Medicine in the Crusades: Warfare, Wounds and the Medieval Surgeon (review)

Piers D. Mitchell brings together expertise as a surgeon, osteo-archeologist, and historian to produce the first history of Western medical practice within the Levantine crusader states of the twelfth and thirteenth centuries. Although the author envisions future volumes on infectious disease, epidemics, and the interplay between religion and medicine, the current volume sets the scene and discusses the prevalence of trauma and surgery within Crusader society. The medical milieu is sketched with chapters on the medical community, hospitals, the sources of medical knowledge, and legislation touching issues of licensure and malpractice. On the clinical side, there are chapters on the location and treatment of traumatic injuries, the use of torture and judicial mutilation, and the practice of elective surgery, anesthesia, and bloodletting.

Mitchell argues that the Frankish medical community in the East was larger and better trained than once thought. Many who served the elite were university-educated clerics. Using later data from Cyprus, he estimates that within the medical community 10 percent were physicians, 14 percent surgeons, 25 percent apothecaries, 35 percent barbers, and the rest nonspecified. Though he discovers few Muslim physicians in practice, he notes the presence of Jewish and especially Orthodox Christian medici. Crusader hospitals, he finds, began as European-style shelters and only evolved into medical establishments during the twelfth century as the result of contact with Muslim and Byzantine models and the need to care for wounded soldiers and ailing pilgrims. These sections and the discussion of the role played by the military orders summarize conventional evidence but include the useful description of the Hospital of St. John in Jerusalem and a reconstruction of inmate capacities for this and other institutions.

The most innovative feature of the study is the effort to assess the character and impact of casualties on the Crusade movement. Overall, Mitchell believes that between 25 and 40 percent of aristocratic participants in an expedition of two or three years' duration died, half from wounds and half from disease and malnutrition. Parallel rates for clerical participants were lower, but rates were higher for those who fought on foot. The particular focus of this work is the trauma caused by particular types of weapons—evidently the lance was the most dangerous—and the treatments that ensued. Mitchell discusses injuries caused by blades, arrows, and lances, as well as crushing injuries and blows to the head. He also takes up traumas that were deliberately inflicted on prisoners and malefactors through torture or judicial mutilation. In addition, he describes the role of opiates as anesthesia; surgery for nontraumatic conditions, such as hernias and cataracts; and the role that bloodletting played in the treatment and prevention of disease.

Mitchell dissents from the consensus that gives priority of place to Spain and Sicily as nodes for the transfer of medical knowledge from East to West. Though he admits that actual translations of texts from Arabic or Greek into Latin, which are attested at Antioch and Tripoli, were modest in number, he believes that much practical knowledge was transferred at the clinical level from Oriental to Occidental practitioners. To buttress this point, he argues that Frankish medical practice as well as Crusader legislation, which regulated medical licensing and malpractice, followed Oriental more than European models. Consequently, he believes that the Crusader states played an important role in disseminating new knowledge and practice to the West, including the introduction of medical practice into hospitals. Finally, Mitchell dismisses as unsubstantiated and unfounded the conventional assertion that Eastern physicians practiced medicine at a higher level than did Western doctors, arguing that there is no concrete evidence that Frankish outcomes were better or worse than those achieved by their Orthodox, Jewish, or Muslim colleagues.

One may quibble about Mitchell's use of the abbreviated APA style for citation or clinical descriptions that leave the nonspecialist at sea. Certainly, some of the conclusions are highly speculative because, as the author readily admits, the evidence is spotty and much remains to...