Once bitten

Some years ago, I was lucky enough to spend a month’s holiday in Botswana.

As I planned to explore the swamps in the north of the country, I took the advice of the doctor at the Clínica de Malalties Tropicals in Drassanes and dosed myself on the prescribed cocktail of anti-malarial drugs. All part of the price for visiting exotic lands. However, a hundred years ago, a tourist visiting many European cities might well have been given the same recommendation had such treatments existed, for malaria was rife in the Old Continent. In Barcelona, paludisme, as it’s called in Catalan, was considered the most pressing public health problem at the start of the 20th century. Indeed, one could imagine a hypothetical Lonely Planet Guide to Barcelona published, say, in 1903 warning visitors not only about the ongoing battle between anarchist hitmen, police shoot-to-kill squads and hired thugs, but also to take doxycycline and not to dream of sleeping without a mosquito net, particularly in the old city.

It is thought that malaria spread north from its ancestral African enclaves with the Neolithic revolution between 8,000 and 10,000 BCE. Sedentary village life, land clearance, irrigation and the increase in the human population all helped it along. New strands of resistant parasites would have been brought by the waves of invadors who swept across the Iberian Peninsula. We know for example that malaria followed Hannibal in his wake.

By the Middle Ages, the nobility had gained control of the best wetlands, where they could hunt and earn lucrative profits by exploiting their natural resources (everything from rice cultivation to leech farming). However, these advantages were offset by the fear of marshes as breeding grounds of plagues and incurable fevers. Until the connection between malaria and mosquitoes was understood in the late 1800s, the disease was thought to be borne by foul air (mal aria in Latin) emanating from such damp places. Such was the dread of these wetlands that a royal decree was passed in 11th-century Valencia sentencing any farmer to death who planted rice too close to villages and towns. Indeed, some marshes such as Doñana in Andalucia, today one of Europe’s largest remaining wetlands, were precisely saved in part due to the presence of malarial mosquitoes.

The marshes of Catalunya were also afflicted and there was much opposition to rice farming due to its connection with the disease. A popular 19th-century saying in L’Empordà warned against marriage to rice farmers, particularly those from the village of Viladamat in the heart of the Aiguamolls wetlands, in the far north-east of Catalunya, which was particularly afflicted:

Mothers who have daughters;

if you do not love them enough,

marry them to Albons or Bellcaire;

and if you want them dead soon,

marry them to Viladamat. *

From the same period there is also this tragic tale from an area that is now a popular summer playground for Barcelona’s rich:

“In 1835, when the fevers possessed the region and extended mourning everywhere, Creixença Vilà, after the death of her husband, her children, and realising that the Governor of Girona was not listening to the pleas of the villages afflicted by the epidemic, began a vigorous protest against the rice crop. The inhabitants of Albons, Bellcaire and Torroella de Montgrí met in the square of the last village and decided to drain the land and thus destroy the crop. That way, the epidemic would end in all the rice areas of the Empordà.” *

But rice was big money and farming continued more or less unabated, despite the dangers. In the Delta del Ebro, where most of our paella rice comes from today, there were 12,000 cases of malaria in 1918 alone. Clearly this had a huge economic effect, particularly as the people who were most affected were of working age who had become infected while toiling in the fields.

Closer to Barcelona, the towns in and around the Delta del Llobregat such as El Prat and Castelldefels also felt the scourge of ague, the former being known in the 19th century as el Poble de les Febres (the Village of Fevers). Being a major source of infection, its proximity to the Catalan capital was of serious concern to the authorities.

In Barcelona itself, there was an outbreak in the 1880s as the city ran out of money to finish the Eixample, as is described by Robert Hughes in his book Barcelona. As speculation sent prices sky high, thousands of investors went bust when the bubble burst and hundreds of plots were left bare for a decade. Moreover, many of the buildings that were constructed at the time did not have adequate sewers installed. Stagnant waters built up, a ripe environ for mosquito larvae. The city was hit by a second epidemic in 1898, this time imported from Cuba. Spain had been defeated there by the United States and lost its colony, the last jewel in its empire. Thousands of troops were dumped on the quays of Barcelona, many of whom were infected with the disease, and after being bitten by local mosquitoes, these then propagated it around the city.

At the turn of the 20th century, malaria was considered the biggest single health risk by the authorities, and an estimated 800,000 people had malaria in Spain, with some 4,000 dying every year. The disease was fought with a battery of measures aimed at breaking the circle between the parasite, the mosquito and the human: medicine, drainage of wetlands, individual protection measures such as mosquito nets, improved housing and the introduction of the mosquitofish, incidentally probably now the most widespread freshwater fish in the world, a voracious devourer of mosquito larvae. There was a huge improvement in the early 20th century but the Civil War meant a temporary halt to malaria’s final retreat—four years after it finished, in 1943, a final serious outbreak hit Spain with 400,000 people affected and 1,250 deaths—but by the end of the Forties, malaria had been effectively controlled and restricted to a few pockets, with the use of DDT from 1947 onwards delivering the coup de grâce.

Spain was finally declared malaria-free in 1964, just in time for the arrival of mass tourism, which certainly would not have taken off had it not been for the parasite’s prior eradication. It also coincided nicely with the UN no longer classifying Spain as a Third World country. The last cases in Spain were in El Prat de Llobregat in 1961, seven years before the last native Western European malaria disappeared from cold and rich Holland.

In what one hopes is a footnote to the history of the disease here, in August 2010 a man from Huesca mysteriously caught malaria after being bitten by a mosquito somewhere in Aragon, making it the first indigenous case in Spain in the last 50 years. Experts are still unsure of the chain of infection. However, so-called ‘imported’ as opposed to indigenous malaria is very much on the rise, with some 500 cases a year in Spain, brought by migrants and returning tourists.

Should we fear a return of malaria? Some articles in the press make the connection between global warming and the disease. But malaria was rife in Europe at a time when the temperature was colder than it is today. As development workers know, malaria is eradicated by means of progress, as it was in Spain, not by a change in the temperature. Malaria could indeed return to Europe, but the real trigger would be a massive economic meltdown rather than climate change, which may only make matters worse.

Nick Lloyd leads Civil War tours in Barcelona with the Centre d’Estudis de Montjuïc and runs the website www.iberianatura.com