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MEDICINE AND THE GERMAN JEWS
A HISTORY
By JOHN M. EFRON YALE UNIVERSITY PRESS
Copyright © 2001 Yale University
All right reserved. ISBN: 0-300-08377-7
Chapter One
THE EMERGENCE OF THE MEDIEVAL JEWISH PHYSICIAN The social link between the Jews and medicine dates to the Middle Ages, for it was then that medicine began to be practiced by significant numbers of Jews. One reason for the profession's popularity among Jews was that from the medieval period until the eighteenth century, physician-rabbis were highly visible figures on the Jewish social landscape. This had a decided effect on the culture and value system of the Jews, bolstering the prestige of medicine, securing its image as a noble undertaking, validating medicine's compatibility with traditional Judaism, and helping its more illustrious practitioners become beloved within their communities. In other words, from early on, doctors became role models for Jews. Moreover, for both Jews and Gentiles, the cognitive and cultural association of Jews with medicine, which persists down to our own time, was also formed during the Middle Ages.
In Western Europe, the transition of Jewish culture from one that was theologically amenable to medicine to one that actually boasted a disproportionate number of physicians was relatively abrupt. From about 1250, medicine came to occupy a central place in the array of professions engaged in by medieval Jewry. At this time, Jews constituted about 1 percent of European society, with slightly higher percentages in larger towns and cities. At various times, however, Jews accounted for as much as 50 percent of the physicians in a given locale.
This is somewhat ironic because although Judaism wholeheartedly sanctions and encourages medicine, there has never been a field designated "Jewish medicine." While the Bible and Talmud certainly address such subjects as human anatomy, hygiene, and the nature of disease and its causes, medical discussions by the rabbis were generally entered into for the purposes of making a halakhic, or legalistic, interpretation. Ancient Jewish disquisitions about the body were not part of a self-contained therapeutic discourse. This is because an independent, secular, Jewish medical tradition akin to that possessed by the Greeks, the Arabs, the Chinese, or the Indians simply has never existed. There were no Jewish medical schools in the talmudic age, nor were there any medical textbooks and treatises written in Hebrew, save the Sefer Asaf, a medical compendium assumed to have been written in Palestine between the third and fifth centuries, but possibly compiled in Byzantium as late as the tenth. Indeed, the dearth of ancient medical literature in Hebrew was even recognized and bemoaned by medieval Jewish translators.
And while the Talmud is full of remedies, treatments, and discussions of physicians, later generations of rabbis specifically warned against using rabbinic literature as medical texts. Just as Moses Maimonides (1135-1204) had warned that the astronomical knowledge of the rabbis was no match for that of the experts, somewhat later no less a figure than Jacob ben Moses Mollin (1365-1427), the most distinguished talmudist of his generation and head of the Jewish communities of Germany, Austria, and Bohemia, argued that: "One should not try any of the medicines, prescriptions or exorcisms recommended in the Talmud because no one today knows how they should be applied. If they should be tried nevertheless and found ineffective, the words of our sages would be exposed to ridicule."
It is all the more remarkable, then, that medicine became so closely associated with Jews, given that no system of medicine derived from Judaism. The history of "Jewish medicine" is mostly the history of its doctors and that of Jews as objects of medical observation. It is a story that spans the medieval and modern periods. The roots of the relationship of Jews to medicine struck deepest in Mediterranean lands, for there perhaps thousands of Jewish doctors ministered to the sick, both Jewish and Gentile, throughout the course of the Middle Ages and early modern periods. While their story, which has been rendered in large brushstrokes, may lack some detail, it nevertheless fills a rather large canvas. It is not the aim of this book to repeat that story. Rather, some general aspects of it serve as necessary, comparative background before moving on to examine the history of medicine among the Jews of Germany.
Generally speaking, the most important developments in medical training and practice between the seventh and eleventh centuries took place in the Muslim world and Southern Europe. Islamic intellectual culture absorbed Greek philosophy, science, and medicine, building on them to create a majestic flowering of knowledge and high culture. Arab physicians elaborated on Greek medicine, composed medical encyclopedias, and led the world in the description and treatment of various diseases.
It is not surprising, then, that prior to 1250 and the rise of the Jewish physician in the West, the greatest concentration of Jewish doctors was to be found in the Islamic world of the eleventh and twelfth centuries. Historian Shlomo Dov Goitein has further observed that under Islam, "an almost unbroken succession of medical men constituted both the actual and official leadership of one of the two minority groups in Egypt and the adjacent countries during the whole of the High Middle Ages and far beyond." Moses Maimonides, the rabbinic authority, philosopher, and court physician, is the most famous such character of this type. As in so many areas of human endeavor, there was a symbiotic quality to the relationship between Arabs and Jews when it came to medicine. Arab medicine played an influential role in Jewish life and culture under Islam, providing it with professional and intellectual inspiration; in turn, Judaism's positive attitudes toward medicine were clearly incorporated into Islam itself, contributing to the prominence of Arab medicine.
While they eventually became important as practitioners, Jewish physicians at the beginning of the twelfth century exerted their greatest influence on the development of later medieval medicine in their role as translators and transmitters of Greek and Arabic medical texts into Hebrew (Jews had already translated an enormous number of Arabic philosophical texts into Hebrew).
Carried by Jewish immigrants to Southern and Western Europe, the Hebrew translations were picked up by Jewish medical practitioners, who in turn developed a keen reputation for their medical knowledge. By 1400, Jews had translated all the most important Arabic medical texts, and the most recent ones in Latin. The consequence of the enterprise of translation was threefold. First, the Jewish physician came to be held in high esteem because he was privy to the wisdom of both Greek and Islamic medicine. Second, the building of what has been called the "Hebrew medical library" meant that the High Middle Ages marks the beginning of a culture of professional medicine among the Jews. This is not a uniquely Jewish story. The creation of a professional medical corps was a European phenomenon-one that saw the imposition of very strict licensing procedures for physicians, and the development of what has been termed the overall "medicalization of society." Nevertheless, it is a further indication that medieval Jewish society was open to Christian innovation and custom. And third, medicine as a course of study exposed the Jewish doctor to other related disciplines such as astronomy, biology, botany, mathematics, and physics. Thus in addition to doctors, a quiet epistemological revolution had its first stirrings in Jewish society with the production of a new type of intellectual: the Jew who could boast philosophical and/or scientific literacy.
To be sure, "Jewish medicine" was a somewhat circumscribed phenomenon. By concentrating on translation, the production of original works of medical scholarship in Hebrew was minimal. In fact, after 1400 Jewish physicians became dependent on Christian medical knowledge and the scholastic model of instruction. By an act of omission, wherein no Jewish authors are mentioned, we are given insight into the limited, intellectual contribution of "Jewish medicine" in the Middle Ages by recalling the description of the ideal physician in the prologue to the Canterbury Tales. Chaucer had him well-versed in Escalapius, Hippocrates, Rufus, Dioscorides, Galen, Rhazes, Hali, Serapion, Averroes, Avicenna, Constantine, Scotch Bernard, John of Gaddesden, and Gilbertine. Not a Jewish author among them. And as if to underscore the point, Chaucer declared of the physician, "He did not read the Bible much." Nevertheless, before 1400, the Jewish translation project was of decisive importance, for Christian students would have come to many of these texts by way of the Latin translations by Jews.
Moreover, those medical treatises were the primary sources used in the education of Jewish physicians during the Middle Ages. In Southern Europe, Jews were largely excluded from universities before the middle of the fourteenth century. Therefore, aspiring Jewish medical students had to seek private instruction, and despite some contact with faculty at universities such as Salerno and Montpellier, the majority of Jewish physicians practicing around the Mediterranean throughout the Middle Ages learned their art from Jewish doctors in a one-to-one apprenticeship, and by studying the Hebrew translations. And rabbinic dicta about the dependency of the community on the physician notwithstanding - the Talmud admonishes that "it is forbidden to live in a city without a physician" - the cost of medical studies was borne solely by the family. It was not a communal responsibility. Very often, the existence of medical dynasties among Jews meant that sons would study medicine under their fathers, or sometimes, the promise of a bride's father to teach medicine to his prospective son-in-law was even written into the marriage contract.
Throughout the Middle Ages and the early modern period, the popular reputation Jews built for themselves as doctors derived principally from their role as practitioners. Two features of medieval Jewish medical practice help explain how this was achieved. The first stems from the relatively large number of Jewish physicians, all engaged in patient observation and treatment. Their exposure to so many sick people provided them with invaluable experience and knowledge. A related point involves the peripatetic nature of medieval Jewish doctors. In their travels to many communities and correspondence with a wide array of medical and rabbinical personalities from all over Europe, Jewish doctors shared a vast quantity of information with one another, thereby bringing wider attention and expertise to a variety of medical conditions. The same, of course, holds true for treatment protocol. The result of the vast circulation of medical knowledge among Jews was, at the very least, a widely held impression that Jews were in possession of a sophisticated body of medical knowledge that enabled them to provide a superior level of medical care compared to Gentile physicians. The fact that the medieval Jewish (and Gentile) doctor was powerless to cure most illnesses is immaterial, for his contemporaries, Christian and Jewish, believed otherwise. It was their faith in his talents that led them to form the enduring stereotype of the Jewish doctor capable of effecting cures.
As a consequence, Jewish doctors enjoyed public recognition both within the narrow confines of Jewish society and far beyond its limits. As is well known, Jewish physicians all over Europe were called upon to be court physicians in the service of kings, princes, and members of the aristocracy. Christian clergy also made use of Jewish doctors, to the extent that the majority of late medieval and Renaissance Popes had Jewish physicians in the medical retinues at their service.
Although temporal and church officials employed Jewish physicians to care for them, they expressly forbade the Christian populace at large from being treated by Jewish doctors. The church council at Beziers (1246) threatened to excommunicate Christians who sought medical treatment from Jews, and similar councils at Alby (1254) and Vienna (1267) excluded Jews from the free practice of medicine. Synods at Avignon (1326 and 1337), Freising (1440), and Bamberg (1491) all reinforced the ban on Christians using the services of Jewish physicians. (Mutual suspicion reigned, as the rabbi likewise passed injunctions against Jews using the services of Christian doctors.) What is paradoxical here is that the felt need of the Church to reimpose the bans time and again indicates that Christian common folk had few qualms about securing the services of Jewish doctors. Nor, would it seem, did they hesitate to defy Church policy when it was in their personal interest to do so.
Their intimate proximity to seats of power served to expand the role played by Jewish doctors. They were not only called upon to heal, but soon became royal confidants, advisors, and even shapers of policy. In addition, when necessary, they were able to use their positions to intercede on behalf of the Jewish community. To a great extent, their role as communal advocates mitigated the resentment fellow Jews expressed toward physicians as a result of the royal privileges they enjoyed, such as exemption from communal taxes, or special dispensation from wearing the distinctive and humiliating clothing and markings other Jews were required to display.
The way both clerical and secular powers used Jewish physicians was also a result of the creation of university medical faculties during the thirteenth century, and the introduction of medical licensing that occurred between the twelfth and sixteenth centuries. The effect of licensing was to reduce the number of individuals who could offer health care. Further reductions were the result of guild protectionism, which also succeeded in preventing or severely controlling the medical practice of non-university-trained personnel. Especially affected were the activities of women, who, it can be assumed, were primary health care providers.
While comparatively little is known of women doctors in the Middle Ages, recent historical research makes it clear that they did not confine themselves to treating other women but offered their services to men as well, and could generally be found across the spectrum of medical specialization. However, the newly imposed conditions of practice that effectively excluded women from universities also took a decided toll on the number of women medical practitioners. Available figures reveal extremely small numbers. In France between the twelfth and fifteenth centuries, women constituted only about 1.5 percent of physicians. In England from the eighth to the sixteenth century, only eight female physicians have been identified.
Continues...
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