Head injuries in the 18th century: the management of the damaged brain

The 18th century was the time when trauma neurosurgery began to develop into the modern discipline. Before this, the management had, for the most part, changed little from the days of Hippocrates, Celsus, and Galen. Attention was directed to skull injuries, and the brain was treated as the seat of the rational soul but without other function. Symptoms after trauma were attributed to injuries to the bone and meninges. Following the lead of the Royal Academy of Surgery in Paris, it was accepted from the 1730s that the brain was the seat of symptoms after cranial trauma. During the 18th century, at least 12 surgeons published articles on cranial injury, 6 describing significant clinical series on this topic. They were Henri-François Le Dran (1685-1770) of Paris, Percival Pott (1714-1788) of London, James Hill (1703-1776) from Dumfries, Sylvester O'Halloran (1728-1807) of Limerick (Ireland), William Dease (1750-1798) of Dublin, and John Abernethy (1764-1831) of London. This article analyzes these series. Each individual made a different contribution. It is suggested that the relatively lesser-known James Hill in Scotland demonstrated the greatest understanding of the management of brain trauma and achieved the best results. A product of the Scottish Enlightenment, he adapted his management to his own experience and was not tied to the accepted authorities of his day, but he improved the management of each case following his experience with previous patients. He deserves to be remembered.