Inflammatory lesions of ribs: an analysis of the Terry Collection

The aim of this paper is to consider the diagnostic criteria for tuberculosis in ancient populations. It investigates the frequency of periosteal new bone formation on the visceral surfaces of ribs from 1718 individuals from the Terry Collection, Smithsonian Institution, Washington D.C. and attempts to determine the aetiological factors producing these lesions. Numbers of individuals with lesions according to cause of death were recorded and the patterning of lesions compared between people who had died from tuberculosis and those whose cause of death was unrelated to a pulmonary disease. Rib lesions were more common in individuals dying from tuberculosis (61.6% or 157 of 255) than in individuals 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 pulmonary tuberculosis may be the cause of empyema of the pleural cavity and that this, per se, may initiate inflammatory change on the visceral surfaces of ribs. The nonrecognition or description of these often very subtle proliferative lesions on ribs by radiological examination of tuberculous victims is significant in the discussion of bone changes in tuberculosis. The possibility that individuals with no recorded history of tuberculosis at death actually suffered from the disease was considered in light of the frequency of rib lesions and noncorrelation with a tuberculous cause of death. Differential diagnoses are discussed including the possibility that the lesions represent a general non-specific indicator of stress.