This is the first comprehensive monograph on medicine in the Crusades and is brought to us by a practising trauma and orthopaedic surgeon, osteoarchaeologist and historian of medicine. It is certainly Piers D. Mitchell's rare combination of talents that has allowed him to make such an invaluable and wide ranging contribution to the histories of both the Crusades and medieval medicine. This book focuses on weapon injuries and surgery in the Frankish states in the chapters on archaeological evidence for trauma and surgery, torture and mutilation, injuries and their treatment and elective surgery. These four central themes are framed by equally fascinating chapters designed with a broader intent in mind; the book opens by surveying the available evidence for medical practitioners and hospitals in the Crusader states, offering comparisons with contemporary Western European, Islamic and Byzantine practice, and ends with two chapters on the exchange of medical knowledge and Frankish medical legislation (with very useful excerpts of the legal material provided in translation by Vivian Nutton). Mitchell is interested both in looking for changes in practice over time and in questioning many conventional assumptions made by historians about medicine during the Crusades. He concludes that the type of medical provision which evolved during the Crusades was highly influential in Western Europe from the thirteenth century onwards, that European practitioners do not seem to have been any more ignorant than their Jacobite, Jewish or Muslim colleagues and that they provided elective and emergency surgical procedures, with analgesia and often with success. He also offers a very useful assessment of the types of injuries prevalent on crusade and the impact of these casualties on the crusading armies, suggesting a mortality rate of between 25 and 40% for nobles taking part in a two to three year expedition, with half these deaths caused by disease and half stemming from injuries inflicted in battle.
Most interestingly, Mitchell convincingly argues that the Crusades must begin to be considered, alongside Sicily and Spain, as, "a portal for the exchange of medical knowledge between cultures." [1] In this suggestion, and in his use of evidence, he weaves together two types of approach to the transfer of knowledge from East to West, one based in the study of the transmission and translation of medical texts (D'Alverny, Burnett, Garcia-Ballester, Jacquart, Kristeller, Savage- Smith and Siraisi amongst others), the other on local studies of practice during the Crusades (including work by Edgington, Kedar and Luttrell). This assertion raises some very interesting implications for the way historians interpret and assess medical knowledge, raising questions about the value of looking beyond the contents of medieval medical texts to practical, empirical, "hands-on" experience as an agent of change. This is by no means a new idea, but one which has often proved difficult to put into practice.
Mitchell has built his picture of the medical landscape in Crusader society by using an impressive range of often little-known sources including archaeological surveys, legal records, chronicle accounts and medical texts. He is consistently conscious of the benefits and weaknesses for the historian of each of these types of source. This makes him careful but not necessarily overly cautious, for example, in his use of the possibilities for retrospective diagnosis offered by archaeological remains. His often speculative approach is mandated by the sometimes patchy evidence provided by his sources; without these educated guesses, the book would be a considerably drier read. If there is one weakness in Mitchell's treatment of his sources, it is that occasionally, in comparing medical writings to less prescriptive evidence, he makes somewhat arbitrary selections from that medical literature. The most obvious case of this is when discussing hospital diet, where he compares crusader hospital regulations to the Regimen of Salerno, a fluidly evolving text difficult to pin down in authorship, dating and content and seemingly aimed for the most part at lay readers looking to maintain their health, not medical practitioners treating the sick or infirm. Perhaps better comparisons could have been drawn with texts which seem to have been more broadly used by practitioners, to set alongside the rather more valid choice of Theodorich Borgognoni's Surgery.[2] However, this seems to me to be a very minor flaw in what is otherwise an excellent and stimulating account.
This is a crucial read for all interested in the Crusades, the Middle Ages and the history of medicine, whatever their academic background. Mitchell has a wonderfully lucid style of writing, and never assumes detailed background knowledge on the part of his readers, instead providing simple but never simplistic information on different types of medieval medical practice and the context of the crusades. The book is full of intriguing characters--who would refuse treatment from two surgeons named Recoverus and Recuperatus for example--and colourful anecdotes which cannot fail to grab the attention.
Mitchell sees this book as the first of a series covering other aspects of Crusade medicine, including disease, malnutrition and the relationship between medicine and religion. Furthermore, his current archaeological projects in the Middle East will inevitably add to the growing evidence for illness and healthcare in the Middle Ages. The potential hinted at throughout the book will, it has to be hoped, encourage further, much-needed research into health in Outremer and the broader interactions between Eastern and Western medieval medicine.
NOTES:
[1] Mitchell, Medicine in the Crusades, 239. [2] See for example: M. Weiss Amer, "The Role of Medieval Physicians in the Diffusion of Culinary Recipes and Cooking Practices," C. Lambert, ed., Du manuscrit a la table: Essais sur la cuisine au Moyen Age et Repertoire des manuscrits medievaux contenant des recettes culinaires (Montreal, 1992), 69-80; B. Laurioux, "La cuisine des medecins a la fin du Moyen Age," Maladies, Medecins et Societes: Approches Historiques pour le Present. Actes du VI Colloque d'Histoire au Present, vol. II (Paris, 1993), 136-148.