The Idea of Health - WHITAKER

The Idea of Health: History, Medical Pluralism, and the Management of the Body in EmiliaRomagna, Italy
Author(s): Elizabeth D. Whitaker

Source: Medical Anthropology Quarterly, New Series, Vol. 17, No. 3 (Sep., 2003), pp. 348-375
Published by: Wiley on behalf of the American Anthropological Association
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ELIZABETHD. WHITAKER
Departmentof Anthropology
AmericanUniversity
The Idea of Health: History, Medical Pluralism,

and the Management of the Body in
Emilia-Romagna, Italy
Basic beliefs about health in northcentralItaly derivefrom an approach
to the personal managementof the body that is notjust reactivebut also
proactive. Thisarticle examinesa complexfield of healthfactors in relation to historical processes and a system of medical pluralism. Rapid
demographicand social changes over the past centuryhave broughtan
accommodationof ancient medical beliefs to more recent germ-oriented
principles.An enduringbelief in thepermeabilityof the body leads to an
emphasis on moderation in personal conduct to prevent debilitation,
whetherby atmosphericinsults,microbialinfection,or modern-daymiasmas such as pollution or additivesinfood. Theidea of health itself is analyzedto show how biomedicinevaries across societies and how historical
processes have shapedcontemporaryculturalpatternsand led to generational continuitiesand differencesin beliefs and behaviors.Thisinformation may also improve interactions between patients and health care
providers. [health beliefs, Italy, Emilia-Romagna,humoral medicine,
medicalpluralism]
edical anthropologistshave shown thatpatientsoften hold differentbeliefs aboutdisease thando healthcareprovidersand thatthe discontinuity may lead to problems in treatment related to inappropriateor
incompletereactionsof healthprofessionals,improperchoice of therapy,or insufficient patientadherenceto medicaladvice.Therehas also been muchdiscussionof
the variousmeaningsof disease, illness, and sickness and the ways in which a lack
of concordancebetweencategoriesmay lead to disease withoutillness or vice versa
(Brownet al. 1994; Hahn 1984, 1995; Kleinman1980; Sedgwick 1981). In this article I examinethe idea of healthitself, notjust as the semanticoppositeof disease.
Both disease and health involve challenge and change, process ratherthan entity
(see Brown andInhor 1990;Dubos 1959, 1965; Goodmanet al. 1988).
For many Italians,health is not simply an absence of disease but, rather,the
fortuitous,fleeting outcomeof a strugglefor balancebetweena permeableself and
Association.
MedicalAnthropology
Quarterly17(3):348-375.Copyright0 2003,AmericanAnthropological
348

THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY
349
an unpredictableoutsideworld.Consequently,healthmustbe managedpersonally
on a daily basis. Thereareboth proactiveandreactivesides to this approachto the
care of the body and spirit,for both internalprocesses and externalconditionsare
thoughtto influence well-being directly.In this context, therecan be no notion of
healthas a staticstateof nondisease.Besides airs,waters,andplaces, personalconduct also influences the fluid relations that make up the bodily constitutionand
thereforeindividualwell-being.
Although there are significant differences, analogous concepts of continual
flux in elements seeking equilibriumarecentralto manybelief systems aroundthe
world. These include the ancient Greek medicine that spreadover the centuries
throughthe Persian-Arabworld and the RomanEmpire;Ayurvedain South Asia;
traditionalChinese medicine;and Hippocraticmedicine broughtby Europeansto
Spanish-Americancountriesandthe Philippines(see Alter 1999;Bates 1995;Foster 1994). The existence of similarbelief systems across ethnically and linguistically diverse groupsprovidesa unit of analysis for comparativestudy of the ways
in which particularunderstandingsof bodily processes emerge and operatein differentsocial contexts(see Rubel andMoore 2001).
In additionto classical notions of bodily balance, Italianhealth beliefs also
encompass severalfundamentalaspects of biomedicine.These include germ consciousness and industrial-eramechanical understandingsof and military metaphors for the body and its parts and functions, as well as more recent electronic
ones (see Foucault 1973; Martin 1994; Osherson and AmaraSingham 1981;
Rhodes 1996). Italianhealth beliefs, consequently,are tied both to a geographically widespreadand very old humoraltraditionandto the morerecentbiomedical
paradigmcenteredin northernEuropeandthe United States.
Yet the practiceof biomedicine is not uniformand is shapedby the unique
historical and culturaltraditionsof each country (see Payer 1996). In Italy, biomedicine is not sharplybounded against other healing traditionsin a system of
medicalpluralism(see Romanucci-Ross1991, 1997). And, in contrastto the naturalistic orientation of humoral medicine and biomedicine, Italian ideas about
health are also informedby a traditionalpersonalisticmedical system thatemphasizes the influence of spiritsand humanmalice as agents of disease and saintsand
divine will as purveyorsof good fortune(see Romanucci-Ross1997).1
The processby which biomedicalconceptshave been incorporatedinto more
ancientunderstandingsin Italyhas been shapedbothby particularhistoricalevents
and by a continuouscourse of accommodationand adaptation.Because Italy underwentits modem demographic,epidemiologic, and economic transformations
relativelylate, thereare olderpeople alive today who grew up in a conceptualuniverse thatwas moreconsistentwith pre-germthinkingandagriculturalconceptsof
time, production,social relations, and personhood.These older understandings
continue to influence ideas and behaviors,bringingboth continuitiesand differences in healthbeliefs acrossgenerations.
Beyond outliningthe contoursof a complex idea of health,this articlehas the
practicalaim of providinginformationthatmight improvepatient-healerinteractions, althoughit does not pretendto be an exhaustiveaccountof Italianhealthbeliefs. In addition,the beliefs describedbelow might reveal some truthsabout the
contributionof debilitatingevents andphysiologicalchallengesto ill health,forces
thattendto receive little attentionin the germ-orientedperspectiveof biomedicine.

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Even in the absence of a causal role, these beliefs may bring abouttheirexpected
result througha nocebo effect (Hahn 1995:93-94), so they should be taken seriously.
The following discussion focuses on the northcentralregion of Emilia-Romagna,where I have conductedresearchfor the past 14 years (in periodsof two to
12 monthsevery year except two). For most of this time, I have lived with my husband and three childrenin a town in the Apennines that I call SantaLucia, but I
have also lived in small towns in the plains and foothills as well as the cities of Bologna and Faenza. This experience has allowed me to conduct demographic,historical,and ethnographicresearchin severallocationsin the region.My children's
attendanceat local schools and our residencein a town with a large populationof
elderly people have given me access to a varietyof contexts for ethnographicobservation and interviewing. I have formally interviewed scores of health care
providers,scholars,clerics, and privateindividualsabouthealthbeliefs and medical care and have observedand interactedwith many more. Nevertheless,this is a
limited numberof people comparedto the totalpopulationof the region.In the following analysis,I have triedto minimizethe impactof my biases and errorsof interpretationthroughtriangulationwith otherdata.
For example, this articledraws on a set of 121 questionnairescompletedby
mothersandfathersof threeto six year olds in fournurseryschools in SantaLucia,
Faenza, and Forli, as part of a project on pregnancy,childbirth,and infant care
practicesconductedin 1992.2A few questions about health beliefs and practices
were includedin the questionnaireto develop a backgroundof parents'overallunderstandingsof health and illness, and these are the questionsreportedon below.
Like the overallpopulationof informantsfor this study,respondentsincludedpeople of a wide rangeof socioeconomic andoccupationalcategories,such as government employees, shopkeepers,health professionals,farm workers,and teachers.
More thanfour-fifthsof themwere in theirthirtiesor forties.3
Althoughmost of the following pertainsto Emilia-Romagna,I have observed
many of the samebeliefs andbehaviorsin otherregionsof Italyandin the nationallevel media.This is not to imply thatall Italiansuniformlysharethe same ideas and
values, or thatthese do not varyin minuteas well as grandways acrosstime, space,
and social classes. On the otherhand, I have observedthatthereis some interplay
of environmental,behavioral,constitutional,andmicrobialhealthfactorsin the beliefs of men and women of all ages, occupationalcategories, and socioeconomic
groups. As Romanucci-Ross(1997:9) found in the nearbyregion of Le Marche,
adherenceto both a folk and biomedicalparadigmis not limited to the ruralareas
or to the less-advantagedsocial classes.
Paradigms for Health and the Functioning of the Body
In line with the idea of health as a fluid concept, when Italiansspeak about
theirown or otherpeople's healththey use the verbstare, which means"tobe,"but
in an impermanentsense comparedto the verb, essere. Stareis used togetherwith
bene to mean well and male or poco bene to mean feeling poorly. Whereasthese
terms refer to the person, several nouns and relatedadjectivesrefer to health in a
more abstractway: il benessere (well-being), la salute (health), and la sanitd
(health,used often in referenceto health services, as in Ministerodella Sanitaor

ITALY
THE IDEAOF HEALTHIN EMILIA-ROMAGNA,
351
Ufficio Sanita). These terms can be modified to refer to mental health, physical
health,or materialor economic status.Similarly,stare bene (or male) can be used
to describehow well a certainhaircutor piece of clothing suits someone,or how he
or she is doing financially,reflectingthe broadnessof the conceptof healthor wellbeing.
Both medical professionals and other Italians express a mixture of beliefs
about la salute. The older beliefs include those recordedby ancient medical philosophers such as Hippocrates,Galen, Avicenna, and Soranus.4Well before their
time, Greek medical philosophershad concluded that the four primaryelements
and their defining characteristics,fire (hot), air (cold), earth (dry), and water
(moist), madeup both the earthandthe humanbody andbalancedeach otherwhen
all was well. The Hippocraticwritingsindicatethat the equilibriummodel of four
humorsrootedin this earlierconcepthad coalesced by the fifth centuryB.C.E. The
humorscombinedopposingpairsof qualitiesfromthe elements:blood was hot and
moist;phlegmwas cold andmoist;blackbile was cold anddry;yellow bile was hot
and dry. Some people had a naturalimbalancein these humors, explaining their
characteristictemperament(e.g., choleric for a preponderanceof yellow bile, or
phlegmaticfor too much phlegm). This meant that everyday forces such as temperature,wind, and humidity directly affected health, as did more general influences fromthe orientationof the house, the qualitiesof nearbybodies of water,and
whetherthe airwas "low"or "high"dependingon altitude.
For all people, outside events, such as atmosphericchanges or perturbations,
as well as internalones relatedto individualbehavior(includingexcessive eating,
drinking,thinking,and emotions), would cause a surfeit or deficit in a particular
humor,with predictablehealtheffects. These beliefs informedmedical science for
many centuriesandarestill present,albeitin modifiedor latentform,in currentunderstandingsof the body andhealthin Italy (see Romanucci-Ross1991, 1997).5
Duringthe early decadesof the 20th century,Italianmedicalscience replaced
the old humoralconception with moder understandingsof hormones and other
bodily fluids. Nevertheless,the constitutionhas remaineda powerfulconcept that
explains individualvariationin temperament,abilities, and resilience or susceptibility to disease. The continuedimportanceof fluid balanceassociatedwith the old
humoralunderstandingmakes it necessary to carefully regulate the secretion of
sweat and otherbodily fluids, the ingestion of liquids, and the digestive process.
Not a few male athletesrefrainfrom sexual relationsbeforea competitionor for an
entireseason in ordernot to be weakenedby the loss of seminalfluid. On the other
hand,to not have sex produceshealthcomplicationsbecause all fluids must be secretedin moderation.The overallbalance of the body, expressedin body size and
weight, must also be maintainedwithin healthylimits, for both excessive thinness
and excessive corpulenceareconsideredunhealthy.In particular,thinnessdenotes
a loss of vital force, a meaningthatwas very significantin the disease conditionsof
the pastbut thatis losing groundin the media-saturatedcultureof today.6
Humoralmedicineprescribesbalancenotjust in fluid flow but also in the experienceof temperatureandmoisture.7Extremesin thermaltemperaturearedestabilizing, whetherin food, drink,or ambientair. Activities thatheat the body, such
as sleeping, exercise, or eating, put a person at risk of cold insults as well as hot
ones thatmightpushthe heatto extremelevels. Loss of fluid,as in diarrhealdisease,
or childbirth,removesheatfromthebody andputsit atrisk.It is always
menstruation,

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prudentto avoid foods thatcause a sensationof heat when consumed(such as hot

peppers)as well as all beverages that are too cold. The lattermay be blamed for
headaches,digestive disorders(including gastroenteritis),fever, or weakness, as
much as two or threedays afterthe cold drink-such as iced tea or beer-has been
ingested.
Thermalimbalance is an importantdiagnostic criterion.Hot and cold ailments arecausedby insultsof correspondingvalue but aretreatedwith remediesof
opposing value. Although there is no explicit designationof metaphorichot and
cold values for foods, illnesses, and remedies in north centralItaly, "hot"foods
such as coffee, chocolate, garlic, and onions are avoided duringill health and hot
conditions such as pregnancy,whereas "cool" ones such as rice (which may be
served warm) are used to treat hot illnesses such as diarrhea.Red wine and red
meat (especiallyhorse) also heatthe body and areused to treatlow blood pressure,
a "cold"chronicconditionsimilarin seriousnessto "hot"high blood pressure.This
exampleillustratesboth the hot-cold oppositionandthe principleof moderationin
physiologicalfunctions.
Beyond such humoralconcepts, there is a strongemphasison microbialfactors in health and disease. Germsare seen as constantlythreateningfrom the outside, and arethoughtto enterthe body more easily when it is compromisedby imbalance.This understandingbuilds on the ancientbelief in miasmas,or dangerous
flows of air capableof spreadingcontagion.For millenniabefore the germ era, it
was mal aria ("badair")thatexplainedepidemicsof malariaamongpeople living
aroundlow, dampplaces nearRome, in Sardegna,and in the Po Valley. The noxious emanationsof air from sick people or corpses were anotherkind of miasma
capableof spreadingdiseases such as plagueor tuberculosis.Like germs,these miasmaswere consideredmorelikely to cause sickness in people who committedimprudentacts such as going out with wet hair or exposing themselves to extreme
weather.
Today, beliefs aboutthe permeabilityof the body to atmosphericinfluences
as well as germslead to protectivebehaviorsagainstcold, wind, andhumidity.The
head, abdomen,and feet are protectedespecially well because they are thoughtto
lose heat andbe struckby cold in a most dangerousmanner.Because the abdomen
is an especially vulnerablepoint on the body, failureto wear an undershirtis sufficient to cause discomfortand sickness, from indigestion to fever. It is extremely
importantto avoid sweating,even in summertime,because overheatingis hazardous in itself andbecause getting hot (andlosing fluid) implies an eventualcooling
down and thereforesusceptibilityto cold insults. To preventproblems,the skin is
coveredmore,not less.
Exposureto excess throughoverexertionor sweating is said to cause fever,
muscle pain, digestive disorders,cough andcolds, flu, andpneumonia.All manner
of infectious, highly contagious diseases may be blamed on an uncoveredbelly,
walking barefootindoors or in damp grass, or riding in a car with open windows
thatexposes the unfortunatepersonto wind. Childrenareadmonishednot to cry or
suck their thumbsbecause to do either of these things causes the body to heat up
more. The hairis scrupulouslyblown-dry,year round-including the hottest,driest days of summer-for wet hairis said to lead inevitablyto arthrosisof the neck
(neckacheand headachethatcan last for many hoursafterthe hair is dry), among
other ailments.Aching in the shouldersof a manuallaboreror factory workeris

353
more likely to be blamedon agghiacciamento(an "icing"or freezing aftersweating) than physical strain.Fevers and other illness symptoms are often blamed on
icing or relatedevents such as raffreddarsi(to take cold), correntior colpi di aria
(draftsor gusts of air),or colpi di vento(gusts of wind).
The fact thattemperatureimbalanceis often consideredthe cause of a health
problemdoes not mean thattreatmentwill be limitedto humoralmedicine.Forexample, sicknesses that are openly describedas viral or bacterial,including colds
and flu, may be tracedto a day at the swimming pool and the temperatureimbalances it causes, or to overexertionfollowed by an agghiacciamento,but be treated
with antibiotics.Special caution about atmosphericand behavioralexcesses is an
obvious complementto this.
In many Westernsocieties thereare sets of healthbeliefs thatcenterarounda
particularorganas the seat of overall well-being, such as the liver in Franceor the
heart in West Germany(see Payer 1996). This emphasis has parallelsin the ancients' ideas aboutcertainorganssuch as the uterusplaying a pivotalrole in physical and mentalhealth. In north-centralItaly, thereis greatconcernfor the proper,
regularfunctioningof the intestine.Digestive disorderis said to cause everything
from toothachesto an unhealthyappearance,so the home use of enemas and laxatives is very common. According to humoralmedicine, digestion heats the body,
so it is dangerousto arise and exert oneself too soon aftereating, therebyrisking
exposureto a hot or cold insult.At the sametime, exposureto such an insultbefore,
during,or after a meal will interferewith the correctfunctioningof the digestive
system.
Digestion is thoughtto be affecteddirectlyand immediatelyby behavior,the
individualconstitution,andthe externalenvironment.In turn,the digestiveprocess
strongly influences well-being, so much so that anticipatedreactionsto the food
served at lunch or dinnerarea frequenttopic of conservation.The focus on digestion centerson the stomachandintestines,but it is also commonfor people to complain, while pointing out the place on theirbodies, of problemsin theirliver, kidneys, or spleen. These problemsrangefrom tendernessin thatareaof the body to a
generalizedfeeling of psychologicalor physicalexhaustion.
The willingness to intervenein the digestive process with enemas and laxatives is just one expressionof a lack of squeamishnessaboutcrossingthe physical
boundariesof the body. Most families include at least one personwho knows how
to give injections, materialsare available in the pharmacy,and physicians frequentlyprescribemedicines in this form. Everydaymedicines such as aspirinand
acetaminophenare routinelytaken in the form of suppositories,and to talk about
themevokes no embarrassment.Forcolds andotherupperrespiratoryailments,the
"aerosol"machineis availablein many homes; this is a mechanismfor delivering
vaporandmedicines,includingantibiotics,into the nostrilsthroughplastictubes.
The absenceof an intactboundaryseparatingthe self from the outside world
is consistentwith the ancientview of the connectednessof the body to its surrounding elements such as air andwater,as describedby Aristotleor Hippocrates.In Italy, as in otherpartsof Europe,thereis a very old traditionof attentionto the properties of differentkinds of waterand theirhealth-promotingeffects.8In general,it
is consideredsalubriousto spendtime nearrivers,lakes, or the sea, althoughopinions vary aboutthe advisabilityof immersion,especially in cold water.However,
riverwatercan become "bad"from agriculturalrunoffor othercauses and may be

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blamedfor sickness, as it was duringa recentrise in cases of breastcancerin Santa

Lucia(wherebottledwaterwas used for drinking).
There are small springsall over the Apenninesesteemed for the qualities of
their drinkingwater (see Montanari1825). People will drive hundredsof kilometers on the weekendsto fill bottles with waterfrom a favoritespring.Some springs
providesulfurouswaterthatis said to be good for the liver andis takenas a preventive. In addition,therearelargethermalspringsused by bathersof all ages, including children,who may travelacrossthe countryfor watersthoughtto improvegeneralwell-being andgive a boost to one's vitality,or to resolve mild to severe health
problems.The spas built aroundthese thermalspringspromiserelief from (or prevention of) a wide range of ailmentsinvolving the cardio-circulatory,respiratory,
dermal, reproductive,digestive, metabolic, and musculoskeletal systems.9 The
mineralsin the healing watersmay be absorbedthroughthe skin's pores in a bath
(or mud bath),the lining of the nose andmouthwhen vaporsarebreathedor water
is forced throughthe nostrils in tubes, or the gastrointestinaltractthroughsmall
doses of swallowedwater.
Likewise, the qualityof the circumambientairis consideredan importantfactor in health.People in the hills andmountainsof Emilia-Romagnastill blame malaria and tuberculosis,which were prevalentin the nearbyPo Valley well into the
first half of the 20th century,on the "low air"there. As in the past, northcentral
Italiansof all ages sojournto places thoughtto have betterair,usually in the mountains or near the sea, to improve their health or maintainit throughannualvisits.
This is especiallytrueof those who live in the cities or anywherewith humidair.At
the same time, travel may be feared because it requiresa change of air, and ill
health after a trip often is explainedin this way. The change of seasons is anticipated with especially careful behavior, to prevent the sicknesses and aches and
pains thatthe differentair is sureto bring.Some people anticipateseasonaldisturbances with preventiveremediessuch as the bee productsroyaljelly and propolis,
which areprizedfor theirnutritionalvalue andhealthbenefits.
The combinationof ancientand modernbeliefs in northcentralItaly leads to
behaviorsthataim, above all, for moderation,as older healthpracticeswould dictate, together with extreme cleanliness, as newer standardsof housekeepingand
germ control would demand.The home is kept as clean as a hospital ward, the
floors swept and washed,or rather"disinfected,"every day. Rugs, especially wallto-wall carpet,are abhorredbecause they are consideredfilthy and impossible to
clean. The body is cleanednotjust by bathingbut also throughspecialproductsfor
washing the eyes, ears, and nose as part of daily personalhygiene. Some people
soak theirproducein wateranda powdereddisinfectantcalled "Amuchina,"not to
removepesticidesbut to kill germs.
In additionto naturalforces, manyItaliansappealto spiritualones to maintain
balanceor deal with illness, even in places with a stronganticlericaltraditionsuch
as Emilia-Romagna.It is still commonin northcentralItalyto prayto certainsaints
or madonnasfor help with childbirth,illness, ill fortune,or specific maladiessuch
as infertility.This may involve a pilgrimageto the preferredsaint's shrineor to a
certainpaintingor church.10It is also importantto avoid malevolent supernatural
forces, whetherof humanor supernaturalsource.Thereare people who still know
or use tests for malocchio(evil eye), andprotectiveobjectssuch as pepperscan still

355
be seen adorningthe home or person,even if these practicesarebecomingrareand

may be used with a touchof irony,humor,or nostalgia.
Takentogether,the coexisting personalisticand naturalisticbeliefs discussed
so far reflect an idea of health as a constantlychangingcondition,one that can be
manipulatedminutely,and one that is constantlythreatenedby imbalancein both
the internalorganismandthe external,natural-spiritualworld.
Demographic and Socioeconomic Transition
One reasonfor the continuedpresenceof diverse medicaltraditionsin Italyis
thatat least some aspectsof the social contextsthatgave rise to themhave endured
to the presentday. Throughthe early decades of the 20th century,ruralItaly was a
small face-to-face society in which health beliefs about miasmas and spiritual
forces matcheda system of close interactionand interrelationamong individuals.
The notion of personhoodwas a more open one, and more communityor kin oriented thanindividualoriented.Beliefs abouthealthwere embeddedin a sociocentric conceptionof personhoodthatallowed for the malevolentinfluenceof dangerous others,eitherthroughsorceryor perhapsunwittinglythroughjealousy or other
socially destabilizingemotions. Spirits,both paganand mainstream,could also be
held accountablefor ill health or ill fortune,or appealedto for relief from these.
Phenomenasuch as malocchiolimited social strifecausedby people boastingor allowing themselves to give way to envy (see Foster 1976; Romanucci-Ross1997;
Scheper-HughesandLock 1987).
Such personalisticbeliefs and the seasonal time scales, traditionalmodes of
production,andideas of permanenceand stabilitycharacteristicof systems of subsistence agriculturehave little place in mass industrialsociety.'1Industrialization
and agriculturalintensificationhave broughta notion of personhoodthatposits the
individualas an entity unto itself, autonomousand impermeableto externalinfluences including sorcery. Accordingly, disease etiology is rooted in particular
agents as they affect individuals,cut off from context and circumstance.Moder
biomedicinegrew up in the industrialera anddrewon the idea of individualautonomy as it supplantedthe old medical system based on in-home care by traditional
authoritiessuch as elders,midwives, andpriests.
This transitionin the organizationand practiceof medicine took place relatively late in Italy, along with othermajorsocial transformationssuch as the rise of
the nation-stateand the developmentof an industrialeconomy (see Clark 1984;
Forgacs 1990; Whitaker2000). Comparedto other Europeancountries, Italy's
moder demographic and epidemiological transitions were compressed into a
short, recent period.'2From birth and death rates that were among the highest in
Europe in the early 20th century, Italy (together with Spain) now has a worldrecordlow fertilityrateanda deathratesimilarto thatof otherEuropeancountries.'3
Birthratesin Italy were in the 30s per 1,000 inhabitantsper year throughthe
first decade of the 20th century(38 from 1881-1885; 32.7 from 1901-1910) and
remainedin the high 20s for anothertwo decades. During the 1930s and 1940s,
birthrateswere in the low 20s. They fell to the teens in the 1950s and below 10 in
the 1980s (settlingat around9 in the 1990s). The averageannualdeathratewas 29
per 1,000 inhabitantsper yearfrom 1871-1885, but 25.2 in the next 15-yearperiod
and 20.7 from 1901-1914. Since the 1950s, it has been 10 or below. Althoughthe

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difference between birthsand deaths was as high as 10 per 1,000 inhabitantsper

year throughthe 1930s, thereafterit dwindledas birthratesplummetedand death
ratescontinuedtheir steadydecline. For the last decade, therehas been a negative
rate of naturalpopulationgrowth.Withinthe country,the northernand centralregions, includingEmilia-Romagna,have the lowest birthratesandthe largestnegative differencesbetween birthsand deaths (see IstitutoCentraledi Statistica;Istituto Nazionale di Statistica [ISTAT] 1991:156, tablel7.4, 1997:43, table 2.7,
2001:52, table2.7; Marconcini1935:16,tablel).
These changes reflect rapidimprovementsin living conditionsover the past
century,particularlysince WorldWarII. Italywas unifiedpoliticallyin the 1860s,
and industrializationproceededslowly throughthe first half of the 20th century.
Until the 1950s, Italy remaineda predominantlyagriculturalcountry,and a rural
one, althoughsome regions in the northwere alreadyfar along in theirindustrialization by then. Since World War II, therehas been a very rapidmovementto the
cities and a spectacularrise in economic well-being affecting all socioeconomic
categories.Lately,people have been returningto the countryside,wherethey have
renovatedold farmhousesor town apartmentsfrom which they commuteto work
in the cities.
The significance of these recent demographicand economic changes is that
the oldergenerationsgrew up in times thatwere radicallydifferentthanthe present
in almost every way. Throughthe first half of the 20th century,most people lived
in large, often complex families settings, and many were in ruralareasrelatively
isolated from the nationalculture.Christianteachings, generationsof high birth
and deathrates,and a history of political subjugationby foreign powers createda
strongelementof resignationandfatalismregardinglife anddeaththatis still quite
evident among older people today. Youngerpeople may believe in the efficacy of
medical intervention,but the oldest people grew up in a time when contact with
hospitalsand physicianswas considereda last resortand the equivalentof a death
sentence.Therewas extremepoverty,crowding,hunger,and sufferingfrominfectious as well as nutritionaldeficiency disease. This combinationof materialand
moralill-being was andis knownby the term,la miseria.
In the 19thcentury,it was not uncommonfor a single physicianor midwife to
serve a populationnumberingin the thousandsdispersedover roughterrain.14
Althere
was
a
movement
toward
medical
inand
though
growing
specialization
creased medical authority,at the turn of the century there were as many phlebotomistsas specializedphysiciansof all kinds in manydistricts,andtheirnumber
was only a fractionof that of the generalistdistrictphysicians.15Physicians suffered from a lack of public and administrativesupport,and the populationcontinued to insist on being treatedby untrained"charlatansand curanderosof both
sexes,"especially in the countryside(see Rosetti 1894:362).
Fromunificationuntilthe fascist period,Italiangovernmentsdid little to amelioratethe healthconditionsof the country,especially in the relativelyinaccessible
ruralareas,aside fromputtinga greatdeal of legislationon the books. In fact, Italy
has a very distinguishedhistory of public healthlegislation,but this must be consideredin light of the sheervolume of Italianlaws in general,togetherwith a scarcity of funds and lack of political will to implementprograms.To illustrate,in
1901, a decadeafternationallegislationconcerningendemicpellagra(affectingup
to two-thirdsof the populationin some regions) had been passed, the government

357
finally allocated 100,000 lire to preventionof the disease. It had recently spent
three times as much on one stallion to add to its stock of racehorses(DeBernardi
1984:173).
This is not to say that nothing was done to improvehygienic conditionsand
public health,however. Local governmentsorganizedmedical services, including
pharmaciesand districtphysicians and midwives. They carriedout programsfor
immunization,surveillanceof meat and fish processing and markets,disposal of
sewage and hospital waste, pasteurizationof milk, and housing construction.
These provisionscontributedto the diffusion of an emerginggerm consciousness,
even if they were first institutedwith an eye to controllingmiasmas.Indeed,germs
were so farfrommanypeople's mindsthroughthe firstdecadesof the 20th century
that the men who illicitly bought household sewage for agriculturaluses would
dip a long spoon into the latrinetaste it. They had to make sureit had fermentedto
the right degree so as not to burnthe fields, as an older couple in SantaLucia explainedto me.
During the interwarperiod, the germ theory of disease was more forcefully
diffused among the populationat large. The fascist governmentsoughtto manage
the populationthroughan unprecedentedeffort to develop a health care system,
expandthe nationalinfrastructure,
replacelocal andregionalautonomywith a unified nationalculture,and createa data-collectionsystem to trackdemographicand
health trends(see Horn 1994; Ipsen 1996; Preti 1987; Whitaker2000). These efforts reflecteda new concept of domestic welfare managementas a responsibility
of the state, even if it was motivatedmore by imperialisticdreamsand plans than
humanitarianideals. There was a new concept of preventivehealth care and the
need to make the world of scientific discoveriesand elite urbanphysiciansknown
to the districthealth workersand the illiterate,impoverishedmajority.Although
much of what the fascists instituted was more show than substance, one real
consequence was that more and more people came into contact with medical
professionals.
In line with the fascist emphasis on embracingfuturismand traditionalism
contemporaneously("movingforwardwhile looking backward"),governmentefforts to combatmalaria,tuberculosis,andotherdiseases includedpropagandathat
attributedthese diseases to microbeswhile also stressingorderandbalancein lifestyle. In a characteristicexample, a fascist governmentpamphletproducedfor the
"battleagainsttuberculosis"(FederazioneItalianaNazionale Fascistaper la Lotta
Controla Tubercolosic. 1928) explainsthatthe disease is causedby a bacillus discoveredby RobertKoch, but includes,between admonishmentsaboutcleanliness,
the recommendation
thatreaders"eathealthyfoods at regularhours"(see Figure 1).
The pamphletalso advises sleeping with the windows partlyopen, but protected
from drafts of cold air; maintaining a composed and straightposition when sitting in a chair; and seeking the healthy benefits of a life near the sea and in the
mountains.
World War II broughtfurtherchanges in medical care. The Allied soldiers
came with antibioticsand other medicines, which continuedto arrivealong with
food afterthe war. Until then, the principalhospital treatmentregime had been a
combinationof diet-mainly a supervised transitionfrom liquid to solid foods
given in precisedoses-and enemas.As I foundin a studyof patientrecordsfroma
small hospital,this treatmentwas appliedno matterwhetherthe patienthad been

I
358
MEDICAL ANTHROPOLOGY QUARTERLY
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che
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odellealbercolol
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ppcnfobou
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jured
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La
fin doi lempi piu remoli. Esso
di grovi donni moleriolie
o
l e fomgliee leNe zioni.Perc;6,
morallper
in ogni epoc., senziali di lultoil mondo
ie _ --"?d l
od
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Figure 1
Illustration from fascist-era pamphlet giving health advice for the prevention of
tuberculosis(FederazioneItaliana Nazionale Fascista per la Lotta Control la Tubercolosi
c. 1928:2).
evermorecontact,
e
la e-r.
t deste
h
icscnl
baeten
paplatsiontinu
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ione
celnasindcaor
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admittedfor Threqueconomictboom
appendicitis,complications childbirth,carcinoma, any

son.'6In 1945, treatmentincludedmany medicines not availablea decade earlier,
such as sulfonamides, anti-tetanusand anti-diphtheriadrugs, and vaccine ther-
apy.'7
After the war, hospitalsthathad been opened for the care of soldiers and injured civilians were converted into general hospitals. The expansion of government health and social services begun duringthe fascist period continuedapace,
bringingever more contactbetween the populationand state and medicalexperts.
The economic boom thatbeganin the 1960s broughtrapidimprovementsin educational levels and materialwell-being. Combined with the provision of universal
healthinsurance(beginningin 1980), this means that both prescriptionmedicines
and alternativeremedies are within reach of almost everyone. Italy now has the
highest numberof physicians per capita in the world, and a huge pharmaceutical
industryto match.'l
The numberof medicalinterventions,the use of medicines,andthe frequency
of contactwith physicianshave risen in step with these changes. A close relationship with the medical system begins early in life. For example, in Emilia-Romagna,infantsup to the age of one year areuniformlytakenin for routinepediatric
visits once every month,andmanyparentscontinuethis for the entiresecond year.
Frequentvisits continue throughpreschool. My questionnairesindicate that parents of preschoolerstake their childrento the pediatricianan averageof six times
per year, combiningpreventiveand sick visits.'9A large proportionof parentsreport having given their preschool children antibiotics,acetaminophenor aspirin,
medicines such as antibiotics put into the aerosol machine, andfermenti lattici
(large doses of lactobacillusfor treatingdiarrhea),as reportedin Table 1.20Local

359

ITALY
physicians confirm that almost all childrenhave been treatedwith many of these
medicinesbeforethey enterfirstgrade.
The children'sillnesses included the usual childhood diseases such as colds
(96 percentof parentssaid thattheir childrenhad been struckwith colds), flu (79
percent), mumps (56 percent),tonsillitis (53 percent), and chicken pox (49 percent). Other common ailments (such as pertussis,bronchitis,and conjunctivitis)
had strucka sizable numberof children,but there were no chronic or very severe
illnesses listed by the parents.Interestingly,13 percentof parentsreportedhaving
purchasedmedicines for theirchildrenfrom an herbalist.These includedpropolis,
cough syrup,Echinacea,herbalcreams,anddropsfor the ears,eyes, andnose.
A study conducted by the national statistics bureauin 2000 found that although93 percentof childrenunderthe age of 15 were in good health(theirparents
having expressedthis as 4 or 5 on a 1-5 scale), 22.6 percentof 0-5 year olds, 12.3
percentof 6-10 year olds, and 10.9 percentof 11-15 year olds had takenmedicine
duringthe two days precedingthe survey. The study found an uninterrupteddecline in the proportionof people reportinggood healthas age increasedand an uninterruptedrise in the proportionof people who had takenmedicinein the previous
two days (in the over-75 age group, 25.3 percentwere in good health and 77 percent had takenmedicine).The proportionof medicinesprescribedby the physician
declined from the earliestage groups (88.9 percent)to a nadiramong 18-19 year
olds (63.7 percent),then rose again as age increased(97.5 percentamong people
75 and older), for an overall averageof 89.5 percent.The proportionof medicines
taken on one's own initiative(or that of one's parents),meanwhile,rose from the
0-5 age group(7.0 percent)to the 18-19 age group (29.5 percent)and then fell as
groupage rose (1.3 percentamongpeople 75 and older), for an overall averageof
8.2 percent.Theproportionof medicinestakenthatwerealreadyin thehomeaveraged
Table 1
Parents' ever-use of medicines for their preschool children
(3-6 years old [69 respondents]).
Antibiotics
Antipyretics
(Tylenol,aspirin)
65
55
94
80
Cough syrup
54
78
Fermentilattici(lactobacillus,
fordiarrhea)
fordeliveringsteamand
Aerosol(apparatus
medicinesdirectlyto thenose)
Dropsforthenose
Dropsfortheears
Medicatedcreams
47
68
45
65
43
31
62
45
39
Expectorants
27
26
Drops for the eyes
19
28

38
360
MEDICALANTHROPOLOGY
QUARTERLY
27.6 percentbutfluctuatedwidely over the age categories(ISTAT2001:97-98, tables 3.14 and3.15).21

These numbers indicate a heavy use of medicines in the managementof
healthandreflectthe frequencyof contactbetweenthe populationand medicalexperts. This is the outcome of several decades of governmentexpansion,improvement in literacy rates, urbanizationand industrialization,and immersion in the
global economy and informationsystem. There has been a shift from resignation
regardinghigh birthand deathratesto a more active approachto the management
of populationandhealth.Yet the presenceof olderpeople with a living memoryof
la miseria and a different understandingof la salute continues to exert a force
againstthe abandonmentof olderways of thinkingaboutandtreatingthe body. Put
together,these trendsbringa complex idea of healthinvolving a subtleinterplayof
forces that affect the body and spiritand an increasedinterestin influencingthem
throughmoderatebehaviorandpreventiveremedies.
Pluralism in Medical Beliefs and Care
The social and culturalchanges of the past centuryhave not led to a complete
abandonmentof older conceptionsof personhoodandhealth.This is becausethese
changes arerelativelyrecentandbecauseItalyhas maintaineda strongagricultural
traditionand state-supportedagriculturalsector that retainsa relativelyhigh proportion of the populationin farming.22Of 14 types of labor analyzed by the national statisticsbureau,only four have a highernumberof workersthan the category of "agriculture,hunting, and silviculture":manufacturing,construction,
repairand sale of automobilesand otherconsumerproducts,and police, military,
and obligatorysocial insurance.That is, there are more agriculturalworkersthan
people employedin hotels andrestaurants,healthand othersocial services, education, or bankingandcomputing(see ISTAT2001:628, table26.4).
Although the proportionof workersin agricultureis higher in the south and
islandsthanthe centralandnorthernregions,all generationsof Italiansareexposed
to elements of both the ruralagriculturaleconomy and society andthe moder industrialor postindustrialone. Many city dwellers continueto grow food in small
gardensandto maintaincontactswith land andrelativesin the ruralareas.Those in
farming and related occupations,meanwhile, remain tied to the nationalculture
throughtechnology, media, education,and communitylife. Very few still occupy
the isolatedfarmhouses in use throughthe decadesafterWorldWarII.
Culturalpatternssuch as children living at home until they marry,often in
their thirties, or public administrationmeasurescentering on place of residence
thattie people to a single geographicallocation (such as the requirementof voting
in one's birthplace),also contributeto stability in many beliefs and behaviors.23
The very presenceof a disproportionatelylarge aging populationdue to low birth
and death rates adds to the influence of traditionand history on younger people.
About equal proportionsof Italiansare over 65 (15 percent)and under 15 (16 percent), whereas27 percentof the populationis over 55. Like othercentralandnorthern regions, Emilia-Romagnahas an even largerproportionof older people and
smallerproportionof young people (20 percentareover 65 whereas 11 percentare
under15) (ISTAT2001:626, table 26.2).

361
Olderpeople often live with or neartheirchildren'sfamilies and take care of

theirgrandchildren,given a enduringalthoughweakeningpreferencefor in-home
care as opposed to institutionalcare of the elderly and the very young.24My questionnairesconfirmedthatmost childrenin Italy see theirgrandparentsat least once
a week, if not daily. Italy has the highest ratein Europeof women over 50 who reportthatthey areresponsiblefor takingcare of childrenon a daily basis and do so
with satisfaction(nearly 30 percent), a rate that is double the Europeanaverage
(Valentini1999:32).
These demographictrendshelp maintainthe vitality of nonbiomedicalhealing traditionsthroughthe continued presence of traditionalhealers and the frequentcontactbetweenpeople of all generations.In addition,the last couple of decades have seen a broad revaluationof traditional,local material cultures (and
dialects), in a sort of reboundfrom the postwarabandonmentof localism in favor
of involvement in mass industrial,internationalsociety. Ironically,Westernconsumerismandthe rise in disposableincome have fueled the rebirthof artisan-made
products,traditionalformsof entertainment,andeven old healthremedies,some of
which have gained legitimacy throughthe media. One interestingresult is that
younger people are reintroducingtreatmentsused by their older relatives (see
Romanucci-Ross1997:11).
Yet some older people, particularlymiddle-agedpeople who bought into the
beliefs thattheir
postwarrejectionof conventionalways, may disdain"traditional"
own childrenembrace,as a conversationwith a 30-year-old woman and her 60year-oldmotherillustrates.While discussinghot-cold values, the youngerwoman
mentionedthe saying in the local dialectthat"chocolateheatsyou up,"and argued
thatthis hadbeen demonstratedscientifically.25I broughtup the traditionalremedy
of using rice to treatdiarrhea.The mothersaid, "Yes, these beliefs arereal but it's
all hogwash."In other cases, the fact that there are still older people aroundwho
lived in the particularsocioeconomic situationthat gave rise to these treatments
means that theircontentand mode of use can be validatedeven if the context has
changed.
The organizationof medicalcare also plays a role in the persistenceof multiple models of health in Italy. While the national health service has expanded
greatlyover the past severaldecades,a mistrustof governmentthathas been noted
by anthropologists and other outside observers contributes to the continued
strengthof the extrabiomedicalhealing traditions(see Romanucci-Ross 1997).
Unlike the biomedical sector in the United States, in Italy there is no lobby of
medical practitionerswith the resourcesnecessaryto eliminatethe others,and this
favors their continued coexistence. In fact, the national health insurancecovers
various nonbiomedicaltreatmentssuch as acupunctureand still pays for many
thermaltreatments(although they are few comparedto the recent past). Mainstreampharmaciessell a range of herbaland biomedicalremedies.Both folk and
biomedical healers refer patients to each other and borrow technical terms from
one another.These forces supporta pluralisticmedical system and allow patients
to maintaintheircommitmentto disparateways of understandingthe body andits
management.
People in northcentralItaly seek care from a varietyof healthprofessionals,
who, in turn,use a varietyof therapies.For example, over the past year, a woman
shopkeeperand landlordin her early forties has consulted general and specialist

362
MEDICAL
ANTHROPOLOGY
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physiciansregardinga persistentrashon herface while seeing a numberof alternative healersat the same time. One of these was a very aged traditionalhealernear
the city of Forli. Elena was surprisedto find thathe performedhis vigorous ritual
scrubbingof all of her exposed skin with water from a dirty bottle taken from an
even dirtiersink. He took a hot pokerfrom the fire andsigned aroundher head and
body with it while chantingincantationsin a low voice. When Elena told him she
lived far away and didn't think she could returnfor the usual three-dayseries of
treatments,he suggested that she try salt watercompressesand antibioticsto furtherthe treatmentalong.
Among the specialist physiciansElena visited was a dermatologistwho prescribedsteroidhormones,which broughta transientimprovement,and told her to
avoid any cause thatwould makethe skin heatup such as certainfoods or exposure
to sunlight. After this failed to bring a lasting change she went to a homeopath,
who prescribedmagnesiumand certainvitamins.She then went to a spa at a thermal springfor a blood test to determinethe degree of her intoleranceof dozens of
foods.26There,Elenalearnedthatshe was intolerantof (not allergicto) some of her
most basic foods (such as wheat and dairyproducts),but not the foods the dermatologist had warnedagainst (such as coffee, chocolate, or peppers).She ended up
trying a mixtureof homeopathicmedicines (but not all of those prescribed),the
diet outlinedat the spa, and black currantextractthatits staff said would boost her
immune system. Her primarycare physicianwas amusedthat she had gone to the
spa, but while makinglight of the problemandtelling herto relax aboutit, he also
suggestedthatmaybe she shouldgo to see an immunologist.
In parallelwith theirpatients,practitionersof mainstreammedicine express a
mixtureof healthbeliefs andmanyareopen to alternativetreatments.A pharmacist
who works in a medium-sizedcity and is marriedto a physicianrecentlyhad pain
in her neck andarm.She was reluctantto take anti-inflammatories
becauseshe was
breastfeeding,but did not want to leave the condition alone because she feared it
would make her milk disappear.She found relief througha series of acupuncture
treatmentsat a local hospital.27
When my eye suddenlyswelled shut one early springday the physicianat the
public after-hoursclinic disagreedwith my suggestionthatit was an insect bite and
concludedthatit was conjunctivitiscausedby a gust of wind. She prescribedboric
acid washes and antibioticdropsandtold me thatshe was currentlyusing the same
remedies because she inadvertentlyhad gotten toothpastein her eye. Like most
otherphysicians,she drew on traditionalmiasmicways of viewing the problem(in
this case, rootedin olderpeople's storiesof the greatwinds of the past,which blew
dust in their eyes and produced an inflammationthey treated with boric acid
washes) and newer germ-orientedideas to come up with a treatmentthat incorporatedboth.
Although most of them have retired,there are still men and women in the
countrysideand in cities including Bologna who lay on hands to treatdisorders
such as the burning-skinailmentknown as "SaintAnthony's Fire."28The ability
does not appearto be dying off with them, for there are youngerpeople who have
discoveredthatthey have healing hands,such as a woman in her forties who lives
in SantaLuciabut worksin a nearbycity. She describesherheat-radiatinghandsas
a gift her fatheralso had but one thatworks only on people with whom she feels a
mutual sympathy. She recently massaged and unblocked the diaphragmof a

363
woman in respiratorydistress, saying things during the process that she didn't
know she knew. As always happensafter she absorbsanother'spain, one of her
eyes madetears.
In keeping with the mutualrespect between practitionersof various healing
traditionsmentionedabove, the physiciansfrom the hospitalcalled this woman to
ask how she had managed to effect a result the volunteer emergency team had
failed to achieve. Far from being considereda freak, she is sought out by people
who know abouther kind of healing and wantto teachher how to manageher gift;
they have shown her a routinefor washing her hands after healing someone and
how she should wear black againstthe skin. Many people, including mainstream
physicians,have told her thatshe should give up her office job and concentrateinsteadon healing.
This pluralismin medical care and beliefs extends to the internationalcommunity of healthprofessionalsand healing traditions,to which both medical professionals and the public are exposed. Beyond biomedical therapies,Italiansare
aware of and have ready access to treatments,herbaland homeopathicremedies,
and vitaminand otherfood supplementsof othercountriesandof foreignersliving
in Italy. The case of anotherwoman with a persistentskin problemillustratesthis
internationalaspect of medical pluralism.Martinalives in Florence and is being
treatedby a Chinese woman who practicestraditionalChinese medicine. She has
told Martinathat she was born with a diseased gastrointestinaltractthat does not
permither to digest many foods, filling her with toxins and fire. The toxins come
out her pores as she sweats, causing the burningsensationin her skin. Treatment
includes bathingand anointingthe skin and practicinga careful vegetable-based
diet. The healer's two childrenare medical studentsin Italy, but also are learning
traditionalChinesemedicinethroughher andby returningto Chinaevery summer.
Like many otherhealth professionalsin Italy, they are learningto blend together
diversemedicaltraditionsandtreatments.
Daily Maintenance Behaviors across Generations
We have seen how several lines of interpretationof psychobiologicalhealth
have emergedover time, how particularsocioculturalanddemographicchangesof
the past centuryhave contributedto maintainingtheirvitality, andhow they manifest themselves in a pluralisticmedical system. This brings us back to the idea of
healthitself, andto the approachto the careof the body involving a readinessto intervene in bodily functions. This is because health constantlymust be managed,
given the ancientbelief in the permeabilityof the body andsoul.
Humoral,biomedical,andpersonalistichealthbeliefs coexist in northcentral
Italy and do not seem to be experiencedas contradictoryor mutuallyexclusive by
either medical professionalsor the public. For example, the ancient idea that the
complementaryor sometimes opposing constitutionsof nursingmothersand their
infants influence or interferewith the process of lactation has been repeatedin
medical advice and popularbelief throughoutthe centuriesto presenttimes. Because of the persistenceof older ideas aboutthe incompatibilityof certainbodily
secretions,many mothers,physicians, and medical texts maintainthat a pregnant
woman may experiencediscomfortduringthe days of her usual menstrualperiod.
After childbirth,her milk will be alteredin quantityand composition duringthe

364
MEDICAL
ANTHROPOLOGY
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same menstrualperiods,whetheractualor missed because of postpartumamenorrhea(see Whitaker2000).

The case of a sixty-year-oldfarmworker'sillness involving high fever and
generalmalaise shows how the humoraland germparadigmscan dovetailfor both
healers and patients.After failing to improveafter visits with her local physician,
she went to see a high-rankingspecialistfrom the Universityof Bologna. She then
said thatthe doctorhad explainedher illness as due to the combinationof a virus
circulatingin the ambientair and the fact that she rode a moped to work on a hot
windy day. This causedher to sweat andtherebyallow the germ to enterand overpowerher system.
Similarly,a Florentinefatherwho works in bankingblamedhis two-year-old
son's cold on a bike ride one summerday. The combinationof heat and wind had
madehim sweat andcome down with the same cold his olderbrotherhadhad a few
days earlier.A thirty-year-oldoffice workerdescribedher friend's case of pneumonia as being so bad that the doctor could listen throughthe stethoscopeto the
bacteriamoving andreproducingin his lungs. The next day, the sick man's sister,a
nurse,said not to worryaboutcatchingpneumoniafrom him because,of course,it
was not a contagious disease. Instead,he must have gotten agghiacciatoor been
struckby cold. Then, when he startedrecoveringand was out of bed, his friendexplained that he was confined to his house because he must not be struckby cold
again.
Temperatureextremes are considereddangerousfor people of all ages, but
those in the primeof life may take more risks with them whereasolder people and
small childrenare consideredmore vulnerableto theirill effects. This is why children's bicycles and outdoortoys are put away at the first sign of autumnand why
the old and very young spend even less time outdoorsduringthe winter months
thanotherpeople. In the summer,it is rareto see babies left unclothedor without
shoes or old people at swimmingpools or using fans or air conditioners.The need
to mix a warmliquid into any cold beverageis more pressingif it is intendedfor a
child or old person, although young and middle-aged people do not hesitate to
blame cold drinksfor any discomfortsor illnesses they might suffer as well. In
similarfashion, a public health service physicianin his forties claims that thereis
scientific proof of his belief that it is not caffeine but the heat of a beverage (no
matterwhatkind)thatkeeps people up at night.
If a family has a summervacationplanned,the parentswill be sureto keep the
childrenaway from the swimmingpool or the gardenhose for at least a week beforehandand may avoid these things themselves as well. Childrenwill spontaneously explain thatthey must not get wet or they will catch bronchitis,completing
their parents'or grandparents'sentences when the lattertell them not to do so or
else. Parentschase aftertheirchildrenat evening festivals in the heatof summer,to
give them a jacket to wearin case they are sweating.A rareparentwill stop a child
to takeits sweateroff, but this exceptiononly provesthe rulethatsweatingis a dangerousconditionthatmustbe managed.
Many people complainaboutthe increasingheat of summerand its mysterious causes, linking their local environmentto global climate trendswhile lamenting the voraciousnessof humansocieties. Fansandairconditionersareavoidednot
because they use energy or createpollutionbut because of the air currentsand the
destabilizingimbalancesbetweenindoorandoutdoortemperaturesthatthey cause.

365
Air conditionersare furtherrejected as being unsanitarybecause they incubate

germs. A 40-year-oldphysical therapistobserves thatcolds have become as common in summeras in winterbecauseof some people's inabilityto resistthe temptation to use air conditioning.In a similar vein, where I might blame the stagnant,
smoggy, pollen-filled air duringa period of intense heat for my nasal congestion,
my neighborsof all ages tell me thatit is due to my body sweatingbutbeing unable
to cool off, or they scold me for sleeping with the windows open.
Although it is importantfor people of all ages to keep covered, especially if
temperatureimbalance threatens, the technique may vary across generations.
Throughthe first half of the 20th century,men wore full-length wool underwear
(top andbottom)yearround,for thatis said to be best for absorbingsweat. During
my bike rides throughthe countryside,I have seen farmerswho still do so. Similarly, a middle-agedformerteacherexplainedone very hot day thatthe reasonshe
was wearing a dark wool suit that completely covered her arms, chest, and neck
was thatshe was going throughmenopause;it was importantto be coveredbecause
she mighthave a hot flash and sweat.
Finally, old and young unfailingly wear cotton or cotton-wool undershirts,
even undertank tops in the height of summer,for at the very least the abdomen
must be protected.One fall day, an acclaimedceramicistfrom Faenzarepeatedly
tugged my children's shirts down over their bellies, as friends and even perfect
strangersoften did. She was not at all concernedthat her four-year-olddaughter
was sittingin the bed of a tractorwhile severaladultsthrewfirewoodinto it.
Traditionalconcepts about sweating and exposure to atmosphericinsults
come to the fore in physical activity, as I have observedover many years of bicycling with men in Emilia-Romagna.As clothinghas improved,it has become possible for cyclists to ride throughthe winter,but they still tend to avoid the climbs
becauseof the riskof getting"iced"on the way down afterhavinggottensweaty on
the way up. This is a risk in the summer,too, so cyclists of all ages put a jacket on
for the descents,no matterhow hot they feel. Whenthey returnhome, they close all
the windows in the bathroom(or even the whole house) to take a shower,in order
not to be exposed to any correnti(drafts).
Duringthe ride, cyclists try to avoid any temperatureshocks, as I foundwhen
riding on a hot summerday with a young man in his late teens or early twenties
who squirtedanothermemberof his militarycycling teamwith waterfromhis bottle. The other,horrified,told him to stop or he would get sick. Interestingly,some
male cyclists have told me thatthey have triedto interesttheirwives in cycling but
the latter are too fearful of sweating and of the inevitable air currentsand wind.
Nevertheless,therehas been a rapidrise in the numberof women cyclists over the
past decade,althoughmanygo out in long pantsand scarveseven in hot weather.
The necessity of maintainingregulardigestive functionremainsan important
componentof the idea of health.A pharmacistin a spa town explainedthat older
women routinelyrequestan enema after a day of constipation.Laxativepills are
also in common use and marketedto people of all age groups.A full-page advertisementfor laxativepills explainsthatthe womanin lacy underwearis wondering
why she is not quite in form,her figure not slim enough, her skin lackingin luster,
andher gaze missing its customarylimpidness:"Listento the mirror:it is warning
you that, probably, something in your organism is not regulated.... Maybe the

366
MEDICALANTHROPOLOGY
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intestine."29 In fact, a cycling buddy gave these pills to my husbandto take the
nightbeforehis next rideafteran undistinguishedperformanceone day.

A preschoolteacherin the city of Faenzahas found thatif the childrendo not
to
go the bathroomat school, they will be given an enema at home that evening.
Parentsare so relentless in asking about this that she has startedwritinga "c"for
"caca"on the children'shands.Routinehospitalpracticeincludes a "bomb"of an
enema before any type of operation,as a man who had arthroscopicknee surgery
describedit. A young man went to New York to runin the marathonrecentlyand
complainedbitterlyto me aboutthe difficultyhe had in finding mineralwaterand
his customaryfoods, especially for breakfast.This, he said, caused his digestive
system to become irregularandinterferedwith his trainingand his performancein
the race. The GranaroloFelsinea dairycompanyrecentlylaunchedtwo new products for health-consciousconsumerslike this man. "Vivi Vivo" milk and yogurt
are said to improve daily benessere throughthe action of a lactobacillusthat "favors intestinalequilibrium"and stimulatesthe productionof antibodiesto boost
the body's naturaldefenses.30
Although all generationsexpress concern aboutatmosphericthreatsand immoderatebehaviors,young and middle-agedpeople seem to be more repulsedby
filth than are the oldest generations.This is not surprising,given that the former
have grown up in an era of mass marketingand rising standardsof cleanliness. I
once openedthe main doorto a friend'shouse andsaw her, with herinjuredarmin
a sling, helping anotherwoman carry the latter's four-month-oldbaby up two
flights of marblesteps, in his carriage.They were doing so because it would have
been unthinkableto puthim on the floor, wherehe would have been exposed to dirt
anddrafts.
In contrast,a formermidwife in her late seventies is puzzledby the way middle-aged and younger people are excessively concernedaboutcleanliness. When
she was young, she came across very healthychildrenliving in extremelydirtyenvironments,but now she worriesthatchildrenare becoming weakerthroughlack
of exposureto germs.At the same time, she observesolderpeople keepingthe heat
on too high andcoveringthemselvesandlittle childrenwith too muchclothingand
blankets;they cannotforget earlierdays when it was cold and the only heat came
fromfarmanimalsor scarcewood.
Many older people and some young people continue to express faith in sorcery as well as saints.My 83-year-oldneighbor,who has workedfor the priestfor
decades,continuesto performthe oil-and-watertest to diagnose the evil eye when
someone experiencessickness or ill fortune(such as my infantdaughter,sick with
the flu a few years ago). A 90-year-oldwoman who formerlyworked as a seamstresskeeps horse chestnutsin her purseto wardoff colds, flu, and fever. She and
many others,includingyoung people, also keep garlic aroundtheirpersonto protect against malevolent forces in general. Whereasnew mothersdo not bathe or
wash theirhairfor a week afterchildbirthbecauseof fearof heatloss, theirmothers
and grandmotherswaited 40 days, with the additionalfear of sorcery should any
hairfall out. Young parentsareoften fearfulof disregardingthe traditionalprohibition, rootedin sorcerybeliefs, againstcuttingthe child's hairor fingernailsuntil its
firstbirthday.Finally,thereis still a reluctanceto complimentnew parentson their
baby's beautyfor fear thatsuch an expressionof possible envy will bringthe child
harmor shed a negativelight on the admirer.

367
A partof the questionnaireansweredby parentsof preschoolershelps illustratehow people today reconcile and prioritizecomplex influenceson health.The
questionnaireaskedparentsto ranka list of factorsaccordingto theirimportancein
influencingchildren'shealth.The questionthatfollowed askedif these factorsaffect adultsin the same way as children,to which almost all respondentsanswered
in the affirmative.3'
The first set of questionnaires(Type A) from a preschool in Forli listed 34
factorsto be rankedon a 0-5 scale, but some parentscomplainedthatthe question
was too long. Accordingly,the second set of questionnaires(Type B) distributedin
three preschools in Faenza and Santa Lucia groupedmany of the factors into 14
umbrellatermsandused a 0-3 scale. Table2 presentsthe meanandstandarddeviation for each factorfrom the Type A questionnaire,whereasTable 3 does the same
for the Type B questionnaire.Only four factors,all of which appearedon the Type
A questionnaire,failed to receive a single highest rankingby the pool of respondents, indicatingthat they are not consideredimportantinfluences on children's
health:too much sleep; too little sleep; solarradiation;and,uncoveredhands.
Table 2
Parents' rankings of factors that influence health from 0 for not important
to 5 for very important (Type A questionnaire, 44 respondents).
Factor
Mean St. Dev.
Contactwith other
children
Factor
Mean St. Dev.
3.79
1.45
Waterpollution
2.15
1.99
Bad or spoiled food
3.35
2.20
1.64
2.81
1.86
Overweight
Exposed abdomen
2.06
Microbesin the air
1.94
1.45
Bad air
2.78
2.00
1.89
1.61
Weather
2.76
1.75
Too-heavy clothing
Bare feet
1.86
1.38
2.70
Humidity
Factorsrelatedto allergies 2.69
1.66
Microbesin soil
1.82
2.01
2.10
Nutrition
1.65
1.40
Air pollution
2.65
1.70
1.72
Microbesin water
2.61
2.23
Insufficientexposureto light 1.63

1.56
Underweight
1.54
Psychological traumas
Continuoususe of
medicines
26.1
2.06
Too-light clothing
1.46
1.38
2.46
2.12
Aridity
1.44
1.54
Contactwith adults
2.44
1.52
Uncoveredhead
1.33
1.53
Chemicalsin food
2.40
1.94
Heat
1.31
1.59
Cold (weather)
2.33
1.72
Solar radiation
0.76
1.28
Wet hair
2.30
1.76
Too little sleep
0.31
0.67
Microbesin food
2.21
2.09
Uncoveredhands
0.03
0.18
Bad water
2.17
2.03
Too much sleep
0.0
0.0

368
MEDICALANTHROPOLOGY
QUARTERLY
In anothersection of the questionnaire,parentswere asked if therewere particularthings thatoften causedtheirchild's illnesses. Of the 42 responsesgiving a
specific cause (79 parentseither said no or gave no answer), nine concernedthe
child taking cold, the child taking cold "andthen sweating and freezing,"or the
child being struckby gusts of cold air. Another 11 involved inflammationof the
tonsils, larynx,and/oradenoids.Six othersrelatedto contagion,contactwith other
children,viruses transmittedby playmates,or germs at nurseryschool. Five mentioned otitis or otitis with tonsillitis. The remaining11 were listed by one or two
parentseach, and includedcontinentalclimate and humiditydue to climate;bronchial tubes takingcold and "takingcold, irritationof nose-throat-ear";
dry, hot air
in closed environments;walkingbarefoot;colds andflu; seasonalvirusesandviral
illnesses; and delicatestomach.
Takentogether,these causes and the rankedfactorspresentedin Tables 2 and
3 indicatea significant,althoughvariable,level of concernfor atmosphericevents
and conditions (especially cold and humidity, with several parentspenciling in
"wind" and "fog"); immoderatebehaviors (wet hair, uncovered head, exposed
belly, barefeet); nutrition;contagion(contactwith childrenandadults,microbesin
air,food, dirtandwater);andmoder-day miasmassuch as airandwaterpollution,
chemicalsin food,cigarettesmoke,accidentsandinjuries,medicines,andradiation.
These parentalconcernsreflect the conditionsof life in northcentralItaly today, where everyone, but especially city dwellers, is exposed to noxious air from
Table 3
Parents' rankings of factors that influence health from 0 for not important
to 3 for very important (Type B questionnaire, 65 respondents).
Factor
Mean
St. Dev.
Cigarettesmoke
Pollution
2.29
0.98
2.27
1.05
Accidents outside the home
2.22
0.90
Accidents inside the home
2.07
0.90
Nutrition
2.03
0.99
Radiation(nuclear,x-rays, cosmic, etc.)

Behaviors (too-heavy or too-light clothing,
wet hair,etc.)
2.02
1.27
1.87
1.04
Use of medicines
1.84
1.13
Microbes
1.75
1.08
Psychological disturbances
Weather/climate/water/air
1.72
1.22
1.67
1.14
Burstsof sun or air/wind
1.65
1.06
Genetic inheritance
1.18
1.21
Body weight
1.08
1.01

369
cars and factories,spectacularlydestructivetrafficaccidentsshown in gory detail

in the media, andthe continuedpopularityof cigarettesmoking,which fills public
places with heavy smoke.The ubiquityof cell phones due to the high priceof service by the state telecommunicationsfirm means that new towers are going up all
over the country,addingto the radio and electric towers that are alreadycreating
invisible pollution.
When askedif theirlives were betterthanthose of theirown parents,most of
the respondentssaid yes. Their parentshad workedharderand lived throughwar
and miseria,whereasthe respondentshave benefitedfrom greatereconomic wellbeing and educational and work opportunities.However, several respondents
wrotethattheirown parentshad had a good life with fewer worriesand dangers.A
40-year-old fatherexpressed this in terms of "moreserenitybut fewer possibilities." A 30-year-oldmothercould not answerwhetherher parents'lives had been
better:"Forcertainthings [my life] is better,for example the conveniences, like a
heated house, hot water, then the abundanceof food, of clothes, of shoes, but for
otherthings their life was better,not as many drugs,less pollution,less boredom,
etc."
When askedif theirchildren'slives would be betterthantheirs,manyrespondents said yes becauseof betterliving conditionsor more social attentionto health,
family, andpsychologicalmatters,but manyalso expresseddoubtsbasedon political instability,environmentalcrisis, and spiritualor moraldecay. As a 27-year-old
fathersaid, "Ido not see a happyfutureworld."Manyparentswroteof an improvement in living conditions being counterbalancedby ever-increasingpollution, a
world growingless healthyday by day, more and more difficultand distantfamily
and social relationships,and rising dangers in the form of violence, AIDS, and
drugs.As a 40-year-oldmothersaid, "Justlook around."A 36-year-oldmotherargued thattoo much well-being has made life too easy, leaving little for young people to strive to achieve. In the words of a 39-year-old mother, "Todaywe have
everythingandnothing."
It is little wonderthatparentsworryaboutthe risks to healthposed by industrial society. At the same time, they worry about the things that concernedtheir
parentsand grandparents,including weather,atmosphericevents, and imprudent
personalbehaviors.The age-old concernfor contagionis also presentin this complex field of ideas abouthealth,for thereis contagionby microbesas well as miasmas.
These examplesillustratehow the enduringassumptionof the permeabilityof
the body allows for microbesandmodem-daymiasmasto comminglewith the old
atmosphericinsults and immoderatebehaviors,as factorsthatcontinuouslyshape
health and well-being. As a result,it is importantto manageexposureto threatening influences while also favoringthe body's balancethroughappropriateactions
on a daily basis. When something goes wrong, the source of the troublemay be
sought in a transgressionof the rules of balanceand moderation,a spiritualcause,
or a biomedicalphenomenon.This variabilityin belief supportsa pluralisticmedical system, in which practitionersmix and merge explanatorymodels and treatments. Such a system is the outcome of historicalprocessesthathave shapedbasic
health beliefs and broughtabout generationalcontinuitiesand differencesin conceptionsof the body andits propercare.

370
ANTHROPOLOGY
MEDICAL
QUARTERLY
NOTES
Acknowledgments. The researchon which this article was based was conducted at
varioustimes over severalyearsthrougha Fulbrightseniorresearchfellowship, a Fulbright
dissertationfellowship, and a predissertationfellowship from the FondazioneGiovanniAgnelli. I gratefullythankthese organizationsfor theirsupport.I am indebtedto the manypeople in Italy who have completedquestionnairesand sharedtheirexperiencesand ideas with
me in interviewsandcasualconversations.I ask theirforgivenessfor any errorsof transcription or interpretationand for their patience with me in futureresearchprojects.Many archives andlibrarieshave generouslygiven me access to documents.I particularlyrecognize
the Archivio di Statoin Faenza,the OspedaleCivile in Faenza,the BibliotecaComunalein
Forli,the municipaloffices of CasolaValsenio, andthe EnteCasaOrianiin Ravenna.I have
benefitedfrom the interestand suggestionsof severalattendeesof the session on alternative
medicineat the 2000 meetingof the AmericanAnthropologicalAssociation,especially Guven PeterWitteveen.Finally,I thankthe editorsof MAQandthreeanonymousreviewersfor
theirhelpfulcomments.
1. In the following discussion,I will use the termstraditionalandmodem in the senses
developed by JaneCollier (1997) to contrastthe beliefs and behaviorsthatpredominatein
presenttimes againstthose thatprevailedin the past.Clearly,all living generationsaremodem people with a modem worldview.
2. After a first set of questionnaireswas competed,I changeda few of the questions.I
discuss differencesin note 21 andthe text below. In all, therewere 97 female and24 male respondents.However, the inputof fatherswas probablygreaterthanthese numbersindicate.
The Type A questionnaireasked the parentswho volunteeredfor the survey in Forli to respond separately,and 31 mothersand 20 fatherssubmittedcompletedsurveys.The Type B
questionnairesoffered couples in Faenzaand SantaLucia the option of answeringtogether,
andwritingpossible differencesin the margins.Womenwere the primaryrespondentsin all
of these but four.
3. Therewere no respondentsunderthe age of 20. Therewere 29 in theirtwentiesand
72 in theirthirties.Seventeenwere in theirforties,andone fatherwas in his fifties.
4. For a translationof ancientmedical treatisesand an overview of the topic of Greek
medicine, see Brock 1929. For an analysis of the influence of Greek medicine on Roman
healthbeliefs andmedicalpractices,see Jackson1988.
5. I have gatherednumerous17th-to early20th-centurybooks andarticleson hygiene
and medicine that illustratethis point. A few include Ballotta 1857, Bertaccini 1922, Bertarelli 1936, andMantegazza1868.
6. Regardingideas about body mass and health in Le Marche, see Romanucci-Ross
(1991:137,140).
7. Foster (1994) finds that although the hot-cold continuum persists in Spanish
Americancountries,the wet-dry opposition has faded out of sight, but he is unable to accountfor this loss.
8. A printadvertisementfor Sangeminimineralwaterannouncesthat"alife thatis arriving requiresgreat attentions."This special water provides the right mineralcontent to
"furnishthe pregnantwoman's organismwith preciousmineralelements"thatwill help her
baby to "growtoday andbe borntomorrowfull of life andjoy." The advertisementfills the
back cover of the television guide, TVSorrisie Canzoni,number18, May 3-9, 1992.
9. This list comes from a pamphletcollected in 1992 in CastrocaroTerme in EmiliaRomagna,where the water is rich in bromide, iodine, and lithium, and the website of the
Termedi Saturniain Toscana,wherethereis hot sulphurouswater.
10. Pregnantwomen still travel from other regions to Umbriato pray to Piero della
Francesca'sMadonnadel Parto (Madonnaof Childbirth,paintedin the 1460s), and local
pregnantwomen have been known to stage sit-ins to protestany change to the fresco or its
location(it was detached,restored,andmoved in the early 1990s).


ITALY
371
11. Regardingthe crossoverof organizingconceptualcategoriesthroughoutsocial relations,politicaleconomy, beliefs aboutpersonhood,andconceptsof space andtime in agriculturalandindustrialsociety, see Friedrich1989.
12. Regardingeconomic, social, and demographicchanges in Italy since Unification,
see Clark1984, Forgacs 1990, andWhitaker2000.
13. This is around1.2 childrenper woman, againsta Europeanaverageof about 1.5.
Forbirthanddeathratesin countriesof the EuropeanUnion, see ISTAT2001:63, table2.18.
14. DeLucca(1983:105) reportsthatin 1865 therewas a physician-to-populationratio
of 1:2520 in a large areaaroundRimini. This is a long way from today's ratioof 1:172 (see
below). For personal accounts of providing medical care in the early decades of the 20th
century,see Cenni 1965 and Sandandrea1992.
15. For two districtsin Romagna,see Rosetti(1894:363).
16. I thank the authoritiesin charge of the now-closed hospital's archive in Casola
Valsenio for access to these records.I comparedall of the clinical chartsfor patientsadmitted to the hospital 1936 and 1945. In 1936, the usualten-daydietbegan with a day of fasting,
followed by threedays of milk andcoffee. On the fifth day, therewould be brothwith small
pieces of pastain additionto the base of milk and coffee. Choppedmeat was addedto the
soup on the sixth day, whereasa vegetable dish was addedto this diet on the seventh. Subsequentdays were a repeatof the seventh-day'sdiet. The enema was typicallygiven on the
fifth day. In 1945, therewas a change in this diet: milk was given on the first day, and the
soup was introducedon day three, with a transitionto a complete diet, includingbread,on
the fourthday.
17. Whereasalmost60 percentof the patientsin 1936 were diagnosedwith appendicitis, in 1945 therewere no patientsadmittedfor appendicitisand the numberof ailmentsas
well as patients(61 in 1936, 139 in 1945) was much greater.At least 25 percentof the patients in 1945 were admittedfor injuries due to weapons or bombs from World War II,
whereasanother20 percentwere admittedfor childbirthor complicationsof pregnancy.The
rest were diagnosed with various diseases including intestinalfever, tetanus,malaria,and
carcinoma.
18. The currentratio is 5.83 physicians per 1,000 inhabitantsin Italy (Calcopietro
2002). Cubaalso has more thanfive physiciansper 1,000 inhabitants,whereasSpain,Norway, Belarus, and Georgiahave more thanfour. There are more thanthree in France,Germany, Greece, Hungary,fewer than three in the United States and the Netherlands,and
fewer thantwo in the United KingdomandJapan(Forgacs2002). Italyhas controlledmedical school enrollmentssince the early 1990s, bringingdown the numberof new graduates.
Nonetheless, thereare still thousandsof physicians(39,000 or 11 percentof the profession)
who cannot find work, beyond those who do not work full time in their profession (Calcopietro2002).
19. This breaksdown to an averageof two- and one-fourthpreventivevisits per year,
plus threeandthree-fourthssick visits.
20. This tableconcernsonly responsesto the second version(Type B) of the questionnaire.The Type A questionnaireaskedthe questiondifferentlyandyielded incomparableresults.
21. See ISTAT(1997:82-84, tables 3.16 and3.17) for the resultsof a similar1996 survey. Interestingly,without exception, the proportionof people reportinggood health is
lower in the morerecentsurveyfor all age groups.In most age groups,andin the overallaverages,the proportionof medicinesprescribedby a physicianis higher,the proportiontaken
on one's own initiativeis lower, andthe proportionalreadyavailablein the home is lower.
22. See ISTAT 1991:92, table7.2; ISTAT2001:628, table26.4.
23. The averageage at firstmarriageis 28 for women (ISTAT2001:64, table2.18).
24. Although 21 percentof households in Italy contain only one person, at the other
extremethere are more than 340,000 families with four or more members(5.7 on average)

372
MEDICALANTHROPOLOGY
QUARTERLY
and two or more nuclei (man and/orwoman with or withoutchildren),out of nearly20 million families in total (ISTAT2001:630, table26.7).
25. For a 19th-centuryscientific calculationof the degree to which hot chocolate excites the heartandthereforeheatsthe blood (morethancoffee, tea, or hot water;less thancocaine), see Mantegazza(1868:46).
26. This is done throughthe Aller ELISA Test for ImmunoglobinG responseto antigen, developed by professorJrikowskiof the University of Jena in Germanyin 1996. The
Termedi Riolo Bagni's flyer aboutthe test "Leintolleranzealimentari" (summer2002) explains thatunlike an allergy,intolerancedoes not involve ImmunglobinE. Instead,in intolerance, the antigenmay provoke a reactioneven several days later,or not at all in times of
"psychosocial well-being." Disturbances caused by food intolerances include eczema,
breathingdifficulties,chronictiredness,insomnia,diarrhea,chroniccolds, andsinusitis.
27. This was in 1996. She paid a copaymentwhile the rest was coveredby the state.
28. This refers to herpes zoster today, but it originally describedergotism. This is a
fungal infection spreadwhen a fungus (claviceps purpurea)growing on rye plantspasses a
toxin (ergotin)into flour throughthe milling process. The orderof monks establishedin the
name of the EgyptianSaintAnthony(protectorof animals)dedicateditself to caringfor pilgrims and the ill, includingpeople sick with the sacredfire. The doors of theirhospitalshad
flames paintedon them to symbolize the illness, and since then Saint Anthonyhas usually
been depicted with both fire and pigs and other animals. Regardingthe role of molds and
theirtoxins in Europeanhistory,see Matossian1989.
29. This advertisement,for Euchessinalaxative,appearson in the frontinside cover of
the April 1992 issue (number4) of Educazionealla Salute.The backcover of the same issue
is an advertisementfor "Family-Test,"a home urinetest thatgives "concretehelp for keeping an eye on the health"of the family, withoutexplainingwhatthe test measures.
30. This is from a packageof Granarolofresh milk from the summerof 2002 and the
company's website.
31. The few who respondedotherwisesaid thatthey did to a lesser degree in adultsor
thatadultshave more antibodiesor defenses.
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The Idea of Health: History, Medical Pluralism, and the Management of the Body in EmiliaRomagna, Italy

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The Idea of Health: History, Medical Pluralism,

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THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

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prudentto avoid foods thatcause a sensationof heat when consumed(such as hot

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THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

This content downloaded from 129.199.59.249 on Wed, 18 Jun 2014 16:57:33 PM

blamedfor sickness, as it was duringa recentrise in cases of breastcancerin Santa

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THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

be seen adorningthe home or person,even if these practicesarebecomingrareand

This content downloaded from 129.199.59.249 on Wed, 18 Jun 2014 16:57:33 PM

difference between birthsand deaths was as high as 10 per 1,000 inhabitantsper

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THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

This content downloaded from 129.199.59.249 on Wed, 18 Jun 2014 16:57:33 PM

MEDICAL ANTHROPOLOGY QUARTERLY

_srcraliroao res'.senza,ma e ucciso daila

convete wint dt o eera

. diosa malatia,pet scoprirnele cuse per

tubercolosi e uno mrallt;aconosciueo

appendicitis,complications childbirth,carcinoma, any

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THE IDEAOF HEALTHIN EMILIA-ROMAGNA,

Drops for the eyes

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27.6 percentbutfluctuatedwidely over the age categories(ISTAT2001:97-98, tables 3.14 and3.15).21

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THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

Olderpeople often live with or neartheirchildren'sfamilies and take care of

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This content downloaded from 129.199.59.249 on Wed, 18 Jun 2014 16:57:33 PM

THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

This content downloaded from 129.199.59.249 on Wed, 18 Jun 2014 16:57:33 PM

same menstrualperiods,whetheractualor missed because of postpartumamenorrhea(see Whitaker2000).

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THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

Air conditionersare furtherrejected as being unsanitarybecause they incubate

This content downloaded from 129.199.59.249 on Wed, 18 Jun 2014 16:57:33 PM

nightbeforehis next rideafteran undistinguishedperformanceone day.

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THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

Mean St. Dev.

Mean St. Dev.

Bad or spoiled food

Microbesin the air

Insufficientexposureto light 1.63

Too little sleep

Too much sleep

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Accidents outside the home

Accidents inside the home

Radiation(nuclear,x-rays, cosmic, etc.)

Burstsof sun or air/wind

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THE IDEA OF HEALTH IN EMILIA-ROMAGNA, ITALY

cars and factories,spectacularlydestructivetrafficaccidentsshown in gory detail