DISEASE

Not surprisingly, the inhabitants of ancient Rome suffered from a wide assortment of diseases. Malnutrifion and the lack of a varied diet would have caused diseases such as scurvy, pellagra, beriberi, and rickets.

The poor level of sanitation would have encouraged many other diseases as well. The presence everywhere of carcasses and excrement, both animal and human; the scavenging dogs, birds, rats, flies, and other vermin; the contamination of the water supply; and the general overcrowding would all have combined to foster the growth of diseases and to rapidly spread them throughout the city. These unsanitary conditions would have made four groups of diseases very common.

One group of organisms frequently found in excrement consists of enteric viruses, such as rotaviruses, parvoviruses, and at least 67 different varieties of enteroviruses. The most common health hazard posed by these viruses is gastroenteritis. Some of the enteroviruses also cause meningitis, which can cause blindness, brain damage, and, frequently, death. Also in this category is the virus causing hepatitis A, a highly infectious form of the disease that produces episodes of fever, lassitude, vomiting, and jaundice, which can persist for weeks.

The second group of disease-causing organisms abundantly present in feces is bacferia. These include the common Escherichia coli bacterium, which causes the familiar 'Traveler's diarrhea" form of gastroenteritis. Another common bacterium found in feces is salmonella, producing salmonellosis, which results in the usual array of gasfroinfestinal ailments but can sometimes invade the respiratory, cardiovascular, and nervous systems as well. Yet more serious is typhoid fever, which is caused by a bacillus of the salmonella family. Vicfims of typhoid are struck with fever, malaise, and diarrhea, and the disease can damage the spleen and intestines.

The third category of organisms is certain parasitic protozoans, which, when transmitted to the gastrointestinal tract, produce diarrhea and infection. These include Giardia lambli (which causes giardiasis). Entamoeba histolytica (causing amebiasis), and Balantidium coli (which causes balantidiasis).

The final group is parasific worms. The mosf common of these are the nematodes, such as hookworms, threadworms, roundworms, pinworms.

And whipworms, and the cestodes, which are various species of tapeworm. While the majority of these parasitic worms are usually not fatal to their hosts, their presence can result in a variety of health problems and substantially weaken infected individuals. On occasion, death might even result, as when roundworms sometimes collect in sufficient quantity to produce a fatal obstruction in the bowels.

One of the most dangerous waterborne diseases, cholera, does not seem to be definitively attested in ancient Rome. The vagueness of ancient descriptions of illnesses makes it difficult to identify diseases for certain, but if cholera were present in ancient Rome, the resulting mortality rates would have been quite high. Dysentery caused by contamination of the water supply would also have been common.

Rome's location near swampy ground and the low-lying areas of the city itself would have offered breeding grounds for mosquitoes, and malaria clearly was a problem. When a carrier mosquito bites a human, parasites are transmitted to the bloodstream and establish themselves in the liver, where they multiply and further infect the bloodstream. While malaria is usually not a fatal disease, bouts are often lengthy and debilitating, and those stricken suffer recurrent episodes of enervating fever and malaise.

The inhabitants of the ancient world formed strong associations between marshes and diseases, although they usually ascribed this connection to "bad air" rather than to insects. Columella, for example, warned that dwellings should not be placed near marshes, "from which are often contracted mysterious diseases whose causes are beyond the understanding of physicians" (Columella, On Farming 1.5).

Malaria has sometimes been identified as the principal agent in the decline of various ancient civilizations. While this view is probably too extreme, the disease was plainly a serious problem whose victims may have included such notable individuals as Julius Caesar and Augustus. In Rome, malaria seems to have been a major health threat that killed large numbers of the city's inhabitants outright and weakened many more, leaving them susceptible to other diseases. Studies of the seasonality of deaths in the city of ancient Rome reveal a strong peak in mortality from August to October, which probably correlates to the malaria season.

While ancient Rome was inferior to modern cities in so many aspects of public health and engineering, in terms of the vulnerability of the water supply to contamination and the speed with which it could recover, the peculiar nature of Rome's water-supply system may actually have made the ancient city both unusually resistant and resilient.

First of all, the continual-flow nature of Rome's water-supply system would have ensured that contaminants did not linger in the pipes and basins but were instead flushed out fairly rapidly and prevented from settling in standing pools of water within the system. The volume of water passing through Rome's water-supply system was enormous, exceeding

Figure 7,4 Model of the center of Rome, giving a nice impression of the densely packed buildings and narrow streets that formed the heart of the city. The Imperial Fora are in the center, and the infamous, lower-class Subura district is immediately behind them.

The per capita water consumption rates of most modern cities. Another quirk of Rome's water supply was that the majority of water did not originate locally but rather was transported a considerable distance to the city by aqueducts. Most of these aqueducts brought water directly from springs located on high ground up in the foothills of the Apennines. These water sources would have been completely unaffected by local disasters such as floods, so their water would have remained pure and uncontaminated.

One sometimes hears that the Romans were relatively healthy because of the public baths where people could bathe frequently. While this might have helped keep them free of dirt, it probably did not improve their overall health, since a standard prescription given by Roman doctors to those suffering from diseases was to go soak in the baths. The warm waters there would have provided an ideal environment for transmitting diseases to the other bathers. The ancient physician Celsus records in his medical writings that he advised his patients suffering from skin diseases, boils, rabies, tuberculosis, fevers, diarrhea, and parasitic worms to go soak in the baths frequently.

While the Romans did not seem to be upset at the thought of sharing bathwater with the diseased, they do seem to have been bothered by having to look at people with diseases while bathing. There are references to those with illnesses having to keep their clothes on while bathing and to

Healthy bathers making fun of their unfortunate bathing companions who had visible ailments. In one instance, the bath attendant allowed a disease-ridden old woman to enter the baths but first extinguished the lamps so that her affliction would not be visible.

It is estimated that under these conditions one-third of babies died before they were one year old, and half never survived childhood. Even the rich were not immune, as evidenced by Cornelia, the mother of the Gracchi brothers, who gave birth to 12 children, yet saw only 3 of them reach adulthood.