Friday, October 2, 2015

1138 -1204 A.D.: Maimonides writes asthma book

Maimonides (1138-1204 A.D.)
While few may know this, the Muslums may be credited as saving ancient Greek and Roman medical theories for modern times. This is because while the Western world was engulfed in the dark ages, the Eastern world was full of rising societies.

Europeans were so busy feuding amongst themselves and destroying towns and libraries, the Muslims were growing a society in Arabia and Spain.  In essence, through their travels, the Muslums brought Greek and Roman medical wisdom to Spain.

Maimonides, born Abu Imran Musa ibn Maimun, was not a Muslim but a Jew who lived from about 1138 to 1204 AD. He was among the most famous writers, physicians and philosophers of his day.

He was born in Muslim controlled Cordova, Spain, and learned from his father, who was a Jewish teacher and Rabbi.  His mother died in childbirth, and so he was raised by his father.  Little is known of his childhood, although, as Fred Rosner notes in his book "The medical legacy of Moses Maimonides."

However, Rosner said it is expected he was an avid reader "since his medical writings show a profound knowledge of ancient Greek authors in Arabic translation and of Moslem medical works.  Hippocrates, Galen, and Aristotle were some of his Greek medical inspirations, and Rhaze's of Persia, al-Farabi, and Ibn Zuhr (Avenzoar), the Spanish-Arabic physicians, are Moslem authors frequently quoted by Maimonides." (1, page 4)

He was born during an ideal time during the crusades where Christians traveled to the Holy land to free the city of Jerusalem from the Muslims, who captured the Holy lands from the Bryzantines in 638 A.D.

In order to avoid religious persecution in Spain, Maimonide's family fled Spain and ended up in Fez, Morocco, said Barry Brenner.  Here, "he devoted himself to the study of medicine and Judaism."  The family then moved to Egypt, and it was here where Maimonide's career in medicine took off.  (3, page 4)

However, Rosner said, Maimonides turned to medicine only after the death of his father and brother in 1166.  Having the responsibility of caring for his brother's wife and child.  He was sick for a year, and then turned to medicine. (1, page 4)

Rosner said:
He was appointed court physician to Vizier al-Fadil, regent of Egypt during the absence of the sultan, Saladin the Great, who was fighting in the Crusades, is reported to have invited Maimonides to become his personal physician, an offer which Maimonides declined. His reputation as a physician grew in Egypt and neighboring countries, and his fame as a theologian and philosopher grew worldwide. (1, page 4)
So he became physician to Saladin and his son, the prince al-Afdal Nur al-Din Ali.  When Saladin died and his son succeeded him, Maimonides had an easier time studying medicine.  (1, pages 4-5)(3, page 4)

He became a "prolific writer."  However, despite all his writings, he left very little along the lines of opinions about everyday life, so we know little about his life and personality. (1, page 6) (2, page 3)

Rosner said he often cited the following parable:
A patient who puts his life in the hands of a physician who has practical experience but lacks scientific training is like a mariner who places his trust in good luck, relying on the sea winds, which sometimes blow in the direction he desires but sometimes spell his doom. (1, page 27)
Rosner said that by this parable he was "obviously cautioning against consultation with and treatment by quacks." (1, page 27)

Maimonide's wrote a lot during his lifetime, and most of his books were written to someone who requested some type of medical advice.  For example, in the last 14 years of his life he was asked by the Prince to provide some advice on how to live with his asthma.  Maimonide wrote to him that asthma was usually started with a cold and advanced to shortness of breath.

Maimonides ended up writing his "Treaties on Asthma," where he recommended against trying any magical cures for any ailments, and any such remedies should treat the cause as opposed to just the symptoms.  Treatment should also be based on age of the patient and the season, as the disease might be seasonal. (3, page 4)

He wrote that ultimately during the course of (an asthma attack) the patient later gasped for air and coughed up a wad of phlegm.

Rosner said Maimonides might have been the first to describe psychosomatic medicine when he wrote how a patient who is "mentally agitated" causes his physical well-being to suffer and eventually he becomes physically ill. (1, page 25)

Rosner sad that Maimonaides also adds that...
...gaiety and joy gladden the heart, and stimulate the blood and mental activity.  Excessive indulgence in the pursuit of pleasure, however, is injurious to one's health.  The avoidance of illness induced by such excesses is by conducting oneself according to ethical and moral principles. (1, page 25-26)
Maimonides said asthma usually starts as a cold during the rainy season. He also might have been the first to describe how city air pollution may cause asthma.  He said:
"Town air is stagnant, turbid, and thick; it is the natural result of its big buildings, narrow streets, and garbage... Air winds carry stealthily inside the houses and many become ill with asthma without noticing it. Concern for clean air is a foremost rule in preserving the health of one's body and soul." (1, page 28)
As remedies, he recommended the inhalation of many herbs.  He may also have been the first to recommend chicken noodle soup as a cure for breathing trouble, as it assists in the expectoration of phlegm (1, page 27-28).

Some of his basic remedies included: (1, pages 24-28)
  • Clean air
  • Healthy eating (he recommends eating certain foods and avoiding others)
  • Healthy drinking
  • Controlling emotion (was this an early reference to psychosomatic asthma?)
  • Exercise
  • Rest
  • Excretion
  • Retention of wastes
  • Bathing
  • Massaging
  • Avoid gas producing foods (causes bloating)
  • Chicken soup (acute asthma only and only if patient is afebrile)
  • Moderate exercise prior to eating
  • No exercise right after a meal
  • Dry months
  • Small quantities of wine
  • Enemas to cleanse the bowels (induce bowel movement and to drain thick juices)
  • Aromic herbs (to fortify the brain and dry out any humidity therin)
  • Emetics to cleanse the stomach (cause vomiting)
  • Sleeping after bathing is good, yet bath water should be warm and contain salt
  • Various compound remedies (1, pages 24-28)
  • Travel to dry regions 
For severe cases of asthma, he recommended: (1, pages 27-28)
  • Emetic should be used 
  • The patient should sleep as little as possible, and in a sitting position.
  • Excessive exercise and strenuous physical exercise should be avoided 
  • Opiates should be used in severe cases only (1, pages 27-28)
He advises against the following common "excessive" remedies from other physicians because they "involve strenuous physical and emotional exercise.": (1, page 24)
  • Sexual intercourse
  • Blood letting
  • Hot baths
  • Urine stimulation (such as diuretics)
  • Purgation (never on healthy people because it doesn't preserve health)
  • Sleeping immediately after meals is harmful
  • Washing with cold water after meals is harmful
  • Excessive bathing during acute attacks (due to wet climate created)
  • Opiates (except in severe cases (1, page 24, 27-28)
Possible triggers:
  • Wet seasons
  • Excessive drinking
  • Pollution (1)
He told the prince he would reference Galen and Hippocrates often.  However, he later wrote that Galen observed Hippocrates to be wrong in many areas of his writings.  But instead of saying, "Hippocrates was wrong," he would cover for Hippocrates, even to the point of changing Hippocrate's meaning, or crediting the error to other writers and not Hippocrates himself. (1, pages 75-77)

As a side note here, while Maimonides' did write a treaties on asthma, and while he did write it to the Prince, modern experts are not sure whether the disease he wrote about was actually asthma as it is defined today, or some other malady with asthma-like symptoms.

Rosner said Maimonides died on December 13, 1204, cremated, and "legend relates that Maimonide's body was placed upon a donkey and the animal set loose.The donkey wandered and wandered and finally stopped in Tiberias.  That was the site where the great Maimonides was buried." (1, page 5)

  1. Rosner, Fred, "The medical legacy of Moses Maimonides," Chapter 2, "A Treaties on Asthma,"   page 13
  2. Yellin, David, "Maimonides," IsraĆ«l Abrahams, Jewish Publication Society of America, Philadelphia, 1903, page 3
  3. Brenner, Barry E, editor, "Emergency Asthma," 1998, New York, page 13
RT Cave Facebook Page
RT Cave on Twitter
Print Friendly and PDF

No comments:

Post a Comment