Tutankhamun Death

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Purported medical diagnoses of

Pharaoh Tutankhamun. Ca. 1325
BC
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Menschen February 2014
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Frank Rhli
University of Zurich
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Salima Ikram
The American University in Cairo
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JCHB-25320; No. of Pages 13
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HOMO - Journal of Comparative Human Biology xxx (2013) xxxxxx
Contents lists available at ScienceDirect
HOMO - Journal of Comparative

Human Biology
journal homepage: www.elsevier.com/locate/jchb
Purported medical diagnoses of Pharaoh

Tutankhamun, c. 1325 BCF.J. Rhli a,, S. Ikram b
a
Swiss Mummy Project/Centre for Evolutionary Medicine, Institute of Anatomy, University of Zurich,
Winterthurerstr. 190, 8057 Zurich, Switzerland
b
Department of Sociology, Anthropology, Psychology and Egyptology, American University in Cairo, P.O.
Box 74, Road 90, Tagammu 5, New Cairo 11825, Egypt
a r t i c l e
i n f o
Article history:
Received 3 October 2012
Accepted 21 August 2013
Available online xxx
a b s t r a c t
King Tutankhamun is one of the most famous rulers of antiquity,
thus it is not surprising that a plethora of scientic studies have put
forth possible medical diagnoses and causes of his death. Diseases
(autologous or infectious), metabolic disorders, trauma (possibly
even murder-related), or tumorous conditions have been postulated, frequently only based on secondary data sources. The aim of
this article is to critically review all these diagnoses.
Since the initial examination of the mummy in the mid 1920s
by Howard Carter and others, several dozens of medical diagnoses
based on various levels of evidence have been proposed. While
some studies did not support any sign of a major disease, others
suggested diseases whose existence cannot be proven with the little
tissue that is preserved for study.
In the last c. ve years new examinations of the mummy were
performed by computed tomography and ancient DNA analyses,
now allowing not only to exclude certain diagnoses that had been
postulated earlier, but also to arrive at new theories with a higher
degree of certainty concerning the state of health and the early
death of this most famous ruler.
2013 Elsevier GmbH. All rights reserved.
Corresponding author. Tel.: +41 446355315; fax: +41 446355702.

E-mail address: frank.ruhli@anatom.uzh.ch (F.J. Rhli).
0018-442X/$ see front matter 2013 Elsevier GmbH. All rights reserved.
http://dx.doi.org/10.1016/j.jchb.2013.08.006
Please cite this article in press as: Rhli, F.J., Ikram, S., Purported medical diagnoses of Pharaoh Tutankhamun, c. 1325 BC-. HOMO - J. Comp. Hum. Biol. (2013),
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F.J. Rhli, S. Ikram / HOMO - Journal of Comparative Human Biology xxx (2013) xxxxxx
Introduction
The mummy of King Tutankhamun (c. 13651346 BC-), the only virtually undisturbed ancient Egyptian royal mummy ever found in its tomb in the Valley of the Kings (KV62) in Luxor, was unwrapped
and examined in the outer corridor of the tomb of Seti II (KV15) by Howard Carter, Douglas E.
Derry and Saley Bey Hamdi three years after its discovery, between the 11th and 19th November
of 1925. After the examination, fragile remains of King Tutankhamun were returned to the outermost cofn on the 23rd October 1926, where they rested until they were removed and put on display
within the tomb on the 4th November, 2007, 85 years to the day since the discovery of his tomb
(Fig. 1).
Fig. 1. The body of Tutankhamun after unwrapping, arranged in the sand box by the excavator. Photo courtesy Grifth Institute,
Oxford.
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For the most part, the kings body has received less attention than the opulent grave goods interred
with him (Carter and Mace, 1923) as is attested by the plethora of books and exhibition catalogs dealing
with the subject. Initial reports about his mummymainly the unwrapping of the body and its outer
appearance without any clinical interpretationwere provided by Carter and Mace (1923) and in an
unpublished manuscript by Derry that was subsequently published by Leek (1972). The mummy was
prepared in a way that was unlike that of the other 18th Dynasty royal mummies that have been studied
(Smith, 1912). Although Tutankhamuns body was eviscerated, the cut was diagonal, going from the
navel toward the left iliac crest, rather than running along the iliac crest; the penis was mummied
erect, as opposed to lying accid; resin was poured into the cranium at two separate times; a huge
amount of resinous material was poured over the body, far more than has been recorded for other
mummies of the time, making it extremely difcult for the excavators to free it of its wrappings and
adornments, much less to study the body (Carter and Mace, 1923; Smith, 1923; Leek, 1972; Forbes,
1998).
Since its discovery and until the 21st century, the mummy has been ofcially examined only twice,
both times in situ (Harrison, 1971; Harrison and Abdalla, 1972; Harris and Wente, 1980). In 1968, an
anatomist from the University of Manchester, R.G. Harrison radiologically examined the royal mummy
for the rst time (Harrison and Abdalla, 1972). Ten years later, James Harris, a dentist from Michigan,
examined the body inside the burial chamber with a particular focus on obtaining high-quality conventional radiographs of the teeth (Harris and Wente, 1980). In 2005, Tutankhamuns mummy was
assessed using a trailer-mounted movable multi-slice CT unit in order to obtain in-depth information about intra vitam, peri mortem, and post mortem alterations (Hawass, 2005; Hawass et al., 2009).
Subsequently the kings mummy was re-examined, together with a select group of royal mummies
(Hawass et al., 2010). This was the rst-ever published CT of any positively identied ancient royal
mummy, as well as the rst published DNA study, yet the results of the latter, molecular part have
been questioned (Lorenzen and Willerslev, 2010).
All of the studies published provide some basic information about the body, such as the age at
death and stature, as well as specics regarding the dead kings health, and the cause of death. Based
on epiphyseal fusion and the eruption of the third molar, Carter and his collaborators in 1925 (after
Leek, 1972) and Harrison and Abdalla (1972) estimated Tutankhamuns age at death to be about 18
years (they thought he might have been anywhere between 17 and 19 years). Leek (1977), however,
proposed the age at death of 16 or 17 years based on the assumption that epiphyseal fusion and the
eruption of the third molar occurred earlier in ancient Egyptian populations. Most recently, Hawass
and colleagues (Hawass et al., 2009, 2010) stated that Tutankhamun died at the age of 19 years, based
on epiphyseal fusion stages. Basically, the various studies are in agreement that Tutankhamun died
when he was between 17 and 19 years of age.
Tutankhamuns height has also been variously reported: according to Carter and his colleagues
(Leek, 1972) direct measurements of the body revealed that it was about 1.61 m, but, based on Karl
Pearsons tables, in life he was probably 1.68 m tall. Harrison and Abdalla (1972) have record the
actual length of the mummy when measured by them in 1968 as being 1.59 m, although it is difcult
to judge the living height of the disarticulated mummied body with complete accuracy. Carter and
his collaborators estimates are roughly supported by Fairman (1972), Doherty (2002), and Hawass
and co-authors (Hawass et al., 2009, 2010).
It is possible that in addition to the scientic examinations, the mummy was disturbed illegally,
and artifacts might have even been removed. Recently, Forbes et al. (2007) postulated that it was quite
likely that the mummy had been disturbed unofcially sometime between 1925 and 1968, possibly
during World War II. Displacement of a bead collar and associated bead girdle, damage to the eye
sockets, detachment of the penis, clavicles and the removal of the anterior ribcage, all of which were
apparently in order when the body was replaced in the cofn by Carter, were listed as evidence to
support this theory. Also, Schnabel (1980) calls to attention the decrease in stature of the mummy
during this short time period (see above), maybe due to a rearrangement and disturbance of the body,
although it is more than probable that some imprecision of measurements might account for this
supposed change.
Of late, due to an increase of interest in mummies, the fact that Tutankhamuns is one of the few
royal mummies recovered in the Valley of the Kings in a semi-intact burial, the richness of the grave
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Fig. 2. Tutankhamuns head with the dark, resinous coating. This image highlights the necessary damage wrought upon the
mummy during its excavation and unwrapping. Photo courtesy Grifth Institute, Oxford.
goods, and the connection of Tutankhamun with Akhenaten, the henotheistic pharaoh, have all made
Tutankhamuns mummy the focus of inquiry in both the lay and scholarly press. The central foci in such
publications are speculative theories regarding the Kings health and especially his possible violent
death (Brier, 1998; Doherty, 2002; King and Cooper, 2006), all based on a few reports of those who
have actually examined the body, together with historical texts of the period, artistic representations,
and speculation. The remains of Tutankhamun and his closest royal relatives also have been analyzed
in the scientic literature, often with a particular focus on possible intra vitam pathologies (Abraham,
1912, 1935; Aldred and Sandison, 1964; Ameline and Quercy, 1920; Boyer et al., 2003; Braunstein
et al., 1988; Burridge, 1993, 2000a,b; Derry, 1934; Gerhardt, 1967; Ghalioungui, 1947; Gray, 1973;
Guest, 1933; Harris et al., 1978; Harrison, 1971, 1973; Harrison et al., 1969,1979; Hawass and Saleem,
2011; Hayes, 1959; Ismail and Barth, 2001; Leek, 1977; Marti-Ibanez, 1958; Paneth, 1974; Paulshock,
1980; Pillet, 1950; Proskauer, 1932; Risse, 1971; Rossbach et al., 2005; Schott, 1971; Smith, 1912;
Snorrason, 1946; Swales, 1973; Walshe, 1973; Weller, 1972).
It also should be noted that numerous reports have stated that the post mortem treatment of this
particular mummy, both in antiquity as well in more recent times, has created a mineeld for current
medico-historical analyses: the mummy was dramatically disarticulated due to the forced removal of
the jewels and amulets attached to it (Carter, 1954; Harrison and Abdalla, 1972; Leek, 1972) (Fig. 2).
Indeed, some lesions might have appeared during the medical-anthropological assessment in 1925
(Leek, 1972). Perhaps these factors are partially responsible for the varied analyses of the mummy.
The aim of the present work is to critically review all the main theories about Tutankhamuns medical
conditions that have been proposed in the last 80 years. While Tutankhamun is an important gure by
himself, a review of his supposed pathological conditions may also giveat least to a certain degreea
wide-ranging perspective on the variety of diseases that might have affected upper class ancient
Egyptians in general. Additionally, it highlights the complexities of palaeopathology: how a single
individual, who has been studied in detail by so many groups, can yield so many and sometimes
contradictory results of analyses.
This case also illustrates how changes in technology and science can improve diagnoses, thus
emphasizing the need to revisit earlier studies.
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Materials and methods

All original reports until March 2013 in scientic journals or booksbut no newspaper articles
or other public media reportsaddressing specically the medical aspects of Pharaoh Tutankhamun
have been reviewed for this work.
Results and discussion
The original report
Neither Carter nor Derry, two of the people present at the very rst macroscopic examination of
this pharaoh mummy, list a cause of death or mention possible diseases that Tutankhamun suffered
(Carter and Mace, 1923; Leek, 1972, 1977). Indeed, Carter specically states that the mummy does not
provide any indication for a cause of death. As Leek (1972) points out, unless a disease or trauma is one
that shows on the bone, it is difcult to identify these from a macroscopic examination, particularly
one carried out on desiccated tissue, much of which was carbonized due to the lavish use of resins,
oils, and unguents, and the manipulations carried out on the body to free it from this material, as well
as all the adornments that stubbornly adhered to the body, together with the resinous materials.
General/unspecic conditions
Several authors claim that Tutankhamun suffered from a variety of diseases, although none of
these was considered fatal. They base their claims on the published evidence of those who studied
the body as well as on artistic and occasionally textual sources, and are often no doubt inuenced by
the appearance of Akhenaten who has been identied as Tutankhamuns father in the Egyptological
literature (Dodson, 2009). Many state that due to inbreeding, Tutankhamun may have been physically
weak and hence short-lived (Forbes, 1998; Walshe, 1973). Czeizel (1974, 1980) proposes celiac disease,
a condition that damages the lining of the small intestine and prevents it from absorbing foods, as a
result of 18th dynasty inbreeding as a possible diagnosis for the kings early demise. There is no
evidence for this diagnosis as the signs (abdominal pain, nausea, bruising, mouth ulcers, to name but
a few) are impossible to check on the mummy.
Walshe (1973) refers to the boy-king as a possible index case of the Tutankhamun syndrome
consisting of breast development, sagging abdominal wall and at feet. Walshe also suggests hepatic
Wilsons disease with early neurological involvement. Wilsons disease is an inherited disorder that
causes the body to ingest and retain excessive amounts of copper in the liver, brain, kidneys, and the
eyes. These deposits cause tissue damage, death of the tissues, and scarring, which causes the affected
organs to fail. Signs that might be relevant to Tutankhamun include an abnormal posture of arms and
legs, abdominal distension, and weakness, among others. Another disease that has been put forward as
one that Tutankhamun might have suffered from is Klippel-Feil syndrome. This is a congenital disease
whose causes are disputed and that manifests itself in changed neck and head anatomy with the
fusion of two cervical vertebrae, resulting in a decreased range of motion. However, this too has been
dismissed (Swales, 1973) and no evidence was found in the 2005 CT study (Hawass, 2005; Hawass
et al., 2009, 2010).
Doherty (2002) interprets numerous pictures of King Tutankhamun shown seated, together with
the large number of walking sticks buried with him, as indicative of a weakness in the limbs (legs)
of the pharaoh. This line of enquiry has been further pursued by Zahradnik (2009), touched upon
(among other hypotheses) by Gillam and Brier (2010), and most recently by Hawass et al. (2010). This
very latest paper argues that Tutankhamun suffered from oligodactyly (hypophalangism) and Khler
disease II and Freiberg-Khler syndrome in his right foot, and clubfoot in his left. Khlers disease is a
rare bone disorder of the foot found in children between six and nine years of age and is correctible,
at least today. It occurs when the navicular bone temporarily loses its blood supply, causing the tissue
in the bone to die and the bone to collapse. Sufferers of this disease experience pain and swelling in
the middle part of the foot and they usually limp, with increased weight on the lateral side of the foot.
The affected foot tends to have a sclerotic and attened navicular bone. FreibergKhler syndrome
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consists of osteochondrosis of the metatarsal head (generally the second, but occasionally the 3rd or
4th). It is characterized by localized pain and swelling over the metatarsal head; interestingly, it is
more common in girls than boys. Clubfoot, or congenital talipes equinovarus, is a congenital deformity
where the affected foot seems rotated medially at the ankles so that it looks as if the person is walking
on his ankles or the sides of his feet. It is more common in boys than girls. Hawass et al. (2010) have
used these diagnoses to set up a possible scenario for the young kings death: the problems in his
extremities caused him to trip and fall, thereby fracturing his leg (see above); this became infected,
leading to Tutankhamuns untimely demise.
There is some debate as to whether these diagnoses regarding Tutankhamuns lower extremities
are indeed correct as, among other things, it is possible that post mortem the feet were treated in such
a way as to give the impression in the CT imaging that the king suffered from these diseases. Certainly
foot deformities were not identied in macroscopic examinations of Carter, and this is quite opposite
to what was stated by Harrison (1973). Some letters, such as that of Gamble (2010) in response to
Hawass et al. (2010) argue against clubfoot, although support the analysis of damaged metatarsals in
the right foot. It also should be noted that sticks and staffs were a very common symbol of ofce in
ancient Egypt, e.g. see the burials of Hetepheres (Reisner, 1927) and Senebtisi (Mace, 1916), and the
inclusion of these items in the tomb does not necessarily indicate weakness of the limbs, although
this is a plausible explanation, if one accepts the most recently reported discoveries of Hawass et al.
(2010).
Other issues with the body that have been mentioned include Velikovskys (1960) statement of
an unusual thickening of the occipital bones, a condition that does not necessarily relate to a cause
of death, and is unsubstantiated by subsequent studies of the body (Harrison, 1971; Hawass, 2005).
Other scholars have mentioned the reverse: a thinning of the occipital bone and subsequent intracranial calcication, which might contribute to the cause of death, if nothing else (see below, Murder or
accident). Indeed, Doherty (2002) has suggested that Tutankhamuns shaved head attests to the doctors searching for the source of a disease. However, it was fairly common for Egyptians to shave their
heads for a number of reasons, including ritual purity, comfort in hot weather, a means of avoiding
lice, and in order to accommodate their wigs more comfortably. Indeed, one of the objects in the tomb
depicts Tutankhamun as the sun god emerging from a lotus ower, the pinpricks of hair on his shaved
head clearly visible on the scalp (Egyptian Museum, Cairo, JE 60723). Additionally, Doherty (2002)
believes that Tutankhamun suffered from a pectus carinatum, or pigeon chest. This is manifested as a
deformity of the chest evidenced by a protrusion of the sternum and the ribsthere is no artistic or
textual evidence to support this, and as Tutankhamuns ribs and sternum are now missing, this cannot
be veried and in fact the head is much more dolichocephalic in shape. Harrison (1971) remarks upon
the brachycephalic appearance of the kingthis might be tied in to familial traits, but has no real
bearing on the kings health.
Metabolic disorder
Several types of metabolic disorders have been suggested as explanations for the peculiarities of
Amarna style art that show, for example, Pharaoh Akhenaton, Tutankhamuns suggested father, with
gynecomastia or having a feminine physical appearance with secondary sex attributes such as breasts,
slender arms, a prominent belly, and thick thighs. As many of the images of Tutankhamun share some
of these traits, this has lead several authors to claim that Tutankhamun also suffered from a possible
metabolic disorder. It should be noted, however, that this mode of representation might be due in
part to theological beliefs reected in the art, rather than reecting an absolute reality (Freed, 1999;
Swales, 1973).
Based on artistic and historical evidence, Weller (1972) suggested that the gynecomastic appearance of Tutankhamun was due to an adrenal tumor. However, this should inuence his fertility, and
if the two fetuses found in his tomb are his offspring, then such a diagnosis is invalid. Wellers suggestion was followed by Paulshock (1980), who also used the publications pertaining to blood group
analysis (Burridge, 1993) to link Tutankhamuns suggested gynecomastia with sterility. It should be
notedand has by some authors writing on medical aspects of the Amarna kings (Farag and Iskandar,
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1998)that neither Akhenaten nor, most probably, Tutankhamun was sterile, thus rmly relegating
these diagnoses to the dustbin.
On the other end of the spectrum, Ismail and Barth (2001) suggest that Tutankhamun may have
suffered from the aromatase excess syndrome, a familial genetic disorder showing, among other
traits, gynecomastia, but with no decreased libido or fertility, which would allow for offspring. Gray
(1973) believes that King Tutankhamuns gynecomastia (as well as that of Akhenaten) is minor, and
denitively not a sign of Klinefelters syndrome, a condition when males have an extra X-chromosome
that reduces fertility and shows signs of gynecomastia.
Other suggestions of diseases from which Tutankhamun might have suffered include a variant
of Antley-Bixler syndrome, also known as trapezoidocephaly-synostosis syndrome, which is a rare
autosomal recessive congenital disorder. It manifests itself in malformations of the craniofacial area
that might result in prominent foreheads, underdeveloped mid-facial regions, and protruding eyes.
Other skeletal abnormalities might also occur. Although this idea had been bruited about in 2009 and
dismissed (Miller, 2009), it has resurfaced as a possibility (Braverman and Mackowiak, 2010) since
the Hawass et al. study (2010), although the same objections to it that were voiced in 2009 still stand
(Miller, 2009), and none of the recent studies show any evidence to support this diagnosis.
Again, using historical and artistic evidence Smith (1923) proposed that Akhenaton and
Tutankhamun suffered from Froehlichs Syndrome, a mixture of endocrine abnormalities believed
to result from damage to the hypothalamus, a part of the brain where certain functions such as sleep
cycles and body temperature are regulated. This syndrome appears to affect mostly males. The more
obvious and frequently encountered characteristics are delayed puberty, small testes, and obesity.
Although this would explain the appearance of the two kings, it does not allow for their fertility.
On the same basis, Burridge (2000b) has suggested Marfans syndrome as a cause of Tutankhamuns
depicted physique. This is a heritable condition that affects the connective tissue. The primary purpose
of connective tissue is to hold the body together and provide a framework for growth and development. In Marfans sufferers, the connective tissue is defective. Because connective tissue is found
throughout the body, the syndrome can affect many body systems, including the skeleton, eyes, heart
and blood vessels, nervous system, skin and lungs. It manifests itself in a variety of ways, all of which
are in keeping with the artistic representations of Akhenaten in particular: it makes sufferers taller,
loose jointed, with elongated limbs, at feet, and curved spines. Burridge also suggests that the presence of more than 130 staves in King Tutankhamuns tomb is due to his need for sticks to support
his attenuated limbs. However, the work of Hawass et al. (2010) found nothing to conrm any of the
above-mentioned disorders, although it did suggest other diseases to explain the sticks and staves
(above), in addition to other conditions (see below).
Recently a physician, H. Ashraan, has suggested that Tutankhamun and his immediate predecesors
(Thutmose IV, Amenhotep III, and Smenkhkare) all suffered from epilepsy, which led to their untimely
demise (Ashraan, 2012). However, there is no hard evidence to support this hypothesis.
Cause of death: murder or accident?
Initial suggestion of a possible traumatic injury to the head of the boy-king was made by Harrison
(1971) based on an intracranial isolated piece of bone he noticed on the radiographs (Fig. 3).
Now most scholars agree that this is the result of a post mortem event (Boyer et al., 2003), particularly in light of the recent CT and other studies carried out in the 21st century. However, this initial
identication has lead to endless speculation as to whether (or how) the king was brutally attacked and
murdered, or that he suffered from a fatal accident (possibly engineered to bring about his untimely
demise) (Brier, 1998; King and Cooper, 2006; Reeves, 1990) although, there is no hard evidence to
support this theory. Often, a thinning of the occipital bone and subsequent intracranial calcication is
mentioned in this context (Brier, 1998; Doherty, 2002), which would have made a blow to the head,
whether deliberate or accidental, a very possible cause of death. Candidates for the role of murderer
include his regents and successors, Ay and Horemheb, or even a cabal of priests, who attacked the
young king and dispatched him with a swift blow to the headof course, recent examinations and
analyses of the different radiographic images of the kings skull indicate that all this speculation rests
in the realm of fantasy (Forbes et al., 2007; Harrison, 1971; Hawass, 2005).
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Fig. 3. Radiograph of Tutankhamuns skull, showing the different resin deposits as well as the bone fragment that fueled the
idea of an unnatural death. Photo courtesy of R.G. Harrison and R. Connolly.
Many authors have attributed the premature death of the boy-king to an accident, rather than
premeditated murder. One possibility would be a traumatic injury caused by a horse-powered chariot
(Booth, 2007). Gage (19921993) proposes King Tutankhamuns supposed chest and face injuries
(caused by the initial examination) could be the result of such an incident. Aldred and Sandison (1964)
have argued that a possible accidental wound to the left ear due to an injury or even an insect bite,
similar to the one that apparently led to the death of Lord Carnarvon, and rst described by Carter
(Leek, 1972)penetrated the skull and resulted in a cerebral hemorrhage, an idea that has had little
popularity amongst Egyptologists or members of the medical fraternity. Forbes (1998) posits a sporting
accident: Tutankhamun was run over by a chariot, fell into a coma and eventually, after a few days
(allowing time for a possible cheek wound to heal) would have died. Collins and Oglive-Herald (2002)
also support a verdict of death by accident rather than murder. Curiously they refer to a story in
the Talmud echoing possibly an accidental fall of a pharaoh, probably King Tutankhamun (Weigall,
1924). Recently, death due to complications resulting from a kick in the chest by a horse, or even the
possibility of an inopportune meeting with a hippopotamus have been put forward (Harer, 2006).
Although, it is more than probable that the king rode a chariot frequentlyindeed, six chariots were
interred with him in his tombit is unlikely that he would be inexperienced enough to stand behind
one of his horses where he might be kicked. Similarly, the rogue hippopotamus theory, although
possible, is not very plausible as it is unlikely the kings guard would have been unable to protect him
from a rampaging animal. After all, Thuthmose III was saved from a berserk elephant when he was
hunting these animals in the Nile, the event recorded in the tomb of Amenemhab at Thebes (Theban
Tomb 85; Breasted, 2001 reprint). Just recently, Harer (2011) postulated further that the heart and
sternum of the Kings mummy must have been missing pre mortem based on his CT data analysis but
at this stage, without giving his interpretation for the most likely cause of death.
Hawass and his colleagues (2009) analysis of the body revealed an open distal femur fracture
lesions [33C3 according to the Arbeitsgemeinschaft fr Osteosynthese- classication (Mller et al.,
1992)], which may have triggered the premature death of the king. The authors of that study (Hawass
et al., 2009) suggest that the kings leg has been broken through an accident of some sort (although the
precise cause of the fracture is not clear), and that the kings death might have been due to septicemia
and complications to the wound.
Additionally, Seton-Williams (1980) suggested Tutankhamuns death was due to murder or a simple accident that left no record on the bones. More sensationally, and with no basis in fact, Velikovsky
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(1960) suggested that the boy-king could have died in a war over control of Egypt between Smenkhare
and himself.
Although all these dramatic ends to the kings life are appealing, there remains little proof for these
on his body or in the artifacts and texts from that time.
Infectious disease
Using historical data, Helck (1971) proposed that the death of King Tutankhamun (as well as that
of his possible relative, Smenkhare) might have been linked with some sort of plague; certainly there
are accounts suggestive of plague from the reign of Amenhotep III as well for the reign of Akhenaten
(Kozloff, 2006; Moran, 1992; Redford, 1984). Tuberculosis as a cause of death was suggested by Brown
(1993) and briey mentioned by Ghalioungui (1947) as well, based on examinations made by pathologist Shaw in Cairo in the 1920s. This claim was dismissed by most scholars, particularly by Derry
(1934) and Leek (1972), Reeves (1990), Harrison (1973) and Harrison and Abdalla (1972). Infestation
by bilharzia as a cause for changes in body appearance is mentioned as a possibility by Booth (2007),
but dismissed by other scholars (Harrison and Abdalla, 1972), as there is no real evidence for this.
The latest evidence garnered by Hawass et al. (2010) indicates that the young king suffered from
malaria. While the authors of that study say that it might not have been the sole cause of death, they
suggest this as a contributing factor, together with an infection of a broken leg (see above). However,
the claim of malaria being primary cause of death is disputed by various authors among others by
Timmann and Meyer (2010a,b) who suggest the ndings to be attributed rather to sickle-cell-disease
and Gaucher disease.
Tumorous condition
El-Mahdy (1999) based on artistic representations, suggested the death of Tutankhamun to be
linked with some sort of slow growing tumor in the skull that would suddenly affect the brain,
manifesting itself as a severe headache, and eventual sudden death. Doherty (2002) specically lists
meningioma as a possible intracranial tumor that Tutankhamun may have suffered from over a long
period of time. Again, there is no obvious evidence - e.g. in the 2005 CT scans - for these theories,
which are based almost solely on artistic representations.
No pathology at all
Despite the numerous claims for pathological conditions of King Tutankhamun, several authors
emphasize that based on their actual knowledge there is no unequivocal evidence for any pathological condition in this particular mummy (Harrison, 1973), and that it is impossible to establish a
certain cause of death (Clay, 1959; Desroches-Noblecourt, 1963). Harrison (1973) states the need for a
broader population-based analysis before one assesses an individuals possible pathologies. He particularly rejects earlier claims of Klinefelters disease, suprarenal tumorous condition, Wilsons disease,
and specically mentions that Tutankhamuns accentuated feet might have nothing to do with any
pathology. Boyer et al. (2003), after examining the cervical radiograph of Tutankhamun, also claims
that there is no obvious pathology to be found on the body of King Tutankhamun. He cannot nd any
signs for traumatic death in the skull and cervical spine. Although he entertains many diseases and
causes of death, he particularly excludes Klippel-Feil syndrome, a skull fracture, and nds no radiological signs for a hematoma, such as an abnormal thinning of the posterior fossa of the skull. All the
visible lesions in this part of the mummys body are attributed to post mortem damage due to the
analysis of Derry and his co-workers in 1925 (Leek, 1972), which resulted in the disarticulation of
the skeleton. One example would be the freely movable intracranial piece of bone, which could be
the posterior arch of C1 vertebra. Finally, Swales (1973) emphasizes that all the apparently abnormal
appearances of the Amarna period are only conventions reective of religious and artistic ideologies,
and not indicative of pathology, an attitude that has some currency amongst Egyptologists (Freed,
1999) and, more to the point, are not manifested on Tutankhamuns body. Furthermore, as mentioned
above, the presence of the fetusessupposedly King Tutankhamuns childrenwithin his tomb proves
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for Farag and Iskandar (1998) and others, that he could not have suffered from infertility and thus did
not have Klinefelters syndrome, or for that matter, Froehlichs syndrome. Additionally, many authors
dismiss the many walking sticks in his tomb as indicative of status, rather than useful props (Booth,
2007). Similarly, Tutankhamuns shaved head and pubic area might have no sinister implications, but
rather be a manifestation of normal ancient Egyptian hygiene practices (Booth, 2007).
Summary
To summarize, one has to be aware that for most of the proposed causes of death (Table 1) the level
of evidence by macroscopic analysis, and even by CT examination is low, although certain misdiagnoses
can be excluded. It should be noted that post-mortem alterations (embalming attempts, modications
due to mummication, destruction due to tomb robbers, etc.) are often so severe, that an ultimate
diagnosis is difcult to achieve (Fig. 4).
This is particularly true for an ancient mummy that is as ill preserved as that of King Tutankhamun.
To assess the degree of evidence for purported medical diagnoses, as in this particular case, one has to
take into account the diagnostic sensitivity and specicity of the examination method. The majority
of claims for the cause of Tutankhamuns death is based on secondary sources, a limited number of
historic texts, artistic representations, or/and artifacts, with only limited use of the primary source
evidence, such as direct gross observation of the body and radiological examination. In order to obtain
a clearer and more reliable understanding of the pharaohs health, scientists must optimally use a
combination of direct gross observation, radiological examination, and aDNA study, as done in the
latest attempts by Hawass et al. (2009, 2010).
Of the plethora of peculiar life conditions and pathologies proposed for King Tutankhamun by a
variety of authors, the CT-based analyses of 20052009 were able to rule out the majority, but still
raise more issues with their conclusion as to how the king died. Hawass et al. (2009, 2010) indicate that Tutankhamun may have suffered from multiple disorders and conclude that all or some of
them might have produced an inammatory, immune-suppressive syndrome that ultimately caused
his death. According to this latest work the young, weak king may have suffered from oligodactyly
(hypophalangism) and Khler disease II in his right foot, and clubfoot in his left, leading him to fall and
fracture his leg. The ensuing infection could have been exacerbated by a malarial infection, bringing
about his untimely end. Various authors, as seen above, have disagreed with different aspects of this
analysis (Pays, 2010a,b). No doubt the debate will continue.
Even with a thorough CT-examination, some unsolved issues still remain, such as the surface
alterations at the posited lesions in the thoracic, knee and feet regions and the skull region of the
mummy. Thus, further possible investigations to increase our knowledge about this particular ancient
king should include a close macroscopic examination of the diseased body by medical professionals,
Table 1
Main purported causes of death and subsequent 20052009 CT ndings (Hawass, 2005; Hawass et al., 2009, 2010).
Purported cause of death
Selected main reference
CT ndings in 20052009
Not determinable/unspecic
Epilepsy
Physically weak
Carter et al. (1925) after Leek (1972)

Ashraan (2012)
Walshe (1973) and
Desroches-Noblecourt (1963)
Harrison (1971), Reeves (1990), and
Brier (1998)
Burridge (1993)
Helck (1971) and Hawass et al. (2005,
2009, 2010)
Irrelevant
No indications for abnormal weakness
Murder (skull trauma)

Marfan syndrome
Plague/infectious disease (not
e.g. posttraumatic
osteomyelitis)
Intracranial tumor
Accident
El-Mahdy (1999), Doherty (2002)

Aldred (1971), Gage (19921993),
Forbes (1998), and Harer (2006, 2011)
No peri mortem skull fracture

No indication based on available tissue
No indication based on available tissue
[however malaria proposed by aDNA
analyses (Hawass et al., 2010)]
No intracranial tissue present, yet no
tumorous bony lesions
Only few bony lesions of most likely
intra vitam/peri mortem origin in lower
limbs
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11
Fig. 4. Radiograph of Tutankhamuns torso showing the state of the ribs as well as the packing of the abdomen area. Photo
courtesy of R. Connolly.
and high-resolution photographic documentation of the mummy itself, CT-scanning of his separately
stored internal organs, as well as further radiological-anatomical comparison or DNA-analyses with
his presumed closest relatives such as e.g. the skeleton found in KV55 (Burridge, 2000b), and the body
of Amenhotep III. As suggested by Weller (1972), invasive investigations such as histological examination of King Tutankhamuns internal organs may provide further ideas about the health of the king.
Furthermore, CT scanning of the embalming materials found in and on his grave goods may increase
our knowledge about its radiological appearance and, thus, elucidate its possible current distribution
within and outside the Kings mummy. More information might also be gained from the bandages
removed by Carter and his colleagues, if they accidentally enclosed human material that can be tested
without destroying the body further.
As time progresses and medical technology improves tests might be developed that could be carried
out on soft tissue that might indicate the presence of diseases that leave no sign on bonesperhaps
even a viral disease such as inuenza. However, even with the best medical and Egyptological forensic
work, it is doubtful that all aspects of Tutankhamuns health and possible causes for his death will ever
be known due to the absence of the indispensable direct medical practitioner-patient interaction, and
the limited amount of body tissue. At least the King currently lies in state in a new case with a stable
air balance that will help to conserve this fragile world-famous mummy for future generations to
examine.
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Acknowledgements
This study has been supported by Swiss National Science Foundation and by Mxi Foundation
Zurich. We are indebted to R. Connolly, Liverpool, and the Grifth Institute Oxford for the images used
in this work.
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Purported medical diagnoses of

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Purported medical diagnoses of Pharaoh

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Materials and methods

Selected main reference

Carter et al. (1925) after Leek (1972)

Murder (skull trauma)

El-Mahdy (1999), Doherty (2002)

No peri mortem skull fracture

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