Some recent medical perspectives on the death of King Tutankhamen

The word “mummy” often conjures up before our mind’s eye the horror movies in which an embalmed body rises up to scare off intruders in a pyramid or a tomb who are in search of treasures or valuables. This, at least, is the plot structure of the 1999 horror-thriller film The Mummy . But it has to be borne in mind that these portrayals are mere figments of our imagination; the art of mummification was part and parcel of the Egyptian civilisation that roughly flourished from 3150 BC, dating from the era of the protodynastic kings like Narmer, also identified as Menes, to 30 AD, when Egypt became part of the Roman empire.

Etymologically, the word “mummy” denotes an embalmed body, thoroughly preserved to fight off corrosive forces like bacteria, fungi, spores and humidity that may otherwise reduce bones to dust within a matter of a few weeks. It comes from the Latin word “mumia” and the medieval Arabic word “mumiya”.

It is a misconception among the common masses that mummies have been found only in Egypt and that only the ancient Egyptians have mastered the ‘art’ of mummification. The earliest mummies belong to the Chincorro tribes of Chile, South America, dating back to 5050 BC. In the province of Xangiang in China, around 1,000 mummies have been unearthed. In my own nation, India, the famed body of St. Francis Xavier kept in the Basilica of Bom Jesus in Old Goa is a mummy, but the intriguing fact is that almost no preservatives have been used to convert the saint’s body into an embalmed one. Mummies of Buddhist and Tibetan monks have also been found in the Indian regions Leh and Ladakh; it seems that these monks went to the extreme extent of mortifying their flesh for “self-mummification”. This practice was also in vogue in Japan.

A hurried mummification and other hypotheses

In this connection, it would not be out of the way to have a peep into the mummy of the boy pharaoh Tutankhamen, who was the 11^th pharaoh of the 18^th dynasty of Egypt, also referred to as “The New Kingdom”. His nearly intact mummy along with its rich trove of treasures and fabulous gold mask was discovered by Howard Carter in 1922 in the Valley of the Kings (or KV62). But the strange fact about this mummy is that it is in a very bad shape now, and this may have been due to the fungi that have been found in his tomb. This has led some microbiologists like Ralph Mitchell from the University of Harvard to believe that his burial was a hurried one that did not even allow the paintings on the tomb to be dried appreciably. However, this idea has been disputed:

“The CT examination of King Tutankhamun provides new evidence of the life and afterlife of this most famous ancient ruler. It rules out a penetrating skull lesion or a chest trauma to be the cause of death, but it raises a possibility of a distal femoral fracture to be of possible premortem significance. Furthermore, the numerous reports of a hurried mummification of Tutankhamun can be dismissed, based on the noted multiple and extensive use of ancient procedures of body preservation.” (Hawass et al, 2008)

The earlier view was that the boy king may have possibly died due to a fractured leg that had become deeply infected. This fracture may have been inflicted due to a full-speed ride in a chariot that eventually broke his leg, or due to a violent blow in the battlefield. The discovery of numerous chariots in the tomb has given the clue to numerous Egyptologists that Tutankhamun was an avid chariot rider. However, recent CT, MRI and Radiology scans refute this. The more accepted view put forth by medical practitioners and archaeologists now is that he probably had a club foot, used a cane to walk (his cane shows extensive wear and tear at the base) and was probably born of inbreeding practices in the 18^th dynasty.

Yet another strand is that he was not the son of Nefertiti, but that of her sister. The mummy found in the tomb “KV35” has been designated “The Younger Lady”, an informal name given to probably one of the sisters of Nefertiti. The mummified remains were thought to be that of Nefertiti, but recent DNA analysis refutes this view and establishes her to be the mother of the pharaoh. Tut married Anhaksunamun, the latter bore two children who died at birth and were mummified as fetuses.

X-ray reports

King Tut was probably eighteen or nineteen when his reign was cut short in 1323 BC. Since the discovery of his tomb by Howard Carter in 1922, scientists and medical practitioners have speculated on how this happened.

It was long believed that the bone fragment in the skull resulted from a blow to his head, but now it is believed that a mishap in the mummification process may be the likely cause. CT scans that generated around 1,700 images during a period of over fifteen minutes show that his skull is intact, leading doctors as well as Egyptologists to look for yet another cause.

Radiology as well as X-ray reports shows that there is a dense embalming around the knee that may have broken shortly before his death, although the situation was not life-threatening.

A more plausible explanation is that Tut’s mummy shows such extensive wear due to an internal combustion to the same within its sarcophagus; others state that the mummy was cut open by modern tomb raiders when the entire world was engrossed in the two world wars. The cutting of the chest probably by a saw in an effort to get the precious necklaces cemented by resin could be a possible explanation. The possibility of malaria is not ruled out as well.

A pioneering study led by Pausch et al (2015) in Leipzig, Germany entitled “Tutankhamun’s dentition: The Pharaoh and His Teeth” points out the condition of the boy pharaoh’s teeth and the possible cause of death related with the same. The authors opine that only three months after the discovery of the X-rays in 1896, three images of the mummy were taken. Since the 1960s, many such images have been taken. But little or no study has yet been conducted on the dental condition of the mummy. The study showed that the mummy’s teeth had no abrasions and were of a high quality that shows a consumption of food without the presence of any “soiling of grit or sand”. The report states:

“CT investigations of Tutankhamun’s skull revealed an excellent condition of the king’s dentition. Crowding of the frontal mandibular teeth as a sequel of the limited space in the dental arch may be noted (11). No caries, missing teeth, or parodontal diseases were found (5). In contrast to these findings, caries decay of the teeth of Egyptian aristocrats is a frequent observation, effect of a copious consumption of processed carbohydrates. Tutankhamun’s dentition was also free of abrasions. This indicates a high grade of nourishment without soiling of grit or sand …Interesting findings in the current report case are the resin plugs in the oral cavity. They fill out the space between the cheek and the maxillary and mandibular lateral teeth. Saleem and Hawass (22) reported in a previous article about subcutaneous packing in royal Egyptian mummies, including King Tutankhamun, which was instilled through skin incisions. However, it remains unclear whether the cheek and intraoral resin masses in this case have been injected by separate approaches or might have entered this space by a transoral approach. The findings of this report suggest that the jaw relation of King Tutankhamun was a Class II malocclusion. Previous publications considered the presence of a mild prognathism (this suggestion probably refers to the maxilla) (5) or a mandibular retrognathism (10). The result of the cephalometric analysis revealed a mandibular retrognathism (SNB 77.8°), no matter whether the reference values by Segner and Hasund or those of an average Egypt population are used. This finding suggests that the maxillofacial skull architecture of Tutankhamun fits in the series of retrognathic average values of Egypt’s pharaohs (Pausch et al, 2015, 14, 23).”

Today what we have are the mummified remains of Tutankhamen as his mummy has been subject to intense pathological analyses by researchers, including the rough autopsy performed by Carter himself.

Results/Conclusion

The mystery regarding the sudden death of the boy king still remains. While earlier hypotheses included a blow to the head, later findings suggested birth deformities resulting from the in-breeding practices in the 18^th century BC dynasty, the case of malaria and even the death from war and a fall from a speeding chariot. Dr. Zahi Hawass seemed to have once supported the breaking of the knee bone and the dislocation of the same that caused the death from infection three days later. Ample episodes from The National Geographic Channel have endorsed opposing views – that Tut was a weak and fragile boy king as well as the fact that he has been depicted as such in order to erase his achievements from history; he even probably oversaw the battle of the Nubians with Egypt for trade routes. The condition of his teeth is excellent and death from molar inflammation or from an acute tooth ache does not seem to be a sufficient cause. His issue of sudden death thus still remains a mystery despite new evidence gathered by medical science and history.

Results of the Cephalometric Analysis
 

Source: Pausch et al, 2015