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previous: Chapter 2 This webpage reproduces a chapter of Ancient Rome in the Light of Recent Discoveries by Rodolfo Lanciani published by Houghton, Mifflin and Company Boston and New York, 1898 Text, maps and black & white illustrations are in the public domain. Any color photos are © William P. Thayer. next: Chapter 4

 p49  CHAPTER III

THE SANITARY CONDITIONS OF ANCIENT ROME.

After describing in the last chapter the humble origin of Rome and the simple causes which led to its foundation on the Palatine hill, we must inquire now whether the selection was equally happy as regards the sanitary conditions of the district which surrounded the new town. The question is full of practical interest on account of the mighty struggle which we modern Romans have actually entered against malaria, a plague which seems to be spreading slowly, but surely, wherever there is a superabundance of moisture, both in the air and in the land; in other words, which is invading one tenth, at least, of the inhabited world.

The history of malaria in connection with Rome must be divided into five periods, — the prehistoric, the republican, the imperial, the mediaeval, and the modern; each one marking a distinct stage in the increase or in the decline of the plague, as well as a change in the means adopted by the inhabitants of the fever-stricken district to protect themselves from the evil.

As regards the prehistoric period, we lack, of course, positive evidence, because, when action writers speak of the hygienic condition which existed at the time Rome was founded, either they speak at random, or else they describe things as they appeared in their own age. It seems probable that at that time all the lowlands surrounding the Alban volcanoes, as, for instance, the Pontine, the Volscian, and  p50 the Latin districts, were comparatively healthy, on account of the purifying action of telluric fires, of sulphuric emanations, and of many kinds of healing mineral springs. In the deadly calm of nature which has succeeded the extinction of the Latin volcanoes, we find it difficult to conceive an idea of the subterranean activity which prevailed at the time. All along the valley of the Roman Forum, which valley corresponds to a fissure or rent of the soil between the Palatine and the Quirinal hills, volcanic phenomena continued to appear even in historic times. The chasm under the northeast spur of the Palatine, into which Marcus Curtius is said to have leaped, seems to have been the crater of a kind of geyser. Near the Janus Quadrifrons there were hot sulphur springs, described by Varro (L. L. V.32). In the fourth century before Christ powerful jets of water sprang up suddenly in a street called Insteia or Insteiana. Julius Obsequens speaks of other jets of reddish water, near the Senate Hall, which he compares to blood (sanguine fluxit). A district of the Campus Martius is called campus ignifer by Livy, fumans solum by Valerius Maximus, τὸ πυρόφερονº πεδίον by Zosimus,​a on account of volcanic smokes and emanations which for centuries had been noticed there.

The Campagna must have been even more strongly purified, especially around the slopes of the Alban hills, where of the mineral springs were particularly abundant. At all events, this is the only way to explain the presence of a thriving, healthy, strong, and very large population in places which, a few centuries later (namely, at the end of traditional and at the beginning of historic times), are described as pestilential. Antemnae, Collatia, Corioli, Tellene, Politorium, Crustumerium, and many other centres, populous in volcanic ages, seem to have been obliterated more by  p51 the deleterious effects of the climate than by the chances of war and the over­powering supremacy of Rome. In the Volscian district, along the marshy Tyrrhenian coast, there were numberless settlements: Ficana, Lavinium, Ardea, Pyrgi, Antium, Alsium, and so forth. As to the Pontine region, Pliny asserts that it was the abode of a dense and thriving population.

It may be a simple coincidence, it may depend on a mere accident, this fact of the extinction of human life at the precise time in which volcanic life was extinguished in the old Latium, but it is coincidence worth scientific investigation. There can no longer be any doubt that malaria invaded the volcanic regions the very minute they ceased to be volcanic.

With regard to the site of Rome itself, we can hardly believe the words of Cicero (De Represent., 2, 6), in which he describes it as in regione pestilenti salubris, salubrious in a pestilential region, although the same observation is made by Livy, who considers it almost a prodigious fact that the town should prove healthy in spite of the pestilent and desert region by which it was surrounded (5.54‑7.38). They evidently refer to the state of things prevailing in their own age. How is it possible that a hill like the Palatine, only a few feet high, and surrounded on three sides by poisonous marshes, should be exempt from the effects of malaria? The other hills of Rome were not better favored, from a hygienic point of view: the Caelian and the Aventine suffered from the effluvia of the swamps near the Porta Metronia;​1 the Quirinal and the Pincian likewise from those of the Caprea Palus;​2 in fact, Livy asserts that, before the  p52 construction of the Cloaca Maxima, every valley between the seven hills was nothing but a boggy quagmire. These hot-beds of malaria were fed by numberless springs, running sometimes above, sometimes under ground, impregnating the whole region with dampness, which is one, and perhaps the most active, of the three coefficients of the plague.

The clearest proof of the virulence of malaria in the first century of the history of Rome is afforded by the large number of altars and shrines dedicated by its early inhabitants to the goddess of the Fever and other kindred divinities. At the time of Varro, there were not less than three temples of the Fever left standing: one on the Palatine, one in the square of Marius on the Esquiline, one on the upper end of the Vicus Longus, a street which corresponds, within certain limits, to the modern Via Nazionale. The Esquiline quarter seems to have been the worst of all in its sanitary conditions; in fact, besides the Fever's temple, there was an altar dedicated to the Evil Eye (Mala Fortuna), and an altar and small wood dedicated to the goddess Mefitis. Near the Praetorian camp, and near the modern railway station, I have found, myself, an altar consecrated to Verminus, the god of microbes; and lastly, in the very centre of the Roman Forum, there was an altar sacred to Cloacina, a goddess of typhoid, I suppose.

It appears from the particulars just given that the  p53 primitive inhabitants of Rome, acting as men always do act when they find themselves exposed to the ravages of an unknown evil, utterly ignorant of its mysterious nature and of the proper way to fight and lessen its effect, raised their hands towards their gods, and actually increased the number of their divinities, and contrived new ones, imploring from heaven the help which they failed to secure with their own resources. After the lapse of many, many years, the request of those simple and energetic men was granted, and their town was made comparatively healthy, not in a supernatural or miraculous manner, but as a just and well-earned compensation for the efforts they had made and for the trouble they had taken to establish a better state of things. Strange as it seems, after the fall of the Empire, when Rome, almost annihilated by the inroads of barbarians, found itself in a condition almost worse than that of its early age, powerless to accomplish any work of improvement, and exposed again to the full influence of malaria, the inhabitants raised again their eyes towards God, built a chapel near the Vatican in honor of the Madonna della Febbre — our Lady of the Fever — which became one of the most frequented and honored chapels of mediaeval Rome.

The principal works of improvement successfully accomplished in ancient times for the benefit of public health and for checking malaria may be chronologically described as follows: I. The construction of drains. II. The construction of aqueducts. III. The multiplication and the paving of roads. IV. The proper organization of public cemeteries. V. The drainage and cultivation of the Campagna. VI. The organization of medical help.

First, as regards the drains. The plan of the Etruscan engineers employed by Tarquinius Priscus to organize the  p54 drainage of the town seems to have been to give an outlet to the ponds and swamps which stretched along the valley between each couple of hills, more than to carry off the sewage, in the modern sense of the word. The Cloaca Maxima, receptaculum omnium purgamentorum urbis, the main collector, as Livy describes it, has been praised, admired, eulogized by Dionysius (3.67), Pliny (36.15), Aurelius Victor (V. Ill. 8), Strabo (5.3), Dion Cassius (49, 43), and in modern times by Niebuhr and Bunsen. There is no doubt that the work is simply wonderful. An immense sewer, built twenty-five centuries ago, on unstable ground, under enormous practical difficulties, which still answers well its purpose, is a work to be classed among the greatest triumphs of engineering. But the exactness of an archaeologist compels me to say that the Cloaca Maxima, in spite of its name, can no longer boast of the priority which it has enjoyed for so many centuries in the department of Roman sewers. In canoeing along the left bank of the Tiber, I had long noticed the mouth of another cloaca, a trifle larger than the Maxima, and separated from it by an  p55 interval of some three hundred feet. I had heard it called the cloaca of the Circus Maximus, but I was ignorant on whose authority and by what reason such a name had been applied. Six years ago, at the bottom of the valley which separated the Palatine from the Caelian, between the Arch of Constantine and the church of S. Gregorio al Monte Celio, a cloaca even larger and higher than the Maxima was discovered, three quarters of a mile from its opening into the Tiber, at the depth of forty feet. The enormous size of its  p56 blocks, the beauty and perfection of its masonry, and the wonderful preservation make it compare most advantageously with its rival, the Maxima, to which it is altogether superior as regards length and extent of district drained.

The sewers of ancient Rome answered their purpose pretty well, especially if we take into consideration the remote age in which they were constructed, and their engineers' ignorance of modern sanitary principles and of the theory of microbes. Their greatest defects are, first, that they were used at the same time to carry off the sewage and refuse of the town and the rain-water; second, that this double employment made it necessary to have large openings along the streets, so that the population was permanently brought into contact with the poisonous effluvia of the sewers. Many of these mouths of drains have come down to us, some exceedingly rough and primitive, some more elaborate and cut in marble. The most celebrated, perhaps, is the so‑called Bocca della Verità, a marble disc, five feet in diameter, with the head of the Ocean in alto-rilievo in the centre, through the open mouth of which the rain-water would escape. This monument, the scarecrow of children who show an inclination to lie, is preserved in the portico of the church of S. Maria in Cosmedin, near the ancient forum Boarium. The third defect of Roman sewage was that each sewer emptied directly into the Tiber, thus polluting its waters, which were used not only for bathing and swimming, but even for drinking.

The best apology for this state of things is to be found in the fact that not only modern Rome itself, but many other European capitals, not to speak of provincial towns and villages, remained until lately in an absolutely identical condition. The improvement in the department of sewers is one of the last, if not the very last achievement of modern  p57 science in connection with hygiene, and it is still far from perfection.

The introduction of pure, drinkable water into Rome took place not earlier than the fifth century after its foundation. Sextus Julius Frontinus, a magistrate who presided over the department of aqueducts during the Empire of Trajan, begins his "Commentaries" on the subject with the following remark: "During four hundred and forty-one years the Romans satisfied themselves with the use of such water as they could obtain on the spot, from the Tiber, from wells, or from springs. Some of these springs are still held in great consideration, on account of their supposed healing power. Such are the springs of the Camoenae, of Apollo, and of Mercury."

The waters of the Tiber, reaching Rome after a run of 249 miles through clay or alluvial soil, are certainly not pure or clear; in fact, they are saturated with mineral and solid matter. It appears from official observations carried on between March, 1871, and February, 1872, that with an average daily efflux of 1,296,000 cubic metres, the river has carried down to the sea 8,582,333 tons of sand, equal to a volume of 4,114,253 cubic metres. In spite of this state of things, with the ancients assert about the potability of its waters is proved by the fact that, after the destruction of imperial aqueducts, the population of mediaeval Rome resorted again to this as the only means of quenching its thirst; in fact, the desire and the necessity of being near the river must be considered as the leading cause of the abandonment of the healthy hills, and of the mustering of the population in the campus Martius. The salubrity of the waters of the Tiber is celebrated by Alessandro Petroni, physician to Gregory XIII, and by Alessandro Bacci, physician to Sixtus V, Clement VII, in the journey to Marseilles,  p58 which he undertook in 1553 to celebrate the marriage of his niece, Catherine de' Medici, with the Duke of Orleans, afterwards Henry II, acting on the advice of his physician, Corti, brought with him such a quantity of water from the Tiber as to be sufficient for all the requirements of the journey. The same precaution was taken by Paul III, Farnese, in his wanderings to Loretto, Bologna, and Nice.

Fancy what must have been, in early Roman times, the sanitary conditions of a town the drains of which, not washed by any influx of water, communicated from space to space with the public streets by large unprotected openings, and emptied into a river, the polluted waters of which were drunk by the whole population! The first remedy against the evil was adopted in •442 A.U.C. by the building of an aqueduct, which was to carry into the city the water of a spring seven and a half miles distant, called Aqua Appia, from the name of Appius Claudius Caecus, the builder of the aqueduct and of the Appian Way. The first step in the right direction once taken, it was easy to advance boldly. I cannot follow stage by stage the history of Roman aqueducts. I will trace simply a brief and comprehensive sketch of the water-supply of Rome, under the Empire; that is to say, at the period in which it was brought to perfection.

Comparing the accounts left by Frontinus and Procopius on this subject with the remains of aqueducts radiating from Rome in every direction, and which form such a characteristic landmark of the Campagna, we gather the following information.

Eighteen springs have been collected and canalized by the Romans from distances varying from a minimum of seven and a half miles to a maximum of forty-four. The waters were brought to Rome by means of fourteen aqueducts,  p59 the length of which varies from a minimum of eleven miles to a maximum of fifty-nine. The aggregate length of these fourteen aqueducts amounts to three hundred and fifty-nine and one third miles; of which three hundred and four miles are under ground, fifty-five above ground, the channel being carried on the top of really triumphal arcades, at prodigious heights, sometimes exceeding one hundred feet. The quality of the waters varied greatly. The best were considered the Marcia, the Claudia, and the Virgo; worst of all, the Anio Vetus and the Alsietina; these two accordingly were employed only for the irrigation of gardens and for washing away the drains, and were drunk only in cases of absolute necessity. As regards the temperature, the Marcia was the coldest:

as Statius sings. It marks •46° Fahrenheit at the spring of S. Lucia. Tacitus relates among the crazy exploits of Nero his attempt to profane the sacred spring by swimming across it from shore to shore. This pollution of the pure icy waters was avenged by a rheumatic fever, which brought the young emperor to the verge of death.

I have many times been asked the question why the Romans spent such an amount of time, labor, and money in building these prodigious channels across mountains and valleys, tunnelling the former and bridging over the latter, with tunnels and bridges many miles long, when it would have been so easy and so economical to lay down pipes, following at a moderate depth the undulations of the carefully. In other words, I have been asked whether the Romans knew or did not know the principle of the siphon. To be sure they knew it, in theory and in practice. The siphons of Patarae and Aspendus in Pamphylia, of Constantina in Mauritania, and  p60 of Lyons in the Gallia Lugdunensis are all well known. The finest and most daring of all is the siphon of Alatri, built by a wealthy citizen, Betilienus Varus, a century and a half before the Christian era, and capable of supporting a pressure of ten atmospheres. As to the main aqueducts which supplied Rome with a daily volume of fifty-four million cubic feet of water, it would have been impossible to substitute metal pipes for channels of masonry, because the Romans did not know cast-iron, and no pipe except of cast-iron could have supported such enormous pressure. Let us rejoice at this state of things, because, had the ancients known the contrivances of modern industry, we should most likely have been deprived of the loveliest sight which our Roman Campagna offers.

Before leaving this interesting subject of the water-supply, I must make two more remarks: the first concerns the system widely followed in our age, of damming the beds of rivers in mountainous regions, in order to create artificial lakes or reservoirs of pure water, from which the supply is derived. The ancients knew and followed this system on a magnificent scale. One of our aqueducts, the Anio Novus, originally drew its supply directly from the river Aniene, at a place forty miles distant from Rome. It happened that every time the river was swollen by rains, the aqueduct carried down troubled and undrinkable water, which would fill up the main channel with incrustations of carbonate of lime, and choke the minor pipes. To mend the matter, and to obtain a constant influx of pure water, the valley of the Anio was dammed, not once, but three times, across the picturesque gorge or cañon of the Symbruine mountains, between the modern town of Subiaco and the Benedictine abbey of the Sacro Speco, and three artificial lakes were thus obtained, in which the water was purified three times.

 p61  The second remark concerns the system employed by the ancients in boring and tunnelling the mountains for hydraulic purposes. Two very curious documents have come down to us on this subject. The first is the official report of the perforation of a tunnel, to bring down to Bougie, Algeria (called then Saldae or Civitas Salditana),º the waters of a spring, fourteen miles distant, now called Aïn-Seur. The report, engraved on a marble altar, discovered in 1866 near Lambaese,º begins with a petition addressed in the year 152 A.D. by Varius Clemens, governor of Mauritania, to Valerius Etruscus, governor of Numidia. The petition reads as follows: "Varius Clemens greets Valerius Etruscus, and begs him in his own name and in the name of the township of Saldae to dispatch at once the hydraulic engineer of the III legion, Nonius Datus, with orders that he finish the work, which he seems to have forgotten." The petition was favorably received by the governor and by the engineer, Nonius Datus, who, when he had fulfilled his mission, wrote to the magistrates of Saldae the following report:—

"After leaving my quarters I met with the brigands on my way, who robbed me even of my clothes, and wounded me severely. I succeeded, after the encounter, in reaching Saldae, where I was met by the governor, who, after allowing me some rest, took me to the tunnel. There I found everybody sad and despondent; they had given up all hopes that the two opposite sections of the tunnel would meet, because each section had already been excavated beyond the middle of the mountain, and the junction had not yet been effected. As always happens in these cases, the fault was attributed to the engineer, as though he had not taken all precautions to insure the success of the work. What could I have done better? I began by surveying and taking the levels of the mountain; I marked most  p62 carefully the axis of the tunnel across the ridge; I drew plans and sections of the whole work, which plans I handed over to Petronius Celer, then governor of Mauritania; and, to take extra precaution, I summoned the contractor and his workmen, and began the excavation in their presence, with the help of two gangs of experienced veterans, namely, a detachment of marine-infantry (classicos milites), and a detachment of Alpine troops (gaesates). What more could I have done? Well, during the four years I was absent at Lambaese, expecting every day to hear the good tidings of the arrival of the waters at Saldae, the contractor and the assistant had committed blunder upon blunder; in each section of the tunnel they had diverged from the straight line, each towards his right, and, had I waited a little longer before coming, Saldae would have possessed two tunnels instead of one." Nonius Datus, having discovered the mistake, caused the two diverging arms to be united by a transverse channel; the waters of An-Seur could finally cross the mountain; and their arrival at Saldae was celebrated with extraordinary rejoicings, in the presence of the governor Varius Clemens and of the engineer.

To come back to Rome, however, the longest tunnel constructed in its vicinity for the sake of the water-supply is the one of Monte Affliano, between Tivoli and S. Gericomio, 4,950 metres (about three miles) long. Its boring was intrusted by Domitian to one of the imperial contractors, L. Paquedius Festus. A bold and arduous work it was, especially on account of the difficulty of ventilation in a channel only seven feet high by three wide. The contractor, before commencing the tunnel, made a vow to a local goddess, named the Bona Dea, to restore her decayed temple on the top of the mountain if the enterprise should  p63 succeed. The two opposite sections met most successfully on July 3, A.D. 88. The beautiful columns and fragments of statuary discovered on the summit of Monte Affliano prove that the vow of L. Paquedius was not what is called the vow of a sailor.

The influence of this magnificent supply of water on the  p64 health of the inhabitants of Rome and the Campagna can easily be understood. There was no farm, no country-house, no villa, there was no neighborhood, however small and insignificant, of rustic people, which could not be favored with copious fountains of icy-cold, salubrious water. Villages and towns, such as Ostia, Portus, Gabii, Bovillae, Veii, the ruins of which are scattered to‑day in a waterless desert, were in Roman times almost overflowed, and their aqueducts vie in length and magnificence with the main aqueducts of the capital.

The reform and regulation of the public cemeteries — another hot-bed of pestilence — took place even later than the reform in the supply of water. I speak, of course, of public cemeteries, for the burial of artisans, of slaves, and of the poorest classes of the people, because persons belonging to higher classes usually provided themselves with private tombs, either within the precincts of their villas and farms, or along the sides of the highways. It is impossible to conceive an idea of the horrors of a common carnarium or fosse in the first centuries of Rome. I will give particulars of one only, which occupied a large district on the Esquiline, because these particulars were discovered by myself, and have not yet been fully disclosed to the general public.

The Esquiline cemetery was divided into two sections: one for the artisans who could afford to be buried apart in Columbaria, containing a certain number of cinerary urns; one for the slaves, beggars, prisoners, and others, who were thrown in revolting confusion into common pits or fosses. This latter section covered an area one thousand feet long, and thirty deep, and contained many hundred puticuli or vaults, twelve feet square, thirty deep, of which I have brought to light and examined about seventy-five. In many cases the contents of each vault were reduced to a  p65 uniform mass of black, viscid, pestilent, unctuous matter; in a few cases the bones could in a measure be singled out and identified. The reader will hardly believe me when I say that men and beasts, bodies and carcasses, and any kind of unmentionable refuse of the town were heaped up in those dens. Fancy what must have been the condition of this hellish district in times of pestilence, what the mouths of the crypts must have been kept wide open the whole day!

But there is something still worse. Every visitor to Rome knows the great fortification which protected the city on the east side, called the Agger or embankment of Servius Tullius, from the king who raised it. This fortification, more than one mile long, comprised a ditch or moat one hundred feet wide and thirty deep, with ramparts one hundred feet wide and thirty high, supported and strengthened on the outside by a lofty battlemented wall. It seems that under the republican rule, and on the occasion of a stupendous mortality, — to use the words of Livy, — the portion of the huge moat which skirted the cemetery of the Esquiline was filled with corpses, thrown in as if they were carrion, until the level of the embankment was reached. The discovery of these revolting particulars took place in 1876, under the circumstances which I am going to relate. In building the foundations of a house at the corner of Via Carlo-Alberto and Via Mazzini, the architect, deceived by the presence of a solid bed of tufa on the northern half of the building-ground, began to lay his masonry and fill up the trenches to the uniform depth of twelve feet below the level of the street. All of a sudden the southern portion of the ground gave way, and one half of the area fell through into a chasm thirty feet deep. On careful examination of the circumstances of the catastrophe, it was ascertained that, whereas the northern half of the foundations rested on the  p66 solid embankment or Agger of Servius Tullius, the southern half had been laid on the site of the ditch, filled up with thousands upon thousands of corpses, which, when brought in contact with the air after twenty centuries, had crumbled into dust or nothing, leaving open a huge chasm. According to measurements which I took at the time, this mass of human remains was, at least, one hundred and sixty feet long, one hundred wide, and thirty deep. Giving to each corpse an average space of twenty cubic feet, which is more than sufficient, there were not less than twenty-four thousand bodies in a comparatively small space.

As if all the evils described were not deemed enough, the town authorities had increased their potency by allowing the daily refuse of a population numbering nearly a million souls to be heaped up within and around the precincts of this Esquiline cemetery. In later times, seven centuries after the foundation of Rome, they endeavored to stop the practice, or at any rate to regulate it. Decree upon decree was issued on the subject, and a line of stone cippi, inscribed with sanitary rules, was set up around the edge of the pestiferous ground. I have found three of these police regulations engraved on square blocks of travertine. Here is the text of one: "C. Sentius, son of Caius, Praetor, by order of the Senate has set up this line of terminal stones, to mark the extent of ground which must be kept absolutely free from dirt and from carcasses and corpses. Here also the burning of corpses is strictly forbidden." Another hand, probably that of a man living in the neighborhood and within reach of the effluvia of the place, had written in huge red letters the following entreaty at the foot of the official decree: "Do carry the dirt a little farther; otherwise you will be fined." This line of stones, beyond which the refuse of the town could be legally thrown and be allowed to putrefy  p67 under the burning sun, was only four hundred feet distant from the walls and embankment of Servius Tullius. On the day of the discovery of the above-mentioned stone, June 25th, 1884, I was obliged to relieve my gang of workmen from time to time, because the smell from that polluted ground (turned up after a putrefaction of twenty centuries) was absolutely unbearable even for men so hardened to every kind of hardship as my excavators.

The reform in this branch of public hygiene, the suppression of the popular cemetery on the Esquiline, took place only under Augustus, at the suggestion of his enlightened prime minister, C. Cilnius Maecenas, who obtained from his sovereign and friend the concession of the whole district, buried it under an embankment of pure earth, twenty-five feet high and a third of a square mile in area, and on the newly made ground laid down his magnificent gardens, the world-known Horti Maecenatiani. The event proved to be of such unexpected importance for the improvement of the health of Rome that Horace himself thought it worth being sung by his muse:

I shall not mention other improvements carried on with the progress of Roman civilization, such as the paving of the streets, the opening of a thick network of roads in the Campagna, the drainage of damp districts, the spreading of suburbs, the careful cultivation of the soil, and the like; because I shall have occasion to speak of these particulars in the chapter on the Campagna. One subject deserves more attention, because little is known about it, — the subject of medical attendance, both public and private, a matter  p68 which is one of the most important factors in the sanitary arrangements of a civilized nation.

The hospital, even in its most rudimentary shape, was not known in Rome much before the third century of the Christian era. In fact, Celsus Aurelianus, an eminent physician, who wrote at the beginning of the third century a treatise "On Acute and Chronic Diseases" (De morbis acutis et chronicis), reproaches his colleagues for their obstinacy in keeping their patients in absolute confinement, as a practice injurious to the progress of science. It is not difficult to explain this state of things. First, the members of the higher classes of society were not in need of public sanitary institutions; secondly, the slaves, of whom the manufacturing and trading class was chiefly composed, had to be assisted at the expense of their own masters in case of sickness; and besides, medicine was not known and practised as a science, but only in an empiric fashion. Hence patients were compelled to confide more in gods than in men, and to trust in supernatural help for the relief of their ailments. We must also bear in mind that charity was a virtue altogether unknown in ancient times, and even if it existed, was stifled by the spirit of conquest, by the maintenance of slavery, and by the passion for bloody and revolting gladiatorial shows, which rendered even the most tender Roman hearts and souls insensible to the sufferings of the neighbor.

Livy asserts that the Romans always remained faithful to the precept of Numa: "Unam opem aegris corporibus relictam si pax veniaque ab diis impetrata esset"— that the peace and good-will of gods were the only remedies and means to recuperate lost health: a passage which testifies that the famous faith-cure is at least twenty-six centuries old. Thus the more common cases of sickness to which  p69 mankind is subject were deified and idolized, and temples and shrines were set up in their honor. I have mentioned above the altars of the Fever, the sacred wood of Mephitis, the shrine of Orbona, and so on. Apollo, as a god of hygiene, ad a temple near the theatre of Marcellus. This temple, built in •the year 321 of Rome, and opened for public worship two years later, on the occasion of a terrific stroke of pestilence, was rediscovered quite by accident nine years ago, in the cellar of a third-class inn, near the Piazza Montanara, called the Albergo della Catena. It will be excavated, we hope, in 1889, in consequence of the destruction of the neighboring Jewish quarter (Ghetto); and considering its remarkable state of preservation, we trust we shall be able to find, at least, fragments of the famous group by Praxiteles or Scopas, representing Apollo annihilating the children of Niobe, described by Pliny (XXXVI.5.28). Next in importance to the temple of Apollo was the temple of Health, the site of which corresponds nearly to that of the Barberini Palace, on the northern slope of the Quirinal. Women laboring in childbirth could apply to no less than thirteen goddesses, from Juno Lucina down to Deverra, Diana, Alemona, Nona, Decima, Partula, Antevorta, Postvorta, Eugeria, Fluonia, Uterina, Intercidona, etc.

In the year of the city 459, when Rome was in danger of annihilation by another plague, the Sibylline books were consulted, as they always were in cases of supreme danger. The answer was: "Aesculapium ab Epidauro Romae arcessendum" (Livy, X., 32) — Aesculapius must be removed from Epidaurus to Rome — and so he was. The new god was comfortably and neatly installed on an island in the Tiber, now called the island of S. Bartolomeo, and his temple became the greatest sanitary establishment in the metropolis.

 p70  The practice followed by the Roman lower classes was this: patients whose life was in danger were brought into the peristyle or atrium of the sanctuary and put to sleep there, evidently by means of narcotic drugs, in order that Aesculapius might manifest in their dreams the proper way of healing their troubles. Once the recipe was obtained, the priests themselves undertook the cure of the patients; and if the cure succeeded, by some unforeseen and wonderful coincidence, then an ex‑voto was suspended in the sacristy of the sanctuary, together with a tablet describing the happy event. Here is the text of one, given by Thomassinus: "In this last day, said the oracle to Caius the Blind, come to the sacred altar and kneel in front of it, then touch it on the left side, and apply instantly your hand to your eye. Having obeyed, he recovered at once his eyesight, amidst the applause of the assembled multitudes."​3 Is it not a striking coincidence, that the very island of the Tiber, the very spot on the island, always has been since Roman times, and is now, the seat of a hospital, the hospital of S. Giovanni di Calabita?

Another curious anecdote is this: It seems that at the entrance of the Fabrician bridge (ponte quattro Capi), leading from the Campus Martius to the island, there were sops for the sale of ex‑votos of every description, exactly as similar shops are to be seen now along the approaches to the great sanctuaries of Catholic countries. One of these shops was discovered in the spring of 1885 in the foundations of the left embankment of the Tiber. It contained a large number of anatomical specimens in painted terra-cotta, beautifully modelled from nature, and representing heads, ears, eyes, breasts, arms, hands, knees, legs, feet, ex‑votos to  p71 be offered by happy mothers, etc. The most interesting pieces are their life-size human trunks, cut open across the front, and showing the whole anatomical apparatus of the various organs, such as the lungs, liver, heart, bowels, etc. These pieces have not yet been examined by experts, and consequently I am not able to say whether they are capable of throwing any light on ancient hygienic and anatomical matters.

We must not suppose that men of education would resort to such absurdities as those I have described in connection with the temple of Aesculapius. Cicero has strongly condemned the practice in his book, "De Divinatione," but the populace, in spite of such good advice, adhered to its ignorance and superstition; and this obstinacy had then, and has still, such a firm hold, and such deep roots in the lowest classes of Italy, that only three years ago, in September, 1885, when the cholera broke out in Sicily, physicians trying to exercise their mission of charity were stabbed and killed by dying patients, just as happened in similar circumstances in Hungary and Croatia.

Another strange practice, imported from the East into Rome, was the exposure of the sick in the streets and under open porticoes, in order that passers-by might give them advice from personal experience.

The first physicians in Rome, if such a name can be applied to men knowing only the use of a few herbs and potions, came from the Abruzzi and from the shores of the lake of Fucino. In process of time, patrician families secured, at a high price, the services of slaves, experts in medicine, to whom the office of a modern valet de chambre was assigned. These slaves, emancipated after long successful services, used to open shops called sometimes Medicinae, sometimes Pharmacopolae, in which drugs  p72 and physic were sold, and surgical operations performed. For these operations the patient was put into an anaesthetic state in a much surer way than is now done with chloroform or laughing-gas. A successful physician was sure to receive high official distinction. Archagathus, a Peloponnesian who migrated to Rome in 219, not only was rewarded with citizen­ship, but obtained a residence, with shop and office, bought at public expense. Asclepias from Drusa, Bithynia, was almost deified by the populace, and held in great estimation by Crassus and Cicero. Julius Caesar was the first statesman to promote the welfare of hygienists, by recognizing them as professors of a liberal art, with rights to citizen­ship. Augustus, when cured by his freedman, Antonius Musa, of a dangerous illness, by means of fomentations and cold compresses, made him a knight, honored him with a bronze statue in the temple of Aesculapius, and exempted forever his colleagues from any kind of income-tax. Nero organized the service by naming an archiatrus, or superintendent of court-physicians. Schools of medicine were opened, and students organized themselves into a corporation, the seat of which was on the Esquiline. When one of the professors was called to visit a patient, he was followed by the whole body of pupils, because, there being no hospitals at the time, this was the only way by which they could learn and gain experience. Martial describes one of these professional visits in the ninth epigram of the fifth book, and relates how Dr. Symmachus, when sent for, came at once to his bed, accompanied by more than one hundred disciples, who, one by one, felt his pulse with hands almost frozen by the northern wind, or tramontana, which happened to be blowing at the time.

The merit of organizing a service of public assistance, in the true modern and philanthropic sense of the word,  p73 belongs to Antoninus Pius, who acted, I am sure, under the indirect pressure of Christian influence and charity, for the new faith had made immense progress in Rome under his wise and temperate rule.

The new sanitary codex comprised the institution of head-physicians (archiatri) in every inhabited centre, and a set of rules for the medical service in the largest cities of the empire. These medical officers had to be elected by the town council, and to be approved by the patres-familiae. In process of time the election had further to be sanctioned by the College of Physicians practising in the same town, and even by the Emperor himself. Assistance to the poor was compulsory and gratuitous.

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The Author's Notes:

1 These swamps, called Decenniae, have been drained lately, and filled up with the earth from the excavations of the Forum.

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2 On the subject of the Caprea Palus, see a recent paper of Comm. de Rossi in Bull. Comm. Rome, 1885.

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3 The authenticity of this tablet is rather doubtful.

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Thayer's Note:

a The passage in Zosimus' New History is II.3.3; but since the anonymous 19c translator whose English we read at that link did not do a good job, having in particular mistranslated the very words of the Greek that concern us here — the original text (in Mendelssohn's edition, 1887, pp57‑58) and my own translation follow.

Instead of a nonsensical dedication of fire, we have a place where fire erupts from the ground: clearly a portal to hell, logically and understandably requiring its consecration to the infernal gods rather than to any other divinities.

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