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.

Southern vacations beckon during the long winter months. Depending on the destination, there may be certain vaccination and malaria- prevention measures that will reduce the traveller’s risk of debilitating disease. Many, however, wait too long before they visit a doctor for a travel medicine consultation.

Recent reports of three cruise ship outbreaks of viral diarrheal illness (gastroenteritis) bring into focus how easily infections spread. Each ship had hundreds of passengers who fell ill. Carnival’s cruise ship Fascination, Disney’s Magic and Holland America’s Amsterdam all underwent extensive decontamination procedures.