Avoiding Death Like the Plague: Wound Care in the Roman Army

#History: A Journal of Student Research Volume 2 Conflict & Law Article 2 6-2018 Avoiding Death Like the Plague: Wound Care in the Roman Army Gwendolyn E. Dougherty Nazareth College of Rochester Follow this and additional works at: https://digitalcommons.brockport.edu/hashtaghistory Part of the Bacteria Commons, Bacterial Infections and Mycoses Commons, Chemical Actions and Uses Commons, History Commons, Immunology of Infectious Disease Commons, Medical Immunology Commons, and the Medical Microbiology Commons Repository Citation Dougherty, Gwendolyn E. (2018) "Avoiding Death Like the Plague: Wound Care in the Roman Army," #History: A Journal of Student Research: Vol. 2 , Article 2. Available at: https://digitalcommons.brockport.edu/hashtaghistory/vol2/iss1/2 This Article is brought to you for free and open access by Digital Commons @Brockport. It has been accepted for inclusion in #History: A Journal of Student Research by an authorized editor of Digital Commons @Brockport. For more information, please contact . AVOIDING DEATH LIKE THE PLAGUE: WOUND CARE IN THE ROMAN ARMY Gwendolyn E. Dougherty, Nazareth College of Rochester Roman Imperial dominion was predicated on aggressive, almost incessant war in far-flung places over several centuries. When reflecting on Rome as a warrior culture, history presents Rome’s wars as a simply two-sided event: the winners who triumphed and the losers who died. But there is another group that is often neglected, the wounded,. The victors lived to fight another day, while the losers either ended up dead or sold into slavery. But what happened to the wounded? How did the Roman army tend to its injured? Rome controlled the world through military might, but could the Romans control or even begin to combat the world of infection and disease, a powerful and unseen enemy? Before the invention of antibiotics, infection was a serious consequence of improperly treated battle wounds. Visible enemies were not the challenge; swords, clubs, and arrows could provide defense. Aside from the traditional battlefield, armies faced silent enemies that could wipe out a third of their forces overnight. Strong, healthy men were reduced to useless skeletons of soldiers within hours, dead in a few days’ time if they were lucky; but most were not. Analysis of the ancient medical literature, such as that produced by the famed Galen of Pergamum (AD 129 – c. 216), indicates little knowledge of bacteria and other microbes by medical authorities. But scholars such as Galen understood that there were changes happening in the body because of wounds that had been inflicted. Having trained under the physicians Satyrus and Pelops, and having been exposed to numerous patients through clinical experiences and practical demonstration, Galen became a leading medical specialist in Rome.1 It was this expertise that resulted in his understanding of infection and disease, one that made distinctions between the healthy and the ill as a consequence of activity and inactivity. As he himself noted: For they consider the person in whom no activity of any part is impaired ‘to be healthy’, but someone in whom one of them is impaired ‘to be sick’. Similarly they call someone in whom all the bodily parts are working naturally ‘healthy’, while someone in whom one of them is impaired is called ‘sick’.2 Despite being the leading Roman authority, Galen’s medical knowledge, like others in his field, was incomplete. While advanced scientific knowledge was lacking, the protocols of Roman physicians for treating wounds were impressive. Since warfare was an inherent part of Roman culture, death from injuries incurred on the field of battle was a regular experience, and always greeted the living with the same stomach-churning odor that would cling to every inch of their bodies. The ancient historians of Rome, such as Livy (59 BC – AD 17), offered vivid descriptions of such wounds in the infantry combat they describe: Dougherty / “Wound Care in the Roman Army” Here and there amidst the slain there started up a gory figure whose wounds had begun to throb with the chill of dawn, and was cut down by his enemies; some were discovered lying there alive, with thighs and tendons slashed, baring their necks and throats and bidding their conquerors drain the remnant of their blood.3 The smell of death was an unmistakable odor when it made its presence known. The stench marked the dead, the living, and the severely infected. Death was not always immediate, however. Those who survived, but had suffered an injury, had another even more difficult battle to win – the one against infection. Clostridium perfringens (C. perfringens), is a living death sentence. It is an invisible enemy more terrifying and destructive than any army the ancient world had seen. An infection by this bacterium marks its victims with fates worse than death itself.4 Starting with increased pain and swelling around the injured area – typically in the lower extremities – victims can come down with fever and tachycardia - rapid heart rate - as the infection begins. Within hours, the skin around the site turns pale, and as the battle continues, the skin progresses to dark red, then purple, then black in color, an indication of necrosis – the death of groups of cells in one area. The smell of death emanates from the area as pus drains out of the tissue, leaking from the infected site. What is worse, this is not a localized infection. It originates in tissue killed by an initial traumatic event – puncture wound, arrow, laceration, etc. Once inside, C. perfringens releases two devastating toxins that cause platelets to aggregate and eventually kill neighboring cells, allowing the bacterium to continue to spread.5 With a reproduction rate of approximately twelve minutes, C. perfringens rapidly colonizes wounds, and the host’s body is taken over unbeknownst to the injured. As the infection spreads and more tissue is killed, quite often one option remains – surgical removal of the dead tissue. If left on the body, the results could range from shock, to kidney failure, to death.6 The most common surgery option for this type of infection is amputation. Later such tissue may become liquefied and slough. The margin between healthy and necrotic tissue often advances several inches per hour despite appropriate antibiotic therapy, and radical amputation remains the single best life-saving treatment. Shock and organ failure frequently accompany gas gangrene and when patients become bacteremic, the mortality exceeds 50%.7 If victims survive the infection and resulting surgery, they are left to live with scarred and dismembered bodies and the possibility that not all of the infection was removed, causing lifelong agony and fear. Known today as gas gangrene, or simply gangrene, this highly virulent bacterium has caused many nightmares for healthcare workers and patients. While ancient Romans did not know 2 #History, Volume 2 that bacteria cause (...truncated)