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

(Likewise Asclepiades said that a persistent quotidian fever is not without danger, and many cases have progressed from it to another disease, such as dissolution of the body or dropsy or whatever occurs through the weakening of the body.)⁷⁰

In early modern Rome the interaction between P. falciparum malaria and the respiratory diseases was observed by everyone who did research there. For example, Rey and Sormani, in an article devoted to studying statistics for causes of death in Rome in the years 1874–6, noted that Rome had a higher death rate from various respiratory diseases than other major European cities whose data were considered for comparative purposes. They attributed this excess to the complications of malaria, even at a time when malaria was on the verge of final eradication from the city of Rome, and even though the highest death rates from these respiratory diseases occurred in the months of January to March: We cannot distinguish in the cause of death statistics between simple forms and those forms with a special character owing to the influence of malaria; nevertheless the observations which have been made permit an argument for a certain frequency of malarial complications in these disease syndromes.⁷¹

⁶⁸ Balfour (1936: 119) on Greece; Giglioli (1972) on Guyana; del Panta (1989: 48–9 n. 23); Gilles and Warrell (1993: 56) described pneumonia as a familiar complication of P. falciparum malaria.

⁶⁹ Hippocrates, Epidemics 1.24, ed. Littré (1839–61), ii. 674–5: åt¤r ka≥ fqin*deeß, ka≥ Òsoi £lla makrÎtera nous&mata nosvousin, ƒp≥ to»t8 [sc. t‘ Ómitrita≤8] m3lista nosvousin.

⁷⁰ Caelius Aurelianus, 2.63, ed. Drabkin (1950): Item Asclepiades ait cotidianum perseverantem non sine periculo esse, atque multos ex eo in alium morbum induci, hoc est 〈 in〉 corporis defluxionem aut hydropem venire et quicquid potest per corporis debilitatem accedere.

⁷¹ Rey and Sormani (1881: 131–2): ‘ Non possiamo sceverare quali siano le forme schiette e quali le 138

Demography of malaria

The increased death rate from certain respiratory diseases was a distinctive feature of mortality patterns in the city of Rome, because some other Italian cities which were not affected by malaria, particularly in the north of Italy, had significantly lower death rates from respiratory infections. For example, a comparison of Genoa with London made a few years earlier had shown that Genoa was much healthier with regard to mortality from tuberculosis and chronic respiratory diseases. Consequently the author felt able to recommend travel to certain parts of Italy as desirable for the recuperation of English patients with chronic respiratory infections, although he advised such patients to stay away in the summer from areas affected by malaria.⁷² Indeed there was even a school of thought that Rome itself was a desirable place to spend the winter for sick people from England, because of the mildness of its winter climate compared to that of London, but other nineteenth-century authors, noting that respiratory diseases were in fact widespread among the population of Rome in winter, rejected this advice. The respiratory diseases of the Roman winter were frequently attributed to the tramontane wind, just as malaria in the summer was associated with the sirocco.⁷³

North wrote as follows:

Chronic malaria is not infrequently associated with a species of chronic pneumonia, which in the experience of the Roman physicians, is often accompanied by the development of tubercle.⁷⁴

After considering the views expressed by more than fifty doctors and scientists on the question of the interaction of malaria and tuberculosis, Collari concluded that tuberculosis struggles to establish itself in a patient already suffering from malaria (perhaps because of the very high fever). However, a malarial infection of a person already suffering from tuberculosis rapidly exacerbates the effects of tuberculosis:

forme che assumono carattere speciale dall’influenza malarica; cionondimeno, da osservazioni raccolte, ci è permesso di argomentare ad una certa frequenza della complicazione palustre in queste manifestazioni morbose [ sc. pleuro-polmonite e bronchite]. ’

⁷² Chambers (1865); Blewitt (1843: 466).

⁷³ Hoolihan (1989: esp. 472–3, 476–7, 479–82 on malaria) discussed this nineteenth-century debate about Rome as a health resort, cf. Wrigley (2000).

⁷⁴ North (1896: 273). Sambon (1901 b: 314–15) expressed the same view: ‘in the Roman Campagna the most frequent complication is pneumonia which occurs in the winter or spring months, during relapses of the intermittent fevers’.

Demography of malaria

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When patients with chronic malaria become infected with pulmonary tuberculosis, it assumes a slow course with a tendency towards sclerosis; whereas when a patient with pulmonary tuberculosis becomes infected with malaria, the tuberculosis tends to be aggravated and to assume a course which develops rapidly.⁷⁵

A recent review of the question of the interaction between malaria and tuberculosis concluded that repeated malarial infections, even if asymptomatic, cause both quantitative and qualitative depression of the human immune system and thereby increase susceptibility to tuberculosis as well as the rate of development of tuberculosis infections, reiterating Collari’s conclusion seventy years ago. This review considered the possibility that the continuing presence of endemic malaria may be one of the reasons for the persistence of tuberculosis in tropical countries (exacerbated now by its interaction with the HIV virus), in contrast to the gradual disappearance of tuberculosis in temperate countries over the last 150

years.⁷⁶

Baccelli also observed that malaria can aggravate many other diseases.⁷⁷ Malarial interference with the T-cell component of the human immune system diminishes the immune response to other pathogens (e.g. the Epstein-Barr virus in relation to Burkitt’s lym-phoma).⁷⁸ Marchiafava and Bignami illustrated a different type of disease interaction with malaria when they described the case of a thirty-three-year-old epileptic man from outside the Porta del Popolo in Rome in whom a malarial infection brought on an epileptic fit. The interaction between malaria and epilepsy has also attracted attention in recent medical research.⁷⁹ We can hardly leave the topic of synergistic interactions between malaria and other diseases without briefly mentioning what might well become the most important interaction in tropical Africa, namely malaria’s interaction with the HIV virus, even though it is not relevant to antiquity. One study found that ‘HIV-1 infection progressively ⁷⁵ Collari