Even when modern medicine was centuries away from being developed, people did manage to treat soldiers wounded in battles, sometimes thousands in a day. In this excerpt from the author’s book ‘The Fascinating History of Medicine and Surgery in the World’, learn how they did that.

In the medieval and the ancient era, military medicine differed from regular civilian medicine in the sense that it involved a sense of great urgency. During battles, soldiers were wounded by the thousands in a day. And, there used to be a series of battles if someone had mounted a campaign. All the injured soldiers needed urgent treatment.
Most people do not bother to think how, in the absence of modern medicines like antibiotics (which became available only from 1944 onwards whereas we have been fighting wars since the past 4500 years or more) and advanced surgical procedures, our ancestors used to treat battlefield wounds. It is not that the injured were left to their fate without any treatment; that is, if they survived, good enough, if they died, well, they were paid for that. No nation could afford to lose so many trained soldiers easily. Moreover, if you were fighting close to your home country or on its borders, perhaps you could absorb casualties. However, if you had launched a campaign thousands of miles away from your home and you had to fight a series of battles on the way; such as, during the Crusades when European armies marched to Jerusalem. You started with a given number of soldiers and no replenishment could be sent from home after that. If you continued to lose soldiers to injuries or sickness, your army stood to get depleted very quickly.

It was therefore vital to find ways to treat battlefield wounds with the resources available in the field. Military medicine, therefore, taxed the skills of the physicians and the surgeons like nothing else.
While it is true that most of treatments given were developed by simple trial and error over centuries, surprisingly, in spite of their being crude and primitive, they did succeed in saving many lives.

For example, the island of Cyprus bears some of the richest copper ore deposits in Europe. A solution of copper sulphate drains away from slow leaching piles of ore. The bright blue colour of copper sulphate (called blue vitriol, bluestone, vitriol of copper, and Roman vitriol) fascinated people to no end. So, one of the methods of wound treatment was to wash the wounds with vinegar and then cover it with copper sulphate powder. At that time they had no idea how it worked. Now we know that its reaction with vinegar (acetic acid) would produce copper acetate, which has mild anti-bacterial properties.
Casualties in ancient and medieval warfare used to be heavy both in numbers of persons wounded as well as in the severity of wounds. If you wish to visualize the terrible wounds produced by ancient and medieval weapons you must watch the History Channel TV series ‘Forged in Fire’. In this immensely popular program running since 2015 till date in 2024, besides other judges, martial artist and sharp-edged weapons specialist Doug Marcaida tests the weapons forged there on ballistic dummies to demonstrate what sort of wounds they would produce on human bodies, and whether they would be lethal or not.

The most primitive of the pre-firearms era weapons, that is, war clubs and maces, smashed skulls and bones. Arrows had the nasty habit of getting stuck in the body and leaving the arrowheads lodged inside if you tried to extricate them. Spikes of war hammers and poleaxes could literally make a hole in the skull even if one wore bronze or steel helmet on it. All sharp-edged weapons, including swords, machetes and battle-axes, inflicted deep cuts and lacerations or deep stab wounds. Thrusting weapons like lances, spears, halberds and pikes inflicted deep wounds and were often so designed that they drew the internal organs and intestines out as they were withdrawn.

In ancient Greece, they had learnt to wash wounds with clean water, vinegar, or wine, and suture them with bronze needles. Wounds were dressed with honey. They had no idea how it worked. However, now we know that honey and granulated sugar both, by increased osmotic concentration, draw fluid from the wound, bringing the bacteria with it, and leading to desiccation and bacterial death. They are used even now for emergency dressing in the field on contaminated, exudative wounds in an early phase of healing. Even the US Army Field Manual (FM 3-05.70) titled ‘Survival’ mentions it as a procedure suitable for survival situations in the field.

Washing the wound with wine also made sense because due to the alcohol, it acted as a mild antiseptic, even as they did not know this fact. Roman army doctors had figured out using the extracts of henbane (hyoscyamus niger), with poppy (opium) to make a sedative/painkiller.
In Sanskrit, one of the words for a surgeon was Shalyahar, meaning one who removes arrows. This, by itself, tells much about the role of military surgeons in ancient India. Surgery was performed under the analgesic effect of opium and cannabis. For fractures, they used splints made of bamboo sticks and bark of special medicinal trees. Splints served as a rigid surface to the fractured bone and the pressure applied to the affected body part could be adjusted at will. It is because of these advantages and the ease with which it could be applied in a battlefield, the idea of the splint was revived by the British in the First World War in the form of the so-called Thomas Splint.
Today, we associate pus with infection but for several centuries, pus formation, known as ‘laudable pus’ was believed to be a sign of a healthy, healing wound as it flushed out bad ‘humors’. The most radical change in treatment of wounds in the Middle Ages came from a couple of bold surgeons, mainly Hugh of Lucca in Italy and his son-cum-pupil Theodoric, who went on to write the famous four-volume book Chirurgia (Surgery) in 1267. In a rebellion against orthodoxy, he debunked the ‘laudable pus’ theory and said that wounds would heal better without pus formation.

They devised a technique known as the dry method of wound treatment. Foreign objects were removed first, the wound cleaned of fuzz, hair, and anything else; bleeding was stopped and the wound wiped quite dry with fine lint soaked in warm wine. The lips of the wound were reunited as well as possible (by bandage, sutures or sticking plasters, as the situation could demand), pads of fine clean lint soaked in warm wine were placed upon the wound and bound up with a light bandage.
The diagnosis of fractures in the skull was based upon black eyes; decreased consciousness; drooping head; reddening/swelling of veins; giddiness; and floating spots in eyes. The case was taken to be bad if there was shivering or progressing paralysis, fever, confused speech, restlessness and insomnia.
If the skull was fractured, they made a V-shaped or X-shaped incision over the site; and removed any ‘harmful’ sections of bone, being careful of joints in the skull. They left the incision open with appropriate dressings until the bone healed. Skulls have indeed been found with healed examples of such procedures.

For arm wounds and fractures, controlling bleeding, so as to prevent the victim from dying because of that, was the first priority. A cut in the inner elbow, which cavalrymen were more likely to get than infantrymen, could injure large vessels and cause great haemorrhage. A sword wound across the upper arm or shoulder could cuts muscles and tendons, causing the arm to lose function. Manipulating bones and setting fractures was, however, old knowledge. Compound fractures presented a baffling problem though. For them, they treated the wounds first, and then proceed to treat the fracture. When they bandaged compound fractures, they left access to allow inspection of the wound.

In 1403, when the man who was later to become the king of England as Henry V, was then a young boy of 16 (Shakespeare’s Prince Hal) and he fought in the Battle of Shrewsbury. An arrow with a bodkin point arrowhead entered his cheek and the tip was buried deep beside his nose. Broad-head arrows were made to ingere unarmoured men. The narrow dagger-like shape of the bodkin arrowhead was designed specially to penetrate mail armour through the gaps in the rings. Shafts of arrows were purposefully not fitted tightly to the arrowheads so that the whole arrow could not be extracted by pulling on the shaft.

His surgeon John Bradmore removed the shaft but the arrowhead was stuck deep. What he did thereafter was absolutely remarkable. He used twigs of the pith of an old elder tree wrapped in linen and dipped in rose honey to keep the wound widened for surgery. Then he ordered a blacksmith to make a special pair of fine ‘tongs’, small, smooth and concave, with an ingenious screw mechanism to open and close it. It was quickly made right there in the battlefield. He inserted that in the wound until he could ‘feel’ that the point of the tongs had entered the hollow part of the arrowhead that had previously held the shaft. The arms of the tong were then opened up and as they gripped the arrowhead, he carefully pulled it out.
Subsequently, he washed the wound with wine and cleansed it with an ointment that had honey in it. Bradmore has recorded every detail of the procedure in his book ‘Philomena’. Another surgeon Thomas Morstede who was present there has also described the episode in his book ‘Fair Book of Surgery’. Henry’s wound healed without complications.

To learn surgery of war wounds there was only one classroom for the budding military surgeons, and it was the battlefield itself. There was no way they could learn those things in civilian practice howsoever long that might have been. And, they were valued for that.
In 1475, the English king Edward IV led a campaign to France. A detailed document called an Indenture is available from the era, which has names of all those people of any consequence who had enlisted to serve the king on that campaign. This includes the names of the physicians and surgeons also, along with their salaries. The physician Jacobus Frise was to receive 2 shillings per day, which comes to about £70 per day in today’s terms. William Hobbys who was both physician and surgeon was to receive 10s 3d per day, which would be about £355 per day (or £129,575 per annum) in today’s value. Compare this with the current average salary of government doctors in England today, which is about £60,500 per annum (or £166 per day) and you will realize how much military surgeons were valued in that era.