Wound Treatment in the Crusader Era

Today guest blogger Fermin Person provides us an expert insight into injuries and their treatment during the crusader era.

A careful look at this medieval manuscript illustration shows a variety of battlefield injuries.

The most common types of injuries in the crusader era were fractures, cuts, puncture wounds, burns and head injuries. Below, is a look at the treatment of these injuries in the crusader era individually:

Fractures

Evidently fractures were quite common during the medieval period in peacetime as well as in wartime. If a long bone of the human body, like the upper arm bone (Humerus) is broken it is important that the broken bone is adjusted in a position so that the bone can heal straight, without forming an angle. To fixate the broken limb in such a position the arm or leg was put into a splint made from several wood sticks or into a plaster made from flour and egg white. Apparently this was considered a simple procedure, since the Laws of the Kingdom of Jerusalem punished the improper use of splints or plaster resulting in the crippling of the patient.

Cuts/Blade injuries

Blade injuries were probably very common during the crusading age.  According to Arabic texts such as Albucasis and its translation into western languages bleeding could be stopped by cauterisation or surgical sutures, however, it was not possible to suture fine structures like blood vessels. Afterwards bandages were applied. In some texts poultices soaked with wine and vinegar are also mentioned. 

In severe wounds or in case of infection, however, an amputation was considered necessary ― but only as a last resort. Albucasis describes a reasonable method. The limb was placed on a wooden block. Ligatures were placed above and under the site of the amputation. Afterwards the soft tissue was cut and the bleeding from the blood vessels was stopped. Thereafter the bone was sawn trough. Finally, the stump was bandaged and left to heal. There is no evidence regarding the length of time needed for amputation.

Spear or bow injuries

Individuals were often hit by several arrows during one engagement. Lances or spears could cause similar wounding patterns. If arrows could not be removed trough their initial point of entry it was recommended to push them through the tissue, completing their way out. 

If the arrow could not be removed immediately, it was possible to wait some days until the swelling around the wound went down.  A further complication resulted from parts of the armour being nailed to the body by the arrow. Afterward the removal of the missile, the wounds were cared for using bandages or poultices.

Burning

Burning was common in medieval warfare, particularly during sieges, and also due to accidents with fire, candles etc.. A source that was exceptional to the Middle East was Greek fire, which could not be extinguished by water, vinegar being needed. Medieval medical texts recommend keeping the wound from drying out by applying  oil, wax, fat or vinegar mixed with other ingredients such as opium or herbs. Additionally, the development of blisters was to be prohibited by applying oil, vinegar or rose oil.

Head injuries

Head injuries were common during medieval warfare. Medieval physicians were aware of seriousness of such wounds, and that many of the victims died. Still an adequate treatment was specified in the legal text of the Kingdom of Jerusalem Livre des Assis de la Cour des Bourgeois.  The phycisian/surgeon had to clean the head wound, search for bone fragments and remove them. From archaeological evidence, such as the skull finding in Jacobs Ford, we know that skull fractures were survived by some individuals.

Excurs: Was there exchange between medieval Arabic and Christian medicine during the crusades? It is not clear to what extent knowledge was transferred between the Islamic world and the Christian west during the crusades in the Holy Land. We do know, however,  there was extensive translation of medical texts in Sicily and Spain. Numerous medical and astrological works (the border between the two areas was in the medieval period fluent) were translated from Arabic into Latin. Several lost Greco-Roman works that had been lost to the West were re-discovered through their translation into Arabic. The actual impact on western medicine of these available translations is, however, difficult to trace or document. Regarding the standards of care there is also little knowledge, no survival rates are reported to compare the different health care standards. There are frequent stories in the literature of the time such as in the autobiography of Usama Ibn Munqidh. But they are often allegoric in nature and do not allow any certain conclusions. According to Edgington (1994), Eastern Roman, Muslim and Western Christian practitioners had a similar standard regarding the practical knowledge of surgery.

Sources

Mitchel, Piers D.  (2007) Medicine during the crusades, Cambridge University press

Tony Hunt (1999) The Medieval Surgery, Boydell & Brewer Inc

Edgington, S. (1994) Medical knowledge of the crusading armies: the evidence of Albert of Aachen and others. In M Barber, The Military Orders: Fighting for the Faith and caring for the Sick, (Aldershot, Ashgate)

Keda, B (1998) A twelfth century description of the Jerusalem Hospital, In H. Nicholson (ed.). The Military Orders. II Welfare and Warfare (Aldershot: Ashgate), pp. 3-26.

Guy de Lusignan Part II: Usurper and Destroyer of a Kingdom

Today I continue with my short biography of Guy de Lusignan:

The Hollywood Guy - Also despicable but largely for the wrong reasons

In early 1185, King Baldwin IV of Jerusalem, the so-called “Leper King” succumbed to his debilitating illness and died. He was succeed by his nephew, a child of eight. Raymond de Tripoli was named regent, and the Count of Edessa was made the boy’s guardian.  The fact that Tripoli was made regent — with the consent of the High Court — and the Count of Edessa, the boy’s great uncle, was made the boy's guardian are both indications of the intensity of the animosity and suspicion the bishops and barons of Jerusalem harbored against Guy de Lusignan by this time. There was, after all, a precedent for a queen reigning for an under-aged son, Melisende had reigned in her own right for her son Baldwin III.

At the death of Baldwin V a little more than a year later, hostility to Guy had not abated. As was usual following the death of a king, the High Court was convened to elect the next monarch. Some modern historians have made much of the fact that Tripoli summoned the High Court to Nablus rather than convening in Jerusalem itself. This is interpreted as a sign of disloyalty, but there is nothing inherently disloyal about meeting in another city of the kingdom. High Courts also met in Acre and Tyre at various times.  Nablus was part of the royal domain, comparatively close to Jerusalem, and the Templars under their new Master, Gerard de Ridefort (surely the worst Master the Templars ever had), were said to have taken control of the gates and streets of Jerusalem. The Templars did not have a seat in the High Court, but they controlled 300 knights and the decision to hold the High Court in Nablus can better be explained as the legitimate desire to avoid Templar pressure than as disloyalty on the part of Tripoli.

In any case, while the bulk of the High Court was meeting in Nablus, Sibylla persuaded the Patriarch to crown her queen in the Church of the Holy Sepulcher.  In addition to the Patriarch (allegedly another former lover of her mother) and the Templars (whose Grand Master had a personal feud with Tripoli), Sibylla was supported by her uncle Joscelyn Count of Edessa and the colorful and controversial Reynald de Chatillon, Lord of Oultrejourdan by right of his wife.  We know of no other supporters by name, but we know that Reynald de Chatillon sought to increase Sibylla’s support by saying she would be queen in her own right without mentioning Guy.  Even Bernard Hamilton, one of Guy’s modern apologists, admits that: "Benjamin Kedar has rightly drawn attention to sources independent of the Eracles [e.g. Ernoul] and derived from informants on the whole favorable to Guy de Lusignan, which relate that Sibyl's supporters in 1186 required her to divorce Guy before they would agree to recognize her as queen.” (The Leper King and His Heirs, Cambridge University Press, 2000 p. 218). 

According to these sources, Sibylla promised to divorce Guy and choose another man for her husband as her consort. Instead, once she was crowned, she chose Guy as her consort — and crowned him herself when the Patriarch refused.  Once again, Sibylla had chosen Guy over not only the wishes of her subjects but in violation of an oath/promise she had made to her supporters (not her enemies, note, to her supporters).

 The Church of the Holy Sepulcher where Sibylla was Crowned

With this dual coronation, Sibylla and Guy had usurped the throne of Jerusalem, but without the Consent of the High Court they were just that — usurpers.  The High Court (or rather those members of it meeting at Nablus) was so outraged that, despite the acute risk posed by Salah-ad-Din, they considered electing and crowning Sibylla’s half-sister Isabella. To risk civil war when the country was effectively surrounded by a powerful and united enemy is almost incomprehensible — and highlights just how desperate the opposition to Guy de Lusignan was. In retrospect, it seems like madness that men would even consider fighting their fellow Christians when the forces of Islam were so powerful, threatening and well-led.

Then again, with the benefit of hind-sight, maybe it would have been better to depose of Guy de Lusignan before he could lead the country to utter ruin at Hattin?

In the event, Humphrey de Toron, Isabella’s young husband, didn’t have the backbone to confront Guy de Lusignan. In the dark of night he fled Nablus to go to Jerusalem in secret and pay homage to Guy. With this act, the High Court lost their alternative monarch and capitulated — except for Ramla and Tripoli, the most inveterate opponents of Lusignan.  Ramla preferred to quit the kingdom altogether, turning over his lucrative lordships to his younger brother and seeking his fortune in Antioch. (He disappears from history and we don’t know where or when he died.) Tripoli simply refused to recognize Guy as his king and made a separate peace with Salah-ad-Din — until he was reconciled after a tragic incident in May 1187.

Two months later, Guy de Lusignan proved that Ramla, Tripoli and the majority of the High Court had rightly assessed his character, capabilities and suitability to rule. Guy led the Christian kingdom to an unnecessary but devastating defeat which resulted in the loss of the holiest city in Christendom, Jerusalem, and indeed the entire kingdom save the city of Tyre. Only a new crusade would restore a fragment of the Kingdom and enable Christendom to hang on to the coastline for another century.

With all due respect to revisionism and the legitimate right of historians to question familiar and popular interpretations of events, it is also wise to remember that chronicles and other historical documents provide us with an imperfect and incomplete picture.  The actions and judgment of contemporaries, on the other hand, were based on much more comprehensive knowledge and information than we have available to us today. Based on the actions of Guy de Lusignan’s contemporaries, I believe the Ernoul’s portrayal of Guy de Lusignan is closer to the mark than the apologist image of modern historians.

Guy is a major character in both "Defender of Jerusalem" and "Envoy of Jerusalem." 

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Guy de Lusignan: Part I – A Parvenu Adventurer

Guy de Lusignan in Ridley Scott's Film "The Kingdom of Heaven"

Guy de Lusignan has the distinction of being the man who lost the Kingdom of Jerusalem by leading the Christian army to an unnecessary but utterly devastating defeat at the Battle of Hattin in 1187.  Such noted modern historians such as Malcolm Barber, Bernard Hamilton and W.B. Bartlett argue Lusignan’s disastrous decision to abandon the Springs of Sephoria and march to the relief of the garrison of Tiberius in July 1187 can be explained by the fact that he was criticized for not taking the offense in the campaign of 1183.  Guy, they argue, was in a difficult psychological position and had every reason to doubt the Count of Tripoli’s loyalty. They generally portray Guy more as a victim of circumstances rather than the cause of disaster.  Guy’s contemporaries saw it differently. 

So who has the right of it? In two essays, I will examine Guy de Lusignan’s biography, starting with his years as a parvenu adventurer.

Guy de Lusignan usually enters history books with his marriage to Sibylla of Jerusalem, King Amalric’s first-born child and older sister too King Baldwin IV. But this may be a mistake.

In the spring of 1168, the Earl of Salisbury was escorting Queen Eleanor of England to Poitiers with a small escort when the party was ambushed by “the Lusignans.” The Lusignans had recently been dispossessed of their lands for rebelling against Eleanor, Duchess of Aquitaine. They hoped by capturing Eleanor to gain a bargaining chip for the restoration of their fortunes. The Earl of Salisbury turned over his own horse, which was stronger and faster, to Eleanor so she could escape, but while he was remounting he was fatally pierced from behind by a lance. Salisbury’s nephew William Marshal (later famous as tutor of the Henry the Young King, Earl of Pembroke and Regent of England) was in Salisbury’s entourage.  According to the 13^th century biography of William Marshal, commissioned by his eldest son and based on the accounts of many of Marshal’s contemporaries, this ambush was led by Guy de Lusignan and his brother Geoffrey. Some sources claim that Guy himself wielded the murderous lance.  Allegedly, this act made Guy persona non grata in the courts of the Plantagenets and induced him to seek his fortune in Outremer. Maybe, but there was a gap of some 12 years, so maybe not.

Nevertheless, when considering Guy de Lusignan’s later reputation, it is important to remember that he was accused of a profoundly unchivalrous murder by contemporaries — before he ever set foot in the Kingdom of Jerusalem.

A Blow from Behind -- Here with a Sword

Guy appears to have arrived in Jerusalem in late 1179 or early 1180 at the invitation of his elder brother Aimery. Older brother Aimery was making a career in Jerusalem, according to some, by sleeping with the Queen Mother, Agnes de Courtenay. At the time Guy arrived in the Holy Land, Baldwin IV was king — and clearly dying of leprosy. Since it was also clear that Baldwin IV would not sire heirs of his body, his sister Sibylla was his heir apparent. Sibylla herself was thus a young (20 year old) widow. There were rumors, however, that she had pledged herself to the Baron of Ramla and Mirabel. The rumors were widespread enough for Salah-ad-Din to demand a king’s ransom when Ramla was taken captive on the Litani in 1179 (apparently in anticipation of Ramla becoming King of Jerusalem) — and for the Byzantine Emperor to pay that exorbitant ransom (since Ramla could not possibly pay it from his own resources) in anticipation of the same event.

But suddenly at Easter of 1180, Sibylla married not Ramla (who was on his way back from Constantinople) but the virtually unknown and landless Guy de Lusignan.  The wedding was concluded in a hasty ceremony lacking preparation and pomp. According to the most reliable contemporary source, the Archbishop of Tyre (who was also Chancellor at the time and so an “insider,”) Baldwin rushed his sister into the marriage with the obscure, landless and discredited Guy because the Prince of Antioch, the Count of Tripoli and the Baron of Ramla were planning to depose him and place Ramla on the throne as Sibylla’s consort. 

Allegedly a Depiction of a Royal Wedding in Jerusalem

Perhaps. But there is no other evidence of Tripoli and Antioch's disloyalty. Furthermore, Ramla’s hopes of marrying Sibylla had been known for a long time — and all the way to Damascus and Constantinople. Why did that marriage suddenly seem threatening to Baldwin IV?

Another contemporary source, the now lost chronicle of Ernoul, suggests another reason for the hasty and unsuitable (for there is no way the third son of a Poitevin baron could be considered a suitable match for the heiress of Jerusalem) marriage: that Guy had seduced Sibylla. Aside from the fact that this had happened more than once in history, the greatest evidence for a love match is Sibylla’s steadfast — almost hysterical — attachment to Guy, as we shall see.  Meanwhile, however, the marriage alienated not only the jilted Baron of Ramla, but the Count of Tripoli as well. In short, it was not a very wise political move and thus hard to explain as a political decision.  Last but not least, even the Archbishop of Tyre admits the King soon regretted the decision. All these factors point to Ernoul’s explanation of a seduction, a scandal and an attempt to “put things right” by a King who was devoted to his sister.

Guy was named Count of Jaffa and Ascalon and appears to have been accepted by the Barons of Jerusalem as a fait accompli that could no longer be changed — until, in September 1183, King Baldwin became so ill that he named his brother-in-law Guy regent.  As such, Guy took command of the Christian forces during Salah-ad-Din’s fourth invasion of the Kingdom. What happened next is obscure. Although Saladin managed to burn some monasteries and there were some bitterly fought skirmishes, ultimately the Saracens were forced to withdraw; an apparent Christian victory (and certainly better than what happened four years later, the next time Guy was in command!)

Yet something more must have happened on this campaign because just two months later, when word reached Jerusalem that the vital castle of Kerak was besieged by Saladin, the barons of Jerusalem “unanimously” refused to follow Guy. They flat out refused to come to the relief of an important border fortress in which both royal princesses (Sibylla and Isabella), the Queen Mother and the Dowager Queen were all trapped (because of a wedding) until Guy was stripped of the regency. 

That is an incredibly strong statement.  The fact that the historical record is too patchy to enable us to explain it does not negate the importance of the event. The collective barons of Outremer were not dolts, cowards or fools.  They had accepted Guy’s command two months earlier. Even Tripoli and Ramla, who both detested him, had mustered under Guy’s command to face Salah-ad-Din in September, putting the welfare of the kingdom ahead of their personal feelings. But two months later even men who had previously shown no particular animosity toward Lusignan refused to accept his leadership. King Baldwin had no choice but to take back the reins of government, command of his army and have his nephew crowned as co-king. The latter was to reassure the barons that even if he died in the near term (as he expected), they would not have to pay homage to Guy.

After Kerak had been successfully relieved, Baldwin IV sought desperately to have his sister’s marriage to Guy annulled. This had nothing to do with personal grievances against Guy (although he had those too); it was necessary in order to find a long-term solution to the succession crisis. His nephew was a sickly boy, and the kingdom needed a vigorous and militarily competent leader. Baldwin’s efforts to replace the discredited Guy were thwarted by Sibylla, who refused to consider a divorce — something she is hardly likely to have done, if the marriage had been political in the first place. Sybilla ws successful: Baldwin IV died before his sister’s marriage to Guy was annulled, paving the way for the next step in Guy’s career: the usurpation of the throne.

Guy’s story will be continued next week on Sept. 15.

Guy is a major character in both "Defender of Jerusalem" and "Envoy of Jerusalem." 

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