Heart Disease
Heart disease, also known as cardiovascular disease, refers to a range of conditions that affect the heart and blood vessels. It is a broad term that encompasses various conditions, including coronary artery disease, heart failure, arrhythmias, and valvular heart diseases, among others. Heart disease is a leading cause of death worldwide.
Recent History
July 21, 1768
Royal College of Physicians of London
First mention of chest pain in England.
Michaels recounts that William Heberden, one of the “most learned physicians of the day,” presented the first properly recorded cases of chest pain to the Royal College of Physicians of London on July 21, 1768. The afflicted “are seized, while they are walking . . . a painful and most disagreeable sensation in the breast, which seems as if it would take their life away if it were to increase or to continue.” These attacks would continue for months, or even years, until the final blow came. Heberden called the condition angina pectoris (severe pain of the breast) (Michaels 2001, 9).
January 1, 1869
Cancer: Disease of Civilization?
Bishop Reeve thinks Athapaskans were healthiest people in the world on native diet - would likely die from old age instead of disease, but became sickly from epidemics and Diseases of Europeanization
"Before Europeans came, Bishop Reeve thought, his Athapaskans must have been among the healthiest peoples in the world. But many of them died young nevertheless. At childbirth the mortality was high, especially for babies but also for mothers. Accidents were many in childhood and youth, indeed throughout life. Though famines came seldom, the wiping out of small groups by starvation was frequent. Murders occurred, but not as often as among whites. Women who survived the childbirth period, and their male contemporaries, would more likely die from old age than from disease.
The problem of whether old age descended upon Indians sooner or later than upon whites, the bishop thought, could be discussed only with regard to probabilities, since undisputed facts were hard to come by. He had read in the books of some explorers, and in some Hudson's Bay Company reports from early traders, that old age was supposed to afflict the native prematurely. But himself he was unable to see how those writers could have found this out, even if their interpreters were of the best. For the very idea of counting years, to keep track of a person's age, was foreign to native thinking and had been brought into the Athapaska country by these same Europeans. The only fact that a Mackenzie River Indian could know about anybody's age, and the only thing he could have told anybody, was which of his neighbors were older than others.
By the time he discoursed with us in 1906, Bishop Reeve had been pondering matters of northern Canadian native health and longevity for thirty-seven years, starting in 1869. During the scores of hours in which the bishop shared his knowledge and thinking with us, I gradually came to understand how he classified the diseases and derangements which he believed were derived from Europe and which he chiefly blamed for changing the Athapaskans from healthy to sickly, and for reducing the population of the northern third of our continent from several millions to fewer than one hundred thousand. His grouping of these presumed imports seemed to be:
1. Cataclysmic germ afflictions that swept away the robust and the weak indiscriminately.
2. Insidious germ infections to which the strong were resistant.
3. Sicknesses which probably were not due to a germ freshly introduced by Europeans but which likely were caused by a deleterious way of life introduced from Europe.
Diseases of Europeanization. These included a dozen maladies such as cancer, rickets, scurvy, and tooth decay. Their recent appearance among the Athapaskans was charged by the bishop to the introduction of such foods as bread and sugar, and to such new food-handling methods as the preservation of meats with salt and the overcooking of fresh foods."
Bishop Reeve seemed a little doubtful about the heroic Marsh technique when it was used against a germ disease like tuberculosis. But against another group of ills he felt sure the native life was a panacea, preventing those derangements which he believed to be caused by eating the wrong foods or by not eating the right ones. This baker’s dozen or so of diseases he thought nutritional. I consider his full list farther on, along with some additions contributed by Alaskan and Canadian medical missionaries. I shall now select three from this lot, because in 1906 everybody along the Mackenzie River system was talking about them, as part of what they had to say about the Klondike Gold Rush.
Stefansson 1960
March 4, 1888
J.H. Salisbury
SOME OF THE DISEASES PRODUCED BY TOO EXCLUSIVE FEEDING UPON AMYLACEOUS AND SACCHARINE FOODS AND FRUITS, WITH THE DIET TO BE USED FOR THEIR CURE. Vegetable Dyspepsia, or the first Stage of Consumption.
"The stomach is the first organ to suffer. In man this organ is mainly designed for digesting lean meats. It may be called a purely carnivorous organ. It requires lean meats to excite a normal quantity of healthy secretions in its glandular follicles for digestion."
XLV. SOME OF THE DISEASES PRODUCED BY TOO EXCLUSIVE FEEDING UPON AMYLACEOUS AND SACCHARINE FOODS AND FRUITS, WITH THE DIET TO BE USED FOR THEIR CURE.
Vegetable Dyspepsia, or the first Stage of Consumption.
This arises from the too exchisive and long-continued use of vegetable or amylaceous and saccharine foods and fruits, or either of them. The stomach is the first organ to suffer. In man this organ is mainly designed for digesting lean meats. It may be called a purely carnivorous organ. It requires lean meats to excite a normal quantity of healthy secretions in its glandular follicles for digestion, and the healthy excitation of these secretions stimulates the muscular fibres to maintain those normal downward peristaltic movements which are necessary for physiological digestion and transmission. The stomach does not digest amylaceous and saccharine foods, fruits and fats. These are digested by the secretions that are poured out into the duodenum by the liver, pancreas, and glands of Lieberkuhn and Bruner. Hence the too exclusive and long-continued use of vegetable, and especially amylaceous and saccharine food, fills the stomach with materials which do not stimulate it even enough to pass them along to where they are digested, in consequence of which they lie so long in this organ that fermentative processes supervene little by little, and we have the stomach filled with carbonic acid gas, sugar, alcohol, acid and alcoholic and acid yeast plants. These products of fermentation soon begin to paralyze the follicles and muscular walls of the stomach, so that it becomes flabby and baggy, and will hold an unusual amount of trashy foods and fluids. The organ has been turned into a veritable sour " yeast pot," and we have the first stage of the disease known as vegetable dyspepsia of the stomach, or the first stage of consumption.
In this stage of the disease, the stomach is almost constantly distended mth gas, which is only partiafly relieved by the frequent sour eructations.
Yeast plants are rapidly developed in the organ, and every particle of vegetable food which is taken in immediately begins to ferment, —the stomach being converted into an apparatus for manufacturing beer, alcohol, vinegar and carbonic acid gas. This carbonic acid gas soon begins to paralyze the gastric nerves, and the follicles of the mucous membranes of the organ commence to pour out a stringy viscid mucus, in considerable quantities. This, together with the partial paralysis, produces a relaxed, dilated state of the blood-vessels, so that a congestion (with a low state of vitality) results. The epithelial surfaces and connective tissue layer beneath them, then begin to mcrease in thickness, and if this process and state continue long enough, we have a gastric fibroid which may terminate ni scirrhus of the organ. If, however, the person is fairly active, so as to shake the food out of the stomach into the duodenum and small bowels, or if the pyloric valve becomes sufadently paralyzed to remain open, so that the food and hquids flow into the small bowels soon after being swallowed, then danger of gastric thickening is lessened : the patient feels much more comfortable and thinks he is greatly improved. The disease, however, is no better. It has simply changed its base of action and is transferred from the stomach to the small bowels. This is the second and most dangerous stage, bemg vegetable dyspepsia of the small bowels.
The exercise, habits of living, eating and dnnkmg may be such as to detain the disease in this stage a long whfle. There is then great danger of the passage of Mycoderma spores (and the products developed by their multipHcation) into the blood stream. Should this occur, we are in the second or transmissive stage of Consumption. In this stage of the disease, the bowels are more or less constipated. Generally speaking, the more constipated they are, the greater the danger.
An inactive, sedentary life, and a great disturbance of the bowels with carbonic acid gas and other yeasty products, may early paralyze the ileo-csecal valve so far as to let the fermenting products pass readily and freely into the large bowels. The danger of having the yeast spores transmitted is then lessened by the free passage of the spores into the colon, where they go on exciting fermentation in the various fermenting foods used. This soon results in many copious, yeasty evacuations during the night or early every morning and forenoon. Sometimes there are twenty or more passages daily. The passages are light and bulky, and have but little weight. They are sour yeast. This is the third stage of Vegetable Dyspepsia or Chronic Diarrhoea, or more strictly speaking, Consumption of the Bowels. The disease, if left to itself, and if the foods producing it are kept up, may run on for months or even years. I have treated and cured cases that had been running on for from fifteen to twenty years.
In all cases of this stage of the disease, the large bowel becomes greatly thickened, and often in severe cases is almost entirely closed up. This thickening goes on quite rapidly in the connective tissue layer, and in the epithelial lining of the bowel. The folds of the bowel soon become greatly enlarged and are elongated from a few inches to a foot or more extra in length. If the patient lives long enough, and is on a curative diet, these folds and the thickening gradually disappear by absorption, though sometimes the elongated folds slough away partially decayed. Occasionally, in severe cases, from three to four years are required to remove all traces of the disease and all thickenings of the bowel. As long as the thickenings are present, there will be more or less of a thick, jelly-like, ropy, viscid mucus, coming- away every day . or every few days or weeks, according to the condition and severity of the disease. In consumption of the bowels, the lungs almost invariably become involved before death. Checking the diarrhea with astringents —while the fermenting foods are kept up —only aggravates the disease in the end and endangers lung invasion.
Summer Complaint in Children.
The summer diarrhoeas in children are of the same character as the so-called Chronic Diarrhoea, previously described. It is essentially a disease of unhealthy or defective feeding, and readily yields to the simplest treatment, by removing the cause and substituting food that will not ferment with yeast. As soon as green vegetables and fruit begin to appear in early summer, children live almost entirely upon this kind of food at the expense of more substantial aliments. The same symptoms and pathological lesions, in the same order, result as has been previously described under the head of chronic diarrhoea, and the disease yields readily to the same treatment.
Influence of Army Diet in Producing Diseases of Soldiers.
In the army there is in all the men a peculiar chronic condition of the "alimentary membranes, excited by frequent fermentation of amylaceous matters too long retained, and which condition does not run on to chronic diarrhoea unless some enervating cause — such as over-fatigue, dysentery, typhoid, bilious, remittent or intermittent fever, or other cause —debihtates the system, and further impairs the condition of the alimentary membranes. This is evidenced by the almost universal condition of the alimentary canal in apparently healthy soldiers who are shot dead in battle. (See Eng. Surg, and Med. Hist, of Crimean War.) The follicles of the large intestines are more or less enlarged and frequently disintegrated, leaving ulcers. The amylaceous, army biscuit diet of the common soldiers, besides its fermentative and carbonic acid poisoning effects, does not furnish to the system the proper proportion of ingredients for healthy alimentation and nutrition. Hence a scorbutic condition results, which renders the disease an obstinate one to treat, unless this state is recognized and particularly attended to. This explains the reasons why the vegetable acids, combined with potassa and iron, are so useful in treating this disease. Rochelle salts are admirably adapted for exciting intestinal epithelial activity, and secretion and absorption in the alimentary canal.
Any one kind of food too long continued has a tendency to produce systemic derangements of a scorbutic type. Amylaceous matters, too exclusively used, tend to excite abnormal actions in the parent epithelial cells of the mucous surfaces and of the glands ; while any one kind of animal food, too long and too exclusively eaten, produces derangements which show themselves more strongly in skin and mouth. A too free use of oils and fatty food, and of alcoholic beverages, produces the red, blotched face, and swollen carbunculated nose, oily surface, and erythematous swelling and redness of the skin generally.
Salt meats produce a dry, scaly eruption upon the surface, with spongy, swollen and discolored gums ; loosened teeth, and a watery, flabby, often bloody tongue ; pains in the limbs and back resembling those of chronic rheumatism ; leaden-hued features ; offensive breath ; patches of extravasated blood in various parts of the body ; hard, contracted condition of the muscles ; stiffness of the joints ; diarrhoea and hemorrhage from mucous surfaces generally ; mental depression and indisposition to any kind of exertion. From this scorbutic condition —produced in all the men by the want of the necessary variety in their food —arises a long train of the most fatal and most obstniate diseases of the army. Among these may be mentioned chronic diarrhoea ; the so-called muscular rheumatism ; dysentery ; hospital gangrene in wounds ; tuberculosis ; fibrinous depositions iii the heart ; the clogging up of pulmonary vessels with fibrinous clots ; paralytic conditions and tendencies, and many of the diseases of the larynx, ear and eye. This condition of the system also renders it extremely subject (when exposed to the exciting cause) to typhoid, intermittent and remittent fevers. The vital powers are so depressed that the organism on light exposure to cold, is liable to be frostbitten and is strongly inclined to attacks of pneumonia and bronchitis, with diseases of the eye and ear. In short, the long list of army diseases may be traced, in great measure, to an extreme susceptibility to them, which susceptibility is produced by a want of the proper admixture of nutrient ingredients in the food of the soldier in campaigns. All authorities agree that scorbutic states arise from this cause, and no one having any experience in army diseases can fail to detect symptoms of scorbutus in almost every one of them. If they are not plainly visible in the apparently well man, they make themselves manifest in him as soon as he is placed under treatment for any disease, in the surprising benefit his system derives from the vegetable acid salts of potassa and iron, and from the free use of those articles of food of which his system has been deprived. Without this treatment almost all army diseases become obstinate to deal with, much more so than similar ones in private practice. In old cases of chronic diarrhoea, it frequently happens that the diarrhoea somewhat abates, the appetite becomes remarkably good and the patient fattens rapidly. His abdomen becomes hard and distended, it being either dropsical, tympanitic, or distended by enlarged viscera ; the whole surface becomes bloated and presents the appearance of having been affected by an excessive use of alcoholic beverages. The eyes become prominent, red and watery ; the thyroid glands become enlarged ; the heart gives marked evidence of fibrinous depositions internally (1 It has been noticed that in certain cases of heart disease tlie thyroid glands become enlarged, and the eyes prominent, watery and red. Whether there is any analogy between the condition of tlie symptom in this form of heart disease, and that productive of heart disease, chronic diarrhea, paralytic tendencies, etc. in the army, I am unable to say. I merely mention the circumstance here to draw attention in this direction.)
Ancient History
Cairo, Cairo Governorate, Egypt
3100
B.C.E.
Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations
Probable or definite atherosclerosis was noted in 47 (34%) of 137 mummies and in all four geographical populations
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.
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.
Cairo, Cairo Governorate, Egypt
945
B.C.E.
Cardiology in Ancient Egypt by Eugene V. Boisaubin, MD
Egyptians describe coronary ischemia: "if thou examinest a man for illness in his cardia and he has pains in his arms, and in his breast and in one side of his cardio... it is death threatening him."
The classic pattern of cardiac pain--radiation to the left arm--was so well known that the ancient Egyptians and Copts even identified the left ring finger as the "heart" finger.
Altogether, ancient Egyptians were aware of a variety of abnormal cardiac conditions, particularly of angina pectoris and sudden death, arrhythmia, aneurysm, congestive heart failure, and venous insufficiency. Numerous remedies for afflicitions of the heart are found throughout the Ebers payrus.
There were a range of them using different foods, some even including carbohydrates like dates or honey and dough, but interesting, there is another combination of "fat flesh, incense, garlic, and writing fluid".
Extensive histologic analysis of mummies began, however; well before the development of the scanning electron microscope. In 1912, Shattock' made sections of the calcified aorta of Pharaoh Merneptah; and the work of Sir Marc Armand Rufer, published posthumously in 1921, is our most valuable early source of information about vascular disease in ancient Egyptians. Ruffer was able to study a relatively large number of tissue specimens from mummies, mainly from New Kingdom (1600-1100 BC) burials, but covering a wide period of time. In a mummy of the 28th to 30th Dynasty (404-343 BC), he observed atheromas in the common carotids and calcific atheromas in the left subclavian, common iliac, and more peripheral arteries. Ruffer concluded from the state of the costal cartilage that this mummy was not that of an old person. A mummy of a man of the Greek period (ca. 300 to 30 BC), who died at not over 50 years of age, showed atheromas of the aorta and brachial arteries. Since the discoveries of Rufer, numerous other mummies, whose ages at death ranged from the 4th to the 8th decade, have shown similar vascular changes (Fig.4).
In 1931, Long described a female mummy of the 21st Dynasty (1070-945 BC), found at Deir-el- Bahari-that of the lady Teye, who died at about 50 years of age. The heart showed calcification of one mitral cusp, and thickening and calcification of the coronary arteries. The myocardium is said to have had patchy fibrosis, and the aorta "nodular arteriosclerosis." The renal capsule was thickened, many of the glomeruli were fibrosed, and the medium-sized renal vessels were sclerotic. The condition appears to be that of hypertensive arteriosclerotic disease associated with atheromatous change. In the 1960s, Sandison examined and photographed mummy arteries using modern histologic methods (Fig.5). Arteries in the mummy tissues were described as tape-like, but could be dissected easily, whereupon arteriosclerosis, atheroma with lipid depositions, reduplication of the internal elastic lamina, and medial calcification were readily visible under microscopy.
Still more recently, one of the most extensively studied Egyptian mummies has been PUMIL from the Pennsylvania University Museum(hence its initials), now on loan to the National Museum of Natural History at the Smithsonian. It is believed to be from the later Ptolemaic period, circa 170BC. The heart and portions of an atherosclerotic aorta were found in the abdominal cavity. Histologically, large and small arterioles and arteries from other organs showed areas of intimal fibrous thickening typical of sclerosis. These findings are particularly striking since the estimated age of PUM I at time of death was between 35 and 40 years.
