- Medicine in the Crusades: Warfare, Wounds, and the Medieval Surgeon
No historian of early medicine can perfectly recapture the clinical reality of his/her subject. There are few patient letters or doctors' casebooks dating from earlier than 1500 to examine. Scholars have had to construct a one-sided picture of medicine from textbooks of the period, which offer an idealized account that cannot be compared with actual experience. Mitchell has tried to find a way out of that dilemma in this account of health practitioners and institutions in the Latin East from 1095 to 1291, and of the wounds and other traumas that they treated (a second volume on nutrition and disease is promised). Being not just a historian but also a surgeon and a paleopathologist, he has juxtaposed texts with archaeological evidence (for example, the excavation of the Hospital of St. John in Jerusalem) and with paleopathological materials (skeletal remains) in a way that brings readers closer to the actualities of health and injury. [End Page 259]
Mitchell's is a useful effort, but it cannot completely respond to the historian's difficulty. Because the study of bony remains is still relatively new, it can only play a minor part in the analysis, by exemplifying the consequences of the battles described in the sources. Nor can archaeological evidence easily be interpreted in the absence of texts: Mitchell's fascinating account of the remarkably sophisticated Jerusalem hospital depends more on a recently discovered description of its functioning in the 1180s than it does on the physical ground plan that has been established. Written evidence must still be the starting point for the medicine of the crusading kingdom, and the great majority of sources from the Latin east in the twelfth and thirteenth centuries are historical and legal, not social or intellectual. They offer accounts of battles, of people wounded in different ways or killed by a variety of weapons (Mitchell interprets shrewdly what must have happened to them, illustrating his analyses with pictures of distinctively perforated skulls or the remains of a twelfth-century mace), but they say nothing about treatment.
What a crusading surgeon actually did for his patients has to be inferred from textbooks of the period, and Mitchell has chosen to depend on the Surgery of Teodorico Borgognoni, a textbook written in Bologna in the 1260s that represents the new literate European surgery that arose late in the life of the kingdom. Is this work really the best index to how Crusader surgeons would have practiced? As Mitchell recognizes, texts that offer testimony to surgical technique have survived from the kingdom itself. The Liber regalis that was translated into Latin in Christian Antioch (1127) includes an extensive section on surgery; 100 years later the Compendium medicine of Gilbertus Anglicus, which purports to reveal the author's earlier medical activity in Syria, also deals thoroughly with surgical topics. Either would have been a more direct witness to probable Crusading practice than Teodorico, and, taken together, they might have revealed changes—or stability—in the surgery of the kingdom of Jerusalem.
Given the importance of written sources, Mitchell might have extracted more from them in the light of European developments. The 200-year life of the kingdom of Jerusalem in Palestine and Syria was a period of enormous changes in European life, thought, and institutions and those changes were reflected in Crusader society. Mitchell is fully alert to institutional evolution in his world, pointing out, for example, that although leprosaria were founded outside city walls in the twelfth century, by the thirteenth century they were being brought inside. But changes affected medicine more broadly. Europe saw a growing belief in medical learning and an enhanced status for the field after 1200, crystallizing around the new medical faculties apparent at Paris and Montpellier and leading in the thirteenth century to a more consistent distinction between medicine and surgery. Appealing to this pattern of development might have helped Mitchell explain his inability to identify many practitioners in the...