Illness, Wounds and Care on Crusade: Medical Support for Medieval Expeditions

From the First Crusade at the end of the eleventh century to campaigns in the thirteenth, crusaders travelled through Anatolia, the eastern Mediterranean and Egypt. Illness and wounds arose within very different settings: on long marches, during sieges, and in camps dependent on uncertain supplies. Monastic hospitals in Jerusalem and Acre provided organised care, but a fixed hospital could not follow a moving army. Care could be supplied by companions, hired medical practitioners or religious hospitals, while shortage and capture disrupted access to all three.

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Campaign movement made care uneven

The First Crusade’s siege of Antioch in 1097–98 brought together famine, disease and desertion. After the city fell, the army’s march towards Jerusalem was delayed by intense summer heat and an epidemic. Adhemar of Le Puy, the papal representative with the crusade, died during this halt.

The Second Crusade illustrates how travel could compound the difficulties of keeping an army supplied. German and French forces encountered shortages, raids and desertions on the route through Anatolia. At Antalya, Louis VII and his knights sailed for Syria, while many of those left behind perished, deserted or were enslaved. Those unable to obtain passage lost the protection and supplies available to the departing royal household.

Sea travel offered some relief from the logistical demands of an overland march. The Third Crusade relied heavily on ships, which eased the movement of supplies and limited the number of non-combatants travelling with the main forces. Yet a naval route did not protect people from disease in a crowded campaign setting, nor did it ensure that a sick or wounded person could reach a hospital. Armies still had to sustain themselves at ports and siege lines far from their home communities.

Siege camps and outbreaks

The long siege of Acre during the Third Crusade exposed both defenders and besiegers to severe illness. In the summer of 1190, an outbreak called plague killed Queen Sibylla of Jerusalem and her daughters. Further outbreaks in the winter of 1190–91 were described as dysentery and fever; among those who died were Frederick of Swabia, Patriarch Heraclius of Jerusalem and Theobald of Blois. Dysentery refers to a serious intestinal illness, while fever is a symptom rather than a diagnosis.

In the Fifth Crusade, disease and food shortages likewise affected an army operating away from secure supply. After Egyptian forces blocked the crusaders’ camp during the advance towards Cairo in 1221, famine and plague weakened the force. The Nile’s floodwaters obstructed its route of retreat, leaving the crusaders trapped and prompting their surrender. These events show how illness could combine with military pressure and disrupted provisions: a force weakened by disease had fewer resources to withstand a blockade or escape a dangerous position.

Companions, surgeons and religious carers

One established source of care in Jerusalem predated the First Crusade’s capture of the city. Merchants from Amalfi had supported a religious community there, and Benedictine monks established separate hospitals for men and women in the late eleventh century. They cared for sick, poor and injured Christian pilgrims. After the city’s capture in 1099, the Hospital of Saint John became a distinct organisation. Its religious brothers continued charitable work, and care in Jerusalem also extended to people including Muslims and Jews.

The work of feeding, washing and watching sick people involved attendants and religious brothers as well as doctors. A physician assessed illness and advised on diet and medicines; a surgeon performed manual procedures such as treating wounds. Some practitioners travelled with rulers or armies. During Louis IX’s Egyptian campaign in 1250, Joinville describes barber-surgeons cutting diseased tissue from swollen gums so sufferers could eat.

Hospitals at Jerusalem and Acre

A hospital in this setting provided lodging, nursing, food and religious assistance as well as medical treatment. Jerusalem’s Hospital of Saint John served pilgrims and other people in need. Twelfth-century visitors describe hundreds of beds and, in some accounts, around 2,000 sick people.

Acre provides a different example. During the Third Crusade, a German nursing confraternity operated a hospital there. Wood and sail from ships in a northern European fleet were used to construct a field hospital. This illustrates how materials brought by sea could support a care facility at a campaign’s destination. Its location beside the besieging forces brought shelter and nursing close to sick participants who could not reach a distant city hospital. In 1198, the confraternity assumed military functions and became the Teutonic Knights.

Hospital treatment and the vulnerability of the sick

The Jerusalem Hospital’s statutes of 1182 required four physicians capable of examining urine, recognising illness and prescribing medicines. Treatment emphasised food suited to the patient and preparations such as syrups and electuaries, mixtures of medicinal ingredients with honey or sugar. Attendants supplied beds, linen and meals, making nursing and provisioning essential parts of care.

When supplies ran short and armies became trapped, illness could turn from an individual hardship into a threat to the whole expedition. The Fifth Crusade’s failure at Cairo followed the combination of famine, plague and an obstructed retreat. On the Seventh Crusade, an epidemic killed many crusaders while they wintered in Cyprus in 1248–49. After the French army’s defeat in Egypt, its camp then faced famine and disease; Louis IX surrendered in April 1250. The Egyptian ruler ordered the poor and sick among the captives killed, while releasing other prisoners under the terms of a ransom.

These campaigns show that care depended not only on the presence of religious institutions but also on movement, food and the fortunes of war. Hospitals could provide organised support at particular centres, while the conditions of a march or siege could place large numbers of people beyond their reach.