A critical assessment of proposed outbreaks of plague and other epidemic diseases in Ancient Egypt.

The current coronavirus disease 2019 (COVID-19) pandemic has reminded us of past epidemics. Pharaonic Egypt has often been associated with epidemics and disasters through the 10 plagues in the Bible. The aim of this study was to examine which epidemics and serious diseases can be effectively proven for Ancient Egypt through mummies and historical source texts. The biblical plagues cannot be proven because there is no agreement on the dating of the Exodus, or the Exodus is a conglomeration of memories of different events. Other diseases such as malaria and schistosomiasis have been proven for Ancient Egypt, while polio and smallpox are still uncertain. There are indications of a bubonic disease from the time of the middle 18th Dynasty, but its exact nature cannot be determined from source texts or mummies, as they are too vague.

Early history of the different forms of neurofibromatosis from ancient Egypt to the British Empire and beyond: First descriptions, medical curiosities, misconceptions, landmarks, and the persons behind the syndromes.

The earliest examples of neurofibromatosis (in this case type 1, NF1) can be traced in the Ebers Papyrus (Ancient Egypt, 1.500 B.C.), in a Hellenistic statuette (Smyrna, 323 B.C.), in the coinage of the Parthians kings (247 B.C.) and in some 13th century monks' drawings. These earlier examples are somewhat less well defined as compared to the most recent better defined reports credited as having NF1 including an Inca child mummy (1480-1650 AD), Ulisse Aldrovandi's homuncio ("Monstrorum Historia", 1592 A.D.) with mosaic NF1 or the illustrations seen in the 18th century "Buffon's Histoire Naturelle" and "Cruveilhier's Anatomie Pathologique du Corps Human". The first English language report on NF1 was made by Akenside in 1768 and the first systematic review by Robert William Smith in 1849, while Virchow's pupil, Friedrich Daniel von Recklinghausen, in 1882, was the first to understand the origin of skin tumors and to name them neurofibromas. The touching story of Joseph C. Merrick (the "Elephant man," (who had Proteus syndrome and not NF1), in 1884, played an important role in the later misconception of NF1, as did the novel by Vicotr Hugo on the hunchback Quasimodo. The studies by van der Hoeve (1921), Yakovlev and Guthrie (1931), and Van Bogaert (1935), categorized "von Recklinghausen's" neurofibromatosis among the phakomatoses and the neurocutaneous syndromes. The first known mention of an acoustic neuroma (at autopsy) is attributed to Eduard Sandifort (1777 AD) while John H. Wishart made the earliest autoptic description of neurofibromatosis type 2 (NF2), in 1822, in a 21-year-old man with bilateral acoustic neuromas, who manifested signs since his infancy (Wishart subtype NF2). Smith likely described the first case of schwannomatosis in 1849. Older, Virchow, von Recklinghausen, and Verocay first classified "neuromas" and Masson and Penfield first used the word "schwannoma" taking it from Theodore Schwann's works. In 1903 Henneberg and Koch described NF2 in detail. Young, Eldridge, and Gardner, in the late '70, established NF2 as a distinct familial entity (Gardner subtype NF2). Schwannomatosis, the late entry of the different forms of neurofibromatosis, was credited in the middle '90.

Paleopathology and Paleomicrobiology of Malaria.

Malaria is a disease caused by parasites of the genus Plasmodium, transmitted through the bites of female anopheles flies. Plasmodium falciparum causes severe malaria with undulating high fever (malaria tropica). Literary evidence of malarial infection dates back to the early Greek period, when Hippocrates described the typical undulating fever highly suggestive of plasmodial infection. Recent immunological and molecular analyses describe the unambiguous identification of malarial infections in several ancient Egyptian mummies and a few isolated cases in Roman and Renaissance Europe. Although the numbers of cases are low, there is evidence that the overall infection rates may have been relatively high and that this infectious disease may have had a significant impact on historical populations.

Wall paintings facies and their possible genetic correlates in the ancient Pompeii: A bio-anthropologic message from the past?

The figurative arts and precisely the ancient Pompeian wall paintings portraits can provide an additional source of information in supplementing bio-anthropological studies. There are several genetic diseases with a wide spectrum of congenital bone stigmata in association to distinctive facial features. Gorlin-Goltz syndrome, also named nevoid basal cell carcinoma syndrome, is an autosomal dominant syndrome characterized by unusual skeletal changes, such as macrocephaly, facial asymmetry, hypertelorism, frontal and parietal bossing caused by germline mutations of the gene PTCH1. The Gorlin syndrome, clinically defined in 1963, existed during Dynastic Egyptian times, as revealed by a spectrum of skeletal findings compatible with the syndrome in mummies dating back to three thousand years ago and, most likely, in the ancient population of Pompeii. In the present research, we discuss the potential relationship between Pompeian wall paintings portrait and the cranio-metric bone changes revealed among the Pompeian skull collections assuming that the ancient portraits can constitute an important tool that should be strictly integrated with osteologic and biomolecular data in order to argue a syndromic diagnosis in ancient population.

Success of long bone fracture healing in ancient Egypt: a paleoepidemiological study of the Giza Necropolis skeletons.

Complications may provide information regarding the management of fractures in ancient populations. The aim of this study was to determine the rates of long-bone fractures and the proportion of misalignments as indicators of failed treatment or no treatment at all in skeletons from the Giza Necropolis dating to the Old Kingdom period (2700-2190 BC). We visually examined for fractures 2287 long bones of 204 adult skeletons (112 male and 92 female) and took x-rays of fractured bones in standard AP and ML views, so that we can analyse misalignments. Fractures were found in 45 of the 2287 examined long bones (1.97 %). Most of the fractures healed with good alignment, most likely as a result of successful treatment, and only three fractures showed misalignment.

Activity patterns in New Kingdom Nubia: an examination of entheseal remodeling and osteoarthritis at Tombos.

The effects of Egyptian imperial expansion into Nubia during the New Kingdom Period (1,550-1,069 BC) have been debated. Here, the impacts of the Egyptian Empire are investigated through an examination of osteological indicators of activity at the archaeological site of Tombos. Entheseal changes to fibrocartilaginous attachment sites and osteoarthritis are examined to infer what types of physical activities this colonial town was engaging in. Many of the skeletal remains at Tombos were commingled due to looting in antiquity; undisturbed burials are presented as a subsample of the population (n = 28) in which age, sex, and body size can be considered. The total sample (n = 85) is then analyzed to better understand overall levels of activity. A number of Nile River Valley bioarchaeological samples are used as points of comparison to the Tombos population. Results indicate that the inhabitants of Tombos had relatively low entheseal remodeling scores; this is highlighted when Tombos is juxtaposed with comparative samples, particularly in men. Furthermore, osteoarthritis, as assessed by eburnation, was also markedly infrequent at Tombos. Collectively, these results indicate a relatively low level of activity and support the hypothesis that Tombos may have served as an administrative center.

Irrigation and infection: the immunoepidemiology of schistosomiasis in ancient Nubia.

Schistosomiasis has been deemed "the most important water-based disease from a global public-health perspective" in modern populations. To better understand the burden of schistosomiasis in ancient populations, we conducted immunologic examinations of desiccated tissue samples from two ancient Nubian populations, Wadi Halfa (N = 46) and Kulubnarti (N = 191). Saqia irrigated agriculture increases the available habitat for the aquatic vector snails and the risk of exposure. On the basis of evidence regarding the impact of saqia irrigation on schistosomiasis prevalence and transmission in modern populations, we predicted that the prevalence of Schistosoma mansoni infection would be higher in Wadi Halfa (saqia irrigation) than Kulubnarti (annual flooding). We also predicted that peak infection prevalence would occur at an earlier age within the Wadi Halfa population than the Kulubnarti population and that in both populations the prevalence of schistosomiasis would be higher in males than females due to differential water contact. The prevalence of S. mansoni was greater in the Wadi Halfa population (26.1%) than at Kulubnarti (9.4%) (P = 0.002). However, peak prevalence of infection did not occur in a younger age category within the Wadi Halfa population; prevalence of infection peaked at 66.7% in the mature adult age group (46+ years) in the Wadi Halfa population and at 16% in the later child age group (6-10 years) in the Kulubnarti population. There were no statistically significant differences in prevalence between males and females of either population. The impact of human alteration of the environment on the transmission of schistosomiasis is clearly shown in these populations.

Medical papyri describe the effects of the Santorini eruption on human health, and date the eruption to August 1603-March 1601 BC.

Egyptian medical papyri date the Santorini eruption, and reconcile the hitherto perceived dichotomy between archaeological/historical and scientific data. The medical documentation describes ailments, which can only have arisen from a volcanic source: ash fallout, rain acidified by ash, and a plume. Furthermore, the Egypt described by the medical texts matches the one in the series of so-called biblical plagues. This match in turn provides the length of time, 19 months, between the initial and final phases of the eruption, each phase contributing to the otherwise odd accumulation of sulfates spread over two consecutive biennia (1603-1600 BC) in Greenland's ice core. As a result, the initial phase of the eruption can be dated to August 21, 1603 BC, and the final one to March 1601 BC, in full agreement with the radiocarbon data (1627-1600 BC) based on the outermost ring on the branch of an olive tree killed by the eruption.

Health of the non-elites at Tombos: Nutritional and disease stress in New Kingdom Nubia.

During the New Kingdom period, Egypt succeeded in occupying most of Nubia. Colonial towns were built, which served as centers of government and redistribution. This paper uses a bioarchaeological approach to address the effects of this cultural contact on non-elites. Skeletal remains from the site of Tombos (N = 100), a cemetery in Upper Nubia dating to this important time, are analyzed, in addition to 1,082 individuals from contemporaneous Egyptian and Nubian sites, in order to shed light on the social, political, and economic processes at play and to determine how the people at Tombos were affected during this transitional period. In many ways, the Tombos population appears to have been affected by similar stressors as the other populations under study. However, a few small differences in the subadult frequencies of pathological lesions, especially remodeling rates, are significant in the overall picture of health at Tombos. These analyses suggest that, although the people of Tombos may have been integrated into the Egyptian colonial network, the additional resources they may have obtained could not protect them from nutritional and disease stress. A lower childhood survival through bouts of ill health at Tombos is suggested. While status may have played a role in the differences seen in the comparative populations, it is likely that parasites and/or other infections led to childhood illness and death.

Did an epidemic of tularemia in Ancient Egypt affect the course of world history?

The dynamics of the spreading, and the identity of a virulent epidemic, similar to bubonic plague or typhus, which hit Ancient Egypt in the middle of the Bronze Age, are hereby presented. Documented in medical papyri as well as archaeological findings, and re-echoed in biblical texts, a plague entered Egypt's main harbor, Avaris, around 1715 BC. As a result, the country was severely weakened at a time when it was already facing serious sociopolitical issues: crumbling central government, immigration, foreign influence, and the rise in power of the army and of warlords. The Hebrews, one of the ethnic groups within the Avaris area, appeared immune amidst the devastation of the plague. This immunity was key to identify the etiological agent of the epidemic: Francisella tularensis, the Gram-negative bacterium passed by ticks, and that causes tularemia. The disease manifests itself as either an ulceroglandular or a typhoid syndrome, accounting for its similarity with bubonic plague and typhus. Cellular immunity provides the main defense against F. tularensis, and is achieved through continuous contact with avirulent strains of the bacterium. Urban dwellers of Avaris, who had a limited contact to animals, would have been defenseless against the virulent strains, unlike the Hebrews, who lived off sheep and other animals. Attempting to consolidate Egypt's central government in the aftermath of the tularemia epidemic, led among others to the internment of the Hebrews in labor camps. The repressive measures against the Hebrews left traces in the subsequent archaeological layer (stratum F) at Avaris. As a corollary, the enslavement would set the stage for the exodus of the Hebrew community from Egypt at a later time.

Molecular analysis of skeletal tuberculosis in an ancient Egyptian population.

A paleomicrobiological study was performed on 37 skeletal tissue specimens from cadavers in the necropolis of Thebes-West, Upper Egypt, (2120-500 BC) and four from the necropolis of Abydos (3000 BC). The subjects had typical macromorphological evidence of osseous tuberculosis (n = 3), morphological alterations that were not specific, but probably resulted from tuberculosis (n = 17), or were without morphological osseous changes (n = 21). DNA was extracted from these bone samples and amplified by PCR with a primer pair that recognised the Mycobacterium tuberculosis complex insertion sequence IS6110. To confirm specificity of the analysis, the amplification products of several samples were subjected to restriction enzyme digestion, or direct sequencing, or both. In 30 of the 41 cases analysed, ancient DNA was demonstrated by amplification by the presence of the human beta-actin or the amelogenin gene and nine of these cases were positive for M. tuberculosis DNA. The results were confirmed by restriction endonuclease digestion and sequencing. A positive result for M. tuberculosis DNA was seen in two of the three cases with typical morphological signs of tuberculosis and amplifiable DNA, in five of 13 non-specific, but probable cases (including two cases from c. 3000 BC), but also in two of 14 cases without pathological bone changes. These observations confirm that tuberculosis may be diagnosed unequivocally in skeletal material from ancient Egypt, even dating back to c. 3000 BC. As a positive molecular reaction was observed in most of the typical cases of skeletal tuberculosis, in about one-third of non-specific, but probable tuberculous osseous changes and, surprisingly, in about one-seventh of unremarkable samples, this suggests that infection with M. tuberculosis was relatively frequent in ancient Egypt.

Brother-sister marriage in Roman Egypt.

According to official census returns from Roman Egypt (first to third centuries CE) preserved on papyrus, 23.5% of all documented marriages in the Arsinoites district in the Fayum (n = 102) were between brothers and sisters. In the second century CE, the rates were 37% in the city of Arsinoe and 18.9% in the surrounding villages. Documented pedigrees suggest a minimum mean level of inbreeding equivalent to a coefficient of inbreeding of 0.0975 in second century CE Arsinoe. Undocumented sources of inbreeding and an estimate based on the frequency of close-kin unions (corrected downwards to 30% for Arsinoe) indicate a mean coefficient of inbreeding of F = 0.15-0.20 in Arsinoe and of F = 0.10-0.15 in the villages at the end of the second century CE. These values are several times as high as any other documented levels of inbreeding. A schematic estimate of inbreeding depression in the offspring of full sibling couples indicates that fertility in these families had to be 20-50% above average to attain reproduction at replacement level. In the absence of information on the amount of genetic load in this population, this estimate may be too high.

Endocranial hyperostosis in Sangiran 2, Gibraltar 1, and Shanidar 5.

Sangiran hominid 2 (S-2), Gibraltar hominid 1 (G-1), and Shanidar hominid 5 (SH-5) exhibit previously undescribed bilateral, paramedian hyperostosis of the endocranial frontal squama that spares the frontal crest, sagittal sinus, and ectocranial surface. The hyperostosis is localized to the frontal (usually the middle third) and parietal and is consistent with a diagnosis of hyperostosis calvaria interna (HCI), inclusive of hyperostosis frontalis interna. The hyperostosis in these specimens is compared to fossil hominids from Indonesia and Europe and to modern human cases of HCI. The three cases of HCI reported here documented the existence and frequency of HCI in fossil hominids and push the antiquity of the disease back to nearly 1.5 million years. The relatively great incidence of HCI in fossil hominids adds another confounding factor to the problematical issue of the taxonomic significance of cranial vault thickness.

Sexual attitudes, preferences and infections in Ancient Egypt.

This socio-sexual review of Ancient Egyptian society aims to increase awareness that the prevalence of sexually transmitted diseases (STDs) is largely determined by the way a society is structured and how that structure functions. The prevalence of STDs in Ancient Egypt has been found to be low. This state of affairs was maintained for centuries. Although the structure of their society was rigidly hierarchical, Egyptian people made it function in an acceptable way. What might be learned is concerned more with prevention than cure. Whether this has any relevance today is discussed.