The Know

In the book of Alma, Helaman recounts how he led over two thousand of the sons of the Anti-Nephi-Lehies to battle on multiple occasions. Helaman, who would call these youth his sons (Alma 56:46), furthermore recounted that on two separate occasions a great miracle was seen: they went to battle and suffered no casualties, even when they suffered many wounds. In Helaman’s own words,

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 we do justly ascribe it to the miraculous power of God. (Alma 57:25–26; compare 56:55–56)

Despite the clearly miraculous nature of this event, some have questioned whether a miracle like this is rationally possible.1 One skeptical reader noted that “the epic tale of the stripling warriors and their miraculous recovery from life-threatening trauma would appear, to the rational mind, highly unlikely or even outright impossible. … The claims of Helaman’s epistle can only be accepted on the principles of religious faith rather than scientific reasoning.”2 Linking this episode to class 4 hypovolemic shock based on the Advanced Trauma Life Support (ATLS) shock table, that reader went as far as to say such a medical diagnosis would be “a sure harbinger of death” that would not be easily treatable without modern medical intervention, such as a timely blood transfusion.3

However, according to a fully documented treatment in 2023 by Latter-day Saint physician Gregory L. Smith, fainting due to blood loss is not a “sure harbinger of death.” Many physicians have demonstrated the ATLS shock table contains unreferenced classifications with “no evidence to fully support it.”4 Smith has noted that “the shock table itself has no basis in research” and “is an oversimplification that provides a framework for the overwhelmed and worried student or physician who encounters trauma infrequently.”5 Moreover, in contrast to the ATLS shock table, it is quite possible for a patient to faint from blood loss before reaching the point when they would need a blood transfusion to prevent death, especially when combined with other factors that would be typical in warfare.

Another item to keep in mind is that it is possible that Helaman’s analysis that his soldiers “had fainted because of the loss of blood” is likely a generalization of many events and causes, especially because Helaman lacked knowledge of modern medicine. Smith rightly observed, “There are several other possible causes [of losing consciousness], however, that an ancient author might mistakenly attribute to severe hypovolemic shock. Quite simply, soldiers can pass out from many things besides massive hemorrhage.”6

For example, it is possible that Helaman’s stripling warriors fainted due to vasovagal syncope, a condition involving the parasympathetic nervous system that affects blood pressure and heart rate. Vasovagal syncope is “the most common cause of fainting.” Further, “in modern settings, [vasovagal] syncope is incredibly common in the young.”7 This condition typically involves “a perfect storm of effects: less blood returning to the heart, a lower blood pressure via several causes, and a lower heart rate. Further, these effects can have a type of positive feedback—a slower heart rate can cause even lower blood pressure, for example.”8

Physicians and researchers have observed a wide variety of factors that can cause vasovagal syncope. These can include severe pain, emotional stress such as fear or anxiety, dehydration, exertional heatstroke, heat exhaustion, spinal shock, concussions, and postural hypotension.9 Many if not all of these factors could easily be found among soldiers in a battle. Moreover, these factors are not mutually exclusive; they could compound to induce fainting sooner.

Smith concluded, “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.”10 In short, the account of two hundred soldiers fainting partly due to blood loss is much more realistic than has been previously understood.

This is also apparent when other cases of fainting due to blood loss are taken into consideration, especially those that occurred in times before modern trauma care was developed. In these cases, it is clear that fainting could occur from either a minor or major loss of blood depending on the circumstances, and a full recovery was possible in even the most severe cases. For example, one US Civil War surgeon wrote, “In occasional instances, severe convolutions are caused by small losses of blood,” which typically rendered patients unconscious for a time. This same surgeon also noted that the return of consciousness could attend more severe cases of syncope.11 In one case in 1734, a woman “was very faint” from suffering “a great loss of blood …  and she gradually recovered.”12 Similar cases were reported in 1825 and 1856 of women who were “almost lifeless from loss of blood” and were “discovered to be half full of blood,” and both women made a full recovery.13

The Why

First and foremost, when considering this miracle it is important for modern readers to read it as what it claims to be: a miracle. It may seem unlikely that any army could naturally survive multiple battles with no casualties, especially in a premodern setting. However, if a reader believes in an intervening God, it is not so impossible to think that God could protect these youths from death in a display of His love and power and in response to their faith and to the priesthood blessings given by their leader, the high priest Helaman.

It was such a profound miracle that it caused “great astonishment” among the Nephite army as well. This was not something Helaman could explain in any way other than that the Lord had protected these faithful soldiers: “And we do justly ascribe it to the miraculous power of God, because of their exceeding faith in that which they had been taught to believe—that there was a just God, and whosoever did not doubt, that they should be preserved by his marvelous power” (Alma 57:26). Nothing else they did or could have done brought about this marvelous result. Because this was a miracle, we need not expect to fully understand how it might have been done or understood anciently.

Nonetheless, modern medical research illustrates that it is indeed possible for young soldiers to have fainted after a battle due to mild blood loss combined with other factors and subsequently survive. Even with modern medical knowledge to help explain how this phenomenon might have occurred anciently, this miracle is in no way diminished. The fact that vasovagal syncope (or any other potential cause for fainting) could have occurred two hundred times and invariably resulted in the revived health of the individual is nothing short of a miracle. Indeed, “we can cheerfully agree with Helaman … when we conclude that the story is indeed amazing. … This, of course, is what made Helaman tell the story in the first place.”14

As Elder B. H. Roberts taught in 1911, “miracles are not, properly speaking, events which take place in violation of the laws of nature, but that they take place through the operation of higher laws of nature not yet understood by man; hence the occurrences which are called miracles are only so in appearance, and we may confidently expect the day to come when they will cease to appear as miraculous.”15 This lucid explanation can be applied especially well to Helaman’s report: what was once considered fantastical by critics actually has, as time has shown, reasonable explanations. God, operating on higher laws, could have therefore worked together with ordinary means to preserve the lives of these faithful youths.