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ON AN autumn day in 1976, a French Air Force plane touched down at Le Bourget airport just outside Paris. The plane was carrying one of the world’s great statesmen, a famous war leader in need of urgent medical treatment. Ramesses II may have been dead for more than 3000 years but his mummified body was welcomed with as much ceremony as any living head of state.

He had been the most magnificent of all the pharaohs, but his mummy was in poor shape. Early on, he was roughed up by tomb robbers, prompting priests to move him to a secret location. In 1881, that too was discovered and from then on the king’s corpse was moved from place to place, partly unwrapped, even exhibited standing up, all of which took a heavy toll. Now, battered and cracked, he was under attack from bacteria, fungi and insects. Ancient Egyptians embalmed their dead to ensure the body stayed intact for eternity, otherwise the soul wouldn’t have the use of it in the afterlife. If Ramesses’s soul was to endure, his mummy needed urgent attention to stop the rot.

From the airport he was driven to the Museum of Man, where for the next eight months a team of French and Egyptian researchers examined, probed and X-rayed him. Their task was to assess the damage and suggest ways to prevent it worsening, but in the process they would discover more about the pharaoh’s life and death. And just in case Ramesses’s soul disapproved of all this probing, the royal cavalcade made a placatory detour past a landmark that would have been familiar to the pharaoh – the obelisk in the Place de la Concorde. Ramesses had the monument raised outside the temple at Luxor, and all over it are hieroglyphs telling of his glorious deeds.

By the time Ramesses left France the following year, there were hints that perhaps those tales weren’t entirely accurate. X-rays had revealed that the king died from cardiovascular disease, which is no surprise for a man of such great age. They also showed changes to the bones of his spine. This time the diagnosis was more surprising: Ramesses had ankylosing spondylitis, a form of arthritis so severe that even in his prime he could never have been fighting fit. Yet at Abu Simbel, the grandest of the monuments left by Ramesses, a carving shows the king riding in his chariot, holding high his spear as he went into battle against the Hittites. Inscriptions describe with admiration his skill and bravery as a warrior. Even a poem relating his triumphs has survived on a papyrus.

“At Abu Simbel, a carving shows the king riding in his chariot, holding high his spear as he went into battle against the Hittites”

Three decades after Ramesses’s trip to Paris, Rethy Chhem, chief radiologist at the London Health Sciences Centre and professor of anthropology at the University of Western Ontario, was finding it hard to reconcile the king’s reputation with a diagnosis of ankylosing spondylitis. This chronic inflammatory form of arthritis would have severely restricted his movements, ruling out anything as physically demanding as riding a chariot. Ankylosing spondylitis afflicts mainly men and starts when they are in their late teens or early twenties. “Normally it begins in the joints between the pelvis and spine and then moves upwards,” says Chhem. There would be long periods of pain and stiffness, occasional periods of remission and then agonising flare-ups with fever and night sweats. In advanced cases, the bones, ligaments and tendons of the spine are almost completely fused, resulting in what’s sometimes called poker back – a rigid spine with almost no movement.

“Today, patients would be treated with anti-inflammatory drugs to relieve the pain, but in the time of Ramesses II anyone with ankylosing spondylitis would have been in incredible pain,” he says. By the time he reached his thirties – when he was supposed to be fighting the Hittites – he would have been severely disabled. “He could sit on a throne and give orders but he would not be fighting in a chariot.”

Chhem, who has studied the X-rays of hundreds of patients with various types of spinal arthritis, decided to investigate. Last year, he went to France and joined up with two other radiologists. One was Clément Fauré of the Trousseau Hospital in Paris; he was a member of the original team in 1976 but had been sceptical about the diagnosis at the time. The other was Pierre Schmit, a radiologist at Necker Hospital for Sick Children in Paris. Each independently examined every X-ray taken in 1976.

In a clinic, a radiologist would insist on images all the way from neck to hip and X-rays of the pelvic bones from back to front to show the sacro-iliac joints. With Ramesses, they had to make do with an incomplete set taken only from the front. This meant much of the spine was obscured, either by the king’s crossed arms or by embalming materials packed inside his chest.

Even so, all three agreed that the changes they could see in the mummy’s bones didn’t add up to a case of ankylosing spondylitis. “Ramesses II died very old and if he had ankylosing spondylitis you would see very advanced signs on the spine,” Chhem says. Those signs would include extensive growth of bone at the edges of the vertebrae that eventually bridges the gaps between them, producing a near-solid bony column. To Chhem, the changes to the vertebrae looked more like those he regularly sees in patients with diffuse idiopathic skeletal hyperostosis, a less severe form of arthritis. In DISH the outgrowths from the vertebrae resemble candle wax dripping down the spine. But not all cases are typical and it can be hard to tell them apart just from these growths.

The key piece of evidence was not something the radiologists saw but something they didn’t see. The ultimate hallmark of ankylosing spondylitis is the fusion of the sacrum and the ilium – the topmost bone of the pelvis. Only part of Ramesses’s right sacro-iliac joint was visible, but there was no sign of fusion. “That alone means we can say he did not have ankylosing spondylitis,” says Chhem. “We can’t be 100 per cent certain it’s DISH without doing a CT scan, but we are 99 per cent certain it’s not ankylosing spondylitis.”

No one knows how common DISH was in ancient Egypt, but it was almost certainly more common than ankylosing spondylitis. Today, DISH is the second most common arthritis after osteoarthritis. In North America, almost 30 per cent of men over 80 have it, while ankylosing spondylitis is rare, affecting around 0.2 per cent of the population. And unlike ankylosing spondylitis, DISH doesn’t begin to cause problems until middle age – by which time Ramesses had signed a peace treaty with the Hittites.

“Sometimes there are no symptoms and we discover it by chance when doing X-rays for some other reason,” says Chhem. Patients might have some back pain, but nothing unusual until well into their fifties. “You can lead a normal life until then, and that fits with Ramesses’s history.”