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

This is a stimulating book that casts welcome light onto many practical aspects of the Frankish struggle to hold on to the Holy Land. Mitchell sets out to describe and analyse weapon injuries and their treatment; the development of hospitals; evidence for elective surgery; and medical legislation. As a working surgeon in London he is expertly placed to discuss the medical aspect of the subject. A diligent and generally careful study of a substantial corpus of works including chronicles, legal materials, pilgrims' texts, and medical treatises provide a sound historical basis; integrated with this is an array of archaeological evidence. In sum, the scene is set for a comprehensive study of the subject.

Some aspects of the book are, by design, highly descriptive, yet they represent the first collation of a broad range of evidence. Hence the opening chapter on the identity of different sorts of medical practitioner, ranging from the well-trained and highly paid to the more workaday barber-surgeons, is rather list-like, but does clearly demonstrate the presence of European medical practitioners on the crusades and the likelihood of interaction with the indigenous practitioners of the Levant, be they Frankish, native Christian, Muslim, or Jewish. Chapter 2 challenges the accepted idea that Frankish hospitals were in some ways primitive compared to their Byzantine and Muslim counterparts. As Mitchell indicates, the requirements of many of the patients in the Franks' greatest hospital, that of St John in Jerusalem (which could accommodate up to two thousand people in extremis) were simply rest and care, rather than the more specialised medical treatment offered in the Muslim and Byzantine institutions, hence the comparison is barely valid. By examining the regimen of the Hospital of St John, Mitchell clearly reveals that by c.1180 it had moved away from western European-style practices to create a hybrid form of care formed by a combination of both Muslim and Byzantine influences to meet the needs and circumstances of the Holy Land and its thousands of pilgrim visitors. With ongoing archaeological and scientific work there is a sense that parts of the book, such as the chapter on trauma and surgery, are a progress report. A neat comparison of injuries from military and urban sites considers the variety of wounds caused by different battle injuries and there are also comparisons made to excavations from other well-known European battle sites such as Visby and Towton.

Probably the most important chapter considers the exchange of medical knowledge between east and west. Here, Mitchell confidently and convincingly sets the record straight; the Crusader States were not the cultural desert they are often perceived to be and there is evidence that medical texts were translated from Arabic into Latin, especially in Antioch. More importantly, he shows that—unlike in the West—all doctors in Frankish lands were assessed and licensed and he argues that they were not inferior to contemporary Islamic practitioners. The provision of a strict series of laws against medical negligence in the Assises de Jérusalem (translated by Vivian Nutton) shows the high standard of practical and theoretical knowledge required. Through the crusades, western medics learned more about trauma and thus influenced practical, rather than theoretical, medicine in Europe. Similarly, the transmission of practices at the Hospital in Jerusalem triggered the evolution of hospitals in the West to run along similar lines.

Overall, this is an original and significant book, breaking fresh ground for the history of the crusades and medieval Europe. It successfully demonstrates both the importance of the Crusader States in Latin medical practice and deploys a rich array of evidence to show one aspect of the Frankish settlers' attempts to survive the challenges posed by their Muslim enemies. Mitchell's next book on diseases and medical conditions in the Crusader States is to be warmly anticipated.