Before Going to Medical School.

The Jewish Doctor: A Narrative History. By MICHAEL NEVINS. Northvail, NJ: Jason Aronson, 1996.

When I asked Wendy, my daughter the gastroenterologist, and my son Jon, the cardiologist, how much they knew of the history of Jewish doctors, the returning answer, even for e-mail, was swift and short: "we probably know as little as you did before reading Michael Nevins's collection of vignettes, The Jewish Doctor. "As a physician and a jew I was immediately overwhelmed with guilt. I was, however, able to excuse myself to myself and to Wendy and Jon, by pointing out that I, like them, never had time to pursue the literature and history of Jewish medicine.

But now we have available in one small volume an attractive book, clearly written, and quickly read, that provides a brief introduction to Jewish medical history and a good collection of references for future investigation. What every Jewish mother and father might want their son and daughter to know before going to medical school could be considered a theme of Nevins's book. In truth, rather than appealing only to Jewish doctors and their families, this book will ignite the curiosity of any reader with an interest in Jewish history or general medical history.

Understand though that this book is not a single "Narrative History," despite its title, nor a specialized discourse with a central argument clearly delineated and supported through analysis of primary sources. Judging from the title, one expects Nevins to confront and answer the issue that he raises in the "Introduction," namely, do "Jews truly have a unique aptitude for medicine?" (xii). This, after all, would make it a signal contribution--but he does not tackle the thorny general questions this might involve. He does not explore aspects of Jewish culture that perhaps prepared Jews-or perhaps not-for turning abstract science into applied practice. He has more to say about Jewish ethical traditions that perhaps-or perhaps not--helped to shape medical practice in the last five decades. Neither does Nevins give us definitions: Is a Jew a Jew because he is born so despite becoming a "converso" or a marrano, outwardly Christian but observing Jewish traditions? Does he consider doctors who are ostensibly Jewish in name and birth but do not practice their religion still "Jewish Doctors"? Can a Jewish feldsher (a communal paramedic) or a basic scientist be considered a "Jewish Doctor" as he implies?

Nevins himself forewarns the reader. A practicing internist, Dr. Nevins has produced instead what he offers in his introduction: an "eclectic collection [that] is not intended to provide a comprehensive review of every aspect of Jewish medical history." Tenuously connected chronologically, the twenty-one short chapters carry the reader through a number of the cardinal events of medical practice and progress from biblical times into the twentieth century, while focusing on the lives of Jewish doctors.

While the brevity of each chapter leaves the reader wishing for more information, especially in "Women in Medical Practice" and "Shtetl Medicine," the accounts tantalize one sufficiently to turn to the well-organized citations in search of sources for further reading. A few segments, however, sorely need either a much more comprehensive examination or should have been left out entirely. One is the unit "Defensive Medicine," three and a half pages describing De Pomis and De Castro, two physicians who wrote against the antisemitic slander of the fifteenth and sixteenth centuries. Similarly "The Jewish Doctor in Literature," a chapter that mentions Israel Singer's novel The Family Carnovsky, Sinclair Lewis's Arrowsmith, and Green's The Last Angry Man, could have been enriched and enlarged by including the prose and the poetry of Jewish doctors.

After the opening chapter of twelve pages (the longest, "An Historical Perspective"), the majority of each of the other chapters are about four pages, the topics ranging from the mandatory "Maimonides," who thought chicken soup to be a good medicine, to the last, a whimsical epilogue on "Bagels and Bankes" (cupping, an ancient medical procedure). Although at times even Ariadne might get lost, I find two threads that do seem loosely to connect the book: why Jews chose the medical profession in relatively large numbers is the first general discourse that cuts across time and chapter; the second, discussed in the "Introduction" as well as in several other segments, examines the difficulties Jews confronted in entering and working in the medical profession.

Any Jew reading the Talmud could have been drawn to medicine on encountering the large number of laws relating to medical practice, 213 of 613, whose "principal concern ... was that the physician should act in accordance with God's will in order to maintain the patient's welfare" (1--2). Chapter Two, "Early Jewish Opinions of Physicians," emphasizes the importance of medicine to the Jewish faith, and Nevins here points out the central concept of "Pikuach Nefesh": in order to save a life even for a very brief time all other holy laws except unchastity, idolatry, and the shedding of blood unjustly can be ignored (13--14). Furthermore despite the "tension between science and religion [that] has characterized much of Jewish history... [and] although the Talmud had acknowledged that disease and its cure ultimately are in the hands of God, physicians were understood to have a legitimate role as God's agents and, therefore, they were esteemed" (14--15).

Because Jewish physicians were often called to serve powerful secular as well as religious leaders, the profession was seen as a way to improve one's social position, with the caveat that, while at times richly rewarded as was Toviah Cohen, the court physician for five different sultans in Constantinople, one could just as easily be hanged, drawn, and quartered as was Rodrigo Lopez after thirty-five years of caring for Queen Elizabeth (46, 36). And unlike careers in the academy, often closed to Jews, a medical practice was seen as an independent way to earn a living. Moreover, accurate medical knowledge being a transferable and appreciated skill everywhere, provided a certain protection against starvation as Jews were forced out of country after country as noted in the life of Garcia de Orta who escaped from Spain to Portugal during the Inquisition, and fled again to Goa where he cared for viceroys and governors (57).

Sociology and history get their due: to achieve and maintain the benefits of being a Jewish doctor was arduous as Nevins clearly points out. It was never easy for a Jew to obtain admission to medical school; quotas existed almost everywhere except Padua, from which the first Jew graduated in 1409 (43 ). In Russia until Alexander II introduced progressive changes in education in the 1860s, Jews had to study medicine in other countries, and after the death of the liberal Alexander, the medical school at St. Petersburg limited the number of Jews to three percent. In America quotas were established in 1920 and remained in place until the last few decades (77, 115, 118). Even after achieving the status of doctor, expulsions, pogroms, and edicts such as that of Pope Pius IV (1555--1559) prohibiting Jews from treating Christians could make life difficult indeed for Jewish doctors (34, 51).

Two chapters that I wish to single out because they brought refreshing new information to me are the stories of feldshers and of Jewish women physicians. Somewhat analogous to our present day nurse-practitioners and physician-assistants were the feldshers, whose origins go back to the barber-surgeons of the thirteenth century. Outnumbering the physicians, feldshers were prominent and important in the nineteenth century providing medical care to the smaller Jewish communities in Europe. At one time in the nineteenth century professional feldshers were well educated with formal schooling required for four years (79--82).

Many have described the plight of Jewish men who sought entrance to medical practice, but little has been said of Jewish women as physicians who experienced bigotry on two counts. While Nevins fails to discuss these problems, at least he does call our attention to a number of Jewish women who achieved prominence in medicine including Sara la Mirgesse who worked in Paris in the thirteenth century and Rachel Hirsch who in 1913 became the first female Jew to receive a professorship of medicine in Prussia. Unfortunately, in the last paragraph of this chapter Nevins is a bit tactless when he pays tribute to Jewish mothers who direct their "sons to pursue careers in medicine," but exhort their "daughters to marry doctors" (99--102).

In "Polish Hospitals and the Holocaust" Nevins is at his best in depicting what happened to the men and women in the Jewish hospital in the Lodz ghetto during the Nazi occupation. And when he tells of the courage of the Jewish doctors in Lodz, one is moved beyond rage and compassion to tears and admiration.

Nevins here encapsulates the very finest traditions of the Jewish physician.

LAWRENCE ZAROFF is a retired cardiac surgeon who recently received a Master of Liberal Arts degree from Stanford University and is now a Ph.D. student in the Program in History and Philosophy of Science at Stanford.