The diagnosis of diabetes mellitus from skeletal remains is very difficult given the complexity of the disease and the fact that there are no pathological skeletal characteristics exclusively associated with diabetes mellitus. Skeletal identification of diabetes mellitus may only be possible through differential diagnosis, when several pathological changes are present. Skeletal and dental changes associated with diabetes mellitus include Charcot's joint (neuropathic arthropathy), osteoporosis, osteoarthritis, diffuse idiopathic skeletal hyperostosis (DISH, or Forestier's disease), adhesive capsulitis (frozen shoulder), dental caries, periodontal disease, and antemortem tooth loss.Skeletal remains of an adult male from the Egyptian archaeological site of Dayr al-Barsha, dated to the Middle Kingdom (ca. 2055-1650 BC), display a myriad of pathological conditions that, when considered together, likely indicate diabetes mellitus, specifically type 2 diabetes mellitus.This diagnosis represents the earliest, and possibly the only recorded archaeological skeletal evidence for this disease.
The use of surgical techniques in ancient Egyptian medicine has only been suggested indirectly through ancient medical texts and iconography, and there is no evidence of amputation as a means of therapeutic medical treatment. This paper presents four cases of amputation from the archaeological site of Dayr al-Barshā , Egypt. Two of the cases (dated to the First Intermediate and Middle Kingdom periods, respectively) are from individuals that display bilateral amputations of the feet, one through the metatarso-phalangeal joints, the other a transmetatarsal amputation. The exact reason for the amputation, perhaps from trauma or disease, is unknown. The particular healing patterns of the distal ends of the amputations suggest these individuals used foot binding or prosthetic devices. Another case represents a healed amputation of the left ulna near the elbow, dated to the Old Kingdom. The final case represents a perimortem amputation of the distal end of the right humerus. The exact date of this individual is unknown, but most likely pertains to the Old Kingdom or First Intermediate period. This individual seems to have suffered a traumatic incident shortly before death, sustaining many fractures, including a butterfly fracture on the right humerus. Several cut marks were identified on top of the butterfly fracture, indicating amputation of the arm at this point. All four cases support the hypothesis that the ancient Egyptians did use amputation as a therapeutic medical treatment for particular diseases or trauma.
This investigation was funded by FWO Vlaanderen and the Bijzonder Onderzoeksfonds of Leuven University. We also express our gratitude for the financial support of Marc Decroo (CompuSoft NV), Christine Decroo, Adolf Devis, and other members of the society Egyptologica Vlaanderen. 1 Transcriptions of Arabic toponyms follow the International Journal of Middle East Studies except where a well established English rendering exists (like Giza).
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