MALARIA and ROME This Page Intentionally Left Blank Malaria and Rome

MALARIA AND ROME This page intentionally left blank Malaria and Rome A history of malaria in ancient Italy ROBERT SALLARES 1 3 Great Clarendon Street, Oxford 2 6 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Bangkok Buenos Aires Cape Town Chennai Dar es Salaam Delhi Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi São Paulo Shanghai Singapore Taipei Tokyo Toronto and an associated company in Berlin Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Robert Sallares 2002 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2002 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquiror British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data applied for ISBN 0–19–924850–8 1 3 5 7 9 10 8 6 4 2 Typeset in Baskerville by Regent Typesetting, London Printed in Great Britain on acid-free paper by Biddles Ltd., Guildford and King’s Lynn To my parents This page intentionally left blank PREFACE A detailed knowledge of medical history is essential for understanding mortality patterns in past populations. Medical history in this context does not mean the history of ideas about causes of death, but the history of diseases themselves. It is a very demanding and difficult subject because it requires a multiplicity of different skills. It is necessary to possess the traditional skills in source criti- cism and analysis of conventional historians, as well as the ability to read texts in foreign or dead languages. However, there is another equally important dimension to it. It also requires a very solid foun- dation of knowledge about medicine and various branches of the natural sciences. Our knowledge and understanding of the malaria parasite Plasmodium falciparum is poised to increase exponentially as a result of the project to sequence its genome. Chromosomes 2 and 3 have already been completely sequenced, and it is likely that the complete DNA sequences of the other dozen chromosomes will have been obtained by the time that this book reaches the book- shops. At the beginning of the new millennium the history of diseases stands on the threshold of a revolution; a revolution created by the application of these new techniques of molecular biology to human skeletal remains excavated on archaeological sites. This revolution will eventually transform our understanding of the evolution, history, and distribution of diseases in prehistory and antiquity. I am engaged in such research, although very little is said about it in this book. Nevertheless the ultimate challenge must be to integrate the data yielded by different approaches, and there is still much to be learned from a comprehensive examination of the ancient documentary and literary sources for malaria, upon which this book concentrates. Very few people have the time and leisure and, dare one say it, the ability to master all the skills that are required by medical historians. The outstanding example of how it should be done is of course the late Mirko Drazen Grmek (obituary in Duffin (2000)). However, he was quite exceptional. There are many historians who are experts in the history of ideas about medicine, but know little or no science. Conversely, there are numerous viii Preface doctors and scientists who know little or no history. This problem applies to the medical history of all ages, including the medieval and early modern periods, but it is particularly serious as far as classical antiquity is concerned, because of the way in which ancient historians are trained. Disease and demography have generally been studied quite separately by classicists. There are few exceptions to this trend. Grmek (1983: 135–77) did include a chapter on palaeodemography in his marvellous book on diseases in the ancient Greek world. He concentrated on the evidence for life expectancy provided by ancient bones, a very thorny subject, but said little about the mortality and morbidity levels and epidemiology of even the most important infectious diseases, such as malaria and tuberculosis. The leading figures in research into Roman demography have paid virtually no attention at all to diseases, the major determinants of mortality patterns. Conclusions about the mortality patterns of ancient populations reached by historians who ignore the determinants of mortality patterns can only be pure description, at best. Nothing is being explained. In reality population history is embedded in a much larger ecological context. It cannot be under- stood without considering this wider context. Demonstrating this in relation to ancient history is the principal objective of this book. Mary Dobson’s (1997) magnum opus on malaria in early modern England provides an admirable model of how it should be done. She showed that the homogeneity of human populations, which is generally taken for granted by ancient historians, is basically a phenomenon of the twentieth century and the later stages of the nineteenth century . It cannot be taken for granted when study- ing earlier periods of history. The homogeneity of modern populations is a recent historical development, which was brought about by various specific means, for example the vaccination of entire populations against specific diseases (such as smallpox), and the provision of pure water supplies to whole populations (eliminating water-borne diseases). The development of universal health care services, for instance when the Italian government made the anti- malarial drug quinine available to the entire Italian population free of charge at the beginning of the twentieth century, also played a major role, as well as general improvements in nutrition and the standard of living. Even so, there are still significant differences in mortality patterns between different regions and different social Preface ix classes in modern European populations. In Britain at the time of writing life expectancy for males varies between 68 and 78 years, and for females between 75 and 83, in different parts of the country. No modern population is entirely homogeneous. It is clear that the populations of early modern Europe were much less homogeneous. In fact, regional diversity prevailed. Yet the homogeneity of populations in antiquity is an assumption built into virtually all published modern literature on ancient Roman demography. There is no evidence at all for this supposed population homogeneity in antiquity. The assumption is the result of a particular method of analysis, namely the brandishing of life tables not derived from evidence for ancient populations as schematic models sup- posedly applicable to the entire Roman Empire. In contrast, this book is a regional case study demonstrating that the regional diversity of demographic patterns now known to have been the norm in early modern Europe was also the norm in antiquity. It argues that actual demographic conditions were strictly dependent on often very highly localized ecological circumstances, particularly the precise configuration of the local ecological community of diseases or pathocoenosis (to use Grmek’s concept), which was in turn inextricably linked to other variables (e.g. climate, physical geogra- phy, hydrology, population density, the history of the distribution of disease vectors, etc.). In central and southern Italy in antiquity malaria was the single most important component of the pathocoenosis. The aim of this book is to focus attention on the effects of malaria on population structure, rather than population size. In the course of this book frequent references are made to com- parative material from later periods of Italian history. However, this book is most certainly not intended to be a comprehensive account of the history of malaria in medieval and early modern Italy. Obviously that would require another book or series of books, given the large volume of source material that is available. The intention here is rather to use later material selectively to expli- cate the generally fragmentary ancient sources. For example, when Cicero describes the course of an infection of quartan fever in Atticus, how typical was the case of Atticus? It is unique in ancient Latin literature for its chronological detail, but statistical analysis is impossible with a sample of one. It is only by considering more abundant evidence from later periods that we can see that his case history was an absolutely typical example of the chronology of x Preface cases of quartan fever in Italy in the past; undoubtedly there were countless other cases like it in antiquity (see Ch. 5. 2 below). It is exceedingly easy for ancient historians who are not specialists in medical matters to grossly underestimate how much material is in fact available. The Italian National Archive Office is currently undertaking a major project to publish all the documentation in its possession relating to malaria in Italy. Fantini and Muzzioli (1987) compiled a long catalogue of the numerous archives in the city of Rome containing documents relevant to the study of malaria in Italy, while in 1998 the journal Medicina nei Secoli : Arte e Scienza (10/3) published a long series of articles on the archival sources for malaria in Italy.

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