166 • Jane E. Buikstra and Sloan Williams 



Table 3. Age distributions for tubercular and nontubercular 

 remains from the Estuquina site 



Table 4. Age distributions for tubercular and nontubercular remains 

 from the Estuquina site 



from this sample, thus contrasting with the pattern presented 

 by the larger North American series. 



An isolated case of diffuse Pott's disease dated to 160 B.C. 

 is the earliest example, followed by three adults from the 

 Caserones site, dated to a.d. 290. These four examples are 

 1500 to more than 2000 years old, much more ancient than 

 Kelley and Micozzi imply in their discussion of the same 

 material: "... these cases are all within about the last 1 ,000 

 years" (Kelley and Micozzi 1984:385). Clearly, the evidence 

 from South America suggests an earlier manifestation of the 

 disease, though with a somewhat different age-specific ex- 

 pression than that found in North America. 



Estuquina series 



The Estuquina site dates to approximately a.d. 1350 and is 

 situated in the Moquegua valley at approximately 1000 m 

 above mean sea level (Rice 1989). Located near the present- 

 day town of Moquegua. in southern Peru, the site is situated 

 on a ridge top and is fortified by stone walls. Three separate 

 cemetery areas have been identified, with burials also occur- 

 ring within domestic structures. Samples of both intact and 

 disturbed tombs have been excavated, resulting in 414 indi- 

 viduals from 244 tombs. Tomb contents and cemetery organ- 

 ization have been described in detail by Williams et al. 

 (1989). 



The demographic structure of the sample is presented in 

 Table 3. along with the distribution of individuals showing 

 skeletal evidence of tuberculosis-like pathology. For com- 

 parative purposes, we also indicate the numbers of individu- 

 als with five or more observable thoracic and lumbar ver- 

 tebrae. Individuals presenting lesions are reported in detail in 

 Appendix I . Table 4 differentiates those individuals with rib 

 involvement from those with other tuberculosis-like lesions. 

 In the latter group, vertebral involvement is typical for 

 adults, with accompanying sacroiliac and paravertebral rib 

 lesions in extreme cases. Also included are juveniles that 

 present periostitic remodeling of the ilia in a manner similar 

 to that reported for the Schild series (Buikstra and Cook 

 1978,1981). 



a. One example of periosteal reaction on internal aspect of sternum 

 (M6- 3269a) included here. 



The list of individuals with rib lesions (Table 4) includes 

 both those cases which present only periosteal remodeling 

 and those displaying primarily destructive foci. Resorptive 

 rib lesions are the form commonly referenced in the medical 

 literature (Rechtman 1929; Johnson and Rothstein 1952; Tat- 

 elman and Drouillard 1953), while periosteal reaction is em- 

 phasized by Kelley and Micozzi (1984) in their discussion of 

 the Hamann-Todd series. 



Kelley and Micozzi (1984) argue that subtle periostitis on 

 the internal aspects of ribs may be associated with pulmonary 

 tuberculosis. They cite data from individuals in the Hamann- 

 Todd collection who were diagnosed as either suffering from 

 pulmonary tuberculosis or "tuberculosis." Most of their 

 cases present periosteal reaction only, although in a few in- 

 stances, more extensive, sharply circumscribed foci are re- 

 ported. Kelley and Micozzi argue that these lesions develop 

 as a result of extension from the lungs and pleura, citing 

 clinical sources in support of this assertion. "That tubercle 

 bacilli are capable of extending from the lung or pleura into 

 the ribs has been well documented clinically (e.g. Rechtman 

 1929; Johnson and Rothstein 1952; Jaffe 1972; and Anderson 

 1976)." 



In fact, the two case studies in this reference list very 

 clearly describe tubercular rib lesions which are attributed to 

 hematogenous spread, not extension from the lung or pleura. 

 The Rechtman (1929) article describes an infant whose 7th 

 rib involvement developed after an earlier focus within the 

 synovium of the knee. Hematogenous spread to the rib is 

 posited. Johnson and Rothstein report three cases of rib in- 

 volvement and conclude. "While the exact pathogenesis of 

 these lesions is not certain, they are probably hematogenous 

 in origin, differing in no way from tuberculous involvement 

 of other bones. There is no evidence in any of our cases of 

 extension from adjacent organs" (1952:880). Although Jaffe 

 (1972: 1002) does state that proximity and extension explain 

 rib lesions, it is clear that the two primary sources do not so 

 argue, it should also be noted that examples of extension 

 from paravertebral abscesses into the lung are commonly 



Zagreb Paleopathology Symp. 1988 



