Malaria has caused suff ering and death on the African
continent for a long time. Transmitted by a certain type of
mosquito, malaria thrives in locations where these mos-
quitoes breed in shallow pools of standing water and is fre-
quently associated with human populations that are engaged
in agriculture. Malaria may very well have originated in Af-
rica and spread to other places on the globe. It is basically a
chronic, endemic disease, but it can reach epidemic propor-
tions when environmental conditions produce large numbers
of the disease-bearing mosquitoes. Written references from
the Classical Period provide evidence for malaria’s long his-
tory in Africa, as does modern biological research. Scientists
have found that individuals who can trace their ancestry back
to western Africa are more likely to have the sickle-cell trait,
which carries inherited resistance to the malaria parasite.
Th is fi nding suggests that over the long course of human his-
tory environmental conditions in this region helped to select
for these connected traits. Th is sort of selection generally oc-
curs over the course of many generations.
Li ke ma laria, schistosomiasis, a disease caused by a para-
site that lives in water, probably also has a long history on the
African continent. Th e disease may originally have occurred
in tropical forests but spread with the advent of irrigation
for agricultural purposes. Th us, human cultural adaptations
probably contributed to its dispersal. As with smallpox, evi-
dence for schistosomiasis in ancient Africa comes primarily
from mummifi ed human remains that show strong indica-
tions of infection with the disease.
On the whole, large-scale epidemics and pandemics ap-
pear to have been relatively rare in ancient Africa, mainly
because the demographic characteristics did not lend them-
selves to these sorts of outbreaks. However, there is good evi-
dence for a number of endemic diseases with the potential for
epidemic or pandemic spread under the right conditions. As
domestication of plants and animals became increasingly im-
portant, the circumstances for epidemic-type outbreaks grew
more common. Future archaeological research and other
sources may help us to understand better the specifi c ways in
which these diseases spread and aff ected the lives of people in
diff erent parts of the continent.
EGYPT
BY PANAGIOTIS I. M. KOUSOULIS
Until the 19th century, modern knowledge of ancient Egyp-
tian medicine depended mainly on the reports of the Greek
authors Herodotus (ca. 484–ca. 425 b.c.e.), Strabo (ca. 64
b.c.e.–aft er 23 c.e.), Diodorus Siculus (fi rst century b.c.e.),
and Clement of Alexandria (ca. 150–ca. 211 c.e.). With the
decipherment of hieroglyphs, Egyptian medical documents
could be translated from the second half of the nineteenth
century onward. Such documents were written on papyri in
hieratic (cursive) hieroglyphs, and they are concerned mainly
with the identifi cation of diseases and their treatments, which
oft en were a combination of rational and “irrational” (magi-
cal) methods. Th e medical papyri tell us nothing of the preva-
lence or the epidemiology of the diseases.
Other sources for the study of pandemics and epidem-
ics in pharaonic times are artistic portrayals and scientifi c
research on mummies and human remains. Th e process of
mummifi cation, dry weather conditions, and the location of
tombs and burial grounds favored excellent preservation of
human remains. Modern scientifi c paleopathologic research,
including the use of such modern techniques as fi ber-optic
endoscopy, electron microscopy, and the recovery and repli-
cation of DNA, can shed light on various pandemics and epi-
demic deceases. Moreover, artistic representation, such as the
famous statues and other images of the king Akhenaton (r.
ca. 1353–ca. 1335 b.c.e.) and his family from the Eighteenth
Dynasty off ers clues to the causes and results of certain dis-
eases and body deformities.
Most common epidemic diseases in ancient Egypt were
caused by parasitic and bacterial or viral infections. Schis-
tosomiasis was one such parasitic disease. According to the
World Health Organization, it aff ects more than 12 percent
of the Egyptian population today; it is acquired by infection
with a certain species of worm. It can result in fever, fatigue,
serious anemia, and even liver damage. Schistosomiasis has
been detected in bodily remains from predynastic times up
to the Roman period, though it cannot be recognized in the
medical terminology of the relevant papyri.
By contrast, bacterial infections, such as leprosy, cannot
be detected on mummies or skeletal remains. A few clues in
medical papyri or tomb illustrations shed light on chronic
progressive infections. Th e earliest case of nodular leprosy
comes from a Christian burial in Nubia, south of Egypt in
modern Ethiopia, of the sixth century c.e. Th e absence of
material evidence on earlier mummies might have been the
result of refusal to mummify victims of a disease if it was
known to be infectious and required isolation from the com-
munity during life.
Evidence for leprosy in the medical papyri is tenuous be-
cause of the diffi cult terminology used. One helpful papyrus
is the Ebers papyrus, which is said to have been found be-
tween the legs of a mummy in Th ebes on the west bank of the
Nile, opposite Luxor, in southern Egypt. Two cases (numbers
874 and 877) from the Ebers papyrus refer to the tumor of a
certain Khonsu, which has been translated as tubercular (or
nodular) leprosy: “Instructions for a tumour of Khosnu. If you
examine a large tumour of Khonsu in any part of a man and
it is terrible and it has made many swellings. Something has
appeared in it like that in which there is air.... Th en you shall
say concerning it: it is swelling of Khonsu. You should not
do anything against it.” Th is passage, however, could equally
well relate to cancer or bubonic plague. Case 813 of the Ebers
papyrus refers to an “eating” of the uterus, which might also
be construed as cancer. Still, both cancer and bubonic plague
are extremely rare in both mummies and skeletons of phara-
onic times. In part, this may be due to relatively early deaths,
but an additional factor might be low levels of carcinogens.pandemics and epidemics: Egypt 821