Egyptian Mummies and Modern Science by Rosalie Ann David

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9780521865791pre CUFX196/David 978 0 521 86579 1 October 31, 2007 18:50
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EGYPTIAN MUMMIES AND MODERN SCIENCE
Egyptian mummies have always aroused popular and scientific interest;

however, most modern studies, although significantly increased in num-
ber and range, have been published in specialist journals. Now, this
unique book, written by a long-established team of scientists based
at the University of Manchester (England), brings this exciting, cross-
disciplinary area of research to a wider readership. Its main aim is to
show how this team’s multidisciplinary, investigative methods and the
unique resource of the Egyptian Mummy Tissue Bank are being used for
new major international investigations of disease evolution and ancient
Egyptian pharmacy and pharmacology. It also assesses the current status
of palaeopathology and ancient DNA research and the treatments avail-
able for conserving mummified remains. Descriptions of the historical
development of Egyptian mummifications and medicine and detailed
references to previous scientific investigations provide the context for
firsthand accounts of cutting-edge research by prominent specialists in
this field, demonstrating how these techniques can contribute to a new
perspective on Egyptology.
A. Rosalie David is KNH Professor and Director of the KNH Centre

for Biomedical Egyptology at the University of Manchester. She was
awarded the Order of the British Empire (OBE) in the New Year Hon-
ours List of 2003 for her services to Egyptology, and she is the author
and editor of twenty-seven books, most recently Religion and Magic in
Ancient Egypt.
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Egyptian Mummies and Modern

Science
Edited by
a. rosalie david
University of Manchester
iii
CAMBRIDGE UNIVERSITY PRESS
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Cambridge University Press

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Published in the United States of America by Cambridge University Press, New York
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© Cambridge Universtiy Press 2008
This publication is in copyright. Subject to statutory exception and to the provision of

relevant collective licensing agreements, no reproduction of any part may take place
without the written permission of Cambridge University Press.
First published in print format 2008
ISBN-13 978-0-511-37705-1 eBook (EBL)
ISBN-13 978-0-521-86579-1 hardback
Cambridge University Press has no responsibility for the persistence or accuracy of urls
for external or third-party internet websites referred to in this publication, and does not
guarantee that any content on such websites is, or will remain, accurate or appropriate.
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Contents
List of Plates page vii

List of Figures viii
List of Contributors xi
Acknowledgments xv
Preface xix
A. Rosalie David
part i: an introduction to the scientific study

of mummies
1. The background of the Manchester mummy project . . . . . . . . . . . 3
A. Rosalie David
2. Egyptian mummies: an overview . . . . . . . . . . . . . . . . . . . . . . . . 10
A. Rosalie David
part ii: diet, disease and death in ancient egypt:

diagnostic and investigative techniques
3. Imaging in Egyptian mummies . . . . . . . . . . . . . . . . . . . . . . . . . 21
Judith E. Adams and Chrissie W. Alsop
4. Endoscopy and mummy research . . . . . . . . . . . . . . . . . . . . . . . 43
Ken Wildsmith
5. Dental health and disease in ancient Egypt . . . . . . . . . . . . . . . . . 52
Judith Miller
6. Slices of mummy: a histologist’s perspective . . . . . . . . . . . . . . . . 71
John Denton
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vi Contents
7. Palaeopathology at the beginning of the new millennium:

a review of the literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Maria Jeziorska
8. The use of immunocytochemistry to diagnose disease
in mummies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Patricia Rutherford
9. DNA identification in mummies and associated material . . . . . . . 116
Patricia Rutherford
10. An introduction to analytical methods . . . . . . . . . . . . . . . . . . . 133
Andrew P. Giże
11. The facial reconstruction of ancient Egyptians . . . . . . . . . . . . . . 162
Caroline M. Wilkinson
part iii: the treatment of disease in ancient egypt

12. The ancient Egyptian medical system . . . . . . . . . . . . . . . . . . . . 181
A. Rosalie David
13. Intoxicants in ancient Egypt? opium, nymphea,
coca and tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
David J. Counsell
14. Pharmacy in ancient Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Jacqueline M. Campbell
part iv: resources for studying mummies

15. The International Ancient Egyptian Mummy Tissue Bank . . . . . 237
A. Rosalie David
16. Conservation treatment for mummies . . . . . . . . . . . . . . . . . . . 247
Antony E. David
part v: the future of biomedical and scientific

studies in egyptology
17. Biomedical Egyptology: some future possibilities
and contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
A. Rosalie David
References 263
Index 297
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List of Plates
Colour plates follow page 138

I. Histological section of underside of a leaf.
II. Bacteria in gram-stained histological section.
III. Histological section of Serpula lacrymans fungus.
IV. Histological section through the fibrous pleura of the
lung.
V. Histological section of the ear of mummified cat.
VI. Histological section of wheat from a tomb.
VII. Histological section of ancient decalcified bone.
VIII. Histological section of bone providing timeline of events.
IX. Histological section of Egyptian bandage.
X. Positive staining of S. mansoni ova within infected mouse
liver: lateral spike. ×100.
XI. Positive staining of S. mansoni ova within infected mouse
liver. ×100.
XII. Positive staining of S. haematobium within infected
hamster liver. ×100.
XIII. Positive staining of mummy bladder tissue. ×100.
XIV. Positive staining of mummy bladder tissue with ova. ×100.
XV. Ultraviolet fluorescence microscopy of hair from a
mummy.
XVI. Visible light and infrared images of hair from a mummy.
XVII. Facial reconstructions of ancient Egyptians.
XVIII. Mummy covered with efflorescence and mould growth.
XIX. Hands and torso of the mummy after conservation
treatment.
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List of Figures
1. Mummy in gilded cartonnage. page 23

2. AP radiograph of the thoracic region of a mummy. 27
3. CT scan through the head: layering of resin posteriorly in the
skull. 29
4. Jumbled bones in a mummy. 31
5. Radiographs of mummy showing metal studs/amulets. 31
6. AP radiograph showing packages in the right thorax of a
mummy. 32
7. Lateral radiograph and CT scan of a mummy showing
packing in mouth. 32
8. Radiograph and CT scan of a mummy showing false eyes. 33
9. Radiographic evidence of brain removal in mummification. 33
10. Radiographic evidence indicating gender in a mummy. 35
11. Age determination in mummies: AP radiograph showing
evidence of epiphyses. 37
12. Radiographic evidence of disease processes in mummies. 39
13. Radiographs of animal mummies. 41
14. Severe wear on tooth. 57
15. Caries in the cervical area of a tooth plus a large
interproximal cavity. 59
16. Periapical destruction caused by the wear shown in Figure 1. 59
17. Dentition showing horizontal and vertical periodontal
disease. 61
18. Example of teeth that could be removed by digital
manipulation. 67
19. The only example of a possible dental extraction found in
Miller’s survey. 69
20. Maxilla showing two non-physiological defects. 69
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List of Figures ix
21. Isomers of C4 H10. 135

22. Diastereomers of cholestane. 135
23. The electromagnetic spectrum. 141
24. Depictions of cyclohexane. 147
25. The structure of glycine and alanine. 147
26. Total ion chromatograms of wax coating a pillow (a) and
beeswax (b). 153
27. SEM image of natron crystals in the bladder of a mummy. 159
28. ESEM image of crystalline wax coating a pillow. 159
29. Facial reconstruction procedures. 165
30. The preserved remains of an ancient Egyptian priest, with
facial reconstruction. 169
31. Production of a three-dimensional skull model from
two-dimensional data. 169
32. Facial reconstruction of Ramesses II from the mummified soft
tissues. 171
33. Comparison of facial reconstructions of ancient Egyptians
with portraits. 172
34. Depictions of disease and trauma in facial reconstruction
work. 174
35. Facial reconstructions of the skulls from Tomb KV5. 175
36. Comparison of the facial reconstructions from Tomb KV5
and Ramesses II. 177
37. Summary of classification of intoxicants. 197
38. Total ion chromatogram for juglet number 744. 201
39. Total ion chromatograms for four Bil-Bil juglets. 203
40. Summary of provenance and forensic laboratory analysis on
Manchester Cypriot Base II Ring Ware collection. 199
41. Summary of botanical features of ancient Egyptian ‘lotuses.’ 205
42. Phytosterol profile of ancient and modern Nymphaea
caerulea compared with petal of Impatiens walleriana. 207
43. Comparison of hair analysis for cocaine and nicotine in
Egypt and South America. 211
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Contributors
The following contributors to this book are actively engaged in the research
performed by the Manchester Egyptian Mummy Project, and in the teach-
ing programmes of the KNH Centre for Biomedical Egyptology, University
of Manchester (UK).
EDITOR
Professor A. Rosalie David, OBE
KNH Professor of Biomedical Egyptology and Director of the KNH Centre
for Biomedical Egyptology, University of Manchester (UK). Director of the
Manchester Mummy Research Project since 1973.
CONTRIBUTORS
Professor Judith E. Adams
Professor of Diagnostic Radiology, Clinical Radiology, Imaging Science and
Biomedical Engineering, Faculty of Medicine, University of Manchester
(UK). Member of the Manchester Mummy Project since 1998.
Chrissie W. Alsop
Manager of Clinical and Research Imaging Facilities, Clinical Radiology,
Imaging Science and Biomedical Engineering, Faculty of Medicine, Uni-
versity of Manchester (UK). Member of the Manchester Mummy Project
for more than twenty years.
Research Associate, KNH Centre for Biomedical Egyptology, University of
Manchester (UK). Specialising in the history of pharmacy in ancient Egypt,
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xii Contributors
particularly medicinal plants and their relevance to current medicine and

nutrition.
Dr David J. Counsell
Consultant Anaesthetist, NHS Trust, Wrexham (UK). His research focuses
on drug history in ancient Egypt.
Antony E. David
Formerly Manager of Support Services, Lancashire County Museums Ser-
vice (UK). A forty-year career in conservation, specialising in artefacts and
Egyptian mummified remains.
John Denton
Pathology Research Fellow, Division of Laboratory and Regenerative
Medicine, University of Manchester (UK). He has nearly forty years of expe-
rience of the histological investigation of biological tissues in diagnostic and
research environments.
Dr Andrew P. Giże
Senior Lecturer, School of Earth Atmospheric and Environmental Sci-
ences, University of Manchester (UK). He runs the organic analytical facility
(gas chromatography–mass spectrometry and microscopy), and uses micro-
probe techniques for research on Egyptology and Late Minoan projects.
Dr Maria Jeziorska
Lecturer in Molecular Pathology, Division of Laboratory and Regenerative
Medicine, University of Manchester (UK). She is engaged in research and
teaching on the use of immunohistochemical methods in contemporary
and ancient human remains.
Dr Judith Miller
Orthodontist, Research Affiliate at the Wellcome Trust for the History
of Medicine, London, and Honorary Fellow in the KNH Centre for
Biomedical Egyptology, University of Manchester. Her specialist study is
the history of dentistry in ancient Egypt.
Dr Patricia Rutherford
Research Associate (until 2006), KNH Centre for Biomedical Egyptol-
ogy, University of Manchester (UK). Pioneered and developed the use of
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Contributors xiii
immunocytochemistry as a diagnostic tool for detecting the presence of

schistosomiasis in mummified tissue.
Roger Speak
Experimental Officer, Department of Chemistry, University of Manchester
(UK). In addition to mass spectrometry, he provides infrared microscopy (a
unique facility) for archaeological projects.
Ken Wildsmith
With a background in engineering, and a career in sales for major companies
manufacturing industrial endoscopes, optical measuring equipment and
microscopes, he has pioneered and developed the application of endoscopic
techniques for Egyptian mummies since he joined the Manchester Mummy
Project in the 1980s.
Dr Caroline M. Wilkinson
Formerly Head of the Unit for Art in Medicine, University of Manchester
(UK), and now Senior Lecturer, Wellcome Unit, University of Dundee
(UK). Her pioneering work on techniques of scientific facial reconstruction
for both forensic and archaeological purposes has received wide media
coverage.
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Acknowledgments
The diverse and complex nature of the research we undertake is only made
possible by the generous support we have received over the past four decades
from many individuals and organisations. Although it is not possible to thank
them all here, we wish particularly to acknowledge those who have provided
the opportunities and facilities for our most recent studies.
First, we are indebted to the support we receive from ‘KNH’ whose gen-
erosity enabled a unique centre (which carries her initials) to be set up
in 2003 at the University of Manchester, and to the two Deans, Profes-
sor Alan North, FRS (Dean and Vice-President, Faculty of Life Sciences,
2004–present), and Professor Maynard Case (Dean, School of Biological
Sciences, 2001–2004), who have both played crucial roles in the centre’s
establishment and development.
We wish to record our gratitude to The Leverhulme Trust (UK) for its
support of the interdisciplinary, international projects we undertake. The
Leverhulme Trust has provided significant funding towards our research
in the form of two Research Grants. The first (1996–1999) facilitated the
establishment of the International Ancient Egyptian Mummy Tissue Bank,
and the current grant (2006–2009) was awarded for the Pharmacy in Ancient
Egypt Project.
We should also like to express our gratitude to Dr Keith Hall, the founder
and Managing Director of Hall Analytical Laboratories, Manchester (UK),
one of the premier organic mass spectrometry facilities in the United King-
dom, which is involved in both analysis and development. Dr Hall has
played a key role in providing additional, essential facilities for our work,
and he and his colleagues have been actively involved in the research and
interpretation associated with many of the archaeological projects under-
taken at the KNH Centre.
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xvi Acknowledgments
At the University of Manchester, we are grateful to many departments

for giving us access to their facilities. In particular, we should like to thank
Dr Paul Taylor, Clinical Director of Radiology, Central Manchester and
Manchester Royal Children’s University Hospitals NHS Trust (CMMC)
for permitting the use of the radiographic equipment and computed tomog-
raphy scanner for imaging of the mummies; the radiographers (Simone
Brooke and Nicola Moran) who performed the imaging; and the CMMC
Research Endowment for funding the out-of-hours imaging that has been
undertaken. We are indebted to Professor Mark W. J. Ferguson for his sup-
port in allowing Dr Patricia Rutherford the use of his laboratories for her
research. We are grateful to all the depositors to the International Ancient
Egyptian Mummy Tissue Bank, and would like to record here that the sub-
stantial loans of material made by Professor A. C. Aufderheide, Professor
D. Van Gervan, the Manchester Museum and the Leicester Museum have
provided significant resources for many of the current projects discussed in
this book.
Indeed, many institutions have made their collections, facilities and
expertise available to the Manchester team. In particular, we would like to
record our gratitude to staff and colleagues at the following: the Agricultural
Museum, Cairo, Egypt; the British Museum, London; the Chelsea Physic
Garden, London; the Duckworth Collection, University of Cambridge; the
Egyptian Museum, Cairo, Egypt; the Forensic Science Laboratory, Exton
Hall, Chorley, Lancashire (UK); the Georges-Labit Museum, Toulouse,
France; the Glyptotek Museum, Copenhagen; the Groningen Museum,
the Netherlands; the Leicester Museum, Leicester, UK; Manchester Royal
Infirmary, Manchester; the Medical Toxicology Laboratory at Guy’s and
St. Thomas’ Hospital, London; the Metropolitan Museum of Fine Art,
New York; the National Museums of Scotland; the National Research Cen-
tre, Cairo, Egypt; the Natural History Museum, London; the Manchester
Museum, University of Manchester; PDR, Cardiff (UK); the Polish Cen-
tre for Archaeology, Cairo, Egypt; the Royal Botanic Gardens, Kew (UK);
the South Sinai Environmental Agency, Egypt (United Nations Devel-
opment Programme); Stapeley Water Gardens, Staffordshire (UK); VAC-
SERA (the Egyptian Organisation for Vaccine and Biological Production,
Cairo, Egypt); and the Vivi Tackholme Herbarium, University of Cairo,
Egypt.
We should also like to express our gratitude to the following individu-
als for supporting and making various contributions to our work: Frank
Barnett; Dr Jenefer Cockitt; Professor M. Doenhoff, University of Bangor,
Wales (UK); Professor K. H. El-Batanony, National Scientific Advisor to the
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Acknowledgments xvii
Egyptian Government; Professor M. El-Demerdash, Director, South Sinai

Environmental Agency; Dr W. El-Saddick, Director, Egyptian Museum,
Cairo; Dr Azza el-Sarry; Dr B. Harer; Dr N. Hepper; Professor Faiza
Hamouda; Professor N. M. Hassan; Professor Fawzia Helmi Hussien; Emer-
itus Professor M. Kassas; Professor E. Rabino Massa, University of Turin,
Italy; Professor A. J. Mills; Professor Moushira Erfan; Caroline Needham;
Richard Neave; Dr P. T. Nicholson; Chris Rynn; Denise Smyth; and Dr J.
Taylor.
It has been a pleasure to work with the staff at Cambridge University Press,
and we are particularly grateful to Publications Director Beatrice Rehl and
Senior Editor Simon Whitmore, for their advice and support during the
commissioning and production of this book.
To my husband, Antony E. David, I give my personal thanks, for his
academic input and significant practical contribution towards preparing
this manuscript for publication, and for providing constant support and
encouragement for my work.
Finally, we should like to acknowledge the contribution made by our
students, whose enthusiasm and interest in this field continually inspire us
to pursue new goals and developments.
A. Rosalie David
Manchester, December 2006
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Preface
A. Rosalie David
The main aims of this book are to show how biomedical and scientific
techniques have led to a new understanding of some aspects of ancient
Egyptian society, and to demonstrate how the focused, multidisciplinary
research of one team, working continuously in this area for more than thirty
years, has been able to contribute to this field.
There has been a remarkable and significant increase in the number and
range of scientific studies undertaken on mummies over the past couple of
decades, and people are now aware of the information that can be derived
from such investigations, in terms of explaining the cultural context of
human remains and in adding to knowledge of how disease has evolved
and developed from ancient to modern times. Much of this work, however,
is published in scientific journals or conference papers, and is not readily
accessible to the reader who has a general interest in the field.
The Manchester Egyptian Mummy Research Project, established at the
University of Manchester in 1973, has conducted pioneering research on the
methodology of using scientific techniques to investigate ancient Egyptian
mummified remains. It has run the longest continuous research programme
in the field of biomedical Egyptology, and this has led to the establishment
(in 2003) of a university specialisation and a dedicated facility – the KNH
Centre for Biomedical Egyptology in the Faculty of Life Sciences at the
University of Manchester (UK).
The earliest phase of this project was published in A. R. David (ed.), The
Manchester Museum Mummy Project (1979). The team has made major
advances since then, and mummy studies in general have progressed and
taken advantage of the many new techniques that can contribute to this field.
This book provides the first opportunity to present the complete picture
of the Manchester team’s more recent studies. The contributors have not
adopted a uniform approach: some chapters provide detailed descriptions
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xx Preface
of techniques, others concentrate on the significance of results, and some

assess the current role and status of the various fields of interest. Taken
as a whole, we hope this book will demonstrate how scientific studies on
mummies can provide new insight into the ancient Egyptians’ attitudes to
life and death.
The book is divided into five parts. The first, An introduction to the sci-
entific study of mummies, considers the aims, methods and development
of the Manchester Mummy Project within the wider context of scientific
studies on Egyptian mummies; it also provides a brief introduction to the
prehistory and history of ancient Egypt and a summary of why and how
Egyptian mummies were produced.
The second part, Diet, disease and death in ancient Egypt: diagnostic
and investigative techniques, describes the Manchester studies on human
and animal remains, with particular reference to disease, and demonstrates
how a wide range of scientific techniques can be developed and used as
diagnostic tools in this research.
The third section, The treatment of disease in ancient Egypt, uses infor-
mation derived from the Manchester studies to explore the ancient Egyptian
medical system and the role of medical practitioners, and to assess the
extent to which these analytical studies can confirm the ancient literary evi-
dence. It also considers the ancient Egyptian use of narcotics and pain relief
in religious, medical and social contexts, and presents the latest research
on the scope and possible therapeutic efficacy of their pharmaceutical
treatments.
The fourth part, Resources for studying mummies, describes the estab-
lishment and role of the International Ancient Egyptian Mummy Tissue
Bank, and surveys the conservation methods available for the treatment of
Egyptian mummified remains. The final section, The future of biomedical
and scientific studies in Egyptology, provides a summary of the contributions
that biomedical and scientific techniques can make to the study of ancient
Egypt, and considers some of the directions that this field of research might
take in the future.
Each chapter is written by an expert in the relevant field, scientists at
the cutting edge of this research who, working together as members of
the Manchester Mummy Project, have conducted this original work them-
selves. Although this is primarily a firsthand account of the group’s own
research and results, the investigations are described within the wider con-
text of mummy studies, and an extensive list of references to other work in
this field is included.
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Preface xxi
Much of the research undertaken at Manchester in recent years has

involved the application of new techniques. To provide sufficient space in
the book for explanation and discussion of these new techniques, we have
decided to omit techniques (such as serology and finger-printing) described
in our earlier publications that are no longer part of mainstream mummy
research.
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9780521865791c01 CUFX196/David 978 0 521 86579 1 October 31, 2007 16:30
part 1
An introduction to the scientific

study of mummies
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2
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chapter 1
The background of the Manchester

Mummy Project
A. Rosalie David
Early investigations
From the Renaissance, Egyptian mummies have attracted the interest of
antiquarian collectors, who brought them from Egypt to enhance the col-
lections of museums, learned societies, and wealthy individuals in Britain,
Europe, and later the United States of America. From the sixteenth century
onwards, some of these mummies were ‘unrolled’ (unwrapped) at frivolous
social events in front of invited audiences. Most of these unwrappings had
little scientific value; however, some were performed by serious investigators
whose detailed publications still provide valuable evidence.
These researchers include Thomas Pettigrew (1791–1865), a London sur-
geon who unwrapped a series of mummies in London (Pettigrew 1834);
Augustus Bozzi Granville (1783–1872), another London doctor who reported
evidence of ovarian disease in an Egyptian mummy (Granville 1825); and
members of the Leeds Philosophical and Literary Society, who undertook
an interdisciplinary study on a mummy in 1825 (Osburn 1828).
In the early twentieth century, various pioneering projects laid the basis
for mummy research. Armand Ruffer, Professor of Bacteriology in Cairo,
developed methods of rehydrating ancient tissues (Ruffer 1921), and invented
the term palaeopathology for the study of disease in ancient populations.
Grafton Elliot Smith, Professor of Anatomy in Cairo, performed extensive
examinations of the mummies of the rulers of the New Kingdom, discovered
at Thebes in 1871 and 1898 (Smith 1912). With his co-workers W. R. Dawson
and F. W. Jones, Smith also undertook an important study on some 6,000
ancient bodies retrieved during the Archaeological Survey of Nubia, a her-
itage rescue operation that was established when the first dam was built at
Aswan in the early twentieth century (Smith and Wood Jones 1910). A third
scientist, Alfred Lucas (1867–1945), also based in Cairo, performed analyses
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4 A. Rosalie David
of many ancient materials and substances, and was the first to demonstrate
that Herodotus’ account of mummification was accurate.
Mummy research has progressed steadily throughout the twentieth cen-
tury, although this development has not shown any continuous or regular
pattern. Nevertheless, the route has been highlighted by many important
studies which are too extensive to list here, but the following provide just
some examples.
Continuing research on royal mummies has included a radiological sur-
vey (Harris and Wente 1980), an interdisciplinary study of the mummy of
Ramesses II (Balout and Roubet 1985), and various investigations of the
mummies of Tutankhamun and the body found in Tomb 55 in the Valley
of the Kings. An extensive radiological survey of nonroyal human remains
in other major collections (Dawson and Gray 1968) has formed the basis
for many subsequent studies, and much information has been derived from
the series of autopsies and scientific studies undertaken in the 1970s on
several mummies in the Detroit Institute of Art, Pennsylvania University
Museum, and the Royal Ontario Museum in Toronto (Cockburn and Cock-
burn 1980).
The role of the Manchester researchers can now be considered within
the context of these earlier and contemporary projects.
Autopsy of the Two Brothers at Manchester

The pioneering work of Dr Margaret Murray at the University of Manchester
characterised the new approach to examining mummified remains that
emerged in the early twentieth century. As the first curator of Egyptology
at the Manchester Museum, she undertook one of the earliest scientific
investigations of Egyptian mummies, heading an interdisciplinary team of
specialists in anatomy, chemical analysis, and textile studies.
In 1908, before an invited audience in the University’s Chemistry The-
atre, the team unwrapped and performed autopsies on the mummies of two
brothers from a tomb (c. 1900 b.c.) at Der Rifeh. The results of subsequent
medical, scientific, and archaeological investigations, which provided infor-
mation about the tomb, bodies, and funerary possessions, were published
in a book (Murray 1910).
The Manchester Mummy Project: initial phase (1973–1979)

Shortly after I was appointed in 1972 to curate the Egyptology collection at
the Manchester Museum, I initiated a similar investigation. The Manch-
ester Mummy Project, as it became known, was established to examine all
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The background of the Manchester Mummy Project 5
the Egyptian mummified remains at the museum, although eventually it

also encompassed collections held in other institutions. A rare set of cir-
cumstances – a university museum with a significant mummy collection,
located near teaching departments and hospitals with sophisticated, spe-
cialised equipment, and supportive university authorities – ensured that the
project had unprecedented access to extensive scientific resources.
An interdisciplinary team of specialists, drawn from the university and
associated teaching hospitals, had the primary aim of establishing a method-
ology for examining mummies based on the availability of a range of tech-
niques and specialist equipment that could be used under near-ideal condi-
tions. Subsequently, other researchers have been able to utilise all or some
of the approaches and principles set out in this ‘Manchester Method,’ to
form the basis for their own contributions in this field (Dawson et al. 2002;
Taylor 2004; Raven and Taconis 2005).
In examining this group of mummies, the team’s second aim was to gain
as much information as possible about disease, diet, living conditions, the
process of mummification, and religious and funerary customs in ancient
Egypt (David 1997).
Techniques used in the first phase of the project (1973–1979) included
a radiological survey; rehydration and processing of mummified tissue to
produce histological sections that could be examined by light and electron
microscopy to demonstrate the framework and cellular detail of the tis-
sue and any evidence of disease; electron microscopy to identify insect
remains associated with the mummies; palaeo-odontology; the develop-
ment and application of special fingerprinting techniques; and the scientific
reconstruction of selected mummified heads. In addition, experiments were
undertaken to investigate the actual process of mummification, and to assess
the accuracy of ancient literary accounts.
In 1975, it was decided to unwrap and perform an autopsy on one of the
mummies, Number 1770, in the Manchester collection, to demonstrate how
these techniques could provide maximum information about the mummy.
As the first scientific autopsy of a mummy in Britain since Murray’s project
some seventy years earlier, it attracted considerable media interest.
Additional methods of analysis included the macroscopic and micro-
scopic examination of the textiles associated with this mummy; chromatog-
raphy to isolate and characterise the substances applied to the bandages;
and radiocarbon dating to establish and compare the approximate age of
the bones and bandages.
This first phase was published in a scientific book (David 1979) and a more
general account (David 1978). In 1979, an international symposium entitled
Science in Egyptology attracted more than 100 delegates to the University
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6 A. Rosalie David
of Manchester to discuss the application of medical and scientific tech-

niques to Egyptological projects. Although earlier Egyptology conferences
had sometimes included sessions on palaeopathology, and some scientific
meetings had surveyed disease in ancient man, this was a new concept
because it focused exclusively on the application of science to Egyptology.
The joint proceedings of this successful meeting and another symposium
held at Manchester in 1984 were published later (David 1986).
The BBC produced a television documentary in the Chronicle series that
examined the team’s research and recorded the autopsy of Mummy 1770.
The Audio-Visual Department of the University of Manchester also made
two films which demonstrated the Manchester techniques and key events in
the unwrapping of 1770. These films, produced for general use in teaching
departments, won awards from the British Association for the Advancement
of Science. A public exhibition at the Manchester Museum (1979–1980)
presented the team’s results within the context of Egyptian funerary beliefs
and customs; it attracted many visitors, and received the Sotheby’s Award
in the Museum of the Year Awards (1980).
The Manchester Mummy Project: second phase (1979–1995)

After 1979, the project moved in new directions (David and Tapp 1984). An
important decision to promote virtually nondestructive methods of investi-
gating mummies introduced the use of endoscopy as a means of obtaining
tissue from inside a mummy for histological and other studies. Also, act-
ing on a proposal made at the 1979 symposium, an International Mummy
Database was established at Manchester to gather, store, and respond to
requests for research data about disease found in Egyptian mummies in
collections across the world.
This phase of the project was recorded in a second BBC Chronicle doc-
umentary, and another film, made by the Central Office for Information
for distribution outside Britain, related how techniques developed for the
project also contributed to contemporary forensic work and plastic surgery.
A major redisplay of the permanent Egyptian galleries at the Manchester
Museum highlighted the research and results of the Mummy Project and
was judged for the Museum of the Year Award, which Manchester won in
1987.
In the 1990s, Manchester’s innovative, virtually nondestructive approach
led to invitations to examine mummies in other collections. Pioneering
research in identifying DNA in mummies (Pääbo 1985) now opened up
new possibilities, and in 1992, at the invitation of Professor N. Kanawati of
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Macquarie University, Sydney, Australia, the Manchester team undertook

pathological and genetic studies on six mummies discovered in a tomb at
El-Hagarsa in Egypt (Elles et al. 1993).
In 1989, P. C. Brears, then Director of the Leeds City Museum, pro-
posed that the Manchester team should undertake a new scientific investi-
gation of the ‘Leeds Mummy,’ which originally underwent autopsy in 1825
(Osburn 1828). The new study gave the Manchester team the unique oppor-
tunity to compare their own techniques and results with those of the earlier
researchers (David and Tapp 1992).
The Manchester Mummy Project: third phase (1995–present)

A major development in this phase was the establishment, in 2003, of a uni-
versity specialisation in biomedical Egyptology within a dedicated centre –
the KNH Centre for Biomedical Egyptology in the Faculty of Life Sciences
at the University of Manchester (UK) (see Chapter 17). This is now the base
for the Manchester Mummy Team and its various projects.
The schistosomiasis in ancient and modern Egypt project

Until the mid-1990s, palaeopathological studies had concentrated on
detailed investigations of individual mummies or defined groups of bodies,
but in 1995, the Manchester researchers were invited to collaborate with sci-
entists in Egypt on an epidemiological project. The scientists were pursuing
a ten-year programme, the Schistosomiasis Research Project, designed to
identify contemporary epidemiological patterns of a parasitic disease, schis-
tosomiasis, and to find more effective methods of treating the condition.
The aim of this joint study was to construct epidemiological profiles of
schistosomiasis in ancient and contemporary Egypt, and then compare the
incidence patterns from the twenty-sixth century b.c. to the seventh century
a.d. with the modern evidence, thus describing the evolution of the disease
over a 5,000-year period. Resources for this study would include evidence
of the disease that occurred in mummies, and contemporary infection data
collected by the Schistosomiasis Research Project on some 100,000 people
living in villages between the north and south of Egypt (Contis and David
1996; David 2000).
Other researchers have used various diagnostic techniques to detect schis-
tosomiasis in mummies, including radiographic examination to identify sec-
ondary pathological indications of the disease, and histological investigation
of mummified tissue to detect the presence of worms and eggs. The latter
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8 A. Rosalie David
method was used by Ruffer, who first identified the disease in mummies in
1910. More recent studies show the effectiveness of immunological analy-
sis of tissue or bone samples by using the enzyme-linked immunosorbent
assay (ELISA). This can detect the presence of circulating anodic antigen (a
glycoprotein regurgitated from the gut of the schistosome) in the mummy,
which will confirm if the infection was active at the time of the person’s
death.
To attempt to trace the pattern of schistosomiasis over the millennia, it was
necessary for the Manchester researchers to gather data from a large num-
ber of mummies, drawn from different locations and chronological periods
(see Chapter 15). For this project, it was decided not to use radiography or
histology, because the former would be expensive and dependent on access
to specialised x-ray equipment, and the latter would be successful only if
tissue could be obtained from specific areas of a mummy.
The Manchester researcher, Dr Patricia Rutherford, therefore decided
to adopt an immunological approach: she pioneered the use of immunocy-
tochemistry to detect this disease in mummies (see Chapter 8; Pain 2001),
and then confirmed the results by means of ELISA and DNA (Chapter
9). Further success was achieved when, for the first time, the DNA of the
causative parasite was identified in one of the samples.
The International Ancient Egyptian Mummy Tissue Bank

To ensure that a sufficient quantity of tissue samples was available for this
project, the International Ancient Egyptian Mummy Tissue Bank was estab-
lished at Manchester (see Chapter 15). The bank was initially funded by a
research grant from The Leverhulme Trust to collect and store samples
(mainly tissue, but also some hair and bone) from mummies held in collec-
tions across the world (apart from Egypt, where there are plans to establish
a similar tissue bank). The bank thus provides a new resource of specially
selected material for ongoing disease studies and other research.
Instrumental methods
In addition to existing techniques, the Manchester group now has access to
a range of instrumental methods, involving organic and inorganic analyses,
which are available to forensic scientists who wish to investigate ancient
and conserved remains and residues (see Chapters 10 and 13).
For example, these mass spectrometric and other protocols are being
applied in a unique study to determine if narcotics and pain-relieving agents
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were used in religious, medical, and social contexts in ancient Egypt. This
study is also investigating the problem of false results produced by contam-
ination, which may arise from mummification methods, environmental
conditions, or diagenesis.
The pharmacy in ancient Egypt project

The most recent area of research in Manchester focuses on the use of
pharmaceutical treatments in ancient Egypt. This study is supported by a
research grant from The Leverhulme Trust, and combines historical and sci-
entific methodology to investigate the therapeutic potential of these regimes
(see Chapter 14).
In a pilot study of more than 1,000 prescriptions found in four Egyptian
medical papyri, 379 drug substances have been analysed and formatted in
the style of the British National Formulary, detailing their active ingredients
and therapeutic efficacy. This initial work, comparing the compounding
and administration of these prescriptions with contemporary pharmacy,
has demonstrated that some 70 per cent of the identified substances used
by ancient Egyptian physicians remained in use in the twentieth century
a.d. Researchers working on this project include specialists in many fields
who have unprecedented access to both the International Tissue Bank and
collections of modern and ancient plants in Britain and Egypt. This provides
a unique opportunity to use scientific analytical methods to assess the validity
of the literary evidence.
These studies are investigating ancient and contemporary plant and inor-
ganic remains from Egypt, identifying any traces of pharmaceutical residues
in mummified tissue samples, and tracing the places of origin and the trade
routes by which the raw materials may have entered Egypt.
It is hoped that the results of this research will not only revolutionise
our understanding of the scope and significance of ancient Egyptian treat-
ments, but will contribute new information to the history of medicine and
pharmacy.
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chapter 2
Egyptian mummies: an overview
A. Rosalie David
Historical background
Mummification (the artificial preservation of the body after death) may have
been practised in Egypt for more than 4,000 years, and perhaps developed
as early as c. 4500 b.c., when Neolithic communities lived in scattered set-
tlements in the Egyptian Delta and along the banks of the Nile. Gradually,
these villages merged into larger groups, drawn together by the common
need to develop irrigation systems, and eventually, the north and south
were ruled as two separate kingdoms. Egyptologists describe this whole era
(c. 5000 b.c.–3100 b.c.) as the Predynastic Period.
In c. 3100 b.c., a southern ruler conquered the northern kingdom, unified
the two lands, and founded dynastic Egypt. Thousands of years later, an
Egyptian priest, Manetho (323–245 b.c.), composed a chronicle of kings
who ruled Egypt between c. 3100 b.c. and 332 b.c., and this king-list has
survived in the writings of later historians. It divides the reigns of Egyptian
kings into thirty dynasties and these, plus a thirty-first dynasty added by a
later chronographer, form the basis for the modern chronology of ancient
Egypt.
Contemporary historians arrange these dynasties into a series of major
periods: the Archaic Period (c. 3100–c. 2686 b.c.), the Old Kingdom (c.
2686–c. 2181 b.c.), the First Intermediate Period (c. 2181–1991 b.c.), the Mid-
dle Kingdom (1991–1786 b.c.), the Second Intermediate Period (1786–1567
b.c.), the New Kingdom (1567–1085 b.c.), the Third Intermediate Period
(1085–668 b.c.), and the Late Period (664–332 b.c.).
The conquest of Egypt by Alexander the Great of Macedon in 332 b.c.
ushered in the Ptolemaic Period. On Alexander’s death, Egypt passed to his
general who became King Ptolemy I, and his descendants (the Ptolemies)
ruled until the death of Cleopatra VII, the last of the dynasty. The next stage
10
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Egyptian mummies: an overview 11
of Egypt’s history, when the country was ruled as a province of the Roman
Empire, is known as the Roman Period (30 b.c.–641 a.d.).
Source material
Apart from the mummified remains themselves, sources relating to mummi-
fication include inscriptions and funerary illustrations, but these generally
concentrate on methods of anointing and wrapping. The earliest detailed
descriptions of mummification were written by Classical authors who vis-
ited Egypt: Herodotus in the fifth century b.c. (Histories: vol.2, 86–88; see de
Selincourt 1976), and Diodorus Siculus in the first century b.c. (Universal
History: vol. 1, 7; see Geer 1954).
The environmental context

Egypt is a land of contrasts: most of the country is desert, but in antiquity the
annual inundation of the Nile brought down water and silt, which created a
triangle of fertile land in the north (the Delta), and a strip of cultivated land
on either side of the river. Continuous irrigation and ceaseless vigilance
were needed to maintain this scarce agricultural land, which supported the
people, and their crops and animals.
From Neolithic times, towns and villages became established here, and
because this cultivated area could not be sacrificed for the burial of the
dead, the corpses – usually covered by a reed or skin mat – were placed in
shallow graves in the nearby desert.
It may have been religious beliefs that first inspired the Egyptians to try to
preserve the bodies of the dead in as enduring and lifelike a state as possible,
but geographical and environmental factors also played a significant role in
the development of mummification.
Natural and artificial mummification

A combination of the hot, dry climate and the location of the shallow graves
in porous sand provided conditions that ensured that these bodies were pre-
served indefinitely. The body fluids of the newly buried corpse evaporated
and were absorbed by the sand, a process that arrested decomposition and
produced desiccated, practically sterile bodies that could last indefinitely in
the right environmental conditions. Such corpses, complete with skin and
hair, are excellent examples of ‘natural mummification,’ and indeed may
have been the inspiration for later attempts at artificial preservation.
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12 A. Rosalie David
Although this method of burial continued in use for the poorer classes
throughout the historical period (c. 3100–332 b.c.), intentional preservation
of the corpse (mummification) was introduced first for the elite burials, and
eventually for all who could afford this method.
The reasons for artificial mummification, and the date when it was first
introduced in Egypt, cannot yet be confirmed. Until recently, Egyptologists
associated this development with a new type of grave built for the kings and
wealthier classes in the Archaic Period. Their bodies now rapidly decom-
posed because they were interred in an underground burial chamber lined
with mudbrick or wood, rather than being in direct contact with the sand.
Even at this date, the Egyptians probably believed that preservation of the
body was essential to enable the deceased owner’s immortal spirit to return
to the corpse and use it to derive spiritual sustenance from food offerings
regularly placed at the tomb. Thus, Egyptologists have speculated that arti-
ficial preservation was possibly introduced now to provide an alternative
method of preserving the lifelike form and features of the deceased.
New evidence indicates, however, that features that may be associated
with early artificial mummification (i.e., enclosing parts of the corpse in
tight-fitting linen wrappings and impregnating this material with resinous
substances) were already present in the Badarian Period (c. 4500–4100 b.c.),
at Badari and Mostagedda.
Elsewhere, in predynastic cemeteries (Naqada IIa-b) at Hieraconpolis
(Davies and Friedman 1998: 206–208) and Adaima (c. 3500 b.c.), some
stages of intentional mummification have also been observed (wrapping
the body and applying resin to the bandages and to selective areas of the
body). This is not, however, conclusive evidence of intentional preservation;
it may simply represent aspects of the funerary ritual (Jones 2002: 7).
There is new confirmatory evidence from Abydos that some features asso-
ciated with intentional mummification were already in use in the earliest
dynasties. A photograph taken by Petrie during excavations of the royal
tombs at Umm el-Qaab, Abydos, during 1899–1900 (Petrie 1901: vol. 2, 16,
pl. ii) shows a wrapped forearm, complete with four bracelets, which was
concealed in a hole in the wall of the tomb of King Djer (first Dynasty). This
arm may have belonged to his queen. Recent studies have demonstrated
that textiles associated with this arm appear to have been impregnated with
a substance that may be resin (Jones 2002: 5–6).
Another early attempt at mummification was noted by Quibell in the sec-
ond Dynasty necropolis at Saqqara (Quibell 1923: 11, 19, 28, 32. Pl.XXIX(3)).
The body of a woman had been wrapped in many layers of bandaging, and
between the bandages and bones, there was a large mass of very corroded
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linen, suggesting that crude natron or some other substance may have been
applied to the surface of the body as a preservative.
Natron is a natural deposit that occurs at El-Kab and in a desert valley
known today as the Wadi en-Natrun; it consists of sodium carbonate and
bicarbonate, and sometimes includes small amounts of sodium chloride
and sulphate. When artificial mummification was practised in later periods,
natron was used as the main dehydrating agent (Nicholson and Shaw 2002:
383–4).
Even in the Old Kingdom, the evidence for artificial mummification is
scant. A mummy discovered by Petrie at Medum (and later presented to
the Royal College of Surgeons in London where it was destroyed during an
air raid in 1941) probably dates to the fifth Dynasty, and demonstrates that
the embalmers had moulded the outer bandages, saturated with resin, to
attempt to recreate the body contours and facial features (Petrie 1892: 17–18).
In 1913, Reisner’s excavations at Giza revealed a similar mummy (Reisner
1913: vol. 11, 58, fig. 9).
Mummification in the Old Kingdom

Generally, the outer appearance of the body was emphasised in mummies
of this period: the limbs were separately wrapped in tight-fitting linen ban-
dages, and the facial features, breasts, and genitalia were moulded in a
gummy substance with the details added in paint. Although Junker, also
working at Giza, found examples in which the head or entire body (covered
first with a fine linen cloth) was coated with a layer of stucco-plaster (Junker
1929–1959: vol. 6, 226; vol. 3, 224), and details of the bodily features and the
head were carefully depicted.
The end result, however, was still unsatisfactory because underneath the
elaborately wrapped and moulded form, the body continued to decom-
pose. A successful method of artificial mummification still had to be found.
A major advance was introduced in the early fourth Dynasty: the eviscera-
tion of the abdominal and thoracic cavities. This was probably a deliberate
and conscious attempt to arrest decomposition, which now replaced earlier
efforts to recreate a modelled likeness of the body.
The first definite evidence of evisceration is provided by the contents of
Queen Hetepheres’ tomb, discovered near the pyramid of her son, Khufu,
at Giza (Reisner 1928: vol. 26, 80–81). Although the mummy itself was
missing (possibly removed by tomb robbers from the original burial site),
this reburial contained packets of viscera that had been treated with natron
(Lucas 1962: 271). Thus, the two crucial procedures required for artificial
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14 A. Rosalie David
mummification – evisceration and the use of natron to dehydrate the bodily

tissues – were already in use by the early fourth Dynasty.
Around the same period, the practise of burying the body in the con-
tracted position was discontinued, and the mummy was now placed in the
extended position, on its left hand side. From the New Kingdom onwards,
this changed again to the dorsal position.
Mummification in the First Intermediate Period

and Middle Kingdom
More mummies are available for study from the First Intermediate Period
and Middle Kingdom, but standards declined: whereas the outer appear-
ance of the mummy is often elaborate, less attention was paid to preservation
of the body itself. In 1903, archaeologists discovered an interesting group
of mummies belonging to princesses of the eleventh Dynasty (Naville and
Hall 1907–13: vol. 1, 44). These mummies showed no evidence of a flank
incision for removing the viscera, but possibly another method – partial
evisceration per anum – was used.
Winlock’s expedition in the same area some years later led to the discovery
of more royal bodies (Winlock 1921: 37–52); again, there is no evidence of
evisceration, and the bodies were probably preserved by injection of resinous
material into the alimentary canal per anum. Their generally poor state of
preservation, however, was probably due to incomplete desiccation of the
tissues, either because they were treated for only a short time with natron
before they were wrapped up or because natron was not used at all.
Generally, during this period, evisceration through the flank incision was
performed for nonroyal persons, but the dehydration process was minimal.
The thin coat of resin customarily applied to the surface of the skin achieved
only incomplete desiccation, and this caused the body to decompose. Even
the two mummies discovered by Petrie in an intact tomb at Rifeh, that
subsequently underwent autopsy and study in Manchester in 1908 (Murray
1910: 31), were poorly preserved, although they had both been eviscerated.
In the Second Intermediate Period, few examples of artificial mummi-
fication are available for study, but the body of Seqenenre, a ruler of the
seventeenth Dynasty, is of particular interest. He died as the result of a severe
head wound, probably falling on the battlefield, which would explain why
his body was cursorily mummified (Smith 1912: 4–6).
New Kingdom mummies

The discovery of two caches of royal mummies at Thebes between 1881 and
1898 a.d. provided the anatomist Elliot Smith, and later palaeopathologists,
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with the means of studying the development of mummification in the New

Kingdom (Smith and Dawson 1924). These royal mummies represent only
one social group, but they provide information that is also relevant when
studying nonroyal human remains of this period.
In the New Kingdom, various types of resin and oils were applied to the
body to preserve the tissues and mask odours associated with putrefaction
and the mummification process.
Brain removal (excerebration) was well established and widely practised
at this period, although it may have been introduced as early as the fifth
Dynasty (Strouhal 1986: 141–154). The most common method was to insert
an iron hook into the cranial cavity through the nostril and ethmoid bone
to reduce the brain to fragments that could then be scooped out with a
spatula.
More unusually, the embalmer gained access to the brain through the
foramen magnum or a trepanned orbit (eye socket). Excerebration was
always incomplete, however, and residual brain tissue was left in the cranial
cavity. Because the Egyptians believed that the heart, and not the brain,
was the locus of the personality and intellect, any extracted brain tissue was
subsequently discarded.
During the reign of Tuthmosis III (1504–1450 b.c.), the location of the
flank incision for evisceration and the positioning of the arms (generally
dictated by gender and historical period) were changed. The hands of female
mummies were usually placed alongside their thighs, whereas the male’s
arms were fully extended, with their hands placed over the pubic area. From
the reign of Tuthmosis II (c. 1512–1504 b.c.) until the twenty-first Dynasty,
kings’ arms were crossed over the chest.
Two outstanding examples of the embalmer’s art date to the nine-
teenth Dynasty: the head of King Sethos I (1318–1304 b.c.) demonstrates
the excellent results that could be achieved, although the body is less
well preserved, whereas in the mummy of his son, Ramesses II (1304–
1237 b.c.), innovative methods have retained the skin’s natural light tones,
in contrast to the blackening and discolouration associated with earlier
mummies.
Mummification in the Third Intermediate Period

Mummification reached its peak in the Third Intermediate Period. During
the twenty-first Dynasty, an official project was launched to rescue and
restore royal mummies damaged by tomb robbers seeking treasure during
the previous centuries. In the course of re-bandaging the mummies, the
embalmers may have recognised that mummification did not preserve an
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16 A. Rosalie David
accurate or lifelike image of the deceased, and this may have led them to
experiment with new techniques.
These innovations were first discovered when nine royal and more than
forty priests’ mummies from the twenty-first Dynasty were examined (Smith
1912: 94–111). Later studies on other mummies of this period supported these
findings; however, the new techniques were apparently first introduced in
the eighteenth Dynasty for the mummy of the obese pharaoh, Amenhotep III
(1417–1379 b.c.). Subcutaneous packing (stuffing inserted under the skin of
the legs, arms, and neck) was used to simulate the king’s ample form when
he was alive.
During the Old Kingdom, the embalmers had added external padding
to the body surface to reproduce the bodily contours. In the twenty-first
Dynasty, subcutaneous packing was widely used to achieve the desired
result. Small incisions made in the skin’s surface allowed the embalmer to
insert sawdust, butter, linen, and mud; these materials were also used to fill
the thoracic and abdominal cavities and to pack out the neck and cheeks.
An interesting transitional example from this period is the mummy of
Queen Nodjme, in which the older method of external packing had been
used, but there is no evidence of subcutaneous packing, although the face
was stuffed with sawdust, introduced through the mouth.
In the twenty-first Dynasty, the viscera, instead of being placed in Canopic
jars, were wrapped in four parcels, each containing a wax figure of one of the
protective Four Sons of Horus, and returned to the body cavities. Further
realism was achieved by inserting artificial eyes in the orbits, using false hair
extensions, and painting the faces (and sometimes the entire body) of men
and women with red and yellow ochre, respectively.
Mummification in later times

These innovations were practised until the end of the Third Intermediate
Period, but in the Late Period, standards gradually declined. Subcutaneous
packing and painting of the skin became less common, and the viscera were
no longer returned to the bodily cavities. Instead, the viscera parcels were
placed between the legs or, once again, stored in Canopic jars. Generally,
the external appearance of the mummy was more important than preser-
vation of the body, although resin was used extensively in the body cavities
and on the skin. As in earlier periods, however, it did not ensure complete
dehydration of the tissues.
In the Ptolemaic Period, a dynasty of foreign rulers and the arrival of Greek
and other settlers introduced many changes. Egyptian religious beliefs were
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gradually eroded, and although some of the immigrants adopted mummifi-

cation and it was more widely practised, the procedure was now dominated
by commercial rather than religious factors.
All of these changes led to a general decline in mummification standards.
As the outer wrappings of the mummy became more elaborate, less attention
was given to preserving the body. Sometimes the viscera were removed
and treated, and then returned randomly to the bodily cavities. Often the
mummy was not eviscerated or the cavities were filled with linen, mud, and
broken pottery.
Resin, now the main embalming agent, was poured into the cavities and
the skull, applied directly to the skin surface, and used to plug the nostrils.
As a result, the skin of these mummies is characteristically dark, hard, and
shiny. Many bodies were in an advanced state of decomposition when they
arrived at the embalmers’ workshop, and the molten resin often trapped
and preserved the insects that were attacking the tissues.
Mummification continued to decline during the Roman Period. The
mummy was now often buried without a coffin, and so the outer wrappings
and decoration were elaborate, sometimes incorporating a painted panel
portrait. Some of these portraits appear to represent a true likeness of the
deceased. Most of these bodies were poorly preserved, and it is often difficult
to confirm if the mummy has been eviscerated or excerebrated. Resin was
applied to the skin surface to arrest total decay, and sometimes missing limbs
were replaced by prostheses.
Even when Roman rule declined and Egypt embraced Christianity,
mummification continued in parts of Egypt and Nubia, and was even prac-
tised by members of monastic communities. The bodies were no longer
eviscerated, but natron and other substances were applied to the skin, and
the body was wrapped in embroidered clothes and linen sheets. Mummifi-
cation gradually disappeared after the introduction of Islam, following the
Arab invasion of Egypt in a.d. 641.
The contribution of mummy studies

Mummies are a unique resource for studying the lives of the ancient
Egyptians, because they provide unbiased evidence about disease, med-
ical treatment, diet, genetics, mummification techniques, and religious
customs.
Favourable environmental conditions and the custom of burying pos-
sessions with the dead have preserved a wealth of evidence for studying
ancient Egypt, and until the late twentieth century, our interpretation of this
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18 A. Rosalie David
civilisation was mainly based on the archaeological sites, monuments, arte-

facts, art, and inscriptions.
Art and literature in particular can present a deliberately distorted or
propagandist picture that does not represent reality. For example, religious
art associated with the elite tombs usually represents the owner, his family,
and friends as youthful and free from illness to ensure that they would
enjoy perfection and health in the life after death. Only the lower classes
are occasionally portrayed with physical signs of ageing, deformity, or illness.
Scientific evidence from human remains, however, should provide a
more accurate insight into the past, and multidisciplinary, analytical studies
have an important contribution to make to Egyptology, although researchers
should be always be aware that with some techniques it may be difficult to
obtain accurate results. Also, if scientific evidence is to be accepted by
Egyptologists, it is essential that investigators demonstrate that they have
interpreted their data correctly.
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part 2
Diet, disease, and death

in ancient Egypt: diagnostic
and investigative techniques
19
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20
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chapter 3
Imaging in Egyptian mummies
Judith E. Adams and Chrissie W. Alsop
Historical background
The application of radiography to the study of Egyptian mummies followed
soon after the discovery of x-rays by Wilhelm Roentgen in December 1895
(Boni et al. 2004). Four months later, in March 1896, Walter Koenig obtained
radiographs of a mummified child and a cat from the Senckenberg Museum
in Frankfurt, Germany (Koenig 1896). In the same year, Thurston Holland
obtained a radiograph of a mummified bird in Liverpool, United Kingdom
(UK) (Holland 1937).
At this time, the radiographic equipment was mobile and used on site
but was quite primitive, with limited tube rating (exposure limited, and
so it may have been impossible for the x-ray beam to penetrate through
very thick and dense material of the sarcophagus/cartonnage) and exposure
times were long (3 minutes or more).
In 1898, William Flinders Petrie, Professor of Egyptology at University
College London, and a major figure in the history of mummies and archae-
ological sciences, applied x-rays to the examination of mummified human
remains from Deshasheh, south of Cairo (Petrie 1898). In 1904, the anatomist
and anthropologist in Cairo, Sir Grafton Elliot Smith, assisted by Howard
Carter, applied x-ray examination to the mummy of Tuthmosis IV, deter-
mining the age of the king at death (Smith 1912).
In 1931, Moodie surveyed the Egyptian and Peruvian mummies in the
Chicago Field Museum in one of the earliest comprehensive radiographic
studies of such collections (Moodie 1931). In 1960, Gray and collaborators
documented the radiographic findings of some 193 ancient Egyptian mum-
mies housed in various museums in the UK and Europe (Gray 1973), includ-
ing the British Museum (Dawson and Gray 1968), the City of Liverpool
21
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22 Judith E. Adams and Chrissie W. Alsop
Museum (Gray and Slow 1968), and the Rijksmuseum in Leiden, Nether-
lands (Gray 1966).
Head computed tomography (CT) scanning was introduced in 1972 and
body CT in 1975 (Hounsfield 1973, 1976). The first applications of CT to
the study of Egyptian mummies were made in Canada by Harwood-Nash
and by Isherwood and colleagues in the UK who examined the Manchester
Museum mummy collection by using radiography and CT (Harwood-Nash
1979; Isherwood et al. 1979). Radiography and CT have now been applied
to study most of the major collections of Egyptian mummies throughout
the world (Chhem and Ruhli 2004).
Imaging methods
Radiographs
X-rays are produced when electrons are accelerated in a vacuum tube to an
anode, and from which a cone beam of x-rays is then emitted. The energy of
the x-ray beam can be altered according to the thickness and density of the
object being radiographed. Some x-rays will be absorbed (attenuated) in the
object, and some will pass through the object and reach the radiographic
film, changing the silver crystals to form the latent image; the radiograph is
then processed to develop the image on it. The attenuation of x-ray photons
is determined by the x-ray beam energy and the atomic number and electron
density of the structures though which the beam passes.
High atomic number materials (e.g. calcium in bones and metal) atten-
uate the x-ray beam and so few photons reach the film and the area is white
(radiodense) on a radiograph (see Figure 1). In areas of the object of low
x-ray attenuation (e.g. air) through which most of the photons pass to the film
the region will be black (radiolucent) (see Figure 1). Soft tissues of the body
are various levels of gray scale between these extremes of black and white
(Curry et al. 1990; Farr and Allisy-Roberts 1997; Dendy and Heaton 1999).
Because of the cone beam shape of the x-ray beam, the further an object is
from the film the greater the magnification of the object. To minimise such
magnification the object needs to be as close as possible to the film (contact
radiograph), and a long Film-Focus Distance (FFD – the distance between
the x-ray tube and the radiographic film) of 100 to 180 cm is required. To
minimise geometric lack of sharpness in the radiographic image, a focal spot
of 1 mm or less (0.6 mm) is required. Although contact radiographs can be
made of bone specimens, this is impossible for mummies in cartonnage
and wrappings. If accurate measurements are required to be made from
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(a) (b)
figure 1. Mummy of a child. (a) The mummy is

encased in linen wrappings and a gilded carton-
nage cover. Credit: The Manchester Museum, The
University of Manchester. (b) Anteroposterior (AP)
radiograph of the same mummy (1a) showing dis-
position of skull within the cartonnage. Note that
the bones of the skull vault are radiodense (white)
and the area between the cartonnage and the skull
is radiolucent (black), because this area is filled with
air. Credit: Judith Adams. (c) AP radiograph of the
same mummy showing remainder of the skeleton,
which is articulated and in a good state of preserva-
tion. The gilding of the cartonnage can be visualised
as radiodense areas, due to the high atomic number
of the gold paint superimposed on the thorax of the
mummified body. Note how there is the problem of
superimposition of structures on the 2D radiograph
of the 3D body structure. Credit: Judith Adams.
(c)
23
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radiographs of mummies, then a radiodense object of known dimensions

(coin, metal ruler) has to be placed at the same level from the tabletop as
the structure to be measured, so that the degree of magnification can be
calculated and an appropriate correction applied to measurements made.
Many of the early radiographic studies of Egyptian mummies were per-
formed in the field with portable equipment that had limited tube cur-
rent (limited beam energy). If the specimens to be examined cannot be
removed from their place of origin then portable or specially manufactured
radiographic equipment on site has to be used. Equipment in a modern
radiology department will be technically superior to field equipment and
will provide higher quality images and more ideal positioning of mummies
than it is feasible to obtain in the field. Radiography of mummified remains
will have to be performed during nonworking hours in a clinical radiology
department.
Although, in the early days of radiology, the differentially attenuated x-ray
beam changed the film directly, now to reduce radiation doses to patients,
films are inserted into a cassette, in which there is a radiosensitive phosphor
screen. This emits light in relation to the x-ray photons reaching it, and the
light forms the image (shadowgram) on the film.
Radiographic tomography
If a patient moves during x-ray exposure, the moving structures are blurred
and consequently not clearly seen, as they are not in the same position during
the x-ray exposure. Tomography (from the Greek word ‘tomos’ meaning
slice) uses such movement to blur out structures that overlay the item of
interest. This blurring out is achieved by the x-ray tube and the radiographic
film moving simultaneously in equal but opposite directions.
The fulcrum around which this movement takes place can be varied
from its distance from the tabletop and provides the ‘in focus’ plane, with
everything above and below this fulcrum plane being blurred out by the
movement. The larger the angle of movement of the x-ray tube, the thinner is
the section of the in focus plane. Tomography had to be widely used before
the introduction of CT, but is now not so necessary in clinical practice.
Current radiographic tomographic equipment uses linear movement of
approximately 20◦ and provides a slice thickness of 10 mm.
Computed radiography (CR)

With technical developments and the introduction of Picture Archiving
and Communications Systems (PACS) to the majority of modern radi-
ology departments, the images are recorded electronically instead of on
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Imaging in Egyptian mummies 25
radiographic film, resulting in ‘filmless’ departments. In CR systems, the

projection x-ray image through the object is acquired on a photo-stimulated
storage phosphor; this image is then transformed by a CR reader into an
electronic latent image, which is then converted electronically into a digi-
tal image. When radiographing mummies, ensure that you know how the
images are stored electronically in the department and for how long; other-
wise the original image data may not be available long term, in which case
you should request that the data are transferred for you to DVD as soon
after acquisition as possible.
Fluoroscopy
In this method, the x-ray photons transmitted reach a phosphor screen
and are intensified by electronic or geometric means. The image can be
recorded photographically by a ‘spot’ camera for static images or on a tele-
vision monitor which allows real time imaging. This may be relevant in
imaging mummies when endoscopy is being performed, and it is important
to identify the anatomical position of the end of the endoscope (e.g. when
a biopsy is being taken) (Notman et al. 1986).
Computed tomography (CT)

CT of the head was introduced in 1972, and transformed clinical imaging of
the brain (Hounsfield 1973). CT enabled a transverse axial slice of the body
to be obtained. The image is made up of a number of picture elements (pix-
els) in which the slice thickness determines the volume elements (voxels);
the latter are given an attenuation value dependent upon how much the
x-ray photons of the beam are absorbed by the material within the voxel.
These attenuation characteristics are defined as Hounsfield Units (HUs),
after Sir Godfrey Hounsfield, who was awarded the Nobel Prize in 1979
(Hounsfield 1980) for devising CT.
CT can be used for quantitation (QCT) and is applied to the measure-
ment of bone density with the use of a bone equivalent phantom to transform
HUs into bone mineral density units. Because QCT, and dual energy x-ray
absorptiometry (DXA) – another method for making quantitative measures
of the skeleton (Adams 2003; Mughal et al. 2005) – depend on the bone
being measured being adjacent to normally hydrated soft tissues, quanti-
tation methods cannot easily be applied to mummified tissue. In CT, for
the attenuation value to be representative of the substance being measured,
the entire voxel has to be filled uniformly with the substance. If the voxel
is filled with tissues of different x-ray attenuations (e.g. bone and air, fabric
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and air), there will be partial volume averaging and the HU will be a mean
value and not representative of the individual components.
The original head scanners used a pencil beam of x-rays and a single
detector that rotated around the head to obtain the transmitted radiation
readings from different angles around the head. With the introduction of
body scanners in 1975, the pencil x-ray beam was replaced by a fan beam
and the single detector was replaced with a curvilinear bank of detectors.
This allowed faster scanning of the larger volume of tissue; each slice still
took 20 seconds to acquire and was 10 mm in thickness.
Over the past decade, there have continued to be remarkable technical
developments in CT, with the x-ray tube rotating continuously to acquire the
images (spiral CT), and multiple rows of detectors (initially four, then six-
teen, thirty-two, and currently sixty-four rows) (multidetector CT – MDCT)
to record the transmitted radiation at different angles around the body. This
enables very fast acquisition (20 seconds for the whole torso) of a large
number of images (100 s), thinner sections (approximately 1 mm), three-
dimensional (3D) volume imaging, and a spatial resolution in the longitu-
dinal plane that is the same as that for the cross-sectional plane, which was
not the case for individual slices of the rotate/translate scanners (Kalender
2000, 2006; Hoffman et al. 2002). CT is now widely used to image mum-
mies and has also been used to guide biopsy sampling in palaeopathological
research (Ruhli et al. 2002).
Magnetic resonance imaging (MRI)

The technique of MRI was introduced in the early 1980s and has had impor-
tant implications for imaging human patients. The principle is that when
the body is placed within a strong magnetic field (current clinical MRI scan-
ners are usually 1.5 Tesla in field strength), the water protons in the body
tissues align along the magnetic field. When exposed to certain radiofre-
quencies, the protons are perturbed through 90◦ or 180◦ . When they realign
to the magnetic field they emit a radiosignal that is detected by a receiver
coil. MRI has high tissue contrast and can image directly in any anatomical
plane, and is widely used in medical diagnosis. It depends, however, on
water being present in the tissue, so unless mummified tissue is rehydrated,
MRI has no role in the imaging of desiccated mummies.
Ultrasound (US)
The technique of US imaging was introduced in the early 1970s, origi-
nally for the scanning of the foetus in utero, as it does not involve ionising
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(a)
(b)
figure 2. Resin and mud in the thoracic region of a mummy. (a) AP radiograph of the
thoracic (chest) region of a mummy showing radiodense resin in both the left and right
hemithoraces; the resin is very extensive and dense on the left. Credit: Judith Adams.
(b) CT through the thorax of the same mummy showing cross-sectional anatomy with-
out overlap, and the layering of resin and other materials (perhaps mud, which is less
radiodense) posteriorly, confirming that the body was supine during the mummification
process. Credit: Judith Adams.
27
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radiation. It is now applied widely for scanning in all body sites. Ultrasound
waves are emitted from a transducer; some are reflected off surfaces within
the body and some are transmitted, particularly through fluid. The differen-
tial reflection of the US waves is received by the transducer and the image
is formed. This technique also depends on water within tissue, and so has
no application to desiccated mummified tissue.
Strengths and limitations

MRI and US, which require hydrated tissue, have no role in the exam-
ination of mummified items. The study of mummies requires techniques
that use ionising radiation (x-rays) – radiography, conventional tomography,
fluoroscopy, and CT scanning. Radiography is the most widely available
technique, is the least expensive, and can be most easily applied in the field
at the site of the mummified artefacts.
Radiographs have the highest spatial resolution (capability of resolving
small structures so long as there is sufficient contrast difference between the
two structures, e.g. bone trabeculae containing calcified bone and measur-
ing between 0.05 and 0.20 mm and which are adjacent to marrow fat) of
approximately 0.1 mm. CR, which is used increasingly in clinical radiology
departments, has a slightly less good spatial resolution of 0.25 mm. CT has
higher contrast resolution than radiographs, and so may demonstrate struc-
tures not identified on radiographs. However, the spatial resolution of CT
is not as good as radiography with spatial resolution between 0.4 mm for
single CT slices and 1 mm and 0.2 mm for MDCT.
A radiograph is a two-dimensional (2D) image of a 3D object and has the
problem of overlap of anatomical structures, so that the object of interest
might be obscured by superimposition of anatomical structures or artefacts
(see Figure 2). Radiographic tomography enables this to be overcome to
some extent, but the introduction of CT has largely made this imaging
method obsolete. Because CT provides transverse axial sections through
the body, it does not have the problem of overlapping structures found in
radiographs (Figure 2). MDCT allows rapid 3D volume imaging that can
depict either the soft tissue or bone facial or entire features of a mummy
within its wrappings, depending on the threshold HU used to display the
images (Figure 3). Such 3D images of the skull and facial bones might
assist in the construction of models that have been made to illustrate how
the mummified person might have looked in life (Neave 1979; Manley
et al. 2002). CT involves a higher radiation dose than radiography, but
whether this is of detriment to mummified tissue (e.g. possible damage to
any remaining DNA) is uncertain at present.
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(a) (b)
figure 3. CT scan of the head of a mummy. (a) CT scan through the head showing
layering of resin posteriorly in the skull vault. More anteriorly, there is a round structure
(arrow) that was identifiable on all sections below and extended into the body through
the foramen magnum, indicating that it is a rod used by the embalmers to stabilise
the position of the body. Credit: Judith Adams. (b) From CT sections such as in 3a, a
3D volume image can either be reconstructed or acquired directly with MDCT, and
with appropriate thresholding can depict either bone, as in this illustration, or soft tissue
features of the mummy. Credit: Judith Adams.
Applications of imaging to the study of Egyptian mummies

The main attribute of imaging in the study of mummies is that it provides a
noninvasive method of examination. The images can provide information
about mummification practices used and important aspects of the person
whose mummified remains are being studied.
State of the mummy and disposition of the body in the cartonnage

Radiography can provide an indication as to the disposition of the skele-
ton in relation to the outer cartonnage and wrappings, if these are not too
radiodense (Figure 1). The images can also indicate whether the mummy
is in a good or poor state of preservation (see Figures 1 and 4). If the mum-
mification process was of poor quality or if the mummy has not been kept
in ideal conditions (e.g. cartonnage placed erect in unfavourable condi-
tions for temperature and/or humidity, which cause the ligaments/tendons
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across joints [e.g. sacroiliac joints] to break under sheer forces) the skeleton
becomes disrupted (see Figure 4).
Wrapping and amulets

The material wrappings are better demonstrated on CT than radiographs,
but the latter can indicate the site of metallic amulets within the wrappings
and other decorations of high atomic number material (gold paint, glass, or
ornamental stones). Such decorations and artefacts can indicate rewrapping
of a mummy (see Figure 5).
Mummification process
As most of the organs were removed prior to wrapping, the cranium, thorax,
and abdomen of the mummy will be largely filled with air, packages (see
below), resin, the skeletal remains, and desiccated soft tissue. The latter
will attenuate x-rays to a greater extent than they do in the living human.
The radiographic contrast between this desiccated soft tissue and air will be
greater than under normal clinical conditions, and it is important that the
appearances are not misinterpreted as disease (e.g. ankylosing spondylitis).
Resin residue can be identified in the dependent part of the body (pos-
terior of skull vault, spinal canal, abdomen, and thorax), confirming that
the body was supine when the mummification process was undertaken.
Sometimes, more dense mud may also be mixed with the resin (Figures 2
and 3).
Packages and artificial appendages

Organs such as the intestines, liver, heart, lungs, and spleen were removed
before mummification and either placed in Canopic jars or placed in pack-
ages in the cavities of the body or between the limbs. These can be visualised
on radiographs but are better seen on CT scans (Figure 6).
It was the aim of the embalmers to try and make the mummified body as
close in appearance to that of the individual in life. This resulted in packing
in the cheeks (infratemporal fossa), oropharynx, neck, and elsewhere in the
soft tissues, which can be identified on radiographs, but again are better
visualised on CT (see Figure 7).
The natural soft tissues of the eyes would shrink on desiccation and false
eyes were placed within the relatively empty orbits (Gray 1971). Such false
eyes may be identified on radiographs, dependent on the radiodensity of the
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(a) (b)
figure 4. Poor preservation (jumbled bones) inside a mummy. If the mummification

process has been poor, or the conditions in which the mummy had been stored were
unfavourable, then the integrity of the mummy is lost, the skeleton is no longer articulated
and the bones are a jumble as is evident in the upper (a) and lower (b) portion of this
mummy. Credit: Judith Adams.
material used, but are more clearly seen on CT scans (see Figure 8). The
desiccated native orbital tissue structures can be identified on CT posterior
to the artificial eyes. As the phallus also shrivelled on desiccation on some
male mummies, an artificial phallus may be identified. To keep the body in
(a) (b)
figure 5. Metal studs/amulets inside a mummy. (a) Radiograph of a mummy with

evidence of metallic studs/amulets scattered throughout the wrappings. Credit: Judith
Adams. (b) CT scan showing the thick wrappings around the pelvic region of the mummy.
The metal studs can be seen on the surface of the wrapping anteriorly. There is a layer
in the middle of the wrappings that is high in attenuation, suggesting gold paint and that
the mummy may have been rewrapped at some time. Credit: Judith Adams.
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(a) (b)
figure 6. Packages in right thorax of a mummy. The organs were removed before mum-
mification and placed in Canopic jars or in packages, which were placed into the body
cavities. These packages can be identified in the right thorax on this AP radiograph (a),
as the package is of soft tissue attenuation and surrounded by air. The package is better
visualised to the right of the spine on the CT scan (b). There are also two packages/fabric
rolls lying anteriorly between the chest and the wrappings. Credit: Judith Adams.
(a) (b)
figure 7. Packing in the mouth of a mummy. The embalmers attempted to make the
mummified body appear as it had in life. To achieve this, packing was placed in the
mouth (area of the mandible appears more dense) and neck (arrow), as seen on this
lateral radiograph (a) of the skull and neck. The CT scan (b) shows the packing in the
oropharynx. Credit: Judith Adams.
32
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(a) (b)
figure 8. False eyes in a mummy. As the native tissues of the orbit became desiccated
during the mummification process, the embalmers often placed false eyes into the orbital
cavities. These were made of a variety of materials; if radiopaque, these can be visualised
on radiographs as on this frontal skull projection (a), but would not be evident if made of
fabric. The false eyes and their construction are better visualised on b) CT scans in which
the desiccated native orbital structures (optic nerve and rectus muscles) (arrows) can be
seen deep within the orbital cavity, posterior to the false eyes. Credit: Judith Adams.
(a) (b) (c)
figure 9. Brain removal during mummification. The brain was removed either through
the foramen magnum or the anterior approach through the ethmoid and cribriform
plate. There will be radiographic evidence of the anterior approach with absence of
the ethmoid bones and air cells, (a) which would normally be seen through the nose
on the frontal radiograph of the skull (with cranial angle of the x-ray tube) with no
bone structures being present (arrows). Credit: Judith Adams. (b) coronal radiographic
tomography showing absence of the right ethmoid bone and cribriform plate (arrow).
Credit: Judith Adams. (c) CT scan showing destruction of the right and left ethmoid air
cells (arrow). Note that anterior to this bone destruction there is material packing in the
nasal cavities (arrowheads). Credit: Judith Adams.
33
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the straight disposition it held in life, rods were inserted that may be visible
on CT (Figure 3).
Some mummies have been found to have artificial limbs. These were
usually added after mummification (restoration limbs), in persons who had
lost a limb before death, to make the body whole in the afterlife. Some,
however, were intended to be functional limbs during life (prosthesis) (Gray
1967; Finch 2005).
Organ removal
The intestinal organs were generally removed through an incision in the
left side of the abdomen, the position of which may be indicated by a metal
cover, or through the perineum, which can be demonstrated to be deficient
on CT.
The brain was surgically removed before mummification via an anterior
approach through the ethmoid air cells and cribriform plate (Leek 1969) on
either side (Hoffman and Hudgins 2002). The consequent bone destruction
can be demonstrated on both radiographs and CT scans (see Figure 9).
Sometimes the surgical instruments would be forced so far into the brain
that the dorsum sellae (posterior bone margin of the pituitary fossa) would
be displaced (Isherwood et al. 1979).
The brain was also sometimes removed through the foramen magnum,
at the junction between the skull and the spinal canal in the posterior aspect
of the skull, but no radiological evidence of this will be seen on imaging.
Mostly, the skulls of mummies are filled with air; sometimes there is resin
layered posteriorly within the skull vault (Figure 3); only occasionally can
the gyri of remnants of brain be identified on imaging (Lewin and Harwood-
Nash 1977).
Imaging of forensic anthropology

Study of the skeletal remains by imaging can provide information about
the age and sex of the mummified person and perhaps give insight into diet
(through the dentition), lifestyle and disease during life, and the cause of
death (Ruhli et al. 2004). There may be sparse information on the latter
because, presumably, systemic infection may have commonly accounted
for death in these times and there will be no skeletal signature of such acute
events.
Sex
Often there will be information on the cartonnage/wrappings of the mummy
as to the details of the individual contained within. Imaging (radiographs)
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(a) (b)
figure 10. Radiographic evidence indicating gender in a mummy. The gender of the
mummified body can be determined from certain skeletal features, one of which is the
shape of the pelvis. The pelvis of a female is more oval (a), whereas in a male it is
more pear shaped (b), where there is also evidence of the construction of a false phallus
overlying the symphysis pubis. The pelvis may be distorted in shape if the wrappings are
very tight. Credit: Judith Adams.
can sometimes be helpful in differentiating whether the body was that of

a male or female. This is best assessed from the shape of the pelvis on
a radiograph or making measurements of the pelvis on a CT scan. The
female pelvis is oval, whereas the male pelvis is pear shaped (see Figure 10).
Care has to be taken, however, when interpreting these signs that the pelvis
has not been narrowed into a male shape by tight wrappings, particularly
in a child.
Age at death
It is easy to differentiate the skeleton of a child from that of an adult because
the growth plates, where enchondral ossification enables growth to take
place up to the time of skeletal maturity, and the epiphyses will be evident
(see Figure 11). Females reach skeletal maturity at between 16 and 18 years
in modern times and males later, at between 18 and 20 years.
In modern times, an assessment of skeletal ageing is made from a radio-
graph of the nondominant hand, using either the method of Greulich and
Pyle (gathered from American Caucasian children) or that of Tanner and
Whitehouse, both of which assess the size and shape of the carpal bones and
epiphyses (Greulich and Pyle 1971; Tanner and Whitehouse 1975). It can
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be problematic applying these parameters to mummified children because

the hands are often superimposed on the pelvis on radiographs, making the
bone detail difficult to define. Also, these reference databases may not be
appropriate to the early Egyptian population.
The dentition can also contribute to the process of differentiating between
a young child and an adult (primary, unerupted teeth visible) (Figure 11),
and the teeth that have erupted and their development can define more
accurately the age of the child (Demirjian et al. 1973; Liversidge et al. 2006;
Dhanjal et al. 2006).
In an adult, it becomes more difficult to define the exact age at death.
Degenerative changes in the spine and joints or skeletal diseases more
common in the elderly (e.g. osteoporosis), if present, may suggest that the
person was of more advanced age. Such changes are not as common in
imaging of mummies as they are in a contemporary population, presumably
because most people in ancient times did not reach the same advanced age
as modern individuals.
State of body
Mummies may be in a good condition and wholly intact, which reflects
a high-quality mummification process and maintenance in an ideal envi-
ronment since mummification. Poor mummification may be associated
with some putrefaction of tissue and postmortem fractures of bones and
dislocation at joints. Alternatively, a poor environment and storage since
mummification could result in disruption of the mummy.
Status of the individual

The quality of mummification, wrappings, ornamentation, and disposition
of the arms may give an indication of the status of the person.
Disease
Because most of the organs have been removed and placed into packages,
only the teeth and skeleton are left to provide an indication of disease. Harris
growth arrest lines (thin horizontal sclerotic lines in the ends of long bones)
indicate that some episode (illness or malnutrition) at that stage of skeletal
development caused cessation of enchondral ossification; the provisional
zone of cartilage calcified is not resorbed as is normal, and remains as an
indicator of disease (Harris 1933; Schwager 1969; Ashby 2001) (Figure 12).
Premortem trauma may be seen in long bones as fractures that have
evidence of healing (callus formation). Osteomyelitis may be evident by
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(a) (b) (c)
figure 11. Age determination in mummies. The age of the mummified person at death
can be determined by the dentition and skeleton. In children there will be evidence of
epiphyses, as seen here in the AP radiograph of the knees (a) and in the bones of the feet
(b), and unerupted teeth (c), depending on the age. Credit: Judith Adams.
periosteal reaction, cloacae, and sequestra. Septic arthritis may be evidenced

by bone destruction or healing by bone ankylosis (Isherwood et al. 1979).
In the more elderly, there may be features of osteoporosis (thinned cortices,
reduced trabecular number, prominent vertical striation in the vertebrae of
the spine as the horizontal trabeculae are lost preferentially, and fractures in
sites of the skeleton rich in trabecular bone such as the spine) or degenerative
joint disease (osteophytes, subchondral sclerosis, cyst formation, and joint
space narrowing). Degenerative changes may, however, also indicate that
the person had been involved in heavy manual labour as compared with a
more sedentary lifestyle.
The tramline calcification in soft tissues indicates calcification in arteries,
which could reflect arteriosclerosis or diabetes (Ruffer 1921; Sandison 1962).
Calcification in the bladder wall is most likely to indicate bilharzia infection;
other infestations may cause soft tissue calcification.
It is difficult to make detailed scientific assessments of the prevalence of
disease in this early Egyptian population because each mummy is just a
‘snap-shot’ of that individual and the time and environment in which he
or she lived. The mummified remains that have been studied are relatively
rare and span an enormous period of time.
Lifestyle
Degenerative changes may indicate that the individual was involved in
heavy manual work rather than a sedentary way of life. Harris growth arrest
lines could indicate periods of malnutrition (Figure 12). Because food con-
tained quite a lot of sand, the cusps of the teeth became eroded (attrition),
giving a flat upper surface, which is best visualised on radiographs (Leek
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1979). If this erosion was severe, the dental canal became open and infec-
tion could pass from the mouth through the tooth (caries) to the mandible
where there may be radiographic evidence of dental abscess (Figure 12) (see
Chapter 5).
Artefacts
The process of mummification can cause changes on images that may
mimic disease processes. The cartilage in joints and intervertebral discs
may appear more radiodense, through dessication, than is the case in living
humans and may be adjacent to air in mummies, resulting in greater con-
trast difference. Joints may appear narrowed as a consequence; the absence
of associated erosive (juxtaarticular erosions) or degenerative (osteophytes,
subchondral cyst, and sclerosis) arthritic changes help to distinguish when
the narrowed joint is the result of the mummification process rather than
premorbid disease. Intervertebral discs may also be calcified (Figure 12).
This was initially considered to be due to onchronosis (alkaptonuria), an
inborn error of tyrosine metabolism, but has now been confirmed to be
artefactual and due to the process of mummification, with the deposition
of natron in the disc (Gray 1967; Wells and Maxwell 1962; Walgren et al.
1986; Baunstein et al. 1989; Phomphutkui et al. 2003).
The paravertebral ligaments may also appear more dense, through
dessication, and more prominent because of increased contrast difference
between ligaments and adjacent air in mummies. These features must not
be misinterpreted as paravertebral ossification of ankylosing spondylitis;
normal sacroiliac joint excludes this pathological diagnosis. Forestier’s
(senile) hyperostosis (diffuse idiopathic skeletal hyperostosis [DISH]) also
causes paravertebral ossification, and has been misinterpreted as ankylosing
spondylitis in the mummy of Ramesses II (Chhem et al.), although there
are distinct radiographic appearances that distinguish these two conditions
(Resnick and Niwayama 1976).
Animal mummies
The mummification of animals was closely linked to the desire to preserve
bodily remains for eternity. The reasons for animals being mummified can
be attributed to the following:
Categories
Certain animals were regarded as godlike, and so were worshipped as cult
animals. Others were mummified as they had been beloved pets during life
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(a) (b)
(c) (d)
figure 12. Disease processes in mummies. (a) AP radiograph of the ankles showing the
dense horizontal Harris lines in the distal tibiae, which indicate some episode (e.g. illness,
malnutrition) at that stage of skeletal development that caused enchondral ossification to
cease for a period, leaving this line of the zone of provisional calcification. Credit: Judith
Adams. (b) CT scan of the pelvis showing calcification in residual tissue in the anatom-
ical region of the bladder. Through image-guided (fluoroscopy) endoscopic biopsy this
bladder calcification was confirmed to be due to bilharzia. Credit: Judith Adams. (c)
Food contained sand, which caused abrasion of the cusps of the teeth and predisposed
to dental infection. The teeth have flat superior surfaces on this lateral radiograph of the
mandible and maxilla, with evidence of caries and some apical bone resorption. Credit:
Judith Adams. (d) Sagittal tomography of the thoracic spine showing the intervertebral
discs to be increased in density. This may, in part, be related to the desiccated cartilage
of the disc being adjacent to air (increased contrast difference compared with that in
living humans). Calcification of the intervertebral disc also occurs, which is now known
to be related to the process of mummification and not due to alkaptonuria, as initially
surmised. Credit: Judith Adams.
39
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and so would be preserved to accompany the person into eternity. Some

animals were bred for slaughter in the temples so that they could become
votive offering to the gods, whereas other animals would serve as food (vict-
uals) in the afterlife for the tomb owner. It is thought that animals intended
for food would not be wrapped but simply placed in a box or on a platter
(Briers 1996).
Animal types
A wide variety of animals fulfilled the various categories for animal mum-
mification (Armitage and Clutton-Brock 1981; Owen 2001). These included
cats, dogs, predatory birds (kestrels, sparrow hawks), other birds (ibis), insec-
tivores, Nile crocodiles, and fish. Radiography can noninvasively confirm
an animal skeleton within the wrapped mummy and, from the skeletal char-
acteristics, can confirm the type of animal mummy it contains (Figure 13).
It has still to be determined whether CT will add further to knowledge of
these animal mummies and the mummification process.
Fakes
In some mummies where the external wrappings indicate the shape and
features of a specific animal, imaging reveals that no skeleton is present
(see Figure 13). Presumably the embalmers ran out of the supply of certain
animal types and so created these artificial animal mummies, or if the cost
of high-quality mummification was not affordable, then less expensive fake
copies of animals may have been provided to accompany the owner into
eternity.
Conclusions
Imaging is an important tool that provides information about the contents
of a mummy, human or animal, without damage to the mummy or its wrap-
pings (Chhem and Ruhli 2004). The most widely applied imaging method
is radiography, which has been feasible in the field for many decades, and
so is the easiest to perform with the items in the place where they have
been found. Radiographs have advantages (least expensive, most widely
available, high spatial resolution), but also some limitations (superimpo-
sition of structures on 2D images; magnification of objects some distance
from the film; limited contrast resolution; difficult sometimes to position
the mummy ideally for the best projection to be obtained; if the wrapping
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(a) (b) (c) (d)
figure 13. Animal mummies. (a) Photograph showing a beautifully wrapped and deco-
rated animal mummy. Credit: Judith Adams. (b) The radiograph of an animal mummy
confirms that the wrappings contain the skeleton of a bird. Credit: Judith Adams. (c) Pho-
tograph of a mummy purporting to contain a bird. Credit: Judith Adams. (d) Radiograph
showing that there are no bones in the wrappings and that the mummy consists simply
of material and reeds (vertical linear structures). Credit: Judith Adams.
is very dense, then the energy of the x-ray beam obtainable may not be
adequate to penetrate to visualise the mummy structure adequately). The
quality of images will generally be higher if the radiography is performed in
a modern, well-equipped clinical radiology department with experienced
radiographic staff performing the radiography.
CT has been increasingly applied to the examination of Egyptian remains
since the mid-1970s. The advantages of CT over radiographs are that there
is no overlap of anatomical structures on cross-sectional images, greater
contrast resolution, and quantisation is feasible (contents of voxel can be
based on its attenuation characteristics), but this cannot be exploited to the
same extent as in the living human because of the mummification process
and desiccation of tissues. There are some limitations (expense, limited
availability in some parts of the world, not generally available in the field
[although recently a mobile CT unit has been made available for imaging
of the mummy of Tutankhamun in the Valley of the Kings], partial volume
effect, and less good spatial resolution than radiographs). The quality (spatial
resolution, 3D volume imaging) of CT images and the speed of acquisition
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have improved greatly over the past decade or more (MDCT), but huge
numbers of images (approximately 1,200 for an entire human mummy) are
required.
For all such imaging, high-quality equipment and skilled technical radio-
graphic staff are important, as is having radiological, in addition to Egypto-
logical expertise for the interpretation of imaging features and differentiat-
ing among premortem disease, postmortem changes, and artefact (technical
and due to mummification process).
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chapter 4
Endoscopy and mummy research
Ken Wildsmith
Medical and industrial applications of endoscopy

Endoscopy is a medical technique whereby a narrow tube is introduced
through one of the natural orifices of the body or through a small incision
in the chest, abdominal wall, or knee joint. The aim is to allow the doctor
to see structures that cannot normally be examined and allow parts of these
structures to be removed by biopsy for subsequent examination under the
microscope.
One of the most common areas to be examined by endoscopy is the
stomach, in cases in which it is suspected that an ulcer is present. Indeed,
there are many instances in which endoscopy can be used as an alternative to
major surgery. For example, by viewing the ulcer through the endoscope, the
medical investigator can often identify whether or not the ulcer is malignant,
and if part of the ulcer is then removed for histological examination, a firm
diagnosis can usually be made. If the ulcer is not malignant, it can be
treated medically, thus avoiding the need for major surgical intervention.
Similar examinations of the rectum and colon are made via the anus; another
common surgical procedure involves passing the endoscope through the
urethra and into the bladder during the investigation of symptoms arising
in the urinary tract.
Currently, the endoscope is used extensively in ‘keyhole surgery,’ and
removal of the appendix, gall bladder treatments, female sterilisation, and
repairs to ligaments in the knee are regular procedures.
The technique of endoscopy is also used extensively in industry, where
it facilitates the nondestructive examination of otherwise inaccessible areas
in, for example, gas turbines, cavity walls, and water mains. Industrial endo-
scopes are often known by other names such as borescopes, introscopes, and
endoprobes. As in medicine, endoscopy can save time and money because
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44 Ken Wildsmith
it facilitates examination without the need to dismantle an engine or other

complicated machinery.
The history of endoscopy

The technique of endoscopy is very old and, indeed, it may have been
practised in ancient Greece and Egypt. Evidence for its use in ancient Egypt
is provided by an enamelled earthenware statuette that dates to the twelfth
Dynasty (c. 1900 b.c.). In this piece, a woman kneels with her head between
her knees, while a man, seated behind her with his hands placed on her
buttocks, is apparently viewing her anus. This was originally regarded as an
erotic statuette, but more recently it has been suggested that it may represent
a physician performing anoscopy. Certainly, some Egyptian physicians were
highly specialised and some may have been skilled in treating diseases of
the anus. It is known that, at an early date, some officials carried the title
‘Shepherd of the Anus,’ but it remains uncertain whether these men were
medical specialists, or whether they merely administered the royal enemas.
The earliest endoscopes were possibly made of either copper or silver
with the internal surface polished to allow sunlight or candlelight to be
reflected down the tube. In the next development, the surgeon wore a lamp
on his head, which shone light down the tube with a slotted mirror to reflect
the light passing down the tube in parallel rays. When the light bulb was
invented in the late nineteenth century a.d., this was incorporated into
the end of the tube, with a system of lenses to transmit the image back
to an eyepiece. This only added to the discomfort already experienced by
the patient as these early instruments measured up to 25 mm in diameter.
Prisms and mirrors were also included in the distal end of the endoscope
to enable the user to obtain different viewing angles inside the patient.
In 1953, there was a major breakthrough with the invention of
‘fibreoptics,’ based on a principle that John Tyndall first demonstrated to
the Royal Society in London in 1870. The basic principle was that a stream
of water flowing from an illuminated vessel conducted light along its length
by the phenomena of total internal reflection.
When this principle was applied to a strand of glass coated with a glass
of different refractive index, it resulted in the term fibreoptics. When a
bundle of these fibres, bonded together in a resin, was incorporated into
the endoscope, light could be transmitted along them from a remote light
source of higher power without discomfort to the patient, as the fibres did
not transmit the infrared part of the spectrum and the light was known as
‘cold light.’
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Endoscopy and mummy research 45
Subsequently, a bundle of these fibres was constructed with each fibre

in the same geometric position at each end. This allowed an image to
be transmitted via lenses at the distal end to an eyepiece at the proximal
end. These bundles were encased in a plastic tube, creating the instrument
known as the ‘fibrescope.’ These early instruments suffered from a slight lack
of flexibility, but the technology soon began to facilitate the manufacture
of increasingly smaller fibres, with the result that the instruments became
more flexible. Typically, a high-specification instrument would have up to
50,000 fibres in the image bundle. This gives very good image resolution
and a high degree of flexibility.
Further developments included the incorporation of a system of wires
connected to the distal end of the fibrescope to allow angulation of the tip
section and channels to allow suction and infusion through the instrument.
Channels were also added to allow the use of small forceps to enable biopsy
sampling.
Rapid advances in the electronics field have now added a new dimen-
sion to endoscopy. The invention of the charge-coupled device, which is
the imaging system in digital cameras and mobile phones, has now been
incorporated into the endoscope. This technology considerably improves
the image quality through the flexible endoscope and they are now usually
known as ‘videoscopes.’ As the image is now produced digitally, the instru-
ment no longer has an eyepiece, but instead the output is fed directly to a
television screen and to video recording, if required. Some instruments have
a small LCD screen incorporated in the proximal end of the videoscope,
together with a joystick control for the angulation of the distal end.
Endoscopy and Egyptian mummies

Approximately thirty years ago, the Manchester Egyptian Mummy team
began to experiment with nondestructive investigative techniques (see
Chapter 1). At first, attempts were made to take specimens from the abdomi-
nal cavities of the mummies by using narrow hollow needles, typically those
used in medicine to obtain liver and renal biopsies. The needles were not,
however, very successful for this application, as they rely to a certain extent
on the slight movement of the organ to be sampled into a groove in the nee-
dle, and the dry and rigid tissue found in Egyptian mummies was difficult
to removal in this way.
Next, a larger hollow needle with a diameter of 0.5 cm and a cutting
edge at one end was tried, with the aim of obtaining solid cores of mummy
tissue. This method was partly successful, but the dry, crumbling nature of
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46 Ken Wildsmith
the mummified tissue prevented the researchers from obtaining satisfactory

samples, and so it was decided to investigate the potential of endoscopy
(Tapp and Wildsmith 1986: 351), a technique used some years earlier by
other researchers in this field (Manialawi et al. 1978).
At a lecture given by Rosalie David to the Institute of Chartered Surveyors,
a member of the audience suggested that the Manchester Mummy team
might develop the application of an industrial borescope of the type used
by surveyors to examine the inside of cavity walls. Keymed (Medical &
Industrial Instruments) Ltd., a firm that manufactures endoscopes for use
in both the medical and industrial fields, was willing to assist the team in
exploring the use of endoscopy in Egyptian mummies.
Professor David and her colleagues soon recognised the advantages
offered by industrial endoscopy, and the team proceeded to purchase six
scopes to facilitate their research. It was not only the team members who
were enthusiastic about this project – as the company representative who
demonstrated the equipment, I was enthralled by the whole subject. I was
invited to join the team as the resident endoscopist, a role that occupies
much of my spare time, with responsibility for endoscoping the mummies
and obtaining all the photographs taken through the instruments.
To obtain successful endoscopy results in Egyptian mummies, it is neces-
sary that the tissues to be viewed inside the body have an air-filled space on
at least one aspect, into which the endoscope can be introduced. Therefore,
the scopes cannot be used, as they are in medicine, to examine the gastroin-
testinal tract or the bladder, because the pathways inside the mummy have
collapsed and cannot be expanded by the introduction of air. Endoscopes
have, however, been introduced into mummies by less conventional routes,
and the technique has provided valuable information regarding mummifi-
cation and disease in ancient Egypt (Tapp and Wildsmith 1992: 152–153).
Some case studies
The mummy of Asru, Chantress of Amun

Egyptian embalmers frequently removed the lungs from mummies, leaving
the thoracic cavity empty, and so this offered a good site to pursue the
use of endoscopic techniques. The first mummy to be examined with an
endoscope belonged to Asru, a Chantress in the Temple of Amun at Karnak,
and the subject of previous investigations by the team. When a private donor
had given the mummy to the Manchester collection in 1825, the bandages
had already been removed and a bandaged package containing her viscera
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(removed from the body during mummification) lay between her legs. In
the team’s previous research, histological examination of tissue from this
package had demonstrated that, when alive, this woman had suffered from
a parasitic infestation, caused by a worm of the genus Strongyloides.
There was no evidence of an incision in the abdominal wall and the
embalmers appeared to have removed the intestine and other internal
organs through the pelvic floor. The anatomy of the anus and vagina could
not be established with certainty but in the dried state, there appeared to
be a common orifice through which the organs had been extracted. X-ray
films of the chest showed radiopaque tissue, which, it was thought, probably
represented collapsed lung or the heart in the central part of the chest, but
the thoracic cavities appeared to be empty.
The skin and subcutaneous tissue on the chest wall were of a hard leathery
consistency but two holes each less than 1 cm in diameter were bored
through the chest wall from the back on either side and a variety of rigid
industrial endoscopes were used to examine the thoracic cavity. An excellent
view of the inside of the thorax was obtained and, as suspected from the
x-rays, the lungs were collapsed down to the midline.
There was no evidence of resin within the chest. The thin membrane
(pleura) lining the inside of the cavity and the underlying ribs could be seen
quite clearly, and appeared to be free from disease. The backbone could be
seen and showed no evidence of disease. Part of the diaphragm, the thin
layer of muscle separating the chest and abdominal cavities, was evident
and appeared to have been damaged at one point, presumably when the
embalmers removed the contents of the abdomen.
Radiographs of the collapsed lung tissue showed peculiar striped mark-
ings, and the researchers attempted to find out what these were, while look-
ing for evidence of lung disease. To take the investigation a step further,
small retrieval forceps attached to the endoscope and manipulated from
outside the chest were used to take samples of the presumed lung tissue.
Direct visualisation of the tip of the endoscope on a radiographic screen was
used to position the endoscope within the chest so that the biopsy could be
taken more exactly from the desired site.
The histological examination of this tissue showed scarring of the pleura
and the lung tissue. It also revealed that not only did Asru suffer from a
Strongyloides infestation but also that a hydatid cyst, caused by another para-
sitic worm, Echinococcus, was present within the lung. Further examination
included introduction of the endoscope through the common anal/vaginal
orifice, but unfortunately, the absence of air within the cavity limited the
view within the abdomen. The embalmers had cleared out this area, and
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48 Ken Wildsmith
as a result, the abdominal wall had collapsed backwards and obliterated the
cavity. Biopsies were taken of muscle and blood vessels from the wall of the
pelvic cavity, but histological examination of these specimens did not reveal
any significant abnormalities.
Finally, attempts were made to examine the inside of the skull. In some
mummies, successful access to the skull can be gained by passing the endo-
scope up the nose and through the defect made by the embalmers in the base
of the skull. Unfortunately, in this instance, the soft tissue in the nose had
collapsed and so it was not possible to use this route; however, the eye sockets
were empty and the hole in the back of the socket through which the optic
nerve enters the brain was open, enabling a narrow-bore rigid industrial
instrument to be passed through this hole, which provided a satisfactory
view of the inside of the skull. There appeared to be some brain tissue in
the skull, but due to the small size of the access hole, it was impossible to
retrieve tissue for a biopsy.
It was necessary to make a burr hole in the skull to allow any remaining
brain tissue to be removed for histological examination. Several intact larval
skins were seen lying free within the skull and these were photographed
through the endoscope and then removed with fine retrieval forceps. They
appeared to be very similar to those examined previously from the intestines
of this mummy, which were identified as Chrysomyia albiceps.
The mummy of Khary, Priest of Amun

The mummy of Khary, a Priest of Amun in the Temple of Amun at Karnak,
was the second mummy in the Manchester collection to be investigated
using endoscopic techniques. This mummy retained most of its bandages,
and therefore presented an even greater endoscopic challenge because all
normal external landmarks of the body were concealed.
To proceed, small holes were made in the chest area, causing minimal
damage to the bandages, and endoscopes of various types were then used
to examine inside the chest. In this case, the views were quite different
from those found inside the mummy of Asru. Here, the lungs were only
partially collapsed and in some places, they were attached to the pleura
over the rib cage. These adhesions are usually the result of inflammation
in the lungs and pleura during life. When present, they prevent the lungs
from collapsing completely as the air is gradually absorbed from them after
death; in this instance, the view from one side of the chest cavity to the other
was obscured, and in fact, the chest cavity was divided into three sections.
There was a significant amount of resin on the surface of the lungs, but it
was possible to use the endoscope and the biopsy forceps to examine several
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areas and to take biopsies for histological examination. Later, microscopic

examination of this tissue produced evidence of sand pneumoconiosis, a
condition observed in Nekht-Ankh, another mummy in the Manchester
collection.
Detached heads in the Manchester Museum collection

The Egyptian mummy collection in the Manchester Museum includes sev-
eral detached heads. Many of these have now been investigated using endo-
scopic techniques, and interesting information has been obtained regarding
embalming procedures and disease (Tapp and Wildsmith 1984: 73–77). Pre-
vious radiological studies demonstrated that, in many mummies, there are
defects in the base of the skull. Presumably these were made by embalmers
introducing instruments through the nose and into the skull to remove the
brain. This procedure was usually performed a few days after death so that
postmortem autolysis would cause some liquefaction of the brain, making
it easier to extract by this route.
In some instances, the defect in the base of the skull provided a pathway
for the endoscope. Because it was sometimes difficult to manoeuvre through
this route, flexible endoscopes were particularly appropriate. When the
endoscope was introduced through the nose, there was usually a good view
of the pathway ahead and the defect in the base of the skull could be seen.
On emerging through this into the skull cavity, a general view of the
anterior part of the cavity (anterior cranial fossa) could be seen, and as the
instrument was moved around, the membranes lining the skull and dividing
it into compartments (falx cerebri and tentorium cerebelli) could also be
visualised.
Additionally, the central part of the cavity (middle cranial fossa) was
visible. It was often possible to see the groove on these bones in which, during
life, the middle meningeal artery was situated. This vessel is important
because it is often damaged when the side of the skull is fractured, and this
may lead to a very dangerous haemorrhage, which quickly threatens life if
it is not stopped by a neurosurgeon.
The endoscope could then be manipulated so that it pointed backwards
towards the posterior cranial fossa and the area of the base of the skull
that encloses the posterior cranial fossa, so that the area of the base of the
skull, which encloses the pituitary gland (sella turcica), could be seen. The
bone behind the pituitary gland (dorsum sellae) protrudes from the base of
the skull, and consequently was in danger of being damaged by the
ancient Egyptian embalmers when they introduced their instruments. In
the case of one mummified head (No. 5275) dating to the Ptolemaic Period
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50 Ken Wildsmith
(c. 300 b.c.), the radiological evidence indicated that this may have
occurred, resulting in displacement of the bone that was embedded in
either resin or brain tissue at the back of the skull where it had been pushed
by the embalmers some 2,000 years before.
In detached mummy heads, it is sometimes possible to introduce flexible
endoscopes through the space within the bones of the neck, which normally
contains the spinal cord (vertebral canal). Passing an endoscope upwards
through this passage allows access to the cranial cavity through the foramen
magnum where, during life, the brain merges with the spinal cord.
It should be pointed out that the endoscope has been of particular value in
investigating the ‘fluid’ levels seen radiologically in several skulls. Through
the endoscope, it is possible to observe that in some instances these ‘fluid’
levels have a smooth flat surface, and when a biopsy of the material forming
these surfaces is taken, it is found to consist of resin. The position of these
resin levels indicates that the body lay prone for some time after the resin
was poured in, and indeed, there was time for it to set hard before the
body was moved. In the case of one detached head (No. 1981/575), the resin
level showed that the body was propped up at an angle from the horizontal
position during the mummification procedure.
Endoscopic examination also provided further information about the
fluid levels observed on the x-rays. For example, in some instances, where
the surface of the fluid level was irregular and fissured, endoscopic biopsies
showed that the fluid forming the fluid level was indeed decomposing brain.
It was evident that the brain had been incompletely removed, and as it
liquefied, it sank to the back of the skull, forming the fluid level. The body
must have been left prone for a considerable time, as the brain must have
dried out and rehardened in this position for the fluid level to have persisted
after the body had been moved.
Finally, in one head (No. 22940) where none of the aforementioned routes
into the skull was available, a burr hole was made using tools employed
routinely in neurosurgical operations. These tools consist of a brace and
bit very similar to those used in carpentry. The normal size of a drill hole
made by a neurosurgeon is approximately 1 cm in diameter, and during an
operation, the surgeon may make several of these around an area of the
skull that is to be removed to operate on the brain below.
It was sufficient, in this detached mummy head, to make one burr hole
through an area of the skull that was shown radiologically to be away from
brain tissue. An endoscope introduced through the hole gave an excellent
view of the interior of the skull and also allowed a brain biopsy to be taken.
The histological examination of this biopsy specimen showed evidence of a
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hydatid cyst, and it is evident that this was another example of Echinococcus
worm infestation.
Endoscopy continues to play a major role in providing a minimally inva-
sive means of obtaining mummified tissue. Additionally, tissue samples
obtained in this manner over many years now form the basis of the Inter-
national Ancient Egyptian Mummy Tissue Bank (see Chapter 15), which
provides material for current studies undertaken by the Manchester team
and other researchers.
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chapter 5
Dental health and disease in ancient Egypt
Judith Miller
Introduction
This survey of ancient Egyptian palaeodontology draws not only on all
available sources and previous studies (e.g. Harris et al. 1980; Bennike and
Fredebo 1986; Harris et al. 1980; Smith 1986), but is also based on research
conducted by the author on more than 500 ancient Egyptian skulls from the
Duckworth Collection in Cambridge and the Natural History Museum,
London. These collections contain more than 5,000 skulls from sites in
Upper and Lower Egypt dating from the Predynastic to Ptolemaic Periods, a
time span of almost 5,000 years. Many skulls display severe dental pathology,
which varies over the millennia and can be explained by the influence of
the diet.
In addition to considering the incidence of dental disease, this chapter
examines the diet of the ancient Egyptians, the role of medical practitioners
who had the title of dentist, and the prescriptions of dental relevance found
in the medical papyri. Finally, there is an assessment of the evidence that
researchers have proposed in support of the theory that dental treatment
was practised in ancient Egypt.
Diet and dental disease in ancient Egypt

After death, when other structures of the body have disintegrated, teeth
are often all that remain intact as they are more resistant to postmortem
decomposition than bone, and appear to be unaffected by the chemicals
used in mummification. The dentition provides information about the diet
and health of a population at a specific period in antiquity.
The historical background

For this study, specimens from the Predynastic Period; the Old, Middle, and
New Kingdoms; and the Graeco-Roman dynasties have been considered as
52
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Dental health and disease in ancient Egypt 53
separate groups. Where possible, more than one site from each period has
been investigated, and the findings have been related to known differences
in diet in the various geographical regions and time periods.
During the Palaeolithic Period, the Predynastic populations lived on
the edge of the desert because the Nile Valley was under water and the
vegetation abounded with wildlife. These people, whose weapons have been
found, were hunters. More information is available from the Mesolithic
Period: for example, near the village of Sebil in the Kom Ombo plain, there
is evidence of three different periods of occupation known as the Sebilian
culture (Saffiro 1969). The plain had originally been under water and, as
this dried up, the population settled at successively lower levels to be near
the water.
The second and third period excavations have yielded millstones and
stone pestles. In the refuse heaps, archaeologists discovered the remains of
molluscs, fish bones, and herbivore bones, which had been opened to extract
the marrow. Butchered hippopotamus skeletons have also been found: the
flesh of these would yield as much meat as forty or more sheep; the bones
were used to fashion fishhooks and other implements (Midant-Reynes 1992).
At the site of El Omari, which may even predate the Predynastic com-
munity at El Badari (Midant-Reynes 1992), the remains of granaries and
dwellings lined with matting, cakes made of wheat, fragments of wheat and
barley, bread, sycamore figs and dates, and stalks of wild sugarcane (Saccha-
rum spontaneum L) (the earliest examples recorded in Egypt) have been
discovered. Among the animal remains found were pig, hippopotamus,
crocodile, snail, ostrich, antelope, goat, and fish bones (Hayes 1964).
A major change in nutrition occurred around 4,000 b.c. when the inhab-
itants of the Nile Valley evolved from hunter-gatherers to settled agricultur-
ists and pastoralists. The cultivation of grain as a main source of food and
the concomitant reduction in hunting for animals resulted in an increased
intake of carbohydrates and a decrease in proteins. Because of the settled
lifestyle, the population rapidly increased, and at times, this would result in
famine.
The ancient Egyptian diet

The influences of the variation in diet engendered by this transition, together
with the periods of drought and flooding that have been recorded through-
out the chronicled history of Egypt had a profound effect on the denti-
tion. There were years of abundance when the inundation of the Nile was
optimum, but these were interspersed with periods of famine when there
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54 Judith Miller
was harvest failure. Other cultural modifications arose within the Dynastic
Period as the result of invasions from neighbouring countries, the capture
of prisoners, and expanding trade, which brought the addition of imported
crops. A reduction in the average stature in communities who ate a mainly
cereal diet has been noted, and even today, the height of the hunter-gatherers
has not been regained (Brewer et al. 1994).
As the water level began to fall after the annual inundation, crops were
sown in November, and harvested in April before the next inundation. Bar-
ley (Hordeum vulgare) and emmer, a species of wheat (Triticum dicoccum),
were the cereals most frequently produced. There was an abundant supply
of vegetables such as lentils, beans, cucumbers, leeks, garlic, radishes, and,
in particular, onions. Fruits were also plentiful, and there is evidence of
grapes, dates, figs, and pomegranates (Gardiner 1961).
Much of the information about the diet has come from the contents
of tombs (Darby et al. 1977), including tomb models, stelae, wall reliefs,
and paintings that depict a variety of consumables, and well-preserved food
offerings, deposited for the afterlife, such as mummified meat and fowl, and
bread. Analyses of the viscera contained in Canopic jars have identified
food particles. Literary sources include texts on papyri listing the rations
given to soldiers and workmen, and inscriptions on temple walls that detail
the food offerings presented to the gods.
References also occur to oil produced from the fruit of the b3q tree,
which is now thought to be ben-oil from the moringa tree (Gardiner 1961).
Although there is no evidence of oil palms in predynastic Egypt, a fragment
of the pericarp of an oil palm was found in a Mesolithic site in the Sudan,
which may mean that food substances were moved between regions.
Fruit and vegetables, the main components of the diet, were enjoyed and
eaten in abundance. In discussing the pyramid builders, Herodotus (Book II:
para.125) (Selincourt 1972: 151–52) reported that an inscription on the Great
Pyramid at Giza recorded the substantial payments spent on food for the
labourers, which included radishes, onions, and leeks. In addition, they
would have been supplied with bread, the staple of the ancient Egyptian
diet. Nowadays the diet would be considered very healthy but the effect on
the teeth was often devastating, mainly because of the wear. The causes of
these problems can be explained by the geography of Egypt, the diet, and
the social conditions that continued for some 4,000 years.
The dietary effect on dentition

The dentition is the only part of the skeleton that, in health, is exposed to
the external environment. Diet has been shown to affect the dentition either
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indirectly or directly. Indirectly, dietary deficiencies causing hypoplasia and

hypocalcification can be seen in the developing teeth. Although the cause is
the same, no direct relationship has yet been found between Harris lines in
the long bones and dental hypoplasia. Direct effects of diet on the dentition
can cause caries, wear, and periodontal disease.
Although the dental condition that most afflicted the Egyptians has been
labelled attrition, this is a misnomer because the problem was not caused
by attrition alone. Attrition is defined as ‘The physiological wearing of teeth
as a result of mastication’ (Shafer et al. 1958), or ‘loss of tooth substance as
a result of tooth to tooth contact’ (Soames and Southam 1998).
It occurs on the occlusal and interproximal surfaces. The occlusal surface
loses enamel and the cusps flatten. When the wear is sufficient to expose
the dentine, the odontoblasts (the cells that form dentine lining the pulp
chamber) are stimulated to form secondary dentine to protect the pulp
from exposure and its subsequent death. The interproximal wear appears
at the contact points of adjacent teeth because of their vertical movement
within the periodontal membrane during mastication. The contact between
adjacent teeth progresses from a contact point to a complete surface of
contact.
Attrition, per se, is not pathological. It is found in groups of people who
have a fibrous diet (Begg and Kesling 1977; Hinton 1982). Although the diet
partly explains the severe wear in the dentition of the ancient Egyptians, it
does not completely clarify the aetiology of the pathology that has often been
found. In addition to the fibrous diet there are quartz phytoliths included
in the cellulose structure, which have an abrasive effect.
There are several scoring systems used to assess attrition but the scheme
illustrated by Molnar (1972) is the most detailed. Contamination of the
bread led to the initial effect being aggravated by abrasion, a condition
described as ‘the pathologic wearing away of tooth substance by the friction
of a foreign body independent of occlusion’ (Soames and Southam 1998).
Most of the papers referring to the extreme wear found in the dentitions
of ancient Egyptians identify this wear as attrition (Grilletto 1969; Leek
1973, 1986); however, severe attrition alone is unlikely to have caused the
devastation seen in these dentitions.
Begg (1954) describes the attrition observed in the Stone Age Australian
Aboriginal, in whom the dentition was frequently worn down so that the
roots had erupted into the occlusal plane, and he comments on the reces-
sion of the pulp chamber with no exposure of the pulp. The Egyptians
often experienced the exposure of the pulp because the laying down of the
secondary dentine was overtaken by the rapid wear of the dentine. This is
an example of tooth wear with a major component of abrasion.
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56 Judith Miller
The distinction between attrition and abrasion cannot be clearly defined;

there is an element of both in each condition. A better term is wear, and
Soames and Southam (1998) give a more accurate description of the process:
‘Tooth wear with a major component of attrition/abrasion.’
Samples of bread from several museum collections (from different sites
and dating to between c. 3000 and c. 1085 b.c.) have been analysed and
compared with other types of bread (Leek 1973). Almost all the ancient
samples appeared to have whole grains on the surface and inorganic con-
taminants. When the fragments were softened, the whole grains were found
to be husks, but this is because the endosperm had degenerated with the
passage of time.
The samples were then examined by x-ray with 4× magnification to show
the inorganic contaminants more clearly. After treating the specimens to
isolate the particles, they were photographed and magnified at ×105 and
compared with samples of sand from sites in Egypt. The particles were
identified in the Department of Mineralogy at the Natural History Museum,
London. Most were rounded grains of quartz, which were recognised as
sand, but grains of feldspar, mica, and hornblende were also present. Only
the samples of English bread had no inorganic contaminants.
Leek (1984) cited the statement by Pliny the Elder (23–79 a.d.) that the
Carthaginians added sand and chalk to the grain to aid the crushing of
the grain. The Egyptians may have applied the same technique but it is
also possible that the accidentally incorporated particles may have had the
desired effect in breaking down the corn. These particles came from soil
itself and from the flint-tooth sickle harvesting tools seen in eighteenth
Dynasty tomb paintings. Wind-blown sand may also have been incorporated
during winnowing.
Additionally, another contribution was made by abrasions from the sur-
faces of querns and saddle-stones, used continuously in the grinding process.
There are also illustrations of stone ovens with bread baked on the outside
where the surface of the bread might have been further adulterated by sand
and granules of stone.
Other dental conditions and diseases

The incidence of caries. Although less common than today, caries
occurred in ancient Egypt, caused by residual dental plaque from a carbo-
hydrate diet. The plaque is colonised by oral bacteria that create an acidic
salivary pH. Decalcification of the enamel, followed by the breakdown of the
matrix, results in cavity formation, allowing the ingress of bacteria to attack
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figure 14. Severe wear with pulp exposure of 2/12. The main reason for this condition is
the contamination of the bread, which was so important to the Egyptians’ diet that they
were known as ‘eaters of bread’ (‘artophagi’). Credit: Judith Miller.
the pulp. The site of this attack varied at different time periods because of
changes in the diet. In the Predynastic Period, there were many examples
of root caries but later periods showed a distribution of interstitial caries,
similar to the present day, which is caused by an increase of sucrose in the
diet.
The cause of caries was thought to be a ‘worm.’ In the Legend of the
Tooth-worm, a Babylonian magical text, toothache is attributed to a demon,
represented by a worm, which must be destroyed to cure the pain. Maggots
found in figs were analogous to the tooth-worm (Weinberger 1948). An even
earlier example occurs in Papyrus Anastasii IV (1200 b.c.) in which an
Egyptian official describes the physical afflictions of a scribal companion,
and states that a fnt-worm (translated as a real or metaphorical intestinal
worm) has invaded his tooth.
Periapical lesions. Both severe wear and caries could have led to the
high incidence of bone lesions thought to have been caused by periapi-
cal abscesses. Some of the periapical lesions that the ancient Egyptian
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58 Judith Miller
developed were caused by caries, which allowed the migration of bacteria

through the dentinal tubules into the pulp chamber. They were, however,
mainly the result of the relentless attrition/abrasion that wore away even the
secondary dentine and resulted in exposure of the pulp. In the Predynastic
Period, the site of the caries was predominantly in the cervical region of the
tooth.
The incidence of caries decreased in the Dynastic Period from 33.33 per
cent to 28.1 per cent of individuals examined and from 6.14 per cent to 4.65
per cent of the teeth examined (Grilletto 1973). Because many teeth had
been lost both ante- and postmortem, these figures may not be accurate.
The postmortem tooth loss in the examined skulls has been found to be
mainly in the anterior segment of the dentition because these teeth have
single, conical roots and, once the periodontal ligament disintegrates, they
are easily dislodged. As these teeth are also the least susceptible to caries,
the percentage of teeth affected may be less than the previously recorded
figures.
Soluble toxins from bacteria, which are present in carious lesions, disperse
through the dentinal tubules and cause the inflammation of the pulp even
before the secondary dentine barrier has been breached by caries. When the
pulp chamber has been penetrated by attrition, it is specifically the bacteria
that cause the pulpitis (inflammation of the pulp). The blood vessels dilate
and inflammatory oedema develops; this compresses the circulation and
the pulp becomes necrotic.
Suppuration occurs with the breakdown products of leucocytes and bac-
teria, and the pus is forced through the apex of the tooth and causes a
periodontitis (inflammation of the periodontium). If the suppuration con-
tinues, the abscess will enlarge, track through the cancellous, alveolar bone,
and eventually penetrate the dense cortical bone that covers the jaw. In the
ancient Egyptian skulls, this is what is sometimes seen as well-defined, cir-
cular holes at the apex of the roots, and which has been previously described
as conclusive proof that this was the result of dental treatment.
Periodontal lesions. It is necessary to distinguish between the periodon-

tal changes that occur as the result of disease and the physiological changes
caused by ageing. Periodontal disease is initiated by gingivitis, which is
caused by microbial plaque left lying around the neck of teeth. As nothing
is known about the oral hygiene habits of the ancient Egyptians, except for
their use of natron masticatories for purification of the mouth for religious
and social reasons, it is likely that the plaque around the cervical margins
might have adhered undisturbed for a considerable period of time.
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figure 15. Caries in the cervical area plus a large interproximal cavity in an ancient
Egyptian dentition. One interesting finding was that the buccal cavities, which arose in
the fissures of the lower molars, did not occur very often. Before a large cavity could form,
the wear would reduce the height of the tooth below the level of the developing cavity.
Credit: Judith Miller.
figure 16. Periapical destruction. This resulted from the wear shown in Figure 14, caused
by the pulp exposure. Credit: Judith Miller.
59
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60 Judith Miller
The plaque becomes mineralised by calcium phosphate that occurs in

the saliva when the pH is alkaline. This forms calculus and the sites where
this is found are closest to the submandibular salivary gland, behind the
lower anterior teeth and at the cheek sides of the upper molars, beside
the duct from the parotid gland. First, there would be acute inflamma-
tory changes, such as vasodilation, resulting in the exudation of fluid in
the crevice between the gingival tissue and tooth. This fluid contains poly-
morphs and immunoglobulins, which initially would help to control the
effects of the gingival infection (Soames and Southam 1998). Eventually,
it would result in the destruction of the attachment of the gingiva to the
enamel, allowing the deposition of subgingival plaque and further apical
movement of the attachment and loss of the supporting bone.
There are two kinds of periodontal bone loss that are noted in the skulls –
horizontal and vertical. In the initial stages, the horizontal bone loss may be
easily confused with the apparent bone loss seen in the skulls, which is the
result of the continuous eruption of the tooth. This is partly the physiological
response to the rapid wear by the deposition of cementum at the apex of
the roots.
Generalised periodontal disease, initiated by plaque retention, is eventu-
ally responsible for the loss of most of the buccal wall of the alveolar bone
and the tooth may become so mobile that it exfoliates. In the early stages
it can be recognised by the presence of pitting in the compact bone of the
alveolar crest.
Because of the condition of the mummified tissue, it is impractical to eval-
uate the soft tissue; however, because large collections of skeletal remains
are available for study, it is possible to assess the skeletal destruction caused
by periodontal lesions.
Although the aetiology of periodontal disease relates to the presence of
dental plaque, there are other factors that influence the progress of disease,
such as nutritional deficiencies and systemic disease (Soames and Southam
1998). In ancient Egypt, nutritional variations were caused by drought and
flooding. There is also evidence of diseases such as diabetes mellitus and
blood dyscrasias such as anaemia (Estes 1993), which cause gingival inflam-
mation and could therefore result in bone loss and periodontal destruction.
The dental practitioners

One outstanding question is whether the ancient Egyptians, who had
sophisticated medical care and treatment, also practised active dentistry.
Herodotus (Book II: para. 85) (Selincourt 1972) is quite explicit on this
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figure 17. Dentition showing periodontal disease – both horizontal and vertical. Vertical
bone loss is very different in appearance and is the result of an acute periodontal infection,
which has resorbed the alveolar bone unevenly. Credit: Judith Miller.
matter, stating that medicine was divided into a number of specialisations,

and consequently, there were many doctors who dealt with different areas
of the body, including diseases of the eyes, head, teeth, and so forth.
From the skeletal evidence, it cannot be disputed that the ancient Egyp-
tians suffered extensive and severe dental disease. Since the advent of foren-
sic Egyptology, it has been a matter of dispute whether any interventional
dentistry was performed in ancient Egypt or if the practice of dentistry
was limited to the use of the prescriptions in the medical papyri (Nunn
1996).
The title of dentist

As the title of ‘dentist’ was used in the Old Kingdom and extant medical
papyri exist from the Middle Kingdom onwards (see Chapter 12), it is aston-
ishing that there is no significant evidence that the Egyptians applied the
advanced technical skills that they had developed in other fields, for the
relief of pain and the restoration of function and appearance in the ravaged
dentition. The need for dental treatment surely had not lessened by the
later periods. Therefore, what is the explanation for this? Are there more
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62 Judith Miller
‘dentists’ to be discovered in the texts or has there been a misinterpretation

of the term that Egyptologists currently translate as dentist? At present, there
are no satisfactory answers to these questions.
Almost a hundred medical practitioners have been identified to date, and
seven of these had the title of dentist (Ghalioungui 1987). Several titles were
used, and although they differ from each other, they all define the role of a
dentist. In their textual contexts in ancient Egyptian writings, the titles refer
to someone who was subordinate to a physician. The most senior title that
has been discovered is the ‘Chief Dentist of the Palace.’
Of the seven named dentists, six date to the Old Kingdom, and only one
is known from a later era, the twenty-sixth Dynasty in the Late Period, which
indicates that this title was not in use for almost 1,700 years. Because this
seems unlikely, more examples may yet be discovered.
Dental prescriptions that have been found in the papyri

Of the ten medical papyri so far discovered (see Chapter 12), five (Kahun,
Edwin Smith, Ebers, Hearst, and Berlin) contain dental prescriptions. In
addition there is the Rylands Papyrus, which is not strictly a medical papyrus.
The Kahun Papyrus (c. 1825 b.c.) is predominantly concerned with gynae-
cology but it includes two cases that mention teeth – the earliest extant
dental references from ancient Egypt (Stevens 1975).
Case No. 5 specifies treatment for a woman who is afflicted in her teeth
and gums and cannot open her mouth. The text states: ‘This is acute pains
of the womb,’ and recommends that she is fumigated over a bowl containing
oil and frankincense and that the urine of an ass is poured into her vagina.
As this is a gynaecological document, the patient was probably of child-
bearing age – the period in which a third molar might be erupting. Inability
to open her mouth might be due to pericoronitis around the crown of a
partially erupted tooth, causing oedema and resulting in trismus. Another
cause of trismus or ‘lock jaw’ might be tetanus. This is a neuromuscular
disorder that may follow trauma; it is caused by an exotoxin of Clostridium
tetani penetrating an open wound. Spasm may occur in the muscles near
the injury (Cecil and Loeb 1959).
Case No. 33 describes a prescription to prevent toothache in a woman
who has conceived, and includes beans ground up with another substance
that could possibly be tjeret (willow), which is the precursor of aspirin.
The Edwin Smith Papyrus (c. 1550 b.c.) is a surgical treatise of cases that
are arranged in order from injuries of the head down through the body. Two
cases are of interest to the dental surgeon.
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Case No. 24 provides instructions concerning a fracture in the patient’s

mandible. The injury is compounded by a wound over the fracture and a
fever. Breasted (1930) suggested that words missing from the text may have
described the injury in more detail and because of the fever no recovery
was likely. The injury may have been a compound fracture and because of
the introduction of secondary infection the patient would have died as the
result of septicaemia.
Case No. 25 is concerned with dislocation of the patient’s mandible,
and provides instructions for manipulation and reduction of the dislocation
that are still in use today. As further treatment, the Edwin Smith Papyrus
recommends binding the mandible with vmrw and honey every day until
the patient recovers.
The Ebers Papyrus (c. 1534 b.c.) is the best preserved and largest of the
papyri; the Berlin Papyrus (c. 1200 b.c.) has similar prescriptions. One of
only two printed copies of an unpublished translation of the Ebers Papyrus
made by Ghalioungui (1987) was given by his widow to Dr. Benson Harer,
who has generously provided the author with a photocopy of the dental
prescriptions.
Some prescriptions are relevant to oral and dental conditions. One (Col-
umn 86), to expel illness of the tongue, recommends: ‘milk, rinse the mouth
and spit out.’ There is no list of symptoms, but a diagnosis is given although
it is difficult to identify the exact nature of the problem. The milk could
have been used to soothe the tongue if it had been burnt.
Another remedy for the tongue consisted of ‘frankincense, cumin, yel-
low ochre, grease of goose, honey, water, rinse the mouth for nine (days).’
This mixture combined a fragrant resin (frankincense), iron oxide (yellow
ochre), a vehicle for active drugs (goose grease), and honey, which has
been found to have an antibacterial effect as it is hypertonic and dehydrates
the bacteria by osmosis, and would have reduced inflammation in swollen,
infected gingivae. It contains propolis from the nectar that until the end of
the nineteenth century a.d. was used as an antiseptic after surgery. Other
constituents of honey that have antibacterial properties are gluconic acid
and hydrogen peroxide.
Eleven dental remedies are given in Column 89, including two pre-
scriptions to ‘fasten a tooth.’ The first recommends filling the tooth with a
mixture of powder of ammi, yellow ochre and honey and ‘scrapings of mill-
stone, yellow ochre and honey.’ Ammi is an aromatic herb (but Ghalioungui
translated the word as ‘emmer seed,’ which is wheat) and millstone scrap-
ings were used for superficial injuries. These substances were mixed into a
paste that would probably set and act like a splint.
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64 Judith Miller
The second prescription recommends that a mixture of frankincense,

yellow ochre, and malachite are pounded and applied to the tooth. The
papyrus also provides a remedy for treating a gum ulcer: the mouth should
be rinsed for nine days with a mixture of cow’s milk, fresh dates, and
manna.
The Hearst Papyrus (c. 1450 b.c.) has one prescription of dental interest, in
Column 1, line 7, which has been translated as: ‘which has fallen downwards;
mm one portion; aam one portion; gum one portion. Apply to the tooth’
(Quirke 1999, personal communication).
The Ebers Papyrus has a similar prescription ‘to consolidate’ a tooth,
which Reisner (1905) translates as a treatment for a tooth that has fallen out
(probably loosened due to periodontal breakdown). Mm is ammi, which
is translated by Ghalioungui as ‘emmer seeds,’ but I have not found a
translation for aam. Gum is a viscous secretion from plants that becomes
firm when it dries and it may have held the tooth rigid in a splint.
The Rylands Greek Papyrus. This later medical document is in the John
Rylands University of Manchester Library, Manchester (Hunt 1911). Case
No. 29a is a prescription for a tooth powder (translated by Murphy 1998,
personal communication). Unfortunately, many words are missing from the
fragment, but it is evidently a treatment for scabs in the mouth that involved
rinsing out the mouth and using various ingredients, including stavesacre
(staphisagria or wild dry grapes, usually known as larkspur, which may
have an antiseptic effect) and smooth Egyptian beans (a remedy for skin
and musculoskeletal disorders [Estes 1993]). For diseased uvulas, the text
prescribes: ‘wheaten flower – smooth like granules – having rubbed in.’
Acacia, which has astringent properties, is also recommended.
Concepts associated with dental disease

The use of dental titles and the presence of dental prescriptions in the papyri
confirm that, at least from the Old Kingdom, there was an acknowledged
need for dental intervention. This is also apparent from the evidence of
severe dental disease that can be seen in the mummies and skeletal material
from this early period. Previous research has documented dental conditions
such as caries, attrition, hypoplasia, periodontal disease, periapical lesions,
and osteomyelitis and osteoarthritis of the temporomandibular joint.
The ancient Egyptian physician realised the importance of air and water
for survival. He thought that air travelled directly into the heart and entered
the blood stream. Various afferent channels then carried it to the organs.
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These channels were called metu (see Chapter 12), and a set of efferent
metu carried the waste products from these organs to the surface. The sunu
(physician) did not distinguish arteries from veins or nerves.
The whdw (waste products) were of great concern to the ancient Egyptian.
In the Ebers Papyrus, there is a chapter about ‘expelling the whdw.’ The
physician thought that the whdw were putrefying faeces, which would enter
the metu and infect the heart and organs, thus causing disease. One of its
manifestations was considered to be dental disease. The term ‘Blood-Eater’
appears in the medical texts and was thought to be the effect of whdw (pus)
on the blood, resulting in the clotting of blood. In Chapter 89 of the Ebers
Papyrus there is a prescription to treat ‘blood-eating in a tooth.’ This clotting
was understood to be pathological and not part of the healing process, and
the physician tried to prevent the formation of a scab so that the whdw could
escape.
Evidence of dental treatment

Dawson (1929) commented that, although it was often claimed that dental
surgery was practised by the ancient Egyptians, he could identify no evi-
dence of tooth-stopping or any other dental technique. Confirmed by his
own examination of human remains, Leek (1984) agreed that evidence was
not forthcoming to support the claims of some archaeologists and philol-
ogists that an organised dental profession had existed during the period of
the Old Kingdom. Indeed, it is difficult to imagine what kind of practical
dentistry could have existed, in view of the lack of evidence seen in the
many thousands of skulls that have been examined.
Some evidence has been put forward to support the claim that practical
dentistry existed. The first example, found by Junker in 1914 in a mastaba
tomb at Giza, dates from the late fourth or early fifth Dynasty. He conjec-
tured that during mummification, the embalmers had made a ‘bridge’ in
the mouth (Leek, 1984), consisting of a length of gold wire (Weinberger
1947, Leek 1967a) that united an upper second and third molar. The third
molar is reported to show more ‘attrition’ than the second and its roots have
been almost completely resorbed.
Professor Euler, the Director of the Breslau Dental Institute who exam-
ined the teeth for Junker, believed that the teeth had belonged to the same
individual because of the similarity in their colour and anatomical form. He
considered that the third molar had become mobile because of its patholog-
ical condition and was held in place by attaching it to the second molar by
using a method that he said was still performed in 1928 when the teeth were
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66 Judith Miller
examined. He also stated that ‘tartar’ on the wire proved that the procedure
had been performed in the mouth of a living person.
The photographs show the teeth wide apart; however, Weinberger (1947)
wrote that, in Junker’s report, both teeth were said to be close together, as
is usually found in the mouth. Ghalioungui (1973) also cites the ‘bridge’
as evidence of dental treatment. Leek (1967a) was sceptical about Euler’s
conclusions. He had, however, only examined the photograph and had
not seen the appliance. Leek reported that the only method by which the
concretions on the wire, which were called ‘tartar,’ could be verified was if
the sample were to be examined microscopically.
He explained that there was often an accumulation of material, resem-
bling calculus, on bones that had been buried over a long period. The
prosthesis must have been interred separately as there was no evidence of a
skull present in the mastaba tomb and so the ‘bridge’ was unlikely to have
been in its owner’s mouth at death. The wire is tied between the teeth;
however, the most convenient position to tie the wire in the oral cavity
would have been mesial to the second molar. The wear is much greater
on the third molar than on the second molar. This would be unlikely in
the mouth as the third molar would have erupted approximately six years
after the second molar and would not have been subjected to as much wear
because of its age and anatomical position.
Another bridge is discussed by Harris et al. (1975). This bridge was found
in 1952 by Farid in a mastaba that dated to the fourth Dynasty. The bones
of the skeleton were almost completely crushed by a fall of stone. The
specimen consisted of the upper right canine, with an intact root, which
has a double wire wound around its neck and tied at the distal aspect. The
authors considered this to be the abutment.
Adjacent to the abutment is a lateral incisor with a groove cut into the
labial surface to accommodate the wire, which was then tied around the
tooth. The root appears to have been modified intentionally as it is both
shortened and narrowed. The central incisor also has a labial groove with a
hole drilled mesiodistally to accommodate the wire. The root of this tooth
also appears to have been altered. It is suggested that this was attached,
in vivo, to the left, central incisor, which was the second abutment to the
bridge.
Again, Harris et al. found calculus on the canine and lateral teeth that they
considered confirmed that the bridge had been worn for a long period of
time. Weeks (1980) alleged that the cemetery had been reused in Ptolemaic
times and so the date of the bridge was speculative, possibly advancing the
date of the construction of the bridge by 2,000 years.
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figure 18. Example of teeth that could be removed by digital manipulation. Credit: Judith
Miller.
Another specimen, found in Phoenicia (modern Lebanon), has gold wire

tied around the gingival margins of the lower incisors and canines to support
these teeth. There is also a Roman appliance, made of rolled gold, extending
from the lower left lateral incisor to the lower right canine. It is 3 mm in
height and is contoured to the gingival margin. Weinberger (1947) suggested
that these later examples were probably of Egyptian construction.
Others have proposed that root canal treatment may have been performed
in ancient Egypt. Zias and Numeroff (1987) examined skulls from a mass
grave in the Negev Desert that dated from the Graeco-Roman Period (c. 200
b.c.). One skull had a discoloured, stained green, right maxillary lateral
incisor. A radiographic examination showed that the root canal had been
widened and a 2.5-mm bronze wire was inserted into the canal. It was
suggested that this had been placed in the tooth to prevent the penetration
of ‘tooth worms,’ which were considered to be the cause of dental pain.
Another theory is that it had been placed there to help to drain the large
apical cyst. Zias and Numeroff also suggested that because bronze has a
similar colour to gold, it may have been substituted fraudulently.
There has also been much controversy about whether there was surgical
intervention to extract teeth or to drain apical abscesses. Because of the loss
of supporting bone caused by periodontal disease and periapical destruction
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68 Judith Miller
resulting from pulp death due to attrition, there are many examples of teeth
that would have been so mobile that they could have been removed by
digital manipulation. These have been left in situ.
Dawson (1929) quoted from the Coptic medical papyrus of Meshaikh
from the ninth century a.d. (during the Roman era in Egypt): ‘A tooth to
be extracted with instruments. Hellebore of good quality and gall; apply to
the region of the cheek where the molar is that you wish to extract, and you
will be astonished.’
Leek (1967b) stated that he had never identified any interruption of the
pathological sequence, and he reached the conclusion that only magical
spells were used to treat dental disease. Nevertheless, he accepted that the
existence of a method of removing teeth could not be entirely discounted.
This very dismissive conclusion about possible historical dental interven-
tion has to be assessed in the light of the evidence provided by the dental
prescriptions in the medical papyri. These were not exclusively magical
incantations; some may have been effective as antiseptics and others may
have supported mobile teeth when the medicaments set to form a splint.
Evidence for the drainage of abscesses has also been considered. In the
foreword to his facsimile of the Edwin Smith Papyrus, Breasted (1930) said
that the treatise mentioned the use of the ‘fire-drill’ for cauterisation. He
suggested that this might have been used in a fourth Dynasty mandible to
drain an abscess under a molar tooth. He identified what he thought was a
drill hole in the mental foramen that he surmised had been made with a
bronze drill.
Although this technique was not mentioned in the papyrus, Breasted sug-
gested that the technique must have been taken for granted by the author of
the papyrus! Weinberger consulted Thoma and Hooton (who had originally
examined the mandible), and they affirmed their original opinion, leading
him to claim (1947) that this ‘evidence’ proved that this operation had been
performed in ancient Egypt.
Ghalioungui (1973) agreed with Breasted that holes were drilled to relieve
abscesses. Leek (1967b), however, attested that it was not necessary to drill a
hole in the bone to drain an abscess because the expansion of the pus, under
pressure, forms a sinus and perforates the compact bone of the alveolus.
Some studies have sought evidence that the ancient Egyptians filled teeth.
Ghalioungui (1973) suggested that teeth were filled, and he quoted trans-
lations of the Ebers Papyrus in which he said that resin, Nubian earth and
chrysocoll, or Nubian earth and honey were used. In his unpublished work
(1987), he translated these as substances to be used to ‘consolidate a tooth.’
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figure 19. The only example of a possible dental extraction found in Miller’s survey (1997).
There is no indication of periodontal disease in the second and third molars and the site
of the missing first molar shows bone regeneration and no evidence that this tooth had
exfoliated because of disease. Credit: Judith Miller.
figure 20. Maxilla showing two nonphysiological defects. This shows the typical sinuses
found penetrating the cortical bone at the apex of the roots. In the past, these have been
interpreted as surgical interventions but they are the result of periapical infection. There
are many examples of these holes, but no evidence has ever been found of any suitable
instrument, such as a right-angled drill, which would be necessary to make the hole
surgically. Credit: Judith Miller.
69
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70 Judith Miller
No verification of this has been reported either in dental evidence or alter-

native interpretations of the papyrus.
From the balance of the evidence provided by all research undertaken
to date, it must be concluded that dental treatment only became a reality
during the Graeco-Roman Period.
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chapter 6
Slices of mummy: a histologist’s perspective
John Denton
Introduction
The technique of histology has been used for more than a century through-
out the world. It is still the basis of modern day pathology for the diagnosis of
plant, animal, and human diseases. Histology is also known as microscopic
anatomy. The word ‘anatomy’ comes from the Greek ana- meaning ‘up’ or
‘through’ plus tome meaning ‘a cutting.’ Thus, at first, the term ‘anatomy’
meant a ‘cutting up’ procedure because the structure of the body was orig-
inally learned through dissecting it with knives.
The word ‘histology’ comes from the Greek histo- meaning ‘tissue’ plus
logos meaning ‘treatise.’ Therefore ‘histology’ is a treatise about the tissues
and cells of the body. When applied to mummified tissues, it is generally
known as ‘palaeohistology,’ a term first used by Moodie (1920). Whereas
modern day histology is a diagnostic tool, very different information is sought
from the histological examination of the ancient tissues. For example, it is
always necessary to identify the type of tissue and its state of preservation.
In addition, it is sometimes possible to diagnose diseases and assess the
nutritional status of the individual from whom the tissue was taken.
The histology of ancient Egyptian tissues
Techniques of rehydration and fixation

Essentially histology is the production of thin sections of tissue that can
be stained and examined with a microscope. The major disadvantage
of histological investigation of ancient tissues is that the samples exam-
ined are destroyed and can never be returned to the body. The resulting
information is, however, often invaluable and can only be gained by this
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72 John Denton
destructive technique. Another frequently encountered problem is that of

misidentification of the tissue when removed from the mummy. It is often
the case that tissues are typed solely on the anatomical site from which
they were removed and not on specific pathological identification criteria.
Only histology has the capacity to identify the tissue type and degree of
preservation. Unless histology is performed in parallel with other methods,
such as the more modern molecular techniques, the validity of some of
the results may be suspect because the specific tissue type has not been
identified.
Ancient tissues have many intrinsic problems that must be taken into
consideration before histological techniques can be applied. The universal
problem is that the tissue is desiccated and crisp, unlike contemporary
tissues that are wet and soft. In this condition, it is impossible to section
the samples using the conventional techniques that are applied to freshly
surgically removed tissues. To allow subsequent processing, and in particular
sectioning, it is necessary to soften the mummified tissues by rehydrating
them. This rehydration step has two main purposes: first, rehydration will
allow the tissue to regain its normal hydrated architectural and cell structural
form, and second, following embedding, it will permit sectioning.
Czermack (1852) was the first person to attempt the histological examina-
tion of mummified tissue when he teased out tissue in a sodium hydroxide
solution and microscopically examined the resulting fibres. It was Ruffer
(1909) who devised the first true tissue rehydrating protocols. He used an
alkaline sodium carbonate solution to soften the tissue and then formalin
or an alcohol solution to harden the tissue prior to processing. Sandison
(1955) further refined the technique originally described by Ruffer.
Some twenty-six years later Turner and Halton (1981) used a commercially
available laundry fabric softener (Comfort® ) to soften pieces of mummified
tissues. One of the problems with using commercially available materials
is that the manufacturer often changes the formulation of the product and
so standardisation of the technique is impossible. Comfort has the particu-
lar problem that, as it is designed for a laundry purpose, it contains optical
brighteners to give a ‘cleaner wash,’ and these optical brighteners also attach
to the mummified tissues, changing staining patterns and preventing sub-
sequent immunofluorescent examination.
A comprehensive account (Mekota and Vermehren 2005) reviews the
many attempts to refine the original rehydration techniques. Currie (2002),
working from basic scientific principles, devised a solution of 1 per cent
sodium laureth sulphate (a detergent) in formol saline for the rehydration
of tissues, and this is now our preferred technique. All rehydration solutions
must have the capacity to kill or at least inactivate bacterial and fungal
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Slices of mummy: a histologist’s perspective 73
organisms that would lead to putrefaction of the mummy tissues during the
process.
Following rehydration, it is necessary to fix the tissue. Fixation involves
a complex series of chemical changes that stabilise the tissue, retaining
the tissue architecture in as lifelike a state as possible; it must also allow
subsequent processing. It is interesting to note that the ancient Egyptians
accidentally discovered fixation many years before the modern histological
techniques were described, as they used natron as a fixative to preserve the
body as part of the mummification process.
Usually, the rehydration and fixation steps are performed in the same
solution, as in the case of formalin and detergent. The rehydration and
fixation steps are used for both soft tissues and bone, but in the case of bone,
further decisions have to be made about the subsequent processing steps.
Trabecular bone (found, for example, in the vertebra and the ends of the
long bones) is very difficult to section without first removing its mineral
content. Cortical bone (which, for example, forms the shafts of the long
bones such as the femur) is impossible to section unless a decalcification
step to remove the mineral hydroxyapatite is first performed.
There are two main types of decalcification, acid and chelation, but the
most common is the use of an acidic solution to breakdown the hydrox-
yapatite into the soluble salt of the acid that then diffuses from the bone
into solution. The mode of action of chelation is different from acidic pro-
cesses as it takes place at neutral pH. The most common chelating agent
is a solution of ethylene diamine tetraacetic acid (EDTA). The crystal of
hydroxyapatite is made unstable by the irreversible capture of a calcium
atom from the surface of the hydroxyapatite crystal by the chelating agent,
which destabilises the crystal, resulting in the subsequent release of a phos-
phorus atom; the consequence of this is the dissolution of the crystal.
Many different solutions have been used but it was not until recently that
Williams (2006) comparatively determined the optimum mode of decal-
cification when applied to ancient bone. Through a comparison of the
controllability, damage, effectiveness, and subsequent staining of the bone
tissues with decalcification by nitric, formic, acetic, and hydrochloric acids
and EDTA, she came to the conclusion that a 12 per cent formic acid/sodium
citrate solution at room temperature with constant slow agitation was the
optimum solution for ancient bone.
Embedding and sectioning the mummified tissue

Mummy tissue is often contaminated by the presence of sand, which
can make the tissue difficult or impossible to section; however, the sand
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74 John Denton
is easily removed from the tissue prior to processing by immersion in

2 per cent hydrofluoric acid (extreme caution) with little or no damage
to the tissue. The technique was originally described (Denton 1998) not
for mummy tissue but for the removal of silica-containing deposits from
human female breast tissue in an investigation into failing silicone breast
implants.
Following the previous steps of rehydration, fixation, and/or decalcifica-
tion, prior to infiltration with the final embedding medium, it is necessary to
remove any water present in the tissue because the final embedding media
are not miscible with water. This stage, known as the dehydration step, gen-
erally involves the removal of water by the immersion of the wet tissue in
many changes of alcohol until all water is removed. The time taken for this
procedure depends on the size and density of the tissue. The media used for
the final embedding are generally not miscible with alcohol, and so another
step of processing has to be taken. This step, which uses a reagent that is
both miscible with alcohol and the embedding media, used to be known
as ‘clearing the tissue.’ This term came about because oils such as cedar-
wood and sandalwood were used that made the tissue almost transparent;
in modern practice, synthetic, cheap hydrocarbons such as xylene are
used.
There are two main embedding procedures: either with paraffin wax or
with plastic resin. Paraffin wax embedding of tissues has been performed
for at least 100 years and it remains the most widely practised embedding
technique in modern day histology laboratories. It is especially useful for
soft tissues, as it sections easily with standard equipment and knives and has
the advantage that it is easily removed with solvents.
For harder modern tissues such as bone, plastic resin embedding has
largely replaced wax as an embedding medium. The disadvantage of this
form of embedding is that it is more expensive, and requires complex equip-
ment and either tungsten carbide–tipped steel knives, glass knives, or even
diamond knives to cut the sections. Well-rehydrated mummy tissues can be
embedded in wax and successfully sectioned; however, it is often the case
that because of their inherent hardness, mummy tissues require plastic resin
embedding.
Karlsen (2006) performed a critical, comparative, evaluation of the
embedding of decalcified and nondecalcified ancient bone samples in
four embedding resins commonly used for modern day samples. These
were Araldite® , Spurr, methylmethacrylate, and LR White resinTM . In the
study he compared the preservation, ease of embedding, sectioning, and
staining of the bone sections. From a staining and sectioning perspective,
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methylmethacrylate embedding was the preferred embedding type for

ancient bone; however, polymerisation of the monomer was very problem-
atic and not controllable most of the time. Karlsen finally concluded that
because of the control and sectioning quality, LR White embedding was
the preferred medium for ancient tissues.
As mummified tissues are so often exceptionally difficult to section,
embedding in one of the plastic resins is the only way, even for soft non-
calcified tissues, to be sectioned. Sections are cut at between 5- and 10-µ
thickness on machines known as microtomes. These machines often simply
consist of a block holder and knife in which the block is passed under the
knife and a section is cut; the block advances on the return stroke and the
process is repeated. For modern tissues, the knife is generally of the dispos-
able type; however, the fragile edge of the knife is easily damaged, and for
mummified tissues it is normal to replace the disposable knife with one that
has a hardened edge or even one that has a tungsten carbide tip.
Once cut, the section is mounted onto a glass microscope slide for support
and to enable the staining process to be performed. Because the majority
of staining techniques take place in an aqueous environment, the wax has
to be removed from the section before staining. This is normally a simple
matter of reversing the sequence of the processing reagents by soaking the
slide in xylene followed by alcohol, and finally immersing the section in
water. This is often referred to as the ‘section to water’ step prior to staining.
The staining process

The whole purpose of embedding and sectioning is to have a section, usu-
ally 5 µ thick, that is thin enough to be examined microscopically. Unfor-
tunately, due to the thinness and transparency of the sections, staining is
required so that individual tissues and components that have no intrinsic
contrast or colour can be visualised.
Thousands of stains are used for histological purposes but many are just
minor variations of each other. Only the types of staining and the results are
described here as there are many other available sources for specific staining
reactions to which the reader can refer. The main reactions are designed to
specifically demonstrate individual properties or cellular configurations of
the tissue in different colours, such as the common haematoxylin and eosin
(H&E) technique that stains cell nuclei blue and the rest of the tissue shades
of pink. Some stains are less specific and just stain all components of the
tissue in the same colour but with varying intensity, such as the toluidine
blue technique.
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76 John Denton
Before embarking on staining the tissue, it is necessary to identify the

required outcome, for example: ‘Do I need to see just a global view of the
tissue?’ or ‘Is the information that I require of a very specific nature?’ Each
question will need to be answered by a different staining technique, and pos-
sibly by many techniques. In palaeohistology, the questions are often quite
simple, for example: ‘Is the tissue what I think it is?’ or ‘Is it well preserved?’
These simple questions, however, sometimes pose complex problems.
Customarily, staining techniques that rely on differing mechanisms of
action are used, so that problems of preservation that may preclude success-
ful staining with one stain can be overcome by another, in order that the
common features of the tissue can be identified. These objectives can often
be achieved by the use of a single stain such as toluidine blue, which is a
general stain of matrix, nuclei, and microorganisms. Toluidine blue staining
in mummy tissues is simple and rapid, as staining takes one minute with a
0.05 per cent aqueous solution of the dye. The drawback to this stain is that
all components including the nuclei are shades of blue, and it is necessary
to have prior knowledge of tissue structures so that they may be identified
by morphology alone.
Pathologists have overcome this barrier by using two stains in sequence
to give a differentiation between the two essential components of tissues:
the nuclei of cells and their cytoplasm. The natural stain haematoxylin
in combination with the dye eosin (H&E) is the most common staining
procedure in histology laboratories throughout the world. It is the basis
of all diagnostic histology applied to surgical tissues where it stains nuclei
blue and other parts of the tissue varying shades of red. When the H&E
stain is applied to ancient tissues, the results are mostly disappointing due
to the degradation of the tissue, resulting in the loss of nuclear staining
and of the contrast to the eosin stain. This problem can be minimised
by using the other staining techniques that rely on other mechanisms of
staining.
As connective tissues are often the only ones remaining on the body, it
is important that their presence can be demonstrated histologically. For-
tunately, staining reactions have been designed that separate the various
tissues, including the connective tissues; these show different colours when
applied in sequence. This type of staining technique is often called after
the number of stains used in the technique; for example, when three dyes
are applied in sequence, this is known as a trichrome technique.
Following staining, the final step before microscopic examination is the
process of encapsulating the stained section. This is performed by dehydrat-
ing the glass slide containing the section with alcohol, replacing the alcohol
with xylene, and applying a small quantity of mounting medium followed
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by the application to the surface of a thin glass coverslip. The mounting

medium is often a solution of the plastic polystyrene in an organic solvent.
It is designed to have the identical refractive index as that of the slide and
coverslip glass, providing a transparent pathway for light and minimising
refraction that is a cause of microscopic resolution loss.
Tissue identification
The identification of tissue can be problematic. For example, visual inspec-
tion of this specimen from a Canopic jar tentatively indicated that it was a
sample of liver (Plate I). To the surprise of the researcher, however, when the
specimen was examined by histological techniques and stained, it was iden-
tified as a leaf. This finding illustrates the point that it cannot be assumed
that visual identification is conclusive. Without correct identification, this
material may have been used for more sophisticated analytical or molecu-
lar techniques, which would have given erroneous results and wasted the
material.
Identification of bacteria and fungi

When mummified tissues are histologically examined, microorganisms
such as bacteria and fungi can often be seen in the section. They are gen-
erally present as a result of continuing putrefaction of the tissues. These
microorganisms are best seen in the toluidine blue staining reaction in
which the whole tissue is stained a shade of blue but the bacteria stain the
darkest.
Bacteria are divided into two main groups on the basis of their stain-
ing by the Gram technique. In this technique, bacteria that are said to be
Gram-positive stain blue and bacteria that are Gram negative stain red.
Pathogenic bacteria that have caused an abscess in the individual before
death most often produce a pus-filled cavity in the tissues, which would
be full of bacteria; this would leave evidence of a cavity in mummified tis-
sues. In contrast, bacteria that are starting to invade the tissues as part of
the putrefaction process use the route of least resistance, which is normally
along and between fibres (Plate II).
Fungi of various types are often seen in ancient tissues; these are a result of
poor storage of the specimen (see Chapter 16). Histology allows conservators
to identify the fungus on morphological grounds and to assess the effects
of the organism on the tissue. A problematic fungus that is encountered is
Serpula lacrymans, more commonly known ‘dry rot.’ Conservators normally
limit the humidity in the air surrounding the exhibit to control the fungi
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78 John Denton
and bacteria, but unfortunately, dry rot fungus is adept at circumventing this
measure by producing its own water as a metabolic byproduct, thus allowing
further growth. So even if the mummy is placed in a dry environment, this
does not inhibit the growth of the fungus, which proceeds to use the bone
as a food source.
In addition to water, the fungus produces oxalic acid as another metabolic
byproduct, which can be a problem, particularly for bony structures. The
acid acts in a similar way to the acids in the decalcification process but
in this case, instead of producing a soluble salt, the oxalic acid produces
an insoluble calcium oxalate compound that forms clusters of crystals in
the tissues. These crystals are best viewed by the technique of polarising
microscopy in which the birefringent properties of the crystal give bright
white or coloured crystals on a black or magenta background (Plate III).
Polarising microscopy
Polarising microscopy can also be used to visualise crystals that were
deposited during the individual’s life as a result of pollution in ancient
Egypt. This can be seen in Plate IV in which crystals and soot have been
deposited in the pleura, the sac surrounding the lungs. Deposits of this
type are accumulated throughout life when the individual is inhaling air
containing sand and other particles.
The contents of the deposit are a reflection of the pattern of particulate
inhalation throughout the person’s life and are nearly always a mixture. It
is common to find sand in lungs from the inhabitants of these desert areas,
and this type of soot is often the result of burning fats used for illumination
in a confined space such as a tomb, mine, or even the home. Mixed particles
are sometimes seen in the lungs of smelters and potters, reflecting the dust
and smoke that they have inhaled in the course of their daily working lives.
Histological examination of mummified cats

Preservation of tissues is optimally achieved by rapid desiccation of thin,
exposed structures that include, for example, the extremities of limbs and
protruding thin structures such as the ears. This is well demonstrated by
this section of a cat’s ear (Plate V). The section shows that there is excellent
cellular preservation: even cell nuclei, which are normally one of the first
casualties of degradation processes, are present. By examining and identi-
fying the different types of tissue that make up the ear, it can be seen that
there is a large band of cartilage running through the centre of the tissue.
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Cartilage of this thickness would give the ears a great degree of stiffness,
and from this it can be assumed that the ears of the cat were quite stiff and
erect. Cats of this type are described and pictured in wall scenes in Egyptian
tombs.
Histological examination of plant remains

Histology can also be used to examine ears of wheat. The seed capsule is
designed to resist dehydration and remain in a viable condition for a long
period of time and is normally harvested in a dried condition. Because of this
dried state, the seed is often very well preserved and has resisted attack by
microbial agents. Histological examination of the seed allows a comparison
to be made between the emmer types of wheat grown in ancient Egypt and
the more modern crops grown today. The morphology of the wheat seed
and the starch contents demonstrate excellent preservation even after 2,500
years and show a remarkable degree of preservation (Plate VI).
The effects of oxidation and putrefaction

Oxidation and putrefaction can have profound effects on the staining of
tissues, in some cases even reversing the normal staining pattern that would
be expected by the individual stain on contemporary tissues. Some staining
techniques are unaffected by reversal of the normal staining pattern, but the
staining techniques that rely on the fact that the molecular pores are filled
by dyes having specific molecular sizes are often affected. It is common in
this type of technique to have three dyes that are applied in sequence to the
section.
The first and largest molecular size dye fills the largest size pores, and
this is then followed by the smallest molecular size dye, which can only
fill the smallest pores because it is not large enough to fill the intermediate
size pores. When the largest and smallest pores are filled, the rest are finally
filled with the last dye. Each of the dyes is of a different colour and become
localised in different tissue types, allowing them to be separated on the basis
of colour alone. This effect is sometimes demonstrated in partially damaged
tissue in which only the surface of the tissue is affected, giving a reversal of
the normal staining pattern.
Putrefaction often destroys the evidence of pathological conditions in
ancient tissues, particularly in softer tissues such as liver (Plate VII). The
skeletal tissues are quite resistant to these changes and can sometimes pro-
vide much information, as they retain and lay down evidence within the
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80 John Denton
structure of the bone, similar to the way in which the annual rings in a tree
are indicative of time and seasons.
The contribution of skeletal material

Skeletal connective tissue remains in mummified bodies are a valuable
biological indicator for understanding lifestyle in antiquity and individual
nutrition. They can show very complex histories that have been archived in
the structure, and these can be revealed through histological examination.
An understanding of the basic biology of bone is essential to understand
any of the changes that may be expected to appear.
Bone is a highly active calcified connective tissue that is the articulating
framework to which the muscles via tendons are attached; it is also the
main depot of calcium vital for homeostasis. There are three formations
of bone that have different configurations but are essentially composed of
collagen fibres, which are calcified with hydroxyapatite. The first type of
bone is known as compact bone; this is the type of bone that forms the
shafts of the long bones (e.g. femur), and the surface of the trabecular or
spongy bone (e.g. vertebra). It is composed of a complex of tubes that are
stress bearing due to their shape, and have haversian canals or nutritional
channels running through the centre of most tubes.
The second type of bone is known as trabecular or spongy bone; it forms
the centre of the ends of the long bones and is the main type of bone in the
spine and pelvis. It is composed of an interconnecting mesh or spongelike
fingers of bone, which are themselves formed of lamellar or layered collagen
fibre structure. In addition, between the bone structure, there is the almost
liquid, blood-cell forming, haemopoetic marrow. The third type of bone
is formed at sites of damage, and is termed woven because of the relative
random structure of the collagen fibres.
As a living, dynamic tissue, bone is not dead or static; it adapts to changes
in body demands, either for support or as a result of a disease state. Bone
is formed and adapts to these influences through the balance achieved
between three different types of cells. Bone is formed by cells known as
osteoblasts, which lay down a precursor of bone called osteoid; some days
later, this becomes mineralised with the complex calcium phosphate known
as hydroxyapatite. So that bone can be removed to change its configuration,
either simply to renew it or as a direct result of pathological conditions, a
cell known as an osteoclast attaches itself to the surface of bone, where it
secretes acid and collagen-degrading enzymes. This results in the specific
removal of bone, leaving hollows or pits and a scalloped surface.
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Following removal, the bone is replaced where necessary by the bone-

forming cells (osteoblasts), which first lay down the nonmineralised osteoid
that then becomes mineralised. It is this relationship of osteoid and min-
eralised bone that is destroyed when the mineral is removed through the
decalcification process. If the relationship is needed, then the bone must
not be decalcified. Although the section is much more challenging to cut,
the diagnosis of rickets and adult osteomalacia can be made.
Telltale changes in the orientation of the collagen fibres occur at the
point at which osteoclasts finish bone removal and when osteoblasts start
new bone formation; there is also a stainable line known as a reversal line
that is produced at the junction of the old and newly formed bone. The
whole process continues throughout life to maintain the biological and
biomechanical properties of bone. Problems occur within the skeleton,
either locally as in the case of a fracture or systemically as in the case of
osteomalacia (in children known as rickets) and osteoporosis. In contem-
porary bones, the difference between osteoid and mineralised bone can be
demonstrated, enabling the ratio of mineralised bone to osteoid to be mea-
sured and compared with normal. If this relationship is to be investigated,
the bone cannot be decalcified and must therefore be embedded in plastic
resin.
In ancient skeletal tissues, the presence of osteoid cannot often be esti-
mated because it is removed as part of the bacterial and fungal putrefaction
process that causes all soft tissues including osteoid to be lost; therefore,
the diagnosis of rickets or osteomalacia cannot be made. In cases of this
nature, the diagnosis of osteomalacia is impossible; however the diagnosis
of osteoporosis can be made because this simply involves the measurement
of bone volume and its comparison with an age- and sex-matched normal
control.
Despite putrefaction, residual detail always remains in the bone. In the
following case (Plate VIII), this has facilitated the reconstruction of a very
specific individual history. A histological section from a Nubian female
of childbearing age was examined and an unusual pattern of staining was
noted. The pattern demonstrated severe bone removal by osteoclastic resorb-
tion, leaving a scalloped surface; this then came to an end but was followed
by a healing phase when new bone formation occurred over this old sur-
face. This pattern was then repeated, but this time, the resorbtion occurred
through the new bone and into the old bone. This process then suddenly
came to an end, and no new bone was formed.
Such rapid removal of bone is often associated with the nutritional
demands of pregnancy in which the maternal skeleton is eroded by foetal
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82 John Denton
demands for calcium. During pregnancy, the demands for calcium are
approximately 300 mg per day, but during lactation, the demand is in the
region of 3,000 mg per day, most of which comes from the maternal skele-
ton. If this is compounded by a poor diet, which was probably common in
ancient Egypt, then this can produce the episodic removal, healing, and
subsequent removal observed in this woman.
Thus, the abnormalities in the section of bone shown in Plate VIII can
be explained by piecing together a timeline of events: a normal woman
with normal healthy bone (HB) becomes pregnant and delivers a healthy
child whom she breast-feeds. This leads to massive calcium demands that
result in bone removal (evidenced by the old resorbtion line [OR]). She
then stops breast-feeding and has a period of normal health that allows her
bone to heal by formation of new bone on the surface of the old bone (NB).
The woman then re-enters the cycle of pregnancy and lactation, which
again results in bone removal by osteoclasts, but this now occurs through
the bone laid down between the two pregnancies and into the original
old healthy bone (NOC). This cycle then stops suddenly, demonstrated
by the resorbtion and lack of new bone formation. This abrupt halt was
almost certainly due to the woman’s death. This example demonstrates how
histological examination of a small sample of bone can produce detailed
information about the months or years of the person’s life prior to death.
Textile studies
Egyptian mummies are often wrapped with cloth bandages, as are some-
times the individual organs in the Canopic jars. It is therefore not unusual
to have pieces of bandage included with the tissue to be examined histolog-
ically.
At the microscopic level, it is usually possible to provide a positive iden-
tification of the structure of the cloth and the type of fibre of which it is
composed (Plate IX).
In conclusion, histology was one of the earliest scientific techniques to
be used for the investigation of ancient human, animal, and plant remains.
It is still the only technique that can identify specific tissues at a cellular
level and allow the pathological diagnosis of disease states.
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chapter 7
Palaeopathology at the beginning of the

new millennium: a review of the literature
Maria Jeziorska
Introduction
The attempt to study the significance of disease in prehistoric and early
historic people is challenging and somewhat analogous to reconstructing
the plot of a feature length motion picture from a few frames. – Miller
et al. (1996)
Human palaeopathology can be defined as the study of disease in ancient

populations by the examination of human remains (Aufderheide and
Rodriquez-Martin 1998). It has changed from a description of isolated cases
of interesting findings during archaeological excavations to a fascinating
branch of science offering insights into the past with clues to understanding
the present. In most of the cases, it is now no longer a solitary task of a single
researcher but an effort of a multidisciplinary team. In many cases, work
on mummified remains from one location is continued over several years,
building a complex interpretation of the cause and circumstances of death
of particular individuals and their place in the society.
This is a review of publications on the issues of palaeopathology published
in the last decade, but mostly after the beginning of the new millennium.
It may seem a short period of time, but the number of publications is quite
substantial so the decision to limit the scope of this review to those years was
made because the earlier publications were exceptionally well presented in
two books by Aufderheide and Martinez (1998) and Aufderheide (2003).
This review is presented from the point of view of a pathologist.
Palaeopathology is a fascinating subject for any pathologist. It is challenging,
baffling, and occasionally humbling to those who are confidently dealing
with contemporary tissues.
Studying ancient human remains presents many challenges. One of the
most difficult situations is when the researchers encounter badly damaged
83
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84 Maria Jeziorska
human remains with a rarely occurring variant of disease or when the indi-
vidual suffered from concurrent diseases that caused superimposed tissue
changes. Such situations can easily lead to misdiagnosis.
Nevertheless, the scientific investigation of mummies and skeletons pro-
vides considerable data for the reconstruction of the living conditions and
diseases of past populations (Nerlich 2002). Ancient human remains occur
either in skeletal form or with soft tissues preserved due to natural or artificial
mummification. The most crucial factor for any kind of scientific assessment
is the state of preservation. It is now understood that both soft tissues and
bone are affected by the mummification process, and the quality and type
of information gained from studying ancient remains depend greatly on the
substances used.
Mummification and materials used for mummification

The favourable environmental effects (hot and dry climate, or the opposite –
ice and snow – alternately desiccating or freezing the tissues) may pre-
serve the bodies in a mummified state without human intervention (see
Chapter 16). Anthropogenic (artificial) mummification is a deliberate act of
preservation of the body after death. It is generally believed that the reason
for intentional mummification was a system of religious beliefs that eventu-
ally evolved into cultural practices. Whatever the reason for its use, mummi-
fication was applied to the bodies to arrest the inevitable decay starting after
death. In ancient Egypt the most effective method of mummification was
evisceration of the corpse, which involved removal of the gastrointestinal
tract containing the greatest source of bacteria (see Chapter 2).
Desiccation and preservation were achieved by surrounding the body
with natron, a naturally occurring mixture of sodium salts that removed
water from the tissues, thus stopping enzymatic activity of both the body’s
own enzymes and those from invading microorganisms. There are indi-
cations that, in certain circumstances, natural mummification preserves
tissues as effectively as the artificial process (Shin et al. 2003; Jeziorska et al.
2006).
Chemical components used in mummification

and their effects on tissue preservation
Resins and bitumen

With the wider use of established methods such as gas chromatography
(see Chapter 10) in combination with other techniques, there is a renewed
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Palaeopathology at the beginning of the new millennium 85
interest in identifying the components of embalming fluids. Mastic resin,

vegetable oil, beeswax, and bitumen were found in the oldest mummies (sev-
enth century b.c.) but the younger samples (second century b.c.) showed
more variation in the components used (Colombini et al. 2000).
The embalming materials from the Roman Period mummies were anal-
ysed for the soluble lipid components to determine the source of embalming
material. The results indicated the presence of plant material (coniferous
resin and possibly beeswax) and bitumen, resembling Dead Sea asphalt
(Maurer et al. 2002). Recent investigations of molecular signatures of oil
seeps from the Gulf of Suez showed that they were used by ancient Egyp-
tians for embalming (Barakat et al. 2005).
Borate
Weser and Kaup (2002) assayed mummification salts and mummified bones
for borate and the reactivity of this compound on bone alkaline phosphatase,
which is known to survive mummification for more than 4,000 years. Further
investigation showed the elevated borate contents in both mummification
salts and ancient bone samples. The experimental work showed that borate
stabilises alkaline phosphatase molecules (Kaup et al. 2003).
Arsenic
Arriazza (2005) recently offered an interesting hypothesis on the origin of the
earliest form of mummification. He proposed that a natural phenomenon of
highly toxic water from a local river that contained a hundred times the con-
temporary level of arsenic caused an extremely high spontaneous abortion
and preterm birth rate in an ancient population of the Chincorro people
who were also apparently the first people in the world to practise intentional
mummification. This author proposed that the Chinchorro mortuary prac-
tice began as a cultural response to an environmental phenomenon.
In much more recent times, c. early 1600 a.d., arsenic was introduced
in Europe for the preservation of birds used as decoys or exhibits (Schulze-
Hagen et al. 2003). In 1835, Giuseppe Tranchina described a method of
injecting the blood vessels of a corpse with an arsenic–mercury solution.
This method was used in 1836 a.d. on the corpse of a prisoner who died of
pleurisy. His mummified body remained in an excellent state of preservation
and was recently examined by computed tomography (CT), with which the
historic case notes indicating pleurisy were confirmed; the pleurisy was most
probably caused by tuberculosis (Ciranni et al. 2005).
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86 Maria Jeziorska
Cedar oil: ‘cedrium’

The examination of unused ancient Egyptian embalming material dated c.
1500 b.c. revealed the presence of phenols, guaiacols, naphthalenes, and
sesquiterpenoids (Koller et al. 2003, 2005). These compounds are found in
wood tar oil obtained from the true cedar tree by dry distillation or smoul-
dering process. Similar compounds were extracted from a Ptolemaic torso
(340 ± 170 b.c.). The authors point to the fact that the examined materi-
als were in striking accordance with Pliny’s description of liquid ‘cedrium,’
which was used in Egypt for mummification. The most valuable attributes
of these compounds are their fungicidal and bacteriostatic properties and
their excellent ability to preserve alkaline phosphatase.
Sodium sulphate
Not all the salts detected in the Egyptian mummies enhanced the preserva-
tion of all tissue components. Sodium sulphate was found in areas where the
degradation of lipid and protein seemed to be higher (Petersen et al. 2003).
Experimental mummification
Each example of human remains that is examined is unique. Even if they are
of a similar age and the mummification process and burial circumstances
were alike, the subsequent fate of each body is unique. Experimental stud-
ies help to explain on a molecular level what happens to the tissue during
mummification and shortly after mummification (Jeziorska et al. 2005a).
Experiments on animal carcasses shed some light on the influence of dif-
ferent conditions of burial on decomposition and the rate of water loss.
Koller et al. (2003) used four selected embalming compounds that were
found in resins and wood tars used for embalming in Egypt to experimen-
tally embalm porcine ribs before air-drying them. The level of alkaline
phosphatase present was used as a measure of preservation of the bone
tissue. Guaiacol was the most effective in retaining alkaline phosphatase
activity. Experimental desiccation of mice showed that even DNA mate-
rial that is highly susceptible to degradation can be identified in the tissues
(Terra et al. 2004).
Methods of rehydration
Desiccated, mummified, or embalmed tissues need to be rehydrated to
resemble contemporary material (see Chapter 6). Each sample changes its
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consistency differently, depending on its histological content, mode of mum-

mification, and preservation, so individual processing of samples under close
macroscopic inspection is essential (personal experience, Jeziorska et al.
2005b). Some samples may even appear to dissolve in the rehydrating/fixing
solution. This is caused by the destructive action of bacteria invading the
tissue some time after death.
Methods of investigation
There are some well-established methods used for the investigation of
ancient human remains.
Gross examination
A thorough macroscopic description of the mummy or its fragments is an
essential part of the scientific assessment. Much valuable medical infor-
mation may be gained from this process. Great care must be taken not to
damage the mummified remains for both ethical and scientific reasons. For
a long time, mummies were treated as ‘curios,’ unwrapped for entertain-
ment, or used for medicinal purposes, following a bizarre belief spreading
in the eighteenth and nineteenth centuries a.d. that powderised mummy
tissue could cure various ailments.
Recently, complex ethical, cultural, and legal issues have been raised (see
Chapter 15) and now great care is taken to use minimally invasive and least-
damaging methods of investigation and sampling. In cases in which the
mummified body is partially dismembered or if an endoscopic procedure
can be performed (see Chapter 4), this may often give valuable informa-
tion about the state of the body cavities, enabling some diagnoses to be
made, similar to contemporary postmortem examination. Removing small
fragments of tissue from carefully targeted areas that are anatomically well
defined and in which the tissue looks best preserved can often form the
basis for good histological study.
Light microscopy
Light microscopy of the histochemically stained sections is the oldest
method of investigating mummified tissues. It remains a very important
technique.
Light microscopy using polarised light has an exceptionally high value
for the differential diagnosis of changes found in dry bones. Using
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88 Maria Jeziorska
thin-ground sections of nondecalcified bone allows for detailed examination

of bone and periosteal changes on the bone surface in different pathological
conditions (Schultz 2001).
Infrared microscopy
The state of conservation/degradation of mummified remains can be
inferred from their biochemical composition, as well as from the secondary
structures of proteins (see Chapter 16). Examination of the skin of an Egyp-
tian mummy by using synchrotron infrared microscopy enabled the main
degradation products to be identified as adipocere and calcium oxalate
(Cotte et al. 2005).
Electron microscopy
This technique was quite often applied to mummified tissues in the past,
but in the last few years it has been used very rarely. Transmission electron
microscopy (TEM) facilitates the study of subcellular details of the tissues,
and therefore is rarely successful in heavily damaged mummified tissues.
Scanning electron microscopy (SEM) is more promising, especially for
bodies that are not desiccated (Shin et al. 2003).
Molecular pathology
Molecular pathological methods used in contemporary research were
recently successfully applied to the investigation of mummified tissues.
They produce particularly good results in palaeomicrobiology (see below,
Tuberculosis).
Infectious diseases
Tuberculosis
Tuberculosis is a re-emerging threat in the contemporary world, which
is why studies of evolution of the disease are being actively pursued. In
recent years, there has been a rapidly growing number of publications about
tuberculosis, especially in the field of molecular pathology, so it is possible
to mention only a few.
Previous macroscopic reports on tuberculosis in pre-Columbian skele-
tal remains from South America causing severe destruction, collapse, and
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fusion of spinal lesions were confirmed by the molecular evidence. Daniel

(2000) presented an overview of the evolving views on the spread of tuber-
culosis. For those with deeper interest in tuberculosis in ancient popula-
tions the book by Roberts and Buikstra (2003) was hailed as the first all-
encompassing work on the history of the disease.
Leprosy
This entity is a chronic infectious disease that affects peripheral nerves, skin,
and in later stages, the skeleton. The disease is not fatal and if there are no
other concomitant diseases worsening the prognosis, the sufferers have a
long life expectancy. Disfiguring and mutilating aspects of the disease led
to ostracism and segregation of the affected individuals from the rest of
the society. Mark (2002) offered a new suggestion as to how leprosy spread
around the Mediterranean. He pointed out that ancient ships are seldom
mentioned in the literature as conveyors of disease, but they undoubtedly
were. He proposed that cargo ships with slaves being taken from India to
Egypt could have easily spread the disease.
A skeleton dated fourth to third century b.c. from a Celtic necropolis in
Italy shows probable lepromatous changes and if the planned DNA inves-
tigation is successful, it might prove to be the earliest case of leprosy in
Europe (Mariotti et al. 2005). The presence of Mycobacterium leprae DNA
was successfully confirmed in a tenth century Hungarian skull (Haas and
Zink, 2000). There are only a few reports that concentrate on the health
status of ancient populations from Central Asia, but the investigation of one
of the kurghans from Uzbekistan showed lesions that were probably due to
lepromatous leprosy (Blau and Yagodin 2005).
Finally, an interesting work by Bolsden (2001) goes beyond descriptive
approaches and uses modern epidemiological methods to address the preva-
lence of leprosy in medieval Denmark. In this study, the author set out to
define the osteological scoring system for leprosy and assess the sensitiv-
ity and specificity of seven leprosy-related osteological changes and the
frequency of leprosy at death in three different medieval burial sites (lep-
rosy institution and urban and rural cemeteries). The statistical approach
and methodology used in this paper show a new critical approach to
palaeopathology.
Treponematoses
There are four treponemal pathogens that affect humans: Treponema
pallidum subspecies pallidum (causing syphilis), T. pallidum subspecies
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90 Maria Jeziorska
endemicum (causing endemic syphilis or bejel, found in temperate and

subtropical areas), T. pallidum subspecies pertenue (causing yaws, found in
tropical/subtropical regions), and T. carateum (causing pinta).
Bejel and yaws are contracted through nonsexual contact but venereal
syphilis is transmitted during sexual contact or transplacentally from mother
to the foetus. The first three pathogens cause skeletal lesions, so evidence
of infection is detectable in skeletal remains. A heated debate on the origin
of European venereal syphilis led to the formulation of three hypotheses:
Columbian (maintaining that venereal syphilis was introduced to Europe
upon return of Columbus and his men from the New World in 1493);
pre-Columbian (claiming that it was present in Europe before 1493); and
a unitarian hypothesis (claiming that treponemal diseases had long been
present in both Old and New World but manifested differently due to dif-
ferent ecological and social conditions).
Recently, there have been some new reports suggesting the presence
of treponemal infections in Europe preceding 1493 a.d. Rothschild (2005)
presents a critical review of the European pre-Columbian cases, arguing that
all of them were caused by taphonomic changes, inflammatory conditions,
or at best other treponematoses, such as yaws or bejel.
His view is that treponematoses originated in Africa in the form of yaws,
passed through Asia forming bejel, and then both forms were transmitted
to North America where another mutation initiated syphilis, which was
spread to continental Europe with the return of Columbus’s men. Never-
theless, the most recent report from Europe (based on four skeletons from
Hull, England, dated between 1300 and 1450 a.d.) described microscopical
changes consistent with venereal syphilis, so the diagnosis of this disease is
most likely unless those individuals were migrants from other parts of the
world (von Hunnius et al. 2006).
Plague
The epidemics of plague were estimated to have killed millions of people,
but obtaining irrefutable evidence of the presence of Yersinia pestis was
very difficult. Drancourt et al. (1998) used unerupted teeth from skeletons
excavated from sixteenth and eighteenth century French graves of individ-
uals thought to have died of plague, thus obtaining sterile samples of dental
pulp. They were able to show a nucleotide sequence indistinguishable from
modern day bacteria, and later they demonstrated that Yersinia pestis was
the aetiological agent of the European Black Death in 1347 a.d. and the two
additional outbreaks in 1590 a.d. and 1722 a.d. in southern France (Dran-
court et al. 2002).
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There is a strong suspicion that peoples of America were infected with

Old World diseases prior to the founding of the first mission in 1769 a.d.
but it is a controversial view and not widely accepted (Preston 2002). This
author quotes numerous publications detailing evidence that much of North
America was devastated by a catastrophic disease prior to Euro-American
occupation, but there is a lack of irrefutable archaeological evidence, so
only a compilation of historical, ethnographic, archaeological, and bio-
logical information taken together could indicate the high probability of
plague.
Viruses
Many researchers doubted the possibility that confirmation of viral infec-
tions in historic material could ever be obtained. Simmonds (2000) dis-
cussed virus archaeology and evolution and stated that the direct evidence
for virus infection by isolation or by polymerase chain reaction is very rare
in material older than thirty years, but the archaeological evidence for virus
infection has been found. He recalled the discovery by Wells (1964) of skele-
tons from the Neolithic and Bronze Age periods with deformities similar
to present day poliomyelitis indirectly implicating viral infection. The best
example of a virus whose existence can be determined from descriptions of
epidemics is smallpox (Simmonds 2000).
The artificially mummified body of a sixteenth century Neapolitan noble-
woman showed the presence of a large papillary skin lesion in the paravul-
var region. The DNA was extracted from the lesion, amplified, cloned,
and sequenced. The diagnosis of condyloma acuminatum, a lesion caused
by human papilloma virus (HPV) was established (Fornaciari 2003). This
report followed an earlier discovery by the same group of the presence of a
smallpox virus in a sample of mummy skin (Fornaciari 1989). These find-
ings are very encouraging for renewed efforts for direct confirmation of viral
infections in ancient material.
Palaeoparasitology
Palaeoparasitology is the study of parasites in archaeological material. Para-
site remains in archaeological sites were sporadically reported for many years
and almost all known human parasites have been found in ancient faeces.
An excellent and comprehensive review of the topic was recently published
(Goncalvez et al. 2003). The authors also present their new data confirm-
ing human ancylostomids, Ascaris lumbricoides and Trichuris trichura, in
pre-Columbian times.
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92 Maria Jeziorska
Chagas’ disease (American Trypanosomiasis)

Mammals infected with Trypanosoma cruzi and the insect vector seem to be
well adapted for coexistence and survival, but for humans, Chagas’ disease
is a purely accidental occurrence and results in a much more serious disease
(Aufderheide et al. 2004, 2005).
Fasciola hepatica
Liver fluke eggs are a rare finding in palaeopathological material (Araujo
et al. 2000), but one such case reported recently describes both human and
cattle hosts involved in the infection cycle (Dittmar 2003).
Trichinellosis (oxyuriasis)
Trichinellosis in an Egyptian mummy was described in the early nineteenth
century a.d., but it has been occasionally reported in Europe, resulting in
outbreaks that have a deadly outcome. For example, a very serious infesta-
tion was reported in Germany (1860–1880 a.d.) that resulted in more than
500 deaths (Blancou 2001).
It is a rare but increasingly frequent occurrence that findings about past
diseases can have a bearing on understanding the contemporary manifesta-
tions of particular ailments. This is particularly true in relation to parasitic
diseases (Araujo 2000).
Cancer/neoplastic diseases
There is no evidence of true neoplastic diseases other than in vertebrate
animals (Capasso et al. 2005), but humans are by no means the first to
suffer from cancer. Rothschild et al. (2003) have recently published their
findings from the examination of a staggering number of over 10,000 speci-
mens of dinosaur vertebrae by using fluoroscopy as a screening technique.
They found evidence of hemangioma, desmoplastic fibroma, osteoblas-
toma, and metastatic cancer but only in Cretaceous hadrosaurs (duck-
billed dinosaurs), leading them to the conclusion that the predilection of
hadrosaurs to tumours is unprecedented and unique.
The prevailing opinion in the literature is that the occurrence of malig-
nant neoplastic diseases in humans is greatly influenced by environmen-
tal factors and blamed on worsening living conditions caused by pollu-
tion. Over the years, there have been numerous examples of neoplastic
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diseases found in the ancient human remains but the frequency of malig-
nant tumours in ancient populations cannot be inferred from the reports of
single cases.
The examination of a large necropolis gives much better insight into
the frequency of cancer in ancient populations, even though there is a
large time-span between the earliest and latest burials, and the investigation
is mainly limited to the skeletal remains. Zink et al. (1999) examined 415
mummified individuals from the necropolis of Thebes-West in Upper Egypt
and found that among 325 adults there were at least four cases of malignant
tumours with osseous manifestation.
The attempted age and sex adjustment and comparison to contemporary
populations showed an astonishing result: namely, that the frequency, albeit
lower than in a comparable present day population, was higher than in an
English population from 1901 to 1905 a.d. This finding led the authors to
conclude that important factors affecting malignant tumours were effective
even in historic populations.
A recent review on the antiquity of cancer (Capasso 2005) summarised
the complexity of palaeooncology and the difficulties in diagnosis and inter-
pretation. The author also offers a critical analysis of the fossil record of
neoplasms and a detailed review of the literature on cancer in human pop-
ulations, as well as his views on why cancer in ancient human populations is
rare. The problem of differential diagnosis between primary and metastatic
bone tumours encountered in contemporary material is even more accen-
tuated in the ancient remains (Rothschild 1998). For further reading on the
subject, there is an excellent review by Halperin (2004).
Diet/palaeonutrition/vitamin deficiency
Danforth (1999) touched on a philosophical question relating to the interre-
lationship of diet, nutrition, and political organization by using the examples
of prehistoric North American and Mesoamerican societies. Although nutri-
tion is only indirectly reflected through the osteological record, it neverthe-
less reveals certain patterns, showing that from egalitarian to chiefdom-level
groups there was little difference between members of the same society. This
suggested that to remain in power, the elite still had to share resources.
In state-level societies, the gap in health status between high- and low-
status individuals is readily apparent, and it widens over time. Recently, it
has been suggested that a low-diversity diet consumed by Neanderthals put
them at a disadvantage and eventually caused the demographic shift towards
the anatomically modern Homo sapiens who consumed a slightly more
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94 Maria Jeziorska
diversified diet, allowing for a lower maternal and fetal-to-infant mortality

(Hockett and Haws 2005).
Anaemia
Cribra orbitalia is a lesion in the bone forming the roof of the orbit; for a
long time, this was generally accepted as a proof that the individual suffered
from anaemia. It is true that the lesion is seen in cases of hypertrophy of
the red bone marrow, which may occur as a result of anaemia, but there
are other conditions, such as inflammation or osteoporosis that result in
formation of cribra orbitalia.
Wapler et al. (2004) examined 333 skulls from a Nubian population and
found that there were histological features indicating anaemia in less than 50
per cent of cases with evident cribra orbitalia, proving that cribra orbitalia is
not synonymous with anaemia. Nevertheless, such findings do not diminish
the value of numerous previous reports on the prevalence of cribra orbitalia
in ancient populations, as discovery of this feature indicated a pathological
condition, even if not necessarily anaemia. It is probable that cribra orbitalia
found in children is more likely to be a reflection of anaemia.
Childhood mortality in individuals with cribra orbitalia was higher
when tuberculosis or tuberculosis-like conditions were present (Blom et al.
2005). Recent advances in multislice computed tomography, with three-
dimensional reconstruction used to image rare cases of cribra orbitalia in
contemporary population, may offer some help in assessment of historic
skulls (Exner et al. 2004).
Scurvy
This entity is caused by the lack of ascorbic acid in the diet. Brickley and Ives
(2006) pointed out that the diagnosis of infantile scurvy based on changes
in the sphenoid bone may be misleading and result in false-negative reports
of the occurrence of this condition. Taking into account changes in cranial
bones and scapulae gives a more realistic reflection of the incidence of
infantile scurvy, which can be linked to recorded periods of potato blight
in the investigated region of Birmingham.
Occupational diseases
Heavy metals
Mercury was mined in Peru in pre-colonial times on a relatively small scale
as cinnabar (mercuric sulfide) and used mostly in cosmetics. In colonial
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times, it was used to amalgamate and refine silver ores, so there was a
great demand for it. The toxic nature of mercury combined with respiratory
diseases, mining accidents (mostly broken limbs), and work at high altitude
made those mines exceptionally dangerous places with a high mortality
rate and constant demand for new workers, which could only be achieved
by forced labour, causing depopulation of surrounding provinces (Brown
2001).
Bone and joints

Recognising periosteal reaction and distinguishing it from postmortem bone
damage (taphonomy) is one of the most difficult diagnostic challenges faced
by palaeoanthropologists. New methods offer some hope but have yet to be
tried and tested on large numbers of skeletal samples. One such method is
an assessment of heat dissipation through the normal bone surface, which is
different from the bone with taphonomic changes (Rothschild et al. 2003).
Rheumatoid arthritis (RA) in Europe and in the New World has been the
subject of many publications.
Recently, more examples of descriptions and representations of a sym-
metric chronic polyarthritis with characteristic deformities were found in
ancient Rome and India, with the first clinical distinction between RA
and gout published in Mexico in 1578 (Aceves-Avila et al. 2001). The
authors searched for descriptions of symmetric chronic polyarthritis and
characteristic deformities seen in contemporary RA and concluded that it
had existed in America since 8,000 b.c. and in Europe since the seventh
century a.d.
A comparison between morphology and radiology, as seen in ancient
skeletal remains, enables a unique appraisal to be made of osteoarthritis
and RA in the advanced stages of those diseases (Lagier 2006). Until fairly
recently, osteoarthritis was considered a wear-and-tear disease and a dis-
ease of the modern age. The examination of large numbers of the spinal
columns of Neolithic ancient Chinese revealed a slightly higher prevalence
of calcification of the posterior longitudinal ligament than found amongst
the modern populations of Japan, Korea, Taiwan, Hong Kong, Philippines,
Malaysia, and Singapore (Hukuda et al. 2000). There are striking similar-
ities in localization (hand, shoulder, knee, and hip) between ancient and
contemporary cases, but the elbow joint was more frequently affected than
it is today (Crubezy 2002).
Traumatic injury seems to be the most common cause of bone pathology
besides arthritis. In the past, there was ample evidence of healed fractures
in animal and human skeletons. Signs of trauma are comparatively high
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96 Maria Jeziorska
in most reports on material from ossuaries. Bone tumours have been men-
tioned in the section on Cancer/Neoplastic Diseases.
Circulatory system
Atherosclerosis
Atherosclerosis has been quite frequently diagnosed in Egyptian and South
American mummies. In the last decade, Fornaciari (1999) found evidence of
atherosclerotic lesions when studying Italian Renaissance mummies. Miller
et al. (2000) described the astonishing discovery of molecular evidence,
obtained using a sensitive and specific assay for cardiac troponin, of cardiac
infarction in mummified tissue.
The most recent report on congenital cardiovascular disease was that of
aortic coarctation in a skeleton (sixth to fifth century b.c., Etruscan popula-
tion), which showed typical indentations on the surface of the ribs, charac-
teristic for collateral circulation caused by narrowing of the aorta (Ciranni
et al. 2006). A very famous case of hyperlipidemia (or only a suspicion of it)
is quoted below in the section on Palaeopathology in Art.
Reproductive and urinary systems

Soft tissues of the body, especially those in the pelvic region, are not eas-
ily accessible for investigation, even with the use of modern endoscopic
techniques; this is probably partially the reason why only two cases of pro-
static hyperplasia have been described in ancient material. The condition
was reported in the mummified body of an Italian prince, Pandolfo III
Malatesta, who died in 1427 a.d. X-ray investigation showed foci of calci-
fications and macro- and microscopic evaluation was typical for nodular
hyperplasia (Ciranni et al. 2000; Fornaciari et al. 2001). The second case of
prostatic hyperplasia was diagnosed in a natural mummy found in a friary
in central Italy (Fornaciari et al. 2001).
The urinary system lies beyond the confines of the peritoneum covering
the inner layers of the abdominal wall, so the Egyptian embalmers left the
kidneys inside the mummified body. There is little information in the liter-
ature about examination of the kidneys in mummified human remains but
the investigators of the mummy of Pandolfo III Malatesta found a staghorn
calculus (calcium urate) in his left kidney (Ciranni et al. 2000).
Nervous system and palaeoneurology

Mummified brain tissue is very rarely available for investigation. The largest
and so far the only systematic investigation of naturally mummified brain
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tissue was performed on the contents of fifteen skulls excavated from the
Atacama Desert in Chile (1000 b.c.–1500 a.d.) (Gerztein et al. 1995).
There has been even less investigation of the peripheral nervous system,
but an interesting approach was used by Appenzeller et al. (2001) who stud-
ied about 200 mummy portraits from the beginning of the first millennium.
The portraits and several skulls were measured and their right/left ratio was
assessed. In four cases, clinical diagnoses of neurological disorders were
proposed (e.g. progressive facial hemiatrophy), from which it is possible to
predict the symptoms with which those individuals presented during life.
Skin
Skin is easily damaged during the mummification process when natron is
used: the epidermis, especially on large flat surfaces, is easily undermined
with escaping moisture and sloughed off, exposing underlying connective
tissue. The places where some patches of undamaged epidermis may survive
are in the natural creases of the skin, such as behind the ears and at the
flexor side of the joints. Infrared spectroscopy is another new method which
can help in the investigation of the skin, hair, and various soft tissues (see
Chapter 10; Kupper et al. 2001; Petersen et al. 2003).
Statistical approach to palaeopathology

The bayesian statistical method interprets probability as a measure of one’s
degree of uncertainty about an event. Probability lies in the mind of the
observer and may vary for people having different information or different
past experiences. Inference is performed by evaluating the probability of a
hypothesised model, given observed data (Bullard 2001). Byers and Roberts
showed how Bayers’ theorem could be practically applied to palaeopathol-
ogy by using an example of prehistoric rib lesions and the probability of
tuberculosis (Byers and Roberts 2003). Another example of using statistical
methods in palaeopathology is mentioned in the section on Leprosy.
Medical conditions recorded in art/palaeopathology in art

By studying the pictures of the New Kingdom pharaoh Amenhotep IV
(Akhenaten), Cattaino and Vicario (1999) concluded that he may had been
affected by myotonic dystrophy (MD) which is an example of mendelian
inheritance in man. The surviving images of Akhenaten are unusual in
their departure from idealised representation of the pharaoh and show some
physical attributes that may support the diagnosis of myotonic dystrophy (e.g.
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98 Maria Jeziorska
distal lower hypotrophy of the lower limbs). The authors have also suggested
that this disease might have caused the end of the eighteen Dynasty.
Conclusions
Palaeopathology makes a very valuable contribution to our general knowl-
edge of disease, both in antiquity and the modern day. The introduction of a
more systematic approach and the use of new technologies and techniques
allow an insight into the nature and epidemiology of diseases in ancient
societies.
We find evidence that some of the diseases thought to be a scourge
of the modern industrialised world were in fact encountered in the past,
proving that their underlying causes are much more complex than origi-
nally thought. Examination of demographics, the anatomical distribution
of changes, the spectrum of manifestations for each disease, and their dis-
criminating characteristics in ancient populations may offer a multilayered
and much needed perspective for the understanding our heritage.
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chapter 8
The use of immunocytochemistry to diagnose

disease in mummies
Patricia Rutherford
Foreword
An epidemiological study of schistosomiasis at the University of Manch-
ester in the United Kingdom (see Chapter 1) indicated a need for diagnostic
tools that could be applied to large numbers of ancient Egyptian tissues.
This chapter discusses the successful application of immunocytochemistry
to both modern and ancient tissues. This was acheved in an initial investi-
gation in which tissue samples from fifty Egyptian mummies were studied
with a view to establishing protocols that are now being applied to a larger
epidemiology research project.
Using an indirect fluorescence staining protocol with antisera directed
against Schistosoma mansoni and Schistosoma haematobium antigens, pos-
itive staining to S. mansoni and S. haematobium antigens in modern tis-
sues, a fifty-year-old tissue sample from an Egyptian cadaver, and ancient
Egyptian tissues has been achieved. Immunocytochemistry has proven to
be cost effective and easy to perform, and is now a preliminary to other
tests.
Although the enzyme-linked immunosorbent assay (ELISA) and other
tests such as histology, enzyme immunotransfer blots (EITB), and DNA
analysis have also been explored to reinforce the initial immunostaining
results, this chapter will focus on the use of immunocytochemistry to diag-
nose ancient disease. The definition of an immunoassay and the principles
of immunocytochemistry are briefly outlined, followed by details of the
development of immunocytochemistry as a diagnostic tool for schistosomi-
asis in ancient tissues. This chapter highlights how experimental principles
have been adapted when working with ancient dehydrated samples.
99
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100 Patricia Rutherford
Terms and techniques
Immunoassays
‘Immunoassay’ describes a technique that measures the presence of a sub-
stance by using an immunological reaction that would naturally occur in
the body. When the immune system detects a foreign substance within the
body, commonly known as an antigen, it responds with a proliferation of
cells; some directly attack the invading organism (T cells), and others pro-
duce specialised molecules called antibodies (B cells). The molecules on
the surfaces of viruses, bacteria and other pathogens such as parasitic eggs
stimulate such an immune response. Antigens are usually large molecules
and the majority are proteins or large polysaccharides that are present as
outer components of the invading pathogen.
The antibodies that are stimulated are specific and bind to antigenic
determinants of the invading pathogen to mark them for destruction by
other cells such as macrophages and T cells. Antibodies do not recognise
antigens as a whole but only localised regions on the actual antigen sur-
face, consisting of seven to fifteen amino acids and sugar residues, com-
monly known as epitopes. Antibodies are so specific that, if only one amino
acid is changed, it does not bind as well, or not at all. If an antigen is
large, many different antibodies are produced, each type binding to specific
antigenic determinants. An immunoassay exploits this reaction between
antibodies and antigens, especially as antibodies raised by infecting labora-
tory animals with the disease of interest can easily be isolated and conju-
gated to a tag that can be visualised directly or under a certain ultraviolet
wavelength.
Immunocytochemistry
Immunocytochemistry is a laboratory technique that has been utilised for
nearly fifty years to perform research and diagnosis. It unites the use of
microscopy and immunology and can be easily performed with routine
microscopy equipment. Immunocytochemistry demonstrates antigens in
tissue sections or smears by using antigen/antibody interactions. As smears
are not available for analysis from ancient samples, this chapter will focus
on immunostaining of dehydrated tissue samples.
Any biological macromolecule, such as proteins, carbohydrates, DNA,
lipids and even cell constituents such as collagen, is capable of stimulat-
ing antibody production. Antigens can be anything of interest, not just
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The use of immunocytochemistry to diagnose disease in mummies 101
disease-causing pathogens, and can be present anywhere in a sample. For

example, cells secreting antigen can be distinguished from nonsecreting
cells.
Reagents used
There are two types of antiserum, polyclonal and monoclonal, and each
has negative and positive characteristics when used for immunostaining.
Polyclonal antiserum is a mix of high-affinity antibodies that have been
stimulated by all antigenic sites (epitopes) present on the surface of an invad-
ing pathogen. The antiserum will also contain antibodies to any impurities
present with the immunogen and these may bind nonspecifically to tissue
components, causing background staining. These often have a low titre
and affinity, and can be diluted out through columns to zero activity before
use. In contrast, monoclonal antiserum only targets a single epitope on an
antigen and is so specific that nonspecific background staining is often elim-
inated. Monoclonal antisera are produced using a more time-consuming
procedure, thus making them a lot more expensive to produce. Also, apart
from the added expense, the epitope in question may be lost during tis-
sue preparation, as antigens are susceptible to destruction during tissue
fixation. This can occur, as fixation may be used to stabilise cells against
dehydration, embedding, sectioning, and staining, but unfortunately it also
denatures proteins.
An array of polyclonal antisera have been used in this study but they are
monospecific and thus very specific towards schistosome epitopes.
Schistosomiasis
Schistosomiasis is endemic today, infecting more than 300 million people,
mainly in the developing world. The disease is caused by a trematode of
the genus Schistosoma, which lives and feeds on the cells, blood, mucus,
and tissue fluids of its primary host. Although most Schistosoma only infect
animals, humans are also infected, the three main species responsible being
S. mansoni, S. haematobium, and S. japonicum.
The S. mansoni and S. japonicum live primarily within the veins of the
hepatic portal system, which drains the intestines, whereas S. haematobium
mainly occupies the veins draining the bladder. Schistosomes can live in
humans for more than twenty years, continually breeding and producing
thousands of ova. Half of these are released back into the water via faeces or
urine, depending on the worm’s location in the body, while the other half
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remain in the body, causing continuous mechanical, immunological, and

pathological damage such as inflammation, fibrosis, cirrhosis, abdominal
distension, and haemorrhaging (Cheever 1969).
Evidence of schistosomiasis in ancient times

Studies of ancient literature, artistic representations, and physical remains
have suggested that schistosomiasis is an ancient disease. It was present in
ancient Egypt, with one of the classic symptoms, blood in the urine, being
described in the Ebers Papyrus (see Chapter 12) as the aaa disease (Farooq
1973; Contis and David 1996). The ancient Egyptians also wrote that boys
became men when blood was seen in their urine, and likened this to the
young female’s first menstruation (Despommier et al. 1995).
Scientific evidence also supports the presence of schistosomiasis. Ruffer
(1910) saw one of the first examples in mummified remains, and subse-
quently other researchers have corroborated this with histological evidence
(Millet et al. 1980). More recently, work performed by Deelder et al. (1990)
has confirmed the presence of Schistosoma circulating anodic antigens
(CAA), regurgitated from the worms’ gut, in ancient Egyptian samples. This
was achieved by means of ELISA. The oldest example was seen in tissue
taken from the shin of a 5,000-year-old predynastic mummy (BM32753),
making this the earliest diagnosis of schistosomiasis to date.
Radiology has also suggested the presence of schistosomiasis in ancient
remains, by revealing one of the classic symptoms of S. haematobium, cal-
cification of the bladder (Isherwood et al. 1979; Adams, personal correspon-
dence 2000). It is therefore clear that methods such as histology, radiology,
and ELISA (Miller et al. 1992, 1993) can be readily adapted for the diagnosis
of schistosomiasis in ancient tissues.
Some of these diagnostic tools can be impractical when working with
ancient tissues on a large scale because they may be very expensive (radiology
and ELISA) or low in sensitivity (histology). Although histology would be the
obvious choice for detecting ova in bladder and viscera samples, previous
research has shown histology to produce inconsistent results (Tapp 1979,
1984; Tapp and Wildsmith 1992). An alternative test was therefore sought that
would be cost effective, reproducible, and sensitive. Immunocytochemistry
meets all the aforementioned criteria, and has been successfully applied to
both modern and ancient tissues (Rutherford 1997, 1999, 2000, 2002, 2005).
The development of immunocytochemistry for ancient samples

Today, immunocytochemistry is frequently used to diagnose many diseases,
as it is a powerful, sensitive, diagnostic tool. It is not considered, however,
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to be an efficient way of diagnosing schistosomiasis in modern samples as it

may obscure the distinctive ova shapes when sections are cut. Therefore, the
application of immunocytochemistry to ancient tissues often only reports
the demonstration of cellular components (Wick et al. 1980; Horton et al.
1983; Krypczyk and Tapp 1986; Fulcheri et al. 1992; Nerlich et al. 1993). In
most studies ancient samples are embedded in paraffin wax, a type of tissue
preparation that has been successfully performed for many years, predom-
inantly for histological purposes (see Chapter 6; Ruffer 1910; Tapp 1979).
In contrast, in this study both modern and ancient tissues are embedded
in an alternative medium called 2-hydroxyethyl methylacrylate (Taab, UK)
to detect Schistosoma antigens (Rutherford 1997, 1999, 2000, 2002, 2005;
Lambert-Zazulak et al. 2003).
This resin was chosen because preparation in hot wax often has dele-
terious effects on the tissue, causing diffusion, loss, and even chemical
alterations to the antigens of interest. As the ancient Schistosoma antigens
will already be degraded and only present in very small quantities, such
high temperatures are avoided when resin, which polymerises at 4◦ C, is
used. The hardened resin also allows much thinner tissue sections to be cut
(2 µm), which enhances the sensitivity of the test, often producing intense
reactions (Heryet and Gatter 1992).
Experimental designs for the ancient samples were approached cau-
tiously and previous research taken into account. For example, in previous
histological studies of ancient mummified tissues, the rehydrating solutions
used most frequently were those developed by Ruffer (1921) or Sandison
(1955). A comparative study done by Turner and Holtom (1981) has shown
that these solutions do not always produce suitable tissue samples for sec-
tioning, when compared with the use of a fabric conditioner trade-named
‘Comfort’ (Lever Bros) (see Chapter 6). In response to this study, several
researchers now use some type of conditioner to rehydrate the sample (Tapp
1984; Tapp and Wildsmith 1992; Rutherford 2002).
Because the types of experiments undertaken in this study are predom-
inately immunological, the colour, preservatives, and perfumes found in
the ‘Comfort’ fabric conditioner are unacceptable, as they may interfere
with the immunocytochemistry in some way. An alternative conditioner
(Surfacem, UK), which contains no perfume, preservatives, or colour, was
therefore selected.
It is the opinion of some researchers that once water has been put back
into the tissue, it will begin to degenerate unless fixed; however, not all
researchers fix the sample with classic fixatives such as formalin (Sandison
1955; Rutherford 2002), regarding it as unnecessary. In particular, I do not
use formalin as it causes cross-links between molecules, and if samples are to
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undergo both histology and immunocytochemistry tests, such cross-linking

may interfere with the immunological reactions. Therefore, the samples
are placed into increasing strengths of alcohol, which slowly fixes the tissue
whilst killing any spurious bacteria and fungi. Furthermore the damaging
enzymes that need water to function are probably too degraded, or not
present (as they are modified proteins), to be reactivated by the addition of
water.
Hydrofluoric acid preparations. As immunocytochemistry was pre-

dominately dependent upon the successful sectioning of both the modern
and ancient tissues, the preparation of the tissue prior to sectioning was
very important. Although there were no problems cutting the modern and
ancient unembalmed tissues, the presence of resins used in the mummifi-
cation process and silica particles enmeshed within certain ancient tissues
made sectioning difficult. It is not known whether the silica (sand) particles
are contamination from the natron used to desiccate the body, or whether
they are from the desert environment.
To overcome such problems, tissues were soaked in a very dilute solution
of hydrofluoric acid (2.5%). This option was chosen after other acid prepa-
rations such as nitric and hydrochloric acid were unsuccessful in removing
the sand. As palaeobotanists use hydrofluoric acid to decalcify ancient pet-
rified seeds and plant material without damaging the delicate specimen, it
was thought that, if dilute enough, the acid would only dissolve the silica
present in the tissue without damaging the tissue itself (F. Barnett, personal
correspondence 1997).
An excellent example of such work, using hydrofluoric acid, is provided
by Professor Stein at Binghamton University in the United States. He used
diamond tip saws to cut through rock specimens to reveal fossilised plant
material within. After the fossils had been honed into thin slices, the fos-
silised plants were removed from the ancient sediment by placing the
rocks into hydrofluoric acid. Although this treatment seems harsh, Stein
states that ‘the fossilised plant material cannot be destroyed because it con-
sists of carbon and is not subject to degradation by the acid’ (Dowling
2002).
This principle seems to be true for tissue samples also, as experiments with
both modern and ancient tissues have shown that at the correct dilution, the
acid does not disrupt the antigenic epitopes, as positive staining still occurs.
It does however enable the ancient tissues to be cut easily after the silica
has been slowly dissolved. Although unembalmed tissues are preferable, if
silica and resins are present, this acid treatment is now an option in future
studies.
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Other reinforcing tests. Although immunocytochemistry is now used

on samples thought to harbour the ova and worms, other diagnostic tests
have also been investigated, namely the ELISA. As the ELISA target is a
CAA regurgitated from the worm’s gut, it should be present in all vascular
tissues of the body, in contrast to the ova and worms that are only found
in specific sites. The ELISA was therefore initially used to both reinforce
immunostaining results and to increase the sample number, as it could be
applied to the many body parts present in collections around the world. The
test, however, does have limitations, as the CAAs are only present during
the occurrence of an active infection, because they are degraded each day
by the liver (Deelder et al. 1990).
If the immunostaining results were positive, then additional techniques
such as histology, EITB (Al Sherbiny et al. 1999), and DNA analysis (Ruther-
ford 2002) were also explored. Histology was used to show the general mor-
phology of tissue samples, whereas the EITB targeted antibodies rather
than antigens in the tissue. Although histology remains a viable, regularly
used technique, the EITBs were quickly discarded from the study as these
targeted antibodies rather than antigens in the samples. The drawback of
testing for antibodies is that their presence does not necessarily indicate the
presence of an active infection. This is because antibodies can be present
in the bloodstream for up to one year after any infection (Neva and Brown
1994), and therefore it can only be concluded that the individual suffered
from an infection, but it may have been in the past. In modern patients,
this is not the case as other symptoms manifest at the time of testing, but
unfortunately, these are not present in ancient mummies.
The results of the immunostaining also dictate whether DNA analysis
is performed. Although such analysis could identify the actual species that
had caused the infection, the decision to destroy finite samples is always
approached with caution, not only from an ethical point of view but also
because considerable problems occur when analysing ancient DNA (Pääbo
1989; Hoss and Pääbo 1993; Hummell and Herrmann 1994). Again, the
availability of suitable samples is also a factor, as the ancient schistosome
DNA can only be extracted from tissue that harbours the ova and worms.
Therefore, only a few selected mummy tissue samples available for testing in
the schistosomiasis study have been investigated for the Schistosoma parasite
at the DNA level.
Materials and method

A protocol had to be established using modern samples infected with Schis-
tosoma, before irreplaceable ancient samples could be investigated. Once
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procedures were established with the modern material, these positive and
negative samples then served as controls, which could be directly compared
with the ancient samples also being tested. To limit unnecessary sampling
of ancient tissues, an interim step ascertained whether antisera would react
with infected tissues that had been blocked in wax, and then badly stored.
Bladder tissue taken from an Egyptian cadaver more than fifty years ago
was used for this purpose. If positive results could not be achieved with this
sample, then it would be unlikely that antigens would be present in the
ancient samples.
The following methods are as already outlined by Rutherford (1997, 2000,
2002, 2005).
Modern tissues. Samples for this study were provided by Professor M.

Doenhoff (University of Bangor, UK). The liver of both S. mansoni infected
and uninfected mice, and S. haematobium infected and uninfected hamster
livers were used as positive and negative controls. Both S. mansoni and S.
haematobium worms were also used. The bladder sample taken from an
Egyptian cadaver more than fifty years ago (provided by the University of
Manchester), and known to be infected with S. haematobium, was also used
as an interim sample.
Mummified tissues. When trying to detect the Schistosoma ova and

worms in ancient tissue, the probable location of such parasites within
the body dictates which samples are worth investigating. The worms live in
the veins that drain the bladder or liver and their ova are more prevalent in
certain areas of the body than others. Therefore, bladder, liver, and visceral
samples were the preferred target. Tissues that may harbour schistosome
ova and worms and could be obtained with little or no destruction were the
optimal specimens. The source of these samples included whole mummies,
from which small sections of bladder, liver, intestines, and pelvic tissue were
taken. Several of the samples had no provenance but this was not relevant
at this point in the research process, as the main aim was to perfect and
establish research guidelines for the large-scale study.
The initial fifty samples were chosen simply so that it could be estab-
lished which experimental formats were most appropriate. Thus, the sam-
ples varied greatly in condition and appearance, although the size of the
samples required for each test did not. A sample as small as 2 mm was 3
acceptable for immunocytochemistry and histology. In contrast, 150 mg of

tissue was required for the ELISA and 100 mg for EITB and DNA anal-
ysis. As bladder, liver, and visceral samples were the preferred target for
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immunocytochemistry, only twenty-four of the fifty samples were suitable

for immunostaining. Once standard procedures had been established, sam-
ple collection then concentrated exclusively on provenanced samples that
could be mapped to a certain place and time. Thus, the samples currently
being studied are provenanced and represent burial groups found in the
Sudanese Desert and the Dahkleh Oasis (see Chapter 15).
Antisera/sera. Several polyclonal antisera directed towards an array of

epitope sites found on S. mansoni (raised in rabbit) and S. haematobium
(raised in hamster) antigens were used. Rabbit and hamster sera taken from
unimmunised rabbits (Sigma Diagnostics, UK) were also used to ensure the
reactivity of the antisera. As an indirect immunostaining protocol was used,
the secondary antibody was conjugated to biotin (i.e. donkey biotinylated
anti-rabbit, Amersham UK; and goat biotinylated anti-hamster, Jacksons,
USA). To visualise the reaction, the protein streptavidin conjugated with
fluorescein isothiocyanate (Amersham, UK), was used. All dilutions were
done with 0.1 M phosphate-buffered saline (PBS), pH 7.4. Before any anti-
serum was applied to the sections, a blocking serum was applied (10 ml PBS,
pH 7.4, 0.05 g bovine serum albumin, 150 µl donkey serum (S. mansoni) or
goat serum (S. haematobium), 50 µl Triton-X).
Preparation of modern and ancient tissues for blocking in

immunogenic. The modern tissue samples were prepared according to
the manufacturer’s instructions (Taab, UK). In contrast, small pieces of
ancient tissue, approximately (0.2 cm3 ), were placed into one part condi-
tioning solution (Surfacem, UK) to ninety-nine parts distilled water, which
completely immersed the tissue. This was then stored at 4◦ C for seven days.
If the tissues retained their form, the conditioning solution was decanted
and the tissues were gently rinsed three times with distilled water.
After the third rinse, the tissues were left to soak in distilled water for
a further two days at 4◦ C. The distilled water was decanted and replaced
with 50 per cent alcohol in which the samples were left to soak for a further
five days at 4◦ C. This was decanted and replaced with 70 per cent, and
then 90 per cent alcohol for thirty minutes each time. The 90 per cent
alcohol was replaced with acetone, in which the samples were left to soak
overnight at 4◦ C. The acetone was replaced with fresh acetone in which
the samples were left to soak for a further eight days at 4◦ C. The acetone
was then replaced with immunoresin and left to soak for three days at 4◦ C.
The immunoresin was replaced with fresh immunoresin three times, and
left at 4◦ C for three days each time.
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Tissues impregnated with sand and resin proved difficult to section unless
the conditioning solution was replaced with a dilute solution (2.5 per cent)
of hydrofluoric acid (Sigma, UK). The samples were left to soak at room
temperature for four weeks. Once removed from the acid, the samples were
washed carefully with distilled water, and then placed into 50 per cent
alcohol. The remainder of the aforementioned protocol was followed from
this point.
Placing tissues (modern and ancient) into immunoresin blocks.

Placing the tissues into immunoresin blocks entailed following the man-
ufacturer’s instructions (Taab, UK). After polymerisation had taken place
at 4◦ C, a Perspex block holding the embedded tissue was secured onto a
semithin LKB Historange microtome and sections ranging from 2 to 3.5 µm
thick were cut with a glass Ralf knife. If the samples were gritty, a diamond
knife was used (Taab, UK).
Immunostaining. An indirect immunostaining protocol was followed: 100

µl of 0.1 M PBS, pH7.4, was applied to each section and left on the tissue
sections for fifteen minutes. After three washes with PBS buffer, 100 µl of
blocking serum was put onto each section and left to incubate at room
temperature for thirty minutes. After thirty minutes, the excess was shaken
off. The actual section was not washed with PBS, as the blocking agent must
remain on the section to compete with the primary antibody. One hundred
microliters of the chosen primary antibody was then applied to each section.
The primary antibody was then left to incubate on each section overnight at
4◦ C. Each section was gently washed three times (five minutes each time)
with PBS to remove unbound antibody.
One hundred microliters of secondary antibody (biotinylated goat anti-
rabbit immunoglobulin, dilution 1:200, Amersham Pharmacia Biotech, UK;
or biotinylated donkey anti-hamster immunoglobulin, dilution 1:200, Jack-
sons, U.S.) was then applied and incubated at room temperature for one
hour. Following washing in PBS, 100 µl of fluorescein isothiocyanate–
conjugated streptavidin (1:100) was applied to each section, and left to incu-
bate at room temperature for forty-five minutes.
An optional step, to stain any DNA present in the tissue sections, was also
performed while the tertiary streptavidin was incubating on the sections.
This was achieved with the application of 100 µl Hoechst – bisbenzimide
stain (Sigma, UK), which intercalates with the A and T residues of DNA.
This was diluted 1:2,000 and was applied to each section two minutes before
the streptavidin was due to be washed off. The slides were carefully mounted
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using the aqueous mountant, gelvatol, and placed between light protective
wooden trays. The slides were then left to dry at – 20◦ C for at least twenty-
four hours. Once dry, they were viewed on the fluorescent microscope and
the results were photographed and noted.
Results
Although positive results have been seen in the provenanced samples col-
lected from the Sudanese Desert and the Dakhleh Oasis, the results pre-
sented below represent the initial sample group used to establish ideal pro-
tocols.
Reaction of antisera upon modern sample. The antisera produced

excellent immunostaining results on S. mansoni–infected mouse liver,
(Plates X and XI), S. haematobium–infected hamster liver (Plate XII), the
1950s bladder and both species of worms. The presence of lateral spines can
clearly be seen on the S. mansoni ova, if the sections are cut in the correct
orientation, whereas the S. haematobium ova do not display the distinctive
spines (Plate XII).
It is worth noting that Plate XI also shows that the classic oval shapes
associated with such ova are not always seen, and some distortion due to the
orientation of the ova may produce obscure results. Immunostaining of the
1950s bladder confirmed that epitopes were still present after many years of
exposure to fluctuating temperatures and conditions. The ova size is smaller
than those seen in the mouse and hamster liver, suggesting that they may
have undergone some shrinkage during the past fifty years. Any ova present
in ancient tissues may therefore be even smaller or totally collapsed, not
resembling ova shapes at all, after thousands of years.
Such positive results towards epitopes that have undergone fluctuating
temperatures and conditions suggest that they may still be present in ancient
samples. Paradoxically, although older, the ancient samples may have been
in more stable, static environments. Positive samples were also assessed for
DNA content to pursue genetic analysis.
The DNA-specific Hoechst stain bound strongly between the A and
T residues within the nuclei of the modern tissue, ova, and worms. All
these results served as good comparative samples to the ancient tissues. The
Hoechst stain also produced positive staining, albeit paler upon the tissue
sections from the modern Egyptian cadaver bladder.
Reaction of antisera on the mummified tissues. Immunocyto-

chemistry was used to test twenty-four different mummy samples for
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schistosomiasis. Of these, six (25 per cent) have displayed positive results
for schistosome antigens. The DNA-specific stain (Hoechst) also bound in
the same areas as the antiserum, which warrants DNA analysis.
(1) Manchester mummy 7700/1766, c. 1800 b.c., Fayoum Oasis (Middle
Egypt), Bladder tissue. Immunostaining of the calcified bladder tissue has
shown discrete staining to both ova and worms. The fluorescent shell and
lateral spike can clearly be seen, with the green fluorescence mainly bound
to the inside of the ovum in Plate XIII.
In contrast, the ova seen in Plate XIV do not display spines and resemble
distorted S. haematobium ova seen in Plate XII. Positive immunostaining
of worms has also been achieved, and although most are distorted in shape,
some of the features could clearly be seen, and show clear similarities to the
modern schistosome worms. Experts at the Egyptian Organization for Vac-
cine and Biological Production (VACSERA), Cairo, assessed these results
and confirmed them to be S. haematobium ova and worms (Al Sherbiny
1999, personal correspondence). The ELISA supports these results, indicat-
ing a positive result for CAA (80 ng/ml).
(2) Leicester Museum 528/1981.1885, mummy 1, c. 2700 b.c., Akhmim (Middle
Egypt), Pelvic tissue. Positive staining to small clusters of ova was seen. As
with the 7700/1766 bladder samples, the staining was more prominent to
the inside of the ova; however, the chitin shell can clearly be seen. DNA
analysis has amplified a small fragment of the S. haematobium cytochrome
oxidase C subunit 1 (COI) from this sample (see Chapter 9).
(3) Leicester Museum 528/1980.1882, mummy 2, c. 2700 b.c., Akhmim (Middle
Egypt), Pelvic tissue. Positive staining to clusters of ova was achieved. This
is unlike the solitary ova and worms found in other mummy samples. The
pattern of ova distribution resembles the 1950s S. haematobium infected
bladder.
(4) Manchester Museum 7700/1777, Asru, c. 2750 b.c., Luxor (Upper Egypt),
Bladder tissue. Discrete immunostaining was found in these bladder sec-
tions. Again, the immunostaining is precise to oval bodies thought to be
ova, with very little background staining. No positive results were found in
the intestinal material, even though Tapp (1979) had shown the presence of
some type of ova. The ELISA showed that the intestinal tissue was positive
for CAA (455 ng/ml) and the (EITB) showed a pale positive reaction for S.
haematobium antibodies.
(5) Manchester Museum 7700/13010/5, no provenance, Bladder tissue. Dis-
crete staining to several oval shapes, with little or no background staining,
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was seen. Although oval shapes are present, no worms have been found. In
this study, all sections taken from the bladder of this mummy have been con-
sistently positive, suggesting that the bladder had a high yield of deposited
Schistosoma ova.
(6) Manchester Museum 7700/9430, no provenance, Canopic jar material.
Positive staining to clusters of oval shapes, resembling ova, was achieved.
These results were positive to varying degrees, as there was variation in
the quality of the sections from this sample because degradation was not
uniform throughout the sample. This inconsistency has been noted for
future studies. ELISA results supported this by showing a positive result for
CAA (22 ng/ml).
Discussion
A marked difference was noticed between preparations of modern and
ancient samples for immunocytochemistry. Unfortunately, only a few
ancient samples were prepared with the same ease as the modern tissues. In
samples from the early dynasties, such as the liver tissue from the Canopic jar
associated with the mummy of Nekht Ankh (twelfth Dynasty), no debris or
resins were present. This easily sectioned tissue showed good tissue integrity,
and supported other researchers’ results (Tapp 1979).
The remaining ancient samples contained varying amounts of mummi-
fication resins and gritty silica particles. A dilute solution of hydrofluoric
acid was used to remove the particles, enabling very thin (2 µm), flat, intact
sections to be cut with ease. Although this pretreatment is now an option,
because of its hazardous nature, tissues without resin or sand are sought
first, but if they are not available, any samples with sand present can be
soaked in an acid solution.
The fragile state of the ancient samples benefited from the use of
immunoresin as it provided a more supportive medium than wax, and can
also be prepared and kept at 4◦ C, thus preserving epitopes of interest. Such
epitopes were visualised by precise staining on both the modern and ancient
samples, thus showing that the antisera used throughout this study are very
specific and are of the highest quality.
As one of the aims of this study is to identify ancient schistosome ova
and worms in ancient Egyptian tissues, their morphology was studied in
modern samples. Cut at different orientations, the ova and worms did not
always display the classic shapes. Such distorted images served as excel-
lent comparisons when analysing the ancient samples. Although the ova
and worms present in the ancient samples were often distorted in shape,
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this is not surprising, as most of the samples were more than a thousand
years old.
Positive reactions, however, still occurred, suggesting that Schistosoma
antigens are present after many centuries. The DNA-specific Hoechst stain
indicated that DNA was still present to some degree in the ancient tissues,
particularly within the immunostained ova. Further research is being pur-
sued to investigate the hypothesis that the chitin shell had played some role
in protecting the DNA within the ova.
Although the results reported in this chapter confirm the presence of
schistosome parasites in both Upper and Middle Egypt, no real pattern
can be seen (Rutherford 2005:82). So far, the only conclusion that can be
drawn is that the S. haematobium parasite was present in Middle Egypt
more than 2,700 years ago at Akhmim, as demonstrated in the pelvic tissue
samples taken from the Leicester Museum mummies. Leicester mummy
1, known as Bes-en-Mut, was a priest in the Temple of Min, whereas
Leicester 2, named Ta-Bes, was a teenage girl. There was a considerable
divergence between the amount of ova found in these two mummies: the
teenage girl had a high distribution whereas the priest had only small clus-
ters. This mirrors the patterns seen in patients today, where children and
teenagers are heavily infected because their activities often entail more
contact with water, and acquired immunity is thought to occur with adult-
hood.
The S. haematobium species was also present in the Fayoum Oasis 1,800
years ago, as seen in the bladder tissue of 7700/1766, and the mummy of
Asru (No. 1777) confirms the presence of S. haematobium in Luxor (Upper
Egypt) some 2,700 years ago. Today, S. haematobium is still prevalent in both
Middle and Upper Egypt, whereas S. mansoni is almost absent in the upper
region. As the EITB results display only a pale band for S. haematobium
antibodies, further tests at the DNA level are needed to reinforce which
species is present in Asru’s bladder.
The positive results seen in mummy 7700/13010/5 and in the Canopic
jar material (7700/9430) have limited impact regarding the epidemiology
study, because the only historical information we have about each sample
is that mummy 7700/13010/5 may have been a scribe, and an inscription
on the Canopic jar confirms that its owner was a priest. Overall, the results
highlight the fact that, in contrast to today when schistosomiasis mainly
affects poorer, rural village communities, in antiquity, there was probably
no marked difference in the incidence of the disease between the various
social classes, as everyone would have bathed in the river or in garden pools
fed with infected water from the canals.
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Now that standard procedures have been established, the context of sam-
ple collection has moved to provenanced-only samples that can be mapped
to a certain place and time (Chapter 15). Such samples form the basis of
the author’s continuing work: medieval samples collected from Sudanese
Nubia (c. 1500 b.c.) have been immunoassayed, and two samples that have
shown positive results are being investigated further.
In addition, preparations are in hand for immunocytochemistry tests to
be performed on a large group of samples from forty-eight Graeco-Roman
mummies found in the Dakhleh Oasis. This particular group is an excellent
source of material as many of the samples have been taken from the liver,
colon, intestines, and coprolites, all of which harbour both the schistosome
worms and ova. Once a substantial number of provenanced samples have
been tested, a distribution pattern should emerge, which will contribute
valid information to the field of anthropology (Rutherford, 2005:82).
From an immunological point of view, the detection of antigens rather
than antibodies would appear to be the preferred method for diagnosing dis-
ease in ancient samples, as antigens seem to be hardier than antibodies and
may therefore still be present in samples more than a thousand years old.
Because of the weak reactions seen in the EITB tests performed on a
few samples, the detection of Schistosoma antibodies rather than antigens
is no longer regarded as a diagnostic option in this continuing study. This
decision has also been reached because the presence of antibodies does not
always indicate an active infection, and the total destruction of the sample
necessitated by this technique conflicts with an ethical approach which
attempts to keep destruction of material to a minimum.
Combining results from several tests can provide an overall picture of
the state of health in the case of each mummy. An excellent example of
this is the bladder samples taken from mummy 7700/1766. Here, immuno-
cytochemistry has clearly demonstrated the presence of schistosomiasis,
especially as the (EITB) dipstick test for GP23 antibodies and the ELISA
test for CAA were positive, and calcification of the bladder was also evident,
suggesting that chronic schistosomiasis may have been present for several
years.
Although DNA-specific Hoechst staining also showed that DNA was still
present for analysis, amplification of Schistosoma DNA was unsuccessful,
perhaps because the DNA of interest was only present as a minute quantity or
because there were no worms or eggs present in the selected tissue sample.
After these initial attempts had been unsuccessful, it was eventually decided
not to use a second sample of bladder because of ethical considerations
about destroying further samples. The overall results obtained for mummy
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7700/1766 provide sufficient evidence to conclude that, when alive, this

person suffered from chronic schistosomiasis caused by S. haematobium.
As tissue samples that contain S. haematobium worms and eggs are already
blocked in immunoresin, in situ hybridisation may be a better option when
less harsh pretreatments are available.
Conclusion
Combining the contributions of science and Egyptology can provide
researchers with insight into a particular disease; however, they must always
be aware of ethical considerations surrounding the destruction of finite
mummy tissue, and any destructive methods they use should be performed
conservatively. Studies on the distribution patterns of any infection such
as schistosomiasis require access to provenanced samples, but this infor-
mation is not available for many mummies or body parts held in museum
collections. Nevertheless, the collection of provenanced samples will be
an essential factor in any future, large-scale epidemiology studies, as it is
pointless to destroy ancient tissues that can provide scientific results which
cannot be placed within particular chronological, geographical, or socio-
logical contexts (see Chapters 15, 17).
In this study, testing the initial fifty samples has provided many answers
and highlighted several problems that may occur in a wider context. For
example, some tests initially considered to be appropriate for this study
(the use of EITB dip sticks for targeting antibodies) have now been dis-
carded or limited. Positive samples will continue to be analysed at the
DNA level, as it is thought that DNA can yield more information than
the detection of an antibody, such as, for example, which species has
infected the host. Ultimately, this should provide the means of mapping the
occurrence of both S. mansoni and S. haematobium infections in ancient
times.
With the current study, results have been obtained using several meth-
ods of investigation rather than relying on one line of enquiry (Rutherford
2002). Immunocytochemistry has made a major contribution to this work,
and will undoubtedly provide a valuable diagnostic tool for other projects.
The techniques used to investigate schistosomiasis can be easily adapted
for research on other diseases present in antiquity. For example, under
the author’s supervision, master’s students at the University of Manchester
(UK) (see Chapter 17) have mirrored the outlined procedures with respect
to diagnosing malaria (Marmion 2003; Bratcher 2006), and several of the
liver samples tested from the Dakhleh Oasis group have shown positive
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results. These positive samples are now being investigated at the genetic
level (Bratcher 2006).
The Tissue Bank was originally developed to collect tissues for the schisto-
somiasis research project (see Chapter 15), but it now facilitates other studies
which, in due course, will produce data that can be used to reconstruct the
living conditions and diseases of the past.
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chapter 9
DNA identification in mummies

and associated material
Patricia Rutherford
Foreword
Molecular analysis such as serological tests were conducted by Boyd and
Boyd (1934) when they tested the blood groups of 300 Indian and Egyptian
mummies, and by Candela (1936) who used a modified version of this
procedure to test eleven mummies. Initially, it was hoped that such tests
would show not only evidence of migration on a large scale but also family
relationships and diseases.
Serological tests were, however, soon discarded as a valid test. One of the
main problems was degeneration, because the A and B antigens targeted
in such blood tests are made up of simple sugars that can degrade over
time (Harrison and Connolly 1969). Contamination is also a major prob-
lem when working with ancient samples, especially mummies that have
been subjected to various herbs and spices during embalming (Flaherty and
Haigh 1984, 1986). Such degradation and contamination hindered Harrison
and Connolly’s (1969) study when they attempted to show kinship between
Smenkhkare and Tutankhamun.
Today, population and sibship studies follow the mitochondrial DNA line,
which is inherited maternally, as studying the ancient DNA molecule can
yield far more information than serology tests as it codes for all proteins in
the body. To date, ancient DNA has been successfully extracted from teeth
(Drancourt et al. 1998; Merriwether et al. 1994), bone (Cipollaro et al. 1998),
soft tissues (Rutherford 2002), hair (Wilson et al. 1995), faeces (Loreille et al.
2001; Pioner et al. 2003), plant material (Brown et al. 1994; Harper 2003;
Bzdega 2006), insects (Cano et al. 1993), and fossils (Goldenberg et al. 1990)
that are seventeen to twenty million years old, although it has still not been
proven how long a DNA molecule can survive. The targets have been both
organellar (chloroplast and mitochondria) and nuclear DNA.
116
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DNA identification in mummies and associated material 117
DNA analysis has its own limits. This chapter discusses the possibilities
and limitations of working with ancient DNA and describes the methods the
author has adapted to amplify and sequence ancient Schistosoma DNA frag-
ments. Several other projects that have been successfully conducted using
these established protocols are presented, and future possibilities within this
field, and the potential contribution to Egyptology and palaeopathology, are
also considered.
Possibilities and limitations of analysing ancient DNA

There are three stages to analysing ancient DNA: extraction, amplification,
and either sequencing or restriction site analysis. Each stage poses consid-
erable problems as only 1–2 per cent of the DNA yield that is expected from
modern samples is extracted from ancient tissues (Pääbo 1989, 2004). There-
fore, many researchers concentrate on targeting mitochondrial (mt)DNA,
as there are several hundred copies of this genome per cell in contrast to
two copies of each gene locus in the nuclear genome (Stone et al. 1996;
Hauswirth et al. 1994; Rutherford 2002; Smyth 2005). Mitochondrial DNA
also has the advantage of being inherited exclusively through the maternal
line and is therefore used in sibship studies (Smyth 2005).
Another advantage is its circular structure, which is supercoiled, in con-
trast to the linear nuclear DNA that is easily degraded. This supercoiling
seems to protect the mtDNA from excessive cleaving, thus producing frag-
ment lengths between 100 and 500 base pairs (bp) (Hagelberg 1994; Pääbo
et al. 2004). In general, only small fragments of ancient DNA survive, even
from the nucleus or organelle, the average size being about 200–300 bp
(Kaestle and Horsburgh 2002).
A recent study by Binladen et al. (2005) has also shown that similar damage
is found in both the nuclear DNA and mtDNA because the same amount
of miscoding occurs. Therefore, despite mtDNA being present in high copy
numbers, the amount of damage is the same. Perhaps the histones present
in the nucleus serve to protect the DNA wrapped around them (∼200 bp),
in the same way that supercoiling protects mtDNA, and therefore the only
real advantage of working with mtDNA is its abundance.
The method that revolutionized ancient DNA analysis

Despite the difficulties posed by working with such small fragments, studies
began in the 1980s and have progressed slowly ever since. The earliest work,
undertaken by Higuchi et al. (1984) and Pääbo (1985), involved cloning the
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ancient DNA into bacteria to amplify the extract. This had many problems;
for example, a large part of the extracted DNA was heavily modified (Pääbo
1989), which meant that cloning artefacts were introduced during replica-
tion of the DNA in bacteria. In contrast, the polymerase chain reaction
(PCR) protocols devised by Mullis and Faloona (1987) for modern DNA
amplification means that small intact copies of DNA can be amplified
alongside the badly degraded molecules, and this eliminates the modifica-
tion problem.
The principle of the PCR is quite simple: it mimics DNA replication in
vivo. As DNA is a double-stranded molecule, and each strand complements
the other (i.e. the adenine [A] residue binds to the thymine [T] residue, and
guanine [G] binds to the cytosine [C]), if one sequence is known, then the
complementary strands sequence can be worked out. The bonds between
these residues are easily broken using heat, which separates the strands.
Once cooled, these complementary strands anneal to each other again. The
structure of the DNA molecule allows for it to be amplified using different
temperatures, adding small primers and the nucleotide residues A, T, C,
and G and an enzyme, to read the template and make a complementary
strand with the free nucleotides. Today, molecular biologists use this method
routinely, as it can now be reproduced in vitro.
The PCR method selectively and repeatedly replicates defined DNA
sequences from a whole DNA mixture. A pair of oligonucleotide primers
some 20 bp long flank the DNA sequence of interest as they complement
the template sequence. Information about the DNA code is needed before
a complementary primer can be synthesized synthetically. Today, millions
of DNA sequences are accessible from the Internet; for example, the Schis-
tosoma mitochondria sequences targeted in the schistosomiasis study were
accessed from GenBank, National Center for Biotechnology Information
(Rutherford 2002).
Polymerase chain reaction has, therefore, given ancient DNA work
more momentum, as it has enabled the specific targeting of informative
sequences. These are often no longer than 200 bp in length, however, and
such targets should be chosen carefully to ensure that the optimum yield of
information is gained. Although the PCR method combined with sequenc-
ing is routinely used for diagnosis of diseases, genetic screening, and popu-
lation analysis in modern humans, it has received more media coverage for
its potential use in the study of ancient DNA molecules.
Overview of ancient molecular work

Initially, DNA was extracted from animals such as the Quagga (Higuchi et al.
1984), mammoth (Johnson et al. 1985), insects (Cano et al. 1993), and plant
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material such as a magnolia leaf from the Miocene period (Goldenberg

et al. 1990). Pääbo (1985) was first to extract human DNA from ancient
Egyptian mummy tissue.
More recently, some of the above-noted results have been questioned. For
example, the sequenced magnolia DNA was 790 bp in length; when Pääbo
and Wilson (1991) repeated these experiments but only amplified bacteria,
they concluded that the initial results were probably due to contamination
rather than ancient magnolia DNA. Furthermore, there is scepticism about
the early date that Goldberg et al. (1990) claim for the magnolia leaf DNA
because studies performed by Lindahl (1993) regarding the rate of DNA
degradation suggest that DNA cannot survive for millions of years.
Racemisation studies by Poinar et al. (1996) have also raised questions
about the age limit of DNA molecules, suggesting that the rate at which the
amino acids racemise correlates to DNA survival. Data suggest that some
of the studies on samples in excess of 10 million years old are questionable.
Enthusiasm also began to wane as it became clear that there were fun-
damental problems with the high failure rate for amplification and it was
realised that modern DNA was a prevalent contaminant.
Limitations
Nearly twenty years after extracting DNA from mummified Egyptian
remains, a recent review by Pääbo et al. (2004) shows that serious con-
cerns still remain regarding degradation, contamination, and authentica-
tion. In particular, degradation is constantly being reviewed in detail (Pääbo
et al. 2004: Hofreiter et al. 2001; Handt et al. 1994; Lindahl 1993). Although
the structure of DNA makes it a stable molecule, postmortem diagenetic
changes occur over time, thus damaging both the double helix and the
nucleotide chains (Poinar et al. 2003). Examples of such damage are denat-
uration, in which two DNA strands separate and the single strands degrade
further.
Hydrolysis and oxidative damage are the two main degradative processes
(Lindahl 1993; Pääbo et al. 2004). Oxidation, which is often due to ionising
radiation producing free radicals, leads to modification (oxidised pyrim-
idines and sugar residues), distortion of the helix, and even the loss of bases.
Furthermore, the C and T are oxidised to hydantoins, which are PCR
inhibitors (Pääbo 1989; Hoss et al. 1996). Hydrolysis also breaks the phos-
phodiester bonds between sugars and phosphates due to the breakdown of
the N-glycosyl bond in the presence of water (Hoss et al. 1996). Although
such degradation occurs continuously in vivo, it is constantly repaired, but
such repair mechanisms cease postmortem and damage accumulates.
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Degradation and modifications of ancient DNA are not the only prob-
lem to consider when trying to amplify the DNA of interest by means of
PCR. Unfortunately, PCR is so sensitive that other components extracted
along with the DNA often inhibit the reaction. Such contamination is
derived from soil components, which several researchers have reported
when extracting DNA from bone and tissue (Krebs et al. 2000).
A variety of organic and inorganic substances may be extracted, such as
salts, heavy metals, and even DNA from soil-dwelling bacteria and fungi.
Krebs et al. (2000) and Tuross (1994) have reported the presence of fulvic
and humic acids and these phelonic products inhibit the polymerase (Taq)
enzymes used in the PCR reactions because they are similar to DNA. It is
therefore important to remove such contaminants before PCR is attempted.
Krebs et al. (2000) have reportedly overcome this by using high-performance
liquid chromatography.
Different innovations have been introduced in individual laboratories,
although many are derived from the protocols developed by Pääbo et al.
(1989). Many researchers have tried different solutions to enhance ancient
DNA extraction, for example, Chelex (Woodward et al. 1994) and guanidine
thiocyanate (Boom et al. 1990; Hoss and Pääbo 1993; Pääbo 1994). Chelex
and guanidine thiocyanate were explored along with the standard phenol
extraction methods by Rutherford (2002). The standard phenol extraction,
repeated twice, seems to clean the extract enough for amplification to be
achieved. Many researchers have used silica beads to clean preparations
(Hoss and Pääbo 1993). If dealing with a very low yield of DNA at the
outset, the extract may be totally lost, and for this reason, the author does
not use silica beads.
Inhibitors are always present to some degree and, as it is not always possi-
ble to eliminate these totally, several strategies are often used to decrease the
chances of inhibiting contaminants. One option is to dilute extracts with
deionised, distilled water as this reduces the concentration of contaminants,
making the primers more specific to the ancient DNA than to the contam-
inants. An increase in the ratio of the polymerase enzyme to the sample
DNA may also be helpful, or the additions of bovine serum albumin to the
PCR mix (Pääbo 1989).
Environmental effects on ancient DNA

The environment from which DNA is retrieved has a significant influence
on its quality (Burger et al. 1999). Several biological, physical, and chem-
ical factors affect DNA preservation. For example, a very low temperature
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can preserve DNA, and research performed by Hoss et al. (1996) showed
that a 20◦ C decrease in temperature reduces DNA degradation by ten- to
twentyfold. Although low temperatures alone are not sufficient to preserve
all specimens (Smith et al. 2001), postmortem degradation is significantly
slowed by cooling.
Humidity provides moistness that aids the action of nucleases. Desiccated
mummies are therefore often well preserved because of the lack of moisture.
An alkaline environment, such as the one provided by mummification in
alkaline natron, is also beneficial to the survival of the acidic DNA molecule.
Desiccation, freezing, or high salt concentrations inactivate the nucleases
before significant damage is done. Therefore, rapid desiccation, particularly
of the skin of a mummy, may result in consistently good preservation.
Research conducted by Bibby (2005) under the author’s supervision
showed good preservation of mummified skin samples, thus supporting
Pääbo’s (1986) hypothesis that overall preservation is directly related to the
rate at which water is removed. Thus, because the skin is dehydrated first,
it could be expected to have a better DNA yield than the internal organs.
The airtight tombs in which many Egyptian mummies are found will
inhibit aerobic conditions where oxygen enables chemical reactions and
decomposition by microorganisms to occur. Researchers often speculate
about DNA survival in ancient mummified tissue, but not all sources of
DNA are equal: muscle tissue contains innumerable mitochondria and
is therefore likely to provide more mtDNA than other tissues. Conditions
inside the tombs need to be considered rather than the outside environment,
as these differ substantially. Low temperatures and dry air in the tomb and
desiccation and alkalinity of the natron used in mummification provide ideal
preservation conditions for the DNA molecule. Therefore, some researchers
have claimed that ‘a DNA investigation in pharaonic mummy tissue samples
is indeed not senseless’ (Zink and Nerlick 2003: 109).
Marota and Rollo (2002) disagree that such conditions are beneficial
and argue that ancient DNA cannot be recovered from ancient Egyptian
mummies. Their study was based on degradation rates in papyri, combined
with racemisation data, and not on tissue samples; thus, it is more theo-
retical than practical. Interestingly, Professor Cooper at the University of
Adelaide, Australia, has recently targeted piles of dung in Australia for his
next ancient genetic project on the basis that because the dung is so dry, it
does not decompose, and a hot dry climate is one of the best environments
for ancient DNA (Salleh 2005). Some studies can benefit from other types of
environment. For example, at Windover, Hauswirth et al. (1994) were able
to analyse samples from bodies that had been in an aqueous environment.
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Sibship studies
In the study by Hauswirth et al. (1994), although mtDNA is often the chosen
target, nuclear DNA was also targeted here to establish family relationships.
Research undertaken at Windover is important because it was possible to
determine that a variety of genetic markers (i.e. nuclear human leucocyte
antigens (HLAs), nuclear microsatellites, and mtDNA) could be examined.
Hauswirth et al. argued that although the samples spanned a thousand years,
DNA analysis showed results that indicated a homogeneous population.
Such results suggest that the same type of analysis could be conducted
on any large number of ancient bodies, particularly Egyptian mummies
found within one burial site, thus providing the opportunity to confirm
relationships.
Other sibship studies have been performed by Evison et al. (1998) and
Elles et al. (1993) by using analysis of HLAs. The HLA genes are found on the
short arm of chromosome 6 and they are the most variable (polymorphic)
gene cluster in humans. The genes code for the proteins that span cell
membranes, and these proteins enable humans to make the distinction
between self and foreign.
Therefore, the proteins are an integral part of the immune system and
must match when a transplant organ is received from a donor. Matches are
invariably found within a family unit, but only rarely in unrelated individu-
als. Allelic variants of the HLA are also associated with disease and resistance
to disease. The HLA differences are now well documented and differences
across the world are known (Charron 1997). When combined with sexing
analysis, the results may provide information about biological relationships
in burials, population movements, evolution of disease, and immunity.
One study by Elles et al. (1993) analysed tissue samples from five bodies
found in a previously undisturbed, communal tomb at El-Hagarsa, Middle
Egypt, to attempt to sex the mummies and match the findings to the evi-
dence on the coffins and face masks (see Chapter 1). The archaeologists also
questioned whether the mummies all came from the same family, as indi-
cated by the inscriptions. Primers were designed for both the HLA DRB1
and the repetitive sequence (DYZ1) found only on the Y chromosome.
The sexing experiments produced contradictory results: for example, the
genetic evidence showed that one of the mummies was male, although its
associated face mask and inscriptional evidence indicated that it belonged
to a female. The HLA results demonstrated that two of the mummies had
a DRB1-1001 allele, which is rare in Caucasians (2.1 per cent) and more
prevalent in Middle Eastern populations. Although the remaining results
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suggested that this was a family group, this could not be clarified because
the researchers were unable to gain access to more tissue samples for further
analysis.
Diseases
There have been many reports of human, animal, and plant DNA being
extracted and amplified. There are fewer reports of extracting DNA from
disease-causing parasites, bacteria, and viruses, although such studies are
important as they can have an impact on modern studies of disease (see
Chapter 7). Work in this field includes the report by Sallares et al. (2000) that
they had amplified part of the 18s ribosomal DNA specific for Plasmodium
falciparum, which causes the disease malaria. Here, the DNA of interest,
amplified from skeletal human remains excavated from a fifth-century a.d.
Roman cemetery in Italy, was more than 1,500 years old.
Another report by Guhl (1997) states that 330 bp of Trypanosoma cruzi
DNA were amplified to confirm the presence of Chagas’ disease. In tests on
a total of twenty-seven samples from skeletal remains that included viscera,
heart, and oesophagus, he found that seven had the target DNA. These
results correlate to the 10–15 per cent of people who are infected today.
More recently I have amplified 236 bp of the Schistosoma haematobium
cytochrome oxidase C fragment from the bladder tissue of an Egyptian
mummy in the Leicester Museum (UK) (see Methods and Materials and
also Chapter 8). Modern genetic techniques have also identified other
ancient diseases such as plague (Drancourt et al. 1998), leprosy (Haas et al.
2000; Montiel et al. 2003), and tuberculosis (Donoghue et al. 1998). In
addition, Ascaris DNA found in coprolites by Loreille et al. (2001) has been
sequenced.
Limited research into viral DNA has also been conducted. Li et al. (1999)
have identified the DNA of the human T cell lymphotropic virus (HTLV)-1
in an Andean mummy. HTLV causes T cell leukemia and may have orig-
inated from paleomongoloids who migrated to Japan and South America
more than 10,000 years ago. The researchers studied 100 Andean mummies
excavated from the Atamaca Desert. Because of the salty, arid conditions
in this rainless plateau, the mummies buried there more than 1,000 years
ago were well preserved. The group extracted DNA from bone marrow and
successfully isolated the viral DNA from one mummy.
Ancient bacterial DNA has also been found in the digestive tract of human
remains. For example, Cano et al. (2000) demonstrated the presence of
Vibrio from the gut flora of the Tyrolean Ice Man, and Escherichia coli has
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been genetically identified in the Lindow Man (c. 300 b.c.) by Fricker et al.
(1997).
Research has been undertaken on various types of archaeological
remains, and many genetic results have been achieved. The ethics regard-
ing total destruction of samples should always be addressed, as there is often
no material left for replication of results. To simply destroy a sample for a
meagre 200–300 bp of DNA seems extreme. The author (Rutherford 2002)
and other researchers believe that alternative methods should always be
considered first, and for this reason, only a select few of the mummy tis-
sue samples available for testing in the Manchester schistosomiasis study
have been investigated for the Schistosoma parasite at the DNA level (see
Chapter 8).
The Schistosomiasis project – methods and materials

The finite samples of mummified material were assessed for DNA con-
tent before any destructive analysis was conducted. As already discussed
in Chapter 8, the DNA-specific Hoechst stain, which intercalates between
the A and T residues of DNA, was used to assess the presence of DNA. It
reacted strongly with both modern and ancient tissue samples. The stain
often bound to the same areas as the antiserum, suggesting DNA analysis
was warranted. Other assessments of DNA content were not used, such as
racemisation (Pioner et al. 1996), because it is a destructive method and
inappropriate for the small samples that are usually available for testing.
At first, amplification of ancient DNA followed the same protocols used
for modern DNA; however, new methods have subsequently been devel-
oped. Parr et al. (1996) substituted the polymerase Taq1 enzyme used for
modern DNA work for Deep Vent (exo-) polymerase (New England Bio-
labs) because it has several qualities that suit the amplification of ancient
DNA. These include a greater sensitivity for deoxyribonucleotide triphos-
phates (dNTPs), and a longer halflife at high temperatures, which results
in prolonged amplifications (i.e. forty cycles instead of the normal thirty),
thus increasing the chances of amplification of any ancient DNA that may
be present. Also, the Deep Vent (exo-) polymerase does not appear to cause
‘jumping PCR,’ a problem reported by Pääbo et al. (1990) who described
this as a phenomenon where the Taq 1 enzyme places an adenosine (A)
residue at damaged sites and then jumps to another template, producing
chimeric products.
Before ancient samples could be analysed, protocols had to be established
for modern samples. Schistosoma mansoni and S. haematobium worm,
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cercaria and egg DNA were obtained from Christies Hospital, Manchester
(UK) to use as positive controls. Negative controls were also incorporated
into the study, that is distilled water and reagents only.
The usual guidelines for ancient molecular work were followed. Pos-
itive controls were amplified and extracted in a separate area from the
ancient samples. The ancient samples were studied in a separate labora-
tory where PCR was not performed. All steps were conducted under ster-
ile conditions. If possible, experiments were also repeated to confirm the
results.
Extraction of genomic DNA from mummy tissue

Extraction of mummy DNA was performed using proteinase K buffer
followed by phenol, based on published methods by Sambrook et al.
(1989). Each crushed tissue sample (∼200 mg) was placed into 1,000 µl
proteinase K buffer and 50 µl proteinase K stock solution (10 mg/ml).
Incubation times were often increased to ensure proper digestion had
occurred. Digestion of tissue samples was variable, according to tissue
type and condition. As each sample was unique, no standard time limit
was set. Adequate digestion was achieved once the tissue had totally
merged with the solution. After digestion a standard phenol extraction was
performed.
Extraction of DNA by using DNAzol

Approximately 500 mg of mummy tissue or 50 mg of modern liver tissue
was homogenised in 1 ml of DNAzol, a guanidine detergent lysing solution
(Helena Biosciences, UK), and then left at room temperature for ten min-
utes. The homogenate was sedimented by centrifugation for ten minutes at
10,000 G. The protocol then followed the manufacturer’s guidelines. The
extracted DNA was resuspended in 8 mM NaOH, pH 7.8.
Extraction of ancient DNA by using instagene matrix

Approximately 200 mg of ancient tissue was crushed with a pestle and
mortar and placed into a sterile Eppendorf tube. One milliliter of 1 X
trypsin/ethylenediamine tetraacetic acid was added, gently mixed, and left to
stand at room temperature for thirty minutes. The extraction then followed
the manufacturer’s guidelines (Chelex, BioRad, UK). Twenty microliter
aliquots were used for PCR.
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Amplification of S. haematobium and S. mansoni DNA from modern

and ancient samples
The author optimised the PCRs, using information from a range of pub-
lished methods (Pääbo 1989; Sambrook et al. 1989) and recommendations
from Promega (UK). Primers were designed by the author to amplify 236
bp of S. haematobium cytochrome oxidase C and S. mansoni cytochrome
C DNA. These were:
1. S. mansoni 1 5 TCTAAGGAATAAAGATTCG 3
2. S. mansoni 2 5 CATACCACAACTATTCAAC, 3
3. S. haematobium 1 5 GATAAGTAATAATGATTCATC 3
4. S. haematobium 2 5 GACCCACAGCTTTTAAG 3 .
Primers 1 and 2 were designed from Accession No: SHU22162 (Bowles
et al. 1995).
Primers 3 and 4 were designed from Accession No: SHU82266 (Blair
et al. 1997).
A range of experiments, using different temperatures, amounts of mag-

nesium (i.e. 2 mM–8mM), the enzyme Deep Vent (exo-) Taq polymerase
(New England Biolabs, UK, 2 U–4 U), and DNA templates (1 µl–20 µl) have
been conducted. The optimum 100-µl reaction contained: 4 U of (exo-) Taq
polymerase, 200 µM dNTPs, 4 mM MgSO4, 1 µM of each primer, made
up to 90 µl per reaction, with ×1 ThermoPol buffer (supplied with [exo]
Taq polymerase). Ten microliters of either the ancient or modern DNA
extract was added. Two controls of reagents only and distilled water were
also included.
The reactions were then amplified in a thermal cycler (Cyclone, Techne)
as follows: First cycle –94◦ C for 5 minutes, 50◦ C for 2 minutes, 72◦ C for
3 minutes; followed by 28 cycles of –94◦ C for 1 minute, 50◦ C for 1 minute,
72◦ C for 1 minute; and a final cycle of –94◦ C for 1 minute, 50◦ C for 2 minutes,
and 72◦ C for 10 minutes.
The ancient samples were amplified for 38 cycles as opposed to the 28
cycles used for the modern samples. Ten microliter aliquots of the amplified
DNA were viewed on a 1 per cent agarose gel stained with 2 µl of ethidium
bromide.
Sequencing and precipitation of sequenced DNA

The PCR products were purified to remove dNTPs and primers by using the
Qiquick Gel Extraction Kit (Qiagen, UK). After quantitating the amount
of DNA present after amplification and purification, a sequencing reaction
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for each sample was set up as follows: To a 1-ml Eppendorf tube, 1 µl (10 ng)
of DNA template was added, plus 4 µl of terminator ready reaction mix,
1 µl (5 pmol) of primer 1 or primer 2 to ensure that both forward and
reverse sequences were obtained. Fourteen microliters of deionized water
was also added to make the total reaction up to 20 µl. After gentle mixing,
the tubes were placed into a thermal cycler (Cyclone, Techne). Twenty-
five cycles were run at the following temperatures and times: 96◦ C for
10 seconds, 50 ◦ C for 5 seconds, and 60◦ C for 4 minutes. Precipitation
of the DNA followed the methods outlined by the manufacturer (ABI,
UK). The precipitated DNA was then passed to the ‘in house’ sequencing
department.
Results and discussion
DNA extraction results

The average yield of DNA extracted from modern eggs, worms, and cer-
cariae by using phenol was in excess of 1 mg/ml, with a purity of 93 per
cent.
Extracting DNA from 0.2 g of ancient tissue by using DNAzol (Helena
Biosciences, UK) produced an average yield of 393 µg/ml, with a purity
of 61 per cent; however, amplification was unsuccessful, even after several
different amounts of ancient DNA template, Taq enzyme, and magnesium
were added. Amplification of DNA extracts obtained from incubation with
Chelex (BioRad, UK) was also unsuccessful.
The supernatant containing the DNA was very dark and could not be
assessed by spectrometry. Therefore, aliquots of the extracts were assessed by
electrophoreses, which showed that the Chelex extractions did not produce
clean preparations, as excessive smearing could clearly be seen. Such con-
tamination inhibited amplification of both modern and ancient samples.
Therefore, this type of extraction will no longer be used in future studies.
The DNA extracted from 0.2 g of ancient tissue by phenol X 2 (Sambrook
et al. 1989) produced an average yield of 1,113 µg/ml, with a purity of 57.5
per cent. Although the purity was not markedly high, the average DNA
yield was approximately four times greater than that extracted when using
guanidine thiocyanate (DNAzol). It was the DNA extracted with phenol that
was successfully amplified from pelvic tissue taken from Leicester Museum
mummy No. 1.
When extracting DNA from a modern sample, visual assessment of the
sample plays an important part in obtaining a clear, uncontaminated extract.
When working with ancient mummy tissues, this is very difficult to achieve
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as the mummification resin, dirt, and salts present are released into the
solutions being used.
Working with dark brown solutions hinders the preparation markedly,
and therefore, several centrifugation steps were sometimes necessary. Even
after this, the preparation was often still slightly brown. This colour often
obscured spectrometry readings and, therefore, before assessment could be
performed, the sample had to be relatively clear in colour. The use of silica
beads was considered, but there is often a loss of DNA with such beads
(Hoss and Pääbo 1993); therefore, as only 1 to 2 per cent of DNA may still
be present, it was decided not to pursue this option.
After extraction from modern samples, the DNA is often visible as small
strands; however, it is often not visible in ancient extracts because of the
discoloration of extraction solutions. Therefore, caution was always taken
when separating the organic and inorganic phases with pipettes. The only
sample in which the ancient DNA was visible after extraction had been
taken from the liver of a twelfth Dynasty (c. 1900 b.c.) mummy, Nekht
Ankh. This was not surprising, because, once treated with conditioning
solution, this sample resembled modern liver.
Amplification of modern and ancient DNA

An amplification procedure for modern schistosome samples was estab-
lished before an attempt was made to amplify any ancient samples. After
several attempts in which different concentrations of the reagents were used,
amplification of both S. haematobium and S. mansoni DNA fragments was
achieved. The primers for each species were used on their respective DNA
extracts, and on each other. This was done to establish the specificity of each
primer. Each set of primers did not amplify the other species’ DNA. The
best results were achieved using 4 mM of MgSO4 and 2 U of Taq, and there-
after, this was used for both modern and ancient DNA amplifications. The
main variable changed in the ancient DNA amplification was the amount
of ancient DNA template. After several attempts, it was established that 10
µl of the ancient DNA extract was the optimum amount to use.
The only ancient sample that produced an amplified DNA fragment
over 200 bp in length was from the bladder of Leicester Museum mummy
No. 1. Sequencing confirmed that the fragment was 209 bp of S. haemato-
bium cytochrome oxidase C subunit. Amplification and sequencing were
time-consuming and there were many failures. If unsuccessful, the finite
samples cannot be retested indefinitely, and therefore, false negatives and
positives are often the only results available from a first or second attempt.
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Initial immunostaining tests suggest that Leicester Museum mummy No.

1 was infected with schistosome worms and eggs; however, distorted egg
shapes, combined with nonspecificity of the polyclonal antiserum for a
particular species, meant that the species type had to be investigated at the
DNA level. Successful amplification and sequencing of the S. haematobium
species cytochrome oxidase C sequence has now enabled the actual species
to be identified.
This identification ensures that for the ancient epidemiology study, it
should be easier to distinguish between the two species, S. mansoni and
S. haematobium, that are present in modern Egypt. Until now, S. mansoni
DNA has not been amplified or sequenced in the ancient samples, thus
supporting the theory that only S. haematobium existed in ancient Egypt.
Other studies
The Manchester research has added to knowledge about the practicalities
of ancient DNA work. Several protocols commonly used in molecular work
have proved to be impractical, whereas others have proved to be effective.
More recently, this knowledge has been successfully applied to several other
ancient DNA projects (see Chapters 15 and 17) performed by Master of
Science students at Manchester, under the author’s supervision (Harper
2003; Parker 2003; Bibby 2005; Schrieber-Goshe 2005; Smyth 2005; Bratcher
2006; Bzdega 2006).
Harper’s study involved the extraction, amplification, and sequencing of
DNA from ancient barley and wheat seeds. Attempts to amplify 822 and 162
bp of chloroplast DNA were only partly successful. The amplification of
the 822 bp would have supported the theory of Goldenberg et al. (1990) that
ancient DNA can be present in excess of 500 bp, but unfortunately, only 162
bp were amplified. Interestingly, when one seed was sterilized and placed
onto plant growth media, a callus formed for a limited period, suggesting
that part or all of the DNA responsible for cell division was still intact.
Eventually, the callus collapsed and the seed was sectioned and plated onto
several separate growth media.
The collapsed seed and callus have now been analysed by Bzdega (2006),
using a comparative study of Rutherford’s established protocols and com-
mercial kits. It was hoped to amplify the larger fragment (822 bp), which may
have indicated new cell and DNA generation, but unfortunately, only 162
bp have been amplified. The addition of the enzyme Restorase (Sigma, UK)
was also explored, but no extended DNA fragments were amplified, suggest-
ing that the template is beyond repair. This particular seed is approximately
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4,000 years old and may therefore be too degraded for Restorase to have
any effect. The commercial kit for general PCR made the experiments less
time-consuming, as it entailed a one-step preparation, but apart from this
advantage, the final results were not improved.
Another project (Parker 2003) addressed the issue of identifying ancient
remains. A collection of mummified cats and cat remains in the Manchester
Museum has been catalogued as specific breeds. For example, one partic-
ularly large detached cat head, covered with black fur, was recorded as the
head of a Felis Silvestris, on the basis that this is a large breed. Successful
DNA amplification and sequencing has now confirmed this visual identifi-
cation; this conclusion is based on the amplification of a small sequence of
301 bp, which has a 97 per cent match to modern Felis Silvestris.
These established protocols were utilized in three further studies. One
project established the gender of a mummy (Bibby 2005), another focused
on sibship studies relating to the mummies of the ‘Two Brothers,’ Nekht
Ankh and Khnum Nakht, in the Manchester Museum collection (Smyth
2005), and the third analysed samples from the mummy Asru for the pres-
ence of the cancer-causing gene BRCA1, as previous research by Tapp
(1984) had suggested the presence of a cancerous growth (Schrieber-Goshe
2005).
Apart from the sibship study, both nuclear and mtDNA were targeted.
Not surprisingly, the nuclear DNA was not successfully amplified, but all
three mummies yielded mtDNA fragments from the hyper variable region
1 (HVR1), which enabled Smyth (2005) to conduct a genetic statistical
analysis on the sequenced results by using a forensic population database.
The results suggest that it is 185 times more likely that they are related than
unrelated.
Finally, molecular analysis has been performed on liver samples taken
from mummies from the Dakhleh Oasis to identify the presence of P. falci-
parum. Because an immunostaining method (Rutherford 1997, 1999, 2000,
2002, 2005) performed by Marmion (2003) had already yielded tentative
positive results, Bratcher (2006) undertook further immunoassaying and
genetic analysis to reinforce this work
Many of the above-noted projects were repeated more than once, and
were independently amplified and sequenced by the separate sequencing
laboratory at the University of Manchester. To reinforce such results, the
findings should also be replicated at independent laboratories, but unfortu-
nately, because of the scarcity of tissue samples, it is not always possible to
repeat the tests. Nevertheless, there is a significant difference between this
current research and the first schistosomiasis study, in that the amount of
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tissue now required is as little as 20 mg. Thus, it is more likely that it will be
possible to repeat tests in future work.
Conclusion
Scientists in this field have faced many challenges, but innovations have
been introduced as the number of investigations has increased. For example,
the extracted inhibitors once common in amplification experiments are
now often eliminated by the use of GuScn and silica beads (Hoss and Pääbo
1993). Also, coextractions of bacterial and fungal genomes are now no longer
amplified, as the great care taken in designing primers that are species
specific (i.e. human or schistosome) eliminates the mispriming of these
exogenous DNA templates which may yield small spurious PCR products.
The problems relating to contamination with contemporary DNA
have also inspired the establishment of facilities such as the Ancient
Biomolecules Centre, housed in the Museum of Natural History, Oxford
University (www1). This enables sterile studies to be undertaken, as the
environment is reportedly free from contaminants such as skin flakes and
exhaled cells. To eliminate these contaminants, the building is provided
with positive air pressure and HEPA filtering systems, and the researchers
are required to remove clothing and to be cleansed by means of air-showers,
before entering the centre.
Although future research undoubtedly holds many answers, there will
always be limits. One of the main limiting factors is the natural degradation
of the DNA molecule, and researchers are now resigned to the fact that
most ancient DNA is preserved in fragments no longer than 300 bp (Pääbo
et al. 1989; Kaestle and Horsburgh 2002; Rutherford 2002). This problem
is now being addressed by designing primers that amplify small fragments
of the genome and specific regions that are connected to family traits and
diseases.
As mitochondrial DNA is inherited exclusively from the mother, targeting
the mtDNA can follow the maternal line. In contrast, targeting nuclear DNA
fragments that are inherited within family groups, such as short tandem
repeats (STRs), variable number tandem repeats (VNTRs) and human leo-
cocyte antigens (HLAs), can show family relationships and perhaps migra-
tion patterns. Nuclear point mutations such as a single base pair change may
also highlight the presence of diseases such as cystic fibrosis and sickle cell
anaemia. However, the majority of primers that are designed to highlight
the presence of disease target mitochondrial DNA for reasons already dis-
cussed. Primers have been successfully designed for detecting diseases such
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as schistosomiasis (Rutherford 2002), syphilis (Fornaciari 1989), Chagas’ dis-

ease (Fornaciari 1992; Guhl 1997; Guhl et al.1999), and malaria (Salleres
et al. 2000). The diagnosis of other diseases, using similar methods, will
inevitably follow the same path.
There is also no direct correlation between the age of a sample and
its DNA preservation, and even if similar in age, remains from different
environments may yield different amounts of DNA (Haynes et al. 2002).
Neither, according to Hoss et al. (1996), is there any correlation between
preservation and tissue type, although bones and teeth provide better pro-
tection for ancient DNA because the DNA binds to the hydroxyapatite in
the bone matrix. An individual assessment should be undertaken of any
remains because no two samples are the same. The environmental factors
for each will be different, even if the material has been excavated as a group
from one burial ground, because the same degradation factors may not have
been present in all the burial sites.
The debate continues regarding whether ancient DNA is present in many
samples, particularly dehydrated tissues. Some researchers have concluded
that high temperatures are detrimental to DNA survival and that permafrost
is the ideal preservation medium. It is the author’s opinion that one of the
main factors is the removal of water. In ten years of working with ancient
mummified tissues and seeds, only mtDNA has been amplified from several
different samples. Some researchers insist that nuclear DNA is too degraded
and therefore any positive results are merely contamination, but this would
be disputed by the many groups who are now regularly targeting nuclear
DNA. This is still a very new field, and in future, the use of sophisticated
methods of analysis such as Stingray, Fourier transform infrared, mass spec-
trometry, and even in situ hybridisation may help to provide some of the
answers.
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chapter 10
An introduction to analytical methods
Andrew P. Giże
Introduction – organic methods

Currently, the integration of organic analyses and interpretations with
archaeology promises an exciting future. Some of the results obtained
in studies undertaken in Manchester on pharmacological applications in
Egyptology are discussed more fully in Chapter 13.
The objective of this review, however, is to introduce selected analytical
methods to study organic matter in archaeological sites and materials. It is
not a comprehensive guide to all techniques. The underlying theme is to
guide the interested reader with an idea to be solved towards an appropriate
analytical strategy. Following an introduction to sample preparation, the
remainder of the chapter summarises general and spectroscopic methods
that provide a general indication of organic composition, followed by phys-
ical techniques that ultimately yield detailed information at a molecular
scale.
This review is based in part on an organic geochemical review by Simoneit
and Giże (2000), in addition to those by Silverstein et al. (1974), Banwell
(1983), and Peters and Moldowan (1993). Additional inorganic analytical
reviews include Pollard and Heron (1996) and Gill (1997). An invaluable
laboratory techniques text is Vogel’s Textbook of Practical Organic Chemistry
(Furniss et al. 1989). Essential data sources are The Merck Index (Budavari
et al. 1989), The Chemical Rubber Company Handbook of Chemistry and
Physics (Weast 1976), and Internet resources such as National Institute of
Standards and Technology and Merck.
All organic analytical methods are constrained by organic matter prop-
erties, such as phase (solid, liquid, or gas), molecular structure (individual
molecules or polymers), and molecular weight (to identify a molecule).
Consequently, part of the analyst’s aim is to render the organic material
133
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134 Andrew P. Giźe
from an archaeological source into a form that can be analysed, without

losing the information sought.
Organic matter in archaeological material is derived predominantly from
biological precursors (e.g. flower wreaths, beeswax, and animal hides), as is
organic matter from geological sources (e.g. bitumens). Biochemical syn-
thesis is enzymatically controlled, resulting in relatively few compounds
being synthesised. This helps the analyst because natural product chem-
istry forms a basis for interpreting data.
The organic analyst is usually concerned with carbon, as well as hydrogen,
oxygen, nitrogen, sulphur, and phosphorus. The Group IV elements are
unusual in that an atom of an element can bond to another atom of the
same element or catenate. Carbon catenates to a greater extent than any
other element, resulting in a major analytical consideration, isomerisation.
If atomic absorption spectroscopy, for example, indicates the presence of
arsenic, there is no other element with the same characteristic absorption
lines as arsenic.
Identification of arsenic automatically fixes the atomic weight. Infrared
(IR) analysis of an organic material will indicate bond energies, from which
a structure can be deduced, but not the molecular weight. Alternatively,
MS of the organic material may provide a molecular weight of, for exam-
ple, 58 D. This fixes the hydrocarbon composition as C4 H10 , from which the
isomers n-butane and methyl propane can be deduced (Figure 21), as well
as other heteroatom compositions (i.e. C3 HgO and CaHgS). To unequivo-
cally identify which isomer is the correct structure, an alternative analytical
method, such as IR spectroscopy or GC, must be used. Although the inor-
ganic chemist may have to use two independent analytical methods (e.g.
x-ray crystallography to identify CaCO3 polymorphs), the organic analyst
must always use two independent methods before a molecular structure can
be assigned.
A final organic analytical issue is determining the three-dimensional
shape of the molecule or its stereochemistry. A small difference between two
molecules in their stereochemistry can result in different interpretations.
Figure 22 shows the structures of 5α(H)-cholestane and 5β(H)-cholestane.
The two molecules differ only in that the hydrogen at the carbon-labelled 5
is directed away from (5α) or towards (5β) the reader. The 5α(H)-cholestane
is derived from the ubiquitous cholesterol, and is common in recent sed-
iments. The 5β(H)-cholestane, however, is derived from the faeces of
carnivores (including humans), and can be used as a marker of carni-
vores.
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An introduction to analytical methods 135
figure 21. Isomers of C4 H10 . a: butane. b: methyl propane. Credit: Andrew Gize.
Sample preparation
Sample preservation should be considered at the site, with immediate pro-
tection from contamination sources, including suntan protection and vehi-
cle exhausts. Museum samples may already be irreversibly contaminated,
for example, from nicotine from cigarettes. Samples should be wrapped
in aluminium foil (previously baked at >300◦ C to remove manufacturing
oils) or sealed in Teflon or laminated polycarbonate-polyethylene (Kapak)
bags. Printer inks in newspaper can cause contamination. Other plastics
figure 22. Diastereomers of cholestane. a: The hydrogen on carbon 5 is depicted as

away from the reader (5). b: The hydrogen on carbon 5 is depicted towards the reader
(5). Credit: Andrew Gize.
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(polyethylene, plastic wraps, etc.) are renowned sources of contamination

by plasticisers (phthalate esters).
In the laboratory, samples and extracts must not be exposed to direct
sunlight because organic compounds can be photosensitive. Sample trim-
ming should be done with a water-cooled saw without any organic-based
antirust. Organic concretions (e.g. resin and bitumen) can be hand picked
for analysis by using a dissecting kit.
Organic matter can be extracted from a sample either by a Soxhlet appa-
ratus or ultrasonic extraction (Furniss et al. 1989). In Soxhlet extraction,
the sample is placed in a preextracted cellulose or quartz thimble, and
the organic matter is extracted with a negative azeotrope (e.g. toluene-
methanol) or single solvent (e.g. dichloromethane) for a specified time (e.g.
twenty-four–forty-eight hours). The extracted organic matter is obtained
after evaporation of the solvent under reduced pressure in a rotary evapora-
tor.
In ultrasonic extraction, the sample is placed in solvent and sonicated with
a sonic probe in the sample. An ultrasonic waterbath is an inadequate alter-
native, resulting in poor extract yields. Soxhlet extraction provides higher
yields, but with some loss of semivolatile compounds. Supercritical CO2
is an alternative extraction technique (Schneider 1978; Hopfgartner et al.
1990) but the yields tend be less than other methods. The organic sample
after extraction is the crude extract.
Chromatography
The crude extract can be analysed directly, but further separations are usu-
ally advisable to maximise the information available using the analytical
methods available. Simplifying a complex mixture into compound classes,
for example, focusses interpretation directly on a compound class, without
ambiguities resulting from peak overlaps. Chromatography is the standard
separation technique, being based on different partitioning of compounds
in a complex mixture between two phases (solid-liquid, solid-gas, and liquid-
gas).
Column chromatography (liquid chromatography) is a routine technique
for separating organic compounds into compound classes by polarity, typ-
ically using a burette as the column. Using, for example, Al2 O3 /SiO2 as
the column stationary phase, the crude extract is separated into compound
classes (e.g. saturated and aromatic hydrocarbons, and polars) by eluting
with a series of mobile solvents with increasing polarity (e.g. hexane to
methanol).
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In thin-layer chromatography, the solid phase (e.g. silica and cellulose)

is on a glass plate, and the mobile solvent moves up the coating. After sam-
ple chromatography, the separated bands are visualised under ultraviolet
(UV) light or by application of iodine vapour or a dye. Fractions corre-
sponding to the elution region of standards (e.g. hydrocarbons, aromatics,
ketones, esters, and alcohols) are removed from the plate, extracted, and
concentrated for further analysis. High-pressure (performance) liquid chro-
matography is a powerful separation technique for polar, nonvolatile, or
thermally unstable compounds that are otherwise incapable of separation
by other chromatographic methods.
Chromatographic separation will provide concentrates of a given class of
organic compounds that can be analysed directly. Nevertheless, for some
compound classes (e.g. saturated or aromatic hydrocarbons, and polars such
as carboxylic acids and alcohols), further preparative work may be desirable.
The saturated hydrocarbons are often dominated by high concentra-
tions of normal and isoprenoid alkanes, but the multi-ring compounds (e.g.
derivatives of steroids) can be in such low concentrations that analysis is
difficult. The molecular shape and size of the molecules can be used for
further separation. Zeolite-based molecular sieves are available with vari-
ous channel diameters. A 5-Å´ molecular sieve will extract the frequently
dominating normal alkanes, leaving an extract containing branched and
cyclic hydrocarbons only. Silicalite has larger channels that will accept
normal and monomethyl alkanes, leaving a concentrate of cyclic saturated
hydrocarbons (Hoering 1981).
Alternatively, urea and thiourea crystals can be grown in the saturated
hydrocarbon fractions that will clathrate the normal alkanes and nor-
mal alkanes and isoprenoids, respectively. Isomers of polycyclic aromatic
hydrocarbons can result in complex mixtures that are difficult to interpret
(especially by UV spectroscopy). These compounds can be simplified by
gel-permeation chromatography separation according to ring size (Giger
and Blumer 1974). Polar compounds, including carboxylic acids, phenols,
amino acids, and alcohols present a special problem in GC because of gas
phase hydrogen bonding resulting in a broad peak that is difficult to quantify
and may hide compounds that elute in a similar retention time. Thicker
film and new bonded phases in GC columns have reduced these problems
to some degree.
It is analytically more elegant, however, to cover the functional group,
which contributes to hydrogen bonding by converting it to a derivative.
Prior to analysis, carboxylic acids typically are derivatised to methyl esters,
and phenols and alcohols to trimethylsilyl ether derivatives (Murphy 1969;
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Pierce 1979). Murphy (1969) provides an introductory review of the separa-

tion of organic mixtures by chromatography, followed by molecular sieving,
clathration, and derivatisation. Lee et al. (1981: 78–112) review other analyt-
ical schemes for aromatic hydrocarbons.
In any analysis, procedural blanks are essential because the concentra-
tions of organic matter in many samples will be small and the potential
for significant contamination is consequently greater. Widespread usage of
plastics in laboratories results in phthalate esters being probably the most
frequently encountered contaminants. In multiuser laboratories, blank sol-
vents should be run first, primarily to eliminate ghost contamination from
the previous user. When the extract yields are small (<1 mg), scrupulous
care should be taken to eliminate losses by adsorption to glassware. A five
weight per cent loss for submilligram samples can occur by adsorption in
each stage in an analytical protocol (Giże 1984).
Pyrolysis
Some samples (e.g. ambers and hair) may not readily dissolve using solvent
extraction, and have to be rendered into smaller fragments before chro-
matography. Pyrolysis is the nonoxidative thermal breakdown of a sample.
A large molecule (a polymer), which cannot be analysed directly, is ther-
mally broken into smaller fragments (pyrolysates) that are facile to analyse.
From the pyrolysates, a conceptual image of the original macromolecule is
deduced.
A simple pyrolysis system comprises a vertical quartz tube within a heater
set at a determined temperature (e.g. 50–1,000◦ C), with an inert gas (e.g.
helium) passed through the tube. The sample (≈1 mg) is injected on a
needle, or falls through the furnace, and is pyrolysed. The pyrolysis time
is of the order of seconds, with ≈600◦ C a suitable temperature for many
applications. An alternative pyrolysis system is to pass a current, using an
inductive coil, through a ferromagnetic material (wire or foil). When the
Curie point temperature of that material is reached, its temperature will
not increase further.
Curie point pyrolysis is advantageous in the temperature control, but a
furnace provides a complete range of temperatures in contrast to those fixed
by Curie points. In both cases, the pyrolysates are flushed in the inert gas
to a capillary column in a gas chromatograph, where they are cold trapped
with liquid nitrogen prior to analysis (Wampler 1999).
Microscale sealed vessel is a mild pyrolysis method (Hall et al. 1999). In
both furnace and Curie point pyrolysis, the thermal fragmentation results
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9780521865791plate CUFX196/David 978 0 521 86579 1 August 22, 2007 12:38
plate i. Histological section of the underside of a leaf. This section of ancient material
shows the underside of a leaf with the lip-like shapes of the stomata through which the
leaf respires. They are surrounded by areas of pigmentation indicating the variegation of
the leaf colour. Credit: John Denton.
1
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plate ii. Bacteria in gram-stained histological section. The invasive nature of bacteria
can be seen in this gram-stained section of mummified tissue in which the gram-positive
bacteria are dark blue and are in tracks and columns along the run of the fibres. Credit:
John Denton.
2
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plate iii. Histological section of Serpula lacrymans fungus. This shows the invasive
nature of Serpula lacrymans fungus. The pink bone (ancient Egyptian) at the top of the
picture (A) is being eroded and eaten away by the fungus. In (B) the bone is stained blue,
between which is the area that was previously occupied by the bone marrow. Occupying
this space is a cluster of crystals of calcium oxalate. The crystals are difficult to define
unless examined by polarised light where the birefringence of the crystal is clearly seen
as yellow and blue against a magenta background (C). Credit: John Denton.
plate iv. Histological section through the fibrous pleura of lung tissue taken from a
mummy. Image A is a section through the fibrous pleura of the lung and it contains
a cavity that has been filled with a deposit of black material, most of which is carbon,
from breathing in a sooty atmosphere. When the section is examined using polarising
microscopy (B), some of the material is shown to be birefrengent and crystalline as
indicated by the white glow against a dark background. The soot is not birefrengent and
remains black. Birefrengent material of this type in a mummy is usually fine deposits of
sand that have been inhaled throughout life. In modern day man, this density of deposit,
which causes pneumoconiosis, is only seen in long term industrial exposure to dusts.
Credit: John Denton.
3
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plate v. Histological section of the ear of a mummified cat. This shows a trachoma-stained
section of the ear of a mummified cat, approximately 2,000 years old. The epidermis (skin
surface) is stained red (E) and the dermis is stained blue. The central orange area is the
cartilage that gives the ear its rigidity. There is excellent preservation of the chondrocyte
cell nuclei within the cartilage. Credit: John Denton.
plate vi. Histological section of wheat from an Egyptian tomb. The toluidine blue–
stained section of 2,500-year-old wheat from a tomb shows almost perfect preservation
of the surface layers (S) and the endosperm that contains the starch (E). Credit: John
Denton.
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plate vii. Histological section of ancient decalcified bone. This section of trichrome-
stained, decalcified bone demonstrates the edge effect of putrefaction and oxidation.
Where the edge of the bone has been degraded, it is red, whereas the normal green stain
is evident in the bulk of the bone. This edge effect is particularly noticeable in bone, as
the soft tissues commonly show the reversal throughout the tissue. Credit: John Denton.
plate viii. Histological section of bone providing a timeline of events. An explanation for
the abnormalities in this section of bone can be explained by piecing together a timeline
of events. Credit: John Denton.
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plate ix. Histological section of Egyptian bandage. This section of bandage from a
mummy shows the twisted bundled of flax forming the warp and weft of the linen. At
the microscopic level, positive identification of the structure of the cloth, and the type of
fibre of which it is composed can be made with a great degree of certainty. Credit: John
Denton.
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plate x. Positive staining of S. mansoni ova within infected mouse liver. ×100. If cut in
the correct orientation, the lateral spike can be clearly seen. Credit: Patricia Rutherford.
7
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plate xi. Positive staining of S. mansoni ova within infected mouse liver. ×100. The
classic oval shapes are not always seen. Credit: Patricia Rutherford.
8
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plate xii. Positive staining of S. haematobium within infected hamster liver. ×100.
Credit: Patricia Rutherford.
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plate xiii. Positive staining of bladder tissue from a mummy. ×100. Tissue from the
bladder of Mummy 7700.1766 (Manchester Museum). The distorted shape of the ova
means that species identification is often difficult. Credit: Patricia Rutherford.
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plate xiv. Positive staining of bladder tissue from a mummy. ×100. The ova in this
2,000-year-old, dehydrated, mummified tissue from the bladder of Mummy 7700.1766
(Manchester Museum) still resemble the modern S. haematobium seen in Plate XII.
Credit: Patricia Rutherford.
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plate xv. Ultraviolet fluorescence microscopy of hair taken from the scalp of a mummy.
The hairs are coated with an orange fluorescing material, which developed droplets at
the hair ends. The observation is that the hair was cut before the coating was applied.
The interpretation is that the coating was not applied as part of a daily cosmetic routine,
but is probably connected to mummification rituals. Width of view: 0.8 mm. Credit:
N. McCreesh, University of Manchester, unpublished data.
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plate xvi. Visible light and infrared images of a hair from the mummy of Asru. Top left:
hair (colourless) with darker coating. Bottom left: Infrared image over entire infrared
spectrum, showing organic material unevenly coating the hair (red colour indicates
highest infrared activity). Top right: infrared image over the range 1,600–1,700 cm -1
only, indicative of the concentration of C = O on the hair. Bottom right: Anticipated
infrared absorbtion area if hair was coated with plant oils. Credit: Andrew Gize.
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plate xvii. Facial reconstruction of ancient Egyptians. Top left: Nesperennub – Twenty-
Second Dynasty priest (British Museum). Top right: Lady X – unknown mummy found
in the tomb of Seti II (Egyptian Museum, Cairo). Bottom left: Janus – mummy of a
man (Groningen Museum, The Netherlands). Bottom right: A 3,800-year-old female
mummy (Georges-Labit Museum Toulouse, France). Facial reconstructions by Caro-
line Wilkinson, Dundee University (UK). Credit: Caroline Wilkinson and University of
Manchester.
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plate xviii. Mummy covered with efflorescence and mould growth. Due to inept environ-
mental storage conditions over many years, the partially unwrapped mummy has suffered
physical damage. Credit: Antony E. David.
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plate xix. Hand and torso of the mummy after conservation treatment. The wet ster-
ilization method has been used to successfully treat this mummy. Credit: Antony E.
David.
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in artefacts, typically unsaturated fragments. For example, the pyrolysate

may yield normal alkanes, but artefacts include mono- and dialkenes. The
microscale sealed vessel method does not generate these artefacts. The
sample (≈1 mg) is placed in a capillary tube and packed with precleaned
silica sand. The sealed capillary and sample are oven heated (e.g. 300◦ C)
for longer times (e.g. forty-eight–seventy-two hours). The capillary tube is
then crushed in a heated gas chromatograph inlet to release the pyrolysates,
which are cold trapped at the head of a capillary column before analysis.
A major advantage of pyrolysis is the small sample size, whereby virtu-
ally negligible samples can be taken from an archaeological artefact, and
considerable molecular information can be obtained. The disadvantage is
that all the pyrolysate is analysed, and significant compounds in low con-
centrations are more difficult to detect. Pyrolysis offers a rapid molecular
screening technique to identify samples that have the potential to offer more
information when using larger sample masses.
Spectroscopy
Introduction
Archaeological material is irreplaceable and consequently nondestructive
methods are preferable. Analytical approaches to screen samples should be
undertaken before deciding which have the potential to offer the most infor-
mation by destructive methods. Spectroscopy offers nondestructive methods
to provide detailed information on the structure of polymers and individual
compounds. Even without detailed interpretation, spectroscopy can ‘fin-
gerprint’ samples into groups, enabling a preliminary classification. Spec-
troscopy, however, does not yield molecular weight. Additional introductory
sources include Banwell (1983) and Smith and March (2000).
Electromagnetic spectrum
The electromagnetic spectrum is a continuum, but is analytically divided
into several regions (Figure 23; Banwell 1983), with each region involving
a different electronic or magnetic response of the sample to the incident
radiation.
1. UV and visible spectroscopy: the region covers 3 × 1014 to 3 × 1016 Hz,

with wavelengths of 1–10 nm. The spectroscopy involves excitation of
valence electrons, requiring energies 105 –107 kJ mol−1 .
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2. IR spectroscopy: the region covers 3 × 1012 to 3 × 1014 Hz, with wave-

lengths of 1–100 µm. The spectroscopy involves molecular vibrations
that change dipole moments, requiring energies ≈104 J mol−1 .
3. Radiofrequency spectroscopy: the frequencies involved are used in
nuclear magnetic and electron paramagnetic resonance spectroscopy.
The region covers 3 × 106 to 3 × 1010 Hz, with wavelengths of 1 cm–
10 m. The spectroscopy involves reversal of the spin of a nucleus or
electron, requiring energies 10−3 to 10 J mol−1 .
Ultraviolet spectroscopy
Molecular absorption in the UV (and visible) regions of the spectrum affects
the electronic structure of the molecule. The absorption of energy is quan-
tised, resulting in the elevation, or excitation, of electrons from ground state
orbitals to excited states in higher energy orbitals. Consequently, two mea-
surements may be made. The intensity of absorption (or transmittance) can
be measured versus the frequency of irradiation. Alternatively, the energy
emitted in the visible range can be measured as the excited electrons drop
back to the ground state.
UV spectroscopy is limited to analysis of conjugate bonds, which are dou-
ble bonds in sequence stabilised by additional -bonding as, for example, in
benzene. One aspect of UV spectroscopy is that characteristic UV-absorbing
bonds can be recognised in molecules with very different structures. The
UV spectra of pure compounds usually show some detail or fine struc-
ture. Mixtures of compounds yield spectra in which fine structure is lost or
reduced as a result of peak overlap. Consequently, UV spectroscopy is best
used in conjunction with other analytical methods, such as GC/MS.
Visible spectroscopy
The visible region of the spectrum can also be used in two ways. One
method is the use of colour. The second is the absorbance in the visible
spectrum by certain molecular compounds. The visible part of the electro-
magnetic spectrum can be used for the identification and quantification of
ring compounds such as the porphyrins, and pigments such as henna.
Infrared spectroscopy
The IR region is one of the most useful for the organic analyst because
it is where changes in dipole moment resulting from bond vibrations are
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figure 23. The electromagnetic spectrum. (after Banwell, C. N. 1983. Fundamentals of molecular spectroscopy. 3rd edn. London: McGraw-Hill.)
Credit: Andrew Gize.
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October 31, 2007
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recorded. In the author’s opinion, IR spectroscopy provides the best ‘finger-

printing’ method.
IR spectroscopy can be performed on organic products, such as extracts
and bitumens. Spectra can be obtained on gases, liquids, and solids. Liquids
can be examined in a cell or as smears on salt plates or pellets of silver
chloride or potassium bromide. Solids can be examined either as a mull or
powdered with potassium bromide and then pressed to make a pellet.
Quantification of chemical groups can be obtained by use of band
intensities (Rouxhet et al. 1980) with application of the Beer-Lambert Law
and determination of the absorption coefficient, K. When similar materi-
als are studied by IR spectroscopy, K is anticipated to be proportional to
the concentration of the chemical groups contributing to the absorption
band.
Fourier transform infrared spectroscopy

A development in spectroscopy has been Fourier-transform infrared (FTIR)
spectroscopy (for an introduction to Fourier transform, see Banwell 1983).
The previous method of collecting spectra was by recording the absorbance
at each point of the spectrum separately. Until relatively recently, it was
only in the visible and UV regions that the whole spectrum could be
recorded simultaneously as a photographic plate. FTIR now provides simul-
taneous and almost instantaneous recording of the whole spectrum in the
IR, microwave, and magnetic resonance regions.
One advantage of FTIR is that spectra can be collected and summed in
seconds. With FTIR, 4,000 scans can be obtained and summed in less than
an hour. The result of the additions is that noise is eliminated or reduced,
and absorbing bands are enhanced. Consequently, FTIR can be used on
seemingly opaque material or very small samples.
Nuclear magnetic resonance

Nuclear magnetic resonance (NMR) is another form of absorption spec-
troscopy, in which a sample can absorb electromagnetic radiation at radiofre-
quencies governed by the atomic nuclei in the sample. Silverstein et al.
(1974) provide an introduction to NMR.
The nuclei of interest in organic chemistry are 12 C and 16 O, and 1 H, and
13
C. The NMR signals produced, for example by 1 H, will depend upon the
bonds present. Originally, NMR could be obtained only on liquids. More
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recently, it has been possible to obtain high-resolution spectra of solids using

cross-polarization magic-angle sample-spinning NMR spectrometry.
Lambert et al. (2002) suggest that NMR is an appropriate method to
fingerprint and classify the sources of resins from Africa and the Americas.
Electron paramagnetic (spin) resonance

The primary application of electron paramagnetic resonance (EPR) or spin
(ESR) lies in determining if samples have been burnt. For example, Hayes
and Schurr (2002) have suggested EPR to be applicable to determining the
thermal histories of burnt bones.
Permanent magnetization occurs only in ferromagnetic and ferrimag-
netic substances, in which the magnetization persists outside of an exter-
nal magnetic field. An induced magnetization can occur in the presence
of an external magnetic field. When the magnetization is proportional to
the applied magnetic field, the material is referred to as paramagnetic or
diamagnetic. Electron paramagnetic- (or spin-) resonance (EPR or ESR)
spectroscopy is based on the electron spin of free radicals. When the
electron of a free radical is placed in a magnetic field, the electron has
one of two possible orientations, which have spin quantum numbers of
m = +1 and m = −1. A transition from the lower to the upper energy
state is effected by absorption of electromagnetic radiation of a suitable
frequency.
Applications of EPR have been reviewed by Marchand and Conard
(1980). Initially, the paramagnetic centres in thermally immature organic
matter are localised. During thermal alteration, volatile organic groups are
broken as free radicals from the parent material (-CH3 , -C2 H5 , etc.), leaving
an unpaired electron on the parent. The residual solid becomes progres-
sively aromatic, with the unpaired electrons remaining delocalised through-
out the molecules. With increasing temperature or time, they grow more
delocalised as the aromatic domains become larger. At 900◦ C, or when
time is very long, the free electrons become more numerous until, at the
stage when the graphite lattice is formed, the electrons become free to move
along the graphite layers.
EPR therefore has been considered as a palaeotemperature index, but
should be utilised as such with extreme caution (Marchand and Conard
1980). There is no direct correspondence between the paramagnetic sus-
ceptibility and the palaeotemperatures. Time must be considered with tem-
perature. The paramagnetic susceptibility also depends upon the biological
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source of the organic matter. Therefore, EPR should be used in conjunction

with other methods.
Microscopy
The advantage of microscopy is that an immediate visual image is obtained.
Spectroscopy offers nondestructive analytical methods to the analyst. When
combined with microscopy, a pinhead sample or a few hairs can be removed
and returned to an artefact. One key piece of information from microscopy
is the extent to which a sample is homogeneous or heterogeneous. Gas chro-
matography/mass spectrometry, for example, can provide detailed molecu-
lar information on a few hair strands, but microscopy alone will give infor-
mation on whether the analyses apply to unaltered hairs, fungally degraded
hairs, or hairs which have been henna coated.
Ultraviolet light microscopy

In UV, or fluorescence microscopy, the sample is irradiated with UV light,
ideally filtered to a fixed wavelength (e.g. 546 nm). If the sample contains
areas with functional groups in which electrons are excited by UV radiation,
then those areas will emit light in the visible spectrum as the electrons
fall back to lower energy levels. As an example, hairs from a Manchester
Museum mummy are shown in Plate XV.
Visible light microscopy

Microscopes using visible light which is passed through the sample are
commonplace in many laboratories, and will not be described further here.
In polarized light systems, light is initially passed through a polar, which
limits the plane of light vibration to one direction only (e.g. 0◦ and 180◦ ).
If the plane of light is not changed by passing through the sample, plac-
ing a second polar at 90◦ to the first (e.g. 90◦ and 270◦ ) will filter out all
light, and the viewer will not see any light from the sample. If the sample
rotates the plane of polarized light to the left or right, then some light will
pass through the second polar to form a visible image. The information
obtained on the sample is varied, including whether it is optically active or
the crystallography.
In reflected light systems, light can be reflected back from the surface
of an opaque sample to give an image of its surface features. Alternatively,
light may pass into the sample before being reflected back. If polars are
placed with their vibration planes set at 90◦ to each other, before the light
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hits and is reflected back from the sample, the image colour seen is usually
diagnostic of the material, and is termed ‘internal reflections.’
Infrared microscopy (with R. Speak, School of Chemistry,

University of Manchester)
IR microscopy is a relatively new nondestructive technique. Rather than
using a single detector, the microscopy system uses a detector array (e.g. 64 ×
64 detectors). This array provides an IR image of an area of approximately
400 × 400 µm, with a resolution of ≈7 µm. With the advantage of Fourier
transform data manipulation, an entire set of 4,096 spectra can be collected
and processed in less than five minutes in the range of 4,000–1,000 cm−1
with a 16-cm−1 spectral resolution.
By cross-indexing the 4,096 spectra, false-colour two-dimensional IR
images are produced which relate the chemical content (using the diag-
nostic vibrational absorbance frequencies of the molecular bonds in the
substance) to its location within the object area. For example, the distribu-
tion of organic matter within a matrix can be determined by mapping the
∼2,900 cm−1 C-H stretch band that is characteristic of aliphatic compounds.
Shown in Plate XVI are optical and IR images of a hair from the twenty-
fifth Dynasty mummy of Asru, a chantress from the Temple of Amun at
Karnak. The lumpy nature of the optical picture, echoed by the average IR
picture, is considered to be due to a paste of oils and dyes applied to the
scalp and hair. This theory is borne out by the uneven orange colouring on
the hair, suggestive of henna.
The active ingredient in henna is hydoxynaphthoquinone, a light yellow
crystalline compound when pure. In henna, it complexes and oxidises to
produce the characteristic orange colour. The uneven coating on the hair
suggests it was applied after death as part of the ritual preparation process
rather than as a cosmetic during life, an identical interpretation to that
obtained from another mummy (Plate XV). Mapping the 1,600 to 1,700-
cm−1 C=O and aromatic carbon region produces an image with bright
spots roughly corresponding to the orange areas in the optical picture, not
inconsistent with the application of the aromatic oil/henna mix.
Molecular analysis
Stereochemistry
Stereochemistry refers to the three-dimensional shape of molecules. An
understanding of stereochemistry is required to appreciate not only GC
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and MS data, but also every aspect of natural product organic chemistry,
including biological sources for archaeological and geological materials,
reaction mechanisms, and the thermodynamic stability of organic mat-
ter. Using GC/MS, information is obtained not only on molecular struc-
ture, which supplements spectroscopic interpretations, but the molecular
weight is obtained. With this information, highly specific questions can
be answered, such as the source of bitumens in mummy wrappings, and
agricultural practices.
To appreciate especially the power of coupled GC/MS as an analyti-
cal method, a brief introduction to stereochemistry and some terminol-
ogy is essential. Stereochemical terminology can be initially daunting, as
it is partly the result of a need to communicate three-dimensional infor-
mation on the two dimensions of a book page. It is the author’s view
that the best method of appreciating stereochemistry is to use commer-
cially available stick-and-ball chemical model kits. Such models immedi-
ately teach understanding of bond rotation and symmetry, in addition to
providing therapeutic pleasure and office decorations. Stereochemistry is
reviewed in most organic chemistry textbooks, including Smith and March
(2000).
The electronic structure of carbon can be represented initially as 1s2 , 2s2 ,
with the remaining two unpaired electrons in two of the three 2p shells. One
arrangement of the 2s and 2p electrons in bonding is by hybridisation to sp3 .
In this instance, the carbon valency is 4, with bonds forming a tetrahedral
arrangement with bond angles of 109◦ 28 . If two or more carbons are linked
by sp3 hybridised bonds, then the molecule (or section of a molecule) is
commonly termed saturated. The nomenclature of saturated hydrocarbons
is an ending in –ane (e.g. methane). A second arrangement in bonding of
the 2s and 2p electrons is by sp2 hybridisation. The resultant carbon has
three bonds in a plane, with an ideal bond angle of 120◦ .
Bonds formed by sp2 hybridisation are commonly termed unsaturated,
or double. Such bonds are relatively unstable and are prone to addition of
an atom to form a saturated bond. The special exception are the aromatic
hydrocarbons, in which carbons linked by conjugate sp2 hybridised bonds
are rendered very stable (and therefore persistent in the natural environ-
ment) by electron delocalisation. Unsaturated hydrocarbons end in –ene
(e.g. ethylene, benzene). One other possible arrangement of the 2s and 2p
electrons in bonding is by sp hybridisation to form triple bonds. Compounds
with sp hybridised bonds end in –yne. In natural environments, sp bonds
are usually extremely unstable, and thus can be neglected in the context of
this introduction.
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figure 24. Depictions of cyclohexane. a: planar view. b: chair conformer. c: boat con-
former. The chair and boat conformers are interchangeable by C – C bond rotation.
Credit: Andrew Gize.
Isomers are compounds with the same empirical formula, but with dif-
ferent three-dimensional structures. When a molecule contains carbons
linked by sp3 bonds, then rotation can occur on those bonds. Rotation can-
not occur between two sp2 -bonded carbons, or in ring compounds formed
by conjugate sp2 carbon bonds (aromatic hydrocarbons). When two differ-
ent arrangements in three dimensions of a molecule are possible by bond
rotation, then the stereoisomers are referred to as conformational isomers
(conformers). In Figure 24, cyclohexane is depicted as a planar molecule
(A), and then as the chair and boat conformers (B and C, respectively).
figure 25. The structure of glycine and alanine. a, b: The structure of glycine, in which
two mirror images are superimposable. c, d: the structure of alanine, in which the two
mirror images are not superimposable. c and d are enantiomers, but a and b are not
enantiomers. Credit: Andrew Gize.
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If two molecules have the same empirical formula, contain the same
atoms linked by the same bonds, but have two or more three-dimensional
shapes that cannot be obtained by carbon–carbon bond rotation, then they
are configurational isomers. Further terminology is then based on the sym-
metry and asymmetry of the groups attached to each of the carbons in the
molecule.
The property resulting in molecular rotation of the plane of polarized
light is exhibited by the reader’s hands. Held palm to palm together, the left
and right hands are mirror images. Placing one hand on top of the other
should result in the thumbs sticking out in opposite directions, indicating
that one hand cannot be superimposed on its mirror image. The property of
nonsuperimposability of a hand or molecule on its mirror image is termed
chirality. A molecule that rotates the plane of plane-polarized light is termed
optically active and cannot be superimposed on its mirror image.
The majority of amino acids are optically active and are based on one
amino group, one carboxyl group, and one hydrogen bonded to a single
carbon. The difference between all amino acids lies in the fourth group.
In glycine, the fourth group is a hydrogen. In Figure 25, the structure of
glycine (A) and its mirror image (B) are shown. Structure (A) can be rotated
180◦ and superimposed on its mirror image. Consequently, glycine is not
optically active.
The structure of alanine, where the fourth bond is to a methyl group, can
have two forms (and only two isomers), which are mirror images of each
other but which cannot be superimposed on each other (Figure 25). The
two isomers are termed enantiomers. The central carbon is the source of
chirality, and is termed a chiral carbon (C∗ ). The properties of the two enan-
tiomers of alanine, and any other enantiomeric pair, are identical except
for the following two properties.
First, each enantiomer will rotate the plane of plane-polarized light in
opposite and equal directions. Consequently, the enantiomer that rotates
the plane to the left is the levo-isomer (designated –), and the other is the
dextro-isomer (designated +). Second, each enantiomer will react at the
same rate with achiral compounds, but at different rates with other chiral
compounds. This latter property forms the basis of analytical separation
techniques. It is noteworthy that chirality in molecules may have been rec-
ognized only because humans consist of chiral compounds such as amino
acids.
A molecule can contain more than one chiral carbon, and in extracts
derived from geological sources, such molecules are usually ubiquitous.
Although there are several isomers for a given compound with several
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9780521865791c10a CUFX196/David 978 0 521 86579 1 October 31, 2007 17:36
chiral carbons, only two can be enantiomers. The other isomers based
on chiral carbons, which are not enantiomers, are termed diastereomers.
Diastereomers have very similar chemical and physical properties, but com-
monly, these properties are sufficiently different for immediate analytical
recognition.
The two isomers of cholestane (5α(H)-cholestane and 5β(H)-cholestane)
are diastereomers, with 5β(H)-cholestane being diagnostic of carnivores.
Identifying the 5β(H) in cholesterol derivatives provided Bull et al. (1999,
2000) with evidence for human and porcine manure in historical sites.
Gas chromatography
Gas chromatography (GC) is a very active aspect of analytical chemistry,
with extensive application in natural product chemistry (including archae-
ology), especially when coupled with MS.
GC is the separation of a complex volatile mixture using an inert gas
and a column which can contain a stationary phase (e.g. a solid packing),
or a high boiling point polymer or liquid. The sample is introduced to the
gas chromatograph through a heated injector (typically ≈300◦ C), using a
syringe, probe, or pyrolyser. A relatively new introduction method, which
can also eliminate solvent use, is a needle coated with an organophilic
polymer (solid phase microextraction, SPME).
The sample is vaporised and swept in an inert gas (e.g. H2 , He, or N2 ) to
the head of a column in an oven, which is held at a lower temperature than
the injector (e.g. 40◦ C, or with a liquid nitrogen cold trap). The sample
condenses in as sharp a band as possible at the column head. The gas
chromatograph oven is then heated at a standard rate (e.g. 4◦ C min−1 ) to a
final temperature (e.g. 300◦ C).
As the boiling point of a compound is reached, it will enter the gas phase
and be transported through the column to a detector. As in a complex
mixture several compounds will vaporise at the same temperature, further
separation occurs between the compounds in the gas phase and the station-
ary phase. Following separation in the column, the compounds leave the
column (elute) to a suitable detector.
The GC column is crucial in analysis. The stationary phase in the col-
umn coating should be tailored to the specific analytical problem (Gruschka
1974). For rapid gas chromatographic analyses and separations of high
molecular weight compounds, shorter columns (e.g. 15 m) are useful, but
these lack the resolution of longer columns (e.g. 30 m). Flexible fused-
silica capillaries with bonded phases are now in virtually exclusive use. To
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separate enantiomers, such as amino acids, the stationary phase must be

optically active.
There are many types of detectors, ranging from general to those specific
to a compound class (Natusch and Thorpe 1973; Buffington and Wilson
1991). The destructive flame ionisation detector (FID) and non-destructive
thermal conductivity detector (TCD) are the two most commonly used. In
an FID detector, the column eluate is taken by the carrier gas into the base
of a flame.
Simplistically, when a compound burns, it forms ions, and the resistance
across the flame will decrease. The resistance change is a function of the
number of ions formed (compound composition) and their concentration.
When the resistance change is recorded, peak area (or height × width at
peak half height) is directly proportional to concentration.
FID is advantageous in that it responds well to hydrocarbons but not to
water. Quantitation is either internal or external. In internal calibration, the
sample to be analysed is spiked with a compound of known concentration
which is not anticipated to be in the sample (e.g. a deuterated aromatic).
In an external calibration, a series of analyses are run, using different con-
centrations of one or several compounds which are expected to be in the
sample.
Additional detectors include electron capture (ECD) which is specific
to compounds containing electronegative elements (e.g. Cl), the nitrogen-
phosphorus detector (NPD), and the flame photometric detector (FPD)
sulfur and phosphorus-containing compounds which produce chemilumi-
nescent species.
The absolute identification of a compound requires two independent
methods. GC using only one stationary phase is not usually reliable to
identify the molecular structure (e.g. which isomer). Identification of the
isomer strictly needs the sample to be run on two columns of different
polarities, usually with standard (reference) compounds. The alternative
route to identifying a molecular structure, which fulfils the requisite of two
independent methods, is chromatography-MS.
Mass spectrometry
MS is unique in terms of both the principle on which it is based and the
instrumentation required. In the mass spectrometer, molecules are ionised
and it is these ions which are analysed in detail. This is an irreversible process
and thus MS is a destructive analytical method. The fundamental stages
in a mass spectrometer are sample introduction, ionisation to form positive
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or negative ions from the organic molecules, which are then separated as a
function of mass to charge, and a detector for mass analysis. MS has been
extensively described (e.g. Biemann 1962; McLafferty 1963; Budzikiewicz et
al. 1967; Burlingame and Schnoes 1969; Silverstein et al. 1974; McLafferty
and Turecek 1993).
Sample introduction methods include direct insertion using a probe,
high-pressure liquid chromatography, and GC. Ionisation methods include
thermionic electrons from a filament (electron impact, EI), or softer indi-
rect ionisation using a reagent gas (chemical ionisation, CI). The ions are
separated by a variety of ‘mass filters’, such as magnetic field, quadrupole,
ion trap, and time-of-flight (TOF). Additional resolution of the ions can be
obtained by tandem MS (MS-MS).
Low-resolution (nominal-mass) mass spectrometric requirements for
most organic compounds can be satisfied with magnetic, quadrupole, or
time-of-flight mass spectrometers. Electron impact (El) is the commonest
method used for sample ionisation. The usual 70 eV ionisation energy is
chosen as it provides a balance between extensive molecular fragmenta-
tion with a high yield of ions (designated by mass to charge, m/z or m/e)
and the detection of parent ions (molecular weight, M+ ), and the best
sensitivity.
The mass spectrum is a plot of ion intensity versus the mass-charge ratio
(m/z or m/e). If the molecule is not fragmented, and has only one charge,
then the molecular weight of the compound is the parent (or mother) peak
(M+ ) in the mass spectrum. When the molecule is fragmented, the original
molecular structure results in some fragments being more frequent than
others. These more frequent fragmentations will be recorded as higher
intensities than the more infrequent fragmentations. Knowledge of the
fragmentations a molecule produces can be used to deduce molecular
structure.
Mass spectral databases (e.g. the National Institute of Science and Tech-
nology [NIST] and the Wiley Registry) are available to facilitate inter-
pretation, but should not be used as the ultimate tool for identification.
Mismatches are common in molecules which fragment to produce many
ions and a molecular ion (parent ion) of relatively low intensity. Identifica-
tion should be based on the user first interpreting the mass spectrum using
known fragmentation rules, determining the parent ion, and using the mass
spectrum and chromatographic behaviour to suggest a molecular struc-
ture, facilitated by a mass spectral interpretation program (e.g. AMDIS).
The mass spectral databases can then be used to support the user inter-
pretations.
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Gas chromatography/mass spectrometry

GC/MS consists of coupled GC and MS, which are two independent ana-
lytical methods, in which the GC is the separation technique and the MS
analyzes ions from compounds according to their mass/charge ratio. The
power of the coupled techniques lies in the separation, followed by struc-
tural determination of the typically complex compound mixtures present
in most samples. The analyst’s approach typically follows three stages: (1)
choice of sample introduction into the GC; (2) choice of GC parameters;
and (3) choice of MS parameters.
There are numerous examples of the application of GC/MS to archae-
ological material. Pollard and Heron (1996) discuss the chemistry of resins
and tars, using their molecular composition. Lampert et al. (2002) applied
GC/MS in a preliminary study of SE Asian resins, and were able to sug-
gest a botanical source. Connan and Nissenbaum (2004) have shown that
detailed molecular studies of bitumens can be used to identify their sources,
and establish trade routes. Seath et al. (2006) showed that a wax coating a
pillow was not derived from beeswax, but geologically sourced (Figure 26).
Introduction – inorganic methods

Inorganic analytical techniques are well established in the archaeological
literature. Many of the techniques introduced in the organic section are
directly applicable to inorganic analyses, especially spectroscopic methods
for the determination of cations and anions in aqueous solutions. Elemental
analyses, for example, can be undertaken by using a plasma to ionise ele-
ments in aqueous solution before MS (inductively coupled plasma – MS,
ICP-MS). Hawthorne (1988) introduces spectroscopic inorganic analyses,
and Pollard and Heron (1996) indicate archaeological applications.
In this section, analytical methods focus on x-ray techniques which are
largely nondestructive, or require small enough samples to be almost non-
destructive. The analytical methods are outlined here, with Reed (1993,
1996) and Potts et al. (1995) recommended for more intensive reading.
X-ray techniques
In 1895, Roëntgen discovered mysterious rays, or x-rays (see Chapter 3). X-
rays are short wavelength electromagnetic radiation, with wavelengths (λ)
between 10−8 and 10−11 m. At the same time, it was also realized that crystals
had periodic groups of atoms and ions, and were a 3D grating.
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C26
100 a C25 C27
C24
C28
C23
%
C29
C22
C21
100 C27
b
%
C29
C25 C31
C30
C26
C28
0
0 10 20 30 40 50 60 70
Time
figure 26. Total ion chromatograms of wax coating a pillow (a) and beeswax (b). The
very different molecular compositions indicate that the pillow wax was not derived from
beeswax, but a geological source. Credit: Reproduced from Seath, J., Gize, A., David, A. R.,
Hall, K., Lythgoe, P., Speak, R., Caldwell, S. 2006. ‘An atypical ancient Egyptian pillow
from Sedment el-Gebel: evidence for migrant worker trading and technology’. Journal of
Archaeological Science 33: 549.
X-ray generation
X-ray radiation is generated when a charged particle is decelerated. When
an electron (e) is accelerated through a high potential difference (V), and
then stopped, released energy (E) will be in the x-ray wavelength (λ) range.
hc
E = eV = hv =
λ
hence
hc 12398
λ= = Å.
eV V
A filament generates thermionic electrons in a sealed low-pressure x-ray
tube which are accelerated through an applied potential difference and to
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hit a metal target. The x-ray wavelength generated depends on the metal
used in the target. Much of the energy released by the metal target is
heat, and it must be water cooled (an advantage of Cu as the target). The
generated x-rays pass through a window in the x-ray tube to the crystal.
If the target stops the electron in one step, then the maximum energy,
shortest λ, x-ray energy will be obtained. Energy transferred to the target
atoms will cause them to oscillate, and lower energy, longer λ x-rays will be
generated. Consequently an x-ray wavelength continuum is generated. To
filter the required x-ray wavelength from the continuum, a metal foil (e.g.
Ni) can be used, or a diffraction beam monochromator.
Powder X-ray diffraction

In x-ray diffraction (XRD), x-rays are reflected by atomic or ionic planes in a
crystal lattice. The spacing between the various lattice planes is diagnostic of
the crystal. Consequently, an XRD pattern can be used to identify unknown
minerals, either singly or in a mixture. In a mixture, a quantitative analysis
of the different minerals can be obtained. As the technique is based on a
crystallographic lattice, it is not applicable to liquids (including resins) or
gases, except liquid crystals. To obtain wavelengths appropriate for XRD
from crystals (≈1 Å), V needs to be ≈10 kV. A copper target is commonly
used, generating λ = 1.5 Å.
A crystal is built from unit cells, which are the arrangement of atoms in a
3D shape (e.g. a cube, rhombohedron), to develop the crystal lattice. The
crystal lattice is the arrangement of atoms as geometric points. The array
of atoms defines a plane, or groups of planes. The interplanar distance is
the d-spacing. The incoming x-ray from the x-ray tube will hit electrons in
the atoms in the crystal. The electrons will emit radiation in all directions.
Most of the wavelengths emitted will cancel each other out, except when
a certain incoming x-ray vector causes enforcement in one direction. This
direction is the ‘reflection.’
Braggs Law expresses the relationship between the incoming and
reflected x-ray vector (θ), the interplanar distance (d), and wavelength (λ):
nλ = 2d sin θ
where n is the order of reflection (frequently 1) (See Reed 1993: 59, fig. 6.1).
Much research has been undertaken on single crystals, but it is recog-
nised that archaeological applications tend to be identification of mineral
mixtures in pot fragments, geological samples (e.g. natron), or residues in
pots. Consequently, only powder XRD will be discussed further.
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Sample preparation. The aim of the sample preparation is to provide a

thin mixture of the analyte on a glass slide, covering an area of approximately
1 × 2 cm, in which the mineral fragments in the sample are randomly
orientated. By randomly orientating the mineral fragments, the maximum
number of diffraction planes will be utilised, providing the best XRD pattern
for interpretation. A few milligrams of sample is sufficient.
The material to be analysed is powdered initially in an agate mortar and
pestle, with amyl acetate. The powdered sample is pipetted as a suspension
in the amyl acetate onto the glass slide, resulting in a random orientation
of material in the amyl acetate suspension on the glass slide. The amyl
acetate is evaporated, leaving a dry residue for analysis. If an amyl acetate
suspension is not effective (e.g. with platey minerals such as micas and
clays), the powder can be mixed with collodion, Vaseline or Apiezon and
then smeared on the glass slide. During powdering of the sample, individual
grains can become covered with other minerals. It is essential to undertake
electron microscopy before powder XRD, as surface characteristics are lost
during powdering.
Analysis. The glass slide is placed in the x-ray diffractometer and kept sta-
tionary. The x-ray source is moved in an arc around the sample to ensure as
many lattice planes are used in the analysis. The reflections are detected.
Historically, photographic film was used as the detector. Alternative detec-
tors are now used with computerised systems.
Interpretation. The powder x-ray diffractogram contains three pieces of

information:
1. The angular position of the reflection line. This is related to the
interplanar distance, d.
2. The intensity of the peak. In a mixture of minerals, the intensity can be
used towards a quantitative analysis. In a single mineral, the intensity
is related to the arrangement of atoms in the unit cell.
3. The shape of the peak. A sharp peak results from a well crystallised
material, whereas a poorly crystalline material will have broader
peaks.
In identifying an unknown mineral, the angular position of the three most
intense lines are used initially, and searched through the Joint Committee
on Powder Diffraction Standards (JCPDS) database. A difficulty is that the
relative intensities of the peaks can vary. Once likely identifications are
made, all less intense peaks are used to complete identification. Use of
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computer databases has simplified and speeded interpretation enormously,

and the identification of several minerals in a mixture is now routinely
realistic.
Electron microbeam techniques
Electron microprobe
The main use of an electron microprobe (see Reed 1993: 14, fig. 2.1) is the
qualitative and quantitative chemical analysis of small volumes of solids
(≤5 µm). A scanning electron microscope is often incorporated as part
of the electron microprobe. The Periodic Table can be analyzed except
for elements lighter than carbon. The minimum detectability is typically
100 ppm, although this is dependent on the sample. Maps of elemental
concentrations can be obtained over a sample.
Advantages of the electron microprobe over other methods include the
following. Sample preparation is relatively simple, requiring a polished sur-
face on a block or glass section. Small volumes are needed, limited to 5 µm
diameter and depth. The analysis is nondestructive. The sample can be
viewed, ensuring that the analysis location is known. The disadvantages
are that the technique cannot generally identify the oxidation state of the
elements (exceptions are potentially Fe and S), groups such as –OH can-
not be identified, and quantitative analysis is poor for elements lighter
than carbon. A good polish is required which may be difficult for soft
materials.
Basics. Analysis is under a vacuum (≤10−4 torr) to permit passage of the

electron beam, and to prevent attenuation of the x-rays generated by lighter
elements. A filament (e.g. tungsten wire) generates electrons which are
drawn away by an anode plate to generate the electron beam. Two electro-
magnetic lenses (condenser and objective) focus the electron beam on to
the sample surface. The beam electrons reaching the sample have a fixed
energy defined by the accelerating potential.
Several processes occur when the electron beam hits the sample, most
important of which include (see Reed 1993 [Schematic diagram of electron
microprobe]):
i. Generation of diagnostic x-rays from the elements present in the sam-

ple
ii. Generation of a background radiation which is a continuum
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iii. The ejection of secondary electrons from atomic orbitals by the elec-
tron beam (the basis of SEM)
iv. The reflection of beam electrons as backscattered electrons (also used
in SEM)
v. Cathodoluminescence
The diagnostic x-rays are emitted from electrons around the atomic
nucleus, provided the incident beam energy is sufficient (the critical exci-
tation energy or ‘binding’ energy). The incident beam electron can ‘hit’ an
orbital electron and be scattered (see Potts et al. 1995: 5, fig. 1.3: Schematic
representation of processes resulting from electron bombardment). The orbital
electron is also ejected.
The empty electron level is filled by an electron from an outer orbital
shell, and the energy lost emitted as a photon. The photon may emit another
electron from the same atom, termed auger electron emission (the basis of
auger spectroscopy), or the photon may be emitted as an x-ray photon. The
x-rays generated from the elements in the sample contain the following
information: the wavelength (λ), which is dependent on the emitting ele-
ment, and intensity, which is dependent on the concentration of elements
in the sample.
If the electron is ejected from the K orbital, it is termed K radiation
(Potts et al. 1995). If the replacing electron comes from the L shell, it emits
Kα radiation, and if from the M orbital, it emits Kβ radiation. An electron
ejected from the L orbital generates L radiation, and if ejected from the
M orbital it generates M radiation. A background radiation continuum is
produced by deceleration of the incident beam electrons as they pass the
atomic nuclei. The loss of energy generates the background radiation (also
termed the braking radiation or Brehmstrahlung).
The generated x-rays hit a curved crystal in which the atomic planes
are physically bent, and are reflected to a detector for amplification and
recording. The angle of the crystal can be set at a specified angle (θ) to
the incident x-rays. From Braggs Law (above), at a specific θ, only x-rays of
a fixed wavelength will be detected. The intensity of the diagnostic peak,
which is proportional to the concentration of the element in the sample,
is subtracted from the background radiation continuum either side of the
diagnostic peak.
This is the basis of wavelength dispersive spectrometry (WDS), in which
detection and quantification is based by ‘sitting’ on a fixed wavelength. WDS
is relatively time consuming, but is best suited to high quality quantitation
and elemental mapping. A representative WDS analysis of brass is shown
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in a diagram in Reed (1993: 143; fig. 11.1), with the emission lines of Cu and
Zn.
Quantitation acknowledges three factors which have to be considered in
obtaining the best quantitative analyses: the ZAF correction. The Z factor
(or generation factor) acknowledges that the incident beam not only inter-
acts with the sample surface, but can interact to depths of approximately 5
µm. The depth to which the beam interacts depends on the atomic num-
bers (Z) of the elements in the sample and their atomic weights. Correction
is needed for absorption (A) or generated x-rays will occur in the sample.
The generated x-rays will cause fluorescence (F) by ionizing elements in
the sample and generating further x-rays. The ZAF correction is now com-
puterised.
The faster alternative to WDS is energy dispersive spectrometry (EDS).
The detector registers the x-ray photon energy and its intensity, and the
detector output is managed by a pulses height analyser. The data are pre-
sented as a plot of pulse height (corresponding to elemental concentrations
in the sample) versus x-ray energy (diagnostic of the elements in the sam-
ple). Although quantitation is not of as high a calibre as WDS, data are
often adequate to identify a material.
Scanning electron microscopy

In the electron microprobe, the incident electron beam is focused on a spot.
The beam can be moved along a line to give a ‘line analysis,’ or rastered
across the sample to give multiple line analyses, which is the basis of SEM.
The advantage of SEM is that it gives topographic information.
Relatively low energy secondary electrons are lost from the surface sam-
ple during bombardment by the incident electron beam. The secondary
electrons are directed to the detector by a positive grid, and then detected
and amplified to give an image of the rastered surface. Back scattered elec-
trons, derived from the incident beam, have higher energies than secondary
electrons, and can provide higher contrast images than those derived from
secondary electrons.
An x-ray detector (typically EDS) can provide elemental analyses in scan-
ning electron microscopes.
Preparation. In both electron microprobe and SEM, the effects of the

incident electron beam and the surrounding low pressure must be con-
sidered. The sample must be dry, or the low pressure will cause physical
distortion of the sample during analysis. If the incident electron beam energy
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figure 27. SEM image of natron crystals (based on morphology) in a desiccation crack
in the bladder of the mummy of Asru, Manchester Museum. Credit: Andrew Gize.
figure 28. ESEM image of crystalline wax coating an ancient Egyptian pillow. Note
the absence of any burning or charging of the wax by the electron beam. Field of view
90 µm. Credit: Reproduced from Seath, J., Gize, A., David, A. R., Hall, K., Lythgoe, P.,
Speak, R., Caldwell, S. 2006. ‘An atypical ancient Egyptian pillow from Sedment el-Gebel:
evidence for migrant worker trading and technology’. Journal of Archaeological Science
33: 548.
159
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is too high, ‘burn off ’ of lighter elements can occur (e.g. Na), or the sample
itself can show signs of damage. A key requirement is that the electrons
from the incident electron beam can flow from the sample to an electrical
ground. If the concentration of electrons builds up in the sample through
‘charging,’ the incident electron beam will become unstable, resulting in
poor analytical data and images.
A variety of sample holders are available in scanning electron microprobes
and scanning electron microscopes. Samples can be in resin, on glass slides,
or attached by an adhesive pad to an aluminium stub. In all cases, to prevent
charging, the sample is either coated in gold (best) or carbon, prior to
analysis.
To illustrate the advantages and disadvantages of SEM, Figure 27 shows
an SEM image of presumed natron crystals along a desiccation crack in the
bladder of the mummy Asru (Manchester Museum). The crystals can only
be presumed to be natron on the basis of their morphology, as the elements
in natron are too light to be easily detected and quantified. The conductive
coating of the specimen, however, has ensured that these fragile crystals can
be recorded.
Environmental scanning electron microscopy

SEM requires sample coating with a thin conductive film (e.g. Au, C) to
conduct electrons away from the surface being impacted by the incident
electron beam. In addition, the sample must be dry before coating. Although
sample sizes are small, a hindrance in archaeological applications is that the
coating can be permanent, and therefore analysis is not strictly destructive.
Environmental scanning electron microscopy (ESEM) is a relatively new
SEM design in which it not necessary to ensure that the sample is dry nor
to coat it to prevent charging.
As in SEM, the electron beam needs to be generated and travel through
low pressures. In an ESEM, a seal with small apertures (micrometre scale)
is placed before the sample. The sample itself can then be exposed to a
higher pressure atmosphere containing water vapour. The water vapour in
the sample chamber excludes the need to desiccate samples.
The incident electron beam passes through the sample chamber and
generates secondary electrons. The secondary ions impact vapour water
molecules to produce additional secondary electrons, which in turn impact
other water molecules to produce further secondary electrons. The genera-
tion of all these secondary electrons in a cascade amplifies the signal reach-
ing the detector. The water molecules that have lost secondary electrons
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have a positive charge, which significantly reduces the effects of charging

on the sample.
Currently, SEM with Au- or C-coated samples produces higher resolution
images than ESEM. Nevertheless, ESEM is advantageous in that it requires
no preparation, and imaging coupled with EDS elemental analysis is usually
non-destructive.
Figure 28 shows crystalline wax coating a pillow, emphasising the non-
destructive potential of ESEM. The wax crystals show no evidence of burn-
ing or partial melting under the beam, and charging is absent from the
crystal edges.
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chapter 11
The facial reconstruction of ancient

Egyptians
Caroline M. Wilkinson
Introduction
Facial reconstruction (otherwise known as facial approximation) is the pro-
cess utilised to reproduce the facial appearance of an individual by relating
the skeletal structure to the overlying soft tissue (Gerasimov 1971; Prag and
Neave 1997; Taylor 2001; Wilkinson 2004). Facial reconstruction has been
used to provoke recognition in forensic identification investigations world-
wide, and is a powerful forensic tool that significantly enhances the chances
of identification of the deceased.
The Manchester mummy team has been at the forefront of research into
the facial depiction of ancient Egyptians since its conception in 1973 (David
1986; David and Tapp 1992). Initial forensic investigations of Egyptian mum-
mies housed at The Manchester Museum involved Richard Neave, a med-
ical artist from the University of Manchester (Neave 1979). In 1973, Neave
reconstructed the faces of the Two Brothers, a pair of twelfth Dynasty (c.
1900 b.c.) Egyptians. This early work followed a rather simple, undeveloped
method and Neave stated that ‘whilst a great deal of attention was paid to
the areas of muscle insertion and their probable effect upon the face, we
put very little effort into developing the muscle groups themselves’ (Prag
and Neave 1997).
Neave used the tissue depth data produced by Kollman and Buchly (1898)
from cadavers of White Europeans for these reconstructions and worked
exclusively with skull casts and sculptors’ clay and often built the neck
structure onto the facial reconstructions to give the finished head a more
balanced appearance. Guidelines set up by Krogman (Krogman and Iscan
1962) and Gerasimov (1971) were also used to interpret the facial features.
Although this early work was heavily based upon the work of Gerasi-
mov (1971), Neave and his successors have developed and refined the facial
162
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The facial reconstruction of ancient Egyptians 163
reconstruction technique through research and experience and this method

has been adopted by other practitioners across the world. The Manchester
method attempts to interpret the skeletal detail of the skull to establish facial
morphology, whilst using tissue thickness data as a guide to the soft tissue
depth. Early work used tissue data from Black Americans (Rhine and Camp-
bell 1980) or mixed-race Africans (Phillips and Smuts 1996), but more recent
facial reconstructions have been able to use tissue depth data taken from
a contemporary Egyptian population (El-Melhallawi and Soliman 2001).
Traditionally, the facial reconstructions of ancient Egyptians resulted
from the invasive study of the mummified remains. Once the soft tissue
had been removed, the skull could be analysed and a replica of the skull
manufactured (Taylor and Angel 1998) on which to produce the facial recon-
struction. Mould making is a complicated and time-consuming craft, and a
great deal of specialised experience is necessary for skull replication. It is not
recommended that inexperienced practitioners perform skull replication
on human remains involved in forensic or archaeological investigations, as
irreparable damage may occur that might preclude further forensic analysis
or historical documentation.
With the development of clinical imaging, noninvasive assessment of
mummified human remains has become possible. Cross-sectional data cre-
ated by x-ray computed tomography (CT) scanning can be utilised to pro-
duce a three-dimensional digital model of the skull (Spoor et al. 2000) and
replica skulls may be produced from digital data by using stereolithography
(Hjalgrim et al. 1995) or another form of three-dimensional model man-
ufacture (Seitz et al. 2005). There are varieties of software packages that
render the surface cross-sectional CT data by extracting selected tissues
and visualising the tissues as three-dimensional models. Surface rendering
involves segmentation (isolation of the tissue by thresholding), interpola-
tion between the slices to create a smooth surface and illumination of the
surface. Digital three-dimensional models of the skull can also be imported
into computer-based facial reconstruction systems.
The accuracy of facial reconstruction

To some extent, forensic identification investigations provide an opportu-
nity to assess the accuracy of the facial reconstruction, when the individ-
ual is finally identified. Comparison of the identified individual with the
reconstruction may be possible, although the results of such comparisons
may be misleading because only successful cases may be used. Conse-
quently, blind studies have been suggested to evaluate the accuracy of facial
P1: JYD
164 Caroline M. Wilkinson
reconstruction, and several such studies have been produced by researchers

from the Manchester mummy team to validate their methods.
Following his early work on the Two Brothers, Neave reconstructed the
faces of four cadavers to establish the accuracy of facial reconstruction.
Neave produced manual reconstructions and then correctly linked each to
a photograph of the cadaver (Prag and Neave 1997).
Later in his career, Neave was provided with another opportunity to eval-
uate the technique when, as part of a challenge set up by the Dutch National
Association for Oral and Maxillofacial Surgery, he was provided with a skull
replica made from CT scans of a volunteer. The clay reconstruction was
sufficiently similar to the individual for Neave to recognise him in a room
full of people (Prag and Neave 1997).
Some years later, Wilkinson conducted a comprehensive accuracy study
in which five female skulls were used (Wilkinson and Whittaker 2002). The
faces were reconstructed by the manual method and evaluated by face pool
identification, resemblance ratings and morphological assessment by image
superimposition. Fifty volunteers correctly identified each reconstruction
as the most frequently chosen face from a pool of ten faces, and there was
an average identification rate of 34 per cent above chance (10 per cent). In
addition the reconstructions were rated on average as a close resemblance
to the identified individuals and image superimposition showed that facial
proportions, nose shape and jaw line were the most accurate features whilst
facial fatness and ear shape were the areas of most error. The authors con-
cluded that it is possible to produce a better than approximate resemblance
using this method.
Further research was conducted a few years later utilizing the computer-
based facial reconstruction system developed by Wilkinson (2003, 2005).
This blind study used the CT data of two live White North American sub-
jects, and facial reconstructions were produced by two practitioners (Wilkin-
son et al. 2006). The reconstructions were evaluated by face pool identifi-
cation and three-dimensional morphological superimposition. Seventy per
cent of the volunteers correctly identified the reconstructions from the face
pools (50 per cent above chance) and both reconstructions received iden-
tification rates at least 50 per cent greater than any other face in the pools.
Even with differences at the cheeks caused by the position of the subject
in the CT scanner, the shell-to-shell deviation maps suggested that 57.5 per
cent of the facial reconstruction surfaces showed less than 2.5 mm error
and 83 per cent showed less than 5 mm error. Both reconstructions showed
upper lip and ear pattern errors.
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figure 29. Facial reconstruction procedures. Top row: Manual two dimensional – the
musculature and facial morphology are drawn over a photograph of the skull. Skin colour
and texture are then added in Adobe Photoshop or with paint. Middle row: Manual three
dimensional – the musculature and skin layer are modelled in clay onto a replica skull.
The finished cast of the head can be painted and a wig, plastic eyes and facial hair
added. Bottom row: Computerised three dimensional – the musculature is added from
a database of premodelled muscles and distorted to fit the skull. A skin layer is then
added in virtual clay, followed by colours and textures that are mapped onto the three-
dimensional model. Facial reconstructions by Caroline Wilkinson, Dundee University.
Credits: Caroline Wilkinson, University of Manchester, and Image Foundry Ltd.
The results of these studies suggest that this method of facial reconstruc-
tion will produce a better than approximate resemblance to the individual
and therefore justifies the use of this method to recreate the faces of ancient
Egyptians from mummified remains.
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Facial reconstruction methods

Currently we can divide the facial reconstruction methods into two basic
groups: two-dimensional and three-dimensional techniques. There are a
variety of different methods within each group.
Two-dimensional facial reconstruction

Manual. Drawings and paintings of the face can be produced on overlays
superimposed onto images of the skull or craniographs (see Figure 29).
Frontal and profile views are often produced using this technique. There
are a number of publications outlining the methodology (Krogman and
Iscan 1986; Iscan and Helmer 1993; Taylor 2001).
Some practitioners prefer to draw the facial musculature onto an initial
overlay before attempting the finished facial morphology (Needham et al.
2003), whereas others draw the finished face directly over the skull images
(George 1993; Taylor 2001). A great deal of artistic ability and portraiture
skills are necessary to produce a realistic facial likeness by using the two-
dimensional manual method.
Computerised. A facial composite created from photographic or sketched

features can be produced over an image of the skull by using computer soft-
ware designed specifically for the reconstruction of facial appearance from
skeletal remains. Facial outlines and features are chosen from a database
dependent upon the skeletal structure, and the proportions of the skull
determine the overall face shape and appearance.
A variety of software exists that create facial images similar to those of Efit,
Identikit, or Profit composite systems. Usually, frontal view images only are
produced (Evenhouse et al. 1992; Ubelaker and O’Donnell 1992; Miyasaka
et al. 1995; Stratomeier et al. 2005).
Three-dimensional facial reconstruction

Manual. Facial sculptures are produced directly onto the skull or skull
replica (see Figure 29). Some practitioners favour an anatomical approach
(Gerasimov 1955; Prag and Neave 1997; Wilkinson 2004), modelling the
facial musculature before applying a skin layer to depict the facial appear-
ance, whereas others favour a morphometric approach, using mean tissue
depth data to create a contour map of the facial surface into which the
facial features are modelled (Gatliff and Snow 1979; Krogman and Iscan
1986; Iscan and Helmer 1993).
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Current practitioners of the anatomical approach also use mean tissue

depth data as guides, and most practitioners of the morphometric approach
also apply some anatomical guidelines. There are a number of publica-
tions outlining these methodologies (Krogman and Iscan 1986; Iscan and
Helmer 1993; Prag and Neave 1997; Clement and Ranson 1998; Taylor 2001;
Wilkinson 2004).
Computerised. Over the last decade numerous systems have been devel-
oped to produce facial reconstruction using computer software, with the
aim of increasing the levels of flexibility, efficiency, and speed. The first
computer technique to be developed for forensic purposes was produced
by Moss and his colleagues at University College London and was based
upon a system used for cranial reconstructive surgery (Moss et al. 1987).
Currently computerised facial reconstruction systems can be divided into
two groups – automated systems and modelling systems.
Automated systems are based on anthropometrical data and/or templates
of skeletal and facial morphology. Tissue data from clinical images are
included and facial templates (dependent upon the sex, age, and ethnic
group of the skull) are ‘morphed’ to fit the skull. Additional manual inter-
vention may also be necessary to apply external facial details. These systems
create multiple variations for each skull, and impose a very specific set of
facial characteristics onto the facial reconstruction, in that the resulting
face will ultimately resemble the sample face (Michael and Chen 1996;
Quatrehomme et al. 1997; Nelson and Michael 1998; Jones 2001).
Three-dimensional modelling systems have also been utilized to mimic
the manual methods of facial reconstruction. Some modelling systems use
three-dimensional animation software (Buhmann et al. 2003; Eliasova et al.
2003; Kahler et al. 2003; Kindermann 2003) to model the face onto the skull,
whereas other systems utilise virtual sculpture systems with haptic feedback
(Wilkinson 2003; Subke and Wittke 2005) (see Figure 29).
The systems with haptic feedback have the advantage of allowing the
practitioner to feel the surface of the skull during analysis, which will
provide some important skeletal details for facial reconstruction, such as
determination of the malar tubercle or muscle attachment strength. Three-
dimensional modelling systems may follow either the anatomical (Wilkin-
son 2003) or morphometric approaches (Subke and Wittke 2005).
The uses of facial reconstruction in Egyptological investigations

The facial reconstruction of ancient Egyptians has a long history and has
been utilized for various purposes.
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Depiction of ancient people. Many archaeological investigations have

concentrated upon the re-creation of the facial appearance solely as an
exercise in depiction: namely, to show the public how these ancient people
looked and to enable comparison with contemporary faces in Egypt and
worldwide. Such examples include the facial reconstruction of Tutanhka-
mun (Gatliff 1980; Handwerk 2005), Nesperennub (Taylor 2004), and Janus
(Tukker and Dassen 1999) (see Plate XVII).
Depiction from mummified soft tissue. Often the assessment of

mummified soft tissues will reveal details of facial morphology that cannot,
as yet, be accurately determined from the skeleton alone (see Figure 30).
Frequently, the ears will be preserved, with varying degrees of deterioration,
and it may be possible to determine ear shape, size, protrusion and/or detail.
Similarly, the nasal tip, vermillion line, hair line and facial wrinkle patterns
may be visible.
Because shrinkage and distortion may affect the facial appearance, the
skeletal detail should also be assessed where possible to establish feature
morphology. Known effects of the mummification procedure should be
taken into account when reconstructing mummified faces, because many
facial features will be distorted by the bandages, the nose may be distorted
by brain removal and the eyes may be sunken due to postmortem changes.
For example, the large majority of Egyptian mummies appear to exhibit
hooked noses in profile, yet this is typically a bandage distortion rather than
the actual profile of the nose, and only experienced facial anthropologists
will recognise this phenomenon.
Three-dimensional models from two-dimensional data. Where

access to the original skull is not possible either directly or via three-
dimensional clinical imaging, methods of three-dimensional model pro-
duction from two-dimensional data (such as radiographs, photographs and
craniometrics) may be utilised. Early researchers (Neave 1986) modelled
the skull shape manually in clay, using outlines from radiographs as tem-
plates. Because only two templates could be utilised, there was a great deal
of estimation involved in this method.
Computer systems may now be used to produce a three-dimensional
model of the skull from radiographs and/or photographs. Multiple views
are aligned using cranial points as registration marks (see Figure 31) and
virtual sculpture (Wilkinson 2003) or mesh distortion of a template skull
(Davy et al. 2005) reproduces the skull morphology. Extrapolation of surface
morphology between the views is inevitable and the more views that are
available, the more accurate the resulting three-dimensional model of the
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figure 30. The preserved remains of an ancient Egyptian priest (A) and facial recon-
struction (B). The replica of the mummified face was produced from CT scan data
by using stereolithography, courtesy of The National Museums of Scotland and PDR,
Cardiff. The facial reconstruction was produced by Caroline Wilkinson. Credits: Caroline
Wilkinson and University of Manchester.
figure 31. Production of a three-dimensional skull model from two-dimensional data.

The skull was modelled utilising radiographs and scaled drawings as templates, whereas
numerous craniometrics and photographs were used to provide the detail and enable
accuracy. (A) Side view of skull model with scaled drawing as template. (B) Three-
quarter view of skull model with all template images visible. (C) Side view of transparent
skull model with radiographs as template. Credits: Caroline Wilkinson and Chris Rynn,
Dundee University.
169
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skull will be. As these methods include a certain degree of estimation and
loss of detail on the surface of the bone, any resulting facial reconstruction
would require photographic records of the skull and/or an appreciation of
the decrease in accuracy of any resulting face.
This same procedure has also been applied to the reconstruction of mum-
mified soft tissue (see Figure 32). One of the more interesting challenges
was the depiction of Ramesses II. Ramesses II was an Egyptian pharaoh
from the nineteenth Dynasty. He is believed to have taken the throne in
his early twenties and to have ruled Egypt from 1304 b.c. to 1237 b.c. His
unwrapped mummified remains are housed at the Egyptian Museum of
Cairo and there are a small number of existing craniographs taken in 1976.
Sadly, the craniographs are of poor quality and of limited views and it was
impossible to recreate an accurate three-dimensional model of the skull of
Ramesses II from this material.
The mummified soft tissues of the face of Ramesses II were visible and had
been photographed from multiple angles and views. It was therefore possible
to recreate the mummified face of Ramesses II by using virtual sculpture.
The craniographs were used to establish the facial proportions and profile
and the photographs were then utilised to model the feature detail and those
areas not visible on the radiographs. The mummified face of Ramesses II
was then ‘dehydrated’ to recreate his living appearance. Because Ramesses
II was estimated to have been between 87 and 93 years of age when he
died, he was given a rather emaciated facial appearance, consistent with
an elderly statesman. Finally the three-dimensional computer model was
given a coloured skin texture, eye colour and hair to realistically depict
Ramesses II in his later years (see Figure 32).
Facial reconstruction has also been utilised in an attempt to investi-
gate cultural, social, medical, genetic and environmental aspects of ancient
Egyptian life.
Comparison with portraiture. The Egyptian mummy portraits (or Fay-

oum portraits) are well known to Egyptologists and all date from the first to
second centuries a.d. Most were produced using the same encaustic tech-
nique and almost all the portraits are frontal, giving a haunting look, as if
they are staring at the viewer.
These portraits have been analysed by Egyptologists to determine
hairstyles, jewellery, fashion, and social status, but little was known about
the accuracy of the portraits. Researchers questioned whether the portraits
really portrayed the deceased or if they were stylized and whether they were
produced during life or posthumously. It has been estimated that there are
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figure 32. The facial reconstruction of Ramesses II from the mummified soft tissues. Radiographs
showing the soft tissue outlines (A) were used as templates to create a three-dimensional model (B)
of the mummified face, and the photographs (C) were used as reference for detail and accuracy.
The soft tissues in life were produced by ‘rehydrating’ the mummified remains (D) to establish facial
appearance prior to mummification (E). Skin tone and texture were estimated (F). Reconstruction
by Caroline Wilkinson, Dundee University. Credit: University of Manchester.
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figure 33. Comparison of facial reconstructions of ancient Egyptians with portraits.

Column 1: Facial reconstruction and portrait of fifty-year-old male. Reconstruction by
Richard Neave. Courtesy of the British Museum. Column 2: Facial reconstruction and
portrait of twenty- to twenty-five-year-old female. Reconstruction by Denise Smith. Cour-
tesy of the British Museum. Column 3: Facial reconstruction and portrait of twenty-nine-
to thirty year-old male. Reconstruction by Caroline Wilkinson. Courtesy of the Polish
Centre for Archaeology, Cairo, Egypt. Column 4: Facial reconstruction and portrait of
thirty-year-old male. Reconstruction by Caroline Wilkinson. Courtesy of the Glyptotek
Museum. Column 5: Facial reconstruction and portrait of thirty- to thirty-five-year-old
male. Reconstruction by Caroline Wilkinson. Courtesy of the Metropolitan Museum of
Fine Arts, New York. Credit for images of reconstructions: University of Manchester.
more than a thousand mummy portraits, but fewer than a hundred are still
bound into their mummies. Thus the number of candidates for a study of
the realism of the portraits was relatively small.
Over the last ten years, facial anthropologists from the Manchester
mummy team have studied five of these mummies with portraits (Wilkin-
son 2003; Brier and Wilkinson 2005). In all cases the reconstructions were
produced blind and then compared to the attached portraits (see Figure
33). Three of the reconstructions were created using actual skulls and two
reconstructions were created on skull replicas produced from the CT data.
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figure 33. Continued
Two examples were from the British Museum: a fifty-year-old male and a
twenty- to twenty-five-year-old female; and another, a twenty-nine- to thirty-
year-old male, was from the Polish Centre for Egyptology in Cairo. All three
of these reconstructions showed high consistency with the facial features on
the portraits, although the portrait of the young male was in poor condition
and showed a fatter face than the reconstruction. These reconstructions
were similar enough to the portraits to suggest that they were indeed painted
during the lifetime of the individuals and were not idealised images (see
Figure 33).
The other two cases produced differing results. The skull of a thirty-year-
old male was provided by the Glyptotek Museum. The portrait and the
reconstruction were very different and appeared to show individuals from
different racial origins. The portrait revealed the face of an older man with
a longer narrower face and longer nose. Superimposition of the skull and
the portrait showed that the proportions of the face did not match those of
the skull, and, therefore, it was suggested that the skull and the portrait may
not be of the same individual (see Figure 33).
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figure 34. Depictions of disease and trauma in facial reconstruction work. (A) Iron Age
woman with haemangioma, a fleshy growth to one side of the face. (B) Soldier from
the Battle of Towton with healed wound to jaw. (C) Medieval woman with meningioma
hyperostosis and related soft tissue changes. Credit: Caroline Wilkinson.
Finally, the skull of a thirty- to thirty-five-year-old male was provided by

the Metropolitan Museum, New York. The portrait appeared to be of a
younger man of a more Caucasian appearance, with a narrower nose, but
there were many consistencies in facial proportions and face shape, with
similar jaw lines and mouth shapes. Skull and portrait superimposition
suggested similarity, except at the nose, where the nose of the portrait was
narrower than the nasal aperture of the skull.
Because the facial proportions and other facial features were consistent
between the skull, reconstruction and portrait, it was suggested that the artist
may have ‘stylised’ the portrait of the individual, perhaps to fit more with the
traditional Graeco-Roman fashion (see Figure 33). It is also possible that the
CT data were not of high enough resolution to visualise the small endings
to the bones at the nasal aperture, suggesting a misleading nasal width.
These five comparisons between facial reconstructions and portraits
yielded somewhat different results, but provided insight into the accuracy
and timing of the artwork. Future studies utilising other mummy and por-
trait combinations would shed further light on these enigmatic portraits.
Depiction of disease and trauma. Facial reconstruction can also be uti-

lized to illustrate the effects and treatment of disease and trauma in ancient
populations. Where wounds show signs of healing or where a pathological
condition or long-standing disease has altered facial appearance, it may be
necessary to demonstrate this as part of the reconstruction.
The first facial reconstruction case that involved facial trauma was Neave’s
work on Philip II, King of Macedon in c. 250 b.c. (Prag and Neave 1997).
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figure 35. Facial reconstructions of the skulls from Tomb KV5. Top row: skull of middle-
aged man in good condition and resulting two-dimensional facial reconstruction. Middle
row: skull of middle-aged male partially excavated and resulting two-dimensional facial
reconstruction. Bottom row: fragmented and partially reassembled skull of middle-aged
male and resulting two-dimensional facial reconstruction. Reconstructions by Caroline
Wilkinson and Caroline Needham. Credit: University of Manchester.
Wilkinson (Wilkinson and Neave 2003) reconstructed the face of a soldier

from the Battle of Towton (c. 1461 a.d.), and the skull demonstrated a massive
healed sword wound to the lower jaw. The reconstructed face exhibited the
scar resulting from the treatment of this wound, and facial paralysis caused
by the trauma (see Figure 34).
There have been a number of reconstructions depicting long-standing
disease in ancient populations (see Figure 34). Neave produced a facial
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reconstruction of Robert the Bruce (Wilkinson 2004), exhibiting the effects

of leprosy and also a number of healed wounds to the forehead. Where
these conditions will have altered the facial appearance of the individuals
significantly and for a long period of time prior to death, it is reasonable to
include the visual symptoms as part of the reconstruction.
There has, however, been little attention to facial pathology with regards
to the reconstructions of ancient Egyptians. Some reconstructions have
shown dental abnormalities (see Figure 34), but there have been few
examples of healed trauma or long-standing facial disease. Further research
into this subject could be rewarding.
Assessment of familial links. Facial reconstruction has been utilized

to attempt to assess the genetic relationship between individuals. Certain
facial features have a hereditary component, such as adherent ears and bifid
noses. Consistency in feature morphology, proportions and characteristic
features cannot, however, positively identify a genetic relationship, and may
only be used to lend weight to such a theory.
Prag and Neave (1995) reconstructed the faces of seven individuals
from an ancient Greek grave circle at Mycenae, with the aim of discov-
ering whether, having recreated the faces, they might be able to judge
whether these individuals were in any way related to each other. They
found that those from the same graves showed family likenesses in facial
proportions and nasal shape, and individuals from graves in different
parts of the circle generally exhibited smaller lower facial proportions
and differences in interorbital distance, nasal prominence and forehead
shape.
Similarly, Wilkinson (Redknap 2002) reconstructed the faces of four
of five individuals from a Viking period (c. 980–1000 a.d.) burial site in
Llanbedrgoch, Wales, and discovered that the skulls all exhibited adherent
ears and supraorbital notches, which are known hereditary characteristics.
In addition, the nasal apertures of these skulls exhibited consistent features.
The facial anthropology assessment suggested a possible familial relation-
ship, even though this could not be positively confirmed.
The ancient Egyptian population has also been studied in this way.
Wilkinson and Needham were involved with the Theban Mapping Project
and the excavation of KV5, a tomb in the Valley of the Kings, thought to
have housed the sons of Ramesses II. Weeks and his colleagues discovered
the skulls of four individuals in KV5 (Weeks 2001) and a facial anthropology
assessment was performed to ascertain whether these individuals could have
been related to Ramesses II. Only three of the four skulls were available for
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figure 36. Comparison of the facial reconstructions from Tomb KV5 and Ramesses II.
The horizontal lines intersect the face of Ramesses II at the top of the head, outer canthus,
base of the nose, mouth slit and base of the chin. Faces 2 and 3 show consistent proportions
with those of Ramesses II. The horizontal proportions of face 3 are significantly different
from all the other faces. Credit: Caroline Wilkinson.
assessment: one was intact and clean, one was still partially buried and one
was fragmented.
Due to the condition of the skulls and limited access, only photographic
evidence was possible and two-dimensional reconstructions were attempted.
The fragmented skull could only be assessed in profile, as many pieces were
missing and full reassembly was not possible; however, enough of the skull
was intact to allow reassembly of the vertical proportions and the left profile.
The remaining two skulls were reconstructed in frontal and profile views
(see Figure 35) by two practitioners.
The facial reconstructions were then compared with the mummified face
of Ramesses II and the facial reconstruction that had been produced from
his mummified soft tissues (see Figure 32). All the faces had similar features,
such as a long narrow face shape, long noses and prominent cheek bones,
and two of the skulls had very similar vertical proportions to Ramesses II (see
Figure 36). The face of Ramesses II exhibits long vertical distances between
the nose and the mouth and the mouth and the chin. It could be said
that this is one of the most striking features of Ramesses II. These vertical
proportions were consistent in two of the faces from KV5; however, one of
the skulls had very different vertical proportions to Ramesses II, exhibiting
a very short nasolabial distance and chin (see Figure 36).
Wilkinson concluded that although two of the skulls were consistent with
Ramesses II in facial proportions and morphology, one was not. Therefore,
these results shed some doubt on this individual being directly related to
Ramesses II.
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The inclusion of facial reconstruction in the scientific investigation of

ancient Egyptian mummies has a long history. In recent years, there have
been many technological developments that have widened the possibilities
and allowed the noninvasive study of mummified remains. With the rapidly
developing computer technology and medical imaging availability, there is
unlimited scope for future research.
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part 3
The treatment of disease

in ancient Egypt
179
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180
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chapter 12
The ancient Egyptian medical system
A. Rosalie David
Sources for the study of Egyptian medicine

The sources for the study of ancient Egyptian medicine include inscrip-
tional, archaeological and palaeopathological evidence (Ghalioungui
1973). The most significant information regarding the Egyptian concept
of the body system, and the medicinal and pharmaceutical treatments they
used is preserved in twelve documents known as the Medical Papyri (see
p. 186–193); also, funerary biographical texts inscribed on stone tablets (ste-
lae) give the titles and brief career details of some doctors.
Those temples associated with medical training and healing procedures
provide limited archaeological evidence; in one, the Temple of Kom Ombo,
there is a Roman Period wall-relief, which may depict a set of surgical
instruments. Until now, the only identified surgical instruments that have
been discovered date to the Graeco-Roman Period; however, it is possible
that earlier, but unidentified, examples of surgical appliances may exist in
museum collections.
In Egyptian tombs, the wall-reliefs generally represented the tomb owner
and his elite contemporaries as stylised figures with a youthful, healthy
appearance. By portraying them in this way, and using magical rites to
activate the life force in these figures, the Egyptians hoped to ensure that
these individuals would spend the afterlife in a state of fitness. Because
of this idealisation of the figures, the scenes do not provide an accurate
record of the diseases and illnesses suffered by the elite, although signs and
symptoms of ill health are sometimes depicted in the representations of
servants and labourers.
Human remains (both naturally preserved and intentionally mummified
bodies) are a very important resource for the study of disease, but so far, they
have provided scant evidence regarding medical practices and treatments.
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182 A. Rosalie David
All the sources therefore provide limited information about the medi-
cal system, and sometimes, as with the principles of idealising the human
figure in the tomb art, the ‘evidence’ can falsify the reality of everyday
existence.
The role of magic in medical practice

The Egyptians believed that supernatural forces could be used to change
the form of things and to influence events. The name for this force was
heka (Pinch 1994: 9), which has been translated into English as ‘magic;’ the
Egyptians personified this force as the goddess Heka.
According to Egyptian mythology, the universe was brought into existence
through the divine creative word, and magic was the principle through
which this spoken command was turned into reality. Although magic was
considered to be more powerful than all the other forces of nature and had
influence over all created forms, it was under the control of the creator god.
Essentially, it provided the gods and the king with a potent weapon for their
continuing struggle against chaos in the heavens and on earth.
Magic was integral to the Egyptian belief system and was widely used at all
levels of society. It took many forms: state magic, performed in the temples,
maintained the equilibrium of the universe; funerary magic ensured that
the deceased attained the afterlife; everyone used spells and amulets to ward
off evil; and magical rites, incantations, and spells played an important role
in treating the sick.
The Egyptians adopted various approaches to treating and healing the
sick. Modern studies classify these as ‘rational’ and ‘irrational’ or ‘magical’
methods, and although this distinction and categorisation would have been
meaningless to the Egyptians, the source material does demonstrate that
there were two medical routes, one based on magico-religious concepts
and the other on scientific observation of the patient’s condition.
Archaeological and literary evidence indicates that magic was an impor-
tant aspect of religion for at least 4,500 years. The Medical Papyri (see below)
clearly demonstrate that rational and irrational methods both played signifi-
cant roles in treatment. Indeed, magic is as prominent in the earlier periods
as in later times, and there is no evidence that medicinal procedures either
‘progressed’ from magical to rational methods or, conversely, declined from
a scientific approach into superstitious practices.
A significant study at Manchester, the Pharmacy in Ancient Egypt Project,
is currently assessing the therapeutic efficacy of ancient Egyptian medica-
ments (see Chapter 14); however, just a few examples can demonstrate the
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The ancient Egyptian medical system 183
Egyptians’ flexible approach to treatment. Some pharmaceutical remedies,

such as the use of honey, cream, and milk to treat throat and chest infec-
tions (e.g. Ebers Papyrus 190, 323), are clearly based on trial and error and
observation of the patient.
Other remedies, however, rely exclusively on principles of magic. Some,
for example, incorporate disagreeable substances such as urine and excre-
ment to dispel ‘evil spirits’ from the patient, allowing ‘good spirits’ to attend
him and assist his recovery (e.g. Ebers Papyrus 326; Edwin Smith Papyrus,
Case 8). In another case, a ‘transfer ritual’ is used to treat migraine (Ebers
Papyrus 250), and the spell sends the pain from the patient into the head of
a fish. A magical incantation was also used to treat the common cold (Ebers
Papyrus 763): ‘Flow out fetid nose! flow out son of fetid nose! Flow out, you
who break the bones, destroy the skull, and make ill the seven holes of the
head!’
When magic was used to treat patients, either close at hand or at a dis-
tance, it usually consisted of three elements. The most important was the
spell or incantation: it was thought that, once recited, the words of the spell
followed a particular course, reaching and hopefully curing the patient. The
spell was often accompanied by a ritual – acts and gestures performed on
the patient or on a doll or wax image; this process might involve the use of
water, wine, oil, perfumes and incense, and be accompanied by dances and
music, to transform the patient’s mental and physical state. Third, amulets
(a type of jewellery worn since at least the fourth millennium b.c.) were fre-
quently used in patient treatment: their symbolic shapes and materials were
believed to have intrinsic powers that could provide magical protection for
the owner.
The medical practitioners

Medicine, like every other aspect of life in ancient Egypt, came under the
control of the gods. Various gods had different areas of responsibility: for
example, the invention of healing prescriptions was attributed to Thoth, the
god of writing; Isis, the devoted wife of Osiris whose body she reconstituted
and restored after death, was the divine patroness of magicians; the gods
Horus and Amun treated eye diseases, and the goddess Tauert was associated
with childbirth and fertility.
Sekhmet, a destructive lioness-headed goddess who brought epidemics,
received an important cult aimed at propitiating her anger. The Egyptians
also worshipped a deified man as the founder of medical science: this was
Imhotep, the vizier, architect and possibly physician of King Djoser of the
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third Dynasty, whom the Greeks later identified with their god of medicine,
Aesculapius.
Some medical practitioners were closely associated with the temples. The
Egyptian temple, never a place of congregational worship, was known as
the ‘House of the God.’ The main function of the priesthood, which played
a significant and influential role in society, was to perform temple rituals
that fulfilled the needs of the resident deity whose spirit was believed to be
present in the cult statue in the sanctuary.
During the Old and Middle Kingdoms, there was some overlap between
priesthood and laity, as many held positions as priests on a part-time basis,
combining it with a career as a lawyer, doctor, teacher, or scribe (Sauneron
1960). In the New Kingdom, this balance was changed when revised tem-
ple organisation resulted in many priestly offices becoming full-time, profes-
sional posts. Some priests continued to play a major role in medical practice,
providing an important link between the temples and the external world.
Because the treatment of illness combined rational and magical meth-
ods, priest-doctors, doctors, and practitioners of magic were all involved in
the healing processes. There is no reference to any rivalry among these
practitioners, and the Ebers Papyrus (854a) indicates that they held parallel
roles in treating the sick (Nunn 1996: 113).
One group of physicians, the ‘Priests of Sekhmet’ (von Kanel 1984), was
attached to the temples. Many probably had specialist skills for treating
specific illnesses, and these appear to have combined rational and magical
methods; some also held titles associated with magic. They shared many
practices with the sunu, another category of doctors sometimes connected
to large communities such as the army, royal palaces and work sites; they
also performed public hygiene duties in the cemeteries. Again, some of the
sunu were attached to temples, whereas others were professional magicians.
There were apparently various groups to which professional magicians
might belong. As well as the sunu, some held the title of sau (from the verb
‘to protect’); these probably included midwives and women who practised
community magic, particularly on behalf of pregnant women and children.
Other magicians were priests of Heka (the goddess of magic) or Serqet (the
scorpion goddess). By placating Serqet, the latter sought to acquire power
against venomous reptiles and insects, and the Brooklyn Papyrus (Sauneron
1989) confirms that they used both magic and rational medicine to treat
snakebites.
Although many magicians, who probably specialised in ritual magic and
healing, appear to have been closely associated with the temples during
pharaonic times, some may have functioned independently, perhaps even
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replacing the conventional doctor in some smaller communities. By the

Roman Period, their association with state religion and the temples had
largely ceased, and instead, they offered their services as independent, paid
practitioners of secular magic.
The temple: a centre of healing and education

Priest-doctors may have made a significant contribution in temples that
enjoyed a special reputation for healing, although it is not known if these
centres provided medical treatments in addition to faith cures. At these
temples, patients underwent ritual cleansing with sacred water, and thera-
peutic dream therapy, which involved ‘incubation’ or temple sleep, when
the patients, in a trancelike state, encountered the gods and, according to
some claims, were healed of their afflictions.
Until now, only two sites have revealed archaeological evidence that
confirms the healing role of the temple, but inscriptions indicate that other
sites had a similar use. In the enclosure of the Temple of Hathor at Den-
derah, archaeologists have identified a building (the ‘sanatorium’) where
patients were accommodated in cells to undergo immersion and prepara-
tion for incubation (Daumas 1957). Here, they were either totally immersed
or their limbs were bathed with holy water that was believed to possess cura-
tive properties.
Other evidence of temple treatment is provided by invalids who, seek-
ing a cure, left graffiti at the temple of Deir el-Bahri (Milne 1914), on the
walls of a chamber where Imhotep (a god of medicine) and Amenhotep,
son of Hapu (a deified wise man) (Wildung 1977) were once worshipped.
These inscriptions show that petitioners came from different, not necessar-
ily wealthy, backgrounds and that some had travelled to Egypt from other
countries to seek a cure.
The ‘House of Life,’ an important institution that was probably attached
to many temples, may have played a significant part in the training and
employment of priest-doctors and others associated with the medical system.
Although its exact purpose is unclear, the prime role of the House of Life was
probably to provide a centre where the rituals designed to protect the gods
and the king could be prepared and developed; this would involve discussion
of theology and the liturgy, the copying of earlier texts, and sometimes the
composition of new, original works.
One interpretation of the House of Life (not however universally accepted
[Gardiner 1938]) suggests that in some cases, in addition to being a scripto-
rium and temple library, this institution may have functioned as a centre of
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higher learning, where doctors received theoretical and practical training

(Strouhal 1992).
The medical papyri

The ancient Egyptians developed a particular concept of the body system,
which was based on observation of the sick and experience of mummifica-
tion, but which reflected a lack of firsthand experience and knowledge of
internal structures and functions that only extensive surgical intervention
in living patients could have provided.
Perhaps directly influenced by their environment, with the great life force
of the Nile and its network of irrigation channels, the Egyptians developed
a unique concept of how the human body functioned, and this came to
dominate their medical theory and practice. This concept was centred on
the metu, a term used for a range of conduits (such as blood vessels), ducts,
tendons, muscles, and possibly nerves, which spanned the body.
It was believed that these formed a network that was centred on the
heart which, because it was supposed to be the seat of a person’s thoughts
and emotions, had a direct influence upon the metu. Sometimes the metu
were envisaged as conduits for the blood, mucus, urine, semen, air, disease
elements, and good or evil spirits that moved around the body, and therefore
obstructions in the system could result in flooding or droughts in various
parts of the body.
Discussion of this concept is preserved in the twelve surviving medical
papyri, which also describe some of the pharmaceutical and surgical treat-
ments that were used (Leitz 2000). A major study and translation (into Ger-
man) of the most important medical papyri are included in the Grundriss
der Medizin der alten Agypter (1954–73).
Inscribed on papyrus, many of these documents date from the Hyksos
Period (c. 1570 b.c.) onwards, but were probably copies of earlier works.
They appear to have originated from two sources. Some may have been
compiled in the House of Life (these existed, for example, at Bubastis, Sais,
Abydos, Edfu, and Amarna), where scribes copied and consulted books on
medicine, magic, and theology. Generally, these papyri incorporate a wide
range of information that may have been drawn from smaller collections of
documents, which perhaps preserved both oral and written traditions.
Other papyri, however, may have been produced by individual physicians
for their personal use. For example, the Hearst Papyrus, which was found
in a house in an ancient provincial town, may have been a reference book
for a local doctor.
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The papyri seem to represent at least three types of documents. They

probably include handbooks of instruction for doctor’s regular use; outlines
for medical lectures; and lecture notes and clinical notebooks that record the
instruction received by medical students. Some may have served more than
one purpose: for example, when a doctor became a practising physician, he
may have retained his student notebook for reference.
The documents that were probably compiled in a temple context seem to
present a more systematic, structured approach, but none of the papyri has
any real unity of composition or subject matter. Each one deals with a variety
of subjects, and some material occurs in more than one papyrus. In indi-
vidual case studies, the proportion of treatment by ‘rational’ or ‘nonrational’
(magical) formulae differs considerably from one papyrus to another, and
with the possible exception of the Edwin Smith Papyrus, none of the papyri
describe firsthand accounts of clinical experience. In many instances, the
prescriptions are given authority either by attributing authorship to a deity,
king, high priest, or official or by using archaic grammar and vocabulary to
indicate the antiquity of the text.
Most of the medical papyri identified to date were acquired by their
modern owners in the nineteenth and early twentieth centuries. Because
these papyri were generally obtained through private sales, little is known of
their provenance; they may have originated from doctors’ houses or tombs,
temple libraries, or town archives. They must surely represent only a small
fraction of the medical papyri that once existed but have subsequently been
lost, destroyed, or remain unidentified in libraries or museum collections.
Brief descriptions of the Medical Papyri are given below. Three of them
(Edwin Smith, Chester Beatty [V, VI, VII, VIII, XV], and Carlsberg [VIII])
are named after their modern owners; one (Hearst) was named after the
woman who financed University of California expeditions to Egypt; four
carry the name of the city where they are now housed (London [BM
10059], London(Leyden [BM 10072], Berlin, Brooklyn [snakebite papyrus]);
others – Kahun, Ramesseum (III, IV, V), and Crocodilopolis – are called
after the site of their discovery; and the Ebers Papyrus carries the name of
its modern owner and editor.
The Kahun Gynaecological Papyrus

The Kahun Gynaecological Papyrus (Griffith 1898; Quirke 2002) is the ear-
liest of the extant medical papyrus (c. 1825 b.c.); this document has a precise,
well-documented archaeological provenance. It formed part of the archive
of papyri discovered by Petrie in 1889 at the site of the pyramid workmen’s
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town of Kahun, built to house the families of the craftsmen engaged in

building the nearby pyramid of Senusret II at Lahun. The papyrus is now
housed at University College London.
This is the earliest known document on gynaecology in the world. Parts
of it are in a fragmentary state, but it provides prescriptions (mainly fumi-
gations, pastes, and applications) for gynaecological conditions, contracep-
tion, pregnancy testing, sterility, and identifying the sex of unborn children.
It does not, however, include any information about obstetrics.
Although exact parallels are not found in other papyri, there are similari-
ties between Papyrus Kahun and the Berlin, Carlsberg, Ebers, London, and
Ramesseum papyri.
The Ramesseum Papyri III, IV and V

The archaeologist Quibell discovered seventeen papyri, housed in a wooden
box, which were part of a burial he excavated in 1896. This tomb (which
probably dates to c. 1700 b.c.) was found under the brick magazines associ-
ated with the Ramesseum (the mortuary temple of Ramesses II) at Thebes.
Although only three of the papyri (III, IV and V [Gardiner 1955; Barns 1956])
have medical content, the burial also contained a set of artefacts (now in
The Manchester Museum), which may have had a magico-medical pur-
pose. The burial goods possibly indicate that the unidentified tomb owner
was a medical practitioner (Gardiner 1955).
The prescriptions, which deal with gynaecological, ophthalmic, and chil-
dren’s diseases, as well as remedies for relaxing stiffened limbs, are similar
to examples in the Hearst and Ebers Papyri.
The Edwin Smith Papyrus

The Edwin Smith Papyrus (Breasted 1930) is the world’s earliest known
treatise on surgery. Edwin Smith purchased the document from a dealer
at Luxor in 1862, and on his death in 1906, his daughter presented it to
the New York Historical Society. Later, it was purchased by the Brooklyn
Museum who donated it to the New York Academy of Medicine in 1948; it
is currently housed in the New York Academy of Sciences. The provenance
is unknown, but the document may have originated from a doctor’s tomb
at Thebes.
Breasted’s translation and commentary emphasised the unique nature of
this work. He demonstrated how it dealt with general surgery and surgery
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of the bones, providing the earliest extant evidence of the existence of

objective, scientific medicine, based on observation of the patient’s condi-
tion and a detailed knowledge of anatomy. In particular, he noted that the
overall organisation of the document, with systematic discussion of each
case, was unequalled in the other major papyri. It revealed a scientific
mind at work, and demonstrated the existence of surgery as a specialisation.
Most important, this provides the earliest extant evidence of the attribu-
tion of medical conditions to understandable physical causes rather than to
demonic or magical causes.
Unlike most other medical papyri, this is an instruction manual rather
than a collection of prescriptions. The forty-eight case studies demonstrate
how the doctor examined the patient and reached a diagnosis. The facts
of each case are observed, listed, and dealt with in a logical order; most
deal with trauma and discuss injuries rather than disease processes. Each
study includes a title, examination with list of symptoms, diagnosis, verdict
(either recovery, probable recovery, or uncertain outcome), and suggested
treatment.
More than any other source, this unique document clearly demonstrates
the sophistication of medical knowledge in ancient Egypt. The injuries
were studied in a way that marks significant progression in medical practice:
for example, in each case, the symptoms were considered in groups (syn-
dromes) rather than individually – a very important advance that is usu-
ally attributed to the Greeks. Also, in Breasted’s opinion, this text demon-
strates that the Egyptians already knew how to count the pulse, thousands
of years before the Greeks recorded this practise. In addition, by noting
how injury to the brain and skull affected the lower limbs, the author of this
papyrus showed that the localisation of function within the brain was already
understood.
The surviving copy of this text dates to c. 1570 b.c., but aspects of its
grammar and vocabulary led Breasted to suggest that the original version
possibly belonged to the Old Kingdom, and may have been compiled by
Imhotep, the vizier accredited with founding medical science in Egypt.
Others, however, dispute this early date.
The purpose and use of the papyrus also remain uncertain. Its damaged
condition indicates that it had been frequently handled, and was perhaps
a copy produced for, used by, and eventually buried with a local medical
practitioner. Because it deals only with injuries suffered by male patients, it
may have been an instruction manual to treat injuries sustained in warfare
or at a building site.
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The Ebers Papyrus

The Ebers Papyrus (Ebers 1875; Bryan 1930; Ebbell 1937) is currently housed
in the University Library of Leipzig. Edwin Smith originally purchased the
document in Luxor in 1862, and it was published as the ‘Ebers Papyrus’ by
Georg Ebers who bought it in a sale in 1872. Its provenance is uncertain
but it may have come from the tomb of a doctor at Thebes.
Until Breasted published the Edwin Smith Papyrus, the Ebers Papyrus
was the most important resource for studying ancient Egyptian medicine
and pathology. It is the longest of the medical papyri (110 pages), and
dates to the ninth regnal year of Amenhotep I (c. 1538 b.c.), although
one part claims to have been in use in the first Dynasty (c. 3000 b.c.).
The Ebers Papyrus incorporates a variety of medical texts, apparently drawn
from many sources, and arranged in a random order. Parallels for many
examples in this document are found in the Hearst, Berlin, and London
Papyri.
The Ebers Papyrus includes three very important paragraphs that present
a treatise on the function of the heart and its vessels (metu). It also contains
clinical cases in which symptoms and treatments relating to a range of ill-
nesses and diseases are described. Some of these have not yet been satisfac-
torily translated and identified, but there are important sections on digestive
disorders and intestinal worms; eye and skin diseases; fractures, burns, and
bites; diseases of the ear, nose, and throat; stiff and painful limbs; gynaeco-
logical conditions; surgical treatments for tumours and abscesses; and the
care of skin and hair.
The Hearst Papyrus

When the Hearst Egyptian Expedition was working near Deir el Ballas
in 1901, a villager presented them with this papyrus (now housed at the
University of California), which may have come from an ancient house
at the site (Reisner 1905; Wreszinski 1912). It probably dates to the reign of
Tuthmosis III (c. 1490 b.c.) and may have been used as a practical reference
book by a local doctor.
The papyrus covers 18 pages and contains 260 case studies. It shares
nearly one-third of the case studies with the Ebers Papyrus, and is clearly
a compilation of material drawn from various sources. Although it is an
inferior source, the Hearst Papyrus provides some information that is not
present in the Ebers Papyrus.
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Generally, it deals with conditions related to the teeth, bones, blood,

bites, hair, the alimentary and urinary systems, and the metu. It also includes
incantations and remedies to treat infectious diseases, most notably against
major epidemics such as the unidentified ‘Asiatic disease.’
The Carlsberg Papyrus VIII

Nothing is known of the origin or provenance of this papyrus (Iversen 1939),
owned by the Carlsberg Foundation and now located in the University of
Copenhagen. Although this document probably dates to the later New
Kingdom (c. 1300 b.c.), it may derive from an earlier version (possibly
c. 1900 b.c.). There is a parallel for its discussion of eye diseases in the
Ebers Papyrus, and sections on conception, pregnancy, and identifying the
sex of unborn children are very similar to parts of the Kahun and Berlin
Papyri.
The London Medical Papyrus

This papyrus, BM 10059, which includes paragraphs on gynaecology, con-
tains sixty-one prescriptions that represent a compilation of medical (twenty-
five) and magical (thirty-six) treatments (Wreszinski 1912); some of these
repeat sections of the Ebers Papyrus.
Now held in the British Museum, the papyrus was formerly owned by
the Royal Institution of London, but details of its provenance are unknown.
It has been assigned to the later New Kingdom (c. 1300 b.c.).
The Chester Beatty Papyri V, VI, VII, VIII and XV

These five papyri, BM 10685, BM 10686, BM 10687, BM 10688, and BM
10695, respectively, form part of an archive, which was started by a scribe in
c. 1200 bc, and then added to and passed down through his family for
over a century. The documents, finally buried in the family tomb chapel
at Deir el-Medina (the village occupied by the royal necropolis workers of
Thebes during the New Kingdom), were discovered by archaeologists in
1928 (Gardiner 1935).
Nineteen of the papyri (which include literary texts, spells, medical
treatments, and rituals) were donated to the British Museum by the phi-
lanthropist Sir Alfred Chester Beatty. The papyri contain both rational
and magical treatments: Papyrus VI discusses rectal diseases (some have
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parallels in the Ebers and Berlin Papyri), Papyrus VII contains spells for
treating scorpion stings, and Papyrus V includes magical treatments for
migraine.
The Berlin Papyrus

This papyrus, No. 3038, purchased in 1827 by Friedrich Wilhelm IV of
Prussia for the Berlin Museum (where it is held today), was formerly owned
by the archaeologist Passalacqua who acquired it at Sakkara (Wreszinski
1909). Although its exact provenance is unknown, studies of the language
and writing style have enabled Egyptologists to assign it to the nineteenth
Dynasty (c. 1200 b.c.). The text asserts the age and authenticity of an original
document by claiming that it was discovered in an old chest containing
antique writings. There are also several references to the author of the text.
Many sections of this significant papyrus repeat the Ebers Papyrus (par-
ticularly the discussion of the metu), and there are some parallels with
the Kahun and Carlsberg Papyri. Subjects covered include breast dis-
eases, contraception, fertility tests, and identification of the sex of unborn
children.
The Brooklyn Papyri: 47,218.48 and 47,218.85

This papyrus, now in the Brooklyn Museum, has been cut into two parts
(47,218.48 and 47,218.85). It provided a practical manual for the kherep-
priests of Serqet (the snake goddess) to use when they treated their patients
for snakebites (Sauneron 1989). Egyptologists have dated this document to
c. 300 b.c., although the authors claim that the original was discovered
during the Old Kingdom (c. 2200 b.c.).
This remarkable document includes, along with some magical treat-
ments, many rational remedies that are based on observation of the patients’
symptoms; it has provided convincing evidence that the kherep-priests (pre-
viously regarded as practising magicians) also used conventional treatments.
The London and Leiden Papyrus

This papyrus, written in Demotic in c. 250 a.d., contains sixty-one prescrip-
tions of which only twenty-five are medical. Its content places it somewhere
between the conventional medical papyri and those documents, such as the
Turin ‘Book of Magic’ (c. 1160 b.c.), which prescribe entirely magical reme-
dies. In addition to treatments to cure illness, the papyrus contains spells
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intended to kill or cause disease, and even prescribes mixtures to induce

sleep (Griffith and Thompson 1904).
Because it was not recognised that the two parts of the papyrus (originally
owned by Anastasi, the Swedish consul in Alexandria) were part of one
document, they were sold to separate institutions: the Dutch government
acquired one section (now in the Leiden collection) in 1828, and the other
(BM 10072) entered the British Museum in 1857.
Papyrus Vindob
Despite its late date (c. 150 a.d.), this papyrus, D.6257, from Crocodilopolis
(now in the Vienna collection) does not include any magical remedies but
provides rational treatments for many conditions (Reymond 1976).
The contribution of human remains to the study

of Egyptian medicine
In his account of the Edwin Smith Papyrus, Breasted (1930) states that pre-
served human remains from Egypt provided little evidence of any surgical
or medical procedures that might have been attempted. He discussed some
examples of wounds and injuries and cited some cases of medical inter-
vention, including an Old Kingdom mandible with surgically bored holes
to drain an abscess below the first molar, and two bodies in which splints,
worn in life, had been left in place when the patients died.
Breasted concluded that palaeopathological evidence could contribute
little to any reevaluation or interpretation of the contents of the Medical
Papyri; however, over the past decades, considerable advances have been
made in the study of preserved bodies from ancient Egypt. New techniques,
many of them described in this book, have been used to diagnose disease and
disease patterns. This evidence can now help Egyptologists and scientists to
reassess the early translations of descriptions of disease, medical terms and
words, and treatments that are listed in the Medical Papyri.
For example, in some cases, it is already possible to match physical condi-
tions identified in the human remains with specific remedies and treatments
in the papyri. One aim of a current study on ancient Egyptian pharmacy
being conducted in Manchester may expand this possibility. The aim here
is to identify scientifically any traces of therapeutic treatments that may
remain in mummified tissue, and this may produce new knowledge that
could inform future studies on the prescriptions in the Medical Papyri (see
Chapter 14).
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Ultimately, it is surely through interdisciplinary studies, using inscrip-

tional evidence from the papyri, palaeopathological data from the bodies,
and ethnographical studies of current traditional medicines, that researchers
will be able to trace the practice of medicine and pharmacy in Egypt over
the millennia.
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chapter 13
Intoxicants in ancient Egypt? opium,

nymphaea, coca and tobacco
David J. Counsell
Introduction
Anthropologists recognise that all societies use intoxicants in aspects of their
cultural lives (Lewin 1964; Rudgley 1993). Modern analysis of plants that
early peoples believed to have intoxicating or healing properties has, in many
cases, demonstrated the presence of pharmacologically active chemicals
such as alkaloids and flavonoids that account for these effects.
In his work on drugs in ancient and primitive societies Emboden (1979),
improving on previous work by Lewin (1964), classified intoxicants into
the different groups summarised in Figure 37. Clearly, some well-known
intoxicants do not fit easily into one category, opium, for example, being
both narcotising and hallucinogenic, depending upon the circumstances
of its use.
Although the use of animal- and mineral-derived drugs is well described
in Egyptian medical practice (Nunn 1996), these do not tend to act as
intoxicants, and thus, for this study, the subject materials of interest tend to
be derived from plants.
Little is known about the use of intoxicants in ancient Egypt beyond the
widespread consumption of beer, as part of the staple diet, and wine, by the
elite. The cultural use of alcohol by the Egyptians is well documented and
will not be considered here. This chapter will focus on a small number of
intoxicants that may or may not have contributed to Egyptian society as a
medicine, recreational drug or in sacred rituals.
Following the controversial TV documentary ‘Mystery of the Cocaine
Mummies,’ first broadcast in 1994 (Schaffer Library 2005), I was invited to
join the Manchester mummy team, to set up a project to look at cocaine
and other intoxicants in Egyptian society.
195
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196 David J. Counsell
For this research, we have concentrated principally on four drugs: opium,

the ‘blue lotus’ (Nymphaea caerulea), cocaine and nicotine, and we have
focused on analytical techniques such as gas chromatography-mass spec-
tometry (GCMS) and liquid chromatography-mass spectrometry (LCMS).
As reference for the reader, Chapter 10 includes a discussion of the tech-
niques that have been used for this study, and this chapter presents the
recent results obtained by the Manchester group. Together with a critical
reappraisal of earlier work undertaken on this subject by other researchers,
our results will be used to explore the history of these drugs in ancient Egypt.
Opium: its history in ancient Egypt and the Mediterranean
The origins of opium

Much of the evidence for opium around the ancient Mediterranean, includ-
ing Egypt, is based upon artistic representations of the poppy capsule. Struc-
turally, poppy capsules – the opium poppy (Papaver somniferum) included
– have several clearly identifiable features, especially the ‘torus’ ring, a bul-
bous swelling on the stalk below the capsule, where the flower’s petals were
attached.
Opium, a resinous residue from dried sap, is obtained by incising the
ripening capsule of the opium poppy, Papaver somniferum, and collecting
the extruded sap as it dries. The resin has a variable composition depending
upon many environmental factors but generally contains a number of phys-
iologically active alkaloids, including the analgesics morphine and codeine
and the vasodilator papaverine, all still used in medical practice.
The opium poppy has lost its ability to self-seed as the capsule does not
split of its own accord, even when dried, thus requiring external assistance
to split the poppy capsule and distribute the seeds. By definition therefore,
opium poppies are a man-made cultivar, and not a natural plant. Its closest
natural relation is Papaver setigerum, the only other poppy variety to produce
opium alkaloids, and probably the precursor from which the opium poppy
developed (De Cadole 1959).
Frequent finds of opium poppy seeds throughout Europe during the later
Neolithic and early Bronze Age (Rudgley 1993), many associated with prim-
itive open and closed systems for burning and smoking the drug (Kritikos
and Papadaki 1967b), indicate an early use of opium in this area.
There seems little doubt that opium was used in Cyprus and Crete during
the second millennium b.c. Finds of poppy remnants and primitive smok-
ing devices attest to this (Kritikos and Papadaki 1967a, 1967b; Karageorghis
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Intoxicants in ancient Egypt? opium, nymphaea, coca and tobacco 197
figure 37. Summary of classification of intoxicants. Credit: David Counsell. Adapted

from Emboden, W. 1979. Narcotic Plants: Hallucinogens, Stimulants, Inebriants and
Hypnotics, their Origins and Uses. London: Studio Vista.
1975). All these finds are, however, from religious contexts, suggesting that
the use of opium was sacred rather than secular, and there is no indica-
tion of any medicinal application at this time. Artefacts and writings from
these neighbouring societies in Cyprus and Crete have proved useful in
investigating the use of intoxicants in Egypt.
The poppy in New Kingdom Egypt

Because the New Kingdom was contemporary with the Mediterranean Late
Bronze Age, it might be expected that opium would be known to the Egyp-
tians, although the sacred use of opium in Crete and Cyprus may have been
a matter of secrecy.
Merrillees (1962, 1979) suggested that opium was imported into Egypt via
trade with Cyprus at the height of the New Kingdom (c. 1500 b.c.) in the
distinctive Cypriot Base II Ring Ware juglets known colloquially as Bil-Bils.
His theory is based upon the design similarities of these small containers
when compared with an opium poppy capsule. There is clear evidence of
trade at that time: the Bil-Bil juglets, regardless of their contents, attest to
that; but was opium really part of that trade?
Scenes in Egyptian tombs and temples show gardens and plants. The
poppy is frequently depicted in New Kingdom art, including a scene in the
tomb of Senedjem at Deir-el-Medina, Thebes. A necklace and matching
earrings found in tomb KV56, Thebes, may also depict poppy capsules
(Gabra 1937).
The names of many plants used as drugs have been identified in the
Medical Papyri. The most important source, the Ebers Papyrus (Ebbell
1937) (see Chapter 12), refers to a large number of plant materials used
in the manufacture of drugs. Unfortunately, these names are not always
easy to translate. One important passage (782), known as The Remedy for
the Crying Child, may refer to opium (Nunn 1996: 153). It includes the
words ‘shepnen of shepen,’ which have been translated (Erman and Grapow
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1926–1931) as ‘seeds’ or ‘petals’ of ‘poppy’ (possibly the opium poppy). Nei-

ther the seeds nor the petals of the opium poppy contain any opium alkaloids
and therefore would be unlikely to act as a sedative.
In summary, although Gabra (1937) and others have proposed that opium
was cultivated as early as the New Kingdom, all the examples cited are now
thought to be the red poppy (Papaver rhoeas) rather than opium poppy.
Bil-bil juglets
None of the above evidence supports the use of opium or the cultivation of
the opium poppy in Egypt during the New Kingdom, but does Merrillees’
theory provide a different perspective?
Opium could have arrived in Egypt during the New Kingdom from
Cyprus, given the spread of its use to the central Mediterranean islands by
that time. The shape of the Bil-Bil juglets is very reminiscent of an upturned
poppy, and Merrillees suggests that some juglets are even decorated with
striated markings similar to the parallel incisions used in modern day opium
harvesting.
There are problems with this theory however. The contents of the juglets
must have been liquid to pass through such a long narrow neck. Some
juglets even have a pouring spout that clearly confirms the liquid nature of
the contents. During the harvesting of opium, extruded sap is allowed to
partially dry on the capsule before being scraped off with the resulting resin
being packed into blocks after drying out further (White 1989).
For centuries, in European medicine, opium was administered by cut-
ting a weighed amount from a solid block of material and then dissolv-
ing it in alcohol to make laudanum or as a constituent of Dover’s powder
(Scott 1969). Why then would the Cypriots come up with such an elabo-
rate method of exportation when transporting the material in its solid form
would be much less complicated? It is entirely possible that some as yet
untested block of opium resin lies in a museum collection somewhere,
awaiting identification.
Also, Cypriot Base II Ring Ware comes in forms other than Bil-Bil juglets;
because these display the same type of markings as Bil-Bil juglets, it is
evident that this decoration is not exclusive to Bil-Bils, and must surely
indicate a decorative style rather than representing opium-harvesting scars.
Nevertheless, despite these concerns, it seemed appropriate to investigate
further Merrillees’ theory by analysing the residues from these vessels for
the presence of opium alkaloids.
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figure 40. Summary of provenance and forensic laboratory analysis on Manchester

Cypriot Base II Ring Ware collection. Credit: David Counsell.
Analytical work on opium in ancient Egypt

The first scientific attempt to identify opium from Egyptian artefacts was
made by Muzio (1925) when residues from pottery removed from the tomb
of the architect Kha at Deir el Medina were analysed. He ‘confirmed’ the
presence of opium; however, in a review of this work, Bisset et al. (1994b)
were unable to identify which jar had been analysed. Many of the jars,
including the one thought to have been analysed, still appeared to have
intact seals. None of the jars were of the Bil-Bil type, although Merrillees
(1968) speculates that their design may have been inspired by Base II Ring-
Ware.
Evans and Card (1986) first reported the detection of opium from a Bil-
Bil jar by using thin-layer chromatography. Koschel (1996) subsequently
reported the detection of opium using radioimmunoassay (RIA), thin-layer
chromatography and GCMS on an unprovenanced pot in the Martin von
Wagner Museum (University of Würzburg, Germany). Although they par-
ticipated in this study, Bissett et al. (1996) were cautious in their interpre-
tation of the result, indicating the need for the analysis of more juglets,
particularly those with a firm provenance, to provide definitive proof.
In the Manchester project, the first step was to arrange for an analysis of
the Bil-Bil juglets in The Manchester Museum collection. Samples from
thirteen pots were analysed by the local forensic science laboratory at Exton
Hall, Chorley, Lancashire. Residues were obtained from all of the complete
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pots, and broken pots were scraped on the inside surface to remove any
dried-on residues. In some cases the pottery surface itself was removed with
a surgical bur, thus increasing the chance of detection of opium even if that
pot had been reused.
The treatment of each juglet and its provenance are summarised in Fig-
ure 40. At the laboratory, the samples were extracted with methanol and
tested using high- pressure liquid chromatography (HPLC), GCMS and
then derivatised to increase the detection of morphine, using further GCMS
analysis. The results were disappointing because no evidence of opium
alkaloids was detected in any of the samples. Five pots were then subjected
to more extensive GCMS analysis, and in two of these, palmitic acid was
found.
The maximum morphine yield in modern opium is approximately 10 per
cent. Thus, given that the actual samples weighed between 0.25 and 0.5 g, a
maximum content of 25–50 mg per sample might be expected. Speculating
that the likely content would be much lower than this, given the age and
inevitable degradation of any residual alkaloids over time, possibly to a
residual factor of 0.1 per cent of the original, it would be expected that the
remaining morphine content would be between 25 and 50 µg, well within
the 2–5 µg per sample reference sensitivity assured by the laboratory.
Despite this, it was decided that further, more sensitive and in-depth
analysis was required, and subsequent analytical work was performed at
Hall Laboratories in Manchester. Reevaluation of a number of pots from the
collection, using GCMS capable of a sensitivity of 0.2–0.5 µg, equivalent
to 0.2–0.5 parts per million in a 1 ml resuspension, detected no opium
alkaloids.
In the 1990s, Nunn and Evans took samples from Bil-Bil pots in The
Manchester Museum collection. Subsequent analysis of this material
involved the use of HPLC with ultraviolet detection and RIA (techniques
that paralleled our own work). They informed us that morphine had been
detected in two of three pots (Manchester No. 744 and Manchester No.
6946A), confirmed by both techniques. Review of our own results on these
pots using GCMS could not confirm the presence of morphine or other
opium alkaloids.
To address these conflicting results, Evans brought the extracts they had
obtained from the ‘positive’ pots to Hall Laboratories, where they were tested
further, using a system linking LCMS against a known sample of opium.
Although morphine, codeine and noscapine were all easily detected from
the opium sample, it again proved impossible to demonstrate the presence
of these alkaloids in the pot extracts. Thus, it had to be accepted that the
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9780521865791c13
CUFX196/David
978 0 521 86579 1
figure 38. Total ion chromatogram for juglet number 744 (Manchester Museum). This is one of the jugs that tested positive for morphine when using RIA
and HPLC. Above are selected ion chromatograms for molecular weights 220 (noscapine), 299 (codeine) and 285 (morphine), which are the major alkaloids
in opium. The lack of any peaks confirms that this sample is devoid of these compounds. If any of the compounds seen in the total ion chromatogram (TIC)
have certain key functionalities present, for example, primary binding sites such as hydroxyl and amino groups on an aromatic framework, it could explain
the positive result obtained with RIA. This will be explored in further work. Credit: David Counsell.
201
October 31, 2007
18:57
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previous positive results were unreliable and that LCMS, being both highly
sensitive and highly specific, now provided the definitive answer.
Later evidence for opium in ancient Egypt

In later times, information regarding plant use in Egypt is found in Classical
writers, the most important source being Dioscoridus Pedanius of Anazarbus
(first century a.d.) whose Materia Medica remained a significant pharma-
cological thesis until the fifteenth century a.d. (Gunther 1934). This makes
it clear that opium was known in Egypt and the Roman World in the first
century a.d. His description suggests that there had been a lively debate
over the previous four centuries regarding the safety of the drug in medical
use.
A wall scene in an intact tomb at Saqqara which belonged to Psamtek
(Psammeticus), Royal Physician to Amasis (c. 500 b.c.), depicts a basket of
seeded bread under a sheaf of what appear to be poppies, a ‘torus’ being
clearly identifiable. This association of a physician, poppies and seeded
bread raises the possibility of the medical use of opium at this time.
Cypriot base II ring ware juglets: an alternative explanation

Detailed chromatographic-mass spectrometric analysis of the contents of
these jars has revealed no firm evidence of their use. The chromatograms
appear to fit two profiles, which either suggest two different uses for the
juglets or their reuse after the initial contents have been drained. A dis-
tinguishing feature between these two groups is the presence of nonanal
(C9 H18 O).
Two samples from the Manchester collection suggest a further possibility:
the pots comprised a pair of holders whose contents were mixed when the
time came to use them. Manchester No. 2149 is actually a double vase,
comprising two juglets fused together during manufacture, and Manchester
No. 6946 A and B were found tied together by a piece of ancient string.
Figure 39 shows that these two pots seem to be different in their contents,
with pot B containing nonanal in contrast to pot A.
Nonanal is known to be a breakdown product of civetone (C17 H30 O).
Civetone, derived from the anal glands, modified sweat glands, of the palm
civet or civet cat is still used in perfume as a fixative, although its use is declin-
ing in favour of modern synthetic fixatives. Sebacic acid (C10 dicarboxylic
acid), derived from sweat glands, is also present in small traces in some of
the samples containing nonanal, lending further support to this possibility.
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9780521865791c13
Sample 6839 Contents

LC24539 (6839) Scan El+
100 TIC
1.17 e7
%
8.63 9.33 30.36
23.52 24.75 25.92 36.79
0
FLASK 1 (2978) Scan El+
CUFX196/David
30.37 TIC
100
6.40 e6
% Nonanal
11.77 33.62
32.77
0
LC26794 (6946B) Scan El+
30.28 TIC
100 33.07
29.55 38.44 2.75 e8
6.05 32.56 35.76
% 6.49 Nonanal 35.45
31.35 37.87
11.60 23.37 25.46 28.85
8.17 8.92 21.13 40.92 48.98
0
LC26793 (6946A) Scan El+
27.96 TIC
100
4.82 e8
%
27.63 30.99
6.64 7.36
0
LC 26792 (744) Scan El+
100 27.49 TIC
3.20 e6
6.26
% 7.65 9.14 9.98
28.64
10.77 20.80 21.53 30.68
0 Time
10.00 15.00 20.00 25.00 30.00 35.00 40.00 45.00 50.00 55.00
figure 39. Total ion chromatograms for four Bil-Bil juglets. The main peaks in all samples are fatty acids, principally palmitic acid (C16). Juglet 6946B
978 0 521 86579 1
shows an extended series of fatty acids not seen in the other samples from C16 through to C22. Note the presence of nonanal in two of the juglets and the
different profiles in 6946A and 6946B. Credit: David Counsell.
203
October 31, 2007
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There is no known evidence for civet species in ancient Egypt or Cyprus,

as their natural habitats are sub- Mediterranean Africa and Southeast Asia,
but the possibility of a trade route for civetone or a civetone-based perfume
from Southeast Asia via Cyprus cannot be discounted.
The Egyptian lotus: narcotic or perfume?

The lotus is one of the most potent symbols of ancient Egypt, expressing
the unity of the ‘Two Lands,’ a tradition referring back to the unification of
the Egyptian nation in c. 3100 b.c. It was also the emblem of Nefertum, the
god of fragrance, and was associated with creation myths, rebirth and solar
imagery. Although the lotus, and particularly the blue lotus, were of great
religious importance to the Egyptians, this does not preclude their use in a
secular context.
Emboden (1979, 1981) suggested the possibility that ancient Egyptians
and the Maya used water lilies as intoxicants. Subsequently, Harer (1985)
suggested that the Egyptians used the blue lotus (Nymphaea caerulea)
and white lotus (Nymphaea lotus) as intoxicants in a recreational con-
text. He proposed that the flowers of these plants were immersed in wine
to extract active alkaloids into a fortified, that is, more intoxicating, drink.
Although not all Egyptologists accept this idea, Harer presents considerable
circumstantial evidence to support his hypothesis. The theory warrants fur-
ther investigation, and here, we reassess the evidence presented by Harer
in the light of our own investigations into the alkaloid content of these
plants.
Our investigations formed the subject of a Channel 4 (UK) television
documentary, as part of the series ‘Private Lives of the Pharaohs’ (Tyldesley
2000). Unfortunately, this documentary presented an oversensational inter-
pretation of our results, implying that we had discovered that the blue lotus
was the ancient Egyptian equivalent of Viagra® . The following discussion
therefore provides the first opportunity to set the record straight.
Botany and phytochemistry of Nymphaea spp.

Three species of water lily are known from ancient Egypt. The white
lotus (Nymphaea lotus) and the blue lotus (Nymphaea caerulea) are widely
depicted in Egyptian art and decoration throughout the historical period.
Identification and phytochemical interpretations are complicated by the
introduction (probably c. 500 b.c.) of a third, nonnative species, the pink
lotus (Nelumbo nucifera), also known as the Persian lotus (Harer 1985).
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figure 41. Summary of botanical features of ancient Egyptian ‘lotuses.’ Credit: David
Counsell. Adapted from Bailey, H. L. and Bailey, E. Z. 1976. Hortus Third: A concise
dictionary of plants cultivated in the United States and Canada. New York: Macmillan.
Also, confusion persists regarding the nomenclature of these plants (Harer

1985). In modern botany, the term ‘lotus’ refers to the genus Nelumbo and
not to the Nymphaea spp., which should more correctly be called blue and
white ‘water lilies.’ Thus, it would seem that the term ‘lotus,’ when found in
a context pertaining to Egyptology, is used incorrectly. The characteristics
of the blue and white water lilies are summarised in Figure 41.
According to Harer, Nymphaea spp. contain a number of alkaloids,
namely, nymphaeine, nuciferine, nupharidine and α-nupharidine, that exist
in both the flower and the rhizome of the plant. This has proven diffi-
cult to confirm even using Harer’s references. In contrast to Nymphaea
spp., the alkaloid profile of Nelumbo spp. is well described and includes
nuciferine, nupharidine and α-nupharidine (Wróbel, 1977). It appears that
the only alkaloid exclusive to the Nymphaea genus is nymphaeine, an 18-
carbon structure, about which very little is known. This is in contrast to
the 15-carbon alkaloids from Nelumbo spp., which are well understood and
include apomorphine derivatives (Dr Duke).
Apomorphine itself is a toxic substance used extensively in the past as an
emetic and more recently as a sexual stimulant (Dula et al. 2001; Montorsi
et al. 2003), giving Nelumbo nucifera a far better claim to be an intoxicant,
with possibly aphrodisiac properties, than the two Nymphaea varieties.
The evidence for ingestion of water lily

Several writers, including Dioscorides and Herodotus (c. 450 b.c.) (The His-
tories, Book 2, para. 92), have recorded that the ancient Egyptians ingested
various parts of the lily plant, but unfortunately they do not describe the
resultant effects. Neither do these accounts confirm which plant was being
consumed, although it is possible that they both refer to Nelumbo.
It is generally agreed that, in the Medical Papyri (see Chapter 12), the
ancient Egyptian word for Nymphaea spp. is seshen, although it is unclear
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whether they made any distinction between the white and blue lotus, or
indeed with the pink lotus after its introduction in the Persian Period. It
is evident, however, that any mention of seshen before this time refer to
Nymphaea spp.
The medical texts contain a number of early references to seshen. In many
examples, the plant appears to have been consumed as a constituent of a
remedy (Manniche 1989), although any untoward effects are not recorded.
The case for lotus-spiced wine

Immersion of lotus flowers in wine would almost certainly facilitate the
extraction of any alkaloids present in the flower because they are generally
readily soluble in alcohol compared to water. Even if the plant contains
alkaloids, this does not necessarily imply that these compounds are present
throughout all parts of the plant, and they may or may not be present in
the flower. As yet, the pharmacological effects, psychotropic or otherwise,
of the alkaloids named by Harer are not well understood but, in support of
his theory, there is evidence of an association between blue lotus and wine
in ancient Egypt.
The Medical Papyri (see Chapter 12) contain two references to the immer-
sion of seshen in alcohol. Ebers 209 and 479 describe seshen ‘spending the
night’ in alcoholic mixtures. It cannot, however, be concluded that the Egyp-
tians knew the importance of this in terms of extracting potentially active
agents. They used many other vehicles such as water, milk and honey in
drug production. The use of alcohol as a vehicle is not restricted to lotus-
containing remedies and similarly, not all lotus-containing remedies utilise
alcohol as a vehicle.
The uninhibited woman depicted in the Turin Erotic Papyrus (No. 55001)
is consistently depicted with a lotus above her head, suggesting that she may
have been intoxicated by its use or that it was being used as an aphrodisiac
(Schumann et al. 2001).
Other archaeological evidence cited by Harer includes tomb reliefs
depicting the lotus in banqueting scenes, implying that it was used as a
recreational intoxicant, and artifacts associated with the immersion and
consumption of lotus-enhanced wine.
Analysis of the Egyptian water lilies

Although blue water lilies are fairly common, most are modern varieties
cultivated to bloom all day or for longer periods. True Nymphaea caerulea
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9780521865791c13
CUFX196/David
978 0 521 86579 1
figure 42. Phytosterol profile of ancient sample (from Royal Botanical Gardens, Kew) and modern petal of Nymphaea caerulea compared with a petal of
Impatiens walleriana (Busy Lizzie). Note the preservation of the profile of the two samples of Nymphaea caerulea and the difference in comparison with a
different species. The structure of the major phytosterol component for each sample is shown alongside. Credit: David Counsell.
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is now a rare plant, seldom found in the wild and only occasionally in
botanical collections. For our research, blue lotus flowers were generously
provided by Stapeley Water Gardens in Staffordshire, UK.
Extraction of these flowers was performed using three techniques, each
performed on fresh blooms. Head space analysis allowed evaluation of the
plant’s scent for intoxicating possibilities. A freon-based supercritical extrac-
tion technique was used to extract the essential oils of the flowers, and finally
a methanol solvent extraction was performed. The extracts were subjected
to analysis by GCMS and LCMS.
Later, the Royal Botanic Gardens at Kew, Richmond (UK), provided a
small sample for the project: this was a Nymphaea caerulea petal, previously
identified by Dr Nigel Hepper (1990), which had been taken from funerary
garlands from Hawara (first century a.d.). This small petal sample and an
equivalent modern sample from the Stapeley flowers were subjected to
micro-scale sealed vessel pyrolysis GCMS, and the results obtained from
the ancient and modern plant were then compared.
Generally, the results were disappointing, as no alkaloids were identified
in any of the analyses performed on the blue lotus; however, in agreement
with other published material (Fossen et al. 1999), high levels of bioflavonoid
were found. Comparison with an extract of Ginkgo biloba showed the level
of these compounds was higher in the fresh blue lotus flowers. Bioflavonoids
are known to have beneficial effects, being oxygen free radical scavengers
and vasodilators that enhance tissue blood flow, so it is likely that like ginkgo,
ginseng and other herbal remedies rich in bioflavonoids, blue lotus has
health promoting properties.
The micro-scale sealed vessel studies on the blue lotus demonstrated
preservation of the phytosterol profile of the two samples, despite the time
gap of some 2,000 years. These compounds are found predominately in the
cell walls of the plant, and their demonstrable stability over time opens up
the possibility that this method might be useful in identifying ancient plant
remains, if consistent species differences in these profiles can be demon-
strated and catalogued.
The general conclusion, however, is that consumption of blue lotus flow-
ers, either by eating or as a wine-based infusion, would not give any addi-
tional intoxicating effect.
Water lilies as aphrodisiacs

Two clear mechanisms exist in which drugs can be used to enhance sex-
ual performance. Best known is the mechanism of sildenafil (Viagra® )
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and similar drugs, which produce a specific vasodilator effect to help pro-
duce and sustain the male erection. Research has suggested a benefit may
be derived from the use of Ginkgo biloba in male impotence although
this research is limited and it is unclear whether the effect is due to the
bioflavonoid or ginkgolide content (Sikora et al. 1989).
Certainly, bioflavonoids produce vasodilation but this is a non-specific
effect that is not proven to influence the male erection; therefore, no aphro-
disiac properties can be ascribed to plants that contain them. It is tempting
to interpret the blue lotus as an aphrodisiac on the grounds of its appear-
ance in scenes in the Turin Erotic Papyrus, but this association cannot
be supported by any scientific evidence. Many substances used today are
believed to have aphrodisiac properties although they contain no active
ingredients, so perhaps the same pertained to the blue lotus in ancient
Egypt.
The Persian lotus, Nelumbo nucifera, is more interesting. Differing from
Viagra® in action, certain compounds are now known to act centrally to
increase libido (the desire for sex), rather than enhancing the ability to per-
form. In this regard, small doses of apomorphine have been demonstrated
to be effective (Dula et al. 2001; Montorsi et al. 2003), although in large
doses, it is a profound emetic that causes prolonged and uncontrolled vom-
iting. This presents the possibility that the Persian lotus might act in this
way, although there is no evidence that the ancient Egyptians used it in this
manner.
Cocaine and nicotine

The report of the discovery of cocaine and nicotine in Egyptian mum-
mies (Balabanova et al. 1992; Parsche et al. 1993) raised the possibility of
transatlantic trade in the second millennium b.c. Although nicotine is not
exclusive to the tobacco plant, as it is found in a number of plants from the
eastern Atlantic landmass, Balabanova considered that the levels discovered
in the mummies were too high to have been derived from a dietary source.
This implied, by default, that they were the result of chewing or smoking
tobacco.
On the other hand, cocaine is only found in the ‘New World’ and could
only be obtained from the South American coca plant (Erythroxylum coca).
There is no clear evidence in the Egyptian archaeological record of any
regular transatlantic trade at this time, although critics might claim that
is because no one has looked properly. If trade did exist, it seems hardly
likely that it was limited to these two plants, and other evidence of cultural
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exchange between the two areas would be expected, in terms of artefacts

and even written records. If it is assumed from this basic analysis that Bal-
abanova’s results are incorrect, then an explanation is required as to how
these results have come about.
Overview of hair analysis for cocaine and other drugs

The detection of the cocaine metabolite benzoylecgonine (BZE) was first
reported in 1981 (Arnold and Püschel 1981), using RIA. There was difficulty
with quantification in early studies due to confusion between specificity
of antibodies for cocaine and BZE and loss of drug during the digestion
processes.
Standard techniques for drug analysis use hair samples of about 100 mg
that are first washed in methanol to remove surface materials such as cosmet-
ics and oils. Extraction is by acid or alkali digestion or using organic solvents,
followed by analysis using RIA or GCMS with quantification against known
concentrations. Alkali digestion is the most efficient method but cannot be
used for cocaine as it completely degrades the drug. Methanol is the pre-
ferred solvent for cocaine extraction. RIA is popular for screening, due to
the high sensitivity of commercial kits working in nano- or picogramme
per milligramme concentrations. GCMS is then used for confirmation and
quantification (Henderson et al. 1995).
The collective experience of modern drug analysis is based on contem-
porary samples from known or anticipated drug users, with predictable con-
tamination and a proven track record in these circumstances. Given the
potential for contamination in archaeological samples, and bearing in mind
our earlier experience with opium (described above), it is questionable if
the rigour of standard techniques is adequate when applied to the more
complex situation seen in Egyptian mummies.
Sampling from Egyptian mummies: the problems

Sampling from ancient human remains, particularly Egyptian mummies,
is fraught with problems seldom encountered in the modern sphere of drug
analysis. Mummified materials (complete mummies and various body parts)
are held in museum collections around the world. Much of this material is
unprovenanced, and some may even have a relatively modern date, as there
was a thriving trade in fake mummies during the nineteenth century. It is
quite likely therefore that positive results for cocaine and nicotine could be
obtained from these post-Colombian individuals.
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figure 43. Comparison of hair analysis for cocaine and nicotine in Egypt and South Amer-
ica. Data given in papers corrected to nanogrammes/milligrammes of sample. Credit:
David Counsell.
Contamination of samples can occur from many sources (Cartmell and

Weems 2001). Plant material and gums and resins were applied internally
and externally in the process of mummification, and the hair of Egyptian
mummies is often densely matted by these ancient unguents. Further con-
tamination of the mummy could occur from spillage or leaching of other
grave goods at the time of burial or during the subsequent millennia when
vermin, insects, bacteria and moulds could enter the body or the wrappings.
After excavation, exposure to environmental factors or poor storage could
lead to further contamination (see Chapter 16). Smoking has only recently
been banned in our museums, and it is likely that many esteemed archaeol-
ogists of the past were users of tobacco. Photographic evidence supports this;
for example, H. A. Harris can be seen smoking a cigarette while examining
an Egyptian mummy in 1930 at University College London (Dawson 1938).
In time, the extensive organic compounds from the mummy itself and
from the mummification and other contaminating processes will undergo a
process known as diagenesis. Compounds that are present become degraded
as the result of oxidation, fermentation and other processes, including cross
reactivity between compounds. This in turn produces new materials and
compounds that were not necessarily present on the mummy at the start,
causing problems with interpretation, and increasing the chances of a false
positive result with RIA and HPLC.
Cocaine and nicotine in ancient populations

Not surprisingly, cocaine has been detected in Peruvian mummies (Cart-
mell et al. 1991; Balabanova et al. 1992). In 1992, Balabanova’s team also
published their first identification of drugs in Egyptian mummies, followed
in 1993 by a further paper (Parsche et al.1993) reporting the detection of
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nicotine, cocaine and hashish in a variety of tissues from ancient popu-

lations from Peru and Egypt, with nicotine, but not cocaine or hashish,
detected in bone from ancient Sudan and members of the ancient ‘Bell’
culture from Germany. More recently, Cartmell and Weems (2001) have
reported the detection of nicotine, but not cocaine, in Egyptian mummies
from the Dakhleh Oasis. The reported levels for hair samples in the Parsche
and Cartmell papers adjusted to microgrammes per milligram of material
are summarised in Figure 43.
Nicotine. Cartmell and Weems (2001) suggest a cut-off point of 2 ng/mg

to distinguish between regular tobacco smokers and those exposed passively
to smoke or ingesting nicotine in the diet, with levels greater than 20 ng/mg
being reported in previous studies on South American mummies. This is
consistent with the range reported by Parsche et al. (1993) in modern addicts.
It seems clear therefore that the nicotine found in Egyptian mummies is
from a dietary source. The ubiquitous presence of nicotine in all the pop-
ulations tested, all at dietary levels, supports the validity of these results.
Duke’s Phytochemical and Ethnobotanical Database lists twenty-three
nicotine-containing plants in addition to tobacco (Nicotiana tabacum). Of
these, two – Withania somnifera and Apium graveolens – were known to the
Egyptians (Manniche 1993), and the latter, celery, was the more likely to
be used as a food. In 1994, as a result of the ‘Cocaine Mummies’ television
documentary, seven samples (six of tissue and one of hair), taken from
mummies in The Manchester Museum collection, were sent for analysis
at the Medical Toxicology Laboratory at Guy’s and St Thomas’ Hospital in
London, UK. Three of these samples tested positive for nicotine and none
for cocaine. Concentration levels were not reported.
All the nicotine-positive samples were taken from disarticulated heads of
unknown provenance. Further investigation and closer inspection demon-
strated that two, No. 7700/ES8(10p) and No. 7700/ES6(4p), originated from
the collection of G. Elliot Smith, former professor of anatomy in Cairo and
Manchester. Neither head showed any evidence of intentional mummifi-
cation. It seems likely, from the evidence of the Dawson (1938) picture,
that environmental contamination could be a factor in these results. The
antiquity of the third head, No. 7700/1981.575(3p), could be confirmed by
the signs of resin use on the hair and residual traces of gilding on the face,
attributing it to the Ptolemaic Period (c. 300 b.c.).
Cocaine. The level of cocaine found in Peruvian hair is reassuringly con-

sistent in the two studies shown, with significantly lower levels detected in
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the Egyptians. Assuming that the identification of cocaine is correct, this

difference might be explained either by a lower level of exposure during life
or greater deterioration of the cocaine present in the hair, over the additional
centuries since death, in the Egyptian sample.
In addition to the seven aforementioned samples, hair, bone and tissue
samples have been tested from a variety of mummies in the Manchester
and Leicester collections. These include four mummies from Manchester:
Asru (No. 1777, Thebes, c. 700 b.c.), Nekht-Ankh (No. 21470, Rifeh, c. 1900
b.c.), No. 1770 (Ptolemaic Period, c. 300 b.c.) and No. 1766 (Fayoum, c.
100–200 a.d.) and four mummies from Leicester. To date, none have tested
positive for cocaine, using methanol solvent extractions of tissue samples,
tested using GCMS to a sensitivity of 0.1 µg/mg of material.
If the theory of transatlantic trade were correct, surely the results obtained
by either Cartmell or Manchester would corroborate the discovery of
cocaine in at least one of the Egyptian mummies that have been tested
by these teams. This lack of results suggests that either Balabanova and her
associates are misinterpreting their results or that the sample of mummies
tested by them have been mysteriously exposed to cocaine.
The levels of cocaine recorded for South American mummies in these
studies compare favourably with reported levels in modern coca chewers in
the range of 1.0–28.9 ng/mg (Henderson et al. 1992) and 1.4 and 50.6 ng/mg
(Möller et al. 1992). By comparison, the levels in the Egyptian mummies
are very low – close to the 0.1 ng/mg limit of detection reported by many
investigators at the time of the study (Henderson et al. 1992, 1995) and
consistently lower than the 0.3 ng/mg suggested by Cartmell et al (1993) as
a cut-off point ‘to differentiate a “negative” and a “positive” result consistent
with previous hair studies.’ (The paper actually states 3 ng/mg, which would
contradict the interpretation of the results given by the authors. We therefore
suspect that a decimal point error has been made, as a cut-off value of 0.3
ng/mg would be consistent with the results shown and the interpretation
given.) According to this interpretation, the results for cocaine reported by
Parsche and Balabanova are negative.
Critique of Dr Balabanova’s work on drug analysis in mummies

It is clear from the general literature on hair analysis for drugs that Bal-
abanova was one of the pioneers of hair analysis, being the first to report
the determination of cocaine in human hair by using GCMS, thus demon-
strating that the primary analyte in hair is cocaine itself, rather than the
metabolite BZE as previously thought (Henderson et al. 1995; Balabanova
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and Homoki 1987). She obviously has expertise in this area in the context
of modern forensic analysis.
Her papers reporting the discovery of cocaine in hair from Egyptian mum-
mies are lacking in detail with regard to the methodology used. It can only be
speculated that the method used was similar to that reported in her original
work, but this does not provide important detail, particularly relating to the
GCMS analysis, in terms of retention times in the chromatography phase,
use of control samples and whether identification was based on detection
of a molecular ion or the full mass-spectrometric profile.
Parsche reports using samples weighing 1 g, which is acceptable for tissue
samples but represents a significant amount of hair (the norm being 100 mg)
to remove from a mummy. Without proven experimental rigour, it is difficult
to accept Balabanova’s findings, particularly as the concentrations are so low
in the presence of heavy contamination when such small quantities of a drug
can be difficult to detect against the background contamination, even when
modern computer programmes are used to facilitate interpretation.
Our own experience with the analysis of Base II Ring Ware, considering
the conflicting results obtained, has highlighted the potential problems
encountered when conclusions are based on the application of modern
tests to ancient materials. Analytical methods that have proven accurate and
reliable in modern uncontaminated samples must be used and interpreted
with caution when applied to ancient samples, particularly mummified
material, which frequently contains many unidentified materials.
Even hair samples from a typical Egyptian mummy are often contami-
nated by the gums and resins used to coat the hair or glue it to the skull, as
compounds from the decaying embalming materials inevitably penetrate
the hair shaft as they do the rest of the body. For example, work in progress
has demonstrated the penetration of camphor and naphthalene, as markers
of embalming material, even into the marrow of intact longbones.
Cocaine: an alternative explanation

If Balabanova’s results are indeed correct (and without reevaluation of her
extracts or retesting of the original mummies she worked on, this is difficult to
accept), then other possible explanations must be considered. The evidence
for transatlantic trade, as presented by the Cocaine Mummies documentary,
is unconvincing. A much simpler explanation is that the Munich mummies
could have been inadvertently contaminated, either in the laboratory or at
some earlier point in their history.
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Historically, the coca leaf has been a gift of nature, fuelling the extraordi-
nary high-altitude achievements of the Inca Empire. It is only as a result of
its identification and extraction into the pure form by Gaedcke in the 1850s
and Niemann’s later improvement of the earlier technique, that cocaine
became available in its powdered and highly concentrated form. In the late
nineteenth and early twentieth centuries, cocaine, devoid of its modern
social stigma, was widely used by members of the upper social classes across
Europe and America, eventually finding its way into popular ‘pick me up’
products such as ‘Coca Cola’ and ‘Forced March.’
According to the Cocaine Mummies documentary and notes from the
Munich Museum where Balabanova’s team obtained their samples, the
mummies were once in the private ownership of the King of Bavaria. The
habits of the king are unknown, but given the fashions of the time, it is not
implausible that the mummies were contaminated with cocaine whilst in
his possession or subsequently.
Conclusions
In summary, Merrillees’ proposal that opium was imported into Egypt from
Cyprus during the New Kingdom cannot be confirmed. Reevaluation of
Cypriot Base II Ring Ware seems unlikely to implicate Bil-Bil juglets, which
more probably contained a perfume product, possibly civetone based. As
for the blue lotus, scientific evidence does not support the use of Nymphaea
caerulea as a narcotic or aphrodisiac, although it may have health benefits
due to its high bioflavonoid content.
Nicotine has been found in Egyptian mummies in small quantities con-
sistent with a trace dietary source, possibly derived from celery, but not at
the levels expected from tobacco use.
The levels of cocaine reported in South American mummies are consis-
tent with the habit of coca leaf chewing. The levels reported in Egyptian
mummies are very low, below the level agreed upon for a positive result by
some laboratories and at the limit of detection by the technical standards
for GCMS in the early 1990s. The results are therefore unreliable. The
possibility of modern contamination cannot be ruled out, but either way, it
seems highly unlikely that the ancient Egyptians were exposed to cocaine
during their lifetimes.
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chapter 14
Pharmacy in ancient Egypt
Introduction
Pharmacy is the practice of sourcing, preparing and dispensing pharmaceu-
tical preparations to treat ailments. The use of medicinal plants as remedies,
from ancient to current times, precedes any formal medical record knowl-
edge being transmitted from generation to generation. This is manifested in
traditional medicine today, in which treatments are characteristic of a local
community.
This century has witnessed a revived interest in natural drug resources and
the reestablishment of sustainable species to satisfy demand (Demerdash
2001). Herbal remedies are now regulated (British Herbal Pharmacopoeia),
whereas scientific interest focuses on pharmacognosy and pharmacology
(Evans 2002).
The classical history of pharmacy

History attributes medicine to Hippocrates, c. 460 b.c., and drugs to
the mythical Chiron. Asclepiades (100 b.c.) communicated Hippocratic
medicine to Rome whilst Dioscorides (c. 50 a.d.) compiled the first phar-
macopoeia of 500 drugs (Gunther 1934). His contemporary, Pliny, wrote
of medicinal plants, whereas Celsus recorded the materia medica of the
Roman world. In c. 150 a.d., Galen developed pharmacy, thereby influ-
encing medicine for 1,500 years (Brock 1952; Sarton 1954; Nutton 2001). In
the fifth century a.d., Oribasius translated Galenic texts into Syriac, which
remained medical doctrine for 200 years. When Islam united Near Eastern
countries under one religion in the seventh century a.d., Galen’s teachings
were embraced (Elgood 1951) and continued to influence Arabic medicine
until the eleventh century.
216
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Pharmacy in ancient Egypt 217
Avicenna combined Galenic tradition with Persian medicine, which had

its origins in the Code of Hammurabi, c. 1950 b.c. (Sigerist 1987:386).
Avicenna’s Canon on Medicine (Gruner 1930) was brought to Salerno, and
subsequently transmitted to Moslem Spain whence the twelfth century Jew-
ish exodus carried his teaching to France and England. Translated into Latin
by Gerard of Cremona, the work influenced medicine until the sixteenth
century when the advent of the printing popularised medicinal herbals
(Gerard 1597; Culpeper 1653), the precursors of modern pharmacopoeia.
Elizabethan trade introduced plants and spices to Britain, and many were
incorporated into materia medica. The Society of Apothecaries (1617) estab-
lished their physic garden in Chelsea, which survives today. Indeed, Galenic
protocol influenced orthodox medicine until the eighteenth century, and
botanical preparations remain known as ‘Galenicals.’
The origin of pharmacy is readily traced to ancient Greece, but the med-
ical records of the ancient Egyptians are very much earlier. The Medical
Papyri (see Chapter 12) not only describe symptoms, but also cite approxi-
mately 2,000 remedies, many in sufficient detail to permit reproducibility.
Ancient Egyptian records

Ancient Egyptian physicians were meticulous in their medical recordings,
but difficulties remain in translating drug sources which have no paral-
lel attestation elsewhere (Quirke 1998). Comprehensive studies on ancient
Egyptian botany have emerged (Loret 1892; Täckholme 1941–1974; Germer
1985; Hepper 1990; Manniche 1999) and much is known of agriculture (Bow-
man and Rogan 1999), food supplies (Darby et al. 1977), and materials and
food technology (Nicholson and Shaw 2003). Consequently, knowledge of
Egyptian flora is increasing but identification in the Egyptian texts remains
uncertain.
Translational uncertainties
Loret (1892) translated m3tt as celery, Dawson (1933) proposing man-
drake, herbs considerably different in pharmacological application. Daw-
son (1926) translated snj-t3 as fenugreek, yet Ebbell (1937: 30) determined
it to be colocynth. Manniche (1999: 122) proposes that b3k is moringer oil,
whereas Ebbell (1937: 33) and Jonckheere (1947: 32) suggest Balanites. To
Ebbell (1937: 32), s’m remains unknown and Manniche (1999: 80) proposes
absinthe. The Grundriss (1954–1973) and Ghalioungui (1987) offer differ-
ent translations, whereas Charpentier (1981) reviewed many in the context
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218 Jacqueline M. Campbell
of botanical evidence. The diverse materia medica of ancient Egypt, how-

ever, is comprehensively recorded (Estes 1993: 139–157; Ebeid 1999: 249–271;
Nunn 2000: 136–162).
The translator not only considers the literal translation, but also assigns
a plant that fits the criteria of both language and medicinal application,
consistent with the literary and artistic evidence (Dawson 1926). Philology
is unlikely to resolve the uncertainties, although there is greater consensus
on trees, cereals and foodstuffs, because these words were used daily, but
less agreement on shrubs and herbs. The identities of fifty-five plants and
minerals are disputed, and 145 ingredients remain unidentified.
Forensic pharmacy provides the potential for validation, enabling trans-
lation to be considered from contemporary pharmacological application.
Common names are used throughout the texts to describe minerals and
plants; for the latter, these names can represent numerous species, so this
type of definitive identification is very important. Awareness of the preva-
lence of individual plants at various historical periods, indicating their avail-
ability, is another significant factor.
Forensic evaluation
The undigested remains of the cereal-based diet in ancient Egypt provide
essential forensic evidence. The last meal eaten, including medication,
may be identified by analysing stomach contents in mummified remains
(Ogell 2005). Additionally, the nutrition and diet of a population may be
determined by studying faecal remains (Aufderheide 2003). Humans have
always taken supplementary food to improve health, and hence it is dif-
ficult to distinguish between food and drug. Hair analysis (Cartmel et al.
2005; Watson 2005) affords longer term evidence of food and toxins while
indicating famine, disease and stress.
Archaeologists have determined the flora available in ancient Egypt (de
Vartavan and Asensi Amorós 1997) but provenance is uncertain in nine-
teenth century museum collections (Germer 1998: 84; Quirke 1998). More-
over, tomb finds do not necessarily indicate the burial cache. Seeds, carried
on the feet of excavators, or burrowing animals can contaminate archae-
ological sites, as can animal dung residues. Surface finds are neither rep-
resentative nor reliable. Unless present in the abundance of a granary or
bouquet, the only reliable plant evidence is in a sealed container, as in
the Tutankhamun collection (Newberry 1927: 189–196) or the Tomb of Kha
(Egyptian Museum, Turin).
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Plants significant to a later era can be placed in or near an earlier tomb

in tribute or when human remains were relocated or rewrapped. Further-
more, tomb offerings may represent the best of what was available and not
necessarily what was abundant. Consequently, plant evidence should not
be considered in isolation. Authenticity of a burial may be determined by
evaluating the phytogeography (Boulos 1999–2005), supported by evidence
of cultivation or importation.
Seeds and twigs are sufficiently robust to survive transportation, but flow-
ers are usually too delicate. Ancient Egyptians were prolific collectors, pre-
serving many items of daily use for the next life, which provide not only
archaeobotanical evidence but patterns of progression in the pharaonic
period and beyond. Techniques now used to recover archaeobotanical spec-
imens (Murray 2003: 509) are more sophisticated than those of the nine-
teenth century because they represent the general populace as opposed to
individual tomb finds.
Identification of plants presents greater difficulties (Germer 1985, 1998).
It is possible to classify family and genus, but not the species which may
be medicinally unique. For example, poppies from the same family and
genus have species with markedly different properties, one a decorative
flower (Papaver rhoeas), the other a potent narcotic (Papaver somniferous
[see Chapter 13]). The climate that preserved human remains equally pre-
served plants, and morphological examination, the least destructive process,
enables identification of some species by observing shape, size, stem, leaf,
fruit or seed.
Fruits and seeds are the most abundant and most extensively identified,
but when dehydrated, the evidence can confuse the observer. Although
dehydration and carbonisation cause shrinkage, physical cellular charac-
teristics, unique to each species, can be identified microscopically (Gale
and Cutler 2000). Provenance can also assist in identification, as can nat-
ural habitat. Fruits are noticeably smaller and often shrivelled; seeds are
robust and change shape the least, but their characteristic morphology is
less defining.
A control specimen, often required, is available in various herbaria (the
Royal Botanic Gardens Kew [RBGK] and the Vivi Tackholme Herbarium,
the University of Cairo). Living specimens can be sourced at RBGK and
the Chelsea Physic Garden, London. Texts of Egyptian flora are invaluable
aids (Täckholme 1941–1969; Boulos 1999–2005).
Palynology permits reconstruction of past flora, from observation of pollen
grains preserved on artefacts, soil, sand and human remains. The resistant
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outer coats of the pollen grain, each with a uniquely patterned surface, afford
qualitative and quantitative estimates of species that occurred thousands of
years previously. A typical pollen grain is 30 µm in diameter; it is visible
under the light microscope and reveals even more detail under scanning
electron microscopy (Ayyad and Moore 1995).
Archaeobotany indicates when plants were harvested. Constant availabil-
ity requires storage and this is confirmed archaeologically (Caton Thomp-
son and Gardner 1934; Fahmy 2003: 20). Archaeobotanical remains, how-
ever, do not necessarily indicate function. The purpose of inclusion may
be agricultural, nutritional, medical, decorative, symbolic or ritual. Cli-
mate and environment influence active principles within plants and, sub-
sequently, in their evolution.
Mass spectrometry (Chapter 10) provides the chemical fingerprint of the
plant, which may be compared with contemporary samples. Gas chro-
matography/mass spectrometry isolates the individual components, typi-
cally essential oils, alkaloids and glycosides that are significant pharmaceu-
tically. Only molecular investigation will afford comparison of species. The
DNA data bank at RBGK is a vital resource to this infant area of interest.
The biodiversity present in pharaonic times may have subsequently dimin-
ished, and thus species once prolific (Balanites and juniper) may be scarce
today.
Pharmacy, one of the few ancient Egyptian technologies which pro-
vides the recipe for formulation, is disadvantaged because there is no
known ancient pharmaceutical preparation. The raw materials, however,
are described and many are identified. Furthermore, Egyptian remedies
may be evaluated for pharmaceutical merit against modern protocols. These
include drug source (habitat, origin, harvesting and storage), pharmacog-
nosy (active principles, extraction and phytochemistry), formulation, prepa-
ration, administration, dosing regime, clinical properties and therapeu-
tic value. Applied with archaeobotany, these can be used to authenticate
species in ancient Egyptian remedies, and to propose plants as candidates
for previously untranslated words in the Egyptian texts (Campbell 2007).
Pharmacy practise in ancient Egypt

The Kahun (Griffiths 1898; Quirke 2002), Edwin Smith (Breasted 1930),
Ebers (Ebbell 1937; Ghalioungui 1987) and the Chester Beatty (Jonckheere
1947) Papyri, containing a thousand prescriptions, representing 50 per cent
of all known remedies, are pivotal in pharmaceutical history (see Chap-
ter 12). Initial assessment, supplemented by the observations of Dawson
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(1926–1935), Jonckheere (1944, 1955), The Grundriss (1954–73), Manniche

(1999), and Nunn (2000), indicate 107 drug sources of plant origin (util-
ising the leaf, fruit, seed, resin, bark and root), twenty-eight minerals and
twenty-four animal ingredients. It is instinctive to assume the materia med-
ica of ancient Egypt parallels contemporary application, but uncertainties
in identification of substances used and the diseases they treated necessitate
pharmacological evaluation.
Formulation of remedies
Ingredients in ancient Egyptian remedies indicate the character of the fin-
ished preparation. Oils used 4,000 years ago remain oils today; similarly,
honey has changed little, and the description ‘powder’ dictates the char-
acter, behaviour and nature of a formulation. Raw materials are relatively
unchanged: frankincense and terebinth trees are still cut to permit the flow
of resin, ricinus seed is pressed for castor oil, aloe leaves are tapped, fruits
are picked, and seeds are harvested and stored. Ancient Egyptian formula-
tions can therefore be directly compared with standard formulations cited
in The British Pharmaceutical Codex (1973), at a time when much was still
formulated within the dispensary.
The ancient Egyptians used creams, draughts, enemata, extracts, eye
lotions, drops, ointments, infusions, inhalations and insufflations. Juices
and linctuses soothed coughs, while liniments, lotions and mixtures soothed
skin and muscles. They used mouthwashes, ointments and pastes, pes-
saries, poultices, powders, solutions, suppositories and tablets (Campbell
and David 2005; Campbell 2006).
Formulations include the active ingredient, ancillary drugs to alleviate the
side effects of the principal drug, flavourings to disguise a bitter or unpleasant
taste, and a vehicle to carry the ingredients in even distribution and permit
measurement of a suitable volume. Nonconforming preparations include
excrement or wholesome, nutritious foodstuffs.
Raw materials
Drugs from plant sources would have been harvested from their agricultural
industry or the wild. Cereals, barley, emmer and flax, which dominated in
antiquity, were sown in November when the Nile waters receded (Murray
2003: 506–536); from these, alcohol, fibre, oils, demulcents and emollients
were sourced. Dates, carob pods, figs and pomegranate were harvested,
yielding stabilisers, laxatives, antiseptics, astringents and anthelminthics.
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The acacia flowered from October, followed by the pod, which is use-
ful in medicine. In January, gum is scraped from acacia main stems and
stored as hard chips to be used as stabilisers and demulcents, which are
useful in respiratory and skin problems. In January, beans and peas would
be sown. In April, sycamore figs, vegetables and cereals were harvested, and
melons, cucumbers and colocynth would ripen, each with potent phar-
maceutical constituents. Flax was harvested whilst young, to produce fine
cloth (Vogelsang-Eastwood 2003: 269–274), and the seed heads, the source
of pharmaceutically active linseed oil, were removed in May.
Cumin and dill seed, yielding essential oils, were harvested in June, as
well as garlic, so that its bulb could be readily stored for six months. July
brought a second harvest of sycamore figs. By August, the abundant water
lily flower was harvested and dried, and its centre was ground and made into
bread (Herodotus 2:92) (see Chapter 13); it was also used pharmaceutically.
Grapes were gathered in August and, although less commonly available
than beer, wine was used as an extraction medium, or for its acidic and
antiseptic properties, when soured.
Onions, plums and juniper berries were gathered, each with its own
medicinal use. Herodotus (2:94) describes the Egyptian marsh dwellers,
pressing castor seeds for oil, and the medicinal uses of castor oil is recorded in
the Ebers Papyrus (Ebell 1937: 59). In October, the agricultural cycle would
recommence when olives, Ziziphus fruit, and a third crop of sycamore
fig were collected; these were pharmaceutically useful as laxatives, diuret-
ics and astringents. Frankincense, cedar and coriander were obtained
through trade with the Near East, Nubia, Libya and the southern Mediter-
ranean. Animal sources originated from husbandry or hunting, and inor-
ganic sources were the products of mining, smelting, building or jewellery
industries. Drug availability probably parallelled food availability and was
subject to the same threats.
Medicinal plants available at the onset of the New Kingdom – typically
the dom palm, garlic and safflower – although not knowingly cited in any
papyri, can possibly be identified with some of the untranslated drug names.
If evidence for the onset of botanical appearance occurs later, this does
not conclusively exclude the plant’s medicinal use, but the likelihood is
reduced, although its introduction through trade must always be considered.
Preparation of remedies
Method of preparation influences the availability of the drug and hence
its ultimate efficacy. Ancient Egyptian preparations show remarkable
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consistency, embracing techniques familiar to contemporary manufactur-

ing pharmacy: boiling; warming; dry heating; vaporising; straining; cold
or warm infusion; extraction in water, alcohol or fat; pressing; triturating;
powders; sieving and moulding.
Instructions are often explicit, reproducible and supplemented by direc-
tions for use. Each details the drug sources to be used, with the most potent
ingredient being cited first, the lesser next, and the vehicle cited last. Drug
extraction demonstrates an awareness of selective solubility. Acacia and
other gums are extracted in water or fat, colocynth is extracted in alcohol,
and hyoscyamus is correctly extracted in nonaqueous solution. Some prepa-
rations use a two-stage extraction, the first being water or alcohol and the
second, acid, from sour milk or wine. Grinding increases the surface area of
the drug to the medium in which it is extracted, and the Egyptian remedies
demonstrate manufacturing control, from coarse to a fine powder. They
were cognisant of storage and shelf life, remedies being prepared daily but
usually no more than four days ahead, unless prepared in alcohol, fat, sugar
or dried.
Measurement
Measurement affords reproducibility and may indicate value, potency, and
the vehicle in which the medication is mixed, as well as any secondary
drugs or flavourings. It greatly influences efficacy, and is significant to the
formulation of remedies.
The papyri cite capacity, based on a standard volume, the units following
a binary halving of the previous subdivision:
/2 , 1/4 , 1/8 , 1/16 , 1/32 and 1/64 , the whole equalling 63/64 .
1
This dyadic system of notation was based on the Horus Eye fractions
(Nunn 2000: 142–143). Believed to equate to the standard unit of measure,
one heqat estimated to be 4.5–4.8 L (Robins and Shute 1998). The smallest
and medicinally used unit, the ro, had a value of 1 /320 th heqat, c. 15 ml.
Pommerenering (2003, 2004, 2005) proposes that the Horus Eye fractions
were a quadruple heqat, corresponding to the dja, first used in the New
Kingdom. This impacted on the efficacy of some remedies, quadrupling
the ro. Ebbell (1937) adopts the numerical notation throughout whereas
Jonckheere (1947) used the fractional representation subsequently detailed
in The Grundriss (1973: 5).
When measurements are not detailed, the pattern previously established
affords nomination of the quantity. The smallest quantity measured is 0.5 ro,
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the largest 160 ro. Characteristic of the varying drug levels in any plant, this
means that no two recipes would have had the same efficacy, even if equal
quantities were used. Indeed, this was the motivation for the development
of synthetic substitutes that revolutionised the twentieth century a.d. Mea-
surements are detailed in 230 remedies; 450 can be estimated by precedent,
leaving 320 in doubt. Those without measurement are generally used top-
ically, where quantities are not critical. When quantities are omitted from
a suppository or enema, volumes were presumably small to accommodate
the rectal capacity.
Prescription format
The format of remedies consistently commences ‘a treatment for’ or, if
in successive order, the term ‘another’ is used. Instructions accompany
remedies: ‘swallow with beer;’ ‘take for four, eight or sixteen days;’ ‘introduce
into anus, nostril, ear, nose or vagina;’ ‘take in one day;’ ‘take at night;’
‘bandage in place;’ and ‘place on wound.’ Prescriptions were detailed for
the ailment, with the dose, quantity and frequency usually specified. There
is no evidence that drugs were considered in relation to the risk involved
but they knew when not to treat ‘a case with which I will contend.’ They
amended remedies for neonates, children and adults.
Ebers Papyrus 273 stipulates an amendment for an infant, ‘to put right
the urine of a child,’ with instructions to the woman to take the remedy
and issue to the infant. This technique of maternal administration is used
to wean the infants of drug addicts off methadone. Palliative care (Edwin
Smith Papyrus 29) was practised, maintaining wound treatment, rest and
nutrition. A number of their prescriptions would satisfy geriatric care today,
including remedies for the cardia, rheumatism, frequent micturition and
constipation. There is no evidence of the holistic approach characteristic
of homeopathy and traditional medicine (WHO 1991).
Administration of remedies
Nunn (2000: 143) describes the administration of drugs from a medical
aspect. Pharmaceutically, to be effective, the drug must arrive at the site
of action, having survived the route of administration, with hazards includ-
ing gastric acid, rectal motility or vomiting reflex. Absinth, acacia, aloe,
ammi, Balanites oil, barley, beer, bayberry, bryony, carob, castor oil, cel-
ery, cumin, coriander, colocynth, dill, dates, figs, grapes, honey, henbane,
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lettuce, milk, myrtle, oils, wheat and wine were all taken orally in extracts,
mixtures, solutions, infusions, pills, draughts or linctuses. Demulcent or
palatable ingredients were incorporated in most remedies to counter bitter
or unpleasant tastes. Rarely (crocodile dung: Ebers Papyrus 334) was any
toxin prescribed orally.
Topical applications include rubefacient pine resin and turpentine or lin-
iments based on alcohol and resins. Emollients included animal fat or plant
oils expressed from ricinus, Balanite or moringer fruit. Insufflations to treat
wounds included copper, malachite or limestone. Others were ointments,
creams and honey. Poultices of high specific heat were used to relieve pain
or bring infection to a focus, utilising, clay, dung, barley or wheat. Seldom
used today, they were popular until the twentieth century, and deployed
similar materials. Pharmaceutically, all topical ingredients were conveyed
in a medium affording even distribution of the medicament to maintain it
in intimate contact with the skin.
Rectal administrations include enemata based on drugs dispersed in a
liquid base of oil, milk or water. Others were demulcent ointments of veg-
etable oils or animal fats incorporating mildly antiseptic honey or antibac-
terial resins. Suppositories were administered to deliver a drug, demulcent
or stimulate defecation, containing finely powdered medicament incorpo-
rated into a fat or mucilage basis, which melted or rehydrated with body
fluids at body temperature.
Inhalation utilises the vapour of pine resins or bitumen, heated on hot
stones and inhaled through a hollow reed or resin inserted directly into the
nostril. Inhalations remain for respiratory problems, although inhalers are
used now rather than hot vapours, which were common only fifty years ago.
Fumigation with mercury, although no longer applied, was used in the
late nineteenth century to treat syphilis, and frankincense was utilised as a
powerful antiseptic. In the Kahun Papyrus (c. 1900 b.c.), frankincense was
cited as a fumigant for the womb.
Vaginal drugs were administered in ancient Egypt as ointments, douches,
pessaries or fumigants, bringing the drug in close contact with the mucous
membrane.
Aural, nasal and ophthalmic preparations are now invariably ointments or
solutions, with ophthalmic preparations being sterile and isotonic. Ancient
Egyptians had no concept of sterility but their remedies were site specific,
consisting of antibacterial agents such as copper, malachite and resins, and
additionally, biocides of antimony and lead, mixed in any vehicle that would
afford application.
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Ancient Egyptian dressings

Ghalioungui (1983: 6–8) cites the term wt to describe the medical dresser,
a term also used in embalming (Nunn 2000: 133–134). Dressings are an
essential adjunct to medical care, affording comfort, protection and physical
support, and ensuring medicaments have close contact with the wound and
thereby increasing efficacy. Vogelsang-Eastwood (2003: 294) reports wax-
impregnated bandages to keep the dressing in place. The type of wound
and stage of healing determines the dressing. Lint, a soft linen product, was
used to apply grease and honey. Bandages were applied in strips (sehed), to
act as a suture and close the wound. Splints were used for (Edwin Smith
Papyrus 35) a ‘fracture of the clavicle’ to hold the arm firmly in place once
the bone had been reset. Stiffened rolls of linen were used to protect injured
tissues for a split ear (Edwin Smith Papyrus 27) or a broken nose. Rolls of
linen served as tampons (Edwin Smith Papyrus 11–15) to absorb body fluids,
and form soft templates for damaged tissue.
Secondarily, dressings must maintain the wound in a moist condition,
and keep it free from infection, toxins and fibre. Lint or seed wool were
soaked in medicaments and applied to the anus. As the wound heals or
deteriorates, differing dressing types are appropriate (British National For-
mulary [BNF] 2001: 689–696), and this staging is exhibited in the Edwin
Smith Papyrus 11. They also reported when not to dress wounds to allow any
infection to drain (Edwin Smith Papyrus 47). The need to change dress-
ings daily was recognised for ulcerated or infected wounds (Edwin Smith
Papyrus 46). Construction of ancient bandages is remarkably consistent with
contemporary dressings (Campbell et al. 2005).
Therapeutic effect of drugs in ancient Egypt

The medicinal chemistry and pharmacology of many plants is well doc-
umented (Martindale 1958–1977; Nunn 2000: 215; Evans 2000). Efficacy
depends on the correct drug and dosage regime, appropriately formulated
and administered for the medical indication. Today, calculations are based
on the dynamics of drug absorption, distribution, and elimination from the
body (Wilkinson 2001: 3–31). A direct relationship exists between the blood
concentration of a drug and its pharmacological action. This may be the
required therapeutic, subtherapeutic or a toxic effect.
Patients respond differently, a dose which is subtherapeutic to one being
efficacious to another. Following administration, drugs follow a recognised
fate. A lag phase precedes the minimum effective concentration (MEC)
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for the drug, the intensity of effect increasing as absorption continues. This
peaks at a specific time, after which elimination dominates, resulting in a
decreased effect.
Once the drug level falls below the MEC, a second dose is normally
administered, its lag phase overlapping the declining phase of the previous
dose. Dose frequency is designed to maintain drug concentration between
the MEC and toxic concentration – the ‘therapeutic window.’ The ancient
Egyptian dosing regimes, probably based on empirical observation that a
single dose rarely works (save for laxatives), satisfies this pharmacokinetic
pattern. Using knowledge of pharmacognosy, pharmacokinetics, formula-
tion, preparation and drug administration, ancient Egyptian remedies may
be pharmaceutically assessed against early twentieth century a.d. pharmacy
protocols (Campbell 2006).
Efficacy must be evaluated against a medical indication: Ricinus com-
munis, the castor oil plant, has a physiological action as a laxative, but acts
physically as an emollient or demulcent. Acacia gum is a physical skin emol-
lient, and physiologically a respiratory demulcent. Pharmacy today utilises
food substances, but this does not preclude its primary nutrient role nor
diminish its pharmaceutical function. Fig (Ficus caricus), a nutritious fruit,
has bulk laxative properties; Balanite nut, a high calorific famine food, has
antidiabetic and anthelminthic properties, its oil being a lubricant.
The efficacy of drugs used in ancient Egypt

Gastrointestinal drugs. Laxatives promote defecation. They are irri-
tant, bulk forming or lubricant. The irritants, castor oil and colocynth,
stimulating fluid secretion and gut motility, were used in ancient Egypt in
therapeutic amounts. Luminally active bulk formers such as whole grain,
figs and fruits, increase the volume of the gastrointestinal tract and are
without therapeutic limit. Oils lubricate the intestine and facilitate the pas-
sage of stools. Without therapeutic limit, these were utilised by the ancient
Egyptians, but rarely taken in more than one dose. No archaeobotanical
evidence exists to support the use of senna or aloes.
Antacids increase the stomach pH. Calcium carbonate (limestone)
was used at unknown therapeutic levels; however, excess would produce
metabolic alkalosis. Digestants, based upon hydrochloric acid and bile salts,
were not available, although they used sour milk, yielding butyric acid, a
digestant. Barley water, milk and honey were used as stomach demulcents,
properties utilised today, each physical in action and without therapeutic
limit.
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Hyoscyamus muticus controls diarrhoea by reducing intestinal motility

and is efficacious in small doses, although no measurement is cited in any
Ebers Papyrus remedy. Gypsum, similar to kaolin, was cited for diarrhoea.
It is hydroscopic and acts physically, binding excess gut water which causes
the diarrhoea. It also adsorbs enterotoxins (Jafri and Pasricha 2001: 1038).
Cardiovascular drugs. Some plant glycosides demonstrate powerful

cardioactivity, and aloe and mustard contain subtherapeutic amounts
(Ebers Papyrus 191–200). Ammi, a cardioactive vasodilator at 2.5 mg, was
prescribed at therapeutic levels (Ebers Papyrus 215).
Diuretics increase the rate of urine flow by reducing superfluous extra-
cellular fluid. Before synthetic diuretics, plant substances were used for this.
Glucose, sucrose and mannitol, present in fruits, carob and honey, promote
diuresis, and the ancient Egyptians utilised them to treat the heart. Owing
to its hypertensive effect, acacia is contraindicated as a diuretic but is cited
in Ebers Papyrus 200 for the ‘cardia.’
Central nervous system. The ancient Egyptians had access to hemp

(Cannabis sativa) but there is no evidence of its sedative properties.
Ghalioungui (1987: 19) proposed š3š3 as the sedative valerian but no ancient
Egyptian remedy is consistent with this property, nor is there any archaeob-
otanical evidence of valerian.
Hyoscine, extracted from Hyoscyamus muticus, controls muscle motility
by depressing motor function. Its extraction and use in Ebers Papyrus 66 is
compatible with its pharmacological properties. Rubefacients and biocides,
each without central nervous system activity, were used in the Ebers Papyrus
for epilepsy (Case 210), and for paralysis (Cases 758–760).
Analgesics and antipyretics. Pain is often synonymous with fever in the

papyri. Salt and alum without analgesic value are antipyretic. Celery, frank-
incense, cinnamon, coriander, juniper and benzoin, vogue in contemporary
aromatherapy, have little analgesic value. Ebers Papyrus 766 and 294 cite
Willow but demonstrate no awareness of the analgesic properties of salicin,
a precursor to salicylic acid. Hemp incorporated in a suppository to refresh
the anus (Chester Beatty Papyrus 24) is without therapeutic benefit but is
physically supportive. There is no Egyptian archaeobotanical evidence of
the opium poppy before the Roman Period (see Chapter 13).
Musculoskeletal disorders. Many disorders result from strain, and

the remedy is immobilisation and heat until the bone or muscle heals. The
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ancient Egyptians used vasodilating rubefacients, which increased blood

circulation and imparted comfort and warmth. Turpentine and mustard,
long utilised in this capacity, were used in ancient Egypt together with
Juniper, pine resins and frankincense, enhanced by warming poultices and
bandages. Tolerance of the irritant determines the therapeutic limit. As
today, the ancient Egyptians used rubefacients to control rheumatism, and
also the recognised antirheumatics, celery and saffron (Ebers Papyrus 655,
296) (Evans 2000).
Genitourinary system. Drugs to influence labour, menstruation, vaginal

infections or contraception were used in ancient Egypt, although diagno-
sis is vague (Nunn 2000: 196–197). Prior to the advent of hormonally based
drugs, treatment differed little from the formulations described in the papyri,
which utilised fumigation, demulcents and topical applications. Crocodile
dung used as a contraceptive (Kahun Papyrus 21) putatively possesses sper-
micidal properties, but would be an effective barrier contraceptive. Juniper
oil, a uterine stimulant (Ebers Papyrus 805), would induce labour and is con-
traindicated today in pregnancy. Reference to hordenine, an alkaloid from
sprouting barley that has adrenergic properties, occurs in Kahun Papyrus
17, in connection with a woman’s bleeding.
Urinary drugs influence urine retention, incontinence, pain and infec-
tion. Demulcents, such as wheat, barley, honey and acacia mucilage, create
an alkaline environment hostile to bacterial growth, while relieving burn-
ing and pain associated with parasitic or bacterial infection. Their action is
physical and effective. Natron and northern salt influence electrolyte bal-
ance. Balanite oil, an anthelminthic, was only used sporadically, suggesting
that the physicians did not recognise its true therapeutic value. Diagnosis
may not always be possible (Nunn 2000: 161 and 91–92), but nevertheless,
remedies affording symptomatic relief may be therapeutically evaluated.
Antibacterials, antibiotics and infestation. Anthelminthics rid the

gastrointestinal tract of worms. Those cited in the papyri remained in phar-
maceutical practice until fifty years ago. Pelletierine, from pomegranate,
depresses intestinal smooth muscle, while simultaneously paralysing the
tapeworm, which is then removed by purgatives. Antimony, a biocide, has
long been used in the treatment of fluke parasites. Laxatives dominated
their treatment and current protocols advocate their use.
Martindale (1958) cites phenols, alcohols, acids, halogens, oxidising
agents, metals, their salts and dyes as antiseptics, germicides and fungicides.
Phenols denature the protein of bacterial cells. As a phenol, the ancient
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Egyptians used bitumen, available from the neighbouring Near East; their
alcohol was provided by beer or fermented wine; and their acid came from
soured wine. Copper bases, safflower and indigo dyes were commonplace
and used in painting and textiles. Oil excludes air, preventing bacterial
growth. Heavy metals are astringent, and in particular, copper salts, with
their germicidal and fungicidal properties, were frequently used in ancient
Egyptian medicine.
Honey was widely used bacteriocidally, inhibiting bacterial growth and
extracting water from wounds by osmosis, thereby providing a dry envi-
ronment that was hostile to bacteria. Today, Mesitran, a new hydroactive
range of dressings, delivers the therapeutic benefits of honey for all stages of
wound healing (Medlock Medical 2005: 10–11). Zinc and aluminium, cited
in the papyri, are locally applied primary astringents, possessing germicidal
properties, that damage the surface protein of the bacterial cell.
Respiratory system. Expectorants promote removal of lung secretion,

and antimony was used to loosen a dry cough. Bitumen was poured on
hot stones and inhaled as a stimulant expectorant (Ebers Papyrus 326).
Turpentine had similar application forty years ago. The ancient Egyptians
used acacia and carob as demulcents to soothe irritated membranes, but
there is no evidence that they utilised anodyne expectorants. Asthma (Ebers
Papyrus 327–336) was treated inappropriately although Ammi, a respiratory
vasodilator, was prescribed for a cough (Ebers Papyrus 319 and 323).
Ophthalmic. Nowadays, eye infections are treated with antibiotics and

antivirals, whereas fifty years ago, mercury and antimony were used.
Although they were effective biocides, absorbed through the conjunctival
capillaries, they were renotoxic. The Egyptians used lead (galena), mala-
chite, copper and possibly antimony to treat eye infection, as well as some
outlandish preparations that contained pathogens and irritants.
Ear, nose and oropharynx. Antibiotics are currently used to alleviate ear
infections although ribbon gauze soaked in astringent aluminium acetate
was formerly prescribed. The therapeutic equivalent in Egypt was mala-
chite, oil and honey on seed wool (Ebers Papyrus 766). Wax, which causes
pain and deafness, requires removal if it is impacted, and today, olive oil is
prescribed to soften the wax. In the Ebers Papyrus (764 and 765), the equally
efficacious goose fat and Balanites oil were utilised.
Today, sodium chloride drops relieve nasal congestion by liquefying the
mucous secretions, and the Ebers Papyrus (761) prescribes the equally
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therapeutic date wine. The ancient equivalent of contemporary deconges-

tants was the fragrant gum placed in the nostril (Ebers Papyrus 763).
Pain from ulceration of the mouth is relieved by mouthwashes, antiseptics
and antifungals. The papyri similarly cite demulcent acacia, carob, milk and
grease to soothe, and yellow ochre, cumin, copper and manna as antiseptics;
all these formulations are prescribed for a number of days. Thymol, from
thyme, is used today, but has no archaeobotanical representation until the
Roman Period. The local anaesthetic properties of celery seed is cited (Ebers
Papyrus 701), although its duration is short term.
Skin. Demulcents, comprising gums, mucilage, aloe and starches, which

coat the surface and protect the underlying irritated tissue, were applied as
lotions. Vegetable oils, animal fats and waxes protect, soothe and hydrate
the skin, and as emollients, they are commonly used to treat eczema;
the Egyptians also used them for these purposes. Today, these treatments
are based on wax, liquid paraffin, lanolin, cod liver oil and urea, whereas
the ancient Egyptians used castor oil, Balanites oil and urine of an ass or of
women who had recently borne a male child.
These contemporary remedies incorporate antimicrobials, but the Egyp-
tian ones included, as antiseptics, salt, frankincense, ochre, alabaster, styrax
and myrrh, as well as antimicrobial honey, each of which demonstrates
pharmaceutical merit. Jaundice, viewed as a skin complaint, was treated
by laxatives, which had no effect on liver function, but improved pallor by
removing bile.
Scalp dermatitis (dandruff) responds to antimicrobials in oil. The papyri
cite ladanum (Ebers Papyrus 357), a mild antiseptic oil, although there is no
archaeobotanical evidence of the shrub. Baldness was treated ineffectively,
with oils, fats, copper and hedgehog quills (Ebers Papyrus 776).
Burns (Ebers Papyrus 484–509) were treated with soothing demulcents,
protective antiseptics and biocides, which were all effective, but the astrin-
gents they used – turpentine, copper and frankincense – would be painful,
although this was ameliorated to some extent by oils, animal fats and honey.
The pathogenic sheep dung recommended in Ebers Papyrus 483 would
have been deleterious.
Trauma and wound management

The Edwin Smith Papyrus (1–48) and Ebers Papyrus (510–588) used honey,
grease and lint, after debriding and suturing. Infected wounds were treated
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with biocides such as malachite, copper, zinc and antimony, each of which
has an infinite therapeutic window.
Conclusions
Although the ancient Egyptian pharmacopoeia was unsophisticated, there
is compelling evidence of recognisable formulation, preparation, adminis-
tration, dosing regime and efficacy. Principal, secondary drug, vehicle and
flavouring are recognisable in 70 per cent of remedies, with only 30 per cent
of remedies characterised by polypharmacy.
The first scientific estimate of pharmaceutical merit demonstrates
that 64 per cent of remedies have therapeutic value, equally divided
between physiological and physical action. Of these 3 per cent are toxic,
1.5 per cent subtherapeutic and 20 per cent undetermined, the remainder
having no known therapeutic activity. If the ro is 60 ml, there is evidence
that colocynth, in some recipes, was occasionally prescribed at a toxic dose.
The placebo effect cannot be overlooked (Nunn 2000: 97 and 137–138).
There is consensus on the translation of 45 per cent of drug sources,
supported by archaeobotany and pharmacognosy. Plants of uncertain iden-
tification can be verified by applying these techniques, which supports the
translation of d3rt as carob, snj-t3 as colocynth, pšd as hyoscyamus, š3w as
coriander, m3tt as celery, b3k as Balanite and s’m as artemisia; however, this
does not support innk as thyme, inst as aniseed, š3š3 as valerian or ims.t
as dill, although there is significant archaeobotanical evidence of dill in
predynastic times (Fahmy 2003).
A single reference confirms that Balanites, an anthelminthic, was used to
treat schistosomiasis (Ebers Papyrus 265), and there is artistic and archaeob-
otanical evidence that mandrake, a potent soporific, existed, although it is
not apparently cited in the texts. The medicinal worth of other plants used in
ancient Egypt is now recognised: for example, saffron, safflower and celery
are antirheumatic and juniper is abortifacient.
There is compelling information to indicate that the food which sustained
their good health in times of plenty was also used selectively in potent
amounts to cure them in sickness. Preliminary research (Campbell 2006)
has demonstrated that prescriptions originated in distinct areas of Egypt or
abroad, closely reflecting the phytogeography of the species.
Finally, the role of the ancient Egyptian pharmacist should be consid-
ered. Prescriptions begin ‘thou shalt prepare for him,’ indicating the exis-
tence of the pharmacist, although this role was synonymous with that of the
physician. The Ebers Papyrus (Ebbell 1937: 75) describes an ointment to be
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made by Chui the venerable, the high priest of Heliopolis. This man did
not have the title of pharmacist, but he was probably the first to be named
as a preparer of drugs.
The pharmaceutical foundations established in early dynastic Egypt were
adopted by the developing Greek and Persian civilisations, particularly from
650 b.c. onwards, and their subsequent political stability, military domina-
tion and communication skills provided the historical context and conti-
nuity in which pharmacy could flourish and develop. Consequently, the
Greeks were recognised as the fathers of pharmacy, but credit for this most
certainly belongs to the ancient Egyptians who practised a credible form of
pharmacy and pharmacotherapy a thousand years previously.
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part 4
Resources for studying

mummies
235
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236
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chapter 15
The International Ancient Egyptian

Mummy Tissue Bank
A. Rosalie David
Introduction
The late twentieth century saw various initiatives to address issues surround-
ing the ethics and treatment of the dead in museum and other collections
(e.g. in papers produced by the World Archaeological Congress [1989] and
the Museum Ethnographers Group [1994]). By the early twenty-first cen-
tury, these matters warranted even greater attention, and in May 2001, Britain
established a Working Group on Human Remains, with the remit ‘to exam-
ine the current status of human remains within the collections of publicly-
funded Museums and Galleries in the United Kingdom, and consider the
desirability and possible form of legislative change in this area’ (DCMS
Report 2005:5).
This Working Group produced a report (DCMS 2003), and there was
subsequent consultation on this document (DCMS 2004). Together, these
formed the basis for the DCMS Report (2005), which sets out nonstatutory
guidance for museums in England, Wales, and Northern Ireland, who own
permanent collections of human remains, and other organisations where
human remains form part of their teaching, research, or display functions.
The DCMS Report (2005) provides information relating to a legal and
ethical framework for the treatment of human remains; the curation, care
and use of remains; and a framework for handling claims, where appropriate,
for the repatriation of human remains to indigenous communities.
This report recognises the contribution to the modern world that research,
teaching and, where appropriate, display of human remains can make, but
also acknowledges that, because of their ‘personal, cultural, symbolic, spiri-
tual or religious significance to individuals and, or, groups’ (DCMS 2005:7),
human remains have a unique status in museum and other collections, and
therefore require special attention.
237
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There is acknowledgment that access to human remains for practical

study is an essential component of higher education courses that have a
medical or osteological element, with the insistence, however, that students
should be made aware of their ethical and legal obligations when working
on these remains (DCMS 2005: 20).
The report also provides guidelines on sampling human remains for sci-
entific analysis (DCMS 2005: 21); it recognises the importance of access to
this material for some research projects, even though the work may ulti-
mately involve destruction of the sample. It explicitly recommends that
only appropriately qualified staff and students should undertake the sam-
pling, that it should be performed to the highest standards, and that only
the smallest samples required for the investigation should be removed.
The guidelines also state that the holding institution should ensure that
there are good scientific justifications for taking the samples, that the sam-
ples will form part of a carefully planned research programme that can be
expected to produce useful results, and that sampling should only be per-
formed after researchers have considered and confirmed that the research
question cannot be answered by nondestructive methods. If appropriate (e.g.
if the effectiveness of the chosen research technique needs to be proven),
the report recommends that a pilot study should be conducted on a small
number of samples before permission is sought for a full project. If any
samples are not destroyed during analysis, they should be returned to the
collection.
Aspects of any research programmes involving sampling should be fully
documented by the holding institution. These records should include: the
application and justification for the project, details of sampling (sample
location and size and sampling process), and, ultimately, a full account
of the results of the analysis. This ensures that such information will be
accessible to future researchers.
This guidance also states that institutions holding ancient human remains
for research purposes should ensure that there is public access to informa-
tion about these collections and the associated research programmes. Pre-
sented within a research framework, this should identify the nature of the
material and the current state of knowledge in the related research areas,
any potential areas of research to which the holdings might contribute, and
a strategy to indicate priorities and methods of research.
Many of the above issues had already been addressed by the Manchester
Mummy Research Project when, in 1994, the International Ancient Egyp-
tian Mummy Tissue Bank was established at the University of Manchester,
initially to provide a resource for the team’s work.
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The International Ancient Egyptian Mummy Tissue Bank 239
Establishing the International Ancient Egyptian Mummy Tissue Bank

The tissue bank was set up to ensure that a sufficient quantity of tissue
samples from Egyptian mummified remains were available for the Ancient
Schistosomiasis Project (see Chapters 1, 8, and 9). The Manchester team’s
studies since 1973 had made the members aware that as well as contributing
to knowledge about health, disease, medical conditions, diet, and occupa-
tions in ancient Egypt, Egyptian mummies are a repository of evidence
about other areas, including mummification practices, funerary beliefs and
customs, chronology and radiocarbon dating techniques, and familial rela-
tionships.
The foundation of the bank was also timely because, by the mid-1990s,
researchers had access to increasingly sophisticated techniques that could
be applied to small tissue samples. These included histology, pathology,
DNA techniques, immunology, chemical analysis, pharmacology, virology,
spectrometry, and radiocarbon dating methods. Therefore, from the begin-
ning, the tissue bank had the potential to provide a resource for a wide range
of studies undertaken both by the Manchester team and other researchers
(Lambert-Zazulak 2000).
There were several factors that had to be addressed when the tissue bank
was established: the methods of study that could be applied to the tissues;
knowledge that might be gleaned from this research; and various archaeo-
logical, practical, and ethical issues related to collecting, storing, and study-
ing mummy tissue samples. For example, the Manchester group was fully
aware that in addition to its primary role as a research resource, the tissue
bank would address some of the conservation and display concerns associ-
ated with requests for access to mummies for scientific investigation (see
Chapter 16).
The removal of full-body mummies or even mummified parts from per-
manent museum displays for repeated access and sampling can cause dis-
ruption and will involve additional handling of the human remains. In
contrast, the establishment of the tissue bank contributes to conservation of
the remains because it reduces the need to handle the mummy. Researchers
can make good use of a single occasion to examine, radiograph, and collect
small tissue samples from the mummy. Using endoscopic techniques (see
Chapter 4), scientists can obtain samples from inside the bodily cavities,
with minimal destruction to the mummy, and these samples can then be
kept in the tissue bank where they are readily available for future studies.
The concept of tissue banking originated many years ago to support med-
ical research, and it has continued to contribute to studies that advance
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disease diagnosis and treatment. For example, some banks store tissues for
transplant surgery, whereas others hold blood and blood products. There
has also been a historical tradition to create institutional resources in muse-
ums, and in some university departments, research institutes, and learned
societies, where many types of artefacts are held and made available for
research. In some cases, these have included ‘libraries’ of samples taken
from ancient and modern material, which include, for example, animal tis-
sues, groups of insects and plants, stone artefacts, and textiles. In many cases,
the holding institutions also compile and store information about these col-
lections. Researchers who work in these institutions or elsewhere can gain
access to this material and associated documentation, which provides them
with the opportunity to add new knowledge to the subject area. Some of
these collections also present excellent opportunities for interdisciplinary
research.
Although tissue banking had already been introduced elsewhere for sam-
ples obtained from South American mummies, the establishment of the
Ancient Egyptian Mummy Tissue Bank at Manchester was the first formal
project, on an international scale, to seek material from Egyptian mum-
mies held in collections outside Egypt. This initiative posed the challenge
of trying to combine the concept of tissue banking with the creation of an
institutional resource of samples, with its associated documentation.
The formation and development of the tissue bank

Initially funded by a research grant (1996–1999) from The Leverhulme Trust
(UK), the tissue bank project set out to obtain samples from a maximum
number of individual mummies held in collections outside Egypt (Lambert-
Zazulak et al. 2003). There was no true precedent for the creation of this
tissue bank. For example, in medical tissue banks, the collection, storage,
distribution, and study arrangements for each bank are dictated by the uses
for which the samples are intended, and each type of bank has its own
scientific and ethical criteria, which represent the bank’s specific mission.
These criteria have little direct relevance to the Ancient Egyptian Tissue
Bank, and so, new criteria had to be established.
The first step was to identify and locate the whereabouts of Egyptian
mummies and mummified parts in collections around the world (excluding
Egypt). A starting point was provided by the International Egyptian Mummy
Database (Pettitt and Fildes 1984). This was established in Manchester in
1984, in response to an urgent request made at the international symposium,
Science in Egyptology, held at Manchester in 1984, that information about
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Egyptian mummies held in collections throughout the world should be

collected, collated, and computerised as soon as possible (Pettitt and Fildes
1986). This database was now used as a primary resource for identifying
potential collaborating institutions.
Searches were also made through directories and other listings of muse-
ums, universities, research institutes, medical schools, learned societies,
libraries, stately homes, and schools. As well as the expected locations,
mummies were also successfully traced to some unusual sources, includ-
ing castles, monasteries, a morticians’ college, a school cupboard, and a
lido.
This stage of the work provided a fascinating insight into the reasons why
people had collected mummies (which were as varied as their collectors)
and the routes by which the mummies had reached their present locations.
Generally, the mummy collections reflect the interests and resources of the
collectors, and, in some cases, the fashions that prevailed at the time.
In past centuries, some travellers and others with a dilettante interest in
Egyptology purchased mummies on the open market from dealers who,
residing in Egypt or elsewhere, supplied an ever-growing demand for antiq-
uities and curiosities. For example, the tissue bank includes samples taken
from a mummy now displayed in a stately home, which was brought back
by a relative of the current owner from her honeymoon in Egypt (Rowley-
Conwy et al. 1998). There is also tissue from a mummy purchased by a
leading member of the Leeds Philosophical and Literary Society (England)
in order that the Society’s members could undertake a detailed philological
and scientific investigation of the mummy and its coffins in 1825 (Osburn
1828).
Mummies from excavations funded by museums, learned societies, and
private art collectors are the most likely to have an archaeological prove-
nance (‘find-spot’) and are therefore particularly important for epidemio-
logical and other studies that require this information. Other mummies
were acquired because of the study interests of their collectors, which
included medicine, pathology, the history of medicine, anthropology, eth-
nology, ancient history, art, archaeology, Bible studies, and pharmacology.
There were also more unusual areas, such as phrenology, eugenics, and
even the history of circuses and showmanship.
In recent years, an unusual opportunity for interdisciplinary research and
university outreach studies was provided when a partial mummy was discov-
ered in a cupboard at a school in England. The mummy had been donated
to the school by its former owner, a pathologist whose daughter had attended
the school; many years earlier, he and his colleagues had unwrapped and
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performed a partial autopsy on the mummy. When the remains were first
found, teachers and pupils from the school brought them to the KNH Cen-
tre for Biomedical Egyptology at the University of Manchester.
Here, samples were removed for the tissue bank, and the mummy pro-
vided the basis for various scientific projects undertaken by students pursu-
ing the Master of Science Degree in Biomedical Egyptology. The mummy,
which has now been returned to the school where it is housed in appro-
priate conditions, and all the new information derived from the studies
undertaken at Manchester, are providing a unique and fascinating resource
for the school’s ongoing science, history, and art projects.
In the past, Egyptian mummified remains have been put to some unex-
pected uses: for centuries, mumia was acclaimed as a medicinal and phar-
maceutical ingredient (see Chapter 16; Dawson 1926–1927), and ‘mummy
brown,’ made from pulverised mummy tissue, was popular as an artists’
pigment (Woodcock 1996). For the tissue bank, it was thought likely that
the main sources of samples (which include mainly tissue but also some
bone and hair) would be full-body mummies, mummified parts, the visceral
contents of Canopic jars, and samples of mumia.
To identify the presence and location of these potential sources, the
Manchester researchers approached more than 8,000 possible owners and
holders of this material. An excellent response brought confirmation of
material in many countries, including Australia, Brazil, Chile, Canada,
Iceland, India, Germany, Italy, Portugal, South Africa, and the United States
of America, as well as collections in institutions throughout Britain. The
types of collection varied considerably, ranging from a single body part,
such as a mummified finger, to human remains representing hundreds
of individuals that were excavated in Nubia as part of a rescue operation
associated with the construction of modern dams on the Nile.
Collecting the samples

The methods and extent of sampling, and the subsequent research that can
be undertaken on the samples, will be largely dictated by the physical state
and degree of preservation of each source of mummified material. Factors
that have most impact in this respect are the natural environmental condi-
tions in Egypt; the provenance of the mummy; the method and quality of
the mummification process; activities of tomb robbers in antiquity; methods
of acquiring, transporting, and storing the body in its more recent history;
and the techniques used by previous scientific investigators and conservators
(see Chapter 16).
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Acquisition of samples for the tissue bank involves several stages. Once
the mummified remains have been identified and located, permission to
undertake tissue sampling is sought from the owner/holder of the material.
If this is granted, then deposits are requested of approximately 1 to 2 g of
dried soft tissue (which can include skin, brain, muscle, or viscera) from
each mummy or mummified part. Also, the bank will receive samples of
hair, bone, and teeth.
These samples can either be collected by the owner/holder (in which
case, the bank administrators will provide advice and detailed instructions),
or, if requested and it is feasible, an experienced member of the Manchester
Mummy Project will undertake this procedure.
During this process, the researchers should ensure that the mummies are
treated ethically and handled with respect at all times, and tissue should
only be collected from sites where this would not be detrimental to the over-
all physical condition of the mummy. Recommended routes for sampling
include any area of the body that has already been opened up through dam-
age or previous investigation, the severed area of a separate limb or head,
or the use of endoscopy to gain access to internal areas of the body (see
Chapter 4).
At the University of Manchester, the tissue bank samples are held in a
metal fireproof cabinet that provides a physically secure store, and this is
housed in a dedicated area that provides the correct environmental condi-
tions for fragile organic material.
When a sample enters the bank, it is allocated a unique identification
code that remains with it throughout its subsequent history. The sample is
always left intact, because preserving its integrity in this way ensures that
it can be used for as many studies as possible; also, a single sample will
often include various tissue types and the macroscopic appearance of an
intact sample can help a researcher to identify and decide which area of
the sample may be most suitable for any proposed research.
The tissue bank documentation system

As well as collecting tissue samples, a major function of the tissue bank is
to provide central record keeping and to store information relating to the
samples, so that this will be available for future research.
A ‘Material Transfer Agreement’ is sent to each depositor of tissue or
other samples. This states that the sample(s) is transferred to the bank for
a renewable period of ten years, and that it can be loaned on approved
application for use in well-planned, documented, and achievable research
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projects. Under the terms of this agreement, reports will be issued to each
depositor on any research conducted on their samples.
Researchers who borrow samples from the tissue bank are asked to sign
a ‘Researcher’s Agreement,’ which allows them to retain the material for
one year, in the first instance. The agreement requires that they report their
results to the tissue bank administrators, and that, in any publications, they
record the reference code of the sample(s) and acknowledge its depositor.
Other documentation kept by the bank includes a central listing of the
location of all mummies and mummified parts that are identified through
the bank’s searches and studies, whether or not these institutions contribute
samples to the bank. Sometimes, for example, biopsy sampling cannot be
performed on the human remains, either because of existing general agree-
ments regarding ethical issues over human remains, or because the remains
are physically inaccessible due to thick or tight wrappings.
Nevertheless, the existence of the remains can still be recorded, and it
may be possible to photograph or radiograph them, thus providing valuable
information for the tissue bank records. The tissue bank documentation,
continually updated, is believed to represent the largest centralised record
of ancient Egyptian human remains held in collections outside Egypt.
The role of the tissue bank in supporting research

As the tissue bank has now been in existence for some eleven years, it is
possible to assess the role it can play in supporting research projects, and
providing material for postgraduate and postdoctoral studies. In addition
to the major programmes undertaken by the Manchester Mummy Project
on disease studies and pharmacy in ancient Egypt (see Chapters 1, 8, 9, 13,
and 14), the bank provides material for various studies undertaken by other
researchers based elsewhere.
One of its new and most significant functions is to provide material for
research undertaken by postgraduate students as part of their Master of
Science and Doctor of Philosophy courses in the recently established KNH
Centre for Biomedical Egyptology at Manchester (see Chapter 17).
Stating that ‘Research into human remains and their context are an
important source of direct evidence about the past,’ the DCMS Report
(2005: 8) specifies several specific areas of study, and it is evident that many of
the research projects undertaken by students in Manchester are making
important contributions to these fields. For example, in the category defined
as ‘human evolution and adaptation, and genetic relationships’ (DCMS
2005: 8), student research has explored the retrieval of parasite, nuclear,
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and mitochondrial DNA (see Chapter 9), and the genetic relationships
between individual mummies or family groups.
In two other specified areas, ‘disease and causes of death’ and ‘history of
disease and of medicine’ (DCMS 2005: 8), there have been disease stud-
ies on sickle cell anaemia, parasitic infestations including schistosomiasis,
tuberculosis, parvoviral infections, malaria, thoracic bacteria, and therapeu-
tic treatments. New knowledge about ‘burial practices, beliefs and attitudes’
(DCMS 2005: 8) has been contributed by forensic studies on the materials
used in mummification such as resin and natron, analyses of the preserva-
tion state of mummified tissue (see Chapter 6), and a scientific investigation
of the mummification process itself.
In relation to ‘diet, growth and activity patterns’ (DCMS 2005: 8), studies
have been undertaken on the drug content in modern and ancient hair, and
ancient Egyptian hair and its treatment with henna have been the subject
of analysis. Other projects have addressed conservation issues, such as bone
decomposition or the identification of fungi in human remains.
Techniques used in these projects include histology, histochemistry, DNA
identification, immunology, mass spectrometry, and micro-scale sealed-
vessel pyrolysis coupled with gas chromatography/mass spectroscopy. Sam-
ples from the tissue bank have also been used for studies on problems that
can occur when radiocarbon dating techniques are applied to Egyptian
material.
In addition to the tissue bank, museums preserve a wealth of other evi-
dence from ancient Egypt. The Manchester students have had access to
ancient plant remains and tissue from mummified animals, and this has
facilitated some very interesting projects. These include a molecular analy-
sis of ancient cereal crops (see Chapter 9), a mass spectrometric analysis of
ancient Egyptian plant remains (see Chapter 10), a histological examination
of tissue from an ancient Egyptian cat (see Chapter 6), and a comparative
study of DNA extracted from modern domestic and ancient Egyptian cats
(see Chapter 9).
The future of the tissue bank

The tissue bank is in the process of moving from The Manchester Museum
to the KNH Centre for Biomedical Egyptology, where it can now fulfil its
role more appropriately. It is important that the bank continues to grow and
develop so that it can provide a valuable resource for palaeoepidemiological,
biomedical, and scientific studies in Egyptology. The recent introduction
of Biomedical Egyptology as a university subdiscipline at Manchester (see
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Chapter 17) will also help to shape the direction this development may take
in the future.
The bank, which currently holds some 1,400 samples, has plans to expand
in several ways. A key issue will be the acquisition of more tissue samples with
a specific provenance to facilitate epidemiological research. Also, it is hoped
that the bank can extend its remit to include more samples of bone, hair,
and resin, and the establishment of a complementary palaeopharmacognosy
bank is also planned.
It is envisaged that this will preserve fragile plant samples, and also
include digital records of plant specimens known to have been used in
ancient Egyptian medicine (see Chapter 14). Future studies on plant devel-
opment and ancient therapeutic treatments will be able to access this data.
The tissue bank and the palaeopharmacognosy bank will provide a unique,
joint resource for studies in palaeopathology, palaeoepidemiology, genetic
research, mummification techniques, archaeobotany, and pharmacognosy.
Another major step, already in progress, is the computerisation of all the
records and documentation associated with the tissue bank and the Interna-
tional Egyptian Mummy Database, which will improve the administrators’
facility to handle, retrieve, and manage information. This development
will be accompanied by the introduction of a system to establish a specific,
appropriate schedule of analytical study for each full or part sample, so that
the maximum amount of information can be retrieved from examining each
fragment (see Chapter 17).
Workers in this field of research are always aware that mummy tissue is a
valuable and irreplaceable scientific resource. Continuing efforts to build
up the International Ancient Egyptian Mummy Tissue Bank will hopefully
ensure that, in the twenty-first century, this unique collection can effectively
support and enhance the research of scientists and Egyptologists.
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chapter 16
Conservation treatment for mummies
Antony E. David
Introduction
Conservation issues relating to Egyptian mummies are discussed in detail
in David and David (1995) and David (1986: 87–89); a survey of the subject
is provided in Aufderheide (2003: 502–514).
Some human remains have survived in skeletal form whereas others
consist of the skeleton and soft tissues. The latter occur in many areas of the
world (Aufderheide 2003) and are often described as ‘mummies,’ although,
originally, the word ‘mummy’ was used exclusively for the preserved bodies
of the ancient Egyptians. The term mummy is reputedly derived from the
word mumia, meaning ‘bitumen’ or ‘pitch.’ The word mumia was apparently
first applied to a black, bituminous substance that coagulated with the
water that brought it down from mountain tops (particularly the ‘Mummy
Mountain’ in Persia).
For centuries, it was claimed that this mumia had medicinal properties,
and it was an increasingly popular ingredient in medieval and later pre-
scriptions. When demand outstripped supply, another source of mumia was
sought, and the preserved bodies of the ancient Egyptians, which often had
a blackened, bituminous appearance, came to be credited with the same
properties as mumia. Consequently, tissue from these bodies began to be
used as a medicinal ingredient, and they became known as ‘mummies.’
In various countries around the world, some mummies (defined as bodies
consisting of the skeleton and soft tissues) are preserved unintentionally, as
the result of the natural circumstances of the burial site or place of death.
Here, the most important factors (which can occur singly or in combi-
nation) are environmental conditions: dryness of the sand in which the
body is interred, heat and coldness of the climate, and an airtight burial
location.
247
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248 Antony E. David
In some instances, a conscious decision was reached to take the process

further. This process resulted in intentional natural mummification, which
involved the deliberate enhancement of these natural circumstances by
means of, for example, heat drying or smoking the body, or ensuring that
air was excluded from the burial (David and David 1995). Finally, some early
societies introduced ‘true’ or ‘intentional’ mummification, which involved
the use of sophisticated procedures and chemical or other agents to preserve
the body.
Archaeological evidence indicates that religious and social factors proba-
bly acted as the impetus to develop intentional mummification, and the pro-
cedure was undoubtedly the result of experimentation conducted over many
years. In Egypt, both natural, unintentional mummification and intentional
mummification occurred in tandem to meet the perceived needs of different
social classes (see Chapter 2).
Deterioration of mummies
The various factors involved in the deterioration of mummies can occur
singly or in combination, but the deterioration will be due to environ-
mental conditions (Meier 1997; Carter and Walker 1999); physical damage
which can be the result of inept handling, or attack by rodents, insects, or
microbiological agents (bacteria and fungi); or damage caused by previous
conservation attempts.
General deterioration in mummies is discussed more fully in David and
David (1995: 77–80) and Aufderheide (2003: 502–505), and an extensive
literature considers the various causative agents involved in this process.
These causes include the environmental factors that have an impact on the
condition of a mummy, such as light and temperature levels (Paine 1992),
and relative humidity; and various studies that deal with the occurrence
and destructive effects of insects found in mummies, such as Curry (1979),
Strong (1981), Stefan (1982), Parsche and Seifert (1992), Pinniger (1994), Rae
(1996), and Pinniger and Harmon (1999). Also, the role of microbiological
agents in the destruction of mummified remains has been quite extensively
recorded (see Chapter 6; Hino et al. 1982; Arene et al. 1992; Subert et al.
1993; Horne 1995; Daniels 1996; Ridgway et al. 1996; English et al. 2002).
In most cases, deterioration and damage can either be avoided or rectified
to some extent, but in some mummies, it is not possible to arrest or remedy
these processes. Any damage or deterioration usually occurred in antiquity –
during the mummification or burial processes and the subsequent period in
the burial context; however, in some cases, the problems have arisen after
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Conservation treatment for mummies 249
the mummy was excavated, as the result of inadequacies in transportation,

handling, or storage.
Conservation treatments for Egyptian mummies

The environmental conditions in which the mummy was found, the type
of mummification procedure it represents, and the extent and type of dam-
age and deterioration it has suffered will inevitably dictate the conserva-
tion methods that have to be devised and adopted in each case. Some-
times, measures to rectify a problematic storage environment, which has
caused the deterioration, will suffice, but for other mummies, it is nec-
essary to adopt more interventionist techniques which affect the whole
body, or to take measures regarding the physical repair and support of the
mummy. In many instances, a combination of these procedures will be
required.
A number of studies describe the various conservation treatments applied
to a range of preserved bodies from many areas of the world. Various
projects have involved Egyptian mummies (e.g. Melville 1995; Maekawa
and Valentin 1996; Fulcheri 1997; David 1998; Johnson and Wills 1988).
Studies have also been performed on other ‘dry mummies’ discovered, for
example, in the Canary Islands (Herraez and Morales 1992) and South
America, and on ‘wet mummies’ such as bog bodies (Glob 1969; Delaney
and O’Floinn 1995; Daniels 1996; Fischer 1998), and frozen bodies (Johans-
son 1989; Boguchi 1996; Reinhard 1998; Ceruti 2003), of which the ‘Ice-
man’ is a particularly famous example (Gaber 2003; Vigl 2003; Spindler
1994; Bruttini 2005). This chapter, however, will concentrate on the meth-
ods available for the intentional and natural mummies found in Egypt,
which are essentially ‘dry mummies.’
Complete intentional mummies from Egypt usually incorporate body
wrappings and funerary artefacts, in addition to the preserved human
remains. These include bandages and funerary artefacts, such as face and
chest covers, amulets, and sometimes, painted panel portraits (see Chapter
11), which are made from a variety of materials ranging from textiles, car-
tonnage, wood, and faience through to metals. These associated materials
have to be taken into account when conservation treatments are selected
(Leveque 1987; Laurin 1988). The treatments indicated in this chapter will
focus on the mummified body itself, where some of the basic choices are
dictated by the overall condition of the mummy – whether, for example, the
body retains its bandages and casing or if the mummy has been unwrapped
at some point in its history.
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250 Antony E. David
Environmental control
Mummified remains are most effectively kept in an environment with a
relative humidity of 35–50 per cent and a constant temperature of 10–15◦ C.
When mummies are stored as part of reserve collections in museums, this
control can be achieved by providing storage areas which meet these opti-
mum conditions (Horie 1988), or when exhibited on public galleries, they
can be housed in specially designed display cases that will provide the appro-
priate environmental control (Pope 1992).
Inert gas environment. This method was devised by Professor Silvo

Curto for the Egyptian mummies in the University of Turin collection.
Inert gas is used within the display case, with a constant regeneration of
the gas to achieve a positive leak as a fail-safe measure if the airtightness
of the case fails. This method, however, is only appropriate if no existing
deterioration can be detected in the mummy, and disadvantages of this sys-
tem include the cost of preparing the gallery and the cases, installing the
equipment, and providing a means of monitoring the system indefinitely.
Another approach was developed at the Getty Conservation Institute in
California, USA, in particular response to the criticism of a technique –
the use of high-energy gamma rays – that had been utilised earlier (see
below) to disinfect the mummy of Ramesses II (Balout 1985; Bucaille 1987).
This innovative display and storage system, designed to preserve mummified
objects by statically controlling the levels of oxygen and relative humidity,
has been used since 1989 in the gallery in the Egyptian Museum, Cairo,
where the royal mummies are now exhibited. The aim of the system is to
prevent deterioration resulting from the constant or repeated fluctuation
of humidity levels, and ‘biological attack by insects and microorganisms,
thermally and photolytically induced oxidation, and degradation by gaseous
and particulate air pollutants’ (Maekawa et al. 1992: 213).
This method uses a hermetically sealed, nitrogen-filled case that ‘main-
tains its pressure equilibrium with surrounding atmosphere by compen-
sating with inflation or deflation of a bellows. The case contains sensors
for oxygen and humidity, humidity buffer, oxygen scavenger and pollution
sorbent’ (Maekawa 1992: 213). The main principle is that all oxygen will be
excluded from the case, but despite precautionary measures, it is recognised
that some air will leak into the case, but to prolong its maintenance-free
life from eleven to twenty years, an oxygen scavenger (AgelessTM ) can be
introduced into the case.
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Clean-air-cycle environment. A method devised by H. Howarth and

A. E. David (David and David 1995: 81–82) was originally incorporated into
a gallery display at Blackburn Museum, Lancashire (UK). The mummy
is placed in an ordinary museum case, and the existing air outside the
case is cleaned through filters and humidified to the correct level (not
exceeding 50 per cent relative humidity). Environmental sensors inside the
case can be used to monitor the relative humidity and temperature there; this
information can be made available through a radio connection which, in
the Blackburn Museum example, was incorporated into a monitor supplied
by Exeter Environmental Systems.
The cleaned and filtered air is then constantly pumped through a sulfur
dioxide filter and sucked through a plenum unit mounted on the case
containing the mummy. Within the case, the mummy is supported on
a construction made of stainless-steel tubing across which polyester has
been stretched, which allows the preconditioned internal environment to
circulate freely around the mummy.
A constant circulation of air is achieved inside the case, because the
case allows a positive leakage of treated air back into the gallery where it is
cleaned, re-humidified to the correct level, and then sucked back into the
case. This system prevents insect attack and fungal growth.
Treatments to counteract fungal, bacterial, and insect attack

Environmental control is effective as a preventative and maintenance
measure; however, if the mummy is already in a state of deterioration, then
direct intervention using methods such as gas fumigation or wet treatments
with fungicides, bactericides, and insecticides is also required to arrest the
damage.
Gas fumigation. Chemical sterilization must be toxic and volatile so that

it can eliminate the cause of the deterioration in the mummy and effectively
sterilize it. This can be achieved by means of gas fumigation, and two
methods are available. In the first, the mummy, appropriately supported, is
placed inside a fumigation chamber from which the air is then evacuated
by using vacuum pressure. A fumigant is then introduced, effected under
vacuum so that it will achieve optimum penetration of the mummy.
In the second method, the fumigant is introduced into a tightly sealed
polythene bag that contains the mummy. This is not the preferred option,
however, as penetration of the fumigant is less effective because the process
P1: KAE
252 Antony E. David
is not assisted by vacuum, and the method can be dangerous if certain

fumigants are used.
In general, the choice of fumigants is a key factor in this procedure. They
must be effective and must comply with all precautions of the European/
British Health and Safety Regulations. The fumigants vary in their ability
to penetrate the mummy; this, and whether or not the mummy is wrapped,
will determine the length of time that is required for each treatment.
In any case, this process cannot permanently eliminate the causative
agents of deterioration, and therefore the treatment should be repeated at
three yearly intervals. The search for safe, more effective fumigants is an
ongoing process for conservators, but there is also an increased emphasis on
preventative pest control measures within museums (Pinniger and Harmon
1999), so that the need for actively intrusive methods of treatment will be
reduced.
Wet Sterilization. If a fumigation chamber is not available, then an

alternative, if the mummy is totally or partially unwrapped, is to apply the
fungicide or insecticide solutions directly to the mummified tissue. First,
the conservator can use dry brushes, with the assistance of a controlled
suction vacuum cleaner, to remove fungal spores and salt recrystalliza-
tion. The operator should be protected from inhaling dust or spores. If
required, an internal inspection of the mummy can then be performed
using an industrial endoscope, so that severe infestations can be identified
and receive concentrated treatment (for further discussion of endoscopy, see
Chapter 4).
The next step is to apply the solution, either with a soft brush or using
very low pressure sprays. This ensures that there is equal distribution inside
and outside the cavities and on the body surface. Again, the operator should
observe all the necessary safety precautions, such as using a mask and pro-
tective gloves and conducting the procedure in a fume cupboard. It was
reported (David and David 1995: 83) that good results had been achieved
using pentachlorophenol (sodium salt) in pure alcohol (see Plates XVIII
and XIX); however, because of its toxicity, pentachlorophenol, although
effective in preventing further microbiological infestations in mummies,
is no longer considered an appropriate method of treatment, and, follow-
ing new European/British Health and Safety Regulations, an alternative
fungicide is used.
Controlled drying. This method is most successfully used for

unwrapped bodies, although follow-up treatment, using a chemical
P1: KAE
application (see p. 251–252) is required. The procedure works by removing

water from the mummy so that the destructive microorganisms that infect
the body are deprived of an essential element for their survival and growth.
To reduce the water content of the mummy, the body is placed in a con-
trolled environment where the relative humidity in the atmosphere is slowly
and gradually reduced. This can be achieved either by using dehumidifiers
to remove moisture from a controlled volume of air or by means of hygro-
scopic agents (e.g. silica gel), but these need to be monitored and checked
regularly to ensure their continued effectiveness.
Ultraviolet irradiation, the use of x-rays, gamma rays and elec-

tron beam radiation. For many years, various methods that can destroy
microorganisms or bring about physical and chemical changes in their cells
have been used as conservation measures for the treatment of wood, paper,
and plaster-covered walls (Belyakova 1960; Van der Molen and Garty 1980)
and to arrest deterioration in human remains (Johansson 1989). This was
perhaps most famously exemplified by the now criticised treatment of the
mummy of Ramesses II (Balout and Roubet 1985; Bucaille 1987).
Physical repair, handling, and support of mummies

Any modern treatment of physical damage in mummies should be con-
ducted in such a way that in the future there is no chance that it will be
mistaken for an ancient repair. The aesthetics of the mummy should be
a key consideration: its original appearance should be retained as far as
possible and, if practicable, any original materials should be incorporated
in the repair. It is also important that any modern repair should be easily
reversible.
Care should always be taken when handling mummies or moving them
from one location to another. Methods of support for mummies, when they
are in storage collections or displayed on public locations, are also a major
consideration for conservators and curators (Gabrielli 2005). For example,
to ensure that minimum stress is placed on sensitive areas such as knee
joints, it is important that mummies are stored or displayed horizontally
and not in the vertical position.
At The Manchester Museum, various methods were developed to provide
support for the mummies both on the gallery and in the reserve stores, and to
facilitate the handling and moving process when, for example, the mummies
were taken to other areas of the university for scientific examination. These
provisions included a foam bed for each mummy, moulded to its individual
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254 Antony E. David
shape; in the stores, the mummies, supported on these beds, were then
placed on specially constructed ‘mortuary-type’ trolleys (Horie 1988).
The impact of conservation treatments on future scientific investigations

It is acknowledged that mummification techniques undertaken in the past
can significantly affect the quality of the samples obtained today for scientific
research (see Chapter 7). There is also a growing recognition that, although
conservation measures are essential to preserve the mummy as an important
source of evidence, some treatments may damage or destroy information
that scientific analysis might otherwise recover (David 1998; Aufderheide
2003: 514). This is particularly important, for example, in relation to DNA
identification.
This is an urgent conflict that should be addressed so that resolutions can
be sought before further evidence is irretrievably lost. Although some studies
have already been undertaken (Brooks et al.1996; Paterakis 1996), and these
issues have been discussed at the First (Tenerife, Canary Islands, 1992),
Second (Cartagena, Colombia, 1995), Third (Arica, Chile, 1998), Fourth
(Nuuk, Greenland, 2001), Fifth (Turin, Italy, 2004) and Sixth (Lanzarote,
Canary Islands, 2007) World Congresses on Mummy Studies, generally this
is an area that has not received due attention. Hopefully, future research
will address some of these issues.
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part 5
The future of biomedical and

scientific studies in Egyptology
255
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256
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chapter 17
Biomedical Egyptology: some future

possibilities and contributions
A. Rosalie David
Introduction
It is hoped that the research outlined in this book has demonstrated how
the subdiscipline of Biomedical Egyptology, based on the analytical inves-
tigation of mummies and associated material, has added a new dimension
to the study of ancient Egypt. Effectively, each mummy can be regarded
as a ‘museum of disease,’ preserving unbiased evidence about its owner’s
lifestyle, diet, illnesses, and sometimes, the cause of death. There may
be additional information about medical or pharmaceutical treatment,
mummification techniques, religious practices, and familial connections.
Increasingly, the use of sophisticated analytical techniques enables us to
extract this information and, provided that investigators interpret their data
correctly, this type of research can provide evidence that cannot be gained
from archaeology, art history, or ancient literature.
This information can add fascinating insights into other aspects of Egyp-
tian society. For example, the author is currently researching dietary links
between the incidence of atherosclerosis identified in mummies belonging
to priests and temple chantresses, and the access these groups had to the
food offered daily in the temple rituals and then divided up amongst
the clergy. Although most of the population ate a mainly vegetarian diet,
the gods’ food included large quantities of meat supplied from the animals
specially slaughtered in the temple precinct. Ultimately, it may be possi-
ble to demonstrate that these dietary variations had a direct impact on the
disease patterns observed in different social groups.
Sometimes, biomedical and scientific analyses will challenge or over-
throw theories that archaeologists, historians, and other scientists have pro-
posed. In our own work, for example, pharmacological studies are ques-
tioning previous suggestions about the use of narcotics in ancient Egypt
257
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(Chapter 13), and research on pharmacy is seeking to demonstrate the effi-

cacy, if any, of their medicaments (Chapter 14).
Biomedical Egyptology is based on a multidisciplinary approach, often
combining not only a range of analytical techniques but also providing a
bridge between the sciences and humanities. In fact, it is the interdisci-
plinary nature of the subject that presents workers with both their greatest
opportunities and their greatest challenges. Most modern educational sys-
tems provide a narrow perspective, dividing ‘arts’ from ‘sciences’ at an early
stage, and most researchers pursuing projects in biomedical and scientific
Egyptology will have received their basic training either in an area of sci-
ence or in Egyptology/archaeology in which the main focus is usually on
history, art history, language studies, or archaeological techniques.
To make progress in biomedical Egyptology, it is essential that workers
drawn from both backgrounds learn to ‘speak each other’s language.’ Egyp-
tologists need to understand the application, potential, and limitations of
the scientific techniques that are available and be able to present specific
and well-considered questions. Conversely, some knowledge of Egyptian
civilisation will make scientists aware of any issues relating to the historical
context of the material on which they are working, and this in turn will
inform their assessment and interpretation of the analytical results.
The Manchester Mummy Project has been notable for its interdisci-
plinary approach. This has been possible because of the project’s continuity
and, particularly, the long-established working relationships of the team
members who, although drawn from different backgrounds in science or
Egyptology, understand each other’s perspective. Throughout the past thirty
years, there have been some inevitable changes in the group’s membership,
and some new techniques have been introduced while others are no longer
used; nevertheless, it has always been possible for the project to adopt a fully
integrated approach to its research.
This was first established during the early stages of the project (Chapter 1),
when the team developed the ‘Manchester Method,’ a protocol designed
for the examination of mummies. This method sets out a sequence for
investigating a mummy, moving from a general overview (radiology), to
sampling techniques (endoscopy), and then to specific studies (e.g. palaeo-
histology, immunology, and DNA identification) performed on material
removed from the mummy.
The KNH Centre for Biomedical Egyptology

In order that future workers are aware of the huge potential of ‘mummy
studies,’ it is essential that appropriate opportunities should exist to train
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Biomedical Egyptology 259
those who wish to pursue a career in this field. In his excellent survey
of scientific studies on mummies, Aufderheide (2003: xiii) stated that this
was still an ‘orphan discipline,’ and, in the United States of America, for
example, there were ‘no committed academic training programs, standing
university faculty positions, students, dedicated funding sources or journals.’
The situation in Europe was little better.
The KNH Centre for Biomedical Egyptology, recently established at the
University of Manchester, now provides a unique facility devoted specifi-
cally to biomedical and scientific studies in Egyptology. The centre, which
carries the initials of its patroness, was opened by His Royal Highness The
Earl of Wessex in 2003 and is located in the Faculty of Life Sciences.
The KNH Centre, recently designated as one of the University’s ‘cen-
tres of excellence,’ has developed rapidly. Directed by the KNH Professor
of Biomedical Egyptology, the centre has two lecturers (one also holding a
Fellowship in The Manchester Museum), a Teaching Fellow, and a postdoc-
toral research group. With its new laboratories and access to the extensive
facilities of a leading science faculty, the centre provides a base for the con-
tinuing work of the Manchester Mummy Research Project, as well as a new
location for the International Ancient Egyptian Mummy Tissue Bank. One
of the centre’s main purposes is to provide training in biomedical and scien-
tific studies in Egyptology. At the undergraduate level, the centre currently
offers a very popular final year option on ‘ancient Egyptian mummies,’ for
students pursuing a Bachelor of Science degree in Biological Sciences, but
currently, postgraduate studies are the centre’s main training focus.
At present, there are twelve students in the Doctor of Philosophy pro-
gramme, and since 1995, Manchester has run a unique Master of Science
degree course in Biomedical and Forensic Studies in Egyptology, which
is now a mainstay of the centre’s work. The main aim of this course is to
demonstrate how a range of scientific techniques can be applied to ancient
Egyptian mummified remains and associated material.
The students (who come from various countries) pursue units in both
Egyptology and scientific and analytical techniques, which are taught by
members of the Manchester Mummy Project; each student also produces a
research dissertation which presents them with the opportunity to undertake
original research on ancient material (examples are given in Chapters 6
and 9). This course, which is available to students with either a science or
an Egyptology/archaeology background, provides specific training to ensure
that students can relate to and work in either aspect of the subject.
The opportunities that Manchester can offer for study in this field include
not only excellent science facilities, but also the extensive resources of the
tissue bank and the university’s major Egyptology collection, held in The
P1: KAE
Manchester Museum. Also, a formal Agreement between the Faculty of

Life Sciences at Manchester and the National Research Centre, one of
Egypt’s leading scientific establishments, has opened up new opportuni-
ties for bioanthropologists at both institutions to cooperate in research and
training programmes. Staff and students from both centres have participated
in joint training workshops held in Cairo in 2004 and 2005, and there are
plans for exchange programmes and conferences on ancient pharmacy and
medicine. In general, this international association of two groups of scien-
tists holds out considerable prospects for the development of new avenues
of research and training in this field.
Some future possibilities

Egypt provides the palaeopathologist with a unique set of circumstances.
Not only have natural and intentional mummification processes preserved
evidence of disease in the skeletal and tissue remains of every social class in
an ancient society but, for the most part, the modern inhabitants of Egypt can
trace their direct descent from that ancient population. This provides a rare
opportunity for scientists to undertake epidemiological studies over a time
span of some 7,000 years, comparing data from contemporary health studies
performed in Egypt, with evidence derived from studies on the mummies.
An important future goal will be to trace the evolution and development
of specific diseases within this Egyptian context – evidence which could
eventually make a major contribution to a universal history of disease.
The success of such epidemiological research can only be guaranteed
if sufficient quantities of provenanced samples are available, and if there
continues to be development of the immunological, genetic, and other
techniques that can be applied to mummified remains. It is important to
recognise, however, that even with the emergence of these techniques,
palaeohistology should remain a key investigative tool in the study of any
sample.
Palaeohistological examination should always be undertaken as the first
step to identify the true nature of any sample taken from a mummy (e.g.
is it tissue, resin, or plant remains?) and to confirm which other analyses
are required. This procedure ensures that time and expense are not wasted
in pursuing techniques that may not be suitable for a particular sample.
Indeed, to extract maximum information with minimal destruction, a spe-
cific analytical plan should be prepared for every sample.
Future researchers will need to ensure that collections of mummified
remains – the basic resource for biomedical and scientific studies – are
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Biomedical Egyptology 261
preserved and developed. This will involve the expansion of the tissue bank,
and close cooperation amongst scientists, Egyptologists, and conservators,
so that there can be an urgent dialogue about the possible effects that some
conservation treatments may have on future scientific studies, and how these
problems can be addressed.
With the new training opportunities that are now being established, and
the career possibilities that should result from this, we can perhaps hope
that, in the twenty-first century, Biomedical Egyptology will start to fulfil its
true potential.
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262
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9780521865791rfa CUFX196/David 978 0 521 86579 1 October 31, 2007 15:30
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9780521865791ind CUFX196/David 978 0 521 86579 1 October 31, 2007 15:19
Index
abrasion, dental, 55 Asru, 47, 48

abscess, 38, 67, 68, 77, 193 Aswan, 3
Abydos, 12, 186 Atacama Desert, 123
Adaima, 12 attrition, dental, 37, 54, 55, 57, 64, 65, 68
Aesculapius, 184 Aufderheide, A., 259
Africa, 90, 143, 204 Australia, 242
afterlife, 38 autopsy, 5, 6
Akhmim, 100–112 Avicenna, 216
Alexander the Great, 10
alkaptonuria, 38 el-Badari, 12, 53
Amarna, 186 Badarian Period, 12
Amasis, 202 Balabanova, S., 209, 211, 213, 214
Amenhotep I, 190 bayesian statistical method, 97
Amenhotep III, 16 beeswax, 85
Amenhotep IV (Akhenaten), 97 bejel, 90
Amenhotep, son of Hapu, 185 Berlin Museum, 192
amulets, 30, 182, 183, 249 Bil-bils, See Cypriot Base II Ring-ware
Amun, 46, 48, 145, 183 juglets
anaemia, 60, 94 bilharzia, 37. See also schistosomiasis
Anastasi, G., 193 Biomedical Egyptology, 7, 245, 257, 258, 261
Ancient Biomolecules Centre, 131 Master of Science degree, 259
ankylosis, 37 biopsy, 25, 26, 43, 47, 48, 49, 50, 244
ankylosing spondylitis, 30, 38 bitumen, 84, 134, 136, 146, 152, 230, 247
Arab invasion, 17 Black Death, 90
archaeobotany, 219, 220, 227, 232, Blackburn Museum, Lancashire, 251
246 bog bodies, 249
Archaeological Survey of Nubia, 3 Brazil, 242
Archaic Period, 10, 12 Breasted, J. H., 63, 68, 188, 189, 193
arteriosclerosis, 37, 96, 257 Britain, 3, 6, 9
arthritis, 37, 38 British Museum, 21, 173, 191, 193
osteoarthritis, 95 British National Formulary, 9
polyarthritis, 95 Bronze Age, 91, 182
rheumatoid arthritis, 95 Brooklyn Museum, 188, 192
Asia, 89 Bubastis, 186
Asiatic disease, 191 burial, 12
297
P1: KAE
298 Index
Cairo, 21, 110, 212, 260 Crete, 196

Egyptian Museum, 170, 250 Crocodilopolis, 187, 193
Canada, 242 CT, See computed tomography
Canary Islands, 249 Cypriot Base II Ring-ware juglets, 197, 198,
cancer, 92, 130 214, 215
cannabis, 228 Cyprus, 196, 197, 198, 204, 215
Canopic jar, 16, 30, 54, 77, 82, 111, 112, 242 cystic fibrosis, 131
caries, 55, 56, 57, 64
Carlsberg Foundation, 191 Dakhleh Oasis, 107, 109, 113, 114, 130, 212
Carter, H., 21 Dawson, W. R., 3
cartonnage, 21, 29, 34, 249 DCMS Reports, 237, 244
cedar oil, 86 Dead Sea, 85
Chagas’ Disease, 92, 123, 132 Deir el-Bahri, 185
Chelsea Physic Garden. See Society of Deir el-Ballas, 190
Apothecaries Deir el-Medina, 191, 197, 199
Chester Beatty, A., 191 Denderah, 185
Chicago Field Museum, 21 Denmark, 89
Chile, 97, 242 dental
Chincorro, 85 abnormality, 176
Chinese, 95 bridge, 65, 66
Christianity, 17 extraction, 68
chromatography, 5, 136, 138, 150 filling, 63, 65, 68
gas, 84, 134, 137, 149, 151 prescription, 62, 63, 64, 68
gas chromatography-mass spectrometry, root canal treatment, 67
140, 144, 146, 152, 196, 199, 200, 202, 208, dentist
210, 213, 215, 220, 245 title, 52, 61, 62, 64
high-pressure (performance) liquid, 137, dentistry
151, 200, 211 interventional, 61, 65
liquid, 136 dentition, 36, 52
liquid-mass spectrometry, 196, 200, 208 Deshasheh, 21
thin layer, 137, 199 Detroit Institute of Art, 4
Chui the Venerable, 233 diabetes, 37, 60
Classical authors, 11, 202 diagenesis, 9, 211
clean-air-cycle environment, 251 diet, 5, 17, 52, 53, 54, 55, 60, 71, 81, 93, 212,
Cleopatra VII, 10 218, 257
cocaine, 196, 209, 210, 212, 213, 215 Diodorus Siculus, 11
Cocaine Mummies, 195 Dioscorides, 202, 205, 216
Columbus, 90 Djer, 12
common cold, 183 Djoser, 183
computed radiography, 24, 25 DNA studies, 8, 28, 86, 89, 91, 99, 105, 106,
computed tomography, 22, 24, 25, 28, 30, 31, 108, 109, 110, 112, 113, 114, 117, 118, 124,
40, 41, 163, 164, 172, 174 127, 128, 129, 220, 245, 254, 258
conservation of mummies, 77, 88, 239, 242, bacterial, 123
245, 247, 261 mitochondrial, 116, 117, 121, 122, 130, 132,
contamination, 9, 116, 120, 127, 131, 132, 210, 245
214, 215 nuclear, 117, 122, 130, 132, 244
contraception, 188, 192, 229 parasite, 123, 244
controlled drying, 252 viral, 123
Coptic, 68 doctors. See medicine, doctors
CR, See computed radiography Duckworth Collection, Cambridge, 52
craniograph, 166, 170 Dynastic Period, 54, 58
P1: KAE
Index 299
Ebers, G., 190 fingerprinting techniques, 5

Edfu, 186 First Intermediate Period, 10, 14
EDS. See spectrometry, energy dispersive fluoroscopy, 25, 28, 92
Egypt,9, 17, 44, 92, 96, 163, 168, 204, 240, 249 forensic studies, 162, 163
Egyptian Organization for Vaccine and Forestier’s hyperostosis, 38
Biological Production, 110 Four Sons of Horus, 16
EITB, See enzyme-linked immunotransfer France, 90
blots Friedrich Wilhelm IV of Prussia, 192
electron beam radiation, 253 FITR. See spectroscopy, Fourier-transform
electron microbeam techniques, 156 infrared
electron microprobe, 156
ELISA, See enzyme-linked immunosorbent Galen, 216
assay gamma rays, 250, 253
elite tombs, 18 gas chromatography, See chromatography
embalmers, 13, 15, 16, 17, 30, 40, 46, 47, 48, gas fumigation, 251
49, 50, 65, 96 GC, See chromatography, gas
endoscopy, 6, 25, 43, 44, 45, 46, 47, 48, 49, GC-MS. See chromatography, gas
50, 87, 96, 239, 243, 252, 258 chromatography-mass spectrometry
environmental factors, 9, 11, 17, 29, 50, 77, Germany, 21, 92, 199, 212, 242
84, 92, 120, 121, 132, 211, 212, 242, 247, Getty Conservation Institute, California, 250
248, 249, 250, 251, 253 Ghalioungui, P., 63, 68
enzyme-linked immunosorbent assay, 8, 99, gingivitis, 58, 63
102, 105, 106, 110, 111, 113 Giza, 13, 54, 65
enzyme-linked immunotransfer blots, Glyptotek Museum, 173
99–110, 112, 113 gout, 95
epidemics, 183 Graeco-Roman Period, 52, 67, 70, 113, 174,
epidemiology,7, 89, 99, 114, 129, 241, 246, 260 181
EPR. See spectroscopy, electron magnetic Granville, A., 3
resonance Gray, P. H. K., 21
ESEM. See microscopy, environmental Greece, 44, 217
scanning Greek, 64, 184
ESR. See spectroscopy, electron Greeks, 16, 176, 189, 233
paramagnetic spin resonance gynaecology, 62, 188, 191
ethics, 114, 124, 237, 240, 243
Europe,3, 85, 89, 90, 92, 95, 182, 198, 215, 259 el-Hagarsa, 7, 122
evisceration, 13, 14, 15 Harer, B., 63, 204, 205, 206
excerebration, 15, 34, 49, 50 Harris lines, 36, 37, 55
eyes Harwood Nash, D. C. F., 22
false, 30 hashish, 212
medical treatment, 188, 230 Hathor, 185
el-Hawara, 208
face pool identification, 164 Heka, 184
facial reconstruction, 162, 174, 178 Heliopolis, 233
computer-based, 164, 167, 168 henna, 145, 245
methods, 166 Herodotus, 4, 11, 54, 60, 205, 222
panel portraits. See mummies, panel Hetepheres, 13
portraits Hieraconpolis, 12
three-dimensional modelling systems, 167 Hippocrates, 216
Fayoum, 110, 112, 170, 213 histology, 7, 8, 43, 47, 48, 49, 50, 71, 79, 82,
fibreoptics, 44 102, 105, 245
fibrescope, 45 Holland, T., 21
P1: KAE
300 Index
Horus, 183 el-Lahun, 188

Hounsfield, G., 25 Late Period, 10, 16, 62
House of Life. See medicine, temple LC. See chromatography, liquid
association LCMS. See chromatography, liquid-mass
HPLC. See chromatography, high-pressure spectrometry
liquid Leeds City Museum, 7
Hungary, 89 Leeds Philosophical and Literary Society, 3,
hydatid cyst, 47, 51 241
hydrolysis, 119 Leek, F. F., 34, 37, 55, 56, 65, 66, 68
Hyksos Period, 186 Leicester Museum, 110, 112, 123, 127, 128, 129,
hypoplasia, 55, 64 213
leprosy, 89, 123, 176
Ice Man, 123, 249 Leverhulme Trust, 8, 9, 240
Iceland, 242 Libya, 222
ICP-MS. See spectrometry, inductively Lindow Man, 124
coupled-mass Liverpool (City of ) Museum, 21
Imhotep, 183, 185 lotus, 196, 204, 206, 215
immunocytochemistry, 8, 99, 100–112, 113, Lucas, A., 3
114 lung disease, 48, 78
immunology, 8, 100, 113, 245, 258 Luxor, 110, 112, 188, 190
India, 95, 242
inert gas environment, 250 Macedon, 174
infrared spectroscopy, See spectroscopy Macquarie University, 7
insects, 5, 48, 240, 248, 250 macroscopy, 5, 87, 243
International Ancient Egyptian Mummy magnetic resonance imaging, 26, 28
Tissue Bank, 8, 9, 51, 115, 237, 238, 239, malaria, 123, 132, 245. See also parasitic
240, 246, 259, 261 disease
documentation, 243 malnutrition, 36
International Mummy Database, 6, Manchester
240 Christie Hospital, 125
intoxicants, 195 Hall Analytical Laboratories, 200
IR. See spectroscopy, infrared Method, 5, 163, 258
Isherwood, I., 22 Mummy Project, 4, 6, 7, 45, 46, 51, 124,
Isis, 183 129, 133, 162, 164, 172, 182, 193, 195, 199,
Islam, 17 238, 239, 243, 244, 258, 259
Italy, 89, 96, 123, 242 Museum, 4, 5, 6, 22, 43, 48, 49, 130, 144,
160, 162, 188, 199, 200, 202, 212, 213, 245,
joint disease, 37, 95 253, 259, 260
Jones, F. W., 3 University, 4, 5, 6, 7, 14, 64, 99, 106, 114,
Junker, H., 13, 65 130, 212, 238, 240, 242, 243, 259
Manetho, 10
el-Kab, 13 mass spectrometry, See spectrometry
Kahun, 187 Medical Papyri, 9, 52, 57, 61, 62, 63, 64, 65,
Kanawati, N., 6 68, 102, 181, 182, 183, 184, 186, 187, 190,
Karnak, 46, 48, 145 191, 192, 193, 197, 205, 206, 217, 220, 222,
kherep-priest, 192 223, 224, 225, 226, 228, 229, 230, 231, 232
Khufu, 13 medicine (ancient Egyptian), 181, 190, 246
KNH Centre for Biomedical Egyptology, 7, body system. See metu
242, 244, 245, 258 doctors, 183, 184, 185, 187, 188, 190, 202
Koenig, W., 21 healing, 181
Kom Ombo, 181 incubation, 185
P1: KAE
Index 301
magic, use of, 182, 183, 184, 187, 189 panel portrait, 17, 97, 170, 174, 249
metu. See metu priests’, 16
midwives, 184 royal, 4, 14, 15, 16, 250
practice, 182, 184, 187, 189, 195 unrolled, 3
prescription, 188, 224, 232 mummification
sanatorium, 185 artificial (intentional), 11, 12, 13, 14, 84, 85,
sau. See sau 212, 248, 249, 260
sunu. See sunu artificial (intentional), natural, 248
surgery, 181, 186, 188, 193 experimental, 86
temple association, 181, 184, 185, 187 inscriptions, 11
House of the God, 184 natural (unintentional), 11, 247, 260
House of Life, 185, 186 packages, 30
therapeutic dream therapy, 185 process, 5, 9, 12, 15, 16, 17, 30, 36, 38, 49,
training, 181 50, 84, 168, 211, 239, 245, 246
Mediterranean, 89, 196, 198, 222 stucco, 13
Medum, 13 Mummy, individual
Merrillees, R., 197, 198, 215 detached heads, 49, 50
Mesolithic Period, 53, 54 Asru, 46, 110, 112, 130, 145, 160, 213
Metropolitan Museum, New York, 174 Bes-en-Mut. See Leicester (1)
metu, 65, 186, 190, 191, 192 528/1981/1885
microscale sealed vessel. See pyrolysis Khary, 48
microscopy, 100, 144 Leeds, 7, 241
electron, 5, 88, 155, 158 Leicester (1) 528/1981.1885, 110, 112, 127,
transmission electron microscopy, 88 128, 129
scanning electron microscopy, 88, 156, 158 Leicester (2) 528/1980.1882, 110
environmental scanning electron, 160 Manchester 1770, 5, 6, 213
fluorescent (ultraviolet), 109, 144 Manchester 7700/1766, 110, 113, 114, 213
infrared, 88, 144–145 Manchester 7700/1981.575(3p), 212
light, 5, 87 Manchester 7700/13010/5, 99–110, 112
polarising (visible light), 78, 87, 144–145 Manchester 7700/9430, 111
ultraviolet light, See microscopy, Manchester 7700/ES6(4p), 212
fluorescent Manchester 7700/ES8(10p), 212
Middle Kingdom, 10, 14, 52, 61, 184 Two Brothers, 4, 130, 162, 164
migraine, 183, 192 Khnum-Nakht, 130
Min, 112 Nekht-Ankh, 49, 111, 128, 130, 213
Moodie, R. L., 21 Uplands College, 242
Mostagedda, 12 Munich Museum, 214, 215
MRI, See magnetic resonance imaging Murray, M. A., 4, 5, 14
MS-MS, See spectrometry, tandem mass museums 3
MSSV. See pyrolysis, microscale sealed Mycenae, 176
vessel myotonic dystrophy, 97
mumia, 87, 242, 247
mummies Naqada, 12
animal, 38, 40, 78, 130, 245 narcotics, 8
as cult animal, 38 National Research Centre, Cairo, 260
as pet, 38 natron, 13, 14, 17, 58, 73, 84, 97, 104, 154, 160,
as victuals, 40 229, 245
as votive offering, 40 Natural History Museum, London, 52, 56
examination techniques, 45, 178 Naville, E., 14
fake, 40 Neave, R., 162, 164, 168, 174, 175
methodology, 5, 6 necropolis, 89, 93
P1: KAE
302 Index
Needham, C., 176 Strongyloides, 47

Nefertum, 204 Passalacqua, J., 192
Negev Desert, 67 pathology, 190
Neolithic Period, 10, 11, 91, 95, 196 PCR. See polymerase chain reaction
Netherlands, 22, 193 Pennsylvania University Museum, 4
neurological disorders, 97 periapical lesions, 57, 64
neurosurgery, 50 periodontal disease, 55, 60, 64, 67
New Kingdom, 3, 10, 14, 15, 52, 97, 184, 191, periodontal lesions, 58
197, 198, 215, 222, 223 periodontitis, 58
New World, 90, 95, 209 Persia, 233, 247
New York Academy of Medicine, 188 Persian Period, 206
New York Academy of Sciences, 188 Peru, 94, 211, 212
New York Historical Society, 188 Petrie, W. M. F., 12, 13, 14, 21, 187
nicotine, 196, 209, 210, 212, 215 Pettigrew, T., 3
NMR. See spectroscopy, nuclear magnetic pharmacist, 232
resonance pharmacognosy, 216, 220, 227, 232, 246
Nodjme, 16 pharmacology, 133, 195, 202, 206, 216, 221,
North America, 91, 93, 95 226, 257
Nubia, Nubian, 17, 81, 94, 113, 222, 242 pharmacy, 186, 216, 220, 227, 233, 242, 244,
258
occupational diseases, 94 Pharmacy in Ancient Egypt Project, 9, 182,
ochronosis, 38 193, 216
Old Kingdom, 10, 13, 16, 52, 61, 62, 64, 65, Phillip II, 174
184, 189, 192, 193 Phoenicia, 67
Old World, 90, 91 plague, 90, 123
el-Omari, 53 plant remains, 79, 104, 129, 211, 240, 245, 246,
opium, 195, 196, 197, 199, 210, 219, 228 260
Osiris, 183 Pliny the Elder, 56, 86, 216
osteoarthritis, 64 Polish Centre for Egyptology, Cairo, 173
osteology, 89 polymerase chain reaction, 91, 118, 120, 124,
osteomyelitis, 36, 64 125, 126, 130, 131
osteoporosis, 36, 37, 81, 94 poppy, See opium
oxidation, 79, 119, 156, 211, 250 Portugal, 242
Predynastic Period, 10, 52, 54, 57, 58, 102, 232
Pääbo, S., 6, 117, 119, 120 pregnancy, 81, 188, 191, 229
pain relief, 8 prostatic hyperplasia, 96
Palaeolithic Period, 53 prosthesis, 17, 34, 66
palaeoepidemiology, 246 Ptolemaic Period, 10, 16, 49, 52, 66, 86, 212,
palaeohistology, 71, 76, 258, 260 213
palaeomicrobiology, 88 Ptolemies, 10
palaeoneurology, 96 Ptolemy I, 10
palaeo-odontology, 5, 52 putrefaction, 79, 81
palaeoparasitology, 91 pyrolysis, 138
palaeopathology, 3, 6, 7, 26, 83, 98, 246, 260 microscale sealed vessel, 138, 208
in art, 97
palynology, 219 quantitation, 25, 150, 158
papyri, 121. See also Medical Papyri Quibell, J., 12, 188
parasitic disease QCT, See quantitation
Ecchinococcus, 47, 51
Fasciola hepatica, 92 racemization, 119, 121
P.falciparum, See also malaria 123, 130 radiocarbon dating, 5, 239, 245
P1: KAE
Index 303
radiographic tomography, 24, 28 Seqenenre, 14

radiography/radiology 5, 7, 8, 21, 22, 28, 29, serology, 116
30, 40, 47, 50, 56, 67, 95, 102, 152, 156, Serqet, 184, 192
258 Sethos I, 15
radioimmunoassay, 199, 200, 210, 211 sibship studies, 116, 117, 122, 123, 130, 176, 239,
Ramesses II, 4, 15, 38, 170, 176, 177, 188, 250, 244
253 sickle cell anaemia, 131, 245
Ramesseum, 187, 188 smallpox, 91
rehydration, 5 Smenkhkare, 116
Reisner, G., 13, 64 Smith, E., 188, 190
Renaissance, 3 Smith, G. E., 3, 14, 21, 212
resin, 12, 13, 14, 15, 16, 17, 30, 34, 47, 48, 50, Society of Apothecaries, London, 217, 219
84, 86, 108, 111, 136, 143, 152, 211, 212, 214, South Africa, 242
221, 225, 245, 260 South America, 88, 96, 123, 143, 209, 213, 215,
RIA. See radioimmunoassay 240, 249
rickets, 81 spectrometry, 128
Rifeh, 4, 14, 213 inductively coupled plasma-mass, 152
Rijksmuseum, 22 mass, 8, 132, 134, 150, 220, 245
Roentgen, W., 21, 152 gas chromatography-mass spectrometry,
Roman Empire, 11, 67, 85, 123, 202 See chromatography, gas
Roman Period, 11, 17, 68, 181, 185, 228, chromatography-mass spectrometry
231 tandem mass, 151
Rome, 95 wavelength dispersive, 157
Royal Botanic Gardens, Kew, 208, 219 spectroscopy, 139, 144
Royal College of Surgeons, 13 atomic absorption, 134
Royal Ontario Museum, 4 electromagnetic spectrum, 139
Royal Society, 44 electron paramagnetic (spin) resonance,
Ruffer, A., 3, 8, 72, 102, 103 143
energy dispersive, 158
Sais, 186 Fourier-transform infrared, 132, 142, 145
sand pneumoconiosis, 49 infrared, 97, 134, 139, 140
Sanderson, A. T., 103 nuclear magnetic resonance, 142
Saqqara, 12, 192, 202 radio frequency, 140
sarcophagus, 21 ultraviolet, 137, 139, 140, 200
sau, 184 visible, 140
schistosomiaisis, 7, 8, 99, 101, 102, 112, 114, Stapeley Water Gardens, 208
131, 132, 232, 245 stereochemistry, 145
Schistosomiasis in Ancient Egypt Project, 7, Stingray analysis, 132
115, 118, 124, 239 Sudan, 54, 107, 109, 212
Schistosomiasis Research Project, 7 sunu, 65, 184
Science in Egyptology symposia, 5, 240 surgery, 67
scurvy, 94 syphilis, 89, 132
Sebi, 53
Sebilian culture, 53 Tapp, E., 6, 103, 110, 130
Seckenberg Museum, 21 Tauert, 183
Second Intermediate Period, 10, 14 TEM. See microscopy, transmission
Sekhmet, 183 electron
priests of, 184 textiles, 82, 240
SEM. See, microscopy, scanning electron Theban Mapping Project, 176
Senusret II, 188 Thebes, 3, 14, 93, 188, 190, 191, 197, 213
septicaemia, 63 Third Intermediate Period, 10, 15, 16
P1: KAE
304 Index
tissue University of Cairo, 219

banking, 239, 240 University of California, 187, 190
decalcification, 73 University of Copenhagen, 191
dehydration, 74 University of Leipzig Library, 190
embedding, 74 University of Turin, 250
fixation, 73 University of Wurzburg, 199
identification, 77 US, See ultrasound
rehydration, 72, 86 UV spectroscopy, See spectroscopy,
sampling, 238, 239, 242, 243 ultraviolet
sectioning, 74
staining, 74, 75, 79 VACSERA. See Egyptian Organization for
Thoth, 183 Vaccine and Biological Production
TLC. See chromatography, thin layer Valley of the Kings, 4, 41, 176
tomb robbers, 13, 15, 242 videoscope, 45
tombs Vienna, 193
Tomb KV5, 176, 177 Vikings, 176
Tomb KV55, 4, 52 viruses, 91
Tomb KV56, 197 Vivi Täckholme Herbarium. See University
Tomb of Kha, 199, 218 of Cairo
Tomb of Psamtek, 202
Tomb of Senedjem, 197 Wadi en-Natrun, 13
tomography, 24, 28 WDS. See spectrometry, wavelength
toothache, 62 dispersive
trade, 9, 54, 197, 204, 209, 213, 214 Weeks, K., 176
trauma, 36, 95, 174, 175, 176, 189, 231 wet sterilization, 252
treponematoses, 89, 90 whdw, 65
trichinellosis, 92 Winlock, H., 14
trismus, 62 Working Group on Human Remains,
tuberculosis, 85, 88, 94, 97, 123, 245 237
Turin, Egyptian Museum, 218 World Archaeological Congress, 237
Turin Erotic Papyrus, 206, 209 World Congresses on Mummy Studies,
Tutankhamun, 4, 41, 116, 168, 218 254
Tuthmosis II, 15
Tuthmosis III, 15, 190 X-rays, See radiography
Tuthmosis IV, 21 X-rays, conservation treatment, 253
X-ray, powder diffraction, 154, 155
ultrasound, 26, 28 X-ray equipment, portable, 24
ultraviolet irradiation, 253 X-ray generation, 153
Umm el-Qaab, 12 XRD. See X-ray, powder diffraction
United States of America, 3, 242, 259
University College London, 21, 167, 188, 211 Yaws, 90

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9780521865791pre CUFX196/David 978 0 521 86579 1 October 31, 2007 18:50

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EGYPTIAN MUMMIES AND MODERN SCIENCE

Egyptian mummies have always aroused popular and scientific interest;

A. Rosalie David is KNH Professor and Director of the KNH Centre

Egyptian Mummies and Modern

Cambridge University Press

© Cambridge Universtiy Press 2008

This publication is in copyright. Subject to statutory exception and to the provision of

ISBN-13 978-0-511-37705-1 eBook (EBL)

ISBN-13 978-0-521-86579-1 hardback

List of Plates page vii

part i: an introduction to the scientific study

part ii: diet, disease and death in ancient egypt:

7. Palaeopathology at the beginning of the new millennium:

part iii: the treatment of disease in ancient egypt

part iv: resources for studying mummies

part v: the future of biomedical and scientific

Colour plates follow page 138

1. Mummy in gilded cartonnage. page 23

21. Isomers of C4 H10. 135

particularly medicinal plants and their relevance to current medicine and

immunocytochemistry as a diagnostic tool for detecting the presence of

At the University of Manchester, we are grateful to many departments

Egyptian Government; Professor M. El-Demerdash, Director, South Sinai

of techniques, others concentrate on the significance of results, and some

Much of the research undertaken at Manchester in recent years has

An introduction to the scientific

The background of the Manchester

Autopsy of the Two Brothers at Manchester

The Manchester Mummy Project: initial phase (1973–1979)

The background of the Manchester Mummy Project 5

the Egyptian mummified remains at the museum, although eventually it

of Manchester to discuss the application of medical and scientific tech-

The Manchester Mummy Project: second phase (1979–1995)

The background of the Manchester Mummy Project 7

Macquarie University, Sydney, Australia, the Manchester team undertook

The Manchester Mummy Project: third phase (1995–present)

The schistosomiasis in ancient and modern Egypt project

The International Ancient Egyptian Mummy Tissue Bank

The background of the Manchester Mummy Project 9

The pharmacy in ancient Egypt project

Egyptian mummies: an overview

Egyptian mummies: an overview 11

The environmental context

Natural and artificial mummification

Egyptian mummies: an overview 13

Mummification in the Old Kingdom

mummification – evisceration and the use of natron to dehydrate the bodily

Mummification in the First Intermediate Period

New Kingdom mummies

Egyptian mummies: an overview 15

with the means of studying the development of mummification in the New

Mummification in the Third Intermediate Period

Mummification in later times

Egyptian mummies: an overview 17

gradually eroded, and although some of the immigrants adopted mummifi-