The first two involve blockage of blood vessels to the heart and brain, usually due to fat build-up, leading to heart attacks and strokes, respectively, but blood clots (emboli) and bleeding from a blood vessel can also cause a stroke. Fat globules may also be released into the bloodstream following severe injuries to bones. They are caused by disruption of fat cells in fractured bones (especially the femur and pelvis), and can also cause blockage of the vessels (Rothberg & Makarewich, 2019). CVDs further include rheumatic heart disease, where the heart muscle and valves are damaged by streptococcal bacteria in rheumatic fever; heart malformation at birth (congenital heart disease; and deep vein thrombosis, which leads to blood clots usually being released from the leg veins into the bloodstream causing blockage of a pulmonary artery, known as an embolism (World Health Organization, 2019).

Following the century-old landmark work by bacteriologist and experimental pathologist Sir Marc Armand Ruffer, who demonstrated the presence of atherosclerosis during autopsies of multiple Egyptian mummies (Ruffer, 1911), an international multidisciplinary group of physicians and scientists (the Horus Team, named for the Egyptian deity; Finch, 2011.) formed to evaluate the existence, extent and aetiology of atherosclerosis in ancient peoples. The Horus Team first described atherosclerotic calcifications on computed tomography (CT) scans in 2009 (Allam et al., 2009).

In February 2010, I was crouching down in a subterranean tomb chamber at the archaeological site of Amara West in modern Sudan, excavating the human skeletal remains of people that had lived some 3000 years ago. Suddenly, I came across fragile tubular objects made of a whitish substance arranged almost like a string of beads parallel to the femur of a middle-aged woman (Figure 1.1). The unassuming little tubes were carefully collected, wrapped in scraps of acid-free tissue paper, packed in cardboard boxes used for Sudanese matches and labelled ‘calcified arteries?’. Together with the excavated skeletal remains, they were later – courtesy of the National Corporation for Antiquities and Museums of Sudan – shipped to the British Museum in London for further scientific analysis within the framework of my PhD research at Durham University under the supervision of Charlotte A. Roberts, the co-editor with myself of this book.

By analyzing the topography of Selinous, a colonial foundation of the late seventh century BC, the chapter explores the way in which temple building and sacred architecture became subordinated to urban design. From the sixth century BC onward, Greek cult places and temples were increasingly seen as an expression of the urban rather than the natural landscape. This holds true for altars and temples at the center of cult places, but also for fountain houses that replaced or were built over natural fountains. The sacredness of a place was increasingly represented and communicated through monumental stone architecture. At the same time, the novel use of man-made images in Greek sanctuaries contributed to a radical change in which the presence of the gods was imagined and experienced. All this went along with a shift of power and agency from local groups to urban elites, who had the means to control the restructuring and reorganization of sacred landscapes. The violence of this shift is reflected in the iconography that tends to rationalize and sublimize violence against the non-Greek, non-urban, and non-male.

As early as the mid-nineteenth century, tangible evidence of cardiovascular disease (CVD) was found in Egyptian mummies, indicating that these people must have experienced atherosclerosis in the same way as modern humans do (Czermak, 1852; Ruffer, 1921). It has been suggested that the origin of the condition among the Egyptian elites was their diet, given that these people consumed food rich in saturated fat (David et al., 2010). However, we do not possess much data on the non-elite individuals from the Nile Valley, as they could not afford mummification.

At the beginning of the sixth century BC, the Aphaia sanctuary on the island of Aegina underwent a radical transformation. What until then had been a local open-air cult place in the woody mountains of the western part of the island, where a female deity had been worshipped as early as the second millennium BC, became an architecturally structured sanctuary that conformed to the novel Doric architectural order. At the same time, a cult image made of ivory was set up in the newly built temple. The goddess, who had previously “shown herself” in the open grove that was associated with her presence, was now represented through a man-made image. In addition, a wall was built around the temple that separated the sacred precinct from the “profane” land outside the sanctuary. Around the same time, the island of Aegina became one of the most important trade centers in the Greek world. The book argues that the transformation of the Aphaia sanctuary on Aegina is typical of the larger area in which the Doric order emerged. This transformation was characterized by economic growth, urbanization, land reclamation, and colonization and prompted the Greeks to rethink their relationship with the gods who inhabited the land.

Computed tomography (CT) is transforming our understanding of mummification in ancient Egypt, revealing a complex evolution of the preparation of the body for its journey to the afterlife and the methods used to preserve it (Ikram & Dodson, 1998; Taylor, 2001, 2010; Aufderheide, 2003; Antoine & Vandenbeusch, 2021). For example, new analyses and large-scale reviews of the treatment of the brain and organs have highlighted previously unappreciated temporal and regional variations, as well as differences according to status (Wade et al., 2011; Wade & Nelson, 2013a, 2013b; Nelson & Wade, 2015; Antoine & Vandenbeusch, 2021).

The Horus and other research teams have found that atherosclerosis is not uncommon in ancient people through the study of their mummified remains (Murphy et al., 2003; Allam et al., 2009, 2011; Thompson et al., 2013, 2014). However, some have postulated that traditional hunter-gatherers are in some ways healthier than modern people and that they had very little atherosclerotic disease (O’Keefe et al., 2010).

The very high prevalence of cardiovascular diseases in populations today makes their study unavoidable, necessary and of paramount importance in forensic sciences. Knowledge about pathological conditions affecting a skeletonised individual is crucial information for reconstructing the biological profile of a victim of crime and may be used in the individualisation and identification of an unknown deceased person (Cunha, 2006). In addition, a correct diagnosis of atherosclerosis in skeletal remains may provide information on the cause of death of the individual.

Cardiovascular diseases (CVDs) are the leading cause of death globally, accounting for around one-third of all deaths overall in 2019 (17.9 million; World Health Organization, 2021). Since then, we have also learnt that there are worse outcomes for people with underlying CVD comorbidities who contract COVID-19: they have an increased risk of death (Nishiga et al., 2020). CVDs are still challenging to manage in populations worldwide, and their continuing presence resonates with many of the United Nations’ Sustainable Development Goals, not least good health and well-being.

The sanctuary of Artemis on the island of Korkyra, modern Corfu, is presented as a case study of the relationship between the changing environment and the monumentalization of Greek sanctuaries through Doric stone architecture. Although the sculptural decoration of the Artemis temple, which is one of the earliest Doric temples known so far, is relatively well preserved, modern scholars disagree on the interpretation of the sculptures. The question of how the representations of Medusa and other mythological figures on the pediments and metopes related to the divinity worshipped in the sanctuary and to the local context are particularly controversial. However, as the chapter argues, the builders of the temple had no interest in highlighting this relationship in the first place. The temple and its sculptural decoration were meant to express Panhellenic values and standards rather than local traditions. Thus, the local elite of Korkyra presented themselves as part of a Panhellenic elite network. At the same time, the elite showed the local population that they were taking care of the religious landscape in an unstable and radically transformative situation.