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Summary of audience discussion: The immune status as defined 

 by the skin tuberculin test has only a minimal influence on suscep- 

 tibility to infection with contraction of clinical tuberculous disease, 

 but it is the dominant factor in determining the form of the infection. 

 A nonimmune individual is more apt to develop the rapid and often 

 lethal course of tuberculous pneumonia or hematogenous spread of 

 "miliary" tuberculosis, while the contained form of the disease 

 (usually restricted to the lung) is more apt to occur in the tuberculin- 

 positive ("immune") person. In the United States the death rate fell 

 dramatically during the century preceding 1960, unaffected by the 

 laboratory identification of the tubercle bacillus, isolation of pa- 

 tients in sanatoria, or specific chemotherapy (the latter available 

 only about the final 10 years of the period) Furthermore, except for 

 the final decade, most people during that period were tuberculin- 

 ptjsitivc by age 18. Neither the immune status nor therapy appears to 

 have been responsible for the straight-line decline. More probable 

 contributions include a reduction in the "dose" (i.e.. number of 

 inhaled organisms) secondary to reduction in crowding and better 

 housing which tend to reduce rebreathing of others' exhaled air. At 

 least today tuberculosis is a population-density disease. 



Recognition of empyema's characteristic rib periostitis lesions as 

 described by Kelley may double the frequency of identifiable tuber- 

 culous lesions in skeletal populations, although the frequency of 

 nontuberculous empyema secondary to pyogenic pneumonia in an- 

 tiquity is unknown — a problem resolvable through the study of 

 mummies with soft tissue preservation. 



Zagreb Paleopalhology Symp. I98fl 



