In Sickness and in Health. Health and Quality of Life in Roman imperial to late Roman and middle Byzantine Sagalassos

Who was the healthiest, the Roman Imperial to Late Roman (1st- early 5th century AD) or Middle Byzantine (11th-13th century AD) population at Sagalassos (Pisidia, SW Anatolia)? That was the question this Ph.D. research started with. Yet, a second question was added – why is the one population healthier than the other? –, because it is more interesting to explain differences in health than to merely asses these. As it is not possible to compare the health of two populations with a broad variety of aspects that may have influenced their health, this thesis limited itself to two hypotheses. Both originated in economic history. The first states that higher population pressure would facilitate a rapid spread of infectious diseases and is likely to cause shortages in food products, which both have negative effects on the population’s health. As such, this hypothesis is neo-Malthusian in nature. Its main advocates – Walter Scheidel, Bruce Frier and Peter Temin – conclude that Roman cities and towns were falling victim to these Malthusian processes. In contrast, scholars like Geoffrey Kron, Elio Lo Cascio and Bruce Hitchner stated that population pressure plays a lesser role in the health of ancient populations, but that hygiene and the availability of safe drinking water are the main factors resulting in a healthy society. The investments the Romans made to provide their citizens with potable water and hygienic conditions, by constructing aqueducts, latrines, public bathing infrastructure, sewers etc., would, consequently, have resulted in a better health. To evaluate these two hypotheses on the Sagalassos case-study, this dissertation avails itself of a quality of life (QoL) framework. QoL-studies regard society as a complex interaction of domains (e.g. environmental quality, personal safety, subjective well-being, housing conditions, etc.) that can be measured and described, and of which their outcomes (here, physical health) can be understood and explained by other domains.

To come to an assessment of the health of both populations, a dataset of 48 Roman imperial to late Roman and 72 middle Byzantine skeletal individuals is used. The proxies consist of paleopathological, paleodemographic and osteometric data (collected by Katrien Van de Vijver, unpublished data), stable carbon and nitrogen isotopic values (published by Benjamin T. Fuller) and aDNA-analysis (published by Claudio Ottoni). Moreover, a detailed analysis of the funerary practices at Sagalassos helps to evaluate the representativeness of the skeletal assemblage. Each of these proxies are analyzed separately to make inferences on disease prevalences, average life expectancies, stature and an evaluation of the diet and genetic inheritance of both populations. These results – as they originated from very distinct source-types – often contradict each other. Life expectancy at birth in Roman imperial to late Roman times, for example, was c. 6 years higher than in middle Byzantine times, whereas the average Roman male was c. 3 smaller than the average middle Byzantine Sagalassian. To bring all the evidence into synthesis, two quantitative methods are used to compare the evidence. First, the Health Index from Richard Steckel and Jerome Rose’s The Backbone of History (2002) was applied, and, second, a Principal Component Analysis (PCA) was executed on seven quantitative variables. Both analyses proclaimed that the Roman imperial to late Roman population was more healthy than the middle Byzantine one. However, these quantitative analyses cannot give a definite answer on whether the evidence can be interpreted in an opposite way, following The Osteological Paradox by Wood et al. (1992). Therefore, a skeletal biography perspective was applied on the Roman and middle Byzantine skeletal assemblages to qualitatively describe differences in health for each life phase. For most of the discussed aspects, the health state of the Roman imperial to late Roman population at Sagalassos remained better than that of the middle Byzantine one.

To further evaluate both hypotheses, the health of the Roman imperial to late Roman and middle Byzantine populations is compared to the population pressure on the one hand, and the available hygiene- and water-related infrastructure on the other. Population pressure is expressed as the estimate of the carrying capacity in the Ağlasun, Dereköy, Çanaklı and Yeşilbaşköy valleys – the fertile area within a 1-3 hour walking distance of Sagalassos which is interpreted as the primary catchment area of Sagalassos – over the estimates of the population numbers in Sagalassos. The population numbers are obtained following Shotgun Method 2.0 (Cleymans 2018). The population pressure in Roman imperial to late Roman times turned out to be higher. The infrastructure was presented as a presence or absence of specific features (e.g. public bathing facilities, sewage systems, public fountains, aqueducts, etc.). Roman Sagalassos appeared to be better equipped with such infrastructure. In conclusion, the infrastructure-hypothesis seems to be more plausible. Yet, the answer is more complex, as there are many other QoL-domains interacting with the health of the Sagalassos populations, which can mask or enforce the two selected hypotheses. Moreover, the domains used in this thesis (population pressure and hygiene/drinking water) influence each other too. For example, the higher the population numbers, the more investments society is able to make on infrastructure. Although these two hypotheses were only tested on Sagalassos – a relatively small town in Asia Minor –, similar patterns can be observed elsewhere in Asia Minor and the Roman and Byzantine Empires. The methodology developed in this dissertation can thus be applied on other ancient towns and regions too.