Article:"Egil's Bones"
by Jesse L. Byock

The entire article on Paget's Disease/Egil's Saga from the January issue
of Scientific American. This was downloaded from the SciAmer area of
America Online before the hardcopy issue was released.

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Egil's Bones

An Icelandic saga tells of a Viking who had unusual, menacing features,
including a skull that could resist blows from an ax. He probably suffered
from an ailment called Paget's disease

by Jesse L. Byock

Egil, the son of Skalla-Grim, is the most memorable Viking to appear in the
Old Norse sagas. Born in Iceland in the early 10th century, he participated
in Viking raids and adventures throughout Norway, Sweden, Denmark, the east
Baltic lands, England, Saxony and northern Germany. Fierce, self-willed and
violent, Egil Skalla-Grimsson was also a fine poet and a man with a sense
of ethics. He epitomizes the Viking urge to travel into the unknown world
seeking action and fortune. From Athelstan, king of the Anglo-Saxons, he
receives valuable gifts and pledges of friendship, but from Erik Blood-Axe,
the Viking ruler of Norway, he hears death threats. Combining courage and
brawn with high intelligence, Egil survives war and treachery to live to an
old age of 80. He dies among his kinsmen in Iceland in about 990,
apparently from natural causes stemming from longevity.

For all Egil's heroic stature, however, there is something deeply troubling
about his character. Despite his prowess and secure social status, his
temperament, as well as his physical appearance, causes alarm. He is
portrayed as an ugly, irritable, brooding individual. In this respect, Egil
resembles his father and his grandfather, men described as physically
menacing. The saga clearly distinguishes them as physiologically different
from their kinsmen, who are depicted as fair and handsome.

What set Egil apart was more than simply a small, personal peculiarity.
Through prose and verse, the saga tells us that Egil became deaf, often
lost his balance, went blind, suffered from chronically cold feet, endured
headaches and experienced bouts of lethargy. Furthermore, the saga
describes unusual disfigurements of his skull and facial features. These
symptoms suggest that Egil may have suffered from a syndrome that results
from a quickening of normal bone replacement. The disease, first diagnosed
by Sir James Paget in 1877, runs in families and is uncannily similar to
Egil's affliction.

Is it really important to determine whether Egil suffered from Paget's
disease? I pondered this question at the beginning of my research and
considered it again when I realized that the enigma of Egil lies at a nexus
of medical science, history, archaeology and literary analysis. The answer
is yes: such a determination does matter. An understanding of Egil's
affliction is a critical step in assembling the evidence needed to evaluate
the historical accuracy of the Icelandic sagas. Do sagas provide accurate
information about a Viking period 250 years before they were written? Or
are they merely flights of fancy and fabrications by 13th-century authors?
Historians, literary scholars, archaeologists and linguists have all had
their say, but science has scarcely played a role in the debate. At times
the subject has stirred so much passion that one scholar promised to
maintain his view until forced by death to lay down his pen. The argument
would change drastically if a new source of information could be found.

For me, that new source lies unexpectedly in the field of modern medicine.
Rather than attributing conflicting aspects of Egil's personality to
artistic hyperbole, I believe the descriptions stem from the progress of
Paget's disease. In breaking tradition to arrive at these conclusions, I
frequently have recourse to another
science--philology, the historical and comparative study of language and
its relation to culture.

Family Stories

The Icelandic sagas constitute one of the largest collections of extant
vernacular narratives from medieval times. In 31 major sagas and scores of
shorter narratives, these texts recount the travels of the first
generations of Norse settlers in Iceland, the major Viking outpost in the
North Atlantic. Written in prose and studded with verse, the family sagas
are set in the period from 870 to 1030. Unlike myths and fantastic tales,
which the Icelanders also produced, the sagas are sober in style. With an
often stark realism they detail everyday agrarian and political life and
describe adventurous Viking voyages, including those to Greenland and
Finland. The crucial question that has remained is whether the sagas are
the product of a long oral tradition or the invention of authors after
Iceland became literate in the 13th century.

According to "Egil's Saga," Egil spent his final years with his adopted
daughter, Thordis, at the farm of Mosfell, in southwestern Iceland, not far
from the present-day capital of Reykjavik. Initially he was buried there in
a pagan grave mound. But 10 years later, when Iceland converted to
Christianity in 1000, Thordis and her husband, Grim, moved Egil's remains
to be interred at a small church built on their farm. About 150 years later
a second church was built about 500 meters from the first. Skapti, one of
Egil's prominent descendants, exhumed Egil's bones to move them to the new
churchyard. The final pages of "Egil's Saga" relate a curious tale about
Skapti's findings:

Under the altar some human bones were found, much bigger than ordinary
human bones.... Skapti Thorarinsson, a priest and man of great
intelligence, was there at the time. He picked up Egil's skull and placed
it on the fence of the churchyard. The skull was exceptionally large, and
its weight was even more remarkable. It was ridged all over on the outside
like a scallop shell. Skapti wanted to find out just how thick the skull
was, so he picked up a heavy ax, swung it in one hand and struck as hard as
he was able with the hammer side of the ax, trying to break the skull. But
the skull neither broke nor dented when hit; it simply turned white at the
point of impact, and from that result anybody could guess that it could not
have been easily cracked by small fry while still covered by skin and

This passage has often been used to exemplify the untrustworthiness of the
sagas. No matter how realistic the description may seem to be, everyone, so
the argument goes, knows that a 150-year-old skull could not possibly have
withstood the blow of Skapti's ax.

Modern medical knowledge, however, suggests that we cannot treat this
episode as a purely literary device intended to magnify heroic Viking
qualities. "Egil's Saga" precisely describes the skull as "ridged all over
on the outside like a scallop shell." The precision is striking because the
passage marks the only instance in all Old Norse literature that the
otherwise well-known words horpuskel (scallop shell) and barottr (ridged,
undulated, waved, corrugated, wrinkled) are used to describe human
characteristics. A "scalloped" bone surface, unique in descriptions of
Viking heroes, closely matches medical portrayals of Paget's disease.
Diagnoses repeatedly list irregularities of the outer skull surface,
describing its appearance as corrugated and wavy. Such a feature appears in
about one in 15 symptomatic cases.

Physicians have also noted the exceptionally resilient, ivorylike hardness
of the afflicted bones. Even the whitening of Egil's skull where Skapti's
ax struck is a clear indication of Paget's disease. When subjected to a
blow, the soft, pumicelike outer material of the enlarged Pagetic skull
gives way to a white, hardened, highly resilient core.

A Helm's-Rock of a Head

In the saga, Egil himself refers to his head in strange ways. In one poem,
written in response to a pardon granted him by his sworn enemy, King Erik
Blood-Axe, Egil composed this verse:

"I am not opposed,
Though I may be ugly,
To accepting my helm's-rock of a head,
From a ruler."

Paget's disease may have been responsible for Egil's memorable facial
appearance, a subject that over the years has engendered a great deal of
creative literary interpretation. The saga offers a detailed description of
Egil as he sits at a feast in England after battle. He faces King
Athelstan, the ruler who he believes owes him compensation for the death of
his brother, Thorolf.

Egil sat upright, but his head hung forward. Egil was marked by prominent
features. He had a broad forehead and large eyebrows, a nose that was not
long but enormously thick, and lips that, seen through his beard, were both
wide and long. He had a remarkably broad chin, and this largeness continued
throughout the jawbone. He was thick-necked and broad-shouldered and, more
so than other men, hard-looking and fierce when angry. Well built and
taller than others, he had thick wolf-gray hair but was early bald. While
he sat as was written above, he jerked one eyebrow down to his chin and
lifted the other one up into his hairline; Egil was black-eyed with
eyebrows joined. He refused to drink, although drink was brought to him,
but alternately he jerked his eyebrows up and down.

King Athelstan does not overlook Egil's threatening stance. Acting to
defuse the Viking's anger, Athelstan offers Egil a liberal payment in
compensation for his brother's death and thus wins his loyalty.

Although literary license may be assumed, it is curious and highly unusual
for the physical features of a saga protagonist to be portrayed in so
grotesque a manner, unless the writer was reporting a well-known story.
Distortion and hardening of the cranium, changes that are characteristic of
Paget's, may lead to leontiasis ossea, or cranial hyperostosis. In this
condition, the facial bones thicken, giving an individual a lionlike
appearance. This pathology, which may occur as early as the first two
decades of life, closely fits the descriptions of Egil. As for the bizarre
mobility of the eyebrows, it is conceivable that a person as menacing as
Egil learned to exploit his facial distortion and was remembered for its
outrageous effect.

Corroborating evidence for a Pagetic diagnosis comes from the saga's
description of the problems Egil had in his old age. These
difficulties--including loss of balance, hearing and sight, chill in the
extremities, headaches and the phenomenon described as a hanging, swaying
head--are all major symptoms of advanced Paget's disease. According to the
saga, the elderly Egil, after moving in with his son-in-law, Grim, at
Mosfell, was walking outside one day when he stumbled and fell. Some of the
women who saw this laughed:

"You're really finished, now, Egil," they said, "when you fall without
being pushed."

"The women didn't laugh so much when we were younger," said Grim. Egil made
this verse:

"The horse of the necklace sways,
My bald head bangs when I fall;
My piece's soft and clammy
And I can't hear when they call."

Why would people remember this poem about a head that "sways" and other
physical difficulties? One reason is that the utterance is a powerful
example of Old Norse verse, encasing personal emotion in a complex and
colorful word puzzle. In Viking times, verse was viewed as the gift of
Odin, and poetic skill was highly respected. Here the lines reflect the
aged warrior's still agile ability to turn physical disorders into
memorable imagery.

Old Norse poetry was a game of puzzles, which, once the rules are
understood, supplies us with critical information. The first line carries
the understanding: "I have swayings of the neck." In building this image,
the author fashioned a Norse poetic circumlocution called a kenning.
Kennings are stylistically similar to certain English metaphors, such as
calling a camel a ship of the desert. The saga's kenning, helsis valr (the
horse of the necklace), means the neck. The word "swayings" is built on the
verb vafa, "to sway or dangle while hanging." Thus, the line in the verse
refers to a neck bent under the weight of a head that wobbles.

A drooping, swaying head is not a standard feature of old age; so, too, the
graphic description "swayings of the neck" is by no means a common usage in
Old Icelandic poetry. I conducted a computer search and found no other
occurrences of this combination, so the poet is clearly describing a
condition that is unusual and highly personal.

The saga further narrates that Egil becomes blind and is humiliated in his
old age by his lethargy and his craving for warmth--all symptoms of

Egil became totally blind. One day in winter when the weather was cold, he
went up to the fire to warm himself.... "On your feet!" said the woman.
"Get back to your place and let us do our work." Egil stood up, walked over
to his seat, and made this verse:

"I flounder blind by the fireside,
Ask females for mercy,
Bitter the battle
On my brow-plains."

In this verse the Icelandic words for "brow-plains" (hvarma hnitvellir)
mean the part of the face where the eyes meet or are located. The passage
is thus unclear as to whether the words refer to the eyes themselves or to
the area of the eyes, including the part behind and around the eye sockets.
If the former, the words again mean Egil's blindness. If the latter, the
phrase expresses the notion that "I bear pain where the eyes meet,"
suggesting that Egil has headaches. Possibly, both interpretations were

Egil's headaches and chills are consistent with his other symptoms. Victims
of Paget's disease sometimes have headaches caused by the pressure of
enlarged vertebrae on the spinal cord. They also show a high incidence of
arteriosclerosis and heart damage. Attendant circulatory problems,
particularly coldness in hands and feet, develop as the heart is overtaxed
and blood is diverted from the extremities in order to support the rapid
bone remodeling.

Cold Feet, Cold Women

Another of Egil's laments supplies further information about his chills and
cold feet--and of his ability to create clever wordplays.

"Two feet I have,
Cold widows.
These frigid crones
Need a flame."

In Icelandic, the words are

"Eigum ekkjur
allkaldar tvaer,
en iaer konur
iurfa blossa."

Here the poet is skillfully playing on an understood double entendre. In
unraveling the puzzle, the Norse audience would know that the key to the
stanza is to find another unmentioned word, one that would provide a bridge
of meaning. That unmentioned word is haell (heel). When substituted for the
word ekkja, meaning "widow," it carries a double connotation; it also means
"heel"--that is, "foot." The members of Egil's audience, who enjoyed the
intricacies of skaldic verse, would know to replace the words ekkjur
(widows) and konur (women)--both translated here as "crones"--with haelar,
the plural of haell, meaning both "feet" and "women."

Once the connection with feet is made, the rest is easy. Both nouns are
connected with the adjective allkaldar, "thoroughly cold." Thus, the
passage carries the meanings of "cold feet" and "cold women," both of which
sadly afflicted Egil in his later years.

Is there a tradition of Icelandic warrior-poets complaining about women?
Yes. But about their cold feet? Hardly. There is, however, a tradition of
recording struggles against one's fate, including enfeeblement. In this
instance the lines preserve the memory of a man's private battle with an
exceptionally harrowing plight. Despite his condition, Egil still had the
acuity to compose clever poetry. James Paget's classic formulation puts it
this way: "Even when the skull is hugely thickened and all its bones are
exceedingly altered in structure, the mind remains unaffected."

Because Egil's symptoms provide a striking picture of Paget's disease, one
might ask whether the unearthing of the bones in the mid-12th century might
be the source for the poetry. Could a 13th-century poet, having learned
about the condition of Egil's bones, have written verses about the hardness
of Egil's head using kennings? The answer is, perhaps yes, at least about
the bones. Such a poet, however, would not have known the particulars of
Paget's disease and could hardly have expounded on the enlarged bones to
construct a detailed portrait of a man with cold feet, chills, headaches, a
swaying, hanging head, inconsistent bouts of lethargy, and loss of balance,
hearing and sight.

The answer is even more persuasive when we remember that the medieval text
simply treats Egil's physical problems as the ravages of time. It makes no
connection whatsoever between the bones and any kind of disease. In fact,
the saga draws the opposite conclusion. Awed by the size and the resiliency
of the skull, it points out how useful such a tough head would be for a
warrior. The crucial factor is that the poetry, which may be the oldest
element in the saga, independently corroborates the specifics about the
bone by giving different details.

Could another disease have caused Egil's problems? I considered conditions
that produce similar symptoms, such as osteitis fibrosa, acromegaly
(gigantism), hyperostosis frontalis interna, fibrous dysplasia, and
osteopetrosis. In each instance, however, critical symptoms do not match.
By using all the sources available today, we can diagnose Egil as a
probable victim of Paget's disease.

Paget's in Scandinavia

I was led to the question of Paget's disease by research intended to
explain passages in a medieval saga, but it is now clear to me that the
currently accepted statistics about the disease in Iceland, and possibly in
all Scandinavia, are certainly inaccurate. Most studies posit an extremely
low incidence, or an almost nonexistence, of the condition in this region.
This situation exists because little attention has been directed to the
effective diagnosis of the pathology. For example, an extensive 1982 study
to determine the European distribution of Paget's disease used
questionnaire replies by 4,755 radiologists. It found the disease more
prevalent in Britain than in any other western European country. The study
excluded Norway, Iceland, Sweden and Finland on the assumption that
incidences there were very low.

Although uncommon, Paget's disease is more prevalent in modern Scandinavia
than these conclusions would suggest. Until recently, the disease was
thought not to exist in Iceland. During the past 10 years, however, Paget's
disease has slowly but increasingly been found in modern Iceland, a fact
unpublished except for a 1981 case study reported in a small journal there
by Gunnar Sigurdsson of the City Hospital in Reykjavik. In July 1991, I
interviewed Sigurdsson, who informed me he was treating 10 patients with
Paget's disease. His observations about the symptoms closely match those of
Thordur Hardarson of Iceland's National University Hospital, who was also
treating patients with Paget's disease.

To the growing evidence of Paget's in Iceland, we can add the high
probability that a saga-age Icelander, and perhaps even a medieval family,
could have been afflicted. Recognizing these individuals as victims of
Paget's disease begins to fill in the picture of the epidemiological
history of the disease in early Scandinavia, providing examples of Paget's
at both ends of a 1,000-year period.

Egil's poetry, Skapti's medieval observation and modern medical knowledge
together provide a detailed composite of a Pagetic affliction. With this
insight, we do not have to discount "Egil's Saga" to explain the misshapen
skull and bones unearthed in the 12th century. On the contrary, we can see
that the saga may well contain accurate information. Although we surely
cannot conclude that all the sagas are historical truths, Egil's bones
strongly suggest that some passages may reliably detail the past.

Is there more work to be done? Yes, for Egil's bones are possibly still
buried in the old churchyard at Mosfell. We await the opportunity to
unearth his remains for the third time in 1,000 years.

BOX: Paget's Disease

In 1854 Sir James Paget became surgeon extraordinary to Queen Victoria and,
a few years later, surgeon ordinary to the Prince of Wales. Paget's fame
rests on his descriptions of several diseases, the most famous of which is
osteitis deformans. According to Paget's classic description, this disease
of the bones "begins in middle age or later, is very slow in progress, may
continue for many years without influence on the general health, and may
give no other trouble than those which are due to changes in shape, size,
and direction of the diseased bones.... The limbs, however misshapen,
remain strong and fit to support the trunk."

Paget's disease is bone growth gone awry. Normal human bones continuously
renew themselves, rebuilding completely about once every eight years.
Paget's quickens the pace of breakdown and reformation, with the result
that the layers of new bone are structurally disorganized, misshapen and
considerably larger than the original ones. The cause of the condition
could be an inherited weakness of the immune system or a virus, or both.

Paget's is an extremely old disease. The first recorded evidence of the
ailment is a grossly thickened Egyptian skull dating from about 1000 B.C.
It affects slightly more men than women, and it usually occurs after the
age of 40.

Increasingly, statistics show that osteitis deformans is not especially
rare. British studies estimate that from 3 to 5 percent of all adult males
older than 40 in the U.K. have Paget's disease in some form; the frequency
may reach 10 percent after age 70. In the U.S. as many as three million
people probably have Paget's disease. Of these, up to 25 percent show
distressing symptoms. Besides its tendency to run in families, the disease
is known to cluster in specific geographical areas, mostly in Europe and
particularly in England and France. Even among populations not prone to
Paget's, the disease may exist, frequently limited to relatively small
areas, such as the town of Avellino in Italy, where a cluster of cases was
found within an extended family.

Pagetic symptoms are frequently misunderstood, and even today many cases
have been attributed to the effects of advancing age. In the example of the
Avellino family, the affliction was recognized only after an emigrant
relative had been diagnosed in New York City. Accurate diagnosis relies on
x-rays or blood tests. These examinations look for increased levels of
alkaline phosphatase, a product of the cells that form bone. Urine tests
may show an increased amount of hydroxyproline, another product of bone
breakdown. Treatment includes drugs, specifically calcitonin and
disphosphonates, which slow or block the rate of bone breakdown and

JESSE L. BYOCK is professor of Old Norse and medieval Scandinavian studies
at the University of California, Los Angeles. He has published three books
on Iceland and the sagas--"Medieval Iceland: Society, Sagas, and Power";
"Feud in the Icelandic Saga"; and "The Saga of the Volsungs: The Norse Epic
of Sigurd the Dragon Slayer." After studying in Sweden, Iceland and France,
he received his Ph.D. from Harvard University. A specialist in North
Atlantic and Viking studies, he once herded sheep in the northern fjords of


EGIL'S SAGA. Translated by Hermann Palsson and Paul Edwards. Penguin Books,

S. K. Das and M. S. Kataria in "Postgraduate Medical Journal," Vol. 53, No.
615, pages 40-46; January 1977.

Praeger Scientific, 1981.

California Press, 1988.

THERAPY. Edited by Frederick R. Singer and Stanley Wallach. Elsevier
Science Publishing, 1991.

Jesse L. Byock in "Viator," Vol. 24, pages 23-50; 1993.

SCIENTIFIC AMERICAN January 1995 Volume 272 Number 1 Pages 82-87

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