Diarrhea-related illnesses are the second leading cause of death in children under five years of age worldwide. Every year around 525,000 children die from these effects, according to data from the World Health Organization (WHO). Access to drinking water and adequate sanitation and hygiene services are essential to prevent these ailments.
Despite their high mortality rates, these types of diseases have been a danger to humans for centuries. A new analysis of fecal remains collected from two ancient Jerusalem latrines dating to the Biblical Kingdom of Judah (9th to 6th century BC) has uncovered traces of the single-celled microorganism Giardia duodenalis, a common cause of dysentery.
The team of researchers from the University of Cambridge say that this is the oldest known example of this parasite capable of causing diarrhea that infects humans anywhere on the planet, they write in an article published in the journal Parasitology. .
“The fact that these parasites were present in the sediments of two Iron Age Jerusalem cesspools suggests that dysentery was endemic to the Kingdom of Judah,” says Dr Piers Mitchell, of Cambridge’s Department of Archeology and the lead author of the study.
“Dysentery is a term that describes intestinal infectious diseases caused by parasites and bacteria that cause diarrhea, abdominal cramps, fever and dehydration. It can be fatal, especially for young children,” Mitchell recalls.
This disease is transmitted by feces that contaminate drinking water or food. “We suspect that it could have been a big problem in the early cities of the ancient Near East due to overcrowding, heat and flies, and limited water availability in the summer.”
The fecal samples found came from the sediment below the toilets found in two excavated building complexes to the south of the Old City, dating to the 7th century BC. C., when Jerusalem was the 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 present-day Iran and Iraq. Jerusalem would have been a flourishing political and religious center estimated to have had between 8,000 and 25,000 residents.
Both toilets had carved stone seats of almost identical design: a shallow curved surface to sit on, with a large central hole for defecation and an adjacent hole at the front for male urination. “Cuthole toilets from this era are relatively rare and were generally only made for the elite,” Piers Mitchell said in a statement.
One of the latrines was from a lavishly decorated estate in Armon ha-Natziv, surrounded by an ornamental garden. The site, excavated in 2019, likely dates to the time of King Manasseh, a monarch in the pay of the Assyrians who ruled for fifty years in the mid-7th century.
The site where the other bath was found, known as the House of Ahiel, was a domestic building made up of seven rooms, which housed a high-class family. The date of its construction is difficult to determine, and some researchers place it around the 8th century BC.
What is securely dated is its destruction, which occurred in 586 B.C., when Babylonian ruler Nebuchadnezzar II brutally sacked Jerusalem a second time after its citizens refused to pay their agreed tribute, ending the Kingdom of Judah.
Ancient Mesopotamian medical texts written during the first and second millennium BC describe diarrhea as affecting populations in what is now the Near and Middle East. “If a person eats bread and drinks beer and subsequently has stomach cramps, cramps and intestinal discharge, the setu caught him,” reads one of the documents.
The cuneiform word often used in these texts to describe diarrhea was sà si-sá. Some texts also included incantations that were recommended to be recited to increase the chances of recovery.
“These early written sources do not provide the causes of diarrhea, but they encourage us to apply modern techniques to investigate what pathogens might have been involved,” Mitchell said. “We know for sure that Giardia was one of those responsible infections.”
“Unlike the eggs of other intestinal parasites, the protozoa that cause dysentery are fragile and extremely difficult to detect in old samples through microscopes without using antibodies,” adds Tianyi Wang, co-author of the study.
The researchers searched for remains of Entamoeba, Giardia and Cryptosporidium, three parasitic microorganisms that are among the most common causes of diarrhea in humans and are behind outbreaks of dysentery. Tests for Entamoeba and Cryptosporidium were negative, but those for Giardia were repeatedly positive.
