Early toilets reveal dysentery in Old Testament Jerusalem

A new analysis of ancient faeces taken from two Jerusalem latrines dating back to the biblical Kingdom of Judah has uncovered traces of a single-celled microorganism Giardia duodenalis -- a common cause of debilitating diarrhoea in humans.

A research team led by the University of Cambridge say it is the oldest example we have of this diarrhoea-causing parasite infecting humans anywhere on the planet. The study is published in the journal Parasitology.

"The fact that these parasites were present in sediment from two Iron Age Jerusalem cesspits suggests that dysentery was endemic in the Kingdom of Judah," said study lead author Dr Piers Mitchell from Cambridge's Department of Archaeology.

"Dysentery is a term that describes intestinal infectious diseases caused by parasites and bacteria that trigger diarrhoea, abdominal cramps, fever and dehydration. It can be fatal, particularly for young children."

"Dysentery is spread by faeces contaminating drinking water or food, and we suspected it could have been a big problem in early cities of the ancient Near East due to over-crowding, heat and flies, and limited water available in the summer," said Mitchell.

The faecal samples came from the sediment underneath toilets found in two building complexes excavated to the south of the Old City, which date back to the 7th century BCE when Jerusalem was a capital of Judah.

During this time, Judah was a vassal state under the control of the Assyrian Empire, which at its height stretched from the Levant to the Persian Gulf, incorporating much of modern-day Iran and Iraq. Jerusalem would have been a flourishing political and religious hub estimated to have had between 8,000 and 25,000 residents.

Both toilets had carved stone seats almost identical in design: a shallow curved surface for sitting, with a large central hole for defecation and an adjacent hole at the front for male urination. "Toilets with cesspits from this time are relatively rare and were usually made only for the elite," said Mitchell.

One was from a lavishly decorated estate at Armon ha-Natziv, surrounded by an ornamental garden. The site, excavated in 2019, probably dates from the days of King Manasseh, a client king for the Assyrians who ruled for fifty years in the mid-7th century.

The site of the other toilet, known as the House of Ahiel, was a domestic building made up of seven rooms, housing an upper-class family at the time. Date of construction is hard to pin down, with some placing it around the 8th century BCE.

However, its destruction is safely dated to 586 BCE, when Babylonian ruler Nebuchadnezzar II brutally sacked Jerusalem for a second time after its citizens refused to pay their agreed tribute, bringing to an end the Kingdom of Judah.

Ancient medical texts from Mesopotamia during the first and second millennium BCE describe diarrhoea affecting the populations of what is now the Near and Middle East. One example reads: "If a person eats bread and drinks beer and subsequently his stomach is colicky, he has cramps and has a flowing of the bowels, setu has gotten him."

The cuneiform word often used in these texts to describe diarrhoea was sà si-sá. Some texts also included recommended incantations for reciting to increase the chances of recovery.

"These early written sources do not provide causes of diarrhoea, but they encourage us to apply modern techniques to investigate which pathogens might have been involved," said Mitchell. "We know for sure that Giardia was one of those infections responsible."

The team investigated the two-and-a-half-thousand year-old decomposed biblical period faeces by applying a bio-molecular technique called "ELISA," in which antibodies bind onto the proteins uniquely produced by particular species of single-celled organisms.

"Unlike the eggs of other intestinal parasites, the protozoa that cause dysentery are fragile and extremely hard to detect in ancient samples through microscopes without using antibodies," said co-author and Cambridge PhD candidate Tianyi Wang.

The researchers tested for Entamoeba, Giardia and Cryptosporidium: three parasitic microorganisms that are among the most common causes of diarrhoea in humans, and behind outbreaks of dysentery. Tests for Entamoeba and Cryptosporidium were negative, but those for Giardia were repeatedly positive.

Previous research has dated traces of the Entamoeba parasite, which also causes dysentery, as far back as Neolithic Greece over 4,000 years ago. Previous work has also shown that users of ancient Judean toilets were infected by other intestinal parasites including whipworm, tapeworm and pinworm.

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Portable toilets of the ancient Roman world

New research published today in the Journal of Archaeological Science Reports reveals how archaeologists can determine when a pot was used by Romans as a portable toilet, known as a chamber pot.

"Conical pots of this type have been recognized quite widely in the Roman Empire and in the absence of other evidence they have often been called storage jars. The discovery of many in or near public latrines had led to a suggestion that they might have been used as chamber pots, but until now proof has been lacking," says Roger Wilson, a professor in UBC's department of classical, Near Eastern and religious studies who directs the Gerace archaeological project in Sicily where the pot was found.

Archaeologists at the University of Cambridge analyzed crusty material formed on the inside surface of a ceramic pot dating to the fifth century from a Roman villa site in Sicily. Using microscopy to identify intestinal parasites, the team from the Ancient Parasites Laboratory identified the eggs of whipworm, confirming that the vessel had once contained human faeces.

"It was incredibly exciting to find the eggs of these parasitic worms 1,500 years after they'd been deposited," says co-author Tianyi Wang, University of Cambridge, who took part in the microscopy work.

Whipworms are human parasites that are about five centimetres long and live on the lining of our intestines. The eggs they lay get mixed in with the human faeces, and so would be deposited in a chamber pot during use. Minerals from urine and faeces built up in layers on the inner surface of the pot as it was repeatedly used, creating concretions.

"We found that the parasite eggs became entrapped within the layers of minerals that formed on the pot surface, so preserving them for centuries," says co-author Sophie Rabinow, also of the Cambridge team.

This is the first time that parasite eggs have been identified from concretions inside a Roman ceramic vessel and confirms the Gerace pot must have been used to contain human faeces.

Although the measurements of the Gerace chamber pot (31.8 cm high with a diameter of 34cm at the rim) indicate it could have been used for sitting on, it was more than likely used in conjunction with a wickerwork or timber chair under which the chamber pot was set.

Ceramics are one of the most commonplace forms of archaeological artifact recovered from Roman sites. This technique provides a crucial tool enabling researchers to identify pots which had the special purpose of being a chamber pot, distinguishing them from those used as storage jars for food or other materials (although occasional alternative uses of such vessels have been documented).

"The findings show that parasite analysis can provide important clues for ceramic research," says Rabinow.

The technique will only work if at least one of those people who used the chamber pot was infected by intestinal worms. Where such parasites are endemic in the developing world today, more than half of people are infected by at least one type of intestinal parasite. If Romans were infected as commonly, there is high probability that this approach will identify most such vessels as chamber pots if encrusted deposits are preserved.

Piers Mitchell, the parasites expert who led the study in the laboratory, says: "This pot came from the baths complex of a Roman villa. It seems likely that those visiting the baths would have used this chamber pot when they wanted to go to the toilet, as the baths lacked a built latrine of its own. Clearly, convenience was important to them."

Mitchell adds: "Where Roman pots in museums are noted to have these mineralized concretions inside the base, they can now be sampled using our technique to see if they were also used as chamber pots."

The identification of intestinal parasite eggs in chamber pots has the potential to advance our understanding of the sanitation, diet and intestinal health of people in the past.

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