258 robert sallares
Anglo-Saxon pilgrims regularly visited Rome in the medieval period, became infected
with “Roman fever”—the malaria for which Rome had become notorious (at least
from the time of Galen in the second century ce onwards), and then returned with it
to England, if they did not die in Rome. For example the monk Eadmer (Rule, 1884:
96–97) described the unhealthiness of Rome during his account of the visit of St
Anselm to Rome in 1098 ce, while Rahere founded St Bartholomew’s Hospital in
London in 1123 ce after recovering from severe illness in Rome (Moore, 1923), and
other writers such as Gervase of Canterbury for 1188 ce gave similar accounts (Birch,
1998: 56–58). French and German armies, such as those of Frederick Barbarossa,
besieging the city of Rome in the medieval period were regularly destroyed by malaria
epidemics outside Rome (Sallares, 2002: 224–228). There are also records of general
observations contrasting the healthiness of northern Europe with the unhealthiness of
the Mediterranean world. For example Paul the Deacon in the eighth century ce
argued that the climate of northern Europe was salubrious and so the north produced
manpower abundantly, leading to a slave trade from northern Europe to an Islamic
world facing labor shortages (McCormick, 2001: 763). Similarly William of
Malmesbury (Gesta Regum Anglorum, 372), commenting on the bravery of the
Crusaders, put their risk of dying from disease on the same level as the risk of being
killed by the Saracens (Mynors et al., 1998: 654–655). The greater disease burden of
the Mediterranean world had long-term consequences for economic history. Although
malaria eradication in recent times was not by itself a sufficient condition for economic
development, it can certainly be described as a necessary condition, for example, for
the development of modern tourism in coastal areas that were formerly zones of
intense malaria (Brown, 1986; Bowden et al., 2008). The economic underdevelop-
ment of the Mezzogiorno in southern Italy relative to northern Italy, a contrast which
commenced in Roman times more than 2000 years ago, can also be related to the
greater disease burden of southern Italy in the past. Similar arguments relating disease
to the nature of the economy can also be made in the case of plague. Borsch (2005)
compared the responses to the Black Death of Egypt and England and argued that
differences in the landholding systems of the two countries explain why England recov-
ered rapidly from the depopulation caused by the Black Death but Egypt did not.
So far, in trying to define a distinctive Mediterranean pathocoenosis, contrasts have
been drawn with geographical areas to the north and the south of the Mediterranean;
northern Europe and tropical Africa. There undoubtedly are substantial differences
between the Mediterranean pathocoenosis and those of areas both north and south of
the Mediterranean. To that extent the attempt to set up the Mediterranean as a useful
category of analysis in disease history is an enterprise which will have a certain amount
of success. If we now briefly make comparisons with the east and the west a somewhat
different picture emerges, a picture more of similarities rather than contrasts. In
China, for example, exactly the same contrast between an unhealthy south and a
healthy north existed as in Europe. Malaria was an important disease in China as well
and is attested as early as 3000 bp. Falciparum malaria was mainly confined to the
warmer Yangtze valley and regions further south and it has been suggested that this
was an important factor in the socio-economic underdevelopment of the Yangtze
River valley relative to the Yellow River valley. Chinese armies moving southwards
encountered exactly the same problems in respect of malaria as medieval French and
German armies attacking Rome. The pressure of malaria led to Pan Geng’s decision