Pathogens and Global Health

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Fifty years after the eradication of Malaria in

Italy.The long pathway toward this great goal and
the current health risks of imported malaria.

Mariano Martini, Andrea Angheben, Niccolò Riccardi & Davide Orsini

To cite this article: Mariano Martini, Andrea Angheben, Niccolò Riccardi & Davide Orsini
(2021): Fifty years after the eradication of Malaria in Italy.The long pathway toward this great
goal and the current health risks of imported malaria., Pathogens and Global Health, DOI:
10.1080/20477724.2021.1894394

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Published online: 18 Mar 2021.

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PATHOGENS AND GLOBAL HEALTH
https://doi.org/10.1080/20477724.2021.1894394

Fifty years after the eradication of Malaria in Italy.The long pathway toward
this great goal and the current health risks of imported malaria.
a
Mariano Martini , Andrea Anghebenb, Niccolò Riccardib and Davide Orsinic
a
Department of Health Sciences, University of Genoa, Genoa, Italy; bDepartment of Infectious - Tropical Diseases and Microbiology, IRCCS
Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Verona, Italy; cUniversity Museum System of Siena (Simus), History of Medicine,
University of Siena, Siena, Italy

ABSTRACT KEYWORDS
Fifty years ago, Italy was declared a malaria-free country by the World Health Organization Malaria; history; discoveries;
(WHO). In remembering this important anniversary, the authors of this paper describe the long Italian malariologists;
journey that led to this goal. In the century following the unification of Italy, malaria was one of travelers; imported
the main public health problems. At the end of the 19th century, malaria cases amounted to
2 million, with 15,000–20,000 deaths per year. This manuscript examines the state of public and
social health in Italy from the end of the 19th century to the beginning of the 20th century, with
particular regard to the government’s measures for the prevention, prophylaxis and treatment
of malaria. The authors describe the main findings of Italian malariologists during the period
under review, from the identification of Plasmodium as a malaria pathogen and the recognition
of the Anopheles mosquito as its vector. They also make some considerations regarding the
current situation and the importation of malaria by travelers and migrants from countries
where the disease is still endemic.

Introduction and some considerations on the the WHO Eastern Mediterranean Region (about
current situation 5 million) [5,6].
Malaria is an infectious disease caused by a parasitic Despite the appreciable decline revealed by these
protozoon called Plasmodium spp, which lives and figures, the death toll remains unacceptably high.
reproduces, in different phases, in human blood and Indeed, malaria is estimated to have caused more
in various species of mosquitoes belonging to the than 409,000 deaths worldwide in 2019, compared
genus Anopheles [1]. Known and described since anti­ with 405,000 in 2018, and 585,000 in 2010 [5].
quity, malaria takes its name from the belief, which was Children under 5 years of age are the most vulnerable
widely held until the late 19th century, that the disease subjects, accounting for 67% of all malaria deaths
was caused by foul emanations (mal’aria meaning ‘bad worldwide in 2019 [5].
air’) from swamps. The epidemiology of malaria in endemic countries,
In 1880, however, the etiological agent of the dis­ combined with population movements and interna­
ease was discovered by the French army doctor tional travel, also explains the proportion of cases of
Charles Louis Alphonse Laveran, who first identified imported malaria in European countries, where malaria
the parasite in the blood of a patient in Constantine, has been eradicated since the 1970s [7], which consti­
Algeria [2]. Characterized by intermittent, putrid, tutes a threat to individual and public health. Soon
malignant fevers, ‘mal’aria’ has constituted a major after the eradication of malaria in Europe, 2,812 cases
social and health problem since ancient times [3,4]. of imported malaria per year were detected in Europe
Fifty years ago, in 1970, Italy was officially declared (1971–1975), becoming 6762 a year in 1986–1987. In
malaria-free by the World Health Organization (WHO). Italy, cases of imported malaria rose from 102 in 1976
Today, many high- and middle-income countries are to 479 in 1989 [8–10].
free from the disease. Nevertheless, it must be remem­ The latest data provided by the Italian surveillance
bered that, according to the data published in the 2020 system, and national case records of imported malaria
World Malaria Report, an estimated 229 million cases between 2013 and 2017, indicate the need to include
of malaria still occurred worldwide in 2019, compared malaria in national plans for the surveillance of vector-
with 251 million in 2010 and 228 million in 2018 [5]. borne diseases [11].
Most of these cases occurred in the WHO African The analysis of provisional 2013–2017 data showed
Region (215 million: 94% of cases), followed by the 3,805 imported cases (677–888/year), 17% of which
WHO South-East Asia Region (about 6.3 million) and among Italians, while the most significant group was

CONTACT Mariano Martini [email protected] Department of Health Sciences, University of Genoa, Largo R. Benzi, GENOA, 16132, Italy.
© 2021 Informa UK Limited, trading as Taylor & Francis Group
2 M. MARTINI ET AL.

Imported malaria cases reported in Italy in 1976-1989

600

500

400

300

200

100

0
1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989

Figure 1. Imported malaria cases reported in 1976–1989. Source: Italian National Institute of Health.

Malaria cases in Italy in the period 2013-2017

1000
900
Number of malaria cases reported

800
700
600
500
400
300
200
100
0
2013 2014 2015 2016 2017

Total cases Foreigners Italians

Figure 2. Malaria cases in Italy in the period 2013–2017. Source: Italian National Institute of Health.

Deaths from malaria in Italy between 1887 and 1899

25000

20000

15000

10000

5000

0
1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899

Figure 3. Deaths from malaria in Italy between 1887 and 1899.

represented by settled immigrants. Twelve cases were Indeed, in Italy, as in other European countries,
autochthonous, 4 induced and 8 cryptic, with a peak of society is undergoing changes (increased international
7 cases that occurred in summer 2017 creating a great travel, climatic and environmental change, migratory
concern for public health. [12]
flows), though these have been drastically reduced by
 PATHOGENS AND GLOBAL HEALTH 3

Deaths from malaria in Italy between 1900 and 1920

18000

16000

14000

12000

10000

8000

6000

4000

2000

0
1900 1902 1904 1906 1908 1910 1912 1914 1916 1918 1920

Figure 4. Deaths from malaria in Italy between 1900 and 1920.

Deaths from malaria in Italy between 1900 and 1920

(x 1,000,000 inhabitants)
600

500

400

300

200

100

0
1900 1902 1904 1906 1908 1910 1912 1914 1916 1918 1920

Figure 5. Deaths from malaria in Italy between 1900 and 1920 (× 1,000,000 inhabitants).

the COVID-19 pandemic. In order to cope with these in the case of suspected autochthonous events [14].
changes, the utmost attention must be paid to the Moreover, preventing the reestablishment of malaria
continuous surveillance of both competent vectors in all countries declared disease-free is among the
and cases of imported malaria. goals of the Global Technical Strategy (GTS) for
Mosquitoes of the genus Anopheles, which are Malaria 2016–2030 [15].
potential vectors of malaria, particularly those belong­ In addition, the current COVID-19 pandemic is
ing to the maculipennis complex, continue to be pre­ a health emergency that must all the more prompt
sent in Italy [13]. Specifically, Anopheles labranchiae, the international community to support all the efforts
which was historically the principal vector of necessary to prevent, detect and treat malaria. Indeed,
Plasmodium in Italy, is still widespread in coastal ‘during the COVID-19 pandemic, the malaria commu­
areas of the central-southern regions and islands. nity must remain committed to supporting the preven­
In Italy, malaria is a notifiable disease, and the tion of malaria infection, illness and death through
Ministry of Health and the Italian National Institute of preventive and case-management services, while
Health are responsible for maintaining a national sur­ maintaining a safe environment for patients, clients
veillance system that carries out annual assessments of and staff. Deaths due to malaria and its comorbidities
the epidemiological situation of imported cases and (anemia, undernutrition, etc.) must continue to be pre­
which enables intervention to be promptly undertaken vented’ [16].
4 M. MARTINI ET AL.

These recommendations are even more important The discovery of the parasite and of the
when we think of the extraordinary commitment that relationship between cause and clinical
Italy had to make in order to be defined a malaria-free picture
country in 1970 [17]. This result, however, was
In this very worrying public health context, it was
achieved only after a long struggle involving the
hoped that aid might come from the important scien­
implementation of numerous social and public health
tific discoveries of the time.
measures, beginning in the second half of the 19th
The belief that emanations from swamps caused
century [18].
intermittent fevers persisted until the middle of the
In the fight against malaria, the most striking
19th century. However, back in 1717, Giovanni Maria
achievements were the result of the initiatives
Lancisi, in his work De noxiis paludum effluviis eorum­
undertaken between the 1930s and the 1950s:
que remediis, had already attributed the cause of
swampland was reclaimed; in 1944–1945, an effica­
malaria to palustral exhalations, which he regarded as
cious insecticide derived from arsenic (dubbed
living beings (effluvia animata), and to mosquitoes
“Paris Green”) [19] was sprayed from airplanes; and
[26]. Indeed, he hypothesized that these harmful ema­
from 1946 to 1947, vast malarial zones were treated
nations were inoculated into humans by mosquitoes,
with DDT (dichloro-diphenyl-trichloroethane)
a conviction which prompted him to study blood
[20,21]. Nevertheless, we should also remember
under the microscope in a search for ‘worms or winged
the progress made through the State quinine cam­
insects’.
paigns at the beginning of the century. In this
However, it was not until 1880, that the French
period, Italy had not long been unified, malaria
doctor Alphonse Laveran managed to detect the pro­
was endemic and the first legislation, in the early
tozoon responsible for malaria in the blood of indivi­
1900s, was passed in the wake of the discovery of
duals affected by the disease, a discovery which earned
Plasmodium and the advances in malariology.
him the Nobel Prize for medicine in 1907.
In 1885, a few years after Laveran’s discovery,
Camillo Golgi demonstrated the association between
Malaria: the ‘Italian national disease’
the periodicity of malarial fevers and the life-cycle of
In 1882, the senator Luigi Torelli, who presided over the parasite that caused the disease; he discerned the
a specific Commission of the Senate of the link between the onset of the fever and the division
Kingdom, wrote in his report accompanying the (which he called ‘segmentation’) of plasmodia [27].
Map of Malaria in Italy: ‘Italy, with its 28 million Indeed, tertian and quartan fevers are caused by two
inhabitants, is physically ill; it is ill with malaria’ distinct species of Plasmodium: Plasmodium vivax,
[22]. In the northern regions of the country, exclud­ responsible for benign tertian malaria, which causes
ing the coastal areas of Veneto, a mild form of the febrile attacks every 3 days, and Plasmodium malariae,
disease prevailed, while in the southern regions and responsible for quartan malaria, which is characterized
the islands, an extremely severe form raged. The by febrile attacks occurring every 4 days.
Kingdom’s first public health statistics, published in Subsequently, in 1889 in Rome, a group of research­
1887, revealed that malaria was endemic in about ers, among whom Ettore Marchiafava, Angelo Celli and
one-third of the national territory, with a mortality Pietro Canalis, demonstrated the existence of
rate of 710 per million inhabitants [21]. The total Plasmodium falciparum, the species responsible for
number of cases was estimated to be about pernicious tertian malaria, or summer–autumn fevers,
2 million, on a total population of about which caused thousands of deaths in the Lazio Region
30 million, while annual deaths exceeded 20,000, and in Southern Italy and the islands [28,29].
mostly among children [23]. In 1894, Patrick Manson, who is regarded as the
In a speech in Parliament prior to the passage of founder of tropical medicine, hypothesized that mos­
Law 460 of 1901 (the law on malaria control) [24], quitoes played a fundamental role in transmitting
a Deputy, Raffaele Perla, described the trend in mor­ malaria, and asked his colleague Ronald Ross to exam­
tality at the end of the 19th century: ‘In 1887, deaths ine this hypothesis. Thus, in 1897–1898, while Ross was
due to malarial fever and palustral cachexia numbered in India, he ascertained that an avian Plasmodium was
21,033; in the following years, up to 1896 (except for transmitted by mosquitoes. He was, however, unable
1891, when the number rose to 18,229), mortality due to demonstrate that malaria was transmitted by the
to the above-mentioned causes oscillated between bite of the mosquito, nor to establish that only one
15,000 and 14,000; in the last two years, it has declined genus of mosquitoes, Anopheles, could act as a vector
markedly, reaching 11,947 in 1897 and 11,378 in 1898’ of the human malarial parasite. ‘These two fundamen­
[25]. These figures indicate that malaria was one of the tal facts were demonstrated experimentally in 1898,
most serious public health problems in Italy at the during work with a patient at S. Spirito Hospital in
time. Sassia, by Amico Bignami, Giuseppe Bastianelli and
 PATHOGENS AND GLOBAL HEALTH 5

Giovanni Battista Grassi, who also described, in the ‘question of the efficacy of the quinine prepara­
humans and mosquitoes, the developmental cycle of tions produced by the State in comparison with
the three species of malarial parasites present in Italy’ a private industrial preparation: Esanofele, produced
[23]. Grassi’s fundamental contribution stemmed from by the company Felice Bisleri & C.’ [23].
his ample biogeographical studies; by mapping all the While Celli advocated implementation of the Law of
species of mosquito in Italy’s malarial and non-malarial 23 December 1900, which established that the State
areas, he was able to correlate the presence of malaria should produce and distribute various quinine-based
with a specific genius of mosquito. In 1898–1899, he formulation – and a fundamental role in this was
identified the Anopheles mosquito as the sole vector of played by the State Quinine Factory in Turin – Grassi
malaria [21]. was conducting experimentation on Esanofele in Ostia
In his volume Studi di uno zoologo sulla malaria, in 1901. Essentially, Esanofele was the ‘Baccelli mixture’
published in 1900 by the R. Accademia dei Lincei, that this Roman clinician had invented in 1869 to treat
Grassi summarized all the procedures and conclusions chronic malaria; it was composed of ‘quinine sulphate,
of his years of study of the Anopheles mosquito and ferric potassium tartrate, pure arsenous acid and dis­
Plasmodium. tilled water’ in fixed proportions [23].
The question gave rise to lively controversy
between Grassi and Ross, who was awarded the 1902
Italian antimalarial legislation
Nobel Prize for medicine ‘for his work on malaria’
[30,31]. Indeed, Ross had shown how malaria entered Leaving aside these polemics, it was precisely the pre­
the organism, thereby laying the foundations for fruit­ sence of doctors and scientists in the Chamber of
ful research into this disease and the methods for Deputies that led Parliament to pass some laws in the
combating it, as stated by the committee of the first few years of the 20th century. Drawn up mainly by
Karolinska Institutet in Stockholm on assigning the the malariologist Angelo Celli, these helped to change
Nobel prize. The dispute was also echoed by Italian the destiny of so many regions afflicted by the disease
scholars, who split into two opposing camps, and was [23]. Law 505 of 1900, dubbed the ‘State Quinine Law’
exacerbated with regard to the strategies that should [32], authorized the Minister of Finance to purchase
be adopted in the fight against malaria. quinine directly from the producers and to sell it to the
Consequently, two distinct schools of thought public at a controlled low price. However, quinine
emerged: therapy was not proposed only to treat malaria, but
- on one side stood those who focused exclusively also as a means of preventing the disease. Indeed, in an
on treating the disease with quinine and on the pro­ address to the Senate, Carlo Bizzozero asserted that,
phylactic use of this drug, according to the indications ‘Now, quinine is no longer only a means of treatment;
provided by the bacteriologist Robert Koch; it is also a highly efficacious means of preventing the
- on the other, malariologists who especially advo­ disease’ [33].
cated taking action against the vector of the disease On the initiative of Angelo Celli and Giustino
and sanitizing the territory [23]. Fortunato, Law 460 of 1901 was then passed, which
Initially, the former approach prevailed, given the imposed obligatory prophylaxis for those workers who
firm conviction that the first step in the struggle were most exposed to malaria [24]. Article 3 of the law
against malaria should be to treat the sick. Very soon, established, in a highly innovative manner, that
however, owing to the various difficulties encountered malaria contracted in the workplace was to be consid­
in administering the drug, it was realized that quinine ered, from the juridical standpoint, to be on a par with
treatment would have to be supported by ‘mechanical injury in the workplace. Public works contractors were
prophylaxis’, as proposed by Giovanni Battista Grassi therefore obliged to distribute quinine free of charge
and Angelo Celli. The indications of these two scien­ to their workers.
tists brought the question of mechanical barriers (mos­ A further step forward was taken in 1902, with the
quito nets) into legislation on malaria prevention. In passage of Law 224, which established that quinine
the early decades of the 20th century, governments of was to be distributed free of charge to malaria sufferers
various political colors returned to the issue several who were poor. This provision was subsequently
times, beginning with Law 460 of 2 November 1901, underscored by Law 209 of 1904, article 2 of which
which provided financial incentives up to 1000 lire for stated that this was applicable, “For the entire duration
those who installed mechanical barriers against mos­ of preventive therapy and treatment of malarial infec­
quitoes in their homes. Unfortunately, however, as the tion” to tenant-farmers and workers “engaged perma­
implementation of such prophylaxis was mainly dele­ nently or temporarily in any work with fixed or piece-
gated to landowners, it was frequently disregarded. rate remuneration” [34]. The norms contained in these
However, a dispute arose between these two laws were subsequently reiterated, in systematic order,
researchers as to who had first demonstrated and in Subsection IV of Section V of the Consolidated Text
practiced mechanical prophylaxis; this culminated in of health laws, approved by Royal Decree on
6 M. MARTINI ET AL.

1 August 1907, which extended the range of action to Romano), in the South and the islands, with malignant
a framework of social intervention [35]. tertian malaria (falciparum malaria) accounting for
In the meantime, while Celli, with the support of 20–30% of cases [21].
some Members of Parliament and of the Italian Society The North was affected almost exclusively by
for the Study of Malaria, was managing to focus the benign tertian and quartan malaria (vivax and malariae
efforts of the government on the distribution of qui­ malaria, respectively). In Europe, malaria was particu­
nine for both the prophylaxis and treatment of malaria, larly present in countries of the Mediterranean basin
Grassi was increasingly being contested and sidelined, and Eastern regions, including European Russia [18].
so much so that he abandoned his studies on malaria. As mentioned above, the use of quinine was one of
However, despite the passage of an important set of the main means of malaria control in Italy. The dosages
norms, the scientific community was not united in recog­ of this drug varied; in general, adults took 0.40 g/day,
nizing the efficacy of quinine prophylaxis, and on several corresponding to two tablets, while in children the
occasions political discussion was shifted to the issues of dose was halved. At the time, dosages of quinine ran­
land reclamation and the large agricultural estates of ging from 0.20 to 0.60 g/day were considered sufficient
Southern Italy. Thus, the problem of malaria had not to kill and/or to arrest the development of the
only public health implications but also economic and schizonts.
social repercussions. Under the pressure of these oppos­ It should, however, be borne in mind that it was
ing positions, in addition to the above-mentioned dis­ very difficult to assess the real impact of quinine treat­
putes among the scientists, Italian malariology formally ment, as the population, which was often poor and
split in 1909. The Italian Society for the Study of Malaria, ignorant, did not look favorably upon this treatment.
which had been founded in 1898, was joined by the Indeed, it was popularly believed that quinine caused
National League Against Malaria, which operated in miscarriages in pregnant women, that it was contra­
Milan under the presidency of Golgi and with the endor­ indicated in persons with mental problems, and that it
sement of Baccelli and Grassi [23]. should not be administered for a long time in children.
At the same time, in 1909 the Badaloni Report Moreover, the diffidence of country folk toward any
was presented to the Superior Council of Health; the new product was compounded by the fact that the
report constituted a veritable attack on Celli’s the­ distribution of quinine was often intermittent and
ories concerning quinine, casting doubt on its ability handled by third persons; consequently, doctors were
to reduce malaria mortality and on the alleged rarely able to supervise administration of the drug. We
harmlessness of its prophylactic administration. can therefore suppose that, while large amounts of
Nevertheless, the Badaloni Commission itself did quinine were distributed, much of it was not actually
acknowledge that ‘everywhere, the treatment of taken, except in more controlled settings, such as mili­
malaria patients has progressed to a degree that is tary barracks and among railway workers and other
incomparable with the past [. . .] and current legisla­ State workers [38]. In addition, members of the general
tion has implemented good social prophylaxis, as it public almost always took quinine only when they had
has provided the means of treating malaria patients’ febrile attacks.
[36]. The conclusions of the Badaloni Report reveal In order to tackle the problems connected with the
the difficulties of the young Italian nation and its cultural context of most of the population that was
public health structures in tackling the problem of afflicted by malaria, some hygienists proposed that
malaria, which manifested itself as the Italian educational interventions be implemented in order to
national disease [37]. promote the quinine campaigns, or even simply the
use of mosquito nets: one of these was Achille Sclavo
[39]. As he routinely dealt with epidemic diseases, he
The fight against malaria
realized that such diseases could, in many cases, be
Over the period of time examined, appreciable results avoided by following simple rules of hygiene that
were clearly achieved in terms of the reduction in could reduce contagion and the spread of infections
mortality due to malaria – a slow and steady reduction [40]. The propagation of good hygiene practices there­
consolidated by the first laws to be passed on this fore became the centerpiece of his activities as an
issue, and interrupted only during wartime. educator and characterized the antimalarial campaigns
Indeed, while 20,000 deaths occurred in 1887 (710 ­ conducted in Sardinia in 1910 and 1911. Angelo Celli
per million inhabitants), the number declined to 15,865 and his wife Anna Fraentzel were also convinced that
(490 per million inhabitants) in 1900, and fell still further education could promote the prevention of both
to 2045 (57 per million) in 1914 [25]. This reduction in the malaria and other infectious diseases. They therefore
mortality rate can largely be ascribed to the widespread helped to found the ‘Scuole per contadini’, which, in
use of quinine, for the purposes of both prevention and 1904, began to provide elementary education in the
treatment. In 1887, the malaria mortality rate was higher rural areas of the Agro Romano, while at the same time
in Central Italy (Maremma in the Tuscany Region, Agro spreading information on the prevention of malaria.
 PATHOGENS AND GLOBAL HEALTH 7

This was made possible by their collaboration with the 325 in 1918. A total of 2050 people died of malaria in
Italian Red Cross. In 1917, there were 90 such schools; 1914, while in 1918 the figure was 11,500.
by 1924, they numbered almost 2000 throughout cen­ Although these numbers again declined in the post­
tral Italy. war years (6800 in 1919 and 4250 in 1920), the prewar
Moreover, in 1918, moreover, a School of Rural values were only reached in 1932. Only when new
Hygiene and Malaria Prophylaxis was established in massive interventions were undertaken – from the
Nettuno (near Rome) in order to train the Public total land reclamation programs conducted by the
Health Staff in charge of malaria control. The School fascist regime to the spraying of “Paris Green” and
was under the authority of the Public Health DDT (dichloro-diphenyl-trichloroethane) – would
Laboratories, national structures of the Public Health a definitive solution be achieved in Italy, which was
Directorate General of the Ministry of Interior of finally declared malaria-free in 1970 [37,41].
Italy [18]. After the discovery of the insecticidal action of
The advent of fascism, however, put an end to these ‘Paris Green’ against the larvae of the Anopheles mos­
schools, as their functions were transferred to the quito, in 1923 the League of Nations promoted an
Opera Nazionale Balilla and, subsequently, to the investigation on malaria endemicity in Europe and
Gioventù Italiana del Littorio. the use of quinine. Thus, the Rockefeller Foundation
in New York launched a program of cooperation in
Italy under the direction of Lewis Wendell Hackett,
Last steps of malaria eradication a public health doctor with previous experience in
ancylostomiasis control in Central America.
While the administration of quinine yielded important Collaboration with Alberto Missiroli led to the foun­
results in terms of reducing mortality due to malaria dation of the Stazione Sperimentale per la Lotta
and improving the health of those affected, the use of Antimalarica (The Experimental Station for Malaria
this drug could not, on its own, put an end to the Control) in Italy, which played a major role in staff
epidemic of malaria in Italy in the period considered. training and updating on the most advanced techni­
Indeed, as already asserted by senator Torelli in 1882, ques of malariology. In 1925, Paris Green was tested
‘No epidemic disease is more closely related to the as an anti-larval agent in several malarial zones in
conditions of the physical environment than malaria central and southern Italy, with good results in
is, since the cause of this disease is stagnant water, the small urban centers.
nature of the terrain and the mixture of brackish water Meanwhile, the fascist regime was beginning to
with fresh water’ [22]. carry out extensive operations of total land reclama­
At the same time, however, the important interven­ tion. In 1934, the Istituto di Sanità Pubblica (the
tions of the drainage of swampland and the reclama­ Institute of Public Health) was inaugurated; this
tion of farmland often remained detached from the absorbed the previous bodies responsible for the
activities of malaria prophylaxis and treatment. In the fight against malaria. In 1941, the Institute of Public
first decade following the unification of Italy, several Health became the Istituto Superiore di Sanità (ISS),
laws were passed with the aim of reclaiming swamp­ and expanded the activities of clinical, laboratory and
land, starting with the Consolidated Text ‘on the recla­ field research in malaria and other public health
mation of swamps and marshland’. Published in 1900, subjects.
this identified some 19 districts for intervention All these actions led to a progressive improvement
throughout the country; the law issued in 1902 raised in the situation. However, Italy’s entry into the war in
this number to 28. Nevertheless, a coordinated pro­ 1940 determined a major upsurge in the transmission
gram of interventions that acted on both malaria of malaria, owing to the interruption of prophylactic
patients and the environment was lacking. interventions and, toward the end of the war, the
Thus, it seems that the government was seeking an systematic destruction of reclamation works by the
immediate and specific solution to the problem of Germans. Thus, in 1944, the number of cases of malaria
malaria, and, while some good results were achieved, in Italy rose to 133,842, albeit with ‘only’ 421 deaths.
more complex and definitive interventions were not In the same year, DDT (Dichlorodiphenyltrichloroethane)
implemented. This is demonstrated by the fact that,
for the control of malaria was first tested in Italy. Sprayed on
when Italy entered the First World War on 24 May 1915, the walls of houses and stables, it proved effective in redu­
the positive trend in the fight against malaria was cing mosquito populations and the level of transmission of
arrested.
the disease.
At the end of the First World War, the direct and
indirect consequences of the conflict had led to In January 1946, Missiroli announced a five-year plan
a serious upsurge of the disease [18]. Indeed, deaths of action designed to eradicate malaria from Italy. [. . .]
due to malaria rose from 57 per million inhabitants in The campaign for the eradication of malaria from the
1914 to 105 per million in 1915, to 237 in 1917, and to whole national territory began in 1947 and ended
8 M. MARTINI ET AL.

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