RESULTS

In total, 103 musculoskeletal injuries were detected during 81 combats (Table 1). The most commonly involved areas were the shoulder (15.5%), the head (14.5%), the cervical vertebrae (14.5%), and the thoracic vertebrae (8.7%; Table 2). The related weapons were spear (n = 52); sword (n = 9); arrow (n = 9); stone (n = 8); and cane, animal, the hand, Chariot race, and broken yoke (each pertaining to one injury). Fifty-four combats (66.6%) resulted in death.

 Overall, four wounded warriors were gods/ goddesses, and the remaining were mortals: Greek (n= 21), Trojan (n= 55), and Lykian (n= 1). The wounds, which eventually ended up with death (n= 40), were caused by spear (n= 4), sword (n= 4), stone (n = 4), and stone and sword (n = 3). Two musculoskeletal injuries were treated with therapeutic herbs. Compound of milk and essence of fig were also used.

DISCUSSION

In this historic review, the authors tried to de- scribe the musculoskeletal injuries in Homer’s Iliad, which is still one of the greatest war stories of all time. Overall, 103 musculoskeletal injuries that had taken place during 81 combats were found. Without any dispute, there might have been thousands of injuries in such a war (which lasted approximately 10 yrs); however, those concerning the musculoskeletal system and those described by Homer have been re- viewed. He actually tells about a period of 45Y52 days of the war^4Y6 and injuries of prominent war heroes.

Frölich¹⁰ was the first to report on the details of the wounds in the Iliad. According to him, the total number of wounds was 147, of which 31 affected the head; 16, the neck; 79, the trunk; 10, the upper extremity; and 11, the lower extremity. In a similar article, Santos⁷ reported a total of 130 wounds, 22 of the head and 19 of the neck region. Herein, the authors believe that these differences may stem from the variations in translation methods. Again, similar to Fro¨ lich but different from Santos, Majno¹¹ re- ported 147 injuries with a 77.6% mortality rate. The authors think that their lower mortality rate (66.6%) might be caused by the fact that injuries outside the musculoskeletal system (e.g., head and thorax) in- crease the mortality.

During the combats, warriors might have nat- urally been wounded at multiple body regions. However, the injuries affecting the thorax and the abdomen were not taken into consideration. For example, during the combat between Peiros and Diores (Table 1), Diores seems to have been wounded from the calcaneus. Notwithstanding, he died be- cause of his fatal abdominal injury, not because of the calcaneal fracture. Another example would be the combat between Hector and Patroclus, one of the most famous ones in the Iliad. Achilles, who was the main character of the poem, withdraws from the war after his commander-in-chief Agamemnon’s misguided decision to seize Briseis (Achilles’ captive woman). He declines all appeals for returning to the battle but eventually decides to send his com- rade, Patroclus, into the fray, where he was killed by Hector (because of a penetrating abdominal trauma). Thereafter, Achilles enters the fight and kills Hector in a single combat (Fig. 2), whereby his death be- comes the harbinger of Troy’s defeat. Again, Patroclus’ injury was not included in this study because it was not of musculoskeletal type.

In keeping with the previous literature, the results of this study have shown that spear was the most commonly used (63.4%)Vand the most fatalVweapon described in the Iliad. Likewise, the

number was reported to be 55.3% by Santos,⁷ 62.9% (for thoracic injuries) by Apostolakis et al.,⁴ and 58.0% by Konsolaki et al.⁸ Sword was the second most commonly used weapon in all those articles and according to the results of this study as well. More- over, Schliemann’s archaeologic excavations have confirmed these findings, whereby he found bronze spearheads with an average size of 65 cm (Fig. 3).

Another important finding of this study is re- garding the treatment descriptions of battle wounds. In the Iliad, aside from their fighting in the battle- field, Mahaon and Podaleirios (the two sons of Aesculapius, the god of medicine) are also referred to as physicians. They are reported to have performed therapeutic/medical interventions in various injuries. Homer usually describesVin detailVthe removal of arrows by Machaon or by his brother with a knife and their subsequent medicine/herb administrations nursing the wounds. Such detailed descriptions of the interventionsVin addition to those of the injuries (e.g., fracture of the first cervical vertebra; book 14, verses 459Y475)Vmay imply that Homer not only had a good knowledge of anatomy/medicine but also was closely associated with the battlefield. Lastly, because the life of a physician was worth that of many men in the ancient Greek society, Homer also men- tions that the Greeks went into deep grief when Machaon (Ba fine surgeon and a brave warrior,[ as he refers) was wounded by Paris.¹² The details of treat- ments (i.e., herbs, dressings, and bandage methods) applied by HomerVnot mentioned in the IliadVcan be found in the study by Majno.¹¹

There seems to be two limitations in this study (or in similar others). The first is the cultural and language differences between various translations of the Iliad.^13,14 The other would be related to the fact that Homer’s Iliad summarizes a limited part of the very long war during which several other inju- ries had possibly ensued. Nonetheless, these issues pertain to historicVnot medicalVlimitations.

In closing, providing a historic snapshot on the war of Troy, the authors tried to take the readers through a discussion on the musculoskeletal inju- ries and their management in those ancient times. Despite the long period in between, unfortunately physicians/surgeons are still faced with war injuriesV of different types (i.e., gunshot, landmine, or chemical weapon injuries)^15Y20 and well documented psycho- social consequences (e.g., posttraumatic stress dis- order, war neurosis)^13,14,21 as wellVin the current medical practice. Further, even particular technol- ogies in the area of health sciences are being de- veloped because of wars (i.e., ultrasound imaging after its use as echolocation of battleships during the first and second world wars). In this regard, the authors strongly hope that, at least in the near fu- ture, physicians are left with only natural health problems to tackle, not with those artificially gen- erated by human beings.

FIGURE 3 The weapons used in the war of Troy (drawn on the basis of the ruins in Hisarlık).