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Sylvia Rose

Malaria: Roman Fever & Renaissance Plague

The malaria parasite P. falciparum has existed for up to100,000 years. Its numbers rise c. 8000 BCE with the Neolithic Revolution. Establishment of human settlements provides the parasite with more opportunities to grow and survive.




Red blood cells with malaria disease
Red Blood Cells under Attack by Parasites

Chimpanzees still harbor close relatives to the human malaria parasites, suggesting a long history of interaction between primates and P. falciparum. Evidence indicates P. falciparum malaria might have originated in gorillas.


Historical records shed light on the impact of malaria throughout human history. The distinct periodic fevers associated with malaria are well-documented, with Hippocrates (456 - 375 BCE) categorizing them as tertian, quartan, subtertian, and quotidian fevers.



Cycle of malaria infection
Cycle of malaria infection

These classifications provide early insights into the different manifestations of the disease. Roman scholar Columella (4 - 70 AD) makes connections between malaria and insects inhabiting swamps.



Hippocrates classifications:


Tetrian: a form of malaria causing a fever that recurs every second day.

Quartan: a mild form of malaria causing a fever that recurs every third day.

Subtetran: a form of malaria from repeated infection by P. falciparum, with continuous fever.

Quatidian: a form of malaria occurring daily.



Malaria mostly spreads to people through the bites of some infected female Anopheles mosquitoes.
Malaria mosquito out for blood - disease is usually transmitted by female Anopheles mosquito

Signs and symptoms of malaria include:


  • Fever

  • Chills

  • General feeling of discomfort

  • Headache

  • Nausea and vomiting

  • Diarrhea

  • Abdominal pain

  • Muscle or joint pain

  • Fatigue

  • Rapid breathing

  • Rapid heart rate

  • Cough



feeling very sick


Patients with malaria may undergo malaria cycles and "attacks." Typically, an attack begins with shivering and chills, proceeds to a high fever, and culminates in sweating and a return to a normal temperature.


Usually, signs and symptoms of malaria start appearing a few weeks after getting bitten by a mosquito carrying the infection. Nevertheless, certain strains of malaria parasites have the ability to remain inactive in the body for as long as a year.



The disease can lurk dormant
The disease can lurk dormant for up to a year

The prevalence of malaria in ancient Rome has significant consequences, with the disease named as one of the factors contributing to the decline of the Roman Empire. Called the "Roman fever," malaria is a serious threat to the population.


Ancient Rome identifies high-risk areas for malaria, having favorable conditions for propagation of mosquito and virus. They include Southern Italy, Sardinia, the Pontine Marshes, coastal Etruria, and Rome along the Tiber River.



mosquitoes breed in stagnant water
mosquitoes like to breed in stagnant water


These regions have a higher incidence of malaria due to various habitat-promoting factors. These include stagnant water, irrigated gardens, swampy terrains, agricultural run-off, and drainage issues from road construction.


Environmental conditions create ideal breeding grounds for mosquitoes, leading to widespread malaria transmission and public health crises in ancient Rome. Malaria is not mentioned in the medical records of the Mayans or Aztecs.



mayan step pyramid
Mayan Pyramid

Nonetheless, antibodies against malaria are found in some South American mummies, suggesting malaria strains in the Americas may have originated before Columbus. European settlers and the West Africans they enslave introduce malaria in the 16th century.


Malaria is a prevalent health issue during the Renaissance period in Italy. Known as “Febbre terzana” (tertian fever), the disease is characterized by patterns of fever recurring at intervals of 2-3 days. The cyclic nature of the illness can cause lengthy suffering and debilitation.



an outhouse out of the house


Malaria plays no favorites. Young, old, male female, rich poor, all are subject to the onslaught of the disease. Lack of medical knowledge prevents effective treatment, leaving many to endure symptoms without relief.


During the final decade of his rule, Duke Cosimo de' Medici I (1519 - 1574) is struck into shock and grief by the loss of his wife and two of his sons to malaria. Despite his wealth, tremendous influence and accomplishments, he can do nothing but watch his family die.



Duke Cosimo de' Medici I (age 19) 1519 - 1574
Duke Cosimo de' Medici I (age 19) 1519 - 1574

Probably already suffering from tuberculosis, Giovanni dies in Livorno at age 19 in 1562. Cosimo's wife Eleanor of Toledo, a keen businesswoman and financier, and younger son Garzia, aged 16, succumb to the same illness a few days later.


Cosimo falls into deep depression. He relinquishes direct control of the Florentine state to surviving son Francesco I, and withdraws into seclusion at his estate on the outskirts of Florence.



Oranges trees grow in Cosimo's estate gardens (now open to public)
Oranges trees grow in Cosimo's estate gardens (now open to public)

In Peru, the Jesuits discover the anti-malarial properties of the 'quina-quina' bark. They're credited with bringing cinchona bark into medical practice in Europe c. 1630 - 40 AD. By 1681, it had gained widespread recognition as a treatment for malaria.


The name comes from a Countess of Chinchon, wife of a viceroy of Peru is said to be cured of a fever in 1638 by use of the bark. It's known for its medicinal value due to effects of quinine and other alkaloids. A member of family Rubiaceae, the tree grows only in South America.



bark o medicinal quinine tree
bark of cinchona, source of quinine

These were the only effective treatments against malaria during the height of European colonialism, which made them of great economic and political importance. Trees in the genus are also known as fever trees because of their antimalarial properties.


Although quinine is traditionally used globally for treating malaria, it's also taken to relieve nighttime muscle cramps. Extracted from bark of the Cinchona tree, it's found in antimalarial drugs and in beverages like tonic water and bitter lemon.



Due to the quinine it contains, tonic water is fluorescent under UV light
Due to the quinine it contains, tonic water is fluorescent in UV light

The field of malaria research sees a pivotal moment in 1880, thanks to contributions of Charles Louis Alphonse Laveran. He observes the parasites within the red blood cells of infected individuals.


Form this arises the hypothesis of these single-celled organisms (protists) as the root cause of malaria. His identification of a protist as disease-causing agent is a monumental achievement. He receives the Nobel Prize for Medicine in 1907.



the Nobel Prize - Alfred Nobel
the Nobel Prize - Alfred Nobel

Quinine is the main treatment for malaria until the 1920s, when other medications emerge. Chloroquine becomes the primary treatment for both uncomplicated and severe malaria in the 1940s, but resistance to the treatment evolves.


For 2,000 years, the medicinal properties of Artemisia annua, also known as qinghao or sweet wormwood, are used in traditional Chinese medicine. In 1596, Li Shizhen recommends a tea of for treating malaria symptoms in his "Compendium of Materia Medica".



Artemisia annua (sweet wormwood) buds, flowers & leaves have most medicinal quailities
Artemisia annua (sweet wormwood) most medicinal properties are in buds, flowers & leaves

Artemisinins are discovered and extracted from the plant Artemisia annua by Chinese scientist Tu Youyou and her colleagues in the 1970s. They're now the recommended treatment for P. falciparum malaria.


In severe cases they're given with other antimalarials. Tu Youyou says her work is influenced by traditional Chinese herbal medicine, "The Handbook of Prescriptions for Emergency Treatments" c. 340 by Ge Hong. In 2015 Tu Youyou wins a Nobel Prize in Medicine.



Ge Hong (263 -  364 AD)
Ge Hong (263 - 364 AD)


Non-Fiction Books:


Fiction Books:

READ: Lora Ley Adventures - Germanic Mythology Fiction Series

READ: Reiker For Hire - Victorian Detective Murder Mysteries





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