Moses Maimonides: A Luminary From the Dark Ages of Medicine
Moses Maimonides (1135–1204 ACE), also known as Rabbi Moshe ben Maimun or Rambam, was perhaps the most famous Jewish physician in medieval times (Figure). Born in Cordova, he later migrated to Palestine and then to Cairo to avoid religious persecution. This rabbi, philosopher, scholar, and writer is revered by those of the Judaic faith, not because of his stature as a physician, but as one of their greatest theologians. As one of my medical students, who is an observant Jew, told me,
“When we think of Maimonides, his role as a physician is about eighth down on the list of what he is known for in Judaism.” Maimonides wrote a number of texts, including Fusul Musa or Chapter of Moses, a collection of medical aphorisms. When researching the long list of those who should be considered in a text about the art of medicine as taught by the masters of medical education, Maimonides’ name is immediately thrust to the top of this list because of his devotion to his patients and his passion for service.
Maimonides was the physician to a sultan, and in a letter sent to Samuel (Shmuel) ibn Tibbon he described the typical scene that awaited him at home after a long and brutal day of work:
“I would find the antechambers filled with people, both Jews and Gentiles, nobles and common people, judges and bailiffs, friends and foes—a mixed multitude, who await the time of my return. I dismount from my animal, wash my hands, go forth to my patients, and entreat them to bear with me while I partake of some slight refreshment, the only meal I take in the 24 hours. Then I attend to my patients, and write prescriptions and directions for their various ailments. Patients go in and out until nightfall, and sometimes even, I solemnly assure you, until 2 hours and more in the night. I converse with and prescribe for them while lying down from sheer fatigue, and when night falls I am so exhausted that I can scarcely speak. . . . I have here related to you only a part of what you would see if you were to visit me.”1
With regard to the physician-patient relationship, Maimonides’ true greatness manifested as a complete commitment to his patients. One can picture this weary man stumbling into his home only to find, amidst the hanging lanterns and dim light, mothers holding their sick children with looks of fear on their faces. Interestingly, Maimonides refers to his practice as healing. So did the Babylonian king (and writer of legendary “codes”) Hammurabi (ca. 1795–1750 BCE). Maimonides revered the great teachers of medicine who preceded him and singled out Hippocrates as “Head of Physicians.” Like Hippocrates, Maimonides taught students of medicine, and advocated that “a physician should begin with simple treatment, trying to cure by hygiene and diet before he administers drugs.”
As Maimonides looked back to Hippocrates for inspiration, so too did Osler look back to Maimonides for his wisdom and highly regarded the Jewish scholar as the “Prince of Physicians.”
Maimonides possessed love for his profession, a true dedication to his practice and his patients. He recognized his skill as a gift from God and passionately wrote of this realization. He is thought by some to have expressed these thoughts in The Physician’s Oath and Prayer. Although the authorship of this text by Maimonides has been called into serious question—it is felt by others to be the work of Markus Herz (1747–1803), a German physician and pupil of Immanuel Kant—this does not detract from the beauty of what follows:
THE OATH OF MAIMONIDES
“The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all times; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.
“May I never see in the patient anything but a fellow creature in pain. Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.
“Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.”2
THE PRAYER OF MAIMONIDES
“Almighty God, Thou has created the human body with infinite wisdom. Ten thousand times ten thousand organs hast Thou combined in it that act unceasingly and harmoniously to preserve the whole in all its beauty the body which is the envelope of the immortal soul. They are ever acting in perfect order, agreement and accord. Yet, when the frailty of matter or the unbridling of passions deranges this order or interrupts this accord, then forces clash and the body crumbles into the primal dust from which it came. Thou sendest to man diseases as beneficent messengers to foretell approaching danger and to urge him to avert it.
“Thou has blest Thine earth, Thy rivers and Thy mountains with healing substances; they enable Thy creatures to alleviate their sufferings and to heal their illnesses. Thou hast endowed man with the wisdom to relieve the suffering of his brother, to recognize his disorders, to extract the healing substances, to discover their powers and to prepare and to apply them to suit every ill. In Thine Eternal Providence Thou hast chosen me to watch over the life and health of Thy creatures. I am now about to apply myself to the duties of my profession. Support me, Almighty God, in these great labors that they may benefit mankind, for without Thy help not even the least thing will succeed.
“Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures. Preserve the strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend. In the sufferer let me see only the human being. Illumine my mind that it recognize what presents itself and that it may comprehend what is absent or hidden. Let it not fail to see what is visible, but do not permit it to arrogate to itself the power to see what cannot be seen, for delicate and indefinite are the bounds of the great art of caring for the lives and health of Thy creatures. Let me never be absent-minded. May no strange thoughts divert my attention at the bedside of the sick, or disturb my mind in its silent labors, for great and sacred are the thoughtful deliberations required to preserve the lives and health of Thy creatures.
“Grant that my patients have confidence in me and my art and follow my directions and my counsel. Remove from their midst all charlatans and the whole host of officious relatives and know-all nurses, cruel people who arrogantly frustrate the wisest purposes of our art and often lead Thy creatures to their death.
“Should those who are wiser than I wish to improve and instruct me, let my soul gratefully follow their guidance; for vast is the extent of our art. Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor, because surrender would bring to Thy creatures sickness and death.
“Imbue my soul with gentleness and calmness when older colleagues, proud of their age, wish to displace me or to scorn me or disdainfully to teach me. May even this be of advantage to me, for they know many things of which I am ignorant, but let not their arrogance give me pain. For they are old and old age is not master of the passions. I also hope to attain old age upon this earth, before Thee, Almighty God!
“Let me be contented in everything except in the great science of my profession. Never allow the thought to arise in me that I have attained to sufficient knowledge, but vouchsafe to me the strength, the leisure and the ambition ever to extend my knowledge. For art is great, but the mind of man is ever expanding.
“Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed.”2
A VOCATION AND A CALLING
In the Oath of Maimonides he cites, “Here am I ready for my vocation and now I turn unto my calling.” This is one of the earliest times in recorded history that we see the field of medicine being referred to as a vocation and a calling. It is clear that Maimonides viewed his work as a physician as sacred, given to him by God so that he could help his fellow man. Indeed, Maimonides states, “Providence Thou hast chosen me to watch over the life and health of Thy creatures.” What inspirational words! I do not imagine there is a single reader who feels differently about his art. History has noted the greatness of Maimonides for his contributions to religion and philosophy, more so than his contributions to medicine. His service to his people, patients, and students is undeniable in many disciplines. That he inspired others to think led to the Jewish adage about him, attributed to the German-Jewish philosopher Moses Mendelssohn (1729–1786): “From Moses unto Moses there arose not one like Moses.”3 We are truly fortunate that a healer as devoted and humanistic as Maimonides found an intellectual and spiritual outlet in medicine. ■
REFERENCES:
1. Illievitz AB. Maimonides The Physician, Responsa Pe’er HaDor. Can Med Assoc J. Apr 1935:440-442.
2. Bull Johns Hopkins Hosp. Trans. Harry Friedenwald. 1917;28:260-261.
3. Chapters on Jewish Literature, Israel Abrahams, Chapter XIII. Moses Maimonides. May 2009. http://www.authorama.com/chapters-on-jewish-literature-13.html.
Dr Colgan is professor and vice chair of medical student education and clinical operations in the department of family and community medicine at the University of Maryland School of Medicine in Baltimore, Maryland. He is the author of Advice to the Healer: On the Art of Caring, released by Springer in November 2012. For more information, go to www.advicetotheyoungphysician.com