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Spiritual Health and Crusading: Aspects of Preventative Health Care in the Thirteenth Century

Published online by Cambridge University Press:  12 October 2026

MEGAN ESTELLE CASSIDY-WELCH Open the ORCID record for MEGAN ESTELLE CASSIDY-WELCH [Opens in a new window]
MEGAN ESTELLE CASSIDY-WELCH*
Affiliation:
University of Divinity , Melbourne
*
E-mail: mcassidywelch@divinity.edu.au
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Abstract

This article explores the nature of ‘spiritual health’ as an important aspect of medieval preventative healthcare. Focusing on prescriptive and practical advice to crusaders and pilgrims, including the understudied thirteenth-century Regimen iter agentium vel peregrinantium of Adam of Cremona, composed for the Emperor Frederick II, the article argues that mobile populations like crusaders were well-informed about the holistic nature of health. It demonstrates that spiritual and physical health were aligned in medieval medical theory, and together shed important light on the nature of preventative healthcare among medieval mobile populations.

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Research Article
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The Journal of Ecclesiastical History , First View , pp. 1 - 19
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© The Author(s), 2026. Published by Cambridge University Press

‘Moreover, man’s spiritual health, which is eternal, is more necessary than bodily health, which is temporal.’Footnote 1

‘The just and holy plan which we conceived by divine inspiration concerning assistance for the Holy Land for the sake of spiritual health and which we strive to bring into effect, you can observe plainly.’Footnote 2

It is now well established that health care in the Middle Ages was a matter of conscious and careful prevention just as much as treatment and cure. The importance of preventative health care has mostly been explored in the context of medieval urban communities, and scholars such as Janna Coomans, Guy Geltner, Carole Rawcliffe, Claire Weeda and others have shown how European cities and towns carefully managed their environments to protect and promote good health through sanitation programmes, provision of medical care, attention to air and water among other efforts.Footnote 3 Preventative healthcare was not an invention of modernity but was a concern of communities throughout the Middle Ages. This medieval history is long and complex. It was shaped by Galenic/Hippocratic ideas of the body’s composition and regulation, strands of both formal and experiential medical knowledge derived from a range of cultural and religious traditions, and technological innovations. And it responded to historical circumstances and needs across time. More recently, attention has turned to the health histories of premodern non-urban and non-European populations. Geltner and Coomans have argued for a more diverse evidence base for histories of health, and new research on rural and mobile populations has begun to show the very many dimensions of healthcare and health knowledge beyond the well-known context of medieval urban Europe.Footnote 4

Within this revival of interest in medieval preventative health care practices and ideas, religion is often very generally invoked and although historians have long acknowledged the importance of theological ideas in medieval medicine, the precise ways in which religion and spirituality were integrated into the health care practices of specific populations may be still further nuanced.Footnote 5 This is particularly the case in relation to the fundamental idea of ‘spiritual health’, a term uttered frequently in medieval texts. As is well-known, medieval medical thought was holistic. That is, bodily health and health of the soul were truly symbiotic, determined both by the humours and by the so-called ‘non naturals’ – the six environmental factors including diet, air/environment, exercise, sleep, passions of the soul and repletion/excretion – that could be managed to bring the humours into balance.Footnote 6 This was achieved personally, collectively and institutionally.Footnote 7 Spiritual health could not be separated from the physical body. It was the physical body that housed the all-important humours, and it was the physical body that experienced the fluctuations of external conditions that affected the proper function of the soul. What ‘spiritual health’ meant, therefore, was highly contingent on the individual and the environment. It was also a category that was deployed collectively to describe the state of groups, communities and populations. How spiritual health was understood and achieved, then, may usefully be illuminated by attention to specific contexts.

This article seeks to explore the nature and meaning of spiritual health among a particularly mobile medieval population: crusaders to the Holy Land during the twelfth and thirteenth centuries. From 1095, crusaders of all ranks came from a variety of western European locations to wage war with the aim of ‘recovering’ what they understood to be Christ’s patrimony, the city of Jerusalem and the Holy Land in general. Crusading as a religious movement stretched well beyond the Holy Land from the mid-twelfth century, but the Holy Land remained both a focus and an ongoing site of conflict and settlement from the late eleventh century onwards. Given the context of war in which crusaders (and the pilgrims who sometimes attached themselves to crusading armies) often operated, it is not surprising that historians have mostly focused on crusader medicine as a matter of treatment and cure. Joanna Phillips, Susan Edgington, Piers Mitchell, Jonathan Rubin, Anthony Luttrell and others have drawn historical attention to the rich source base of narratives, medical and legal texts, archaeological remains and literary sources revealing the many ways in which twelfth- and thirteenth-century crusaders experienced and managed their health and created their own cultures of medical care through networks of hospitals and other environments.Footnote 8 This historiography invites further reflection on the particular place of spiritual health among this distinctive population of travellers whose purpose and motive in engaging in holy war was primarily spiritual. Crusaders understood themselves to be pilgrims as well as fighters; they were promised remission of sins for their efforts which often involved travelling vast distances. They also took with them the ideas and cultural and embodied knowledges of their ‘home’ environments, including medical knowledges and, as travellers, were also responsive to new environments and challenges – including health challenges – on their journeys. Crusaders are therefore an especially informative historical population in relation to health management, including (and perhaps especially) spiritual health.

This article makes two principal suggestions. The first is that broad attention to mobile populations casts into sharp relief the dynamism of medieval health practices and the often very close relationship between ideas of prevention, care and cure. Mobile populations were necessarily responsive to different environmental and other conditions which influenced and informed their decisions about healthcare. Such responsiveness meant that preparedness was never simply a matter of pre-travel management, but, as outlined below, responded to the realities of travel and movement through different places. The second is that contextual attention to spiritual health adds depth to historical arguments about the importance of preventative health care in premodern contexts. This is particularly the case for crusaders and other pilgrims, whose journeys were significantly informed by spiritual and religious discourses and demands, and whose conceptions of health accommodated both physical and spiritual dimensions. These conceptions were not necessarily static across the crusading period, and the ebb and flow of how the body and soul were understood to be intrinsically linked can be usefully historicised through consideration of specific time and place.

This article begins by exploring these ideas through the thirteenth-century Regimen iter agentium vel peregrinantium of Adam of Cremona. Adam is something of a shadowy figure, a cantor of Cremona, clearly versed in medical and classical knowledge and interested in the intersections between prevention, treatment and cure, and between physical and spiritual health. His Regimen is not without its controversies around dating, but the recent work of Laura Esposito has shown compelling connection with both Cremona as a centre of medical knowledge from the late twelfth century, and with the controversial crusader, the Emperor Frederick ii.Footnote 9 The article then turns to outline some dominant medieval religious ideas about spiritual health more generally, including the significance of sin and confession and how they interact with bodily health, ideas of divine prophylaxis and crusading as an act of health management, before considering more specifically the role of motion or mobility in theories and practices of preventative health. Sources for the spiritual health of crusaders are diverse and include sermons and crusade calls among others. These sorts of texts had significant reach throughout medieval Christendom and, alongside texts more overtly focused on medicine and health, they provide critical insight into the cultural history of crusader experiences.

Mobility and spiritual health

Practical advice for travellers often drew on medical and other sources of knowledge for those venturing into new places. The latter category included the well-known corpus of pilgrimage ‘guidebooks’ and other literature, which contained descriptions of useful and interesting locales as well as pragmatic information about water sources, the best routes to walk or ride, the need for local guides and the challenges of dangerous fauna.Footnote 10 In terms of specific preventative healthcare, travellers were instructed to undertake measures such as purgation and bloodletting prior to travel, while compilers of encyclopaedic knowledge such as Gilbert Anglicus advised travellers on the best diet and how to cope with sea travel. Crusaders knew the hazards of travel very well. Jacques de Vitry’s sermons to crusaders told them of ‘dangers on land, dangers on sea, the dangers of thieves, the dangers of predators, the dangers of battles’, while Gilbert of Tournai also preached on the hazards of travel and the probability of, at the least, sore feet.Footnote 11 Underpinning such advice for crusaders was the notion that the act of crusading was meant to be a painful act of sacrifice in imitation of Christ’s suffering. The dangers that a crusader may encounter en route, including sickness and probable death, signalled the crusader’s penitential commitment to the physical and spiritual journey modelled by Christ and his suffering. This did not mean that crusaders were not interested in protecting their health or preventing illness while travelling. Rather, they were attuned both to the spiritual efficacy of the meaningful act of crusading and to the need for bodily care in order to remain effective fighters.

One relatively understudied text that specifically draws together these physical and spiritual aspects of crusader health is the thirteenth-century Regimen iter agentium vel peregrinantium of Adam of Cremona. This short text was probably composed for Frederick ii around 1227 ce for his crusade to the Holy Land and survives in a single early fifteenth-century manuscript (Universitätsbibliothek, Marburg, ms 9, fos 107v–130v). That manuscript also contains medical and other treatises connected to the court of Frederick ii.Footnote 12 Adam’s Regimen is heavily reliant on Ibn Sina’s Canon in some parts, but is also a distinctive text in other ways, including as a very early example of regimen literature. For the purposes of this article, Adam of Cremona’s text provides a neat illustration of the connections between physical and spiritual health through the management of the mobile body.Footnote 13 The text itself is divided into three main ‘books’, preceded by a short prologue. The first book is by far the longest at 196 chapters (the ‘regimen’ part of the text including diet advice, information about bloodletting and bathing), the second contains twenty-three chapters (on fatigue while journeying and care of the feet) and the third comprises only three chapters. This short third book reflects on the end of the journey and the correlations between spiritual and physical health. Together, the three books reveal both the universality of advice about health and the individualisation of preventative healthcare for travellers.

It is tempting to relate such ideas to the circumstances of Frederick ii’s well-known reluctance to embark on a crusade himself, despite having taken the cross in 1215 following his coronation as king of the Romans. A crusade was to depart for the Holy Land in 1217 and although it is not conclusive that Frederick was the intended leader of that crusade, correspondence from the papal curia subsequently shows discussion between Pope Honorius iii and Frederick about both papal and imperial priorities, including the crusade.Footnote 14 Several years elapsed before Frederick, now emperor (from 1220), finally set out for the Holy Land in 1227, one year after the Diet he convened in Cremona had also discussed the crusade. Yet, his delay in Brindisi in 1227 and subsequent abandonment of the journey due to his own illness and illness among his troops exasperated Pope Gregory ix to the extent that Frederick was famously excommunicated. Joanna Phillips has provided an excellent account of the medical and geographic challenges faced by Frederick in Apulia that year, arguing that the unhealthiness of the sea and the air in Apulia caused Frederick to leave for the medicinal baths at Pozzuoli (the healing waters of which were well known), which was ‘the last straw’ for the pope who suggested that Frederick had deliberately kept the crusading host at the unhealthy port at Brindisi in order to delay or prevent its departure to the Holy Land.Footnote 15 Although it cannot be conclusively established that Adam of Cremona wrote his text in response to the emperor’s specific actions, it is none the less certain that the text was meant for Frederick, as the dedication at the end of the third book attests.Footnote 16 And indeed, Laura Esposito has proposed that it is entirely possible that Frederick commissioned Adam of Cremona to write his Regimen precisely at a time when both his commitment to the crusade and to his own spiritual health were under significant question.Footnote 17

The state of mobility experienced by all travellers created various health challenges at all stages of the journey. Adam of Cremona noted that travel could involve many states of motion: sometimes it could be on horseback, sometimes on water, sometimes on foot, thus motion was unevenly experienced over a shorter or longer periods of time, continuously or intermittently, quickly or slowly, with ease or with difficulty.Footnote 18 Adam was also one of many medieval medical writers who warned that such motion (and particularly the motion of sea travel) could cause illness or poor health. He advised that to prevent this as much as possible, a traveller should reduce the amount of food consumed in the two or three days before travel and that drinking the oil from the fruits of the gourd (‘fructibus cucubitae’) could be useful to ward off heat and bad odour that could induce illness. Nausea and vomiting could occur and although these states were also helpfully purgative, Adam advised the traveller to avert their eyes from the sea if they were suffering for too long, and to eat a little bread broken in water or wine, while hyssop could help to clear the nose of foul odours.Footnote 19 On the other hand, Adam also noted the positive physical effects of being on a ship might include the cure of some afflictions including kidney problems.Footnote 20 Crusaders including Frederick ii took medicinal items with them on their journey, as is clear from Adam of Cremona’s references to items like rose water and wormwood for chewing to alleviate nausea. Such supplies, which could also include particular foodstuffs, were listed as essentials in a later manuscript also directed at Holy Land pilgrims (Herzog-August-Bibliothek, Wolfenbüttel, ms Weissenb. 41) which also listed ‘good theriac, powder for seasoning, constrictive powder and laxative powder, green ginger, roses conserve and sugar’.Footnote 21

Movement was both bodily and spiritual, as Adam of Cremona points out in the first book of the Regimen. He notes that exercising the soul occurs when the physical body is at rest and comprises imagining, reasoning and thinking, while bodily exercise, which may include such activities as riding or running, takes place while the soul is at rest. Activities such as reading and writing combine both forms of exercise.Footnote 22 All forms of exercise can cause lassitudine, the weariness that might afflict the traveller physically and mentally and which is also associated with exercise and its various consequences as he describes in book ii. Adam of Cremona writes of the necessity to conserve the vital spirit (the warm substance comprising blood from the heart and air from the lungs that carried heat to the body to maintain life) and the natural spirit (comprising blood and other humoural matter from the liver and which together provided nourishment for growth). The function of exercise of all sorts was to keep this system appropriately volatile; bodily processes like digestion could only work with motion. Exercise should generally be moderate but could also be highly dependent on individual factors: ‘It is necessary, therefore, that the exercise of the weak body, in whatever way and at whatever time it is done, should be light, small, and pleasant. But in him who is strong in body, the opposite is evident … and more or less, according as it will seem more expedient in each according to the ratio of time, age, complexion, exercise, habit, and region.’Footnote 23 As Carole Rawcliffe recently outlined, medieval medical commentators related the need for exercise to the stage of the digestive process as well as ‘age, gender, humoural temperament, physical stamina, the time of year and social rank’.Footnote 24

Although Adam of Cremona recommended that if someone felt pain when exercising they should immediately stop and rest, crusade enthusiasts like the thirteenth-century bishop of Acre and vociferous crusade preacher, Jacques de Vitry, and others were keen to emphasise the value of more challenging bodily and spiritual movement. Jacques preached that ‘As a ship cannot sail across the sea without any weight but is thrown about by currents and in danger of lingering because of its lightness, thus people cannot reach the haven of calm without heavy and harsh work’, relating the travel of the crusader to the spiritual effort of holy war.Footnote 25 Jacques was also generally cognisant of the bodily effects of movement on nourishment, noting that physicians agree that animals who are mobile are the best sources of nutrition as they are healthier and that water that has not been in motion ‘acquires a taint’ and is not good to drink.Footnote 26 In the same way that those who are idle and averse to movement are not properly nourished, those who do not take up the cross to travel to the Holy Land are spiritually impoverished. Another mid thirteenth-century preacher, the papal legate Eudes of Châteauroux, also noted the ‘burden of this pilgrimage’, describing the crusader’s act of leaving home as a movement toward Christ, a conversion of the spirit that is expressed outwardly by motion including following, running, jumping and climbing. Quoting John i.2, Eudes preached that ‘whoever claims to remain in Christ must walk just as he walked’, noting the dangers that threaten travellers ‘on the side of the heart and on the side of the body’, but reminding his listeners that the reward for this effort is eternal.Footnote 27 Adam of Cremona was not writing a sermon. But his understanding of exercise as health-giving for the body, soul and mind speaks to the significance of movement as a set of crucial practices for travellers and crusaders.

The third book of the Regimen reflects more specifically on the spiritual benefits of the pilgrim’s journey. Having previously discussed things that ‘seemed useful or necessary for travellers’, Adam recognises that it is ‘not enough for a traveller to have what the body needs without also understanding the path they must take’.Footnote 28 This path, ‘the way by which pilgrims must walk’, is Christ’s path. Adam quotes the Gospel, reminding the traveller that Christ is ‘the way, the truth and the life, and whoever follows me will not walk in darkness’ (John xvi.6; viii.12). The traveller should be mindful that ‘as Seneca teaches, the traveller’s path involves something certain, whereas outside the path there is immense error’.Footnote 29 Thus the journey itself is a way of demonstrating commitment to following Christ, taking the right path. ‘If anyone wants to reach the true Jerusalem by pilgrimage, it is necessary that they walk this path by imitation … take up their own cross and follow Christ by enduring the suffering of his body and life.’Footnote 30 Commitment to the physical journey was to be accompanied by the imaginative understanding that the more important journey was interior and spiritual.

In terms of health, then, this section of the Regimen reminds Frederick and his fellow travellers that crusading may be physically demanding, but it is also spiritually corrective. The journey will purify the soul. But this will only be so if the crusader eradicates the poisons of vice – anger, hatred, envy and other ‘vices of the heart’ – prior to the journey. Adam of Cremona also emphasises the preventative purgative aspects of spiritual health care. Expelling vice, eliminating sin, purging evil – all these things would empty the body and soul of previous error and allow the crusader to start his journey with the right intention and clarity of purpose. This would also mark a transformation of life, a conversion, from focus on the body to focus on the spirit. The reward for ‘crossing the sea of vices and the gulf of desires’ would be reaching ‘the heavenly Jerusalem and the vision of eternal peace … where he will live and reign forever with Christ and all the angels and saints’.Footnote 31

Adam of Cremona’s text reveals quite clearly the integration of physical and spiritual health in medieval crusading culture. Read alongside crusade calls and sermons, the Regimen demonstrates that spiritual health was not a vague, generalised category. It was, in fact, quite carefully calibrated, reflecting both theologies of sin and attitudes toward the health of the physical body. For Adam of Cremona, the movement of the blood in the body and the movement of the traveller from one environment to another created a state of volatility that could be – indeed must be – carefully managed. The Galenic and Hippocratic influences of balance were important here. But so was the individualised aspect of a traveller’s health. The impact of travel, of movement, on each pilgrim and crusader might have been determined by common humoural frameworks and the place of the stars in the heavens. But it was also determined by the inner composition of each traveller, their own environmental ‘set point’, and importantly, their own spiritual state. Thus, constantly volatile internally and externally, the crusader to the Holy Land embodied and participated in a particularly symbiotic health discourse.Footnote 32

Calibrating body and soul

Medieval understandings of poor spiritual health were principally linked to individual and collective sin. Augustine’s comments that the ‘human race is afflicted not by bodily illness but by sin’ presented Christ as ‘the almighty physician’ who ‘gives wholesome prescriptions and is disdained, [although] those who listen are freed’.Footnote 33 This well-known patristic trope of Christus medicus found a home in both clerical and monastic thought and spiritual direction throughout the Middle Ages as Jonathan Zecher and Patrick Outhwaite have recently shown, and was also echoed by popes and crusade preachers, especially from the mid-twelfth century.Footnote 34 Most evident is the oft-repeated notion that sin – individual and collective – was to blame for cumulative crusading defeats and losses (‘peccatis nostris exigentibus’).Footnote 35 Although sin was an individual pathology, it was also a sickness afflicting all Christendom, according to some crusade preachers who understood Christendom to be a body in itself, at risk of ill-health through such scourges as heresy and in need of careful attention to its unity. Several sources describing the loss of Jerusalem in 1187 refer to the damage inflicted on the Christian body by the arguments of Christian leaders. The Cistercian and cardinal bishop Henry of Albano was one who highlighted the conflicts between Christians as like ‘members against members’, which fought ‘against the order of nature’, while the anonymous author of the late twelfth/early thirteenth-century Libellus de expugnatione Terrae Sanctae per Saladinum corporealised political instability in the Holy Land prior to the loss of Jerusalem, describing malice in the hearts of the leaders, the weakening of love (‘caritas’) among them, and the consequent division of the Christians.Footnote 36 These conditions were partly to blame for the loss of the holy city according to Pope Innocent iii who, ten years after the loss of Jerusalem, reminded all Christians that ‘various kings and Christian princes may have taken up arms in admonition of the pagans but … they have not walked as they should have in the law of the Lord … trusting not in the hand of God but in their own power [and so] perished by the sword while others were consumed with illness’.Footnote 37

The thirteenth-century Cistercian, Caesarius of Heisterbach, wrote in his Dialogus miraculorum that confession is the medicine of both the soul and the whole body, as it ‘delivers the soul of the sinner from the pains of hell, so sometimes it delivers his body from temporal pains’.Footnote 38 This rehabilitative and curative power of confession was significant for all Christians including crusaders, and in sermons to those who were about to undertake these dangerous journeys there are often clear links between confession, the act of crusading and good spiritual health. This was especially the case from the early thirteenth century when confession was more generally gaining sacramental force, as the well-known Fourth Lateran Council Omnis utriusque sexus decree of 1215 reflected.Footnote 39 One preacher who emphasised these connections was Jacques de Vitry, preacher of the Albigensian and Fifth Crusades and later bishop of Acre. In a sermon to pilgrims, he preached of the hardship of travel and its benefits – ‘true pilgrims take care to offer … their own bodies by afflicting them for the Lord’s sake’ – and reminded his audience that while ‘the baggage of pilgrimage is the satchel of charity’, the real baggage of pilgrimage ‘consists of a contrite heart and the confession of sins’.Footnote 40 All crusaders were required to confess their sins and take communion prior to travel; participation in these rituals signified the inner transformation of these holy travellers, but it also signified a certain rehabilitation of a sick spirit. Preachers like Jacques de Vitry reflected that ‘many people until they are healed do not consider how great the usefulness of this pilgrimage is, like the madman who at first mocks his doctor but after he is healed thanks him’.Footnote 41 The salvific instruments of confession and communion represented both a necessary conversio of the pilgrim’s interior self prior to travel and an act of spiritual healthcare. Indeed, as another sermonist preached, ‘you cannot cross the sea unless you vomit up every sin’.Footnote 42

Yet there was more to spiritual health than simply the absence or eradication of sin. Good spiritual health was evidence of God’s own protection of the crusader, a sort of divine prophylaxis. Sermons and crusade calls as well as departure prayers and blessings frequently used therapeutic images and ideas to underscore the connections between this special sort of pilgrimage and good health. Protective blessings for departing crusaders reminded them that the sign of the holy cross itself ‘might be a remedy to save the human race and … that those who should take it up or wear it might obtain bodily health and protection for their souls’.Footnote 43 Such small but important rituals of protection were meant to ensure spiritual health just as much as physical and material defence by locating the act of travel in the realm of spiritual activity, and by calling on the power of prayer to ensure special safeguarding for these singular travellers. Cecilia Gaposchkin has outlined these rituals of departure, showing that the cross blessings so common to crusading rites showed the cross’s salvific power generally and protected the individual traveller specifically. Crosses, sewn on robes as an identifying mark and sometimes worn as badges, were also worn around the neck of crusaders according to a thirteenth-century pontifical from France.Footnote 44 The cross was generally a powerful signifier of protective health and Gaposchkin also cites the example of a twelfth-century Italian pontifical which includes a cross blessing for departing pilgrim-crusaders in which it was to be stated ‘bless the sign of this holy cross … so that he who picks it up or bears it on him might gain health of body and protection of soul’.Footnote 45 This was accompanied by the instruction to pilgrims to Jerusalem that should they travel to the holy city ‘with the rivulet of your tears streaming forth before him, you may be able to wash away the filth of your crimes’.Footnote 46 This ‘washing away’ certainly had a confessional dimension, but it also indicated something of that inner transformation of life that would situate the traveller in a new landscape of healing, protected by God.

Added to divine prophylaxis was the idea that the act of crusading itself was a mode of spiritual healing for individuals and Christendom more generally. Crusaders were encouraged to understand themselves as being in Christ’s image but also flawed in body and spirit, so it was thought that the meritorious and laborious action of taking up the cross and going on a crusade would restore health. Again, Jacques de Vitry’s sermons are illustrative. Talking of the power of preaching the crusade as a motivational, didactic practice that inspires knowledge of Christ, he emphasised Christ’s humanity as visible ‘in medical terms’ to those who recognise him:

I shall not rest, but labour and preach to convert souls and enlarge the church, until her right shines forth like a bright light, that is [until] it is made known through my preaching, and her salvation is lit like a lamp in the hearts of the listeners. The lamp means Christ, whence in Zechariah it says that there was a lamp above the candleholder, that is Christ above the church, whose flesh is likened to glass, because it was as pure and fragile as glass. And as glass is fitted to wood, so that a better likeness of the onlooker results, so, with Christ’s flesh fitted to it, anyone can recognise his own likeness in the mirror of the cross, so that he may behold his weakness in medical terms.Footnote 47

In a subsequent complex and evocative passage, he wrote:

Whence Jeremiah: Is there no more balm in Gilead? Why has the scar on my people not been removed? As if the Lord were saying: It does not depend on me; the medicine is ready. It is the medicine against all illnesses, a sweetener for all bitterness, whence Ecclesiasticus: The Almighty has brought forth medicine from the ground, and no sensible man will despise it. Is not bitter water sweetened by a piece of wood? So put yourself into the balance of the cross by taking the cross, and the Lord, who is weighing, will raise you up to the glory of the resurrection. It is the last plank for a shipwrecked world, the wood of life, the scales of justice, the king’s sceptre, the diadem of kings, the imperial throne, the shading tree, the staff of punishment, the supporting stick, the banner made red by the blood of Christ, by the sight of which we are encouraged to fight.Footnote 48

By underscoring individual identification with Christ’s flesh with the collective and unifying sign of the cross, Jacques preached that crusading also represented life-giving ‘medicine’. His use of Jeremiah viii.18 (and Isaiah lxii.1, referring to the lamp of salvation) spoke to the providential nature of the crusade journey, linking the opportunity for divine medicine to the fulfilment of biblical prophecy. The use of Ecclesiastes, too, reminded listeners of the gift of the medicinal cross and the wisdom of those who recognise and embrace it in a spirit of repentance. One striking aspect of this particular sermon is the emphasis on balance. Both balance and motion were central pillars of humoural medicine in general. Here, Jacques de Vitry also invokes ‘the balance of the cross’ in the context of the crusader’s mission and journey.

Beyond the general notion that sin led to sickness, specific bodily functions were equated with or could be affected by sins or vices. Crusading was also thought to be a remedy for these. Among these were frequent images in crusade preaching relating to digestion and nourishment. This was not necessarily specific to Holy Land crusades, as is seen in Pope Gregory ix’s 1233 crusade call against heretics, Vox in Rama, which employed images of the Church itself suffering stomach and bowel pain as a result of the disruptive poison of heresy. In this letter, the pope also talked of his own stomach pain and trembling kidney in a personal analogy with the ill and troubled Church.Footnote 49 Jacques de Vitry’s sermons are also typically rich with similar imagery in relation to the nature of the crusaders’ task as defenders of the faith ‘with the word like doctors against the heretics’ and ‘with the sword like soldiers of Christ’. Using the metaphor of swallowing and digesting, he explained the phrase in Proverbs xx.17 – ‘the bread of lying is sweet to man, but his mouth will be full of gravel’ – as ‘carnal pleasure which pretends to be bread’. Jacques writes that ‘the nature of bread is to satiate and to strengthen, which deceitful pleasure does not do; gravel which cannot be digested means eternal punishment because the punishment of hell is unbearable and cannot be consumed and cannot be swallowed since it is big and fiery’.Footnote 50 A soul that is hot cannot be extinguished, according to Jacques, until it has swallowed something; those who have drunk from the devil’s cup – ‘the froth of pleasure’ – will never extinguish that fire, while those who are signed with the cross will be protected from this unnatural and eternal heat. These images resonate with the notion of proper digestion as the cleansing, purifying, central mechanism of humoural and bodily balance.Footnote 51 Other commentators such as Eudes of Châteauroux talked of the heart being made shrunken and blocked because of sin, yet able to be enlarged by love of God. Crusaders’ hearts had been made lighter and empty of sin through true penance.Footnote 52

Adam of Cremona’s Regimen echoed both current preventative healthcare practices and contemporary understandings of the connection between physical and spiritual health. These practices and understandings had long histories in medieval medical and religious thought. But they were brought together in new ways around the early thirteenth century when the emergence of perceived new threats to Christendom emerged, when the crusading movement was shifting to new locales and new targets and when the dangers of dualism, the place of individual conscience and the consolidation of the sacrament of confession, and the fate of the Holy Land converged. The health of crusaders as individuals and collectively was of particular interest to those who tried to mobilise support for crusading in the decades from the loss of Jerusalem and into the mid-thirteenth century. This included Adam of Cremona, whose text began with this aim: ‘I believe that everyone should be cared for with brotherly love in preserving their health, particularly those who, remembering the Passion of Christ, follow the holy cross and its insignia to liberate the Holy Land from the hands of the enemies.’Footnote 53 His particular concern was the health of that most controversial crusader, Frederick ii, but Adam’s text was simultaneously directed at Frederick’s army, too, ‘his companions’. Crusading thus provides a unique context in which to explore the links between individual and collective health, especially through the lens of spiritual health, which required both individual attention and group action.

At the same time, crusading offers a different set of contexts in which to understand pre-modern preventative healthcare more generally. Although the literature on preventative health is rich, it is often focused on municipal contexts and urban efforts to implement collective health measures at population level. Consideration of mobile groups such as crusaders may broaden historical understandings of what a ‘population’ might look like, and how practices of prevention manifested outside urban boundaries, and in different ways. This article has suggested that evidence drawn from a range of sermons and other sources, including Adam of Cremona’s Regimen, reveals active concern about health in all its forms. Such sources also indicate strong health literacy among those who advocated for the crusade, including broad commitment to the principle of balance expressed in Galenic medicine. And it is clear that what constituted good health was not only a matter of the body but a matter of mind and soul, too. The preachers and others who advised crusaders on how to manage their health before and during their often arduous journeys carefully linked these two strands to provide knowledge that applied equally to the single pilgrim and to a large, militarised group.

This article has principally intended to look more closely at the idea of spiritual health in the context of crusading. Like bodily health, spiritual health was both collective and individualised at this time and thus provides us with an opportunity to understand the relationships between the general and the particular in medieval medical thought. It has been long known that medieval medical knowledge and practice was holistic, and this can be borne out by looking at the precise connections between the languages and practices of preventative healthcare, especially among mobile groups such as pilgrims and crusaders. These links were stronger than simple metaphor. This article also suggests that this particularly mobile population illuminates a commitment to preparedness and responsiveness that is often overlooked in conversations about preventative health where, as noted above, the emphasis historically has been on the urban environment, and that attention to the question of spiritual health illuminates this. Those travellers to the Holy Land who encountered a myriad of environments and challenges show us something of the necessary dynamism of advice and practice that existed in the high Middle Ages and remind us that although pilgrims and crusaders understood that their ultimate fate lay in the hands of God, they concomitantly had plenty of knowledge and opportunity to manage and shape their own physical and spiritual outcomes.

Footnotes

MGH = Monumenta Germaniae Historica; PL = Patrologia Latina; Regimen = F. Hönger, Ärztliche verhaltungsmassregeln auf dem heerzug ins heilige land für Kaiser Friedrich II. Geschrieben von Adam v. Cremona (ca. 1227), Borna–Leipzig 1913

All references to Adam of Cremona’s Regimen are from Hönger’s edition.

Research for this article was funded by the Australian Research Council (DP220102914) through a project administered by Monash University entitled ‘Pursuing Public Health in The Preindustrial World, 1100–1800’. I would like to thank the research team for their helpful comments on an initial draft of this article.

References

1 ‘Praeterea, magis est necessaria hominis salus spiritualis, quae est aeterna, quam salus corporalis, quae est temporalis’ at <https://www.corpusthomisticum.org/sth2106.html>: Thomas Aquinas, Summa theologiae, prima secundae, q. 106, art. 3, arg. 3, line 1.

2 Gregory ix, Pium et sanctum, 1234, ed. K. Rodenberg, MGH, Epistolae saeculi XIII e regestis pontificum romanorum selectae per G.H. Pertz, Berlin 1883–94, i. 495–6. This is the letter entrusting preaching of the crusade to the Franciscans: ‘Pium et sanctum propositum, quod de subventione Terre Sancte pro communi salute Deo inspirante concepimus et produce satagimus ad effectum, ex generalibus litteris poteritis advertere manifeste.’

3 J. Coomans, Community, urban health and the environment in the late medieval Low Countries, Cambridge 2021; G. Geltner, Roads to health: infrastructure and urban wellbeing in later medieval Italy, Philadelphia, Pa 2019; C. Rawcliffe, Urban bodies: communal health in late medieval English towns and cities, Woodbridge 2013; C. Weeda, R. Stein and L. Sicking (eds), Communities, environment and regulation in the premodern world: essays in honour of Peter Hoppenbrouwers, Turnhout 2022.

4 G. Geltner and J. Coomans, ‘The healthscaping approach: toward a global history of public health’, Historical Methods: A Journal of Quantitative and Interdisciplinary History lxi (2023), 18–33. See also S. Bhattacharya, ‘Global and local histories of medicine: interpretative challenges and future possibilities’, in M. Jackson (ed.), A global history of medicine, Oxford 2018, 243–62. Some non-European studies of premodern public health strategies include A. K. C. Leung, ‘Hygiène et santé publique dans la Chine pré-moderne’, in P. Bourdelais (ed.), Les Hygienists: enjeux, modèles et practiques, Paris 2001, 343–71; O. Gómez-Dantés and J. Frank, ‘La atención a la salud en Mesoamérica antes y después de 1519’, Salud Pública de México lxii (2020), 114–17; S. B. Hanley, ‘Urban sanitation in preindustrial Japan’, Journal of Interdisciplinary History xviii (1987), 1–26; and N. Kodesh, ‘Networks of knowledge: clanship and collective well-being in Buganda’, Journal of African History xlix (2008), 197–216.

5 For some excellent exceptions see, for instance, the essays in C. Methuen and A. Spicer (eds), The Church in sickness and in health (Studies in Church History lviii, 2022), including C. Burridge, ‘Healing body and soul in early medieval Europe: medical remedies with Christian elements’, at pp. 46–77. In an Islamic context see A. Ragab, Piety and patienthood in medieval Islam, London 2018.

6 L. García-Ballester, ‘On the origin of the “six non-natural things” in Galen’, in J. Arrizabalaga and others (eds), Galen and galenism: theory and medical practice from antiquity to the European Renaissance, Aldershot 2002, 105–15.

7 Carole Rawcliffe, for example, has argued persuasively that the predominant concern of medieval English hospitals was to promote spiritual health: Medicine for the soul: the medieval English hospital and the quest for spiritual health, London 1999.

8 On crusader chronicles as sources for medical history see J. Phillips, ‘Who cared?: Locating caregivers in chronicles of the twelfth- and thirteenth-century crusades’, Social History of Medicine xxxiv/2 (2019), 489–508; on influences on crusader medicine in the Holy Land see S. Edgington, ‘Medicine and surgery in the “Livre des Assises de la Cour des Bourgeois de Jérusalem”’, Al-Masaq: Islam and the Medieval Mediterranean xvii/1 (2005), 87–97. On archaeology see P. Mitchell, Medicine in the crusades: warfare, wounds and the medieval surgeon, Cambridge 2004, and ‘Crusaders as microcosm: soldiers, pilgrims and their intestinal parasites in the medieval Mediterranean’, in J. Bird and E. Lapina (eds), The crusades and nature: natural and supernatural environments in the Middle Ages, London 2024, 71–84. On the intellectual culture of Acre see J. Rubin, Learning in a crusader city: intellectual activity and intercultural exchanges in Acre, 1191–1291, Cambridge 2018. For the Hospitallers see A. Luttrell, ‘The Hospitallers’ medical tradition, 1291–1530’, in M. Barber (ed.), The military orders, I: Fighting for the faith and caring for the sick, Aldershot 1994, 64–81. For a recent study focusing on diagnosis see T. Wagner, Die Seuchen der kreuzzüge: krankheit und krankenpflege auf den bewaffneten pilgrerfahrten ins heilige land, Würzburg 2009.

9 L. Esposito, ‘Per l’edizione del “De regime” di Adamo da Cremona: note preliminari’, in B. Borghi (ed.), Vie e mete dei pellegrini ne medioevo euromediterraneano, Bologna 2007, 95–119.

10 See the collections of some of these accounts in S. De Sandoli (ed.), Itinera hierosolymitana crucesignatorum: saec. XII–XIII: textus Latini cum versione Italica, Jerusalem 1978; R. Röhricht (ed.), Deutsche pilgerreisen nach dem heiligen lande, Innsbruck 1900, repr. Aalen 1967; and D. Pringle (ed.), Pilgrimage to Jerusalem and the Holy Land, 1187–1291, Aldershot 2012.

11 ‘Periculis in terra, periculis in mare, periculis latronum, periculis predonum, periculis preliorum’: C. Maier, Crusade propaganda and ideology: model sermons for the preaching of the cross, Cambridge 2000, 112; ‘Si dolent pedes ex itinere, cogita quod pedes Christi clavis confixi sunt pro tua liberatione’: Gilbert of Tournai, ibid. 206.

12 An early transcription is by F. Hönger, Ärztliche verhaltungsmassregeln auf dem heerzug ins heilige land für Kaiser Friedrich II. Geschrieben von Adam v. Cremona (ca. 1227), Borna–Leipzig 1913. For an argument for a later date see M. Nicoud, Les Régimes de santé au moyen âge: naissance et diffusion d’une écriture médicale en Italie et en France (XIIIe–XVe siècle), Rome 2016. For the most thorough recent studies see L. Esposito, ‘Il “De regimine et via itineris et fine peregrinantium” di Adamo di Cremona e la practica della flebotomia’, in E. Cuozzo (ed.), Studi in onore di Guglielmo de’ Giovanni-Centelles, Salerno 2010, 125–65; Esposito, ‘Per l’edizione del “De regime” di Adamo da Cremona’; and C. Fossati (ed.), Medicina e letteratura fra medioevo ed età moderna, Genova 2023.

13 For mobile bodies including armies see G. Geltner and C. Weeda, ‘Underground and over the sea: more community prophylactics in Europe, 1100–1600’, Journal of the History of Medicine and Allied Sciences lxxvi/2 (2021), 123–46, and G. Geltner, ‘In the camp and on the march: military manuals as sources for studying premodern public health’, Medical History lxiii/1 (2019), 44–60.

14 See T. W. Smith, Curia and crusade: Pope Honorius III and the recovery of the Holy Land, 1216–1227, Turnhout 2017.

15 J. Phillips, ‘The experience of sickness and health during crusader campaigns to the eastern Mediterranean, 1095–1274’, unpubl. PhD diss. Leeds 2017, esp. pp. 152–9.

16 ‘Quod ille excellentissimo et gloriosissimo imperatori Romanorum Friderico Rogerio concedere dignetur suisque fidelibus, qui eum ab impiis et occursantibus mirabiliter liberavit pater scilicet miseriordiarum dominus et largitor omnium bonorum, qui vivit et regnat per infinita saecula saeculorum’: Regimen, 96.

17 Esposito, ‘Il “De regimine et via itineris et fine peregrinantium” di Adamo di Cremona’.

18 ‘Sed exercitium itineris variatur multis modis, prima sit quandoque iter gressu proprio, quandoque alieno ut equo, navigio, etiam curru vel vehiculo … Exercitiorum vero alius brevis alius longinquus et alius continuus, alius interpolates, alius velox, alius tardus, alius levis, alius gravis’: Regimen, 61.

19 ‘Oculos ad aquis maris avertat … [P]anis etiam fractus in aqua vel vino redolente ad hoc est utile, ysopo etiam confert nares claudere’: ibid. 66–7.

20 Ibid. 65–6.

21 ‘De bona tyriaca, de pulvere pro salsamentis, de pulvere stiptico et pulvere laxativo …, de zinzibre virido, de conserva rosarum et de succara’: J. Rubin, ‘Spiritual and practical instructions for pilgrims: a preliminary presentation of two unknown texts’, Mediterranean Historical Review xxxv/2 (2020), 200–18 at p. 215.

22 ‘Exercitium est res, quae vehementer prohibet, ne repletionis materia congregetur, vel exercitium est exercitatio nimia, prout expedit cuiusque artis officium. Exercitium itaque aliud est corporis, aliud est animae. Exercitium animae corpore quiescente est imaginari, rationari, cogitare et huiusmodi facere. Exercitium tamen corporis est equitare, currere et similia facere anima quiescente. Exercitium vero utrusque est legere, scribere, docere et talia exercere’: Regimen, 60.

23 ‘Oportet igitur exercitium debilis corporis, quocumque modo et quocumque tempore fiat, sit leve, parvum et suave. Sed in eo, qui est fortis corporis, patet contratrium in praedictis, sed mediocre in neutris et plus et minus, secundum quod in uniquoque exercitandi videbitur magis expedire ratione temporis, aetatis, complexionis, exercitii, consuetudinis et regionis’: ibid. 61.

24 C. Rawcliffe, ‘Keeping fit in later medieval England: exercise for man and beast’, History (2022), 507–25.

25 ‘in omni motione corporis, cum quis dolere ceperit, statim quiescendum erit’. For Jacques de Vitry see Maier, Crusade propaganda, 90; ‘Sicut autem navis sine aliquo pondere non potest mare transire, sed fluctibus iactatur et levitate sua evagando periclitatur, ita sine pondere et labore non valet homo ad portum quietis pervenire’: Regimen, 68.

26 ‘Dicunt autem physici quod partes animalis que magis sunt in motu saniores sunt ad comedendum; et vitium capiunt, ni moveantur, aque’: Maier, Crusade propaganda, 90.

27 ‘Onus istius peregrinationis’; ‘Qui dicit se in Christo manere debet sicut et ipse ambulavit ambulare’; ‘ex parte cordis et ex parte corporis eis angustie imminent’: ibid. 138–40.

28 ‘Non satis est viatori corporis habere necessaria, nisi et viam, per quam imre debeat intelligentia comprehendat’: Regimen, 95.

29 ‘[U]t docet Seneca, aliquid certum, extra vero error in immensum, et propheta errare fecit in invio et non in via. Via igitur, per quam peregrinantes debent incedere et praecipue, qui sacrae crucis insignia sequuntur, est salvator noster Christus dominus et redemptory, qui ait, ego sum via, veritas et via et quis sequitur me, non ambulat in tenebris’: ibid.

30 ‘Si quis igitur peregrinando ad veram Ierusalem pervenire desiderat, necesse est, cum imitando hac via incedat et abnegando sui ipsum crucem suam tollat et seguendo christum corpore ac vitae passionem sustineat’: ibid.

31 ‘Qui vero hac via incedit vel greditur, quia veram crucem defert et christum sequitur et reddit unicuique iuxta opera sua, non ambulat in tenebris, ut ipse dominus ait, sed transeundo mare vitiorum et cene cupiditatis, omnibus superatis inimicis spiritualibus et terrenis, perveniet ad celestem Ierusalem et ad visionem pacis aeternae, sci-licet viventium ubi cum christo et angelis et sanctis omnibus vivet atque regnabit in aeternum’: ibid. 96.

32 I note here that crusaders were often quite diverse in terms of social rank and age and, to some degree, gender. Adam’s text does differentiate between age groups, but for further information on crusading populations generally see, for instance, C. Kostick, The social structure of the First Crusade, Leiden 2008; S. Bennett, Elite participation in the Third Crusade, Woodbridge 2021; and J. Powell, The anatomy of a crusade. 1213–1221, Philadelphia, Pa 1986. For the ‘ideal crusader’ see M. Tamminen, Crusade preaching and the ideal crusader, Turnhout 2018.

33 ‘Aegrotat humanum genus, non morbis corporis, sed peccatis. Iacet toto orbe terrarum ab oriente usque in occidentem grandus aegrotus. Ad sanandum grandem aegrotum descendit omnipotens medicus. Humiliavit se usque ad mortalem carnem, tamquam usque ad lectum aegrotantis. Dat salutis praecepta, contemnitur: qui audiunt, liberantur’: Augustine, Sermones de scripturis 87, 11, 13, PL xxxviii.537–8.

34 J. L. Zecher, Spiritual direction as a medical art in early Christian monasticism, Oxford 2022; P. Outhwaite, Christ the physician in late medieval religious controversy: England and Central Europe, 1350–1434, York 2024. See also C. Rawcliffe, ‘Christ the physician walks the wards: celestial therapeutics in the medieval hospital’, in M. P. Davies and A. Prescott (eds), London and the kingdom in the Middle Ages: essays in honour of Caroline M. Barron, Donington 2008, 78–97.

35 See S. Schein, Gateway to the heavenly city: crusader Jerusalem and the Catholic west, 1099–1187, Aldershot 2005.

36 Henry of Albano, Tractatus xiii (Digressio qua lamentatur auctor Jerusalem ab infidelibus captam), PL cciv.360; K. Brewer and J. Kane (eds), The conquest of the Holy Land by Salah Al-Din: a critical edition and translation of the anonymous Libellus de expugnatione terrae sanctae per Saladinum, London 2018, chs i, ii.

37 ‘Licet autem diversi reges et principes christiani ad commonitionem ipsius arma moverint in paganos, quia tamen, sicut effectus demonstrat, non ambulaverunt prout debuerant in lege Domini, immo revertebantur cum incederent, et ollas carnium in deserto et Egipti delitias in solitudine affectabant nec in digito Domini sed sua potius potentia confidebant, quibusdam eorum pereuntibus gladio aliis infirmitate consumptis, nondum aversus est a nobis furor Domini, sed adhuc manus eius extenta’: Innocent iii, Opera omnia, PL ccxiv.263. Cf Ezekiel i.9 and Jeremiah xxiv.10. As late as 1245, similar ideas were communicated by Pope Innocent iv at the first Council of Lyons, 1245 (canon 2), which indicated that the loss of the empire of Constantinople would mean that ‘the church would incur the brand of shameful deformity on account of a missing member, and would endure the affliction of painful debility’: J. Bird, E. Peters and J. Powell (eds), Crusade and Christendom: annotated documents in translation from Innocent III to the fall of Acre, 1187–1291, Philadelphia, Pa 2013, 303.

38 Caesarius of Heisterbach, the dialogue on miracles, trans. H. Von E. Scott and C. C. Swinton Bland, New York 1929, i. 145.

39 H. Leclercq, Histoire des conciles d’aprés les documents originaux, Paris 1949, 1350. See also J. Bird and D. Smith (eds), The Fourth Lateran Council and the crusade movement: the impact of the council of 1215 on Latin Christendom and the East, Turnhout 2018.

40 ‘Et vere peregrini se, suos, et sua domino offere procurant, se ipsos corpora pro Domino affligendo’: ‘Vasa peregrinationis pera caritatis ubi opera nostra ponamus … Vasa etiam peregrinationis sunt cordis contritio et peccatorum confessio’: J. Bird, ‘James of Vitry’s sermon to pilgrims’, Essays in Medieval Studies xxv (2008), 81–113 at pp. 95–6.

41 ‘Multi quidem donec sanati fuerunt, quanta sit huius peregrinationis utilitas non attendunt, sicut freneticus qui prius medicum derisit, postquam sanatus et gratias agit’: ibid. 101.

42 Bird, Peters and Powell, Crusade and Christendom, 152, 116.

43 ‘Benedic domine hec signacula sancte crucis ut sint remedium salutare humano generi, et presta per invocationem sanctissimi nominis tui, ut qui ea susceperint vel gestaverint, corporis sanitatem et anime tutelam percipiant’: K. Pennington, ‘The rite for taking the cross in the twelfth century’, Traditio xxx (1974), 429–35 at p. 433.

44 M. C. Gaposchkin, ‘From pilgrimage to crusade: the liturgy of departure, 1095–1300’, Speculum lxxxviii/1 (2013), 44–91 at p. 59.

45 ‘Benedic domine hec signacula sancte crucis … ut qui ea susceperint vel gestaverint, corporis sanitatem et anime tutelam percipiant’: ibid. 67.

46 ‘Christi domini nostri passionis signum accipe frater, et perge ad ecclesiam iherosolimitanum, in qua gloriosum sepulcrum nostri redemptoris secundum humanitatem constat adesse, quatinus profusis coram eo rivulis tuarum lacrimarum, abluere valeas sordes tuorum facinorum annuente ipso domino nostro Iesu Christo’: ibid. 72.

47 ‘[E]t propter Ierusalem non quiescam, laborando scilicet et predicando propter animas convertendas et multiplicandam ecclesiam, donec egrediatur ut splendor iustus eius, id est cognoscatur per predicationem meam, et salvator eius ut lampas accendatur in cordibus auditorum. Per lampadem Christus designatur, unde in Zach. [iv. 2] dicitur quod lampas super candelabrum erat, id est Christus super ecclesiam, cuius caro vitro assimilatur, quia pura fuit et fragilis sicut vitrum. Et sicut vitrum ligno adaptatur, ut melius ymago inspicientis resultet, ita in crucis speculo adaptata Christi carne quilibet imaginem suam potest cognoscere, ut ex medicine qualitate infirmitatem suam agnoscat’: Maier, Crusade propaganda, 84–5. For thirteenth-century preaching on medical themes see also E. Sutcliffe, ‘Medical knowledge in thirteenth-century preaching: the sermons of Luca da Bitonto’, Journal of Medieval History xlix/1 (2022), 45–71.

48 ‘Unde Iere. [viii. 22]: Numquid resina non est in Galaat? Quare non est abducta cicatrix populi mei? Quasi diceret Dominus: per me non stat, parata est medicina. Hec est medicina contra omnes infirmitates, dulcedo contra omnes amaritudines, unde Ecc[us]. [xxxviii. 4–5]: Altissimus de terra creavit medicinam, et vir prudens non abhorrebit eam. Nonne a ligno dulcorata est aqua amara? Pone igitur te crucem assumendo in statera crucis, et Dominus preponderans sublevabit te ad gloriam resurrectionis. Hec est suprema tabula mundo naufraganti, vite lignum, iustitie libra, sceptrum regni, regum diadema, thronus imperialis, arbor obumbrationis, virga correctionis, baculus sustentationis, vexillum Christi sanguine rubricatum, quo viso ad prelium incitamur’: Maier, Crusade propaganda, 108–9.

49 Discussed in T. W. Smith, ‘The use of the Bible in the arengae of Pope Gregory ix’s crusade calls’, in E. Lapina and N. Morton (eds), The uses of the Bible in crusader sources, Leiden 2017, 206–35, with a transcription of Vox in Rama at p. 229.

50 ‘Nam sicut in Parab. [xx. 17] Suavis est homini panis mendacii, sed os eius implebitur calculo. Panis mendacii voluptas carnalis, que mentitur se esse panem. Panis quidem natura est satiare et confortare, quod non facit mendax voluptas; calculus autem dicitur pena eterna, que masticari non potest pre nimia duritia, quia intollerabilis et inconsumabilis pena gehenne, nec glutiri potest, quia est magnus et ignitus’: Maier, Crusade propaganda, 91.

51 See F. van Dam, ‘Permeable boundaries: bodies, bathing and fluxes, 1135–1333’, in P. Baker, H. Nijdam and K. van’t Land (eds), Medicine and space: body, surroundings and borders in antiquity and the Middle Ages, Leiden 2012, 117–45.

52 ‘Ideo currit hec militia, ut impleat mandatum Domini, quia corda habent dilatata per amorem’: Maier, Crusade propaganda, 154.

53 ‘Cum necessarium sit unicuique, semper et ubique corporis sanitate gaudere, qui divinis vel humanis debet inhaerere negotiis, in custodiendo eam fraterna caritate omnibus consulendum arbitror; si illis maxime, qui ad liberandam terram sanctam de manibus inimicorum, passionis Christi memores, sancti crucis insignia relictis omnibus sequuntur’: Regimen, 7.