The pitted teeth of an individual with advanced fluorosis. / Wikimedia Commons
By Mary Harrsch / 08.25.2016
A history resource article by Mary Harrsch © 2016
Modern day school children living around Mount Vesuvius are suffering the effects of drinking ground water contaminated by naturally occurring fluoride generated by chemical changes to the volcanic debris present in the water-bearing strata just as their ancient Roman ancestors did over 2,000 years ago.
“Fluorine is present in its ionic form of fluoride in soil, water, plants, foods and even air. During weathering and circulation of water in rocks and soils, fluorine can be leached out and dissolved in groundwater and thermal gases. In groundwater, the natural concentration of fluoride depends on the geological, chemical and physical characteristics of the aquifer, the porosity and acidity of the soil and rocks, the temperature and the action of other chemical elements. Potentially fluoride-rich environments are mainly linked with Precambrian basement areas and those affected by recent volcanism…Long-term intake of high doses of fluoride can have adverse effects on human health, including dental, musculoskeletal, reproductive, developmental, renal, endocrine, neurological, and genotoxic effects [such as mutations].” — P. Petrone et al., Ancient and recent evidence of endemic fluorosis in the Naples area
Researchers point out that skeletal fluorosis from long-term exposure is characterized by calcification of tendons and ligaments and the fusion of bone structures in joints and the vertebrae of the spine.
“In advanced stages the entire skeleton may be involved by crippling deformities which can be found in the pediatric age group too,” researcher Pierpaolo Petrone observes. “Despite the increase in bone tissue mass but not in density, fluorotic bones are thus brittle, of poorer mechanical quality and easier to break.” — P. Petrone et al., Ancient and recent evidence of endemic fluorosis in the Naples area
In a 2013 effort to reveal the long-term effects of continued exposure to the contaminated groundwater of the Vesuvius region, a team of Italian researchers conducted studies on 76 human skeletons recovered in the 1997–99 excavations of the water-front chambers at Herculaneum to determine if they, too, displayed evidence of advanced fluorosis.
“In studies of ancient skeletal populations, this condition has rarely been considered in differential diagnoses of palaeopathological lesions, mostly concerning specific single cases showing excessive ossification and joint ankylosis [fusion].” — P. Petrone et al., Ancient and recent evidence of endemic fluorosis in the Naples area.
“We analyzed 76 human skeletons aged 0 to 52 years old, excavated within the water-front chambers 5, 10 and 12 of the Herculaneum suburban area. The composition by age of the entire sample shows about 62% of adults vs. 38% of sub adults (24% infants and 14% juveniles), with a sex-ratio of 1.89 (36 males vs. 19 females) assessed on individuals > 15 years old. Sex and age at death, as well as the prevalence of linear enamel hypoplastic defects (LEH) and dental caries were assessed according to standard diagnostic procedures…The chest bones, spine, pelvis and long bones of each individual were examined for the calcification of ligaments, cartilage, and tendons, as well as the presence of healed fractures. ” — P. Petrone et al., Ancient and recent evidence of endemic fluorosis in the Naples area
A staggering 91.8% of the individuals tested showed ossification processes in at least one of the long or flat bones (femur, tibia, clavicle, pelvis), with clavicle as the most involved bone (88.2%). At least 39.2% of the individuals sampled exhibited ankylosis (fusing) of the vertebrae of the spine, toe joints and/or manubriosternal joint.
“In the appendicular skeleton, a 47.2% overall occurrence of osteoarthritic-like alterations of the joints appears particularly severe given the mean age of about 30 years of individuals ≥ 15 years old.” — P. Petrone et al., Ancient and recent evidence of endemic fluorosis in the Naples area.
Over 96% of the individuals were affected by dental defects with severe enamel alterations occurring in 34.4% of the victims. Although in modern times the intake of small amounts of fluoride in drinking water is associated with the prevention of dental decay, high levels of fluoride produce the opposite effect as seen in the Herculaneum victims whose caries occurrence was unusually high if compared with other Roman Imperial age communities.
The skeleton of a young woman known as “The Ring Lady” found in a boat house in Herculaneum. / Wikimedia Commons
The researchers also pointed out that the presence of fractures was also particularly high in comparison with other Roman and pre-Roman communities, even with those of low social status.
Since a poor diet can also result in similar pathology the researchers noted that a previous trace-element analyses of the excavated group indicated the victims consumed a well-balanced diet consisting of red meat, crustaceans, oysters, dry fruit and legumes.
Today, we have the technology to implement water treatment to reduce the levels of fluoride in the drinking water of communities in arid or volcanic areas where high fluoride levels are an issue. But, did the Romans associate dental disease and the early onset of disability in these areas with local water supplies?
We see from the treatments described by 1st-century Roman physician and encyclopaedist Aulus Cornelius Celsus in his treatise De Medicina that Roman physicians had developed quite elaborate procedures for the treatment of tooth pain and extraction of teeth when treatments failed. But, I found no references to discolored teeth or to possible causes of dental deterioration in any of the eight books of his work still extant.
That’s not to say the ancients did not attempt to identify causation when presented with such obvious deterioration. Galen certainly recognized a causal relationship between a damaging condition and disease.
“…nothing happens without cause, for if this is not accepted we would be unable to seek the cause of damage to vision or its complete destruction. But since this is clear to thought, having postulated that there is some cause of damage, we proceed to look for it. With respect then to this cause, it makes no difference, at least to present considerations, whether you wish to call it some condition of the body or the body being somehow affected. In all cases then you will either say the disease itself is this [cause], or if the disease is a damage of function, the damaging condition is the actual cause of the disease.” – Galen, De methodo medendiX.51K.
But no identification of the cause of dental and skeletal deterioration in residents around Vesuvius is noted in any extant ancient medical sources. If there was some intervention, though, even if it was only applied to the upper strata of Roman society, there would be an absence of the condition in some skeletal remains. In fact, inconsistent findings of fluorosis in Roman remains recovered in Herculaneum had been noted in an earlier study.
In a 1995 study of remains found in Herculaneum, researchers Gino Fornaciari, M. Rognini and M. Torino reported in the British medical journal The Lancet finding a high percentage of calcium-deficient tooth enamel — a condition often resulting from starvation at an early age but also found in well-nourished individuals suffering from fluorosis — in six of eight individuals tested. However, the condition was not found uniformly throughout all individuals in the sample.
Researchers concluded that some of the sampled remains may have been visitors to the area, since the Roman aristocracy maintained vacation villas around the Bay of Naples. Although the explanation given by the researchers is quite plausible, I would offer an alternative explanation. Perhaps wealthier individuals drank imported wine frequently enough to avoid the ravages of the fluoride-contaminated water. Of course, without reference to this practice as a preventative measure in specific areas like those around Mount Vesuvius in any ancient sources we will never be certain if such avoidance was simply a fortunate side effect of a wealthier lifestyle or recommended by medical practitioners familiar with the disease patterns observed in these locations.
The researchers conducting the 2013 study point out the serious socioeconomic impact of a community with an ongoing permanent fluoride hazard. So how did the Romans respond to this problem?
Archaeological evidence has revealed that Herculaneum is among the very first communities in the Roman Empire to develop an organizational fraternity of freedmen known as the Augustales. Scholars have pondered why this organization officially dedicated to the cult of the emperor arose first in three communities (including Herculaneum) around the Bay of Naples in the Augustine period. In his paper, Augustales along the Bay of Naples: A Case for Their Early Growth, Steven E.
Ostrow points to a number of factors including a high concentration of slaves and freedmen due to the trading activities centered around the ports of Micenum and Puteoli as well as extensive agriculture in the rich volcanic soils around Vesuvius. Ostrow also points to the special relationship between these communities and Rome because Puteoli served as the main grain reception port for the city of Rome and the wealthy of Rome built numerous sumptuous villas around the bay to escape the heat in Rome during the summer months. But what if the Augustales were at least partially motivated to consolidate their resources to deal with a serious regional health issue?
Herculaneum membership in the Augustales numbered over 450 men based on recovered inscriptions. Of that total about 400 were identified as freedmen with the remainder listed under the heading “ingenui“. The individuals constituted some of the most successful men of their community.
“We have said that the Augustales were wealthy, and the evidence is abundant. If we simply glance at the kinds of public benefactions which they offered their fellow townspeople in the region of Campania alone — and these are fairly representative of the Augustales elsewhere — we are struck by the mighty expense that must have been involved (even if monetary sums are unfortunately, rarely specified). From the towns of Misenum, Puteoli, Abella, Pompeii, Teanum Sidicinum, Cumae Salernum, and Nuceria, we hear of the donation of ubiquitous statues, distributions of food, a set of awnings for shade in an open-air theater, gladiatorial games, highway repairs (at a cost of HS 2000), a public bath building (cost of HS 60,000), a basilica and — in the specifically religious sphere — an altar and three temples (dedicated to Pomona, to the Genius of the town of Stabiae, and to Victoria Augusta).” – Steven Ostrow, “Augustales” along the Bay of Naples: A Case for Their Early Growth.
The remains of the Temple of the Augustales in Herculaneum. Photo by Peter and Michael Clements, Creative Commons
Of the benefactions listed, I was particularly struck by the distributions of food and the public bath building, both related to the support of individual health. In addition, one of the statue bases found with an inscription referring to the Augustales held a statue of Asclepius, the god representing the healing aspects of the medical arts. In fact, even the sheer volume of statue dedications and constructions of temples may relate to attempts at addressing a health crisis through appeasing the gods, often considered a way to relieve disease in the ancient world.
So why did representation of the emperor’s cult become the ordained purpose of the Augustales?
As Ostrow points out in his paper, Compania had a regional history of civil unrest.
“During the Republic, in the very years that two great slave rebellions swept across Sicily, Campania witnessed severe, if less serious, revolts of its own: at Minturnae and Sinuessa in 135 [BCE], and again in 104 [BCE] at Nuceria and Capua. And the greatest of all ancient slave wars, that led by Spartacus beginning in 73 [BCE], broke out right in the heart of Campania, at Capua. It lasted for two years, during which the slave army rose perhaps to some 100,000 persons and managed to defeat at least five Roman armies. It ended, of course, with the crushing defeat of the rebels, and their annihilation. Although nothing like this and the Sicilian rebellions ever touched Italian soil again, the memory of them in Campania must have remained vividly alive for a long time to come.”
Ostrow observes that Augustus’ establishment of the imperial fleet at Misenum posed a potential threat of social and even military discord. In fact in 69 CE, the “Year of the Four Emperors,” the Misenum fleet actually did rebel.
Between 41 and 52 CE a political crisis is thought to have occurred at Pompeii and an incident of mob violence occurred at Puteoli in 58 CE, according to Tacitus. The next year Nero assassinated his mother after the failure of the collapsible boat debacle in the bay and later that same year rioting broke out during gladiatorial games at the amphitheater in Pompeii.
Fear of potential imperial misunderstanding was well-founded. Suspicion about the intent of group gatherings is clearly reflected in a letter from Trajan to Pliny when Pliny, serving as a provincial governor in Bithynia and Pontus in the early second century CE, asked imperial permission to form a fire fighting unit in Nicomedia.
“… we must remember that it is societies like these which have been responsible for the political disturbances in your province, particularly in towns. If people assemble for a common purpose, whatever name we give them and for whatever reason, they soon turn into a political club.” – Trajan, Letter to Pliny the Younger, Ep.
What better way to deflect Imperial suspicion of gatherings of wealthy powerful men in the area, then, than to petition the emperor for status as his official designated priesthood?
“…in view of the critical importance of Campania to Rome, any role played by the very institution of the Augustales in easing social friction would have been highly prized — both by Rome, and by the governing classes in the towns,” — Steven E. Ostrow, Augustales along the Bay of Naples: A Case for Their Early Growth
Such a designation would also enhance the social standing of the wealthy freedmen involved as well.
“The freed Roman slave, though a citizen, was permanently disbarred (at least from the early Empire, if not before) from any active role in the ‘official’ political life of his town: he could neither hold a magistrate’s post nor sit on the town council. For the average freed slave of modest means, this political disability must have mattered very little; his very freedom — limited as it was by all the ties of the patron-client relationship — may have satisfied whatever ‘political’ ambitions he felt, if any. But for the wealthy freedman — and some clearly became very wealthy indeed — this state of affairs must have presented a dilemma that could take on a major psychological and even sociological dimension. For such a freedman, the consciousness that his wealth — and perhaps his energy, wits, and ambitions — were equal to those of his fellow townsmen of free birth, but that his political path was blocked for all his lifetime, must often have been a painful experience indeed.” — Steven E. Ostrow, Augustales along the Bay of Naples: A Case for Their Early Growth
The Augustales’ success in achieving this goal of social advancement is documented in hundreds of inscriptions testifying to the high status and remarkable prestige enjoyed by them.
“In the event of public celebration, when monetary gifts were customarily awarded to all the citizenry, the Augustales always received more than the plebs, even as the local Decurions gained the richest gift of all. Augustales were frequently granted the honors of a public statue, or of a public funeral, or of the so-called ‘trappings’ of a town councilor (Ornamenta decurionalia), even if they could not enjoy membership in the council itself.” — Steven E. Ostrow, Augustales along the Bay of Naples: A Case for Their Early Growth
Although the college of Augustales could have been implemented from “the top down” through a program envisioned by the Emperor, I think it could have just as easily been a “grass roots” movement with the socioeconomic problems created by widespread fluorosis in the slave and freed populations around Vesuvius serving as the catalyst.
Petrone, P., Guarino, F. M., Giustino, S., & Gombos, F. (2013). Ancient and recent evidence of endemic fluorosis in the Naples area. Journal of Geochemical Exploration, 131, 14-27. doi:10.1016/j.gexplo.2012.11.012
Torino, M., Rognini, M., & Fornaciari, G. (1995). Dental fluorosis in ancient Herculaneum. The Lancet, 345(8960), 1306. doi:10.1016/s0140-6736(95)90952-4
Ostrow, S. (1985). “Augustales” along the Bay of Naples: A Case for Their Early Growth. Historia: Zeitschrift Für Alte Geschichte, 34(1), 64-101. Retrieved from http://www.jstor.org/stable/4435911
Galen, De methodo medendi X.51K.
Celsus, De Medicina, VI.9
Pliny the Younger, Ep.