109 FC 135.
110 Enumeration of the decrees used here is taken from Somerville’s edition of the canons of Clermont: R. Somerville (ed.), Decreta Claromontensia, Amsterdam: Hakkert, 1972, p. 94. While Somerville used the Stubbs and Le Prevost editions for Orderic and William, respectively, the Oxford Medieval Text Series editions, not then available to Somerville, will be used here. The manuscripts are as follows: C – Cambridge, University Library Kk. 4.6; L – London, British Museum Harleian 633; P – Paris, Bibliotheque nationale lat. 134413.
111 FC 133; RM 727.
112 RM 727–8; BD 12–15.
113 RM 727; BD 12–13.
114 Hagenmeyer, Epistulae et Chartae, pp. 136–7.
115 PL 151, Cols. 316a, 354c, 516a, 537a.
116 FC 124–5. For usage by reform papacy see PL 143, Cols. 779c, 835b, 1065a, 1197c–d, 1198d–1199a, 1199b–1200c, 1201d–1203a, 1207a–1208b, 1211a–1212a; PL 144, Col. 669b; PL 145, Col. 327c; PL 146, Col. 1364d; PL 148, Cols. 364a, 432a.
117 FC 126. For usage by the reform papacy, see PL 143, Cols. 622b, 1033b, 1035d, 1209d; PL 148, Col. 759b.
118 FC 125. For usage by the reform papacy see, PL 143, Col. 935c; PL 144, Col. 221a.
119 I.S. Robinson, ‘Reform and the Church 1073–1122’, in D.E. Luscombe and Jonathan Riley-Smith (eds), The New Cambridge Medieval History c.1024–c.1198, Volume 1, Cambridge: Cambridge University Press, 2004, pp. 268–334, at p. 268.
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120 Peter Damian, Various Writings, PL 145, Col. 179; FC 126: ‘ceterum vos ipsos prius corrigite, ut inreprehensibiliter subditos vestros queatis emendare’. For reform papacy use of the term ‘ corrigere’, with regards to vice and abuses in the Church, see PL 143, Cols. 696, 1150, 1348; PL 144, Col. 216; PL 146, Col. 1329; PL 148, Col. 296.
121 FC 129: ‘quapropter treviam, sic vulgariter dictam, iam dudum a sanctis patribus determinatam, reformari oportet’.
122 RA 238.
123 Hagenmeyer, Epistulae et Chartae, pp. 136–7: ‘ad liberationem Orientalium ecclesiarum’.
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O R I E N TA L A N D O C C I D E N TA L
M E D I C I N E I N T H E
C R U S A D E R S TAT E S 1
Susan B. Edgington
The epic poem about the capture of Jerusalem in 1099, the Chanson de Jérusalem, recounts an episode when Peter the Hermit was captured and maltreated by enemy guards. He was brought into the sultan’s presence and asked to account for himself:
As Peter finished speaking,
he fainted away in the middle of the tent.
Seeing him in this state, the emir summoned Lucion,
the most learned doctor anyone had ever seen.
‘Make up a potion straight away,’ said the Sultan.
‘Cure this Frank for me and be quick about it!’
Unlocking a chest, [Lucion] pulled out some marabiton,
a most holy herb prepared by the skill of the Simeon
who rescued the seven sages when they were put in prison.
Forcing the medicine past Peter’s jaws,
he treated the wound which was gaping so wide that the lung was visible.
Peter immediately bounced up in better shape than a sparrowhawk or a falcon.2
I quote this impressive cure not because it happened in reality, but because it clearly shows the esteem in which ‘Saracen medicine’ was held in thirteenth-century France, where the poem was composed.3 Oriental physicians were thought to be very learned and to have access to drugs that were magical in their potency. In this chapter I shall investigate whether this perceived gulf in knowledge really existed, and examine the interaction between oriental and occidental medicine in the crusader states.
Before proceeding it is necessary to make the point that Saracens and Christians shared the same conceptual framework for medical science, which they inherited from the classical world. This system, usually attributed to Hippocrates, had been 189
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elaborated in a corpus of writings in the period BCE.4 It was believed that the health of the body depended on maintaining the balance of the four humours, or liquids, of which it was composed: blood, yellow bile, black bile and phlegm. Each humour was associated with a season of the year (spring, summer, autumn, winter), and –
importantly – each had two ‘qualities’. Thus, blood was moist and hot; yellow bile hot and dry; black bile dry and cold; and phlegm cold and moist. If one of the humours predominated in a person’s body, then his health was compromised and he or his physician would seek to redress the balance. The first way of doing this was by adjusting the patient’s regimen, or lifestyle. There were six subdivisions of regimen: the air around us; movement and rest; eating and drinking; sleeping and waking; excretion and retention; and the soul’s moods.5 Thus a person suffering from an excess of yellow bile would be encouraged to eat and drink substances that were classed as cold and moist, and perhaps to sleep on an airy balcony. A patient with an excess of phlegm would be given ‘hot, dry’ foods and encouraged to sit by the fire. This was physic, or internal medicine, and by the end of the eleventh century it had been practised by ‘physicians’ for some fifteen hundred years. It was rational and required some book-learning. It was also relatively non-aggressive.
More interventionist strategies for treatment included drugs, which could be vegetable, animal or mineral in origin, and which were administered by the apothecary, often under instruction from the physician. Third in the hierarchy of treatments was surgery, such as bloodletting or administering an enema to remove the superfluous humour physically. It is important to realise that in the period under discussion this was not the treatment of first choice: only in later times did copious bloodletting become routine, and the medic’s first resort rather than the last.
Three categories of practitioner might be involved in orthodox medical treatment, therefore: the physician, who was the only one entitled to be called
‘doctor’, since that referred to his education; the druggist or apothecary, a tradesman who might act under the physician’s orders, or be consulted by members of the public independently; and the surgeon, who was called upon to carry out manual treatments (the origins of his name) but frequently made his living as a barber and occasional dentist and/or lancer of boils. When a western source uses ‘ medicus’, ‘ mire’ or ‘ miège’, one should be aware that it could refer to any of these practitioners. In the Chanson de Jérusalem extract, Lucion is described as a ‘ mire’, but he is (a) learned (like a physician), (b) uses drugs to cure (like an apothecary), and (c) is dealing with a wound (normally the province of the surgeon). The distinctions which existed in later times were only beginning to be drawn in the twelfth century, and even later were often blurred or crossed. In particular, this is the period during which the university was emerging in Western Europe, standardising medical education to the point that by, say, 1400, only a university-educated practitioner could call himself a physician, or ‘doctor of physic’, like the one in Chaucer’s prologue to The Canterbury Tales.6 The term
‘medic’ will be used in this chapter, unless it is certain that another should be preferred.
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Although the same Hippocratic legacy underlay medical theory and practice in all of Europe and the Mediterranean world, its transmission and reception had been different in Greek Christendom, in Latin Christendom and in Islam. While the Byzantine world centred on Constantinople preserved important elements of Greek and Roman medicine, Western Europe had only patchy survival of classical learning, usually preserved by the Church, which had a virtual monopoly of literacy.7 In the Islamic lands, however, literacy was much more highly valued and widespread, and from the eighth century CE the Abbasid dynasty were patrons of an active and prolific translation movement from Greek (often via Syriac) into Arabic.8 Some of the medical texts were re
translated into Latin, first in southern Italy at the great monastery of Monte Cassino and the linked site at Salerno, and then in Spain. This retranslation was going on at the same time as the crusades to the Holy Land: for example, Constantine the African, who translated Al-Majusi’s Complete Book of the Medical Art at Salerno, arrived there in 1077 and died by 1099; and Gerard of Cremona went to Toledo to learn Arabic and there translated works by Ibn Sina and al-Razi, before dying in 1187.9 This synchronicity greatly complicates an examination of the interface between Christian and Islamic medicine in the Holy Land.
In 1971 Ann F. Woodings tackled this complexity in a seminal article.10
Acknowledging the importance of the ‘two points [in Europe] where Moslems and Christians met, the kingdoms of Sicily and Spain’, she sought to investigate the crusades and ‘to discover what benefit, if any, the Franks derived from this direct confrontation with more advanced Moslem medical science’.11 The assumption underlying the latter quotation inhibited a fully critical approach to the evidence, which was anyway limited almost entirely to sources available in English translation.12 More recent investigations, particularly by Beni Kedar and Emilie Savage-Smith, have added enormously to the body of evidence from Arabic sources, I and others have expanded the range of western sources, and Piers Mitchell has contributed his knowledge of archaeology and palaeopathology and as a practising doctor.13 This chapter presents an overview of this more recent research.
Medics on crusade
The eyewitness accounts of the First Crusade have little to say about medical matters in the army on the march, or during the earliest period of settlement, times at which it might be expected that the Latins were relying on medical expertise brought with them from Western Europe.14 The surviving letters sent by participants are unhelpful, as is the anonymous Gesta Francorum. Raymond of Aguilers is apt to ascribe both illness and cure to divine intervention. Fulcher of Chartres, whose testimony should be invaluable, does include a chapter on native cures encountered by the settlers, including a medicine made of bedbugs and the use of snake poison as an antidote, but his information appears to derive not from experience, but from Solinus, and thus ultimately from Pliny.
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Contemporaries writing at a distance do mention doctors and surgeons, but of course their testimony has to be treated with some caution. Thus Robert the Monk describes the ministrations of doctors after the Battle of Dorylaeum, but whether it is an invented depiction, or based on evidence not in the Gesta Francorum, cannot be known.15 An episode when Godfrey of Bouillon was injured while fighting a bear is reported independently by Albert of Aachen and Guibert of Nogent.16 It took place in northern Syria in the summer of 1097: Godfrey responded to cries from a poor pilgrim who was being attacked, and in the ensuing rescue he managed to slash his own thigh with his sword. The flow of blood from the wound was ‘unstaunchable’,17 though (since he survived) he had probably damaged the femoral vein rather than the artery. He collapsed, and was carried on a litter to the crusaders’ camp, where his distressed peers summoned ‘the most skilled doctors to heal him’.18 Godfrey recovered and went on to become the first Latin ruler of Jerusalem, but it is clear both from Albert’s account and from Guibert of Nogent that he was seriously ill for some weeks: Guibert claims he had to be carried on a litter until after the siege of Antioch.19
Nevertheless, he did recover, perhaps aided by the skilled medics. Without attach-ing undue weight to a source written hundreds of miles from the action, it is reasonable to argue that Albert was well informed about the personnel in Godfrey’s army and that it included medical staff. If other, more closely involved writers did not mention them, it was because their presence was routine and unremarkable.
Albert referred to the attendants as ‘ medici ’, the general term. When William of Tyre, writing two generations later and almost certainly using Albert’s account, reported the same incident, he used the more specialist word ‘ cirurgici ’ (surgeons).20 If indeed medics were travelling with Godfrey’s army, then it is likely that they were surgeons rather than physicians. As outlined above, surgeons were essentially artisans, who dealt with wounds, fractures, skin complaints and anything else that manifested itself externally and visibly on the body. In civilian life, and probably in the army too, they often subsisted day to day as barbers, and could also be called upon to pull teeth, let blood, or carry out any minor operation that required a sharp blade. Physicians, on the other hand, had some education, and they practised humoral medicine: pre-eminently they aimed to keep their patrons healthy; failing that, they specialised in internal medicine, considering themselves socially superior to the surgeons, who were manual workers. If there were specialist physicians in the crusading armies of 1096–1100, then it is likely that they were attached to the households of the leaders. Godfrey, therefore, may well have been attended by surgeons working under the supervision of physicians. The only other scraps of evidence for medics going on the First Crusade are the names of two witnesses to early documents: Lambert, a ‘ medicus’ and Genoese, witnessed a charter in 1098; and Geffroi, a ‘ medicus ’ from Nantes, witnessed the will of Count Herbert of Thouars at Jaffa in 1102.21
Evidence for medics accompanying later crusades is equally sparse.22 It is possible that Gilbertus Anglicus went on the Third Crusade with Hubert Walter, 192
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and he claimed to have successfully treated Bertram, son of Hugh of Gibelet, for an eye condition when local Syrian doctors had failed to help him.23 Ralph Besace was a physician to Richard I on the crusade, and witnessed Saladin’s execution of noble captives.24 On the same expedition was John of St Albans, a physician who treated Philip Augustus of France for ‘a double tertian fever’.25 Two English medics, Roger and Thomas, are documented as participating in the Fifth Crusade, 1218–21; and there were two physicians, John of Brideport and Robert of Murisien, as well as a surgeon, Hugh Sauvage, on Prince Edward’s expedition of 1270.26 An eminent Italian surgeon, Hugh of Lucca, went with Bolognese troops to Egypt as part of the Fifth Crusade, along with another Luccan medic, Robert.27
The most intriguing reference is to a female medic (she is called ‘ magistre’ and
‘ physica’). Hersent went with the crusade of St Louis to Egypt, 1248–50. The evidence for this includes a promise of a pension of twelve Parisian deniers a day, dated at Acre, August 1250. Hersent was evidently highly valued, and she was employed directly by the royal household, but it goes beyond the evidence to suggest that she was university educated and Louis’s personal physician.28 Louis’s queen had given birth to a son in Damietta in the spring of 1250, and it is likely that Hersent’s primary responsibility was as royal midwife.29 She returned to Paris at the end of 1250 and married an apothecary. Hersent is a reminder that alongside the acknowledged medics, the crusading armies would have contained numbers of empirics, and some of these were undoubtedly women – midwives, wise women and others. It used to be thought that another ‘female physician’, Laurette de Saint-Valery, was present on the Third and Fourth Crusades, but this has been comprehensively disproved.30
The real challenge to medicine during the crusading campaigns was epidemic disease. However, since there could be no concept of germ theory or real understanding of the transmission of disease, prevention and treatment were not generally seen as medical problems. For example, when pestilence first appeared during the siege of Antioch (1097–8) the leaders thought that the ‘devastating mortality’ had arisen among the people because of their ‘great number of sins’.31
Therefore, they forbade sinful behaviour and imposed penances. They were forced to consider other causes when a second, even more devastating epidemic struck: according to Albert of Aachen, it lasted for six months and killed over 100,000
people.32 Godfrey left Antioch for Edessa because he recognised this as the same disease that had afflicted Rome in 1083, and the two epidemics were linked
by the ‘plague-bearing month of August’.33 This was repeated later, in reference to the same epidemic, but ‘the unhealthiness of the place’ was also offered by some as a cause.34 This is a thoroughly orthodox explanation, informed by Hippocrates’
influential tract On Airs, Waters, Places.35 Various writers associated the disease with the famine that preceded it: Ralph of Caen suggested the crusaders were poisoned because they were driven by hunger to eat unfamiliar plants.36 William of Tyre put it thus: ‘Others believe that when the people, so long victims of cruel hunger, finally obtained an abundance of food, they were overeager to eat in order to make up for their privations. Thus their unrestrained gluttony was the cause of 193
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their death.’37 William’s moralistic tone seems to us unwarranted, but harks back to sin as the cause of corruption. The other cause he put forward is surprising and prescient: ‘Some say that it arose from seeds of disease that were latent in the air.’38
The more common concept of airborne disease was miasma, or corruption of the air: Guibert of Nogent, describing an earlier outbreak of disease in Apulia, gave the possible causes as the unaccustomed heat, corruption of the air, and unfamiliar food.39 Ekkehard, writing of an epidemic in 1100, similarly blamed the heat and the stink of corpses corrupting the air, but also said some thought that the water had been poisoned.40 A further explanation is found in Baldric of Dol: Let us rest quietly while our sick and wounded recuperate, and mean-while let us relieve the poor among us. Let us wait for the autumn rains and avoid the harmful influences of the Crab and the Lion. In November the temperature will fall; then let us assemble and set out again together along the chosen road. Otherwise all our people will be prostrated with the untimely heat.41
The reference to the astrological signs of Cancer and Leo was not pure super-stition, as it would be viewed now, but grounded in the natural philosophy (the science) of the period.
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