R. Sallares — Malaria and Rome. A History of Malaria in Ancient Italy

Автор: R. Sallares
Название книги: Malaria and Rome. A History of Malaria in Ancient Italy
Формат: PDF
Жанр: История медицины
Страницы: 358
Качество: Изначально компьютерное, E-book

Malaria and Rome is the first comprehensive book on the history of malaria in Roman Italy. Aimed at an interdisciplinary readership, it explores the evolution and ecology of malaria, its medical and demographic effects on human populations in antiquity, its social and economic effects, the human responses to it, and the human interpretations of it.

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 criticism
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 foundation
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 bookshops.
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
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 understood
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 studying
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 antimalarial
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
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 supposedly
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 geography,
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 comparative
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 explicate
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
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.
Traditionally ancient history ended with the downfall of the last
Roman emperor in  476, with the implication of a sharp break
between the ancient and medieval eras, although it is arguable that
this date had no real significance. As far as the city of Rome is
concerned, the Gothic wars described by Procopius in the sixth
century  did the worst damage to Rome itself. The old civic
institutions such as the Roman Senate seem to have disappeared by
the time of the reign of Pope Gregory the Great ( 590–604).
Some specialists in late antiquity speak of the transformation of
the Roman world and extend the chronological span of antiquity
forwards into the sixth or seventh centuries , reverting towards
Henri Pirenne’s (1937) opinion that the break between the ancient
and the mediaeval worlds occurred in the time of Charlemagne in
the eighth century, rather than in the fifth century. However, this
position still leaves a dividing line between, on the one hand,
ancient Roman history, and, on the other hand, later Italian
history. The argument of this book is that the divide between
ancient history and later periods is a barrier to understanding, at
least as far as the topic of this book is concerned. It has prevented
ancient historians from using the much more abundant and
detailed later evidence to make sense of the fragmentary ancient
sources.