PONE-D-20-18111

Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

PLOS ONE

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: This article examines the relationship between tuberculosis and two classes of endocranial lesions, abnormal blood vessel impressions and periosteal appositions. The authors use the Terry Collection, which represents something of a control sample, coding individuals by the listed cause of death, which as the authors mention, is not necessarily synonymous with how cause of death would be diagnosed and/or recorded today using 21st century medical understanding of disease and mortality. The ultimate goal, is to then to make these findings available to paleopathologists and ostearchaeologists, who are nearly always dealing with skeletal remains where the cause of death is unknown. The hope is that endocranial lesion frequency, context, and morphology can be used to help diagnose more ancient disease and/or causes of death.

I enjoyed reading the paper and found it quite interesting. Overall, I find the study well-designed, the statistical analysis simple but adequate, the text to be very well-written and concise, and the results significant and of great interest to the paleopathology field. I have no hesitation in recommending its publication in PLOS-ONE. I make a few remarks below that the authors might consider in moving towards a final publication. They are merely suggestions.

I wonder if the authors could pull out from the NTB group, specifically, those that died from accidents, and analyze them as a subgroup (in addition to the entire NTB group)? While individuals dying from accidents could still have some underlying TB infection (or NTB disease associated with meningeal infection), it might represent a better “control” group for the specific goals of this paper. On the other hand, the sample size of the NTB-accident cohort may be so small, that statistical comparison is not possible.

Are any of the individuals in the collection specifically identified as having died from meningococcal disease (Neisseria meningitidis infection), or other diseases associated with meningeal infections?

Lines 228-231: for the NTB group, could you give in parentheses (n=X) the number of individuals with ABVIs dying of cardiovascular, respiratory disease, syphilis, etc.? So we don’t have to go to the supplementary table.

It would be helpful in the figures of bones to add small arrows to draw the reader’s attention specifically to the features the authors wish to highlight in each frame.

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Reviewer #1: No

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Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

PONE-D-20-18111R1

Dear Dr. Spekker,

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Kind regards,

JJ Cray Jr., Ph.D.

Academic Editor

PLOS ONE

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