This column was contributed by Alvaro Pemartin
In my last column I reviewed the history of malaria in the UK, but this is far from being the only European country that suffered this disease in the past. Just to follow a geographic pattern, I will discuss the history of malaria in two of the most southern countries of Europe: Spain and Italy.
When looking at the fight against malaria in the British Islands, this effort shaped the country and influenced the movement and settlement of people. The same happened in Spain, where huge extensions of wetlands were drained to put an end to the breeding of mosquitoes. Interestingly, the risk of malaria prevented the agricultural use of the land of a big area in the province of Huelva. Thanks to this, we can enjoy the Doñana National Park, a natural UNESCO World Heritage Site, today.
Probably, malaria appeared on the Iberian Peninsula (a bull skin shaped appendix in the South of Europe) after the Neolithic revolution, when improved life conditions allowed a growth in the populations. This demographic explosion favored the spread of malaria (and other transmissible diseases). In the Old Ages, the geographical position of the Peninsula, a natural bridge between Africa and Central Europe, turned it in a coveted prey that was invaded by Greeks, Carthaginians, Romans or Arabs. It is likely that these invaders brought there our strains of the parasite to Spain. In the middle ages, wetlands, beside the always essential presence of water, offered ideal places for rice cropping, game and bird hunting and even leech farming. Yes, at those times leeches were a popular good in the pharmaceutical industry. But, the risk of the disease was not unknown. In most western countries the term 'malaria' was used (from the Latin malus aer meaning 'bad air') and in Southern Europe it is also known as paludism (from the Latin palus meaning 'lagoon' or 'pod').
Although its etiology and treatment were unknown, Spaniards were aware of some of their features. For example, natives from Northern regions of Spain where malaria was not common were usually not allowed to travel to the brand new American territory, due to his propensity to 'get the fevers'. This tradition was probably based on the 'semi-immunity' developed by the inhabitants of warmer regions. It also explains the predominance of Spanish surnames like Conquistadores, the first Spanish explorers of America.
In the modern history of Spain malaria is not forgotten. For instance the suspected cause of death of several Kings and Queens (Elisabeth I, Felipe II, IV, V and VI and Carlos I) and well-known persons as Hernán Cortés the explorer or Teresa de Jesús, the mystic writer was malaria. The disease was still a great health concern at the beginning of the 20th century. In the first decades malaria was responsible of 4000 deaths every year. The Spanish Civil War (1936–1939) was a serious backlash, with a severe malaria outbreak that caused more than 1000 deaths in 1943. But the battle against malaria continued in the second half of the last century and with the introduction of the mosquito-fish (Gambusia affinis), the use of DDT (Dichlorodiphenyltrichloroethane, a powerful insecticide) and the extensive drainage of marshals, Spain was declared free
of malaria in September of 1964. (Image: Malaria in Spain in 1780. Yellow areas are malaria free. Dark red areas are labeled as high risk of malaria).
The history of the different species and strains of Plasmodium is still controversial but there are sufficient written accounts about tertian and quartian fevers to affirm P. vivax and P. falciparum were already endemic from India and China to Greece back in 500 B.C. Malaria came to Italy following two routes. From the south: coming from Africa through the Tyrrhenian Sea it reached the Mediterranean isles of Sardinia and Sicily around 700 BC, the South of Italy around 600 B.C. and Rome around 450 B.C. From the East: coming from Central Europe and Asia, through the Adriatic Sea, malaria reached the South East of Italy (the heel of the 'Italian boot') around 300 B.C. and arrived to Venice, in the North East around 750 A.D. From this dates is The infant cemetery of Lugano in Teverina, seventy miles North from Rome was built in 450 B.C. Here the remains of more than 40 children (many of them, premature births) supposedly dead form a malaria outbreak, can be found.
In spite of this long history, at the beginning of the 20th century malaria was still prevalent in Italy. It caused 20.000 deaths and more then 2.000.000 cases per year among a general population of 30.000.000 inhabitants. In 1925, in Rome, l'Istituto di Malariologia (the Italian School of Malariology) was founded. The aim of this centre, supported economically by a grant of the Rockefeller Foundation, was to study and fight malaria in Italy. Scientists like Camillo Golgi, Ettore Marchiafava, Angelo Celli, Giovanni Battista Grassi, Amico Bignami, and Giuseppe Bastianelli worked in this institute and made essential contributions to the understanding of malaria. Celli and Marchiafava for instance described and baptized Plasmodium and Grassi, Bigmani and Bastianelli identified the mosquito as the vector of Plamodium transmission. An intense research activity, both scientific and preventive (with education and spraying campaigns) reduced the disease. Many of these successes were sadly swept during the second World War when the German
retreating army bombed of a large number of draining systems and water pumps that as a result flooded the terrain and created the ideal environment for the growth and dispersion of the Anopheles mosquito. In the post war era, an ambitious 'Five Year Malaria Eradication Program' was established in November 1944. This program mainly focused on the use of DDT. Several campaigns were launched in later years. At last, the World Health Organization declared Italy free from malaria on November 17, 1970. (Image: Italian envelope honoring Dr Grassi, one of the Italian fighters against malaria).
I have already discussed briefly two cases of countries that were very severely affected by malaria but, with the proper tools and the right political will, eradicated the disease from their landscapes. Once again we verify that defeating malaria is possible…
Alvaro Pemartin (Spain) Prehospital Emergency and Remote Site Doctor. My daily tasks are providing emergency and primary care in Remote Sites (Sierra Leone, Guinea-Conakry, Mauritania) Volunteer in my local Civil Protection Agency, Interested in Emergency and Disaster Management and in scientific ways of improving this management (Lessons Learned, Operational Research, Simulation, Modelling)… Member of International Association of Emergency Managers and Member of the Editorial Board of Crisis Response Journal.