Unum facere et alterum non omittere: antimalarial strategies in Italy, 1880-1930

At the end of the XIXth Century the attitude towards malaria changed dramatically from fatalism and resignation to an active policy that made the eradication of the disease a possible objective. This dramatic change in the scientific political and cultural attitudes towards malaria was the result of two main phenomena: i) the impact of the scientific medicine and Pasteurian revolution on medicine and health policies, and ii) the discovery of the theoretical simplicity of the cycle of malaria transmission and of the possibility to interrupt it, by avoiding the contacts between people and the Anopheles mosquitoes. However, scientifically based strategies against malaria were in place before the discovery of the real causative agents and of the transmission cycle at the end of the XIXth century, as the origin of the scientific medicine had already produced a 'rationale' for local and national campaigns against malaria. According to Tommasi-Crudeli, for example, the cause of malaria was not a 'chemical compound', a 'miasma', but a 'living ferment', specific and autonomous. As a consequence, the aim of antimalarial measures was to eliminate the conditions indispensable to the multiplication of the specific ferment contained in the soil. The theory of malaria aetiology changed after the discovery of the transmission cycle by Ross and Grassi, but the general strategy remained the same: to eliminate one of the factors indispensable to the multiplication and diffusion of the agent. The detailed knowledge of the malaria transmission cycle made it possible to define the exact conditions which were alone responsible for the propagation of the disease and its persistence in the endemic areas. The theoretical linearity and the specificity of the 'Grassi's law' was decisive and produced a fundamental paradigmatic shift in the antimalarial policies. The essential point for the epidemiology and prophylaxis of malaria became to clarify the conditions which contribute to facilitate or to prevent the infection of the Anopheles.