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The History of the Greek Anti-Malaria League and the Influence of the Italian School of Malariology

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The History of the Greek Anti-Malaria League and the Influence of the Italian School of Malariology Le Infezioni in Medicina, n. 1, 60-75, 2013 Le infezioni The history of the Greek nella Sto - Anti-Malaria League and the ria della Medicina influence of the Italian School Infections of Malariology in the La storia della Lega anti-malaria greca e l’influenza History of della Scuola italiana di malariologia medicine Costas Tsiamis, Evangelia-Theophano Piperaki, Athanassios Tsakris Department of Microbiology, Medical School, University of Athens, Greece n INTRODUCTION Malaria in Greece and Italy: a parallel history Malaria is a disease probably as old as humani - ollowing the liberation of Greece from the ty itself. The palaeo-pathological study of pre - Ottoman Empire in 1832 and until the eve historic human skeletal remains suggests that Fof the 20 th century, the small new country malaria was present during the Neolithic Age remained under the siege of malaria [1-4], the [6-8]. In the ancient world, malaria was endem - deadly disease at times becoming out of con - ic in the Mediterranean region. Malaria was en - trol. The nascent Greek state was fragile and al - demic in Greece as depicted in the case reports ways at risk of a new war with the Ottoman in Hippocrates’ first book of “ Epidemics ” and Empire. From 1882 to 1887, the Greek Army “Airs, Waters, Places ” [9-11]. suffered enormous losses due to malaria; ap - Conditions were similar in the Italian peninsu - proximately 42,000 soldiers were treated in the la as early as the Etruscan era [6, 7]. The Greek Military Hospital of Athens [5]. At the popula - physicians who came to Rome like Galen, Her - tion level, from 1899 until 1906, 2,147 individu - aclides and Agathinus also described the dis - als, especially neonates and young children, ease and focused on the fevers in their treatises died of malaria [5]. [12]. An interesting fact is detected from the The sanitary campaigns against malaria in epigraphic data of the Christian cemeteries of Greece started in the beginning of the 20 th cen - Rome from 3 rd -7 th century AD, many centuries tury and can be divided into three periods. The later. The epigraphic inscriptions as document - first period, from 1900-1930 comprises the ini - ed in the editions of Inscriptiones Christianae Ur - tial control efforts of the pioneers of the Greek bis Romae and Rivista di Archeologia Cristiana , in - Anti-Malaria League. The second period covers cluded the day, week and month of burials, re - the years 1930-1940, with the anti-malaria cam - vealing a high mortality rate for all age groups paign organized by the Malaria Department of in September [13]. the Athens School of Hygiene. The final period Using this data, the biological cycle of Anopheles from 1945-1960 comprises the successful joint during the summer months in the swamps efforts of the Malaria Department of the Na - around Rome can be easily correlated with the tional School of Hygiene of Athens, UNRRA onset of malaria in September. Similar data on and Rockefeller Foundation in the first years af - fever mortality can be found in other Christian ter the end of World War II. cemeteries in Italy. The records of the Deliberations of the Con - siglio Comunale depict malaria as a new Han - nibal, ante portas of Rome, until the eve of the *Corresponding author 20 th century [14]. Costas Tsiamis In the Middle Ages, many eminent Byzantine E-mail: [email protected] physicians, such as Oribasius and Paul of Aegi - 60 2013 na, provide information on fevers in the Eastern seems that the disease was consistently endem - Roman Empire (Byzantium) while at the same ic there [22]. time in Italy the Monastic Orders of the Bene - Actually, malaria in Greece did not attract dictines and Cistercians, were further develop - much attention before the liberation from the ing the nursing of patients [12, 15]. Moreover, Ottoman Empire. Brief references to reports these Orders, although they did not possess sci - about malaria in Greece, can be found in Roux’s entific knowledge of the interaction between edition of “ Histoire médicale de l’Armée française the environment and the disease but acting in en Morée ” (1829), in Faure’s “ Des Fièvres inter - compliance with their motto Ora et labora , culti - mittents et continues ” (1833) and Thomann’s vated the land, changing the topography of “Ueber die Wechselfieber in Griechenland ” (1839). lakes and rivers and controlling the annual Also, a geographical-climatological study car - floods [15]. ried out by Gittard in 1834, “ Considérations gen - Until the middle of the 19 th century, the only ac - erals sur la Constitution physique de Péloponèse et curate epidemiological data regarding the son influence sur le caractère et les maladies de ses Greek territory was derived from British habitants ”, provides us useful information on records for the Ionian Islands (1815-1864), dur - the Greek climate and the connection with ing the period of the British Protectorate fol - malaria [12]. lowing the Treaty of Paris in 1815 [16-18]. Some Greek physicians practising in the Greek British physicians studied malaria while assess - State collected epidemiologic data locally. Sev - ing the mortality and morbidity from local in - eral publications on malaria, mostly case re - fectious diseases in their new colonies. Accord - ports and reviews, rather than original research ing to this data, the most prevalent endemic in - studies, can be found in the Proceedings of the fectious disease in the region was malaria, Medical Society of Athens from 1835-1900. Ac - which in the British studies was described as cording to the records of the Medical Society of tertian fever , quartan fever , benign or malignant Athens found in the Microbiology-Epidemiolo - fever . In studies carried out by Greek physicians gy-Hygiene section, there are four studies on of the Ionian Islands who had studied medicine the nature of malaria (1849, 1855, 1859 and in Italian universities, fevers were described as 1894), two on malaria epidemics in Athens therma continua or amphimerina paludosa [16, 19]. (1868, 1886), and only one epidemiological Beginning in 1815, the British Army recorded study (1861). In 1881, Hirsch published his numerous casualties due to malaria and during study on the historical and geographical distri - the period 1822-1829, fevers were the leading bution of Greece, containing remarkable data cause of death in the British garrisons of the on malaria prevalence [12]. During 1884, Ionian Islands [20]. Stéphanos published his monumental work “ La The military physician of the Allied Regiment Grèce au point de vue naturel, ethnologique, anthro - of Sicily, Dr. Benza, later Protomedico and pologique, démographique et médical ”, in which he member of the Magistrato di Sanita di Corfu provides us information about the topography (1831), investigated the morbidity of the “ma - of the disease in Greece. According to lignant fevers” among the soldiers of the local Stéphanos, malaria incidence in modern Greece regiments in the fortress of Corfu [21]. Dr. Ben - fluctuated from year to year. The proportion za proposed that the cause of this morbidity patients with malaria in the total number of ad - was: “ that the temperature of the Veccia Fortezza di missions in the City Hospital of Athens “ Αστυ Corfu was 10 degrees higher than in any of the bar - κλινικ η’ Αθην w’ ν” ranged from 56.3% in 1865 to rack-rooms at Corfu ”, but he did not connect the just 19.9% in 1867. After 1890, the proportion mortality with the swamps present around the ranged from 25.4% to 8.8% [12]. town and of course the mosquitoes that bred In 1895 the Medical Newspaper of the Army in - there [21]. However, as the Inspector of the augurated a section entitled “Epidemic diseases British Military Hospitals in the Mediterranean, of Athens”, where the physicians recorded dis - John Davy, explains: “ It is more easy to say what ease morbidity and the mortality in the capital malaria is not, that what it is… ”. Dr. Davy’s re - monthly [3, 4]. In the Greek studies, physicians search also provides us with interesting data on differentiated clinical forms of malaria into: in - malaria mortality as well as a comparison of the termittent fevers, remittent fevers, pernicious disease’s prevalence in Greece and Malta. Simi - fevers, blackwater fever, chronic malaria and lar conditions were found in other Greek re - malarial cachexia. The pernicious fevers (which gions under the rule of Ottoman Empire and it had either quotidian or tertian periodicity) 61 2013 were further subdivided into: comatose fever, paign. However, due to political instability, the gastric fever, hyperpyrexial fever and convul - defeat in the Greek-Turkish War of 1897 and sive fever [12]. the destroyed postwar economy, the State was At the end of the 19 th century, the calculation unable to organize even a small anti-malaria made from the entries to the Athenian public, project for the country’s capital, let alone a na - private or university’s hospitals show the vari - tion-wide anti-malaria campaign. Malaria ous kinds of malaria in Athens: intermittent could be found even in the heart of Athens. fevers (91.52%), remittent fevers (3.44%), perni - From 1860 to 1905, there were 14 major malaria cious fevers (0.3%), blackwater fever (0.06%) epidemics in the Athens area [31]. The area sur - and malarial cachexia (4.66%) [12]. For the en - rounding the Panathenian Stadium, where the tire country the proportions were: intermittent first modern Olympic Games were held in 1896, fevers (91.67%), remittent fevers (6%), perni - was full of swamps created by the River Ilissos, cious fevers (0.27%), blackwater fever (0.09%) with a subsequent morbidity rate of 95% in the and malarial cachexia (1.95%) [12].
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