pandemics and epidemics: Asia and the Pacific The next epistolary archive containing references to epidemics is from Amarna in Egypt, though the letters were sent to Egypt from Mesopotamia and the Levant and report on events in those regions One writer asks whether a disease affecting donkeys, which prevents them from walking, also affects people Armies and cities were often attacked by plague during times of war, as exemplified by an Amarna letter sent from Megiddo in Palestine referring to a plague in the city as a result of its being under siege In later periods such contemporary reports of epidemics are rare One Babylonian chronicle refers to an epidemic in Assyria during the reign of Merodach-baladan II (ca 715 b.c.e.), but otherwise historical sources from the first millennium b.c.e reveal very little about epidemics One possible reason for this lack of information is that there was no ancient bureaucratic structure dedicated to dealing with public health, and no officials were permanently assigned to this task Illness was treated on an ad hoc basis whenever it occurred The usual word for plague in the Akkadian language widely used in ancient Mesopotamia, mutanu, which literally means “deaths,” occurs mainly in contexts of omens and divination Plague was often predicted based on examinations of the livers of sacrificial sheep or on omens drawn from the movements of stars and planets, but such reports provide few clues to the nature of epidemics or pandemics in the region The information is usually general, such as “There will be constant epidemics in the land” or “An epidemic will occur in a city” or “There will be an epidemic every day.” One clue to the nature of such epidemics, however, occurs in lists mentioning specific diseases that will affect the land following particular unfavorable omens Babylonian planetary omens taken from sightings of Jupiter, for instance, predict plague in the land but also foretell that a type of joint disease, known as rapadu, will “seize” the land Although we cannot diagnose this specific disease with any accuracy, the omen occurs with other health-related predictions, such as that a cattle epidemic will take place or that “pregnant women will die with the child in their womb.” Such phenomena, of course, were probably unrelated to each other, but these omens were intended to refer to widespread conditions affecting the entire country, not to individual cases of affliction Another unfavorable planetary omen, associated with sightings of Venus, warns that dogs will become rabid, biting men, cattle, sheep, and donkeys, and that whatever is bitten will not recover It is likely that many diseases besides rabies were thought to be caused by dog bites As we learn more about the nature of the diseases mentioned in omens such as these, we will have a better chance of identifying diseases that were considered epidemics as well as illnesses attacking individual patients Diseases and pestilence were often considered to be the work of Nergal, the Babylonian god of pestilence and cattle disease, who was associated with the planet Mars Diseases were considered to originate from the “evil dew of the gods” or were associated with divine spittle or even divine semen 823 raining down from heaven These are all religious metaphors for the cosmic origins of disease, which was thought to have been created when the rest of creation took place; disease was often regarded as the handiwork of demons emanating from the netherworld The technical literature of diagnosis and medicine often refers to diseases as the “hand of a god,” with the god or demon mentioned by name, but many of these labels eventually came to serve as proper names of particular diseases, without much theological importance ASIA AND THE PACIFIC BY KIRK H BEETZ Much is mysterious about the nature and frequency of epidemics in ancient Asia and the Pacific In general, anthropologists believe that epidemics were rare or nonexistent among many peoples of the Pacific before the coming of Europeans, whose diseases killed numerous Australians and Pacific islanders During ancient times there were migrations from the Asian mainland to Japan, the Philippines, New Guinea, and some of the islands of Indonesia, and the migrants brought their diseases—and their developed immunities—with them, which may explain why peoples of these places did not suffer from diseases later imported from Europe as severely as others did The most prevalent ancient scourge among these islands was leprosy Another that was common among the Indonesian islands was malaria Malaria, caused by a single-celled parasitic organism transmitted to humans by one particular type of mosquito, occurred throughout southern Asia The disease—but not its cause—was well known to ancient Asian writers Malaria was responsible for much suffering and countless deaths among both dense and sparse populations wherever pools of quiet water abounded during warm weather—conditions in which the disease-bearing mosquitoes bred prolifically Ancient Indian physicians, in particular, tried to find treatments for malaria but in the end could little more than attempt to reduce the fever it entailed In China an epidemic was taken as a sign that a ruler had lost the mandate of heaven and could be lawfully deposed Thus it is not surprising that government officials were reluctant to record epidemics Surviving Chinese medical writings from the Han Dynasty (202 b.c.e.–220 c.e.) indicate that epidemics occurred in various parts of the empire so frequently that they could be discussed in broad general statements rather than in descriptions of specific outbreaks Influenza was a common disease among pigs and ducks in Asia, and it mutated frequently into forms that could be transmitted to human beings Archaeologists suspect that influenza began in China because early in Chinese culture pigs became an important part of everyday life Although a new strain of influenza might begin in a rural area, it was easily carried by pigs or infected humans into towns and cities, where it took on epidemic proportions Like modern strains of influenza, those of ancient China probably varied in severity,