Landscapes of Disease: Malaria in Modern Greece by Katerina Gardikas (review)

Until the late 1940s, Greece was the most malarial country in Europe—about one-quarter to one-third of the population was infected every year. During epidemic years and in places where the disease was particularly entrenched, such as Lake Copais in Boeotia and Elos in the southeast Peloponnese, infection rates well over fifty percent were sometimes recorded. In Landscapes of Disease, Katerina Gardikas presents a history of malaria in Greece from 1832 until the disease was finally eradicated in the country in the mid-1970s. The book, however, is not a history of the efforts made to control malaria, which is already addressed by recent scholarship. Instead, Gardikas offers a social history of the disease, examining the many roles it played in Greek society and the multitude of ways that human activities helped and hindered its progress.

Gardikas was Associate Professor of Modern Greek History at the National and Kapodistrian University of Athens until her retirement in 2016. This book is the result of over a decade of research on the history of malaria and its place in Modern Greek history, and the author notes that she has been interested in the topic since the mid-1960s. She utilizes a wide variety of sources, including a number of medical surveys, personal papers, and the archival records of organizations that took part in malaria control work in Greece.

The central inquiry of the book is how independent statehood affected malaria in Greece: "Did nationhood and its freedoms and pressures increase or reduce the suffering of the Greeks from malaria?" (12). The answer, we learn, is complicated. A number of factors need to be taken into account: landscape, climate, the effects of wars and military life, economic developments, population movements, advances in science and medicine, hereditary and acquired immunity, and more. What emerges from this investigation is the story of a highly contingent, dynamic process of human-environment interaction.

Malaria was an early priority for the Greek state. Many Ottoman-era drainage canals had been neglected during the war, and the Othonian regency of 1833–1835 was immediately confronted with a "nationwide malaria epidemic" (52). The regency implemented sanitary policies based on Bavarian and French models. They created a Greek Royal Medical Council for monitoring and controlling the disease and established a medical school in Athens. In the years after the regency, however, state spending on public health declined, and many of these policies were abandoned. For the rest of the nineteenth century, Greece experienced frequent epidemics of malaria.

Beyond the Greek state's early inability to confront epidemic malaria, Gardikas convincingly argues that other state-building processes actually helped the disease to spread. For example, the military reforms in the 1880s brought together enlisted men from all over the country. Non-immune soldiers were exposed to malaria and then returned home as carriers of the disease, helping to spread the infection around the country (62–63). The construction of railroads in the late nineteenth century also helped to spread malaria in the same way; once the projects were done, the workers returned home and took the disease with them (173). The ditches created on the sides of the tracks also became ideal mosquito breeding grounds, helping the disease to spread into new areas along the railroad lines (192).

Lowland settlement promoted the spread of malaria in a similar way. From the mid-1860s to the 1890s, the profitability of export agriculture, especially currant raisins, compelled villagers from the hills and mountains of the Peloponnese to settle in low-lying, coastal plains. Great numbers of non-immune farming families moved from their healthy, upland villages into zones of endemic malaria during the worst of the malaria season. The currant harvest also aligned with the peak months for contracting falciparum, the deadliest form of malaria (171). The villagers themselves also transformed the landscape in ways that promoted malaria. Land reclamation projects undertaken...