Morphometric analysis of accessory vessel grooves (AVG) in the skulls of the ancient spradon population: an anthropological approach / Análisis morfométrico de los surcos de vasos sanguíneos accesorios (SVA) en los cráneos de la antigua población de spradon: un enfoque antropológico

SUMMARY: Accessory vessel grooves (AVG), or accessory vessel sulcus, is the name given to grooves seen in the frontal region of the skull. In studies conducted by anthropologists on antiquity skeletons, it is seen that some variations are confused with traumas due to the unknown skeletal morphology. This situation leads to an incorrect evaluation of the socio-economic or health structure of the population. In this study, an accessory vessel grooves research was carried out on the skeletons of the late Roman-early Byzantine population. Studies were conducted on 69 adult human skeletons of known age and sex, and 3 human skeletal skulls whose sex could not be determined. Accessory vessel grooves rate was calculated as 10.54 % in the Spradon ancient population. While there is 10.52 % AVG in female individuals in the population, lower AVG levels have been detected in males compared to females with 9.67 %. There is no significant difference between male and female individuals in terms of AVG. Although the lengths of AVG differ in the right and left frontal, it can be said that there is no difference in direction. Although the relation of AVG variation with high blood pressure is included in the literature, the intense appearance of this structure in the Spradon Population, especially in young individuals, weakens this hypothesis. The literature on the existence of AVG will expand further with the studies to be carried out on ancient Anatolian populations in the following years.

RESUMEN: Surcos de los vasos accesorios (SVA), o canales de vasos accesorios, es el nombre que se les da a los surcos que se ven en la región frontal del cráneo. En los estudios realizados por antropólogos sobre esqueletos de la antigüedad, algunas variaciones se pueden confundir con traumas debido a la morfología esquelética desconocida. Esta situación conduce a una valoración incorrecta de la estructura socioeconómica o sanitaria de la población. En este estudio, se llevó a cabo una investigación de surcos de vasos sanguíneos accesorios en los esqueletos de la población romana tardía y bizantina temprana. Se realizaron estudios en 69 esqueletos humanos adultos de edad y sexo conocidos, y 3 cráneos esqueléticos humanos cuyo sexo no se pudo determinar. La tasa de surcos de vasos accesorios se calculó como 10,54 % en la población antigua de Spradon. Si bien hay un 10,52 % de SVA en las mujeres de la población, se han detectado niveles más bajos de SVA en los hombres en comparación con las mujeres en un 9,67 %. No existe una diferencia significativa entre hombres y mujeres en términos de SVA. Aunque la relación de la variación de SVA con la hipertensión arterial está incluida en la literatura, la importante advertencia de esta estructura en la población de Spradon, particularmente en sujetos jóvenes, debilita esta hipótesis. La literatura sobre la existencia de SVA se ampliará aún más con los estudios que se llevarán a cabo en las antiguas poblaciones de Anatolia en el futuro.

The Birth of Hospital, Asclepius cult and Early Christianity / 의사학

History of hospital is one of main fields of researches in medical history. Besides writing a history of an individual hospital, considerable efforts have been made to trace the origin of hospital. Those who quest for the origin of hospital are faced with an inevitable problem of defining hospital. As the different definition can lead to a different outcome, it is important to make a clear definition. In this article, the hospital was defined as an institution in which patients are housed and given medical treatments. According to the definition, the Great Basilius is regarded to have created the first hospital in 369 CE. The creation of hospital is considered to be closely related with Christian philantrophy. However, the question is raised against this explanation. As the religious philantrophy does not exclusively belong to the Christianity alone, more comprehensive and persuasive theory should be proposed to explain why the first hospital was created in the Christian World, not in the Buddhistic or other religious world. Furthermore, in spite of sharing the same Christian background, why the first hospital appeared in Byzantine Empire, not in Western Roman Empire, also should be explained. My argument is that Asclepius cult and the favorable attitude toward medicine in Greek world are responsible to the appearance of the first hospital in Byzantine Empire. The evangelic work of Jesus was heavily depended on healing activities. The healing activities of Jesus and his disciples were rivalled by Asclepius cult which had been widely spread and practiced in the Hellenistic world. The temples of Asclepius served as a model for hospital, for the temples were the institution exclusively reserved for the patients. The exclusive housing of patients alone in the temples of Asclepius is clearly contrasted with the other early forms of hospitals in which not only patients but also the poor, foreigners and pilgrims were housed altogether. Toward the healing god Asclepius, the Latin Church fathers and Greek Church fathers showed significant difference of attitudes. The Latin fathers were generally very critical on Asclepius while the Greek fathers were more favorable to the same healing god. This difference is also considered to be an important factor that can explain why the first hospital appeared in the Byzantine Empire.

A comparison of the relationship between the golden ratio and anatomical characteristics of the supraorbital foramen in bare skulls belonging to the Byzantine era and modern era / Comparación de la relación entre la proporción áurea y las características anatómicas del foramen supraorbitario en cráneos de la época bizantina y la edad moderna

The aim of the present study is to determine the frequency of the occurrence of supraorbital foramen/notch (SOF/N) in the skulls of the people who lived in the modern era and the late Byzantine era, to determine the symmetry and the asymmetry between the two halves of the skulls by measuring the linear distance to various landmarks, to check the consistency between the location of the SOF/N and the golden ratio by calculating the ratio between linear distances and to evaluate the differences between the skulls from both historical periods. In the study, the frequency of the occurrence of the supraorbital notch in the skulls from the Byzantine era was found to be 26.60 % on the right and 13.30 % on the left while it was 14.30 % on the right and 9.52 % on the left in the skulls belonging to modern humans. In the skulls belonging to the Byzantine era, the average distance between SOF/N and the sagittal axis passing along the lateral orbital wall was found to be 34.81±2.51 mm and 32.99±2.81 mm respectively on the right and the left while it was 33.14±2.19 mm and 33.39±2.06 mm in the skulls belonging to modern era. The average distance between the SOF/N and the sagittal plane passing along the midline of the skull was found to be 24.55±2.79 mm and 21.57±2.44 mm on the right and the left respectively in the skulls belonging to the Byzantine era while it was 0.04±3.30 mm and 20.96±2.37 mm in the skulls belonging to the modern era. The average distance between the SOF/N and sagittal plane passing along the medial orbital wall was found to be 23.78±3.60 mm and 23.81±3.20 mm on the right and the left respectively in the skulls belonging to the Byzantine era while it was found to be 22.23±3.29 mm and 23.97±1.93 mm in the skulls belonging to the modern era. The average value of the distance between the sagittal planes passing along the lateral and medial sides of the orbit and the ratios between the distance from SOF/N to the sagittal plane passing along the lateral side of the orbit was found to be 1.47±0.21 mm and 1.60±0.08 mm respectively in the skulls belonging to the Byzantine era and the modern era. No significant difference was found between this ratio and the golden ratio; the average value of the ratios between the distance from the SOF/N to the sagittal plane passing along the midline of the skull and the distance from the SOF/N to the sagittal plane passing along the lateral side of the orbit was found to be 0.98±0.26 mm and 1.04±0.36 mm respectively in the skulls belonging to the Byzantine era and the modern era. A significant difference was found between this ratio and the golden ratio for both historical periods (modern society and late Byzantine period) (p <0.005). The comparison of the relevant anatomic characteristics of the SOF/N is very important for anthropologists while a broad knowledge on proportional calculations regarding morphometric values and the location are important for reconstructive surgeons and the experts in forensics and pain control.

El objetivo fue determinar la frecuencia del foramen y incisura supraorbitaria (FSO/E) en cráneos de individuos de la era moderna y aquellos de la era bizantina, para determinar la simetría y asimetría entre las dos mitades de cráneos, mediante la medición de la distancia lineal a varios puntos de referencia, para comprobar la coherencia entre la ubicación del FSO/ y la proporción áurea, a través del cálculo de la relación entre las distancias lineales. Además, se evaluaron las diferencias entre los cráneos de periodos históricos. En el estudio, se determinó que la frecuencia registrada de la incisura supraorbitaria en los cráneos de la época bizantina fue del 26,60% en el lado derecho y 13,30 % en el izquierdo; mientras que en cráneos humanos modernos fue de 14,30% en el lado derecho y 9,52 % en el izquierdo. En los cráneos pertenecientes a la época bizantina, la distancia media entre FSO/E y el eje sagital a lo largo de la pared lateral de la órbita fue de 34,81±2,51 mm y 32,99±2,81 mm, a la derecha e izquierda, respectivamente; mientras que en cráneos de la era moderna fue de 33,14±2,19 mm y 33,39±2,06 mm, a la derecha e izquierda, respectivamente. La distancia media entre la FSO/E y el plano sagital que pasa a lo largo de la línea mediana del cráneo, en los cráneos de la época bizantina, fue de 24,55±2,79 mm y 21,57±2,44 mm a la derecha e izquierda, respectivamente; mientras que fue de 0,04±3,30 mm y 20,96±2,37 mm en los cráneos de la era moderna. La distancia media entre la FSO/E y el plano sagital que pasa a lo largo de la pared medial de la órbita, en los cráneos pertenecientes a la época bizantina fue de 23,78±3,60 mm y 23,81±3,20 mm, a la derecha e izquierda, respectivamente; mientras que en los cráneos pertenecientes a la era moderna fue de 22,23±3,29 mm y 23,97±1,93 mm, a la derecha e izquierda, respectivamente. Se determinó que el valor medio de la distancia entre los planos sagitales a lo largo de los márgenes lateral y medial de la órbita y las proporciones entre la distancia desde FSO/E al plano sagital a lo largo del lado lateral de la órbita fueron de 1,47±0,21 mm y 1,60±0,08, respectivamente, en los cráneos pertenecientes a la época bizantina y la era moderna. No encontramos diferencias significativas entre esta relación y la proporción áurea. El valor medio de las relaciones entre la distancia de la FSO/E al plano a lo largo de la línea mediana del cráneo y la distancia de la FSO/E al plano sagital a lo largo de la pared lateral de la órbita fueron de 0,98±0,26 mm y 1,04±0,36 mm, respectivamente, en los cráneos pertenecientes a la era bizantina y la era moderna. No se encontró una diferencia significativa entre esta relación y la proporción áurea en ambos períodos históricos (la sociedad moderna y el periodo bizantino tardío) (p <0,005). La comparación de características anatómicas relevantes para el FSO/E son importantes para los antropólogos, donde un conocimiento integro de cálculos proporcionales con respecto a los valores morfométricos, mientras que para los cirujanos reconstructivos y los expertos en medicina forense es importante su ubicación.

A comparison of anatomical measurements of the infraorbital foramen of skulls of the modern and late Byzantine periods and the golden ratio / Comparación de las medidas anatómicas del foramen infraorbitario en cráneos de la época bizantina tardía, edad moderna y la proporción áurea

The aim of this study was to examine the morphometric characteristics of the infraorbital foramen of skulls of people living in modern society and in the late Byzantine period, to ascertain the symmetry or asymmetry of the two halves of the skulls by measuring the linear distance between various landmarks, to evaluate at the conformity between the infraorbital foramen and the golden ratio by calculating the ratios between these linear distances, and to set out the differences or similarities between the skulls of these different periods. It was found in the study that the morphometric characteristics of the infraorbital foramen in skulls of the modern period were 47.05 % circular, 41.17 % oval and 11.76 % atypical (semilunar and triangular) on the right, and 70.58 % circular and 29.41 % oval on the left, while those of the Byzantine period were 46.06 % circular and 53.3% oval on the right, and 50% circular and 50 % oval on the left. It was found that the measurements across the infraorbital foramen of the Byzantine skulls averaged 2.93±1.05 mm and 3.15±1.03 mm on the right side and 2.62±0.97 mm and 3.16±0.68 mm on the left vertically and horizontally respectively, and those of the modern period measured 2.32±0.50 mm and 3.00±0.92 mm on the right and 2.48±0.45 mm and 2.76±0.65 mm on the left vertically and horizontally respectively. The ratio between the distances from the outer orbital wall of the IOF to the sagittal plane and the piriform aperture were 1.46±0.25 mm and 1.40±0.21 mm for left and right respectively for the Byzantine skulls, and 1.24±0.24 mm and 1.29±0.42 mm for the modern skulls. A significant difference was found between the ratio obtained and the golden ratio for each of the periods (modern and Byzantine) (p<0.005). A comparison of anatomical characteristics of the infraorbital foramen of people living at different historical periods is important for anthropologists and knowing morphological types and amassing knowledge on the proportional calculation of location is important for dentistry, maxillofacial surgery and algology.

El objetivo fue examinar las características morfométricas de los forámenes infraorbitarios en cráneos de personas que viven en la sociedad moderna y aquellas que vivieron en el periodo bizantino tardío, para determinar la simetría o asimetría de las dos mitades de los cráneos. Se realizó la medición de la distancia lineal entre varios puntos de referencia, para evaluar la conformidad entre el foramen infraorbitario (FO) y la proporción áurea, mediante el cálculo de la relación entre esas distancias lineales, así como las diferencias y similitudes entre los cráneos de estos períodos. En relación a las características morfométricas, se encontraron en cráneos de la época moderna FO circulares (47,05%), ovalados (41,17 %) y atípicos (semilunar y triangular) en un 11,76 %, del lado derecha, y en el lado izquierdo estos porcentajes correspondieron a circulares (70,58 %) y ovalados (29,41%). Por su parte, los cráneos del período bizantino presentaron FO circulares (46,06 %) y ovalados (53,3 %) del lado derecho, mientras que del lado izquierdo fueron circulares (50 %) y ovalados (50 %). Se encontró que las medidas del FO de los cráneos bizantino tuvo un promedio de 2,93±1,05 mm y 3,15±1,03 mm en el lado derecho, y 2,62±0,97 mm y 3,16±0,68 mm a la izquierda, vertical y horizontal, respectivamente; y en el período moderno midieron 2,32±0,50 mm y 3,00±0,92 mm a la derecha y 2,48±0,45 mm y 2,76±0,65 mm a la izquierda, en medidas verticales y horizontales respectivamente. La relación entre las distancias de la pared orbitaria exterior del FO al plano sagital y la apertura piriforme fue de 1,46±0,25 mm y 1,40±0,21 mm, a izquierda y derecha respectivamente, para los cráneos bizantinos; y 1,24±0,24 mm y 1,29±0,42 mm para los cráneos modernos. Se encontró una diferencia significativa entre la proporción obtenida y la proporción áurea para cada uno de los períodos (moderno y bizantino) (p <0,005). La comparación de las características anatómicas del FO de individuos que vivieron en diferentes períodos históricos es valioso para los antropólogos y los conocimientos sobre el cálculo proporcional de la ubicación del FO son importantes en la odontología, cirugía maxilofacial y el estudio del dolor.

A Development of Byzantine Christian Charities during the 4th-7th Centuries and the Birth of the Hospital / 의사학

This study aims to examine the beginning and the development of Christian Charities during the 4th-6th centuries which would eventually result in the birth of the hospital in modern sense in the first half of the 7th century. For this purpose, I looked carefully into various primary sources concerning the early Christian institutions for the poor and the sick. Above all, it's proper to note that the first xenodocheion where hospitality was combined with a systematic caring, is concerned with the Trinitarian debate of the 4th century. In 356, Eustathios, one of the leaders of homoiousios group, established xenodocheion to care for the sick and the lepers in Sebaste of Armenia, whereas his opponent Aetios, doctor and leader of the heteroousios party, was reckoned to have combined the medical treatment with his clerical activities. Then, Basil of Caesarea, disciple of Eustathios of Sebaste, also founded in 372 a magnificent benevolent complex named 'Basileias' after its founder. I scrupulously analysed several contemporary materials mentioning the charitable institution of Caesarea which was called alternatively katagogia, ptochotropheion, xenodocheion. John Chrysostome also founded several nosokomeia in Constantinople at the end of the 4th century and the beginning of the 5th century. Apparently, the contemporary sources mention that doctors existed for these Charities, but there is no sufficient proof that these 'Christian Hospitals,' Basileias or nosokomeia of Constantinople were hospitals in modern sense. Imperial constitutions began to mention ptochotropheion, xenodocheion and orphanotropheion since the second half of the 5th century and then some Justinian laws evoked nosokomium, brephotrophia, gerontocomia. These laws reveal that 'Christian Hospitals' were well clarified and deeply rooted in Byzantine society already in these periods. And then, new benevolent institutions emerged in the 6th century: nosokomeia for a specific class and lochokomeia for maternity. In addition, one of the important functions of Sampson Xenon was, according to Novel 59, to hold a funeral service for the people of Constantinople. Nevertheless, there is no sufficient literary material that could demonstrate the existence of a hospital in modern sense. The first hospital where outpatient service, hospitalization and surgery were confirmed was Sampson Xenon in the first half of the 7th century, figured in the tale of Stephanos of the The Miracles of St. Artemios. Why was the early Byzantine literary so reticent as to write the medical activities in the Christian Charities? It's because Christian innovation didn't rest on the medical treatment but caring for the poor and the sick, depending on the word of Mt. 25.35-36. In this meaning, I'd like to say that the Early Byzantine history of Christian Charities or 'Christian Hospitals' consists of only a footnote of the verse.

A comparative study of variation of the pterion of human skulls from 13th and 20th century Anatolia / Un estudio comparativo de la variación del pterion en cráneos humanos de los siglos 13 y 20 de Anatolia

The pterion is a commonly used anthropologic and neurosurgical landmark defined as the junction of the sphenoid, temporal, parietal and frontal bones. It is commonly classified into four types based on sutural pattern: sphenoparietal, in which the sphenoid and parietal bones are in direct contact; frontotemporal, in which the frontal and temporal bones are in direct contact; stellate, in which all four bones come into contact at a point; and epipteric, in which a small sutural bone is found between the parietal bone and the greater wing of the sphenoid bone. In the present study, 44 Anatolian skulls from two different eras, Byzantine (13th century) and contemporary (20th century), were investigated for morphology and location of the pterion. Sphenoparietal was the most common form, comprising 87.5 percent and 89.2 percent in the Byzantine and contemporary groups, respectively. The frequencies of the epipteric type of pterion were 6.25 percent and 3.6 percent in the Byzantine and contemporary groups, respectively. Measurements of the location of the pterion were made by using stainless steel calipers and Scion Image software. There were no significant differences in digital and manual measurements between the right and left sides of the skulls in both groups. However, the distance from the pterion to the inion was significantly greater in the manual measurements compared to the digital measurements. Anatomical variations of the pterion, which are of interest to anthropologists, forensic pathologists and surgeons, deserve further investigation in other populations from different geographical areas.

El pterion es un punto comúnmente usado como punto de referencia antropológico y neuroquirúrgico, correspondiendo a la unión de los huesos esfenoides, temporal, parietal y frontal. Generalmente es clasificado en 4 tipos basado en padrones suturales: esfenoparietal, en el cual los huesos esfenoides y parietal están directamente en contacto; frontotemporal, en el cual el frontal y el temporal se encuentran en contacto directo; estrellado, en el cual los cuatro huesos mencionados se contactan directamente en un punto y epiptérico, en el cual un pequeño hueso sutural se encuentra entre el hueso parietal y el ala mayor del esfenoides. En el presente estudio, investigamos la morfología y la localización del pterion en 44 cráneos Anatolian de diferentes épocas, Bizantina (Siglo XIII) y contemporánea (Siglo XX). La forma más común que se encontró fue la Esfenoparietal, con un 87,5 por ciento para los del grupo Bizantino y 89,2 por ciento para los de la era contemporánea. La frecuencia del tipo epiptérico fue de 6,25 por ciento y 3,6 por ciento, respectivamente. Se realizaron medidas de la posición del pterion utilizando un caliper y un software de imágenes. No hubo diferencias estadísticamente significativas en las mediciones manuales y digitales entre los lados derecho e izquierdo de los cráneos de ambos grupos. Sin embargo, la distancia desde el pterion al inion fue significativamente mayor en las medidas manuales comparadas con las digitales. Las variaciones anatómicas del pterion, las cuales son de interés para antropólogos, patólogos forenses y cirujanos, son un tema de investigación a desarrollar en otras poblaciones de diferentes áreas geográficas.

Rufus, Oribase y Pablo de Egina: continuación / Rufus, Oribase and Pablo de Egina: continuation

Continuación del artículo presentado en la edición anterior de la revista. Se expresan las terapéuticas utilizadas por Oribase y Pablo de Engina relatando tratamientos que aún tienen vigencia