Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/studiesinpalaeopOOruff STUDIES IN THE PALAEOPATHOLOGY OF EGYPT THE UNIVERSITY OF CHICAGO PRESS CHICAGO, ILLINOIS THE BAKER & TAYLOR COMPANY NEW YORK THE CAMBRIDGE UNIVERSITY PRESS LONDON THE MARUZEN-KABUSHIKI-KAISHA TOKYO, OSAKA, KYOTO, FUKDOKA, SENDAI THE MISSION BOOK COMPANY SHANGHAI SIR MARC ARMANI) RUITKR STUDIES IN THE PALAEOPATHOLOGY OF EGYPT By SIR MARC ARMAND RUFFER, Kt., C.M.G., M.D. Late President of the Quarantine Council of Egypt; formerly Director of the British Institute of Preventive Medicine; Professor of Bacteriology in the Cairo Medical School; Member of the Indian Plague Commission, etc. Edited by ROY L. MOODIE, Ph.D. Professor of Anatomy in the University of Illinois THE UNIVERSITY OF CHICAGO PRESS CHICAGO, ILLINOIS 135" I93LI Copyright 1921 By The University of Chicago Press All Rights Reserved Published October 192 Coniposed and Printed By The University of Chicago Press Chicaeo, Illinois, U.S.A. PREFACE Sir Marc Armand Ruffer, whose Studies in Palaeo pathology con- stitute this volume, had intended to retire from active duty in 1919 and devote his attention to the preparation of a work dealing with his antiquarian studies of ancient Egypt. The present collection of papers issued under the direction of his wife, Lady Ruffer, is intended to replace that proposed undertaking. While the details of his plan are uncertain, since he left no notes on the project, it has been deemed best to select only those studies which deal with the evidences of disease in ancient Egypt. These by no means represent his life's work, but are rather the result of one of his keenest interests during the twenty years of his residence in Egypt. When Sir Armand Ruffer left in December, 1916, on his mission to Salonika, where he had gone to reorganize the sanitary service of the Greek Provisional Government, he left with Lady Ruffer the titles and notes of several unpublished papers which he intended to finish on his return. Since his death at sea in the spring of 191 7, as he was returning from Salonika, Lady Ruffer has issued five of these studies. Two of them, "Some Recent Researches on Pre- historic Trephining" and "Arthritis Deformans and Spondylitis in Ancient Egypt," appeared in 19 18 in the Journal of Pathology and Bacteriology under the title "Studies in Paleopathology." A third was printed by the Geological Survey of Egypt, with the title "Studies in Palaeopathology, A Pathological Specimen Dating from the Lower Miocene Period," describing spondylitis in an early crocodile. His Food in Egypt has been printed in quarto by the Institut d'Egypt, and his "Consanguineous Marriages among Egyptian Kings" in the History of Medicine section of the Proceedings of the Royal Society of Medicine in London. One study, that on diseases of the teeth in ancient Egypt, is published in a recent number of the American Journal of Physical Anthropology. Another study, with the title ". \ l< ohol ;i nd \l( oholism in Ancient Egypt," is regarded by Lady Ruffer and her advisers as too incomplete for publication. vi PREFACE The present work is the first separate volume to be devoted entirely to a discussion of paleopathology, although there are several large memoirs which have devoted considerable space to an account of ancient pathology. Such, for instance, are the works of G. Elliot Smith and F. Wood Jones in the Report of the Archaeologi- cal Survey of Nubia and that of Lortetand Gaillard on the mummified fauna of Egypt. Sir Armand Ruffer made the first move toward establishing the science of paleopathology as a distinct subject, and he gave the first definition of the science in medical literature; although there had been a prior definition of the subject by Ameri- can palaeontologists. Paleopathology has an especial appeal to students of medical literature and particularly to those who find an interest and a delight in the history of medicine. The subject is of importance also to Egyptologists in showing them something of the intimate life of the makers of the pyramids. Acknowledgment is gladly made the publishers and editors of the Annals of Medical History, the Journal of Pathology and Bacteri- ology, the British Medical Journal, the Cairo Scientific Journal, the Memoir es presentes a I'lnstitut d'Egypte, the Bulletin de la Societe Archeologique d'Alexandrie, the American Journal of Physical Anthropology, and Professor Karl Sudhoff, of Leipzig, for their kind permission to reprint the studies in the present volume. Professor James Ritchie, of Edinburgh, has granted the use of twenty-nine engravings from the Journal of Pathology and Bacteriology. It is a pleasure to express to Professor James H. Breasted our gratitude for the use of his " Chronological Summary " of Egyptian history, which, on his advice, has been taken from his History of the Ancient Egyptians. My own connection with the volume began when Lady Ruffer requested me to find an American publisher for the book. Follow- ing a request of mine for permission to dedicate my monograph on the palaeontological evidences of disease, now in preparation, to Sir Armand Ruffer, which Lady Ruffer has kindly granted, there has grown up between us a most delightful friendship. My first acquaintance with Sir Armand Ruffer's studies in palaeopathology was in 191 2 when I saw his "Histological Studies on Egyptian Mummies" in the library at the University of Kansas. Since my PREFACE vii work on evidences of disease among fossil vertebrates and ancient men has a close connection with his work on ancient Egyptians, it is especially pleasant to be intrusted by Lady Ruffer with such an important undertaking as the issuing of her husband's Studies in the Palaeo •pathology of Egypt. Roy L. Moodie Department or Anatomy College of Medicine University of Illinois Chicago, Illinois CONTENTS PAGE List of Illustrations xi Biographical Sketch xiii Bibliography of the Writings of Sir Marc Armand Ruffer, 1888-1920 xvii Note on the Histology of Egyptian Mummies 1 Pott'sche Krankheit an einer agyptischen Mumie aus der Zeit der 21. dynastie (um iooo v. chr.) 3 Remarks on the Histology and Pathological Anatomy of Egyptian Mummies n Note on the Presence of "Bilharzia haematobia" in Egyptian Mummies of the Twentieth Dynasty (1250-1000 b.c.) . . 18 On Arterial Lesions Found in Egyptian Mummies (1580 b.c. — 525 a.d.) 20 An Eruption Resembling That of Variola in the Skin of a Mummy of the Twentieth Dynasty (1 200-1 100 b.c.) 32 On Dwarfs and Other Deformed Persons in Ancient Egypt . . 35 Histological Studies on Egyptian Mummies 49 On Osseous Lesions in Anclent Egyptians 93 Notes on Two Egyptian Mummies Dating from the Persian Occupation of Egypt (525-332 b.c.) 127 On Pathological Lesions Found in Coptic Bodies (400-500 a.d.) . 139 On the Diseases of the Sudan and Nubia in Ancient Times . . 156 Pathological Notes on the Royal Mummies of the Cairo Museum 166 A Tumour of the Pelvis Dating from Roman Times (250 a.d.) and Found in Egypt 179 A Pathological Specimen Dating from the Lower Miocene Period 184 Some Recent Researches on Prehistoric Trephining . . . 194 Arthritis Deformans and Spondylitis in Ancient Egypt . . . 212 A Study of Abnormalitles and Pathology of Ancient Egyptian Teeth 268 On the Physical Effects of Consanguineous Marriages in the Royal Families of Ancient Egypt 322 Appendix 358 Index 367 LIST OF ILLUSTRATIONS FACING PAGE Sir Marc Armand Ruffer Frontispiece A Trephined Skull Text figure, page 200 Plate I. A Mummy of a Priest of Ammon with Pott's Disease . . 10 Plate II. Muscle Fibers and Fungus from the Abscess .... 10 Plate III-V. Arterial Lesions from Egyptian Mummies .... 30 Plate VI. Lesions of Variola in the Skin of a Mummy .... 34 Plate VII. The Dwarf Chnoum-Hotep 48 Plate VEIL Achondroplastic Dwarfs Depicted on Walls of Tombs 48 Plate IX. Other Achondroplastic Dwarfs 48 Plate X-XI. Deformed Persons in Ancient Egypt 48 Plate XII. Embalmed Liver with Image 92 Plate XIII. Embalmed Stomach and Intestines 92 Plate XIV. Embalmed Lung and Heart 92 Plate XV-XXII. Histology of Various Organs from Egyptian Mummies 92 Plate XXIII-XXXI. Osseous Lesions of Ancient Egyptians . 126 Plate XXXII-XXXVIII. Egyptian Mummies Dating from the Persian Occupation 138 Plate XXXLX-XLIV. Osseous Lesions Found in Coptic Bodies 154 Plate XLV-XLVI. An Osteosarcoma of the Pelvis 182 Plate XLVII-XLVIII. Spondylitis Deformans in a Miocene Crocodile 192 Plate XLIX-LIV. Arthritis Deformans and Spondylitis in An- cient Egyptians 266 Plate LV-LXII. Lesions of the Teeth and Jaws of Ancient Egyptians 320 Plate LXIII-LXXI. Ancient Royal Egyptians as Seen in Their 11 1 11 is, Tombs, and Coins 356 BIOGRAPHICAL SKETCH 1 Original investigation in medical history of late years has been furthered in remarkable ways by archaeologists, anthropologists, numismatists, antiquarians, collectors of engravings, sinologists, Egyptologists, and particularly by travelers and explorers. Indeed, the journey method of Sudhoff goes to show that he who enjoys the advantages of travel is much more likely to turn up new facts than the stationary investigator. One of the most prominent exponents of this new tendency was Sir Marc Armand Ruffer, late president of the Sanitary Council of Egypt, who lost his life at sea during the spring of 191 7 on his return from Salonika, where he had gone to reorganize the sanitary service of the Greek Provisional Govern- ment. He made his mark in the medical history of ancient Egypt by his contributions to its paleopathology, in particular the palaeo- histology of the pathological lesions found in mummies of the XVIIIth-XXVIIth Dynasties. He was born at Lyons, France, in 1859, the son of the late Baron Alphonse Jacques de Ruffer. His mother was a German. He was educated at Brasenose College, Oxford, where he took his B.A. degree in 1883, and at University College, London, becoming Bachelor of Medicine and Surgery in 1887 and Doctor of Medicine in 1889. He then became a pupil of Pasteur and Metchnikoff at the Pasteur Institute, devoting special study to the then novel subject of phagocytosis. In his papers of 1890, he gave an early and timely exposition of Metchnikoff's concept of inflammation as a protective mechanism against infection, particularly in the intesti- nal canal. He described the diphtheritic membrane as "a battle- field," in which pathogenic bacteria and amoeboid leucocytes contend for mastery. In 1891, Ruffer became the first director of the British Institute of Preventive Medicine, his assistant being his wife, Alice Mary Ruffer, who prepared many colored drawings. At Metchnikoff's instance, Ruffer and Plimmer took up the study ' Slightly modified from a memorial notice by F. H. Garrison, Annals of Medical History, I (1919), 218. xiv BIOGRAPHICAL SKETCH of cancer and established the provisional status of the quasi-parasitic formations in cancer cells. While testing the new diphtheritic serum at the Institute, Ruffer fell a victim to the disease, and he was so severely smitten with the paralytic sequelae that he felt compelled to resign his directorship. He then went to Egypt for recuperation and subsequently took up his permanent residence at the Villa Menival, Ramleh. Ruffer was one of the ablest organizers of medical administra- tion in recent times. He did much to make the present Lister Institute what it is today, became professor of bacteriology in the Cairo Medical School (1896), which he reorganized, and was the president of the Sanitary, Maritime, and Quarantine Council of Egypt (1901-17), in which office he was instrumental in ridding Egypt of cholera by rigorous hygienic policing of the routes of pilgrimage at the Tor Station and elsewhere. In this work he enjoyed the confidence and support of both Lord Cromer and Lord Kitchener. He served on the Indian Plague Commission, was Egyptian delegate to sanitary conferences of 1903, 1907, and 1911, and from the outbreak of the war was highly efficient as head of the Red Cross in Egypt. He was the recipient of many honors and decorations, and was knighted in 1916. A man of the world in the widest sense, he was a remarkable linguist, a talented violoncellist, and an expert at his favorite game of billiards. In December, 1908, in connection with the excavations made in Nubia by Reisner, Elliot Smith, Wood Jones, and Derry prior to the flooding of the country by the raising of the Assuan dam (1907), Ruffer began to exhibit microscopic sections of pathological lesions in mummies at the Cairo Scientific Society. In this field Fouquet was the pioneer (1889), but Ruffer made it his own by his expert skill in microtomic technique and staining methods. To overcome the hard, brittle, and friable character of the tissues, before cutting them with a Minot microtome, he softened them in a solution of alcohol and sodium bicarbonate, with subsequent hardening in alcohol. For this new branch of pathological histology he devised the term "paleopathology." His "preliminary note" of 1909 {British Medical Journal, I [1909], 1005) was followed by a striking series of papers on the presence of Bilharzia haematobia in Egyptian BIOGRAPHICAL SKETCH xv mummies of the XXth Dynasty, 1250-1000 B.C. (ibid., I [1910], 16), on a varioloid eruption in the skin of a mummy of the same period (Journal of Pathology and Bacteriology, Cambridge, XV [1910-n], 1-3, 1 pi.) , on arterial lesions in mummies of 1 580 B.C. — 525 a.d. (ibid., 453-62, 3 pis.), on the osseous lesions in Egyptian skeletons, ranging from 2980 B.C. to the Greek period (ibid., XVI [1911-12], 439-65, 9 pis.), on dental, osseous, and articular lesions in Coptic bodies of 400-500 a.d. (ibid, XVIII [1913-14], 149-62, 6 pis.), on a tumor of the pelvis from the catacombs of Kom el Shougafa, 250 a.d. (ibid., 480-84, 2 pis.), and a monograph on "Histological Studies on Egyp- tian Mummies" (Cairo, 1911). In 1 910, Elliot Smith and Ruff er de- scribed a case of Pott's disease in a mummy of the XXIst Dynasty, ca. 1000 B.C. (Giessen, 1910), perhaps the earliest landmark we have in the history of tuberculosis. In these studies Ruffer showed the presence of calcified Bilharzia eggs in the kidneys of two mummies, a common cause of prehistoric haematuria, as shown in the hiero- glyphs and medical papyri; also the common occurrence of arthri- tis, spondylitis deformans, dental caries, rarefying periodontitis, pyorrhea alveolaris, Bouchard's nodes, malarial enlargement of the spleen, biliary calculi, and particularly arteriosclerosis (atheroma) which was found even in the aorta of Ramses II, and was as fre- quent three thousand years ago as it is today. Its causation Ruffer leaves an open question, since, in his view, alcohol, tobacco, meat diet, strenuous exercise, and "wear and tear" could, none of them, have availed to produce it. His final studies of dental and osseous lesions in specimens dug up at Faras (100 B.C. — -300 a.d.) and at Merawi (750-500 B.C.) in the Sudan (Sudhojf's Mitth., XIII [1914], 453) led him to the conclusion that these people were short lived, dying before fifty. The war interrupted his work, which was cut short forever by his untimely death, but he had already planned a volume of studies which is represented by the present collection of papers. Ruffer's large-hearted, sympathetic personality made him well loved by every class and nationality in the cosmopolitan city of Alexandria. Some native pashas on the Municipal Council, of which Ruffer was for some years vice-president, remarked to Lady Ruffer after her husband's death that no one had ever been so xvi BIOGRAPHICAL SKETCH mourned and regretted by them as he even after three years. A young medical officer remarked, during the war: "Sir Ruffer always treats us as if we were his equals; he listens sympathetically to all that interests us, and never talks down to us." Ruffer's love for the game of billiards has already been men- tioned by Dr. Garrison, and it is interesting to learn also of his great love for music; being an accomplished celloist and possessed of a rich baritone voice, he and Lady Ruffer spent many delightful evenings at the piano. Among other brilliant traits was his unusual pentecostal gift, a real gift of tongues, unusual even for a versatile European. This gift was a very real aid to him in his work on the Quarantine Council, where he had to come in contact with representatives of so many nationalities, often being able to converse with them in their native tongue. This ability, added to his tact and discretion in handling the difficult affairs of the Council which often involved as many as eighteen nations, brought his efforts to establish quaran- tine stations on the boarder lands to a success. His greatest monument of all, perhaps, is the quarantine station at El Tor, established for the return of Mecca pilgrims in the Peninsula of Sinai, where he encouraged research work on plague, cholera, and dysentery, and from which station several of his own studies were issued. Ruffer's friend and co-worker for many years, Harry G. Plimmer, says in his obituary notice in Nature, May 10, 1917: "As a colleague Ruffer was ideal, ever ready to help and advise, and never thinking of himself; and he was one who had the truest, kindliest, and most appreciative affection for his many friends." The loss of such a man is truly a great one, and this volume of his studies will go far to keep alive his memory among men with whom he so loved to work and live. BIBLIOGRAPHY OF THE WRITINGS OF SIR MARC ARMAND RUFFER 1888-1920 i. "Sur l'elimination par les urines des matieres solubles vaccinantes fabriquees par les microbes en dehors de rorganisme." Comptes rendus des seances de V Academie des Sciences, 1888, pp. 1-3. 2. The same (cont'd). Comptes rendus des seances de la Sociele de Biologie, XL (October 20, 1888), 696-97. (With M. Charrin.) 3. "Mecanisme de la fievre dans la maladie pyocyanique." Comptes rendus des seances de la Societe de Biologie, XLI (March 9, 1889), 208-10. (With M. Charrin.) 4. "Les matieres solubles vaccinantes dans le sang des animaux." 1889. 2 pp. 5. "Influence du systeme nerveux sur l'infection." 1889. 2 pp. 6. "Rabies and Its Preventive Treatment." Lecture given at the Society of Arts, December 6, 1889. 9 pp. (The above were written while working at the Pasteur Institute, Paris.) 7. "Nature of the Disease Produced by Inoculation of the Bacillus Pyo- cyaenus." 1889. Paper read before University College Medical Society, March 7, 1889. 33 pp. 8. "Remarks on the Prevention of Hydrophobia by M. Pasteur's Treatment." Brit. Med. Jour., London, II (1889), 637-43. 9. "On the Phagocytes of the Alimentary Canal." Quart. Jour. Micros. Sci., XXX (February, 1890), 481-505. 1 pi. 10. "On the Destruction of Micro-Organisms by Amoeboid Cells." Paper read before British Medical Association, August 30, 1890. Brit. Med. Jour., London, II (1890), 491-93. ■ 11. "Chronic Hydrocephalus," Part I. Reprinted from Brain, XIII (1890), 117-44. Abstract from thesis written to obtain the degree of Doctor of Medicine at the University of Oxford, lune, 1888. 12. "Chronic Hydrocephalus," Part II. Brain, XIII (1890), 240-69. 13. "On the Destruction of Micro-Organisms during the Process of Inflamma- tion." Brit. Med. Jour., London, I (1890), 1 177-83. 2 pb. of pencil draw- ings by Lady Ruffer. 14. "Preliminary Note on Processes Taking Place in the Diphtheritic Mem- brane." Brit. Med. Jour., London, II (July 26, 1890), 202-3. 15. "Recherches sur la destruction des microbes dans les cellules ameboides dans l'inflammation." 1890. 21 pp. (This paper is a continuation and enlargement of the subject of Paper 13.) 16. "Recent Advances in Bacteriology." Medical Annual, 1892. 14 pp. and 2. pis. of water-color drawings by Lady Ruffer. xviii BIBLIOGRAPHY 17. "Immunity against Microbes," Part I. Quart. Jour. Micros. Sci., XXXII (1891), 99-109. 18. "Immunity against Microbes," Part II. Quart. Jour. Micros. Sci., XXXII (1891) , 41 7-50. 2 double-page pis. of water-color drawings by Lady Ruffer. 19. "Remarks Made at the Discussion on Phagocytosis and Immunity at the Pathological Society of London, March 15, 1892." Brit. Med. Jour., London, I (1892), 591-96. 20. "The New Science — Preventive Medicine." The Nineteenth Century, December, 1891. 19 pp. si. "Further Investigations on the Destruction of Micro-Organisms by Amoeboid Cells." Lancet, II (December 26, 1891), 377. 22. "Preliminary Note on Some Parasitic Protozoa Found in Cancerous Tumours." Brit. Med. Jour., London, II (July 16, 1892), 113. (With J. H. Walker.) 23. "Second Note on Parasitic Protozoa in Cancerous Tumours." Brit. Med. Jour., London, II (November 5, 1892), 993. (With J. H. Walker.) 24. "On Some Parasitic Protozoa Found in Cancerous Tumours." Jour. Path, and Bacleriol., I (1892), 198-215. 3 pis. of water-color drawings by Lady Ruffer. (With J. H. Walker.) 25. "Do the Interests of Mankind Require Experiments on Living Animals, and If So, Up to What Point Are They Justifiable ?" Remarks made at the Church Congress of 1892. 5 pp. 26. "The Morality of Vivisection." The Nineteenth Century, November, 1892. 6 pp. 27. "Should Experiments on Animals Be Prohibited by Law?" Lit. Rev., 1892. 8 pp. 28. "The British Institute of Preventive Medicine." Paper read to further its objects at Birmingham, 1892. 29. "On Protozoa and Cancer." Trans. Path. Soc. Lond., XLIV (1893), 209-16. 1 pi. of drawings by Lady Ruffer. 30. " Further Researches on Parasitic Protozoa Found in Cancerous Tumours." Jour. Path, and Bacterid, II (October, 1893), 3-25. 4 pis. colored. (With H. G. Plimmer.) 31. "A Visit to the Institut Pasteur, by an Old Student." Brit. Med. Jour., London, I, January 7, 1893. 32. "The Celebration of Louis Pasteur's Seventieth Birthday: Its Significa- tion." Med. Mag., February, 1893. 10 pp. 33. "Sur les parasites des tumeurs epitheliales malignes." Extrait du Traite de pathologie generate, Tome II (decembre, 1895). 12 pp. and 1 pi. wood- cut reproduction of water-color illustrations by Lady Ruffer. 34. "Discussion on Diphtheria .... and Its Treatment by Serum." Glas- gow Med. Jour., July, 1895. 7 pp. 35. "Measures Taken at Tor and Suez against Ships Coming from the Red Sea and the Far East." Lancet, London, II (December 30, 1899), 1801-8. BIBLIOGRAPHY xix 36. "A Contribution to the Study of the Presence and Formation of Agglu- tinins in the Blood." 14 pp. (With M. Crendiropoulo.) 37. "On the Toxic Properties of Bile and on Antihaemolytic (Haemosozic) Serum." Jour. Path, and Bacteriol., Edinburgh and London, IX (1903-4), 278-3^. (With M. Crendiropoulo.) 38. "Note on Haemosozic Sera. 3 pp. (With M. Crendiropoulo.) 39. "On Haemolytic and Haemosozic Serums." Brit. Med. Jour., London, II (1904), 58r. 40. "On Substances Favouring and Inhibiting the Action of the Haemolysins of Bile and Serum." 9 pp. (With M. Crendiropoulo.) 41. "Sur le pouvoir hemosozique du chlorine du sodium et son mode d'action." if pp. (With M. Crendiropoulo.) 42. "On a Hitherto Undescribed Change in the Urine of Patients Suffering from Nephritis." Brit. Med. Jour., London, II (1905), 544- (With G. Calvocoressi.) 43. "On the Lesions Produced by Oxyuris Vermicularis." Brit. Med. Jour., London, I (1901), 208-9. ' 44. " Contribution to the Technique of Bacteriology." Brit. Med. Jour., London, II (1900), 1305-6. 1 fig. (With M. Crendiropoulo.) 45. "Note on the Dialysis of Toxins through Collodion Walls. if pp. (With M. Crendiropoulo.) 46. "On Some Results Obtained by Disinfection and Isolation against Cholera." 3! pp. (With Zackariades Bey.) 47. "On the Lysogenic and Haemosozic Properties of Urine." 23 pp. (With M. Crendiropoulo and G. Calvocoressi.) 48. "Researches on the Bacteriological Diagnosis of Cholera by the Medical Officers at the Quarantine Council of Egypt, under the Direction of Sir Armand Ruffer." Brit. Med. Jour., London, I (1907), 735-42. 49. "Perpetual Sanitary Supervision of Ports: Permanent Measures to Be Taken in Harbours." Bericht iiber den XIV. Intern. Kongress fiir Hygiene und Demographie, Berlin, 1907. 95 pp. 50. "On the Etiology of Dysentery." Brit. Med. Jour., London, II (Septem- ber 25, 1909), 862-66. (With J. G. Willmore.) 51. "The Serum Treatment of Dysentery." Brit. Med. Jour., November 12, 1910, pp. 1-12. (With J. G. Willmore.) 52. "Sur la guerisondutetanos experimental^ chezlecobaye." 1913. Comples rendus des seances de la Sociele de Biologie, Paris, LXXIV (1913), 1277-79. (With M. Crendiropoulo.) 53. "Sur la guerison du tetanos experimentale des cobayes. Presse Medicale, November 8, 1913. 19 pp. (With M. Crendiropoulo.) 54. "Note on the Anti-Haemolytic (Haemosozic) Properties of Normal Urine." Brit. Med. Jour., London, I (1904), 1418. 55. "Note on the Presence of 'Bilhurzia Ilacmatobia' in Egyptian Mummies of the XXth Dynasty." Brit. Med. Jour., London, I (January 1, 1910), 16. xx BIBLIOGRAPHY 56. "Remarks on the Histology and Pathological Anatomy of Egyptian Mummies." Cairo Sci. Jour., IV (January, 1910), 1-5. 57. " Note on an Eruption Resembling That of Variola in the Skin of a Mummy of the XXth Dynasty." Jour. Path, and Bacteriol., XV (1910), 1-3. (With A. R. Ferguson.) 58. "Potts'che Krankheit an einer agyptischen Mumie aus der Zeit der 21. Dynastie." Zur hislorischen Biologie der Krankheitserreger, 3. Heft, Giessen, 1910. 2 pis., 1 colored, by Lady Ruffer. (With Elliot Smith.) 59. "On Arterial Lesions Found in Egyptian Mummies." Jour. Path, and Bacteriol., XV (191 1), 453-62. 3 pis. 60. "On Dwarfs and Other Deformed Persons." Bull, de la Soc. Archeol. d'Aexandrie, No. 13 (191 1), 1-17. 3 pis. of photographs, 2 pis. of drawings from the tombs, by Lady Ruffer. 61. "Histological Studies on Egyptian Mummies." Memoires presenles a I'ln- slitut Egyplien, Tome VI, Fasc. hi, 39 pp., n pis., roy. 4to (mars, 1911). 62. "On Osseous Lesions in Ancient Egyptians." Jour. Path, and Bacteriol., XVI (1912), 439-65. 9 pis. of photographs. (With A. Rietti.) 63. "Notes on Two Egyptian Mummies Dating from the Persian Occupation of Egypt." Bull, de la Soc. Archeol. d'Alexandrie, No. 14 (1912), 1-18. 7 pis. of photographs. (With A. Rietti.) 64. "Pathological Notes on the Royal Mummies of the Cairo Museum." Mit- theil. z. Gesch. der Med. undderNaturwissensch.,No. 56, XIII (1914), 239-68. 65. "Note on the Diseases of the Sudan and Nubia in Ancient Times." Mit- theil. z. Gesch. der Med. und der Naturwissensch. No. 58, XIII (1914), No. 6, 453-60. 66. "On Pathological Lesions Found in Coptic Bodies." Jour. Path, and Bacteriol., XVIII (1913), 149-62. 2 pis. 67. "On a Tumour of the Pelvis Dating from the Roman Times and Found in Egypt." Jour. Path, and Bacteriol., XVIII (1914), 480-84. 2 pis. (With J. G. Willmore.) 68. "A Pathological Specimen Dating from the Lower Miocene Period." (Extrait de Contributions a I'Etude des Vertebres miocenes de I'Egyple.) Cairo: Survey Dept., 1917. 2 pis. 7 pp. 69. "The Use of Natron and Salt by the Ancient Egyptians." Cairo Sci. Jour., IX (1917), 34-53- 70. "Some Recent Researches on Prehistoric Trephining." Jour. Path, and Bacteriol., XXII (1918), 90-104. 1 fig. 71. "Arthritis Deformans and Spondylitis in Ancient Egypt." Jour. Path, and Bacteriol., XXII (1918), 152-96. 6 pis. of photographs. 72. "Food in Egypt." Memoires presentes al'Institul Egyplien, I (1919), 1-88. 73. "On the Physical Effects of Consanguineous Marriages in the Royal Families of Ancient Egypt." Proc. Royal Soc. of Med., Sect, of Hist, of Med., London, XII (1919), 1-46. 27 figs. 74. "Abnormalities and Pathology of Ancient Egyptian Teeth." Amer. Jour. Phys. Anthrop., Ill (1920), No. 3, 335-82. 8 pis. NOTE ON THE HISTOLOGY OF EGYPTIAN MUMMIES {British Medical Journal, I [London, 1909], 1005) Some time ago my friend Professor Elliot Smith, F.R.S., gave me some fragments of mummies of the XXIst Dynasty (dating from 1250-1000 B.C.), and I endeavored to examine these fragments by histological methods. As far as I knew, then, this was practically the first attempt to study microscopically the minute structure of tissues mummified for about three thousand years; at any rate, I found nothing bearing on this subject in the literature at my disposal, but I was informed that Professor Looss of Cairo had shown the striation of mummified muscular fibres to his colleagues. I demonstrated some of my sections at the Sheffield meeting of the British Medical Association and at the December meeting (1908) of the Cairo Scientific Club. Quite lately my friend Mr. Shattock has read a paper on a similar subject before the Royal Society of Medicine. It was found impossible to obtain good microscopical sections without first restoring, to some extent at any rate, their flexibility to the tissues, as their brittleness and hardness broke the edge of the microtome knives; even when a fair section was obtained, this invariably crumbled up when transferred to the slide. I need not describe the various methods tried and rejected, but it will be sufficient to note that, by combining an alkaline salt such as carbonate of soda with a hardening reagent such as alcohol or formol, the mummified tissue placed in the mixture gradually swells up and resumes its former shape. The solution which has given me the best results is composed of alcohol, 100 parts, 5 per cent carbonate of soda solution, 60 parts. In many cases, however, such a solution softens the tissues too much, and more alcohol must then be added. After a period of time, the length of which depends on the bulk and nature of the tissue, the solution is replaced by 30 per cent 2 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT alcohol, and more alcohol is added day by day. After two or three days the softened tissue is transferred to absolute alcohol, then chloroform, paraffin, and cut secundum artem. During these manipulations the tissue remains pliable, though it shrinks a good deal. Very thin sections do not present any particular advantages, and I generally use three divisions of Minot's microtome. Such preparations, after maceration in i in 10,000 caustic potash, give excellent pictures. RESULTS I have prepared sections of muscle (voluntary, cardiac, and involuntary), blood vessels, skin, intestine, stomach, liver, kidney, bone, mammary glands, and testicles, "and the main characters of all these organs and tissues can be readily recognized. The stria- tion of muscular fibres, for instance, the muscular coats, the submucous tissue, and occasionally even the glands of the intestines and the convoluted tubules, the straight tubules and glomeruli of the kidneys, the various layers of the skin can be identified with certainty. I have no doubt that coarse pathological changes, such as inflammation, cirrhosis, tubercle, or cancer could be demonstrated by this method. POTT'SCHE KRANKHEIT AN EINER A.GYPTISCHEN MUMIE AUS DER ZEIT DER 21. DYNASTIE (UM 1000 V. CHR.) 1 (Sudhoff und Sticker, Zw historischen Biologie der Krankheits- erreger [Giessen, 1910], 3. Heft) Es ist nichts Neues, die Entdeckung eines Falles von Pott'scher Krankheit in Uberresten aus Altagypten anzukiindigen. Wir glauben jedoch, dass unser Fall das erste echte Beispiel jener Krankheit ist, das an agyptischen Mumien gefunden wurde, dessen Wichtigkeit durch die Tatsache wachst, dass uns ihr typisches Bild ermutigt hat, mehrere spater ausgegrabene Falle als tuber- kulos zu identifizieren. Die Wirbelsaulen archaischer Agypter, welche von Dr. Fouquet als Beispiele Pott'scher Krankheit beschrieben wurden (siehe J. de Morgan, Recherches sur les origines de I'Egypte, Paris, 1897, Ap- pendice par le Dr. Fouquet), sind fur uns typische Beispiele von Osteoarthritis, so wie sie Dr. Wood Jones unter dem Namen "Spondylitis deformans" beschrieben -und abgebildet hat. (The Archaeological Survey of Nubia, Bulletin No. 2, Cairo, 1908, Plate LIV.) Diese Erkrankung war in Ober-Agypten so verbreitet — be- sonders wahrscheinlich in pradynastischer Zeit — , dass gelegentlich einer von uns (G. E. S.) Beweise davon an jedem ausgewachsenen Skelett in einem grossen allgemeinen Begrabnisplatze fand. Sie war auch zur Zeit der persischen Dynastien, zirka 525-332 v. Chr., verbreitet, und in Unter-Agypten zeigen selbst die Skelette von makedonischen Soldaten und deren Familien (seit zirka 332 v. Chr.) — kiirzlich von Dr. Breccia ausgegraben — oft unverkennbare Merkmale dieser Krankheit. (M. A. R.) Professor Poncet stellt auch die Diagnose tuberkuloser Erkrank- ung an der Wirbelsaule eines Affen, den Professor Lortet in einem alten thebanischen Begrabnisplatz gefunden (Lortet et Gaillard, /.'/ fuune momifiee de I'ancienne Egyple, Lyon, 1905, pp. 228-31, [ papei w mtten with Graf ton Elliot Smith as senior author. 3 4 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT Fig. 95), und sagt Seite 231: "Ich will als Beweis hierfiir nur die Ahnlichkeit dieser Wirbelankylosen mit denjenigen anfiihren, die wir oftmals beim Menschen konstatierten und deren tuberkulosen Ursprung wir dargewiesen haben Diese Diagnose wird noch bekraftigt durch die Tatsache, dass die Tuberkulose beim Affen sehr haufig vorkommt." 1 Wir konnen der Diagnose von Professor Poncet nicht beipflich- ten, da wir mit der Mehrzahl der Pathologen behaupten, dass — was auch immer die Ursache von Spondylitis deformans sein mag — der Tuberkelbazillus nicht als Faktor in deren Atiologie nachge- wiesen worden ist, und dass eine scharfe Unterscheidungslinie zwischen ihr und der Riickenwirbeltuberkulose (Pott'scher Krank- heit) gezogen werden muss. Einer von uns (G. E. S.) fand vor ungefa.hr fiinf Jahren — bei der Priifung menschlicher Uberreste, die Dr. Reisner in einem Be- grabnisplatz des alten Kaiserreiches (Ausgrabungen der Hearst- Expedition) in Gizeh entdeckt hat — das Skelett eines kleinen Kindes (vielleicht aus der Zeit um 2700 v. Chr.), an welchem die typische krankhafte Veranderung von vorgerucktem Hiiftleiden zu sehen war. Obgleich dasselbe hochstwahrscheinlich durch Tuberkulose entstanden war, konnte man keinen positiven Beweis dafiir erbringen. Im ersten Bulletin des Archaeological Survey of Nubia (p. 38) beschreibt Dr. Wood Jones eine Mumie mit ausgesprochener patho- logischer Veranderung des Hiiftgelenks (linkes Uiosakral-Gelenk) und der letzten beiden Lendenwirbel. Auch das linke Ellbogen- gelenk war stark verandert; von diesem liefen Fistelgange aus, die sich auf der Hautoberflache offneten. Damals wurde die Diagnose einer tuberkulosen Erkrankung gestellt, aber Professor A. R. Ferguson von der medizinischen Schule in Kairo setzte dem entgegen, dass die Natur der Knochen- neubildung nicht auf eine tuberkulose Veranderung hindeute. Auch Dr. Charles Todd vom Public Health Department suchte vergeblich nach Tuberkelbazillen in den Lungen. 1 " Je n'en veux pour preuve que la similitude de cettes ankyloses vertebrates avec celles que nous avons maintes fois constatees chez l'homme et dont nous avons deraontre l'origine tuberculeuse. ... Ce diagnostic est encore corrobore par ce fait que la tuberculose est tres commune chez le singe." POTT'SCHE KRANKHEIT 5 Seit jener Zeit hat Dr. Derry (im Verlaufe seiner anthropolo- gischen Arbeiten im Zusammenhang mit dem Archaeological Survey of Nubia) eine Reihe von kranken Wirbelsaulen — aus der Zeit von 2000 bis 3000 v. Chr. und sogar noch friiher — gefunden, die eine so vollkommne Ahnlichkeit mit den Fallen besitzen, die hier be- schrieben werden sollen, dass — wenn letztere fur tuberkulos erklart werden diirfen, dieselbe Diagnose bei der Untersuchung der friiher gefundenen Wirbelsaulen gestellt werden muss (siehe Archaeological Survey of Nubia, Bulletin No. 3, p. 32, No. 4, pp. 10, 26 und No. 5, pp. 21 und 22). Die Mumie, mit der wir in diesem Bericht zu tun haben, war die irdische Hulle eines Priesters des Amnion aus der 21. Dynastie (zirka 1000 v. Chr.) und befand sich unter der grossen Sammlung menschlicher Korper der Seconde trouvaille de Deir el Bahari, die 1891 von M. Grebaut vom Service des Antiquites in der Gegend der grossen thebanischen Hauptstadt aufgefunden wurden. 1904 iiberantwortete Sir Gaston Maspero (Generaldirektor des Service des Antiquites) vierundvierzig dieser Mumien (seit 1891 im Museum der Altertumer von Kairo aufbewahrt) an das anatomische Museum der medizinischen Schule von Kairo. Unter diesen fand einer von uns beiden (G. E. S.) die Mumie dieses typischen Buckeli- gen; leider trug sie aber keinen Zettel, der bezeichnet hatte, aus welchem Sarg sie genommen war, und auch auf den diesen Leich- nam umhullenden Leinwandbandagen keine Angabe, um uns die Identifizierung oder die Festsetzung ihrer genauen chronologischen Stellung zu ermoglichen. Die besonders gut erkennbare Technik des Einbalsamierungs- vorgangs, wie solche in den Tagen der 21. Dynastie angewandt wurde, ist ausfiihrlich anderswo beschrieben (G. E. S., "A Contribu- tion to the Study of Mummification in Egypt," Memoires presenles a rinslitut Egyptien, Vol. V, Fasc. 1, 1906), lasst uns jedoch mit Sicherheit feststellen, dass diese Mumie in der genannten Zeit einbalsamiert worden war. Das allgemeine Aussehen der Uberreste dieser Mumie eines jungen erwachsenen Mannes wurde in der von Mrs. Cecil Firth freundlichst verfertigten Skizze (Tafel I, Figur 1) ausgezeichnet portratiert. Tafel I, Figur 2, ist eine unretouchierte Photographic, 6 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT die die Ansicht des Korpers von vorne darstellt, nachdem die vordere Korperwand entfernt war.- Augenscheinlich hatte hier eine ausgedehnte Zerstorung der Mitte des i . Lendenwirbels und der unteren drei oder vier Riickenwirbel stattgefunden; das Riickgrat hatte in der unteren Riickengegend nachgegeben, und es war eine ausgesprochene unregelmassige Einknickung entstanden. Die Riickengegend der Wirbelsaule bildet einen Winkel, dessen Spitze in der Verschmelzungsstelle des 8. und 9. Riickenwirbels liegt. Der erste Lendenwirbelkorper hat vorne und oben einen Ansatz zu einer starken neuen Knochen- bildung genommen (wie Tafel I, Figur 2, gut zeigt) ; soweit durch Priifung mit dem Messer gefunden werden konnte, war die Kon- solidierung der Wirbelkorper eine vollstandige und keine andere Knochenneubildung zu entdecken. Von der rechten Seite des 1 . Lendenwirbelkorpers sieht man eine breite abgeplattete Anschwellung ausgehen, die sich nach unten langs eines Stranges hinzieht, demjenigen entsprechend, welchen an der linken Seite der Lendenmuskel (Musculus psoas) bildet, bis in die rechte Darmbeingrube (Fossa iliaca), in welcher sie sich verliert. Keine Spur von einer Offnung in der Haut war am Oberschenkel oder am Bein oder in der Lendengegend zu finden, wo Abszesse von Krankheiten der Wirbelsaule sich bei einigen Fallen zu off nen pfleg- ten, die einer von uns im Sektionsraum zu Kairo zu untersuchen Gelegenheit hatte. MIKROSKOPISCHE ITNTERSUCHUNG Bruchstiicke von Trachea, Larynx und Bronchialdriisen wurden mikroskopisch nach einer Methode untersucht, die einer von uns (M. A. R.) schon besprochen hat. Man erweichte die Gewebe in einer Losung, die wie folgt zusammengesetzt war: Alkohol 30 cc Wasser 50 cc 5% kohlensaure Natronlbsung 20 cc legte sie dann in immer konzentrierteren Alkohol, in absoluten Alkohol, in Chloroform, und bettete sie schliesslich in Paraffin ein. Schnitte solcher Gewebe wurden mit Hamatoxylin oder speziell fur POTT'SCHE KRANKHEIT 7 Tuberkelbazillen gefarbt, etwas Abnormes konnte jedoch nicht daran entdeckt werden. Mit einer kleinen Trepankrone von ungefa.hr 1 5 mm Durchmes- ser entfernten wir sodann von dem vermutlichen Psoasabszess einen Gewebszylinder. Es zeigte sich, dass eine deutliche Hohlung, gross genug, um einen kleinen Finger durchzulassen, die obere Schicht vom Knochen trennte, und durch diese Hohlung konnte mit Leicht- igkeit eine Sonde nach dem Oberschenkel geschoben werden. Deutliche muskulose Fasern konnten mit blossem Auge nicht gesehen werden. Behufs Kontrolle dieser Beobachtung wurde mit derselben Trepankrone ein Probestiick an der entsprechenden Stelle in der linken Fossa iliaca entnommen. Nur eine diinne Gewebeschicht trennte den Knochen hier von der Obernache, und dies war un- zweifelhaft quergestreifte Muskelsubstanz. So ergab sich also der positive Beweis fiir eine krankhafte Veranderung in der Gegend des rechten Lendenmuskels (Muse, psoas). LINKE ODER GESUNDE SEITE Das angebohrte Stuck bestand aus gelblich-weissem, fleckigem Material von Aussehen und Konsistenz normaler einbalsamierter Muskelfaser (siehe Tafel II, B). Es fiihlte sich hart an, wenn auch nicht kornig, und kleine biegsame Muskelfaserstreifen konnten leicht abgetrennt werden (siehe Tafel II, C). Wegen der sehr tief gelb gefarbten Materie, die die Struktur einbalsamierter Gewebe immer verdunkelt, vermochte man nach einfachem Zupfen durch histologische Untersuchung sehr wenig zu finden. Nach der Erweichung kleiner Stiickchen durch 12-24 Std. in Vioooo Atzkali- losung war aber die Muskelfaser leicht zu erkennen. Die Querstreif- ung war unverkennbar und an einigen Stellen war das Sarkolemma nachweisbar, doch waren, wie es meist bei einbalsamierten Muskeln der Fall ist, keine Zellkerne zu unterscheiden. Schnitte hiervon wurden auch nach der oben beschriebenen Methode prapariert, und die Praparate zeigten, dass der Muskel sehr gut erhalten und kein Leichen-Packungsmaterial zwischen die Fasern gedrungen war. Die Querstreifung, obgleich gut erkennbar, war vielleicht nicht so voUkommcn erhalten wie an Muskeln anderer 8 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT Mumien. Dieser Punkt ist nicht so sehr wichtig, da es betracht- liche Unterschiede im Erhaltungszustand agyptischer Mumien gibt, selbst bei denjenigen der namlichen Dynastie. RECHTE ODER KRANKE SEITE Der Stand der Dinge auf dieser Seite war makroskopisch und mikroskopisch ein durchaus anderer. Erstens musste man von der Oberflache des herausgebohrten Stiickes eine verhaltnismassig grosse Menge pulverigen schwarzen Stoffes, hauptsachlich aus Holzkohle bestehend, entfernen. — Zweitens sah das durch das Ausbohren erhaltene Stuck ganz anders aus wie dasjenige von der linken Seite. Es zeigte eine schmutziggelbe Farbe, war aber stellen- weise glanzendweiss und hie und da mit pechschwarzen Flecken getupft (siehe Tafel II, A). Seine Konsistenz war hart, aber kleine Partien zerkriimelten rasch unter dem Finger, was allein schon geniigte, um den Unterschied zwischen der Muskelstruktur rechts und links zu veranschaulichen. In den inneren Partien des ausge- bohrten Stiickes zeigte der leicht zerkriimelnde Stoff ein schmutzig- gelbes Aussehen und ein ganz wenig Beimischung des oben beschriebenen schwarzen Pulvers. In Deckglaspraparaten konnte man erkennen, dass die schwar- zen Bestandteile des ausgebohrten Stiickes fast ganzlich aus klein- sten Teilchen von Holzkohle und Pflanzeniiberresten bestanden, die augenscheinlich als Verpackungs- oder Ausstopfungsmaterial ge- dient hatten. Ausserdem fand man eine gewisse Menge eines gelben glanzenden Stoffes (Harz?). — Die Bemuhungen, aus dieser schwarzen Substanz Schnittpraparate zu machen, waren von keinem Erfolge gekront, da dieser Stoff in der ihn erweichenden Losung nicht aufquoll, sondern hart und zerbrechlich blieb. Der gelbliche Stoff veranderte sich nicht merklich in der erweich- enden Losung, nichtsdestoweniger wurden aber ziemlich gute Erfolge erzielt. Die Praparate zeigten: (a) muskulose Fasern, obgleich nicht zahlreich, so doch geniigend gut erhalten, um die Querstreifung und des Sarkolemma zu zeigen. Die Muskelfasern waren (b) in einen kornigen Stoff, bestehend aus unregelmassigen rundlichen Korpern, eingebettet, von keiner besonderen Struktur, aber mit Hamatoxylin und Eosin (siehe Tafel POTT'SCHE KRANKHEIT g II, F) gut sich farbend. Man war versucht, diese Korper fiir Leukozy ten anzusehen ; obgleich aber diese Diagnose nicht unwahr- scheinlich ist, konnte doch kein typisches weisses Blutkorperchen nachgewiesen werden. Vermischt mit diesen Korperchen war (c) eine gewisse Menge Holzkohle (siehe Tafel II, E und F) und eines gelblich-krystallartigen Stoffes (siehe Tafel II, F), welche augen- scheinlich Packungsmaterial waren. Man konnte auch (d) eine grosse Anzahl von eiformigen Korper- chen (siehe Tafel II, G) sehen, welche sich mit Hematoxylin schwach und gleichmassig farben liessen, und deren aussere Enden etwas verdickt waren und tiefer sich farbten (siehe Tafel II, G). Ihre Konturen waren scharf, und bei manchen war eine deutliche Membran zu erkennen. Sie lagen vereinzelt, ofter auch in Gruppen von 6 bis 12, manchmal sogar von 30 bis 40 zusammengeballt. In manchen Fallen hatten sie alle gleichmassige Struktur (siehe Tafel II, G), aber manchmal waren sie mehr oder weniger deformiert (siehe Tafel II, J). Nach ihrer Form und Struktur zu urteilen, sehen wir sie als Schimmel-Sporen an; denn sich verastelnde Myzelien waren deutlich an vielen Praparaten zu sehen (siehe Tafel II, H). Mikrokokken oder Bazillen konnten durch keine Methode nachgewiesen werden. Um es kurz zusammenzufassen: Der linke Psoas bestand aus normalen Muskelfasern; dagegen war die Oberflache des rechten Psoas mit einer grossen Menge schwarzen staubigen Stoffes, bestehend aus Holzkohle, Pflanzenfaser, Harz ( ?) etc., als Packungs- und Ausstopfungsmaterial gebraucht, bedeckt. Die tiefen, mehr gelben Teile bestanden aus Muskelfasern, welche in einer grossen Menge kornigen Stoffes (Leukozyten ?) eingebettet lagen, vermischt mit einer gewissen Menge von Holzkohle etc. (Packungsmaterial) und Schimmel. SCHLUSSFOLGERUNG Der mikroskopische Befund des rechten Psoas unterstiitzt die Diagnose, zu der man nach einer Priifung mit blossem Auge gelangte, namlich das Vorhandensein eines Psoasabszesses auf der rechten Seitc. io STUDIES IN THE PALAEOPATHOLOGY OF EGYPT Es wurde zwar kein Eiter gefunden, der mit Sicherheit erkannt werden konnte, aber man muss sich vergegenwartigen, dass wahrend des Einbalsamierungsprozesses der meiste Eiter mechanisch weg- gewaschen oder aufgelost oder zur Unkenntlichkeit verandert wurde durch das sogenannte "Natronbad." Dass der rechte Psoas in einem weicheren, halb niissigen Zustand sich befand, als der Korper aus der konservierenden Losung genommen wurde, wird bewiesen durch die Tatsache, dass das Ausstopfungsmaterial (Holzkohle etc.) tief zwischen die Muskeifasern gedrungen ist. Eine andere wichtige Tatsache, die zugunsten dieser Ansicht spricht, ist, dass sich eine Hohlung zwischen Muskel und Knochen der rechten Seite befand, wogegen sich an der linken Seite keine derartige Hohlung aumnden liess. Der rechte Muskel muss deshalb durch irgend einen pathologischen Prozess schon bei Lebzeiten mehr oder weniger von dem Knochen losgelost gewesen sein. DESCRIPTION OF PLATES I-II Fig. i. — A drawing, by Mrs. Cecil M. Firth, of the mummy of a priest of Ammon of the XXIst Dynasty (1000 B.C.), showing in lateral view the protrusion of the spine so commonly seen in Pott's disease. Fig 2. — An untouched photograph of the anterior aspect of the mummy, showing the huge psoas abscess into which the pus from the tuberculous lesion in the lumbar vertebrae had drained. The mass was soft at the time of embalming. PLATE II (Drawings by Alice M. Ruffer) A. — Portion of the external surface of the right psoas muscle (diseased side) removed by a trephine. B. — Portion of the external surface of the left psoas muscle (normal side) removed by a trephine. C. — Small, isolated fragment of A. D. — Small, isolated fragment of B. E. — Cover-glass preparation of the yellow substance of A. (Leitz, Oc. i, Obj. 4.) F. — A small portion of E greatly enlarged. (Leitz, Oc. i, Obj. 1/12.) G. — Spores of mold. The same diameter. H. — A branched fragment of fungus. The same magnification. I. — Fungus and spores more or less degenerated. The same magnification. PLATE II J "^ :>* gfc. C ( I ■■*. REMARKS ON THE HISTOLOGY AND PATHOLOGICAL ANATOMY OF EGYPTIAN MUMMIES {Cairo Scientific Journal, Vol. IV [January, 1910], No. 40) At the meeting of the British Medical Association in Sheffield (July, 1908) and at a meeting of the Cairo Scientific Society (Decem- ber, 1908), I gave a demonstration of the microscopic structure of mummified tissues. The organs examined came from mummies of the priests of the twentieth dynasty, and had been given me by Professor Elliot Smith. On the same occasion, and in a note published in the British Medical Journal (January, 1909), I de- scribed the method which I then used for the preparation of such specimens. My intention now is to give a short account of the results obtained by this and similar methods during the last year, but before doing so, I wish to thank Sir Gaston Maspero, Professors Flinders Petrie, Elliot Smith, and Keatinge, for providing me with the necessary material. Urinary calculi. — Professor Flinders Petrie gave me three stones found by him in a predynastic skeleton, and which he had correctly diagnosed as urinary calculi. The largest of these stones weighs 30 grammes, and measures 4 . 5 centimetres in its greatest length, and 3 centimetres in its greatest thickness. It is roughly pear-shaped, with a whitish smooth surface streaked here and there with yellow (incrustations of fine sand ?). The second calculus weighs 24 grammes, and measures 4 centi- metres in its greatest length, and 2 . 5 centimetres in its greatest thickness. It is roughly triangular in shape, and its surface resembles that of the first. The third stone weighed 1 1 . 7 grammes only, and resembled the d in shape. Professor Aders Plimmer, of the Physiological 12 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT Laboratory, University College, London, kindly analysed it for me, and found its composition to be as follows: Per Cent Water 6.5 Organic Matter 34. 8 PA 37-6 MgO 19.7 CaO 0.8 Total 99-4* *The insoluble residue gave a strong murexide reaction. The centre of this calculus is yellow, the periphery irregularly laminated, and by the usual methods crystals of uric acid are easily obtained. Microscopically, the insoluble residue consists of organic debris, staining with haematoxylin (leucocytes and epithelial cells possibly). Anatomical elements or eggs of parasites 1 were not recognisable. The third calculus, therefore (and probably the others also), is a mixed phosphatic and uric acid calculus, which are common enough in Egypt at the present time. Liver of Ranefer.—I received from Professor Flinders Petrie a fragment of an organ found in the tomb of Ranefer. It looked like some internal organ, or part of such an organ, imbedded in a large quantity of mud. The mud was removed and then the typical arrangement of liver cells was easily recognised; the blood vessels, biliary tubes and connective tissue had disappeared. Tissues of predynastic mummies. — The fragment of tissue just described was about five thousand years old and the remarkable results obtained encouraged me to study microscopically the prehistoric bodies of the Hearst collection, which are now in the museum of the School of Medicine at Cairo, and which, I am in- formed, date from eight thousand years ago at least. The method used so far is fatal to these tissues, as they first crumble to pieces and then dissolve almost completely. By using a macerating fluid with a slightly different composition, however, good sections are easily prepared, and these I intend to describe fully on some future 1 Nearly all the specimens described in this paper are now deposited in the Museum of the Government School of Medicine, Cairo. HISTOLOGY AND ANATOMY OF EGYPTIAN MUMMIES 13 occasion. It is extraordinary that the striation of the voluntary muscular fibres and the nuclei of some cells should be perfectly plainly visible eight thousand years after death. Diseases of arteries in mummies of the eighteenth to twentieth dynasties. — In order to dissect the arteries, the following method was adopted after many failures. The whole mummy or the limbs to be examined are immersed in a solution having the following composition: Per Cent Carbonate of soda 2 Formol 0.5 Tap water 97 The skin becomes soft after twenty-four hours or longer and is then stripped off. The parts are replaced in the macerating fluid until this has penetrated to the bones, when the large arteries are easily dissected out. The muscles are separated from one another by simply running the finger along the intermuscular septa, and nerves, ligaments of joints, cartilages, etc., are readily seen. The arteries are still remarkably elastic; whereas the muscles, though soft, do not return to their former size after stretching. a) The first aorta examined consists of a piece 4^ inches long, covered, throughout its whole length almost, by a hard calcareous plate. Small pieces of this plate were decalcified in the following solution: Per Cent Absolute alcohol 98 HNO3 2 washed several times in 30 per cent alcohol, hardened and cut secundum artem. Microscopical preparations show the main alterations of calcareous degeneration. b) Another aorta was taken from one of the mummies (eight- eenth to twentieth dynasties) given me by Professor Flinders Petrie. Its arch had been hacked away by the embalmer, who had also cut right through all the coats just above the bifurcation of the vessel. The thoracic aorta from a point just above the origin of the left subclavian artery, and the whole of the abdominal artery, were intact and easily removed. The internal coat is studded with small calcareous patches and the two largest, each the size of a shilling, 14 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT are situated just above the bifurcation. The left subclavian artery, at a point just above its origin, is almost blocked by a raised, ragged calcareous excrescence, as large as a threepenny bit (calcified atheromatous ulcer). Small atheromatous patches, not calcified, are scattered through the whole length of the aorta, and these, owing to the dark coloration of the tissues, are more easily felt than seen. The common carotid arteries show small patches of atheroma, but the most marked changes are found in the pelvic arteries and in those of the lower limbs. The common iliac arteries are studded with small patches of atheroma and calcareous degeneration. The other arteries of the pelvis are converted by calcification into rigid, "bony" tubes, down to their minute ramifications. So stiff and brittle are they that it was impossible to dissect them out entire, as in spite of every possible care they were invariably broken. The minute intra- muscular arteries were easily felt on triturating the muscles under the fingers. Both armsand the legs (about 6 inches below Poupart's ligament) had been lost, but on the right side the common femoral and the profunda were dissected out. Both are converted into rigid calcareous tubes. It is to be noted that as far as could be made out from the examination of the cartilages of the ribs the mummy was not that of a very old person. c) A Greek mummy given me by Sir Gaston Maspero also shows atheromatous patches in the aorta and brachial arteries. From the examination of the cartilages, etc., I concluded at the time that the man was not above fifty years old at the time of death. d) I had an opportunity also of examining the legs of an old woman of the twentieth dynasty. The body has been very care- fully embalmed, and all the muscles and most of the arteries removed, sand and linen filling their places. The posterior tibial artery, however, was dissected out and found ossified from end to end. Arterial disease, therefore, was of frequent occurrence among Egyptians of old, and indeed temporal arteries of mummies in HISTOLOGY AND ANATOMY OF EGYPTIAN MUMMIES 15 various museums are as tortuous as they are at the present day, even in people who died when comparatively young. I may add that very interesting microscopical preparations were obtained from all arteries which had been isolated. Lesions of lungs. — Owing to the shrivelled state of the lungs, naked-eye evidence of pulmonary disease is not easily obtainable. With the microscope, however, pathological changes were detected in the lungs of several mummies. a) The lungs of one mummy (twentieth dynasty) present all the signs of diffuse anthracosis, the alveoli and the alveolar interspaces containing an enormous quantity of jet-black or dark yellow mate- rial (soot). Some of the alveoli are so full of this black stuff that at first I thought that an emulsion of finely divided charcoal had been poured down the trachea into the bronchi. I realized my mistake when I found that the material had penetrated into the depths of the tissues and that there were evident signs of inflammation in the alveoli. This condition of things is frequently found at the present time, among miners, cooks, and persons living in a smoky atmos- phere, and I have no doubt that this person was engaged in some work necessitating his presence in smoke-laden air. b) The two lungs (twentieth dynasty) to be described now present nothing abnormal to the naked eye, but nevertheless I expected to find pathological change in them, as small pieces had been left behind and were sticking to the pleura. I suspected that pathological adhesions had probably existed during life. Under the microscope, all the alveoli are seen to be crammed with cells, some of the characteristics of which, e.g., nuclei, can be recognized still. No micro-organisms are visible except in one place where numerous micrococci are packed in an alveolus. Although they still stain by Gram's method, I am unable to say to what species of micrococci they belong. In spite of the almost total absence of micro-organisms and judging from the pathological appearances only, I do not hesitate in making the diagnosis of pneumonia, which had advanced to the stage of hepatisation. c) This lung came from a mummy dating from the Greek period. There is nothing abnormal in the apex and upper half of 16 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT this organ, which became flexible after softening in the usual manner, and floats in 60 per cent of alcohol. On the contrary, the lower part immediately sinks in that fluid. Moreover, on section, the upper portion of the organ is spongy looking, the lower part shows* a dense, almost solid section, much resembling muscle. Con- solidation of the lower lobe, therefore, had evidently taken place. Microscopic examination of the upper part of the lung shows here and there patches of inflammation, and a few short bacilli, with rounded edges, scattered in groups through the tissue. The alveoli of the lower part of the lung are full of exudation in which very few anatomical elements are plainly recognisable, and an enormous number of the bacilli just mentioned. The liver of the same mummy was also examined. The inter- lobular connective tissue is much denser than usual, and strands of the tissue run between the liver cells. The interesting point, how- ever, is the large number of the same bacilli in the tissues and in blood vessels. These bacilli stain well with haematoxylin, 1 methylene blue, fuchsin, but not with Gram's method. They are ovoid in form about the size of plague bacilli, though plumper, and, except in a few cases, without a clear interspace between their extremities. A careful examination of numerous preparations left me with the impression that they had certainly been present during life and that they were pathogenic. Indeed, had a bubo been found I should have diagnosed the case as one of plague. At present, with the very scanty knowledge of the changes undergone by micro- organisms in mummified tissue, it will be best not to make any definite diagnosis. It is clear, however, that micro-organisms retain their characters unaltered in mummified tissue. I have found in organs that had evidently undergone putrefaction Gram-positive and Gram-negative micro-organisms, and others the spores of which gave all the typical staining reactions. Considering that the nuclei of some mummified or simply dried tissue stain characteristically, this result was not unexpected. 1 1 use Bohmer's haematoxylin, not less than one year old. I do not know why this simple and excellent stain is not used more extensively for micro-organisms. HISTOLOGY AND ANATOMY OF EGYPTIAN MUMMIES 17 Renal lesions. — (a) The kidneys of one mummy given me by Professor Flinders Petrie had not been removed by the embalmers. The right kidney presents nothing abnormal, but the left measures only 4.5 centimetres in length, 3.5 centimetres in breadth, and weighs 3 grammes. Microscopically, there are no signs of inflammation except for some slight thickening of the capsule and of the connective tissue in some parts of the medulla. I am not satisfied that where the connective tissue looks denser, this appearance is due to a pathologi- cal change, and not to an unequal expansion of the organ in the softening fluid. Any cirrhosis would be easy of detection, for the connective tissue stains well, the epithelium is remarkably well preserved, and there is no desquamation whatever. The atrophy was congenital, therefore, a condition not infrequently found at the present day. b) The kidneys of another mummy of the eighteenth to twen- tieth dynasties (1580-1050 B.C.) contained multiple abscesses with well-staining bacilli, and other lesions, which so far I have not yet diagnosed. The bacilli are found in the abscesses and their im- mediate neighbourhood, but nowhere else. They are short, straight bacilli, which take haematoxylin and basic aniline dyes readily, but not Gram's stain. They greatly resemble the bacillus coli, as seen at the present day. c) In the kidneys of two mummies of the twentieth dynasty 1 I have demonstrated a large number of calcified eggs of Bilharzia haematobia situated for the most part among the straight tubules. These kidneys had other lesions as well, which, owing to the shrunken state of the organs, I am unable to define as yet. Renal disease, therefore, was not infrequent among Egyptians living over three thousand years ago. Conclusion.— The only object of this paper has been to draw attention to the possibilities opened up by this method of study, with the hope of encouraging others to take up the same subject. I have purposely avoided giving histological details, as I hope to publish these and other results fully at some not very distant date. 1 Sec also British Medical Journal, January, 1910, p. 16. NOTE ON THE PRESENCE OF "BILHARZIA HAEMATO- BIA" IN EGYPTIAN MUMMIES OF THE TWENTIETH DYNASTY (1250-1000 B.C.) {British Medical Journal, January i, 1910) In a previous note published in this Journal, I described a process by which mummified tissues could be prepared for histologi- cal examination. I ventured to predict that it was highly probable that, by this method, one would be able to recognize pathological changes, such as cirrhosis, cancer, etc. Thanks to the kindness of Professor Elliot Smith, Professor Flinders Petrie, and Professor Keatinge, I have obtained several organs from mummies of the eighteenth to the twentieth dynasty, and I may state at once that such diseases as atheroma, pneumonia, renal abscesses, and cirrhosis of the liver are plainly recognizable. In the renal abscesses and in other lesions I have stained micro- organisms with methylene blue, fuchsin, haematoxylin, and even by Gram's method. At the present time there is perhaps no disease more important to Egypt than that caused by the Bilharzia haematobia. So far no evidence has been produced to show how long it has existed in this country, although medical papyri contain prescriptions against one of its most prominent symptoms — namely, haematuria. The lesions of this disease are best seen in the bladder and rectum, but unfortunately these are just the two mummified organs which 1 have not been able to obtain so far. Nevertheless, in the kidneys of two mummies of the twentieth dynasty, I have demonstrated in micro- scopic sections a large number of calcified eggs of Bilharzia haema- tobia, situated, for the most part, among the straight tubules. Although calcified, these eggs are easily recognizable and cannot be mistaken for anything else. I may add that I showed some of my sections to Professors Looss and Ferguson, whose paramount authority on such a subject cannot be disputed, and both confirmed my diagnosis. "BILHARZIA HAEMATOBIA" IN EGYPTIAN MUMMIES 19 I have examined microscopically the kidneys of six mummies. The kidneys of two were apparently healthy; the left kidney of another was congenitally atrophied; those of the fourth contained multiple abscesses with well-staining bacteria and other lesions, which so far I have not diagnosed; those of the fifth and sixth showed Bilharzia eggs, and the latter had other lesions as well, which, owing to the shrunken state of the organ, I am unable to define accurately as yet. ON ARTERIAL LESIONS FOUND IN EGYPTIAN MUMMIES (1580 B.C.— 525 A.D.) {Journal of Pathology and Bacteriology, Vol. XV [191 1]) The mummies examined came from the XVIIIth-XXVIIth Dynasties (1580 B.c-525 a.d.), and from the time of the Persian con- quest (500 B.C.). I also dissected a Greek 1 and a Coptic mummy, the latter dating from the fifth or sixth century after Christ. The investigations therefore range over a period of two thousand years — namely, from 1580 B.C. to 525 a.d. I take this opportunity of thanking Sir Gaston Maspero, Profes- sor Flinders Petrie, Professor Elliot Smith, Dr. Derry, and Dr. Keatinge for help. To the last gentleman my thanks are specially due for giving me a number of arms and legs from broken-up mum- mies of the XXIst Dynasty (1090-945 B.C.). These limbs were of no possible use as museum specimens, and I had no hesitation, there- fore, in dissecting them. Most of the preparations came from them. 2 DIFFICULTIES OF THE INQUIRY The chief difficulty consisted in the extensive mutilations made during the process of embalming. Dr. Elliot Smith has shown that at the time of the XXIst Dynasty, the embalmers removed the whole of the viscera, the aorta, and most of the muscles of the body. The body cavity and the holes left in the limbs after removal of the muscles are found filled with mud, sand or rags, or all three. The sole of the foot is packed with sawdust mixed with some "resinous" material. The muscles and big blood vessels of the 1 This mummy was given me as coming from the Greek period. Judging from the way it was embalmed, I am of opinion that it really dated from the XXIst and certainly not later than the XXIId Dynasty. ■ The only papers I know on the subject are: (a) Shattock, "Microscopic Sections of the Aorta of King Merneptah," Lancet, London, January 30, 1909; and (b) Armand Ruffer, " Remarks on the Histology and Pathological Anatomy of Egyptian Mummies," Cairo Scientific Journal, Vol. IV, January, 1910. Some of my pathological sections were shown at a meeting of the Cairo Scientific Society in December, 190S. ARTERIAL LESIONS IN EGYPTIAN MUMMIES 21 neck are also gone, the larynx is either pushed upwards or has been removed, and the neck is filled with mud or rags. The cheeks are filled out with a fatty material mixed with sand and sawdust, and the brain removed. It is only by accident, therefore, that the whole or a portion of the aorta, or one of the large arteries is left behind. Fortunately for our purpose, one artery, namely the posterior peroneal, owing to its deep situation, often escaped the embalmer's knife. In a few cases also, when the embalm- ers had evidently scamped their work, the arm or leg was untouched. After the removal of the foreign material, and when the limb is plunged in the softening solution, the walls of the cavity thus left are often found lined with a hard black material, not easily removed by water or a weakly alkaline solution. It must be taken away mechanically, and this often proves a very tedious process. When left standing in the hot and damp summer atmosphere of our laboratory, a brown gummy sticky fluid exudes out of this material. The same gummy substance is also found in bandages kept under similar conditions. I hope shortly to have some chemical evidence as to its nature. The limbs of such mummies of the XXVIIth Dynasty as I exam- ined were intact, but the body cavity had been almost cleaned out. The thoracic cavity contained an enormous quantity of jet black material showing a glistening surface, which I should certainly never have suspected of containing any tissue. In one case, however, a lump of this substance, which to the naked eye appeared to contain no tissue whatever, was placed in running hot water. The black substance slowly dissolved out, and then a small piece of aorta appeared, which, after long washing, showed exquisite calcareous patches. Mr. Lucas, who has chemically examined some of the material found in the mummies, will doubtless, later on, give the result of his researches. Suffice it to say that the black shiny material is not bitumen. Indeed, it is a striking fact that up to the present I have never found bitumen in any mummy, even in those of the Ptolemaic period. The Coptic mummy had apparently been simply dried, and there was no evidence of its having been embalmed in any way. 22 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT METHOD OF ISOLATING THE ARTERIES The mud, sand, bandages, and gummy material are first picked out with forceps, or slowly scraped away; a most unpleasant task, as the dust floating in thick clouds about the room is most irritating to the lungs. The "packing" does not appear to contain patho- genic microbes, as, in spite of numerous cuts and scratches, no inflammation followed. The limbs or trunk are thoroughly washed, and deep incisions are made into the skin wherever necessary. The parts to be exam- ined are then placed in a solution containing carbonate of soda i per cent and formol 0.5 to 1 per cent, and soaked for twenty-four to forty-eight hours, when the skin can be taken off as a rule. After a few days of this treatment, the remaining muscles, fasciae, etc., are soft enough to allow the arteries to be dissected out. Unfortunately, the condition of the tissues is very variable, part of one limb, for instance, softening quickly, the remainder more slowly, In some cases, without any apparent reason, the muscles remain as hard as stone. The arteries, especially the larger ones, such as the aorta, fem- oral, brachial, etc., are completely flattened out, looking as if they had been well ironed, and are therefore often difficult to find. If they have undergone marked fibroid or calcareous changes, the lumen may be patent and the vessel easily seen. The arteries are dissected out and placed in a fresh solution of the aforementioned fluid for twenty-four hours. All adhering con- nective tissue is now removed, and the vessels are plunged into glycerine to which a few drops of formol have been added. This solution must be changed two or three times in the course of the next few weeks, as some coloring matter invariably dissolves out. For microscopic examination small pieces of a calcified artery are placed in alcohol containing nitric acid, or better into Marchi's solution. 1 After twenty-four hours or longer the decalcified piece is washed in water for some hours, hardened, embedded in paraffin, and cut in the usual manner. 1 1 have given up alcohol and nitric acid, as Marchi's solution gives much better results. ARTERIAL LESIONS IN EGYPTIAN MUMMIES 23 Fibrous pieces were hardened in alcohol in the usual way. It is very difficult to know, however, whether a given artery does or does not contain small calcareous patches, so that for practical purposes it is always better to decalcify first. Marchi's solution does no harm, and by adopting this process much time will be saved. DESCRIPTION OF ARTERIES EXAMINED 1. Aorta (XX 1st Dynasty) consists of a piece 4! inches long, covered almost throughout its whole length by a hard calcareous plate. 2. Aorta (XVIIIth-XXth Dynasties). — The arch had been hacked away by the embalmer, who had also cut right through all the coats just above the bifurcation of the vessel. The thoracic aorta from a point just above the origin of the left subclavian artery and the whole of the abdominal aorta were intact and easily removed. The internal coat is studded with small calcareous patches, and the two largest, each nearly the size of a shilling, are situated just above the bifurcation. The left subclavian artery at a point just above its origin is almost blocked by a raised, ragged, calcareous excrescence, as large as a threepenny-bit (calcined atheromatous ulcer). Small atheromatous patches, not calcified, are scattered through the whole length of the aorta, and these, owing to the dark coloration of the tissues, are more easily felt than seen. The common carotid arteries show small patches of atheroma, but the most marked changes are found in the pelvic arteries and in those of the lower limbs. The common iliac arteries are studded with small patches of atheroma and calcareous degeneration. The other arteries of the pelvis are converted by calcification into rigid "bony" tubes, down to their minute ramifications. So stiff and brittle are they that it was impossible to dissect them out entire, and in spite of every possible care they were invariably broken. The minute intramuscular arteries were easily felt on triturating the muscles under the fingers. Both arms and the legs (about 6 inches below Poupart's ligament) had been lost, but on the right side the common femoral and profunda were dis- sected out. Both were converted into rigid calcareous tubes. It is to be noted that, as far as could be made out from the examination of the cartilages of the ribs, the mummy was not that of a very old person. 3. Atheromatous patches in the aorta and brachial arteries in a Greek mummy. — From the examination of the cartilages, etc., I concluded at the time that the man was not above 50 years old at the time of death. 4. Piece of thoracic aorta (XXVIIth Dynasty), altogether 4^ inches long. It contains seven calcareous patches, two of which are figured in Plate III, Fig. .3. No other lesion. 24 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT 5. Aorta from a Coptic mummy. — Small hard calcareous patches scattered throughout its length. The two largest are just above the bifurcation and are almost the size of a sixpenny-piece. 6. and 7. Pieces of two aortae, thoracic {XXI st Dynasty). — No lesions. 8. Posterior tibial artery. — From a woman of the XXIst Dynasty, calcified from end to end. 9. Posterior peroneal artery. — A piece about 4 inches long. Artery stiff, lumen patent; evidently calcareous in places. After soaking, artery still very stiff; calcareous patches visible from outside. On opening, internal and middle coats almost completely calcified in places. In other places, vessel studded with minute calcareous nodules projecting into the lumen of the tube, hardly any healthy tissue being left between nodules. 10. Anterior tibial artery. — Apparently healthy, though lumen patent. On careful examination with lens, small points about the size of a pin's head> of a darkish brown color. Microscopically these points were found to be foci of disease. 11. Posterior tibial artery. — One piece about 6 inches long. This is com- pletely calcified, the whole being converted into a rigid calcareous tube. 12. Posterior peroneal. — Apparently quite normal. The contrast between this smooth, highly flexible artery and the diseased vessels is most striking. 13. Posterior peroneal artery. — Quite soft and flexible, but here and there small highly colored brown patches project into the lumen. 14. A small piece of anterior tibial artery and dorsalis pedis. — Walls not markedly thickened, but distinctly nodular, with dark brown small nodules projecting into lumen. 15. Femoral, profunda, and branches. — Very tortuous and almost com- pletely calcified. 16. Posterior tibial and branches. — Almost completely calcified from end to end. 17. A piece of artery found mixed with the packing of the leg. — Apparently quite normal. 18. Part of posterior tibial and peroneal artery. — Stiff, but no other changes to the naked eye. 19. Piece of ulnar artery, about 3 inches long. — Lumen patent and artery stiff after soaking and being plunged in glycerine for weeks. It has a curiously mottled, brown and white appearance. On cutting sections, fairly extensive calcification was discovered. 20. Several small pieces of a brachial artery.— In glycerine it becomes beautifully transparent, light yellow in color, but in spite of several weeks' soaking the longitudinal folds do not disappear. From the outside small brownish spots are seen studding it. On opening, these spots are seen to be small nodules projecting into the lumen. Some have a whitish centre with a brown irregular margin. ARTERIAL LESIONS IN EGYPTIAN MUMMIES 25 21. Ulnar artery. — Apparently quite normal. 22. Part of palmar arch, soft and flexible. — Small brownish patches in first digital branch. 23. Ulnar artery. — Apparently normal. 24. Brachial, ulnar, and two inches of radial arteries. — Ulnar and radial almost completely ossified. Brachial studded throughout its length with brownish prominent patches projecting into lumen of the tube. These are mostly quite soft, but the centre of some is undoubtedly calcified. The whole artery is markedly thicker than it should be. N.B. — When not otherwise stated the mummies belonged to the XXIst Dynasty. The results noted may be summed up as follows: 1. Complete or incomplete calcification. — There is no difficulty in recognising completely or partially calcified arteries. Even before they are placed in the softening solution, or at any rate shortly afterwards, their hard, "osseous" structure is manifest. Arteries, such as are depicted in Plate III, Fig. 1, are as rigid as calcified arteries of the present day. When slit up, even with the finest scissors and the greatest care, the calcareous middle and inner coats have a tendency to detach themselves from the adventitia, and to break up into small brown roughly rectangular plates (see Plate III, Fig. 2). In this picture a small artery just branching off shows well-marked calcareous change. After decalcification in picric acid and staining, microscopical sections of such arteries are most interesting and will be best under- stood by examining Plate IV, Fig. 9 This shows, under a low power, a decalcified posterior peroneal artery, stained by Van Gieson's method, from a mummy of the XXIst Dynasty. The section is perhaps not quite satisfactory, in so far that, nearly the whole of the artery being diseased, it is difficult to find points of comparison between healthy and calcareous tissue. Only shreds of endothelium and fenestrated membrane, for instance, are left at a, ai, and 02. The point of interest is that the muscular coat has been changed almost wholly by calcification, following on degeneration of the muscle fibre, into a magma of no particular structure. The disease clearly did not begin in one spot, but in several foci which coalesced, 26 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT as at b, for example. When the section is stained with haematoxy- lin alone the calcified parts are coloured so black that hardly any structure is recognisable. Plate IV, Fig. 10, represents part of a calcified ulnar artery under a high power (same stain as previously). In this section the muscular fibres at a have been completely destroyed by calcification, so that no structure is recognisable. At b, on the other hand, the annular fibres are still indicated, though somewhat vaguely, whereas at c they are plainly visible. To the naked eye this artery appeared to be completely calcified. Partial calcification was best seen in the aorta, and is well illus- trated by Figs. 3 and 4 in Plate III. Here we see calcareous patches in two aortae. Fig. 3 represents part of the abdominal aorta of a mummy of the XXVIIth Dynasty, and Fig. 4 a piece of a thoracic aorta dating from the same dynasty. The flattened vessel did not open out again, in spite of long soaking in glycerine, but remained angular. The calcareous patches are quite obvious, and it is unnecessary to describe them any further. In the aorta depicted in Plate III, Fig. 3, they projected to a considerable extent into the lumen of the tube. Such aortae are not good objects for microscopical examination, because, however careful the decalcification, the calcified part almost invariably falls off. In the calcified part nothing can be seen except a few shreds of muscular tissue lying between oval or round masses of calcified material staining almost black with haematoxylin. In the coats of the aorta, beneath the wholly calcified parts, one sees almost normal muscular fibres, but here and there are small round darkly staining masses such as have been already described in the posterior peroneal and radial arteries. These are manifestly patches of incipient calcareous degeneration. An interesting point is that very often the disease seems to pick (see, for instance, Plate III, Fig. 4) just the point of origin of the smaller arteries. On examining carefully the inner lining of such an artery, one often sees small brownish nodules. These, however, are much more evident in the smaller arteries and will be described more fully here- ARTERIAL LESIONS IN EGYPTIAN MUMMIES 27 after. Indeed, in the larger vessels they are much more easily felt than seen. 1 In one subclavian artery of the XVIIIth-XXth Dynasties the lumen of the artery near its origin was almost blocked by a ragged calcareous excrescence, depicted in Plate III, Fig. 5. There can be no doubt that this person narrowly escaped embolism. 2. Partial calcification and atheroma. — When an artery like the femoral or brachial is partly or completely calcified, there can be no difficulty in recognising such a lesion. The case is differ- ent, however, when the lesions are slight, as they are com- pletely obscured by the colouring matter and the opacity of the tissue. Good results can be obtained, however, by soaking pieces in glycerine to which a few drops of formol have been added, when, after a few days, the tissues become transparent. In many cases, even before the artery is opened, one sees through the coat (Plate III, Fig. 8) small dark brown patches, which are then also felt easily. When the artery is opened these patches are seen to protrude into the lumen (Plate III, Figs. 6 and 7), and sometimes they have a hard white centre (Plate III, Fig. 6) , which is manifestly calcareous to the touch. In pieces of such an artery, hardened and stained in the usual way, these patches are found to be just under the fenestrated mem- brane, which is easily recognised at one or both edges of the prepara- tion (Plate V, Figs. 116 and 1 2) . The inner membrane of the artery is often intact; sometimes the lesion has evidently broken through it (Plate V, Fig. 12). The lesion, therefore, is in the middle coat of the artery, the muscle fibres of which are transformed into dark deeply staining strands, which have evidently undergone some very marked degeneration (Plate V, Fig. nd, e,f, and Fig. 12). Very often nothing more can be seen, and there is no sign of emigration of leucocytes in or around the diseased tissue. 1 In this connection it must not be forgotten that, for some unexplained reason, air bubbles arc often present between the middle and inner coat. These cause the inner coat to bulge outwards, causing an appearance as if the aorta were studded with small atheromatous patches. A little pressure at once causes them to flatten out and di appear. 28 STUDIES IN THE PALEOPATHOLOGY OF EGYPT In some arteries, however, I have seen around the degenerated patch small irregular bodies, which may or may not be leucocytes (Plate V, Fig. 13a). I do not attach much importance to this absence of leucocytes, as I know from experience that leucocytes are hardly ever found in mummies, even in such tissues and lesions where we know that they must have been present in considerable numbers during life. Why this should be the case need not be discussed here. I have already drawn attention to the fact that some arteries, although not necessarily showing any sign of calcification or other degeneration, feel like whip-cord and are plainly thickened, though they are not atheromatous. I regret that I cannot show any satis- factory microscopical specimens illustrating this fibroid change. When we remember that the thickness of an artery in microscopical sections of the tissues from fresh bodies depends on many condi- tions, it will be manifest that in mummified bodies comparison and inferences are practically impossible. Moreover, at present 1 can- not always distinguish, with certainty, fibrous from unstriated muscular tissues in mummies. I repeat, however, that to the naked eye and to the touch some arteries are distinctly thickened and fibrous. DISCUSSION OF RESULTS Nature of the lesions. — There can be no doubt respecting the calcification of arteries, and that it is of exactly the same nature as we see at the present day, namely, calcification following on atheroma. The small patches seen in the arteries are atheromatous, and though the vessels have without doubt been altered by the three thousand years or so which have elapsed since death, nevertheless the lesions are still recognisable by their position and microscopical structure. The earliest signs of the disease are always seen in or close below the fenestrated membrane — that is, just in the position where early lesions are seen at the present time. The disease is characterised by a marked degeneration of the muscular coat and of the endothe- lium. These diseased patches, discrete at first, fuse together later, ARTERIAL LESIONS IN EGYPTIAN MUMMIES 29 and finally form comparatively large areas of degenerated tissue, which may reach the surface and open out into the lumen of the tube. I need not point out how completely this description agrees with that of the same disease as seen at the present time. I have already mentioned the absence of leucocytes and cellular infiltration, and need not therefore return to it here. In my opinion, therefore, the old Egyptians suffered as much as we do from arterial lesions identical with those found in the present time. Moreover, when we consider that few of the arteries exam- ined were quite healthy, it would appear that such lesions were as frequent three thousand years ago as they are to-day. The etiology of this disease three thousand years ago is as obscure as it is in modern people. One cause which is supposed to play a part in modern times, namely tobacco, can certainly be eliminated, as this drug was not used in ancient Egypt. Syphilis also can be eliminated with considerable certainty, as no pathological specimens of this disease in ancient Egyptians have as yet been discovered. Alcohol played a part in Egyptian social life, in so far that on festive occasions some of the old Egyptians certainly got drunk, as is shown by pictures found in Egyptian tombs. Beer was a common beverage, and wine was not only made in the country but also imported. It is clear, however, that the Egyptians as a race are not and never have been habitual drunkards. If I may be allowed a short digression, I would remark in this connection that my personal experience has led me to call in ques- tion the importance of alcohol as a cause of arterial disease. During the Mussulman pilgrimage, I have made over eight hundred post- mortem examinations of people who had certainly never touched alcohol in their lives, and I have found that disease of the arteries is certainly as common and occurs as early in total abstainers as in people who take alcohol regularly. Another favourite cause invoked for the production of arterial disease is the supposed increased wear and tear of modern life. 30 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT This has always appeared to me an extraordinary theory, consider- ing that people, even as late as the beginning of last century, worked far harder and had much greater difficulty in getting their living than in the present day. In my opinion, the theory that the wear and tear of human life has increased is a myth, the fact being that our life is easier and that we work less than did our ancestors. There is no evidence that old Egyptians worked hard either mentally or physically. Indeed, the time-tables of workmen which have been discovered show that the Egyptian navvies of ancient times toiled practically the same hours as the Egyptians do now. They enjoyed a holiday every seven days, as do many nations at the present time. I do not think we can accuse a very heavy meat diet. Meat is and always has been something of a luxury in Egypt, and although on the tables of offerings of old Egyptians haunches of beef, geese, and ducks are prominent, the vegetable offerings are always present in greater number. The diet then as now was mostly a vegetable one, and often very coarse, as is shown by the worn appearance of the crown of the teeth. Nevertheless, I cannot exclude a high meat diet as a cause with certainty, as the mummies examined were mostly those of priests and priestesses of Deir el-Bahri, who, owing to their high position, undoubtedly lived well. I must add, however, that I have seen advanced arterial disease in young modern Egyptians who ate meat very occasionally. In fact, my experience in Egypt and in the East has not strengthened the theory that meat-eating is a cause of arterial disease. Finally, strenuous muscular exercise can also be excluded as a cause, as there is no evidence that ancient Egyptians were greatly addicted to athletic sport, although we know that they liked watch- ing professional acrobats and dancers. In the case of the priests of Deir el-Bahri, it is very improbable, indeed, that they were in the habit of doing very hard manual work or of taking much muscular exercise. I cannot therefore at present give any reason why arterial disease should have been so prevalent in ancient Egypt. I think, however, that it is interesting to find that it was common, and that three PLATE III J ■ : Fig. 4 * PLATE IV Fig. 9 r^ h PLATE V .J • V* S ~£ Fig. 13 i ARTERIAL LESIONS IN EGYPTIAN MUMMIES 31 thousand years ago it represented the same anatomical characters as it does now. DESCRIPTION OF PLATES III-V (For particulars see text) PLATE III Fig. 1. — Pelvic and arteries of thigh completely calcified (XVIII th-XXth Dynasties). Fig. 2. — Completely calcined profunda artery after soaking in glycerine (XXIst Dynasty). Fig. 3. — Partly calcified aorta (XXVIIth Dynasty). Fig. 4. — Calcified patches in aorta (XXVIIth Dynasty). Fig. 5. — Calcified atheromatous ulcer of subclavian artery (XVIIIth- XXth Dynasties). Fig. 6. — Patch of atheroma in anterior tibial artery (glycerine). The centre of the patch is calcified (XXIst Dynasty) . Fig. 7. — Atheroma of brachial artery (glycerine) (XXIst Dynasty). Fig. 8. — Unopened ulnar artery, atheromatous patch shining through (glycerine) (XXIst Dynasty). PLATE IV Fig. 9. — Section through almost completely calcified posterior peroneal artery (low power). Van Gieson staining, a, ai, 0,2, remnants of endothelium and fenestrated membrane ; b, calcified patches. Many more are seen. Fig. 10. — Section through calcified patch of ulnar artery. Same stain. (Leitz, Oc. 1, XtV.) a, d, calcified patches; b, partially calcified muscular coat; c, annular muscular fibre. plate v Fig. 11. — Section through atheromatous patch of anterior tibial artery. Same stain. (Leitz, Oc. 1, X iV) a, remains of endothelium; b, fenestrated membrane; c, muscular coat; d, f, membrane coat undergoing degeneration; e, completely degenerated remnants of muscular coat. Fig. 12. — Section through atheromatous patch of ulnar artery. Same stain. (Leitz, Oc. 1, Xn-) (Reference letters the same as in Fig. n.) Fig. 13. — Section at edge of atheromatous patch. Haematoxylin stain. (Leitz, Oc. 1, XAO a, leucocytes (?). The atheromatous part on the left stains intensely dark with haematoxylin. AN ERUPTION RESEMBLING THAT OF VARIOLA IN THE SKIN OF A MUMMY OF THE TWENTIETH DYNASTY (1200-1100 B.C.) 1 {Journal of Pathology and Bacteriology, Vol. XV [191 1]) The body from which the skin was taken was that of a tall man of middle age. It was brought to the attention of one of us by Professor G. Elliot Smith during his investigations into the process of mummification as illustrated in the royal mummies in the Cairo Museum of Antiquities. The body was the seat of a peculiar vesicu- lar or bulbous eruption which in form and general distribution bore a striking resemblance to that of small-pox. The portion of skin we were permitted to remove, and which forms the subject of the present note, was taken from the adductor surface of the right thigh. The eruption on the inner surface of the thigh was, as the drawing shows (see Plate VI, Fig. 1), a closely set vesicular one, and it was in this situation that the general resemblance to small-pox was most noticeable. Small portions of skin were treated by the following method: 2 (1) The tissue was softened in a solution of sodium carbonate mixed with alcohol (alcohol, 100 parts; water, 15 parts; 5 per cent solu- tion of sodium carbonate, 60 parts) ; (2) this solution was replaced by 30 per cent alcohol, and the tissue gradually brought thereafter into absolute alcohol, and embedded in paraffin. A reference to Plate VI, Fig. 2 (a low-power drawing of a micro- scopical section), shows that the superficial epithelial covering is very much disintegrated, all traces of Malpighian layer and its papillae having disappeared. No nuclear staining is discernible in any of the sections, a considerable number of which were stained and examined. The skin is everywhere broken up into a series of deeply staining lamellae or blocks. The dermis shows a more definite structure, and its wavy fibrillae and bundles are easily dis- 1 This paper was written with A. R. Ferguson as junior author. 2 Marc Armand Ruffer, British Medical Journal, I (London, 1909), 1005. ERUPTION RESEMBLING VARIOLA 33 cernible. No distinct vessels, however, can be made out. On looking at the skin layer with a planatic magnifier, the presence of the dome-shaped vesicles is clearly demonstrated. They must have originated and developed in the middle of the prickle layer, i.e., in the situation in which the small-pox eruption is first seen. In the fully matured state of the vesicles, as they are present in the skin under consideration, their bases are formed by the deepest (Malpighian) layer, whilst the elevated superficial layers of the epidermis form their roofs. In one or two of the sections examined there are traces of the vertical septa and curtains which subdivide the developing vesicle in small-pox. The structure of the dermis has been much less interfered with, and wavy or curling hyaline fibrillae of the fibro-areolar tissue are as distinct as in many similar sections from freshly fixed tissues. There are no traces of cellular infiltration beneath the vesicles. Sections stained by Gram's method reveal very large numbers of bacteria, the large majority of which are strongly Gram-positive. By far the largest proportion of these occur in the connective tissue of the dermis, where they are met with either in dense clusters or diffusely sprinkled throughout the tissue, following the lines of separation of the fibrillar bundles. Occasionally, however, they are seen to follow the track of what may have been a small vessel, the direction of which is more or less oblique to the surface (see Plate VI, Fig. 3). Owing to the tenacity with which the epithelial layer retains the Gram's stain, the presence of bacteria amongst the epithelial remains is impossible to establish. Careful search, how- ever, in sections stained with methylene-blue, leaves no doubt as to their presence here also. They appear to be more numerous in the neighbourhood of the vesicles than elsewhere. The organisms present in the largest numbers are short, plump bacilli, often swollen at one end, so as in many instances to resemble one of the drum-stick bacilli. Others are distinctly beaded in form or have a torpedo shape. A cluster of bacilli with such characters bears a superficial resemblance to a group of diphtheria-like organisms. A few micro- cocci also occur; these are more apparent in sections stained with methylene-blue (see Plate VI, Fig. 4). 34 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT It is certainly unusual to find the sub-epithelial tissue so invaded by bacteria in small-pox as in the skin under consideration. Nor do we wish to maintain that these organisms played any part during the progress of the malady (supposing it to have been small-pox) ; but, after careful examination of a large number of sections, we are of opinion that these bacteria were present in the body at the time of death, although they have probably multiplied enormously after death. It may be firmly surmised that bacteria already present in the tissues might in some cases greatly multiply locally between the time of death and the mummification proper. The specimen which we have described thus provides several points of quite exceptional interest, among which may be mentioned : i. The probable existence of small-pox as evidenced by as characteristic an eruption as the conditions of preservation of such ancient material permits. 2. The conservation of the form of minute organisms such as bacteria after such a phenomenal period. 3. The demonstrability of bacteria in mummified tissues by modern staining methods. DESCRIPTION OF PLATE VI Fig. 1. — Naked-eye view of skin. Fig. 2. — Microscopic section of skin under low power. Fig. 3. — Section through dermis; Gram and eosin; Zeiss, DD, Compens. Oc. 6. Fig 4. — Section through dermis; methylene-blue ; Zeiss, DD, Compens. Oc. 6. PLATE VI F.oJ ' ' \* Re3 AKP. - . . * - - ■ - i P.O. 2. ON DWARFS AND OTHER DEFORMED PERSONS IN ANCIENT EGYPT (Bulletin de la Societe Archeologique d'Alexandrie, No. 13) It is not a little strange that certain deformed individuals should have had, from time immemorial, and should even now have a peculiar fascination for some men and women. Of these misshapen human creatures, perhaps the most popular have been dwarfs and hunchbacks. Even at the present time, dwarfs are kept in the household of several Eastern potentates, and some have a distinct influence at court. It is altogether outside the scope of this paper to try and explain this strange taste, the reasons for which are very complicated. There is a superstition for instance, not only in the Levant but also in some parts of Europe, that to touch a hunchback's hump brings good fortune. ^Mythology and folklore have endowed dwarfs or gnomes with supernatural powers.) Hunchbacks also enjoy an unmerited reputation as merry grigs; witness the French expression s'amuser comme un bossu. Dwarfs were kept as pets in the palaces of kings, princes, and nobles during the Renaissance and Middle Ages. I would suggest, though without being able to adduce any proof, that this fashion was introduced in Europe by the Crusaders returned from the East. Painters such as Raphael, Titian, Mantegna, Veronese, Carpaccio, and others introduced dwarfs into their pictures, nor did they disdain to paint their portraits. An excellent account of this branch of art has been written by Richer. 1 Among the Romans, nani were kept in rich houses for the amuse- ment of inmates and guests. 2 The fashion may have come from Syria, but not from Greece, as dwarfs do not seem to have been a feature in households of Greece proper before the Roman conquest. In Lucian's banquet, the host introduces a dwarf to amuse his 1 (Jr. J'aul Richer, L'Arl el la Mtdecine. ' See Smith's Dictionary of Archeology. 36 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT guests, and he falling foul of the pompous philosopher present, a fierce fight ensues between the two ill-matched adversaries, the philosopher getting much the worst of it. At Rome, great ladies especially delighted in dwarfs, as Livia and Seneca's wife; and the prevalence of the fashion at Rome is marked by Suetonius, when he mentions particularly that Augustus did not care for them. There is no clear distinction between nanus or pumilio or pumilus, the dwarf, and morio, the jester, since the jesters seem to have been selected for their absurd appearance as well as for that power, often found in the malformed, of making comical remarks for which mediaeval jesters were in demand. There seem to have been several kinds of dwarfs. One of them 1 is described as "acuto capite et auribus longis" and in another place 2 it is said "si solum spectas hominis caput, Hectora credas, si stantem videas Astyan- acta putas, " which indeed exactly describes the deformity due to the comparatively big head and short limbs of an achondroplastic dwarf. Some dwarfs were possibly cretins or myxoedematous dwarfs. 3 Misshapen limbs as well as small stature added to their price, and the most revolting part of the fashion was that the deformity was sometimes caused by artificial means, the children being kept in a case or frame which would stunt or distort their growth. 4 The Romans kept female as well as male dwarfs. Amongst the extreme cases recorded on ancient authority one may notice Philetus, a contemporary of Hippocrates, who was so small that he "had to ballast himself to avoid being carried away by the wind"; the Egyptian dwarf mentioned by Nicephorus Callistus, who "at the age of 25 years did not exceed a partridge in size, " and lastly the poet Arisastus, of whom Athenaeus records that he was so small that "no one could see him. " I leave the reader to make whatever allowance he thinks fit for exaggeration. Little is known about dwarfs among the Jews, except that they are mentioned among those who were forbidden access to the temple. 1 Mart. vi. 39. 2 Mart. xiv. 212. 3 Mart. viii. 12. * I confess to much scepticism with regard to the possibility of making dwarfs artificially. ON DWARFS 37 In Egypt, dwarfs were common, and indeed, the pictures, statuettes, etc., found in this country copied nature with such fidelity that in many cases it is possible to recognise to what disease the deformity was due. Nevertheless, many Egyptologists, instead of regarding dwarfs as pathological specimens, look upon them as having been pygmies brought into Egypt from Central Africa. In order to illustrate this view I can do no better than quote the most modern, excellent, and learned work, namely the History of Egypt by Breasted. Breasted relates that: in the young king's [Pepi II, about 2400 B.C.] second year, Harkhuf, one of the king's best officers, was for the fourth time despatched to Yam, 1 whence he returned bringing a rich pack train and a dwarf (Figs. 41, 75) from one of the pygmy tribes of Central Africa. Breasted adds: These uncouth, bandylegged figures were highly prized by the noble class of Egypt; they were not unlike the merry genius Bes in appearance, and they executed dances in which the Egyptians took the greatest delight. The land from which they came was connected by the Nile dwellers with the mysterious regions of the West, the sojourn of the dead, which they called "the land of the spirits" and the dwarfs from this sacred land were especially desired for the dances with which the king's leisure hours were diverted. I have copied Fig. 41 (Plate VIII, Fig. 1), and Fig. 75 of Breasted's book is represented here by the excellent photograph of the dwarf Chnoum-hotep, given me by my friend His Excellency E. Brugsch Pasha (Plate VII). A glance at these figures shows that they do not represent pygmies, but typical achondroplastic dwarfs. Granted that Egyptians brought pygmies back from Central Africa, it does not follow that all or even the majority of dwarfs in Ancient Egypt were pygmies. I have examined carefully hundreds of illustrations of people depicted in ancient Egyptian monuments, without finding a true pygmy among them. On the contrary, the dwarfs figured in tombs are always typi- cally pathological specimens. Indeed, Edward Tyson in 1699 had ' A country in the South, probably Central Africa. 38 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT already pointed out the mistake into which some authors had fallen by grouping together pygmies and dwarfs. He wrote : Now by Men Pygmies we are by no means to understand Dwarfs. In all Countries, and in all Ages, there have been now and then observed such bvMiniature of Mankind, or under-sized Men. Cardan (de subtilitate lib. II, p. 458) tells us that he saw one carried in a Parrot's cage, that was but a Cubit high. Nicephorus tells us (Nicephor. Histor. Ecclesiast. lib. 12. cap. 37) that in Theodosious the Emperour's time, there was one in Aegypt that was no bigger than a Partridge; yet what was to be admired, he was very Prudent, had a sweet clear Voice, and a generous Mind; and lived Twenty Years. So likewise a King of Portugal sent to a Duke of Savoy, when he married his daughter to him, an Aethiopian Dwarf but three Palms high (Happelius in Relat. Curiosis. No. 85, p. 677). And Thevenot (Voyage de Levant lib. 2. c. 68.) tells us that the Present made by the King of the Abyssins, to the Grand Signor, of several little black Slaves out of Nubia, and the countries near Aethiopia, which being made Eunuchs, were to guard the Ladies of the Seraglio. And a great many such like Relations there are. But these being only Dwarfs, they must not be esteemed the Pygmies we are enquiring about, which are represented as a Nation, and the whole Race of them to be of the like stature. 1 I I will begin by the description of a dwarf who has already figured as an achondroplastic dwarf in Dr. P. Richer's book. The name of this person was Chnoum-hotep (Plate VII), and his limestone statuette, now in the Cairo Museum, was found at Saqqarah. He lived in the Vth Dynasty (about 2700 B.C.), that is, about 4,500 years ago. Le nain a la t£te grosse, barrelee, cantonnee de deux vastes oreilles. La figure est niaise. [I do not agree with Sir Gaston here, as the face to me appears rather cunning than otherwise.] L'ceil, ouvert etroitement, est retrousse vers les tempes, la bouche mal fendue. La poitrine est robuste et bien developpee, mais le torse n'est pas en proportion avec le reste du corps ; l'artiste a eu beau s'ingenier a. en voiler la partie inferieure sous une ample jupe blanche, on sent qu'il est trop long pour les bras et pour les jambes. Le ventre se projette en pointe et les hanches se retirent pour faire contrepoids au ventre. Les cuisses n'existent guere qu'a l'etat rudimentaire, et l'individu entier, campe qu'il est sur des petits pieds contrefaits, semble etre hors d'aplomb et pret a tomber face contre terre. The description is from every point of view perfectly correct. It is obvious that the large head and bust are out of all proportion 1 A Pathological Essay Concerning the Pygmies of the Ancients, by Edward Tyson, a.d. 1699, now edited, with an introduction treating of pygmy races and fairy tales, by Bertram C. A. Windle. ON DWARFS 39 to the diminutive lower limbs. The knot in the girdle is well above the symphysis pubis, which, judging from the position of the umbilicus, I take to be level with or just a little below the tips of the fingers. The femur is very short, and there is same diminu- tion in length of the bones of the legs. The feet are squat and flat. The bones of the upper limbs, as compared to the length of the trunk, are much shorter than they should be, as the tips of the fingers only reach the top of the thigh. The arms do not hang down straight, but away from the sides, and the palms of the hands are turned forwards. There is probably some deformity of the legs also, but this is hidden by the skirt. The hands are squat. A certain amount of lordosis 1 is present also. Otherwise the little man is strongly built, and the muscular develop- ment of the arms specially well marked. In fact, this statuette shows the chief characteristics of an achon- droplastic dwarf, namely disproportion between the size of the trunk and limbs, the latter being much too short for the former, a head too large in proportion to the size of the body, and good muscular development. The description of achondroplasia in any modern textbook of medicine exactly applies to this dwarf. The only other possible diagnosis, namely that of myxoedema, is negatived by the fact that this person held a high position at court. His tomb was one of the finest and richest at Saqqarah, and according to Maspero he was "Chief of the Perfumes" or "Head of the Wardrobe." No myxoedematous dwarf, whose mental faculties are generally impaired, could have held court functions, which, among the intrigues of the East, must have required no little tact and cleverness. Achondroplastic dwarfs are not stupid as a rule, and are often distinctly cunning. Some have occupied important functions at court as jesters. Muscularly they are well developed and not unfrequently at the present time earn their living as dancers and acrobats. 2 As will be seen presently, they had definite duties assigned them in Egyptian households. ' I.'-., forward curvature of the lumbar spine. ' lioth in Pari- and London a< hondroplastic dwarfs are appearing on the music- at I be pre ent time. 40 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT The other illustration, which Breasted gives as representing pygmies, comes from a tomb of the Old Empire and represents four dwarfs working at jewelry. The copy which is shown here (Plate VIII, Fig. i) demonstrates that these persons were not pygmies, but achondroplastic dwarfs of the same class as Chnoum-hotep. Though the body is well developed, the arms and especially the lower limbs are stunted. The picture shows incidentally how care- fully Egyptian artists followed nature sometimes, as in the extreme left of the picture a fat man has been introduced whose obesity is in sharp contrast with the spare bodies of this fellow workman. Several other achondroplastic dwarfs have been copied by archaeologists on monuments of ancient Egypt. Perhaps the oldest is the "dwarf of Zer" (Plate VIII, Fig. 2) discovered by Flinders Petrie at Abydos, and dating from about 4715-4658 B.C. The drawing, a mere outline on a bowl of metamorphic rock, is wonderfully spirited, as Petrie has remarked. Some of the characteristics of an achondroplastic dwarf are obvious, as for in- stance the great length and breadth of the trunk as compared with the lower limbs. The shortness of the thighs and the great muscu- lar development are noticeable, but the right lower limb is so foreshortened that it is practically impossible to say where the thigh ends and the leg begins. The arms are short also. The head, how- ever, is not characteristic, being small and the features sharp and intelligent. Nevertheless, the other characteristics justify the diagnosis of achondroplasia. It is only right to add that Petrie had recognised the dwarfish nature of this person. Many similar dwarfs are depicted on Egyptian monuments, and a few more instances may be given. Plate VIII, Fig. 3, shows two dwarfs from the tomb of Aba, about 2400 B.C., 1 at work in the manufacture of necklaces. The contrast between the size of the trunk and the lower limbs is well marked, though other details are obscured. In the same work 2 a dwarf (Plate VIII, Fig. 4), perhaps one of the four just mentioned, is seen standing under his master's chair holding a mirror in his hand. The dwarf looks exceedingly small, 1 N. de G. Davies, Deir el Gebrawi, Plate XIII. 2 Plate XVII. ON DWARFS 41 but as the Egyptian artist always drew the master much larger in proportion to the other people in the picture, no opinion can be formed regarding the real size of the little man. Two more achondroplastic dwarfs (Plate VIII, Fig. 5) are repre- sented on the walls of a tomb at Deshasheh, dating from the middle of the Vth Dynasty (about 2700 B.C.). 1 The one on the left of the picture holds a necklace in his right hand and carries a box on his head, whereas the other is busy at the work table. In both the characteristic deformity is accurately shown. • In the same tomb a dwarf is represented (Plate VIII, Fig. 6) holding a sling ( ?) in his hand and standing in the prow of a boat. The contrast between the slim oarsman and the squat dwarf is very noticeable. In the tombs of Sheikh Said, dating from the Vth Dynasty prob- ably, a dwarf (Plate VIII, Fig. 7) holding a monkey in leash stands under his master's chair, and another (Plate VIII, Fig. 8) leads a greyhound. Although both figures are in a bad state of preserva- tion, yet the deformities are recognisable. The female dwarf (Plate IX, Fig. 9) discovered at Athribis 2 dates from the IVth Dynasty. It is not a very good specimen, though the squat figure shows off the slim, naked girl walking in front. Other achondroplastic dwarfs might doubtless be found on Egyptian monuments, but in my opinion the examples copied here are sufficient to show that this disease has been in existence for the last five thousand years at least, and that it presented then the same pathological characteristics as it does now. The occupations of these little people, in the majority of cases, appear to have been of two kinds. The first was the care of pet animals, and it is not a little odd that in comparatively modern times they should have been similarly employed. The Egyptian dwarf is seen leading his master's greyhound or holding a monkey in leash, the Italian dwarf is caressing a greyhound (see Tiepolo's picture in the Berlin Museum), and Valesquez has painted an English dwarf holding a greyhound in leash (see the picture of Don Antonio, the Englishman, by Velasquez in the Madrid Museum). 1 Petrie, Desha tfu h. ' Pel rie, Athribis, Plate I. 42 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT Another occupation was the care and making of jewelry. An eminent Egyptologist has suggested to me that valuables were entrusted to dwarfs, because their deformities provided an easy means of identification if they ran away with their master's prop- erty. This view appears to me to be probably correct. II I may now pass on to the description of some other malformed persons depicted on Egyptian tombs. The first that I would draw attention to represents two young people copied by Mr. Percy New- berry, from the walls of tombs at Beni-Hassan, dating from the XI th and Xllth Dynasties (about 2000 B.C.). One of them has already been figured by Richer in the work quoted already (Plate IX, Fig. 1 ob and Fig. n). The diagnosis here is easy, for the position of the feet is typical of talipes equino-varus. 1 Notice the contrast between these youths and the achondroplastic dwarfs previously described, for in the case of the club-footed people, the proportion between the length of the limbs and that of the body is almost normal. The female dwarfs (Plate IX, Fig. 13) with well-marked talipes equino-varus are represented on the walls of the tomb at El Amarna, dating from the XVIIIth Dynasty (1375 B.C.). Next to them the artist has represented one of the king's daughters, and the contrast between the slim child and the deformed little figures is most striking. Ill Two other figures show the typical features of Pott's disease. In the first (Plate IX, Fig. 15) discovered in the tombs of Beni- Hassan (Xlth-XIIth Dynasties, about 2000 B.C.) the characteristic deformity occupies the upper dorsal and lower cervical region. In consequence, the head is protruded slightly forwards. The other (Plate IX, Fig. 14) was copied from a tomb at El Amarna and dates from the XVIIIth Dynasty. The hump in this case occupies the lower dorsal or lumbar region. These are the only two examples of Pott's disease that I have found so far on old Egyptian monuments. They acquire impor- 'Anglice: club-foot. ON DWARFS 43 tance from the fact that they date from nearly two thousand years before Christ. Mme Constantine Sinadino of Alexandria owns a little, marble statuette dating from the Greek period, which shows the charac- teristic deformity of Pott's disease (Plate X, Fig. 2). Another statuette in the Alexandria Museum hollowed in the shape of a pot, and dating from the Graeco-Roman period, shows a similar deformity (Plate X, Fig. 3). IV There is some evidence also that rickets existed in Old Egypt. The man outlined in Plate IX, Fig. 106, shows considerable enlarge- ment of the cranium, which is evident on comparing his head with those of his companions. The smallness of the face accentuates the deformity. The squareness of the trunk suggests an adult man, the breadth being out of proportion to the length of the body. On the other hand, the trunk does not appear to be much too long for the limbs. The lower limbs are greatly deformed and the bowed legs are typical of rickets. The foot is flat, whereas the arch of the foot in people from the same period is high. In my opinion, we are here in presence of a case of rickets, with evident deformity of the legs, and probably some amount of hydro- cephalus also. Achondroplasia and myxoedema are plainly out of the question. A dwarf (Plate IX, Fig. 12) from another tomb at Beni-Hassan shows deformities similar to the preceding one. The head, how- ever, does not appear to be larger than usual. The little person was pot-bellied, for the abdomen is prominent, and the curve of the waist, usually emphasised in Egyptian pictures, is absent here. The bowed legs are characteristic of rickets. The arch of the foot has almost disappeared. V I now proceed to describe one statuette and two bas-reliefs in which the etiology of the deformities is not quite plain. The first (Plate X, Fig. 2) is a small statuette, now in the Ashmolean Museum at Oxford. The work is rough, and the figure 44 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT in a bad state of preservation, for the left leg is broken. It is inter- esting to find that the British artist who repaired it was obliged to make a plaster leg bending outwards in order that it should fit the other leg. Although the lower limbs are short as compared to the trunk, yet the disproportion is not marked enough to warrant the diagnosis of achondroplasia. The deformity was probably due to rickets. The statuette dates from the 1st Dynasty and is at least five thousand years old. A bas-relief (Plate IX, Fig. 16) of the 1st Dynasty figured by Flinders Petrie (Royal Tombs, II, Plate XXVIII, the tomb of Zer- Ta) shows another interesting dwarf. The work is primitive and coarse, though the figure is full of movement. The prominent pathological features are the bowed legs, the stout body, and the shortness of the arms. Owing to the want of finish in the carving, the size of the head cannot be ascertained with accuracy, though it appears somewhat too large as compared with the body. An exact diagnosis is in my opinion impossible. Considering the absence of any marked disproportion between the size of the body and that of the legs, considering also the well marked deform- ity of the legs, I conclude that the disease which had produced these deformities was probably rickets. Perhaps the most striking figure which has been assumed to be a dwarf (see Richer, loc. cit.) is that of the celebrated "Queen of Punt" (see Plate XI) which was carved in relief on the walls of the Temple of Deir el Bahri and is now in the Cairo Museum. The authorities of the Cairo Museum consider this person to have been a steatopygous woman. Richer, on the other hand, thinks that the deformity was typical of achondroplasia. He expresses himself as follows : Derriere lui, le roi de Poun [Anglice:Punt], se trouve sa femme. Celle-ci a sa chevelure soigneusement peignee et ramassee en queue epaisse par derriere, Quant a ses traits, ils sont assez reguliers, quoiqu'un peu virils, mais tout le reste de sa personne est repoussant. Ses bras, sa poitrine, ses jambes, sont comme charges de chairs ramollies; le bassin se projette en arriere, et accuse ure deformite que l'artiste egyptien a rendue avec une naivete surprenante. Faut-il voir la l'ensellure et la preeminence des fesses signalees par Parrot, chez certains nains, ou bien, comme le pense M. Bordier, ne s'agirait-il pas de ON DWARFS 45 la representation du type des Boschemans, avec Pensellure et la steatopygie characteristiques ? Broca fait une remarque qui ruine cette derniere hypothese. II fait remarquer que l'humerus parait plus court que le radius. Or, ce fait ne se rencontre dans aucune race, moins chez les Boschemans que chez aucune autre. Nous ajouterons que la disproportion des membres tres courts avec le torse trop long, leur surcharge graisseuse, s'ajoutent aux signes ci-dessus releves, pour faire de cette figure une veritable naine se rattachant a la categorie des achondroplasiques. The problem is rendered more difficult by the fact that the legs, abdomen, and head are drawn in profile and the chest almost full face. My opinion agrees with Richer 's in so far that I do not think that the Queen of Punt was either a steatopygous woman nor a Bushwoman. The first hypothesis is disproved by her face, which is certainly not that of a Bushwoman but is rather of a Semitic type. The diagnosis of steatopygia can also be shown to be incorrect. The chief characteristic of a steatopygous woman is the dis- proportion between the size of the buttocks and thighs. If, in the case of the Queen of Punt, a horizontal line be drawn just below the top of the thigh, it will be noticed that, as a matter of fact, the buttocks do not stand out at all prominently above that line; whereas in a steatopygous woman, a Hottentot, for instance, the prominence is very noticeable. In the Queen of Punt, the most marked characteristic is the pronounced lordosis. The lumbar spine is bent forwards, the whole abdomen has sunk, and the umbilicus is only a little above the level of a line drawn across the lower edge of the gluteal fold. Very remarkable also is the depres- sion of the symphysis pubis. In any case, the lordosis alone is sufficient to account for the size of the buttocks. It is true that steatopygous women look as if they had lordosis, but in them, if the deformity exists at all, it is very slight indeed. Although, therefore, I consider the diagnosis of steatopygia as not proven, yet neither do I consider Her Majesty of Punt as an achondroplastic dwarf. In the first place, it cannot be proven that the Queen was smaller than her companions. On the bas-relief she is just as tall as the men preceding and following her. The point is perhaps not of great importance, as it may be argued that the artist drew her the same size as her companions for the sake of symmetry. Much 46 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT more important, however, is the fact that although there is undoubt- edly some disproportion between the length of the trunk and that of the lower limbs, yet this is rendered very prominent by the depression of the umbilicus. Were it not for the depression of the abdomen, the umbilicus would be situated about one and a half centimetres higher than it is in the photograph, which would correspond pretty nearly to the centre of the figure. Another important fact against the diagnosis of achondroplasia is that the arms are by no means short, and I can see no reason for supposing, as Broca did, that the humerus was shorter than the radius. The hand and fingers are shapely and very unlike the squat extremities of the achondroplastic dwarf. One fact must not be forgotten, which appears not to have been noticed by all those who have examined this bas-relief, namely that the Queen of the Punt had a daughter. Part of the bas-relief discovered by Mariette has unfortunately been lost and the missing portion showed the daughter of the Queen. The fact is mentioned by Naville {The Temple of Deir el Bahri), and Sir Gaston Maspero informs me that the daughter showed the same deformities as the mother, though to a slighter degree. Although achondroplasia has been known to be hereditary, yet it appears to me that the extreme lordosis of the Queen would certainly have interfered with parturi- tion, and that it is very probable therefore that the deformity was an acquired one. I confess my inability to propose any definite diagnosis for the present. The lordosis is self-evident, but I cannot account for the redundant flesh on the limbs and trunk, whereas the face, hands, feet, and apparently the breasts also, have remained normal. I say flesh and not fat advisedly, for the enlargement of the thighs, etc., resembles far more the jelly-like tissues of certain cases of elephan- tiasis than adipose tissue. The deformity is not due to filaria, for all the limbs and the trunk are enlarged. I have seen in Egyptian women enlargement of one limb exactly corresponding to that seen in the Queen of Punt, and neither during the day nor at night did I find parasites in their blood. This deformity may perhaps occur in several limbs? I cannot say. ON DWARFS 47 VI Among the dwarfs of Egypt, the gods Bes and Phtah have also been mentioned. The first is supposed to have been copied from a rickety dwarf and the other from an achondroplastic dwarf. I have examined a great many statuettes of the latter without arriving at any definite conclusion for the present. Some statu- ettes, however, show a distinct swelling in the region of the navel, most resembling an umbilical hernia. The former, in my opinion, is not a dwarf at all. As, however, the discussion of this ques- tion would entail entering into a great many archaeological prob- lems, I must leave this subject until another occasion. For the same reason, it would also be inexpedient to describe the many dwarfish figures found in Egypt which date from the Greek and Roman times. The old Egyptians kept not only human dwarfs, but animal dwarfs also. On the walls of the tombs of Beni-Hassan there are representations of dwarf cattle and dogs, the latter resembling somewhat the dachshund of the present day (Plate IX, Figs. 18 and 19). A point which as far as I know has escaped everybody's attention is that giants were employed also, for in the same tombs some men are depicted who were without doubt at least a foot taller than their fellows. It may be that these men were simply Shillouk slaves, but at any rate the point requires investigation. CONCLUSIONS The statuettes, bas-reliefs, and paintings found in ancient Egyptian tombs show that: 1. Achondroplasia has existed for at least five thousand years. 2. Rickets has probably existed for the same period, and certainly since 2000 b.c. 3. The deformities characteristic of Pott's disease and of talipes equino-varus were put on record about four thousand years ago. 4. In addition to the deformities of the skeletons mentioned, there arc a number of others to be found on Egyptian monuments in which the diagnosis remains doubtful. 48 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT DESCRIPTION OF PLATES VII-XI (For particulars see text) plate vn The dwarf Chnoum-Hotep. plate vin Achondroplastic dwarfs. Fig. 9. — Female achondroplastic dwarf following a young girl. Fig. 10. — A boy with talipes equino-varus and a rickety dwarf. Fig. 11. — A boy with talipes equino-varus. Fig. 12. — A rickety dwarf. Fig. 13. — Two female dwarfs with talipes equino-varus. Fig. 14. — A hunchback. Fig. 15. — Another hunchback. Fig. 16. — A dwarf. (Diagnosis?) Fig. 18. — Dwarf bull led by a man. Fig. 19. — Dwarf dog. PLATE X Fig. 1. — Statuette from the Ashmolean Museum at Oxford representing a female dwarf. (Diagnosis ?) Fig. 2. — A hunchback, from Mme Constantine Sinadino's collection (Greek period). • Fig. 3. — A hunchback. Terra-cotta pots in the Alexandria Museum (Greek period). PLATE XI The Queen of Punt. Bas-relief from Deir el Bahri. PLATE VII PLATE VIII Fig. 1 Flo. 2 . Fig. 3 FiG. 5. r* WZ ^W. 5 Fio 6. m 1 \ Fio. 8. PLATE IX Fig. 9. w MJQf Fig. 13. ^ Fij.fS FtQ.7#. Fig. 10- ~ "X \ ) -J Fig. 14-. n s- Fy. 16. Fi„. //• Fa. 12. f ^ fy./X PLATE XI 'M^K W^mm^m % tifim 5^ HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES {Memoires presentes a I'Institut Egyptien, Le Caire, Tome VI, Fascicule 3 [mars 191 1]) INTRODUCTION The diseases of ancient Egyptians have been studied by several different methods. Philologists have translated a few Egyptian papyri relating to medical subjects, and the chief interest of their studies lies in the demonstration of the existence of a medical literature and of a fairly extensive pharmacopoeia at an early period. These documents, however, are not adequate for the identification of diseases which were fatal in olden times. Even in the "Papyrus Ebers, " the most famous of Egyptian medical documents, the description of symptoms is crude, and, although the papyrus contains some information regarding the occurrence of intestinal worms and diseases of various organs, yet an indisputable diagnosis of any one disease in this work is in my opinion impracticable. The same is partly true of the Berlin medical papyrus 1 lately edited and translated by Wreszinsky. The veterinary papyri dis- covered by Professor Flinders Petrie demonstrate that the old Egyptians cultivated veterinary as well as human medicine. Another source of information regarding ancient Egyptian pathology is found in the pictures and statues representing mal- formed persons which have been discovered in many places. Egyp- tian temples and tombs contain likenesses of people with club-foot (tombs of Beni-Hassan), rickets (Kasr-el-Nil Museum), steato- pygia (Ashmolean Museum). Pictures and statuettes of malformed persons, e.g., dwarfs, are common in some of the oldest tombs of Egypt, in those dating from the Greek period and the Roman occupation. I have seen figures of typical hunchbacks and several of men with cutaneous cysts (private collection). ' The description of facial paralysis in this papyrus is excellent. 50 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT The evidence from historical works of comparatively modern times is of little service, because, as a rule, the symptoms noted are indicative not of one disease, but of several. To take an example of comparatively recent times, the epidemic which devasted Athens and was graphically described by Thucydides, has been identified according to the diverse tastes of medical and other commentators as black typhus, smallpox, yellow fever, cerebro-spinal meningitis, scarlet fever, influenza, and ergotism complicated with typhus. Very precious information has been obtained by the examina- tion of skeletons. Lately a new stimulus has been given to this hitherto neglected branch of Egyptology, by the description by Professor Elliot Smith, Dr. Wood Jones, and Dr. Derry, of bones found in the Nile Valley above Assuan. Unfortunately, the inspection of skeletons reveals only the few maladies which cause osseous lesions, whereas many diseases leave no traces on the bones. The result of the macroscopical examination of mummified organs is unsatisfactory also, as, in the process of drying, the soft parts shrank and are therefore so changed as to render pathological lesions unrecognisable (see Plates XII, XIII, XIV). Still, this method may give noteworthy results, and Professor Elliot Smith, for instance, showed me a gall-bladder which undoubtedly contained biliary calculi. One other available method consists in the microscopical exami- nation of mummies, which, as far as I know, has never been applied systematically. Histologists were probably repelled by the very unpromising appearance of the material. It is not easy to say, for instance, to what organ some of the brownish, dry, hard fragments found in the body cavity belong. A provisional diagnosis, as I have found to my cost, not infrequently proves incorrect. I am in- formed, however, that Professor Looss demonstrated the striation of mummified muscles to his colleagues, but I am not aware of any systematic work on the histological examination of mummies. It appeared to me that if, by any process, the flexibility and original shape of the mummified tissues were restored, their micro- scopical structure would be recovered also, partially at least, and that pathological alterations might then possibly be demonstrated. HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 51 This paper, however, is concerned with the first two questions only, viz., the restoration of mummified tissues to their original size and the recovery of their microscopical appearance. For the material necessary for this work I am indebted in the first instance to Professor Elliot Smith. I obtained also very valu- able specimens from Professor Flinders Petrie, Sir Gaston Maspero, and from Dr. Keatinge. I take this opportunity of thanking all these gentlemen for their help, as also Mr. A. Cooper for many of the illustrations and Mrs. Alice Mary Ruffer for most of the paint- ings of microscopical specimens accompanying this paper. METHODS OF EMBALMING I do not intend to give here a full account of the various methods of embalming in successive dynasties, as a volume would be required for that purpose. It is extraordinary that, as far as I know, no such work exists and a full account has not been written of the meth- ods of embalming the bodies discovered in the many tombs opened lately. Indeed, most of the writers on this subject are content to copy the accounts given by Herodotus and by Diodorus Siculus. Herodotus' 1 description is as follows: There are certain individuals appointed for the purpose [embalming], and who profess that art; these persons after any body is brought to them, show the bearers some good models of corpses, painted to represent the originals; the most perfect they assert to be the representation of him whose name I take it to be impious to mention in this matter; then they show a second which is inferior to the first, and cheaper; and a third, which is cheapest of all. They then ask of them according to which of the models they will have the deceased prepared: having settled upon the price, the relations immediately depart, and the embalmers, remaining home, thus proceed to perform the embalming in the most costly manner. In the first place, with a crooked piece of iron, they pull out the brain by the nostrils; a part of it they extract in this manner, the rest by means of pouring in certain drugs: in the next place, after making an incision in the flank with a sharp Egyptian stone, they empty the whole of the inside; and after cleansing the cavity, and rinsing it with palm wine, scour it out again with pounded aromatics : then having filled the belly with pure myrrh pounded, and cinnamon, and all other perfumes, frankincence excepted, they sew it up again; having so done, they steep the body in natrum, 2 keeping it covered for 70 days, for it is not lawful to leave the body any longer in the 1 This is copied from Pettigrew. > Pettigrew wrote natrum. 52 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT brine. When the 70 days are gone by, they first wash the corpse, and then wrap up the whole of the body in bandages cut out of cotton cloth, which they smear with gum, a substance the Egyptians generally use instead of paste. The relations, having then received back the body, get a wooden case, in the shape of a man , to be made ; and, when completed, place the body in the inside; and then, shutting it up, keep it in a sepulchral repository, where they stick it upright against the wall. The above is the most costly manner in which they prepare the dead. For such as choose the middle mode, from a desire of avoiding expense, they prepare the body thus : they first fill syringes with cedar oil, which they inject into the belly of the deceased, without making any incision, or emptying the inside, but sending it up by the seat; they then close the aperture, to hinder the injection from flowing backwards, and lay the body in brine for the specified number of days, on the last of which they take out the cedar oil which they have previously injected, and such is the strength it pos- sesses that it brings away with it the bowels and inside in a state of dissolution: on the other hand, the natrum dissolves the flesh, so that, in fact, there remains nothing but the skin and the bones; when having so done, they give back the body without performing any further operation upon it. The third mode of embalming, which is used for such as have but scanty means, is as follows: after washing the inside with syrmaea, they salt the body for the 70 days, and return it to be taken back. The wives of men of quality are not given to be embalmed immediately after their death, neither are those that may have been extremely beautiful, or much celebrated; but they deliver them to the embalmers after having been 3 or 4 days deceased: this they do for the following reason, that the workmen may not be able to abuse the bodies of these females; for it is reported by them, that one of these artificers was discovered in the very act on the newly-deceased body of a woman, and was impeached by his fellow workman. Diodorus Siculus wrote as follows on the same subject: When anyone amongst the Egyptians dies, all his relations and friends, putting dirt upon their heads, go lamenting about the city till such time as the body shah be buried. In the meantime they abstain from baths and wine, and all kinds of delicate meats, neither do they during that time wear any costly apparel. The manner of tneir burial is threefold; one very costly, the second sort less chargeable, and the third very mean. In the first, they say there is spent a talent of silver, in the second 20 minae, but in the last there is very little expense. Those who have the care of ordering the body are such as have been taught that art by their ancestors. These, showing to the kindred of the deceased a bill of expenses of each kind of burial, ask them after what manner they will have the body prepared; when they have agreed upon the matter, they deliver the body to such as are usually appointed for this office. First, he who has the name of scribe, laying it upon the ground, marks about HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 53 the flank on the left side how much is to be cut away. Then he who is called the cutter or the dissector, with an Ethiopic stone cuts away as much of the flesh as the law commands, and presently runs away as fast as he can: those who are present, pursuing him, cast stones at him, and curse him, hereby turn- ing all the execrations which they imagine due to his office, upon him. For, whosoever offers violence, wounds, or does any kind of injury to a body of the same nature with himself, they think him worthy of hatred; but those who are called the embalmers they esteem worthy of honour and respect; for they are familiar with their priests and go into the temples as holy men, without any prohibition. So soon as they come to embalm the dissected body, one of them thrusts his hand through the wound into the abdomen, and draws forth all the bowels but the heart and kidneys, which another washes and cleanses with wine made of palms and aromatic odours; lastly, having washed the body, they anoint it with oil of cedar and other things for above thirty days, and afterwards with myrrh, cinnamon, and other such like matters, which have not only a power to preserve it for a long time, but also give it a sweet smell; after which they deliver it to the kindred, in such manner that every member remains whole and entire, and no part of it changed, but the beauty and shape of the face seems just as it was before, and may be known, even the hairs of the eye-lids and eye-brows remaining as they were at first. By this means many of the Egyptians, keeping the dead bodies of their ancestors in mag- nificent houses, so perfectly see the true visage and countenance of those that died many ages before they themselves were born, that in viewing the pro- portions of every one of them, and the lineaments of their faces, they take as much delight as if they were still living among them. The importance of these two classical accounts of the process of embalming must not be overrated. Herodotus died 406 B.C., and Diodorus Siculus 440 years afterwards. Their descriptions, there- fore, though possibly true for their epoch, may not represent accurately the practice followed during the thousand preceding years or so, when embalming was a common practice. The same criticism holds good for all the old descriptions. The only way to obtain information with regard to embalming processes, therefore, is to dissect the mummies of various dynasties. Such an attempt was made by Pettigrew 1 who gave a somewhat incom- plete resume of the literature and of the facts known at his time, and carefully described some of the mummies he had studied. 1 A History of Egyptian Mummies and an Account of the Worship and Embalming of the Sacred A nimals by Egyptians, with remarks on the funeral ceremonies of different and observations on the mummies of the Canary Islands, of the ancient , Burman |.ri< .1 5, < l< ., London, 1834. 54 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT More lately two papers on the subject have appeared : the first by Dr. Fouquet 1 and the other by Professor Elliot Smith. 2 The two memoirs are based on the study of mummies of the priests and priestesses of Anion found at Deir el Bahri and dating from the XXIst Dynasty (iooo B.C.), and as most of my specimens come from these same mummies, I must enter more fully into the work of these observers. Dr. Fouquet states that such a mummy when unrolled is found to be enclosed in two layers of bitumen. The legs are extended, the arms brought alongside the body or slightly crossed at the pubis. The skin is everywhere smooth and clean, absolutely shaved, except for the hairs of the head, the eyebrows, and the eyelashes. The mouth, the nostrils, the eyes, and the ears are covered with a layer of virgin wax closely applied and with resin of cedar under the wax. The closed mouth conceals the teeth, the lips are painted red, the eyebrows are painted also, and the eyelids are often adorned with kohl. The face, hands, feet, and sometimes even the whole body are painted. The body itself has sometimes kept to some extent the well-nourished appearance it had during life, the breasts alone of women are flattened and closely applied to the thorax. The neck, comparatively thin, looks even thinner on account of the face, which is artificially distended. I have no doubt that the account given by Dr. Fouquet is correct as far as the mummies examined by him are concerned. In the fragments of the five mummies which Professor Flinders Petrie gave me, dating from some period between the XVIIIth and XX th Dynasties, and in numerous mummies of the XXIst Dynasty, I was not able to find the slightest trace of bitumen on the surface of the bodies, but the abdominal walls were covered by a thick layer of what looked like resin. Similarly, Dr. Elliot Smith says nothing about bitumen. 3 The female bodies that he examined were painted 1 Note pour servir d Vhistoire de I'embamnemcnt en Egypte, communication faite a l'Institut Egyptien dans la seance du 6 mars 1896, Le Caire, 1896. 2 "A Contribution to the State of Mummification in Egypt," with special refer- ence to the measures adopted during the time of the XXIst Dynasty for moulding the form of the body, Memoires prescntesd l'Institut Egyptien (publies sous les auspices de S. A. Abbas II, Khedive d'Egypte), Cairo, 1906. 3 It is a peculiar fact that I have never yet found bitumen in any mummy, and my experience now extends from prehistoric to Coptic times (March, 191 1). HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 55 with a mixture identified by Dr. Schmidt as yellow ochre and gum. The bodies of the men were painted either red, rose-coloured, or more usually a dull reddish or yellowish brown. This, judging from my own observations, is quite correct. I discovered no trace of paint in mummies of later periods, nor in a Greek ( ?) mummy, but the face, though not the body of a Roman child, was gilded all over (see also Pettigrew, loc. cit.). According to Dr. Fouquet, a ball made of rag, on which the iris was roughly painted, was placed under the half-closed eyelids. I have confirmed this observation in one case. In another body of which I examined the eyes there was not a trace of rag. The eyeballs had disappeared, but the pedicles of the eyes (muscles) were still to be seen. In another, two artificial eyes had been inserted. Professor Elliot Smith states that during the preliminary stages of embalming, the eyes collapsed and fell back into the orbits. Artificial eyes were then introduced in front of the remains of the real eyes, and the eyelids puUed down into a semi-closed position. The artificial eye usually consisted of a piece of linen rolled up roughly; the pupil is represented by a spot of black paint; in two cases the eye was represented by a piece of white stone with a black spot on it. In the mummy of Ramses IV, small onions were put in front of the collapsed eyes. In two mummies of the XXVIIth-XXIXth Dynasties which I examined the eyeballs had shrunk greatly, but the eyes were uninjured, and the contents of the orbit had not been interfered with. The eyelashes were perfect. In a Roman child and in a Greek ( ?) mummy nothing appeared to have been done to the eyes. The orbits certainly contained no foreign matter whatever. I also examined the eyes of several bodies of the Greek period, which had simply been buried in the sand. The eyeballs could not be recognised. On the other hand, all the muscles were unmistak- able and the transverse striation easily demonstrated. The optic nerves were visible; unfortunately their microscopical structure was greatly altered by an enormous growth of moulds. \>r. Fouquet states that some of the tissues and bandages which touched the bodies were examined by Professor Lacassagne and 56 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT that he obtained the characteristic reaction of haemoglobin. On the other hand, Professor Elliot Smith writes : No one has a greater knowledge of all the most modern tests, chemical and biological, for blood-stains, nor a better acquaintance with those methods in medico-legal practice than my colleague Prof. Schmidt of the Cairo School of Medicine. Dr. Schmidt has examined large numbers of pieces of stained cloth and pieces of highly vascular tissues from a large series of mummies; he tells me that he has been utterly unable to recognise the presence of haemo- globin, although the tests in use now are immeasurably more delicate and sure than those used 10 years ago. All the reddish stains on linen were found to be due to resin. I can only agree with Professor Elliot Smith and Professor Schmidt. I have repeatedly tried to get blood reactions from tissues of mummies, but always unsuccessfully. Although I have examined many hundred specimens, I have never demonstrated undoubted red blood corpuscles. In one case only did I see some brownish bodies which certainly resembled red blood corpuscles, but I could not identify even them with certainty. METHODS OF PRESERVING THE DEAD We may now give a general account of the treatment to which the body cavities and the viscera were subjected after death. I shall limit myself almost wholly to the method of embalming which was used during the XXIst Dynasty, and hence, I cannot do better than follow closely the account given by Professor Elliot Smith. The price having been agreed upon, the embalmers took charge of the body, and, as the process is supposed to have taken at least seventy-two days to carry out, the body was probably carried to some special laboratory fitted for the purpose. Considering the delay which must have ensued while the bargain was made and the body carried to the laboratory, it is not improb- able that, in the majority of cases, several hours elapsed from the time of death to that of the first incision. The embalming incision usually caused a large, vertical, fusi- form, gaping wound in the left lumbar region, extending from the iliac crest, about 2-3 cm. behind the anterior superior iliac spine, to the costal margin. HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 57 It may be further forward, or extend lower down in front of the iliac spine. As a rule, no attempt was made to close the wound, which was then covered with a plate, usually of wax, but some- times of bronze, bearing the conventional sign of the eye or Uta. In some cases, the gaping wound was not protected by a plate of any sort; and in two cases examined by Professor Elliot Smith the edges were brought together and kept in position by a running ligature. In one mummy that I dissected the wound was firmly closed by a linen plug which must have been rammed in with considerable force, after the body had been well filled with earth. The body cavity having thus been opened, the intestines, liver, spleen, kidneys, stomach, pelvic viscera, and most of the vessels were completely removed. The diaphragm having been been cut through, the lungs were freed by severing the bronchi, or, in some cases, the lower end of the trachea. The heart was left in the body but never exactly in the normal position. Generally it was pushed upwards into the upper part of the right side of the thorax; sometimes it was left in the middle line in front of the vertebral column, or again, it is found in the left side of the chest. In one mummy which I examined the heart had been removed by the embalmer. It had not been replaced in its proper position, however, for both kidneys filled the pericardium. Behind the liver there was a packet containing striped muscular fibre, which was probably the heart. Sometimes only the arch and a small part of the aorta were left behind, but in one body Professor Elliot Smith found the whole aorta and iliac arteries. I also dissected out the whole of the aorta (except the transverse part), together with the iliac arteries, of one mummy. After the viscera had been removed, both the body and the organs were put into the saline bath described by Herodotus. The various tissues of the body and the organs contain saline material and the skin shows unmistakable signs of having been macerated until all the cuticle, together with the hair, except that of the head, harl peeled off. There are certainly exceptions to this rule, as in 58 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT some cases I have found the epidermic cells intact and even their nuclei stained well. The heart left in the body cavity is always well preserved. In many cases the valves are intact and it is often possible to recognise the chordae tendineae and musculi papillares. As a rule, the organ is considerably damaged, as the result no doubt of unintentional hackings inflicted on it by the operator cutting through the roots of the lungs and the oesophagus (Plate XIV, Figs. 2 and 3). The commonest injury to the heart is, as is natural, a complete opening of the left auricle, or often of both auricles; in many cases great gashes are found in one or both ventricles. The cavities of the heart are in many subjects tightly stuffed with mud or a mixture of mud and sawdust. How this material was introduced is doubtful. The viscera, after having been removed from the salt bath, were thickly sprinkled with coarse sawdust of various aromatic woods, and when still flexible were moulded into shape and wrapped in linen. This must have been done before desiccation, as one end of the linen bandage is almost always interwined with — and so fixed to — some part of the organ. The small intestines are usually bent upon themselves many times so as to form an elongated parcel of parallel bands. Among these bands there was placed (when the viscus was still flexible) a wax image of one of the four genii, usually the hawk- headed Khebsennuf. Then, after being sprinkled with sawdust, the mass was wrapped in the linen bandage. The liver is usually flexed round its transverse axis, so as to form a hollow tube open on one side, and either the upper or lower surface may form the surface of the tubular cylinder. Inside the cylinder thus prepared a wax statuette, usually the human headed Amset, is found in most cases. In other respects the liver was treated exactly like the intestines. It would appear, however, that in many cases the embalmer was unable to remove or reintroduce the liver without tearing it. In such cases he was content to replace only a fragment of the organ into the body (see further on). Although either of these parcels may be found in any part of the body cavity, yet in the majority of subjects they occupy definite HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 59 situations. The parcel of intestines is placed vertically in the abdo- men against the right wall and extends from the iliac fossa to the right costal margin, and the liver lies transversely in the lower part of the thorax. After the various parcels of the viscera had been returned to the body and had been packed tightly in sawdust or coarser fragments of wood, a large part of the abdomen and pelvis still remained comparatively empty. This region was then tightly stuffed with sawdust, and the opening in the left flank was subsequently closed. The genital organs of women are always absent, the labia majora being the only parts of the vulva left. In only two or three cases the remains of the pudenda and the labia majora were left in their natural position. In most cases, the skin, while still soft and flexible, had been pushed back towards the anus, so as to form an apron covering the rima pudendi. The bladder, according to Elliot Smith, is sometimes in situ. The penis and scrotum were painted red like other parts of the body, and as a rule were wrapped separately from the limbs. In some cases the genital organs were pushed against one or the other thigh and wrapped with the limbs. In one case the penis was flat- tened against the perineum, so that, at a casual glance, the organ seemed to be missing. In several subjects, male and female, the pubic region was packed either with cloth or with mud. When the viscera were returned to the body cavity, it was customary to place, along with some of the organs, certain wax or pottery models of the children of Horus. Details regarding this custom are contained in Elliot Smith's papers, and it will be suf- ficient to say that besides the human-headed Amset generally found wrapped up in the liver, the hawk-headed Khebsennuf with the intestines, the ape-headed Api is usually associated with the left lung, and the jackal Tuamautef with the stomach. Flowers and other vegetable substances, especially onions, are often found among the wrappings, on the surface of the body or inside the mummy. Elliot Smith says that the saline bath toughened the skin and the lining of the cavity, but the underlying tissues in the limbs, back, or neck were not exposed to the action of the preservative 60 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT agent, and were soon reduced to a soft pulpy mass, of fluid or semi- fluid consistency. It was the custom to stuff into this pulpy mass large quantities of foreign material, so as to restore to the collapsed and shrunken members some semblance of the form and consistency they possessed during life. The foreign material varied a good deal, the ingredients chiefly used being mud, linen bandages, a mix- ture of mud and sawdust, or a mixture of soda and butter. The ways in which this material was introduced and the body packed have been fully described in Professor Elliot Smith's paper. The description of the packing is of course perfectly correct, but I must point out that there is no proof that the tissues were changed into a soft, pulpy mass. I have examined several mummies, the limbs of which had not been packed by the embalmer, and I found the muscles, nerves, arteries, etc., in a very good state of preserva- tion. Indeed, most of the histological details were plainly visible. A good deal of interest attaches to the "natron" bath in which the bodies were immersed for seventy days, and some controversy has taken place with regard to its chemical constitution. Analyses of the mineral salts from mummies have given but doubtful results. According to Mr. A. Lucas, the inorganic substances used by embalmers were essentially of two kinds: namely "natron" and common salt. Natron is the natural soda found in Egypt, chiefly in the Wady Natroun, and is essentially a mixture of sodium carbon- ate, sodium chloride, and sodium sulphate in varying proportions. It contains also a certain amount of clay and calcium carbonate. Mr. Lucas found that of two samples of natron discovered in Cano- pic jars in the tomb of Iaa at Thebes, one was crude natron of pure quality, such as occurs in many parts of Egypt, and the other a mixture of crude natron and coarse sawdust. Several other observ- ers have found natron in the bodies of wrappings of mummies. The resinous material from mummies also contains a large amount of natron. On the other hand, Professor Schmidt of Cairo is of opinion that the inorganic material used for packing was not natron but common salt. His results may be summed up as follows : Mummies contain volatile and nonvolatile fatty acids, albumi- nous substances, cholesterin, and traces of unaltered fat. Specific HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 6 1 human antisera (whether obtained by the injection of blood or muscular tissue) produce no precipitate in mummy tissue. The presence of haemoglobin cannot be demonstrated by any method. He does not deny that natron was used, but considers that it was only used for packing, as, for instance, in the mouth, and in that case it was mixed with fat, e.g., butter to form a paste. He maintains that the fatty acids are derived not from the fat of the body only, but from the albuminous material, and that during mummification fixed fatty acids were formed which, later on, were converted into volatile fatty acids. He bases this hypothesis on the fact that the older the mummy, the greater the amount of volatile fatty acids as compared with the quantity of fixed fatty acids. Schmidt found a large quantity of higher fatty acids in the natron used for packing. He is of opinion that the volatile acids present in this natron were not due to the decomposition of some fat added, but originated in the body fat and tissues. He has found, for instance, the higher fatty acids in the spleen and liver, which had never been in contact with natron. Schmidt summed up his opinion as follows : We see that the old Egyptians worked with very simple methods. The following are the only important parts of their process: ist: removal of the most easily putrescible viscera, 2nd: the salt bath, 3rd: thorough drying of the corpse in the air, and 4th: the rolling of the body in bandages. Modern researches on the microscopical changes taking place in putrefying or mummifying tissues help us very little, for the microscopical appearance of putrefying organs has not been the subject of many careful investigations. The appearance of putrefaction in nervous tissue shows itself first in the axis cylinder and nerve fibres, which break up into frag- ments. The nervous cells of cerebral and peripheral ganglia resist for a long time. In the lungs, the epithelial lining of the alveoli and bronchi is first affected. This is loosened and finally disappears totally. The elastic tissue long remains unaltered. The epithelium cells of the liver, kidneys, and stomach become opaque and lose their nuclei. The epithelium cells of the kidney — iallj those of the contorti — fall off, and chronic nephritis may 62 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT then be simulated. The connective tissues of all organs keep their nuclei longer than the epithelium cells. ■ The unstriated muscular fibres retain their characteristic appear- ance for a long time, and so do the striated muscular fibres which lose their striation only slowly. The heart fibres show their charac- teristic arrangement, and the structure of kidney and liver is no longer recognisable. The state of the stomach gives no valuable information, as self-digestion varies considerably. It is stated that in contradiction to putrefying organs, dried (mummified) tissues retain their characteristic structure for a much more extended period. ON THE FORMATION OF ADIPOCERE ( ?) IN MUMMIFIED ORGANS I attempted to soften entire organs of mummies of the XXIst Dynasty by placing them in a solution of i per cent formol, contain- ing i per cent carbonate of soda. Some organs, e.g., lungs, swell up considerably, and their characteristic spongy structure becomes evident. The liver never swells up to any extent, whereas the kidneys become considerably larger and softer. When the carbon- ate of soda-formol solution extracts no more colouring matter, it is replaced by a 5 per cent solution of formol, in which the organs may remain indefinitely. Not infrequently a curious change is observed to have taken place, especially in the lungs. After the mud and vegetable matter have fallen to the bottom or floated off, the organ, or part of it, is found to be converted into a snow-white, somewhat brittle and stiff substance. The pleura and the parts immediately underlying it appear to be specially affected. I presume that this white sub- stance is adipocere or some substance closely resembling it. I have never seen this change in the liver, and only once in the two kidneys of one mummy. One of these showed small patches of adipocere (?), whereas the other was almost snow-white. The stomach of one mummy, though it had kept its shape fairly well, was completely converted into adipocere. The intestines of an- other had been almost wholly changed into rigid white strands by the same process. HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 63 I have seen indications of a similar change in Roman and Greek bodies, which had been simply buried in sand. In these, the change occurs in the shape of small white patches scattered over the intes- tines, lungs, heart, and kidneys, which have a curious resemblance to miliary tuberculosis. Microscopically one sees nothing except an amorphous substance staining faintly with haematoxylin. Here and there, however, one finds places where the structure of the organ is preserved. METHODS OF HISTOLOGICAL EXAMINATION The naked-eye appearance of the tissues will be described as we treat of each; for the present it will be sufficient to say that most mummified organs are hard to the touch, brownish in colour, and often very brittle. Even in the damp heat of an Alexandria summer, when the temperature of my laboratory seldom feU below 30 C, most of the mummified pieces underwent but little change. Some pieces of intestines alone became soft and pliable and gave off a distinct musty odour. An exception must also be made for the skin, muscles, and internal organs of some mummies of the XVIIIth- XXth Dynasties, which, though stiff, had a peculiar soft, soapy feel. A satisfactory microscopical examination of organs in such a condition is not possible, not only on account of the brittleness of the tissues, but also because the microscopic structure is obscured by an opaque, dark-brown colouring matter with which the tissues are saturated. Further, the larger amount of the closely adherent "packing," e.g., mud, charcoal, sand, and sawdust, increases the difficulty. The objects to be attained were: (1) to soften the tissues in order to render them less brittle, (2) to remove the colouring matter, and (3) to bring back consistency sufficient for histological examina- tion. Microscopical sections had to be prepared, as except in the case of muscular fibres all other methods, such as teasing, etc., proved useless for the reasons already stated. I need not enumerate all the reagents I employed together and seriatim. The main difficulty was that reagents such as alkalies, 64 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT neutral, alkaline and acid salts, mineral and organic acids, glycerine, formol, acetone, alcohol, chloroform, ether, etc., whether employed together or alone or in solutions of different concentrations, either softened the tissues too much or not enough, and the invariable result was failure. After many attempts the following stock solution proved most useful : c.c. Alcohol 30 Water 50 S per cent carbonate of soda solution 20 In some cases instead of water and alcohol a 1 per cent solution of formol was used. Although this solution generally gives good results, yet the details of the process must often be altered. The time during which the tissues remain in this solution, and the percentage of alcohol and carbonate of soda require modifying according to the size and consistency of the tissue to be studied. The harder and larger the tissue, the more carbonate of soda required, and the longer the time during which the tissue must remain in the liquid. The process, therefore, is delicate, empirical, and requires constant watching. On the whole, it is better to soak small pieces (3-5 mm.) in dilute solutions of carbonate of soda, rather than larger ones in stronger solutions. Within two minutes of placing the tissue in the softening solu- tion, a brownish-yellow colouring material begins to dissolve out. This does not diffuse readily throughout the fluid, but falls to the bottom of the beaker; so that for hours and days even, the lower layer of fluid resembles a strong solution of iodine, the supernatant liquid remaining almost colourless. This brown colouring matter is thus extracted not only from organs which had been removed from the body during the process of embalming and then replaced, but also from muscles, blood vessels, etc., which had been left in situ; and even, though in lesser quantity, from the heart. The muscles appear to contain a great deal of it. During this process, a certain quantity of mud, sand, sawdust, etc., drops off the tissue and can then be mechanically removed. HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 65 The tissues, especially the internal organs, after remaining in the fluid for a few hours, sometimes become so soft that the slightest movement of the vessel may entirely break up the material. Even the removal of the fluid by careful decantation or by means of a pipette is not infrequently disastrous, as the flow of liquid may suffice to disintegrate the fragment, or the tissue may run up the pipette as a sticky, oily, brown fluid containing a few shreds. The difficulty is obviated by placing the piece which is to be softened on a small wire-platform, and adding softening fluid until the layer of reagent above and below the tissue are about equal. When the tissue is softened sufficiently, the lower third of the fluid, containing most of the colouring matter, is pipetted off and replaced by absolute alcohol. The same process is repeated on three con- secutive days, and on the fifth day the tissue has become so firm that all the fluid can be poured off and replaced by absolute alcohol, or acetone. Under the influence of the solution the mummified pieces become of grey colour and somewhat transparent, as if they had been plunged for some hours in a clearing fluid, e.g., turpentine or oil of cloves. A certain amount of differentiation is then notice- able: the mucous membrane of the intestine stands out from the muscular layer, the fiver tissue from the Glisson's capsule, the pleura from the lung; but as alcohol is added, all differentiation disappears, and every tissue, though remaining pliable, becomes opaque again and of a dirty-grey colour. The material is now plunged in chloroform. Sometimes this liquid extracts a further quantity of colouring matter; at other times a precipitate is formed. Embedding in paraffine, carried out in the usual manner, then follows, and the pieces are ready for cutting. Very thin sections (one division of Minot's microtome) are easily obtained, but present no advantages. The famous dic- tum attributed to Virchow "nur so dick wiemoglich" is certainly true for this work. For staining, acid and basic dyes are equally useful. The best colorations are obtained with a dilute solution of Bohmer's haematoxylin or a o. 5 per cent solution of acid fuchsine. After staining, the sections are dehydrated, cleared, and mounted in Canada balsam in the usual manner. 66 STUDIES IN THE PALAEOPATHOLOGY OF EGYPT HISTOLOGICAL EXAMINATION OF THE SKIN I obtained from the Museum in Cairo particles of skin of the bodies of the Hearst collection, which, I am informed, are between eight thousand and twelve thousand years old. The tissue was extremely fragile and disappeared almost entirely in the ordi- nary softening solution. The skin could be prepared for section by using a solution containing only 0.25-0.50 per cent of carbonate of soda. In such preparations the epidermis had completely disappeared but the dermis had retained its peculiar structure fairly well. The extraordinary part, however, is that many of the nuclei of the subcutaneous tissues still stained darkly with haematoxylin (Plate XVI, Fig. 6). The amount of material at my disposal was so small that I was not able to get many preparations. Before the body was put up into the macerating solution (soda bath) by the embalmers, each nail of both hands and feet was carefully secured by a piece of string wound in a circular manner round the finger or toe, so that when the epidermis peeled off, it did not carry the nails with it. The impressions left by these pieces of string are visible in almost all cases, and it often happens that the string is left in position on one or more fingers or toes. In most cases, however, the string was removed when the body was taken out of the salt tank. Professor Elliot Smith gives various photo- graphs illustrating this, but as I shall show presently, in many cases the epidermis, especially that of the toes and hands, is practically normal. Several pieces of skin from the front of the chest and fingers of various men and from one woman were examined. The whole finger of one mummy was macerated for a fortnight in 90 per cent alcohol, containing 3 per cent of pure nitric acid, then transferred to pure alcohol, which was repeatedly changed until all the acid had been washed out. The skin before being prepared is yellowish white, very hard, and brittle, so hard indeed as often to break the edge of the knife (Plate XIII, Fig. 3). When broken across, the fractured surface is smooth and glistening; the muscles below dark-brown, hard and glistening, with a distinctly resinous fracture. The connective HISTOLOGICAL STUDIES ON EGYPTIAN MUMMIES 67 tissue, fat, etc., between the muscle and skin are not recognis- able. Under the influence of the softening solution, the skin of the chest and mammae separate into two layers; the first is composed of the muscles and the greater part of the connect- ive tissue, which sink to the bottom of the vessel, and the second of the dermis which floats on the surface. The latter is ex- quisitely smooth, soft and much resembles yellow wash-leather, except that it is not so pliable. The epidermis on the fingers is well preserved, and long thin strips of yellow colour float off when the finger is allowed to soak in the acid alcoholic solution. These prove to be layers of horny scales, which, though somewhat thinned out, are easily recognisable (Plate XVI, Fig. 4). The rete mucosum of the skin of chest and mammae is almost completely gone (Plate XVI, Fig. 2). I at first attributed this state of things to the effect of the salt bath, but that it cannot be wholly due to this is proved by the fact that the epidermis of bodies which had certainly never been placed in this bath had aJso fallen off. This shedding of the epidermis did not take place in the softening solution used by me, for some of the extraneous material in which the skin had been packed (bits of bandages and sawdust, etc.) was still in contact with the corium (Plate XVI, Fig. 20). The few epithelium cells which are left behind are usually found in the depressions between the papillae, forming the somewhat wavy free border of the preparation. The outermost layer of the corium of the chest and mammae is represented by wavy homogeneous tissue with no particular struc- ture. Its texture, however, is closer than in the parts below and it stains intensely. The deeper parts of the corium and the connective tissue below form a loose network; so loose indeed as to show that a good deal of the original connective tissue has disappeared (Plate XVI, Fig. 2). Some preparations are riddled with almost circular holes, which, as their walls have no particular structure, must have been formed post mortem. Some of these cavities extend to the outer edge of tli'- preparation ;m