Ann Thorac Surg 2002;74:973
© 2002 The Society of Thoracic Surgeons
The diseased statues
Daniel Roux, MDa,
Laurent Brouchet, MDa,
Chantal Diana, MDa,
Martin Thottan, MDa,
Alain Labat, MDa,
Yves Glock, MD, PhDa,
Gérard Fournial, MDa
a Départment de Chirurgie Cardiovasculaire Hôpital de Rangueil 1 ave Jean-Poulhès F-31403 Toulouse Cedex 4, France
To the Editor
During a humanitarian visit to Cambodia to operate, I encountered several children with advanced cyanotic heart disease and digital clubbing. I also visited Angkor temples where I noticed statues with clubbed toes in the temples of Angkor Thom (13th century) (Fig 1).
The presence of the sculptural detail of these statues is very interesting in that clubbing is not present on the older statues of Kompong Thom (7th century) and Angkor Vat (11th century). It is known that the doors of Angkor Thom, where the statues are located, were built in the 14th and 15th centuries, just before the fall of the Khmer empire .
The rapidity of the fall and the extent of destruction, which astonished archeologists, led to decadence and eventual abandonment of the Angkor capital in the 15th century. Natural causes, such as floods, droughts, or earthquakes, are not considered likely explanations because no hints of these catastrophes appear on the walls of the temples .
The fact that sculptors carved clubbed toes on the statues is evidence that they observed this anatomic detail on the feet of the local population. Since severe cyanotic heart disease and pulmonary arterial hypertension are the primary causes of clubbing, we postulate that perhaps a significant increase in these diseases in the population undermined the level of health and contributed to the rapid fall of the Khmer empire.
- Glaize M. Les monuments du groupe d Angkor. Paris: J Maisonneuve, 2001.