Public health in Ancient Rome

Ancient Rome was an advanced civilization that lasted in one form or another for over a thousand years. At it's height in 117 CE, Rome stretched from Britain to Bagdad and contained nearly 60 million inhabitants. Unfortunately our view of Rome and the ancient world in general is through rose colored lens. As a general rule, life in the ancient world was filled with constant disease, income inequality, and death. Public health in Rome was almost nonexistent, if one of us were to spend a day in 117 CE on the streets of Rome we would think we were in a third world nation after a natural disaster.
The average lifespan of an Roman was 22 years, this is taking into count the astonishing infant mortality rate that hovered around 50%. If a Roman managed to survive childhood he or she could look forward to encountering the following disease for the rest of their life (their 50's):

Tuberculosis- Caused by the bacteria Mycobacterium Tuberculosis and its variants, the bacteria infects the lungs and is spread by an active patient coughing up the bacteria. Tuberculosis is an insidious bacteria as it can remain latent for decades and cause no health problems until the patient is immunocompromised, where then it becomes active and can be spread. Interestingly enough the bacteria produces no toxins and tissue damage is caused by the body overacting to the presence of the bacteria.

Malaria- Caused by Plasmodium spp, malaria is a parasitic protozoa that has it's life cycle split between mosquitos and human liver cells and red blood cells. The parasite is spread by mosquitoes to humans where it travels to the liver and then goes to red blood cells. Inside the blood cells the parasite develops into a more mature form and erupts from the cell; it is this stage of malaria infection that leads to visible clinical symptoms. Malaria would have been a very big problem in the southern parts of the empire due to the abundance of hot marshlands that were breeding grounds for mosquitos.



Leprosy- Caused by the bacterium Mycobacterium leprae, this bacteria is spread by direct contact with an infected person. The same as with it's cousin Tuberculosis, it is not the bacteria it self that leads to necrosis and joint damage, but the body's inflammatory response to the bacteria. Interestingly enough in North America the armadillo acts as a natural reservoir of M. leprae.



GI infections- Probably the most numerous ways to get sick and die in the ancient world were from GI pathogens such as E.coli, Salmonella enterica spp, Shigella spp, Citrobacter spp, Campylobacter spp, and many more. With no concept of germ theory of disease, and poor to nonexistent hand hygiene; oral-fecal bacterial contamination would have been high. In addition, most Romans in cities would have lived in cramped apartments where waste management meant throwing a bucket of waste out onto the street below.


Streptococcus pneumoniae- An opportunistic bacteria that is carried by roughly 40% of the population. Certain strains have the ability to cause meningitis and sepsis. The bacteria is spread by respiratory droplets from infected persons or non symptomatic carriers. Living in cramped apartments in ancient Rome would have allowed this bacteria to run rampant among the inhabitants of the city.
Gram stain of S. pneumoniae


There are many more diseases that the romans would have faced on a daily basis, but I will stop here before I get ahead of myself.

The good news for us living in 2019 is that all the diseases listed above are mostly treatable and survivable with modern medicine. It is truly amazing that from the discovery of germ theory by Louis Pasteur in the late 1860's to the modern day we have reduced infant mortality to less than 6%, and are living healthier and longer lives that our ancestors could only have dreamed of. So to celebrate our advances in public health, here is an denarius of Alexander Severus with the reverse of the goddess Salus(Safety and Security).





Fun reading on the topic
https://ourworldindata.org/child-mortality-in-the-past

https://www.macrotrends.net/countries/USA/united-states/infant-mortality-rate

https://www.sciencedirect.com/science/article/abs/pii/S1472979215000062

https://timesofindia.indiatimes.com...ancient-Roman-Empire/articleshow/55833159.cms

https://www.medicaldaily.com/ancien...-very-unclean-spread-around-intestinal-368348

 

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Nice writeup!

The Cloaca Maxima (the Great Sewer of Rome), although crude by modern waste disposal solutions, probably kept Roman citizens from suffering even more disease and early death.

Venus Cloacina, the sewer goddess, is relevant to this thread:


Moneyer issues of Imperatorial Rome
L. Mussidius Longus, 42 BCE
AR denarius, Rome mint.
Obv: Diademed and veiled head of Concordia right; CONCORDIA upwards behind; star in right field below chin
Rev: Shrine of Venus Cloacina: Circular platform surmounted by two statues of the goddess, each resting right hand on cippus, the platform inscribed CLOACIN and ornamented with trellis-pattern balustrade, flight of steps and portico on left; L • MVSSIDIVS • LONGVS around above.
Ref: Cr. 494/42b; Bab. 6; BMC 4244; Cr. 494/42 b; Syd. 1093 a


Moneyer issues of Imperatorial Rome
L. Mussidius Longus, 42 BCE
AR denarius, 18 mm, 3.8 gm. Rome mint.
Obv: Radiate and draped bust of Sol facing
Rev: Shrine of Venus Cloacina: Circular platform surmounted by two statues of the goddess, each resting right hand on cippus, the platform inscribed CLOAC and ornamented with trellis-pattern balustrade, flight of steps and portico on left; L • MVSSIDIVS • LONGVS around above.
Ref: Crawford 494/43b; CRI 189a; Sydenham 1094a; Kestner 3758-9 var. (CLOACIN); BMCRR Rome 4252-4; Mussidia 7a.
Acquired from Barry Murphy at the 2014 ANA World's Fair of Money, Chicago, who acquired it from another dealer at the show after I inquired about wanting one .

 

Occasionally I think about how interesting it would be to live in ancient times but I soon bring myself back to reality by remembering how much more likely dying from stuff like deadly diseases, war, and slavery was. I feel fortunate that I don’t have to worry about things like my village being raided tomorrow, or being executed because I didn’t bow low enough to the king. Of course, I do not diminish the fact that some people today around the world still live day-to-day with these kinds of dangers.

 

Great write up & food for thought!...something we don't consider when we revel about ancient engineering feats & the vast realms of ancient empires. Sometimes I think it would be fascinating to have lived in that time...but in reality, NO!

 

Kinda gross but cool post!

I'll contribute a Valetudo with notes cribbed from @zumbly:

M. Acilius Glabrio AR denarius, 49 BCE, from the Quidenham hoard (buried at the time of Boudicca's revolt)
–– Valetudo on the reverse was the goddess of physical well-being. It has been suggested that the Acilia were possibly responsible for the early promotion of private medical practice in Rome, and this may be a reference. It may also refer to Pompey's recovery from a grave illness the year before the coin was issued, an event which was widely celebrated throughout Italy.

 

I am hypochondriac. I didn’t like this article. Since I read it, I feel feverish, a bit dizzy and very nauseous. Do not tell me it’s all in my head. Here is the future epitaph on my grave :

 

Yeah, life was brutal back in the day. This is why things like public execution wasn’t a big deal. Death was more of a reality then than it seems to be in modern times, surviving to your 30’s was an accomplishment. It’s really incredible how drastically life has changed in such a seemingly short time.

It really does put things in perspective for me, how lucky we truly are to even have the chance to survive with such ease, and even to be able to collect ancient coins. They say middle class America lives how an ancient king lived. That’s pretty cool to realize.

 

Pretty remarkable article. Thank You. I have not thought much about this topic to date but it is eye-opening. The growth in modern populations because of basic sanitation and medicine has allowed formerly challenged populations to flourish. Consider the case of Egypt with an estimated population of a couple of million in ancient times to almost 100 million today in a country not much bigger than the state of California. Of course in the old days one probably consulted the gods on the issue of health and protection from disease, including Bes and Hathor. Nothing to stop the spread of malaria and plague in those times. Death was more of an everyday experience, where one could even be eaten by a crocodile while working on irrigation projects near the Nile. No wonder they spent so much time worrying about the afterlife.

 

A coin dedicated to Rome's Poop-Chute:


RR Mussidius Longus
42 BCE AR Denarius
Radiant Sol
- Platform CLOACIN
Sear 494 Craw 494-42


I have been fortunate to have travelled extensively in my career, including many Western Countries in Europe, The Americas, Asia, etc. However, most of my travels have been to "Third-World" or "Third World Areas."

I have had most the shots, malaria pills, gamma globulin (hurts worse than what you are curing!).

I was poisoned in SE China (brutal, life-threatening experience - dislocated my jaw from tossing cookies for 3 days.) I had dysentary from some back-areas in Mexico / Guatemala (not good - it is NOT just a Montezuma's Revenge experience.) I also contracted Typhus when I was a child (around 10 years old) in a FIRST World Country - USA - from a local community public pool. THAT was pretty rough too! I have had all the childhood diseases, but those do not compare to some of my adult experiences.

Yeah, we still have all those old diseases, but in a different form today!

 

Soak them thar Roman coins in Lysol!

 

My youngest son contracted something (Alice and I can't remember what) when he was just a few months old where he had to have gamma globulin shots every two weeks for several months. The poor kid cried every time he saw someone wearing white. They are horrible injections!

 

My first time in Egypt while in college I came up with severe dysentery and high fever which precluded my work in the excavations I was supposed to be working on as part of my studies. Second time I was mildly ill. Third time most recently (2011-2012) I was in and out of the country over a period of four months (also traveled in Turkey and Jordan) and was completely fine no matter what I ate or drank. Hard to figure. Maybe just the aging process or a more effective immune system. I suppose it's possible to gain some additional immunity from more exposure to bacteria, etc.

 

When I travelled that extensively, I would drink a small amount of the local water to "innoculate" myself. I also innoculated myself with the local beers and liquor in accordance to local customs and culture...

 

As bad as it was in Rome, Rome was probably the best, and safest place to be back then. I can only imagine what the rest of the world was like.

 

One of my favorite SALVS coins:

 

Life would have been pretty miserable anywhere back then, but honestly the cities would have been worse. Most of the population lived in cramped apartments (insulae) this would have been a perfect breeding ground for respiratory diseases, water and arthropod borne diseases due to the very close proximity of many people. All it takes is one person with the flu to get everyone on the block sick.

 

As a teacher of history one of the places I have always liked visiting, and presumably will wind up spending a great deal of time in, is a cemetery. I like to read the tombstones and meditate on what one can decipher from the information formation provided. The saddest are of the family plots where parents buried their children. Until the discovery of microbes and infection parents could expect that half their children would never grow up. The idea that parents did not feel the loss as much as we would is nonsense. I recall visiting a museum in ancient Rome many years ago and seeing a funerary sculpture that was placed on the tomb of a toddler showing him languidly playing with his worthless bulla and a rattle. Those parents must have suffered and felt a great loss to have placed that sculpture there. As much as I love to read about and study the past I am darn glad my living then and there is purely vicarious.

 

A side note: Humans back then were not different than us today. I believe it was Cicero who wrote that man could expect to live to about 80 years...if he/she were not killed earlier by some of those diseases above.....if my 88 year old brain remembers correctly

 

Wow, I am sorry your son had to go through that. I am sure it impressed on his mind. For years my wife tried to get me to go swimming in public pools with her. For some reason, I just did not care to go. It dawned on me a few years ago that my episode of typhus at a young age, and knowing that I contracted it from a public pool, was why I was subconsciously resistant to swimming in pools. Oh, well, LOL, I never contracted typhus again!

 

Not that it did much good, but the Roman people put much faith and credence into the worship of SALVS (Greek equivalent, more or less, of HYGIEIA). Here is a denarius of circa 49 BC showing SALVS and the inscription SALVTIS wishing the user of the denarius, "Good Health" while on the reverse is VALETU(do) or "Fare well" with the serpent of Asklepios which she was responsible for feeding. It is interesting that several of the Romance languages use a variation of her name for modern versions of good health and faring well. The denarius weighs 3.71 grams and is Sear 412.