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

be remembered that malarial infections as a whole did substantially reduce life expectancy in European historical populations in the long run (see Ch. 5. 4

above). Galen observed that quartan fever generally followed other ³⁶ Mason et al. (1999) wrote a very interesting article on the epidemiology of P. malariae and its interaction with P. falciparum.

³⁷ Livy 41.21.5: qui superaverant, longinquo, maxime quartanae, implicabantur morbo (the survivors were ill for a long time, particularly with quartan fever).

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fevers instead of occurring on its own. This statement can only mean that multiple infections were normal.³⁸

for the most part quartan fever does not appear immediately at the beginning of the illness, but occurs after other fevers have manifested themselves³⁹

Cicero gives a specific example of this phenomenon, namely the case of Tiro:

since the essence of the disease has changed into a quartan fever (for so writes Curius), I hope that you [Tiro], with due diligence, will be even stronger⁴⁰

This letter is dated 12 January 49 , precisely the right time of year for that development. Scepticism is always possible with regard to the value of the evidence provided by an author like Juvenal, although in this particular case his words make perfectly good sense in the light of modern medical knowledge. Recent research in tropical countries employing the techniques of molecular biology to detect very low population densities of malaria parasites has shown that mixed infections (as well as subclinical chronic infections) are more frequent than was often thought previously when examination of blood smears under a microscope was the only means of detecting parasites. The ancient medical writers provide very important evidence confirming that P. falciparum malaria was indeed common among the population of the city of Rome from the second century  to the second century . Caelius Aurelianus quoted Asclepiades of Bithynia, a Greek doctor who enjoyed great success at Rome (in spite of Cato’s condemnation of Greek medicine) in the late second century , according to ³⁸ Other ancient texts which mention this phenomenon include: Hippocrates, Airs, Waters, Places 10: to»ß te perigenomvnouß ƒß tetarta≤ouß åpoteleut$n (the survivors ended up with quartan fevers); [Aristotle,] Problems 1.19.861b tetarta∏oi g≤nontai to∏ß swzomvnoiß (those who were saved had quartan fevers); Galen 11.114K: πsti d’ oÍsin oÛk øl≤goisin ƒx £llwn puret0n ka≥ noshm3twn åpost3sieß ƒß tetarta≤ouß ƒg≤nonto (in many cases there was a transition from other fevers and diseases to quartan fevers). Galen is quoting Hippocrates Epidemics, 1.6. Mixed infections were the norm in the town of Sermoneta in the Pontine region in the early twentieth century, according to Hackett (1937: 243). Similarly mixed infections were common in Greece (Balfour (1935: 312) ). Galen recognized mixed infections and wrote about them e.g. 7.464–5K and 9.646K.

³⁹ Galen 11.18K: mhd’ eÛqŸß åp’ årc[ß t¤ poll¤ tÏn puretÏn toıton [sc. tetarta∏on]

ejsb3llein, åll’ ‰tvrwn proshghsamvnwn sump≤ptein.

⁴⁰ Cicero, Epist. ad familiares 16.11.1: cum in quartanam conversa vis est morbi (sic enim scribit Curius), spero te, diligentia adhibita, etiam firmiorem fore.

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Rawson’s redating of his floruit. Asclepiades may have invented the idea of seeds of disease that was employed by Lucretius.⁴¹

Asclepiades states that a persistent quotidian fever is not without danger . . . at Rome, he says, we notice that these fevers with a violent seizure of the body and mind, resembling lethargy, are frequent . . . he writes similar comments about these fevers, not once but frequently, saying that for a certain reason this seizing of the mind occurs in attacks of intermittent fevers, and that this is common at Rome.⁴²

Asclepiades states that quotidian fevers, the most dangerous manifestation of P. falciparum malaria, were common in Rome, frequently exhibited the symptoms of cerebral involvement called catalepsy or lethargy by ancient medical writers, and could be fatal.

He made these remarks repeatedly, emphasizing the importance of the phenomena under discussion. Similarly, Marchiafava and Bignami noted that ‘lethargic and comatose “complicated” fevers’

with cerebral symptoms were the forms of P. falciparum malaria most frequently encountered by doctors in hospitals in Rome in the nineteenth century. Baccelli also noted that lethargy was a dangerous condition in some forms of the disease.⁴³ Francesco Torti, the author of an important treatise on (the use of quinine in) cinchona bark, described lethargy as one of the seven symptoms of pernicious periodic fevers that were particularly liable to lead to death, and noted that it did not occur in tertian fever (caused by P. vivax).

Finally the seventh lethal symptom of any intermittent pernicious fever, not characteristic of a simple tertian fever, is an extremely sleepy state of mind, or deep lethargy, which very frequently tends to accompany the febrile paroxysms . . . if it is neglected, and its progress is not inhibited, I would almost say that lethargy, if not conquered by any medical art, will be fatal, like a major stroke, during one or other of the periodic episodes of fever. When this state of mind commences, the patient first falls into a deep sleep. If he is awoken, he immediately goes back to sleep. Shortly afterwards he cannot remember what had happened immediately before.

Consequently he frequently asks for a pot, then forgets to pass urine, and ⁴¹ Rawson (1982) and the speculative arguments of Polito (1999); Nutton (1983: 10–11).

⁴² Caelius Aurelianus, On acute diseases 2.63–4, ed. Drabkin (1950): Item Asclepiades ait cotidianum perseverantem non sine periculo esse . . . apud Romam vero, inquit, frequentare advertimus has febres cum corporis atque mentis oppressione in similitudine lethargiae . . . item similia de his scribit, et non semel sed frequenter, dicens certa ratione mentis apprehensionem typorum in accessionibus fieri, atque hoc apud Romam frequentare.

⁴³ Marchiafava and Bignami (1894: 93, 123–6, 150–1); Baccelli (1881: 180). Caelius Aurelianus II.65–6 described catalepsy as a condition predominantly occurring in the autumn.

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is drowsy in the meantime. Sometimes he answers a question, but is unable to express himself coherently. It may be the case