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

all those interested in this subject that P. vivax (and P. malariae, generally regarded as insignificant with regard to mortality) was present in the Mediterranean by the fifth century .

This is shown by numerous texts in the Hippocratic corpus and later medical writers. Even if, for the sake of argument, only the presence of P. vivax (and P. malariae) in Greece in the fifth century 

is accepted, recent research in historical demography (see Ch. 5. 4

below) has demonstrated that P. vivax, in synergistic interactions with other diseases, is capable of enormous effects on the mortality regimes of human populations, even though it seldom kills otherwise healthy and well-nourished individuals by itself, according to the general consensus of medical literature.¹⁴ The position with regard to the history of P. falciparum, the most dangerous species of human malaria, is more controversial. Some authors (e.g. G. Belios and J. P. Kardamatis for Greece) have regarded P. falciparum as present in Mediterranean countries from time immemorial. Similarly Brunt found no evidence in literary sources that malaria was regarded as a new disease in Italy in classical times. Nevertheless others have reached the conclusion that P. falciparum malaria was only introduced to the Mediterranean world in the course of the Graeco-Roman period. W. H. S. Jones originally suggested that it was introduced to Italy by Hannibal’s soldiers during the Second Punic War, but later suggested that it had reached Sybaris by the end of the archaic period. He also maintained that the disease played a major role in the decline of classical Greek civilization.

Grmek once argued that malaria flourished in Greece in the Neolithic period, continued to exist at a low level in dispersed locations, and spread again in the fifth century . More recently he declared that the evidence for P. falciparum malaria in Neolithic Greece, adduced by J. L. Angel, is no longer compelling, even though it is ¹³ Gravenor and Kwiatkowski (1998), but cf. Hoshen et al. (2000).

¹⁴ L. H. Miller in Wernsdorfer and McGregor (1988: i. 713): ‘infections with P. vivax are rarely fatal’, cf. Gilles and Warrell (1993: 44): ‘severe vivax malaria has been described in the past (for example, in Europe) possibly related to malnutrition and other intercurrent diseases. However . . . the acute mortality of vivax malaria is very low’.

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Types of malaria

likely that it was present in small foci. Zulueta is even sceptical about the presence of P. falciparum in Greece as late as the fifth century . He dates its spread in the Mediterranean to the time of the Roman Empire. Celli, the author of what remains the only comprehensive survey of malaria in the Roman Campagna

throughout history, sidestepped the debate about the time of introduction of P. falciparum by devising a theory of periodic attenuations of the virulence of the disease (‘ grandi attenuazioni periodiche dell’

infezione’). Celli’s book is still extremely valuable for its collection of historical sources. However, it is inevitably to some extent out of date owing to the steady march of progress in science and medicine during the twentieth century. Tomassetti reckoned that malaria was above all a phenomenon of the early modern period and was not so bad in antiquity, but he did not examine the ancient sources thoroughly. Many modern historians have expressed similar opinions without studying the relevant ancient sources (especially the medical authors—Celsus, Galen, and Asclepiades) in the necessary detail.¹⁵ It is now time to examine some of these ancient sources.

Celsus, writing in the time of Tiberius in the early first century , provides important evidence. The interpretation of his text is easy if it is compared to the very detailed account and case studies of Ettore Marchiafava, who in collaboration with Celli first described P. falciparum under the microscope in 1889, in Italy. After describing quartan fevers caused by P. malariae (see Ch. 5. 2 below), Celsus continued as follows:

There are two types of tertian fever.The first type commences and terminates in the same manner as quartan fever. Its distinguishing feature is that it disappears for one whole day and returns on the third day. The second type is much more pernicious. It too recurs on the third day. However, out of the forty eight hours, the paroxysm lasts for almost thirty-six hours (sometimes more or less), nor is there any total cessation during the remission, but it becomes less severe. Most doctors call this type of fever semitertian.¹⁶

¹⁵ The Bibliography for this book concentrates on recent literature, although the most important older works are included. Fraccaro (1919) discussed the principal theories which had been proposed up to then; Jones (1907), (1908) and (1909 a) and (1909 b); Brunt (1987: 611–24); Corvisier (1994); Grmek (1983: 397–407) and (1994); Zulueta (1973), (1987: 200–3), and (1994); Celli (1933); Tomassetti (1910: i. 68–72, 164–71).

¹⁶ Celsus, de medicina 3.3.2: Tertianarum vero duo genera sunt. Alterum eodem modo, quo quartana, et incipiens et desinens, illo tantum interposito discrimine, quod unum diem praestat integrum, tertio redit.

Alterum longe perniciosius, quod tertio quidem die revertitur, ex quadraginta autem et octo horis fere triginta et Types of malaria

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In a later passage, Celsus confirms that the pernicious semitertian fevers were frequently fatal. He ascribed that outcome to mistakes made by doctors, unintentionally suggesting that treatment may often have been worse than no treatment at all.¹⁷ This point of view was explicitly enunciated, in relation to all diseases occurring in Italy, by Latanzio Magiotti, physician to the court of the Grand Duke of Florence in the seventeenth century . Celsus himself recommended blood letting at the beginning of treatment. This is unlikely to have been beneficial to patients with the anaemias typically associated with malaria.¹⁸ Moreover tools used for bleeding could conceivably themselves have been a source of transmission of malaria via contaminated blood, if they were not cleaned thoroughly after each use. The elder Cato’s denunciation of Greek medicine as