H19 The bronze diabetic

Abstract

Abstract Many works of art throughout the centuries have not only garnered intrigue, but also debate among physicians relating to a possible medical diagnosis depicted by the artist. Representation of both anatomy and disease with the use of votive offerings and forms of grotesque art is well recognized. Such work was particularly prevalent in pieces produced during the Hellenistic Age and includes statuettes, anatomical replicas, coins and other art work. Diseases such as acromegaly, Gorlin syndrome, lymphoedema, neurofibromatosis and ophthalmic disorders, among others, have been represented in such pieces. It had been thought by the suppliants that in presenting these offerings to the Gods, particularly Asclepius, the Greek god of medicine and son of Apollo, they could be cured from their ailments. An example of an artistic piece representing an individual with disease is that of a small bronze statuette described as a ‘Statue of an Emaciated Man’ and housed at the Dumbarton Oaks Research Library and Collection, Washington DC. It is a small bronze statue measuring at just 11.5 × 5 × 8.3 cm, and is thought to date from around the first century Bc to the first century Ad. It depicts a gaunt young man sitting atop a bench with his left hand held limply and an apparently swollen right foot. It has been suggested that this individual could have suffered from lead poisoning. However, lead neuropathy is typically symmetrical and emaciation is uncommon. A more common source of lead poisoning in ancient times was wine drinking, as lead was used both as a sweetener and preservative. In addition, occupational exposure was common as lead was used widely in pottery, painting, lead smelting and glass ceramics. A disease that could explain the three features of emaciation, wrist drop and a swollen foot is diabetes mellitus. Diabetes had been recognized in Egyptian manuscripts dating back to 1500 Bc commenting on ‘honey urine’. Diabetes has been well documented during the Hellenistic Age with Apollonius of Memphis in 250 Bc being credited for coining the term ‘diabetes’. Insulin insufficiency can cause emaciation mainly through ketosis. The neuropathy of diabetes mellitus can affect single nerves, and a radial nerve palsy resulting in a wrist drop has been recognized. The appearance of an apparent swollen foot could be due to a Charcot joint, which is a result of repetitive microtrauma-induced complications of polyneuropathy. In conclusion, we believe this statuette represents features consistent with diabetes mellitus and is a ‘bronze diabetic’.