title: The sudden death of Alaric I (c. 370-410AD), the vanquisher of Rome: A tale of malaria and lacking immunity.
abstract: BACKGROUND
  Alaric I (c. 370-410AD), 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 410AD, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland. Electronic address: francesco.galassi@iem.uzh.ch.
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Galassi
authors.affiliation: Department of Public Health and Paediatric Sciences, Legal Medicine Section, Laboratory of Physical Anthropology, University of Turin, Corso Galileo Galilei 22, 10 126 Turin, Italy; Faculté de Médecine de Marseille, UMR 7268, Laboratoire d'Anthropologie bio-culturelle, Droit, Etique & Santé (Adés), France.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bianucci
authors.affiliation: Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Gorini
authors.affiliation: Botswana-University of Pennsylvania Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana; Perelmann School of Medicine, University of Pennsylvania, Building 421, 5162, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Giacomo M
authors.initials: GM
authors.lastname: Paganotti
authors.affiliation: Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Habicht
authors.affiliation: Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rühli
mesh_terms: D003645:Death, Sudden / Q000209:etiology*; D049690:History, Ancient; D006801:Humans; D007109:Immunity; D016778:Malaria, Falciparum / Q000266:history* / Q000276:immunology*; D008297:Male; D010164:Paleopathology; D012384:Rome; D012621:Seasons
keywords: Alaric I; Immunity; Malaria; Paleopathology