The 14th Historical Clinicopathological Conference

Humanoid Praying Mantis

Historical figures, whose deaths have not been ­satisfactorily explained, are patients for our annual ­conference, sponsored by the Baltimore VA Health Care System, medical school, and Medical Alumni Association. Past conferences have examined the deaths of Edgar Allan Poe, Alexander the Great, Mozart and others. Below is an abbreviated case history of this year’s patient:

This patient ruled Egypt during the twilight of the house of the Thutmosids as a revolutionary and an iconoclast. He was the second son of Amenophis III and ascended the Horus Throne of the Living only because his older brother died young of unknown cause. It has been suggested that when he donned the white and red crowns of Upper and Lower Egypt, the patient was ill-prepared to rule the most powerful empire on earth; because previously he had been excluded from court functions owing to some congenital ailment which made him hideous to behold. Although some speculate that excessive inbreeding caused his deformities, others disagree, pointing out that he was the product of a gene pool that had not been polluted by close intermarriage for at least two generations.

During his reign, the patient fomented revolution within his own kingdom, elevating Aten, the Sun-disc, above all other gods in Egypt’s pantheon, eclipsing even the all-powerful Amun, who had ruled in Thebes as king of the gods for centuries. Some have suggested that in this respect, he was the first monotheist and that Aten, his one and only god, was the avatar of the god of Abraham, Isaac and Jacob and the god of Muhammad as well. It was this “heresy” which inspired his successor, Horemheb, to systematically obliterate every trace of the patient’s existence a little more than a decade after his eyes turned to behold the Sun-disc for the last time.

His distinctive physical features depicted in statues and reliefs are at once odd, strikingly diverse and inconsistent. In existing statuary, the patient appears more natural and life-like than in reliefs. Moreover, likenesses produced at the beginning of his reign depict him in traditional pharaonic guise with little to distinguish his image from the perfect physiques of other pharaohs of the 18th Dynasty. Only after he concentrated his worship on Aten was the patient portrayed in his new image. That image, at its most florid, is androgynous, with striking abnormalities of the head, chest, abdomen, hips, extremities and spine.

The patient’s skull, in some representations, is malformed, with an elongated head, almond-shaped eyes, lantern-like jaw, protruding teeth and large ears. The neck is inordinately long and serpentine. In some representations the chest has a deeply depressed sternum and in others, a protruding sternum characteristic of a pigeon breast deformity. The breasts are sometimes as large and round as a woman’s, as are the hips and buttocks. These feminine characteristics are all the more striking because, more often than not, they are accompanied by a belly as prominent as that of a pregnant woman, as if to emphasize the patient’s fertility and to validate his claim that he was “the Nile which fills the entire land.” Moreover, the only nude statue of the patient known to exist lacks a phallus. In fact, it shows no evidence of external genitalia whatsoever. In many representations, the shoulders are gaunt, the arms and legs long and spindly, with flat feet, spider-like fingers and toes, and knee joints that flex posteriorly. In some representations, these distortions of the head, body and extremities are also shown in the patient’s children, as well as in his wife.

Only a bit more is known of the health of the patient or of his family. He had six daughters by his principal wife. Many of his family died suddenly, including his second wife and queen mother. The reason for these sudden deaths is unknown. However, plague was ravaging the Levant at the time and might also have invaded Egypt to decimate the royal family. The patient survived the plague only to die at Akhenaten in the summer of 1359 B.C.E., under obscure circumstances. He was not yet 40 and had ruled the land of Egypt for 17 years.

Irwin M. Braverman, MD

Donald B. Redford, PhD