Health Care

My Son, The Doctor

By

The saga of Jews and medicine.

I. 

Why is it, in fact, that so many Jews have become doctors? Here follows a twice-told tale that bears telling once again.

Imprisoned in a tower in Madrid, disabled by syphilis and further weakened by an abscess in his scalp, the French king Francis I asked of his captor, the Holy Roman Emperor Charles V, that he send his finest Jewish physician to attempt a cure. At some point after thedoctor arrived, Francis, in an attempt at light conversation, asked him if he was not yet tired of waiting for the messiah to come. To his chagrin, he was told that his healer was not actually Jewish, but a converso who had long been a baptized Christian. Francis dismissed him, and arranged to be treated by a genuine Jew, brought all the way from Constantinople.

Apocryphal or not, this charming story has endured because it illustrates the position of the Jewish doctor during the Middle Ages and Renaissance. The narrative's supposed events took place at a fixed point in time, some years before the death of Francis in 1547, but they form part of a genre of anecdote that had existed for centuries. Though not as pervasive as it once was, the legend of the Jewish doctor's special skills is still current today, enduring in attenuated form alongside the legend of the profession's attractiveness to young Jews as a career. Intertwined with myth, the legendary relationship between the Jew and the art of healing continues to evoke a variety of responses, ranging from humorous comment to scholarly study.

To explore that relationship, several questions are easily framed and may be succinctly stated. Three questions, to be precise. Why have so many Jews been drawn to the study of medicine, far out of proportion to their numbers? Why have so many achieved distinction, far out of proportion to their numbers? And why, at least in centuries past, have Jewish doctors been thought to have accomplished so many more cures than their Gentile counterparts, far out of proportion to their numbers?

Not surprisingly, the answers to these questions are multifactorial, multilayered, and multigenerational. But like so many multiplicities, they can be comprehended by recognizing that the answers are ultimately woven into a unity, not only of origin but of intent. Though the origin and the intent are now obscured by strata of time and cultural change, they are nevertheless there to see, if we are willing to look closely and cast aside--even if briefly--the religious skepticism of our age.

As in so many areas of Jewish questing, we can serve our purpose no better than by turning to the writings of the great philosopher and physician Maimonides, in this case the fifth of the so-called Eight Chapters, or Shemonah Perakim, with which he prefaced his exegesis of Pirkei Avot, or Ethics of the Fathers, in his commentary on the Mishnah, completed in 1168, when he was thirty years old. There he articulates a theme that would continue to appear in his writings for the rest of his life, summarized by his statement that the real purpose of wealth or any other acquisition should be to expend it for noble purposes, and to employ it for the maintenance of the body and the preservation of life, so that its owner may obtain a knowledge of God, in so far as that is vouchsafed unto man.

From this point of view, the study of medicine has a very great influence on the acquisition of the virtues and of the knowledge of God, as well as on the attainment of true spiritual happiness. Therefore, its study and acquisition are pre-eminently important religious activities.

It was a Maimonidean precept that the purpose of keeping the body healthy is to enable the unhindered pursuit of knowledge of God, and of the perfect morality for which God is the model. The study of medicine, in sum, is a religious activity.

In saying this, Maimonides was echoing a thesis promulgated by the rabbis of the Talmud, who spoke of the physician as a messenger--or in certain ways even a partner--of God. This Talmudic concept, like so many others, has its origins and its inspiration in the Torah. The stringent directives about public health, hygiene, preventive medicine, and sanitation laid out in Leviticus are expanded in the Talmud to cover every facet of personal behavior. The aim of these injunctions being cleanliness in the presence of God, the underlying message of the Talmudic sages is the biblical link between physical and moral purity, always emphasizing that maintenance of health is maintenance of life: the obligation of every Jew, though it might mean disobeying commandments. All Jewish law, even the Decalogue, may be violated in the interest of saving a life, the only exceptions being the injunctions against blasphemy, adultery, incest, and murder. "First choose life," enjoins God, linking the acceptance of God's precepts to the embrace of life. And by the very word "choose," God makes it clear that man has freedom of will.

It is in the notion of free will, I believe, that the essence of the Jewish approach to healing is to be found. The concept is repeatedly proclaimed in scripture, in the rabbinic literature, and in the writings of many Jewish philosophers. Throughout the Jewish tradition, one is aware of the tension between the concept of God's omnipotent will and the concept of humankind's free will, manifest in an unspoken compromise that leaves the care of the body to man. In this matter, the intervention of God is not to be assumed.

In this way the rabbis of the Talmud are rather like the Greeks, whose most lasting contribution to medical theory was to separate their worship of the gods from their nature-based methods of diagnosis and therapy. This approach is exemplified by the Hippocratic Oath and the entire corpus of classical Greek medical literature, in which the physicians swear by Apollo and Aesculapius, and then go on to proclaim the principles of a school of healing independent of direct reliance on these or any other gods. Not only that, but some of the leading practitioners of Hippocratic medicine saw the study of their art as a way of understanding the divine, just as the Jews did.

And they went even further. Galen of Pergamon, the most influential physician who has ever lived, believed that the proper way to worship the Divinity is not with prayer and sacrifice but with experiment and observation. Late in the second century C.E., he described his greatest anatomical work, De Usu Partium, as "the sacred discourse which I am composing as a true hymn of praise to our Creator." To him, learning about the body was the sure way to learn about the godhead. He wrote: "And I consider that I am really showing him reverence, not when I offer him unnumbered hecatombs of bulls and burn incense of cassia worth ten thousand talents, but when I myself first learn to know his wisdom, power and goodness and then make them known to others."

Galen's way of knowing and making known was to experiment on animals in order to learn and then demonstrate the principles of anatomy and physiology. Though he believed that the divinity he called the Creator made the universe and everything in it according to a preordained plan, he never called on anything but his own skill in treating the sick.

From the beginning, this was precisely the way in which Jewish doctors approached the healing of their patients. In fact, their entire system of medicine was Greek, in the Middle Ages and for centuries afterward. There was never a Jewish medicine in the same way that there was an Egyptian or a Chinese or an Ayurvedic or a Western medicine. Then and now, Jewish medicine has been the medicine of the culture in which it is practiced. In Talmudic times, it was strongly influenced by the heritage of the Greeks, and not only because of their similar notions concerning the physician's independent role in healing. The remarkably learned concepts of anatomy and physiology--as well as preventive and clinical medicine--found in the Talmud can be traced to a broad familiarity with Hippocratic and Galenic understanding of such matters, and the influence of Hellenism.

If its function is to help man know God and to achieve the moral life, then healing must be based on ethical principles. Here, too, the Greek and the Jewish systems of medicine were parallel. Just as they are credited with being the first to separate religious faith from the treatment of disease, so also have the Greeks been credited with introducing ethics into the teachings of medical care. But the Torah preceded them. Either way, the interlocking methods and aims of the Jewish and the Greek physicians--based partly on shared notions of the divinity's distanced role, and partly on the commingling of cultures during the Hellenistic period of about 280 to 160 B.C.E.--would have vast implications in creating the background against which the three questions have been framed, which are here being addressed.

Even the origin of the Hebrew word for doctor, rofe, has within it the implication of independent action on the part of the physician. It means "to heal" in the sense of "to repair." The basic image is the mending of a torn place, or the sewing of a seam to bring parts together. As raphe, the word exists in modern anatomic terminology, to designate any of several places in the body where tissues from each side are joined in the midline. It appears as healing by God in Numbers 12:13 and Jeremiah 3:22 and 30:17, among other places. Applied to healing by humans, it is a reference that requires the hands of the practitioner and the actual doing of something. It is interpreted as a human intervention. (Modern dictionaries erroneously trace the etymology of raphe to Greek.)

And so the rabbis of the Talmud taught in the presence of a heritage of ethics and with the conviction that the preservation of life is a basic teaching of their religious system of values, to be carried out by human action, existing as an instrument of divine will, yet applied independently of the divinity's direct intervention. Though God is the ultimate healer--and indeed, in several dramatic biblical passages God chooses to intercede in order either to cause or to cure illness--God is not to be used by mankind as a medicine. When sickness occurs, a doctor is to be sought out, an imperative clearly articulated by Maimonides: "One who is ill has not only the right but also the duty to seek medical aid."

II.

But the Jewish doctors of the time entered into their work with yet another assumption, which may be of critical importance in their history of accomplishment. This was the concept--articulated centuries later in the Shulhan Arukh, the sixteenth-century legal code that quickly achieved canonical status--that the rofe, though acting independently and with free will, is the individual messenger or deputy of God, and is therefore irreplaceable in healing by anyone else. This specificity was interpreted to mean that he himself must respond when called upon, because it may be in the divine will that he alone is capable of that particular mission of healing. This tradition may sound familiar to us: it is issued in the sense of personal responsibility--or, as today's bioethicists might put it, the deontological obligation--that has characterized those physicians determined to excel because they are committed to the duty imposed by their own uniqueness. Such values as these are not easily thrown off with the passage even of centuries, because they are transmitted from teachers to pupils in a tradition going back millennia. Though they are hardly any longer uniquely Jewish, they entered our medical culture with monotheism.

It is in the time of the Talmudic sages (the third to the sixth centuries C.E.) that the relationship between Jews and medicine began to form the social foundation by which it would be characterized to the present day. The rabbis were not bloodless scholars, but committed members of the community whose experiences of daily life equipped them to understand the moment-to-moment existence that they addressed in their discussions of the Law. They lived in the real world, in which prayer and cogitation were considered insufficient without real engagement and real work. Their position would much later be stated by Nahmanides, the intellectual giant of Spanish Jewry in the thirteenth century, who declared that "it is part of the service of the Lord to attend to the affairs of the world." It is hardly a source of wonder that 213 of the 613 commandments enumerated by the sages and eventually codified by Maimonides have in one way or another to do with care of the body.

Being committed to a principle that the Talmudic sage Rabbi Zadok articulated with the words, "Make not of the Torah a crown wherewith to aggrandize thyself, nor a spade wherewith to dig" (and also stated by the great Hillel, who said that "whosoever derives a profit for himself from the words of the Torah is helping in his own destruction"), the scholars of that period and afterward rejected payment for their religious services and sought secular employment. Given the Jewish emphasis on bodily health, it was only natural that some of them turned to healing as a source of income. It was in this way that the association of medical skills and rabbinic wisdom became, in a sense, formalized. From that point on and continuing well into the Renaissance, many physicians were rabbis. It has been estimated that during the Arabic period, approximately half of the Jewish doctors were rabbis. It should not be forgotten that the word "rabbi" derives from the Hebrew rav, meaning "teacher"; and "doctor" derives from the Latin verb docere, meaning "to teach."

Unlike the medical practitioners of medieval Christian Europe, the majority of whom were self-proclaimed and sometimes illiterate healers, the Jewish physician was likely to have mastered the intricacies of his art as taught by skilled members of the profession. This meant not only that so many of them were valued because they were among the most secularly educated of the Jews, but also that they were leaders of the communities in which they lived. The tradition that doctors were among the leadership enhanced the prestige and the social standing of the profession, and as Jewish doctors became more sought out by prominent Muslims and Christians, they gradually came to represent their coreligionists before the Gentile rulers. Power often passed into their hands, and increasingly many of them were looked to as men of authority not only among the Jews, but also in the dominant non-Jewish world. In these ways, the stature of the Jewish physician became ever more elevated even during centuries of unrelieved oppression.

This would be vastly enhanced following the Enlightenment of the eighteenth century, when the lowering of cultural barriers allowed even greater social mobility and contact between Jews and Christians. During those times, when the education of Jews was gradually becoming less confined to religious schooling, the esteem in which secularly knowledgeable doctors were held became even greater. Comfortable in both worlds, they were seen as idealized figures who attained worldly accomplishment while resisting assimilation.

The Gentile seeking-outof Jewish physicians had several causes, the first of which was simply that any individual among them was, for the reasons given, likely to be more skilled than his non-Jewish counterpart, especially in Christian lands. Some achieved considerable renown, and their services were requested by powerful people separated by long distances, adding to the general impression among the multitude of citizens that there was something special about Jewish healers. Such an impression was hardly lessened by a disquieting perception that these devious strangers in their Christian midst, who spoke among themselves in an inscrutable tongue and called upon a God whose ways seemed so cryptic, had special hidden knowledge, perhaps of the occult. And thus their very differentness, and the apprehension that it aroused, meant that superior, even demonic, healing gifts were often attributed to them. The mystique of the Jewish doctor not only added to his reputation, it likely had a placebo effect on many a patient. It is hardly a wonder that in the thirteenth and fourteenth centuries Jews were doctors in numbers far exceeding their representation in the general populace. Only 5 percent of the twenty thousand people living in Marseilles during the first half of the fourteenth century were Jewish, but they accounted for ten of the city's twenty-three physicians.

The conditions in which Jews lived also contributed to their medical expertise. Era after era, Jews had been forced to flee from country to country, usually taking few of their possessions and often able to retain little of their money. Medical knowledge was not only transferable; until licensing laws were established in various territories around the late eighteenth century, it was a means of starting up an enterprise immediately upon arrival in a foreign place. Before the complexities of modern science began to overtake it in the early nineteenth century, it could be taught by father to son, or within a community. Not permitted to own land until relatively recent times (and in any event unable to put it into a suitcase), Jews looked on medicine as a form of un-real estate, valued because of the very real conditions to which they had to respond realistically.

Traveling as they did, Jews learned many languages, and the medical men among them had contact with physicians from many areas, adding to their store of information and their comprehension of available texts, as well as enabling them to study the drugs used by local practitioners. In addition, the shared ability to speak and read Hebrew enabled them to transmit knowledge to one another. Thus their very privations added to their skills. Jews were of necessity cosmopolitan, and so was their medicine.

Fluency with languages and the transmitted history of familiarity with Hellenistic culture made the Jewish physician a valuable intermediary of Greek medicine--which continued to live as the scientific medicine of the Middle Ages and Renaissance--to the Christian and Arabic worlds. Not only were Jews among the translators of the ancient Greek texts into Arabic during the approximately six centuries when that language dominated medical thought, they also produced versions in Hebrew, to be disseminated among themselves throughout Europe and the Muslim lands. Consequently, Jews had ready access to the most highly regarded of medical texts, which were generally unavailable to doctors on the Continent until the end of the twelfth century, if not later, when Latin translations were published, some of them by Jewish scholars. In fact, even the few Christian medical writings of this period were translated into Hebrew as well as Arabic, so Jewish doctors had access to everything then available in any literary form, whether emanating from Europe or from the Arab lands. It is hardly a wonder that more than a few Jews were members of the faculty of the first great university medical school, at Salerno, in the tenth, eleventh, and twelfth centuries. When the schools at Montpellier and Paris were established in the thirteenth century, Jewish physicians were called to teach there as well.

And always there remained the religious basis upon which healing was so highly valued by Jews. When during the Middle Ages certain rabbinic authorities--threatened by the intellectual incursions of the sciences and philosophy--forbade the study of such matters, medicine was exempted because of the principle that life must be chosen, as God and the sages had decreed. In 1305, the threat of excommunication was imposed by the renowned Rabbi Solomon ben Adret (known as the Rashba) on anyone who read in a scientific or philosophic discipline before the age of twenty-six, but learning medicine was allowed. And by then the authority of Maimonides was being invoked to protect students of the sciences as well, as in a letter written to the Rashba by another prominent rabbi, Jedaiah ben Abraham Bedersi. "We cannot give up science," he wrote. "It is in the breath of our nostrils. Even if Joshua were to appear and forbid it, we would not obey him. For we have a warranty which outweighs them all, that is to say Maimonides, who recommended it and impressed it upon us. We are ready to set our goods, our children and our lives at stake for it." So not only medicine, but science in general, was vouchsafed as a valued outlet for Jewish intellectual energies.

This was not the only exemption granted to Jewish doctors. Though church synods until well after the Renaissance frequently ordered Christians not to consult Jewish physicians, many of the ecclesiastical and royal dignitaries continued to employ Jewish doctors, as did prominent families. In Spain, this situation persisted even after the Jews were expelled in 1492, including at the court of Ferdinand and Isabella. Not surprisingly, the medical entourage of late medieval and Renaissance popes more likely than not included one or more Jewish physicians.

The Jewish emphasis on maintaining health existed in the presence of a Christian abnegation of concerns with the body. The ascetic tradition, strong since the earliest days of the Church, meant that the truly religious must not only avoid the vanity of pursuing what is corporeal, but must also accept that disease is the work of the devil or a judgment from God, to be treated, if at all, by confession and prayer. In the twelfth century, Bernard of Clairvaux--who seems to have gloried in being plagued throughout his life by chronic anemia and stomach problems--declared that monks who took medicines were in violation of Church precepts. In 1135, the Council of Rheims forbade monks and clergy from practicing medicine as contrary to theological principles. Restrictions became even greater with succeeding councils, effectively shutting the profession off from participation by some of the most educated men of the time. More than one Church assembly threatened to excommunicate physicians who instituted treatment before requesting ecclesiastical consultation. Unlike the attitude of Jews, religious dogma pervaded Christian theories of sickness.

Christians fundamentally saw their existence on earth as mere preparation for the next world, regarding the body as no more than a container for the soul. But Jews have lived robustly for the time on earth, for the here and now, preserving health and this life as the way to understand God. The notion of a world to come is certainly present in Judaism, but its place in Judaism was not like its place in Christianity. Though believing in the eventual coming of the messiah, Jews have always preferred to deal in a practical way with whatever is before them. This practicality is a matter of principle. This Jewish realism is a powerful factor in the Jewish determination to remain healthy and stave off death. Though the medieval Muslims called both Jews and Christians "the people of the book," Jews are in effect the people of the body as well.

III.

It was Jewish realism that resulted in the building of institutions for the Jewish sick, as early as the Middle Ages but increasingly around the time of the Enlightenment. Living in ghettos or confined by social pressure to specific areas of cities, their doctors usually restricted in their ability to treat in the hospitals that were beginning to appear in large numbers during the eighteenth century or to study in universities, Jews founded their own social service organizations under the leadership of community councils--among whose officers physicians figured prominently--that supported hospitals and sick-care societies, as well as other functions. Young Jewish men determined to learn the principles of the newly emerging scientific medicine were thus given the opportunity to work in the kinds of facilities that might not otherwise have been available to them or to their patients. And the ancient Jewish proclivity to seek care assured a large pool of patients. In these ways, restrictions that might have hindered professional development were countered by societal responses.

Jews, like everyone else, began to aspire to the middle class once that became possible. Just as the profession of medicine had brought entry into the courts of medieval monarchs and popes, it could make a Jew a member of the bourgeoisie after the Enlightenment. In the wake of the Haskalah--the Jewish Enlightenment, when so many left the intellectual confines of religious study to seek secular knowledge and acceptance--medicine was the ideal means to accomplish such an objective, especially since the civil service, that other traditional stepping-stone to the middle class, was almost entirely closed to Jews.

Though particularly characteristic of the German community, the founding of Jewish health care institutions was a process that came into being in various forms throughout Europe. And so was the increasing attempt to burst out of the constricting confines of a totally religious perspective. As the universities became more accessible, the Jewish emphasis on education began to be increasingly secularized, as a consequence of the Haskalah, and drew young Jews into classrooms and lecture halls as though to a magnet of worldly intellectualism. Jews became over-represented at every grade, from primary school upward. Consider one example: although they made up only 9 percent of the population of Vienna in 1912, Jews accounted for 47 percent of Gymnasium students. The situation was almost as remarkable at higher levels: 25 percent of the students enrolled at the University of Vienna in 1904 were Jewish. Many of these were studying medicine.

For more than a generation, Jewish families had been pouring into the great capital city of Vienna from all parts of the Austro-Hungarian Empire, drawn by the relative liberalism of Emperor Franz Josef, and not deterred by political expressions of anti-Semitism that were everywhere rampant. As they freed themselves from the confining religious environment of the small cities and villages in which they had been brought up, parents did what they could to secure for their children the advantages of the surrounding society. In no area was this phenomenon more pronounced than in the study of medicine.

The situation alarmed some of the most prominent figures in German academic medicine. Theodor Billroth, the leading surgical professor at the university's General Hospital of Vienna in the late nineteenth century, railed against the presence of such large numbers of newly arrived Jewish immigrants in his classes. He described his view of the problem in The Medical Sciences in the German Universities, a book destined to become a classic of educational philosophy throughout the world.

No profession, except perhaps, the clergy, is so often exploited by uneducated families who aim to climb into the cultured classes on the shoulders of the younger generation, as is the medical profession. For the Jews, a medical career offers comparatively fewer difficulties than any other, and if a doctor once achieves moderate success, countless others will attempt to duplicate it.…

A Jewish merchant in Galicia or Hungary (the Hungarian Jews have the worst reputation among the Viennese students themselves), earning just enough to keep himself and his family from starving, has a moderately gifted son. The vanity of the mother demands a scholar, a Talmudist, in the family.… He comes to Vienna with his clothes and nothing else. What impressions, what stimuli can such a boy have received? He has been surrounded all his life by the pettiest and most miserable circumstances, nor will he ever be able to rid himself of this narrowest of horizons. Now he comes to the university.… [O]ur teaching methods were not intended for such students, or for such conditions, for those methods demand a free mind and free intellectual movement. Such people are in no way fitted for a scientific career.

And this was written by a man of broad liberal outlook, generally conceded to have been among the most tolerant of the German-speaking professors of the day.

Among the reasons his words had wide appeal was that they did, in fact, reflect certain truths about Jewish medical aspirations in a Christian society, some of which have never disappeared--nor would any Jew want them to. But, almost certainly unappreciated by all but a few of Billroth's readers, they also reflected some of the conditions under which Jews in every era and land have striven toward careers in medicine, not only for the immediate reasons given by Billroth, but for those far more sweeping and all-inclusive historical reasons.

IV.

Though the association of Jews with medicine that consolidated during the early Middle Ages was based on religious precepts and cultural ambience, the centuries have interlarded another factor, as universal as it is personal. By this I mean a characteristic that can only be called the Jewish personality. In this era of extreme sensitivity to such notions as ethnic and national characteristics, some might think it preferable to use more euphemistic terms such as "worldview," "philosophical outlook," and "cultural orientation," but they all amount to the same thing. The Jewish attitude toward life and the world has certain qualities that have been remarked upon for centuries, by observers both friendly and hostile; stereotypes, of whatever group, do sometimes persist because they support personal impressions. Though some such impressions are only what the beholder wants to see, some of them are true observations, in the sense of having validity to objective minds. Among those that have been made about Jews, several would seem to bear on the questions posed at the outset of this essay, which can be summarized by asking, "What is it about Jews and medicine?"

Among Jews, especially those of an intellectual bent, there is commonly a kind of restlessness, an anticipation of uncertainty, ambiguity, imperfection, and the sense that one must do something about it even though the total solution will never be found. Many have lived in relative comfort with a chronic sense of discomfort. Irritability and a persistent low-grade aggravation are in the very marrow of such people. Though these qualities rankle, they may be the source of an active response to the world, whether productive or counterproductive. As Thorstein Veblen famously put it in his essay "The Intellectual Pre-eminence of Jews in Modern Europe" in 1919, "They are neither a complaisant nor a contented lot, these aliens of the uneasy feet."

Out of this restless dissatisfaction there arises a skepticism, a questioning of oneself, of one's place in the predominantly Christian world and, indeed, of the givens of that world, both great and small. Many Jews have felt themselves less bound by the encompassing assumptions of the surrounding culture, in part because they could never wholly be a part of it. "The first requisite for constructive work in modern science, and indeed for any work of inquiry that shall bring enduring results, is a skeptical frame of mind," Veblen correctly pointed out. And what is the practice of medicine, and what is the science upon which it is based, but exercises in applied skepticism, a dissatisfaction with the direction in which things are going, and a determination to do something about it, even though the doing may of necessity remain incomplete?

So ancient is the restlessness to get underway with this enterprise that it was already being articulated in the first century C. E. in a famous adage of Rabbi Tarfon: "It is not your duty to complete the work, but neither are you free to desist from it." All the discontinuities and differences notwithstanding, modern Jews often approach their work in the same way as the Talmudists who preceded them by a millennium and a half: by focusing on details, by applying a questioning eye to the most minute annoyances and inconsistencies in their lives and in their fields of vision. They ruminate and lucubrate on such seemingly small things, and never stop turning them over in their minds. The very closeness of their grievances with the presumed order demands a closeness of scrutiny.

Does any of this sound familiar? It should, because it is the way of the scientist and the way of the physician. From the specific to the general, proclaim the advocates of the inductive reasoning that has been the boon of science; use the general principles to explain the tiniest details of observations and disorders, say the advocates of the deductive reasoning that is the key to diagnostic and therapeutic medicine. When the Nazis hatefully called psychoanalytic theory "Jewish science," they were also expressing, far better than they knew, the debt that Sigmund Freud owed to the meticulous cogitations of his rigorous and empirically minded forebears. Though psychoanalysis is hardly a science, it derived its scrutinizing methodology from Freud's training in the laboratory, as he sought to interpret minutely the laws of nature as they applied to neurophysiology. And I would submit that it derived a part of its distinctive viewpoint from its author's absorption of the ancient rabbinic tradition--knowingly and unknowingly transmitted by his own Talmudically steeped father--of painstakingly interpreting the laws of God as they apply to daily living. As much as Jews are the people of the book and the people of the body, they are the people of transmitted memory.

And now it is necessary to return to the words of the Geheimrat, Billroth. Many jokes are made about the Jewish mother who boasts about "my son, the doctor." But viewed in the perspective of millennia of history, of a tradition ultimately based on the search for knowledge of God, of a society that has valued learning almost as much as it values life--and, indeed, perceives learning as the high road to life and therefore to God--is it any wonder that such a society would hold the practice of healing to be the greatest good, and therefore to hold those who practice it in greatest esteem? Only the scholar has stood higher than the rofe in the calculus of Jewish honor, and in early times the two were frequently embodied in the same person. Several centuries ago, the religious intellectualism of the rabbi began to be replaced by the secular intellectualism of thedoctor, and that process has grown. The rav has become the docere.

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