Fire and crime were serious problems in the city, even after Augustus created urban fire and police forces. Streets were narrow, drainage was inadequate, and sanitation was poor. Private houses generally lacked toilets, so people used chamber pots.

In the second century, urban planning and new construction improved the situation. For example, engineers built an elaborate system that collected sewage from public baths, the ground floors of buildings, and public latrines. They also built hundreds of miles of aqueducts, sophisticated systems of canals, channels, and pipes, most of them underground, that brought freshwater into the city from the surrounding hills.

Better disposal of sewage was one way that people living in Rome tried to maintain their health, and they also used a range of treatments to stay healthy and cure illness. This included treatments based on the ideas of the Greek physician Hippocrates; folk remedies; prayers and rituals at the temple of the god of medicine, Asclepius; surgery; and combinations of all of these.

The most important medical researcher and physician working in imperial Rome was Galen (ca. 129–ca. 200 C.E.), a Greek born in modern-day Turkey. Building on the work of Hellenistic physicians (see "Medicine" in Chapter 4), Galen wrote a huge number of treatises on anatomy and physiology, and became the personal physician of many prominent Romans, including several emperors. He promoted the idea that imbalances among various bodily fluids caused illness and recommended bloodletting as a cure. His research into the nervous system and the operation of muscles proved to be more accurate than did his ideas about the circulation of fluids. So did his practical advice on the treatment of wounds, much of which grew out of his and others’ experiences with soldiers on the battlefield.

Along with fire and disease, food was an issue in the ever more crowded city. Because of the danger of starvation, the emperor, following republican practice, provided the citizen population with free grain for bread and, later, oil and wine. By feeding the citizenry, the emperor prevented bread riots caused by shortages and high prices. For those who did not enjoy the rights of citizenship, the emperor provided grain at low prices. By maintaining the grain supply, the emperor kept the favor of the people and ensured that Rome’s poor did not starve.