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The results from this study reaffirm that exploring approaches to control dengue further would be economically valuable. We thank Emma Shapiro and Eleanor Steele for comments on early drafts, three anonymous reviewers for thoughtful comments and suggestions, and Clare L.

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Hurley for editorial assistance. This study was supported in part by a research agreement between Sanofi Pasteur and Brandeis University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. National Center for Biotechnology Information , U. Published online Mar Eduardo A. Duane J. Scott B. Donald S. Author information Article notes Copyright and License information Disclaimer.

Received Oct 3; Accepted Jan This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. This article has been cited by other articles in PMC. Associated Data Supplementary Materials S1 Table: Expenditures of symptomatic patients who did not seek healthcare in a health center or hospital. S1 Text: Adult questionnaire. Abstract Background Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries.

Methods and Findings We estimated the annual economic and disease burden of dengue in Mexico for the years — Conclusion With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive illness and preventive empirical estimates of dengue burden. Author Summary During the past decades, dengue fever has become the most common arthropod-borne viral disease, imposing a substantial economic and disease burden in most tropical and subtropical countries, including Mexico.

Number of dengue episodes To refine the estimates of the total number of dengue episodes, officially reported dengue episodes can be adjusted for underreporting using an expansion factor EF. Economic burden of dengue We derived costs per episode by combining patient interviews in four major hospitals in the states of Quintana Roo, Morelos, and Tabasco, macro-costing data from two major public hospitals in Tabasco, MoH health and surveillance data [ 66 ], WHO-CHOICE [ 67 ] estimates for Mexico, and previous literature on dengue burden.

Open in a separate window. Fig 1. Age distribution of reported dengue episodes, — Sensitivity analysis We used a probabilistic sensitivity analysis to address the uncertainty in our estimates of the disease and economic burden of dengue. Results Input for the estimation model Expansion factors to adjust reported episodes. Table 1 Main results from the prospective cohort study in Morelos, Mexico — Town Participants Total Symptom.

Visited Public facility a Private facility only n infections infection a facility Rep. Not rep. Total Rep. Table 3 Summary of direct medical unit costs US dollars derived using macro-costing with data from two tertiary hospitals in Tabasco. Table 4 Estimation of direct medical unit costs US dollars per bed-day and outpatient visit to a public hospital. Table 5 Summary of the parameters varied simultaneously in the sensitivity analysis, assumed probability distributions, and data sources.

Table 6 Total symptomatic DENV infections reported by the Ministry of Health and estimated episodes using expansion factors from the Morelos cohort study. Fig 2. Distribution of the economic burden of dengue in Mexico by component, — Table 7 Economic burden for adjusted dengue episodes in Mexico US dollars , — Fig 3. Variation in total economic burden of dengue based on listed parameters included in the sensitivity analysis average for years and Table 8 Dengue disease burden estimates in Mexico per million population.

Fig 4. Estimated symptomatic and fatal dengue episodes and economic and disease burden, — Discussion Dengue imposes a substantial economic and disease burden in Mexico. Supporting Information S1 Table Expenditures of symptomatic patients who did not seek healthcare in a health center or hospital.

PDF Click here for additional data file. S1 Text Adult questionnaire. Acknowledgments We thank Emma Shapiro and Eleanor Steele for comments on early drafts, three anonymous reviewers for thoughtful comments and suggestions, and Clare L. Funding Statement This study was supported in part by a research agreement between Sanofi Pasteur and Brandeis University. Data Availability All relevant data are within the paper and its Supporting Information files.

References 1. Nature : — Nat Rev Microbiol 8 : S7—S N Engl J Med : — Cuddehe M Mexico fights rise in dengue fever. Lancet : — Arch Med Res 37 : — Accessed 23 October, PLoS One 8 : e Rev Panam Salud Publica 25 : 16— Salud Publica Mex 47 : — PLoS Med 7 : e Kallenberg J, Nguyen A, Vaccine investment strategy. Accessed 20 November, Costing dengue cases and outbreaks: A guide to current practices and procedures.

Accessed 15 September, Gubler DJ How effectively is epidemiological surveillance used for dengue programme planning and epidemic response? Dengue Bull 26 : 96— Epidemiol Infect : — Cad Saude Publica 25 : S19—S Rev Saude Publica 40 : — BMC Public Health Oslo, Norway: University of Oslo; 65 p. Dengue: Guidelines for diagnosis, treatment, prevention and control.

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New edition. Accessed January 13, Accessed December 15, Nat Rev Microbiol 11 : — Proc Natl Acad Sci : — Lancet Online July Gubler DJ Prevention and control of Aedes aegypti-borne diseases: lesson learned from past successes and failures.

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Paediatr Int Child Health 32 Suppl 1 : 10— Accessed 4 November, Am J Trop Med Hyg 84 : — Am J Trop Med Hyg 79 : — Am J Trop Med Hyg 80 : — Am J Trop Med Hyg 86 : — Am J Trop Med Hyg 87 : — Salud Colect 8 : — Rev Panam Salud Publica 19 : — Am J Trop Med Hyg 59 : — Dengue Bull 34 : 77— World Health Organization, The global burden of disease: update. Accessed January, Murray CJL Quantifying the burden of disease: the technical basis for disability-adjusted life years.

Bull World Health Organ 72 : — World Bank, World development indicators. Accessed 20 October, Dengue and Dengue Hemorrhagic Fever. Atlanta, GA. BMC Public Health 12 : Acta Trop c : 15— J Infect Dis : — Clin Diagn Lab Immunol 7 : — Accessed 1 November, Accessed January 4, Epidemiology 10 : — Accessed WHO guide for standardization of economic evaluations of immunization programmes. Available at: www. Accessed November 2, Cifras e indicadores del sistema educativo nacional — Accessed Jan 16, Life tables for WHO member states for year Accessed September 22, Ahmedabad, India: Indian Institute of Management.

Seminars in Immunology 25 : — Am J Trop Med Hyg 83 : — BMJ Case Reports J Pediatr : — Emerg Infect Dis 19 : — PLoS Med 5 : — Trop Med Int Health 14 : — Charlene Kurland has been named business relationship officer focusing on business development with Allstate Leasing.

In this role, Kurland will focus on equipment leasing for small businesses. Kurland joins Allstate Leasing with more than 10 years of experience in business development. Most recently, Kurland served as a business relationship manager for SECU, a not-for-profit cooperative-style bank, where she developed new business relationships focused on both commercial and residential real estate lending, as well as investment and owner-occupied. Leonzio Pilato made an almost word for word translation of Homer's works into Latin for Giovanni Boccaccio. It was also in direct conflict with the dominant Catholic and scholastic doctrines of the time concerning how to consider politics and ethics.

Italian Renaissance painting exercised a dominant influence on subsequent European painting see Western painting for centuries afterwards, with artists such as Giotto di Bondone , Masaccio , Piero della Francesca , Domenico Ghirlandaio , Perugino , Michelangelo , Raphael , Botticelli , Leonardo da Vinci , and Titian. Their works include Florence Cathedral , St.

Finally, the Aldine Press, founded by the printer Aldo Manuzio , active in Venice, developed Italic type and the small, relatively portable and inexpensive printed book that could be carried in one's pocket, as well as being the first to publish editions of books in ancient Greek. Yet cultural contributions notwithstanding, some present-day historians also see the era as one of the beginning of economic regression for Italy due to the opening up of the Atlantic trade routes and repeated foreign invasions and of little progress in experimental science, which made its great leaps forward among Protestant culture in the 17th century.

High Medieval Northern Italy was further divided by the long running battle for supremacy between the forces of the Papacy and of the Holy Roman Empire. Each city aligned itself with one faction or the other, yet was divided internally between the two warring parties, Guelfs and Ghibellines. Warfare between the states was common, invasion from outside Italy confined to intermittent sorties of Holy Roman Emperors.

Renaissance politics developed from this background. Since the 13th century, as armies became primarily composed of mercenaries , prosperous city-states could field considerable forces, despite their low populations. In the course of the 15th century, the most powerful city-states annexed their smaller neighbors. The first part of the Renaissance saw almost constant warfare on land and sea as the city-states vied for preeminence. On land, these wars were primarily fought by armies of mercenaries known as condottieri , bands of soldiers drawn from around Europe, but especially Germany and Switzerland, led largely by Italian captains.

The mercenaries were not willing to risk their lives unduly, and war became one largely of sieges and maneuvering, occasioning few pitched battles. It was also in the interest of mercenaries on both sides to prolong any conflict, to continue their employment. Mercenaries were also a constant threat to their employers; if not paid, they often turned on their patron.

If it became obvious that a state was entirely dependent on mercenaries, the temptation was great for the mercenaries to take over the running of it themselves—this occurred on a number of occasions. At sea, Italian city-states sent many fleets out to do battle. The main contenders were Pisa, Genoa, and Venice, but after a long conflict the Genoese succeeded in reducing Pisa. Venice proved to be a more powerful adversary, and with the decline of Genoese power during the 15th century Venice became pre-eminent on the seas. In response to threats from the landward side, from the early 15th century Venice developed an increased interest in controlling the terrafirma as the Venetian Renaissance opened.

On land, decades of fighting saw Florence, Milan and Venice emerge as the dominant players, and these three powers finally set aside their differences and agreed to the Peace of Lodi in , which saw relative calm brought to the region for the first time in centuries. This peace would hold for the next forty years, and Venice's unquestioned hegemony over the sea also led to unprecedented peace for much of the rest of the 15th century.

The foreign invasions of Italy known as the Italian Wars began with the invasion by France that wreaked widespread devastation on Northern Italy and ended the independence of many of the city-states. Originally arising from dynastic disputes over the Duchy of Milan and the Kingdom of Naples, the wars rapidly became a general struggle for power and territory among their various participants, marked with an increasing number of alliances, counter-alliances, and betrayals. Much of Venice's hinterland but not the city itself was devastated by the Turks in and again invaded and plundered by the League of Cambrai in In , most of the towns of Apulia and Abbruzzi had been sacked.

Worst of all was the 6 May Sack of Rome by Spanish and German troops that all but ended the role of the Papacy as the largest patron of Renaissance art and architecture. The long Siege of Florence — brought the destruction of its suburbs, the ruin of its export business and the confiscation of its citizens' wealth. Italy's urban population fell in half, ransoms paid to the invaders and emergency taxes drained the finances.

The wool and silk industries of Lombardy collapsed when their looms were wrecked by invaders. The defensive tactic of scorched earth only slightly delayed the invaders, and made the recovery much longer and more painful. The history of Italy in the Early Modern period was characterized by foreign domination and economic decline.

Nonetheless, following the Italian Wars to , Italy saw a long period of relative peace, first under Habsburg Spain to and then under Habsburg Austria to in which some important cultural and scientific achievements were made. During the Napoleonic era , Italy was invaded by the French Empire and divided into a number of client states. The Congress of Vienna restored the situation of the late 18th century, which was however quickly overturned by the incipient movement of Italian unification.

The 17th century was a tumultuous period in Italian history, marked by deep political and social changes. These included the increase of Spanish influence over the Peninsula, as well as of the power of the Pope and the Roman Catholic Church at the peak of the Counter Reformation , the Catholic reaction against the Protestant Reformation. Despite important artistic and scientific achievements, such as the discoveries of Galileo in the field of astronomy and physics and the flourishing of the Baroque style in architecture and painting, Italy experienced overall economic decline.

Effectively, in spite of Italy having given birth to some great explorers such as Christopher Columbus , Amerigo Vespucci and Giovanni da Verrazzano , the discovery of the New World undermined the importance of Venice and other Italian ports as commercial hubs by shifting Europe's center of gravity westward towards the Atlantic. The Black Death returned to haunt Italy throughout the century. However, Spain attempted again to retake territories in Italy and to claim the French throne in the War of the Quadruple Alliance — , but was again defeated. At the end of the 18th century, Italy was almost in the same political conditions as in the 16th century; the main differences were that Austria had replaced Spain as the dominant foreign power after the War of Spanish Succession though the War of the Polish Succession resulted in the re-installment of the Spanish in the south, as the House of Bourbon-Two Sicilies , and that the dukes of Savoy a mountainous region between Italy and France had become kings of Sardinia by increasing their Italian possessions, which now included Sardinia and the north-western region of Piedmont.

This situation was shaken in , when the French Army of Italy under Napoleon invaded Italy, with the aims of forcing the First Coalition to abandon Sardinia where they had created an anti-revolutionary puppet-ruler and forcing Austria to withdraw from Italy. On 15 May the French general then entered Milan, where he was welcomed as a liberator. Subsequently, beating off Austrian counterattacks and continuing to advance, he arrived in the Veneto in Here occurred the Veronese Easters , an act of rebellion against French oppression, that tied down Napoleon for about a week.

Napoleon conquered most of Italy in the name of the French Revolution in — He consolidated old units and split up Austria's holdings. He set up a series of new republics, complete with new codes of law and abolition of old feudal privileges. Napoleon's Cisalpine Republic was centered on Milan. Genoa the city became a republic while its hinterland became the Ligurian Republic. The Roman Republic was formed out of the papal holdings while the pope himself was sent to France. The Neapolitan Republic was formed around Naples, but it lasted only five months before the enemy forces of the Coalition recaptured it.

In , he formed the Kingdom of Italy , with himself as king and his stepson as viceroy. All these new countries were satellites of France, and had to pay large subsidies to Paris, as well as provide military support for Napoleon's wars. Their political and administrative systems were modernized, the metric system introduced, and trade barriers reduced. Jewish ghettos were abolished. Belgium and Piedmont became integral parts of France. Also that year a second satellite state, the Ligurian Republic successor to the old Republic of Genoa , was pressured into merging with France.

In , he conquered the Kingdom of Naples and granted it to his brother and then from to Joachim Murat , along with marrying his sisters Elisa and Paolina off to the princes of Massa-Carrara and Guastalla. In , he also annexed Marche and Tuscany to the Kingdom of Italy. In , Bonaparte occupied Rome, for contrasts with the pope, who had excommunicated him, and to maintain his own state efficiently, [67] exiling the Pope first to Savona and then to France.

After Russia, the other states of Europe re-allied themselves and defeated Napoleon at the Battle of Leipzig , after which his Italian allied states, with Murat first among them, abandoned him to ally with Austria. The resulting Congress of Vienna restored a situation close to that of , dividing Italy between Austria in the north-east and Lombardy , the Kingdom of Sardinia , the Kingdom of the Two Sicilies in the south and in Sicily , and Tuscany , the Papal States and other minor states in the centre. On Napoleon's escape and return to France the Hundred Days , he regained Murat's support, but Murat proved unable to convince the Italians to fight for Napoleon with his Proclamation of Rimini and was beaten and killed.

The Italian kingdoms thus fell, and Italy's Restoration period began, with many pre-Napoleonic sovereigns returned to their thrones. The political and social events in the restoration period of Italy — led to popular uprisings throughout the peninsula and greatly shaped what would become the Italian Wars of Independence. All this led to a new Kingdom of Italy and Italian unification. The Risorgimento was the political and social process that unified different states of the Italian peninsula into the single nation of Italy. As Napoleon's reign began to fail, other national monarchs he had installed tried to keep their thrones by feeding those nationalistic sentiments, setting the stage for the revolutions to come.

In Italy, the Congress restored the pre-Napoleonic patchwork of independent governments, either directly ruled or strongly influenced by the prevailing European powers, particularly Austria. In , Spaniards successfully revolted over disputes about their Constitution, which influenced the development of a similar movement in Italy. Inspired by the Spaniards who, in , had created their constitution , a regiment in the army of the Kingdom of Two Sicilies , commanded by Guglielmo Pepe , a Carbonaro member of the secret republican organization , [71] mutinied, conquering the peninsular part of Two Sicilies.

The king, Ferdinand I , agreed to enact a new constitution. The revolutionaries, though, failed to court popular support and fell to Austrian troops of the Holy Alliance. Ferdinand abolished the constitution and began systematically persecuting known revolutionaries. Many supporters of revolution in Sicily , including the scholar Michele Amari , were forced into exile during the decades that followed. The leader of the revolutionary movement in Piedmont was Santorre di Santarosa , who wanted to remove the Austrians and unify Italy under the House of Savoy.

The Piedmont revolt started in Alessandria , where troops adopted the green, white, and red tricolore of the Cisalpine Republic. The king's regent, prince Charles Albert , acting while the king Charles Felix was away, approved a new constitution to appease the revolutionaries, but when the king returned he disavowed the constitution and requested assistance from the Holy Alliance. Di Santarosa's troops were defeated, and the would-be Piedmontese revolutionary fled to Paris.

At the time, the struggle for Italian unification was perceived to be waged primarily against the Austrian Empire and the Habsburgs , since they directly controlled the predominantly Italian-speaking northeastern part of present-day Italy and were the single most powerful force against unification. The Austrian Empire vigorously repressed nationalist sentiment growing on the Italian peninsula, as well as in the other parts of Habsburg domains.

Austrian Chancellor Franz Metternich, an influential diplomat at the Congress of Vienna, stated that the word Italy was nothing more than "a geographic expression. Artistic and literary sentiment also turned towards nationalism; and perhaps the most famous of proto-nationalist works was Alessandro Manzoni 's I Promessi Sposi The Betrothed. Some read this novel as a thinly veiled allegorical critique of Austrian rule.

The novel was published in and extensively revised in the following years. The version of I Promessi Sposi used a standardized version of the Tuscan dialect , a conscious effort by the author to provide a language and force people to learn it. Those in favour of unification also faced opposition from the Holy See , particularly after failed attempts to broker a confederation with the Papal States , which would have left the Papacy with some measure of autonomy over the region. The pope at the time, Pius IX , feared that giving up power in the region could mean the persecution of Italian Catholics.

Even among those who wanted to see the peninsula unified into one country, different groups could not agree on what form a unified state would take. Vincenzo Gioberti , a Piedmontese priest, had suggested a confederation of Italian states under rulership of the Pope. His book, Of the Moral and Civil Primacy of the Italians , was published in and created a link between the Papacy and the Risorgimento. Many leading revolutionaries wanted a republic, but eventually it was a king and his chief minister who had the power to unite the Italian states as a monarchy.

One of the most influential revolutionary groups was the Carbonari charcoal-burners , a secret organization formed in southern Italy early in the 19th century. Inspired by the principles of the French Revolution , its members were mainly drawn from the middle class and intellectuals. The revolutionaries were so feared that the reigning authorities passed an ordinance condemning to death anyone who attended a Carbonari meeting. The society, however, continued to exist and was at the root of many of the political disturbances in Italy from until after unification.

The Carbonari condemned Napoleon III to death for failing to unite Italy, and the group almost succeeded in assassinating him in Many leaders of the unification movement were at one time members of this organization. Two prominent radical figures in the unification movement were Giuseppe Mazzini and Giuseppe Garibaldi. The more conservative constitutional monarchic figures included the Count of Cavour and Victor Emmanuel II , who would later become the first king of a united Italy.

Mazzini's activity in revolutionary movements caused him to be imprisoned soon after he joined. While in prison, he concluded that Italy could — and therefore should — be unified and formulated his program for establishing a free, independent, and republican nation with Rome as its capital. After Mazzini's release in , he went to Marseille , where he organized a new political society called La Giovine Italia Young Italy. The new society, whose motto was "God and the People," sought the unification of Italy.

The creation of the Kingdom of Italy was the result of concerted efforts by Italian nationalists and monarchists loyal to the House of Savoy to establish a united kingdom encompassing the entire Italian Peninsula. The Kingdom of Sardinia industrialized from onward. A constitution, the Statuto Albertino was enacted in the year of revolutions, , under liberal pressure. After initial success the war took a turn for the worse and the Kingdom of Sardinia lost. Garibaldi, a native of Nice then part of the Kingdom of Sardinia , participated in an uprising in Piedmont in , was sentenced to death, and escaped to South America.

He spent fourteen years there, taking part in several wars, and returned to Italy in After the Revolutions of , the apparent leader of the Italian unification movement was Italian nationalist Giuseppe Garibaldi. He was popular amongst southern Italians. Although the kingdom had no physical connection to Rome deemed the natural capital of Italy , the kingdom had successfully challenged Austria in the Second Italian War of Independence , liberating Lombardy-Venetia from Austrian rule. The kingdom also had established important alliances which helped it improve the possibility of Italian unification, such as Britain and France in the Crimean War.

The transition was not smooth for the south the " Mezzogiorno ". The path to unification and modernization created a divide between Northern and Southern Italy. People condemned the South for being "backwards" and barbaric, when in truth, compared to Northern Italy, "where there was backwardness, the lag, never excessive, was always more or less compensated by other elements". The entire region south of Naples was afflicted with numerous deep economic and social liabilities. However, on the other hand, transportation was difficult, soil fertility was low with extensive erosion, deforestation was severe, many businesses could stay open only because of high protective tariffs, large estates were often poorly managed, most peasants had only very small plots, and there was chronic unemployment and high crime rates.

Cavour decided the basic problem was poor government, and believed that could be remedied by strict application of the Piedmonese legal system. The main result was an upsurge in brigandage , which turned in a bloody civil war that lasted almost ten years. The insurrection reached its peak mainly in Basilicata and northern Apulia , headed by the brigands Carmine Crocco and Michele Caruso. With the end of the southern riots, there was a heavy outflow of millions of peasants in the Italian diaspora , especially to the United States and South America.

Others relocated to the northern industrial cities such as Genoa, Milan and Turin, and sent money home. Italy became a nation-state belatedly on 17 March , when most of the states of the peninsula were united under king Victor Emmanuel II of the House of Savoy , which ruled over Piedmont. In exchange Prussia would allow Italy to annex Austrian-controlled Venice.

The victory against Austria allowed Italy to annex Venice. The one major obstacle to Italian unity remained Rome. In , France started the Franco-Prussian War and brought home its soldiers in Rome, where they had kept the pope in power. Italy marched in to take over the Papal State. Italian unification was completed, and the capital was moved from Florence to Rome.

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In Northern Italy , industrialisation and modernisation began in the last part of the 19th century. The south , at the same time, was overpopulated, forcing millions of people to search for a better life abroad. It is estimated that around one million Italian people moved to other European countries such as France, Switzerland, Germany, Belgium and Luxembourg. Parliamentary democracy developed considerably in the 19th century. The Sardinian Statuto Albertino of , extended to the whole Kingdom of Italy in , provided for basic freedoms, but the electoral laws excluded the non-propertied and uneducated classes from voting.

Italy's political arena was sharply divided between broad camps of left and right which created frequent deadlock and attempts to preserve governments, which led to instances such as conservative Prime Minister Marco Minghetti enacting economic reforms to appease the opposition such as the nationalization of railways. In , Minghetti lost power and was replaced by the Democrat Agostino Depretis , who began a period of political dominance in the s, but continued attempts to appease the opposition to hold power.

Depretis began his term as Prime Minister by initiating an experimental political idea called Trasformismo transformism. The theory of Trasformismo was that a cabinet should select a variety of moderates and capable politicians from a non-partisan perspective.

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In practice, trasformismo was authoritarian and corrupt, Depretis pressured districts to vote for his candidates if they wished to gain favourable concessions from Depretis when in power. The results of the election resulted in only four representatives from the right being elected, allowing the government to be dominated by Depretis. Despotic and corrupt actions are believed to be the key means in which Depretis managed to keep support in southern Italy. Depretis put through authoritarian measures, such as the banning public meetings, placing "dangerous" individuals in internal exile on remote penal islands across Italy and adopting militarist policies.

Depretis enacted controversial legislation for the time, such was abolishing arrest for debt, making elementary education free and compulsory while ending compulsory religious teaching in elementary schools. The first government of Depretis collapsed after his dismissal of his Interior Minister, and ended with his resignation in The second government of Depretis started in Depretis' goals included widening suffrage in and increasing the tax intake from Italians by expanding the minimum requirements of who could pay taxes and the creation of a new electoral system called which resulted in large numbers of inexperienced deputies in the Italian parliament.

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Francesco Crispi — was Prime Minister for a total of six years, from until and again from until Historian R. Bosworth says of his foreign policy that Crispi:. Crispi had been in the Depretis cabinet minister and was once a Garibaldi republican. Crispi's major concerns before during —91 was protecting Italy from Austria-Hungary. Crispi worked to build Italy as a great world power through increased military expenditures, advocation of expansionism, and trying to win Germany's favor even by joining the Triple Alliance which included both Germany and Austria-Hungary in which remained officially intact until While helping Italy develop strategically, he continued trasformismo and was authoritarian, once suggesting the use of martial law to ban opposition parties.

Despite being authoritarian, Crispi put through liberal policies such as the Public Health Act of and establishing tribunals for redress against abuses by the government. The overwhelming attention paid to foreign policy alienated the agricultural community which needed help. Both radical and conservative forces in the Italian parliament demanded that the government investigate how to improve agriculture in Italy. There was aggravation by lower class Italians to the break-up of communal lands which benefited only landlords.

Most of the workers on the agricultural lands were not peasants but short-term labourers who at best were employed for one year. Peasants without stable income were forced to live off meager food supplies, disease was spreading rapidly, plagues were reported, including a major cholera epidemic which killed at least 55, people.

The Italian government could not deal with the situation effectively due to the mass overspending of the Depretis government that left Italy in huge debt. Italy also suffered economically because of overproduction of grapes for their vineyards in the s and s when France's vineyard industry was suffering from vine disease caused by insects.

Italy during that time prospered as the largest exporter of wine in Europe but following the recovery of France in , southern Italy was overproducing and had to split in two which caused greater unemployment and bankruptcies. The Socialist Party became the main political party, outclassing the traditional liberal and conservative organisations.

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Starting from the last two decades of the 19th century, Italy developed its own colonial Empire. It took control of Somalia and Eritrea. In , Giovanni Giolitti 's government sent forces to occupy Libya and declared war on the Ottoman Empire which held Libya. Italy soon conquered and annexed Tripoli and the Dodecanese Islands. Nationalists advocated Italy's domination of the Mediterranean Sea by occupying Greece as well as the Adriatic coastal region of Dalmatia but no attempts were made. The First World War — was an unexpected development that forced the decision whether to honor the alliance with Germany and Austria.

For six months Italy remained neutral, as the Triple Alliance was only for defensive purposes. Italy took the initiative in entering the war in spring , despite strong popular and elite sentiment in favor of neutrality. Italy was a large, poor country whose political system was chaotic, its finances were heavily strained, and its army was very poorly prepared.

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They operated in secret, enlisting the king later on, but keeping military and political leaders entirely in the dark. They negotiated with both sides for the best deal, and got one from the Entente, which was quite willing to promise large slices of the Austro-Hungarian Empire, including the Tyrol and Trieste , as well as making Albania a protectorate.

Russia vetoed giving Italy Dalmatia. Britain was willing to pay subsidies and loans to get 36 million Italians as new allies who threatened the southern flank of Austria. When the Treaty of London was announced in May , there was an uproar from antiwar elements. Salandra resigned but no one could form a majority against him, and he returned to office. Most politicians, and indeed most Italians opposed the war, including most Catholics. Reports from around Italy showed the people feared war, and cared little about territorial gains.

Rural folk saw war is a disaster, like drought, famine or plague. Businessmen were generally opposed, fearing heavy-handed government controls and taxes, and loss of foreign markets. Reversing the decision seemed impossible, for the Triple Alliance did not want Italy back, and the king's throne was at risk. Pro-war supporters mobbed the streets with tens of thousands of shouting by nationalists, Futurists , anti-clericals, and angry young men. Benito Mussolini , an important Socialist Party editor took a leadership role, but he was expelled from the Party and only a minority followed him.

Apart from Russia this was the only far left party in Europe that opposed the war. The fervor for war represented a bitterly hostile reaction against politics as usual, and the failures, frustrations, and stupidities of the ruling class. Italy entered the war with an army of , men, but the army was poorly led and lacked heavy artillery and machine guns, their war supplies having been largely depleted in the war of —12 against Turkey. Italy proved unable to prosecute the war effectively, as fighting raged for three years on a very narrow front along the Isonzo River , where the Austrians held the high ground.

In , Italy declared war on Germany, which provided significant aid to the Austrians. Some , Italian soldiers died and , were wounded, while the economy required large-scale Allied funding to survive. Before the war the government had ignored labor issues, but now it had to intervene to mobilize war production. With the main working-class Socialist party reluctant to support the war effort, strikes were frequent and cooperation was minimal, especially in the Socialist strongholds of Piedmont and Lombardy.

The government imposed high wage scales, as well as collective bargaining and insurance schemes. Many large firms expanded dramatically. The workforce at Ansaldo grew from 6, to , as it manufactures 10, artillery pieces, 3, warplanes, 95 warships and 10 million artillery shells.

At Fiat the workforce grew from 4, to 40, Inflation doubled the cost of living. Industrial wages kept pace but not wages for farm workers. Discontent was high in rural areas since so many men were taken for service, industrial jobs were unavailable, wages grew slowly and inflation was just as bad. Italy participated in the war primarily to gain new territory in the North and the East; it blocked a major Austrian peace proposal in Italy did not receive other territories promised by the Pact of London, so this outcome was denounced as a " Mutilated victory ".

Mussolini was a World War I veteran, working for the Socialist newspapers until he broke off and established his new Nationalist organization, Fasci di Combattimento. In , at the Paris Peace Conference , Italy was denied the execution of wartime secret Treaty of London it had concorded with the Triple Entente ; [] wherein Italy was to leave the Triple Alliance and join the enemy, by declaring war against the German Empire and Austria-Hungary , in exchange for territories Istria and Dalmatia , at war's end, upon which the Kingdom of Italy held claims.

The disrespect for the promises caused widespread indignation among Italian nationalists, while poet and adventurer Gabriele D'Annunzio led an expedition to occupy ethnic Italian Fiume , assigned to Yugoslavia. At the same time, the so-called Biennio Rosso red biennium took place in the two years following the first world war in a context of economic crisis, high unemployment and political instability. The —20 period was characterized by mass strikes, worker manifestations as well as self-management experiments through land and factories occupations.

In Turin and Milan , workers councils were formed and many factory occupations took place under the leadership of anarcho-syndicalists. The agitations also extended to the agricultural areas of the Padan plain and were accompanied by peasant strikes, rural unrests and guerilla conflicts between left-wing and right-wing militias. Thenceforth, the Fasci di Combattimento forerunner of the National Fascist Party , of Benito Mussolini successfully exploited the claims of Italian nationalists and the quest for order and normalization of the middle class.

In , old Prime Minister Giolitti was reappointed in a desperate attempt to solve Italy's deadlock, but his cabinet was weak and threatened by a growing socialist opposition. Giolitti believed that the Fascists could be toned down and used to protect the monarchy from the socialists. He decided to include Fascists on his electoral list for elections. The Fascists rejected Giolitti's offers and joined with socialists in bringing down his government. In October , Mussolini took advantage of a general strike to announce his demands to the Italian government to give the Fascist Party political power or face a coup.

With no immediate response, a group of 30, Fascists began a long trek across Italy to Rome the March on Rome , claiming that Fascists were intending to restore law and order. The King was forced to choose which of the two rival movements in Italy would form the government: Mussolini's Fascists, or the marxist Italian Socialist Party. He selected the Fascists. Upon taking power, Mussolini formed a coalition with nationalists and liberals. The Fascist Party used violence and intimidation to achieve the threshold in the election , thus obtaining control of Parliament. Socialist deputy Giacomo Matteotti was assassinated after calling for a nullification of the vote because of the irregularities.

Over the next four years, Mussolini eliminated nearly all checks and balances on his power. On 24 December , he passed a law that declared he was responsible to the king alone, making him the sole person able to determine Parliament's agenda. In , all political parties were banned, and parliamentary elections were replaced by plebiscites in which the Grand Council of Fascism nominated a single list of candidates. Duggan , using private diaries and letters, and secret police files, argues that Mussolini enjoyed a strong, wide base of popular support among ordinary people across Italy.