Malaria and Rome: A History of Malaria in Ancient Italy (32 page)

¹³¹ Bede,
Historia Ecclesiastica
, 5.7, ed. Plummer (1896); Paulus Diaconus 6.37.

¹³² Bede,
HE
iii.12:
tempore fuit in eodem monasterio puerulus quidam longo febrium incommodo graviter vexatus: qui cum die quodam sollicitus horam accessionis exspectaret, ingressus ad eum quidam de fratribus: ‘Vis,’ inquit, ‘mi nate, doceam te quomodo cureris ab huius molestia languoris? Surge, ingredere ecclesiam, et accedens ad sepulcrum Osualdi, ibi reside, et quietus manens adhaere tumbae. Vide ne exeas inde, nec de loco movearis, donec hora recessionis febrium transierit. Tunc ipse intrabo, et educam te inde.’ Fecit ut ille suaserat, sedentemque ad tumbam sancti, infirmitas tangere nequaquam praesumpsit; quin in tantum timens aufugit, ut nec secunda die, nec tertia, neque umquam exinde eum auderet contingere
.

Demography of malaria

159

In the late medieval period there continued to be regular contact between England and Rome. The resident English community in Rome suffered from malaria there as well as the numerous pilgrims, the so-called
Romipetae
. Gervase, a monk in Canterbury, described a severe epidemic of ‘bad air’ in Rome in  1188. It badly affected both visitors from England and the Roman cardinals who were patrons of the Canterbury church. It started its ravages in July, but continued to claim victims as late as October in that particular year. (‘For a terrible epidemic, arising from the excessive heat of summer and atmospheric conditions which appeared after the festival of St John the Baptist, devastated the Roman people to such an extent, and especially foreign visitors, that several thousand of the clerics and people died. Indeed the cardinals who were the patrons of the Canterbury church were killed by this abomin-able pestilence, as well as five monks who were companions of the prior and many of the servants. All the others were so ill that no one was able to pass on a drink of cold water to anyone else. However the prior Honorius, who was already on the point of death, was taken, through the good offices of the bishop of Ostia, to a mountainous location in the province of Velletri so that he could be cured by breathing purer air. Nevertheless that execrable poison of bad air, now occupying his vital organs, finally killed him on 21

October . . . Other monks, who had died in July, were buried in various churches.’)¹³³ A noted English doctor, Hugh of Evesham, was elevated to the status of cardinal of San Lorenzo in Lucina by Pope Martin IV (1281–5) to protect him from malaria, but Hugh himself died from Roman fever.¹³⁴ In view of these contacts it is ¹³³
The historical works of Gervase of Canterbury
, ed. Stubbs (1879) i.:
The chronicle of the reigns of Stephen, Henry II and Richard I,
42:
Horrida enim pestilentia ex ardore aestatis nimio, et diversis aeris pas-sionibus quae post festum Sancti Johannis Baptistae emerserunt, Romanum adeo vastavit populum et maxime peregrinos, ut non nulla milia cleri et populi spiritus exhalerent. Ex hac pestilentia detestanda cardinales quidem Cantuariensis ecclesiae patroni extincti sunt, et ex sociis prioris monachi quinque et plurimi servientes.

Caeteri omnes adversa valitudine adeo detenti sunt, ut nec unus alteri vel aquam frigidam valeret propinare.

Prior autem Honorius iam fere praemortuus, beneficio episcopi Hostiensis in montana Velletrensis provinciae absportatus est, ut ibidem liberiori refectus aere respiraret. Sed illa corrupti aeris detestanda infectio, iam ipsius occupans vitalia, ad extrema perductum XIIo Kalendas Novembris compulit exspirare . . . Alii vero monachi, qui mense Julio mortui sunt, in diversis ecclesiis sepulti quiescunt
.

¹³⁴ Brentano (1974: 50, 89). For the history of medieval pilgrimage to Rome and malaria see Birch (2000: esp. 56–8), citing numerous sources,
e.g.
Peter the Venerable, abbot of Cluny, Letter 118, in
The Letters of Peter the Venerable
, ed. Constable (1967) ( =
Harvard Historical Studies
, 78) i. 311:
mortem ipsam, quam Romanus aer nostratibus celeriter inferre solet
(death itself, which the Roman air is accustomed to bring rapidly to our colleagues). Peter suffered from malaria himself and made several other references to the unhealthiness of the Roman air in his letters written in the twelfth century (Constable, (1967) ii. 247–51).

160

Demography of malaria

likely that
P. vivax
malaria in Britain was regularly replenished and refuelled directly from Rome during the Roman and medieval periods, in exactly the same way that during the First World War the return of infected British soldiers from Greece led to a resurg-ence of malaria in the English marshlands. Rome exported diseases.

Dobson’s demographic data from the Kent and Essex marshlands can be directly compared to the data from Grosseto studied by del Panta to illustrate the profound deviations in the age-structure of mortality produced by malaria. Del Panta compared the population of Grosseto to Coale and Demeny Model South Level 2 (for males) because of the similarity in infant mortality in the first year of life.¹³⁵ He pointed out that adult mortality, especially in the age-group 20–50, was much higher in Grosseto relative to the (high) level of infant mortality than the model life-tables predict ( Table 3).

Table 3. Probability of death (qx) at various ages (in %) Interval

Grosseto

Treppio

South 2

South 1

East 1

1q0

31.7

19.6

31.1

33.6

50.5

5q1

34.0

16.5

31.6

34.7

24.7

50q20

60.0

26.5

43.1

46.0

46.3

e
0

20.0

37.0

22.3

19.9

1 7.4

The data in Table 3 show that the effect of malaria on the population of Grosseto was to produce a much higher level of adult mortality between the ages of 20 and 50 than even the ‘worst’

model life-tables used by demographers (and Coale and Demeny Model East Level 1 is a theoretical construct). In plain language, conditions in Grosseto were so bad that adult mortality went right off the bottom end of the scale generally used by demographers.

This is the full magnitude of Varro’s ‘reckoning with death’,
ratio cum orco
(see Ch. 9 below). Historians who have attempted to minimize the role of malaria in Italian history have completely failed to appreciate the magnitude of the ‘reckoning with death’. Del Panta, a leading Italian historical demographer, stated that numerous places in Italy, especially in the Mezzogiorno, had demographic patterns similar to those of Grosseto.¹³⁶ One example from the ¹³⁵ Del Panta (1989: 22).

¹³⁶ Del Panta (1989: 23).

Demography of malaria

161

Mezzogiorno is the territory of the Crotonese. Arlacchi described the excess adult mortality: [sc. in the early twentieth century] ‘for every 100 deaths in the Crotonese 15 befell persons between the ages of 20 and 40, compared to 7 to 8 for Calabria and 6 to 7 for Italy as a whole’.¹³⁷ According to Bonelli 12.3% of all deaths in the Crotonese in 1882 were directly attributed to malaria. This was substantially less than the direct mortality from malaria at Grosseto in the same year. Nevertheless Arlacchi’s description shows that malaria had severe effects on the entire population of the Crotonese. This once again demonstrates that the overall effects of malaria stretch far beyond the proportion of deaths directly attributed to it. In the nineteenth century the crude death rate reached 60 per 1,000, while as recently as 1890 life expectancy at birth in the Crotonese was no higher than 20. It is likely that this was the fate of the once prosperous populations of the great coastal cities of Magna Graecia, such as Croton and Metapontum, during the Hellenistic and Roman periods following the spread of malaria.¹³⁸

Table 4. Probability of death (qx) at various ages (in %) Interval

Treppio

South 8

South 9

(Females)

(Males)

1q0

19.6

18.5

19.0

5q1

16.5

18.5

16.2

50q20

26.5

26.5

27.0

e
0

37.0

37.5

38.5

Incidentally, the data for the age distribution of mortality of the population of Treppio, the Appennine community located at high altitude to which del Panta compared Grosseto, are very similar to model life-tables with similar levels of life expectancy at birth ( Table 4). This shows that at the very same time when some Italian populations had severely atypical age-structures as a result of ¹³⁷ Arlacchi (1983: 182).

¹³⁸ Arlacchi (1983: 176–83) on the Crotonese; Bonelli (1966: 662 n. 5). On malaria in Calabria see also Douglas (1955: 293–300), a perceptive account by a traveller who realized that the physical environment has changed substantially over the last two thousand years and appreciated the importance of these changes in relation to malaria. He reached the following conclusion: ‘Malaria is the key to a correct understanding of the landscape; it explains the inhabitants, their mode of life, their habits, their history’ (p. 300). Levi (1945: 156–7) described the effects of malaria in Lucania. Genovese (1924: 56–126) described the distribution of malaria in Calabria in recent times.

162

Demography of malaria

malaria, other populations in Italy not affected by malaria had quite normal patterns.

The population of Grosseto had three distinctive features: (1) much lower life expectancy at birth; (2) much higher overall mortality; (3) an unusual and distorted age-specific distribution of mortality. The third feature merits some further analysis. Table 5

shows that age-specific mortality was higher than predicted in Grosseto from age 5 to 9 and from 20 to 50. These characteristics of age-specific mortality emerge not only from the comparison with the communities of Stia and Pratovecchio in the Casentino given by del Panta, but also from the comparison with model life-tables.¹³⁹

Table 5. Number of deaths per person-years lived between age x and x+n (m(x) ) Age-group

Grosseto

South 2

Grosseto

South 2

(Males)

(Males)

(Females)

(Females)

0–4

16.5

18.0

17.7

17.3

5–9

1.5

1.7

10–19

1.2

0.9

1.0

1.1

20–9

1.8

1.6

1.5

1.6

30–9

1.7

0.9

40–9

2.3

1.9

50–9

3.6

3.0

Note
: Bold type indicates items which deviate significantly from the values predicted by the model life-tables.

Del Panta was undoubtedly right to explain the excess age-specific mortality in the 5–9 age group in Grosseto as a direct consequence of
P. falciparum
malaria, as in tropical African countries today. Since direct mortality among adults from malaria was low in Grosseto, del Panta explained the excess adult mortality in terms of synergistic interactions with respiratory and gastro-intestinal diseases. Very high mortality rates required very high fertility rates if the population was to have a chance of reproducing itself. Consequently populations badly affected by malaria, such as Grosseto and the Sardinian populations mentioned earlier, had both higher mortality and higher fertility levels than other populations. Del Panta showed that the marriage patterns of Grosseto favoured very ¹³⁹ Del Panta (1989: 21); del Panta (1997) on infant mortality.

Demography of malaria

163

high fertility levels. Elsewhere he has described the coastal regions of central and southern Italy with intense malaria as characterized by neolocal marriage, with simple nuclear families and a predominance of agricultural wage labour.¹⁴⁰ Gregorovius made the following observation in Latium:

They marry very early in these parts—a young fellow of twenty one chooses frequently a girl who has only numbered fifteen summers.¹⁴¹

Table 6 demonstrates that an age-specific mortality pattern with some similarities to the data from Grosseto can be identified in the malarial parishes in the marshlands of south-east England.¹⁴²

Table 6. Number of deaths per person-years (m(x) ) for various age-groups Age-group

Marsh parishes

Model West 6

(Females)

0–4

9.5

10.0

5–9

0.9

0.9

10–14

0.7

15–19

1.0

20–9

1.3

30–9

1.6

40–9

1.9

50–9

2.9

60–9

5.9

5.7

Note
: Bold type indicates items which deviate significantly from the values predicted by the model life-tables.

The demographic pattern found by Dobson in the English

marsh parishes is not dissimilar to the pattern of Grosseto, but with differences in detail; this is not surprising taking account of the fact that
P. falciparum
malaria was absent from England, not to mention numerous other environmental differences between England and Italy. In the English marsh parishes there was no deviation of the mortality level from the model’s expectations in the 5–9 age group.

This is comprehensible, since no significant degree of mortality produced directly by
P. vivax
in this age-group is to be expected.

P. vivax
does not produce death directly itself in the same way that ¹⁴⁰ Del Panta
et al
. (1996: 162–4); Livi-Bacci (2000: 98–9, 145–6).

¹⁴¹ Gregorovius (1902: 90).

¹⁴² Data for the parishes of Canewdon, South Benfleet, Burnham and Tollesbury, which Dobson (1997: 169) compared to Coale and Demeny Model West Level 6.