Bio-archaeological studies and historical documents are a great tool to reconstruct the lifestyle and health conditions of the ancient populations, and to understand the correlation between man and the environment over the course of time. The Anthropological Service has taken part in the environmental protection activity of the Soprintendenza Speciale per il Colosseo, il Museo Nazionale Romano e l’Area Archeologica di Roma. This has contributed to outline the biological history of Roman society, in particular that of the Imperial age. In the last decades, new excavation methods applied to the human skeletal remains have helped to collect valuable information on Roman sepulchres, especially those found in the Suburb, because of the large number of civil buildings built after the urban development. These data, together with those deriving from in-depth laboratory investigation, are helping to understand the complex biological landscape of the ancient Roman population with its bio demographic and social processes.

What did the Suburb look like during the Imperial age? As Rodolfo Lanciani [1] wrote: “In its best days, Rome was practically one with the nearby towns of Veii, Nomentum, Tivoli, Palestrina, Tusculum and Bovillae. Villas, vineyards, rural estates with country houses shaped both small and large areas creating a wide populated park around Rome”.

In recent years, the investigation on a large number of broad excavations held by the Soprintendenza, has been throwing light on wide areas whose countless archaeological contribution had been ignored [2]. The anthropological material, firstly collected during the systematic excavation of the necropolis [3] and then through laboratory investigation [4] is a considerable help to understand how the funeral services were held and how life was in the Urbs and in its surroundings, in an attempt to analyse funeral customs and everyday lifestyle through a chronological and socio-historical perspective which has been overlooked for a long time [5].

Moreover, an inter-disciplinary analysis allows to establish a connection between the everyday life conditions, the diseases, and the specific therapies of the communities that the anthropological finds belonged to. This book is an example of the valuable contribution given by medical historians and pathologists to this aim.

The anthropological analysis of a burial must begin “in the field”, at the time when it is found (Fig. 1.1). Taphonomy is the branch of knowledge which studies the processes (chemical, physical and biotic) that the body experiences between the individual’s death and the body’s discovery, based on the reconstruction of the action and interaction of the different factors which have interfered with it, from the moment of the deposition until its finding.

The information obtained through the taphonomic study of skeleton, reported case by case on an appropriate database, need a careful examination of the position of every skeletal element and the record of the condition of every joint. This is how the deposition can be defined as primary or secondary. In a primary deposition, the body has been buried, immediately after its death, in its ultimate place, where it decayed; at the time of unearthing, the skeleton must be in its original burial position, accepting for changes of position due to the action of taphonomic agents or secondary handling. Further changes of positions after the burial can be detected, whether designed, as in profanation, or accidental, linked to natural causes, as either the passage of animals or water damage [6]. A secondary deposition refers to a burial performed at two or more different times: the finding of the skeleton, and so the definitive deposition, happens in a different place from the one of the decay. The bones may have moved from their earlier position simply due to gravity, which pulls the bones down during the decomposition of the corpse, because of the absence of the soft tissues and ligaments which normally hold them together.

These movements can therefore be interpreted in order to reconstruct the original position of the body, thus highlighting the funerary practices of deposition: for instance, we will be able to determine the presence of perishable funeral structures (as cushions, coffins or dressings), or whether the deposition occurred in the ground, and so the decomposition took place in a restricted space, or in a sarcophagus, with the decomposition in a hollow space.

During the excavation process, experts should not only collect taphonomic information, but also determine, when possible, the gender and age at death of the subject, detect any pathological alterations and perform some measurements, because the frequent frailty of the finds can cause a serious loss of information, if the findings are recorded after the exhumation. This is the reason why most of the methods which will be briefly described below are usually applied in the field first and then in a laboratory in a more thorough and detailed way [7].

Ancient Rome is, for the historian of medicine, an extremely rich reality due to the theoretical development, the available and highly intellectual, methodological and technical written sources, and the rich evidence provided by the archaeological findings and remains [53].

The chronological period, the anthropological and palaeopathological study dwells on in this book is one of the most representative of the whole ancient times: in Rome, a rich Italics heritage of herbal and therapeutic competence faces the medical knowledge acquired in Greece since the classical times, rising increasingly complex pharmacological theories, whose peak is Galen of Pergamon’s “grades theory” but also the flourishing of encyclopaedic essays and manuals addressed to a wide and less refined public [55].

As regards the rational medicine, the physicians claiming a medical training regularly gained in famous schools and teachers, have already learnt the lessons of the Hippocratic medicine suggesting a reworking which comes to an amazing complex degree (one of the most striking examples are Galen of Pergamon’s writings) [54].

The heritage of the Alexandrian medicine, whose history is halfway the third century B.C. in a very short-term and extremely important period, is seen in Rome with a meaningfully increased anatomical awareness compared to the Greek experience: the human body, which was conceptualized as a hollow vessel intended to hold fluids in almost all the Hippocratic writings, is seen as an elaborate system of parts interacting to each other in the innovative Galenic medicine, completely able to exploit the Alexandrian Herophilus’ and Erasistratus’ medical experience on dissection and autopsy. Every part of the body has got its own function, which leads to health if successfully achieved; the change in the anatomical structure involves an impairment and so a disease [55].

The medical sects question the method as well as the epistemological nature of medicine [56]; the Empire opens up to imported cultural phenomena and faces with experiences, the therapeutic ones too, from the conquered countries and from the ones with an active trade, leading to wonderful opportunities of theoretical and practical enrichment particularly seen in pharmacopoeial works, as the Compositiones, dated around 47–48 A.D. and written by Scribonius Largus, a physician operating under emperor Claudius. In these works new substances of vegetable, animal and, in small percentage, mineral origin, spread by the maritime trade, meet the earliest pharmacological expertise, raising a really varied pharmacopoeia, where features of folk medicine merge, as well as the scientific ones. [57] Moreover, in their preface letter sent to Callistus, Scribonius’ Compositiones are an example of how the Roman medicine achieves original results as regards the moral and ethic thought; the suggestion to judge every patient equal and worth of treatment, even the enemies of the homeland, enriches a moral “inner” tradition coming from the Hippocratic Oath with new elements [58].

So, a very rich “medical marketplace” [59], characterized by different professional competences and by a progressive refinement of the medical knowledge comparing to the Greek origin, practised together by physicians from the Hippocratic tradition, traditional healers, specialist surgeons, obstetricians, priests of Asclepius and Gods and heroes skilled in the art of medicine, military doctors and slaves.

Consulting the several available historical sources, Roman Imperial medicine looks like a field of knowledge deeply related to the civil and social life, a field where different expectations and waitings join with an increasingly rising market demand [60]. The geographical borders expansion with the high variability of the socio-economic status of the inhabitants of the Empire, also followed by the change of the risk factors, of the onset conditions and spread of infectious diseases, in a word of the whole pathological background (called “pathocenosis” by Mirko D. Grmek, who coined a highly important neologism for the future study of the ancient Greek–Roman diseases) makes the Roman world a privileged place to investigate on the sanitary ancient history.

Celsus (1st cent. A.D.), as well known, has not got a medical background, but he is a highly brilliant data collector showing the best example of technical refinement ever reached in the Roman encyclopaedic field in his work De Medicina; in his survived book on surgery many pages regard the orthopaedic techniques and the description of the tools used for the treatment of bone injuries in Rome during the first Empire [61].

Galen (130–200/210) is the well-known intellectual giant of medicine in antiquity; a versatile, very lucky and rich man, Marcus Aurelius’ doctor first and then his son Commodus’, he spends almost his whole life in Rome being on duty of the higher social classes. During his long Roman years, Galen collects books and makes up one of the most important medical library in the ancient times (destroyed by the Temple of Peace fire in 192 A.D. it was rebuilt by Galen himself, book by book, buying again what could be found on the market and writing “ex novo” his own works, when he didn’t manage to find a copy among friends and acquaintances). His work, which survived almost entirely through the Syriac and Arabic translations, includes several essays on the treatment of fracture and dislocation, the instruments and technique [62].

The available written sources are very rich. We can also add the support of the material history, thanks to archaeology [63]: the healing temples, consecrated to Asclepius and to a huge number of principal and secondary deities, all involved in disease healing, which carry on their task during the Empire, a task confirmed by the richness of anatomical ex voto (Fig. 1.10a–c), a wide field of documents on diseases and deformity affecting the Romans and the Empire inhabitants, although unable to originally repeat the typologies already documented by the Greek and Etruscan clay production in forms and genres [64]; the treatment centres for slaves and soldiers (above all established at the borders of the Empire, the valetudinarian are complex buildings where wounded soldiers are admitted and where a military competence is practised, also extended to the orthopaedic treatments) [65]. We can add some most singular events: the ruins of private surgeries, as the Surgeon’s House in Rimini, a second century A.D. building, where the Hellenic physician Eutyches lived and worked. When his house was destroyed by a fire, maybe in the third century after a barbarian raid, he left one of the richest surgical legacy of the ancient times; a hundred and fifty tools, of different material and dating, testifying their owner’s high specialized level, and, maybe, the “military” origin of his medical knowledge [66].

Epigraphy helps to recreate the profile of the physicians working around the Empire, testifying the wandering features of the medical profession practised till the end of the Empire, excepting some cases concerning very famous physicians, settled for long periods in the same town. As regards, a slight difference between the practice of the Roman medical knowledge and its wandering organizational features in the Greek world, is the really wide dimension of the territories where doctors practice and the different cultures they meet: often coming from the eastern and Greek lands, not rare sepulchral statements testify their profession at the opposite edges of the great Empire.