Caroline Partiot | Austrian Academy of Sciences (original) (raw)

Papers by Caroline Partiot

Research paper thumbnail of The distal femoral epiphysis used as a fetal maturity marker: Implications of extant medical data for bioarcheological analysis

The distal femoral epiphysis used as a fetal maturity marker: Implications of extant medical data for bioarcheological analysis, 2023

The distal epiphysis of the femur is classically reported as a marker of fetal maturity and is th... more The distal epiphysis of the femur is classically reported as a marker of fetal maturity and is thus identified in a bioarcheological context as an indicator that an individual died at or around the time of birth; it thus provides crucial information in the creation of the biological profile and associated burial practices. The aim of the present study was to re-evaluate this use by investigating an extant sample to assess (i) the agerelated frequencies of both distal femoral and proximal tibial epiphyses and (ii) the influence of factors such as sex, vitality, and morbidity on the maturation of both epiphyses. The study was conducted on medical CT scans acquired in utero and ex utero between 2008 and 2017 in the hospital of Marseille (France). The final sample included 248 individuals aged between 26 and 42 completed gestational weeks (GW). Based on the results obtained in this study, 11% of the individuals from the sample aged between 26 and 33 completed GW had already developed a distal femoral epiphysis, whereas individuals aged between 38 and 42 GW had already developed both femoral and tibial epiphyses. According to these observations and current obstetrical practice, this maturation indicator cannot therefore be considered a precise estimator of whether a fetus is at term or not in an archeological context. Similarly, no delayed ossification was found among individuals who did not survive to 42 GW, or among those with severe developmental abnormalities, which does not support the hypothesis that delayed epiphysis maturation of the distal femur may be a morbidity marker for this age group in past populations.

Research paper thumbnail of Diversité biologique des enfants décédés en période périnatale et traitements funéraires au Kerma classique : Les exemples de la nécropole 8B-51 (Kerma classique, Nord Soudan) et des cimetières de Blandy-les-Tours (Xe-XIIe siècle, France) et de Provins (XIIIe-XVIIIe siècle, France)

Despite the high rates of child mortality in past populations, subjects deceased in perinatal per... more Despite the high rates of child mortality in past populations, subjects deceased in perinatal period were often neglected in bioarchaeological and paleoanthropology studies. Unlike biological analysis on adults, investigations on newborns rarely include individual or populational variability comparisons as a major component. In the present work, we will focus on metrical and non-metrical diversity of subject deceased between 22 and 48 amenorrhea weeks, based on the biological study of 116 subjects from three archaeological collections (one kerma and two medieval and modern) and one current virtual collection with 364 individuals. The first research axis characterizes the intra-individual, inter-individual and populational variability, and differences by age at death in both samples. The second line of research aims to identify criteria making it possible to estimate individual morbidity and live birth on dry bones, informations that are needed to understand the child’s position in s...

Research paper thumbnail of La question de l’utilisation sépulcrale des cavités naturelles par les populations amérindiennes des Petites Antilles : apports de l’étude archéoanthropologique du site de la grotte des Bambous (Guadeloupe)

Bulletins et Mémoires de la Société d'Anthropologie de Paris, 2020

La fréquentation des cavités naturelles de l’archipel des Petites Antilles par les populations am... more La fréquentation des cavités naturelles de l’archipel des Petites Antilles par les populations amérindiennes, mentionnée par les chroniqueurs européens, est aujourd’hui un phénomène archéologiquement attesté. Les modalités de l’utilisation de ces abris rocheux en tant qu’espaces sépulcraux demeurent cependant peu documentées, avec pour conséquence un manque de données concernant les pratiques funéraires des populations précolombiennes. Dans ce contexte, le site de la grotte des Bambous (Grande Terre, Guadeloupe) offre un nouveau témoignage de l’usage potentiellement funéraire des cavités par les populations amérindiennes des Petites Antilles. Un sondage, puis une fouille archéologique ont livré des vestiges osseux humains datés de la période précolombienne et attribués à un unique sujet décédé au cours de la période périnatale. Bien que le site ait fait l’objet de remaniements de grande ampleur, les résultats de notre étude archéoanthropologique appuient l’hypothèse d’un dépôt prima...

Research paper thumbnail of Du giron au cercueil: regard bioarchéologique sur la mortalité périnatale

ArkeoGazte: Revista de arqueología - Arkelogia aldizkaria, 2020

Research paper thumbnail of The Cro-Magnon babies: Morphology and mortuary implications of the Cro-Magnon immature remains

Journal of Archaeological Science: Reports, 2020

Cro-Magnon site (Dordogne, France) have been studied several times, the immature remains known as... more Cro-Magnon site (Dordogne, France) have been studied several times, the immature remains known as Cro-Magnon 5 and exhumed at the same time were only analyzed in detail once, some thirty years ago. Since then, doubts have persisted concerning, in particular, the minimum number of immature individuals present in the assemblage. A re-analysis of these immature remains (cranial fragments and long bone diaphyses) documents the presence of three neonates and one older infant in the sample. They are morphologically and metrically similar to recent and Late Pleistocene modern human infants, although the metaphyses of one femur are modestly unusual. They also document an unusual mortuary age profile at Cro-Magnon, with four infants, three older adults, and an additional adult, which raises questions about the manner of selection of individuals deposited in the Cro-Magnon rock-shelter.

Research paper thumbnail of Asymétries directionnelles et fluctuantes en période périnatale : étude exploratoire dans les populations du passé

Bulletins et mémoires de la société d'anthropologie de Paris

Research paper thumbnail of Du giron au cercueil: regard bioarchéologique sur la mortalité

Revista ArkeoGazte Aldizkaria, 2020

Even with the very high infant mortality rates before vaccination, children were for a long time ... more Even with the very high infant mortality rates before vaccination, children were for a long time considered to be of secondary importance for the understanding of ancient societes, and therefore frequently neglected in bioarcheological studies. This scientific marginalizaton was particularly true for perinates, since their deaths may sometimes be considered as a failed pregnancy, rather than the death of a community member. However, over the past decades, new scientific approaches, including “New Archaeology” or processual archaeology and archaeothanatology, increased the interest in studying the archaeology of the short life histories of perinates. By placing the lives and deaths of these children at the centre of the scientfc process, this new feld of research contributes in a unique manner to the investigation of issues that have long remained inaccessible, and are now cuting-edge. Regardless of the chrono-geographical context, underlying social, religious, funerary, legal, or even emotional issues are indeed remarkably similar between past and present populatons. How to grieve such a short life, or face such a frequent loss? The aim of this paper is to examine, though a bibliographical review, the historiographical, terminological and methodological issues raised by the bioarchaeological investgaton of skeletonized remains of perinates. By challenging the theories of parental disregard for newborns with very litle chance of survival, the bioanthropological discipline is now allowing to take into account their place and status in past societes through the investigation of their life trajectories. Therefore, and because of disciplinary divergence from obstetrical sciences, the bioarchaeological terminology related to perinatality has undergone changes and adaptatons, while the identificaton of vitality at birth and the study of the circumstances of death have become major aims of research.

*

Malgré la mortalité infantile très élevée dans les populations préjenerriennes, les sujets immatures ont longtemps été considérés comme étant d’une importance secondaire pour la compréhension
des sociétés anciennes, et, de fait, fréquemment négligés dans les études bioarchéologiques. Cette marginalisation scientifique a plus particulièrement touché les sujets décédés en période périnatale,
leur mort pouvant parfois être davantage perçue comme une grossesse non aboute, plutôt que comme la perte d’un membre de la communauté. Au cours des dernières décennies, de nouvelles approches scientifiques, dont en premier lieu la “New Archaeology” ou archéologie processuelle,
ainsi que l’archéothanatologie, ont cependant induit un regain d’intérêt pour l’archéologie de ces courtes trajectoires individuelles. En plaçant leurs vies et morts au cœur du processus scientifique, ce nouveau domaine de recherche contribue dès lors à des questions de premier plan, longtemps restées hors d’atteinte. Quel que soit le contexte chrono-géographique, les enjeux sociaux, religieux,
funéraires, juridiques ou même émotionnels soulevés par cet événement apparaissent en effet remarquablement similaires entre les populations du passé et les populations actuelles. Comment faire le deuil d’une vie si courte, faire face à une perte si fréquente ? L’objectif de cet article est
d’investir, à travers une revue bibliographique, les enjeux historiographiques, terminologiques et méthodologiques soulevés par l’analyse bioarchéologique des restes squelettisés de nouveau-nés.
En remettant en cause les théories soutenant l’existence d’une indifférence, voire d’un certain mépris parental pour des nouveau-nés ayant de très faibles chances de survie, les disciplines archéologiques permettent en effet aujourd’hui d’investir leurs place et statuts dans les sociétés anciennes à travers l’étude de leurs trajectoires de vie. Par conséquent, et du fait des écarts disciplinaires par rapport aux sciences obstétricales, la terminologie bioarchéologique relative à la périnatalité a subi des évolutions et des adaptations, tandis que l’identification de la vitalité à la naissance et l’étude des circonstances du décès sont devenus des axes de recherche de premier plan.

Research paper thumbnail of Partiot et al. 2020 La question de l’utilisation sépulcrale des cavité

Bulletins et Mémoires de la Société d'anthropologie de Paris, 2020

La fréquentation des cavités naturelles de l'archipel des Petites Antilles par les populations am... more La fréquentation des cavités naturelles de l'archipel des Petites Antilles par les populations amérindiennes, men-tionnée par les chroniqueurs européens, est aujourd'hui un phénomène archéologiquement attesté. Les modalités de l'utilisation de ces abris rocheux en tant qu'espaces sépul-craux demeurent cependant peu documentées, avec pour conséquence un manque de données concernant les prati-ques funéraires des populations précolombiennes. Dans ce contexte, le site de la grotte des Bambous (Grande Terre, Guadeloupe) offre un nouveau témoignage de l'usage poten-tiellement funéraire des cavités par les populations amérin-diennes des Petites Antilles. Un sondage, puis une fouille archéologique ont livré des vestiges osseux humains datés de la période précolombienne et attribués à un unique sujet décédé au cours de la période périnatale. Bien que le site ait fait l'objet de remaniements de grande ampleur, les résultats de notre étude archéoanthropologique appuient l'hypothèse d'un dépôt primaire, et possiblement d'une sépulture. Ces observations permettent ainsi d'apporter de nouveaux élé-ments de réflexion concernant l'utilisation sépulcrale des abris rocheux naturels de l'archipel des Petites Antilles au Céramique final, et posent la question des spécificités du comportement funéraire des populations locales par rapport au décès périnatal. Abstract The use by Amerindian populations of natural caves within the Lesser Antilles archipelago, mentioned by European chroniclers, is now archaeologically attested. However, the use of these rock-shelters as sepulchral spaces is not well documented, resulting in a lack of data on the mortuary practices of Pre-Columbian populations. The "Grotte des Bambous" site (Grande Terre, Guadeloupe) has yielded new evidence on the potential funerary use of rock cavities by Amerindian populations of the Lesser Antilles. The survey and the subsequent archaeological excavation, which was carried out in 2017, resulted in the discovery of human remains dating from the pre-Columbian period, with an attribution to a single individual who died during the perinatal period. Although the site had been extensively disturbed , the results of the archaeo-anthropological study support the hypothesis of a primary deposition, possibly to be identified as a burial. Moreover, these observations provide new insights into the sepulchral use of natural rock-shelters in the Lesser Antilles archipelago during the Final Ceramic period, and raise questions about specific characteristics of the fune-rary behaviour of native populations in connection with perinatal death.

Research paper thumbnail of Identification des cas de trépanations dans les populations anciennes : base de données et outil interactif de soutien au diagnostic différentiel

Partiot et al., 2017

The great majority of cranial trepanning cases in ancient populations are identified by the shape... more The great majority of cranial trepanning cases in ancient populations are identified by the shape of the opening made in the skull. However, if there are no distinctive traces left by the trepanner’s tools, the hole may be a “pseudo-trepanation,” apathologicalor taphonomicopening similarinaspecttoatrepanation.Thepurposeofourstudyis to improve the process of comparison for differential diagnoses by developing a reference system for the many factors responsiblefor vaultdefects.Each factoris associatedwith a detaileddescriptionofthecorrespondingdefectondrybone. This reference system led to the development of Xper3, a versatile data management platform and the first interactive online tool to support differential diagnoses of cranial defects. From a bibliographical review of the anthropological and medical literature, the morphological features of defects produced by 79 etiologies were compiled in a database according to 13 quantitative and qualitative description criteria. Using the interactive tool to compare an archaeological case with documented cases facilitates comparative studies by guiding the user towards possible aetiologies and strengthens the differential diagnosis by increasing the number of factors to be examined.

Research paper thumbnail of The distal femoral epiphysis used as a fetal maturity marker: Implications of extant medical data for bioarcheological analysis

The distal femoral epiphysis used as a fetal maturity marker: Implications of extant medical data for bioarcheological analysis, 2023

The distal epiphysis of the femur is classically reported as a marker of fetal maturity and is th... more The distal epiphysis of the femur is classically reported as a marker of fetal maturity and is thus identified in a bioarcheological context as an indicator that an individual died at or around the time of birth; it thus provides crucial information in the creation of the biological profile and associated burial practices. The aim of the present study was to re-evaluate this use by investigating an extant sample to assess (i) the agerelated frequencies of both distal femoral and proximal tibial epiphyses and (ii) the influence of factors such as sex, vitality, and morbidity on the maturation of both epiphyses. The study was conducted on medical CT scans acquired in utero and ex utero between 2008 and 2017 in the hospital of Marseille (France). The final sample included 248 individuals aged between 26 and 42 completed gestational weeks (GW). Based on the results obtained in this study, 11% of the individuals from the sample aged between 26 and 33 completed GW had already developed a distal femoral epiphysis, whereas individuals aged between 38 and 42 GW had already developed both femoral and tibial epiphyses. According to these observations and current obstetrical practice, this maturation indicator cannot therefore be considered a precise estimator of whether a fetus is at term or not in an archeological context. Similarly, no delayed ossification was found among individuals who did not survive to 42 GW, or among those with severe developmental abnormalities, which does not support the hypothesis that delayed epiphysis maturation of the distal femur may be a morbidity marker for this age group in past populations.

Research paper thumbnail of Diversité biologique des enfants décédés en période périnatale et traitements funéraires au Kerma classique : Les exemples de la nécropole 8B-51 (Kerma classique, Nord Soudan) et des cimetières de Blandy-les-Tours (Xe-XIIe siècle, France) et de Provins (XIIIe-XVIIIe siècle, France)

Despite the high rates of child mortality in past populations, subjects deceased in perinatal per... more Despite the high rates of child mortality in past populations, subjects deceased in perinatal period were often neglected in bioarchaeological and paleoanthropology studies. Unlike biological analysis on adults, investigations on newborns rarely include individual or populational variability comparisons as a major component. In the present work, we will focus on metrical and non-metrical diversity of subject deceased between 22 and 48 amenorrhea weeks, based on the biological study of 116 subjects from three archaeological collections (one kerma and two medieval and modern) and one current virtual collection with 364 individuals. The first research axis characterizes the intra-individual, inter-individual and populational variability, and differences by age at death in both samples. The second line of research aims to identify criteria making it possible to estimate individual morbidity and live birth on dry bones, informations that are needed to understand the child’s position in s...

Research paper thumbnail of La question de l’utilisation sépulcrale des cavités naturelles par les populations amérindiennes des Petites Antilles : apports de l’étude archéoanthropologique du site de la grotte des Bambous (Guadeloupe)

Bulletins et Mémoires de la Société d'Anthropologie de Paris, 2020

La fréquentation des cavités naturelles de l’archipel des Petites Antilles par les populations am... more La fréquentation des cavités naturelles de l’archipel des Petites Antilles par les populations amérindiennes, mentionnée par les chroniqueurs européens, est aujourd’hui un phénomène archéologiquement attesté. Les modalités de l’utilisation de ces abris rocheux en tant qu’espaces sépulcraux demeurent cependant peu documentées, avec pour conséquence un manque de données concernant les pratiques funéraires des populations précolombiennes. Dans ce contexte, le site de la grotte des Bambous (Grande Terre, Guadeloupe) offre un nouveau témoignage de l’usage potentiellement funéraire des cavités par les populations amérindiennes des Petites Antilles. Un sondage, puis une fouille archéologique ont livré des vestiges osseux humains datés de la période précolombienne et attribués à un unique sujet décédé au cours de la période périnatale. Bien que le site ait fait l’objet de remaniements de grande ampleur, les résultats de notre étude archéoanthropologique appuient l’hypothèse d’un dépôt prima...

Research paper thumbnail of Du giron au cercueil: regard bioarchéologique sur la mortalité périnatale

ArkeoGazte: Revista de arqueología - Arkelogia aldizkaria, 2020

Research paper thumbnail of The Cro-Magnon babies: Morphology and mortuary implications of the Cro-Magnon immature remains

Journal of Archaeological Science: Reports, 2020

Cro-Magnon site (Dordogne, France) have been studied several times, the immature remains known as... more Cro-Magnon site (Dordogne, France) have been studied several times, the immature remains known as Cro-Magnon 5 and exhumed at the same time were only analyzed in detail once, some thirty years ago. Since then, doubts have persisted concerning, in particular, the minimum number of immature individuals present in the assemblage. A re-analysis of these immature remains (cranial fragments and long bone diaphyses) documents the presence of three neonates and one older infant in the sample. They are morphologically and metrically similar to recent and Late Pleistocene modern human infants, although the metaphyses of one femur are modestly unusual. They also document an unusual mortuary age profile at Cro-Magnon, with four infants, three older adults, and an additional adult, which raises questions about the manner of selection of individuals deposited in the Cro-Magnon rock-shelter.

Research paper thumbnail of Asymétries directionnelles et fluctuantes en période périnatale : étude exploratoire dans les populations du passé

Bulletins et mémoires de la société d'anthropologie de Paris

Research paper thumbnail of Du giron au cercueil: regard bioarchéologique sur la mortalité

Revista ArkeoGazte Aldizkaria, 2020

Even with the very high infant mortality rates before vaccination, children were for a long time ... more Even with the very high infant mortality rates before vaccination, children were for a long time considered to be of secondary importance for the understanding of ancient societes, and therefore frequently neglected in bioarcheological studies. This scientific marginalizaton was particularly true for perinates, since their deaths may sometimes be considered as a failed pregnancy, rather than the death of a community member. However, over the past decades, new scientific approaches, including “New Archaeology” or processual archaeology and archaeothanatology, increased the interest in studying the archaeology of the short life histories of perinates. By placing the lives and deaths of these children at the centre of the scientfc process, this new feld of research contributes in a unique manner to the investigation of issues that have long remained inaccessible, and are now cuting-edge. Regardless of the chrono-geographical context, underlying social, religious, funerary, legal, or even emotional issues are indeed remarkably similar between past and present populatons. How to grieve such a short life, or face such a frequent loss? The aim of this paper is to examine, though a bibliographical review, the historiographical, terminological and methodological issues raised by the bioarchaeological investgaton of skeletonized remains of perinates. By challenging the theories of parental disregard for newborns with very litle chance of survival, the bioanthropological discipline is now allowing to take into account their place and status in past societes through the investigation of their life trajectories. Therefore, and because of disciplinary divergence from obstetrical sciences, the bioarchaeological terminology related to perinatality has undergone changes and adaptatons, while the identificaton of vitality at birth and the study of the circumstances of death have become major aims of research.

*

Malgré la mortalité infantile très élevée dans les populations préjenerriennes, les sujets immatures ont longtemps été considérés comme étant d’une importance secondaire pour la compréhension
des sociétés anciennes, et, de fait, fréquemment négligés dans les études bioarchéologiques. Cette marginalisation scientifique a plus particulièrement touché les sujets décédés en période périnatale,
leur mort pouvant parfois être davantage perçue comme une grossesse non aboute, plutôt que comme la perte d’un membre de la communauté. Au cours des dernières décennies, de nouvelles approches scientifiques, dont en premier lieu la “New Archaeology” ou archéologie processuelle,
ainsi que l’archéothanatologie, ont cependant induit un regain d’intérêt pour l’archéologie de ces courtes trajectoires individuelles. En plaçant leurs vies et morts au cœur du processus scientifique, ce nouveau domaine de recherche contribue dès lors à des questions de premier plan, longtemps restées hors d’atteinte. Quel que soit le contexte chrono-géographique, les enjeux sociaux, religieux,
funéraires, juridiques ou même émotionnels soulevés par cet événement apparaissent en effet remarquablement similaires entre les populations du passé et les populations actuelles. Comment faire le deuil d’une vie si courte, faire face à une perte si fréquente ? L’objectif de cet article est
d’investir, à travers une revue bibliographique, les enjeux historiographiques, terminologiques et méthodologiques soulevés par l’analyse bioarchéologique des restes squelettisés de nouveau-nés.
En remettant en cause les théories soutenant l’existence d’une indifférence, voire d’un certain mépris parental pour des nouveau-nés ayant de très faibles chances de survie, les disciplines archéologiques permettent en effet aujourd’hui d’investir leurs place et statuts dans les sociétés anciennes à travers l’étude de leurs trajectoires de vie. Par conséquent, et du fait des écarts disciplinaires par rapport aux sciences obstétricales, la terminologie bioarchéologique relative à la périnatalité a subi des évolutions et des adaptations, tandis que l’identification de la vitalité à la naissance et l’étude des circonstances du décès sont devenus des axes de recherche de premier plan.

Research paper thumbnail of Partiot et al. 2020 La question de l’utilisation sépulcrale des cavité

Bulletins et Mémoires de la Société d'anthropologie de Paris, 2020

La fréquentation des cavités naturelles de l'archipel des Petites Antilles par les populations am... more La fréquentation des cavités naturelles de l'archipel des Petites Antilles par les populations amérindiennes, men-tionnée par les chroniqueurs européens, est aujourd'hui un phénomène archéologiquement attesté. Les modalités de l'utilisation de ces abris rocheux en tant qu'espaces sépul-craux demeurent cependant peu documentées, avec pour conséquence un manque de données concernant les prati-ques funéraires des populations précolombiennes. Dans ce contexte, le site de la grotte des Bambous (Grande Terre, Guadeloupe) offre un nouveau témoignage de l'usage poten-tiellement funéraire des cavités par les populations amérin-diennes des Petites Antilles. Un sondage, puis une fouille archéologique ont livré des vestiges osseux humains datés de la période précolombienne et attribués à un unique sujet décédé au cours de la période périnatale. Bien que le site ait fait l'objet de remaniements de grande ampleur, les résultats de notre étude archéoanthropologique appuient l'hypothèse d'un dépôt primaire, et possiblement d'une sépulture. Ces observations permettent ainsi d'apporter de nouveaux élé-ments de réflexion concernant l'utilisation sépulcrale des abris rocheux naturels de l'archipel des Petites Antilles au Céramique final, et posent la question des spécificités du comportement funéraire des populations locales par rapport au décès périnatal. Abstract The use by Amerindian populations of natural caves within the Lesser Antilles archipelago, mentioned by European chroniclers, is now archaeologically attested. However, the use of these rock-shelters as sepulchral spaces is not well documented, resulting in a lack of data on the mortuary practices of Pre-Columbian populations. The "Grotte des Bambous" site (Grande Terre, Guadeloupe) has yielded new evidence on the potential funerary use of rock cavities by Amerindian populations of the Lesser Antilles. The survey and the subsequent archaeological excavation, which was carried out in 2017, resulted in the discovery of human remains dating from the pre-Columbian period, with an attribution to a single individual who died during the perinatal period. Although the site had been extensively disturbed , the results of the archaeo-anthropological study support the hypothesis of a primary deposition, possibly to be identified as a burial. Moreover, these observations provide new insights into the sepulchral use of natural rock-shelters in the Lesser Antilles archipelago during the Final Ceramic period, and raise questions about specific characteristics of the fune-rary behaviour of native populations in connection with perinatal death.

Research paper thumbnail of Identification des cas de trépanations dans les populations anciennes : base de données et outil interactif de soutien au diagnostic différentiel

Partiot et al., 2017

The great majority of cranial trepanning cases in ancient populations are identified by the shape... more The great majority of cranial trepanning cases in ancient populations are identified by the shape of the opening made in the skull. However, if there are no distinctive traces left by the trepanner’s tools, the hole may be a “pseudo-trepanation,” apathologicalor taphonomicopening similarinaspecttoatrepanation.Thepurposeofourstudyis to improve the process of comparison for differential diagnoses by developing a reference system for the many factors responsiblefor vaultdefects.Each factoris associatedwith a detaileddescriptionofthecorrespondingdefectondrybone. This reference system led to the development of Xper3, a versatile data management platform and the first interactive online tool to support differential diagnoses of cranial defects. From a bibliographical review of the anthropological and medical literature, the morphological features of defects produced by 79 etiologies were compiled in a database according to 13 quantitative and qualitative description criteria. Using the interactive tool to compare an archaeological case with documented cases facilitates comparative studies by guiding the user towards possible aetiologies and strengthens the differential diagnosis by increasing the number of factors to be examined.