A Mighty Foe

The city of Florence has a long and rich history of associating itself with the Biblical hero David, usually through artistic means. According to the Old Testament, the young David was able to defeat the giant Goliath not through brute strength, but by cunningly knocking out the bigger man with stones thrown from a slingshot (and subsequently killing Goliath by severing his head). The story is one of the brave underdog overcoming a mighty foe. Florence, a relatively small city lacking in military strength, fought against the great city of Milan in the first decade of the fifteenth century, and were proved victorious through a combination of skill and luck (an outbreak of plague halted Milan’s attack on the city). Florence adopted David as their own icon: the young hero was captured in sculpture by the likes of Donatello and Michelangelo and painted by great Florentine masters such as Andrea del Castagno (circa 1421-1457). This particular work of art is, in fact, a ceremonial battle shield, unusually showing a narrative scene as opposed to a plain coat of arms. Here, David is depicted in simple dress, forgoing the armor worn by Goliath, holding his slingshot, with the giant’s severed oversized head at his feet. Though the original owner of this shield is unknown, it seems likely that the patron’s aim was to associate himself with the triumphant David.

Dr. Deirdre Donnelly and Prof. Patrick Morrison, both of the Centre for Cancer Research and Molecular Biology at Queen’s University, Belfast, have proposed that the giant Goliath may, in fact, have suffered from the medical condition of gigantism. In 1 Samuel 17, Goliath’s height is listed as six cubits and a span—one cubit equals one and half feet, meaning Goliath stood over nine feet tall. The scholars at Belfast have traced Goliath’s ancestry through Biblical references, and by examining his family tree have suggested that he may have inherited a pituitary disorder caused by a certain gene known as AIP (aryl hydrocarbon receptor interacting protein). This mutation may have resulted in early onset autosomal dominant pituitary gigantism, which would account for Goliath’s large size.

Pituitary gigantism occurs when excess growth hormone is secreted in childhood—before the bones have finished growing. Excessive growth hormone after bone maturation causes bone thickening rather than lengthening. Acromegaly is the more general term for excessive growth hormone production. The most common cause is a tumor of the pituitary gland that causes the gland to swell and secrete the hormone at levels in excess of what the body needs. Apart from the obvious manifestation of large size, there are many other effects on the body. The tumor itself can cause headaches. The pituitary sits directly below the crossing of the optic nerves. As it grows, it can push on these nerve fibers and cause a loss of vision in the periphery on both sides called bitemporal hemianopia—a form of tunnel vision. This would give David an advantage if sneaking up from the side of Goliath. Swollen and overgrown joints can lead to carpal tunnel syndrome—compression of a nerve as it goes through the wrist. This can cause sensory loss, pain, and weakness in the hands—an obvious limitation when fighting. Heart failure is common and can lead to fatigue and poor exercise tolerance. Obstructive sleep apnea causes sleepiness and impaired cognitive function. With all of these disadvantages, compared with the young, healthy, nimble, strong, and smart David—Goliath didn’t really stand a chance.