Egyptian reliefs, wall paintings, and ostraca depict kings and tomb owners using the conventional image of a well-formed, healthy human body with a young face. In scenes with servants, however, a body afflicted by a deformity may occasionally be shown. An exception to the rule is the naturalistic style of the Amarna period, which presented the king, Akhenaten, with deformed features. John F. Nunn (1996) expressed the view that abnormal forms might have been artistic conventions, too; obesity could have indicated high social status, and all dwarfs were shown with short limbs.

If the Egyptian sense of individualization is taken into account, as was inherent in their afterlife beliefs, abnormal forms may be considered an accentuation of individual identity, especially in commoners. Most of the deformities depicted really existed, then as now, and have been found in mummies and skeletons. They could not have escaped the attention of ancient Egyptian artists. Many examples are known in reliefs and paintings of specific individuals who were characterized by their features, attributes, activities, names, and titles. For deformities, only iconographic and palaeopathological sources have been used. Egyptian medical texts do not deal with them, perhaps because there were no means to treat them.

For clarity, recorded deformities were divide into those which affected (1) the whole body, (2) the head, (3) the face, (4) the spine and thorax, (5) the belly, and (6) the extremities.

The Body.

The form of the body was affected in systemic disorders, such as aberrant growth caused by chondrodystrophy, a genetically transmitted disorder; there, enchondral ossification afflicts the bones of the face, pelvis, and extremities, which become short, broad, and deformed. Bones of the cranial vault and trunk remain normal but the stature of such adult males is only about 125 to 130 centimeters (47 to 51 inches), adult females only 115 to 120 centimeters (45 to 47 inches).

Depictions of chondrodystrophic dwarfism are abundant in Egypt, especially from the Old Kingdom. V. Dasen (1993) has collected as many as 207 instances; and Kenneth R. Weeks (1970) described nine skeletal finds. Two more were discovered in the fourth-to-sixth dynasty cemeteries at Giza by Zahi Hawass. One was Perenakh, in whose tomb were found not only his skeletal remains but also his funerary statue, allowing assessment as to how accurately his deformity was reproduced. The second was a female who died in childbirth, delivering a normal (non-chondrodystrophic) baby whose head could not pass throught her small and deformed birth canal.

Chondrodystrophy did not disqualify people from moving into higher levels of society or even to attain significant offices, as the nobleman Seneb attests. Their short hands were usually dexterous and their well-developed brains indicated intelligence. Thus, they might be employed as jewelers, servants, attendants, or wardrobe officials. In some depictions, they care for the pets of their masters or perform music and dance. Some gods, such as Bes, the protector of homes and childbirth, and the late form of the god of craftsmen and artists, Ptah (Pataikos), were depicted as chondrodystrophic dwarfs, especially in the form of protective amulets. No other types of dwarfism are yet known from ancient Egypt—not ethnic (Central African) or pathological (pituitary, thyroid, etc.); nor are instances of oversize growth (gigantism).

The conventional ideal image of King Akhenaten was replaced in his third regnal year by acromegalic features (long protruding chin, long fingers) and feminine proportions and traits. This abrupt change has sometimes been explained as a hypophysal disorder (acromegaly, or Fröhlich's syndrome, also called dystrophia adiposogenitalis), caused usually by the pressure of a pituitary tumor. J. Worth Estes (1989, p. 50) pointed to the occurrence of gynecomastia in the putative father and two half-brothers of Akhenaten; he conjectured that they might have shared genes for it, but the relationship is by no means certain. The endocrinologist Charles Edmonds has suggested (Nunn 1996) Klinefelter's syndrome for Akhenaten, a chromosomal abnormality with a doubling of the female X strand alongside the male Y chromosome (XXY, instead of the normal XY). Marfqu's syndrome has also been suggested. The alternative view is that it was an artistic convention, exaggerating certain features of the actually normal body of the king. As Joyce Filer (1995, p. 36) suggested, it could also have been an expression of Akhenaten's religious doctrine; because his sole god Aten was considered father and mother of all beings, the king might therefore have been depicted as male and female simultaneously.

None of the hypotheses may be checked by examining the king's mummy, because the only extant male royal mummy of the period, found in Theban tomb number 55, is too young (20–25 years) to be in harmony with the seventeen-year duration of his reign.

Obesity might be considered a physiological feature that older wealthy people might have added to depictions to indicate an elite social position. In the relief showing the Queen of Punt, however, in the temple of Hatshepsut at Thebes, her obesity is so exaggerated that the fat tissue forms thick folds and lobes that hang like grapes on her arms, belly, hips (steatopygia), and legs. The belly weight caused a hyperlordosis of her spine. Such deformities had a pathological cause: either lipodystrophy, or neurolipomatosis (Dercum's disease), a painful disorder in which fat accumulates as multiple lipomas or neurolipomas. Scenes with the contrasting condition, emaciation in people afflicted with hunger, are known from the reliefs on the walls of the Unas causeway at Saqqara and recently found on blocks that fell off the causeway of Sahure at Abusir. They show emaciated bodies with protruding ribs and may have been portrayals of desert nomads. Similarly emaciated bodies can be found in old individuals leaning on a walking stick and in the ideogram or determinative for seniority.

The Head.

The Egyptians did not belong to those cultures that caused artificial deformation of the heads of their children during the nursing period. Yet statues and drawings of Akhenaten's daughters exist in which their heads are drawn up and backwards into protruding round occiputs. It has been considered a foreign custom, perhaps introduced to Egypt by Akhenaten's queen, Nefertiti. Her supposed Mitannian origin has however, been rejected in favor of Egyptian ancestry. Was it then an artistic exaggeration of the less common, but normal type of cranial growth occasionally seen in Egyptian skulls? Or, again, was it some symbolism important to Akhenaten and the Amarna period?

An enlarged skull with signs of increased intracranial pressure was published by Douglas E. Derry (Journal of Anatomy and Physiology 47 [1912/13], pp. 436–458) in a thirty-year-old male from the cemetery of Roman date at Shurafa near Helwan. It probably caused his left hemiplegia, since his left upper and lower limb bones were thinner than the right ones. He could have survived only by being cared for. Such finds are rare, because children so afflicted usually die at a young age, and the thin bones of their cranial vaults do not survive.

The Face.

Deformities of the facial skeleton are known only from rare finds and not from depictions. Cleft palate (usually combined with hare lip in living humans) was present in an adult female from Nubia (now in the Natural History Museum, London) and in two other adult female skulls of the twenty-fifth dynasty and Roman period. In another adult woman from a cemetery south of Asyut, the premaxillary portion of the upper jaw is missing. In the Christian period series from Sayala in Nubia, a skull was found with a swollen middle region of the upper jaw, the result of a developmental defect, a cyst of the nasopalatinal ductus. Finds of larger inborn anomalies cannot be expected, because they led quickly to the death of the afflicted infants.

Deformities of the chondrodystrophic face (broad saddle of the nose deeply inserted under the protruding glabella, small cheeks and jaws) and those called acromegalic features (broad, long and high lower jaw) are known, but the typical features of the leprous or syphilitic face have not, however, been found in the remains of ancient Egyptians or in their depictions.

The Spine and Thorax.

Curved spine is known from pictures, mummies, and skeletons. It can be an exaggerated, kyphotic, fluently arched bend of the spine's thoracic vertebrae, sometimes combined with a scoliotic deviation and a deformity of the thorax. The causes for it include the following: Scheuerman's disease; lowering of the intervertebral discs in old age; severe osteoporosis, bad body posture, and intensive vertebral osteophytosis; ankylosing spondylitis; rachitis, or other less common spinal diseases.

An angular humpback is the result of the compressive fracture of a vertebra. Single or more vertebrae, usually not adjoining, are in an osteoporotic spine or in a spine with cancers (metastases of carcinoma). If a few adjoining vertebrae (usually two to four) are involved, spinal tuberculosis (Pott's disease) should be taken into account; the typical place for it is the lower thoracic spine or the thoracicolumbar transition. Some ten statuettes and reliefs depict this condition, and a few are from the Predynastic period. The same deformity has been found in seven mummies, including that of the priest Nesparehan of the twenty-first dynasty, the skeletized ones of Huyankh found at Abusir from the Middle Kingdom, and that of the son of Sety I, Pa-Ramessu, from Abu Ghurob.

More than thirty cases have been detected of chronic tubercular infection in skeletons, in which the course of the disease can be followed. It results in abscess cavities in vertebral bodies, which later fuse into one large one. Following evacuation of the tubercular pus down along the psoas muscle, a pathological fracture imparts a wedge shape to the affected vertebral body and an angular humping of the spine. The tuberculosis process destroys also the intervertebral discs between the affected bodies.

A coincidence of two skeletons with Pott's disease, found in two nearby graves at the Predynastic site of Adaima near Esna, was accompanied in both cases by pottery representations of the same deformity, a rare case of congruence of the skeletal and iconographic evidence (E. Crubézy and T. Janin, Papers on Paleopathology Presented at the 20th Annual Meeting in Toronto, 1993). The diagnosis of tuberculosis was provable in the mummy of a five-year-old child (1000–600 BCE) from the tomb of Nebwenef by Michael R. Zimmerman (Bulletin of the New York Academy of Medicine 55 [1979], 604–608). Tubercular infection of the lungs was shown histologically, and Mycobacterium tuberculosis was demonstrated in a destroyed lumbar vertebra, along with hemorrhage in the trachea.

This oft-mentioned occurrence of tubercular deformation of the spine, as well as about five cases in which tuberculosis was suspected in other anatomical locations, signifies the extent of that disease in ancient Egypt and Nubia. Future research, based on DNA determinations in suspect finds, could reveal the prevalence of tuberculosis with respect to the social status of those infected, as well as other quantifiable factors.

The Belly.

In a few tombs, scenes (with numbers in the sixth dynasty tomb of Mehu at Saqqara) show servants and workmen with a protruding formation in the umbilical region, suggesting umbilical hernia. Knowledge of that condition is reflected in Papyrus Ebers (Case 864), which refers to swelling “above the umbilicus” apparent when the patient coughs. Yet inguinal hernia has not yet been discerned. Cases of scrotal hernia might have manifest themselves by swelling of the scrotum, known, for example, in the sixth dynasty tomb of Ankhmahor at Saqqara.

This last diagnosis is, however, not unequivocal, since similarly enlarged scrotums could contain hydrocele, an effusion of tissue fluid into the tunica vaginalis, which surrounds the testicles. Both possibilities were taken into account by Grafton Elliot Smith in his Royal Mummies (Cairo, 1912, p. 91), after finding an enlarged but empty scrotum in the mummy of Ramesses V.

A swollen scrotum, with an enlarged penis and swollen abdomen, shown in the reliefs from the same tomb were attributed by P. Ghalioungui (1963, pp. 89–90) to the parasitic disease schistosomiasis. It might instead be an expression of filariasis, as suggested by Edmund Tapp and K. Wildsmith in The Mummy's Tale (edited by A. R. David and E.Tapp, London, 1992), who found tissue, perhaps from the scrotum of the mummy of Natsef-Amun at the Leeds Museum, permeated by Filaria bancrofti worms. In no picture or mummy, however, has the typically swollen legs that often accompany this disease, yet been found.

The Extremities.

Club foot (talipes equinovarus) that touches the ground not by the sole but by toes, combined with a shorter and thinner leg, is a characteristic feature of two different conditions. It can be inborn (often combined with the anomalous inward rotation, shape, and size of the foot) or it can be the result of poliomyelitis experienced in childhood. This is the case of the mummy of King Siptah, whose left foot was considered at first to be a club foot but later a result of poliomyelitis or an inborn defect of the spine. Similarly, the stela of the door-keeper Ruma of the nineteenth dynasty (now in the Copenhagen Museum) depicts the same condition, which was more probably the result of poliomyelitis than a club foot. Through the depiction of very long, thin fingers, the condition called arachnodactyly has been observed in a statue from the Old Kingdom (see Westendorf 1992, p. 251).

Bibliography

  • David, A. R., and E. Tapp, eds. The Mummy's Tale. London, 1992.
  • Dasen, V. Dwarfs in Ancient Egypt and Greece. Oxford, 1993. An up-to-date listing of iconographic evidence for dwarfs.
  • Estes, J. Worth. The Medical Skills of Ancient Egypt. Canton, Mass., 1989. Deals with healers, diseases, surgery, and medicines of ancient Egypt and is written by a modern medical specialist.
  • Filer, Joyce. Disease. London, 1995. Descriptions of common diseases of the ancient Egyptians; discusses treats deformities in detail.
  • Ghalioungui, P. Magic and Medical Science in Ancient Egypt. London, 1963. A survey of the Ancient Egyptian medical profession; deals with diseases described in the medical papyri and some known from iconography.
  • Ghalioungui, P., and Z. el Dawakhly. Health and Healing in Ancient Egypt. Cairo, 1965. Well-illustrated book based mostly on pictorial evidence, with a chapter on diseases and deformities.
  • Manchester, K. The Archaeology of Disease. Bradford, 1983. A survey of paleopathology, dealing with the deformations of congenital and infectious diseases.
  • Nunn, John F. Ancient Egyptian Medicine. London, 1996. Survey of the different aspects of Egyptian medicine, written by a medical doctor who is also an Egyptologist.
  • Weeks, Kenneth R. “The Anatomical Knowledge of the Ancient Egyptians and Representation of the Human Figure in Egyptian Art.” Ph.D. diss., Yale University, 1970. Analysis based on linguistic evidence, medical texts, iconographic sources, and skeletal finds.
  • Westendorf, Wolfhart. Erwachen der Heilkunst: die Medizin im Alten Ägypten. Zurich, 1992. A general survey of Egyptian medicine based primarily on textual sources.

Eugen Strouhal