The extraordinary greatness of the Roman Empire manifests itself above all in three things: the aqueducts, the paved roads, and the construction of the drains.
This is what of Halicarnassus, a famous Greek historian who lived during Augustus’ reign, had to say about the Roman empire.
He was right, of course: the Romans were extraordinarily good at water management compared to their contemporaries, and built aquaducts, fountains, bathhouses, and public restrooms wherever they went. Their legacy is still clearly visible today in major cities like Rome, Istanbul, and some smaller places in Europe.
But he was also wrong.
If you were an ordinary Roman citizen, you’d probably take your shits at public toilets. These toilets would usually be conveniently located in or near public baths, where water and plumbing were already available.
Typically, you’d drop your deuce in and then rinse your bottom with something like a sponge, moss, or piece of cloth on a stick, while a steady stream of water flushes your faeces away. When you’re done, you’d go back to whatever it is you were doing (sitting in the baths I guess).
If you were lucky, you also had access to a private toilet inside your building. These were usually located or under a staircase if your building had multiple storeys.
In neither case would you wash your hands afterwards.
Needless to say, toilet hygiene was pretty poor. Intestinal pathogens spread easily to food, drinks and other people, and large-scale outbreaks of water-borne infections were very common in the ancient world.
There are no sources that directly illustrate the relationship between water, toilets, and public health. But fortunately we can still get pretty far by carefully studying ancient texts and archaeological remains.
References to diarrhoeas and dysentery in ancient texts are numerous, although it’s not always easy to identify the cause from their (often vague) descriptions.
There are other methods though. For instance, identification of microbial DNA sequences extracted from victims’ dental pulp suggests that typhoid fever was a thing during antiquity. Others have managed to find evidence that in the ancient Romans.
However, ancient texts can be misleading. Some modern authors believe that cholera was a common intestinal disease in antiquity. While the word cholera (χολέρα) existed in antiquity, it was used to refer to a different, unspecified disease – the disease that we nowadays know as cholera didn’t actually exist in Europe until the 19th century, which would be about 1,700 years later.
Roman toilets were kind of nasty
Public health in the Roman era was pretty bad
We know this because we can study ancient texts and archaeological remains