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

⁴⁶ Marchiafava and Bignami (1894: 93, 129–31); Marchiafava (1931: 36); Alexander of Tralles 1.5, per≥ trita≤ou, i. 379, ed. Puschmann (1963): ƒndvcetai d’ e”nai ka≥ gvronta nose∏n trita∏on: ƒg° goın aÛtÎpthß ƒgenÎmhn to»twn ƒp≤ tinoß gvrontoß (It is accepted that an old man can become sick with tertian fever; indeed I myself witnessed a case of tertian fever in an old man.); obituary of W. D. Hamilton in The Times, 9 March 2000.

⁴⁷ Marchiafava and Bignami (1894: 107).

Demography of malaria

131

This is clearly illustrated by the chronology of the most detailed malaria cases available from antiquity, namely the cases of Cicero’s friend Atticus and his wife Pilia. Cicero’s letters suggest that Atticus had contracted quartan fever ( P. malariae) by 19 September 50 , by which time he had an unspecified fever. Although quartan fevers have a longer average duration than other types of malarial fevers, the Horton Hospital experiments showed that P. malariae does not manifest the latency and prolonged incubation periods of up to about nine months displayed by some strains of P. vivax.

Consequently it can be inferred that Atticus was actually infected in August 50 . By 25 November it had become clear that Atticus had had a double quartan fever, although one of the two fevers had ceased, and the second fever was reported to Cicero to have become milder by then. Yet the troubles continued. Another letter, dating to the middle of December, shows that Atticus still had the fever, while his wife Pilia had contracted it as well. Eventually Cicero worked out for himself from Atticus’ letters the periodicity of his quartan fever and knew on which days Atticus would be suffering. A letter of February 49  reports that Atticus’ quartan fever had left him. Nevertheless a recrudescence of the illness must have occurred (more likely than a fresh infection at that time of the year), since letters dating to early March 49 show that Atticus was suffering again. A letter dating to 17 March 49 suggests that the fever was easing again. Another letter dating to 10 May 49 states that both Atticus and Pilia had lost their quartan fevers for good by then, although it is quite possible that some parasites persisted for the rest of their lives without causing any subsequent acute clinical symptoms. The case of Atticus, which ran from September 50 

right through the winter to April 49 , demonstrates how easy it was for malarial infections to be running their course at the same time of the year as the respiratory diseases of winter.⁴⁸ Atticus’ case ⁴⁸ Cicero, Letters to Atticus, ed. Shackleton-Bailey (1965–70), nos. 123.1 (Atticus had a fever when he arrived in Rome on 19 September 50 ), 124.1 (by 16 October 50  Acastus had reported that Atticus had recovered), 125.2 (by 25 November 50 Atticus had lost one of his two quartan fevers, while the second was milder, while a second report claimed that the second fever had gone as well), 128.1 (Pilia had contracted quartan fever by mid-December 50), 128.3 (Cicero intended to visit a location in the Pontine Marshes at the end of December), 128.5 (Cicero begs Atticus to shake off his quartan fever), 130.3 (on 19 December 50 Cicero wrote that he did not know on which day Atticus’ fever was due), 131.2 (by 25–6 December 50 Cicero had found out exactly when Atticus’ fever was due), 154.4 (by 20 February 49 

Cicero had heard that Atticus had lost his quartan fever, but Pilia still had hers), 168 (on 7

March 49 Cicero mentions Atticus’ bad day, indicating that he still had the fever after all), 132

Demography of malaria

history is an absolutely typical example of the chronology of cases of quartan fever in central Italy in the past. In the early eighteenth century  Lancisi described as follows the quartan fevers to which those who lived near wetlands were subject:

The inhabitants of marshes . . . suffer from very prolonged illnesses, especially quartan fevers, which generally persist throughout the winter, and the following spring.⁴⁹

Pliny the Elder made a few comments on the epidemiology of quartan fever:

For nature has imposed some laws even on diseases: quartan fever never commences at midwinter or in the winter months. It does not occur in some people after the age of sixty, others, especially women, lose it at puberty.⁵⁰

The case of Atticus shows that a quartan fever contracted earlier could run right through the winter, even if a new infection could not be contracted in the middle of winter. This is confirmed by modern research. In considering Pliny’s other comments, it is necessary to remember that the periodicity of quartan fever can be concealed by the more powerful rhythms of other species of human malaria, and that once a person has been infected, parasites may survive virtually throughout that person’s entire lifetime (Ch. 2

above). Quartan fever is mentioned in historical literature surprisingly often in view of its relative insignificance as an agent of mortality. One reason for this prominence is that it flourished in highly seasonal Mediterranean-climate regions in the past, to which it was highly adapted, more than it does in tropical countries today.

Another reason for its visibility in historical literature is that the quartan periodicity is more regular than the periodicities of P. vivax or of P. falciparum. Celsus noted that quartan fevers were simpler 171.1 (again mentions Atticus’ bad day, on 10 March 49), 173.3 and 175.2 (Atticus’ bad day is mentioned in both these letters of 12 March and 14 March 49), 200.3 (by 3 May 49 Cicero has learnt that Atticus’ fever is easier), 207 (by 10 May 49 both Atticus and Pilia have lost their quartan fevers), 208 (on 14 May 49  Cicero again states that Atticus is free of his fever, and a cold as well). Galen 9.561K described quartan fevers contracted in autumn as very long lasting. Atticus was a good example of this dictum.

⁴⁹ Lancisi (1717: 46): paludum habitatores .