**6. Conclusions**

*Healthcare Access - Regional Overviews*

Along with the Greeks, the Etruscans, the people who lived in the area south of the Arno River, had linked individual hygiene and public health with the presence of clean water but with the immediate removal of dirt and excess water from very early. That's why they had developed the hydraulic art and had built plumbing facilities from very early, sophisticated, so that they were used as models by the Romans. Even Cloaca maxima in Rome was built by Etruscan engineers around 600 BC, while the first aqueduct in Rome in 312 BC is also attributed to them [30]. Also, the thermal baths of Etruria (Chianciano, Del Sasso), as well as the famous

Roman medicine, very much like Greek medicine, in parallel with its scientific base, was very strongly connected with religious influences and superstitions [6]. However, apart from a large number of doctors and physicians who developed the science and practice of medicine, the Romans' real contributions to healthcare are the hygiene and sanitation technologies, water sophisticated supply, and sewage systems. Hygiene in Roman era included baths and toilets in private and public buildings. The Romans developed the art of baths, which in every case had as an essential condition to the adequate supply of water and the presence of an efficient drainage system. Many of the baths were grandiose bands that operated until sunset and were

centers of Etruscan medicine, have been of a magical religious character.

open for the sick up to 2 hours and in the afternoon for the rest of the guests.

In addition to the baths, the Romans greatly promoted the use of natural hot springs scattered throughout the Empire [31]. Most of them had healing properties and could relieve various body or even insane sufferings. The fact that therapeutic bathing in medicinal and thermal springs provide relief for many complaints was very well-known since the Hellenistic period; nevertheless the Romans were the ones who developed systematically [32]. High-temperature springs were treated as a special kind of waters ages before the Roman era. In fact, some of them were considered to be sacred, with supernatural powers and special healing properties. In ancient Greek and Latin literature numerous well known thermal springs were reported. Many of them seemed to have components which give them different properties, and make them suitable for the treatment of different diseases. The Romans built splendid baths on the sites of hot springs in all over the empire, where many people flocked in order to find healing or relief for their illness. This practice of them was certainly not free from their theocratic perceptions. Besides, Vitruvius recommended spots with natural water springs as the best choice for shrines dedicated to every god or goddess, especially to those connected to healing: "*…naturalis autem decor sic erit, si imum omnibus templis saluberrimae regiones aquarumque fontes in iis locis idonei eligentur in quibus fana constituantur, deinde maxime Aesculapio Saluti, quorum deorum plurimi medicinis aegri curari videntur. cum enim ex pestilenti in salubrem locum corpora aegra translata fuerint et e fontibus salubribus aquarum usus subministrabuntur, celerius convalescent…*" (*De Architectura, 1, 2, 7*). This roughly translates as follows: "*……Natural consistency arises from the choice of such situations for temples as possess the advantages of salubrious air and water; more especially in the case of temples erected to Æsculapius, to the Goddess of Health, and such other divinities as possessing the power of curing diseases. For thus the sick, changing the unwholesome air and water to which they have been accustomed to those that are healthy, sooner convalesce; and a reliance upon the divinity will be therefore* 

Ages later, Caelius Aurelianus, a Roman citizen who lived in the fifth century AD in the town Sicca in the African province Numidia, supported the therapeutic use of sea bathing as a very relieving and curative body treatment. He suggested people to

**5. Roman era**

**68**

*increased by proper choice of situation…*".

The connection between public health, clean water, and sanitation has been explored since antiquity. Medicine in Classical and Hellenistic times became gradually more based on clinical observations and scientific investigations. Before that time advances, medicine was entirely confined to religious beliefs and rituals [35]. Since the sixth century BC, philosophy began to flourish in the Greek cities of the Aegean and the Ionian coast of Asia Minor. The environment was mature enough, and scientific medicine was enabled to be born. Physicians attempted to identify material causes for illnesses; in parallel, people never stopped flocking to sanctuaries so as to find succor for their illnesses. They usually preferred Asclepieia, which were located in areas with lush vegetation, rich, and fresh water.

Ancient authors many times commented about the influence of different kinds of water on people's health. Thus, they were all aware that waterborne infections have been among the main causes of people's deaths. The Romans believed that illnesses had a cause and that the bad health is connected to bad water and sewage. Both Greek and Romans were trying to improve the quality of water using settling tanks, filters, or boiling it, which was the most recommended of all existing methods.

Influenced by the advent and progress of philosophy in Classical and Hellenistic periods, sanitation and hygienic conditions and especially medicine became gradually more based on clinical observations and scientific investigations.

The role of water is crucial in the Hippocratic medicine. Specifically, what is shown here is that diseases are less frequent in cities with an eastern aspect, since the waters, which flow there, is considered to be healthier and more suitable for drinking.

In conclusion, although the above descriptions do not provide a complete picture of urban sanitation technologies in ancient Greece, they serve to illustrate the fact that such technologies were in use in ancient Greece since about 4000 years ago. These advanced technologies, developed originally in Minoan era, were subsequently transferred to the Mycenaean civilization and then the Archaic, Classical, and Hellenistic Greece. These sanitation and hygienic technologies were further improved during the Roman period formed, for example, a type of lavatory which survived with limited modifications for more than 1500 years. Based on historical and archeological evidences, the present-day progress in urban water technology as well as in comfortable and hygienic living is clearly not a recent development. The Greeks considered pioneers in developing the basic sanitation technologies in the

western world. They placed emphasis on providing an urban hygienic environment, with emphasis in a sustainable way since the prehistoric times.

Undoubtedly ancient Hellenic and Roman views contain excellent remarks on the role of the water and hygiene with regard to people's health. For that many of which have survived until modern times. Centuries later, in the late nineteenth century, the role of personal and public hygiene and water on people's health was really very well understood. The fact that hygiene technologies and safe drinking water are intimately tied to human health has been so perfectly conceivable that Lewis Thomas mentioned [36]: The connection between public health, clean water and sanitation has been explored since antiquity. Medicine in Classical and Hellenistic times became gradually more based on clinical observations and scientific investigations. Before that time advances, medicine was entirely confined to religious beliefs and rituals [35]. Since the sixth century BC, philosophy began to flourish in the Greek cities of the Aegean and the Ionian coast of Asia Minor. The environment was mature enough, and scientific medicine was enabled to be born. Physicians attempted to identify material causes for illnesses. In parallel, people never stopped flocking to sanctuaries so as to find succor for their illnesses. In the late Hellenistic period, the knowledge of the ancient world of hygienic matter was incorporated in legislative rules.

Ancient authors many times commented about the influence of different kinds of water on people's health. Thus, they were all aware that waterborne infections have been among the main causes of people's deaths. There is no question that our health has improved spectacularly in the past century. One thing seems certain: It did not happen because of improvements in medicine, or medical science, or even the presence of doctors, much of the credit should go to the plumbers and sanitary engineers of the western world [37].
