Angel, J. Lawrence

English

Henry Ford Health System Scholarly Commons

Henry Ford Hosp Med Journal Vol 27, No 1, 1979 Osteoarthritis in Prehistoric Turkey and Medieval Byzantium J. Lawrence Angel, PhDt In 1978 I studied skeletons from ancient populations of Byzantium and Turkey in order to assess the extent of the osteoarthritic process and to test the fol lowing two hypoth-eses. 1, Although the incidence of this disease was high in prehistoric times, it has steadily decreased through classic to modern periods, 2. Osteoarthritis was consistently more common in men than in women. These hypotheses were derived in part from my earlier observations^ about os-teoarthritis found in samples from prehistoric to classic times and from later Greece. Materials Forthe 1978 study, the skeletons in the samples came from two areas. In one group, there were 54 adults as well as 19 children, including infants, representing the Chalcolithic to Early Bronze Age (dated 4th-3rd millennium B.c). These specimens came from Kalinkaya in the Hittite territory of Central Anatolia. Secondly, the Byzantine specimens, which consisted of 132 adults and 31 children of the 7th to 12th centuries A.D., came from Kalenderhane Camii in Istanbul. These prehistoric and medieval skeletons were compared with 179 skeletons of modern Caucasian Amer-icans obtained from various sources.* The data on os-teoarthritis as well as possibly related skeletal stress and fractures for these three populations groups are presented (Tables I-III). The following lesions were considered. 1. Osteophytosis with varying degrees of lipping on vertebral bodies and on intervertebral facet joints. These were divided into four categories ranging from slight (0) to most pronounced (+ + + ); the last represents virtual ankylosis or fusion. 2. tDepartment of Anthropology, National Museum of Natural History, Smithsonian Institution Address reprint requests to Dr. Angel, National Museum of Natural History, Smithsonian Institution, Washington, DC 20560 * 154 skeletons were submitted for consultation from the FBI andother law-enforcement agencies and 25 were wil led skeletons. Limb (diarthrodial) joints with the four degrees of lipping as classified above. Eburnation^ was also identified as a conse-quence of cartilage damage and loss. Results The Early Bronze Age village people of Anatolia lived mainly by farming and trade (obsidian, copper, grain and meat) and to a lesser extent by hunting. At Kalinkaya (Figures 1, 2, 4), nutritional stress during the growing years of childhood is indicated by the following features: flattened pelvic inlets (index: 77, N=3),* clearly to strongly bowed tibiae in 70%, and flattened long bone shafts (humeral shaft index: 78.6, platymericor upperfemur index: 73.2,cnemic or tibial shaft index: 65.2, with N= 35-29).** The short stature (164.2 cm in ten men and 153.1 cm in nine women) may also be derived in part from dietary deficiencies. Twenty percent ofthe women have healed ankle fractures or foot strains (Figure 1) affecting bone, which probably re-sulted from falls in their rocky country located at the junction of the plateau with the northern mountains. Both sexes have huge deltoid crests (75% of 29 people) and muscle stress signs throughout, thereby indicating equally hard workfor both sexes in farm ing and hunting as well as in childbearing for women. In the sample specimens from Byzantine Kalenderhane (Figures 3, 5, 6), there are more adult males (75% or a sex ratio of 300:100), no doubtdue to the monastic character of the Kyriotissa foundation. Nutrition seems adequate, or at about the same level as that found in Byzantine Greece. Thus, the true pelvis is adequately deep, with the index being87.6 (19) in comparison with 91.6 (103) in our modern American sample and contrasted to 75-85 in the 19th century.' " Except perhaps forthe femur, long bone shafts are not notably flattened (humeral shaft: 81.1, platymeric: 84.3, and cnemic: 72.8, with N=51-71); tibiae are not bowed; * Ratio of depth of pelvic inlet to breadth x 100 ** A higher index means less flattening. In modern, middle class USA, the humeral shaft index = 79, platymeric or upper femoral shaft index = 87,5, and cnemic or tibial shaft index = 70,5. 38 Angel TABLE I OSTEOARTHRITIS: VERTEBRAE PERCENTAGE FREQUENCIES MALES FEMALES Average Age At Death Kal inkaya Early Bronze 34 Kalenderhane Byzant ine 46 USA Modern 43 Kal inkaya Early Bronze 30 Kalenderhane Byzantine 37 USA Modern 37 Degree of Severity of Lesions 0 trace 67% 3 1 % 50% 46% 6 2 + % 6 1 - % -1- 17% 3 1 % 24% 23% 25% 2 4 + % + + 16% 25-1-% 18% 23% 13-% 15% + p ronounced 0 13% 8°-o 8% 0 0 No, of Specimens 21 95 108 26 32 7-% wi th osteoarthr i t is 33% 69% 50% TABLE II 5 4 % 38% 39% O S T E O A R T H R I T I S : E X T R E M I T I E S P E R C E N T A G E F R E Q U E N C I E S MALES FEMALES Average Age at Death Kal inkaya Early Bronze 34 Kalenderhane Byzant ine 46 USA Modern 43 Kalinkaya Early Bronze 30 Kalenderhane Byzantine 37 USA Modern 37 Degree of Severity of Lesions 0 trace 88% 67 + % 7 1 % 93% 87% 86% + 12% 28% 16% 7% 85% 10% + + 0 5-% 1 1 % 0 3% 1 % + -!--(- p ronounced 0 0 2% 0 C 3 No, of Specimens 21 95 108 26 32 71 + w i th osteoarthr i t is 12% 33% 29% T A B L E III 7% 13% 14% OTHER FINDINGS: P E R C E N T A G E F R E Q U E N C I E S MALES FEMALES Average Age at Death Kal inkaya Early Bronze 34 Kalenderhane Byzant ine 46 USA Modern 43 Kalinkaya Early Bronze 30 Kalenderhane Byzantine 37 USA Modern 37 Vertebrae Fractures .3% 3% 12% 8% 12% 13% Sct imor l herniat ions 8% 33% 3 1 % 0 12% 28% Special stress 17% 5°o 7% 33% 0% 10% Extremit ies Fractures 6% 17% 4 7 % 33% 13% 2 7 + % Special stress 55% 28% 3 4 % 67% 26% 32% 39 Osteoarthritis in Prehistoric Turkey and Medieval Byzantium and the stature is 169.8 cm for 68 men and 154.9 cm for 16 women, or only 1-2 cm belowthatof contemporary Greece. The general health characteristics appear to have been better; for example, "age at death" is several years above that in Byzantine Greece. At Kalenderhane, however, there may be a selective factor favoring aged males (Figures 3, 6), since monks retired after an active life that often may have included military service. Fractures occur in 18-19%, which is less than half the modern LJ.S. value, but high for ancient peoples. Out of about 70 skeletons, these fractures include 4 ribs, 2 Colles', 2 legs, 2 vertebrae, and 1 each of calcaneus, talus, clavicle, humerus neck, and femur intertrochanteric. There are two unreduced shoulder dislocations and numerous wounds of the legs, foot, hip, and head, suggestingwar injuries in some cases. Surviving males at Kalenderhane may thus have been extra vigorous, but injuries may have increased the inci-dence ofosteoarthritis. Deltoid crest size is even largerthan at Kalinkaya, befitting work-related arthritis. Mongoloid traits (shovel incisors, extra-big flatfish face, pinched fore-head, etc) occur in 15-25%, which suggests mercenaries and merchants either from beyond the Caucasus or from the Russian steppes. Discussion From the data presented (Tables l-lll), it is evident that the overall incidence of osteoarthritis found in those samples from ancient Turkey is less (27% vs 38%) in prehistoric than in Byzantine times (influenced partly by a nine-year age increase) and in modern U.S. (27% vs 33% with no age increase). As expected, osteoarthritis affects vertebral joints more than limb joints, although fractures influence limbs about twice as much as vertebrae. At prehistoric Kalinkaya, more women than men exhibited evidence of osteoarthritis, if one allows for the four-year age difference. In the modern American group, the frequency is higherin men than in women,even allowingforthesix-year difference in age of death between females (37) and male accident victims (43). Consequently, for these two groups, the difference in the incidence of osteoarthritis is related to age and occupation rather than to sex per se. However, in the Byzantine sample, there is an excessively high number of males and a nine-year age difference between men (46) and women (37). Here, there is a sharp sex contrast that is probably occupat iona l . Cul tural dif ferences are most relevant Fig. 1. Kalinkaya Female (ca. 33) Exostosis f rom ankle strains, especially of bifurcating ligament. 40 Angel Fig. 2. Kalinkaya Male (ca. 45) "Arthritis": neck, thoracic vertebrae, shoulders, biceps insertion. Fig. 3. Kalenderhane Male (old) Chronic old shoulder dislocation. 41 Osteoarthritis in Prehistoric Turkey and Medieval Byzantium Fig. 4. Kalinkaya Female (early middle age) Compound fracture of leg with fusion. Conclusion The sample specimens we studied from the populations of ancient Turkey and Byzantine Istanbul give little support to the two hypotheses presented above. Contrary to the first hypothesis, we found no clearcut decline in the incidence of osteoarthritis from ancient to modern times, since the incidence in the Early Bronze Age culture at Kalinkaya was lowerthan in medieval Kalenderhane or in the modern LJ.S. control. With respect to my second hypothesis, no consist-entsexual pattern of difference was evident. While men had more osteoarthritis than women in thetwo later periods, this difference did not hold true for the sample from ancient Turkey. Fig. 5. Kalenderhane Male (subadult, ca. 18) Epiphyses just fused; schmorl herniations; lumbar inferior surface. No arthritis yet. 42 Angel Fig. 6. Kalenderhane Male (old) Neck arthritis Acknowledgments Wewould like to thank the following individuals: Sara Bisel and Peggy Angel, my wife, fortheir field assistance; Dr. Raci Temizer, Director of the Museum of Anatolian Prehistory in Ankara, for inviting us to study the Kalinkaya skeletons; Dr. Cecil L. Striker of the University of Pennsylvania and Dr. Dogan Kuban of Istanbul Technical University for inviting us to study skeletons from the cemetery next to the former Kyriotissa Church. Dumbarton Oaks also supported the excavation with travel funds. References 1. Angel JL: The People of Lerna. Am SchI Cl Stud. Athens, Princeton, NJ, and Washington, DC, 1971, 2. Johnson LC: Joint remodeling as the basis for osteoarthrits. / Am Med Assoc 141:1237-1241, 1962. 3, Nicholson G: The two main diameters atthe brim of the female pelvis,/ Anat 79:131-135, 1945. 4, Greulich W W and Thoms H: The dimensions of the pelvic inlet of 789 white females. Anat Rec 72:45-51,1938, 43 

Osteoarthritis in Prehistoric Turkey and Medieval Byzantium

https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?article=2041&amp;context=hfhmedjournal

Osteoarthritis in Prehistoric Turkey and Medieval Byzantium

Abstract

Similar works

Full text

Available Versions

Henry Ford Health System Scholarly Commons