Paleopathological evaluation and radiological Study of 46 Egyptian mummified specimens in Italian museums more

EVO XXXII (2009) VALENTINA GIUFFRA*, DONATA PANGOLI*, PAOLA COSMACINI**, DAVIDE CARAMELLA***, FLORA SILVANO****, GINO FORNACIARI*, ROSALBA CIRANNI* PALEOPATHOLOGICAL EVALUATION AND RADIOLOGICAL STUDY OF 46 EGYPTIAN MUMMIFIED SPECIMENS IN ITALIAN MUSEUMS A paleopathological study of a number of Egyptian mummies started at the beginning of the last century with the pioneering work of Sir Marc Armand Ruffer. The application of radiological examination to mummy studies has a long tradition, and dates back to the year 1898 when Sir William Flinders Petrie used X-rays for the first time. Paleopathology and radiology both provide a quantity of data about the health status of past populations, in addition to the body conservation techniques adopted. Many mummified human remains from ancient Egypt are stored in Italian Museums. The University of Pisa carried out a project, named “Anubis”, whose aim it was to catalogue and examine these findings from a paleopathological and radiological point of view. Thirty-three complete mummies and thirteen body parts were surveyed and then submitted to complete radiological examination. In two cases it was possible to perform Computerized Tomography, two other mummies were investigated through endoscopy and in one case histology was also carried out. Sex and age at death were determined for each specimen; embalming techniques, pathological conditions and post-mortem events were observed. X-rays also provide interesting egyptological data and paleopathological information. Although it is not possible to elaborate a statistical analysis because of the scarce number of specimens coming from different parts of Egypt and different periods, evidence of joint and dental diseases and a number of other pathologies, such as fractures, osteoporosis and cysticercosis, were observed. Following the example of studies performed on collections of Egyptian mummies in other countries, this work tries to reduce many gaps in the knowledge of Egyptian human mummified material preserved in Italy. Keywords: mummies, ancient Egypt, Italian museums, paleopathology, radiology. Abstract * Department of Oncology, Transplants and Advanced Technologies in Medicine, Division of Paleopathology, History of Medicine and Bioethics, University of Pisa, Italy. ** Radiodiagnostic Department, ASL Roma B, Rome, Italy. *** Department of Oncology, Transplants and Advanced Technologies in Medicine, Division of Diagnostic and Interventional Radiology, University of Pisa, Italy. **** Department of Historical Science of the Ancient World, University of Pisa, Italy. 121 The extensive excavation campaigns executed by Ernesto Schiaparelli (1856-1928) at Assiut and Gebelein between 1911 and 1935, provided Italian museums with numerous Egyptian mummified human remains. But even earlier, during the first half of the 19th century, the work of Italian art collectors, of enthusiasts of Egyptian antiquities, of merchants and, above all, of consuls gave rise to a wide collection and import of ancient human remains which enriched private and public collections and, consequently, Italian museums. A survey estimated their number to be 141 entire mummies and 214 disarticulated parts (Fulcheri 1994). In 2000-2001, the University of Pisa performed a multidisciplinary survey, named “Anubis - Illness, Health and Socioeconomic Conditions in Ancient Egypt”, whose aim it was to collect data and information about the Egyptian mummies stored in Italian museums (Ciranni et al. 2005). In this work, we classify and examine all the human mummified remains for which permission for a study were obtained by the Museums or Institutions where they are stored. The extremely poor state of preservation of some specimens did not allow us to perform X-rays. The application of radiology to the study of mummies has a significant and long history (Böni et al. 2004; Cosmacini and Piacentini 2008). Thanks to its non-invasive nature, X-ray examination is an essential instrument of investigation to detect ancient diseases and to acquire information about embalming methods (Chhem 2006; Chhem and Brothwell 2007). Conventional X-rays and, more recently, CT-scanning, have been applied to the systematic examination of Egyptian mummies. In the 1960s intensive researches were carried out by Gray and his collaborators, who X-rayed the largest collections housed in the Netherlands and in the United Kingdom, in particular the 27 mummies and 1 head of the National Museum of Antiquities of Leiden (Gray 1966), the 18 mummies and 2 mummy parts of the City Museums of Liverpool (Gray 1968) and the 78 mummies of the British Museum of London (Dawson and Gray 1968). In 1975 17 mummies and 8 mummy parts stored at the Manchester Museum were examined by X-ray and, in 2 cases, by CT, within the framework of the well-known Manchester Museum Mummy Project, directed by Rosalie David (David 1979). In the same period all the Egyptian mummies of the Czech Republic, for a total of 24 mummies and 75 mummy parts, were X-rayed by Strouhal and Vihnanek (1979). The expansion of scientific investigations starting from the last decades of the XX century implied the more frequent application of modern techniques, in particular CT, to Egyptian mummy collections. In the U.S., 11 mummies of the Museum of Fine Arts of Boston (Marx and D’Auria 1986), 4 mummies within the University of Minnesota Mummy Project, (Notman et al. 1986) and 9 mummies of the Michael Carlos Museum of Atlanta (Hoffman et al. 2002) were CT-scanned. In Europe the researches remained initially limited to the use of conventional radiology, with the examination of the 8 mummies of the Kunsthistorisches Museum of Vienna (Seipel 1998) and the mummies of the Brussels Museum (Francot et al. 1999). Since 1998 the Swiss Mummy Project has been aimed at the study of the mummies contained in different Swiss museums using non-invasive techniques (Rühli and Böni 1999). More recently, the mummified remains 122 Introduction of the National Museum of Antiquities of Leiden – including 29 mummies, 8 heads and 70 embalmed animals – have been re-investigated, after a first radiological exam carried out by Gray (Gray 1966). All the findings were again submitted to X-ray examination and this time also to CT (Raven and Taconis 2005). In Italy X-ray examinations were performed on the 26 mummies of the Egyptian Museum in Turin (Delorenzi and Grilletto 1989), 13 of which have recently been submitted also to a CT-scan (Cesarani et al. 2003). The other scientific studies of Egyptian mummies were mostly limited to single cases studied by X-ray. A list of the examined specimens and of the relative references is provided below: Bergamo, Archaeological Museum: 1 mummy (Guidotti 1987); Bologna, Civic Archaeological Museum: 1 mummy (Aa.Vv. 1998); Como, Archaeological Museum: 1 mummy (Guidotti and Leospo 1994); Genoa, Civic Museum of Ligurian Archaeology: 1 mummy (Leospo 1999); Milan, Civic Archaeological Collection: 1 false mummy; 1 mummy (Lise 1974); Padua, Museum of the Institute of Anthropology of the University of Padua: 1 mummy (Drusini et al. 1982); • Trieste, Civic Museums of History and Art: 1 mummy (Dolzani 1982; Vidulli Torlo 1994); • Trieste - Civic Museums of Natural History: 1 mummy (Dolzani 1969). This work represents the effort to collect data from materials distributed in the museums and institutes of 12 Italian towns and to report the results of the paleopathological analysis and X-ray examinations. • • • • • • In the present study 33 complete mummies and 13 parts of mummies, for a total of 46 specimens, were examined. In particular the 33 mummies are distributed as follows: 2 are in the Archaeological Museum of Saint Peter’s Baptistery of Asti, 1 in the City Museum of Biella, 1 in the Museum of the Etruscan Academy of Cortona, 15 in the Archaeological Museum of Florence, 2 in the Civic Museum of Ligurian Archaeology of Genoa, 2 in the Liceo Classico Machiavelli of Lucca, 1 in the Civic Archaeological Collection of the Sforza Castle of Milan, 3 in the National Archaeological Museum of Naples, 1 in the town hall of Narni, 2 in the National Archaeological Museum of Parma, 1 in the Visconti Castle of Pavia, 1 in the Museum of Pathological Anatomy of Pisa (Fig. 1). Except for the study of the mummies of Florence (Guidotti 2001), the remaining material is unpublished. All specimens were submitted to conventional X-ray examination and evaluated. In addition, 2 specimens were also studied by Computerized Tomography (CT) (33, 35). Autopsy and histological exams were carried out on 1 mummy (19), whereas endoscopy was performed on two specimens (23, 24). The paleopathology team of Pisa performed most of the imaging studies, while the Soprintendenza Archeologica della Toscana provided the X-ray films of 9 mummies (6, 123 Materials and methods 8, 10, 11, 12, 13, 15, 16, 19) and the CT scan of the head (35) stored in the Archaeological Museum of Florence. The paleopathology team of Pisa used two portable devices for the X-ray examination: Minibloc 100/70 designed for animal studies (voltage 220 V, frequency 50 MHz) and Gilardoni X GIL S.G. (voltage 220 V, frequency 50 MHz). The X-rays were taken at 90 cm focus-film distance. The film used was Du Pont, CRONEX 4 Blue Base, 30x40 cm, and 3M R2, 30x24 cm. All films were manually processed in situ. The quality of X-rays, which in some cases is lower than in comparison to clinical standards, was conditioned by the in situ examinations. X-rays from two 90° angles were taken to avoid overlapping effects in the mummies. The right side is indicated in most films by the presence of a radio-opaque marker. The Pisa mummy (33) was studied by multidetector spiral CT equipment (16-detector rows Lightspeed RT General Electric Medical Systems) using the following parameters: 120 kV, 99-126 mA, 512x512 matrix, 26.8x31.9 cm FOV (body), 19x26.5 cm FOV (head), slice thickness 1 mm. Endoscopic examination of the Lucca mummies was performed by means of a rigid endoscope OLYMPUS A 3904: as for Lucca 1 (23) the device was inserted in the body through a cut performed in the thorax skin, while for Lucca 2 (24) through the evisceration incision present in the abdomen. The histological examination was carried out by taking a small amount of tissue sample, rehydrated in Sandison’s solution, paraffin-embedded, sliced, mounted on histological glass slides, stained and then examined by electronic microscope (Sandison 1955). The mummies are classified in alphabetical order and arranged according to the city of conservation. For each mummy, sex, age, date and references are reported in Table 1. The evaluation of sex was based on the observation of morphologic features of the body, primarily the pelvis and the skull (Ferembach et al. 1980; Gulekon et al. 2001). The age at death was determined by evaluation of dental calcification and eruption (Ubelaker 1989), length of long bones (Ubelaker 1989), epiphysis fusion and bone development for subadults (Ubelaker 1989; Suchey et al. 1984; Iscan and Kennedy 1989; France and Horn 1988). The skeletal age in young subjects under 20 years was also determined following the Radiological Atlas of Greulich and Pyle (1959). For adults the evaluation was based on dental wear (Kvaal et al. 1994; Lovejoy 1985) and suture closure (Meindl and Lovejoy 1989), and other parameters were assessed, such as osteoarthritis changes and osteoporosis. Date of the mummy was established on the basis of the embalming techniques employed and on eventual funerary equipment. 124 Table 1 - The 33 complete Egyptian mummies, with number in our catalogue, inventory number (if any) in the Museum/Institution Catalogue, analysis performed, sex, age at death and date. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 N. Inventory number Asti 93 Asti 94B Biella Cortona 3369 Cortona 396 Florence 2158 Florence 2163 Florence 2164 Florence 2165 Florence 2167 Florence 2168 Florence 2169 Florence 2171 Florence 5739 Florence 6526 Florence 6528 Florence 7244 Florence 7449 Florence 8686 Florence Genoa 1 Genoa 2 Lucca 1 Analysis by X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays X-rays; endoscopy X-rays; endoscopy X-rays X-rays X-rays X-rays X-rays; autopsy; histology X-rays X-rays X-rays X-rays; CT Sex F M F M M ? M F M F F M ? ? M ? M M M M F F F Age at death 30-35 30-35 35-45 40-50 25-35 45-55 25-35 60-70 32 25-30 7 1-2 1 5 50-60 4 25-35 45-55 35-45 35-45 40-50 35-45 30-35 III Intermediate Period III Intermediate Period Ptolemaic Period Ptolemaic Period Ptolemaic Period III Intermediate Period (XXI-XXV D ?) III Intermediate Period (XXI-XXII D) III Intermediate Period (XXII-XXIII D) Roman Period (179-180 A.D.) Roman Period (I-II c A.D.) Roman Period (I-II c A.D.) Roman Period (II-III c A.D.) Roman Period (I-III c A.D.) Ptolemaic Period New Kingdom (XVIII-XIX D) Roman Period ? III Intermediate Period (XXII-XXIII D) Late Period (XXV-XXVI D) ? ? ? Late Period Date 25 26 27 28 29 24 Lucca 2 30 31 32 33 Milan 1017 Naples 2341 Naples 2343 Naples 2344 Narni 2374 Parma 1 Parma 2 Pavia 212 Pisa 1 F F M M F M Legend: D = Dynasty; c = century. F M F M 3-9 months 25-35 20-25 35-40 35-45 c. 20 17-19 55-65 20-30 25-35 ? ? Ptolemaic Period ? Late Period (beginning of XXVI D) III Intermediate Period Ptolemaic- early Roman Period ? Ptolemaic Period Late Period 125 GA (General Appearance) describes the general radiographic aspect of the skeleton, with eventual presence of post-mortem (p.m.) fractures or dislocations, and phenomena related to bandage compression. If present, osteoporosis is signalled in this section. HS (Head Status) reports excerebration marks, such as filling of the cranial cavity and breakage of the ethmoid bone; presence of artificial eyes; pathologies of the skull. TS (Teeth Status) describes the state of dentition, observing the presence of deciduous or permanent teeth and of dental pathologies, from tooth loss to edentulia, tooth wear, caries and abscesses. AP (Arms Position) reports the position of arms and hands. BA (Body Appearance: thorax and abdomen) refers to the status of thoracic, abdominal and pelvic cavities, detecting the presence of evisceration marks, packages, fillings and tampons and of any particular pathologies. SS (Spine Status) describes the spinal column, and related pathologies. LS (Limbs Status) reports the state of the upper and lower limbs, as well as the presence of fractures, Harris lines, degenerative changes, such as coxarthritis and gonarthritis. For each specimen included in the catalogue, a general part describes external appearance: presence and pattern of wrappings, presence and aspect of soft tissues and general state of preservation. A good state is intended if the soft tissues are still largely present and if any lacking of body parts or of bandages is observable; on the contrary, a mummy is defined poorly or badly preserved if it is mostly skeletonized and if lacunae in some parts of the body or disruption in the wrapping are observed (Spindler et al. 1996, Adams and Alsop 2008). From a radiological point of view the results of imaging study, which include observations concerning the embalming process and the paleopathological findings, are organised as follows in the following sections: Results Imaging studies GA Bad appearance with head detached from the body; sternum, clavicles, ribs and hands disjoined; displacement due to p.m. events also of vertebral bodies of the thoracic spine. Feet disarticulated. HS Cranial cavity empty. Integrity of the ethmoid bone not discernible. Two teeth reduced to their roots in the interior of the skull. TS Upper teeth not visible; lower medial incisor missing; lower teeth wear; a tooth in the oral cavity. A caries on the right third molar. AP Arms along the sides, with hands on the pubic region. BA Body cavities empty. Little bone fragment detachment of the left pubis, near the pubic symphysis. 126 1) Asti Inv. 93 Head unwrapped and skeletonized. Dark stains on the left parietal bone and on the mandible. Wrappings originally in disruption, leaving some parts uncovered, in particular the back; restored in modern times. Bad state of preservation. Complete mummies References: Leospo 1986 SS LS Harris lines. Imaging studies GA Bad appearance with left scapula, humerus, ribs and left knee disarticulated. Spine totally or partially disjoined (Fig. 2b). Displacement due to p.m. events: ulna, radius and several small fragmented bones positioned between the femurs. Feet missing. A great number of long vertical lines of different thickness, slightly radiopaque, can be seen from the neck to the inferior limbs. HS Cranial cavity empty. Ethmoid bone intact (Fig. 2a). TS Partially edentulous intra-vitam, with alveolar resorption; upper medial incisors lost p.m. Upper right and left second incisor, canines and some premolars, lower right first incisor, left second incisor and canine, left first molar, right second molar present (Fig. 2a). A free tooth in the thorax (Fig. 2b). AP Arms along the sides. BA Body cavities empty. SS LS References: Leospo 1986 3) Biella No inv. Number (Named Scepsit-a-esi) Mummy wrapped in a shroud, fastened with horizontal linen strips. Good state of preservation. 2) Asti Inv. 94B (Named Ankhpakhered) Wrappings torn in correspondence of the head, thorax, pelvis and feet. Bandages restored in modern times. Very bad state of preservation. References: - Imaging studies GA Good appearance. Verticalisation of clavicles and ribs probably caused by bandage-press. Osteoporosis. HS Cranial cavity empty. Ethmoid bone intact. Faintly opaque shadows in the orbits, probably linen rolls. TS The projection employed does not allow to examine the state of dentition in detail. Upper and lower left molars lost intra-vitam. AP Arms crossed over the thorax. BA Thoracic cavity empty. Faintly opaque material in the abdominal cavity. Dense and circumscribed opaque material, probably an anal or vaginal tampon in the pelvic cavity (Fig. 3a). SS Degenerative changes in the thoracic and lumbar spine, with minimal osteophytosis and flattening of the vertebral bodies. LS Poorly healed spiral fracture of the distal third of the right tibia and fibula, with partial overlapping of the broken ends (Fig. 3b). Lateral gonarthritis, with reduction of the external hemirima and sclerosis of the subchondral bone, more severe on the left. Harris lines. 127 Imaging studies GA Good appearance. HS Cranial cavity empty. Ethmoid bone intact. Opaque material in the orbits interpreted as artificial eyes (Fig. 4a). TS Tooth wear (Fig. 4a). AP Right arm along the side, with hand on the internal thigh; left arm crossed over the thorax, with hand over the right shoulder. BA Heterogeneous material and two homogeneous opaque masses identifiable as packages in the thoracic cavity: an oblong-shaped one in the lower left thorax, the other in the lower right thorax. A smaller package in the abdominal cavity (Fig. 4b). SS Degenerative changes in the lower thoracic spine with osteophytosis and flattening of a vertebral body in the central thoracic spine. LS Slight degenerative changes in the hip joints (Fig. 4b). Bilateral gonarthritis. 5) Cortona Inv. 395 (Named Siosiris) Mummy covered with a painted cartonnage. Good state of preservation. References: Botti 1955; Bruschetti et al. 1988 4) Cortona Inv. 3369 Completely wrapped mummy. Good state of preservation. References: Guidotti 2001 Imaging studies GA Good appearance. HS Decubitus of opaque material in the occipital region. Ethmoid and nasal bones fractured. TS Except for a missing right third molar, lower teeth present, showing marked wear, particularly on first and second molars. Only upper anterior teeth present. AP Arms crossed over the thorax. BA Body cavities filled with heterogeneous material and three oblong separate packages, longitudinally positioned: two at the sides of the thorax and one in the central portion of the abdomen. Little opaque object in the pelvis, interpreted as a funerary genius. SS LS Faintly opaque objects around the ankles, probably cartonnage anklets. 6) Florence Inv. 2158 Mummy completely wrapped and covered with a stuccoed painted cartonnage. Good state of preservation. References: Botti 1955; Bruschetti et al. 1988 Imaging studies GA Good appearance even if medial and inferior ribs are disarticulated. HS Cranial cavity empty. Ethmoid bone fractured. Tooth wear. TS AP Arms along the sides, with hands on the pubic region. BA One opaque package in the right body cavities, another in the pelvis and heterogeneous material on the left side of the body cavities. SS LS Meniscal opacification on the right. 128 Imaging studies GA Good appearance. HS Cranial cavity empty. Ethmoid bone intact. Thickening of the skull vault. TS Dentition complete and in good conditions. AP Arms along the side, with hands on the thighs. BA Well healed fracture of the left clavicle. Faintly opaque mass in the abdominal cavity, interpretable as a package; rectal tampon in the sacral region. SS 129 9) Florence Inv. 2165 (Named Telesforo) Mummy completely wrapped in the original wrappings and in a shroud, fastened with horizontal and oblique linen strips. Year of death reported in the demotic inscription on the coffin lid. External genitalia embalmed. Good state of preservation. References: Guidotti 2001 Imaging studies GA Good appearance. Marked osteoporosis. HS Metallic mask on the frontal region of the head. Scanty and faintly opaque material in the cranial cavity. Ethmoid bone fractured. TS Partially edentulous, only a lower left premolar and incisor, and upper anterior teeth present. AP Arms along the sides, with hands on the internal thighs. BA Opaque material in the thoracic and abdominal cavities; oblong package near the lumbar spine. Metallic object in the epigastric region, identifiable as a winged scarab. SS Degenerative changes in the lumbar spine, with partial flattening of the vertebral bodies and reduced intervertebral spaces. LS Radio-opaque plaque in correspondence of the third medial distal ulna, interpretable as a bracelet around the right forearm. Degenerative changes in both knee joints with reduction of the external hemirimae as gonarthritis. Medial left meniscal opacification. 8) Florence Inv. 2164 (Named Diasethebsed) Mummy enclosed within a cartonnage, covered with a layer of resinous material. Good state of preservation. References: Guidotti 2001 Imaging studies GA Good appearance. HS Cranial cavity empty. Hyperlucent areas as arachnoid granulations in the cranial vault. Ethmoid bone intact. Opaque artificial eyes inserted in the orbits. TS Dentition complete, with slight wear. Diastema between the lower medial incisors. AP Arms along the sides, with hands on the thighs. BA Heterogeneous opaque material in the body cavities. Opaque rounded mass in the pelvis, interpreted as a rectal tampon. SS Degenerative changes in the thoracic spine. LS Degenerative changes in both knee joints as gonarthritis. 7) Florence Inv. 2163 (Named Paugimaiu) Mummy completely wrapped in the original wrappings and in a shroud, torn in correspondence of the head and feet. Good state of preservation. LS Imaging studies GA Good appearance. HS Cranial cavity empty. Ethmoid bone intact. TS The employed projection does not allow to examine the state of dentition. AP Arms along the sides, with hands on the external thighs. BA Heterogeneous opaque material in the body cavities, mainly in the pelvis. Package on the left side of the thoraco-abdominal region, longitudinally disposed, and another one in the pelvis. SS LS 12) Florence Inv. 2169 (Named Callisto) Completely wrapped in the original wrappings and in a shroud, fastened with horizontal and oblique linen strips. Poor state of preservation. References: Guidotti 2001 11) Florence Inv. 2168 (Named Giupra) Mummy completely wrapped, except for the head. Piceous-coloured skin; hair, eyelashes and eyebrows well preserved; lips and eyelids closed. Good state of preservation. References: Guidotti 2001 Imaging studies GA Good appearance. HS Cranial cavity empty. Ethmoid bone intact. TS Dentition complete and in good conditions. AP Arms along the sides, with hands on the external thighs. BA Body cavities empty. Preauricular sulcus well-marked, detachment of the coccyx and diastasis of the pubic symphysis. SS LS Opaque irregular material between the thighs, interpretable as a mass of cloth. 10) Florence Inv. 2167 Mummy completely wrapped in the original wrappings and in a shroud, fastened with linen strips, arranged in a criss-cross pattern. Good state of preservation. References: Guidotti 2001 Evidence of periostitis in both tibiae. Imaging studies GA Bad appearance with p.m. fractures of many bones. HS Cranial cavity empty. Ethmoid bone intact. TS The employed projection does not allow to examine the state of dentition. AP Arms along the sides, with hands on the external thighs. BA Package in the left hypochondriac region. SS LS References: Guidotti 2001 130 Imaging studies GA Good appearance. HS Cranial cavity empty. Ethmoid bone intact. TS The employed projection does not allow a detailed examination of the state of dentition. Deciduous dentition regular; some germs of the permanent teeth are visible. AP Arms along the sides, with hands on the external thighs. BA Faintly opaque material in the body cavities. SS LS References: Guidotti 2001 14) Florence Inv. 5739 Mummy in its original wrappings and in a shroud. Good state of preservation. 13) Florence Inv. 2171 Mummy in its original wrappings and in a shroud, fastened with linen strips, arranged in a crisscross patterns. Good state of preservation. Imaging studies GA Good appearance but feet detached from the body for a p.m. breakage. HS Scanty and faintly opaque material in the cranial cavity, deposited in the occipital region. Ethmoid and nasal bones fractured. Two pairs of circled earrings. TS The employed projection does not allow to examine the state of dentition. AP Arms crossed over the thorax. BA Faintly opaque package in the lower thorax, transversally disposed; two further dense opaque packages longitudinally positioned at the sides of the abdomen. SS LS 15) Florence Inv. 6526 (Named Qent) Mummy completely wrapped in the original wrappings and in a shroud, fastened with horizontal linen strips. Poor state of preservation. References: Guidotti 2001 Imaging studies GA Bad appearance with disarticulated ribs and column broken into three segments. HS Cranial cavity empty. Ethmoid bone intact. TS Partially edentulous; only lower anterior teeth, root of the upper right second premolar with large abscess cavity, upper right first molar and left third molar present. Caries in the neck of the upper right third molar. Marked tooth wear. A loose tooth is situated in the cranial cavity. AP Arms along the sides, with hands on external thighs. BA Body cavities empty. SS Degenerative changes in the lumbar spine. LS References: Guidotti 2001 131 Imaging studies GA Bad appearance with facial bones missing and mandible disarticulated. Incomplete femur and some disconnected bones of the forearm present at the thorax level. A stick passing through the foramen magnum and arriving at the knee had been inserted, probably in modern times, to support the fragile mummy. HS Faintly opaque material in the cranial cavity. TS The employed projection and the state of preservation do not allow to examine the state of dentition. AP Arms along the sides, hands on the thighs. BA Faintly opaque material in the body cavities. SS LS 17) Florence Inv. 7244 Mummy unwrapped in the XX century, the original shroud had been subsequently replaced. Head unwrapped and completely skeletonized. Bad state of preservation. References: Guidotti 2001 16) Florence Inv. 6528 Mummy in its original wrappings, which are loose and disarranged. Bad state of preservation. Imaging studies GA Bad appearance with elbow joints totally disarticulated and hand, knee and foot joints partially disconnected. HS Cranial cavity empty. Hyperlucent areas as arachnoid granulations in the cranial vault. Ethmoid bone intact. Mandible detached and lying down. TS Some teeth (two premolars and a third molar) free under the maxilla. Lower root of the right second incisor, canine, first and second premolar, first molar, left third molar present; upper right and left second molar present. Abscess cavity in correspondence of the lower right first molar. Anterior upper teeth lost intra-vitam; lower right second molar lost post-mortem. AP Arms along the sides. BA Healed fracture of the right clavicle. Body cavities empty. SS LS 18) Florence Inv. 7449 Mummy partially unwrapped; bandages in poor state of preservation. Body partially skeletonized, piceous-coloured skin, cloth pad soaked in resin inserted in the orbits. Bad state of preservation. References: Guidotti 2001 Imaging studies GA Bad appearance with a pivot recently inserted to fix the head to the thorax. HS Scanty and faintly opaque material in the cranial cavity. Ethmoid bone fractured. TS Edentulous. AP Arms crossed over the thorax. BA Two oblong packages longitudinally disposed at the sides of the thoracic cavity and a package transversally positioned at the base of the thorax. A package in the pelvis. SS Degenerative changes in the thoracic and lumbar spine, with osteophytosis. LS Harris lines. Severe bilateral gonarthritis. 132 References: Guidotti 2001 Imaging studies GA Bad appearance with feet detached from the body. HS Cranial cavity empty. Ethmoid bone intact. TS Dentition complete, except for the lower left third molar. AP Arms along the side, with hands on the thighs. BA Heterogeneous faintly opaque material in the body cavities. Rectal tampon. SS LS References: Guidotti 2001 20) Florence No inv. number Mummy partially unwrapped. Bandages longitudinally cut, leaving the half right part of the body uncovered. Head completely skeletonized. Skin partially present on the body. Poor state of preservation. References: Guidotti 2001 Imaging studies GA Bad appearance. Head detached from the body due to post-mortal breakage. HS Turbinate hypertrophic. Opaque material in correspondence of the facial and nasal bones. TS Dentition not visible, due to overexposure of the film at the level of the oral cavity. AP Arms crossed over the thorax. BA Abundant fairly opaque material in the body cavities, in particular in the hypochondriac region and in the pelvis. Package in correspondence of the lateral left wall of the left thoracic vertebrae. SS LS Degenerative changes in both knee joints as gonarthritis. 19) Florence Inv. 8686 Inferior part of the body covered with a cartonnage. Completely wrapped, bandages horizontally arranged and covered by a resinous paste. Poor state of preservation. Imaging studies GA Bad appearance with fractures of the distal epiphysis of the humerus and of the central diaphysis of the femur due to p.m. events. HS Cranial cavity empty. Ethmoid bone intact. TS Edentulous. Opaque mass in the oral cavity, interpreted as an oral tampon. AP Arms along the sides, with hands over the pubic region. BA Abundant heterogeneous material in the body cavities (Fig. 5a). SS Degenerative changes in the lower thoracic and lumbar spine, with ostephytosis and flattening of the vertebral bodies (Fig. 5a). LS Harris lines. Bilateral gonarthritis (Fig. 5b). References: - 21) Genoa Inv. 1 Head and feet unwrapped. Wrappings in disruption. Skin of a piceous colour; preserved and reddish hair. Semi-opened mouth. Poor state of preservation. 133 References: - Imaging studies GA Bad appearance due to multiple p.m. fractures of the hand bones; clavicles verticalised and ribs disarticulated due to the bandage-press. Severe osteoporosis. HS Cranial cavity empty. Ethmoid bone intact. TS Mandible missing. Some upper teeth missing. Marked tooth wear. AP Arms along the sides, with hands over the pubic region. BA Heterogeneous and granular material in the thorax. Opaque mass in the lower pelvis, interpreted as a rectal or vaginal tampon, probably escaped. Diastasis of the pubic symphysis. SS Degenerative changes in the thoracic and lumbar spine, with osteophytosis and flattening of the vertebral bodies, in particular in the lumbar tract. LS Healed fracture of the distal end of the right fibula. Ipsilateral gonarthritis. Opaque material in the soft tissues of the thighs. 22) Genoa Inv. 2 Head unwrapped and skeletonized. Wrappings torn in correspondence of the feet. Poor state of preservation. Imaging studies GA Good appearance. HS Opaque material in the cranial cavity. Ethmoid bone fractured. Radiolucent channels like enlarged vascular channels at cranial vertex (Fig. 6a). Marked tooth wear, particularly on the premolars, with smoothed crowns (Fig. 6a). TS AP Arms along the sides, with hands on the internal thighs. BA Heterogeneous faintly opaque material in the body cavities. Urinary calculosis (two fragments); calcified uterine fibroma. Dense opaque material in the pelvis, interpreted as a rectal or vaginal tampon (Fig. 6b); endoscopic examination, performed through an incision in the thorax, ascertained the presence of linen fillings in the thoracic cavity. SS Degenerative changes in the cervical and thoracic spine. LS Harris lines. 24) Lucca Inv. 2 Mummy completely unwrapped. Skin of a piceous colour. Hair partially preserved. Nose deformed for bandage compression. Evisceration incision on the left flank. External genitalia discernible. Good state of preservation. References: Silvano 1990; 1991 23) Lucca Inv. 1 (Named Heruimen) Completely unwrapped mummy. Skin of a piceous colour. Reddish preserved hair. Nose deformed for bandage compression. Semi-opened mouth. Evisceration incision on the left side. Good state of preservation. Imaging studies GA Good appearance. HS Cranial cavity empty. Ethmoid bone fractured. TS Germs of deciduous dentition present. AP Arms along the sides. BA A package in the right thorax, another in the pelvis. Heterogeneous opaque material mixed 134 SS LS with small rounded 5 mm formations, in the abdominal cavity. Endoscopic examination, performed through the evisceration incision on the left flank. Presence of clay and fine river gravel have been ascertained in the abdominal cavity. References: Silvano 1990; 1991 Imaging studies GA Good appearance. Verticalization of the clavicles, due to bandage compression. Fracture of ribs and scapulae, diastasis of the pubic symphysis, both due to p.m. events. HS Cranial cavity empty. Ethmoid bone intact. TS Dentition present, but not fully visible, due to overexposure of the film, in particular at the level of the oral cavity. Slight tooth wear. AP Arms crossed over the thorax. BA Diffuse and heterogeneous material in the thorax and abdominal cavities. SS LS Gonarthritis. 26) Naples Inv. 2341 Mummy unwrapped in unknown time restored in XIX century. Skin deteriorated and covered by a layer of dust and mould. Reddish hair, empty orbits, slightly aquiline nose, semi-opened lips. Evisceration incision on the left flank. Good state of preservation. References: Lise 1974 25) Milan Inv. 1017 (Named Peftau-auiset) The bandages are still present and darkened. Several faience beads of a funerary net scattered on the bandages at the thoracic level. Good state of preservation. Imaging studies GA Good appearance with p.m. diastasis of the pubic symphysis. HS Cranial cavity empty. Ethmoid bone intact. TS Dentition complete. AP Arms crossed over the thorax, with hands on the upper thorax. BA Opaque material in the lower right and left thorax. SS LS References: De Caro 1989 27) Naples Inv. 2343 Bandages opened by a longitudinal cut and lying at the sides of the body; they are intact only in correspondence of the feet. Head skeletonized; skin partially present on the thorax and of a piceous colour. Poor state of preservation. Imaging studies GA Bad appearance with p.m. fracture of the left acetabulum, carpal bones and fingers of the left hand between the femurs; left fibula and feet missing. HS Cranial cavity empty. Ethmoid bone fractured. TS Edentulous. 135 AP BA SS LS Imaging studies GA Bad appearance with multiple bony disarticulations and post-mortal fracture of the mandible. HS Decubitus with limited amount of opaque material in the occipital region. Hyperlucent areas like arachnoid granulations in the cranial vault. Integrity of the ethmoid bone not discernible (Fig. 8a). TS Partially edentulous. Marked tooth wear with flattened crowns (Fig. 8a). AP Arms along the sides, with hands on the internal thighs. BA Healed bilateral rib fractures. Opaque material in the thoracic cavity; three packages on the left and two on the right-hand side. Dense opaque mass in the pelvis, interpreted as a tampon (Fig. 8b). Slight degenerative changes in the lumbar spine. SS LS Degenerative changes in the knee joint, more severe on the left. Radiolucent areas as osteolytic area in the left femur neck with radio-opaque halo (Fig. 8b). 29) Narni Inv. 2374 Mummy covered with a cartonnage. Completely unwrapped probably in modern times. Head completely skeletonized. Skin partially present on the body and piceous-coloured. Evisceration incision present on the left flank, about 8 cm long. Poor state of preservation. References: - 28) Naples Inv. 2344 Mummy completely unwrapped. Partially skeletonized. Skin partially present on the thorax and of a piceous colour. Poor state of preservation. References: Giuffra et al. 2006 Arms crossed over the thorax, with hands on the shoulders. Opaque material in the body cavities; rounded package in the pelvis. Degenerative changes in the spine with flattening of the fourth lumbar vertebra. Deformation of the femoral heads due to severe bilateral coxarthritis (Fig. 7a). Meniscal opacification. Feet substituted by artificial wooden prostheses fixed to the tibiae with metallic nails (Fig. 7b). Imaging studies GA Bad preservation, with mandible disarticulated and fractured p.m., disconnection between cervical vertebrae due to p.m. manipulation, toe fingers and calcaneus bones disarticulated. Femurs inverted compared to the normal anatomical position, with heads in contact with the tibial plates, due to erroneous manipulation on the occasion of a modern restoration. HS Decubitus of opaque material in the occipital region. Ethmoid bone fractured. TS Dentition almost complete and in good condition. P.m. loss of lower left first premolar. A free premolar is positioned in the posterior jaw region. AP Arms crossed over the thorax. BA Opaque material in the body cavities. SS LS Linen masses between the femurs. Autopsy Access was close to the evisceration incision and a linen package, containing a muscular hollow 136 Histological examination A muscular tissue sample was taken from the abdominal package. A cysticercus of Tenia solium, 6 x 4 mm in size, was found. References: Morigi Govi et al. 1990; Bruschi et al. 2003; 2006 organ, 9 x 6 x 3 cm in size, identifiable as the stomach, was revealed. Abundant material in the abdominal cavity. References: - Imaging studies GA Good appearance even if asymmetry of the lower limbs, with right leg shorter than the left, probably due to the position of the body in the coffin. HS Cranial cavity empty. Ethmoid bone fractured. Digitated impressions on the inner skull, as for endocranial hypertension (Fig. 9a). TS Dentition complete and in good condition. Malposition of lower right third molar (Fig. 9a). AP Arms along the sides, with hands on the external thighs. BA Thoracic cavity empty. Heterogeneous opaque material in the abdominal cavity, in particular in the pelvis. Iliac crest not fused (Fig. 9b). SS Proximal and distal metaphysis of the tibiae recently fused. Meniscal opacification. LS 30) Parma Inv. 1 Mummy completely unwrapped. The bandages lie around the trunk and the lower limbs. Skin piceous-coloured and scattered with concretions of powder and mould. Hair partially present. Evisceration incision present on the left flank. External genitalia discernible. Good state of preservation. Imaging studies GA Good appearance. Osteoporosis. HS Cranial cavity empty. Ethmoid bone fractured. Craniotomy performed in modern times (Fig. 10a). TS Edentulous with alveolar resorption and thinning of the mandible (Fig. 10a). AP Arms along the sides, with hands on the external thighs. BA Healed fracture of the left clavicle with superimposition of the ends and shortening of the bone (Fig. 10b). Heterogeneous opaque material and linen masses in the lower right thorax. Heterogeneous opaque material in the lower abdominal cavity. Opaque rounded mass in the pelvis, interpreted as a rectal tampon. SS Degenerative changes in the cervical and lower thoracic spine with osteophytosis. Severe large thoracic-lumbar scoliosis (Fig. 10b). LS Bilateral gonarthritis. 32) Pavia Inv. 212 Mummy completely unwrapped. Traces of the bandages still visible on the trunk. Post-mortal breach in the right parietal bone. Very well preserved piceous-coloured skin. Facial features clear137 References: Botti 1964 31) Parma Inv. 2 (Named Usir-ur) Completely unwrapped. Skin of a piceous colour. Good state of preservation. Imaging studies - CT GA Good appearance. HS Tampon in the right nostril. Ethmoid bone fractured. AP Arms along the sides, with hands on the external thighs. BA Linen package in the anterior-lateral region of the abdominal cavity. Other opaque packages in the left abdominal cavity and in the pelvis. SS LS References: Ciranni 1999; Bresciani 2000; Caramella et al. 2007; Silvano 2007 33) Pisa Inv. 1 The inferior part of the coffin corresponding to the lower limbs, damaged during the Arno inundation of 1944, was restored. Mummy completely unwrapped. Skin piceous-coloured. Presence of short and reddish hair. Eyelid semi-closed, with orbits empty. Nose deformed for bandage compression. Lips closed. A hole present under the chin. Nails preserved. Evisceration incision on the left flank. Good state of preservation. References: - Imaging studies GA Bad appearance. Sixth cervical vertebra missing. Post-mortal fracture in the right parietal bone (Fig. 11a). A pivot fixes the lumbar spine to the pelvis (Fig. 11b), another pivot fixes the left femur to the tibia. Sticks and nails inserted on the occasion of a XIX century restoration are visible. HS Decubitus of opaque material in the occipital region. Ethmoid bone intact (Fig. 11a). TS Dentition complete and in good condition (Fig. 11a). AP Arms crossed over the thorax, with hands on the proximal humeri. BA Two oblong packages in the lower right thorax and in the left abdomen. Opaque rounded shaped material in the pelvis (Fig. 11b). SS LS Slight bilateral thinning of the articular rima of the knees. Harris lines. Opaque material in the soft tissues of the left thigh. ly distinguishable. Nose deformed by bandage compression. Lips semi-opened; upper anterior teeth exposed. Evisceration incision present on the left flank. External genitalia distinguishable. Poor state of preservation. Parts of mummies 34) Cortona Forearm. No inv. number Partially unwrapped. Skin of a piceous colour. Good state of preservation. 35) Florence Head. Inv. 8643 Head unwrapped; fragments of bandages still on the forehead, neck, ears and around the mouth. Skin of a light colour, hair partially preserved, nasal and auricular cartilages well preserved; eyelids and lips half open. Good state of preservation. 138 Imaging studies Regular hand bones in proper connection. Imaging studies Cranial cavity empty. Ethmoid bone fractured. Dentition complete, with moderate tooth wear. Craniotomy in the parietal bone, performed p.m. in modern times to carry out the autopsy. Cervical vertebrae up to the fifth one conserved. 38) Milan Head. Inv. 41116 Completely unwrapped. Dark, long hair and moustache preserved. Eyelid closed, lips semiopened. Aquiline nose. Good state of preservation. 37) Milan Head. Inv. 41115 Completely unwrapped. Skin preserved and light coloured in the lower part of the face, darker in the orbit region and on the skullcap. Breach in the parietal bone. Good state of preservation. Imaging studies Regular hand bones in proper connection. 36) Florence Right hand. No inv. number Unwrapped, but traces of bandages still visible. Skin of a piceous colour. Faience ring on the ring finger. Good state of preservation. Imaging studies - CT Decubitus of opaque material in the occipital region. Ethmoid and nasal bones fractured. Dentition complete and in good condition; breakage of upper left first molar. Cervical column conserved up to the sixth cervical vertebra. Porotic hyperostosis with characteristic “hair-on-end” appearance, indicating an anaemic picture. 39) Parma Head. Inv. 1 Completely unwrapped. Piceous-coloured skin. Nose partially damaged. Lips semi-opened. Good state of preservation. Imaging studies Cranial cavity empty. Ethmoid bone intact. Post-mortal breach in the left parietal bone, 6 x 4 cm. Diastema between the upper incisors. Dentition in good condition, except for the upper central incisor fractured p.m. Atlas conserved. Circular and rectangular elements with metallic density, probably belonging to the coffin. 41) Parma Head. Inv. 3 Partially unwrapped. Good state of preservation. Imaging studies Scanty opaque material in the cranial cavity. Ethmoid bone fractured. Dentition complete. Tooth wear, with flattened crowns. Cervical vertebrae conserved up to the fifth one. 40) Parma Head. Inv. 2 Completely unwrapped. Hair partially present. Skin partially present and piceous-coloured. Nose largely damaged. Mouth semi-opened. Poor state of preservation. Imaging studies Cranial cavity empty. Ethmoid bone fractured. Wormian bones on the left and on the right, and lambda bone. Slight tooth wear. Fracture of the upper medial incisor crowns. 139 Imaging studies Cranial cavity empty. Ethmoid bone fractured. Dentition almost complete. Marked tooth wear. Atlas and axis conserved. Imaging studies Cranial cavity empty. Ethmoid bone fractured. Dentition complete. Slight tooth wear. Increase of the transverse diameter, suggesting hydrocephalus. Cervical vertebrae conserved up to the fifth one. 42) Parma Head. Inv. 4 Completely wrapped; bandages torn and poorly preserved. Good state of preservation. Imaging studies Cranial cavity empty. Ethmoid bone intact. Dentition complete. Slight tooth wear. Fracture of the upper left central incisor. 44) Parma Legs. No inv. number Completely wrapped. Good state of preservation. Imaging studies A cervical vertebra is placed between diaphysis of the tibiae. Slight osteoporosis. 43) Parma Head. Inv. 5 Completely unwrapped. Traces of bandages still present in the occipital region. Head almost completely skeletonized. Good state of preservation. Imaging studies Scanty heterogeneous opaque material in the cranial cavity. Ethmoid bone fractured. Dentition complete. Slight tooth wear. Cervical vertebrae conserved up to the sixth one. 45) Pavia Head. Inv. 985 Completely unwrapped. Skin of a piceous colour. Nose damaged by bandage compression. Lips semi-opened; some teeth exposed. Good state of preservation. Imaging studies Cranial cavity empty. Ethmoid bone intact. Dentition complete, except for the upper right first molar missing. Occipital bone missing. Diastasis of the cranial sutures. 46) Pavia Head. Inv. 181 Completely unwrapped. Head covered with a layer of darkish material, probably used to mould the features of the face. Lacuna in correspondence of the occipital bone. Poor state of preservation. Discussion Sex - 16/33 mummies are of male sex, 13/33 are female and 4/33 of uncertain sex. For 4/33 cases (6, 13, 14, 16) it was not possible to determine the sex, partly because of the very young age of the mummies (13, 14, 16) and, in 1 case (6), owing to the presence of heterogeneous material in the body cavities, which did not allow a correct evaluation. 140 Age at death - The mummies were subdivided according to age at death interval distribution, using the categories suggested by Buikstra and Ubelaker (1994): Infant (0-3 years); Child (3-12 years); Adolescents (12-20 years);Young Adult (20-35 years); Middle Adult (35-50 years); Old Adult (50+ years). 3/33 mummies (12, 13, 24) were newborn under 3 years of age, 3/33 (11, 14, 16) were children under 12 years of age, only 2/33 (29, 30) were adolescents under 20 years. Most of the mummies, 12 (1, 2, 5, 7, 9, 10, 17, 23, 25, 26, 32, 33), showed an age at death between 20 and 34, 8/33 mummies reached an age between 35 and 49 (3, 4, 19, 20, 21, 22, 27, 28), whereas 5 (6, 8, 15, 18, 31) were adults over 50. Dates - All the mummies were dated on the basis of the embalming techniques employed and the funerary equipment, if present. Chronology was based on Baines and Malek (1980), who thus divided the Egyptian history: Archaic Period (I-III Dynasty): 2920-2575 BC; Old Kingdom (IV-VIII Dynasty): 2575-2134 BC; First Intermediate Period (IX-XI Dynasty): 2134-2040 BC; Middle Kingdom (XIb-XIV Dynasty): 2040-1640 BC; Second Intermediate Period (XV-XVII Dynasty): 1640-1550 BC; New Kingdom (XVIII-XX Dynasty): 1550-1070 BC; Third Intermediate Period (XXI-XXIV Dynasty): 1070-712 BC; Late Period (XXV-XXXI Dynasty): 712-332 BC; Ptolemaic Period: 332 BC - 30 BC; Roman Period: 30 BC - 395 AD. New Kingdom (1550-1070 BC) Third Intermediate Period (1070-712 BC) Late Period (712-332 BC) Ptolemaic Period (332-30 BC) Roman Period (30 BC-395 AD) Uncertain dating The mummies of the present work are distributed as follows: 1 mummy (15) 7 mummies (1, 2, 6, 7, 8, 18, 26). 4 mummies (19, 23, 24, 25) 7 mummies (3, 4, 5, 14, 27, 29, 32) 6 mummies (9, 10, 11, 12, 13, 16) 8 mummies (17, 20, 21, 22, 28, 30, 31, 33) In particular, only 1/33 mummies, badly preserved, is dated back to the New Kingdom; this subject reached an advanced age. 7/33 mummies belong to the Third Intermediate Period, of whom 4 in good state of preservation (6, 7, 8, 26) and 3 poorly preserved (1, 2, 18). In this group 3 are middle aged or older adults (6, 8, 18). 4/33 mummies belong to the Late Period, of whom only 1 (19) is in poor state of preservation and 3 (23, 24, 25) are well-preserved. Among the 7/33 mummies of the Ptolemaic Period, 3 (27, 29, 32) are poorly preserved and 4 (3, 4, 5, 14) are in good state of preservation. As concerns the 6/33 mummies dating back to the Roman Period, all are in good state of preservation, except for 2 (12, 16); of the 6 Roman mummies 4 belong to children (11, 12, 13, 16), while 2 (9, 10) are young adults. For 8 mummies the date remains uncertain, owing to the lack of funerary equipment or other elements which could help determine a chronological position. 5 mummies are in bad or poor state of preservation (17, 20, 21, 22, 28), 3 are well preserved (30, 31, 33). 141 Excerebration - In 16/33 mummies (2, 3, 4, 7, 9, 10, 11, 12, 13, 15, 17, 20, 21, 22, 25, 26) excerebration was not performed as demonstrated by the intact ethmoid bone and the empty cranial cavity. In 14/33 cases the fracture of the ethmoid bone (5, 6, 8, 14, 18, 24, 27, 29, 30, 31, 33) and/or the presence of endocranial embalming material (6, 8, 14, 16, 18, 28, 29, 32) were detected, attesting that excerebration had been performed. In 3/33 (1, 19, 23) it was not possible to ascertain the excerebration marks, due to the employed projection or the presence of material in correspondence to the face. Foreign bodies - Foreign bodies are present in 12/33 mummies. They include artificial eyes (3, 4, 7), a very small statue (6), a scarab (8), ankle bracelets (6), an armlet (8), earrings (14), opaque material in correspondence to the face (19), a real funerary mask (8), an oral tampon (21), opaque material in the soft tissues of the thighs (22), between the thighs (32), and cloths (10). A case of artificial wood prosthesis substituting missing feet has been recorded (27) (Giuffra et al. 2006). The presence of anal or vaginal tampons (3, 11, 22, 23) and rectal tampons (7, 9, 20, 28, 31) is also attested in mummies of each period except for the New Kingdom one. Position of the arms - In 21/33 mummies the arms are positioned along the sides, with hands on the external thighs (10, 11, 12, 13, 15, 24, 30, 31), on the superior thighs (7, 9, 16, 17, 20), on the internal thighs (8, 23, 28) or on the pubic region (1, 2, 5, 21, 22). In 11/33 the arms are crossed over the thorax (3, 6, 14, 18, 19, 25, 26, 27, 29, 32, 33). Only in 1/33 one arm is positioned along the side, with the hand on the internal thigh, and the other crossed over the thorax (4). Presence of packages or filling materials in the body cavities - Only 5/33 mummies have empty body cavities (1, 2, 10, 15, 17). All the remaining mummies present some filling in the thoracic and/or abdominal cavities. In 9/33 mummies it is possible to distinguish definite packages (4, 5, 6, 9, 12, 14, 18, 32, 33), whereas in 15/33 cases the filling is represented by heterogeneous opaque material (3, 7, 13, 16, 19, 20, 21, 22, 23, 25, 26, 28, 29, 30, 31). In 4/33 cases both packages and heterogeneous material are present (8, 11, 24, 27). Healed Fractures - Intra vitam fractures are diagnosed in 6/33 mummies, 2 of which are young adults (9, 17), 3 are middle-aged adults (3, 22, 28), and 1 is an old adult subject (31). In 3 cases (9, 17, 31) the fractured bone is the clavicle, in 1 cases (28) the ribs, in 1 142 Dental pathologies - 11/33 mummies show tooth loss (2, 3, 6, 8, 15, 17), to total edentulia (18, 21, 27, 28, 31). Dental wear, from slight abrasion to marked wear with smoothed crowns, is observed in 9/33 mummies (4, 5, 6, 7, 15, 22, 23, 25, 28); abscessual cavities are present in 2/33 (15, 17), caries in 2/33 (1, 15), malposition in 1/33 (30). In 1 mummy (1) two teeth reduced to their roots have been retained after their loss caused by periodontal disease in a woman of 30-35 years of age and it is unlikely that they were inserted into the cranial cavity during the embalming process. The retaining of the teeth in the cranial cavity has been already widely discussed, even considering its displacement ad artem with the possible motivation in a historical-religious context (Harbor et al. 2008). case (22) the fibula, while 1 case (3) consists in a spiral fracture of tibia and fibula, with partial overlapping of the broken ends, probably caused by a fall. Vertebral pathology - The spine shows degenerative changes in 12/33 mummies (3, 4, 7, 8, 15, 18, 21, 22, 23, 27, 28, 31). The lesions go from slight arthritic changes to marked lesions, with osteophytosis and flattening of the vertebral bodies. Vertebral osteoarthritis is diagnosed in most cases in middle-aged and older adult subjects, although 2 cases are also detected in young adults (7, 23). The thoracic (3, 4, 7, 18, 21, 22, 23, 31) and lumbar segments result to be the most involved (8, 15, 18, 21, 22, 27, 28), whereas the cervical spine shows arthritic changes only in 2 cases (23, 31). Scoliosis is diagnosed only in 1/33 mummy (31). Lower limb pathologies - 6/33 mummies showed Harris lines in the femurs and/or tibiae (1, 3, 18, 21, 23, 32). Tibial periostitis was observed in 1/33 mummies (9). Arthritic changes - X-ray alterations compatible with gonarthritis were detected in 14/33 (3, 4, 5, 7, 8, 18, 19, 21, 22, 27, 28, 30, 31, 32) mummies. The arthritic lesions are characterized by reduced width of the femuro-tibial articular space on both sides with sub-condral sclerosis, marginal sharpening at the level of the articular margin of the lateral femural condyle and sharpening of the inter-condylar prominence. Arthritic changes of the knee joint are all bilateral (3, 4, 7, 8, 18, 19, 21, 22, 28, 31, 32). In the case of mummy 3 the lateral gonarthritis of the right knee seems to be related to the ipsilateral spiral fracture of the tibia and fibula. These lesions might have caused limping. Meniscal opacification, thin and regular hypodiaphanous lines, resulting from calcification of the fibrous-cartilagineous meniscus and sign of meniscal suffering, is present in 3/33 mummies (5, 8, 27). It can not be ruled out that these radiological findings could be post mortal consequences derived from the embalming process. Coxarthritis, with thickening and sclerosis of the acetabular roof, sharpening of the cotyloid edges and reduction of the articular interlinear width, has been diagnosed in 2/33 mummies (4, 27). Similarly to vertebral osteoarthritis, arthritic changes of the knee and hip joint mostly affect middle-aged and older adult subjects, even if 2 cases (7, 32) were also recorded in young adults. Osteoporosis - Osteoporosis has been diagnosed on the basis of resorption of the trabecular bundles, prevalently horizontal, and consequently better visualization of the vertical bundles. 4/33 mummies show osteoporosis (3, 8, 22, 31), 3 of whom are females and only 1 is a male (31); all the affected subjects are over 35 years of age. Other pathologies - A possible chondroma is present on the acetabulum or neck femur of a mummy (28). Diastasis of the pubic symphysis has been observed in 2/12 female adult mummies (10, 22). In mummy 10 the diastasis is also associated with a well-marked preauricular sulcus and a dislocation of the coccyx, indicating multiple deliveries. 143 Autopsy and histologic exams carried out on mummy 29 allow to diagnose a case of schistosomiasis, a parasitic disease. A case of urinary calculosis and uterine fibroma was detected in one female mummy (23). The value of the data presented is limited by the randomness of the findings and by the small number of specimens, 33 mummies, which belong to different periods of Egyptian history from the New Kingdom to the Roman Period, and to different geographic regions of the Nile Valley. Such heterogeneity does not allow to perform any statistical or epidemiological analyses. For these reasons pathocenosis, which is the set of pathological conditions affecting a determined population in a determined period (Grmek 1969), of ancient Egyptians cannot be reconstructed as a whole, but relevant information can be obtained by this precious mummified material to better understand the lifestyle and disease spectra that affected the ancient Egyptians during their long history. Despite the limited number of specimens, it should be noticed that all age categories are represented and that 4/5 mummies of senile age are dated before the late Period. The results of this study reveal that the ancient Egyptians were mainly affected by joint and dental diseases. The pathologies diagnosed in our specimens are summarized in Table 2. The most frequent pathology is represented by osteoarthritis, a functional and age-related joint disease, with prevalence for the spinal column and knee joint. This data could suggest that the lifestyle in ancient Egypt involved significant biomechanical stress, which produced marked and early degenerative changes, in particular to the weight bearing parts of the body, that is the spine and lower limbs. The most diffused dental pathology is tooth wear, the progressive loss of enamel and then of dentin caused by the masticatory activities. The early and severe degree of wear in ancient Egypt is a well-documented characteristic. As attested by Leek (1966, 1972a and b, 1984), the frequency and severity of tooth wear in ancient Egyptians is to be attributed to different factors. The dental study of ancient Egyptian individuals, as well as the examination of bread samples from funerary offerings, revealed a high presence of inorganic components like quartz, sand and mica in farinaceous food. These elements had been identified as desert sand, which was intentionally added as a grinding agent during the milling process. Furthermore, the use of stone tools for harvest and wheat milling implied the inclusion of stone particles and mineral fragments in food, contributing to teeth grinding (Smith 1986). Less frequent was the caries. In the diet of the ancient Egyptians, carbohydrate was present (in bread and other starchy food), but sugar, which is responsible for the increase of this pathology in the modern age, had not yet been introduced. Considering the relatively small sample of examined mummies in relation to the long period of time in which they are distributed, the number of healed fractures, probably due to accidental trauma, appears relatively high. The localisation and type of fractures suggest that these individuals were victims of accidental traumas. 144 Conclusions Table 2 - Pathologies diagnosed on Anubi Project specimens Diastasis of the pubic symphysis is probably the result of deliveries. The cases of osteoporosis are numerous and mostly in mummies of female sex, to be related to the climacteric or to deliveries and lactation. The high incidence of Harris’ lines, even if not evaluated qualitatively and quantitatively by a standardised and semi-automatised method (Suter et al. 2008), indicates the presence of stress episodes, due either to malnutrition or to acute pathologies occurred in the age of growth. The study both of Ancient Egyptian texts, and of ancient Egyptian mummified remains proved that parasitic diseases had been one of the most common health problems in ancient Egypt, as well as in the Modern Age (Nunn 1996). The Schistostomiasis Project, a recent survey based on immunocytochemical techniques carried out by the University of Manchester, the Egyptian Ministry of Health and the Medical Service Corporation 145 International, have revealed the presence of Schistosoma in 30 percent of the mummified tissue samples (David and Archbold 2000). The only specimen of our series submitted to autopsy revealed the most ancient case of cysticercosis. This disease is caused by a particular form of Tenia Solium infection, in which a human serves as an incidental intermediate host of the tapeworms. A possible case of chondroma was detected. Several other cases of neoplastic diseases are documented in ancient Egyptian remains (Giuffra et al. 2004). The specimens present in Italy are stored in a number of Museums and Institutions distributed over the entire the territory, which makes it difficult to collect data. However, we believe that our extensive work has allowed us to describe with sufficient detail the Egyptian mummies housed in the Italian museums. The final aim is to contribute to fill in the gap in the knowledge of the human ancient Egyptian mummified remains present in our country. Acknowledgments We are grateful to Prof. Edda Bresciani for promoting this project. This work was supported by MURST, coffin. 40%, 1999-2000, prot. N°9810246721_002: “Malattie, salute e condizioni socio-economiche nell’Egitto Antico: un progetto multidisciplinare”. References AA.VV, In visita alla… collezione egiziana, Futura Press, Bologna, 1998. BAINES J., MALEK J., Atlas of Ancient Egypt, Andromeda, Oxford 1980. ADAMS J.E., ALSOP C.W., «Imaging in Egyptian Mummies», in R. DAVID (ed.), Egyptian mummies and modern sciences, Cambridge University Press, Cambridge, 2008, pp. 21-42. BOTTI G., Le antichità egiziane del Museo dell’Accademia di Cortona ordinate e descritte, Olschki, Firenze 1955. BRESCIANI E., La piramide e la torre. Due secoli di archeologia egiziana, Pacini, Pisa 2000. BOTTI G., I cimeli egizi del Museo di Antichità di Parma, Olschki, Firenze 1964. BRUSCHETTI P., GORI SASSOLI M., GUIDOTTI M.C., Il Museo dell’Accademia Etrusca di Cortona. Catalogo delle collezioni, Calosci, Cortona 1988. BONI T., RUHLI F.J., CHHEM R.K., History of paleoradiology: early published literature, 18961921, Canadian Association of Radiologists Journal 55/4 (2004), pp. 203-210. BRUSCHI F., MASETTI M., LOCCI M.T., CIRANNI R., FORNACIARI G., Studio paleopatologico della mummia di Narni: il primo caso di cisticercosi, Egitto e Vicino Oriente 24 (2003), pp. 53-61. BRUSCHI F., MASETTI M., LOCCI M.T., CIRANNI R., FORNACIARI G., Cysticercosis in an Egyptian mummy of the Late Ptolemaic Period, American Journal of Tropical Medicine and Hygiene 74 (4) (2006), pp. 598-599. 146 CARAMELLA D., NATALE G., PAPARELLI A., FORNACIARI G., Esame Tomografico Computerizzato (TC) della mummia egiziana conservata nel Museo di Anatomia Umana dell’Università di Pisa, Egitto e Vicino Oriente 30 (2007), pp. 106-108. CESARANI F., MARTINA M.C., GRILLETTO A., BOANO R., MAROCHETTI E.F., DONADONI A.M., GANDINI G., Whole-body three-dimensional multidetector CT of 13 Egyptian mummies, American Journal of Roentgenology 180 (2003), pp. 597-606. BUIKSTRA J.E., UBELAKER D.H., Standards for data collection from human skeletal remains, Fayetteville Arkansas Archaeological Survey Research Series 44, 1994. CIRANNI R., PANGOLI D., GIUFFRA V., CARAMELLA D., BRESCIANI E., SILVANO F., FORNACIARI G., The Anubis Project. An inventory and paleopathological study of the Egyptian Mummies collected in Italian Museum, Paleopathology Newsletter 129 (2005), pp. 6-11. DAVID A.R., Manchester Museum Mummy Project, Manchester University Press, Manchester 1979. CIRANNI R., I musei delle collezioni dell’Università di Pisa nel 1999, Primula, Pisa, 1999. CHHEM K.R., BROTHWELL D.R., Paleoradiology: imaging mummies and fossils, Sprinter, Berlin, 2007. CHHEM R.K., Paleoradiology: imaging disease in mummies and ancient skeletons, Skeletal Radiology 35 (11) (2006), pp. 803-804. COSMACINI P., PIACENTINI P., Notes on the history of the radiological study of Egyptian mummies: from X-rays to new imaging techniques, Radiologia Medica 113 (2008), pp. 615-626. D AVID R., A RCHBOLD R., Conversation with mummies: new light on the lives of Ancient Egyptians, The Madison Press Book, London, 2000. D AWSON W.R., G RAY P.H.K., Catalogue of Egyptian antiquities in the British Museum. I Mummies and human remains, Trustee of the British Museum, London, 1968. DELORENZI E., GRILLETTO R., Le mummie del Museo Egizio di Torino, Cisalpino, Milano, 1989. DE CARO S., La Collezione egiziana del Museo Archeologico Nazionale di Napoli, Electa, Napoli, 1989. D OLZANI C., Mummia egiziana del Civico Museo di Storia ed Arte di Trieste, Rivista di Antropologia 39 (1982), pp. 236-244. DOLZANI C., Sarcofago egiziano con mummia del civico Museo di Storia naturale di Trieste, Atti del Museo Civico di Storia Naturale di Trieste 26 (fascicolo 7, n.9) (1969), pp. 249-275. DRUSINI A., RIPPA BONATI M., PARNIGOTTO P.P., FELTRIN G.P., FIORE D., Indagine radiografica e con CT della mummia egiziana dell’Istituto di Antropologia di Padova, Quaderni di Anatomia Pratica 38 (1-2) (1982), pp. 53-66. FEREMBACH D., SCHWIDETZKY I., STLOUKAL M., Recommendations for age and sex diagnoses of skeletons, Journal of Human Evolution 9 (1980), pp. 517-549. FRANCE D.L., HORN A.D., Lab manual and workbook for physical anthropology, West Publishing Company, New York-Los Angeles-San Francisco, 1988. FRANCOT C., LIMME L., VAN ELST F., VANLATHEM M.P., VAN RINSVELD B., Les momies égyptiennes des Musées royaux d’Art et d’Histoire à Bruxelles et leur étude radiographique, Brepols, Turnhout, 1999. 147 GIUFFRA V., CIRANNI R., FORNACIARI G., I tumori maligni nell’antico Egitto e in Nubia, Egitto e Vicino Oriente 27 (2004), pp. 81-93. FULCHERI E., BARACCHINI P., DORO GARETTO T., PASTORINO A., RABINO MASSA E., Le mummie dell’antico Egitto custodite nei musei Italiani, Museologia Scientifica XI(1-2) (1994), pp. 1-11. GRAY P.H.K., Radiological aspects of the mummies of Ancient Egyptians in the Rijksmuseum Van Oudheden, Leiden, Mededelingen uit het Rijksmuseum van Oudheden, Leiden, 1966. GIUFFRA V., FORNACIARI G., CIRANNI R., A new case of ancient restoration on an Egyptian mummy, Journal of Egyptian Archaeology 92 (2006), pp. 274-278. GRAY P.H.K., Egyptian mummies in the city of Liverpool Museums, Liverpool Bulletin Museums Number 15 (1968), pp. 1-74. GRMEK M.D., Préliminaires d’une étude historique des maladies, Annales E.S.C. XXIV (6) (1969), pp. 1437-1483. GREULICH W.W., PYLE S.I., Radiographic atlas of skeletal development of the hand and wrist, 2 nd ed., California University Press, Stanford, 1959. GUIDOTTI M.C., Civiltà egizia nel Civico Museo Archeologico di Bergamo, Pressservice ’80, Bergamo, 1987. GUIDOTTI M.C., Le mummie del Museo Egizio di Firenze, Giunti, Prato, 2001. HARBOR J., GURVIT Ö., BECK L.A., POMMERENING T., Extraordinary dental findings in an Egyptian mummy skull by means of Computed Tomography, PalArch’s Journal of Archaeology of Egypt/Egyptology 1 (2008), pp. 1-8. ISCAN M.Y., KENNEDY K.A.R., Reconstruction of life from the skeleton, Alan Liss, New York, 1989. HOFFMAN H., TORRES W.E., ERNST R.E., Paleoradiology: advanced CT in the evaluation of nine Egyptian mummies, Radiographics 22(2) (2002), pp. 377-85. GULEKON I.N., TURGUT H.B., The preauricular sulcus: its radiologic evidence and prevalence, Kaibogaku Zasshi 76 (6) (2001), pp. 533-535. GUIDOTTI M.C., LEOSPO E., La collezione egizia del Civico Museo Archeologico di Como, Musei Civici Como, Como, 1994. LEEK F.F., Observations on the dental pathology seen in Ancient Egyptian skulls, Journal of Egyptian Archaeology 52 (1966), pp. 59-64. KVAAL S.I., SELLEVOLD B.J., SOLHEIM T., A comparison of different non-destructive methods of age estimation in skeletal material, International Journal of Osteoarchaeology 4 (1994), pp. 363-370. LEEK F.F., Bite, attrition and associated oral conditions as seen in Ancient Egyptian skulls, Journal of Human Evolution 1 (1972a), pp. 289-295. LEEK F.F., «Dental problems during the Old Kingdom. Facts and legenda», in A.R. DAVID, E.TAPP (eds.), Evidence embalmed. Modern medicine and the mummies of Ancient Egypt, Manchester University Press, Manchester, 1984, pp. 126-127. 148 LEEK F.F., Teeth and bread in Ancient Egypt, Journal of Egyptian Archaeology 58 (1972b), pp. 126-132. LEOSPO E., Io vivrò per sempre, Tormenta, Genova, 1999. LEOSPO E., Museo Archeologico di Asti. La collezione egizia, Ages Arti, Torino, 1986. LISE G., La Civica Raccolta Egizia - Castello Sforzesco, Comune di Milano, Milano, 1974. LOVEJOY C.O., Dental wear in Libben population: its functional pattern and role in the determination of adult skeletal age at the death, American Journal of Physical Anthropology 68 (1985), pp. 47-56. MARX M., D’AURIA S.H., CT examination of eleven Egyptian mummies, Radiographics 6(2) (1986), pp. 321-30. MEINDL R.S., LOVEJOY C.O., Ectocranial suture closure: a revised method for the determination of skeletal age at death, based on the lateral-anterior sutures, American Journal of Physical Anthropology 68 (1989), pp. 57-66. RAVEN M.J., TACONIS W.K., Egyptian mummies. Radiological atlas of the collections in the National Museum of Antiquities in Leiden, Turnhout, Brepols, 2005. RUHLI F.J., BONI T., Radiological aspects and interpretation of post-mortem artefacts in ancient Egyptian mummies from Swiss Collections, International Journal of Osteoarchaeology 10 (1999), pp. 153-157. NUNN J.F., Ancient Egyptian medicine, The British Museum Press, London, 1996. NOTMAN D.N., TASHJIAN J., AUFDERHEIDE A.C., CASS O.W., SHANE O.C., BERQUIST T.H., GRAY J.E., GEDGAUDAS E., Modern imaging and endoscopic biopsy techniques in Egyptian mummies, American Journal of Roentgenology 146 (1986), pp. 93-96. MORIGI GOVI C., CURTO S., PERNIGOTTI S., L’Egitto fuori dall’Egitto: dalla riscoperta all’egittologia, Atti del Convegno Internazionale Bologna 26-29 marzo 1990. Clueb, Bologna, 1991, pp. 51-55. SEIPEL W. (ed.), Mumien aus dem Alten Ägypten. Zur Mumienforschung im Kunsthistorischen Museum, Kunsthistorichen Museum, Wien, 1998. SANDISON T., The histological examination of mummified material, Stain Technology 30 (6) (1955), pp. 277-283. SILVANO F., Antichità egiziane in Toscana. I Il sarcofago di Lucca, Egitto e Vicino Oriente 13 (1990), pp. 45-58. SILVANO F., «Gli oggetti egiziani nel Museo di Storia Naturale-Liceo Classico di Lucca», in C. MORIGI GOVI, S. CURTO, S. PERNIGOTTI (eds.), L’Egitto fuori dell’Egitto. Dalla riscoperta all’Egittologia, Atti del Convegno Internazionale Bologna 26-29 marzo 1990, Clueb, Bologna, 1991, pp. 403-407. SILVANO F., Antichità egiziane nel Museo di Anatomia Umana dell’Università di Pisa, Egitto e Vicino Oriente 30 (2007), pp. 95-105. SMITH N.J.D., «Dental pathology in an Ancient Egyptian population», in A.R. DAVID (ed.), Science in Egyptology, Manchester University Press, Manchester, 1986, pp. 43-48. S TROUHAL E., V YHNANEK L., Egyptian mummies in Czechoslovak collections, Acta Musi Nathionalis Prague: 35B, Prague 1979. 149 SPINDLER K., WILFING H., RASTBICHLER-ZISSERNIG E., ZURNEDDEN D., NOTHDURFTER H., Human mummies. A global survey of their status and the techniques of conservations, Springer, New York, 1996. U BELAKER D.H., Human skeletal remains. Excavation, analysis, interpretation, 2nd Ed. Taraxacum, Washington D.C., 1989. SUTER S., HARDERS M., PAPAGEORGOPOULOU C., KUHN G., SZEKELY G., RUHLI F.J., Technical note: Standardized and semiautomated Harris lines detection, American Journal of Physical Anthropology 137 (3) (2008), pp. 362-366. VIDULLI TORLO M., La Collezione egizia del Civico Museo di Storia ed Arte di Trieste, Quaderno Didattico dei Civici Musei di Storia ed Arte di Trieste VI. Comune di Trieste, Trieste, 1994. SUCHEY J.M., OWINGS P.A., WISELEY D.V., NOGUCHI T.T., «Skeletal aging of unidentified persons», in T.A. RATHBUN, J.E. BUIKSTRA (eds.), Human identification: case studies in forensic anthropology, Charles C Thomas, Springfield, 1984, pp. 278-297. Fig. 1 - Map with the distribution of Egyptian mummies in Italian Museums. 150 Fig. 2 - Mummy 2 (Asti 2): a) AP projection of the skull; b) AP projection of the thorax. Fig. 3 - Mummy 3 (Biella): a) AP projection of the pelvis; b) AP projection of the legs. 151 Fig. 4 - Mummy 4 (Cortona 3369): a) AP projection of the skull; b) AP projection of the pelvis. Fig. 5 - Mummy 21 (Genova 1): a) AP projection of the thorax; b) AP projection of the knees. 152 Fig. 6 - Mummy 23 (Lucca 1): a) LL projection of the skull; b) AP projection of the pelvis. Fig. 7 - Mummy 27 (Naples 2343): a) AP projection of the pelvis; b) LL projection of the feet. 153 Fig. 8 Mummy 28 (Naples 2344): a) AP projection of the skull; b) AP projection of the pelvis Fig. 9 - Mummy 30 (Parma 1): a) LL projection of the skull; b) AP projection of the pelvis. Fig. 10 - Mummy 31 (Parma 2): a) LL projection of the skull; b) AP projection of the thorax. 154 Fig. 11 - Mummy 32 (Pavia 212): a) LL projection of the skull; b) AP projection of the pelvis. 155