It is often assumed that the people who practiced medicine in the Middle Ages were ignorant, untrained, guided by “pure superstition” and accountable to no one. In today’s post, the second in a series of guest essays by German scholar Fermin Person, we look at medical practitioners and standards in the Crusader States.
In today’s world, the permission to practice medicine (prescribe medication, operate etc.) is usually closely regulated by the state.
In the west during 11th – 13th century several distinctions were made between the grades of knowledge and practical training a medical practitioner had.
A rather small group were called physicus / fisicien. They had a high degree of knowledge for their time, combining the study of liberal Arts at a university with medical education. The title of physicus/fisicien usually implied the degree of magister because of the received education in liberal Arts. The centres for learning in the Latin west were Salerno, Montpellier, Paris, Bologna, Cambridge, Oxford or Padua. It was at these universities that the physicus/ficicien were trained.
Notably, there are examples of female physicians such as Hersende. Hersende was physician to Louis IX and accompanied him during the crusade to Egypt (1248-50).
The term medicus/ miege /mire was used for all types of doctors during the medieval period. They would take the patients history, examine them and treat them, for example with diet, medication or bloodletting. To some degree they also practiced surgery.
The profession of cyrurgicus (surgeon) was considered a trade rather than a profession. It was learned via an apprenticeship, until the end of the 13th century when it started to be studied on the universities of the Latin west. Cyrurgici were commonly seen as less well educated, were worse paid and had a lower social status than physici. Surgery was seen by medici as a manual trade along the line of carpentry or stone masonry. During the late 13th century cyrurgici with the title of master, indicating their academic education started to appear. Their task was the treatment of wounds as well as the treatment of illnesses that could be seen from the outside (like leprosy or venereal diseases) or might require a surgical treatment.
The profession of berberus /rasorius was likewise a trade learnt via an apprenticeship. Their task was to shave as well as to care for wounds in time of need.
Similarly, the minutor/phlebotomus/sangunator was a specialist tradesman that only did bloodletting. He was also educated during an apprenticeship and would follow the orders of a physician or blood-let on the request of a patient.
The apothecarius/ herbolarius/ spicer prepared medicine according to the orders of a medicus or he could sell the medicine directly to the patients.
Despite the restrictions that were placed on medical education of clergyman during the council of Tours many physicians (physicus/fisicien) were clergyman. Apart from minor restrictions by the fourth Lateran council for subdeacons, deacons and priests, clergyman could practise surgery to the full extant.
The known sources suggest a strong influx of European physicians and surgeons as well as barbers to Outremer. However, there is also documentary evidence for local Christian and Jewish physicians. Furthermore, there seem to have been Muslim physicians as in the hospital of St John in 12th century Jerusalem there were two versions of an oath for newly hired surgeons, supposedly allowing also non-Christians to practise. In addition, a decree of the Frankish church of Nicosia forbade their employment in a church run hospital. Note, however, that we have no comprehensive records of the overall numbers and qualifications of medical practitioners, but are instead dependent on predominantly juridical documents where physicians stood witness for testaments etc.
Medical Standards in the Crusader States
The crusader states seem to have adopted and modified the Muslim system of hisbah.
In the Muslim system of hisbah an official called the muhtasib (in Frankish mahteseb) controlled quality standards of crafts. In the Frankish adoption of the system (found in the commentaries of the legislation of the kingdom of Jerusalem the “Assis de la Cour de Bourgeois” from 1240-44) a council of the best doctors of a town under the provost of the local bishop licensed a physician.
Therefore a thorough examination was conducted by the council of physicians. If a candidate did not show sufficient knowledge he was forbidden to practice medicine.
If he practiced medicine without a license he was beaten out of town. A similar system developed about the same time in the kingdom of Sicily.
Excurs: Medical negligence in the Laws of the Kingdom of Jerusalem
The Assis de la Cour des Bourgeois from 1240-44 is our principal source about medical legislation in the crusading states. It lays out the mechanisms of medical licensing and punishment for medical negligence.
In case of medical negligence, a distinction is made if the victim is a slave or a free man.
Furthermore, a distinction is made if the illness can be realistically healed by a physician (like a bone fracture) or not (like measles).
If a physician crippled or killed a slave because of medical negligence he was bound to pay compensation to the owner.
If a physician killed or crippled a free man because of medical negligence he was submitted to various physical punishments such as the amputation of the right thumb or even hanging.
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.
Medical the Jerusalem Trilogy the comparatively high standard of medical care in the crusader states is recognized.