Early Descriptions of Malarial Illness

Malaria as a clinical entity was well known to ancient peoples of the world. References to repeated paroxysmal fevers associated with enlarged spleens and a tendency to epidemic occurrence can be found in the Chinese Nei Ching (The Canon of Medicine), dated 4,700 years ago. The Sumerian and Egyptian texts dating from 3,500 to 4,000 years ago refer to fevers and splenomegaly and also to deadly epidemic fevers, probably due to P. falciparum. The Vedic (3,500 to 2,800 years ago) and later scriptures of Northern India (Indus valley), as well as the medical texts such as Charaka Samhita (300BCE) and Susruta Samhita (300-400CE) also contain many references to fevers akin to malaria.[1] In ancient Greece, malaria was considered as ‘the fever’ and the Romans knew of its ‘intense burning’ and its periodicity.[2]

Hippocrates (Greece, 460-370 CE) was the first to clearly describe the different types of malaria depending upon the tertian and quartan periodicity of the fever as well as to appreciate the diagnostic significance of splenomegaly in malaria.[2] He also related the fever to time of the year and to where the patients lived. Celsus (Rome, 25BCE-54CE) differentiated between a tertian fever with a clear, day long, fever free interval and a semi-tertian fever that had longer duration of fever and shorter or no remission. Galen, (Rome, 129-199CE) recognized its association with jaundice.[2]

William Osler (Canada, 1849 –1919CE) clearly described the symptoms and clinical course of malarial illness and also clearly differentiated between the clinical features of malaria and typhoid fever.[2] Osler’s description of a malarial paroxysm was as below:


The patient generally knows he is going to have a chill a few hours before it is evident by unpleasant feelings and uneasy sensations, sometimes by headache. The paroxysm is divided into three stages—cold, heat, and sweating. Of symptoms associated with the chill, nausea, and vomiting are common. There may be intense headache. The pulse is quick, small, and hard. The chill lasts for a variable time, from ten to twelve minutes to an hour, or even longer. The hot stage is ushered in by transient flushes of heat; gradually the coldness of the surface disappears and the skin becomes intensely hot. The face is flushed, the hands are congested, the skin reddened, the pulse is full and bounding, and the patient may complain of a throbbing headache. The duration of the hot stage varies from half an hour to three or four hours. The patient is intensely thirsty and drinks eagerly of cold water. In the sweating stage, the entire body is bathed in a copious sweat. The uncomfortable feeling associated with the fever disappears, the headache is relieved and within an hour to two the paroxysm is over and the patient usually sinks into a refreshing sleep.[2]


  1. The History of Malaria, an Ancient Disease. Available at http://www.cdc.gov/malaria/history/index.htm
  2. Cunha CB, Cunha BA. Brief history of the clinical diagnosis of malaria: From Hippocrates to Osler. J Vector Borne Dis 2008;45:194–199. Available at http://www.mrcindia.org/journal/issues/453194.pdf

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