SOME OBSERVATIONS ON MALARIA AND
THE ECOLOGY OF CENTRAL MACEDONIA IN ANTIQUITY
The following article is taken from the 4th issue of the American Journal
of Ancient History, pp. 102-124.
In the first volume of his history of Macedonia, Hammond describes the
central (Emathian) plain of Macedonia in the time of Philip 11 thus:
One imagines that the central plain was at that time intensive cultivated
by men and women who walked as far as 20 km from the cities to their fields
in the plain and lived in the fields at the busiest seasons. The climate
was healthy, and malaria was as yet unknown.(1)
How different this seems from the desolate and malaria-ridden country widely
portrayed by nineteenth- and early twentieth-century visitors in the region,
before the modern agricultural revolution changed the face of the landscape.
At another time I hope to deal at length with the matter of cultivation
in the Emathian plain in antiquity. At present, however, it may be useful
to attempt to understand something of the physical condition of this plain,
which was the heartland of the Macedonian kingdom. There are two immediate
concerns: the incidence of malaria in the region in antiquity, and the
topography of the plain itself.
The history of malaria in Macedonia is essentially the same as the history
of the disease in Greece. There are three methods of determining the prevalence
of malaria in antiquity. First, a considerable body of testimony about
the affliction survives in the ancient writers. Second, modern techniques
in paleo-pathology as a branch of the history of medicine enable us to
trace the spread of this scourge. Finally, one may argue by analogy from
the modern experience with malaria where it can be demonstrated that the
ecological conditions which nurture the disease have not changed significantly
Malaria is an infection of the blood by a minute plasmodium parasite.(2)
The parasites multiply rapidly and destroy red cells. Victims normally
suffer severe fevers, general malaise, and sometimes death, depending upon
the age and general health of the victim and the particular species of
plasmodium parasites. Until recently the agent responsible for transmitting
the disease was unknown. European colonial interest in the tropical malaria
belts of Africa and Asia in the late nineteenth century led to considerable
scientific investigation into the affliction. In July 1898, a British researcher
working in India, Ronald Ross, described the results of his observations
in a letter to a friend: "Malaria is conveyed from a diseased person
or bird to a healthy one by the proper species of mosquito and is inoculated
by its bite."(3) Ross' discovery led
to his being awarded the Nobel Prize for medicine in 1902.(4)
Italian scientists learned later that the mosquito genus Anopheles was
the culprit, and recent research has shown that of the nearly 3000 known
species of mosquito, about 375 are anopheline, of which more than 70 are
vectors of four species of human malaria.(5)
Several anopheline species and subspecies are responsible for human malaria
in Greece.(6) The Anopheles' habitat
and breeding grounds are well known they are mainly (but not exclusively)
marshy areas, regions of humidity and still or slow-moving water, where
there are mean daily temperatures above 60 F--conditions necessary to incubate
the mosquito. These conditions are conducive to endemic malaria in every
habitable continent in the world.
Modern Macedonia, with its marshy areas in the Emathian and Strymonian
plains and along the lower Axiosriver, is well-known as a malaria center.(7)
In Macedonia malaria was especially severe because the two main vectors,
A. sacharovi and A. superpictus, are complementary. A.
sacharovi breeds in marshes, and in Greece has adapted to the brackish
salt-water marshes in coastal areas, where it flourishes in early and mid-summer.
It is a mosquito which bites man readily, and is the chief vector of malaria
in regions where it exists. A. superpictus is a secondary vector,
and is often found in the Mediterranean basin and Near East in conjunction
with A. sacharovi. A. superpictus is a late-summer and autumn
breeder in foot-hill streams which are reduced in volume and flow-force
at that time of the year. These two malaria vectors, adapted as they are
to different types of water surfaces where each may breed and thrive in
conditions unfavorable to the other, combine to produce a transmission
season which in Greece lasts from April to November. The transmission is
thereby intensified through a long season over a range of ecological conditions;
the result is that only those areas of Macedonia marked by high elevations
and cool temperatures would be free from malaria.
Moreover, the winter pause in transmission and occasional drought amidst
normally abundant rainfall interrupts the transmission process, which in
the tropics enables the adult population to build limited immunities to
the disease. Much of the Balkans, including Macedonia, has thus suffered
through the deadly "endemic-epidemic" cycle which has proved
so costly to human health and life (see notes 6 and 7).
A malaria crisis struck the area in the early twentieth century. In 1916-18
Macedonia became a major military front, and the susceptible personnel
of the British, French and German armies were laid low. The situation was
exacerbated by the fact that only a few years before, in the aftermath
of the Balkan Wars, about 150,000 Greek refugees, many from malaria-free
regions of the Balkans and Asia Minor, had settled in Macedonia and had
become infected. The paralysis of three modern armies and a large civilian
population before the ancient disease was a tragic lesson in human vulnerability.
Malaria has disappeared from Greece only since the early 1950s.(8)
Ross' success in identifying the mosquito as the vehicle for transmitting
the malaria parasite, and the rapid medical advances which followed his
discovery, resulted in an especially high interest in the subject in the
early twentieth century. Impressed with Ross' work, the Cambridge classicist
W.H.S. Jones produced two volumes investigating the prevalence of malaria
in classical antiquity.(9) Jones was correct
in calling malaria a "neglected factor" in ancient history; ironically,
his work has had much more influence on the students of epidemiology and
the history of the disease than on the classical scholars for whom it was
intended. The main criticism of Jones' work is that, having collected the
ancient testimonia on malaria, he drew a number of inferences about
social, moral and economic decline that appear naive to a modern public.
Jones' views about the "degeneration" of the Greek character,
the "loss of brilliance" after ca. 400 BC as the result
of malarial infection, are based on outmoded racial and social premises.(10)
Ross himself subscribed unreservedly to Jones' views, and argued that malaria
was responsible for the "decline" of a vigorous Greek civilization.
And no less an expert than the present leading scholar of the paleo-epidemiology
of malaria restated Jones' thesis that after malaria became endemic ca.
500 BC it was probably responsible for the downfall of Greek civilization.(11)
Simplistic cultural notions like "degeneration" and "decline"
aside, the value of Jones' work was his comprehensive collection of testimony
from the ancient medical and non-medical writers. All subsequent accounts
of the history of the disease in ancient Greece ultimately depend on Jones'
Malaria and Greek history.
The weight of the ancient testimonia is impressive. It is collected
and commented upon in Jones in detail, and there is no need to set it down
a summary will suffice. The common ancient Greek word for fever was pyretos,
and by the fifth century BC it is clear that, except in a few special cases,
the use of the word normally refers to malaria.(13)
"Fever" was well known after the mid-fifth century, and that
it was often malarial fever (as opposed to other types) is evident for
two reasons. One is the ancients' association of the affliction with marshy
areas and seasonal attacks, corresponding to modern experience with the
disease. The other is the description of fever stages, degrees of severity
(until recently the modern diagnostic terminology for malaria was based
mainly on the phrases in the Hippocratic corpus), and the condition known
as splenomegaly (enlargement of the spleen), which is one of the observable
symptoms of the malady. It is obvious from the Hippocratic corpus and from
the medical writers of the following four centuries that the ancients were
so well acquainted with malaria as to describe symptoms in terms clear
enough for modern medical scientists to recognize without doubt.(14)
Two challenges to Jones' view have emerged in recent years. One utilizes
modern techniques in paleo-pathology; the other reveals underlying assumptions
that the physical environment of the Emathian plain was not productive
of malaria. Both argue that Greece was in fact virtually free from malaria
in the classical period.
First, J. Lawrence Angel has offered the materials of physical anthropology--skeletal
remains in particular--to suggest that the evidence of patho-physiological
adaptation in response to malaria is lacking for classical Greece.(15)
Angel's thesis is based on the connection he sees between malarial environment,
bone enlargement and thalassemia. Thalassemia is a blood disorder resulting
in severe anemia. It is a recessive genetic trait which can affect the
individual's ability to resist malaria. Like a related disorder, sicklemia
("sickle-cell disease"), thalassemia provides the victim with
a level of protection against the malaria parasite. It was observed long
ago, for example, that Blacks in Africa and the American South seemed generally
more resistant to fevers than Whites who worked in mosquito- infested areas.
Many Blacks are traditionally affected by sicklemia, a debilitating and
often lethal genetic blood disorder. Sicklemia harbors fewer malaria parasites
by incidentally providing an unfavorable environment for the parasite.(16)
Like sicklemia, thalassemia is often fatal, and would logically disappear
through natural selection by the death of the host, but it curiously persists
among populations which are also subject to malaria. By a mechanism not
understood at the moment the presence of malaria infections activates certain
resistant factors which provide a protection counteracting the defect of
thalassemia and other genetic bloods disorders. A malarious population
is sometimes characterized by a relatively high frequency of other blood
disorders, especially those red-cell abnormalities that seem to exist in
a symbiosis with malaria.(17) That is,
the continuing existence of a population surviving such afflictions as
thalassemia and sicklemia may indicate the presence of malaria as well,
even while malaria may also exist in populations not suffering from other
A third important disorder often coincides with malaria, the glucose-6-phosphate-dehydrogenase
(G6PD) deficiency. Known as "favism", this hereditary blood defect
produces a severe temporary anemia when the affected individual ingests
or inhales the pollen of a broad bean (viciafava). Exposure to the
fava produces a deficiency in the vital G6PD enzyme which normally arrests
the deterioration of red-cell membranes; the result of favism is a transient
acute hemolytic anemia.(18) An advantageous
effect of the malady is that, as in the cases of thalassemia and sicklemia,
a hostile environment for the malaria parasite is also created; that is,
an individual may continue to be affected by the genetic blood disorder,
but will suffer less from malarial infections.
There is a considerable literature on the use of the fava among Greeks
and other eastern Mediterranean peoples as the focal point of ritual, cult
and kinship-systems.(19) There is also
a notorious taboo on beans to be found in the philosophical writings, especially
among the Pythagoreans.(20) It is problematic
whether the existence of widespread beliefs and practices related to the
bean suggests that a significant segment of the population of the eastern
Mediterranean suffered from a G6PD deficiency often associated with endemic
Within a population, individuals or groups may or may not be affected by
these blood disorders, including thalassemia. In those who are thalassemic,
however, an adaptive individual physiological response to their condition
may occur: certain of the body's bones enlarge as the internal spongy matter
producing red cells must of need increase to combat disease. The enlarged
bone condition is known as porotic hyperostosis. On the basis of skeletal
examinations Angel reports that there is a substantially higher incidence
of porotic hyperostosis among farmers living in marshy areas--e.g., the
sixth-millennium BC Macedonian settlement near Nea Nikomedeia in the southwestern
part of the Emathian plain--than among those living on higher, drier ground.
Angel claims a generally high incidence of porotic hyperostosis among persons
who lived in the malarial belts of the Old World, although the statistical
basis for this view is not made clear.
Angel also suggests (again on the basis of skeletal examinations) that
there have existed fluctuating levels of malaria in the eastern Mediterranean,
caused by two factors: one is the periodic draining of swampland; the other
is the occasional variations in climate, which result in lower sea levels
and drier land in normally marshy areas.(22)
During such "dry" periods the incidence of malaria would at least
in theory decline.
Now, to the crux of Angel's argument. The incidence of poroffc hyperostosis
appears to be variable from time to time. For example, the prehistoric
Macedonian farmers at Nea Nikomedeia were presumably malaria-ridden, according
to Angel, because their bones show evidence of porotic hyperostosis, an
indication of the thalassemia which is sometimes symbiotic with malaria.
Angel claims a 50% incidence of hyperostosis among the late Paleolithic
bones he has studied, but the incidence drops gradually to only 8% for
the Greek Bronze Age, 4% for the Archaic (early Iron) Age, and then to
virtually "no malaria" for the classical period down to ca.
There is a marked upward swing in the Hellenistic era (10%), and by Roman
times malaria has again become endemic (24%) in the eastern Mediterranean.
Any attempt to establiish a necessary relationship between malaria and
thalassemia is a complex problem, and there are some diffculties with Angel's
First, the sample of bones studied is small, being limited to the availability
of materials from a few archaeological investigations. The lack of a broadly-based
statistical sample in both geographical and chronological terms makes one
feel insecure in accepting a thesis describing fluctuations in a major,
widespread disease over a long period of time.(25)
Next, Angel assumes "that much of this anemia [that which may have
caused the bone enlargement] was thalassemia".(26)
But thalassemia is not necessarily a function of climate or environment,
and Angel appears to have overlooked the fact that thalassemia (which always
produces bone enlargement as an adaptive response to infection) is also
prevalent in some non-marshy areas where the bones may enlarge to combat
some nonmalarial infections. Indeed, one modern diagnostic study in modern
Greek villages has shown that the frequencies of thalassemia in malarious
lowland villages and non-malarious mountain areas were approximately the
same.(27) Further, even if the anemia causing
bone enlargement were proven thalassemia--which it is not--there are other
than malaria-related factors which can cause porotic hyperostosis.(28)
In sum, there is an apparent coincidence between porotic hyperostosis and
marshy areas in parts of the Old World as evidenced in a few ancient sites
(as Angel points out); these regions may or may not have been malarious.
The existence of bone enlargement may or may not be evidence of thalassemia,
and the existence of thalassemia, even in a marshy area not a proof of
the existence of malaria (see note 27). That is, we cannot use the bones
alone to show the existence of malaria.
Angel has suggested that there is a correspondence between the datable
low incidence of porotic hyperostosis and minor climate fluctuations resulting
in drier climate (hence fewer marshes and less malaria). At evidence he
cites the work of Denton and Porter on climate variations.(29)
Denton and Porter discuss "neoglaciation", that is, the post-Ice-Age
climate fluctuations evidenced by the occasional retreat and advance of
glaciers. Glacial growth and shrinkage over the past five millennia reflect
the slight reversible shifts from the warmer/ wetter range to the cooler/
Pollen records, Carbon-14 dating, botanical analyses, changes in the habitat
of man and animals, agricultural data and, in the historical period, eyewitness
accounts, are among the kinds of evidence used to document these climatological
phenomena. Denton and Porter's data indicate that the first millennium
BC was marked by a glacial advance which peaked about 500 BC. Thus the
climate was cooler and drier than that of the Hellenistic period which
followed. By ca. AD 500 the glaciers were in marked retreat beyond
even present conditions. Angel sees a correlation between the incidence
of porotic hyperostosis (malaria?) and glacial fluctuations (climate variations).
He uses the climate data to suggest a reason for the lower incidence of
bone enlargement: that is, a drier climate produces less marshland, hence
That there appears to be a correlation between Angel's data on porotic
hyperostosis and minor climate changes is not in dispute. But Angel goes
a step further in arguing that marshiness was further reduced because the
Mediterranean sea level was 34 meters lower than present levels, as some
Mycenaean and classical sites are now 1-2 meters below sea level. Whatever
the value of sea-level arguments in archaeology (e.g. local land-subsidence
can also produce underwater sites, for which see p. 111 below), the particular
case Angel makes is dubious. For example, he uses the case of underwater
"Mycenaean and Classical" (my italics) sites, even though
the data published by Denton and Porter show that much of the second millennium
BC was a period of relative glacial retreat, that is, higher
sea levels according to Angel's argument (are we to suppose that the
Mycenaeans deliberately constructed their sites underwater?), whereas classical
glaciers were at the peak of advance (lower sea levels). One cannot
have it both ways.(32) Angel's thesis is
not supported by the evidence he cites.
Finally, Angel correlates the decline of malaria (presumably evidences
by porotic hyperostosis) with the increase in population and more progressive
methods of agriculture between the prehistoric and classics periods.(33)
One must weigh this against the view that with an increase in population
and consequent stripping of forest and cover-land for agricultural use,
natural surface absorption and drainage are interfered with. The result
is an expansion of the breeding grounds for anopheline mosquitoes.(34)
Such a transformation of the countryside for human use does not necessarily
produce malaria, for the mosquito-vector must be infested with the deadly
parasite; but one may suggest that, on ecological grounds alone the classical
era offered more potential for the scourge than did the earlier periods.
We may now turn in detail to the matter of the sea level in antiquity,
both for its general interest and for its connection with Macedonian marshland
particularly in the Emathian plain. In his History of Macedonia, Hammond
wrote (I 145):
In antiquity the level of the sea in the Mediterranean was some 5 feet
lower than it is today, and this means that the high flood level in the
central plain, e.g., in the vicinity of Alorus, was 5 feet lower and that
the rivers had that much more fall.
The question of sea-level changes since antiquity is vexed and a matter
of continuing concern to archaeologists and oceanographers alike. For his
view that the level of the sea was lower in antiquity Hammond cites the
evidence in his earlier article on the battle of Salamis and in his Epirus.(35)
The evidence in the Salamis article consists of references to suggested
North Sea level changes and opinions of local Greek seamen. Hammond admitted
that the matter was problematic, and assumed (for the sake of his discussion
of the topography of the Straits of Salamis) that the sea level has risen
5-6 feet since antiquity. In his account of the battle of Marathon published
twelve years later,(36) Hammond made no
reference to sea-level changes in an otherwise detailed discussion of topography.
At Marathon five or six feet less depth of water would have significantly
altered the coastline of that shallow bay and perhaps affected both fresh-water
marshes and the sea-water lake. We cannot assume that Marathon Bay in 490
BC was as it is today, but that the level of the Aegean dropped five or
six feet by the time of Salamis a decade later.
In Epirus Hammond cited six different points along the western coast
of Greece, between the Gulf of Arta and the Gulf of Valona, where ancient
remains can be seen beneath the surface of the sea. Hammond's argument
is based entirely upon the existence today of these submarine remains,
all consistently 5-6 feet below the present surface, and he concludes that
the sea level was from three to five feet lower in antiquity. This view
figures prominently in Hammond's reconstruction of the topography of the
Emathian plain and the central Macedonian coastline. It even corresponds
(although he does not mention this himself) with his view stated elsewhere
(see note 1) that Macedonia was free from malaria in Philip II's time,
on the assumption, of course, that a lower sea level would have produced
more efficient alluvial drainage, hence less marshland in the Emathian
There now exists a body of scientific research into the matter of sea-level
changes. N.C. Flemming and others have devised a method using the resources
of both archaeology and geology, which attempts to establish average sea-level
measurements exclusive of wave and tidal fluctuations.
Analysis of the placement and type of coastal sites from antiquity, when
joined with a study of attendant land forms with a known geologic history,
has produced some conclusions about the ancient sea level relative to local
coastlines. Flemming studied 69 Aegean sites; this survey, when taken together
with his earlier research in the western Mediterranean, shows that the
last great sea-level change occurred in the Mediterranean 10-11,000 years
ago, and that since about 2000 BC the level of that sea has been within
a few centimeters of present conditions.(37)
The world-wide sea level has not increased more than about 30 cm (about
one foot) in the last 3000 years. Any ostensible large change as evidenced
by numerous sunken sites is more likely the result of local volcanic and
tectonic subsidence, common in this geologically active part of the world.
It is thus local earth movement which accounts for the apparent rise in
the Mediterranean sea level; it may be understood that this subsidence
of landforms is relative to a virtually stable sea level.(38)
One final note on climate. That minor periodic climate changes occur is
beyond dispute; beyond this little else is certain about climate fluctuations.
Since precise measurements of climatological conditions are lacking for
ancient times, we are totally dependent upon the occasional observation
of phenomena in our written sources, the dating of organic materials, botanical
analyses, changes in human and animal habitat, agricultural data and mountain
glacier variations. These data can indicate long-term trends or abnormal
variances, but in the absence of detailed records they can provide only
guidelines for describing the climatic history of a single region like
The literature of antiquity, however, suggests that ancient Greece's climate
was not significantly different from today's. Hesiod's growing seasons
in Boeotia could provide a guide to a modern planter; Theophrastus' plants
still grow in the same regions, though many are reduced in number owing
to human mismanagement; some forms of wildlife are long extinct, but domestic
animals continue to flourish in the same regions as in antiquity; the capes
at Malea and Athos still blow fierce, and as recently as 1971 the author
witnessed Athens "crowned in violet", as Pindar put it.(40)
Aberrations aside, we can assume that the climate of the Greek peninsula
in antiquity was about as it has been in modern times, when malaria was
endemic in Greece.
Thus the views of Hammond and Angel on the physical conditions Conducive
to malaria, and of Angel on the link between the bone evidence and the
disease, seem unconvincing. It seems more prudent to accept the testimony
of the ancient writers about the prevalence of malaria. It is unlikely
that so much precise information could be transmitted about a disease that
did not exist. Moreover, it will be shown below that the ecology of the
Emathian plain in the classical period was about as it was in the early
twentieth century (except for some coastline alterations resulting from
alluvial processes), when the region was notorious as a malaria center.
When did malaria come into Greece? The original home of Anopheles may
have been the
Ethiopian regions, and it may have preceded man's existence both there
and in other temperate climates.(41) It
undoubtedly took time for the relationship between the plasmodium parasite
and the host Anopheles to develop; precise ecological and physical
balance is necessary. The mosquito-borne infection is thought to have progressed
from its East African genesis down the Nile valley and eventually into
the Mediterranean and Near East.(42)
It is clear that the disease was endemic in the Greek world by the fifth
century, since it was well known after midcentury by both the writers of
the Hippocratic corpus and non-medical writers alike.(43)
To search for references to malaria in the pre-classical period is to confront
the usual problem of historical research in that era: the paucity of literary
evidence. Nonetheless and to risk an argumentum e silentio--it is
curious that our best early source for practical matters, Hesiod, who complains
about everything else, fails to mention the fever in his work. Perhaps
his town of Ascra was high enough above the Boeotian plair (where malaria
was rife in the early twentieth century) on the slopes of Mt. Helikon to
have escaped the affliction, although modern Anopheles has spread
its scourge in Greek villages up to 600 m elevation. It is also possible
that malaria had not yet arrived in Greece. Whatever the case may be Hesiod
is silent about the fevers when we would expect him to be otherwise. Also
silent are a series of votive tablets at Epidaurus dating from the early
classical period. Sigerist summarized some seventy cases of afflictions
noted on these tablets, and Bruce-Chwatt concluded that none referred to
If it is correct to suggest that there is no evidence of malaria in at
least two early sources where one would expect some indication of its existence,
and that there is clear evidence of malaria in fifth-century Greece, we
may postulate some post-Hesiodic and pre-Hippocratic circumstance that
was favorable to the introduction and consequent spread of malaria in Greece.
A single event may supply the answer: the entry into Greece in the early
fifth century BC of a large number of Asians, many of whom came from areas
of the Near East with endemic malaria.(45)
Did Xerxes' armies or the military and administrative personnel who preceded
them carry the scourge that would eventually attract so much attention
from the Greek medical writers? Perhaps low incidences of malaria had already
existed in parts of Greece. One assumes that malaria inevitably would have
become endemic in Greece during the course of its inexorable spread. Yet
one is tempted to suggest that the Persian army may have hastened the process,
especially in those marshy areas where the hitherto uninfected Asian mosquitoes
already flourished, which, now having an infected Asian population to prey
upon, spread malaria to the local population.(46)
The residents of northern Greece, especially the inhabitants of what in
modern times was the malaria belt of Thrace and Macedonia, may have suffered
more from the bite of the newly-infected mosquitoes than from the passage
of a vast Asian army through their land.
There are other possible sources for the infection and for its spread.
The gradual stripping of the land of its natural cover created mosquito
breeding-grounds.(47) Increased commerce
with malarious regions plus the occasional mingling of large groups of
people from throughout Greece at panhellenic festivals may have contributed
to the spread of the disease. There can be no certainty about these matters,
but if we accept the notion that malaria was endemic in Greece at least
by the fifth century--whatever its origin--and we believe that the Macedonian
environment was as conducive to the affliction then as in modern times,
we have little reason to doubt that it was a factor in Macedonian history.
What effect this scourge had on the Macedonians is diffficult to say. The
disease takes its greatest toll among those who are newly exposed, as was
the case with the highly susceptible recently-arrived populations in Macedonia
in the early part of this century. Long-term inhabitants in heavily endemic
areas develop some forms of resistance, but these are idiosyncratic and
weak, as studies of modern Greek mortality rates and incapacitation among
Macedonian villagers have shown. An infected population is unhealthy. The
major effect of malaria on a population--after producing a high infant
mortality rate is to reduce the residents' work efficiency. As modern experience
throughout the world has shown, populations have lived and worked for centuries
in malarious regions.(48)
One suspects that in antiquity the inhabitants of Macedonia kept to the
highest, driest ground available, living and working on the terrace lands
bordering the deadly marshes which were the center of ancient Emathia.(49)
Macedonia shares with the rest of Greece the fact that only a small part
of the total land area is suited to agriculture. The combination of scant
rainfall sharply eroded land forms which do not hold soil and water and
a large proportion of mountainous terrain reduces the amount of tillable
and grazing area. These factors are somewhat mitigated in Macedonia, however,
by its large alluvial plains, relatively more abundant rainfall through-out
the year, and cultivable terrace lands on mountain slopes. Moreover Macedonia's
major rivers flow year-round, permitting both natural and artificial irrigation
for crop and pasture land. As an agricultural area Macedonia is, compared
with much of Greece, blessed by nature. The large mountain ranges also
provide abundant well-watered summer pasture slopes and basins, a phenomenon
which has sustained Macedonian agriculture for millennia. Until the agricultural
revolution of the past half-century, Macedonia looked much as it had in
antiquity. Two major natural factors particularly affecting river-plain
cultivation in central Macedonia are climate and sea level. We have suggested
that both in modern times are virtually what they were in antiquity.
As for human attempts to alter the landscape, Hammond claims that Philip
II was responsible for a flood control project in the Emathian plain.(50)
No direct evidence for this exists, although Theophrastus (de Caus Plant.
5.14.6) mentions that Philip drained and reclaimed the land around
Phillippi. This area, the lower part of the plain which begins above Drama
and runs down to the Kavalla coastal ridge, is hardly analogous to the
central plain. The Philippi plain is an ill-drained alluvial basin, fed
by the numerous streams falling from nearby mountains. The plain's drainage
system narrows to a single stream where the Angitis river pierces the Pangaion-Menikion
mountain barrier to flow into the lower Strymon plain. The drainage of
the Philippi plain was accomplished with relative ease in modern times
by the erection of a pumping station at the Angitis bottleneck.(51)
If Philip was responsible for draining the Philippi plain shortly after
he took it in 356 BC, he may have solved the drainage problem in some equally
The Emathian plain, however, is a different matter. It is huge and complex,
fed by everflowing major rivers, and resists any single easy method for
flood control and reclamation. In modern times it took the combined effort
of the most advanced American and Greek hydraulic engineering skills and
considerable amounts of money to alter river courses and drain swamps,
a process occupying much of the two-decade period 1920-40 and continuing
for several years after the end of World War II and the Greek Civil War.
One doubts that ancient Macedonian technology and the royal purse were
up to this formidable task, even on a more limited scale. That the region
around Philippi was reclaimed may or may not be true. In either case, Philippi's
drainage cannot serve as an analog for the great central plain. If the
sea level were several feet lower in antiquity, it might be argued that
drainage was naturally more efficent than it is today, and thus the Emathian
plain was less swampy. But we have seen that the sea level in historical
times has remained virtually unchanged; moreover, the silting process by
which the plain was formed (for which see below) indicates that it was
ill-drained in antiquity. It is thus best to assume that the area remained
undrained, as it was until the modern program of reclamation.
The historical geography of the central plain's metamorphosis over the
centuries is too complex to deal with here.(52)
As late as the classical period an inlet of the Thermaic Gulf extended
quite far west into what became the central plain, much as the sea stretches
eastward today to form the Gulf of Salonica (see Map). No evidence of prehistoric
settlement has been found in the area,(53)
and all the known sites of the historical period--including Aigai (Vergina),
Beroia, Mieza, Edessa and Pella--lie on the adjacent terrace-land.(54)
The alluvial activity of the four rivers which flow into the region--the
Haliakmon from the southwest, the Moglenitsas (Loudias) draining Almopia,
the Axios and the Gallikos (anc. Echedoros) from the north--plus innumerable
small streams draining the slopes of Mt. Bermion, gradually began to silt
up the inlet. In the fifth and fourth centuries BC Emathia was still largely
a sea inlet and marshes, with the main route from Tempe and the Pierian
coastal plain hugging the adjacent piedmont. It was not until Roman times
that lower Emathia was able to support a road directly across the deltas
from Pieria to Salonica,(55) and that the
plain assumed roughly the form it has retained until the twentieth century:
a large marsh with a nuclear lake of varying dimension (Lake Loudias in
antiquity; mod. Yiannitsa) connected to the sea by a river.(56)
We may thus envisage the central Macedonian homeland as the fertile terraces
above the swampy Emathian plain. Farmers tilled the slopes, or drained
patches at the marsh's edge,(57) probably
avoiding the central swamp wherever possible. Pasturists utilized the mountain
meadows above, and game and timber was widely available from the nearby
slopes. It was, by Greek standards, a prosperous region, but awkwardly
arranged in its central portions. As local populations increased and the
foreign demand for Macedonian metals and timber grew, the need both for
cultivable land and for security against Greek encroachments gave rise
to an expansion of Macedonian interests in all directions.(58)
Eugene N. Borza
Institute of Classical Studies, London/
The Pennsylvania State University
2. The literature on malaria is extensive, most of it,
as one might expect, on technical matters relating to treatment of the
disease and to mosquito-eradication programs. Useful general accounts include:
Gordon Harrison. Mosquitoe malaria and man: A history of the hostilities
since 1880 (London 1978). with frightening fnal chapter showing that
because of political instability and the breakdown of public health services,
malaria is again becoming endemic in parts of Asia and Africa; L.W. Hackett,
Malaria in Europe. An ecological study (London 1937); and Paul F.
Russell, Man's mastery oi malaria (London 1955). On the origins
and early spread of the affliction see LJ. Bruce-Chwatt, "Paleogenesis
and paleo~epidemiology of primate malaria," Bull. World Health
Org. 32 (1965) 363-87 this is a comprehensive account of what is known
about the transmission of malaria in antiquity written by the (then) Chief
of Research and Technical Intelligence for the World Health Organization.
For a valuable description of the disease see Brian Maegraith in Adams
and Maegraith, Clinical tropical diseases (Oxford 1976) chap. 16.
3. Letter reprinted in full in Russell; see esp. p.
4. Ross' own account of these matters can be read in
Sir Ronald Ross, Memoirs (London 1923).
5. Bruce-Chwatt 36S; and see next note.
6. The taxonomic classification of anopheline mosquitoes
is a continuing problem. As an indication of the increasingly subtle distinctions
brought to this study by taxonomists, the number of known separate species
of mosquitoes has risen from about fourteen hundred in 1932 to nearly three
thousand in 1973, see the statistics cited in Kenneth L. Knight and Alan
Stone, A catalog of the mosquitoes of the world (College Park, Maryland
1977) 1. Part of the difficulty in determining the vectors for malaria
in Macedonia rests in the changing classification of anopheline mosquitoes,
and, in particular, the precise type and location of the species A. maculipennis
and its various subspecies, once thought to be vectors in Greece. see
Marston Bates, "Anophelines of the palearctic regions 420, 422 and
426; M.F. Boyd, "Epidemiology of malaria. Factors related to the definitive
host", table 104; and L.W. Hackett, "Conspectus of malaria incidence
in northern Europe. the Mediterranean region and the Near East" 788,
all in M.F. Boyd (ed.), Malariology (Philadelphia and London 1949),
The most recent comprehensive classification (Knight and Stone, Catalog;
see indices) makes A. maculipennis' status uncertain, but clearly
identifies Anopheles anopheles sacharovi and Anopheles cellia
superpictus as the main vectors in Macedonia. See especially Hackett
(pp. 79S-97 and 1422 in Boyd, Malariology) for a description of
the ecological relationship between the two species.
7. Great Britain, Admiralty, Naval Staff, A handbook
of Macedonia and surrounding territories (London 1920) 65: "Malaria
is notoriously the disease which is the scourge of these lands." As
late as 1936 malaria was (excluding deaths ascribed to senility) the fourth
leading cause of death in Greece, behind pneumonia. tuberculosis and intestinal
diseases. The malaria death-rate (7580 per 100,000 population) was twenty
times that of any other European country of the time. An observer noted
that on any one day in eastern Macedonia up to 5.6% of the village population
was incapacitated during the malaria season. In the summer of 1936, 69%
of the infants in those Macedonian villages under observation were infected.
It was estimated that about two million of Greece's seven million inhabitants
were malarious. See Great Britain, Admiralty Handbook, Naval Staff, Greece
I (London 1944) 170-75 and 270-80, and the studies cited by Hackett,
in Boyd, Malariology 796. For a basic demographic survey of the
incidence of malaria in modern Greece, see M.C. Balfour, "Malaria
Studies in Greece. Measurements of Malaria, 1930-33", American
Journal of Tropical Medicine 15 (1935) 301-30.
8. Malaria was also endemic in the eastern sections
of Yugoslavia in the 1930s and spread quickly as the result of the govemment's
policy of shifting soldiers from one province to another. See H.E. Sigerist,
The Sociology of Medicine, ed. M.l. Roemer (New York 1960) 97.
9. Malaria, a neglected factor in the history of
Greece and Rome (London 1907). and Malaria and Greek history (Manchester
10. E.g.., Malaria and Greek history 101-108.
11. Bruce-Chwatt 377.
12. Malaria and Greek history, passim. A useful
epitome of Jones' testimonia, conclusions and historical theories
can be found under his name as "The prevalence of malaria in
ancient Greece," in Diseases in Antiquity, ed. Don Brothwell
and A.T. Sandison (Springfield, I11 . 1967) 170-76.
13. In modern Greek "malaria" is either elodis
pyretos or elonosia.
14. E.g., Bruce-Chwatt 377; Harrison 1; Russell 80-82;
Sigerist 301-302; Adam Patrick, "Disease in antiquity: Ancient Greece
and Rome", in Diseases in antiquity 238-46; Douglas Guthrie,
A history of medicine (London 1945) 57; Arturo Castiglioni, A
history of medicine, trans. E.B. Krumbhaar (New York 1940) 163 and
170; and Henry E. Sigerist, History of Medicine 11 (New
York 1961) 328-30.
15. J.L. Angel, "Porotic hyperostosis, anemias,
malarial and marshes in the prehistoric eastern Mediterranean", Science
153 (1966) 760-63 [henceforth Science], "Porotic hyperostosis
and osteoporosis symmetrical", in Diseases in antiquity 378-89;
and "Ecology and population in the eastern Mediterranean", World
Archaeology 4 (1972) 88-105 [henceforth World Archaeology].
It must be emphasized here that agreement among anthropologists
and biologists on many of these technical medical matters is
lacking. Malaria itself is a complex disease; its mechanisms and pathological
effects are not completely understood. In the following pages I cannot
claim to have avoided controversy, as any serious review of the medical
literature will confirm. I hope, however, to have provided for my fellow
ancient historians a fair summary of the main trends, and to have shown
that there is little to suggest that malaria was absent from Greece classical
16. For a detailed review of the processes of acquired
and innate immunities to malaria, see Carol Laderman, "Malaria and
progress: some historical and ecological considerations", Social
Science and Medicine 9 (1975) 587-94, with comprehensive bibliography.
17. Ibid. 589 and 592.
18. Ibid 488-89, with bibliography for the mechanics
of the process.
19. Summarized in A.C. Andrews, "The bean and
Indo-European totemisms, Amer. Anthropologist 15 (1949) 274-92.
20. Walter Burkert, Lore and science in ancient
Pythagoreanism, trans. E.L. Miner, Jr. (Cambridge, Mass. l 972), passim,
esp. l83-5. The fava-Pythagorean link is, however, no aid in attempting
to date the introduction of malaria into classical Greece. Pythagoras was
a sixth-century figure, but the earliest firm date for the writings of
the Pythagorean school in which the bean is mentioned is the fourth century.
See Burkert, 97- 120, and Holgor Thesleff, An introduction to the Pythagorean
writings of the Hellenistic period, Acta Academiae Aboeosis, Humaniora
XXIV.3 (Abo 1961) 30-45.
21. Paul B. Burke, Jr., of Clark University, has recently
argued in his detailed study of favism and the Pythagorean taboo that loog-term
exposure to malaria led the peoples of antiquity to develop a substantial
lore about the bean. l am grateful to Dr. Burke for permitting me to see
and use a draft version of his paper, "Malaria in the ancient world:
Prolegomenon to an ecological and environmental study" presented at
the 1978 meetings of the American Philological Association and now being
prepared for publication.
22. World Archaeology 98.
23. Ibid 94-95 and 100 (". . . malaria
may have actually disappeared."); also Diseases in antiquity 384,
and Science 760-63.
24. Angel was aware of some of the problems inherent
in the attempt to connect hyperostosis with thalassemia and thus malaria;
see Diseases in Antiquity 381-84.
25. The statistical bases for Angel's conclusions raise
some questions about method. The table in Science, which serves
as the foundation for the hyperostosis-malaria link, gives the following
data for Greece (my summary):
Site Date No. skeletal remains
Nea Nikomedeia 6000 BC 45
Kephala, Kea 3000 BC 37
Corinth 2400 BC 21
Lerna 1800 BC 149
Classic Greece [sic] 450 BC 115
The frequencies of hyperostosis vary among these remains; what can be concluded
from such variations? The data are drawn from one site in Macedonia, two
in the Peloponnesus, one on Kea island, and one general category. They
represent a chronology ranging from the early Neolithic to the classical
periods, but at widelyseparated sites. Further, there is no topographical
evidence to provide a common frame of reference for anopheline ecology
beyond a proximity to marshes. With respect to the aforementioned we have
already seen that at least one malaria vector (A. superpictus) is
a stream, not a marsh, breeder. An examination of the statistical tables
in Angelo 1967 (Diseases in Antiquity) and 1972 (World Archaeology)
articles reveals that the data are based on the same few sites (plus
some new excavation material), and arranged virtually in the same manner.
The method seems questionable on the grounds that a constant geographical
or chronological reference is lacking. If, for example, one were to take
a single site (or region) and examine skeletal remains representing a long
period of time--say, several centuries--it might be possible to produce
a history of the health of the inhabitants of that locale. Moreover, if
several such area-analyses existed, we would be in a position to speculate
about a large region such as Greece. But to utilize materials from a handful
of sites scattered throughout the Aegean world over a 5500-year period--a
sample lacking any constant factor--does not, on methodological grounds
alone, seem convincing.
Further, the statistical sample is small, and percentage figures can be
misleading. In one case (Angel's report on Neolithic human remains in "Excavations
in the Franchthi Cave, 1969-71. Part II", Hesperia 42 (1973)
277-82) it is stated that 31 % of
the Neolithic skeletons at the Franchthi cave showed evidence of hyperostosis,
and were probably rnalarious. This is an impressive figure until one realizes
that the evidence is drawn from the remains of four persons out of a total
of thirteen discovered. Similarly, we may note conclusions derived
from four persons at early Bronze Age Corinth, and two skeletons from the
late Bronze Age level at Episkopi, Cyprus. The percentages drawn from the
observable hyperostosis in these human remains serve to plot curves upon
which Angel bases his theories about the incidence of malaria in the entire
One of the oddest examples of this method occurs when Angel describes adult
porotic hyperostosis at the 4% level ("trace to slight degree",
World Archaeology 101) in the modern period, even though there is
abundant first-hand evidence that much of the Balkans (especially Greece)
was malarious in the extreme in recent times (see note 7 above). And it
will be recalled that this same 4% level for hyperostosis was given for
the Greek archaic period when malaria, according to Angel, was declining
to virtual nonexistence in the classical period (see note 23 above).
26. World Archaeology 97.
27. G.L. Fraser at al, "Thalassemias, abnormal
hemoglobins and Glucose-6-Phosphate Dehydrogenase deficiency in the Arta
area of Greece: Diagnostic and genetic aspects of complete village studies",
Annals of the New York Academy of Science 119
(1964) 415-35. The studies accepted by Angel, Diseases in antiquity
385, offer a contrary view.
28. See Laderman 589-90, who points out that to explain
porotic hyperostosis in the New World, Angel posits causes other than malaria:
iron deficiency and prolonged lactation, restricted childhood diet, dysentery
and response to other parasitic infections. Laderman comments: "With
so many choices before us, why should we attribute porotic hyperostosis
in two groups of early farmers to thalassemia alone? With a change from
hunting and gathering to sedentary farming [precisely the stage of development
of the Nea Nikomedeia farmers] there are many opportunities for anemia
to develop, including parasitism and infection of all sorts, as well as
29. World Archaeology 89 and 100. George H.
Denton and Stephen C. Porter, "Neoglaciation," Scientif c
American 222.6 (June 1970) 100-110.
30. See Denton and Porter's diagram (p. 107) of estimated
average fluctuations of mountain glaciers.
31. World Archaeology 89 ff. We have already
noted that the presence or absence of marshland per se is not a
contributing factor to the incidence of thalassemia, and also that bone
enlargement can result from other than thalassemic conditions.
32. Roughly speaking, there is a constant amount of
free water on this planet. It exists in the atmosphere, in seas, lakes,
rivers, etc., and in the form of ice and snow. The balance between the
amount of water in ice sheets and glaciers and in the sea will shift depending
upon the temperature of the general climate.
I accept the view that the change in the level of the Mediterranean in
historical times has been no more than 30-S0 cm; see W. Gordon East, "The
destruction of cities in the Mediterranean lands," The sixth J.L.
Mares memorial lecture (Oxford 1971) 4-5, following the archaeological-geological
surveys of N.C. Flemming, for which see below.
33. As far as Angel's argonauts on the efficacy of
man-made marsh drainage are concerned, the only evidence we possess is
Theophrastus' statement (de Caus Plant. 5.14.6) that Philip II reclaimed
the water-logged plain of Philippi. There is no evidence for drainage in
Emathia, and the Lake Kopais region of Boeotia (heavily malarious in modern
times) remained marshy following the breakdown of the Mycenaean drainage
system. Pollen analysis in the Kopais region shows that the forests had
been decimated since at least Bronze Age times; see J.R.A. Grieg and J.
Turner, "Some pollen diagrams from Greece and their archaeological
significance", Journ. Archaeol. Science 1 (1974) 177-94. Malaria
may be the "fever" mentioned as having struck the region not
long afler the battle of Chaeroneia (338 BC); see Theophr. Hist. Plant
34. Laderman 587-88 and 592-93, and L. W. Hackett,
"Distribution of malaria", in Boyd, Malariology 722-35.
esp. p. 730.
35. "The battle of Salamis," JHS 76
(19S6) 32-54, esp.35-36, and Epirus (Oxford 1967), see index under
"Sea level, changes of."
36. "The campaign and battle of Marathon"
JHS 88 (1968) 13-57. Revised versions of both the Salamis and Marathon
papers appear in Hammond's Studies in Greek history (Oxford 1973),
but nothing there affects the present discussion.
37. N.C. Flemming, N.M.G. Czartoryslca and P.M. Hunter,
"Archaeological evidence for eustatic and tectonic components of relative
sea level changes in the South Aegean., Marine Archaeology, ed.
D.J. Blackman, Colston Papers, Vol. 23, Proceedings of the 23rd Symposium
of the Colston Research Society (Bristol 1971) 1-63. Also see Flemming,
Cities in the
sea (New York 1971), App. II, and "Changes of land and sea
level in the Aegean area since the Bronze Ages", 155
57. The view the the sea reached close to its present level about 5000
years ago is found in H.E. Wright, Jr., "Glacial
fluctuations, sea-level changes and catastrophic floods," in Atlantis:
fact or f iction? ed. Edwin S. Ramage (Bloomington, Ind. and
London 1978) 161-74.
The matter, however, is being debated. Opposed to Flemming's view, and
arguing that the Mediterranean
sea level has been rising at the rate of about one meter per millennium
since about 6000 BC, is John Bintliff, Natural
environment and human settlement in prehistoric Greece, British
Archeological Reports, Suppl. Ser. 28i (Oxford 1977) 13-26,
although in his preface (p. 1) he suggests that he feels less confident
about his argument than when he first wrote it. Bintliffs
thesis is summarized in his "New approaches to human geography. Prehistoric
Greece: A case study., in F.W. Carter (ed.), An
historical geography of the Balkans (London, New York and San Francisco
1977), chap. 3.
38. E.g., thc block of the Peloponnesus is now tilted
relative to its position in antiquity, and apparently southeastern England
is sinking, with London some 12 feet lower today than it was in Roman times.
In Greece the effect of land subsidence caused by seismic disturbances
was clearly recognized by the excavators of the (now) underwater harbor
site at Kenchresi on the east side of the Corinthian isthmus. See Robert
Scranton and Joseph Shaw, "Changes in relative sea levels, App. E
in Robert Scranton, Joseph W. Shaw and Leila Ibrahim, Kenchreoi, eastern
port of Corinth I. Topography and architecture (Leiden 1978). The authors
have compiled a useful list (with sources) of earthquakes attested in the
region and have added an outline of the effect of these seismic disturbances,
which have resulted in a subsidence of more than two meters since Roman
times. In some cases, however, earth movements have caused a relative rise
in land forms, as in the example of the isthmus of the Athos peninsula,
which is nearly 14 meters higher today than when Xerxes cut a canal through
it. An important methodological point emerges from these studies: the evidence
of a few scattered submarine remains from antiquity cannot, without corroborating
geological data, be used alone to prove that there has been a general rise
in the sea level of the Mediterranean.
39. For example, a comparison of Denton and Porter's
data (op. cit., n. 29) showing estimated average fluctuations of mountain
glaciers (an indicator of shifts between warmer/wetter and cooler/drier
climate patterns) with pollen records from the plain of Philippi shows
no correlation between climate change and the two brief periods
(ca. 1900-1300 BC and ca. 1050-500 BC ) during which a few
olives grew in the region. See Denton and Porter 107,and Grieg and Turner
(cit. n. 33), passim. For a review of additional studies supporting
the notion that the climate of Greece today is much as it was in Classical
antiquity, see Bintliff, Natural environment 51.
40. Although the famous honey-bees have fled Attica's
Mt. Hymettos for relief from the quarrying operations, the small purple
Hymettan flowers that occasionally suffuse Athens' atmosphere with a reflected
pale violet light in the late afternoon sun still exist. For Hesiod's comments
on the seasons see Erga 383ff., 415ff., 448ff., 479ff., and 564ff.
While we cannot pinpoint Hesiod's home-town of Ascra, the region of Mt.
Helikon where it was located is still "bad in winter, difficult in
summer, good at no time" (Erga 639-40). On the abundance of
pine, oak and beech--major Macedonian woods today--in antiquity, see, e.g.,
Theophrastus, Hist. Plant. 3.8.7; 3.9.2,6; 3.10.2; 4.5.5; 5.2.1.
For a useful survey of Macedonian timber resources see E.C. Semple, The
geography of the Mediterranean region. Its relation to ancient history
(London 1932) 276-77. The olive tree, which characterizes the "Mediterranean"
climate par excellence, is not a regular feature of the Macedonian
scene. Mention of its existence in Macedonia is lacking in our ancient
sources (except for a fragment of Theopompus in Athen. 3.77E, which is
too complex to deal with here beyond pointing out that it is mainly nonsense,
speaking as it does of double-bearing fruit trees and fig trees, vines
and olive trees producing fruit in the middle of Spring). Except for the
southern slope and the peninsulas of the Chalcidice, the olive is rarely
seen in Macedonia. the climate being too harsh and unmitigated by Mediterranean
sea-breezes. The northern limit of olive trees I have observed lies along
the northwestern Chalcidic coast about 20 miles south of Salonica (This,
of course, excludes the single tree which the Director of the New York
and San Francisco 1977), chap. 3. Archaeological Museum in Salonica claims
to have planted and nurtured in the Museum courtyard!) For a general survey
of plant life in Macedonia see W.B Terrill, The Plant-liJe of the Balkan
peninsula A phytogeographical study (oxford 1929).
As for fauna, many of the wild and domesticated animals of antiquity--goats
sheep, cattle, boar, pigs--are common enough today in the mountains and
plains of the region. Finally, both Xerxes and Odysseus would appreciate
the warnings on wind force at Athos and Malea mentioned by any Mediterranean
pilot's guide, and confirmed by the Greek Meteorological Service; some
of this information appears in a table which accompanied my "Alexander's
Communications", Archaia Makedonia II (Thessaloniki 1977);
see p. 303 for Kythira, lying opposite Malea. Where these matters can be
checked, it appears that the general climate of Greece in modern times
is similar to what it was in classical antiquity.
41. See Bruce-Chwatt 36S-77.
42. Evidence of malaria may exist in some first-millennium
BC mummies, and splenomegaly is mentioned in Egyptian medical texts (ibid.),
although the symptoms may reflect other diseases as well. It would
appear that malaria was more prevalent in upper Egypt than in the region
of the Nile Delta; see the studies cited by Bruce-Chwatt 373 and 376. One
also recalls that Herodotus commented on the excellent health of the Egyptians
(2.77), even while describing (2.95) the annoying biting flying insects--probably
mosquitoes. Much of the above is confirmed by modern experience. It is
curious that lower Egypt--in particular the vast Delta, which on ecological
grounds alone would appear likely to be malarious--is only mildly infected,
even though the country is surrounded by regions of intense malaria in
the eastern Mediterranean and tropical Africa. None of the deadly anopheline
vectors of East Africa, the Near East or the northern Mediterranean littoral
inhabit the Nile Delta The short life of the ubiquitous Delta mosquito,
A. pharoensis, living under conditions of extreme heat and low humidity,
plus the inability of the fearsome A. gambiae to penetrate into
Egypt from the south because of the geographical configuration of the upper
Nile valley, has made transmission of the disease into the region
difficult. Only in the oases of the Western Desert, where some hardy anophelines
have adapted to the harsh existence, and in the pools of the upper Nile
is malaria a serious health hazard; see Hackett, in Boyd, Malariology
794-9S, and George Macdonald, The epidemiology and control of malaria
(London 1957) 51 and 75-77.
43. Evidence for antiquity cited in Jones, Malaria
and Greek history 23-59 (nonmedical writers) and 61-73 (medical writers).
Also, see a selection of passages describing malaria drawn from the Hippocratic
corpus, Aristophanes, Varro. Celsus, Pliny the Elder and Martial, in R.
H. Major, Classic descriptions of diseased (Springfield, Ill.
and Baltimore 1939) 105-111.
44. Henry E. Sigerist, History biomedicine II (cit.
n. 14) 66; Bruce-Chwatt 377, whose citation of Sigerist is incorrect.
45. See Bruce-Chwatt 376, for the incidence of malaria
in Mesopotamia as early as ca. 2000 BC. Sigerist, The Soc. of
Med. (cit. n. 8) 338, suggested that Greece was saved because of the
outbreak of an epidemic of malaria that decimated the Persian armies. Sigerist,
however, offered no evidence for this, and the reader is left wondering
whether the Persians suffered from an affliction brought with them or from
one contracted in Greece.
46. Laderman (p. 592) is among others who have suggested
a Persian source for the disease. For another example of an infected army
spreading malaria, see note 8 above. An extraordinary example of malaria
being transmitted into a region by an infected person occurred in 1952-53,
when a single outbreak of 35 cases was reported in California All the victims
were females (mainly teenagers) who had spent 12 days at a Camp Fire Council
summer camp at Lake Vera, California, in the foothills of the Sierra Nevada
near the Nevada border. Anopheline mosquitoes inhabit the area, but malaria
was virtually unknown in the region. Intensive investigation of the outbreak
revealed that the source of the infection was probably a single American
serviceman, recently discharged after duty in Korea, who himself had suffered
a malaria attack, and who was known to have spent a holiday weekend at
Lake Vera. The presence of the infected man in the area in early July,
and the appearance of symptoms among the girls not long afterwards, coincide
with the acceptable timing for infection and transmission by the mosquito
vector. See Rosemary Brunetti, RF. Fritz and A.C. Hollister, Jr., "An
Outbreak of Malaria in California, 19S2-S3", Amer. Journ. of Trop.
Med. and Hygiene 3 (19S4) 779-88. The development of international
travel on a mass scale at a time when malaria is increasing in the tropical
and subtropical regions (see note 2 above) raises the spectre that the
disease may again become a serious world health problem. Indeed, during
the final days of revision of the present paper, the travel section of
the Sunday edition of the New York Times (May 11, 1980) carried
a bleak and ominously-entitled article, "Travelers Are Warned of Increasing
Danger of Malaria."
47. See note 34 above.
48. In Greece the Lake Kopais region was also highly
malarious in modern times, yet continued to support a large, though diseased,
population. For the possibility that the area was malarious in antiquity,
see note 33 above.
49. I have not attempted yet to read through the accounts
of death and disease among the ancient Macedonians as preserved in authors
from antiquity, but attention should be called to the article of Donald
Engels, "A note on Alexander's deaths, CP 73 (1978) 224-28,
who argues that Alexander died of malaria first contracted in Cilicia.
Perhaps the king was reinfected at Babylon, the original source of the
disease having been Macedonia itself.
One might also wonder whether, when in the course of a campaign against
the Olynthians in 380 BC the Spartan king Agesipolis came down with fever
and died at Aphytis on the Cassandrean peninsula, the "fever"
might not have been malaria. See Xen. Hen. 5.3.10; Diod. 15.22.2,
23.2; Paus. 3.5.9; Tod, GHI 2.120. My thanks to Professor Fordyce
Mitchel for calling this incident to my attention.
50. History of Macedonia I (cited n. 1 above)
149 and 160.
51. Admiralty Handbook, Greece 111 (cited note
7 above ) 140 and plate 57.
52. The most comprehensive recent studies are by Hammond,
History of Macedonia I 145-47, C.F. Edson, "Strepsa
(Thucydides 1.61.4)", CP 50(195S) 176, and J. Bintliff, "The
plain of Macedon and the neolithic site of Nea Nikomedian", PPS
42 (1976) 241-62. and Hisr. Geog. Balkans (cited n. 37 above),
chap. 3 Whose reconstruction of the geological history of the Emathian
plain I follow. Apparently the observable chages in the plain's topography
are the result of a fairly well understood alluvial process, not of any
tectonic or volcanic shift.
53. See the distribution of prehistoric sites in D.H.
French, Index of prehistoric sites in central Macedonia (Athens 1967),
now reproduced as an end paper in R.A. Crossland and Ann Birchall, Bronze
Age migrations in the Aegean. Archaeological and
linguistic problems in Greek prehistory (London 1973).
54. Modern maps and travellers' accounts agree that
medieval and modern settlement also was confined to the nearby higher ground.
The eshablishment of villages in the plain itself had to await the twentieth-century
program of reclamation.
55. This is, roughly speaking, the route of the new
National Road, from which can be seen, near the village of Kleidi, the
sole remnant of the Roman road, an impressive bridge arch. For background,
see Hammond, History of Macedonia I 162, and Edson 180.
56. In Colonel Leake's time (1806) the lake of Yiannitsa
was deep and fresh enough to provide large pike to the residents of Naoussa.
See William Martin Leake, Travels in northern Greece 111 (London
57. We must assume that Macedonian farmers, like those
of Egypt and Mesopotamia in an earlier age, were capable of irrigating
and draining land on a small scale. But the evidence is lacking for any
large-scale reclamation in the Emathian plain, which was not receptive
to flood-control and irrigation works as used in thc Nile and Tigris-Euphrates
valleys. Even at Babylon, flooding continued to be a problem, and we hardly
need a reminder that it was in those very Babylonian marshes that Alexander's
final ailment struck; see note 49 above.
58. I am indebted to Don Brothwdl, Department of Environmental
Studies of the University of London, to Alexander C. Tokarewicz, M.D.,
and to the library staff of the London School of Hygiene and Tropical Medicine
for their assistance with some of the technical medical aspects of this
paper. The Editor of and readers for this Journal have offered additional
valuable criticism, which I acknowledge with gratitude. None of the above
is to be held responsible for my views.