With this tradition familiarly known and deeply studied by the mass of the Hebrew people, it is no surprise to find that when the next great Hebrew development of religious writing came in the Talmud during the earlier Middle Ages, that also contains much with regard to medicine, not a little of which is so close to absolute truth as never to be out of date. Friedenwald, in his "Jewish Physicians and the Contributions of the Jews to the Science of Medicine," a lecture delivered before the Gratz College of Philadelphia fifteen years ago, summed up from Baas' "History of Medicine" the instructions in the Talmud with regard to health and disease. The summary represents so much more of genuine knowledge of medicine and surgery than might be expected at the early period at which it was written, during the first and second century of our era, that it seems well to quote it at some length.
"Fever was regarded as nature's effort to expel morbific matter and restore health; which is a much safer interpretation of fever, from a practical point of view, than most of the theories bearing on this point that have been taught up to a very recent period. They attributed the halting in the hind legs of a lamb to a callosity formed around the spinal cord. This was a great advance in the knowledge of the physiology of the nervous system. An emetic was recommended as the best remedy for nausea. In many cases no better remedy is known to-day. They taught that a sudden change in diet was injurious, even if the quality brought by the change was better. That milk fresh from the udder was the best. The Talmud describes jaundice and correctly ascribes it to the retention of bile, and speaks of dropsy as due to the retention of urine. It teaches that atrophy or rupture of the kidneys is fatal. Induration of the lungs (tuberculosis) was regarded as incurable. Suppuration of the spinal cord had an early, grave meaning. Rabies was known. The following is a description given of the dog's condition: 'His mouth is open, the saliva issues from his mouth; his ears drop; his tail hangs between his legs; he runs sideways, and the dogs bark at him; others say that he barks himself, and that his voice is very weak. No man has appeared who could say that he has seen a man live who was bitten by a mad dog.' The description is good, and this prognosis as to hydrophobia in man has remained unaltered till in our day when Pasteur published his startling revelation. The anatomical knowledge of the Talmudists was derived chiefly from dissection of the animals. As a very remarkable piece of practical anatomy for its very early date is the procuring of the skeleton from the body of a prostitute by the process of boiling, by Rabbi Ishmael, a physician, at the close of the first century. He gives the number of bones as 252 instead of 232. The Talmudists knew the origin of the spinal cord at the foramen magnum and its form of termination; they described the œsophagus as being composed of two coats; they speak of the pleura as the double covering of the lungs; and mention the special coat of fat about the kidneys. They had made progress in obstetrics; described monstrosities and congenital deformities; practised version, evisceration, and Cæsarian section upon the dead and upon the living mother. A. H. Israels has clearly shown in his 'Dissertatio Historico-Medica Inauguralis' that Cæsarian section, according to the Talmud, was performed among the Jews with safety to mother and child. The surgery of the Talmud includes a knowledge of dislocation of the thigh bone, contusions of the skull, perforation of the lungs, œsophagus, stomach, small intestines, and gall bladder; wounds of the spinal cord, windpipe, of fractures of the ribs, etc. They described imperforate anus and how it was to be relieved by operation. Chanina Ben Chania inserted natural and wooden teeth as early as the second century, C. E."
There is a famous summing up of the possibilities of life and happiness in the Talmud that has been often quoted—its possible wanting in gallantry being set down to the times in which it was written. "Life is compatible with any disease, provided the bowels remain open; any kind of pain, provided the heart remain unaffected; any kind of uneasiness, provided the head is not attacked; all manner of evils, except it be a bad woman."
There are many other interesting suggestions in the Talmud. Sometimes they have come to be generally accepted in the modern time, sometimes they are only curious notions that have not, however, lost all their interest. The crucial incision for carbuncle is a typical example of the first class and the suggestion of the removal of superfluous fat from within the abdomen or in the abdominal wall itself by operation is another. That they had some idea of the danger of sepsis may be gathered from the fact that they suspected iron surgical instruments and advised the use of others of less enduring character.
The Talmud itself was indeed a sort of encyclopedia in which was gathered knowledge of all kinds from many sources. It was not particularly a book of medicine, though it contains so many medical ideas. In many parts of it the authors' regard for science is emphatically expressed. Landau, in his "History of Jewish Physicians," closes his account of the Talmud with this paragraph:
"I conclude this brief review of Talmudic medicine with some reference to how high the worth of science was valued in this much misunderstood work. In one place we have the expression 'occupation with science means more than sacrifice.' In another 'science is more than priesthood and kingly dignity.'"[4]
After all this of national tradition in medicine before and after Christ, it is only what we might quite naturally expect to find, that there is scarcely a century of the Middle Ages which does not contain at least one great Jewish physician and sometimes there are more. Many of these men made distinct contributions to medical science and their names have been held in high estimation ever since. Perhaps I should say that they were held in high estimation until that neglect of historical studies which characterized the eighteenth century developed, and that there has been a reawakening of interest in our time. We forget this curious decadence of the later seventeenth and eighteenth centuries which did so much to obscure history and especially the history of the sciences. Fortunately the scholars of the sixteenth and early seventeenth centuries accomplished successfully the task of printing many of the books of these old-time physicians and secured their publication in magnificent editions. These were bought eagerly by scholars and libraries all over Europe in spite of the high price they commanded in that era of slow, laborious printing. The Renaissance exhibits some of its most admirable qualities in its reverence for these old workers in science and above all for the careful preparation by its scholars of the text of these first editions of old-time physicians. The works have often been thus literally preserved for us, for some of them at least would have disappeared among the vicissitudes of the intervening time, most of which was anything but favorable to the preservation of old-time works, no matter what their content or value.
During the second and third centuries of our era, while the Talmudic writings were taking shape, three great Jewish physicians came into prominence. The first of them, Chanina, was a contemporary of Galen. According to tradition, as we have said, he inserted both natural and artificial teeth before the close of the second century. The two others were Rab or Raw and Samuel. Rab has the distinction of having studied his anatomy from the human body. According to tradition he did not hesitate to spend large sums of money in order to procure subjects for dissection. At this time it is very doubtful whether Galen, though only of the preceding generation, ever had the opportunity to study more than animals or, at most, a few human bodies. Samuel, the third of the group, was an intimate friend of Rab's, perhaps a disciple, and his fame depends rather on his practice of medicine than of research in medical science. He was noted for his practical development of two specialties that cannot but seem to us rather distant from each other. His reputation as a skilful obstetrician was only surpassed by the estimation in which he was held as an oculist. He seems to have turned to astronomy as a hobby, and was highly honored for his knowledge of this science. Probably there is nothing commoner in the story of great Jewish physicians than their successful pursuit of some scientific subject as a hobby and reaching distinction in it. Their