Bad Air, Amulets and Mosquitoes

2,000 Years of Changing Perspectives on Malaria

Ernst Hempelmann; Kristine Krafts


Malar J. 2013;12(232) 

In This Article

Marcus Terentius Varro

The "bad air" or miasma theory of malaria aetiology remained an accepted hypothesis well into the 19th Century CE, when mosquitoes were found to be the transmitting agent of the disease. However, the correlation between disease and insects has its roots in antiquity.

The avoidance of insects is certainly not a new phenomenon. In the 26th Century BCE, the Egyptians ate foods of the onion family – most likely garlic – to ward off mosquitoes. Herodotus, a Greek historian who lived in the Fifth Century BCE, described the practice:

On the pyramid it is declared in Egyptian writing how much was spent on radishes and onions and leeks for the workmen, and if I rightly remember that which the interpreter said in reading to me this inscription, a sum of 1,600 talents of silver was spent.[5]

Insects have been recognized as agents of death and decay since ancient times. In the Old Testament of The Bible, the fourth plague of Egypt consisted of swarms of flies (******):

Else, if thou wilt not let my people go, behold, I will send swarms of flies upon thee, and upon thy servants, and upon thy people, and into thy houses: and the houses of the Egyptians shall be full of swarms of flies, and also the ground whereon they are.

Exodus 8:21 (King James Bible, Cambridge Ed)

The ancient Hebrew word, ******, often translated simply as "flies", most likely represents a multitude of various sorts of insects – not only flies, but gnats, wasps, and hornets – of a more pernicious nature than their common counterparts.

Years later, disease began to be associated not only with insects but with tiny organisms too small to be seen. Marcus Terentius Varro (116–27 BCE), a Roman scholar and writer, recognized the importance of tiny creatures in the pathogenesis of disease:

Advertendum etiam, siqua erunt loca palustria, et propter easdem causas, et quod crescunt animalia quaedam minuta, quae non possunt oculi consequi, et per aera intus in corpus per os ac nares perveniunt atque efficiunt difficilis morbos. Fundanius, Quid potero, inquit, facere, si istius modi mi fundus hereditati obvenerit, quo minus pestilentia noceat? Istuc vel ego possum respondere, inquit Agrius; vendas, quot assibus possis, aut si nequeas, relinquas.

Precautions must also be taken in the neighbourhood of swamps, both for the reasons given, and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases. "What can I do", asked Fundanius, "to prevent disease if I should inherit a farm of that kind?" "Even I can answer that question", replied Agrius; "sell it for the highest cash price; or if you can't sell it, abandon it".[6]

Over 1,500 years passed before the term "malaria" came into use. The word malaria has its roots in the miasma theory, as described by historian and chancellor of Florence Leonardo Bruni in his Historia Florentina, which was the first major example of Renaissance historical writing:

Recepto Florentini castello munitissimo praesidioque imposito, quid iam agendum foret consultabant. Erant quibus optimum videretur exercitum reducere,praesertim morbisgravitateque coelilaborantem, et longa difficilique militia per aestatis autumnique ferventissimos ardores insalubribus locis confectum, missione etiam multorum a duce concessa diminutum: nam postquam diutius in his locis commoratum est, multi, vel tedio castrorum vel metu valetudinis adversae, commeatum a duce postulaverant.[7]

Avuto i Fiorentini questo fortissimo castello e fornitolo di buone guardie, consigliavano fra loro medesimi fosse da fare. Erano alcuni a' quali pareva sommamente utile e necessario a ridurre lo esercito, e massimamente essendo affaticato per la infermità e per lamala ariae per lungo e difficile campeggiare nel tempo dell'autunno e in luoghi infermi, e vedendo ancora ch'egli era diminuito assai per la licenza conceduta a molti pel capitano di potersi partire: perocchè, nel tempo che eglino erano stati lungamente a quello assedio, molti, o per disagio del campo o per paura d'infermità, avevano domandato e ottenuto licenza da lui[8] .

After the Florentines had conquered this stronghold, after putting good guardians on it they were discussing among themselves how to proceed. For some of them it appeared most useful and necessary to reduce the army, more so as it was extremely stressed by disease and mala aria (bad air), and due to the long-lasting and difficult camps in unhealthy places during the autumn. They (the Florentines) further considered that the army was reduced in numbers due to the leave permits granted to many soldiers by the officers. In fact during the siege many soldiers had asked and obtained the permit to leave due to the camp hardships and fear of illness. (Translation into English by Paolo Arese, personal communication)

The Italian term "mal'aria" (bad air) was introduced into England 300 years later by Horace Walpole in a letter he wrote on 5 July, 1740: "There is a horrid thing called the malaria, that comes to Rome every summer, and kills one.".[9] John MacCulloch introduced the word into the English scientific literature in 1827.[9] However, Charles Laveran, the first to see the malarial organism in blood in 1893, intensely disliked the name malaria. He considered the term unscientific and vulgar, preferring the name "paludisme" (Latin: palus = swamp) which is still used in France today.[10] Currently, the use of the word malaria is restricted to the disease and its symptoms (and not its causative agent).

Perhaps in part due to the name of the disease, the aetiological concept of bad air prevailed until the latter part of the 19th Century. During his many travels, the journalist and African explorer Henry Morton Stanley (1857–1932) erected a glass screen on his boat, which he used for his trips on the Congo River, as protection against miasma.[11]