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

If you live among them, you will see, too often, hunger-stricken human beings coming out of this paradise to meet you . . . [the peasant] would starve if it were not for the meal of the Indian corn [sc. maize], which is his sole nutriment.⁹⁸

North carried out a short experiment which suggested to him that ‘a few ounces of well-cooked red meat, and a liberal allowance of good red wine, will have an effect, equal, if not superior, to a large dose of quinine’.⁹⁹ North’s experiment was not a double blind test, as is generally expected in modern medical research, and his conclusion undoubtedly understates the seriousness as a disease of malaria in non-immune individuals. In fact, the belief in the value of red meat and red wine against malaria, a disease of red blood (cells), was ultimately yet another instance of sympathetic magic.

Other similar experiments yielded completely different results.

For example, in 1897 Cirio, who had made his fortune in the fruit-canning industry, brought a colony of non-immune farming families from the Veneto in the north of Italy to the Pontine territory and provided them with very large rations of meat, wine, and other commodities to test this theory.¹⁰⁰ Although the results of the experiment were disastrous, they do not necessarily exclude the possibility that malnutrition might exacerbate the severity of malarial infections, perhaps particularly in individuals with some degree of immunity. The increasing use of quinine, especially after the Italian government made it available to all free of charge by ⁹⁷ Celli (1900: 170–2); Mallegni and Fornaciari (1985) found that the skeletons from Settefinestre had a high zinc content and a low strontium content, indicative of a diet rich in meat and short of vegetables. They rightly interpreted these results in terms of a pastoral economy in the Maremma in late antiquity. Ciuffoletti and Guerrini (1989: 97–100) described the traditional diet of the inhabitants of the Maremma. Similarly Arlacchi (1983: 176–9) commented on the very poor nutritional state in the nineteenth and early twentieth centuries of the inhabitants of the Crotonese, a population severely affected by malaria. He noted the consequence that the average height of these people was 10 cm less than the regional average, cf. Douglas (1955: 130).

⁹⁸ Gregorovius (1902: 82).

⁹⁹ North (1896: 161).

¹⁰⁰ Snowden (1999: 33–4); Hackett (1937: 28).

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Demography of malaria

a series of laws passed in the years 1900–4, a few years after North’s research, was probably the most important single factor in the reduction of mortality from malaria in Italy.¹⁰¹ Nevertheless North’s primitive experiment and the general experience of observers at the time indicate how important malnutrition may have been in the past. De Felice, after considering comments on the matter in the writings of the early modern Roman agronomists, concluded that animals were better fed, on the lush pastures of Latium, than most of the local inhabitants!¹⁰²

Of course the early modern period had its own peculiar problems, which were not necessarily shared by antiquity. Gregorovius attributed the poor diet of peasants in Latium to the economic effects of high taxation. Reliance on maize, imported from the western hemisphere after Columbus, introduced the possibility of pellagra. This was not a problem in antiquity.¹⁰³ Nevertheless the general impression given, namely that malnutrition did significantly aggravate the effects of malaria in the Roman Campagna in the early modern period, is very important. The balance of probability is that the sort of malnutrition now being revealed by the Italian studies of the Vallerano skeletal population in the second century  increased both mortality and morbidity from malaria in western central Italy in Roman times. One vital but imponderable question about antiquity is the question of how well fed were slaves.

There is no way of knowing if the recommendations for rations given by the ancient Roman agronomists were widely followed in practice, but even if they were, slaves might still have had an impoverished diet. In his recent discussion of this topic, de Martino concluded that the recommendations of the agronomists would have given slaves a very poor diet:

It can be inferred, based on the sources, that there was without doubt a ¹⁰¹ Florence Nightingale noted how it emerged during a papal visit to the Santo Spirito hospital in Rome in January 1848 that patients were actually only being given half the quantities of drugs prescribed to them in order to save money, in spite of the hospital’s enormous endowments (Keele (1981: 183) ). The fact that drugs were known does not necessarily mean that they were available in the right quantities (and at the right price) to those who needed them. That is why the laws of 1900–3 were so important. Corso (1925) gives the text of these laws. Pope Innocent III founded the Santo Spirito hospital near Castel S.

Angelo in 1198 ( Regula ordinis S. Spiritus in Saxia, ed. Migne, Pat. Lat. vol. 217, cols 1130–57).

¹⁰² De Felice (1965: 96): ‘ Per tutto il Settecento e buona parte dell’Ottocento si può dire che in gran parte del Lazio il bestiame era meglio alimentato della massa dei contadini’.

¹⁰³ Livi-Bacci (1986) on pellagra.

Demography of malaria

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great scarcity of animal protein, insufficient fats and a lack of very important vitamins, C and D, with A being very rare.¹⁰⁴

A clinical trial in Papua New Guinea concluded that symptomatic episodes of P. falciparum malaria were about 30% less frequent in young children who received vitamin-A supplements than in those who received placebos.¹⁰⁵ Much older writers also raised the question of the importance of nutrition in relation to malaria. Carmichael described one case that was reported in the Necrologi (or death registers) of Milan, in which the death of a fifty-year-old man on 7 August  1479 was attributed by one doctor to ‘simple tertian fever with a bad regimen’. A second doctor who also examined this case concluded that the poor diet must have played a significant role, since tertian fevers alone were usually not fatal.¹⁰⁶

At the end of the eighth century  Alcuin gave the