Malaria and Rome: A History of Malaria in Ancient Italy by Robert Sallares (beach read .TXT) π

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Β²β΄ Bruce-Chwatt and Zulueta (1980); Zulueta (1973), (1987), and (1994); Karlen (1996).
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Types of malaria
existing in their own time in works in the Hippocratic corpus dating to the fifth and fourth centuries ο’ο£. The Hippocratic texts are basically very similar to, but less detailed than, the later Roman texts. For example:
The most acute, most serious, most difficult and deadliest diseases were continuous fevers. The safest and easiest of all, but the longest in duration, was quartan fever . . . acute disease occurs in the fever called semitertian, which is more fatal than the others . . . exact tertian fever reaches its crisis rapidly and is not fatal.Β²β΅
Although it would be nice to have more detail, basically this text looks very similar to Celsus, and Galen had no difficulty interpreting it in his commentary on this Hippocratic text.Β²βΆ It lists continuous fevers as the most dangerous of all (in agreement with Marchiafava), semitertian fevers as the most dangerous of the others (similar to Celsus), tertian fevers as not dangerous, and quartan fevers as the safest of all. Grmek has also adduced other evidence for P. falciparum malaria in the fifth century ο’ο£ with his exquisite retrospective diagnosis of the case of Philiscus in the Hippocratic Epidemics as blackwater fever. In blackwater fever a breakdown of erythrocytes on a massive scale causes excretion of haemoglobin in the urine. This complication of P. falciparum malaria occurred not infrequently in adults in Mediterranean countries in the past.Β²β· The balance of the evidence, pace Zulueta, is that P. falciparum was already present in the fifth century ο’ο£ in Greece. Marchiafava himself had no doubt whatsoever about this and quoted the very same text of Hippocrates quoted above. The origin of the name semitertian was uncertain in antiquity. Galen wrote that he could fill three volumes with what had been written about it previously. This indicates both its importance and its antiquity, since the origin of the term was hopelessly lost. Galen himself interpreted semitertian fever as a combination of tertian and quotidian fevers, although other ancient medical authors may have interpreted it in terms of other combinations of fevers.
Β²β΅ Hippocrates, Epidemics 1.11, ed. LittrΓ©, ii. 672β5: ejsi dβ ΓΈxΒ»tatai mβ n kaβ₯ mvgistai kaβ₯
calep*tatai noΔ±sai, kaβ₯ qanatwdvstatai Ζn tβ xuneceβ puretβ. Γ₯sfalvstatoΓ dβ p3ntwn, kaβ₯ Γ&β«stoΓ, kaβ₯ makrΓtatoΓ Γ tetartaβoΓ . . . Ζn dβ tβ Γmitritaβ€8 kaleomvn8 xumpβ€ptei mβ n kaβ₯ ΓΈxva nous&mata gβ€gnesqai, kaβ€ Ζsti t0n loip0n oΛtoΓ qanatwdvstatoΓ . . . tritaβoΓ Γ₯kribΒΆΓ, tacukrβ€simoΓ, kaβ₯ oΓ qanat*dhΓ.
Β²βΆ Galen 17A.227β36K.
Β²β· Grmek (1983: 409β36); James (1920: 159β62); Stephens (1937: 530β3); Marchiafava (1931: 32β3) on blackwater fever.
Types of malaria
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It is important to distinguish the problem of the etymology of the word semitertianβa linguistic and philological problemβfrom the problem of identifying the clinical symptoms described under that heading, a problem in retrospective medical diagnosis.Β²βΈ Galen rightly formulated the problem in this way:
the question is not about the reality of the disease, but about the meaning of the name, in relation to those fevers which are called tertian, semitertian, and fevers with a tertian formΒ²βΉ
He then observed correctly that in relation to periodic fevers recurring on the fifth, seventh, or ninth days, which some other ancient medical authors claimed to have observed, the right question to pose concerned not the meaning of the names, but the very existence of these diseases. The uncertainty about the origin of the word semitertian is not a good reason for doubting the equivalence of the symptoms described under that heading with those of a recog-nizable modern disease, pace Jarcho.Β³β° It simply reflects the complexity of the manifestations of the disease, which has already been noted. The testimony of Marchiafava, which has already been examined, shows that Jarcho was quite wrong to suggest that modern doctors cannot recognize the disease that Celsus and Hippocrates called semitertian fever. Celli and the other early modern Italian malariologists and numerous other modern specialists such as Grmek have all made the same identification. Furthermore, the evidence adduced by Jarcho of the failure of early modern authors to recognize semitertian fever is not pertinent, since most of the authors he considered lived in cold climates in northern Europe where P. falciparum malaria could not possibly have been endemic.
Consequently it would hardly be surprising, for example, if the famous English doctor Thomas Sydenham in the seventeenth century had not recognized a disease which could not have been Β²βΈ Galen 17A.120K: trβ€a moi nomβ€zw biblβ€a plhrwq&sesqai, cf. 17A.228K for Agathinusβ
discussion of this problem; 7.363K: Γ g3r toi sΒ»nqetoΓ Ζk tritaβ€ou kaβ₯ Γ₯mfhmerinoΔ± sunecoΔ±Γ, ο£Ώn Γmitritaβon ΓΈnom3zomen; 7.369K; Oribasius, Synopsis 6.23: Γ Γ₯kribΒΆΓ ΓmitritaβoΓ Ζx jsosqenoΔ±Γ kr3sewΓ duoβn puretoβn ginΓmenoΓ, tritaβ€ou dialeβ€pontoΓ kaβ₯ Γ₯mfhmerinoΔ± sunecoΔ±Γ (A genuine semitertian fever is made up of an equal mixture of two fevers, a tertian intermittent fever and a continuous quotidian fever); Aetios of Amida 5.82, ed.
Olivieri (1950); Marchiafava and Bignami (1894: 88 n. 1). W. D. Smith (1981: 7) commented that the author of Hippocratesβ Epidemics 7.43, 94β6 simply assumed that his audience would know what a semitertian fever was.
Β²βΉ Galen 17A.222K: oΓ perβ₯ pr3gmatoΓ, Γ₯llΒ€ perβ₯ shmainomvnou kaβ₯ ΓΈnΓmatΓΓ Ζstin Γ
z&thsiΓ, oΓΓ t0n proeirhmvnwn puret0n ΓΈnom3zein pros&kei tritaβ€ouΓ, Γmitritaβ€ouΓ kaβ₯
tritaiofueβΓ.
Β³β° Jarcho (1987), contrast Sambon (1901 b, 305β10).
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endemic in London in his own time during the climatic conditions of the βLittle Ice Ageβ (see Ch. 4. 5 below), although he undoubtedly did recognize βagueβ or βmarsh feverβ, the indigenous English malaria caused by P. vivax (see Ch. 5. 4 below). Even as late as the nineteenth century, LittrΓ© in his great edition of the Hippocratic corpus had to insist that the diseases described in it had to be searched for among those present
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