Unit:
Τομέας Βασικών ΕπιστημώνLibrary of the School of Health Sciences
Author:
Protopapa Anastasia Sofia
Dissertation committee:
Εμμανουήλ Αγαπητός, Καθηγητής, Ιατρική, ΕΚΠΑ
Γεώργιος Λυρίτης, Καθηγητής, Ιατρική, ΕΚΠΑ
Κωνσταντίνα Τηνιακού, Αναπλ. Καθηγήτρια, Ιατρική, ΕΚΠΑ
Θεόδωρος Πίτσιος, Καθηγητής, Ιατρική, ΕΚΠΑ
Μυρσίνη Κουλούκουσα, Αναπλ. Καθηγήτρια, Ιατρική, ΕΚΠΑ
Ανδρέας Λάζαρης, Καθηγητής, Ιατρική, ΕΚΠΑ
Ευστάθιος Χρονόπουλος, Αναπλ. Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Παλαιοπαθολογική μελέτη του μεσαιωνικού πληθυσμού της πόλης της Ρόδου
Translated title:
Paleopathological study of the medieval population of Rhodes town
Summary:
Introduction
Paleopathology constitutes an interdisciplinary field of research which focuses on the pathological evidence demonstrated by human skeletal remains originating in pre-history and in the historical past and investigates the natural history, as well as the evolutionary and historical aspects of human disease.
Material and methods
Systematic research conducted by the 4th Ephorate of Byzantine Antiquities during 1980-1996 revealed numerous Byzantine monuments of great significance in the Medieval Town of Rhodes. The Anthropology Museum of the Medical School of the National and Kapodistrian University of Athens participated in the processes of excavation, collection and classification of the rich anthropological material revealed inside Byzantine churches. Two skeletal populations with origins in the Byzantine church of Agios Spyridon (13th-16th century) and the family chapel on Agesandrou street (12th-14th century) were studied. Demographic parameters were determined according to standard anthropological methods. Investigation of the osseous pathological manifestions included macroscopic and stereoscopic examination and imaging analysis using X-ray and Computed Tomography. 449
Results
The two skeletal populations in the Byzantine church of Agios Spyridon and the Agesandrou street cemetery revealed minimum number of individuals 157 and 114 and ratios of adult to non-adult individuals 92/65 and 54/60, respectively. The present study revealed differences between the two skeletal populations of Rhodes with regard to their demographic characteristics as well as to osseous lesions and skeletal markers related to a wide pathological range.
The two populations differed significantly by age. Specifically, young adult individuals (aged <25 years) in the cemetery of Agesandrou street were found to be three times more frequent, compared with the cemetery of Agios Spyridon (61.7% vs 20%, respectively, p<0.001). The wide and complex range of skeletal pathology exhibited by an extended part of osseous finds associated with the greater number of graves in Agesandrou street infers the acute manifestations and chronic complications of sickle-cell disease. Skeletal abnormalities compatible with chronic severe anemia regarding bone outline and bone internal architecture constitute a generalized feature in the Agesandrou street population, observed macroscopically and verified through X-ray imaging analysis of the respective cranial and post-cranial finds.12 skeletons (22.2%) from Agesandrou street demonstrate long bone discrepancy as opposed to one from Agios Spyridon (1.1%). The morphological find of porotic hyperostosis (cribra orbitalia) was found in 11 out of 29 (37.9%) cranial find in Agesandrou street cemetery and in 3 out of 15 (20%) cranial finds in Agios Spyridon cemetery. In Agesandrou street the X-ray pattern of the lamellated diploe was determined in the complete set of finds in which more than 50% of the cranial surface area is represented and ranging between 2.5-5.5 years of age, while the mixed
450
lamellated/hair-on-end diploic pattern is demonstrated in an adult skull, localized to the parietal eminence. In another adult skeleton X-ray analysis revealed the central “step-like” deformity in contiguous vertebrale of the thoracic spine. Spondylosis and osteoarthritis of the cervical spine are demonstrated with statistically significant dominance in the Agesandrou street population, while spondylosis and osteoarthritis of the lumbar spine are manifested with apparent dominance in the Agios Spyridon population. Radiographic patterns compatible with those exhibited in dactylitis are demonstrated by the complete range of young skeletons, including bones of the hands and feet. Osteonecrosis of the head of the metatarsal bones is detected by X-ray analysis and generally verified by macroscopic observation in 20 adult skeletons (37%), osteonecrosis of the humeral head in 6 out of 16 skeletons and osteonecrosis of the femoral head in 6 out of 17 skeletons. Macroscopically, surface bone lesions, lytic cortical lesions and focal bone regeneration are widely demonstrated in the skeletal material of Agesandrou street. Sclerotic lesions, the pattern of cortical fissuring, calcified debris in the marrow cavity and evidence of single or multiple bone infracts are widely observed imaging finds, primarily in the skeleton of the limbs in the above population. Vessels of the bone circulatory network macroscopically exhibiting characters of mummification/calcification constitute a dominant feature in Agesandrou street which was not observed in Agios Spyridon cemetery. The percentage of cranial finds demonstrating enamel hypoplasia was found 3.4 times higher in the Agesandrou cemetery, compared with the Agios Spyridon cemetery (55.6% vs 16.4%, respectively, p<0.001). Wormian bones are dominant features among cranial finds in Agesandrou street manifested with statistically significant difference regarding frequency of appearance, size and number per skull. 451
The caries sicca morphological sequence, pathognomonic for treponemal disease, was demonstrated on a cranial find from Agios Spyridon cemetery, exhibiting features with regard to extent, severity, and distribution more compatible with the syphilitic infection. The find was dated between 1450-1480 with a probability of 68.2% and most likely represent evidence of syphilis in the European continent, prior to the return of Columbus from the New World in 1493.
Lower leg skeletal finds from Agios Spyridon cemetery demonstrate macroscopic/radiographic tibial lesions compatible to the pattern exhibited in the medial tibial stress syndrome. Additional pathological evidence from the present study included tuberculosis of the spine, probable intraosseous cranial meningioma and metastatic disease.
Conclusions
Differential morbidity between the two populations from medieval Rhodes is suggested in the wide and complex range of sickle-cell disease pathology regarding the Agesandrou street cemetery population and is in accordance with differential life expectancy and frequency and degree of expression of skeletal markers reflecting developmental defects. Skeletal manifestations pathognomonic for sickle-cell disease reveal the presence of the underlying genetic mutations in the geographical area of the Mediterranean 900 years before present . Novel observations that cannot be realized in the living skeleton involve mummified/calcified vessels of the bone circulation and X-ray imaging of osseous infarcts. Diagnosis of syphilis in a cranial find from Agios Spyridon most likely dating prior to 1493 suggests the presence of the disease in the old world prior to Columbus’ contact with the 452
new world and contributes in the unraveling of disease origins and history in Europe. Lower leg skeletal finds demonstrate surface lesions compatible to the pattern in medial tibial stress syndrome which cannot be observed in the living skeleton. Primary (physical) evidence of disease in the absence of modern medical intervention are presented in this study while inferring historical and evolutionary aspects of ecological parameters relating to human biology. 453
Main subject category:
Health Sciences
Keywords:
MTSS, Caries sicca, Diagnosis, Diagnostic imaging, Meningioma, Digital radiography, Computed tomography, 3D reconstruction
Number of references:
602
