Sally Metzler
Chicago, Illinois, United States

Holy Roman Emperor Emperor Otto II (AD 955–983) conquered the Saracens and quelled the invading Magyar menace. However, his ambitious reign abruptly ended, not in battle, but in bed. At the young age of twenty-eight, he departed from this world. Tradition maintains that a malarial fever caused his premature death. Though this fever may have initially sparked his decline, the treatment, described as an “overdose of four drachms of aloes,”¹ more than likely sealed his coffin. In pharmacology, a drachm, or more commonly known as a dram, would be equivalent to approximately 4 ml (1/8 fluid ounce). Numerous varietals of aloe exist; therefore, the precise medicine administered to Otto remains unknown.

The only surviving son of Emperor Otto the Great and Adelaide of Italy, Otto II entered the political arena as a young boy, his father striving to secure a peaceful transition of power when that moment arrived. He carried forth his father’s political platform, aiming to strengthen the German Empire and take control of Italy. After reigning for merely a decade, while traveling home from an incursion with the Saracens, he stopped in Rome where he took ill. He died near St. Peter’s, on December 7, 983, and was laid to rest in a sarcophagus, originally in the atrium of the old basilica.²

At the time of his death, a malaria epidemic raged in Rome. Believed to have arrived from North Africa, malaria cast its noose on thousands of victims in antiquity. Though uncertainty persists surrounding the initial date of entrance, “the spread of malaria in Italy did not happen suddenly. It took at least 1500 years, from c.500 BC to c.1000 AD.”³ Conditions rampant in the eternal city such as poor drainage, hygiene, and overcrowding exacerbated the spread. The disease inflicted its wrath on the city and the countryside. Malaria lingered in Southern Italy as late as the 1930s to 1940s.⁴

The current pharmacological treatment in the United States for severe malaria prescribes intravenous drugs followed by an antimalarial oral regimen. The United States Food and Drug Administration approved in 2020 only artesunate for injection to treat severe malaria. Quinine fell out of favor and was no longer marketed in 2019.⁵ But in Africa, where healthcare facilities are limited, the situation diverges significantly; “Medicinal plants are the primary resource for treating malaria… Antimalarial drugs available there such as quinine, halofantrine, mefloquine, chloroquine, and artemisinin are of plant origin.⁶

Though Otto II died in 983, and aloe in some form was believed to combat malaria in centuries past, even today studies continue to explore the efficacy of aloe plants against malaria. A 2023 study conducted by the University of Pretoria found that natural active ingredients in the roots of an aloe species “have anti-plasmodial properties that have the potential to kill all the phases of the malaria-carrying Plasmodium falciparum parasite and block the all-important transmission.”⁷ Further, an investigation from 2021 evaluating the potency of aloe to thwart malaria concluded that in addition to its benefits in assuaging skin wounds, the leaf latex of Aloe weloensis successfully curbed malaria.⁸

For centuries, aloe has served as a panacea for myriad ills in nearly mythic proportions, purportedly providing succor for skin wounds and overall epidermal enhancement, digestive issues, and afflictions of the gums, as well as boosting immunity and others. Current clinical trials focus on issues relating to the “application of Aloe vera and its main compounds, particularly on bone protection, cancer, and diabetes.”⁹ Much of the research today concerning the treatment of malaria with aloe appears unaware of the earlier practices of the ancients. Indeed, many medical beliefs and procedures of days gone past have been rightfully and resolutely refuted, among these bleeding and removing tonsils. Nevertheless, in the case of Emperor Otto II, one should be reminded that what is past is prologue, and lessons from history remain dear, if not in some circumstances, lifesaving.

End notes

1. J. Julius Norwich, A History of Venice (New York: Vintage Books, 1989): see p. 47.
2. For more on Otto’s sarcophagus, see: https://stpetersbasilica.info/Grottoes/Otto%20II/Tomb%20of%20Otto%20II.htm
3. See p. 318: Robert Sallares, Abigail Bouwman, and Cecilia Anderung, “The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems,” Medical History, Jul 1, 2004;48(3):311-28.
4. See: Jazz Demetrioff, “Miasma: Malaria’s Breeding Grounds and its Effects on Rome,” Past Imperfect 2020;22:3-32.
5. FDA press release, May 26, 2020: FDA Approves Only Drug in U.S. to Treat Severe Malaria.
6. See: Gedefaw Getnet Amare, Amsalu Degu, Peter Njogu, and Zemene Demelash Kifle, “Evaluation of the Antimalarial Activity of the Leaf Latex of Aloe weloensis (Aloaceae) against Plasmodium Parasites,” Evidence-Based Complementary and Alternative Medicine, 2021:1-8. https://doi.org/10.1155/2021/6664711
7. Sephora Mianda Mutombo, Luke Invernizzi, Mariëtte van der Watt, Janette Reader, Phanankosi Moyo, and Lyn-Marié Birkholtz, “In vitro dual activity of Aloe marlothii roots and its chemical constituents against Plasmodium falciparum asexual and sexual stage parasites,” The Journal of Ethnopharmacology, October 28, 2022;297. Summarized in the University of Pretoria newsletter, Research Matters, February 9, 2023: https://www.up.ac.za/research-matters/news/post_3126442-up-led-study-finds-aloe-plant-could-impede-life-cycle-of-malaria-carrying-parasite
8. The study “confirmed the prominent antimalarial activity of the leaf latex of Aloe weloensis against the 3D7 strain of P. falciparum and P. berghei and corroborate its use in folk medicine. The medium and higher doses of the latex showed a greater prophylactic and curative effect. Therefore, an advanced study is required for organ toxicity study and to identify, characterize, and isolate the bioactive compounds that possess the antimalarial activity.” See p. 8 in Gedefaw Getnet Amare et al.
9. For an overall discussion of the efficacy of aloe and its comprehensive use, see: Marta Sánchez, Elena González-Burgos, Irene Iglesias, and M. Pilar Gómez-Serranillos, “Pharmacological Update Properties of Aloe Vera and its Major Active Constituents,” Molecules Molecules March 13, 2020;25(6):1324. https://doi.org/10.3390/molecules25061324