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

. . longissimis morbis implicari, maximeque quartanis, quae per universam hyemem, et proximum ver aegros solent exercere.

⁵⁰ Pliny, NH 7.50.170: morbis quoque enim quasdam leges natura inposuit: quadrini circuitus febrem numquam bruma, numquam hibernis mensibus incipere, quosdam post sexagensimum vitae spatium non accedere, aliis pubertate deponi, feminis praecipue.

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than other fevers.⁵¹ Consequently quartan fevers were more easily diagnosed than fevers caused by P. vivax or P. falciparum, which frequently took a quotidian form that was liable to be confused with typhoid fever, typhus, influenza, hepatitis, and other diseases.

Dante mentioned quartan fever in the Divine Comedy: Like someone so close to the next bout of quartan fever that he already has blue nails, and trembles all over at the mere sight of cool shade, so I became at his words.⁵²

The Jewish king Alexander Jannaeus was one individual whose death in 76  was associated with an infection of quartan fever lasting for three years, but also with excessive drinking and with severe exertions on military campaigns.⁵³ Although quartan fevers were generally not regarded as fatal (at least in comparison to other types of malaria), nevertheless there was a persistent view in the past that they were particularly dangerous for the elderly. Sydenham expressed this opinion in the seventeenth century, while a traditional Sicilian saying ran as follows: ‘Quartan fever kills the elderly and heals the young’.⁵⁴

Quintus Serenus expressed the opinion that quartan fevers could lead to death and should not be underestimated.⁵⁵ Nevertheless quartan fevers were often regarded in antiquity as ‘weaker’

than benign or malignant tertian fevers, even though they lasted longer on average, simply because quartan fevers only recurred every seventy-two hours.⁵⁶ Since Pliny recognized that there was ⁵¹ Celsus 3.3.1: et quartanae quidem simpliciores sunt. Incipiunt fere ab horrore, deinde calor erumpit, finitaque febre biduum integrum est: ita quarto die revertitur (Quartan fevers are certainly simpler.

They generally commence with shivering, then the heat erupts, and after the fever terminates there is an interval of two days; and so it returns on the fourth day.).

⁵² Dante Alighieri, La Commedìa. Inferno. Canto .85–8, ed. Lanza (1996): Qual è colui che sì presso ha ‘l riprezzo | della quartana c’ha già l’unghie smorte, | e triema tutto pur guardando il rezzo, | tal divenn’io alle porte parole.

⁵³ Josephus, BJ 1.105 and Ant. J. 13.398; Kottek (1994: 34).

⁵⁴ Pitrè (1971: 218): frevi quartana li vecchi ammazza e li giuvini sana.

⁵⁵ Quintus Serenus, Liber medicinalis 48.895–8, ed. Pépin (1950): nec tu crede levem dilato tempore febrem, quae spatium sibi dat, magis ut cessando calescat: letali quoque grassatur quartana calore, ni medicas adhibere manus discamus et herbas (Do not believe that this delayed fever is mild, it gives itself a rest in order to return with even greater force: the quartan attacks with a deadly fever, unless we teach you to apply healing hands and herbs.).

⁵⁶ Pliny, NH 30.30.98–9: in quartanis medicina propemodum nihil pollet (in cases of quartan fever medicine has virtually no effect); [Aristotle,] Problems 1.56.866a ej g¤r m¶ Án åsqen&ß, oÛk #n tetarta∏oß ƒgvneto (for if it was not weak, it would not be a quartan fever). Galen 11.18–19K

compared the onset of quartan and of tertian fevers. See also Ch. 2 above on quartan fevers.

Horace, Sat. 2.3.290 also mentioned quartan fever.

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Demography of malaria

no effective herbal remedy or any other cure for quartan fever, he decided to list a series of magical treatments for it.⁵⁷ It would not serve any useful purpose here to go through all the references in the works of Pliny and other ancient authors to remedies for malaria, except to stress that their sheer number demonstrates once again the frequency of malaria in antiquity and the difficulty of treating it. A typical example is his reference to an otherwise unknown doctor called Icatidas, who claimed that quartan fevers in men were terminated by sexual intercourse with women who were just beginning to menstruate.⁵⁸ Similar beliefs persisted in Italy until recently.

In traditional Sicilian folk medicine bathing with the urine of a pregnant woman was considered a remedy for persistent cases of quartan fever. Several early modern Italian writers recommended eating bedbugs ( Cimex lectularius L.) as a cure for quartan fever, following a tradition stretching back to antiquity. Quintus Serenus had recommended eating bedbugs, with eggs and wine, in cases of both quartan and tertian fevers. Pliny also noted this idea, although he believed that it was useless as a remedy for malaria.⁵⁹ Another recommended method was eating the liver of a seven-year-old mouse. A different approach to the problem was the recommendation to arise on three consecutive mornings at dawn, face a window or door, and then shut it suddenly after reciting a particular prayer.⁶⁰ These ‘remedies’ merely serve to show how helpless doctors were in the face of malaria, but they continued trying. Martial wrote an epigram about a doctor who treated cases of quartan fever.⁶¹

The sophist Favorinus ( c. 85–155) delighted in displaying his skill as a speaker by discoursing on unlikely subjects, according to ⁵⁷ Lane (1999: esp. 639–43, 650–1) discussed the role of sympathetic magic in Pliny’s remedies for malaria and also provided a list of relevant passages in the NH, esp.20.8.15, 26.71.115–17, 28.23.82–6 and 28.25–6.90–1, 28.28.111, 114, 30.30.98–104, and 32.38.113–16.

Quintus Serenus, liber medicinalis 48.907, ed. Pépin (1950), suggested placing the fourth book of Homer’s Iliad under those who feared the return of quartan fever, another striking instance of sympathetic magic.

⁵⁸ Pliny, NH 28.23.83: Icatidas medicus quartanas finiri coitu, incipientibus dumtaxat menstruis, spopondit.

⁵⁹ Quintus Serenus, liber medicinalis 48–9,ed. Pépin (1950); Pliny, NH 29.17.63; Dioscorides, MM 2.34.

⁶⁰ Pitrè (1971: 220–1) on Sicilian folk medicine. Similar beliefs occurred in other cultures, e.g. in Islamic medical literature. Ullmann (1978: 109) quotes the famous doctor Ar-Razi (Rhazes) as saying that ‘quartan fever can be cured if the patient