Wound Treatment in the Crusader Era

Today Fermin Person provides us 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 were fractures, cuts, puncture wounds, burns and head injuries. Below, is a look at their respective in the crusader era:

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 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 yet 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 through 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 bod by the arrow. After the missile had been removed, 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, to prevent blisters the application of oil, vinegar or rose oil was recommended.

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 know, however, tha many Arab medical texts were translated into Latin in Sicily and Spain. In addition, several Greco-Roman works on medicine which had been lost in the West were re-discovered through translations into Arabic, which were then re-translated back into Latin. However, the actual impact on western medical practice is difficult to trace or record. 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 these are often of allegoric 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.