Sanitation, Latrines and Intestinal Parasites in Past Populations

Piers D. Mitchell

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317059523
• Edition: 1
• Topic: History
• Subtopic: Ancient History
• Index: History

Sanitation and intestinal health is something we often take for granted today. However, people living in many regions of the developing world still suffer with debilitating diseases due to the lack of sanitation. Despite its clear impact upon health in modern times, sanitation in past populations is a topic that has received surprisingly little attention. This book brings together key experts from around the world to explore fascinating aspects of life in the past relevant to sanitation, and how that affected our ancestors. By its end readers will realize that toilets were in use in ancient Mesopotamia even before the invention of writing, and that flushing toilets with anatomic seats were a technology of ancient Greece at the time of the minotaur myth. They will see how sanitation compared in ancient Rome and medieval London, and will take a virtual walk around the sanitation of York at the time of the Vikings. Readers will also understand which intestinal parasites infected humans in different regions of the world over different time periods, what these parasites tell us about early human evolution, later population migrations, past diet, lifestyle, and the effects of sanitation technology. There is good evidence that over the millennia people in the past realized that sanitation mattered. They invented toilets, cleaner water supplies, drains, waste disposal and sanitation legislation. While past views on sanitation were very different to those of today, it is clear than many past societies took sanitation much more seriously than was previously thought.

Chapter 1
Why We Need to Know About Sanitation in the Past

Piers D. Mitchell

Sanitation describes the disposal of human faeces and urine, wastewater and rubbish in order to maintain hygienic conditions. This is known to be a key factor in optimising health in poorly developed parts of the world today.¹ Millions of children die every year from diarrhoeal illness and many adults suffer malnutrition and chronic ill health from parasites caught due to poor sanitation.² Latrines are one of the cornerstones of effective sanitation, as they help to physically separate people from their urine and faecal waste. They also provide a place for such waste to decompose, which tends to kill off those viral, bacterial and parasitic diseases that can be spread by urine and faeces. Those of us interested in how our ancestors lived, and what their lives were like, quite reasonably assume that similar diseases may have afflicted people living long ago. However, surprisingly little research has been undertaken to investigate the big questions such as how did sanitation change as early populations changed their lifestyles from hunter-gatherers to city dwellers, and what impact did those sanitation technologies have upon their health?

This book aims for the first time to tackle the issue by bringing together research from archaeologists, historians and paleoparasitologists. It does so by focusing on three key areas through which past hygiene can be evaluated, namely evidence for sanitation and waste disposal, the technologies such as latrines that were developed to facilitate sanitation, and the diseases such as intestinal parasites that can be spread by poor sanitation. The manner in which these three areas are interlinked is the cornerstone for the book, and explains why it is so important that they are considered in one place. We cannot hope to understand intestinal diseases in past populations if we do not also investigate their approaches to sanitation. Changes in waste disposal technologies such as cesspools, flushing latrines, drains and hand washing have limited meaning without our interpreting the consequences for the lives of those who developed those technologies.

However, the reason that this has not been done before is that certain elements in this process are extremely hard to evaluate. While past public health can be studied using written sources from suitable populations,³ this is clearly not possible for prehistoric populations who lived before the invention of writing. For example, in these populations we cannot know why a sanitation technology such as the latrine was first developed, we can only note the date the first toilets appear and how they were built. In consequence, we can only speculate as to whether latrines were first developed to reduce smells in the home, cut down on flies, remove the need to walk to the town rubbish tip with a pot of faeces each day, or prevent diseases that could be spread by living with faeces around the living space. Another challenge faces those studying past health from human remains, as analysing the skeletons of those who died in the past cannot reliably tell us much about how sanitation affected health. However, by using modern clinical research on sanitation from the developing world we can employ theoretical modelling to estimate how different lifestyles (such as hunter-gathering, farming crops, herding animals and living in early cities) and the invention of sanitation technologies may have resulted in changes to health.⁴

Some of those sanitation technologies are then discussed with articles on toilets and waste management in early Mesopotamia,⁵ and latrines in the classical Greek and Roman world.⁶ Complementing a recent volume on Roman toilets,⁷ the manner in which large cities such as ancient Rome and medieval London dealt with sanitation is explored.⁸ The systematic study of sanitation in York over nearly two thousand years spanning Romans, Vikings, and medieval and Victorian inhabitants is a classic example of what such analysis can tell us about changing sanitation in past population centres.⁹ These studies bring together considerable evidence for sanitation in different past civilisations, and help to demonstrate how they have evolved over time. The contrasting geographic, social and cultural environments of the ancient Near East, the classical Greek and Roman worlds, and medieval Britain can show how people facing the same challenges regarding sanitation may respond in quite different ways, and accept varying degrees of technology to attain a level of hygiene which they presumably found acceptable.

Parasites can be described as infectious diseases that live on or in another species (their host) while contributing nothing to the survival of that host. Viruses, bacteria and prions are generally not classed as parasites although they do also meet this description. Parasites may be single-celled organisms (such as those that cause malaria or amoebic dysentery) or large multicellular intestinal worms many feet long. A number of intestinal parasites are spread as a direct consequence of suboptimal sanitation, so the surviving eggs of these parasites can act as an indicator of sanitation. Ancient parasites can be detected in latrines, coprolites (preserved faeces) and soil taken at excavation from the pelvic area of burials, where the intestines would have been located during life. One very useful edited book in Portuguese that complements this volume includes papers on infectious disease and parasites in the past.¹⁰ However, the coverage of ancient parasite research today is not perfect as certain parts of the world have never undergone study (including much of Africa, Australasia and Oceania) and early time periods are less well understood due to the difficulty obtaining samples. Nevertheless, overviews of the parasites found in Africa and the Middle East,¹¹ Asia¹² the Americas,¹³ and Europe,¹⁴ provide a fascinating picture of how parasites came to infect humans, how certain parasites are only found in certain regions of the world, and how different parasites may have become more or less common over time. The analysis of the evidence for Entamoeba dysentery in the past¹⁵ shows how considering all the evidence for one species can allow the construction of a hypothesis as to where the disease originated.

This book does not aim to provide all the evidence for sanitation in different regions of the world, nor can it cover all time periods. While the parasite papers do cover large geographic areas, the archaeological and text based articles on sanitation and latrines will by definition focus on a particular region, culture, or group writing in the same language. Nevertheless, these studies do help to show the variety in sanitation practices in different regions, highlighting that we have to be very cautious when trying to extrapolate findings from one area of the world to another until local evidence is identified. It will be many decades before such a comprehensive knowledge base is formed, from the study of ancient manuscripts in libraries, excavation of sewers and latrines, and the application of paleoparasitological analysis at new excavation sites.

In the meantime, this volume does advance the field considerably as the first book to investigate the topic of past sanitation and health using examples from around the world, from a broad range of time periods, taking the perspective of the archaeologist, historian and parasitologist. Within it can be found a number of fascinating hypotheses that lay the foundation for that further work. The key questions we would all like to have answered are how did sanitation change as early populations changed their lifestyles from hunter-gatherers to city dwellers, and what impact did their sanitation technologies have upon their health? Those reading this book will know the latest evidence available, which will help them to make up their own mind.

¹ Kariuki, J.G., Magambo, K.J., Njeruh, M.F., Muchiri, E.M., Nzioka, S.M., Kariuki, S., ‘Effects of hygiene and sanitation interventions on reducing diarrhoea prevalence among children in resource constrained communities: case study of Turkana District, Kenya’, Journal of Community Health 37 (2012): 1178–84; Kumar, S., Vollmer, S., ‘Does access to improved sanitation reduce childhood diarrhoea in rural India?’, Health Economics 22 (2013): 410–27.

² Halpenny, C.M., Kosi, K.G., Valdés, V.E., Scott, M.E., ‘Prediction of child health by household density and asset-based indices in impoverished indigenous villages in rural Panama’, American Journal of Tropical Medicine and Hygiene 86 (2012): 280–91; Ngui, R., Lim, Y.A., Chong Kin, L., Sek Chuen, C., Jaffar, S., ‘Association between anaemia, iron deficiency anaemia, neglected parasitic infections and socioeconomic factors in rural children of West Malaysia’, PLoS Neglected Tropical Diseases 6 (2012): e1550.

³ Rawcliffe, C., Urban Bodies: Communal Health in Late Medieval English Towns and Cities (Woodbridge: Boydell & Brewer, 2013).

⁴ Mitchell, this volume, Ch. 2, pp. 5–17.

⁵ McMahon, this volume, Ch. 3, pp. 19–39.

⁶ Antoniou and Angelaki, this volume, Ch. 4, pp. 41–67.

⁷ Jansen, G.C.M., Koloski-Ostrow, A.O., Moormann, E.M. (eds), Roman Toilets: Their Archaeology and Cultural History (Leuven: Peeters, 2011).

⁸ Taylor, this volume, Ch. 5, pp. 69–97.

⁹ Hall and Kenward, this volume, Ch. 6, pp. 99–119.

¹⁰ Ferreira, L.F., Reinhard, K.J., Araújo, A. (eds), Fundamentos da Paleoparasitologia (Rio de Janeiro: Editora Fiocruz, 2011).

¹¹ Anastasiou and Mitchell, this volume, Ch. 7, pp. 121–41.

¹² Seo and Shin, this volume, Ch. 8, pp. 149–64.

¹³ Araujo et al., this volume, Ch. 9, pp. 165–202.

¹⁴ Anastasiou, this volume, Ch. 10, pp. 203–217.

¹⁵ Le Bailly and Bouchet, this volume, Ch. 11, pp. 219–228.

Chapter 2
Assessing the Impact of Sanitation upon Health in Early Human Populations from Hunter-gatherers to Ancient Civilisations, Using Theoretical Modelling

Piers D. Mitchell

Introduction

The quest to understand the health of our ancestors fascinates many of us. We can only wonder what it might really have been like to live as an early human who hunted and gathered for their food, or a prehistoric farmer who scattered the remains of last year’s grains upon the ground in the spring. It might seem obvious that life was precarious and disease might cause serious illness or death at any time. However, recent investigation of past health is starting to enable us to bring some scientific evidence to bear upon what diseases affected past populations, and what they may have done to avoid becoming ill. One of the key areas that seems to have impacted upon health in the past is sanitation, or the lack of it.

A number of key steps have been noted in the cultural evolution of anatomically modern humans.¹ It would be of great interest if we could determine what role the major steps in human evolution may have had upon health. There is likely to have been a clear advantage to those ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• List of Figures
• List of Tables
• List of Contributors
• 1 Why We Need to Know About Sanitation in the Past
• 2 Assessing the Impact of Sanitation upon Health in Early Human Populations from Hunter-gatherers to Ancient Civilisations, Using Theoretical Modelling
• 3 Waste Management in Early Urban Southern Mesopotamia
• 4 Latrines and Wastewater Sanitation Technologies in Ancient Greece
• 5 A Tale of Two Cities: The Efficacy of Ancient and Medieval Sanitation Methods
• 6 Sewers, Cesspits and Middens: A Survey of the Evidence for 2000 Years of Waste Disposal in York, UK
• 7 Human Intestinal Parasites and Dysentery in Africa and the Middle East Prior to 1500
• 8 Parasitism, Cesspits and Sanitation in East Asian Countries Prior to Modernisation
• 9 New World Paleoparasitology
• 10 Parasites in European Populations from Prehistory to the Industrial Revolution
• 11 A First Attempt to Retrace the History of Dysentery Caused by Entamoeba histolytica
• 12 A Better Understanding of Sanitation and Health in the Past
• Bibliography
• Index