Concussion: A History of Science and Medicine, 1870‐2005

Abstract

To review the intellectual history of concussion from the mid-19th century to the opening decade of the 21st century. Head injuries (HI) and their acute and long-term effects have been investigated for centuries, with major reviews of the topic appearing by 1870. Thus, while it has long been acknowledged that chronic traumatic encephalopathy was first described by Harrison Martland in 1928, an examination of the history of concussion research up to Martland's seminal report places his studies in a deeper historical context. This history makes clear that Martland's findings were one among many such studies showcasing the lasting dangers of blows to the head. In the years after Martland published his study, his paper was frequently cited in other papers that made clear that blows to the head, of all ranges of severity, were dangerous injuries with potentially life-changing consequences. The author has engaged in an historical analysis of the development and elaboration of concussion research in clinical medicine, neurology, neurosurgery, and those scientific disciplines related to clinical medicine. The author has found numerous primary sources from the history of medicine and science that describe the acute and chronic effects of single and repeated sub-concussive and concussive blows to the head. This study makes clear that evidence-based methodologies inevitably short-change the knowledge of past clinicians and scientists by holding these figures to normative standards of recent invention. What criticism of this kind fails to recognize is that past investigators, many of them pioneers in their fields, published their work in ways that matched the highest normative standards of their day for the presentation of evidence. It has been recognized for a long time that concussions are dangerous injuries with potentially life-changing consequences, ranging from permanent symptoms to degenerative neurological states. The intellectual history of medicine and science from 1870 to the recent past shows both a continuity of clinical observations about HI and a steady, incremental accumulation of knowledge refining our understanding of those observations from a remarkably wide sphere of scientific disciplines.