Friday, October 28, 2016

Philip II of France in the Holy Land

Seal of Philip II Capet

Philip II Capet of France has gone down in French history as Philip Augustus, another way of saying Philip the Great or Philip the Magnificent. He earned this epithet primarily for wresting territory away from King John of England and restoring the control of the French monarchy over the vast lands in Continental Europe that had been controlled for half a century by John’s father (Henry II) and brother (Richard I). Philip II was able to reduce the English-controlled territories to a small enclave near Bordeaux. Having successfully subdued the most powerful of his insubordinate vassals, he proceeded to systematically re-establish the primacy of the monarchy over all the barons of France. By the end of his reign he had greatly increased the wealth, prestige and power of the central government in Paris, built the Louve, and established the University of Paris. He ruled a total of 43 years, from 1180 to 1223, and was the first king to style himself “King of France” instead of “King of the Franks.”

But most of this occurred well after Philip’s brief sojourn in the Holy Land, and the focus of this post is on Philip Capet at the time of and during the Third Crusade.

Philip had been born in August 1165, or eight years after Richard of England. He had been crowned king in late 1179 while his father yet lived, and became sole king of France at the age of 15 the following year. Almost at once he started fighting with the Count of Flanders over territory, and while this was resolved by treaty in 1185, Philip had meanwhile started making demands on Henry II for the return of his sister’s dowry. (His sister Marguerite was the widow of Henry the Young King, Henry II’s eldest son, who had died in 1183)  This war with the Plantagenets was to last the next thirty years, with periodic truces.

The war between the Capets and Plantagenets was an intimate affair. Eleanor of Aquitaine, Henry II’s queen and mother of Henry the Young King, Richard, Geoffrey and John, had been married to Philip’s father. Philip had two half-sisters, who were Eleanor’s daughters by his father ― and they, of course, were half-sisters of the young Plantagenets also, by their mother. Philip’s sister Marguerite was married to Henry the Young King, making them brothers-in-law. Philip’s other sister Alys was betrothed to Richard. Henry the Young King and his brothers represented their father at Philip’s coronation in 1179, they attended the French court at other times as well. Philip knew the Plantagenets well, and they him.

This medieval illumination is meant to depict Philip II's Coronation. The Figure on the Right Represents Henry II, who was not present. Henry II is also shown wearing three lions/leopards, a device that was not adopted by the English royal house until Richard returned from the Holy Land.
In 1186, Philip succeeded in pulling the third Plantagenet son, Geoffrey, into his net. Geoffrey was preparing to rebel against his father (again), when he was killed in a tournament. Philip allegedly tried to throw himself into the grave from grief. Two years later, Philip lured the eldest of Henry’s surviving sons, Richard into his camp by claiming (almost certainly untruthfully) that Henry did not intend to name Richard his heir. Richard publicly paid homage to Philip as his liege after confronting his father about his inheritance, and then fought at Philip’s side until his father was defeated, humiliated and dead. During this period of alliance, Philip and Richard were said to be so close that they shared a bed, a fact that has given rise to many accusations of homosexuality against Richard but, curiously, not against Philip. 

In any case, everything changed the minute Richard was King of England.  Richard and Philip might have been allies against Henry II, but they were enemies the moment Richard took up his father’s mantle. Richard Plantagenet had no more intention of playing humble vassal to Philip than his father had; he intended to retain control over all his territories. Philip and Richard were thus on a collision course from July 6, 1189 onward.

But on the surface they had a common cause. They had both taken the cross and vowed to recover Jerusalem for Christendom. Richard had been the first prominent nobleman in the West to do so, and his subsequent actions attest to his sincere commitment to restoring Christian rule to the Holy City. Philip on the other hand is widely believed to have been pressured into crusading by his nobles and clergy; his subsequent actions seem to bear this out. Nevertheless, from 1189 to 1190 Philip was engaged in preparing for what would become known as the Third Crusade. 

On July 1, 1190, Philip met up with Richard at Vezelay in Burgundy and travelled together at the head of their respective hosts as far as Lyon, before proceeding by different routes to the next rendezvous: Messina on Sicily. Philip was by now mourning the loss of his wife Isabelle, who had died giving him twin sons, who died shortly afterwards. He therefore arrived in Sicily a widower. Evidently to the disappointment of the spectators ― but very indicative of Philip’s nature ― he made no great show of his arrival. He arrived in a single ship (i.e. ahead of his fleet) and immediately disappeared inside the castle on the harbor.

In Sicily, King William II, a staunch supporter of the crusader cause and brother-in-law to Richard of England, had died unexpectedly in November 1189, shortly before the Kings of France and England arrived. Lacking any direct heirs, the Sicilian throne had been seized by his illegitimate first cousin Tancred, who made the tactical error of placing the Dowager Queen of Sicily (Richard the Lionheart’s sister Joanna Plantagenet) under arrest.

Richard of England, in contrast to Philip, arrived in Sicily with his entire fleet and a with a showy fanfare of trumpets, fluttering banners, banging shields and the like. On landing and learning that his sister had been impressed, he demanded not only her release but the restoration of her dower portion (or compensation) and the full payment of everything William II had pledged to the crusade itself. Tancred capitulated rapidly, and Joanna Plantagenet made an immediate conquest: in Philip of France.

This illustration allegedly shows Richard, Joanna and Philip in Sicily
Accounts suggest that Joanna, who like Philip was just 25 years old, was beautiful (she was Eleanor of Aquitaine’s daughter, after all), and, of course, she was a dowager queen by marriage and a princess by birth. As Richard was already betrothed to his sister Alys, Philip may have seriously considered strengthening the bonds by taking Joanna to wife. Richard absolutely refused to think about this because he had no intention of marrying Philip’s sister Alys Capet.

Meanwhile, however relations between Richard and Philip, already brittle with unspoken rivalry and latent hostility, had broken into the open when fights broke out between the local inhabitants and Richard’s troops. The English claimed they were being cheated, the locals claimed the English were disorderly and disrespectful. There were too many fighting men in a strange town, harassing the girls and probably being pick-pocketed etc. The situation is perennial and resurfaces whenever there are large armies in foreign territory. Something ignited an all-out fight, and while Richard first tried to calm tempers, he soon lost his own and came to the aid of his men. Philip of France, probably out of spite for Richard rather than sympathy for the Sicilians, took the side of the locals against his fellow crusader.  The break was so public and bitter that it took the efforts of many noblemen on both sides to get the two kings to reconcile.

The atmosphere between them deteriorated further when suddenly Eleanor of Aquitaine arrived in the company of Berengaria of Navarre.  Richard  now announced that he had chosen her as his wife instead of Alys. To an astonished and furious Philip, Richard explained that he could not possibly marry Alys because his father had known her carnally. The brilliance of this argument against a marriage that had been agreed years earlier was that this allegation stemmed from none other than Philip himself. Philip had used the accusation in his web of lies to induce Richard to turn against his father. As a result, Philip could do little more than swallow his own pride (and bile no doubt). But a marriage with Joanna was now obviously off the table. The kinship ties so elaborately devised by Philip and Richard’s fathers had all broken, and what remained was open and growing hatred.

But first there was a crusade to carry out, and the Kings of England and France publicly vowed to share all spoils in the upcoming campaign in the Holy Land. Then at the first opportunity Philip embarked his army and set sail for the Holy Land on March 30, 1191.   

Philip’s entire fleet crossed the Mediterranean without notable incident. On May 20, the King of France arrived off the city of Tyre, the last Frankish stronghold in the Kingdom of Jersualem. Tyre was controlled by a distant relative of Philip’s, Conrad de Montferrat, one of the two contenders for the throne of Jerusalem. Philip immediately threw his support behind Montferrat, bolstering his claim to the crown against those of his rival, Guy de Lusignan. He and Conrad together proceeded to the Christian siege of Acre. Here Philip brought not only new troops but new vigor to the siege, at once erecting a number of powerful siege engines.

However, he soon became ill with what the contemporary chronicles call “Arnoldia,” a debilitating illness that caused the loss of hair and nails and could be fatal. Furthermore, with the arrival of King Richard there were two commanders in the same camp and frictions between them sparked almost at once. Allegedly, Richard refused to let his troops support at least one attack ordered by Philip.  But then Richard too fell ill with “Arnoldia.”

Various assaults and above all the action of the siege engines continued as both kings gradually regained their strength. Most significantly, the arrival of the French and English fleet had enabled the sea blockade of Acre to become completely effective and no supplies, munitions or reinforcements were slipping into the city. By early July the Saracen garrison of Acre had reached the breaking point. The commanders of the Saracen garrison therefore sought a truce in which to seek instructions from Saladin. They told the French and English kings that they would surrender if Saladin did not come to their aid within a set period of time, asking to be allowed to take their arms and their moveable valuables with them and enjoy a safe-conduct to wherever they wished to go. King Philip, supported by his nobles, agreed. King Richard insisted they should not be allowed their arms and valuables. Negotiations broke down.

Medieval depiction of the Surrender of Acre -- notably to Philip. Richard is beside him.

Ten days later, with still no relief from Saladin, the garrison again sought terms and this time agreed to much harsher conditions: the return of the Christian relic known as the “True Cross” that had been captured at the battle of Hattin, the release of an unspecified number oChristian prisoners taken at or after Hattin, and the payment of 200,000 Saracen gold pieces, all to be delivered one month after the signing of the agreement. Members of the garrison (the numbers vary according to source) were to be held as hostages to ensure the release of the Christians, the remaining members of the garrison were free to go ― but without their arms or valuables. The kings of France and England accepted these terms.

On July 12, the hostages were surrendered, the remaining garrison marched out ― proudly by all accounts ― and the crusaders took possession of Acre after four years of Saracen occupation. They found the churches desecrated, but otherwise most of the city intact. It was divided equally between the French and English, with Richard’s men notably (and foolishly as it turned out) throwing down the banner of the Duke of Austria because that represented a claim to the spoils and Richard wasn’t sharing with anyone but Philip of France.

But now that Acre was in the hands of the crusaders, the issue of who was the rightful King of Jerusalem came again to the fore. As noted above, Philip backed the claims of Conrad de Montferrat (a kinsman), who was married to the sole remaining legitimate heir, Isabella of Jerusalem, and was supported by the High Court of Jerusalem. Richard, however, stubbornly backed the architect of the disaster at Hattin, King Guy, who was a vassal of the Plantagenet. After much bitter fighting, a compromise was found. Guy was recognized as king for his life-time, but Conrad was recognized as Count of Tyre (to include Sidon and Beirut, if/when these cities were ever recovered) and heir to the throne at Guy’s death. Curiously, however, Guy’s elder brother Geoffrey, who had come out from the West with the crusaders, was also awarded the title of Count of Jaffa and Ascalon, the county that traditionally belonged to the heir of the throne. To be sure Jaffa and Ascalon were at this point in still in Saracen hands, but it was an ominous hint that the Lusignans did not really accept ― and did not intend to respect ― the agreement to make Montferrat king at Guy’s death.

With that dispute at least temporarily out of the way, Philip dropped a bombshell: he announced that he was turning over his share of all the booty to Conrad de Montferrat and intended to return to France. No one, not even his own nobles, had expected or approved of this abandonment of the crusade. His official excuse was “ill-health.” (He had either never fully recovered from the Arnoldia or he had contracted dysentery subsequently.) No one accepted this as a legitimate reason to break-off a crusade. Crusaders were supposed to achieve their objective, or die in the attempt. No one, however, was able to reason with or shame Philip into changing his mind. Despite alleged curses and bitter recriminations, Philip prepared to depart. Richard, suspicious that Philip’s intentions were to attack his lands in his absence, demanded that Philip swear on holy relics that he would leave the Plantagenet territories in peace until Richard’s return.

On August 1, 1191, Philip boarded an galley loaned to him by Richard of England and sailed for Tyre. He took Conrad de Montferrat and the most valuable of the Saracen hostages from the surrender of Acre with him. The exact date of his departure from Tyre is not recorded, but he was no longer in Outremer when the deadline for the delivery of the True Cross, captives and cash payment expired in mid-August. The decision to massacre the hostages fell to Richard of England alone.

Philip was back in Paris by late 1191. He immediately began undermining Richard’s authority and drawing the last and youngest of the Plantagenet brothers, John, into his net. His vow not to attack Richard during his absence was as meaningless as the crusader vow he’d taken before leaving for the Holy Land ― and as meaningless as the marriage vows he exchanged with Ingeborg of Denmark. Philip Capet, great as his legacy was for France, lacked any sense of personal honor, integrity, and a fear of God. While his qualities served his kingdom well, he remains for me a distasteful character.

Philip II of France plays a minor role in Envoy of Jerusalem

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Thursday, October 20, 2016

Hospitals in the Holy Land: Innovations at the Cross-Roads of Civilization

Last month I noted that the crusader states (collectively known as Outremer) had benefited from the hygienic traditions of the civilizations that had preceded them in the Levant, namely the Greeks, Romans, Byzantines, Arabs and Turks.  Another area in which the crusader states benefited from being at the cross-roads of civilizations was with respect to medical care. This was not as simple as having access to Arab medical knowledge, since both Western and Arab medicine of this period was based on false premises. Rather, it was the exposure to medical practices from the Eastern Roman Empire, India, Persia, Arabia, Egypt and the West that gave medicine in the Levant a degree of sophistication and flexibility unknown elsewhere at this time. Before looking at medical practices, however, I want to first consider one of the greatest innovations of Outremer: the hospital.

At the time of the First Crusade, Western Europe did not know hospitals in the sense of places where acutely ill patients received professional medical treatment. There were, of course, infirmaries in monasteries and convents to treat the sick members of the community, but they were not established for the benefit of the general public. Furthermore, the infirmerer and his assistants were first and foremost monks/nuns, not trained doctors/nurses. There were also alms houses for the infirm and aging, hospices for the dying, and various forms of charitable institutions to look after the chronically and incurably ill such as lepers, the blind, and the seriously disabled. In general, however, if the rich got sick, they sent for a physician to treat them in their homes; if the poor got sick they treated themselves or sought the services of a barber or other informally trained medical practitioner.

Another feature of 1th century Western medicine was that all care was centered around religious institutions, and even in those cases where wealthy secular benefactors had taken the initiative to found or endow a house for the poor/sick/aged/blind/leprous etc, care was almost invariably provided by members of the clergy (secular or monastic).  In addition, an important component of the “treatment” was hearing Mass and saying prayers regularly. While men and women patients were separated by a partition or by being housed on separate floors, there was little attempt to separate patients based on type of illness at this time.

Fontfroid Monastery in Southern France
The Byzantine tradition was quite different. Although, as in the West, care of the sick had initially been provided at monasteries, already by the 7th century AD most hospitals were both financially independent and employed paid, professional staff rather than relying on members of a monastic institution to provide the care and treatment of patients. Most Byzantine hospitals were small to modest in size, ranging from ten to a hundred beds, although there were larger hospitals which boasted a large and highly specialized staff. In the most prestigious hospitals in Constantinople, for example, physicians and surgeons (some of these further specialized by the type of operations they predominantly performed such as hernias, appendices, eyes etc.), pharmacists, attendants (nurses), instrument sharpeners, priests, cooks, and latrine cleaners are all listed on the payroll. The administration of these institutions was in the hands of the senior medical staff, and the patients were divided up into wards based on both sex and medical condition. Notably, there is documentary evidence of a small number of female doctors as well as female nurses for the women’s wards. 

Equally important, the medical staff worked in the hospitals for very small salaries, but only for six months of a year; presumably they earned the bulk of their income from private practice in the alternating months in which they did not work in the hospital. This suggests that Byzantine hospitals, although no longer run by the Church, were nevertheless viewed as charitable places accessible to the middle and poorer classes. Furthermore, the most junior doctors earned no salary at all since they were considered apprentices in their craft (the equivalent of modern interns). In the larger hospitals, however, there were libraries and teaching staff, making these the equivalent of modern “teaching hospitals.”

Source: Ahmed Ragab, Harvard Divinity School
In the Muslim world, in contrast, there is no evidence of hospitals until the end of the eighth century. Furthermore, the idea of an institution dedicated to healing the sick appears to have been inspired by contact with the Eastern Roman Empire following the conquest of Syria and the Levant. It soon became a matter of prestige, however, for Muslim rulers to establish and endow hospitals, so that by the twelfth century most major cities in the Middle East boasted at least one and often more hospitals. The staff of these hospitals were all paid medical professionals and they could be drawn from any faith, so that the doctors could be Muslim, Christian or Jewish. Although nursing staff for the women’s wards was female, doctors were invariably male. The famous Adudi hospital in Baghdad (and presumably other hospitals) was also a training institution with library and a staff that wrote medical texts as well.  

The administration of most hospitals in the Muslim world, however, was in the hands of a bureaucrat appointed by the ruler; in short, even in the age of the crusades these hospitals were “public” in the sense of being state-run. The salaries were small, and again the doctors worked only half time (in the Muslim world, half-days rather than alternating months) in the hospital in order to be free to earn “real” money with private patients. (This practice is still common in Egypt today, by the way.) Hospitals in the Muslim world were large, often having several thousand beds. Perhaps because of this, it was also usual to divide patients up based on the diagnosis, so that there were separate wards for the mentally ill, people with fevers, stomach ailments, eye or skin conditions etc. Patients were also segregated by sex, of course. 

Possibly due to the the nomadic past of both Arab and Turkish Muslims, the Muslim world appears to have been very progressive with respect to the establishment of mobile hospitals. These traveled with the Sultan’s armies as early as 942. They also provided care to outlying, rural areas not serviced by the large central hospitals in the urban centers of the Middle East.  

With the establishment of the crusader states in the Levant following the First Crusade, pilgrims from across the Latin West started flooding into the Holy Land on pilgrimage. The journey, whether by land or sea, was arduous and fraught with dangers from pirates and highway robbers to unfamiliar foods, snakes, scorpions and accidents. Many pilgrims arrived in the Holy Land with injuries and/or in poor health. Being far from home, these pilgrims had no families, guilds or other networks of support; they needed assistance. 

Their plight sparked the foundation of one of the most important religious orders of the Middle Ages: the Hospitallers or Knights of St. John. (See separate entry.) But not just the Hospitallers. Pilgrims were coming from across Europe and they spoke different languages; they needed care-takers who could understand them. In consequence, a number of early hospitals were established by monks speaking the same language as the pilgrims, but most of these were later absorbed into the Hospitaller’s network as the Knights of St. John became increasingly wealthy, powerful, and international. 

A few, such as the establishments for lepers and the German hospital established during the siege of Acre in Third Crusade, evolved into independent orders. The leper hospitals were taken over by the Knights of St. Lazarus and German hospital became the Teutonic knights, to mention just two examples. Notably, all hospitals in the crusader states were run by religious/military orders; there were no secular hospitals in the Byzantine and Muslim tradition.

Furthermore, it is fair to say that the medical landscape of Outremer was dominated by the Hospitallers, and it is from this Order that we have the most complete information about care for the sick in the crusader period. The hospitals of the Knights of St. John retained many features of Western medical institutions, but adopted others from Byzantine and Muslim examples. 

Hospitaller Complex, Acre
For example, being a religious order, the Hospitaller retained the Western emphasis on prayer as a means to recovery. The wards were usually situated to enable patients to hear Mass being read in an adjacent chapel or church.  Furthermore, patients were required to confess their sins on admittance to the hospital because it was believed that sin (and God’s displeasure) could cause illness. That said, eye witness accounts report that Muslims and Jews were also treated in the hospitals; we can only presume that they were exempt from confession at admittance.

Breaking with Western tradition, however, the hospitals run by the Knights of St. John employed professionally trained doctors and surgeons at least by the second half of the 12th century. There is at least one case of Jewish doctor being employed and taking the oath required of all doctors on the “Jewish book” rather than the bible. In contrast to both Byzantium and the Muslim world, the doctors of the Order of St. John were well-paid and worked full-time in the hospitals. The attendants or care-givers on the other hand were brothers and sisters of the Order of St. John, i.e. monks and nuns and as such neither salaried nor professionally trained, although they would certainly have rapidly gained extensive on-the-job training. The male care-givers are listed as “sergeants” in the records of the Order. The Rule of the Order of St. John required the nursing staff (male and female) "serve the sick with enthusiasm and devotion as if they were their Lords.”

Following the Muslim more than the Byzantine tradition, the Hospitallers maintained very large establishments in major cities such as Jerusalem, Nablus, and Acre. The Hospital in Jerusalem had more than 2,000 beds, for example, and was divided into eleven wards for men and an unknown number of wards for women. (Our source for this information were male patients reporting on the hospital, who did not have access to the women’s wards.) Patients appear to have been segregated not only by sex but by type of illness, although this may not have been possible at smaller institutions in more provincial towns. The larger hospitals, such as that in Jerusalem, Nablus and Acre, are described as very well appointed by eye witnesses that stressed there was adequate room for beds and for personnel to move between patients, and adequate windows for fresh air and light. Archaeological evidence testifies to the Hospital in Jerusalem’s proximity to a major aqueduct and no less than five large cisterns providing ready water, while a network of drains made it possible to flush out refuse and human waste.

Diet formed an important part of the treatment in Hospitaller establishments, possibly because so many of the patients were pilgrims suffering more from malnutrition than disease. Food poisoning and various forms of dietary problems were likewise common. Furthermore, medieval medicine was based on the premise that illness resulted from an imbalance between the “humors” (e.g. blood, bile). Certain foods, notably lentils, beans and cheese, were completely prohibited in the hospitals of St. John, but white bread, meat, and wine were daily fare. Patients also benefited from the wide variety of fruits available in the Holy Land: pomegranates, figs, grapes, plums, pears and apples are all mentioned.  

The Hospitallers were able to provide such extensive and professional care to large numbers of patients because of the enormous endowments left to them ― often from former patients. Grants were also made in kind, for example, obligating a town or distant estate to provide set quantities of, say, sugar cane (used in medicines), almonds, or linen sheets on an annual or more frequent basis.  

Principal source: Medicine in the Crusades: Warfare, Wounds and the Medieval Surgeon, by Piers D. Mitchell, Cambridge University Press, 2004.

Daily life in the crusader states is depicted as accurately as possible in my "Jerusalem Trilogy."

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