• ancient Egypt
• forensic pathology
• pharaoh's mummy
• cause of death

A rude letter from Apophis, ruler of the Hyksos invaders, complaining about the snoring of the hippopotami in the sacred pool at Thebes¹ initiated the war that ultimately led to the restoration of the rule of the pharaos in Egypt in the 16th century BC. Unfortunately, this war also led to the death of the addressee, Seqenenre Taa II, 14th pharaoh of the Theban dynasty.

Thirty four centuries later, the pharaoh's mummy has become the subject of forensic pathological interest and speculation. Found in 1881, it is in a badly damaged, disarticulated condition, but nevertheless shows remarkable details. Five different wounds to the head have been identified, including two perforating impression fractures of the frontotemporal region, severe blunt injury to the nose and right side of the face, and sharp injuries to the left cheek and below the left ear (fig 1).² Contrary to the embalming customs, the pharaoh's brain was left inside the skull, his heart was not replaced, and his limbs were not straightened into the usual position of a pharaoh's mummy, suggesting that he was hurriedly prepared for the afterlife.¹

This, together with the massive head injuries, have led to the hypothesis that Seqenenre Taa II died on the battlefield, and several types of weaponry used in that period have been forwarded as possible agents of his destruction. For instance, the frontotemporal lesions may have been caused by axes, whereas the blunt injury to the nose and right face could result from the impact of a mace.^1,3 However, although these injuries are generally accepted as being the cause of his death, the precise chronology of their infliction remains a matter of debate.

Radiological examination of the mummy showed that the fracture sides of the lower frontotemporal lesion are more radiolucent than those of the lesion above,⁴ which might indicate active bone resorption, as seen in fracture healing.⁵ It has therefore been hypothesised that the pharaoh initially survived the lower frontotemporal injury,⁴ and some have gone so far as to suggest that he was finally assassinated on his sickbed, the other wounds being inflicted only then.^2,6

Histological examination of the wounds might be helpful to estimate the age of the different injuries.⁵ However, the age of Seqenenre's body and the mummification treatment it received (the exact nature of which is unknown to us, in this case) may be expected to influence the findings. Indeed, as discussed by Bockenheimer et al, the difference in radiolucency of the fractures could be caused by artificial bone dissolvement, as a result of the use of embalming fluids.⁴

In our opinion, the case of Pharaoh Seqenenre Taa II demonstrates the importance of extensive and adequate clinical data. Until the discovery of an eyewitness's report, the precise circumstances of his death remain to be elucidated.

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Figure 1

The head of Seqenenre Taa II, showing multiple injuries.² (a) A horizontal cut in the frontal bone, measuring approximately 63 mm. (b) A gaping frontotemporal wound, 31 mm long. (c) This perforation above the right jaw was caused by dislocation of the malar bones, which in its turn was caused by (d) blunt injury with fracture of the nasal bones and destruction of the right orbita. (e) An edged tool cut through the skin of the left cheek. Not visible in this picture is a sharp injury inflicted immediately below the left ear.