Professor of Neurosurgery Mayo Clinic College of Medicine and Science Newton, Massachusetts, United States
Disclosure(s):
T Forcht Dagi, MD, DMedSc, DHC, FRCSEd, FAANS: No financial relationships to disclose
Introduction: This study traces the categorization of post-concussive brain injury from the mid 19th century to the present. The term "trauma" first appears in the 1690s with the meaning of "wound." By 1894, the term "psychic trauma," had been introduced. The term "traumatic encephalopathy," was also introduced around that time to describe both physical changes in the brain and functional disturbances. Under the influence of the new field of psychiatry, these terms confounded discussions around concussion. Neurological concerns about repetitive blows to the head were largely ignored until football players in the NFL were shown to have brain injuries.
Methods: Literature review
Results: Post-concussive signs were recognized in the 18th century but dismissed as failures of character. They were attributed to fanciful causes such as "railroad spike syndrome," the "irritable heart" in the Civil War, "psychic trauma," and hysteria. During World War I, there was pressure to deny the diagnosis altogether to reduce the numbers of disabled veterans.
The tide turned with Martland's 1928 studies of post-concussive neuropathology. Strauss and Savitsky offered additional pertinent clinical observations in 1934. In 1938 "dementia pugilistica" was discussed. In 1941, Meyers separated shell "shock" and shell "concussion." In 1955 and 1959, Gurdjian published classic studies of head injury in primates. Then, in 1980, PTSD was formally entered into the DSM. The idea of precedent physical trauma was quickly incorporated into concepts of PTSD in veterans. Findings of degenerative neuropathological changes in professional football players made repetitive traumatic brain injury a household concern, and introduced questions about the age at which students ought to be permitted to engage in certain sports.
Conclusion : The history of head injury reflects the difficulty of overcoming reductionist resistance to new interpretations of clinical data, the importance of disambiguating diagnoses and the need for public discussions around public threats.
