INTRODUCTION

As neophyte paleopathologists, five of us in Detroit (Aidan and Eve Cockburn, Robin Barraco, William Peck and Theodore Reyman) were involved in the autopsy of two mummies, DIA I (Detroit Institute of Arts) in 1970 and PUM I (Pennsylvania University Museum) in 1971. The findings from the examination of these two bodies were minimal. Both mummies were poorly preserved and without personal data or provenance. Although we were able to learn little from the gross and microscopic examination, we did establish one thing – we didn't know much about identifying and testing ancient tissues.

Aidan Cockburn was interested in extracting gamma globulin from mummified organs, theorizing that if this were possible, we could use modern testing techniques on this material in order to survey disease patterns in ancient times. With these data, we would then be able to track infectious diseases from antiquity to the present time and perhaps determine whether alterations in life cycle, virulence and other epidemiological parameters had changed over the years. We were able to extract and identify small amounts of serum albumin and globulin, although the reactivity in modern tests for infectious diseases never came to fruition. We learned that many proteins, carbohydrates, and lipids were present in mummified tissue but generally in very fragmentary form (Barraco 1980).

Chemical elemental analysis told us whether the mummy had been treated with natron and how the heavy metal content of ancient tissues correlated with modern equivalents (Barraco et al. 1977).

Why mummies? That is the question we are often asked. How did an otherwise respectable physician and a senior member of the University of Oxford, whose field is modern language and literature, find themselves regarded as ‘the mummy experts’?

The story begins in Aidan's early medical years. He is cursed with the satiable curiosity of the elephant's child and always wants to know ‘why?’. Why are diseases the way they are? Were they always like this? Where did they come from? Under the influence of the nineteenth-century ideas of Darwin and Huxley, he worked out a series of theories that would explain how disease organisms evolved, how they changed during the different epochs of the development of human society, and how the interaction of these two streams of evolution resulted in our current infectious disease patterns. Eve, with her nonscientific background, found herself looking at these ideas with the cold and critical eye of an outsider, then helping with the sorting and organizing of theories – and so a partnership was born.

After Aidan's first two books on the evolution of infectious diseases (1963 and 1967), there was a hiatus of several years. Then came two casual conversations, which led to the present line of research and the present book. At a meeting of the American Association of Physical Anthropologists in Boston in 1971, Lucile St. Hoyme of the Smithsonian Institution remarked: ‘Aidan, why don't you apply for a grant from the Smithsonian to study in some area where you could find facts to back up your theories? We have local currency funds available in at least seventeen countries’. She listed them, and the obvious one that would provide a fertile field for research was Egypt. Aidan applied for and received a grant to go to Egypt on a reconnaissance trip to investigate the possibility of organizing a project for the autopsy of large numbers of mummies, thus obtaining facts to back up his, until then, largely speculative ideas.

The traditional Egyptian mummy is one on which all the arts of the embalmers have been employed; the organs have been preserved, the body is wrapped in linen, and everything is contained in a highly decorated sarcophagus. Such was mummy PUM II. It belongs to the Philadelphia Art Museum and was lent to the Paleopathology Association for dissection and study through the courtesy of David O'Connor of the Pennsylvania University Museum, thus its name PUM II, being the second mummy from that museum. PUM II is now on display at the Pennsylvania University Museum, complete with the sarcophagus and photographs of the unwrapping and the autopsy findings.

Little is known of the provenance of this mummy (Figure 4.1). It was brought to America about the turn of the century by John T. Morris, a wealthy Philadelphian, who donated it to the Philadelphia Art Museum (Cockburn and Ballard 1992), but its origins in Egypt are unknown. The sarcophagus was highly decorated but lacked the name and any details of the person inside (Figure 4.2). The unwrapping and autopsy of PUM II took place on February 1, 1973, as part of a symposium (Death and Disease in Ancient Egypt) that was held at Wayne State University Medical School, Detroit, Michigan (Cockburn 1973). Radiographic and xerographic examinations at Mt Carmel Mercy and Hutzel Hospitals, Detroit, were performed prior to and following the autopsy (Kristen and Reyman 1980). The mummy seemed to be well preserved.

The Egyptian embalmers were masters of their art. The trial and error method they employed for 2000 years resulted in a scientific discipline for preserving bodies (Mokhtar et al. 1973). These embalming techniques required long hours of toil, expensive medicants, and fine linen wrappings. The costs were necessarily high. Because the majority of people who were mummified in the early dynasties were royalty or the rich and influential of the time, cost had little importance. As the poorer segments of the populace were allowed the privilege of mummification, these costs became prohibitive. For this and possibly other reasons, modifications were made in the classical mummification process, most being aimed at reducing the cost. The external form and appearance of the mummy remained the same but the fact is that mummification for the poor became less a preservative and more a symbolic exercise. Two examples of a common alternative method are presented: mummification with evisceration per ano. Both mummies were provided by David O'Connor, Department of Egyptology, Pennsylvania University Museum. Neither had known provenance or coffin. The first, designated PUM III, was an adult female; the second, a male child called PUMIV. They will be described separately.

PUM III

Radiography

Before the unwrapping, the mummy was examined radiographically (Kristen and Reyman 1980). The body arrived with the head unwrapped and separated from the body at the level of the fifth cervical vertebra, probably occurring postmortem. There was a healed fracture of the left second rib. Harris lines were present in the distal femora. The chest cavity revealed central densities suggesting the heart and lungs. The diaphragm clearly separated the thorax and abdominal cavities. A right upper abdominal mass appeared to be the liver. The remainder of the abdominal cavity contained irregular, speckled opacities. In the pelvis, a double shadow centrally suggested the urinary bladder with an air contrast lumen and the uterine body behind it. There were numerous air contrast lines in the thigh muscle, suggesting fissuring.

In the twenty years since Aidan and I first started working on Mummies, Disease and Ancient Cultures, the pace of discovery and change has been remarkable. We started from the 1971-75 series of autopsies carried out by our little group on Egyptian mummies, then decided to be adventurous by adding Peruvian. As we continued working, we were surprised to realise how ubiquitous the practice was, and so we continued to add new reports as we went along. Although we were not aware of it at the time, most of the types of mummification described in the first edition had actually appeared in Pettigrew's pioneering 1834 book – as we were humbled to discover some time later.

What a huge change occurred during the next few years! When Cambridge University Press decided in 1995 that it was time for an update, Theodore Reyman (my new co-editor) and I found ourselves suffering from an embarras de richesses. Some of the chapters needed very little revision. As far as ancient Egypt is concerned, the facts about mummification practices have been well documented for many years, and so chapter 1 stays virtually untouched. There have been some interesting discoveries about diseases there in ancient times, but A. T. Sandison's classic account (chapter 2) needed no serious change, just updating with additional material. Chapter 3 on dentistry and dental practices reflects the author's ongoing research during the past twenty years, told from today's vantage point, and the four elaborate case reports describing the autopsies of Egyptian mummies carried out by the founders of the Paleopathology Association and their colleagues (chapters 4, 5, and 6) have been condensed to some extent.

Herodotus noted that the least expensive form of mummification was where no treatment was given and the body was simply wrapped in linen. ROM I, autopsied in Toronto in August 1974, was just such a mummy. The name is shorthand for the Royal Ontario Museum, to which the mummy belongs. The autopsy was an international operation, demonstrating cooperation among members of several disciplines from the Royal Ontario Museum, the Toronto Academy of Medicine, the University of Toronto and the Detroit group of the Paleopathology Association (Lewin et al. 1974; Hart et al. 1977a). The study arose as the result of a lecture on PUMII given by Aidan Cockburn and Theodore Reyman in February 1974 at the Academy of Medicine in Toronto. The following day, Eve Cockburn suggested a joint Canadian-United States project, and a day later Nicholas B. Millet offered to provide a mummy from the collection of the Royal Ontario Museum.

Following the unwrapping by Millet and his staff, the examination of ROM I was carried out in the anatomy department of the Medical Sciences Building, University of Toronto. Radiographic examination had been completed by D. F. Rideout prior to the unwrapping. The autopsy was directed by Reyman, Zimmerman and Lewin. Specimens obtained from the dissection were distributed to qualified participants and observers as this had the advantage of ensuring greater coverage in the search for abnormalities.