Noma — cancer aquaticus: First indication of 

 the skin involving disease in ancient Egypt? 



Wolfgang M. Pahl and W. Undeutsch 



Paleopathological publications on 

 Egyptian mummies sporadically report 

 skin lesions, which are usually the re- 

 sult of trauma and very often connected 

 with skeletal damage, whereas there is 

 little evidence of pathological changes 

 of the soft tissue only, especially the 

 skin (Sandison 1967; Ruffer and Fer- 

 guson 1911; Pahl 1986). This fact can- 

 not be explained by a lower incidence 

 of such diseases in antiquity — ample 

 evidence as well as therapeutic advice 

 is provided, for example, by the Pa- 

 pyrus Ebers, the Hippocratic Corpus, 

 or Celsus's reports. The paucity of 

 cases could be due either to the poor 

 state of tissue preservation or to the lack 

 of special research projects in this field. 

 In a smaller number of cases the em- 

 balming substances applied to the body 

 surface of the mummy prevent an ade- 

 quate evaluation of the object. 



Presentation of the following casu- 

 istry is justified on the grounds of the 

 rarity of soft tissue pathology and the 

 macroscopic uniqueness and singular- 

 ity of such a finding in mummy remains 

 from ancient Egypt. As far as we know, 

 no comparable case has been reported 

 from other geographical regions. 



Material and methods 



The object under investigation is the 

 head of a male, adult mummy about 30 

 years of age. Provenience: Lower 

 Egypt. Date: Late Period. It is stored in 

 the Egyptian mummy collection of the 

 Institute of Anthropology and Human 



Zagreb Paleopathology Symp. 1988 



Genetics at the University of Tubingen, 

 registration No. 1565. 



In addition to a detailed macroscopic 

 inspection, microphotographs with dif- 

 ferent stains were prepared from most 

 of the ulcerations. Radiological inves- 

 tigations, including orthopantomogra- 

 phy, were carried out. 



Description of lesions 



It was possible to identify a total of five 

 skin defects. Based on their exterior ap- 

 pearance it can be stated with almost 

 complete certainty that at least four of 

 these are of the same origin. 



Lesion I: Region of the jaw, approxi- 

 mately 10 mm right lateral to the medi- 

 an sagittal line on the level of the lower 

 canine. The lower lip is partly involved 

 (Figures 1,2,7,8). 



Lesion II: Region of the infratem- 

 poral facies of the right maxilla, imme- 

 diately cranial to the 2d upper molar. 

 Exposure of the gingiva (Figures 2, 

 9,10). 



Lesion III: Left buccal region at the 

 level of the lower margin of the zygo- 

 matic bone (Figures 1 ,3, 1 1 ). 



Lesion IV: Region of the right inner 

 mandibular angle, near lesion II (Fig- 

 ures 2.9.10). 



Lesion V: Region of the right exter- 

 nal mandibular angle, immediately on 

 the frontal cord of the sternocleidomas- 

 toid muscle (Figures 2,12). 



Lesions I-IV are characterized by an 

 irregular, circular, sharply defined, al- 

 most punched-out appearance; ulcera- 



tion of all soft tissue down to the bone; 

 and almost uniform size of ca. 15 mm 

 in diameter. Lesion I shows a steeply 

 sloping, craterlike margin. There is no 

 outer wall and no recognizable color 

 changes or scars. Minute perforations 

 and tunnel formations caused by insects 

 are to be found in the area of lesion III 

 and in other skin regions outside the 

 face. Except for lesion III, in which two 

 perforations of the maxillary bone are 

 observable — most likely caused by an 

 apical tooth abscess, no further osseous 

 destruction traceable pathologically to 

 the soft tissue lesions was detected 

 macroscopically. 



Lesion V, located outside the frontal 

 and lateral part of the face, cannot be 

 compared either macroscopically or to- 

 pographically with the other ulcera- 

 tions. Rather, it is a partially smooth, 

 oval cavity with a diameter of ca. 12 

 mm and a depth of ca. 14 mm, with a 

 slightly punctured surface on the bot- 

 tom connected to the soft tissue of the 

 neck. 



Discussion 



Taking into account the missing body of 

 the mummy, which precludes a differ- 

 entiation between local and whole body 

 involvement of the soft tissue, diagnos- 

 tic considerations based on the follow- 

 ing criteria can be evaluated with all 

 due consideration: localization, num- 

 ber, limitation, shape, and extension of 

 skin lesions I- V. They are supported by 

 radiological and histological findings. 



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