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

Robert Sallares's Malaria and Rome juxtaposes ancient literary and archeological evidence about malaria with what is now known about the disease's ecology and epidemiology in the Italian peninsula from the early modern period to its virtual eradication in the middle of the last century. Sallares's focus is on explaining and understanding mortality and morbidity among the ancient peoples of Etruria, Latium, Campania, and Magna Graecia, intertwining medical history with Roman demography so as to demonstrate the "awesome power" malaria has "as a determinant of demographic patterns" (pp. 2, 283-85). Malaria elevates mortality not only among neonates and young children (although the survivors thereby acquire a degree of subsequent immunity) but also among adults when it is endemic. Nonetheless, malaria's effects are not everywhere the same, and Sallares is at considerable pains to display the disease in its many manifestations from locality to locality and diachronically in the same location. Ancient evidence is jejune and anecdotal, yet by linking it to modern Italian experiences Sallares builds an argument cumulatively and persuasively. Both variations in climate (malarial parasites require temperatures above 20°C to reproduce rapidly) and altitude (mosquitoes seldom venture above 400 to 500 meters above sea level), as well as ecological changes—natural in the case of alluviation and anthropogenic in deforestation and drainage—affect mortality differently over time and space. There is, then, in Sallares's argument not a single demographic profile for Roman Italy but a multitude of profiles, because the existence and intensity of malaria affect birthrate, death rate, and overall vigor.

Sallares finds no indication that medical writers of the Roman period associate mosquito bites with the intermittent fevers of malaria, although they repeatedly label air in the vicinity of wetlands unhealthy. The phenomenon of "anophelism without malaria," such as prevails in antiquity along the northeastern coastal marshes near Ravenna, no doubt obscures the connection between parasite and vector. Roman agronomists counsel avoidance, urging readers not to establish a villa or lay out a farm near wetlands. Ancient descriptions of "tertians" and "quartans" emphasize the periodicity of malarial fevers, with the most pernicious, the tertian, now associated with Plasmodium falciparum, and the mildest, the quartan, with P. malariae. Avoidance behavior, however, is a prerogative of the wealthy: The younger Pliny does not summer at his Laurentine villa on the insalubrious coast of Latium but rather inland at Tifernum near the Appenine foothills in Umbria (Epist. V 6.2). Slaves and the Roman poor have no choice but to live and labor where they find themselves, whether in the countryside or in Rome with its own marshlands the result of the Tiber's inundations. As Sallares points out (pp. 270-71), Pliny's same long letter to his friend Domitius Apollonarius not only enunciates the demographic consequences of a healthful environment for villagers of Tifernum—populated, as Pliny claims, by many grandfathers and great-grandfathers—but also for his own slaves, no one of whom died at Tifernum.

Coastal areas and river valleys leading inland may have originally experienced low levels of malaria, for cities on or near the coast, from Etruscan Vetulonia to Greek Poseidonia and Metapontum, flourish in the seventh to fifth centuries B.C.E., before stagnating or disappearing later. Sallares suggests that the level of salinity at Rome's port of Ostia, for example, was at first too high for Anopheles mosquitoes, with malaria becoming endemic in later antiquity, as alluvial deposits at the Tiber's mouth cut inland lagoons off from the sea and lowered saline levels (pp. 86-87).

It is common for classicists, ancient historians, and historians of ancient medicine to note that Mussolini's draining of the Pontine marshes turned the west coast of central Italy into a site of vacation villas and the adjacent regions into intensely cultivated fields, despite repeated failures in earlier times by Julius Caesar and others. With Rome and Malaria, Sallares repositions malaria as the important cause of death for...