Noma in an Egyptian mummy? • 303 



of paleopathology, to merely describe 

 "cases" without including any subse- 

 quent discussion of the global features 

 of a particular disease (i.e.. relating a 

 single case to the frequency of a partic- 

 ular disease in a defined geographical 

 region, or to pri)ject a certain disease 

 against the background of all diseases 

 endemic to a certain locality). Our un- 

 derstanding of the term "descriptive" is 

 not limited to "merely describing" vis- 

 ible, exterior characteristics. In addi- 

 tion to comprehending "visual" or 

 "macroscopic" phenomena, scientific 

 description, as the word implies, also 

 encompasses the entire range of what 

 can be perceived, that is, what remains 

 hidden to the unaided eye and can only 

 be "seen" with the help of analytical 

 methods. The case presented here from 

 the field of soft tissue pathology pro- 

 vides an opportunity to refer to descrip- 

 tion as the conditio sine qua non of sci- 

 entific work and interpretation. It is of 

 fundamental importance for any indi- 

 vidual as well as comparative study and 

 essential for every experimental model. 

 Contrary to the widespread misconcep- 

 tion, however, description must be re- 

 garded as a pars pro toto and not as an 

 exclusive whole. To be of any scientific 

 relevance, it must necessarily serve a 

 defined goal, strive for knowledge and, 

 if it is not to become an end in itself, be 

 complemented by interpretation. 



The study presented above is by ne- 

 cessity a descriptive one. Using various 

 methodological procedures, it is a se- 

 lective description of "externa" as well 

 as "interna." Due to the unique charac- 

 ter of its findings, at least for the paleo- 

 pathology of ancient Hgypt, it con- 

 ceivably could be concluded at this 

 point and presented for subsequent dis- 

 cussion. Above all, this means that the 

 opportunity to compare its findings 

 with related anthropological cases is 

 lost and creates problems in locating 

 relevant, diagnostic information con- 

 cerning the alleged disease "noma" in 

 modem medical literature. In terms of a 

 histopathological account of the find- 

 ings, there is no unanimous consensus 

 concerning the origin of microorga- 

 nisms occasionally seen in the lesions. 



The question of whether these colonies 

 of microorganisms represent secondary 

 contamination or a primary coloniza- 

 tion by a pathogen has yet to be an- 

 swered satisfactorily. 



In our study we have attempted to go 

 beyond a merely descriptive method 

 and by the process of elimination for- 

 mulate a differential diagnosis based on 

 the macroscopic appearance of the de- 

 fects as well as additional information 

 obtained from x-ray procedures and 

 conventional histology. Furthermore 

 medical texts from ancient Egypt relat- 

 ing to the clinical picture of "noma" 

 were examined in detail. This resulted 

 in a probable diagnosis and the emer- 

 gence of new, fundamental questions 

 relating to the field of soft tissue pathol- 

 ogy. For our purposes the question of 

 prime importance is the paradox that 

 medical papyri from Egypt contain a 

 large volume of direct and indirect re- 

 ports concerning skin diseases or 

 pathological skin manifestations, but 

 the amount of anthropological evidence 

 is very scarce indeed. To state it very 

 simply, this means that although Egypt 

 has provided more subjects for anthro- 

 pological study than any other single 

 culture, no more than a handful of der- 

 matological clinical cases are known. 

 What are the reasons for this pathetic 

 situation which discourages and even 

 handicaps us in formulating any con- 

 crete statements concerning an individ- 

 ual case other than a purely descriptive 

 one? Are they due to insufficient 

 technical-diagnostic possibilities? To 

 an inadequate inspection of the subjects 

 under study? To the state of preserva- 

 tion of organs or soft tissue? Or do the 

 written records constitute an inap- 

 propriate yardstick for calculating the 

 frequency of diseases which may have 

 occurred to a much lesser extent than 

 the historical sources suggest? 



It is difficult to provide an explana- 

 tion for this phenomenon. In our view, 

 the primary reason for this is the fact 

 that up to now qualified specialists have 

 not conducted selective studies on the 

 paleopathology of skin and soft tissue. 

 Based on our own experiences during 

 archeological excavations in Egypt the 



superficial examination of bodies (at 

 least those which are found without 

 wrappings) is not sufficient in itself. 

 One must also conduct a precise inspec- 

 tion of darkened skin with definite 

 questions in mind and employ all ap- 

 propriate instruments. At the same time 

 the necessary arrangements should be 

 made concerning the taking of samples 

 and their preservation until they reach 

 the laboratory. 



As another important aspect for fu- 

 ture research in the field of soft tissue 

 pathology (as well as in the area of os- 

 teopathology), we would like to con- 

 sider ways to increase the effectiveness 

 of specimen evaluation. In the past this 

 has been carried out mainly by individ- 

 uals without consulting a group of spe- 

 cialists which should have included not 

 only paleopathologists, who are famil- 

 iar with the characteristic properties 

 and appearance of mummified soft 

 tissue, but also clinicians. Such a com- 

 mittee should be made up of experts 

 regardless of nationality. Criteria for 

 their participation in diagnostic evalua- 

 tions should be based on proven com- 

 petence, prior experience in investigat- 

 ing mummified tissue, and the ability to 

 apply methods best suited for a specific 

 analysis. The publication of the results 

 thus represents a joint effort of all per- 

 sons and institutions involved. This 

 proposal means that scientists should 

 be willing to sacrifice their egotistical 

 interests for the sake of group consulta- 

 tion, that is, that each individual recog- 

 nizes the limits of his or her own 

 capabilities when investigating a bt>dy 

 and has the courage to delegate the cor- 

 responding tasks and decisions to those 

 more authorized, regardless of geo- 

 graphical or political boundaries. This 

 proposal requires explicit and defined 

 game rules which nonetheless should 

 not deviate too much from those un- 

 written laws of fairness and considera- 

 tion already common among scientists 

 in their dealings w ith one another. Yet it 

 is also essential that the mammoth con- 

 gresses of today be replaced by smaller, 

 more comprehensible gatherings with 

 the possibility for clVcctive group work 

 and di.scussion of current problems. It 



Zagreb hileopathology Symp. I9HH 



