Malaria and Rome: A History of Malaria in Ancient Italy, Robert Sallares [reading a book TXT] 📗

wears the unwashed and sweaty shirt of a woman in labour’ (note also pp. 1–2 on the importance of malaria in Arabia).

⁶¹ Martial 10.77.

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Aulus Gellius. One such topic he chose was to produce a eulogy of quartan fever:

When he sought to praise Thersites and when he eulogized quartan fever, he made many observations on both topics which were charming and not obvious. He has left these comments written in his books. But in his eulogy of fever he even cited Plato as a witness, saying that he wrote that a person who got well and regained his full strength after suffering from quartan fever would afterwards be more surely and more constantly healthy.

Of course, since quartan fever was milder than tertian fevers, and since the advent of quartan fever was regarded in antiquity as a sign of the end of these more serious tertian fevers (in cases of mixed infections—see Ch. 8 below), Favorinus made life easy for himself by choosing a relatively easy subject to display his skill at rhetoric!⁶²

According to Galen’s own account of his career at Rome and the intense rivalry between doctors in the city, his fame there commenced when he correctly diagnosed quartan fever in the case of the Peripatetic philosopher Eudemus, sixty-two years old at the time. This case also shows quartan fever lasting well into the winter, just as in the case of Atticus.⁶³ Elsewhere in his works Galen observed that quartan fevers could last for as long as two years, and that they were most frequently ‘contracted’ in the autumn.⁶⁴ He also commented that quartan fevers could be dangerous in con-junction with other diseases, especially tuberculosis, and could result in dropsy:

Quartan fevers are difficult to shake off and last for up to two years, longer than the other types of fever . . . some even become dangerous in association with symptoms of other diseases, with the result that they eventually produce tuberculosis or dropsy. Quartan fever is most frequent in autumn ⁶² LiDonnici (1998: 85–7) drew attention to Aulus Gellius, Noctes Atticae 17.12.2–5: Cum Thersitae laudes quaesivit et cum febrim quartis diebus recurrentem laudavit, lepida sane multa et non facilia inventu in utramque causam dixit eaque scripta in libris reliquit. Sed in febris laudibus testem etiam Platonem [ Timaeus 86a] produxit, quem scripsisse ait qui quartanam passus convaluerit viresque integras recuper-averit, fidelius constantiusque postea valiturum.

⁶³ Galen 14.606–14, 619, 624K, with Nutton’s commentary in his edition of Galen’s work On prognosis.

⁶⁴ Celsus 2.8.42 also regarded quartan fevers as prolonged if they appeared in the autumn (presumably new primary infections): quartana aestiva brevis, autumnalis fere longa est maximeque quae coepit hieme adpropinquante (Quartan fevers that start in summer are brief, while those that commence in autumn are usually long, and those which begin as winter approaches have the longest duration of all.). In 3.15–16 he gave his recommendations for treating quartan fevers.

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and infections at that time of the year are most persistent. However infections in summer are shaken off very easily.⁶⁵

Dropsy as a late manifestation of quartan fever, in other words gross oedema appearing usually after the symptom of fever has ceased to be apparent even if the patient still has a high rate of parasitaemia, is also mentioned in the Hippocratic Airs, waters, places. Dropsy in these ancient texts was identified by Kibukamusoke as the nephrotic syndrome of quartan malaria, a severe kidney disease probably caused by an immunological reaction to the parasite.⁶⁶

Tuberculosis, singled out by Galen as a major complication of quartan fever, was the most dangerous of the respiratory diseases.

The respiratory diseases were the second category of disease assigned importance by Shaw to explain excess seasonal mortality in ancient Rome. These diseases are indeed very well documented as a cause of morbidity and mortality in the winter months in early modern Italy, for example in the towns of Pontedera, Cascina and Ponte di Sacco in Tuscany in 1610 as described by Cipolla from the records of the Florentine health magistrates.⁶⁷ Nevertheless detailed modern studies have demonstrated, just as in the case of the gastro-intestinal diseases, that death rates from respiratory diseases alone are much lower than they are when malaria is present as well. For example, studies in Greece in the 1930s showed that death rates from pneumonia were much higher in villages where malaria was endemic than in otherwise similar villages where malaria was not present at all. Del Panta observed that the Tuscan Maremma in the nineteenth century, in the presence of endemic malaria, had a higher death rate from respiratory diseases than the average rate for the whole of Italy (including regions where malaria did not occur at all). In Guyana following malaria eradication, mortality from both acute (tuberculosis, pneumonia) and from chronic (asthma, emphysema, bronchitis) respiratory diseases dropped significantly, accompanying a reduction in the crude ⁶⁵ Galen 7.470K: [tetarta∏oi] d»slutoi ka≥ croni*teroi par¤ p3ntaß toŸß t»pouß ¿ste ka≥ mvcri dietoıß proba≤nein . . . g≤gnontai d† ƒn≤oi ka≥ kindun*deiß di¤ t¤ peplegmvna aÛt‘

sumpt*mata, ¿ste fq≤sin tÏ teleuta∏on ∂ paregc»seiß Ëdrwpik¤ß åpotele∏n. pleon3zei d†

m3lista fqinop*r8 ka≤ ƒsti m3lista d»slutoß: Ø d† qerinÏß eÛlut*tatoß.

⁶⁶ Hippocrates, Airs, waters, places 10 (ƒk t0n tetarta≤wn ƒß drwpaß) (from quartan fevers to dropsy). Kibukamusoke (1973: 34) defined the nephrotic syndrome of quartan malaria as ‘a symptom complex comprised of massive proteinuria, hypoalubuminaemia, gross oedema and hypercholestrolaemia’.

⁶⁷ Cipolla (1992: 35–9).

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death rate and elimination of the periodic variations which had previously occurred simultaneously in the overall crude death rate and in the mortality rate directly attributed to malaria.⁶⁸ The recent research on the syndrome of respiratory distress as a product of P. falciparum malaria raises the possibility that some deaths which were ascribed to respiratory diseases in the past might actually have been directly caused by P. falciparum malaria. The synergistic interactions of P. falciparum malaria with other diseases were observed in antiquity:

Patients with consumption, and those who suffer from other longer diseases,