Malaria and Rome: A History of Malaria in Ancient Italy (39 page)

The ridiculous reason for its abandonment should not be recorded in serious

Accounts, but it would be undesirable to conceal a funny story.

The citizens are said to have been forced to move away, Abandoning their homes infested with rodents.¹⁰

Again, the observation of desolation is more convincing than the explanation of the population explosion of mice or rats offered for it in the case of the abandoned town of Cosa. True plague (
Yersinia pestis
), which is transmitted principally by rat fleas, did not appear on the scene until the reign of the Byzantine emperor Justinian in the sixth century . Celli argued that there was no endemic malaria on the Tuscan coast in the early fifth century  because Rutilius does not mention it. Celli’s ‘argument from silence’ is untenable because the reference in line 282 to the smell of the marshes of Graviscae in summer is a very explicit reference to ‘bad air’, (i.e.
mal’aria
). Consequently it is extremely probable that the depopulated condition of Graviscae in the early fifth century 

was caused by malaria.¹¹ Rutilius’ words can be compared to the famous invocation of the same stretch of coast by Dante in the Divine Comedy
.¹² Dante himself died of fever at Ravenna in 1321.

Again, as has already been seen in the case of Pliny the Elder, Rutilius showed no interest whatsoever in describing the natural, as opposed to the human, environment for its own sake.

The Maremma continued to be infested with malaria until modern times.¹³ Malaria generated acquired immunity in those ¹⁰ Rutilius Claudius Namatianus,
de reditu suo sive Iter Gallicum
, ed. Doblhofer (1972), ll.

281–90:
Inde Graviscarum fastigia rara videmus,
|
quas premit aestivae saepe paludis odor;
|
Sed nemorosa viret densis vicinia lucis
|
pineaque extremis fluctuat umbra fretis.
|
Cernimus antiquas nullo custode ruinas |
et desolatae moenia foeda Cosae.
|
Ridiculam cladis pudet inter seria causam
|
promere, sed risum dissim-ulare piget.
|
Dicuntur cives quondam migrare coacti
|
muribus infestos deseruisse lares
.

¹¹ Celli (1933: 48–9), contrast Scullard (1967: 61); Sallares (1991: 263–71) and the papers in the forthcoming publication of the conference on the plague of Justinian at the American Academy in Rome (2001) on true plague; Dennis (1878: 194–211) described the condition of the Maremma in the nineteenth century.

¹² Dante Alighieri,
La Commedìa: Inferno. Canto
.1–9, ed. Lanza (1996):
Non era ancor di là Nesso arrivato,
|
quando noi ci mettemo per un bosco
|
che da neun sentiero era segnato.
|
Non fronda verde, ma di color fosco;
|
non rami schietti, ma nodrosi e ’nvolti;
|
non pomi v’eran, ma stecchi con tòsco.
|
Non han sì aspri sterpi né sì folti
|
quelle fiere selvagge che ’n odio hanno
|
tra Cecina e Corneto i luoghi cólti.

¹³ Ciuffoletti and Guerrini (1989: 86) quoted the following traditional Italian song:
Tutti mi dicon Maremma Maremma
|
E a me mi pare una Maremma amara
|
L’uccello che ci va perde la penna
|

Io ci ho perduto una persona cara
|
Sia maledetta Maremma Maremma
|
Sia maledetta Maremma e chi l’ama
|
Sempre mi trema il cor quando ci vai
|
perché ho paura che non torni mai.

Tuscany

199

27. The maintained wetland which is displayed to visitors to the Parco Naturale della Maremma, photographed at the end of July in an extremely hot summer (daytime temperature approaching 40oC). Parched vegetation is visible in the foreground, as the wetland desiccates during the summer. The national park guide told the author that the water in these wetlands is not completely fresh but brackish, although the salt content is very low. These conditions favoured those species of
Anopheles
mosquito which were important vectors of malaria in Italy in the past. The cattle in the background belong to the breed indigenous to the Maremma.

who survived childhood in the Maremma just as it did in the region of Ravenna (see Ch. 4. 2 above). Consequently it was possible for the local inhabitants to deny that malaria was a serious problem, as those questioned by the English novelist D. H. Lawrence at Montalto di Castro, near Vulci, did during his visit to Tuscany in April 1927, the healthiest time of the year. However, Lawrence was perceptive enough to understand the reality of the situation. He also noted that malaria was a severe problem for early modern archaeologists attempting to explore ancient Etruscan sites.¹⁴ One of the disease’s victims was Alessandro François, discoverer of the famous François tomb at Vulci.

As a postscript, it should not be forgotten that malaria is spreading again in developing countries, following the evolution of ¹⁴ Lawrence (1986: 121–3, 129, 132).

200

Tuscany

resistance to antimalarial drugs by the parasites and resistance to insecticides by the mosquitoes.¹⁵ In spite of all the bonifications of the twentieth century, the potential for malaria to return to western central Italy in the future still exists. This potential does not reside so much in modern
tropical
strains of
P. falciparum
, to which Italian mosquitoes are refractory, as Coluzzi has argued, as in
P. vivax
.¹⁶ In August 1997 an Indian girl, who had moved to the Maremma from the Punjab and was infected with
P. vivax
malaria, was bitten by an Italian mosquito (probably
A. labranchiae
), which then transmitted the disease to an Italian woman resident in a sparsely populated area of the Maremma.¹⁷ This case shows how easily a single infected individual can spread malaria over large geographical distances. There were close political relations and commercial links between the Etruscan city-states and Carthage (i.e. North Africa) in the middle of the first millennium . This is shown by the Phoenician–Etruscan bilingual texts excavated at Pyrgi, the port of Caere (modern Cerveteri), and Aristotle’s comments on the close political relations between Carthage and the Etruscan city-states.¹⁸

Later on in Roman times North Africa was an important source of grain and other commodities for the city of Rome. Consequently it was inevitable that malaria would be introduced to central Italy in antiquity directly from Africa, as well as from southern Italy, Sardinia, Sicily, Greece, and the Near East. It became endemic in central Italy as soon as localized (and frequently anthropogenic) environmental change created suitable breeding sites for the mosquito vectors.

¹⁵ Krogstad (1996); Marsh (1998) on the recent upsurge of mortality directly caused by
P.

falciparum
malaria in Africa following the development of resistance to the drug chloroquine.

¹⁶ Coluzzi (1999).

¹⁷ Baldari
et al
. (1998), cf. Castelli
et al
. (1993); Sabatinelli
et al
. (1994); Romi
et al
. (1997).

¹⁸ Aristotle,
Politics
1280a35–7.

8

The city of Rome

The city of Rome itself is obviously of particular interest. It requires discussion on its own, since it constituted a distinctive environment, as far as malaria is concerned, which must be considered separately from the Campagna Romana, the Pontine Marshes, and the Tuscan Maremma. Cicero gave credit to the legendary Romulus for choosing a healthy spot in a pestilential region for the site of the city:

He chose a site which both has abundant sources of water and is healthy, in a pestilential region, for there are hills¹

Similarly Livy spoke of the ‘very healthy hills’ of Rome.² He put these words into the mouth of Furius Camillus in a speech supposedly delivered
c
.386 , following the siege of Rome by the Gauls, in the context of a proposal to move the entire population of Rome to the healthier site of Veii. The statements of Cicero and Livy are admissions that the areas surrounding the hills of Rome were unhealthy in their own time. (Whether Livy’s statements actually tell us anything about the fourth century  is a separate question.) During his description of the Gallic siege Livy had earlier described an outbreak of disease among the Gauls (exacerbated by food shortage). This epidemic was attributed to the unhealthy location of their camp on low ground between hills.³ Such localities were evidently regarded as unhealthy in Livy’s own time. Malaria is the only major disease that has this precise ecological requirement in Mediterranean environments, because the low ground is where mosquitoes breed. The Gallic siege may be the earliest attested example of the devastating malaria epidemics destroying foreign armies attacking Rome that occurred in so many later ¹ Cicero,
de republica
2.6.11:
locumque delegit et fontibus abundantem et in regione pestilenti salubrem; colles enim sunt
.

² Livy 5.53.4:
saluberrimos colles
.

³ Livy 5.48.1–3:
urgebat, Gallos pestilentia etiam, cum loco iacente inter tumulos castra habentes
, (Pestilence was also affecting the Gauls, since their camp was situated in a place between hills.).

202

City of Rome

historical episodes, and this could be the reason why the Gallic sack of Rome apparently did little damage to the city, according to the results of recent archaeological research. Unfortunately no description of the symptoms is provided by Livy.⁴

Livy’s comments illustrate the close juxtaposition of healthy and unhealthy areas that was characteristic of malaria in Italy in the past. In the early modern period the incidence of malaria in the most densely populated districts of the city of Rome itself on the hills was also often described as relatively light. For example, Bonelli described ‘light malaria’ in the city of Rome in 1782. Bercé, writing about the sixteenth and seventeenth centuries , stated that ‘the city of Rome was not regarded as really dangerous, except for the hot months in some districts exposed to Tiber floods’.⁵

Nevertheless the description of how the cardinals, who assembled in the Vatican following the death of the pope on 8 July 1623 to elect a new one, were decimated by malaria by 6 August suggests that it was essential (especially for non-immune visitors) to be very careful indeed which districts of Rome they entered. Eight cardinals and thirty other officials died and numerous others became ill.

The new pope Urban VIII fled for his life from the Vatican to the Quirinal (61 metres above sea level), which was thought to be safer.

Subsequent papal elections were less lethal because of the increasing use of quinine, which was brought back to Rome in 1632 from South America in the bark of the cinchona tree by the Spanish priest Alonso Messias Venegas. It became popular after a successful trial in the Santo Spirito hospital in Rome organized by Cardinal Juan de Lugo in 1643.⁶

The artificial infection experiments at Horton Hospital in England demonstrated that by the twentieth century infections with Italian strains of
P. falciparum
required much larger doses of quinine for treatment than infections with African or Indian strains. This may be evidence for the evolution of a degree of resistance to quinine by
P. falciparum
strains in Italy between the seventeenth and the ⁴ About four years earlier, according to the annalistic tradition (Livy 5.31.5), a very hot and dry summer had caused disease and famine in the vicinity of Rome, preventing the Romans from sending out an army against Volsinii. This might be an even earlier malaria epidemic, but there is no description of the symptoms.

⁵ Bonelli (1966: map on pp. 678–9); Bercé (1989: 241):
la ville de Rome n’était d’ailleurs pas réputée vraiment dangereuse, avec l’exception des mois chauds dans les quelques quartiers accessibles aux débordements du Tibre
.

⁶ Celli (1933: 130); P. F. Russell (1955: 93).

City of Rome

203

28. Cardinal Juan de Lugo (1583–1660) orders the use of cinchona bark to treat patients with intermittent fevers. Reproduction of an oil painting by a Roman painter in the Ospedale di Santo Spirito in Rome. The Wellcome Library, London.