Malaria and Rome: A History of Malaria in Ancient Italy

in Greece, not among the diseases of northern Europe.³¹
Any attempt to trace the history of P. falciparum malaria in Greece before the fifth century  encounters the perennial problem of the shortage of evidence, which bedevils the historiography of archaic Greece. There is no reason whatsoever for supposing that authors such as Hesiod or the lyric poets ever envisaged producing ancient equivalents of Pauly’s Realencyclopädie. Consequently arguments from silence based on such sources are just as worthless in respect of malaria as they are in respect of other problems in Greek history. There is one passage in Homer which has attracted attention. The reference to ‘fever’ (puretÎß, a hapax legomenon in Homer) in such an early source is by itself inadequate to prove that this text is a reference to malaria. Although there is no doubt that specialist medical literature such as the writings of Celsus and Galen does refer specifically to malaria, there will always be room for doubt whether the vocabulary of authors who were not specialists in medicine was used in the same way as doctors used it.³² The meaning of the Homeric text was already debated in antiquity, as shown by the scholiast.³³
³¹ Celli (1933: 47); Œuvres complètes d’Hippocrate, ed. Littré, ii. 538–84; Bruce-Chwatt (1976) on the history of the term ague. Pace Jarcho, there did continue to be some recognition of semitertian fevers in literature in northern Europe in the early modern period (e.g. Black (1789: 46, 49).
³² The brief reference to an epidemic attributed to ‘bad air’ during the summer in Virgil, Aeneid 3.137–42 raises similar problems of interpretation. There is no detailed description of the symptoms. Livadas (1959: 301) quoted a passage from the ‘Orphic’ Lithika as ‘pre-Hippocratic’ evidence for malaria in Greece in the sixth century , but this poem is now regarded as a late work of the fourth century  (so West (1983: 36) following R. Keydell in Pauly-Wissowa, RE xviii.2 (1942), cols. 1338–41): ej d† puriflegvqwn ‰ter&meroß £ndra qam≤zwn | ∂ kruerÏß m3rptwn puretÏß paradhq»n7sin, | ]† tetarta≤hß p[ma brad», m& pote l&gein | Boulomvnhß, åll’ ajvn, Òp7 pel3s7si, meno»shß, | tÎnde s» g’ j$sqai di’
åm»monoß åntiac3tou: | o˜toß g¤r puret0n polŸ fvrteroß (If a fever blazing like fire on alternate days regularly attacks a man, | or a fever creeps in while the man is in the grip of an icy chill, | or a quartan fever, never wishing to cease, but always remaining, | brings slow misery to a man as it approaches, | you cure this fever with an excellent agate[?]. | This stone is much better than fevers.) ( Lithika 633–8, ed. Abel (1885) ).
³³ Òti ‹pax ƒntaıqa Ø puretÎß, AAext ka≥ Òti puretÏß kur≤wß lvgei, oÛc ¿ß tineß dvcon-Types of malaria 21
The old man Priam was the first to see him [sc. Achilles] with his eyes, as he hurried across the plain, shining like the star which rises at harvest time [sc. Sirius]. Its rays are conspicuous among the numerous stars in the dead of night, and it is called the dog of Orion by men. It is the brightest star, but its appearance is a sign of evil, for it brings much fever to wretched humans.³⁴
Nevertheless, if the circumstantial details provided in this passage are approached with an open mind, without any preconcep-tions as to when P. falciparum reached Greece, the whole context is much more suggestive of P. falciparum malaria than anything else.
The parallel with Achilles, avenging the death of Patroclus, suggests a disease capable of causing very high mortality rates.³⁵ The rising of Sirius (in late July) was definitely associated with malarial environments in Etruria by Tibullus:
Remain by the water which flows from Etruscan springs, a stream not to be approached during the heat at the time of the dog star, but now second only to the holy waters of Baiae, when the ground thaws during the varie-gated spring.³⁶
The association with the harvest recalls the name ‘aestivo-autumnal fever’ that was frequently given to P. falciparum malaria by Italian doctors, such as Marchiafava and Bignami in the late nineteenth century. In contrast P. vivax only requires temperatures of 15–16ºC to complete its cycle of development inside the mosquito and has a tendency to cause spring relapses following primary infections in the previous autumn. Consequently vivax malaria was tai t¶n di3kausin toı åvroß: prÏß g¤r tÏ fqoropoiÏn Ó parabol&. ka≥ Òti deilo∏sin ånt≥ toı deila≤oiß (The word ‘fever’ only occurs once [sc. in Homer]. Moreover it really means ‘fever’, not ‘burning of the air’ as some maintain, for the comparison is with something which causes destruction): Scholia Graeca in Homeri Iliadem [ Scholia Vetera], ed. H. Erbse (1972), v. 268–9. The same pair of alternative explanations is found in Eustathius, Commentarii ad Homeri Iliadem pertinentes, ed. van der Valk (1987), iv. 566, writing in the twelfth century .
³⁴ Homer, Iliad 22.25–31: tÏn d’ Ø gvrwn Pr≤amoß pr0toß ÷den øfqalmo∏si, |
pamfa≤nonq’ ¿ß t’ åstvr’ ƒmpess»menon ped≤oio, | Òß Â3 t’ øp*rhß e”sin, år≤zhloi dv oÈ
aÛga≥ | fa≤nontai pollo∏si met’ åstr3si nuktÏß åmolg‘: | Òn te k»n’ ∞Wr≤wnoß ƒp≤klhsin kalvousi. | LamprÎtatoß m†n Ò g’ ƒst≤, kakÏn dv te s[ma tvtuktai | ka≤ te fvrei pollÏn puretÏn deilo∏si broto∏sin.
³⁵ The rising of the dog-star was regarded as an important time in the development of seasonal disease epidemiology by Hippocrates, Airs, Waters, Places 11.
³⁶ Tibullus, 3.5.1–4: Vos tenet, Etruscis manat quae fontibus unda, | unda sub aestivum non adeunda Canem, | nunc autem sacris Baiarum proxima lymphis, | cum se purpureo vere remittit humus.
22
Types of malaria
observed from March onwards under Mediterranean environmental conditions and was not especially associated with the harvest as such, although it certainly was frequently transmitted during the harvest in the past (see Ch. 5. 4 below). Grmek rightly noted that acute enteric diseases are also prevalent in summer and