Advances in Anthropology
2012. Vol.2, No.2, 57-63
Published Online May 2012 in SciRes (
Copyright © 2012 SciRes.
Soft Tissue Contributions to Pseudopathology of Ribs
Courtney Anson1, Bruce Rothschild2,3,4*, Virginia Naples5
1Anthropology Department, Wooster Uni ve rsity, Wooster, USA
2Biodiversity Institute, University of Kansas, Lawrence, USA
3Anthropology Department, University of Kansas , Lawrence, USA
4Department of Medicine, Nor t h eas t Ohio Medical Uni versity, Rootstown, USA
5Department of Biological Sciences, Northern Illinois University, DeKalb , USA
Email: *
Received February 16th, 2012; revised Ma rch 22 nd, 2012; ac c e p t e d A pr i l 1st, 2012
This study reports the results of a de novo classification and characterization of macroscopically perceiv-
able bone alterations relating to the pathologic significance of rib alterations as noted in defleshed bones.
We distinguish between nonspecific two-dimensional color alterations and three-dimensional surface
modification which appears to have diagnostic significance. Color alterations were patchy in nature with
brown being most prominent, followed by creamy, white and orange, but appear taphonomic in nature.
Categorization of three dimensional alterations, e.g., periosteal reaction, bumps and holes, identifies
which is specific for diagnosis of tuberculosis. Rib periosteal reaction is significantly more common
among individuals with tuberculosis than those with non-tubercular pulmonary disease (Chi square =
33.75, p < 0.0001), cancer (Chi square = 5.82, p < 0.02), cardiac disease (Chi square = 7.404, p < 0.008),
and others (Chi square = 63.19, p < 0.0001). This study explains past errors in recognition of the signifi-
cance of rib alterations.
Keywords: Periosteal Reaction; Hypertrophic Osteoarthropathy; Bumps; Color
Ribs have long been a source of scientific, gastronomic and
even theological interest (Anon, 1959; Crocker, 1972; Schmidt
& Freyschmidt, 1993; Kunos et al., 1999). Their global anato-
mic appearance in humans is well characterized (Kunos et al.,
1999; Resnick, 2002). Somewhere between the global and his-
tologic appearance (Takahashi & Frost, 1966; Qui et al., 2003)
is a less-well defined area of study (Naples & Rothschild, 2011).
Macroscopic examination is the term applied to study of the
character of the external surface of bone (Rothschild & Martin,
1993, 2006).
Macroscopic examination of ribs reveals details which are
helpful in recognizing certain intra-thoracic pathologies (Schmidt
& Freyschmidt, 1993). This information derives predominantly
from individuals whose cause of death is recorded and whose
skeletons repose in medical collections, such as the Ham-
man-Todd and Terry Collections (Pfeiffer, 1991; Roberts et al.,
A great challenge to understand the significance of rib altera-
tions is the great variation in the reported frequency of skeletal
pathology, even with examination of identical skeletal series
(Kelly & Micozzi, 1984; Pfeiffer, 1991; Roberts et al., 1994;
Santos & Roberts, 2001). The challenge includes distinguishing
growth and taphonomic markings (Figure 1) from those related
to pathology. Pfeiffer (1991) relates Terry Collection (discussed
below) numbers 158, 255, 466, 468 and 522 as exemplary, but
our examination fails to identify any abnormalities. It is sus-
pected that she mistook residual (Figure 2) tissue (further
cleaned after her examination) for periosteal reaction. Unless
her catalogue designations derive from a different system
Figure 1.
Inferior view of ribs (Terry Collection 570). Pseudopathology (arrows)
related to focal spalling (loss of outer layer of bone). Appearance of
residual surrounding bone is sometimes mistaken for periosteal reac-
Figure 2.
Inferior view of rib (Terry Collection 424). Residual (adipocere or su-
ponified) tissues show the characteristic white appearance of this form
of taphonomic alteration.
than that currently utilized, her report highlights the chal-
This is analogous to the problem with periosteal reaction af-
*Corresponding author.
fecting the appendicular skeleton, reported variably as zero or
100% affliction, again examining the same population (Rose,
1985; Katzenberg, 1992; Byers, 1998; Larson as cited by Pow-
ell & Eisenberg, 1998). Our perception is intermediate and is
validated by an independent physical chemical technique predi-
cated upon the second law of thermodynamics (Rothschild &
Rothschild, 2003).
Concern that the same “Emperor’s New Clothing Syndrome”
might be operative in the lack of reproducibility of findings in
rib reports leads to an alternative approach. Are the researchers’
variable observations (Rose, 1985; Katzenberg, 1992; Byers,
1998; Larson as cited by Powell & Eisenberg, 1998) biased by
their mentors? Are their diagnostic criteria ever independently
validated? Pfeiffer (1991) arbitrarily divides rib lesions into
plaque, expansile and resorptive lesions, based on her previous
anthropologic experience. It is of interest, however, to identify
an independent system.
The current study categorizes macroscopic (as opposed to
global) rib alterations and assesses correlation with documented
pathology diagnose s.
Materials and Methods
The sample for this investigation is derived from the well-
studied Terry Collection. The Terry Collection consists of 1709
dissected individuals (of known age, sex, race and usually
cause of death) who died in St. Louis, Missouri between 1910
and 1940 and is currently curated at the National Museum of
Natural History, Smithsonian Institution (Roberts et al., 1994).
To establish an unbiased approach, an individual (AC) with
no prior training in osteology or bone pathology was therefore
asked to examine a series of individuals. She was not privy to
the perspectives of her coauthors. She was asked to identify any
alterations she perceived and to design a system for categoriz-
ing them. Two of us (BMR and VN) examined the same skele-
tal series and found that she successfully identified all ribs with
any surface alteration. The system she independently developed
for color, texture and cortical character alterations also proved
reproducible. Because time did not permit examination of the
entire Terry Collection, and biases are often inherent in selec-
tion techniques, cohort analysis is pursued. To evaluate rib
alterations as life experience(s), it seems appropriate to exam-
ine those representing the decades at the turn of the century.
Analysis is pursued with the cohort of 443 individuals born in
the 20 year period between 1890 and 1909. This sample (Table
1) consists of 52% males, 77% of whom were African Ameri-
Tuberculosis is responsible for 26% of deaths; pneumonia,
10%, cancer, 5%; and heart disease, 15%. Seventy-one of the
Table 1.
Nathanson, L., & Cohen, W. (1941). A statistical and roentgen analysis
of two hundred cases of bone and joint tuberculosis. Radiology, 36,
Pfeiffer, S. (1991). Rib lesions and new world tuberculosis. Interna-
tional Journal of Osteoarchaeology, 1, 191- 19 8 .
Pineda, C., Coindr eau, J., Vazquez, J., Nava, A. & Martinez-Lavin, M.
(1999). The significance of rib notching in Takayasu arteritis. Arthri-
tis & Rheumatism, 42, S211.
Powell, M. L., & Eisenberg, L. E. (1998). Syphilis in Mound Builders’
bones: Treponematosis in the prehistoric southwest. American Jour-
nal of Physical Anthropology, 26, 180.
Qiu, S., Fyhrie, D. P., Palnitkar, S., & Rao, D. S. (2003). Histomor-
phiometric assessment of Haversian canal and osteocyte lacunae in
different-sized osteons in human rib. Anatomical Record, 272A, 520-
525. doi:10.1002/ar.a.10058
Resnick, D. (2002). Diagnosis of bone and joint disorders. Philadelphia:
Roberts, C., Lucy, D. & Manchester, K. (1994). Inflammatory lesions
of ribs: An analysis of the terry collection. American Journal of
Physical Anthropology, 95, 169-182. doi:10.1002/ajpa.1330950205
Rose, J. C. (1985). Gone to a better land. Arkansas Archeological Sur-
vey Research Service, 25, 1-216.
Rosencrantz, E. A., Priscitelli, A., & Bost, F. C. (1941). An analytical
study of bone and joint lesions in relation to chronic pulmonary tu-
berculosis. Journal of Bone and Joint Surgery, 23, 630-638.
Rothschild, B. M., & Martin, L. D. (1993). Paleopathology: Disease in
the fossil record. London: CRC Press.
Rothschild, B. M., & Martin, L. D. (2006). Skeletal impact of disease.
Albuquerque: New Mexico Museum of Natural History Press.
Naples, V. L., & Rothschild, B. M. (2011). Do ribs actually have a bare
area? A new analysis. Journal of Comparative Human Biology, 62,
368-373. doi:10.1016/j.jchb.2011.08.001
Rothschild, B. M., & Rothschild, C. (1998). Recognition of hypertro-
phic osteoarthropathy in skeletal remains. Journal of Rheumatology,
25, 2221-2227.
Rothschild, B. M., & Rothschild, C. (2003). Thermodynamic resolution
of periosteal reaction and taphonomic change. Reumatismo, 55, 195-
Rothschild, B. M., & Woods, R. J. (1993). Implications of isolated
osseous erosions related to population skeletal health. Historical Bi-
Copyright © 2012 SciRes.
Copyright © 2012 SciRes. 63
ology, 7, 21-28. doi:10.1080/10292389309380441
Santos, A. L., & Roberts, C. A. (2001). A picture of tuberculosis in
young Portuguese people in the Early 20th century: A multidiscipli-
nary study of the skeletal and historical evidence. American Journal
of Physical Anthropology, 115, 38-50. doi:10.1002/ajpa.1054
Schmidt, H., & Freyschmidt, J. (1993). Kohler/Zimmer borderlands of
normal and early pathological findings in skeletal radiology (4th ed.).
New York: Thieme.
Sen, D. K. (1961). Skeletal tuberculosis associated with pulmonary
tuberculosis. Jou r nal of the Indian Medical Association, 36, 146-149.
Takahashi, H., & Frost, H. M. (1966). Age and sex related changes in
the amount of cortex of nor mal human ribs. Acta Orthopaedica Scan-
dinavica, 37, 122-130. doi:10.3109/17453676608993272