Disease in Ancient Rome

By Joseph Manning

The other day I was having a conversation and Europe’s Black Death came up.  I don’t know much about the Black Death or Medieval history generally, but the opinion I heard went something like this:  “Ancient Rome was able to effect order, health, and quarantine to a degree that wasn’t possible after its fall.  It was the collapse of the Empire that in part allowed epidemics like the Black Plague to wreak havoc in the disorganized Europe that followed.”

This view of Roman disease-control is too idealized.

The city of Rome, a high population urban center, was a hub of diseases.  Trade and an influx of foreigners made it inevitable that every disease known to the Empire would find its way to the city. Life expectancies for Romans were far lower than modern ones, but that belies my point. Life expectancy is low if you factor the high infant mortality. City residents that survived childhood tended to gain immunity, but to foreigners the city was a ‘consumer of people.’ While the Romans placed some emphasis on health, their lack of knowledge often only worsened problems. For those who lived and stayed there, Rome was an unhealthy place for all — disease cut through class divisions of wealthy and poor alike.

A variety of diseases overtook the city of Rome.  When its major river, the Tiber, flooded, runoff from hills created stagnant sources for mosquitoes to breed and spread malaria.  Likewise, the wealthy ignorantly collected pools of stagnant water in their houses in impluvium.  In addition to malaria, other diseases such as tuberculosis and leprosy were present.  Leprosy at this time was not very prominent as it was more outstanding in the east and would not spread to the north until later. Malaria was one of the most prominent diseases, and its bacterial rivalry may have halted leprosy’s spread.

The ancients associated the famous Roman saunas with good health. Easy access to public latrines and baths was available. Yet, textual evidence shows baths were a breeding house for diseases. The Romans did not use disinfectants, and the healthy bathed with the unhealthy (though at different times of day). The Romans didn’t know some diseases flourished in water. Despite their keen desire to practice what they considered healthy lifestyles, poor hygiene abounded. Not all habits were poor; the wealthy simply left the city during the heights of the malarial season for their country estates in drier, higher altitude areas. This had a substantial positive impact on their demographic.

Nutritional factors for Roman health were probably insignificant. For example, the wealthiest Romans would have had the best nutrition, yet they were also the ones most able to leave during heavy outbreaks — avoiding exposure in the first place.  Conversely, malnutrition can actually inhibit a malarial infection from worsening; even still, any benefits against malaria in particular gained by a lack of nutrition would be far overshadowed by other health problems in general.

Rome was at its unhealthiest during the Imperial era.  We glean that it was far unhealthier than any other part of the Empire by looking at rates of death of garrisoned soldiers in the city compared to those abroad. A high population amidst unsanitary urban conditions unavoidably led to high rates of mortality.

As far as actual plagues comparable to the Black Death check out this article. The greatest plague during the classical Roman Empire was probably the Antonine Plague.


Walter Scheidel, “Stratification, Deprivation and Quality of Life,” Poverty in the Roman World, edited by M. Atkins and R. Osborne, (Cambridge 2006)

Walter Scheidel, “Germs for Rome,” Rome the Cosmopolis, edited by C. Edwards, (Cambridge 2003)

Alex Scobie, “Slums, Sanitation, and Mortality in the Roman World” Klio 68 (1986):399-433


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