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In December of 2010 we had the opportunity to examine a sample group of 26 mummies, including 16 adult males and 10 immature individuals preserved in the Capuchin Catacombs of Palermo. At the end of the 16th century, the Catacombs were constructed as a burial site for deceased friars. Over the course of time, extensive subterranean corridors were carved out of massive deposit of tuff that underlies the Capuchin Church and Convent. The first mummified bodies were placed there in 1599, and the last ones in the early 20th century [40], [41]. Today the Catacombs form an impressive site where over twelve hundred bodies, many of which still retain soft tissue, are displayed along the sides of the corridors (Figure 1). The Catacomb mummies of Sicily are mainly the result of a spontaneous-enhanced preservation mechanism. Shortly after death, bodies were taken to special preparation rooms, and laid on terracotta racks designed to allow draining of the body fluids and promote spontaneous desiccation of the cadavers. The rooms were then sealed for approximately one year, after which time the corpses were exposed to the air, washed with vinegar and dressed. Some bodies were also preserved with anthropogenic methods, such as briefly immersing the bodies in lime or by means of arterially injecting specific chemicals [40]–[43].
Figure data removed from full text. Figure identifier and caption: 10.1371/journal.pone.0036537.g001 Image of one of the corridors of the Catacombs.Over eighteen hundred bodies, many of which still retain soft tissue, are displayed along the sides of the different corridors. Many of them are stored in wall niches or upon shelves while others lie in wooden coffins. Over time, bodies were grouped according to sex, age and occupation. Almost all mummies are clothed and wear hats, shoes or even gloves.
For the present study, only the adult sample group, consisting of 16 males dating from the late 18th to the late 19th centuries AD, was considered. The sample selection was mainly based on the accessibility and preservation state of the bodies. Furthermore, the short time availability of the mobile CT scanner only allowed a small number of mummies to be studied. Any available information on these subjects, such as age, identity, occupation and time of death was either determined through observation of the artifacts associated with the bodies and the coffins, the embalming technique employed, or gleaned from the death records present in the Archives of the Capuchin Convent and in the Municipal Archives of Palermo. At least six bodies from the sample group underwent a process of anthropogenic mummification. The mummies were examined by a mobile 4-section CT scanner (Alliance Medical, Warwick, UK; LightSpeed Plus, GE Healthcare, Milwaukee, Wisconsin, USA) which was positioned in front of the Capuchin Church next to the entrance of the Catacombs. All examinations were obtained as whole body CT in helical technique with slice thickness of 1.25 mm, interval of 1.25 mm and pitch of 0.75 with 120 kV in a standard algorithm. Paleoradiological evaluation as well as performance of multi-planar reconstructions (MPR) was carried out at the Picture Archiving and Communicating System (ImpaxEE, Agfa HealthCare, Bonn, Germany) in the Department of Radiology by the first author who is also experienced in paleoradiology and musculoskeletal radiology. HPs at the femoral neck were characterized by size, shape, margin, cortical breaks and Hounsfield Unit (HU) representing the density values in CT examinations. In case of mummies with HPs, MPRs of the respective hip joint were generated. The location of each HP was classified in the parasagittal plane in which the anterior, almost semicircular half of the femoral neck was divided into a superior and inferior portion and the transition zone between the two [37]. To determine the femoral head-neck junction, the angle α introduced by Nötzli et al. [44] was measured on a plane parallel to the axis of the femoral neck passing through the centre of the femoral head. The angle α was defined by two lines: the first line between the centre of the femoral head and the anterior point where the distance of the centre of the femoral head exceeds the radius of the surface of the femoral head and the second line between the centre of the femoral head and the centre of the femoral neck at its narrowest point (Figure 2).
Figure data removed from full text. Figure identifier and caption: 10.1371/journal.pone.0036537.g002 Measurement of the angle α.Paraaxial (parallel to the axis of the femoral neck) reformation CT image in case 3. The angle α was defined by a line between the centre of the femoral head and the anterior point, where the distance of the centre of the femoral head exceeds the radius of the surface of the femoral head and a second line between the centre of the femoral head and the centre of the femoral neck at its narrowest point.
Degenerative disease of the hip joints containing HPs was evaluated by the assessment of osteophytes, subchondral cysts and eburnation. The criterion of joint space narrowing, which is used in the clinical situation, is not applicable to paleoradiology as soft tissues and joint alignment in mummies are known to change as a result of dehydration [6].
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