Stohs, Alexandra

Anth. 436
September 5, 2018
Cultural Adaptations to Malaria in Sardinia: An Abstract
Introduction
This paper, written by Peter J. Brown, is a case study that analyzes the cultural
adaptations to malaria on the island of Sardinia, Italy by examining the basic features of
traditional Sardinian culture and economy. Diseases act as agents of natural selection and
therefore affect human evolution both biologically and culturally. Malaria has been a force in
shaping human evolution and historically has been the largest single cause of human mortality.
The island of Sardinia has been a classic case study in population genetics and there is extensive
data linking the geographic distribution of malaria to thalessemia and G-6-PD deficiency (79).
Cultural Adaptations in Sardinia
Cultural adaptations to malaria in Sardinia either limited exposure to anopheles mosquitoes,
or prescribed behaviors which decreased the probability of malaria relapses. From the native
viewpoint, these traditions reflected rational choices based upon an ethnomedical theory in
which malaria was caused by "bad air (80)." Nevertheless, such traditions did function to
interrupt the transmission of malaria through anopheles mosquitoes (80).
The Concept of Cultural Adaptation
In this paper, the concept of cultural adaptations refers to certain culture traits or social
institutions which function to increase the chances of survival for a society in a particular
ecological context. Cultural adaptations can be by choice, though are not always the result of
conscious processes. Brown does “not argue that endemic malaria caused Sardinian culture to
develop in a certain way, but rather that particular traits functioned to limit malaria prevalence
and malaria mortality.” These cultural traits increased chances of survival but also satisfied more
direct, functional needs (80).
Ecologic and Ethnographic Setting
Sardinia is an autonomous, rectangular island of the Italian Republic. Historically, it has had
a low-population density due to endemic malaria and for two thousand years, it was the most
malaria-ridden territory of the western Mediterranean. However, it was selected as the site of
malaria eradication project conducted by the Rockefeller International Health Foundation
between 1947 and 1951 which eliminated malaria from the island completely (81).
The Epidemiology of Malaria in Sardinia
Two epidemiological factors of Endemic malaria in Sardinia:
1. The seasonal cycle of malaria prevalence: Sardinia has a temperate climate with
seasonal cycles of malaria, or “estivo-autmnal” cycles , with transmission reaching
 peak during August, September, and October. Adults cannot gain immunity to
malaria as they do in tropical zones, since acquired immunity is possible only from
constant exposure to the disease.
2. The sylvatic, or nonanthropophilic nature of the principal vector, A. labranchiae: Did
not regularly rest in human settlements or rely on human blood. This vector also
preferred fresh water and predominated low elevation zones with fresh water (82).
Types of Malaria
P. Falciparum: Deadlier type with unstable annual incidence during late summer and fall.
P. Vivax: Effects children mostly and has consistent annual incidence and accounts for the
endemic nature of the disease (82).
The Geographic and Social Distribution of Malaria
Distribution predicted by two ecological variables:
1. Elevation: Altitude is inversely correlated with malaria prevalence because of its
relationship to two ecological parameters—temperature and standing water. Lowlands
had higher temperatures and inland swamps and thus, higher densities of malaria vector.
2. Settlement size: Urban centers, with populations greater than 10,000, had relatively low
malaria rates; while the smallest agricultural communities, with populations less than
1,500, generally had the highest malaria rates. Malaria was a rural disease. Cities are
generally inhospitable to anopheles mosquitoes and transmission in cities is low (83).
Sociological Distribution of Malaria
Four generalizations:
1. Children experience more malaria than adults: reflect more P. vivax to which adults
have possibly acquired a mild immunity
2. Among adults, men experience more malaria than women.
3. Among men, agro-pastoral workers experience more malaria than professionals,
artisans, and merchants.
4. Among agro-pastoral workers, peasants experience more malaria than shepherds.
Highest rates of malaria infection: Rural-dwelling, male agriculturalists.
Lowest malaria prevalence: Urban-dwelling, upper-class adult females (84).
Cultural Adaptations to Malaria
Cultural adaptations found at three levels of traditional Sardinian culture: economic production,
social organization, and folk medical beliefs.
 1. Human Ecology: Nucleated Settlement Pattern and Inverse Transhumance

Nucleated Settlement
The settlement pattern found in all ecological zones of the Sardinia is “characterized by
extreme nucleation and a clear preference for ‘high ground’ locations, specifically hilltops,
precipices, and foothill (86)”. Linked to sylvatic behavior of A. labranchiae and lower
prevalence of malaria. However, settlement pattern of people moving from coastal plans to
hilltop sites probably more due to historical threat pirate raids, military conquests, and the
expropriation of land by foreigners rather than than malaria. It was malaria, however, which
made the resettlement of abandoned lands extremely difficult because it threatened the health of
individuals in isolated farmsteads. Native ideology argues most important for settlement site
buon-aria or good air (86).
Inverse Settlement
In inverse transhumance, permanent settlements located in the mountains and flocks travel
down to the lowlands for winter. The adaptive value of the inverse transhumance pattern rests on
the coinciding seasonality of flock movements and the annual malaria cycle. Allows for the
exploitation of fertile but malarial lowland pastures during the "safe" season of November to
May, while it also permits shepherds to escape those high-risk zones during the peak of the
malarial cycle (86).
2. Social Organization
Lower malaria prevalence for adult women, children, and upper-class individuals. Traditional
cultural rules restricted geographical mobility of women, especially for pregnant women. Eomrn
were told to not leave the confines of the nucleated settlement during most of their lives. Men
operate in the public sphere and women control the domestic sphere. Women are not expected to
do agricultural labor since it would reduce the social prestige of a family so they were generally
able to stay in confines of settlement. During pregnancy, ideal behavior was for women to stay
within the house itself since a malaria attack during pregnancy carries a high risk of spontaneous
abortion. In Sardinia, pregnancy is perceived as a seriously dangerous state. A famous Sardinian
novel begins with the statement, "The pregnancy went well, she did not contract malaria. . ."
There’s been a significant-increase in Sardinian fecundity rates since elimination of malaria (87).
Similar pattern for Sardinian upper classes: traditional elites did not regularly commute to the
fields and therefore had low exposure to the malaria vector, and usually remained within safe
confines of nucleated settlement. Also, the upper classes had the means to escape from the
epidemic peak of the malaria cycle during the summer. This is seen in Bosa case study (Western
Sardinia): Town with upper-class families that would escape to vineyards with buon-aria during
malaria season to make wine (88).
3. Ethnomedicine and Relapse Rates
Folk theories of fever causation had adaptive value by reducing malaria relapse rates through
prevention of spontaneous relapses. These theories stressed the necessity of moderation in daily
life and danger of the sudden mixtures of hot and cold elements which may cause physiological
shock and bring on fevers.
Intemperie Sarda
In 19th century, “Intemperie” was the name for malaria and its etiology in Sardinia. Before
the twentieth century and the discovery of the relationship between malaria, there was no
standardization of the name "Malaria," nor was there a consistent method of diagnosis or
treatment of the disease. Illness was thought to be caused by a sudden shift from hot to cold, or
from dry to wet. External environment, not internal equilibrium is implicated as a causal
element. There is a meteorological analogy throughout this literature, and the earliest source
(Aquenza-Mossa 1702) argues that climatic conditions which cause sudden storms also cause
human fevers (89).
Colpo d’ Aria
Means “blast of air” and is when an individual is exposed to a variety of minor illnesses, such
as the common cold or flare-ups of chronic pains. The Sardinians' held a belief that an individual
with a warm physiological equilibrium is at a great health risk when "shocked" by a sudden blast
of cold. A sudden change in an individual's internal temperature equilibrium results in an
unhealthy physiological shock and possibly illness. As such, a fever represents the body's efforts
for renewed equilibrium after being exposed to cold (89).
Benefits of Folk Theories and Remedies
Both theories produce behavioral restrictions that seek to reduce the risk of temperature
imbalance and illness.
Common Recommendations:
Avoiding drafts and dampness; avoiding overexertion; keeping one's stomach full; drinking
spirits regularly, but not to excess; wearing hats and layers of clothing; avoiding cold beverages
when hot; not sleeping outside without shelter; closing shutters at dusk; never getting overly hot
or cold; special care when bathing; and general moderation in all things (90). May have had
significant adaptive value while providing a functional explanation of the seasonality of malaria.
Questions
What practices or behaviors have you observed yourself or others taking part to avoid being
exposed to various diseases (i.e. wearing bug spray, getting a yearly flu shot, using hand
sanitizer)? What common recommendations have you been told to avoid getting sick?
Works Cited
Brown, P. (1981). Cultural adaptations to endemic malaria in Sardinia. Cultural and Political
Ecologies of Disease, 79-90.