The sudden death of Alaric I (c. 370–410AD), the vanquisher of Rome: A tale of malaria and lacking immunity

Published:March 09, 2016DOI:https://doi.org/10.1016/j.ejim.2016.02.020

      Abstract

      Background

      Alaric I (c. 370–410 AD), King of the Visigoths, sacked Rome for the second time in over eight centuries of history. Historians suggest that malaria, probably contracted either in Rome or in the Pontine Marshes, was responsible for his sudden death in Cosenza (Calabria) in the autumn of 410 AD, where he was allegedly buried in the River Busento. In this article, we aim to examine this hypothesis through a full pathographic reassessment of the most likely cause of Alaric's demise.

      Methods

      To achieve this, we resorted to a dual philological–medical approach: clinical likelihood and malaria seasonality coupled with primary historical sources (mainly Jordanes' work De origine actibusque Getarum) and the reconstruction of the itineraries followed by Alaric and his army after the sack of Rome.

      Results

      Sudden death is caused by several factors. The possibility that Alaric died of a cardiovascular disease was discarded since no description of potentially pathological signs emerged from the available sources. Given his lack of semi-immunity, falciparum malaria was considered as the most likely cause of his demise. It took him over two months to reach the coasts of Calabria during the peak of malaria's transmission (summer–autumn). During the march, Alaric did not suffer from recurrent fevers or other ailments, which would have been reported by historians.

      Conclusion

      The scenario emerging from this multidisciplinary reanalysis allows us to hypothesise that Plasmodium falciparum malaria, contracted during his journey through Calabria, was the most likely candidate responsible for Alaric's unexpected demise.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Ghilardi M.
        • Pilara G.
        I barbari che presero Roma. Il Sacco del 410 e le sue conseguenze.
        Aracne editrice, Roma2010
        • Jordanes
        De Origine actibusque Getarum.
        in: CC Mierow The Gothic History of Jordanes. Princeton University Press, Princeton1915: 156-158 (English Translation)
        • Procopius
        History of the Wars, Books III and IV. The Vandalic War.
        (with an English translation by H.B. Dewing. Loeb Classical Library) London: William Heinemann. New York: G.P. Putnam's Sons, 1916
        • Wolfram H.
        History of the Goths.
        University of California Press, Berkeley, Los Angeles, London1990: 160
        • Galassi F.M.
        • Ashrafian H.
        Has the diagnosis of a stroke been overlooked in the symptoms of Julius Caesar?.
        Neurol Sci. 2015; 36: 1521-1522
        • Sallares R.
        Malaria and Rome.
        Oxford University Press, Oxford2002: 225
        • Celli A.
        The History of Malaria in the Roman Campagna from Ancient Times.
        Bale and Danielson, London1933: 58
        • Bray R.S.
        Armies of Pestilence: The Impact of Disease on History.
        James Clarke & Co., 2004: 99
        • World Health Organisation
        ([accessed 13.01. 2016])
        • Centre for Disease Control and Prevention
        ([accessed 13.01.2016])
        • Pasvol G.
        The treatment of complicated and severe malaria.
        Br Med Bull. 2005; 75-76: 29-47
        • Artavanis-Tsakonas K.
        • Tongren J.E.
        • Riley E.M.
        The war between the malaria parasite and the immune system: immunity, immunoregulation and immunopathology.
        Clin Exp Immunol. 2010; 133: 145-152
        • Caramelli G.
        • Lipani F.
        • Macor A.
        • Bellor S.
        • Riva G.
        • Caramello P.
        Severe and complicated falciparum malaria in Italian travelers.
        J Travel Med. 1998; 5: 39-41
        • Yapo E.H.
        • Koffi K.
        • Botti K.
        • Jouvet A.
        • Effi A.B.
        • Honde M.
        Sudden death caused by parasites: postmortem cerebral malaria discoveries in the African endemic zone.
        Am J Forensic Med Pathol. 2002; 23: 202-207
        • Retiers F.
        • Cilliers L.
        Periodic pyrexia and malaria in antiquity.
        S Afr Med J. 2006; 96: 685-688
        • Sallares R.
        • Bouwman A.
        • Gomzi S.
        The spread of malaria to Southern Europe in antiquity: new approaches to old problems.
        Med Hist. 2004; 48: 311-328
        • Bianucci R.
        • Tognotti E.
        • Giuffra V.
        • Fornaciari G.
        • Montella A.
        • Milanese M.
        • et al.
        Origins of malaria and leishmaniasis in Sardinia: first results of a paleoimmunological study. I Meeting Nazionale del GiPaleo. L'Aquila, 22nd March 2014.
        Pathologica. 2014; 106: 89
        • Bianucci R.
        • Mattutino G.
        • Lallo R.
        • Charlier Ph.
        • Jouin-Spriet H.
        • Peluso A.
        • et al.
        Immunological evidence of Plasmodium falciparum infection in a child mummy from the early dynastic period.
        J Archaeol Sci. 2008; 35: 1880-1885
        • Nerlich A.G.
        • Bettina S.
        • Dittrich S.
        • Jelinek T.
        • Zink A.R.
        Plasmodium falciparum in ancient Egypt.
        Emerg Infect Dis. 2008; 14: 1317-1319
        • Ziskind B.
        Malaria: a plague of ancient Egypt.
        Rev Prat. 2009; 59: 586-589
        • Lalremruata A.
        • Ball M.
        • Bianucci R.
        • Welte B.
        • Nerlich A.G.
        • Kun J.F.J.
        • et al.
        Molecular identification of falciparum malaria and human tuberculosis co-infections in mummies from the Fayum Depression (Lower Egypt).
        PLoS One. 2013; 8e60307
        • Khairat R.
        • Ball M.
        • Chang C.-C.H.
        • Bianucci R.
        • Nerlich A.G.
        • Trautmann M.
        • et al.
        First insights into the metagenome of Egyptian mummies using next generation sequencing.
        J Appl Genet. 2013; 54: 309-325
        • Bianucci R.
        • Araujo A.
        • Pusch C.M.
        • Nerlich A.G.
        The identification of malaria in paleopathology—the actual “state-of-the-art”.
        Acta Trop. 2015; ([S0001-706X(15)30098-X])
        • Sallares R.
        • Gomzi S.
        Bioarchaeology of malaria.
        Anc Biomolecules. 2001; 3: 195-213
        • Sallares R.
        Malaria and Rome.
        University Press, Oxford2002: 1-123
        • Scheidel W.
        Disease and death in the ancient city of Rome, Princeton/Stanford Working Papers in Classics.
        ([accessed 31.01. 2016])
        • Röthlisberger F.
        1000 Jahre Gletschergeschichte der Erde.
        Frankfurt, Sauerlander Aarau1986
        • Majori G.
        Short history of malaria and its eradication in Italy with short notes on the fight against the infection in the Mediterranean Basin.
        Mediterr J Hematol Infect Dis. 2012; 4e2012016
      1. Salisbury JE. Rome's Christian Empress‬: Galla Placidia Rules at the Twilight of the Empire. Baltimore, Maryland: JHU Press; 2015,‬ p. 74–77.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬

        • Tagarelli A.
        La malaria nella storia antica.
        in: Tagarelli Antonio La malaria in Calabria. Comitato per gli Studi Storici e Scientifici della Malaria in Calabria, Mangone (Cosenza)1997: 77-79