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Pharaoh explained

The Baltimore Sun

Who will speak for the pharaoh Akhenaten, the builder of temples and cities who reigned over ancient Egypt 2,400 years ago?

Who will explain his oddly shaped head, sunken eyes, pendulous breasts and a belly that made him look pregnant?

That would be Irwin M. Braverman. The Yale medical school dermatology professor will address a University of Maryland medical school conference today on the genetic disorders that might have determined Akhaenaten's strange appearance. He has spent months pouring over images of Akhenaten and come up with a theory about the teenage pharaoh's peculiarities.

"I think it's very exciting," he said.

Braverman's forum is the Maryland's 14th annual Historical Clinicopatholoical Conference, held each year to diagnose disorders that afflicted prominent historical figures.

The conference, open to the public, is designed to spark interest in pathology and encourage doctors to enhance their powers of observation when they diagnose disorders, according Dr. Philip Mackowiak, the UM professor who organizes the conference.

"I firmly believe it makes one a better physician," said Mackowiak, who has written a book about the disorders that may have killed a variety of historical figures.

Dr. Barry Daly, a professor of diagnostic radiology at the medical school, will speak tomorrow about CT scans conducted on a mummy brought to University of Maryland Medical Center from the Walters Art Museum on March 18.

Scientists are still evaluating the scans, but so far they appear to show the mummy was a woman between 40 and 60, and not a young girl as they once thought, said Regine Schulz, the Walters' curator of ancient art and director of international curatorial relations.

The shape of the pelvis and the size of her skeleton indicate that she was about 4 feet 10 inches tall, while signs of osteoarthritis in her shoulders and spine indicate middle age, Daly said.

Previous UM historical pathology conferences have speculated on what killed Wolfgang Amadeus Mozart (kidney failure), Ludwig von Beethoven (syphilis), Alexander the Great (typhoid fever) and Booker T. Washington (malignant hypertension).

Akhenaten doesn't share quite the same name recognition these days. "He's not like Columbus or Alexander the Great," said Mackowiak. "But he is prominent, he is famous, he had what was probably a mysterious medical disorder and there's enough evidence about it to put on a conference."

Mackowiak, who is also chief of the medical service at the Baltimore Veterans Affairs Medical Center, said he selected the pharaoh because he was important and medical historians have speculated for years about his unusual appearance. "Either he was just uncommonly funny looking-ugly, or he had some sort of genetic disorder," Mackowiak said.

Akhenaten plays a central role in the history of ancient Egypt in part because many believe he was history's first monotheistic ruler, said Donald B. Redford, a professor of classic and ancient Mediterranean studies at Pennsylvania State University, who also will speak at the conference.

"He's the favorite son of ancient Egyptian history," said Redford, who has been studying Akhentaken for more than 40 years.

Subsequent rulers brought back Egypt's pantheon of gods and tried to wipe out any evidence of Akhenaten's rule, dismantling his temples and monuments. His existence was confirmed only when archaeologists found statues and busts embedded in walls and foundations of later buildings where they were used as construction materials by subsequent rulers, Redford said.

"Egyptians were practical, and they simply recycled his masonry," he said.

In the 1960s, medical experts theorized that Akhenaten suffered from Froehlich's syndrome, which would account for the unusual body shape. Others have speculated that he suffered from Klinefelter syndrome, a chromosomal abnormality that can enlarge a man's breasts.

But both those conditions cause sterility - and Akhenaten had six daughters and two sons.

Braverman believes Akhenaten's feminine characteristics were the result of familial gynecomastia caused by an inherited hormone imbalance known as aromatase excess syndrome. His misshapen head was the result of craniosynostosis, where the joints in the skull fuse at too early an age and interfere with healthy skull formation.

No one is sure what killed Akhenaten, but a plague of some sort ravaged the area at the time of his death.

Some Egyptologists believe a mummy found about 100 years ago in Luxor, in a region known as the Valley of the Kings, was his remains. But that has yet to be confirmed with any genetic tests.

There is some question as to whether Akhenaten even looked as strangely as depicted in ancient drawings known as hieroglyphs.

"Hieroglyphs aren't meant to be accurate representations," said Betsy Bryan, a professor of Egyptology at the Johns Hopkins University.

The same elongated head, large belly and pendulous breasts can be found in depictions of other Egyptian royalty in the years following his reign, experts say. The question is whether artists at that time may have been incorporating symbols of fertility and the afterlife into their work.

"Akhenaten is a good topic for discussion, but from an Egyptologist standpoint, there's a lot going on below the surface in most of these works," Bryan said.

Other experts, including Redford, are convinced Akhenaten looked the way statues show him.

Evidence of Akhenaten's congenital conditions show up in many of the 300 or so statues, busts and hieroglyphs that survive him, experts said.

"Overall treatment of the king's figure never varies, including a statue of him in the Louvre with an elongated face, enormous belly and spindly legs," Redford said.

Braverman agrees with Redford: Akhenaten was one strange-looking ruler.

There is evidence his family kept him from public view until he ascended the throne, and the same misshapen features can be seen in his ancestors, daughters and other relatives, including King Tut, who was either a brother, a son or both a son and son-in-law, Braverman said.

"He was the first pharaoh to insist on realistic representation from the artists of his time," Braverman said.

dennis.obrien@baltsun.com

Today's gathering is open to the public and is scheduled for 1 p.m. May 2 at Davidge Hall on the medical school campus at the northeast corner of Lombard and Greene Streets.

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