Helaman’s Fainting Soldiers

During the military conflicts recorded in the book of Alma, Helaman wrote a letter recounting the miraculous preservation of his young soldiers:

And it came to pass that there were two hundred, out of my two thousand and sixty, who had fainted because of the loss of blood; nevertheless, according to the goodness of God, and to our great astonishment, and also the joy of our whole army, there was not one soul of them who did perish; yea, and neither was there one soul among them who had not received many wounds. And now, their preservation was astonishing to our whole army, yea, that they should be spared while there was a thousand of our brethren who were slain. And we do justly ascribe it to the miraculous power of God. (Alma 57:25–26)

Two things are worth emphasizing from this account. First is the explicit designation of this outcome as a miracle. The fact that so many wounded soldiers survived such a conflict, including the relatively small percentage who fainted, was seen as “astonishing.” Second is the interesting comment that “two hundred” of these soldiers specifically “fainted because of the loss of blood.”

Attributing Fainting to Class 4 Hypovolemic Shock

In an article published in 2002 in the journal Dialogue, Robert Patterson assessed this story from a modern medical perspective.¹ Taking Helaman’s description at face value (i.e., that the soldiers fainted strictly due to blood loss), Patterson proposed that they must have experienced Class 4 hypovolemic shock, the most severe category of a four-class schema. This diagnosis is outlined in the Advanced Trauma Life Support (ATLS) program produced by the American College of Surgeons Committee on Trauma. As explained by Patterson,

Class 4 hypovolemic shock means that the patient has lost 40 percent or more of his blood volume. Only in Class 4 does loss of consciousness transpire. Death occurs after a deficit of 50 percent of blood volume. Thus, the window between loss of consciousness (40 percent blood loss) and death (50 percent blood loss) is small indeed. Treatment for Class 4 hypovolemic shock involves immediate intravenous fluid replacement, preferably with whole blood or packed red cells. With such severe blood loss, unless a patient is transfused in a timely manner, he will die. If a bleeding patient is transfused after too long a delay, he may still die, as shock soon reaches a point where the process of cellular physiologic decay becomes irreversible, despite aggressive fluid resuscitation.²

Even if it were assumed that the Nephite medical knowledge and treatments were somewhat more advanced than other known ancient cultures, Patterson still found the story to be scientifically problematic:

In any case, with loss of consciousness as in Class 4 hypovolemic shock, the treatment consists not only of control of ongoing bleeding, but also of immediate fluid resuscitation. Without a timely blood transfusion, the victim will die. Thus, Helaman recounts the saga of two hundred young men who suffered significant physical trauma and then bled to the point where they lost consciousness—a sure harbinger of death. All two hundred then spontaneously recovered, with no fatalities recorded. According to our current understanding of human pathophysiology, such an event is so extremely unlikely as to border on the impossible.³

Limitations of the ATLS Shock Schema

“That no one died in the battle is certainly miraculous,” writes Latter-day Saint scholar and physician Gregory L. Smith, “but it may not be accurate to portray all unconsciousness as ‘a sure harbinger of death.’”⁴ In a recent publication reviewing this topic, Smith notes that the ATLS shock schema referenced by Patterson is not particularly reliable. In actual practice, the “vast majority of trauma patients do not fall neatly into its outlined categories” and “the level of consciousness tends to drop sooner than the schema suggests.”⁵ Surprisingly, Smith points out that while somewhat helpful as a generalized approach to trauma, “the shock table itself has no basis in research.”⁶

Smith’s conclusions derive from research that post-dates Patterson’s Dialogue article. For instance, after reviewing relevant findings in an article from 2010, Smith concluded,

Thus, in penetrating trauma—likely the best match for the type of wounds suffered by Helaman’s stripling warriors—level of consciousness diminishes without the severe drop in blood pressure or rise in heart rate that ATLS class IV shock would require. This strongly suggests that a lesser amount of blood loss can still cause impaired consciousness.⁷

A second study from 2013 notes that the ATLS schema “seems to dramatically underestimate the degree of mental disability associated with increasing heart rates.”⁸ In other words, for various reasons, patients might exhibit symptoms of cognitive impairment well before reaching Class 4 in the schema. The main point here is simply that it seems quite possible for a patient to faint from blood loss before reaching the point where they would need a blood transfusion to prevent death. Modern accounts of this very outcome are provided by Smith in the Appendix to his article.⁹

Fainting for Reasons beyond Blood Loss

The bigger concern, however, may be due to Patterson’s fairly narrow interpretation of Helaman’s statements. While acknowledging at one point that “Helaman might have wrongly attributed a cause-and-effect association with blood loss and fainting,” this possibility isn’t seriously considered in most of Patterson’s analysis.¹⁰ This seems problematic since there is no compelling reason to assume, in the first place, that Helaman was providing a scientifically accurate explanation for every single instance of fainting experienced by his soldiers. It seems more likely that his statement reflects a generalized, non-scientific explanation for why many of his soldiers appeared to experience loss of consciousness or perhaps other forms of cognitive impairment.

With these interpretive considerations in mind, Smith outlines a number of additional possible causes for fainting that don’t require blood loss. A condition known as vasovagal syncope is actually “the most common cause of fainting” and is also “incredibly common in the young.”¹¹ Factors which might trigger this condition include pain, fear, anxiety, emotional stress, dehydration, exertional heatstroke, heat exhaustion, spinal shock, concussion, and postural hypotension—all of which would seem more likely to transpire in this type of military context.¹²

This opens up the possibility that the fainting of soldiers may have been due to a variety of causes. As concluded by Smith, “These factors could easily combine with even mild blood loss to cause unconsciousness, which contemporary observers might easily have concluded was largely or wholly due to bleeding.”¹³

Symbolic Significance

In a study on several Nephite cultural practices, Mark Wright noticed an interesting pattern. Numerous individuals in the Nephite record fall to the ground in some type of coma, loss of consciousness, helplessness, or exhaustion. In most of these instances, the individual who falls to the ground has some sort of visionary experience or miraculous healing. Examples include Lehi, Nephi, Alma the Younger, Zeezrom, King Lamoni and his household, and Ammon (on more than one occasion).¹⁴ While the details may differ, these experiences are laden with the theme of death and rebirth—symbols which are particularly fundamental to the doctrine of Christ.

While no mention of visionary experiences or religious healings is made in relation to the soldiers who fainted in Helaman’s army, their recovery still appears to be symbolically significant. It should be remembered that the social identity of these stripling soldiers began with King Lamoni falling to the earth as if dead, and then rising again (Alma 18–19). That was the miracle that initiated their people’s distinct existence as a righteous Lamanite sub-group.

In addition, they were also called the “people of Ammon” (Alma 27:26)—named after Ammon the missionary who, as Wright put it, “appears to have fallen to the earth more than any other individual in the Book of Mormon,” only to rise again unharmed.¹⁵ The language Mormon uses to describe the miraculous preservation of these stripling Ammonites even somewhat mirrors the Lord’s blessing of preservation upon Ammon and the sons of Mosiah:¹⁶

Thus, the fact that approximately two hundred of these Ammonite soldiers fainted and then recovered—whether due to natural or supernatural causes, or both—would likely have been seen as a continuation of their particular religious heritage. It was a culturally appropriate miracle and a sign that God was indeed with their people due to their covenant faithfulness, just as he had raised up Ammon and King Lamoni after they had fallen unconscious.

Conclusion

It is certainly interesting that what seemed highly implausible to one observer in 2002—based on a widely-accepted shock schema—is not so outlandish after all. Smith writes, “It is no small irony that an account presented to demonstrate God’s miraculous preservation has more medical plausibility than we might expect.”¹⁷ As explained elsewhere by Smith,

Given all the possible options, the temporary loss of consciousness in 10 percent of Helaman’s force does not seem so implausible. It is premature, then, to assume that all the stripling warriors who lost consciousness did so because of blood loss. When bleeding was a factor, we should not conclude that they were all in level IV shock, virtually doomed to death without medical intervention.¹⁸

That being said, divine intervention was probably involved in the recovery of at least some of the soldiers who lost consciousness. The greater miracle, which shouldn’t be downplayed, is simply that none of them died at all—whether in combat, subsequently from wounds, or after fainting. In that more general sense, the modern reader can certainly agree that “their preservation was astonishing” (Alma 57:26). It should also be pointed out that purported miracles can neither be proven nor disproven by known scientific principles. Therefore, if one wants to reliably test the Book of Mormon’s historical or scientific claims on secular grounds, one will have to select patently non-miraculous examples for the analysis.

And in that vein, the literary implications of this story are quite intriguing. Whether fact or fiction, scientific or miraculous, the fainting and recovery of these 200 soldiers appears to hold symbolic significance. It is part of a consistent textual pattern that reinforces the redemptive power of Christ—his ability, against all odds, to raise us up from spiritual and even physical death. That those being preserved in this manner were none other than a band of Ammonite warriors is especially apt. If the poorly educated Joseph Smith concocted this story, he infused it with a surprisingly subtle and rich layer of symbolic meaning.

Gregory L. Smith, “‘All Bleeding Stops … Eventually’: Helaman’s Warriors and Modern Principles of Trauma Revisited,” in Steadfast in Defense of Faith: Essays in Honor of Daniel C. Peterson, ed. Shirley S. Ricks, Stephen D. Ricks, and Louis C. Midgley (Orem, UT: Interpreter Foundation; Salt Lake City, UT: Eborn Books, 2023), 223–246.

Mark Alan Wright, “Nephite Daykeepers: Ritual Specialists in Mesoamerica and the Book of Mormon,” in Ancient Temple Worship: Proceedings of the Expound Symposium, ed. Matthew B. Brown, Jeffrey M. Bradshaw, Stephen D. Ricks, and John S. Thompson (Orem: UT: The Interpreter Foundation; Salt Lake City: Eborn Books, 2014), 247–252.

Alma 57:25–26

Alma 57:25–26