Images of young servicemen and women who have suffered terrible injuries rightly affect civilians back home. I make a point to sit in silence and read the names and study the faces of the fallen that are shown at the end of PBS' The News Hour (there were fifteen in tonight's broadcast). They come from all over the country these men, for they are mostly men; and from time to time the name of a local town in Central Texas appears. Distressing is that the majority seem to have been less than 30 years of age when they died (the youngest in tonight's list was just 19 years old).

At the outset of the present War in Iraq, we were warned this would be a long engagement and that there would be deaths. To date, the number of Americans who have been killed in Iraq numbers 3,219 (1). 132 British and 124 soldiers of other nations have also perished during the conflict (2). On that count, it could be said, they had prepared us.

Perhaps we were less ready to deal with the casualties, the walking wounded, that would find their way back to the homeland. That total currently stands at 23,924 (1). As the war has passed into its fourth year and the public has become more aware of those men and women returning home with all manner of injuries, politicians on both sides of the Atlantic have been keen to reassure concerned voters that wounded troops are being cared for to the highest standards - the standards that sophisticated industrial democracies expect for those who defend this way of life.

Shocking it was then to the unsuspecting American public to read the front page of The Washington Post on February 18 - or the many TV and radio reports that covered it - that all was not well with the military system of health care (3). Since that story broke the name 'Building 18' of the Walter Reed Army Medical Center has passed into the lexicon of everyday language as a synonym for a moldy, rat infested hovel suffered by powerless damaged soldiers who were supposedly there receiving care.

In Britain too, The Daily Telegraph revealed a report that "highlighted failings in the military medical service that have led to 5,000 servicemen languishing on NHS waiting lists", despite assurances from General Sir Mike Jackson, former head of the Army, that problems surrounding the care of wounded soldiers "had been properly dealt with" (4).

In a country where "Support Our Troops" magnets grace the backs of cars and trucks, American politicians, journalists, members of the public, and belatedly the Military itself, have had to come to terms with the stark facts of the woeful neglect of the country's finest in their time of greatest vulnerability (5). There have been resignations and dismissals (6). There is the official investigation by a bipartisan committee, which will make recommendations to the President (7). These measures, while well intentioned, will take time and the situation may at best stabilise before the recommendations are implemented (8). It has been a swift loss of innocence for a nation that genuinely prides itself on looking after its men and women in uniform.

All the more shocking then, that these revelations are not new. The Walter Reed Army Medical Center actually had been due for closure (9). The allegations of neglect had been raised before by the families of the wounded, but their voices had not been heard. Until, that is, The Washington Post put the story on its front page, where, in the nation's capital, finally, it could no longer be hidden.

According to Lindsey O. Graham, Republican Senator for South Carolina, who has served as a military Staff Judge Advocate, speaking on PBS' The News Hour on March 7 he said the problem is one of "capacity" (10). Under the military system, a wounded soldier goes before a medical evaluation board, which determines the extent of his injuries and whether he should stay in service or not. It is a medical legal issue. If he is not to stay in service, a second panel assesses the severity of the injuries and rates accordingly whether to retire the soldier. Thereafter the soldier passes into the care of the Veterans' Administration (VA) which administers long-term health care. Mr Graham said that the process works when appropriately resourced. With more wounded troops returning from Iraq than anticipated, the system is now overwhelmed and the paucity of staff to process the cases is leading to lengthy wait times for soldiers to be reviewed. He noted,

Was it any different in the days of that other great professional army of history? The Romans certainly understood the need for proper medical care in the military. The army led by Emperor Trajan that marched into the mid-eastern lands of Armenia, Assyria and Mesopotamia was equipped with doctors and medical orderlies (medici) who tended to injured troops on the battlefield. The column in Rome that bears his name and celebrates his campaigns in Dacia, features a scene in which a helmeted capsarius (after the capsa, or box he carried for bandages and medications) whose job it was to apply bandages, attends to the thigh of an auxiliary soldier, while another supports a wounded legionary by holding his arm (Webster, p251-2).

Roman accounts of battles often cite the number of dead and wounded. At the Battle of Mons Graupius in 73/74CE, 360 Romans were killed compared to the 10,000 Britons under Calgacus, reports Tacitus. While Roman troops did not face attacks from guns, rocket propelled grenades or exploding shrapnel, the wounds from barbed arrows and other airborne missiles, axe blows or being trampled by horses, stabs or slash cuts from swords or axes, burns from fire or hot oil inflicted terrible injuries or loss of limbs. War in the ancient world was nasty, brutish, close-up and personal.

To carry off the wounded from the battelfield, there were carriages and horses (Davies, p215). But what of care off the battlefield? In each of the fortresses around the empire that were the homes to the twenty-five legions, there was a hospital (valetudinarium). Excavations of several fortresses reveal that the Romans had a surprisingly sophisticated knowledge of pre- and post-operative care (Webster, p248). In the hospital at Vetera - modern Xanten in Germany - dating to Nero's time, which follows a common ground plan, wards were arranged on three sides of a square around a central courtyard, which was open to the sky (Davies, p223). A large building on the fourth side housed the doctors' surgeries, dispensary, operating theatre, bath suite, kitchen and latrines. There was also a mortuary. Wards were made up of cubicles (sixty in all, which is the same number of centuries in a legion) arranged in pairs, separated by wide corridors that allow for air to circulate. Even in the far outpost of Inchtuthil in Scotland, the wooden hospital of this temporary fortress has double walls to insulate "against noise and extremes of temperature" (Webster, p254).

Medical staff were very well trained and some specialised in particular areas - internal ailments or eyes, for instance (Davies, p212-215). They were also important enough to report to the camp prefect (praefectus castrorum), who was second only to the legate. Surviving medical instruments show doctors had a remarkable understanding of human anatomy and how to remove foreign bodies and repair wounds. Exquisitely made scalpels, levers, hooks, spatulas, tweezers with and without serrated ends, forceps, probes and even clips for veins have been found.

Troops could be discharged (missio) if wounded and unable to continue in service (Le Bohec, p224). Ex-soldiers normally received a plot of land and a sum of money paid to them from a fund (Aerarium Militare) founded by Caesar Augustus in 6BCE. These retired soldiers, referred to as veterani, could return to the land of their birth or move in to a nearby settlement (vicus) or one of the cities initially founded for discharged soldiers (coloniae). These quasi-military hamlets and colonies of veterans offered a ready-made networks for old soldiers. Roman veterans, not unlike their modern US Marine counterparts today, probably had a strong sense of loyalty to their unit even in retirement and would get respect and support from new troops. Although not allowed to marry during active service, many took common law wives and settled down with them, setting up as shopkeepers and bar owners taking custom from the men currently serving with the eagles,. no doubt telling the younger soldiers "it was harder in my day".

The technology may have moved on since Roman times, but the lot of soldiers today has not changed that much. In armed conflict, those sent into harm's way get hurt. War is still butchery. We who are fortunate not to have to serve, have a duty of care for those injured troops who return home. Writing in the 5^th century CE, Vegetius noted that "men who are hard pressed by the exigencies of war and illness are badly off" (Davies, p209). His words still ring true today when he said

We have a duty to restore Building 18 of Walter Reed Hospital and its like to ensure that the highest standard of care is available to those serving men and women who need it.

Cornelius Tacitus, The Agricola

Yahnn Le Bohec, The Imperial Roman Army, English edition 1994

Roy Davies, Service In The Roman Army, 1989 - see Chapter X Roman Military Medical Service, pp209-236

Graham Webster, The Roman Imperial Army, 1979