BMCR 2000.08.17

The Treatment of War Wounds in Graeco-Roman Antiquity

, The Treatment of War Wounds in Graeco-Roman Antiquity. Leiden: Brill, 2000. 299. $78.00.

Warfare was a fairly constant feature of ancient life and literature, and war wounds no less so. Pliny the Elder tells us ( HN 7.104) that M. Sergius Silus, a Roman fighting in the late 3rd century BC, was wounded an amazing 23 times in two campaigns. In a more famous example, Arrian recounts how Alexander the Great was wounded in the thigh, the shoulder, the leg, the neck, the shoulder again, the ankle, and very seriously in the chest “so that, according to Ptolemy, breath as well as blood spouted from the wound” ( Anab. 6.10.1). Alexander may have owed his survival to superior care provided by a coterie of royal physicians, but ordinary soldiers who received less expert medical attention might also recover, like a certain Athenian named Polystratus who comes home wounded from Eretria in 411 BC (Lysias 20.14).

Men who did not immediately die of their wounds required medical care. In this most recent addition to the series Studies in Ancient Medicine, edited by John Scarborough, Christine Salazar (S.) presents an excellent and comprehensive analysis of the medical treatment of war wounds in ancient Greece and Rome as well as the literary treatment of same. She demonstrates how specific medical treatments were shaped by ancient concepts of anatomy and pathology and limited by the available surgical techniques and medications. The latter included fewer pain-killers than we would like, so the courage to receive wounds and to endure their aftermath formed part of the heroic ideal from Homer onward. S. shows how non-medical as well as medical writings can be used, with caution, to understand the treatment of war wounds; and, conversely, how war wounds are deployed in literary depictions of the martial hero. Her work corrects two frequent and mistaken tendencies (1) to take literary descriptions of war wounds at face value as actual medical events, and (2) to regard the medical literature as a genre completely separate from and unrelated to other genres of writing and thought in classical antiquity.

Amid recent work on ancient medicine, much of which has focused on women’s bodies and gynecology, the subject of war wounds has received no full-length treatment; until now, perhaps the most interesting discussion has been found in Guido Majno’s The Healing Hand: Man and Wound in the Ancient World (1975), written for a general audience. Unlike Majno, S. does not attempt to determine the efficacy of ancient remedies; the strength of her work lies in its scholarly depth and breadth. The volume includes eight black-and-white photographs, although these are not of the highest quality, as well as thorough and extensive bibliographies, a 20-page index of passages, and a useful general index. The footnotes quote Greek and Latin passages in full. S. commands an impressive range of sources both primary and secondary. The ancient works she draws upon include medical and other scientific treatises, military treatises, philosophy, history, epic and lyric poetry, tragedy, comedy, and oratory, as well as inscriptions. At least half of the voluminous modern scholarship S. cites is in German, French, and Italian; her own text is studded with medical terminology in English, Greek, and Latin.

Part I (Chs. 1-5) covers wounds and their treatment, Part II (Chs. 6-9) addresses wounding as a literary topos and metaphor for heroism in ancient literature, and Part III (Ch. 10) surveys the archaeological evidence.

Chapter 1: Sources (1-7): S. briefly reviews the medical writings that deal with war wounds, from the Hippocratic treatises, the earliest of which date to the late 5th or 4th century BC, through Dioscorides and Celsus in the 1st century AD, Galen and Rufus in the 2nd century, Oribasius in the 4th century, and Paul of Aegina, writing as late as the 7th century but clearly drawing on earlier material. She also summarizes the literary sources, non-medical ‘scientific’ texts, and non-textual evidence.

Chapter 2: Surgical Aspects of Wound Treatment (9-53): S. discusses trauma caused by swords, spears, arrows, and other weapons. She has sections on hemorrhage, difficulties posed by arrows and other foreign objects lodged in the body, injuries to vital organs, fainting, inflammation and suppuration, the effects of poisoned weapons, “tetanus” and spasms, sepsis, gangrene, etc. She then considers, from the ancient physician’s point of view, the challenges of making a correct diagnosis and offering effective treatment. This chapter, though not intended for the squeamish, is full of interest. The author shows that fainting, despite the advantages it offered as a natural anaesthesia, was perceived as life-threatening; she also notes the surprising dearth of ancient descriptions of what we call shock. The removal of missiles or other foreign bodies is of particular importance because of its recurrence as a literary motif. If the wounded man or his companions attempted to extract an arrow by pulling on the shaft, there was a good chance that the arrowhead itself would be left within the wound. Celsus and Paul of Aegina offer step-by-step instructions that S. says would have been useful only to experienced surgeons. She doubts the importance of the “spoon of Diocles” described by Celsus; she outlines the methods of withdrawing the missile from the side it entered ( ephelkysmos) or pushing it through the other side ( diĆ“smos).

Chapter 3: Pharmaka (54-67): This chapter covers a wider category than our “drugs” since pharmaka also included substances such as wine and pig fat. S. identifies three major categories: styptics, agglutinants, and anti-inflammatory remedies. She puzzles over the relative absence, in the context of wound treatment, of pharmaka to reduce either fever or pain. Mandrake, henbane, and opium were considered dangerous because it was difficult to gauge the correct dose and mistakes could be fatal.

Chapter 4: Medical Services in Armies (68-83): Greek and Roman armies are dealt with in separate sections. Finding that doctors were an expected feature of Greek armies, S. cites Xen. Anab. 3.4.30f.; she might also have noted that the practice of hiring surgeons to accompany Greek armies is also reflected in Xenophon’s fictionalized account of Cyrus the Great ( Cyrop. 1.6.15-16, 3.2.12). S. calls attention to several inscriptions that support the idea that town-physicians treated casualties wounded on their own or nearby territory. It is unclear whether armies far from home would have been attended by Greek physicians or local healers. Commanding officers often were cared for by multiple physicians in their own tents; common soldiers presumably enjoyed less attention under less favorable circumstances, the details of which we can only imagine. But S. correctly notes that medical care came to be regarded as important for building troop morale. Turning to Rome, S. praises the relative abundance of evidence, at least for the imperial period when the distance at which troops were fighting necessitated the development of an army medical service. There are hints that medical training was in some cases provided, though experienced practitioners would likely have been preferred. S. correctly calls the military hospital “an entirely Roman idea” (81); some valetudinaria have been excavated.

Chapter 5: Expert and Layman (84-124): S. considers the applicability of our distinction between “expert” and “layman” in Greek and Roman writings on medicine. She finds that Greek medical authors strove to create a terminology that would reflect and emphasize their specialized knowledge of anatomy and pathology while non-medical authors were willing to concede their ignorance; but since practitioners of ancient medicine, from physicians to midwives to root-cutters and gymnastic trainers, represented divergent points of view, she sees a wide gray area between expert and layman, representing very different levels and types of training. Since Roman authors used Greek terminology, S.’s discussion of Latin medical writings is brief. The fact that medicine became an expected branch of learning among the literate elite proves especially significant for S.’s discussion of ancient literature in Chs. 6-9.

Chapter 6: The Iliad (126-158): S. responds to the copious scholarship on wounding in Homer; her fresh contribution is to analyze scenes of wounding and the treatment of wounds as part of the poem’s central theme of heroism. The use of vivid anatomical detail underscores the violence of war, but S. argues that Trojans tend to suffer more gruesome deaths than Greeks. She finds that an implausibly high proportion of non-fatal wounds necessitate the removal of a spear or arrow, thereby affording the best of the Achaeans a chance to prove their mettle. She notes two themes, the low status of the archer and the honor of wounds on the front of one’s body, that persist throughout antiquity.

Chapter 7: Beautiful Death; the Adjustment of an Ideal (159-183): S. traces the evolution of the ideal warrior’s death through the development of hoplite warfare, which necessitated a shift in emphasis from individual exploits to the shared task of maintaining the phalanx in defense of the city. Though the core notion of martial heroism remains constant, scenes of individual wounding decline in number between the late 7th and early 4th centuries BC. S. offers a chronological survey of woundings in Greek literature starting with archaic lyric poetry and moving through Herodotus, tragedy, funeral orations, Xenophon, Plato, and Aristotle, taking care to relate literary descriptions to material in the Hippocratic corpus.

Chapter 8: Alexander the Great (184-208): S. rightly finds in ancient accounts of Alexander the quintessential example of how scenes of wounding can be used in literary characterization. Neither strictly accurate nor perhaps wholly fictitious, Alexander’s many woundings are offered by Arrian, Curtius, Diodorus and others as proof of heroism often seen as deliberately Homeric. The emphasis is on daring, leadership, and resistance to pain. S. reviews each wounding episode in turn, leading up to a grand finale on Alexander’s dangerous chest wound. She thus supplies a detailed, original, and welcome consideration of a motif too long neglected in the literature on Alexander.

Chapter 9: Epilogue (209-227): It is odd and a bit confusing to find the ninth out of ten chapters titled “Epilogue.” This is in fact an epilogue to Part II. S. aims to suggest how literary topoi associated with wounding and wounds continue in the post-Alexandrian literature, but she has so much to say that her expostion cannot avoid superficiality. Perhaps these 500 years or more deserve a full-length treatment of their own. S. nonetheless offers some provocative observations, especially that the Roman writers are the first to have war heroes showing off their scars; the Greeks, she speculates, were too enamored of physical perfection to celebrate any kind of disfigurement. She would probably concede that such boasting must have taken place in real life; indeed, Xenophon has Nicomachides show off his battle scars ( Mem. 3.4.1).

Chapter Ten: The Archaeological Evidence (230-247): This chapter all too rapidly surveys ancient arms and armor, skeletal remains, architectural remains, surgical instruments, and relevant artistic representations ranging from the Attic wine cup that depicts Achilles tending Patroklos, to Trajan’s Column. As in the preceding chapter, there is too much material in too few pages, but S. is to be complimented for taking the archaeological evidence into account.

Scholars serious about ancient medicine, or about war heroes in ancient literature, should buy this book, which represents a substantial contribution to our knowledge in both areas.