Ancient Egypt

Highlights

• Carbonate δ13C was measured in tooth enamel and bone of Ancient Egyptians.

• δ13C remains largely constant from 5500 to 2000 BP and indicates very low C4-intake.

• High δ15N of mummy hair is indicative of aridity and not of trophic level.

• δ13C of hair indicates <50% of dietary protein came from animals.

• Sulfur isotopes suggest that fish, such as the Nile Perch, was not regularly consumed.

Abstract

Carbon, nitrogen and sulfur stable isotope compositions were measured in hard and soft tissues from Egyptian mummies of humans and animals in order to track the diet of ancient Egyptians from 5500 to 1500 years B.P. The carbon isotope ratios of bone apatite (δ13Cbo = −14.3 ± 0.9‰) and hair protein (δ13Ch = −19.9‰) are compatible with a diet based almost exclusively on C3-derived food (proportion of C4 < 10%). Less negative carbon isotope ratios of enamel (δ13Cen = −11.6 ± 0.7‰) relative to bones from the same mummies could be the result of differences in the chemical microenvironment in which mineralization occurred, as well as of differences in diet between children and adults, in particular through the consumption of milk or millet gruel during infancy and childhood. High values of nitrogen isotope ratios for hair protein (δ15Nh = 9.1‰–15.5‰) are ascribed to aridity rather than fish consumption because the δ34S values of human hair are lower than those measured in Nile perch scales. Except for Coptic mummies, the constancy of δ13Cbo and δ13Cen over a duration of ∼3000 years is striking considering the various political, technological, and cultural changes that impacted the Egyptian civilization during this time interval.

Carbon isotope ratios were measured in enamel, bone, and hair of ancient Egyptians.

 A significant offset (+2.5‰) is observed between the 13C values of teeth and bones that

 cannot be ascribed to the weaning effect. Following Warinner and Tuross (2009), this isotopic

offset rather may be caused by differences in mineralization conditions of the two types of

tissue. Using tissue-specific equations, the 13C value of the reconstructed diet is comparable and close to the average value of C3-plants (-25‰). 13C values of hair from ancient

with previous studies (Iacumin et al., 1996; Thompson et al., 2005).

Egyptians also suggest that C4-derived foods were rare in the diet (<10%), a result consistent

proportion of protein of animal origin may have reached 50%. Both estimates are lower than
Sulfur isotope ratios of mummy hairs further indicate that freshwater fish, such as the Nile

Carbon isotope ratios in mineralized tissues are constant throughout the studied period, indicating a preference for C3-derived food throughout the investigated time span. This is a surprising result given that C4 plants are better suited to arid environments, and that the climate became increasingly arid during this period (Touzeau et al., 2013). Coptic mummies have 13C values slightly lower than other mummies, possibly as a result of the introduction of olive oil during the Roman Period.

Assessing the consumption of animal products is difficult because the 15N of soft tissues, such as hair, is controlled by parameters other than diet, and in particular by the prevailing hydric stress. Using the carbon isotope ratios of mummy hairs, the contribution of animal protein to the total dietary protein was estimated here at 29±19%, corresponding to an ovo-lacto-vegetarian diet. Taking into account potential biases in the diet reconstruction, the

the average value of 64% characterizing modern omnivorous Europeans (Petzke et al., 2005).

perch, was not consumed in significant proportions.

Summary

Background 

Atherosclerosis is thought to be a disease of modern human beings and related to contemporary lifestyles. However, its prevalence before the modern era is unknown. We aimed to evaluate preindustrial populations for atherosclerosis.

Methods 

We obtained whole body CT scans of 137 mummies from four different geographical regions or populations spanning more than 4000 years. Individuals from ancient Egypt, ancient Peru, the Ancestral Puebloans of southwest America, and the Unangan of the Aleutian Islands were imaged. Atherosclerosis was regarded as definite if a calcified plaque was seen in the wall of an artery and probable if calcifications were seen along the expected course of an artery.

Findings 

Probable or definite atherosclerosis was noted in 47 (34%) of 137 mummies and in all four geographical populations: 29 (38%) of 76 ancient Egyptians, 13 (25%) of 51 ancient Peruvians, two (40%) of five Ancestral Puebloans, and three (60%) of five Unangan hunter gatherers (p=NS). Atherosclerosis was present in the aorta in 28 (20%) mummies, iliac or femoral arteries in 25 (18%), popliteal or tibial arteries in 25 (18%), carotid arteries in 17 (12%), and coronary arteries in six (4%). Of the five vascular beds examined, atherosclerosis was present in one to two beds in 34 (25%) mummies, in three to four beds in 11 (8%), and in all five vascular beds in two (1%). Age at time of death was positively correlated with atherosclerosis (mean age at death was 43 [SD 10] years for mummies with atherosclerosis vs 32 [15] years for those without; p<0·0001) and with the number of arterial beds involved (mean age was 32 [SD 15] years for mummies with no atherosclerosis, 42 [10] years for those with atherosclerosis in one or two beds, and 44 [8] years for those with atherosclerosis in three to five beds; p < 0.0001).

Interpretation 

Atherosclerosis was common in four preindustrial populations including preagricultural hunter- gatherers. Although commonly assumed to be a modern disease, the presence of atherosclerosis in premodern human beings raises the possibility of a more basic predisposition to the disease.

37 mummies from populations of four disparate geo- graphic regions were studied by whole body CT scanning: 76 ancient Egyptians (predynastic era, ca 3100 BCE, to the end of the Roman era, 364 CE, 13 excavation sites), 51 early intermediate to late horizon peoples in present day Peru (ca 200–1500 CE, five excavation sites), five Ancestral Puebloan of the Archaic and Basketmaker II cultures living in southwest America (ca 1500 BCE to 1500 CE, five excavation sites), and five Unangan people living in the Aleutian Islands of modern day Alaska (ca 1756–1930 CE,

one excavation site). These geographical areas were selected because of access to mummies with appropriate age and varied cultural attributes. Mummies were selected for imaging on the basis of their good state of preservation and the likelihood of being adults. Mummies were not selected for study in a random fashion.

It may be presumptuous to assume that an Egyptian relief sculpture from the tomb of a noble of the Sixth Dynasty (2625-2475 B.C.) may suggest sudden death possibly due

to coronary atherosclerosis and occlusion. Much of the daily life of the ancient Egyptians has been disclosed to us through well-preserved tomb reliefs. In the same tomb that contains the scene of the dying noble, there is the more widely known relief "Netting Wildfowl in the Marshes." The latter sculpture reveals some of the devices used four thousand years ago for catching waterbirds alive. It gives a minute account of this occupation, which in ancient Egypt was both a sport and a means of livelihood for the professional hunter.

The relief (fig. 1), entitled "Sudden Death," by the Egyptologist von Bissing2 represents a nobleman collapsing in the presence of his servants. The revelant part of the explanatory text, as given by von Bissing, follows (translation by the author):

The interpretation of the details of the theme is left to the observer. We must attempt to comprehend the intentions of the ancient artist who sculptured this unusual scene. In the upper half (to the right) are two men with the customary brief apron, short hair covering the ears, busying themselves with a third man, who obviously has collapsed. One of them, bending over him, has grasped with both hands the left arm of the fallen man; the other servant, bent in his left knee, tries to uphold him by elevating the head and neck, using the knee as a support. Alas, all is in vain. The movement of the left hand of this figure, beat- ing against the forehead, seems to express the despair; and also in the tightly shut lips one can possibly recognize a distressed expression. The body of the fallen noble is limp. . . . Despite great restraint in the interpretation, the impression which the artist tried to convey is quite obvious. The grief and despair are also expressed by the figures to the left. The first has put his left hand to his forehead. (This gesture represents the Egyptian way of expressing sorrow.) At the same time he grasps with the other arm his companion who covers his face with both hands. The third, more impulsively, unites both hands over his head. ... The lord of the tomb, Sesi, whom we can identify here, has suddenly collapsed, causing consternation among his household.

In the section below (to the left) is shown the wife who, struck by terror, has fainted and sunk totheflor. Two women attendants are seen giving her first aid. To the right, one observes the wife, holding on to two distressed servants, leaving the scene. . . .

von Bissing mentions that the artist of the relief must have been a keen observer of real life. This ancient Egyptian scene is not unlike the tragedy that one encounters in present days, when someone drops dead of a "heart attack." The physician of today has almost no other choice than to certify the cause of such a death as due to coronary occlusion or thrombosis, unless the patient was known tohave been aflictedwith rheumatic heart disease or with any of the other more rare conditions which may result in sudden death.

Atherosclerosis among the Ancient Egyptians 

The most frequent disease of the coronary arteries, causing sudden death, is atherosclerosis. What evidence is available that atherosclerosis was prevalent in ancient Egypt?

The first occasion to study his condition in peoples of ancient civilizations presented itself when the mummified body of Menephtah (approx.1280-1211B.C.), the reported "Pharaoh of the Hebrew Exodus" from Egypt was found. King Menephtah had severe atherosclerosis. The mummy was unwrapped by the archaeologist Dr. G. Elliot Smith, who sent a piece of the Pharaoh's aorta to Dr. S. G. Shattock of London (1908). Dr. Shattock was able to prepare satisfactory microscopic sections which revealed advanced aortic atherosclerosis with extensive depositions of calcium phosphate.

This marked the beginning of the important study of arteriosclerosis in Egyptian mummies by Sir Mare Armand Ruffer, of the Cairo Medical School(1910-11). His material included mummies ranging over a period of about 2,000 years (1580 B.C. - 525 A.D.).

The technic of embalming in the days of ancient Egypt consisted of the removal of all the viscera and of most of the muscles, destroying much of the arterial system. Often, however, a part or at times the whole aorta or one of the large peripheral arteries was left behind. The peroneal artery, owing to its deep situation, frequently escaped the em- balmer'sknife. Otherarteries,suchasthe femorals, brachials, and common carotids, had persisted.

In some mummies examined by Ruffer the abdominal aorta was calcified in its entirety, the extreme calcification extending into the iliae arteries. Calcified plaques were also found in some of the larger branches of the aorta. The common carotid arteries frequently revealed patches of atheroma, but the most marked atheroselerotic alterations were in the arteries of the lower extremities. The common iliae arteries were not infrequently studded with calcareous plaques and in some instances the femoral arteries were converted into rigid tubes. In other mummies, however, the same arteries were near normal.

What is known as Mdnekeberg's medial calcification was also observed in some of the mummified bodies. In a histologic section of a peronieal artery, the muscular coat had been changed almost wholly by calcification. In one of Ruffer's photographic plates, a part of a calcified ulnar artery is shown. The muscular fibers had been completely replaced by calcification.

In the aorta, as in present days, the atherosclerotic process had a predilection for the points of origin of the intercostal and other arteries. The characteristics and the localization of the arterial lesions observed in Egyptian mummies leaves litle doubt that atherosclerosis in ancient times was of the same nature and degree as seen in today's postmortem examinations.

As to the prevalence of the disease, Ruffer ventured to say that the Egyptians of ancient times suffered as much as modern man from arterial lesions, identical with those found in our times. Ruffer was well qualified to make this statement having performed many autopsies on modern Egyptians, Moslems, and other people of the Middle East. In going over his material and examining the accompanying photographic plates of arteries, one can have litle doubt that what Ruffer had observed in Egyptian mummies represented arteriosclerosis as it is known today.

Although the embalming left no opportunity to examine the coronary arteries inl mummified bodies, the condition of the aorta is a good index of the decree of atheroselerosis present elsewhere. In individuals with extensive atheroselerosis of the aorta, there is almost always a considerable degree of atherosclerosis in the coronary arteries. If Ruffer's statement is correct that the Egyptians of 3,000 years ago were afflicted with arteriosclerosis as much as we are nowadays, coronary occlusion must have been common among the elderly population of the pre-Christian civilizations.

Furthermore, gangrene of the lower extremities in the aged has been recognized since the earliest records of disease. Gangrene of the extremities for centuries did not undergo critical investigation until Cruveilhier (1791- 1873) showed that it was caused by atherosclerotic arteries, associated at times with a terminal thrombus.

SUMMARY

The record of a sudden death occurring in an Egyptian noble of the Sixth Dynasty (2625-2475 B.C.) is presented. Because of the prevalence of arteriosclerosis in ancient Egyptian mummies there is presumptive evidence that this incident might represent sudden death due to atheroselerotic occlusion of the coronary arteries.

This choice was helped by a paragraph in Ruffer's book, Food in Egypt, which reads,

The most important food of the Egyptians was bread made of various cereals, wheat, barley, and possibly, as well from lotus seeds and dum-palm dates. The fondness of Egyptians for bread was so well known that they were nicknamed 'artophagoi', or 'eaters of bread'; it was the food par excellence, and the word was and has remained synonymous with food in this country. The most terrible curse was 'They shall hunger without bread and their bodies die.'

Later in the chapter, he wrote, 'Bread and oil formed the main food for the people. The troops and the King's messengers were given 20 deben (about 4 lbs.) of bread daily as rations, which was carried by numerous parties accompanying the march.'1

We were aided in this investigation, as indeed in many other inquiries that arise in Egyptology, by the scenes painted on the walls of a number of the tombs of the nobles at Thebes. Noteworthy examples are to be found in the tombs of Nakht, Menna, Sennedjem, and Rekhmirec, nobles who lived during the New Kingdom period c.

1567-1085 B.C. Methods of sowing the grain, and of reaping the corn with a sickle mounted with flint teeth are to be seen, as well as the subsequent beating, threshing, and winnowing of the harvested grain.

Examples of the ensuing processes in bread-making, that of grinding the corn, mixing the dough, and baking the bread, are even more realistically presented, by examples of three-dimensional sculpture and wooden models, showing precisely the methods used. These statuettes are to be seen in Cairo and other world museums. In the Louvre, Paris, and the Rijksmuseum, Leiden, are examples of Middle Kingdom (c. 2134-1786 B.C.) moveable wooden toys, illustrating actions involved in the preparation of dough. Only the string is not original, and this, when pulled, moves the hinged joints of the models. Garstang, who excavated at Beni Hasan in Middle Egypt for three

seasons from 1902, found a number of wooden models depicting methods of making bread and beer during the Twelfth Dynasty (c. 1991-1786 B . C . ) . 2 In the times of the earliest dynasties, ivory and clay were the materials used for the figurines, but by the time of the Fourth Dynasty these had been superseded by limestone, and many such figures are extant. During the First Intermediate Period and the Middle Kingdom many realistic wooden models of corporate scenes were made. The earlier limestone statuettes usually depicted a servant, man or woman, kneeling behind a stone slab with a bowl containing the grain resting between the legs. The servant is leaning forward grasping a hand-stone, and at the lower end of the saddle-stone is a groove into which the cereal falls as it is ground. The pose is both purposeful and efficient.

Since bread was so popular as food for the living Egyptian, it is not surprising that it was a common practice to place some in the grave of the departed to support life during the hereafter. It has been found in the graves of the common people, in the tombs of the nobles, and even in the tomb of the Pharaoh himself.

DISCUSSION OF RESULTS.

Nature of the lesions. There can be no doubt respecting the calcification of the arteries, and that it is of exactly of the game 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 characteiised by a marked degeneration of the muscular coat and of the endothelium. These diseased patches, discrete at first, fuse together later, 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 now from arterial lesions identical with those found in the present time. Moreover, when we consider that few of the arteries examined were quite healthy, it would appear that such lesions were as frequent three thousand years ago as they are to-day.

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-Bahari, 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, aa there is no evidence that ancient Egyptians were greatly addicted to athletic sport, although we know that they liked watching professional acrobats and dancers. I n the ca6e of the priests of Deir el-Bahari, 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 thousand years ago it represented the same anatomical characters as it does now.

FIG. 1.-Pelvic and arteries of thigh completely calcified (XVIlIth-XXth Dynasty).
Fro. 2.-Completely dcifiedprofundaarteryaftersoakinginglycerine(XXIstDynasty). FIQ. 8.-Partly calcified aorta (XXVIIth Dynasty).
Fro. 4.-Calcified patches in aorta (XXVIIth Dynasty).
Fio. 5.-Calcified atheromatous ulcer of subclavian artery (XVIIIth-XXth Dynasty). Fro. &-Patch of atheroma i n anterior tibia1 artery (glycerine). The centre of the patch

is calcified (XXIst Dynasty).
FIG. 7.-Atheroma of brachial artery (glycerin) (XXIst Dynasty).
Fro. &-Unopened ulnar artery, atheromatous patch shining through (glycehne) (XXIst Dynasty). 31

FIG. 9.-Section through almost completely calcified posterior peroneal artery (low power). Van Gieson staining. a,al, n2, Remnants of endothelium and

fenestrated membrane. b, Calcified patches.

Many more are seen.
Same stain. (Leitz, Oc. 1, x &.)

FIG. 10.-Section

FIG. 11.-Section m(Leitz, Oc. 1, x *.)

a,Remains of endothelium.
b, Fenestrated membrane.
c, Muscular coat.
d,f,Membrane coat undergoing degenerntion.
e, Completely degenerated remnants of muscular coat.

atheroniatous patch of n h a r artery. Same stain. (Leitz, (Reference letters the same as in Fig. 11.)

FIG. 12.-Section Oc. 1, x fa.)

through calcified patch of ulnar artery. a,d, Calcified patches.
b, Partially calcified m wular coat. c, Annular muscular fibre.

 through atheromatous patch of anterior tibia1 artery. Same stain through
FIG. 13.-Section at edge of atheromatous patch. Hreniatoxylin stain (Leitz, Oc. 1, XTh.1 a,Leucocytes (1). The atheromatous part on the left stains intensely dark with hamatoxylin.