Hat tip to Mind Hacks for reporting on a recent very controversial hypothesis by Prof. Benny Shanon of the Hebrew University of Jerusalem that psychotropic drugs may have played a role in Israelite religious experience. This reminded me of a neuroscientifically interesting, hopefully less provocative, example of medico-deductive reasoning that I came across many years ago.
Prof. Michael Saling of the University of the Witwatersrand Department of Neuropsychology recounted this anecdote at a clinical neuropsychology course in around 1988/9. A question in the Wits final year neurology residents' exam read simply: "How did David kill Goliath?"
The answer, as I recall (it was 20 years ago), was that Goliath being a giant, may have had a pituitary tumor. The tumor's pressure on the optic chiasm resulted in a bilateral hemianopsia (visual field defect). It also led to the weakening of the arteries in the Circle of Willis. The visual field defect allowed David to get closer to Goliath and have a more accurate slingshot. The impact and penetration of the stone into Goliath's forehead, resulted in the rupture of the arteries and severe haemorrhaging. Goliath lost consciousness, allowing David to decapitate him.
I can't recall if Prof. Saling mentioned whether any of the residents got it right!
This graphic image of a pituitary macroadenoma from eMedicine.
When preparing this post, I tried to find the origin of the theory. The first similar account seemed to be in a 1983 letter by Rabin and Rabin to the New England Journal of Medicine, entitled "David, Goliath, and Smiley's people. I was unable to get access to it online, but I found this summary of their theory by Dr. Stanley Sprecher:
Undoubtedly Goliath's great size was due to acromegaly secondary to a pituitary macroadenoma. This pituitary adenoma was apparently large enough to induce visual field deficits by its pressure on the optic chiasm, which made Goliath unable to follow the young David as he circled him. The stone entered Goliath's cranial vault through a markedly thinned frontal bone, which resulted from enlargement of the frontal paranasal sinus, a frequent feature of acromegaly. The stone lodged in Goliath's enlarged pituitary and caused a pituitary hemorrhage, resulting in transtentorial herniation and death.
As can be seen, the pathology is different from my recollection of Dr. Saling's account. A review of other possibilities by Dr. Vladimir Berginer can be found online in Medical Archaeology
We try and come up with scientific data for everything. But the same bible that speaks of Goliath also speaks of the people of Anak who were said to be very large tall people. Goliath was said to be a decendant of Anak. The children of Israel failed to enter the Promised land because of the giants of Anak. The spy's stated that "we were like grasshoppers before them". They did not enter because of fear and lack of faith in their God. Caleb and Joshua later entered the Promised land after the 40 years of wandering in the wilderness. The previous generation died out and the only two who entered were Joshua and Caleb. Caleb had spoken 40 years before and said that the land was theirs for the taking because God had told them he would give them victory. Joshua and Caleb were promised land when they entered for their faith. Caleb, being 80 years old then had not abated in strength. When Joshua asked Caleb what part of the Promised land he wanted for his tribe and family, Caleb said" give me the giants.....I want Anak" (paraphrase mine) So if Goliath had a pituitary gland tumor, then all of his descendants must have had the same problem.
ReplyDeleteThank you for your comment. This was merely an exercise in medico-inductive reasoning. I take your point, however, just as the bible is not a scientific treatise the emergence of man, it is problematic to subject incidents in the bible to scientific scrutiny, i.e. David and Goliath, or the walls of Jericho. Remains interesting though.
ReplyDeleteYou're welcome
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