Ancient and historic mummified remains are a valuable source of bioarchaeological and biomedical information, offering insights into individual behavior, disease, and past funerary practices (1, 2). While such remains are found in various cultures worldwide, they are particularly common in religious buildings like Christian churches, which often contain subterranean chambers for the burial of distinguished members of society (3).

The eight mummified individuals discussed in this paper, dating to the 17th and 18th centuries AD, were recovered from a crypt in the Evangelical Reformed Church of Kėdainiai, a historic town in central Lithuania (geographical coordinates: 55°17′N 23°58′E) (Figures 1A–C). This chamber was used over generations to bury members of the Radziwiłł family, a powerful dynasty of the former Grand Duchy of Lithuania and the Crown of the Kingdom of Poland (1569-1795). The church also contained another crypt, used for other dignitaries not related to the Radziwiłł family but living in the same context. Both rooms had been disturbed multiple times, particularly after WWII, when the building was converted into a sports hall, leading to potential mixing and desecration of the remains (4).

In July 2019, members of the Kėdainiai Regional Museum and the Faculty of History of Vilnius University began a project to inspect the remains from both crypts, with the goal of identifying the deceased and reinterring them with new coffins (Figure 1C). During this process, 37 bodies and body parts were recovered, including 29 mummified or partly mummified individuals and eight skeletonized ones. Of these, 18 were identified as males or probable males, 13 as females or probable females, and six had undetermined sex. Age estimates were made for 25 of the individuals, while the remaining mummified cases were categorized simply as “adults.” Additionally, there were 73 commingled skeletonized individuals. Previous inspections of these remains were conducted in 1986-1987, providing a reference point for evaluating their preservation status.

The primary aim of this research is to assess the health, social status, and cultural practices of the individuals buried in the crypts. The research questions guiding this study include: What can these remains reveal about the individuals’ health, social rank, and diseases? How do these findings fit within the broader historical, social, and biological context of the time? The specific objectives of this sub-project are to evaluate the social status of the deceased based on biological and cultural indicators, identify pathological conditions and their possible causes, and assess the preservation status of the remains for documentation purposes.

Paleoradiological imaging was used on the eight best-preserved mummified individuals to confirm their identity and examine the bone and soft tissue abnormalities observed. These activities were conducted with great care to avoid causing visible damage to the corpses, respecting ethical standards (5). This study offers new insights into the lives of these individuals, shedding light on their health, social roles, and the funerary practices of 17th- and 18th-century Lithuania.

Upon visual inspection, the eight individuals selected for this study showed no evidence of anthropogenic manipulation, indicating a process of spontaneous mummification, except for one case that revealed an abdominal incision (Figure 1B) (1). They were studied using standard bioanthropological methods, including sexual assessment based on cranial and pelvic features, inspection of the external genitalia, and age-at-death estimation using indicators such as changes in the sternal rib ends, and dental and long bone development (6–8). This assessment was not possible for all cases, as some of the anthroposcopic areas (e.g., the skull, the pelvis) were either missing or covered by desiccated soft tissue (9, 10). The remains were also examined for pathological changes visible on the skeletonized parts (11–13).

For this assemblage, computed tomography (CT) was chosen as the method of analysis due to its non-invasive nature and effectiveness in mummy research (14). The scanning was conducted at Santaros Klinikos Vilnius University Hospital using a 64-slice LightSpeed VCT scanner (GE Medical Systems), with a slice thickness of 0.6 mm at 120 kVp. Measurements were taken to ensure the safety of both the environment and the research team (15). The CT data were visualized, measured, and rendered using RadiAnt DICOM Viewer software (Medixant). Pathological alterations observed in the soft and hard tissues were described using a modified version of the standardized Istanbul protocol, which categorized signs as inconsistent, consistent, highly consistent, typical, or diagnostic of certain conditions (16).

Since the mummified remains were not in a standard anatomical position, it was not possible to depict them in a conventional plane system. Therefore, all CT images were created using multi-planar reconstructions, with planes shifted from multiple angles to provide the best possible view while sacrificing traditional plane orientation. In addition to pathological examination (1), stature estimation was performed by measuring the femur using the methodology devised by Trotter and Gleser (17) for European-ancestry populations. Biological samples from both soft and hard tissues, taken from areas affected by post-depositional changes, will be investigated in future studies.

The mummified remains central to this article provide a valuable source of information, both historically and biomedically (1). Given the significance of the Radziwiłł family and their role in Lithuanian history, periodic evaluations of the remains were necessary to monitor their condition. Differential preservation of some of the remains suggested that, since the last analysis in 1987, several individuals lost their soft tissue and became skeletonized due to environmental changes over time. This indicates that the conservation conditions within the chambers were not optimal for the long-term preservation of these remains, justifying the museum’s decision to produce new coffins and restructure the area. As mentioned earlier, we confirmed that some of the skulls were missing from the bodies, likely due to events during the Soviet occupation of Lithuania, when religious practices were suppressed, and churches were often repurposed for other uses (4).

Concerning the mummification process, the majority of the remains we examined were spontaneously mummified, likely due to the low temperatures in the crypts, protection from rainwater by the overlying church structure, and burial in wooden coffins that formed a barrier against the surrounding environment (1). Burial in subterranean chambers is a widespread practice across Europe, often linked to individuals of high social status as is the case for the Kėdainiai community (3). Only one case involved artificial mummification, specifically the body identified as Janusz II Radziwiłł (1612-1655) (individual #0). He was embalmed and placed in a metal coffin (sarcophagus #2), and is the only individual for whom the identity could be somewhat confirmed. Inspection of his body revealed a capsized U-shaped, suture-closed abdominal incision, with the cavity stuffed with common hops (Humulus lupulus), known for its antimicrobial properties (29). A similar process of evisceration and stuffing was documented starting in the Middle Ages for prominent individuals and aristocrats, such as the Aragonese in Naples and the Capaccis in Siena, Italy (30, 31). This special treatment may have been due to the transportation of his body from Tykocin (Poland) to the crypt, further indicating his elevated status. Assuming a mechanical origin, his bipartite acromion—previously observed in another mummy from Vilnius (32)—may suggest chronic tearing of the rotator cuff due to stress, while the presence of Schmorl’s nodes indicates flexion and bending of the vertebral column (27, 33, 34). Additionally, pseudopathology and post-mortem alterations, such as the eggshell in the pelvic cavity and two fragments of animal bone in one of the mummies, suggest animal (possibly marten) activity and minimal care for the remains over time (35).

Turning to pathological conditions, evidence of age- or activity-related degenerative changes in the joints—such as altered articular contours, lipping, osteophyte formation, and cyst development—was found in five individuals. One case showed signs of sacroiliitis, possibly related to non-specific spondyloarthropathy (13). Although degenerative joint disease is a multifactorial condition, it is often regarded as age-related, resulting from the continuous mechanical loading of joints or the spine throughout an individual’s life (36). Findings from a roughly coeval sample of skeletal remains from Vilnius indicate that age was a significant factor in the prevalence of degenerative disease in both males and females, likely also applying to the majority of the mummies examined, who survived into adulthood (37).

Calcifications were observed in the chest cavities of four individuals, indicating lung disease among the Polish-Lithuanian upper classes (38). These findings are comparable to those in other coeval mummy contexts, such as a male from Sommersdorf, Germany, and a female from Leuk, Switzerland (39, 40). In paleopathology, calcified pulmonary nodules and fibrotic changes are commonly associated with tuberculosis (1, 41, 42). Ancient DNA testing has confirmed that these calcifications are related to tubercle bacillus infections, as seen in the Vác mummies from Hungary (43, 44). This disease was endemic during the relevant time frame, narrowing down the range of possible conditions affecting the Kėdainiai individuals. However, other pathological processes with similar lung lesions, such as histoplasmosis, coccidioidomycosis, pneumoconiosis, and sarcoidosis, though less likely, should also be considered (25).

A calcified abdominal aorta was found in two cases, one of which also showed coronary and aortic valve calcifications (26). Although extensive tissue sampling for histological confirmation was not permitted, the most likely explanation for these findings, as emphasized in a similar study of a 17th-century Korean mummy from Mungyeong, is atherosclerosis (45). This is not surprising, considering the highly atherogenic diets of Lithuanian elites, a fact also supported by historical records (32, 46). However, other conditions such as age, diabetes, metabolic disorders, localized inflammation, and kidney disease could also result in similar calcifications, with filariasis and hyperparathyroidism ruled out (47).

This study also identified benign tumors in the sample (48). The vertebral hemangioma and intraosseous hemangioma observed are of particular paleopathological interest, as they have been rarely documented in the literature. A case affecting the skull was identified in a skeleton from the Chinese archaeological site of Redianchang (49), and another was found in a Roman-period skeleton from the Dakhleh Oasis in Egypt (50). Differentials include Paget’s disease, which may sometimes be confused with hemangioma. The other tumor case found in this study is also noteworthy. Its location on the epiphyseal-metaphyseal area of the proximal tibia, along with its solitary, eccentric, and osteolytic appearance with smooth edges, suggests a giant cell tumor (GCT)—a benign tumor that can occasionally become aggressive. Other conditions such as aneurysmal bone cyst, chondroblastoma, and non-ossifying fibroma are less likely due to the adult age of the individual, and cancer was ruled out due to the absence of bone reaction and the regular appearance of the lesion contours. The lesion also showed a cortical break in the lateral border, which could have led to a limited periosteal reaction, while the sclerotic and irregular condylar surface might indicate a micro-pathological fracture. A similar case was recently discovered in an 18th-century Italian mummy from Roccapelago (51). However, it is important to note that some conditions may mimic GCT, and without clinical data, the diagnosis must remain tentative (52). Additionally, bone islands, which are benign, non-cancerous bone lesions, were also identified. These often-overlooked findings contribute to the understanding of non-cancerous skeletal formations in ancient populations (13, 53). Malignant neoplasms can result from various oncogenic factors, such as mutations, viruses, bacteria, or even specific dietary habits, such as high meat consumption among European upper classes (46, 54). In this assemblage, these tumors likely went unnoticed due to the inability to conduct dissections and histological evaluations of internal organs (55).

In conclusion, the CT investigation of eight high-status members of the Kėdainiai historic community allowed the assessment of incidental pathological conditions in a set of mummified remains, which could partly be explained by environmental influences. These findings provide a narrative of social status, disease, and post-mortem manipulation. Although providing a definitive diagnosis for some of the conditions was challenging due to the lack of clinical history, as well as potential alterations to the inner organs caused by taphonomic factors (56), the imaging study lays the foundation for future investigations using biopsy and other biomedical techniques. These techniques can maintain the integrity of the bodies while avoiding major damage (57), and further advocate for periodic monitoring of the remains, ensuring their continued potential for storytelling through future research and conservation efforts (58).

Beyond the specific diagnoses, this study also reveals the broader historical, cultural, and biological context of the population, shedding light on how the individuals faced challenges such as bone degeneration, respiratory infections, and cardiovascular issues, as well as other non-cancerous conditions rarely represented in the bioarchaeological literature. It also offers insights into their funerary rituals and the impact of political changes that led to the profanation of their graves. This broader context not only helps address key research questions about their social status, health, and cultural practices, but also frames their lives within 17th- and 18th-century Lithuania (59, 60). Paleopathology, coupled with paleoradiology, remains an anatomical discipline devoted to exploring disease in once-living societies through non-destructive or minimally invasive methods, maintaining the dignity of human remains while providing the most realistic explanations for the lesions observed.