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following advice to a disciple travelling to Italy:

Italy is an unhealthy country. It provides harmful foods. Consequently exercise extreme caution with regard to what, when, or what sort, or which foods you eat; and above all avoid being constantly drunk, since it is from the heat of wine that intense fevers tend to strike the unwary.¹⁰⁷

The urban poor in Rome in antiquity faced food shortages, certainly from time to time, and perhaps chronic food shortages as well. The ‘Mediterranean diet’, whose health advantages have attracted so much publicity in recent years, is of course a modern invention. As has been seen already, peasants in many parts of early modern Italy relied heavily on foods like maize and prickly pears which were not available in Europe in antiquity.¹⁰⁸ Even aspects of the ancient diet apparently conducive to good health probably made little difference to mortality and morbidity from ¹⁰⁴ De Martino (1993: 422): ‘ Da tutto quel che precede si desume che stando alle fonti, vi era senza dubbio grande scarsità di proteine animali, grassi insufficienti e mancanza di vitamine molto importanti, la C

e la D, scarsissima la A’.

¹⁰⁵ Shankar et al. (1999).

¹⁰⁶ Carmichael (1989: 39).

¹⁰⁷ Alcuin, epistolae 281, ed. Duemmler (1895), Monumenta Germaniae Historica. Epistolae, iv.

439: Italia infirma est patria et escas generat noxias. Idcirco cautissima consideratione videas, quid, quando, vel qualiter, vel quibus utaris cibis; et maxime ebrietatis assiduitatem devita, quia ex vini calore febrium ardor ingruere solet super incautos.

¹⁰⁸ Ferro-Luzzi and Branca (1995) defined ‘the Mediterranean diet’ as the diet of southern Italy in the 1960s. If defined as such, it is of course a legitimate object of research, but it must be recognized that the subject as defined has little relevance to antiquity. Ferro-Luzzi and Branca noted, for example, the importance in ‘the Mediterranean diet’ of the tomato, which was not available in Europe before Columbus.

150

Demography of malaria

infectious diseases like malaria. A good example is emmer ( Triticum dicoccum), the most important type of wheat cultivated in Latium and Tuscany in the Iron Age and the early stages of Roman history, as shown both by palaeobotanical remains and literary sources.

Emmer comprised 58% of the cereals from excavations of the archaic layers of the Roman Forum; einkorn ( T. monococcum) comprised 10%, barley ( Hordeum vulgare 32%), and there was no naked wheat at all. Research at Etruscan sites such as Acquarossa and Podere Tartuchino is producing broadly similar results, sometimes with a greater importance of barley over all types of wheat. Rations of emmer are mentioned in the Twelve Tables, confirming its importance in the fifth century . By the Roman Empire cultivation of emmer in Latium had declined in favour of poulard wheat ( T. turgidum), even though emmer was suitable for the wet conditions of Latium and contains a higher proportion of protein than modern varieties of bread wheat ( T. aestivum), but it continued to be important in more mountainous regions such as Umbria. By the early modern period cultivation of emmer ( farro) had decreased to the point that statistics for its production were not recorded in the documentary investigations into Latin agriculture of that period, such as the Inchiesta Iacini. Nevertheless it continued to be grown by a handful of farmers and data survive for emmer prices on the markets of Rome in the nineteenth century, allowing its price ratio with respect to naked wheats to be firmly established. Within the last twenty years emmer has been rediscovered by Italian botanists being cultivated on a few farms in isolated areas of the Apennines, after it was thought to have become extinct in Italy. It is now sold and marketed as a health food in Italy ( farro perlato) because some research has suggested that consumption of emmer reduces the risks of heart disease and cancer of the colon, perhaps because of its high fibre content. However, these diseases attain their highest frequencies among elderly people. Population age-structures produced by endemic malaria show that most people would have been killed by infectious diseases before they became old enough for intestinal cancers, for example, to become a major cause of death.

Consequently it is unlikely that consumption of emmer in western central Italy in antiquity did significantly improve the health of the population in practice.¹⁰⁹

¹⁰⁹ De Martino (1979); Ampolo (1980: 15–19); Hjelmqvist (1989); Perkins and Attolini (1992); Rendeli (1993: 140); Twelve Tables, 3.4; Pliny, NH 18.19.83–4; Sallares (1991: ch. 3, esp.

Demography of malaria

151

Before leaving the topic of the interaction of malaria and malnutrition in humans, it is important to remember that other parasites may also figure in this equation. For example, the presence of intestinal worms may help to cause malnutrition in cases of malaria. Some research in Madagascar suggests that treatment with antihelminthic drugs considerably reduces the frequency of severe malaria attacks.¹¹⁰

5. 4 C      I

 E

A fully comprehensive population history of Italy in more recent times, based on local studies (akin to the English parish studies) of both mortality and fertility covering a long period of time from all over the country, has yet to be produced by Italian demographers.

To see how endemic malaria drastically altered demographic patterns at the local level against the background of a historical situation where large parts of the population of a country as a whole were quite healthy, it is necessary to turn to Britain and consider the sort of data that were used in Wrigley and Schofield’s Population History of England 1541–1871 and in subsequent research. Although England is too cold for P. falciparum to have ever become endemic in the past, it is warm enough for P. vivax. P. vivax only requires a temperature of 15–16°C to complete sporogony inside the mosquito in summer, and many of its strains in temperate climate regions have developed a certain tendency in the direction of avirulence to enable it to survive long, cold winters in

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