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

This book deserves to be in every university library collection, not only because the topic is important, but because it includes such impressive scholarship and bibliography. The author's primary aim is to emphasize the critical importance of malaria for understanding the demography of ancient Rome and its immediately adjacent territories. The history and ecology of malaria in the Agro Romano was once an important topic for classicists like W. H. S. Jones (Malaria: A Neglected Factor in the History of Greece and Rome, 1907) as well as scholars like the public health activist and historian Angelo Celli, whose volume The History of Malaria in the Roman Campagna from Ancient Times (1933; English ed. repr. 1977) was the last comprehensive treatment of this subject. Celli's posthumous publication (he died in 1914) argued in grand nomothetic manner that there was an inverse correlation between the malaria rates and the various "highs and lows" of the empire's local economic and political success.

In contrast, the present volume by Robert Sallares is ideographic, providing a wealth of facts, observations, and citations about malaria in the ancient and early modern Italian context, without a wider theoretical synthesis. Sallares first summarizes the kinds of malaria and the evolutionary history of the disease. In the two central chapters of the book he discusses the ecology of malaria and its demographic impact. The final chapters are geographically based, presenting the evidence about malaria in Rome itself, the Pontine marshes, the Roman Campagna, Tuscany, and Apulia. Quite unlike Celli's history of malaria, this book does not follow a chronological sequence.

Despite many internal references, the book's organization is hard to follow—not because of its interdisciplinary nature (the combination of classical quotations and ribosomal DNA sequences), but because it occasionally jumps between topics. Many single paragraphs include references to multiple historical epochs—from ancient texts to medieval clinicians to twentieth-century malariologists—in a stunning way. Most biomedical malariologists would feel very uncomfortable with the author's frequent use of archaic clinical terms like "tertian," "semitertian," and "quotidian" fevers.

Much of the book is not about malaria in ancient Rome per se, but rather relies heavily on historical analogs in ecology and demography from nineteenth-century Italy. For example, the central example in the historical demography chapter is a comparison of demographic life tables of Grosseto (Maremma, southwest of Florence in Umbria) from the 1840s that clearly demonstrates that the mortality patterns do not fit the famous Coale-Demeny life tables of age structures for historic English populations. This is because the burden of malaria increased mortality so that the pattern in Grosseto was more similar to areas of contemporary Africa, where Plasmodium falciparum malaria is endemic, than to early modern Europe. By implication, therefore, the mortality regime in ancient Rome was at least as bad.

One of the most interesting parts of this volume, which has been widely (and simplistically) covered in the popular press, is the interpretation of epidemic malaria from a collection of child and infant burials from the fourth-century (ce) site of Lugnano in Teverina (Umbria), excavated by David Soren. Using a newly developed molecular paleopathological method, Sellares and Susan Gomzi used PCR to amplify residual DNA in a leg bone (with traces of marrow), and then compared those genetic sequences with structurally distinct ribosomal RNA sequences from the malaria parasite P. falciparum. Although confirmation of P. falciparum malaria at this site is hardly surprising, the great potential of this new method warrants much more discussion than is found in this book.

Similarly, important ecological concepts—differences in adult-acquired immunity in contexts of endemic versus temperate-climate epidemic malaria, and the phenomenon of "anophelism without malaria" due to racial (subpopulational) behavioral differences in blood host preferences within anopheline species.¹ The...