NOTES ON TRHE SMIATOLOGY AND PATHOLO)GY O:P; ANCIENT EGYPT BY ~ ~ N fto., WOcp LIGH TJNI SITY OF CA;JFQ'NIA PVBL1;ATI 0 S IN AicBaro~ATErA.Io AND Tx~oo Vlme 4,No.1, pp 1A4, 41pate UNIVERSITY OF CAL~~~~~IFORNIA PRES 7~~~~MVRI~ 0 0' ..AL. E S Y00;e .0' BER-KELEY CALIFORNUA '1934 NOTES ON THE SOMATOLOGY AND PATHOLOGY OF ANCIENT EGYPT BY R. WOOD LEIGH UNIVERSITY OF CALIFORNIA PUBLICATIONs rN AMERICAN ARCEAEOLOGY AND ETHNOLOGY Volume 34, No. 1, pp. 1-54, 7 plates Issued June 22, 1934 Price, 75 cents UNIVESITY OF CALIFORNIA PRESS BERKELEY, CALIFORNIA CAMBRIDGE UNIVESITY PRESS LONDON, ENGLAND PRINTED IN THE UNITED STATES OF AMERICA CONTENTS PAGE Introduction.1 Somatology.1 Mandible ...................... . 2 Palate ....................... . 8 Dental index . . . . . . . . . . . . . . . . . . . . . . 9 Gnathic index. 9 Occlusion ...................... . 17 Diastema ...................... . 17 Tuber maxillare .17 Posterior nasal spine . . . . . . . . . . . . . . . . . . . 18 Hamulus pterygoideus .18 Anomalies of cranial sutures . . . . . . . . . . . . . . . . . 18 Tooth morphology . . . . . . . . . . . . . . . . . . . . 19 Cusps .... . . . . . . . . . . . . . . . . . . . . 19 Roots .22 Pathology ...................... . 23 Attrition .23 Dental caries . . . . . . . . . . . . . . . . . . . . . . 25 Periapical osteitis .26 Radicular cyst .28 Maxillary sinusitis chronic . . . . . . . . . . . . . . . . . 29 Extraneous accretions and periodontoclasia .30 Exfoliation and senility . . . . . . . . . . . . . . . . . . 31 Osteo-arthritis .32 Syphilis, rachitis, lesions on parietal bosses .33 Fractures .3.4.................... . 3 Dental operative interference .34 Corn in Egypt .35 Literature cited . 38 Explanation of plates .39 PLATES 1-7. .41 . . . . . . . . . 41 NOTES ON THE SOMATOLOGY AND PATHOLOGY OF ANCIENT EGYPT BY R. WOOD LEIGH INTRODUCTION THIS STUDY is based on an examination of the Egyptian skeletal collection in the Museum of Anthropology, University of California. Opportunity for observing this valued group was afforded by Professor A. L. Kroeber, director of the museum. The collection was made by the Hearst-University of Califor- nia Expedition (1899-1905) directed by G. A. Reisner. The collection is the largest and probably the most representative, geographically and chronologi- cally, of any in America. Reisner's monograph(")* is the archaeological back- ground as to provenience and chronology. Excavations were made at Gizeh, El-Ahaiwah, and Naga-ed-Der. The director of the expedition relates that at tl-Ahaiwah a Predynastic cemetery, and one of the late New Empire, were excavated. At Naga-ed-Der in the Thebaid the series of cemeteries was found to be nearly complete from the earliest Predynastic period down to the pres- ent day. From the necropolis at Gizeh in the Delta were recovered bodies of the official class of the Pyramid-builders. G. Elliot Smith did the anatomical work of the expedition. The material is fragile because of its extreme age-some of it, roundly, is six thousand years old-and because of the exigencies of collecting, packing, shipping, and an extended exhibit in Cairo before it was sent to Berkeley. Therefore some of the skeletons are fragmentary; but all cranial specimens, including calvarium, facial bones, and teeth, were examined and notes were made on them, though details of descriptive characters and measurements were carded for only two hundred and thirty. The craniometric measure- ments were made in accordance with the definitions and technique outlined in Hrdlicka's Anthropometry. The instruments and aids used were: com- pass d'6paisseur, compass glissiere, metric rule, copper wire, and hand lens. SOMATOLOGY There is a rich literature on the somatology of ancient Egypt, with some differentiation of various stocks which entered the Nile valley in the course of history. Only certain facial measurements and an attempt at appreciation of some non-measurable features of maxillae and dentition were made on this group. * Superior figures refer to works cited. [1] University of California Publications in Am. Arch. and Ethn. The stature was slight; the height probably averaged about 66 inches; the figure was agile and pleasing. Skulls from Predynastic burials are extremely narrow at the temples, diverging toward the parietal bosses, rather longish, but characteristically pentagonoid or coffin-shaped when viewed from the vertex. When better filled the outline is ovoid. There is a prominent roundish eminence of the occiput between the crest and lambdoid suture. The forehead tends to be vertical and fairly high. There are rather high, distinct temporal crests, which indicate a fairly well developed masticatory musculature. The zygoma are peculiarly flat laterally and thus harmonize with the lateral as- pect of the calvarium. The bridge of the nose is high, smooth, and well formed. The face is orthognathous (vide gnathic index). The whole cranium is re- fined in structure. The palate is usually ovoid, or elliptical, and thus simu- lates the outline of the vertex; it is uniformly symmetrical and pleasing in outline, and malposition of teeth is extremely rare. MANDIBLE With respect to racial variation, Smith(8) has this to say of the mandible: "It is a part of the skeleton which lends itself most admirably to the display of those raciial contrasts, such as are associated with other differences of skull and skeleton." Greenwell and Rolleston insisted upon the exceptional impor- tance of the mandible as a racial document. Great muscular development will alter the size and the ruggedness of the bone, but cannot affect those essen- tial features in its form which reveal racial traits. Nor, again, is the shape of the bone, they say, determined wholly by the form of the cranium, as some anatomists maintain. In races in which there are well defined sexual differences, the mandible may serve as an important aid in sex determination. The female mandible is usually smaller, more delicate in outline and surface, smoother; the areas of insertion of the musculature are not so rough as in the male; as a rule, the angle is more obtuse in the female. But the sexual characters of the Egyptian skull are ill defined as a rule, and sex determination from the whole skull is often attended with considerable uncertainty. The Nubians of the upper Nile were similar, according to Jones'4': "The sexual characters of the skull are often ill-defined, and, therefore, sex determination therefrom is not altogether certain." Male skulls listed as female would of course vitiate data for statis- tical results. Indices derived from the craniometric measurements would seem to indicate, however, a correct trend in my sex determination by cranial characters, including mandibular. Two distinct mandible types appear in Egypt. The archaic type is rather small; relative to the body, the ramus is short and broad, the angle is definite, the anterior border of the ramus is an open S with the concavity beyond the third molar and a considerable convexity below the coronoid process; the sig- 2 Leigh: Somatology and Pathology of Ancient Egypt moid notch is a wide graceful crescent, the impressions of the insertions of the muscles are prominent, the gonions may be slightly everted, the chin is pointed. This type comes from all the sites. Another type, apparently more recent and possibly of an intrusive stock, of frequent occurrence at Naga-ed-Der, exemplified by 4804*, xii Dynasty, is characterized by a high narrow ramus, surmounted by a high pointed coro- noid process, a fairly deep sigmoid notch, a fairly straight anterior border of the ramus, an angle singularly obtuse and indefinite, large mental foramina, smooth rounded menton. This type of mandible is effeminate. There is, of course, a range of variation in both the archaic and more recent types. Tables 1 and 2 give the complete data of mandibular measurements for males and females respeetively. Table 3 gives the range of mandibular meas- urements-a summary. It is of interest to compare these figures with the measurements of a royal mandible of the XVII Dynasty as given by Smith(9): "The jaw conforms to the Egyptian type: the bigonial breadth is 95 mill., the bicondylar breadth is 135 mill., the height of the symphysis is 37 mill., and the vertical measurement of the sigmoid notch is 46 mill. The length and breadth of the palate are 59 mill. and 38 mill. respectively." Palate breadth is to be distinguished from alveolar breadth in my tables. There is no appreciable difference between the two sides of the mandible; that is, with but very few exceptions it is symmetrical. The slight but con- sistent sex difference in table 3 would seem to indicate that my sex determina- tion tended to be correct, as the range for females is smaller than the range for males. This contrast also holds, but to a slighter degree, for the maxillar'y measurements. Superior and inferior geni;al tubercles are two pairs of small, and for many races sharp, spines near the lower part of the inner side of the symphysis for the genio-glossi and genio-hyoid muscles respectively. These tubercles on more than half of the Egyptian mandibles are low, rounded, or ill defined. Even on males, which ordinarily have larger and sharper tubercles than fe- males, they axe poorly developed. The character of the genial tubercles is in keeping with the small, refined mandible of the Egyptian. The mental foramen for the terminal branches of the inferior dental nerve and artery is located somewhat below the middle of the mandible and antero- posteriorly anywhere from the apex of the first premolar to below the mesial root of the first molar, the mode being the position below the second premolar. Table 4 gives the data for location of this foramen. There were occurrences of accessory foramina. * These are not the Reisner original field numbers; they are the Museum permanent numbers as entered in its catalogue 12. The original field numbers are on record in the cata- logue. To avoid needless repetition the 12- has been omitted in front of the specimen num- bers in this paper. 3 University of California Publications in Am. Arch. and Ethn. co b I S o .5 C Io Q a -P IOS an as _'0 Im ba b l OS 03 a oS 0 , a2 I C) IQc I c I ? as .S 03 d 4) oGo 0) c = .0 0 C)k +.0 C C C ,Q f p n) O- C) *~ a as p cO *C) 0 I < o C) I4 ?O 4 C) "0 0 as 0 O S a 1$ .c~ 0 C) I _ I I I I. I eq qeqeq eq CI eq- eqqq eq eq eq eqeq r-q eqeqeqq eqq .e1 q sso s : Ss :: eq qee PL4 P-;I PL4I Ii II A A4 I 44 44 A I P 0--4 1 w- m OC -4 $ 0 eq r .e . 't ..00 ~~~~~ ~~~:0lo L O Rd 1O0 x o10 101010 LO LO it51 0 o z I_ _ _ _ _ _ _ _I _ _ _ _ _ _ _ _ _ _ I _ _ _ _ I__ _ I X b N s * CO :,-~~ t~.COeq c l =4 coeq t.. 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Oetteking says the alveolar prognathism (sub-nasal) distinguishes them from other orthog- nathous races. TABLE 7 CLASSIFICATION OF INDICES Males Females No. Per cent No. Per cent Maxillo-alveolar index Dolichouranic ........ 14 19.1 16 21.6 Mesuranic .......................... 17 23.3 17 23 Brachyuranic .......................... 42 57.6 41 55.4 73 100 74 100 Dental index Microdont .......................... 35 66 25 65.8 Mesodont .......................... 13 24.5 8 21 Megadont .......................... 5 9.5 5 13.2 53 100 38 100 Gnathic Index Orthognathous .......................... 50 72.5 57 80.3 Mesognathous .......................... 19 27.5 12 16.9 Prognathous ........................ (1) ........ 2 2.8 69 100 71 100 TABLE 8 R8sumA OF MAXILLARY MEASUREMENTS Average Minimum Maximum Skulls Measurement M F M F M F M F Prosthion-alveolon .......................... 54.6 51.4 48 45 62 59 (72) (76) Alveolar breadth .......................... 63 59 56 50 70 67 (73) (76) Maxillo-alveolar index ...................... 115.5 118.1 100 103.3 127 127 (73) (74) Basion-prosthion ................................ 93.4 92 88 85 104 106 (69) (71) Basion-nasion ......... 101 96 91 91 109 104 (69) (71) Gnathic index ......... 95.2 95.6 85.1 85.2 103 104.9 (59) (71) Dental length ......... 41.4 39.8 38 35 47 44 (53) (38) Dental index ......... 40.9 41.4 35.7 36.3 48.4 47.2 (53) (38) Note: Discontinuous numbers were eliminated eriatim. 16' Leigh: Somatology and Pathology of Ancient Egypt OCCLUSION Even though the Egyptian is orthognathous, the shortened maxillae provide fully for a symmetrical dental arch with its units in beautiful alignment. The compensatory changes accompanying shortened maxillae have been re- duction in tooth size, and, to some extent, degradation of morphology, of the two posterior molars particularly (vide dental index, cusps). There is seldom an incongruity of jaw size and tooth size that has crowded some of the teeth outside of the line of occlusion. Only one exception is present: in a female, age 25, with a U-shaped, undersized palate, the two cuspids are in facio-occlu- sion and the right third molar is in disto-bucco occlusion. The mesio-distal relationship of mandible to maxillae is invariably correct. Resulting from function and attrition in older individuals, the incisors may assume an edge-to-edge relationship. In the group only five other simple Class 1 (Angle) cases of malocclusion occur. A female has an impacted right man- dibular molar. In a female, 40, the superior right cuspid is unerupted-im- pacted, lying horizontally in the palate; in a female, 35, there is a retained left deciduous cuspid, and its permanent successor can be seen in the alveolus above; in a male, the inferior central incisor is in facio-occlusion; and in a child a superior lateral incisor is rotated and in lingual relation to the cuspid. DIASTEMA Skull no. 5066, male, Predynastic, has diastema measuring 5 mm. at cervix between the inferior cuspid and first pre-molar bilaterally. The superior teeth are large. This is a simian character which accommodates the interdigitation of the larger superior cuspid. In this skull only was this anomaly of phylo- genetic significance noted. TUBER MAXILLARE The maxillary tuberosity has interest from morphologic as well as surgical and prosthetic considerations. I measured the post-dental length of the alveo- lar process in some 140 skulls. This length varied from 1 to 10 mm.; 128 of these were equally distributed in the range of lengths from 2 to 5 mm. More females than males had the shorter measurement. On the evolutionary hy- pothesis that the progressive shortening of the maxillae and mandible accom- panying the frontal enlargement of the brain-case has resulted in a mutabil- ity in size and form of the teeth, a correlative form of tuber maxillare and third molar might be expected, that is, a tooth may be small because of lack of space in the shortened jaw. But there seems to be no true correlation in this regard in this group. No. 4782 has small third molars with two and three cusps but with a post-dental alveolar space of 6 mm. No. 5132 has very diminutive third molars-abortive vestiges; yet posterior to these teeth is an alveolar 17 University of California Publications in Ain. Arch. and Ethn. extension of 10 mm. Similarly, no. 5072 has a one-cusp third molar, but a post- dental extension of 6 mm. But no. 4794 with third molars of five cusps, large, also has tubers 7 mm. long; and no. 4823 with third molars of five cusps has an excess alveolar length of but 3 mm. It appears that the size and form of the third molar is not always dependent upon the length of the tuberosity; nor the tuberosity on the size of the tooth. Jaw form and size, and tooth form and size, would appear to be distinctly separate units of inheritance. In the mandible of living orthognathous races, such as the Caucasian and Japanese, incongruity of jaw length and tooth size is often unfortunate for the individual, resulting in oversized, impacted, or malposed teeth. In the Egyptian group there were not more than two malposed mandibular third molars. Impacted maxillary cuspids occur with different causative factors operating. POSTERIOR NASAL SPINE At the medial point of the posterior border of the osseous palate is a pointed terminal of the palate bone, which with that of its opposite forms the poste- rior nasal spine. There is a wide racial variation in form of this spine. The prevailing Egyptian type is a long sharp triangle, a variant of which is a bud-shaped terminal; the next most frequent type is a short triangle, often ill defined, sometimes broad and truncated. The larger triangular spines end with a bevel lip. A few broad spines are bifid. HAMULUS PTERYGOIDEUS Extending from the lower margin of the inner ptergoid plate is a conspicuous but fragile, more or less hook-like, process, directed outward and bounding a deep little notch through which the tendon of the tensor palati plays. Marked racial differences in the form of the hamulus occur. The Egyptian type is a fine roundish process about 1 by 8 mm. There are a few short flat ones, about 3 by 6 mm. ANOMALIES OF CRANIAL SUTURES The metopic suture between the original halves of the frontal bone occurs in several males, some of the largest individuals, but is not observed in females. Nos. 5174, 4839, 4783, 5142 are typical of this persistent suture. The sphenoparietal suture in these rather small, frontally narrow, skulls is usually no more than an angle or point suture. In an appreciable number of crania it is absent; the superior-posterior angle of the great wing of the sphe- noid is 2 cm. anterior to the angle of the parietal: the frontal articulates with the squamous portion of the temporal bone, as, for example, in nos. 5007, 4952, 5133. In this suture in many of the skulls is an interealated small bone, the pterion ossicde, between the sphenoidal angle of the parietal and the great wing of the sphenoid. Wormian bones in the lambdoid suture occur very infrequently. 18 Leigh: Somatology and Pathology of Anoient Egypt TOOTH MORPHOLOGY The enamel is well formed and usually has a white to light brown hue. In an appreciable number of individuals it is singularly smooth with a beautiful pearly or waxy luster and light cream to whitish hue. These teeth probably received hygienic attention. Crenated or convoluted enamel is observed occa- sionally only on third molars. No. 5155 has maxillary molars in which there is a deep circular groove demarcating the occlusal third; this doubtless is the stigma of a developmental disturbance-hypoplastic defect. The cusp ele- ments are demarcated, more frequently than not, by deep grooves; but this does not imply a break in continuity of enamel. In the absence of requisite oral environmental factors these deep grooves are not the locus of caries. The cervical enamel margin of premolars and molars is roughly horizontal. There is no tendency of the enamel to extend rootwise into the bifurcations terminating in a sharp point as is quite characteristic of the American Indian. Occasionally, however, a detached enamel pearl is present on a root some dis- tance from the cervix. Physical anthropologists have set up as a criterion of racial affiliations the presence or absence of lingual marginal ridges on superior incisors. The Amer- ican Indian and various Mongoloid groups have incisors with very prominent marginal ridges as the norm-the shovel-shaped teeth of Hrdlicka. Hellman has classified with type photographs the varying height of these ridges. Some of the Egyptian incisors have low marginal ridges, but usuallty there are no ridges. Not many of the superior anterior teeth are in situ. Because of their coni- cal-shaped roots the incisors have been lost post mortem. A detailed descrip- tion of an occasional one is pertinent: no. 4880, Old Empire, female, 17; the central incisor is 9 mm. wide, antero-posterior thickness at crown-cervix 7.5 mm., crown height 12 mm. The lingual marginal ridges are very low, but dis- cernible; there is a narrow, shallow, rough fossa just above the linguo-cervi- cal bulge. The difference in size of central and lateral is marked. The type lateral incisor has on its lingual aspect a triangular fossa formed by rather low broad marginal ridges which converge to a well developed eingulum. This fossa seldom occurs on the central incisor. CUSPS The cusp formula of the molar teeth varies with race. The dentition of archaic races, such as the Australian and Negroid stocks, is comparatively constant in cusp pattern; while most other races show considerable mutability of cusp formula. In lower races the superior molars are quadricuspid, the inferior 4 4 5 quinquecuspid:v-v 19 0University of California Publications in Am. Arch. and Ethn. The cusp form of the inferior second molar has been a subject of special somatological study by Sullivan. In modern Caucasians this molar usually has but four cusps. Owing to advanced attrition and ante mortem loss, ob- servation of this tooth was limited to eighty-one mandibles. These jaws came from all sites and eras: the cusp formn of the mandibular second molar appears to have been stable for four thousand years in Egypt, and it is strictly com- parable to that of other white races, including the typical crucial arrange- ment of the grooves. Table 9 gives the data concerning this tooth. TABLE 9 CUSPS ON SECOND MANDIBULAR MOLAR Cusps Mandibles Per cent 3.5 1 1.2 4 78 96.3 5 2 2.5 Mode 4 81 100 The norm of the mandibular first molar in this group is five cusps; the fifth cusp is a small triangular tubercle intercalated at the mid-distal margin. That of the second is four cusps, with the typically modern crucial arrange- ment of the grooves. There is distinct contrast in size and form between these two teeth-typical of modern Caucasians. Mandible no. 4891, Naga-ed-Der, Old Empire, is exemplary. The inferior third molar tends to be quadricuspid; but it is frequently degenerate, small, or diminutive. However, it maintains its size and form better than does the maxillary third molar. The jaws studied show not more than two occurrences of impacted mandibular third molars. The Egyptian maxillary first molar is distinctive. In addition to the normal four cusps it has an accessory cusp which is known as the tuberculus anoma- lus of Carabelli. This accessory element is coalesced on the lingual aspect of the mesiolingual (antero-internal) cusp. Duckworth(2) shows (fig. 192, p. 257) these accessory cusps or tubercles on the molar teeth of an Egyptian skull. Skull no. 4900 has molars possessing the typical tubercle of Carabelli. On unworn teeth, where a sizable cusp is not present, there is a vestige-an incipient bulge demarcated by a slight groove or pit. No. 4882, child, 7, is a good illustration of sizable cusps. A smaller accessory cusp is similarly posi- tioned on the second molars of this skull. No. 4910 has a vestigial groove on one second molar, and a well defined pit on the other second molar; thus there is a tendency to form these cusps on the second molar, concrete evidence of evolutionary changes. No. 4822, male, 25, has Carabelli's cusps on all three molars bilaterally. No. 4880, Naga-ed-Der, female, 17, has second superior molars, trapezoidal in form, bearing vestigial cusps of Carabelli. 20 Leigh: Somatology and Pathology of Anoient Egypt It can be stated definitely that the dentition of the remains of the Gizeh Pyramid-builders, like those of Proto-Egyptians from Naga-ed-Der, is char- acterized by constancy of Carabelli's cusp on the maxillary first molar-a racial character. It is a sizable cusp, plainly observable on unworn teeth; on worn teeth its former presence is determined by the remains of the upper end of the groove which demarcates this cusp, on the mesial surface, well toward the lingual angle. A standard of comparison is established by observing the terminal of this groove on unworn teeth possessing the accessory cusp; also by the nonexistence of the groove-ending on teeth of other races patently not possessing this cusp. This criterion for determining the occurrence of the tu- berculus anomalus on all Egyptian teeth is, then, valid; and the uniform oc- currence justifies the foregoing characterization. It is asserted (Duckworth, 2:259 ff.) that this accessory cusp is distinctive of the higher rather than the lower human races. The maxillary second molar in this Egyptian group is undergoing degrada- tion second only to that of the third, both in form and in size. Both the second and third maxillary molars appear to be compressed in the arch mesio-dis- tally, and assume a characteristic trapezoidal form. The decrease in size and distortion in form is mostly at the expense of the hypocone, disto-lingual cusp. The maxillary third molar shows many gradations of involution from a quadricuspid to a tricuspid, bicuspid, and conical form. The predominating tendency is to the tricuspid form, trapezoidal or triangular in outline. No. 5159 has a left tricuspid third molar on which are two most indistinct lines showing the degradation of the hypocone, disto-lingual cusp; and on the right is a tiny crescentic tubercle. This is concrete, graduated, evidence of involu- tion. No. 4959 has a third molar with the disto-lingual cusp placed lingually to the mesio-lingual cusp-involution resultant from antero-posterior com- pression. Some maxillary third molars have a small extra buccal element fused to them, for example, no. 5071. This buccal cusp is the homologue of an infrequent supernumerary element in this region in some races-an atavism of a larger dental series. No separate supernumerary dental elements were observed in the Egyptian collection. Diminutive size of maxillary third mo- lars is not necessarily imposed by lack of space in the alveolar arch. No. 5132, female, 35, has diminutive, cylindrical-shaped third molars which measure only 5 mm. in diameter; but there is posteriorly an excess space of 10 mm. in the tuber maxillare. The molar norm for the California Egyptian series tends to be: in the max- illa, a rapid diminution in size from first to third; the first molar possesses Carabelli's accessory cusp; the second is markedly compressed mesio-distally, and this produces a trapezium in occlusal outline, mostly at the expense of the hypocone, disto-lingual cusp, both in size and in form, but the other cusps are reduced and distorted also; the third maxillary molar is tricuspid, with some vestigial markings of the hypocone. No skulls, however, were devoid of evidence of the third molar; nor is its reduction so great as obtains in an ap- 21 2University of California Publicatiomn in Am. Arch. and Ethn. preciable number of skills of another race I recently examined-pre-Spanish Peruvians, in which it is a vestigial remnant. In the mandible, the first molar is quinqueeuspid; the second is quadricuspid; and the third tends to be quadricuspid, there being some variants. If the tuberculus anomaluts be as- signed the value of one-half cusp, then the dental cusp formula for Egypt is: 4.54-3 .Table 10, Cusps on Molars, gives the complete data from which this 5 4 4 formula is derived. TABLE 10 CUSPS ON MOLARS Molar ....... ml M2 Ml Ml Ma Ma Teeth ob- served....... 153 150 131 87 84 72 Cusps Per cent 5 .... ........ ........ 100 5 27 4.5 100 1.3 5.3 .... .... 10 4 .... 84 29 .... 95 54.4 3.5 .... 9.4 8.2 .... .... 3.1 3 5 5.3 49 .... .... 5.5 1.. ...... 4 .... .... .... ROOTS Crown form and cusp evolution have been subjected to much more detailed study by anatomists than have dental root forms. Observation and recording of what appear to be anomalies of roots, with respect to both form and num- ber, may aid toward conelusions with respect to racial phylogeny. The follow- ing anomalies were observed in the Egyptians. The superior central incisor root tapers rapidly and uniformly to a fine point. This is in keeping with the rather small and refined osseous system. The mandibular premolars are characterized by a bifurcation line through- out their length; and the first is bifid, more often than not, in its apical third, with distinct divergence of the two branches. A form similar to this was found to be the norm in the dentition of several tribes of American Indians. In gen- eral, it may be said here, descriptions of roots in most texts of anatomy are generalized and conventionalized statements based on remote observation of a limited number of Caucasian teeth. There were occurrences of bifid inferior cuspid root; for example, in nos. 5162 and 5149. Nos. 5222 and 5250, males, have superior premolars with three completely divergent roots, and the inferior second premolar root of the former is marked with a deep bifurcation line. Table 11 gives the occurrence of bifurcation and 22 Leigh: Somatology and Pathology of Ancient Egypt trifurcation of maxillary premolars and bifurcation of mandibular premolar roots. Radiography would doubtless reveal many similar occurrences in the series. With respect to premolar roots, Duckworth (2:265) observes: "In the Simiidae the upper premolar teeth have three roots, thus resembling the upper molar teeth in those animals and in the Hominidae. The occurrence of three-rooted upper premolar teeth in the Hominidae is by no means un- known." I have observed the occurrence of three-rooted superior premolar teeth in the Eskimo, Sioux, California Indians, Peruvians, prehistoric people of Guam, and old Hawaiians. In modern white races this form of premolar is of infrequent occurrence. In this Egyptian collection a number of post-cuspid teeth have broad septa connecting the ordinarily separate roots, for example, the mesial and lingual roots of the superior first molars. Such teeth suggest similarity to the so- called taurodont teeth of Neanderthal and other primordial races. No. 5056, Middle Empire, is an example; but the Egyptian teeth are not nearly so large and blocky. TABLE 11 BIFURCATION OF PmOLAR RooTs (Males) Mus. no. Teeth Anomaly 4897 P2 Bifid 4822 Pm1Pm2 Two roots 5092 Pm2 Two roots 4899 Pm1PM2 Two large divergent roots; bifurcated 5222 Pm1 Three completely divergent roots 5250 Pm1; Pm2 Two roots; three roots 5190 PmlPm2; PM2 Three roots each; two roots 4869 Pm1 Three roots 4849 Pm1 Bifurcated 4819 Pm1Pm2 Two roots each Note: The following females have similarly divided premolar roots: 4830, 4842, 4817, 4808, 4825, 6140, 5238, 5244, 5155, 5225, 5163, 5119. PATHOLOGY ATTRITION Attrition is the gradual wearing away of the hard parts of the teeth through the physical and physiological agencies of mastication of food. Dental path- ology of the archaic Egyptians is characterized by attrition, to the degree of pulp exposure, particularly of the superior molar teeth; and resultant peria- pical osseous lesions. It is possible that these lesions were causally related-as primary infection foci-to the serious and widespread osteo-arthritic de- formities of the Nile people. Attrition frequently shortened the teeth to the 23 4University of California Publications in An. Arch. and Ethn. cervices without pulp exposure, as shown, for example, by no. 5046. This is particularly true of the maxillary premolars. The gradual centripetal lesion stimulates the pulp to form adventitious dentine, which is laid down in ap- position to the shortening process. In these teeth the pulp retreats and suc- cessfully blocks, literally and figuratively, the onslaught of attrition which threatens its exposure. Microscopically, the secondary dentine is dense with few, if any, fine fibrils; macroscopically, it is well defined. The circumferential primary dentine has become sclerosced by reduction and obliteration of the dentinal tubuli, effected by calcium deposition. The destructive and irritat- ing action of attrition stimulates the pulp and protoplasmic fibrils of its peri- pheral cells to react in a protective manner by retreating, diminishing in size, and increasing the density of its protective covering. But the protective reaction of the vital dental tissue frequently fails to cope with the rapid centripetal destruction, caused by functioning on an abrasive diet, of the superior first molar in particular. The eruption of this tooth in the sixth year, together with its key position in the dental arch which tends to impose the brunt of the masticatory function upon it, tend to bring about its destruction before others. In Predynastic times especially, the tri- turation of bread containing the coarse husks of barley and millet, of resist- ent stringy fibers of marsh tubers, admixed with a liberal contamination of rock particles from the grinding-stones and the desert winds, abraded the functioning surfaces of the teeth too fast for vital protective reaction to save the formative organ-the pulp. Even royalty of the xvii Dynasty exhibits the effects of an abrasive diet. Smith, in The Royal Mummies, 9) depicts on plates 2 and 3 the mummy of the king Saqnounri m, and remarks: "Although the teeth are so well-worn as to be almost all molariform, the fact that all the cranial sutures are still patent suggests that the king was not much more than thirty years of age at time of death." In describing the type jaw he says further: "There is a complete set of healthy teeth almost entirely free from tartar deposits. The third molars on both sides of both jaws are practically unworn, but all the other teeth are well worn." Jones 4) describes dental attrition of the early people of Nubia: The essential feature in the worn-down teeth of the Predynastic man is the levelling of their crowns-the tooth wears down uniformly all over its surface. In contrast to this archaic form of attrition, in the teeth of later and alien people in the Nile Valley, there is a marked hollowing out of the centre of the crowns. Wearing of the teeth is common in Nubia to the present day. Attrition of teeth is common in the remains from all the sites, ranging from exposure of dentine of the cusps, first degree; through second, obliteration of cusps leaving islands csf enamel at bottom of grooves; shortening of the crown to near its neck, third degree; to exposure of the pulp, fourth degree, and be- yond. Remains from the earlier epochs show wear younger in life, and more 24 Leigh: Somatology and Pathology of Ancient Egypt teeth with fourth degree attrition than those of the Middle Empire; while Coptic specimens have slight wear, in fact show afunctional conditions of the teeth. Not only was attrition the primary cause of pernicious periapical os- seous lesions and possibly metastatic consequences (vide periapical osteitis, osteo-arthritis); it was also a proximate factor in the causation of dental caries by means of inducing inter-proximal food impaction following oblit- eration of contact between the units of the arch. Generally speaking, cusps were obliterated by the age of 35 years and the pulps of one to four of the first molars were exposed by 50. In many old persons the pulp of every tooth was exposed through wear; for example, no. 5244. DENTAL CARIES In this collection onl~y 12 per cent had one or more carious teeth. In age, one was a child of 7 years, seven were young adults, and twenty were from 40 years of age to senility. Thus caries in this group has its highest incidence past middle life. Occurrence was practically the same in each sex. Of an aggregate of fifty-four cavities, 60 per cent had begun at the proximo-cervix. The lesions developed at these proximo-cervical sites after the teeth had been worn be- yond the contact points, or after slight migration of teeth in the arch follow- ing the loss of some; and both of these conditions induced food impaction and eventuated in caries. There are few pit cavities. Only post-cuspid teeth were attacked by caries. About 65 per cent of individuals having carious teeth had periapical osseous lesions consequent thereupon-on an average of two per person. The provenience and chronology of skulls with carious teeth are: Naga-ed- Der, Predynastic, 2; Gizeh, Old and Middle Empires, 17; Naga-ed-Der, VI to xn Dynasties and to Coptic, 9. Because of the small number of crania and the disproportion of numbers from the various epochs, this list would probably not be a true indication of incidence of caries in eras. Widespread attrition and negative evidence of caries in Predynastic times seem to indicate, how- ever, that coarse subsistence was not contributive to prevalence of caries. Also it seems that in later epochs, caries was more prevalent in the upper social strata, among persons living on a more refined diet, as suggested by the greater number from Gizeh-remains from the mastabas of the Pyramid- builders. Smith?10) sums up the replacement of attrition by caries as the chief de- structive process as the history and civilization of Egypt unfolded. But dental caries, although extremely rare before the Pyramid Age, became common as soon as people learned luxury. In the cemetery of the time of the Aneient Empire, exca- vated by the Hearst Expedition at the Gizeh Pyramids, more than five hundred skeletons of aristocrats of the time of the Pyramid-builders were brought to light, and in these bodies it was found that tartar-formation, dental caries and alveolar abscesses were at least as common as they are in modern Europe today. And at every subsequent period of Egyptian 25 26University of California Publication8 in Am. Arch. and Ethn. history one finds the same thing-the wide prevalenee of every form of dental disease among the wealthy people of luxurious diet, and the relative immunity from it among the poorer people who live mainly on a coarse uncooked vegetable diet. The same observer(9" presents photographic evidence and gives a word pic- ture of the ravages of caries in a royal personage of an undetermined era. The skull exhibits large symmetrical thinning of both parietal bones, such as is common in the remains of the Egyptian aristocracy from the time of the Ancient Empire onward. The cranium is a short, relatively broad ovoid: the face is a small oval with pointed chin. All the teeth on the left side of the upper jaw are carious excepting only the canine and the third molar; and the first and second left lower molars are reduced to mere carious stumps. PERIAPICAL OSTEITIS Exposure of the dental pulp by any destructive process entails its infection, and ultimately necrosis, since this bit of embryonic tissue encased within un- yielding walls is utterly devoid of powers of regeneration. Infection atria are simultaneously opened by way of the apical foranmina into the periapical tis- sue. The infected alveolo-dental periosteum proliferates and the surrounding bone is involved in a limited osteitis with or without a fistulous drainage into the oral cavity. The initial acute stage is followed by a usually painless continuous lesion so long as the tooth remains in situ and until the proliferat- ing membrane is destroyed. In skeletal material this chronic process is evi- denced b'y varying-sized apertures in the alveolar processes into which pro- ject denuded root apices, as is richly illustrated in the Egyptian collection. I have found pulp exposure widely effected by attrition caused by abra- sives admixed with food in its preparation by primitive peoples, exemplified by the California Indians'5' and other American tribes. Caries, prevalent with people of sedentary habits and carbohydrate diet-for which associa- tion there is overwhelming evidence, destroys the hard parts of the teeth and thus infects and exposes the pulp. Traumatic fracture of teeth, which occurs fairly frequently in primitive people such as the Eskimo, causes pulp expos- ure. Rarely, by extension, the inflammatory process, which begins at the alveo- lar border, encroaches upon and infects and kills the pulp by way of the root apex. Periapical osseous lesions ensue from pulp exposure by any and all of these agents. In archaic Egypt attrition was the primary cause of lesions of the facial bones. Parelleling the development of civilization, and directly concomitant with a more refined cuisine among persons of the upper strata of Egyptian society, caries replaced attrition as the primary cause of alveolar abscess-periapical osteitis. These observations on the University of California Egyptian collection with respect to the pernicious effects of attrition are in agreement with the extensive and discerning observations of both Smith and Jones. On page 158, Egyptian Mummies,"10) Smith says: ~26 Leigh: Somatology and Pathology of Ancient Egypt Both in Nubia and Egypt the ordinary form of dental caries is exceedingly rare in pre- dynastic and proto-dynastic people, and among the poorer classes it never became at all common until modern times. But as these people ate coarse food mixed with a considerable amount of sand, the teeth rapidly wore down, and as the result the pulp-cavities became opened up; in the fertile soil of the exposed dental pulp, septic infection found a much readier place of attack than the hard resisting enamel and dentine of the tooth itself af- forded; hence it is common to find alveolar abscesses without dental caries, but some of the royal mummies suffered from both. Most of the dental disease of the archaic Egyptians and the poorer classes of the ancient Nubians in all periods is to be explained in this way. Jones'4' remarks: Neglected dental disease accounts for practically the whole of the septic conditions of the bones of the face. The pulps of the maxillary first molars are more frequently exposed than other teeth. This is because this tooth erupts and begins to be used at the early age of 6 years; also because, owing to its key position in the arch, it receives the brunt of mastication. The maxillary second molars are the next most fre- quently involved. In senile persons the pulps of nearly all the maxillary teeth are exposed with resultant lesions surrounding the roots; and the loss of teeth in the edentulous and nearly edentulous is traceable to this pernicious sequen- tial process. No. 5125, male, 60, shows the pulps of all the maxillary teeth ex- cept the third molars exposed through wear, with periapical osteitis result- ant; and there are four more osseous lesions from the same cause in the man- dible. Periapical osseous lesions are well represented in the material from all the sites and eras. Table 12 summarizes the occurrence and causes of periapical osteitis. TABLE 12 PERIAPICAL OSTETIS Number of Skulls lesdons Primary caus Per cent 18 31 Carie8 7.5 92 378 Attrition 92.5 The lesions vary in size from a few millimeters to 10 and even 15 mm. in diameter. A variant of the ordinary lesion is the radicular cyst (vide infra Radicular Cyst); and by direct extension the pathological process comes to in- volve the maxillary sinus with suppurative sinusitis ensuing (vide infra Max- illary Sinusitis). The periapical lesion frequently fuses with resorption of bone, starting at the alveolar border-periodontoclasia. And, in the light of present medical knowledge, it is a legitimate inference to assume that by means of metastasis the periapical osseous lesions have a causal relation with the prevalent osteo-arthritis in Egypt. 27 Univerity of California Publications in Am. Arch. and Ethn. The process of dental attrition exposing the pulp with its pernicious se- quelae is well known to dental pathologists, and is clearly defined in Egyptian crania. The primary cause of periapical osseous disease is patent to the prac- ticed observer in at least 98 per cent of the lesions. In the light of these facts it is unfortunate that statements credited to Sir Marc A. Ruffer'7) have en- tered scientific literature. They may have originated in posthumous editing of his notes. In seetion 5, Other Lesions, of his paper the following statement with regard to the etiology of alveolar abscess in Egyptian crania is made; it is crude and inaccurate in description and nomenclature, naive in ration- alization: If the infection had spread from the exposed pulp to the apex of the root through the apical canal, signs of softening of the pulp chamber [sic] should have been evident, whereas in many cases no trace of such previous softening existed. On the contrary the pulp, though freely exposed, appeared hard and healthy [8ic], this state of things giving no sup- port to the theory that micro5rganisms had penetrated through the apical canal. The writer obviously knew neither dental anatomy nor pathology. Evi- dently secondary dentine formed by the living pulp has been called the "pulp." A bit of soft, delicate, embryonic tissue, such as the pulp is, freely exposed ante mortem with rapidly ensuing necrosis certain, and after a post mortem lapse of several millennia, could not appear "hard and healthy." More than a few fragments of roots of deciduous molars are encased in the alveolus formed around the permanent premolars. Physiological resorption by giant-cell activity ceased before the destruction of these spicula; they are caught rigidly in the new alveolus formed around their successors; but they appear to be physiologically innoxious. They are mistaken by some observers for supernumerary or anomalous dental elements. RADICULAR CYST This lesion is a variant of the chronic periapical abscess, and it is always as- sociated with a pulpless tooth. Its development is contingent upon the exist- ence of two factors: (a) embryonic-occurrence of epithelial rests in the dento-alveolo periosteum, classically described by Malassez as debris epithe- liaux paradentaires; and (b) infectious-the entry of bacteria which may stimulate the rests to proliferate. The epithelial cells proliferate into small spherical masses; these aggregations are doomed to central liquefaction, and the gradual accumulation of fluid within the central cavity produces pres- sure on the overlying bone with atrophy ensuing. The cortical covering may become attenuated to a parchment-like thinness. This type of cyst is well represented in this group of crania, occurring in about twelve persons. The cavities vary in average diameter from 5 to 15 mm. Teeth involved are maxillary incisors, cuspid, and premolars. The cyst occurs more frequently about the lateral incisor than in connection with any other 28 Leigh: Somatology and Pathology of Anioient Egypt tooth. In an old female, no. 4945, a cavity 10 mm. in diameter existed beyond the apex of the left cuspid. The wall is smooth and hard. In no. 4799, also a senile female, a cyst had developed which involved the teeth from the right central incisor to the second premolar; it measures about 15 mm. in length, the facial wall is greatly bulged out, and the floor of the right naris is domed upward. Jones describes a similar cyst involving the floor of the naris of a Nubian skull, but does not apply the name "radicular cyst." No radicular cysts were observed in the mandible. No coronal-dentigerous -cysts occur in this collection. MAXILLARY SINUSITIS CHRONIC Of 206 skulls, 21, or more than 10 per cent, showed old fistulae draining the maxillary sinus through the alveolus of a molar tooth, or, in two edentulous skulls, the former site of molar teeth. Skull no. 5222 has a fistula leading from each sinus through the alveolus of the second molar; the left fistula measures 10 by 5 mm. and is depicted in plate 6b. No. 5136 has two distinct fistulae by way of two roots of the second molar. The apertures of such fistulous tracts are well defined: the margins are sclerosced and rounded, the diameter varies from 1 to 3 cm., chronicity is obvious. There are doubtless many other fistulae that were not observed because of their close proximity to tooth roots. The first and second molars were involved, eleven times each; occurrence was al- most equally divided between right and left sides. Thus in this small group, which includes children and young adults, there is an incidence of 10 per cent with chronic maxillary sinusitis. If the figures were given of those persons only who were more than 45 years old at death, the percentage would be ap- preciably higher. The obvious cause of the diseased sinuses is infection by extension from periapical dental lesions in close proximity to the sinus floor. Reversing the order of genesis, the periapical lesion resulted from an infected necrotic pulp, which in turn was exposed to the oral environment through the ravages of attrition, rarely caries. This skeletal material affords plentiful evidence of the far-reaching sequelae of infection atria through the teeth. No. 5072, female, 35, had chronic ethmoiditis. From the ethmoid cells two fistulae, 5 and 8 mm. in diameter, pass through the left orbit wall; the floor of the orbit is depressed. The left maxillary sinus has been involved through a crescent-shaped opening at the margin of the ethmoid bone. This, of course, was not of dental origin. It probably proved fatal. No. 5130, male, about 60, has an extensive osteomyelitis extending from the second premolar to the second molar in the right maxilla. The facial cortex and cancellous bone are destroyed, but the lingual plate is intact. Two teeth were lost. The margin of the lesion below the zygomatic ridge is smoothly beveled, probably indicating trauma. 29 University of California Publication8 in Am. Arch. and Ethn. EXTRANEOUS ACCRETIONS AND PERIODONTOCLASIA Excretion of calcium and other salts dissolved in the saliva is a physiological process which varies with metabolism. On contact with air the dissolved salts tend to precipitate on the surfaces of teeth in proximity to the orifices of the salivary ducts, that is, upon the lingual surfaces of the inferior incisors and the facial surface of the superior first molars. Some organic material from the mouth is entrapped with the salivary precipitate. Friction of tongue and food, particularly if the latter is fibrous and requires vigorous mastication, reduces the adhesion to the teeth. The tenaciousness with which lime deposits adhered to the gingival margin of the teeth of some of the Egyptians is shown by their presence in situ after the lapse of several millennia. Accretions of a whitish hue are very hard; more friable material has a brownish coloration and clay-like texture. Pendulous aprons of the foreign material overlap the labial gingival tissue of the mandibular incisors and the lingual tissues of the molars. Periodontoclasia is chronic destructive degeneration of the investing tis- sues of teeth, eventuating in exfoliation. Alveoloclasia is the breaking down of the osseous support, and is observable in skeletal material. It is to be said there is a physiological recession of the alveolar crest from childhood to se- nility. This recession is to be distinguished from pathological resorption. The distance from the enamel margin to the alveolar crest gradually increases. This increase is, in effect, a continued physiological eruption of the teeth- partly compensatory for the shortening of the teeth by wear. In a child of 7 years the distance at the mesio-facial angle of the maxillary first molar is 0; at 16 years of age it is about .5 mm., as, for example, in no. 4817; in no. 5230, male, 30, the distance is 1.5 mm., with healthy conditions; in no. 4850, male, 55, the distance on the maxillary molar is 4 mm., conditions of tissue healthy. The pathological degeneration may be discerned not only in greater exposure of the tooth root, but also in resorption of the cancellous as well as the cortical alveolus; and it extends to the bifurcation, and eventually to the apices. Evidence in the Egyptian crania indicates that accretions, periodonto- clasia, and caries are not incompatible, as is often stated. Both accretions of considerable size and caries are strongly indicative of reduced function. Where the teeth have been used vigorously, as generally in archaic Egypt, and death came before attrition exposed the pulp or destroyed contact, the teeth are free from both caries and alveolar degeneration. But following fourth degree attrition, periapical osteitis abets resorption both near the apex and at the alveolar border. In these crania, loss of some teeth has induced alveolar resorption of neighboring teeth: afunction, malfunction, migration, further accretions, and extended alveoloclasia are induced. But it is patent that accretions are the alpha of proximate causes of periodontoclasia. A skull from Coptic times, circa 300 A.D., male, 40, shows very large brown- ish friable accretions, on the molars particularly, and the teeth show very 30 Leigh: Somatology and Pathology of Ancient Egypt slight wear-both afunctional manifestations; and concomitantly the alveo- lar process is resorbed to the bifurcations of the roots. This more recent skull is in contrast to the Protodynastic type; it is thin and scaphoid, and the palate is broad. It furnishes an example of advanced periodontal degeneration. With the advent of Greek influence in Egypt the cuisine became luxurious and refined. With reference to accretions, Jones'4' in his somatological and pathological descriptions of ancient Nubia notes: It is not until the era of the alien settlers of the Byzantine times that dental disease be- comes really common and assumes anything like its modern frequency of incidence. It is in this period that accretions upon the teeth are sizable. There are no Predynastic skulls with typical alveolar resorption, that is, resorption having its origin at the margin. Those with periodontoclasia come from all sites, and in time from the Old Empire to Coptic times, and from the latter era come the most pronounced examples of degeneration of the invest- ing tissues accompanied with enormous extraneous accretions and evidences of afunction. All the persons affected were 45 years of age or older. In the order of frequency of involvement were the third, second, and first molars, mandibular and maxillary; in only about six skulls were the premolars in- volved, as for example in no. 4895, male, 60 (pl. 6c); and in only one were the superior incisors involved with typical periodontoclasia. EXFOLIATION AND SENILITY Teeth, or parts thereof, surviving middle life are subjected to the cumulative effect of pernicious influences as old age approaches. A trio of forces-disease, function, and senility-converges to the ultimate exfoliation of the dentition. First, periapical lesions, consequent upon pulp exposure and degeneration of the alveolar margin caused by accretions and other factors, continue and fre- quently fuse in the general process of bone resorption. Secondly, as attrition destroys the teeth to their cervices, the former obtuse plane on the superior teeth, slanting from the linguo-cervical to the facio-occlusal angle, gradually shifts toward the facial, and eventually the gradient is toward the facio- cervical region. The occlusal force is now upward and inward, inducing out- ward pressure on the apices, and this induces pressure atrophy, resorption, of the facial cortex. The economy with which tooth remnants function exem- plifies the continuing adaptation of an organ to requirements. Thirdly, ac- celerating these processes is the physiological state of calcium resorption now taking place in the life-cycle of the individual, a salient phase of the involu- tion of senescence. Verily, the dentition is a transitory organ not designed to be taken to the grave by the extremely senile. But the individual has time to adapt himself to the inevitable; and these resorptive processes, more evident in the maxillae of ancient Egypt, were neither unduly painful nor the causal factors unknown and mysterious as redundantly set forth by Ruffer.'7) 31 University of California Publications in Am. Arch. and Ethn. Most persons who had lost teeth were past the half-century mark in age; and no person under 35 years or so had lost any. About 50 per cent had lost one or more teeth; but of this proportion one-half had lost only one or two, such as the maxillary or mandibular third molar or the first molar. Five were eden- tulous or nearly so. Exfoliation of teeth in by far the greater number was consequent upon pulp exposure; but a few molars were lost directly by perio- dontoclasia. Half as many mandibular as maxillary teeth were lost, and nearly 80 per cent of those were mandibular molars; first, third, and second, in order of frequency. Table 13 gives the relative percentage of maxillary teeth lost. TABLE 13 MAxIwSARY TEETH LoST ANTE MORTEM (Relative percentage) Tooth Per cent Tooth Per cent Central incisor ..................... 5.6 Second premolar .11 Lateral incisor ..................... 6.2 First molar .22 Cuspid ..................... 3.1 Second molar .15 First premolar ..................... 9.6 Third molar .27.5 OSTEO-ARTHRITIS Osteo-arthritic lesions, including osteo-arthritis deformans and spondylitis deformans, are evident throughout the Nile valley and from Predynastic epochs to the present time. The commonest form of this pathological process is spondylitis deformans, occurring in the spinal column. Varying numbers of vertebrae of the lumbar, dorsal, or eervical regions may be immovably coa- lesced. The Hearst Expedition recovered at the Gizeh Pyramids one body in which there was a complete union of all the vertebrae. In other joints the changes usually consist of (a) eburnation of bone on the articular surfaces or (b) roughening outgrowths-bone hyperplasia. There are many skeletons in the California collection with severe arthritic changes. Smith"10? says: "Rheumatoid arthritis is par excellence the bone disease of the ancient Egyptian and Nubian. It is of great antiquity and prevalence." He further states that the vertebrae, the shoulder joints, and the temporo- mandibular joint were the seats of its ravages. Jones,(4' in his preliminary report on Nubia, says of arthritis deformans, it "is fairly abundant at all periods and affects most commonly the shoulder and the hip: but scarcely any joint-not even excepting the temporo-mandibular joint-has failed to present several examples of the disease." There are several examples of osteo-arthritis of the temporo-mandibular joint in this collection. No. 4803 (pls. 3b and 4) is typical. There is erosion and porosis of the superior and posterior surfaces of the left condyle; and a 32 Leigh: Somatology and Pathology of Anoient Egypt dense, macroscopically amorphous exostosis, 2 mm. in thickness, covers the glenoid fossa and eminentia articularis. There has been considerable com- pensatory adaptation in the mandibular movement, resulting in fourth de- gree attrition of several teeth on the left side. The left joint is more frequently involved than the right. With respect to the etiology of these osteo-arthritic lesions, it may be sig- nificant that in the very example just mentioned, the individual harbored an old periapical abscess; and several others developed from teeth the pulps o,f which were exposed by malfunction resulting from the arthritis-a vicious cycle. Paradental bone lesions occurring in the same skeletons as arthritic changes suggested to Ruffer'7) that the former may have a primary causal relation to the latter. Elective localization of infectious processes may have been the inciting cause; and the infection may have found atria into the body by way of dental lesions, the genito-urinary tract, or otherwise. Jones 4) says, of cause: "The causal factor of the disease is essentially one of environment, and not race." It was the mode of life of the indigenous peo- ple, as well as the immigrants, in the Nile valley. Their constant dabbling in the waters of the Nile was not without deleterious effects on the osteo-arthritic system, according to this keen observer. Hard labor and dietary factors may be named also. SYPHILIS, RACHITIS, LESIONS ON PARIETAL BOSSES There are no dental stigmata of congenital syphilis in the collection of crania examined; nor is there any lesion of the calvarium or facial bones which re- motely resembles specific lesions. Hypoplastic enamel and atypical teeth are extremely rare in this group. My observations are not at variance with those of Smith and Jones. The former('0) says: "No true case of rickets or of syphilitic disease has been found in any ancient Egyptian remains ... nor anything even remotely re- sembling s~yphilitic injuries to the teeth." With reference to Nubia, Jones notes'4' : "The complete absence of any affection of the teeth in any way resem- bling the effects of syphilis is a very strong argument against its existence." He also says that some curved and distorted bones suggest the existence of rickets, but that many of these curvatures were brought about in the grave 1from pressure and other post mortem causes. On the parietal bosses of many skulls there is a flattened or sometimes in- dented area apparently caused by intentional pressure acting over a consid- erable period of time, such as the carrying of some burden habitually on that part of the head. The lesions are usually bilateral, but are not always of equal size. No. 5125, vi-xII Dynasties, about 60, has a triangular area just above the temporalis crest measuring 4 cm. on each of its sides. The external plate is indented and somewhat eroded and of dark color; and, evidently because of pressure, excessive vascularization and ulceration had occurred. No. 5244, 33 4University of California Publications in Am. Arch. and Ethn. Gizeh, Old Empire, female, senile, has triangular depressions on the parietal bosses. The triangle is roughly equilateral and the sides measure about 4 cm. Between these two depressed areas and along the sagittal suture is a roundish groove, measuring about 1 cm. across. The left triangular area is translucent in this senile skull. Endoscopic examination shows the internal table unaf- fected on the triangular areas, but there is evidence of an inflammatory pro- cess under the sagittal groove. Jones invokes the ethnic habit of carrying water jars on the head as the cause of these triangular areas on the parietal eminences. They show long- continued vascularities, periosteitis, and ulceration, with sinking in of the outer table, the inner table usually being unaffected. Lesions occur on females, and the females are known to have been the bearers of the water jars. FRACTURES Fractures of the radius, ulna, and clavicle are of frequent occurrence in this skeletal material-more frequently from Gizeh. Many of these fractures may have been caused by clubbings by masters: the unfortunate victim, fending his head, received the blow on forearm and collar. Archaeological evidence apparently supports the somatological findings in this respect. No. 5148, male, 50, shows a healed fracture at the neck of the left condyle, and this has caused the head of the condyle to incline inward and forward from the normal. DENTAL OPERATIVE INTERFERENCE In the Hearst Eglyptian collection there is absolutely no evidence of dental operative interference. In many individuals, diseased remnants of teeth could have been eliminated with the simplest gesture, but nothing was done to rid the person of unsound teeth. The utmost biological economy is shown in the retention and functional utilization of diseased and frail teeth. Attrition often shortened the superior first molars beyond the pulp chamber; large osseous lesions frequently encompassed their apices; the position of the roots shifted as the plane of attrition approached the cervix, with resultant atrophy of the bone overlying the apices through untoward pressure, yet active func- tion continued. No. 5065 is typical. This condition is common to many primi- tive people. My observations concerning the absence of dental surgery is in agreement with the findings of Smith and Jones. In Egyptian Mummies,(10) page 158, the former states: "There is in no case the slightest suggestion that any oper- ative measures were adopted in order to cope with dental trouble and in spite of frequent statements to the contrary, tooth-stopping was never practiced in ancient Egypt." In the Survey of Nubia,'4' page 283, Jones says of the people of the upper Nile valley: "At no period do the teeth of any body show signs of the dentist's handiwork." 34 Leigh: Somnatology and Pathology of Ancient Egypt The literary evidence from ancient Egypt is of similar import. It is evident from the prescriptions in the Ebers and other papyri that dental therapeutic measures were doubtless practiced; but with reference to definitive operative procedures, such as extraction of teeth, filling operations, or prosthesis, no literary allusions have been discovered. The Ebers papyrus mentions no den- tal operations, though operations on other parts of the body are detailed. Professors Ebers and Schmidt, Egyptologists, say they found nothing that could be attributed to the work of dentists. Similarly, Virchow, the craniolo- gist and pathologist, found no evidence of dental surgery or art. Guerini'3' sa'ys that J. R. Mummery made a careful research on purported dental art in ancient Egypt and reported negative findings. CORN IN EGYPT Man, like the bear, is naturally omnivorous. The ability to subsist on a wide range of edibles has been of decided advantage to both species in their rise, their spread over wide latitudes, their dominion, and their survival. Primi- tive man without trade subsisted exclusively upon the fauna and flora of his limited habitat; and the extent and variety of his sustenance were determined by his ability to retrieve and to some extent by his ingenuity in preparing food. Adaptation of a tribe or race to a geographical area invariably entailed specialization in one or two main articles of diet-staples, which were supple- mented by occasional or seasonal foods. The predominant subsistence in the Nile valley from archaic times has been graminivorous; cereals have been the staples. Analysis of the intestinal con- tent of Predynastic man has identified husks of indigenous barley uniformly, and to a lesser extent millet. Small root-tubers have been found both in very ancient burial pots and in the alimentary tract; also copious remains of fish were found as well as mammalian bones. Fish was abundant in the waters of the Nile, and game on its banks. But primitive man inhabiting the Nile valley was ingenious; this race in this soil and climate evolved possibly the first distinctive civilization. This native power of invention, fortunately situated on rich arable lands in a salu- brious climate, possessed an area singularly isolated by natural barriers which prevented its culture from being molested until after it was well established. The inventiveness and industriousness of the Egyptians so nurtured the nat- ural resources for food production that with the flowering of civilization the diet became varied, luxuriant, and refined. The early Egyptians were prob- ably the first to make metal fishhooks. Very early they domesticated sheep, goats, and cattle-truly a great stride of primitive man toward dominion. The archaeological evidence seems to indicate that this people introduced the cultivation of barley; certainly they devised the technique of irrigation; and 35 6Univer8ity of California Publicationm in Am. Arch. and Ethn. probably they were the first people to use cow's milk as food for human be- ings. (8) Here, then, are the fundamental inventions for a rich and varied diet. Following the annual inundation of the flood lands bordering the Nile, the ground remains moist enough for the complete growth of millet, barley, and wheat. With the development of irrigated agriculture the cereals became firmly entrenched as the staples. From barley, not only was bread made, but from it also was the divine beverage, beer, fermented. Barley attained a s~ym- bolic significance as the life-giving element. Egyptian civilization developed directly with the cultivation of cereals. And the diffusion of civilization over other lands has been coextensive with the cultivation of the cereals. Egypt did not possess the superior cereal wheat in its wild state, but she wisely appro- priated and naturalized many plants from adjoining countries-the vine and the olive, probably before recorded history, and later the peach and cherry. The wheat first cultivated in Egypt was emmer. Barley was superseded by emmer, and then emmer by the superior and later Syrian wheat-bread grain. Following the cultivation of wheat came horticulture. The vine was culti- vated at an early time, as was the fig. Other fruits were dates, melons, pome- granates, and apricots. Not only did all Egypt enjoy the fermented beverage from barley; the upper classes, as humanity became stratified, fortified their meals with wine of both the grape and the date. The date palm was as impor- tant in ancient times as it is now. Beekeeping was a very ancient industry. Honey was much eaten, cane-sugar being unknown. Honey was held in high regard from most ancient times: the legendary ruler of the Delta bore the title of Bya, the "Bee-man," and his emblem was the figure of a bee. A legend has the Nile flowing with honey for eleven days. Egypt not only became the granary of the world, but was also regarded as the land of milk and honey. Flocks were herded; milk products manufactured; pigs and goats raised for their flesh and milk. Breasted(l) summarizes the diet for the Old Kingdom, circa 3000 B.C., as follows: The food was rich and varied; we find that even the dead desired in the hereafter "ten different kinds of meat, five kinds of poultry, sixteen kinds of bread and cakes, six kinds of wine, four kinds of beer, eleven kinds of fruit, besides all sorts of sweets and many other things." This, of course, refers to the rich, the noble, and official classes. The same author continues: It was the enormous harvests of wheat and barley gathered by the Egyptians from the inexhaustible soil of the valley, which made possible the social and political structure so well organized. Besides grain, the extensive vineyards and wide fields of succulent vege- tables, which formed a part of every estate, greatly augmented the agricultural resources of the land. Large herds of cattle, sheep, goats, droves of donkeys, and vast quantities of poul- try, wild fowl, the large game of the desert and innumerable Nile fish, added not incon- siderably to the produce of the field, in contributing to the wealth and prosperity which the land was now enjoying. 36 Leigh: Somatology and Pathology of Anoient Egypt The food of Egypt became more refined and luxuriant as time went on. A few centuries before the Christian era, circa 300 B.C., a Greek dynasty, the Ptolemies, were ruling and applying Greek science to Egyptian horticulture. A fine quality of olive oil was produced, and various nuts and citrus fruits were cultivated. At this time a sample menu for an overseer might be: lunch- eon-wheaten-bread and honey, to which is added a cup of milk (warmed as was always the custom); for a man of the menial class-lotus-bread or barle'y- bread, relished with an onion or some cloves of garlic, and washed down with copious draughts of barley brew; evening meal for a master-lentil soup flavored with onion, garlic, or leek, eaten with bread made of barley or wheat; grape or date wine; a meat list including beef, mutton, veal, goose, goat's flesh; vegetables, asparagus and chickpeas or cabbage; cheese with celery, lettuce, or cress; for second wine the juice of the grape spiced with coriander; honey. It is to be noted that in Byzantine and Coptic eras the teeth functioned less than in Predynastic times. Large accretions formed on the teeth, and perio- dontoclasia and caries contributed to tooth destruction. It may be noted in passing that many of the therapeutic recipes (several of which are dental) recorded on the medical papyri included for their vehicles dough, honey, and milk, all certainly conducive to dental caries. It is to be said, finally, that so far as the health and preservation of the teeth are concerned, the mode of preparation of food is primary. In Egypt in Predynastic times abrasives were admixed with the food being prepared, with resultant destructive attrition; when the Ptolemies ruled, the cuisine was refined, afunction was abetted, caries and alveolar degeneration were rampant. 37 8Universitty of California Publications in Am. Arch. and Ethn. LITERATUTRE CITED 1BRnsTE, JAMis H. 1916. A History of Egypt. New York. 2DUCKWORTH W. L. H. 1915. Morphology and Anthropology. Cambridge. 8 Guznim, VINcENzo 1909. History of Dentistry (Eng. trans.). Philadelphia. 4 JoNES, F. WOOD, and SmT, G. ELioT 1910. The Archaeological Survey of Nubia, Report for 1907-1908, Report of the Hu- man Remains, vol. 2. Cairo. 5 LEIGH, R. W. 1928. Dental Pathology of Aboriginal California, UC-PAAE 23:399. 6 REISNER, GEoRonc A. 1908. The Early Dynastic Cemeteries of Naga-ed-Der, UC-P Egyptian Archaeology, vol. 2. Leipzig. 7 RUPP=, Sm MARc ARmAND 1908. Abnormalities and Pathology of Ancient Egyptian Teeth, AJPA 3:335-382. 8 SMITH, G. ELUIoT 1923. The Ancient Egyptians. London. 9 SMITH, G. ELLIOT 1912. Catalogue du Mus6e du Caire, The Royal Mummies. Cairo. 10 SMITH, G. ELlOT, and DAWsON, W. R. 1924. Egyptian Mummies. London. 38 EXPLANATION OF PLATES [Numbers preceded by 12- are University of California Museum of Anthropology catalogue numbers; numbers in parentheses are Leigh's original numbers.] I'I,\I'AI; I o1. 1-'> 4-, )4 N 1,64 ). Nornm8: };Si;liS (1 kisihlrI, 1o;f(' St ' 11m I} ill ,1\, .\,;1-,';1 ('d I( I)'l \-I .\1' | >'IIISit'. . Ii?'l {illXtt' >;l;lz' I"?)llllO(Slt'S l 10l'-tl; irrh'1. .\0 (ti1 \\'( s( lO t ill(, lI(It( T11 lwn''( iS II() *'\vid('11c(,( (,1' '1, ' T'S w ''l ill('iSO's }11'( imrl 'l;t' 1'(( bOt t 10t 1( 1. T1lwi shmvti SlO\ 11'11''lFtliif I II(' p)h111' ,t \\<;f Sw;Il t Shll 111m,\11'(d f',lB ilII,6 f'w(io m-ch((ils;ll itt' it tllv ri l ( t V'tt itt l ii I ti itt t-II t III(i (i''01vtil. Aiit it ill. it'sliu tll i t t''l-m i l ;I '1 Sii (iI('t 11pulp ('XlstOSln'( tl(lwnt'r'l' l, wdlE 1wr''ti{'ir IIS p);ltlm toim'"Ir llll 1''t'Xi'll'lt})tS'lt( ill tIlls skIlIII. (')ftl;l is)sii> l0t scco idirvt ((I(lltllw ill tl1w p)n''llmiO];l's II:IS 1t(XV1t iwrI,,l it (d villt it ( t ( tiIIi i ii it t i i (t w p pti't , w itt II Iit, iie l ioi I it I( 1 it lit \0(111 dr,111\\'it"'. f'ibSlulw< 1|1l({l(SSo't 1,1,m1,,l l1wprr("s oll(I( I,0iw-IIr,i ;ol disls(Iss ()(flMlut 1 t. i it ' i(Vtilt i,!11 jttit; I,'!lti; s l l, .\'; I'; - I I -)(', v\'1 I I\1 i)Y II, I sti S. 'I' I IPS ('I I, ';I I ,I c 'iS I( \(I 't' c vo i IS I I I I I .o lI( () I ( it I I - S I I I I tIlw fr'lolt;l t* o iS s;tlo I(\( 1)11-1m f1w( tfzi~llphs hl,t w\ili (lhbfilwd( froi(llt.l ('lillll HCI(''s; tIw I'le lll (,I;I ho ll(Il li-ws ,I ,s l rtlli-Illt lilws (live( , II(), Im"Iost0t v otl I Iw p()OSI(lj l itlI 11.1 1- l1 ]if(' I lls Xllrf';lc(' \'I mil2X kll1 \;Is( IlI;$II iz.( (d ,1wrM iste 1iis ;1l(1 xlilkill". i, ol ' tilf Ilw llt('r t;11)1(' ('I\XsI('d. T he ( ( om ( i I I \\'IS (iOl}t](SS 1j1'1-m 'l( t ()II "1,_''1ldim lv tllt-mI>'1 frm'X II''t'( ll ;, 1w(ld1 hil,,ldcl. It is .,m (tIiI'D 1111;ll rk o ()III d ito I loi- tII lw \'il h -,11 , III (wc r III ( ) II fem l ( Ils \0 m k\(1( Ixiiovi 1, to Owtl CZ CZ C: E:~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~4 _ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~b UNIV. CALIF. PUBL. AM. ARCH. & ETHN. VOL. 34 PLATE 2 a. 12-4894 (L103). Lateral aspect of skull, male, age about 40, Naga-ed-Der, Coptic, early Clhristian epochls. The skull is frail, of fine texture, scaplioid, but witlh typical narrow forelhead and occipital eminence. The palate is broad. Tlhere is no dental attrition; but note heavy browniislh accretions on molars witlh concomitant resorption of the alveolus perio- dontoclasia. The crowns of tlle left cuspid and first premolar lhave been destroyed by caries. The dietary lhabits lhave evidently beeni quite different from those of earlier epoelis; reduced function of teetlh is obvious. b. 12-4886 (1,145). Lateral aspect of skull, female, age about 35, Naga-ed-Der, Old Eni- pire. On the lateral aspect of the left maxilla involving the alveoli of the second and tlhird molars is a lhemisplherical depression 2 cm. in diameter. Tlhe miarginis are slharp; thte walls forni a fine reticulum; an aperture opens into the maxillary sinus. Evidence of osteoperios- teitis extenids from the depression over the posterior surface of the maxilla-under the zy- goma. The clhaiacter of this lesion precludes chronic periapical abscess or its cystic variant. Tlhe destruction probably resulted from the growtlh of a neoplasmii, possibly fatal. a. Male, Copt: Dental accretions, afunction. b. Female: Osteo-periosteitis of maxilla involving siniUs. [LEIGH] PLATE 2 UNIV. CALIF. PUBL. AM. ARCH. & ETHN. VOL. 34 PLATE'11': ,. 1'-,12''2 1 ',: Nortim; h;ttorlli-S ot sllill, f(l111;11C 11'(t Nkll t 4.5, McIs1ildi, MTidd(11 I. III I nT vI' I I vi;l I t I ; I n I"i' llolili l( I I t : I I I I I elillie Ilio II Ic 1. tv II oI III 1s f I; c I I' i(I 1d II I ;s; I I) . Id g, S IIII 1 c s!1)(til tI,I I I ll,(II I. A t t I.iti ,t i I ) f O l ;Illd1 resorpxtio l ()t :Il\-(oIll hordl(r :11, evidl("t. .\ lwee,-slmlwdl( ptiom(s's' 4 >: 7111 prl(>j(cts to\-lfro III\ll ti 1 i,teil-1, t d th 11i1 e '11 t i cu]; ti( 11 su t" ( () ilI s.i i ,'11 s 11 1k d (I /,. 12' 4,s():, ( 1 '94 ). -I ;t rt :;l isliccl ,, skutll ;1ll(d 111,111(lihk,l withl i11cgrullillt i '11l( te .Xtllk wr;iIp;1.Sillo sittl ()II f;lc('; 't;1 1_ llmult 6i) \15 v(ll)l \-.xii I)lh l;stics. S v(\I(1 t( ,IlI- I'll ;11trlioll 11;scxltmsed1 III(' putlp ott1w stil1wriol fi Ist Ilmil;l. withl Icsilltllilt chItomlic ,l;li (1 ;11 o)sl( itis. 1-eSllt (>l ot ,, der (,t ;t\ (lve lus illve slill'g Illohl;l tec(t'll ll;s oe( c tlrne d. Aoe (;1 11l1- il v the n)Sion( ) o stlwim>( li I ll l Iferlt ;l surilccs ( )f ot ld,1 v1X ; c F(MIllir ostew,1-;lthilisi I;Is ill\4al(dv II( , ie I tt tI l i oo-l;lllu li ;t I I;ltio,110l. ai. Female: Occipital emillence, olthiogilathious face, ar-ciled lias"al bIridge. 1). -allle: I oi 't ii tsttitis; ostto-i ittiihitis of atrtoitiad uli a rtictul ationii. I LEIGH I PLATE 3 UNIV. CALIF. PUBL. AM. ARCH. & ETHN. VOL. 34 12' 4SW') (I 1 ,4 ). k,(isih;lr 'Isliccl (\1 sIf i Skd 110\v11 ill pliclt ",I). F-irst IlmhIr;ls heci\ l wm.(1 u\N l i,( \v>1(d tilw ti?l()I (d tf1w pu111p Ai11> I..trtitim 11 1' II;I IS() ( '} Osed pulp (i} t' tillc i ttf Iil-St Pr(AIM1 ,11. ;111(d culsptid w\il l I-Stiltllilt cOmIIhilled( fistuhle; ()IIt lll, f1 lwt i; ;t (; 111(i IlIc Ic tt 1;tt1;1rd illci-iSOr ('Xilillits 1} iSli l st(t itS ()I1 Ilw( t;lv( il II ( t. o tc tll \\-( I( ]()St 1Illte 11101M- IcIlil. Ill tl 1w I(4 tt 1 Ic mI d f ()Ss,l iS I ;Il 11 m{ttsi Im II otIf l) IIvIw pl)};lsti Ir OIImm tlOIII I to) : it11111I. II Ii(-k. Th Iss ll(,\\- Imm,( is v^t^Zl d ( I sI sc. I)ff,(,res t i;liI I > I I>ilII( 'I E 1Ol lOi ( tS; 111;1\ v ( IIOt((d m I> itS p&()sI (lir I'I;I,ill '1iI. A p>l)sitiOIm I O+ w t11 il it t Oh f(SS;I i S cmll p>lenwil-It1 r v l(1S01ITI (mI (If t he 1w,Id(;l( o t tI ( ) (-11(i v (' ( SlI Imv ill prIviO Is v \(~\v ) (}Otll reS It;II IIt tlI()lII ]()II(r )Ito lIlII II ill;iii ,IIIII to 1 , 10()(-(SS. I I Iit:ltIII)I O fII II 0 ,H)(ti II II:;IS n) duccd(( t Iw SYIS I mwI tl r ol SI tI ,I IImII I10(fl 1.\A r (I I I S;I I1 ,II IIII I, IY I I, 1;1 v11- (x i St(( (\((l (, do Iit w(cI cI1.^II Ir I w I 1,I I c' os I II I s 1I.(l tlf )iS I l}II ;11( ts l s( I( If Is(( dltlii 8 tII I IlS,II(ililI (il Sam1111 illndiiividual s pl. 3/,: HIi Ivp Plfsti( bone ill left glenoid fossl- I LEIGH I PLATE 4 UNIV. CALIF. PUBL. AM. ARCH. & ETHN. VOL. 34 0 I I "-*-2 2 I ( I'r' I!I I Itell ;s 1)e r( ( v t-) (^ I I , II fI dils (Io,fo 1ll; I I 1o SI 1) Il )--) (;i.(ll O)1 i~l l ) (X. T III- J;I Nv is (t Iss i IIIIl i; to i() Iw I )Icd vimStt Ic 1w(. TIw I( md(1 is Imo 11 ,1, II; tIII c ; ll 111s is 1v(;tl s ;io I II Iho t l 1wIl^itll:1 re().mls tho( illc-isiv-( fos,.l is IllOt def'illo'l ;111(i tilt' Illtf'l'iOIM Slll'- I ; ( ( ) I) I I1 IS \v I t e ( )c c I tIX; , I I I I ; c Il 11 t I st tIS ',( r: I I I I t 1- I; 1 1 ;1 1 , I t Il 1 I I I I I . T I I i s i s (I| i sti1 ti- tl\-1)(, It ;m mxil,ld ; itI ill dic;t I s I: i;t(' r stork I il tII Nilt Io v lloY!. /,. 1-I2 lll (1 209)). I-I or (IIl ;Is pu o t ) 1111 l; iil > side \l illm IIII . TIw :w rol t io) II S -I n S('('l ;II leIwIilldu I()s" pr()ItI s over i I ;lo Ih i; xII - i \-l wj tII ssilo s. T I oI {i t II( I t ol; mI ol c z; ll SI d o'II ;1(I t h 1(s 4) I'IMll (.(,III l';l Hll( sOm lmd( ho(('o II h t II it II( ) I'ot(tl >II h v,II (;l l ()fo ti( SIw I H)'tII S. T II o( Iko\'('0 1- l' mI' (-'SS iS ( X\t (~ II S iv\(d v \ ro S z>I}>() (-h d t- I.m; II t h i n II I, I I II ' II()s], 1 r ItItI |. II;(') )1( ( L2w)1 (). FlI'OII t;I ,I SI wrI (' t III I;lI (hh}l(' 1}1;1:1 1>( SII mu t . I1 (; I I,' ( )II F1 o'i n,il(. (' I n,mI'('O I r nI't 'I'(t II S ()V('I'1;1 p tOw( dvod(' l;' I fO'( r. T I'II" (,\II,: ll(om S gIm Ocrm I; i i-iit It o I tlt (VII( I VII (I "Im Is ;1\(II vo )1 1 o I ( l wd o r,r(- till It } Im" s Ol ti( . I )wsl t (I fI ((tt' II I 'r,I cII '(' It svIII ph v!si S. a. Fn('iIIe, type mandible: Highi, nairow ralfInius; obtttse anigle. b. -alae: Pendulous (al(areous accretioins. C. -im1le ind(ividlual: Alvewola re tsorp9tionl below -X (c -(tio ss. I LEIGH I PLATE 5 UNIV. CALIF. PUBL. AM. ARCH. & ETHN. VOL. 34 PLATE 6 a. 12-4809 (L91). One type of Egyptian mandible: the body is short, the rami low and broad with anterior borders of sigmoid outline; the coronoid process is blunt, the notch a shallow crescent. No teeth were lost ante mortem. Attrition exposed the pulp of the left first molar, chronic periapical osteitis consequently oceurring. b. 12-5222 (L191). Interior of maxillary sinus, male, age about 55, Gizeh, Old Empire. Fragment of left maxilla, as exposed to view downward to the floor of the sinus in the re- gion of the molar teeth. Through the floor is a large oval fistula, 10 x 5 mm.; the margins of the aperture are well rounded and seleroseed, indicating chronicity. The infection atrium by way of the apices of the first and second molars was consequent upon pulp exposure through attrition. The external surface of the maxillary sinus shows an osteoperiosteitis. The right maxillary sinus is similarly involved through the lingual root of the second mo- lar, producing a fistulous opening, 6 x 4 mm. in diameter. c. 12-4895 (L123). Lateral aspect of mandible, male, age about 60, Naga-ed-Der, vI-xII Dynasties. Later type of mandible: the ramus is high and narrow with high sharp coronoid process and deep sigmoid notch; the anterior border is straight. The angle is roundish and obtuse, the gonions everted. The mental eminence is well developed. The dentition tends to be a transitory organ. The posterior teeth are extensively involved in periodontoclasia to the point of exfoliation. Heavy brownish accretions are on the lingual surfaces. A thin, everted, collar of new bone is evident at the margin of the resorbing alveolus; this sharp lamina is characteristic of this destructive inflammatory process. The lower teeth are not worn nearly as much as the upper teeth. d. 12-5050 (L139). Lateral aspect of Predynastic type mandible, female, age about 20, Naga-ed-Der, Predynastic. This mandible is an excellent example of the Predynastic type -female. The jaw is characterized by beauty of symmetry, definition of outline, refine- ment of structure and surface detail, and harmony and efficiency of the implanted denti- tion. The body is amply deep, the mental protuberanee triangular. The ramus is broad, the angle well defined, the gonions mildly inverted. The anterior border of the ramus is smoothly notched beyond the third molar; above, a convexity terminates in the coronoid process. The sigmoid notch is a broad perfect crescent. The articular surface of the condyle is refined. The musculature was not too heavy. The dental arch is a broad ellipse with ideal arrangement of its units. The enamel is without fissures, and is of a pearly hue. This speci- men being from a young female adult, there is maturity without the advanced effects of funetion, ravages of pathologic processes, or atrophy of senility. The enamel is clean and shows slight wear. From this mandible the norm of the distance from the enamel border to the alveolar crest may be taken-1.5 mm. a. Type mandible: Low, broad rami; periapical osteitis resultant from attrition. b. Interior of left maxillary sinus: Large fistula through floor. c. Male, type mandible: Higlh, narrow ramus: advanced periodontoelasia. d. Female, beautiful example of Predynastic type mandible. [ LEIGH ] PLATE 6 UNIV. CALIF. PUBL. AM. ARCH. & ETHN. VOL. 34 PLA TE 7 a. 12--)5250 (L2 10). Occlusal viev of left mandibular teeth, miiale, age( about 40, Gizell, Old Elmpire. Se(ond degree attrition is exemiiplified: denitille is exposed at positions of for- i11er eusps, islanids of enamel, foiniierly at the bottom of grooves, forimi a mosaic with thle contrasting deniti ie. b. 12 5222 JA'(II ) . Left lateral aspect of llanidilble of male, age about 55. 'I'This is esseni- tially1 the ar'llaic type lIlmandible wvithi some variation: the ramus is Iuiglher anid the coronloid process is exceptionally h-ighi. Othier morphologic features are t pical: definiite, alimiost riglit, anigle; goiiioIIs niot everted; sigiiioid notch a symmetrical crescent; the anterior lorder of tihe ramus presents a large concavity at its base, surimiounited by! a con1vexity. c. 12 -5056 (1J231). Oeclusal view of thiree superior left molar teeth, feniiale, age 18, Gizelil Middle Empire. These teeth are laige; the enlamnel is renmarkal)ly lighit colored. Th'lere is a. ra-pid dimliinutioii in size fromii first to thiird. The Egyptian denititioni is clarac- terized b)y a constamut occurrence of (arabelli's cusp oni the superior first molar. 'I'This anlloia- Ious tubercle is sizable oni this first milolar, anid outlinied on1 the second. While the cusps anid gr-oov-es are wvell marked, tlher-e is a characteristic softness in their lines. (1. 12 -5163 (L164). Lateral atspect of mandible of female, age about 45, MAeslieikil, Mid- dle Emnpire. 'I'This type nlanl(dil)le is archlai; it is characterized l)va definite angle, aid a ramus the anterior bor der of wh luli has a imiar ked sigimioid curvature. Several teethi with Supportinlg bone have 1eull extensivcly dest-oyoed ) v (caries amid its periapical sequelae. In thl(e first molar, carmies at the disto-cer-Vical 1bIorder of the enamel has extended to the p)ill), with chronic pemiapical osteitis consequent. >Note the old fistula A ith sclerosced border openin,g fionli the dist.al root. Fouir osseous lesions of idelnti(al cause are in this jaw. a. Ocelusal mosaic: Second degree attrition. b. Male, areliaic type mandible: Exceptionanly lligib coronioid. c. Occlusal aspect of maxillary molar teethi; Carabelli's cusp. d. Feemale, aebliaic type imandible: Dental caries and periapical sequelae. I LEIGH] PLATE 7