Malaria and Rome: A History of Malaria in Ancient Italy Page 9
Since most individual attacks of malaria in adulthood in endemic areas are not actually directly fatal (although overall life expectancy of the whole population is sharply reduced—see Ch. 5.
4 below), owing to acquired/inherited immunity, in practice many attempted ‘treatments’ in antiquity would have appeared to have been successful, even though they were in reality no better than placebos. St. Augustine was still well aware of the Febris cult in late antiquity.¹⁹ The cult of Fever in fact long outlived antiquity.²⁰
Religious rites and festivals directed against fever have continued to exist in various parts of Italy until modern times. For example, Ferdinando Forlivesi described how in 1889 thousands of the inhabitants of the region around Ravenna went down to the sea to bathe on 10 August, the day when the festival of St. Lorenzo was celebrated, in the belief that bathing on that holy day gave protection against malarial fevers. At Mazzara in Sicily the feast day of Salvatore on 6 August was regarded as effective against intermittent fevers.²¹
The references to the Febris cult in antiquity remind us that probably only a small minority of the population in antiquity, belonging to the educated upper class which produced most of our literary texts, actually followed the precepts and mode of reasoning of Hippocratic medicine. This conflict of different types of explanation was not merely an intellectual debate. It also spilled over into the legal and judicial domain. In the reigns of the paranoid emperors Caracalla ( 198–217), Constantius ( 337–361) and Valentinian ( 364–375) individuals were punished for wearing amulets to ward off quartan and tertian fevers, since it was adhuc unum in Palatio, alterum in area Marianorum monumentorum, tertium in summa parte Vici Longi extat, in eaque remedia quae corporibus aegrorum adnexa fuerant deferebantur. The corrupt text of Theodorus Priscianus 3, ed. Rose (1894), does not add any further significant information, however it be emended.
¹⁹ St. Augustine, de civitate Dei 3.25; Richardson (1992: 149–50); Jones (1909 a); Burke (1996: 2266–71) gives an interesting discussion of the Fever cult, referring to Dunst (1968) for a Greek parallel from Samos (perhaps influenced by Roman practice); Cornell (1995: 96–7) on the Palatine hill; P. F. Russell (1955: 79–82).
²⁰ R. Lanciani, ‘Sulle vicende edilizie di Roma’, in Monografia (1881: 8) wrote about the Fever shrine in the Vatican as follows: La chiesa di santa Maria delle Febri al vaticano, distrutta nella riedificazione della basilica, fu una delle più venerate tra i mille luoghi di culto che il Panvinio registra nel Magnus Catalogus eccles. urban. (Mai. Spicileg. IX, p. I. 79). There were similar shrines elsewhere in Italy. Pitrè (1971: 218) mentioned a church dedicated to the Madonna of Fevers outside Partanna in Sicily, cf. Corti (1984: 666–7).
²¹ Emiliani and Dalla Valle (1965: 379); Pitrè (1971: 222–3).
Ecology of malaria
53
reckoned that any magic might be turned against the emperor.²²
Both Cicero and Pliny the Elder regarded the Roman custom of deifying evils such as fever as a mistake and a sign of the weakness of the human race, but it is likely that most people in ancient populations did indeed regard malaria as the work of a demon.²³
In his antiquarian book on the Roman calendar John Lydus ( c.
490–560), working at Constantinople, described malaria under the heading of September. He attributed quotidian fevers to the demon of air, tertian fevers to the demon of water, quartan fevers to the demon of earth, and envisaged a constant struggle between these entities and the demon of cold in order to explain the periodicity of malarial fevers.²⁴ There are also documentary sources from Roman Egypt describing protective charms or exorcism spells for malarial fevers. It is striking that malaria is mentioned much more ²² Lane (1999: 648–9) drew attention to these texts: Ammianus Marcellinus 19.12.14, nam siqui remedia quartanae vel doloris alterius collo gestaret . . . pronuntiatus reus capitis interibat (For if anyone wore around his neck amulets against quartan fever or any other illness . . . he was condemned to death and executed.), and 29.2.26, anum quandam simplicem intervallatis febribus mederi leni carmine consuetam, occidit ut noxiam, postquam filiam suam ipso conscio curavit adscita (He had a simple old woman, who used to cure intermittent fevers with a gentle charm, executed as a criminal, after she had been summoned with his knowledge and had treated his own daughter.), cf. 16.8.2; scriptores historiae Augustae— Caracalla 5.7: damnatis et qui remedia quartanis tertianisque collo adnexas gestarent (Some men were even condemned to death for wearing amulets against quartan and tertian fevers around their necks.). McCollough and Glazier-McDonald (1996) published a particularly fine example of a fever amulet with an Aramaic text from Sepphoris in Israel.
²³ Cicero, de natura deorum 3.63 and de legibus 2.28; Pliny, NH 2.5.15–16. Probably more representative of popular thought in antiquity is the obscure third century (?) Christian text called the Testament of Solomon. McCown (1922: 47) in his edition described this work as follows: ‘the prime interest of the writer of the Test was medical. For him demons were what bacilli are to the modern physician, and his magical recipes and angel names are his pharmacopoeia’. Chapter 18.20 and 23 of the Testament mentions demons that bring fevers to men.
²⁴ John Lydus, liber de mensibus 4.130, ed. Wunsch (1957): Òti pleon3santoß m†n purÏß puretÏß g≤netai, åfhmerinÏß d† åvroß, trita∏oß d† datoß, tetarta∏oß d† g[ß. file∏ d†
to»twn prokat3rcein tÏ ∏goß. ØpÎtan g¤r ËpÏ toı yucroı—ƒpeid¶ toıto ÷dion datÎß te ka≥ g[ß—t¤ ejrhmvna Ëgr¤ pacunq∫, thnikaıta ferÎmena di¤ t0n åraiwm3twn ƒxwqe∏n m†n oÛ d»natai t¤ puknÎtera, ƒmpesÎnta d† ta∏ß to»twn 1draiß s»nwsin ka≥ ql≤yin ƒrg3zetai, mvcriß #n ËpÏ toı purÏß ƒpeigÎmena tmhqvnta diacuq∫, Òper ånagka≤wß klÎnon tin¤ ka≥
seismÏn ƒmpoie∏, d¶ p3qoß trÎmoß ka≥ yıcoß ønom3zetai (With excessive heat a fever is generated. Air produces quotidian fevers, water produces tertian fevers, and earth produces quartan fevers. However cold likes to begin before all of these. For whenever liquids are soli-dified by cold (since cold is unique to water and earth), being thicker they cannot be driven out through the interstices of the body, but falling into the bases of the interstices they created compression and pressure, until they are dissolved by fire, having being overpowered and thinned, wherefore it must cause a degree of agitation and commotion, and so the illness is called shivering and cold.).
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Ecology of malaria
frequently than any other disease in the magical papyri. The magical papyri use exactly the same terminology for malarial fevers as the mainstream medical authors such as Galen.²⁵ Such evidence suggests that religious or magical explanations of malaria and other diseases were widely adopted in antiquity and indeed afterwards.
The word abracadabra, used in magic, originated as a spell against semitertian fever. ‘Write down on papyrus the word abracadabra |
and repeat it many times, moving down the paper, but each time remove the final letter | from the line so that more and more of the letters of the word are missing, and mark the others, | until there is only one letter in the last line of the diagram at the apex of a cone. | Remember to tie it around one’s neck with a linen thread’
(Quintus Serenus, liber medicinalis).)²⁶
The shift from pagan religions to Christianity probably made no significant difference to popular perceptions of malaria, which was frequently the target of healing miracles in Christian literature. Just to give one set of examples here, Gregory of Tours in his book on the Glory of the Confessors made a series of references to healing miracles involving quartan fever, tertian fever, and fevers without any further specification. His evidence shows that malaria was common and well known in France in the sixth century .²⁷ In the thirteenth century even a pope, Honorius IV (1285–7), is said to ²⁵ Vakaloudi (2000: esp. 185, 196, 206) noted these texts, which are to be found in Daniel and Maltomini (1990) nos. 2, 3, 4, 9, 11, 14, 18, 19, 21, 22, 23, 25,
29, 31, 34, and 35. Part of no.
14, a papyrus dating to the fourth century , is reproduced here as an example: tÏn ∞Iw3nnhß toı πcontoß ≤gou ka≥ puretoı . . . | kaqhmerinÎn, åpÏ pantÎß ≤gou . . .|
kef]alarg≤aß, kaqhmerinÎn, nukterinÎn . . . | te]tarte&on, Ómitrite&on, ‡dh ‡dh, tacŸ, t[acŸ|
tan Óm0n åq3raton £ggelon . . . | [tÏn ∞Iw3]nnhß åpÏ pantÏß ≤gou ka≥ p[uretoı| åpÏ t[ß s&meron Ómvra〈ß〉 ka≥ åpÏ £rti Òr[aß ejß tÏn]| [‹]panta crÎnon t[ß Òlhß aÛtoı do[[ß| [ . . .
]sin, ‡dh ‡dh, tacŸ, tac» (. . . Ioannes of the shivering and fever that possess him | quotidian, from all shivering, | . . . headache, quotidian nocturnal fever, | . . . quartan, semitertian, now, now, fast, fast | . . . our immortal angel | . . . Ioannes from all shivering and fever from this day today and from this hour now for the entire time of the rest of his life | . . . now, now, fast, fast.).
²⁶ Quintus Serenus, liber medicinalis 51.935–40, ed. Pépin (1950) ( Hemitritaeo depellendo): inscribes chartae quod dicitur abracadabra | saepius et subter repetes, sed detrahe summam | et magis atque magis desint elementa figuris | singula, quae semper rapies, et cetera † figes† , | donec in angustum redigatur littera conum: | his lino nexis collum redimire memento.
²⁷ Gregory of Tours, Liber de gloria beatorum confessorum, ed. Migne, Patrologia Latina, lxxi., cols. 838 (quartan), 845 (quartan), 890 (quartan), 893 (quartan), 895 (quartan), 904 (tertian).
Of course, as we have already seen, references to periodic fevers are only the tip of the iceberg of malaria in antiquity. Consequently many of the other references made by Gregory to unspecified fevers will also have been cases of malaria. A likely example is col. 847, where the vocabulary is that of malaria ( febricitans), even though no periodicity is mentioned. Cf.
Horden (1992) on malaria in early medieval France.
Ecology of malaria
55
have explained malaria in astrological terms. Ultimately Cicero’s more ‘rational’ approach to periodic intermittent fevers was not an improvement on the explanation from religion. The ancient Chinese, whose conception of the nature of the subject of medicine was in some respects fundamentally different, came closer than the ancient Greeks and Romans to understanding the cause of malaria, as well as coming closer to finding an effective treatment for the disease, as has already been seen.²⁸
4. 2 M
Given the failure of Greek rational thought, it was left to the practical instincts of the Romans to try to make an impact on the situation. Undoubtedly a limited measure of success was enjoyed, at least from time to time. As Scarborough put it, ‘Roman practical acumen allowed a certain amount of experimental understanding of the problems involved’, with regard to the siting of villas in relation to malarial swamps.²⁹ The association of malaria with swamps was common knowledge at least from the time of the Hippocratic Airs, Waters, Places onwards, if not long before. The Roman agronomists all warned of the dangers of marshes. Cato insisted that a farm had to be situated in a healthy place. Varro said that a farm facing a river was unhealthy in summer.³⁰ The recommendation to face away from the danger area was well founded. Celli noted that in the nineteenth century those inhabitants of the hill town of Sezze (ancient Setia) in Lazio whose houses faced a marsh contracted malaria, while those who lived on the opposite side did not. The population of Sezze experienced different rates of infection not only according to locality of residence, but also according to sex, since it was observed that women who stayed in their homes on the hill were infected less frequently than men who went down to work on the plain below the town.³¹ Malaria penetrated far inland up ²⁸ According to Tomassetti (1910: i. 170) Honorius attributed malaria: ad un movimento della ottava sfera del cielo; Lloyd (1996) on China.
²⁹ Scarborough (1969: 82).
³⁰ Hippocrates, Airs, Waters, Places 7 and 24; Cato, de agricultura 1.3 ( loco salubri (in a healthy place) ); Varro, RR 1.12.1, sin cogare secundum flumen aedificare, curandum ne adversum eam ponas; hieme enim fiet vehementer frigida et aestate non salubris (If you have to build a villa next to a river, make sure that it does not face the river, since it will be very cold in winter and unhealthy in summer.).
³¹ Celli (1900: 84, 132). Tommasi-Crudeli (1892: 131) and North (1896: 103) recorded that it was not uncommon for a woman of Sezze (their idleness was proverbial) to have had three [ cont. on p. 57]
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Ecology of malaria
7. Plan of modern Sezze (ancient Setia).
Ecology of malaria
57
river valleys in the early modern period. For example, the Tiber was affected for a large part of its course, as were many other rivers in Lazio such as the Aniene, Arrone, Galera, Marta, Sacco and Timone. Tibullus’ recommendation, quoted above, that the vicinity of rivers and streams in Etruria should be avoided in the summer, should be recalled. It suggests that river valleys were as unhealthy in the first century as in the early modern period.
Varro and Vitruvius also recommended building a villa on elevated ground, not in a hollow.³² This was a frequent and again well-founded recommendation in antiquity, since mosquitoes, which are weak fliers, dislike flying upwards and dislike windy locations.
Antyllus, writing in the second century , summarized the prevailing view in antiquity as follows: Localities situated at high altitude are the healthiest places, since the air is not static, but is scattered around and continuously driven away by the winds. Airy places are suitable for all afflictions of the chest and head and all the faculties.³³
Procopius stated that the air on Mt. Vesuvius was very light and extremely healthy. Consequently patients with tuberculosis were sent there to recuperate.³⁴ At least such patients would have avoided the synergistic interactions of tuberculosis with malaria (see Ch. 5. 2 below). Celli noted that the town of Norma, situated on a hill 433 metres above sea level overlooking the Pontine Marshes, was free from malaria in the nineteenth century, while the vicinity of Ninfa (described by Gregorovius as ‘the little medieval Pompeii’), located at the foot of the same hill, was intensely malarious, the cause of its abandonment between 1675 and 1680.³⁵ In husbands, who had all died from malaria, by the time she reached the age of thirty. This was the inverse to the situation described in the English marshlands by Dobson (1997), where men who had been brought up in the marshes married women moving into the marshlands from other areas, who died rapidly. [Aristotle] Problems 1.21.862a described marshes as unhealthy.
³² Varro, RR 1.12.3; Vitruvius 1.4.1.
³³ Antyllus per≥ tÎpwn ka≥ t0n ƒn aÛto∏ß åvrwn in Stobaios, florilegium 101.18, ed.
Wachsmuth and Hense: oÈ Ëyhlo≥ t0n tÎpwn ËgieinÎtatoi, toı åvroß ƒn aÛto∏ß oÛ mvnontoß åll¤ ka≥ periceomvnou ka≥ ËpÏ t*n ånvmwn sunec†ß åpwqoumvnou: eÛpnoo≤ te d¶ ka≥ diaqvs-esi p3saiß ƒpit&deioi ta∏ß per≥ q*raka ka≥ kefal∫ peponqu≤6 ka≥ to∏ß ajsqhthr≤oiß p$sin.
Nutton (2000 b) discussed the ancient tradition of meteorological medicine.
³⁴ Procopius, BG 2.4.30, ed. Haury (1905).
³⁵ Celli (1900: 85); Pratesi and Tassi (1977: 140–1) described the area of Ninfa, as did Tomassetti (1910: ii. 393–406, esp. 399–400 for the date of Ninfa’s abandonment). Tomassetti thought that Ninfa was healthy in antiquity, but there is no positive evidence for this.
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Ecology of malaria
8. View of Norma
in the distance from
Sermoneta. Situated
on top of a hill overlooking the Pontine
plain, modern
Norma and the
ancient Roman
colony of Norba
(450 metres above
sea level), which lies
beyond it, did not
have endemic
malaria, since
mosquitoes are
weak fliers.
9. View of Ninfa
from Norma.
Situated at the foot
of the hill below
Norma, in the
Ecology of malaria
Pontine plain, Ninfa
suffered from intense
malaria as a result of
which the settlement
was eventually completely abandoned
in the seventeenth
century. Today the
ruins of the settlement are part of a
botanical park and
wildlife reserve
administered by the
Fondazione Caetani
and the World
59
Wildlife Fund.
60
Ecology of malaria
general malaria was not found above 500 metres in Italy. Consequently it was not found in the higher parts of the Colli Laziali, Monti Lepini, Monti Simbruini, and Ciociaria in Lazio. In the eighteenth century population growth occurred in these more mountainous areas, while the lowland populations stagnated or declined, and the bulk of the population was concentrated in the more mountainous regions. However, in southern Etruria there are not many localities whose altitude exceeds 500 metres.³⁶ Malaria creates differential demography according to altitude. Nevertheless it is important to bear in mind that people who live at altitude but descend to work will still be vulnerable to infection in their working environment, as we have already seen in relation to Sezze.
North observed that those inhabitants of Rocca Massima, situated at an altitude of over 700 metres, who went to work on the plain below frequently became infected with malaria. In general, upland areas were much healthier than lowland areas in the past in central and northern Europe, as various studies have shown. However, in the more mountainous parts of central Italy, where peasants often lived in housing which was inadequate for the winter, the winter cold could cause some adverse demographic effects. A comparison of Treppio, located 700 metres above sea level, with Casalguidi found that infant mortality in the first year of life was higher in Treppio for that segment of each cohort born during the winter months. To understand the ancient preference for elevated locations, it is essential to remember that it is only when the comparison is with lowland populations affected by endemic malaria that upland regions in central Italy in the past had an overwhelming advantage in terms of health. It is only in comparison with the intense malaria of Grosseto that Treppio appears extremely healthy.³⁷