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Trauma and Surgery in the Crusades to the Medieval Eastern Mediterranean

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Trauma and Surgery in the Crusades to the Medieval Eastern Mediterranean Trauma and Surgery in the Crusades to the Medieval Eastern Mediterranean by Piers D. Mitchell Wellcome Centre for the History of Medicine at UCL University of London Thesis Submitted for M.D. Degree 2002 The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without the prior written consent of the author. ProQuest Number: U644117 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest U644117 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract When we think of the crusades the first thought that most people have is of the medieval battlefield. This study investigates the evidence for weapon injuries as well as the treatment given to the injured in the Frankish states during the 12th and 13th centuries. A number of named medical practitioners have been identified as having joined one of the crusades from Europe and many indigenous doctors continued to practice once the crusaders arrived. Over sixty individuals are discussed, with origins from France, England, Italy, Hungary, Spain and the Middle East. Hospitals were established as fixed institutions in towns but also mobile field units that accompanied the army. There is detailed information about daily life, disease and treatment in the hospitals of a number of the major military orders such as the Order of St. John and the Order of the Temple. These are compared with hospitals known in neighbouring Islamic and Byzantine regions. The textual evidence for weapon injury and it’s treatment allows an assessment of the proportion of individuals who died from weapon injuries as opposed to malnutrition and infectious disease. Surgery as actually practiced for wounds is presented, from the removal of arrows, suturing of wounds, manipuLating limb fractures, treatment for skull fractures and excision of overgrown fungating tissue from the gums resulting from scurvy. The research presented here employs complimentary historical and archaeological techniques to investigate weapon injuries and their treatment in the crusades and gives a vivid depiction of the appalling conditions experienced by the medieval soldier. Table of Contents Page Introduction Medical Practitioners in the Frankish states 11 Hospitals on the Battlefield and in the Towns 53 Trauma and its Treatment 125 Conclusion 182 Bibliography 187 List of Tables Page Table 1 51 Salary Given by King Louis IX to his Crusading Medical Staff (1250-60). Table 2 115 Foods Forbidden to the Sick in Hospitaller Orders and Medical Texts. Table 3 116 Foods Encouraged to the Sick in Hospitaller Orders and Medical Texts. Introduction The crusades could be said to be the most fascinating of all events that took place in the medieval world. The mass migration in sequential waves of hundreds of thousands of people from Europe to the eastern Mediterranean for such a disparate number of reasons led to a complex and unique society. The armies were not just comprised of trained soldiers but ranged from the nobility to paupers, clergy to criminals, businessmen to con artists (Setton 1955-89; Mayer 1988; Riley-Smith 1991; Riley-Smith 1999a). The First Crusade set out for Jerusalem in 1096 and the invaders established the kingdom of Jerusalem in the south, the county of Tripoli in the centre with the principality of Antioch and county of Edessa in the north. The island of Cyprus was added to these states during the Third Crusade in 1189-92. While the king was based the city of Jerusalem in the twelfth century, after the loss of Frankish territory following the battle of Hattin in 1187 the monarchy moved to the coastal city of Acre. Nearly two hundred years after the initial conquest, the loss of Acre in 1291 effectively signified the end of the mainland Frankish states. The scramble of individuals, military groups and religious organisations for land, power and royal favour with each conquest or defeat would alone make things interesting enough to study. To make the situation even more complex we see the interaction between the crusaders and Frankish settlers with the local Christians, Jews and Muslims who lived under Frankish rule and also relations with the neighbouring Christian kingdoms of Armenia and Byzantium to the north and Muslim territory to the northeast, east and south of the Frankish states. Needless to say this cultural melting pot would be expected to have profound implications upon diseases of all kinds as well as the efforts made by medical practitioners to treat their patients. For the many crusaders who may never have ventured beyond the next village prior to their expedition the journey itself was enough of a challenge (Hamilton 1999). The overland and sea routes could lead to malnutrition, frost bite, drowning and the potential for the spread of communicable conditions from fleas to tuberculosis. An individual with a culture and an immune system developed for cooler northern Europe may have been at considerable risk migrating to the Middle East. Firstly they would encounter new diseases to which they may have little immunity, such as dracunculiasis and schistosomiasis. Furthermore, with their culture developed for a different region may have increased their risk of succumbing to conditions resultant from the different climate, such as heat stroke, food poisoning or famine from crop failure. Medicine and disease in the crusades are topics that have clearly interested historians for many years (Walsh 1919; Ell 1996; Ficarra 1996; Dolev 1996). This interest appears to be increasing as the last decade has seen more than twice as many articles published on this topic than the entire total produced prior to 1990. The work of Susan Edgington, Benjamin Kedar, Tony Luttrell and others have brought refreshing insight to particular aspects of medicine in the Latin East. The sources that provide evidence for this project can broadly be divided into written texts and archaeological excavation. A large number of chronicles were written that described events during the crusades and over forty have provided evidence for this study. Some were written by soldiers or clerics participating on a particular crusade and recorded their journey so they could tell those from their home town on their return what the experience was really like. These often saw events from the perspective of a particular subgroup of the crusade, such as those from a particular region of Europe or those in the entourage of a certain noble. In consequence the version of events tend to favour members of their own group and are more prone to discrediting or gossiping about the activities of other sections of the army. This is especially the case when old rivalries already existed between these groups back in Europe. Many pilgrims travelling in peacetime also wrote of the route they took and noted the highlights along the way. While some were secular, a significant proportion of these accounts were written by clerics, for the use of other clerics. Others who had never been to the Latin East used the works of these eye witnesses to write works themselves, and these ‘second hand’ chronicles have to be interpreted with appropriate caution. Even amongst the eye witness works there was plenty of plagiarism and sections copied from older sources. Sometimes this was because certain areas were unsafe for pilgrims to travel to allow a first hand report, while other sources were copied as they were regarded as infallible (Wilkinson 1988 p.2-3). Some Frankish settlers undertook formal histories of their own kingdom that often covered much longer time periods than the detailed but short term coverage in the texts by the transient Europeans. The indigenous Christian communities that lived in areas covered by the Frankish states continued their own historical traditions and several chronicles in Syriac recorded life under the Franks. The Byzantines to the north were another group that seemed to experience a love-hate relationship with the Franks, sometimes intermarrying and fighting side by side with them and other times fighting against old enemies who also happened to be crusaders. The neighbouring Islamic states to the north, east and south of the Frankish states were all prolific in the recording of historical events and some of this understandably addressed the interaction between themselves and these invaders from Europe, both when at war and in peacetime (Hillenbrand 1999 p.9). Two twelfth century Islamic works are extremely useful for their descriptions of the Frankish kingdoms and are examples of some of the pitfalls in the use of any written source. Ibn Jubayr was a pilgrim from Spain who passed through the kingdom of Jerusalem on his return from Mecca (Ibn Jubayr 1952). While his observations on life in the Latin East are fascinating, he was just as prone as any of us to memory lapses and he was on occasion misled by the erroneous testimony of his guides. Usama ibn Munqidh personally witnessed many battles and events in the era of the crusades. His ‘autobiography’ is not an autobiography in the western sense. where important or representative episodes are collected together to summaries the authors life. It instead belonged to a genre of arable literature known as adab, which aimed to instruct but also amuse and please its readers.
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