180 • Mary Lucas Powell 



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Summary of audience discussion: The absence of skull involve- 

 ment by tuberculosis in this study is consistent with the paucity of 

 reported cases both in ancient and in modem populations. Prior to 

 the availability of effective chemotherapy, tuberculous meningitis 

 certainly was not rare , and the primarily cortical response which one 

 would expect ought to be easily separable from the "caries sicca" 

 lesion characteristic of cranial treponematosis. It is conceivable 

 tuberculous periostitis is present more frequently than reported but 

 overlooked because the lesions may be small, of nonspecific struc- 

 ture and difficult to see in an intact skull because of their endocranial 

 position. The rapid course of tuberculous meningitis in modem 

 populations also probably provides insufficient time for develop- 

 ment of the osseous reaction. Since a slower course would imply the 

 development of greater resistance to the tubercle bacillus, it is un- 

 likely that its course was any slower in antiquity. 



Zagrffe Paleopathology Symp. 1988 



