- Landscapes of Disease: Malaria in Modern Greece by Katerina Gardikas
This book explores malaria's complex interactions with Greek geography and society from the beginning of Greek nationhood through malaria's eradication in the 1970s. Drawing on an impressive array of sources, Katerina Gardikas unveils a rich set of detailed local histories that allows her to study the drivers of malaria and how this disease, in turn, influenced the economic, demographic, and cultural aspects of Greek society. This work is of particular interest to readers interested in how technology influences, and is shaped by, social change, since Gardikas conducts her analysis in relation to various phases of technological change in the overall economy, and in the field of medicine in particular.
Gardikas's highly relevant and ambitious main research question seeks to understand "how malaria interacted with the new social and economic realities that emerged in Greece after independence" (p. 12). The author looks at these interactions within the fragmented geographic landscape of the country and concludes that nationhood contributed to a higher incidence of malaria. Indeed, she shows convincingly that after independence, emerging economic opportunities in export markets (primarily currants) created conducive environments for the spread of the disease. For instance, the colonization of new lands connected previously safe locations with malarial areas as workers moved in and out. Similarly, epidemic outbreaks wreaked havoc in mining sites located near marshlands and manmade pools of water. Technological advances in the transport sector resulting from the expansion of railways made things worse, since they increased mobility with populations that were less resistant to the disease, and small pools of stagnant water along railway tracks served as mosquito breeding sites. However, as the author rightly argues, one should not immediately conclude that the effects of this technology were overall detrimental. Railways also integrated distant localities into national markets, greatly reduced transport costs, and thus led to rising living standards.
Military activities and the disruptive effects of war also contributed to the spread of malaria. Conscription created a homogeneous disease environment for soldiers that brought the disease with them when they returned home. Population displacements during and after military conflicts exposed communities that had been previously untouched by malaria—often [End Page 280] in dire conditions. However, in this case too, Gardikas shows us that the impact of military presence on malaria was not straightforward, since citizens often traded with soldiers in nearby barracks to acquire quinine tablets in exchange for food, tobacco, or wine.
The book discusses two major imported technologies that played a crucial role in the control and ultimate eradication of the disease: DDT spraying and quinine. The first was an insecticide that was widely applied throughout the country with the help of the international community after the Second World War. The second had been available to the population for a longer period of time, since pre-independence trading manuals mention the exchange and consumption of cinchona bark. It grew in popularity by the mid-nineteenth century, when doctors observed how the British and French military forces protected their troops using quinine. This observation prompted a strong cultural reaction among the Greek peasantry, who then also used quinine extensively for relief. Consumption levels were so high that the country consumed 1/5 of the global production during the refugee crisis in 1922.
The breadth of this book is remarkable, as it effectively combines insights from natural and social science with detailed historical analyses. It presents a complex picture of epidemiological, social, and economic processes that clearly show the nonlinear character of progress against malaria. The high level of geographic detail, while useful for understanding these complexities, can be overwhelming for readers that are not fully acquainted with the country's geography. The author concedes that some of the answers the book provides are indirect or inconclusive due to lack of data before the country's independence (p. 306). To overcome this limitation, the analysis would have benefitted from the comparison of other European countries with malaria as a benchmark. These issues aside, this is a...