Did Agrippina poison the Roman Emperor Claudius? Was General George Armstrong Custer mentally sound when he ordered the 7th Cavalry to attack at the Little Big Horn River? History is full of medical mysteries. After all, everyone has to die of something. But modern medical practitioners have actually found clues to the progress of diseases that still afflict mankind today by studying ancient sources who recorded the afflictions and demise of peoples of the past.

Thursday, October 7, 2010

"Grotesque" Imagery of Amarna Art Religion Not Reality

A history resource article by  © 2010

Small statue of Ahkenaten wearing the blue crownImage of small statue of Akhenaten  via Wikipedia
I was researching Egypt's 18th dynasty in the course of writing a book review and came across the official journal article detailing the results of a medical analysis recently done on mummies either identified or tentatively identified as members of the 18th dynasty.  The report is fascinating, although laymen may need to keep dictionary.com handy as it is written for the medical professional members of the American Medical Association.

I had heard that the studies had definitely concluded that Pharaoh Tutankhamun was not murdered but probably died as the result of a severe infestation of malaria.  But this report goes much further and discounts most pathological speculations about his father, the "heretic" pharaoh, Akhenaten, as well.

Replica of the bust of Queen Nefertiti 18th Dy...A reproduction of the famous bust of Nefertiti photographed at the Rosicrucian Egyptian Museum by Mary Harrsch (mharrsch) via Flickr
 Macroscopic and radiological inspection of the mummies did not show specific signs of gynecomastia, craniosynostoses, Antley-Bixler syndrome or deficiency in cytochrome P450 oxidoreductase, Marfan syndrome, or related disorders (eAppendix, Table 2). Therefore, the particular artistic presentation of persons in the Amarna period is confirmed as a royally decreed style most probably related to the religious reforms of Akhenaten.  It is unlikely that either Tutankhamun or Akhenaten actually displayed a significantly bizarre or feminine physique.

It is important to note that ancient Egyptian kings typically had themselves and their families represented in an idealized fashion. A recent radiographic examination of the Nefertiti bust in the Berlin Museum illustrates this clearly by showing that the original face of Nefertiti, present as a thin layer beneath the outer surface, is less beautiful than that represented by the artifact.33 Differences include the angles of the eyelids, creases around the corners of the mouth on the limestone surface, and a slight bump on the ridge of  the nose.34 Thus, especially in the absence of morphological justification, Akhenaten’s choice of a “grotesque” style becomes even more significant. - Ancestry and Pathology in King Tutankhamun's Family, Journal of the American Medical Association
I see the researchers also did exhaustive skull studies and apparently the elongated skulls of Akhenaten and Nefertiti's daughters portrayed in Amarna art were also exaggerated. Unlike the Mayans, the Egyptians may have admired an unusually shaped head but they did not attempt skull binding to create it.

Related articles by Zemanta
Akhenaten: Egypt's False Prophet   Amarna Sunset: Nefertiti, Tutankhamun, Ay, Horemheb, and the Egyptian Counter-Reformation   The Amarna Letters

Tuesday, February 3, 2009

Alexander the Great's Mysterious Death: Poisoned wine or Intestinal Bug?

A history resource article by  © 2015
Head of Alexander the Great photographed at
The Capitoline Museum in Rome, Italy by
Mary Harrsch  © 2005.

I noticed that a program entitled "Alexander the Great's Mysterious Death" on the Discovery Channel put forward the hypothesis that Alexander died from an accidental overdose of hellebore, a poisonous plant used to induced vomiting in ancient times.

[Alexander the Great, Photographed at the Capitoline Museum, Rome, Italy by Mary Harrsch © 2005 ]

Back in 1998, however, a group of doctors gathered for a clinical pathology conference at the University of Maryland Medical Center expressed their belief that Alexander was killed by an intestinal bug:
Alexander the Great, who ruled much of the ancient world until his death in 323 B.C., was conquered at age 32 not by an enemy, but possibly by a tiny intestinal bug. In an analysis based on available historical records, physicians at the University of Maryland Medical Center believe that Alexander was the victim of typhoid fever.

Their analysis, titled, "A Mysterious Death," is published in the June 11 issue of the New England Journal of Medicine. The most popular theories among historians previously have been that Alexander was poisoned or had died of malaria.

In the week before he died, historical accounts say Alexander the Great had chills, sweats, exhaustion and high fever, all of which are typical symptoms of certain infectious diseases, including typhoid fever.

"He was also described as having severe abdominal pain, causing him to cry out in agony," says David W. Oldach, an infectious disease expert at the University of Maryland Medical Center and lead author of the article.

"That was an important clue, because untreated typhoid fever can lead to perforation of the bowel and may have been the reason for his abdominal pain," according to Dr. Oldach, who is also an assistant professor of medicine at the University of Maryland School of Medicine.

"My discussions with Dr. Oldach and his colleagues caused me to change my mind about what caused the death of Alexander the Great," says Eugene N. Borza. Ph.D., professor emeritus of ancient history who taught for 31 years at Penn State University. Dr. Borza, who is also an author of the New England Journal article, previously thought that malaria caused Alexander's demise.

A curious symptom described in ancient accounts is that Alexander's body did not begin to decay for at least several days after his death. Dr. Oldach says while that defies reason, those around him may have gotten that impression because of another complication of typhoid fever, called ascending paralysis. It is a neurological problem that starts with the feet and moves up the body, paralyzing muscles and slowing down breathing. It can make a person look dead, even if he is not. Alexander may have been in that state for a few days before he died.
The death of Alexander the Great.  Courtesy of History.com.
 Accounts of the death were not consistent with poisoning, although Dr. Borza says that has been a popular belief. "It was an ancient conspiracy theory. People have often suspected a conspiracy when a famous young person dies unexpectedly." Dr. Borza says ancient Greeks who didn't succumb to disease as a child or a battlefield wound often lived into their 70's, because of a healthy diet and constant physical activity.
The New England Journal of Medicine article is believed to be the first collaboration between medical scientists and an historian to answer an ancient question about what caused a famous historical figure to die. Dr. Borza says the earliest surviving accounts about Alexander's death available today were written three centuries after he died, so there was not a lot of information to go on.

"Even so, we found out that much of the scant information we do have is credible, because it makes sense to the medical community. It is important for us to be able to validate the evidence and set the record straight. As historians, that's what we try to do," says Dr. Borza.

For his analysis, Dr. Oldach also had to rely on historical medical accounts of what happens when typhoid fever goes untreated with antibiotics, which did not become available until the 1950's. U.S. physicians today rarely witness untreated patients in the late stages of typhoid fever.

Typhoid fever comes from salmonella typhi, an organism that lives only in humans and can be spread by contaminated water or because of poor hygiene.

Update: 2/18/2015:  

In January 2014 an article was published in the Journal of Clinical Toxicology.  Co-authored by the University of Otago 's Dr. Leo J. Schep, from the National Poisons Centre in New Zealand, the researchers theorized that Alexander was killed by a toxic wine created using a fermented form of Veratrum album (also known as white hellebore) sometimes used to induce vomiting.  The study's authors detailed the potential deadliness of the plant in the study abstract:

"Veratrum album flower" by Alpsdake.
Courtesy of  Wikimedia Commons.

Veratrum poisoning is heralded by the sudden onset of epigastric and substernal pain, which may also be accompanied by nausea and vomiting, followed by bradycardia and hypotension with severe muscular weakness.

"Exposure to extracts from this plant causes clinical effects similar to [Alexander's] reported signs and symptoms," Schep observes, "Of note was the duration of symptoms, which could continue for more than 12 days if intoxicated patients are not treated."

Personally, I think the analysis by the pathologists in Maryland appears more credible (to me) since they evaluated the overall reported symptoms as detailed in fragments of the ancient sources rather than focus on the relatively immediate reactions Alexander experienced at a banquet with his generals that has long been viewed historically as suspect.  If Alexander's digestive tract was  already severely compromised (by a pathogen like typhoid), his consumption of normal wine at the banquet  could have triggered an acute episode of abdominal distress. Without his remains, however, I guess we will never know!

Sunday, December 7, 2008

Egyptian doctor thinks Akhenaten Suffered From hyper-pituitarism rather than Marfan's Syndrome

A history resource article by  © 2015

A sculpture of Akhenaten at the Neues Museum in Berlin.
Image courtesy of Miguel Hermoso Cuesta via
Wikimedia Commons.
The so-called heretic pharaoh, Akhenaten, has fascinated both Egyptologists and the medical community for decades since the discovery of his lost city of Amarna in the late 19th century. Although a mummy was found in a tomb identified as belonging to the enigmatic pharaoh in 1907 (KV55), this identification has been called into question by a number of forensic and medical professionals. 

In his article, "A 3300-year-old medical mystery: What disease was Akhen-aton Suffering From?", Dr. Sameh M. Arab, a professor of cardiology at Alexandria University in Egypt, attempts to deduce the cause of the strangely shaped features of the 18th dynasty pharaoh as depicted in art that has been recovered from the Amarna site while taking into account the forensic evidence presented by the KV55 mummy.  What follows is an abstract of his key points:

"...[Akhenaten's] odd features could not be simply attributed to his foreign descent (Asian blood) from his maternal side. His undue tall stature and feminine-like appearance has raised suspicion that he was suffering from a certain medical syndrome."

"Mariette, the famous French Egyptologist argued that Akhen-Aton was castrated, but
such claim was rejected. He was known to have 6 daughters (and possibly at least one son, his successor, Smenkh-Ka-Ra, from a secondary wife Kiya)."

"The striking features found from the study of his statues, pictures as well as his
mummy (if it were truly his) were those of tall stature, unduly long limbs, elongated skull, long slender neck and long face with a huge mandible (lower jaw)." 

A colossal statue of
Pharaoh Akhenaten
from Karnak.  Image
courtesy of Wikimedia.

"In addition, his feminine features included gynaecomastia (female-like breasts) and a
wide pelvis with fat hips (the breadth of the pelvis exceeds that of the shoulders – a characteristic feature of females). A nude statue during his early reign showed him without genitalia at all. 
Moreover, he showed a redundant belly in all his pictures."

"Studies of the assumed mummy and specifically the ossification of bony epiphyses (union between the bone shaft and its both ends) have concluded a “bony age” of 26 years (according to Prof. Eliot Smith) or 23 years (Prof. Derry). This age does not match his [Akhenaten's] chronological age as estimated by Egyptologists and historians, which was 37 – 40 years at his death or disappearance." 

Such discrepancy obviously [could be explained] by delayed bony ossification, a condition known in medicine to be due to retarded sexual gland activity." 

But, Arab admits that relying on the physical attributes of a questionable mummy is problematic.

[DNA analysis in 2010 points to discrepancies as analyzed by Kate Phizackerley in her article "DNA Shows that KV55 Mummy Probably Not Akhenaten"]

In 1907, Prof. Eliot Smith also claimed the KV55 mummy indicated a slight hydrocephalus (fluid accumulating inside the brain cavity) and epilepsy. 

"Careful study of the skull has negated the presence of any hydrocephaly. In addition, epilepsy is known to leave no pathological marks on the skull. It is diagnosed in the living by measuring the electrical impulses from the brain. Such claims would certainly be untrue, observes Arab.

Skull from mummy found in KV55.  Image courtesy of
Wikimedia Commons.
Study of depictions of the pharaoh throughout different stages of his life have proved helpful, though. 

"His early reliefs do not show any deformity, while the later ones do. This denotes a disease presenting later in life, at least not during childhood or adolescence," Arab observes.

Several diagnoses were suggested.  The earliest proposed was Florisch's syndrome. 

Florisch's syndrome, a disease caused by diminished secretion of the pituitary gland occurring before puberty or a tumor of the pituitary gland after puberty. The syndrome is characterized by retarded puberty, hypogonadism (diminished sexual activity) and feminine-like fat distribution (thighs, hips and breasts) as depicted in some representations of Akhenaten.  However, it is also associate with dwarfism (if occurs before puberty) and obesity but normal stature if it occurs after puberty.  Akhenaten was described as tall (not dwarfed) and not depicted as obese.

Other suggestions included Marfan's and Kleinfilter's syndromes as well as pituitary gland dysfunction. 

"Klienfilter's syndrome could be ruled out as well," Arab states, "Despite the abnormal skeletal features of the disease that resemble Akhen-Aton's condition, as well as gynaecomastia and small testes, two characteristic features of the disease are inconsistent. Akhen-Aton was neither obese nor infertile. Egyptologists give hard evidence that he had had children."

Fragmentary relief depicting
either a pathogenic condition
or simply stylized portrait of
the pharaoh Akhenaten.
"Marfan's syndrome, [however], could not be [immediately] ruled out. [However,]though the skeletal anomalies are suggestive, there is no evidence of any cardiovascular or eye manifestations [characteristic of this condition] to support this likelihood, even if the mummy found was his. It was a tradition to remove the eye during the process of embalming [so examination of the eyes would not be possible]. Moreover, the feminine-like manifestation would still remain unexplained."

"The most likely diagnosis of Akhen-Aton's disease is hyper-pituitarism. All bony abnormalities seem to favor such diagnosis, together with the sexual ones. A late onset of acromegaly or delayed hypo-gonadism sound to be most descriptive for his illness."

"Further studies of the mummies and pictures of Akhen-Aton's family might be an additive. The mummy of his grandfather Yoya (maternal side) shows a tall man with thick lips and large nose. The mummies of his two successors Smenkh-Ka-Ra and Tut-Ankh-Aton (Tut-Ankh-Amon) also show large skulls. Both are thought by some Egyptologists to be his sons from a secondary wife, Kiya. The early death of a younger brother at young age should also be kept in consideration."

"All reliefs of Akhen-Aton's family show that this large elongated skull was a common feature among his daughters, and his wife Nefertiti as well. This has led some scholars to believe that this skull feature has become a model of Egyptian art during this time. Nefertiti, the six princesses and all the court as well were so depicted as [possibly] a compliment to Akhen-Aton" [who may have indeed exhibited the actual physical characteristics depicted]. 

House altar relief of Nefertiti with her
daughters, Meketaten and Ankhesenpaaten.
Courtesy of Wikimedia Commons.
If this suggestion is untrue, then the possibility of a hereditary disease - rather than an acquired one - is very likely. - More, Sameh M. Arab. MD.

Monday, April 28, 2008

Fluorosis a problem for ancient Palmyrans and Herculaneum victims

A history resource article by  © 2015

The great archway leading to the grand collonade in Roman Palmyra.  Image
courtesy of Wikimedia Commons.
A study suggests Palmyra's waters may have been ruinous in the end for the city's inhabitants. Palmyra, today, is a World Heritage Site, a designation bestowed by the United Nation Educational, Scientific and Cultural Organization in 1998. About 140 miles southeast of Damascus, the trading town known as Tadmor (also spelled Tadmur) to the ancients, later Palmyra, had been a center of trading since around 2000 B.C.E. But the town really bustled during the Roman Empire, and was filled with magnificent buildings throughout the 1st and 2nd century, beginning with the reign of Roman emperor Hadrian in 129 A.D.

Hadrian renamed the oasis town "Palmyra Hadriana." Modest guys, those Roman emperors. The city's wealth faded with the decline of Roman influence in ancient Syria.

Starting in 1990, Japanese archaeologists began excavating the southeast necropolis of Palmyra and examined remains from the Roman era. Despite Palmyra's prosperity, "skeletal remains uncovered from the underground tombs of Palmyra have been found to retain an arthropathy of the joints, especially in the knee joint, bone fracture, marked bone lipping, spur formation, and eburnation (smoothed bone cavities)," reports the team led by Kiyohide Saito of the Archaeological Institute of Kashihara in the Journal of Archaeological Science.

Funerary Portrait of Yarkhai, Son of Ogga and Balya his Daughter
from Palmyra in Roman Syria 150-200 CE Limestone.  Photographed at the
Portland (Oregon) Art Museum by Mary Harrsch © 2012.
Fluoride in small concentrations is thought to deter microbes that cause tooth decay, the reason why about 66% of public water supplies in the United States are now fluoridated, according to the federal Centers for Disease Control and Prevention. But the Palmyrans' symptoms, along with discolored teeth, point to "fluorosis," a skeletal and enamel-damaging syndrome caused by ingesting too much fluoride over a long time, the researchers note. Looking at two large tombs for example, 25 of 33 individuals (76%) had discolored teeth in one, and 45 out of 65 (69%) had discolored teeth in the other.

Palmyrans drank, and still drink, water from wells tapped from ground water by long tunnels called "qanats" (an excellent Scrabble word). The area's geology and water table has been stable for about 7000 years, meaning water conditions now aren't greatly different from those during Roman times. In a bid to estimate the fluoride burden suffered by the town's ancient inhabitants, the researchers analyzed the water from these wells. Fluoride levels were as high as three parts per million in the water, a level that a National Academy of Sciences report in March warned could lead to fluorosis.

Archaeologists also ground up seven discolored teeth from tomb inhabitants, and compared them to seven others without discoloration, to reveal their fluoride concentration. In a chemical reaction, fluoride tends to replace some calcium in tooth enamel, making overexposure to fluoride particularly worrisome for children with growing teeth and bones. The ground-up teeth revealed that in the most discolored ones, about 22% of the calcium had been replaced by fluoride. "Thus, it was possible to directly verify that the ancient inhabitants of Palmyra did suffer from fluorosis," they conclude.

Update, 2/19/2015:

Vesuvius still hovers threateningly over the remains
of Herculaneum near Naples, Italy.
Photo by Mary Harrsch © 2007.
In 1981 when skeletal remains of victims of the Vesuvius eruption were found in the boat chambers on the shore of Herculaneum, researchers were provided with another opportunity to study dental conditions of Roman residents in a different ancient setting. In The Lancet, researchers Gino Fornaciari, M. Rognini and M. Torino reported finding only 3.8% of teeth recovered from 41 adults and 12 children damaged from tooth decay.

"This percentage is very low for both modern and ancient populations, in which values were between 8.5%, as in classic Magna Graecia and 11.4%, as in Roman Britain," the researchers stated.

However, the researchers also discovered a high percentage of individuals with calcium-deficient tooth enamel - a condition often resulting from starvation at an early age but also found in well nourished individuals suffering from fluorosis.

"To elucidate this hypothesis, we examined thin sections of permanent teeth enamel (first molar) from 8 individuals found in the Herculaneum arches site and from a present-day patient from Pisa without evidence of fluorosis, as control," the researchers explained, "Enamel was analysed by energy dispersion system (EDS) with an SEM (Jeol) 6400 connected to a microanalysis system (EDS) (Noran-Tracor) with a detection of Z-MAX 30. Enamel fluorine concentrations were greater than 10-fold higher than normal (1500-3600 parts per million [ppm]) were recorded in 6 individuals."

Skeletal remains of 32 victims awaiting evacuation in the boat chambers of
Herculaneum.  Image courtesy of Tom Huesing via Flickr.
However, the condition was not found uniformly throughout all individuals in the sample and no fluorine was found in soil samples. But, researchers did find a strong concentration of fluorine in the water-bearing stratum of Herculaneum (3-8 mg/mL), with a calculated intake of 11.4-19.0 mg a day per person at the time of the volcanic eruption.

Researchers concluded that some of the sampled remains may have been visitors to the area, since the Roman aristocracy maintained vacation villas in the area.

Sunday, April 13, 2008

Mary Queen of Scots Miscarriage Points to Collusion in Death of Lord Darnley

Mary Queen of Scots at Madame Tussaud's Wax Museum in
London.  Photographed by Mary Harrsch © 2006
A history resource article by  © 2015

Interesting article in the Times Online about research by modern gynecologists:

"Mary Stuart, Queen of Scots, was an “adulteress and liar” who plotted to kill her husband in order to marry her lover, a study by modern gynecologists has suggested.

An intriguing medical analysis claims that Mary, the cousin of Elizabeth I, concocted a story of kidnap and alleged rape to justify her marriage to her third husband – potentially shedding light on a 400-year-old royal murder mystery.

Far from being the saintly and wronged Roman Catholic monarch portrayed in portraits and films, Mary was actually a “moral loose cannon”, whose striking beauty and sex appeal gave Elizabeth other reasons to imprison and execute her, the researchers suggest.

The study revolves around the report by Claude Nau, Mary’s adviser and secretary, that on July 24, 1567, at Loch Levan Castle, Kinross, Mary miscarried twins. Information about the miscarriage is scant, but in May 1567, just 12 weeks after the murder of Mary’s second husband, Lord Darnley, the Scottish Queen married James Hepburn, fourth Earl of Bothwell, who had abducted and “ravished” her at Dunbar Castle, in April, some sources say.

Henry Stuart (Lord Darnley) with his wife/cousin, Mary Queen of Scots circa 1565
by unknown artist.  Image courtesy of Wikimedia Commons.
Mary later claimed that her pregnancy began after her marriage but experts now say this is impossible.

In a study published in the Journal of Family Planning and Reproductive Healthcare, Lesley Smith, a medical historian, claims that it would have required modern microscopes and knowledge about fetal development to identify that the miscarriage was of twins after the seven weeks of pregnancy that Mary claimed.

It would also have been an “astonishing coincidence” if conception occurred at the time of the “rape”, and even then the twins would have been just 12 weeks old and hard to identify upon miscarriage.
Instead, it is more likely that “the widowed Mary had an affair with Bothwell, became pregnant and had used the abduction story as a cover for her condition and justification for marriage,” Ms Smith says.

Along with other historians, she believes both Mary and Bothwell to have been implicated in the death of Darnley, a drunken and controversial figure who was found strangled at Kirk O’Fields, Edinburgh, after being married to Mary for just 19 months.

Bothwell was a prime suspect but was acquitted at what is now regarded as a sham trial.

James Hepburn, the 4th Earl of Boswell c. 1535-1578.
Image courtesy of Wikimedia Commons.
“Mary had an undoubted passion for Bothwell, her supposed kidnapper, and did not try and escape from him despite ample opportunity. By contrast, she hated Darnley and was publicly separated from him by the time of his murder. The suspicion of an affair is not a new idea,” Ms Smith says, “but the medical evidence brings us very much closer to the likely truth.”

Tony Roberts, a consultant obstetrician at Queen’s Hospital, Burton on Trent, says that it would have required “a sensible and weathered eye” to identify a twin miscarriage at 12 weeks.

“If you want to prove pregnancy, a midwife in those days should have been able to do this, but standards were low, even for a queen,” he adds.

As such, Claude Nau’s report of the miscarriage implies that Mary became pregnant by Bothwell well before the abduction. The unlikely possibility that Darnley was the father would have left the Queen at least five months pregnant with the twins, a condition which would have been “hardly unnoticeable”, Ms Smith says.

The researcher, who is the curator of Tutbury Castle in Staffordshire, where Mary was held prisoner, says her theory further explains the animosity between Mary and Elizabeth I.

Remains of Tutbury Castle in Staffordshire, England where Mary Queen of Scots
was held prisoner.  Image courtesy of Wikimedia Commons.
“Mary Stuart was a remarkable specimen of humanity,” she writes. “She was 5 ft 11 in when the average woman was around 4 ft 11 in, so she was the equivalent of 6 ft  5 in by modern standards. [She] was also beautiful and very sexually attractive. “All in all, Mary Queen of Scots was a very dangerous creature to the unmarried Protestant Elizabeth, and her physical presence made her positively intoxicating to anyone who met her.”

She said: “All the available evidence creates a damning impression. Elizabeth probably considered Mary to be a moral loose cannon and fool for men. It is also interesting that, while Mary was prisoner in England there was no Catholic nation that made a serious attempt to release her: was there a more widely held view that she was better out of the way?”

Queen of plots

December 1542 Mary born to James V of Scotland. Her father dies when she is six days old and Mary becomes Queen of Scotland

1548 Henry VIII begins his “rough wooing” — a military campaign designed to impose marriage to his son on Mary. Instead she promises to marry the French Dauphin and flees to France

1559 Marries François II

1561 She returns to Scotland following François’s death

1565 Marries Henry Stuart, Lord Darnley, her first cousin, below. Their son, James I of England, is born the following year

February 1567 Darnley found dead. James Hepburn, 4th Earl of Bothwell, bottom, is prime suspect

April 24 1567 Mary visits her son for the last time at Stirling but is abducted by Bothwell and taken to Dunbar Castle, where she is allegedly raped

May 15 1567 She marries Bothwell, a Protestant, to preserve her honour, but is condemned by the Scottish nobility

July 24 1567 Imprisoned at Loch Levan Castle by her own people, she miscarries twins and is forced to abdicate the Scottish throne

May 1568 Mary escapes but is defeated at Battle of Langside and flees to England, where she is captured and spends the next 19 years as a prisoner

1578 Bothwell dies, insane and imprisoned in Denmark

1587 Mary is found guilty of treason and executed.