As I start this column, I am unsure whether I am writing about public health or environmental health.
I think the drivers for public health are public comprehension - do people understand the consequences of their actions? - and public compliance, which cannot be taken for granted. As we are now acutely aware, infections can be spread in the air and animals can be a vector for disease.
At its height, Ancient Rome (AD 117) was a city of 1.1 million people drawn from across the three continents. Most of Rome’s population lived in poorly constructed tenement blocks. Its streets were filthy with chamber pots and rubbish tipped into the streets on a regular basis. The satirist Juvenal recommended making your last will before venturing into the street, lest something more solid than the contents of a chamber pot be dropped on your head from up to six storeys above!
Despite this clearly hazardous environment, there were steps taken to address public health – after all, in such a crowded environment it was in everyone’s interest to keep disease to a minimum. The Romans understood that bad air leads to disease and that extended to personal hygiene. Daily bathing was strongly encouraged as was exercise and a free grain dole ensured that those who were citizens had at least some sort of nourishment on a daily basis.
Rome’s thousand or so public baths and in excess of 140 public toilets (some of which seated up to 50 people simultaneously) were constantly fed by a network of 11 aqueducts that delivered up to 750 litres of spring water per day per resident. Much of that water was used to flush out latrines and the city’s extensive sewer network, but a large part also went to public fountains that offered fresh clean water to the citizens of Rome for free.
To put that in perspective, it would not be until Victorian London achieved a population of a million people in the 19th century that public conveniences were again as readily available and it would take until the 1890s for a city’s citizens to enjoy the same level of access to fresh clean water. The infrastructure the Romans created to combat public health issues is still in use today.
The modern city of Rome still uses sewers built large enough to sail through and its public drinking fountains are still fed by mountain springs. So it is clear that plumbing had a major effect on public health because it dealt with both fresh and clean water supply and the disposal of sewage.
We have spoken about Ancient Rome, but John Snow (15.03.1813-16.06.1858) conducted pioneering investigations into cholera epidemics in England, and particularly in London, in 1854 in which he demonstrated that contaminated water was the key source of cholera outbreaks. His thorough investigation of an epidemic in the Soho district of London led to his conclusion that contaminated water from the Broad Street pump was the source of the disease.
This was contested by many members of the public, however the removal of the handle from the pump led to the cessation of the epidemic. So to return to the beginning, comprehension is one thing, achieving compliance is another thing altogether.
About the contributor
Stan Atkins
CEO
BICSc