Ancient Rome owed its military superiority partly to innovative medical treatment of its soldiers. Fascinating evidence of a well-oiled health care system has been discovered at the site of the besieging Roman army’s field hospital at Masada

Fifteen hundred years have elapsed since the fall of the Roman Empire, yet no other army rivals the Imperial legions’ influence on modern military organizational principles, logistics, and even treatment of soldiers. One area in which the Roman forces uniquely excelled was medicine, responding to both routine needs and emergencies as well as providing preventive care.

 

Noble Calling

The founding myth of the Roman army was the citizenry’s determined defense of Rome’s city wall, built in 753 BCE. Legend has it that Romulus, for whom Rome was named, killed his brother Remus after the latter leapt over the fence Romulus had constructed around the city. As he slew his sibling, Romulus allegedly shouted, “So perish whoever else shall leap over my walls” (Livy, History of Rome, vol. 1, book 1 [Loeb Classical Library], p. 25). Rivers of blood marked Rome’s later development too, as the city’s inhabitants waged war on one neighboring tribe after another before learning to forge peaceful alliances, uniting the peoples of the Italian Peninsula. 

During the agricultural off-season, Roman citizens were recruited for battle, their only compensation being the satisfaction of defending their homes. It would be four hundred years before the Roman legionaries became salaried employees with an economic status all their own. Until the fourth century BCE, Rome raised and disbanded its army as needed, war by war. As a result, no logistics division provided for soldiers’ day-to-day necessities, and long-term medical problems went unattended. Combat injuries required immediate attention, though, since their neglect would lower both morale and recruitment.

Eventually the task was assigned to Rome’s patrician families, who cared for the wounded with great devotion, regarding the job as both a duty and an honor. According to Livy’s (Titus Livius’) History of Rome, however, in his account of a battle between Romans and Etruscans in 437 BCE, Roman general Marcus Fabius bestowed the privilege on the Flavian families, the lowest-ranking in Roman society. Sometimes, though, it fell to the conquered to heal their erstwhile attackers.

Yet the care offered by all these parties was extremely basic: cleansing, bandaging, and providing for the soldier’s needs until he could fend for himself. Medical science was still in its infancy, with Hippocrates only beginning to develop the ideas that would later spread from Greece all over the Hellenistic world. It would take another three centuries – and Rome’s conquest of Greece and absorption of its culture – for Greek medicine to reach Rome. Then the winning combination of Greek theory and Roman practice started making real strides in healing. 

 

Corps of Healers

The first to factor injured fighters into the logistics of battle was Julius Caesar. His Civil War (written in the first century BCE) describes how he delayed troop movements to accommodate the wounded, setting up a legion to accompany casualties to safety. Rome’s first doctors, Greek prisoners of war, had kept their expertise to themselves. Realizing the vital military importance of professional medical care, Caesar bestowed Roman citizenship on all members of the medical profession. When Vespasian became emperor a century later, he permitted doctors to form a guild and even exempted them from taxation and civil duties such as the housing of military personnel.

Meanwhile, however, at the end of the first century BCE, Augustus Caesar had reorganized the Roman forces, attaching a physician to each legion. Until then, soldiers had administered first aid to one another, carrying bandages as part of their standard equipment. Extracting arrowheads from their bodies, they did the best they could as amateurs. Now Augustus added medics, who were forbidden to accept remuneration from patients.

It’s estimated that fully 5 percent of Roman legionaries served in one of three medical capacities.

The first was that of Militas medici, soldiers who’d received basic training in first aid, sometimes bolstered by apprenticeship under a doctor. Their job was to bandage wounds on the battlefield and evacuate casualties to the nearest field hospital. They administered dried aloe vera to stanch bleeding and stimulate clotting, disinfected with vinegar, and cautiously dispensed henbane (a potentially deadly nightshade) for pain relief.

The second and third levels of care were provided by doctors accompanying each regiment and legion, respectively. Hence the inscriptions on headstones all over Europe: Medicus cohortis, indicating that the deceased had serviced a battalion, or Medicus legionis, if he’d treated an entire legion. While the battalion doctor was responsible for the individual soldier, the legion physician was in charge of the camp valetudinarium (hospital), all health care providers, and medical supplies.