Jewish Halakhic Authorities' Attitudes Towards Treating Muslims in the 12Th

Home , Beit Yosef (book), Chaim Soloveitchik, Cyril Elgood, Gentile, Goy, Joel Sirkis

The Review of Rabbinic Judaism 21 (2018) 108–133

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“I bear the burden of treating the gentiles”: Jewish Halakhic Authorities’ Attitudes towards Treating Muslims in the 12th–18th Centuries

Abraham Ofir Shemesh Ariel University, P.O.B. 3, Ariel, 40700, Israel [email protected]

Abstract

The paper focuses on the religious, social, and historical aspects of the ancient Jewish prohibition against treating non-Jews. It discusses the attitude of rabbinic authorities towards providing medical service to Muslims in medieval and pre-modern times. It points out that circumstances did not enable the public to fulfill these instructions to the letter, and therefore many halakhic authorities in the post-Talmudic period dispensed with the prohibition almost completely. The question of treating Muslims was discussed by halakhic authorities in both Christian and Muslim countries. Stricter views were voiced concerning the treatment of Christians, but the dispensation to treat Muslims and deliver their babies was more pronounced. Halakhic authorities claimed that the original prohibition regarded idolaters, while Muslims do not engage in idolatry. Another major claim supporting the concession was a concern for animosity and harassment within the non-Jewish environment.

Keywords

Maimonides – Baruch Harofe – Ḥekim Yakub – idolaters – halakhic authorities – Jews treating non-Jews

The physician-patient relationship is the basis of all medical systems, and it is inherent in all enduring human societies. Such interpersonal relationships have social significance as well, as they create an essential point of conver- gence between people who belong to diverse faiths and cultures, which are

© koninklijke brill nv, leiden, 2018 | doi 10.1163/15700704-12341339Downloaded from Brill.com09/26/2021 12:30:07PM via free access “I bear the burden of treating the gentiles” 109 sometimes rival and hostile. The physician’s ethical duty to provide medical treatment to patients from all backgrounds and social classes is one of the principles of the Hippocratic Oath: “Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.”1 The Hippocratic Oath does not deal explicitly with ethnic and racial differences between patients, but this issue has been incorporated in modern physicians’ oaths.2 Do the early Jewish halakhic sources agree with the ethical attitude of the Hippocratic Oath in its objection to distinguishing among patients? The Bible voices no injunction against medical relationships with non-Jews. The story of Elisha the Prophet who cured Na’aman, the Aramaic captain of the guard who suffered from leprosy, may indicate that no such restriction existed. The story was clearly intended to reinforce the status of the prophet as a miracle worker not only in the eyes of the Israelites but also as perceived by gentiles.3 Moreover, God is described in Scripture as one who “strikes and heals,” a principle applied to both Jews and gentiles.

1 For the English translation of the Hippocratic Oath, see James Copland, “The Hippocratic Oath,” in The London Medical Repository 23 [135] (1825), p. 258. For the Greek text, see W.H.S. Jones, ed., Hippocrates Collected Works (Cambridge: Harvard University Press, 1868), pp. 130–131. On the ethical principles of the oath, see Ludwig Edelstein, The Hippocratic Oath: Text, Translation and Interpretation (Baltimore: Johns Hopkins Press, 1943). 2 The modern version of the Hippocratic Oath is the Declaration of Geneva (Physician’s Oath) of the World Health Organization (WHO). The declaration is currently published by the World Medical Association (WMA). The revised version mentions the physician’s duty to cure all patients: “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.” See in the WMA website: http://www .wma.net/en/30publications/10policies/g1/ 3 2 Kings 5:1–14. On this trend in the Elisha stories, see Alexander Rofe, The Prophetical Stories: The Narratives about the Prophets in the Hebrew Bible, Their Literary Types and History (Jerusalem: Magnes, Hebrew University, 1982), pp. 42–64 [Hebrew]; Uriel Simon, Literary Reading of the Bible: Stories of the Prophets (Jerusalem and Ramat Gan: Biyalik Institute and Bar Ilan University Press, 1997), pp. 279–324 [Hebrew]. On the prophets as physicians see Ernst R. Wendland, “Elijah and Elisha: Sorcerers or Witch Doctors?,” in Bible Translator 43 (1992), pp. 213–223.

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The first signs of restrictions on Jewish-gentile medical relationships emerged and crystallized in the period of the sages (c. 300 BCE–500 CE). Medical prohibitions are one of many rabbinical restrictions on relationships between Jews and non-Jews, based on the concern that non-Jews would harm Jews, for example, when they received haircuts from non-Jewish barbers who used knife and scissors, or even just walked together, for fear of attack.4 The rabbis imposed a double restriction. First, they prohibited the provision of medical services to non-Jews—medical care, circumcisions, and delivering their babies5—based on the injunction against assisting and supporting pagan societies that contradict the foundations of monotheistic Jewish faith.6 We assume that these restrictions did not stem only from a conflict between monotheism and polytheism. The gentiles presumed in sages’ texts were not only the advocates of an objectionable theology but the rapacious Roman occupying power with whom the Jews were also in a protracted struggle for political independence. At the same time, second, receiving services from non-Jewish physicians and healers was limited for fear of harassment or murder disguised as a medical failure.7 It was forbidden to receive medical treatment from non-Jews or to buy medicines that may be lethal if taken in inexact doses.8 Another concern was the use of idolatrous elements contradicting the patient’s Jewish faith as part of the medical treatment, or the negative religious influence of non- Jewish physicians on Jewish patients.9 Still, with several restrictions, the sages allowed Jews to receive medical treatment from non-Jews: If the patient is an important and prominent person, or if the physician is an expert with a well-known reputation, such

4 M. A.Z. 2:2; B. A.Z. 29a. On the ambivalent attitude of sages to gentiles in the period of the Mishna and Talmud, see Samuel Safrai, “The Relationships between Israel and the Nations after the Destruction of the Second Temple,” in Maḥanāyim 75 (1963), pp. 50–52; Gedalyahu Alon, The History of the Jews in Eretz Israel during the period of the Mishnah and Talmud (Tel Aviv: haKibbutz haMehuchad, 1975), pp. 342–352; Gary G. Porton, Goyim: Gentiles and Israelites in Mishnah-Tosefta (Atlanta: Scholars Press, 1988); Alan Brill, Judaism and Other Religions: Models of Understanding (New York: Palgrave-Mcmillan, 2010), pp. 31–62. 5 B. A.Z. 26b. On the injunction against assisting non-Jewish women in labor see M. A.Z. 2:1. 6 See M. A.Z. 1:1–2; 2:2; B. A.Z. 25b. 7 M. A.Z. 2:2; T. Hul. 2:21 (Zuckermandel ed., Jerusalem, 1975). 8 Such as opium and Theriac, See Y. A.Z. 2:2, 40d. 9 B. A.Z. 27b.

The Review of RabbinicDownloaded Judaism from 21 Brill.com09/26/2021 (2018) 108–133 12:30:07PM via free access “I bear the burden of treating the gentiles” 111 that he would be prevented from any harmful intentions towards Jews,10 or if the patient is at death’s door, as in such case the treatment could only be beneficial.11 These restrictions and prohibitions reveal an atmosphere of distrust and social hostility between Jews and non-Jews. These religious restrictions might also have aggravated the friction between the faiths and created severe social conflicts, particularly in circumstances that entailed a mixed society utilizing joint systems (economy, trade). As a result, as early as the Talmudic age we see rabbinical reservations with regard to the all-inclusive prohibition against medical relationships. Accordingly, the risk of interfaith tension served as grounds for permitting medical treatment of non-Jews and assisting in the labor of non-Jewish women, for a fee.12

Physician-Patient Relationships in Multicultural Societies: Historical Context and Theoretical Framework

Beliefs and religious values are an inseparable part of human culture and have a major effect on the medical world. Researchers have indicated the impact of religion on medicine in several main areas: A. Rates of illness or health maintenance, for example traditional eating habits that contribute to main- taining health or creating health problems; B. Assigning causality to illness— associating illness with sin or with improper religious and moral behavior; C. Guidance in reaching medical decisions; D. Adherence or non-adherence to medical recommendations, with consequent impacts on treatment outcomes.13 In certain faiths, a person who contracts an illness is obligated to seek medical help in order to recover and return to a normative routine, and the physician is obligated to treat the patient.14Then again, some clerics instruct their followers to avoid conventional health care and recommend seeking the

10 Ibid., 28a. 11 Ibid., 27a. 12 Ibid., 26b. 13 On this factor, see Allen Harwood, ed., Ethnicity and Medical Care (Cambridge: Harvard University Press,1981), pp. 1–36; Aasim I. Padela, Amal Killawi, Michele Heisler, Sonya Demonner, and Michael D. Fetters, “The Role of Imams in American Muslim Health: Perspectives of Muslim Community Leaders in Southeast Michigan,” in Journal of Religion and Health 50 [2] (2011), pp. 359–373. 14 On this commitment in Jewish law, see Shulkan Arukh, Yore Dea, siman 336:1.

The Review of Rabbinic Judaism 21 (2018) 108–133 Downloaded from Brill.com09/26/2021 12:30:07PM via free access 112 Shemesh assistance of people within the community who use supernatural methods.15 A religious ban against receiving medical care that is potentially harmful may have a positive effect. However, an inclusive ban against interaction with certain medical practitioners might prevent the patient from receiving efficient high-quality medical services. Intercultural differences between practitioners and patients are inevitable in socially diverse societies. Medical conflicts emerge in multicultural environ- ments when an ethnic minority resides within the geographical boundaries of another group or in countries in which the population comprises many na- tionalities with different cultural identities, usually an outcome of migration and demographic transitions.16 The Jewish community lived under the rule of other nations for many generations, and thus was compelled to cope with realities and norms that differed and even contrasted with its own culture. On the one hand, the Jews were a segregated group that maintained social “restrictions” intended to prevent mixing that could lead to interfaith marriage and assimilation, and, on the other, they were a persecuted minority. As a result of these two factors, Jewish religious texts include laws that express suspicion and reservations regarding open contact with the environment, and the medical field was no exception.17 Notably, in certain historical contexts Jews were barred from full participation in the medical field by general society as well. In medieval Christian Europe, Jews were forbidden from treating Christians,18 and they were even restricted in applying for medical studies at universities,19 but some Jewish physicians nonetheless attained a high professional level, achieved fame, and were appointed to the courts of

15 On halakhic authorities’ objection to conventional therapy, see Immanuel Etkes, Ba’al Hashem: The Besht: Magic, Mysticism, Leadership (Jerusalem: Merkaz Zalman Shazar, 2000), pp. 73–76. 16 Oyedeji Ayonrinde, “Importance of Cultural Sensitivity in Therapeutic Transactions: Considerations for Healthcare Providers,” in Disease Management and Health Outcomes 11 [4] (2003), pp. 233–248. 17 See, e.g., Mishne Torah, Hilchot Ma’achalot Asurot, 17:3–26. 18 The law forbidding Jews from treating Christians was enacted by Pope Eugenius IV in 1431. It was approved by Nicholas V in 1447 and toughened by Paul IV in 1555. See N. Shapira, “R. Abraham Portaleone, Physician and Encyclopaedist, and His Book Shiltei ha-Gibborim (1542–1612),” in Harofe Ha’Ivri 33 (1960), pp. 109–116 [Hebrew]. 19 Since European universities were to a large degree religious institutions and intended for followers of their faith, it was hard for Jews to be admitted. Institutions made it difficult for Jews, charged double rates, and teaching arrangements were not conducive to Jewish religious observance. See Michael Endel, The Jewish Physician in the 16th to 18th Centuries (Tel Aviv: Chechik, 1955), pp. 16–32 [Hebrew].

The Review of RabbinicDownloaded Judaism from 21 Brill.com09/26/2021 (2018) 108–133 12:30:07PM via free access “I bear the burden of treating the gentiles” 113 popes and secular rulers. This type of discrimination probably increased the Jewish sense of prejudice and antagonism against gentile society. Two elements are involved in the intercultural medical process, and bring- ing them to a state of accord is a complicated and complex task. Practitioner- patient tensions are not merely a thing of the past; rather their social and medical implications are evident to this day,20 for example in the relationship between white doctors and Afro-American patients in the US.21 In addition to differences such as age, sex, and language, each of the parties involved might have a different cultural background, and both might find the encounter difficult. The ancient Jewish law against treating idolaters, resulting from the negative attitude of monotheistic Judaism to paganism, is a clear example of extreme alienation and segregation of practitioners and potential patients based on their different beliefs. Another possible situation is when practitioners and patients interact, but the practitioner is not cognizant of factors shaping the patient’s cultural world—unique values, expectations, norms, and taboos.22 Religious faiths have a characteristic routine, types of foods, ceremonies, fasts, prohibitions, etc. Disregard for these factors might lead to conflict between practitioners and patients. In more extreme cases, incompat- ibility between the treatment offered and the patient’s culture, or insensitivity to religious features, might be perceived as aggressive and result in the patient’s reluctance or absolute avoidance of seeking medical care.23 Historians have shown that, in medieval Christian and Muslim societies, people preferred to be treated by observant, popular healers rather than by certified secular physicians, as the former adhered to known religious precepts. In the Muslim world these were healers with religious training that including knowledge of � � ن and in Europe ,(ا ل��ط� ب� ا ل�� ب��و�ي� ,prophetic medicine (in Arabic: ‘Al-Tibb al-nabawī medical services were provided by monks.24

20 Lisa Cooper-Patrick, Joseph J. Gallo, Junius J. Gonzales, Hong Thi Vu, Neil R. Powe, Christine Nelson, and Daniel E. Ford, “Race, Gender, and Partnership in the Patient- Physician Relationship,” in JAMA 282 [6] 1999, pp. 583–589; David R. Williams and Ronald Wyatt, “Racial Bias in Health Care and Health: Challenges and Opportunities,” in JAMA 314 [6] (2015), pp. 555–556. 21 T.A. Laveist and T. Carroll, “Race of Physician and Satisfaction with Care among African American Patients,” in Journal of the National Medical Association 94 (2002), pp. 937–943. 22 Ayonrinde, “Importance of Cultural Sensitivity,” pp. 233–248. 23 Ibid. 24 Sami K. Hamarneh, “Some Aspects of Medical Practice and Institutions in Medieval Islam,” in Episteme 7 (1973), pp. 15–31. On the Prophetic medicine see Cyril Elgood, “The Medicine of the Prophet,” in Medical History 6 [2] (1962), pp. 146–153.

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According to the model of Davis and Voegtle (1994), an appropriate intercultural relationship is possible when the practitioner is sensitive to the patient’s cultural world and when the treatment is provided with no stereotypes and prejudices. “Cultural competence” means providing treatment based on knowledge, skills, awareness, and sensitivity to cultural factors that might have a role in the patient’s health or illness behavior.25 This modern term was forged, of course, in a society that acknowledges the elementary right of the other to be treated and respects and honors the other’s cultural needs. In medieval times, however, there seems to have been little sensitivity to the cultural needs of the other. An example of such awareness is Jewish physicians’ care to omit wine as a component of medicinal prescriptions given to Muslim patients, due to the prohibition on this beverage in Islam.26 Nonetheless, it may be assumed that this was also a result of the physician’s fear or concern for his own good. Very few scientific studies deal with doctor-patient relationships in medieval and early modern times based on cultural differences, and these focus primarily on Eastern countries. One of the questions asked by modern researchers is whether cultural compatibility between physicians and patients might produce better results and lead to greater patient satisfaction (the concordance theory). Some researchers claim that it is not the practitioner’s race that is important, rather his or her knowledge and sensitivity to the patient’s culture. Other studies, such as of LaVeist and Nuru-Jeter, show that, in practice, some patients display trust in doctors who belong to their own race or culture and prefer to be treated by them.27 As a rule, the research does not deal with the doctor’s preferences with regard to patients’ race or faith, as all practitioners trained in modern settings are obligated to treat all patients, regardless of race, faith, and sex.

25 Betsy J. Davis and Katherine H. Voegtle, Culturally Competent Health Care for Adolescents: A Guide for Primary Care Providers, Department of Adolescent Health (Chicago: American Medical Association, 515 N. State St., 1994), pp. 1–67. 26 R. Moshe b. Maimon, On Asthma, Suessmann Muntner edition (Jerusalem: Mossad HaRav Kook, 1965), p. 85. 27 Earnest Moy and Barbara A. Bartman, “Physician Race and Care of Minority and Medically Indigent Patients,” in JAMA 273 (1995), pp. 1515–1520; Somnath Saha, Sara H. Taggart, Miriam Komaromy, and Andrew B. Bindman, “Do Patients Choose Physicians of Their Own Race?,” in Health Affairs 19 (2000), pp. 76–83; Thomas A. LaVeist and Amani Nuru-Jeter, “Is Doctor-Patient Race Concordance Associated with Greater Satisfaction with Care?” in Journal of Health and Social Behavior 43 (2002), pp. 296–306.

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The Purposes of the Study

The current article deals with the attitude of Jewish halakhic authorities towards treating Muslims in medieval and pre-modern times (twelfth– nineteenth centuries).28 Our basic assumption is that medieval and modern halakhic authorities had to determine how much of the ancient religious and legal categories remained valid in the radically altered medieval realities, when the Roman empire and its polytheistic cult had been replaced by a different kind of gentile, adherents of Bible-based monotheistic religions (Christianity and Islam).29

28 Rabbinic texts often do not identify the patient’s faith, only mentioning that the patient is non-Jewish (goy, nochri). The basic premise is that texts written by sages operating in Islamic countries usually refer to Muslim patients who comprised most of the population. Sometimes there is a reference to the patient’s faith, e.g. “Ishmaelite patient,” “Arab patient,” Togarmi, or Turk. Some halakhic authorities do not discern between Muslims and Christians to begin with, as they make no distinction between the two faiths with regard to restrictions of or dispensations to maintain medical relationships. 29 See for example the discussion of Maimonides on circumcision of Christians and Muslims, whether they are included in the ancient prohibition in B. A.Z. 26b not to circumcise a goy. See R. Moses ben Maimon, Maimonides’ response, Joshua Blau edition (Jerusalem: Sumptibus Societatis Mekize Nirdamim, 1958), vol. 1, siman 148, p. 282). In another case, the Talmudic commentator, R. Menachem HaMeiri (Provence, thirteenth century) explicitly separated classical rabbinic categories of idolatry from the practices of his contemporary gentiles and claimed that idolatry no longer exists in the world. See R. Menachem HaMeiri, Bet HaBekhira on Avoda Zara (Jerusalem: Kedem, 1971), 2b (p. 4), and in his commentary to Baba Qama, Bet HaBekhira (Jerusalem: Mossad HaRav Kook, 1950), 113b (p. 320). See also Brill, Judaism and Other Religions, pp. 175–207. The differ- ing and sometimes inconsistent rabbinic responses to this situation have been studied quite intensely. See, e.g., Jacob Katz, Exclusiveness and Tolerance: Studies in Jewish-Gentile Relations in Medieval and Modern Times (London: Oxford University Press, 1961), pp. 24– 36. On the identity of Amalek and the impact of his symbolism on Jewish-Christian relationships through history, see Elliot Horowitz, Reckless Rites: Purim and the Legacy of Jewish Violence (Princeton: Princeton University Press, 2006). According to Israel Jacob Yuval, the emergence of medieval Jewish perceptions of identifying Edom with Rome (and Christianity) is presumably the result of the disappearance of the Edomites. See his, Two Nations in Your Womb: Perceptions of Jews and Christians in Late Antiquity and the Middle Ages (S. Mark Taper Foundation Imprint in Jewish Studies; Berkeley, Los Angels and London: University of California Press, 2006), pp. 10–20.

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The study asks the following questions:

1. How did rabbis cope with the ancient prohibition against treating gentiles? Were Muslims considered idolaters so that it was not permitted to treat them? 2. Assuming that Jews were permitted to treat Muslims, how did Jewish physicians conduct themselves on the Sabbath? Did they treat patients even when this involved what some might have viewed as desecrating the holy day? 3. What was the historical reality? Did Jews avoid treating non-Jews?

1 Medical Services for Muslim Patients: Coping with the Ancient Prohibition Despite rabbinical restrictions on medical relationships between Jews and non-Jews, rabbis permitted the provision of medical services to Muslims. Two major factors may have facilitated this dispensation: A. The identification of Islam as a non-idolatrous faith; B. The inferior status of Jews and fear of animosity by Muslim society.

A The Religious Status of the Muslims: Idolaters or Partial Proselytes? In his halakhic tome Mishne Torah, Maimonides (Rambam, 1138–1204) objected to treating non-Jews.30 Based on the B. A.Z. 26b, he permits the circumcision of non-Jews (goyim) in order to fulfill the commandment of circumcision, but not when this had medical purposes.31 He forbids Jews to midwife non-Jewish

30 On the biography and manuscripts of Maimonides, see Max Meyerhof, “The Medical Works of Maimonides,” in Salo W. Baron, ed., Essays on Maimonides: An Octocentennial Volume (New-York: Columbia University Press, 1941), pp. 265–301; Fred Rosner, “Maimonides the Physician: A Bibliography,” in Bulletin of the History of Medicine 43 (1969), pp. 221–235; Tzvi Langermann, “Maimonides: Abū ʿImrān Mūsā ibn ʿUbayd Allāh [Maymūn] al‐Qurṭubī,” in Thomas Hockey, ed., The Biographical Encyclopedia of Astronomers (New York: Springer, 2007), pp. 726–727. 31 Mishne Torah, Hilchot Mila 3:7: “It is forbidden for a Jew to circumcise a gentile (goy) who is forced to remove his foreskin because of a wound or because of a tumor, since we are instructed neither to save the gentiles (goyim) from death nor to cause them to die.” All the citations of the Mishne Torah are from Shabtai Frankel edition, Jerusalem and Benei- Brak: Hotza’at Shabse Frankel LTD, 2002.

The Review of RabbinicDownloaded Judaism from 21 Brill.com09/26/2021 (2018) 108–133 12:30:07PM via free access “I bear the burden of treating the gentiles” 117 women [nuchrit] or to nurse their children,32 and also forbids assisting non- Jews (goyim) on the Sabbath, even in the case of a landslide.33 With regard to providing medical services to non-Jews, Maimonides distinguishes between oved avoda zara (an idolater) and ger toshav. In Hilchot Avoda Zara 10:2, he writes:

Hence, it is forbidden to offer medical treatment to ovedei avoda zara even when offered a wage. If, however, one is afraid of the consequences or fears that ill feeling will be aroused, one may treat them for a wage, but to treat them for free is forbidden. [With regard to] a ger toshav, since we are commanded to secure his well-being, he may be given medical treatment at no cost.34

Accordingly it is forbidden to offer medical treatment to an idolater.35 However, concerning delivering the babies of non-Jews, Maimonides distinguishes between goy and ger toshav:

32 See ibid., Hilchot Avoda Zara 9:16: “A Jewish woman [Bat Israel] should not nurse the child of an idolater [nuchrit], since, by doing so, she raises a son who will be an idolater. She should not serve as a midwife for an idolatrous woman [nuchrit]. She may, however, do so for a fee, lest strife arise. An idolatrous woman [nuchrit] may serve as a midwife for a Jewess [Bat Israel] and nurse her child. [This must be done] in premises belonging to a Jew, lest the idolatrous woman kill the child.” 33 Ibid., Hilchot Shabbat 2:20–21: “When an avalanche falls on a courtyard in which are lo- cated both non-Jews (goyim) and Jews (Israelim), even if there are a thousand gentiles and only one Jew, we should remove all [the debris] for the sake of the Jew.” 34 There are many different versions of Maimonides, Hilchot Avoda Zara 10: 1–2. In many manuscripts and printings) the version is: goy ovedei avoda zara. See, e.g.: Oxford, Bodleian Library 569 (ARCH. SELD.82); Cambridge library Dd 13.1; Oxford, Bodleian Library, Sephardic manuscript 572 [MICH. 624]; Kaufmann manuscript, Budapest library A77 (vol. IV), Defus R. Moses Ibn Shaltiel [Spain or Portugal before 1492 or 1497, facsim- ile edition of the copy in the Jewish Theological Seminary of America. Introduction by Shlomo Zalman Havlin, Jerusalem 1975], Defus Romi 240 (before 1480), Defus Constantina 269 [= Constantinople 1509], Defus venezia [= Venice] [Bragadin and Yuśṭinyan 310–311 [= 1550–1551]. In Defus Venice 334–336 [= 1574–1576] and in most of the recent printings the version was changed to: kuti oved Kochavim umazalot. Several recent printings have: goy aku”m and in the new printings: aku”m. See Shabtai Frankel edition, Hilchot Avoda Zara 10: 1–2, p. 540. 35 On this understanding, see also Nahum Eliezer Rabinowitz, Mishneh Torah, Sefer Hamadda, with Yad Peshuta Commentary (Jerusalem: Ma’aliyot, 2008), part 2, pp. 778–779.

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We should not help non-Jew woman (goya) give birth on the Sabbath, even if payment is offered. We do not worry about the possibility of ill- feelings being aroused. This applies even when there is no violation [of the Sabbath laws] involved. In contrast, one may offer assistance to a daughter of a ger toshav woman who gives birth, since we are commanded to secure her well-being. We may not, however, violate the Sabbath laws on her behalf.36

On these medical laws, Maimonides uses three different terms: goy, oved avoda zara, and nochri. The term goy means gentile (not necessarily an idolater), and the two other terms signify an idolater. Hence, the definition of the non-Jews to whom he objects providing medical treatment or delivering babies is not clear.37 Maimonides permitted providing medical treatments to or delivering babies for partial proselytes (ger toshav). He determines that a ger toshav is a gentile who observes the seven Noahide Laws: “A person who accepts these seven mitzvot is a ger toshav. A ger toshav may be accepted only in the era when the [laws of the] Jubilee Year are observed.”38 Did he consider Muslims ger toshav as well? On the one hand, Muslims keep the seven Noahide Laws, but on the other, the laws of the Jubilee Year were not observed at that time, so Muslims might not be accepted as ger toshav.

36 Ibid., Hilchot Shabbat 2:12. 37 Note that standard printings of most rabbinic works, ancient and medieval, incorporate censors’ glosses with respect to all terms designating other religions, heresies, etc. Basic words like goy [gentile], min [sectarian, often referring to Jewish-Christians], meshum- mad [apostate] and others were replaced by aku”m (worshipper of stars and constel- lation—a term that was only invented in seventeenth-century Europe), kuti or Kuthite [i.e., Samaritan], Sadducee, etc., in order to remove or minimize the implication that they were referring to contemporary Christians. On the censors’ glosses in Venice printings since 1534, see Shabtai Frankel edition, p. 540. 38 Ibid., Hilchot Avoda Zara 10:6. On the halakhic status of ger toshav according to Maimonides, see, e.g., David Novak, The Image of the Non-Jew in Judaism: An Historical and Constructive Study of the Noahide Laws (New York, 1983); Dov I. Frimer, “Israel, the Noahide Laws and Maimonides: Jewish-Gentile Legal Relations in Maimonidean Thought,” in Jewish Law Association Studies 2 (1986), pp. 89–102; Steven D. Fraade, “Navigating the Anomalous: Non-Jews at the Intersection of Early Rabbinic Law and Narrative,” in Laurence J. Silberstein ‏and Robert L. Cohn, eds., The Other in Jewish Thought and History: Constructions of Jewish Culture and Identity (New York and London: New York University Press, 1994), pp. 145–165 (see the bibliography, p. 159, n. 2).

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Medieval halakhic authorities deliberated whether Muslims should be defined as idolaters. Maimonides claimed that Muslims are not idolaters, since they believe in one God (monotheism) and do not worship idols. In Hilchot Ma’achalot Asurot 11:7 he writes:

One who accepted the observance of seven Noahide Laws: it is forbidden to drink his wine, but it is permitted to benefit from it. Any gentile who does not serve false deities, e.g., the Ishamaelim [= Muslims]: it is forbidden to drink their wine, but it is permitted to benefit from it. The Geonim rule in this manner.

In other words, Muslims are not partial proselytes, but they have the same status concerning wine. According to this, we may assume that Maimonides holds that they have the same status regarding medical treatment as well. But there is no unequivocal proof of this.39 While others, such as R. David ibn Avi Zimra (Radbaz, Egypt and Israel, 1479–1573), claimed that Islam is idolatry,40

39 See also R. Moshe ben Maimon, Rambam Responsa, ed. Abraham H. Freiman (Jerusalem: Mekitze Nirdamim, 1938), siman 369. On Maimonides’ attitude towards Islam and Muslims there is a large literature, but my impression is that this medical aspect has not been given enough attention. See G.F. Hourani, “Maimonides and Islam,” in William M. Brinner and Stephen D. Ricks, eds., Studies in Islamic and Judaic Traditions: Papers Presented at the Institute of Islamic–Judaic Studies, Center for Judaic Studies, University of Denver (Atlanta: Scholars Press, 1986), pp. 153–165; David Novak, “The Treatment of Islam and Muslims in the Legal Writings of Maimonides,” in ibid., pp. 233–250; Eliezer Schlossberg, “The Attitude of Maimonides toward Islam,” in Peamim 42 (1990), pp. 38–60 (Hebrew); Yosef Kapach, “Islam and the Treatment of Muslims in Mishneh Torah,” in Maḥanāyim 1 (1991–92), pp. 16–21; Jacob [Gerald] Blidstein, “The Status of Islam in the Halakhah of Maimonides,” in Menachem Mautner, Avi Sagy and Ronen Shamir, eds., Multiculturalism in a Democratic and Jewish State (Tel Aviv University Press, 1997–1998), pp. 465–476; Daniel J. Lasker, “Tradition and Innovation in Maimonides’ Attitude towards Other Religions,” in Jay M. Harris, ed., Maimonides after 800 Years: Essays on Maimonides and His Influence (Cambridge, 2007), pp. 167–182; Brill, Judaism and Other Religions, p. 245; Daniel Boušek, “Polemics in the Age of Religious Persecution: Maimonides’ Attitude towards Islam,” in Asian and African Studies 20 [1] (2011), pp. 46–85. On the differences between Islam and Christianity in Maimonides’ writing, see David Novak, Jewish-Christian Dialogue: A Jewish Justification (New York and Oxford: Oxford University Press, 1989), pp. 57–66. 40 See R. David ibn Avi Zimra, Radbaz Responsa (Warsaw 1892), siman 1123 (vol. IV, p. 92). For other opinions on this controversy, see Abraham Steinberg, Encyclopedia of Jewish Medical Ethics (Jerusalem: The Dr. Falk Schlesinger Institute for Medical-Halachic Research, 1988), vol. 1, p. 125 [Hebrew]; Allan Brill, Judaism and World Religions: Encountering Christianity, Islam, and Eastern Traditions (New York: Palgrave Macmillan, 2012), pp. 166–171.

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Maimonides held that, while Muslims are not partial proselytes, they also are not considered idolaters (akum). The question then is: did Maimonides think that people of this status are entitled to receive medical support from Jews? .people أcommon أMaimonides himself treated Muslims, both lords and ا � ن � � � ص � � � ة (1270–1203 , ب � ب ي� � ي ب� �ع � �) The Arab physician and historian Ibn Abi Usaibia reports that Maimonides was appointed one of the court physicians of Ṣalāḥ ad-Dīn Yūsuf ibn Ayyūb (Saladin, d. 1193).41 Modern scholars, such as Bernard Louis, have doubted this historical fact;42 at any rate, it is obvious that Maimonides served as the personal physician and court physician of ف ض -In his letters, fur .( ا �ل�� ا ��ل) Saladin’s son, the Egyptian Ayoubi ruler El Fadil ther, Maimonides describes the large crowd of gentiles that sought his medical services: “When I return to Egypt [= Cairo] after half a day […] I find all the balconies full of gentiles, important people and non-important people, judges and officers. The masses know the time of my return to the city […] I bear the burden of treating the gentiles.”43 The question is whether he treated these people based on the belief that they are not idolaters or whether there was another reason, such as need for sources of subsistence and inevitability? R. Joseph Karo (Israel, sixteenth century) in his commentary Kesef Mishne on the Mishne Torah, claimed that Maimonides believed that the rabbinical prohibition against treating non- Jews refers only to those idolaters who lived when the injunction was given, e.g., in the Tanaaitic and Amoraic era.44 R. Karo stated this principle in general without specifically mentioning Muslims; however we may assume that this was his intention.

41 Ibn Abi Usaibia, ʿUyūn ul-Anbāʾ fī Ṭabaqāt ul-Aṭibbāʾ (= Lives of the Physicians), Nizar Reda, ed. (Beirut: Dar Maktabat al Hayat, 1965), p. 582. On Salah a-Din’s staff of physicians, see Samira Jadon, “A Comparison of the Wealth, Prestige and Medical Work of the Physicians of Salah al-Din in Egypt and Syria,” in Bulletin of the History of Medicine 44 (1970), pp. 64– 75. For general information on Jewish court physicians and doctors in Muslim hospitals in the eleventh-thirteenth centuries according to the Geniza documents, see Shelomo Dov Goitein, A Mediterranean Society (Tel Aviv: Yediot Aharonot, Sifre Hemed and Tel Aviv University, 2005), pp. 134–135, 192 [Hebrew]. 42 See Bernard Louis, The Islam in History (Tel Aviv: Zemora Bitan, 1984), pp. 152–161 [Hebrew]. 43 Itzhak Shilat, ed., The Letters of Maimonides (Jerusalem: Ma’aliyot, 1987–1888), vol. 2, pp. 550–552. 44 R. Joseph Karo, Kesef Mishne, Hilchot Avodat Kochavim 10:2. This claim was voiced in pre- vious centuries by other sages, for example R. Menachem Hame’iri (Provence, thirteenth century) in his commentary Beit Habehira (Jerusalem: Kedem, 1971), Avoda Zara 26a.

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One of the rabbis who was in favor of providing medical care for Muslims was R. Chaim Benveniste (1603–1673), a prominent rabbinical authority in Izmir, Turkey. When asked by a Jewish midwife whether it is permitted to assist a “Togarmi woman” (= Muslim of Turkish origin) giving birth on the Sabbath, he claimed in his book Knesset Hagedolah that the prohibition against assisting in labor and treating non-Jewish patients refers to idolaters, while Muslims believe in God and therefore are not included.45 On this basis, Benveniste granted the midwife dispensation to assist the Muslim woman in labor on the Sabbath, with the provision that she would not perform operations involving desecration of the Sabbath. It follows that on weekdays there is no reason not to provide regular medical care to non- Jews. R. Benveniste does not claim that concessions were made on this matter as a result of the fear of animosity by Muslim society, and this reinforces the conclusion that he believed that there was never any problem with providing medical care to Muslims. As he understood the matter, Maimonides forbade the treatment or assisting in the labor of idolaters. But Muslims are considered ger toshav, for whom Jews must care, and they should supply them with medical treatment providing this does not involve desecration of the Sabbath.

أ ذ ة The Status of Jews in Muslim Society B ( � �ه�ل ا �ل�� م�� ,The inferior personal status of Jews as protected people (dhimmis precluded the option of avoiding medical treatment of non-Jews. As claimed by Amnon Cohen, Jewish minorities’ treatment of Muslim majority patients was a very sensitive issue. Thus, cases of complications or failed medical treatment might have resulted in undesirable actions against the Jewish physician or the entire Jewish community.46 In such circumstances it was only natural that halakhic authorities operating in Islamic countries gave their consent to providing medical services to non-Jews, based on the rabbinical dispensation stated above.

45 Chaim Benveniste, Knesset Hagedolah (Jerusalem: Keren Otza’at Kol Sefre Knesset Hagedolah, 1966), Orah Chaim, siman 330, p. 187. R. Benveniste discusses treating non- Jews elsewhere in his books; see Dina Dehaya (Constantinople, 1742), Lavin 45, 41:4; Shyarei Knesset Hagedolah (Salonica, 1767), Yoreh De’ah, siman 154:6, Hagahot Beit Yosef, p. 10. 46 Amnon Cohen, Jews under the Rule of Islam, the Jerusalem Community in the Early Ottoman Period (Jerusalem: Yad Itzhak ben Zvi 1982), p. 189 [Hebrew]; Amnon Cohen, Elisheva Simon-Pikali and Ovadia Salama, Jews in the Moslem Religious Court: In the Eighteenth Century (Jerusalem: Yad Itzhak ben Zvi, 1996), p. 323 [Hebrew].

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2 Halakhic Conflicts Resulted from Treating Non-Jewish Patients The basic dispensation to treat Muslims did not solve all the problems deriving from the encounter between the two faiths. Providing medical treatment to non-Jews aroused various halakhic problems, which presented the rabbis with new and varied challenges.47 One of the questions was whether it is permitted to assist in labor or to treat non-Jews on the Sabbath, as the treatment requires labors forbidden by Jewish law. In his Shulkan Arukh, R. Joseph Karo objects to assisting in the labor of a Kutit even if this does not involve desecrating the Sabbath. Generally, the term kuti refers to a Samaritan, but in this context it is interpreted as any kind of gentile. R. Avraham Abele Gombiner (Poland, 1637–1683) explains that assisting in the labor of non-Jewish women on the Sabbath is not allowed, because Jews can claim that they cannot cure someone who does not observe the Sabbath.48 But in the case of antagonism by non-Jews it is permitted to treat them, without desecrating the Sabbath.49 Gombiner notes that according to this principle it is not permitted to treat Muslims (Ishmaelim). On the other hand, it is permitted to treat Karaites, who observe the Sabbath, even though they do not obey rabbinical halakhah.50 R. Benveniste agrees with R. Gombiner that the fact that they are not idolaters does not sanction their treatment on the Sabbath if this requires any halakhic transgression, even if only of a rabbinical commandment.51

47 Physicians working in public hospitals or in the courts of rulers encountered halakhic problems related to kashrut, such as wine or mead manufactured by non-Jews and added to medicines. One example is a question referred to R. Nissim Chaim Mizrachi, Rabbi of Jerusalem in the eighteenth century: “The custom of Israeli doctors serving in the homes of rulers, who prepare concoctions and for these concoctions use the wine of non-Jews or the honey of non-Jews and other prohibited substances” (Responsa Admat Kodesh, Constantinople, 1752, vol. II, p. 12). On halakhic problems faced by Jews in non-Jewish hospitals, see Fred Rosner, “The Jewish Patient in a Non-Jewish Hospital,” in Journal of Religion and Health 25 [4] (1986), pp. 316–324. 48 This argument was first introduced by the Babylonian Amora Abayye (d. 339 CE) in B. A.Z. 26a. 49 The Italian R. Ishmael Hacohen Modena (1724–1811) argued that the dispensation to assist non-Jewish women in labor for reasons of animosity was based on the concern of insult, as refraining from treating them would have created the impression that Jews consider non-Jews “animals” and thus might justifiably cause them insult and arouse their anger. Responsa Zera Emet (Livorno, 1833), III, Orah Chaim 32 (on Hilchot Shabbat 301), 40:1. 50 R. Abraham Abele Gombiner, Magen Abraham on Shulkan Arukh (Warsaw, 1879), Orah Chaim, siman 330, nn. 4–5. 51 Benveniste, “Knesset Hagedolah,” Hilchot Shabbat 330, 187; Shyarei Knesset Hagedolah (Salonica, 1767), Yoreh De’ah 154, Hagahot Bet Yosef 10.

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It is interesting that several European halakhic authorities over the past few centuries have permitted the treatment of non-Jews on the Sabbath even when involving labors forbidden by the Torah due to the fear of interfaith antagonism or since non-Jewish physicians might refrain from treating Jews in protest.52

3 Did Jewish Physicians Actually Avoid Treating Muslims? As we saw above, Maimonides provided medical care to Muslims. Interestingly, not only on medical issues did the Maimonides act differently from his halakhic rulings in Mishne Torah, rather in other areas as well. For example:

1. There is inconsistency between Maimonides’ strict theoretical rulings in the Mishneh Torah about conditions requiring martyrdom during religious persecution53 as against his much more lenient guidance to persecuted communities in his “Iggeret ha-Shemad to the Jews of North Arica.”54 2. Maimonides ruled that Jews should not live in Egypt, while he himself lived and worked there.55

52 See, e.g., R. Chaim Halberstam from Sanz, Responsa Divrei Chaim (Lvov, 1875), II, Orah Chaim, 25. For additional sources see Steinberg, Encyclopedia of Jewish Medical Ethics, pp. 126–127. 53 Hilchot Yesode HaTorah 5:1–4. 54 This phenomenon was discussed by many scholars. See David Hartman, “‘Iggeret ha- Shemad’ of Rabbenu Moshe ben Maimon: Speculum to the Complex of Halachic Ruling,” in Mekhkare Yerushalyim beMahashevet Israel 2 [3] (1983), pp. 362–403; Chaim Soloveitchik, “Maimonides’ Iggerot ha-Shemad: Law and Rhetoric,” in Leo Landman, ed., Rabbi Joseph H. Lookstein Memorial Volume (New York: Ktav Publishing House, 1980), pp. 281–319; ibid., “Parameters of Halakhic Ruling: Answer to Dr. D. Hartman,” in Mekhkare Yerushalyim beMahashevet Israel 3 [4] (1984), pp. 683–687; ibid., Oxford Collected Essays (Oxford: Littman Library of Jewish Civilization, 2013–2014), vol. II, pp. 331–337; Arye Strikovski, “‘Iggeret ha-Shemad’ of Maimonides: Halakha or Rhetoric?” in Itamar Verhaftig, ed., The Jubilee Book Minkha leIsh (Jerusalem: Bet Yaakov Synagogue Ramot Eshkol, 1991), pp. 242– 275 [Hebrew]; Yair Lorberbaum and Chaim Shapira, “Maimonides’ ‘Epistle on Martyrdom’ in the Light of Legal Philosophy,” in Diné Israel 25 (2008), pp. 123–169; Yair Lorberbaum and Chaim Shapira, “‘Iggeret ha-Shemad’ of Maimonides: Hartman- Soloveitchik Controversy according to the Philosophy of the Law,” in Avi Sagi and Zvi Zohar, eds., Jewish Renewable Obligation (Jerusalem: Shalom Hartman Institute and Kibbutz haMehukhad, 2002), vol. 1, pp. 345–373 [Hebrew]. 55 Mishne Torah, Hilchot Melachim 5:7–8.

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3. He ruled that it is forbidden to read the books of heretics,56 but in his book Guide for the Perplexed he states that he himself had read them.57

How did other physicians conduct themselves? The historical reality is cer- tainly compatible with the widespread dispensation to treat non-Jews. There is abundant historical evidence indicating that Jewish physicians provided medical services to Muslims in medieval and pre-modern times. Such evidence is widely found in various literary genres: rabbinic literature, historical chron- icles, and archives of the Muslim courts. The Responsa literature includes a fairly wide range of discussions dealing with halakhic questions submitted to rabbis by Jewish physicians concerning treatment of non-Jews.58 Interestingly, in these discussions the rabbis refer to the treatment of non-Jews as self- evident and do not refer to or comment on any prohibition, a fact that indicates the prevalence of the dispensation to treat non-Jews. Jewish physicians treated both Muslim and Christian patients, and we may assume that at least for some of these physicians the medical occupation was perceived as a way of attaining prominent positions in the courts of kings and rulers.59 The Ottoman Sultans not only allowed Jewish and Marrano immi- grants to profess their religion but, unlike many Christian rulers in Europe, also permitted the physicians among them to treat non-Jewish patients. Moreover, the Muslim Sultans asked them to serve as court doctors. The most famous Jewish physician in the second half of the fifteenth century was Jacob of Gaeta, حم� ث ن , �م�د ��ا �ي�) known as Ḥekim Yakub, the private physician of Sultan Meḥmed II 1432–1481), conqueror of Constantinople.60

56 Ibid, Hilchot Avoda Zara 2:2. 57 See, e.g., Maimonides, More Nevochim 3:29, Yosef Kaphach edition (Jerusalem: Mosad HaRav Kook, 1963–1965), pp. 339–344; Paul B. Fenton, “Maïmonide et L’Agriculture naba- téenne,” in Tony Lévy and Roshdi Rashed, eds., Maïmonide, Philosophe et Savant (1138– 1204) (Leuven: Peeters, 2004), pp. 303–333. 58 See, e.g., R. Yaakov Castro (Moharikash, Egypt, sixteenth century), Erech Lechem (Constantinople, 1728), Yoreh De’ah 112, 28:1; R. Moshe of Trani (Mabit, Israel, sixteenth century), Responsa Mabit (Lamberg, 1861; Rep. Jerusalem, 1974), vol. II, p. 169; R. Mordechai Halevy (Egypt, seventeenth century), Responsa Darchei Noam (Venice, 1707; Rep. Jerusalem, 1970), vol. XIV, p. 26. 59 Examples of physicians who treated Christians are R. David de-Silva (1684–1740), a native of Jerusalem of Portuguese ancestry who treated a woman from the Armenian Convent in Jerusalem, and R. Tuvia the Physician (1652–1729), who treated a monk at the Franciscan Hospital. See Zohar Amar, “Comrades in Medicine: Medicine as a Bridge between Franciscans and Jews in Ottoman Jerusalem,” in Et-Mol 29 (2003), pp. 22–23 [Hebrew]. 60 On Ḥekim Yakub, see Franz Babinger, “Ja’qûb-Pascha, ein Leibarzt Mehmed’s II—Leben und Schicksal des Maestro Jacopo aus Gaeta,” in Rivista degli Studi Orientali 26 (1951),

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The most famous physicians at the Ottoman court in the first half of the sixteenth century were members of the Hamon family. Josef Hamon, a native of Granada and probably a relative of Isaac Hamon, physician to one of the last Muslim rulers there, became court physician under Bāyezid II, the ruling Sultan. His son, Moses Hamon (1490–1554), also became physician at the Ottoman court during the reign of Sultan Süleymān the Magnificent (1520– 1566).61 Another Jewish physician at the Ottoman court in Istanbul in the sixteenth century was Dr. Abraham Ibn Shanjis.62 One physician who treated Muslims was a Chief Rabbi of Israel, Rabbi Yosef Mordechai Meyuhas, whose medical expertise was greatly valued by the Muslims.63 Others in the Land of Israel were Ibrahim Ben Shomali,64 Rabbi Yaakov Tzemach who served as personal physician of the Governor of Safed,65 as well as physicians Rabbi Mordechai Harofeh (= the physician), Rabbi Salmon Harofeh, and Salmon Hamenate’ach (= the surgeon), mentioned in cases involving Muslims treated with unfavorable results.66 Protocols from the archives of the Muslim court that operated in Jerusalem in the eighteenth century report, among other things, on a Jewish physician who treated Muslims and enjoyed the support of the Sultan, an eye healer who treated Muslim patients, and a Jewish surgeon who operated on Muslims.67

pp. 87–113; Bernard Lewis, “The Privilege Granted by Meḥmed II to his Physician,” in BSOAS 14 (1952), pp. 551–563; Eleazar Birenboim, “Hekim Yakub—Mehmed the Conqueror’s Physician,” in HaRofe Ha’Ivri 1 (1961), pp. 108–134 [Hebrew]; Minna Rozen, A History of the Jewish Community in Istanbul: The Formative Years, 1453–1566 (Brill: Leiden, 2002), pp. 202–203. 61 On Moses Hamon and his son Josef Hamon, see Uriel Heyd, “Moses Hamon, Chief Jewish Physician to Sultan Süleymān the Magnificent,” in Oriens 16 (1963), pp. 152–170; Salo W. Baron, A Social and Religious History of the Jews (Philadelphia and New York: The Jewish Publication Society of America & Guildford, Surrey: The Columbia University Press, 1983), vol. 18, pp. 74–77; Rozen, A History of the Jewish Community in Istanbul, pp. 208–209. 62 See Myron M. Weinstein, “The Correspondence of Dr. Abraham Ibn Sanchi,” in Studies in Bibliography and Booklore 20 (1998), pp. 145–176. 63 Zohar Amar, “Jewish Physicians of Jerusalem in the 16th–18th Centuries,” in Zohar Amar, Efraim Lev, and Joshua Swartz, eds., Medicine in Jerusalem throughout the Ages (Tel Aviv: Eretz, 1999), p. 94, n. 46 [Hebrew]. 64 Mentioned in a document from 1542 in regard to treatment of a Muslim patient. See Cohen, Jews under the Rule of Islam, p. 189. 65 Amar, “Jewish Physicians,” p. 93, n. 24. 66 Ibid., pp. 93–94, nn. 32, 33, 44. 67 See Cohen, Eighteenth Century, document 280, 326; document 282, 327; document 286, 328; document 287, 329.

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Rigid Attitudes Towards Providing Medical Care to Non-Jews

Some physicians, such as Rabbi Chaim Vital (Safed 1543–Damascus 1620) took a more rigid stance towards medical interactions with non-Jews; however the impression is that they were in the minority. In his account of prescribed treatments in times of epidemic, Vital describes a protective talisman and notes that its secret should not be revealed to non-Jews.68 Vital operated in a Muslim region, so we can assume that he meant Muslims. We do not know whether he also refrained from treating non-Jews and why he objected to revealing the secret of the medical prescription to non-Jews, whether for fear of religious hostility or since he wished to keep the prescription secret. In any case, he himself did not hesitate to benefit from non-Jewish medical services (see below). An extreme attitude towards the healing of gentiles appears in a responsa sent by Abraham Baruch Harofe to Rabbi Chaim Benveniste in 1665. Dr. Baruch inquired whether Jewish physicians attending gentiles are permitted to kill them by administering poison drugs or to cause their death indirectly by withholding medical treatment:

Query: May our Rabbi teach us whether doctors who treat gentiles, Ishmaelites [= Muslims], Arelim [= uncircumcised, Christians], and Amalekites69 are permitted to give them terufot negdiyot [= counter- medicines; medical compounds containing toxins that were used to cure snake bites and the like but could also cause death] so that they die, or to at least withhold treatment so that they die, or is all of this prohibited.70

This seemingly general question by Abraham Baruch raises the real possibility of a doctor’s misusing his medical authority in order to harm innocent people under the guise of failed medical treatment. The concept of non-maleficence is one of the basic ethical principles. The Hippocratic Oath includes the prom- ise of the physician “to abstain from doing harm” (in Greek: ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν) and this is also embodied by the phrase “first, do no harm” (in

68 Manuscript in the Musayof collection, no. 228, Yad Itzchak Ben Zvi, tape no. 2675. About his medical techniques, see Yael Buchman and Zohar Amar, Practical Medicine of Rabbi Chayyim Vital (1543–1620): Healer in the Land of Israel and Vicinity (Jerusalem: Unit of the History of Medicine, Bar Ilan University, 2007), pp. 9–29 [Hebrew]. 69 The meaning of “Amalekites” here is not clear. 70 R. Chaim Benveniste, Responsa Baye Haye (Salonica, 1791), Yoreh De’ah 177, 129b.

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Latin: primum non nocere).71 The principle of non-maleficence is mentioned also in the Jewish physician’s oath and this issue is discussed below. The questions that arise are: who was this doctor Abraham Baruch, what were the circumstances of his question, and does it imply a real intention to harm gentiles? Gershom Scholem surmised that Abraham Baruch was a well-known doctor from Izmir who was a follower of Shabbetai Zvi. This is apparently the same man mentioned by the name Dr. Barut in a book by the Dutch priest Thomas Künen published in 1669, described as a doctor whose medical services were used by many Christians. Abraham Baruch, appointed by Shabbetai Zvi as “king of Portugal,” was descended from Portuguese crypto-Jews, and some of his family continued to live as crypto-Jews in France.72 Assuming that this is the same person, David Tamar proposed that his hatred for gentiles in general and for Christians in particular was caused by his own life experience and by his messianic zeal. It is not surprising that such a man, who believed that the messiah had arrived and would redeem Israel and avenge its enemies, wanted to be an active part of that process.73 In his lengthy answer, R. Chaim Benveniste quoted multiple sources from Talmudic and rabbinic literature that deal with the different situations in which it is permitted or forbidden to cause the death of gentiles, such as when they are not at war with Jews or when Jews are in a weakened position. In his summary, R. Benveniste presents three different opinions current among halakhic authorities: a. According to R. Joseph Caro and others, it is permissible not only to withhold treatment from a gentile but even to cause his death by giving him counter-medicines, although this is optional and not a religious duty. b. According to R. Joel Sirkis, a seventeenth century Polish rabbinical authority and author of the well-known book Bayit Hadash, in any case it is not permitted to cause the death of a non-Jew, even by inaction.

71 On the attitude of the Jewish Physicians’ Oaths toward harming the patient, see below. 72 Gershom Scholem, Shabbetai Zvi and the Shabbetaic Movement in His Period (Tel Aviv: Am Oved, 1957), pp. 111–12, 351 [Hebrew]. On Shabbetaic doctors, see Ya’akov Barnai, “The Marranos of Portugal in Izmir in the Seventeenth Century,” in Samuel Etinger, ed., Nation and Its History (Jerusalem: Merkaz Shazar, 1984), vol. II, pp. 291–292 [Hebrew]. 73 David Tamar, Researches in the Jews’ History in Eretz Israel and in Eastern Lands (Jerusalem: Mossad Harav Kook, 1981), pp. 143–144 [Hebrew].

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In practice, R. Benveniste recommends a moderate course, but not in all cases. If the gentile is a person who harms Jews, it is permitted to harm him, even directly, in the guise of medical treatment. On the other hand, if the gentile does not harms Jews, there is no obligation to harm him and it is better not to do so, even indirectly. Even though R. Benveniste concludes with a ruling, the feeling is that he considered the discussion to be mainly theoretical and philosophical. He treats the different halakhic opinions technically, without considering the practical consequences of the relations between Jews and gentiles such as the possibility of assaults by non-Jews, and, even more strangely, he does not consider the halakhic prohibition against causing enmity.

Discussion

The current study shows that medieval and pre-modern halakhic authorities permitted the medical treatment of Muslims as a matter of principle. This dispensation was related to Jews’ inferior personal and social status and to the risk of being harmed by non-Jewish society. This was particularly true of physicians, whose status was even more sensitive. There are many Jewish Physicians’ Oaths from the middle ages and in modern times.75 The question is: how is the issue of providing medical treatment reflected in these documents? Did those who composed these oaths display a favorable attitude toward treating gentiles? Asaph the physician (Asaph Harofe), who lived in the Land of Israel or Mesopotamia, wrote the first Hebrew medical book as well as the Physician’s Oath that bears his name.76 The prohibition against striking patients was

74 R. Chaim Benveniste, Responsa Baye Haye 130b. 75 For a general discussion of Jewish Physicians’ Oaths, see Mordecai B. Etziony, The Physician’s Creed: An Anthology of Medical Prayers, Oaths, and Codes of Ethics Written and Recited by Medical Practitioners through the Ages (Carson City: Charles C. Thomas, 1973). 76 The researchers have suggested many dates for Asaph’s life term—the first centuries, the sixth-seventh centuries, and the tenth century. On the biography, medical activities, and writings of Asaf Harofe, see Sussmann Montner, Introduction to Asaf Harofe’s Book

The Review of RabbinicDownloaded Judaism from 21 Brill.com09/26/2021 (2018) 108–133 12:30:07PM via free access “I bear the burden of treating the gentiles” 129 mentioned in the Oxford manuscript.77Asaph refers to the physician’s duty to provide medical support undifferentiated by socioeconomic status, such as that of poor people who can’t pay for the treatment. He does not mention the ancient prohibition against treat gentiles, nor does he encourage discrimination against patients from different faiths. A different impression arises from the physician’s oath of Amatus Lusitanus (1511–1568), a notable Portuguese Jewish physician. Lusitanus emphasizes that as a doctor he treated all types of people, of varied faiths and socioeconomic status—Jews, Christians, and Muslims. Lusitanus writes:

[I have given my services in equal manner to all, to Hebrews, Christians, and Muslims] [the bracketed words are in the text]. Loftiness of station has never influenced me and I have accorded the same care to the poor as to those of exalted rank […] I might, in some measure, contribute to the furtherance of the health of mankind.78

Abraham Steinberg assumes that the bracketed words are a later addition and that the text was appended because of censorship.79 At any rate, Lusitanus’s biography shows that he treated many non-Jews. For instance, he received

(Jerusalem: Geniza, 1957), pp. 31–64; Elinor Lieber, “Asaf’s Book of Medicine: A Hebrew Encyclopedia of Greek and Jewish Medicine, Possibly Compiled in Byzantium on an Indian Model,” in Dumbarton Oaks Papers 38 (1984), pp. 233–249; Stephen T. Newmyer, “Asaph’s ‘Book of Remedies:’ Greek Science and Jewish Apologetics,” in Sudhoff’s Archive 76 (1992), pp. 28–36; ibid, “Asaph the Jew and Greco-Roman Pharmaceuticals,” in Irene Jacob and Walter Jacob, eds., The Healing Past: Pharmaceuticals in the Biblical and Rabbinical World (Leiden: Brill, 1993), pp. 107–120. See also the plentiful bibliography of David Ruderman in his book Jewish Thought and Scientific Discovery in Early Modern Europe (New Haven and London: Yale University Press, 1995), p. 379. 77 Asaph Harofe’s oath was first published by Duker, Monatsschrift für Geschichte und Wissenschaft des Judentums, 8 (1859), p. 201. For the Hebrew version see Abraham Steinberg, Sefer Assia: Articles, Abstracts and Reviews in Medicine and Halakha Issues (4th edition) (Jerusalem: Reuven Mas, 1989), vol. 1, pp. 257–258. Sussmann Montner, “Hebrew Medical Ethics and the Oath of Asaph,” in JAMA 205 [13] (1968), pp. 912–913. On this oath see Shlomo Pines, “The Oath of Asaph the Physician and Yohanan Ben Zabda: Its Relation to the Hippocratic Oath and the Doctrina Duarum Viarum of the Didachē,” in Proceedings of the Israel Academy of Sciences and Humanities vol. 5 [no. 9] (1976), pp. 223–264. 78 The oath was written in Latin in 1559 and mentioned in vols. 6 and 7 of Amatus Lusitanus’s seven volumes, entitled Curationum Medicinalium Centuriæ Septem. For an English translation of the physician’s oath of Amatus Lusitanus, see Harry Friedenwald, “Amatus Lusitanus,” in Bulletin of the Institute of the History of Medicine 5 [7)] (1937), pp. 640–641. 79 Abraham Steinberg, “Sefer Assia,” p. 254.

The Review of Rabbinic Judaism 21 (2018) 108–133 Downloaded from Brill.com09/26/2021 12:30:07PM via free access 130 Shemesh an invitation from the municipality of Ragusa (Dubrovnik) to serve as the town physician, a mission he accepted.80 In 1547, he left Ferrera and moved to Ancona. Here he was called upon to treat Jacoba del Monte, sister of Pope Julius III, and he also prescribed for Julius himself. In Ancona he served as the regular physician of several monasteries.81 Lusitanus was born in Castelo Branco, Portugal, in 1511 to a Converso (Marrano) family, which secretly led a Jewish life. Forced to leave his country because of the Portuguese inquisition, he wandered among many countries. He reports: “I have endured the loss of private fortune and have suffered fre- quent and dangerous journeys and even exile with calmness and unflagging courage, as befits a philosopher.” Hence, in spite of the hostile religious attitude of his close surroundings he did not retaliate against his patients; he provided medical treatment indiscriminately.82 As a rule, medieval European rabbis also provided medical treatment to non-Jews, probably Christians. For example, R. Shlomo ben Aderet (Rashba, 1235–1310), who lived and operated in the city of Barcelona in Christian Spain, permitted a Jewish physician to treat a non-Jewish woman suffering from infertility, particularly when the physician provided medical services to the general population, for fear of arousing animosity. Rashba states that his teacher, Moses ben Nachman Gerondi (Nahmanides or Ramban, Spain, 1194– 1270), acted similarly and consulted a woman who suffered from a similar problem.83 But R. Joseph Karo reports that the Catalan R. Yonah ben Abraham

80 Marija-Ana Dürrigl and Stella Fatović-Ferenčić, “The Medical Practice of Amatus Lusitanus in Dubrovnik (1556–1558): A Short Reminder on the 445th Anniversary of His Arrival,” in Acta Medica Portuguesa 15 [1–2] (2002), pp. 37–40; Jurica Bačić, “Two Cases of Pediatric Urology: Dubrovnik, 1555–1557,” in International Pediatrics 17 [1] (2002), pp. 57–59; Jurica Bačić, Katarina Vilović and Baronica Koraljka Bacic, “The Gynecological- Obstetrical Practice of the Renaissance Physician Amatus Lusitanus (Dubrovnik, 1555– 1557),” in European Journal of Obstetrics & Gynecology and Reproductive Biology 104 (2002), pp. 180–185. 81 Y. Leivovitch, “Amatus Lusitanus,” in Yosef Kloizner, ed., Encyclopedia Hebraica (Jerusalem and Tel Aviv: Encyclopedia Publishing Company, 1953), vol. 3, pp. 944–950. 82 Historians of Jewish medicine emphasize that Amatus Lusitanus’s biography reflects the fate of the Jews and the part they continue to play in the diffusion of scientific knowledge and ethics. See Harry Friedenwald, “Amatus Lusitanus,” in Bulletin of the Institute of the History of Medicine 5 [7] (1937), pp. 603–653; Aaron J. Feingold, “The Marriage of Science and Ethics: Three Jewish Physicians of the Renaissance,” in Natalia Berger, ed., Jews and Medicine (Philadelphia: The Jewish Publication Society, 1995), pp. 89–98. 83 R. Shlomo ben Aderet, Rashba Responsa, (Bnei Brak: Sifriyati 1958), I, siman 120. On treatments or the transfer of knowledge between Jewish and Christian neighbors, midwives, and doctors in Spain, Provence, Germany, and Northern France, see, e.g.: Shulamit

The Review of RabbinicDownloaded Judaism from 21 Brill.com09/26/2021 (2018) 108–133 12:30:07PM via free access “I bear the burden of treating the gentiles” 131

Gerondi (died 1264), who was Nahmanide’s cousin, objected to his medical efforts on behalf of non-Jews. In a case of treating a woman suffering from infertility he wrote to Nahmanides: “You multiply the offspring of Amalek.”84 It is obvious that he was referring to Christians and not Muslims. Knowing that Jewish physicians treated both Muslims and Christians we may assume that the rabbis’ halakhic decisions had a part in shaping reality. However we cannot deny the possibility that people’s actual conduct stemmed from a lack of choice and from existential needs and was not necessarily a direct derivative of rabbinical decisions. One question that arises from this study concerns the extent to which Jews and non-Jews at the peak of the Ottoman Empire (fifteenth–eighteenth centuries) interacted for medical purposes, and, in light of that, to what degree was it actually necessary to permit medical relationships between members of the two faiths. Jewish and Muslim medical interactions depended to a great degree on the type of medical institution in which they existed. Three major types of medical facilities were extant in the Ottoman Empire: A. General-public hospitals, aimed at serving people of all faiths and socioeconomic status; B. Ethnic- community medical services for Jews or Christians who preferred independent facilities; C. Private clinics.85 Studies dealing with the medical establishment during the Ottoman period indicate that although imperial hospitals were intended for the entire population, in reality they served only isolated, poor, or mentally ill Muslims.86 The reason was that members of Ottoman society preferred to receive medical aid from their family members, and in more severe

Shachar, Medieval Childhood (Tel Aviv: Dvir, 1990), p. 85 [Hebrew]; Joseph Shatzmiller, Jews, Medicine and Medieval Society (Berkeley, Los Angeles, and London: University of California Press, 1994), pp. 119–139; Elisheva Baumgarten, “‘Thus Say the Wise Midwives:’ Midwives and Midwifery in 13th Century Ashkenaz,” in Zion 65 (2000), pp. 56–57 [Hebrew], presented in more detail in her book, Mothers and Children: Jewish Family Life in Medieval Ashkenaz (Jerusalem: Zalman Shazar Center for History of Israel, 2005), pp. 80–85, 208–216 [Hebrew]. See also Nathan Micael Gelber, “History of Jewish Physicians in 18th Century Poland,” in Yosef Tirosh, ed., Tribute to Yeshaayahu (Tel Aviv: Center of Culture of Hapoel Mizrachi, 1957), pp. 347–348 [Hebrew]; Moshe Rosman, Founder of Hasidim: A Quest for the Historical Ba’al Shem Tov (Berkeley: University of California Press, 1996), p. 57. 84 R. Joseph Karo, Beit Yosef (Jerusalem: Machon Yerushalayim, 1993–1994), Yoreh De’ah, siman 154. 85 Cohen, Jews under the Rule of Islam, p. 191; Zohar Amar and Efraim Lev, Physicians, Drugs, and Remedies in Jerusalem from the 10th to the 18th Century (Tel Aviv: Eretz, 2000), pp. 74–76 [Hebrew]. 86 Miri Shefer, “Hospitals in Three Ottoman Capitals (Bursa, Edirne, and Istanbul) in the 16th and 17th Centuries” (Ph.D diss., Tel-Aviv University, 2001), pp. 54–56 [Hebrew].

The Review of Rabbinic Judaism 21 (2018) 108–133 Downloaded from Brill.com09/26/2021 12:30:07PM via free access 132 Shemesh cases they turned to private healers or to clerics who used traditional medical techniques.87 Physicians from various faiths could all serve in public hospitals and some were appointed by the central authorities in Istanbul. Such hospitals saw an intermingling of physicians from different religious and national groups, and these included Jewish physicians, such as Yiḥye the Physician, whose letter of appointment (from October 19, 1564) stated that he preferred to be a physician in Jerusalem.88 Jews who served in public hospitals and saw Muslim patients clearly relied on the halakhic authorization to treat Muslims, and this also seems to be true of physicians who worked in private clinics and were sought out by people of all faiths. In community hospitals the situation was slightly different. In Jerusalem the Jewish congregation established autonomous community hospitals (Sephardic and Ashkenazic),89 which operated according to Jewish norms and rules with regard to the laws of kashrut, Sabbath, etc., and they employed Jewish physicians.90 In these facilities physicians treated only Jews, so there was no need for permission to treat non-Jews. However, we must remember that a not insignificant number of non-Jewish patients requested the services

87 Abraham Marcus, The Middle East on the Eve of Modernity: Aleppo in the Eighteenth Century (New York, Columbia University Press, 1989), pp. 265–266; Rhoads Murphy, “Ottoman Medicine and Transculturalism from the Sixteenth through the Eighteenth Century,” in Bulletin of the History of Medicine 66 (1992), pp. 376–403; Lawrence I. Conrad, “The Arab-Islamic Medical Tradition,” in Lawrence I. Conrad, Michael Nive, Vivian Nutton, Roy Porter, and Andrew Wear, eds., The Western Medical Tradition 800 BC to 1800 AD (Cambridge: Cambridge University Press, 1995), pp. 93–138. 88 Amnon Cohen and Elisheva Simon-Pikali, Jews in the Moslem Religious Court in the 16th century (Jerusalem: Yad Itzchak Ben Zvi, 1993), document no. 303, p. 269 [Hebrew]. On physicians in Jerusalem during the Ottoman period, see Uriel Heyd, “The Jews of Israel in the late 17th century Jerusalem,” in Studies of Israel, Dedicated to Yesha’ayahu Peres 4 (1953), pp. 179–80 [Hebrew]; Cohen, Jews under the Rule of Islam, p. 188; Mina Rozen, The Jewish Community of Jerusalem in the 17th Century (Tel Aviv: Tel Aviv University and Misrad Habitachon, 1984), pp. 232–233 [Hebrew]; Amar, “Jewish Physicians,” pp. 79–98 [Hebrew]. 89 On the hospital that functioned in Jerusalem during the sixteenth-eighteenth centuries and served members of the Ashkenazi and Sephardic congregations, see Amar and Lev, “Physicians, Drugs, and Remedies,” pp. 76–78. 90 Two types of physicians operated in Jerusalem. There were physicians authorized by the authorities who had acquired their medical education at European universities or at the medical schools in the center of major Ottoman cities or who received their medical accreditation based on experience and practice in the hospitals. However, there were also unqualified physicians who had no licensed medical training and were not registered by the authorities. See Amar and Lev, “Physicians, Drugs, and Remedies,” pp. 72–73.

The Review of RabbinicDownloaded Judaism from 21 Brill.com09/26/2021 (2018) 108–133 12:30:07PM via free access “I bear the burden of treating the gentiles” 133 of these physicians when the latter were not busy at the Jewish hospital, so that permission to treat non-Jews was relevant in these cases as well. The findings presented here concerning halakhic problems that arose as a result of medical relationships support the views of Amar and Lev, who claim that establishing a special hospital for Jews solved some of the problems and received the approval of the Ottoman authorities, who recognized the special needs professed by Jews and the halakhic problems that they might encounter in public hospitals and in interactions with physicians of other faiths.91 A review of responsa that set out grounds for permitting desecration of the Sabbath in order to help non-Jewish patients indicates that the issue mainly occupied halakhic authorities operating in Christian countries (Europe) but relatively few in Muslim countries.92 This fact leads to the question: was the concern for animosity from non-Jewish sources more relevant and tangible in Christian countries, while people in Muslim countries demonstrated understanding and tolerance towards physicians’ religious limitations? Maybe so; however this must be established in a separate discussion. Rabbis were afraid that non-Jewish doctors would harm Jewish patients (see above). The case of Abraham Baruch shows that Jewish doctors as well were capable of misusing their medical authority to harm innocent gentiles under the guise of failed medical treatment. It would seem that the harmful intentions of Abraham Baruch against gentiles were an exception to the rule and were motivated by his personal mind-set. They cannot be seen as part of a wider phenomenon. In any case we see that not only could the ruling majority harm the minority, but the opposite was also possible.

91 Amar and Lev, “Physicians, Drugs, and Remedies,” pp. 75–76. 92 See, e.g., R. Yoel Sirkis (Poland, seventeenth century), The New Bait Hadash Responsa (Jerusalem: Safra Press, 1959), siman 2; R. Israel Lifschitz (Danzig, nineteenth century), Tiferet Yisrael (Warsaw, 1873), Mishnah Avoda Zara 2:6; R. Moses Sofer-Schreiber (Germany, 1762–1839), Responsa Chatam Sofer (Bratislava 1851), II—Yoreh De’ah, siman 131; Responsa Divrei Chaim, II, Orah Chaim, siman 25. We reached this insight among others through R. Ovadia Yosef’s reference to the issue, which is still relevant today. All the sources mentioned in the answer given by R. Yosef, who is recognized as a halakhic authority who often quotes other Responsa, are of European rabbis. See R. Ovadia Yosef, Responsa Yabia Omer (Jerusalem: Machon Meor Israel, 1995), vol. VIII, Orah Chaim 38.

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