THE ANATOMICAL RECORD 298:1099–1110 (2015)

A Critical Look at Mummy CT Scanning

SAMANTHA L. COX1,2*
1
Physical Anthropology Section of the Penn Museum, University of Pennsylvania,
Pennsylvania, USA
2
Department of Archaeology and Anthropology, Division of Archaeology, University of
Cambridge, Cambridge, UK

ABSTRACT
Computed tomography scanning of mummies has been conducted for
almost 40 years, and has become an increasingly popular method of
mummy study in the 21st century. However, most CT scan analyses pub-
lished today still do little more than praise the technique’s non-
destructive, non-invasive properties. Despite the wealth of information
contained within a modern, high definition scan, most researchers have
yet to fully exploit the full potential of this technology. In addition, those
that have utilized CT scanning in ancient remains continue to interpret
mummified tissues as though they were living, without investigating how
taphonomy and mummification could have effected the tissue images that
are produced. Because of this, there is very limited information available
for clear interpretation of mummy CT’s. This article presents a critical
assessment of the development of mummy CT scanning and presents the
results of two Egyptian mummies CT’ed at the Penn Museum as an
example of the potentials and pitfalls of high-resolution scanning. Anat
Rec, 298:1099–1110, 2015. V C 2015 Wiley Periodicals, Inc.

Key words: mummy; CT scan; paleopathology

For nearly four decades, computed tomography (CT) tations imposed on CT analysis due to the dearth of infor-
scanning has been employed in the scientific study of mation available on tissue changes in paleo-imaging.
mummified remains. However, despite the numerous
mummies that have been examined, we know almost REVIEW OF MUMMY CT HISTORY
nothing about them beyond the process of their mummifi-
cation. More than that, the formula of most CT scan stud- Computed tomography scanning was first developed
ies of mummies has remained almost unchanged since in 1975 for medical imaging, and it was a mere 2 years
they first began in 1977. The vast majority of articles are later that the technology was applied to a mummy.
case reports that come to the same conclusion: CT scans Lewin and Harwood-Nash (1977) performed the first CT
are a powerful, nondestructive, noninvasive way to study scan on an Egyptian mummy named Nakht from the
mummies. Though this is true, much time has passed Royal Ontario Museum in 1977 to examine the brain.
and the technology continues to improve and evolve, but Though the findings of this study were not remarkable,
its potential for mummy research has never been fully it was a mile-stone in mummy studies for the application
exploited. While CT scan studies have become increas- of the new technology. Lewin (1978) also produced the
ingly prevalent over the last 10 years, very little research first whole-body scan of a mummy in 1977. From 1977
has been done to explore the limitations of the technology until 1985, CT scans were not often used for analysis in
or the differences between living and long-dead tissues in
imaging. This article takes a critical look at the history of
mummy CT scanning to understand the current state of *Correspondence to: Division of Archaeology, Department of
paleo-imaging and address the weaknesses of the field in Archaeology and Anthropology, University of Cambridge, Down-
order utilize CT technology to its fullest potential and ing Street, Cambridge CB23DZ, E-mail: slc77@cam.ac.uk
encourage mummy studies to continue evolving. The CT Received 16 January 2015; Accepted 30 January 2015.
scans of two Penn Museum mummies are presented here DOI 10.1002/ar.23149
as an example of the wealth of information available from Published online in Wiley Online Library (wileyonlinelibrary.
detailed CT scans, but also as an illustration of the limi- com).

C 2015 WILEY PERIODICALS, INC.

V
1100 COX

their own right, but to aid in directing mummy autopsy Though this is not an exhaustive list of publications by
and tissue sampling. For example, Notman and his team any means, the one thing that is consistent in all these
(1985) on the Minnesota Mummy Project, Zimmerman studies is the use of higher-resolution CT scans, though
(1996; note the study was carried out in 1983) on Alas- often a lower resolution is used for the post-cranial
kan mummies from St. Lawrence Island, and Ascenzi elements than for the head. Teeter and Vannier (2009)
et al. (1996; note, the study was carried out in 1983) on published the CT scan of Meresamun for exhibit at the
the mummy of a girl from Rome. From 1985 to the pres- Oriental Institute in Chicago at a reconstructed slice
ent at least one mummy CT publication has come out thickness of 0.7 mm, claiming that this is the highest
every year, and they have become increasingly numerous resolution mummy scan published to that date.
through time. These articles consist mostly of case There are surprisingly few pathology studies. Though
reports that generally describe mummification techni- this is what the technology was designed for in a clinical
ques, artifacts, preservation, and pathology (e.g., Marx setting, it has rarely been applied to anthropological
and D’Auria, 1986, 1987; Magid et al., 1989; Pickering investigations. Most published work of this type is
et al., 1990; Watson and Meyers, 1991; Gregorczyk et al., rather limited in scope, and the full potential of the tech-
1993; Hughes, 1993; Baldock et al., 1994; Arriaza, 1998; nology seems to have not been adequately explored (for
Gaafar et al., 1999; Macleod et al., 2000; Thekkaniyil a full review and critique see Chhem, 2006). The first
et al., 2000; Mininberg, 2001; Hoffman et al., 2002; Previ- pathology-specific study with a CT scan was probably
gliano et al., 2002; Shin et al., 2003; Kim et al., 2006, the one performed on Otzi € the Iceman (Holden, 2001),
2006; Lee et al., 2006; Hawass and Saleem, 2011; Nelson since this is likely the first time that scan resolutions
et al., 2011; Wade et al., 2012), though there are some were high enough to allow for this type of analysis. The
publications that specifically address pathology, facial most famous pathology study is probably that of the
reconstructions, and new approaches and applications. mummy of King Tutankhamun to attempt to determine
Many of the early CT papers compare traditional X-rays the cause of death of the boy king (Hawass et al., 2009).
to CT scans to determine the strengths and weaknesses of In a few instances, researchers have attempted to use
the new technology and establish it as a reliable method CT pathology analyses in more creative ways. For exam-
for investigation (for instance, Watson and Meyers, 1993, ple, Ceruti (2004) looked at pathology to determine
and Hunt and Hopper, 1996). These early studies are quite cause-of-death in Peruvian mummies and compared it to
constrained by the low resolutions and large file sizes pro- historical accounts of human sacrifice. In other cases,
duced by early CT machines. It is not surprising that most investigators have attempted to use CT for pathology
of the mummies scanned are ancient Egyptian, and the analysis, but were unsuccessful in identifying any, as
extended positions of the bodies produce large scans that was the case for Bianucci et al. (2008).
take up large quantities of file space. It is for this reason It is apparent after this review that there are some
that some of these early scans report slice thicknesses of large gaps in knowledge and understanding of CT scan-
up to 24 mm (Marx and D’Auria, 1986), to keep the scan- ning in ancient remains. As of yet, the vast majority of
ners themselves from overheating and file sizes to a mini- articles published are merely individual case reports.
mum. However, while the volume of data is easier to Nothing has been done to take the data presented in
manage, the scans could not have contained enough detail those articles and synthesize it into a work that has
for any kind of in-depth analysis. It was the mid-1990’s meaning applicable to the field of anthropology. There is
before scanning resolutions were high enough to allow for potential here to evaluate health in mummies, as a pop-
the first CT investigations of mummy dentition (as in ulation, given how many have been CT scanned, but
Nikol et al., 1995; Melcher et al., 1997). Also at this time, focus continues to remain on mummies as individuals
a study of a female South American mummy is notewor- rather than representative members of a group. The
thy because of her probable tuberculosis. It is one of the exception to this generalization is the Horus Mummy
first studies to identify a specific pathology via CT, as well Project team. This group has evaluated the CT scans of
as providing some of the oldest evidence of tuberculosis over 20 mummies and found persuasive evidence of
(Correal-Urrego and Florez, in Cockburn, 1998). heart disease that would indicate some prevalence
At this point in the literature, CT mummy analysis throughout the upper class population (Allam et al.,
seems to be progressing along at a steady pace; some 2009). This study is the only example of a synthetic
authors began to experiment with utilizing CT scans in analysis that finally takes CT scans beyond the “gee,
different ways, but with limited results (e.g., Brown and wow!” factor and begins to explore the potential of this
Wood, 1999). However, by the beginning of the new mil- hi-tech method to add to our knowledge of ancient Egyp-
lennium, CT studies appear to stagnate. Despite contin- tian life, questioning the assumptions that have always
ued advances in CT technology, the focus is still primarily been made regarding health and diet of ancient people.
on describing the mummies and the mummification pro- Unfortunately, only a handful of researchers have
cess on an individual basis. Friedrich et al. (2007) does ever considered and written about any of the negative
this with 12 Chachapoyan mummies, Gupta et al (2008) aspects of CT scanning. There is little consistency in the
with an Egyptian head as does Chan et al. (2008). Jack- manner in which findings are reported, for instance the
owski et al. (2008) attempt to compare mummies from specs for the CT machines and scanning parameters are
Ancient Egypt to those from Peru, but the article focuses often omitted. In 2001, Weber published a detailed cri-
heavily on Egyptian mummification, only briefly discus- tique of this issue in which he proposes a scheme of
sing Peru and the connection between the two is unclear. information that should be standardly reported in high
Collier (2009) reports on another mummy being CT technology academic articles. He is of the opinion that
scanned in Toronto, Gerloni (2009) again considers Egyp- this kind of digital media should be made freely avail-
tian dentition and Lynnerup (2009) applies these techni- able for all scholars to consider, so that other evaluations
ques to the Bog Bodies housed in the British Museum. and comparisons can be made. It is quite apparent that
 A CRITICAL LOOK AT MUMMY CT SCANNING 1101
few publications have adopted his standard, and, to my Museum) was undertaken, it was with the aim of setting
knowledge, no one has proposed another. Few share these two individuals within their historical contexts. It
their scans; however, this may be starting to change was soon clear, however, that despite all the mummies
with the University of Pennsylvania Museum’s Online that have been CT’ed in the world, there was not suffi-
Research Scan Archive (ORSA) and the IMPACT Radio- cient information available to soundly interpret the
logical Mummy Database, which are free for scientists images or understand these two people as a part of
that wish to use them. Ancient Egyptian life. They are presented here as exam-
While there are many wonderful and useful applica- ples of the potential and limitations faced when inter-
tions of CT scans, there is also a noticeable gap in the preting CT scans of ancient human remains. PUM II
literature concerning the discussion of its weaknesses. and Hapi-Man, from the Penn Museum were CT
For instance, few consider how mummification, especially scanned in April 2009, at the Hospital of the University
artificial mummification, may alter the appearance of tis- of Pennsylvania (HUP). Dr. Morrie Kricun Emeritus
sues. Chew et al (2006) noted in their cadaver study that Professor of Radiology at HUP and the University of
modern embalming changes the way that structures Pennsylvania Medical School assisted with the interpre-
appear radiologically in recently dead cadavers. The tations of the mummy images. A spiral multislice
image quality was greatly reduced by beam hardening Siemens’ SOMATOM Sensation 64-Slice Computed
artifacts, attenuation between soft tissues was reduced as Tomography machine scanned the mummies with a slice
compared with living people, and other less uniform thickness of 1 mm (0.5 mm reconstructed). To produce
changes were visible due to the embalming process. If this the best results, both mummies were scanned in three
is the case today, it could have critical implications for the sections, from the head to mid-thorax, mid-thorax to
interpretations of mummified tissues, as most scans of mid-femur, and mid-femur through the feet, producing a
ancient remains are read and interpreted as though they total of about 2,000 images for each mummy. The analy-
were living people. Villa and Lynnerup (2012) have begun
sis was done using the freeware program Osirix v. 3.7
to tackle some of these concerns, but information is still
with the 64-bit upgrade on an Apple Mac Pro.
needed before mummified remains can be reliably inter-
Hapi-Man was excavated in Abydos in 1902 by the
preted with medical imaging techniques.
famous archaeologist Sir Flinders Petrie. He is thought
To date, there is no published data, of which I am
to date from the Late Period and be about 35–45 years
aware, that investigates embalming materials, their
of age at death (Lawrence, 1980). Hapi-Man has been x-
appearance, and their effects on tissue appearance on
rayed on two occasions during his stay at the Penn
CT. A good case example is the famous CT scan of
Museum and research in the Penn Museum Archives
Tutankhamun (Hawass et al., 2009). The debate over
turned up a set of apparently unpublished X-rays from
the whether or not the femoral fracture represents an
April 1932, by Dr. J.G. Cohen. A second envelope of com-
ante- or postmortem break, and thus whether or not it
pletely unmarked films was also found in archives and
could have contributed to events surrounding the boy
matched to Hapi-Man based on the placement of the
king’s death, cannot be laid to rest because the research
has not been done to be say how the resin in mummies amulets around the neck. The date and researcher for
behaves through time or whether or not mummification this second set of X-rays is unknown, but it is clear that
processes would eliminate any signs of hematoma. they are more recent than the first set and it is possible
Though many great studies have emerged with this that they were produced in the late 1970s for the Penn
technology, there is still much more that has to be con- Museum exhibit The Egyptian Mummy: Secrets and
sidered before the true meaning of what has been Science.
observed can be adequately assessed and synthesized. The CT scan of Hapi-Man revealed information about
R€uhli et al. (2004) is one of the very few that offer his mummification and identified some possible pathol-
caution about the interpretation of CT scans. He argues ogy. It is clear on the scans that his abdomen was
that every radiologic examination of ancient human stuffed with rolled bundles of cloth that might contain
remains should include an experienced radiologist as the internal organs as is typical of Late Period mummifi-
well as an experienced physical anthropologist to inter- cation (David, 2008); however, there does not appear to
pret the images. The radiologist can recognize pathology be anything inside and it is likely that these are prob-
more readily than the anthropologist, but the anthropol- ably symbolic only (Fleming, 1980). Hapi-Man also had
ogist will be more adept at recognizing confounding his brain removed through the nose and the body is com-
factors that might mar the diagnosis. Resins and other pletely covered in resin which lies in a pool in the cra-
artifacts of mummification are the most important nium, thorax and abdomen. It is clear in the CT that he
factors to recognize. There is no comprehensive guide to has an udjet eye on his forehead, no fewer than twelve
diagnosing paleopathology in radiology; however, Chhem amulets arranged around his neck, like a necklace,
and Brothwell published Paeloradiology: Imaging Mum- including beads, heart amulets, an udjet eye, goddess
mies and Fossils (2008) which dedicates about half the figurine, Horus falcon, scarab, and Amun feather. The
book (100 pages) to this topic. Though it is by no left hand has an unidentifiable square amulet on the
means complete, and focuses mainly on X-rays it gives ring finger, though there does not appear to be anything
pictures and characteristics of the most common patholo- attaching it to the finger (Fig. 1). On the right rib cage
gies in both humans and animals and is at least a good there are three rows of amulets, the first is three scarab
starting reference for analyzing paleoradiography. beetles, the second is four djed pillars, and the third is
five tyet knots with a goddess figurine, probably of Isis
(Fig. 2). The placement of these kinds of amulets in the
THE PENN MUMMIES
wrappings of the deceased was quite common, but it is
When the CT scanning of two Egyptian mummies clear from the scans that none of these objects are likely
from the University of Pennsylvania Museum (Penn metallic, most are probably fiance (Andrews, 1994).
1102 COX

Fig. 1. Hapi-Man amulets, (top left) goddess figure, Horus falcon, and square “ring” on hand; (top right)
jars, udjet eye, scaraab, beads; (bottom left) Amun feather; (bottom right) udjet eye on forehead.

The teeth are quite clear, and we can confirm the age However, evidence of discontinuous calcification of the
of the individual to be between 35 and 45 years of age annulus at every disc level and clear osteoarthritis
using cranial suture closure patterns (Walker in Buik- between the posterior elements of the L4 and L5 is pres-
stra and Ubelaker, 1994). There is clear evidence of ent. The fifth lumbar vertebra is sacralized as well as
uncovertebral arthropathy as well a rib fracture. The fused bilaterally to the sacrum on the caudal side.
scans do show that there are numerous air spaces in the This might have marginally effected the mobility of his
vertebral bodies that are not present in living individu- lumbar spine but would not have been crippling.
als; it is unclear if this has to do with the age of the Osteoarthritis was observed on both hips, but it was
specimen or if it is pathological. There is also a uniform apparent on the scan that there was no bone reaction to
distribution of some substance around the periphery of the cartilage loss, suggesting that this may be a result of
the annulus of the thoracic and lumbar vertebrae which specimen age or mummification process instead of dis-
could either be attributed to the resin or pathology, ease. In the feet, there were no bone reactions and only
likely only an autopsy would be able to tell for certain. some medial narrowing of the first metatarsophalangeal
 A CRITICAL LOOK AT MUMMY CT SCANNING 1103
joints, probably not enough to be considered arthritic, torn through in the same plane. There are bright spots
but it is a possibility. This may have only been the very on the scan inside the joint space and on the wrappings
beginnings of arthritic changes, just an unusually nar- that are hypothesized to be some kind of adhesive or
row joint space, or maybe an artifact of mummification. restorative material to reconnect the feet to the body. It
It appears on the scan that Hapi-Man’s feet became is unclear when or how this damage occurred or was
detached from his body at some point after his mummifi- repaired.
cation. This is most visible in the very large tibiotarsal Like many Egyptian mummies, PUM II (an acronym
joint space but upon close inspection the wrappings are for Pennsylvania University Museum II) has a long and
rather cloudy history. The area of Egypt from which he
comes is unknown and he is first recorded in the early
twentieth century on a ship to Philadelphia. He came to
America by way of John T. Morris, a wealthy Philadel-
phian who then donated him to the Philadelphia
Museum of Art (PMA). Though the sarcophagus is
highly decorated, the name of the individual was not
recorded on it nor was any clues about his life. He
remained at the PMA until the end of January 1973
when he was shipped to Michigan to be autopsied on
February 1 at the Wayne State University Medical
School in Detroit as part of a symposium there entitled
Death and Disease in Ancient Egypt. Known as PUM II
because he was the second mummy to be acquired by
the institution, radiographic and xerographic exams
were done at the Mt. Carmel Mercy and Hutzel hospitals
both before and after the autopsy (Cockburn, 1998).
Following the autopsy, he was sent to be on exhibit at
the Museum of Natural History in Washington DC, on
loan to the Smithsonian Institution (Cockburn 1975). He
is now on display and has been a part of the Egyptian
Mummies: Secrets and Science exhibit since it opened in
1980 at the Penn Museum.
The right toes of PUM II are flexed, pulled back
towards the top of the foot. Though the X-rays and
autopsy report of PUM II dismissed the unusual appear-
Fig. 2. (left) Right rib cage, top row- three scarab beetles, middle ance of the toes as an effect of tight wrapping, CT scans
row- four djed pillars, bottom row- five tyet knots and Isis figurine, show that it is probably a condition known as hammer-
(right) scarab beetle on left rib cage.
toe that is resultant of a cavus deformity of the right

Fig. 3. Measured angle of cavus foot deformity, 45 is considered normal and 90 is severely cavus,
here the angle on the right foot of PUM II measures about 100 (image captured using Osirix v. 3.7).
1104 COX

Fig. 4. (left) Axial slice illustrating the difference in density between the two feet (image captured with
Osirix 3.7), (right) 3D reconstruction of feet colored by density, red is high density, yellow is medium, and
green is low red is high density, yellow is medium, and green is low

Fig. 5. Arrow indicates small bunion on the right medial proximal first metatarsal of PUM II.

foot. Aminian and Sangeorzan (2008) define cavus foot midfoot. Radiographically, a foot can be called a cavus
deformity as describing “a spectrum of foot shapes that foot with an increased Hibbs angle, measured through
have a high arch” and is usually characterized by a high the axis of the calcaneus and metatarsal. A normal foot
pitch angle of the calcaneus and plantar flexion of the is around 45 while cavus can be 90 ; the angle on PUM
 A CRITICAL LOOK AT MUMMY CT SCANNING 1105

Fig. 6. Orange arrow shows large air pocket between S1 and L5 would be indication of a hernia in liv-
ing people but is inconclusive here, blue arrows point to narrowing of the hip joints that could be mild
arthritis or an artifact of mummification in PUM II.

Fig. 7. What appears to be DISH in PUM II may just be residual soft tissues and resin.
1106 COX

Fig. 8. Mild hypertrophy of the lischka joints with Schmorl’s nodes on the caudal C3 (top) and cranial
C4 mildly encroaching on the neural foramen (bottom) in PUM II.

II’s foot is about 100 (Fig. 3). The bones of the foot are appear atrophied as compared to the other foot. The
formed normally and well articulated, indicating that authors of the autopsy noted that the right foot
this deformation occurred after the bones matured. appeared swollen, so perhaps what we interpreted as
Today, two-thirds of modern cases of cavus foot have an atrophy is actually normal and the other leg is possibly
underlying neurological condition (Aminian and San- inflamed (Fig. 4). However, since the body was dehy-
georzan, 2008). Other causes can be muscle spasticity drated with natron it is necessary to consider whether
leading to muscle imbalance in the foot. Based on the swellings in a limb would be been preserved. The color-
periosteal reaction described in the autopsy, it might be ing on the scan might also suggest that for some reason
possible that a chronic infection, perhaps due to parsitic the right leg is full of resin or fat and the left is not,
infestation as those authors suggest, could have led to accounting for the difference in density. A deep sub-
muscle imbalance in that leg and caused the cavus foot. articular cyst is visible in the center of the left and right
The left foot has a normal shape, but it is significantly tali as are small cysts in the MT 1 and 2 on the left foot.
less radiolucent than the right foot and the soft tissues The medial aspect of the MT1 seems to have a small
 A CRITICAL LOOK AT MUMMY CT SCANNING 1107

Fig. 9. Orange arrow indicates nasal bones that could show healed fracture, blue arrow shows where
the ethmoid was broken to remove the brain of PUM II.

Fig. 10. The cloudy appearance of the right mastoid of PUM II as compared to the left could show
chronic mastoiditis but could also be the air spaces filled with resin and fat.

bunion forming, perhaps as a result of the gait caused thirds of the left tibiotarsal joint, perhaps be the result
by the cavus foot (Fig. 5). The talus and tibia appear to of some kind of trauma (Fig. 20). The knees show sub-
be starting to fuse together on the lateral half to two- chondral cysts, the beginnings of osteoarthritis,
1108 COX

Fig. 11. Green lines show the abnormal A/P measurements (ca. 25 mm at the maximum) of the sella
turcica probably indicative of a tumor of the pituitary gland in PUM II.

especially in the right knee (Fig. 21). It is quite clear in between the C3 and C4. An osteophyte is visible on the
Fig. 6 that the legs of PUM II are different lengths, but posterior caudal end plate of the C4 and the caudal facet
after careful consideration, it was decided that this is of C4 also has an osteophytic cyst. There is mild
because his pelvis was not completely level when mum- encroachment on the neural foramen in this area with
mified, making his legs appear asymmetric; it should be an osteophytic ridge and large Schmorl’s nodes on the
noted that this kind of asymmetry is often also seen anterior caudal aspect of C3 and anterior cranial aspect
with cavus foot (Aminian and Sangeorzan, 2008). of C4 (Fig. 8).
A bone island is visible in the right ilium and narrow- The autopsy reports did not give an estimated age-at-
ing of the hip joints suggest mild arthritis, though it death and most of his cranial sutures were removed dur-
could also be an effect of mummification. The vertebral ing autopsy. However, the condition of his teeth and
disk between the L5 and S1 is in good shape but a large joints looks quite similar to Hapi-Man so we decided
air pocket in the center would indicate a hernia in a liv- that it is probably reasonable to estimate that he is
ing person, and this cannot be said conclusively in the about the same age, 35–45 years. PUM II’s nose exhibits
case of ancient remains (Fig. 6). Though the autopsy an unusual curve at the end that is not consistent with
reported a sixth lumbar body on the X-rays, we found no the general shape, perhaps the result of a healed frac-
indications of this; however, the vertebral bodies were ture. The ethmoid has clearly been broken through for
removed from this area during autopsy to look for spinal access to the cranium and removal of the brain (Fig. 9).
cord samples, so this could be affecting the interpreta- The mastoid bone appears to be cloudy on the right side,
tion. Most of the vertebral disks are in good condition indicative of chronic mastoiditis, but this could be also
with no degenerative changes but Schmorl’s nodes are be another example of the fat and resins filling the air
present on the caudal endplate of T11. A build-up of spaces (Fig. 10). Measurements indicate an abnormally
some substance on the thoracic vertebral bodies was large sella turcica, the maximum anteroposterior (A/P)
originally identified as diffuse idiopathic skeletal hyper- dimension is about 25 mm and maximum depth is
trophy (DISH) (Fig. 7). However, upon further investiga- 14 mm (Fig. 11). The normal dimensions, given as a
tion, this was not visible on the cervical spine and in Dr. range by Jones et al. (2005) are up to 16 mm A/P and
Kricun’s experience, it would be incredibly unusual to 12-mm deep. Though the depth measurement is not far
suffer from DISH in the thorax without involvement of from what is considered to be normal, the A/P is much
the cervical vertebrae. We finally decided that it is more larger than the given range and suggests the presence of
likely to be resin-covered soft tissues adhering to the a pituitary tumor. Pituitary tumors cause a range of dif-
spine. Small osteophytes are visible on some of the ver- ferent effects but the most common are hormonal imbal-
tebral bodies and those with the Schmorl’s nodes indi- ances, dizziness, disturbances of consciousness, and
cate a mild osteoarthritis. There appears to be a mild blindness (Wakai, 1981). The tumor is of significant
bilateral hypertrophy of the uncovertebral lishka joints enough size that it could have been the cause of death
 A CRITICAL LOOK AT MUMMY CT SCANNING 1109
for PUM II, but if not, it was at least a source of great (2006) concerning CT analyses on medical school cadav-
discomfort and illness. ers serves as a warning, and we need to know more
about these changes before CT scans of ancient remains
can yield any meaningful results.
DISCUSSION
As is always the case with studying ancient remains, LITERATURE CITED
there are many confounding factors at work, including
preservation and taphonomic processes. There are many Allam, AH, Thompson RC, Wann LS, Miyamoto MI, Thomas GS,
2009. Computed tomographic assessment of atherosclerosis in
instances in the cases of these two mummies when a ancient Egyptian mummies. JAMA 302(19):2091–2094.
conclusion could not be reached because of insufficient Aminian A, Sangeorzan BJ. 2008. The anatomy of cavus foot
data on the imaging of ancient tissues. However, the deformity. Foot Ankle Clin N Am 13:191–198.
detailed scan resolution allowed for very specific analy- Andrews C. 1994. Amulets of Ancient Egypt. United Kingdom:
sis of minor changes, some of which can be confirmed as British Museum Press. pp. 190–236.
probable arthritis and others which are less clear as Arriaza BT. 1998. South American mummies: culture and disease.
they could be artifacts of mummification. Research in In: Cockburn A, Cockburn E, Reyman TA, editors. Mummies, dis-
the future needs to focus on sorting out the differences ease, and ancient cultures. 2nd ed. Cambridge, UK: Cambridge
between ante- and postmortem changes on these kinds University Press. pp. 190–236.
Ascenzi A, Bianco P, Nicoletti R, Ceccarini G, Fornaseri M,
of medical images as a means of eventually being able to
Graziani G, Guiliani MR, Rosicarello R, Ciuffarella L, Granger-
tease out the most accurate results. If there is more data Taylor H. 1996. The Roman mummy of Grottarossa. In: Spindler
available on this in the future, we could, perhaps, be K, Wilfing H, Rastbichler-Zissernig E, zur Nedden D, Nothduffer
able to ascertain if thin layers of resin in the joints give H, editors. Human mummies. Austria: Springer-Verlag/Wien. pp.
the appearance of arthritis when condensed on X-ray 205–218.
film but would then be absent on CT scans. As it stands, Baldock C, Hughes SW, Whittaker DK, Taylor J, Davis R, Spender
the amount of information on these processes is limited AJ, Tonge K, Sofat A. 1994. 3D reconstruction of an ancient Egyp-
and means that the data cannot be properly interpreted tian mummy using X-ray computer tomography. JRSM 87:806–808.
except for large, severe pathologies. Bianucci R, Mattutino G, Lallo R, Charlier P, Jouin-Spriet H,
Peluso A, Highan T, Torre C, Massa ER. 2008. Immunilogical evi-
There is a distinct lack of data that has been synthe-
dence of plasmodium falciparum infection in an Egyptian child
sized between mummies, but discrepancies in scan report- mummy from the early dynastic period. J Archaeol Sci 35:
ing means that published studies cannot be compared or 1880–1885.
aggregated because of differences in scan specifications. Brown KR, Wood H. 1999. The utility of minimal CT scanning in
Even if it were possible to compare all the mummies that the study of two Egyptian mummy heads. Int J Osteoarchaeol 9:
have been scanned thus far, it is quite likely that a lack 199–204.
of understanding of the impacts of taphonomy and mum- Buikstra JE, Ubelaker DH. 1994. Standards for data collection from
mification on the radiologic appearance of tissues means human skeletal remains. Fayetteville, AK: Akransas Archaeologi-
cal Survey Report Number 44.
that many published findings are likely to have been mis- Ceruti C. 2004. Human bodies as objects of dedication at inca
interpreted. It is clear from Hapi-Man and PUM II that mountain shrines (north-western Argentina). World Archaeol 36:
there are some common factors, arthritis and dental 103–122.
pathology being the main ones, but two individuals are Chan SS, Elias JP, Hysell ME, Hallowell MJ. 2008. CT of a ptole-
not enough to draw conclusions about a population. The maic period mummy from the ancient Egyptian city of Akhmim.
cavus foot deformity and the enlargement of the sella tur- RadioGraphics 28:2023–2032.
cica in PUM II are interesting pathologies to note, but Chew FS, Relyea-Chew A, Ochoa ER. 2006. Postmortem computed
tomography of cadavers embalmed for use in teaching gross anat-
they have little meaning beyond this one individual
omy. J Comput Assist Tomo 30:949–954.
unless other examples can be found in other mummies. Chhem RK, Brothwell DR. 2008. Paleoradiology: imaging mummies
The smaller pathologies like arthritis that were observed and fossils. New York: Springer.
numerous times in this analysis are ones that we know Collier R. 2009. Radiologists virtually unwrap mummy’s secrets.
will translate more between individuals; however, these CMAJ 180:E23–E24.
cannot yet be positively identified and interpreted until Cockburn A, Barraco RA, Reyman TA, Peck WH. 1975. Autopsy of
data is compiled to distinguish taphonomic changes from an Egyptian mummy. Science 187. pp. 115–1160.
antemortem degradation. Cockburn A, Barraco RA, Rayman TA, Peck WH. 1998. A Classic
MummyL PUM II. In: Cockburn A, Cockburn E, Reyman TA, edi-
At this point, it is probable that over one hundred
tors. Mummies, disease, and ancient cultures. 2nd ed. Cambridge,
mummies have been CT scanned and reported on. None UK: Cambridge University Press.
of this data has yet been synthesized into a work that is David R. 2008. Mummies and modern science. Cambridge: Cam-
meaningful beyond the scope of more than the one indi- bridge University Press.
vidual scanned. Because data has been collected on a Fleming S, Fishman B. 1980. The Egyptian mummy: secrets and
number of mummies, the next logical step would be to science. Philadelphia: University Museum.
collate the data and see the conclusions that can be Friedrich KM, Nemec S, Czerny C, Fischer H, Plischke S,
drawn about these mummies as a population rather Gahleitner A, Viola TB, Imhof H, Seidler H. 2007. The story of 12
than just as single people. However, this study shows chachapoyan mummies through multidetector computed tomogra-
phy. Eur J Radiol. doi:10.1016/j.ejrad.2009.07.009
that, despite the plethora of mummies imaged, the data
Gaafar H, Abdel-Monem MH, Elsheikh S. 1999. Nasal edoscopy and
to interpret scans more critically does not yet exist. This CT study of pharonic and roman mummies. Acta Otolaryngol 119:
casts some doubt on the conclusions that have been 257–260.
drawn in these numerous investigations since we cannot Gregorczyk A, Hydzik A, Moczulska K, Niwinski A. 1994. CT inves-
reliably recognize taphonomy and mummification radio- tigation of Egyptian mummy form the XXI dynasty period. Przegl
logically. The medical research published by Chew et al. Lek 51:57–61.
1110 COX

Hawass Z, Saleem SN. 2011. Mummified daughters of king tutank- Marx M, D’Auria SH. 1987. Three-dimensional CT reconstructions
hamun: archaeologic and CT studies. AJR Am J Roentgenol 197: of an ancient human Egyptian mummy. AJR 150:147–149.
W829–W836. Melcher AH, Holowka S, Pharaoh M, Lewin PK. 1997. Non-invasive
Hawass Z, Shafik M, R€ uhli FJ, Selim A, El Sheikh I, Abdel Fatah computed tomography and three-dimensional reconstruction of
S, Amer H, Gabella F, Gamal Eldin A, Egarter-Vigl E, et al. 2009. the dentition of a 2800-year-old Egyptian mummy exhibiting
Computer tomographic evaluation of pharaoh tuutankhamun ca. extensive dental disease. Am J Phys Anthr 103:329–340.
1300 BC. Ann Serv Antiq Egypt 81:159–174. Mininberg DT. 2001. The museum’s mummies: an inside view. Neu-
Hunt DR, Hopper LM. 1996. Non-invasive investigations of human rosurgery 49:192–199.
mummified remains by radiographic techniques. In: Spindler K,
Nelson AJ, Chhem R, Cunningham IA, Friendman SN, Garvin G,
Wilfing H, Rastbichler-Zissernig E, zur Nedden D, Nothduffer H,
Gibson G, Granton PV, Holdworth DW, Holowka S, Longstaffe F,
editors. Human mummies. Austria: Springer-Verlag/Wien. pp.15–
Lywood V, Nguyen N, Shaw R, Trumpour M, Wade AD, White
32.
CD. 2011. The ROM/UWO mummy project: a microcosm of pro-
Jackowski C, Bolliger S, Thali MJ. 2008. Common and unexpected
gress in mummy research. Yearbook of Mummy Studies. Vol. 1.
findings in mummies from ancient Egypt and South America as
Pfeil, F. M€
uchen, Germany: Verlag.
revealed by CT. RadioGraphics 28:1477–1492.
Jones RM, Faqir A, Millett TD, Moos KF, McHugh S. 2005. Bridg- Nickol T, Germer R, Lieberenz S, Schmidt F, Wilke W. 1995. An
ing and dimensions of the sella turcica in subjects treated by examination of the dental state of an Egyptian mummy by means
Surgical-orthodontic means or orthodontics only. Angle Orthod of computer tomography: a contribution to “dentistry in ancient
75:714–718. egypt.” J Histol Dent 43:105–112.
Kim MJ, Park SS, Bok GD, Coi YH, Lee IS, Shin kj Han GR, Youn Notman DNH, Tashjian J, Aufderheide AC, Cass OW, Shane OC,
M, Han SH, Kang IW, Chang BS, Cho YJ, Chung YH, Shin DH. Berquist TH, Gray JE, Gedgaudas E. 1985. Modern imaging and
2006. Medieval mummy from yangju. Archaeol Ethn Anthr Euras endoscopic biopsy techniques in Egyptian mummies. AJR 146:93–96.
4:122–129. Pickering RB, Conces DJ, Braunstein EM, Yurco F. 1990. Three-
Kim SB, Shin JE, Park SS, Bok GD, Chang YP, Kim J, Chung YH, dimensional computed tomography of the mummy wenuhotep.
Yi YS, Shin MH, Chang BS, Dong HS, Kim MJ. 2006. Endoscopic Am J Phys Anthr 83:49–55.
investigation of the internal organs of a 15th-century child Previgliano CH, Ceruti C, Reinhard J, Araoz FA, Diez JG. 2002.
mummy from yangju, korea. J Anat 209:681–688. Radiological evaluation of the llullaillaco mummies. AJR 181:
Lawrence SV. 1980. Unraveling the mysteries of the mummies. Sci- 1473–1479.
ence 118:362–364. Villa C, Lynnerup N. 2012. Hounsfield units ranges in CT-scans of
Lee IS, Kin MJ, Yoo DS, Lee YS, Park SS, Bok GD, Han SH, bog bodies and mummies. Anthropol Anz 69:127–145.
Chung YH, Chang BS, Yi YS, Oh CS, Shin DH. 2006. Three- Wade AD, Garvin GJ, Hurnanen JH, Williams LL, Lawson B,
dimensional reconstruction of medieval child mummy in Yangju, Nelson AJ, Tampieri D. 2012. Scenes from the past: multidetector
Korea, using multi-detector computed tomography. Ann Anat 189: CT of Egyptian mummies of the redpath museum. Radiographics
558–568. 32:1235–1250.
Lewin PK. 1978. Whole body CT scan of an Egyptian mummy
Wakai S, Fukushima T, Teramoto A, Sano K. 1981. Pituitary apo-
(abstract). Paleopath Assn T7–T8.
plexy: its incidence and clinical significance. J Neurol 55. pp.
Lewin PK, Harwood-Nash DC. 1977. Computerized axial tomogra-
187–193.
phy in medical archaeology. Paleopath Newsl 17:8–9.
Lynnerup N. 2009. Medical imaging of mummies and bog bodies. Watson EJ, Myers M. 1993. The mummy of Baket-en-her-nakhy in
Gerontology 56(5):441–448. teh hancock museum: a radiological update. J Egypt Archaeol 79:
MacLeod RI, Wrights AR, McDonald J, Eremin K. 2000. Historical 179–187.
review: mummy 1911-210-1. RCSE 45:85–92. Weber GW. 2001. Virtual anthropology (VA): a call for glasnost in
Magid D, Bryan BM, Drebin RA, Ney D, Fishman EK. 1989. paleoanthropology. Anat Rec 265:193–201.
Three-dimensional imaging of an Egyptian mummy. Clin Imag Zimmerman MR. 1996. Mummies of the Arctic regions. In: Spindler
13:239–240. K, Wilfing H, Rastbichler-Zissernig E, zur Nedden D, Nothduffer
Marx M, D’Auria SH. 1986. CT examination of eleven Egyptian H, editors. Human mummies. Austria: Springer-Verlag/Wien. pp.
mummies. RadioGraphics 6:321–330. 83–92.