Tuberculosis in the Americas: 

 Current perspectives 



Jane E. Buikstra and Sloan Williams 



Histologic studies of the hydrated lungs showed a large amount of fibrous tissue 

 in the right apex. Dr. Garcia-Frias concluded the combination of spine and lung 

 disease showed that tuberculosis is the most likely diagnosis, and the present 

 writer agrees, although other conditions cannot be ruled out. 



—Morse 1961:497 



The case presented herein should conclusively end this dispute and remove doubt 

 that tuberculosis did exist in the Department of lea in southern Peru, South 

 America, hundreds of years before the coming of any European to the Americas. 



— Allison etal. 1973:985 



Rchydrated soft tissue from South American mutnmies has 

 proved crucial in the ongoing debate concerning the presence 

 of a "tuberculosis-like" pathology in the prehistoric Amer- 

 icas. In the 1961 review cited above, Morse, while skeptical 

 of North American skeletal examples attributed to tuber- 

 culosis, was willing to accept tuberculosis as "the most likely 

 diagnosis" for mummified Peruvian remains reported by 

 Garcia-Frias in 1940. Even though he found the tissue evi- 

 dence convincing, Morse (1961:497) was led to question the 

 archeological context for these materials and thus concluded 

 that a pre-Columbian attribution was not secure. 



Further investigations of mummified soft tissue, reported 

 by Allison and co-workers in 1973 and 1981 , provided con- 

 vincing histologic and contextual data. The 1973 report de- 

 scribed acid-fast bacilli. Pott's disease, and a psoas abscess 

 in the remains of a Nazca child, dating to approximately a.d. 

 700, and thus established with certainty the presence of a 

 tuberculosis-like pathology in the prehistoric Americas. 

 Even Morse was led to alter his stance, remarking that al- 

 though he generally agreed with Allison and co-workers con- 

 cerning the diagnosis, "there should have been many more 

 cases of suspect tuberculosis than have been found to date" 

 (1978:53). 



Recent studies of pre-Columbian tuberculosis, as indi- 

 cated in Table 1 , are rapidly providing the "many more cases" 

 called for by Morse. Most examples cited in this survey are 

 descriptive reports of skeletal lesions from North American 

 series, including isolated cases as well as profiles from larger 

 samples. Both isolated examples and frequency data are im- 



Zagreh Pateopatholof^y Symp. 1988 



portant in establishing the probable antiquity and distribution 

 of the pathology, although for issues relating to community 

 health and quality of life, the large-scale series are most 

 useful. In South America, Allison and co-workers (1981, 

 1984) have documented additional cases from Peru and 

 Chile. Surveys of large Andean skeletal samples to establish 

 lesion form and distribution in a manner suitable for com- 

 parison with North American data sets have, however, yet to 

 occur. The ultimate goal of this paper is, therefore, to estab- 

 lish lesion patterning within a large prehistoric Peruvian skel- 

 etal sample and thus provide a data base for comparison with 

 North American examples. 



Related topics addressed within the past few years include 

 the persistent question of origins. The argument that tuber- 

 culosis could only have developed in the context of domestic 

 animals as hosts (Cockburn 1963) has proved unconvincing 

 in the North American example. The possibility that atypical 

 mycobacteria should be implicated has been raised (Clark et 

 al. 1987; Eisenberg 1986; Klepinger 1982) and will be dis- 

 cussed in detail below. 



A novel approach, recently applied to the study of pre- 

 historic tuberculosis, is the development of mathematical 

 models for the spread of disease. Although this strategy has a 

 lengthy history within the medical sciences (Grigg 1958; 

 Waaler et al. 1962), it has been developed only recently 

 within paleoepidemiology (McGrath 1986,1988; Milner 

 1980). As this form of investigation holds promise for estab- 

 lishing expectations and comparabilities across time and 

 space, it also will be reviewed here. 



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