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

Piers Mitchell is a practicing surgeon who has made himself into a part-time osteoarchaeologist. He has been putting many of the rest of us medievalists to shame with his productivity, enthusiasm, and ability to bring together textual and paleopathological evidence. His first book is also, despite a swelling tide of articles, the first monograph on its subject. It has therefore been widely welcomed by specialists, and indeed by all who share its author's belief that "the crusades could be said to be the most fascinating events of the medieval world" (p. 1). The subtitle of the book is narrower than the title, and we are to understand that this is only a first installment, focusing on surgery after some general preliminaries, to be followed by another volume on doctors, diseases, and religious healing. Even with this understandable restriction of scope, however, the book makes a substantial contribution.

Three related projects are involved. The first is to begin to establish a prosopography of physicians, apothecaries, and the like active in the Crusader states, using charter and narrative evidence in the manner of Jonathan Riley-Smith's revelatory anatomy of the first Crusaders. Mitchell's results will not be so striking, but they lend greater precision than was previously possible to overall judgments about the multiethnic character of the Crusaders' medical world.

The second project is to bring together all the latest findings—surprisingly, more documentary than archaeological—on hospitals and related institutions, not only of the major military orders, but also of some more obscure pious groups. The exclusion here of leprosaria because they were not medicalized imposes an anachronistic distinction on the evidence, and the hospital plans in Adrian J. Boas, Jerusalem in the Time of the Crusades (2001), are rather easier to interpret. But Dr. Mitchell offers the most comprehensive synthesis we now have, with some original observations about patient capacity, and a discussion of the European and Middle Eastern influences on the evolution of Crusader hospitals that is weakened only by some forcing of limited evidence to prove a point about dietary regime.

The third project represented in the book is a trawl of some forty chronicles for evidence of trauma and its treatment that can be related to the paleopathology and the surgical texts of the period. Though the author deploys his own professional experience to very interesting effect, the results, which take up almost half the book, are less satisfactory than the earlier chapters on doctors and hospitals. Perhaps this was inevitable: The chronicles offer only anecdotes, which Mitchell, despite pronouncing methodological caveats, sometimes takes too much out of literary context. The available paleopathology is meager (Mitchell is one of only a handful of pioneers in the study of Crusader sites), and paleopathology gives us, at best, a keyhole view of trauma and disease. On such a fragile base no statistically significant results can be erected. Essentially all that can be said is, first, that the Crusader world was marked by high levels of violence, but also (less obviously) that the evidence presented by Mitchell confirms the impression created by the Assises of the Kingdom of Jerusalem on medical malpractice: quite high levels of successful surgical intervention could be expected in response to that violence.

A brief discussion of the Assises, and of the evidence for centers of medical learning in the Crusader states—at Acre, Antioch, and Tripoli—concludes the volume. Dr Mitchell wants us to entertain the possibility that there was, after all, something in the old idea of the Crusades as decisive for East-West contact and the subsequent cultural and intellectual evolution of Europe. He may be right to do so. But his main achievement in this book is more to have shown that the medical skills brought from West to East belie the image propagated in some still widely quoted Islamic sources that Frankish doctors were quacks and bunglers.