The Fever

by Sonia Shah

  By AD 476, the Roman Empire was no more, its canals filled with rubble and its aqueducts crumbled.34

  Foreign powers took control of Naples, Sicily, and Sardinia. Only the northern city-states, beyond A. labranchiae’s reach, prospered. Elsewhere, P. falciparum took so many lives that the deadly compromise forged in Africa—the sickle-cell gene—emerged and spread along the shores of the Mediterranean.35 Even the most celebrated Romans, such as the poet Dante Alighieri, suffered the “shivering of the quartan.”36 Dante died of malaria in 1321.37

  The Vatican founded a vast hospital, Santo Spirito, along the banks of the Tiber, which overflowed, generally to at least three times capacity, with fever patients.38 But there wasn’t much that could be done to save the sufferers. The parasite took the life of Pope Innocent VIII in 1492, Pope Alexander VI in 1503, Pope Adrian VI in 1523, and Pope Sixtus V in 1590.39

  The people of Rome no longer could understand their fevers. They seemed to have something to do with bad air, they said: the mal’aria.40 The demons of air, water, and earth were locked in battle with the demon of cold, the sixth-century historian John Lydus speculated.41 No, a foul dragon lurked in a cave beneath the city, others said, breathing out the bad air.42 It was a vengeful Febris, the poet Poliziano said, flying through the air in her lion-drawn chariot, followed by a train of monsters. She injected flames from her torch and icy snow mixed with venom into the bones of her victims.43

  Rome’s unknowable malaria inspired images of horror still potent today. There’s nothing intrinsically sepulchral about mists and wetlands. And yet, then and now, writers describe these environments as deathly. “The rising of the sparkling Dog Star at the morbid foot of Orion was imminent,” one medieval bishop wrote, in anticipation of a deadly malarial summer in Rome.

  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 rage of the Dog Star . . . grew even hotter, and there were hardly any men left who were not debilitated by the seething heat and bad air.44

  Healthful northerners visited the malarious Vatican and the ruins of Rome and professed disgust. “There is a horrid thing called the malaria, that comes to Rome every summer, and kills one,” Horace Walpole wrote in a 1740 letter, introducing, at long last, the word malaria into the English language.45 There was “a strange horror lying over the whole city,” wrote the English critic John Ruskin in 1840. “It is a shadow of death, possessing and penetrating all things . . . you feel like an artist in a fever, haunted by every dream of beauty . . . but all mixed with the fever fear.”46

  “The Valley of the Shadow of Death”—that’s how Florence Nightingale, in 1847, described the silent, thyme-covered Roman Campagna into which nonimmune villagers from the surrounding hills descended during the summer to harvest wheat.47 The wheat ripened at the height of the malaria season, and the impoverished peasants who worked the fields spent their nights in caves, stables, and under the stars, easy prey for mosquitoes.48 They were “the most unhappy, most resigned” people in Italy, the French writer Stendhal wrote in 1829. “They visited Rome on Sundays, dressed in their primitive costumes, their faces showing traces of malaria.”49 They were “pale, yellow, sickly,” wrote Hans Christian Andersen in 1845.50 In the first half of the twentieth century, it wasn’t unusual for the women who stayed behind in the mountain villages to lose three or more husbands to the Campagna’s fever.51 As a result, two million hectares of arable land remained fallow, and two million more were “cultivated badly,” writes historian Frank Snowden.52

  The earth’s axis wobbles about one degree every seventy-one years, so the dog star and the sun no longer rise as one in the summer sky. The dog days are technically over. But the plague of P. falciparum that befell Rome during the end of the empire and those early medieval caniculares dies lingered for more than a thousand years.

  Of course, the kinds of environmental disruptions that allow more malignant malarial mosquitoes to extend their territory vary from locale to locale. In the northeastern United States, the troubles began when people started building dams.

  Colonial New England’s myriad brooks and creeks provided plentiful habitat for populations of Anopheles punctipennis, a little forest mosquito that thrives in shaded, running waters. A. punctipennis has a predilection for animals, and so it wasn’t a particularly potent vector for the few malaria parasites it picked up here and there. Despite hot summers and the repeated introduction of vivax parasites from farther south, malaria’s grip on the Northeast was weak and sporadic.53

  But by the late eighteenth century, industrious New Englanders started to realize they could harness the power of the region’s rocky, tumbling rivers to card wool, grind grain, and cut logs. All they had to do was build some dams so they could draw down the water power as their mills required.54

  Behind the dams, of course, what was once tumbling river got backed up into still, sunny ponds. A. punctipennis faltered in such environments, but the sun-loving Anopheles quadrimaculatus thrived in them. A. quadrimaculatus, which unlike A. punctipennis happily entered homes in search of blood, was malaria’s prime vector in the southern states. Now they started moving north. As New England’s brooks turned into vegetation-choked ponds, A. quadrimaculatus populations grew and A. punctipennis populations declined.55

  This ecological shift overlapped with the advent of the Revolutionary War, during which nearly half of some regiments were infected with malaria parasites. Infected soldiers returning home to New England introduced the parasites into a subtly but powerfully transformed landscape.56

  One such soldier was Elijah Boardman, from New Milford, Connecticut. Boardman suffered weeks of fever during the war. For forty days, he sweated and shook while camped in the mosquito-ridden swamps of Long Island. The experience “left not less enduring traces,” one of his descendants would later write, “then such wounds as he would cheerfully have received . . . from the musket-ball or sword.”57

  His father advised him in letters: “If you are not well,” he wrote, “do not think too much about home.”58 It was good advice but, for Boardman and countless other malarious soldiers, impossible to follow. Rather than evacuate to New Jersey, as their superiors advised, they fled on wagon and horseback to their homes, malaria parasites burning in their veins.59

  The town of New Milford, Connecticut, situated along the banks of the Housatonic River, centered around a muddy, manure-littered town green. Although he suffered regular bouts of malaria—most likely relapses of vivax malaria from his original infection during the war—Boardman prospered there. He opened a general store with his brother, selling lace, wine, and imported tea, and bought several farms and fishing rights.60 The painter Ralph Earl arrived in 1789 to paint his portrait, which eventually made its way into the Metropolitan Museum (where it still hangs). His name grew to become a “passport to particular respect” in New Milford, as a local historian wrote,61 and when a widely admired local beauty consented to marry him, Boardman began building one of the grandest homes New Milford had ever known, a great Georgian mansion that stands to this day.62 The Housatonic River flowed gently behind the house, and was dammed not far off, powering two small mills that ground grain and cut logs.63

  In the summer of 1796, that dam was raised ten inches by its new owner, Joseph Ruggles. The waters of the Housatonic above the dam flooded over its low-lying banks, swamping more than fifty acres of low ground behind Boardman’s house. The water settled into a large, shallow pond.64

  Even inside his Georgian mansion, parasite-carrying locals such as Boardman were vulnerable to the bites of bloodthirsty A. quadrimaculatus. The insect came silently and softly in the middle of the night, barely noticed. When she did, Boardman’s war-era parasites, locked inside his veins by the capricious biting behavior of A. punctipennis, emerged out of dormancy, and took flight into the New Milford night.

  Within weeks, malaria spread
throughout the town. Three hundred New Milford residents fell sick with fever.65 “Almost every family near the middle of the town have been afflicted more or less,” Boardman informed his brother-in-law in a letter. Three of Boardman’s employees had been taken down by the fever, and two towns people had died. “So many persons are sick that it is almost impossible to get sufficient assistance from those that are well to take care of those that are ill,” he wrote.66

  During the last week of August, things deteriorated in the Boardman mansion. On Saturday, Boardman’s wife spiked a fever. She was “considerably reduced,” he wrote. “How long it will last or how low she will be brought cannot be known at present.” On Monday, Boardman’s two-year-old son, William, was down, too. On Wednesday, as his wife lay prostrate in her bed, Boardman watched William convulse. He scrawled a letter to his brother-in-law. The child was “very sick and decaying,” he wrote in a shaky hand. Boardman’s only hope was that some person, perhaps a doctor, perhaps his father-in-law—his usually fine handwriting, at this point in the letter, is now illegible—would arrive in New Milford to rescue them.67

  Malaria broke out all over southern New England in those final years of the eighteenth century, every where in connection with the establishment of a local milldam. In 1795, it struck Sheffield, Massachusetts, about forty miles north of New Milford, where a dam had created a swampy pond. “A number of inhabitants, about the north pond [are] afflicted with a fever,” remembered the local physician, Dr. Buel. “The people first attacked were those who lived nearest to the pond; whole families of whom were taken down at once.” By the fall, two thirds of the population within three quarters of a mile of the pond were sick with a raging malaria. “The pains in the head, limbs and back were very severe,” Buel remembered, and their faces and eyes had turned a terrifying yellow, suggesting the possibility that P. falciparum may have been at work.68 A dam at South Hadley, which flooded ten miles of meadowlands, similarly rendered Northampton, Massachusetts, long considered “one of the healthiest” towns in the area, “extremely afflicted with fever and ague.”69

  Two years later, another malaria epidemic struck New Milford, and a year after that, another.70 During one year’s epidemic, nearly one hundred perished. “Young as you are, you may die,” Boardman’s wife warned their son in a letter. “Endeavor to be ready.”71

  A similar confluence of factors occurred in the wake of the Civil War, bringing another wave of malaria to the northeastern United States. The war itself served as a giant malarial feast. Union troops suffered 1.3 million cases of malaria, leading to 10,000 deaths.72 In 1864, every single federal soldier in the Union army active in Louisiana and Alabama came down with at least one episode of malaria.73 Over half of Northern troops suffered the scourge.74

  War-making—the digging of trenches, the destruction of dams, the building of roads—levels an ecological insult that malaria can often exploit. Trenches fill with water, craters become puddles, previously untrammeled valleys become rutted and fetid. At the same time, war brings together great masses of previously unacquainted people, with their varieties of malaria parasites and immunities, in the middle of prime mosquito habitat. In countless wars, malaria has killed more soldiers than combat. And the intensity of wartime malaria can extend well into peacetime, as soldiers returning home introduce their newly gained malaria parasites into virgin landscapes, triggering yet more malaria epidemics.

  As the Civil War soldiers returned home, outbursts of malaria rippled northward from New Jersey to New England. Madison Square, Washington Square, and Tompkins Square in Manhattan became “dangerous hot-beds of disease and death,” as a New York Times headline put it.75 Every man, woman, and child in the neighborhoods of Dutch Kills and Ravenswood in Long Island, it seemed to a New York Times reporter in 1877, had been “poisoned” with malaria. “There has been so much malarial fever that it amounts almost to an epidemic,” the Times reported. The schools were emptied of students, and half the police force was “unfit for duty.” Residents fled the island en masse, “To Let” signs fluttering on their abandoned homes.76

  In Bound Brook, New Jersey, not a single family escaped malarial infection. “I have resided here 33 years,” a lumber merchant told a newspaper reporter, “and was never compelled to take a dose of [the antimalarial remedy] quinine, or use it in my family, until 1878. Now we all take it in pretty large quantities, and have had touches of the malaria in some form.”

  Across New England, the story was the same: chills and fevers reported in epidemic form all the way up to the foot of the Berkshire Hills.77

  • • •

  Malaria’s victims sensed that their plight had something to do with the changing landscape, in particular the recent spread of still waters. Over the previous years, as New York City had grown to become the nation’s largest metropolis, Manhattan Island’s watery idyll of stream, creek, and bog had been paved over entirely. Critics suspected that the graded streets, by blocking the island’s natural drainage, were to blame for outbreaks of fever.78 Worse, city officials had constructed the city’s public squares atop the swampiest parts of the island, land that private builders had rejected. “Unhealthy vapors” rose from the “stagnant and mephitic” waters below foot, critics charged.79

  “Every case of death which occurs from malarial disease in an organized community is a crime committed by the authorities,” one irate reader wrote to The New York Times. “I consider the neglect of the absolutely necessary precautions to preserve health by drainage as much a crime against humanity as the burning of Russian hospitals by the Turks.”80 Leaving New York City’s underground streams intact was a “suicidal policy,” the paper editorialized.81

  “There is but one radical remedy for this scourge anywhere,” proclaimed New York public health official General Egbert L. Viele. That, he said, was the destruction of milldams. “Mill-dams produce . . . vegetable decomposition over a wide extent of territory,” he explained. “This decomposing vegetable matter must be removed and these mill-dams converted into what they ought to have been from the beginning . . . containing nothing but pure potable waters.”82

  But in the face of entrenched economic interests such arguments fell upon deaf ears. The nation’s rising manufacturing sector relied on the pent-up water power the dams provided. In 1800, Connecticut manufacturers operated some fifteen hundred milldams in the state,83 and by 1869, water power provided nearly 50 percent of all power used in U.S. manufacturing.84 To protect the milldams and their operators, legislators passed “mill acts,” which dramatically curtailed the damages locals could seek against mill owners whose dams had caused them flood or fever.85 In 1805 a Massachusetts court went so far as to state that property rights themselves were null and void in the face of “all things necessary to the upholding of mills,” which they described as “obvious and important purposes of public utility.”86

  In 1799, Elijah Boardman was reduced to leading a group of towns people on a rampage against the dam in New Milford. The group headed into the fetid waters of Ruggles’s millpond and, with their tools and bare hands, began to dismantle the dam piece by piece, until all that remained was some rubble on the banks.87 The released waters rushed toward them, and millions of tiny black A. quadrimaculatus eggs washed away downstream.88

  Critics of the milldams had better luck in the years after the Civil War, as water power faded into obscurity. Miners discovered the nation’s rich veins of coal in the 1830s, and coal-fired factories rapidly eclipsed those powered by dammed water. By 1909, water accounted for less than 10 percent of U.S. manufacturing power; by 1919, just 6 percent.89

  The mill owners’ economic power sapped, public health experts stepped up their attacks on milldams. “I’ve had the supreme satisfaction of seeing a number of mill-dams destroyed through my own agency as an expert,” Viele boasted. “One mill-dam of my own knowledge was the absolute cause of the deaths of over 20 adults.” After five decades of man-made malaria, many milldams were destroyed and mill owners indicte
d for the public nuisance their dams had caused.90

  The malaria outbreaks of the American Revolution and the Civil War that bled into the northeastern United States were far from the worst bouts of wartime malaria. The most notorious malaria epidemic associated with ecological disruptions and wartime population movements occurred during the First World War, on the Macedonian front.

  The scene was the valley of the Struma River, which runs south from Bulgaria into Greece. Clusters of tiny sagging houses, verandas festooned with laundry, dot the hillsides, streams slipping down their sides. Anopheles superpictus roosted in these streams, while Anopheles maculipennis rose from the sodden, sun-dappled valley floor below. P. vivax, P. malariae, and P. falciparum parasites made a decent living, despite the local insects’ fickle feeding habits. The villagers generously allowed their livestock to live in the lower levels of their homes, greatly improving the odds that the gourmand mosquitoes would eventually deposit parasites in the correct host. Malaria flourished in the valley six months of the year.91

  In 1915, under the command of the French general Maurice Sarrail, six hundred thousand British, French, and Italian troops descended upon the Struma Valley. Their aim was to help the Serbs fend off the Bulgarians, but by the time they arrived, the Bulgarians had already beaten the Serbs. And so, in preparation for greater battles to come, they set up their tents along the spongy ground and started to remake the valley’s landscape.92 Needing roads for their motorized vehicles, they loosed thousands of locals upon the valley, shovels in hand, to clear brush and dig quarries, which the region’s heavy rains promptly turned into a “giant’s staircase of mud slides.”93

  Having thus extended the local mosquitoes’ already capacious territory, the soldiers offered up their flesh, with the tents they retired to each night providing little barrier to the insects’ entry. One soldier counted one hundred mosquitoes in his tent alone.94 The introduction of just a handful of malaria parasites could easily have launched an epidemic, but, in fact, the bodies of the troops and the locals together housed scores of parasites from all over the globe. Each tent sheltered three soldiers, many of whom had arrived direct from other malarious fronts of the war. Local mosquitoes could pick up malaria parasites from India, East Africa, or Palestine, not to mention the already extensive range of local strains.95