Utente:Elisapera/Sandbox

Giuseppe Bastianelli

<<Con Bastianelli possiamo ben dire che scompare dalla scuola medica romana un grande scienziato e dalla società un uomo probo ed onesto che meritatamente fu chiamato ad occupare un seggio nel Senato italiano. >> Senato della Repubblica, Atti parlamentari. Resoconti stenografici, april 7th 1959.

Giuseppe Bastianelli (Rome, October 25, 1862 – Rome, March 30, 1959) was an Italian physician, who was

first interested in chemistry, physiology and neurology, before dedicating himself in a particular way to the

study of the physiopathology of malaria.

He was the personal physician of Pope Benedict XV and senator of the XXX legislature of the Italian

Kingdom beginning from December 20, 1939.

Biography

Early Life

Giuseppe Bastianelli was born in Rome on October 25, 1862 in a family originally from the Umbria region of

Italy, from parents Giulio Bastianelli and Teresa Zanca.

Being the son of Giulio Bastianelli, chief physician in the hospital of S. Spirito in Rome and municipal

councilor, as well as the nephew of a surgeon operating in Trevi in Umbria, Giuseppe Bastianelli grew up in

a medical-influenced environment, along with his younger brother Raffaele Bastianelli. This oriented his younger self towards the

development of medical interests, which he will then explore and deepen during his university years.

His elder brother Raffaele Bastianelli (Rome, 26 december 1863 – Rome, 1 september 1961) undertook a

successful carreer as well, being a surgeon specialized in oncology as well as a political figure.

Primary doctor at Policlinico Umberto I of Rome (1896-1927) who then was awarded the role of Scientific Director at

the Institute Regina Elena for the study and cure of tumours, R. Bastianelli is the author of several papers

and treaties about surgery and oncology, with particular interest to malignant tumours. R. Bastianelli

was additionally nominated senator of the Italian Kingdom in 1929.

Study Years

Giuseppe Bastianelli attended the Medicine faculty at the University of Rome, and he explored with diligence the subjects of

physics and chemistry but especially of physiology, and he soon became a student of the physiologist J. Moleschott, with

whom he started interesting investigations on intestinal juices, which were unfortunately interrupted then for

lack of means. He also studied chemistry with Stanislao Cannizzaro. Thus, a medical culture of the highest

order was formed, which later made him gain recognition even outside of Italy, in America, England,

Germany.

In 1891, at twenty-nine years old, Bastianelli won the competition earning the title of primary doctor in the

hospital of S. Spirito in Rome, where he worked alongside the physicians Angelo Celli, Ettore Marchiafava

and Amico Bignami.

Reasearch

Work on Anopheles

Bastianelli was a man characterized by a broad humanistic and medical knowledge, and he found great

interest and dedication in computing a long series of research on the various clinical forms of malaria, a life-

threatening disease that represented one of the most serious issues of the social medicine of his time and that

claimed many human victims in some areas close to Rome, where himself lived.

Between 1880 and 1885, him and his colleagues Angelo Celli, Ettore Marchiafava, Amico Bignami,

Giuseppe Bastianelli, Camillo Golgi and Giovanni Battista Grassi contributed proficiently to the resolution

of this big social and sanitary issue by associating a different species of Plasmodium (single-celled parasites)

to each type of malaric fever: the most severe form of malaria, called “terzana maligna” was attributed to

Plasmodium falciparum, while a milder form of the disease called “terzana benigna” was associated to

Plasmodium vivax. Additional species of Plasmodium are Plasmodium malariae, ovale and knowlesi.

The research that, among all, gave Bastianelli his fame was indeed those on the cycle of the parasite in the

anopheles:

since 1894, he and Amico Bignami, based on the studies conducted by the zoologists on the coccidia, had

argued that the half-moons were only those forms of coccidia that can only complete their development in

the environment and in the tissues of another animal. It was only after the introduction of Romanowski’s

staining method, which made the observation of parasites much easier, that the two scholars were able to

clarify the meaning of the half-moons and the mobile filaments they originated from and therefore

describe the morphology of the microgametes, convinced that the further development of the half-moons

took place in mosquitoes.

Bastianelli and Bignami worked on anofelids that were caught and sent to them by Grassi and fed with the

blood of malarici, and this allowed them to finally obtain the development of the parasite: they could

therefore describe all the phases of the sporogonic cycle of Plasmodium Vivax from the Cocists stage of 42

hours until the formation and liberation of the sporozoites, and they presented their report on the subject

to the Accademia dei Lincei on December the 4th 1898 (“Cultivation of man’s malarial half-moons in the

Anopheles Claviger”;[in coll. with A. Bignami and G. B. Grassi], in Atti d. R. Accad. Lincei, s. 5, VII, 2

[1898], pp. 313 s.) and, later, at the Medical Academy of Rome (“On the development of tertian parasites in

the Anopheles Claviger”; [in coll. with A. Bignamil, in Bull. d. R. Accad. medica, XXV [1898-1899], pp.

277-303).

Between September 1898 and February 1899, Grassi concluded the research on identification of malaria

vectors (the mosquitoes belonging to the genus Anopheles are the only incriminated vectors), and together

with Bignami and Giuseppe Bastianelli clarified the biological pattern of plasmodia from Anopheles

mosquito to man in studies conducted in Santo Spirito Hospital in Rome using Anopheles claviger.

Once the biological pattern of malaria transmission had been identified, all the possible breaking points in

the transmission chain were considered to achieve the target of stopping it. But, a clear divergence of views

between the two Schools of Malariology in Italy came out in selecting the existing malaria control methods:

in an extreme fell those scientists who promoted the prophylactic and curative use of quinine, according to

the method of radical treatment of malaria cases proposed by the famous bacteriologist Robert Koch (winner

of the Nobel Prize in Medicine or Physiology in 1905) and, at the other extreme fell the malariologists who

put major emphasis on vector control.

Given his high merits, he was awarded the direction of the Institute of Malariology, which represented a

model of scientific organization and was greatly admired by his foreign counterparts who visited it.

Trials and Methodology

It is also appropriate to mention Bastianelli among the early attempts to conduct modern clinical trials in

Italy. Between 1934 and 1936 he carried out two studies using synthetic drugs to treat malaria.

The first was a preventive trial whose aim was to establish the efficacy of atabrine, a synthetic

antimalarial drug. He carried it out in Pasada, a small village on the east coast of Sardinia, where

endemic malaria was very widespread. The infection peaked in July and August, thus treatment started

in May 1935 and continued until the end of the year. The whole village of 781 inhabitants was involved

and divided into three groups, as homogeneous as possible. Group 1 was given atebrin every day and

group 2 was given it twice a week on non-consecutive days (except for children under the age of four,

who were given the drug every other day), while group 3 was given no treatment, but kept under

observation as controls.

The doses of atabrine administered to those in group 1 were 25 mg up to eight years of age and 50 mg

if over eight years. Group 2 got a higher dose of atabrine twice a week, 50 mg up to two years old, 100

mg up to four, 150 mg up to eight, and 200 mg over eight years of age. Malaria cases in the three

groups were treated with atabrine at therapeutic doses, which means around 100-300 mg, depending

on age, every day for seven days.

Compliance was quite good, probably due to the visits of two nurses, that made the patients take the

drug in their presence. Also, temperature measurements, blood tests and spleen index were made. All

the blood tests were done at the Institute of Malariology in Rome.

As expected, few sides effects were detected, such as yellow discoloration of the skin and urine which

disappeared when treatment ended. Follow-up was extended for a further six months.

Besides the concurrent controls in Posada, the authors decided to have historical controls by taking

into account also the cases cases of malaria in previous years, as well as those observed in the same

period in a village nearby.

Final data showed 161 cases of malaria (70.3%) in the control group, but only 55 (23.4%) in the daily

atebrin and 34 (13.9%) in the twice-weekly treatment groups. During the six-month follow-up, the

group receiving treatment twice-weekly had 60% fewer cases of malaria.

The second trial reported by Bastianelli and colleagues assessed treatment of malaria among the 1100

inhabitants of the village of Torpé. It compared treatment with atebrin to a combination of atebrin and

plasmoquine

As in the prevention study, nurses ensured compliance with medication. Temperatures were taken

twice a day, and blood samples were taken daily during the atebrin period. However, they concluded

that the addition of plasmoquine to atebrin does not achieve improvements sufficient to justify use of

the combination.

Methodological features of the Bastianelli trials:

These Italian trials on antimalarial agents can also be considered important on a methodological point

of view.

1. Epidemiological studies of the entire population of the two villages, Posada and Torpé. Information

on the prevalence of the disease and its symptoms was very useful, not only for planning the trials, but

also to ensure that historical controls were not used as substitutes for concurrent controls, but in

addition to the latter.

2. Both studies had concurrent controls.

3. Selection in the prevention trial (1st one) was based on similar demographic characteristics, while in

the therapeutic trial (2nd), patients were assigned to one of the two comparison groups by the order of

their presentation. This important methodological feature had been used increasingly frequently since

the beginning of the 20th century and was a prelude to the adoption of concealed random allocation in

the 1940s.

4. No informed consent was required: patients could refuse prophylaxis or treatment if they wished.

5. Two nurses made sure that they observed participants taking the drugs, thus compliance was way

better than in many other trials.

6. The central analysis of blood samples at the Institute of Malariology in Rome.

7. The description of side effects, which was limited, but still accurate. The

8. The researchers were interested in the short-term findings of their studies as much as in extended

follow-up to assess whether the action of the preventive or therapeutic interventions persisted over

time.

Work on Leukocytes

Between 1891 and 1892, Bastianelli dedicated himself to the study of the function of leukocytes in the blood, concluding that circulating mononucleated cells behave in the same way as the fixed elements of the splenic and medullarypulp with which they share the morphological significance: observation that anticipated the concept of the reticulum-endothelial system, which was established only some years later, and illustrated, in addition, the pathogenesis of malaria hemoglobinuria. (“On malaria hemoglobinuria” [in collaboration with A. Bignami], in Bullettino d. Soc. Lancisiana, XII [18921, pp. 81-92) and the passage of parasites from mother to fetus (“On the transmission of malaria parasites from mother to fetus”, ibid., pp. 48 s.).

Teaching

New Teaching Method

In 1926, Bastianelli was entrusted with the teaching of medical semeiotics at the University of Rome,

occupying the first chair of semiotics in Italy, which he left in 1935 for age limits. Endowed with a vast

culture that allowed him to form a large group of pupils, he established a new educational course, which was

mainly practical and consisted in putting small groups of students in contact with the patient and instructing

them with the help of his collaborators.

The method became established and was followed by numerous doctors; practical teaching was

supplemented by a few theoretical lessons, real essays on anatomy, physiology, physics and chemistry

applied to sick people. He endowed and enriched the Institute, even only for generous personal donation,

of the best scientific apparatus, and the laboratories he set up were admired for their richness and

modernity, and of course for the predominantly chemical-biological footprint.

Institute of Malariology

The Institute "Ettore Marchiafava" was born as an evolution of the Superior School of Malariology,

established in Rome in 1925 as an output of the international Congress of malaria. The school was

established with the aim of "Promoting studies and training on all the medical problems related to malaria

and on the reclamation and on the cultivation of marshy areas".

Initially, the institute was directed by Professor Vittorio Ascoli and had its headquarters at the Medical

Center of the Royal University of Rome. Giuseppe Bastianelli succeeded to Ascoli, being appointed Director

on March 25, 1931. With the new direction, the school was relocated from the medical clinic to the IX

pavilion of the Policlinico Umberto I. Six years on from its creation, the School was transformed into the

“Institute of Malariology Ettore Marchiafava” because more suitable toward research. The Institute had the

aim of teaching malariology and studying malaria. Prof. Giulio Raffaele became the next Director of the

Instistute after Bastianelli, until the closure of the institute in 1967. In the Institute there were courses of

specialization for doctors from all over the world, initially promoted by the League of Nations, to create

competent personnel to be sent to the different countries struggling with malaria. During these courses,

Bastianelli organized trips and visits to the areas of Italy most plagued by malaria to illustrate the

organization and defensive and prophylactic network against it and to raise awareness on chronic malaria.

Over the years, he followed the development of studies on malaria, keeping on publishing numerous works,

among whom we remember: &#39;&#39;Considerations on the treatment of malaria&#39;&#39;, in Health Forces, II (1933), pp.

27-29; &#39;&#39;On the treatment of malaria. Immunity and therapy&#39;&#39;, in Rev. of malariology, XV (1936), sez. I, pp.

1-13; Malaria, in Lo Sperimentale, 95 (1941), pp. 979-1003; &#39;&#39;What must be done to prevent and treat

malaria, in Sanitary Forces&#39;&#39;, X (1941), pp. 3-16; Malaria, in Riv. by malariolog. n.s., XXI (1942), pp. 1-28;

“Exo-Erythrocytic forms of malaria parasites&#39;&#39;, in British Medical Journal, I (1948), pp. 520 s. Later, during

the conflict of the Second World War, the Laboratory of Malariology continued its work of research, despite

the imaginable difficulties of the moment. The activity, in fact, took place mainly in the laboratory and to a

very limited extent in the field. In 1943 and 1944 they continued to organize the training and refresher

courses on malaria for the national and military personnel.

Giuseppe Bastianelli was the only member of the Roman School of Malariology to take part in the campaign

of eradication of malaria, supporting the work of Alberto Coluzzi.

Publications

Laveran had Recently announced the discovery of the parasitic nature of malaria, which had already been

glimpsed by Grassi and Marchiafava but very briefly: it was necessary to deepen the studies. Bastianelli

made clinical and anatomo-pathological researches, describing various clinical cases thus making it possible

to specify the pathogenesis, the pathology and the clinical aspects of malarial fever and its possibile

variants.

Among his principal writings on the subject are: &#39;&#39;On spring malarial infection&#39;&#39; (in collab. with A. Bignami),

in Medical Reform, VI (1890), pp. 860 ff.; &#39;&#39;Observations on summer-autumn malarial forms&#39;&#39; (in collab. with

A. Bignami), ibid. , VI (1890), pp. 1501 ff.; &#39;&#39;Studies on malarial infection&#39;&#39; (in collab. with A. Bignami), in Bull.

d. R. Accad. medica, XX (1893-94), pp. 151-237; &#39;&#39;Sur la nature des parasites des fièvres estate-autoninales&#39;&#39;

(in collab. with A. Bignami), in Archives italiennes de biologie, XXII (1895), pp. CXLII-CXLVI; &#39;&#39;Weitere

Untersuchungen úber den Lebenslauf der menschlichen Malariaparasiten in Körper des Moskito&#39;&#39; (in collab.

with A. Bignami and G. B. Grassi), in Untersuchungen zur Naturlehre des Menschen und der Thiere, XVI

(1899), pp. 573-583; &#39;&#39;Untersuchungen die malaria&#39;&#39; (in collab. with G. B. Grassi and A. Bignami), ibid. XVII

(1900), pp. 10-16; Ueber die Structur der Malariaparasiten, insbesondere der Gameten der Parasiten des

Aestivoautumnalfieber (in collab. with A. Bignami), ibid. , pp. 108-126.

He carried out investigations on the summer-autumn forms by &#39;&#39;Plasmodium Falciparum&#39;&#39; his colleague

Bignami, describing the various pictures of the pernicious malarial and, in particular, those with nerve

localizations, since he had always been interested in general problems of neuropathology; in 1896, in fact,

he carried out a research on combined sclerosis of the spinal cord in pernicious anemias (&#39;&#39;Combined

sclerosis of the spinal cord in pernicious anemias'', in Boll. d. R. Accad. medica, XXII [1895-96], pp. 197-245).

Political Life

Giuseppe Bastianelli was then awarded the nomination of senator in 1939, due to his admirable scientific

accomplishments, and he was able to get the recognition he deserved for his excellence in both the medical

and social field. He died in Rome on March 30, 1959.

Bibliography

Bastianelli G, Canalis A., Mosna E., Prevention and Treatment of Malaria by synthetic drugs: Field Experiments, The James Lind Library, 1937/2010

Battaglia F., Campofiorito N., Deplano C., “Malaria”,  Edurete,

Cardillo M., “Bastianelli Giuseppe”, Siusa.archivi.beniculturali.it, 2017

Conci, C., Repertorio delle biografie e bibliografie degli scrittori e cultori italiani di entomologia. Memorie della Società Entomologica Italiana, 48 1969(4) 817-1069, 1975

Conci, C. & Poggi, R. 1996 Iconography of Italian entomologists, with essential biographical data. "Mem. Soc. Ent. Ital." 75 159-382, 418 figures.

Cox, Francis EG. 2010. “History of the Discovery of the Malaria Parasites and Their Vectors.” Parasites & Vectors 3

Howard, L. O. 1930 [Bastianelli, G.] "Smithson. Miscell. Coll". 84 468, 491, 580

Raffaele, G. 1959 [Bastianelli, G.] "Riv. Parass." 20 223-228.

Raffaele, G. 1959 [Bastianelli, G.] "Rivista Malariol." 38 1-8, Portrait.

Sebastiani A., “I Disturbi Del Ritmo Cardiaco : Prefazione Di Giuseppe Bastianelli” Biblioteca Nazionale Di Firenze.”, 1924.

Senato, Scheda Senatore BASTIANELLI Giuseppe,

Treccani Enciclopedy, “Giuseppe Bastianelli”

‌