King Tutankhamun – What caused his mysterious death?

 nile

“Today the traveller on the Nile enters a wonderland at whose gates rise the colossal pyramids of which he has had visions perhaps from earliest childhood.  James Henry Breasted”.

To know the people and a country you have to visit it. Talk to the people, look into their eyes and try to understand their local culture.

Egypt is an enchanting country with many exciting stories and unsolved mysteries from the past.
Some of the most intriguing questions are related to mysterious death of the great Pharoah (king) Tutankhamun.
mummy

The most exciting discovery of ancient Egyptian remains was that of the tomb of  Tutankhamun, the last pharaoh of the XVIIIth dynasty.

The tomb was found in 1922 by an Englishman called Howard Carter who was member of an expedition team led by Lord Carnarvon. The tomb was in the Valley of the Kings, where so many Egyptian kings were buried, but this was only one that had not been broken open or robbed of its treasures.

The mummy of  Tutankhamun himself was enclosed in a decorated coffin of gold, which in its turn was inside two wooden coffin and a stone one. The face of the mummy was covered with a gold mask, decorated with precious stones and there were gold ornaments on the head.

According to Dr Saleem SN et al  “Subcutaneous packing procedure was used as part of mummification of royal Ancient Egyptians dated to 18th to 20th dynasties earlier than what was believed in archaeology. The Ancient Egyptian embalmers must have been skilled in dissection and possessed surgical tools that enabled them to perform this fine procedure.”

Tutankhamun became king when he was only 12 and died unexpectedly at the age of 18 years. If his tomb had not been found with all its treasure he would have been forgotten long time ago.

A curious superstition sprang up about the tomb of Tutankhamun. It was said that the people who broke it open were committing an offence against something sacred, and that they would meet sudden death as a result.

Strange incidents happened and several people connected with discovery did die tragically, one of them being Lord Carnarvon, who died  in Egypt, from poisonous mosqito bite and pneumonia, five months after the finding of the tomb.

According to Dr Gandon the mysterious death of Lord Carnavon after entering the tomb of the Egyptian pharaoh Tutankhamun could be explained by an infection with a highly virulent, long living pathogenic agent. “The ‘curse of the pharaoh‘ has been used as a metaphor for the hypothesis that higher parasite propagule survival selects for higher virulence.”

The cause of  King Tutankhamun’s death has been matter of speculation for several decades. Many interesting medical articles have been written on this subject.

It has been suggested that the young king was murdered by a blow to the head based on skull radiographs obtained by a team of researchers in 1968. Professor R.G. Harrison stated, “While examining X-ray pictures of Tutankhamun’s skull, I discovered a small piece of bone in the left side of the skull cavity. This could be part of the ethmoid bone, which had become dislodged from the top of the nose when an instrument was passed up the nose into the cranial cavity during the embalming process. On the other hand, the X-rays also suggest that this piece of bone is fused with the overlying skull and this could be consistent with a depressed fracture, which had healed. This could mean that Tutankhamen died from a brain hemorrhage caused by a blow to his skull from a blunt instrument.”

According to Hussein et al pathological findings included craniofacial dysmorphia, bilateral alterations of the feet, malarial disease and an acute traumatic fracture of the knee.

Hawass et al. used imaging, anatomical and DNA techniques and suggested Plasmodium falciparum malaria, concomitantly with Morbus Köhler-Freiberg, as his probable cause of death. The authors also indicated that there were no signs of gynecomastia and craniosynostoses (eg, Antley-Bixler syndrome) or Marfan syndrome. Genetic testing for STEVOR, AMA1, or MSP1 genes specific for Plasmodium falciparum revealed indications of malaria tropica in 4 mummies, including Tutankhamun‘s. These results pointed to  avascular bone necrosis along with the malarial infection as the most likely cause of death of Tutankhamun. 

According to Timmann et al “The age of 18–19 years attributed to Tutankhamun makes malaria as his primary cause of death rather unlikely, as a certain degree of  semi-immunity may readily be assumed.”   Plasmodium falciparum malaria was endemic in ancient Egypt and probably caused death. Local residents after continuous exposure to plasmodium developed immunity against both parasites and disease. Fatal courses of malaria usually affect young children (6- 9 year) and pregnant women but not adults.

According to Timmann et al  bone lesions of two metatarsals of the left foot and  shortening of the second left toe, indicated  advanced osteonecrosis, osteomyelitis or ulcerative osteoarthritis in the article by Hawass et al.  These radiographic findings are consistent with osteopathological lesions as often noted in sickle cell disease , a haematological condition described to occur in many local residents of Egypt (El-Beshlawy & Youssry 2009). The occurrence of anaemia, other pathological haematologic disorders, and of the haemoglobin mutation that causes sickle cell disease (HbS) has been demonstrated in predynastic Egyptian remains (Marin et al. 1999).

Timmann et al  indicated,  “in contrast to osteonecroses associated with sickle cell disease, Köhler-Freiberg disease is highly unlikely to be a co-cause of death in young adulthood.”

Avascular osteonecroses, inflamed by osteomyelitis and septicaemia  due to pathogenic agents including Salmonella and Staphylococcus,  are known sickle cell disease complications and may be exacerbated by malaria attacks.

Gaucher’s disease (type 1-3) should be considered which may cause painful avascular osteonecroses. Gaucher’s disease is a rare autosomal-recessive lysosomal storage disease and has been described in Egyptians.

Other features considered in the differential diagnosis of avascular osteonecroses in King Tutankhamun’s bones included other inheritable and non-hereditary disorders – trauma, sequelae after osteomyelitis, acute pancreatitis and systemic lupus erythematosus. 

Brandt G.  suggested the theory that Tutankhamun may have suffered from hypophosphatasia, an inherited metabolic disorder that affects especially the musculo-skeletal system in many ways.  The author has compiled both medical and archaeological findings to support his theory and suggests that existing DNA samples of Tutankhamun and other members of his family should be tested for defects on the ALPL gene.

The question on Tutankhamun‘s supposed gynaecomastia cannot be answered as most of mummy’s chest wall was missing.

 All the scientific findings can neither be proved or ruled out.

We do know that the most common diseases of Ancient Egypt were traumatic injuries, malaria and tuberculosis.

mummy1

King Tutankhamun is one of the most famous  king of Ancient Egypt. It is not surprising that extensive scientific studies have been made to find the actual cause of death. Infectious disease, metabolic disorder, neoplastic lesion, trauma (crash of his chariot causing lethal injury) and even murder have been suggested by various authors.

The cause of death of the great ruler of Egypt will continue to fascinate researchers.  I wrote a similar post about Death of Alexander the great – A medical Enigma. 

The difference between the two cases is that the remains of Alexander the Great was not found, hence anatomical and other scientific examinations could not be done.  In case of King Tutankhamun extensive studies including virtual autopsy, imaging , anatomical and DNA analysis were performed.

Reference:

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