The Conquest of Malaria: Italy, 1900–1962 (review)

The history of malaria has received a great deal of scholarly attention. Much of this scholarship—including Angelo Celli's classic volume on the history of malaria in the Roman Campagna, Edwin Ackerknecht's study of malaria in the Upper Mississippi Valley, and more recent histories of malaria in early modern England by Mary Dobson, and in the American South by Margaret Humphreys—has documented the complex interplay between the epidemiology of this parasitic disease and broader patterns of social and economic change. Frank Snowden's history of malaria in Italy is an important addition to this scholarly tradition.

Italy holds a special place in the modern history of malaria, for it was the site of several of the most important developments in malaria control. From Giovanni Grassi's demonstration of the role of the anopheline mosquito in the transmission of malaria in humans, to the country's highly successful quinine campaign during the early decades of the twentieth century, to the efforts to eliminate the disease by combining malaria control with general social and economic development, to the early use of DDT in the 1940s and 1950s, Italy has been at the center of efforts to conquer the disease. Snowden's thoroughly researched and highly readable account examines each of these developments and at every point revises what we know about them, by placing them within a broader historical context.

This approach is clearly visible in Snowden's description of Italy's quinine campaign, begun in 1901, which resulted in a dramatic decline in malaria mortality. While others have described the campaign, Snowden deepens and revises our understanding of it in several ways. First, he convincingly argues that its success rested as much on its organization as on the effectiveness of quinine in suppressing infections. In particular, he shows how the campaign was based on the creation of a network of health stations that, together with price subsidies, made the drug available to the poorest of the poor. In addition, the creation of peasant schools aimed to educate rural populations about malaria, but also more generally greatly facilitated popular acceptance of quinine.

Secondly, by placing the quinine campaign within the context of Italian history, Snowden is able to show that its success was supported by social and economic changes occurring in southern Italy in association with massive emigration to the United States. The outflow of men and women reduced labor supplies and forced employers to negotiate better terms of employment with workers, including reduced hours; the reduction permitted workers to avoid exposure to anopheline mosquitoes, which fed on human hosts during the early morning and evening. In addition, returning migrants brought back new financial resources, which contributed to improvements in housing and general welfare. In a similar way, Snowden adds complexity to the stories of Italy's efforts to control malaria through land reclamation or so-called bonification, and through the use of DDT after World War II.

This study also illustrates, as well as any study to date, the complex ways in which warfare disrupts local ecologies and contributes to the resurgence of malaria. In a particularly chilling passage, Snowden describes how the retreating Nazi army at the end of World War II purposely destroyed the sophisticated drainage system that had been created to reclaim the Roman Campagna and Pontine Marshes by Mussolini's government. The destruction was specifically designed to re-create breeding grounds for local malaria-carrying mosquitoes that had been eliminated by the drainage system. This act of biological warfare, designed to slow the advance of allied troops and punish Italians for withdrawing from the war, reintroduced malaria to the region.

Snowden ends his account by drawing important lessons for current malaria-control efforts. For example, the history of the quinine campaign suggests that the success of current efforts to control malaria through the wide distribution of bed nets and other protective technologies will depend on the creation of effective distribution...