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Home , Autopsy, Siptah

A JOURNEY INTO THE HUMAN studying to understand ancient BODY by michael r. zimmerman

40 EXPEDITION Volume 61 Number 1 RIGHT: The mummified Pha- raoh Ramses V (died 1145 BCE), who had smallpox. Photo from Wikimedia. OPPOSITE TOP (LEFT TO RIGHT): affecting ancient populations included small- pox, subcorneal pustular dermatosis, , and rheumatoid arthritis. Images by Gaetan Stoffel, Michael R. Zimmerman, 7 Active Studio, and Bernd Brägelmann/Wikimedia.

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AS AN ANTHROPOLOGIST AND RETIRED PATHOLOGIST, DR. MICHAEL ZIMMERMAN’S RESEARCH FOCUSES ON PALEOPATHOLOGY. HE DETAILS WHAT CAN BE ACCOMPLISHED IN STUDYING ANCIENT DISEASE AND REFLECTS ON WHAT REMAINS TO BE DISCOVERED USING 21ST CENTURY MEDICAL TECHNIQUES.

expeditions reported in this magazine frequently in linen without going through a full mummifcation involve a journey to a remote part of the world. In process, was a skeleton with some attached dry skin and 1972, I was part of a group of physicians, anthropolo- muscle on the legs and trunk. Desiccated or dried matter gists, archaeologists, and other scientists assembled at in the chest was sampled for rehydration with a solution the Penn Museum for a time travel expedition into the of , alcohol, and sodium carbonate. Although our human body, specifcally to examine the mummy of an studies of the decomposed tissues were mostly unreward- ancient unknown Egyptian man. He was dubbed PUM ing due to bacterial , there was a signif- I (Pennsylvania University Museum I), in anticipation cant positive fnding in a sample of skin from the upper of a continuing series, which would also include PUMs inner thigh, which showed a much greater degree of II, III, and IV. preservation, probably due to prompt desiccation. Within Paleopathology, the study of disease this skin were small blister-like spaces flled with the in ancient remains, adds the dimension of remnants of infammatory cells, resulting in a diagno- time to improve our understanding of the sis of a rare disease, subcorneal pustular dermatosis, or evolution of diseases and their role in Sneddon-Wilkinson disease. human biological and social history. Te First described in 1956 by Drs. Sneddon and Wilkin- examination of mummies expands our son as a process of sterile pustule formation on the abdo- knowledge of the life stories and fate of men and in the axilla and groin areas, the disease has ancient individuals, their relationship been linked to more serious disorders such as rheumatoid to others, and ancient migrations. Tese arthritis or thyroid problems. Te frst mummy dissected discoveries have applications in modern in the Penn Museum series was probably aficted by and implications for health Sneddon-Wilkinson disease almost 3,000 years ago. throughout the modern world. A standard of PUM I was fol- What Mummies Do We Study? lowed as much as possible, although results For most people, mummies are associated with ancient were limited by the mummy’s poor state of Egypt. However, mummies are found in many other preservation. Te body, apparently wrapped areas of the world as well. Te oldest human mummies,

TOP: Mummies are found in many locations around OPPOSITE: The Museum’s Egyptian mummy PUM II before and after un- the world. LEFT: The Museum’s PUM I rebandaged wrapping. The autopsy revealed bone abnormalities, pneumoconiosis, after the autopsy in 1972. PM image 32908. roundworm, and perforated eardrums. PM images 31408 and 95477.

42 EXPEDITION Volume 61 Number 1 UNDERSTANDING ANCIENT DISEASE

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FAR LEFT: This 13-year-old female mummy, called the Llullaillaco Maiden, was recovered in 1999 from the Andes. Photo courtesy of Johan Reinhard, National Geographic Society. LEFT: Animal mummies, such as this seal, have been found as far as Antarctica. Photo by Johner Images/Alamy.

of the Chinchorro culture from what is now northern from relatively basic X-rays, beginning with Flinders Chile and southern Peru, date from 5000 to 3000 BCE, Petrie’s X-rays of prehistoric Egyptian bones in 1897, thousands of years before Egyptians began performing followed in the late 20th century by the development mummifcation. Frozen bodies, usually buried by ac- and application of sophisticated CT and MRI analyses, cident, have been found in the Arctic. Ötzi, the famous allowing for non-destructive examinations. Enhance- 5,300-year-old Iceman, was found in 1991 in the Alps ments in MRI technology have allowed the examina- between Austria and Italy. Human mummies have been tion of mummies without the need for rehydration, and found in such diverse places as Japan, the Torres Strait CT-guided endoscopic yield many diagnoses. between Australia and New Guinea, and the Canary We also use gas in Islands, Peru. Animal mummies have been found the study of ancient Egyptian materials. Im- as far as Antarctica, where extremely dry conditions provements in ancient DNA (aDNA) detection are also have produced seal mummies. Human remains and expanding our knowledge of the history and evolution bones from the seal mummies are currently being of diseases. Recently, we even learned about a remarkable studied to improve our understanding of the spread clarifcation of the relationships among members of King of tuberculosis from Africa to South America some ’s family. 1,000 years ago. What Can We Learn From Mummies? How Do We Study Mummies? Te examination of mummies has two paleopathological In 1972 X-rays were referred to as “flms,” which was goals: ftting the diseases of individual mummies into a considered progress from earlier glass “plates.” Com- picture of the health status of a given ancient population puterized tomographic (CT) scans, magnetic resonance and providing information on the evolution of diseases. imaging (MRI), and digital technology were still in the Congenital skeletal deformities and traumatic future and ultrasound was limited to the Navy’s sonar have been seen in mummies. Clubfoot was recently search for submarines. As in all other branches of scien- diagnosed in Amenhotep III and Tutankhamun. Tis tifc and medical investigation, the study of mummies may account for depictions of Tutankhamun seated in has been facilitated by the development of new technol- activities that normally require an upright posture and ogy. We have seen the progression of radiologic study the presence of numerous walking sticks, several show-

LEFT: Ötzi the Iceman has been intensively studied by archaeologists from all over the world. South Tyrol Museum of Archaeology/Eurac/ Samadelli/Staschitz.

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TOP: Computerized Tomography (CT) scan of King Tutankhamun’s mummy. Photo by Danita Delimont/Alamy. ABOVE: Magnetic Resonance Imaging (MRI) of a 3,000 year old Egyptian mummy at University College Hospital in central London. Photo by PA Images/Alamy.

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ABOVE: The mummified Siptah (died 1191 BCE), who had talipes equinovarus (club foot) and most likely suffered from poliomyeli- tis, or possibly cerebral palsy. Photograph from The Royal Mummies by G. Elliot Smith (1912), plate #LXII.

46 EXPEDITION Volume 61 Number 1 UNDERSTANDING ANCIENT DISEASE ing wear, in Tutankhamun’s tomb. Another Egyptian mummy sufered from a club foot and his liver showed the scarring of cirrhosis, perhaps due to self-medication by an excess of wine during his life. One of the most notable traumatic injuries was diagnosed in the Iceman by CT scanning, an arrowhead in the shoulder region, resulting in a fatal hemorrhage. Tere have been many reports of infectious and infammatory disease found in mummies. Examination of the Pharaoh Siptah using x-ray technology showed an overall shortening of the entire right leg and of the soft tissues, diagnosed as characteristic of poliomyeli- tis, or possibly cerebral palsy. Smallpox has been diag- nosed in the mummy of Ramses V. Pneumonia, one of the most common bacterial and a major of in the pre-antibiotic era, has also been diag- nosed in Egyptian mummies. Tuberculosis has been well documented in and pre-Columbian South ABOVE: Life-long exposure to open fires for heating and cooking have America. Of interest is the absence of evidence of tuber- left carbon and silica particles in the of almost all Egyptian culosis in pre-Dynastic Nubian skeletons and mummies, mummies. Photo by Simon Podgorsek. suggesting the Dynastic period (from ca. 3000 BCE) for the onset of human tuberculosis in the Nile Valley, but A more life threatening disorder, atherosclerosis or the recent molecular evidence indicates a much older date for buildup of plaque in arteries, has been very well docu- the evolution of human tuberculosis. mented by historic evidence. A recent CT study identifed Studies of aDNA have determined that Tutankhamun the disorder in 9 of 22 mummies in the Cairo Museum. sufered from falciparum malaria, the most serious form Tis much higher incidence than had previously been of the disease. Parasitic worms remain well preserved for reported raises the question of the cause of this disease. millennia, and the characteristic ova of Ascaris lumbricoi- Ancient Egyptians did not smoke cigarettes, eat much des, hematobium, and Taenia solium have all meat or sugar, or deal with the environmental pollution been reported in Egyptian mummies. Te Dakhleh Oasis or stresses of the 21st century. Tis disorder may actually is far from the Nile but schistosome ova were discovered be due to an infectious disease, caused by as yet uniden- in a mummy from that area; this may be evidence of a tifed bacteria, analogous to the recent discovery of the trade route or the movement of people via oases in the infectious cause of ulcers. western desert. Another common degenerative process is the ac- Dental and middle ear disease have also long been cumulation of foreign material, particularly in the lungs. part of the human condition. Periodontal disease, dental Te combination of carbon and silica particles has been wear, and caries (cavities) have been noted in seen in the lungs of almost all Egyptian mummies, due to and fellahs (Arabic for commoners). Tese conditions can life-long exposure to open fres for heating and cooking, lead to of the middle ear and mastoid sinuses, and inhalation during the sandstorms common to Egypt. and, in fact, perforated eardrums were seen in PUM II. Te diagnosis of in Egyptian mummies is rare. Te degenerative process most common in mummies is At this point, the literature contains only two reports osteoarthritis, often seen in Egyptian mummies, where its of microscopically confrmed cancer in Egyptian mum- presence in the hot dry climate of Egypt and Nubia belies mies, cancer of the rectum and of the urinary bladder the folk attribution of the disease to damp climates. X-rays in two ca. 200 CE mummies from the Dakhleh Oasis. of Ramses II have revealed severe osteoarthritis in his hips. It has been suggested that the short life span of individu-

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The Future of Mummy Studies In a computerized 21st century world where privacy is difcult to achieve, caution has been raised regarding issues of privacy for ancient historical fgures. Should they have the same rights as deceased modern individu- als? Should rules be developed for mummy studies, and in what way might that change our approach to studying disease? We must always remember that we are in fact studying deceased humans. As part of the consideration for the rights of mummies, it is important to limit the number of individuals attending mummy , thus avoiding what one observer referred to as a circus atmosphere. One cannot undervalue serendipity in the ex- amination of mummies. Even bodies that appear most unpromising may turn out to provide insight into the history and nature of disease processes. Modern technol- ogy has allowed the study of mummies to be performed by CT scanning and MRI studies, allowing selective minimally invasive sampling, thus preserving these invaluable museum specimens. It is even more likely that signifcant fndings await us in the future. Ä ABOVE: The mummified body of Pharaoh Ramses II (died 1213 BCE). Modern examinations performed with x-rays have revealed severe osteoarthritis in his hips. Photo by Wolfman12405/Wikimedia. DR. MICHAEL R. ZIMMERMAN is a Lecturer in Anthropology at the University of Pennsylvania, Adjunct Professor of Biology at Villanova University, and Visiting Professor at als in antiquity precluded the development of cancer. the KNH Centre for Biomedical Egyptology, Te University Although this statistical construct is true, due to high of Manchester. , individuals in ancient Egypt did live long enough to develop such diseases as atherosclerosis FOR FURTHER READING and osteoporosis. It must also be remembered that in , A.R. and M.R. Zimmerman. “Cancer: A new disease, modern populations, bone tumors primarily afect the an old disease, or something in between?” Invited paper, young. Another explanation for the lack of tumors in Nature Reviews Cancer 10: 728–733 (online publication, ancient remains is that tumors might not be well pre- September 3, 2010). served. However, my experimental studies indicate that Hawass, Z. et al. “Ancestry and in King the features of malignant cells are favorable to preserva- Tutankhamun’s family.” Journal of the American Medical Association 303: 638–647 (2010). tion by mummifcation. Cancer cells are characterized Zimmerman, M. “New Approaches to the Study of Ancient by large darkly staining nuclei, which are preserved by Disease.” Expedition 17.1 (Fall 1974): 24–30. mummifcation. In an ancient society lacking surgical Zimmerman, M. “Te Analysis and Interpretation of intervention, evidence of cancer should be found. Te Mummifed Remains.” In A Companion to Paleopathology. virtual absence of malignancies can be interpreted as A. L. Grauer, ed., Malden, MA: Wiley-Blackwell, pp. 152–169, 2012. indicating their rarity in Egyptian antiquity. Carcino- Zimmerman, M. My Patients Were Mummies. Nova Science genic factors increase the incidence of cancer in societies Publishers, Happauge, NY, 2017. afected by modern industrialization and tobacco usage.

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