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

that he understands his own error, but nevertheless cannot correct himself, or continue, but babbling instead, he either cuts short his words, or uses the wrong word, just as if he were affected by a slight stroke causing paralysis of the tongue. Eventually, as his drowsiness intensifies, he is completely immobile, and snores through his nostrils. He cannot be awakened by any sound, physical force or contact, ligatures or tourniquets, affixing of cupping-glasses or of vesicants, or even fire at any time whatsoever, and if he does become conscious for a time, he immediately relapses into the same sleep, or falls into an even deeper coma, and does not begin to awaken until the periodic attack of fever is coming to an end. Even if he begins to awaken after the first or second period of fever, it is always with a little more difficulty, and if spasmodic gasping is added to the lethargy, he succumbs to his inevitable fate during the third or fourth periodic attack of fever at the latest.⁴⁴

The fact that lethargy was frequently a term applied in antiquity to cerebral malaria caused by P. falciparum is demonstrated by a text of Aetios of Amida, quoting Archigenes and Poseidonius.⁴⁵ Aetios states that lethargy could arise in various ways, but goes on to say that it was a common effect of quotidian and semitertian fevers. It was also possible in quartan fevers, according to Aetios. However, it is significant that he does not mention tertian fever (caused by P. vivax) here. P. vivax does not cause cerebral malaria because it does not (unlike P. falciparum) induce cytoadherence of parasitized erythrocytes to the endothelium of capillaries in the brain.⁴⁶

⁴⁴ Torti (1755: 195–6): Septimum denique lethale symptoma Perniciosae cuilibet Intermittenti, non uni Tertianae familiare, est gravis affectus soporosius, seu profundus Lethargus, qui paroxysmos febriles saepe-saepius comitari consuevit . . . si negligatur, nec inhibeatur progressus, Lethargum una, vel altera accessione mortiferum, ac omni arte invincibilem, fortis Apoplexiae instar, fere dixerim certo portendit. Cum huiusmodi affectus incipit, aeger primo est in soporem pronus, a quo excitatus, statim in sommum relabitur; paulo post fit immemor rerum immediate ante gestarum, unde non raro matulam poscit, deinde mingere obliviscitur, atque interim dormitat; nonnumquam obloquitur, nec suos conceptus valet exprimere; & licet sui erroris sit compos, se tamen nequit corrigere, aut continere: immo quandoque balbutiens, vel verba mutilat, vel unum pro alio pro-fert, non secus ac si levi Apoplexia in linguae paralysim degenerante foret detentus. Ingravescente tandem sopore omnino iacet, ac stertit naribus, neque ulla voce, ulla vi, frictione, ligatura, cucurbitularum, aut vesicantium appositione, immo nec igne quandoque actuali valet excuti; & siquidem excutiatur aliquantisper, statim in eumdem soporem, immo in profundiorem recidit, nec nisi declinante accessione incipit expergisci. Quod si una, vel altera vice resipiscat quidem, sed semper paulo difficilius, aut si soporosae affectioni adjungatur singultus, tertia ad summum, vel quarta accessione, inevitabili fato succumbit. Marchiafava and Bignami (1894: 13–18, 96 n.1) discussed Torti’s classification of intermittent fevers.

⁴⁵ Aetios of Amida 6.3: [Ø l&qargoß] ƒn≤ote d† ka≥ ƒp≥ t0n cron≤wn puret0n sumba≤nei kat¤ per≤odon bapt≤zesqai aÛtoŸß t‘ pn8, oÍon poll3kiß g≤netai ƒp≥ åmfhmerin0n puret0n ka≥ Ómitrita≤wn, πsti d’ Òte ka≥ ƒp≥ tetarta≤wn.

⁴⁶ This is the conventional explanation of the pathology of severe P. falciparum malaria. An 222

City of Rome

The situation described by Asclepiades lasted throughout the Principate (and most probably throughout late antiquity as well), since Galen made very similar comments in the second century .

Galen wrote pages and pages on forms of ‘fever’ (puretÎß) that can now be identified as malarial fevers. Since it would take a very long time to scrutinize all his writings on the subject in detail, it is only possible to mention a few of the most important points here.

Galen described semitertian fevers as very common in Rome, more familiar to men in the capital of the Roman Empire than anywhere else.⁴⁷ This passage also shows clearly that Galen recognized that different places had different pathocoenoses, and this implies a diversity of mortality patterns in different parts of the Roman Empire.

That there is such a fever, as I have stated, does not require the evidence of Hippocrates or anyone else as a witness, since we observe it every day, especially at Rome. For just as other diseases are common in other places, so this evil is frequent in this city.⁴⁸

The fever arising from yellow bile on its own is called tertian, but the fever which requires an equally strong share of the raw humour is strictly called semitertian. It is most frequent at Rome, being very familiar to men in the city.⁴⁹

He explicitly states that semitertian fevers were extremely dangerous, much more dangerous than tertian fevers: ‘this type of fever [semitertian] is malignant and extremely dangerous’;⁵⁰ ‘Semitertian fever . . . is . . . much worse than tertian fever.’⁵¹ Galen also discussed mixed infections, which are only to be expected where malaria is endemic, as noted above. His comments on the various alternative view, expounded most recently by Clark and Schofield (2000), is that the severe pathological effects are the result of an inflammatory state caused by a toxin released by the malaria parasite.

⁴⁷ Martial 2.40 and 4.80 also mentioned semitertian fevers, cf. 2.16 and possibly 3.93 for less specific references to fevers. Rodrígues (1985/6) and Wittern (1989) discussed Galen on fevers.

⁴⁸ Galen 7.435K: Òti g¤r ka≥ toioutÎß tiß g≤netai puretÏß, Øpo∏on e”pon, oÛkvt’ ƒn t‘de m3rturoß oÇq’ <Ippokr3touß oÇte £llou tinÏß Ø lÎgoß cr…zei, mÎnon oÛ kaq’ ‰k3sthn Ómvran Ør*ntwn Óm0n aÛtÏn, ka≥ m3lista ƒn <R*m7. ¿sper g¤r ƒn £lloiß £lla cwr≤oiß, otwß ƒn t∫de pÎlei pleon3zei tÏ kakÏn toıto.

⁴⁹ Galen 17A.121–2K: Ø m†n oˆn ƒp≥ mÎn7 t∫ toia»t7 [sc. xanq∫ col∫] sunist3menoß ønom3zetai trita∏oß, Ø d† ka≥ tÏn ∑mÏn cumÏn jsosqen[ proslab*n, åkrib¶ß Ómitrita∏oß g≤netai, ple∏ston ƒn <R*m7 ginÎmenoß, „ß #n t0n kat¤ t¶n pÎlin ånqr*pwn ojkeiÎtatoß •n.

⁵⁰ Galen 7.467–8K: [Ø Ómitrita∏oß] . . . £griÎß tv ƒsti ka≥ kindunodvstatoß o˜toß Ø t»poß.

⁵¹ Galen 17A.235K: Ø