It is believed that his disease was a malarial form of recurrent quinsy acting upon an extremely neurotic system.
In 1557, however, a great flood caused the Tiber to change its course, so that it no longer flowed under the walls of the castle, but some half a mile farther west; and its old bed (Fiume Morto) has ever since then served as a breeding ground for the malarial mosquito (Anopheles claviger).
In the north, however, the hot lowlands are malarial and unsuited to north European settlement, while the dry, elevated plateaus are celebrated for their healthiness, those of Catamarca having an excellent reputation as a sanatorium for sufferers from pulmonary and bronchial diseases.
Malarial fevers make their appearance in places where the forest has been recently felled, or where the surface earth has been disturbed.
Part of the state on the Atlantic coast and along the lower Parnahyba is low, swampy and malarial.