Ancient, Military

Roman Battlefield Medics, a Brutal Job

So, what did the Romans do for us? Stab wounds, burns, broken bones and amputations are just some of the injuries you might sustain as a Roman Legionary.
The Romans forged not only an empire but a military medical system which outperformed those of their enemies by far.

Although the treatment of wounded soldiers is a crucial part of military organisation, it actually existed in one form or other long before the Roman Empire.

Let us begin

In Ancient Egypt (around 1600 BC) writings exist on the treatment of wounds, fractures and cauterisation as a means of stemming the flow of blood. These writings also hint at medical practitioners being appointed to support individual garrisons.

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Babylonian and Assyrian medicine (1000 – 600BC) took this further by providing full time military physicians. Unlike the Persians who apparently had no military medical service to speak of around a century later!

Much of the Roman medicine was derived from the earlier writings of the ancient Greeks. Making Roman medicine, an uneasy combination of superstition, hearsay and practical experience.

But of all the developments in these ancient civilisations, it is Roman medical practice which most closely resembles what we have in place today.

What did they do differently?

Early on it appears as though Roman soldiers with no real medical knowledge were initially expected to treat each other. However, as each new ruler came and went, the care of soldiers for an empire which was growing as fast as theirs became the number one priority.

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In Ancient Rome, the dissection of the human body had been banned. Therefore, one of the best ways for a medically minded person to gain experience of human anatomy beyond dissecting pigs and primates was to become assigned to a Roman legion.

Under Caesar, physicians were specifically hired to treat the army and special tents set up for their practice. These were the first field hospitals.

Roman physicians doing what physicians did back then. Discussing other Romans pain!

After the military system was reorganized under Augustus (27 B.C.–A.D. 14), soldiers were subject to ever more rigorous medical assessments before being recruited. They then participated in regular fitness assessments and were medically discharged if found to be physically or mentally unfit for service.

The first field hospitals

Permanent camps were established and medici (medically trained staff) were appointed to each division. This reorganization of the system made healthcare provision much more efficient and increased positive results.

These physicians were intentionally ranked as officers or senior NCOs and they set about transforming the face of battlefield medicine in a number of ways.

Fundamentally, the Romans understood that the survival rates of their injured legionaries would increase by employing a militarily disciplined approach to sanitation.

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Their knowledge of microbes was limited and yet they understood that sanitation and preventive health measures were crucial to the health of the army. They constructed and maintained effective lavatory and drainage systems which were located a safe distance from base camps.

Combat Medics?

The Romans produced military medical manuals to ensure consistency of approach across the legions.

Daily bathing was actively encouraged and netting provided to protect soldiers from mosquitoes. Soldiers were required to have a nutritious diet and partake in daily exercise.

This depiction of wounded Roman soldiers as depicted on Trajan’s Column. The wounds would have been horrific.

Some soldiers also received basic medical training and effectively became battlefield first aiders known as Capsarii. These were serving troops who could provide medical assistance on the front line, bandaging wounds and so on.

Later, a special detachment of troops was established whose role it was to remove wounded men from the battlefield and evacuate them to field hospitals (valetudinaria) where they could receive treatment.

Triage tactics were also employed to sort patients depending on the type and seriousness of their injuries enabling doctors to provide good quality care to the largest volume of people.

Eventually came the development of the purpose-built military field hospital. Careful hygiene practices were observed in all military hospitals at this time.

In truth, the Romans had a better understanding of sanitation than any of their contemporaries and even those who lived long after their empire had ended.

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Roman military hospitals were located within Roman camps (Castrae) or forts (Castella).

These camps were located wherever possible near rivers and away from areas of stagnant water such as marshes.

Each hospital had a similar layout with wards separated by corridors. Physicians were careful to avoid sepsis and separated soldiers admitted with sickness and with wounds to prevent the spread of contagious illness.

Bath Time

There were also separate spaces allocated for dining, storage of medical equipment and a mortuary. Toilets, baths and an effective drainage system also featured. The baths were often located next to a gymnasium for fitness and massages.

The baths generated the water which was used to routinely flush the toilets. And all toilets were fitted with handwashing facilities.

To prevent lice, soldiers were expected to be clean shaven and to bathe daily. The hospital was also cleaned every single night by a special detachment of troops.
Fitness regimes were drawn up to promote soldiers’ health. Alongside this, the Physician Celsus prescribed rest, relaxation and a balanced, nutritious diet.

The Great Bath. Roman soldiers were encouraged to bathe everyday to prevent disease.

So, a Roman military hospital sounds comparable to a modern-day luxury spa experience complete with a personal trainer. However, let us not forget that those men occupying the hospital wards had probably sustained some pretty nasty injuries. Time to get to the gory bit!

Common injuries and their treatments

Everyday knowledge of medicine in Roman times was rudimentary. But, the incredible injuries sustained by legionaries in battle facilitated the rapid invention of new tools and treatments.

There was a focus on treating wounds inflicted by arrows, javelins and other missile type weapons. Assuming the weapon had not penetrated any arteries or major blood vessels the standard procedure was to draw it out the way it went in.

However, if the object was firmly embedded or broken inside then the procedure was to open up the body on the other side of the entry point. The arrowhead or weapon point could then be forced through and pulled out on the other side of the limb.

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If the soldier was unlucky enough to have been penetrated with a broadhead arrow then neither of the above two options would work. If they attempted to draw out the arrow point it would cause further, more extensive damage.

Cue the development of an entirely new tool called the Cyathiscus. Though there are no surviving examples, it is described in Celcus’ medical manual as a hooked tool.

It would be pushed into the wound, hooked around the barbed points and then the head could be drawn out safely. But the legionary was not out of danger yet!

If these extractions were unsuccessful or if infection set in then the next option would be, you guessed it, amputation!

Out on a limb

Amputation could be conducted using a range of knives and saws. Patients often died from loss of blood or they lost consciousness entirely and never regained it!

But, as deadly as it often was, amputation after infection was really the only option available to a Roman surgeon. So, how was it done.

First the flesh is cut down to the bone by use of a scalpel, which looked much like our modern-day instrument. It was thought best not to attempt an amputation on top of a joint and the advice (correctly given) at the time was that it is better to cut away healthy flesh than to leave any diseased flesh behind.

If you thought these Roman surgeons instruments looked gruesome imagine the wounds they were used to heal.

When the bone is reached, the healthy flesh is drawn back using forceps and then undercut around it. This would expose the section of bone fully.
The surgeon will then use a small saw to cut through the bone as close as possible to the healthy flesh.

Of course, once the sawing was complete the edge of the remaining bone would be rough and require smoothing down. Presumably with some sort of file.

The remaining skin could then be drawn over the top of the exposed bone to cover it fully. Over this new stump, a sponge soaked in vinegar would be applied and then bandaged into place with linen strips which had been previously sterilised in boiling water.

It is reasonable to suggest that the patient may well have been tied or held down during this excruciating procedure. For the safety of the man carrying out the procedure if nothing else!

They didn’t use bullets, did they?

Oh yes they did. Lead bullets in fact. Lemon or acorn shaped and of varying sizes, these little lead projectiles were hurled via slings and were a favoured weapon of the Ancient Romans some 1,800 years ago.

Many have been found around sites just North of Hadrian’s Wall in Scotland. And in other locations around Europe where battles are known to have occurred.
In the hands of a skilled ‘sling-shotter’ (is that a word?) experts have suggested that the larger of these projectiles could be travelling at speeds upwards of 100mph (160kmh)!

The Romans had highly skilled slingers who were capable of slinging a lead ‘bullet’ at great speed and distances.

If you were unlucky enough to be on the receiving end of a sling shot bullet you would likely have it cleanly extracted with specially designed forceps and you would be fine. If however, the bullet became embedded in a joint, the procedure would be altogether more complex and painful.

The bullet would need to be extracted by the doctor making a v-shaped incision around the sides of the joint. Tools would then be used to force the two parts of the joint apart so that the bullet could be withdrawn.

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I imagine the recovery period for this type of injury would be considerable assuming infection does not set in and amputation is not then required. Amputation of course would signal the end of your military career, if not your life!

Sword Wounds

A very common injury was of course a stab wound or laceration. These wounds would need to be cleaned, sterilised and stitched up or dressed to prevent infection.

In terms of recovery success, these were probably the least deadly injuries you could sustain.

If you were bleeding heavily and blood needed to be staunched the Medici would use linen which had been soaked in boiling vinegar. They would stuff this into the wound and apply pressure with a sponge over the top. A conceptually similar approach to how we staunch bleeding today.

A Re-enactor shows the width of a Pompeii-type gladius blade. The sword was the Romans main weapon.

If you’ve ever sustained a paper cut and then squeezed a lemon with the same hand you may have experienced in some tiny amount the agonizing pain that must have been experienced by a soldier having vinegar-soaked linen stuffed into his open wound! OUCH!

There is one problem though. On a battlefield not every wound is a nice neat stab wound. If the wound was too large to be stitched then the Romans employed a fibulae. This was an ancient form of pin like a safety pin.

A Modern technique?

Applying basic stitches to close a wound is again strikingly similar to today’s approach. If there were concerns about the development of infection or inflammation then the fibulae approach was generally preferred.

Applying fibulae to a wound involved passing copper alloy needles through the wound and then looping threads around them in a criss-cross or figure of eight pattern. Much like lacing your shoes or doing up a corset.

Celsus explained that using fibulae would leave the wound partially open so that any fluid collecting (such as pus) within could have an outlet rather than skin healing over the top of an infected wound which would necessitate the reopening of the wound and starting the process again.

Pharmaceuticals – When drugs are good.

Whatever the case, whatever the injury, it is likely that any soldier receiving treatment would require some form of painkiller. In the case of the Ancient Romans, this would likely be opium. Something we still use in the opiate based painkillers of today such as morphine.

If surgery was required the Romans also had their own version of anaesthesia. They used the root of the Mandagora (Mandrake) plant soaked in wine. The soldier would then drink the wine and hopefully fall asleep. Well, thats what the Romans hoped for anyway.

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The Romans also employed their own antiseptic to the area which consisted of honey and wine mixed together. As well as using boiling water, boiling vinegar and boiling wine. They clearly recognised the antiseptic qualities of honey thanks to its use by previous civilisations.

Though they had no concept of bacteria at this time they understood enough to strictly observe a clean hospital environment. This included the sterilisation of surgical equipment and dressings prior to use by boiling.

They also demonstrated an understanding of the importance of good nutrition and its part in aiding swift recovery. Archaeologists have discovered superfoods including fruits, meats, lentils, peas and eggs in sites believed to be Ancient Roman hospitals.

The biggest killer?

Of course there was a deal of nonsense mixed in with all of this sage treatment advice. And despite the best efforts of the Medici, the majority of soldiers who died did so through disease and infection.

There was still a leaning towards theories involving Galen’s 4 humors where an imbalance of one humor might cause specific types of illness and the cure would be to purge the body in some way. This often only succeeded in weakening the patient.

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Pseudo medicine was still practiced, often doing more harm than good. The presence of amulets and charms found in field hospital sites remind us that the Ancient Romans still held their spiritual beliefs.

Despite the good intentions and perceived expertise of the Medici, you would probably still have made a sacrifice to the Gods to protect you from illness and aid in your recovery…just in case!