Malaria and Rome: A History of Malaria in Ancient Italy (12 page)

Ecology of malaria

51

6. The Virgin of Fevers in the Sacristy of St. Peter’s in the Vatican in Rome. Reproduction of engraving by Pietro Leone Bombelli (1737–1809) in 1792. The Wellcome Library, London.

52

Ecology of malaria

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 Â∏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 Â≤gou ka≥ puretoı . . . | kaqhmerinÎn, åpÏ pantÎß Â≤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 Â≤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
]