Malaria and Rome: A History of Malaria in Ancient Italy, Robert Sallares [reading a book TXT] 📗

The reason for the unreliability of ¹¹ Raoult et al. (1998) and Tarasevich et al. (1998) on typhus.

¹² Shaw (1996: 112); Brown (1986: 857).

¹³ Del Panta et al. (1996: 292 n. 10): le statistiche ufficiali possono cogliere, purtroppo, solo la fase dis-cendente della mortalità per malaria, a partire dal 1887; del Panta et al. (1996: 152); Sori (1984: 542–3).

¹⁴ L. Molineaux in Wernsdorfer and McGregor (1988, vol. 2, p. 974).

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national statistics is that ‘medical science shows that for each death attributed to malaria there are several other deaths, which are attributed to other causes, but nevertheless are directly linked to malaria or indirectly caused by the debilitating effects of malaria infections’.¹⁵ The empirical demographic evidence for this conclusion is that it has frequently been observed, both in Italy in the past and in tropical countries today, that after the eradication of malaria the reduction in total mortality rates is much larger than the reduction that would have been predicted from the proportion of deaths that were directly attributed to malaria before its eradication. For example, Hackett described the town of Sermoneta on the edge of the Pontine Marshes in 1925, just before eradication started. The population of Sermoneta, which could not reproduce itself, had a crude death rate of 41 per 1,000. All the children had splenomegaly, but only a dozen individuals, mainly children, had acute symptoms of malaria, because almost all adults had developed acquired immunity earlier in life. Only 8% of all deaths were directly attributed to malaria in 1925 (in absolute numbers, three out of thirty-seven). Nevertheless the eradication of malaria in Sermoneta led to a fall in the crude death rate from 41 per 1,000 to 20 per 1,000.¹⁶

Although the problems of Sermoneta in the early twentieth century were a product of the early modern period, there is no doubt that other communities in western central Italy were affected in the same way much earlier. For example, Toubert quoted the decree of Pope Innocent IV in  1253 granting permission to the inhabitants of Mozzano to move their village to a new location, because of ‘bad air’ in summer. This text clearly describes virtually the entire population of Mozzano in the thirteenth century as severely affected by malaria, and shows malaria directly altering human settlement patterns in that period. (Since the town had been built in a place that was so pestilential and unhealthy, owing to bad air, especially in summer, almost all of its inhabitants suffer from severe disease and chronic lethargy . . . we shall allow them to move to the place called Colle Vecchio to live in the territory of the town set aside for them there).¹⁷

¹⁵ Bonelli (1966: 662): la scienza medica mostra che per ogni morto classificato come deceduto a causa della malaria ce ne sono parecchi altri classificati come morti per ‘altri’ eventi morbosi, i quali, peraltro, sono alla malaria direttamente connessi o indirettamente dovuti al processo di debilitazione fisica delle persone col-pite.

¹⁶ Hackett (1937: 237); Molineaux (1997); Brown (1986); Giglioli (1972).

¹⁷ Toubert (1973: i. 363–4 n. 3): cum castrum in tam pestifero et corrupto sit loco constructum quod

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19. A view of Sermoneta, a hill town dominated by the Castello Caetani, with a history of contact with malaria. The following saying, quoted from the guidebook, Sermoneta: storia del paese (1989) by L. Sciotti and A. Nastri, refers to malaria: Sermoneta che stai ncima a na fossa, | ntorno ntorno ci sta l’acqua puzza:| a le femmene fa cresce la trippozza, | a gli ommeni ce cala la cocozza.

When malaria eradication caused a reduction in overall mortality of more than 50%, as it did in Sermoneta, it seems reasonable to conclude that malaria did in fact dominate the mortality regime before propter aeris intemperiem, aestivo praecipue tempore, habitatores ipsius quasi omnes infirmitates graves et diutinos languores incurrunt . . . transferendi se ad locum qui Collis Vetulus [modern Collevecchio] nun-cupatur . . . in territorio castri predicti ad inhabitandum inibi . . . concedere curaremus.

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eradication, even if the bulk of its effects were indirect rather than direct. In tropical countries similar results followed the eradication of malaria. One study estimated that in Ceylon the total number of deaths in which malaria played a role was 4.7 times that of the deaths caused directly by malaria, while in the coastal regions of British Guyana the total number of deaths involving malaria was 3.8 times that of those directly attributed to it.¹⁸ The standard view of malariologists is that ‘the mortality attributable to malaria . . .

was about three times the mortality actually attributed to malaria on the basis of death certification’.¹⁹ For Grosseto, for example, where 23% of all deaths were directly attributed to malaria in 1882, that would imply that well over half of all deaths were in fact linked to malaria, directly or indirectly. Morbidity data, which were collected alongside the cause-of-death data for Grosseto in 1840–41, indicate that about 60% of all recorded illnesses in Grosseto were intermittent fevers.²⁰ This suggests that malaria might have been more frequent in Grosseto than all other diseases put together.²¹ In such contexts, it is easy to understand the equation of ‘fever’, puretÎß or febris, with malaria as the disease par excellence, as seen for example in the de medicina of Celsus. Malaria was the first disease discussed by Celsus in book 3 of his work, when he considered diseases one by one. He explicitly stated that malarial fevers were extremely common, for the benefit of any modern historians who find it hard to believe:

The next subject is the treatment of fevers, which both affect the entire body and are extremely common. One type of fever is quotidian, the second tertian, and the third quartan.²²

The data from Grosseto demonstrate the scale of the effect which malaria might be expected to have had on the population of