Vertebral tuberculosis in ancient 

 Egypt and Nubia 



Eugen Strouhal 



It has become a widely accepted view that diagnosis of 

 tuberculosis from archeologically excavated human skeletal 

 remains is not easy, but that a reasonably reliable prediction 

 can be made if the spine is involved (Haneveld 1980:2). 

 Vertebral tuberculosis (spondylitis tuberculotica) was first 

 described by Sir Percival Pott, a surgeon at St. Bar- 

 tholomew's Hospital in London, in 1779 (Pott 1790) and 

 named malum Potti in honor of him. It deserves to be studied 

 by modem paleopathologists also 200 years later. Its patho- 

 logical anatomy is usually very characteristic, making it pos- 

 sible to distinguish it from other spinal diseases. 



While modem clinical reports indicate that skeletal tuber- 

 culosis as a rule occurs as a complication secondary to either 

 pulmonary or intestinal tuberculosis in about 1% of such 

 patients, its incidence was considerably higher during the 

 preantibiotic era: between 5 and 7% (Steinbock 1976:175; 

 Zimmerman and Kelley 1982:103). In the same period the 

 spine was involved in 25-50% of skeletal tuberculosis cases 

 (Steinbock 1976:176). This means that cases of skeletal tu- 

 berculosis represent about 1-3.5% of the total number of 

 people who were infected by tuberculosis. 



It is encouraging that the acid-fast bacterium Mycobac- 

 terium tuherculosis (bacillus Kochi) was recently demon- 

 strated in a Peruvian mummified child of the seventh century 

 A.D. Nasca culture (Allison et al. 1973) as well as in the 

 vertebrae and pulmonary blood of an Egyptian mummified 

 child from Thebes West, dated 1000-400 years B.C. (Zim- 

 merman 1977,1979). Nevertheless, bacteriological tech- 

 niques can be used only exceptionally in excavated material 

 and the agent of the disease is not always preserved in it. For 

 current studies on the incidence of tuberculosis in ancient 

 [xjpulations, however, macroscopic and radiological diag- 

 nosis of cases of vertebral tuberculosis may still be used as 

 convenient and technically simple methods. The presence of 

 vertebral tuberculosis has to be considered at the same time 

 as evidence for the presence of other tuberculotic forms, such 

 as pulmonary, intestinal or glandular, without, however, re- 

 vealing their specitlc frequencies (Grmek 1983:265). 



Zagreb Paleopathology Symp I9HH 



Moreover, the description of each newly detected case 

 adds some new knowledge to the morphology, extent, and 

 course of the disease. This applies to two cases recently 

 found in a Middle Kingdom burial in Egypt (case no. 1 ) and 

 in a Christian period cemetery in Nubia (case no. 2). They are 

 of interest because of their considerable extent and contrast- 

 ing developmental phases, pointing to different social im- 

 plications. 



Case number 1 



ARCHEOLOGICAL BACKGROUND 



An isolated secondary burial of Middle Kingdom dating was 

 found in the 5th dynasty Pyramid Temple of King Raneferef 

 at the royal cemetery at Abusir by the mission of the Czecho- 

 slovak Institute of Egyptology, Charles University, Prague, 

 in 1984. The burial of a male called Khuyankh (Hwy'nh) 

 (900/1/84) was placed at the bottom of a rectangular shaft 

 excavated in the northern half of room AA-Ec, situated in the 

 NE comer of the hut-nemet section of the temple. The lower 

 part of the shaft was lined with sun-dried bricks delimiting 

 the burial chamber, oriented with its longer axis roughly N-S . 

 As no traces of roofing were detected, it seems probable that 

 after insertion of the cotTins the shaft was simply filled up 

 with sand. 



The dead individual was provided with two coffins. The 

 external, box-shaped one was decorated on its outer surface 

 by inscriptions, and on its interior sides by further in.scrip- 

 tions, coflfin texts, and pictures of offerings. The intemal, 

 anthropoid coffin was lying on its left side inside the external 

 coffin with the head end to the north. The skeleton, 155 cm 

 long, was in an extended position at the bottom of the inner 

 coffin with the skull tumed with its face down. 



In the inner coffin two faience beads and the head of a 

 wooden stick were found. South of the foot end of the outer 

 coffin a low chest was placed, divided by two boards into 

 four compartments with remnants of organic matter and 



181 



