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Abstract This book is the first comprehensive study of malaria in ancient Italy since the research of the distinguished Italian malariologist, Angelo Celli, in the early 20th century. It demonstrates the importance of disease patterns in understanding ancient human demography. It argues that malaria became prevalent in Roman times in central Italy as a result of environmental changes, such as deforestation and the spread of certain types of mosquitoes. Using contemporary sources and comparative material from other periods, it is suggested that malaria had a significant effect on mortality rates in certain regions of Roman Italy. All the important advances made in many relevant fields since Celli’s time are incorporated. These include geomorphological research on the development of the coastal environments of Italy that were notorious for malaria in the past; biomolecular research on the evolution of malaria; ancient biomolecules as a new source of evidence for palaeodisease; the differentiation of mosquito species that permits understanding of the phenomenon of anophelism without malaria; and recent medical research on the interactions between malaria and other diseases. In addition to its medical and demographic effects, the social and economic effects of malaria are also considered, for example on settlement patterns and agricultural systems. The varied human responses to and interpretations of malaria in antiquity, ranging from the attempts at rational understanding made by the Hippocratic authors and Galen to the demons described in the magical papyri, are also examined.