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IF THERE鈥橲 one thing most people know about the ancient Romans, it鈥檚 that they spent a lot of time in the bath. As the Roman Empire expanded, public baths proliferated across the newly annexed territories. From plain and practical to polished-marble luxury, baths provided both colonists and colonised the means of a daily soak. Less well known is the Roman passion for another hygienic innovation: the public convenience. Wherever the Romans went, they took their toilets.

What did all that washing and flushing do for the health of less fastidious folk who came under Roman rule? 鈥淕iven what we know now about the benefits of sanitation, you might safely assume this would lead to an improvement in people鈥檚 health,鈥� says , a doctor and palaeopathologist at the University of Cambridge.

But hard evidence was lacking, so Mitchell went in search of it. He scoured records of Roman remains from towns and graveyards to fossilised faeces, for parasites such as intestinal worms, lice and fleas. What he found was precisely the opposite of what he expected.

According to legend, Rome was founded in the 8th century BC. Two centuries later work began on the cloaca maxima, or great sewer, which eventually became part of an immense network of drains and underground sewers. Work on the first of the city鈥檚 remarkable aqueducts got under way in the 4th century BC. By the end of the 1st century there were nine, carrying more than enough water for drinking, bathing, flushing the streets clean and holding mock naval battles in a purpose-built lake.

By now Rome was the world鈥檚 biggest city, with a population of a million, mostly living in squalid tenements in dirty narrow streets. Yet most people had access to public baths and toilets: the much-travelled Romans had acquired the technology from their Greek neighbours centuries earlier and built bigger, better and more of both. To most Romans, personal cleanliness was a matter of pride and bathing a daily ritual. The city now had 200 public baths of varying sizes and degrees of luxury 鈥� places to relax, socialise and wash off the day鈥檚 dirt. Toilets were ubiquitous; private houses and tenements had latrines that seated several at a time, while some public lavatories could accommodate as many as 50. The authorities, keen to keep the city clean, introduced laws requiring human waste and rubbish to be removed outside the city.

As Rome鈥檚 tentacles stretched ever farther across Europe, so did its plumbing technology, waste-removal regulations and passion for bathing. Eventually even the empire鈥檚 extremities had baths and toilets, and the unwashed 鈥渂arbarians鈥� of the north were finally introduced to the pleasures of washing.

But just how did this affect public health? 鈥淚t鈥檚 difficult to study the prevalence of most infectious diseases because they don鈥檛 leave much evidence,鈥� says Mitchell. 鈥淏ut what you can track are parasites.鈥� They often leave clearly identifiable traces. Intestinal worms have eggs with tough chitinous walls that can survive millennia in coprolites 鈥� preserved faeces 鈥� and persist at burial sites in soil within the pelvic region of long-vanished bodies. The more delicate cysts of parasitic amoebae, such as those responsible for dysentery and giardiasis, rarely survive intact but can be identified from proteins unique to each species. External parasites such as fleas, lice and ticks also survive at archaeological sites, clinging to fragments of ancient cloth, the teeth of combs and in soil from graves. More than just a nuisance, they can transmit bacteria responsible for potentially fatal diseases such as typhus and plague.

To establish how baths and toilets affected the health of Britons, Gauls, Germans and other Europeans who had never seen either before the Romans arrived, Mitchell dug out every reference to parasites found at archaeological sites before, during and after the Roman period. Scouring records from more than 50 sites, he mapped changes in the distribution of species over the centuries.

When the Romans invaded, the dominant internal parasites were roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and Entamoeba histolytica, the amoeba that causes dysentery. All three are spread in food or water contaminated with human faeces. With the adoption of toilets and baths, Mitchell expected to see them decline. .

Of the 12 species of internal parasite found in Roman remains, including a variety of tapeworms, flukes and nematodes, those linked to faeces continued to be the most widespread, especially whipworm, the most widely found intestinal parasite in the Roman Empire. 鈥淔or all their sophisticated sanitation, under the Romans intestinal parasites did not decrease,鈥� says Mitchell.

Despite the building of baths, fleas and lice 鈥� head, body and pubic 鈥� also clung on, their numbers undiminished. And there was another surprise. Mitchell expected to see some evidence of more exotic parasites, brought to the northern territories by much-travelled Roman soldiers, officials and traders from warmer parts of the empire. Instead, he saw traffic in the opposite direction. Before the Romans, the fish tapeworm had a limited distribution in what is now France and Germany. During the Roman period, it spread as far as Poland in the east, Britain in the north and Israel in the south.

Why didn鈥檛 Rome鈥檚 sanitation revolution make a dent in Europe鈥檚 dirt-loving parasites? Closer inspection of Roman baths and toilets provides plenty of clues. Take baths. The Romans and their subjects certainly did. Bathing was a communal activity: the largest known baths could take 3000 people at a time, clean and dirty, healthy and sick. No one used soap. People preferred to be slathered in oil and scraped clean with a curved implement called a strigil. Writers of the time complained about scummy water contaminated by oil and excrement. 鈥淣o one knows how often the bathwater was changed,鈥� says Craig Taylor, an archaeologist at the University of Alberta, Canada.

This meant there was a significant risk of contracting something nasty. Celsus, a 1st-century writer on medical matters, warned of the dangers of gangrene from bathing with an open wound. The intact could also leave with more than they bargained for. Traces of excrement combined with warm bathwater would have encouraged the spread of roundworm and whipworm eggs if bathers swallowed any water, says Mitchell. Eventually there was some recognition that sharing a bath with the unwell might be unwise: the 1st-century emperor Hadrian ordered that the sick and healthy should bathe at different times 鈥� the sick first.

The persistence of fleas and lice is more puzzling; you would think that regular baths would get rid of them. Perhaps bathing wasn鈥檛 as popular in the northern reaches of the empire, or perhaps Roman hygiene was lacking in another area. 鈥淲e don鈥檛 know how often they washed their clothes or whether they boiled them,鈥� says Mitchell. 鈥淚f they put clean bodies into dirty clothes they鈥檇 still have ectoparasites.鈥�

If baths were dirty, toilets were worse. Those in private homes and tenements were often sited in the worst possible place: in or next to the kitchen. Most emptied into cesspits, which was considered preferable to linking to a sewer. 鈥淩oman toilets didn鈥檛 have traps, so where they were connected to the sewers there were problems of smells coming back into the home, and the possibility of vermin,鈥� says Taylor. In Rome itself, the river Tiber regularly flooded. When it did, anyone connected to the sewers could expect a deluge of filthy water and worse to pour into their homes.

Public latrines had more mod cons. A continuous stream of water ran through a trench beneath the seats, flushing waste into a sewer. At least some provided the Roman equivalent of toilet paper 鈥� a sponge on a stick, with a water-filled channel in the floor to rinse it in. Later designs could be positively luxurious, with carved marble armrests between each seat, painted walls and washbasins (but no soap). Nevertheless, people often chose to relieve themselves elsewhere, as the graffiti in ancient Roman cities attests.

鈥淎nybody urinating here will incur the wrath of Mars鈥�

鈥淭o the one defecating here beware of the curse鈥�

鈥淪hit with comfort and good cheer, so long as you don鈥檛 do it here鈥�

A visit to the latrine was probably unpleasant and only for the desperate, according to archaeologist Ann Olga Koloski-Ostrow, author of . She has looked into more Roman lavatories than most. Aside from the total lack of privacy, she notes, they were almost invariably dark, smelly and potentially dangerous. Noxious gases built up in the trench below and sometimes exploded, sending flames shooting up through the toilets. Rats could bite unwary visitors. The sponges were almost certainly shared. It鈥檚 no wonder many public toilets included a shrine to the goddess Fortuna.

That鈥檚 not all. The seemingly hygienic habit of removing faeces from Roman towns and cities may have contributed to the spread of disease, too. Every day, cartloads of waste from cesspits trundled out of Rome itself, where much of it was sold to farmers to fertilise their crops, a practice that was probably adopted across the empire. 鈥淚t鈥檚 possible that sanitation laws requiring the removal of faeces actually led to reinfection of the population, when they ate locally grown produce contaminated with parasite eggs,鈥� says Mitchell.

So should we write off Roman sanitation as a failure? Not at all, says Mitchell. 鈥淲e are looking at things from a modern perspective. .鈥� Piped water, sewers, baths and toilets were probably never intended to improve health. The cloaca maxima was built to drain mosquito-ridden marshes around Rome. Later sewers were intended mainly as storm drains. And having piped water instead of collecting it from the river in a bucket would have been seen as 鈥減ractical and time-saving鈥�, says Mitchell. Besides, the Romans didn鈥檛 understand the link between good hygiene and health. 鈥淭hey didn鈥檛 know about microorganisms and they didn鈥檛 know how parasites spread,鈥� he says.

One mystery remains. Why did the fish tapeworm migrate across the empire? Mitchell offers an intriguing explanation. These parasites are found in fish species that spend all or part of their life cycle in fresh water. Cooking kills the eggs, and before the Romans came, most infections probably arose from eating dried, pickled or smoked fish. The Romans, however, liked to perk up their meals with lashings of garum, a malodorous mix of raw fish and herbs left to ferment in the sun. Demand for the stuff was huge, and a product that originated in the Mediterranean was soon being made in more northern regions, where fish tapeworms were much more common. The stinking liquid was packed in sealed jars and traded round the empire 鈥� and the parasite went with it.

This article appeared in print under the headline 鈥淭he emperor鈥檚 new loos鈥�