With a bloodcurdling yell, the Dacian spearmen threw themselves in one last desperate attempt against the Roman shield line. Here and there, a few spears found their mark, wounding legionaries who were immediately replaced by men calmly stepping forward from the second rank. The bleeding soldiers were allowed to pass to the rear by their comrades but not without some jests and raucous comments on their manhood. Just to the rear of the standard bearers, the wounded men found medical help at an advanced dressing station where lightly armed surgeons and medical staff of their cohort were on hand to bandage and splint their wounds. As the wounded received immediate aid, a throaty growl went up from Trajan’s legions as they heard the trumpets signalling a general advance. Their Dacian foe was in flight, and, as the well disciplined cohorts moved inexorably forward, many tribesmen in their frantic efforts to flee the Romans took their chances in the cold pewter-grey waters of the lower Danube River.
This moment is recorded for posterity on Trajan’s Column, a memorial to the great soldier-emperor’s conquests and an excellent pictorial source for understanding all aspects of a Roman army on campaign. One vignette depicts the scene described with a legionary receiving treatment for an arm wound while an auxiliary soldier receives attention to his leg. The wound-surgeons, in addition to their winter campaign breeches, are wearing helmets and light mail, and armed with short swords. Their location just behind their maniple standard bearers indicates that battlefield medicine was practised at a central and easily recognised point on the battlefield before eventual evacuation to a well-established camp hospital.
Though the Roman army was the first to practice organised military medicine on a large scale, the need to care for the wounded had existed since tribes and city-states had first taken up arms and made war upon one another. Wounds and sickness were part and parcel of the warrior’s trade, but it was obvious to their leaders that trained soldiers were a valuable resource and thus made sure they some form of medical resource in their armies. Good generals would also have noted that morale was significantly higher in their armies if the rank and file knew they would receive immediate treatment and care should they fall sick, or should luck not be with them on the day of battle.
The armies of ancient Egypt had surgeons and physicians who were paid for by the state and restricted from charging their patients. Usually of the priest class, they relied more on charms, incantations and astrology to treat wounded than any recognisable or valid medicinal practices familiar today. However, they certainly knew the technique of trepanning, the surgical procedure of removing part of the skull to relieve pressure on the brain, a common result of heavy blows to the head. In certain societies trepanning was associated with the release of evil spirits. This is just one example of the way in which more scientific medical practice emerged from more primitive responses to disease and injury.
The ancient Greeks drew much of their knowledge of surgery and other kinds of therapy from the Egyptians and Persians. The hero Asclepius, a son of Apollo the sun god, was looked upon as one of the originators of Greek medical science. He sailed in the heroic era as perhaps the earliest recorded naval surgeon on the historical buccaneering expedition mythologised as the ‘Voyage of Jason and the Argonauts’. Asclepius was said to have had daughters called Hygeiea (Health), Panacea (Cure-all) and Iaso (Healing) and two sons, Podalirius and Machaeon, who went to Troy and both attended the wounded, and fought in the ranks. When Machaeon was wounded by the Trojan champion, Paris, Homer records that Achilles himself anxiously inquired after ‘the wounded offspring of the gods’. The entire Greek army closely prayed for Machaeon’s recovery, for a surgeon ‘who knows how to cut out darts and relieve the smarting of wounds by soothing unguents was to armies more in value than many other heroes’. The word ‘physician’ as employed by Homer throughout his epic, derives from the Ionian dialect spoken in the Greek colonies of the eastern Aegean and originally meant ‘extractor of arrows’.
Asclepius was credited with the ability to raise the dead and ranked as a god in later legend. Though Thessalian in origin he was adopted as a Greek and his shrine at Epidauros had become a very important centre by the 5th century BC. The poet Pindar (active 498-460) wrote of it:
He healed all who came to him,
Suffering from the sores of disease,
Wounded by bronze or far-flung stones,
Or with bodies wasting from
summer or winter fever.
He delivered them from their sorrows
With soft incantations and cordials,
With herbal cures he bound upon their limbs,
Or with his knife.
(from Pythian Ode III)
This extract and other literary sources clearly illustrate how primitive ritual and more scientific medical procedures intertwined with a recognition that care for the patient as a person was equally important. Contemporary vase paintings include some depictions of battlefield medicine and in hoplite warfare it was clearly normal for comrades to give medical aid to each other.
Western medicine was greatly advanced by Hippocrates (known as ‘The Father of Medicine’), who lived in the second half of the 5th century and into the 4th. His name lives on in the Hippocratic oath, which is as meaningful to the medical profession around the world today as it was to Greek doctors 2,500 years ago. Hippocrates also wrote ‘Fights between citizens and their enemies are rare, but frequent and almost daily between mercenary soldiers; he who would become a surgeon, should join an army and follow it.’
As early as 500 BC we find that it was customary for Roman armies to take their wounded with them after a battle and seek safe refuge for those who were too badly hurt to be moved long distances. Rome added technology and organisation to the medical science imported form Greece. However, the profession was not an honoured as it was in Greece until the time of Julius Caesar. By 46 BC, Suetonius, a Roman historian, relates that he ‘conferred citizenship on all practitioners of medicine... in Rome’ in order to encourage them and others to take up residence there. Augustus Caesar went a step farther when he gave all free physicians, including educated army surgeons, the dignitas equestris, which conferred the right of full citizenship with the privilege of wearing the ring of the knightly class. It is known from literary and historical sources that educated physicians known as medici were attached to the army. By the time of Hadrian, they were distinctly classed as non-combatants and the services of the legions’ physicians (medici legionis) are commemorated in some 46 Latin inscriptions that have been found in different countries that once formed part of the mighty Roman Empire: Italy, Germany, Austria, England, France, Holland, Switzerland, Romania, Bulgaria, Serbia, Asia Minor, Egypt and Algeria. These gravestones attest to the extensive medical organisation of the Roman army during the first two centuries of the Christian era. Very typical is the inscription found on the six-foot tombstone of a medici ordinarius of a Tungrian cohort stationed near Hadrian’s Wall at Housesteads, now in the collection of the Newcastle Museum. It reads: ‘To the Shades: Anicius Ingenuus, Ordinary Physician of the First Tungrian Cohort. He lived 25 years.’
By the time of Trajan and Hadrian (AD 98-138) each legion of 10 cohorts (numbering approximately 6,000-6,500) had a legionary physician (medicus legionis) with medici cohortis assigned to each cohort of approximately 600 men. These military-establishment physicians were regarded as immunes, exempt from guard and combat duty and ranked as principales (non-commissioned officers). In the elite Praetorian and city cohorts, the physicians were required to be Roman citizens, while the physicians of the vigiles and auxiliary troops serving in Italy and the Roman provinces could be freedmen or foreigners. For this reason, the staff surgeons of the Roman army outside Rome were called medici ordinarii. Legionary physicians were considered all to be of equal rank, had no immediate medical superiors and were subordinate only to their camp commander (praefectus castrorum), or in his absence, the tribunes of the legion. It was their task to supervise the food, clothing, encampment and general hygiene of the troops and to run the camp hospital.
The greatest contribution of Rome to battlefield medicine was the establishment of the hospital system. Each military camp had its own travelling valetudinarium to accommodate the sick and the wounded. According to the writer Vegetius, hospital personnel consisted of hospital superintendents (optiones valetudinarii), physicians (medici castrorum), and sanitary personnel (capsarii) who carried dressing materials in a pouch and were attended by pupil understudies (discentes). A turn of the century excavation of a static Roman hospital at Köln, Germany revealed a well-laid out structure with design features that indicated awareness of infection and ways of preventing its spread. This hospital could accommodate up to 220 patients comfortably with 38 small wards, a dining room, two exercise quadrangles, sewers, water-piping, a heating plant and a kitchen.
When the Romans withdrew from Britain in the 4th century, most of their customs and medical organisation were stamped out by the invaders who followed. The army surgeon of Roman times did survive in Wales - there is a mention of medeci attached to the forces of Welsh kings - but in England and the rest of Europe, it is not until the Norman conquest and the Crusades that we again find a rudimentary form of medical attention on the battlefield and then there was little real advance until the Victorian era.
by Ian McCulloch
Further reading
Cassin-Scott, Jack, Men-at-Arms 69: The Greek and Persian Wars 500-323 BC (Osprey, 1977)
Sekunda, Nick, Warrior 27: Greek Hoplite 480-323 BC (Osprey, 2000)
Sekunda, Nick, Elite 42: The Persian Army 560-330 BC (Osprey, 1992)
Sekunda, Nick, Elite 7: The Ancient Greeks (Osprey, 1986)
Wilcox, Peter, Men-at-Arms 129: Rome's Enemies (1) Germanics and Dacians (Osprey, 1982)