The surgical aphorisms of Moses Maimonides

Abstract

Moses Maimonides, physician, theologian, philosopher, mathematician, and astronomer of the twelfth century, left a rich legacy of medical writings. Maimonides’ “Guide for the Perplexed” and his massive codification of Talmudic law, the Mishnah Torah, are better known than his medical works since the latter have only recently begun to be edited and published in Hebrew and English based upon the numerous manuscripts extant. Perhaps the most popular of Maimonides’ medical writings is The Medical Aphorisms of Moses (Pirke Moshe in Hebrew). This is a book of twenty-five chapters or treatises containing approximately 1,500 aphorisms based mainly on the works of Galen and other Greek and Arabic physicians. Each chapter or treatise is devoted to a different specialty in medicine and treatise fifteen deals exclusively with surgery. The source upon which each aphorism is based is given at the conclusion of the aphorism. This entire work has never before been translated into a western language. Chapter fifteen, dealing with principles of surgery, is presented here in its entirety translated from Hebrew Manuscript # 11’73, a copy of which was obtained from the Bibliotheque Nationale in Paris, France. Words in parentheses are our own additions to aid in the clarity of the translation but are not included in the original. The reader is particularly directed to the modernity of the concepts advanced by Maimonides. The principles of sterility and cauterization are outlined in aphorism Number 8 in which Maimonides cautions against infecting open wounds. In aphorism Number 10, the recognition of gangrene and the necessity for surgical intervention are pointed out. Early cure of “cancer” by wide excision is advocated in aphorism Number 13. The surgical approach to varicose veins, nasal polyps, peritonsillar abscesses, various tumors, and many other conditions, is described. That effective hemostasis requires the application of ligatures to bleeding vessels was recognized and advocated by Maimonides in aphorism Number 40. Incision and drainage of abscesses is depicted in aphorism Number 48. The final several FRED ROSNER, MD, Brooklyn, New York SUSSMAN MUNTNER, MD, Jerusalem, Israel