Moses Maimonides' Treatise on Poisons - 2nd Chance

Moses Maimonides' Treatise

The parts,

Treatise on Poisons and Their Antidotes written by Moses Maimonides, in two at the request of his lord protector, the Visier Kadhi Al Fadhil,1 also known as Abu-Rahim ben 'Ali el Beisani,2 in the Muhammadan month of Ramadhan in the year 595 (corresponding approximately to July 1198). Maimonides himself states this in the introduction to his work, where he also mentions that he entitled his discourse Treatise to the Honored One or Treatise of Fadhil: was

was

in the month of Ramadhan in the year 595 that His

Highness addressed his humble servant and said: "It occurred to me yesterday that someone might be bitten by a poisonous animal and the poison spread throughout his body. and he would die therefore, I order you . to .

write

a

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.

.

short and concise manual of first aid to the bitten .

.

.

person." In compliance with the command and wish of your highness, I set out to write the following treatise and entitled it "The Treatise to the Honored One!"

The original Arabic version is available in Arabic lettering in the following manuscripts: Bodleian Uri No. 578 (beginning missing) and No. 608;

Escorioal No. 884 (written in 1312); Florence Medicea No. 253; Gotha No. 1986; Paris No. 2962 (?lost); and Paris No. 1094. The Arabic text with Hebrew lettering is extant in Manuscripts Bodleian Neubaurer No. 12705; Bodleian Uri No. 78 (middle part missing); Paris No. 1211 (missing in the cata¬ logue, perhaps should be No. 411); and Sassoon No. 573.10 Maimonides' Treatise on Poisons was translated into Hebrew in the 13th century by Moses Ibn Tibbon under the titles Ma'amar Hanichbad (lit: The Important Treatise or Treatise to the Honored One) and Hama'amar Betheriac (lit: Treatise on the Theriac) and is extant in more than a dozen manuscripts.1 a These include Bologne No. 202; Florence Medicea Plut No. 88, Codex No. 29; Munich No. Ill,2 Folio 936; Paris No. 11247 (in¬ complete); Paris No. 11734; Parma de Rossi No. 1280; Vienna No. 152; Giinzburg No. 165b54; (Steinschneider No. 30, Folio 104)-Berlin No. 836; Bodleian Neubauer No. 2585, Folio 16. A second Hebrew translation, probably by From the Division of Hematology, Department of Medicine, Maimonides Medical Center, Brooklyn, NY. Reprint requests to 4802 Tenth Ave, Brooklyn, NY 11219

(Dr. Rosner).

Poisons

Zerachiya ben Yitzchak ben Shealtiel Chen,

Fred Rosner, MD

It

on

of only the foreword of this work is extant in Munich manuscript No. 280,2 Folio 37b and copied in Munich manuscript No. 43,5 Folio 86. The Treatise on Poisons was translated from the original Arabic into Latin by Armengand de Blasius of Montpellier. Five Latin manuscripts are extant45: Oxford Corpus Christi No. 125; Cam¬ bridge College St. Pétrie No. 209; Vienna Tabula IV, 95 No. 53061; Parma de Rossi Latin No. 59 (incomplete), and Bibliot. Medicini Practic 1, No. 399.

Friedenwald6 describes

an

additional Latin

man¬

uscript which Muntner5 states is the translation of John de Capua. This manuscript is probably iden¬

tical to the one that Muntner7 states was discov¬ ered by L. Bertalot, MD, in the Vatican. Frieden¬ wald6 also mentions that Maimonides' Treatise on Poisons is also found in Latin in Manuscript Palat No. 1298, Folios 189-205 in the Vatican Library and in Codex No. 2280, Folios 89-99 of the Na¬ tional Library in Vienna. A German translation of this work based upon the Bodleian Hebrew manuscript was published by Steinschneider in 1873," complete with com¬ mentary. A French translation of Maimonides' work on poisons based upon three Paris manu¬ scripts (one Hebrew, one Arabic in Arabic letters [now lost], and one Arabic in Hebrew letters) was published by Rabbinowicz in 1865 and reprinted in 1935.8 The latter also provides an alphabetical table of Arabic and Hebrew pharmaceutical names mentioned in the book. Rabbinowicz' French edi¬ tion stimulated the writing of two articles910 which outline and briefly comment on this medieval work on poisons. Other articles1112 deal in general with the natural sciences, particularly zoology, in the writings of Maimonides and specifically in his Treatise on Poisons. In 1926, Steinschneider's German translation4 was translated into English by Bragman.13 No commentary is provided. A definitive Hebrew edi¬ tion, based upon Paris manuscript No. 1173, com¬ plete with introduction, bibliography, extensive

illustrations, appendices, published by Muntner in 1942.2 Shortly thereafter, Muntner wrote a brief article describing this work.14 In 1966, an English translation, based upon the Arabic original from Paris manuscript No. 1211, was published by Muntner,5 together with a photocommentary, and indices

numerous

was

Downloaded from jama.ama-assn.org at Texas A&M University on January 17, 2012

reproduction of the entire Paris manuscript. Muntner's English edition, reviewed by DiCyan,15 is complete with preface, bibliography, illustrations, static

commentary, and index.

Maimonides' Treatise The text is divided into an introduction and two main parts or sections. In the introduction, Maimonides praises the Visier Al Fadhil and his virtues, including his modesty, his deeds of charity, his preserving holy places from destruction, his diplomacy in peace and heroism in war, his redemp¬ tion of prisoners and education of children, and his distributing among his people all those blessings of wealth and riches which God bestowed upon him. Maimonides then describes Al Fadhil's orders to him to import from distant lands drugs which were lacking in Egypt for the preparation of the great theriac and the electuary of Mithridates. These costly remedies were to be distributed to any per¬ son suffering from a poisonous bite or sting. Fol¬ lowing this, Al Fadhil asked Maimonides to com¬ pose a short treatise on the treatment of cases of poisoning by venomous animals prior to the arrival of a physician or until the patient could be brought to the dispensary to receive the theriac antidote. The first section of Maimonides' Treatise on Poisons, in six chapters, deals with the bites of snakes and mad dogs and the stings of scorpions, bees, wasps, and spiders. Chapter 1 concerns the conduct of the victim in general. Thus Maimonides states as follows: When

someone

is bitten, immediate

care

should be taken

to tie the spot above the wound as fast as possible to pre¬ vent the poison from spreading throughout the body; in the meantime, another person should make cuts with a

black lancet directly above the wound, suck vigorously with his mouth and spit out. Before doing that, it is ad¬ visable to disinfect the mouth with olive oil or with spirit in oil. Care should be taken that the sucking person has no wound in his mouth or rotten teeth should there be no man available to do the sucking, cupping-glasses should be applied, with or without fire; the heated ones have a much better effect because they combine the advantages of Then apply sucking and cauterizing at the same time. the great theriac. Apply to the wound some medicine which should draw the poison out of the body. .

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Chapter 2 in section 1 deals with simple and compounded remedies which draw out the poison when applied to the bite or sting. Maimonides de¬ scribes such efficacious preparations and names the easily procured well-tolerated ingredients. In chapter 3, Maimonides provides information the efficacy of simple remedies to be taken in¬ ternally, which are helpful to the snake-bite victim. Distinction is made between hematotoxic (hot) and neurotoxic (cold) effects of the particular poi¬ on

son

when Maimonides states:

I have not come across a single cooling, nerve affecting medicine against bites, except the Mandragora root. It may be reasonably assumed that both the heating and cool¬ ing antidotes are helpful against poison of any kind. It all depends whether the poison generates heat or cold. in the case of a man bitten by an animal, I would ad.

...

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vise to observe his condition first of all. If he feels very hot, as happens to victims of a viper-bite, he should choose medicines taken with milk or vinegar. If he feels very cold, as is the case, for example, of a victim of a scorpion-sting, he should choose a medicine taken with wine.

Maimonides recognizes the prohibition of wine to Moslems and offers an alternative when he states: "Where the consumption of spirits is prohibited, a decoction of aniseed may be taken instead." The preparation of the various simple remedies as well as the dosages for adults and children are then detailed. Chapter 4 consists of descriptions of the various theriacs and electuaries including the great theriacs, the asofoetida theriac of Rhazes, the nut theriac, the onion theriac of Ibn Zohr, the electuary of Avicenna, and the antidote of Galen. Chapter 5, still in the first section of this book, deals with specific remedies against the bites of certain animals. It first describes the treatment for a

scorpion sting:

One starts with the general procedure, as aforementioned, namely the cuts, the sucking and the bandaging. Then a plaster is applied to the spot. Next one applies the simple

remedies specific against

These remedies

are

scorpion sting. detailed as follows: a

Three drams of an extract of leaves of the herba citrina should be imbibed as well as rubbed into the site of the bite. Three drams of the seed of citrus fruits should be imbibed. The colocynth root is an excellent antidote against scorpion sting; its maximum dose is 2 drams. When the root is still fresh it should be crushed and rubbed into the site of the bite. When dried, it should be crushed, kneaded in vinegar and honey and applied to the site of the bite. Of the sesame seed, boil one ounce in 2 liters of water until it is fully extracted and wash the site of the bite therewith. Similarly, sulfur and fennel, one part of each, 2 parts of garlic, crush all and apply the resultant plaster to the affected spot. So, too, salt and flaxseed, one part of each, 2 parts of garlic, crush all and apply as a plaster to the stung spot. Likewise the theriac of the 4 in¬ gredients is more suitable than anything else for scorpion stings; 1 to 4 drams should be taken.

Chapter 5 continues with descriptions of stings of various spiders, bees, and wasps and specific remedies for them. For snake bites, the best rem¬ edy is the great theriac. If not available, substitute the electuary of Mithridates. Amazing in this chapter is Maimonides' recogni¬ tion of the long incubation period for human rabies: An old well informed doctor told

me that he saw a spinning bitten by a dog; it was not apparent that the bite was from a mad dog and so the physicians pronounced the dog domesticated and allowed the wound to close after a month or so. The boy improved and, for a long time, performed his functions like other healthy in¬ dividuals. Finally he became apprehensive of death and died one should leave the site of the bite open and not close it under any circumstances before 40 days have

factory boy who

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.

was

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elapsed. The final chapter of the first section deals with diet in general and particular for the bitten person, together with a few appropriate specifics. Dishes rich in salt, honey and butter, and strong wine are recommended. The popular belief that unleavened bread is efficacious for someone bitten by a poison¬ ous animal or for someone who has swallowed some


poison is rejected by Maimonides as being without rational, scientific, or traditional basis.

The second section of Maimonides' Treatise on Poisons describes, in four chapters, vegetable and mineral poisons and their antidotes. In the first chapter dealing with precautionary measures against poisons, Maimonides seems to allude to the fact that since poison is a common means used to eliminate undesirable enemies or competitors, rulers and prominent people should beware of col¬ ored foods, thick broths, or astringent aliments with strong odors. He calls for exacting examina¬ tion of all sharp and bitter foods before their in¬ gestion. Thus he states: There is a pungent plant which may be taken for wild rad¬ ish yet is really a deadly poison; similarly there is a plant which resembles the mushroom, inclines to be black in color and is poisonous. We tend to be cautious of these various kinds of bad odors and tastes and against every¬ thing of whose nature we are unaware.

Toward the end of this same chapter, Maimoni¬ des specifically mentions premeditated poisoning: One does not take any [bread] from those whom he suspects of a trickery but only from those he firmly trusts. It is not far-fetched or difficult to place poison in a simple or complex food and succeed with his intention with any food or beverage taken. Even if it doesn't kill, it will cause harm and deliverance rests only in the hands of G'd. The second chapter deals with general rules for those who have either taken or believe they have taken poison. Emesis should be induced by means of hot water with Anethum and much oil followed by fresh milk, butter, and honey—all of which should be vomited. Then the specific antidote should be administered. Chapter 3 of the second section deals with simple and compounded remedies effective for the person who has swallowed one of the general varieties of poisons. Universal antidotes consist of the great theriac, the electuary of Mithridates, and the small theriac (composed of only four ingredients). Ibn Zohr is described as one of the greatest toxicolo-

gists.

He was the greatest man to prove the value of these reme¬ dies and the one who experimented with them. He had the greatest talent in this regard on account of his great afflu¬ ence and erudition in the art of therapeutics.

The final chapter of Maimonides' Treatise on Poisons details the treatment for one who knows the kind of poison he took. Here is described the wicked habit of the women who strew poison (men¬ strual blood) into their husband's food and the difficulty with which the physician is faced in ar¬ riving at the correct diagnosis. Maimonides gives excellent descriptions of the symptoms of belladona poisoning: "redness and a sort of intoxication. ." Equally vividly described are the symptoms follow¬ ing ingestion of cantharides (Spanish flies) : "... in¬ jury to the bladder, hematuria, severe pain [colic], and [intestinal] inflammation. Death intervenes after a few days...." The Treatise on Poisons shows Maimonides to be a scientist who did not abide by medical dogma .

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but experimented for himself or accepted valid in¬ vestigations of others. His originality, conciseness, and lucidity are reflected in every chapter. His recommendations in the 12th century concerning first aid for poisonings still have much validity.

For this reason, Maimonides' Tractatus De Venemis was considered one of the foremost textbooks of toxicology and therapeutics throughout Europe and the Near East in the Middle Ages. The age-old adage "an ounce of prevention is worth a pound of cure" is evident from Maimonides' emphasis on

preventive

or prophylactic measures. Perhaps most interesting of all in this work is the distinction he makes between "hot" and "cold" poisons, prob¬ ably equivalent to the modern hemolysins and neurotoxins.2 The latter are exemplified by the scorpion's poison which "cools" and paralyzes the victim's respiratory center with fatal outcome. Hemolysins or "hot" poisons are found in adder's poison, as from certain vipers, and produce hemor¬ rhage, intravascular hemolysis, hypertension, fever,

and death. It is hoped that this brief exploration into the Treatise on Poisons will stimulate the reader to ex¬ amine the entire work now available in English5 and evaluate for himself the genius of the medieval medical giant, Moses Maimonides. References Steinschneider, M.: Die Arabische Literatur der Juden: Ein Beitrag zur Literaturgeschichte der Araber, Grossenteils aus Handschriftlichen Quellen, Frankfurt, Germany: J. Kauffmann. 1902, pp 213-214. 2. Muntner, S.: Samei Hamaveth Ve Harefuoth Kenegdam (Poisons and Their Antidotes), Jerusalem: Rubin Mass, 1942, 1.

pp xx and 236. 3. Steinschneider, M.: Die Hebraeischen

Uebersetzungen des Mittelalters und die Juden als Dolmetscher: Ein Beitrag zur Literaturgeschichte des Mittelalters Meist nach handschriftlichen Quellen, Berlin: 1893, pp 764-765. 4. Steinschneider, M.: Gifte und ihre Heilung: Eine Abhandlung des Moses Maimonides, auf Befehl des Aegyptischen Wezirs (1198) Verfasst, nach Einer Unedierten Hebr\l=a"\ischen \l=U"\bersetzungbearbeit, Virchow Arch Path Anat 57:62-120 (Feb 21) 1873. 5. Muntner, S. (ed.): The Medical Writings of Moses Maimonides: Treatise on Poisons and Their Antidotes, Philadelphia: J.B. Lippincott Co., 1966, vol 2, pp xxxviii and 77. 6. Friedenwald, H.: Jewish Luminaries in Medical History and a Catalogue of Works Bearing on the Subject of the Jews and Medicine From the Private Library of Harry Friedenwald, Baltimore: Johns Hopkins Press, 1946, p 99. 7. Muntner, S.: Sefer Hakatzereth (The Book on Asthma), Jerusalem: Rubin Mass, 1940, p 10. 8. Rabbinowicz, I.M.: Ma\l=i"\monide(Abou-Amram Moussa Ibn\x=req-\ Maimon, 1135-1204): Trait\l=e'\des Poisons, ed 2, Paris: Librairie Lipschutz, 1935. 9. Perel, L.: Sur quelques id\l=e'\esmodernes dans le "Trait\l=e'\des Poisons" de Ma\l=i"\monide(1135-1204), Paris M\l=e'\dical96:iv-vii (May 25) 1935. 10. Herscovici, H.: Le traitement des norsures venimeuses, d'apr\l=e`\sMa\l=i"\monide,Practicien du Nord de l'Afrique 11:505-508 (Oct 15) 1938. 11. Aharoni, J.: Maimonides the Zoologist, Harefuah 10:105\x=req-\ 110 (March) 1936. 12. Theodorides, J.: Les sciences naturelles et particuli\l=e`\rement la zoologie dans le "Trait\l=e'\des Poisons" de Ma\l=i"\monide, Rev d'Hist M\l=e'\dH\l=e'\br9:87-104 (May) 1956. 13. Bragman, L.J.: Maimonides' Treatise on Poisons, Med J Rec 124:103-107 (July 21); 169-171 (Aug 4) 1926. 14. Muntner, S.: Maimonides' Book for Al-Fadil, ISIS 35:3-5 (winter) 1944. 15. DiCyan, E.: Treatise on Poisons and Their Antidotes by Moses Maimonides, Arch Intern Med 119:431-432 (April) 1967.
