Recent History
May 3, 1870
Diabetes Mellitus and its dietetic treatment
Cantani's third patient, Mr Nicola Cardinale, a priest, was guilty of "abuse of flour for a year" and Cantani realized the priest was eating carbohydrates during mass and thus forbade him from celebrating it.
OBSERVATION III. - Mr. Nicola Cardinale, priest, 65, received at the Clinic on May 3. Diabetic by abuse of flour for a year, with large soil, polyuria, weight loss; he too had been following our treatment for two months, but not with sufficient rigor, and he continued to have 74 gr. of sugar per liter of urine, total amount for 24 hours; specific weight 1028. Subjected to the full rigor of treatment, it improved rapidly, but persisted in presenting 4 to 8 gr. of sugar per day. After having studied the causes of this singular persistence, I forbade him to celebrate mass. The sugar disappeared immediately. This fact shows to what excess of rigor this treatment must be carried out in advanced cases of diabetes. The urine went down as a weight to 1014. This patient weighed on entering 49kil, 5, after six weeks 50kil, 2; in view of his advanced age, the declared senile marasmus, this increase in weight is not to be despised.
September 15, 1870
Diabetes mellitus and its dietetic treatment.
Cantani's diabetic patient observations 21 - 30 are shown, all of whow he put on a carnivore diet to cure them. The scale of the diabetes epidemic even in 1870 Italy seems to be due entirely to carbohydrates.
OBSERVATION XXI. - Mr. Antonio G., notary of Ajello del Sabato (Avellino), had suffered for two years from a dry mouth, and for a year from a sharp thirst, with polyuria, increase of the appetite, impotence and perspiration: for three months, very remarkable loss of weight, with general weakness. He is a man with a flaccid temperament, with an adipose tendency, he has already had ten attacks of gout; for the past two years he has been rid of it: he particularly abused floury foods. Recognized as diabetic by Doctor De Capraris of Atripalda on September 12, 1870, he presented himself to me on September 15 with a polyuria of 5 to 6 liters, the specific weight being 1032, and 72 gr. of sugar per liter. Submitted to the cure, and seen again on November 24, 1870, he was doing perfectly well, had gained in strength and in nutrition and presented urine of the weight of 1022, entirely free of sugar. He resumed with impunity the moderate use of flour; I have long lost sight of him.
OBSERVATION XXII. Canon Vito M., 59 years old, of S. Agata dei Goti, archpriest of T., abused during all his life mealy and fruit; he had been diabetic for eight months, with 8-10 liters of urine per day, severe weight loss, and beginning to darken his eyesight. He came to see me in March 1872. After twenty days of treatment, he no longer presented any sugar: he continued the treatment for a few months, then returned to mixed food. - Even today (September 1874), he is doing perfectly well, eats everything, and as a precaution has adopted the following diet: three days a week, he eats absolutely nothing but meat.
OBSERVATION XXIII .-- Canon Francesco F., aged 61, episcopal vicar of Malta, ate meat very rarely, ate almost exclusively flour and sweet fruits, and also abused sugar, to the point of almost constantly having a piece of it in your mouth. Since a long time suffering, weakened, emaciated, recognized diabetic for seven months, he came to see me on August 3, 1872, with notable polyuria (3 to 4 liters per day): the urine, with a specific weight of 1032, contained 60 gr. of sugar per liter: subjected to the cure, the urine, after eight days, was free of sugar, and their weight fell to 1018. It gradually returned to the use of starches, without any unfortunate result, and until the last news he continued to enjoy the best health. I had another report about him in June 1874, from his brother who had come to Naples for an illness; I have learned with pleasure that he is doing very well, eats everything, but mealy foods with wise moderation.
OBSERVATION XXIV. Mr. C. Pietro B., 44 years old, from Malta, a large consumer of flour, of fruit and sugar, for he ate, even at night, candied fruit and candy. Recognized as diabetic for two years, he presented himself to me on July 14, 1872, with 100 gr. of sugar per liter; the specific gravity of his urine was 1041: he had, moreover, a weakness of sight, attributed by Professors Castorani and Del Monte, whom he had consulted successively, to hyperemia of the optic papilla. Submitted to my cure, the urine was free of sugar from July 22, its specific weight reduced to 1025; he then thought he could use milk, but was quickly punished by the reappearance of sugar in the urine at a dose of 6 gr. per liter, with an increase to 1028 of their specific weight: the milk removed, and the rigorous treatment instituted again, the analysis of the urine carried out on August 3, by Professor Primavera, demonstrated that the sugar had disappeared, and that the specific weight had returned to 1025 (weight still high and due to the abundance of urea and urates); this condition persisted for a long time, then the patient was lost to follow-up.
OBSERVATION XXV. - M. Domenico 2., lawyer, from Oppido (Calabria), 56 years old, of fat constitution, presented himself to me on May 14, 1871. He has never had only intermittent fevers, and has always eaten a lot of starchy foods. Having come to live in a very humid country, he began to experience a torment in his feet and in his hands, and then tautness and contractions in his whole person which his doctors altered to rheumatism. At the same time, he suffered from polyuria which made him fill two or three vases a day. The demonstration that the sugar had disappeared, and that the specific weight had returned to 1025 (weight still high and due to the abundance of urea and urates); this condition persisted for a long time, then the patient was lost to follow-up. May 16 his urine showed 100 gr. of sugar per liter: submitted to the treatment, on May 19 the sugar was hardly appreciable: this patient having experienced a little diarrhea and some visceral pains, one had to order opium and gum at that time. He later resumed the cure, and was completely cured of the diabetes, as the news received at the beginning of 1874 confirms to me.
OBSERVATION XXVI. Mr. Francesco P., from Corato (Bari), owner, aged 44, rarely ate meat, and always in very small quantities: he ate almost exclusively starches, fruits and above all made a very - great abuse of sweets. Sick for three years, with no known cause: impotence, thirst, polyuria up to about 4 liters per day, and, for several months, weakened eyesight; he came to me on July 29, 1872; his urine analyzed by Professor Primavera contained 45 gr. of sugar per liter, and presented a specific weight of 1033. Subjected to the treatment on July 31, the urine was, from August 8, of the specific weight of 1014, and completely deprived of sugar. These urine were therefore very poor in urates. After three months of very rigorous treatment, the patient had two months of a mixed diet, but ate mainly meat: the urine was maintained normal. From December 23, 1872, the patient ate everything, like a healthy man, and yet the urine, examined on January 12 and June 7, 1873 by Professor Primavera, was found completely free of sugar: thus the patient could consider himself cured of diabetes, by this ordeal of eight months of mixed diet followed with impunity: this does not prevent that, fearing his old and pronounced penchant for sweets, I urged him to never return to this fatal habit, which could give him the diabetes a second time, as she had done a first (1). .. (1) I learn, when I am correcting the proofs, that a diabetic from Corato, seen by nioi and by Professor PRIMAVERA, and who, for a year, had been perfectly well, had fallen ill again of diabetes, following a new abuse of flour and sweets, and that, as he had not wanted to immediately return to a rigorous cure, he was reduced to the saddest state. It may be Francesco P., but it could also be M. Mat., From Corato, whom I also treated, but that I did not see again, so that I did not know anything positive about it. (Author's note.)
OBSERVATION XXVII. - M. le Baron D'A., Of Naples, aged 50, a great consumer of flour and frozen candies, suffered, without appreciable cause, for two and a half years, from polyuria, general weakness and incapacity ; for a year the thirst, especially after meals, had been so extraordinary that, to quench it, he usually took three or four ice creams (rich in sugar, as we know), after which he was even more thirsty than before. On July 3, 1872 he had his urine examined by Professor Primavera, and they found 40 gr. of sugar per liter: the specific weight was 1025. Submitted to the cure, his urine presented on July 26, the specific weight of 1017, and was absolutely free of sugar: he has continued to do very well since then. though he returned to ordinary food. In the fall of 1873, as a result of an excessive absorption of flour and frozen candies, the sugar reappeared in the urine, but taken in time, and treated for only a month, health returned, the urine remained free of sugar until March 1874: I have no further information.
OBSERVATION XXVIII. - Mr. Diego della R., diabetic for two years, who absolutely never ate meat, and who, however subjected to my rigorous treatment, got used to it so well that he digested it perfectly, even without lactic acid. His urine had, on July 18, 1872, for specific weight 1040, and containing 100 gr. of sugar per liter: on August 15, they were starved of sugar, and their specific gravity was 1014. He continued to do well, until to the last news received: but it is already some time ago.
OBSERVATION XXIX. - Baron Francesco TS, of Nicastro, client of Doctor Staglianò: interesting case especially by the intermittences of his diabetes. This patient was doing well when he put himself on the absolute meat diet, and even when he took only moderate quantities of starchy substances. But when he used it extensively for a few consecutive days, he became melituric again, and suffered from drought, thirst and polyuria. His nutrition, however, was still quite good. He did my treatment, not however with all its rigor, on the advice of Doctor Stagliano, and recovered to the point of doing well for a whole year, eating everything. Finally, however, there was a relapse, and this time more serious, October 15, of sugar per liter. The patient subjected to the cure, the sugar disappeared very quickly, reappeared sometimes for a very short time, as I have since learned, and disappeared again, all this as regulated by the diet. - According to later news received in January 1873, his urine was free of sugar, but he suffered from intermittent fevers with hemoptysis; this last accident was, according to his doctor, dependent on the malarial infection. In September 1874, I knew he was fine.
OBSERVATION XXX. - Mr. Antonio Tirabelli, from Villarica, owner, aged 35, client of Dr. Domenico Majone, abused flour and sweets, had intermittent fevers, and was exposed to colds: no other cause of diabetes can be found in him. For some time, he suffered from polyuria with thirst, without great hunger, and without impotence. For two months, we had observed, in the urine, the presence of sugar, which, on January 5, 1872, reached 80 gr. per liter. The patient submitted to my treatment, and after only three days the urine was free of sugar. He continued the cure for two months, very rigorous for 25 days, but allowing himself three times the use of chicory: later on he softened it even more. The urine, reexamined on January 31, specifically weighed 1019 and did not contain any sugar: it remained that way, as I was convinced by doing my own qualitative analysis of the urine. The patient was well for more than a year, and looked at himself as completely healed, having gained much in nutrition, strength and good looks. The last information received in 1874, by Doctor Majone, is as follows: the patient felt so well that, relying too much on his recovery, he began to eat sugar in great excess, and especially sugar sweet dishes: he noticed at the same time that, each time he made a similar deviation in diet, thirst and polyuria reappeared: sugar was even observed in the urine. If he resumed the rigorous treatment for a single day, the urine became free of sugar again. But he too often repeated these abuses of sweets, for he very much disliked submitting to this suggestion, and, in a fit of mistrust, he decided that he would run the chance, without following any further treatment: so noticeable, impotence, aphonia and general weakness. This last recurrence lasted four months, during which he continued to abuse sugary foods in this way, to eat them every day for 3 or 4 francs ..... and he made all these deviations, because, having become edematous until groin from weakness of the heart, and also a little from excessive fatigue of the kidneys which caused a slight nephritis with albuminuria, he persuaded himself that he would die fatally from dropsy, even though he would be cured of diabetes.
Finally, at the insistence of his friends, he resumed the treatment, but not rigorously enough: after two weeks, the sugar, which was very abundant on board, had come down to 30 g. per liter, the edema decreased, the strength returned a little, while the thirst and the quantity of urine were normal, and that manly power had reappeared. On March 9, 1874, he underwent the rigorous treatment which I had prescribed for him again, and after a few days the edema had disappeared entirely. The urine examined on April 27, 1874, by Professor Primavera, was completely free of sugar, but contained a small, though quite evident amount of albumin. However, a serious gastric catarrh had developed with complete inappetence; the alvine evacuations were abundant and discolored, according to his attending physician, which made me suspect that the atrophy of the pancreas and the liver were too advanced, as well as the defect of assimilation and absorption of intestines, resulting in thinning and discoloration of feces.
In the hope, however, that he was not a primary degeneration of the pancreas and the liver, but an incomplete atrophy of these organs, which could still be remedied, (if it was consecutive to the diabetic exhaustion, which could be oppose an improvement in nutrition), I advised adding to lactic acid and pepsin, already ordered by the attending physician, pancreatic fats; and behold, immediately after their use, the patient began to digest better, the stools improved and nutrition was restored. Dr Majone then wrote to me: “Under the influence of this treatment, the patient has always gotten better and better. After five days, the voice became natural, the forces gradually improved, the pulse became stronger and more frequent, the moral state improved, thirst completely extinguished, because he never drinks outside of meals; appetite has become normal, with desire for various foods, and with this peculiarity remarkable, an instinctive tendency towards broths and towards pancreatic fats, all things he hated at first; the stools are regular in quantity, and even in their necks, although they are not absolutely normal. The urine examined by Professor Primavera on May 18, 1874, had a specific gravity of 1018, and, although it was free from sugar, contained some traces of albumin, with a normal proportion of urea and urates. - This patient is still doing well now, September, 1874. This case is still very important, by its apparent form of intermittent diabetes; the intermittences were related to food. After being cured of diabetes, the patient continued to be well, although making use of a mixed diet, provided that it was not too rich in sugary materials, and his urine remained normal: with each excess of sweetness, the urine became sweet and abundant. The organism could therefore overcome and burn a mediocre quantity of hydrocarbons, but it could not overcome the excess of these, and when it had been, for some time, encumbered with these hydrocarbon elements, it lost tolerance towards them, - and intermittent diabetes reverted to the state of continuous diabetes. This case shows again that one can cure diabetes, by following the treatment long enough and rigorously, and that one can continue it again when one is well; but that we must no longer fall back into the excess of hydrocarbons, and especially sweets; it also shows that, even a very slight case of diabetes may change and become very serious, to the point of threatening life in the near future.
September 20, 1870
Diabetes Mellitus and its dietetic treatment.
Cantani's fifth patient, cured of diabetes with an all meat diet "Francesco Maria R., 60 years old, from Aversa. He was little fond of meat, and hardly ever ate it: no cause but the abuse of flour and sweets: no moral emotions, no sorrows."
OBSERVATION VM Francesco Maria R., 60 years old, from Aversa. He was little fond of meat, and hardly ever ate it: no cause but the abuse of flour and sweets: no moral emotions, no sorrows. Fading and losing weight for a long time, for three or four years, he had experienced a great dryness of the mouth: for a year very great polyuria, extraordinary thirst, and still more rapid emaciation. For six months, glycosuria had been known, and treated with alkalis, without any advantage: the polyuria itself had increased.
In the first quantitative analysis, on September 20, 1870, Professor Primavera noted 4 liters of very pale urine, with a specific gravity of 1034, with 100 g. of sugar per liter. In the second analysis, 5 liters of urine were found with 550 gr. sugar. On October 2, Professor Buonomo submitted him to my meat cure, with ö gr. lactic acid. After four days, the urine again examined was completely free of sugar: one liter in twenty-four hours: specific gravity 1018; normal color: abundant uric acid. It was at this time, October 2, 1870, that I saw the patient, in consultation with Professors Buonomo and Ramaglia, and Doctors Ruffo and Grimaldi d'Aversa. It was decided to continue the cure, which was done very scrupulously by the patient, although it was a great sacrifice. Every eight or ten days, we redo the examination of the urine, which remained examples of sugar, with a weight of 1017 to 1020, and rich in urea and urates. The cure was thus followed very rigorously until the end of December. The patient then began to eat green vegetables, then fruit: in February a little bread and pasta; and little by little he increased their quantity, preferring beans, peas and lentils to cereals, but eating above all meat and eggs. In June, he began to eat sweets. The glycosuria did not reappear. Even today this gentleman, whom you saw here because he wanted to hear one of my lessons on diabetes, enjoys the best health. His weight has increased by several kilograms, he is strong and healthy. In September 1874, the healing persisted, complements.
November 10, 1870
Diabetes mellitus and its dietetic treatment
Angelo, an architect in Palma, Italy, was diabetic for four years having "abused flour and fruit" but was cured by the meat diet of Dr Primavera and Dr Cantani
OBSERVATION XI. - Mr. Angelo n., Architect in Palma (near Nola), 47 years old, diabetic for about four years. He abused flour and fruit. Three years ago, he had an apoplexy with right hemiplegia: his right arm remained weak: for two years the voice has been extinguished, by paralysis of the glottic muscles. On November 10, 1870, Primavera's analysis showed: 6 liters of urine per day: specific weight 1035: 900 gr. of sugar per twenty-four hours. Submitted to my cure by Primavera himself, from November 22, the urine had come down to 1 liter in. about, specific gravity 1022, no trace of sugar. The patient weighed 66 kilog., On January 31 he weighed 71 kilog. This soft man. rut more than a year after being cured of diabetes, stroke: although he had resumed mixed feeding for a long time, his urine had remained free of sugar: their weight at 1016-1018 .
November 22, 1870
Diabetes Mellitus and its dietetic treatment
Mr Adamo, a famous artist as well as a recognized diabetic for a few months caused by his "habitual abuse of flour" was cured with Cantani's meat diet. Cantani jokes "MA is doing very well, and will continue thus, if he no longer abuses the flour: we hope for the sake of Italian art"
OBSERVATION XII. Mr. Adamo A., famous artist of the Italian theater, suffering for a long time from thirst, polyuria and general weakness, recognized diabetic for a few months: unknown causes apart from the habitual abuse of flour. He presented 65 gr. of sugar per liter of urine, and the specific gravity of 1030, when, Submitted to my cure by Primavera himself, from November 22, the urine had come down to 1 liter in. about, specific gravity 1022, no trace of sugar. The patient weighed 66 kilog., On January 31 he weighed 71 kilog. This soft man. rut more than a year after being cured of diabetes, stroke: although he had resumed mixed feeding for a long time, his urine had remained free of sugar: their weight at 1016-1018. On April 22, 1872, he was submitted to my treatment by M. Finizio, pharmacist of Naples. On May 25, the urine weighed 1013: they were free of sugar, and have remained such until this day (September 1874): MA is doing very well, and will continue thus, if he no longer abuses the flour: we hope for the sake of Italian art.
Ancient History
8000
B.C.E.
Evolutionary and Population Genomics of the Cavity Causing Bacteria Streptococcus mutans
S. Mutans, the bacteria involved in creating cavities likely evolved and expanded with the population growth 10,000 years ago as humans started relying more on starches and sugars.
Streptococcus mutans is widely recognized as one of the key etiological agents of human dental caries. Despite its role in this important disease, our present knowledge of gene content variability across the species and its relationship to adaptation is minimal. Estimates of its demographic history are not available. In this study, we generated genome sequences of 57 S. mutans isolates, as well as representative strains of the most closely related species to S. mutans (S. ratti, S. macaccae, and S. criceti), to identify the overall structure and potential adaptive features of the dispensable and core components of the genome. We also performed population genetic analyses on the core genome of the species aimed at understanding the demographic history, and impact of selection shaping its genetic variation. The maximum gene content divergence among strains was approximately 23%, with the majority of strains diverging by 5–15%. The core genome consisted of 1,490 genes and the pan-genome approximately 3,296. Maximum likelihood analysis of the synonymous site frequency spectrum (SFS) suggested that the S. mutans population started expanding exponentially approximately 10,000 years ago (95% confidence interval [CI]: 3,268–14,344 years ago), coincidental with the onset of human agriculture. Analysis of the replacement SFS indicated that a majority of these substitutions are under strong negative selection, and the remainder evolved neutrally. A set of 14 genes was identified as being under positive selection, most of which were involved in either sugar metabolism or acid tolerance. Analysis of the core genome suggested that among 73 genes present in all isolates of S. mutans but absent in other species of the mutans taxonomic group, the majority can be associated with metabolic processes that could have contributed to the successful adaptation of S. mutans to its new niche, the human mouth, and with the dietary changes that accompanied the origin of agriculture.
Undoubtedly, one of the major challenges that S. mutans had to overcome as the carbohydrate content of the human diet increased was surviving at low pH. Although S. mutans does not constitute a significant proportion of the oral flora colonizing healthy dentition, it can become numerically significant when there is repeated and sustained acidification of the biofilms associated with excess dietary carbohydrates or impaired salivary function (Burne 1998).
Luxor, Luxor Governorate, Egypt
2475
B.C.E.
The Earliest Record of Sudden Death Possibly Due to Atherosclerotic Coronary Occlusion
WALTER L. BRUETSCH
The sudden death of an Egyptian noble man is portrayed in the relief of a tomb from the Sixth Dynasty (2625-2475 B.C.). Since there is indisputable evidence from the dissections of Egyptian mummies that atherosclerosis was prevalent in ancient Egypt, it was conjectured that the sudden death might have been due to atherosclerotic occlusion of the coronary arteries.
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.
Cairo, Cairo Governorate, Egypt
1580
B.C.E.
ON ARTERIAL LESIONS FOUND IN EGYPTIAN MUMMIES
Arteries of Egyptian mummies from 1580 B.C.E. to 525 A.D. have extensive calcification of the arteries, the same nature as we see today, and unlikely to be due to a very heavy meat diet, which was always a luxury in ancient Egypt. Instead, the diet was mostly a course vegetarian one.
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.
