Ophthalmology of the Pharaohs: Antimicrobial Kohl Eyeliner in Ancient Egypt

The bold eye makeup in the ‘60s, best exemplified by Sophia Loren’s winged ‘cat eye’ liner and Twiggy’s spidery eyelashes, had nothing on the ancient Egyptians and their gods. Their eyelids were heavily smeared with black kohl eyeliner, thick lines rimming the eyes, and the fashion was sported by everyone from peasants to pharaohs to effigies of the worshiped gods Horus and Ra. Though it may seem nothing more than a cosmetic fancy nowadays, kohl was considered to have potent magical powers and it has since turned out to possess unique pharmaceutical and antimicrobial properties. In fact, this deceptively simple beauty product may actually be one of the most ancient ophthalmological preparations known to man.

A piece of limestone pottery shows a woman nursing her child while a servant holds up a mirror and a crayon of khol. Dated from the 19th to 20th dynasty, 1285-1069 BCE, this shard is held at the Louvre, Departement des Antiquites Egyptiennes, Paris, France. Click for source.

Kohl served multiple roles in Egyptian antiquity. Egyptians of all social classes applied the eyeliner daily in veneration of the deities, satisfying both religious obligations and beautifying desires. Wearing the glossiest, highest quality kohl denoted one’s upper class status in society while the less wealthy adulterated their kohl with fire soot. Before the advent of Ray-Bans, it was applied liberally around the eyes to reduce the sun’s glare, to repel flies and to provide cooling relief from the heat. It also trapped errant dust and dirt, a simple remedy to curb the desert’s regular assaults on the body. Besides lining the eyes, the substance was also used to outline the eyebrows and enhance facial tattoos. In death, pouches containing the cosmetic and applicators were buried alongside the deceased, a testament to its importance not just in day-to-day living but also in the afterlife (1).

Kohl’s vast presence throughout history and across the globe testifies to its cultural, social, and hygienic purchase and evidence for its usage has been unearthed at the sites of ancient civilizations across North Africa, Central Asia, the Mediterranean and East Asia (2). It’s an incredibly old product, having been present since the Bronze Age (3500-1100 BC) and it’s usage has even been alluded to in the Old Testament, with two allusions at Kings II 9:30 and Ezekiel 23:40 to “painted eyes”.

An ancient Egyptian alabaster kohl pot dated from 1550 BC to 1070 BC. The opening was large enough to allow for a finger, feather or small stick to be dipped into the pot and then applied to the face. Image: Unknown. Click for source.

As with any product with a wide geographic distribution, it has picked up multiple labels. Arabs and modern Egyptians refer to it as “kohl”, while the Romans and Greeks named the product “kollurion”. The Iranians and those in the Indo-Pakistan region to this day call our eye-lining friend ‘surma” (2).

Kohl is predominantly composed of the mineral galena, a dark, metallic lead-based product that is also known by the chemical name lead sulfide (PbS). The mineral would be crushed and mixed  with several other ingredients such as ground pearls, rubies and emeralds, silver and gold leaves, frankincense, coral, and medicinal herbs such as saffron, fennel, and neem (1)(2). These compounds were then diluted in liquids such as oil, gum, animal fats, milk, or water to solubilize the lead and assist in its eventual facial smearing. Today we use galena for less prestigious and artistic purposes, in rechargeable batteries and as lead shot to fill shotgun shells.

A sample of the mineral galena, an ancient Egyptian source of lead sulphates. Image: Creative Commons. Click for source.

In 2010, French researchers analyzed samples from 52 kohl containers residing at the Louvre museum in Paris and found that the cosmetic contained trace amounts of four uncommon lead species: galena (PbS), cerussite (PbCO3), phosgenite (Pb2Cl2CO3), and laurionite (Pb(OH)Cl) (3). These last two compounds, the lead chlorides, are not naturally found in Egypt, which points to the possibility of deliberate manufacturing using lead oxide (PbO), rock salt (NaCl), natron (Na2Co3 and NaHCo3), and water. The authors of the study reckon that “it is clear that such intentional production remains the first known example of a large scale chemical process.” (4)

When researchers exposed skin cells to the lead sulfates found in kohl, they discovered that the lead ions elicited a profound immunological response. The cultured cells released one of the most important messaging molecules in the immune system, nitric oxide gas (NO); this gaseous molecule serves an activating messenger to bacteria-eating macrophage cells and stimulates blood flow by increasing the diameter of capillaries, encouraging rapid immune cell movement within the bloodstream (3). A 240-fold increase in NO production was sparked by the presence of lead ions, a bona fide tsunami of molecules flooding surrounding cells to respond to invading bacteria. This intense biochemical interaction suggests that kohl was more than just a beautifying cosmetic and the forefather of sunglasses, but also an important antibacterial ointment.

Why does it matter that the Egyptians were smearing black antibacterial gunk around their eyes? Aside from dastardly sandy winds introducing grit and irritating the sensitive eye region, infections of the eye were a serious and widespread concern (5). The desert conditions and annual flooding of the river Nile primed the eye for inflammations and bacterial infections. Antibacterial eyeliner seeping into the conjunctiva of the eye would activate an immune response, killing off pathogenic bacteria and preventing infections before they even started. The cosmetic’s regular usage could have cut down on the prevalence of ocular scarring, cataracts and blindness, nothing for an Egyptian living in antiquity to scoff at.

The Ebers Papyrus, a sort of medical textbook in ancient Egypt. It is considered to be one of the most complete and most exquisite of the medical papyri to be found. Click for source.

Perhaps it’s not all that strange that kohl has been found to have medicinal properties: the chemists and pharmacists in Egypt were considered quite knowledgeable by their Greek and Roman counterparts and their mastery of anatomy, diseases and pharmaceuticals were widely respected throughout the Mediterranean (3). We’re fortunate enough to actually have concrete evidence of this, in the form of several medical papyri scavenged by scrappy archaeologists in the late 1800s and early 1900s.

One of these is the Ebers papyrus dating from 1550 BC, the oldest known medical texts in existence (in existence, ladies and gentlemen!), and the hieroglyphic manuscript describes a plethora of ophthalmological multisyllabic quandaries including “blepharitis, chalazion, ectropion, entropion, trichiasis, granulations, chemosis, pinguecula, pterygium, leucoma, staphyloma, iritis, cataract, hyphaema, inflammation, ophthalmoplegia and dacryocystitis” (6). It contains detailed herbal preparations for eye drops, salves, ointments and even plaster dressings for the eyelids. Some of it seems to be clearly nonsense – beetle honey, anyone? – and in some unfortunate cases the papyrus recommends prayers and magical incantations to cure an ailment, another way of saying “You’re S.O.L., pal. Speak to my falcon-god-friend Horus here.” Aside from attendant ocular dilemmas, there are also remedies for gynecological, intestinal and dermatological issues and more.

A painted wood mask of an Egyptian face with kohl-lined eyes. Dated from 2000 BC, this object is located at the Swansea Museum, Swansea UK. Click for source.

The very existence of these papyri suggests a dedicated core of physicians and pharmacists collating their experiences, observations and empirical testing to create one of mankind’s first monstrously large medical textbook. Really, we contemporary humans are so damn lucky to have captured this surviving piece of ancient medical history, thanks to several original Indiana Jones-types from a century ago.

Kohl is still used today in North Africa and Central Asia, despite its considerable toxicity. I know what you’re thinking, “Now, a warning?” Heavy metals such as lead, mercury and arsenic often contaminate today’s product leading to cases of ‘saturnism’ or lead poisoning. This is particularly a serious issue with young children sporting the cosmetic as protection against the evil eye, as they are more likely to engage in hand-to-mouth behavior while learning about their environment (See here).

Even today, women mimic the application of kohl to enhance and brighten eyes but, sadly, there aren’t any therapeutic side-effects to expertly drawn winged cat-eyes. This idea of “cosmetics as medicine” that is vigorously pursued by the beauty industry in the form of “plumping” lipsticks, skin foundations embedded with minerals to combat acne, anti-aging creams and so much more was originally the province of Egyptian chemists. Maybe the secret to Cleopatra’s beauty wasn’t Maybelline but lead sulfate.

Note: The title of this article is derived from this short letter in the British Medical Journal: The Ophthalmology Of The Pharaohs. (1909) Brit Med J (2): 2543: 902. View it here on JSTOR.

Resources

Nothing’s safe from the FDA: Kohl, Kajal, Al-Kahal, or Surma: By Any Name, a Source of Lead Poisoning.

A group at Bard College completed an “interlinear transliteration” and English translation of parts of the Ebers Papyrus that they believe covered what we now know as diabetes mellitus. Neat, huh? Go here to check out their incredible work.

For a short but captivating read on kohl’s usages among women in North Africa in the early 1900s, download this pdf from Harquus, a website devoted to traditional women’s tattoos and facial markings.

References
(1) Cartwright-Jones C (2005) Introduction to Harquus: Part 2: Kohl as traditional women’s adornment in North Africa and the Middle East. Ohio: TapDancing Lizard Publications
(2) Mahmood ZA (2009) Kohl (Surma): Retrospect and Prospect. Pak. J. Pharm. Sci. 22(1): 107-122
(3) Tapsoba I et al (2010) Finding Out Egyptian Gods’ Secret Using Analytical Chemistry: Biomedical Properties of Egyptian Black Makeup Revealed by Amperometry at Single Cells. Anal. Chem. 82(2): 457–460
(4) American Chemical Society (2010, January 11). Ancient Egyptian cosmetics: ‘Magical’ makeup may have been medicine for eye disease. ScienceDaily. Retrieved April 18, 2012, from here.
(5) Finlaysonthe J (1893) Ancient Egyptian Medicine. Brit Med J. 1(1689): 1014-1016
(6) CN Chua. (Date unknown) A Historical Tour To Ophthalmology: The Ancient East. MRCOPTH. Accessed April 18, 2012, from here.

Tapsoba I, Arbault S, Walter P, & Amatore C (2010). Finding out egyptian gods’ secret using analytical chemistry: biomedical properties of egyptian black makeup revealed by amperometry at single cells. Analytical chemistry, 82 (2), 457-60 PMID: 20030333

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Nobel Prizes, Tropical Medicine & One Nazi Sympathizer

Nobel Prizes! We all want one, don’t we? While fantasizing about heavy gold medallions and the Swedish Nobel Assembly, I wondered how many of the Nobel Laureate prizes in Physiology and/or Medicine have gone towards scientists studying infectious diseases, immunology and the tropical medicine field. Snooze button alert, am I right? This is the product of a one-track mind so you have my apologies. But! If it’s any consolation, there’s a story hidden in this article of a Nobel Laureate Nazi sympathizer that infected mental patients with malaria to cure them of their psychoses. Science!

Let’s get down to numbers. As of 2011, this prize has been awarded 101 times to 199 scientists for their research in this field.  In recent years, the Nobel Prize has often been awarded jointly to two or three scientists for either collaborative research or for research that is similar in scope and specialty. Of those 101 occasions, 22 of these awards have been given to 39 researchers for their work in infectious diseases, virology, parasitology and/or immunology. Only one woman is on this list, Françoise Barré-Sinoussi, for her incredible work with Luc Montagnier in identifying HIV at the height of the HIV/AIDS epidemic in the 1980s.

The Nobel Medal for Physiology or Medicine is embossed with the Genius of Medicine "holding an open book in her lap, collecting the water pouring out from a rock in order to quench a sick girl's thirst". Description from NobelPrize. Click for image source.

(FYI, there have been nine years in which the Nobel Prize ceremony and awards did not occur due to the disruption of the two World Wars – in 1915 to 1918, 1921, 1925 and 1940 to 1942. Those Nazi’s again!)

So roughly one-fifth of the Nobel Prizes in medicine have gone to scientists making breakthroughs in the study of infectious diseases or in the immunological response to those diseases, indicating how crucial this particular field of medicine is to the scientific community. We’re not talking dermatology or podiatry here, folks.

In the early years, the Assembly awarded prizes for game-changing advances in the research of big killer diseases of the day – diptheria, tuberculosis and malaria, to name a few. The development of a yellow fever vaccine (1951), discoveries of vital antibiotics that are still used today globally (1939, 1945 and 1952), and the finding that HPV causes cervical cancer (2008) are just a few of the discoveries that the Nobel Assembly considered so revelatory to the field of medicine. Until the past century, how infectious diseases entered the body, their mechanisms of pathogenesis and even their treatment was largely unknown. Malaria is transmitted by mosquitoes? Not known till 1899 and Sir Ronald Ross’s discovery of the parasite hiding inside the stomach of an Anopheles mosquito was justly recognized by the Nobel Assembly in 1902. Lice transmit typhus? Charles Nicolle’s finding won him a good amount of money and worldwide recognition/obscurity in 1928. In 1954, a trio of American researchers were awarded the Nobel for identifying a method to culture the polio virus, launching the beginning of the end of polio’s affliction on humanity.

Many of the awarded discoveries laid the foundation for productive research that has led to profound advancements in disease and pest control, the emergence of the field of public health, development of the pharmaceutical industry and the industrial production of vaccines, antibiotics, and antivirals. Life-changing stuff, ya’ll. Flipping through this list is a reminder of how far we’ve come in the past century in establishing our domain over bacteria and viruses that previously wiped us out with shocking regularity. In fact, some of their findings and methods are so commonplace, hell! even banal, in today’s laboratories that it’s like stepping into a science time-warp reading about their discoveries. Thanks to these scientists, we possess the complex knowledge of genetics, immunology, antibiotics, vaccines and their respective methods to identify, culture and combat new diseases.

The list of winners is below and includes the year they were awarded, their country of origin and the award’s justification from the Nobel Assembly in quotes; those quotes come from the official website of the Nobel Prize. I’ve included in the list a few winners awarded for their work in immunology and antibiotics; while these are not strictly related to infectious diseases, their research laid a strong foundation for future infectious disease work and, well, they’re related and it’s important so get over it.

Scroll past this engrossing list that I’ve compiled for your disease-seeking pleasure.

1901
Emil Adolf von Behring (Germany) “for his work on serum therapy, especially its application against diphtheria, by which he has opened a new road in the domain of medical science and thereby placed in the hands of the physician a victorious weapon against illness and deaths”. Victorious weapon! I’d think the flowery language alone should do the trick. In any case, von Behring developed a diphtheria antitoxin, known as a “serum”, by repeatedly injecting a horse with diphtheria toxin.

"A Future Pharmacy". An editorial cartoon mocking Emil Adolf Von Behring and his discovery of serum therapy, in which a diphtheria antitoxin was developed by repeatedly exposing a horse to the diphtheria toxin. Click for source.

1902
Sir Ronald Ross (United Kingdom) for his discovery that malaria is transmitted by mosquitoes.

1905
Robert Koch (Germany) “for his investigations and discoveries in relation to tuberculosis”.

1907
Charles Louis Alphonse Laveran (France) “in recognition of his work on the role played by protozoa in causing diseases”.

1927
Julius Wagner-Jauregg (Austria) “for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica”. In 1927, Wagner-Jauregg received the  Prize for his discovery of pyrotherapy, the treatment of mental disease by febrile diseases. Besides being a Nobel Laureate, Wagner-Jauregg was also a Nazi sympathizer, anti-semite and racial hygienist. A charmer of a man who forced sterilization upon the mentally ill and the criminal and the so-called “father of fever therapy”(1).

Mustachioed Wagner-Jauregg stands behind a mental patient receiving malarial pyrotherapy. Click for image source.

Since 1887, he had been investigating the phenomenon of how fever, as induced by tuberculosis or St. Anthony’s Fire, may reduce the effects of psychosis caused by tertiary syphilis. Bacterial infections didn’t seem to do the trick in terms of bringing about recurrent high fevers and so in 1917 Wagner-Jauregg turned to the malaria parasite. Turns out, malaria is an excellent specimen for this sort of thing and led to its usage as an established treatment for paralytic dementia and neurosyphilis. An application of quinine would end the fever therapy, eliminating the infection and leaving the patient free of his psychoses. For this hot discovery, Wagner-Jauregg is the only psychiatrist to have ever won the Nobel for investigative fieldwork on mental illness.

1928
Charles Jules Henri Nicolle (France) for his discovery that lice transmitted typhus. Nicholle was a master researcher of infectious diseases and made many discoveries regarding the pathology and epidemiology of brucellosis, leishmaniasis, measles, rinderpest, scarlet fever, Mediterranean spotted fever, toxoplasmosis, trachoma and tuberculosis. Nicholle’s typhus work was performed in Tunisia using chimpanzees and toque macaques (2).

Vials and tablets of prontosil, an industrial dye discovered to have antibacterial properties by Gerhard Domagk. Click for source.

1939
Gerhard Domagk (Germany) “for the discovery of the antibacterial effects of prontosil”. Prontosil was the first drug to be found effective against bacterial infections and Domagk made quick use of this fact – as a streptococcal infection threatened his daughter, his treatment with prontosil prevented the therapeutic amputation of her arm.

1945
Sir Alexander Fleming (United Kingdom), Sir Ernst Boris Chain (United Kingdom), and Howard Walter Florey (Australia) “for the discovery of penicillin and its curative effect in various infectious diseases”.

1951
Max Theiler Union (South Africa) “for his discoveries concerning yellow fever and how to combat it”. He had an enormous forehead. His award is the only one that has gone towards a virus vaccine.

1952
Selman Abraham Waksman (United States) for his discovery of streptomycin, the first antibiotic effective against tuberculosis”. Waksman coined the term “antibiotic”.

There's really no reason why I'm including this photo of Selman Waksman here aside from the fact that it's so gloriously Science!-y. Lab coat, check. Flask of something liquid, check. Mood lighting, check. Click for image source.

1954
John Franklin Enders, Thomas Huckle Weller and Frederick Chapman Robbins (all from the United States) “for their discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue”. Their work laid the groundwork for Jonas Salk’s development of the polio vaccine.

1958
Joshua Lederberg (United States) “for his discoveries concerning genetic recombination and the organization of the genetic material of bacteria”.

1966
Peyton Rous (United States) “for his discovery of tumour-inducing viruses”. In 1911, Rous found that some cancers can be transmitted by viruses, known as retroviruses. Forty years later, he was awarded for his work.

1969
Max Delbrück, Alfred D. Hershey and Salvador E. Luria (all from the United States), “for their discoveries concerning the replication mechanism and the genetic structure of viruses”. The trio discovered that bacterial resistance to bacteriophages (viruses that infect bacteria) was a result of random mutations.

1972
Gerald M. Edelman (United States) and Rodney R. Porter (United Kingdom) used immunoglobins sourced from human blood to identify the chemical structure of antibodies.

1976
Baruch S. Blumberg and D. Carleton Gajdusek (United States) “for their discoveries concerning new mechanisms for the origin and dissemination of infectious diseases”. These guys were awarded for their research on kuru, a disease caused by human prions. Fun fact: Blumberg also discovered the hepatitis B virus and developed the diagnostic test and vaccine for it.

1984
Niels K. Jerne (Denmark), Georges J.F. Köhler (Federal Republic of Germany) and César Milstein (Argentina and the United Kingdom) “for theories concerning the specificity in development and control of the immune system and the discovery of the principle for production of monoclonal antibodies”.

1989
J. Michael Bishop and Harold E. Varmus (United States) “for their discovery of the cellular origin of retroviral oncogenes”.

1997
Stanley B. Prusiner (United States) “for his discovery of Prions – a new biological principle of infection”.

2005
Barry J. Marshall and J. Robin Warren (Australia) “for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease”. Marshall is famously known for downing culture medium loaded with H. pylori to directly prove that the bacterium is responsible for causing ulcers.

2006
Andrew Z. Fire and Craig C. Mello (United States) “for their discovery of RNA interference, [otherwise known as] gene silencing by double-stranded RNA”.

2008
Harald zur Hausen (Germany) “for his discovery of human papilloma viruses causing cervical cancer”, along with Françoise Barré-Sinoussi and Luc Montagnier (France) “for their discovery of the human immunodeficiency virus”.

Resources

The Nobel Prize website has a fleshed-out timeline for every Laureate and includes their biography, a short article about their research, the lecture they delivered to the Nobel Assembly and much much more.

References
(1) Howes OD et al (2009) Julius Wagner-Jauregg, 1857–1940. Am J of Psy. 166(4): 409.
(2) Schultz MG and Morens DM. (2009) Charles-Jules-Henri Nicolle. Emerg Infect Dis. 15(9): 1520-22. Accessed online.

Schultz, M. (2009). Charles-Jules-Henri Nicolle Emerging Infectious Diseases, 1519-1522 DOI: 10.3201/eid1509.090891

TB or Not TB: The Weirdness that is Extra-Pulmonary Tuberculosis

I like wild plot twists in my novels, remixes of my favorite songs and food with unexpected, exotic flavors. Needless to say, I also love hearing of cases where an infectious disease takes an unpredictable turn, appearing where it traditionally does not. We have quite the curve-ball with Mycobacterium tuberculosis, a microbe with itinerant tendencies that materializes in some surprising anatomical locales.

Patient Richard Pendlebery with extrapulmonary tuberculosis infection of the joints. He's dapper aside from the flipper, no? Photograph taken by William H. Rhoads in Philadelphia circa 1866-98. Property of the College of Physicians of Philadelphia and the Mutter Museum. Click for source.

Tuberculosis (TB) is in the big league of the leading infectious diseases that cause profound morbidity and mortality throughout the world. We all know this, yes? When we think of TB, we think of the frail poet John Keats, sticky handkerchiefs, bloody loogies, and wracking wet coughs. But for a microbe that we customarily associate with the lungs, this guy can really do a corporeal tour, appearing in such disparate locations as the spine, joints, intestines, and skin. In fact, it’s not that uncommon. Extra-pulmonary TB (EPTB) is responsible for 15 to 20% of all cases of TB, and can increase to up to 50% for those who are severely immunocompromised, as is the case with AIDS patients (1).

We often think of microbes and parasites as uniquely adapted to whichever locale in which they cause disease. But TB can be rather laissez faire about its home base as it lives rather comfortably within the peripatetic macrophage. Following inhalation of the rod-shaped microbe, the bacterium is phagocytized by a macrophage in the alveoli of the lung, which can then travel into the blood stream or into the lymph nodes via lymph. This so-called “lymphohematogenous seeding” of the bacteria spreads the microbes from their pulmonary location to other distant sites of the body. Like pollen floating in the wind, these hardy microbes traverse and populate new foreign lands. Ultimately, the bacteria + macrophage pair will lodge within a tissue that attracts the attention of the immune response. This condition is known as EPTB, disseminated TB or miliary TB. Indeed, that pollen metaphor may not be too far from fact: the term “miliary TB” derives from the appearance of the small, discretely formed tuberculoid nodes on MRIs and X-rays as tiny millet seeds seasoned throughout the organ of its choice.

An unidentified man suffering from Pott's disease or extrapulmonary tuberculosis infection of the spine. Photo taken by John Mayall in 1877. Click for source.

EPTB can manifest itself in nearly every type of organ system of the body, though the most common sites are the lymph nodes, urinary tract and reproductive system, meninges of the brain, bones and joints, pleural cavity, skin, and peritoneal cavity. Some of these localized infections have acquired their own proprietary name: Pott’s disease for spinal TB, lupus vulgaris for TB of the skin, and scrofula for infected lymph nodes located in the neck/cervical region (or if you’re fancy: cervical tuberculous lymphadenopathy).

The point is: tuberculosis is not exclusively a respiratory disease but an opportunistic pathogen capable of infecting pretty much any organ in the body. It’s happy anywhere, sitting in its macrophagic throne pissing off the immune system with its infuriating presence and forming graulomas. It’s not only impressive but unique and weird.

A young unidentified patient with a case of scrofula or cervical tuberculous lymphadenopathy. Infection is characterized by abscess formation of the lymph nodes in the neck. Image: Images from the History of Medicine (IHM). Click for source.

It can get weirder: it seems that the serial monogamist King Henry VIII of England, as well as other less romantically inclined English and French monarchs between the 1200 to 1700s, had an intimate relationship with scrofula, the cervical lymphadenopathy form of TB (2). At the time, there existed a strong conviction that divinely appointed sovereigns could cash in on that holiness and, with a “royal touch”, cure scrofula sufferers. At the time, scrofula was considered any old disease with a prominent glandular presentation around the facial and cervical region, tuberculoid or not, and I imagine King Henry had quite the encyclopedic tour of illnesses (goiters! tumors! mumps!) during his time of curative prowess. Didn’t seem to do much of anything to temper his roving philandering eyes but, alas, libido is a powerful, powerful thing. As such, this quirk of history earned scrofula the moniker, the “King’s Evil”. Share that historical nugget at your next cocktail party!

EPTB can be tricky to diagnose as its a great disease mimicker, a lyrebird of an illness. Because the clinical presentation is so non-specific, so vague, it can be many years before a diagnosis of EPTB has definitively been made (3). Physicians must be on their toes in considering an individual’s risk factors for EPTB: history of travel, birthplace, ethnicity, sex and age. Aside from appearing most commonly in those infected with HIV/AIDS, it is also prevalent among young children and tends to infect women in greater numbers for unknown reasons .

As if we don’t already have to wonder about mites, toxoplasmosis and herpes lurking undetected in our bodies, now you can fret over possible extrapulmonary infection with that odd vagabond M. tuberculosis. You’re welcome.

Editor’s Note: Body Horrors has been quiet for the month of February in preparation for, celebration of and recuperation from Carnival Season and Mardi Gras in New Orleans, LA. My sincere apologies for my extended absence. If it makes you feel better, I was having the time of my life. I’m back now.

Resources

Wanna get deep into every clinical presentation of EPTB that has ever occurred? This exhaustive 38-page review is FREE with lots of pictures.

Jules Talrich was a popular anatomical model maker in the 1850s using wax and plaster to model various diseases and disfigurements. The Frenchman, who served as the official model maker for the Faculty of Medicine of Paris, currently has a number of his anatomical waxes peppered throughout medical museums around the world. This life-like wax model dating from the 1890s and now living at the National Museum of Health & Medicine in Washington, DC shows a man with a rather serious scrofula infection.

References

(1) Sharma SK & Mohan A. (2004) Extrapulmonary tuberculosis. Indian J Med Res. 120(4):316-53

(2) Barlow F. (1980 )The King’s Evil. Eng Hist Rev. 95(374): 3-27

(3) Dolberg OT, Schlaeffer F, Greene VW, & Alkan ML. (1991) Extrapulmonary Tuberculosis in an Immigrant Society: Clinical and Demographic Aspects of 92 Cases. Rev of Infect Dis. 13(1): 177-179

Dolberg OT, Schlaeffer F, Greene VW, & Alkan ML (1991). Extrapulmonary tuberculosis in an immigrant society: clinical and demographic aspects of 92 cases. Reviews of infectious diseases, 13 (1), 177-9 PMID: 2017620