Hippocrates (460?-377 BC) described it in his written observations. Ancient Chinese, Egyptian and Middle Eastern cultures refer to this disease. Outbreaks often coincide with warfare, mass migrations and other societal disruptions. The British blamed “bad air” in the mid 1800’s India for a disease that killed many of their nationals. This mala aria (from the Italian) has killed more soldiers in the 20th century wars than bullets. The World health Organization reported 270 million worldwide cases and one million deaths in 1998.