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Friday, June 16, 2017

Hospital Care in the Crusader Era

In his final guest post, Fermin Person talks about hospitals in the crusader era.

A hospital in a modern sense is a place where ill or wounded people go to be treated for their illness. Persons from all social strata use hospitals equally. In the medieval world, this was different.

The medieval Latin word hospitalia or hospite meant a variety of things. It could mean an institution along the basic idea of a modern hospital but it also meant hospice, guest house or hostel. It also could be charitable institution caring for old or poor people. This is largely because it was mostly poor people who needed and made use of these institutions, while wealthier people were cared for and treated at home.

The word domus infirmorum or firmaria meant “house of the sick”, but did not imply the attendance of physician. Usually a monk or a servant cared for the inmates there, although a physician or surgeon could be called on from the outside.

In the crusader states, because so many pilgrims were far from home and unable to avail themselves of “the family doctor,” there were several institutions that cared for the sick and wounded and had, exceptionally, had physicians and surgeons caring for their patient. These were predominantly run by religious orders such as the Order of St John (Hospitalers), the Teutonic order (from about 1200 onward) and by the order of St Thomas of Canterbury from the start of the 13th century on. The orders of St Anthony and of St Lazarus also ran probably institutions for the specific chronic illnesses (Ergotism and Lepra) that were under their focus. The Templars, in contrast, appear to have run infirmaries only for their own members.

The biggest and best researched hospital in the crusading states is the hospital of St John in Jerusalem. According to estimates by Piers Mitchel and by B. Kedar the capacity of the hospital ranged from 400-900 beds under normal circumstances to as many as 2500 under extreme circumstances, for example after battles.

Under normal circumstances the hospital of St John in Jerusalem would house a mixture of exhausted pilgrims, sick, wounded or dying patients. On arrival, the guests had to confess, following that they were clothed by the hospital and fed, segregated by sex. Physicians, surgeon and bloodletters were employed by the hospital and paid a good salary to provide treatment to patients if necessary daily, while sergeants and sisters took care of non-medical needs of the patients.

Patients whose conditions made it dangerous, impossible or unsustainable to keep them with the other guests were separated from them. A classic example for this is diarrhoea or delirium because of a fever. 

Excursus: Medieval western urine-diagnostic
Before the development of modern laboratory medicine there were only few possibilities to diagnose illnesses. One of those was the urine-diagnostics.
It was an obligatory part of the medical treatment by a physician to inspect, smell and taste the urine of the patient.
The smell or taste of urine could indicate metabolic disease of a patient such as diabetes or liver failure.
Similarly, could the colour and the amount of the urine indicate several other diseases.

The guests / patients were given a diet that was seen to be healthy for them, but great emphasis was also placed on the spiritual cleaning of the patients. Prayers and mass were thus a fixed part of the treatment. Other than in big byzantine or Muslim hospitals the patients were not distributed at their admission per their conditions onto different wards, but members of the Order of St John had separate infirmaries in case of falling ill or getting wounded.

Little is known about the actual quality of the big hospitals in the crusade states, especially about the death rates etc. John of W├╝rzburg (c 1170) reports that up to 50 dead per day were being carried out of the St Johns hospital in Jerusalem, he named 2000 inmates of the hospital. It is unclear if his numbers are exaggerated or if the hospital was at that moment particularly filled with patients. Similarly, without knowing the composition, the age and the general physical state of the inmates of the hospitals we can only guess about the quality of the medical caring.

Theoderich, a pilgrim that saw the hospital of St John in 1169 praised the equipment and the caring work of the hospital. Judging by the composition of the personal there was by the standards of time probably an adequate care for the sick and dying.

Field hospitals during the crusades

Little is known about field hospitals of the armies of the crusader states, however, there are various references to the wounded being carried to the army camp or the nearest city to be cared for. Examples of this is after the Battle of Antioch in 1119, the ambush of a Christian caravan on the 17 June 1192, and January 1192, when Richard I organised for the sick to be transported to Ramla. 

The first clear mention of something comparable to a field hospital is from the 1180s. According to the text of an anonymous cleric the Hospitallers set up a field hospital in the army’s camp, transporting wounded if needed back to Jerusalem. Similarly, German sailors from Bremen and Hamburg set up an improvised hospital during the siege of Acre in 1190, dismantling their ships to build it. During the same siege, English sailors also set up a field hospital dedicated to St Thomas Becket.

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