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

vel talis est, ut perseveranter intermittat, efferamque naturam suam tantum prodat immani quopiam, & peculiari symptomate febrilem Paroxysmum comitante, cuius ferociam exitialem minime tollit intermedia quies, quae caeteroqui securitatem ex Hippocrate pollicetur: vel talis est, ut, intermis-sione paulatim deperdita, ad Continuam, & Acutam saepius quidem lente, nonnumquam & festinanter ten-dat, cum extensione gravium quorumdam, variorumque symptomatum ad tempus ipsum turbulentae quietis.

(Furthermore this periodic pernicious fever generally takes one of two forms: 1. there are persistent intermissions, and it prodigiously displays its own savage nature, and is accompanied by the characteristic symptom of a febrile paroxysm, and the rest periods of intermission, which would in other circumstances offer safety according to Hippocrates, have hardly any effect on its destructive nature; 2. the period of intermission gradually disappears, it develops into a continuous fever, frequently becoming acute slowly, but sometimes rapidly, with the extension of a variety of serious symptoms into the turbulent intermission periods.) ⁴⁰ Marchiafava and Bignami (1894: 111–12, 151–2); Marchiafava (1931: 31); T. Harinasuta and D. Bunnag in Wernsdorfer and McGregor (1988: i. 726).

Demography of malaria

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found abundantly in the intestinal organs (cf. the explanation of placental malaria given above). In fact, the view has been expressed that a degree of gastro-enteritis occurs in all cases of malaria.⁴¹

The upshot of the discussion so far is that P. falciparum malaria and gastro-intestinal diseases are not alternatives, as Shaw reckoned, but in fact went hand in hand in bringing about high infant mortality.⁴² In the city of Rome in antiquity, gastro-intestinal diseases were undoubtedly very common as a result of grossly inadequate hygiene, for example the fact that most habitations used cesspits (in order to recover faeces for use as agricultural fertilizer) for waste disposal and were not actually connected to the city’s network of sewers. This has been shown beyond reasonable doubt by Scobie’s remarkably detailed account.⁴³ Nevertheless it remains the case that in historical European populations gastro-intestinal diseases alone had less impact on the mortality regimes of human populations than malaria, where it was endemic. The combination of the two in Rome in antiquity should have generated a very high level of infant mortality.

Two major clinical syndromes, namely severe anaemia and cerebral malaria, have long been generally recognized and accepted as major manifestations of P. falciparum malaria when it attacks children. Both can be aggravated by concomitant bacterial infections, as indicated by indirect methods such as increased levels of leucocytes (white blood cells). Evidence is now emerging from research in Kenya in favour of the recognition of a third major syndrome of childhood malaria, namely respiratory distress. The suggestion is now being made that nearly 50% of all children who are diagnosed in hospital as suffering from acute respiratory diseases in that area, the heartland of the evolution of P. falciparum, may actually have malaria instead and should be treated with antimalarial drugs.

This suggests that the effects in terms of morbidity of P. falciparum malaria where it is endemic are even greater than was generally thought until recently.⁴⁴

⁴¹ De Korte (1899), cf. Murty et al. (2000) for a modern case study. The sort of account given by Wilson (1898) is still highly suggestive, even if Widal’s test is no longer believed to be absolutely diagnostic for typhoid fever.

⁴² Writing about Sardinia, Tognotti (1996: 102) described: la vera e propria strage degli inno-centi che la malaria e le malattie gastro-enteriche provocano nell’isola tra i bambini appena svezzati.

⁴³ Amulree (1973: esp. 248–9 on malaria) was much less perceptive than Scobie (1986).

⁴⁴ Modiano et al. (2001) on leucocytosis; research at the Wellcome Trust Tropical Over-seas Unit at Kilifi in Kenya, directed by K. Marsh, and reported in the Wellcome Trust Newsletter Q3 (1997: 12–14). James (1920: 158) described cases of P. falciparum malaria with 130

Demography of malaria

P. falciparum malaria can also directly kill non-immune young adults, such as immigrants to ancient Rome from regions where malaria was not endemic. Those were the cases which were most likely to be noticed by ancient doctors, who on the whole showed relatively little interest in the diseases of infants, judging by extant ancient medical literature.⁴⁵ On top of that, P. falciparum malaria can attack elderly people, whose immune systems may be weakening. In such cases it is possible to have severe infections marked by a high parasite count in the blood without any obvious fever, which is often suppressed in the elderly. Marchiafava and Bignami made these observations on cases in Rome in the nineteenth century and described in detail as an example the case of a seventy-year-old man, a watchman on the Rome–Tivoli railway line. Alexander of Tralles described a case of tertian fever in an old man in the sixth century , while a couple of centuries later Alcuin suffered from P. vivax malaria after the age of sixty. W. D. Hamilton, a prominent scientist in the field of evolutionary biology from Oxford, died recently at the age of sixty-three from malaria contracted on a visit to Africa.⁴⁶ Besides its own direct effects on elderly people, P. falciparum malaria can also strongly exacerbate both the heart diseases and the respiratory diseases whose main effects in terms of mortality are often felt most frequently by elderly age-groups.

Marchiafava and Bignami noted several fatal malaria cases in which autopsy revealed not only malaria parasites but also extensive arteriosclerotic changes in the heart. Since they noted that acute dilatations of the heart occur during severe malarial fevers, pre-existing heart disease probably played a synergistic role in the death of these patients.⁴⁷ Malaria also had every chance to interact with the respiratory diseases of winter in central Italy in antiquity, since malarial infections often occurred as late as October or even November, as has been seen, after which the disease could take several months to run its course.

symptoms predominantly in the respiratory system. Chalandon and Kocher (2000) described a case of an adult with acute respiratory distress.

⁴⁵ Bertier