Of Italy I can but afford to say generally, that except at a very few points where the Alps or Apennines reach the sea, the whole of its shores are pestilential, and often to such a degree as to lead to their entire desertion, more frequently to their abandonment in summer. And to avoid wet lands, or low lands, is not always a sufficient precaution; since the most pestilential parts of the maremma of Tuscany are dry, and since the annual mortality of Sienna from fevers, even without epidemics, is one in ten. In the north of Italy, the great plain is similarly insalubrious; though the more unhealthy district does not commence until we arrive at Mantua, extending thence to the sea. Of the Mediterranean islands, I can only afford room to say, that the same rule holds good as to the sea coasts, while the entire of Greece in the same circumstances is similarly unhealthy, and subject to autumnal fevers in as great a degree as the worst parts of Italy. The same is true of Spain and Portugal, and the same rule also will be a guide; namely, that malaria is to be expected in all the flat grounds, even when under cultivation, and at all the exits of rivers on the sea, even though no marshes should be present: and if I were desirous to name any tract of land in Spain peculiarly [p057] insalubrious, it would be the province of Valencia; while Carthagena is almost invariably fatal even to those who, as labourers, are compelled to resort to it for the needful work of its port, even during a few days.
Of France, little as it has hitherto been suspected by those who, associating the term malaria with Italy, have been accustomed to consider it as peculiar to that country, it would scarcely be untrue to say that it contains as large a portion of insalubrious territory as Italy itself, and produces fever and disease of as great severity and extent, not merely on its sea coasts, but over very extensive tracts in its interior. And this insalubrity may be conjectured, when there are entire districts in which the average of life does not exceed twenty, and in which the entire people are diseased from their births to their graves. Such tracts are found chiefly on the course of the Loire, and some other of the great rivers; and among them, Bresse in the Lyonnais, the plain of Forez, and Sologne in the Orleannais, are of the most notorious; while the coasts of Normandy, and the whole of low Britanny, are similarly subject to eternal intermittents, or to epidemic seasons of autumnal fevers, amounting to absolute pestilences. And how English families have suffered in this country from the incautious choice of residences in such places, will be easily ascertained by whoever shall be at the trouble of making the necessary inquiries.
But as I dare not pursue this extensive subject, I can only suggest to our countrymen the utility of making themselves acquainted with this matter, and with this dangerous geography, before encountering the hazards which await them; while to physicians I need still less name the necessity of that knowledge, since it is so often their duty to choose and recommend for their patients, and since no man can feel much at his ease who finds that he has sent into a land of malaria the patient who has already been suffering from its diseases, or that where he speculates on the cure of a consumption, that cure is attained through the death of the patient, at Avignon, or at Poitiers, or Nantes, or in some or other of the numerous places subject to this most fearful poison.
It remains only to give a brief enumeration of the diseases [p058] which are the produce of malaria, and of the general condition of the inhabitants in the countries subject to it. With respect to this latter, the most remarkable general fact is the contracted duration of life. In England, the average may, if not very accurately, and indeed considerably under the mark, be taken at 50; and when in Holland it is but 25, it follows that the half of human life is at once cut off by this destructive agent. In the parts of France to which I have alluded, it becomes as low as 22 and 20, and Condorcet, indeed, has calculated it as low as 18. With this, very few attain the age of 50; and in appearance and strength, this term is equivalent to 80 in ordinary climates; while 40 forms the general limit of extreme and rare old age. The period of age, indeed, commences after 20; and it is remarked, in particular, that the females become old in appearance immediately after 17, and have, even at 20, the aspect of old women. In many places, even the children are diseased from their birth; while the life which is dragged on by the whole population, is a life of perpetual disease, and most frequently of inveterate and incurable intermittents, or of a constant febrile state, with debility, affections of the stomach, dropsy, and far more than I need here enumerate.
While the countenances of the people in those countries are sallow or yellow, and often livid, they are frequently so emaciated as to appear like walking spectres, though the abdomen is generally enlarged, in consequence either of visceral affections or dropsy. With these, rickets, varices, hernia, and, in females, chlorosis, together with scorbutic diseases, ulcers, and so forth, are common; and it is even to be suspected that the cretinage may depend on this cause, since goitre is also one of the results of malaria, and since, in the Maremma of Tuscany, idiotism is a noted consequence of this pestilential influence.
The general mental condition is no less remarkable; since it consists in an universal apathy, recklessness, indolence, and melancholy, added to a fatalism which prevents them from even desiring to better their condition, or to avoid such portion of the evils around them as care and attention might diminish: and while it is asserted that even the moral character becomes [p059] similarly depraved, I prefer a reference to Montfalcon for a picture which it would not be very agreeable to transcribe.
As to the absolute or positive diseases, besides those which I have already named, I need scarcely say that remittent and intermittent fevers, under endless varieties and types, form the great mass; and next in order to them, may be placed dysentery and cholera, together with diarrhœa. To these I must also add, those painful diseases of the nerves, of which sciatica stands foremost, and the remainder of which may be ranked under the general term of neuralgia; and further, a considerable number of inflammatory diseases of a more or less remittent type, among which rheumatism under various forms is the most general, and the intermittent ophthalmia the most remarkable. Lastly, I must include the various paralytic affections; since apoplexy is one of the primary and direct consequences of malaria, as various paralytic affections are the produce of intermittent, or the consequences of the diseases of the nerves which are associated with it.
It is still a curious and interesting fact, that this poison affects, in an analogous manner, many different animals, and appears, in reality, to be the cause of all the noted endemics and remarkable epidemics which occur in the agricultural animals in particular. This has been noticed even by Livy: and in France and Italy it is equally familiar that the severe seasons of fever among the people are similarly seasons of epidemics to black-cattle and sheep, while the symptoms are as nearly the same as they could be in the circumstances, and the appearances on dissection also correspond. Thus also does it appear probable, that the rot in sheep is actually the produce of malaria, as is indeed the received opinion among French veterinarians; while Mr. Royston has observed that the animals of this class are subject to distinct intermittents.
And while it is not less familiar in the West Indies, and in Dominica particularly, that dogs suffer from a mortal fever in the same seasons and periods as the people, the epidemic always breaking out in them first, I have the most unexceptionable medical evidence of the occurrence of a regular and well-marked tertian in a dog; that evidence consisting in the concurring decision of many surgeons, by whom the case was [p060] frequently examined, during a very long period. But it is time to terminate a paper, which, if it is but a sketch of an important subject, will at least convey to those to whom malaria has not hitherto been an object of attention, a general notion of the leading particulars which appertain to its natural history.J. M.