The Ancient Romans, like the Ancient Greeks and Ancient Egyptians, made a huge input into medicine and health. The Romans input was mainly concerned with public health schemes. Though the Roman ‘discoveries’ may not have been in the field of pure medicine, poor hygiene by people was a constant source of disease, so any improvement in public health was to have a major impact on society.

The Romans learned a great deal from the Ancient Greeks. They first came into contact with the Greeks in about 500 B.C. By 146 B.C. part of Greece had become a province of the Roman Empire and by 27 B.C. the Romans were in control not only of Greece but of Greek-speaking lands around the Mediterranean. They used the ideas of the Greeks but they did not simply copy them. Greek ideas that they found impractical were ignored. It seems that the Romans preferred ideas that would lead to the direct improvement in the quality of life for the people in their huge empire.

“The Greeks are famous for their cities and in this they aimed at beauty. The Romans excelled in those things which the Greeks took little interest in such as the building of roads, aqueducts and sewers.” Strabo – a Greek geographer.

Though Strabo may have been less than accurate, it does seem that the Romans were more practical especially as the Romans do seem to have been more interested in mathematics and solving practical problems.

“The Greeks held the geometer in the highest honour, and, to them, no-one came before mathematicians. But we Romans have established as the limit of this art, its usefulness in measuring and reckoning. The Romans have always shown more wisdom than the Greeks in all their inventions, or else improved what they took over from them, such things at least as they thought worthy of serious attention.” Cicero, Roman writer.

In the early years of the Roman Empire there was no established medical profession. It was believed that each head of the household knew enough about herbal cures and medicine to treat illnesses in his household. The Roman writer Pliny wrote:

“Unwashed wool supplies very many remedies… is applied….with honey to old sores. Wounds it heals if dipped in wine or vinegar….yolks of eggs….are taken for dysentery with the ash of their shells, poppy juice and wine. It is recommended to bathe the eyes with a decoction of the liver and to apply the marrow to those that are painful or swollen.”

As the Roman Empire expanded into Greece, many Greek doctors came to Italy and Rome. Some of these were prisoners of war and could be bought by wealthy Romans to work in a household. Many of these doctors became valuable additions to a household. It is known that a number of these men bought their freedom and set up their own practices in Rome itself. After 200 BC, more Greek doctors came to Rome but their success at the expense of Romans did generate some mistrust.

Pliny did not trust Greek doctors:

“I pass over many famous physicians men like Cassius, Calpetanus, Arruntius and Rubrius. 250,000 sesterces were their annual incomes from the emperors. There is no doubt that all these physicians in their hunt for popularity by means of some new idea, did not hesitate to buy it with our lives. Medicine changes everyday, and we are swept along on the puffs of clever brains of the Greeks… if thousands of people do not live without physicians – though not, of course, without medicine.”

However, despite Pliny’s caution, many Greek physicians had the support of the emperors and the best known doctors were highly popular with the Roman public. Pliny wrote that when Thessalus walked around in public, he attracted greater crowds than any of the famous actors and chariot riders based in Rome.

The Romans and Public Health:

The Romans were great believers in a healthy mind equalling a healthy body. There was a belief that if you kept fit, you would be more able to combat an illness. Rather than spend money on a doctor, many Romans spent money on keeping fit.

“A person should put aside some part of the day for the care of his body. He should always make sure that he gets enough exercise especially before a meal.” Celsus.

The Romans did believe that illnesses had a natural cause and that bad health could be caused by bad water and sewage. Hence their desire to improve the public health system in the Roman Empire so that everyone in their empire benefited. – not just the rich. Those who worked for the Romans needed good health as did their soldiers. In this sense, the Romans were the first civilisation to introduce a programme of public health for everyone regardless of wealth.

Roman cities, villas and forts were built in what were considered healthy places. The Romans knew not only where to build but also where not to build:

“When building a house or farm especial care should be taken to place it at the foot of a wooded hill where it is exposed to health-giving winds. Care should be taken where there are swamps in the neighbourhood, because certain tiny creatures which cannot be seen by the eyes breed there. These float through the air and enter the body by the mouth and nose and cause serious disease.” Marcus Varro.“There should be no marshes near buildings, for marshes give off poisonous vapours during the hot period of the summer. At this time, they give birth to animals with mischief-making stings which fly at us in thick swarms.” Columella.

The Romans became practised at draining marshes to rid areas of malaria-carrying mosquitoes. Julius Caesar drained the Codetan Swamp and planted a forest in its place.

The Romans paid especial attention to the health of their soldiers as without these soldiers, the Roman Empire could collapse. Great emphasis was placed on soldiers having access to clean water and being able to keep fit. Commanders ordered their junior officers not to set up a camp too near a swamp and the drinking of swamp water was especially discouraged. Soldiers were moved around as it was believed that if they stayed too long in one place, they would start to suffer from the illnesses that might have existed in that area.

Clean water was very important to the Romans.

“We must take great care in searching for springs and, in selecting them, keeping in mind the health of the people.” Vitruvius, a Roman architect.

Cities, towns and forts were built near springs. However, as Roman cities and towns grew, they needed to bring in water from further afield. As the population grew, so did the need for clean water. Trying to shift large volumes of water underground in pipes was not possible as lead pipes would be too weak and bronze pipes would be too expensive. The Romans could not make cast iron pipes as the techniques for doing this were not known to them. If water could not be brought via pipes, the Romans decided to bring it overland in what were conduits. When the water got to the city, it was fed off into smaller bronze or ceramic pipes. To get the water to flow at an even (and slow) pace, conduits were built on a slight slope. Valleys were crossed by using aqueducts. One of the most famous of these is the Pont du Gard aqueduct at Nimes in southern France. Where possible, the Romans did take water through tunnels but the hills needed to be relatively small for this to be successful.

Rome, as the capital of the empire, had to have an impressive water supply. The supply was designed by Julius Frontinus who was appointed Water Commissioner for Rome in 97 AD. The aqueducts that fed Rome carried an estimated 1000 million litres of water a day. Frontinus was clearly proud of his work but scathing of other well known engineering works:

“Compare such important engineering works carrying so much water with the idle pyramids and the useless though famous buildings of the Greeks.”“Water is brought into the city through aqueducts in such quantities that it is like a river flowing through the city. Almost every house has cisterns and water pipes and fountains.” Strabo, a Greek geographer.

Personal hygiene was also a major issue in the day-to-day life of Romans. Their famous baths played an important part in this.

The baths were used by both rich and poor. Most Roman settlements contained a public bath of some sort. In Britain the most famous are at Bath (then called Aquae Sulis by the Romans). The entrance fee for the baths were extremely small – usually about a quadrans (1/16th of a penny!). This extremely low price was to ensure that no-one did not bathe because it was too expensive.

From the writings of Seneca, we know that the Romans spent large sums of money building their baths. Seneca wrote about baths with walls covered in huge mirrors and marble with water coming out of silver taps! “And I’m talking only about the common people.” (Seneca) The baths of the rich included waterfalls according to Seneca. Even people who were sick were encouraged to bathe as it was felt that this would help them to regain their good health.

Roman houses and streets also had toilets. Other civilisations had also used toilets but they had been the preserve of the rich and were essentially a sign of your wealth. By 315 AD, it is said that Rome as a city had 144 public toilets which were flushed clean by running water. All forts had toilets in them. To complement these toilets, the Romans also needed a sufficiently effective drainage system. Pliny, the writer, wrote that many Romans believed that Rome’s sewers were the city’s greatest achievement. Seven rivers were made to flow through the city’s sewers and served to flush any sewage out of them. The importance of hygiene also extended as far as military hospitals which had drainage and sewage systems attached to them. Quite clearly, the Romans believed that an injured soldier would get back to health quicker recovering in a hygienic environment.

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