist and pioneer in pulmonary physiology, Antoine Laurent Lavoisier (1743-1794). In 1780, Lavoisier presented his thesis on the role
52
of oxygen in combusion. It has remained one of the basic principles of chemistry. His contributions to the understanding of the physiology of respiration have become classic precepts. He was found guilty of political conspiracy and beheaded, Pleas for clemency on the basis of his inestimable contributions to the advancement of science were rejected mercilessly with the arrogant and senseless slogan: the revolution needs no scientists. Andrew L. Banyai, M.D.
DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
SPECIAL REPORT Maimonides'Treatise on Asthma SU8811IlJnn Muntner, MD. °
Maimonides (1135-1204) was body-physician to King Saladin, the wisest and most astute ruler in the world of Islam. Apart from his monumental halakic compendium, Mishne Tora, his classic Talmudic commentaries and his still valuable ventures in the fields of philosophy and astronomy, Maimonides also wrote ten medical treatises. These include the book on Asthma; Poisons and their Antidotes: Regimen Sanitatis; Aphorisms of Moses; De Coitu; Commentary on the Aphorisms of Hippocrates; On Haemorrhoids; The Names of the Simplicia in the Materia Medica; Medica! Responsa; and Compendia of the Opera Galeni. Written in Arabic, most of these treatises were rendered into Hebrew in his lifetime and some into Latin, soon after his death. Everything he wrote-theology, religious law, and medicinebears the mark of method and orderliness, and is imbued with rational thinking which leaves no room for superstition of any kind. The book on Asthma was written for the benefit of Saladin's son and heir, an asthmatic. Its first Hebrew version, based on the Arabic manuscript, was published in Jerusalem in 1940; the English translation appeared much later.>' It deals with the asthmatic condition both from the etiologic and symptomatologic points of view, devotes much space to dietary considerations (in the widest sense of the word) and dwells on its psychotherapeutic implications, Benvenisti of Zaragoza was the first to translate the book into Hebrew, naming it Sefer llamis'adim (Foods and Diet); another Hebrew version stems from Xativa. Both versions date from the 13th century and are extant in numerous manuscripts as described by Steinschneider' and myself. The first Latin rendering was done by Blasius in 1302, another by di Capua in the 14th century.v" In his book on asthma, Maimonides presents his views on medicine at large, with special emphasis on the duties attending the medical practitioner. He is forcefully outspoken against the quackery rampant among the medical profession of his day. Every patient, he says, requires individual treat°rernsalem, Israel.
48
ment, which is especially true in cases involving psychic conditions. In his view, proper diet is conducive to mental health. Of particular importance is Chapter VIII where the role of clean air and the interplay of emotional and hormonal states is amply discussed. Certain disturbances, in his opinion, do not respond either to dietary or to pharmaceutical remedies, but belong rather to the sphere of psychology and ethics. The main task of medicine, according to Maimonides, is the teaching of preventive measures, a theory he stressed in all his medical Writings. Maimonides recognized the psychosomatic character of asthma, stressed its importance and advocated the treatment of this disease by an allround physician. It is not without interest to compare Cecil's widely acknowledged Textbook of Medicine' with what Maimonides has to say in this connection. After discussing all the available remedies for bronchial asthma, Francis M. Rackman, the author of the chapter, goes on to say: "Finallv it should be said, whereas treatment of asth~a is important, treatment of a patient as a whole is more important. For asthma the physician must be a doctor in every sense," In addition to the wealth of medical and hygienic advice it offers, much of which is of value even today, the book on Asthma brings to light autobiographic and hitherto unknown episodes from his professional past which have so far escaped his biographers. Unlike his other medical writings, the discussion is not confined to psychosomatic diagnosis and therapy hut illuminates his methods as a medical practitioner, as well as his fight for the truth as he saw it and is a contribution to the history of medical treatment in the Middle East and to medical history at large. The book cites a great number of long-forgotten popular remedies and sheds light on some important aspects in the history of Morocco, where Maimonides acquired the bulk of his medical knowledge. You will also find there some basic truths of medical art and quotations from ancient and contemporary writers (such as Hippocrates, Galen, Razi, ibn Zohr and others) whose works are, for DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
MAIMONIDES' TREATISE ON ASTHMA
the most part, lost to us. All things considered, there still remains in the book on Asthma a sound kernel of practical advice on the treatment of bronchial asthma which has not yet been superseded. Fol1owing are some quotations from Maimonides, some verbatim and others paraphrased: In his Preface to the book, the author says in all modesty: "I have no magic cure to report, all I have in mind is a rational conduct of life." This is followed, inter alia, by an enumeration of symptoms in an asthmatic patient and a description of various constitutions. Hair, it says, weighs heavily on a patient's head and may lead to allergies. The book, although written for the ruler, is intended to be of use to other sufferers as wel1. Thereupon fol1ows a discussion of the relative climatologic merits of Alexandria and Cairo. In Chapter 1:4, Maimonides criticizes the ancient physicians for not paying sufficient attention to exercise, and suspension of coitus in certain maladies, to which he devotes a special section (X:8) (of particular interest in the Middle East where men of consequence kept amply furnished harems). Chapters II-III deal with fatty and fatproducing foods and suggest a cure for obesity. Here mention is made of bronchitis and pulmonary alveoli. In Chapter IV Maimonides discusses foods and dishes popular in Egypt and Spain of his day. Of special note is his insistence, when referring to Spain, as "our country in the West" (IV:4) i.e, Spain (IV:6)-after more than 30 years had passed since he left that country. Chapter V treats of the quantity of food proper to a man with asthma and of physical exercise before and after mealtime. As to the time for meals and snacks, much is said in Chapter VI:4 and IX:15. Chapter VII deals with beverages and illustrates the way in which Maimonides approaches the Islamic ban on wine-drinking for both the healthy and the sick. Substitutes are suggested. In VII:2, the author cites a drink of this type which he says he learned from his teacher in Morocco. There is a curious rendering of the word inflammation in Benvenisti's Hebrew translation; instead of the modem "daleqet" he writes "lehava," literal1yflame, inflammation. Chapter VIII is among the most interesting and important because it deals with air purification and the interplay of body and soul in all diseases. especially in asthma. DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
129 This is what Maimonides has to say in this respect: It is well known that clean, fresh air is advisable for all people, whether healthy or sick; with the latter, air purification is of primary importance. This means that on hot days the air should be conditioned by spraying and sprinkling the Hoor with scented water, by flowers, heat-abating leaves, and draft. On rainy days, the room temperature should be raised by fumigation with dried herbs. Cold, humid air is very harmful in this condition and excessive heat and warmth should be avoided as much as possible. The impact of mental suffering, such as agitation and obstinacy, is to impair mental activity and physical wel1-being so much so that one's appetite for food is completely lost when in mental anguish, fear, mourning or distress. In such a condition a man cannot even use his voice properly because his agitation affects his respiratory organs and he cannot exercise them at will. The weight of the accumulated gas residue within him keeps him from walking erect and inhaling a sufficient volume of air. Should this condition endure, a man cannot avoid falling ill and if it takes on a chronic character, death is not long in coming. AIl this is universalIy known and should not detain us here. On the other hand, gaiety and liveliness have the opposite effect; they gladden the heart and stimulate blood circulation and metabolic processes. However, when people indulge to excess in the pursuit of pleasure, which sometimes happens with the ignorant and the foolish, they too invariably falI sick and may even sink altogether; their soul is burdened with decay and hastens to leave the body, their hearts fail to function and death becomes inevitable. The cure of these two kinds of psychic states and their prevention lies not in food recipes, neither in drugs alone, nor in regular medical advice. It belongs rather to other spheres of professional knowledge, by which we mean the philosophic virtues taught by the philosophers who are engaged in the study of ethics, morals, etc. Undoubtedly, these psychologic methods are a greater help in these emotional disorders and a better safeguard against them for they uncover the nature of such conditions and the best way to cure them by learning from experience and failure. Furthermore, the philosophic virtues guard a man against extreme emotional states. They keep a man from falling into brutish emotionalism on mournful or joyous occasions as happens with the ignorant multitude.
49
SUSSMANN MUNTNER
130
While listing the various remedies which might help in individual cases, Maimonides recalls the "modem " Egyptian physicians (XII :I), again mentions remed ies sold "in our country in the West" and discusses contemporary doctors and medical writers (111:3). He tells about a young woman whom he cured of asthma (XII I :S) having treat ed her in a manner unprecedented in modem and ancient literature. "We learned it from our teachers ," he says, "who were greatly experienced in it. Th e greatest doctors in the West approved of such treatment and we witnessed it in person." In Chapter XIII:l it says: Fresh air is much more important than food. This is followed by a discourse on the harmful effect of city air, of built areas , on the advantages of suburban living (XIII :4) . Chapter XIII :5 cautions against resorting to medicaments at a time when nature is in a position to effect a cure on its own so that remedies become superfluous, often harmful! Comp arative notes on medicine at large are found in Chapter XIII :6. Chapter XIII :IO speaks of FIGURE 1. Original Anlbic manuscript, written in Hebrew letters , contain ing references to Maimonides' Book on Asthma (Paris, 1211) (evidence of aging is apparent).
In the world of pure reason they are no more than ludicrous, idle specters which vanish away . For a man like Your Highness it is fitting that he adopt these proph ylactic measures and follow in the footsteps of the just and (learned ) prophets, laugh at death in his face and follow the laws of nature and necessity . In Chapter IX, on constipation and purgatives, Maimonides falls baek on Avenzoar of Seville and warns that the latter should be taken only on expert advice . He also offers a prescription of his own making ( LX:l 5) . The role in asthma of sleep , massage and c0habitation is fully discussed in Chapter X. Maimonides quotes a saying from his own Regimen Sanitatis: "Diseases are individual and should be treated as such" (XI :2). The patient, not the disease, should be the subject of medical treatment (XIII:3l) . Ch apter XI deals with doctors and charlatans. "He who puts his life in the hands of a physician skilled in his art but lacking scientific training is not unlike the mariner who puts his trust in good luck." A doctor with much theoretic knowledge and little experience is no more reliable than one who has wide experien ce but little or no scientific training.
50
FIGURE
2. Hebrew translation by Joshua Xativa .
DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
131
MAIMONIDES' TREATISE ON ASTHMA
modesty such as pious men resort to when deliberately understating their knowledge even if they are experts in their vocation ... I state the truth as it is" (XIII:27). "The physician should be a practiced experimenter" (XIII:28). A further elaboration of the Hippocratic view on the art and duties of medicine is given in XIII:30. The doctor should treat the patient as a whole. Maimonides illustrates the point with a case of a young man in Morocco who was unnecessarily subjected to blood-letting and died as a result of it. This is followed by an exchange of words between the attending physicians and the populace. In Chapter XIII:38, an account is given of the untimely death of the young King of Morocco through the fault of his doctors. Famous medical names are cited, teachers of Maimonides, among them two Jews. The case described, he says, should serve as an aid to the advancement of medical science and the relief of suffering humanity. "Anything which might be cured with simple remedies should not be treated with combined remedies" (XIII:45); in this he upholds the practice of Egyptian doctors who adhere to this rule. Finally, there is a description of certain rich patients who are not content with a single physician FIGURE 3.
century).
Hebrew translation by Moses Ibn Tibbon (13th
medical errors and of what they can lead to. In Chapter XIII:13, the Hippocratic view is contrasted with that of quacks and charlatans: "Help the patient, do not harm him," Maimonides gives a short description of his student days and medical training in Chapter XIII: 18, while Hippocrates' and Galen's bedside manner is discussed in XIII:19. Aristotle is quoted as saying: "Most people die of medicine," Medicine, says Maimonides, is a science essential to man, at any time, anywhere; not only in times of illness but in health as well (preventive medicine). Provided, of course, the doctor is a true doctor, not a charlatan. In XIII:25, the Greeks are reputed as having relied upon nature whenever doubt arose with regard to any disease. "Having heard all this, Your Highness should in no way conclude that I am the right man in whose hands you might place your body and soul for treatment. Heaven be mv witness that I mvself know well that I belong to those who are not'perfect in this art and shrink from it (for lack of adequate experience). Again, heaven be my witness that the words I say are not motivated by any DIS. CHEST, VOL. 54, NO.2, AUGUST 1968
FI<:UR E
century).
4.
Latin tra nslation by [ohann di c..pua (14th
51
132
SUSSMANN MUNTNER
for one and the same disease and call in various unallied doctors, according to their paying ability. The damage to both physician and patient from such practices is pointedly brought home. On the other hand, there is much praise for the concerted action of allied physicians at the patient's bedside, for no man can know everything (XIII:47, 49). The book ends with a philosophic reflection on the eventual harm to the cause of truth when diagnosis is tainted with hate or love between fellow consultants. A recent review of the book on Asthma contained this statement. "It is hoped that these few brief quotations from Maimonides' Treatise on Asthma will stimulate the reader to examine this work more closely and perhaps avidly read the entire book since it is now available in the English language.'?"
REFERENCES S.: Moshe ben Malmon (Maimonidesi, The Book on AsthmtJ, Rubin Mass, Jerusalem, 1940.
MUNTNER,
S.: Maimonides, Sefer Hakatzeretb (The Book of Asthma) or Sefer Hamis'adim, Geniza, Jerusalem, 1963. 3 MUNTNER, S.: Moshe ben Maimon, On Haemorrhoids; On the Increase of Physical Vigour; On AsthmtJ; Mnssad
2
MUNTNER,
Harav Kook, Jerusalem, 1965. MU"'"TNER, S.: The Medical Writings of Moses Malmonides, Treatise on AsthmtJ, Lippincott, Philadelphia, 1963. 5 STEINSCHNEIDER, M.: Die Arabische Lileralur der [uden, J. Kauffman, Frankfurt a.M., 1902. 6 STEINSCHNEIDER, M.: Die Hebriiischen Obersetzungen des Millelaller. und die [ude» als Dolmetscher, Berlin, 1893. 7 CECIL, R. L.: A Textbook of Medicine, Philadelphia, 1947, Francis M. Rackman, Diseases of Allergy, p. 540. 4
8
MUNTXER,
(Regimen 1957.
S.: Moshe b. Maimon, Hanhagal Habriuth
Sanilalis), Mossad
Harav Kook, Jerusalem
S.: Maimonides, Regimen Sanitatis oder Diiiletik fur die Seele und den Korper. Mit Anhang der Medizinischen Responsen and Ethik des Maimonides
9 MuNTNER,
10
(German Translation). S. Karger, Basel-New York, 1966. ROSNER, F.: Moses Alaimonides' Treatise on AslhmtJ, Medical Times, October, 1966.
Reprint requests: Dr. Muntner, Prophets Street 54, Jerusalem. Israel
FREEDOM OF SCIENCE VERSUS POLITICS The guillotine was in use in various parts of Europe for centuries prior to the French revolution. It is named after a French physician who is given credit for its mechanical improvement. Dr. Guillotine had only narrowly escaped this gruesome instrument of execution at the time he was found to be too vociferous about severe punitive measures of the revolutionaries. Less fortunate was the fate of the great chemist and pioneer in pulmonary physiology, Antoine Laurent Lavoisier (1743-1794). In 1780, Lavoisier presented his thesis on the role
52
of oxygen in combusion. It has remained one of the basic principles of chemistry. His contributions to the understanding of the physiology of respiration have become classic precepts. He was found guilty of political conspiracy and beheaded, Pleas for clemency on the basis of his inestimable contributions to the advancement of science were rejected mercilessly with the arrogant and senseless slogan: the revolution needs no scientists. Andrew L. Banyai, M.D.
DIS. CHEST, VOL. 54, NO.2, AUGUST 1968