Nasal leishmaniasis and amputation in ancient Peruvian ceramics • 97 



Some paleopathologists have de- 

 scribed these nasal and oral lesions as 

 pathognomonic of a form of leprosy. 

 Ortner and Putschar (1981). in their 

 classic paleopathology book, have 

 commented on the findings of different 

 investigators in skulls found in a medi- 

 eval Danish leprosy cemetery in 1953. 

 All of them think that these nasal and 

 oral lesions are characteristic of lep- 

 rosy. However, they did not discard the 

 pt>ssibility that similar lesions could be 

 found in tertiary syphilis and in lupus 

 vulgaris. 



My experience in more than thirty 

 years as a pathologist of tropical infec- 

 tious diseases is different. Today, in the 

 jungle of the Amazon River, leprosy is 

 endemic. We have seen more than 300 

 patients with leprosy there. Many of 

 them were in the acute lepromatous 

 stage and others had chronic, advanced 

 lesions. Most of those patients had mi- 

 croconfluent, nodular lesions of the 

 nose. Some of them also had gran- 

 ulomatous lesions in the nasal septum 

 with ulceration and perforation of the 

 septum, but we did not find one case in 

 which the nasal septum and the palate 

 bone were totally destroyed giving the 

 classic appearance of a round, wide and 

 large nasal cavity with nasal-oral com- 

 munication. 



However, in the jungle of the Ama- 

 zon River, mucocutaneous leishmania- 

 sis is also endemic. We have studied 

 almost 100 cases of these patients. 

 More than 20 were in an advanced 

 stage, showing the typical destructive 

 lesions of the nasal septum and the pal- 

 ate bones, exactly like the graphic rep- 

 resentations in the ceramics of the an- 

 cient Peruvians. 



Mitsuda and Ogawa (1937) reviewed 

 150 autopsies in the Aisein National 

 Leprosarium in Japan. On this subject 

 they said. "Some leprotic periostitis 

 and involvement of the osseous struc- 

 ture are found in various bones, such as 

 the tibia and the phalanges." However, 

 they did not describe any special naso- 



FiGURE 5. Ceramic representation of a case of mucocutaneous leishmaniasis. Third 

 stage. Infection has destroyed nasal septum, rounding and widening nasal cavity. 

 Peruvian Mochica culture. Lima, Peru. 



Figure 6. Ceramic representation of a case of mucocutaneous leishmaniasis. Last 

 stage. Complete destruction of nasal cavity with partial resorption of hard palate 

 bone. Peruvian Mochica culture. Lima, Peru. 



Figure 7. Ancient Peruvian skull with a case of mucocutaneous leishmaniasis, 

 showing classical nasal and oral lesions of this disease. Nose is round and wide for 

 total destruction of nasal bones. Part of palate bone also destroyed. Skull of Peru- 

 vian mummy. Lima, Peru. 



Figure 8. Ceramic representation of face of a normal skull showing anatomical 

 proportion of size and shape of nasal and oral cavities, including septum. Peruvian 

 Mochica culture. Lima, Peru. 



Zagreb Paleopathology Symp. 1988 



