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qui estus fervore et aeris intemperie corruptionem non sentirent, sauciatis quoque de civitatum, castellorum, oppidorum expugnatione pluribus nonnullisque extinctis, non sine cordiis amaritudine ad Transalpina redire cogitur.

⁶² Krautheimer (1980: 317) noted that in medieval Rome in the twelfth century ‘the hills were comparatively healthy; the low parts of the disabitato were not to be trusted’, and were abandoned by everyone who could afford to move away in summer.

⁶³ The context of the phrase rabies Canis in Otto’s account enables us to understand its full significance when it appears in the verses of Horace, Epist. 1.10.15–17: Est ubi plus tepeant hiemes, ubi gratior aura | leniat et rabiem Canis et momenta Leonis (It is a place where the winters are milder, where a rather agreeable wind softens both the fury of the Dog Star and the violent movements of Leo). Cf. Sat. 2.6.18–19: nec mala me ambitio perdit nec plumbeus Auster | autumnusque gravis, Libitinae quaestus acerbae (and no ruinous ambition destroys me there, nor the oppressive south wind and the noxious autumn, a source of gain to the severe goddess of the dead).

⁶⁴ Celsus 2.10.1–4; Seneca, QN 6.1.6: in pestilentia mutare sedes licet (it is permissible to change one’s dwelling place during a pestilence); Snowden (1999: 37–8).

⁶⁵ Martial, Epig. 10.85.

⁶⁶ Pliny, NH 3.5.54.

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irritated people by insisting that they visit him in his villa alongside the Tiber at the unhealthiest time of the year:

He stays in his gardens across the Tiber, where he has filled a very large area with huge colonnades and covered the river bank with his statues, since he is extravagant despite his avarice, and a braggart in spite of his bad reputation. Consequently he irritates the citizens at the most unhealthy time of the year and derives satisfaction from annoying people.⁶⁷

Frontinus, writing towards the end of the first century , confirms that Rome had a reputation for ‘bad air’.⁶⁸ He claimed that water-management operations under the emperor Nerva had solved the problem, but Galen’s later observations show that the problem had not been solved at all. Since the frequency of malaria fluctuated depending on numerous variable environmental parameters (such as the amount of rainfall, the height of the Tiber, the temperature, etc.), some mild years might have occurred by chance immediately following Nerva’s operations. That would explain Frontinus’ comments. Celli and several other writers expressed the view that epidemics of malaria occurred in Rome and the Roman Campagna every five to eight years on average in the early modern period.⁶⁹ It could also simply be the case that Frontinus had no option but to praise the emperor:

Not even waste waters are lost: the causes of the rather unhealthy atmosphere have been eliminated, the appearance of the streets is clean, the air is purer, and the bad air for which the city was always notorious, according to older writers, has been removed.⁷⁰

The argument so far has shown that P. falciparum malaria was not ⁶⁷ Pliny, Ep. 4.2.5–6, ed. Schuster (1958): Tenet se trans Tiberim in hortis, in quibus latissimum solum porticibus immensis, ripam statuis suis occupavit, ut est in summa avaritia sumptuosus, in summa infamia gloriosus. Vexat ergo civitatem insaluberrimo tempore et, quod vexat, solacium putat.

⁶⁸ Jordan (1879) discussed the corrupt text of Frontinus. Seneca, Epist. 104.6 also mentioned the gravitatem urbi. In this passage Seneca described another notable feature of the city of Rome in antiquity, atmospheric pollution. The air of Rome was unhealthy not only because of mosquitoes carrying malaria and of airborne pathogens such as tuberculosis, but also because of the high level of pollution caused by burning wood, oil, and other materials for industrial and domestic purposes. Capasso (2000) noted that the Grotta Rossa mummy, the only mummy found in Rome so far, shows severe anthracosis even though the individual in question died young.

⁶⁹ Corti (1984: 638).

⁷⁰ Frontinus, de aquae ductu urbis Romae 88.3, ed. Kunderewicz (1973): Ne pereuntes quidem aquae otiosae sunt: ablatae causae gravioris caelii munda viarum facies, purior spiritus, quique apud veteres se〈 mper〉 urbi infamis aer fuit est remotus.

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confined to the Pontine Marshes, its most notorious focus, but was also endemic in at least some districts of the city of Rome itself, and extended inland into Umbria, during the period of the Roman Empire. This geographical distribution resembles that of the early modern period, when the Tiber valley was severely affected along most of its course, far into Umbria. By the first century  there had already been created in and around the city of Rome a distinctive disease community or pathocoenosis, to use Grmek’s concept, which was dominated by P. falciparum, the most dangerous species of malaria. That was a distinction for which the city of Rome was to be famous over the succeeding 1900 years or so, as the home of ‘Roman Fever’, the title chosen by North for his book on a disease which was certainly not confined to Rome yet was more characteristic of Rome than of other major European cities. Before leaving the city of Rome to examine some aspects of the medical situation beyond the suburbs of the city, in the Roman Campagna, let us glance at a few more of the later literary references to malaria in Rome (out of a vast corpus of literature which could be quoted).

These sources and numerous others show that malaria remained a major problem in and around Rome throughout the medieval and early modern periods.

First, Pope Gregory the Great, who himself suffered from malaria, mentioned a great epidemic of fever at Rome in August 

599. He states that there were reports every day of high mortality in neighbouring towns (and also reports of plague epidemics in the eastern Mediterranean):⁷¹

For every day I am weak and in pain and sigh, waiting for the remedy of death. Assuredly among the clergy of this city and

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