The Military Medicine of Ancient Rome

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Editors: Neil Schlager and Josh Lauer
Date: 2001
Publisher: Gale
Document Type: Topic overview
Length: 1,611 words
Content Level: (Level 4)
Lexile Measure: 1240L

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Overview

In his writing on surgery, famous ancient Greek physician Hippocrates (c. 460-377 B.C.) is credited with saying, "He who desires to practice surgery must go to war." What Hippocrates meant was that it was only during warfare that a physician could learn about closing wounds, infection, and human anatomy and become skilled at using the variety of surgical and other medical instruments in the doctor's kit. While caring for wounded soldiers was not always a priority for ancient military commanders, the medical care of wounded soldiers was a hallmark of Greek armies. Other armies learned from them. It was only after the heavy influences from the Greek tradition of military medicine that, by the first century A.D., the art of Roman military medicine rivaled the art of their conduct of warfare as it was carried out on three continents and over four hundred years.

Background

Before Greek influences, the Roman legions did not have any organized, professional medical services. Wounded soldiers were cared for by their fellow soldiers. Before the first century A.D., there were clear distinctions between sick Roman soldiers and wounded soldiers, and sick soldiers often did get some medical treatment. It was not until Emperor Trajan's time in the second century that wounded soldiers were cared for by medici, or doctors. The medici were not trained doctors but could dress wounds and perform simple surgeries.

Much about the history of military surgery can be understood through the artifacts discovered during archaeological excavation of military forts and camps. Many of the medical and surgical implements used by the Greek and Roman armies have been found at archeological sites and, interestingly, many are not greatly different from similar instruments in use today.

It is believed that Roman armies began marching with trained physicians and setting up field hospitals during the time of Galen (c. 129-216), a famous Greek physician who wrote extensively on the medical arts and the care of wounds. In addition to treating wounds, it appears that Roman army doctors also had great knowledge of pharmacology. They knew medicinal plants and regularly made medical preparations as well as recommending healing foods to return sick and wounded soldiers to the ranks.

Much of our knowledge about Roman army medicine comes from several sources: the writings of Galen, who attended gladiators; the writings of Celsus (25 B.C.-A.D. 50) and Paul of Aegina (c. 625-690); and the archeological excavations of Roman fortresses and battlefield sites.

Impact

The Roman Legions were highly structured and very efficient. By the time the Roman military medical service became a standard part of the legions, the Roman military medical service was also highly organized and efficient. Most sources suggest that the Roman medical service expanded on the Greek military variety of purposes.

The Roman author Vegetius wrote that the Roman army should be "preserved" by providing a good, clean water supply, taking seasonal considerations into account, the use of medicine, and exercise for the troops. Specifically, Vegetius suggested that commanders not march the troops in the hot sun or in freezing weather and that they provide the troops with clean drinking water at all times. Once more, he said that sick soldiers should be "brought back to health by suitable food and cured by the skills of doctors." Likewise, it was recognized that soldiers could get sick from overeating after experiencing a famine. Most important, as recognized in today's best armies, the ranks of the Roman armies were filled with only the most physically fit soldiers, who had to pass a medical examination before their service began.

In the early days of Roman military medicine, there was little distinction between medical and veterinary services, and human and animal hospital services were set up side by side. Later, when formal medical service became as highly organized as the rest of the Roman army, a praefectus castrorum was placed in overall charge of medical services. The optio valentudinarii were responsible for running the hospitals at legion fortresses. Wounded soldiers were cared for by medics called capsarii, who carried bandage boxes.

The medicus was the Roman medical officer, a fully trained doctor who directed medical personnel. Many medici were either Greek or Greek-trained. Later Roman army surgeons were usually given the rank of magister or "master." Records show that medical supplies and carriages for bearing the wounded were placed in the middle of marching columns.

One of the most common medical procedures was the removal of "missiles" from the body, generally arrows but also small lead beads or pebbles shot from slings. These often penetrated flesh and became embedded. The tools used by Roman military doctors, many used for extracting missiles, are themselves legion.

Archaeologists have found medical instruments at Roman forts and campsites that are classified as probes, spatulas, spoons, tweezers, scalpels, lances, curved and straight needles, medical glassware, small vessels, and ointment boxes. One of the most prolific Roman army medical service archaeology sites is at Baden, Germany, where the remains of a Roman military hospital were excavated. Artifacts described as earscoops, catheters, spoons, and other medical equipment were found. Coins found in association with the medical equipment showed the fort was active between A.D. 100 and 200.

Another military hospital unearthed at Vetera (now Xanten, Germany) revealed hospital wards, rooms full of medical instruments, surgical suites, convalescence rooms, and possibly mortuaries. Among the discovered artifacts were levers and scoops thought to be used for extracting missiles from the body and notched probes that may have been used for extracting arrowheads after the arrow shaft was broken off. Although later than the heyday of the Roman legions, surgeon Paul of Aegina described how stones and other missiles from slings were to be removed by an ear probe, modified for the job at hand by adding a scoop.

Roman army records show that Celsus suggested using a "weapon extractor." Celsus noted that missiles that have entered the body and become fixed inside "are frequently troublesome to extract," because of their shape, size, or the way they have penetrated. "If the head of the weapon has fixed in the flesh," he wrote, "it is to be drawn out with the hands or by laying ahold of the appendage which is called the shaft, if it has not fallen off. When it has fallen out we make the extraction by means of a toothed forceps." Celsus went on to say that when he saw a curable wound he looked at two things: preventing hemorrhage and preventing inflammation. He suggested vinegar to staunch the flow of blood yet said that to prevent inflammation, blood must flow. He noted that inflammation was more likely when bone, sinew, cartilage, or muscle was injured. "If the wound is in a soft part, it must be stitched," he noted. "But if the wound is gaping, stitching is not suitable." Celsius also wrote on bandages, preferring bandages of wide linen "sufficiently wide to cover in a single turn not only the wound but to a little extent the edges on both sides."

Roman industrial arts also aided in the cause of treating wounded soldiers. New metal alloys of bronze and silver provided sharper edges and were less expensive to manufacture. Because of rust, iron was not used for medical instruments. Artwork as well as poetry from just before and after the first century A.D. depict Roman army doctors removing arrows from soldiers.

Amputations were also performed by Roman military doctors. Celsus may have been one of the first military surgeons to discuss the merits of amputating above or through the damaged flesh. He advocated cutting only through good flesh and then sawing through the bone as close as possible to the good flesh, but leaving enough good flesh as a flap to cover the bone.

Most historians agree that there was not sufficient call for craftsmen who specialized in making medical instruments, but that physicians would likely have found craftsmen who could make what they described.

Roman army doctors also had a firm knowledge of pharmacology. Many medicines mentioned by Celsus are not unlike those of today made for the same purposes. Archaeologists have found the remains of five medicinal plants at Roman fort excavations. St. John's wort, used for blood ailments; fenugreek for poultices; figs for treating wounds; and plantain for dysentery have been found. Medicated wine was also thought to have been used. Some historians have suggested that the courtyard of each Roman army hospital was laid out as a garden for growing medicinal herbs.

The axiom "an army marches on its stomach" could well date to Roman times. Records show that Roman doctors knew that a balanced diet was necessary for healthy troops. Sources suggest that Roman soldiers were kept fed with corn, cheese, ordinary wine, fresh fruit, and vegetables. Bread was considered the most nutritious food, and each soldier received a ration of panis militaris--army bread made of wholemeal. Special diets were prepared for sick and wounded soldiers. Garden peas, lentils, and figs seemed to be popular for treating the sick.

Roman army doctors also understood that soldiers were prone to overeating after a battle or after going without food for a long time. The Roman historian Appian wrote after the siege of Mutina in 43 B.C. that a number of soldiers fell sick after "excessive eating." The Roman remedy--drinking a concoction of wine and olive oil--probably cured many.

Not only did Roman military medical instruments influence military doctors for the next millennium, their experience and their records, particularly those kept by Celsus and Galen, directly influenced future military surgeons, who improved the art and science of military medicine in the eighteenth and nineteenth centuries.

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Gale Document Number: GALE|CV2643450064