M A L A R I A A N D R O M E
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Malaria and Rome
A history of malaria in ancient Italy
R O B E R T S A L L A R E S
1
3
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© Robert Sallares 2002
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First published 2002
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P R E F A C E
A detailed knowledge of medical history is essential for understanding mortality patterns in past populations. Medical history in this context does not mean the history of ideas about causes of death, but the history of diseases themselves. It is a very demanding and difficult subject because it requires a multiplicity of different skills. It is necessary to possess the traditional skills in source criticism and analysis of conventional historians, as well as the ability to read texts in foreign or dead languages. However, there is another equally important dimension to it. It also requires a very solid foundation of knowledge about medicine and various branches of the natural sciences. Our knowledge and understanding of the malaria parasite Plasmodium falciparum is poised to increase exponentially as a result of the project to sequence its genome. Chromosomes 2 and 3 have already been completely sequenced, and it is likely that the complete DNA sequences of the other dozen chromosomes will have been obtained by the time that this book reaches the book-shops. At the beginning of the new millennium the history of diseases stands on the threshold of a revolution; a revolution created by the application of these new techniques of molecular biology to human skeletal remains excavated on archaeological sites. This revolution will eventually transform our understanding of the evolution, history, and distribution of diseases in prehistory and antiquity. I am engaged in such research, although very little is said about it in this book. Nevertheless the ultimate challenge must be to integrate the data yielded by different approaches, and there is still much to be learned from a comprehensive examination of the ancient documentary and literary sources for malaria, upon which this book concentrates. Very few people have the time and leisure and, dare one say it, the ability to master all the skills that are required by medical historians. The outstanding example of how it should be done is of course the late Mirko Drazen Grmek (obituary in Duffin (2000)). However, he was quite exceptional. There are many historians who are experts in the history of ideas about medicine, but know little or no science. Conversely, there are numerous viii
Preface
doctors and scientists who know little or no history. This problem applies to the medical history of all ages, including the medieval and early modern periods, but it is particularly serious as far as classical antiquity is concerned, because of the way in which ancient historians are trained.
Disease and demography have generally been studied quite separately by classicists. There are few exceptions to this trend.
Grmek (1983: 135–77) did include a chapter on palaeodemography in his marvellous book on diseases in the ancient Greek world.
He concentrated on the evidence for life expectancy provided by ancient bones, a very thorny subject, but said little about the mortality and morbidity levels and epidemiology of even the most important infectious diseases, such as malaria and tuberculosis.
The leading figures in research into Roman demography have paid virtually no attention at all to diseases, the major determinants of mortality patterns. Conclusions about the mortality patterns of ancient populations reached by historians who ignore the determinants of mortality patterns can only be pure description, at best. Nothing is being explained. In reality population history is embedded in a much larger ecological context. It cannot be understood without considering this wider context. Demonstrating this in relation to ancient history is the principal objective of this book.
Mary Dobson’s (1997) magnum opus on malaria in early modern England provides an admirable model of how it should be done.
She showed that the homogeneity of human populations, which is generally taken for granted by ancient historians, is basically a phenomenon of the twentieth century and the later stages of the nineteenth century . It cannot be taken for granted when studying earlier periods of history. The homogeneity of modern populations is a recent historical development, which was brought about by various specific means, for example the vaccination of entire populations against specific diseases (such as smallpox), and the provision of pure water supplies to whole populations (eliminating waterborne diseases). The development of universal health care services, for instance when the Italian government made the antimalarial drug quinine available to the entire Italian population free of charge at the beginning of the twentieth century, also played a major role, as well as general improvements in nutrition and the standard of living. Even so, there are still significant differences in mortality patterns between different regions and different social
Preface
ix
classes in modern European populations. In Britain at the time of writing life expectancy for males varies between 68 and 78 years, and for females between 75 and 83, in different parts of the country.
No modern population is entirely homogeneous. It is clear that the populations of early modern Europe were much less homogeneous. In fact, regional diversity prevailed. Yet the homogeneity of populations in antiquity is an assumption built into virtually all published modern literature on ancient Roman demography.
There is no evidence at all for this supposed population homogeneity in antiquity. The assumption is the result of a particular method of analysis, namely the brandishing of life tables not derived from evidence for ancient populations as schematic models supposedly applicable to th
e entire Roman Empire. In contrast, this book is a regional case study demonstrating that the regional diversity of demographic patterns now known to have been the norm in early modern Europe was also the norm in antiquity. It argues that actual demographic conditions were strictly dependent on often very highly localized ecological circumstances, particularly the precise configuration of the local ecological community of diseases or pathocoenosis (to use Grmek’s concept), which was in turn inextricably linked to other variables (e.g. climate, physical geography, hydrology, population density, the history of the distribution of disease vectors, etc.). In central and southern Italy in antiquity malaria was the single most important component of the pathocoenosis. The aim of this book is to focus attention on the effects of malaria on population structure, rather than population size.
In the course of this book frequent references are made to comparative material from later periods of Italian history. However, this book is most certainly not intended to be a comprehensive account of the history of malaria in medieval and early modern Italy. Obviously that would require another book or series of books, given the large volume of source material that is available.
The intention here is rather to use later material selectively to explicate the generally fragmentary ancient sources. For example, when Cicero describes the course of an infection of quartan fever in Atticus, how typical was the case of Atticus? It is unique in ancient Latin literature for its chronological detail, but statistical analysis is impossible with a sample of one. It is only by considering more abundant evidence from later periods that we can see that his case history was an absolutely typical example of the chronology of x
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cases of quartan fever in Italy in the past; undoubtedly there were countless other cases like it in antiquity (see Ch. 5. 2 below). It is exceedingly easy for ancient historians who are not specialists in medical matters to grossly underestimate how much material is in fact available. The Italian National Archive Office is currently undertaking a major project to publish all the documentation in its possession relating to malaria in Italy. Fantini and Muzzioli (1987) compiled a long catalogue of the numerous archives in the city of Rome containing documents relevant to the study of malaria in Italy, while in 1998 the journal Medicina nei Secoli : Arte e Scienza (10/3) published a long series of articles on the archival sources for malaria in Italy.
Traditionally ancient history ended with the downfall of the last Roman emperor in 476, with the implication of a sharp break between the ancient and medieval eras, although it is arguable that this date had no real significance. As far as the city of Rome is concerned, the Gothic wars described by Procopius in the sixth century did the worst damage to Rome itself. The old civic institutions such as the Roman Senate seem to have disappeared by the time of the reign of Pope Gregory the Great ( 590–604).
Some specialists in late antiquity speak of the transformation of the Roman world and extend the chronological span of antiquity forwards into the sixth or seventh centuries , reverting towards Henri Pirenne’s (1937) opinion that the break between the ancient and the mediaeval worlds occurred in the time of Charlemagne in the eighth century, rather than in the fifth century. However, this position still leaves a dividing line between, on the one hand, ancient Roman history, and, on the other hand, later Italian history. The argument of this book is that the divide between ancient history and later periods is a barrier to understanding, at least as far as the topic of this book is concerned. It has prevented ancient historians from using the much more abundant and detailed later evidence to make sense of the fragmentary ancient sources.
A C K N O W L E D G E M E N T S
This book was largely written during a very fruitful period of collaborative research with Walter Scheidel. Indeed it would probably never have been written at all without him. Our original intention was to integrate my research with Walter’s research into a much larger volume comparing the effects of diseases on demographic patterns in different parts of the Roman world, but it became clear that our combined manuscript was too long for a single book. Consequently the original manuscript was broken up into pieces for separate publication. However, Walter’s forthcoming book Death on the Nile: disease and the demography of Roman Egypt should be read as a complement to this book. It demonstrates convincingly that regional variation in mortality patterns was as normal in Egypt during the time of the Roman Empire as it was in Italy, as is argued here. His book considerably extends the critical discussion in Chapters 5 and 11 here of the irrelevance to ancient populations of model life-tables based on data from modern populations. It also contains interesting pages on malaria in Roman Egypt, where the disease flourished in environments very different from those described here, illustrating its adaptability.
Mario Coluzzi, Gilberto Corbellini, Tim Cornell, Peter
Garnsey, Mirko Grmek, and John Scarborough all read previous versions of the text. Carmine Ampolo made helpful comments at a conference in Parma. Mary Dobson provided a photocopy of an important article that was difficult to obtain. Peter Attema and Franco Ravelli supplied copies of some of their own work. Mario Coluzzi, Clem Ramsdale, and Graham White provided information about mosquitoes. James Oeppen and Richard Smith gave advice on one technical detail about life-tables. The comments of the anonymous referees were very helpful. Susan Gomzi, Abigail Bouwman, and Cia Anderung worked alongside me on the bones from Lugnano in Teverina, which were provided by David Soren.
I wish to thank Mario Coluzzi and Claudio Finistauri for their hospitality when I visited the Istituto di Parassitologia in La Sapienza University, Rome, and Lugnano in Teverina. I also wish to thank xii
Acknowledgements
Hilary O’Shea and the staff of Oxford University Press and Jane Wheare. Last but not least, financial support from the Leverhulme Trust was invaluable.
Obviously I am solely responsible for the views expressed and for any faults that remain. All the translations of Latin, Greek, and Italian texts are my own translations. I benefited enormously from the resources of the John Rylands Library in Manchester and the Wellcome Library for the History and Understanding of Medicine in London, as it is now called. One important work exploited in this book was accidentally discovered, while looking for something else, gathering dust on a shelf in the Rylands Library. It did not look as if anyone had read it for a hundred years. I hope this book will enjoy a better fate.
R. S.
C O N T E N T S
List of illustrations
xiv
List of figures, maps, and tables
xvi
1. Introduction
1
2. Types of malaria
7
3. Evolution and prehistory of malaria
23
4. The ecology of malaria in Italy
43
Malaria and mosquitoes
43
Malarial environments
55
Malaria in Sardinia
90
Malaria, roads, and housing
93
Climatic change
101
Agricultural change and deforestation
103
5. The demography of malaria
115
Direct and indirect approaches to the demography of
malaria
115
Interactions of malaria with other diseases
123
Malaria and nutrition
140
Comparative demography of malaria in Italy and
England
151
6. The Pontine Marshes
168
7. Tuscany
192
8. The city of Rome
201
9. The Roman Campagna
235
10. Apulia
262
11. Geographical contrasts and demographic variation
269
References
287
Glossary
329
Index
331
I L L U S T R A T I O N S
All photographs were taken by the author except where stated otherwise in the captions to the illustrations.
1. Mussolini’s inscription at Sabaudia.
5
2. Ospedale di San Giovanni.
17
3. Anopheles labranchiae.
45
4 . Fontana di Trevi.
46
5 . Artemisia absinthium.
47
6. The Virgin of Fevers in the Sacristy of St. Peter’s in the Vatican in Rome.
51
7. Plan of modern Sezze.
56
8. View of Norma in the distance from Sermoneta.
58
9. View of Ninfa from Norma.
59
10. Ruins of the Roman villa of Poggio Gramignano,
near Lugnano in Teverina.
66
11. PCR products amplified from the Lugnano bones.
67
12. The coastal forest of the Parco Naturale della Maremma.
73
13 . The entrance to the Cloaca Maxima.
76
14. Anopheles sacharovi.
84
15. A traditional peasant hut in the Pontine region.
94
16. The Val di Chiana and Lago Trasimeno.
99
17. The Monti Cimini.
104
18. The northern slopes of Monte Circeo.
107
19. A view of Sermoneta.
120
20. Centro culturale polivalente in Pontinia.
170
21. View of the Lago di Sabaudia.
171
22. The ilex-oak forest of Monte Circeo.
172
23. The Pontine plain viewed from Sermoneta.
175
24. The southern end of the Pontine plain.
184
25. Ruins of the Roman colony of Graviscae.
194
26. The modem saline of Graviscae.
195
27. Wetland in the Parco Naturale della Maremma.
199
28. Cardinal Lugo orders the use of cinchona bark.
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