The Monster in the Marsh: Analyzing Literary Representations of Malaria in Classical Greek and Late Anglo-Saxon Societies
Ali Houston is an undergraduate history student at Princeton University, particularly interested in studying the effects of endemic disease on political evolution in pre-modern European societies. She wishes to continue to study malaria in graduate school, as it is her particular favorite endemic disease.
Malaria is sometimes excitedly described as the most important disease in the history of mankind. Some disease historians have gone so far as to posit that the presence of malaria was what prevented early civilizations developing in tropical Africa. The permanent brain damage caused by cerebral malaria may have been enough, in the tropical region where anthropophilic malaria parasites flourished, to suppress human development and force people to migrate north and east before settled societies could form. Certainly, chronic malaria has been proven to cause debilitating psychological and physical effects even in survivors, and interacts with other diseases so that past sufferers are often vastly more susceptible to death by other diseases like tuberculosis and pneumonia. Even the least dangerous form, quartan fever or plasmodium malariae, can live in a human sufferer for an entire lifetime and cause chronic weakness and anaemia.
Early malaria historians, notably W. H. S. Jones, credited the disease with the fall of classical Greece in the late fourth century BCE, claiming its pervasive presence in the population permanently damaged the Greek psyche and philosophy. Such a hypothesis is surprising given that malaria is an extremely location-specific disease, reliant as it is on arthropod vectors (mosquitoes) that rarely, if ever, fly more than a few kilometres from their homes. It takes a region of great geographic specificity to successfully harbour the few malaria vectors which transmit the parasite to humans: Rome during the early modern Roman period, in an area infested with malaria-carrying mosquitoes, had hilltop neighbourhoods almost completely safe from the disease due to their relative elevation, since mosquitoes dislike flying uphill.
Because of the extreme pickiness of its vectors and the uniqueness of several symptoms, notably splenomegaly and intermittent fever, malaria is one of the easier diseases to safely retroactively diagnose. It is an endemic, rather than epidemic, disease, one that coexists with the human population in regions where malaria vectors thrive and, often, is worked into both their medicine and their literature. The Romans looked forward to the late summer quartan fevers because they believed quartan fever protected against other illnesses. The Hippocratic treatise Airs, Waters, Places characterises the inhabitants of the marshland Phasis as weak, bloated, and incapable of hard labour because of the unhealthy location of their city, all of which fit the description of patients inflicted with chronic malaria. There has even been scholarship suggesting that the eighth to eleventh century Anglo-Saxon epic poem Beowulf is an extended allegory for malaria, which exists in marshlands and renders halls uninhabitable. In the following pages, I will establish that malaria was present in Greece from the fifth century BCE on and England from at least the eighth century CE and probably well before. I will argue that malaria was endemic to the populations in these regions, and analyse and compare medical, philosophical and narrative literature from the Classical Greeks and Romans and the Anglo-Saxons to find the similarities and differences in the ways the two cultures treat and react to endemic disease. The Greek and Roman societies share a great deal of foundational medical literature with the Anglo-Saxons, creating a common ground of contemporary understanding of the disease upon which to build our comparative analysis. Both used the Hippocratic humoural theory as the basis for their medicine, though even with this initial unanimity their responses and analyses of malaria differed hugely. Greek literature gives distinct moral causation to a diseased body: the sick are so through their own actions. The Christian Anglo-Saxons have a very different representation of disease, focusing more on its alienation from and distortion of the body, in spite of sharing their foundational medical theory, of the four humours, with the classical Greeks. Contrasting these representations will reveal key differences in specific cultural views of an endemic disease and show that the experience of pre-laboratory illnesses cannot and indeed must not be generalized across borders. Even if it is beyond a doubt (and it is rarely beyond a doubt) the same pathogen, and even if their medicines are based upon or directly derivative of one another’s, societal factors have huge influence on how disease is experienced and represented within a culture.
Ecology of Malaria
There are at least three anthropophilic species of mosquito capable of carrying and transmitting these parasites: Anopheles labranchiae, which is mostly concentrated in the western Mediterranean, A. sacharovi, found in the eastern Mediterranean, and A. atroparvus, which is the largest malaria vector in northern Europe. Mosquitoes favour humid environments and tend to breed in swamps, marshes and wetlands, but can settle in standing water, such as a lake or puddle. Acts of nature such as river flooding and unusually high rainfall can cause a spike in the mosquito population of an area just as drought and artificial draining of wetlands can diminish them. Mosquitoes respond to the temperature of their climates just as the plasmodium parasite does: being coldblooded, they cannot reproduce in climates with too low an annual temperature. As a short-lifespan, high-volume breeding species, their populations fluctuate with environmental conditions, but with temperatures benign enough they can breed in any marshy environment.
The three species of human malaria that can survive in European climates are Plasmodium falciparum, the most dangerous, and the two less virulent strains P. vivax and P. malariae. All three parasites may coexist in warm Mediterranean climates, but P. falciparum cannot survive in northern Europe, where only the more benign P. vivax and P. malariae are found. P. falciparum requires temperatures around 20° Celsius for up to twenty three days to complete the sporogony process inside the mosquito necessary to infect new hosts, rendering it incapable of surviving winters north of the Alps. Conversely, P. vivax requires only 16°C temperatures, though its incubation period is a full week longer at thirty days. The parasites are all thought to have originated in the tropical climate of Africa and moved northwards primarily during the Holocene, as this was the beginning of the period where temperatures in Europe could accommodate the parasites and their vectors.
Multiple methods have been used to determine the presence of malaria in historical populations. Recently, the ParaSight-F test, a dual-antibody test designed to detect the trophozoite-derived P. falciparum histidine-rich protein-2 antigen, has been used to detect P. falciparum in Egyptian and Nubian mummified human remains as old as the Predynastic period c. 3200 BCE. This strongly suggests that P. falciparum travelled with human populations north out of tropical Africa starting around the time of the “warm period” in the mid-Holocene. Molecular evolution studies have found that the P. falciparum malaria species became a human-affiliated parasite distinct from the related chimpanzee parasite between four and ten million years ago. Malaria has been in the human population since long before the beginnings of civilization, though its spread beyond tropical Africa was limited to the favourable climatic conditions of the humid mid-Holocene “warm period” which began around nine thousand years ago, creating the conditions necessary for the vectors’ migration north. This “warm period” was far friendlier to mosquito populations than present day conditions, as winters in Europe became warmer and summers more humid, allowing both the vectors and the parasites to flourish far north of their African origins.
One might at this point wonder whether a generally plasmodium-friendly climate during the “warm period” would supply enough evidence to support the claim that malaria-carrying mosquito populations, long after the warm period came to an end, were suitably dense and stable for endemic malaria in Greek and even later Anglo-Saxon populations. Only last year, July 2014, the mosquito species Aedes japonicus, native to Asia, was discovered in British Columbia. Mosquito populations are anything but static: they fluctuate wildly according to climatic conditions and can disappear and reappear in unexpected regions, as evidenced by the population boom in western Canada during the exceptionally warm and humid summer of 2014. That being said, ecological research supports the theory that the Mediterranean climate in late antiquity consistently provided sufficient temperatures during summer months for mosquito populations and their parasitic inhabitants to flourish. Tree ring analysis on oaks by Ulf Büntgen and team indicates that precipitation in Southern Europe was steadily above average and fluctuated within narrow margins from the end of the Iron Age until around 250 CE, providing steadily high levels of humidity during the classical Greek period. Those same tests established that these conditions returned to Europe, including Northern Europe, from 700-1000 CE, resulting in wetter summers in England during the Anglo-Saxon period, providing ample marshland for mosquito habitats. Robert Sallares’ ecological research goes into great depth about the capacity of the Greek climate in antiquity to support endemic malaria.
Malaria in Classical Greece and Rome
Sallares’ work combines the ecological history of the Mediterranean with the written medical evidence in the Hippocratic corpus to establish an extremely viable claim that malaria was endemic to regions within classical Greece. His research establishes that the Mediterranean climate in antiquity was warm and humid enough to sustain the sporogony process of three anthropophilic species of the malaria parasite, and the parasite was able to migrate out of tropical Africa during a warm mid-Holocene as mosquito populations grew in response to the conditions. He incorporates Greek classical literature in his argument, pointing out that classical authors explicitly noted increasingly large mosquito populations around the time that river deltas in Greece and Turkey began to stop advancing and collect sediment (around 1000 BCE), creating perfect mosquito breeding conditions. The Hippocratic corpus explicitly describes intermittent fever in its discussion of fevers, and cautions against living near stagnant water due to its negative impact on human health. There is even evidence of endemic malaria in populations to be found in Hellenistic art. Seven statuettes recovered from a region in western Turkey dated to around 300 BCE show “swollen faces with hypertrophied zygomatic arches and symmetrical protuberances on the fronto-parietal parts of the skull”, symptomatic of homozygous thalassaemia, a genetic disorder that protects sufferers against infection from malaria. Such representation suggests that the disorder was fairly common to the region, due perhaps to endemic malaria forcing natural selection in Mediterranean human populations during antiquity.
W.H.S Jones is widely regarded as the first historian of malaria, compiling evidence of its presence in classical Greece and Rome entirely from literary sources. His argument relies on the Hippocratic corpus, as it contains a detailed account of intermittent fevers. The three malaria parasites have different periodicities of fever: the gravest, P. falciparum, has a malignant tertian periodicity of an up to forty-hour long fever recurring every other day, while P. vivax has a benign tertian (eleven hour fever every other day) and P. malariae has a quartan (every third day) periodicity. He points out that the Hippocratic corpus warns against fever being most prevalent in late summer, when Mediterranean malaria would be most active according to Sallares’s ecological findings. The Hippcratic writers also record that people who drink marsh water will suffer from enlarged spleens (splenomegaly): this, a result of the iron deficiency resulting from chronic malaria infection, is a tell-tale symptom of long-term malaria. Jones surveys mentions of fever in medical and layman texts starting from the fifth century BCE, when the first Hippocratic writing describing malaria was written. He argues that the Greek word was used by laymen only for malarial or intermittent fever: Thucydides’ avoidance of the term in his description of the plague of Athens and Plato’s use of other terms to describe continuous fevers suggest this specific meaning. A cognate of this word is used to describe those of nervous or excitable dispositions: Jones translates it literally as “like one who has had malaria”, suggesting that the debilitating neurological effects of chronic malaria were common enough in antique Greek populations that such a term could be meaningfully used outside of medical texts.
The similar ecological climate of Italy was also a perfect place for the plasmodium parasites and their vectors to breed. Historian Walter Scheidel has done extensive demographic work on seasonal mortality in the city of Rome, the physically less elevated neighbourhoods of which were almost certainly afflicted with endemic malaria. Using Christian burial inscriptions from the late antique period, Scheidel compiled a comprehensive demographic study that revealed a statistically significant spike in mortality rates in late summer and early fall. The period from July to October, when malaria would have been most active, had a death rate 73% higher than the remainder of the year. Although this data is late antique, literature from earlier authors such as Horace provide compelling evidence that malaria was prevalent much earlier in the Empire and even during the Republic. Scheidel makes the case that since these rates were not remotely similar to mortality rates from Christian burial inscriptions of other late antique Roman cities, which often had no spike in late summer, conditions of the city must have had great influence over the death rate. Late summer, the hottest and most humid part of the year when mosquito populations were at peak levels, was the most dangerous time for malaria infections. He argues that endemic malaria in the Roman population, although not the most virulent killer in itself, weakened sufferers to the extent that other diseases endemic to the region could easily finish them off. This study and other “demographic analysis of mortality rates consistently [show] that populations afflicted by malaria had much worse demographic profiles than populations not affected by malaria”.
There is no clear evidence that any Bronze-Age European society suffered endemic malaria: the earliest record of anything resembling malarial symptoms is from the fifth century Hippocratic corpus cited by Sallares and Jones. This, of course, does not prove that malaria began its endemic presence in Greece from the fifth century BCE on, but merely gives a definitive point from which it can be ascertained that it was active in the population. Although it is entirely possible malaria was endemic to Bronze-Age Minoans or other early societies, there is a dearth of written or molecular evidence for its presence before in Europe before the fifth century BCE. As such, it shall henceforth be assumed that by this time, P. falciparum, P. vivax and P. malariae were active and endemic to populations within areas of southern Europe, notably the classical Greeks. By no means is this an assumption that malaria was endemic across southern Europe: it has been previously stated that mosquito populations are highly region-specific and prone to fluctuations, and so it can only be assumed that certain areas within southern Europe with the correct conditions to support both parasites and vectors suffered from endemic malaria.
Malaria in Anglo-Saxon England
It is less easy to ascertain the presence of malaria in the poorly documented region inhabited by the Anglo-Saxons. They simply were not a culture of prolific writing, and a great deal of their medical literature is derivative of, or even directly copied from, Roman and other Mediterranean corpuses. Likewise, less paleopathological research has been done on English bones to determine the presence of the malaria parasite. This much is known: P. falciparum could not possibly survive in the cool temperatures of the United Kingdom, as its breeding process requires significant warmth. The far less virulent P. vivax and P. malariae are capable of reproducing at cooler temperatures and could feasibly survive in England’s marshy fens. There is a wealth of later English historical evidence pointing to endemic malaria in England starting from around the fifteenth century, but the ecological evidence suggests it may have been introduced far earlier during the Roman occupation (around the first century AD). Unfortunately, the Christianization of the British Isles was not complete until the seventh century and superficially so at that, so there are none of the meticulous church mortality records such as those found in Christian Rome with which to study its presence and effects in these societies. Spatial epidemiology has recently been used to investigate skeletal evidence for its presence in England.
P. vivax malaria is the form most likely to exist in England in the A. atroparvus species of northern Europe. Unfortunately, malaria does not leave any particularly distinguishing marks on the skeleton the way other chronic diseases such as leprosy do, making it harder to diagnose. What it does do is cause haemolytic anaemia, which contributes to a condition called cribra orbitalia, which manifests as lesions on the orbital roof. Bioarchaeologists R.L Gowland and A.G Western conducted a spatial analysis of the cribra orbitalia rates in Anglo-Saxons cemeteries in relation to the geology and topography of the areas, historically recorded distribution patterns of malaria, and habitats of known vector A. atroparvus. Although A. atroparvus only flies approximately four kilometres maximum from its habitat, mosquitoes and people both migrate, making the affected areas found in the study probably much smaller than the true extent of the malarial infectivity during the Anglo-Saxon period. Soil and temperature studies undertaken during the analysis found that during the Anglo-Saxon period between 600-1000 AD, temperatures and precipitation in marshy areas of England were favourable conditions for A. atroparvus. They found that wetland and marshy populations had much higher cribra orbitalia rates and generally poorer skeletal health than dry areas. Their results correspond to a 2010 Gowland and Garnsey study of cribra orbitalia rates in malarial Roman Italy, making a solid case for the endemic presence of malaria in Anglo-Saxon populations. Excavations of Anglo-Saxon settlements near the Fen-edge revealed that the marsh-dwellers lived in wooden houses usually with their animals, in a relatively warm climate surrounded by stagnant water. Such conditions could not be more perfect for the proliferation of mosquitoes and P. vivax, as the mosquitoes are known to only be able to survive winters in colder climates by bunking either in houses or with livestock. With this evidence, we can tentatively assume that malaria was endemic to the Anglo-Saxon marsh-dwelling populations in much the same way as it was to the classical Greeks, though with considerably less virulence.
Mary Dobson studied the mortality records from the English marshlands in Kent and Essex, which showed vastly different mortality trends from the surrounding countryside from the sixteenth to the nineteenth century. Although this is centuries away from the Anglo-Saxon period we are concerned with, the sixteenth-century ecological conditions of England are similar enough to those of eleventh-century England that the mortality trends can reveal how malaria interacted with English marshland populations. Using parish records (evidence very similar to Scheidel’s antique Christian burial records), she establishes that the average marshland population burial rates were three to four times higher than those of the rest of the country. Infant and child mortality in marshland parishes was also much more pronounced, and from the seventeenth to eighteenth centuries the burial rate was significantly higher than the baptism rate. Of course, since age, sex, and migration rates all affect birth to burial ratios, these statistics cannot be directly used to measure natural growth. However, the excessively high burial rate is a feature of marsh parishes from the start of the records until the nineteenth century. Contemporary commenters on these rates attributed them to “marsh fever”, “ague”, or “intermittent fever”, umbrella terms for symptoms recognized as vivax or malariae malaria. Physicians’ records indicate that marshland inhabitants were rarely without the symptoms of the disease, “so that it is not unusual to see a poor man, his wife, and whole family of five or six children… shaking with an ague all at the same time”. According to Dobson’s research, malaria was so endemic to the region that vicars rarely chose to permanently reside in their own marsh parishes for fear of the disease. Why, then, would anyone, Anglo-Saxon or otherwise, choose to remain in this disease-infested part of England? Simply put, marsh soil is the richest England has to offer, and families could support themselves entirely on their farmland. Even constant intermittent fever could not entirely negate the economic value of marsh soil, which attracted residents consistently from the start of the parish records onward. It is safe to assume that this richness is what stayed the Anglo-Saxon populations as well, though remaining in the marshes indefinitely came at an enormous cost.
Malaria Representations in Classical Greek Literature
In classical Greek thought, malaria was both a fever caused by insalubrious waters and an ill character, caused by disproportion within the body and only curable through restoration of order. The classical Greeks, who suffered from endemic virulent P. falciparum as well as the Anglo-Saxons’ more benign vivax and malariae, wrote extensively on the causes of intermittent fever in their medical literature. Airs, Waters, Places, a late-fifth-century BCE Hippocratic physician’s manual for understanding the interaction between physical condition and the environment, stresses the great effect of water on health. To that end, it condemns “marshy, standing and stagnant” waters as the most unhealthy of all. Drinkers of these waters generally show distended spleens and thin, emaciated bodies and faces, symptoms consistent with the anaemia and chronic malnutrition malaria causes. They also fall subject to “long quartan fever” in the summers, which, when suffered protractedly, permanently weakens their constitutions. The description of the fever as a summer illness and the specification of quartan periodicity and splenomegaly make it fairly certain that Greeks inhabiting marshlands suffered from endemic malaria. Where the killer P. falciparum was not present, P. vivax and malariae would have stressed the immune system of their victims and, as Scheidel has argued for late antique Rome, made them more vulnerable to other diseases, aggravating overall mortality. Medically, malaria was treated as a very serious and geographically specific disease afflicting anyone living in the ‘wrong’ area.
We know malaria as an environment-specific illness and so, too, did Greek physicians. However, that did not stop Greek thinkers ascribing personality traits to sufferers in afflicted areas and listing them as causes, rather than symptoms, of their troubles. Airs, Waters, Places, the Hippocratic treatise considered earlier, describes the inhabitants of Phasis, a marshy region on the river Colchis, as weak, bloated and incapable of hard labour. Although they are near swamps, which the Hippocratic corpus establishes as unhealthy, the Phasis residents’ weakness is described as a trait of their society rather than a symptom of location. Throughout classical Greek thought, human physiology corresponded at least in part to the city or region in which one grew up. As a result, malarial areas where inhabitants were bloated, neurotic, exhausted, weak and prone to bouts of other illness were thought of as inferior in spite of the established connection between proximity to marshy, stagnant water and ill health. Centuries of malaria within certain settlements created a culture of illness that, by the fourth century BCE, was attributed to the character of the residents rather than its geography.
Although consensus often eludes the Hippocratic corpus, its contributors unanimously reject the notion of divine causality in their writings. They embrace natural determinism: all that occurs in the body has a natural cause, be it environmental or behavioural. This philosophy forced the patient to change his habits, lifestyle, location or behaviour to recover. In this view, illness is internal: both the cause and the treatment come from the patient’s personal balance. Disease, then, had moralistic overtones, and qualities that accounted for illness, particularly fever, were ubiquitous as philosophical metaphors in Greek literature. Before Plato, a common metaphor in oration to describe the effects of civil unrest on a society was to call the body politic wounded or diseased, in the same way a physical body might be. Technical understanding of the human body, even in the late-fourth century when the Hippocratic corpus was firmly established and such knowledge was common, did not enter into the illness metaphor for the body politic, which was resolutely vague and did not commonly incorporate anatomical language.
It was only in the mid-fourth century, around the time of Plato, that the metaphor began to expand and specify. With Plato, the metaphor of civil unrest as a political disease acquired a moral aspect: one’s own behaviour determined one’s health. While earlier sophists painted an ultimately optimistic picture of an ailing political body by keeping the illness imprecise, by the end of the fourth century the grim metaphorical use of chronic illness in narrative and philosophical literature had become far more common. This is the time Jones identifies as the turning point for Greek literature and philosophy, which he somewhat theatrically (and deterministically) blames solely on endemic malaria. By this time in the fourth century, according to Jones, malaria was so ubiquitous in Greek peoples that its neurological effects of exhaustion and neurosis had seeped into the cultural canon. Of course, we know now malaria was not universally endemic to ancient Greece, and not every fourth-century author was afflicted. However, it cannot be denied that the cultural opinion of disease was shifting at this time, putting more emphasis on the responsibility of the patient to heal himself than on the conditions of his environment.
Plato’s Republic is the most prominent early example of this specification process in the Greek treatment of disease as metaphor. Before him, the stasis or civil unrest as an illness metaphor was left purposefully vague despite the Greeks’ increasing technical vocabulary for human sickness. Authors like Thucydides and Lucretius, describing the Plague of Athens, abounded with detail: the warning tone they crafted in their histories of real disease made true illness out to be a canny and amorphous foe, an alien and unconquerable force. Thucydides declares that “doctors… were unable to cope with [the Plague of Athens]… no other human knowledge was any use”, and people gave up both spiritual and natural attempts to cure it, “defeated by the evil of the disease”. This introduction to the plague immediately characterises it as something unstoppable by human intervention, both through medicine and through prayer. He follows this with a list of where it attacked, and declares he is writing the account so that if it breaks out again “people may know in advance and not be ignorant”. He then describes, in lurid detail, the plague’s symptoms, of high fever, inflammation of the eyes, bleeding of the tongue, violent coughing, vomiting, pimples and ulcers on the skin, diarrhoea, unquenchable thirst, and loss of extremities such as fingers and toes. This account of a disease outbreak claims to go into such details for the future good of those who read it, and the effect is to characterise the plague as something outside of human control, causing a highly specific, violent outcome in all who come across it, without hope of rescue or rectification. He also ends on a judgement, suggesting that the plague fulfilled a prophecy Apollo gave the Lacedaemonians declaring he would take part in their fight, since it seemed to attack mostly Athenians. The effect of this passage is to warn of the inevitable physical and societal results of such a plague. In direct contrast, the sophists’ early inexplicit descriptions of ill health in the body politic struck a hopeful tone. Although the body festered chronically, it did not run rampant with sudden and specific ailments, and could still be saved through human intervention. With Plato there was a shift away from the critical optimism of the endemic stasis metaphor toward a darker view, more akin to Thucydides’ explicit and grim account of illness.
Plato uses ailment imagery often in Republic, and each time he places the responsibility of health squarely on the shoulders of the ailing, rather than on the physician. While describing the byzantine legislations of the Athenian government, Plato’s speaker Socrates compares supporters of Athenian democracy with “those who are ill and are unwilling to escape from a life of poor quality through a lack of self-discipline”. Describing illness as a decision made by the ill person through his unwillingness to change his habits explicitly blames the patient for his condition. According to the Hippocratic corpus, all ailments have a natural cause. Although the corpus stresses both behavioural and environmental sources of illness, Plato’s writings and those of writers after him neglect the role of the environment and infuse their medical metaphors for struggling city-states with moral judgement. In the above quote, Plato equates the Athenian style of elaborate peace-maintaining legislation to stubborn, lazy patients seeking doctor after doctor, and refusing to change their lifestyle. Before this time, stasis and unstable political states were described optimistically with the vague literary terms used to explain their ailments suggesting the possibility of intervention and cure. Plato’s metaphor takes away the capacity for an outside force to heal the sick patient. He believes Athenians and, by extension, all imperfect city-states circle the true problem of their flawed construction by endlessly attempting surface repairs; “if someone recommends a medicine to them, they always expect to be cured by it”. Plato’s ailing city-state has an internal issue of imbalance: it is simply not constructed in a way that enables it to maintain long-term peace and wellbeing of its citizens. Outside help from “physicians” or legislators only prolongs the illness by allowing the lazy patient to believe he is cured for a time before moving onto the next treatment.
Of course, Plato is not the be-all and end-all of classical Greek thought. Indeed, very few agreed with his rejection of democracy, notably his immediate philosophical successor Aristotle. However, the moralistic quality he introduced to the stasis/illness metaphor was wholly adopted into Greek literature by the middle of the fourth century. This mind-set is important to our discussion. The Greeks, by the mid-fourth century BCE, embraced in their philosophical and narrative literature an internal, moralistic understanding of the causes of illness even as the Hippocratic corpus and Greek physicians expounded on the environment’s role. Before this time, according to Jones before malaria became holoendemic to the region, sickness was not presented in metaphor as a judgement on the suffering body but rather as an outside force that human power could treat. It was Plato who introduced patient responsibility and the importance of behavioural change to regaining health. Indeed, early orators condemned radical action as more harmful rather than less, and early Hippocratic treatments (pre-fourth-century) favoured little intervention. As medical knowledge and philosophical thought progressed, as did the prevalence of malaria in Greek regions, more intervention began to feel necessary in metaphorical and medical writings. Plato places the responsibility of returning to wellness on the patient through listening to and not expecting to understand his physician’s commands, changing his lifestyle and habits as recommended. This view underlines the Greek belief in disease resulting from a process of interactions between a person, his environment and his internal balance. Throwing off the balance causes sickness. By the middle of the fourth century, though environment still played a role in Greek physicians’ guides, philosophical focus was on the patient’s capacity for re-balancing himself. Illness started within. It was not miasma, nor invisible seeds, nor the act of any god, which brought illness upon people and regions.
What does this mean for the Greek perception of malaria? As an endemic, rather than epidemic, illness, malaria was a constant presence within affected communities. As populations evolved within the parameters of their pathocoenoses, the consistency of malaria symptoms and its capacity to chronically affect sufferers allowed it to become instrumental to the character of an affected region. Citizens of malarial areas were malarial in character as well as in body. Because of the growing Greek perception of disease as an internal imbalance caused partially by the environment and partially by behaviour in the fourth century, malarial regions were perceived as unhealthy, but equally were their inhabitants perceived as lazy and weak by nature. By the middle of the fourth century, growing moral judgement from Greek writers in their medical metaphors showed a general consensus of the Greek population that illness was at least in part the responsibility of the sick. These viewpoints suggest illness as an entirely internal event, affected by external causes such as weather and location inasmuch as these things throw off the delicate balance of the body. No outside agent created illness within a person, but rather all illnesses were the result of that person allowing his body to be thrown off balance. It was, then, that person’s own responsibility to restore it.
Malaria’s appearances in non-medical writings, both narrative and philosophical, show that intermittent fever was almost synonymous in Greek opinion with a neurotic mind and weak body. Since it was so ingrained in certain regions, and since Greece itself was so regional and Greek writers assigned particular character traits to particular settlements, malaria in Greece was a cultural weakness, used like many other common and endemic diseases to represent fundamental issues with a body politic. Its position within the metaphor as a totally internal, indeed structural issue, reveals the Greek opinion that malaria, and to a lesser extent other endemic illnesses, was caused in part by the character of its victims.
Malaria Representations in Anglo-Saxon England
England’s Anglo-Saxon era spans five hundred years. Despite the length of this period, written records are sparse, few to none predate the eighth century. As a result, studying the Anglo-Saxon understanding of endemic disease is a more arduous task. Two major works give insight into their views: Bald’s Leechbook, a three-volume physician’s guide to native Anglo-Saxon medicines dating from the eleventh century, and, perhaps surprisingly, the epic poem Beowulf. The Leechbook is a magnificent resource, the only extant medical text from the Anglo-Saxon period written in Old English, not Latin, and indeed the only one not entirely corrupted by Mediterranean medical knowledge. It not only gives treatments to the maladies most commonly experienced by Anglo-Saxons, but also provides the causes for these ailments. Written for a Christian patron, the Leechbook’s remedies heavily favour psalms, hymns and blessings along with older pagan magic and medicine. Careful analysis of the text reveals the delicate balance between ancient earth-worshipping paganism and relatively new Christianity in Anglo-Saxon religious and medical matters. Beowulf, too, walks the line between these influences. Originally a pagan Scandinavian myth, clearly inscribed by a Christian Anglo-Saxon author, the poem, written in Old English, contains the same harmony between pagan practices and Christian beliefs that the Leechbook does. This religious worldview deeply influences the Anglo-Saxon viewpoint on disease, just as the Greek morals-based outlook influenced theirs.
The Leechbook consists of three volumes, the first two of which have distinct Mediterranean influences. Since medieval authors’ intention was not originality but practicality, or, rather, to provide the best representation of ancient knowledge, such corruption of native medical views cannot be avoided. However, the third book, Leechbook III, is almost entirely a stand-alone as a source of native Anglo-Saxon magical and medical remedies. It contains Celtic and Teutonic charms as well as Christian prayers in its magical treatments. Although Christianity was officially the religion of England by the time of Leechbook’s writing, the means by which it was spread was usually nothing more intensive than the building of a church in each locality. As a result, a great deal of pagan practice and traditional magic and medicine lived on in Anglo-Saxon practices, even though officially it followed Mediterranean medicine and Roman Catholicism. We know that the Leechbook is a Christian volume from the content of its inscription, which implores that Christ not allow the Leechbook to be stolen or in any way damaged. It incorporates in its first two volumes a great deal of Mediterranean medicine adjusted for the availability of English-grown ingredients, as well as Christian prayers and hymns to provide the best possible remedy for the illnesses and injuries it covers.
Leechbook I distinguishes and has specific remedies for continuous fever, tertian and quartan fevers, indicating that they were thought of as distinct though related entities. Drinking a draught in the hours before the fever is supposed to come on treats both tertian and quartan fevers. Both remedies are simple, composed of few ingredients and taking up little room in Leechbook I, suggesting that the fevers were not considered extraordinary or particularly worrying. Such diseases that could potentially disable or disfigure a working man, such as cataracts, are given as many as a dozen separate remedies, so that everything may be tried to return the ill person to full health. The relative brevity of the intermittent fever section in Leechbook I reveals its place as a staple illness among the Anglo-Saxons. Because it was simply something to be dealt with, not a great deal of energy is expended upon curing it. As well, it is clear that these draughts were not particularly effective at expelling the fever, for there is also listed a prayer to exorcise the fever as a final curative option. By writing John i.I. on a dish in holy water, singing the Credo and Paternoster over it, the twelve prayer pslams, and thrice drinking from the dish, the fever will be banished from the body. This exorcism tactic is a particularly interesting one: it reveals the Anglo-Saxon viewpoint of fever as an alien force within the body, similar to possession. Indeed, the very next section of Leechbook I deals with demonic possession and also prescribes the singing of psalms and the blessing of a drink before consumption.
Leechbook II shares treatments for splenomegaly, the enlargement of the spleen. In this volume, the condition of the ill person is described before the treatment is given, and people suffering from enlarged spleens are said to be “meagre and uncomfortable… though ere this they were fat”. Chronic malaria causing anaemia creates swelling in the spleen as well as weakness and general malaise. The Anglo-Saxons blamed the swelling on hot air collecting in the spleen as a result of fever, a symptom common to the sufferers. Once more, draughts are used in an attempt to cure the disease, with evidence of the four humours theory (originating in Greek medical literature) coming into play in the cure. They balance out the dry heat causing the swelling of the spleen through application of cool, moist ingredients.
Leechbook III is the least corrupted by Mediterranean medical sources, and also the most magical of the three volumes. It deals with native treatments to the same diseases the other two volumes attempt to cure, but dips more deeply into ritual and strays from the balance theory the others generally uphold. It includes spells to keep away or cast out the devil, elves, fairies and night terrors as well as healing and preventative spells for illnesses. To silence “a woman’s chatter”, for example, one must fast all day and that night taste the root of a radish for the chatter to cease the next day. It includes many of the herbs and plants seen in Leechbooks I and II, but also dictates incantations and rituals that must be completed. This volume reveals the important role that pagan magic and ritual played in Anglo-Saxon medicine. It is theatrical and untrue to say that native Anglo-Saxon medicine was based upon magic alone, for much of the first two Leechbooks contain a great deal of Greco-Roman influence and sometimes very accurate advice (such as forbidding pregnant women from consuming alcohol). This Leechbook, too, contains medical treatments, but reinforces them with magic to strengthen the medicine’s power. In the first two Leechbooks, Christian prayer supplemented the medicine, and pagan magic does the same in Leechbook III. These books provide insight into the balance struck between Christian and pagan ritual: a great deal of Christian words and practices are worked into older pagan magic to strengthen and legitimize them. Using both, perhaps, created more probability that the aim of the medicine or spell would be reached.
Although the Anglo-Saxons shared the four humours theory common to the Romans and the Greeks before them, suggesting a medical basis of belief in internal balance, the Anglo-Saxon perception of their endemic fever is an external one. The fever is treated like a possession, and Christian prayer is used to banish it from the body. Already we see a key divergence from the Greeks. Classical Greek thought blamed the sick person’s internal imbalances for his condition, partially caused by his surroundings and partially by his own character. The Leechbook, however, suggests that the Anglo-Saxons perceived the fever as an outside force not caused nor treated by behaviours. Its exorcism tactic places the fever in the same category as possession by an alien force. There is no moralistic element laid upon the shoulders of the sick, as we saw with the Greeks. The Christianity of the Anglo-Saxons certainly changed their reading of the Greek and Roman medicine, shifting away from Hippocratic rejection of divine cause. Instead of focusing on behaviour and environment as treatment, the Anglo-Saxons call upon God for healing, suggesting that they allow room for a divine cause of their illnesses.
The epic Anglo-Saxon poem Beowulf spans many levels of interpretation, and the following analysis neither precludes nor negates any of the manifold conceptions of its meaning. However, I believe there is a physical basis under which these more philosophical interpretations are pinned, and that Grendel as much provides an analogy to Anglo-Saxon malaria as he does to all other analyses of his role in the poem. This is, of course, a highly speculative analysis of the poem, but aspects of both the plot and the language offer compelling reasons to entertain this reading. In Beowulf, the monster Grendel terrorizes Heorot Hall, Hrothgar’s castle “whose utterance was law”. The poem opens with an explanation of Hrothgar’s heroic ancestry, establishing him as a lawful good figure commanding a strong army. Immediately after the poem describes Heorot’s construction, it introduces a threat: Grendel, a “powerful demon” who is “harrowed” by the banquet hall’s din and the praising of God in its music. Grendel is a descendent of Cain and a “fiend out of hell” who lives in “the marshes, marauding round the heath / and the desolate fens”. An immediate dichotomy is thus created between the God-praising, warm, light-filled hearths of Heorot and Grendel’s wet, grim home. Marsh, heath, and fen are noted living quarters for A. atroparvus, and subsequently P. vivax and malariae.
Knowing that the Anglo-Saxons treat fever similarly to possession in the Leechbook, having Grendel immediately introduced as a “demon” on the marshy perimeter of Hrothgar’s Christian hall suggests that his presence may be analogous to the “marsh fever” that plagued the Anglo-Saxons. He creeps, an uninvited guest, into the hall in the night and makes off with thirty men, unseen and unheard by the others in Hrothgar’s army. Only at the break of dawn is the destruction discovered. The next night, Grendel strikes again, ruling the hall “in defiance of right” by destroying Hrothgar’s armed ranks and reducing his military prowess to impotence. There are several important things to note here: first, Grendel’s reliable intermittent pattern, striking once every night. His every other twelve-hour period pattern directly calls to mind quotidian intermittent fever, which can occur when infected with multiple Plasmodium parasites, or parallel infections. With the level of infestation the ecological data discussed earlier suggests, multiple infections would be plausible if not common to the Anglo-Saxons. Second, he strikes only in this hall, which is built close to his own marshy homeland, and he does so in a very predictable pattern. We know that malaria does not move past a particular locality within the vectors’ parameters, and that the intermittent fever it causes also follows an extremely reliable periodicity. His behaviour is analogous to that of the Anglo-Saxons’ “marsh fever”, as is his representation within the poem.
Grendel is described as demonic, merciless, and “malignant by nature”. He is an alien force, infiltrating Heorot Hall under cover of darkness and through his murderous efforts, eventually coming to rule it, stripping Hrothgar of his rightful might and power. Grendel is a powerful and external enemy of the Christian inhabitants of Heorot, and his protracted presence (ruling Heorot for “twelve winters”) reflects the capacity of the plasmodium parasites to afflict a body for years, even decades. His destruction of Hrothgar’s army and reduction of the powerful king to utter helplessness can also be read as representative of the depletion of strength experienced by chronic sufferers of malaria. Anaemia, exhaustion and lethargy are all symptoms of chronic malaria, all of which contribute to decreased strength and physical capacity. However, these chronic forms of malaria do not kill the sufferer themselves, rather simply making them vulnerable to other causes of death. Similarly, though Grendel is said to “rule” Heorot, he “was kept from approaching” Hrothgar’s throne: he is unable to entirely claim the kingdom, even though he has rendered its king impotent and weak. In fact, Grendel’s reign of terror is described as a “steady affliction / for Halfdane’s son”. The choice of the word “affliction” is a careful one, a term with undeniable medical connotations comparing Grendel to a chronic illness afflicting Hrothgar’s land.
The Christian and pagan aspects of the Grendel and Hrothgar story in Beowulf must be addressed in the context of Anglo-Saxon society. We know from the analysis of Leechbook that the Anglo-Saxons, when faced with illness, resorted to magical treatments after medical ones were proven ineffectual. Christian psalms, holy water, and prayers mingle with proper medical treatments, while older pagan charms are included in case all else fails in Leechbook III, where native medicine is most accurately represented. In Leechbook III there is hardly any Mediterranean corruption. The remedies here are representative of how Anglo-Saxons dealt with their maladies without being able to consult a manual. As Grendel lays waste to Heorot Hall, and Hrothgar’s counsellors “sometimes… vowed / offerings to idols”, a practice condemned in the next few lines of the Christian poem. The first instinct of the counsellors is to ask the help of heathen gods, just as Leechbook III suggests the Anglo-Saxons would have done when faced with strenuous alien opposition. In Leechbook III, pagan charms are put in place to protect from “fiends” and other magical creatures who want to infiltrate the Anglo-Saxon household or body. The counsellors in Beowulf implement exactly the same strategy. Understanding, as we do, that fever was treated by the Anglo-Saxons similarly to a possession of the body by an external force, Grendel’s possession of Heorot and the counsellors’ enlisting of pagan gods to expel him strike a very similar note to how tertian and quartan fever were viewed and dealt with.
If we accept Grendel as in some way analogous to malaria or “spring fever” as the Anglo-Saxons viewed it in the late Anglo-Saxon period, as the similarities between his actions and our understanding of malaria behaviour suggest, we can learn a great deal about the Anglo-Saxon perspective of this endemic disease. Grendel’s close proximity to the hall and capacity for infiltrating it in the dead of night speak to the view of malaria as an essentially external illness. He is described as a demon, and a descendent of Cain, rejected by God, and this suggests that the Anglo-Saxons view this endemic disease as in some way connected to acts of God. Grendel’s ancestry is one of betrayers of God, who walk an evil path. This associates them inextricably with God’s goodness, as they have rejected it: if we assume that Grendel and his relatives represent malaria and endemic disease, we see that the Anglo-Saxons connect the presence of disease in their community to God. As well, the ineffectual pagan sacrifices by the counsellors to try and get rid of Grendel show that Christian Anglo-Saxons believed only true love for God would rid the community of the pestilence. When Beowulf himself arrives to rid Heorot of Grendel, Hrothgar thanks “Holy God” for his arrival. His piety is thus immediately established, giving hope for Beowulf’s ultimate victory and the banishment of the pestilence from Heorot Hall.
Greeks and Anglo-Saxons Compared
From our analysis, we know that the classical Greeks and the Christian Anglo-Saxons had very dissimilar views on the causes and repercussions of malaria in their communities. Both agreed upon the fundamentals of the disease: its intermittent fever and splenomegaly, and its origins in marshlands and stagnant waters. These are, of course, the bare essentials of what allows us now to deduce both societies were experiencing the same endemic disease. Elsewhere, they diverge in crucial ways.
The Greeks adopted an increasingly moralistic view based on their acceptance of the four humours theory that the fevered person at least in part caused his own fever through internal imbalance of his humours. They do stress the importance of environment on illness in their medical texts, but in narrative literature regions are given identities and character traits of their own. Because of this tendency, regions where holoendemic chronic malaria caused splenomegaly, weakness and exhaustion were considered unhealthy, but opinion of their citizens’ characters was deeply affected by the illness. By the middle of the fourth century BCE, even the medical texts ascribed character traits of malarial populations as causes of their constant illnesses rather than symptoms. In direct contrast, the Anglo-Saxons viewed intermittent fever (as a category within all fevers) as a possession of the body by an alien power. This is a very important distinction to make, as technically the Anglo-Saxons embraced the same theory of the four humours used by the Greeks. On the surface, then, it would be easy enough to say both cultures viewed and experienced malaria very similarly. Anglo-Saxon treatment methods recorded in Bald’s Leechbook incorporate Mediterranean influences, including the treatment of hot and dry illnesses with cold, moist ingredients and vice versa. However, more careful analysis of their malaria representations reveals where they break from the Greek view.
The Hippocratic corpus firmly and universally rejected the very idea of divinely sent illnesses or issues, even in narrative literature on plagues and sudden disease outbreaks. Medically, the Greeks found no room for supernatural cause in their understanding of illness, which rested on the theory of balance within the body. The Anglo-Saxons, on the other hand, used prayer, hymns and holy water in their “exorcising” of fever from a sick body, calling upon God to calm the fever, strongly implying a belief that God had a hand in igniting in the first place. Greek orators and philosophers, starting with Plato in the mid-fourth century, placed a great deal of moral responsibility on the sick person in their metaphors for the Greek city-state as a human body. They decry the ailing state as a patient who will not change his own habits, ensuring his continued illness. Contrastingly, Anglo-Saxon medical cures rarely include any sort of behavioural change, but rather prescribe draughts, herbs and often prayers to cure the illness, placing little to no blame upon the head of the sufferer. In Beowulf, the monster Grendel attacks a good, powerful and lawful king, rendering him weak and ineffectual over years of relentless, repetitive attacks. It was not the king’s behaviour that brought the monster upon him. In the Greek political metaphors, it is without question that the state’s improper governance brought stasis (sickness) upon it.
We can now see, from our analysis of the two societies’ treatment of endemic malaria in their medical and narrative literature, that although the Anglo-Saxons and classical Greeks purportedly shared many of their foundational medical views, to assume that endemic malaria affected them the same way or even similarly is to risk the same sweeping overgeneralization that plagued the conclusions of W.H.S Jones in the early days of the study of historical malaria. We know that malaria played a crucial role within both populations. It was a fact of life, but the Anglo-Saxons and the Greeks understood it and represented it in their literatures very differently, indicating that although they suffered from the same disease, it had very different repercussions within the separate societies. It would be of great academic interest to do a similar study on other endemic diseases both societies experienced, such as tuberculosis or leprosy, to further flesh out how the Anglo-Saxons and classical Greeks differed in their understanding of and reactions to endemic disease. This preliminary study has made clear that two pre-modern European societies, sharing the same medical foundations, can vastly diverge in the ways they perceive the same illness.
 Robert Sallares, “Pathocoenoses Ancient and Modern” Hist. Phil. Life Sci. 27 (2005): 216.
 Sallares, “Pathocoenoses”, 210.
 Otto S. Knottnerus, “Malaria Around the North Sea: a Survey.” In Climate Development and History of the North Atlantic Realm, edited by Gerold Wefer and Wolfgang H. Berger, 341-342. Springer-Verlag: Berlin Heidelberg, 2002.
 Robert Sallares, “The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems” Medical History 48 (2004): 318.
 Abnormal swelling/enlargement of the spleen.
 Sallares, “Pathocoenoses”, 210.
 Tom Shippey, “Klaeber’s Beowulf Eighty Years On: A Triumph for a Triumverate” The Journal of English and Germanic Philology 108 (2009): 363.
Robert Sallares, “Role of Environmental Changes in the Spread of Malaria in Europe during the Holocene” Quaternary International 150 (2006): 21-22.
 Sallares, “Malaria during the Holocene”, 22.
 Robert Sallares and Susan Gomzi, “Biomolecular Archaeology of Malaria” Ancient Biomolecules 3 (2000): 197-198.
 Sallares and Gomzi, “Archaeology of Malaria”, 196.
 Sallares, “Malaria During the Holocene”, 21.
 Canadian Press, “Disease-carrying Mosquito Species Found in B.C.” The Globe and Mail, November 6, 2015, accessed December 12, 2015, http://www.theglobeandmail.com/news/british-columbia/disease-carrying-mosquito-species-found-in-bc/article27150226/
 Ulf Büntgen, “2500 Years of European Climate Variability and Human Susceptibility” Sciencexpress 2011, 1-3.
 Sallares, “Malaria During the Holocene”, 21-22.
 Mirko Grmek and Danielle Gourevitch, Les maladies dans l’art antique (Fayard, 1998), 97-99.
 Sallares, “Malaria During the Holocene”, 24.
 William H. Jones, Malaria: a Neglected Factor in the History of Greece and Rome (Cambridge: MacMillan and Bowes, 1907), 11-60.
 Walter Scheidel, “Libitina’s Bitter Gains: Seasonal Mortality and Endemic Disease in the Ancient City of Rome” Ancient Society 25 (1994): 151-164.
 Sallares, “Pathocoenoses”, 210.
 Sallares, “Spread of Malaria to Southern Europe”, 315.
 Although drier, colder areas of England are entirely inhospitable to mosquito populations, suggesting that mosquito populations could potentially fluctuate more in this climate than in the more consistently temperate Mediterranean, the topographic evidence in this study shows that Anglo-Saxon period temperatures were warmer than average, keeping the marshlands hospitable enough to hold populations steady.
 R.L. Gowland and A.G. Western, “Morbidity in the Marshes: Using Spatial Epidemiology to Investigate Skeletal Evidence for Malaria in Anglo-Saxon England” American Journal of Physical Anthropology 147 (2012): 301.
 Sallares, “Malaria During the Holocene”, 21.
 Gowland and Western, “Morbidity in the Marshes”, 309.
 Sallares, “Malaria During the Holocene”, 21.
 Mary Dobson, “‘Marsh Fever’ – the Geography of Malaria in England” Journal of Historical Geography 6 (1980): 357-389.
 Edward Hasted, History of and Topographical Survey of the County of Kent VI (London 1797-1801), 144.
 Dobson, “Marsh Fever”, 367.
 W. Jones and P. Potter, trans., Airs, Waters, Places (Cambridge, Mass., 1984), 2.
 Hippocrates, Airs, Waters, Places, p. 15
 Kosak, “City and Disease”, 40.
 Robert Brock, “Sickness in the Body Politic: Medical imagery in the Greek polis” in Death and Disease in the Ancient City, ed. V.M Hope and E. Marshall (Routeledge, 2000), 24-34.
 Jones, “Malaria: A Neglected Factor”, 13.
 Brock, “Sickness in the Body Politic”, 26.
 Thucydides. “The Plague: Human Nature Laid Bare by a Natural Disaster.” On Justice, Power, and Human Nature: The Essence of Thucydides’ History of the Peloponnesian War. Ed. Paul Woodruff (Indianapolis: Hackett, 1993), 47.
 Thucydides, Peloponnesian War, 47.
 Thucydides, Peloponnesian War, 48.
 Thucydides, Peloponnesian War, 50.
 C. Emlyn-Jones and W. Preddy, trans., Plato’s Republic (Cambridge, Mass., 2013), 425b-c.
 Jones and Preddy, Plato’s Republic, 426a.
 Holoendemic: a disease so endemic that it is essentially ubiquitous within a community, with almost everyone in the population infected.
 Brock, “Sickness in the Body Politic”, 28.
 Jones and Preddy, Plato’s Republic, 489b-c
 Kosak, J., “Fifth Century Greek Ideas on City and Disease” in Death and Disease in the Ancient City, ed. V.M Hope and E. Marshall (Routeledge, 2000), 35-54.
Jones, “Malaria: A Neglected Factor”, 52.
 Cameron, M., Anglo-Saxon Medicine (Cambridge University Press, 2006), 11-23.
 Cameron, Anglo-Saxon Medicine, 23.
 Cameron, Anglo-Saxon Medicine, 11.
 Each form of intermittent fever was thought to come from a different imbalance of humours: e.g. tertian fever from excess red bile, which is hot and dry.
 Thomas Cockayne, trans., Bald’s Leechbook (London, 1864), Book I p. 135
 Cockayne, Leechbook I, 137.
 Cockayne, Leechbook I, 139.
 Cockayne, Leechbook II, 243.
 Cockayne, Leechbook III, 343.
 Cameron, Anglo-Saxon Medicine, 23.
 Seamus Heaney, trans., Beowulf (WW Norton, 2001), p. 7
 Heaney, Beowulf, 9.
 Heaney, Beowulf, 11.
 Heaney, Beowulf, 13.
 Heaney, Beowulf, 15.
 Heaney, Beowulf, 27.
Brock, Robert. “Sickness in the Body Politic: Medical imagery in the Greek polis” in Death and Disease in the Ancient City, edited by V.M Hope and E. Marshall, 24-34. Routeledge, 2000.
Büntgen, Ulf, “2500 Years of European Climate Variability and Human Susceptibility” Sciencexpress 2011, 1-3.
Cameron, Malcolm. Anglo-Saxon Medicine. Cambridge University Press, 2006.
Canadian Press, “Disease-carrying Mosquito Species Found in B.C.” The Globe and Mail, November 6, 2015, accessed December 12, 2015, http://www.theglobeandmail.com/news/british-columbia/disease-carrying-mosquito-species-found-in-bc/article27150226/
Cockayne, Thomas, trans. Bald’s Leechbook. London, 1864.
Dobson, Mary. “‘Marsh Fever’ – the Geography of Malaria in England” Journal of Historical Geography 6 (1980): 357-389.
Emlyn-Jones, C., and W. Preddy, trans. Plato’s Republic. Cambridge, Mass., 2013.
Gowland, R. and Western, A., “Morbidity in the Marshes: Using Spatial Epidemiology to Investigate Skeletal Evidence for Malaria in Anglo-Saxon England” American Journal of Physical Anthropology 147 (2012): 301-309.
Grmek, Mirko, and Danielle Gourevitch. Les maladies dans l’art antique. Fayard, 1998.
Hasted, Edward. History of and Topographical Survey of the County of Kent VI. London 1797-1801.
Heaney, Seamus, trans. Beowulf. WW Norton, 2001.
Jones, W. and P. Potter, trans. Airs, Waters, Places. Cambridge, Mass., 1984.
Jones, William H., Malaria: a Neglected Factor in the History of Greece and Rome. Cambridge: MacMillan and Bowes, 1907.
Knottnerus, Otto. “Malaria Around the North Sea: a Survey” in Climate Development and History of the North Atlantic Realm, edited by G. Wefer. Springer-Verlag Berlin Heidelberg, 2002.
Kosak, J., “Fifth Century Greek Ideas on City and Disease” in Death and Disease in the Ancient City, edited by V.M Hope and E. Marshall, 35-44. Routeledge, 2000.
Sallares, Robert, and Susan Gomzi. “Biomolecular Archaeology of Malaria” Ancient Biomolecules 3 (2000): 197-198.
Sallares, Robert, “Pathocoenoses Ancient and Modern” Hist. Phil. Life Sci. 27 (2005): 216.
Sallares, Robert, “Role of Environmental Changes in the Spread of Malaria in Europe during the
Holocene” Quaternary International 150 (2006): 21-22.
Sallares, Robert, “The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems” Medical History 48 (2004): 318.
Scheidel, Walter, “Libitina’s Bitter Gains: Seasonal Mortality and Endemic Disease in the Ancient City of Rome” Ancient Society 25 (1994): 151-164.
Shippey, Tom, “Klaeber’s Beowulf Eighty Years On: A Triumph for a Triumverate” The Journal of English and Germanic Philology 108 (2009), 363.
Thucydides. “The Plague: Human Nature Laid Bare by a Natural Disaster.” On Justice, Power, and Human Nature: The Essence of Thucydides’ History of the Peloponnesian War. Ed. Paul Woodruff. Indianapolis: Hackett, 1993. 47-54. Print.