Anthropol. Anz. 72/1 (2015), pp. 55–65 J. Biol. Clinic. Anthropol. published online 2 December 2014; published in print February 2015
Article
The advantage of CT scans and 3D visualizations in the analysis of three child mummies from the Graeco-Roman Period Chiara Villaa, Janet Daveyb, Pamela J.G. Craigc, Olaf H. Drummerb, d, and Niels Lynnerupa a
Laboratory of Biological Anthropology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark [email protected] b Department of Forensic Medicine, Monash University, Southbank, Australia c Unit of Oral Anatomy, Medicine & Surgery, Melbourne Dental School, The University of Melbourne, Melbourne, Australia d Victorian Institute of Forensic Medicine, Southbank, Australia With 5 figures
Summary: Three child mummies from the Graeco-Roman Period (332 BCE – c. 395 CE) were examined using CT scans and 3D visualizations generated with Vitrea 2 and MIMICS graphic workstations with the aim of comparing the results with previous X-ray examinations performed by Dawson and Gray in 1968. Although the previous analyses reported that the children had been excerebrated and eviscerated, no evidence of incisions or breaches of the cranial cavity were found; 3D visualizations were generated showing the brain and the internal organs to be in situ. A larger number of skeletal post-mortem damages were identified, such as dislocation of mandible, ribs, and vertebrae, probably suffered at the time of embalming procedure. Different radio-opaque granular particles were observed throughout bodies (internally and externally) and could be explained as presence of natron, used as external desiccating agent by the embalmers, or as adipocerous alteration, a natural alteration of body fat. Age-at-death was estimated using the 3D visualization of the teeth, the state of fusion of the vertebrae and the presence of the secondary centers of the long bones: two mummies died at the age of 4 years ± 12 months, the third one at the age of 6 years ± 24 months. Hyperdontia or polydontia, a dental anomaly, could also be identified in one child using 3D visualizations of the teeth: two supernumerary teeth were found behind the maxillary permanent central incisors which had not been noticed in the Dawson and Gray’s X-ray analysis. In conclusion, CT-scan investigations and especially 3D visualizations are important tools in the non-invasive analysis of the mummies and, in this case, provided revised and additional information compared to the only X-ray examination. Key words: mummies, CT scan, 3D visualization, Graeco-Roman Period, hyperdontia.
Introduction In 1968 Dawson and Gray published their radiological investigations of the human remains of the British Museum collection in the “Catalogue of Egyptian Antiquities 쏘 2014 E. Schweizerbart’sche Verlagsbuchhandlung, Stuttgart, Germany DOI: 10.1127/anthranz/2014/0330 eschweizerbart_XXX
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the British Museum: I. Mummies and Human Remains” (Dawson & Gray 1968). Included in this group were three unwrapped child mummies who were acquired by the museum in 1898. The provenance of these mummies was unknown but they were dated to the Roman Period, the latter part of the Graeco-Roman Period (332 BCE – c.395 CE) of ancient Egypt. The mummification procedure followed the same techniques of previous periods but became more affordable to the whole of society, from the wealthier class to the middle class. Thus, what changed was not the technique but rather the care used in executing it. Alongside mummies with a quality of mummification comparable with the Pharaonic Period (Taylor 2001), mummies with a more hasty and incomplete mummification treatment can also be found (Dunand & Lichtenberg 2006). In such cases abundant desiccation agents were often used to preserve the body instead of the internal organs. Even the bandaging could be complex, creating intricate and decorative geometric motifs, or rather perfunctory. A characteristic practice in the Graeco-Roman Period was the gilding of the body both of adults and children. It has been demonstrated that the use of X-ray film to study ancient Egyptian mummies has provided valuable information about the condition of bodies that had been desiccated, eviscerated and excerebrated post mortem (Harris & Wente 1980). However, modern medical imaging in the form of Computed Tomography (CT) has improved the quality of images and the analysis of data has been further enhanced by the use of various graphics workstation programs that have produced detailed images and 3D reconstructions of specific areas of interest within the body in a way not possible with X-ray film (Taylor 2004). CT scans have been used to investigate mummies from the Pharaonic Period to the Graeco-Roman Period (Adams & Alsop 2008, Craig & Davey 2009, Ikram & Dodson 1998, Wade et al. 2011). The aim of this study was to re-examine the three British Museum child mummies from the Graeco-Roman Period using CT images and 3D visualizations for determining if the previous X-ray examinations performed by Dawson & Gray (1968) had produced accurate data on the mummified bodies. In addition the study aimed to determine if the lack of clarity in X-ray films allowed for incorrect analysis of condition of the bodies, trauma and pathologies. Finally the age-at-death was estimated.
Material and methods The three child mummies are in storage at the British Museum. Each mummy is identified with the following acquisition number: EA 30362, EA 30363 and EA 30364. The mummies appear to be in very good state of preservation. A distinctive pleasant aroma emanates from each one; they are unwrapped but small sections of linen bandages adhered to the neck and skull areas. The skin has a dark brown brittle appearance and had been decorated with rectangles of gold leaf, both on the body and on the face. The hair, fingernails and toenails have remained intact. There is no evidence of an embalming incision in the left flanks of the mummies and the examination of the nasal area of each mummy did not reveal any visible evidence of breaches. The left hand of EA 30363 is damaged but due to the placement of the hand close to the buttocks, the injuries are difficult to assess. In 2006 CT scans were performed at Blackheath Hospital (BMI Healthcare) London UK using a Toshiba Aquilion 64 CT scanner (Toshiba Medical Systems Corporation, Tochigi, Japan) with the following settings: 120 kV, 300 mAs, 0.5 mm slice thickness, 0.4 mm slice increment and reconstruction algorithm FC13.
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The CT images were examined using two graphic workstation programs: Vitrea 2 (Vital Images) and Mimics (Materialise). Both the graphic programs allowed examining the CT images in the axial, coronal and sagittal planes. In particular, Vitrea 2 allowed an easy and fast reconstruction of data using the visualization method of the Maximum Intensity Projection (MIP) and provided a virtual access to all areas of the body using the ‘fly through’ function, i.e. virtual endoscopy. Differently, Mimics software allowed the segmentation, isolation and 3D visualization of specific internal structures of the body, based on their attenuation. The X-rays passing through the bodies are differently absorbed by the tissues and this effect is expressed as attenuation. The attenuation is expressed as Hounsfield Units (HU) that are calibrated to the attenuation produced by air as –1024 HU and the attenuation produced by water as 0 HU. A number of sources provide tables of typical HU ranges of human tissues for medical use. The ordinary range of Hounsfield Units (HU) relevant to living person could not be used to create 3D visualizations of the mummified tissues, as anatomical structures were not correctly identified. Revised HU ranges (Villa & Lynnerup 2012) were therefore used, followed by manual editing where required. Anthropological and paleopathological analyses were performed on CT-scan images and on 3D visualizations. First, each mummy was examined to find traces of pathologies or trauma using the CT images, ‘fly through’ and MIP using Vitrea 2. Then, the areas of specific interest were isolated and 3D visualizations were created using Mimics. The age-at-death was estimated using several methods normally applied to the skeleton remains: we compared the 3D visualizations of teeth with the chart of teeth development from Ubelaker (1978); and we evaluated the state of fusion of the vertebrae, in particular the atlas and the axis, and the presence and the degree of development of long bone’s secondary centers using the CT images and estimated an age using Schaefer et al. (2009).
Results Cranial and ventral cavities An examination of the nasal area in the CT scans of each mummy did not produce any evidence of breaches and no trace of forced access to the cranial cavity could be found. The cribriform plate of the ethmoid bone was intact and no apparent breach was present in the area of the foramen magnum or in the orbital cavity; the remains of the optical nerves and the extra ocular muscle were also present in all mummies. Access to the cranial cavity was possible using the Vitrea 2 image “fly through” function, suggesting the presence of desiccated brain; Fig. 1 shows a detail of the brain in EA30364 as seen during the “fly through”. Subsequently, the brain of each mummy was isolated and its 3D visualization was created using Mimics (Fig. 2): the gyri and the sulci are clearly identifiable in all the 3D visualizations of the brain, as such the midline fissure in the brain of EA30362 (Fig. 2a) and EA30364 (Fig. 2c). Fig. 2 also shows the axial view of the brain of each mummy. Furthermore, it was found that the spinal cord was in direct conjunction with the brain and could be identified within the cervical vertebrae with fragments visible within the vertebral column. No embalming incision was found in the thorax and abdominal regions, and dehydrated or desiccated lungs, intestine, liver and urinary bladder could be identified in the abdominal cavity of all mummies. A probable desiccated heart was identified in EA30363 and EA30364. The lungs and heart of EA30364 are shown in Fig. 3 using the visualization method of the Maximum Intensity Projection (MIP). No foreign objects, such as burial artifact, amulet or bandages, were found within the thoracic or abdominal cavities.
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Fig. 1. Vitrea 2 ‘Fly through’ image showing an internal aspect of the cranial cavity with the remnants of probable desiccated brain in EA 30364.
Post-mortem damage All children showed some skeletal post-mortem disruption or dislocation. EA30362 was the mummy with most evidence of trauma: a foreign object (c. 1050 HU) had been forced into the mouth resulting in movement of some teeth inside and outside dental arches. In addition, we found that the frontal bone was separated from the parietal bones, the right temporal bone was to some extent pushed outward; the spheno-occipital synchondrosis was dislocated. Several vertebrae were not aligned: 1st–2nd cervical vertebrae, 6th–7th thoracic vertebrae and 1st and 2nd sacral vertebrae. The ribs also suffered from extensive dislocation: the left ribs from 8th to 11th shifted downwards. In EA30363, the mandible is shifted forward resulting in the tongue being forced forward and between the teeth; the atlas and axis are separated from the rest of the vertebral column. The left hand showed gross damage to the whole carpus including a dislocated finger: the medial and proximal phalanges of 2nd, 4th and 5th fingers of the left hand were missing. The third finger was complete but the medial and proximal phalanges were broken and almost separated from the hand. EA30364 showed only a dislocation of the 4th cervical vertebra with respect to 3rd and 5th. We also found in the same mummy a circular puncture of less than 2 millimeters in the mid-line posterior region of the neck, approximately to level of the 2nd cervical vertebra. Investigation of CT images showed that the small hole does not penetrate to the spinal canal and had not caused corresponding damage to the spinal cord. Finally, it is worth mentioning that the linear crack fracture reported by Dawson &
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Fig. 2. 3D Mimics visualizations and axial views of the brain of the three mummies: (a) EA 30362, (b) EA30363 and (c) EA30364.
Gray (1968) resulted to be a suture variation, known as “variant of a persisting sutura mendosa” (Hauser & De Stefano 1989).
Age-at-death estimation Based on the development of the teeth as assessed using 3D Mimics visualizations, we estimated an age-at-death of 4 years ± 12 months for EA30363 and EA30364. An older age of 6 years ± 24 months was estimated for EA30362. Similar ages were found by looking at the state of fusion of the vertebrae and the presence of the secondary centers. EA30362 was 5–7 years old at the time of death based on the complete fusion of the atlas and the axis (fusions occur around 5–6 years), as well as the presence of the secondary center of the distal end of the ulna (secondary center appears around 5–7 years). EA30363 was approximately 4–5 years based on the fusion of the foramen transversarium in all cervical vertebrae (it occurs around 3–4 years), the fusion of the posterior synchondrosis of the atlas (it happens at 4–5 years), and the absence of the secondary center in the ulna and the radius (they appear around 5–7 years). An age of 3–4 years was estimated for EA30364, slightly lower than EA30363, since the posterior synchondrosis of the atlas was not fused.
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Fig. 3. Visualizations of the heart (upper arrow) and the lungs (lower arrow) of EA30364 in Maximum Intensity Projection (MIP) obtained with Vitrea 2.
Pathologies and anomalies It was determined that EA30363 suffered from the dental anomaly known as hyperdontia or polydontia: two supernumerary teeth were observed behind the maxillary permanent central incisors. They have a simple conical form with no root development. Fig. 4 shows the 3D Mimics visualizations of the deciduous and permanent teeth and the two supernumerary teeth. Three Harris lines are identifiable on both tibias of EA30362. No sign of pathology or anomaly was found in EA30364.
Radio opacities Radio-opaque granular particles with the dimension ranging from 2 to 5 mm are present in the bodies of the mummies, mainly in the thorax, abdomen and in cranial cavity: these radio-opaque spots had range values from about 250 to 1300 HU (EA30362: HU 265/1171, EA30363: HU 337/1179, EA30364: HU 238/1291). They were identified in the brain, in the remains of the lungs, inside the mouth, in the muscles, in the joints, in the dermis and hypodermis layers. Fig. 5 shows the radio-
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Fig. 4. 3D visualizations of the teeth and the tongue of EA30363, (a) frontal view, (b) lateral view and (c) posterior view. In pink the deciduous teeth, in light blue the permanent teeth and in green the two supernumerary teeth.
Fig. 5. Radio opacities in the brain of EA30364 as seen in the coronal, axis and sagittal views. 3D visualization of some of the opacities in the brain can also be seen in the lower right corner.
opaque granular particles in the brain of EA30364 in the CT views and as the 3D visualizations. Other areas with increased HU (HU 855/1438) were identified in correspondence with the remains of gold leaf on the skin.
Discussion In this study, three British Museum child mummies from the Graeco-Roman Period were re-examined using CT images and 3D visualizations to compare the results with the earlier X-ray film examination carried out in 1968 by Dawson & Gray (1968). New and revised information could be obtained from the analyses. Consistent with
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previous authors (Cesarani et al. 2003, Hoffman & Hudgins 2002, Rühli et al. 2004, Wade et al. 2011), we demonstrated that CT scans and 3D data are important tools in the study of the Egyptian mummies. The CT investigation revealed the presence of intact brain and internal organs in the three child mummies. Dawson & Gray (1968) incorrectly interpreted the opacity in the occipital region of the skull as a resinous material mixed with sand, probably due to the superimposition artifact and low contrast difference of the X-ray films. Using virtual endoscopy and CT images, it was easy to accurately investigate any possible area of access to the cranial cavity: we did not find any access route via the nostrils, through the foramen magnum or via optic nerve (Aufderheide 2003). Jackowski et al. (2008) reported an unusual access route behind the left ear in an infant from the Roman Period, but no such route could be found. Moreover, using 3D visualizations the substance inside the cranial cavity could be clearly identified as brain, since gyri, sulcus and midline fissure could be detected. Dawson & Gray (1968) also reported that the thoracic cavities appeared to be without internal organs in two of the mummies (EA30362-3) and they identified desiccated remnants of the viscera or heart only in the third one (EA30364). Our evaluation of the contents of the thoracic and abdominal cavities was also more complete and accurate using 3D visualization than by visual inspection of X-ray films, and it revealed that all internal organs are still present in the three mummies. The presence of intact brain and organs in our three child mummies of Graeco-Roman Period is consistent with findings from other studies of mummies from the same (Aufderheide 2003, Wade et al. 2011) as well as different periods (Harwood-Nash 1979, Hoffman & Hudgins 2002, Karlik et al. 2007). The dental anomaly of hyperdontia also could be identified through the CT images and 3D visualization. Dawson & Gray (1968) did not report any anomaly in the teeth of EA30363. The angulations of the supernumerary central upper incisors would suggest that the path of eruption of these teeth would be inclined palatally, whereas that of the permanent central incisors would be labially. We could not determine the correct occlusal relationship of the teeth of the mummy, because the mandible was not in the correct anatomical position due to post-mortem dislocation. However, if it were normal, the probable ultimate result would be that the central incisors would have occupied a relatively normal position labial to the mandibular incisors and the supernumeraries would have occupied a position lingual to the mandibular incisors. This would give the child the appearance of having “two rows of teeth”. The child died before any of this would have been visible. Supernumerary teeth have been reported in Ancient Egyptian skulls but they were not frequent among the population (Ruffer 1920); they were found occasionally in the upper incisor region, more commonly in the molars and in some cases in the premolar region. Ruffer (1920) discovered one supernumerary central upper incisor and 35 supernumerary teeth between the 2nd and the 3rd right lower molar out of 156 Egyptian Pre-Dynastic skulls. Rare is the presence of supernumerary teeth in ancient Nubians, described only in seven cases (Ruffer 1920). To our knowledge, the presence of this dental anomaly has not previously been reported in mummies. CT scans showed post-mortem damages not recognized or misinterpreted in the X-ray film. Dawson & Gray (1968) only reported the dislocation of the ribs in EA360362; they did not notice the foreign object in the mouth, the separation of the skull bones and the misalignment of several vertebrae. For EA30363, they did not
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mention any damage to the left hand; this might indicate that the damage to the hand occurred later than the publication of the catalogue in 1968. In addition to the incomplete identification of the post-mortem damages, Dawson & Gray (1968) misinterpreted a normal anatomical variant of the occipital bone of EA30364 as linear-crack fracture. Finally, they indicated a sacralization of the 5th lumbar vertebra of EA30362 that we could not confirm. All the skeletal damages described, with the exception of those to the left hand of EA30363 and the puncture in the neck of EA30364, may have been caused by the embalmers when preparing the bodies for burial or at the time the body settled after mummification and wrapping. Although these mummies arrived at the British Museum in an unwrapped state, small remnants of linen were visible on the bodies and it was presumed that the original wrappings may have had an impact on the bodies. The use of tight bandaging over the thoracic region may have caused some dislocation of ribs and vertebrae. The dislocation of the mandible may have resulted from forcing the head downward to touch the sternum. Mortuary practices in the Graeco-Roman Period were sometimes carried out perfunctorily and the embalmers often used a large quantity of resin and applied gold leaf and other techniques to enhance the exterior appearance (Aufderheide 2003). Chemical investigations have revealed that appreciable quantity of coniferous resin and beeswax were used for embalming in the Graeco-Roman Period, both ingredients having antibacterial properties (Buckley & Evershed 2001). These substances have characteristic HU measurable in CT images: beeswax corresponds to –140 HU, the resin-like fluid to 71 HU (Gostner et al. 2013, Rühli et al. 2004). In the three child mummies, we could not identify these substances; instead we found material with higher density, ranging in the interval of unspecified “various embalming material” (Rühli et al. 2004). Similar radio-dense opacities, visible as granular particles, were identified in the nasal cavity, thorax and abdomen of a child mummy dated to the Roman Period (Jackowski et al. 2008); subsequent chemical analysis revealed that these granular particles were composed predominantly by crystalline sodium chloride used during dehydration process (Jackowski et al. 2008). Since no access way to insert similar material in the cranial cavity was found in the three child mummies, the opacities in the brain may be explained as adipocerous alteration due to mummification. Harwood-Nash (1979) also found similar granules in the intact brain of a male teenage mummy. Macroscopic examination of his brain revealed a firm waxy texture consistent with adipocerous material. The alteration of tissue into wax material was further confirmed chemically by Oakley (1960) in a brain found in the United Kingdom dated to the second century C.E. (Roman-British Period). Adipocerous changes are usually related to bodies exposed to damp conditions (Knight 1996). Further analysis would be required to ascertain the chemical composition of the granular particles identified in the three child mummies, but the restriction on invasive examination of ancient Egyptian mummies precludes investigation of these opacities at this time.
Conclusion CT scans and especially 3D visualizations provided new insight in the conditions of the three child mummies compared to an earlier study of plain X-ray film. The study provided new images of internal aspects of the mummies with clarity and detail
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and as such add new information to the limited amount of knowledge about the subject of Graeco-Roman child mummies. No evidence of excerebration and evisceration could be identified, but numerous post-mortem damages, gilding of bodies and probably application of embalming fluids indicate that some mummification procedures were executed. The dental condition of hyperdontia was identified which is a rare condition reported in few ancient Egyptian skulls. The age-at-death of the children was estimated between 3 and 8 years.
Acknowledgements For their assistance in this research the authors wish to thank Dr. John Taylor of the British Museum, Dr. Shelley Robertson of the University of Melbourne, Craig Hagenmaier formerly of Toshiba UK Medical Systems, Martin Coyne and Lauren Fogarty of Siemens Australia, Dr. Bob Fabiny of the Radiology Department, Austin Hospital Melbourne and Forensic Radiologist Dr. Chris O’Donnell of the Victorian Institute of Forensic Medicine, Melbourne, Australia. The authors also thank the anonymous reviewers for their constructive comments that helped us to improve the manuscript.
References Adams, J.E. & Alsop, C.W. (2008): Imaging in Egyptian Mummies. – In: David A.R. (ed.): Egyptian Mummies and Modern Science. – Cambridge University Press, Cambridge, pp. 21–42. Aufderheide, A.C. (2003): The Scientific Study of Mummies. – Cambridge University Press, Cambridge. Buckley, S.A. & Evershed, R.P. (2001): Organic chemistry of embalming agents in Pharaonic and Graeco-Roman mummies. – Nature 413: 837–841. Cesarani, F., Martina, M.C., Ferraris, A., Griletto, R., Boano, R., Marochetti, E.F., Donadoni, A.M. & Gandini, G. (2003): Whole-body three-dimensional multidetector CT of 13 Egyptian human mummies. – Am. J. Roentgenol. 180: 597–606. Craig, J.G. & Davey, J. (2009): Mummified Child – A Further Investigation. – Buried History 45: 15–22. Dawson, W.R. & Gray, P.H.K. (1968): Catalogue of Egyptian Antiquities in the British Museum 1: Mummies and Human Remains. – The British Museum Press, London. Dunand, F. & Lichtenberg, R. (2006): Mummies and Death in Egypt. – Cornell University Press, Ithaca, USA. Gostner, P., Bonelli, M., Pernter, P., Graefen, A. & Zink, A. (2013): New radiological approach for analysis and identification of foreign objects in ancient and historic mummies. – J. Archaeol. Sci. 40: 1003–1011. Harris, J.E. & Wente, E.F. (1980): An X-ray atlas of the Royal Mummies. – The University of Chicago Press, Chicago. Harwood-Nash, D.C.F. (1979): Computed-Tomography of Ancient Egyptian Mummies. – J. Comput. Assist. Tomo. 3: 768–773. Hauser, G. & De Stefano, G.F. (1989): Epigenetic Variants of the Human Skull. – Schweizerbart, Stuttgart. Hoffman, H. & Hudgins, P.A. (2002): Head and skull base features of nine Egyptian mummies: Evaluation with high-resolution CT and reformation techniques. – Am. J. Roentgenol. 178: 1367–1376. Ikram, S. & Dodson, A. (1998): The Mummy in Ancient Egypt: Equipping the Dead for Eternity. – Thames and Hudson, New York.
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Jackowski, C., Bolliger, S. & Thali, M.J. (2008): Scenes from the past – Common and unexpected findings in mummies from ancient Egypt and South America as revealed by CT. – Radiographics 28: 1477–1492. Karlik, S.J., Bartha, R., Kennedy, K. & Chhem, R. (2007): MRI and multinuclear MR spectroscopy of 3,200-year-old Egyptian mummy brain. – Am. J. Roentgenol. 189: W105– W110. Knight, B. (1996): Forensic Pathology. – Arnold, London. Oakley, K.P. (1960): Ancient preserved brains. – Man 60: 90 –91. Ruffer, S.A. (1920): Study of abnormalities and pathology of ancient Egyptian teeth. – Am. J. Phys. Anthropol. 3: 335–382. Rühli, F.J, Chhem, R.K. & Boni, T. (2004): Diagnostic paleoradiology of mummified tissue: interpretation and pitfalls. – Can. Assoc. Radiol. J. 55: 218–227. Schaefer, M., Black, S. & Scheuer, L. (2009): Juvenile Osteology: A Laboratory and Field Manual. – Academic Press, Amsterdam. Taylor, J. (2001): Death and the Afterlife in ancient Egypt. – Bristish Museum Press, London. Taylor, J. (2004): Mummy: The Inside Story. – The British Museum Press, London. Ubelaker, D.H. (1978): Human Skeletal Remains. – Taraxacum, Washington D.C. Villa, C. & Lynnerup, N. (2012): Hounsfield Units ranges in CT-scans of bog bodies and mummies. – Anthropol. Anz. 69: 127–145. Wade, A.D., Nelson, A.J. & Garvin, G.J. (2011): A synthetic radiological study of brain treatment in ancient Egyptian mummies. – Homo – J. Comparat. Hum. Biol. 62: 248–269. Submitted: 19 February 2013; accepted: 23 June 2014. Address for correspondence: Chiara Villa, Laboratory of Biological Anthropology, Department of Forensic Medicine, University of Copenhagen, Frederik d. 5.’s Vej 11, 2100 Copenhagen, Denmark [email protected]
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Article
The advantage of CT scans and 3D visualizations in the analysis of three child mummies from the Graeco-Roman Period Chiara Villaa, Janet Daveyb, Pamela J.G. Craigc, Olaf H. Drummerb, d, and Niels Lynnerupa a
Laboratory of Biological Anthropology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark [email protected] b Department of Forensic Medicine, Monash University, Southbank, Australia c Unit of Oral Anatomy, Medicine & Surgery, Melbourne Dental School, The University of Melbourne, Melbourne, Australia d Victorian Institute of Forensic Medicine, Southbank, Australia With 5 figures
Summary: Three child mummies from the Graeco-Roman Period (332 BCE – c. 395 CE) were examined using CT scans and 3D visualizations generated with Vitrea 2 and MIMICS graphic workstations with the aim of comparing the results with previous X-ray examinations performed by Dawson and Gray in 1968. Although the previous analyses reported that the children had been excerebrated and eviscerated, no evidence of incisions or breaches of the cranial cavity were found; 3D visualizations were generated showing the brain and the internal organs to be in situ. A larger number of skeletal post-mortem damages were identified, such as dislocation of mandible, ribs, and vertebrae, probably suffered at the time of embalming procedure. Different radio-opaque granular particles were observed throughout bodies (internally and externally) and could be explained as presence of natron, used as external desiccating agent by the embalmers, or as adipocerous alteration, a natural alteration of body fat. Age-at-death was estimated using the 3D visualization of the teeth, the state of fusion of the vertebrae and the presence of the secondary centers of the long bones: two mummies died at the age of 4 years ± 12 months, the third one at the age of 6 years ± 24 months. Hyperdontia or polydontia, a dental anomaly, could also be identified in one child using 3D visualizations of the teeth: two supernumerary teeth were found behind the maxillary permanent central incisors which had not been noticed in the Dawson and Gray’s X-ray analysis. In conclusion, CT-scan investigations and especially 3D visualizations are important tools in the non-invasive analysis of the mummies and, in this case, provided revised and additional information compared to the only X-ray examination. Key words: mummies, CT scan, 3D visualization, Graeco-Roman Period, hyperdontia.
Introduction In 1968 Dawson and Gray published their radiological investigations of the human remains of the British Museum collection in the “Catalogue of Egyptian Antiquities 쏘 2014 E. Schweizerbart’sche Verlagsbuchhandlung, Stuttgart, Germany DOI: 10.1127/anthranz/2014/0330 eschweizerbart_XXX
www.schweizerbart.de 0003-5548/14/0330 $ 2.75
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the British Museum: I. Mummies and Human Remains” (Dawson & Gray 1968). Included in this group were three unwrapped child mummies who were acquired by the museum in 1898. The provenance of these mummies was unknown but they were dated to the Roman Period, the latter part of the Graeco-Roman Period (332 BCE – c.395 CE) of ancient Egypt. The mummification procedure followed the same techniques of previous periods but became more affordable to the whole of society, from the wealthier class to the middle class. Thus, what changed was not the technique but rather the care used in executing it. Alongside mummies with a quality of mummification comparable with the Pharaonic Period (Taylor 2001), mummies with a more hasty and incomplete mummification treatment can also be found (Dunand & Lichtenberg 2006). In such cases abundant desiccation agents were often used to preserve the body instead of the internal organs. Even the bandaging could be complex, creating intricate and decorative geometric motifs, or rather perfunctory. A characteristic practice in the Graeco-Roman Period was the gilding of the body both of adults and children. It has been demonstrated that the use of X-ray film to study ancient Egyptian mummies has provided valuable information about the condition of bodies that had been desiccated, eviscerated and excerebrated post mortem (Harris & Wente 1980). However, modern medical imaging in the form of Computed Tomography (CT) has improved the quality of images and the analysis of data has been further enhanced by the use of various graphics workstation programs that have produced detailed images and 3D reconstructions of specific areas of interest within the body in a way not possible with X-ray film (Taylor 2004). CT scans have been used to investigate mummies from the Pharaonic Period to the Graeco-Roman Period (Adams & Alsop 2008, Craig & Davey 2009, Ikram & Dodson 1998, Wade et al. 2011). The aim of this study was to re-examine the three British Museum child mummies from the Graeco-Roman Period using CT images and 3D visualizations for determining if the previous X-ray examinations performed by Dawson & Gray (1968) had produced accurate data on the mummified bodies. In addition the study aimed to determine if the lack of clarity in X-ray films allowed for incorrect analysis of condition of the bodies, trauma and pathologies. Finally the age-at-death was estimated.
Material and methods The three child mummies are in storage at the British Museum. Each mummy is identified with the following acquisition number: EA 30362, EA 30363 and EA 30364. The mummies appear to be in very good state of preservation. A distinctive pleasant aroma emanates from each one; they are unwrapped but small sections of linen bandages adhered to the neck and skull areas. The skin has a dark brown brittle appearance and had been decorated with rectangles of gold leaf, both on the body and on the face. The hair, fingernails and toenails have remained intact. There is no evidence of an embalming incision in the left flanks of the mummies and the examination of the nasal area of each mummy did not reveal any visible evidence of breaches. The left hand of EA 30363 is damaged but due to the placement of the hand close to the buttocks, the injuries are difficult to assess. In 2006 CT scans were performed at Blackheath Hospital (BMI Healthcare) London UK using a Toshiba Aquilion 64 CT scanner (Toshiba Medical Systems Corporation, Tochigi, Japan) with the following settings: 120 kV, 300 mAs, 0.5 mm slice thickness, 0.4 mm slice increment and reconstruction algorithm FC13.
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The CT images were examined using two graphic workstation programs: Vitrea 2 (Vital Images) and Mimics (Materialise). Both the graphic programs allowed examining the CT images in the axial, coronal and sagittal planes. In particular, Vitrea 2 allowed an easy and fast reconstruction of data using the visualization method of the Maximum Intensity Projection (MIP) and provided a virtual access to all areas of the body using the ‘fly through’ function, i.e. virtual endoscopy. Differently, Mimics software allowed the segmentation, isolation and 3D visualization of specific internal structures of the body, based on their attenuation. The X-rays passing through the bodies are differently absorbed by the tissues and this effect is expressed as attenuation. The attenuation is expressed as Hounsfield Units (HU) that are calibrated to the attenuation produced by air as –1024 HU and the attenuation produced by water as 0 HU. A number of sources provide tables of typical HU ranges of human tissues for medical use. The ordinary range of Hounsfield Units (HU) relevant to living person could not be used to create 3D visualizations of the mummified tissues, as anatomical structures were not correctly identified. Revised HU ranges (Villa & Lynnerup 2012) were therefore used, followed by manual editing where required. Anthropological and paleopathological analyses were performed on CT-scan images and on 3D visualizations. First, each mummy was examined to find traces of pathologies or trauma using the CT images, ‘fly through’ and MIP using Vitrea 2. Then, the areas of specific interest were isolated and 3D visualizations were created using Mimics. The age-at-death was estimated using several methods normally applied to the skeleton remains: we compared the 3D visualizations of teeth with the chart of teeth development from Ubelaker (1978); and we evaluated the state of fusion of the vertebrae, in particular the atlas and the axis, and the presence and the degree of development of long bone’s secondary centers using the CT images and estimated an age using Schaefer et al. (2009).
Results Cranial and ventral cavities An examination of the nasal area in the CT scans of each mummy did not produce any evidence of breaches and no trace of forced access to the cranial cavity could be found. The cribriform plate of the ethmoid bone was intact and no apparent breach was present in the area of the foramen magnum or in the orbital cavity; the remains of the optical nerves and the extra ocular muscle were also present in all mummies. Access to the cranial cavity was possible using the Vitrea 2 image “fly through” function, suggesting the presence of desiccated brain; Fig. 1 shows a detail of the brain in EA30364 as seen during the “fly through”. Subsequently, the brain of each mummy was isolated and its 3D visualization was created using Mimics (Fig. 2): the gyri and the sulci are clearly identifiable in all the 3D visualizations of the brain, as such the midline fissure in the brain of EA30362 (Fig. 2a) and EA30364 (Fig. 2c). Fig. 2 also shows the axial view of the brain of each mummy. Furthermore, it was found that the spinal cord was in direct conjunction with the brain and could be identified within the cervical vertebrae with fragments visible within the vertebral column. No embalming incision was found in the thorax and abdominal regions, and dehydrated or desiccated lungs, intestine, liver and urinary bladder could be identified in the abdominal cavity of all mummies. A probable desiccated heart was identified in EA30363 and EA30364. The lungs and heart of EA30364 are shown in Fig. 3 using the visualization method of the Maximum Intensity Projection (MIP). No foreign objects, such as burial artifact, amulet or bandages, were found within the thoracic or abdominal cavities.
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Fig. 1. Vitrea 2 ‘Fly through’ image showing an internal aspect of the cranial cavity with the remnants of probable desiccated brain in EA 30364.
Post-mortem damage All children showed some skeletal post-mortem disruption or dislocation. EA30362 was the mummy with most evidence of trauma: a foreign object (c. 1050 HU) had been forced into the mouth resulting in movement of some teeth inside and outside dental arches. In addition, we found that the frontal bone was separated from the parietal bones, the right temporal bone was to some extent pushed outward; the spheno-occipital synchondrosis was dislocated. Several vertebrae were not aligned: 1st–2nd cervical vertebrae, 6th–7th thoracic vertebrae and 1st and 2nd sacral vertebrae. The ribs also suffered from extensive dislocation: the left ribs from 8th to 11th shifted downwards. In EA30363, the mandible is shifted forward resulting in the tongue being forced forward and between the teeth; the atlas and axis are separated from the rest of the vertebral column. The left hand showed gross damage to the whole carpus including a dislocated finger: the medial and proximal phalanges of 2nd, 4th and 5th fingers of the left hand were missing. The third finger was complete but the medial and proximal phalanges were broken and almost separated from the hand. EA30364 showed only a dislocation of the 4th cervical vertebra with respect to 3rd and 5th. We also found in the same mummy a circular puncture of less than 2 millimeters in the mid-line posterior region of the neck, approximately to level of the 2nd cervical vertebra. Investigation of CT images showed that the small hole does not penetrate to the spinal canal and had not caused corresponding damage to the spinal cord. Finally, it is worth mentioning that the linear crack fracture reported by Dawson &
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Fig. 2. 3D Mimics visualizations and axial views of the brain of the three mummies: (a) EA 30362, (b) EA30363 and (c) EA30364.
Gray (1968) resulted to be a suture variation, known as “variant of a persisting sutura mendosa” (Hauser & De Stefano 1989).
Age-at-death estimation Based on the development of the teeth as assessed using 3D Mimics visualizations, we estimated an age-at-death of 4 years ± 12 months for EA30363 and EA30364. An older age of 6 years ± 24 months was estimated for EA30362. Similar ages were found by looking at the state of fusion of the vertebrae and the presence of the secondary centers. EA30362 was 5–7 years old at the time of death based on the complete fusion of the atlas and the axis (fusions occur around 5–6 years), as well as the presence of the secondary center of the distal end of the ulna (secondary center appears around 5–7 years). EA30363 was approximately 4–5 years based on the fusion of the foramen transversarium in all cervical vertebrae (it occurs around 3–4 years), the fusion of the posterior synchondrosis of the atlas (it happens at 4–5 years), and the absence of the secondary center in the ulna and the radius (they appear around 5–7 years). An age of 3–4 years was estimated for EA30364, slightly lower than EA30363, since the posterior synchondrosis of the atlas was not fused.
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Fig. 3. Visualizations of the heart (upper arrow) and the lungs (lower arrow) of EA30364 in Maximum Intensity Projection (MIP) obtained with Vitrea 2.
Pathologies and anomalies It was determined that EA30363 suffered from the dental anomaly known as hyperdontia or polydontia: two supernumerary teeth were observed behind the maxillary permanent central incisors. They have a simple conical form with no root development. Fig. 4 shows the 3D Mimics visualizations of the deciduous and permanent teeth and the two supernumerary teeth. Three Harris lines are identifiable on both tibias of EA30362. No sign of pathology or anomaly was found in EA30364.
Radio opacities Radio-opaque granular particles with the dimension ranging from 2 to 5 mm are present in the bodies of the mummies, mainly in the thorax, abdomen and in cranial cavity: these radio-opaque spots had range values from about 250 to 1300 HU (EA30362: HU 265/1171, EA30363: HU 337/1179, EA30364: HU 238/1291). They were identified in the brain, in the remains of the lungs, inside the mouth, in the muscles, in the joints, in the dermis and hypodermis layers. Fig. 5 shows the radio-
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Fig. 4. 3D visualizations of the teeth and the tongue of EA30363, (a) frontal view, (b) lateral view and (c) posterior view. In pink the deciduous teeth, in light blue the permanent teeth and in green the two supernumerary teeth.
Fig. 5. Radio opacities in the brain of EA30364 as seen in the coronal, axis and sagittal views. 3D visualization of some of the opacities in the brain can also be seen in the lower right corner.
opaque granular particles in the brain of EA30364 in the CT views and as the 3D visualizations. Other areas with increased HU (HU 855/1438) were identified in correspondence with the remains of gold leaf on the skin.
Discussion In this study, three British Museum child mummies from the Graeco-Roman Period were re-examined using CT images and 3D visualizations to compare the results with the earlier X-ray film examination carried out in 1968 by Dawson & Gray (1968). New and revised information could be obtained from the analyses. Consistent with
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previous authors (Cesarani et al. 2003, Hoffman & Hudgins 2002, Rühli et al. 2004, Wade et al. 2011), we demonstrated that CT scans and 3D data are important tools in the study of the Egyptian mummies. The CT investigation revealed the presence of intact brain and internal organs in the three child mummies. Dawson & Gray (1968) incorrectly interpreted the opacity in the occipital region of the skull as a resinous material mixed with sand, probably due to the superimposition artifact and low contrast difference of the X-ray films. Using virtual endoscopy and CT images, it was easy to accurately investigate any possible area of access to the cranial cavity: we did not find any access route via the nostrils, through the foramen magnum or via optic nerve (Aufderheide 2003). Jackowski et al. (2008) reported an unusual access route behind the left ear in an infant from the Roman Period, but no such route could be found. Moreover, using 3D visualizations the substance inside the cranial cavity could be clearly identified as brain, since gyri, sulcus and midline fissure could be detected. Dawson & Gray (1968) also reported that the thoracic cavities appeared to be without internal organs in two of the mummies (EA30362-3) and they identified desiccated remnants of the viscera or heart only in the third one (EA30364). Our evaluation of the contents of the thoracic and abdominal cavities was also more complete and accurate using 3D visualization than by visual inspection of X-ray films, and it revealed that all internal organs are still present in the three mummies. The presence of intact brain and organs in our three child mummies of Graeco-Roman Period is consistent with findings from other studies of mummies from the same (Aufderheide 2003, Wade et al. 2011) as well as different periods (Harwood-Nash 1979, Hoffman & Hudgins 2002, Karlik et al. 2007). The dental anomaly of hyperdontia also could be identified through the CT images and 3D visualization. Dawson & Gray (1968) did not report any anomaly in the teeth of EA30363. The angulations of the supernumerary central upper incisors would suggest that the path of eruption of these teeth would be inclined palatally, whereas that of the permanent central incisors would be labially. We could not determine the correct occlusal relationship of the teeth of the mummy, because the mandible was not in the correct anatomical position due to post-mortem dislocation. However, if it were normal, the probable ultimate result would be that the central incisors would have occupied a relatively normal position labial to the mandibular incisors and the supernumeraries would have occupied a position lingual to the mandibular incisors. This would give the child the appearance of having “two rows of teeth”. The child died before any of this would have been visible. Supernumerary teeth have been reported in Ancient Egyptian skulls but they were not frequent among the population (Ruffer 1920); they were found occasionally in the upper incisor region, more commonly in the molars and in some cases in the premolar region. Ruffer (1920) discovered one supernumerary central upper incisor and 35 supernumerary teeth between the 2nd and the 3rd right lower molar out of 156 Egyptian Pre-Dynastic skulls. Rare is the presence of supernumerary teeth in ancient Nubians, described only in seven cases (Ruffer 1920). To our knowledge, the presence of this dental anomaly has not previously been reported in mummies. CT scans showed post-mortem damages not recognized or misinterpreted in the X-ray film. Dawson & Gray (1968) only reported the dislocation of the ribs in EA360362; they did not notice the foreign object in the mouth, the separation of the skull bones and the misalignment of several vertebrae. For EA30363, they did not
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mention any damage to the left hand; this might indicate that the damage to the hand occurred later than the publication of the catalogue in 1968. In addition to the incomplete identification of the post-mortem damages, Dawson & Gray (1968) misinterpreted a normal anatomical variant of the occipital bone of EA30364 as linear-crack fracture. Finally, they indicated a sacralization of the 5th lumbar vertebra of EA30362 that we could not confirm. All the skeletal damages described, with the exception of those to the left hand of EA30363 and the puncture in the neck of EA30364, may have been caused by the embalmers when preparing the bodies for burial or at the time the body settled after mummification and wrapping. Although these mummies arrived at the British Museum in an unwrapped state, small remnants of linen were visible on the bodies and it was presumed that the original wrappings may have had an impact on the bodies. The use of tight bandaging over the thoracic region may have caused some dislocation of ribs and vertebrae. The dislocation of the mandible may have resulted from forcing the head downward to touch the sternum. Mortuary practices in the Graeco-Roman Period were sometimes carried out perfunctorily and the embalmers often used a large quantity of resin and applied gold leaf and other techniques to enhance the exterior appearance (Aufderheide 2003). Chemical investigations have revealed that appreciable quantity of coniferous resin and beeswax were used for embalming in the Graeco-Roman Period, both ingredients having antibacterial properties (Buckley & Evershed 2001). These substances have characteristic HU measurable in CT images: beeswax corresponds to –140 HU, the resin-like fluid to 71 HU (Gostner et al. 2013, Rühli et al. 2004). In the three child mummies, we could not identify these substances; instead we found material with higher density, ranging in the interval of unspecified “various embalming material” (Rühli et al. 2004). Similar radio-dense opacities, visible as granular particles, were identified in the nasal cavity, thorax and abdomen of a child mummy dated to the Roman Period (Jackowski et al. 2008); subsequent chemical analysis revealed that these granular particles were composed predominantly by crystalline sodium chloride used during dehydration process (Jackowski et al. 2008). Since no access way to insert similar material in the cranial cavity was found in the three child mummies, the opacities in the brain may be explained as adipocerous alteration due to mummification. Harwood-Nash (1979) also found similar granules in the intact brain of a male teenage mummy. Macroscopic examination of his brain revealed a firm waxy texture consistent with adipocerous material. The alteration of tissue into wax material was further confirmed chemically by Oakley (1960) in a brain found in the United Kingdom dated to the second century C.E. (Roman-British Period). Adipocerous changes are usually related to bodies exposed to damp conditions (Knight 1996). Further analysis would be required to ascertain the chemical composition of the granular particles identified in the three child mummies, but the restriction on invasive examination of ancient Egyptian mummies precludes investigation of these opacities at this time.
Conclusion CT scans and especially 3D visualizations provided new insight in the conditions of the three child mummies compared to an earlier study of plain X-ray film. The study provided new images of internal aspects of the mummies with clarity and detail
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and as such add new information to the limited amount of knowledge about the subject of Graeco-Roman child mummies. No evidence of excerebration and evisceration could be identified, but numerous post-mortem damages, gilding of bodies and probably application of embalming fluids indicate that some mummification procedures were executed. The dental condition of hyperdontia was identified which is a rare condition reported in few ancient Egyptian skulls. The age-at-death of the children was estimated between 3 and 8 years.
Acknowledgements For their assistance in this research the authors wish to thank Dr. John Taylor of the British Museum, Dr. Shelley Robertson of the University of Melbourne, Craig Hagenmaier formerly of Toshiba UK Medical Systems, Martin Coyne and Lauren Fogarty of Siemens Australia, Dr. Bob Fabiny of the Radiology Department, Austin Hospital Melbourne and Forensic Radiologist Dr. Chris O’Donnell of the Victorian Institute of Forensic Medicine, Melbourne, Australia. The authors also thank the anonymous reviewers for their constructive comments that helped us to improve the manuscript.
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Jackowski, C., Bolliger, S. & Thali, M.J. (2008): Scenes from the past – Common and unexpected findings in mummies from ancient Egypt and South America as revealed by CT. – Radiographics 28: 1477–1492. Karlik, S.J., Bartha, R., Kennedy, K. & Chhem, R. (2007): MRI and multinuclear MR spectroscopy of 3,200-year-old Egyptian mummy brain. – Am. J. Roentgenol. 189: W105– W110. Knight, B. (1996): Forensic Pathology. – Arnold, London. Oakley, K.P. (1960): Ancient preserved brains. – Man 60: 90 –91. Ruffer, S.A. (1920): Study of abnormalities and pathology of ancient Egyptian teeth. – Am. J. Phys. Anthropol. 3: 335–382. Rühli, F.J, Chhem, R.K. & Boni, T. (2004): Diagnostic paleoradiology of mummified tissue: interpretation and pitfalls. – Can. Assoc. Radiol. J. 55: 218–227. Schaefer, M., Black, S. & Scheuer, L. (2009): Juvenile Osteology: A Laboratory and Field Manual. – Academic Press, Amsterdam. Taylor, J. (2001): Death and the Afterlife in ancient Egypt. – Bristish Museum Press, London. Taylor, J. (2004): Mummy: The Inside Story. – The British Museum Press, London. Ubelaker, D.H. (1978): Human Skeletal Remains. – Taraxacum, Washington D.C. Villa, C. & Lynnerup, N. (2012): Hounsfield Units ranges in CT-scans of bog bodies and mummies. – Anthropol. Anz. 69: 127–145. Wade, A.D., Nelson, A.J. & Garvin, G.J. (2011): A synthetic radiological study of brain treatment in ancient Egyptian mummies. – Homo – J. Comparat. Hum. Biol. 62: 248–269. Submitted: 19 February 2013; accepted: 23 June 2014. Address for correspondence: Chiara Villa, Laboratory of Biological Anthropology, Department of Forensic Medicine, University of Copenhagen, Frederik d. 5.’s Vej 11, 2100 Copenhagen, Denmark [email protected]
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