Epistle on Hemorrhoids

Moses Maimonides

Risāla fī ’l-bawāsīr (Epistle on Hemorrhoids), Introduction, Chapters 2, 6 (selections)

ca. 1187

In the Name of God, the Merciful, the Compassionate.

Says Mūsā ibn ‘Ubayd Allāh, the Israelite from Córdoba: There was a young man from a prominent and renowned family, from a noble house and of great power, whose case concerned me and whose service was incumbent upon me, who was affected by hemorrhoids at the anus, which irritated him at certain times. He received the customary treatment for them until their pain subsided and the excrescences that had emerged [re]entered and returned to the interior of the body, so that it reassumed its normal functions. But when [the ailment] recurred to him several times, he thought of cutting [the hemorrhoids] off in order to extirpate this malady from its root, so that it would not come back to him again. But I informed him about the danger inherent [in such an operation], in view of the fact that I was not sure whether these excrescences were of the kind that may be cut off or not; because in some people they are cut off, but then other excrescences appear. This happened because the causes that produced the first ones in [these people] remained, and therefore new ones occurred to them. I gave him sincere advice and told him about the right method to treat this illness and all similar chronic illnesses, or about that which diminishes these illnesses so that their burden becomes very light and only the slightest trace thereof remains. [ . . . ]

Chapter Two: On the Food from Which One Should Refrain Because of This Illness

(1) It is well known that these hemorrhoids mostly originate from a melancholic humor. Only rarely do they originate from a surplus of blood, and even more rarely from phlegm. What one always observes is that they are produced by black bile; for if melancholic humor increases in the blood, the blood becomes thick and turbid and the organs reject it. Then this superfluity is expelled from organ to organ until this residual and turbid [blood] sinks to the lowest parts of the body because of its heaviness and the thickness of its substance. The vessels of the anus become overfilled and stretched and widened. Then the heat and moisture of these spots overtakes [these vessels], and those excrescences—that is, hemorrhoids—develop.

(2) Some of them are open and flow—they are the easiest ones¹—while others are obstructed and blind, and nothing flows out of them. One should not interrupt the flow of those that flow, because it is a protection against very grave diseases, such as insanity, the [various] types of melancholy, and epilepsy. And [as for] those that do not flow, one should make their blood flow or incise them, if possible. But none of this belongs to the scope of this treatise, because it was [not] composed so that one could do without the personal attendance of a physician, nor [so that one could] treat [the subject] of healing [all the different] kinds of this illness exhaustively.

(3) But we specifically mentioned what we mentioned so that our master (may his strength be permanent) knows that the main thing in the case [of the different varieties of this illness] is to beware of the consumption of foods that produce black bile, thicken the blood, and make it turbid—such as beans, lentils, vetch, cabbage, eggplant, sumac, beef, meat of goats, and salted, dried meat. [ . . . ]

Chapter Six. On That Which One Should Rely Upon When This Disease Flares Up

(1) It is well known that all chronic diseases do not remain in one and the same condition, but sometimes are quiescent and at other times flare up, and their danger increases for days and then slowly diminishes. The same is the case with those suffering from hemorrhoids; sometimes [the hemorrhoids] flare up, become swollen, and [are] very painful, and it becomes impossible to relieve nature because of the narrowness of the passages due to the swelling. Sometimes part of [the hemorrhoids] protrudes and swells on the outside and becomes very painful and is followed by fever and distress.

(2) The first thing that one should [do] is rapidly let blood from the basilic vein, if the strength [of the patient] can tolerate this. To bleed from the vein in the inner side of the knee is the most beneficial thing that exists. If the strength [of the patient] does not support this because of his age or the season [of the year] or [because of] any other obstacle that prevents bleeding, one should apply cupping glasses between the hips. After the evacuation, one should administer a thinning diet, consisting of thinning foods such as young chicken soup with mallow, or spinach, or beet, or safflower and sugar.

(3) Thereafter, one should attend to alleviating the pain by means of topical remedies, which should be inserted as a suppository or put as a liniment on the protruding part of the hemorrhoids, and by means of sitting in waters that alleviate the pain and reduce the swelling. This includes sitting in hot waters in which marshmallow leaves or marshmallow roots, or melilot, or peeled lentils, or chamomile, or aneth, or linseed have been cooked. Each of these should be cooked—[on its own], or all together, or [only] those that can be easily found—until the power of the remedies emerges in the water; and one should sit therein while it is warm and not leave until one feels it turning cold. Then one should get out of it and heat it again. As for those things that are applied as a liniment or [are used] to sit upon so that the pain becomes less and the swelling is reduced, the first of these is ‘asīda,² made from fine white flour with sesame oil and duck or chicken fat. If one adds some saffron to it, it has an [even] stronger alleviating effect.

Translated by Gerrit Bos.

Notes

Words in brackets appear in the original translation.

I.e., they do not have to be treated.

[ . . . ] Wheat-flour moistened and stirred about with clarified butter, and cooked. [ . . . ]

Credits

Moses Maimonides, from On Hemorrhoids, ed. and trans. Gerrit Bos (Provo, Utah: Brigham Young University Press, 2012), 1–2, 8–10, 21–23. Used with permission of the publisher.

Published in: The Posen Library of Jewish Culture and Civilization, vol. 3: Encountering Christianity and Islam.