 Chapter 4 of OLD TIME MAKERS OF MEDICINE Chapter 4 MIMONIDES The life of one of the great Jewish physicians, who has come to be known in history as MIMONIDES, is of such significance in medical biography that he deserves to have a separate sketch. Born in Spain, his life was lived in the east, where his connection as royal physician with the great Sultan Saladin of Crusade's fame made his influence widely felt. He is a type of the broadly educated man, conversant with the culture of his time and of the past, knowing much besides medicine, who has so often impressed himself deeply on medical practice, while the narrow specialists in each generation, the men who are quite sure that they are curing the special ills of men to which they devote themselves, have always felt that whatever progress there was, in any given time, was due to them. They occupy but little space as a rule in the history of medicine. The men who loom large were the broad-minded, humanely sympathetic, deeply educated physicians who treated men and their ills rather than their ills without due consideration of the individual and who not only relieved the discomfort of their patients and greatly lessened human suffering and added to the sum of human happiness in their time, but also left precious deeply significant lessons for succeeding generations of their profession. Hippocrates, Galen, Syndenham, Auenbrugger, Morgogny, these are representatives of this great class, and Maimonides must be considered one of them. Moses Ben Maimoum, whose Arabic name was Abu Amran Musa Ben Maimoum Oybad ala el-Kordavi, who is called by his Jewish compatriots Rambam, or Rambam, was born at Cordova in Spain in the 30th of March in 1135 or 1139, the year is in doubt. It might not seem of much import now after nearly eight centuries, but not a little ink is spilt over it, yet by devoted biographers. We are rather prone to think, in our time, that the conditions in which men were born and reared before what we are pleased to call modern times, and above all, in the Middle Ages, must have made a distinct handicap for the intellectual development. Most of us are quite sure that the conditions in medieval cities were eminently unsuited for the stimulation of the intellect, for incentive to art impulse, for uplift in the intellectual life, or for any such broad interest in what has been so well called the humanities, the humanizing things that lift us above animal necessities, as would make for genuinely liberal education. We are likely to be set in the opinion that the environment of the growing youth of an old-time city, especially so early as the middle of the 12th century, was poor and sordid. The cares of the citizens are presumed to have been mainly for material concerns, and indeed mostly for the wants of the body. They were only making a start on the way from barbarism to something like our glorious culmination of civilization. As the heirs to all the ages in the foremost files of time, we are necessarily far in advance of them, and we are only sorry that they did not have the opportunity to live to see our day and enjoy the benefits of the evolution of humanity that is taking place during the eight centuries that have elapsed. As a matter of fact, there was much more of abiding profound interest in real civilization in many a medieval city, much more general appreciation of art, much more breadth of intelligence and sympathy with what we call the humanities than in most of our large cities. The large city, as we know it, is eminently a discourager of breadth of intelligence. Specialism in the various phases of money-making obscures culture. Maimonides, born in Cordova, was brought up amid surroundings that teamed with incentives of every kind to the development of intelligence, of artistic taste, and everything that makes for cultivation of intellect rather than of interest in merely material things. It is well said that it is hard to judge the Cordova of old by its tawdry ruins of today. The educated visitor still stands in awe and admiration of the great mosque, which expressed the high cultivation of the Moors of this time. It is a never-ending source of wonder to Americans. The city itself has many reminders that the fine era of Moorish culture and refinement of taste and of art expression, which is in the best sense of the word a city beautiful. The Arab invaders had found a great prosperous country, which had been the most cultured province of the Roman Empire, and on this foundation they made a marvelous development. The banks of the Guadalquiver, says Mr. S. Lane Pool in the Moors of Spain, London, 1887, were bright with marble houses, mosques, and gardens, in which the rarest flowers and trees of other countries were carefully cultivated, and the Arabs introduced their system of irrigation, which the Spaniards both before and since have never equalled. The greatest beauty of the city, of course, had come, and some of it had gone, before Maimonide's time. So much remains in spite of time and war, and many unfortunate influences, that we can have some idea how beautiful it must have been in his youth seven centuries ago, and how even more beautiful in the foretime. Of the great mosque, writers of travel can scarcely say enough. Mr. Lane Pool says, quote, Travelers stand amazed among the forest of columns, which open out apparently endless vistas on all sides. The porphyry, jasper, and marbles are still in their places. The splendid glass mosaics, which artists from Byzantium came to make, still sparkle like jewels in the walls. The daring architecture of the sanctuary, with its fantastic crossed arches, is still as imposing as ever. The courtyard is still leafy with the orange trees that prolong the vistas of columns. As one stands before the loveliness of the great mosque, the thought goes back to the days of the glories of Cordova, the palmy days of the great Caliph, which will never return. End quote. Of all the countries in which the Jews all down the centuries have lived, there is probably none of which they have been more loud in praise than Spain. There are poets saying of it as if it were their own country. For centuries the people were happier here, than probably they have been anywhere else for so long a period. Elsewhere in this book I have called attention to all that Spain meant in Europe during all the centuries from the beginning of the Roman Empire down to the end of the Middle Ages. Maimonides was fortunate in his birthplace then, and while circumstances compelled the family to move away, this change did not come until a good effect had been produced on the mind of the growing youth. Even when persecution came, Maimonides clung to Spain with a tenacity born of deep affection and emphasized by admiration for all that she was and had been. Cordova was the jewel of the Spain of this time, and though much less than she had been in the long preceding time, she was the birthplace of Lucan and the two Seneca's, or even than what she had been in Abd or Raman's times, or when she was the birthplace of Avaros, still she remained wonderfully beautiful and attractive, winning and holding the affections of men. Maimonides' father, Maimum Ben-Joseph, was a member of the rabbinical college of Cordova and famous for his knowledge of the Talmud. There are some writings of his on mathematics and astronomy extent. He directed the education of his son, who, like many another distinguished scholar in later life, seems to have exhibited very little talent in his early years. There is no rule in the matter. Pricosity often disappoints. Geniuses often dull in childhood, but there are exceptions that prove both rules. The basis of education in Spain at the time, among the Jews, was the Bible, the Talmud, mathematics, and astronomy, a good rounded education in literature, the basis of law, and some exact physical science. After his preliminary education at home, Maimonides studied the natural sciences and medicine of Moorish teachers. Nature's study, in spite of frequent expressions that declare it new in modern times, is as old as man. He also received a grounding in philosophy as a preparation for his scientific studies. At the age of 23, he began the composition of a commentary on the Talmud, which he continued to work on at his journeys in Spain and in Egypt. This is considered to be one of the most important of this class of works extant, though, almost needless to say, similar writings are very numerous. In the light of wanderings in philosophy during the centuries since, it is rather interesting to quote from that work the end of man as this Jewish philosopher of the middle of the 12th century saw it. Recent teleological tendencies in biology add to the interest of his views. According to Maimonides, quote, man is the end of the whole creation, and we have only to look to him for the reason for its existence. Every object shows the end for which it was created. The palm trees are there to provide dates, the spider to spin her webs. All the properties of an animal or plant are directed so as to enable it to reach its purpose in life. What is the purpose of man? It cannot lie alone in eating and drinking or yielding to passion, nor in the building of cities and the ruling of others, since these objects lie outside of him and do not touch his essential being. Such material striving he has in common with the animal. A man is lifted from a lower higher condition by his reason. Only through his reason is he placed above the animals. He is the only reasonable animal. His reason enables him to understand all things, especially the unity of God, and all knowledge and science serve only to direct man to the knowledge of God. Passions are to be subdued since the man who yields to passion subjects his spirit to his body and does not reveal in himself the divine power which in him lies in his reason, but is swallowed up in the ocean of matter. Not long after Maimonides passed his 20th year, the family, consisting of the father and his two sons, Moses and David, and a daughter, moved from Cordova to Fez, compelled by Jewish persecutions. Here it is said that they had to submit to wearing the mask of Islam in order to lead a peaceful existence. This has been doubted, however, and his whole life is in flagrant contradiction with any such even apparent apostasy from the faith of his fathers. Father and son took advantage of the opportunity of intercourse with Moorish physicians and philosophers to increase their store of knowledge but could not be content in the political and religious conditions in which they were compelled to live. About 1155 then they went to Jerusalem but found conditions even more intolerable there and turned back to Egypt where they settled down in Old Cairo. In 1166 the father died and after this he learned that the sons made a livelihood and even laid down the foundation of a fortune by carrying on a jewelry trade. Moses still devoted most of his time to study while his brother did most of the business but the brother was lost in the Indian Ocean and with him went not only a large sum of his own money but also much that had been entrusted to him by others. Father took to pay off these debts and at the same time had to meet the necessities not only of himself and sister but also of the family of his dead brother. It was then that he took up the practice of medicine and succeeded in making a great name and reputation for himself. He continued to write however and completed his commentary on the Talmud. About the age of 50 Mymonides as seems to be true of a good many men who lived to old age became rather discouraged and despondent about himself. He refers to himself in his letters and writings rather frequently as an old and ailing man. He had nearly 20 years of active life ahead of him but he had the persuasion that comes to many that he was probably destined for early death. His son was born shortly after this time and that seems to have had not a little to do with brightening his life. While in Egypt Mymonides married the sister of one of the royal secretaries who in turn wedded Mymonides sister. Mymonides took on himself the education of his son who also became a physician though his father was not to have the passion of watching his success in the practice of his chosen profession. This son, Abraham became the physician of Mali Al-Kamen the brother of Saladin and besides was a physician to the hospital at Cairo. His son, David the grandson of Mymonides practiced medicine also at Cairo till 1300. He in turn left two sons Abraham and Solomon who achieved reputation in the chosen profession of their great grandfather. Mymonides after the birth of his son became one of the busiest of practicing physicians. Indeed, it is hard to understand how he had the time to do any writing in his busy life. Still less can we understand his time for teaching. He was the physician to Saladin and the physicians with Richard Cordeleon have made him known to English speaking people. Every morning as the court physician Mymonides went to the palace situated half a mile away from his dwelling and if any of the many officials and dependents that then as now were at Oriental Courts were ill he stayed there for some time. As a rule he could only get back to his own home in the afternoon and then he was as he says himself almost dying with hunger Knowing the scantiness of the Oriental breakfast we are not surprised. There he found his waiting room full of patients Jews and Mohammedans prominent and unimportant friends and enemies He says himself quote a varied crowd who are looking for my medical advice there is scarcely time for me to get down from my carriage and wash myself and eat a little and then until night I am constantly occupied so that from sheer exhaustion I must lie down only on the Sabbath day have I the time to occupy myself with my own people and in my studies and so the day is away from me end quote What a picture it is of the busy medical teacher at all times in the world's history yet it must not be forgotten that it is from these busy men that we have derived our most precious lessons in caring for patients rather than disease in the art of medicine rather than medical science that have been valuable long after the fine spun theories of the scientist that took so long to elaborate have been placed definitely in the lumber room his reputation as a writer on medical topics is not as great as that which has been accorded him for his writings on philosophy and in Talmudic literature but he well deserves a place among the great practical masters of medicine as well as high rank among the physicians of his time there is little that is original in his writing but his thoroughgoing common sense his wide knowledge and his discriminating eclectic faculty make his writings of special value as might have been expected the aphorisms of Hippocrates attracted his attention and besides he wrote a series of aphorisms of his own the most interesting of his writings however is a series of letters on diatetics written for the son of his patron Saladin the young prince seems to have suffered from one of the neurotic conditions that so often develop in those who have their lives all planned for them and little incentive to do things for themselves the main portion of his complaints centered as in the case of many another individual of leisure in disturbances of digestion besides he suffered from constipation and feelings of depression doubtless like many a young person of the modern time he was quite sure that these symptoms portended some insidious organic ailment which would surely bring an early death when fathers having done all that there is to do just expect their sons to enjoy the fruits of the paternal accomplishments conditions of this kind very often develop unless the young man proceeds to occupy himself with even more dangerous distractions than he finds in unending thought about his own feelings the rules of life and health that mymonides laid down in these letters have become part of our popular medical tradition probably more of the ordinary current maxims as to health have been derived from them then would possibly be suspected by anyone not familiar with them in various forms his rules have been published a number of times a good idea of them can be obtained from the following compendium of them which I abbreviate from a biographical sketch of mymonides by Dr. Oppler which appeared in the Deutsches Archive for Birsteige der medicine und medischen geography binding to Leipzig 1879 quote one, man is bound to lead a life pleasing to God he wants to have a healthy body and he must hold himself far from everything that can hurt his health and accustom himself to whatever renews his strength he should eat and drink only when hungry and thirsty and should be particularly careful of the regular evacuation of the bowels and of his bladder he must not delay either of these operations but as far as possible satisfy the inclination at once two a man must not overload his stomach but be content always with something less than is necessary to make him feel quite satisfied he should not drink much during the meal and only of water and wine mixed taking somewhat more after digestion has begun and after digestion is completed in moderation according to his needs before a man sits down to table he should note whether he has any tendency to evacuation and should make the body warm by movement and activity after this exercise he should rest a little before taking food it is very beneficial after work to take a bath and then the meal three, food should be taken always in the sitting position there should be no riding nor walking nor movements of the body until digestion is finished a man who takes a walk or any strenuous occupation immediately after eating subjects himself to serious dangers of disease four day and night should be divided into 24 hours men should sleep for 8 hours and so arrange their sleep that the end of it comes with the dawn from the beginning of sleep until sunrise there should be an 8 hour interval we should all leave our beds about the time that the sun rises five during sleep a man should neither lie on his face nor on his back but on his side the beginning of the night on his left and at the end on his right he should not go to sleep 24 hours after eating and should not sleep during the day fruits that are laxative as grapes, figs, melons, gourds should be taken only before meal time and not mixed with other food it would be better to let these get into the abdominal organs and then take other food seven eat what is easily digestible before what is difficult of digestion the flesh of birds before beef and the flesh of calves before that of cows and steers birds were then thought more digestible than other flesh we have reversed the ruling the note shows how light and digestible their flesh was considered and the reason therefore eight in summer eat cooling food acids and no spices contrary, eat warming foods rich in spices, mustard and other heating substances in cold and warm climates one should eat according to the climactic conditions nine there are certain harmful foods that should be avoided large salt fish, old cheese old pickled meat young new wine evil smelling and bitter foods are often poisonous also some which are less harmful but are not to be recommended as ordinary nutritive materials large fish, cheese milk more than 24 hours after milking the flesh of old oxen beans, peas, unleavened bread sauerkraut onions, radishes and the like these are to be taken only in small quantities and only in the winter time they should be avoided in the summer beans and lentils are to be recommended neither in winter nor summer ten, as a rule one should avoid the eating of tree fruits or not eat much of them especially when they are dry and even less when they are green if they are unripe they may cause serious damage Johannes Brod is very harmful at all times these are also all the sour fruits and only small amounts of them should be eaten in summer or in warm countries eleven the fruits that are to be recommended dry as well as fresh are figs, grapes and almonds these may be eaten as one has the appetite for them but one should not accustom himself to eat them much though they are healthier than all other fruits twelve honey and wine are not good for children though they are beneficial for older people especially in winter in summer one third less of them should be eaten than in winter thirteen special care should be taken to have regular movements of the bowels that carry off the impurities of the body it is an axiom in medicine as long as evacuations are absent or difficult or require strong efforts the individual is liable to serious disease every medical means should be taken to overcome constipation in order to escape its dangers for this purpose young people should be given salty food materials that have been soaked in olive oil salt itself vegetable soups with olive oil and salt older people should take honey mixed with warm water early in the morning and four hours later should take their breakfast this proceeding should be followed up from one to four days until the constipation is overcome fourteen another axiom of medicine is that so long as a man is able to be active and vigorous does not eat until he is over full and does not suffer from constipation he is not liable to disease even such men however are much safer if they do not take food that may disagree with them fifteen whoever gives himself up to inactivity or puts off evacuations of the bowels or suffers from constipation will be sure to suffer from many diseases and will see his strength disappear even should he eat the best food in the world and make use of all the remedies that physicians have immoderate eating is a poison for men and the cause of many diseases which attack them most diseases come from either eating too much or partaking of unsuitable food that was what Solomon meant with his proverb he who puts a guard over his mouth and his tongue protects himself from many evils end quote that is to say whoever protects his mouth from the overindulgence in food and his tongue from unsuitable speech protects himself from many evils sixteen every week at least a man should take a warm bath one should not bathe when hungry nor after eating until the food is digested and bathe the whole body in warm but not too hot water and the head in hot water afterwards the body should be washed in lukewarm and cool water until finally cold water is used one should pour neither cold nor even lukewarm water on the head nor bathe in cold water in the wintertime nor when the body is tired in perspiration at such times the bath should be put off for a while seventeen even as soon as one leaves the bath one should cover oneself and especially cover the head so that no drought may strike it even in summer care must be taken to observe this rule after this one should rest for a while until the heat of the body passes off and then should go to table if one could sleep a little just before a meal it is often very beneficial neither during the bath nor immediately after it should cold water be drunk and if there is an in a feasible thirst a little wine and water or water and honey should be taken in winter it is beneficial to rub the body with oil after the bath venus section should not be practiced frequently for it is only meant for serious illness it should not be permitted in winter or summer nor during the months of April or September the are months after passing his fiftieth year an individual should abstain from venus section venus section should not be practiced on the day when one takes a bath or goes on a journey or returns from it on the day when it is practiced less than usual should be eaten and drunk and the patient should give himself to rest undertake no work nor bother some occupation and take no walk 19 whoever observes these rules of life faithfully I guarantee him a long life without disease he shall reach a good old age and when he comes to die will not need a physician his body will remain always strong and healthy unless of course he has been born with a weak nature or has had an unfortunate bringing up or should be attacked by epidemic disease or by famine 20 only the healthy should keep these rules whoever is ill whoever from any injuries or has lost his health through bad habits for him there are special rules for each disease only to be found in the medical books let it be remembered that every change in a life habit is the beginning of an ailment 21 if no physician can be secured then ailing people may use these rules as well as the healthy include these rules are, of course full of the common sense of medicine that endures at all times from the tropical climate of the eastern countries they probably represent as good advice as could be given even at the present time with them before us it is not surprising to find that on other subjects mymonides was just as sensible perhaps, in nothing is this more striking than in his complete rejection of astrology considering how long astrology in the sense of the doctrine of the stars influencing human health and destinies had dominated men's minds and how universal was the acceptance of it mymonides strong expressions show how much genius lifts itself above the popular persuasions at this time even among the educated and how much it anticipates subsequent knowledge it is well to remind ourselves that as late as the middle of the 18th century mesmer's thesis on the influence of the stars on human constitutions was accepted by the faculty of the university of Vienna as a satisfactory evidence not only of his knowledge but of his power to reason about it at the end of the 12th century mymonides was trying to argue it out of existence on the best possible grounds quote know my masters and quote that no man should believe anything that is not attested by one of these three sanctions rational proof as in mathematical science the perception of the senses or traditions from the prophets and learned men end quote his biographer in the monograph mymonides published by the Jewish Publication Society of America expresses his further views on the subject in compendious form and then gives his final conclusion as follows quote works on astrology are the product of fools who mistook vanity for wisdom men are inclined to believe whatever is written in a book especially if the book to be ancient and in olden times disaster befell Israel because men devoted themselves to such idolatry instead of practicing the arts of martial defense and government he says that he had himself studied every extant astrological treatise and had convinced himself that none deserve to be called scientific mymonides then proceeds to distinguish between astrology and astronomy in the latter of which lies true and necessary wisdom he ridicules the supposition that the fate of man could be dependent on the constellations and urges that such a theory robs life of purpose and makes man a slave of destiny it is true he concludes that you may find strange utterances in the rabbinical literature which imply a belief in the potency of the stars at a man's nativity but no one is justified in surrendering his own rational opinions because of this or that sage urd or because an allegorical remark is expressed literally the man must never cast his own judgment behind him the eyes are set in front not in the back while mymonides could be so positive in his opinions with regard to his subject on which he felt competent to say something he was extremely modest with regard to many of the great problems of medicine he often uses the expression in his writings to see how to explain this matter end quote he quotes with approval from a rabbi of old who had consoled his students quote teach thy tongue to say I do not know end quote in this of course he has given the best possible evidence of his largeness of mind and his capacity for making advance in knowledge as when men are ready to say I do not know that progress becomes possible it is very easy to rest in a conscious or unconscious pretense of knowledge that obscures the real question at issue a great thinker who lived in the century in which mymonides died Roger Bacon set down as one of the four principal obstacles to advance in knowledge indeed as the one of the four that hampered intellectual progress the most the fact that men feared to say I do not know one of the most interesting features of mymonides career for the modern time is the influence that his writings exerted over the rising intellectual life of Europe within a half century after his death most people would be rather inclined to think that this Jewish author of the east would have very little influence over the thinkers and teachers of Europe within a generation after his death he died in 1204 just at the beginning of one of the great productive centuries of humanity perhaps one of the greatest of them all in literature, in art in architecture, in philosophy and in education this century made wonderful strides two of its greatest teachers Albertus Magnus and his pupil Thomas Aquinas quote from Moses Egypteus the European name for mymonides at the time and evidently knew his writings very well mymonides was for them an important connecting link with the world of old Greek thought others of the writers and teachers of this time as William of Avernier and the two great Franciscans Alexander of Hales and Dunn's Scotus were also influenced by mymonides in a word the educational world of that time was much more closely united than we might think and it did not take long for a great writer's thoughts to make themselves felt several thousand miles away mymonides was then in his own time one of the world teachers and in a certain sense he must always remain that as representing a special development of what is best in human nature end of chapter 4 chapter 5 of old time makers of medicine this is a LibriVox recording all LibriVox recordings are in the public domain for more information or to volunteer please visit LibriVox.org recording by Adam Marsatich September 2009 Alexandria, Virginia old time makers of medicine by James Joseph chapter 5 great Arabian physicians part 1 of 2 in order to understand the place of the Arabs in medicine and in science a few words as to the rise of this people to political power and then to the cultivation of literature and of science are necessary we hear of the Arabs as hireling soldiers fighting for others during the centuries just after Christ and especially in connection with the story of the famous Queen Zenobia at Palmyra after the destruction of this city we hear nothing more of them until the time of Muhammad during these 6 and a half centuries there is little question of education of any kind among them except that at the end of the 6th century the Persian king Khoroses 1 who was much interested in medicine encouraged the medical school in Jondisabor in Arabistan founded at the end of the 5th century by the Nestorian Christians who continued as the teachers there until it became one of the most important schools of the east it was here that the first Arab physicians were trained and here that the Christian physicians who practiced medicine among the Arabs were educated among the Arabs themselves before the time of Muhammad there had been very little interest in medicine girl notes that even the physician of the prophet himself was according to tradition a Christian Muhammad's intermediate successors were not interested in education and their people mainly turned to Christian and Jewish physicians for whatever medical treatment they needed when the caliphs came to be the rulers of the Mohammedan empire they took special pains to encourage the study of philosophy and medicine though dissection was forbidden by the Quran most of the other medical sciences and especially botany and all the therapeutic arts were seriously cultivated until the coming of Muhammad the Arabs had been wandering tribes getting some fame as hireling soldiers but now under the influence of a feeling of community in religion and led by the military genius of some of Muhammad's successors whose soldiers were inspired by the religious feelings of the sect they made great conquests the Muhammadan empire extended from India to Spain within a century after Muhammad's death Carthage was taken and destroyed Constantinople was threatened in 661 scarcely 40 years after the Hegira or flight of Muhammad from which good Mohammedans date their era the capital was transferred from Medina to Damascus to be transferred from here to Baghdad just about a century later where it remained until the Mongols made an end of the Abbasad rulers about the middle of the 13th century at the beginning the followers of Muhammad were opposed to knowledge and education of all kinds Muhammad himself had but little according to tradition he could not read or write the story told with regard to the Caliph Omar and the great library of Alexandria seems to have a foundation in reality though such legends usually are not to be taken literally certainly it represents the traditional view as to the attitude of the earlier Muslim rulers to education Omar was asked what should be done with the more than 2 million volumes he said that the books in it either agreed with the Koran or they did not if they agreed with it they were quite useless if they did not they were pernicious in either case they should be done away with because there was an element of danger in them accordingly the precious volumes that had been accumulating for nearly 10 centuries served it is said to heat the baths of Alexandria for some 6 months probably the most precious fuel ever used fortunately for posterity the edict was not quite as universal in its application the story would indicate and exceptions were made for books of science in the course of their conquests however the Mohammedan Arabs captured the greek cities of Asia Minor they were brought closely in contact with greek culture, greek literature and greek thought as has always been the case captive greece took its captors captive what happened to the romans came to pass also among the Arabs inspired by greek philosophy science and literature they became ardent devotees of science and the arts while not inventing or discovering anything new like the romans they carried on the old Damascus Basra, Baghdad Bokhara, Samarkand all became centers of culture and of education large sums were paid for greek manuscripts and for translations from them under the famous Haroun Al Rashid at the end of the 8th century whose name is better known to us than that of any others because of the stories of his wandering by night among his people in order to see if justice were done 300 scholars were sent at the cost of the caliph to the various parts of the world in order to bring back treasures of science and especially of geography and medicine it is an interesting historical reflection that the Japanese and Chinese are doing the same thing now the Arabs were very much taken by the philosophy of Aristotle and it became the foundation of all their education greek thought as always inspired its students to hire things soon everywhere in the dominions of the caliphs philosophy, science, art, literature and education nourished medicine was taken up with the other sciences and cultivated assiduously frined in his Historia medicinee says that the writings of the old Greeks which treated of medicine were saved from destruction with the other books at Alexandria for the desire of health did not have less strength among the Arabs than among other nations since these books taught them how to preserve health and were not otherwise contrary to the laws of the prophet that served to bring about their preservation frined also calls attention to the fact that grammars and books which treated of the science of language were likewise saved from destruction besides the library of the Arabs after their conquest of Alexandria in the 8th century came under the influence of the university still in existence there in the west, in Spain the Arabs enjoyed the same advantages as regards contact with culture and education as their conquest of the eastern cities and Alexandria brought them in the east while it is not generally realized what the meaning was as we have pointed out the province of the Roman Empire in the west that advanced most in culture before the breaking up of the empire the silver age of Latin literature owes all of its geniuses to Spain Lucan, the Seneca's Marshal, Quintilian are all Spaniards Spain itself was a most flourishing province Spanish Caesars from the end of the 1st to about the end of the 2nd century increased rapidly in population Spain was the leader in these prosperous times and the tradition of culture maintained itself when Spain became Christian the first great Christian poet, Prudentius born about the middle of the 4th century came from there he has been called the first in Virgil of the Christians the coming down of the barbarians from the north disturbed Spain's prosperity and the peace and culture of her inhabitants but it should not be forgotten that the first medieval popularization of science a sort of encyclopedia of knowledge the first of its kind after that of Pliny in the classical period came from Saint Isidore of Seville a Spanish Bishop there has been considerable tendency to insist that Spanish culture and intellectuality owe nearly all to the presence of the Moors in Spain this can only be urged however by those who know nothing at all of the Spanish Caesars the place of Spain in the history of the Roman Empire and the continuance of the culture that then reached a climax of expression during succeeding centuries on the contrary the Moors who came to Spain owe most of their tendency to devote themselves to culture and education to the state of affairs existent in Spain when they came there is no doubt that they raise standards of education and of culture above the level to which they had sunk under the weight of the invading barbarians from the north and Spain owes much to the wise ruling and devotion to the intellectual life of her Moorish invaders all the factors however must be taken together in order to appreciate properly the conditions which developed under the Arabs in both the east and the west the Arabs invented little that was new in science or philosophy carried on older traditions it is for that that the modern time owes them a great debt of datitude Raziz the most distinguished of the Arabian physicians was the man whose rather lengthy Arabian name beginning with Abu Bekir Mohammed finished with El-Razi and who has hence been usually referred to in the history of medicine as Raziz he was born about 850 at Raj in the province of Khorasan in Persia he seems to have had a liberal early education in philosophy and in philology and literature he did not take up medicine until later in life and according to tradition supported himself as a singer until he was 30 years of age then he devoted himself to medical studies with the ardor and the success so often noted in those whose opportunity to study medicine has been delayed his studies were made at Baghdad where Ibn Zain al-Tabari was his teacher he returned to his native town and was for some time the head of the hospital there later he was called by the Sultan to Baghdad to take charge of the renovated and enlarged hospital of the capital his medical career then is not unlike that of many another successful physician especially of the modern time at Baghdad he had abundant opportunities for study and the ambition to make medicine as well as to make money and gain fame his studies in science were all founded on Aristotle though he was called the Galen of his time and looked up to the Greek physician as his master even the authority of Galen did not override that of the stagiorite in his estimation one of his aphorisms is said to have been quote, if Galen and Aristotle are of one mind on a subject then surely their opinion is true when they differ however it is extremely difficult for the scholar to decide which opinion should be accepted end quote he drew many pupils to Baghdad and when one knows his teaching this is not surprising some of his aphorisms are very practical while the expressions just quoted with regard to Galen and Aristotle might seem to indicate that Rosses was absolutely true authority there is another well-known maxim of his which shows how much he thought of the value of experience and observation quote, truth in medicine he said quote is a goal which cannot be absolutely reached and the art of healing as it is described in books is far beneath the practical experience of a skillful physician end quote some of his other medical aphorisms are worth noting at the beginning of a disease choose such remedies as will not lessen the patient's strength when you can heal by diet prescribe no other remedy and where simple remedies suffice do not take complicated ones end quote well, the value of the influence of mind over body even in serious organic disease and even though death seemed impending one of his aphorisms is physicians ought to console their patients even if the signs of impending death seem to be present for the bodies of men are dependent on their spirits end quote the most valuable thing for the physician to do was to increase the patient's natural vitality hence his advice quote let your first thought be to strengthen his natural vitality if you strengthen that you will remove ever so many ills without more ado if you weaken it however by the remedies that you use you always work with your heart end quote the simpler the means by which the patient's care can be brought about the better in his opinion he insists again and again on diet rather than artificial remedies it is good for the physician that he should be able to cure disease by means of diet if possible rather than by means of medicine his aphorisms seems worthwhile quoting the patient who consults a great many physicians is likely to have a very confused state of mind end quote some idea of razi's strenuous activity as a writer on medical subjects may be obtained from the fact that 36 of his works are still extant and there are nearly 200 others of which only the titles have been preserved some of these are doubtless the works of pupils and students of succeeding generations published under his name to attract attention his principal work is continent's or comprehensor which owes its title to the fact that it was meant to contain the whole practice of medicine and surgery and it owes to the writings of all previous distinguished medical writers from Hippocrates to Honain Ben Ishak also known as Yohanitis a Christian Arabian physician one of razi's teachers the most frequently quoted of these authorities are Galen or Abasius and Paul of Ejina the work however it is not made up entirely of quotations but contains many observations made by the author himself girl says that the foundation of the theoretic medicine of razi's is the system of Galen while in practice he seems to cling more to the aphorisms of Hippocrates he has many practical points which show that he thought for himself for instance in wounds of the abdomen if the intestines are extruded and cannot be replaced he suggests the suspension of the patient by his hands and feet in a bath in order to facilitate their return if they do not go back readily compresses dipped in warm wine should be used cancer he declares to be almost incurable he has much to say about the bites and their tendency to be poisonous new rabies very well and new also that the bites of men might have similar serious consequences it is impossible to give any adequate idea of the thoroughly practical character of razi's medical writing in a few lines but it may suffice to say that there is scarcely any feature of modern medicine and surgery that he does not touch and oftener than not his touch is sure and rational and frequently much better than the advice of successors long after him in the same matters an example or two will suffice to illustrate this in the treatment of nasal polyps he says that whenever drug treatment of these is not successful they should be removed with a snare made of hair in the fall of the uvula he suggests gargles but when these fail he advises resection and cauterization among the affections of the tongue he numbers abscesses fissure ulcer cancer ranula shortening of the ligaments hypertrophy erythema of the mucous membrane and inflammatory swelling in general this treatment of the upper respiratory tract is much further advanced than we might think possible at the time he advises tracheotomy whenever there is great difficulty of respiration and describes how it should be done after the dyspnea has passed the edges of the wound should be brought together with sutures it is not surprising then to find that the treatment of fractures and luxations is eminently practical and indeed, on any subject that he touches he throws a practical light in the introduction to his edition of the works of embroise pare malgaigne says that the first reference to a metal band in connection with trusses is to be found in razies hernia was, of course one of the serious ailments that because of its superficial character was rather well understood and so it is not surprising to find that much of our modern treatment of it was anticipated the manipulation for taxes the use of a warm bath for the relaxation of the patient by means of heat and by putting the head and feet higher than the abdomen while in the bath and the employment of various kinds of trusses to prevent strangulation of the hernia recur over and over in the authors of the middle ages many of the suggestions are to be found in the early Greek authors but subsequent writers give a certain personal expression to them which shows how much they had learned by personal observation in the employment of various methods Pagle in Pushman's Handbook of the History of Medicine declares that razies most important work for pure medicine is his monograph on smallpox its principal value is due to the fact that though he has consulted old authorities carefully his discussion of the disease is founded almost entirely on his own experience his description of the various stages of the disease on the forms of the eruption and of the differential diagnosis is very accurate he compares the course of the fever with that of other fevers and brings out exactly what constitutes the disease his suggestions as to prognosis are excellent those cases he declares are particularly serious in which the eruption takes on a dark or greenish or violet color the prognosis is also unfavorable for those cases which having considerable fever have only a slight amount of rash his treatment of the disease in young persons was by venisection and cool douches cold water and acid drinks should be administered freely so that sweat and other excretions may carry off poisonous materials care must be taken to watch the pulse the breathing the appearance of the feet the evacuations from the bowels and to modify therapy in accordance with these indications the eruption is to be encouraged by external warmth and special care must be taken with regard to complications in the eyes the ears, the nose and the pharynx a fact that will, perhaps give the best idea to modern readers of the place of rosies in the history of medicine is that the salius considered it worth his while to make a translation of his principal work unfortunately that translation has not come down to us when the salius pestered by the controversies that had come upon him because of his venturing to make his observations for himself accepted the post of physician to the emperor charles fifth he burnt a number of his manuscripts among these were his translation of rosies and some annotations on galen which as he says himself had grown into a huge volume the galenists were bitterly decrying his refusal to accept galen on many points and both of these works would have added fuel to the flame of controversy he deemed it wiser then not to give any further opportunities for rancorous criticism and feeling presumably that in his new and important post it was not worthwhile to bother further over the matter he burnt them he tells the reason in his letters to joaquin roland when i was about to leave italy to go to court since a number of the physicians whom you know had made the worst kind of censure of my books both to the emperor himself and to other rulers i burnt all the manuscripts that were left although i had never suffered a moment under the displeasure of the emperor because of these complaints and in spite of the fact that a number of friends who were present urged me not to destroy them the salius' translation of rasis was probably undertaken because he recognized in him a kindred spirit of original investigation and inquiry to his work because it was many centuries old would command the weight of an authority and at the same time help in the controversy over galenic questions this of itself would be quite enough to make the reputation of rasis even if we did not know from the writings themselves and from the admiration of many distinguished men as well as he incented that his works have so often proved to original observation link in the chain of observers in medicine who, though we would naturally expect them to be so frequent are really so rare end of part one of two chapter five of old time makers of medicine this is a LibriVox recording all LibriVox recordings are in the public domain for more information or to volunteer please visit LibriVox.org recording by Adam Marsatich September 2009 Alexandria, Virginia old time makers of medicine by James Joseph chapter five great Arabian physicians part two of two Ali Abbas rasis lived well on into the 10th century his successor in prestige though not his serious rival was Ali Ben Abbas usually spoken of in medical literature as Ali Abbas it distinguished Arabian physician who died near the end of the 10th century he wrote a book on medicine which because of its dedication to the Sultan to whom he was body physician is known as the Libre Regius or Royal Book of Medicine this became the leading textbook of medicine for the Arabs until replaced by the Canon of Avicenna some two centuries later the Libre Regius was an extremely practical work and like most of the Arabian books of the early times is simple and direct quite without many of the objectionable features that developed later in Arabian medicine it is valuable mainly for its contributions to diet Ali Abbas tested many of his medicines on ailing animals before applying them to men of course it owes much to earlier writers on medicine and especially to Paul of Aegina an example of its practical value is to be found in his description of the treatment of a wound in the brachial artery when as happened often in Venice section from Median basilic vein it was injured through carelessness or inadvertence if astringent or cauterizing methods do not stop the bleeding the artery should be exposed carefully isolated tied in two places above and below the wound and then cut across between them he has many similar practical bits of technique for instance in pulling a back tooth he recommends that the gums be incised so as to loosen them around the roots and then the tooth itself may be drawn with a special forceps which he calls a molar forceps in ascites he recommends that when other means fail an opening should be made three finger breaths below the navel with a pointed phlebotomy knife and a portion of the fluid allowed to evacuate itself a tube should then be inserted but closed the next day more of the fluid should be allowed to come away and then the tube removed and the abdomen wrapped with a firm bandage it is easy to understand that Ali Abba's book should have been popular and the more we know of it the easier it is to explain why Constantine africanus should have selected it for translation it contains ten theoretic and ten practical books and gives an excellent idea of the medical knowledge and medical practice of the time probably the fact that Constantine had translated it led to its early printing so that we have an edition of it published at Venice in 1492 and another at Leones in 1523 during the middle ages the book was often spoken of by Alice Dispositio the royal disposition of medicine Moorish physicians after Razis the most important contributors to medical literature from among the Arabs with the single exception of Avicenna were born in Spain they are Albuquesis or Abulqasis the surgeon Avenzor the physician and Averroes the philosophic theorist in medicine besides it may be recalled here that Maimonides the great Jewish physician was born and educated at Cordova in Spain it might very well be a surprise that these distinguished men among the Arabs should have flourished in Spain so far from the original seat of Arabian and Mohammedan where, owing to conditions in the modern time the English speaking world particularly is not likely to assume that the environment was favorable for the development of science and philosophy anyone who recalls however, the history of Spanish intellectual influence in the Roman Empire as we have traced it at the beginning of this chapter will appreciate how favorable conditions were for Spain for the fostering of intellectual development with the disturbances that had come from political strife and the invasion of the barbarians in Italy Spain had undoubtedly come to hold the primacy in the intellectual life of Europe at the time when the Arabs took possession of the peninsula Abulqasis the most important of the Arabian surgeons is Abulqasis or Abulqasis also Abulqasim who was born near Cordova in Spain the exact year of his birth is not known but he flourished in the second half of the 10th century he is said to have lived to the age of 101 the name of his principal work which embraces the whole of medicine is Altasrief which has been translated the miscellany most of what he has to say about medical matters is taken from Raziz his work on surgery however in three books represents his special contribution to the medical sciences it contains a number of illustrations of instruments and is the first illustrated medical book that has come to us it was translated into Latin and was studied very faithfully by all the surgeons of the middle ages Guy de Choliak has quoted Abulqasis about 200 times in his Chiroguia magna even as late as the beginning of the 16th century Fabricius de Aquapedente the teacher of Harvey confessed that he owed most to three great medical writers Celsus Filius Celsus Paul of Agena 7th century Abulqasis 10th century Abulqasis insisted that for successful surgery a detailed knowledge of anatomy was above all necessary he said that the reason why surgery had declined in his day was that physicians did not know their anatomy the art of medicine further required much time unfortunately to quote Hippocrates there are many who are physicians in name only and not in fact especially in what regards surgery he gives some examples of surgical mistakes made by his professional brethren that were particularly called to his attention they are the perennially familiar instances of ignorance causing death because doctors were tempted to operate too extensively his description of the procedure necessary to stop an artery from bleeding is an interesting example of his method of teaching the practical technique of surgery apply the finger promptly upon the opening of the vessel and press until the blood is arrested having heated a cottery of the appropriate size take the finger away rapidly touch the cottery at once to the end of the artery until the blood stops if the spurting blood should cool the cottery, take another there should be several ready for the purpose take care, he says not to cotterize the nerves in the neighborhood for this will add a new ailment to the patient's affection there are only four ways of arresting arterial hemorrhage 1. by division of the artery 2. by division of the artery when that is not complete for then the extremities contract and the blood clots or by a ligature or by the application of substances which arrest blood flow aided by a compressive bandage other means are inefficient and seldom and at most accidentally successful his instruction for first aid to the injured in case of hemorrhage in the absence of the physician is to apply pressure directly upon the wound itself the development of the surgical specialties among the Arabs is particularly interesting Abul Qasas has much to say about nasal polyps he divided them into three classes 1. cancerous 2. those with a number of feet and 3. those that are soft and not living these latter he says are neither malignant nor difficult to treat he recommends the use of a hook for their removal or a snare for those that cannot be removed with that instrument his instructions for the removal of objects from the external ear are interestingly practical he advises the use of bird lime on the end of a sound to which objects will cling or where they are smaller suction through a silver or copper cannula hooks and pin sets are also suggested insects should be removed with the hook or with the cannula or having been killed by warm oil removed by means of a syringe some of his observations with regard to genitourinary surgery are quite as interesting he even treated congenital anomalies he suggests cutting of the meadis when narrowed dilation of strictures with lead sounds and even suggests plans of operations to improve the condition in hypospadias he gives the signs for differentiation between epitheliomata and condolomata and distinguishes various forms of ulceration of the penis obu cases discusses vericose veins in a very much the same spirit as a modern surgeon does they occur particularly in people who work much on their feet and especially who have to carry heavy burdens they should not be operated on unless they produce great discomfort and make it impossible for the sufferer to make his living they may be operated on by means of incision or extirpation incision consists of cutting the veins at two or three places where they have been made prominent by means of tight bandages around the limb the blood should be allowed to flow freely out of the cut ends and then a bandage applied for extirpation the skin having been shaved beforehand the vein should be made prominent and then carefully laid bare when freed from all adhesions it should be lifted out on a hook and either completely extirpated or several rather long pieces removed he lays a good deal of stress on the necessity for freeing the vein thoroughly and lifting it well out of tissues in old cases special care must be taken not to tear the vein minute details of technique are often found in these old authors obel cases for instance treats of adherent fingers with up to date completeness they can occur either congenitally or from injury as for instance burning they should be separated by separation maintained by means of bandages or by the insertion between them of a thin lead plate which prevents their re-adhesion adhesions of the fingers with the palm of the hand which obel cases has also seen should be treated the same way at times there is surprise at finding some rare lesion treated with modern technique and a hint at least of modern apparatus fracture of the pubic arch for instance is described in obel cases quite as if he had definite experience with it when this occurs in a woman the reposition of the bone is often greatly facilitated by a cotton tampon in the vagina this tampon must be removed at every urination there is another way however of securing the same purpose of counter pressure one may take a sheep's bladder into the orifice of which a tube is fastened one should introduce the bladder into the vagina and then blow strongly through the tube until the bladder becomes swollen and fills up the vaginal cavity the fracture will as a rule then be readily reduced here is, of course not alone the small pure inter but a very practical form of the apparatus complete old time physicians use the bladders of animals very generally for nearly all the medical purposes for which we now use rubber bags Avicenna undoubtedly the most important of obel cases contemporaries is the famous physician whose Arabic name was transformed into Avicenna he was born toward the end of the 10th century in the Persian province of Khorasan at the height of Arabian influence and is sometimes spoken of as the chief representative of Arabian medicine as of much importance for it as Galen for later Greek medicine his principal book is the so called canon replaced the compendium contents of razzis and in the east continued until the end of the 15th century to be looked upon as the most complete and best system of medicine Avicenna came to be better known in the west than any of the other Arabian writers and his name carried great weight with it there are very few subjects in medicine that he did not receive as suggestive if not always adequate treatment at the hands of this great Arabian medical thinker of the 11th century he copied freely from his predecessors but completed their work with his own observations and conclusions one of his chapters is devoted to leprosy alone he has definite information with regard to bubonic plague and the filaria nesses here and there one finds striking anticipations of what are supposed to be modern observations nothing was too small for his notice one portion of the fourth book is on cosmetics in which he treats the affections of the hair and of the nails he has special chapters with regard to obesity emaciation and general constitutional conditions in the book the antidotarium is the foundation of our knowledge of the drug giving of his time some idea of the popularity and influence of avicenna five centuries after his time can be readily derived from the number of commentaries on him issued during the renaissance period by the most distinguished medical scholars and writers of that time so in his das arabische un hebraische indoor anatomy quote some of them Bartholomeas de Varignana Gentilus de Folgenis Jacobus de Partibus Deidesis Lopez Jacobus de Forlivio Hugo Sinesis Dinas de Garbo Mathias de Gratibus Nicholas Leonis Senus Thaddeus Florentinius Geladis de Sancta Sophia a more complete list with the titles of the books may be found in Heiler's Bibliotheca Anotomica for over three centuries after the foundation of medical schools in Europe and even after Mondino's book had been widely distributed Avicenna was still in the hands of all those who had an enthusiasm for medical science Avanzor Another of the distinguished Arabian physicians was Avanzor the transformation of his Arabic family name Ibnzor He was probably born in Peneflor from Seville He died in Seville at 1162 at the age of 92 years He was the son of a physician descended from a family of scholars, jurists physicians and officials He received the best education of the time not only in internal medicine but in all the specialties and must be counted among the greatest of the Spanish Arabian physicians He was a teacher of Avaros who always speaks of him with great respect He is interesting as probably being the first to suggest nutrition per rectum A few words of his description show how well he knew the technique His apparatus for the purpose consisted of the bladder of a goat or some similar animal structure with a silver cannula into its neck to be used about as we use a fountain syringe Having first carefully washed out the rectum with cleansing and purifying clisters he injected the nutriment eggs, milk and gruel into the gut His idea was that the intestine would take this and as he said suck it up carrying it back to the stomach where it would be digested He was sure that he had seen his patients benefitted by it Some light on his studies of cases that would require such treatment may be obtained from what he has to say about the handling of a case of stricture of the esophagus He says that this begins with some discomfort and then some difficulty of swallowing which is gradually and continuously increased until finally there comes complete impossibility of swallowing It was in these cases that he suggested rectal alimentation but he went farther than this and treated the stricture of the esophagus itself The first step in this treatment is that a cannula of silver or tin should be inserted through the mouth and pushed down the throat till its head meets an obstruction It is being withdrawn when there is a vomiting movement until it becomes engaged in the stricture Then freshly milked milk or gruel made from farina or barley should be poured through it He says that in these cases the patient might be put in a warm milk or gruel bath since there are some physicians who believe that through the lower parts of the body the pores of the whole body nutrition might be taken up While he considers that this latter method should be tried in suitable cases he has not very much faith in it and says that the reasons urged for it are weak and rather frivolous It is easy to understand that a man who has reached the place in medicine where he can recommend manipulative treatments of this kind and discuss nutritional modes professionally knew his practical medicine well and wrote of it judiciously Avarose Among the distinguished contributors to medicine at this time the more a philosopher than a physician is the famous Avarose whose full Arabic name among his contemporaries was Abul Walid Mohammed Ben Ahmed Ibn Rojt El Maliki Like Avan Zor of whom he was the intimate personal friend and Abul Qasus and Maimonides he was born in the south of Spain He was in high favor with the king of Morocco and of Spain El Mansour Jacob often known as El Mansour who made him one of his counselors His works are much more important for philosophy than for medicine and his philosophical writings gave him a place only second to that of Aristotle in the western world during the middle ages Avaroism is still a subject of at least academic interest and Renan's monograph on it and its author was one of the popular books of the latter half of the 19th century in philosophic circles In spite of his friendship with the Moorish king and with Avan Zor he fell under the suspicion of free thinking and was brought to trial with a number of personal friends who occupied high positions in the Moorish government He escaped with his life but only after great risks and he was banished to a suburb of Cordova in which only Jews were allowed to live He hated in securing the pardon of himself and friends and then was summoned to the court of the son and the successor of El Mansur in Morocco He died not long after in 1198 Altogether there are some 33 works of Avaros on philosophy and science Only three of these are concerned with medicine One is the Kali Ghet containing seven books on anatomy, physiology pathology, diagnostics materia medica hygiene and therapy Then there is a commentary on the Contica of Avicenna and a track date on the Theriac Avaros idea in writing about medicine was to apply his particular system of philosophy to medical science His intimate relations with other great physicians of the time and in particular his close friendship with Avanzor enabled him to get abundant medical information in faultless order so far his knowledge then went but his theoretic speculations instead of helping medicine as he thought they would and as philosophers have always been inclined to think as regards their theoretic contributions were not only not of value but to some extent at least hindered human progress by diverting men from the field of observation to that of speculation It is interesting to realize that Avaros did in his time what Descartes did many centuries later and many another brilliant thinker has done before and since Arabian Influence The fame of these great thinkers and writers in philosophy and in medicine came to be known not only through the distribution of their books long after their death but during their lifetime and in immediately subsequent generations ardent seekers after knowledge who were themselves afterwards to become famous by their teaching and writing found their way into the Arabian dominions in order to take advantage of the educational opportunities afforded These were better than they could secure at home in Christian countries because the process of bringing culture and devotion to literature and science into the minds of the northern nations who had replaced the old Romans in Europe was not yet completed Baghdad and Cordova were the two favorite places of educational pilgrimage The names that are most familiar among the scholars in the middle ages in Europe are those of whom it is recorded that they made long journeys in order to get in touch with what the Arabs had preserved of the old Greek civilization and culture Among them are such men as Michael Scott or Scottus who was afterwards a great teacher at Salerno Daniel Morley Edelard of Bath Egedius otherwise known as Giles de Corbile Romaldus Gerbert of Avernier who later became Pope under the name of Sylvester II Gerard of Cremona and the best known of them all at least in medicine Constantine Africanus whose wanderings, however were probably not limited to Arabian lands but who seems also to have been in Hindustan We are rather prone to think that this great spirit of going far afield for knowledge's sake is recent or at least quite modern as a matter of fact one finds it everywhere in history Long before Herodotus did his wanderings there were many visitors who went to Egypt and many more later who went to Crete and many more a few centuries later who went to the shores of Asia Minor seeking for the precious pearl of knowledge and sometimes finding it without finding the even more precious pearl of wisdom whose worth is from this coasts to the Arabs we owed the foundation of a series of institutions for the higher learning like those which had existed around them in Asia Minor and in Egypt at the time they made their conquest Alexandria Pergamus Kos and many other eastern cities had had what we would call at least academies and many of them deserved the name of universities the Arabs continued the tradition in education that they found and established educational institutions which attracted wide attention as we have said the two most famous of these were at Baghdad and at Cordova Most answer the predecessor of the last caliph of the family of the Abbasids built a handsome palace in which the academy of Baghdad was housed it is still in existence and gives an excellent idea of the beneficent interest of this monarch and of other of the Abbasidi rulers in education it's fate at the present time is typical of the attitude of the Mohammedans toward education though the building is still standing the institution of learning is no longer there as hurdle remarks it is not ideas that are exchanged in it now but articles of commerce it has become the chief office of the Turkish customs department in Baghdad these institutions of the higher learning founded by the Arabs at first as rather strict imitations of the museums or academies of Egypt and Asia Minor gradually changed their character under the Arabs their courses became much more formal examinations became much more important scholarship was sought not so much for it's own sake as because it led to positions in the civil service to the favor of princes and in general to reputation and pecuniary reward formal testimonials proclaiming education signed by the academic authorities were introduced and came to mean much lawyers could not practice without a license physicians also required a license these formalities were adopted by the western medical universities to a considerable degree and have been perpetuated in the modern time undoubtedly they did much to hamper real education among the Arabs by setting in place of the satisfaction of learning for it's own sake and the commendation of teachers the formal recognition of a certain amount of work done as recognized by the educational authorities there was always a tendency among the Arabs to formulate and formalize to over systematize what they were at to think that new knowledge could be obtained simply by speculating over what was already acquired and developing it there are a number of comparisons between this and later periods of education that might be suggested if comparisons were not odious the influence of Arabian medicine on modern medicine can perhaps best be judged from the number of words in our modern nomenclature which though comparing Latin forms often with suggestion of Greek origins still are not derived from the old Latin or Greek authors but represent Arabic terms translated into Latin during the Renaissance period hurdle without pretense of quoting them all gives a list of these which is surprising in its comprehensiveness for instance the mediastinum the sagittalis the scrubiculus cordus the marsupium cordus the chambers of the heart the vellum palatii the trochanter the rima glotidis the fontanels the alea of the nose all have their present names not from original Latin expressions but from the translation of Arabic terms for all such words the Greeks and Romans have quite other expressions in which the sense of our modern terms is not contained this has given rise to many misunderstandings and to many attempts in the modern times to return to the classic terminology rather than preserve what in many cases are the barbarisms introduced through the Arabic but it is doubtful whether hence of reform in the matter can be effected so strongly entrenched in medical usage have these terms now become refined in his history of medicine already cited calls attention to the fact that the Arabs had an unfortunate tendency to change by addition or subtraction of their own views the authors that they studied and wished to translate to others this seems to have been true even of some of the most distinguished of them of course, the idea of preserving an author's text untouched and making it clear just where note and commentary come in had not come to men's view but quite apart from this the Arabs apparently often tried to gain acceptance for their own ideas by having them masquerade as the supposed ideas of favorite classic authors another unfortunate tendency among the Arabs was their liking for the discussion of many trivial questions hurdle in his volume on Arabian and Hebrew words in anatomy declares that it is almost incredible how earnestly some trivial questions in anatomy and physiology were discussed by the Arabs some examples why does no hair grow on the nose of men why does the stomach not lie behind the mouth why does the windpipe not lie behind the esophagus why are the breasts not on the abdomen why are the calves on the anterior portion of the legs even such men as Rosies and Avicenna discussed such questions it was this tendency of the Arabs that passed over to the western Europeans with Arabian commentaries on philosophy and science and brought so many similar discussions in the scholastic period these trivialities have usually been supposed to originate with the scholastics themselves for they are not to be found in the Greek authors on whom the scholastics were writing commentaries but they are typically oriental in character and it must be remembered that during the 12th and early 13th centuries at least Greek philosophy found its way largely into Europe in Arab versions and these characteristically Arabian editions of the discussion of curious trivial questions came with them and produced an imitative tendency among the Europeans as a rule the more careful has been the study of Arabian writers in the modern time particularly by specialists the clearer it has become that they lack nearly all originality especially were they faulty in their observations besides they had a definite tendency to replace observation by theory of fatal defect in medicine the fine development of surgery that came at the end of the Arabian period of medicine in Europe could never have come from the Arabs themselves girl has brought this out particularly but it will not be difficult to cite many other good authorities in support of this opinion hurdle in his thesis on the rarer old anatomists says that quote the Arabs paid very little attention to anatomy and of course because of the prohibition in the Quran added nothing to it whatever they knew they took from the Greeks and especially Galen not only did they not add anything new to this but they even lost sight of much that was important in the older authors the Arabs were much more interested in physiology they could study this by giving thought to it without soiling their hands they delighted in theory rather than in observation end quote while we thus discuss the lack of originality and the tendency to over refinement among the Arabian medical writers it must not be thought that we would make little of what they accomplished they not only preserved the old medical writers for us but they kept alive practical medicine with the principles of the great Greek thinkers as its basis there are a large number of writers of Arabian medicine whose names have secured deservedly a high place in medical history if this were a formal history of Arabian medicine their careers and works would require discussion for our purpose however better to confine attention to a few of the most prominent Arabian writers on medicine because they will serve to illustrate how thoroughly practical were the Arabian physicians and how many medical problems that we are prone to think of as modern they occupied themselves with solving them not infrequently nearly as we do in the modern time end of chapter 5