7th-century BC elite in Jerusalem suffered from hygiene-related diseases

The ancient elite of Jerusalem may have had a lot of influence and power but they lacked toilet hygiene, and as a result, suffered from intestinal parasites, a study finds. Recently published online in the International Journal of Paleopathology (March 2022 issue), a study by Tel Aviv University and the Israel Antiquities Authority finds a 2,700-year-old toilet in Israel infested with intestinal worm eggs.

According to a news release, the egg remnants from the late Iron Age “belong to four different types of intestinal parasites: roundworm, tapeworm, whipworm, and pinworm.”

The news release notes the stone toilet was the restroom of a “magnificent private estate” and the fact that there were worms there showed that even the wealthy residents of Jerusalem at mid-7th century BCE were not immune to suffering from diseases and epidemics.

The paper says there was a collection of 15 sediment samples from the cesspit below the stone toilet seat at the site of Armon Hanatziv in occupied southern Jerusalem. The toilet was located in the garden of a house, one that the paper calls “a monumental structure with extraordinary architectural elements.”

The leader of the study was Dr Dafna Langgut, Head of the Laboratory of Archaeobotany and Ancient Environments, Institute of Archaeology and The Steinhardt Museum of Natural History. She collected sediment samples from underneath the stone toilet, where the cesspit was located thousands of years ago. Then she took the samples to the lab, chemically extracting the parasite eggs which she later examined under a light microscope, identifying them.

Langgut and Ya’akov Billig, the director of the excavation on behalf of the Israel Antiquities Authority, were “not surprised” by the recovery of a toilet in the estate’s prestigious garden. “Toilet facilities were extremely rare at that time and were a status symbol – a luxury facility that only the rich and high-ranking could afford. As the Talmud teaches, ‘Who is wealthy?... Rabbi Yosef says: Anyone who has a bathroom close to his table.’” (Bavli Shabbat 25: 2).

“The findings of this study are among the earliest observed in Israel to date,” says Langgut. “These are durable eggs, and under the special conditions provided by the cesspit, they survived for nearly 2,700 years. Intestinal worms are parasites that cause symptoms like abdominal pain, nausea, diarrhoea, and itching.  Some of them are especially dangerous for children and can lead to malnutrition, developmental delays, nervous system damage, and, in extreme cases, even death.”

The article discusses each worm one by one. The two largest taxa in the Armon Hanatziv assemblage, the Langgut writes, are “roundworm (Ascaris lumbricoides) and whipworm (Trichuris trichiura), [which] often contribute to malnutrition and to childhood stunting resulting from heavy infections. Both taxa have a faecal-oral transmission. They are common in conditions of limited sanitation and/or poor hygiene, where inadequate disposal of faecal material, contamination of food and water supplies with faecal waste, and the use of human faeces as field fertiliser are prevalent.”

Then there is the beef/pork tapeworm Taenia sp. which causes moderate infections such as abdominal pain, nausea, and diarrhoea. “It requires cattle or swine as intermediate hosts to complete its life cycle and is transmitted to the definitive human host through the consumption of raw, salted, dried, smoked, or poorly cooked beef and pork.”

The fragile eggs of the parasite pinworm (Enterobius vermicularis) appeared in the lowest frequencies throughout the assemblage. The scientists suggest that “the  low ratios may stem from preservation issues … [yet] Their presence in the Armon Hanatziv record, though in small numbers, indicates a relatively good state of preservation.” Pinworms are spread by fecal contamination of the hands or by airborne transmission and cause intense anal itching at night.

Langgut theorises that the intestinal disease at the time may have been due to poor sanitary conditions that led to faecal contamination of food and drinking water. Another possible scenario is a lack of hygiene awareness, such as failing to wash hands regularly after using the bathroom. Other possibilities are the use of human faeces to fertilise field crops or undercooked beef or pork.

The study notes that human faeces could be used as fertiliser, yet if it were not composted “for many months before being added to the fields, viable parasite eggs can spread to the plants grown.” This means that “the use of human faeces as crop fertiliser under the specialised Assyrian economy may have led to a growth in whipworm and roundworm.”

Because there was no proper medicine to speak of at the time, infected individuals would not be treated and would live with the symptoms until the end of their lives. Langgut says that while the parasites still exist today, the modern Western world has developed medication to deal with them so they don’t turn into an epidemic.