Maimonides’ treatise On Rules Regarding the Practical Part of the Medical Art is a welcome addition to his medical opera omnia. It was lost to scholars for centuries before it was identified in the Biblioteca Nacional de Madrid (formerly MS Escorial 888, fols. 109a–123a) by the renowned Jewish scholar Moritz Steinschneider, who initially thought it was simply another copy of the same author’s work On Asthma. Upon examination, Bos and Tzvi Langermann, however, discovered that the work was, in fact, a separate monograph. It is composed in Maimonides’ favoured aphoristic (fuṣūl) format and contains, inter alia, some unique advice on serious abdominal wounds, most likely reflecting Maimonides’ own experience with battlefield casualties. The book includes a useful supplement section, which traces connections between On Rules and other works by the author under consideration, a glossary of technical terms and materia medica, notes to the English translation, bibliographies and a full subject index.
Few secular texts had such an impact on subsequent generations as the Hippocratic Aphorisms. They not only influenced medical theory and practice, but also affected popular culture. Maimonides even reports that school children knew some of the more famous Hippocratic Aphorisms by heart.Footnote 1 According to the Arabic polymath Muwaffaq al-Dı̄n ‘Abd al-Laṭı̄f ibn Yūsuf al-Baghdādı̄ (d. 1231), they constituted the most important Hippocratic text for medical teaching; therefore he, like so many other physicians, composed a commentary on them. Others also remarked that the Aphorisms ideally lend themselves to didactic ends: students should study medicine through the Aphorisms and the commentaries on them.
Bos and Tzvi Langermann emphasise that ‘there is a basic difference between the “regular” fuṣūl and those found in On Rules, and maintain that the latter are clearly far more comprehensive than those in Aphorisms 1–25’. This leads them to the, in my view, legitimate conclusion that the Aphorisms in On Rules were written at the end of Maimonides’ days and the result of a life of ‘learning and practice’. It could, moreover, very well be that these apparently more elaborate and advanced Aphorisms were meant, in the first place, for medical practitioners and were incorporated into the scientific discourse and scientific debate of the specific period, whereas the regular Aphorisms were chiefly used in medical teaching and training, and may often have been employed as a mnemonic device, a memoria technica, by would-be physicians.
Maimonides’ description of the treatment of serious abdominal wounds, in which the intestines have become dislodged, is rather spectacular and has not been described in published studies of medieval texts, according to Bos and Tzvi Langermann. I wholeheartedly agree with this. The procedure sketched is, however, rather odd, even for the standards of medieval medicine. Could it be that the procedure in question was meant as a ‘conversation piece’, which merely served as a vehicle for the broader medical discourse: debate and discussion? I am inclined to believe that this example is not taken from practical medicine, but represents a theoretical model, but I sincerely hope that I am wrong in assuming this. The example given by Maimonides is, in any case, an excellent addition to the existing literature on the topic of war wounds and battlefield casualties.Footnote 2
In section 33, Maimonides questions the rather common practice of advising feverish patients to visit the bathhouse by claiming that in his day and age, no one knows any longer about the effect of the bath upon fevers. Bos and Tzvi Langermann state that Galen had advised feverish patients to visit the baths, and his opinion was repeated by ‘all physicians’. Maimonides, in their opinion, has thrown out Galen’s rule, and instead advises treating the different types of fever by diet or bloodletting. Bos and Tzvi Langermann are slightly missing the point here, because it was already well known in Galen’s time that it was dangerous for feverish patients to visit the bathhouse in certain circumstances. It could, for example, severely worsen their condition and ultimately result in death. If we now turn briefly to the beginning of lemma I.4 of Galen’s Commentary on the Hippocratic Prognosticon we find that ‘a certain physician took to the bathhouse a young man who had just begun to perspire with a syncope-type sweat. When this sweating grew heavier, the doctor congratulated himself on having acted at exactly the right time, but shortly afterwards his young patient died, and he was accused of having killed him.’ We find the same Galenic anecdote in two other Arabic commentaries on the Hippocratic Prognostic: one by Barhebraeus (d. 1286) and the other by Muhadhdhab al-Dı̄n ‘Alı̄ ibn al-Dakhwār (d. 1230). The latter altered Galen’s text a little and added the fruits of his own experience as a practical physician: ‘The physician was happy in his foolishness, as he firmly believed that a discharge of sweat indicates recovery and health … but know that sweat that indicates death has certain signs, and sweat that indicates recovery also has certain signs’.Footnote 3 In short, Maimonides knew exactly what the problem was with hot baths and feverish patients, and therefore (cf. section 34) wanted to prevent feverish patients from sweating: ‘When he [the patient] is close to sweating, immerse him in cold water all at once, lift him up quickly, and rub him off immediately with moist towels so that the water goes away’. Maimonides apparently felt a strong need to warn his peers about the application of the bathhouse therapy in the case of strong fevers. Apparently, many of the physicians of his time lost the ability to differentiate between the types of sweat, and were for that reason no longer capable of recognising the signs of life and death.
The Arabic edition and English translation of Maimonides’ On Rules Regarding the Practical Part of the Medical Art by Gerrit Bos and Y. Tzvi Langermann is an excellent contribution to the history of medicine of the Middle East. Therefore, I look forward to the forthcoming volumes of Maimonides’ Medical Aphorisms, but also to his Commentary on Hippocrates’ Aphorisms and The Regimen of Health.
