AMARNA KINGS, ANAEMIAS AND PARASITIC LIVER DISEASE - II

Thomas M. Simms (tsimms@nbnet.nb.ca)
Sat, 18 Jan 1997 09:31:35 AST

survived.{53} The young man in question suffered heavy schistosome
infestation. He showed clear signs of bleeding from the urinary
tract. He showed obvious evidence of severe liver cirrhosis and
of a greatly enlarged spleen. The latter ruptured shortly before
death.){54}
Inherited anaemias might have caused the deaths of the three
Kings under discussion, but, as explained, could not have caused
the peculiar iconography of their reigns, an iconography so
insistent that the embalmers attempted to continue the image by
overstuffing Tut Ankh Amen's abdomen.{55} The periostitis seen in
Smenkh Ka Ra's bones could have come from the anaemia of parasitic
liver infestation or from inherited anaemia. The epigraphic
evidence helps us decide. Likewise, the parallel nearly
contemporary physical and somatic evidence of Nekht helps us.{56}
Then we can take what we know of the opportunities for infestation.
We can couple that with what we know of the progression of the
outward signs of the disease. Finally, we can compare this
information with what see in the epigraphic record surviving from
the time of the Amarna Kings.
Amen Hetep III excavated a lake, the remains now called Birket
Habu, in front of his palace at Malqata. The palace lies just on
the desert edge of the wide plain forming the western bank of the
Nile at modern Luxor.{57} The opportunities for Bilharzias
infestation would have increased immensely. He gave Queen Tiye in
the eleventh year of his reign a similar newly dug lake at the
doors of her palace at Tahta.{58} The construction would have created
another epidemic of schistosomes affecting his whole family.
These two massive explosions of opportunities for Bilharzias
infestation could very likely have caused the death of the first
Crown Prince, Djehuti (Thoth) Meses. Given equal insults, his
adult parents would have enjoyed a much stronger immunity than
their eldest son.{59} In addition, by the greater and more playful
mobility of youth, the chances for infestation by the prince were
much greater. And the god status of his parents meant they did
not take part in the extensive lustrations of "The Pure", the
priesthood. These lustrations used "living" water, the most
infective kind.{60} They also involved the most intimate contact.{61}
The young princes had plenty of opportunities for exposure to
infestation by schistosomes. Contrary claims therefore rest on
uncertain foundations.
The career of the sixteen year old weaver, Nekht, took place in
sight of the palace of Amen Hetep III at Malkata and within two
centuries of the rules of the Amarna Kings.{62} As a temple staff
member, he had regular priestly duties. This alone put him at risk
if his nearness to the hydraulic works didn't. He likely enjoyed
as reasonable a diet as did the Amarna Kings. His viscera
survived. Theirs did not in any useful way. His showed all the
signs just elaborated.{63} He died at some time between fourteen and
eighteen, likely sixteen.{64} The prince likely died near or just
before that age.{65} The comparison passes suggestion.
Please note that Nekht's opportunity for infestation had
stabilized from the greater hazard present when the hydraulic
constructions were new.{66} Nonetheless his priestly duties presented
an additional hazard.
The next prince, Amen Hetep, did not expect to rule. On the
record, he held no priestly offices, although he had his own
estate.{67} His exposure therefore had to be purely adventitious, not
due to intimate lustrations. If he had moved to Thebes from Mem-
phis with his father at the end of his youth, his exposure would
be less again.
With moderate exposure, as we've noted, the disease becomes
chronic, the body compensates. The signs of the acute stage become
permanent. The change from the normal iconography of the first
year or so of Amen Hetep IV's reign{68} to the new images apparent in
the Jubilee Temple of the second year of his reign now has a
reason.{69} Failing some other insult, from the first several years
of his reign a life span of ten to fifteen years is likely. During
that time vigorous living is possible.{70} There even is a certain
immunity to further infestations.{71} So the record confirms. Once
the body compensated for the infestation, the outward appearances
would change little. In fact, the lack of change as the body
otherwise assumes its fully adult configuration would suggest a
return to normal. This effect offers an explanation for the more
normal iconographic appearances of the later years of the reign of
Akhu En Aten.{72}
The next prince, Smenkh Ka Ra, almost certainly lived all his
life in the midst of the new constructions. Like his older
brother, he too was not subject to much priestly opportunity for
infestation. However, because his father's construction project
continued unabated, he was at greater general risk.{73}
Smenkh Ka Ra's light, non-robust skeleton, with its evidence of
periostitis,{74} coupled with his consistently Amarna iconographic
appearances, suggests strongly the disease affected him young.
His death at twenty is therefore not a surprise, for no image shows
him driving a chariot, and at least one image shows him supporting
himself with a staff.{75}
On the contrary, the last prince, Tut Ankh Aten, lived much of
his young life at Akhuet Aten in the North Palace area with his
mother.{76} We can argue he lived near the new hydraulic works at
Thebes only in his earliest years.
Tut Ankh Amen's skeleton suggests a more vigorous, robust person
than his brother Kings.{77} Chariot driving is no mean task. The
ones buried with him were made to use. They weren't just for
display.{78}
The bows buried with him, both his and those of his brother,
Smenkh Ka Ra, also were made to use.{79} Just who used them is
difficult to prove. An Egyptian compound bow is a powerful weapon,
even by today's standard, and is not easy to string, as Homer
relates.{80} We suspect from the epigraphic evidence the youngest
King put them to most use.
Nonetheless, the iconography of his reign and the treatment of
his mummy suggest the disease had reached an acute stage and he was
at risk.
The unhealed abrasion on his left cheek{81} may show evidence of
a final insult. However, it may also be the result of a trivial
accident brought on by weakness in the acute stage. There is no
evidence of underlying tissue damage. However, like the weaver
Nekht, whose autopsy has been mentioned, his spleen may have
ruptured.{82} Harrison considered that the unhealed abrasion was
"...likely to represent a skin lesion resulting from some injury
such as falling off a horse for example".{83} (To those who might
suggest that Egyptian Kings drove chariots and did not ride horses,
the riding crop from the tomb of Tut Ankh Amen teaches its own
lesson. The inscription on it says that the King "appeared upon
his horse like Re when he shone".{84} Such a fall might have ruptured
his spleen. In those days, that meant death. Without the fall,
he might have lived on. The unhealed nature of the abrasion argues
strongly it was associated with his death.Because they were
brought up in a similar location, the Amarna Kings were as casually
exposed as the unfortunate Nekht, save for the exceptions noted.
So schistosome infestation accounts for each peculiarity of the
Amarna iconography and explains such evidence as we have from the
remains of two of the Kings of the era.
In future, non-intrusive tomographic examination of all of the
present remains of the central personnel of the Amarna era might
definitively settle the issue. Paleobiology may reach the point
where ancient tissues yield full information, even to the point of
supplying the entire genetic code.{85} Perhaps too, the visceral
remains might yield more information than they have at present.
Of course, discovery of the remains of Akhu En Aten might solve
the problem. For the present, pathology offers the simplest
explanation of the course of many of the events of the Amarna
period.

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NOTES

{a} An earlier, less complete version of this paper was read by title at the
Amarna Centennial Symposium held at the Oriental Institute of the University of
Chicago in February, 1987. It appears in the Proceedings of the Symposium, now
in press.
The author thanks Dr. S.E. Naguib, pathologist at Carleton Memorial Hospi-
tal, Woodstock, N.B., and Mrs. Emery Perkins, Laboratory Technician there, for
their seminal help with this study. Ms. Janice Dimock-Cummings, D.V.M.,
suggested the ascites consequences.
The author especially thanks Prof. Howard Savage of the Department of
Anthropology, University of Toronto, who pointed out the Schistosome evidence in
the autopsy of Nacht, ROM I. The present author had viewed the television
program demonstrating the autopsy without appreciating those findings.

{1} The dates bridging the period are on p. 238, K. A. Kitchen Pharaoh Trium-
phant: The Life and Times of Ramesses II. Mississauga, Ontario: Benben Public-
ations, 1985.

{2} The view here follows Cyril Aldred's analysis of the relationships among
the four kings as summed up on p. 293 in his text, Akhenaten King of Egypt, New
York: Thames and Hudson, 1988.

{3} Figures 1 and 2 - Davies, N. de G. The Tomb of the Vizier Ramose, [London:
1941, pls. xxix and xxxiii. The captions of the figures and the datings of the
panels as well as the proposition the changes reflect reality derive from
Aldred, C. Op. cit., pp. 89-94 and his discussions inter alia about pls. 26, 27
and 28. In Figure 1, the present author takes that the presence of the phrase
"great in the duration of his life" directly below the Sa Ra, Amen Hetep
cartouche indicates with certainty that the damaged cartouche beside it read
Nefer Kheperu Ra Ua En Ra. There can be no doubt the king pictured is Amen
Hetep IV/Akhu En Aten.

{4} Aldred, C. and Sandison, A. T. `The Pharaoh Akhenaten: A Problem in Egypt-
ology and Pathology', Bull. Hist. Med. 36, 1962, p. 293.

{5} Harrison, R. G. `The Anatomical Examination of the Pharaonic Remains
Purported to be Akhenaten.' J. E. A., 52, 1966, pp. [95-119.

{6} Ibid., p. 105

{7} Ibid., p. 105.

{8} Harrison, R. G. and Abdalla, A. B. `The remains of Tutankhamun.' Anti-
quity, XLVI, 1972, pp. 8-14.

{9} Ibid., p. 13.

{10} Ibid., p. 12.
Harrison, 1982, Personal Communication, reaffirmed that conclusion.

{11} Harrison, R. G. `The Anatomical Examination of the Pharaonic Remains Pur-
ported to be Akhenaten.' J. E. A., 52, 1966, p.105.

{12} Ruffer, and Rietti, J. Path. Bact. 16, 1912, p. 439, and Salib, J. Bone Jt.
Surg., 44B, 1962, p. 944.

{13} Harrison, R. G., Op. cit., p. 105.

{14} Moody, Peter. `Yaws, Pinta and Begel' in Braude, A. I., ed. Medical
Microbiology and Infectious Diseases, Vol. II. Philadelphia: W. B. Saunders
Company, 1981, pp. 1613-1620.

{15} Ibid., p. 1614.

{16} Ibid., p. 1613.

{17} Ibid. pp. 1616 and 1618 and illustrations on those pages.

{18} Dennert, Gunther. `Schistosomiasis.' in Braude, A. I., ed. 1981, Op. cit.,
p. 1099.

{19} Ghalioungui, P. `A medical study of Akhenaten,' A.S.A.E., 1947, 47, 29-46.
Ghalioungui, P. `Some body swellings illustrated in two tombs of the
ancient Empire and their possible relation to Aaa', Z..S.,1962, 87, p. 114.
Ghalioungui, P. Magic and Science in ancient Egypt. London: 1963, p. 56.

{20} Pawlowski, Z. S. `Trematoda (Flukeworms)', in Braude, A. I., ed. 1981, Op.
cit., p. 726.

{21} Ibid. See Fig. 3 and `Epidemiology', pp. 732-33.

{22} Symptomologies not congruent. See preceding footnote.

{23} footnote 36 in Risse, Guenter B. `Pharaoh Akhenaton of Ancient Egypt:
Controversies among Egyptologists and Physicians Regarding His Postulated
Illness'. J. Hist. Med., January 1971, pp.3-17.

{24} footnote 37 in Risse, Guenter B. Ibid.

{25} Smith, W. S. Art and Architecture in Ancient Egypt. London: Harmonds-
worth, 1965, p. 174.

{26} Aldred, C. Akhenaten King of Egypt. London: Thames and Hudson, 1988, pp.
234, 235.

{27} Hillson, S. W. `Chronic Anaemias in The Nile Valley.' MASCA Journal, 1(6),
1980, pp. 172-174.

{28} Ibid., p. 174.

{29} Ibid., p. 174.

{30} `Nubia', p. 20 and pp. 178-185, and `Upper Nubia', pp. 186-187, in Baines,
J., and Malek, J. Atlas of Ancient Egypt. New York: Facts on File, 1985.

{31} Hillson, 1980, Op. cit., p. 173.

{32} Dennert, Gunther. Op. cit., p. 1099.

{33} Hillson, 1980, Op. cit., p.173.

{34} Ibid., p.173.

{35} Harrison, R.G. Personal Communication.. 1982.

{36} P. 85 under `Anaemias' in Bennington, James L., Ed. Saunders' Dictionary
and Encyclopedia of Laboratory Medicine and Technology. Philadelphia: W. B.
Saunders, 1984.

{37} Hillson, 1980, Op. cit., p. 173.

{38} Lewin, P. K. `Mummies That I Have Known.' American Journal of Diseases of
Children, Vol. 131, March, 1977, p. 350.

{39} Dennert, Gunther. Op. cit., pp. 1094 and 1104.

{40} Ibid., p. 1094.

{41} Ansari, N. Epidemiology and Control of Schistosomiasis (Bilharziasis).
Basel: S. Karger, 1973, as reported on p. 732 in Pawlowski, Z. S. Op. cit., pp.
726-733.

{42} Dennert, Gunther. Op. cit. p. 1095.

{43} Ibid. p. 1095.

{44} Ibid., pp. 1097.

{45} Ibid., p. 1100, including Fig. 6.

{46} P. 86 under `Anaemias' in Bennington, James L., Ed. Op. cit.

{47} Dennert, Gunther. Op. cit., pp. 1100-1102.

{48} Ibid., p. 1097.

{49} Ibid., pp. 1102-1104.

{50} Hillson, 1988, Personal communication.

{51} The present author prefers Nekht to Nacht. The details of such a decision
are not the concern of this paper.

{52} Hart, G.D., Millet, N.B., Scott, J.W., and Cockburn, A., editors. `Autopsy
of an Egyptian Mummy {Nacht - ROM I}.' Canadian Medical Association Journal,
Vol 117, 1977, pp.461-477.

{53} Ibid., p.464.

{54} Ibid. p. 464.

{55} Derry, Douglas, M. D., in Carter, H. The Tomb of Tutankhamen. London:
1972., p. 229.

{56} Lewin, P. K. `Mummies That I Have Known.' American Journal of Diseases of
Children, Vol. 131, March, 1977, p. 350.

{57} P. 85 in Baines, J., and Malek, J. Op. cit.

{58} Aldred, C. The Egyptians. London: Thames and Hudson, 1984, p. 70.

{59} Dennert, Gunther. Op. cit., p. 1102

{60} White, J. E. Manchip. Ancient Egypt Its Culture and History. New York:
Dover, 1970, p. 41 (a reprint and revision of a 1952 text), notes the ritual
use, as does Budge, Sir E. A. Wallis. The Dwellers On The Nile. New York:
Dover, 1977, p. 147 (a reprint of a 1926 edition). Dennert, Gunther. Op.
cit., p. 1094, describes the infective hazard.

{61} Budge, Sir E. A. Wallis. The Dwellers On The Nile. New York: Dover, 1977,
p. 147(a reprint of a 1926 edition) quotes the Egyptian description of the
intimate nature of the contact.

{62} Millet, N. B. `Archaeological Background.' in Hall, Millet, Scott, and
Cockburn, eds. 1977, Op. cit., p. 462.

{63} Reyman, T. A., Zimmerman, M. R.and Lewin, P. K. `Histopathologic investi-
gation.' in Hart, Millet, Scott, and Cockburn, editors. 1977, Op. cit., pp.470-
471.

{64} D. F. Rideout. `Radiological examination'. in Hart, Millet, Scott, and
Cockburn, editors. 1977, Op. cit., p. 463. Dr. Rideout notes the difficulty
even simple dehydration presents in making age estimates. Hip joints, deep in
the body, suggested an age of 18 years. Knee joints, subjected to a different
protocol of desiccation, suggested 14 years. The cited author split the
difference at 16 years. The present author takes these discrepancies as notice
the best estimates of age come from sites deep in the body of anciently pre-
served remains. He considers that radiographic protocols for desiccated or
dehydrated tissues do not have sufficient experience to make exact age
estimates. It seems for the present, therefore, visual notices have to have
predominant weight.

{65} Aldred, C. Op. cit., p. 259.

{66} Dennert, Gunther. Op. cit., pp. 1102 and 1104.

{67} Redford, D. B. Akhenaten, The Heretic King. Princeton, N. J.: Princeton
University Press, 1984, pp.58-59.

{68} Budge, Sir E. A. Wallis. Tutankhamen, Amenism, Atenism, and Egyptian
Monotheism. London: 1923, p. 78.

{69} Redford, D. B. Op. cit., p.57 and following.

{70} Dennert, Gunther. Op. cit., p. 1099.

{71} `Immunology', p. 731 in Pawlowski, Z. S. Op. cit.

{72} Aldred, C. Akhenaten King of Egypt. London: Thames and Hudson, 1988,
pls. 1, 17, 21, and 25 with discussions.

{73} Dennert, Gunther. Op. cit., p. 1104.

{74} Harrison, l966, Op. cit., p. 105.

{75} DesRoches-Noblecourt, Christiane. Tutankhamen. Boston: New York Graphic
Society, 1963, p. 166, pl. 98.

{76} P. 169 in DesRoches-Noblecourt, Christiane. Op. cit.

{77} Harrison, R. G. Personal Communication, 1982.

{78} Hoving, T. Tutankhamun The Untold Story. New York: Simon and Schuster,
1978, p. 121.

{79} McLeod, W. Composite Bows from the Tomb of Tutankhamen. Oxford: Tutankh-
amun Tomb Series, 1970., p. 10, 12.
McLeod, W. Personal Communication, 1991.

{80} McLeod, W. `The Bow and The Axes', in Studies Presented to Sterling Dow On
His Eightieth Birthday. Durham, N. C.: Duke University, 1984, p. 205.

{81} Harrison, 1982, Op. cit.

{82} Reyman, T. A., Zimmerman, M. R.and Lewin, P. K. `Histopathologic investi-
gation.' in Hart, Millet, Scott, and Cockburn, editors. 1977, Op. cit., p. 472.

{83} Harrison, 1982, Op. cit.

{84} DesRoches-Noblecourt, Christiane. Op. cit., p. 66.

{85} Pabo, S. `Molecular Cloning of Ancient Egyptian Mummy DNA.' Nature, Vol.
314, 18 April 1985, pp. 644-45.