 Chapter 2 of Old Time Makers of Medicine. Chapter 2, Part 3 of 3. Alexander Alexander's first book of pathology and therapeutics treats of head and brain diseases. For baldness, the first symptom of which is falling out of the hair. He consoles cutting the hair short, washing the scalp vigorously, and the rubbing in of sulfur ointments. For gray hair, he suggests certain hair dyes as nut galls, red wine, and so forth. For dandruff, which he described as the excessive formation of small flake-like scales, he recommends rubbing with wine with certain salves and washing with salt water. He gives a good deal of attention to diseases of the nervous system. He has a rather interesting chapter on headache. The affection occurs in connection with fevers, after excess in drinking, and as a consequence of injury to the skull. Besides, it develops as a result of disturbances of the natural processes in the head, the stomach, the liver, and the spleen. Headache, as the first symptom of inflammation of the brain, is often the forerunner of convulsions, delirium, and sudden death. Chronic or recurrent headache occurs in connection with plethora, diseases of the brain, biliousness, digestive disturbances, insomnia, and continued worry. Hemicrania has its origin in the brain because of the presence of toxic materials and especially their transformation into gaseous substances. It also occurs in connection with abdominal affections. This latter remark particularly is directed to the cases which occur in women. For apoplexy and the consequent paralysis, Alexander considered venisection the best remedy. Massage, rubbings, baths, and warm applications are recommended for the paralytic conditions. He had evidently had considerable experience with epilepsy. It develops either from injuries of the head, or from disturbances of the stomach, or occasionally other parts of the body. When it occurs in nursing infants, nourishment is the best remedy, and he gives detailed directions for the selection of a wet nurse and very careful directions as to her mode of life. He emphasizes very much the necessity for careful attention to the gastrointestinal tract in many cases of epilepsy. Planned diet and regular bowels are very helpful. He rejects treatment of the condition by surgery of the head, either by trefining or by incisions or cauterization. Regular exercise, baths, sexual abstinence are the foundation of any successful treatment. It is probable that we have returned to Alexander's treatment of epilepsy much more nearly than is generally thought. There are those who still think that remedies of various kinds do good, but in the large epileptic colonies, regular exercise, planned diet, regulation of the bowels, and avoidance of excesses of all kinds, with occupation of the mind, constitute the mainstay of their treatment. Alexander has much to say with regard to phrenitis, a febrile condition complicated by delirium, which, following Galen, he considers an affection of the brain. It is evidently the brain fever of the generations preceding the last, an important element of which was made up of the infectious meningitis. Alexander suggests its treatment by opiates after preliminary venous action, rubbings, lukewarm baths, and stimulating drinks. Every disturbance of the patient must be avoided, and visitors must be forbidden. The patient's room should rather be light than dark. His teaching crops up constantly in the centuries after his time until the end of the 19th century, and while we now understand the causes of the condition better, we can do little more for it than he did. Alexander divided mental diseases into two, the maniacal and melancholic. Mania was, however, really a further development of melancholia, and represented a high grade of insanity. Under melancholy, he groups not only what we demonstrate by that term, but also all depressed conditions, and the paranoias, and also many cases of imbecility. The cause of mental diseases was to be found in the blood. He counseled the use of venous action, of laxatives and purgatives, of baths and stimulant remedies. He insisted very much, however, on mental influence in the disease, on change of place and air, visits to the theatre, and every possible form of mental diversion, as among the best remedial measures. After his book on diseases of the head, his most important section is on diseases of the respiratory system. In this, he treats first of angina, and recommends as gargles, at the beginning, distringents, later stronger astringents, as alum and soda dissolved in warm water should be employed. Warm compresses, venous action from the sublingual veins, and from the jugular, and purgatives, in severe cases, are the further remedies. He treats of cough as a symptom due to hot or cold, drier wet dyscraseas. Opium preparations carefully used are the best remedies. The breathing in of steam impregnated with various ethereal resins was also recommended. He gives a rather interesting, wee modern treatment of consumption. He recommends an abundance of milk, with a strong nutritious diet, as digestible as possible. A good auxiliary to this treatment was change of air, a sea voyage, and a stay at a watering place. Asses and mare's milk are much better for these patients than cows and goats' milk. There is not enough difference in the composition of these various milks to make their special consumption of import, but it is probable that the suggestive influence of the taking of an unusual milk had a very favorable effect upon patients, and this effect was renewed frequently, so that much good was ultimately accomplished. For hemoptysis, especially when it was acute and due as Alexander thought to the rupture of a blood vessel in the lungs, he recommended the opening of a vein at the elbow or the ankle in order to divert the blood from the place of rupture to the healthy parts of the circulation. He insisted that the patients must rest, that they should take acid and astringent drinks, that cold compresses should be placed upon the chest, our ice bags, and that they should take only a liquid diet at most lukewarm, or better, if agreeable to them, cold. When the bleeding stopped, a milk cure was very useful for the restoration of these patients to strength. It is not surprising then to find that Alexander suggests a thoroughly rational treatment for pleurisy. He recognizes this as an inflammation of the membrane covering the ribs, and its symptoms are severe pain, disturbance of breathing, and coughing. In certain cases, there is severe fever, and Alexander knows of purulent pleurisy, and the fact that when pus is present, the side on which it is warmer than the other. Pleurisy can be, he says, rather easily confounded with certain liver affections, but there is a peculiar hardness of the pulse, characteristic of pleurisy, and there is no expectoration in liver cases, though it also may be absent in many cases of pleurisy. Sufferers from liver disease usually have a paler color than pleuristics. His treatment consists in venisection, purgatives, and, when pus is formed, local incision. He recommends the laying on of sponges dipped in warm water and the internal use of honey lemonade. Opium should not be used unless the patient suffers from sleeplessness. Some of the general principles of therapeutics that Alexander lays down are very interesting, even from our modern standpoint. Trust should not be placed in any single method of treatment. Every available means of bringing relief to the patient should be tried. Quote, the duty of the physician is to cool what is hot, to warm what is cold, to dry what is moist, and to moisten what is dry. He should look upon the patient as a besieged city and try to rescue him with every means that art and science places at his command. The physician should be an inventor and think out new ways and means by which the cure of the patient's affection and the relief of his symptoms may be brought out. The most important factor in his therapeutics is diet. Watering places and various forms of mineral waters as well as warm baths and sea baths are constantly recommended by him. He took strong ground against the use of many drugs and the rage for operating. The prophylaxis of disease is, in Alexander's opinion, the important part of the physician's duty. His treatment of fever shows the application of his principle. Cold baths, cold compresses, and a cooling diet were his favorite remedies. He encouraged diaphoresis nearly always and gave wine and stimulating drugs only when the patient was very weak. He differentiates two kinds of quarten fever. One of these he attributes to an affection of the spleen, because he had noticed that the spleen was enlarged during it and that, after purgation, the enlarged spleen decreased in size. Alexander was a strong opponent of drastic remedies of all kinds. He did not believe in strong purgatives nor in profuse and sudden bloodlettings. He opposed arteriotomy for this reason and refused to employ extensive cauterization. His diagnosis is thorough and careful. He insisted particularly on inspection and palpation of the whole body on careful examination of the urine of the feces and the sputum, on study of the pulse and the breathing. He thought that a great deal might be learned from the patient's history. The general constitution is also of importance. His therapeutics is, above all, individual. Remedies must be administered with careful reference to the constitution, the age, the sex, and the condition of the patient's strength. Special attention must always be paid to nature's efforts to cure, and these must be encouraged as far as possible. Alexander had no sympathy at all with the idea that remedies must work against nature. His position in this matter places him among the dozen men whose name and writings have given them an enduring place in the favor of the profession at all times when we were not being carried away by some therapeutic fad or imagining that some new theory solved the whole problem of the causation and cure of disease. Gert, in his history of surgery, has abstracted from Alexander particularly certain phrases of what the Germans call external pathology and therapeutics. For instance, Alexander's treatment of troubles connected with the ear is very interesting. Gert declares that this chapter alone provides striking evidence for Alexander's practical experience and power of observation as well as for his knowledge of the literature of medicine. He considers that only a short abstract is needed to show that. For water that has found its way into the external ear, Alexander suggests a mode of treatment that is still popularly used. The patient should stand upon the leg corresponding to the side on which there is water in the ear, and then, with head leaning to that side, should hop or kick out with the other leg. The water may be drawn out by means of suction through a reed. In order to get foreign bodies out of the external auditory canal, an ear spoon or other small instrument should be wrapped in wool and dipped in turpentine or some other sticky material. Occasionally, he has seen sneezing, especially if the mouth and nose are covered with a cloth and the head lent toward the affected side, bring about a dislodgement of the foreign body. If these means do not succeed, gentle injections of warm oil or washing out of the canal with honey water should be tried. Foreign bodies may also be removed by means of suction. Insects or worms that find their way into the ear may be killed by injections of acid and oil or other substances. Girl also calls attention to Alexander's careful differentiation of certain very dangerous forms of inflammation of the throat from others which are rather readily treated. He says, quote, Inflammation of the throat may, under certain circumstances, belong to the severest diseases. The patients succumb to it as a consequence of suffocation, just as if they were choked or hanged. For this reason, perhaps, the affection bears the name synanche, which means constriction, end quote. He then points out various other forms of inflammation of the throat, acute and chronic, suggesting various names of the differential diagnostic signs. One of the most surprising chapters of Alexander's knowledge of pathology and therapeutics is to be found in his treatment of the subject of intestinal worms, which is contained in a letter sent by him to his friend Theodore, whose child was suffering from them. He describes the oxiurus vermicularus with knowledge manifestly derived from personal observation. He dwells on the itching in the region of the anus, caused by the oxiurus, and the fact that they probably find their way into the upper part of the digestive tract because of the soiling of the hands. He knew that the tapeworms often reached great length. He has seen one over sixteen feet long, and also that they had a life cycle so that they existed in two different forms. He describes the roundworms as existing in the intestines, but occasionally wandering into the stomach to be vomited. His vermifuges were the flowers and the seeds of the pomegranate, the seeds of the heliotrope, castor oil, and certain herbs that are still used by country people, at least as worm medicines. For roundworms he recommended especially a decoction of Artemisia maritima, coriander seeds, and decoctions of thyme. Our return to thymol for intestinal parasites is interesting. For the oxiurus he prescribed clisters of ethereal oils, we have not advanced much in our treatment of intestinal worms in the fifteen hundred years since Alexander's time. Paul of Aegina Another extremely important writer in these early medieval times, whose opportunities for study and medicine and for the practice of it were afforded him by Christian schools and Christian hospitals, was Paul of Aegina. He was born on the island of Aegina, hence the name Aeginetis, by which he is commonly known. There used to be considerable doubt as to just when Paul lived, and the dates for his career were placed as widely apart as the fifth and seventh centuries. We know that he was educated at the University of Alexandria. As that institution was broken up at the time of the capture of the city by the Arabs, he cannot have been there later than during the first half of the seventh century. An Arabian writer, Abul Farag, in The Story of the Rain of the Emperor Heraclius, who died 641, says that, quote, among the celebrated physicians who flourished at this time was Paulus Aeginetis, end quote. In his works, Paul quotes from Alexander of Trolles, so that there seems to be no doubt now that his life must be placed in the seventh century. The most important portion of Paul's work for the modern time is contained in his sixth book on surgery. In this, his personal observations are especially accumulated. Girl has reviewed it at considerable length, devoting altogether nearly 30 pages to it, and it well deserves this lengthy abstract. Paul quotes a great many of the writers on surgery before his time, and then adds the results of his own observation and experience. In it, one finds careful detailed descriptions of many operations that are usually supposed to be modern. Very probably, the description quoted by Girl of the method of treating fish bones that have become caught in the throat will give the best idea of how thoroughly practical Paul is in his directions. He says, quote, It will often happen in eating that fish bones or other objects may be swallowed and get caught in some part of the throat. If they can be seen, they should be removed with the forceps designed for that purpose. Where they are deeper, some recommend that the patient should swallow large mouthfuls of bread or other such food. Others recommend that a clean soft sponge of small circumference to which a string is attached be swallowed and then drawn out by means of the string. This should be repeated until the bone or other object gets caught in the sponge and is drawn out. If the patient is seen immediately after eating and the swallowed object is not visible, vomiting should be brought on by means of a finger in the throat or irritation with the feather and then not infrequently the swallowed object will be brought up with the vomit. End quote. In the chapter immediately following this, 33, there is a description of the method of opening the larynx or the trachea with the indications for this operation. The surgeon will know that he has opened the trachea when the air streams out of the wound with some force and the voice is lost. As soon as the danger of suffocation is over, the edges of the wound should be freshened and the skin surfaces brought together with sutures. Only the skin without the cartilage should be sutured and general treatment for encouraging union should be employed. If the wound fails to heal immediately, a treatment calculated to encourage granulations should be undertaken. This same method of treatment will be of service whenever we happen to have a patient who, in order to commit suicide, has cut his throat. Paul's exact term is, perhaps, best translated by the expression, slashed his larynx. One of the features of Paul's treatise on surgery is his description of a radical operation for hernia. He describes scrotal hernia under the name Enterosil and says that it is due either to a tearing or a stretching of the peritoneum. It may be the consequence either of injury or of violent efforts made during crying. When the scrotum contains only omentum, he calls the condition Epiplosil, when it also contains intestine, and Epiplo Enterosil. Hernia that does not descend into the scrotum, he calls bubonosil. For operation, the patient should be placed on the back and the skin of the inguinal region being stretched by an assistant and oblique incision in the direction in which the blood vessels run should be made. The incision should then be stretched by means of retractors until the contents of the sac can be lifted out. All adhesions should be broken up and the fat be removed and the hernia replaced within the abdomen. Care should be taken that no loop of intestine is allowed to remain. Then a large needle with double thread made of ten strands should be run through the middle of the incision in the end of the peritoneum and tied firmly in cross sutures. The outer structures should be brought together with a second ligature and the lower end of the incision should have a wick placed in it for drainage and the site of the operation should be covered with an oil bandage. The Arab writer, Abul Farag, to whose references we owe the definite placing of the time when Paul lived, said that, quote, he had special experience in women's diseases and had devoted himself to them with great industry and success. The midwives of the time were accustomed to go to him and ask his counsel with regard to accidents that happened during and after parturition. He willingly imparted his information and told them what they should do. For this reason he came to be known as the obstetrician, end quote. Perhaps the term should be translated to the man midwife, for it was rather unusual for men to have much knowledge of this subject. His knowledge of the phenomena of menstruation was as wide and definite. He knew a great deal of how to treat its disturbances. He seems to have been the first one to suggest that in metroragia, with severe hemorrhage from the uterus, the bleeding might be stopped by putting ligatures around the limbs. This same method has been suggested for severe hemorrhage from the lungs as well as from the uterus in our own time. In hysteria he also suggested ligature of the limbs and it is easy to understand that this might be a very strongly suggestive treatment for the severer forms of hysteria. It is possible too that the modification of the circulation to the nervous system induced by the shutting off of the circulation in large areas of the body might very well have a favorable physical effect in this affection. Paul's description of the use of the speculum is as complete as that in any modern textbook of gynecology. Further Christian Physicians Another distinguished Christian medical scientist was Theophilus Protos Betherius, who belonged to the court of the Greek Emperor Heraclius in the 7th century. He seems to have had a life very full of interest and surprisingly varied duties. He was a bishop and, at the same time, commander of the Imperial Bodyguard and the author of a little work on the fabric of the human body. The most surprising chapter in the history of the book is that for some two centuries in quite modern times he was used as a textbook of anatomy at the University of Paris. He was printed in a number of editions early in the history of printing, at least one very probably before 1500 and several later. There are very interesting phases of medicine, delightfully surprising in their modernity to be found here and there in many of these early Christian writers on medicine. For instance, in a compend of medicine written by one Leo, who, under the Emperor Theophilus, seems to have been a prominent physician of Byzantium. The compend was written for a young physician just beginning practice. We find the following classification of hydrops or abdominal dilation. There are three kinds. The first is ascites due to the presence of watery fluid for which we do paracentesis. Second, tympani, when the abdomen is swollen from the presence of air or gas. This may be differentiated by percussion of the belly. When air is present the sound given forth is like that of a drum while in the first form ascites the sound is like that from a sack. The word used is the same as for a wine sack. The third form is called anisarka when the whole body swells. It is often been the subject of misunderstanding as to why medicine should have developed among the Latin Christian nations so much more slowly than among the Arabs during the early Middle Ages. Anyone who knows the conditions in which Christianity came into existence in Italy will not be surprised at that. The Arabs in the East were in contact with Greek thought and that is eminently prolific and inspiring. At the most the Christians in Italy got their inspiration at second hand through the Romans. The Romans themselves in spite of intimate contact with Greek physicians never made any important contributions to medical science nor to science of any kind. Their successors the Christians of Rome and Italy then could scarcely be expected to do better hampered especially as they were by the trying social conditions created by the invasion from the North. Whenever the Christians were in contact with Greek thought and Greek medicine above all as at Alexandria or in certain of the cities of the Near East we have distinguished contributions from them. Arabian Christian Physicians that this is not a partial view suggested by the desire to make out a better case for Christianity in its relation to science will be very well understood. Besides from the fact that a number of the original physicians of Arab stock who attracted attention during the first period of Arabian medicine that is during the 8th and 9th centuries were Christians. There are a series of physicians belonging to the Christian family Bachtistua a name which is derived from Bacht Jisu that is servant of Jesus who from the middle of the 8th to the middle of the 11th century acquired great fame. The first of them George discordcis after acquiring fame elsewhere was called to Baghdad by the Caliph El Mansur where because of his medical skill he reached the highest honors. His son became the body physician of Haran El Rashid in the third generation Gabriel de Skibro acquired fame and did much as had his father and grandfather for the medicine of the time by the translations of the Greek physicians into Arabian. These men may well be said to have introduced Greek medicine to the Mohammedans. It was their teaching that aroused Muslim scholars from the apathy that had characterized the attitude of the Arabian people towards science at the beginning of Mohammedanism. As time went on the other great Christian medical teachers distinguished themselves among the Arabs. One of these, the most prominent was Masui the Elder who is known as Janus de Masanus. Both he and his father practiced medicine with great success in Baghdad and his son became the body physician to Haran El Rashid either after or in conjunction with Gabriel Bacchistua. Like his colleague or predecessor in the official position he too made translations from the Greek into Arabic. Another distinguished Arabian Christian physician was Saperian the Elder. He was born in Damascus and flourished about the middle of the 9th century. He wrote a book on medicine called The Aggregator or Bravarium or Practica Medicineae which appeared in many printed editions within the century after the invention of printing. During the 9th century also we have an account of Honain Ben Ishak who is known in the west as Yochanitius. After traveling much especially in Greece and Persia he settled in Baghdad and under the patronage Caliph Mamoum made many translations. He translated most of the old Greek medical writers and also certain of the Greek philosophic and mathematical works. The accuracy of his translations became a proverb. His compendium of Galen was the textbook of medicine in the west for many centuries. It was known as the way in Artem Parvam Galeni. His son Ishak Ben Honin and his nephew Hobaish were also famous as medical practitioners and translators. Still another of these Arabian Christians who acquired a reputation as writers in medicine was Alkindis. He wrote with regard to nearly to 100 books however and so came to be called the philosopher. He is said altogether to have written and translated about 200 works of which 22 treat of medicine. He was a contemporary of Honin Ben Ishak in the 9th century. Another of the great 9th century Christian physicians and translators from the Greek was from the Greek origin but lived in Armenia and made translations from Greek into Arabic. Nearly all of these men took not alone medical science but the whole round of physical science for their special subject. A typical example in the 9th century was Abusan Ben Korra many of whose family during succeeding generations was Christian as scholars. He became the astronomer and physician of the caliph Motahid. His translations and medical literature were mainly excerpts from Hippocrates and Galen meant for popular use. These Christian translators thoroughly scientific as far as their times permitted them to be were wonderfully industrious great teachers in every sense of the word and they are the men who form the traditions on which the greater Arabian physicians from Razi's onward were educated. It would be easy to think that these men occupied so much with translations and intent on the reintroduction of Greek medicine might have depended very little on their own observations and been very impractical. All that is needed to counteract any such false impression, however is to know something definite about their books. Geralt in his history of surgery has some quotations from Serapion the Elder who is often quoted by Razi's. In the treatment of hemorrhoids Serapion advises a doctor and insists that they must be tied with a silk thread or with some other strong thread and then relief will come. He says some people burn them medicineis acudis touching with acids as some do even yet and some incise them with a knife. He prefers the ligature however. He calmly discusses the stones from the kidney by incision of the pelvis of the kidney through an opening in the loin. He considers the operation very dangerous however but seems to think the removal of a stone from the bladder a rather simple procedure. His description of the technique of the use of a catheter and of a stylet with it and apparently also of a guide for it in occult cases is extremely interesting. He suggests the opening of the bladder in the median line midway between the scrotum and the anus and the placing of a cannula therein so as to permit drainage until healing occurs. Even this brief review of the careers and the writings of the physicians of early Christian times shows how well the tradition of old Greek medicine was being carried on. There was much to hamper the cultivation of science in the disturbances of the time the gradual breaking up of the Roman Empire and the replacement of the peoples of southern Europe by the northern nations who had come in. Yet in spite of all this medical tradition was well preserved. The most prominent powers were themselves men whose opinions on problems of practical medicine were often of value and whose powers of observation frequently cannot but be admired. There is absolutely no trace of anything like opposition to the development of medical science or medical practice but on the contrary everywhere among political and ecclesiastical authorities we find encouragement and patronage. The very fact that in the storm and stress of the succeeding centuries manuscript copies of the writings of the physicians of this time were preserved for us in spite of the many vicissitudes to which they were subjected from fire and war and accidents of various kinds for hundreds of years until the coming of printing shows in what estimation they were held. During this time they owed their preservation to churchmen for the libraries and the copying rooms were all under ecclesiastical control. End of Part 3 of 3 End of Chapter 2 Chapter 3 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 Marcicic September 2009 Alexandria, Virginia Old Time Makers of Medicine by James Joseph Chapter 3 Great Jewish Physicians Part 1 of 2 Any account of Old Time Makers of Medicine without a chapter on the Jewish positions would indeed be incomplete. They are among the most important factors in medieval medicine representing one of the most significant elements of medical progress. In spite of the disadvantages under which their race labored because of the popular feeling against them on the part of the Christians in the earlier centuries and of the Mohammedans later men of genius from the race succeeded in making their influence felt not only in their own times but accomplished so much in making and writing medicine as to influence many subsequent generations living the segregated life that as a rule they had to from the earliest times the ghettos have only disappeared in the 19th century it would seem almost impossible for them to have done great intellectual work. It is one of the very common illusions however that great intellectual work is accomplished mainly in the midst of comfortable circumstances and as the result of encouraging conditions. Most of our great makers of medicine at all times and never more so than during the past century have been the sons of the poor who have had to earn their own living as a rule before they reached manhood and who have always had the spur of that necessity which has been so well called the mother of invention. Their hard living conditions probably rather favored than hampered their intellectual accomplishments it is not unlikely that the difficult personal circumstances in which the Jews were placed had a good deal to do at all times with stimulating their ambitions and making them accomplish all that was in them. Certain it is that at all times we find a wonderful power in the people to rise above their conditions with them however as with other peoples luxury, riches, comfort bring a surfeit to initiative and the race does not accomplish so much in various times in the Middle Ages particularly we find Jewish physicians doing great work and obtaining precious acknowledgement for it in spite of the most discouraging conditions later it is not unusual to find that there has been a degeneration into mere money making as the result of opportunity and consequent ease and luxury at a number of times however both in Christian and in Mohammedan countries great Jewish physicians arose where names have come to us and with whom every student of medicine who wants to know something about the details of the course of medical history must be familiar there are men among them who must be considered among the great lights of medicine significant makers always of the art also in nearly all cases of the science of medicine a little consideration of the history of the Jewish people and their great documents eliminates any surprise there may be with regard to their interest in medicine and successful pursuit of it during the Middle Ages the two great collections of Hebrew documents the Old Testament and the Talmud contain an immense amount of material with reference to medical problems of many kinds both of these works are especially interesting because of what they have to say of preventive medicine and with regard to the recognition of disease our prophylaxis and diagnosis are important scientific departments of medicine dependent on observation rather than on theory while therapeutics has all sorts of absurdities the advances made in prophylaxis and in diagnosis have always remained valuable and though at times they have been forgotten rediscovery only emphasizes the value of proceeding work it is because of what they contain with regard to these two important medical subjects that the Old Testament and the Talmud are landmarks in the history of medicine as well as of religion pause in his outlines of the history of medicine says quote it corresponds to the reality in both the actual and chronological point of view to consider the books of Moses as the foundation of sanitary science the more we have learned about sanitation in the prophylaxis of disease and in the prevention of contagion in the modern time the more have we come to appreciate highly the teachings of these old times on such subjects Moses made a masterly exposition of the knowledge necessary to prevent contagious disease when he laid down the rules with regard to leprosy first as to careful differentiation then as to isolation and finally as to disinfection after it had come to be sure that cure had taken place the great law giver could insist emphatically that the keeping of the laws of God not only was good for a man's soul but also for his body end quote with this tradition familiarly known and deeply studied by the mass of the Hebrew people it is no surprise to find that when the next great Hebrew development of religious writing came in the Talmud during the earlier Middle Ages that it also contains much with regard to medicine not a little of which is so close to absolute truth as never to be out of date Freidenwald in his Jewish physicians and the contributions of the Jews to the science of medicine a lecture delivered before the Gratz College of Philadelphia 15 years ago summed up from Baz history of medicine the instructions in the Talmud with regard to health and disease the summary represents so much more of genuine knowledge of medicine and surgery than might be expected at the early period at which it was written during the first and second century of our era that it seems well to quoted at some length quote fever was regarded as nature's effort to expel morbid matter and restore health which is a much safer interpretation of fever from a practical point of view than most of the theories bearing on this point that have been taught up to a very recent period they attributed the halting in the hind legs of a lamb to a colossity formed around the spinal cord this was a great advance in the knowledge of the physiology of the nervous system and e-medic was recommended as the best remedy for nausea in many cases no better remedy is known today they taught that a sudden change in diet was injurious even if the quality brought by the change was better that milk fresh from the udder was the best the talmud describes jaundice and correctly ascribes it to the retention of bile and speaks of dropsy as due to the retention of urine it teaches that atrophy or rupture of the kidneys is fatal induration of the lungs tuberculosis was regarded as incurable separation of the spinal cord had an early grave meaning rabies was known the following is a description given of the dog's condition his mouth is open the saliva opens from his mouth his ears drop his tail hangs between his legs he runs sideways and the dogs bark at him others say that he barks himself and that his voice is very weak no man has appeared who could say that he has seen a man live who was bitten by a mad dog the description is good and this prognosis as to hydrophobia in man has remained unaltered till our day when past year published his startling revelation the anatomical knowledge of the talmudists was derived chiefly from dissection of the animals as a very remarkable piece of practical anatomy for its very early date is the procuring of the skeleton from the body of a prostitute by the process of boiling by rabbi Eshmel a physician at the close of the first century he gives the number of bones as 252 instead of 232 the talmudists knew the origin of the spinal cord at the foremen magnum and its form of termination they describe the esophagus as being composed of two coats they speak of the pleura as the double covering of the lungs and mention the special coat of fat about the kidneys they had made progress in obstetrics described monstrosities and congenital deformities of the talmudist version evisceration and cesarean section upon the dead and upon the living mother A.H. Israels has clearly shown in his dissertation historical medica inauguralis that cesarean section according to the talmud was performed among the Jews with safety to mother and child talmud includes a knowledge of dislocation of the thigh bone contusions of the skull perforation of the lungs esophagus stomach small intestines and gallbladder wounds of the spinal cord windpipe of fractures of the ribs etc they described imperforate anus and how it was to be relieved by operation chanina benchania inserted natural and wooden teeth as early as the second century CE there's a famous summing up of the possibilities of life and happiness in the talmud that has been often quoted it's possible wanting in gallantry being set down to the times in which it was written quote life is compatible with any disease provided the bowels remain open any kind of pain provided the heart remain unaffected any kind of uneasiness provided the head is not attacked all manner of evils accept it be a bad woman end quote there are many other interesting suggestions in the talmud sometimes they have come to be generally accepted in the modern time sometimes they are only curious notions that have not however lost all their interest the crucial incision for carbuncle is a typical example of the first class and the suggestion of the removal of superfluous fat from within the abdomen or in the abdominal wall itself by operation is another that they had some idea of the danger of sepsis may be gathered from the fact that they suspected iron surgical instruments and advise the use of others of less enduring character the talmud itself was indeed a sort of encyclopedia in which was gathered knowledge of all kinds from many sources it was not particularly a book of medicine though it contains so many medical ideas in many parts of it the author's regard for science is emphatically expressed landau in his history of jewish physicians closes his account of the talmud with this paragraph quote i conclude this brief review of talmudic medicine with some reference to how high the worth of science was valued in this much misunderstood work in one place we have the expression quote occupation with science means more than sacrifice end quote in another quote science is more than priesthood and kingly dignity end quote after all this of national tradition in medicine before and after christ it is only what we might quite naturally expect to find that there is scarcely a century of the middle ages which does not contain great jewish physician and sometimes there are more many of these men made distinct contributions to medical science and their names have been held with high estimation ever since perhaps i should say that they were held in high estimation until that neglect of historical studies which characterize the 18th century developed and that there has been a rewakening of interest in our time we forget this curious decadence of the later 17th and 18th centuries which did so much to obscure history and especially the history of the sciences fortunately the scholars of the 16th and early 17th centuries accomplished successfully the task of printing many of the books of these old time physicians and secured their publication in magnificent editions these were brought eagerly by scholars and libraries all over europe in spite of the high price they commanded in the era of slow laborious printing the renaissance exhibits some of its most admirable qualities in its reverence for these old workers in science and above all for the careful preparation by its scholars of the text of these first editions of old time physicians the works have often been thus literally preserved for us for some of them at least would have disappeared among the vicissitudes of the intervening time most of which was anything but favorable to the preservation of old time works no matter what their content or value during the second and third centuries of our era while the Talmudic writings were taking shape three great Jewish physicians came into prominence the first of them Chanina was a contemporary of Galen according to tradition as we have said he inserted both natural and artificial teeth before the close of the second century the two others were Rob or Ra and Samuel Rob has the distinction of having studied his anatomy from the human body according to tradition he did not hesitate to spend large sums of money in order to procure subjects for dissection at this time it is very doubtful whether Galen though only of the preceding generation ever had the opportunity to study more than animals or at most a few human bodies the third of the group was an intimate friend of Rob's perhaps a disciple and his fame depends rather on his practice of medicine than of research in medical science he was noted for his practical development of two specialties that cannot but seem to us rather distant from each other his reputation as a skillful obstetrician was only surpassed by the estimation in which he was held as an occulist he seems to have turned to astronomy as a hobby and was highly honored for his knowledge of this science probably there is nothing commoner in the story of great Jewish physicians than their successful pursuit of some scientific subject as a hobby and reaching distinction in it their surplus intellectual energy needed an outlet besides their vocation and they got a rest by turning to some other interest often accomplishing excellent results in it like most great students with a hobby the majority of them were long lived their lives are a lesson to a generation that fears intellectual overwork during the fourth century we have a number of very interesting traditions with regard to a great Jewish physician Abba Omna to whom patients flocked from all over the world he seems particularly to have been anxious to make his services available to the scholars of his time he looked upon them as brothers in spirit fellow laborers whose investigations were as important to his own and whose laborers for mankind he hoped to extend by the helpfulness of his profession in order that it might be easy for them to come to him without feeling abashed by their poverty and yet so that they might pay him anything that they thought they were able to he hung up a box in his anti-room in which each patient might deposit whatever he felt able to give his kindness towards men became the foundation for many legends needless to say he was often imposed upon but that seems to have made no difference to him and he went on straight forwardly doing what he thought he ought to do regardless of the devious ways of men even those whom he was generously assisting while we do not know much of his scientific medicine we do know that he was a great example of a practitioner of medicine on the highest professional lines with the foundations of the school at Jorn Disabor in Arabistan or Kusistan by the Persian monarch Korosiz some Jewish physicians come into prominence as teachers and this is one of the first important occasions in history of the Persian side with Christian colleagues Jorn Disabor seems distant from us now laying as it does in the province just above the head of the Persian Gulf and it is a little hard to understand it's becoming a center of culture and education yet according to well-grounded historical traditions students flocked here from all parts of the world and particularly became famous according to the documents and traditions that we possess clinical teaching was the most significant feature of the school work and made it famous as a consequence graduates from here were deemed fully qualified to become professors in other institutions and were eagerly sought by various medical schools in the east with the rise of the strong political power of the Mohammedans enough of peace came to the east at least to permit the cultivation of arts and sciences to some extent again and then at once the eminence of Jewish physicians both as teachers and practitioners of medicine once more becomes manifest the first of the race who comes into prominence is Maser Jawa ebn Jejal of Basra to him we owe probably more than to anyone else the preservation of old scientific writings and the cultivation of arts and sciences by the Mohammedans he prevailed on Caliph Moawiya 1 whose physician he had become to cause many foreign works and especially those written in Arabic to be translated into Arabic he seems to have taken a large share of the labor of the translation on himself and prevailed upon his pupil the son of Moawiya to translate some works on chemistry the translation for which Maser Jawa is best known is that of the pandex of Haroon a physician of Alexandria the translation of this work was made for the end of the 7th century unfortunately the pandex has not come down to us either in original or translation but we have fragments of the translation preserved by Razi the distinguished Arabian medical writer and physician of the 9th century and there seems no doubt that it contained the first good description of smallpox a chapter in medicine that is often though incorrectly attributed to Razi's himself Razi's quoted Maser Jawa freely and evidently trusted his declarations implicitly the succeeding Caliphs of the first Arabian dynasty did not exhibit the same interest in education and above all in science that characterized Moawiya political ambition and the desire for military glory seemed to have filled up their thoughts and perhaps they had not the good fortune to fall under the influence of physicians so wise and learned as Maser Jawa more probably however they themselves lacked interest for the end of the 7th century they were succeeded by the Abba cities Alman Saur the second Caliph of this dynasty was attacked by a dangerous disease and sent for a physician of the Nestorian school after his restoration to help he became a liberal patron of science and especially medical science the new city of Baghdad which had become the capital of the realm of the Abba cities was enriched by him the large number of works on medicine which he caused to be translated from the Greek he did not confine himself to medicine however and also brought about translations of works with regard to other sciences one of these, astronomy was a favorite he made it a particular point to search out and encourage the translation of such books as had not previously translated from Greek into Arabic while he provided a translation of Ptolemy he also had translations made of Aristotle and Galen it is not surprising then that the school of Baghdad became celebrated Jewish physicians seemed to have been most prominent in its foundation and the most distinguished product of it is Isaac Ben Emron almost as celebrated as a philosopher as he is as a physician one of his expressions with regard to the danger of a patient having two physicians whose opinions disagree with regard to his illness has been deservedly preserved for us Zaid an emir of one of the chief cities of the Arabs in Barbary fell ill of a Tertian fever and called Isaac another physician in consultation their opinions were so widely in discord that Isaac refused to prescribe anything and when the emir who had great confidence in him demanded the reason he replied quote disagreement of two physicians is more deadly than a Tertian fever end quote this Isaac who is said to have died in 1999 is the great Jewish physician one of the most important members of the profession in the 8th century his principal work was with regard to poisons and the symptoms caused by them this is often quoted by medical writers in the after time end of part one of two chapter three 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 three great Jewish physicians part two of two the prominent Jewish physician of the 9th century was Joshua Ben Nunn Haroun El Rashid whose attempts to secure justice for his people are the subject of so much legendary lore and whose place in history may be best recalled by the fact that he is a contemporary of Charlemagne was particularly interested in medicine he founded the city of Taurus as a memorial to the cure of his wife he was a generous patron of the school of John Disabor and established a medical school also at Baghdad he provided good salaries for the professors insisted on careful examinations and raised the standard of medical education for a time to a noteworthy degree the greatest teacher of this school at Baghdad was Joshua Ben Nunn who was known as the rabbi of Seleucia his teaching attracted many students to Baghdad and his fame as one of the great practitioners of medicine of this time brought many patients among his disciples was John Mose whose Arabian name is so different Yahya Ben Masovia that in order to avoid confusion in reading it we want to know both almost better known perhaps at this time was Abud Joseph Jacob Ben Esa Kendi fortunately for the after time these men devoted themselves not only to their own observations and writings but made a series of valuable translations Joshua Ben Nunn seems to have been particularly zealous in this matter of the example of Maser Jawa of Basra Baghdad then became a center for Arabian culture Mahmud one of Harun's successors provided in Baghdad a refuge for the learned men of the east who were disturbed by the wars and troubles of the time he became a liberal patron of literature and education when the emperor Michael 3 of Constantinople was ordered in battle one of the obligations imposed upon him was to send many camel loads of books to Baghdad and Aristotle and Plato were studied devotedly and translated into Arabic the era of culture affected not only the capital but all the cities and everywhere throughout the Arabian empire schools and academies sprang up we have records of them at Basra Arkan, Ispahan from here the thirst for education spread to other cities ruled by the Mohammedans and each town became affected by it Alexandria the cities of the Barbary states those of Sicily and province where Moorish influences were prominent and of distant Spain Cordova, Seville, Toledo Granada, Saragosa all took up the rivalry for culture which made this a glorious period in the history of the intellectual life already in the chapter on great physicians in early Christian times I have pointed out that many of the teachers of the Arabs were Christian physicians here it is proper to emphasize the other important factor in Arabian medicine the Jewish physicians who influenced the great Arabian rulers and were the teachers of the Arabs in medicine and science generally these Christian and Jewish physicians particularly encouraged the translation of the works of the great Greek physicians and thus kept the Greek medical tradition from dying out it is not until the end of the ninth or even the beginning of the tenth century that we begin to have important contributors to medicine from among the Arabs themselves even at this time they have distinguished rivals among Jewish physicians indeed these acquired such a reputation that they became the physicians to monarchs and even high ecclesiastics and we find them nearly everywhere throughout Europe their success was so great that it is not surprising that after a time the vogue of the Jewish physicians should have led to jealousy of them and to the passage of laws and decrees limiting their sphere of activity the great Jewish physician of the ninth century was Isaac Ben Solomon better known as Isaac L Israeli and who is sometimes spoken of as disraeli he was a pupil of Isaac Ben Amram the younger probably a grandson of another Ben Isaac Amram who after having become famous in Baghdad went to Cairo and became the physician of the Ymer Jadeth 3 the younger Isaac established a school and it was with him that Israeli obtained his introduction to medicine he practiced first as an oculist and then became a body physician to the Sultan of Morocco because of the sympathy of his character and his unselfishness he acquired great popularity hurdle refers to him respectfully as that scholarly son of Israel curiously enough considering racial feeling in the matter he never married and when asked why he had not and whether he did not think that he might regret it he replied quote I have written four books through which my memory will be better preserved than it would be by descendants end quote the four books are his treaties on fevers his treaties on simple medicines and ailments a treaties on the elements and a treaties on the urine besides these we have from him shorter works on the pulse melancholy and andropsy his hope with regard to his fame from these works was fulfilled for they were printed as late as 1515 at laden and Sprengel declared them the best compendium of simple remedies and the diet that we have from the Arabian times one of his translators into Latin has called him the monarch of physicians some of his maxims are extremely interesting in the light of modern notions on the same subjects he declared emphatically that quote the most important duty of the physician is to prevent illness most patients get better without much help from the physician by the power of nature end quote he emphasized his distrust of using many medicines at the same time in the hope some of them would do good he laid it down as a rule quote employ only one medicine at a time in all your cases and note its effects carefully end quote he was as wise with regard to medical epics as therapeutics he advised a young physician quote never speak unfavorably of other physicians every one of us has his lucky and unlucky hours end quote it is pleasant to learn that the old gentleman lived to fill out a full hundred years of life and that in his declining years he was surrounded by the good will and the affection of many who had learned to know his precious qualities of heart and mind more than of any other class of physicians do we find the large human sympathies of the Jewish physicians of the middle ages praised by their contemporaries and succeeding generations during the next centuries a number of Jewish physicians became prominent though none of them until mymonides impressed themselves deeply upon the medical life of their own and succeeding centuries very frequently they were the physicians to royal personages Zedkias for instance was the physician to lewis the pious and later to his son Charles the bald his reputation as a physician was great enough to give him the popular estimation of a magician but it did not save him from the accusations of having poisoned Charles when that monarch died suddenly there seemed to be no good grounds however for the accusation there were a number of schools of medicine in Sicily and the southern part of Italy in which Jewish Arabian and Christian physicians taught side by side one of these teachers was Jude Sabatai Ben Ibrahim usually known by the name of Danolo who is famous both as a writer on medicine and on astronomy Danolo studied and probably taught at Terrentum and there were similar schools at Palermo, at Bari and then later on the mainland at Salerno the foundation of Salerno in which Jewish physicians also took part we shall discuss later in the special chapter devoted to that subject one of the great translators whose work meant very much for the medical science of his own succeeding generations was the distinguished Jewish physician Faraj Ben Salim sometimes spoken of as Farachi Faragut or Ferrarius who was born at Giurgenti in Sicily he made his medical studies in Salerno and did his work under the patronage of Charles of Anjo toward the end of the 13th century his greatest work is the translation of the whole on the continents of Razzis the translation is praised as probably the best of its time made in the Middle Ages Faraj came at the end of a great century when the intellectual life of Europe had reached a high power of expression and it is not surprising that he should have proved equal to his environment this translation has also been published in some editions made by Faraj himself notably a glossary of Arabian names in Spain also Jewish physicians rose to distinction the most distinguished in the 10th century was Chazdai Ben Shaprut like many of the great physicians of this time he had studied astronomy as well as the medical sciences he became the physician for Ramon III of Cordova he seems also to have exercised some of the functions of prime minister to the caliph and took advantage of diplomatic relations between his sovereign and the Byzantine emperor to obtain some works of Dioscorides these he translated into Arabian with the help of a Greek monk whom he seems to have secured through the diplomatic relations undoubtedly he did much to usher in that enthusiasm for education and study which characterized the next centuries the 11th and 12th at Cordova in Spain when such men as Avanzor Avesena and Avaros attracted the attention of the educational world of the time Jewish writers have sometimes claimed one of the most distinguished authorities Avanzor himself as a Jew but hurdle and other good authorities consider him of Arabic extraction and point to the fact that his ancestors bore the name of Mohammed this is not absolutely conclusive evidence but because of it I have preferred to class Avanzor among the Arabian physicians the one historical fact of Avaros is that everywhere in Europe at the time Jews were being accorded opportunities for the study and practice of medicine there are local incidents of persecution but we are not so far away from the feelings that brought these about as to misunderstand them or to think that they were anything more than local popular manifestations the more we know about the details of the medical history of these times the deeper is the impression of academic freedom and of opportunities for liberal education much has been said about the intolerance of ecclesiastical authorities toward the Jews and of the church decrees that either absolutely forbade their practice of the medical profession and their devotion to scientific study or at least made these pursuits much more difficult for them than for others of course it has to be conceded even by those who most insistently urge the existence of formal legislation in the matter that in spite of these decrees and intolerance and opposition Jews continued to practice medicine and to be the chosen physicians of kings and even of high ecclesiastical dignitaries as well indeed of the popes themselves this it is usually declared must be attributed to the suppressing skill of the Jewish physicians causing men to overcome their prejudices and override even their own legal regulations there is no doubt at all about the skill of Jewish physicians at many times during the middle ages there is no doubt also of the sentiment of opposition that often developed between the Christian peoples and the Jews any excuses good enough to justify men to themselves at least in putting obstacles in the paths of those who are more successful than they are themselves religion often became a cloak for ill-will and persecution the state of affairs that has been presumed however according to which those and decrees were being constantly issued forbidding the practice of medicine to Jews by the ecclesiastical authorities while at the same time they themselves and those who were nearest to them were employing Jewish physicians is an absurdity that on the face of it calls for investigation of the conditions and from its very appearance would indicate that the ordinary historical assumption in the matter must be wrong I have been at some pains then to try to find out just what were the conditions in Europe with regard to the practice of medicine by the Jews there is no doubt that at Salerno where the influence of the Benedictines was very strong and where the influence of the popes and the ecclesiastical authorities was always dominant full liberty of studying and teaching was from the earliest days allowed to the Jews down at Montpellier it seems clear that Jewish physicians had a large part in the foundation of the medical school and continued for several centuries to be most important factors in the maintenance of its reputation and the upbuilding of that fame which draw students from even distant parts of Europe and the medical school in the south of France during the 9th, 10th, 11th and 12th centuries Jewish physicians were frequently in attendance on kings and the higher nobility on bishops and archbishops cardinals and even popes every now and then the spirit of intolerance among the populace was aroused and occasionally the death of some distinguished patient while in a Jewish physician's hands was made the occasion for persecution we must not forget after all that even as late as Elizabeth's time when Shakespeare wrote The Merchant of Venice he was taking advantage of the popular sentiment aroused by the execution of Lopez, the queen's physician for a real or supposed participation in a plot against her majesty's life Shylock was presented the next season for the sake of adventitious popularity that would thus accrue to the peace the character was played so as to depict all the worst traits of the Jew and was scornfully laughed at every representation this is an index of the popular feeling of the time bitter intolerance of the Jew has continued down almost to our own time the ghettos have existed in Europe and popular tumults against them continue to occur quite needless to say these do not depend on Christianity but on defective human nature during the Middle Ages the best possible criterion of the attitude of the church authorities towards the Jews is to be found in the legislation of Pope Innocent III he is the greatest of the popes of the Middle Ages he shaped the policy of the church much more than any other his influence was felt for many generations after his own time his famous edict with regard to them was well known quote let no Christian by violence compel them to come dissenting or unwilling to baptism further let no Christian venture maliciously to harm their persons without a judgment of the civil power or to carry off their property or change their good customs which they have hitherto in that district which they inhabit end quote Innocent himself and several of his predecessors and successors are known to have had Jewish physicians example speaks even louder than precept and the example of such men must have been a wonderful advertisement for the Jewish physicians of the time besides Innocent III many of the popes of the 12th and 13th centuries issued similar decrees as to the Jews it may be recalled that this was the time when the papacy was most powerful in Europe and when its decrees had most weight in all countries Alexander II Gregory IX and Innocent IV all issued formal documents demanding the protection of the Jews and especially insisting that they must not be forced to receive baptism nor disturbed in the celebration of their festivals Clement VI did the same thing in the next century and even offered them a refuge from persecution throughout the rest of France at Avignon distinguished Jewish scholars who know the whole story from careful study have given due credit to the popes for all that they did for their people they have even declared that if the Jews were not exterminated in many of the European countries it was because of the protection afforded by the church we have come to realize in recent years that persecution of the Jews is not at all a religious matter but is due to racial prejudice and jealousy of their success by the peoples among whom they settle all sorts of pretexts are given for this persecution at all times formal church documents and the personal activities of the responsible church officials show that during the Middle Ages the church was a protector and not a persecutor of the Jews there is abundant historical authority for the statement that the popes were uniformly beneficent in their treatment of the Jews in order to demonstrate this there is no need to quote Catholic historians for non-Catholics have been rather emphatic in bringing it out Neander the German Protestant historian for instance said quote it was a ruling principle with the popes after the example of their great predecessor Gregory the Great to protect the Jews in the rights which had been conceded to them when the banished popes of the 12th century returned to Rome the Jews went forth in their holiday garments to meet them bearing before them in the present too on an occasion of this sort blessed them end quote English non-Catholic historians can be quoted to the same effect the Anglican dean Millman for instance said quote of all European sovereigns the popes with some exceptions have pursued the most humane policy towards the Jews in Italy and even in Rome they have been more rarely molested than in the other countries end quote Harlem has expressed himself to the same effect especially as regards the protection afforded to the Jew by the laws of the church from the injustice of those around him laws sometimes fail of their purpose and the persecuting spirit of the populace is often hard to control but everything that the central authority could do to afford protection was done and essential justice was enshrined in the church laws prominent ecclesiastics would naturally follow the lines laid down by their papal superiors the attitude of those whose lives mark epochs in the history of Christianity and who had more to do almost with the shaping of the policy of the church at many times than the popes themselves can be quoted readily to this same effect Neander has called particular attention to Saint Bernard's declarations with regard to the evils that would follow any tolerance of such an abuse as the persecution of the Jews quote the most influential men of the church protested against such Christian fanaticism when the abbot Bernard of Clairvaux was rousing up the spirit of the nations to embark in the second crusade and issued for this purpose in the year 1146 his letters to the Germans East Franks he at the same time warned them against the influence of those enthusiasts who strove to inflame the criticism of the people he declaimed against the false zeal without knowledge which impelled them to murder the Jews a people who ought to be allowed to live in peace in that country end quote but it has been said that there are decrees against Jewish physicians issued especially in the south of France by various councils and synods of the church to be called at once to the fact that these are entirely local regulations and have nothing to do with the attitude of the church as a whole but represent what the ecclesiastical authorities of a particular part of the country deem necessary for some special reason in order to meet local conditions indeed at the end of the 13th and the early 14th century when these decrees were being issued at France full liberty was allowed in Italy and there were no restrictions either as to medical practice or education founded on adhesion to Judaism what need to be realized in order to understand the issuance of certain local ecclesiastical regulations forbidding Jews to practice medicine are the special conditions which developed in France at this time many Jews had emigrated from Spain to France and the reputation acquired by Jewish physicians at Montpelier led to a number of the race taking up the practice of medicine without any further qualification than the fact that they were Jews that gave them a reputation for curative powers of itself because of the fame of some Jewish doctors and their employment by the nobility and the highest ecclesiastics it was hard to regulate these wandering physicians as a consequence of this the faculty at Paris always jealous of its own rights and those of its students at the beginning of the 14th century absolutely forbade Jews from practicing on Christian patients within its jurisdiction of course the faculty of the University of Paris was dominated by ecclesiastical authorities the medical school was however almost entirely independent of ecclesiastical influence and was besides largely responsible for this decree it was felt that something had to be done to stop the evil that had arisen and the charlatanry and quackery which was being practiced this was, however rather an attempt to regulate the practice of medicine and keep it in the hands of medical school graduates than an example of intolerance toward the Jews practically no Jews had graduated at its university Montpellier being their favorite school and Paris was not a little jealous of its rights to provide for physicians from the northern part of France we have not got away from manifestations of that spirit even yet as our non reciprocating state medical laws show during the next quarter of a century decrees not unlike those of the University of Paris were issued in the south of France especially in Provence and Avignon anyone who knows the conditions which existed in the south of France at this time with regard to medical practice will be aware that a number of attempts were made by the ecclesiastical authorities just at this time to regulate the practice of medicine great abuses had crept in almost anyone who wished could set up as a physician and those who were least fitted were often best able to secure the number of patients by their cleverness their knowledge of men and their smooth tongues the bishops of various diocese met and issued decrees forbidding anyone from practicing medicine unless he was a graduate of a medical school of the neighboring university of Montpellier after a time he was found that the greatest number of Jews accordingly special regulations were made against them they happen to be ecclesiastical regulations because no other authority at the time claimed the right to regulate medical education and the practice of medicine what is sure is that many Jewish physicians reach distinction under Christian as well as Arabian rulers at all times during the Middle Ages it would be quite impossible in the limited space at command here to give any adequate mention of what was accomplished by these Jewish physicians whose names we have scarcely been able to more than catalog nor of the place they hold in their times as the physicians of rulers their influence for culture and the cultivation of science was extensive for what was best and highest in education the story of one of them who is generally known in the Christian world at least mymonides given in some detail may serve as a type of these Jewish physicians of the Middle Ages he lived just before the flourishing period of university life in the 13th century brought about that wonderful development of medicine surgery in the west of Europe that meant so much for the final centuries of the Middle Ages his works influenced not a little the great thinkers and teachers whose own writings were to be the foundations of education for several centuries after their time mymonides was well known in the western universities though his life had been mainly spent in the east and he died there there was scarcely a distinguished scholar of Europe who is not acquainted directly or indirectly with his works and the greater the reputation of the scholar as a rule the more he knew of mymonides moses aegeptaeus as he was called and the more frequently he referred to his writings end of chapter 3 part 2 of 2