Salus Patriae: Public Health and the Roman State Caroline Garrahan Wazer Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2017 © 2017 Caroline Wazer All rights reserved ABSTRACT Salus Patriae: Public Health and the Roman State Caroline Wazer The Romans had a term for public health, salus publica, which was frequently invoked in a political context, but the concept is rarely discussed in historical studies of Roman political ideology, medicine, or infrastructure. This dissertation offers a diachronic analysis of the development of the term from the middle Republic to the beginning of the third century CE using four case studies: Senatorial responses to epidemic disease, the construction of aqueducts, the state recognition of medical authorities, and the healthcare of the military. While medical theory and hydraulic technology are relevant throughout, in each case changes in the abstract and concrete meaning of salus publica are more closely tied to broader political and social changes including the expansion of the empire, the self- presentation of the emperor, and the role of the individual citizen in the Roman state. Contents Lists of tables and figures iv Acknowledgements v Chapter 1. Introduction 1 I. What Roman public health? 1 II. The historiography of Roman public health 10 a. The Sanitarians 10 b. Rethinking Roman health and sanitation 14 c. New paradigms 26 d. Pre-modern public health on its own terms 30 III. Revisiting Roman public health 34 IV. A note on definitions: the Roman state and Roman medicine 46 Chapter 2. Epidemics, Religion, and the Roman State 49 I. Epidemics and Roman medicine 50 II. Roman epidemics in histories of the Republic 55 III. Epidemics in the Principate 67 a. Low-mortality epidemics 73 IV. Roman state responses to epidemics during the “Age of Pandemic Disease” 76 a. The Antonine Plague 77 b. The Plague of Cyprian and the “Persecution of Decius” 83 V. A “classic plague narrative”? 88 Chapter 3. Aqueducts, Political Power, and the Roman State 97 i I. The political history of Rome’s aqueducts 100 a. The Republican period: ambition in the public interest 100 b. The Julio-Claudian period 110 II. Aqueducts outside Rome 119 a. Aqueducts in the correspondence of Pliny the Younger 120 b. Hadrian’s letter to Aphrodisias 125 III. Conclusions 128 Chapter 4. Medical Authority and the Roman State 131 I. Human and divine medical authority in the Roman world 133 II. Physicians and the Roman state 136 a. Professional physicians in the Republican period 136 b. Professional physicians in the Principate 139 III. Minting health: Emperors and healing deities on Roman coinage 154 a. Coins and the communication of Imperial ideology 154 b. Asclepius and Roman coinage 162 IV. Conclusions 171 Chapter 5. Soldiers and Civilians in Roman Public Health 176 I. The military in the history of Roman medicine and sanitation 177 II. Identifying Roman military physicians 180 III. Military healthcare in its broader context 190 a. Exceptional bodies and the Roman state 190 Chapter 6. Conclusion: Constants and Variables in Roman Public Health 201 ii I. Identifying Constants in Roman Public Health 201 II. Roman Public Health: A preliminary diachronic narrative 210 a. Public health and the Roman Revolution 210 b. Roman public health after the Principate Model? 216 Bibliography 220 Appendices Appendix 1. Proposed timeline of Roman public health models 234 Appendix 2. Catalogue of High-Mortality Epidemics in the City of Rome, Early Republic to the Flavian Period 235 Appendix 3. Numismatic tables 240 Appendix 4. Figures 242 iii List of Tables and Figures Tables Table 1.1. A proposed chronology of Roman public health 41 Table 4.1. Core benefits of empire 156 Table 5.1. Epigraphically attested military physicians by region, Western Empire 180 Table 5.2: Legal status of physicians in the western provinces from inscriptions 183 Table 5.3: Locations of physician inscriptions in the western provinces 188 Figures Figure 4.1. Marble stele of heroized physician receiving supplicants 242 Figure 4.2. Grave stele of a physician 243 Figure 4.3. Denarius of Mn. Acilius Glabrio 244 Figure 4.4. Medallion of Antoninus Pius 244 Figure 4.5. As showing Caracalla on horseback saluting city goddess 245 Figure 4.6. As showing Asclepius and Caracalla 245 iv Acknowledgements It has been a privilege to work closely with William V. Harris not just over the course of writing this dissertation, but also in the classroom and at the Center for the Ancient Mediterranean. His genuine curiosity about all aspects of Roman history is infectious, and watching how he identifies questions, interrogates evidence, and builds arguments has been instrumental to my development as a researcher. I likewise consider myself very lucky to have had Roger Bagnall generously read many drafts of this dissertation. His 2013 seminar on Public Health in Antiquity at the Institute for the Study of the Ancient World was enormously helpful in the early stages of this project; more generally, the way he balances rigorous standards with an open mind and interest in new methodologies is inspiring. Francesco de Angelis, in addition to providing many helpful comments on this study, has been a warm and generous mentor throughout my time at Columbia, and I am so grateful for the many intellectual doors he has opened for me. Kyle Harper and Pamela Smith both provided thoughtful suggestions both big and small, and I am very thankful for the time and energy they both put in. Thanks to their engaged but collegial questions, I left my dissertation defense feeling excited to get back to work. This dissertation owes a great deal to a number of dear classmates-turned-friends, at Columbia and other universities, whose love of learning, generosity, and dedication to fostering collaboration over competition embody the best of what academia can be. I was lucky enough to meet many such people over the course of my education, but I especially want to express my deep gratitude to Lucia Carbone, Irene Soto, Joe Sheppard, Emily Cook, Mahmoud Samori, and Evan Jewell. Despite not knowing me personally, Calloway Scott at v New York University and Ianto Jocks at the University of Glasgow have also embodied this spirit by generously corresponding with me about their unpublished research. There are also many people outside the academy to whom I am very grateful. My colleagues at Columbia University Press and Lapham’s Quarterly have been wonderfully kind and supportive in my final year of dissertation-writing. My friends Laura Patterson, Martin Bourqui, Jo Duara, and Rachel Boillot have been great cheerleaders, as have my sister, Annie, and her husband, Hayden. My parents, Katherine Garrahan and David Wazer, and their respective spouses, Bob Distel and Alice Finn, have among them a staggering number of post-graduate degrees—one MD, two JDs, one and a half PhDs, an MBA, an MPH, and an MSW—with the result that each of them has been a great resource for sound advice, support, and celebration of milestones. I am very lucky to have not one, not two, but four parental figures who understand the path I’ve chosen and have cheered me on the whole way. Finally, I would not have finished this dissertation without the love and support, both emotional and practical, of my partner Steven, who always saw me crossing the finish line even when I didn’t myself. vi 1 Introduction I. What Roman public health? Over the four years it has taken to write this dissertation, I have encountered the term “Roman public health” almost exclusively in publications written by and for public health practitioners. Graduate programs in public health generally require an introductory course that covers the history and methodologies of modern Western public health, and textbooks used in these classes invariably devote a page or two to describing the public health of the Classical world. Below, I reproduce an excerpt from one especially popular such textbook.1 Ancient Rome adopted much of the Greek philosophy and experience concerning health matters, with high levels of achievement and new innovations in the development of public health. The Romans were extremely skilled in engineering of water supply, sewerage and drainage systems, public baths and latrines, and medical care. Roman law also regulated businesses and medical practice. The influence of the Roman Empire resulted in the transfer of these ideas throughout much of Europe and the Middle East. Rome itself had access to clean water via 10 aqueducts supplying ample water for the citizens. Rome also built public drains. By the early first century BCE, the aqueducts made available 600-900 liters per person per day of household water from mountains. Marshlands were drained to reduce endemic malaria. Public baths were built to serve the poor, and fountains were built in private homes for the wealthy. Streets were paved, and organized garbage 1 Now in its third edition, the textbook has been translated into seven languages, and according to the authors “is used not only in introductory courses in public health at bachelor’s and master’s levels but also as a general review for PhD students coming to public health from different disciplines, in North America, Europe, and many other countries. It has also been frequently recommended for use as a desk reference for practitioners.” 1 disposal served the cities… Rome made important contributions to the public health tradition of sanitation, urban planning, and organized medical care.2 This narrative is distilled from the chapter on Greece and Rome in George Rosen’s 1958 A History of Public Health, which is the only source that covers antiquity mentioned in the textbook’s references.