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Cloaca Maxima exists to this day, incorporated into the modern sewer system. The Roman Empire didn't survive but its sewer did.

 

Side note: Throwing waste into the street was acceptable in ancient times. Live on an upper floor? Too much trouble to move your movements to the street? Too poor to pay a stercorarius to pick up your poop? No problem. Just toss it out the window. Be sure that it doesn’t land on anyone though. Rome had a law against that, Dejecti Effusive Actio. Oddly, it only applied to daylight hours. If your waste landed on someone, the personal injury attorneys were ready and waiting. The fine varied according to extent of damages. If the injury proved fatal, the fine was 50 aurei.

 

 

Sanitation, health, and epidemiology

 

They may not have understood the link between sewage and standing water and disease, but Romans did know that marshlands were dangerous places. They attributed this to bad air. In fact, malaria means "bad air". With the markedly improved drainage of Rome, malaria rates apparently decreased along with other diseases supported standing water and sewage.

 

Rome's superior public water works did not eradicate disease but the effect was mitigating. Consider Ostia Antica, a city once similar to Rome. The once-thriving port city did not have a sophisticated drainage system. The port silted over, standing water abounded, and it is theorized that rampant malaria played a significant role in the city's demise.

 

The Pontine region with its marshes suffered a fate similar to Ostia Antica. The population collapsed around the turn of the millennium, likely due to infectious diseases such as malaria.

 

By contrast, although residents of the city of Rome certainly contracted many diseases, the population as a whole survived and thrived.

 

 

Venus Cloacina

 

In the six century BCE, a statue of a woman was supposedly found in the Cloaca Maxima. She became known as the Goddess Cloacina; a deity that likely had its origin in the mythology of the Etruscans. Her name stems from either the Latin verb cloare or cluere, meaning "to wash, clean or purify" or from the Latin word cloaca, meaning “sewer”. How and when she became associated with Venus is unknown.

 

Recognizing the importance of their sewer system, even without understanding the infectious disease mitigation it provided, a shrine to the goddess was built in the Forum: the Sacrum Cloacina. I'm not sure when it was constructed. The details of the shrine are known only from these two denarii of Mussidius Longus.