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. Numerous inscriptions record prohibitions against dumping human refuse and even cadavers on the grounds of sanctuaries and cemeteries. Private houses generally lacked toilets, so people used chamber pots.

In the second century C.E. 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. The aqueducts, powered entirely by gravity, required regular maintenance, but they were a great improvement and helped make Rome a very attractive place to live. Building aqueducts required thousands and sometimes tens of thousands of workers, who were generally paid out of the imperial treasury. Aqueducts became a feature of Roman cities in many parts of the empire.

169

170

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. Like anyone hoping to rise in stature and wealth, he came to Rome. Building on the work of Hellenistic physicians (see 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. This would remain a standard treatment in Western medicine until the eighteenth century. His research into the nervous system and the operation of muscles — most of which he conducted on animals, because the Romans forbade dissections of human cadavers — 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.

Neither Galen nor any other Roman physician could do much for infectious diseases, and in 165 C.E. troops returning from campaigns in the East brought a new disease with them, which spread quickly in the city and then beyond into other parts of the empire. Modern epidemiologists think this was most likely smallpox, but in the ancient world it became known simply as the Antonine plague, because it occurred during the reigns of emperors from the Antonine family. Whatever it was, it appears to have been extremely virulent in the city of Rome and among the Roman army for a decade or so.

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. This measure was designed to prevent speculators from forcing up grain prices in times of crisis. By maintaining the grain supply, the emperor kept the favor of the people and ensured that Rome’s poor did not starve.