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    Knives, gunfights, pituitaries

    Neuro-ophthalmologists in battle would have altered outcome


    There is some controversy about this, but a number of people who ponder this type of question have an explanation for Goliath’s failure, and it is not that he was stupid. Rather, they believe that his pituitary was at fault.1

    Not only do they suspect he had acromegaly, but that he probably had a familial (autosomal dominant) form of the disease.2 Familial isolated pituitary adenoma (FIPA) is an autosomal dominant condition with incomplete penetrance caused by germline mutations of the aryl-hydrocarbon receptor-interacting protein gene 4. Goliath’s brother and three sons were giants and one of his sons had six fingers on each hand and six toes on each foot. It must have been quite a treat to receive a year-end postcard of that family!

    Anyway, the arguments supporting acromegaly in Goliath include:

    • His height was “six cubits and a span”—apparently about 6’ 9” (pretty big for those days).
    • He presumably had poor vision, as evidenced by his having a shield bearer lead him down to the field of battle to face David, his statement that David was carrying sticks when he had only a single shepherd’s staff, and his failure to duck or hide behind the shield as David prepared to launch his rock and his failure to dodge the missile that beaned him.

    My conclusion? If the Philistines had neuro-ophthalmologists in their army, the battle would have turned out very differently.


    1. Berginer VM. Neurological aspects of the David-Goliath battle: Restriction in the giant’s visual field. Isr Med Assoc J. 2000;2:725-727.

    2. Donnelly DE, Morrison PJ. Hereditary gigantism-the biblical Goliath and his brothers. Ulster Med J. 2014;83:86-88.

    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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