Folk medicine used to heal malaria in Calabria (southern Italy)

The empirical remedies that were used by the Calabrian people, as evidenced by the sources consulted in this work, were used both prophylactically and therapeutically, and were based on drinks, objects, animals, plants and other sources; some of these elements were created ex novo, while others were inherited from the "official" medicine of 1th-3th century AD [Tables 3 and 4].

Empirical prophylactic remedies. One of the most commonly used prophylactic empirical remedies was bleeding (which was already described by Galen that affirmed "Saluberrimum igitur, ut praediximus, est in febribus venam incidere" (during the fever, as mentioned, it is very useful to incise a vein) (De Methodo Medendi XI, 15) [17]. Bleeding was performed preventively by "barbieri" (barbers) and "magare" (witches) during the month of March [53]. During the same period (when the cure was called "marziale"), Calabrian people drank different types of decoctions, such as those made with "durcamara" (Solanum dulcamara L.), "acropastu" (Cynodon dactylon (L.) Pers.), "strazza buttuni" (Smilax aspera L.) and "fumaria" (Fumaria officinalis L.) [11, 54]. To prevent contagion of the disease during the night in the summer months, people slept for few hours and near a fire [54‐56]. Moreover, they drank strong spirits or wine. In particular, they were advised to drink half a litre of wine on an empty stomach [57, 58], eat garlic (Allium sativum L.) [59], smoke and chew tobacco and swallow the spittle [56, 60], while always maintaining the pipe in the mouth [54‐56]. On awaking, it was recommended to eat a macerate of raw garlic in vinegar [54]. Finally, people living on the coast used to spread olive oil mixed with absinth on their bodies, according to Dioscorides who affirmed "Itemque ex oleo perunctum, culices abigere, ne corpus tangant" (Rubbed on with oil it forbids the mosquitos to touch the body) De Materia Medica, III, 23) [16, 61] and according to Pliny "culices ex oleo perunctis abigit" (who use this oil keep mosquitos away), Naturalis Historia XXVII, 28) [13].

Empirical therapeutical remedies. Fasting and purging were recommended for the treatment of malaria-associated fevers. Fasting was thought to appease fever, while purging was thought to remove the malaria-causing parasite from the affected organism. In general, purging was achieved via the administration of ricinus seeds (Ricinus communis L.) and by using the root of "savucu" (Sambucus nigra L.) [26]. Fasting and purging were inherited from Galenic medicine. Galen wrote the following about fasting: "(in tertiariis) ... neque quotidie cibum dare oportet, sed alternis diebus abunde fuerit" (with tertian fevers ... food must not be offered every day, but on alternate days) (Ad Glauconem de medendi methodo I, 11) [18]; and about purging: "ac vacuatio quidem excrementorum omni febri est utilissima" (during the fever, no doubt, it is very useful to defecate) (Methodo medendi IX, 10) [17]. Other treatments aimed at purging and restoring the affected subjects were also used. These included the decoction of "gamumilla" (Matricaria chamomilla L), "ordica" (Urtica dioica L., Urtica urens L.), and the decoction of the root of "alivu" (Olea europaea L.) or of the rhizome of "canna" (Arundo donax L.) [26, 62, 63]. Several empirical therapeutic remedies against malaria-associated fevers were loathsome. These included the ingestion of the subject's own urine, that of young virgin or that of a healthy woman (in particular, the affected subject was advised to drink 100 g of the urine of a non-affected woman early in the morning) [55‐57, 64], the consumption of various animals (or parts of animals), such as earthworms (Lumbricus terrestris) which were previously placed in the oven and pulverized, or two or three bedbugs (Cimex lecturalius) within a Host [56, 58, 64]. Moreover, patients were encouraged to eat pills of "pappici" (cobweb) [26, 56, 63‐66], the head of a viper (Vipera aspis), fried and mixed with absinth [55], goat (Capra hircus) dung within a Host, eaten from morning until midday [26, 57], one spoonful of coffee per hour [57] and pills of soot [67, 68]. Alternatively, to cure hepato-spleenomegaly were used hedgehog (Erinaceus europaeus) or ox (Bos taurus) gall and goat (Capra hircus) dung [55]. As three "Cantarelle" (Cantharis vescicatoria) minced in water were used as a diuretic against dropsy [56].

Calabrian people believed without any doubt in the remedies described above; however, they also used numerous plants to cure malaria. Some of these plants are still currently used in Calabrian folk medicine to cure various diseases [Table 1]. Many decoctions or infusions of various herbaceous species were used to cure malaria-associated fevers. These herbaceous plants included "issopu" (Hyssopus officinalis L.), "valariana" (Valeriana officinalis L.), "filici masculu" (Dryopteris filix-mas (L.) Schott.), "lupinu" (Lupinus albus L.), "cametriu" (Teucrium chamaedrys L.), "brundulija" (Erythraea centaurium (L.) Borkh.), "centu gruppa" (Centaurea centaurium L.), "centarva" (Centaurea benedicta L.), "sarvia" (Salvia officinalis L.), "rosamarinu" (Rosmarinus officunalis L.), "nepitella" (Calamintha nepeta (L.) Savi), "ruta" (Ruta spp.), "erva janca" (Artemisia absinthium L.), "cipuddra" (Allium cepa L.), "agliu" (Allium sativum L.), "millefoglio" (Achillea millefolium L.), "erva pignola" (Borago officinalis L.), "marrobio nero" (Ballota nigra L.), "campezio" (Ajuga chamaepitys Guss.), "elitropia" (Heliotropium europaeum L.) (which was ingested with white wine), "genziana" (Gentiana lutea L.) and "erba i la crucivia" (Verbena officinalis L.) [11, 26, 55‐58, 60, 62‐65, 67‐72]. Some ligneous species must be added to this list, particularly the following plants: the aerial parts of "vruca" (Tamarix spp.), and "leandru" (Nerium oleander L.); the leaves of "alivu" (Olea europaea L.) and "calipsi" (Eucalyptus spp.); the roots of "granato" (Punica granatum L.), "cucumele" (Prunus spinosa L.), "savucu" (Sambucus nigra L.), and "cerza" (Quercus spp.). The bark of "cucumele", "cerza" and "salici" (Salix spp.) was also used [24, 26, 55, 58, 62, 65, 68, 69, 72, 73].

Other remedies were similarly efficacious; these included the mesocarp of "nuci" (Juglans regia L.) chopped finely and mixed with wine, "bergamotto" (Citrus bergamia Risso), "limuni" (Citrus limonum Risso, which was broken, boiled and maintained fresh overnight, then drunk at breakfast for three mornings), "pipi nivuru" (Piper nigrum L.), "pepe arsente" (Capsicum annuum L.) and ten bitter seeds of decorticated "lupinu" (Lupinus albus L.), taken in the morning [11, 56, 58, 60, 62‐65, 68, 74, 75].

Other than fever, the most evident symptoms of malaria are hepato-spleenomegaly and dropsy. We also found descriptions of several remedies for these symptoms. There were many cures for hepato-spleenomegaly: a decoction of the root of "chiappara" (Capparis spinosa L.), or of "acropistu" (Urtica dioica L., Urtica urens L.), the latter taken together with potassium nitrate in the morning; eating "cipuddra" (Allium cepa L.) or "pipi" (Capsicum annuum L. Var. acuminatum Fing.), the latter together with a strong wine. Finally, another remedy involved the use of "cucumaju" (Chelidonium majus L.) [55‐57, 60, 63, 68, 76].

To treat dropsy, which was called "acqua 'ntà panza" (water in the stomach), Calabrian people used several diuretic remedies, such as "erba i muru" (Parietaria officinalis L.), "cipuddazza" (Urginea maritima (L.) Baker), and "cametriu" (Teucrium chamaedrys L.) [11, 26, 55, 56, 62, 66].

Because of the presence of malaria in the daily lives of Calabrian people, this disease was considered a normal life trouble; however, its most dangerous and deadly forms were considered by Calabrian people as a condition of supernatural nature. Therefore, they resorted to magic remedies that were believed to "link" the disease. These included, in particular, wearing a "nuci trischéra o a tri guarri" (a three-valve walnut shell) (Juglans regia L.), a spider that was enclosed between two shells of a walnut or skin, skeleton and fangs of snake, the latter extracted when animal was still alive, as it was believed that the disease would then affect the walnut, the spider or the parts of the snake, and not the subjects who wore these amulets [65, 77]. Furthermore, a live "carpurita" (Pachyiulus communis) was sewn into the clothes of the affected subject (without the patient realizing it) or a "paletta" (Opuntia ficus-indica (L.) Mill.) was placed near the fireplace. It was believed that when the animal died, or when the stem of the plant dried, the fever or the hepato-spleenomegaly would disappear [26, 60]. In an analogy with the ancient belief in the therapeutic principle of "contact", to defeat spleenomegaly Calabrians were encouraged to place "erba i la crucivia" (Verbena officinalis L.) on the abdomen of the affected subject before sleeping, as it would absorb the "bad blood" [56, 57, 62]. Finally, every morning the affected subject had to urinate on "cucuzzielli acriesti maturi", the fruits of Ecballium elaterium (L.) A. Rich., to transfer the disease from the subject to the fruit [57].

Calabrian people alternated or combined both empirical and magical remedies and, very often, used prayers and acts of devotion, as diseases were believed to be associated to divine punishment. Thus, in Cosenza (Northern Calabria) the "Madonna della Febbre" was invoked with prayers, ex voto and pilgrimages [78]; in Castrovillari (province of Cosenza), the prayer to the "Madonna d'Itria" was as follows: "Madonna mia 'i L'Itria, chi stai 'nganna a'sta jumara fammi passà 'sta freva 'i quartana c'u jurnu tuju non vugghiu mangià panu" ("My Lady of Itria, close to the river, let the fever out and on your commemoration day I will not eat bread") [79].