A source of clean drinking water is essential, and the Aztecs were quite advanced in providing it. While London still drew its drinking water from the polluted Thames River as late as 1854, the Aztecs brought potable water to Tenochtitlán from springs on the mainland by means of the aqueduct built by Nezahualcoyotl between 1466 and 1478. A second aqueduct was constructed in 1,499–1,500 by the ruler Ahuizotl when the first aqueduct became inadequate. Although the Aztecs had no citywide drainage system, and much of the wastewater ended up in the lake surrounding the city, they had a system to handle human waste by means of privies in all public places and many private dwellings from which excrement was collected in canoes. The excrement was applied as fertilizer to chinampas (floating parcels of land) or sold in the market to be used for tanning animal hides. Urine was collected in pottery vessels to be used later as a mordant for dyeing cloth. The Tenochtitlán environment was obviously healthy for its time, especially in comparison to European cities. Public and personal hygiene contributed to minimize the incidence and severity of illnesses.

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