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MOSES MAIMONIDES' TWOTREATISES ON THEREGIMENOFHEALTHFiTadbiral-Sihhah
***
andMaqalahfiBayanBa'dal-A'radwa-al-Jawab'anha
TranslatedfromtheArabic and edited inaccordancewiththeHebrewand Latinversionsby
ARIELBAR-SELA,M.D.,HEBBELE.HOFF, M.D.,
and
ELIASFARIS
CONTENTS
PAGE
Introduction ..........................................3References...........................................14TheRegimenof Health ................................16ChapterI.......................................... 16ChapterI I........................20ChapterIII........................................23ChapterIV.........................................27The Treatise onAccidents..............................32Gossary.............................................41Index................................................45
INTRODUCTIONFromAsiaMinor,Greek medicinewascarriedbythe NestorianstotheEast where it was takenupbytheArabssurgingoutof the desert under thebanners of Islam.TheconqueringArabswerewillingstudents;themedical works ofHippocratesand Galenwere translatedinto ArabicalongwiththeworksofPlatoand Aristotle.BlendingtheknowledgeofGreecewiththewisdomof theEast,theArabs furtherdevelopedthearts andthesciences;undertheirrulemedicine attainedastatusinsomeaspects unsurpasseduntilmoderntimes.Towardthesecondhalf oftheeighthcentury,theArab worldwas dividedbyschism andpersonalrivalriestoform the EasternCaliphateof theAbassidswithBaghdadas itscapital,and the Western Cali-phateof theUmayyadswithCordova as itscapital.Twoschoolsofphilosophyand medicinesubsequentlydeveloped;theEasternSchool ofRhazes andAvi-cenna,andtheWesternSchool of AvenzoarandAverroes.Withthe decline ofbothCaliphates,the seat oflearningmovedcentrallytoEgypt,then undertheenlightenedruleoftheAyyubites.Itwasin thisperiodthat one ofthe most celebratedphysiciansofold,Moses benMaimon,camefromtheMaghribtoEgypt.EmbodyingthebestinArabicmedicineofboth East andWest,he contributedto itspropagation,andplayedanimportantroleinitsintroductiontoEurope.Mosesben Maimonha-Sefardi(theSpaniard)iscommonlyreferredto as theRambam,anabbreviationofRabbi Mosesben Maimon.He is also known astheMaimoni,hencethenameMaimonides.InArabic,thelanguageheemployedinmost of hiswritings,heisknown asAbfu'Imran Mfisaibn'UbaydAllahibnMaymfin.This nameposesaquestion;the nameAbu'Imran isobviouslyakunya,anickname,whileibn'UbaydAllah,theArabicequivalentofObadiah,appearstobe thenisba,orpatronymicname.IbnAbiUsaybi'ahdoes not listibn'UbaydAllahinhisdiscussion of Maimonides(21),*whereas someJewishmedievalscribes list itsHebrewtransliteration 'evedelohim asan honorific title(43,45,46)whileothersmaintaintheoriginalform(43);suchisthe case alsowithLatinmanuscripts.Consideringthe usualformofArabicnames,this isratherunusual,butallauthors,accept Maymun(Maimon)as the name of thefather.Theearliestknownbiographyof Maimonides waswrittenbythe notedmedicalbiographerIbn AbiU~aybi'ah(1203-1270),himself aphysicianand anacquaintanceofMaimonides' sonAbraham.Hisac-count ofthelifeof Maimonides and his sonAbraham,translatedfrom theArabic edition ofhiswork(21),is asfollows:al-Ra'isMusaisal-Ra'isAbu'ImranMfsa ibnMay-mun,theCordovan,aJew.Hewaslearned in theLawsoftheJews,and wascountedamongtheirlearnedandtheirsages.He wastheir head(Ra'is)intheProvinceofEgypt.He wasuniqueinhis time intheArtof Medicineanditspractice,versed in thesciencesandpossessedof anexcellentknowledgeofphilosophy.al-Sultanal-Malikal-Nasir$alahal-Dinsaw himand consultedhim,andlikewise hisson al-Malik al-Afdal 'Ali. Itis saidthatal-Ra'is Mfsa became aMoslemintheMaghrib,memo-rizedtheKoran and wasoccupiedinits studies.Then,oncehearrived intheProvince ofEgyptandsettled inFustat,Cairo,herecanted. Saidal-Qadial-Sa'idibnSanaa' al-Mulk inpraiseofal-Ra'is Musa:IdeemGalen'sMedicinefitforthebodyalone,ButAbu 'Imran's forbothbodyand mind.Had theMedicine of the Timeon him come tocall,Throughknowledgehewouldhavecureditofignorance'slls.Had theripeningmoonhiscounselrequired,Shecould attaintheperfectiontowhichsheaspired.Thedayofthefull-moon hewouldcure herofspots,And save herfromwaningattheendofhermonth.
*Numbersinparenthesesndicate references isted onpage14.
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BAR-SELA,HOFF,FARIS:MOSESMAIMONIDESThe books of al-Ra'is Musaarethe extracts of thesixteen books ofGalen,atreatise onhemorrhoids nd theirtreatment,atreatise ontheregimenofhealthcompiledforal-Malikal-Afdal'Aliibn al-Malikal-Ndair$alabal-DinYfisufibnAyyfub,atreatise onpoisonsandprotectionagainstlethaldrugs,a book inexplanationofdrugs,andalargebook on thereligionof theJews.Ibrahimibn al-Ra'is Misais Abf al-ManiIbrahimibnal-Ra'isMiusa bnMaymun,borninFustat, Egypt.Hewasa famousphysician,knowledgeablein the ArtofMedicineand excellent in itspractice.He was in attend-anceonal-Malik al-KamilMuhammadbn Abi Bakr ibnAyyfub.HealsowentfrequentlyfromthepalacetothehospitalinCairo,and treated the sickthere.Imethimintheyearsix hundredandthirtyone orthirtytwo(1233-4)whenIwaspracticingin thehospitalthere.Ifound himatall oldman,thinofbody,handsomeinappearance, pleasant-spoken,anddiscriminatingn medi-cine. Ibrahimibn al-Ra'isMfisadiedinEgyptinthe
yearsix hundredthirty...(missing).
IbnAbiUsaybi'ah'snarrative,wantinginbothdetailsandscope,leaves muchto bedesired,andintheabsenceof bettercontemporarybiographies,informa-tion about Maimonides'life had tobedrawnfromothersourcessuchas hiscorrespondencewithhisstudentsandfollowers,andthewritingsof otherswhoknewhim.Manyof thesesources,thoughwrittenbycontemporaries,arequestionable. Typicalof theseis anarrative,foundinMS.Opp.Add. 8?36 oftheBritishMuseum,writtenbyan unknownpersonwhoidentifieshimselfas follows:"I,whowritethisletter,amfrom Tulitulaandmy birthplaceisSpain;Ialso
escaped.. . and left Tulitulaintheyear4946(1186)
. ..and wentto the land of Fez." Thusthisauthoris aSpaniardwhosought refugefrompersecutioninFez,only twenty-fiveyearsafterMaimonides didthesame.His narrativecontainsonlya fewbiographicaldetailsaboutMaimonides,and these areoftenincon-flictwith well-establishedfacts,while mostof the workis devotedtoadescriptionof a fanciful and chimericalletter,saidto have beenwrittenbyMaimonidestoacertainIsaac,sonofNathan,whichappearsto be bothapocalypticandapocryphal.Itisapparentthat evenin hisownlifetime,legendsandfables obscuredtheimageof Maimonidestheman,andmadeitdifficultto understandhimandhiscontributionsinterms ofhispersonality;toomanyquestionsremainunansweredifnot unanswerable.This is even moreapparentwithrespectto Maimon-idesthephysician;infact,in theeyesof latergenera-tionshisreligiousandphilosophicalcontributionsoutshonethoseinmedicinetosuchanextent thatmanystudentsofhisworks,while awareofhisfameasaphysician,weretotallyunfamiliarwith the natureandthescopeofhis medical contributions.RabbiMoses MaimonideswasborninCordova,Spain,the seat ofthe WesternCaliphate,on March30,1135;his father andmentor was a well-knownscholarand authorin theJewishcommunitythatflourishedthere(53).Itisbelieved,thoughnotproven,thatthe Maimonfamilywere descendentsof theHouseofDavid(53,55).LittleisknownofMaimonides'earlylifeandeducation, but,judging byhislaterworks,hewasthoroughlytutoredinmathematics,astronomyandastrology,medicine,philosophy, theology,andJewishstudies.Undoubtedly,itwasthelatter sub-jectwhichcaptured youngMaimonides'fancy,andtothis he devoted most of his time andenergy.Itisnot clear where andwithwhom Maimonidesstudiedmedicine,althoughthereisno doubt that heacquiredthe foundation of hisartinthe West.InhisRegimenofHealthhestates,insupportofaprescrip-tion,"this iswhat wehave receivedfromthe Elders
of theArt,"and,again,in his Treatise onAccidentshestates,"thus we have seentheoutstandingEldersdointhe landofAndalusia,"buthe does not mentionthese Eldersbyname.Some authors claimhim asastudentofAbu Marwan ibnZuhr(Avenzoar;1091-1162),who livedinSpain,while othersplacehimasastudentofIbn Rushd(Averroes;1126-1198),himselfa Cordovanandonlytenyearsolder than Maimonides.Maimonideshimself,however,claims neitherashisteacher.Hefrequentlyrefersto the venerableibnZuhr, but he makeslittle mentionof IbnRushd.In
his treatise on asthma(44),herecordsanincidentinvolvingIbnZuhr,but he states that he hearditfromhis sonAbu Bakr with whom hewasacquainted.Thus,while thereis nodoubtthat Maimonides waswellacquaintedwith the works of these two mastersofthe schoolofmedicineof theWesternCaliphate,the exact source ofhismedicaleducationisnotyetestablished(17,41,57).In 1148Cordova,alongwiththerest of MoorishSpain,wasconquered bythe al-Muw'ahhidin(Almo-hades),a sect ofunitarian Moslemzealots.Aneraofreligiousintoleranceandpersecutionensued,andtheJewswere oftengiventhe choiceof conversiontoIslam or exile.Choosingthelatter,Maimon'sfamilyescapedin1160 to thecityofFez, Morocco,andspenta fewyearsthere,apparentlydisguisedas Moslems.There isnoevidence whatsoeversupportingIbn AbiUsaybi'ah'sclaim thatMaimonideseveracceptedIslam.Infact,itwasduringthattime thathe en-dangeredhisown lifebypublishinghisIggeretha-SHemad,theEpistleonApostasy,followingwhichhisfamilyfled Fez andin1165 arrivedinAcre,Pales-tine(53).AccordingtotheBritishMuseummanu-scriptcitedabove,Moses' fathervoluntarilyleft forFezso that hischildrenmight studyunderthegreatRabbiJudahha-Kohen; then,whenRabbiJudahdiedamartyr'sdeath,theyfledto Palestine.TheirsojourninPalestinewasbrief,andtheyfinally sought refugeinEgypt.Maimon,thefather,diedonthelaststageoftheirjourney,andin1165Moses andhisbrother David settledinFustat(oldCairo).Accordingto the above-mentionedmanu-script,the fatherdiedinJerusalem,whileaccordingtoothershe diedinFustat(18,53,57).While David turnedtocommerce,Maimonidescon-4
[TRANS.AMER. PHIL.SOC.
TWOTREATISESONTHEREGIMEN OF HEALTHtinuedtodevotehis time tohisstudies,and in1168hepublishedhis firstmajorreligiouswork,Kitdbal-Siraj,acommentaryon the Mishnah.Bythat timehe wasalreadyknownthroughhis treatises on theArt ofLogicand theJewishCalendar(publishedin1151 and1158,respectively),and wasrecognizedinEgyptas anauthorityonJewishsubjects.When hisbrother DavidperishedintheIndian Ocean notlongafterthesettlementin
Cairo,Maimonides had to earnhislivelihoodinorder to sustainhimself and hisbrother'sfamily.Refusingtoacceptremunerationforrabbinicalduties,heturnedto theonlyotherprofessionhe knew-medicine(15,18).Maimonides' endeavorsin hisnewoccupationprovedsuccessful,and withina shorttimeheattracted
the attention ofthe Vizieral-Qadial-Falilal-Baysani,who obtainedhisservicesandintroducedhimtothecourt ofal-'Adid,the last ofthe FatimidImamsofEgypt.Whenthe latter wasdeposedin1171,thecapableVizier,who retainedhishighoffice,introducedMaimonidestothe courtof the newSultan,$aldabal-Din(Saladin) (38,41).The detailsof Maimonides'risetomedicalfame are notaltogetherclear.Frieden-wald(18)fixeshisappointmentto Saladin's courtatamuch laterdate,whileZeitlin(65)maintainsthatMaimonideslingereda fewyearsinAlexandriaanddidnot settleinFustat until1171,whichappearstopre-cludethepossibilityofhisappointmentto the courtofal-'Adid.Maimonides' fameas aphysicianhadspread,andhewasnowoccupiedfrommorningtillnightattendingthe court ofSaladin,andcateringtoa wideclientele.Inadditionto hispractice,hewasappointedbySaladinaNagidover theJewishcommunityofEgypt,apositionsimilarto that of theExilarchinBabyloniawho was a directdescendantofthe House of David(21,38).Soheavywas theburdenonhisshoulders,thatin aletterto his friend andtranslatorIbnTibbon,hewrote,inorder todissuadehim fromcomingforavisit,"Iconversewith andprescribefor themwhilelyingdown from sheerfatigue,andwhennightfallsIamso
exhaustedthatIcanscarcelyspeak"(18).ThereputationofMaimonideswasapparentlysogreatthat he receivedan invitationtobecomethepersonal physicianofa"Sovereignofthe FranksinAscalon,"thoughtto be RichardCoeurdeLion,whoheardofhimfromSaladin's brotheral-'Adil(41).Maimonidesmusthave declinedtheinvitation,foritis known thathe neveragainleftEgypt.Nonethe-less,it hasbeensuggestedthat theportrayalof theHakiminScott'sTalismanwasdrawn after Mai-monides(11).Hismedicalpracticenotwithstanding,Maimonidescontinuedtopursuehisreligiousandphilosophicalstudies,andin1180,hepublishedhismajor religiouswork,the MishnehTorah,inwhichheorganized,edited, summarized,andcodified theimmense collec-tion oflaws, customs,opinions,andregulationsfoundintheTalmud.Thiswas no minortask,andbythiscontributionalone,Maimonidesearned himselfim-mortality.Theproverbstillprevails,"from Mosesto Moses there wasno one like Moses."Composedoffourteenbooks,theMishnehTorah isoften referredto as Yadha-.Iazaqah,TheMightyHand,since theHebrew lettersyodanddalet which madeupthewordyad(hand)have thenumerical valueoffourteen.Maimonides himselfwas calledBa'al Yadha-Hazaqah,Master of theMightyHand,inallusionto theverylastsentenceof the Torah(Deuteronomy34:12),"Andinallthemightyhand andinall thegreatterrorwhich MoseswroughtinthesightofallIsrael."In1190hepublishedtheDaldlatal-.Hayrin,TheGuide tothePerplexed,the crown ofhisphilosophicalachievements.Thiswas anattemptto reconcileJewish thoughtandAristotelianphilosophy,aphil-osophicalfeat thatwasgreatlyacclaimedandoftenquotedbyChristianscholastics,as wellasby JewishandMoslemscholars,and the influenceofwhichreachedintotheageofSpinozaandKantas wellasintoour ownage(7,55,56).As hisreputationas aphysicianandahealerspread,Maimonideshad todevote moreandmore time tohispracticeattheexpenseofwhat he consideredhisprimeinterest.Ina letter toRabbiJonathanof Lunelhewrote:BeforeIwas formedinthebellythe Torahknewme,andereIcame forth fromthewombshe had sanctifiedmeforitsstudies,and ordainedmetospreadwideits fountain.Sheismybeloveddoe,andthewife ofmy youthwhoseloveIhave followedever since.Nevertheless,manyforeignwomen becameher rivals...and God
knowsthat at firsttheywerenottakenexceptto beheranointers,cooks andbakers,to showthepeopleand the noblesherbeauty. . .nowIhavebecomeremissinmy dutytothismarriage,formyheartisdividedamongthevarioussciences. ..(MS.Add.27,129,fol.117-8;BritishMuseum).Amongthese"foreignwomen"medicine wasthe fore-most,and theonemostdemandingofhistime. Hewas nowailing;inthat same letterhenoted:myillnesslingeredfornearlyayear,andnow thatI haverecovered,Iamlikea sick man nolongerndanger.Mostof thedayIrecline in bed with the burden of thepeopleuponmyneck,regardingmatters ofmedicine,weakeningmy strength.Theydo notleave me alone for anhour,neitherin thedaynoratnight,andwhat canIdo nowthatmyreputationhasspreadinmanycountries. . .?Apparently,he was neverinsoundhealth,andhadalwaysbeen weak andailing.Inhis letter toal-Afdal,thesecond treatiseinthistranslation,he notedthat"thebadness ofhisoriginaltemperamentandtheweakness of hisnaturalbuild-ifwhenyounghowmuch moresoinoldage-stoodbetweenhim andmanypleasures."Itwasonly duringthe last two decadesof his lifethatMaimonides devotedtimeto medicalwriting.Notonlywas hewellreadand familiar withthe works
VOL.54,PT.4,1964]
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