The Roman giant”: overgrowth syndrome in skeletal remains from the Imperial Age

SHORT REPORT

“The Roman Giant”: OvergrowthSyndrome in Skeletal Remains from theImperial AgeS. MINOZZI,a* W. PANTANO,b P. CATALANO,b F. DI GENNAROb AND G. FORNACIARIaa Division of Paleopathology, Department of Translational Research and Advanced Technologies inMedicine, University of Pisa, Pisa, Italyb Special Superintendence to Archaeological Heritage of Rome, Rome, Italy

ABSTRACT A very tall skeleton was found during archaeological excavations in the territory of Fidenae, an administrativecentre of the Roman territorial organization, situated along the Via Salaria about 7 km north of Rome (Italy). Theindividual was a young male, dated back to the Imperial Age (3rd century AD), presenting a very tall but normallyproportioned stature, estimated around 202cm. The longbones showed incomplete epiphyseal union; therefore,the stature would probably have been taller, if he had lived longer. In this work, themetric data are comparedwiththose from the Roman Imperial Age population, and differential diagnosis is discussed.The skeletal evidence is characteristic of a form of gigantism, a rare growth disease that may be linked to

different syndromes. The most common etiology is associated with a dysfunction of the pituitary gland, whichcauses overproduction of the growth hormone (hGH) during childhood. This endocrine disorder stimulatescartilaginous activity at the growth plate, delaying epiphyseal fusion and resulting in increased bone length.Copyright © 2013 John Wiley & Sons, Ltd.

Key words: gigantism; growth disease; Italy; pituitary; Roman Imperial Age

Introduction

Skeletal remains belonging to a very tall individualwere found in a small cemetery, dated back to theImperial Age, discovered south-east of Fidenae (about7 km north of Rome, Italy).The extraordinary long bones indicate a growth

disease which may be linked to different syndromesthat produce excessive growth in most growth parame-ters. The most common etiology of overgrowth diseaseis due to a dysfunction of the pituitary gland, causingoverproduction of the somatotrophic or growthhormone (hGH). High exposure to the hGH producesgigantism in youths prior to epiphyseal fusion andacromegaly in adults (Aufderheide & Rodrìguez-Martìn,1998; Ortner, 2003).Growth disorders can also be due to a deficit of

development of the sexual organs before puberty, as

in Eunuchoid Gigantism (eunuchs are castrated males);it is characterized by a disproportionate increase in thelength of the lower compared to the upper limbs(Aegerter & Kirkopatrick, 1975). Tall stature associatedwith male hypogonadism can also be due to Klinefelter’ssyndrome caused by a chromosomal defect (Aufderheide& Rodrìguez-Martìn, 1998). Growth disorders also de-pend on cerebral gigantism associated with the so-calledSotos syndrome, in which the circulating levels of hGHare normal; children who are affected present acceleratedgrowth during the first two or three years (Melo et al.,2002). Growth increase and tall stature can also be dueto Marfan’s syndrome, a genetic disease affecting theconnective tissue, causing overgrowth of the lower withrespect to the upper limbs, with very slim diaphyses(Goodman & Gorlin, 1983).The presence of giants, like the tremendous legend-

ary individuals – such as Goliath killed by David – hasoften been reported in the past by ancient scriptures,but the first medical description of this disorder, called‘acromegaly’, was made in 1886 by Pierre Marie, whomarked the beginning of the study on pituitary disease

* Correspondence to: Simona Minozzi, Divisione di Paleopatologia, Storiadella Medicina e Bioetica, Università di Pisa, Via Roma 57, 56126 Pisa, Italy.e-mail: [email protected]

Copyright © 2013 John Wiley & Sons, Ltd. Received 13 September 2012Revised 9 April 2013

Accepted 19 April 2013

International Journal of OsteoarchaeologyInt. J. Osteoarchaeol. (2013)Published online in Wiley Online Library(wileyonlinelibrary.com) DOI: 10.1002/oa.2322

(Marie, 1886; Sheaves, 1999). Therefore, the cause ofacromegaly and gigantism finally became known inthe early years of the 20th century. The interest ingiant individuals was widespread in circus shows anddisplays of giant skulls and skeletons first appeared in18th century museums, but we have no reports abouttheir presence in the Roman world during the ImperialAge. The only exception was the Emperor Maximinusthe Thrax (235–238AD), described by literary sourcesas a human mountain, and according to the image onhis coinage had an acromegalic head; therefore, hemay well have been a giant (Roberts, 1978).In palaeopathological literature gigantism has been

rarely documented: a Polish female skeleton probablyaffected by gigantism dating to 12th–13th centuriesAD was described by Gladykowska-Rzeczycka et al.(1998), and a probable case was reported in a FifthDynasty skeleton (2494–2345 BC) from Giza, Egypt(Mulhern, 2005). More common cases of acromegalywere described by Brauer (1991), Brothwell (1981),Hosovski (1991), Ortner (2003), and Charlier &Tsigonaki, 2011.Cases of gigantism are better known in modern

times such as the famous case of the Irish Mr. Byrne,who died in 1783, and other case reports on generallyfamous giants published in the early years of the 20thcentury, when the abnormal stature attracted theattention of the community and also of doctors (Fulton,1946; Bergland, 1965); exhaustive descriptions in themedical literature have been reported by de Herder(2009). Some skeletons of giants are exposed inmuseums,but the oldest died only 250 years ago (Aufderheide &Rodrìguez-Martìn, 1998). Modern and more recent casesof pituitary gigantism are reported in endocrinologicalliterature (Vogl et al., 1994; Gläsker et al., 2011; Danielet al., 2013).

Materials and methods

The skeletal remains examined in this research werefound in 1991 during archaeological excavations inthe modern large estate of ‘Torre Serpentana’, to theeast of the 5th mile of the Via Salaria (di Gennaro &Finocchietti, 2006). In Roman times, this area wasindirectly managed by Rome, through the Municipium(administrative centre of the Roman territorial organi-zation) of Fidenae, the site of which lies 1.3 km fromthe burial area; Roman Fidenae arose in the site of aprevious independent Latin city, then conquered byRome (di Gennaro, 2006), from which it was dividedby Anio (Aniene river).The small cemetery probably refers to a community

living and working on one of the hundreds of farms(villae) documented in this sector of the Roman ager(di Gennaro et al., 2005). A total of 31 tombs wereexcavated, and the skeletal remains of 28 individualswere recovered. A tomb (T.30) longer than the otherswas found (2.6m), and the skeletal remains appearedto be those of a very tall individual (Pantano et al.,2011). Tomb 30 belongs to a group of simple fossagraves (originally covered with pottery roof tiles) thatseems to have been prepared and used during the firsthalf of the 3rd century. The individual was buried insupine posture with the hands placed under his pelvis,with no funerary goods. The skeleton was completeand in good condition, but the skull was fragmented.Diagnosis of the sex was performed according to the

morphological characteristics of the skull and pelvis(Ferembach et al., 1980; Buikstra & Ubelaker, 1994).Age determination was based on dental wear, stage offusion of the cranial sutures, and stages of epiphysealclosure (Brothwell, 1981; Meindl & Lovejoy, 1985;Scheuer & Black, 2000; Canci & Minozzi, 2005); the

Table 1. Grade of epiphyseal closure in the main bones of individual T.30 and estimated age

Bone Right Left Estimated age

spheno-occipital suture fused >20proximal humerus partially fused unfused 18–20distal humerus fused fused >18proximal radius visible epiphyseal line visible epiphyseal line 14–18distal radius visible epiphyseal line / 17–22proximal ulna fused fused >16distal ulna unfused / <17vertebral annular epiphyses partially fused partially fused 17–24iliac crest partially fused unfused <21proximal femur visible epiphyseal line visible epiphyseal line 16–20greater trochanter fused fused >17lesser trochanter unfused unfused <16distal femur visible epiphyseal line unfused 14–20proximal tibia fused fused >16distal tibia fused fused >15

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Copyright © 2013 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2013)

pubic symphysis and auricular surface phases in thepelvis were evaluated (Lovejoy et al., 1985; Burns, 1999).The mandibular and postcranial bones were mea-

sured and the bone length ratio was calculated follow-ing the classical methods described by Martin & Saller(1957). Stature reconstruction was performed usingthe anatomical method proposed by Fully (1956) andrevisited by Raxter et al. (2006, 2007), including theage term of 18 years, which is probably one of the bestestimates of living stature. This method is based on thesum of all the skeletal components of height, but, in in-dividual T.30, the skull was partially fragmented andsome vertebrae were missing. Stature reconstructionwas also based on regression equations applied to longbone lengths. There are different regression formulaeobtained from different skeletal samples, but we usedthe classical formulae of Trotter & Gleser (1958) forWhite samples, which according to Formicola (1993)fit better with individuals over 179 cm. Moreover, theapplication of this method permits a comparison withother samples.Osteometric data and stature for individual T.30 were

compared with the mean values obtained from different

Roman Imperial Age male samples (unpublished datafrom the anthropological archive of the Service ofAnthropology of the Special Superintendence toArchaeological Heritage of Rome). The z-score wasaimed at evaluating the distance between the sizes ofT.30 and averages of the normal population. Z-scorewas calculated as the difference between T.30 measure-ment and average of the comparison samples dividedby standard deviation (SD).Skeletal pathologies were recorded following macro-

scopic and X-ray examination.

Results

The skeletal remains were attributed to a young male.The age estimation methods produced incongruentresults: the cranial suture closure is consistent with anage range of 35–45 years, while dental wear suggestsa range of 20–30 years. Epiphyseal closure does notprovide consistent evidence of age at death becausethe pathology may have delayed the fusion(Aufderheide & Rodriguez-Martin, 1998; Melmed &

Figure 1. Fragment of occipital bones of individual T.30 where the pituitary area of the sella turcica is partially observable. This figureis available incolour online at wileyonlinelibrary.com/journal/oa.

Gigantism in a Roman Skeleton (3rd Century AD)


Kleinberg, 2011). Moreover, the stage of epiphysealclosures shows variability and scarce uniformity be-tween the left and right sides, as reported in Table 1,and is consistent with an age range of 16–20 years.The pubic symphysis and auricular surface phases arein agreement with an age range of 18–20 years.Although partially fragmented, the skull presents al-

most normal dimensions and morphology, but thethickness of the frontal and parietal bones is irregular,with very thin spots and thicker areas, in addition tothe frontal internal plate which shows a slight form ofhyperostosis frontalis interna. External auditory exostosis ispresent in the right acoustic canal, half-occluding theexternal meatus. The sphenoid bone is not conserved,owing to postmortem damage, but a fragment of thehypophyseal fossa of the sella turcica is fused with theoccipital bone. The pituitary area appears enlarged anddepressed; in fact, the normal size of anterioposteriordiameter for the sella turcica is 11.3� 1.1 (Axelsson et al.,

2004), while in individual T.30, the partial dimensionsare 16mm at the anteroposterior diameter and 17mmat the transversal axis, but could be larger and longer asthe bone is only partially conserved (Figure 1).The maxillary and mandibular bones are massive and

prominent with a teeth-to-teeth occlusion; the jaw haslarge mandibular condyles and is very wide and longwith a prominent chin (Figure 2).Large residual vascular channels are visible on the

anterior surfaces of the thoracic vertebrae, a conditionoften observed in infantile skeletons with strongvascularized bones, but not in youths like individualT.30. This suggests active bone stimulation by con-tinuing growth.The most evident anomaly is represented by the

large size of all the bones: the postcranial bones arevery long with regular morphology and withoutpronounced musculature (Figures 3, 4). The handsand feet present extremely long bones. X-rays show

Figure 2. Teeth-to-teeth occlusion of individual T.30 (top). Comparison of the mandible between T.30 and a normal male individual (bottom). Thisfigure is available in colour online at wileyonlinelibrary.com/journal/oa.

S. Minozzi et al.


that cortical thickness and long bone length wereaffected proportionally (Figure 5).The proximal epiphysis of the femurs shows a

change in head orientation: the head and the foveacapitis are vertically rotated (Figures 5, 6). The proximalepiphysis of the tibias is also tilted towards the midlineresulting in genu valgum with medial bowing of the legsat the knee level, with slight different inclination of thetibial plate between the two tibias which, associatedwith non-uniformity of the epiphyseal closure, pro-duced the difference of 10mm observed in their totallengths (Table 2).These anomalies probably reduced the mobility and

working abilities of this individual, in particular in thelower limbs, where the musculo-skeletal attachments ofthe muscle involved in walking show slight development,

and the slipped capital femoral epiphysis may havecaused loss of motion in the hip joint (Loder, 1998).The stature reconstruction resulted in 196.4 cm by

the anatomical method of Fully (1956), and 197.8 withthe Raxter et al. (2006, 2007) correction. These valuescan be increased by almost 3–4 cm as supplementarycorrection because many vertebral annular epiphyseswere unfused, as well as the distal epiphysis of the leftfemur. The stature was also calculated on the basis ofthe long limb bones by means of regression formulae(Trotter & Gleser, 1958, White formulae). Staturevalues ranged from 199.6 cm for the tibia to 205.9 forthe femur with an average value of 202.2 cm.Table 2 reports the skeletal measurements for

individual T.30, Table 3 reports selected comparativedata for male samples from other Roman Imperial Agenecropoles, and Table 4 shows the estimated statureby long bone lenghts. The average male Roman staturewas around 167 cm during the Imperial Age, and thedifference with T.30 is 35 cm (21% over the averagestature of the population), indicating an overgrowthsyndrome. Classic overgrowth disorders are those inwhich all or most of the parameters of growth andphysical development exceed 2 SD above average forthe person’s age and sex (Weaver, 1994). We can eval-uate this condition by means of the z-score tabulated inTable 3, where it is possible to verify that all the mainlong bone lengths are over 5 SD. The bone length ratioshows similar values between T.30 and the Romansample, indicating normal body proportions (Table 3).In conclusion, this individual exhibited a very tall but

normally proportioned stature due to an overgrowth dis-order; some long bones and vertebral bodies did not showcomplete epiphyseal union, and therefore the staturewould probably have been taller, if he had lived longer.

Discussion

The observed skeletal evidence is characteristic of agrowth disease which may be linked to different disor-ders. Differential diagnosis was performed taking intoaccount the overgrowth syndromes that produce ex-cessive growth in most growth parameters.In Eunhnuchoid Gigantism, puberty and epiphyseal

fusion are delayed, bones are long and tubular with lackof normal muscle development, and there is a dispro-portionate increase in the length of the lower com-pared to the upper limbs. This disease, as well ashypogonadism, induces bone loss in both cortical andtrabecular bone (Aegerter & Kirkpatrick, 1975; Chew,1991; Kung, 2003), anomalies not found in individual

Figure 3. Comparison of the long bones of the upper limb betweenT.30 and a normal male individual. This figure is available in colour on-line at wileyonlinelibrary.com/journal/oa.



T.30 in which X-rays showed normal trabecular massand thick cortical bone.Klinefelter’s syndrome can be associated with delayed

skeletal maturation, small skull dimensions, short meta-carpals, radio-ulnar synostosis, and accessory epiphyses(Kosowicz & Rzymski, 1975; McAlister, 1988), notpresent in individual T.30.Cerebral gigantism associated with the so-called

Sotos syndrome induces a rapid growth during the firstyears of life with significant increase in head circumfer-ence and delayed psychomotor development (Meloet al., 2002), while Marfan’s syndrome induces over-growth of the lower compared to the upper limbs.These characteristics were not found in this case study.Pituitary gigantism and acromegaly are the most

common etiology of overgrowth disorder, caused byoverproduction of the growth hormone (hGH), associ-ated with a dysfunction of the pituitary gland(Aufderheide & Rodrìguez-Martìn, 1998; Ortner, 2003).Gigantism is a very rare condition, in which the

hypersecretion of hGH onset before epiphyseal closurestimulates cartilaginous activity at the growth plate andaccelerates linear growth of normal body proportionsultimately resulting in very tall stature. Gonadotropinsuppression causing delayed epiphyseal fusion andpuberty disorders are also quite common (Aegerter &

Kirkopatrick, 1975; Aufderheide & Rodrìguez-Martìn,1998; Melmed & Kleinberg, 2011). Overproductionof the growth hormone (hGH) during adulthoodresults in acromegaly, a more common condition thangigantism, in which the continuing secretion of hGHafter epiphyseal fusion stimulates the growth of theremaining cartilage and periosteum, causing over-growth of the facial bones, mandible, ribs, sternum,intervertebral discs, and marked periosteal bone appo-sition. Hyperpituitarism is often caused by a pituitaryadenoma, a benign tumour that can provide stimulusfor the hypersecretion of the growth hormone,resulting in body overgrowth with normal proportions(Resnick, 1988; Aufderheide & Rodrìguez-Martìn, 1998;Ortner, 2003).The pathological features observed in individual

T.30 are more consistent with a pituitary disturbancethan any other syndromes resulting in skeletal over-growth. In this case, we cannot talk of acromegalybecause T.30 presents some unfused epiphysis (Table 1).Moreover, acromegaly induces periosteal apposition andbone overgrowth in the mandible, hands, and feet,which were not observed in this case (Resnick, 1988).The very long proportionate bones and the

nonuniformity or delayed epiphyseal closure combinedwith possible enlargement of the sella turcica agree with

Figure 4. Comparison of the long bones of the lower limb between T.30 and a normal male individual. This figure is available in colour online atwileyonlinelibrary.com/journal/oa.

S. Minozzi et al.


hypophyseal abnormality onset during childhood,leading to a diagnosis of hyperpituitary gigantism.Other elements such as alteration of the frontal bone

and femur capitis support the diagnosis. Hyperostosisfrontalis interna is a condition in which there is thicken-ing of the internal table of the frontal bone and an as-sociation with pituitary gland disorders, acromegaly,toxic goiter, and diabetes has been reported in clinicalliterature (Fulton et al., 1990; Waldron, 2008). There-fore, endocrine diseases such as gigantism and acro-megaly can be associated with slipped femoral head,as observed in individual T.30 (Reeves et al., 1978;Feydy et al., 1997).

Conclusion

Differential diagnosis, performed considering otherovergrowth disorders, suggests that the most probableetiology of the pathological alterations observed isconsistent with pituitary gigantism. In particular, thepossible alteration of the hypophyseal fossa of the sellaturcica could be due to a pituitary adenoma that canproduce a dysfunction of the pituitary gland, causingoverproduction of the growth hormone (hGH).The life span of people affected by gigantism is not

high; in fact, several diseases may be associated withthis disorder such as chronic complications dominatedby cardiovascular and cerebrovascular diseases,

Figure 6. Femur of T.30 showing the slipped capital femoral epiphysis. Comparison between T.30 and a normal male individual. This figure is avail-able in colour online at wileyonlinelibrary.com/journal/oa.

Figure 5. X-ray of principal long bones of individual T.30. From theleft: humerus, femur, and tibias. In the femur, the slipped capitalfemoral epiphysis can be appreciated (arrow).



Table 2. Measurements of main bones for individual T.30

Bone Description Measurements (mm)

Cranium (1) g-op maximum cranial length 195(5) n-ba cranial base length 110(9) ft-ft minimum frontal breadth 102(10) co-co 123(17) ba-br cranial height 141(43) fmt-fmt 111(60) pr-alv 55(61) ekm-ekm 67.5(62) ol-sta palate length 52.5(63) enm-enm palate breadth 50

Mandible (65) kld-kld mandibular breadth 126.4(67) ml-ml anterior length 50(68) body length 117(69) id-gn chin height 31

left right(69.2) M2 body height 36.5 29(69.3) body thickness 12.3 11.7(70) go-kdm ramus height 85(71a) minimum ramus breadth 38 36.5

Clavicle (1) max length 165(6) circumference of midshaft 45

Humerus (1) max length 421(2) physiological length 420(3) proximal epiphyseal breadth 52 54(4) epicondylar breadth 65 67(5) max midshaft diameter 22 22.7(6) min midshaft diameter 18.1 18.3(7) min circumference of shaft 65 65(9) trasversal head diameter 45(10) vertical head diameter 46 46.6

Radius (1) maximum length 320(3) minimum circumference 42(4) mediolateral midshaft diam 17.2 16.7(5) anterioposterior midshaft diam 12.4 12

Ulna (3) minimum circumference 36(11) anterioposterior shaft diameter 12.8 13.2(12) mediolateral shaft diameter 15.7 15.8(13) mediolateral upper shaft diam 20.2 21.5(14) anterioposterior upper shaft diam 23.4 22.3

Femur (1) max length 607(2) physiological length 605(4) physiological subtrochanteric length 580(6) anterioposterior midshaft diam 36.5 36.5(7) mediolateral midshaft diam 28.8 28.8(8) midshaft circumference 101 103(9) mediolateral subtrochanteric diam 35 35.2(10) anterioposterior subtrochanteric diameter 31 30(15) vertical neck diameter 33.4(16) anterioposterior neck diameter 32.4(18) vertical head diameter 51.4(19) transversal head diameter 51.6

Tibia (1) total length 485 475(1a) max length 490 485(3) proximal epiphyseal breadth 74.3(8) anterioposterior midshaft diam 31 33(8a) anterioposterior nutrient foramen diam 35 37(9) mediolateral midshaft diam 23.3 23.7(9a) mediolateral nutrient foramen diam 24.5 24.6(10) min circumference 81 81

Fibula (2) max midshaft diameter 20.2(3) min midshaft diameter 15.7(4a) min circumference 40

Numbers in parentheses correspond to the coding of Martin & Saller (1957).

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respiratory, and musculoskeletal problems (Rossi et al.,1977; Sheaves, 1999). Many and different symptomscan be suffered by the person affected, including

muscular weakness, fatigue or lethargy, headache, visualimpairment, and rhinorrhea. The most frequent causesof death are cardiac or cerebral complications, which

Table 3. Selected measurements for T.30 compared with mean values for Roman Imperial Age male skeletal samples

T.30 Roman Imperial Age Males

mm N mean SD z score

Cranium(1) g-op maximumcranial length 195 25 187.2 8.7 0.9(5) n-ba cranial base length 110 10 100.9 6.2 1.5(9) ft-ft minimumfrontal breadth 102 33 88.5 34.9 0.4(17) ba-br cranial height 141 13 134.5 4.1 1.6(62) ol-sta palate length 52.5 3 46.3 3.5 1.8(63) enm-enm palate breadth 50 9 37.5 1.2 10.7

Mandible(65) kld-kld mandibular breadth 126.4 18 124.6 6.7 0.3(68) body length 117.0 24 77.0 4.4 9.1(69) id-gn chin height 31.0 29 31.5 3.4 �0.1(69.2) M2 body height 32.75 37 26.8 2.0 3.0(69.3) body thickness 12 47 11.6 1.6 0.2(70) go-kdm (ramus height) 85 24 62.8 6.0 3.7(71a) minimum ramus breadth 37.25 38 32.9 2.3 1.9

Clavicle(1) max length 165.0 106 147.6 9.5 1.8(6) circumference of midshaft 45.0 148 39.9 3.2 1.6

Humerus(1) max length 421 142 316.2 21.1 5.0(5) max midshaft diameter 22.4 243 23.6 10.6 �0.1(6) min midshaft diameter 18.2 242 19.8 9.8 �0.2(10) vertical head diameter 46.3 147 46.1 3.3 0.1

Radius(1) max length 320 134 237.2 11.9 7.0(4) mediolateral midshaft diam. 17.0 225 17.4 13.0 0.0(5) anterioposterior midshaft diam. 12.2 221 13.6 9.9 �0.1

Ulna(3) min circumference of shaft 36 175 38.2 5.1 �0.4(11) anterioposterior diam. 13.0 228 14.9 2.4 �0.8(12) mediolateral diam. 15.8 227 16.4 2.1 �0.3Femur(1) max length 607 176 441.5 27.9 5.9(6) anterioposterior midshaft diam. 36.5 240 29.4 2.2 3.2(7) mediolateral midshaft diam. 28.8 241 27.7 2.1 0.5(18) vertical head diameter 51.4 197 46.9 3.0 1.5

Tibia(1) total length 480 147 357.3 21.9 5.6(8) anterioposterior midshaft diam. 32 213 31.0 2.5 0.4(9) mediolateral midshaft diam. 23.5 214 22.6 2.3 0.4

Fibula(2) max midshaft diameter 20.2 138 15.6 1.9 2.4(3) min midshaft diameter 15.7 137 12.4 1.6 2.0

Stature 202.2 69 167.1 5.9 5.9Bone length ratios(1) Radius / (2) Humerus 76.2 76.7(1) Tibia / (2) Femur 79.3 81.5Upper / lower limbs 68.2 68.7

N, sample size; Mean, group mean; SD, standard deviations.Numbers in parentheses correspond to the coding of Martin & Saller, 1957.



generally appear before age 30 years (Aufderheide &Rodrìguez-Martìn, 1998).Gigantism is a very rare disease (modern annual

incidence: 3/1,000,000), rarely documented in ancientskeletal remains (Mulhern, 2005), so we suppose thegreat height of the individual we have studied must havemade him a curiosity in Roman society. Unfortunately,we know nothing about the presence of giants in theRoman world and whether or not they were treateddifferently from others, but we know that during theImperial Age, the members of the high society devel-oped a pronounced taste for entertainers with evidentphysical malformations, such as hunchbacks and dwarfs.We presume that even a giant is likely to have arousedinterest and curiosity. However, the archaeological datarelated to the necropolis did not reveal any peculiardifference of the tomb of the giant, which belongs to agroup of simple fossa graves with no funerary goods.This case represents an extraordinary discovery for

the first time documenting gigantism in a completeancient skeleton, providing an important contributionto palaeopathological literature.

Acknowledgements

The authors thank Prof. D. Caramella and D. Giustini ofthe Univerisity of Pisa for x-ray examination, Dr. FlavioDe Angelis and Dr. Mauro De Filippis for their helpduring the research, and the anonymous reviewersfor their suggestions.

Declaration of interest

The authors declare that there is no conflict of interestthat could be perceived as prejudicing the impartialityof the research reported.

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Table 4. Maximum long bone lengths and estimated stature bymeans of different techniques

T.30 Max length (mm) Stature

(1) Humerusa 421 200.1(1) Radiusa 320 200.0(1) Femura 607 205.9(1) Tibiasa 480 199.6(1) Femur+ (1) Tibiasa 205.6Stature by anatomical methodb 197.8

Numbers in parentheses correspond to the coding of Martin &Saller, 1957.aTrotter & Gleser, 1958 estimation methodbFully, 1956, Raxter et al., 2006, 2007

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The Roman giant”: overgrowth syndrome in skeletal remains from the Imperial Age

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