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Malaria History

Malaria History The Conquest of Malaria: Italy, 1900-1962 by Frank M. Snowden, 296 pp, with illus, $40, ISBN 0-300-10899-0, New Haven, Conn, Yale University Press, 2006. The title of Frank Snowden's book invokes an earlier, more optimistic era, when infectious diseases seemed to have receded from urgent medical concern. We now know that the complacency was never appropriate for developing countries, and the emergence of new infectious diseases, the specter of influenza, and drug resistance have punctured the coziness, even in the richest countries. Despite these contemporary concerns, Snowden's title is accurate. His subtle and sober account of the campaigns against malaria in Italy is never triumphalist, but it tells a success story. In 1900, malaria was a serious disease in many parts of Italy, blocking economic development and causing significant morbidity and mortality. In 1962, it had disappeared, and Italy shares with other European countries only the occasional case of travelers' malaria. Italy had long been highly malarious, with different patterns in the north and south. Snowden's careful study elucidates the eradication well, and the Italian experience offers much to ponder as we face malaria in the present century. First, as he demonstrates, the transition from fatalism to activity was stimulated by scientific discoveries. The 1898 elucidation of the role of the Anopheles mosquito in malaria's transmission by Giovanni Grassi in Italy and Ronald Ross in British India catalyzed the Italian antimalaria campaign. Although Ross and Grassi never negotiated their respective priority claims, the knowledge itself convinced scientists (and some politicians) that malaria could be controlled and possibly even eradicated. Second, scientific knowledge rarely dictates only one course of action. Ross always strongly advocated Anopheles elimination as the best course of action. The early Italian campaign concentrated on prophylactic and therapeutic quinine, on the rational principle that mosquitoes themselves become dangerous only when they have bitten an individual with malaria parasites in his or her bloodstream. An early 20th-century statute made quinine available without charge, and the Italian government set about ensuring that supplies were widely distributed. The program had significant effect in some areas. The quinine distribution program furnished a third lesson: monolithic vertical programs have their own problems. The health workers in the field soon discovered that illiterate peasants who had never had any contact with medical personnel were suspicious of their motives, had little interest in taking the drug, and in any case would have had difficulties following instructions. The early quinine program quickly became much more horizontal, with schools set up next to health centers, and basic literacy teaching and simple health education added to the agenda. What started as a campaign against malaria became a much more widespread initiative aiming at social melioration. The fourth Italian lesson is that governments can damage your health. The liberal programs before the First World War were replaced by Mussolini's fascist regime in the interwar years. Mussolini placed malaria control high on his agenda, but he had bad advisors, and in any case believed he already knew everything. His malaria work in the Pontine Marshes, the most malarious area of Italy, had some positive effects, but the program was ill-conceived, inefficient, and extremely expensive. After Italy changed sides during the Second World War, the retreating Nazi forces were able to destroy many of the drainage canals, in an act of deliberate biological warfare. Finally, the Italian experience amply demonstrates the negative impact of war on health. The First World War dented, and almost destroyed, the quinine and education initiative of the early malaria pioneers. Malaria thrives during times of unrest and the movement of refugees and troops from malarious areas to nonmalarious ones. Quinine supplies were also in short supply, and quinine and other antimalarials were scarce during the Nazi occupation. DDT, however, was developed during the Second World War, and despite the problems that it also presented, its availability undoubtedly hastened the decline of malaria during postwar reconstruction. There are a lot of other lessons that one might draw from Snowden's moving account of malaria and society in Italy. He fully justifies the notion of an “Italian School” of malariologists, but also pays proper attention to the role of external agencies, such as the Rockefeller Foundation, and to the subtle ways that nonmedical events, such as war or a change in government, have important bearings on the people's health. Back to top Article Information Financial Disclosures: None reported. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Malaria History

JAMA , Volume 296 (20) – Nov 22, 2006

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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.296.20.2493
Publisher site
See Article on Publisher Site

Abstract

The Conquest of Malaria: Italy, 1900-1962 by Frank M. Snowden, 296 pp, with illus, $40, ISBN 0-300-10899-0, New Haven, Conn, Yale University Press, 2006. The title of Frank Snowden's book invokes an earlier, more optimistic era, when infectious diseases seemed to have receded from urgent medical concern. We now know that the complacency was never appropriate for developing countries, and the emergence of new infectious diseases, the specter of influenza, and drug resistance have punctured the coziness, even in the richest countries. Despite these contemporary concerns, Snowden's title is accurate. His subtle and sober account of the campaigns against malaria in Italy is never triumphalist, but it tells a success story. In 1900, malaria was a serious disease in many parts of Italy, blocking economic development and causing significant morbidity and mortality. In 1962, it had disappeared, and Italy shares with other European countries only the occasional case of travelers' malaria. Italy had long been highly malarious, with different patterns in the north and south. Snowden's careful study elucidates the eradication well, and the Italian experience offers much to ponder as we face malaria in the present century. First, as he demonstrates, the transition from fatalism to activity was stimulated by scientific discoveries. The 1898 elucidation of the role of the Anopheles mosquito in malaria's transmission by Giovanni Grassi in Italy and Ronald Ross in British India catalyzed the Italian antimalaria campaign. Although Ross and Grassi never negotiated their respective priority claims, the knowledge itself convinced scientists (and some politicians) that malaria could be controlled and possibly even eradicated. Second, scientific knowledge rarely dictates only one course of action. Ross always strongly advocated Anopheles elimination as the best course of action. The early Italian campaign concentrated on prophylactic and therapeutic quinine, on the rational principle that mosquitoes themselves become dangerous only when they have bitten an individual with malaria parasites in his or her bloodstream. An early 20th-century statute made quinine available without charge, and the Italian government set about ensuring that supplies were widely distributed. The program had significant effect in some areas. The quinine distribution program furnished a third lesson: monolithic vertical programs have their own problems. The health workers in the field soon discovered that illiterate peasants who had never had any contact with medical personnel were suspicious of their motives, had little interest in taking the drug, and in any case would have had difficulties following instructions. The early quinine program quickly became much more horizontal, with schools set up next to health centers, and basic literacy teaching and simple health education added to the agenda. What started as a campaign against malaria became a much more widespread initiative aiming at social melioration. The fourth Italian lesson is that governments can damage your health. The liberal programs before the First World War were replaced by Mussolini's fascist regime in the interwar years. Mussolini placed malaria control high on his agenda, but he had bad advisors, and in any case believed he already knew everything. His malaria work in the Pontine Marshes, the most malarious area of Italy, had some positive effects, but the program was ill-conceived, inefficient, and extremely expensive. After Italy changed sides during the Second World War, the retreating Nazi forces were able to destroy many of the drainage canals, in an act of deliberate biological warfare. Finally, the Italian experience amply demonstrates the negative impact of war on health. The First World War dented, and almost destroyed, the quinine and education initiative of the early malaria pioneers. Malaria thrives during times of unrest and the movement of refugees and troops from malarious areas to nonmalarious ones. Quinine supplies were also in short supply, and quinine and other antimalarials were scarce during the Nazi occupation. DDT, however, was developed during the Second World War, and despite the problems that it also presented, its availability undoubtedly hastened the decline of malaria during postwar reconstruction. There are a lot of other lessons that one might draw from Snowden's moving account of malaria and society in Italy. He fully justifies the notion of an “Italian School” of malariologists, but also pays proper attention to the role of external agencies, such as the Rockefeller Foundation, and to the subtle ways that nonmedical events, such as war or a change in government, have important bearings on the people's health. Back to top Article Information Financial Disclosures: None reported.

Journal

JAMAAmerican Medical Association

Published: Nov 22, 2006

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