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

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age-groups, which were characteristically targeted by different types of malarial fevers, are of great significance for establishing the epidemiology of malaria in the second century . Galen says that semitertian fevers struck men in the prime of life in autumn, when it was very dangerous, while tertian fevers attacked young men, and quotidian fevers, the most dangerous of all, attacked young children in particular.⁵²

Tertian fever, caused by P. vivax, becomes a disease of childhood when P. vivax is hyperendemic, as it was on Sardinia, for example, in the nineteenth century. However, to interpret all these texts it is necessary to remember that ancient Rome (like early modern Rome) was constantly receiving large numbers of adult immigrants who would have been vulnerable (see Ch. 11 below). All the literature on malaria in early modern Rome states that adult immigrants or visitors were more vulnerable than people who had been born and had lived all their lives in Rome.⁵³ This was because the indigenous inhabitants knew what had to be done in the way of avoidance behaviour, as will be seen later (Ch. 11 below). They might also have had acquired immunity following childhood infection, or even inherited innate immunity. Galen’s observation on the epidemiology of quotidian fevers is extremely important because it shows that primary attacks of P. falciparum malaria frequently occurred in infancy or early childhood in the second century .⁵⁴

⁵² Galen 7.468K: [Ø Ómitrita∏oß] . . . pleon3zei d† ƒp≥ m†n t[ß f»sewß t[ß kat¤ toŸß £ndraß, Ólik≤aß d† t[ß kat¤ toŸß åkm3zontaß, ¿raß d† m$llon t[ß fqinopwrin[ß, Òte ka≥

l≤an kindun*dhß tugc3nei ([semitertian fever] . . . is common in men, particularly those in the prime of life, most frequently in autumn, when it is exceedingly dangerous); 17B.642

[trita≤oi] . . . o˜toi g¤r colwdvstato≤ te puret0n Åp3ntwn ejs≥ ka≥ ple∏stoi to∏ß nean≤skoiß g≤nontai . . . oÈ presbıtai t0n nvwn t¤ m†n ple∏sta nosvousin ¬tton ([tertian fevers] . . . are the most bilious of all fevers and most frequently occur in young men . . . in most cases old men are less affected than young men); 11.23K: pa∏deß d† ka≥ m3lista oÈ mikrÎteroi ka≥ Òsoi t0n tele≤wn flegmatik*tero≤ tv ejsi ka≥ t¶n 1xin toı s*matoß pace∏ß ka≥ årgÏn tÏn b≤on πconteß ƒn plhsmona∏ß ka≥ mvqaiß ka≥ loutro∏ß sunecvsi ka≥ m3lista to∏ß ƒp≥ trof∫

åmfhmerino∏ß eÛ3lwtoi (children, especially younger children, and adults who have more phlegm and are fat and lead an idle lifestyle with excessive eating and drinking and continuous bathing, and most of all those who are being cared for by a nurse, are easily affected by quotidian fevers).

⁵³ e.g. Aitken (1873); Baccelli (1881); Rey and Sormani (1881); North (1896); Bercé (1989).

Similarly Dobson (1994: 47) and (1997: 318) ) noted that P. vivax malaria was more dangerous to immigrants than to the indigenous inhabitants of the English marshlands.

⁵⁴ M. Greenwood (1921) considered Galen as an epidemiologist. In many other instances, for example in relation to the Antonine plague, Galen’s epidemiology turns out to be very disappointing. Grmek (1994: 4) accepted Galen’s epidemiological evidence, speaking of une expansion hyperendémique aux temps de Galien. However, the idea of an expansion in Galen’s time does not take account of the earlier evidence of Asclepiades.

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The inference is that the transmission rate of P. falciparum malaria was very high; high enough to create a situation in which acute clinical illness and direct mortality as a result of malaria was concentrated among children. In relation to the fact that the Romans continued to use the Greek word semitertian and had not coined a specific Latin word for the disease, Quintus Serenus stated that mothers did not want to use a specific word for it for fear that by speaking of it it would be attracted to their own children. This fascinating observation confirms that P. falciparum malaria was regarded as typically a disease of childhood during the time of the Roman Empire. It also illustrates the importance of sympathetic magic in Roman popular thought:

more deadly is the fever which is called semitertian in Greek; no one, I think, could have named it in our language and mothers would not have wanted to⁵⁵

Acquired immunity to the strains present in such a locality is gradually built up by survivors of primary attacks, in response to repeated infections. The result is that episodes of acute clinical illness become less frequent with increasing age. Under such circumstances the bulk of severe illness is concentrated among children.

Severe illness among adults is only observed among immigrants, who do not have any acquired immunity. After the city of Rome became the centre of Christianity during the period of the Roman Empire, Christians migrating to or visiting Rome were particularly susceptible to the scourge of ‘Roman fever’. The cases of St.

Augustine and Alcuin have already been mentioned, as well as the English monks mentioned by Gervase in  1188. Hyperendemic malaria was the pattern over much of the Campagna Romana throughout the medieval and early modern periods. Under such circumstances acute infections of indigenous adults were less frequent. Epidemics of malaria among adults were only observed when large groups of people who were not native to the area appeared on the scene, for example French and German armies.

Many historians have observed that malaria acted as a protection for Rome from foreign invaders. This viewpoint had already been explicitly articulated by Godfrey of Viterbo as early as  1167, when he recorded in verse the destruction of the army of Frederick ⁵⁵ Quintus Serenus, liber medicinalis 51.932–4, ed. Pépin (1950): mortiferum magis est quod Graecis hemitritaeos | vulgatur verbis; hoc nostra dicere lingua | non potuere ulli, puto, nec voluere parentes.

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Barbarossa. It can be surmised that the rainfall during the summer storm mentioned by Godfrey created mosquito