Malaria: The Ancient Disease That Likely Killed Genghis Khan

Despite being a disease which has caused devastation throughout the modern period, malaria has been affecting the earth’s population since the ancient period too. Without modern technological advancements, our ancestors were left to fend off this deadly disease whilst lacking the scientific and medical developments we have made today. Nevertheless, this did not prevent any attempts to cure the disease and many endeavored to do so. These methods include both medical practices and public health measures. The Romans went so far as to build infrastructure in their cities to prevent the spread of the disease. So, what other methods did ancient people use to fight this deadly disease? How did their medical ideologies influence how they tackled it? And what medical theories did they use to explain their practices?

There is biological evidence that malaria was endemic in Ancient Egypt. Recently the malaria antigen (P. falciparum) was discovered in Egyptian remains which date from around 3200 and 1304 BC. Physical evidence has also shown that ancient Egyptians used a handful of methods to tackle the disease; one of these was bednets.

There is evidence that both the Pharaoh Sneferu (reigned 2613-2589 BC) and Cleopatra VII (reigned 51-30 BC) used a bed net to protect themselves against mosquitoes. It is unclear, however, whether they used these nets to protect themselves against malaria specifically or against the general discomfort caused by mosquito bites.

Herodotus, the Ancient Greek historian wrote that the builders of the pyramids in Ancient Egypt (2700-1700 BC) were given garlic to protect them against malaria. Whether this was actually the case, however, is unknown.

Hippocrates & the Four Humors: Malaria in Ancient Greece

There is also evidence that malaria was wreaking havoc on the population of Ancient Greece.

The Greek poet Homer (750 BC) mentions the disease in The Iliad as well as Aristotle (384-322 BC), Plato (428-357 BC) and Sophocles (496-406 BC) who all mention the disease in their work. This written evidence implies there was a cultural understanding of the disease in Greece at the time.

Perhaps the most influential work on malaria in Ancient Greece, however, was conducted by the physician Hippocrates (450-370 BC). Now considered the “Father of Medicine,” Hippocrates, like Homer linked the appearance of Sirius the dog star (late summer/autumn) with malarial fever and misery. He also noted the connection of the disease to the marshes just outside of Athens as well as the disease causing the enlargement of the spleen. Furthermore, he described the “malaria paroxysm” (chills, fever, sweats, exacerbation).

Hippocrates also recognized that those who died from the disease often had black deposits on their organs. He argued that these were characteristic of malaria and were due to a build-up of black bile in the body. This theory was held up by Hippocrates’ own, wider theory of medicine which formed the base of much medical understanding for centuries to come.

Hippocrates’ theory was based on what he called the four humors. According to this understanding, the body contained four liquids: blood, phlegm, yellow and black bile. In order for an individual to be healthy, these four liquids had to be perfectly balanced, existing in harmony alongside one another.

It was when these humors were unbalanced, by either too much or too little, that problems were caused and disease resulted. It was, therefore, evidence to Hippocrates and those who agreed with his theory that these black deposits found on people’s organs were caused by an excess of black bile. Therefore, in order to cure malaria, this excess had to be treated and set right. This would have been done by purging the body of the bile through the use of medicines like laxatives.

By the Roman period, the disease had become much more serious. While Ancient Romans recognized the connection between stagnant water, the summer months, and malaria, this did not make the disease any less devastating.

In their book on the disease, KJ Arrow, C Panosian, and H Gelband argue that malaria’s appearance in Ancient Rome during the first century BC marked a turning point in European history. They argue that the disease probably traveled to Europe from Africa down the Nile and to the Mediterranean. Roman merchants carried it through Europe as far east as Greece and west to England and Denmark.

Whilst the inherent medical beliefs behind the Ancient Romans’ connection between stagnant water and malaria were wrong, they did motivate them to make medical decisions that, unbeknownst to them, helped prevent the disease from spreading.

One of these medical beliefs was the idea that disease was caused by bad air (mal aria). Because malaria was always found around stagnant water, ancient Romans believed that it was the horrid smell coming from the water that was causing the disease, not the mosquito bites.

However, because of this, they unknowingly made the correct connection between bodies of water and the disease. This motivated them to improve their cities and towns. Roman engineers began developing and building drainage networks to remove this stagnant and smelly water from populated areas. This effectively limited malaria in areas where the drainage systems were in place.

Aulus Cornelius Celsus, the Roman encyclopedist (25 BC – 54 AD), wrote about malaria in his treatise on medicine. In De Medicina (vol. 1), he describes the course of the disease. Translated from the original Latin, he states:

“The fevers begin with shivering, then a heat erupts, and then, the fever having ended, the next two days are free of it. On the fourth day it returns.”
(Cunha and Cunha, 2008)

He then proceeds to describe two kinds of fevers the disease could be responsible for. He states that some people who suffer from the disease simply become cold, and others get shivers. Some seem to recover from the illness only to become ill again:

“Again, some end with that, and a period free of symptoms follows; others end thusly, so that the fever diminishes somewhat, but nevertheless, some remnants of disease remain, until another paroxysm occurs; and some often have no remission, and continue on.”
(Cunha and Cunha, 2008)

Some historians have even argued that malaria contributed to the downfall of the mighty Roman Empire. An epidemic of the disease in 79 AD destroyed the fertile and marshy croplands surrounding Athens, which were relied on heavily for food. Local farmers were forced, in the end, to abandon their farms and villages. This led to a mass shortage in food which, in turn, led to deaths.

With the eventual sacking of the Roman cities, which came with the military defeat of the Empire, came the unfortunate destruction of the drainage systems the engineers had built, which were preventing the spread of malaria. Therefore, the invading barbarians soon began to catch malaria again. Alaric, who was the first barbarian prince to conquer Rome in 410 AD, caught the disease as well as much of his army.

After the Ancient Roman period and the beginning of the very early Middle Ages, malaria continued to cause destruction as it had been since the Ancient Egyptian period. Another mighty empire that would be faced with its destruction was the mighty Mongol Empire (1206-1368) which was territorially 2.5 times larger than the Roman Empire and ruled over by the infamous Genghis Khan, history’s most famous conqueror. Despite his infamy, historians and archaeologists are still uncertain about what caused Khan’s death.

The difficulty in determining Khan’s death is caused by the Mongolian belief that after the death of a king, the body would retain some of its divine power. Thus, the corpses of kings were buried in unmarked graves in protected and impracticable places like the mountains. Here those who wished to disrupt the grave would have an extremely hard time accessing it, but also, the site’s height would have made the corpse closer to heaven. Therefore, historians, archaeologists, and grave robbers have been unsuccessfully in locating his grave.

Because of this, the theories about his death have remained just that: theories. Without a body to examine, it is almost impossible to know for certain what led to the conqueror’s demise. This has not prevented stories from growing, however. One of the most popular is that malaria caused his death. Another is that it was a fall from a horse and the subsequent injury that led to his death. Others have argued that his death was caused by blood loss after he was stabbed by a Tangut princess. Or, some have suggested he perished in battle, either by a poisoned arrow in his last campaign against the Western Xia or a battle against the Chinese.

Khan’s death is further shrouded in mystery because his close family and friends were encouraged to keep the issue private. This, therefore, limits the written records about his death. They were instructed to do so because his death occurred right in the middle of his conquest of Western Xia, and his advisors did not want the issue to destabilize the empire.

To conclude, malaria was a disease that caused devastation throughout much of history. During the ancient period, medical thinkers and governments attempted to control and prevent the spread of this deadly disease either through applying contemporary medical theories or through public health measures. Whilst some of these efforts were ultimately futile, some early theories, like the link by the Romans between stagnant water and malaria, led to early civilizations unknowingly preventing malaria’s spread through their cities.