Contrary to the common assumption, the 'germ theory' (microbial theory of pathological conditions), although invaluable to the subsequent development of medicine and related fields of knowledge, was not necessarily a paradigm shift. 'Germ theory' was essentially a series of observation and experiments that allowed the scholars to identify the pathogens and their role in the process of infections and transmission of various conditions what allowed them to develop much more accurate and efficient ways of curing and preventing infectious diseases. But long before these scientific breakthoughs, people generally had an instinctive understanding of the link between dirt and infections as well as of the various infection vectors, even though they were unable to explain them adequately (in other words, they understood that one should keep wounds as clean as possible even though the did not know that the infections were caused by minuscule living organisms).

And there is one more thing. Human body is pretty resilient in its own right, especially in the case of young, strong, healthy and relatively well-fed people like the gladiators. In theory, one can become superficially injured every day, do not use any sort of disinfectant and still never develop any serious infection, due to the efficient operation of an immune system. Of course, in practice, it is quite possible that at least some of these wounds could have been infected with e.g. Clostridium tetani bacteria, leading to serious complications (especially given that tetanus spores are quite resistant to antiseptics and short-term application of high temperatures). But please remember, than even non-treated tetanus (and from the modern perspective most if not bacterial infections, especially internal ones, were impossible to be efficiently treated until late 19th century and development of the earliest antibiotics) is not a death sentence as its mortality is estimated to circa 30-40%, meaning that majority of affected people had a at least some chance to recover. The same can be said about other bacterial infections.

Also please note that even though the practice of inflicting deliberate wounds to make combat more entertaining is not exactly well corroborated by the contemporary sources, gladiatorial fight were by nevertheless quite hectic and thus inherently dangerous with at least some damage bound to happen. And as it can be inferred from the medical texts of the era, it was not uncommon to suffer various wounds not only during actual show where real, sharp weapons were used, but also in training, with bruises and minor cuts being the everyday nuisance for the gladiators.

Galen, who worked as a doctor in a gladiatorial school in Pergamon between 158 and 161 CE has written in length about the methods he used to treat the wounds suffered by the gladiators during the training and combat. In Drugs by Kind he also boasted that although fatal results of wounds were not unknown, during his tenure none of his charges died of wounds that were not considered fatal in the first place. Galen mentions that he replaced cleaning of wounds with hot water and application of flour-based plasters with oil-based wound dressing utilizing various plant materials, such as silphium, commiphora, fennel or spurge, as well as the minerals known for their healing properties, such as verdigris and similar copper alloys. Physicians of that time were already well-versed in the styptic (anti-hemorrhagic) and anti-inflammatory properties of various substances. Given that Galen left accounts on more or less successfully healed deep wounds that resulted in muscle and tendon damage, we might assume that superficial wounds were not overly difficult to treat effectively. It was also noted by Galen and his contemporary physicians that wounds suffered in summer tend to get inflamed more often (presumably because of more profuse perspiration and increased bacterial growth on contaminated objects) and they suggesting that the 'heat' from the wounds should be 'drawn out' by wrapping the affected area with linen bandages doused in wine and vinegar, collecting the excess fluid with sponges. Now we know that although quite painful in initial phases, such treatment created strongly acidic, and thus hostile environment for many pathogenic microbes, facilitating healing. It is telling that in his Method of Medicine Galen notes that inflammation is not a given, and if the proper treatment is administered, it is possible for a wound to start healing without complications two to four days after being inflicted.

It is worth noting that Galen, quite quick to criticism his colleagues, he usually focused his ire on the attempts to suture various tissues together, although he doesn't criticize the suturing of the superficial wounds and it seems that he used already existing techniques what suggests that they were adequate, especially with proper cleaning and post-operational treatment.

Marcus Terentius Varro (116-27 BC) posited even that any sort of suppuration is a sign of contamination caused by an inadequate cleaning of the wound and much as Galen, he was in favour of frequent cleaning and re-dressing the wounds to keep them as dry and clean as possible. It is also worth noting that Varro was also aware that the contaminants need not to be visible, and thus the cleaning of wounds should include thorough washing, not only removal of visible contaminats, such as sand, dirt or fibers. In his warning against settling near the marshlands, he noted that 'swamps breed certain minute creatures which cannot be seen by the eyes, but which float in the air and enter the body through the mouth and nose and cause serious diseases.' This is pretty much one of the earliest speculation about the existence of invisible pathogens, although adverse results of the swamp vicinity were usually caused by presence of mosquitoes transmitting malaria and the contamination of nearby water sources, as the marshlands by themselves are not repsonsible for any airborne diseases.

Either way, ancient Romans were already well aware of the contamination of wounds and knew various methods of protecting the wounds from infection, most likely resulting from the centuries old hit-and-miss attempts followed by observation. Superficial wounds were most commonly washed with wine or vinegar (possibly meaning the same substance, i.e. old wine that oxidized and was no longer fit for pleasant consumption) what was a good choice, given that acidic environment is generally hostile to many pathogenic microorganisms. They also used various natural tree resins that contain aromatic compounds presenting strong antibacterial properties (the common use of carbolic acid as a common disinfectant since 19th century might be considered a natural, more streamlined successor of the ancient approach), and honey that due to high sugar content and possibly also minor content of naturally forming hydrogen peroxide could have also facilitated wound healing. It is almost certain that ancient Roman physicians did not understood the exact processes behind increased healing but the fact that usage of such substances resulted in more recoveries than other methods was enough for them to use it and advocate such practices.

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Forrest R.D., Early history of wound treatment. Journal of the Royal Society of Medicine. 1982, no. 75, pp. 198–205.

Majno, G., The Healing Hand; Man and Wound in the Ancient World, Harvard University Press, 1991.

Magner L.N., The art and science of surgery. A history of medicine. Marcel Dekker, New York 1992.

Salazar, C.F., The Treatment of War Wounds in Graeco-Roman Antiquity. Brill, Leiden 2000.