Medical Practitioners in the Crusader Era
Dr. Helena Schrader
Included in this blog: (VIDEO)Was Christian Europe Threatened by Islam at the Time of the First Crusade?
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.
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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.
