Trauma management in Homer's Iliad

Abstract

Homer's Iliad is one of the highest intellectual products of the early ancient Greek civilisation. A plethora of medical information lies within Iliad's 24 rhapsodies, and a total of 147 injuries are described. The present study records and evaluates all cases of trauma management included in this epic poem. Not only Iliad's original text but also all myths related to Iliad from the five‐volume Greek Mythology by Ioannis Kakridis were meticulously studied to locate the injured person, the type of trauma, the care provider and the type of given care as well as the outcome of each case. A total of 21 cases were found and evaluated with a 5% mortality rate. The majority of these injuries were caused by an arrow (43%) and were located to the upper extremity (43%). Injuries of the head, neck and trunk were not treated as all of them were lethal. Many of the recorded trauma management techniques can be correlated to modern medicine. Furthermore, the role and skills of military doctors and paramedics, mentioned by Homer, is discussed.

Introduction

The Homeric poems are the highest intellectual product of the early ancient Greek civilisation and are included among the masterpieces of global literature. Iliad and Odyssey were written between 800 BC and 700 BC, describing heroic acts of the past (5–6 centuries earlier), also including descriptions of the everyday and military life of Homer's time. Medical and surgical information are widely mentioned throughout the poems, as well as a plethora of anatomical knowledge emanating from traumas and fractures 1. Blood is considered the main element of the human body, and its loss leads to death. The soul is incorporeal and considered the main source of life, leaving the body with the final breath. Therapy is empirical but also linked to divine intervention. The amount of medical knowledge included in these poems led some to believe that Homer himself could be a military doctor or that he was a descendant of the guild of lay physicians named Asclepiads, something not proven 1, 2. Two other ‘fighting doctors’, Machaon and Podalirius, chief medical officers to the Greek forces, are often mentioned in the Iliad 1.

Trauma is mostly found in Iliad, the story of the Trojan War, where the 10‐year siege and the battles in front of the walls of Troy between the Achaeans and Trojans are described. Troy was also called Ilion, where the name ‘Iliad’ is derived from. According to Greek mythology Helen, the beautiful wife of King Menelaus of Sparta, was abducted by her lover Paris,

son of King Priam of Troy. In order to expunge the offence, an alliance of the powerful kings of ancient Greece, under the leadership of King Menelaus' brother, King Agamemnon of Argos, organised a military expedition against Ilion.

Heinrich Schliemann, an amateur archaeologist, in late 19th century, excavated the remnants of Troy in Asia Minor, providing historic basis to the epic poem. Iliad is divided into 24 ‘rhapsodies’ or ‘books’, each identified by a letter of the Greek alphabet.

To our knowledge, the present study is the first to document all cases of trauma management in the Iliad. Additionally, the role of the Iliad's military physicians Podalirius and Machaon, and similarities of their trauma management to modern medical care are discussed.

Methods

The Iliad's original text was meticulously studied for identification of every trauma and its management. All cases were recorded and evaluated. The injured person, the type of trauma the care provider, the type of given care and the outcome were located in the original text and described. Cases were listed per injury and not per injured warrior. Furthermore, the five‐volume Ancient Greek Mythology by Ioannis Kakridis was also studied to find supplementary information about trauma cases in myths related to the Iliad. This additional information refers strictly to the relevant wounds in the Iliad. Related literature and references were also studied to support the present findings.

Results

A total of 21 cases of trauma management were identified. Most of them (7 or 33%) were found in rhapsody E, which mainly describes Diomed's achievements in the battle. The majority of treated injuries were caused by an arrow (9; 43%), followed by spear (6; 29%), stone (3; 14%), snake bite, a punch and a fall (1; 5% each). The most commonly injured body part treated was the upper extremity (9 or 43%), while lower extremity, abdomen and thorax followed, with five cases (24%), three (14%) and two cases (10%), respectively. Most head, neck and trunk traumas were not treated as most of them were fatal in the first place. There was also one documented case of a jaw injury and an unspecified body injury caused by a fall, certainly including the lower extremity (5% each). Mortality because of treated trauma was found to be 5%.

Surgeon Machaon and physician Podalirius were mentioned as chief medical officers, while other warriors, such as Sthenalus, Diomed and Nestor, provided medical care. Furthermore, Mecisteus and Alastor were mentioned as paramedics. The gods had their own physician, Paeeon, for trauma management and treatment.

Regarding given care, many measures were recorded, such as extraction procedures, wound cleaning, warm baths, herb application, wind‐blowing treatment etc. Disinfection of surgical instruments was performed using sea water. Trauma cases and their management are shown in Table 1.

Table 1.

Trauma management cases in Homer's Iliad

Rh.	Verse	Management	Type of injury	Injured	Care provider	Outcome
A	594	Care and rest	Fall	Vulcan	Sintians	Survival*
B	721–725	Bed rest	Snake bite of foot	Philoctetes	Philoctetes, Machaon*	Survival*
Δ	212–219	Arrow and blood extraction, wound care, application of southing drugs	Arrow injury of abdomen	Menelaus	Machaon	Survival
E	112	Arrow extraction	Arrow injury of shoulder	Diomed	Sthenelus	Survival
E	401–402	Application of southing herbs	Arrow injury of shoulder	Hades	Paeeon	Survival
E	416–417	Wound cleaning and care	Spear injury of hand	Venus	Dione	Survival
E	447	Divine treatment	Stone injury of hip	Aeneas	Latona and Diana	Survival
E	692–698	Spear extraction, north wind blowing treatment	Spear injury of thigh	Sarpedon	Pelagon	Survival
E	794–798	Wound cleaning and care	Arrow injury of shoulder	Diomed	Diomed	Survival
E	900–904	Painkilling herb treatment	Spear injury of abdomen	Mars	Paeeon	Survival
Θ	332–334	Immediate transport for rest	Stone injury of collar bone	Teucer	Mecisteus, Alastor	Survival
Λ	396–397	Arrow extraction	Arrow injury of foot	Diomed	Diomed	Survival
Λ	455–458	Spear extraction	Spear injury of thorax	Odysseus	Odysseus	Survival
Λ	510–515	Immediate transport for rest	Arrow injury of shoulder	Machaon	Nestor	Survival
Λ	844–849	Arrow extraction, wound care, painkilling herbs	Arrow injury of thigh	Eurypylus	Patroclus	Survival
N	421–423	Immediate transport for rest	Spear injury of abdomen	Hypsenor	Mecisteus, Alastor	Death
N	598–599	Spear extraction, use of a bandage	Spear injury of hand	Helenus	Agenor	Survival
Ξ	1–3	Warm bath, wound care	Arrow injury of shoulder	Machaon	Hecamede	Survival
Ξ	424–439	Immediate transport for rest, cleaning with pouring water	Stone injury of thorax	Hector	Polydamas, Aeneas, Agenor, Sarpedon, Glaucus	Survival
Π	520–530	Pressure applied to the wound	Arrow injury of upper extremity	Glaucus	Glaucus	Survival
Ψ	695–698	Rest	Punch injury of jaw	Euryalus	Comrades	Survival

^*Cases completed with information from Greek Mythology by I. Kakridis.

Discussion

Trauma in the Trojan War was first recorded by the German military doctor H. Frölich in 1879 3. A total of 147 injuries were described, with 31 head (21%), 16 neck (11%), 79 trunk (54%), 10 upper extremity (7%) and 11 lower extremity wounds (7%). Most injuries were fatal (77·5%). The highest mortality was caused by those to the head (100%), trunk (85%) and neck (81%). Injuries of the extremities had much better prognoses, with 14% mortality rate. The majority of wounds were caused by a spear (106), followed by those caused by a sword (17) and arrow (12). A total of 12 slingshot wounds were also described. The most lethal weapons were the sword and the spear, with 100% and 80% mortality rates, respectively, while slingshot and arrow wounds follow, with a mortality of 67% and 42%, respectively 3.

Homer, in the Iliad, refers to Machaon and Podalirius as highly decorated fighting doctors. They were brothers, sons of Asclepios 4. Machaon was a surgeon, while Podalirius was a physician. Podalirius' name is mentioned twice and Machaon's is mentioned 11 times. Podalirius used to clean and dress wounds and applied a special ointment for pain, while Machaon had a more decisive role: he attended King Menelaus' injury from an arrow, and when he was himself injured by an arrow in the right shoulder, the Greeks rallied around him so that he would not be taken or killed by the enemy 5. He was considered so important that even the great Achilles, concerned about his state, sent his closest friend Patroclus to assess his situation. Hence, it is clear that the physician was highly appreciated, and his life was considered equal to that of many men as he had the knowledge and the ability to save lives 6.

While the two brothers were the chief medical officers, other warriors also possessed medical knowledge when it came to trauma management. Achilles had learnt the medical ‘art’ from centaur Chiron and had passed it on to Patroclus, who attended to a femoral injury by surgically increasing the incision to remove an arrow. Nestor, king of Pylos, was the one to attend Machaon's injury, while Nestor's slave Hecamede was a nurse. On another occasion, Sthenelos attended his fellow warrior Diomed's injury (Figure 1). Later, Diomed himself also took care of his own wound.

Figure 1.

Sthenelos bandaging the wounded finger of Diomedes. Ink drawing after a Chalcidian neck‐amphora circa 550 B.C. (Edited in black and white). Credits to ‘Wellcome Library, London’. Copyrighted work available under CC‐BY Attribution 4·0 International licence.

Even gods had their own physician, Paeeon, who was summoned when needed.

Homer had clearly distinguished the role of paramedics. Mecisteus and Alastor were transferring their Greek comrades back to camp to receive urgent medical attention. Homeric Greeks had a basic concept of cleanliness and disinfection. The ‘surgical’ instruments were cleaned and disinfected by sea water 7.

Wound care and surgical extraction procedures are most often described in the Iliad. However, conservative measures are also mentioned. Machaon received a warm bath from Hecamede after his injury, which could prevent hypothermia because of blood loss. Sarpedon was relieved from pain after the blowing of the north wind, which could be correlated to oxygen delivery. Helenus also received a woollen bandage for his injury.

Most treated wounds were located in the upper and lower extremities as head and abdomen injuries were proven lethal. The same can be said for the type of weapon that caused the damage as no sword injury had been treated, while most treated wounds were those caused by arrows. The mortality rate of treated traumas was only 5%, compared to that of 77·5% of all trauma cases in the Iliad. This huge difference reflects the successful management of treated traumas based on the knowledge and skills of the Homeric surgeons and physicians and the organisation of medical care in the military camps. The Iliad provides important information of what medical science meant at that time.

Wars and battles demanded improvement and evolution of medical knowledge, as well as surgical techniques and skills, which initiated the basic principles of today's medical care.