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Maimonides vs. Aristotle Regarding Preventative Medicine

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    Aristotle's view on preventive medicine is evident in his Nicomachean Ethics. Aristotle argues that bodily strength and health are dependent on the actions of the individual. Strength is derived from doing the most appropriate level of exercise, while health is dependent on the right quantity of food and drink. Clearly, physical strength, well-being and good health are dependent on the decisions made by individuals in this regard. Aristotle places the emphasis on prevention rather than curing disease or illhealth. This is evident in the following passage from Nicomachean Ethics.

    First of all then we have to observe, that moral qualities are so constituted as to be destroyed by excess and by deficiency–as we see is the case with bodily strength and health …Strength is destroyed both by excessive and by deficient exercises, and similarly health is destroyed both by too much and by too little food and drink; while they are produced, increased and preserved by suitable quantities. …Temperance and Courage are destroyed by excess and deficiency, and preserved by the observance of the mean. But not only are the virtues both generated and fostered on the one hand, and destroyed on the other, from and by the same actions, but they will also find their full exercise in the same actions. This is clearly the case with the other more visible qualities, such as bodily strength: for strength is produced by taking much food and undergoing much exertion, while also it is the strong man who will be able to eat most food and endure most exertion. The same holds good with the virtues. We become temperate by abstaining from pleasures, and at the same time we are best able to abstain from pleasures when we have become temperate.

    Aristotle argues that individuals have the knowledge to do what is right to preserve good health. Aristotle sharply departed from the Socratic idea that knowledge of justice and goodness was all that was necessary for a person to behave justly. He argued that people in their souls often possess knowledge of what is right but that their irrational desires overrule this knowledge and lead them to do wrong " People who know the evils of hangovers still get drunk, for instance " Recognizing a conflict of desires in the human soul, Aristotle devoted special attention to the issue of achieving self-control by training the mind to win out over the instincts and passions. Self-control did not mean denying human desires and appetites; rather, it meant striking a balance between suppressing and heedlessly indulging physical yearnings, of finding the mean." Aristotle claimed that the mind should rule in striking this balance because the intellectual is the finest human quality and the mind is the true self, indeed the godlike part of a person.

    So they choose what is pleasant as good and shun pain as evil. If then whereas we wish for our end, the means to our end are matters of deliberation and choice, it follows that actions dealing with these means are done by choice, and voluntary. But the activities in which the virtues are exercised deal with means. Therefore virtue also depends on ourselves. And so also does vice. For where we are free to act we are also free to refrain from acting, and where we are able to say No we are also able to say Yes; if therefore we are responsible for doing a thing when to do it is right, we are also responsible for not doing it when not to do it is wrong, and if we are responsible for rightly not doing a thing, we are also responsible for wrongly doing it. But if it is in our power to do and to refrain from doing right and wrong, and if, as we saw, being good or bad is doing right or wrong, it consequently depends on us whether we are virtuous or vicious. To say that None would be vile, and none would not be blest seems to be half false, though half true: it is true that no one is unwilling to be blessed, but not true that wickedness is involuntary; or else we must contradict what we just now asserted, and say that man is not the originator and begetter of his actions as he is of his children. But if it is manifest that a man is the author of his own actions, and if we are unable to trace our conduct back to many other origins than those within ourselves, then actions of which the origins are within us, themselves depend upon us, and are voluntary. For more information go to

    People, therefore, can choose to maintain their health by making the right choices, such as not overindulging. They should strike a balance -the mean – between giving into their desires and practicing virtue. This can be seen as being in line with the moderation in terms of preventive medicine, in such issues as food and drink intakeparticularly in regard to alcohol.

    Maimonides view of preventive medicine is similar in many ways to that expoused by Aristotle, as is evident in the following passage from his Mishneh Torah.

    Anyone who lives a sedentary life and does not exercise or he who postpones his excretions or he whose intestines are constipated, even if he eats good foods and takes care of himself according to proper medical principles-au his days will be painful ones and his strength will wane. Excessive eating is like a deadly poison to the body of any man, and it is a principal cause of all illnesses. Most diseases that man is afflicted with are due to bad foods or because lie fills his abdomen and eats excessively even of wholesome foods.

    Maimonides, was nurtured on Aristotelian philosophy as interpreted by the Arabs. He was a devoted follower of Aristotle, who, he taught was the supreme master of human science, as the Scriptures were of divine truth. Maimonides emphasized the freedom of the will and made moral, rather than intellectual, perfection the goal of human endeavor.

    Maimonides was a prolific writer. His famous trilogy consists of the Commentary on the Mishnah, the Mishneh Torah, and the Guide for the Perplexed.. Each of these works alone would have, indelibly recorded Maimonides name for posterity. However, in addition to these, he also wrote a book on logic (Ma'amar Hahigayon), a book of commandments (Sefer Hamitzvot), an epistle to Yemen, a letter on apostasy, a treatise on resurrection (Ma'attiar 7echiyat Hattictitti), commentaries on several tractates of the Talmud, and over 6oo Responsa. Over and above all these books, Maimonides also wrote ten medical works.

    Fred Rosner has pointed out that preventive medicine is a major feature of Maimonides medical writings. In this he is in line with Aristotle with the emphasis on prevention rather curing illhealth.

    The preventive medicine approach and the interrelationship between physical and mental health are described in Medical Aphorisms the most extensive of all his medical works. This book contains 1500 aphorisms based primarily on Greek medical writers. There are twenty-five chapters each dealing with a different area of medicine, including anatomy, physiology, pathology, and diagnosis, etiology of disease and therapeutics, fevers, blood-letting or phlebotomy, laxatives and emetics, surgery, gynecology, hygiene, exercise, bathing, diet, drugs, and medical curiosities. In the seventh chapter, Maimonides asserts that fasting, insomnia, anxiety, severe pain and their like weaken body strength. Most people are said to faint following severe emotional strain. This occurs most frequently in ill people, the elderly, and the weak. Many of these individuals faint following anxiety or happiness or anger. Other times, they break out in profuse perspiration.10 The need to preserve one's physical health to prevent mental illness and vice versa is thus a recurring theme in Maimonides' writings.

    Maimonides treatise on poisons discusses at length the prevention of both accidental and intentional poisoning.

    One should be careful about those foods…whose appearance is altered such as foods containing sumac or pomegranate juice- or foods cooked in fishbrine or foods in which an apparent sour or extremely sweet taste predominates or foods which hive a bad odor such as those prepared with vinegar or those containing onions or those cooked with garlic. One should only eat these types of foods if they were prepared by a reliable person and about whom one does not have the slightest doubt because the cunning of those who wish to harm by poisoning is only accomplished through such foods in which the taste or the odor or the appearance of the poison is assimilated.

    He also cautions against drinking water that was left uncovered lest a poisonous creature had discharged poison there. Hence this work also emphasises prevention.

    A whole treatise (entitled Hilchot Deot) in Maimonides' legal code, known as Mishneh 7orah, is devoted to moral dispositions or human traits or temperaments. Particularly notable is the fourth chapter, which examines a variety of hygienic and medical prescriptions for healthy living and for the prevention of illness. Among the many subjects discussed are normal bodily excretory functions, recommended times for eating, amounts and types of food to be consumed, beverage imbibition, exercise, sleep habits, cathartics, climatic and weather effects on eating habits, detrimental and beneficial foods, fruits, meats, vegetables, bathing, bloodletting, sexual intercourse. The following passage from this chapter clearly emphasizes prevention over treatment:

    Since when the body is healthy and sound one treads in the ways of the Lord, it being impossible to understand or know anything of the knowledge of the Creator when one is sick, it is obligatory upon man to avoid things which are detrimental to the body and acclimatize himself to things which heal and fortify it. These are as follows: A person should never eat except when he is hungry nor drink unless he is thirsty He should not postpone his eliminations for even a single moment-, rather, every time that micturition or defecation be- comes necessary, he should respond thereto immediately. A person should not eat until his stomach is replete but should diminish his intake by approximately one-fourth of satiation. One should not drink water during meals save a little and mixed with wine. When the food commences to be digested in the intestines, one may drink as much water as one finds necessary. However, even after the food has been digested, he should not imbibe water excessively. One should not eat until one has examined oneself carefully lest it be necessary to excrete wastes. A person should not eat until he his walked prior to the meal so that his body begins to become warmed or he should perform a physical task or tire himself by some other form of exertion. 'The rule in this matter is that one should exert one's body and fatigue it every day in the morning until one's body begins to warm, Then one rests a little until one's soul has settled, and then one may eat. If one washes with warm water, after the exercise, so much the better.

    Mamionides continues with prescriptions for the correct time and manner of bloodletting, and sexual intercourse. Many of these rules and regulations are based upon discussions in the Talmud. Mamionides codifies these rules in his authoritative legal code, the Mishneh Torah, to indicate that these rules are not optional but mandatory. Prevention of illness and a healthy life style are obligations upon Jews in order to enable them to serve the Lord. If one is ill, one cannot serve the Lord properly or fulfill the precepts of the Torah. Maimonides concludes chapter four of his Hilchot Deot.

    I guarantee anyone who conducts himself according to the directions we leave laid down that he will not be afflicted with illness all the days of his life until he ages 6,reatly and expires. He will not require a physician, and his body will be complete and remain healthy all his life unless his body was defective front the beginning of his creation, or unless he became accustomed to one of the bad habits from the onset of his youth, or unless the plague of pestilence or the plague of drought comes onto the world. Maimonides cites exceptions to the goal of preventing rather than treating illness. Genetic diseases and certain epidemics of disease cannot be prevented. For this reason, the final paragraph in Maimonides' chapter on the regimen of health states that a person should not reside in a city that does not have a physician. A similar declaration is found in the Talmud.

    The final chapter of his Treatise on Asthma deals with "advice to help all people preserve their health and avoid illness." Maimonides advises that one must first pay attention to the improvement of the air, then to the improvement of the water one drinks, and then to the improvement of one's diet. He emphasizes important ecological and environmental factors in the preservation of one's health in the following passage:

    The relationship between the air of the cities and its streets and the air of open fields and deserts is comparable to the relationship between thick turbid water and clear, light water, This means that cities because of their buildings, the narrowness of their streets, the refuse and wastes of their inhabitants, their corpses, and animal carcasses, and the putrefaction of their foods, provoke stagnation of the air which becomes turbid and thick . . . if one cannot find a way to escape front this, having grown up in cities and become accustomed thereto, at least choose a city with wide horizons, preferably in a north easterly direction … if that is not possible, at least try to live at the outskirts of the city … living quarters should be on an upper floor with large rooms so that the northern wind can traverse them and the sun can shine in … pay attention to locate toilets as far removed as possible from one's living quarters … strive to improve the air and dry it with aromatic, scented substances and fumigations … this is the regime for preserving the health of one's body and soul.

    Maimonides quotes the famous Persian physician Rhazes (850-923 C.E.) who said, if the illness is stronger than the patient, medicine is not beneficial. If the patient can overpower the illness, there is no need for a physician. But, if they are equal, the physician is needed to reinforce the strength of the patient to help him overcome the illness. 'This is the credo known to all physicians as pritnsim non tiocere, first do no harm.

    Maimonides also quotes Hippocrates who said that a physician should pay attention to two things:to benefit the patient and not to harm him. Maimionidess himself asserts that a person who can manage without a physician is greater than one who needs him. Clearly, Maimonides preventive approach to medicine is evident throughout his Treatise on Asthma.

    Maimonides expands on some aspects of Aristotle's view -and provides a far more detailed and voluminous discussion. Nevertheless, the influence of Aristotle on Maimonides is evident in his emphasis on the actions of man and his ability to make sound decisions to prevent illness.

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