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(the Ghettos have only disappeared in the nineteenth century), it would seem almost impossible for them to have done great intellectual work. It is one of the very common illusions, however, that great intellectual work is accomplished mainly in the midst of comfortable circumstances and as the result of encouraging conditions. Most of our great makers of medicine at all times, and never more so than during the past century, have been the sons of the poor, who have had to earn their own living, as a rule, before they reached manhood, and who have always had the spur of that necessity which has been so well called the mother of invention. Their hard living conditions probably rather favored than hampered their intellectual accomplishments.
It is not unlikely that the difficult personal circumstances in which the Jews were placed had a good deal to do at all times with stimulating their ambitions and making them accomplish all that was in them. Certain it is that at all times we find a wonderful power in the people to rise above their conditions. With them, however, as with other peoples, luxury, riches, comfort, bring a surfeit to initiative and the race does not accomplish so much. At various times in the early Middle Ages, particularly, we find Jewish physicians doing great work and obtaining precious acknowledgment for it in spite of the most discouraging conditions. Later it is not unusual to find that there has been a degeneration into mere money-making as the result of opportunity and consequent ease and luxury. At a number of times, however, both in Christian and in Mohammedan countries, great Jewish physicians arose whose names have come to us and with whom every student of medicine who wants to know something about the details of the course of medical history must be familiar. There are men among them who must be considered among the great lights of medicine, significant makers always of the art and also in nearly all cases of the science of medicine.
A little consideration of the history of the Jewish people and their great documents eliminates any surprise there may be with regard to their interest in medicine and successful pursuit of it during the Middle Ages. The two great collections of Hebrew documents, the Old Testament and the Talmud, contain an immense amount of material with reference to medical problems of many kinds. Both of these works are especially interesting because of what they have to say of preventive medicine and with regard to the recognition of disease. Our prophylaxis and diagnosis are important scientific departments of medicine dependent on observation rather than on theory. While therapeutics has wandered into all sorts of absurdities, the advances made in prophylaxis and in diagnosis have always remained valuable, and though at times they have been forgotten, re-discovery only emphasizes the value of preceding work. It is because of what they contain with regard to these two important medical subjects that the Old Testament and the Talmud are landmarks in the history of medicine as well as of religion.
Baas, in his " Outlines of the History of Medi
cine," says: " It corresponds to the reality in both the actual and chronological point of view to consider the books of Moses as the foundation of sanitary science. The more we have learned about sanitation in the prophylaxis of disease and in the prevention of contagion in the modern time, the more have we come to appreciate highly the teachings of these old times on such subjects. Moses made a masterly exposition of the knowledge necessary to prevent contagious disease when he laid down the rules with regard to leprosy, first as to careful differentiation, then as to isolation, and finally as to disinfection after it had come to be sure that cure had taken place. The great lawgiver could insist emphatically that the keeping of the laws of God not only was good for a man's soul but also for his body."
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 Kabbi 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 oesophagus 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 Caesarian section upon the dead and upon the living mother. A. H. Israels has clearly shown in his 'Dissertatio Historico-Medica Inauguralis 'that Caesarian 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, oesophagus, 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