The diagnosis of skeletal tuberculosis in human remains has traditionally been based upon the detection of secondary skeletal lesions which result from hemotogenous dissemination of tubercle bacilli (e.g., Pott's disease). Since such lesions develop in less than 7% of cases of human tuberculosis, the paleodemography and paleoepidemiology of this disease have been difficult to assess from skeletal remains. This study presents a new diagnostic approach to tuberculosis, focusing on the skeletal manifestations of chronic pulmonary disease (which comprises approximately 90% of human-form tuberculosis). Four hundred forty-five skeletal remains from persons dying of tuberculosis during the first half of the 20th century were examined. A total of 70/445 (16%) exhibited skeletal lesions in one or more locations as a response to infection. Of these 70, 39 (56%) were found to display a specific set of lesions restricted to the internal aspect of the ribs. These lesions take one of two forms: (1) diffuse periostitis or (2) localized abscess, and appear to correspond to areas of chronic pulmonary infection. The diffuse type of rib lesion is more commonly observed than the localized type. In our observations (and according to the natural history of tuberculosis) the occurrence of chronic pulmonary tuberculosis is usually mutually exclusive with hematogenous dissemination to secondary bone locations. Thus, the detection of rib lesions in cases of chronic pulmonary disease increases the absolute sample size of skeletal tuberculosis by a factor of two in this study.

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A detailed analysis of the female bony pelvis in relation to parity status was made. A total of 198 complete pelves were inspected for five features considered to be associated with pregnancy and parturition. During final analysis two features were eliminated. Three remaining features - dorsal pubic pitting, pre-auricular grooves, and grooves located at the site of interosseous ligament insertion were found to be significantly related to partirution. Other findings of interest were: (1) pits and grooves acquired through pregnancy and parturition appear to become obliterated in old age, (2) the preauricular groove is the most sensitive indicator of pregnancy and parturition, (3) moderate-large pitting in the dorsal pubic region rarely occurs in nulliparous females, and (4) it is doubtful that more precise statements than "no children" and "one or more children" can be made on the basis of skeletal remains alone.

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