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Dwarfism in Egypt and Classical Antiquity: Iconography and Medical History

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Dwarfism in Egypt and Classical Antiquity: Iconography and Medical History Medical History, 1988, 32: 253-276. DWARFISM IN EGYPT AND CLASSICAL ANTIQUITY: ICONOGRAPHY AND MEDICAL HISTORY by VERONIQUE DASEN' Many aspects of the medical history of the ancient Mediterranean world remain unclear. For many conditions, especially genetic, texts are missing and human remains are scanty. We must rely essentially upon iconography to throw some light on the pathological forms existing in the past, as well as on ancient medical notions. In this paper, I take the example ofrestricted growth, commonly called dwarfism, a condition characterized by a significantly short stature, over three standard deviations below the mean height ofa population ofthe same age and sex.2 The causes ofgrowth disorders are extremely varied (endocrine, metabolic, nutritional), but most types of short stature are due to genetic mutations, which suggests that the birth incidence of dwarfism should be similar in all societies throughout known human history.3 The occurrence of the most common disorder, achondroplasia, is of one mutant baby in 34,000 live births, or, ifwe include related types, ofone in 10,000. When the disorder is due to a dominant genetic mutation, as in achondroplasia, if one parent is I V6ronique Dasen, Lincoln College, Oxford. Paper read at the Wellcome Unit for the History of Medicine, Oxford, June 1986, and at the Oxford University Anthropological Society, October 1986. The final version has greatly benefited from discussions with Dr R. Wynne-Davies at Oxford and with Dr S. Braga, Inselspital, Berne. I am also very grateful to Prof. J. Baines, Prof. J. Boardman, Dr N. Horsfall, and Dr Smith (Nuffield Hospital) at Oxford, as well as to authors mentioned below for their valuable comments and suggestions. This paper presents some conclusions ofmy thesis on the status ofdwarfs and malformed people in Antiquity, submitted at Oxford University in 1988. ABBREVIATIONS ABV J. D. Beazley, Attic black-figure vase-painters, Oxford, Clarendon Press, 1956. ARV2 J. D. Beazley, Attic red-figure vase-painters, 2nd ed., Oxford, Clarendon Press, 1963, 3 vols. LA W. Helck, E. Otto, W. Westendorf (eds.), Lexikon der Agyptologie, Wiesbaden, Harrassowitz, 1972-1986, 6 vols. Wb A. Erman, H. Grapow, Worterbuch der agyptischen Sprache, repr., Berlin, Akad. Verlag, 1971, 7 vols. 2 Today, in western countries, most affected persons are between 100cm and 140 cm in height, but some people can be as short as 70 cm. See the standards established by J. M. Tanner, R. H. Whitehouse, and M. Takaishi, 'Standards from birth to maturity for height, weight, height velocity and weight velocity: British children', Arch. Dis. Childhood, 1966, 41: 454-471, 613-635. Compare W. A. Horton, J. I. Rotter, and D. L. Rimoin, 'Standard growth curves for achondroplasia', J. Pediatr., 1978, 93: 435-438; and A.-M. E. Nehme, E. J. Riseborough, and S. J. Tredwell, 'Skeletal growth and development of the achondroplastic dwarf, Clin. Orthop., 1976, 116: 8-23. In this paper, I will use the term "dwarf" frequently, not condescendingly, but as a convenient generic word including mythical, as well as human, short people. 3 M. D. Grmek, Les maladies a l'aube de la civilisation occidentale, Paris, Payot, 1983, pp.21-30. On future perspectives see A. E. H. Emery and D. L. Rimoin, 'Nature and incidence of genetic disease', in A. E. H. Emery and D. L. Rimoin (editors), Principles and practice of medical genetics, Edinburgh, Churchill Livingstone, 1983, vol. 1, pp. 1-3; and F. Vogel, 'Mutation in man', ibid., pp. 26-48. 253 V&onique Dasen average-sized, there is one chance in two that the offspring will inherit the disorder.4 While ancient texts are scrappy and human remains rare, pictures of short people are extremely numerous and informative. Dwarfism has even probably been the most commonly depicted human phyisical disorder, since earliest times. My study is based on over a thousand representations of dwarfs (tomb reliefs, vase paintings, mosaics, statuary), which were found in Egypt, Greece, and in the Roman world; they range from the Predynastic Period in Egypt (about 3000 BC) to the end ofthe Roman Empire (fifth century AD). These pictures can complete the literary sources in two ways. On the one hand, a number of accurately observed pathological forms can be identified. Most previous studies date to the first part ofthis century and should be revised in the light of present medical nomenclature and of an increasing body of evidence;5 during the past decade, medical research has progressively refined the classification of the different types of short stature, which now include over eighty distinct forms. On the other hand, there are a number oficonographic conventions that may limit the realism of the depictions; the rendering of a pathology may be too stylized, or too crude, or it may mix imaginary anomalies (hybrid figures). These iconographic conventions can bring to light ancient folk beliefs that influenced medical understanding. No picture is innocent, no artist is "de bonnefoi". The way ofstylizing, ofselecting relevant features, of misconceiving the rendering of an anatomy, every choice on the artist's part, whether conscious or unconscious, can reveal how the condition was considered in the past. In this perspective, iconography offers us a unique means of approaching the history of collective attitudes and medical notions. I. MEDICAL DEFINITION Before analyzing ancient depictions, I present briefly the main types of growth disorders known today in order to define the visual features that may allow their identification in art, keeping in mind that ancient writers and artists could not differentiate between very similar conditions and only noted the most striking features of the prototype.6 4 R. J. M. Gardner, 'A new estimate ofthe achondroplasia mutation rate', Clin. Genet., 1977, 11: 31-38; J. L. Murdoch et al, 'Achondroplasia: a genetic and statistical survey', Ann. Hum. Genet., 1970, 33: 227-244. 5 See, for example, the studies ofH. Meige, 'Les nains et les bossus dans l'art', Nouvelle iconographie de la Salpetrie're, 1896: 161-188; P. Richer, L'art et la medecine, Paris, Gaultier, Magnier, 1901; M. A. Ruffer, 'On dwarfs and other deformed persons in Ancient Egypt', Studies in thepalaeopathology ofEgypt, University of Chicago Press, 1921, pp. 35-48; W. R. Dawson, 'Pygmies, dwarfs and hunchbacks in Ancient Egypt', Ann. med. Hist., 1927, 9: 315-326; B. Schrumpf-Pierron, 'Les nains achondroplasiques dans l'ancienne Egypte', Aesculape, 1934, 24/9: 223-238; W. R. Dawson, 'Pygmies and dwarfs in Ancient Egypt', JEA, 1938, 24: 185-189; K. R. Weeks, 'The anatomical knowledge of the ancient Egyptians and the representation of the human figure in Egyptian art', PhD diss, Yale University, 1970. More recently, F. N. Silverman, 'De l'art du diagnostic des nanismes et du diagnostic des nanismes dans l'art', J. Radiol., 1982, 63: 133-140. 6Select bibliography: D. Bergsma (editor), Birth defects compendium, 2nd ed., London and Basingstoke, Macmillan Press, 1979; V. A. McKusick, Heritable disorders of connective tissue, 4th ed., St Louis, C. V. Mosby, 1972; P. Maroteaux, Diseases of children, Philadelphia, J. B. Lippincott, 1979; H. Moll, Atlas of pediatric diseases, Philadelphia, London, Toronto, W. B. Saunders, 1976; D. L. Rimoin and R. S. Lachman, 'The chondrodysplasias', in Principles andpractice ofmedical genetics, op. cit., note 3 above, pp. 703-735; D. W. Smith, Recognizable patterns ofhuman malformations, 2nd ed., Philadelphia, W. B. Saunders, 1976; R. Smith, 'Disorders ofthe skeleton', in Oxfordtextbook ofmedicine, Oxford, Oxford University Press, 1983, vol. 2, pp. 17, 30-36; J. W. Spranger, L. 0. Langer, and H. R. Wiedemann, Bone dysplasias. An atlas of 254 Dwarfism in Egypt and classical antiquity There are two main categories of short stature: a disproportionate type, where restricted growth affects the limbs, or the trunk, or both in varying degrees, and a proportionate type, where the whole body is involved and remains small. In the most frequent types (for example, achondroplasia, hypochondroplasia) men and women seem to be equally affected. The body proportions are defined by the measurement of the upper to lower segment ratios (U/L), taken from the top ofhead to pubis and from pubis to heel.7 Normal adults have an upper/lower segment ratio of approximately 0.95 and an arm span equal to their total height (fig. la). The deviation ofU/L from the average defines the type of dwarfism present, with short limbs, a short trunk, or a proportionate stature. DISPROPORTIONATE SHORT STATURE Short-limbed dwarfism The most common type ofdwarfism is achondroplasia, a short-limbed disorder due to a dominant genetic mutation that involves the ossification process of the cartilaginous bones, initiated in the uterus. The limb shortening is severe, while the trunk is almost normal in length (fig. lb and plate la); the head shows a large cranial vault and small facial bones. The prominent forehead is due to the normal development ofthe cranium from membraneous bone, while the base of the skull ossifies in cartilage and remains shorter: the small foramen magnum may produce hydrocephalus. The nasal bridge is depressed; in later development, protruding jawbones are common. A pronounced pelvic tilt induces lumbar lordosis with very prominent abdomen and buttocks. There may be associated thoracolumbar kyphosis. The finger tips reach only to the top ofthe thigh (greater trochanter), or even the hips (iliac crest). Joint mobility at the shoulders and the elbows is limited; the arms do not extend normally and fall in a stiffened way to the sides. The legs are short and slightly bowed. Folds ofskin are due to the abnormal shortening ofthe bones. This growth disorder is not associated with metabolic defects, and mental development is usually unimpaired. Physical strength is normal, and agility can be very developed. The genital organs are normal and sexual maturity occurs at the proper time, although the small pelvis may create obstetric problems.
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