The Roman army was the longest lived political institution of the West, both before and since its time.  It started shortly after the founding of Rome in 753 BC and lasted until 478 AD, when the Goths deposed the last Roman emperor.  Until the city dominated all of Italy, it engaged in many battles with its neighboring Italian rivals.  During that period, the army became more and more organized.  But it wasn’t until 90 BC that Roman general Gaius Marius, shown to the right, really transformed the army into the incredibly disciplined, professional, highly trained entity it’s remembered as today.   Interestingly enough, the rise in Roman medicine did not begin until this new level of military organization was in place.  Before this, Romans deeply believed that transcendental practices such as superstition, rituals, and a belief in spells would rid the country of disease.  This was based on the idea that disease came from the anger of the gods.   The practical, professional army was much less concerned about pleasing the gods and much more concerned about keeping their men in battling condition.  Thus, medical practitioners in the army felt the same way and operated on a trial-and-error basis, passing whatever they learned on to others and to future generations.

In particular, the fifteen-year civil war directly following the assassination of Julius Caesar led to significant medical innovations.  The war was fought between the best armies of the world and yielded such high levels of injury that the newly emerged emperor, Augustus, formed a professional military medical corps.  Before this, doctors had fairly low status.  August, realizing that they were key in an empire and especially an army, gave all physicians that joined his new army medical corps dignified titles, land grants, and special retirement benefits!  For the next five hundred years, fueled by the motivations and opportunity for medical advancement supplied by the many battles, and supported by the powers that be, this serious group advanced the study and practice of medicine to a level not seen again until late in the nineteenth century.

Although it is not a direct treatment of wounds or disease, one of the most profound innovations was that of a formal medical school.  At the beginning of the first century, all army doctors were required to attend the new army medical school, and by the third century, all doctors, both civilian and army, were required to pass medical school.   During war, the battlefield doctors tended to discover the most.  Anything they found out or already knew would be taught in the medical schools and would eventually be put to use.  But how good was Roman medicine?

Ancient Roman medicine was, surprisingly, incredibly similar to that of the late nineteenth century.  Like the modern medical practice, Ancient Roman medicine was split among different specialties, such as internists, ophthalmologists, and urologists.   All surgical tasks were only preformed by appropriate specialists.   Surgeons used practically the same tools as American doctors did only one hundred years ago.   An Ancient Roman doctor’s tool kit (shown in the four pictures to the right) would include forceps, scalpels, catheters, and even "arrow-extractors"!!  Similarly, Ancient Roman surgeons had a wide range of painkillers and sedatives to help in surgery, including extracts of opium poppies (morphine) and of henbane seeds (scopolamine).  There is little doubt that the many folk remedies used throughout the Roman Empire were tested in battle by Roman physicians on wounded and ailing soldiers, who sifted through and found the treatments and methods with the most useful effects.  Further, the bureaucracy of Rome ensured that the treatments were recorded and taught in the medical school.

Interestingly, the Romans did not yet really understand how germs related to disease, but they did use many of the techniques that killed germs, techniques that were not reinvented until much later.  For example, they boiled their tools before use and would not reuse the same tool on a patient before reboiling.  Wounds were washed with "acetum," which is actually a better antiseptic than Joseph Lister’s carbolic acid (Joseph Lister rediscovered antiseptics in the 1860’s, based on Louis Pasteur’s brand-new germ theory of disease).  In Ancient Rome, it was common knowledge that arteries and veins carried blood.  All surgeons knew how to use tourniquets, arterial clamps, and ligatures to stem blood flow.  They also used amputation to prevent deadly gangrene.

Over the years, Roman war doctors also learned how to prevent many battlefield epidemics.  They accomplished this by placing forts AWAY from insect infested swamps.   They also installed drains and sewers to transport sewage away from the men.   Similarly, they invented sophisticated permanent hospitals, with specialized rooms for different tasks, and with isolation of some patients from others to reduce the spread of disease.  Central heating and good ventilation also helped patients.