Malaria and Rome: A History of Malaria in Ancient Italy

by Robert Sallares

  more deadly is the fever which is called semitertian in Greek; no one, I think, could have named it in our language and mothers would not have wanted to⁵⁵

  Acquired immunity to the strains present in such a locality is gradually built up by survivors of primary attacks, in response to repeated infections. The result is that episodes of acute clinical illness become less frequent with increasing age. Under such circumstances the bulk of severe illness is concentrated among children.

  Severe illness among adults is only observed among immigrants, who do not have any acquired immunity. After the city of Rome became the centre of Christianity during the period of the Roman Empire, Christians migrating to or visiting Rome were particularly susceptible to the scourge of ‘Roman fever’. The cases of St.

  Augustine and Alcuin have already been mentioned, as well as the English monks mentioned by Gervase in  1188. Hyperendemic malaria was the pattern over much of the Campagna Romana throughout the medieval and early modern periods. Under such circumstances acute infections of indigenous adults were less frequent. Epidemics of malaria among adults were only observed when large groups of people who were not native to the area appeared on the scene, for example French and German armies.

  Many historians have observed that malaria acted as a protection for Rome from foreign invaders. This viewpoint had already been explicitly articulated by Godfrey of Viterbo as early as  1167, when he recorded in verse the destruction of the army of Frederick ⁵⁵ Quintus Serenus, liber medicinalis 51.932–4, ed. Pépin (1950): mortiferum magis est quod Graecis hemitritaeos | vulgatur verbis; hoc nostra dicere lingua | non potuere ulli, puto, nec voluere parentes.

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  Barbarossa. It can be surmised that the rainfall during the summer storm mentioned by Godfrey created mosquito breeding sites in the vicinity of Barbarossa’s camp.

  The hot Dog Star is accustomed to give men’s bodies fever. | This heat tends to kill men at Rome, | and often inflicts pains through countless fevers; | now it produced more than usual. | When Rome cannot protect itself by the sword, | fever can be seen as an ally, a means of salvation: |

  the soldier dies of fever, which he feared yesterday. | Those whom Rome could not destroy were annihilated by the wind, | at whose arrival the German youth were killed: | thus when Rome is silent, our imperial glory lies in ruins, | alas, because the lord [sc. Frederick] of the city and the world is vanquished and stopped | by the diseases of Romulus in a short span of time; | he whom sea and land fear groans at the heat of the fever. | All of Rome had sworn an oath at Caesar’s will. | A wind came from the southern zone with thunder and lightning, | and the storm hit the camp. | Every man was drenched as the heat of the sun decreased, and became ill with a terrifying fever following the shivering. | The soldiers ached with pain in their heads, as is to be expected, and internal organs and legs. All of them were now injured by the wounds of fever.⁵⁶

  Malaria was almost certainly already playing that role in late antiquity, when Alaric died from a disease contracted during the siege of Rome in the summer of  410, while Attila’s failure to march on Rome in 452 was probably motivated at least partly by the threat of pestilence as well as famine in Italy.⁵⁷ However, that epidemiological situation had arisen long before the fifth century.

  Tacitus describes an episode during the short-lived occupation of Rome by Vitellius in  69 that sounds very similar to the numerous catastrophes which befell French and German armies attacking Rome in the medieval and early modern periods, as catalogued ⁵⁶ Gotifredus Viterbiensis, de gestis domni Friderici Romanorum imperatoris, sec. 27, ll. 625–46, ed. G.H. Pertz (1870), Monumenta Germaniae Historica. Scriptores Rerum Germanicarum, xxx, 24–5: Fervida stella poli canis est coniuncta leoni, | Ordine zodiaci connectens sidera soli, | Datque calore poli corpora febre mori. | Hoc solet ardore sol perdere corpora Rome, | Febribus innumeris infligere sepe dolores; |

  Nunc dedit ex more deteriora fore. | Dum nequid in gladio se maxima Roma tueri, | Febris ab auxilio poterit salvanda videri: | Miles febre perit, quem metuebat heri. | Quos non Roma potest, potuit disperdere ventus, |

  Cuius in adventu cecidit Iermana iuventus: | Sic ubi Roma tacet, gloria nostra iacet. | Heu quia Romuleis modico sub tempore morbis | Vincitur et premitur dominator et Urbis et orbis; | Febre calente gemit, quem mare terra tremit. | Cesaris ad libitum iuraverat omnia Roma. | Venit ab australi ventus cum fulgure zona, | Castraque precipitant ventus et aura tonans. | Omnis homo madidus, solis fugiente calore, | Leditur orribili febri, veniente rigore. | Et caput ex more, viscera, crura dolent. | Omnia iam fuerant febrili vulnere lesa.

  ⁵⁷ Romer (1999); Olympiodorus ap. Photius, bibliotheca, ed. Henry (1959), i. 168–9 and Jordanes, de origine actibusque Getarum, 157–8, on Alaric’s death; novellae divi Valentiniani, 33

  ed. Meyer and Mommsen (1905).

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  by Celli, Celli-Fraentzel, and more recently Bercé. The German and Gallic troops of Vitellius, like Julius Caesar’s army after it had spent years in Gaul in the previous century (see Ch. 10 below), were not accustomed to the P. falciparum malaria of Mediterranean countries and had no acquired (or innate) immunity to it. This episode shows that the Vatican district was extremely dangerous in summer in the first century , just as it was during the papal election in 1623:⁵⁸

  Finally, not even caring about life, many of them camped in the unhealthy Vatican district, as a result of which there were many deaths among the rabble. The Tiber was near by, and the Germans and Gauls, whose bodies were already liable to disease, were weakened by their lack of tolerance for the heat and their desire for the river’s water.⁵⁹

  Medieval accounts of the perils of the areas of the city close to the river Tiber are more detailed. For example, Godfrey of Bouillon, the Duke of Lower Lorraine who later became one of the leaders of the First Crusade, was infected near the Tiber with quartan fever during the siege of Rome in  1083 and vowed that he would go to Jerusalem if God cured him. He survived the siege, although one strand of tradition suggests that a recrudescence of quartan fever played a role in his death in Jerusalem in  1100, but many of his colleagues were killed by malaria during the siege of Rome.

  Advancing to storm Rome, he was the first to break through that part of the wall which had been allotted to his own section of the army, opening a large window to make an entry. Sweating very heavily,and panting as his blood was so hot, he entered an underground store-room which he found by chance as he moved around there: when he had satisfied his excessive thirst by drinking too much wine, he developed a quartan fever.

  Some say that he was infected by poisoned Falernian wine, because the Romans, and the men of that land, are accustomed to pour poisons into ⁵⁸ Bercé (1989: 239–40); Celli (1933: 73–82, 95); Celli-Fraentzel (1932); Scheidel (1996: 128–9); Lapi (1749: 17–18) noted that foreigners such as Germans who visited Rome in the eighteenth century were particularly likely to become ill. Even a severe disease like malaria could sometimes be evaluated positively, cf. P. F. Russell (1955: 244) noting that some Africans regarded malaria as an ally against European colonists. Jarcho (1945) drew attention to a German propaganda exercise in the Second World War. It attempted to induce American soldiers in Italy to believe that getting infected with malaria was desirable in order to be invalided out of military service and so avoid death in battle.

  ⁵⁹ Tacitus, Hist. 2.93: Postremo ne salutis quidem cura infamibus Vaticani locis magna pars tetendit, unde crebrae in vulgus mortes; et adiacente Tiberi Germanorum Gallorumque obnoxia morbis corpora fluminis aviditas et aestus impatientia labefecit. Alexander Donatus (1694: iii.21, p. 274) in the seventeenth century believed that the ‘Vatican district’ included the Ianiculum in Tacitus’ eyes.

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  whole casks of wine. Others say that by chance he had been allotted that section of the walls where the current of the Tiber in the m
orning exhales deadly mists, which were the cause of death of all but ten of his own soldiers. He himself lost his hair and nails and recovered with difficulty.

  Nevertheless in truth it is agreed that, whatever the reason, he was never free from the inconvenience of a continuous but slow fever until, having heard of the crusade to Jerusalem, he vowed that he would go there if God graciously bestowed good health upon him . . . the story is that the king’s old fever revived because he was unaccustomed to leisure.⁶⁰

  In the following century Bishop Otto of Freising gave a detailed description of the first destruction by malaria at Rome of an army belonging to Frederick Barbarossa in  1155.

  For the unhealthy climate and the heat at that time, especially around the city, had more power to hurt our men than the weapons of the Romans . . . the rising of the sparkling Dog Star at the morbid foot of Orion was imminent, and all the air in the vicinity became dense with misty vapours arising from the neighbouring swamps and caverns and the ruined places around the city, air that was pestilential and lethal for mortals to breathe.

  The citizens in the city, accustomed to take refuge in the mountains at that time of the year, and the soldiers in the camp, who were not accustomed to such bad air, were both afflicted with this disease . . . As innumerable men developed very severe illnesses as a result of this corruption of the air, the prince, although chagrined and unwilling, was forced to transfer the tents of the camp to the neighbouring mountains to gratify his own men .

  . . but as the rage of the Dog Star upon the army grew even hotter, and there were hardly any men left who were not debilitated by the seething heat and the bad air, and as many soldiers had also been injured and some killed during the storming of cities, castles, and towns, he was forced, not without feeling bitter about it, to go back across the Alps again.⁶¹

  ⁶⁰ William of Malmesbury, gesta regum Anglorum, iv.373, ed. T. D. Hardy (1840), pp. 573–5: Ad oppugnandam Romam profectus, eam partem muri quae vigiliis suis observabatur primus prorumperet, magnam fenestram irrupturis aperiens. Ita potissimum sudans, et praefervidis venis suspiriosus, cellarium subterraneum, quod forte se discursanti obtulerat, ingressus est: ibi, cum nimio vini haustu intemperantiam sitis placasset, febrim quartanam iniit. Dicunt alii venenato Falerno infectum; quod soleant Romani, et illius terrae homines, totis infundere toxica tonnis. Alii, ei partem illam moenium sorte obtigisse ubi Tiberis influens mane saevas exhalat nebulas, quarum pernicie omnes milites eius praeter decem interiise; ipsum, amissis crinibus et unguibus, dubie convaluisse. Veruntamen, quodlibet horum fuerit, constat eum nunquam continuae sed lentae febris incommodo vacasse; donec, audita fama viae Ierosolymitanae, illuc se iturum vovit si Deus propitius ei salutem largiretur . . . fama est regem otii desuetudine febrim antiquam nactam fuisse.

  ⁶¹ Ottonis et Rahewini gesta Friderici I. Imperatoris, ii.33–4, 37, ed. de Simson (1912): plus enim nostros intemperies caeli estusque illo in tempore maxime circa Urbem inmoderatior quam Romanorum ledere poterant arma . . . iam tempus imminebat, quo Canis ad morbidum pedem Orionis micans exurgere deberet, e vicinis stagnis cavernosisque ac ruinosis circa Urbem locis tristibus erumpentibus et exhalantibus nebulis totus vicinus crassatur aer, ad hauriendum mortalibus letifer ac pestifer. Urgebatur hoc incommodo in Urbe civis, 228

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  Otto clearly describes the custom of Rome’s inhabitants of fleeing the city for the mountains each summer, during the dog-days, in the medieval period.⁶² This was also a custom in antiquity, at least for the élite, as Pliny the Younger, when he went to Tifernum Tiberinum, and Horace, when he went to his farm in the Sabine territory, prove.⁶³ Celsus recommended flight from the scene of pestilence. Since he specifies that his recommendations particularly apply to pestilences brought on by the south wind and to travel in unhealthy regions and during the unhealthy season of the year, it is clear that in this case at least the word pestilentia does include malaria.⁶⁴

  The extant ancient sources are less detailed than the medieval ones, but there is no reason for supposing that the situation with regard to the unhealthiness of the Tiber valley was fundamentally different in antiquity. Martial clearly described the conditions that created mosquito breeding sites in the Tiber valley. He stated that Ladon’s property near the Tiber was frequently flooded, turning the fields into a lake in winter. As the year progressed the fields near the river would gradually dry out, creating breeding sites for mosquitoes.⁶⁵ One of the letters of Pliny the Younger confirms that the banks of the Tiber were unhealthy in the first century , even though his uncle had said that there were more villas lining the Tiber than all the other rivers of the world.⁶⁶ The letter describes the activities of Regulus who, among numerous other faults, hoc tempore ad montana consuetus fugere, in castris miles, tanto desuetus aeris intemperie . . . Verum innumeris hac caeli corruptione in morbos gravissimos incidentibus, princeps dolens ac nolens suisque tantum morem gerens ad vicina montana transferre cogitur tabernacula…Verum excandescente amplius in exercitum Canis rabie vixque aliquibus residuis, qui estus fervore et aeris intemperie corruptionem non sentirent, sauciatis quoque de civitatum, castellorum, oppidorum expugnatione pluribus nonnullisque extinctis, non sine cordiis amaritudine ad Transalpina redire cogitur.

  ⁶² Krautheimer (1980: 317) noted that in medieval Rome in the twelfth century ‘the hills were comparatively healthy; the low parts of the disabitato were not to be trusted’, and were abandoned by everyone who could afford to move away in summer.

  ⁶³ The context of the phrase rabies Canis in Otto’s account enables us to understand its full significance when it appears in the verses of Horace, Epist. 1.10.15–17: Est ubi plus tepeant hiemes, ubi gratior aura | leniat et rabiem Canis et momenta Leonis (It is a place where the winters are milder, where a rather agreeable wind softens both the fury of the Dog Star and the violent movements of Leo). Cf. Sat. 2.6.18–19: nec mala me ambitio perdit nec plumbeus Auster | autumnusque gravis, Libitinae quaestus acerbae (and no ruinous ambition destroys me there, nor the oppressive south wind and the noxious autumn, a source of gain to the severe goddess of the dead).

  ⁶⁴ Celsus 2.10.1–4; Seneca, QN 6.1.6: in pestilentia mutare sedes licet (it is permissible to change one’s dwelling place during a pestilence); Snowden (1999: 37–8).

  ⁶⁵ Martial, Epig. 10.85.

  ⁶⁶ Pliny, NH 3.5.54.

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  irritated people by insisting that they visit him in his villa alongside the Tiber at the unhealthiest time of the year:

  He stays in his gardens across the Tiber, where he has filled a very large area with huge colonnades and covered the river bank with his statues, since he is extravagant despite his avarice, and a braggart in spite of his bad reputation. Consequently he irritates the citizens at the most unhealthy time of the year and derives satisfaction from annoying people.⁶⁷

  Frontinus, writing towards the end of the first century , confirms that Rome had a reputation for ‘bad air’.⁶⁸ He claimed that water-management operations under the emperor Nerva had solved the problem, but Galen’s later observations show that the problem had not been solved at all. Since the frequency of malaria fluctuated depending on numerous variable environmental parameters (such as the amount of rainfall, the height of the Tiber, the temperature, etc.), some mild years might have occurred by chance immediately following Nerva’s operations. That would explain Frontinus’ comments. Celli and several other writers expressed the view that epidemics of malaria occurred in Rome and the Roman Campagna every five to eight years on average in the early modern period.⁶⁹ It could also simply be the case that Frontinus had no option but to praise the emperor:

  Not even waste waters are lost: the causes of the rather unhealthy atmosphere have been eliminated, the appearance of the streets is clean, the air is purer, and the bad air for which the city was always notorious, according to older writers, has been removed.⁷⁰

  The argument so far has shown that P.
falciparum malaria was not ⁶⁷ Pliny, Ep. 4.2.5–6, ed. Schuster (1958): Tenet se trans Tiberim in hortis, in quibus latissimum solum porticibus immensis, ripam statuis suis occupavit, ut est in summa avaritia sumptuosus, in summa infamia gloriosus. Vexat ergo civitatem insaluberrimo tempore et, quod vexat, solacium putat.

  ⁶⁸ Jordan (1879) discussed the corrupt text of Frontinus. Seneca, Epist. 104.6 also mentioned the gravitatem urbi. In this passage Seneca described another notable feature of the city of Rome in antiquity, atmospheric pollution. The air of Rome was unhealthy not only because of mosquitoes carrying malaria and of airborne pathogens such as tuberculosis, but also because of the high level of pollution caused by burning wood, oil, and other materials for industrial and domestic purposes. Capasso (2000) noted that the Grotta Rossa mummy, the only mummy found in Rome so far, shows severe anthracosis even though the individual in question died young.

  ⁶⁹ Corti (1984: 638).

  ⁷⁰ Frontinus, de aquae ductu urbis Romae 88.3, ed. Kunderewicz (1973): Ne pereuntes quidem aquae otiosae sunt: ablatae causae gravioris caelii munda viarum facies, purior spiritus, quique apud veteres se〈 mper〉 urbi infamis aer fuit est remotus.

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  confined to the Pontine Marshes, its most notorious focus, but was also endemic in at least some districts of the city of Rome itself, and extended inland into Umbria, during the period of the Roman Empire. This geographical distribution resembles that of the early modern period, when the Tiber valley was severely affected along most of its course, far into Umbria. By the first century  there had already been created in and around the city of Rome a distinctive disease community or pathocoenosis, to use Grmek’s concept, which was dominated by P. falciparum, the most dangerous species of malaria. That was a distinction for which the city of Rome was to be famous over the succeeding 1900 years or so, as the home of ‘Roman Fever’, the title chosen by North for his book on a disease which was certainly not confined to Rome yet was more characteristic of Rome than of other major European cities. Before leaving the city of Rome to examine some aspects of the medical situation beyond the suburbs of the city, in the Roman Campagna, let us glance at a few more of the later literary references to malaria in Rome (out of a vast corpus of literature which could be quoted).