Case report: Boundaries of oncological and traumatological medical care in ancient Egypt: new palaeopathological insights from two human skulls.

The present case studies report malignant neoplastic and traumatic lesions observed on two ancient Egyptian skulls held at the Duckworth Collection (Cambridge University). The analysis aims to characterise the lesions and provide a diagnosis using a methodology based on micro-CT scanning and microscopic bone surface analysis. Results pointed towards neoplastic lesions in both cases and healed severe skull trauma in one of them suggesting successful traumatological therapy. Interestingly, our analysis has identified the presence of perimortem cutmarks associated with metastatic lytic lesions in one of the skulls, indicating a potential surgical treatment attempt or postmortem medical exploration. We argue that the two cases, although not contemporary, allow a palaeopathological discussion on oncological and traumatological understanding and management of such conditions in the past. The confrontation of two potential managements represented by two different types of lesions represent a clear boundary in ancient Egyptian medical care and a milestone in the history of medicine.

"Mesmerizing and Terrifying": Senusret III's Unique Macrotia.

The ancient Egyptian pharaoh Senusret III was a legend to both his contemporaries and his descendants: an ideal of kingly power whose legacy of control and intimidation was remembered for centuries. Of particular note is the unique macrotia that the king's statues display. In this paper, we discuss possible etiologies of Senusret's unique presentation and ultimately conclude that Senusret's immortalized features were likely rooted in propaganda rather than a medical cause.

A gastric sarcoma from 3000 years ago: paleopathological diagnosis at the field.

OBJECTIVE: Ancient remains tell a lot to those who can solve their mysteries. Mummified remains of individuals have the potential to tell their life stories. Pathological conditions in mummies are identified, commonly, thorough macroscopic inspection and radiological techniques. PATIENTS AND METHODS: In 2017, a hypogeum tomb was excavated close to the courtyard of Djehuty's tomb (TT11) at the archaeological site of the Spanish Djehuty Project in Luxor (Egypt). In Sector 10, a set of at least 10 mummies were recovered. All showed clear signs of plundering and were found scattered at the site. Wrappings and associated goods indicated that the individuals were from the first half of the 20th dynasty (922 to 888 BCE). RESULTS: All the individuals were male and from a high social status. Upon removing the individuals for study, two dried stomachs were found. There were clear macroscopic differences. A field histological analysis was performed which revealed that the stomach that showed no alterations, at first glance, presented a pathological pattern that was compatible with gastric sarcoma. CONCLUSIONS: Malignant diseases are seldom described in Paleopathology; to our knowledge, this is the oldest and most unique case of this type of pathology in mummies worldwide.

Evolution of orthopaedic diseases through four thousand three hundred years: from ancient Egypt with virtual examinations of mummies to the twenty-first century.

PURPOSE: This study conducts a comprehensive comparative analysis of bone pathologies between ancient Egypt and today. We aim to elucidate the prevalence, types, and potential aetiological factors influencing skeletal disorders in these two distinct temporal and cultural contexts. METHODS: The research employs a multidisciplinary approach, integrating osteological, paleopathological, and historical data to understand bone pathologies in mummies and the actual world. Applying radiographs and CT scans as noninvasive techniques has shed new light on past diseases such as fractures, dysplasia, osteoarthritis, surgery, and tuberculosis. Virtual inspection has almost replaced classical autopsy and is essential, especially when dealing with museum specimens. RESULTS: Findings indicate no significant disparities in the prevalence and types of bone pathologies through 4300 years of evolution. Moreover, this study sheds light on the impact of sociocultural factors on bone health. Examination of ancient Egypt's burial practices and associated cultural beliefs provides insights into potential behavioral and ritualistic influences on bone pathologies and the prevalence of specific pathologies in the past and present. CONCLUSION: This comparative analysis illuminates the dynamic of bone pathologies, highlighting the interplay of biological, cultural, and environmental factors. By synthesizing archeological and clinical data, this research contributes to a more nuanced understanding of skeletal health's complexities in ancient and modern societies, offering valuable insights for anthropological and clinical disciplines.

How reliable is the application of the sex classifier based on exocranial surface (Musilová et al., 2016) for geographically and temporally distant skull series.

Sex estimation is one of the crucial trends in cases of findings of unknown skeletal remains in forensics and bioarchaeology. The changing nature of sexual dimorphism (population specificity, secular trend, other external and internal factors influence) brings challenges to developing new methods; and there are new aims to be independent of these changes such, as the method by Musilová et al. (2016). These methods need to be evaluated on different datasets to determine if they are truly reliable among populations from different places and times, in the case of bioarchaeology. This study assessed the application of the aforementioned method on non-European contemporary and ancient populations to identify the reliability of the method on this separate dataset. The study sample consisted of 96 CT scans of skulls from contemporary Egyptians and 54 3D models of skulls from the Egyptian Old Kingdom Period (2700-2180 BC). The classifier method, previously tested on both Czech and French populations, yielded high accuracies (over 90 %) for sex estimation. For the contemporary Egyptian skull sample, the classifier was able to determine males versus females with an 89.59 % accuracy rate and an AUC value (area under the curve - a measure of the combined specificity and sensitivity of the test) of 0.99; this proves that the classifier is reliable even with a lower degree of accuracy. Conversely, the Old Kingdom Period sample yielded a lower level of accuracy at around 70 % (61.11 %, precisely), although with an AUC value of 0.92, the result is not considered reliable.

Postmortem changes in ancient Egyptian child mummies: Possible pitfalls on CT images.

OBJECTIVE: To identify and interpret computed tomography (CT) findings of postmortem changes in ancient Egyptian child mummies. MATERIALS: Whole-body CT examinations of 21 ancient Egyptian child mummies from German (n = 18), Italian (n = 1), and Swiss museums (n = 2). METHODS: Conspicuous CT findings from prior evaluations with various research questions that were assessed as postmortem changes were classified, and special cases were illustrated and discussed. RESULTS: Postmortem changes were classified into several categories. From these, individuals with evidence of invasion of resin/oil/tar into bone, dried fluid-levels within bone most likely due to natron, probable interaction of natron with soft tissues and bone, as well as insect infestation were demonstrated. CONCLUSIONS: One challenge of paleoradiology is to differentiate between intravital and postmortem changes, which can be multifarious. These changes can be obvious, but also subtle, and can mimic diseases. SIGNIFICANCE: The provided classification of postmortem changes, as well as the demonstrated cases, may serve as models for further paleoradiological investigations. The dried intraosseous fluid levels in two mummies, most likely due to natron, suggests that these children were immersed in a liquid natron bath, in contrast to the current scientific view that natron for mummification was routinely applied in the solid form. LIMITATIONS: CT was used as the only examination method, as sampling of the mummies was not possible. SUGGESTIONS FOR FURTHER RESEARCH: The awareness that postmortem changes on CT images of ancient Egyptian mummies might mimic pathology should be raised to reduce or avoid incorrect interpretation.

Two God-Kings, Two Skulls: Artificial Cranial Deformation in Akhenaten of Egypt and Khingila of the Huns.

Separated by half a continent and over 1800 years, Akhenaten, the "Heretic Pharaoh" of Egypt, and Khingila, "The God-King" of the Alchon Huns, had a great deal in common. Both rulers laid claim to divinity, labeling themselves as gods amongst men, and both are represented in their official imagery with unusually shaped skulls consistent in appearance with artificial cranial deformation (ACD) performed upon them soon after birth. This article compares the evidence - including the KV55 mummy, likely the remains of Akhenaten himself - between the two God-Kings and determines that Khingila almost certainly possessed an annular erect ACD consistent with the wider Hun culture. Akhenaten's ACD in his state-sponsored imagery was likely solely an artistic choice meant to emphasize his oneness with the divine. In both men, their represented ACD was ultimately intended to solidify their power through two different avenues. For Khingila, it was to emphasize a common ethnic and cultural heritage with his subjects. For Akhenaten, it was meant to set the pharaoh even further apart from the rest of humanity.

Two cases of pelvic trauma with survival in the necropolis of Qubbet el-Hawa (Egypt).

OBJECTIVE: To evaluate the presence of a trauma that results in pelvic ring disruption and its clinical implications in two individuals from ancient Egypt. MATERIALS: Two complete skeletons of adult women, dated to the Middle Kingdom (c. 1980-1760 BCE), from two tombs in the necropolis of Qubbet el-Hawa (Aswan, Egypt). METHODS: The anatomical elements were examined macroscopically in Egypt. RESULTS: Unilateral sacroiliac luxation with disruption of the pubic symphysis was detected in both individuals. The presence of an overlapped symphysis was evident in female QH34aa. A healed fracture of the iliopubic ramus are present in female QH122. Antemortem bone alterations in the pelvis demonstrate that they survived the trauma. CONCLUSIONS: Pelvic trauma due to a lateral compression was detected in the os coxae. Both women survived but probably had severe sequelae that impaired their quality of life. At least one of them might have received some type of medical treatment. SIGNIFICANCE: Both cases shed light on pelvic fractures, their mechanisms of production, and their effects on bone and its functionality, as well as revealing possible associated lesions of soft tissues and vital organs. LIMITATIONS: The pelvis, or at least the pubic symphysis, must be well preserved to allow the correct diagnosis of this type of lesion. SUGGESTIONS FOR FURTHER RESEARCH: Studies are warranted on the detection of this type of fracture, focusing on the subtle bone changes that indicate its presence. There is also a need to develop methodologies that combine the study of bone and soft tissue alterations.

Found in the Folds: A Rediscovery of Ancient Egyptian Pleated Textiles and the Analysis of Carbohydrate Coatings.

Charles T. Currelly, first director of the Royal Ontario Museum, participated in excavations of the tomb of King Nebhepetre, now known as Mentuhotep II, (Dynasty XI) in Deir el-Bahri, Egypt in 1906. He brought to Canada many objects from the excavations, and objects that he purchased while in Egypt; these formed the initial collection of the museum. Among the objects were seven fragments of fine linen cloth with intricate pleat patterns. Recently, the cloths became the subject of a study to learn how they had retained their pleats for 4000 years. Samples were examined and analysed using polarised light microscopy, scanning electron microscopy-electron dispersive X-ray spectrometry, gas chromatography-mass spectrometry, and pyrolysis-gas chromatography-mass spectrometry. Three of the cloths were likely fragments of clothing re-purposed as bandages and were found to be saturated in mummification balms composed of Pinaceae resin, Pistacia resin, and an essential oil characterised by a high abundance of cedrol, possibly originating from a juniper species. All seven of the cloths were found to have traces of polysaccharides from two probable sources: an arabinogalactan gum such as gum arabic or a fruit gum, and a polyglucoside, possibly starch.

Tracing the Fate of the Northern Bald Ibis over Five Millennia: An Interdisciplinary Approach to the Extinction and Recovery of an Iconic Bird Species.

We trace the history of the endangered Northern Bald Ibis through different epochs to the present. A particular focus is placed on its life in and disappearance from ancient Egypt, where the bird attained great cultural and religious significance, and on the modern endeavour to re-wild the species. Due to the characteristic appearance, behaviour and habitat of the species as well as its need for open foraging areas, a close mutualistic relationship between humans and the birds was formed in ancient Egypt, as in other cultures. A clear benefit for the Northern Bald Ibis was the availability of feeding habitats, which were cleared by humans for farming or grazing. The benefit to people was rather cultural because the bird attracted religious veneration or symbolic meanings from ancient Egypt to medieval Europe. The proximity to humans, however, carried a high risk as well. We discuss various types of impact (including human impacts as well as climate change) as triggers for the extinction of the species. The evidence for a triple disappearance of the Northern Bald Ibis (around 2000 BCE, around 1600 CE and in modern time) represents a unique basis for studying both the bird's habitat preferences and its vulnerability. This is because different, mainly anthropogenic, causes stood behind these three historical disappearances, although the disappearances in all three epochs occurred during a period of climate change.

Metagenomic analysis of Ancient Egyptian canopic jars.

Ancient Egyptian remains have been of interest for anthropological research for decades. Despite many investigations, the ritual vessels for the internal organs removed during body preparation-liver, lungs, stomach, and intestines, of Egyptian mummies are rarely used for palaeopathological or medical investigations. These artifacts, commonly referred to as canopic jars, are the perfect combination of cultural and biological material and present an untapped resource for both Egyptological and medical fields. Nevertheless, technical challenges associated with this archeological material have prevented the application of current ancient DNA techniques for both the characterization of human and pathogenic DNA. We present shotgun-sequenced metagenomic profiles and ancient DNA degradation patterns from multiple canopic jars sampled from several European museum collections and enumerate current limitations and possible solutions for the future analysis of similar material. This is the first-ever recorded evidence of ancient human DNA found in Ancient Egyptian canopic jars and the first associated metagenomic description of bacterial taxa in these funerary artifacts. OBJECTIVES: In this study, our objectives were to characterize the metagenomic profile of the Ancient Egyptian funerary vessels known as canopic jars to retrieve endogenous ancient human DNA, reconstruct ancient microbial communities, and identify possible pathogens that could shed light on disease states of individuals from the past. METHODS: We applied ancient DNA techniques on 140 canopic jars to extract DNA and generate whole-genome sequencing libraries for the analysis of both human and bacterial DNA. The samples were obtained from museum collections in Berlin (DE), Burgdorf (DE), Leiden (NE), Manchester (UK), Munich (DE), St. Gallen (CH), Turin (IT), and Zagreb (HR). RESULTS: Here we describe the first isolated DNA from the Egyptian artifacts that hold human viscera. No previous work was ever conducted on such material, which led to the first characterization of human DNA from Ancient Egyptian canopic jars and the profiling of the complex bacterial composition of this highly degraded, challenging, organic material. However, the DNA recovered was not of enough quality to confidently characterize bacterial taxa associated with infectious diseases, nor exclusive bacterial members of the human microbiome. DISCUSSION: In summary, we present the first genomic survey of the visceral content of Ancient Egyptian funerary artifacts and demonstrate the limitations of current molecular methods to analyze canopic jars, such as the incomplete history of the objects or the presence of uncharacterized compounds that can hamper the recovery of DNA. Our work highlights the main challenges and caveats when working with such complicated archeological material - and offers sampling recommendations for similarly complex future studies, such as incrementing the amount of starting material and sampling from the less exposed parts of the jar content. This is the first-ever recorded evidence of ancient human DNA found in Ancient Egyptian canopic jars, and our results open new avenues in the study of neglected archeological artifacts.

Suicidal Depression in Ancient Egypt.

OBJECTIVE: To evaluate the oldest record of a depressed individual contemplating suicide. METHOD: A directed review of ancient Egyptology literature of translations and discussion regarding a papyrus that is approximately 4,000 years old. RESULTS: The content of the document is consistent with a man going through a severe depression and is contemplating suicide. However, this does not appear to be a suicide note, but more of an ancient example of 'journaling' or working through the thoughts of suicide and its possible consequences to the man's eternal life in the afterworld. CONCLUSIONS: Presentation of depression, the reasons for considering suicide, and the process by which an individual works through those thoughts have not varied significantly over the past 4,000 years.

Congenital kyphosis due to a body agenesis from Ancient Egypt.

In Paleopathology, total lack of a vertebral body is a rare finding, mostly due to infectious diseases or tumors. We report the case of an adult male from the necropolis next to "Temple of the Millions of Years" of Thutmose III dated to the Late Old Kingdom and First Intermediate Period (2345-2055 BCE). He showed a fracture of T12, more than 50%, associated with the complete disappearance of the body of L1 and bilateral transverse process. Infection and tumor involvement were ruled out due to the morphology of the spinal segment. The most likely diagnosis was complete body agenesis. Congenital kyphosis related to vertebral agenesis has been described as a possibility in paleopathology, but it had not been reported until now.

X-ray Imaging Investigation on the Gilding Technique of an Ancient Egyptian Taweret Wooden Statuette.

Diagnostic physical methods are increasingly applied to Cultural Heritage both for scientific investigations and conservation purposes. In particular, the X-ray imaging techniques of computed tomography (CT) and digital radiography (DR) are non-destructive investigation methods to study an object, being able to give information on its inner structure. In this paper, we present the results of the X-ray imaging study on an ancient Egyptian statuette (Late Period 722-30 BCE) belonging to the collection of Museo Egizio in Torino and representing an Egyptian goddess called Taweret, carved on wood and gilded with some colored details. Since few specific studies have been focused on materials and techniques used in Ancient Egypt for gilding, a detailed investigation was started in order to verify the technical features of the decoration in this sculpture. Specifically, DR and CT analyses have been performed at the Centro Conservazione e Restauro "La Venaria Reale" (CCR), with a new high resolution flat-panel detector, that allowed us to perform tomographic analysis reaching a final resolution better than the one achievable with the previous apparatus operating in the CCR.

Molecular analysis of black coatings and anointing fluids from ancient Egyptian coffins, mummy cases, and funerary objects.

Black organic coatings and ritual deposits on ancient Egyptian coffins and cartonnage cases are important and understudied sources of evidence about the rituals of funerary practice. Sometimes, the coatings were applied extensively over the surface of the coffin, resembling paint; in other cases, they were poured over the mummy case or wrapped body, presumably as part of a funerary ritual. For this study, multiple samples of black coatings and ritual liquids were taken from 20 Egyptian funerary items dating to a specific time period (c. 943 to 716 BC). Multiple sampling from each object enabled several comparisons to be made: the variability of the black coating within one application, the variability between two applications on one object, and the variability from object to object. All samples were analyzed for lipids using gas chromatography-mass spectrometry (GC-MS), and 51 samples from across the 20 items were further analyzed for the presence of bitumen using solid phase separation followed by selected ion monitoring GC-MS. The majority of the black substances were found to comprise a complex mixture of organic materials, including bitumen from the Dead Sea, conifer resin, and Pistacia resin, providing evidence for a continuation in international trade between Egypt and the eastern Mediterranean after the Late Bronze Age. Both the coating and the anointing liquid are very similar to mummification balms, pointing to parallels with Egyptian embalming rituals and raising questions about the practical aspects of Egyptian funerary practice.

Evaluation of a characterization method of Egyptian human mummy balms by chemometric treatments of infrared data.

In the context where lengthy protocols are used to extract and to characterize each substance from mummification balms using techniques such as gas chromatography and mass spectrometry, this paper presents the evaluation of the efficiency of an original method to characterize mummification balms using the SIMPLISMA algorithm in infrared spectroscopy. This tool is a pure variable approach corresponding to the selection of calibration variables. This developed approach was combined with chemometric treatment (principal component analysis) to interpret the 47 Fourier Transform Infrared spectra of human mummies' balms from Ancient Egypt. This treatment gave 6 pure spectra and their corresponding extracted concentration profiles. The first pure spectrum corresponded to residual species, and the second to the identification of polycyclic aromatic hydrocarbons, molecules which have a pyrolytic origin. The fourth pure spectrum corresponded to proteins which were characterized, and could be considered as markers of good conservation of individuals. The fifth pure spectrum characterized polysaccharides. Finally, two pure spectra showed the same natural substance, namely fat, which, on the one hand, was unaltered and, on the other hand, was degraded fatty matter. This fast, simple and non-destructive approach allowed the composition of each balm to be studied and their state of conservation/degradation to be characterized. This approach enabled the presence of proteins, polysaccharides and fatty matter or beeswax in different states of conservation/alteration in the studied balms to be characterized.

Digital Unwrapping of the Mummy of King Amenhotep I (1525-1504 BC) Using CT.

The mummy of King Amenhotep I (18th Dynasty c.1525-1504 BC) was reburied by the 21st Dynasty priests at Deir el-Bahari Royal Cache. In 1881 the mummy was found fully wrapped and was one of few royal mummies that have not been unwrapped in modern times. We hypothesized that non-invasive digital unwrapping using CT would provide insights on the physical appearance, health, cause of death, and mummification style of the mummy of King Amenhotep I. We examined the mummy with CT and generated two- and three-dimensional images for the head mask, bandages, and the virtually unwrapped mummy. CT enabled the visualization of the face of Amenhotep I who died around the age of 35 years. The teeth had minimal attrition. There was no CT evidence of pathological changes or cause of death. The body has been eviscerated via a vertical left flank incision. The heart is seen in the left hemithorax with an overlying amulet. The brain has not been removed. The mummy has 30 amulets/jewelry pieces including a beaded metallic (likely gold) girdle. The mummy suffered from multiple postmortem injuries likely inflicted by tomb robbers that have been likely treated by 21st Dynasty embalmers. These included fixing the detached head and neck to the body with a resin-treated linen band; covering a defect in the anterior abdominal wall with a band and placing two amulets beneath; placement of the detached left upper limb beside the body and wrapping it to the body. The transversely oriented right forearm is individually wrapped, likely representing the original 18th Dynasty mummification and considered the first known New Kingdom mummy with crossed arms at the chest. The head mask is made of cartonnage and has inlaid stone eyes. The digital unwrapping of the mummy of Amenhotep I using CT sets a unique opportunity to reveal the physical features of the King non-invasively, understand the mummification style early in the 18th Dynasty, and the reburial intervention style by 21st Dynasty embalmers. This study may make us gain confidence in the goodwill of the reburial project of the Royal mummies by the 21st dynasty priests.

njures of most probably traumatic origin on an ancient Egyptian mummy's head / Feltehetoen traumás eredetu sérülések egy ókori egyiptomi múmiafejen.

Összefoglaló. Bevezetés: Egy traumás eredetu sérüléseket mutató, ókori egyiptomi koponya vizsgálatát ismertetjük a Magyar Természettudományi Múzeum gyujteményébol. A jelen cikkben egy mumifikált fej elemzését emeltük ki, ennek átfogó vizsgálatát és részletes eredményeit közöljük. Célkituzés: Célunk egy multidiszciplináris vizsgálatsorozat megvalósítása volt, amelyen keresztül képet kapunk az egykor Egyiptom területén élt emberek egészségi állapotáról. Módszer: A kutatás során a múmiákon szerves és szervetlen kémiai analíziseket, komputertomográfiai és röntgenvizsgálatot, szénizotópos kormeghatározást végeztünk, és felhasználtunk biológiai antropológiai módszereket is. Eredmények: A koponya igazoltan az ókori Egyiptomból származik, és mivel sebei gyógyulásnak indultak, véleményünk szerint az egyén túlélte a fejét ért behatást. Ez meglepo eredménynek minosül, hiszen ilyen jellegu életveszélyes traumás sérüléseket csak akkor lehet nagy valószínuséggel túlélni, ha megfelelo orvosi ellátás áll rendelkezésre. Következtetés: Úgy gondoljuk, ebben az esetben is ez történt, bizonyítva, hogy az egyiptomi orvosi ismeretek valóban igen fejlettek és az orvoslás magas színvonalú volt. Orv Hetil. 2020; 161(51): 2162-2170. INTRODUCTION: We are presenting the analysis of an ancient Egyptian mummified head from the collection of the Hungarian Natural History Museum, which shows special traumatic injuries. The examination of this artefact nicely demonstrates the procedures we usually apply in our research on the Egyptian mummies of the Museum. OBJECTIVE: Our aim was to implement a series of multidisciplinary studies to get a picture of the health condition of these people once living in the territory of Egypt. METHOD: When researching the mummies, we performed organic and non-organic chemical analyses, computed tomography, X-ray examinations, radiocarbon isotope dating as well as biological anthropological methods. RESULTS: In this article, we report on the comprehensive examination of the skull and the detailed results we got. The skull is proven to originate from ancient Egypt. CONCLUSION: As the wounds began to heal, we can conclude that the individual survived the impact on his head. This is quite surprising as such life-threatening traumatic injuries can only be survived if adequate medical care is available. We believe this was the case also here, i. e., ancient Egyptian medicine was highly developed and of really high standards. Orv Hetil. 2020; 161(51): 2162-2170.

The Vaults of Umm al-Dabadib: Geometric Study.

This article focuses on the shape of the vaults that cover the rooms of the Fort of Umm al-Dabadib (Kharga Oasis, Egypt's Western Desert), dating to the Late Roman Period. This building is the central element of the contemporary Fortified Settlement, consisting of a dense, three-dimensional mosaic of domestic units, all covered by similar vaults, and belonging to a chain of similar installations. Two elements make Umm al-Dabadib an interesting case-study: the excellent preservation of its architectural remains, and the possibility to rely on an accurate photogrammetric survey of the entire built-up area. Thanks to this combination, it was possible to analyse the geometric shape of the vaults in connection to the ancient building techniques. The study determined that the vaults of the Fort are elliptical; this conclusion will impact on the study of all the similar settlements built in the Kharga Oasis, and possibly to other contemporary buildings elsewhere in Egypt.