All Things Medieval

Medieval Christians often feared that Jews were not bound by the same moral rules as Christians. Their helplessness in the face of disease or medical hocus-pocus made them suspicious that their medicine might be poison.

Leprosy had already established medicine as an adjunct of the legal profession: there were court battles over whether a man did or did not have leprosy, because if he was certified to have it, he had to die legally. The city enforced his writing a will and vanishing from society. Some men hired their own doctors and took the city to court. Sometimes juries had to decide if they could trust the word of a Jewish doctor who disagreed with Christian doctors.

All medieval doctors were liable to being sued for malpractice. Doctors were frequently fined, and sometimes they were condemned to banishment or even death. Jewish doctors were not more liable than others, but when they were found guilty, it reinforced Christian suspicions against their whole community. When fines were too heavy for an individual doctor to pay, the Jewish community often helped because paying the fine made the talk settle down.

Jews avoided working as pharmacists, since that was the quickest way to be accused of maliciously compounding a poison. If a Christian did the compounding, then the Jewish doctor at least did not bear responsibility if he could prove that his prescription was reasonable. After the plague of 1347-50 sharpened Christian fears that some disease was deliberate Jewish poisoning, Jewish doctors were required to taste their medicinal wines before administering them—and the wine not being kosher was excluded as an excuse.

But the basic problem was that upper-middle-class and middle-class people began to expect that doctors should care for them, too, and there was a shortage of Christian doctors. University education was very expensive, and the Church forbade its priests and monks from studying medicine. But Jewish families had an advantage in using family networks to get medical training. The number of Jewish doctors was rising and demand remained high, so authorities were reluctant to cut off this source of supply.

But, eventually, some rulers forbade Jews to practice medicine. A number of doctors had been accused of poisoning their patients; those convicted were hanged. Moreover, Christians heard rumors going back to to the 12th century that suggested Jews liked to dig up dead Christian bodies. Supposedly, the Jews would make potions out of their ground-up bones, adding Hebrew spells that invoked Satan. These rumors turned the tide against Jewish doctors.

The Duchy of Provence forbade Jews to practice medicine, or Christians to consult them, in 1306. Sicily did the same in 1310. In 1337, the Pope at Avignon spelled out rules forbidding Christians to consult Jewish doctors unless the patients was at death’s door and nobody else was reachable. But it was no good; Jewish doctors were needed. Provence had to revoke its decree a few years later, as did the Pope.

For the next few centuries, this pattern continued. A ruler would forbid Jewish doctors, but everyone would circumvent and complain against these laws. Sometimes the decrees were repealed, other times both the Church and secular officials just ignored them and continued to call in Jewish doctors. The situation got worse after the plague, when all professions, including doctors, ran short, but social prejudice and fears still ran high. In the early 1400s, Italian cities that had public hospitals were confronted with firing their Jewish doctors or losing patients. Still, Christians really never stopped consulting their favorite Jewish doctors.

By this time, medicine was widely taught among Jewish families. It was a life-preserver; in countless cases, a Jewish man’s ability to treat a sick ruler preserved his family’s life in a time of crisis. It became standard for Jewish boys to learn a basic curriculum of herbal medicine.

During the Middle Ages, Jews became prominent as doctors, but it took a few centuries for this to happen. There was no real Jewish medical tradition, apart from common sense patient care.

The first step toward Jewish medicine was that Jews in the Arabic world began translating books into Hebrew, so that Jews in Europe could read them. In 800, the Caliph of Baghdad had ordered his new House of Books to buy and translate every book they could find. This project became the main way that a lot of Greek literature was preserved when its original cities were sacked or burned. We have Euclid’s Geometry only as translated back out of Arabic into Greek and Latin.

During the 11th and 12th centuries, enterprising Jewish scholars who spoke Arabic as a first language were involved with Christian efforts to translate Arabic medical books into Latin. Naturally, they also produced Hebrew renditions.  Toledo was a center of this translation activity, because Spain had such a large Jewish community that spoke Arabic as a mother tongue, learned Hebrew at home and synagogue, and studied Latin in school. Maimonides’ medical books in Hebrew were primary sources for Jewish study.

The most prestigious doctors held the “laurea” degree from universities, but these schools did not admit Jews during most of the medieval period. All doctors, university-trained or privately schooled, had to pass licensing exams. Each city had a medical examining board composed of two or three Christians. Aspiring physicians had to give lectures and explanations of material in medical textbooks and answer other questions. They could be licensed with limitations if the board was uncertain of their skill; for example, a Jewish doctor with a limited license might be required to practice in partnership with a Christian, or a young doctor with an older, more experienced one, or the license might specify the areas of medicine in which the board felt the holder was competent.

A licensing process like this was personally biased against Jews, but it also was reasonably objective. If a man studied privately with an established doctor, the board did not discriminate against this education if he could pass their exam. That’s where it all came together for Jewish doctors, because their distant relations in the Arabic world could provide them with textbooks, and their families could arrange mentoring, sometimes through marriage to a doctor’s daughter. Medicine became a sort of family dynastic practice.

Outstanding Jewish doctors were richly rewarded by Christian city or national rulers. They were paid a lot, of course. Additionally, they could be given special exemptions from taxes or rules imposed on other Jews. Some got permission not to wear weird pointy yellow hats or other distinctive clothing. In some cases, the secular rulers sent word to synagogues stating that the favored doctor should be given precedence in the service. There’s no question that “My son, the doctor” became an exceptionally important bragging point.

When the Almohad Berber dynasty conquered most of Muslim Spain, their puritanical, tough-nomad attitudes brought persecution on religious minorities. They ended the practice of “dhimmi” minorities as a protected class paying a higher tax. Now, Christians and Jews had to convert, leave, or die. Many left, and the family of Maimon ben Joseph was among them.

Maimon had two sons, David and Moses. Moses studied Torah in Hebrew and Greek philosophy in Arabic, while David was a merchant. After the family resettled in Morocco, then in Egypt, David died in a shipwreck. Moses ben Maimon needed to support both his own family and his brother’s. He became a doctor, probably building on studies begun in Cordoba. We know he also trained in medicine in Fez. In Egypt, his family settled in Fustat where there was a Jewish community and synagogue. He became their doctor.

Fustat was very close to the new city of Cairo, built by the Fatimid dynasty, but now home to Saladin—of Crusades fame. Moses’s reputation reached Saladin, who called him in to consult on his maladies that included asthma. Moses split his time between the royal court in Cairo and his Jewish neighborhood in Fustat for many years. He worked extremely long hours, seeing patients at all hours. Somehow, he managed to write books at the same time.

We know Moses as “Maimonides” in English because when his books were translated into Latin, his Hebrew name “ben Maimon” became “Maimonides.” He is also known in Hebrew as the Rambam, an acronym for “Rabbi Moses Ben Maimon.” Maimonides wrote treatises on Jewish law, theology, and philosophy; he really was very prolific. His most famous title is “Guide for the Perplexed.”

And of course he wrote about medicine. By writing in Hebrew, he made the medical lore of Greece and Rome easily accessible to other Jewish doctors. But he added to it, in fact warning other doctors not to accept anything they read in a book, but always to impose their own empirical testing on ideas. In addition to the theories of the four humors that were typical of his time, he recommended some ideas that still are right to modern eyes. For example, he recommended whole wheat bread and avoiding a lot of meat fat, vigorous aerobic exercise, avoidance of city pollution, and attentiveness to helping patients avoid depression. His medical titles include treatises on hemorrhoids, asthma, poison, and fertility. His fertility book is “On Cohabitation,” and it gives aphrodisiac prescriptions.