Disease in Imperial Rome

Imperial Rome is often thought of as one of the great civilizations and empires of all time. The prevalence of disease in Rome's history is often overlooked. As said by Roman Physician Galen, "This populous city, where daily ten thousand people can be discovered suffering from jaundice, and ten thousand from dropsy."^[1] While there are few documents remaining from the time period documenting demographics and other factors in disease, bone studies help to indicate various diseases, and speculations can be made on why the diseases we know existed were rampant through the empire.

Causes

Hygiene

Sewer system

Hygiene in ancient Rome was not ideal for combatting diseases. Their sewer system, praised for its longevity, had many flaws. As Water History’s Roger Hanson explains, street drainage and sewage flowed through the same pipes, which led to sewage openings on the streets. Also, since most sewer systems were privately owned, they were also privately maintained and in turn neglected. Instead, citizens would turn to their latrines; if they lived on anything but the ground floor they would even throw their excrement onto the street. This led to exposure of sewage to flies, dogs, and bacteria, all of which helped spread disease among Romans.^[2]

Bathing

The high poverty rate in Rome led to a need for public baths, or thermae since it was uncommon for the middle class citizens to own one of their own according to journalist Jay Stuller. When the heated bath water was not chemically cleansed or filtered with chemicals such as chlorine, bacteria thrived and spread. When Christianity came to Rome, it saw the public nudity of the bathing system and saw it as debauchery and therefore frowned upon. While the bathing system may not have been pristine, abstaining from cleanliness altogether brought upon many more potentially fatal diseases, especially in infants. This trend started and ended in Rome. As the necessity for bathing became recognized, the protests of the Christian church died down and a new elaborate bathing system was designed under the rule of Emperor Augustus. Even an imperial-version sauna was created for cleansing the body of toxins.^[3]

Diet

In contrast to today's diet, Romans ate little meat. According to scholar Linda Gigante, they consumed large amounts of grain, fruits, and some vegetables. Similar to the diet encouraged by modern United States' food stamps, the poor were given monthly supplies of grain and hardly had money to pay for anything else. Due to this, many Romans suffered from malnutrition and multiple vitamin deficiencies. Even those who had money for food didn’t always have the best choices. There was no food and drug regulatory agency in ancient times, so low food standards brought contamination and parasites. Also apparent is the water quality. The Roman Army’s drinking from the contaminated Tiber River contributed to their vulnerability to many diseases.^[4]

Environment

Population density

Rome had an extremely high population, and remnants of buildings suggest the average living space was very small.^[1] Many people crammed into small spaces led to very high rates of infection for transmittable diseases. The Antonine and Cyprian plagues were transmitted through touch, so a dense population rate would contribute highly to their spread.

Deforestation

Deforestation of Rome’s cities, particularly near the Tiber River, led to higher disease rates. The causality is as follows: deforestation lead to a rising water table, which increased marshes. This increased the larva in Rome, and in turn increased disease borne from blood-sucking bugs. As in many of today’s third world countries, mosquitos and other vectors were carriers of various diseases, such as malaria and the Ross River virus.^[5]

Diseases

Influenza, colds, and other ailments were just as apparent, if not more, in Imperial Rome as in today’s life. However, they had many more noteworthy afflictions from catastrophic plagues to sexually transmitted diseases.

Plagues

The Antonine Plague

The Antonine Plague, possibly the most widespread and catastrophic outbreak of disease in Imperial Rome, was named after the emperor whose reign it originated in, Aurelius Antoninus according to Louise Cilliers and Francis Retief. Historical sources suggest that Roman soldiers returning from campaign in Mesopotamia spread the disease, which lasted from 165-180 AD.^[6] Based on the written observations of fever, diarrhea, and boils by the Greek physician Galen, historians infer that smallpox caused the plague.^[7] Including substantial army deaths, the outbreaks decimated an estimated two thirds of the Roman population, killing roughly 2000 people per day.^[8]

The Plague of Cyprian

Cilliers and Reteif go on to describe that the second great plague affecting Rome. The Plague of Cyprian, mainly occurred from 251 to 266 AD with some traces lingering as late as 270 AD; although considered to be separate from the Antonine Plague, it is very similar and also believed to have originated from smallpox, or perhaps measles. Saint Cyprian makes the most vivid description of the effects of the disease as dysentery, loss of motor skills, and of course fever, and in turn has the disease named after him (also possibly due to the oppression of Christianity at the time). Notably, his list does not include skin rashes or swelling, which is the main separation from the bubonic plague and Antonine Plague.^[9] This plague was very widespread, possibly originating in Ethiopia and spreading to Scotland. With the skin contact-spreading nature of the disease and the crowded civilization style in Rome, the death toll was tremendous in the empire.^[8]

Blood-borne diseases

Morbus Gallicus

Morbus Gallicus, better known in modern times as syphilis, was prominent in all of ancient Europe, not excluding Rome. Its effects were skin lesions and in some cases it could lead to insanity. With recent bone studies, it has been found that congenital syphilis even affected children.^[10] However, according to an article published by Kristin Harper in 2008, Romans may have suffered from a related form of syphilis but not venereal syphilis itself, which may have had its origin in the pre-Columbian Americas. ^[11] The term ‘syphilis" was even coined later on by an Italian poet Girolamo Fracastoro, who wrote an epic poem of a boy named Syphilus who insulted Apollo, and was in turn punished with the disease.^[12]

Malaria

The earliest known case of malaria is from Roman DNA dated to 450 AD. An excavation of a village shows signs of a serious malaria problem, with bone tests and traces of honeysuckle, a plant used to treat fevers. Also noted is that the area was a "zone of pestilence".^[13] Deforestation and sanitation issues were the main causes of malaria.

Mentagra

Mentagra, notably thought by the Imperial Romans to be spread by kissing, was a skin disease most commonly starting in the chin and moving on to the entire face and sometimes other body parts. The aesthetic factor was very unappealing, while the disease was hardly adverse to health at all. Even though it was not dangerous, Romans ironically went as far as scar-inducing cauterizations to rid them of the abhorrent disease.^[8]

Respiratory disease

Respiratory disease, most prominently anthracosis, was common due to pollution in Roman homes according to Professor Luigi Capasso. Carbon was constantly produced with their lamps, cooking, and fireplaces. The carbon produced lesions on their lungs, apparent in bone studies (interestingly made possible by the well-preserved bodies stored under the remnants of a volcanic eruption of Vesuvius) and even a study on a Roman mummy.^[14]

Relevant study

An extensive study done by Mario Novak and Mario Slaus found many skeletal remains available for examination in one specific colony in ancient Rome, Colonia Iulia Iader also known as Zadar. With tests it was found that the mean age of death for men was 37.4 years (with a standard deviation of 9.43 years), and for women was 38.4 years (with a standard deviation of 9.29 years). While this is only a sample representation of our study population, it could give reasonable insights to the whole of Rome. In the remains, several indicators of nutritional stress were found widespread among certain age groups. With the rates of these nutritional problems, it was even found that Romans favored male children in things like breastfeeding, leaving the females with higher rates of malnutrition. Periostitis was also found in many samples, with a frequency indicating overcrowding and overall poor quality of life.^[15]

Treatment

Rome had a few prominent physicians in its Imperial era who came up with treatment for various diseases, and were generally the only source of medicinal information. Their service was focused on the military, which was often the most vulnerable group to any given disease. Dioscorides served under Emperor Nero, experimenting with surgical techniques and medicinal herbs. Pliny the Elder also had a strong focus on botany, well known for his herbal knowledge. Galen, perhaps the most prominent Roman physician, studied anatomy as well as herbal remedies.^[16]

Herbal medicines

Natural medicine was of great importance, seeing as they could not synthetically manufacture anything. Many traces of herbs at ancient Roman army bases have been found, as well as medicated wine. Army doctors had knowledge of the herbs, and perhaps even grew their own in their respective gardens.^[17] The Romans were not correct with all of the herbs uses, but a placebo effect possibly still made some of the herbs useful.

Anti-inflammatory

Marigold (Calendula officinalis)

Marigold was used mainly to prevent/reduce fevers.^[16]

Chamomile (Matricaria Chamomilla and Anthemis nobilis)

Chamomile was identified by Pliny as treatment for headaches and inflammation of the kidneys and liver.^[16]

Disease prevention

Hyssop (Hyssopus officinalis)

Hyssop was believed by Romans to prevent both the Antonine and Cyprian plagues. This inaccurate assumption was most likely based on the fact that Hyssop has oils that can treat coughing often found in plague victims.^[16]

Garlic (Allium Sativum)

Garlic is suggested as a sort of panacea in Galen’s studies, and as such was used to fend off virus, bacteria, parasites, and fungus in Imperial Rome.^[16]

Cough treatment

Marshmallow (Althea officinallis)

Marshmallow root was thought by Pliny to be effective as a cough remedy.^[16]

Horehound (Marrubium vulgare)

Pliny also found white horehound to be effective at treating coughs.^[16]

Performance enabling supplements

Tarragon (Artemisia dracunculus)

Tarragon was used by Romans to enhance their stamina in daily tasks, particularly soldiers who walked extensively.^[16]

Parsley (Petroselinum Crispum)

Gladiators, and perhaps even soldiers, consumed parsley in the hopes that it would give them an edge above their opponent.^[16] they were used to tame wild animals and for the gladiators to get the edge on their fights

Wound treatment

Yarrow (Achillea millefolium)

Yarrow is an healing agent, and is shown to exist in Imperial times through stories such as Homer’s Illiad, where it is used by Achilles to treat a wound.^[16]

Uva Ursi (Arctostaphylos uva-ursi)

Galen’s notes show uva ursi was commonly used to reduce bleeding and to nurse various types of wounds.^[16]

Borage (Borago officinalis L)

Borage was used mainly to combat tissue inflammation/bruising.^[16]

Plantain (Plantago major, minor, lanceolata)

Plantain was believed to be effective at nursing wounds and also reversing the effects of various poisons.^[16]

Military use

Blackberry (Rubicus fruticosus)

With the low water quality and unideal diet of Roman armies, soldiers often suffered from dysentery. Pliny’s remedy to this was for the soldiers to consume blackberry leaves and even bark.^[16]

Thyme (Thymus vulgaris)

The poor living conditions and many ailments of being in the Roman army often led to depression in the soldiers. For some reason, it was commonly believed that lying on thyme while sleeping would provide a more positive outlook. Although less common, some Roman civilians also practiced this. While this is a misconception, a placebo effect may have even stronger effects on mental ailments such as depression.^[16]

Fenugreek (Trigonella foenum-graecurn)

Fenugreek was readily available for the cavalry units in Imperial Rome, as they would feed it to their horses as a treatment for most sicknesses. It was also commonly used for cattle and other livestock. While that was the main use, it was also sometimes prescribed to citizens for things such as fevers and diseases resembling anthracosis. Fenugreek has been recorded in modern times as a somewhat effective anti-inflammatory, so this was one of the herbs Roman physicians correctly identified.^[16]

Stinging nettle (Utrica dioica)

Roman troops made use of stinging nettle when traveling to cold foreign climates. When stung with the needles, it provided a warm sensation that helped the soldiers gradually grow accustomed to harsh conditions.^[16]

References