Malaria and Rome: A History of Malaria in Ancient Italy

by Robert Sallares

  203

  29. Monte Testaccio.

  208

  Illustrations

  xv

  30. Via della Reginella.

  210

  31. The Colosseum.

  213

  32. Ospedale di Santo Spirito.

  216

  33. The Roman Forum.

  217

  34. The monument of Leopold II in Grosseto (front and

  side views).

  232–3

  35. Luigi Torelli’s Carta della malaria dell’Italia.

  237

  36. The angel of death striking a door during the plague of Rome.

  274

  37. The Circus Maximus.

  281

  F I G U R E S , M A P S , A N D T A B L E S

  M 

  1. Italy

  6

  2. Umbria and northern Lazio

  65

  3. Ravenna and Emilia-Romagna

  80

  4. Southern Lazio

  169

  5. The Maremma and Valdichiana

  193

  6. The city of Rome

  207

  7. Salpi and Apulia

  263

  F 

  1. Evolutionary relationships of selected Plasmodium species

  24

  T 

  1. Some of the species in the genus Plasmodium

  8

  2. Palaearctic mosquito species in the Anopheles maculipennis complex

  44

  3. Probability of death at various ages

  160

  4. Probability of death at various ages

  161

  5. Number of deaths per person-years

  162

  6. Number of deaths per person-years (m(x) )

  163

  7. Number of people aged 20+ who die between ages

  x and y

  164

  8. Distribution of lakes within the city of Rome

  215

  9. Baptisms and deaths in early modern Rome

  275

  1

  Introduction

  Keith Hopkins moved the study of the demography of the ancient Roman world into a new era with his demonstration that ‘ages at death derived from Roman tombstones cannot be used to estimate expectation of life at birth or at subsequent ages’.¹ He suggested that the life expectancy at birth of the Roman population lay between 20 and 30 and advocated that life-tables derived from data from modern populations should be used as models for the age-structure of the Roman population in antiquity. Since then, the use of these model life-tables has enjoyed a considerable degree of popularity among ancient historians. Indeed it has become the current orthodoxy, almost an article of faith in certain quarters.

  Hopkins himself was careful to add an important qualification, in terms of a requirement for further research, at the end of his article: ‘Our attention . . . should . . . be directed . . . to a more general assessment of the applicability of these model life tables and to an analysis of the determinants of mortality, both in Rome in particular, and in general.’² Unfortunately he never followed up his own recommendation. The bulk of subsequent research has also failed signally in this respect. Yet an analysis of the causes of death is absolutely essential if we are ever to move beyond attempting to describe mortality in antiquity towards explaining and understanding it.

  The message of this book is simply that in order to understand the demography of the ancient Roman world, it is necessary to pay much more attention to medical history than has been done in the bulk of research carried out so far into Roman demography.

  Karl Julius Beloch, the pioneer of Roman demography, did not confine himself to antiquity. He intensively investigated Italian population history in more recent periods to provide a comparative foundation for his analysis of the scanty evidence from antiquity.

  A large proportion of the output of Roman historians over the last ¹ Hopkins (1966: 246).

  ² Hopkins (1966: 264).

  2

  Introduction

  thirty years or so has failed to follow his example. Yet there is a wealth of evidence there, waiting to be exploited, which provides food for thought. The starting-point of the argument here is an extremely interesting recent discussion, by two leading Italian historical demographers, del Panta and Rettaroli, of an earlier study by one of them (del Panta) of the demography of Grosseto in the last century.³ They observed that the age-structure of the population of Grosseto in the 1840s does not match closely any of the Coale and Demeny life-tables, the set of model life-tables for the age-structures of human populations most widely employed by demographers, which are so popular with some ancient historians.

  Nor did the age-structure of the population of Grosseto match any of the other available sets of model life-tables based on data for modern European populations. However, the demography of Grosseto in the last century does resemble something else that is completely different. What it resembles more than anything else, as they pointed out, is the demography of certain parts of Africa today where malaria is endemic.⁴ Of course the demographic patterns are not, and never could have been, precisely identical, because of numerous profound differences in the environment between central Italy and tropical Africa.

  Nevertheless the degree of similarity in the demographic patterns between Grosseto and tropical Africa is striking. Malaria has an awesome power as a determinant of demographic patterns. It is estimated to have caused about a million deaths in Africa in 1995, and it also has far-reaching indirect effects, as will be seen later.⁵ In addition, it had the ability in the past to overcome the ecological barriers between tropical Africa and the Mediterranean world and so bring its power as a determinant of human demographic patterns to the ancient Mediterranean world, but this has been ignored by most Roman historians interested in ancient demography.⁶

  ³ Del Panta and Rettaroli (1994: 201–3); del Panta (1989).

  ⁴ Root (1999) discussed the relationship between differences in the intensity of malaria transmission and differences in spatial mortality patterns in various parts of Africa.

  ⁵ Snow et al. (1999).

  ⁶ A few historians have noted malaria as a possible contributing factor to mortality in antiquity. For example, J. C. Russell (1985: 88–9, 228, 234) rightly associated malaria with extremely high adult mortality, but regarded tuberculosis as more important. His suggestion that the ‘Antonine plague’ in the second century  was P. falciparum malaria is exceedingly improbable (it was almost certainly smallpox). Similarly the suggestion (Karlen (1996: 69–70); Cartwright and Biddiss (2000: 9–10) ), that the epidemic which struck Rome (Cassius Dio 66.23.5; Suetonius, Divus Titus 8.3–4) after the eruption of Vesuvius in  79 was the first

  Introduction

  3

  The crux of the matter, as a problem in demography, is the relationship between infant mortality and adult mortality. This balance is affected by the differing effects of malaria on different age groups.

  These effects of malaria on different age groups depend, in turn, on its transmission rate. In general, European populations in the past where malaria was endemic had higher levels of adult mortality relative to infant and child mortality than otherwise similar populations unaffected by malaria, as well as much higher total mortality.

  The overall effect of malaria in terms of increasing mortality has indeed long been known, at least in principle (and, as will be seen later, the essence of the matter was also known in antiquity). Angelo Celli, one of the pioneers of the important Italian school of malariology, wrote at the end of the nineteenth century as follows: ‘the average life of the worker in malarious places is shorter, and the infant mortality higher, than in healthy places’.⁷ However, at that time modern historical demography based on such techniques as family reconstitution had not yet developed. It is only more recently that it has become possible to appreciate in quantitative terms the sheer scale o
f the phenomenon. Del Panta and Rettaroli compared the demography of Grosseto in the last century with the demography of Treppio, an Appennine community located northeast of Pistoia which was not affected by malaria. The population of Treppio had a life expectancy at birth of 37, but the population of Grosseto had a life expectancy at birth of only 20, with corresponding substantial differences in the age distribution of mortality in the two populations. The effect of the presence of malaria was to nearly halve life expectancy at birth (see Ch. 5. 4 below for further discussion).

  Given such enormous effects, it is not surprising that Italian historians, scientists, and politicians devoted a great deal of attention to malaria so long as it continued to be a major public health problem in Italy. As Bonelli put it, ‘malaria was for centuries . . .

  appearance of P. falciparum malaria in Rome, has nothing to recommend it, even if the emperor Vespasian himself did die from malaria in that year at Aquae Cutiliae in the Sabine region (Cassius Dio 66.17.1: nos&saß . . . pureto∏ß (he became ill with fevers); Suetonius, Divus Ves-pasianus 24.1). Scobie (1986: 422) mentioned malaria alongside gastro-intestinal diseases; Morley (1996: 43) also mentioned malaria; Salmon (1992) is rather more detailed. Nevertheless its importance has in the main not been appreciated by historians interested in ancient demography. A. Wear (1995: 226), writing about the early modern period, asserted that ‘the falciparum form of malaria did not exist in Europe’, an extraordinary error.

  ⁷ Celli (1900: 18).

  4

  Introduction

  one of the determining factors of the demographic and socio-economic evolution of a large part of the Italian peninsula’.⁸ Celli compiled a bibliography containing no less than 354 items on malaria in the Roman Campagna, up to the end of the last century.⁹ Interest continued to be strong in the first half of the twentieth century. However, the level of interest has waned since the final eradication of malaria from Italy after the Second World War. The last cases of native malaria in Italy were recorded in 1962. A re-organization of research in Rome led to the demise of the principal journal in the field, the Rivista di Malariologia, in 1967. This decrease in interest is reflected in the length of the bibliography, compiled by the eminent medical historian Mirko Grmek, of studies written in the twentieth century devoted to malaria in antiquity, only 113

  items.¹⁰ This, in turn, is an example of the truism that historiography reflects contemporary interests. However, it is very important for modern historians to remember that so long as it was present, malaria was felt to be an enormous problem in Italy. The Pontine Marshes, one of the principal havens of malaria in central Italy, during the last two millennia attracted the attention of such major historical figures as Julius Caesar, Napoleon, and Mussolini, besides countless others of less note. Julius Caesar, who suffered from a quartan fever in his youth, conceived a scheme to drain the Pontine Marshes and make the area fit for agriculture, but it had not commenced at the time of his death.¹¹ Napoleon is reported to have been displeased when he learned that the French Empire contained a very large marsh. His efforts did not make any progress either, although the investigations of his prefect of Rome, M. le Comte De Tournon, constitute a fundamental source for the state of Lazio before modernization.¹² Mussolini finally succeeded where all his predecessors had failed for over two thousand years, and completely drained the Pontine Marshes, as part of his policy ⁸ Bonelli (1966: 659): ‘ la malaria fu per secoli . . . uno dei fattori determinanti della evoluzione demografica ed economico-sociale di una vasta parte della penisola italiana’.

  ⁹ Celli (1900: 256–75).

  ¹⁰ Grmek (1994).

  ¹¹ Suetonius DJ 1.2: morbo quartanae adgravante (seriously ill with a quartan fever) and 44.3: siccare Pomptinas paludes (to drain the Pontine marches); Cicero, Philippics 5.7: ille paludes siccare voluit (he wanted to drain the marshes); Plutarch, Caesar 58.9, ed. Ziegler: t¤ m†n 1lh t¤ per≥

  Pwment∏non ka≥ Sht≤an ƒktrvyaß ped≤on åpode∏xai polla∏ß ƒnergÏn ånqr*pwn muri3si (he wished to turn the marshes around Pomentinum and Setia into a plain which could be cultivated by many thousands of men).

  ¹² Celli (1900: 102); De Tournon (1831).

  Introduction

  5

  1 Mussolini’s inscription at Sabaudia, commemorating the eradication of malaria from the Pontine Marshes and the foundation of the new town of Sabaudia in 1934.

  of internal colonization in Italy.¹³ In doing so, he altered the environment in a way that makes it difficult to imagine now what it was like in the past. The justification for another lengthy discussion of malaria, in spite of the volume of literature on the subject, is that there is nothing recent which combines a comprehensive assessment of the ancient sources for malaria in Italy with the latest results in historical demography and the latest advances in medical research and the scientific understanding of malaria. This book is devoted to reassessing the history and ecology of malaria in western central Italy in antiquity, and in particular its demographic consequences.

  ¹³ Collari (1949); Desowitz (1992: 210–11).

  N

  Milan

  Venice

  Ferrara

  F R A N C E

  B O S N I A A N D

  Genoa

  H E R Z E G O V I N A

  Ravenna

  Pistoia

  Pisa

  Florence

  Ancona

  Livorno

  TUSCANY

  A d r i a t i c S e a

  Perugia

  GrossetoUMBRIA

  Terni

  MAREMMA

  Pescara

  Rome

  CORSICA

  LAZIO

  Pontine

  APULIA

  Marshes

  Capua

  CAMP

  Bari

  Brundisium

  Naples

  ANIA Tarentum

  SARDINIA

  Paestum

  A L B A N I A

  Metapontum

  T y r r h e n i a n

  Sybaris

  Cagliari

  S e a

  Paola

  SILA

  Croton

  M

  Palermo

  e

  CALABRIA

  d

  S I C I L Y

  i

  Akragas

  t

  (Agrigento)

  Syracuse

  Carthage

  Camarina

  e

  r r a

  T U N I S I A

  n

  e

  a

  n

  S

  e

  a

  Map 1. Italy

  2

  Types of malaria

  There are about 200 species of malaria, eukaryotic parasitic protozoa that belong to the suborder Haemosporina, order Eucoccidiida, subclass Coccidia, class Sporozoea of the phylum Apicomplexa.¹ New species are indeed still being discovered; yet another instance which illustrates the incompleteness of our current knowledge of biodiversity.² Most of these species of malaria infect other primates, rodents, bats, reptiles, and birds. Avian species of malaria have a much wider geographical distribution than malaria parasites of terrestrial animals (except the human species transported by man around the world) because of the mobility of birds. The avian species of malaria are abundant at the heart of the geographical area under study here, in the Roman Campagna. Since research in molecular evolution indicates that the malaria parasites are a very ancient group of organisms that originated at least two hundred million years ago, and birds are now widely believed to be descendants of dinosaurs, it is quite likely that dinosaurs also suffered from malaria. Malaria is not solely a problem for humans. Indeed it can sometimes cause severe problems for other animals as well. For example, the role of the introduction of avian species of malaria to Hawaii in the extinction of species of birds indigenous to that country has been a subject of debate in conservation biology.
³

  However, the focus of this book will be on human malaria.

  The word ‘malaria’ originally signified ‘bad air’ ( mal’aria) in Italian. This name was derived from the theory of the miasmatic nature of the disease which prevailed until Laveran’s discovery of malarial parasites in human blood in 1880 (see Ch. 4. 1 below).

  Gilberto Corbellini and Lorenza Merzagora found that the first attested use of the term mal aere was by Marco Cornaro in a book entitled Scritture della laguna, which was published in Venice in 1440.

  The earliest Italian publication to use the word malaria without the ¹ For the Greek and Latin origins of these names see Scarborough (1992: 37, 111).

  ² Kreier and Baker (1987). Perkins (2000) is a recent report of the discovery of a new species of Plasmodium.

  ³ Cann and Douglas (1999).

  8

  Types of malaria

  Table 1. Some of the species in the genus Plasmodium Species

  Host

  Periodicity

  P. vivax

  Humans

  Tertian

  P. schwetzi

  Chimpanzees

  Tertian

  P. pitheci

  Orang-utans

  Quartan?

  P. hylobati

  Gibbons

  Quartan?

  P. eylesi

  Gibbons

  Tertian

  P. jefferyi

  Gibbons

  Tertian

  P. cynomolgi

  Monkeys

  Tertian

  P. ovale

  Humans

  Tertian

  P. simium

  Monkeys

  Tertian

  P. fieldi

  Monkeys

  Tertian

  P. simiovale

  Monkeys

  Tertian

  P. gonderi

  Monkeys

  Tertian

  P. malariae

  Humans

  Quartan

  P. inui

  Monkeys

  Quartan

  P. brasilianum

  Monkeys

  Quartan

  P. knowlesi

  Monkeys

  Quotidian

  P. coatneyi

  Monkeys

  Tertian

  P. fragile

  Monkeys

  Tertian

  P. falciparum

  Humans

  Tertian

  P. reichenowi