Medical Archaeology

Neurological Aspects of the DavidGoliath Battle: Restriction in the Giants Visual Field

Vladimir M. Berginer MD PhD Department of Neurology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

Key words: David and Goliath, acromegaly, gigantism, anopsia, craniocerebral trauma IMAJ 2000;2:725727

The celebrated battle between David house to his older brothers at and Goliath that took place more than the Israelite camp. The Philis- 3,000 years ago in the Valley of Elah is tine giant, meanwhile, was fully described in the Bibles Book of daring the Israelites to send Samuel I [1,2]. Throughout the centu- out their best fighter. After 40 ries, this story became a symbol of the days and no response, it was victory of faith over brutal force, the David who took up the chal- mastery of good over evil. It inspired lenge. A devout believer in the the imagination of writers [3], compos- power of God and an enthusi- ers, sculptors (Donatello, Michaelange- astic patriot, David was also a lo, among others.), and artists cunning and pragmatic fellow. (Rembrandt, Doré, etc.) [Figure 1]. He knew of King Sauls prom- The name David, personifying heroism ise that he who conquered and goodness, has been given by Goliath could take the kings parents to their sons from generation daughter as a wife and would to generation in different countries and be granted wealth for himself in various languages. and his family. He refused the Beyond the mystique of this time- kings proposal to don armor of honored story, the details and outcome heavy metal, preferring to re- of this battle can be explained by main in his shepherds gar- contemporary scientific and medical ment and armed with a mere knowledge, and several articles and stick, sling and smooth stones letters have been published in this  weapons with which he was regard [48]. Among the theories is the familiar. Thus were David and assumption, although never proven, Goliath the representatives of Figure 1. "David defeats Goliath." Painting by P. that Goliath might have had a visual the warring Israelite and Phil- Puget, 18th Century. Note typical facial features of acromegaly in Goliaths head, a point remarkable disorder. I shall try to show that Goliath istine armies, and the victory since the painting was done more than one hundred did in fact suffer from visual field of one foretold the defeat of the years before Marie originally described the condition restriction. other. in 1886. During the battle David ran The story fast, as noted several times in David was a young, handsome ("of fair the Bible ("David hastened and ran and a span" or according to another countenance") and nimble shepherd. towards the army to meet the Philis- version "four cubits and a span" (ap- We know of his strength and bravery tine"). In contrast, Goliath, a terrifying proximately 2.53 meters). Such gi- and that he had overcome wild beasts, giant from the area of Gat, was slow- gantism is a feature of pituitary including a lion, while minding the moving and ponderous [13]. It is most macroadenoma with hypersecretion of sheep. No soldier, David the youth likely that Goliath was suffering from growth hormone from childhood was sent to bring food from his fathers acromegaly. His height was "six cubits [4,9,10]. Measurements of acromegalic

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athy and myopathy frequently appear in to thee in the name of the God of the late stages of acromegaly [9]. There Israel." The combat itself was not a have been assumptions that the giant face-to-face struggle. While the giant mayhavebeenaffectedbythese "Philistine arose and came slowly to complications, but I found no indication meet David, the quick David ran of this in the original text. The third toward the army to meet the Philis- theory claims a visual disorder. Goliath tine." Owing to his agility, a function was not blind; he saw and taunted the not only of his youth and size but of his young boy who confronted him. David experience scaling the Judean hills carried a stick, yet Goliath saw "several while minding his flock, he succeeded sticks," which may be one of the in transforming the battle into a mobile indications of his impaired vision. I duel. He struck Goliath from a dis- suggest that Goliath suffered from tance, "David put his hand in his bag visual field restriction. Bitemporal and took thence a stone, and slung it, hemianopsia is seen in large pituitary and smote the Philistine on his fore- macroadenomas as a result of optic head." chiasm compression in the suprasellar The confrontation between David region [Figure 3]. and Goliath, as described in the Book of Samuel I, has been analyzed using Hypothesis modern ballistics and computational Intrigued by the story, for more than 20 methods. The result confirms the de- years I have repeatedly examined the tailed descriptions of the battle and its original text of the Bible, seeking for an physical outcome  a stone sunk into allusion to the visual field difficulties of Goliaths forehead [11]. Such a rapid Goliath. I believed that the original and sharp injury of the head could text, so detailed in the description of possibly kill even a healthy person Goliath and his behavior, must contain at least a hint to his supposed visual field restriction. Only recently did I succeed in finding evidence, which lies in the Figure 2. Robert Wadlow, acromegalic words twice mentioned in the Bible: " giant, height 272 cm (measured by Drs. &. And a man bearing a shield went C.M. Charles and C. MacBride on June 27, before Goliath." This man was most 1940 in St. Louis, MO, USA). likely a guide who would indicate to Goliath the direction from which the individuals approximating such a height enemy was approaching. Running have been recorded [Figure 2]. swiftly, David could intermittently dis- It is noted several times in Samuel I appear from Goliaths vision. Surprised that he "came to pass and drew nigh to and disconcerted, the giant was un- meet David." The slowness of Goliath prepared to defend himself against the has been attributed to three phenom- stone that David slung. While astonish- ena. The first is the heavy weight. In ingly powerful in a face-to-face duel, addition to his vast physical size, Goliath was ineffectual in mobile com- Goliath was dressed in a heavy metal bat due to his slowness and visual field suit of armor. "And he had a helmet of limitations. brass upon his head, and he was armed The battle began with psychological with a coat of mail; and the weight of attacks from both sides. The large the coat was five thousand shekels of Philistine abused and insulted the brass [about 70 kg]. And he had Israelites, confident that he would greaves of brass upon his legs, and a defeat any of their warriors. Both Figure 3. Magnetic resonance imaging of target of brass between his shoulders. David and Goliath swore to kill each pituitary macroadenoma [TM]. The tumor enlarged the sella turcica, eroded its floor other and to give the enemy as "flesh And the staff of his spear was like a and pressed upon the optic chiasm causing weavers beam; and his spears head unto the fowls of the air, and to the wild bitemporal hemianopsia. TM fills the third weighed six hundred shekels of iron." beasts of the field." David, highly ventricle almost to the intraventricular fora- The second explanation is that arthrop- motivated, addressed Goliath: "I come men of Monro.

726 V.M. Berginer IMAJ · Vol 2 · September 2000 Medical Archaeology from a distance of up to 4080 meters less likely in view of the fact that his 2. Samuel I, 17. In: Prophets, Neviim (with translation into Russian), Jerusalem: Mossad [8,11]. How much more so in the case temporal bones were protected by the Harav Kook, 1978:936. of acromegaly, where the frontal si- "helmet of brass upon his head." 3. The works of Flavius Josephus and the life of nuses became enlarged and the frontal Pituitary apoplexy induced by cranio- Josephus (written byhimself and accurately bone consequently thinner [6]. Trans- cerebral trauma is rarely observed in translated from the original Greek). Philadel- phia: Lippincot, Crambo and Co., 1854, vol. 1, orbital intracranial penetration has also head injuries of patients suffering from Chapter 9: 1068. been suggested [12]. pituitary tumors [6]. 4. Greenblatt RB. Giants in those days. In: Search I have not found evidence to support Goliath did not expire immediately of the Scriptures. Philadelphia and Toronto: JB Lippincott Co, 1968:1923. the theory that Goliath suffered from after the stone had "sunk into the multiple endocrine neoplasia type 1, 5. Rabin D, Rabin P, David, Goliath and Smileys forehead." David quickly "ran and stood people [Letter]. N Engl J Med 1983;309:992. including hyperthyroidism, which upon the Philistine, and took his sword, 6. Shapiro R, Mintz A. Head injuries in the Old caused extensive osteitis fibrosa and a and drew it out of the sheath thereof, Testament [Letter]. Radiology 1990;174:84. brown tumor on his forehead through and slew him and cut off his head 7. Sprecher S. David and Goliath [Letter]. Radiol- which the stone pierced his brain. therewith." The death of Goliath was ogy 1990;176:288. Neither have I found evidence that he 8. Feinsod M. Head injuries in the Bible. Harefuah not an immediate result of the head 1995;129:5379 (Hebrew). may have been hypoglycemic on the injury that caused him to "fall on the 9. Lamberts SWJ. Acromegaly. In: Grossman A., morning of the contest [5]. earth" (unconsciously, most probably), ed. Clinical Endocrinology. Oxford Blackwell The smooth stone was slung at high but due to his decapitation. Scientific Publications, 1992:15468. speed, force and accuracy at the After the battle David brought 10. DaughadayWH. Pituitarygigantism. Endocri- unprotected face of Goliath, where it nologyand Metabolism. Clin North Am Goliaths head to Jerusalem and pre- 1992;21:63347. "sunk into the forehead." It caused a sented it to King Saul. As promised, he 11. Hirsch E, Cuadros JH, Backofen JE. Davids penetrating craniocerebral injury, in- did indeed marry the kings daughter. choice: a sling and tactical advantage. In: 15th sufficient to cause immediate death; International Symposium on Balistics. Jerusa- He became a cherished member of lem, Israel, May21-24, 1995:11 20. but following this blow, Goliath "fell King Sauls court, his proficiency on upon his face to the earth." The reason 12. van Duinen MThA. Historical aspects regard- the harp and the poetry of his psalms ing the transorbital intracranial injury. In: The for this fall could have been a sudden being the only balm to soothe the Transorbital Intracranial Penetrating Injury. loss of consciousness due to brain Harbound, The Netherlands: Kluwer Academic kings tormented soul. The rest is Publishers, 1999:176. contusion induced by the penetrating history. smooth stone. As a result of the 13. Graham DI, Adams JH, Path FRC, Gennareli ______TA. Pathologyof brain damage in head injury. trauma, acute occlusion of foramen In: Cooper PR, ed. Head Injury. 2nd edition. Monro with bleeding and edema [13] Baltimore: Williams and Wilkins, 1987:7288. of injured suprasellar pituitary macro- References ______adenoma is a possibility. This could 1. Prophets, Neviim, Samuel I, 17. In: The Jewish Correspondence: Dr. V. M. Berginer, P.O. have led to acute decerebration. The Bible, Tanakh, a new translation of the Holy Scriptures into English. Jerusalem: Jewish Box 941, Omer 84965, Israel. Tel: (972-7) 646- possibility of epidural hematoma seems Publication Society, 1985:4437. 9292; Fax: (972-7) 646-0111.

Contraceptives should be used on every conceivable occasion.

Spike Milligan, Irish writer (1918 )

Capsule Younger and longer is better Amid the excitement surrounding recent cloning of aging, telomere length, is increased, rather than de- animals from adult somatic cells was the lingering doubt creased, and above normal in cells from the cloned that the cloned offspring would not be able to live out their animals. Exactly how the cloning process reprograms the normal life span. Because cells can divide only a finite donor nucleus to a more youthful state is not clear, nor are number of times in their lives, the progeny of the adult the implications of these findings for the cloned organisms nucleus used for cloning might be limited in their ability to life spans. Nevertheless, cloning from adult cells now divide. Lanza et al. show that they are not. Even when seems a more realistic possibility. senescent cells are used as nuclear donors, the cells of cloned calves can divide more times than cells of normal animals of the same age. Another putative index of cell Science 2000;288:665

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