Malaria and Rome: A History of Malaria in Ancient Italy

worthless was probably well founded in practice, especially in relation to malaria, however interesting the Hippocratic approach to medicine may be to modern historians of medicine, although many treatments could have worked as placebos.¹⁹
Marchiafava wrote as follows: ‘I may say, at once, on the basis of forty-three years’ experience, that pernicious symptoms arise only in connection with . . . P. falciparum [and not P. vivax].’ He later went on to differentiate P. falciparum from P. vivax malaria by ‘the long duration of the febrile access, viz. from 24 to 36 hours or more, with brief and poorly defined intervals.²⁰ The tertian character of the fever is recognised from the period elapsing between the onset of one access and that of the next, and in pure forms, it can clearly sex per accessionem occupat (interdum etiam vel minus vel plus), neque ex toto in remissione desistit, sed tantum levius est. Id genus plerique medici Ómitrita∏on appellant. Compare the Hippocratic definition of a semitertian fever as a fever which becomes milder on one day, without completely ceas-ing, and then severe again on the following day: Hippocrates, Epidemics 1.2, ed. Littré (1839–61), ii. 606–9: tÏ m†n Òlon oÛ diale≤ponteß: Ø d† trÎpoß Ómitrita∏oß: m≤an koufÎteroi, t∫ ‰tvr7 ƒpiparoxunÎmenoi.
¹⁷ Celsus, de medicina 3.8.2: plurimique sub alterutro curantis errore subito moriuntur. Ac nisi magnopere res aliqua prohibet, inter initia sanguis mitti debet, tum dari cibus (Many patients die suddenly as a result of various errors by doctors. And unless there is a strong reason for not doing so, bleeding should take place at the beginning of the illness, and then food should be given to enable the patient to sustain a long period of fever without aggravating it).
¹⁸ Cipolla (1992: 57) for Magiotti. Thomas Sydenham regarded blood-letting as very dangerous during acute attacks of malaria in the autumn (Dewhurst (1966: 134–5); Meynell (1991: 127) ). Similarly Palmero and Vega (1988: 346) quoted the Spanish doctor Andrés Piquer as arguing in the eighteenth century that bleeding as a therapeutic method eventually led to the death of patients suffering from malaria.
¹⁹ Cato in Pliny, NH 29.7.14.
²⁰ Marchiafava (1931: 4, 11), cf. Sambon (1901 c: 348).
16
Types of malaria
be seen that the attacks come on alternate days’. He stressed that all the symptoms of pure infections with P. falciparum are more intense and more severe than the symptoms of pure infections with P. vivax. The obvious similarity to Celsus’ description was noted by Marchiafava himself, and it does not end there. In a passage too long to be reproduced here Celsus then went on to describe quotidian fevers, emphasizing the great range of variation they displayed.²¹ The sheer length of his description of quotidian fevers relative to his description of tertian fevers indicates the great frequency and severity of quotidian fevers in ancient Rome and correlates precisely with the results of the modern research in medicine mentioned above. Celsus’ account was indeed based on an accurate assessment of the relative importance of the various classes of malarial fever. Similarly Marchiafava, on the basis of the experiences of doctors treating cases of malaria from the Roman Campagna in the Santo Spirito (for men) and San Giovanni (for women) hospitals in Rome in the late nineteenth and early twentieth centuries, went on to describe quotidian fevers, irregular intermittent fevers, and subcontinuous fevers. These were all frequently caused by P. falciparum, as was confirmed by microscopic examination of blood smears. He emphasized that the subcontinuous fevers were generally serious, more dangerous than cases exhibiting the classic tertian periodicity. Marchiafava also emphasized that only primary attacks or early recrudescences can become pernicious.²²
After that, survivors are developing acquired immunity. Consequently people suffering from pernicious malaria often do not yet have enlarged spleens, another classic symptom of malarial infection, noted for example in the Hippocratic treatise Airs, Waters, Places. What are being described in such texts are survivors with a long history of repeated infections, not those killed directly by the disease at an early stage of infection. Splenomegaly is more pro-nounced in cases of P. malariae than in cases of P. falciparum. It is least frequent in P. vivax malaria. A spleen may weigh as much as twenty times its normal weight as a result of malaria. The splenomegaly associated with malaria was already well known to the Romans by ²¹ Celsus 3.3.3–6.
²² Marchiafava (1931: 14–20), cf. Marchiafava and Bignami (1894: 231–2) for their views on Celsus. The San Giovanni hospital, near the church of San Giovanni in Laterano, is now Rome’s main accident and emergency hospital.
Types of malaria
17
2. Ospedale di San Giovanni, in Piazza di Porta San Giovanni, is one of Rome’s major hospitals. It formerly received patients with indigenous malaria.
the second century , and Cato prescribed cabbage as a remedy for splenomegaly.²³
There is no doubt that P. falciparum malaria was present and well known in all its varied manifestations in Rome at the beginning of the imperial period. It is sometimes suggested that it was a completely new disease in Roman times.²⁴ However, it must be stressed that there is no positive evidence whatsoever for this hypothesis.
There is not a ghost of a sign in the writings of Celsus, or Galen, or any other ancient Greek or Roman author, that any type of malarial fever was regarded by anyone as a new disease at any time in the period c.500 – c. 500. Both Celsus and Galen had no doubt that they could recognize all the types of intermittent fever ²³ Hippocrates, Airs, Waters, Places 24: ej mvntoi potamo≥ m†n m¶ e÷hsan, t¤ d† \data limna∏3 te ka≥ st3sima p≤noien ka≥ ‰l*dea, ån3gkh t¤ toiaıta e÷dea progastrÎtera ka≥
splhn*dea e”nai (However if there are no rivers and it is necessary to drink stagnant water from marshes, people’s bodies inevitably have swollen bellies and enlarged spleens); Cato, RR 157.7: et si