Roman Health Reforms that Made the Legions Stronger

The medical might of the Roman army.

Portion of Trajan’s column showing soldiers leading the wounded away.

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For Vercingetorix and his remaining men inside Alesia, there was nothing but death and despair surrounding their miserable station. Supplies were quickly running out and there was no chance of escaping as the Romans built two layers of walls to block their movements. But when it seemed like all hope was lost, Gallic reinforcements had arrived, sending a squall of hope to every surviving Gaul. They now far outnumbered the Romans and in fresh confidence undertook several sallies at the invaders. But all was in vain. Commanding the Romans was the consummate champion Julius Caesar whose military aptitude and will empowered the legions, bestowing fortitude and force unto their tired spirits. He rallied his men to stand their ground and sent his generals to confront every crack in their line. Each Gallic attempt was thwarted and it didn’t take long until Vercingetorix understood the futility of his resistance. As the Gallic forces quickly eroded, Caesar realised that the opportunity to eradicate them all was his for the taking, but he was not inclined to enforce carnage where it had just cascaded in excess. Instead, Caesar ordered his troops to attend to each other, to give their allies rest and safety from battle. “[A]nd if the Romans had not been tired out after a long day’s work during which they had been repeatedly summoned to the relief of hard-pressed comrades,” he writes in The Gallic Wars, “the enemy’s army might have been annihilated.”

It was in Caesar’s best interest to rescue as many men as possible for two reasons. First, he needed arms and men ready to quell any Gallic rebellion that might arise in the aftermath of Alesia; and second, the presence of perfidious elements in the Roman senate, the younger Cato for example, meant that having a strong standing army was necessary to extend and ensure his political career. However, it was also not just out of military and political expediency that Caesar opted to save lives rather than to kill; his choice was also compelled by changes he designed to implement within Rome in general and in the legions in particular. That is to say, saving his soldiers was consistent with Caesar’s political aims and ambitions.

To improve the physical force of the legions, Caesar looked not to sharpen their blades, neither to lengthen their spears, nor to harden their shields. What he did to make his men more efficient as killing machines was to make them as healthy as possible by instituting radical but much needed reforms. 

But in order for us to truly realise and appreciate the scope of Caesar’s innovations, we must first look back at the ways Rome cared for its soldiers during its Republican chapter.

Before the influx of eastern (mostly Greek) doctors into the city, medicine in Rome was primarily the practice of the pater familias, or the oldest male member of the family which was usually the father. Folk tradition obliged fathers to administer the health of the family. Surviving records from the period are not entirely clear on the scope and limitation of women’s roles, but circumstantial and ethnocultural evidence suggest that they also partook in some form of domestic healthcare particularly in herblore. 

As it was men that comprised the legions, it was expected of them to practice field medicine on themselves and on their comrades. Cicero attests to this when he extols the bravery and endurance of seasoned soldiers when wounded for they only sought to be bandaged by their comrades while newer recruits squirmed and screamed. He writes in Tusculanae Disputationes:

“Thus you see, when the wounded are carried off the field, the raw untried soldier, though but slightly wounded, cries out most shamefully, but the more brave experienced veteran only enquires for someone to dress his wounds.”

It is unclear what Cicero meant by “someone”, so it is difficult to conclude that there was a specialised platoon in the Republican army tasked to nurse the wounded back to health. But since there was “someone”, it is definitely clear that select members of the legions, regardless of rank and position, were quite adept at dressing injuries, most probably due to them having practiced domestic medicine as the family patriarch.

It might also be the case that prominent and wealthy families were assigned to care for Rome’s injured soldiers when things turned dire, similar to what happened after a punishing encounter with the Etruscans in 437 BCE. As Rome suffered heavy casualties, Livy writes in The History of Rome that the surviving consul Marcus Fabius “billeted the wounded soldiers on the patricians, to be cared for”.

Things started to change under Caesar’s leadership. After the Civil War which Caesar had won against his long-time ally-turned-nemesis Pompey, he instituted a number of reforms that improved Roman public life. One such reform was giving political rights to doctors practicing in the city, whether they were citizens of Rome or not. In The Lives of the Twelve Caesars, Suetonius writes that Caesar “made all those who practiced physic in Rome. . . free of the city, in order to fix them in it, and induce others to settle there.” The first Greek doctor to practice in Rome arrived in the city in 219 BCE—more than a century before Caesar was born—and other doctors of Greek and eastern origins soon followed. But they stood against folk traditions (and stereotypes) and had no political support, making the practice of their medicine quite difficult as the locals harangued them with charges of “barbarism” for their bloody surgical operations. With Caesar’s legislation, they now had legal protection to practice their craft, leading to their firm establishment in the city and eventually legitimising their brand of medicine. This had the gradual effect of subsuming folk Roman medical practices into the gamut of Greek medicine, which was then becoming the premiere medical service at the time. The medici, or doctors, were soon recognised as the health authorities in the city, effectively usurping medical responsibility from fathers and patriarchs. With them at the helm, a standardised medicine according to established Hippocratic ideas and practices soon took hold in Rome, and the services of eastern doctors became highly sought-after (especially those educated and trained in Alexandria, click here to read my other essay discussing this).

The presence of more sophisticated doctors at home must have improved the living conditions of soldiers during peacetime. They no longer had to rely on themselves to dress their injuries or to suture still gashing wounds. Healing was not limited to the landscape of folk practices anymore, and they were given access to more treatments and drugs. But what happened to them during wartime? Historians have yet to uncover conclusive evidence showing that Caesar enlisted doctors in his legions. Perhaps he never did. It’s possible that ranked officials had slaves in their entourage who were adept at Greek medicine. But even without professional physicians in the ranks, Caesar was able to make his legions healthier by promoting exercise routines in their daily regimen. “Exercise contributes greatly to health,” he writes in The Civil War, “and therefore the Romans took care to keep their troops always employed, either in casting up new works round the camp or in hunting after provision and forage, or in performing those several exercises, that tend to render the body robust and active.” 

These weren’t novel innovations in military organisation and administration. Other nations also included regular exercises and labour in their military management. But despite falling short of originality, what was unique in Caesar was his emphasis on individual development as a means to collective success. Soldiers weren’t only expected to kill the enemy, Caesar also demanded of them a standard for personal growth. This he made possible by championing health and safety in his military administration. Under his leadership, soldiers weren’t just expendable resources that could be easily replaced; he shaped them into healthier humans, hence, much better killing machines. Caesar, ever the revolutionary, made being healthy extremely lethal.

Although things did not end up well for Caesar’s wellbeing, as daily exercise could hardly deter treacherous intents, Augustus, his chosen heir, took up his adoptive father’s reforms and improved them. He further refined the military makeup of Rome by transforming the legions into a permanent fighting force (the Republican army was composed of enlisted soldiers that disbanded after campaigns) and established a medical division within the army. This decision to include a  professional cadre of medical personnel in the legions was perhaps influenced by two things: a high regard for Caesar’s reforms and a personal history of being saved by a doctor. All throughout his life, Augustus suffered from debilitating illnesses that mostly kept him out of combat, others speculate bouts of cowardice. During these episodes the Greek physician Antonius Musa was by his side, treating him with therapies and cold baths to restore his health. Judging by the fact that Augustus lived and ruled Rome for four decades ushering its greatest period, it’s safe to say that Musa’s treatments worked. Augustus was of the same opinion, and he later conferred high praises on his doctor. In Divus Augustus, Suetonius writes that Augustus dedicated a statue to Antonius Musa “who had cured him of a dangerous illness.” And Augustus’ appreciation for the medical arts didn’t stop there, for he had more in store. According to Cassius Dio in Roman History, Musa and all the “members of his profession” were “granted exemption from taxes”. This was an endowment that included not just the physicians “living at the time but also those of future generations.” This decree made Rome an ideal place for doctors to establish their careers. Some of them ended up serving in the legions. It’s no surprise then that archaeological and epigraphical fragments bearing inscriptions of medicus legionis or medicus cohortis have all come from Rome’s imperial period.

Sketch of Roman inscription mentioning the medicus ordinarius cohortis Anicius Ingenius (Barnes, 1914).¹

As part of the legions, these medici were entered into the ranks as miles, or as common soldiers (the Latin miles is where the modern words militia and military come from). As such, they were all subject to military laws and discipline. However, this does not automatically mean that they were required to participate in actual combat. It might be the case that they were enlisted as noncombatant members, given that their role as healers was important in keeping the fighting soldiers in optimal health.²

Their inclusion in the army also coincided with another important imperial innovation: the formation of military hospitals called valetudinaria. Excavations along the Danube and Rhine have exposed these hospitals, giving us a glimpse of how they were built and what kind of activities happened in them. Surgical tools, medical equipment, and remnants of plant material used as drugs were found in these sites, indicating varied and sophisticated medical interventions.³ The valetudinaria were also built with a uniform rectangular plan, but differed in room sizes and count, and interior layout, similar to the oldest excavated valetudinarium in Westphalia, Germany which is thought to have been built in 9 CE, during the reign of Augustus.⁴ These rooms were divided according to purpose and function. Doctors performing a dangerous operation in the surgery ward were free from incoming and outgoing noises in the admittance section.

Plan of a late 1st century CE valetudinarium in Neuss, Germany. (Source: Wellcome Collection)

The valetudinaria were also staffed by personnel serving specific functions. The optio valetudinarii were in charge of the overall administration of the hospitals while the medicus castrensis handled all the medical concerns.⁵ There’s also the possibility of doctors conducting lectures in the valetudinaria as inscriptions bearing the title discentes capsariorum (medical trainee) were found in several sites.⁶

The construction of these hospitals near rivers may suggest that the Romans utilised these bodies of water as natural boundaries that separated the empire from the “barbarian” frontiers, helping keep foreign aggressors at bay. But it is also possible that it was from a careful consideration for the general health and nutrition of the legions. Flavius Vegetius, writing in the 4th century CE, provides us with the Roman rationale for this arrangement in his De re militari. “Do not allow the army to use water that is unwholesome or marshy,” he writes, “as drinking bad water, just like poison, causes illness for men.” Also, these rivers not only provided the Romans with clean water for drinking, but additionally served as endless streams for personal hygiene. It was also easier to grow food near rivers as the soil was more fertile and could be easily irrigated, helping ensure that the legions were well nourished and hydrated.⁷

Unfortunately, patient records from these valetudinaria are nowhere to be found; perhaps all have been ravaged by age or are yet to be uncovered. Without the names and case details of those who perished or were saved in these hospitals, present historians have found it difficult to discern how well these structures helped maintain and restore the health of the legions. But despite the lack of qualitative data, a reasonable approximation of their effectiveness can still be drawn from the quantity of hospitals assembled across the empire. Remains of valetudinaria have been unearthed not just along the Rhine and Danube, but also in other faraway outposts like in Britain⁸ and Spain⁹. For what other reason would the Romans build these hospitals wherever they expanded if not for keeping their soldiers healthy? As master pragmatists, they would have immediately abandoned these hospitals after their first iteration had they failed their purpose. Thus, conversely, their continued proliferation for centuries during the imperial period strongly indicates the success of these hospitals and its attending physicians in healing sick and wounded soldiers, improving overall health in military camps, and educating new healers. 

Remains of a valetudinarium uncovered in Spain (Vega Avelaira, 2017)¹⁰

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1. Henry Barnes, “On Roman Medicine and Roman Medical Inscriptions Found in Britain.” Proceedings of the Royal Society of Medicine 7, Sect Hist Med (1914): 75.

2. Vivian Nutton, “Medicine and the Roman Army: A Further Reconsideration.” Medical History 13, no. 3 (1969): 262.

3. Cybulska, M., C. Jeśman, A. Młudzik and A. Kula, “On Roman military doctors and their medical instruments.” Military Medicine and Pharmacy 5, no. 2 (2014): 3.

4. Guenter Risse, Mending Bodies, Saving Souls: A History of Hospitals. (Oxford University Press: 1999), 49.

5. Nutton, op. cit., p. 263.

6. Ibid., p. 265.

7. Risse, op. cit. p. 43.

8. Colin Martin, “The Legionary Hospital at Inchtuthil.” Britannia 26 (1995): 309-312.

9. Tomás Vega Avelaira, "Hallazgos de instrumental médico-quirúrgico en el campamento romano de Aquae Querquennae (Porto Quintela, Ourense / España)." Sautola 21 (2017): 221-232.

10. Ibid., p. 223.