The Romans are often lauded for their ingenious engineering: the graceful arches of their aqueducts, the grandeur of their bathhouses, and even the grim efficiency of their sewers. The remains of these monuments are proof – we like to think – that the Romans were at the cutting edge of public sanitation. But when we compare their sanitary standards to ours, Rome’s glossy marble starts to crack.
Many of the innovations we associate with hygiene in ancient Rome did not always improve sanitation. Instead, in many cases, they made things far, far worse.
In this article, I’ll be exploring just how dirty the Romans were, looking at public health, disease, toilets, sewers, and the sensory world of everyday life. Rome was, as we will see, a city of astonishing scale and achievement. But it was also a city of pervasive stench, constant noise, and a startling intimacy with filth.
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Public Health in Ancient Rome
Ancient Rome never codified any clear Roman public health policy. What existed was instead a patchwork of reactive measures, cobbled together only when disaster struck. One early law, most likely arising from an outbreak of dysentery or cholera, forbade cremations and burials within the city walls. This is why we find so many tombs lining roads outside the city walls, like on the Appian Way (Via Appia Antica) or the Latin Way (Via Latina). Yet citizens long persisted in ignoring it, dumping the corpses of slaves or unwanted infants throughout the city’s streets and inside its sewers — more on which later.
Only in the 3rd century BC, after a ferocious plague struck the city, did the Romans consecrate Tiber Island as a healing sanctuary with its own Asklepion (temple of healing). The island’s founding myth speaks to how deeply pestilence shaped Roman consciousness, and how some inventive storytelling concerning a serpent hid something far more sinister.
The story goes that when a plague ravaged Rome in 293 BC, the Senate consulted the Sibylline Oracles and dispatched envoys to Epidaurus, the god’s sanctuary in Greece. Upon their arrival, they were instructed to bring the Greek god of medicine, Asclepius, from his sanctuary in Epidaurus to Rome to end the plague. Following the Oracle’s advice, the envoys returned to Rome with a sacred snake, Asclepius incarnate, onboard, which leapt (somehow) from their ship as they were sailing down the River Tiber and swam ashore onto the island.
This myth reads nicely, but it reflects a grimmer reality. The Romans had recognised the need to isolate their infected, and a small island in the middle of the River Tiber was ideal.
The Constant Companion of Disease
Roman cities teemed with microorganisms that thrived in waste. Cholera and other waterborne diseases were widespread wherever sewage mixed with drinking supplies, whether at the fountains, in the baths, or in the fast-flowing River Tiber. Malaria also flourished in what was a paradise for mosquitoes: standing water in basins, gutters, fountains, and, ironically, bathtubs.
Scientists have recently discovered a parasite that afflicted people throughout the Roman Empire. Although not strictly a disease, it’s still pretty disgusting. The Romans loved garum, a fermented fish sauce that provided the Roman diet with salt in the form of a dark-colored, strong-tasting, and rather smelly liquid — and they exported this condiment to every province. The problem is that this raw fish sauce spreads eggs, which then grow into tapeworms of up to 20 to 25 feet long, coiling around the intestines of those unfortunate enough to consume it.
Faecal matter also formed an all-too prevalent part of the urban landscape, and came not just from animals but from humans too. Shit filled the streets of every Roman city, as attested by numerous written sources and examples of graffiti begging passers-by not to do it outside their house. Laws had to be written to punish citizens who dumped dung or filth into the water supply, and that such laws were necessary tells you everything.
But step outside the city walls, and the situation was not much improved.
Faeces as Fertiliser
The Romans reused human excrement in ways that would alarm any public health officer in the industrialised world: as a cheap and plentiful form of fertiliser. The agricultural writer Varro describes slave privies built directly above manure pits to provide a free source of fertiliser. A later writer, Columella, recommends sludge from the sewers as an excellent soil supplement. He tells us that human manure is “the very finest,” though best reserved for soils so poor they require extra nourishment.
So how did Roman farmers get their faeces? Well, some poor souls had to fetch it.
Cesspit-emptying was a regular urban job. In Rome, a night cart would pass by and collect refuse from toilets not connected to the sewers. We don’t know how much a Rome-based waste collector could expect to make. But in Herculaneum, one graffito records an 11-as payment (a pitiful amount) “for removal of ordure.”
A shit job, quite literally — but essential nonetheless.
Quack Doctors
With so much shit to sift through, disease must have been rife. But when you got laid low by disease, to whom could you go? Until the time of the Roman Empire, Rome had no public physicians. By the late 1st century, the medical profession had diversified to include medici publici (public doctors), surgeons, oculists, physicians for gladiators, physicians for slaves, and the imperial court’s own high-earning healers — as well as magicians and quacks who would promise to cure you of your malady for a fraction of the price.
Doctors enjoyed enviable perks: exemption from taxes, immunity from billeting soldiers, relief from prison, and premium seats at the games. Julius Caesar even granted citizenship to every physician practicing in Rome. But their skill varied dramatically. There were some checks in place. The Lex Aquilia (286 BC), for example, offered damages for medical negligence. Jurists like Ulpian record punishments for lethal potions sold as “aphrodisiacs.” But quack doctors were commonplace. One such “doctor”, known to history as Diaulus, got suitably skewered by the 1st-century poet Martial:
“Diaulus, lately a doctor, is now an undertaker: what he does as an undertaker, he used to do also as a doctor.”
Martial, Epigram 1.47
From the reign of Antoninus Pius (138–161 AD), physicians were required to present accreditation. Yet free medical care for the poor wasn’t mandated until late in Roman history in 386 AD: a remarkably late development for a civilisation often credited with inventing the Western city. Hospitals for soldiers and slaves existed from the 1st century AD, but hospitals for civilians didn’t appear until Christianity pushed charitable care forward. And none of this stopped the catastrophe: the Plague of Justinian (6th century AD) ravaged the empire for more than half a century, helping finish off the Western Empire.
The impact of all of this was predictably grim. While some wealthy Romans might live into their 60s or even 70s, life expectancy at birth in Rome averaged just 25 years.
Roman Toilets
Ancient Rome had an impressive variety of toilets, ranging from public latrines (foricae) to private household toilets, and from cesspit systems to sewer-connected facilities. Yet none of these worked quite as hygienically as modern visitors might assume.
In Rome, only the houses of the elite connected directly to the main sewer, the Cloaca Maxima. Everyone else relied on cesspits. Most toilets were on the ground floor, but not all of them. In some insulae — the multi-storey apartment blocks where most Romans lived — upper-floor toilets emptied into terracotta downpipes. Over time, these cracked or loosened, sending their contents cascading down the building’s exterior or into the rooms of tenants downstairs.
In Pompeii, nearly every house had a toilet, usually positioned next to or inside the kitchen. Only one has been found to have had a water flush. The rest emptied into cesspits cut into porous volcanic rock.
Private Toilets: “Shitting Where You Eat”
Household cooks often worked beside built-in latrines placed there out of convenience. Waste liquids, peelings, and scraps went straight down the hole. But the risks were enormous. Cross-contamination would have been constant. The smell would have been overwhelming. Insects (cockroaches especially) would have thrived.
For all the talk of poisoning in ancient Rome, we might want to take a closer look at the kitchen.
Many Romans preferred cesspit toilets to sewer-connected ones, and for a very good reason. You see, sewers regularly flooded, and lacking traps, allowed anything—rats, snakes, even sea creatures—to come crawling back up. Aelian, writing in the 3rd century AD, recounts a tale of an octopus that swam from the sea, through a sewer, and into a merchant’s home in Pozzuoli to devour his pickled fish. Terrifying? Absolutely. Implausible? Not necessarily.
Eventually, the merchants and servants killed the octopus by waiting for it to climb up from the sewers one night, closing off the conduit, and hacking it to death with axes and razors — not dissimilar to that scene in The Fellowship of the Ring where the fellowhip take on the Kraken.
This story is quite clearly a fable. It does, however, have more modern “beast beneath” analogies with the legend of the swine in the sewers of London andalligators in the sewers of New York, suggesting it speaks to our deeper fear.
Public Toilets & Explosive Shits
Public latrines were social spaces, but they could also be hazardous. With no U-bend in the sewers or trap system beneath the seats, methane and hydrogen sulphide from the sewers gradually built up. As a result, explosions occurred — occasionally lethal for the poor souls tasked with cleaning the sewers. Some Romans blamed malevolent spirits dwelling in the pipes.
We know that there were 144 public latrines in Rome by the 4th century AD. Pompeii was even more latrine-rich, with toilets found everywhere from bars to tiny shops. Most lacked running water. Most lacked washing facilities. All were covered in graffiti:
“On April 19th, I made bread.”
(Almost certainly a euphemism. Found in a latrine).
“We have wet the bed… there was no chamber pot.”
(Left by frustrated travellers in an inn).
“Apollinaris, doctor to the Emperor Titus, had a good crap here.”
(Given that Titus died of a perfectly curable disease, this may well have been his doctor’s life’s work).
A more sanitary question comes to mind. After scribbling something on the wall, how did the Romans wipe themselves? The famous sponge-on-a-stick (tersorium) is often mentioned in texts, but archaeologists still debate whether it was used on the body or simply for cleaning the latrine seat. Either way, the communal aspect is clear—and unsettling.
Chamber Pots
To save having to go downstairs in the middle of the night and making the dangerous journey to the public latrines, most Romans would have relieved themselves in chamber pots and then disposed of their contents in the morning. The Romans were pretty creative as to what form these chamber pots could take. Martial (Epigram 6.89) talks about a drunkard called Panaretus relieving himself in a wine jar and filling it back up to the brim. (Rather grimly, he proceeds to take a swig).
But where would you have emptied the pot? Good citizens might have carried a brimming chamber pot down to the public latrines, but the less scrupulous would have probably poured the contents out the window or directly onto the streets below.
The jurist Ulpian (9.3.1) discusses the laws and punishments surrounding chucking stuff out of one’s window and onto public thoroughfares. For example, the fine for killing a freeperson is 50 gold coins, and should it be the son of the household who throws something out the window and kills someone, it is he who is liable and not the head of the household (paterfamilias). He also provides evidence that someone died from having a chamber pot landing on their head.
Fulleries
If ancient Rome had a smell, a good part of it would be down to the fullers.
Fulleries were the ancient equivalent of dry cleaners, and one of their key ingredients was urine. Urine is rich in ammonia, and therefore perfect for degreasing and whitening clothes. To keep the supply to the fulleries flowing, terracotta jars were set out in streets and alleyways so passersby could make their contribution.
There was, however, a problem.
The terracotta jars for collecting urine were often unglazed and porous. They cracked easily in the heat, leaked constantly, and had an unfortunate habit of spilling their contents onto the street. Imagine a summer’s afternoon in Rome: already hot, already crowded, and now decorated with the occasional splash of warmed human urine.
Sometimes, the Romans did better. At Ostia Antica, the so-called Baths of Mithras were directly connected to a nearby fullery via a lead pipe, allowing used bathwater to be channelled straight into the fullers’ vats. Efficient, yes. Hygienic, no.
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Urine was valuable enough that Emperor Vespasian famously taxed it. When his son Titus reproached him for the indignity of taxing something so disgusting, Vespasian held a coin under his nose and asked whether it smelled. When Titus said no, his father delivered a punchline that’s echoed down the centuries: pecunia non olet—“money doesn’t stink.”
The same could not be said for Rome’s streets.
The Sewers
The Romans were immensely proud of their sewers. Strabo, writing around the turn of the millennium, marvelled at the scale of the underground world:
“The sewers, covered with a vault of tightly fitted stones, have room in some places for hay wagons to drive through them… almost every house has water tanks, and service pipes, and plentiful streams of water.”
For Roman writers, the sewers ranked alongside the roads and aqueducts as proof of Roman greatness. Pliny the Elder called them a work “more stupendous than any,” noting that mountains had to be pierced and that, like Babylon, ships could effectively pass beneath the city. Dionysius of Halicarnassus put it succinctly: the aqueducts, the paved roads, and the drains were the three supreme achievements of the empire.
The Sewers’ Dark Origin Story
Pliny also preserves a darker side to this triumph. The sewers, he says, were begun under King Tarquinius Priscus, who conscripted Rome’s lower classes to dig them. The work was so brutal and so prolonged that many labourers chose suicide rather than continue.
Tarquinius responded with a characteristically Roman mixture of pragmatism and cruelty: he ordered that anyone who killed themselves be crucified after death and left on display as carrion. The logic was macabre but effective. Romans might not fear suffering after death, but they did fear public shame. Suicides dropped, and the project continued.
We’re told that the sewers were made large enough to admit a wagon loaded with hay, and that seven artificial rivers were forced to flow beneath the city, carrying away waste and stormwater alike. Swollen by rain and by the overflow of fountains and basins, these subterranean torrents reverberated along their channels and swept the filth of a million-person city towards the Tiber.
That is a lot of filth. Rome may have produced 40–50,000 kilograms of human waste every day, much of it eventually funnelled into or through the sewer system.
Venus of the Sewers
Dirty or not, the water running through the sewers was still “living” in Roman eyes—and therefore sacred. It’s no accident that the Cloaca Maxima, Rome’s first great sewer, had its own protective deity: Venus Cloacina, “Venus of the Sewers”, who watched over the city’s drains. Even excrement, in Rome, had its goddess.
Cleaning the Sewers
Of course, once you build a giant U-shaped sewer system, you have to maintain it. Roman sewers tended to silt up, block, and backflow. Someone had to go in and fix that.
A letter from the emperor Trajan (98–117 AD) to Pliny the Younger sheds some light on who drew the short straw. Condemned men, Trajan notes, were often assigned to work in the public baths, clean out the sewers, and repair roads and streets.
Sewer cleaning was penal or slave labour. Those condemned to do it worked in claustrophobic, poorly ventilated tunnels, exposed to hydrogen sulphide, methane, stagnant water, and whatever else a city of one million people could flush, tip, or throw away. Death by suffocation or poisoning was a constant risk.
There was also an engineering incentive to keep the sewers flowing. Jurist Ulpian warns that neglected drains could undermine mud foundations and cause buildings to collapse. So if the smell and the gas didn’t convince the city to send someone down, the threat of sudden structural failure might.
The Roman Baths
According to Agrippa’s census of 33 BC, Rome already boasted 170 public and private baths. By the 4th century AD, that number had swollen to nearly 1,000. Admission was cheap—a quadrans, the smallest coin in circulation—so almost everyone could afford to go. We don’t know how strictly they were closed at night, and it’s not unreasonable to imagine people dozing in the warm, steamy rooms after hours.
Bathing Practices: Marinating in Other People’s Gunk
A typical visit involved moving between different temperature rooms: a cold plunge, a hot chamber, and the more popular warm room—the tepidarium—where bathers lingered, chatted, and relaxed.
Think of it like a large, warm swimming pool with no chlorine and no filtration system. Now picture hundreds of bodies, day after day, sliding in and out of that same water. The Romans certainly urinated in the baths; even with attendants glaring at them, some people always do. Add to that sweat, oils, skin flakes, and whatever pathogens they brought in, and you have a near-perfect breeding ground for diseases like dysentery and cholera.
One mercy: children were generally not allowed in the baths. Adults went daily; kids were expected to make do at home with a bucket of water drawn from the local fountain. It’s a small concession to hygiene, but a concession nonetheless.
Cleaning Practices: Scraped, Not Washed
Bath-goers brought clean clothes, towels, oils and ointments, and a strigil—a curved metal scraper used to remove a mixture of oil, sweat, and dirt from the skin. Contrary to expectations, strigil-cleaning is actually quite effective. You emerge feeling genuinely scrubbed.
The water, however, remained dubious. Baths were rarely drained and refilled; instead, they were periodically flooded to push off the worst of the scum. Over time, a cloudy film of oil, grime, and organic matter would build up on the surface. Several Roman writers couldn’t resist pointing out the irony: citizens seeking health in a place where they effectively marinated in each other’s body residue. As part of Roman bathing etiquette, the sick usually bathed in the afternoons to avoid healthy bathers. However, like public toilets and the streets, there was no daily cleaning routine for keeping the baths themselves clean, so illness was often passed to healthy bathers who visited the next morning.
Baths weren’t just about washing. They were gyms, social clubs, medical clinics, and political meeting points rolled into one. One thing they were not, in the modern sense, was clean.
Baths, Wine, and Sex: Vices Worth Dying For
A popular epigram, found on the tombstone of Tiberius Claudius Secundus and repeated across the empire, captures the Roman attitude perfectly:
Balnea, vina, Venus corrumpunt corpora nostra,
sed vitam faciunt balnea, vina, Venus.
“Baths, wine, and sex ruin our bodies,
but baths, wine, and sex make life worth living.”
Another epitaph from Ostia has a man named Primus boast that he lived on Lucrine oysters and Falernian wine, and that baths, wine, and love aged with him through the years. If he achieved that, he says, may the earth lie light on him. No regrets. Just oysters.
Not everyone saw the baths as grim reapers in disguise. The Christian writer Minucius Felix praises the marine baths of Ostia as a soothing remedy, taken while the law courts were on holiday. Archaeology backs up the idea of baths as health centres: statues of healing deities, including Asclepius, have been found in Ostian bath complexes.
Health hazard or health cure? In true Roman fashion, the answer seems to be “both.”
Where Does All This Water Come From?
All of this bathing, flushing, and sewer-scouring depended on the real heroes of Roman sanitation: the aqueducts.
By the early Empire, nine major aqueducts supplied Rome (more still were added later). Seven of their lines still stride through what is now the Parco degli Acquedotti (Rome’s Aqueduct Park), including the later Aqua Felice. Before the first aqueduct was built in 312 BC, the Romans relied on the Tiber, on rainwater collected in cisterns, and on the odd spring. That means there was a span of a couple of centuries where Rome had a sewer system funnelling filth away — but no truly reliable way of bringing fresh, clean water in.
The aqueducts changed that dramatically. Ancient engineers boasted that they carried more water than all the hand-built monuments of Greece combined. They weren’t exaggerating. At their peak, Rome’s aqueducts supplied over 992,000 cubic metres of water a day: that’s about 992 million litres, or roughly 262 million gallons.
Break it down per person, and you’re looking at around 992 litres (263 gallons) per head, per day—more than double what most of us use now (about 100 gallons), and we’re the ones with flush toilets and hot showers. Most of Rome’s water went not into cleaning waste away, but into fountains, baths, ornamental displays, and industrial uses like fulleries.
As Dionysius of Halicarnassus put it, the aqueducts, the roads, and the drains were the empire’s crowning achievements.
They were spectacular. They were effective. And still, Rome stank.
Streetlife in a Roman City
If you’d walked Rome’s streets in antiquity, you’d have encountered a sensory overload that puts modern traffic and pollution into perspective. The roads were littered with human and animal waste. Corpses of slaves and exposed, unwanted infants could be left out in some districts. There were no municipal street-cleaning crews in the modern sense. The responsibility for urban upkeep lay with the aediles, magistrates with limited resources and competing priorities.
The satirist Juvenal has left us with an especially evocative description of a street scene in first-century AD Rome:
You have to be filthy rich to find rest
in Rome. That’s the source of our sickness. The endless traffic
In narrow twisting streets, and the swearing at stranded cattle,
Would deprive a Claudius of sleep, or the seals on the shore.
When duty calls, the crowd gives way as the rich man’s litter,
Rushes by, right in their faces, like some vast Liburnian galley,
While he reads, writes, sleeps inside, while sped on his way:
You know how a chair with shut windows makes you drowsy!
Yet, he gets there first: as I hasten, the tide ahead obstructs me,
And the huge massed ranks that follow behind crush my kidneys;
This man sticks out his elbow, that one flails with a solid pole,
This man strikes my head with a beam, that one with a barrel.
Legs caked with mud, I’m forever trampled by mighty feet
From every side, while a soldier’s hobnailed boot pierces my toe.
Do you see all the smoke that rises, to celebrate a hand-out?
There’s a hundred diners each followed by his portable kitchen.
Corbulo, that huge general, could scarce carry all those vast pots,
With all the rest that the poor little slave transports, on his head.
Juvenal, Satire 3, 232-267
One famous anecdote has the emperor Caligula, furious at Vespasian’s neglect of his street-cleaning duties as aedile, ordering soldiers to shovel mud into the folds of his purple-bordered toga. It was a humiliating reminder that Rome’s filth was everyone’s problem—especially the man whose job it was to hide it.
Excess water didn’t always stay underground. When sewers backed up or overflowed, fouled water bubbled out into the streets. Refuse was picked over by dogs, pigs, and carrion birds. The air would have buzzed with flies.
Stepping Stones and Survival
In Pompeii, the famous raised stepping stones that still dot the streets were not whimsical design features. They were practical survival tools. They allowed pedestrians to cross the road without stepping directly into whatever mixture of mud, dung, urine, and kitchen waste was flowing between the ruts left by cart wheels. It was, quite literally, a city built with the expectation that the road would often be running with filth.
When Did Things Get Better?
In many ways, ancient Rome wasn’t uniquely disgusting. It was simply ahead of the curve in being large and crowded. Its sanitation problems were the same ones that plagued every major European city right up to the 19th century.
Conditions in Rome would, in fact, have looked depressingly familiar to residents of industrial London before its modern sewer system was built. It wasn’t until reformers like Edwin Chadwick and his Sanitary Report in the mid-1800s that governments seriously invested in large-scale public health infrastructure.
Modern Romans, incidentally, often find us unhygienic. Many can’t imagine a bathroom without a bidet, and they’re mildly horrified that so much of the Anglophone world makes do without one. Standards change. The debates continue.
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