Valetudinarium

[guy]

Valetudinarium (Military Hospital)

First priority was sanitation.
Emphasis on sewage and waste removal, running water, and good ventilation.
Buildings were a double row of rooms separated by a corridor and arranged around a courtyard.

Battlefield injuries required the knowledge of tourniquets, arterial clamps, and ligatures to stem blood flow.
Amputation to prevent gangrene.
Prevent battlefield epidemics by placing forts away from insect infested swamps and installed drains to transport sewage away from the camp.

 

Precautions must also be taken near swamps because they breed certain minute creatures which cannot be seen by the eyes, but which float in the air and enter the body through the mouth and nose, causing serious diseases.

Marcus Varro Roman scholar and writer (116-27 BCE)






Military Medical Corps 27 BCE

Formed by Emperor Augustus.
First permanent and professional corps of physicians and surgeons, hygiene officers, and bandagers or medics (capsarii).
Physicians given land grants, dignified titles, special retirement gifts such as exempt from certain taxes and civil duties.
Medical personal trained and qualified by military schools.

guy also known as gaius Edited January 23, 2017 by guy

[caldrail]

I would urge caution in gettin g carried away with the apparent modern-ism of this kind of thing. It is true the Romans had learned a thing or two about treating injuries, but if you look at what they actually did many of their methods were just as painful or just plain wrong as anyone elses. The trouble, as always, is that we look for things we recognise and as soon as we spot anything with a modern parallel, people make all sorts of assumptions.

 

Furthermore, it must be pointed out that the only legionaries who got treated in a hospital of this kind were those that made it there. Plenty of wounded men never left the battlefield, and the provision of evacuating men wounded in melee was pretty well non-existent.

[Northern Neil]

Even without getting carried away or making assumptions, it is difficult to ignore the modern parallels, though. True, religeous and astrological `influences muddied the picture somewhat, but the fact that there were purpose built hospitals at all, and that hygiene was a consideration, is pretty conclusive.

 

As a dual trained nurse, I can see the modernity of many of these surgical instruments:

 

[barca]

 

[Maty]

During the First World War many front line surgeons still used Roman manuals on battlefield surgery for things like amputations.

[Trajan]

Even without getting carried away or making assumptions, it is difficult to ignore the modern parallels, though. True, religeous and astrological `influences muddied the picture somewhat, but the fact that there were purpose built hospitals at all, and that hygiene was a consideration, is pretty conclusive.

 

As a dual trained nurse, I can see the modernity of many of these surgical instruments:

 

 

Throughout many ancient cultures the importance of hygiene was recognized. That doesn't mean that the techniques used in treating patients were especially modern. It wasn't so much the influence of religion, but the methods of treatment and the procedures. In the field, many soldiers needed to be treated from various training injuries or other afflictions. Because of the constant stream of patients, many of the medical instruments were used on a series of different people before being cleaned. Without vaccines or any way to really treat infections or contagious viruses medically there was no way to prevent the spread of these contagions. You're right in the modern parallel of purpose built hospitals, but any culture without infinite soldiers had these. It was necessary to keep your soldiers on their feet and fighting. They were a valuable resource, and letting them die would be a major problem. The Spartans are one of the few cultures I can think of that did not use medicine on their soldiers, instead preferring them to die in battle than from another medical condition. But because the Roman empire was centered around conquest, and they did not have unlimited resources to draw soldiers from, keeping their men healthy was of the utmost importance.

[Northern Neil]

Interesting how he "knew" about those microbes about 2000 years before scientists such as Leewenhoek, Koch, and Pasteur described them in detail.

Indeed, it was an hypothesis which was found to be valid 1900 years later. In much the same way as Leucippus and Democritus' hypotheses regarding atoms were subsequently found to be valid.

 

Historically speaking, nothing is actually 'modern' prior to the year 1500. But I think it is fair to say that, as with so many other aspects of human development, the area of medicine in Roman times was quite advanced, and following the fall of classical culture and the moribund centuries of the early mediaeval age, it took a few hundred years before such advances were at a comparable level.

Edited September 18, 2011 by Northern Neil

[guy]

I would urge caution in gettin g carried away with the apparent modern-ism of this kind of thing. It is true the Romans had learned a thing or two about treating injuries, but if you look at what they actually did many of their methods were just as painful or just plain wrong as anyone elses. The trouble, as always, is that we look for things we recognise and as soon as we spot anything with a modern parallel, people make all sorts of assumptions.

 

I think you are a little harsh. We like to think of ourselves as "modern," with a great concern about asceptic technique. It is only most recently (the latter part of the 19th century) that such concepts as sterility and infection control have become better understood.

 

Here are two paintings from the late 1800s by the American artist Thomas Eakins done only fourteen years apart. Note how they show how quickly concepts such as hygiene and sterile surgical fields evolved.

 

 

Note in the above picure "The Gross Clinic" done in 1875, the medical team is wearing the equivalent of "street clothes" while in the midst of an invasive surgery (the treatment of osteomyelitis of the thigh).

 

 

This second picture "The Agnew Clinic" was done in 1889, portraying surgery for breast cancer. The medical staff is now wearing surgical gowns in a cleaner and brighter surgical theater.

 

I think it is sometimes all too easy for us today to criticize the Ancient Romans for their sometimes ludicrous and primative concepts of health care while we now live in clean, modern environments with a hand sanitizer at every turn and a private bathroom with indoor plumbing in every building. Remember, it wasn't too long ago that we "moderns" were still using leeches and purges on our sick patients. In fact, George Washington suffered bloodletting on his deathbed in 1799.

 

guy also known as gaius

Edited September 18, 2011 by guy

[Melvadius]

... Remember, it wasn't too long ago that we "moderns" were still using leeches and purges on our sick patients. ....

guy also known as gaius

 

In point of fact; you may well find that 'leeches' are still used as part of specific treatments by some doctors. This company advertise themselves as 'the Biting Edge of Science' (sic) for uses including in 'plastic and reconstructive surgery' and 'successful ongoing research into relieving symptoms of osteoarthritis'.

 

I'm sure that in the same way someone else will still be using purges in specific circumstances. In fact come to think of it it is still the recommended 'first response' treatment for some specific forms of poisoning...

 

[GhostOfClayton]

In point of fact; you may well find that 'leeches' are still used as part of specific treatments by some doctors.

 

Maggots most certainly are.

[caldrail]

Even without getting carried away or making assumptions, it is difficult to ignore the modern parallels, though. True, religeous and astrological `influences muddied the picture somewhat, but the fact that there were purpose built hospitals at all, and that hygiene was a consideration, is pretty conclusive.

 

As a dual trained nurse, I can see the modernity of many of these surgical instruments:

 

 

That's exactly the assumptive frame of mind I'm warning against. This hospital would in all likeliehood be used for illness or minor injury - in other words, keeping legionaries fit for battle rather than patching them up afterward. Furthermore, the chances of severely wounded men making it back to camp without death from shock, bloodloss, or infection is not good. If the Romans lost the battle, this was virtually impossible.

 

As regards the apparent modernity of the instruments, remember that these are tools and whilst I agree they were intended for a similar purpose, there is no guarantee the Romans used them for extacly the same objective. In other words, they may have done certain things to affect health care, but not necessarily in the same order or purpose that we do today. Also, we know that treatments prescribed for aiolments often had no actual curative strength. Indeed, some of them were more likely to cause harm. What we have to be aware of is that sophistication in Roman medicine was not uniform at all.

 

Be aware that overall the Romans had little idea of hygiene other than a social custom. The connection beyween conditions and infection was not something that was really understood until recent times and I seriously doubt the Romans did either, other than an empirical realisation that clean conditions appeared to be more condicuve to heath, but then they would have thought that anyway due to the idea that cleanliness was a human condition to be applauded. Note that legionaries, despite being of various origin and of rough disposition, were encouraged to bathe as much as their betters. In fact, it could be argued that medics (being educated men) were probably keen to create clean conditions within the hiospital merely to suit themselves.

 

It must also be realised that medics in the legion were invariably greeks (I don't know of any exceptions) and this would have been the skill that gave them immunes status. That does not guarantee that the greek legionary actually knew anything. As long as he could convince his seniors of his knowledge then he got off manual labour, and given the hospital was normally fairly empty anyway whilst good health was the norm in peacetime, it was an easy assignment. Educated medics like Galen were an exception, and although his knowledge was well ahead of his time, it served the medic no good at all to teach those skills to all and sundry. The Romans earned a living from expertise after all. Only in certain cases where the common good was emphasised - such as combat skills - was there establisjed means of teaching skills to others freely.

[Northern Neil]

I would urge caution in gettin g carried away with the apparent modern-ism of this kind of thing.

 

 

Throughout many ancient cultures the importance of hygiene was recognized. That doesn't mean that the techniques used in treating patients were especially modern...You're right in the modern parallel of purpose built hospitals, but any culture without infinite soldiers had these.

 

I'm not sure that Guy in his initial post, or any subsequent poster, was actually making a case for modernity, so much as giving us an interesting insight into the Roman concept of hospitals. In any discussion such as this, advances they made which ultimately led to modern practice will naturally be remarked upon.

 

I think there is a counter assumption going on here that when the advancement of some Roman achievements are referred to, and parallels noted, the writer is thinking of modernity. After all, none of us has come up with any assertion that they had an x-ray camera, antibiotics or a Machine That Goes 'Ping'. I would be interested, though, to hear of any other cultures at that time, or for any time up to the crusades come to that, when hospitals were purpose built.

Edited September 19, 2011 by Northern Neil

[Melvadius]

<SNIP>In fact, it could be argued that medics (being educated men) were probably keen to create clean conditions within the hiospital merely to suit themselves.

 

I am with Northern Neil on this one that Caldrail may may be flagging issues which were neither stated nor intended in the original posting although they may be valid points for wider discussion regarding military medical procedures.

 

To pick up on a couple of related issues; writing around 110 AD Pseudo-Hyginus states that when laying out a large camp the animal hospital and workshop should be "deployed further away so that the infirmary can be quiet for [those] convalescing".

 

Recent research at the Roman legionary camp of the legio I Italica in Novae/Bulgaria has found positive evidence for the healing function of the buildings assumed to be hospitals. In the middle of the 'valetudinarium' there they found a sacred precinct including votive inscriptions to Roman healing gods. Specifically 'a small temple to Asclepius stood in the center of the courtyard' and 'altars, statue bases and votive slabs to other deities, such as Juno and the Capitoline Triad, were erected in the unpaved courtyard around the temple.'.

 

So far as non-Greeks being medicaly trained is concerned there probably will always be an issue preventing identifying them since many may voluntarily taken, or in the case of slaves been assigned, 'Greek' names as a matter of educated 'prestige'.

[GhostOfClayton]

To pick up on a couple of related issues; writing around 110 AD Pseudo-Hyginus states that when laying out a large camp the animal hospital and workshop should be "deployed further away so that the infirmary can be quiet for [those] convalescing".

 

Do I dare hope that it was from Hyginus Gromaticus (Pseudo-Hyginus was an unknown writer basing work on that by Hyginus Gromaticus) that we get the word 'Hygiene'?

[Melvadius]

I couldn