Vertebral tuberculosis in ancient Egypt and Nubia • 185 



Figure 7. Case no. 1. Synostosis of 

 part of right sacroiliac joint, cranial 

 view. 



ABUSIR 



OSTEOMA ON THE RIGHT FIBULA 



A longitudinally oriented oval, roundish protrusion (18 x 10 

 mm, elevated 4 mm) was situated at the medial aspect of the 

 distal end of the right fibula. Its surface was covered by 

 compact bone, smooth or slightly uneven. 



CONGENITAL ANOMALIES 



A bilateral small foramen arcuatum atlantis (diameter 1 mm) 

 was combined with bilateral, anteriorly open foramina trans- 

 versalia atlantis. The left foramen transversale epistrophei 

 was also open laterally and there was an anomalously small 

 opening (diameter 2 mm) at the site of the right foramen 

 transversale. 



DIAGNOSIS OF THE SPINAL PATHOLOGY. 



Features considered to be characteristic for spinal tuber- 

 culosis in current paleopathological literature have been 

 compared for both cases in Table 1 . Leaving aside age and 

 sex, there are 20 features of which the majority fit for case 

 no. I. There are, however, seven features which disagree 

 with the scheme and need to be explained. 



The extent of the pathology usually involves two to four 

 vertebrae (Manchester 1983:40; Zimmerman and Kelley 

 1982:105), but occasional cases may involve considerably 

 more (examples are quoted by Zimmerman and Kelley 

 1982:105), as shown by our case. Lack of the progressive 

 erosion of the circumferential surface of vertebral bodies 

 betrayed the termination of the activity of the disease. The 

 same applied for the absence of a recent central abscess 

 cavity in any of the vertebrae. In the course of the process, 

 which was limited only to vertebral bodies, no changes lead- 



Zafirrb Paleopatbolony Symp. 1988 



ing to narrowing of the intervertebral openings or of the 

 neural canal occurred. Paravertebral abscesses, derived from 

 original abscesses in vertebral bodies T8-L1 , apparently did 

 not affect any bony surface to leave observable changes. Not 

 every patient with tuberculosis must be emaciated. Our case 

 indicates a successful course of the disease thanks to the 

 extraordinary resistance of the host. 



The strong kyphotic curvature observed in our case, in- 

 stead of an angular nick, also can be reconciled with the 

 diagnosis of .spinal tuberculosis. It was the result of summa- 

 tion of six lesser angular kyphoses which gradually devel- 

 oped after evacuation of the abscesses and pathological frac- 

 tures of bodies of the afflicted vertebrae. 



COURSE OF THE DISEASE 



The infection must have begun early in childhood as evi- 

 denced by the adaptive greater increase of anterior heights of 

 the healthy vertebrae. It is well known that before the devel- 

 opment of an effective therapy, vertebral tuberculosis devel- 

 oped during the first decade of their life in 50-10% of tuber- 

 culous children and usually appeared 9 months to 2 years 

 after the primary infection (Ulrich-Bochsler et al. 1982: 

 1 322). Other authors also stress the onset in early childhood, 

 mostly before 7 years of age (Ortner and Put,schar 198 1 : 145). 

 From the beginning of the disease in his first decade of life 

 the affiicled man lived 30-50 more years, during which com- 

 plete healing occurred except for the preservation of the de- 

 formity of the spine by firm fusion of the remnants of the 

 involved vertebral bodies. It seems highly probable that dur- 

 ing this long period his immune response succeeded in sub- 

 duing also other possible manifestations of bacillus Kochi in 

 his other organs. 



