Recent History
January 2, 1892
Emmet Densmore
Obesity, Carnivore
How nature cures: comprising a new system of hygiene; also the natural food of man; a statement of the principal arguments against the use of bread, cereals, pulses, potatoes, and all other starch foods.
Dr Densmore promotes an "exclusive flesh diet" to cure obesity and comments how family doctors give poor advice.
"A fat person, at whatever period of life, has not a sound tissue in his body: not only is the entire muscular system degenerated with the fatty particles, but the vital organs--heart, lungs, brain, kidneys, liver, etc.,--are likewise mottled throughout, like rust spots in a steel watch spring, liable to fail at any moment. The gifted Gambetta, whom M. Rochefort styled the fatted satrap died--far under his prime--because of his depraved condition; a slight gunshot wound from which a clean man would have speedily recovered ended this obese diabetic's life. Events sufficiently convincing are constantly occuring on both sides of the Atlantic; every hour men are rolling into ditches of death because they do not learn how to live. These ditches have fictitious names--grief, fright, apoplexy, kidney troubles, heart disease, etc.,--but the true name is chronic self abuse."
Fortunately there is a considerably greater apprehension in the public mind now than a few years ago as to the evils of growing fat. The writings of Mr. Banting, an enthusiastic layman who was greatly helped by a reduction of obesity, and whose interest in his fellow men prompted him to make as widely known as possible some thirty years ago his method of cure, has done much to dispel dense ignorance concerning this topic; and in more recent years the illness of Bismarck, and his restoration through the reduction of his obesity, was also a great help to spread knowledge on this most important subject.
The exciting cause of obesity is the ingestion of more food that the system requires, together with the weakening of the excretory organs, which results in the failure of the system to adequately throw off its waste matter. But the profound and primal cause of obesity will one day be recognized to be the use of cereal and starch foods. An obese person weighing two, four or six stone, twenty-five, fifty, or eighty pounds, or even a still larger amount, more than is natural, may be given a diet of flesh with water with or without the addition of starchless vegetables, as lettuce, watercress, tomatoes, spinach, and the like, excluding bread, pulses and potatoes, and the patient will be gradually but surely reduced to his normal weight. As soon, however, as the patient returns to his usual diet of bread and potatoes he straightway begins to increase in weight; and while an obese patient can easily be reduced eight pounds per month when placed upon a flesh diet, he will gain fully this much or more upon returning to a free use of bread and starch vegetables. If this patient who has been reduced, and who has again developed obesity, is persuaded to again adopt the exclusive flesh diet, again the reduction is sure to take place; and in the course of our practice this process has been repeated among many patients, and in a few a reduction and return to flesh has been repeated three times. It is plain from such demonstrations that without starch foods corpulency would not exist. Chemically starch foods are chiefly carbon; adipose tissue is also carbon, and it would naturally be expected that a diet of oil and the fat of animal flesh would contribute quite as much to obesity as bread and starch foods. But experience proves that such is not the case. The reason for this is not, in the present state of science, understood; it will likely be found in the fact that starch foods undergo a complicated process of digestion, whereas oils require only emulsion to render them assimilable by the system.
The courage and strength of conviction possessed by the average family doctor is curious to behold. It will be found to be inversely to the ratio of his knowledge. The less conversant he is with this malady the greater confidence he seems to have in his opinions. During the years that we were in practice some hundreds of patients came to us for assistance in this trouble, a large number of whom were under the control of their family physician. Many of these patients came in defiance of the express orders of their physicians; and while they had assumed courage enough to disobey their orders and come to us, they needed much encouragement to enable them to proceed with any confidence. They were usually told by their medical advisers that in them it was natural to be stout, that they had "better leave well enough alone," and the direst results were prophesied in the event that they had the temerity to proceed. In point of fact these patients quite invariably experienced nothing but the happiest results. many of them came out of an interest in their personal appearance; finding their figures destroyed and their beauty going, they desired restoration to their youthful form and feature. Others, again, were annoyed at clumsiness in getting about, shortness of breath in climbing stairs, and the general awkwardness and inconvenience that result from this "too, too solid flesh." Only a small proportion of these patients came from a knowledge that obesity is a disease, that it encourages other states of inflammation and other diseases, and that its reduction is a great aid in the return of health. But while thees patients as a rule did not come to us with this expectation, it was common for them to testify to geat benefits that had resulted from their treatment. These benefits were quite frequently greater than the patient would readily admit or remember. It was our custom, with all patients beginning treatment, to take the name, age, height, weight, and a list of the infirmities, if any, from which they were suffering. These details were elicited by a series of questions, and the answers duly recorded. Out of sight out of mind is the old adage; and human beings are fortunately so conditioned that when their aches and pains have taken flight they forget not infrequently that they were ever present. many of these patients would have stoutly denied the benefit rendered but for the diagnosis taken at the beginning of treatment, and a reference to wich only would convince them of the coniditon they had been in.
January 1, 1896
Food in Health and Disease
Yeo describes an experiment of pigs fed grain to see whether animals could turn carbohydrates into fat. "But if we desire a substantial addition to the fat, the food should contain less albumen and more carbohydrates, with a fair proportion of fats."
In connection with this interesting and important discussion, the following observations by Tsclierwinsky arc referred to in Landois' "Textbook of Human Physiology." He fed two similar pigs from the same litter.
No. 1 weighed 7,300 grammes ;
No. 2 7,290 grammes. No. 1 was killed, and its fat and proteids estimated. No. 2 was fed for four months on grain, and then killed. The grain and excreta and the undigested fat and proteins were analysed, so that the amount of fat and proteins absorbed in four months was estimated. The pig then weighed 24 kilos. ; 11 was killed, and its fat and proteins were estimated : —
No. II. contained 2.50 kilos. of albumen and 9.25 kilos. of fat
No. I. 0.94 „ „ 0.69 „
Assimilated 1.56 „ „ 8.56 „
Taken in in Food 7-49 „ „ 0.66 „
Difference — 5.93 " +7.90"
There were therefore 7.90 kilos, of fat in the body which could not be accounted for in the fat of the food. The 5.93 kilos. of albumen of the food which were not assimilated as albumen could yield only a small part of the 7.90 kilos, of fat, so that at least 5 kilos. of fat must have been formed from carbohydrates. Lawes and Gilbert calculated that 40 per cent of the fat in pigs was derived from carbohydrates. How the carbohydrates changed into fat in the body is entirely unknown."
As has already been stated, the weight of evidence appears to be distinctly in favour of the conclusion that, in some way or other, the carbohydrates are capable of being converted into fat in the system ; but, in any case, the same result occurs, and they promote, either directly or indirectly, the deposition of fat within the body.
The probability that lactic and other acids of the same class are formed in the body, chiefly or solely from carbohydrates, is drawn attention to by Parkes. "The formation of these acids is certainly most important in nutrition, for the various reactions of the fluids, which offer so striking a contrast (the alkalinity of the blood, the acidity of most mucous secretions, of the sweat, urine, etc.), must be chiefly owing to the action, of lactic acid on the phosphates or the chlorides, and to the ease with which it is oxidised and removed." We may conclude, then, that the carbohydrates by their capacity for rapid metabolism contribute largely to the production of heat and mechanical work, find also that their use greatly favours an increase in the constituents of the body, and especially of the albumen and fat. If we desire to increase the albumen without adding greatly to the store of fat, we should (according to Bauer) give a liberal allowance of albuminates with relatively small quantities of carbohydrates. But if we desire a substantial addition to the fat, the food should contain less albumen and more carbohydrates, with a fair proportion of fats.
January 1, 1896
Food in Health and Disease - Carbohydrates in Nutrition
It must, we think, be admitted that all practical observations tend to prove that animal food is digested more rapidly than vegetable food, and it therefore seems highly probable that meat can replace the waste of the nitrogenous tissues more rapidly than meal of any kind, and it is probably true that there is a more active change of tissue in meat eaters than in vegetable feeders, and that the former require more frequent supplies of food.
Some differences of opinion exist as to the relative value of foods of the same class. Albuminates, as has been seen, can be obtained from either the animal or vegetable kingdom ; they have a similar chemical composition, and they serve the same purposes in the body. It has, however, been suggested that they are probably utilised in a somewhat different manner, or with different degrees of rapidity, and that the man who feeds on meat, like carnivorous animals, "will be more active, and more able to exert a sudden violent effort, than the vegetarian or the herbivorous animal, whose food has an equal potential energy, but which is supposed to be less easily evolved." In support of this view it has been urged that the movements of carnivorous animals, especially in the pursuit of their prey, are far more active than those of herbivorous cattle ; that the form in which they take their food enables them to give out sudden spurts of energy of which the vegetable feeder is incapable. But this view has been questioned by others, who refer to the known activity and speed of the horse, the rapid movements of the wild antelope and cow, and even of the wild pig, all animals mostly herbivorous, as inconsistent with the conclusion that vegetable feeders cannot give forth energy as rapidly and continuously, or even more so, than the predaceous carnivora. It is further stated that with the human race also, the East Indian native, if well fed on corn, or even on rice and peas, shows, when in training, no inferiority in capacity for active physical exertion to the animal feeder. It has also been argued that the complicated alimentary canal of the herbivora pointed to a slower digestion and absorption of food; and with certain kinds of vegetable food this would certainly seem to be the case ; but it has again been contended that this is chiefly intended for the digestion of cellulose, and that the digestion and absorption of albuminates may be as rapid as in other animals.
It must, we think, be admitted that all practical observations tend to prove that animal food is digested more rapidly than vegetable food, and it therefore seems highly probable that meat can replace the waste of the nitrogenous tissues more rapidly than meal of any kind, and it is probably true that there is a more active change of tissue in meat eaters than in vegetable feeders, and that the former require more frequent supplies of food. Apparent differences in nutritive value in different meals, as in wheatmeal and barley meal, probably depend on difference of digestibility.
The difference in the nutritive value of different fats would seem to depend on the relative facility with which they are digested and absorbed. Animal fats appear to be more easily absorbed than vegetable. And even different animal fats differ much in digestibility, and, therefore, in nutritive value. This depends partly on chemical composition, and partly on mechanical aggregation or subdivision. Mutton-fat is generally found difficult of digestion, while pork-fat is easily digested. Butter can be readily digested by many persons who cannot digest other forms of fat and the ready digestibility of ccxl-liver oil is one of its chief advantages.
The different carbohydrates are generally supposed to be of equal value in nutrition. Sugar, from its ready solubility, should be more easily absorbed and more quickly utilised than starch, but it is found that when both are procurable a mixture of the two is usually preferred.
January 1, 1896
Food In Health and Disease - Functions of the Carbohydrates
The occurrence of this "amyloid substance" in the liver, even when a purely animal diet has been taken, he accounts for by the supposition that the liver is the organ in which the splitting-up of the albuminates into urea and a non-nitrogenous substance occurs, and that the latter is metamorphosed by the liver into "glycogen."
The class of carbohydrates have much in common with the fats. They serve the same purpose of checking albuminous waste ; like them, they are resolved by combustion within the body, ultimately, into carbonic acid and water, and so, like the fats, are capable of yielding heat and mechanical work. Unlike the fats and the albuminates, however, they do not appear to enter into the structure of the tissues, although they are found in some of the fluids and organs of the body.
All the carbohydrates are converted into glucose, or grape sugar (or maltose), before they are absorbed, and in this form they are much more readily metabolised than the fats or albuminates.
It is believed by many, and the weight of evidence, as will be seen, is in favour of the conclusion, that carbohydrates can be converted into fat within the organism. Bauer,* however, is indisposed to accept this view. Basing his opinions on the experiments of Pettenkofer and Voit, who showed that carbohydrates, even when administered in great excess, are almost completely destroyed within the body, he maintains that although the carbohydrates, when given together with albumen and fat, favour an increase of the constituents of the body, and especially of fat, yet it is not because they are themselves converted into fat, but because, owing to the facility with which they are metabolised, they protect the other food-stuffs from destruction.
"When fat and carbohydrates co-exist in the food, the latter are always the first to be consumed; and when they are present in sufficient amount, the consumption of fat in the body may be completely suspended." And he explains in a similar manner the fact that a deposit of fat may be observed to take place when the diet consists of albuminates and carbohydrates alone, without any fat; for in that case, he says, the fat, which "originates as a product of the splitting-up of albumen, is withdrawn from further metabolism in favour of the carbohydrates, and contributes to the gain." He also rejects the view that the ready decomposition of the carbohydrates in the body depends on their great affinity for oxygen; he considers it lies rather in the properties of the animal tissues, and he points out that the assumed equivalents of starch and fat, as 240 of the former to 100 of the latter, calculated on the quantity of oxygen required for their combustion, are incorrect; and that in the living organisms "175 parts of starch are in the material actions approximately equivalent to 100 of fat."
Germain Sée begins by supporting the view taken by Bauer, and asserts that the principal function of the carbohydrates is the immediate development of heat and mechanical work ; that they are not annexed in any way directly or indirectly to the organisms ; and that the fat that is deposited in consequence of their use is derived from the splitting-up of albuminates. He urges the experiments of Boussingault, who found that when he fed ducks on a pure carbohydrate like rice, they grew thin; but on adding a small quantity of butter, they grew fat. The same experimenter also asserted that milch-cows only gave out the quantity of fat in their milk that was contained in their food. Sée also points out that the particular kinds of grain selected for fattening animals are always such as contain, like maize, a considerable quantity of fat. But, notwithstanding all this, he appears in the end to yield to the weight of evidence that fat may be, under certain circumstances, formed from carbohydrates.
Dujardin-Beaumetz believes in the possibility of the transformation of glucose, the product of the digestion of carbohydrates, into fat. He sees a great analogy between the formula for glucose, C6H12O6, and that of glycerine, C3H8O3, and thinks that the latter may result from the splitting up of the former with the addition of hydrogen. He also shares, to a certain extent, Pavy's views, and considers that a portion of the glucose derived from the digestion of carbohydrates is deposited as " hepatic glycogen" in the liver, and thus furnishes the glucose necessary to the organism when the food does not contain any carbohydrates, Pavy maintains, as is well known, that saccharine matter, when absorbed, "on reaching the liver is transformed by that organ into amyloid sub- stance [glycogen], which is stored up in its cells for subsequent further change preliminary to being appropriated to the purposes of life." The occurrence of this "amyloid substance" in the liver, even when a purely animal diet has been taken, he accounts for by the supposition that the liver is the organ in which the splitting-up of the albuminates into urea and a non-nitrogenous substance occurs, and that the latter is metamorphosed by the liver into "glycogen." Pavy believes that carbohydrates are first converted into this "amyloid substance," and that this is afterwards converted into fat. But he points out what is doubtless a most important condition in the conversion of carbohydrates into fat, namely, "the co-operation of nitrogenous in conjunction with saline matter," for it is probably by the changes occurring during the metabolism of the albuminates that this transformation is excited. The presence of a small amount of fat with the carbohydrates would seem also to favour this conversion, for the rapid deposition of fat which sometimes occurs when animals are fed on such a mixture appears to be more than can be accounted for by the small quantities of fat ingested. Pavy dops not admit that any of the carbohydrates undergo direct oxidation in the system, or contribute strictly to force production.
January 1, 1903
Social Culture; a Manual of Etiquette and Deportment
A book on etiquette says: "A perfectly safe way to get thin is to eat chopped meat without any potatoes, and if possible eat no bread, butter, or sweets. Thin people who wish to get stout should eat oatmeal, hominy, or any of the preparations of wheat now sold."
How to Reduce Flesh
A man or woman who feels that flesh accumulating too rapidly may lose it by drinking sassafras tea, either cold or hot, with or without sugar, as the taste demands. There might be conditions of the system when it might be injurious, however, and it would be better to consult a doctor before using it. A strong infusion may be made of one ounce of sassafras to a quart of water. Boil half an hour very slowly, let it cool, and keep from the air.
A perfectly safe way to get thin is to eat chopped meat without any potatoes. Drink as little as possible of any fluid. Exercise a great deal without drinking and if possible eat no bread, butter, or sweets. Lemonade, acid drinks of any kind, a little strong tea and saline mineral waters will assist you, but of thees take only as little as possible. Start the morning by drinking a glass of clear water.
How to Increase Flesh
Thin people who wish to get stout should eat oatmeal, hominy, or any of the preparations of wheat now sold. Wheat rolls, corn mush, cream, chocolate, milk, sugar, omelets, jams, eggs, potatoes, bacon, and all other fattening foods.
Ancient History
8000
B.C.E.
Evolutionary and Population Genomics of the Cavity Causing Bacteria Streptococcus mutans
S. Mutans, the bacteria involved in creating cavities likely evolved and expanded with the population growth 10,000 years ago as humans started relying more on starches and sugars.
Streptococcus mutans is widely recognized as one of the key etiological agents of human dental caries. Despite its role in this important disease, our present knowledge of gene content variability across the species and its relationship to adaptation is minimal. Estimates of its demographic history are not available. In this study, we generated genome sequences of 57 S. mutans isolates, as well as representative strains of the most closely related species to S. mutans (S. ratti, S. macaccae, and S. criceti), to identify the overall structure and potential adaptive features of the dispensable and core components of the genome. We also performed population genetic analyses on the core genome of the species aimed at understanding the demographic history, and impact of selection shaping its genetic variation. The maximum gene content divergence among strains was approximately 23%, with the majority of strains diverging by 5–15%. The core genome consisted of 1,490 genes and the pan-genome approximately 3,296. Maximum likelihood analysis of the synonymous site frequency spectrum (SFS) suggested that the S. mutans population started expanding exponentially approximately 10,000 years ago (95% confidence interval [CI]: 3,268–14,344 years ago), coincidental with the onset of human agriculture. Analysis of the replacement SFS indicated that a majority of these substitutions are under strong negative selection, and the remainder evolved neutrally. A set of 14 genes was identified as being under positive selection, most of which were involved in either sugar metabolism or acid tolerance. Analysis of the core genome suggested that among 73 genes present in all isolates of S. mutans but absent in other species of the mutans taxonomic group, the majority can be associated with metabolic processes that could have contributed to the successful adaptation of S. mutans to its new niche, the human mouth, and with the dietary changes that accompanied the origin of agriculture.
Undoubtedly, one of the major challenges that S. mutans had to overcome as the carbohydrate content of the human diet increased was surviving at low pH. Although S. mutans does not constitute a significant proportion of the oral flora colonizing healthy dentition, it can become numerically significant when there is repeated and sustained acidification of the biofilms associated with excess dietary carbohydrates or impaired salivary function (Burne 1998).
Luxor, Luxor Governorate, Egypt
2475
B.C.E.
The Earliest Record of Sudden Death Possibly Due to Atherosclerotic Coronary Occlusion
WALTER L. BRUETSCH
The sudden death of an Egyptian noble man is portrayed in the relief of a tomb from the Sixth Dynasty (2625-2475 B.C.). Since there is indisputable evidence from the dissections of Egyptian mummies that atherosclerosis was prevalent in ancient Egypt, it was conjectured that the sudden death might have been due to atherosclerotic occlusion of the coronary arteries.
It may be presumptuous to assume that an Egyptian relief sculpture from the tomb of a noble of the Sixth Dynasty (2625-2475 B.C.) may suggest sudden death possibly due
to coronary atherosclerosis and occlusion. Much of the daily life of the ancient Egyptians has been disclosed to us through well-preserved tomb reliefs. In the same tomb that contains the scene of the dying noble, there is the more widely known relief "Netting Wildfowl in the Marshes." The latter sculpture reveals some of the devices used four thousand years ago for catching waterbirds alive. It gives a minute account of this occupation, which in ancient Egypt was both a sport and a means of livelihood for the professional hunter.
The relief (fig. 1), entitled "Sudden Death," by the Egyptologist von Bissing2 represents a nobleman collapsing in the presence of his servants. The revelant part of the explanatory text, as given by von Bissing, follows (translation by the author):
The interpretation of the details of the theme is left to the observer. We must attempt to comprehend the intentions of the ancient artist who sculptured this unusual scene. In the upper half (to the right) are two men with the customary brief apron, short hair covering the ears, busying themselves with a third man, who obviously has collapsed. One of them, bending over him, has grasped with both hands the left arm of the fallen man; the other servant, bent in his left knee, tries to uphold him by elevating the head and neck, using the knee as a support. Alas, all is in vain. The movement of the left hand of this figure, beat- ing against the forehead, seems to express the despair; and also in the tightly shut lips one can possibly recognize a distressed expression. The body of the fallen noble is limp. . . . Despite great restraint in the interpretation, the impression which the artist tried to convey is quite obvious. The grief and despair are also expressed by the figures to the left. The first has put his left hand to his forehead. (This gesture represents the Egyptian way of expressing sorrow.) At the same time he grasps with the other arm his companion who covers his face with both hands. The third, more impulsively, unites both hands over his head. ... The lord of the tomb, Sesi, whom we can identify here, has suddenly collapsed, causing consternation among his household.
In the section below (to the left) is shown the wife who, struck by terror, has fainted and sunk totheflor. Two women attendants are seen giving her first aid. To the right, one observes the wife, holding on to two distressed servants, leaving the scene. . . .
von Bissing mentions that the artist of the relief must have been a keen observer of real life. This ancient Egyptian scene is not unlike the tragedy that one encounters in present days, when someone drops dead of a "heart attack." The physician of today has almost no other choice than to certify the cause of such a death as due to coronary occlusion or thrombosis, unless the patient was known tohave been aflictedwith rheumatic heart disease or with any of the other more rare conditions which may result in sudden death.
Atherosclerosis among the Ancient Egyptians
The most frequent disease of the coronary arteries, causing sudden death, is atherosclerosis. What evidence is available that atherosclerosis was prevalent in ancient Egypt?
The first occasion to study his condition in peoples of ancient civilizations presented itself when the mummified body of Menephtah (approx.1280-1211B.C.), the reported "Pharaoh of the Hebrew Exodus" from Egypt was found. King Menephtah had severe atherosclerosis. The mummy was unwrapped by the archaeologist Dr. G. Elliot Smith, who sent a piece of the Pharaoh's aorta to Dr. S. G. Shattock of London (1908). Dr. Shattock was able to prepare satisfactory microscopic sections which revealed advanced aortic atherosclerosis with extensive depositions of calcium phosphate.
This marked the beginning of the important study of arteriosclerosis in Egyptian mummies by Sir Mare Armand Ruffer, of the Cairo Medical School(1910-11). His material included mummies ranging over a period of about 2,000 years (1580 B.C. - 525 A.D.).
The technic of embalming in the days of ancient Egypt consisted of the removal of all the viscera and of most of the muscles, destroying much of the arterial system. Often, however, a part or at times the whole aorta or one of the large peripheral arteries was left behind. The peroneal artery, owing to its deep situation, frequently escaped the em- balmer'sknife. Otherarteries,suchasthe femorals, brachials, and common carotids, had persisted.
In some mummies examined by Ruffer the abdominal aorta was calcified in its entirety, the extreme calcification extending into the iliae arteries. Calcified plaques were also found in some of the larger branches of the aorta. The common carotid arteries frequently revealed patches of atheroma, but the most marked atheroselerotic alterations were in the arteries of the lower extremities. The common iliae arteries were not infrequently studded with calcareous plaques and in some instances the femoral arteries were converted into rigid tubes. In other mummies, however, the same arteries were near normal.
What is known as Mdnekeberg's medial calcification was also observed in some of the mummified bodies. In a histologic section of a peronieal artery, the muscular coat had been changed almost wholly by calcification. In one of Ruffer's photographic plates, a part of a calcified ulnar artery is shown. The muscular fibers had been completely replaced by calcification.
In the aorta, as in present days, the atherosclerotic process had a predilection for the points of origin of the intercostal and other arteries. The characteristics and the localization of the arterial lesions observed in Egyptian mummies leaves litle doubt that atherosclerosis in ancient times was of the same nature and degree as seen in today's postmortem examinations.
As to the prevalence of the disease, Ruffer ventured to say that the Egyptians of ancient times suffered as much as modern man from arterial lesions, identical with those found in our times. Ruffer was well qualified to make this statement having performed many autopsies on modern Egyptians, Moslems, and other people of the Middle East. In going over his material and examining the accompanying photographic plates of arteries, one can have litle doubt that what Ruffer had observed in Egyptian mummies represented arteriosclerosis as it is known today.
Although the embalming left no opportunity to examine the coronary arteries inl mummified bodies, the condition of the aorta is a good index of the decree of atheroselerosis present elsewhere. In individuals with extensive atheroselerosis of the aorta, there is almost always a considerable degree of atherosclerosis in the coronary arteries. If Ruffer's statement is correct that the Egyptians of 3,000 years ago were afflicted with arteriosclerosis as much as we are nowadays, coronary occlusion must have been common among the elderly population of the pre-Christian civilizations.
Furthermore, gangrene of the lower extremities in the aged has been recognized since the earliest records of disease. Gangrene of the extremities for centuries did not undergo critical investigation until Cruveilhier (1791- 1873) showed that it was caused by atherosclerotic arteries, associated at times with a terminal thrombus.
SUMMARY
The record of a sudden death occurring in an Egyptian noble of the Sixth Dynasty (2625-2475 B.C.) is presented. Because of the prevalence of arteriosclerosis in ancient Egyptian mummies there is presumptive evidence that this incident might represent sudden death due to atheroselerotic occlusion of the coronary arteries.
Cairo, Cairo Governorate, Egypt
1580
B.C.E.
ON ARTERIAL LESIONS FOUND IN EGYPTIAN MUMMIES
Arteries of Egyptian mummies from 1580 B.C.E. to 525 A.D. have extensive calcification of the arteries, the same nature as we see today, and unlikely to be due to a very heavy meat diet, which was always a luxury in ancient Egypt. Instead, the diet was mostly a course vegetarian one.
DISCUSSION OF RESULTS.
Nature of the lesions. There can be no doubt respecting the calcification of the arteries, and that it is of exactly of the game nature as we see at the present day, namely, calcification following on atheroma.
The small patches seen in the arteries are atheromatous, and though the vessels have without doubt been altered by the three thousand years or so which have elapsed since death, nevertheless the lesions are still recognisable by their position and microscopical structure.
The earliest signs of the disease are always seen in or close below the fenestrated membrane,-that is, just in the position where early lesions are seen at the present time. The disease is characteiised by a marked degeneration of the muscular coat and of the endothelium. These diseased patches, discrete at first, fuse together later, and finally form comparatively large areas of degenerated tissue, which may reach the surface and open out into the lumen of the tube. I need not point out how completely this description agrees with that of the same disease as seen at the present time.
I have already mentioned the absence of leucocytes and cellular infiltration, and need not therefore return to it here.
In my opinion, therefore, the old Egyptians suffered as much as we do now from arterial lesions identical with those found in the present time. Moreover, when we consider that few of the arteries examined were quite healthy, it would appear that such lesions were as frequent three thousand years ago as they are to-day.
I do not think we can accuse a very heavy meat diet. Meat is and always has been something of a luxury in Egypt, and although on the tables of offerings of old Egyptians haunches of beef, geese, and ducks are prominent, the vegetable offerings are always present in greater number. The diet then as now was mostly a vegetable one, and often very coarse, as is shown by the worn appearance of the crown of the teeth.
Nevertheless I cannot exclude a high meat diet as a cause with certainty, as the mummies examined were mostly those of priests and priestesses of Deir el-Bahari, who, owing to their high position, undoubtedly lived well. I must add, however, that I have seen advanced arterial disease in young modern Egyptians who ate meat very occasionally. In fact, my experience in Egypt and in the East has not strengthened the theory that meat-eating is a cause of arterial disease.
Finally, strenuous muscular exercise can also be excluded as a cause, aa there is no evidence that ancient Egyptians were greatly addicted to athletic sport, although we know that they liked watching professional acrobats and dancers. I n the ca6e of the priests of Deir el-Bahari, it is very improbable, indeed, that they were in the habit of doing very hard manual work or of taking much muscular exercise.
I cannot therefore at present give any reason why arterial disease should have been so prevalent in ancient Egypt. I think, however, that it is interesting to find that it was common, and that three thousand years ago it represented the same anatomical characters as it does now.
FIG. 1.-Pelvic and arteries of thigh completely calcified (XVIlIth-XXth Dynasty).
Fro. 2.-Completely dcifiedprofundaarteryaftersoakinginglycerine(XXIstDynasty). FIQ. 8.-Partly calcified aorta (XXVIIth Dynasty).
Fro. 4.-Calcified patches in aorta (XXVIIth Dynasty).
Fio. 5.-Calcified atheromatous ulcer of subclavian artery (XVIIIth-XXth Dynasty). Fro. &-Patch of atheroma i n anterior tibia1 artery (glycerine). The centre of the patch
is calcified (XXIst Dynasty).
FIG. 7.-Atheroma of brachial artery (glycerin) (XXIst Dynasty).
Fro. &-Unopened ulnar artery, atheromatous patch shining through (glycehne) (XXIst Dynasty). 31
FIG. 9.-Section through almost completely calcified posterior peroneal artery (low power). Van Gieson staining. a,al, n2, Remnants of endothelium and
fenestrated membrane. b, Calcified patches.
Many more are seen.
Same stain. (Leitz, Oc. 1, x &.)
FIG. 10.-Section
FIG. 11.-Section m(Leitz, Oc. 1, x *.)
a,Remains of endothelium.
b, Fenestrated membrane.
c, Muscular coat.
d,f,Membrane coat undergoing degenerntion.
e, Completely degenerated remnants of muscular coat.
atheroniatous patch of n h a r artery. Same stain. (Leitz, (Reference letters the same as in Fig. 11.)
FIG. 12.-Section Oc. 1, x fa.)
through calcified patch of ulnar artery. a,d, Calcified patches.
b, Partially calcified m wular coat. c, Annular muscular fibre.
through atheromatous patch of anterior tibia1 artery. Same stain through
FIG. 13.-Section at edge of atheromatous patch. Hreniatoxylin stain (Leitz, Oc. 1, XTh.1 a,Leucocytes (1). The atheromatous part on the left stains intensely dark with hamatoxylin.
