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Mummified Daughters of King Tutankhamun: Archeologic and CT Studies

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The purpose of this study was to use MDCT to examine two mummies found in the tomb of King Tutankhamun to estimate their gestational ages at mummification, to determine the mummification method, and to investigate the congenital deformities of one of the mummies that had been suspected at previous medical examinations. MDCT was performed on the mummies of the daughters of King Tutankhamun (article numbers 317a and 317b), and the images were reconstructed and subjected to forensic imaging analysis. The gestational ages at mummification of mummies 317a and 317b were estimated to be approximately 24.7 and 36.78 weeks. The skeletal congenital anomalies of mummy 317b suggested at past radiographic analysis were ruled out. The results of this study may set a precedent for use of CT and forensic image analysis in the study of ancient mummified fetuses.
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AJR:197, November 2011 W829
er, until 1932, when Douglas Derry, of the
department of anatomy at Cairo University,
performed autopsies on both mummies [1].
At the postmortem examination, Derry de-
scribed both mummies as female fetuses at 5
and 7 months of gestation. The smaller fetus,
317a, was almost perfectly preserved at that
time and measured 25.75 cm in length with
the arms placed on the fronts of the thighs.
It had no eyebrows or eyelashes, and 21 mm
of the umbilical cord was preserved. Derry
did not notice any abdominal incisions in fe-
tus 317a, which raised the suspicion that it
had mummified naturally. The larger fetus,
317b, was less well preserved when Der-
ry first examined it and measured 36.1 cm
in length with the arms extended and placed
beside the thighs. The eyebrows and eyelash-
es were visible; the eyes were open, and there
was downy hair on the scalp. It appeared that
mummy 317b had been artificially mummi-
fied: A 1.8-cm left inguinal embalming in-
cision was found, and skull linen packs had
been inserted through the nose [2].
After the 1932 examination, the two mum-
mies were placed at the Faculty of Medicine,
Cairo University, for safekeeping. In 1978,
Harrison and colleagues examined mummy
317b radiographically. In their report [3], those
authors theorized that the girl was 35 weeks’
gestation to term at mummification and had
Mummified Daughters of King
Tutankhamun: Archeologic
and CT Studies
Zahi Hawass
1
Sahar N. Saleem
2
Hawass Z, Saleem SN
1
Department of State for Antiquities, Egypt, Cairo, Egypt.
2
Department of Radiology, Kasr Al Ainy Faculty of
Medicine, Cairo University, 4 St 49 Mokattam, 11571
Cairo, Egypt. Address correspondence to S. N. Saleem
(saharsaleem1@gmail.com).
Special Article Original Research
WEB
This is a Web exclusive article.
AJR 2011; 197:W829–W836
0361–803X/11/1975–W829
© American Roentgen Ray Society
I
n 1922, Howard Carter found
two small mummies in the trea-
sury chamber of the tomb of
King Tutankhamun (circa 1336
1327 BC) in the Valley of the Kings, Luxor,
Egypt (Valley of the Kings tomb 62, or
KV62) [1]. The two mummies were found in-
side an undecorated wooden box, which
Carter designated article 317. Nestled within
the box were two anthropoid coffins laid side
by side in opposing directions. The two cof-
fins and their respective mummies were des-
ignated articles 317a, the smaller mummy,
and 317b, the larger mummy. Both coffins
were covered in a layer of black resin and
decorated with gold bands, which simply
named the deceased children as the Osiris.
The lids were attached to the coffin bases by
eight flat wooden tenons. Around the coffins
were bands with clay seal impressions of the
jackal and nine captives, also referred to as
the nine bows, or the nine enemies of Egypt.
Bands were also wrapped around the mum-
my bundles beneath the chin, around the
waist, and around the ankles. A second cof-
fin covered in gold foil was in each outer cof-
fin. Within these gilded inner coffins were
the mummified fetuses [1].
Carter first examined the smaller mum-
my in 1925, when he removed the bandages.
Both fetuses were not fully studied, howev-
Keywords: congenital, CT, fetus, mummy
DOI:10.2214/AJR.11.6837
Received March 11, 2011; accepted after revision
June 10, 2011.
OBJECTIVE. The purpose of this study was to use MDCT to examine two mummies
found in the tomb of King Tutankhamun to estimate their gestational ages at mummification,
to determine the mummification method, and to investigate the congenital deformities of one
of the mummies that had been suspected at previous medical examinations.
MATERIALS AND METHODS. MDCT was performed on the mummies of the
daughters of King Tutankhamun (article numbers 317a and 317b), and the images were re-
constructed and subjected to forensic imaging analysis.
RES ULTS . The gestational ages at mummification of mummies 317a and 317b were esti-
mated to be approximately 24.7 and 36.78 weeks. The skeletal congenital anomalies of mum-
my 317b suggested at past radiographic analysis were ruled out.
CONCLUSION. The results of this study may set a precedent for use of CT and forensic
image analysis in the study of ancient mummified fetuses.
Hawass and Saleem
CT of Fetal Mummies
Special Article
Original Research
W830 AJR:197, November 2011
Hawass and Saleem
multiple congenital anomalies of Sprengel
deformity, spinal dysraphism, and scoliosis.
These findings were suspected because the
mummy had the raised left scapula, long left
clavicle, and open vertebral laminae that con-
stitute Sprengel deformity. In 2001, Cham-
berlain [4] hypothesized that the two fetuses
were twins and that their difference in devel-
opment was a consequence of twin-twin
transfusion syndrome. In 2008, Hellier and
Connolly [5] reassessed the radiograph of the
larger fetus (317b) and suggested a younger
age (30 weeks’ gestation) than had been pre-
dicted by Harrison and colleagues.
DNA studies conducted by the Tutankha-
mun Family Project, a substudy of the Egyp-
tian Mummy Project, in 2007–2009 showed
that Tutankhamun is the most likely father
of the two fetuses. The degrees of probabil-
ity were 99.97992885% and 99.99999299%
for mummies 317a and 317b [6]. The Egyp-
tian Mummy Project contacted the Faculty
of Medicine at Cairo University to study the
two fetuses with CT. The purpose of this CT
study of the two mummified stillborn daugh-
ters of King Tutankhamun was to estimate
their ages at mummification, to assess the
mummification method, and to investigate
the alleged congenital anomalies of the larger
mummy, 317b, suspected at previous medi-
cal examinations.
Materials and Methods
CT Technique and Image Analysis
We used an MDCT scanner (LightSpeed, GE
Healthcare) in the radiology department at Cairo
University. Institutional and departmental ethical
approvals were obtained before the study. On July
28, 2008, each mummy was placed separately in
an open wooden box inside the gantry. The ap-
propriate settings were adjusted to not exceed the
thermal capability of the x-ray tube (120 kV, 140
mA). Anteroposterior and laterolateral scout im-
ages were obtained to include the whole mummy.
The minimum scanning thickness allowed by the
CT unit (0.625 mm) was chosen. A total of 495
CT images of mummy 317a and 701 images of
317b were obtained. Multiplanar reformatted im-
ages, including curved images along the dental ar-
cades (orthopantomogram style) and advanced 3D
reconstructed images were obtained, and manu-
al tracing and virtual removal of linen tissue and
other embalming materials were performed on
site at a workstation (Advantage Windows version
4, GE Healthcare).
Three-dimensional reconstruction was accom-
plished with preset algorithms for soft tissues with
varying window width parameters and volume
rendering techniques. Bone length and the attenu-
ation of soft-tissue structures, linen, and embalm-
ing materials were measured electronically. Each
measurement was made once.
Estimation of Stature
We first attempted direct vertex-tarsal measure-
ments on the maximum intensity projection mid-
sagittal reconstructed CT image. When this was
not possible, stature was extrapolated from a long-
bone measurement with the following equation [7]
Stature in centimeters = 7.92 ×
(humeral length in centimeter – 0.32) + 1.8
Estimation of Gestational Age
at Mummification
Estimation of the average age at mummifica-
tion of each fetus was attempted with radiologic
forensic methods that depended on measurements
of long bones, the presence of ossification centers,
the morphologic features of the bones, and tooth
mineralization. The following regression equa-
tions based on bone length in millimeters were
used to estimate fetal age [8, 9] in weeks:
Fetal age SD 2.33 =
(0.4585 × humeral length) + 8.6563
Fetal age SD 2.0 =
(0.3303 × femoral length) + 13.5583
Fetal age SD 2.1 =
(0.4207 × tibial length) + 11.4724
The normal chronologic appearance of ossifi-
cation centers of the calcaneum occurs at 24–26
weeks of pregnancy, the talus at 26–28 weeks,
the distal femoral epiphysis at 36 weeks, and the
proximal tibial epiphysis at 38 weeks [10]. Age
also was estimated by inspection of the ossifica-
tion center clusters around the knee, foot, and pel-
vis and assignment of the Olsen score of ossifica-
tion for children who die in the perinatal period
[11]. We also used multifactorial estimation of the
age of a dead fetus with the Stempfle radiographic
scoring system, which is based on the appearance
of ossification centers; the bone structure at the
knee, hindfoot, wrist, and pelvis; and tooth min-
eralization [12].
Determination of Sex and Other Observations
The sex of both fetuses was determined by
study of the morphologic appearance of the exter-
nal genitalia and os coxa. Additional analysis of
the CT images was performed to determine pres-
ervation status, body position, mummification
method, presence of skeletal anomalies and dis-
ease, and cause of death.
Results
Fetus 317a
At the time of this study, fetus 317a was in
very poor condition with marked bone and
soft-tissue damage likely caused by post-
mortem trauma. This damage was evident on
2D and 3D reconstructed CT images (Figs.
1A and 1B). It was not possible to accurate-
ly measure stature on CT images because of
the poor preservation status of the mummy.
From the reasonably preserved left humerus
(length, 35 mm), however, the body stature
was extrapolated to be 27.7 cm. From humer-
al length, gestational age at mummification
was inferred to be 24.7 (SD, 2.3) weeks (5–6
months). The sex of the mummy could not be
assigned from the CT images.
The cranium of mummy 317a was filled
with contents of mixed high and low CT at-
tenuation (–922 to 172 HU) that might have
represented atrophic brain tissue or embalm-
ing material (Fig. 1C). The deteriorated con-
dition of the mummy hampered determina-
tion of use of the transcranial embalming
route or abdominal incision. However, elabo-
rate structures of mixed attenuation (–900 to
600 HU) detected in the torso (Fig. 1D) like-
ly represent visceral packs used for artificial
mummification. No evidence of gross skele-
tal anomalies or a cause of death was found.
Fetus 317b
Preservation status—Two- and three-di-
mensional reconstructed CT images of mum-
my 317b (Figs. 2 and 3) showed multiple post-
mortem fractures of the skull, cervical spine,
shoulders, arms, and feet. Because this mum-
my was better preserved than 317a, a more
thorough study was conducted.
Position—The mummy was in the supine
position with the arms laid straight along
both sides of the body.
Method of mummicationThe follow-
ing CT observations suggest that artificial
embalming was used. A left inguinal inci-
sion extended obliquely for 18 mm with a
maximum depth of 13 mm and opened lips
of 5–11 mm. No evidence of metal plaque
or sutures within the incision was present.
Multiple convoluted structures with mixed
CT attenuation (–1000 to 609 HU) were de-
tected inside the torso, likely representing
visceral packs and embalming materials.
Brain extraction could not be verified be-
cause the skull base was fractured. The skull
contained structures of variable attenuation
(–1000 to 200 HU) that might represent atro-
phic brain or embalming material. Evidence
AJR:197, November 2011 W831
CT of Fetal Mummies
of subcutaneous high-attenuation filling was
found in the lower extremities. This material
probably was used to restore the contour of
the mummys legs. As a result, the left thigh
was noticeably larger than the right.
Stature and bone measurements—The
presence of multiple skeletal and craniofacial
fractures hampered direct measurement of
vertex-to-heel length. Body stature extrapo-
lated from humeral length was 45 cm.
Estimation of age at mummificationTa-
ble 1 and Figure 4 show the bone morpholog-
ic features, secondary ossification centers,
and teeth mineralization of mummy 317b.
These data facilitated estimation of gesta-
tional age at mummification with different
forensic radiographic scores and formulas
(Table 2). With these methods, the gestation-
al age of mummy 317b was estimated to be
36.78 (SD, 1.91) weeks.
Determination of sexThe morphologic
features of the external genitalia of the fetus
were consistent with those of a girl, as was
the morphologic appearance of an os coxa
with its wide subpubic angle (118°) and an
ischiopubic ratio less than 1.
CT Findings in Anatomic Regions in Mummy 317b
Skull—Multiple postmortem comminuted
fractures involved the cranial vault and base.
Neither skull dimensions nor the status of su-
ture fusion could be assessed in the presence
of the fractures (Fig. 3).
A B C
D
Fig. 1Female fetus at 56 months of gestation
(mummy 317a).
A, Coronal full-length 2D reconstructed CT image
shows multiple comminuted postmortem fractures
(arrows).
B, Color frontal 3D reconstructed CT image shows
body surface and postmortem cranial injuries (arrow )
that are difficult to appreciate in A.
C, Transverse CT scan through skull shows skull
filled with contents of mixed high and intermediate
attenuation (arrow ) that may represent atrophic brain
residue or embalming material. Presence of multiple
postmortem skull fractures hampers determination of
transcranial embalming route.
D, Transverse CT scan through torso shows dense
structures (arrows ) within torso that likely are
visceral packs used in artificial mummification.
W832 AJR:197, November 2011
Hawass and Saleem
Shoulder girdlesThe left shoulder was
completely separated from the body and dis-
placed upward by an oblique postmortem
fracture (Fig. 5A). The left scapula was 6
mm higher than the right, but both scapulae
had normal comparable lengths (right, 18.2
mm; left, 20 mm). No CT evidence of Spren-
gel shoulder deformity, scapular hypoplasia,
or an omovertebral bone was found. The left
clavicle was dislocated from its scapular at-
tachment and thus appeared more horizontal
than the right (Figs. 5B and 5C). The clav-
icles had comparable normal lengths of ap-
proximately 2.4 cm each.
SpineComminuted postmortem frac-
tures involved the cervical vertebrae from
C1 to C6. The fragments of vertebrae were
seen at the base of the skull. At C7, only the
left lamina and pedicle were present; the oth-
er vertebral parts were missing. An oblique
postmortem fracture crossed the upper four
dorsal vertebrae. The fracture disrupted the
vertebral rings and widely separated the lam-
inae of the dorsal vertebrae from D1 to D4.
Multiple comminuted fractures of the bod-
ies of the upper four dorsal vertebrae likely
occurred postmortem; many fragments were
missing. The vertebrae looked normal from
D5 to the sacrum. Mild thoracic scoliosis,
likely postural, with the convexity to the left
maximum at D12 was found.
Torso The right anterolateral aspect of the
lower chest and abdominal wall were defective.
Soft-tissue residue and strands within the tho-
racic cage possibly represented the heart. Mul-
tiple convoluted visceral packs and embalming
materials were seen within the torso.
ExtremitiesMultiple postmortem frac-
tures of the right humeral neck, left humer-
al diaphysis, both wrists, and both feet were
found. There was no CT evidence of bone
healing or anomalies.
Cause of deathCT did not show anoma-
lies that indicated the cause of death.
Discussion
The two stillborn daughters of King Tu-
tankhamun (circa 13361327 BC) were
mummified and buried with their father in
his tomb (KV62) in the Valley of the Kings,
Luxor, Egypt. In ancient Egypt, stillborn
infants and fetuses were buried with their
parents. A perinatal skeleton was recov-
ered from near the tomb of King Horem-
heb (1323–1295 BC) at Saqqara, Egypt, with
what might be the fragmented remains of
Queen Mutnodjmet (possibly the mother)
[13]. The Italian Egyptologist, Ernesto Schi-
aparelli, found another ancient mummified
fetus in the Valley of the Queens (QV), Lux-
or, Egypt, between 1903 and 1906 [14]. It is
on display in the tomb of Amonherkheper-
shef (QV 55), a son of King Ramesses III
(1184–1153 BC). This child may be the off-
spring of Ramesses III, but no evidence has
been found to prove it. At another site (Kel-
lis 2), 82 fetal and perinatal skeletons were
buried alongside other juveniles and adults
in a Roman Period (50450 AD) cemetery in
Dakhleh Oasis, Egypt [15]. Apart from the
fetuses of the Chinchorro people, dating to
5000–500 BC in northern Chile and south-
ern Peru [16], no other mummified fetuses
from ancient civilizations have been docu-
mented, to our knowledge.
In this study, we documented the poor
current status of the mummified daughters
cataloged 317a and 317b. The full-length 2D
and 3D reconstructed CT images allowed
overall noninvasive inspection of the mum-
mies without further damage to the pre-
cious ancient remains. The condition of the
mummies, especially mummy 317a, has de-
teriorated markedly since the original pho-
tographs taken by Carter and Derry in late
1920s and early 1930s.
In 18th dynasty artificial mummification,
the brain often was removed, usually through
A B
Fig. 2Female fetus at 9 months of gestation
(mummy 317b).
A, Coronal photograph obtained on January 7, 2009,
soon after CT examination, shows poor current
status of mummy. Physical examination was not
performed because of fragile condition of mummy.
Used courtesy of Kenneth Garrett.
B, Coronal CT image shows poor preservation
status of mummy and multiple postmortem skeletal
fractures. Arrowhead points to dislocated fractured
right foot. Dense structures in torso (arrow) are likely
visceral packs and suggest artificial mummification
was performed.
AJR:197, November 2011 W833
CT of Fetal Mummies
a nostril and a skull-base defect. Viscera were
removed through a left inguinal incision and
replaced with packs of linen impregnated
with resin or other chemicals. Spontaneous
natural mummification implies dryness of the
tissues in a hot environment without removal
of the viscera or brain. In his autopsy report,
Derry [2] mentioned skull linen packs insert-
ed through the nose of mummy 317b and sug-
gested that the body had been subjected to
artificial mummification. In our study, CT de-
picted intracranial structures with variable at-
tenuation in both mummies that may repre-
sent atrophic brain remnants or embalming
materials. However, brain extraction was not
verified in either mummy owing to extensive
postmortem skull fractures.
The results of our study corroborate Der-
ry’s autopsy report, which noted a left ingui-
nal incision in mummy 317b but did not identi-
fy abdominal incisions in the smaller mummy
317a. The results of our CT study suggest that
both daughters might have been artificially
mummified: We detected elaborate structures
within the body cavities that likely represent
visceral packs. These findings negate Derry’s
assumption that mummy 317a was naturally
A B
Fig. 3Female fetus at 9 months of gestation
(mummy 317b).
A, Frontal reconstructed CT image of skull shows
multiple comminuted craniofacial fractures that give
false impression of enlarged skull.
B, Lateral reconstructed CT image shows flattened
skull and facial injuries (arrows ).
TABLE 1: Bony Morphologic Features and Secondary Ossification Centers Used to Estimate Gestational Age of Fetus 317b
Anatomic Feature Finding
Femoral length (mm)
Right 65
Left 65
Tibial length (mm)
Right 55
Left 55
Knee ossification centers Present bilaterally, slightly more developed on left
Right knee diameters (mm)
Distal femoral epiphysis 4
Proximal tibial epiphysis 1.6
Left knee diameters (mm)
Distal femoral epiphysis 4.1
Proximal tibial epiphysis 1.7
Hindfoot ossification centers
Talus Present on both sides with concavity at the upper and plantar surfaces
Calcaneus Present on both sides
Cuboid Not visualized
Superior pubic ramus Ossified with dumbbell shape
Ischial ramus Ossified, concave in anterior aspect
Sternum Ossified
Inferior radial metaphysis Flat
Inferior tibial metaphysis Flat (in most parts with areas of convexities)
Dental mineralization Ossified crowns of maxillary and mandibular teeth; central and lateral incisors, canine, first and second molars on both
right and left
W834 AJR:197, November 2011
Hawass and Saleem
mummified. However, the mummies were
not subjected to chemical analysis. There-
fore, with imaging alone, we can only spec-
ulate on whether artificial mummification,
which is chemical, was performed.
Because long-bone growth has a linear
relation to fetal development [17], we de-
termined gestational age at mummification
for the two mummies by performing precise
digital measurements of their bones on CT
images. Digital measurements on CT images
are more precise than manual measurements
on radiographs [3, 5]. We estimated the ges-
tational age of mummy 317a to be 24.7 (SD,
2.3) weeks on the basis of the length of the
humerus. This result is close to Derry’s [2]
estimate of the mummy’s age at approxi-
mately 5 months’ gestation based on findings
at physical examination. CT images of the
larger mummy (317b) showed that the diaph-
yseal lengths of the long bones indicate the
fetus is approximately 35 weeks’ gestation,
as Harrison and colleagues [3] and Hellier
and Connolly [5] predicted. However, cal-
culation of the gestational age of a shrunk-
en, mummified fetus based only on measure-
ments in nonmummified skeletons can lead
to inaccurate predictions [18].
Several radiographic methods of assessment
of fetal maturity based on the chronologic pat-
terns of bone ossification and tooth mineral-
ization, bone measurements, and morpholog-
TABLE 2: Estimation of Gestational Age of Fetus 317b
Method Estimated Age (wk)
Scheuer and Black regression equation using maximum femoral length [9] 35 (SD, 2)
Scheuer and Black regression equation using maximum tibial length [9] 34.6 (SD, 2)
Radiographic appearance of ossification centers ≥ 38.0
Olsen score [11] 39.0
Stempfle radiographic score [12] 37.3
Mean 36.78 (SD, 1.91)
A CB
D
Fig. 4Female fetus at 9 months of gestation (mummy 317b). Multiplanar 2D reconstructed CT images show
bony morphologic features, secondary ossication centers, and tooth mineralization used for estimating
gestational age at mummification.
A, Sagittal reconstructed CT image of right forearm shows flat inferior radial metaphysis (arrow ).
B, Coronal reconstructed CT image of right ankle shows flat inferior tibial metaphysis (arrowhead) and concave
surface of talus (arrow ).
C, Coronal reconstructed CT image of right knee shows ossified distal femoral (arrow) and proximal tibial
(arrowhead) epiphyses.
D, Curved multiplanar reconstructed orthopantomogram-style CT image of mandibular (arrowhead) and
maxillary (arrow ) dental arcades shows ossification of multiple crowns.
AJR:197, November 2011 W835
CT of Fetal Mummies
ic features of bone have been widely used in
clinical, forensic, and archeologic investiga-
tions [10–12]. MDCT also has been recog-
nized as an ideal tool for assessing ancient
human remains [19]. However, CT examina-
tion and analysis of postmortem findings
with forensic formulas (virtopsy) have not
been tested on ancient mummified fetuses, to
our knowledge. To maximize the results of
this study, we tailored the CT and image
analysis to suit the study of small, poorly pre-
served ancient human remains. We chose the
optimum CT parameters, used the minimal
thickness allowed by the CT scanner (0.625
mm), and digitally separated linen tissue and
other embalming materials from the fetal
skeleton. We also used different 2D and 3D
image reconstruction methods and varying
window width parameters to discriminate
tiny fetal anatomic structures.
Through analysis of the reconstructed CT
images of mummy 317b, we detected tooth
mineralization and multiple ossifying centers
around the knee, foot, sternum, and pelvis
(Table 2). CT detection of secondary ossifi-
cation centers around both knees of mummy
317b suggested a gestational age of approxi-
mately 38 weeks compared with known val-
ues [10]. Secondary ossification around the
knees was not visualized on radiographs in
a previous study of mummy 317b by Hellier
and Connolly [5], who suggested a gestation-
al age of approximately 30 weeks. More so-
phisticated radiographic methods of perina-
tal assessment of bone age with parameters
such as detailed mineralization of the teeth,
changes in shape in centers of ossification,
and the mere presence or absence of a center
have been used [11, 12]. With two of these
methods, the Stempfle score and the Olsen
method, we estimated gestational ages at
mummification of mummy 317b of 37.3 and
39 weeks. We calculated the mean gestation-
al age of mummy 317b to be 36.78 (SD 1.91)
weeks by considering the results of the dif-
ferent methods we used for age estimation.
The study of diseases in archeology, or pa-
leopathology, is important in understanding
the origins, prevalence, and natural history
of the diseases and in comparing ancient and
modern diseases [20]. In our study, CT facili-
tated assessment of the mummies, especially
the better preserved 317b, for evidence of dis-
ease and gross anomalies. The results negat-
ed the presence of gross skeletal congenital
anomalies in mummy 317b and attributed the
changes noted by Harrison and colleagues [3]
on plain radiographs to postmortem trauma.
The reconstructed CT images showed that
the left shoulder region was completely sepa-
rated from the rest of the fetal body; the left
scapula consequently was displaced upward,
and the left clavicle was dislocated. Howev-
er, both scapulae and clavicles have normal
comparable dimensions, which rules out the
previous erroneous suggestion of a small left
scapula or long left clavicle [3]. Similarly, at
radiographic study of mummy 317b [3], the
postmortem spinal fracture had been falsely
interpreted as a deformed spine (neural tube
defects). Despite the poor condition and mul-
tiple fractures in fetus 317a, there is no ev-
idence of anomalies in the preserved verte-
brae and rest of the skeleton. CT of neither
mummy revealed the cause of death.
In his twin theory, Chamberlain [4] sug-
gested that the two daughters of King
Tutankhamun were identical (monozygotic)
twins. Chamberlain attributed the difference
in size of the fetuses not to singleton births
at different gestational ages but to discrepan-
cy in intrauterine growth as a consequence of
sharing the same placenta when the smaller
fetus (donor) transfused its twin (twin-twin
transfusion syndrome). The twin theory in
daughters of King Tutankhamun is a remote
possibility that cannot be proved or negated
with imaging findings alone. However, the
difference in the predicted gestational ages
of the two mummies found in this study de-
A
C
Fig. 5Female fetus at 9 months of gestation (mummy 317b).
A, Coronal posterior projection 3D reconstructed CT image of shoulder girdle and
thoracic spine shows complete separation of left shoulder by oblique postmortem
fracture (arro ws ) that involves laminae of upper thoracic vertebrae. Consequently,
left shoulder is displaced upward. No evidence of Sprengel shoulder deformity is
evident.
B, Frontal (anterior projection) color 3D reconstructed CT image of shoulder girdle
region shows apparently longer and higher position of left clavicle (arrow).
C, Inferosuperior projection color 3D reconstructed CT image of shoulder girdle
region shows left clavicle (arrow) posteriorly dislocated at acromioclavicular
junction and thus having more horizontal position than normally positioned right
clavicle.
B
W836 AJR:197, November 2011
Hawass and Saleem
creases the likelihood of twin-twin transfu-
sion syndrome.
The results of this CT study of the two
mummified stillborn daughters of King Tu-
tankhamun (circa 13361327 BC) are an im-
proved estimate of their gestational ages at
mummication, suggest articial mummi-
cation was performed, and rule out the pres-
ence of major skeletal congenital anomalies
in the larger daughter (mummy 317b).
Acknowledgments
We thank Andrew Nelson and Stan Ko-
gan, Schulich School of Medicine and Den-
tistry, University of Western Ontario, Canada,
and Mary Lewis, Reading University, UK, for
providing relevant references and for benefi-
cial discussions; Kenneth Garrett, photogra-
pher of Figure 2A; and Ayman Lotfy and Mo-
hammad Ghobashi, Cairo University, Egypt,
for assisting in preparation of the images.
References
1. Carter H, Mace AC. The tomb of Tut-Ankh-Amen.
New York, NY: Cooper Square Publishers, 1963
2. Derry D. Report upon the two human fetuses dis-
covered in the tomb of Tut-Ankh-Amen. In: Cart-
er H, ed. The tomb of Tut-Ankh-Amen. London,
UK: Gerald Duckworth, 1933:167–169
3. Harrison RG, Connolly RC, Ahmed S, Abdalla
AB, El Ghawaby M. A mummified foetus from the
tomb of Tutankhamun. Antiquity 1979; 53:1921
4. Chamberlain G. Two babies that could have
changed world history. Historian 2001; 72:610
5. Hellier CA, Connolly RC. A re-assessment of the
larger fetus found in Tutankhamens tomb. Antiq-
uity 2009; 83:165–173
6. Hawass Z, Gad YZ, Ismail Z, et al. Ancestry and
pathology in King Tutankhamun’s family. JAMA
2010; 303:638–647
7. Olivier G, Pineau H. New determination of the
fetal height based on the diaphysial lengths of the
long bones [in French]. Ann Med Leg Criminol
Police Sci Toxicol 1960 ; 40:141–144
8. Scheuer JL, Musgrave JH, Evans SP. The estima-
tion of late fetal and perinatal age from limb bone
length by linear and logarithmic regression. Ann
Hum Biol 1980; 7:257–265
9. Scheuer L, Black S. Developmental juvenile oste-
ology. London, UK: Academic Press, 2000
10. Hartley JB. Radiological estimation of foetal ma-
turity. Br J Radiol 1957; 30:561–576
11. Olsen ØE, Lie RT, Lachman RS, et al. Ossifica-
tion sequence in infants who die during the peri-
natal period: population-based references. Radi-
ology 2002; 225:240–244
12. Stempfle N, Huten Y, Fondacci C, et al. Fetal bone
age revisited: proposal of a new radiographic
score. Pediatr Radiol 1995; 25:551–555
13. Martin G. The hidden tombs of Memphis: new discov-
eries from the time of Tutankhamun and Ramesses
the Great. London, UK: Thames and Hudson, 1991
14. Leblanc C, Fekri M. La prospection archéologiques
des vallés laterals de T3 ST NFRW: bilan et per-
spectives. In: Zaccone GM, ed. Sesto Congresso
Internazionale di Egittologia, Atti. Torino, Ita ly:
Tipografia Torinese, 1993:259–268
15. Tocheri MW, Dupras TL, Sheldrick P, et al. Ro-
man period fetal skeletons from the east cemetery
(Kellis 2) of Kellis, Egypt. Int J Osteoarchaeol
2005; 15:326341
16. Arriaza BT. Beyond death: the Chinchorro mum-
mies of ancient Chile. Washington, DC: Smithso-
nian Institution Press, 1995
17. Lewis ME, Flavel A. Age assessment of child
skeletal remains in forensic contexts. In: Schmitt
A, Cunha E, Pinheiro J, eds. Forensic anthropol-
ogy and medicine: complementary sciences from
recovery to cause of death. Totowa, NJ: Humana
Press, 2006:243–257
18. Huxley AK, Kósa F. Calculation of percent
shrinkage in human fetal diaphyseal lengths from
fresh bone to carbonized and calcined bone using
Petersohn and Köhler’s data. J Forensic Sci 1999;
44:577–583
19. Cesarani F, Martina MC, Ferraris A, et al. Whole-
body three-dimensional multidetector CT of 13
Egyptian human mummies. AJR 2003; 180:597606
20. Standison AT, Tapp E. Disease in ancient Egypt.
In: Cockburn A, Cockburn E, Reyman TA, eds.
Mummies diseases and ancient cultures, 2nd ed.
Cambridge, UK: Cambridge University Press,
1998:38–58
... In several occasions, skeletons of pregnant women from ancient Egypt were identified (Ahramonline, 2021). Few fetuses were found mummified and individually wrapped; however, no fetuses have been reported inside an artificially mummified ancient Egyptian body (Hawass and Saleem, 2011). This makes this study (Ejsmond et al., 2021) important. ...
... The CT study of the two mummified fetuses daughters of King Tutankhamun (c. 1324 BC) at gestational ages of 24 weeks and 36 weeks revealed their skeletal and soft tissues that enabled estimation of their gestational ages ( Fig. 1) (Hawass and Saleem, 2011). ...
... We do not see any anatomical configuration of a fetus; no spine, skeleton, or limbs could be detected. In our experience, ancient Egyptian mummified fetuses and also non-mummified skeletons kept anatomical details (Hawass and Saleem, 2011). We believe that it is not possible to identify, with any certainty, the pelvic object in question as a fetus. ...
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Ejsmond et al. described a fetus inside the pelvic cavity of an ancient Egyptian mummy from the first century BC based on a Computed Tomography (CT) study. The objective of this reply is to open a discussion about this interesting finding with the scientific community. The article based the diagnosis on the external appearance of a pelvic mass that resembled a rolled up fetus but without being able to detect any anatomical configuration or bones. We welcome the authors effort to do advanced radiological mummy studies; however, we are unconvinced by their interpretation. We believe that it is not possible to identify, with any certainty, the pelvic object in question as a fetus. The article explained lack of identification of fetal bones that they must have shrunk. In our experience, ancient Egyptian un-mummified fetal skeletons and mummies kept their anatomical details. It is very unlikely that the dense semi-rounded compact structure could be ‘a fetal head’ as assumed in the article because the skull bones during fetal life are un-fused and would have collapsed and disarticulated after death. We encourage Ejsmond et al. to revise or re-do the CT scan of the mummy with the proper protocol supervised by a paleo-radiologist, to revise/clarify the diagnosis of the ‘pregnant mummy’ and include possible differential diagnosis such as visceral packs/condensed embalming materials, or a calcified pelvic tumor.
... For example, Zahi Hawass and Sahar Saleem (2011) used CT imaging to refine the ages of two fetal individuals (twenty-five and thirty-seven fetal weeks) previously believed to be possible twins from the tomb of King Tutankhamun. Although it is not uncommon for twins to have discordant fetal growth trajectories (Blickstein and Goldman 2003), their significant difference in fetal development made this relationship unlikely (Hawass and Saleem 2011). In another example, mtDNA analysis found that individuals from a double burial at Angel Mounds in North America once believed to be conjoined twins did not even share maternal relatives (Marshall et al. 2011). ...
... Identified also in radiology, for both X-ray (seeHarrison et al. 1979;Hellier and Connolly 2009) and CT (seeHawass and Saleem 2011). In the latter, identification of the ossification centres from CT scans of the children from KV62, provided methodology for estimating the gestational age of ancient mummified feti, which should have been considered byEjsmond et al. 29 The "argument by analogy" is inconclusive by its very nature, as philosophy of science proves. ...
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The case of the first “pregnant ancient Egyptian mummy”, as published by Ejsmond et al. (2021), has raised doubts regarding their conclusions unsupported by (paleo)radiological expertise. Their interpretation of the structures inside the pelvis of the Warsaw mummy as a fetus in the 26th–30th week of gestation has starkly demonstrated some of the pitfalls in the mummy studies. In doing so, it has also accentuated the potential of an enhanced Mixed Reality (XR) technology applied to the interpretation of computed tomography (CT) results acquired through tested mummy scanning protocols. The present paper reassesses the same initial radiological data generated for the Warsaw Mummy Project (WMP) that Ejsmond et al. used, applying the same software, more complex software and also enhanced by XR technology. This new approach supports the specific field of mummy studies while holding enormous potential for scientific popularization also in a museum environment. The new CT analysis by a diagnostic imaging professional, illustrated extensively with radiological images, bolstered by a review of archaeological Egyptian literature on mummies and feti, provides grounds for dismissing the fetus interpretation in lieu of a more probable identification of the relevant structure as a bundle that is more readily expected within the pelvis of a mummified body. A discussion of the assumptions made by Ejsmond et al. (fetal preservation, age, aspects of fetal methodology with relevant literature) reveals the dangers of misuse of the mummy research protocols as used today and suggests certain methodological improvements in cases of suspected fetal presence.
... Elities who lived during the Roman Period of ancient Egypt prioritized the artificial mummification of their deceased children(Helmbold-Doyé, 2017;Martina et al., 2018;Wheeler, 2012). However, there exist high-quality mummified corpses of children preserved from earlier periods as well(Hawass & Saleem, 2011). ...
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The aim of this study was to investigate the prevalence and anatomical distribution of recovery lines (growth arrest lines) in ancient Egyptian child mummies. Whole‐body computed tomography (CT) examinations of 21 ancient Egyptian child mummies from European museums were evaluated for estimation of age at death and sex of the children. CT examinations were systematically assessed for recovery lines by inspection for metaphyseal lines, diaphyseal transverse lines and bone‐within‐bone appearance at several sites of the skeleton. The estimated age at death of the children ranged from about 1 year to the age of 12‐14 years. Twelve children were assessed as male, 7 as female and in 2 the sex was indeterminate. Recovery lines were found in 18 out of the 21 (86%) child mummies. Metaphyseal lines were present in 12 mummies (57%), diaphyseal transverse lines in 12 mummies (57%), and bone‐within‐bone appearance in 11 mummies (52%). One case showed particularly dense metaphaseal bands typical of lead lines in lead poisoning. In conclusion, systematic assessment of recovery lines on CT images of ancient Egyptian child mummies showed a high prevalence of these lines. Many children had a combination of different lines, indicating more than one episode of growth disturbance. The spectrum of recovery lines included the better known metaphyseal and diaphyseal transverse lines as well as the less known bone‐within‐bone appearance that share the same pathomechanism. The mummy with lead lines seems to be the first case of radiological evidence of lead poisoning from ancient Egypt.
... In other cases, possible twinhood has been suggested for perinatal skeletons whose burials coincided, based on similarities in body size or other aspects of morphology, age-at-death, or mortuary treatment that has often included elements of the skeletons touching one another or being "intertwined" (e.g., Crespo et al. 2011;Flohr 2014;Halcrow et al. 2012). Halcrow et al. (2012) suggested the presence of relatively rare congenital anomalies could be used to infer twinhood as well but to my knowledge, this has only been suggested and remains unconfirmed in one previous case Harrison et al. 1979;Hawass & Saleem 2011). ...
... 0.50-2.00 mm slice thickness, 20-200 mA tube current, and 100-120 tube voltage (Boyd et al. 2015;Chiba et al. 2013;Akhlaghi et al. 2017;Appleby et al. 2015;Cesarani et al. 2003;Gufler et al. 2014;Hawass & Saleem 2011;Sakuma et al. 2010). ...
Article
Age estimation from human skeletal remains is an important step to reconstruct a biological profile. Cranial suture has long been studied for its age-related closure. However, until now, forensic anthropologists still attempt to investigate the best way of estimating age at death from cranial suture closure because skull is usually found at the crime scene due to its easy recognised-appearance and persistence to post-mortem insults. For these reasons, a study of age estimation from cranial suture closure in a Thai population was conducted, which focussed to study the appearance and visibility of facial suture closure using computed tomography (CT). CT image series of 140 cases were obtained in order to investigate ectocranial closure of the selected facial sutures. The results from CT image analysis revealed that nasomaxillary provided the most consistent examination of suture closure (52%) while frontonasal delivered the lowest consistency in suture closure examination (29%). The inconsistency mostly occurred in assigning the closure score of 1 and 2. Thus, it could be suggested that a 3-scale scoring system of closure: open, closing, and closed, could be an appropriate method of evaluating degree of ectocranial closure of facial sutures obtained from CT imaging. This fundamental information of facial suture closure from CT images could serve as a starting point on development of age estimation technique from suture closure by utilising CT images.
... Indeed, multiple studies report the preservation of black, resinous or shiny brain tissue in the archaeological record (Table 1), and the "remnant liquid or paste" found in modern crania from forensic contexts (Hayman and Oxenham 2017; Table 3) echoes the description of resinous-like, organic material reported pooled in the crania of many ancient mummified corpses (e.g. Hawass and Saleem 2011;Proefke et al. 1992;Rühli, Chhem, and Böni 2004;Lynnerup 2010;Wade et al. 2010;Saleem and Hawass 2013). ...
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Brain tissue is ubiquitous in the archaeological record. Multiple, independent studies report the finding of black, resinous or shiny brain tissue, and Petrone et al. [2020 "Heat-induced Brain Vitrification from the Vesuvius Eruption in C.E. 79." N Engl J Med. 382: 383-384; doi:10.1056/ NEJMc1909867] raise the intriguing prospect of a role for vitrification in the preservation of ancient biomolecules. However, Petrone et al. (2020) have not made their raw data available, and no detailed laboratory or analytical methodology is offered. Issues of contamination and misinterpretation hampered a decade of research in biomolecular archaeology, such that addressing these sources of bias and facilitating validation of specious findings has become both routine and of paramount importance in the discipline. We argue that the evidence they present does not support their conclusion of heat-induced vitrification of human brain tissue, and that future studies should share palaeoproteomic data in an open access repository to facilitate comparative analysis of the recovery of ancient proteins and patterns of their degradation.
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Fetal and perinatal diagnostic imaging with MRI has evolved and expanded during recent times, allowing more widespread use and availability. Common indications are for neurodevelopmental conditions that are inconclusive with ultrasonography. The modality is pivotal in treatment planning for in utero interventions, such as repair of neural tube defects, and for particular obstetrical complications. The technique is also useful for identifying neurological sequelae from conditions like congenital heart defects and maternal viral infections. Many other applications are not indicated for routine use, particularly due to the high cost, but show much promise in research applications. Recently, complications associated with COVID-19 have been an area of interest, with prenatal MRI cohorts and case studies reporting obstetrical complications and neurodevelopmental effects. This review is aimed at highlighting common indications for the use of MRI in maternal-fetal medicine, including the MRI sequences and physics often implemented. Also, an in-depth analysis of the SARS-CoV-2 virus is discussed; in addition to pregnancy-related complications and the role of prenatal MRI in diagnosis and treatment.
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Howard Carter (1874–1939) was an English archaeologist and Egyptologist, now renowned for discovering the tomb of the pharaoh Tutankhamun. Published between 1923 and 1933, this three-volume study contains Carter's detailed account of the sensational discovery, excavation and clearance of Tutankhamun's tomb and its treasures. The tomb was almost fully intact when discovered and remains the most complete burial discovered in the Valley of the Kings. Each volume of Carter's book is richly illustrated with over 100 photographs of the tomb and objects found in it, showing their original state and how they appeared after reconstruction. Carter's meticulous recording and conservation techniques are faithfully documented in his account, providing a vivid and engaging description of the work which occurred during the excavation of this famous site. Volume 3 describes the recording and conservation of objects in the Treasury and Annexe rooms and puts forward Carter's interpretation of their use.
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As noted by Geoffrey Chamberlain, the two baby girls found in Tutankhamen's tomb were probably his stillborn heirs. More controversially he suggested that they were twins, although one appeared to be larger than the other. Here new research on estimating the age of a fetus is shown to support the twin hypothesis, while recent work on Twin-Twin Transfusion Syndrome explains why they could be such different sizes.
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Much can be learned about the religious ideology and mortuary patterns as well as the demographic and health profiles of a population from archaeological human fetal skeletons. Fetal skeletons are rare, however, largely due to poor preservation and recovery, misidentification, or non-inclusion in general burial populations. We present an analysis of 82 fetal/perinatal skeletons recovered from Kellis 2, a Roman Period cemetery dated to the third and fourth centuries AD, located in the Dakhleh Oasis, Egypt. Most of the fetal remains were individually wrapped in linen and all were buried among the general cemetery population in a supine, east–west orientation with the head facing to the west. Gestational age estimates are calculated from diaphysis lengths using published regression and Bayesian methods. The overall similarity between the fetal age distributions calculated from the regression and Bayesian methods suggests that the correlation between diaphysis length and gestational age is typically strong enough to avoid the ‘regression’ problem of having the age structure of reference samples adversely affecting the age distribution of target samples. The inherent bias of the regression methods, however, is primarily reflected in the gestational age categories between 36 and 42 weeks corresponding with the expected increase in growth variation during the late third trimester. The results suggest that the fetal age distribution at Kellis 2 does not differ from the natural expected mortality distribution. Therefore, practices such as infanticide can be ruled out as having a significant effect on the observed mortality distribution. Moreover, the Kellis 2 sample is well represented in each gestational age category, suggesting that all premature stillbirths and neonatal deaths received similar burial rites. The age distribution of the Kellis 2 fetal remains suggests that emerging Christian concepts, such as the ‘soul’ and the ‘afterlife’, were being applied to everyone including fetuses of all gestational ages. Copyright © 2005 John Wiley & Sons, Ltd.