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Not long ago a chance remark overheard in a BBC Radio 4 history program sent me to the computer to check a detail on the reign of King James I of England (James VI of Scotland), the first monarch of the Stuart dynasty and the only son of Mary Queen of Scots. Try as I might, I couldn't remember his exact dates, nor the circumstances of his death either, even though I had once studied the period in detail at school.

I soon discovered that James I had died at the age of 59 in 1625. The surprise was that one contributory factor in his demise was described as 'tertian ague'. This was a wholly unfamiliar term, what on earth could it be ? An ague I knew was a type of shivering fit associated with a fever, it comes from the Latin 'acuta febris' - (acute fever). I recalled reading of Sir Walter Raleigh defiantly puffing his pipe on Tower Hill and saying "It is the hour of the day when my ague comes upon me..."

So, a fever fit that appeared with clockwork regularity at a certain time on given days ? There was only one plausible candidate I could think of. Another search of an archive of archaic medical terms soon confirmed my suspicion.

Tertian Ague, also known as 'paludinal poison' or 'marsh miasm', was an old fashioned medical term for Malaria. Up until the late 19th century, Malaria was thought to be caused by the foul miasma of stagnant water in marshes, hence the name 'mal-aria' ('bad air' in Italian). As we now know it is in fact caused by a parasitic protozoal micro-organism spread by the bites of the female Anopheles mosquito (only the females drink blood incidentally, the males drink flower nectar). There happen to be several different subtypes of Malaria caused by slightly different species of the infectious parasitic organism. The form of Malaria caused by Plasmodium Malariae manifests itself in the form of a severe fever fit that happens every 36-48 hours. Hence the name 'Tertian Ague', because the affliction commonly descended on the patient as a fit on every third day. Other patterns of affliction were known as 'Quotidian Ague' (every day) and 'Quartan Ague' (every 72 hours).

The surprise here was discovering that Malaria which is normally thought of as a tropical or sub-tropical illness had once been endemic within England, and also sufficiently common to lay low kings of the realm too. An interesting article called "The History of Malaria in England" (Mary Dobson - 1999) published by the Wellcome Trust filled in a number of details:

Malaria probably existed in southern England from at least the time of the Roman invasions. By the 16th century AD it had become endemic in estuarine regions and most especially the low lying marshland areas of Essex and the East Anglian Fens.:
"Fenland locals became addicted to opium from locally grown poppies, while hostelries served opium-laced beer". writes Mary Dobson.
From around 1620 onwards, a rather more dependable remedy for Malaria began to gain popularity. Spanish Jesuit missionaries had brought back to Europe a medicine made from the bark of the Chinchona tree found in Peru. This became the earliest form of Quinine based medication available for treating Malaria in Europe. In England during the second half of the 17th century, a young apothecary's apprentice called Robert Talbor somehow gained knowledge of this medicine and over a period of years began to acquire a reputation as a specialist in the treatment of malarial fever in the Fenlands.

King James I was not the only English king to be laid low by Malaria. His grandson King Charles II also fell ill with the same disease in the late 1670s after the restoration of the monarchy in England. (Oddly enough, Oliver Cromwell who overthrew the monarchy and established the English Republic is said to have died of Malaria in 1658). There was a major European epidemic of Malaria between 1678-82, and the King contracted his illness from a mosquito bite while staying at Windsor in August 1679. King Charles II heard of the reputation of the Fenland apothecary, and enlisted his help. Robert Talbor's successful treatment of the King's malarial fever using a decoction of Chinchona bark led to an honorary knighthood and admission to the prestigious Royal College of Physicians. Robert Talbor subsequently also treated the son of the French king Louis XIV in the same way in 1679 and received a gift of 2,000 gold crowns and a pension. It wasn't until after Talbor's death two years later in 1681 that his special formula was published :
"six drams of rose leaves, two ounces of lemon juice and a strong decoction of the cinchona bark served with wine. Wine was used because some alkaloids of the cinchona bark are not soluble in water, but are soluble in the ethanol in wine."

Quinine was first extracted from Chinchona bark in a purer form from 1820 onwards, and remains an important medicine in the treatment of Malaria to this day. Scientists are still unsure precisely how or why it works. The best guess is that it promotes a cytotoxic uptake of Iron that kills the parasite. Malaria remained an endemic disease in parts of southern England up until 1950 when it was finally eradicated by systematic improvements in drainage and vector control in marshland areas.

A lengthy list of Kings and other famous people in history who died from Malaria can be found at :

Last edited by toucana on July 7th, 2012, 5:23 pm, edited 4 times in total.
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