INFLAMMATORY LESIONS OF RIBS - AN ANALYSIS OF THE TERRY COLLECTION

The aim of this paper is to consider the diagnostic criteria for tuber culosis in ancient populations. It investigates the frequency of perio steal new bone formation on the visceral surfaces of ribs from 1718 in dividuals from the Terry Collection, Smithsonian Institution, Washingt on D.C. and attempts to determine the aetiological factors producing t hese lesions. Numbers of individuals with lesions according to cause o f death were recorded and the patterning of lesions compared between p eople who had died from tuberculosis and those whose cause of death wa s unrelated to a pulmonary disease. Rib lesions were more common in in dividuals dying from tuberculosis (61.6% or 157 of 255) than in indivi duals dying from other causes (15.2% or 165 of 1086). It is suggested that tuberculosis at a peripheral lung focus may disseminate directly through the pleura to the visceral surfaces of the ribs, or that pulmo nary tuberculosis may be the cause of empyema of the pleural cavity an d that this, per se, may initiate inflammatory change on the visceral surfaces of ribs. The nonrecognition or description of these often ver y subtle proliferative lesions on ribs by radiological examination of tuberculous victims is significant in the discussion of bone changes i n tuberculosis. The possibility that individuals with no recorded hist ory of tuberculosis at death actually suffered from the disease was co nsidered in light of the frequency of rib lesions and noncorrelation w ith a tuberculous cause of death. Differential diagnoses are discussed including the possibility that the lesions represent a general nonspe cific indicator of stress. (C) 1994 Wiley-Liss, Inc.