Malaria and Rome: A History of Malaria in Ancient Italy

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.
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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