This book is part of an ongoing project to critically translate and edit Maimonides' medical works that have not yet been edited at all, or whose available editions are currently considered unreliable. The editor and translator is an expert in medieval Jewish and Islamic science—this expertise is perceived throughout the book. The first ten volumes were published by the Middle Eastern Texts Initiative of the Neal A. Maxwell Institute for Religious Scholarship at Brigham Young University (some with the collaboration of Tzvi Langermann and Michael McVaugh). The present text, as well as the two previous ones, are published with Brill.
On the Elucidation is a consilium written for al-Malik al-Afḍal, Saladin's eldest son, sometime after 1200 but before 1204. This is in fact the second consilium Maimonides wrote for the same patron. The first one, On the Regimen of Health,Footnote 1 is also edited and translated in the same series. The fact that a second consilium was needed is a hint to the reader concerning the relationship between client and his – well-appreciated – physician. I will return to this point later on.
Bos begins by describing the available editions and translations of On the Elucidation, and explains the need for a new one—available editions of the Arabic text relied on a faulty and inaccurate manuscript. The present text includes an edition of the Arabic, using additional manuscripts that allow a better reading, and editions of the two partial Hebrew translations. The introduction includes a short biography of Maimonides; a discussion of the popularity, or lack thereof, of the treatise; the available manuscripts and their condition, editions and modern translations; followed by a short presentation of the treatise's contents.
The introduction is short and to the point, presenting the needed information for the reader, both regarding the text as well as relating to existing dilemmas and disagreements, e.g. whether Maimonides wrote in Arabic or in Judeo-Arabic and then had his text transliterated. Bos keeps us in the dark regarding his own opinion of the matter. The rest of the book comprises a parallel Arabic-English edition and translation, an edition of the Hebrew translations, a rich glossary and indices.
The treatise as mentioned is the second consilium Maimonides composed for al-Malik al-Afḍal. One may wonder why a second one was needed, and why the client should refer again to Maimonides if the first one didn't work? The first one was written a few years prior, probably around the time of al-Afḍal's ascent to the throne. The second one was written after he was banished from the court, and from Egypt, and when Maimonides was already old and too weak to personally attend him. Asking for Maimonides' advice again may indicate the great confidence al-Afḍal had in him, and his mistrust of his present care-takers, as they gave him contradictory advice, or such that seemed dubious to him. Hence, al-Afḍal sent for his much-appreciated doctor's advice and indeed received it in the form of a treatise. He asked Maimonides to judge which of the advices was the right one.
The treatise is divided into aphorisms (Ar. fuṣūl), short paragraphs each discussing a particular issue or medical matter. This literary genre has deep roots in medical writing, going back as far as Hippocrates' Aphorisms, and was employed by Maimonides in other treatises.
Maimonides begins by presenting the cures and regimen prescribed by the others, explaining whether or not he approves of this advice. His explanation includes a theoretical explanation, one that requires at least some basic knowledge of medicine and humoral theory. Again and again Maimonides repeats that “it is clear to this Servant the knowledge of my Master about those afflictions and their causes in perfect.” (pp. 21–22) The discussion offers prescriptions and the various indications for taking or changing ingredients. Maimonides does not flinch from harshly criticising doctors for their incorrect advice (e.g. aphorism 9). He also indicates that his own advice is elaborated by familiar and well-respected authorities (e.g. aphorism 8; also in other parts of the treatise, e.g. aphorism 21).
After discussing other doctors' advices, Maimonides offers his own suggestions and counsel, with prescriptions and further explanations how and under what circumstances a particular medicine should be taken. Prescriptions come with variants, depending on the client's temperament. For instance, aphorism 22 provides instructions for treating a person “dominated by a hot bad temperament” (materia medica and modes of preparation), while in aphorism 23 he explains the necessary changes in case the patient is “dominated by a cold bad temperament” (pp. 52–53).
Aphorisms 27–35 offer the appropriate dishes al-Afḍal's nutrition should include, whereas aphorisms 35–45 present the way of life al-Afḍal should adopt, from sleep to exercise, and their adaptation with the change of seasons.
The last aphorisms are of particular interest. In a way they illustrate the relationship Maimonides sees between doctor and patient. In aphorism 46 Maimonides says the following: “This Servant knows that because of the excellence of the intellect of our Master and the soundness of his perception he is capable of adhering to a regimen as is proper according to that preceding treatise and these chapters and all the more so if there is at hand someone who can guide him and help him by his knowledge and familiarity with the Art.” (pp. 78–79) This, as well as other instances throughout the book (e.g. pp. 60–61), repeatedly mention the knowledge the Master holds and that this knowledge allows him to keep healthy. The doctors in this case are needed to help, but not to make their own decisions leaving the patient uninvolved.
This is very curious, as treatises discussing bedside manners do not express similar confidence in clients' involvement in their medical treatment. For instance, Abū Bakr al-Rāzī, the famous tenth-century physician, dedicated a whole treatise to the wrong conceptions lay people have of medicine, and how these misconceptions cause them to consult charlatans rather than knowledgeable physicians.Footnote 2 In other words, whereas Maimonides has complete confidence in the patient's ability to make reasonable well-educated decisions, al-Rāzī is rather doubtful that lay people possess the basic intellectual abilities required. For instance, he explains that lay people expect doctors to know everything without even talking to the patient. Hence they are tricked by charlatans who pay men—but mostly women—to eavesdrop and gather information about patients.Footnote 3
Of course it is possible that Maimonides refers to the particular addressee and sees him as a unique case, of a well-bred man, whose fine education and previous attachment to a good doctor, have provided him with the appropriate tools to be involved in his medical treatment. Another possibility is that Maimonides did not hold al-Afḍal in particularly high esteem, but that this is his way of reprimanding and scolding al-Afḍal's physicians, claiming that they lack the most basic medical knowledge that even a lay person is expected to have.
The last aphorisms also relate to the relationship between doctor and patient, but from a different angle. In these sections, Maimonides discusses the extent of the doctor's responsibility for the patient. More specifically, Maimonides refers to his repeated recommendation of wine. He acknowledges the religious prohibition against drinking wine, but once again leaves it up to the patient to decide. According to Maimonides, “this Servant has not recommended that this should be done, but has mentioned what his Art requires” (pp. 78–79). And once again: “he [al-Afḍal] has the choice” (pp. 80–81).
In other words, as in the case of being responsible for which advice to heed, and which to reject, medically, so is the patient expected to employ his mental abilities to choose when medical advice contradicts a religious commandment and one's values. Once again, Maimonides places great confidence in the client's ability to make informed decisions.
Bos's knowledge and familiarity of Maimonides's works are well felt in the meticulous editing and translation of the text, as well as in the rich footnotes, where the reader may find abundant additional information: identification of ambiguous components in prescriptions; cross-references with others of Maimonides's works, as well as other medical authorities; and in some cases corrections to Maimonides's words (e.g. when wrongly ascribing a prescription to Ibn al-Tilmīdh, see pp. 32–33). The book ends with a rich trilingual glossary, and three indices, one for each edited text.
The book is an excellent edition for historians of medieval medicine, and is important not only for researchers, but also as a teaching tool.
