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¹ For the Greek and Latin origins of these names see Scarborough (1992: 37, 111).

² Kreier and Baker (1987). Perkins (2000) is a recent report of the discovery of a new species of Plasmodium.

³ Cann and Douglas (1999).

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Types of malaria

Table 1. Some of the species in the genus Plasmodium Species

Host

Periodicity

P. vivax

Humans

Tertian

P. schwetzi

Chimpanzees

Tertian

P. pitheci

Orang-utans

Quartan?

P. hylobati

Gibbons

Quartan?

P. eylesi

Gibbons

Tertian

P. jefferyi

Gibbons

Tertian

P. cynomolgi

Monkeys

Tertian

P. ovale

Humans

Tertian

P. simium

Monkeys

Tertian

P. fieldi

Monkeys

Tertian

P. simiovale

Monkeys

Tertian

P. gonderi

Monkeys

Tertian

P. malariae

Humans

Quartan

P. inui

Monkeys

Quartan

P. brasilianum

Monkeys

Quartan

P. knowlesi

Monkeys

Quotidian

P. coatneyi

Monkeys

Tertian

P. fragile

Monkeys

Tertian

P. falciparum

Humans

Tertian

P. reichenowi

Chimpanzees

Tertian

P. berghei

Rodents

Quotidian ?

P. chabaudi

Rodents

Quotidian ?

P. girardi

Lemurs

Quartan

P. sandoshami

Colugo

Quartan

P. traguli

Mouse deer

?

P. bubalis

Water buffalo

Quartan

P. atheruri

Porcupines

Quotidian

P. voltaicum

Bats

?

P. relictum

Birds

36 hourly

P. subpraecox

Owls

Quotidian

P. cathemerium

Birds

Quotidian

P. matutinum

Birds

Quotidian

P. giovannolai

Birds

Quotidian

P. gallinaceum

Birds

36 hourly

P. circumflexum

Birds

Tertian

P. lophurae

Birds

Quotidian

P. pinottii

Birds

Quotidian

P. rouxi

Birds

Quotidian

P. elongatum

Birds

Quotidian

P. floridense

Lizards

?

P. mexicanum

Lizards

?

P. wenyoni

Snakes

?

Source: Garnham (1966). There are numerous other species infecting mammals, birds and reptiles belonging to other genera which are closely related to Plasmodium but differ from it in that they are transmitted by vectors other than mosquitoes and in that schizogony does not occur in erythrocytes.

Types of malaria

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apostrophe that indicated its original meaning was Francesco Puccinotti’s book Storia delle febbri intermittenti di Roma, published in Naples in 1838, although Guido Baccelli’s book La malaria di Roma, published just two years before Laveran’s discoveries, was the first work to apply it to the disease.⁴ The word malaria was introduced into English literature by Horace Walpole in 1740. He made his exit from Rome just before the annual epidemic of P. falciparum malaria started. The English traveller did not expect to be able to get a Christian burial if he died from malaria in Catholic Rome!

You will wonder, my dear Hal, to find me on the road from Rome: why, intend I did to stay for a new popedom, but the old eminences are cross and obstinate, and will not choose one, the Holy Ghost does not know when. There is a horrid thing called the malaria, that comes to Rome every summer, and kills one, and I did not care for being killed so far from Christian burial.⁵

Today there are known to be four species of human malaria belonging to the genus Plasmodium: P. falciparum (malignant tertian), P. vivax (benign tertian), P. malariae (quartan), and P. ovale. P. ovale, a fairly mild type of malaria, was not endemic in Mediterranean countries. Consequently only the first three species will be considered here.⁶ Their common names, such as tertian and quartan fever, are no longer used in modern medical literature, but of course are found in historical sources. All three species generate a variety of clinical symptoms and syndromes, many of which can also be produced by other diseases.⁷ Malaria can easily mimic typhoid fever, hepatitis A, or influenza, for example. It is above all ⁴ Corbellini and Merzagora (1998: 53–4). Baccelli’s work was reprinted in Monografia (1881).

⁵ Letters of Horace Walpole, ed. C. D. Yonge (1889), i. 20, ‘to the Hon. H.S. Conway’, 5 July 1740.

⁶ Garnham (1966: 217) recorded an isolated case of P. ovale malaria in Epirus in Greece.

Qari et al. (1993) identified a new human malaria parasite morphologically similar to P. vivax, but with the same circumsporozoite protein as the monkey parasite P. simiovale, which they termed ‘ P. vivax-like’. Since it occurs in Papua New Guinea (besides Indonesia, Madagascar, and Brazil), where there are no monkeys, it appears to be established now in human populations, although it doubtless arose as a zoonosis, cf. Escalante et al. (1995). Since there is no evidence for its occurrence in Mediterranean countries it is not relevant for current purposes. Other species of malaria which typically infect primates other than man may occasionally cause zoonoses in humans (Fiennes (1967: 70–5) ).

⁷ For the symptoms see Gilles and Warrell (1993: 35–49); Harinasuta and Bunnag in Wernsdorfer and McGregor (1988: i. 709–34); Marchiafava and Bignami (1894) and Marchiafava (1931) on symptoms of P. falciparum malaria in Italy; Armand-Delille et al. (1918: 13–77) described the symptoms of P. falciparum malaria in Macedonia.

10

Types of malaria

the characteristic periodicity of intense fever recurring on the second day, in the case of P. falciparum and P. vivax, or on the third day, in the case of P. malariae, which distinguishes malaria from other diseases. This feature enables us to be certain that ancient texts do in fact refer to malaria.

There are indeed other diseases which have some periodic tendencies, for example relapsing fever ( Borrelia recurrentis) transmitted by the human body louse, or brucellosis (undulant fever), which is most commonly acquired by ingesting contaminated milk or cheese. In relapsing fever attacks last for five to nine days, followed by a similar period of intermission, while in some cases of brucellosis there is a daily periodicity more reminiscent of that of malaria.

These diseases certainly existed in Roman times.⁸ However, they lack the characteristic association with certain types of environment, especially wetland environments, which are strongly associated with malaria, because they are not transmitted by mosquitoes.

Similarly all the other major infectious diseases transmitted predominantly either directly by the respiratory route (e.g. tuberculosis, influenza, and smallpox) or by vectors other than mosquitoes (e.g. typhus and bubonic plague) do not have any epidemiological association with wetland environments. In the tropics important viral diseases transmitted by mosquitoes exist (for example, yellow fever and dengue fever). However, mosquito-transmitted diseases caused by viruses cannot become endemic in Europe because they induce complete immunity in survivors and require constant transmission to new hosts. Yellow fever, for example, cannot survive the winter in Europe because its vector mosquito ( Aedes aegypti) cannot stand European winters.⁹ In Europe malaria was the only major disease transmitted by mosquitoes in the past and so strongly associated with mosquito breeding sites in wetlands. Consequently in the search for ancient malaria in this book the focus will be on texts that give general descriptions of particular regions in which seasonal unhealthiness is associated with certain types of environments. Such descriptions on the whole constitute a better source ⁸ Capasso (1999) has recently demonstrated the presence

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