Post-factum dissections of medieval Korean mummies exhibiting similar preservation patterns in computerized tomography[JH1] images

Abstract

In our previous studies on CT scans and post-factum dissections studies of on the medieval Korean mummies, well -[JH2] preserved internal organs were generally were found to have been displaced to the dorsal side of the body cavities cavity. It This movement seems to have been caused by a the effect of gravitational force exerted on the mummified organs over the duration of long burial durations. However, when recently we examined a newly discovered medieval Korean mummy (SN1-2) by a CT, scan, most of the mummified organs were placed found to have remained in their original natural positions. Our post-factum dissection on of SN1-2 showed that the mummified[JH3] the organs might be have undergone expanded expansion by posthumous gas formation, after death; and then after which they be changed into hardened into a stony hard nature substance;, therefore, finally hampering which state mitigated against their displacement. of internal organs.

Similar CT findings were also[JH4] observed made in the case of other a second Korean mummy case (KU-1). Since the internal organs within the thoracic cavity were shown discovered to be situated in their original natural positions, we first[JH5] suspected if that the mummified organs of KU-1 they, like those in the case of SN1-2, were had also been changed into stony hard state structures. like SN1-2. However, the post-factum dissection confirmed showed that the internal organs of KU-1 did not show had neither stone-like hardness. hardened And nor they were not been displaced into the back side wall of the thoracic cavity, possibly owing possibly to the presence of a pleural adhesion. Overall, Oour report results indicated clearly conclusively showed that CT scan alone is not sufficient inadequate for correct estimation of the preservation status of internal organs in Korean mummies. This calls for further accumulation of dissection data, against which CT diagnosies could can be compared and by which they can be improved. upon.

Introduction

Since Given that Ancient embalmers in ancient times used to have customarily removed the internal organs of from the dead person body during well-organized in the course of artificial well developed and often[JH6] ritualistic mummification procedures (i.e., e.g., as in Egypt), mummified internal organs has modern and contemporary anthropologists have not been had sufficiently diagnosed opportunities to examine mummified organs and make diagnoses accordingly. by anthropologists around the world. In those limited number of cases When in which the internal organs were have been found to be present within body cavities the body cavity, of mummies, they researchers were have examined them by computerized tomography (CT) in order to inhibit limit the tissue damages. to their skins. However, some researchers also pointed out that[JH7] the severe[JH8] dehydration-induced deformation and displacement of mummified organs has dictated that correct interpretation of mummy such CT images was has been much more difficult than they[JH9] originally expected, even for experienced radiologists (Lim et al. 2008). Briefly, due to the deformities and displacement of mummified organs by severe dehydration, interpretation of mummy CT images was very challenging even for experienced radiologists.

The Rrecent discovery of well preserved mummies has fueled excitement among in the archaeological community[JH10] in Korea. Fortunately, due to the nature of their the bodies’ mummification, without which lacked any kind or degree of embalming, internal organs were have been found still[JH11] preserved, within body cavities of Korean mummies,[JH12] enabling further researches to be done conducted on them, by means including CT radiography. However, for the past several years, the relative lack of dissection data regarding CT scan on Korean mummies has continued to hamper CT the interpretation of them studies. Anyway, it could be finally achieved by accumulation of sufficient experiences on postfactum confirmation of CT readings. Only an adequate accumulation of such data can rectify this situation. In this regard, Rrecently, since we could get had the rare opportunity lucky chances of to post-factum dissections on two medieval Korean mummies which showed showing unique CT radiological patterns, rarely observed in previously reported cases,. wWe will report our findings herewith.

Materials and methods

Two medieval Korean mummies (SN1-2 and KU-1; Fig. 1) recently were discovered in the medieval tombs of Joseon Dynasty (1392-1910) tombs,. Korea[JH13] . Based on the archaeological and anthropological information findings, SN1-2 mummy was a male;, and KU-1 was a female. CT scans were also done performed, on in both cases, with a 64 MDCT scanner (VCT, GE Healthcare) in at Dankook University Hospital, Korea. A spiral volume was acquired from the head to toe., the Sscan was having been done accomplished at 120kVP using the[JH14] helical technique. at 120kVP. All The images pictures were reconstructed into axial images with taken a 1.25mm thickness[JH15] at 1.25mm intervals. From these, Ccoronal and sagittal multi-planar reformation and volume-rendering images were obtained from the reconstructed axial images by a workstation using (Advantage Windows Workstation 4.3; (GE Healthcare).

Post-factum dissections were then performed on in both cases, SN1-2 and KU-1. after CT scans were finished. Since parts certain patches of of skin and flesh were not remained intact on SN1-2 had completely decomposed, in SN1-2 mummy, some of the internal organs of the case[JH16] could be examined through the skin defects without the necessity of preparatory procedures[JH17] . As for In the case of KU-1, mummy, incisions were made along the borders of the xyphoid process, the 12th ribs, the linea alba and the inguinal ligaments, in order to expose the organs within the abdominal cavity. for examination of internal organs within abdominal cavity. As for the organs within the thoracic cavity, Mummified organs in thoracic cavity could be also inspected through the defects made in diaphragm[JH18] afforded adequate views. CT images The post-factum of dissection findings for both cases were compared with the findings of post-factum dissections on them corresponding CT images.

Results

SN1-2 mummy

In the CT scan images of SN1-2, mummified brain was still remained within the skull. While Whereas each brain lobe could be was easily discernable, by CT,[JH19] the radiodensities of the gray matter were not easily differentiated from those of the white matters (Fig. 2A). The mummified organs in the thoracic cavity, (i.e. lungs and heart), were had not been displaced to the dorsal side, but were situated in their original natural positions. In CT images,[JH20] sSmall cavities or lumens were identified in the lung parenchyme (Fig. 2B). Mummified[JH21] The organs within the abdominal cavity also[JH22] showed similar CT[JH23] radiographic patterns. Every intra-abdominal organ was located in likewise remained in their their original normal positions, s and neither were their radiodensities of them were not of any use[JH24] ful for differentiation. of one from another[JH25] . Small cavities or lumens were also were observed in these mummified abdominal [JH26] organs on CT[JH27] (Figs. 2C and 2D).

When Upon post-factum dissection was done for of SN1-2, mummy, we found that most of the internal organs became had hardened like into a stone-like substances (Fig. 3; Movie 1). Internal organs They seemed not to have been displaced toward the dorsal side, owing presumably[JH28] to their hard stony nature composition. The Llung parenchyma was had changed into become whitish firm whitish substances (Fig. 3C). Small cavities seemingly the results of bloated bloating during post-[JH29] mummification were found scattered in throughout the lungs and intestines (Figs. 3C to 3G), which corresponded roughly to the luminal structures on the CT images of SN1-2[JH30] (Figs. 2B to 2D).

KU-1 mummy

The sStructures like including[JH31] the aortic arch, trachea, lungs, bronchi, heart and pericardial space were clearly observed on in the chest CT images of KU-1 mummy (Figs. 4A to 4C). Since the mummified organs were located at in their original natural positions, on CT axial images, we first thought considered that they might have been converted to hardened, hard nature as in the case of like SN1-2. mummy. However, the post-factum dissection showed, unexpectedly, that every intra-thoracic organ was unexpectedly soft[JH32] , in KU-1 mummy, which was distinct from those of SN1-2 case[JH33] . We also noted that there was a pleural adhesion present[JH34] between the lungs[JH35] and the anterior chest wall (Fig. 4D). When Once we removed pleural adhesion was removed by us it, the lung was not dangling from the anterior wall anymore; but was displaced fell[JH36] to the dorsal side of the thoracic cavity (Fig. 4E). We speculated therefore that the pleural adhesion might hinder have prevented displacement of the intra-thoracic organs of in the KU-1 case. during mummification.

On the other hand However, CT axial images showed that the intra-abdominal organs of KU-1 mummy were had moved shifted to the dorsal side (Figs. 5A to 5D). The Iinternal organs identified on in these abdominal CT images[JH37] of KU-1 mummy included the liver, stomach, small intestine and rectum, even if though abdominal organs they could not be easily be differentiated from each other, owing to their location displacement, of locations, the distortion of their morphologies and little the negligible differences in their radiodensity radiodensities. between them. Many small cavities or lumens could be also identified in the intestines also could be identified on CT (Fig. 5D).

In the Ppost-factum dissection of KU-1 mummy (Fig. 6A), we found that the abdominal organs were found to be to be very soft, which were distinct in contrast to from those of SN1-2. mummy. The Iintestines were had flattened; and were been displaced to the dorsal side of the abdominal cavity (Fig. 6B). Even though the small[JH38] intestines adhered to each other, we could separate them very easily (Fig. 6C). When the we incised the intestinal walls, were incised by us, moreover, we found that the intestinal lumens were very well maintained very well (Figs. 6D and 6E). We think thought that the these intestinal lumens corresponded ent well to the small cavities found on in the CT images of KU1 intestines (Fig. 5D).

Discussion

In the findings of our previous [JH39] CT scan studies on Korean mummies (Lee et al. 2009, Lim et al. 2008, Kim et al. 2006, Shin et al. 2003), the[JH40] internal organs were had been displaced to the dorsal side of the body cavities cavity (Figure for Reviewers; Movie 2). Macro- or microscopic examinations showed that in these dorsal displacement cases, the organs’ preservation status of the dorsally displaced cases were was quite good. (Lee et al. 2009, Lim et al. 2008, Kim et al. 2006, Shin et al. 2003). We speculated that the internal organs of well preserved Korean mummies generally[JH41] was are displaced to the dorsal side, in general, possibly owing to the gravitational force exerted on them during over long periods (Shin et al. 2003, Lee et al. 2007, Lee et al. 2009[JH42] ).

On the other hand, And yet, the CT images and dissection findings reported in this the present study were quite distinct from those of the dorsally displaced earlier cases just cited. On In the CT images of SN1-2, mummy, the internal organs were not displaced to the dorsal side, but retained remained in their original natural positions. By Ppost-factum dissection, we confirmed that severe hardening to the point of stone-like hardness substances was occurring had occurred in the internal organs of SN1-2, mummy, possibly[JH43] inhibiting their dorsal displacement. of the organs during mummification. As for the presence of small cavities in lungs or and intestines of SN1-2, mummy, we suspected considered if whether[JH44] putrefaction-byproduct gasses formed during putrefaction might concern it have been the cause. According to Gill-King (1997), anaerobic bacteria were grow rapidly grown in the body after death, finally inducing the changes the transformation of carbohydrates, proteins or and lipids into gases trapped within the organs. And Jjudging from the expanding patterns, of the small cavities in the lungs or and intestines of SN1-2, might be caused by[JH45] such gases formed after death, which maintained the can maintain pressure until the final stage of mummification.

In the case of KU-1, mummy, some of the internal organs on in the CT images were had not contracted shifted to the dorsal side either,. like SN1-2 case[JH46] . Since it the CT image pattern of the lungs of KU-1 was very similar to CT image pattern that of SN1-2, mummy, we first suspected if that[JH47] the lungs of KU-1 mummy might be also have expanded by as the result of intra-luminal gas pressure formed after death. However, the post-factum dissection of KU-1 mummy confirmed that the intra-thoracic organs situated in their original normal positions were had not been changed into hard stony state substances, but had remained very soft, just like those of as in our cases of dorsally displaced displacement cases we previously reported. We speculated that the dorsal displacement potential shifting of the mummified lungs might have been hindered by the presence of a pleural adhesion in KU-1. mummy. Certainly, Eeven if the CT images of the intra-thoracic organs looked alike, SN1-2 and KU-1 mummies showed different preservation patterns from each other. Briefly This is to say speaking, that correct diagnosis of the mummies in this study must have been very difficult to be performed[JH48] if CT scan was adopted as were[JH49] the one and only examination tool for them available.

Of course, since there is a needs for preservation of strong preference[JH50] nowadays mummies have increased nowadays in on the parts of museums or and other institutions that non-invasive techniques be used in examining mummies (O’Brien et al. 2009), and so we admit that CT radiography could be one of the best diagnostic options, especially in studies on Korean mummies[JH51] (Shin et al. 2003, Lee et al. 2007, Lee et al., 2009[JH52] ). Even so Nonetheless, it should also be also noted that the technical limits limitations of CT analysis in as pertaining to mummy studies have been repeatedly pointed out by several researchers (Aufderheide 2003, Lynnerup 2007[JH53] ). Even if CT scan in fact becomes an invaluable diagnostic tool, for mummy studies around the world, it is not it remains an imperfect substitute for direct examination through dissection, simply because the (usually) dehydrated internal organs of mummies could cannot be easily be differentiated by means of CT images imaging (Lynnerup 2007).

We clearly know that in clinical fields, the correct reading of CT images from taken from the living patients has been guaranteed by repetition of post-factum confirmations[JH54] of the CT diagnoses. Likewise, the reading of mummy CT images must become be much sophisticated made much more effective by sufficient provision of a sufficient number of post-factum dissections for reference. s on the mummies[JH55] . which were performed after CT scans[JH56] . We will continue our post-factum dissections on Korean mummies to make our experiences needed for correct readings of mummy CT images accumulated sufficiently in Korea. [JH57]

---

[JH1]OR:

“computerized tomography (CT)”

[JH2]… for consistency

[JH3]Implicit here

[JH4]Redundant given the foregoing “Similar”

[JH5]implicit

[JH6]OR:

(1) usually

(2) always

[JH7]implicit

[JH8]OR: {Delete.}

[JH9]… implicit

[JH10]OR (if you prefer—same meaning):

“among archaeologists”

[JH11]implicit

[JH12]implicit

[JH13]redundant

[JH14]OR (if there is more than one example of the helical technique): a

[JH15]redundant

[JH16]redundant

[JH17]*OR (if you mean “ALL” of the organs, not just some of them):

“Since much of the skin and flesh of SN1-2 had completely decomposed, the internal organs could be examined without the necessity of preparatory procedures.”

[JH18]OR (if you DO NOT mean that YOU made the defects):

“the absence of diaphragm skin and flesh (which had completely decomposed)”

[JH19]implicit

[JH20]implicit

[JH21]implicit here

[JH22]redundant given the following “similar”

[JH23]implicit here

[JH24]OR:

“much use”

[JH25]implicit

[JH26]implicit here

[JH27]redundant

[JH28]… to conform with your expression in the Abstract

[JH29](?) OR:

(1) during

(2) “during or post-”

[JH30]implicit

[JH31]OR (if not a complete [exhaustive] list):

“such as”

[JH32]OR:

“relatively soft”

[JH33]Strongly implicit in this immediate context

[JH34]Implicit in the foregoing “was”

[JH35]OR:

(1) “the right lung”

(2) “the left lung”

[JH36](?) OR: shifted

[JH37]OR (same meaning): “on CT”

[JH38]Already established in this context

[JH39]OR (if not ALL previous):

“some of our previous”

[JH40]*OR (if not ALL organs):

“some of the”

[JH41]… for emphasis

[JH42]* probably you should change the order here to “most-recent-first,” as was the case at the top of this paragraph

[JH43]OR:

probably

[JH44]OR (alternative meaning):

“suspected that”

[JH45]… already pointed out (4 lines above)

[JH46]Redundant given “either”

[JH47]OR:

“considered whether”

[JH48]Redundant because if “correct” (or “incorrect”), they must have been performed

[JH49]* “were” is correct—not “was”

[JH50]OR (alternative meaning): demand

[JH51]OR: {Delete this.}

[JH52](date-sequence issue again)

[JH53]… (date sequence)

[JH54]OR (alternative meaning): “repeated post-factum confirmation”

[JH55]implicit

[JH56]implicit

[JH57]already covered, either explicitly or implicitly, in this paragraph—in any case, the previous sentence is a much better (stronger, more emphatic) sentence with which to end the paper.