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Difficulties for cardiovascular retrospective diagnosis on mummified foetal remains

Published online by Cambridge University Press:  27 September 2012

Philippe Charlier*
Affiliation:
Department of Forensic Medicine and Pathology, University Hospital R. Poincaré (AP-HP UVSQ), Garches, France Department of Medical Ethics and Legal Medicine, University Paris 5, Paris, France
Isabelle Huynh-Charlier
Affiliation:
Department of General Radiology, University Hospital Pitié-Salpétrière (AP-HP), Paris, France
*
Correspondence to: Dr P. Charlier, MD, PhD, Department of Forensic Medicine and Pathology, University Hospital R. Poincaré (AP-HP, UVSQ), 104 R. Poincaré boulevard, F-92380 Garches, France. Tel: +33 1 47 10 76 80; Fax: +33 1 47 10 76 83; E-mail: ph_charlier@yahoo.fr
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Abstract

Type
Letter to the Editor
Copyright
Copyright © Cambridge University Press 2012 

We read with great interest the recent article by Séguéla et al,Reference Séguéla, Pierrat-Bonnefois and Paul 1 which raises the problem of long-term conservation and retrospective diagnosis on foetal mummified bodies. Indeed, some incertitude exists with regard to the methods and results, needing further data from both forensic anthropology and radio-pathology points of view.

First, organs are very mobile within a mummy – regardless of its archaeological or forensic origin – and images of organs within their cavities can vary from one position of the body to another.Reference Cesarani, Martina and Ferraris 2 Therefore, the right-sided position of the “heart” observed on computed tomography-scan images is not necessary the real intra-vitam one. The authors assess that “it was a primary dextrocardia rather than a simple displacement of the heart” (p. 3). What about the aorta? Is a flattening visible on the right anterior part of the lower thoracic and upper lumbar vertebras, as currently seen in that case?Reference Charlier, Costea, Huynh-Charlier, Brun and de la 3 The aorta is an anatomical structured fixed to the vertebra – and subject to a much less risk of post-mortem displacement, and thus it may help in confirming the diagnosis.

Second, the crushing of the skull as a consequence of a forceps extraction is not so clear. Forceps are not attested in the Egyptian antiquity,Reference Sullivan 4 but existed during the Ptolemaic period (4th to 1st century BC), corresponding to the datation of these remains.Reference Burns and Calache 5 In all cases, the use of such material for so tiny remains – foetal body at 15 weeks of gestation – seems unclear. Maybe the crushing of the skull vault is merely due to post-mortem changes such as maceration of the foetus,Reference Charlier, Khung-Savatovsky and Huynh-Charlier 6 or any embalming process – such as wrapping, for example).

Furthermore, the nature of the “heart” is very dubious, and this is really a limit of non-destructive methods such as post-mortem computed tomography-scan. Full-density screening – measure of Hounsfield Unit for each internal structure – is the rule, and may confirm – or not? – the exact nature of the organ.Reference Villa and Lynnerup 7 What about the liver and other visceral organs? As seen in Figure 1d (p. 2), no isolate organ can be determined, but rather a homogenised entity. Does it correspond to altered organs after initial decomposition process? Or to linen packs following an embalming, as we know it was carried out even on foetuses?Reference Hawass and Saleem 8 The same with the so-called “heart”: “supposed cardiac structure” appears very long (extended on almost 10 thoracic vertebral bodies (unfortunately, there is no scale on the images), which is very long for a foetal heart. In addition, no ventricular and/or auricular cavity is visible. Identification of the spleen is also very dubious. The only way of being sure would be to perform an autopsy with further histological/microscopic examination, that is, a destructive method that cannot be carried out for museum reasons.

References

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