Was King Tut a warrior king or “one sick kid”?  Even as the Family of Tutankhamun Project was publishing its findings in the Journal of the American Medical Association that the Boy King was a frail young man who needed a cane to walk, Egyptologist W. Raymond Johnson was publishing his evidence that Tut was an active young man who rode chariots into battle.

So which is the true Tut?  What if both versions are accurate?  Could this perfect storm of physical challenges and adventurous behavior have led Tutankhamun to a heroic but early grave?

 

When Howard Carter discovered Tutankhamun’s tomb in 1922 he was surprised by the number of canes that had been interred with the young pharaoh.  Finding a walking stick in a royal tomb was not unusual by itself.  According to Dr. Emily Teeter of the Oriental Institute, walking sticks were “primarily decorative, and every well-dressed Egyptian man carried a cane — just like a man in the 1940s with a pocket square” (Source:  Los Angeles Times: King Tut’s mundane death).

Tutankhamun leaning onto a walking stick

Tutankhamun leaning onto a walking stick

But Tut had 130 of them, many of which show signs of use.  Tutankhamun is sometimes depicted using a cane, and there are images of him seated while participating in activities such as hunting, where one would expect to see him standing.  These, plus the abundance of canes provided for his use in the afterlife, have always hinted at some sort of foot problem, but the extent of his mobility issues has always been a matter for speculation (JAMA, p. 645).

The recent article in the Journal of the American Medical Association (“Ancestry and Pathology in King Tutankhamun’s Family.” Hawass, Zahi, Yehia Z. Gad, Somaia Ismail, et al, JAMA. 2010; 303(7):638-647) summarizing the two-year forensic study on Tutankhamun and other Eighteenth Dynasty royals has shed light on this question.  As part of the on-going Family of Tutankhamun Project, the study sought to identify certain unnamed mummies who were thought to be members of Tutankhamun’s bloodline, along with their pathological profiles, with special attention going to the Boy King.

The JAMA article paints a picture of a young man with a variety of foot problems, the cumulative effect of which would have caused him considerable pain and difficulty in getting around.  Taken individually his foot maladies are not too bad, but for poor Tut, they formed a perfect storm. 

 

Freiberg-Kohler’s Disease

Some of Tutankhamun’s problems were more readily observable than others.  He suffered from a mild clubfoot on his left side, along with mild scoliosis, which would have given him some problems but would have been fairly manageable in an otherwise healthy young man. Both of these conditions were common in the other mummies of the study.  But Tut had other problems with his left foot.

With the aid of tomographic imaging, the researchers detected a bone condition called Freiberg-Kohler’s disease in Tutankhamun’s left foot.  Freiberg-Kohler’s is a bone disease, but its catalyst is actually a circulatory condition.  It begins when blood flow to the end of one (or more) of the metatarsals becomes compromised.  The metatarsals are the long bones of the feet that connect the highest part of the arch to the toes.

Usually the second and/or third metatarsals are affected, and the condition manifests on the end that points toward the toes.  In a healthy metatarsal, the end of the bone is rounded and rests against cartilage that serves as a shock absorber between the metatarsal and the proximal phalange, the adjacent toe bone.   

But as the blood flow to the end of the metatarsal is cut off, the bone material begins to die, a process called bone necrosis, or osteonecrosis.  Living bone is spongy and flexible, but dead bone is brittle and more susceptible to breakage and collapse.  As the bone at the end of the metatarsal dies, it begins to crack and split.

As more of the bone dies, the end of the metatarsal begins to collapse.  The round surface begins to dimple inward and what would be normal pressure from usage becomes an unending series of minor traumas.  As more bone dies, the crown of the metatarsal continues to crush inward as the edges are forced outward, forming a trumpet shape.

With continued wear and tear the edges of the metatarsal head wear down, flattening the end of the bone.  By this point the cartilage between the metatarsal and the toe bone has become disconnected.  The cartilage and chips of bone become loose bodies that irritate and damage the surrounding tissue, and the already-damaged metatarsal may begin to rub directly against the toe bone.

As the living part of the bone attempts to heal and compensate for the dead part, the metatarsal develops areas of unusual thickness and density.  This causes problems because the foot is a pretty complex mechanism with a lot of moving parts that depend on each other having specific shapes and sizes.  When one or more of these parts change, the whole machine suffers.

The deformed metatarsal puts even more stress on the surrounding tissue.  Muscle and connective tissue become inflamed, fluid begins to build up and exert pressure, and loose cartilage and bone fragments may become absorbed, leaving sensitive areas completely unprotected. 

If caught early, Freiberg-Kohler’s disease can usually be corrected with physical therapy.  So long as it does not proceed to the latter stage even untreated Freiberg-Kohler’s seems to clear up on its own, as very few adults ever present with the condition.  Although not an ideal form of therapy, most sufferers simply favor the other foot, giving the bad one time to heal before too much damage is done.  For Tutankhamun, however, this strategy didn’t work so well.

 

A Perfect Storm of Podialogical and Political Problems

In Tutankhamun’ case, both the second and third metatarsals of his left foot were affected by Freiberg-Kohler’s, and the analysis showed that he was still suffering from serious complications at the time of his death. His club-footedness may or may not have predisposed him for Freiberg-Kohler’s, although it is certainly not a prerequisite for the condition.  But causative or not, his already compromised foot didn’t help matters.

The combination of these problems resulted in an accumulation of defects in Tut’s left foot that would have caused sharp pain when he placed any weight on it.  The tomographic images showed that there was marked soft tissue damage along with bone necrosis and deformity, especially in the second metatarsal.  Out of sheer reflex, Tutankhamun would have avoided putting weight on his left foot.  But our unfortunate pharaoh had problems in the other foot as well.

Tutankhamun suffered from hypophalangism in his right foot, which means he was missing toe bones.  This can be challenging under the best of circumstances because it results in an unnatural distribution of stress throughout the foot.  By shifting his weight from his painful left foot onto his fragile right foot, Tut was literally stacking problem upon problem upon problem.

As mentioned above, Freiberg-Kohler’s is treatable with physical therapy, but in Eighteenth Dynasty Egypt this would have probably been no more sophisticated than walking with assistance and avoiding standing as much as possible.  The combination of dysfunction in both feet would have made taking things easy highly advisable.  But as a haughty young king, a living god, Tutankhamun would probably have been loath to take even these minimal precautions. Pharaohs did not show weakness.

Tutankhamun seated while bird hunting

Tutankhamun seated while bird hunting

Indeed, images of Tutankhamun seated while hunting suggest a young man struggling against his challenges while appearing as nonchalant as possible.  Other images show Tut participating in similar activities without such restraint.  One might interpret this as the king having good days and bad days, but the condition of his mummy’s feet suggest he probably didn’t have many good days but chose to exert himself anyway.

The analysis of Tutankhamun’s mummy revealed that he was flatfooted in his right foot, which makes perfect sense if he was regularly placing extra weight on it.  Tut’s right foot wasn’t even suited to bear its normal share of weight, so the added burden was simply too much on the arch.  But even if Tutankhamun had wanted to lead a more reserved lifestyle, he may have had no choice but to flex.

Consider his political situation for a moment.  He came to the throne at a young age which raised concerns about his competency from the beginning.  It had fallen upon him to reverse the unpopular policies of his father, Akhenaten, which undoubtedly exerted a constant pressure for Tut to prove himself—changing his name from Tutankhaten to Tutankhamun, for instance.   He probably felt a need to assert at least a symbolic independence from his ambitious advisor, Ay, who many believe was really calling the shots.

Tut as a marauding sphinx (Photo courtesy of ThutmoseIII)

Tut as a marauding sphinx (Photo courtesy of ThutmoseIII)

In this atmosphere Tut may have, in a combination of youthful indiscretion and a very real need to minimize his weaknesses, pushed himself to dangerous limits.  The evidence published in the JAMA report shows a young man with many physical challenges. 

But some of the iconography seems to show a robust young king sowing his royal wild oats.  Which is the real Tut?  Could he have been both, and could this perfect storm of hindrances and determination have played a role in his death?

 

One Sick Kid, Warrior King, or Both?

Freiberg-Kohler’s disease undoubtedly caused Tutankhamun a good deal of pain and mobility issues, and while its underlying causes are unknown, its manifest effects were not good.  “Necrosis is always bad,” advises Dr. Carsten Pusch, one of the co-authors of the JAMA report, “ because it means you have dying organic matter inside your body” (Source:  National Geographic Daily News:  “King Tut Mysteries Solved: Was Disabled, Malarial, and Inbred”).  But it would not have directly caused Tut’s death.

The bone necrosis caused by Freiberg-Kohler’s is aseptic, which means that by itself it does not result in infection, which is the real threat of dead matter in the body (see Kinderradiologie-online:  “Kohler’s Disease II, Bilateral Freiberg-Kohler Disease”).  Dr. Albert Zink, another of the JAMA authors, stated emphatically that it was not a fatal condition by any stretch (Source:  University of Tubingen:  Tutankhamun’s parents identified). 

So as painful and malformed as Tutankhamun’s left foot may have been at the time of his death, there was nothing about the condition itself that was life-threatening.  But overall, the JAMA article reports that King Tut was indeed, as Emily Teeter summarized, “one sick kid” (Source: Physorg:  “Tut’s ills won’t kill fascination, historians say”). 

So this returns us to the question, What if Tut pushed through his physical challenges, possibly a bit too far?  In two articles published pretty much simultaneously with the JAMA report, one in Archaeology and the other in KMT (citations below), Dr. W. Raymond Johnson, director of the Oriental Institute Epigraphic Survey, describes evidence of Tutankhamun living rather dangerously. 

A relief of Tutankhamun at Luxor Temple (Photo by Crucifixion)

A relief of Tutankhamun at Luxor Temple (Photo by Crucifixion)

Dr. Johnson has spent the last twenty years transcribing narrative imagery from the walls of Luxor Temple and from talatat-style blocks recovered from the area, many of which deal with Tutankhamun and his deeds.  The descriptions portray Tut as “much more active than was thought, and [he] may have led military campaigns against the Syrians and Nubians before he died” (Source:  Archaeology:  “Warrior Tut”).

Dr. Johnson’s work with the battle narratives of King Tut have brought to light scenes depicting the young king riding a chariot in an assault on a Syrian-style citadel, participating in battles with Nubians and Asiatics, and otherwise behaving in ways a frail young king ought not to act. Charioteering on a battlefield is tricky business.  Whether actually mixing it up in battle or just making an appearance to rally the troops, Tutankhamun would have been encumbered with armor and weapons and performing athletics for which he was not well suited.

Dr. W. Raymond Johnson thinks that images such as this, taken from a chest found in Tutankhamun’s tomb, are accurate depictions of an active young pharaoh

Dr. W. Raymond Johnson thinks that images such as this, taken from a chest found in Tutankhamun’s tomb, are accurate depictions of an active young pharaoh

Something to keep in mind is that during Tutankhamun’s day there really were no minor wounds.  Any cut which broke the skin could result in an infection, and there were no antibiotics.  While it is true that Tutankhamun was buried with a fully stocked pharmacy (see the JAMA article appendix), ancient medicine was more about management than cure.  They could reduce pain, lower fevers, and had some relatively effective local antiseptics, but trauma and infections were either survived or not.

One of the top theories regarding the cause of King Tut’s death points to a vicious leg injury he sustained in the days just before he died.  The wound, incidentally, was a compound fracture of his left thigh, the same side as his clubfoot and necrotic bones.  The broken thigh ripped through muscle and skin, opening a gash that would have resulted in a really nasty infection and almost certain death, which seems to be supported by the forensic evidence.

Did Tut eschew his walking sticks for throwing sticks, only to learn his limits the hard way?  Whether indulging in the popular pastime of hunting on the Giza Plateau, a terrain fraught with hazards for man and horse alike, or gallivanting about battlefields, Tutankhamun would have encountered many opportunities to take a bad fall.

Replicas of throwing sticks found in Tutankhamun’s tomb, which would have been used for hunting (Photo by Dr. Günter Bechly)

Replicas of throwing sticks found in Tutankhamun’s tomb, which would have been used for hunting (Photo by Dr. Günter Bechly)

It is easy to imagine a brash young pharaoh handing his cane to a servant as he climbed aboard his chariot, insisting on taking the reins himself.  Tut was surrounded by decorated military leaders such as Ay and Horemheb, both of whom would eventually take turns at the throne.  Perhaps Tut was cognizant of their ambitions and wanted to show that he, too, could lead an army, just as he is depicted doing at Luxor Temple.  Dr. Johnson raises a similar question:

The recent analysis of Tutankhamun’s mummy which indicates traumatic injury to his leg—possibly the result of a chariot accident—that appears to have led to infection and premature death gives one pause.  Could Tutankhamun’s tragic accident have occurred during a military campaign?  (Source: Kmt:  “Tutankhamun-Period Battle Narratives at Luxor.”  Vol. 20,  no. 4, pp. 20-33:Winter 2009-10.)

Dr. Johnson’s question is all the more plausible in light of the even more recent analysis of Tutankhamun’s feet.   The conclusions in the JAMA report show that if Tut had participated in dangerous activities such as charioteering he would have been extremely vulnerable to the type of accident that seems to have felled him.

  

The heart craves certitude, but science speaks in probabilities.  Simply put, we can outline likely scenarios, but we will never know what killed King Tut.  He may have died from an infected wound received in an attempt to prove himself at war or sport.  Then again, he may have fallen from weakness brought on by a lethal case of malaria, or when a duplicitous courtier whacked him in the back of the head.  Maybe, as some still suggest, the broken leg occurred with Howard Carter’s rough handling of the mummy.

Tut as a marauding sphinx (Photo courtesy of ThutmoseIII)Dr. Johnson closes both of his articles with the observation that we may never know what killed Tutankhamun, at least not from the narratives themselves, because it would be impolitic to document the accidental death of a pharaoh, a living god.  That would count double if the living god’s death was the result of a frail young man acting like a badass. 

Then again, given his challenges, maybe he really was a badass.

 

  

See Also

 

Copyright by Keith Payne, 2010.  All rights reserved.

 

Photo “Tut with cane” modified from “Anuk” which is in the public domain due to expired copyright.  Photo “Metatarsals” modified from “footx” courtesy of Jlcruse and is used in accordance with the Creative Commons Attribution-Share Alike 2.5 Generic license.  Photo “TombofTut-ench-Amun” adapted from Fischfang und Fischkult im Alten Ägypten, by Dietrich Sahrhage, is in the public domain due to expired copyright.  Photo “Kingtut2” (both left and right) courtesy of ThutmoseIII and is used in accordance with the Creative Commons Attribution-ShareAlike 3.0 License.  Photo “Tut-tuxure 407” by Crucifixion is in the public domain.  Photo “Ägyptischer Maler um 1355 v. Chr. 001” is in the public domain.  Photo “Tut bumerangs” by Dr. Günter Bechly and is used in accordance with the Creative Commons Attribution-ShareAlike 3.0 License.

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4 comments so far

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 1 

Hello Shemsu Sesen

Interesting article, certainly Tutankamen had problems including the use of canes to get around. I would be interested to know if the sandals found in his tomb bear any wear patterns to back up the kings stance.

Reigning at the end of the Amarna period Tutankhamen needed a great deal of propaganda just to repair the damages done by his predecessors and I would expect that propaganda to be of a truly idealized king.

The protection of the last Thutmoside ruler without any prince to take over after Tut’s death may have left king Tut seriously sheltered at court leaving absolutely nothing of the boy kings personality to history.

March 28th, 2010 at 7:38 pm
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 2 

Hello Tim!

I like the idea of checking the sandals for wear patterns. That would certainly tell us a lot about not only how well he walked, but possibly how much. Of course, the absence of use would not tell us much because they may have simply not been used much during his lifetime. But if they were used a good deal, then we could learn a good deal.

Personally, if I were choosing shoes for the afterlife, I would want something already broken in, but not too shabby!

The point about the need for propaganda is well taken, and one of the reasons my thesis in this article should be approached with a healthy bit of skepticism. I have to admit, when I first read Dr. Johnson’s articles in KMT and Archaeology (which are very good articles for reasons I never really get into in my own article) my initial reaction was “Now that is unfortunate timing!”

Coming out with headlines like “Warrior Tut” and descriptions of a “very active” young king just as Zahi Hawass et. al. were finishing up an article in JAMA, of all places, which seems to smash your thesis to pieces seemed to me like a classic example of the left hand not knowing what the right hand was up to. If anything it was an example of what happens when peers sit on their work in hopes of making a big sensational debut.

But then I decided to try a different angle. First, my assumption that Dr. Johnson was unaware of the work going on with the Family of Tutankhamun Project and its possible implications for his own work was just that—an assumption. Second, what if both were right? What if, as Dr. Johnson suggests, the iconography of that period stressed realism and historicity?

I knew going into this that there were some pretty good reasons to doubt that last part. One of the other controversies which concern the Amarna Period is the question of how reliable the artistic imagery is in terms of realism. In fact, that is exactly what I will be working on this week with an article about the whole gender bender question regarding representations of Akhenaten and to a lesser degree Tutankhamun.

Since I have already shown my cards on this elsewhere I won’t be giving away any surprises by saying here that I do not think that the art of the Amarna Period stressed realism, quite the opposite. So I will be spending this week working really hard to disprove part of what I suggested today! I am not sure if that indicates journalistic detachment, or just plain old garden variety schizophrenia! But the real point is that there are good reasons to intelligently disagree and even arrive at differing interpretations of the subjective data while working from the same objective data.

I think that your final conclusion is absolutely correct—all that we know so far of Tutankhamun’s life and deeds is wrapped in uncertainty because there were even more reasons to present an idealized image of the young pharaoh than normal. And as we see in a few more generations with Ramesses II, when it came to creating a marketable brand the ancient Egyptians could teach Wall Street a thing or two!

Speaking of Ramesses II, have you heard that the next leg of the Egyptian Mummies Project looks like it will be a Family of Tutankhamun-style clarify- and-classify mission with the Ramesside bloodline, particularly Ramesses II? Tut is good for selling museum tickets (and admittedly, generating web traffic!), but historically, he really isn’t that interesting in my opinion. It’s a good mystery, and it is a good exercise trying to figure out who he was and what became of him, and there is some romance and potential adventure. But really, it’s all about the gold.

Ozymandias, on the other hand..

March 28th, 2010 at 9:02 pm
Monica
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 3 

Just want to rectify a thing: Tut`s missing toe bone is in the left foot where all other problems are (see JAMA Paper).
So his right foot was generally healthy, just a bit flattened by extra strain.

April 1st, 2010 at 9:14 am
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 4 

Hi Monica,

You are absolutely correct. Table 3 under the heading of Malformations lists “oligodactyly (hypophalangism) right,” however the text clearly states that the hypophalangism was in the second toe of the left foot (p. 645), and the notes under Figure 5 repeatedly state “The right foot shows no pathological findings.”

So maybe the “perfect storm” was not so perfect after all! The right foot was only flattened, as you point out, and would have lent more support than indicated in my article. I think the basic thesis still holds true, namely that if Tutankhamun had put himself into risky situations his stability would have been compromised enough to increase his risk of injury significantly. And not to be overly tenacious, but a right foot that was healthier than I had presumed might even have made Tut more likely to participate in risky behavior.

But as I state in the above response to Tim, the notion that Tut was riding chariots and leading armies based on the Luxor battle narratives is certainly open to challenge! I personally think the truth is probably somewhere in the valley. As Tim mentioned, Tut had no heir so it is difficult to imagine Ay letting him ride forth to meet the Syrians or Nubians or anybody else in battle.

Then again, maybe Ay had motives to encourage Tut to do just that… 😉

But regardless, that was such an easy goof to have prevented with a slightly closer reading of the JAMA article, and it is such a small thing that even a last minute catch would have made for an easy re-write. Good catch! And for today I get to be “that guy,” as in “don’t be”!

April 1st, 2010 at 10:12 am

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