192 • Eugen Strouhal 



crowded villages and towns which enabled close contact of 

 people and easy transmission of the agent. 



Three different sources of information, scattered in the 

 literature, may be consulted for a survey of the presence of 

 vertebral tuberculosis: iconography, excavated skeletal re- 

 mains, and mummies. 



ICONOGRAPHY 



Several statues and drawings of hunchbacks may be found in 

 Egyptian art (Morse et al. 1964:525-528; Morse 1967:263; 

 Baud 1978:pl.l6). Their evidence is, however, ambiguous. 

 Diagnosis of vertebral tuberculosis can be based only on the 

 shape of the kyphosis. If it is angular, the probability of 

 tuberculous origin is great. If it is arched, other diseases such 

 as rachitis, Scheuermann's disease, osteoporosis, and bad 

 body posture also must be taken into account. 



Better information may be gained in plastic art. The diag- 

 nosis of vertebral tuberculosis is suggested in an allegedly 

 predynastic clay statuette of an emaciated man with a thor- 

 acic angular kyphosis found inside a bowl (Morse et al. 

 1964:524-525), a possibly predynastic standing, ivory fig- 

 ure showing protrusion of the back and chest (Morse et al. 

 1964:525), a probably Archaic statuette of a squatting, 

 bearded man with a thoracic angular protuberance and an 

 angular protrusion of the chest (Jonckheere 1948), and a 

 wooden statue from the Cairo Museum with an angular 

 kyphosis on the transition between upper and middle third of 

 the thoracic spine (Ghalioungui and Dawakhly 1965:20, 

 fig.64). 



In drawings, evaluation is more complicated, because the 

 hunchback can also be factitious due to artistic ineptitude and 

 stylistic convention. In Egyptian pictures, human shoulders 

 traditionally were represented in frontal view and if the artist 

 failed to place one of the arms correctly the protruding shoul- 

 der may resemble a strongly arched hunch, situated high on 

 the spine. This can be the case of the representation of the 

 "deformed" gardener from the New Kingdom tomb of Ipuy 

 (Davies 1927:pl.XXIX), of the relief of the priest Ankhutus 

 from the false door of his Old Kingdom tomb (Mogensen 

 1930:90, pi. XCV), as well as of the relief of a servant leading 

 two dogs in the Ti's Vth dynasty tomb (SteindorflF 1913: 

 pi. 1 15). Only the relief of a serving girl from tomb no. 45 at 

 Giza, dated IVth dynasty, shows a strongly arched thoracic 

 protuberance (Vandier I964:rig.2), and the painting of an 

 attendant from a Xllth dynasty tomb at Beni Hasan demon- 

 strated a protruding, arched hump at the cervicothoracic tran- 

 sition, both suggesting tuberculous origin. 



SKELETAL REMAINS 



Altogether, 30 cases of vertebral tuberculosis were gathered 

 in the last reviews of tuberculosis in ancient Egypt by Morse 



et al. (1964:529-540) and Morse ( 1967:263-268). There are 

 13 cases from the Upper Egyptian site at Nagada with "typi- 

 cal pathological changes to be considered as tuberculosis and 

 seven of them . . . quite typical" (Morse 1967:268). Unfor- 

 tunately, their dating is problematic. While some are pre- 

 dynastic (B 107, T 52), others may come from dynastic times 

 upto 1400 B.C. In six cases (B 107,60, 1003, D5, R, andQ) 

 the diagnosis of tuberculosis seems to be less probable, and 

 other causes (such as acute osteomyelitis or healed com- 

 pressed fracture) were also taken into consideration (Morse 

 etal. 1964:535-539). 



Of the nine cases described by Derry (1938:1) and sum- 

 marized in a table by Morse (1967:264) only two were from 

 Egypt, one found in an aged woman from Saqqara dated as 

 early as 3300 B.C. , and the other in an old woman from Deir 

 el-Bahri dated 1500 B.C. Seven other cases come from 

 Nubia, most of which are dated 3000 b.c. , and in case no. 1 , 

 2000 B.C. Four adult men, two adult women and a nine-year- 

 old boy were afflicted. Epidemiologically interesting are two 

 graves, each containing remains of two tuberculous individu- 

 als (a man with a woman in tomb no. 314, and a man with a 

 boy in tomb no. 452). 



A series of six unfortunately isolated Nubian vertebral 

 specimens were described by Morse et al. (1964:531-534) 

 and summarized by Morse (1967:265). One of them listed 

 under catalog no. 1 82 E, together with vertebrae of two other 

 persons, is identical with Derry 's case no. 1 , being a lumbar 

 vertebra with a large smoothly delimited cavity more sugges- 

 tive of a bone cyst or osteolytic neoplasm (Morse et al. 

 1964:533, fig. 9 above right) and should be excluded. 



Another case of vertebral tuberculosis was described by 

 Smith (1927:24) and quoted by Morse et al. (1964:534). but 

 insufficiently quoted by Morse (1967:265,267). In the in- 

 complete remains of Pa-Ra'messu, the son of Seti I and 

 brother of Ramesses II, aged 26-30 years, a mass consisting 

 of six thoracic vertebrae (probably T4-9) with parts of corre- 

 sponding ribs was found, all firmly ankylosed together. The 

 bodies of the middle vertebrae had collapsed causing a right- 

 angle bend between probably T6-7. Smith associated with 

 this process the slendemess and gracility of the left leg com- 

 pared with the right one. 



The case described by Watermann (1960:170-171) has 

 been misquoted by Morse et al. (1964:531) and Morse 

 (1967:264) as originating at Giza and excavated by Abu 

 Bakr. In reality it was found in a prehistoric grave and stored 

 in the Museum of Helwan. Two fused sections of the spine 

 were apparent, the first between T4 and T7 with wedge- 

 shaped bodies and another between L I and L5 with a wedge- 

 shaped body L3 . In both areas neural arches were massively 

 involved, making the diagnosis of tuberculosis somewhat 

 doubtful (Morse etal. 1964:531). 



To this survey we may add another case of a middle-aged 

 male found in shaft no. 42 of the uninscribed mastaba B near 

 the Pyramids of Giza with wedge-shaped vertebrae TIO and 



Zagreb Paleopathology Symp. 1988 



