300 • Wolfgang M. Pahl and W. Undeutsch 



TREPONEMATOSIS 



It seems that there are no sure indica- 

 tions that diseases caused by Trep- 

 onema pallidum infected the ancient 

 Egyptian population (Sandison 1972: 

 218). Nevertheless, some of these in- 

 fections have to be included in the dif- 

 ferential diagnosis because the defects 

 in case 1565 are similar to lesions ap- 

 pearing in the extragenital primary 

 manifestation of primary lues, in sub- 

 cutaneous syphilides of tertiary lues, 

 and occasionally in yaws — a non- 

 venereal type of treponematosis. How- 

 ever, extragenital manifestations are 

 less frequent than genital ones and usu- 

 ally appear as a single lesion. Nor- 

 mally, they do not reach the degree of 

 soft tissue destruction detected in indi- 

 vidual 1565 (Luger 1981). Similar rea- 

 soning can be applied in regard to the 

 advanced stage of syphilis. Another, 

 more important argument for not cor- 

 relating the disease in the investigated 

 specimen with venereal and non- 

 venereal syphilis is the morphologic 

 uniformity of lesions I-IV. Further- 

 more, yaws is a disease of subtropical 

 climates, and accordingly its occur- 

 rence in Egypt is far less probable than, 

 for example, the non venereal endemic 

 syphilis found today in the Nile Delta 

 (Maleville 1976). 



TROPICAL ULCER 



Tropical ulcer is a phagedenic ulcer pri- 

 marily found in tropical and humid cli- 

 mates. Established lesions contain 



fusospirochaetal organisms, but it is 

 unclear whether these are the primary 

 infecting agents. Epidemics have been 

 reported from northern Africa. Follow- 

 ing erythema a pustule develops, fol- 

 lowed in turn by a sharply limited, 

 circular or oval ulceration with under- 

 mined, slightly raised margins. Later 

 the margin hardens, further deepening 

 the crater to the point of exposing the 

 bone (Connor and Neaffie 1976). Mal- 

 nutrition, inappropriate treatment, un- 

 hygenic living conditions, and con- 

 tamination of the ulcers are factors 

 which prevent healing. Such defects are 

 located primarily on the distal part of 

 the leg above the malleoli (compare 

 Haneveld 1974). The diagnostic differ- 

 ence between tropical ulcer and lesions 

 I-IV consists in the former's raised 

 margins, isolated lesions, and charac- 

 teristic location on the lower ex- 

 tremities. 



CUTANEOUS LEISHMANIASIS 



An infection of the skin by a protozoan 

 of the genus Leishmania includes three 

 clinical-pathological entities. One of 

 them, the tropical sore, must be in- 

 cluded in the differential diagnostic 

 possibilities. It represents a single le- 

 sion caused by Leishmania tropica. 

 Geographical distribution: tropics and 

 subtropic; sporadic in the southern part 

 of Europe. Predominantly the un- 

 clothed regions of the body (mainly 

 face) are involved. The disease shows 

 circular or oval, sharply limited, partly 

 raised margins, and its development be- 



FiGURE 14. Diflferentdegreesofnoma in clinical patients. Photos courtesy of Armed 

 Forces Institute of Pathology, Washington, D.C. 



gins with a local erythema, followed by 

 pustules and papules, and finally a shal- 

 low ulceration (Braun-Falco et al. 

 1984:178-181). Normally the lesions 

 disappear after one year and a scar re- 

 mains. Distinctive marks concerning 

 the lesions in case 1565 are the slight 

 outer wall, the depth of the ulcerations, 

 the absence of bone exposure and the 

 stages of the growth process. 



NOMA (CANCRUM ORIS) 



Noma is an acute, progressive, necro- 

 inflammatory process of unknown ori- 

 gin. It involves the soft tissue of the 

 face and during later stages the facial 

 skeleton as well. Although spread 

 throughout the world, noma is rare in 

 western Europe and North America 

 (Joseph and Duncan 1976). In recent 

 years, it has been reported in Africa and 

 Asia. The disease corresponds to the 

 so-called cancer aquaticus of the Mid- 

 dle Ages and was prevalent during that 

 era. Predisposing factors include im- 

 mune deficiency due to malnutrition or 

 consumptive diseases. Bacteria iso- 

 lated from the base of the lesions often 

 include spirochetes, corynebacteria 

 and others, but it is more likely that 

 these represent secondary contamina- 

 tion. The prognosis of the disease was 

 fatal in the preantibiotic era and is still 

 severe today (Tempest 1966:949). The 

 macroscopic appearance of noma cor- 

 responds in its essential features to le- 

 sions I-IV of subject 1565. The local- 

 ization (facial region), number of foci 

 (multiple lesions are reported), exten- 

 sion (exposure of the bone), shape and 

 size of the ulcers are in absolute agree- 

 ment with lesions I-IV. Differences do 

 exist, such as those concerning the age 

 of the involved patients, which are 

 mainly infants in present-day clinical 

 medicine (Figure 14). 



In addition to the hitherto diagnostic 

 considerations, lesion V (Figure 12), 

 located in the right mandibular angle 

 and clearly defined, should be dis- 

 cussed. Obviously there is no mor- 

 phological similarity between lesion V 

 and lesions I-IV. Nevertheless a patho- 



Zagreb Paleopathology Symp. 1988 



