The history of head injuries: an overview

The history of cerebral trauma is a large subject and this overview is an attempt to summarise the main trends of understanding and management over the millenia. Although beginning with anthropological evidence, papyrology and Homeric times, the main impetus for its scientific study began with Hippocrates, but little progress was made until the Salernitan period. Because the ancients believed it was the fractured bone and not the underlying neurological status that mattered, and determined whether an operation was to be performed, the classification of head injuries was based on the types of skull fracture and not the underlying neurological damage. Only in recent centuries was it realised that it was not skull fractures that were important but the brain lesion. Further improvement in management occurred during warring periods but the lessons learned were not passed on, although mortality from military wounds has steadily declined. Since only a small percentage of head injuries require surgery, consideration should be given to reserve the time and skills of the neurosurgeon to those cases requiring his expertise; this would require that the preliminary care should be undertaken by physicians with a specific interest in this field.